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Thursday, July 31, 2008

I’m sooooo beat up: An overworked nurse's medication error

I've been an LPN for a month. I made a med error this week...Gave .50 mg of Ativan instead of .25 mg. Devastating.

On top of that, I was called into the ADON's office to see how they could help me from having so much overtime on my charting.

I'm soooo beat up. I have 40 residents to care for, and I had CNA's that were gone during the 6am med pass to leave me alone with my residents taking them to the bathroom, etc...They didn't ask to break, and if they had, I would have asked them to wait until my meds were passed.

I try hard to allow as many breaks as possible. I try to help them, because I know what it was like being a CNA...needing help and not getting it...

Here I am...

Med Error, Overtime...

I feel I already take too many "short-cuts" for a new LPN to be taking, and some of the things that go on on 3rd shift...that we are "taught" to do...I won't do anymore. It's not worth it to lose my license.

I hope it is not too late for me.

Advice to people needing to go into the hospital in July or August: Bring a patient advocate, as the new crop of residents has just begun work.

Read another story of an overworked nurse.

Thanks to LookingBeyond [no name given] for the source blogpost today at allnurses.com/forums.

Tuesday, July 29, 2008

He needed surgery again: A settlement for a defective artificial hip gets justice for one, but no registry for all

Months after his hip replacement, "the pain was grabbing me around the back," said Stephen Csengeri, a 54-year-old lawyer from California. He needed surgery again because of the pain. He has reached an undisclosed settlement with Zimmer Holdings, the maker of his metal hip socket.

His orthopedic surgeon, Dr. Lawrence Dorr, realized that Stephen was one of many hip replacement patients with the same problem. Dr. Dorr contacted the device's manufacturer. X-rays showed the socket was separating from bone, rather than fusing with it. For patients, who had been told their new hips might last 15 to 20 years, it meant agony as the metal cup moved around in the hip socket and rubbed against bone.

One doctor told Dr. Dorr, "If ever there was an example of why we need a registry [recording all patients’ hip appliances], this is it." A registry is a database of each patient, the brand, model and type of appliance implanted, the surgical technique used, the doctor, and any subsequent replacement. Orthopedists in Sweden and Australia have used such registries to learn of systematic problems with particular devices. But there is no registry in the U.S. As a result, there is no systematic way for the public to know of patterns of problems.

Advice to joint replacement patients: Look into the devices beforehand on domestic and foreign registries and on the Internet.

Read another medical device lawsuit story.

Thanks to Barry Meier for the source story in today's New York Times.

Sunday, July 27, 2008

I am downright annoyed with my diabetes: Self-care

Motivation Consternation
I don't know about you, but I find that the novelty's wearing off. After nearly three years of continuous carb counting, fingerstick checks, pills, injections, lab tests, prescription woes and doctors' appointments, I am officially DOWNRIGHT ANNOYED with my diabetes. I find myself wondering how the veterans do it. How do you "keep up the good work" as your diabetes care drones on and on over weeks, months, and years?

Seems like it's quite natural to go through up and down phases, for sure. But even with the most diligent of care, diabetes can be terribly unpredictable. And often our test results just don't seem to show improvement. Don't you just want to scream? Or give up?

But of course we must soldier on. It might help to examine these feelings more closely, and there must be some proactive things we can do to kick-start our motivation every so often.

Failure & Burnout

Feeling like a failure? You are not alone. Some of the most motivated, well-informed diabetics I know are still asking themselves, "What am I doing wrong?" because their blood sugar levels aren't in "perfect range." I must say that if I learned anything from my endocrinologist, it was that "sometimes the magic works, and sometimes it doesn't." When we have bad diabetes days (or weeks), we just have to pick ourselves up and move on.

But of course, there's a boatload of guilt associated with less-than-optimal care. Maybe you've been ignoring your diabetes or struggling with it for many years, and feeling pretty crummy. And all the negative headlines about diabetes and heart disease, gum disease, kidney damage, blindness, etc. certainly don't help your incentive.

I know people with other illnesses have to be diligent, too, but I strongly believe that no other disorder requires such intense, round-the-clock attention and motivation as diabetes does. It can really grind you down. Like Dr. William Polonsky, author of the book "Diabetes Burnout" says, "In order to get everything right all the time, you'd have to be a 'Professional Diabetic.' You'd never have time for anything else…

So you have to find a balance between making an effort for good control and having a life."

A New Toy, or Study Me

Sometimes a new gadget or treatment can really make a difference. I've met quite a few Type 1 diabetics who either get themselves a new meter or new pump periodically, or sign up for clinical studies on a regular basis. Ideally, the new gadget makes a significant improvement in your quality of life. For example, I was delighted when I got the FreeStyle Flash glucose meter, because it requires just a tiny blood drop, and it's small enough to fit into a cute, fashionable purse (instead of that suitcase I'd been carrying)!

Another gal I know was delighted with the MultiClix Lancing Device because she finds it painless and convenient (pre-loaded lancets mean less waste and carrying load).
Being part of a clinical study means your health gets lots of extra attention, both from yourself and from the medical professionals running the study. Added benefits are free stuff – the sponsoring company pays for supplies and exams – and the knowledge that you are helping the diabetes community and further generations by fostering important research. Some people find they get their best care and motivation under this kind of close scrutiny.

Amy Tenderich’s Advice:
It's worth asking your CDE (Certified Diabetes Educator) about new products and research opportunities (those without any serious health risks).

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

Thanks to blogger Amy Tenderich for the source story at DiabetesMine.com

Friday, July 25, 2008

So I might as well do it: Pan-Mass Challenge

Rebecca Hopkins, now a junior at Salve Regina University in Newport, Rhode Island, has survived a brain tumor, surgery, chemotherapy and radiation. She will be one of 5,000 bike riders next week in the Pan-Mass Challenge, the annual 192-mile bike ride to raise money for the Dana-Farber Cancer Institute.

She will ride in honor of her doctor, Samuel Blackman, who treated her when she was a teenager.

"To be able to help people and give them a better life, that's great," she said. "It's something I can do, so I might as well do it."

She was first diagnosed with cancer at age 11. Part of her brain tumor was removed, but began to regrow in a few years. After radiation, she is now virtually symptom-free.

Dr. Blackman says, "When you save a pediatric patient, you don't just save a life, you save a future. Rebecca and her fight are proof positive of that. This is a person who I know is going to make a difference in this world."

"We have the cachet of being the Tour de France of charity events," said Barry Starr, the founder of the fund-raising event.

Advice to cancer survivors:
Keep on truckin’. And bikin’.

Read about another Tour de France cyclist and cancer survivor.

Thanks to Adrian Walker for the source article in today’s Boston Globe.

Thursday, July 24, 2008

I'd land at the hospital again, if not for this: Telemonitoring

Mariano is 87 and lives in a suburb of Boston. He struggles with "a few health problems – heart failure, glaucoma, and I know I have some [heart] ventricles that are not functioning properly."

He's one of five million people who are living with heart failure. It's a chronic, life-changing condition that impacts his whole family. His daughter Michele visits frequently to help take care of him.

"Everybody in that position knows it's difficult," he says.

After his most recent hospitalization, he came home with a new type of helper. "I'm being checked every day by nurses, at headquarters, I presume. The nurse contacts me separately. If I put on a pound or two, I get a call, sure as heck. That helps so much! I'd land at the hospital again, if not for this."

He's a participant in the Cardiac Connect Program at Partners Healthcare, which was designed for people with heart failure. It brings state of the art equipment to homes, to help monitor heart conditions daily.

"What's important for cardiac care is what patients do daily at home. Telemonitoring is a great tool," according to Dr. Stephanie Moore. "What's important is NOT what is in the 20-minute office visit, and what they say they're doing, but what they're really doing at home."

Patients use the equipment at home to monitor their heart rate, oxygen levels in their blood, and their weight. They answer a few questions about how they're feeling, which takes a few minutes, and that's transmitted electronically to the Home Care program's nursing station.

"The system identifies any problems, and we'd call those patients immediately," says nurse Susan Leonard.

They might ask, "I've noticed your weight has gone up by two pounds. How are you feeling? Did you have a lot to eat with sodium yesterday?"

Mariano's daughter Michele says, "It make me feel comforted that he can operate it himself and knows what ranges he should fall in."

He says, "It created a little more confidence. Once the machine is gone, I'll do my best to carry on, since I know the Why's, and the If's, and the Don'ts."

Advice to people with serious chronic illnesses:
Ask your insurer and doctor what kind of ongoing help they can give you.

Read a story on the role of education in coping with chronic illness.

Thanks to the Center for Connected Health for their source video.

Wednesday, July 23, 2008

Without getting out of my chair: A medical home

Robert Williamson, a 60-year-old Philadelphia resident, recalls the cursory exam he received a few years ago from a harried doctor who missed seeing some danger signals, and sent him home. Robert had a stroke a short time later. He had to stop working as a customer service representative, and go on Social Security disability.

Missed diagnoses like these should occur more rarely with his new doctor. "I give him my heart and diabetes readings by email and phone, without getting out of my chair," Robert says. "I can get better directions, at the very moment I need them. It's life-saving."

Some of the area's largest insurers are conducting an experiment with 100 physicians. In addition to paying for office visits, the insurers are paying the medical groups to keep better track of their patients by phone and email. The doctors are encouraged to hire additional staff to monitor patients' treatment and follow-up, and send reminders for mammograms, colon exams, and other forms of early detection. Robert's doctor has hired a patient educator and has acquired supporting technology.

This model of primary care provides a "medical home" where doctors, patients and families will ideally pull together as a big, happy family. Insurers are studying whether this will lower their costs and improve patient satisfaction.

Advice: Ask your primary care physician whether he or she can contact you proactively and regularly about follow-up care and upcoming appointments for early detection.

Read another story on how a more modern doctor's office feels to a patient.

Thanks to Milt Freudenheim for the source story in the July 21 issue of the New York Times.

Tuesday, July 22, 2008

Is it better to bring 8,000 individual cases?: Pathology errors in breast and prostate cancer biopsies

Patients impacted by a misdiagnosis and the quality of service at the Miramichi Regional Hospital will file a class-action suit on Tuesday.

Halifax lawyer Raymond Wagner will file the proposed lawsuit in Miramichi on Tuesday. It is available to any patients who had a biopsy or other procedure at the Miramichi Regional Hospital between 1995 and February 2007, regardless of their test results.

"They suffered great mental distress, frustration, and needless anxiety while awaiting confirmation that the original results were correct," he said.

The province is reviewing more than 23,700 cases from the hospital dating from 1995 to 2007 while a public commission is examining the rate of breast and prostate cancer misdiagnoses.

An independent audit of 227 cases of breast and prostate cancer biopsies from 2004-05 found 18% had incomplete results and 3% had been misdiagnosed at the health authority in northeastern New Brunswick, which was being served by a now-suspended pathologist.

Filing a lawsuit will hold the system accountable, Wagner said, adding that arguments revolve around allegations of negligent hiring and poor quality control at the pathology department.

"The suit of course is to assist the people in the community surrounding the Miramichi with respect to their health care," he said. "It is to bring to account the hospital administration with respect to oversight and quality control and to assure the community that their health care is of sufficient quality for them to have confidence in that health care."

A judge will have to decide if the suit will go ahead, which will involve testing whether the lawsuit is the most efficient way to proceed, Wagner said.

"Is it more appropriate and more efficient to have the case determined in one case, or is it better for everybody to bring their own individual cases, in other words 8,000 cases?" he said.

The Halifax law firm, Wagners, is working in co-operation with Newfoundland and Labrador firm Ches Crosbie Barristers.

Advice: Pathologists have to use very subjective judgments in assessing biopsies. Ask the pathologist how certain s/he is about the findings of your biopsy.

Read another Pathology error story.

The source article comes from a posting today on the Canadian Broadcasting Corporation's website.

Monday, July 21, 2008

More days happy than in the blues: A coach for diabetes care

Maria is a 66-eary-old Hispanic woman with diabetes. She receives her primary care at Massachusetts General Hospital's Chelsea health center. At her last visit in June of 2006, Maris had far too much glucose [sugar] in her blood; her hemoglobin HbA1c was 12.6, far more than a normal level of about 7. Her doctor referred her to a diabetes "coach," a multilingual, bicultural layman trained to identify barriers to care management and to assist patients in addressing barriers.

After several counseling sessions, the coach learned that Maria was taking one of her medications "only when I feel my blood sugar is too high," and was not taking her other medication at all because "it makes me dizzy." Maria was overweight, and ate a lot of rice, bread, pasta and other carbohydrates, and foods high in cholesterol like pizza, pork, meat, and fried food. She would not eat at all when she felt that her blood sugar was elevated. She was not exercising and reported often feeling depressed and "in the blues."

After working with the coach, Maria began taking both of her medications regularly and eating better. She cut down on carbohydrates and started eating more vegetables and fruit. She also ate more frequently in small portions. Due to her arthritis, exercise was a challenge for Maria, but she managed to walk 20 minutes on most days. In just a few months she lost 30 pounds. After 11 sessions with the coach, Maria felt very pleased with her progress, she is more confident, and has "more days happy than in the blues." When last seen by her coach in December, Maria's hemoglobin HbA1c had fallen to 7.7.

Advice for people with diabetes or another chronic health issue: ask your insurer to assign you a health coach.

Read an athlete’s diabetes story.

Thanks for our source, the 2006 Annual Report on Mass General's Community Benefit Program.

Sunday, July 20, 2008

An hour after being discharged from the Emergency Room: A family physician's conflict of interest

Question for the Ethicist:
I am a family physician. A patient I'd not seen in months passed away about an hour after being discharged from an emergency room. Her mother, also my patient, asked me to review the records and autopsy to see if she should bring a malpractice suit against the E.R. physician and the hospital. I am friends with the physician and on the hospital's board. Ought I to comply with this request?
-J.R., Connecticut

You should not. Indeed, you cannot – not properly, not without risking charges of bias. Your attachment to your friend and your position on the hospital’s board create – or may seem to create – divided loyalties. You should recuse yourself from this task, explain to the patient's mother why you are doing so and refer her to a disinterested physician with the expertise to review the records and advise her how best to proceed.

J.R. met with the family but did not offer a medical opinion, explaining that the records offered insufficient information for him to do so. He said he believed that they would not be satisfied unless the matter were investigated further and so suggested they speak to a lawyer who would have a neutral expert review the case.

Read about another ethical issue.

Thanks to Randy Cohen for the source story in the Ethicist column in the New York Times Magazine of May 25.

Saturday, July 19, 2008

His last, best and only chance: Experimental drug for Duchenne muscular dystrophy

Doctors discovered that Jacob Gunvalson had a rare and devastating genetic disorder – Duchenne muscular dystrophy - when he was 7 or 8, about eight years ago. Many of the young men who have the disease, which nearly always affects males, do not live past their 20s. A biotechnology company is now testing an experimental drug, PTC124, which would give Jacob "his last, best and only chance to slow, stop or even reverse the effects of his condition," according to his attorney, Michael Hatch.

But the company refuses to give Jacob the drug, as he does not meet the narrow guidelines for the research protocol. The reason: scientists at the company worry that it may not be effective for a patient at Jacob's stage of the disease: Jacob can no longer walk. If the drug is known not to be effective in him, the company executives worry that that news may block the company's chances of proving it is effective and bringing it to market.

Jacob's mother Cheri, who has a masters degree in nursing, seems to have done all the right things. She has been active in a parent's advocacy group, Parent Project Muscular Dystrophy, which has helped PTC Therapeutics, the drug maker, to find financing for its research. Indeed, she was instrumental in getting federal legislation passed to provide more research money for the disease.

The company may even have told her that it would give Jacob the drug. Drug companies sometimes allow patients access to experimental drugs through a "compassionate use" policy. In this way, patients enroll in a single-patient study, or participate in a clinical trial, even if they do not meet the eligibility criteria and their results are not included in the final study.

In the absence of that, both Jacob and his mother are bitterly disappointed, after thinking "so many times," he said, that he would receive the drug. He is increasingly too tired to do some of his favorite activities like cooking and painting.

Advice to family members of gravely ill patients: Explore compassionate use if an appropriate drug is in clinical trials. If the answer is no, take your story to the news media.

Read an experimental drug story.

Thanks to Reed Abelson for the source article in the July 17 issue of the New York Times.

Friday, July 18, 2008

She turned 104 in April: Aggressive treatment for centenarians

Her father had sent her to secretarial school. She married, and then split up with her husband, a traveling salesman, during the Great Depression. She worked as a stenographer to pay rent to her parents for a small sunny bungalow overlooking a canal in East Rockaway, New York. She retired in 1961.

Then in 2003, when Hazel Homer was 99, after several recent hospital stays, more than one doctor advised that there was little to be done about her failing heart except wait for it to fail a final time. But Hazel was not interested in waiting to die of old age.

She kept talking to doctors until one agreed to install a biventricular defibrillator, five years ago. Now, at 104, her heart is still ticking, thanks to the specialized pacemaker and defibrillator that synchronize her heartbeat and can deliver a slight shock to revive her if her heart falters.

So far, it has never needed to shock her heart out of a potentially fatal arrhythmia.

Hazel now has a live-in aide at her tiny bungalow. She has been quite healthy throughout her life. Indeed, since the surgery, she has had only a single hospital stay, a brief one for pneumonia.

Her operation, a month before her 100th birthday, reflects a new frontier in medicine: surgery for centenarians. Some say, however, that aggressive treatment for the extremely elderly can give patients false hope and a diminished quality of life.

Advice to adult children of extremely elderly parents: Heed your parent's preferences about aggressive care, rather than your own.

Read a story about aggressive care on the other side of the coin.

Thanks to Anemona Hartocollis for the source article in today’s New York Times.

Thursday, July 17, 2008

I became poor trying to save her: Unaffordable cancer care

After Dave Williams learned in April that the mass in his neck was malignant, his doctor referred him to a local cancer center. At his appointment, he was stunned at what he heard. "They said, 'We're looking at $30,000 of treatment, and we need $20,000 upfront,'" says Dave, 62, of Beesville, Texas. I don't have that kind of money."

For the retired landscape designer, the hospital's demand was an especially heavy blow, since he had recently paid off $273,000 in out-of-pocket costs for his ex-wife's care for ovarian cancer (his employer-sponsored health plan refused to cover her because she had cancer when he enrolled). "I became poor trying to save her, but she died," he says. He now lives in a trailer on a friend's property.

He applied for "charity care" at other hospitals but was rejected because he has saved about $10,000 in a 401(k) retirement savings account. "They all asked for a lot of money upfront before they would do anything to help me," he says. Dave is still exploring his options.

Advice to people with ruinously high healthcare expenses: Almost no one pays the full retail amount of a hospital's charges. The typical insurance plan gets a discount of about 60%, according to Sid Kirchheimer, so negotiate aggressively, or get someone who can.

Read a story of how universal health insurance has helped people who have found it hard to pay for their care.

Thanks to Sid Kirchheimer for the source article in the July-August issue of AARP Bulletin.

Wednesday, July 16, 2008

Easy for the drug dealers to sneak into your living room: Online drug sales

"The Internet made it easy for the drug dealers to sneak into your living room," said Francine Haight of La Mesa, California, whose son Ryan died in 2001 at 18 from an overdose of hydrocodone, generic Vicodin, which he had secretly ordered online with a debit card. An A-student and varsity tennis player, he had claimed in an online questionnaire to be a 25-year-old with back pain. He got his prescription and received the drug in the mail. His mother, a registered nurse, has fought against online sales since then.

In April, the U.S. Senate passed the Ryan Haight Online Pharmacy Consumer Protection Act, which would require certification of online pharmacies. It would also require doctors see patients before prescribing controlled substances. The bill is now in committee in the U.S. House of Representatives. At least eight states have passed laws barring electronic prescribing or sales without a legitimate prescription.

"Abuse of prescription drugs has exploded among college students, and…one way they get these drugs is over the Internet," said Joseph Califano, the director of the National Center on Addiction and Substance Abuse at Columbia University. The use of prescription opioids and anxiety drugs, especially in combination, accounts for a growing share of deadly overdoses nationwide.

Advice to parents of college students: Read their monthly credit card statements.

Read another prescription drug overdose story affecting a well-known actor.

Thanks to Erik Eckholm for the source article in the July 9 issue of the New York Times.

Monday, July 14, 2008

We are not foolish, selfish or blind: Use of Avastin for a glioblastoma

We continue to put our hopes for my father-in-law's health in Avastin. He is being treated off-label with Avastin for a glioblastoma. We are not foolish, selfish or blind for putting our hope in this expensive and controversial treatment.

When all other available treatments have an even smaller chance of providing any benefit, Avastin's positive results – however sparse – are extremely valuable to us.

The hope this drug provides our family is just as important to prolonging my father's life as the drug itself. Like many affected by cancer, we are smart advocates who do our research and know the odds. But no doctor or research study has ever told my father he couldn't be the outlier.

Advice to the families of cancer patients: Keep hope alive, and heed your cancer patient's preferences.

Read a story of a famous long-shot "outlier" survivor.

Thanks to Jana Jett Loeb for the letter to the editor, published in the July 12 New York Times.

Saturday, July 12, 2008

Not a moment too soon, I thought of Tim Russert: Early warning signs of heart attack

Most Saturday mornings, I bicycle with a group of men, mostly in their 50s, whom I affectionately call the Cheat Death group. We are all in pretty good shape, competitive but supportive, and convinced that hard-core exercise is our ticket to postponing the inevitable.

The ride a few Sundays back was a tough one. At 6:30 am, the pack took off fast and immediately headed for the hills near Durham, New Hampshire. The first few climbs felt pretty good, but by the third hill I started to feel nauseated.

Figuring that was probably a result of the four beers and large Chinese dinner the night before, I kept going. Twenty-five mles into the ride, I had fallen to the back of the pack. I was short of breath and wondering how I was going to make it much farther.

I am someone who hates to quit. But after the third time the group had to stop and wait for me, I decided I had no choice. I watched them pedal away, then lay down in the grass. Besides the nausea, my only symptoms were a persistent cough and an overwhelming feeling that something was not right. I called my wife and got a ride home.

I started thinking: Though I'm a 50-year-old guy with a stressful job and a little too much around the middle, I had a clean bill of health. I had good cholesterol numbers and a great doctor, and recently I had passed a cardiac stress test.

That's when Tim Russert popped into my head. I bolted out of bed and Googled a list of warning signs of a heart attack, according to the American Heart Association. Nausea: check. Shortness of breath: Check. Chest discomfort: Perhaps, though it really didn't feel like much.

Ignoring the web site's advice to call 911 (I was too vain to have an ambulance pull up to my house), I drove to the hospital.

I was having a severe heart attack – despite the stress test, the red wine, olive oil, and all my exercise. They gave me a stent in the cath lab [for "cardiac catheterization"] to open the artery that had suddenly been blocked by a blood clot.

As in Tim Russert's case, there had been no warning signs. If I had not gone to the hospital, I might very well have died.

Advice to middle-aged guys like me: Listen to your body. Michael risked some teasing by his bicycle buddies and quitting the ride, and going to the hospital, and it saved his life.

Read a story of appropriate care after getting a stent.

Thanks to Michael Bicks for the source article in the July 8 issue of the NY Times.

Friday, July 11, 2008

He doesn't make mistakes: Cadaver grafts for ACL knee surgery

An orthopedic study, released yesterday, found a 24% failure rate in operations on young athletes who get a cadaver graft [from a dead person] in knee surgery to repair an ACL ("anterior cruciate ligament"). Many have discussed whether Tiger Woods should have this surgery. Here's the story of Keith, an avid amateur soccer player in California:

Having played an awesome game of soccer on Saturday the 15th, on Sunday July 16, 2006 I decided to help out a teammate and play for his team since they were short. The league that I play in have artificial turf fields. The league my teammate played in used various grass fields. On this particular day, it was an awful field of a junior high school. I had just recovered from a mild Achilles tendon strain to my right heel, so jokingly I stated "there's a hole out there w/my name on it, watch." 

Unfortunately, I was right, but had no clue what was in store for me. With maybe 10 minutes left in the game, the other guy playing forward w/me was on a breakaway. I was running with him, wide open, so he crossed the ball to me leaving me 1v1 with the keeper (who sucked btw). It was a simple setup that I've played through many times before: a quick cut to the side and pass the ball in. That's all I had to do. So, I did just that. 

Or attempted.

What happened, to my recollection, was that I tried to cut to the left w/the outside of my left foot. Somehow in my footing my left leg got stuck as if I couldn't lift it up quick enough. Maybe I stuttered in my steps while trying to quickly change my direction or something, but my leg was firmly planted as the rest of my body moved over it. Before I knew it, I was on the ground, my knee having bend backward and to the inside a bit and having heard a pop. I was in the most excruciating pain I've ever felt in my life, and as I was literally digging out clods of dirt and grass from the field I could only say two things, "f***" and "oh s***!" I didn't even move for a few minutes (from the ground that is). When a teammate shouted to the sideline "get some water" I blew up. "I DON'T NEED ANY F***ING WATER, WATER ISN'T GONNA HELP ME!" 

And it figures, because with my Achilles tendon strain, I bought and brought a bag of ice from Ralph's every game. The one day I don't do that is the day I tear my ACL, and some ice would have been nice initially. Anyway, when my teammates helped me up, I tried to walk and immediately my knee buckled. It was as if it were jelly, just no stability at all. The fact that somebody else said they heard a pop was a bad sign, but for the time being I had hoped that it was just a severe hyperextension. In high school I hyperextended my knee a few times and may have had Osgood Schlatter's disease (it was a debate, I had a lot of the symptoms but currently show no sign of ever having it).

My 1hr+ drive home was nervewracking because I started analyzing what could be wrong and what it could mean for the rest of MY season (screw my teammate's season!), and where the heck should I drive to. The urgent care I had intended on going to was apparently closed even though they have "24hrs 7 days a week" posted on their window. In tears from the pain, I made it to the hospital (having never been there before) and apparently parked the furthest distance from the urgent center as possible. In time I got a wheelchair and X-rayed, and 4 hours later (it was a long wait) was told to see an orthopedic surgeon. My leg/knee was in an immobilizer brace and a friend picked me up and took me home.


The next day, Monday July 17th, 2006, I went to Blue Cross' website and found the closest orthopedic surgeon to me and called. They had an opening if I could get there in 1/2hr, so I lucked out. The surgeon asked me a series of questions and prodded around my knee for a bit, injecting a giant needle into my knee and pushed out a TON of blood. The needle felt like it was going so deep so as to hit the bone, but it wasn't. Definitely painful while it lasted. I wish I could say the amount, because it was a lot even for an ACL tear, but must have been 4-6 CC's worth. He sent me off to get an MRI as it was the only way to tell for sure what was wrong. I had my fingers crossed for a "best of" situation, meaning I didn't want it to be an unhappy triad (torn ACL, MCL, and torn meniscus), but I wasn't gonna be happy with an ACL tear either. During this time, I had not only the immobilizer brace but was on crutches too. Anyway, a few days later I got the MRI results and sure enough...ACL complete tear. Unfortunately, my stupid surgeon was going on vacation to the Caribbean for THREE weeks! I wanted the surgery right away and this wasn't going to help. So, I painfully had to wait nearly a month in order to have it. At some point I got a hinged immobilizer brace which was a lot better than what the hospital gave me. This new brace had hinges which you could lock into various degrees of flexion and would be key mostly for after the surgery. So anyway, let's get to that already shall we?


Finally, the big day came: Friday August 25th, 2006. The process I was told would take about 1hr 15 minutes, which I found surprising, but I guess it's not that long for a non life-threatening surgery, heh. The method of surgery was an allograft: a cadaver graft, meaning some dead guy's Achilles tendon was used as opposed to a hamstring (or patellar tendon) autograft. My surgeon explained he preferred this method because it doesn't require cutting into your own body. Why heal from 2 places when you can do it from 1? Fortunately, despite his jackassery of leaving for 3 weeks, he's a very good surgeon in LA. I got extremely lucky by finding him at random!

 The morning of the surgery, I wrote a giant "NO" on my right knee as it is my healthy knee. The docs later laughed at me for doing that, because "he doesn't make mistakes." But hell, why take the chance? Anyway, I was told that after the surgery I would be sent home: an outpatient. I found that cool because who wants to be in a crappy old hospital? BUT, the surgery didn't go quite as planned. Apparently my surgeon's assistant was also assisting another surgery, so rather than 1hr 15 min, it was 4 friggin hours! But, it was a success. I woke up and they wheeled me out of the recovery room and into a room in the hospital...so, rather than being an outpatient, I was an inpatient and had to spend a night in the hospital. 

That night was the longest friggin' night of my life. I knew that surgery would be painful, but I figured that knee surgery was small in comparison to hip replacement, shoulder surgery, etc...WRONG! Sorry to say but you're gonna have pain and it's gonna be extreme. I was asking for morphine every 4 hours on the hour and didn't sleep for s***...kinda sucked. I didn't eat nor drink much while there either. The next morning was quite a task as it was time to go home. Time to go home after going through traumatic surgery and having no food in my stomach. It also meant moving with a recently-operated knee. A therapist-type guy came in and helped me out of bed (painful) and showed me how to go up and down stairs w/crutches. After a long process of getting me into a wheelchair, into and out of my mom's car, and into my bed...I was home. Aside from moving, there really wasn't much pain...from surgery and on I only took 3 Vicodin pills and honestly didn't really need them. This is to say that while laying on my back all day I wasn't experiencing pain. Getting in and out of bed (basically, when my leg wasn't laying in bed) hurt, but that's to be expected. Maybe 3 inches below my knee was, and still is to this day, numb because apparently they have to cut through a nerve, but the area is only 4x3 inches? Its not bad, but it's one of those things that I'd like to have back just because I'm supposed to. 

There are some other side effects of the surgery such as lightheadedness. Considering you're stuck on your back for such a period of time AND a loss of blood/traumatic surgery AND your usual eating habits have been changed temporarily, it's entirely natural, but I tried to sit up when possible to read, etc. 

So, my surgery was Friday Aug 25th, right? Well, Wednesday August 30th I was back at my surgeon's office for a followup, and my first day of physical therapy. I guess this leads us to our the next point...


The goal of therapy is to achieve full flexion (bending) and extension. When I saw the therapist the first time, he just did some electro-pulse type stuff on my knee. I've done it before back in high school so it was nothing new. Because a little more than a month passed between injury and surgery, my leg muscles atrophied pretty bad. If there's one thing I've always had pride over, it was my muscular soccer legs, heh. My right leg hadn't changed, but my left was kinda chicken-legged. Most notably, my quads. 8 months later, my quads are still diminished...better than post-op, but still not to where they need to be. I'd like to say that my therapist didn't have me work on them in the early stages of therapy. He stressed that the hamstrings are really important because they're the muscles that aid flexion. But, I still feel like he neglected them when it was key because I'm only doing 15 lbs on my left leg...it's not that my muscles can't handle the weight, it's that the ACL is still weak at this point. Which is normal.

Advice: Look into other patients' stories thoroughly before choosing elective surgery.

Read a more grim story of a young athlete's knee surgery.

Thanks to Keith, and to Drs. Kurre Luber and Gene Barrett for their presentation at the 2008 American Orthopaedic Society for Sports Medicine's Annual Meeting.

Thursday, July 10, 2008

With hormone pills, radiation, surgery and grit: Skin lotion for cancer patients

Kairol Rosenthal, 35, is a choreographer and writer in Chicago. For the last seven years she has battled thyroid cancer with hormone pills, radiation, surgery and grit. She has had to contend with 101-degree fevers, heart palpitations, and a severe lack of appetite.

The hormone therapy to slow the growth of the tumor, leaves red blotches on her face and bone-dry patches along her jaw line.

"I have not yet made my peace with skin that doesn't look good," she said. She spends much of her free time in hunting for news about thyroid cancer. She is writing a book about living with the disease.

Radiation can cause what looks and feels like a sunburn on the area that the beam passes through to get to cancerous cells. Chemotherapy can make the skin and lips feel dry and itchy because it indiscriminately tries to damage all fast-growing cells, including skin cells.

Kairol heard a radio ad for Lindi Skin, a skincare line of products designed for cancer patients. Several companies now make skincare products for cancer patients.

Depending on who you ask, such products give patients one more tool to ease side effects, or a false hope that a costly lotion will be more effective than a mild drugstore lotion.

Oncologists and dermatologists are now looking into these products because cancer-fighting drugs called targeted therapies can cause rashes so severe that some patients threaten to drop out if they are left untreated. As of now, there is no scientific study that shows these products are any better than less expensive and less glamorous products like Cetaphil or CeraVe.

Yet some patients prefer them. Dianne Dassa, a breast cancer patient in New York, said the Lindi body wash and serum helped heal her radiation burn and her psyche. And "they were so beautifully packaged, I felt like I was getting a gift."

Advice: As a gift, you can give the fancy lotions to the cancer patient you care for. Cancer patients themselves can buy the less expensive drugstore products that have been shown to be effective.

Read a story of an entrepreneurial cancer survivor.

Thanks to Kayleen Schaefer for the source article in today's NY Times.

Wednesday, July 9, 2008

They said it was a new policy, just out: Denial of care for an insured undocumented immigrant

Over the Memorial Day weekend, a 9-year-old girl in the Bronx, New York went grocery shopping with her mother. A man banged into Lauren's left arm with his cart, tearing away part of a big mole. Her mother brought her to the local hospital's Emergency Room, where a biopsy of the mole revealed that Lauren had a serious skin cancer - melanoma.

At a cancer hospital, she was scheduled to have the mole, surrounding tissue lymph nodes in her arm removed, and to have scans of her lungs and liver. Yet no treatment has started: Lauren was born in Ireland, and is not a legal resident of the US. Since age 4, she has had regular checkups and immunizations through a managed care company that was set up by the Roman Catholic bishops of New York under contract with the state to provide Child Health Plus insurance – which had been created precisely for children who did not qualify for ordinary government insurance.

Her mother said, "Around the 14th of June I got the call that since she did not have any [legal] status, her request was being denied. I never heard anything about this until she got sick. They said it was a new policy, just out."

Though several employees of the insurer have said the matter has been resolved, Lauren still has not received treatment. Most recently, the surgery, which had been rescheduled for Wednesday, was further postponed because the hospital is not a member of the insurer's network of providers.

Advice to undocumented immigrants needing health care: Your local newspaper and your congressman may be strong champions. The Irish Times and the office of U.S. Senator Charles Schumer are now helping Lauren.

Read another child’s healthcare access story.

Thanks to Jim Dwyer for the source story in today's NY Times.

Tuesday, July 8, 2008

It's an inconvenience, but the alternative is death: Paying for cancer drugs

William Dexter, a 67-year-old retired Air Force sergeant and mail carrier, had been coming to his doctor's office for monthly intravenous immune globulin infusions to bolster his immune system after a bone-marrow transplant, radiation and chemotherapy and other drugs for non-Hodgkin's lymphoma, a cancer of the lymph system.

The infusions can leave patients drained and shivering, with low blood pressure. William liked getting them in his doctor's office, where nurses comforted him with coffee, blankets, and chats about his dogs and military history.

But with the gap between his Medicare policy and his doctor's expenses, the doctor's medical practice was losing about $500 on each infusion. Now, instead of one monthly doctor visit, William makes two 90-minute round trips: one to the doctor for a checkup and to open the IV port in his chest, and another to the hospital, where the four-hour infusion involves more delays and less comfort. "It's an inconvenience, but the alternative is death," William says.
"I knew the doctor had to do it to stay in business."

Advice to cancer patients who need to take costly drugs: Ask about the drug company's financial aid programs.

Read another chemotherapy story.

Thanks to Marilyn Chase for the source article in today's Wall St. Journal.

Monday, July 7, 2008

For an audience of one: A hospice musician

As Judith Jackson recalls, last October "my mother was in her final week of life when Marcia [Feldman] came to play for her. It was a wonderful gift not only to my mother but to me. I was spending hour after hour sitting at her bedside, and then Marcia would come in and play this very soothing music. The nurses told me the last thing to go is the hearing. And my mother always loved that type of music."

Marcia, a classical guitarist, is a hospice musician. She has educated herself in the musical traditions of a variety of cultures, so that she can best match the music she plays to the heritage and preferences of the patient she is playing for. "Even when patients are too sick for verbal expression, the nurses can tell me when they are responding well to my music – their breathing may become less labored, for example," she said.

Marcia first began thinking about the connection between death and music when she lost her father 20 years ago. "His situation did not involve hospice care; he died suddenly. But something about the process of grieving for him made me think increasingly about the role music plays at our most troubling times," she said.

She has recently released a new CD, "Between the Worlds."

Advice: Consider bringing some music for your loved one in hospice care.

Read another hospice story.

Thanks to Nancy Shohet West for the source story in today's Boston Globe Sidekick magazine.

You can order her CD at CDBaby.com. I haven't heard the CD. I don't get any money for recommending this.

Sunday, July 6, 2008

My military psychiatrist advocated for me: Treatment of mental illness

Ann Breitengross' story:
The military needs to arrive at a consensus concerning proper mental health care for troops. When I received a diagnosis of a mental illness in 2003 prior to an impending deployment, my military psychiatrist advocated for me. Despite my suggesting an alternative assignment to honor the terms of my contract, he recommended a medical discharge, giving me the opportunity to recover and develop the coping skills necessary to live a successful life. Not all military officers are so empathic. Had I been forced to deploy at that time, I know the stresses of being in a war zone would have exacerbated my symptoms, compromising the mission or, worse yet, my own life.

Advice to soldiers:
Most people now know that tough soldiers can get mental illness without being crazy.

Read a story of a tough soldier who has overcome tough psychological issues.

Thanks to Ann for her letter to the editor of Time Magazine, published on June 30.