As a patient, you probably see lots of hype-filled reports about various drugs. After a drug is approved, there’s an inevitable blitz of negative publicity which often scares people away from important new solutions that could help them.
There has been so much news lately about Multaq (dronedarone), the drug designed to provide the benefits of amiodarone but with fewer risks. This drug is important to people with afib, especially those with heart disease whose choices are limited, so it’s time to put into context for patients what has transpired in the two years since FDA approval.
These two companion articles provide an in-depth analysis into issues that have been reported about Multaq, including whether it can cause: Read more »
*This blog post was originally published at Atrial Fibrillation Blog*
Every once in a while we physicians make an astute (or perhaps lucky) observation that becomes a turning point in a patient’s life.
I’ll never forget the time that I placed a hand on an elderly woman’s belly after she said that she felt a little bit dizzy – the pulsatile abdominal mass that I discovered set in motion a cascade of events that resulted in life-saving surgery for an disecting abdominal aortic aneurysm (AAA). It was incredibly gratifying to be involved in saving her life – and now anyone who so much as swoons in my vicinity gets a tummy rub! (Yes, Dr. Groopman I know that’s not necessarily a rational response to one lucky “exam finding.”)
Last week I made a fortunate “catch” on the order of the AAA discovery from years ago. I was giving a close friend of mine a hug (he’s significantly taller than I am) when I noticed that his heart was beating rather quickly through his shirt. I instinctively grabbed his wrist to check his pulse, and voilà - it was irregularly irregular. My friend had new onset atrial fibrillation – and although he was initially resistant to my idea of going straight to the ER, I eventually convinced him to come with me. An EKG confirmed my clinical diagnosis, and blood thinners (with Pradaxa) and a rate control agent were administered. He will undergo cardioversion in a couple of weeks. We were both relieved that our intervention may well have averted a stroke, heart failure, or worse.
My peers at the hospital have been poking fun at me for my hug diagnosis, and my reputation as the “hug doctor” now preceeds me. I continue to protest that I do know how to use a stethoscope - but alas, there have been more requests for stat hugs from me than cardiopulmonary exams.
I don’t know if I’ll ever be able to top this clinical diagnosis, but a life of trying to find my next case of atrial fibrillation through hugging will likely make a few people smile.
This is a guest post by Dr. Juliet Mavromatis:
The emergence of a new generation of anticoagulants, including the direct thrombin inhibitor, dabigatran and the factor Xa inhibitor, rivaroxaban, has the potential to significantly change the business of thinning blood in the United States. For years warfarin has been the main therapeutic option for patients with health conditions such as atrial fibrillation, venous thrombosis, artificial heart valves and pulmonary embolus, which are associated with excess clotting risk that may cause adverse outcomes, including stroke and death. However, warfarin therapy is fraught with risk and liability. The drug interacts with food and many drugs and requires careful monitoring of the prothrombin time (PT) and international normalized ratio (INR).
Recently, when I applied for credentialing as solo practioner, I was asked by my medical malpractice insurer to detail my protocol for monitoring patients on anticoagulation therapy with warfarin. When I worked in group practice at the Emory Clinic in Atlanta I referred my patients to Emory’s Anticoagulation Management Service (AMS), which I found to be a wonderful resource. In fact, “disease management” clinics for anticoagulation are common amongst group practices because of the significant liability issues. Protocol based therapy and dedicated management teams improve outcomes for patients on anticoagulation with warfarin. Read more »
*This blog post was originally published at ACP Hospitalist*
Facial transplants, hand replants, and free flaps are only possible in large part due to microsurgery.
I finally got around to reading the “History of Microsurgery.” The article is good reading for anyone interested in the history of microsurgery.
The article, written by Susumu Tamai, M.D., Ph.D., (Japan) was received for publication in Plastic & Reconstructive Surgery on June 14, 2007.
Microsurgery is relatively young, and Dr. Tamai breaks down the history into four periods. Read more »
*This blog post was originally published at Suture for a Living*