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Sunday, December 30, 2007

When I play, it feels like a massage: Synesthesia as an adverse drug reaction

Prof. Sherrilyn Roush woke up one morning seven years ago to discover that the left side of her body had gone numb, with a stroke. The day before, she had taken a prescription decongestant with ingredients that were suspected of causing strokes in young women. The decongestant had caused a lesion the size of a lentil in her mid-brain. Five months later, the Food and Drug Administration took the drug off the market.

Sherrilyn did not realize that her stroke would lead to sensations that few people had ever experienced. She began to feel tingling on her body in response to sounds. Today, more than ever, she feels sounds on her skin.

The first time it happened, she heard the voice of an announcer on a local FM station. "I felt an unpleasant sensation on my left thigh, left arm, the back of my shoulder and even the outside of my left ear. It was the kind of icky feeling that uniformly washes over you at a scary movie,"she said. "I had to stop listening. It made me cringe."

Psychologists at Rice University have tested her over the last seven years, observing how her brain's wiring has reorganized. Their article appears in the November issue of Annals of Neurology. They call her brain’s odd mixing of the senses "acquired synesthesia," and attribute the rewiring to the stroke.

Some sounds set her teeth on edge. Others evoke pleasant feelings on her skin. The soft sound of water bubbling is "soothing, almost like a massage on my skin."

Recently, she learned how to exploit her oddly mixed up senses. "I took up the string bass," she said. "Most people get pleasure from this instrument. It is huge. It has a soft deep sound. But I get more pleasure from this instrument, right here in my left arm. When I play, it feels like a massage."

She has learned to exploit the effects of her condition, in a way reminiscent of patients whom the neurologist Dr. Oliver Sacks described in "The Man Who Mistook His Wife for a Hat." Indeed, Sacks found that music had an exceptional power to help that severely disabled man to anchor himself in the world.

Advice to people who are greatly affected by their disease: Look for innovative ways to make the best of your disease, as Sherrilyn has.

Browse for related stories in the index at the very bottom of this page, or read a story of a patient-entrepreneur who made the best of her disease.

Thanks to Sandra Blakeslee for the source article in the Dec. 25 issue of the NY Times.

Saturday, December 29, 2007

I decided to report a colleague who had problems: Lawsuit and countersuit on reporting of medical malpractice

Dr. Ernst Heilbrunn's letter to the editor of the New York Times:

Your editorial states that almost half of those doctors "who had direct knowledge of impaired or incompetent colleagues, or who knew of significant medical errors, had failed to report them."

Twenty years ago, I was the director of a clinical department at a metropolitan area hospital. I decided to report a colleague who had problems. The hospital administration agreed and disciplinary action was started, and eventually successfully concluded.

It took me four years to settle the multiple lawsuits against me personally and as director of the department.

Based on my experience, I believe legal protection should be provided so that doctors who do their duty are not penalized with long and expensive lawsuits. If this were done, reporting would increase.

Advice: Google the name of your physician and the terms "lawsuit" and "court."

Browse for related stories in the index at the very bottom of this page, or read a story about impaired physicians.

Thanks to Dr. Heilbrunn, whose letter appeared in the NY Times of Dec. 29.

Friday, December 28, 2007

Should I accept this new version of my husband?: Chronic pain management

Dear Annie,
My husband and I have been married for 20 years. He's had health problems during his time, but has always managed his pain.

Last year, he went to a pain management clinic and they prescribed narcotics. He takes them every day and is in a fog every night. He has gained weight, become sloppy, and stopped caring how I feel.

I have suggested counseling, but he refuses, saying he has no problem with our marriage. I have seen a counselor myself, but am totally torn up by this. I still receive attention from other men. I don't want to spend the rest of my life with someone who is continually numb. I have a solid job offer in another town close to family. Should I stick it out and accept this new version of my husband?
--Signed, Falling Out of Love

Annie's Advice:

Your husband doesn't want to stop taking this medication because he feels good for the first time in years. However, if he is "in a fog," he may be overmedicated, and his doctor should be told. If you've been with him for 20 years and this latest phase has lasted only 12 months, please stick it out and give him time to adjust his medication. If that doesn't help, insist on counseling for your sake so he can understand how close he is to losing his marriage.

Browse for similar stories in our index at the very bottom of this page, or read a pain management story.

Thanks to "Annie" for the letter and her response, published in Annie's Mailbox, in the Dec. 27 issue of the Boston Globe.

Wednesday, December 26, 2007

A normie wandered in unawares: Coffee, karaoke, and group therapy

Harold Jonas, 52, kicked a heroin habit two decades ago in the beachfront city of Delray Beach, Florida, far from his native Philadelphia, and decided to stay. He married a fellow addict, raised a family, earned a doctorate and opened a halfway house for substance abusers making the transition from residential care to independent living.

Steadily, he and his wife, Dawn, expanded their cottage industry. They organized an association of halfway house owners and opened KoffeeOkee, the coffeehouse-karaoke bar.

About 20 residents of Delray Beach recently gathered at the café one night for a weekly counseling session. One "normie" – their word for the 65,000 year-round townspeople – wandered in unawares and was allowed to stay. First-timers sat at the periphery of the circle, avoiding eye contact with others.

Advice to people struggling with drug habits: You can have fun and friends without harmful drugs.

Browse for related stories in the index at the very bottom of this page, or read one of our Delray Beach stories.

Thanks to Jane Gross for the source article in the Nov. 16 issue of the New York Times.

Tuesday, December 25, 2007

I did it to myself, and so I better do everything I can to get out of it: Missed diagnosis of COPD

The crisis came five years ago for Jean Rommes, on a Monday morning when she had planned to go to work but wound up in the hospital, barely able to breathe. She was 59, the president of a small company in Iowa. Although she had quit smoking a decade earlier, 30 years of cigarette smoking had taken their toll.

After several days in the hospital, she was sent home tethered to an oxygen tank, with a raft of medicines and a warning: "If I didn't do something, life was going to continue to be a pretty scary experience."

Jean has chronic obstructive pulmonary disease, or C.O.P.D., a progressive illness that permanently damages he lungs and is usually caused by smoking. She has both emphysema and chronic bronchitis, as well as asthma. She had symptoms for years before receiving a correct diagnosis.

She began smoking in college in the 1960s, when she was 18. People whom she admired smoked, and it seemed cool. She smoked for 30 years.

When she quit in 1992, it was not because she thought she was ill, but because she realized that she was organizing her day around chances to smoke. But she almost certainly was ill. She was only 50, but climbing a flight of stairs left her winded. From what she found in medical dictionaries, she began to suspect she had lung disease.

By 2000 she was so short of breath that she consulted her doctor about it.

He gave her a spirometry test. In one second, healthy adults should be able to blow out 80% of the total they can exhale; her score was 34%, indicating moderate to severe lung disease.

"I don't know whether he knew," she said of her doctor. "I suspect he did, but he didn't call it emphysema. He put me on a couple of inhalers and he called it asthma. I sort of ignored the whole thing because the inhalers did make me feel better. I started to gain some weight, and things got progressively worse."

She cannot help wondering now if she could have avoided becoming so desperately ill, if she had only known sooner what a dangerous illness she had.

The turning point came in February 2003 when she tried to take a shower and found that she could not breathe. The steam all but suffocated her. She managed to drive from her home in Osceola, Iowa, to her doctor's office, struggle across the parking lot like someone climbing a mountain and collapse, gasping, onto a couch inside the clinic. Her blood oxygen was perilously low, two-thirds of normal, even when she was given oxygen. The hospital was next door, and her doctor had her admitted immediately.

She had Type 2 diabetes as well as lung disease, and her doctor told her that losing weight would help both illnesses. But she said, "He made it pretty clear that he didn't think I would or could."

Motivated by fear and anger, she began riding an exercise bike, walking on a treadmill, lifting weights at a gym and eating only 1,200 to 1,500 calories a day, mostly lean meat with plenty of vegetables and fruit.

"I came to the conclusion that if I didn't, I probably wasn't going to be around," she said. "I wasn’t ready to check out. And my husband was beginning to show the signs of Alzheimer's disease."

By December 2003, her efforts were starting to pay off. She went from needing oxygen around the clock to using it only for sleeping, and by January 2005 she no longer needed it at all. She was able to lower the dosage of her inhalers and diabetes medicines. By February 2005, she had lost 100 pounds.

The daily exercise also helped her deal with the stress of her husband's illness.

"I had no clue that exercise would do as much for ability to breathe as it did," she said, adding that it helped more than the drugs, which she described as "really pretty minimal."

"Exercise is absolutely essential, and it's essential to start it as soon as you know you have C.O.P.D.," she said.

"I will tell pretty much anybody that I smoked for 30 years, and I quit in 1992." Maybe it's why I've attacked this the way I did. OK, I did it to myself, and so I better do everything I can to get out of it. We all do things in our lives that are stupid, and then you do what you can to fix it."

Advice to former smokers: Exercise will help your lungs function better.

Browse for related stories in the index at the very bottom of this page, or read one of our COPD stories.

Thanks to Denise Grady for the source article in the Nov. 29 issue of the New York Times.

Sunday, December 23, 2007

A second opinion for Lou Gehrig's Disease

Gaetan Guertin, a native of Quebec, Canada, sought a subspecialist's opinion after his first neurologist suggested the diagnosis of amyotrophic lateral sclerosis (ALS, or Lou Gehrig's Disease). Gaetan began to experience leg fatigue when he was 55 and soon developed foot weakness and muscle atrophy. In an interview with Neurology Now, Gaetan said the expert's approach was more confident. "She had a lot of experience and knowledge and was more open,” he said. He added that since the neurologist worked at a research and training hospital, the diagnostic testing could proceed more promptly.

Advice: If you're unclear about a diagnosis, consider getting a second opinion.

Browse for related stories in the index at the very bottom of this page, or read a story about a man with Lou Gehrig's disease.

Thanks to Dr. Orly Avitzur for the source article in the November/December, 2007 issue of Neurology Now.

Saturday, December 22, 2007

The insurer had initially refused to pay: A liver transplant lawsuit

Nataline Sarkisyan was a very sick teenager. She had been diagnosed at 14 with leukemia. Her cancer went into remission after two years of chemotherapy, but it returned last summer.

The day before Thanksgiving, she received a bone marrow transplant from her brother. Unfortunately, a complication caused her liver to fail.

Her parents asked CIGNA, their insurer, to authorize a liver transplant. CIGNA initially refused to pay for it, saying it did not cover experimental or unproven treatments.

Four doctors at UCLA submitted a letter to CIGNA on December 11 that urged the insurer to reconsider, saying that in Nataline's case the liver transplant would be neither experimental nor unproven. They cited the survival rate in such cases.

The University of California at Los Angeles Medical Center told the family on Dec. 14 that a liver was available, if the family could pay a down payment of $75,000, in view of CIGNA's denial of authorization. The family couldn’t afford it.

On Thursday, Dec. 20, following a rally by 150 nurses and community members outside its office in suburban Los Angeles, CIGNA changed its decision. But it was too late; Nataline died a few hours later.

Nataline's father has retained a lawyer, Mark Geragos, to bring a lawsuit against the insurer, asserting the initial refusal of the liver transplant contributed to Nataline's death.

Advice: Check the customer satisfaction ranking of your insurer, and switch if their rankings are low.

Browse for related stories in the index at the very bottom of this page, or read a story about the affordability of a liver transplant.

Thanks to Alicia Chang for the source article in today's Boston Globe.

Thursday, December 20, 2007

Every day was a bonus: Heart transplant survivor

John Scripter's heart was failing. Without a transplant, he had six months to live, doctors at Massachusetts General Hospital in Boston said. With a transplant, he had a chance to live five years.

John, then a 45-year-old manual laborer from Greenville, New Hampshire, asked his cardiac surgeon how many heart transplant he had performed. The answer: None. John would be the first.

John underwent the novel surgery in 1985, giving him 22 more years of life. He died Friday, after spending the afternoon with one of his nine children.

"After five years, every day was a bonus," said his wife of 46 years. "It was a day that he might not have had. We lived every day like it was the last. It was still scary because it was a whole new avenue. And he got a second chance. He was so fortunate. We had our good times, we had our bad times. He said, 'You know, I've had it all. It's wonderful. I've seen everything. I've seen my kids grow up. I've seen their kids.'"

Life wasn't easy; John was not able to return to work. He battled heart infections caused by his heart medications, said his cardiac surgeon. He lost his right leg to infection in March.

But he never gave up, said his wife Linda. "He said, 'Look, fit me for an artificial leg and I’ll keep going.'"

Advice: Live every day like it's the last one.

Browse for related stories in the index at the very bottom of this page, or read a story from a blog about zestful living in the bonus round.

Thanks to Anna Badkhen for the source article in yesterday's Boston Globe.

Wednesday, December 19, 2007

Then he walked out of the room: A neurologist's misdiagnosis

When Todd Bischoff developed a tremor at age 46, a neurologist diagnosed essential tremor and gave him two prescriptions to fill. "He said to let him know if I wanted to take the medications. Then he walked out of the room without explaining what essential tremor was or telling me anything about the drugs," Todd says. This was the first red flag. Then, when Todd went home and researched the condition, descriptions of Parkinson's disease seemed to fit his symptoms much better. Todd sought a second opinion, and his next neurologist confirmed the diagnosis of young-onset Parkinson's.

Todd's second neurologist sent him to a Parkinson's disease specialist because he felt that the early age of onset warranted special consideration. Although he had to pay out of pocket, Todd ultimately received his care from a movement disorder subspecialist because he felt that the doctor's expertise and superior level of skill were worth it. "I'm much more confident in dealing with my condition now and know that if I have questions, my neurologist is available to assist me," he said.

Todd believes teamwork is critical for those dealing with a progressive neurodegenerative disease. "This is your health we're talking about – you have to advocate for yourself. If you don’t, you could potentially suffer from poor care, or even the wrong care," he says. "You need to solidify your diagnosis so you know exactly what you're dealing with. Otherwise, how can you most effectively treat what you have?!"

Todd runs a support group (PDTalks.com).

Advice: If you don't have confidence in the diagnosis, get a second opinion.

Browse for related stories in the index at the very bottom of this page, or read a second opinion story.

Thanks to Dr. Orly Avitzur for the source article in the November/December, 2007 issue of Neurology Now.

Tuesday, December 18, 2007

Never again in California will someone be kicked to the curb: Universal health care on International Migrants Day

California moved significantly closer to broadly expanding health insurance coverage yesterday, when the Democratic-controlled Assembly passed legislation that Gov. Arnold Schwarzenegger backs.

Three other states – Massachusetts, Vermont and Maine – have passed similar plans in recent years. The California plan mimics Massachusetts' by requiring most individuals to obtain basic health coverage and requiring insurers to offer policies regardless of a consumer's age or health status. The plan would use a sliding scale for premiums and tax credits to make coverage affordable. Children who are in the U.S. illegally could receive coverage, though adult illegal immigrants would not be eligible.

Assembly Speaker Fabian Nunez said, "There is hope through this bill that never again in California will someone be kicked to the curb by an insurance company."

This is a significant step, just in time for International Migrants Day, which is celebrated today, Dec. 18.

Browse for related stories in the index at the very bottom of this page, or read a health care for all story.

Thanks to Kevin Sack for the source article in today's NY Times.

Monday, December 17, 2007

I would end the calls blubbering with gratitude: The psychology of kidney donors and recipients

Dr. Sally Satel's story:

My kidneys were failing. On a steamy day in August 2004, I went to the doctor for a routine checkup. I was feeling fine, but a basic test revealed that my kidneys were shot, functioning at about 16% of normal capacity. One nephrologist I went to predicted that within roughly six months to a year I would need to begin dialysis, three days a week, for four debilitating hours at a time.

In October 2005, I stumbled across a web site called MatchingDonors.com that helps link potential donors and recipients. I wrote only a short self-description.

Three days later, a Canadian man called. He told me he considered becoming a donor five years ago when he heard through his church about someone who was failing on dialysis. That was the most personal thing I learned about him. Well into November, we were in regular contact, mostly about logistics – whether my insurance would pay for his tests, whether he could take time away from a project he was working on, and so on. I ended the calls blubbering with gratitude, and he would tell me to stop.

Until both of us were snug in our adjoining operating rooms, I could never relax – everything was tentative, conditional, and prone to collapse.

About a week before Thanksgiving, the Canadian went dark. By then I was fatigued most of the time and fluid was pooling in my ankles. I took four antihypertensive drugs a day and had injections of a hormone that stimulated my body to make more red blood cells. Dialysis was closing in.

Around Christmas, he finally called. He swore he was still "raring to go with the transplant." A few days later, my young transplant coordinator, Julie, called him. Straight talking and bright-eyed, she spoke to him in a way I could not. "We need to know how to proceed," she told him firmly. "There is no time to spare. Can you be here in January for the surgery?" He conceded that the campaign he was working on was too unpredictable. Julie said he seemed to feel genuinely bad about reneging, but he did not tell her to convey that disappointment to me, and I never heard from him again.

I was astonished at the Canadian's … what? Negligence, cowardice, rudeness? It was a sickening roller-coaster ride: hope yielding to helpless frustration, gratitude giving way to fury. How dare he reduce me to groveling and dependence? Yet I assume he intended no such thing. I think the Canadian was actually quite devoted to the idea of giving a kidney – just not necessarily now or to me. He had led me on for weeks, and would have continued doing so had Julie not pushed him. Meanwhile, my kidneys were deteriorating, and I didn't have time for more cycles of commitment, silence and rejection.

Just before the Canadian withdrew, another potential donor had contacted me. She was the right blood type; even better, she was the right personality type. On March 4, 2006, I became the proud owner of Virginia Postrel's right kidney. She was out of the hospital within three nights; I was home after seven, and our recoveries were uneventful. I require no drugs except medication that prevents my body from rejecting the new organ.

Altruism is a beautiful virtue, but it has fallen painfully short of its goal. We must experiment with offering potential donors other incentives for giving, not necessarily payment but material reward of some kind. Unless we stop thinking of transplantable kidneys as gifts, we will never have enough of them.

Advice: Sally was able to discover her kidney condition through a routine physical exam, which gave her the time to find a good donor. Get a physical exam when your doctor suggests it.

Browse for related stories in the index at the very bottom of this page, or read a kidney transplant story.

Thanks to Sally Satel for the source story in yesterday's New York Times Magazine.

Friday, December 14, 2007

More than about asterisks and cheating: Steroids, major league baseball, and high school suicides

Taylor Hooton was a junior in high school, a tall, thin pitcher on his baseball team in Plano, Texas. His coach told him he needed to get bigger for his senior year to compete effectively, so Taylor took steroids, as did many of his teammates. He rapidly gained more than 25 pounds. And he began to display the aggressiveness that is characteristic of steroid abuse. He confessed his "aggressive depression" to his brother.

He experienced the depression in coming off the steroids. He committed suicide, leaving the vial of steroids wrapped in an American flag.

His father, Don Hooton, said, "Taylor was a top-notch student. He, like so many, was doing it because he thought it might make him better."

Today we read about the Mitchell Report on the use of steroids by 89 of major league baseball's top players – Barry Bonds, Roger Clemens, Andy Pettite, Ken Caminiti, Jose Canseco, Mo Vaughn, Miguel Tejada, Jason Giambi…

As Taylor's father said, "This is more than about asterisks and cheating; it's about the lives and health of our kids."

Advice to parents of high school athletes: Become an impassioned patient advocate like Don Hooton.

Browse for similar stories in our index at the very bottom of this page, or read an athlete’s story.

The source story comes from today’s New York Times and the London Times of Dec. 1. Thanks, Owen Slot.

Wednesday, December 12, 2007

So many children: Flu vaccines

The New Jersey Public Health Council voted on Monday to require all children in New Jersey who attend preschool or are in day care to get annual flu vaccinations. This makes New Jersey the first state in the nation to require these immunizations.

Dr. Robert Morgan, a Monmouth County pediatrician, said that over the years he and his colleagues had "seen so many children not only suffer but die from diseases that could be immunized against. That could have been prevented simply by administering a vaccine."

Dr. Eddy Bresnitz, the New Jersey Deputy Commissioner of health and the state immunologist, agreed, citing the 600 children hospitalized in the state each year for influenza.

But some parents of autistic children link a mercury compound, thimerosal, in the vaccines to their children's autism. For example, Anne Downing believes her 7-year-old daughter's autism was tied to vaccines for the flu and pneumonia that the girl received in utero and as a baby, respectively. Many experts, however, say no solid evidence supports this view.

Dr. Bresnitz says most vaccines contain no, or negligible amounts of, thimerosal. In any event, he says, parents can request thimerosal-free formulations of the vaccine.

Advice: Vaccinate your kids against the flu. If you're concerned about the risk of autism, ask for a vaccine without thimerosal.

Browse for similar stories in our index at the very bottom of this page, or read a sad flu vaccination story.

Thanks to Jill Capuzzo for the source story in the Dec. 11 issue of the New York Times.

Tuesday, December 11, 2007

Like a bartender who serves a drunk customer: The physician's liability for drug side-effects

David Sacca, 75, was a very sick man, with emphysema, high blood pressure, and metastatic lung cancer. He was taking oxycodone, Zaroxolyn, prednisone, Flomax, potassium, Paxil, oxazepam, and furosemide – some of which can cause drowsiness, dizziness, and fainting.

While driving in Spring 2002, David passed out and drove off the road, hitting and killing a ten-year-old boy, Kevin Coombes, who had been standing on the sidewalk with a friend.

Yesterday the Massachusetts Supreme Judicial Court ruled that David's doctor could be sued for failing to warn his patient about the side effects of the drugs and for failing to warn him of the danger of driving while under the drugs' influence.

In writing the court's lead opinion, Justice Roderick Ireland compared the doctor's liability to that of a bartender who serves a drunk customer.

Almost every drug has side effects. Drowsiness is a common side effect of many prescription drugs. This ruling greatly expands physicians' liability for the prescriptions they write every day.

Advice: Ask your doctor and pharmacist about the likely side effects of your drugs.

Browse for related stories in the index at the very bottom of this page, or read a story of the sad consequences of a different kind of expectable side effect, from Zyprexa.

Thanks to Liz Kowalczyk for the source article in today's Boston Globe.

Monday, December 10, 2007

A jolt of pain wrenched him from sleep: Cardiac rehab

Last February, a jolt of pain wrenched him from sleep. It was a heart attack. Ninety minutes later, he was at Massachusetts General Hospital, where doctors cleared a potentially lethal clog from one of his heart arteries.

Then they told Arthur Manjourides, 66, it was time to change his life. They gave him prescriptions for both pills and cardiac rehabilitation. Now he's 55 pounds lighter, and has lower cholesterol – and fewer hours at work.

"I wanted to get better. I wanted to get healthy. I would rather not be alive than have to be crippled by not doing things," he said.

A study in the October issue of Circulation by Dr. William Stason and others said few older survivors of heart attacks (14%) and few heart surgery patients (31%) enter cardiac rehab, though many more would benefit from it. Bypass surgery and artery-clearing procedures don't actually cure patients; they only address the most pressing symptoms of heart disease. Lifestyle changes and medications fix the underlying problems.

Advice to advocates for heart attack and heart surgery patients: Ask the doctor whether cardiac rehab would help.

Browse for related stories in the index at the very bottom of this page, or read a heart story.

Thanks to Stephen Smith for the source article in today's Boston Globe.

Saturday, December 8, 2007

It's not who he is: Misdiagnosis of autism

Jeremy is a 20-year-old young man who lives in Columbia, Missouri, and works on the "Mizzou" college campus as a volunteer, cleaning classrooms.

From the looks of him, you can't tell Jeremy has autism. He has a high functioning form called Aspergers. Doctors didn't diagnose him until he was 16. Before then, Jeremy said he had complications stacked up against him from doctors not knowing much about autism.

"They put me on several drugs and misdiagnosed me several times," said Jeremy. "Those were probably the most catastrophic years of my life, being misdiagnosed, being on those drugs, being treated poorly by the school, of their ignorance of autism, of my condition."

Now "his autism does play a part in his life, plays a big part, but it is not who he is," said his mother, Robin. "He is someone who has dreams and aspirations, who has many skills, who has a kind heart, who likes to volunteer, likes to help people... that is who Jeremy is."

Despite the difficulties he faces, Jeremy has no tolerance for those who want to "cure" autism.

"It's insulting to me because it is saying, you know, when people say, 'I am not going to try to understand this, I just want to cure it.' When it is actually something neurological. It is hard-wired into your brain. There is nothing you can do about it. That is just the way it is. They just want a cure, they don't want to understand it. They don't need to treat it. They don't want to deal with it. It is a lifelong thing," said Jeremy.

Advice to people whose drugs aren't helping: Find other people in your situation; they might help you learn a more accurate diagnosis.

Browse for similar stories in our index at the very bottom of this page, or read another delayed diagnosis story.

Thanks to Ashley Reynolds for the source story.

Thursday, December 6, 2007

A ridiculous situation shortly after surgery: Two residents' tonsillectomy care of a toddler

Blogger Dominic Carone, PhD, writes of the care and communication from two polar opposite residents who treated his young son after a tonsillectomy in "A Tale of Two Residents," here.

Advice to patients in teaching hospitals: Ask the resident to bring in a senior physician if you feel uncomfortable about the resident's treatment.

Browse for similar stories in our index at the very bottom of this page, or read a resident's error story.

Wednesday, December 5, 2007

Nine years of HIV treatment, but no HIV: A lawsuit about misdiagnosis

Testimony has begun in a lawsuit brought by a Fitchburg, Massachusetts woman who received nine years of HIV treatment after being misdiagnosed with the virus. Audrey Serrano is seeking unspecified damages from several doctors and clinics that were involved in her treatment.

One of those doctors told a Worcester Superior Court jury Tuesday she began treating Audrey in 1994, about 18 months after another doctor had diagnosed her with HIV. The doctor testified she had no reason to question the original diagnosis because Audrey convinced her she had the virus that causes AIDS.

Audrey claims in her suit that she suffered a variety of physical ailments because of AZT and other harsh medicines she took daily because of the diagnosis. She says the emotional distress led to depression.

Advice to those receiving a diagnosis based on a lab test for a dread disease: Verify the diagnosis. Many lab tests have high false-positive rates.

Browse for similar stories in our index at the very bottom of this page, or read another false positive story.

Thanks to the Associated Press for the source story on Dec. 4.

Tuesday, December 4, 2007

Evel Knievel: Hepatitis from a blood transfusion

Evel Knievel, the red-white-and-blue-spangled motorcycle daredevil, died yesterday at age 69. He had been in failing health for years, suffering from diabetes and pulmonary fibrosis, an incurable condition that scarred his lungs.

He had undergone a liver transplant in 1999 after nearly dying of hepatitis C, probably contracted through a blood transfusion in one of his 14 surgeries to repair bone-shattering spills.

Now the blood supply is safer, and hepatitis C from transfusion is less of a worry.

Advice to patients undergoing surgery: You or your patient advocate should double-check that the donor's blood type matches yours.

Browse for similar stories in our index at the very bottom of this page, or read another blood transfusion story.

Thanks to Mitch Stacy for the source story in today's Boston Globe.

She had lost custody of her children: Recovery from alcoholism

Jennifer Boeth Whipple, 53, is a journalist who arrived at Delray Beach, Florida, in the clutches of alcoholism in 1998. Jennifer said she "took to heart" during her third effort at rehabilitation – "that some people have to change their lives completely to maintain their sobriety."

She had lost custody of her children.

She stuck around in Delray Beach, following a carefully phased program known as the Florida Model, from residential treatment to a halfway house and a "recovery job" at Home Depot. Eventually she bought a condominium and worked for an art dealer.

For six years, she said, she "felt very safe here, surrounded by people who'd been through what I’d been through" – detoxing in the same roach-infested apartments, cycling through recovery centers familiar to New Yorkers, like Silver Hill or Four Winds.

Then a year ago, "after I'd gotten my sea legs," she returned to New York City, where her son lives with his father.

Advice to people struggling with a drinking problem: It might take more than one attempt to get and stay sober.

Browse for related stories in the index at the very bottom of this page, or read another Delray Beach recovery story.

Thanks to Jane Gross for the source article in the Nov. 16 issue of the New York Times.

Sunday, December 2, 2007

Blue flames shot up from her midsection: A surgical error

During her gallbladder surgery at a hospital on Boston's north shore four years ago, a flash fire ignited on the abdomen of Antoinette DiPhillipo.

Immediately after the gallbladder surgery, her surgeon had rubbed an alcohol-based cleaning solution on her abdomen to help prevent post-op infections, wiped it clean, and then decided to remove a mole there with a hot cautery instrument. Blue flames immediately shot up from her midsection – "similar to a flambé," the surgeon told the state public health investigators. The sterile draping also ignited.

Antoinette suffered painful first- and second-degree burns, even though Operating Room staff had quickly patted down the flames and pulled off the flaming sterile drapes.

All surgery is risky. Specify beforehand what your surgeon should and should not operate on.

Browse similar stories via the index at the very bottom of this page, or read another gallbladder surgery story.

Thanks to the Boston Globe for this story.

Saturday, December 1, 2007

A reassuring influence: Ambulance emergencies

While watching my son's track meet, I saw his friend Jay collapse on the field. I rushed over to help. Jay had been stung by a bee and was having a severe allergic reaction. Thankfully, he had an epinephrine injector with him. I identified myself as an RN, administered the epinephrine, and asked bystanders to call 911 and Jay's parents. He responded well to the drug.

Meanwhile, his older brother ran up and said that their parents weren't at the meet. As the coach tried to contact the parents, emergency medical technicians (EMTs) arrived. Both boys demanded that the older brother be permitted to ride with Jay to the hospital. The EMTs were reluctant, but the coach and I insisted that keeping the children together would help keep Jay calm.

Later, I learned that the parents felt I'd overstepped my authority by allowing the older brother to ride in the ambulance. Should I have done something differently?

Signed, A.W., Pennsylvania

Columnist Susan Salladay's Answer:

A family presence is calming in an emergency if the individuals are in control emotionally. In this case, it sounds as if the older brother was a reassuring influence and that keeping the boys apart might have added to Jay’s distress, so you probably made a good call.

Advice: In an emergency, a family member should go along in the ambulance.

Read one of our allergic reaction story, or read more from the source article in the November issue of Nursing2007 by Prof. Susan Salladay.