May 30th, 2008 by Dr. Val Jones in Expert Interviews, True Stories
Tags: Disabilities, News, Obstetrics And Gynecology, Podcast, Reproductive Endocrinology
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Revolution Health expert, Dr. Rafat Abbasi, is a reproductive endocrinologist and fertility specialist in Washington, D.C. She told me this exciting story about a miracle baby that brought great joy to a young family. She hopes that this news will bring hope to other young men and women who have spinal cord injuries and want to have children.
Dr. Val: Tell me about the fertility success story that has you so excited.
Dr. Abbasi: A young couple was referred to me because they wanted to have a baby. They had been married for about a year, and had been through one miscarriage already. Sadly, the young husband (he is about 35 years old) was then involved in a freak mountain biking accident and broke his neck, severing his spinal cord. He was paralyzed from the neck down and confined to a wheelchair, unable to function sexually. His 29 year old wife and he were devastated.
They came to me wondering if there was any way that they could get pregnant under the current circumstances. And due to the amazing advances in fertility treatments, I was pleased to report to them that there was a chance that they could. I explained how we’d do it.
First we had to collect some sperm from the testes of the husband. We could do this by using an electric current to stimulate a spontaneous ejaculation reflex and then inseminate the wife with the fluid, or if that didn’t work, we could withdraw some immature sperm directly from the testes with a needle. I explained that if we retrieved the sperm with a needle we’d need to mature the sperm in a test tube incubator overnight, and retrieve eggs from her and then use in-vitro fertilization techniques to create embryos to implant into her womb. In order to get the eggs, we’d need to use egg-stimulating hormones (for about 10-12 days) and an ultrasound-guided needle retrieval technique (under local anesthesia).
As it turns out, we used the second method for this couple. We transferred three embryos and one of them took, and she gave birth to a beautiful baby girl. The couple is now interested in having a second baby.
Dr. Val: Isn’t it true that spinal cord injury can contribute to infertility? How does that work?
Dr. Abbasi: Over time, men who’ve had a spinal cord injury suffer from testicular atrophy which affects their hormone levels and can make it much more difficult to retrieve viable sperm. Fertility rates start to decrease substantially 5-7 years after a spinal cord injury.
Dr. Val: What made this story touching for you?
Dr. Abbasi: I think the whole story is incredibly touching because this young man, who was in the prime of his life, had a freak accident that took away his hope of ever having kids. His rehabilitation medicine physician thought to refer him to a fertility specialist (because he’d heard about the technique we use to retrieve sperm from patients who’ve had spinal cord injuries) and now he’s blessed with a family. Until then he mistakenly believed that there was no hope for a pregnancy after his injury. His life is different now due to his physical limitations, but he is full of joy because of his baby daughter. It gives me goose bumps just thinking about it.
To listen to the full interview (with a step-by-step clinical account of how the fertility procedure was managed), click here.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
May 24th, 2008 by Dr. Val Jones in True Stories
Tags: Emergency Medicine, Infectious Disease, News, Otolaryngology, Pharmaceuticals
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One of my colleagues at Revolution Health has a daughter who is a freshman in college (we’ll call her Julie). Julie has been struggling with a very sore throat for many months, and her mom would occasionally ask my opinion about her care.
Julie initially believed that she had a viral throat infection and tried to wait it out. Several weeks later the pain was quite severe and worsening instead of improving, so she sought help at the student health service at her university. The nurse reassured her and told her to wait a little bit longer and come back in a couple of weeks if things weren’t improving.
Two weeks later Julie was back, and was offered a monospot test (which was negative). The nurse practitioner gave her some samples of Keflex to treat her presumed strep throat, and was told to return in 2 weeks if her symptoms hadn’t resolved. Julie’s mom asked me if I thought that was ok, and I mentioned that drug resistance was not uncommon to Keflex, but that it was really cheap. I explained that Julie’s throat had been sore for an awfully long time, and that if the Keflex didn’t improve her symptoms within a few days, she might want to try something stronger.
Guess what? A week later Julie went back to the student health service with continued symptoms, and their response was to continue the Keflex for a full 10 days. Julie asked if a different antibiotic might be appropriate, and they simply replied that the health service only carried Keflex.
Julie completed the full course of antibiotics with no improvement. She called her mom to ask what she might do next and I suggested that she consider seeing a physician about an antibiotic with a lower resistance profile (like azithromycin). She was unable to get an appointment for a couple of weeks. The student health service nurse said that Julie’s throat did not appear concerning.
As it happened, Julie began having difficulty swallowing, was unable to sleep because of her throat pain, and had a low grade fever. I worried about a peritonsillar abscess (pus trapped in the deep tissues of the throat) and counseled Julie’s mom to get her to a physician right away. Julie flew to DC to be with her mom for the weekend, and was able to get an appointment with a primary care physician who gave her some azithromycin and steroids and said that there did not appear to be any visible signs of a peritonsillar abscess.
Again, Julie’s pain continued unabated. Her throat became even more swollen – and at that point I encouraged them to go to the ER to rule out an abscess. Julie was seen by an affable young ER physician who promptly ordered a CT scan of her neck. Several hours later the diagnosis was confirmed: Julie had pus trapped in the deep recesses of her throat. The ER doc numbed up the tonsil area and inserted a needle into the pus and pulled out several cc’s of thick green goo.
Man I wish I could have been there. (I know that’s a weird response, but docs LOVE pus.)
As I thought about this case, I wondered if we’ve gone too far in withholding antibiotics from deserving patients in our quest to reduce resistant bacterial strains. For every Julie there’s probably 100 others receiving (quite inappropriately) azithromycin for a viral throat infection… but Julie’s case may represent a new kind of provider problem: their own resistance to antibiotics.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
May 15th, 2008 by Dr. Val Jones in True Stories
Tags: Hospitals, International, News, Orthopedic Surgery, Personal, Physical Medicine And Rehabilitation, Physical Therapy
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I spent my senior year of college abroad in Scotland. Between the fall and spring semesters I went on a ski trip to Austria, and in usual Val fashion did something klutzy out of enthusiasm. I was racing down a slalom course in a snow storm and was so excited to have finished without missing a wicket that I looked up at some bystanders to give them a thumb’s up and I tripped on a clump of snow and fell down. Unfortunately my binding didn’t release and I ripped some ligaments off my knee. I heard them pop too. It was quite gross.
Anyway, I was shipped back to Canada for a complex ACL repair procedure by the Olympic Ski Team’s surgeon (I was NOT Olympic material in case any of you had the slightest doubt – I was just in the right hospital at the right time). What followed my fine surgery was a not so fine follow up – in fact I didn’t get any physical therapy whatsoever, and had no idea about how to make my knee functional again. All I knew is that it hurt like heck and I didn’t want to move it. And I pretty much didn’t. Not for a month or so.
Now the healthcare professionals in the audience just winced at that. Not moving a limb for a month is highly inadvisable. My knee became contracted so that I couldn’t straighten it at all. I could barely bear weight on it and I relied almost solely on crutches. I didn’t know how long knees were supposed to take to heal so I figured everyone went through this crutch phase for months.
I returned to Scotland for my spring semester, and I can tell you that traveling alone with one functional leg, a pair of crutches, winter gear and two suitcases is no piece of cake. But the most memorable part of this whole debacle was when I received my new dorm room assignment: the room was on the 5th floor – no elevators. I pleaded with the dorm warden (a humorless, underweight Scottish man with extraordinarily greasy hair and snaggle teeth) to have pity on me and reassign me to a room on the first floor or maybe the second. He handed me the 5th floor room keys unflinchingly.
So it took me about an hour to drag myself and all my stuff up to the 5th floor. I was really in a lot of pain, and totally exhausted from the multi-stop flight overseas – hadn’t slept in about 36 hours. Of course the room was the last one at the end of the hall and no other students had checked in yet – the whole place was deserted because I’d come back early to see if I could get a more conveniently located room (thinking ahead).
When I got to my room I was nearly overwhelmed by the smell of vomit. Apparently the winter session kids had been using my dorm room for drunken partying and had puked on the mattress. I was so tired all I wanted to do was go to sleep but the options were the cement floor or the pukey mattress so I called down to the front desk. The warden picked up – I really couldn’t understand much of what he said in his thick brogue. I explained to him that I’d made it to my room but that the mattress was covered in vomit and I wondered if (now) I might be eligible for a different room. He said he’d come up to check on the mattress.
It took him about 40 minutes to show up. He made no eye contact with me as I limped after him into the room to show him the vomit. He looked at the mattress, smiled wryly, dragged it to the edge of the bed frame and flipped it over. Then he walked out of the room and went back down the stairs to retake his post at the front desk at the entrance to the building.
Now that’s cold.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
May 11th, 2008 by Dr. Val Jones in True Stories
Tags: Personal
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My regular readers know that I’m a very conscientious person, and that although I try my best to prepare in advance for all manner of SNAFUs, I still fall victim to the occasional malfunction or “blonde moment.”
My most recent episode occurred en route to interviewing Governor Huckabee. I was really looking forward to our interview and was quite determined not to have anything go wrong. I packed my briefcase the night before the meeting, and made sure that my digital voice recorder was working, had batteries, etc. and that I had a pad of paper and a pen in case of emergency.
I carefully gathered all my things together and hopped in a cab (a black jeep with a yellow taxi sign on top) to the interview destination – a hotel lobby near the Newseum. I was re-reading my interview questions when I reached into my briefcase to get out my wallet to pay the driver. My heart sank. I had forgotten my wallet! My car-less husband (the first person I hit up for cash) was at a doctor’s appointment across town. I had no friends meeting me at the hotel lobby (and I certainly wasn’t going to ask Gov. Huckabee if he could lend me $20). I explained the situation to the driver and sheepishly asked if he had a card or if I could arrange to meet him later on in the day once I had my wallet.
The driver saw how sincerely sorry I was – and told me that he had no cards, and that I should just consider the ride complimentary. I promised him that I wasn’t in the habit of stiffing taxi drivers, and that I really did want to pay him back. He would have none of it. “It’s not a problem, ma’am. Don’t worry about it.” So off I went to meet Gov Huckabee – and I only dropped my Blackberry once in front of him.
Flash forward 4 days… I’m returning home from The Big Sleep Show (it was in Chicago) and waiting in the taxi line at the Reagan National Airport. This time I have hubby with me (he’s always good for a $20) so I figure the cab ride home will be smooth (though I’ve had some bad experiences with DC cabs in the past). As I get to the front of the line, I look over at the cab that we’re about to get into. It’s a black jeep with a yellow taxi sign on top.
I ask the driver if he remembers a woman who didn’t pay him for an early morning cab ride a few days prior. “Oh, yeah.” He said. “You mean the doctor lady?”
“That was ME!” I exclaimed. “I didn’t know how I was going to repay you for your kindness. And now I can do it in person! This is quite a coincidence.”
The driver smiled and was quiet the whole ride home.
I paid him for both rides plus a nice tip. “Keep paying it forward, brother.” I said, “you never know when it will come back to you.”
What are the odds?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
May 2nd, 2008 by Dr. Val Jones in True Stories
Tags: Dermatology, Personal, Podiatry
5 Comments »
Ask most men how many shoes their wife, girlfriend, or sister has and the
answer is: “too many.” I can’t speak for everyone with large shoe collections,
but I can tell you why I have too many shoes. They each hurt my feet in slightly
different ways – ways that are impossible to predict at the time of
purchase.
Some of my shoes pinch my toes, others cause blisters under the straps, still
others cause blisters on the bottom of my feet or heels. Some of them are
comfortable for short distances but begin to hurt after 5 blocks. I’ve tried to
purchase shoes from the major “comfortable brands,” but without consistent
success in avoiding self-injury.
My husband has difficulty understanding my predicament, as his feet haven’t
seen a blister in over a decade. He occasionally points to his baby soft feet
as evidence of a defect in my own. I protest that women’s shoes are not
comfortable, and he counters with arguments about my not needing any more
shoes.
A recent conversation went something like this:
Dr. Val: [Sitting down on my couch after a long day of
work.] Argh! I’m so disappointed… remember those shoes that looked so
promising when we bought them in the shoe store, honey?
Hubby: [Chewing a bite of sandwich and contemplating my
question.] Which pair might that be?
Dr. Val: You know the nice, wide, dress sandals with a low
heel? [I point to the shoes as I remove them from my bare feet.]
Hubby: The ones that cost a hundred and fifty dollars?!
Dr. Val: Yeah, those ones. Look at what they did to my feet!
[I point out two strips of raw skin on the top of my toes.]
Hubby: [Wincing] There’s something wrong with you.
Dr. Val: What do you mean? I try so hard to find comfortable
shoes and yet I’m always thwarted – no matter how soft they look in the store,
or how expensive they are, they always hurt in the end!
Hubby: Why don’t I hear other people complaining about their
shoes? Everyone seems to be fine with shoes except you.
Dr. Val: I bet other women have shoe problems too… The
only shoes that are comfortable are sneakers.
Hubby: Your sneakers are unattractive.
Dr. Val: I know! That’s why I keep buying more shoes, trying
to find ones that look good but are as comfortable as sneakers.
Hubby: Maybe you have a connective tissue disorder?
Dr. Val: [Eye roll]. I don’t have a connective tissue
disorder. I just need to find that perfect pair of shoes – ones that look good
with suits and shorts and I can walk for long distances in and don’t give me
blisters.
Hubby: You don’t need any more shoes.
***
Am I crazy or do women’s shoes wreak havoc on our feet? Do any of you have
tips for finding that perfect pair of black dress shoes?
(For summer shoe drama, check out my blog post about “flip
flop foot” and racing
in stilettos.)This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
