August 21st, 2009 by CodeBlog in Better Health Network, True Stories
Tags: Code, Code Blue, Crash, Flu, H1N1, ICU, Intensive Care, Internal Medicine, Nursing, Pediatrics, PICU, Pregnant
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Just over a month ago, our unit had several H1N1 flu patients. And they were sick. Really really sick. They were also fairly young – 30’s to 50’s. I wondered at the time why the media hullabaloo about the flu had died down when I was seeing more and more patients in my unit who had it.
Last time I worked there was only 1 flu patient and they weren’t too sick (yet?) to require a ventilator. I was really glad to see the decrease in this particular patient population. I won’t lie – it’s frightening to be a nurse caring for someone with a highly communicable disease. Masks, gloves, gowns are all provided by the hospital, but I can’t ever shake the feeling that I’ve somehow come in contact with it despite these precautions.
And what of the times that we admit patients and don’t know they have a communicable disease? At least one coworker I know of contracted H1N1 from taking care of a patient who had it before we knew they had it.
I’m sure she was quite shook up – every single patient who turned up positive for the flu in our unit in that time period ended up literally fighting for their lives on a ventilator.
The most harrowing patient we had was a woman in her 30’s who was pregnant. Like the other patients, every time she coughed on the vent, her oxygen saturations would decrease to the 80’s and would take a long time to come back up. Unlike the others, though, she was so fragile that sometimes merely coughing on the vent caused her to go into asystole.
I’m somewhat jaded about coding people at this stage in my career. I remember, as a brand new ICU nurse, talking to a well-seasoned ICU nurse. She said that hearing “code blue” being announced overhead didn’t give her any kind of adrenalin rush anymore. At that time, I couldn’t imagine being in that frame of mind. Being new, I was expected to go to every code blue that was called so as to get experience. My heart started going into SVT at simply hearing the word “code.” If the word “blue” came after I practically had to defib myself before running off to defibrillate the patient.
I eventually got to a place where I could fairly confidently go run a code without freaking out. I’ve been an ICU RN for 11 years. In those 11 years, there have been some awful codes. Two stand out in my mind, and the absolute worst was on the pediatric floor. When I heard “code blue, pediatrics” overhead, my first (naive) thought was, “little kids code???” My second thought was to wonder if it was really an adult overflow patient. Sometimes the gyn surgeries went to the pediatric floor if there was no more room on the surgical floors. You know, maybe one of them got a little too much morphine and the nurse called a code. A little Narcan, a few bagged breaths and everyone would sigh with relief and go on with their day.
No such luck. After running full speed up 3 flights of stairs, I arrived at the room that had the most people spilling out of it only to find a bald, thin 5 year old in the bed. I thought I was going to be sick. PICU nurses – bless you all. I could not do that for any length of time.
She didn’t make it. Having been a nurse for a couple of years at that point, my naivety about the world already had a few chips and cracks in it. But on that day a huge chunk fell out.
Since then I’ve come to be more like that seasoned ICU nurse that I spoke with so early in my career. Along with the semi-jaded “oh crap, a code blue” comes a confidence in one’s abilities, so it’s not all bad.
However, watching that woman go into asystole, knowing that we would have to crash c-section her if she stayed in it? That took me back to the days when I was new and inexperienced. I’ve never seen anything like that happen. Although I was perfectly comfortable with my (pre-arranged) personal role, the overall situation would be completely new to me.
Although HIPAA prevents me from saying much more, I will say that I did not have to experience that situation; not because I was off when it happened but simply because it never happened.
If it had, it surely would have made my top 3.
*This blog post was originally published at code blog - tales of a nurse*
August 21st, 2009 by Medgadget in Better Health Network, News
Tags: Basic Science, Organ Transplant, Rat, Research, stem cells, Tooth
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The individual in the photo is not displaying his newly acquired gold tooth bling, but rather something more precious: the first fully functioning 3D organ derived from stem cells, described in PNAS as “a successful fully functioning tooth replacement in an adult mouse achieved through the transplantation of bioengineered tooth germ into the alveolar bone in the lost tooth region.”
More from The Wall Street Journal:
Researchers used stem cells to grow a replacement tooth for an adult mouse, the first time scientists have developed a fully functioning three-dimensional organ replacement, according to a report in the Proceedings of the National Academy of Sciences. The researchers at the Tokyo University of Science created a set of cells that contained genetic instructions to build a tooth, and then implanted this “tooth germ” into the mouse’s empty tooth socket. The tooth grew out of the socket and through the gums, as a natural tooth would. Once the engineered tooth matured, after 11 weeks, it had a similar shape, hardness and response to pain or stress as a natural tooth, and worked equally well for chewing. The researchers suggested that using similar techniques in humans could restore function to patients with organ failure.
Press release from the Tokyo University of Science (in Japanese)…
Full story in WSJ: From Stem Cells to Tooth In the Mouth of a Mouse…
Takashi Tsuji Lab…
*This blog post was originally published at Medgadget*
August 21st, 2009 by Bongi in Better Health Network, True Stories
Tags: End Of Life, Gastric Cancer, Hematemesis, Oncology, Stomach Cancer, Surgery
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Surgeons are not stand back kind of people. They fall more comfortably into the category of charge in where angels fear to tread. I think the work tends to preferentially attract those type of people. But sometimes standing back can be the lesser of two very evil evils.
The call was a standard weekend consultation. The patient had hematemesis and his doctor was worried. Nothing I hadn’t seen many times before. But when he came in the patient’s wife had a few more details to spice the story up a bit.
Just about a year ago he had had a resection of his stomach for cancer. The surgeon had told his wife they couldn’t get all the cancer out because it was growing into some big blood vessels behind the stomach. For some reason they both decided not to tell him this. So when he was referred for his chemotherapy (something that could not be described as awe-inspiringly effective in stomach cancer) he truly thought he was well on his way to full recovery. and now he lay before me, pale and restless.
He was a shadow of what he once must have been. His skin hung loosely as if in remembrance of the large man it once covered. I was not happy with the mass I clearly felt just under his left rib margin. The cancer was back and it seemed angry. I got the necessary drips running and ordered blood. I considered dropping to my knees but due to a back injury when I was still a student I wasn’t sure I’d be able to get up onto my feet again.
The wife called me aside and told me the patient was not aware of the fact that the operation was not a roaring success and therefore that he was essentially living on borrowed time (which I grimly thought he is about to pay back with interest).
“You need to tell him.” I said.
“No!! Doctor!! I can’t do that.” She needed the truth.
“This man, your husband may die here in this hospital within a day or two. you need to speak to him.” But she would hear none of it. She also didn’t want me to tell him things were not so rose coloured (I suppose depending on what colour roses you’re talking about of course).
The next day the patient was feeling much better. Amazing what a bit of blood will do. We chatted a bit. You know, shared a moment. He even laughed at how bad he had felt the previous day in comparison to today. Then it was back to business. In this case business meant I was going to take a long, not so thin pipe and stick it down his throat to take a quick look at the source of the bleeding in his stomach. I sort of lied to myself, telling myself that maybe I’d see something that could be fixed with a knife. In truth I knew what I would see. The palpable mass and the history dispelled almost all my doubt (or hope). But I knew I needed to look. I needed to know for sure how much or how little I would be able to do for him. Maybe I needed evidence for one day after it all when I am called to account.
The cancer was a large fungating mass with a deep necrotic core. It was gently oozing blood but I could see it was capable of so much more. It seemed to me it had stopped its torrent of blood long enough to give me a glimpse as if to taunt me. As if to say you know me and you know you have no power here. It was right.
After the procedure the patient once again started spewing forth blood. I sat with him for quite some time. between his retching we spoke.
“This is not good, doctor.”
“I know.” What more was there to say?
“What are we going to do?”
“We are going to hope the bleeding stops.” What more was there to do?
Then I went against the wishes of his wife. I told him this cancer was going to be the end of him. He looked at me with a calmness and a gentle smile.
“I know.”
He probably had known for some time but I think he felt he had to go along with the charade and maintain the lie with his wife. He seemed relieved that the truth was out. He seemed to relax.
That night the sister called me to tell me he was bleeding massively. I explained the situation and asked her to push blood IV. If that didn’t help, nothing that I could do would. The next morning he was dead.
Somehow when we sit behind our computers and in our nice expensive offices deciding about the futility of certain treatments and who should get what based on cost or whatever, the actual point is lost. The nice old man finally vanquished by the hideous monster called cancer or the old lady with heart disease or whatever who is forced to succumb to the dark inevitable is the point. It is the person, the individual. the one like me. and maybe like you.
I was just left with a sense of how difficult it is to stand back and let someone die when you know what that means. It, I assume, is much easier for the powers that be, snug in their artificial real worlds.
*This blog post was originally published at other things amanzi*
August 20th, 2009 by BarbaraFicarraRN in Better Health Network, Health Tips
Tags: Geriatrics, Internal Medicine, shingles, Vaccine, Zostavax
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A Guest Blog by Kevin Soden, MD
I ran into an old friend this past week and, as all of us over 60 do, we began talking about our health and the various ailments afflicting us as we age.
He shared with me that he was currently dealing with a bad case of the “shingles” (known as Herpes Zoster in medical circles) at age 65 and how terribly painful they were. He said that he wouldn’t wish them on his worst enemy.
As many of you may know because you’ve suffered a similar problem, shingles is caused by the Varicella Zoster virus, the same virus that causes chickenpox.
Only someone who has had a case of chickenpox – or gotten chickenpox vaccine – can get shingles. The virus stays in your body and it can reappear many years later to cause a case of shingles.
Always being the doctor, I asked my friend whether or not he’d gotten the vaccine to help reduce his risk of getting shingles.
He acted shocked and was quite angry as he explained that he’d never been told by his doctor about that there was a vaccine available that might prevent shingles.
The vaccine available for adults 60 and over to prevent shingles is called Zostavax. In clinical trials, the vaccine prevented shingles in about half of people 60 years of age and older. Even if you do get shingles after being vaccinated, it may help reduce the pain associated with shingles but it cannot be used to treat shingles once you have it.
I’m really not pushing the Zostavax vaccine because it’s not recommended for everyone but rather am reminding everyone that prevention is much better than treating after someone has a disease.
Talk to your doctor at your yearly visit to see what preventive steps you should be taking.
Check the CDC website for more information about vaccines that might be right for you especially if you are traveling to other countries.
Frankly, if your doctor is not talking to you about preventing disease, then it just might be time to find another doctor.
About Kevin Soden, MD
Dr. Kevin Soden has been a medical journalist for over 20 years appearing on CBS, NBC and most recently on NBC’s Today Show. He now serves as the host for Healthline, the national award-winning daily medical television show seen on the Retirement Living Network. He also serves as the worldwide Medical Director for Texas Instruments and Cardinal Health and teaches as a courtesy Professor at the Univ. of Florida College of Medicine.
His awards include 3 Telly’s, the 2008 CableFax award for best cable health show, the 2008 and 2001 National Award for Excellence in Medical Reporting from the National Association of Medical Communicators, a finalist for the International Freddie Awards in 2001, and as the Executive Producer for Rush of the Palms received the 2003 International Film Critics award for short films.
Kevin published The Art of Medicine: What Every Doctor and Patient Should Know…a critically acclaimed book focusing on improving doctor-patient communications. He is also the primary author of a consumer medical book Special Treatment: How to Get the High-Quality Care Your Doctor Gets. He is also a contributing author to the recently published A Practical Approach to Occupational and Environmental Medicine and to Physician Leaders: Who, How and Why Now? He has just finished his third book Think Like a Man: Male Behaviors that Can Help Woman Lighten the Load, Loosen Up and Find Happiness in a Stress-Filled World. He also is a regular contributor to numerous popular magazines.
Soden graduated with honors from the University of Florida College of Medicine and is one of the original inductees into the UF Medical Wall of Fame. He also has a Masters in Public Health from the Medical College of Wisconsin and a Masters in Personnel Administration from Florida State University.
*This blog post was originally published at Health in 30*
August 20th, 2009 by EvanFalchukJD in Better Health Network, Health Policy, Opinion
Tags: Comparative Effectiveness, Employer, Evidence Based Health Plan, Healthcare reform, Why reform is going badly
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As I’ve blogged about before (here, here, here and here), a big reason reform is going so badly is this: Reformers don’t understand how people react when you try to make changes to their health benefits.
Companies across America have been making changes to health benefits for years.
Reformers seem to have ignored the lessons of their experience.
Take one of the hottest trends in benefits – evidence-based plan design.
These are plans that offer better coverage if care is done based on evidence-based guidelines. It’s similar to the “comparative effectiveness” ideas that are so important to some of the reform proposals.
The National Business Group on Health published a study of challenges companies face implementing these plans. The study tried to understand how employees feel about these kinds of changes to their benefits.
Here are three of the major findings.
1. Most employees believe that more care is better care. Employees tend to view the idea that sometimes less care is the right care as “both unfamiliar and counter-intuitive.” Quality care is viewed as “trying as many things as possible, including new or alternative treatments.” In other words, you get what you pay for, and efforts to pay less are interpreted as efforts to give less.
2. Employees are suspicious of their employer’s motives. Employees tend to assume that their employer just wants to save money, and doesn’t really care about the quality of care they get. They suspect that moving to an evidence-based plan design is really just the first step toward more severe restrictions on choice and access.
3. Employees worry that employers are overstepping their bounds. Employees report worries that their employer wants to influence treatment decisions. They feel strongly that those decisions should be made by them and their doctor.
Reformers made a big mistake by focusing so intently on health care cost savings as the “single most important fiscal issue we face as a country.” It’s almost as if they decided to pick a way to promote reform that would create the most resistance.
Spend less on health care? That was almost certain to be understood as meaning you want to deny me or my loved ones the care we deserve. A panel of government experts deciding what treatments are effective? Who are they to tell me and my doctor what’s right? And don’t you dare tell me the reason you want to do all this is to make sure I get the best care.
Reformers have stumbled into a trap of their own making. Based on the continuing effort to demonize those who raise objections, they still don’t see it.
This is why reform is going so badly.
*This blog post was originally published at See First Blog*
