November 14th, 2007 by Dr. Val Jones in News, Opinion
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“Grow old along with me! The best is yet to be, the last of life, for which the first was made.”
— Robert Browning
As a rehabilitation medicine specialist I do a lot of work with cognitively impaired men and women. The brain is a fragile and fascinating organ, and perhaps the most perplexing one to treat. Alzheimer’s disease, of course, has no known cure – and those who contract it meander through a frustrating cognitive web towards a final common pathway of dementia, dependence and eventually death.
Former Chief Justice Sandra Day O’Connor has been in the news lately because her husband, an Alzheimer’s patient who requires nursing home assistance for activities of daily living, has forgotten who she is. But even more emotionally difficult is the fact that he has fallen in love with a fellow nursing home resident, and has been behaving like a love-sick teen – holding hands, staring into her eyes and kissing her tenderly.
The New York Times reports that Ms. O’Connor is “happy for her husband” that he has found joy in the midst of his cognitive decline. I wonder if there truly isn’t part of her that mourns the loss of those kisses that were once for her.
My fondest hope is that I can grow old with my husband, and that we will enjoy our final years together, in possession of all our faculties. I hope that Robert Browning’s poem will ring true at the end, and that I never have to watch my husband forget who I am. Sadly, since my grandmother passed away from Alzheimer’s – I wonder if it will be my husband, and not me, who watches the other decline?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
November 13th, 2007 by Dr. Val Jones in Expert Interviews, News
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Sadly, four transplant patients in the Chicago area recently discovered that their new organs were infected with HIV and hepatitis C. This is the first case of infected organ donation in the past 20 years, with over 400,000 successful, healthy transplants completed in that time period.
I’m actually a little surprised that this is the only known case of infected organ transplants in the past two decades, since the tests to rule out HIV and hepatitis C rely on antibodies. It takes the body at least three weeks to produce antibodies to these viruses, and so people who are infected with HIV and hepatitis C have false negative tests for the first few weeks. So there is always the risk that an organ donor could have contracted these viruses within 3 weeks prior to his or her death.
I asked Dr. David Goldberg, an infectious disease specialist in Scarsdale, NY, to weigh in:
Are there any tests available now that can detect the viruses themselves, or only antibodies? How early after infection could we detect them?
Traditional serologies measure antibodies against the viruses which take weeks or months to develop, whereas there is a more rapid test, called “PCR,” that is a direct measure of the number of viruses in the blood.
HIV reproduces rapidly, so the virus can usually be detected in the bloodstream within 8 days of infection. By contrast, hepatitis C virus replicates more slowly, so the virus may not be detectable until as long as 8 weeks after exposure. So the use of the HIV PCR test in addition to antibody tests would pick up almost all cases of HIV, but the hepatitis C PCR might still miss a number of early infections.
How can we protect future organ recipients from such a tragic event?
PCR is not generally performed because the test is time-consuming and many organ donors are trauma victims, which leaves little time for testing. However, PCR testing could theoretically reduce the number of HIV infected organs that are transplanted (from recently infected individuals), but would not improve the odds in hepatitis C because of the slow growing nature of the virus. In the end there’s no perfect test or 100% guarantee that organ donors don’t have HIV or hepatitis C.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
November 13th, 2007 by Dr. Val Jones in Health Tips, News
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Diabetes is a tricky disease. Sugar build up in the blood stream can damage tiny blood vessels that supply nerve endings, resulting in skin numbness. The feet are at the highest risk for nerve damage (neuropathy) and folks with diabetes often cannot sense pain in their feet.
How many of us have gotten blisters from ill fitting shoes? Painful, right? Well imagine if you didn’t feel the pain of the blistering and kept on walking, oblivious to the injury. Eventually you’d have a pretty bad sore there. This is what happens to people with diabetes who don’t choose their shoes carefully. In addition, sores don’t heal well because of the decreased blood supply to the area (from the damaged blood vessels). And to top it off, the high sugar levels in the sores provides additional sustenance to any bacteria that might be lurking on the skin. It’s pretty easy for diabetics to develop infected wounds, which can grow larger and even require amputations of dead tissue.
A recent research study suggests that the secret to avoiding this downward spiral is in choosing shoes that fit well – though they estimate that as few as one third of people with diabetes actually wear optimal fitting shoes. This may be because there is a strange temptation for people with diabetes to choose extra small shoes due to their neuropathy. When normal sensation is lost in the feet, tight fitting shoes actually feel better because they can be sensed more readily by the brain. So even though spacious shoes that don’t cramp the toes or cause blistering are the best footwear, they don’t always feel as comfortable. However, patients with diabetes who are properly fitted for orthopedic shoes with the help of a physiatrist or podiatrist, may substantially reduce their risk of ulcers.
So the bottom line for people with diabetes: choose your footwear carefully, and get professional help to make sure that your shoes fit well. Proper shoes could help to decrease your risk for foot and leg ulcers and potential amputations.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
November 9th, 2007 by Dr. Val Jones in Opinion
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“One major responsibility of an expert is to know what to ignore.”
— Scott Haig, MD
Health information is more plentiful and accessible to patients than ever before. As a physician I am thrilled that people are empowered with knowledge to take control of their health, but I am also sincerely worried about the “misses:” misinformation, misconceptions, misdiagnoses and mistakes.
The great sculptor Michelangelo believed that every piece of marble was a beautiful statue just waiting for the artist to remove the parts that didn’t belong. I believe that this principle applies to health information – the utility of the information is directly proportional to the reader’s ability to ignore the parts that are irrelevant or incorrect. Google cannot remove the irrelevant, because it can’t evaluate the science behind various claims, appreciate the nuances of an individual’s life circumstances, or confirm a diagnosis. No, as powerful and wonderful as search engines are, they are mere marble. The master sculptors in health information are physicians – trained for at least a decade in the art of analyzing data, appreciating the connectedness of various symptoms and body systems, and focused on chipping away at the irrelevant to uncover personalized solutions and cures – they are the artists whose experience and insight can make the difference between life or death.
Are sculptors flawed? Sure. Are some better than others. Yes. But the bottom line is that information in the hands of a person who can apply it in an intelligent, personalized, and relevant way is our best shot at good, quality healthcare. There is an art to medicine, and the trick is to know what to ignore. Find a good sculptor and stick with him/her so that you can live your very best and avoid the “misses!”This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
November 8th, 2007 by Dr. Val Jones in True Stories
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Today a dear friend of mine told me a horror story about her recent trip to a hospital ER. She has kidney stones, with rare bouts of excruciating pain when they decide to break off from their renal resting place and scrape their way down her ureters.
My friend is a stoic person who also doesn’t like to cause trouble for others – so when she was awoken at 4am with that same familiar pain, she decided not to call an ambulance but rather drive herself to the ER. She also chose not to call her doctor out of consideration for his sleep needs.
She managed to make it to the triage desk at her local hospital and was relieved to see that the ER was quite empty. There were no ambulances in the docks, no one in the waiting area, and no sign of any trauma or resuscitations in the trauma bay. She approached the desk trembling in pain and put her health insurance card, driver’s license, and hospital card on the desk and let the clerk know that she was in incredible pain.
The clerk responded,
“Lady, I saw you walk yourself in here. There’s no way you’re in that much pain. Sit down and fill out this paper work!”
My friend replied in a soft voice,
“Please, can you help me fill out these forms? I can barely see straight and can’t concentrate well. I have a kidney stone and it’s excruciating.”
Tears fell softly from her face as the clerk rolled his eyes at her.
“Yeah, I’m sure you do. And I bet you’re allergic to everything but Demerol.”
My friend started becoming frightened, realizing that she was being pegged as a “drug seeker” and would be punished with a long wait time for pain medication. “Please let me just speak to the triage nurse.”
“Sure, sweetheart,” hissed the clerk. “I’ll get him when you’ve finished your paperwork.”
And so my friend sobbed as she tried to fill in her address, phone number, insurance information, etc. on the paper form at a hospital where she had been treated for over 7 years for ovarian cancer. All of that information was in their EMR, but the registration process would not be waived.
The triage nurse slowly emerged, still chewing a bite of his steak dinner. “What have we got?” He said to the clerk looking out into a waiting room populated only by my sobbing friend.
The clerk replied to him under his breath. The nurse rolled his eyes and sighed heavily. “Alright lady, let’s get you back to an examining room. Follow me.”
My friend followed him back to the patient rooms, doubled over in pain and was put on a stretcher with a thin curtain dangling limply from the ceiling.
She couldn’t control her tears. She couldn’t get comfortable and she moaned softly as she took short breaths to explain her past history. She handed him her business card, explaining who she was and that she was not faking her pain. The nurse made no eye contact, jotted down some notes in a binder, and prepared to leave the room.
“Listen, your crying is disturbing the other patients,” he said, yanking the curtain across the front of the room to block her visually, as if the curtain would make her disappear.
Hours passed. My friend had no recourse but to writhe on the stretcher and cry out occasionally when the pain was too intense too bear. She asked for them to order a CT scan so they could see the stones. The nurse ordered it, a physician never came to examine her.
Four hours later my friend was greeted by a physician. “You have kidney stones. One is in your right ureter, and there are others sitting in your left kidney. Do you need some Dilauded?”
“Yes please!” said my friend, hoping that some relief was in sight.
“Alright, the nurse will be here shortly.” Said the doctor, glancing at her chart without completing a physical exam.
The shift changed and a new nurse came in to place an IV. She was gruff and complained that my friends veins were too small. “I’ve never seen anyone with a kidney stone need this much pain medicine” she snapped with a suspicious tone.
Five hours after her arrival at a virtually empty ER my friend received pain medicine for her kidney stone. She is a cancer survivor and national spokesperson for patient advocacy. In her time of need, though, she had no advocate to help her. No, she received nothing for her years of service, for her selfless devotion to helping others, for her tenderness to patients dying of a disease with no cure.
That night, my friend did not even receive the benefit of the doubt.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
