September 24th, 2007 by Dr. Val Jones in News
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The oncology community bid farewell to one of its greatest leaders last week, Dr. Marty Abeloff. Marty was a dear colleague of Dr. Avrum Bluming (a guest blogger and friend of Dr. Val & The Voice of Reason) and Av was kind enough to write this obituary to honor him:
On September 14, 2007, Marty Abeloff died.
An intelligent, gracious, caring and supportive human being, he brought all those qualities to his roles as physician, mentor, educator, administrator, and friend.
He was a Phi Beta Kappa graduate of Johns Hopkins and an Alpha Omega Alpha graduate of Johns Hopkins Medical School. He did his house staff/fellowship training at the University of Chicago, the National Cancer Institute, Harvard, the New England Medical Center, and Johns Hopkins. At the time of his death, he was Professor of Medicine and Director of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University. He was a past President of the American Society of Clinical Oncology, past Chairman of the Oncology Drugs Advisory Committee of the Food and Drug Administration, past Chairman of the Board of Scientific Counselors to the National Cancer Institute’s intramural division of clinical sciences, and past Chairman of the Breast Cancer Committee of the Eastern Cooperative Oncology Group. He was the lead Editor of Clinical Oncology, a comprehensive textbook, now in its third printing, Editor of Current Opinion in Oncology, former Associate Editor of the Journal of Clinical Oncology, and founding Editor in Chief of Oncology News International, a wonderfully informative periodical, a position he established and occupied since 1992.
He was held in high esteem by his peers, and beloved by his colleagues, co-workers, patients, students, family members and friends. Patients held on to his phone number long after they finished treatment, and those of us seeking advise in the management of our own patients never hesitated to call upon his help. He was always available and always helpful.
Any individual looking to fashion a life and career distinguished by accomplishment and filled with love could find no finer role model.
Avrum Z. Bluming, MD, MACP
Clinical Professor of Medicine
University of Southern California
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
September 23rd, 2007 by Dr. Val Jones in Health Tips
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If you’re one of those unlucky souls who is easily nauseated by riding in planes, trains, and automobiles – and forget about boats, they’ll keep you hanging over the rail for hours – then welcome to the motion sickness club. You’ve probably already read about your treatment options, but you may not find any of them completely satisfying.
Motion sickness (like car sickness, sea sickness, etc.) is caused by an uncoupling of input from the eyes, ears, and joint position-sensing nerves throughout your body. In other words, your brain becomes confused by conflicting messages about where your body is in space. If you’re sitting in a chair, your brain expects it to be fixed and not to move – but then if that chair is in a car or on a boat, the movement doesn’t make sense to it, and you become dizzy and nauseated. The details of the science behind motion sickness is quite complex – and there are many different approaches to treating and preventing it.
In terms of medications – antihistamines such as Benadryl (diphenhydramine), Dramamine, Antivert (meclizine), and Phenergan and anticholinergics like Scopolamine may be the most commonly used. They have varying sedative side effects which can be very inconvenient for those who need to be alert and active immediately after they get out of the car, train, boat, etc.
Some people have used Zofran (ondansetron) for motion sickness prevention – and although this drug is only approved for the treatment of nausea side effects caused by cancer chemo and radiation therapy, it has a unique mechanism of action for preventing nausea. It works by blocking serotonin receptors in the brain (and perhaps in the gut) to head off motion sickness. It does not produce drowsiness as a side effect, and is generally well tolerated. Unfortunately, it is very expensive (about $50 per pill – without insurance).
Personally, I try to stay away from medications as much as I can (they always have the potential for unwanted side effects) – but if you’re really struggling with motion sickness and have exhausted all your options, you might want to ask your doctor about Zofran. I must admit that for me (someone who gets ill just looking at amusement park rides), a little bit of Zofran has radically improved my traveling difficulties. In fact, I’m writing this blog post from a seaside vacation spot in sunny California… and I have no worries about the flight home, choppy air or not. Bring on the deep sea fishing, parasailing, and jet skiing – I have no fear, Zofran is here!This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
September 18th, 2007 by Dr. Val Jones in True Stories
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Dr. Rob wrote a touching blog post today about death and dying. He contrasts two deaths – one in which the family members were excluded from the room as physicians deliberated about the patient’s heart rhythm (while she was dying), and another one in which a patient was surrounded by family members who sang a hymn and held him in their arms as he passed.
Although the ultimate mortality rate of individuals has been 100% throughout history, physicians are trained to fight death at all costs. When you think about it – we must be the most optimistic profession on the face of the planet. Who else would leap headlong into a battle where others have had a 100% failure rate since the beginning of time?
Instead of thinking of medicine as a means to defeat death, I think we should consider it a tool to celebrate life. Adding life to years is so much more important than adding years to life – and yet we often don’t behave as if we believe that. Unfortunately in my experience, death has not been handled well in hospitals. For every hymn singing departure, there must be 100 cold, lonely, clinical deaths surrounded by a crash cart, CPR and shouting.
I remember my first death as a code team leader in the ER. An obese, elderly man was brought in on a stretcher by EMS to the trauma bay. They were administering CPR and using a bag valve mask to ventilate his lungs. He skin was blueish and there was absolutely no movement in his lifeless body. His eyes were glassy, there was no rhythm on the heart monitor… I knew he was long gone. The attending asked if I’d like to practice placing a central line on him, or if I’d like to intubate him to get further experience with the procedure. She saw that I was hesitant and she responded, “This is a teaching hospital. It is expected that residents learn how to do procedures on patients. You should take this opportunity to practice, since it won’t hurt him and it’s part of the code protocol.”
As I looked down at the man I overheard that his family had arrived and was awaiting news in the waiting area. I sighed and closed his eyes with my gloved hand, gently moving his hair off his forehead. I looked up and told the attending that I was sorry but I couldn’t justify “practicing” on the man while his family waited for news. I took off my gloves, quietly asked the nurses to please prepare the body for viewing, and walked with my head hung to the private waiting room.
The family scanned my face intensely – they could see immediately that their fears were confirmed by my expression. I sat down very close to them and told them that their loved one had died prior to arrival in the Emergency Department, and that he did not appear to have suffered. I told them that we did all we could to revive him, but that there wasn’t any hint of recovery at any point. I explained that his death was quick and likely painless – probably due to a massive heart attack. I told them that they could see him when they were ready, and that I believed that he had passed away with dignity. They burst into tears and thanked me for being with him at the end. I hugged his wife and walked the family to his bedside and closed the curtains around them so they could say goodbye in their own way. I hoped that they felt some warmth on that very dark night. “Doing nothing” was the best I could do.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
September 17th, 2007 by Dr. Val Jones in News
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Physicians have known for at least 40 years that infectious bacteria (like staphylococcus aureus) can be transmitted on clothing. And now, as part of a comprehensive plan to reduce hospital infection rates, Britain’s National Health Service has recommended against physicians wearing white coats.
An interesting research study showed (back in 1991) that the dirtiest part of physicians’ coats are the sleeve tips and pockets. But surprisingly, coats that were washed at 1 week intervals and coats that were washed at 1 month intervals were equally capable of transmitting bacteria. Now that multi-drug resistant bacteria have become so common, they too can hitch a ride on coat sleeves and make their way from patient to patient.
During my residency, I clearly remember being horrified by the grunge I saw on my colleagues’ coats, all hanging up together on hooks outside the O.R.s. and in various parts of the hospital. I used to wonder if they were spreading diseases – but comforted myself that many bacteria need a moist environment to survive – so while the coats were certainly filthy, by and large they were not moist. Unfortunately my self-comfort was somewhat ill conceived – gram negative bacteria (like E. coli) do indeed need moisture for survival, but many viruses and gram positive bacteria (they usually live on the skin) do just fine in a dry environment. Other studies have confirmed that stethoscopes also carry a high bacterial load if not cleaned between patients. In fact, in reviewing some research studies for this blog post, I found that researchers have analyzed everything from hospital computer keyboards, to waiting room toys and patient charts. Infectious bacteria have been cultured from each of these sites.
Which leaves me to wonder: can we ever create a sterile hospital environment? Not so much. Although I agree that infections can be spread by white coats, and that a short sleeved clothing approach might help to reduce disease spread, I’d like to see some clear evidence of infection rates being reduced by not wearing coats before I’d prescribe this practice uniformly (pun intended). Bacteria can be spread on any type of clothing, by blood pressure cuffs, by stethoscopes, by dirty hands, by hospital charts… and we certainly can’t dispose of all of these. What would be left?
White Coat Rants (a wonderful new ER blog) describes the “ER of the future” – adhering to all the possible safety concerns of oversight bodies. Take a look at this whimsical perspective on what it would take to make the Emergency Department truly “safe” and imagine what it would take to make the hospital totally sterile.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
September 16th, 2007 by Dr. Val Jones in Health Policy, News
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I was glad to to hear from Wendy from wendysbattle.com … like my friend, she is battling stage IV colon cancer. Unlike my friend, she lives in Ontario and has no assistance to pay for her chemotherapy. In a jaw dropping video from a cancer press conference in Ontario, Wendy and 2 other colon cancer patients testify about being denied coverage for standard of care colon cancer therapy. Wendy says that Ontario has valued her life at less than $18 thousand dollars.
In a recent interview with Senator Mike Kirby, I learned that one of the major problems facing the Canadian healthcare system is the cost of expensive new drugs. The universal system was designed to have patients pay out of pocket for their medicines and have the government cover almost everything else. When this health insurance strategy was created, drugs were very inexpensive. However, with all of the technological advances in medicine – diseases like HIV/AIDS and cancer have become chronic, manageable illnesses with expensive treatment price tags. And now, the lack of drug coverage is shifting unmanageable costs directly to the patient. Sadly, Wendy is one of many victims of lack of drug coverage in Canada.
All this to say that the grass is not really greener in Canada – especially for cancer patients.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
