December 12th, 2007 by Dr. Val Jones in True Stories
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A few months ago I wrote about my dear friend who was diagnosed with stage IV colon cancer just after having her first baby. Her optimism and positive focus was inspirational to me, and I marveled at her ability to live life unencumbered by prognosis.
Today I am happy to report that she has completed her 7th round of chemotherapy (with avastin, oxaliplatin, 5FU, and leukovorin) and her liver tumors have already shrunk by two-thirds. She is bothered by neuropathy (burning sensations in her hands and feet – a known side effect of this drug regimen) and has lost the ability to taste food fully, but otherwise she is maintaining her weight and her blood counts are good. She told me that her plan is to complete 12 rounds of chemo and then meet with a liver surgeon to consider surgical removal of the remaining tumors. Miraculously, her doctors believe that she may be a candidate for liver resection and eventual cure.
This couldn’t be any better news and I am so pleased to be able to celebrate my friend’s success. I have learned a great deal myself about the journey, and about how many people are willing to reach out and help those who are struggling. As for my friend, she has greatly benefited from:
1. CarePages – an online gathering place where friends and family can find out the latest news about her progress, and leave well wishes and virtual gifts. CarePages is part of the Revolution Health family.
2. The Colon Cancer Alliance (CCA) – this wonderful non-profit organization linked my friend up with a mentor who has been through a similar treatment regimen and diagnosis and can speak to her about what to expect. The CEO of CCA has even taken time out of his busy schedule to make sure that my friend gets the best support available and has put her in touch with top liver surgeons.
3. Dr. Lenz’s Colon Cancer Blog – Dr. Lenz is a leading medical oncologist and Co-director of both the Colorectal Center and the Gastrointestinal (GI) Oncology Program at USC/Norris Comprehensive Cancer Center in Los Angeles. He also prepares 3 fresh blog posts per week here at Revolution Health, to make sure that cancer patients have access to the latest research and information about colon cancer.
With incredible advances in evidence-based cancer therapies and these terrific online resources, colon cancer patients have a brighter future than ever before. I’m so pleased that my friend is doing well, and I’m grateful for the many people and organizations that have touched her life. Expect another update on her progress in March!This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
December 11th, 2007 by Dr. Val Jones in News
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I was troubled by an article that I read in the Washington Post today. Apparently a common cold virus (adenovirus) has mutated unexpectedly into a killer strain (with a death rate as high as 23% for those infected in Oregon). The CDC has been carefully tracking this virus over the past year, and has noted outbreaks in Oregon, Washington State, Texas, and New York. Genetic studies of this virus suggest that it is similar to adenovirus 14, first described in Holland in 1955, but has very recently mutated into a more virulent form.
The interesting (and frightening) thing about this virus is that it’s so strong that it can kill young, otherwise healthy people, rather than the usual “at risk” populations of the very young and the very old. There’s no way to know if this virus will spark an epidemic, or whether it will die down and disappear for now.
Those who have had the virus, and lived to tell about it, say that it came on like a usual cold but then instead of getting better at the usual 4-7 day point, their symptoms got worse, and high fevers, cough, and difficulty breathing ensued. Some folks have even required mechanical ventilation in the ICU setting to help them breathe.
This virus reminds me that we are very vulnerable to unexpected attacks from infectious diseases. All the while we docs had our eyes on bird flu and SARS, this little cold virus mutated into a killer. If you have a high fever with difficulty breathing, please see your doctor right away. Let’s hope this epidemic threat dissipates before it can gain a real foothold.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
December 8th, 2007 by Dr. Val Jones in Medblogger Shout Outs, True Stories
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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.
December 4th, 2007 by Dr. Val Jones in Expert Interviews
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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.
December 4th, 2007 by Dr. Val Jones in Medblogger Shout Outs, Opinion
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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.
