I was hiking in the woods recently with a group of women friends when something caught my attention. It wasn’t an interesting bird or plant, but the surprising number of “pit stops” my friends needed to make.
Their frequent detours into the bushes struck me because I had just finished working on Better Bladder and Bowel Control, the latest Special Health Report from Harvard Medical School. According to the report, incontinence is the unintended loss of urine or feces that is significant enough to make it difficult to do ordinary activities without frequent trips to the restroom. In the United States, about 32 million men and women have some degree of incontinence. For women, incontinence is a common but rarely discussed result of childbirth and aging—that could explain the pit stops of my hiking friends, who were all mid-life mothers. For men, incontinence is most often a side effect of treatment for prostate disorders.
Many things can go wrong with the complex system that allows us to control urination. Read more »
*This blog post was originally published at Harvard Health Blog*
Even doctors get sick, but there is often a difference.
I was rotating through orthopaedics and was on call that night. They tended to relegate us mere general surgeons to casualties during the calls so I was quite excited to get some theater time that afternoon, even if it was for a simple wound inspection and secondary closure and even if it meant there would be a backlog of patients in casualties for me to see afterwards. Once I had finished operating I rushed through the change rooms to get back to casualties. While I was changing I heard the unmistakable sounds of someone throwing up in the toilet cubicle. Quite soon the door opened and out came the orthopaedic registrar who was on call that night with me. He did not look good. He glanced at me but didn’t seem to see me. His face was pale, verging on grey and there were fine droplets of sweat on his brow. He was staggering slightly as he made his way to the basin to throw water over his face. I greeted him but the only reply he gave was a sort of grunt.
Much later that night Read more »
*This blog post was originally published at other things amanzi*
Perhaps you’ve heard that increasing your water intake is part of a healthy lifestyle – and that you should drink at least 8 glasses of a day. This “rule of thumb” is actually not based on scientific evidence. Although for many people it’s not harmful advice, you may not need to work so hard at getting enough water every day.
The amount of water that your body needs depends on three main variables (yes, needs can vary with different illnesses and conditions, but let’s talk about the average American):
1. Your body’s size
2. Your activity level
3. Your environment (weather and humidity conditions)
The larger you are, the more water you lose from sweat (be it from physical activity or hot weather conditions), the more water you need to replace. The amount you need can vary a lot – and in most cases there are two tricks you can use to stay properly hydrated: Read more »
It may seem rather unusual to talk about injuries and weather in the same context, but extreme weather can pose significant risks for many kinds of injury. Currently, many parts of the United States are experiencing a major heat wave, with record-setting heat and heat indices over the next few weeks. As we have seen in the recent past, deaths are occurring from heat-related and possibly from participation in outside activities that increase the risk of heat-related illness.
During the month of August, many athletes train for the fall sports season, sometimes participating in two practices a day over the course of a few weeks. While training is necessary and important for athletes to build up their stamina and to improve their performance, health consequences can be deadly if Read more »
*This blog post was originally published at CDC Injury Center: Director's View Blog*
People are basically sacks full of water. The skin keeps the water inside. Trust me when I say you want to keep your water inside.
The second post I ever wrote had to do with watching someone with burn wounds fade slowly away. In the end it had more to do with my own mortality. When I read it recently I was reminded of quite a few poignant stories. This is one.
Usually things happen in groups and, it seems, burn wounds are no exception. On two successive nights two severely burned patients came in. I got the first. My colleague got the second. My patient had 98% burn wounds (Usual story of being doused in petrol and being set on fire. Someone didn’t seem to like him). Only where his hair had been was he not burned. That means that 98% of the sack that is supposed to keep the water in was leaking.
Let me take this moment to say that it is not possible to survive 98% burn wounds in any setting. This patient was as good as dead, so whatever we were going to do would only partly help. The outcome could not be changed.
The immediate treatment for burns is to replace the fluid that is leaking out through the wounds where the skin used to be. The amount of fluid one gives is proportional to the surface area burned or the surface area leaking. In 98% that turns out to be quite an amazing amount of fluid. And that is what we did. I worked out the fluid needed, put up a good central line and started running it in. The next day he was still alive.
The next day was when the second burn wound patient came in. He had 95% burns and therefore was leaking pretty much the same amount as my patient. My colleague admitted him, but he treated him differently. My colleague knew that the end of the road was predetermined and didn’t see the point in prolonging the inevitable. He only gave him normal maintenance fluid which a normal person would require. He considered more as treatment and didn’t see the point in treating something that could not be treated. I considered that he may have a point. I went to see his patient.
His patient was not doing well. The loss of fluid had pushed him into a stuporous state. He didn’t seem to have long to go. I left. He died soon after.
My patient remained alive through that day too. Because of his wounds he could not lie in bed without extreme discomfort. But the soles of his feet had no skin so he could not stand either. The skin of his hands had all peeled off and they had swollen into useless immovable paws.
The head of the firm then decided we should take him into a shower and remove all remaining loose skin. I got the feeling he was trying to teach us some sort of lesson. The only thing I learned is that it is brutal to try to remove loose skin, even gently from such a patient. The patient was not having fun at all. I kept thinking why are we making the last days of his life any more miserable than they already are? The head then decreed that we would repeat this process in two days time. I felt sick at the thought. The wisdom of my colleague not treating his patient seemed much clearer to me then.
The next day when I arrived at work I was relieved to discover my patient had finally succumbed to the inevitable. It would not befall us to have to torture him the next day in order that we learned some mysterious lesson.