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Treating Combat Injuries And Its Similarities To Wilderness Medicine

The 2011 Annual Summer Meeting of the Wilderness Medical Society that was held in Snowmass, Colorado was excellent and provided terrific education for all in attendance. In a series of posts, I’ll highlight some of what we learned.

Brad Bennett gave a wonderful lecture on Tactical Combat Casualty Care (TCCC) for the Wilderness Provider. Military medicine and wilderness medicine share certain common elements: extreme and remote environments, a practice of medicine where definitive care can be hours or days away, difficult patient access, limited medical personnel and equipment, prompt decision making, creative thinking, and improvisation. Medical injuries may overwhelm resources and evacuation may be delayed due to environment conditions and the features of the terrain.

In military situations, Read more »

This post, Treating Combat Injuries And Its Similarities To Wilderness Medicine, was originally published on by Paul Auerbach, M.D..

Cerebral Vasculitis Occurring With A Corpus Callosum Infarction

Cerebral vasculitis is a known cause of ischemic and hemorrhagic strokes and has been described as one of the rare but important causes of corpus callosum infarction. Biopsy-proved giant cell arteritis causing callosal infarction is an exceedingly rare finding because a tissue specimen is usually not obtained and conclusions are drawn on the basis of clinical and radiologic findings alone. We present a case of callosal infarction, which evolved and eventually affected large portions of both cerebral hemispheres.

A 63-year-old woman presented to our hospital with left-sided numbness and neglect, cognitive changes, and apraxia. One month earlier, she was found to have a C-reactive protein level of 8.0 mg/dL (normal <0.5 mg/dL) and 75% stenosis in both femoral arteries. These results prompted Read more »

*This blog post was originally published at AJNR Blog*

Article Compares Hemostatic Agents: Are There Any Differences?

Once of the major recent advances in trauma care has been the evolution of topical substances that can be applied to wounds in order to limit or stop hemorrhage (bleeding). This is very important in wilderness medicine, because uncontrolled bleeding is a leading cause of death from injuries. When the bleeding site can be approached in such a manner as to stop the bleeding, then something very valuable may possibly be done for the patient.

In article entitled “Comparison of Celox-A, ChitoFlex, WoundStat, and Combat Gauze Hemostatic Agents Versus Standard Gauze Dressing in Control of Hemorrhage in a Swine Model of Penetrating Trauma,” Lanny Littlejohn, MD and colleagues used an animal model of a complex groin injury with a small penetrating wound, followed by completely cutting the femoral artery and vein, to determine whether there was any benefit to one or another hemostatic (stops bleeding) agent in comparison to each other and to standard gauze dressing. To cut to the chase (no pun intended), the results showed that no difference was found among the agents with respect to initial cessation of bleeding, rebleeding, and survival. In this study, WoundStat was inferior with respect to initial cessation of bleeding and survival when compared to Celox-A.

The authors point out how important it is to Read more »

This post, Article Compares Hemostatic Agents: Are There Any Differences?, was originally published on by Paul Auerbach, M.D..

Pregnancy After 45: A High-Risk Dilemma

As more older women attempt to beat the biological clock and conceive, they are at greater risk for developing birth-related complications. For women over 45, there is less than a 1 percent chance of getting pregnant using their own eggs. Successful pregnancy for women over 45 is nearly always the result of in-vitro fertilization (IVF) and the use of an egg donor.

Researchers at Tel Aviv University reviewed birth records from 2000 to 2008, specifically looking at the records of 177 women who gave birth at the age of 45 and beyond. The majority of the women had IVF and received donor eggs, and 80 percent of the babies were delivered via cesarean section (C-section).

Despite their celebrity, Kelly Presley (age 47), Celine Dion (age 42), and Mariah Carey (age 40), are older pregnant women who are at risk. The premature birth of Celine Dion’s twin sons did not surprise me at all. Women over 35, and especially those over 45 with underlying medical problems, should be treated prior to becoming pregnant. I cannot emphasize this enough. Read more »

*This blog post was originally published at Dr. Linda Burke-Galloway*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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