March 24th, 2008 by Dr. Val Jones in Medblogger Shout Outs
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I was really impressed with some beautiful work done by a French plastic surgeon on behalf of this patient with Von Recklinghausen’s disease (Elephant man’s syndrome). Thanks to Dr. Bates for pointing it out. A full face transplant was performed with incredible improvement in the man’s appearance and quality of life. I discussed the ethics behind face transplantations in a previous post.
I also applaud the plastic surgeon who carefully filled the nose defect of my fellow blogger TBTAM who had a large basal cell carcinoma removed from the side of her face. See the post-op photo and recent healing shot here. I myself have had some facial surgery, after being mauled by a dog as a child.
I am so grateful to the surgeons who do this kind of work. I know they get a bad rap with all the Dr. 90210 publicity and breast/botox focus. But there are also many unsung heroes. This post is for you! Many thanks from those whom you’ve helped over the years.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
March 24th, 2008 by Dr. Val Jones in True Stories
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I was participating in morning rounds with a team of internal medicine residents. That day was the beginning of a rotation change, and a new “house attending” (the doctor in charge of the inpatients who had no primary care physician) was getting to know his patients. The residents who had been caring for the patients took turns explaining (near the bedsides) what had gone on since their admissions to the hospital, and described their treatment plans.
One intern presented a case of a patient with “fever of unknown origin” (FUO). This particular diagnosis will make any internal medicine specialist delirious with curiosity and excitement, since it means that all the previous attempts at discerning the cause of the patients fever have failed. Generally, a fever only receives this exciting honor when it has gone on for at least 3 weeks without apparent cause.
The intern explained (in excruciating detail I might add) every single potential cause of the fever and how he had ruled them out with tests and deductive reasoning. The attending was hanging on every word, and nodding in approval of some real zebras (rare and highly unlikely causes for the fever) that the intern had thought to consider and disprove.
I must admit that my mind wandered a bit during this long exercise, and instead I looked at the patient, smiled, and examined his thick frame with my eyes. Of course, an attending has a keen sense for wandering minds, and so to “teach me a lesson” he abruptly stopped the intern’s presentation and looked me dead in the eye. You could have heard a pin drop.
“So, Dr. Jones” he snarled. “You seem to have this all sorted out, don’t you. Apparently you have determined the diagnosis?”
“Well, yes, I think I may have.” I replied calmly.
The attending’s face turned a slightly brighter pink. “Well, then, don’t withhold your brilliance from us any longer. You’re a rehab resident, are you not?” He made a dismissive move with his right hand and rolled his eyes.
“Yes, I am.” (Snickers from the internal medicine residents.) I shot a glance at them that shut them up.
I continued, “Well, Dr. ‘Attending,’ as the intern was reviewing the potential causes of FUO, I took a look at the patient. It seems that there is a pus stain on the bottom of his right sock. I didn’t hear the intern describe the patient’s foot exam.”
The intern’s face went white as a sheet.
The attending turned to the intern with an expression of betrayal. “Did you examine this patient’s feet?”
“Well I uh… well, no.” Stammered the intern. “I guess I forgot to remove his socks.”
The attending marched over to the bedside and quickly removed the patient’s right sock, a small snow storm of dried skin flakes fell gently to the hospital floor. A festering foot ulcer proudly displayed itself to the team.
The attending gingerly nodded at me. He turned to the intern and announced that he would be given an extra night of call this month so that he’d have time to examine his patients’ bodies from head to TOE.
The patient was treated with antibiotics and sent home.
The intern later went on to become a radiologist.
I am working on improving patient empowerment on a national basis through Revolution Health.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
March 23rd, 2008 by Dr. Val Jones in True Stories
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I just learned a valuable lesson.
A friend of mine described some fluid build up in her knee, made worse by exercise. She said she had seen an orthopedist who recommended surgery… and she wondered what I thought. Based on her description, I assumed that she had an acute knee effusion – potentially from some recent exercise-induced ligament or meniscal damage.
My friend said that she was concerned about having surgery, and that she was planning to have an MRI first. I must admit that I was a little bit confused as to why surgery was recommended so quickly, without having the MRI results to confirm the cause of the effusion (and that surgical correction was warranted). My knee jerk response was to question the clinical judgment of the orthopedist, and to wonder if he was too “surgery happy” and was leading my friend away from conservative measures (of which I am a great fan).
Several weeks passed, and I finally met my friend in person for a quick look at her knee (she was still waiting for the MRI). Guess what? She did NOT have a knee joint effusion at all. What she had was an almond-sized ganglion cyst on the side of her knee.
I felt pretty silly. Of course the orthopedist recommended surgery (a tiny procedure under local anesthetic) without the MRI. He was indeed offering the appropriate treatment.
Sometimes a picture’s worth 1000 words. And sometimes the physical exam can make the diagnosis – no other studies needed.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
March 21st, 2008 by Dr. Val Jones in Uncategorized
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This week I was honored to be featured as the first post in the line up at Polite Dissent’s Grand Rounds. Over the past couple of weeks Revolution Health’s bloggers have been doing their part to contribute to health knowledge. Here’s my round up of the best of their recent posts:
Health tips
Spring break is coming up for millions of children and teens. Dr. Stacy Stryer has some health tips for sun and water safety.
Stretching is an important healing technique for some injuries and conditions. Dr. Jim Herndon explains what we know about the use and value of stretching exercises.
Does an affair mean your marriage is over? Mira Kirshenbaum has some suggestions for healing after infidelity, and a group to help you do it.
Some people feel regret after prostate cancer surgery. Dr. David Penson offers some empathy and advice.
What’s new in prostate cancer treatment? Dr. Mike Glode give a short synopsis.
Meditation might decrease your sleep requirements. Dr. Steve Poceta reviews this claim.
Did you know?
Men hate to apologize. Relationship expert Mira Kirshenbaum has some ideas as to why that might be.
Teen scientists are contributing to colon cancer research. Dr. Heinz-Josef Lenz discusses what his daughter and a Junior Nobel Science Award-winning teen have in common.
Toenail fungus is very common in the elderly. Dr. Joe Scherger explains why this is so, and why it’s so difficult to treat.
Overweight menopausal women may suffer more severe hot flashes. Dr. Vivian Dickerson explains why.
An anti-snoring shirt has been developed to help people remain on their sides while asleep. Dr. Steve Poceta explains how sleep position is related to snoring.
Human growth hormone doesn’t actually strengthen your muscles, it just makes you retain water. Dr. Jim Herndon reviews the latest research.
There’s a new clinical trial designed for women with metastatic colon cancer. Dr. Heinz-Josef Lenz explains what the scientists are hoping to learn from the research study.
Baby-naming is an art. Dr. Stacy Stryer discusses the history of finding just the right name for your child.
Patient advocate Robin Morris discusses her opinion of Larry King’s recent autism-focused show.
How should a doctor share bad news with a patient? Neurologist Larry Leavitt explains.
***
Happy Easter weekend everyone!
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
March 20th, 2008 by Dr. Val Jones in News
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About a year ago I had the chance to speak with the founder of Micromedex Inc. about his views on the potential differences between brand name and generic drugs. He expressed some concern about the allergenic potential of filler substances in both brand name and generic drugs, and I was quite interested in the clinical impact of these differences.
Just recently, an article in the LA Times has shed more light on the debate about drug equivalency, and my fellow bloggers Abel Pharmboy and Joseph (at Corpus Callosum) have summarized the issues very well. As it turns out, the FDA allows for a fairly broad interpretation of equivalency when it comes to the rate at which the bioactive ingredients are released into the bloodstream.
To use an imperfect analogy – let’s pretend that water is the drug you’re taking. You can access water from a drinking fountain or a fire hydrant, and the amount you get in your mouth all at once may vary between the two sources, though the water itself is the same “drug.” This is the sort of difference that exists between some generic drugs and their brand name “equivalents.” The rate at which they get into your system can differ by as much as 36% and still be considered identical drugs by the FDA.
Now, imagine that someone offered you water in a paper cup or in a water balloon. The water’s container (analogous to the “inert filler” used to hold the medicine together in a pill or liquid form) is made of different substances (paper versus latex) and doesn’t make that much of a difference in quenching your thirst… unless you’re allergic to latex.
So there are true differences between generic and brand name drugs, though most of the time these differences are not clinically important. But in those special circumstances where people are allergic to fillers, or need a constant or regular concentration of their drug in the bloodstream, generic vs. brand name really does matter.
However, I think that in general generic drugs are terrific and have substantially reduced costs and increased access for millions of people. It is reasonable to save money by switching to generic drugs when possible. It is also important to resist the urge to believe that higher drug prices guarantee more effective products. In a recent JAMA article it was demonstrated that people believed that pain medication placebos were more effective if they were told that they were also more expensive.
But, if you’re one of those patients who tried switching to a generic drug and found it less effective – don’t let your doctor tell you you’re imagining things. There could be a real difference that you need to explore.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
