January 31st, 2008 by Dr. Val Jones in News
Tags: Cancer, Dermatology, News, Pathology, Skin Cancer, Veterans Affairs
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Tonight (Jan 31, 2008) the CBS evening news will be airing a segment about a tragic case of a young Marine who died of melanoma. According to the news transcript, an unusual mole was diagnosed as a melanoma in 1997, but no follow up was scheduled, and no explanation given to the young man about his diagnosis or treatment plan. Eight years later in Iraq he complained to medical personnel of the mole growing larger and he was told it was a wart which would be treated once he returned to US soil. He slipped through the cracks somehow, and tragically died in 2008 of stage IV melanoma.
One interesting issue raised in the segment is that the Marine was not eligible to to sue for negligence in his case. There is a law, the Feres Doctrine, that denies military personnel the right to sue the government in cases of perceived or real medical malpractice. The rule was established in 1950 after a case was brought to the U.S. Supreme Court (Feres v. United States) in which servicemen who picked up highly radioactive weapons fragments from a crashed airplane were not permitted to recover damages from the government.
While I do understand (in theory) the purpose of this law – if every battle injury allowed soldiers to sue the government, we’d bankrupt our country in the span of a year – it does seem to be over-reaching in this case. The Marine was not injured in battle, but his life was indeed compromised by sloppy medical follow up. In my opinion, the doctor who correctly diagnosed him in 1997 should be held accountable for lack of follow up (if that’s indeed what happened). As for the military personnel who thought the Marine’s advanced melanoma was a wart, that is a tragic misdiagnosis, but hard to say that there was malpractice at play. With limited access to diagnostic pathology services, it is difficult (in the field) to be sure of the diagnosis of a skin lesion. And yes, I can imagine that an advanced melanoma could look wart-like. This is a tragic shame, but since the young man had the melanoma for 8 years prior to the misdiagnosis of the “wart,” in the end I doubt that a correct diagnosis at that point would have changed his terminal outcome.
But I wonder if the Feres Doctrine should be modified to allow for more accountability amongst military physicians in caring for diseases and conditions unrelated to military service? Although I am not pro-lawsuit, it does seem unfair that this Marine was denied the opportunity to pursue justice in his case. What do you think? Check out the segment with Katie Couric tonight and let’s discuss.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
January 25th, 2008 by Dr. Val Jones in News
Tags: Infectious Disease, News, Research, Vaccines
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I spent a year working in a vaccine research laboratory at the Mayo Clinic. My project involved analyzing the DNA of military personnel who had died of the measles in the early 20th century. Strangely enough, the military saved small pieces of their flesh embedded in paraffin wax (and frozen) for future study. I guess that “future study” was my research project.
I must admit that I felt a little bit creepy as I cut tiny slivers of tissue out of the waxy fossils. I wondered about the lives of the tissue’s original owners. Who were these soldiers? Did their families still think of them? Did they leave wives and children behind?
Well, as it turned out, most of the tissue samples had a little piece of DNA in common and it was pretty exciting to discover what may have been a genetic susceptibility to this particular virus. Figuring out why some people survive the measles while others are overcome and die from it can be the turning point in understanding how to protect future generations from its ravages.
Today I read about some new research linking susceptibility to the influenza virus to certain family lineages. This makes perfect sense, since our body’s ability to defend itself against disease is largely based on our genetic code. However, we’re only just beginning to unwrap the subtle role of each piece of DNA code in our immune function. The complex interactions of microscopic proteins and chemicals in our bodies is much more difficult to interpret and predict than we can even fathom. Nonetheless, it’s really exciting that we’re inching closer to being able to protect ourselves from scary viruses. We’ve won a few battles, but haven’t yet won the war.
And on another front, some researchers are working on modifying the ebola virus so as to render it harmless to humans. I’m not sure I’d want to sign up for THAT research project, frankly. I have a lot of respect for those who work in labs with such risky pathogens – but let’s just say I wouldn’t want to invite those folks out for a beer.
Let’s keep an eye on scientific discoveries in the field of virology. With the bird flu and other threats looming on the horizon, our lives may one day depend on it!This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
January 23rd, 2008 by Dr. Val Jones in News
Tags: Illicit Drugs, Pathology, Pharmaceuticals
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I was shocked and saddened to hear of the sudden and unexpected death of actor Heath Ledger. As fate would have it, I had watched his movie, “Candy” on the weekend prior to his death. Candy is the sad story of a young Australian couple who get involved in the drug culture, begin shooting heroin, and end up as junkies, prostituting themselves to afford their habits.
While the cause of Heath’s death is not yet known, a drug overdose is suspected and autopsy results will not be available for up to two weeks. A coworker asked me why the results would take so long, and what’s involved in an autopsy. I found a good article on the subject and will excerpt it here:
- Before the actual autopsy, as much information as possible is gathered about the person who died and the events that led to the death. Other information may be gathered by investigating the area where the person died, and studying the circumstances surrounding the death.
- Procedures done during the autopsy may vary depending on the circumstances surrounding the death, whether the medical examiner or coroner is involved, and what specific issues are being evaluated during the autopsy.
- The autopsy begins with a careful examination of the external part of the body. Photographs may be taken of the entire body and of specific body parts. X-rays may be taken to evaluate skeletal or other abnormalities, confirm injuries, locate bullets or other objects, or to help establish identity. The body is weighed and measured. Clothing and valuables are identified and recorded. The location and description of identifying marks, such as scars, tattoos, birthmarks, and other significant findings (injuries, wounds, bruises, cuts), are recorded on a body diagram.
- A complete internal examination includes removal of and dissection of the chest, abdominal, and pelvic organs and the brain. The examination of the trunk requires an incision from the chest to the abdomen. The removal of the brain requires an incision over the top of the head. The body organs are examined before removal, then removed and examined in detail.
- In some cases, organs may be placed in a preservative called formalin for days to weeks prior to dissection. This is particularly important in the examination of the brain for certain types of diseases or injuries. Tissue samples are taken from some or all of the organs for examination under a microscope.
- Completion of the autopsy may require examination of tissues under a microscope, further investigation of the circumstances of death, or specialized tests (such as genetic or toxicology tests). The tests performed may vary based on the findings at the autopsy dissection, the circumstances of death, the questions asked about the death, and the condition of the tissues and body fluids obtained at autopsy. A written report describes the autopsy findings. This report may address the cause of death and may help answer any questions from the deceased person’s doctor and family.
So it makes sense that autopsy results take as long as they do. A thorough investigation requires everything from documenting items from the scene of the death, to a careful analysis of blood toxins, to preserving tissues in formalin before viewing them under a microscope. All of the clues must be carefully weighed (Is there any evidence of a heart attack? Was there a blot clot in the lungs? Was there a brain hemorrhage?) to get the full picture and to be sure of the exact cause of death. All things considered, it’s amazing that the pathologists can render an opinion so quickly.
My heart goes out to Heath’s family as they await closure on the cause of his death.
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See also:
Mira Kirshenbaum discusses depression, suicide, and a healthy way to handle stressful life circumstances
.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
January 16th, 2008 by Dr. Val Jones in News
Tags: Disabilities, News, Pharmaceuticals, Physical Medicine And Rehabilitation, Psychiatry, Research
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We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.
– The US Declaration of Independence, July 4, 1776
When I was in college I spent my summers working with mentally and physically disabled adults in group homes and camps. Many of the patients had IQs<75, which presented a unique communication challenge. Emotional outbursts were not uncommon as the adults used the only form of communication that seemed to draw attention to an immediate need. I spent a lot of my time trying to predict needs before frustrations bloomed, and after getting to know the peculiarities of each individual, I could generally keep the group in a fairly content state.
Most of the adults were on a long list of medications – some were for epilepsy, others were for heart defects, but many were antipsychotics and sedatives. At the time I didn’t realize exactly what each medicine was for, and wondered why these relatively young men and women needed so many pills.
In retrospect I believe that many of the medicines were a misguided attempt to control behavior. It’s analogous to giving someone, with their hand in a bucket of very hot water, a pain medicine instead of removing their hand from the bucket. And now new research in the Lancet suggests that antipsychotic medications (such as haldol or risperdal) do little or nothing to control aggressive behavior in the mentally disabled (though not psychotic) population.
So why have we been giving mentally disabled individuals antipsychotics for decades? Sadly, we thought that these pills would provide a quick and easy way to conform their behavior to our sensibilities, without having to get to know the reasons for their frustrations. And of course, these people weren’t intellectually sophisticated enough to question the utility of this approach or to decline the use of such medications.
I find it terribly sad that it has taken us this long to realize that giving anti-psychotics to mentally impaired people is not in their best interest. Surely more evidence would have been gathered prior to subjecting “normal” adults to such treatments. In this imperfect world, it does seem that those without a voice are less often heard. It is our responsibility as healthcare professionals to look after their interests and not take the easy way out. Mentally disabled individuals have the right to express themselves, and to be free of unproven and unnecessary drug treatments. Life, liberty, and the pursuit of happiness. Our own Declaration of Independence argues as much.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
January 3rd, 2008 by Dr. Val Jones in News
Tags: News, Psychiatry, Relationships, Weight Loss
4 Comments »
A colleague of mine asked me what I thought about the recent New York Times article correlating household clutter with weight gain. It’s an interesting connection, so I thought I’d blog about it.
I think that clutter is probably a reflection of person’s emotional state, personality type, and upbringing. Some people seem to be more orderly by nature, others don’t focus on neatness as much. Some of us were trained to make our bed every morning, a few had a parent or nanny to do that. And still others have been “whipped into shape” by their spouse. Overall I think most of us prefer some degree of order over chaos, and given the choice would like to keep a fairly orderly home.
Now, what’s interesting to me is the emotional component in all this. We each have a certain level of baseline neatness, and we stray from that when we feel anxious, depressed, or exhausted. Think about what your house looks like now – is it at your natural baseline of orderliness? If not, are you more anxious, depressed, or tired than usual? I bet there’s a connection.
Many people gain weight when they’re anxious, depressed, or sleep deprived. So in a way, household messiness can be a marker for emotional distress. And it’s the emotional distress that fuels the weight problems. When a person is ready to lose weight, they’re probably motivated because they’ve managed to rise above their emotional concerns to achieve their goal.
So my point is this: take a look at your home to get a sense for how you’re doing emotionally. Are you anxious or depressed about something? Are you having relationship problems? Are you having difficulty sleeping?
Revolution Health has expert-led groups available to help you understand your emotions and how they influence your behavior. I think you will really benefit from getting into a discussion group and sharing your stories with others like you.
Here are some examples of groups that you can join right now (click to join):
Relationship Help – Mira Kirshenbaum, Counselor
Sleep Better – Steve Poceta, MD, Neurologist
Take Charge of Your Life – Ned Hallowell, MD, Psychiatrist
Lose Weight – Val Jones, MD, Rehabilitation Medicine
A Fit Family– Stacy Stryer, MD, Pediatrician
De-stress – Brad Jacobs, MD, Internal Medicine
Quit Smoking – Joe Scherger, MD, Family Medicine
Walk Your Way Thin – Jim Hill, PhD, Psychology
Maintain Your Weight – Chris Newport, Personal Trainer
Eat Right– Sandra Foschi, Nutritionist and Physical Therapist
Why not join a group? They may really help you to look and feel your very best this New Year. Not too many websites will offer this for free as Revolution Health does.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
