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Tear Jerkers – True Stories From The Medical Blogosphere

There’s nothing sadder than the death of a child. Young hopes and aspirations are snuffed out long before they can ignite their potential. That’s why the Make-A-Wish Foundation is doing their part to make sick childrens’ dreams a reality – to bring a sense of joy and fulfillment to kids whose days are cut short by illness.

I had the chance to participate in making a child’s wish come true earlier this year. I blogged about it here. It was a really moving experience for me and all involved – we helped a young terminally ill boy fulfill his dream of being President of the United States for a day. Amazingly, the White House even provided a real motorcade to shuttle him around. I got to play the role of paparazzi.

An EMT student blogged about another Make-A-Wish recipient whose dream it was to become a fireman. This story is also very touching. Here’s an excerpt:

There he stood, a father watching his son’s fantasy come to life. Sometimes, the deepest pain brings the greatest happiness.

William is usually outgoing and exuberant. Not Saturday. Saturday, he was awestruck.

Powers gave William a badge and the firefighters lined up to shake his hand. As they finished introducing themselves, William lifted the badge a few inches off his lap.

“He’s showing you to let y’all know he’s a fireman now,” said his mother, Marion Bussey.

Powers reached into a bag, pulled out a hat, and gave it to William. Then he gave the boy a shirt and yellow helmet as the rest of the firefighters looked on.

William leaned toward his mother and smiled. “Mom, I like this,” he whispered.

Tears formed in Bussey’s eyes and rolled down her cheeks.

“William is our hero and you guys are his hero,” she said to the firefighters. “He doesn’t have to say he wants to be a fireman anymore.”

What happened next wasn’t scripted. Maybe it was coincidence. Maybe no explanation exists.

William’s parents and the dozen firefighters looked at William and said the same words at the same time: “You are a fireman.”

William lifted his right hand and placed it on his forehead.

“I am William McKay,” he said, “and I’m an official fireman. Thank you.”

Then he saluted.

The firefighters looked at each other, tears welling in their eyes. They began crying. Some left the room. Others dabbed their eyes with tissues. William’s family began crying. Hospital staff began crying. Almost everyone began crying.

But not William. He had no reason to cry. He was the happiest boy in the world.

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Asthma in Women: Gender Differences Are Important

I recently interviewed Dr. Cliff Bassett about asthma in women and he gave some interesting insights into gender differences associated with this disease. I’ve summarized our conversation below – or you can listen to it here.

The CDC reports that 9% of women have asthma compared to 5% of men. I think that’s a very important finding and I’m not sure if women know that they’re at higher risk than men. The good news is that asthma is completely treatable, although sadly we have as many as 4000 deaths per year in this country attributed to asthma. We’re doing a better job identifying those with severe asthma, and the death rates are decreasing.

Women need to understand that even a small amount of weight gain (as little as 5 pounds) can add up to a much higher risk of death for women with severe asthma. So weight management is very important for those with more challenging asthma symptoms.

Women are more likely to be hospitalized due to an asthma attack than men. And interestingly, up to 40% of women report that their asthma symptoms get worse just before and after menstruation. So for women it’s important to keep a symptom diary, so that if there’s a regular worsening of asthma during menstruation, they might need to be treated more aggressively (perhaps with steroids or other medications) during that time of the month.

The new asthma guidelines (from the NIH) emphasize understanding asthma triggers as the foundation of prevention. It’s much safer to avert an asthma attack than to have to treat a full blown one. So it’s really important for women with asthma to figure out what might trigger their symptoms, and avoid those triggers as much as possible.

Now that it’s winter time, most environmental triggers are of the indoor variety. Over 100 million US households have pets. The most common pet is the cat, and up to 10% of people with allergies develop specific allergies to cats. If an individual suspects that she has a pet allergy, she should see an allergist to get tested to confirm that. Avoidance measures are important, though there are medications and allergy immune therapy (allergy shots) that can help with pet allergies.

Cold dry air can be an asthma trigger in some individuals, especially if they’re engaging in outdoor physical activity. Warm ups and cool downs can help to head off an asthma attack in the cold, though it’s always a good idea to have a rescue inhaler handy.

**Listen To Podcast***This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Guaranteed Quality Medical Care: Fantasy or Reality?

I have witnessed various disappointing doctor-patient interactions over the years. Sometimes the doctor is insensitive, other times he or she doesn’t listen to the patient – and errors can result. Young physicians are more prone to inappropriate patient and family interactions when they are feeling inadequate and insecure. A fellow blogger describes just this kind of problem with a young pediatrics resident:

A meek lady with a white lab coat
walks in and just starts asking medical questions. So
my answer to her first question was “Who are you?” She apologized and
said she was the pediatrics resident and asked a bunch of questions
that didn’t seem to us to have much bearing on the situation at hand.
We asked about why my son was making unusual gasping breaths ever since
he woke up and she said it was because he was crying. We said that he
was making these breaths before he started crying. She then said it was
probably hiccups. My wife, who is a registered nurse, said there was no
way it was hiccups because she felt him pressed against her body and
could tell. The resident then said that it was probably due to the
anesthesia. I could tell she was just giving that answer to say
something but really had no clue what was going on. So I challenged her
on it and said “Have you ever seen this after anesthesia before?” She
paused and said, “Maybe once.”

Although this is not the wost example of an unsatisfying doctor-patient interaction (read the rest of the post to get the full story), it is pretty typical for inexperienced physicians to “make up” explanations for symptoms or problems that they don’t understand. This can be dangerous or even life threatening if certain symptoms are ignored.So how do we protect ourselves against this kind of potential error? Sadly, the current quality assurance programs are rather ineffective. In his recent blog post about ensuring physician quality, Dr. Scalpel published a letter he recently received from his hospital. The letter was prepared as part of the Joint Commission quality assurance program. They actually require doctors to get a letter of recommendation from someone (who doesn’t work with them) to ensure that they’re practicing good medicine… It’s like asking a stranger to grade your work competence.

Dear Dr. Scalpel:

In
accordance with Joint Commission regulations, we are required to
request an evaluation of your clinical performance. The Credentialing
Committee now requires the completion of an evaluation form by a peer in your specialty who is not a member of your group practice.

Attached,
you will find a letter and accompanying evaluation form which you
should forward to a peer of your choice for completion. In order to
proceed with the processing of your reappointment application, it is
necessary that you ensure that the required evaluation form is
forwarded to a peer and returned to us in a timely manner. A return
envelope is provided for this purpose. Please note that the evaluation
form must be returned to us by the person completing the form. If we do
not receive the evaluation form before ________, your clinical
privileges may be interrupted.

Sincerely,

An Unnamed Bureaucrat

So, how do you ensure that you’re getting good medical care? It’s not easy, and you can’t necessarily depend on oversight committees to come up with sensible safeguards. Being an informed patient is part of being an empowered patient – you should do what you can to research your doctor’s and hospital’s credentials and reputation (you can do that right here with Revolution Health’s ratings tool), you should read about your diagnosis or condition on reputable websites like Revolution Health, and you should advocate for yourself or loved one at the hospital when necessary. You have the right to reasonable explanations for care decisions – and if you’re concerned about a symptom, you should ask about it.

Unfortunately, there’s no way to guarantee quality medical care. However, perhaps the most important thing you can do (besides advocate for yourself and become educated about your condition) is to develop a close relationship with a primary care physician.  Establishing a medical home with a good primary care physician can go a long way towards helping you to navigate the system. They can be your best advocate in this broken system.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Breast Augmentation: Mixed Emotions

I recently had the chance to observe a breast augmentation procedure performed by a surgeon friend of mine. The patient was a tall, attractive woman in her late thirties. Her husband was in the room, quietly listening to my friend’s explanation of the procedure and what should be expected. The patient was friendly and enthusiastic – the breast augmentation procedure was her birthday gift to herself. This was her second procedure, as she had already increased her cup size from an A to a C a few years prior. This time she wanted D or larger.

I felt mixed emotions as I observed the surgery. On the one hand the patient’s breasts looked fine the way they were (in my humble opinion) and it seemed wrong to further distort her natural body type. Yet on the other hand, I think that patients have the right to look the way they want to, and my personal beauty ideal shouldn’t be projected on to them. I asked my friend how she dealt with this sort of conflict.

“Well,” she said, looking at me with her surgical mask and blue hair net, “if a woman wants a green dress, it’s not the store clerk’s business to try to pressure her into buying a red one. I just try to give the patients what they want, and not impose my opinions on them.”

And so I watched as my friend carefully sutured the wounds around the new implants. She checked the movement of the saline-filled sacs inside the chest. She pushed the breasts together to check the cleavage.

“But the breasts don’t touch each other when you push them to the center,” I said, head tilted sideways.

“Her sternum is too wide for that. This is one of the limitations of implants of this size on her body. She just doesn’t have enough tissue to make that kind of cleavage.”

“Is that ok with her?” I asked, glancing down my own scrub top.

“It’s a give and take – she knows that going larger will not give her a natural look, but she’s ok with that. This is what she wants.”

And so the anesthesiologist woke the patient up, extubated her, and the nursing staff slid her over to the stretcher that would carry her to the recovery area. My friend escaped her sterile gown and gloves and prepared her post-op note at the nursing station desk. I smiled at the nurses who assisted in the surgery, and we shrugged at each other and went on our separate ways. I hope the patient is pleased with the outcome, though most of all I hope she feels content with how she looks, no matter what the bra cup size.

What do you think about breast augmentation?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Finding Your Calling

I recently spent some time with Dr. Kevin Means, Chairman of the Department of Physical Medicine and Rehabilitation at the University of Arkansas in Little Rock. I asked Dr. Means about his life, how he chose his specialty, and how he came to Little Rock from New York City. This is his story:

Kevin Means grew up on Long Island and attended college in Binghamton, NY. The summer after his first year of college he began looking for work to help him pay his way through school. Jobs were few and far between, and only “undesireable” work remained for college students. Kevin heard about a position as a physical therapy assistant at a facility for the disabled. They were having a difficult time recruiting and retaining candidates due to the strenuous work requirements – heavy lifting, assisting patients with exercises, and moving imobile (and sometimes obese) individuals around was not feasible for many people. But Kevin was a tall, strong, African American man – undaunted by the challenges.

The first few days filled him with sadness – young men with spinal cord injuries, elderly people recovering from severe strokes, amputees with traumatic brain injuries – all doing what they could in the gymnasium. Kevin surveyed the patients and took to heart the individual tragedies that had brought each of them there. He observed the physical therapists as they encouraged movement in the imobile, taught people how to use shriveled limbs, and helped amputees use new prostheses to walk again. Over time, he began to see that each life was a beautiful story of triumph over adversity, and his initial sadness melted as he witnessed the daily victories of recovery.

Slowly, Kevin began taking on more responsibility at the facility. He would sometimes offer additional therapy sessions to patients and stayed late in the evening to make sure that everyone had a full day of exercise. Although he had no formal training as a physical therapist, he grew to understand and practice their techniques, and was dearly loved by the patients.

One day Kevin was offered an office job that paid substantially more than the PTA position. He accepted it gladly, but in the afternoons found himself thinking about his friends at the rehab facility. He wondered if the patients were being cared for correctly, if they were recovering well, and if the nurses were strong enough to help the therapists transfer the patients safely. These nagging questions burned in his mind as he filed paperwork and made phone calls. He just couldn’t stop worrying about them.

A few days later, Kevin returned to his position as a PTA in the rehab facility. He had learned that working with disabled men and women was more fulfilling to him than an office job. He spent the next 3 years working there part-time, and developed long lasting friendships with the patients and staff.

When it came time to go to medical school, Kevin promised his friends that he would do all he could to sharpen his therapy skills and research new ways to help them become independent in their daily lives. For this reason, he chose PM&R as his specialty and attended residency at the top-ranked Rehabilitation Institute of Chicago (RIC). When I asked Kevin why he didn’t stay on at RIC after his residency, he simply said that they didn’t need him. They had plenty of bright, talented physicians who could help to advance the field. Kevin wanted to go where needs were greater, and where his work might bring new hope to those who had very little.

And so Kevin went to Little Rock, Arkansas in the mid ’80’s – to help to build a PM&R program there. He was single – a fact that his friends in Chicago and New York must have called to his attention. But he forged ahead on faith, assuming that he would meet his wife in good time.

Over the past two decades, Kevin has worked tirelessly to grow and establish the PM&R department at UAMS as a center of excellence in rehabilitation medicine. He met his (now) wife while she was working a second job as a clerk at a department store in Little Rock (she is a teacher), and they have 2 lovely children. Kevin took me on a tour of the UAMS facilities which span 3 modern buildings equiped with 2 large swimming pools, beautiful gardens and multiple gymnasiums.

I watched his face as he looked out onto a team of 30+ therapists assisting disabled adults with their goals in a gym. He smiled at the physical therapists and PTAs and I had to wonder if the scene reminded him of his days in Binghamton, and the friendships that gave him the first glimpse of his calling as a physician.

Kevin never did lose sight of his first love: advocating for the needs of the disabled. His career path has taken him from Binghamton to Little Rock – as he steadfastly fulfills his calling as a nurturing healer, working in places where needs are great, and workers are few.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

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