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Wednesday, October 31, 2007

It's atrocioius that doctors do not carry enough liability insurance: A surgical error lawsuit

Here’s the comment by a reader who was the subject of my recent blog post:

I am the person mentioned in the article which Dr. Paul Cho disabled while addicted to narcotic prescriptions which he was writing for himself. I think it is atrocious that these doctors do not carry enough liability insurance. Not to mention that the Texas Medical Board did not pull his license; barely reprimanding the doctor at all. Who is out there to protect the patient from these doctors? Something needs to be done. Dr. Cho simply moved out of El Paso to open another practice in Fort Worth. Why, so he can disable more people? These doctors need to start taking responsibility for their actions and the Texas Medical Board needs to start doing what they are supposed to be there to do...PROTECT THE COMMUNITY.

Thank you,
Demian M. McElhinny

Advice: Tell your story to warn others.

Read the original blog post, or read more from the source article in the Oct. 5 issue of the New York Times.

Tuesday, October 30, 2007

I was telling everyone to "feel their boobies": a breast cancer survivor

Leigh Hurst, 37, said she never intended to start a business when her cancer was diagnosed in 2004. She just wanted to spread the word among her friends and other young women that they needed to be serious about breast self-examination. "Basically, I was telling everyone I met to 'feel their boobies,' and when I walked with a group of friends in the Avon breast cancer walk in New York, I set up a one-page web site, put 'Feel your Boobies' on our T-shirts and printed an extra hundred to sell," she said. She sold all the T-shirts within minutes, and donated the proceeds to Komen for the Cure.

Her group was filmed by the Today TV show, and when she returned home to Harrisburg, Pennsylvania, she started filling orders that were coming in through the web site.

After much thought, she decided her company should be a nonprofit, to raise awareness and encourage breast self-exams. She put her parents to work in her house, filling orders and handling customer service, and quit her job.

Advice: Find a way to raise others' awareness to prevent them from getting your disease, and help them detect it early, like Leigh.

Read another breast cancer survivor story, or read more from the source article by Marci Alboher in the Oct. 25 issue of the New York Times.

Monday, October 29, 2007

She might have been upset by the mistake: A wrong patient error

At a hospital in Somerville, Masschusetts, two patients with the same first name were waiting in separate exam rooms in the gynecological clinic one day in November 2005. One needed a colposcopy – an examination of the vagina and cervix with a magnifying device and a biopsy. The other woman needed a routine, less-invasive checkup. A medical assistant accidentally switched the women's charts while hanging them outside each door.

One woman mistakenly received a colposcopy, but neither she nor her interpreter objected, according to the chief of surgery.

The chief of surgery said the woman had not suffered physical harm, though he acknowledged that she might have been upset by the mistake. A friend of mine who has, unlike the surgeon, experienced the pain and discomfort of a colposcopy, might argue with him….

Presumably this is less likely to happen now at that hospital, since staff now take time-outs before office procedures to verify patients' names and the purpose of the procedure.

Advice to people about to undergo a medical procedure: Make sure the doctor knows your full name.

Read another wrong patient story, or read more from the source article by Liz Kowalczyk in the Oct. 26 issue of the Boston Globe.

Sunday, October 28, 2007

She was well enough to start making plans again: A cancer survivor and entrepreneur

Ms. Banu Ozden is a computer scientist whose cancer was diagnosed in 2001. She said from the time she started dealing with the disease, she wanted to design a system that would make it easier for patients to keep track of their medical costs and also help them find errors in billing and reimbursement records.

In 2005, when teaching computer science at the University of Southern California, she was told that she again had cancer and that this time the disease had spread.

She took a leave of absence from her job and moved to New York so she could be treated at Memorial Sloan-Kettering Cancer Center. Within a month of her diagnosis, she was feeling well enough to start making plans again.

Once again in the morass of medical bills, she knew she wanted to proceed with her company. She started Smart Medical Consumer with her own funds and investments from friends and family.

Advice: See if you can help those struggling with a disease you have learned how to face, as Banu is doing.

Read one of our cancer survivor entrepreneur stories, or read more from the NY Times article on October 25 by Marci Alboher.

Saturday, October 27, 2007

Concussion is the white elephant in the room: Safer football helmets

Years ago, as a quarterback wearing the uniform and helmet of the Harvard University football team, Vin Ferrara sustained several concussions. Now his photo appears in the newspaper, helmet in hand, again, in a very different way.

Vin has developed a radically different football helmet through his company, Xenith LLC. Instead of using foam inside the helmet to cushion impacts, this helmet uses shock absorbers filled with air. The helmet seems better at preventing concussions than are the standard foam-filled helmets. Mike Oliver, the head of the helmet certification agency, said, "Concussion is the white elephant in the room right now when it comes to helmets, and I'm cautiously optimistic about how low these numbers [from the impact tests] are."

This is important because high school athletic programs usually use reconditioned old helmets with degraded foam padding. While these helmets continue to prevent skull fractures, they fail to prevent many concussions. Studies find that 10% to 50% of high school players each season sustain concussions, whose effects range from persistent memory problems and depression to coma and death.

For example, Max Conradt, a high school player in Yachats, Oregon, was wearing a 20-year-old helmet when he sustained hits that left him comatose for two months and left him permanently impaired.

Hopefully the new helmet will keep football players safe.

Vin Ferrara had concussions, and from that experience, he developed a product to prevent others from getting the injuries he did. He joins other entrepreneur patient advocates in businesses aimed at preventing or reducing the harm of multiple sclerosis, Lou Gehrig’s disease, and other conditions, as described on this blog. Now that’s worth cheering for!

Advice: Consider if there are ways you can help others beat your disease.

Read one of our football concussion stories, or read more from the source article by Alan Schwarz in today’s New York Times.

Friday, October 26, 2007

He lost a $25,000 bet: Chewing tobacco addiction

Red Sox Manager Terry Francona was seen in last night's World Series baseball game spitting five times and what clearly looked like brown tobacco juice emerged three times. He knows he has a problem: he lost a $25,000 bet that he could kick his habit by the end of the season. Francona appeared to switch to gum last night.

Watching Francona's toxic brown spit should spur Major League Baseball into a vigorous campaign against chewing tobacco. Joe Garagiola, who has spoken to major leaguers and amateur players about the risks of chewing tobacco, said yesterday that Francona's parents had asked him to talk to their son about his addiction. Garagiola said his message is that chewing tobacco is addictive, causes oral cancer and can cost you your life. "If I were to talk to Terry, I'd tell him to think seriously after the World Series about getting help," he said. "I know a good place, like the Mayo Clinic in Rochester, Minnesota."

Advice to nervous members of Red Sox Nation: Chew sugarless gum for the tension, and warn your tobacco-chewing friends about the dangers.

Read another of our baseball stories, or read Richard Sandomir’s source story in today’s New York Times.

Thursday, October 25, 2007

It’s just middle-aged white guys making them, not the customer: Compression sleeves for lymphedema

Rachel Troxell, 37, learned she had breast cancer three years ago. After going through surgery, chemotherapy and radiation, she said the hardest part was learning that she had lymphedema, a condition that affects a sizable number of breast cancer survivors and cause their limbs to swell with fluid. "With the cancer, there was a clear path to follow, and I knew there was an end to it," she said. "With lymphedema, you are stuck with it, and it affects the quality of your life."

Her treatment for lymphedema required her to wear a compression sleeve constantly, leading to questions from everyone she encountered. Rachel, a videographer and graphic designer, said she became consumed with finding an alternative to the drab, unsightly and uncomfortable sleeve.

"I called some companies that made the ugly garment, asking if there were other options, and they all said no," she said. "It is just middle-aged white guys making them, and they aren’t the customer."

She connected with Kristin Dudley, who was then a 22-year=old fashion student at Drexel University in Philadelphia. They designed a more fashionable and comfortable compression sleeve. Kristin was excited about it because her own grandmother, who had lymphedema, had refused to wear her own compression sleeves.

Rachel and Kristin won third place for the idea in a business plan contest sponsored by Drexel University. They are now partners in Lymphedivas, since starting the company last year.

Their business owes its inspiration to the brush with breast cancer.

Survival rates have increased markedly, so there are now 2.3 million breast cancer survivors in the U.S., according to the Susan G. Komen for the Cure, one of the largest breast cancer research and advocacy organizations. Many survivors are committed to doing something to ease the ordeal of others or to solve a particular problem they encountered in their own treatment.

Advice to those with a serious health condition: Perhaps, like Rachel, you can find innovative ways to help others who suffer from the same health condition you do.

Read another of our entrepreneur stories, or read Marci Alboher's source story in today’s New York Times.

Tuesday, October 23, 2007

It is an intensely personal thing with me: Sen. Thompson's daughter & Terri Schiavo

In a news conference on Monday, former Senator Fred Thompson answered a question about the Terri Schiavo case:

"I had to face a situation like that in my own personal life with my own daughter [Elizabeth Panici]. I am a little bit uncomfortable about that because it is an intensely personal thing with me. These things should be decided by the family. The federal government and the state government too, except for the court system, ought to stay out of those matters.

"I was at that bedside. And I had to make those decisions with the rest of my family. No matter which decision you make, you will never know whether or not you made exactly the right decision."

Elizabeth had suffered from bipolar disorder and died in 2002 from an accidental drug overdose. Toxicology tests of her blood showed six times the lethal level of hydrocodone, a painkiller. She arrived unconscious at a Tennessee hospital, where staff revived her, and apparently placed her on life support. Mr. Thompson did not say who ultimately made the decision to withdraw her from life support. She never regained consciousness, and six days later, she was pronounced dead.

Advice to family members with a gravely ill relative: Consider hospice care as an alternative to life support in a hospital.

Read a peaceful end of life story, or read Marc Santora’s source story in today’s New York Times.

Monday, October 22, 2007

Her bravest act: Betty Ford’s recovery from addiction

From Nan Robertson:

Rancho Mirage, California

I sat with Betty Ford, the wife of the 38th President of the United States, a recovering pill addict and alcoholic, in the soothing beige and pink interior of the intensive rehabilitation center named after her. She is a vital part of that center, informing and inspiring patients by her own example of steadfastness and honesty. "I was in a little euphoria of my own once," she said, "functioning but less than aware."

Just before her 60th birthday, in April 1978, her children and her husband, Gerald Ford, only 14 months out of the White House, confronted her. With them was Dr. Joseph Pursch, then head of the Long Beach Naval Hospital's Alcohol and Drug Rehabilitation Service. He had carefully rehearsed the family, all its members armed with written lists detailing specific instances of Mrs. Ford's drugged, drunk behavior as each had experienced it.

The President recalled times she had fallen asleep in a chair, her blurry speech, her memory lapses. Her son Mike and his wife told her why they hadn't wanted to have a child—because they didn’t want it to have a grandmother who was not there for the baby. Another son, Steve, remembered bringing a new girlfriend home and cooking dinner for his mother while Mrs. Ford slipped into a haze in front of the TV with one drink, two drinks, three. "You hurt me," Steve said.

Mrs. Ford collapsed in a storm of weeping and shock. But, she said, she had enough sense left to realize her family was doing this because they loved her and wanted to help. She entered the Long Beach hospital for treatment and issued a statement to a stunned nation. She confessed to “overmedicating” herself: "It's an insidious thing, and I mean to rid myself of the damaging effects." But she resisted any suggestion that liquor was also a major problem. Dr. Pursch ordered her to read the basic text that Bill Wilson had written for A.A, known informally as the Big Book. Just substitute "chemically dependent" for the word "alcoholic," he told her. Mrs. Ford comforted herself with the thought that she never needed to take a drink in the morning to stop the shakes. She found people who knocked back Bloody Marys well before lunch "pathetic." She could admit to the pills, prescribed for arthritis, a pinched nerve, muscle spasms in her neck. After all, the doctors had done it to her. She could not face the alcoholism—because that meant she had done it to herself.

Finally, after further treatment at Long Beach, with her husband's assurance that it would not embarrass him, she issued another statement: "I have found that I am not only addicted to the medications I have been taking for my arthritis but also to alcohol. I expect this treatment and fellowship to be a solution for my problem, and I embrace it not only for me but for all the others who are here to participate." I said to Mrs. Ford that it was hard enough for ordinary people to confess they are drunks and then set about to rebuild their lives. "I think it was my bravest act," I told her. "What it must have been like for a President’s wife!?"

She replied, "Granted, I had the advantage of being the wife of a former President, which put me, in the eyes of others, in a special place. But I never could have found recovery if I thought myself to be in a special place. I am just a recovering woman."

Advice to problem drinkers: Share your story with others to help them heal, like Betty Ford has done.

Read another famous person’s recovery story, or read the source, "Getting Better: Inside Alcoholics Anonymous" by Nan Robertson.

Sunday, October 21, 2007

I’m in remarkably good shape: A Parkinson’s patient advocate

Parkinson's disease hasn't robbed A.C. Cowan of his ability to enjoy life or fight for causes he's passionate about.

The 82-year-old spoke at a symposium this week to raise awareness about Parkinson's disease at LSU Health Sciences Center-Shreveport's. He spoke to an audience of patients, their families and caregivers, allied health and medical professionals and students

"For my age and the disease, I'm in remarkably in good shape," having lived with Parkinson’s for ten years, he said. "There's nothing I can't do for myself. I drive, eat well and I enjoy my life."

"Now in retirement, I have time to work with the Parkinson's group as an advocate. I've been to Washington, D.C., three times to try and pry money out of Congress" for Parkinson's disease research.

Advice to Parkinson's patients: Live like A.C. Cowan.

Read one of our Parkinson’s stories, or read more from the source article by Mary Jimenez.

Friday, October 19, 2007

Your disease is not your fault: Oprah on Thyroid Disease

From Mary Shomon:

If you already have a diagnosed thyroid condition -- and you also heard Dr. Christiane Northrup say recently on Oprah's TV show that "your symptoms are actually your soul's way of bringing deeper issues to your attention," then I'm here, as a thyroid patient advocate, to tell you that your thyroid disease is NOT your fault, despite what Dr. Northrup says.

Here's what else Dr. Northrup has to say about thyroid disease:
"In many women thyroid dysfunction develops because of an energy blockage in the throat region, the result of a lifetime of 'swallowing' words one is aching to say. In the name of preserving harmony, or because these women have learned to live as relatively helpless members of their families or social groups, they have learned to stifle their self-expression....It's no coincidence that so many more women than men have thyroid problems. Thyroid disease is related to expressing your feelings..."

Thousands of women, for example, developed thyroid problems because they lived downwind of the Chernobyl nuclear plant after its accidental release of radiation. Were those women stifling their self-expression? What about women exposed to thyroid-damaging perchlorate by drinking contaminated water here in the U.S. Are they swallowing their words, or swallowing contaminated water? Many women develop thyroid conditions after having a baby. Are those new mothers unable to express themselves, or are their out-of-whack post-partum hormones expressing themselves? What about women with thyroid cancer? Will exercise, nutrition and sex fix their thyroid problem?

Thyroid disease results when heredity and genetics, autoimmunity, environmental exposures, viral infections, and hormonal shifts come together in a perfect storm to trigger a dysfunction. And while emotional and physical stress, as well as nutrition and lifestyle, can play a role creating a climate receptive for -- or fighting against -- most diseases including thyroid conditions, these factors are only part of a larger, complicated puzzle.

Oprah is the richest and most powerful woman in television, one of the richest women in the world, and has a humanitarian and media platform that reaches billions. She is, to many, the ultimate example of an empowered woman. And Dr. Northrup is a best-selling author and "celebrity" doctor on television. What do you think? Did Oprah and Dr. Northrup each develop thyroid disease because they have spent "a lifetime of swallowing words" and stifling "self-expression?"

Explaining the symptoms of a thyroid condition, what women can do to reduce their risk of developing thyroid problems, explaining how women can get tested, giving them the confidence and courage to insist on testing even if their doctor, HMO or insurance says no, and then explaining how to interpret the confusing results -- THAT would be doing what America's women really need.

Mary Shomon's advice: Take the advice you get from doctors on television talk shows with a big grain of iodized salt...

Read blogger Mary Shomon’s source blog post.

Thursday, October 18, 2007

There was nothing wrong with me: Unnecessary triple bypass surgery

Ron Spurgeon's health began to unravel when he hurt his shoulder doing yard work. He eventually wound up at a hospital in northern California, where a cardiologist told him he had a life-threatening heart condition. Four days later, he had triple bypass surgery.

Restrictions on heavy lifting as a consequence of the incision in his breastbone led the robust 56-year-old to give up his job maintaining machinery at lumber mills.

In 2003, two years after his operation, Ron learned that Tenet Healthcare, the hospital's owner, had paid $54 million to settle U.S. government allegations that it billed Medicare for unnecessary heart procedures. The next year, Ron and 344 others sued the hospital and eight cardiologists and surgeons for performing unnecessary procedures. The defendants ultimately paid $442 million to settle the suit, and Tenet says safeguards are now in place. Outside experts who reviewed patient charts determined that Ron was among the many patients who hadn't needed their procedures.

"There was nothing wrong with me," he says. "Those guys violated me. They took away my trust in doctors."

Advice: Ask your doctor beforehand what the medical research says is the likely result of your surgery.

Read another unnecessary surgery story, or read Consumer Reports' source story.

Thanks, Helen Haskell.

Wednesday, October 17, 2007

Theoretically a totally preventable disease: MRSA infections

A high school student in Bedford, Virginia who was hospitalized for more than a week with an antibiotic-resistant staph infection, has died. After a student protest, officials shut down 21 schools for cleaning to keep the illness from spreading. Ashton Bonds, 17, a senior at Staunton River High School, died Monday after being diagnosed with Methicillin-resistant Staphylococcus aureus, or MRSA, his mother said.

"I want people to know how sick it made my son," Veronica Bonds said.

MRSA is a strain of staph bacteria that does not respond to penicillin and related antibiotics but can be treated with other drugs. The infection can be spread by skin-to-skin contact or sharing an item used by an infected person, particularly one with an open wound.

Ashton went to the hospital on Oct. 4 after complaining of pain in his side, his mother said. He was sent home after doctors ruled out appendicitis, but was readmitted three days later and taken to another hospital. Last week doctors diagnosed him with a MRSA infection that had quickly spread to his kidneys, liver, lungs and the muscles around his heart. Early Thursday morning, Ashton had to be sedated and put on a ventilator. He was about to undergo surgery to drain the infection from his lungs when doctors detected a blood clot near his heart. But the clot was inoperable.

Ashton is one of 19,000 people who die each year from infections by drug-resistant bacteria. The vast majority – about 85% - of invasive MRSA infections are associated with healthcare treatment, e.g., in a hospital or nursing home, according to a study published today in the Journal of the American Medical Association.

Some hospital systems, e.g., Evanston Northwestern Healthcare, have dramatically reduced their rate of MRSA infections. Dr. Lance Peterson, an epidemiologist at ENH, said, "MRSA is theoretically a totally preventable disease."

Advice to hospitalized patients: Put up a sign near your bed asking your doctors and nurses to wash their hands.

Read another drug-resistant infection story, or read more from today’s Associated Press stories, or the New York Times article by Kevin Sack.

Tuesday, October 16, 2007

So many things my doctor and Medtronic didn’t tell me: A defibrillator wire defect

Stephanie Martinson, 35, a speech pathologist in Palo Alto, California, said that in March she had a defective wire – a Fidelis lead - removed from the defibrillator device in her heart. The removal was necessary because instead of correctly monitoring her heart rhythm, and only shocking it back into a normal pattern when needed, the Medtronic device had delivered a jolting shock 26 times in an hour. Medtronic notified doctors of the defect, and in May, she received a replacement wire. Unfortunately, the replacement was another Fidelis lead, which may be defective.

"There are so many things my doctors and Medtronic didn't tell me," she said.

Five patients are known to have died because of malfunctions of the device's leads, or wires, which connect the device to the heart.

Medtronic disclosed that the new thin leads have a tendency to form small cracks in the wire, which either blocks or distorts its electrical flow. The flaws may result in faulty signals to the defibrillator, making it unnecessarily shock the heart or fail to deliver a life-saving jolt of electricity when needed.

No one knows how common this problem is. Medtronic says it might affect 2.3% of the 235,000 patients who have the suspect wires, i.e., more than 5,000 patients.

Advice: Tell your friends with implanted defibrillators to ask their doctors whether they have the Medtronic-made Fidelis leads (which have identifying numbers 6930, 6931, 6948 and 6949, on their wallet card), and if so, to schedule computerized testing of the device.

Read another defibrillator story, or read the source stories by Barry Meier and Lawrence Altman in today's New York Times.

Monday, October 15, 2007

Years of nagging are paying off: Progress in the war on cancer

The death rates from cancer are falling faster, according to today's Annual Report to the Nation by the American Cancer Society, National Cancer Institute and others. The death rate is falling more than 2% each year, about twice the pace of the previous decade. That means more than 10,000 people's lives have been saved each year.

"Years of nagging and pleading by health officials are finally beginning to pay off, experts say, in smoking cessation and increased use of mammograms, colonoscopies and other screening tests for colorectal and prostate cancer," in Denise Grady's words in today's NY Times.

But "it's still a minority of individuals that undergo screening for colon cancer. If everyone were screened appropriately, these incidence numbers would fall even more dramatically," said Dr. Neal Meropol of the Fox Chase Cancer Center.

Advice: Prevention can work.

Read another prevention story by Denise Grady, or read her source story in today's New York Times.

Sunday, October 14, 2007

Now the West Point grad leads a different fight: Iraq veterans' health care

After his commission from the U.S. Military Academy at West Point in 2000 and basic training, Marc Giammatteo was deployed to Iraq in April 2003. In nine months in Iraq, Marc led 100 combat missions before he was severely injured by a rocket-propelled grenade during a January 2004 ambush. The grenade penetrated his vehicle, tore off the outside half of his right leg from knee to ankle and caused multiple shrapnel wounds to his body.

Over two years he had more than 20 surgeries at Walter Reed Army Medical Center, in Washington, D.C. Surgeons saved his permanently damaged leg. While recovering from his wounds he became an unofficial patient advocate, testified to the Committee of Veterans' Affairs and consulted with the secretary of the Veterans Administration, the secretary and deputy secretary of Defense, and two chairmen of the Joint Chiefs of Staff on behalf of wounded service members from operations Iraqi Freedom and Enduring Freedom.

Earlier this year, President Bush named him to his Commission on Care for America's Returning Wounded Warriors. Under his leadership, the Commission recommends creating comprehensive recovery plans, restructuring the disability and compensation system, aggressively preventing and treating post-traumatic stress disorder and brain injury, strengthening support for families, rapidly taking patient information from the Department of Defense to the Veterans Administration and recruiting and retaining first-rate professionals for the Veterans Administration.

Advice to injured veterans: Become strong advocates for yourself and your fellow veterans, like Marc.

Read another Iraq story, or read more from the source article by Scott Whipple in New Britain [CT] Herald.

Saturday, October 13, 2007

It was always a good day: Recovery from heroin addiction

Jessie Skillman of Waynesboro, Virginia found his escape from the real world by snorting heroin for 18 months.

The drug fueled a false optimism.

"It was always a good day," said the 24-year-old Jessie, who at one point was spending $75 to $100 a day on the drug, and traveling as far as Baltimore to get it. He graduated to heroin after earlier taking pain medications such as Vicodin and Dilaudid for a thumb injury.

Jessie's world came crashing down in 2005, when he blacked out and wrecked his car on U.S. 250 outside Waynesboro, and was stopped by police for driving with three flat tires and part of a tree stuck in his windshield wipers.

Already on federal probation, Jessie's probation officer suggested he enter detox treatment, which he did through the Valley Community Services Board.

"I stayed in bed and just shook," he recalled. Jessie survived the seven-day detox program with the help of counselors and group therapy. And after his initial treatment, he committed to a three-times-a-week outpatient program for nine months that included group therapy and work with counselors for two hours a session.

"The other patients pull you through. You become a family," said Jessie, who also credits counselors with listening and helping him beat his addiction.

For Jessie, his bout with heroin "was a terrible experience, a nightmare, the first thing I thought about in the morning." But now, he is concentrating on his work as a caterer.

Jessie’s advice for any person with a substance abuse problem: "Get detox and get yourself through. Go in for after addiction treatment and come out clean."

Read another addiction recovery story, or read more from the source article by Bob Stuart.

Friday, October 12, 2007

We were halfway down the hall before someone heard me yelling: A hospital transport error

It was 4 am, but Gillian Trumbull was wide awake. The 24-year-old Chicago woman knew she had to stay alert, having had many hospital stays.

She was waiting to be taken to a heart test. Instead, a hospital employee said he was taking her for dialysis, a treatment for kidney failure. He had confused Gillian with the patient in the next bed. He ignored Gillian’s protests and began wheeling her out the door.

"We were halfway down the hall before someone heard me yelling," she said. "A nurse manager said, 'She’s pretty lucid. I think she knows what she is saying.'"

Advice: Feel free to ask that a family member or patient advocate be with you, involved in your care.

Read another wrong patient story, or read Liz Szabo's source story in the Feb. 5, 2007 issue of USA Today.

Thursday, October 11, 2007

She’s back home: Recovery from addiction in a residential facility

Myra Williamson is back home. She's moving into a house just around the corner from where she grew up - and where, not so coincidentally, her downward spiral began.

 "I spent most of my life in this community," Myra said as she prepared to move into a newly refurbished home at Monroe and Lexington streets. "I became addicted here."
" She had to leave town about 10 years ago to get the kind of drug treatment she felt she needed, but today, Myra will celebrate the opening of a residential facility in which she will help others fight their own addictions - without leaving the Southwest Baltimore neighborhood.

Myra will be the in-house manager of a new transitional home for women in drug treatment, through the initiative of Recovery in Community. She said she's "loving the thought" that she can now help provide what wasn't available to her back when she needed a place to live as she struggled toward recovery.

 "I had a nice job, a home, a car, and was blowing all that," Myra said of her use of first cocaine and then crack cocaine. "I knew I needed some help, and I started trying some out-patient programs, but it was not working." 

Instinctively, she knew she needed to be in a more structured environment rather than living on her own, and a friend ended up taking her to Philadelphia, where she moved into a group home. Ultimately, she beat her addiction and even became a manager of a similar facility. On a visit to family in her old neighborhood in Baltimore, she met RIC's director, Lena M. Franklin, and eventually was hired to manage the group's new residential facility.

"The farther people have to go, the less likely they are to go," said Jane Harrison, who as senior program officer at the Abell Foundation helped design RIC and now serves on its board of directors. "You have to give people the tools to be able to live in the community that they're from."

Among the first residents of the new house will be Cherese Roberts, 33, who has been clean for a year thanks to RIC's drug treatment programs. While living in a neighborhood where drugs are so readily available might seem like it would hinder recovery, Cherese said it's been just the opposite. 

"Everything out there," she said, "is showing me what I don't want to be a part of."

Advice to people in recovery: Look for ways to help others who are fighting the fight that you're winning.

Read another recovery story, or read Jean Marbella's source story or see the video in the Baltimore Sun.

Wednesday, October 10, 2007

He always took the blows in stride: Multiple concussions in athletes

In his years as a Harvard University defensive tackle and a professional wrestler, Chris Nowinski has been leveled by a helmet-to-helmet collision, based in the chin, and kicked in the head. He has been knocked unconscious, seen double, and forgotten where he was or what he was supposed to be doing.

Chris says he always took the blows in stride, getting back into play as soon as he could, sometimes within minutes of the injury. He handled it the way he'd handle any other injury.

"Guys work through all sorts of pain," he says. "If everyone took a day off because of pain, no one would show up to work. I just considered it like a normal bruise."

But concussions, he would find out later, aren't like any other injury. The cumulative effect of six concussions ended his career with World Wrestling Entertainment in 2004 and left him struggling with chronic headaches and memory problems.

Today, Chris is a crusader, raising awareness about the dangers of concussions through the Boston-based Sports Legacy Institute.

Multiple concussions also have had serious lasting effects for Troy Aikman, the Dallas Cowoys quarterback; San Francisco Giants catcher Mike Matheny, New England Patriots linebacker Ted Johnson, and NFL players Andre Waters and Terry Long, among others.

Advice for parents of high school football players: Get your son to a physician if he shows these symptoms after a concussion: headache, dizziness, problems sleeping, imbalance or lack of coordination, fatigue, sensitivity to light or noise, difficulty remembering or concentrating, difficulty thinking clearly, work-finding difficulty, irritability/moodiness/ impulsiveness, or feeling depressed or anxious.

Read another athlete’s concussion story, or read Lisa Phillips' source story in the September/October issue of Neurology Now.

Tuesday, October 9, 2007

Curt was able to get rid of one curse – let’s see if he can get rid of another: ALS patient advocate

Bruce Statham wasn't dying of Lou Gehrig's Disease, he was living with it. For more than a decade after his diagnosis, he lived on, and became a spokesman abut the disease. He helped raise funds for research on ALS, also called Lou Gehrig's Disease, and helped Harvard Medical Students understand what is was like to live with the disease. He died this week at age 39, of complications from ALS.

He worked with the Angel Fund, a nonprofit that raises money for research at the Cecil B. Day Lab for Neuromuscular Research at Mass General Hospital. There, soon after the Boston Red Sox won the World Series, he was invited to introduce pitcher Curt Schilling, who raises money for the National ALS Association. He said, "Curt was able to get rid of one curse; let's see if he can get rid of another."

Advice for survivors: See if you can help others with your disease by being a patient advocate

Read another ALS story, or read more from Bryan Marquard's story in the October 9 Boston Globe.

Monday, October 8, 2007

The surgeon later admitted he was addicted: A spinal surgery lawsuit

Demian McElhinny, 33, a former hospice pharmacy technician in El Paso, recently settled claims against a neurological surgeon for spinal surgery that left him and his family impoverished. He said he emerged with "pennies on the dollar." His wife, Kelly, found work as a school bus driver, he said, while "I'm at home being a housewife to my two boys."

Demian's surgeon, Dr. Paul Henry Cho, later admitted to the medical board that he was addicted to a narcotic cough syrup and had written fraudulent prescriptions. Dr. Cho's license to prescribe drugs was suspended, although it was soon restored, and he moved from El Paso to a hospital in Fort Worth.

Demian collected so little because four years ago, Texas voters passed an amendment to the state constitution that limits malpractice awards.

Advice to victims of malpractice: If state law prevents you from collecting for your injury, your best form of accountability may be telling your story to the public.

Read another neurosurgical error story, or read the source story by Ralph Blumenthal in the October 5, New York Times.

Sunday, October 7, 2007

Hospitalists improve quality of care

Hospital staff are working so fast that it's easy for them to forget to do something, or to give short shrift to some patients. It's good to have a special kind of doctor, who works full-time in the hospital, focusing only on inpatients – a "hospitalist."

A study last month found evidence of the positive role that hospitalists play. Patients with serious illnesses like stroke, congestive heart failure, and pneumonia recovered the fastest when cared for by hospitalists. On average, care by hospitalists enabled patients to leave the hospital about a day sooner than patients treated by other doctors. As Dr. William Southern, the lead author of the study, said, "We believe hospital-based physicians offer the highest quality of care."

Advice for patients choosing a hospital:
Look for a hospital that employs hospitalists.

Labels: hospitalists, archives of internal medicine, William Southern, length of stay, hospital readmission, complex discharge planning

Read more useful advice from a different study in the same medical journal , or read more from Sena Desai Gopal’s summary in Monday’s Boston Globe, or the Sept. 24 issue of Archives of Internal Medicine.

Friday, October 5, 2007

A matter of iron: Patient compliance

Dr. Larry Kirkland's story:

What I've come to think of as "the ferrous sulfate affair" may seem trivial but it was representative of the conflicts that occurred during my stay. Because of anemia from a chronic infection secondary to a pressure ulcer, I was placed on ferrous sulfate three times a day. That is not a prescription drug [as it can be bought over the counter]. Since I knew that ferrous sulfate can irritate the stomach, I requested that the pill be left on the table and told the nurse that I would take it during my meal, which had just arrived. The nurse said, "I can’t do that." I thought she was kidding, so I explained my concern and assured her that I'd take the pill 10 or 15 minutes later, adding jokingly, "I promise not to try to sell it." Her response was to pick up the pill cup and say, "I'll wait until you're ready." When I told her it might be a few minutes, she repeated that she'd wait. Rather than prolonging this demeaning and unnecessary charade, I told her to cancel the medication order.

Although I knew it would mean that the attending physicians wouldn't know all the medications I was taking, I had my wife bring some ferrous sulfate tables from home. The fact that I needed the iron was never mentioned in the negotiation over when I took it. Instead of honoring the patient's right to be involved in decisions, the nurse was practicing a form of "directly observed therapy," an approach usually reserved for patients who won't comply with antituberculosis therapy, drug addicts in methadone programs, prisoners, and mentally incapacitated patients.

It's possible that such a rigid approach had evolved at this hospital out of dealing regularly with emotionally fragile patients….But if the patient is a physician…conflicts will arise if he is treated in the same manner as, for example, a patient with brain damage….

I'd never before come across so many staff members seemingly fearful of using their own experience, common sense, and judgment in making a decision, nor so many who cited "policy” or "regulations" to explain a particular action. I could single out individuals, but it seems likely that a share of the blame for the pervasive disrespectful treatment I encountered at this hospital should be assigned to the hospital administration and the priorities it transmits to the staff through training, example and regulations….

I remember a time when the patient, not regulations or the "bottom line," was the central driving force in the system. Maybe this is naïve, but I fail to see how a return to more personal and compassionate attitudes would reduce safety or be economically unsound.

Advice to hospitalized patients on taking their home medications: Stick up for yourself, and discuss this with nurses and doctors in the hospital.

Read our Hospital Patient Bill of Rights story, or read Dr. Kirkland's source story in the June 2007 issue of the American Journal of Nursing.

Thursday, October 4, 2007

Pulling in the same direction: Alcoholics Anonymous

I sat near the back and looked out over the room. Familiar faces, unfamiliar faces, all of us more or less like John, pulling in the same direction. Then I had an image of every person in that room climbing into bed that night, all fifty of us getting into our beds clean and sober, another day without a drink behind us. It was a simple image but it filled me with a range of complicated feelings: appreciation for the simple presence of all those people, admiration for their courage and strength; a tinge of melancholy for the amount of pain it must have taken each and every one of them to put down the drink; affection for their humanity.

I didn't realize until hours later that there was a name for that feeling. It's called love.

Advice to recovering drinkers: Find a sustaining source of love to support you in your recovery.

Read another of our AlAnon stories, or read more from Caroline Knapp's memoir, Drinking: A Love Story.

Tuesday, October 2, 2007

A steadfast partner: Sobriety and relapse

From Caroline Knapp's memoir:

Michael and I still see each other most nights, but I am taking time to be alone, trying to understand myself as a person a little better before I make any choices about myself as part of a couple.

Choice is the key word here, and it's still a relatively foreign one for me. For the first time the relationship with Michael isn't washed over by waves of alcohol or haunted by Julian; for the first time I feel I'm with him because I've decided to be, not just because I've been buffeted in his direction by circumstances or pain or need. There's great relief in that: I often look at Michael these days with the sense that I'm finally seeing the relationship through glasses that have the right lenses. Sobriety has helped me appreciate his kindness with greater purity and depth, as though it exists in its own right now and not merely as a measure of comparison to Julian. I can't imagine a more steadfast or supportive partner: Michael hasn't had a drink in front of me since I went off to rehab, and he's as bolstering about my sobriety as anyone in AA. These days he does a great imitation of me in the kitchen before a dinner party, compulsively trying to drink a glass of wine and smoke a cigarette and stir a sauce all at the same time, and I appreciate his ability to capture the frenzied insanity of those days and to help me laugh at it too. If I've been through a war, he's been in charge of triage through most of it, and sometimes the gratitude I feel toward him wells up so powerfully I think I'm going to burst.

Advice to drinkers: Find a loyal friend to help you stay sober.

Read one of our stories about a friend as patient advocate, or read more from Caroline Knapp's memoir, Drinking: A Love Story.

Monday, October 1, 2007

From Tragedy to Safer Care: A stillborn baby

Seven years ago, a series of errors befell Mrs. W. while she was an obstetric patient at Beth Israel Deaconess Medical Center in Boston, and her 9-month old fetus was stillborn. Mrs. W. herself needed a hysterectomy, and 18 days of subsequent hospitalization in the intensive care unit.

According to the Chief of Obstetrics in the Journal of the American Medical Association article, staff made several errors in her care. After she started labor, doctors discharged Mrs. W. back home, though her blood pressure should have led doctors to keep her in the hospital. When she was re-admitted at midnight, a few hours later, doctors did not consider that preeclampsia could be involved. Doctors ordered lab tests, but the tests were never sent, due to miscommunication. When the fetus' heart rate exhibited a worrisome "non-reassuring" pattern of "late decelerations," a C-section should have been promptly performed at 5:30 am.

Several factors contributed to the errors. The attending physician had been on call for 21 hours, and fatigue may have led the doctor to stick to a diagnosis despite evidence to the contrary. There were an unusually high number of women giving birth there at that time. Residents were afraid to speak up to the more senior doctors. At age 38, Mrs. W was relatively old for a first-time birth. The hospital had been experiencing severe financial difficulties, which might have affected nurse staffing levels. The crisis occurred in the early morning. Mrs. W. did not know about the drug used to induce her labor.

In the words of Mrs. W's husband, "That night, I saw residents who were afraid. They were either unable or unwilling to get the doctor, when clearly things weren’t going the right way."

As a result of the multiple tragic errors in her care, doctors and other staff aggressively have since acted to safeguard their system of care to prevent similar errors. Indeed, they were able to reduce errors by about 25%.

This improvement led the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) to honor the hospital last week with the John M. Eisenberg Patient Safety and Quality Award.

I hope the improvement will be permanent. Two factors, however, will make this doubtful. First, hospital policy continues to have attending physicians on call for 24-hour shifts, despite the Chief's clear attribution of overwork and fatigue as significant contributing factors. Second, the Chief is leaving the hospital, and it is unclear whether his successor will as strongly advocate team communication ("crew resource management," from the aviation industry).

Dr. Sachs' advice to patients and their spouses, patient advocates:
Ask the attending physician, "What's going on, and what are the plans?"

Read one of our stories by a pilot who is expert in crew resource management, or read more from the discussion among doctors in the August 17, 2005 issue of the Journal of the American Medical Association.