Photo Credit: Mark Crislip, M.D.
During a recent trip, I met a woman whose father had just passed away. When she discovered that I was a physician, she decided to tell me the sad story of the events leading up to his death. She gave me permission to share the story on my blog so long as I did not identify her or her family by name. For the purposes of the story, I’ll refer to the woman as Sue, and her father as Frank.
Frank was a healthy, robust man, descended from a long line of nonagenerians. Everyone assumed that he would live well into his 90′s – at least 30 more good years. One day Frank began having some leg pain, which he ignored as long as he could. Sue noticed him limping around a week later and decided to take him to see a physician. As it turned out, Frank had a deep venous thrombosis (or blood clot) in his leg, caused by a previously undiagnosed, mild genetic clotting disorder. The physicians treated him with heparin to prevent the clot from expanding, and prescribed coumadin to protect him from having the clot travel to his lungs – a condition (pulmonary embolism) that carries with it a high risk of death.
While researching his new medicines, Frank came upon an alternative medicine website. The site warned people against taking coumadin (stating that it was “a form of rat poison”) and offering herbal supplements instead. Frank decided to stop taking his coumadin, and purchased the alternative medicine from the website. Two weeks later he Read more »
There are big companies like Quintiles that run clinical trials around the world. There are local clinics that specialize in clinical trials and make a lot of money at it. There are, of course, pharmaceutical companies and device manufacturers who depend upon the results to gain marketing approval for new products. People in all those groups know a lot about trials.
But the perspective that counts is the view from you and me – patients. Most of us do not enroll in clinical trials. We don’t want to get too up close and personal with anything “experimental.” And often our doctors never tell us about available trials anyway since it can be a lot of paperwork for them. Given that most people don’t enroll in trials and new science is delayed because of it and also because most people in trials are not journalists, I thought I’d put hunt and peck to the computer keyboard and speak out about trials. I am especially motivated because I have participated twice. The first one, a leukemia trial in 2000, I believe, saved my life. And I enrolled in a second one, studying a new drug for clots in the legs (deep vein thrombosis or DVT) just a week and a half ago.
I enrolled in the DVT trial because 1) the first one worked for me and 2) I crow all the time about how patients should always consider being in a trial as a treatment option. I had to put up or shut up. So I signed on the dotted line.
This particular trial, Read more »
*This blog post was originally published at Andrew's Blog*
You know I am a cancer survivor – 15 years down the road from a leukemia diagnosis and enjoying a 10 year remission. So whenever something seems weird about my health it’s cancer coming back, right? Wrong! Just how wrong was proven last night. I am writing this from my hospital bed in Seattle.
The first symptom of a possible problem came three days ago when I had soreness in my right calf. A pulled muscle? Maybe. But I had not noticed straining it. Back at the gym the next day I had soreness again but thought it was no big deal. Last night it was worse. It hurt some to walk. I got home and, after my wife and son were asleep, got ready for bed. I had a slight fever and then noticed the right calf was not only sore, but swollen and warm. Very strange. I’d never seen that before.
Trying not to be stupid I called the 24-hour consulting nurse. She immediately began to focus on deep vein thrombosis (DVT), a worrisome condition that affects about two million Americans a year and can lead to a life threatening situation. She had a doctor call me. Normally those doctors would rather make a house call then send you to the more costly emergency room. But not this time. “Dr. Steve” urged me to go to the ER rather than let a DVT progress and endanger my life. An ultrasound exam would determine if it was really a DVT. Read more »
*This blog post was originally published at Andrew's Blog*
New clinical trials and published research are giving us information on how to improve health in elderly patients. Here are some brief points from the Cleveland Journal of Medicine that were surprising to me:
– Each year 30 percent of people age 65 or older fall and sustain serious injuries so preventing falls and fractures is important. Vitamin D prevents both falls and fractures, but mega doses of Vitamin D (50,000 mg) might cause more falls. A better dose is 1,000mg a day in people who consume a low-calcium diet.
– Exercise boosts the effect of influenza vaccine.
– The benefits of dialysis in older patients is uncertain, as it does not improve function in people over age 80. We don’t even know if it improves survival. Older patients who receive dialysis for kidney failure had a decline in function (eating, bed mobility, ambulation, toileting, hygiene, and dressing) after starting treatment.
– Colinesterase inhibitors (Aricept, Razadyne and Exelon) are commonly used to treat Alzheimer disease, but they all can have serious side effects. Syncope (fainting), hip fractures, slow heart rate, and the need for permanent pacemaker insertion were more frequent in people taking these drugs. The benefits of these drugs on cognition is modest.
– A new drug called Pradaxa (dabigatran) will likely prove to be safer than Coumadin (warfarin). Over two million adults have atrial fibrillation and the median age is 75. The blood thinner warfarin is critical for prevention of strokes but it caries a high risk of bleeding and drug levels have to be monitored frequently. Dabigatran will probably replace warfarin, but it will probably also be a lot more expensive.
As I often say, medicine and science are constantly changing and evolving. As new evidence comes forth, physicians and patients need to re-evaluate they way we do things.
*This blog post was originally published at EverythingHealth*
I’ve not been blogging much lately because of work craziness and traveling. One of my recent travels, however, was not for work but for pleasure. I’ve been studying karate (a traditional Okinawan version called Shorin-Ryu) for over fifteen years. There’s a national federation to which I belong and there are seminars three or four times a year taught by some of our more senior instructors. This was one such seminar, and it focused on joint lock and grappling techniques, some of which our style shares in common with other martial arts such as Akido and Judo.
At one point I was working with a fifth-degree black belt instructor, “Bill.” Super nice guy, and absolutely amazing in his speed and techniques. He was also very kind in teaching me a number of useful tricks and nuances of the techniques we were working on. There was a sequence which culminated in a choke-hold, and he was unhappy with the manner in which I was choking him. Read more »
*This blog post was originally published at Movin' Meat*