Have a Story to Tell? Had a medical error?

This blog is about patient safety, medical malpractice, staying healthy, and preventing future errors. Help & empower someone else, Teach a lesson, Bear witness, Build our community - Email us or call 781-444-5525.

Frustrated with a health problem?

Need an ally in your health crisis? Call 781-444-5525, or learn more.

Monday, March 31, 2008

She used her retirement savings: Gastric banding surgery

"I weighed 424 pounds in May 2004, before losing 250 pounds [from gastric banding surgery],”"said Sandi Henderson, a dark-haired woman in her 50s. Gastric banding restricts food intake through an elective surgical procedure in which a surgeon wraps a silicone band around the upper stomach. This creates a small pouch that limits food intake. After it's installed, the doctor makes periodic adjustments depending on the patient's weight loss, food craving, and physical reaction to the band. Patients typically need four to six adjustments in the first year, and two to three in the next two years or so.

Sandi swims every morning and has tossed out her old medications. "I put my food-addiction money toward shopping and exercise," she laughed. Since her insurance specifically excluded bariatric surgery, Sandi says she used some of her retirement savings to pay for the procedure.

Like any major surgery, gastric banding patients have a risk of infection and even death. The silicone device can shift after surgery, causing it to lose effectiveness, or erode into the stomach. No one knows how long it will last inside the body, so patients may eventually need another operation to replace or remove it. And some surgeons say the banding causes a smaller weight loss than do other procedures.

Advice to people looking to lose a lot of weight: Exercise will help keep off the pounds, even if surgery helps you lose a lot of weight quickly.

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

Thanks to Rhonda Rundle for the source story in the March 31 issue of the Wall Street Journal, "Industry Giants Push Obesity Surgery."

Saturday, March 29, 2008

In death, she has given life: An organ donor

Dr. Tan Bee Hooi, 37, an anaesthetist with the Penang Hospital in Malaysia, died in Paris on Wednesday following complications from surgery related to arteriovenous malformation (AVM) in her brain.

She had undergone treatment by a world-renowned interventional neuro-radiologist. The complicated procedure of the embolization of the AVM on March 11 went well but Dr. Tan's condition took a turn for the worse and she died on Wednesday due to complications from the follow-up surgeries.

Dr. Tan's father, Datuk Tan Gin Soon, believed that his daughter would have wanted him to donate her organs, given her "deep and abiding interest" to serve fellow human beings.

Her family has donated her organs, including her corneas, heart, kidneys and liver, to patients in France and other countries of Europe.

"She was truly a remarkable woman. Even in death, she has given life," said the Malaysian Ambassador to France, Datuk S. Thanarajasingam.

Advice: Write and sign a note card stating your wish to have your organs donated, have it witnessed, and keep it in your wallet.

Read an organ recipient’s story.

Thanks to the New Straits Times for the source article from today's NST Online.

Thursday, March 27, 2008

No better way to pay back the universe: A cancer survivor's story

During Thanksgiving weekend in 2005, Henri Engle's throat swelled up. Two weeks later, while watching a movie, he began coughing up blood. He finished the movie before going to the Emergency Room at Massachusetts General Hospital. They took him into surgery immediately, and he awoke in the Oncology unit, diagnosed with a very rare cancer – synovial sarcoma of the throat.

The tall 24-year-old went through four doses of chemotherapy over five months, and six weeks of radiation treatment, twice a day for five days a week. He had to be fed through a gastric feeding tube, and he lost 85 pounds.

Now, he's cancer-free, and at 175 pounds he's in the best shape of his life. How? He attributes his strength to workouts with cast-iron kettlebells – which look like cannonballs, each with a handle, and weigh from 10 to 88 pounds.

Henri encountered personal trainer Anthony DiIuglio, the owner of the first American kettlebell gym, in East Providence, Rhode Island, and began working out. He progressed rapidly under Anthony's guidance. Anthony is himself a cancer survivor. He works with patients while they are undergoing radiation, to offset the scarring and stiffening ("fibrosis") of muscle tissue that radiation can cause.

Henri’s progress prompted him to ask Anthony for a license to open his own Punch Kettlebell Gym. Henri opened the gym this week in Newton Centre, Massachusetts. With the gym, he says, "I get to help people doing something I enjoy – there's no better way to pay back the universe than that. Not everyone gets that kind of direction in life."

Advice: Take heart; people are amazingly resilient. Some find that cancer has led them to find their calling.

Read another inspirational cancer survivor story.

Thanks to Rachana Rathi for the source article in today's Boston Globe.

Wednesday, March 26, 2008

The chief medical officer made the error public: Wrong side kidney surgery

When doctors at a Minnesota hospital made a mistake by removing the healthy kidney from a cancer patient, the hospital system's chief medical officer made the error public. 
Accounts by the hospital place blame on a crucial error that happened several weeks before the surgery. Apparently the kidney on the wrong side was identified on the patient's medical chart as potentially cancerous.
 New procedures have now been put into place requiring the surgical team to verify sites using the diagnostic imaging before an operation begins.

According to news reports, 24 wrong site surgeries were reported to the Minnesota Department of Health between October 2006 and October 2007. That is two per month, just in Minnesota!
 These would have surely gone unreported but for Minnesota Governor Tim Pawlenty, who signed a bill requiring that hospital errors must be reported to the state.

Advice to surgery patients: Read your medical chart carefully beforehand, or have your patient advocate do so.

Read another wrong site surgery story.

Thanks to Frank Bailey and Sach Oliver for their source blog post on March 24 at the InjuryBoard, the blawg of their law firm.

Tuesday, March 25, 2008

You wouldn't think she needed surgery: Death from breast augmentation surgery

Stephanie Kuleba had a charmed life: captain of the varsity cheerleading squad at West Boca High School in Florida, a near-perfect grade-point average, Barbie-doll looks and a ticket to the University of Florida, where she hoped to start her journey toward becoming a medical doctor.

Her friends said she was "perfect," so when Stephanie died Saturday of complications from breast augmentation surgery, none of them could understand how the girl whose success in life "was a sure thing" could perish in such a strange and devastating fashion.

"She was a role model for a lot of people," said friend and classmate Vicky Goldring, 16. "She was incredibly smart. She wanted to help people. She was just a happy 18-year-old girl."

While no official cause of death was released by authorities or Stepanie's family, many of her friends said she suffered a severe reaction to anesthesia given to her during a breast augmentation procedure Friday night.

Paramedics were called to an outpatient surgery center in Boca Raton, Florida, and rushed her to a nearby hospital, where she died Saturday.

With her long blonde hair and shy smile, Stephanie charmed people from an early age, friends said. A talented athlete, her path toward cheerleading began with competitive gymnastics. At 11, she had placed first all-around at a gymnastic invitational event in Tampa, competing in bars, beam, floor and vault events.

She had brains to match her beauty, friends said, earning a GPA above 4.0, acing advanced placement courses and earning an acceptance letter from the University of Florida, where she planned to head after graduation, imagining a career as a doctor.
"If you knew her, you wouldn't think she needed that [surgery]," said a friend. "She's perfect."

In recent years, doctors have been performing an increasing number of procedures such as breast implants, liposuction and tummy tucks on young women and even girls as young as 14.

The enormous popularity of reality TV shows like Extreme Makeover have fueled the desire of adolescent girls to alter their bodies permanently, and they are finding more surgeons willing to oblige them. Breast implants and liposuction are now bestowed by parents as graduation or birthday gifts. Some doctors say they have performed breast augmentations on Baby Boomer mothers and their teenage daughters. From 2002 to 2003, according to the American Society for Aesthetic Plastic Surgery, the number of girls 18 and younger who got breast implants nearly tripled, from 3,872 to 11,326.
Among all age groups, cosmetic implants have skyrocketed in popularity, according to the American Society of Plastic Surgeons. Last year, according to the ASPS, about 247,000 women got implants for augmentation, compared with 32,000 in 1992.

Anesthesia is a way to control pain using medication. In rare cases, an allergic reaction to local or general anesthetic can create health risks or even cause death.

Advice to people thinking of surgery at outpatient centers: Ask who’ll give the anesthesia.

Read another breast augmentation story.

Thanks to Kevin Deutsch for the source story in the March 24 issue of the Palm Beach Post.

Monday, March 24, 2008

Reluctantly, he said the dentist had done a good job: Medical tourism

When Josef Woodman's father decided to fly to Mexico for a few months to have some restorative dentistry done, his son was horrified, and took the trip with him out of fear for his father's well-being, as well as to satisfy his own curiosity.

"My dad had isolated three clinics in the area of Puerto Vallarta that performed the procedure he needed, and had eliminated two of them rather quickly. At the third, a board-certified dentist performed work that, here in the States, would have cost about $24,000, for $11,000 including accommodations and traveling costs for a month."

"I've traveled for my own procedure – a $4,000 root canal that, in Cost Rica, cost about 25% less. There were many Americans in the waiting room. Upon returning home, I had my dentist check the work. Reluctantly, he said the dentist had done a good job."

The Joint Commission International (JCI) a US-based accrediting body that evaluates medical facilities overseas with a particular focus on state-of-the-art technology, has been accrediting hospitals overseas for about 10 years, and in 2002 there were less than 40 accredited hospitals. Now, there are more than 130.

Singapore alone receives 400,000 visitors a year as part of medical tourism, and most speak English. It seems to be a growing trend; about 200,000 Americans, and even more Canadians, travelled abroad for medical care last year.

Upon their return, Mr. Woodman had a new smile – and his son had a new focus for his writing. Now Josef has written a book, Patients beyond Borders [which I haven’t read yet] about medical tourism.

Advice to underinsured people needing expensive care: In considering medical tourism, do your homework about the quality of care.

Browse for related stories in the index at the very bottom of this page, or read another medical tourism story.

Thanks to Jaclyn Stevenson for the source article in the March 2008 issue of The Healthcare News of Western Massachusetts.

Sunday, March 23, 2008

He was stuck in quicksand: Building knowledge about multiple sclerosis

Todd Small was stuck in quicksand again. It happened, as always, at the Seattle machine shop where he worked. His shift complete, Todd was making the 150-yard walk to his car, when he realized that his left leg was sinking deep in the stuff. This happened nearly every day now. His Nikes still looked normal, firmly planted on the concrete floor. But he was stuck. His brain was sending an electrical pulse saying "walk," but the signal snagged on scar tissue where the myelin layer of insulation for the nerve fibers had broken down because of his multiple sclerosis. He felt up to his waist in quicksand.

Doctors usually treat this with baclofen, a muscle relaxant. Every day for 14 years, Todd had taken a 10-milligram pill. He explained, "My neurologist always told me if you take too much it will weaken your muscles. So I never wanted to go over 10 milligrams." It didn't seem to have that much effect, but he carried on as best he could.

He would have continued just as he was had he not logged on, last June, to a web site called PatientsLikeMe. There, he listed his symptoms and treatments, including other medications. The web site revealed that 200 or so other patients like him were taking a range of doses of baclofen, up to 80 milligrams, and are doing fine. "So it hits me," he recalls, "I am not taking nearly enough of this drug."

A few days later, he asked his neurologist to raise the dose; now he takes 40 milligrams daily. While his foot drop isn't cured, he no longer feels he's sinking into quicksand while walking to his car.

There are more than 7,000 Todd Smalls at PatientsLikeMe, with diseases like MS, Parkinson's, and AIDS. Each one contributes his or her experiences, and quantifies their dosages and symptoms. All this is compiled over time into bar graphs and progress curves, and it's all open for comparison and analysis by the patients.

These are not typical patients. They are co-practitioners who are treating their conditions and guiding their care, with their doctors – with profound implications. "People who use it will live longer; those who don't, won't," says Jamie Heywood, the co-founder of PatientsLikeMe. "That's evolution."

Advice to people with MS, Parkinson's, and AIDS: Consider using PatientsLikeMe. Discuss what you learn there with your doctor.

Browse for related stories in the index at the very bottom of this page, or read a story on an MS hero.

Thanks to Thomas Goetz for the source article in today's New York Times Magazine.

Saturday, March 22, 2008

Like I had never heard before: A dialysis rescue story

Temarie Lee's story:
About five years ago I went to the Humane Society. I stuck a finger in a cage to say "hi" to a chubby black cat. He took to me straight away!

Three years later, I had fallen asleep after dialysis, when my arm started bleeding. Tubbee put his front paws on my face and started meowing like I had NEVER heard before. He woke me up and I was able to stop the bleeding. Tubbee saved my life.

Advice: Pets can be lifesavers, in more ways than one.

Read another pet story.

Thursday, March 20, 2008

I don’t have any more leg to give: Wounded Iraq veterans

At the start of a House Veterans’ Affairs Committee hearing Thursday, the witnesses were asked to stand and raise their right hands to be sworn in.
But former Marine Cpl. Casey Owens lost both legs when he ran over two anti-tank mines in a Humvee on Sept. 20, 2004.

He didn’t stand.

And former Army Sgt. Edward Wade lost his right arm when his Humvee hit a roadside bomb Feb. 14, 2004.

He didn’t raise his hand.

But their stories convinced the committee that after a year of hearings, new laws, toll-free help lines and enhanced programs, troops and veterans still fall through the cracks of the military and Department of Veterans Affairs medical systems.
“Someone needs to reach back and find the people who have been lost over the last few years,” said Sarah Wade, who told her husband’s story because a severe traumatic brain injury has left him disabled.

Both service members showed examples of recent lapses in their care caused by rules and bureaucracy. Owens has yet to be fitted with a prosthesis for his right leg after enduring three surgeries to re-attach his femur muscle to the bone because it kept tearing.

The fourth time it tore — after having an additional three inches of thigh bone, nerve and muscle amputated in the third surgery — his VA doctor suggested the same surgery again.

When another doctor suggested a different surgery might work better for him, it took six months to get VA approval in Houston, compared with 72-hour approval for his previous surgery.

“It was very painful,” Owens said of the wait. “But I don’t have any more leg to give.”

He lost six months’ worth of rehabilitation, as well as time at school or work. He had to go back on pain medication, from which he had weaned himself. As he waited, his Tricare insurance was canceled as a result of a clerical error.
He was finally approved, Owens said, and the fourth surgery seems to have been successful. When he was ready to go off his medication again, he asked for a doctor’s supervision to help him through the withdrawal.

But the VA doctor was too busy, Owens said, and sent him to the substance abuse clinic — which sent him to a methadone clinic.

“I said I wanted to get off the drugs,” not go on methadone, Owens said. So he went to a different doctor with the help of a nonprofit agency and was off his meds within a week.

“Most of my care is from outside doctors,” he said. “I rarely see the VA.”
In fact, he’ll head to Oklahoma with the Wounded Warrior Program to be fitted with a prosthesis because VA scheduled him for only an hour of rehab per week and, when he complained, sent him to a civilian prosthetics specialist who said he didn’t have time to fit Owens with a device because he was swamped.

It took 18 months to finalize his VA claims, and he still doesn’t have copies of his military medical records.

Rep. Tim Walz, D-Minn., said Owens’ story made him ashamed. “I’m not even sure what to say,” he said. “Would it surprise you that VA officials have sat before us and said they don’t need any more resources?”

Madhulika Agarwal, chief of patient care services for the Veterans Health Administration, later testified that VA has increased its number of case managers, created the Federal Recovery Coordination Program in October for some injured vets, and is seeking funds for its volunteer respite program and foster home program.
The Wade family had issues similar to Owens.

“Ted was retired from the military before he regained consciousness,” she said. “Much of his treatment was by trial and error, as there was no model system of care for a patient like Ted, and there is still no long-term model today.”
Since his injury, he has been in seven facilities, his wife said. The blast that severed his right arm above the elbow also caused vision problems and left him with post-traumatic stress disorder.

“The amputee center at Walter Reed [Army Medical Center] are the only people who have been with us for the whole ride,” she said. “Ted’s care was very fragmental.”
She still doesn’t have his medical records, and she is fighting to appeal his disability rating so he can receive special compensation because he needs at-home care.

Meredith Beck, national policy director for the Wounded Warrior Project, said she hears similar tales all the time. She said the government needs to work on individualized care, rather than standardized care, and needs to make greater use of community resources rather than making veterans travel to VA facilities far from home for treatment.

“There’s a common misperception that all their problems are fixed now because their injuries occurred a while ago,” she said. “That’s why it’s so important to reach back and find those who still need help.”

Advice on the fifth anniversary of the Iraq war’s start: Elect a president who won’t lie us into a needless war.

Browse for related veterans’ stories in the index at the very bottom of this page.

Thanks to Kelly Kennedy for the source story in the March 17 issue of Navy Times.

Tuesday, March 18, 2008

She's attending first grade, and doing very well: Experimental treatment for a malignant brain tumor

Melanie Joy McDaniel was 9 months old in 2002 when her parents faced an agonizing decision. She had already had two operations for an ependymoma – malignant, progressive brain tumor - and doctors could not be sure they had removed all of the cancer. She needed more treatment, but standard chemotherapy offered little hope in exchange for its harsh side effects. And yet her parents knew that if they did nothing, the odds were high that the terminal cancerous tumor would return.

Doctors at Dana Farber Cancer Institute in Boston offered another option: an experimental treatment. Melanie's parents took a gamble, and signed her up. "It won't save her, but it may help other people," said Paul McDaniel, her father.

Recently, her father wrote to NY Times writer Denise Grady, "Melanie is now 7 years old, attending first grade, and doing very well. The doctors do not see any residual tumor in her brain. Their original diagnosis was that her tumor had no known cure."

The developer of the treatment, Dr. Judah Folkman, passed away on January 14. He used drugs strictly to fight the process by which tumors form new blood vessels to feed themselves ("angiogenesis"). The drugs, given orally in small frequent doses, included Celebrex, thalidomide, and two other cancer drugs. The approach is called metronomic, low-dose or antiangiogenic chemotherapy.

Advice to cancer patients: Remember that some experimental treatments really do save lives.

Read another brain tumor survivor’s story.

Thanks to Denise Grady for her source article in today's NY Times.

Monday, March 17, 2008

Meet the future: Brain enhancement

Ben's story:
I'm a high school student who took several smart drugs on the morning of my SAT and aced the Critical Reading section. Could I have done it without them? Maybe, but why bother? I don’t use amphetamines, being skeptical about their side-effect and addiction profiles, but the only reason I don't constantly use enormous amounts of clarifying supplements on a daily basis is the cost. I can only imagine that professionals are using the best and most expensive available. Not only have the substances aided me on tests and cleared up many a case of writer's block, they have made me more sociable and better at networking. Meet the future - safe, powerful, cognitive enhancement for the daily cost of a cup of coffee.

As Benedict Carey writes in the NY Times of March 9:
The public backlash against brain enhancement, if it comes, may hit home only after the practice becomes mainstream. Dr. Anjan Chatterjee suggested, "You can imagine a scenario in the future, when you're applying for a job and the employer says, 'Sure, you've got the talent for this, but we require you to take Adderall.' Now, maybe you do start to care about the ethical implications."

Advice: Go ask your mother.

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

Thanks to the source comment on the news blog web site of the Chronicle of Higher Education.

Saturday, March 15, 2008

Silicone Breast Implants: Platinum Suzy's story

I worked for a national real estate company as a District Manager for nearly 19 years. I started with them in Houston, was transferred to Richmond, VA, then to Orlando and eventually to Nashville, where I have lived for the past nine years. In December of 2004, I was informed that all of my properties were going to be sold and that I would be laid off effective 5/1/05. This was fine. I was building a house and very busy with my son and my elderly parents, so the timing was very good for me personally. I had planned to take off the remainder of 2005 and return to work 1/1/06. I was turning 50 in November and my present to myself was breast implant surgery. I contacted a local teaching hospital and was told that they were having a clinical trial for silicone implants. When asked if they were safe, I was told that they had used them for 30 years and had never had any problems. I signed up, paid the $6,000 and had the surgery on 11/9/05.

Almost immediately I began to have unusual health symptoms. These included: neck, back and left shoulder pain, ringing in ears, dizziness, problems with depth perception, blurred vision, achy joints, fatigue, heart palpitations, memory problems, insomnia, tingling/numb hands and feet, twitching muscles, difficulty swallowing, and a metallic taste in my mouth. Prior to this, I had experienced only one of these symptoms - back pain resulting from a volleyball injury.

I spent all of 2006 getting sicker and sicker and more desperate to find out what was happening to me. Every day I would wake up with something new terribly wrong. By July I was terrified that I was going to die. I spent all my time in bed or in doctors' offices. At one point, I called my daughter and asked her to take my 12-year old son if something happened to me. I had never been ill like this before and never had to consult a specialist for any of these symptoms. The pain in my neck was so severe that I had cervical fusion performed on 8/2/06. Every doctor I was seeing and every physical therapist advised against this surgery after reviewing the results of the MRI's, but I felt this was the only option I had. Unfortunately, they were right. This surgery did not alleviate any of the symptoms I was having.

Sometime in September, my breasts began to ache and became hard. I visited my primary care doctor and my OB-GYN of eight years and they confirmed that I had developed contracture of the silicone implants. They were removed on 9/29/06. I never considered the problems to be connected to the silicone implants because I had saline implant surgery in November, 1995. I had no problems with these-no contracture, but I thought I needed to have the saline implants changed out because there was some rippling on the sides of my breasts. (I am on the thin side and the edge of the implant could be felt). Within a few weeks of the explant surgery, many symptoms were gone. By six months, all symptoms were gone with the exception of severe neck and thoracic back pain (which I still have every day and continue to do physical therapy for) and cognitive/memory issues that my doctor believes is due to the trauma of being so ill during the time I had the silicone implants. (Post Traumatic Stress Disorder is the diagnosis.)

Two doctors at the same medical facility have told me that I had a reaction to the chemicals in the implants. Although I do not fully understand the process that made me sick, I believe that my symptoms were caused by nerve inflammation due to exposure to the chemicals in the implants. I was tested for platinum and it was found in three different oxidation levels-0, +2 and +4 in my urine. I have asked INAMED for a list of the other chemicals, but they did not respond to my certified letter.

I have spent about $30,000 for the privilege of participating in the silicone research trial, the explantation, MRI's, and over 100 office visits to diagnose and treat my health problems. I am also uninsurable as a result of the treatments I have received.

However, the good news is that the vast majority of women get better once the implants are removed.

Advice to women thinking of having breast implants: Be sure to do your research first.

Read another of our breast implant stories.

Thursday, March 13, 2008

Seventeen doctors for shortness of breath: Unnecessary services

Dr. Sandeep Jauhar's story:
I recently took care of a 50-year-old man who had been admitted to the hospital short of breath. During his month-long stay he was seen by a hematologist, a endocrinologist, a kidney specialist, a podiatrist, two cardiologists, a cardiac electrophysiologist, an infectious-diseases specialist, a pulmonologist, an ear-nose-throat specialist, a urologist, a gastroenterologist, a neurologist, a general surgeon, a thoracic surgeon and a pain specialist.

He underwent 12 procedures, including cardiac catheterization, a pacemaker implant and a bone-marrow biopsy (to work up chronic anemia). When he was discharged, follow-up visits were scheduled with seven specialists.

Expert consultations had sprouted with little rhyme, reason or coordination.

Doctors are usually reimbursed for whatever they bill. Where doctors are paid piecework for their services, if you have a slew of physicians and a willing patient, almost any sort of terrible excess can occur. As reimbursement rates have declined in recent years, most doctors have adapted by increasing the quantity of services. The culture in practice is to grab patients and generate volume. Doctors are doing too much testing and too many procedures, often for the sake of business.

Advice: Ask, or have your patient advocate ask, about the value of an uncomfortable or painful procedure before it is performed.

Wednesday, March 12, 2008

More like an artist’s retreat than a treatment program: the communal GROW house

Bruce's story
The world where he was born, then where he was beaten and raped by relatives, did not invite him to open up. Understandably, he did not learn to communicate his true emotions in his family's abusive home. So early on, Bruce made a variety of survival adjustments. As a child, he learned to block out his pain by talking to an imaginary friend. When he joined the Navy at 17, right at the end of the Vietnam War, he was quickly introduced into drinking and getting high. The alcohol and drugs provided him with welcome relief from his psychic wounds. He couldn't just drink a little; he had to drink until he fell down, which led to a serious motorcycle accident. He was pronounced dead at the scene by paramedics, resuscitated, pronounced dead on arrival at the hospital, and brought back to life once more. After he recovered physically from the wreck, he decided to deepen his recovery by attending AA.

Bruce soon became a drug and alcohol counselor and got a Bachelor's degree, but the more he counseled others for their addictions, the more his own unexamined mental illness became apparent to him. His powerful capacity for denial, reinforced by his role as a mental health professional, allowed Bruce to ignore his worsening symptoms. After three suicide attempts and florid hallucinations and delusions of being possessed by demons, he ended up in a state hospital, where he heard of GROW.

Bruce went to a few GROW groups after his discharge from the state psychiatric ward. From his sporadic attendance, at the groups, he knew he needed to learn to be honest, to argue, and to disagree.

"I've got a lot of head knowledge," he said, pointing his tattooed, ropy arm to his head and chest. "But I've never been able to get it from my head to my heart."

Beaten into submission by mental illness, Bruce was willing to make the necessary sacrifices to find stability. Part of the GROW organization included a communal home, where people like him could live together and support each other in their suffering. He decided he was ready to take direction from someone else and willing to give up his privacy. He made his way to the GROW house.

It housed a nontraditional family. Its residents were all adults, unrelated to each other, who shared the burden of mental illness and the need for a place to call home.

He credited the balance of work, play, rest, eating and studying inside the community for the healing he experienced. AA meetings alone were not enough. Once he moved into the GROW house, Bruce learned how to handle himself maturely and began to generalize his new way of being to the larger community. Before GROW, Bruce could not keep a job because his living arrangements did not provide enough psychological safety to keep his overwhelming childhood memories at bay. Unexamined wounds resurfaced, and he would not show up at work, or he would fly into a rage if he got frustrated. Complete and honest disclosure was the norm for GROW residents, so Bruce never felt ridiculed or stigmatized for baring his soul. Residents talked about their illnesses in everyday terms, staying away from clinical labels.

"I learned to go by what I knew, not what I felt," Bruce explained, quoting GROW's own phrasing. "So instead of raging on a piece of equipment I couldn't fix, I remembered that I could do it after I calmed down."

The GROW house was more like an artist's retreat than a treatment program. People went there to retreat from the outside world and to work on their masterpieces: their own lives. The communal aspect of their daily interactions with other residents had more in common with writing workshops, where artists give each other feedback on ways to improve their respective work, than with the counseling of a therapeutic authority.

Bruce was surprised by how well people got along in the house, considering they were always in each other's company. People were at once able to follow a familiar routine and to cope with unexpected changes. Bruce found the daily household routine to be a reliable support, a guardrail that kept him on the road to rehabilitation, away from the pathological extremes of paralysis and extreme change. That link people felt with each other inside the house as they completed everyday tasks together was very spiritual to Bruce. The subtle levels of mutual support achieved inside the GROW house started with physical proximity and shared routines.

Advice: Find a supportive healing community for family members with severe mental illness.

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

Thanks to Leonard Jason and Martin Perdoux for the source story in their book, Havens: Stories of True Community Healing.

Monday, March 10, 2008

They got into the business sideways: Recovering physicians in addiction treatment

[Recovering physician] addicts increasingly encountered one another at ASAM events. One talked about a late 1980s review course for ASAM's certification exam where there was an AA meeting of the hotel hosting the event:

"There were probably 150 of us in that course…So I showed up for [the AA meeting], being a recovering person myself, and almost everyone from upstairs was downstairs. Out of the 150 who were there [for the review course], I would say there were about 120 in that [AA] meeting, which was a real eye-opener. So the first five or ten years that I was doing this, most of the other doctors that I talked to were like me – they were just old drunks who sort of got into the business sideways."

Like Dr. Douglas Talbott himself, the graduates of Talbott’s impaired physicians program (the Disabled Doctors' Plan] were inspired by their own recovery from addiction to reorient their careers to care for other alcoholics and drug addicts. "These people came out bonded into AA," said an addiction treatment expert familiar with this history. "And many of these people – surgeons, obstetricians, anesthesiologists...internists, family physicians – decided that they wanted to work in the field of addiction." Years later Talbott himself wrote that "most [state-run treatment] programs were initiated by physicians who were in the recovery phase of their disease."

Another physician in recovery recalls that there were "anesthesiologists galore…[and] a handful of…pathologists who didn't deal with 'live ones' at all. We even had a couple of forensic pathologists which I thought was great sport. Can you think of better people to be counseling you? But there they were. So it's been a grand hodge podge."

Help others who are making the same mistakes you made.

Browse for related stories in the index at the very bottom of this page, or read another impaired physician story.

Thanks to Dr. Christopher Freed for the source article in the Spring 2007 issue of Contemporary Drug Problems.

Sunday, March 9, 2008

I feel like a movie star: Medication reminder nurses and aides

Ida Canapp insists she would take her five medications and two vitamin pills every day whether or not a nurse's aide came to her Parkville, Maryland home to monitor her. But her niece, Renee Gowland, knows this is the dementia talking. "She wouldn't take them. Or she wouldn't know if she was taking the a.m. or p.m. doses."

At 82, Ida is energetic, hospitable and fiercely independent, with the help of Aricept, a drug that tempers the effects of mild to moderate Alzheimer's Disease. Ida needs to take medicine for her diabetes, high cholesterol, high blood pressure, and depression, and it’s hard for her to take them all at the right time.

Without assistance from an elder care group called Senior Helpers, based in Towson, Maryland, Ida would probably have to give up her home, where she has lived for more than 50 years, and move to an assisted living facility or nursing home, her niece said.

Through the MedServ program, Senior Helpers sends a registered nurse to manage Ida's medicine-taking. The nurse fills marked pill boxes every two weeks with Ida's medicines. She monitors the prescriptions and communicates with Ida’s pharmacy and doctors. An aide comes daily to fix meals and run errands with Ida, and reminds her to take her pills when appropriate – and watches her take them.

With so many people checking on her well-being, Ida says, "I feel like a movie star."

Her niece says this helps Ida "because she can stay here, she can go where she wants to go, and can do what she wants to do."

"About 23% of nursing home admissions is due to to mismanagement of medications," says Dr. Joan Chang, medical director at Good Samaritan Nursing Center. "Because people don’t have that social support, they don't have the means of ways of getting their medication taken appropriately, so they have to go to some kind of assisted living, where someone is there to help."

Advice to family members of forgetful seniors: Finding a way to help them keep taking their medicine might keep them out of a nursing home.

Browse for related stories in the index at the very bottom of this page, or read a story on use of multiple drugs by elderly people.

Thanks to Tanika White for the source article in the March 9 issue of the Baltimore Sun.

Saturday, March 8, 2008

I feel like I will be the most educated patient: Bariatric surgery

From “Aquameliza,” age 38:
My PCP has given me a referral and I have my first appointment with my surgeon (Dr T at BWH in Boston) on 2/27/08. I cannot wait, but am terrified of not getting insurance approval. I have Harvard Pilgrim HMO - the plan and my employer allow for bariatric surgery and do not appear terribly strict on the requirements, but becuase I want this so badly, I am sure that something will prevent me from getting approval.

I have been thinking about this surgery for more than 5 years. A girlfriend went to Mexico to have it done then and watching her lose weight effortlessly made me soooo jealous. However, I also watched her gain weight back because she did not get fills or follow any program or get any real support. I learned from her that the only way to do this is to do it all the way and follow whatever they tell me to do. Another friend had it done at the same hospital with insurance coverage 2 years ago and looks great. Finally, my father was banded in January and for a man who could never lose weight- he has lost 26 pounds.

I feel like I will be the most educated patient - I read everything there is to read, have watched the surgery on the web and have discussed this with my therapist. Honestly, I do not know what I will do if I am turned down. I can't even think about it - the idea of starting ANOTHER diet makes my stomach hurt and my head ache. I cannot walk into another Weight Watchers Week one meeting - or eat any more cabbage soup or try any more pills - I have even bought ones not approved by the FDA from Hong Kong - how crazy is that???!! Diets have been nothing but bad for me- I lose 20 pounds only to gain back 25. Aurgh!!!!

I guess I am writing to see if anyone else went through this or is going through this same thing now. I feel a little obsessive and do not like that - I wish I could stop thinking about it, but I feel like the next stage of my life is on hold until I get the thumbs up and have a surgery date.

Anyone else ever feel like this??

Advice: Become a thoroughly educated patient before undergoing any elective surgery.

Browse for related stories in the index at the very bottom of this page, or read another _elective surgery story.

Thanks to Aquameliza for the source, her comment at lapbandtalk.com

Friday, March 7, 2008

Both complaints accused him of the same error: A fatal drug interaction medication error

Laura Migliano had herniated a disk in her back while doing sit-ups back in 1994. She spent a decade fighting the pain — with surgery, steroid injections, and finally with a battery-powered spinal cord stimulator. The stimulator helped, reducing the ache with electric shock. But then the battery died. Laura, who was 41 years old by that time in 2004, was in agony when she saw a pain specialist in Mesa, Arizona.

It turned out she needed only a battery change. But the doctor couldn't replace the battery for another six days, so he prescribed painkillers. Although a nurse by profession, Laura had no idea that the doctor's prescribed dosage of methadone — a narcotic usually reserved for heroin addicts trying to kick the habit — could interact with her other painkillers and kill her.

It did.

In his notes, the doctor wrote that Laura should take five to 10 milligrams of methadone. But on her prescription, he wrote 120 milligrams — a fatal dose when combined with her other medications, which he had never determined before writing the prescription.

Laura drove to the pharmacy and filled the prescription. Then she went home and drank the pills down with a large glass of water — just as the doctor ordered. She was expecting relief from her lower-back pain.

Instead, her best friend found her dead the next morning.

Within 30 days of her death in 2004, the state medical board received two more serious complaints against the same doctor. Both accused him of the same error that had killed Laura — prescribing narcotics without learning what drugs his patients were taking and failing to document their visits.

Advice to patients on pain medications: Verify that your drugs will not dangerously interact with each other by using the free drug interaction checker under our Resources and Links section.

Browse for similar stories in our index at the very bottom of this page, or read a celebrity’s drug interaction story.

Thanks to John Dickerson for the source story in the Phoenix New Times News of March 6.

Thursday, March 6, 2008

Patients like me are part of the problem: Hospital aesthetics

Virginia Postrel's critique of hospital aesthetics:
One of the bleakest rooms at the UCLA Medical Plaza, where I spend my time [as a breast cancer patient], is a waiting room in the imaging center. Small and beige, it epitomizes aesthetic neglect, with stained chairs, mismatched tiles, and tattered copies of US News and World Report. The only wall art is a drug-company poster on myocardial perfusion imaging – just the thing to comfort anxious patients.

Patients like me are part of the problem. When I was diagnosed with breast cancer, I didn't shop around for the most attractive chemotherapy clinic. I went to the best oncologist I could find and got the room that came with him. "Most people would take the most competent clinicians even if they were in the worst possible environment," says Jain Malkin, a San Diego-based interior designer and author of several reference books on healthcare design.

But why assume good medicine must come with bad design? "Evidence-based design" is the great hope of professionals who want to upgrade the look and feel of medical centers. A seminal article by Roger Ulrich described the health outcomes of patients in different kinds of hospital rooms. Ulrich looked at patients recovering from gallbladder surgery. He matched the patients to control for factors that might affect the speed of their recovery, like age and obesity. Patients with a view of a grove of trees had shorter hospital stays and required significantly less expensive pain medication than patients whose rooms only gave them a view of a brick wall. Other studies have found similar positive effects from sunny hospital rooms, and rooms with images of nature on the walls.

Advice to family members of hospital patients: Bring soothing pictures and plants to the hospital room.

Browse for similar stories in our index at the very bottom of this page.

Thanks to Virginia Postrel for the source story in the April issue of the Atlantic Magazine.

Wednesday, March 5, 2008

Illegally writing prescriptions to himself: An impaired physician in long-term recovery

He had five knee operations, and by the late 1970s he was treating his constant pain by illegally writing prescriptions to himself. Dr. Michael Palmer became hooked on painkillers and was drinking heavily. In 1978 he was arrested for writing false prescriptions, was put on probation, and had to surrender his right to prescribe narcotics for two years. For nearly a year, he didn't work at all.

Then, he says, "a group of doctors with problems similar to mine mentored me and helped me. By the end of the 1970s I was in solid recovery, and by 1981 I began to reach out to find doctors I could help. It coincided with the beginning of writing [novels]. In retrospect, having a book to write was one of the things that kept me sane."

After his first novel was published, he left private practice to serve in the Emergency Room at the Falmouth Hospital, where he worked for the next ten years. He volunteered to work with the "Impaired Physicians Committee" of the Massachusetts Medical Society. In 1993, around the time its name was changed to Physician Health Services, he left the E.R. and began to work with troubled doctors nearly full-time.

He explains, "It seemed to me that I was put on earth to take care of people. This is what I should be doing, and I never got tired of it."

Advice to people struggling with tough health or personal problems: See if writing, and helping others who have your problems, helps in your own long-term recovery, as it has for Dr. Palmer.

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

Thanks to David Mehegan for the source story in the Feb. 23 issue of the Boston Globe.

Monday, March 3, 2008

The FDA had violated its own policy: Adverse drug reactions from defective heparin

Baxter International announced recently that it is recalling virtually all its heparin products. Baxter makes and sells more than 500,000 multi-dose vials of heparin in the U.S. each month. Heparin is used to prevent blood from clotting during dialysis and some common forms of heart surgery.

More than 400 adverse reactions have already been reported in the US from the use of heparin, including up to 21 deaths. Investigators are trying to identify the root cause, which seems related to the practices of small Chinese suppliers of crude heparin.

To make heparin, workers collect and cook the mucous membrane from the intestines of slaughtered pigs, producing crude heparin. Major producers refine that and sell it to Baxter and others, which make the finished product for use in hospitals.

Blue ear pig disease has swept through China, depleting stocks, and leading some farmers to sell sick pigs. This led companies to switch to using small, often unsanitary and unregulated village workshops as less expensive suppliers. As much as 70% of China’s crude heparin now comes from such small factories in poor villages.

The FDA had admitted this month that it had violated its own policy by failing to inspect Changzhou SPL, located west of Shanghai, before the factory began shipping crude heparin, an ingredient of the medicine heparin, in 2004. The Chinese government does not inspect such factories.

Advice to heart surgery and dialysis patients: Ascertain, or ask your patient advocate to ascertain, the source of the heparin you will receive. A sufficient supply is available from safer suppliers.

Browse for related stories in the index at the very bottom of this page.

Thanks to Walt Bogdanich and David Barboza for the two source articles in last week's NY Times.

Saturday, March 1, 2008

He used an alias: A lawsuit on John Ritter's misdiagnosis

When actor John Ritter checked into a Burbank, California hospital the day he died, he used an alias, "Edwin Marcus," to protect his privacy. He died of an aortic tear, which might have been diagnosed by an X-ray. His widow, Amy Yasbeck, is suing two of the doctors who treated him, saying they misdiagnosed his condition, and did not order an X-ray. The doctors' attorneys say the name change created confusion at the hospital, for which John is responsible.

John Ritter was 54 years old when he died of an aortic tear in 2003. His widow is seeking $67 million in damages.

Advice: Patients using aliases, or their advocates, should carefully track their care against the hospital's checklist to ensure all necessary physician orders are performed.

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

Thanks to ContactMusic.com for the source story yesterday.