The idea of creating a game about diabetes both intrigues me and creeps me out a little bit. Diabetes is a game? I guess after an evening of “WHY 200? WHY?!!” I’m not feeling so light and fluffy about diabetes. But I see the potential for kids to learn about diabetes and its management through the use of games, so I’m all so for whatever gets good information out there. And over the last few days, I’ve come across two particularly interesting games, thanks to reader alerts, aimed at kids who either have diabetes or have friends with diabetes.
The first game is on the Nobel Prize educational games site and it’s cleverly called The Diabetic Dog game. (Wee bit short on imagination once they got to the naming part, I suppose.) I will admit – I played this game for at least 15 minutes and I appreciated the cuteness of the doggy.
As a “caretaker,” I was instructed to keep my diabetic doggy (named, in my profile, “DoggyPants”) happy (by petting him), well-fed (by purchasing food for him), getting him to exercise (by walking him), and keeping his blood sugar in check by giving him insulin injections. Keeping an eye on the bar at the bottom left of my screen let me know what DoggyPants’s blood sugar was, and I could feed and dose him accordingly.
(Sidenote: Having that bar gauge with his blood sugar in it sure helped me figure out what I was doing, and I wondered if the developers of this Diabetic Dog Game realized how they’re helping further the case for continuous glucose monitors.)
Overall, I liked how this game showed the importance of insulin, food choices, and exercise as the cornerstones for good diabetes management, and it didn’t tout insulin as “a cure.” Basically, all you do is chase this little puppy around and feed him or dose him or walk him. Constant cycle of redundancy, only the results aren’t predictable. Kind of like real life. 🙂
The other game I have been receiving reader alerts on is the Didget from Bayer. I haven’t seen this game in person, but according to the word on the street (read: their website), “The Didget blood glucose meter from Bayer is the only meter that plugs into a Nintendo DS or Nintendo DS Lite gaming system to reward children for consistent testing.”
So it’s an actual meter that snaps into the Nintendo system. (It appears to be, or be completely identical to, the former “GlucoBoy” from a bit ago.) Honestly, that is pretty darn cool, and I wish that kind of “fun” was available when I was testing my blood sugar as a kid. Hell, I’d like to have that kind of positive reinforcement NOW, thank you very much.
“This unique meter helps encourage consistent testing with reward points that children can use to buy items within the game and unlock new game levels. And, since the DIDGET meter is based on Bayer’s trusted CONTOUR™ system, you know you’re getting a meter that’s reliable.” They are also building a community for kids to “hang out in” virtually, comparing notes. Of course, since it’s Bayer, they need to slide in their personal product endorsement, but they have the right idea. Test often, get rewarded for keeping tabs on your numbers, and maybe Nick Jonas will show up at your house and give you a hug.
That last part? A lie. But Bayer is working its way into the hearts of kids with diabetes, and as a former kid with diabetes myself, I would have appreciated that kind of innovation as part of my childhood with this disease. From what I can tell so far, this meter is being marketed towards diabetics in the UK, but hopefully there will be a United States counterpart. With mg/dl readings. Because doing conversions when low? Not so easy.
So there you have it. We’ve come a long way from that game with the elephants or the other one about the Escape from Diab, and hopefully more efforts will be made to engage kids – and adults! – with diabetes. Positive reinforcement is hard to come by in this whole diabetes mess, so every little bit helps.
*This blog post was originally published at Six Until Me.*
A team at Johns Hopkins has coordinated the world’s largest kidney swap, involving sixteen patients in multiple medical centers across the US. One of the donors was the vice president of human resources at Johns Hopkins Health System, a woman who has promoted organ donation and finally got a chance to do the ultimate charity work herself.
Johns Hopkins reports:
An altruistic donor started the domino effect. Altruistic donors are those willing to donate a kidney to any needy recipient. Just like falling dominoes, the altruistic donor kidney went to a recipient from one of the incompatible pairs, that recipient’s donor’s kidney went to a recipient from a second pair and so on. The last remaining kidney from the final incompatible pair went to a recipient who had been on the United Network for Organ Sharing (UNOS) waiting list.
As part of this complex procedure, Johns Hopkins flew one kidney to Henry Ford, one kidney to INTEGRIS Baptist and one kidney to Barnes-Jewish, In exchange, Henry Ford, INTEGRIS Baptists and Barnes Jewish each flew a kidney to Johns Hopkins.
The 16 surgeries were performed on four different dates, June 15, June 16, June 22 and July 6. The 10 surgeons in charge included four at Johns Hopkins, two at INTEGRIS Baptist, two at Barnes-Jewish and two at Henry Ford.
Johns Hopkins surgeons performed one of the first KPD transplants in the United States in 2001, the first triple-swap in 2003, the first double and triple domino transplant in 2005, the first five-way domino transplant in 2006 and the first six-way domino transplant in 2007. Johns Hopkins also performed the first multihospital, transcontinental three-way swap transplant in 2007 and the first multihospital, transcontinental six-way swap transplant in 2009.
Nearly 100 medical professionals took part in the transplants, including immunogeneticists, anesthesiologists, operating room nurses, nephrologists, transfusion medicine physicians, critical care doctors, nurse coordinators, technicians, social workers, psychologists, pharmacists, financial coordinators and administrative support people.
*This blog post was originally published at Medgadget*
Dr. Alan Dappen, Dr. Steve Simmons, and nurse practitioner Valerie Tinley are regular contributors to the Better Health blog. I’m a big fan of their innovative medical practice, and decided to follow them during one of their work days as they deliver affordable, quality healthcare to patients in Virginia.
This is how primary care used to be… and a model that deserves more attention.
In 2006 the Centers for Disease Control and Prevention (CDC) estimated that 1.1 million people were living with HIV, 4.4% of whom were 13 to 24 years old, and 48% of those youth are unaware they are infected. Using the Youth Risk Behavioral Survey (YRBS) data from 2007, the CDC estimated that about 12.9% of high school students had been tested for HIV.
The good news is that the highest risk teens were the ones getting tested more often, but only 22% of the highest risk teens had been tested.
To decrease the number of undiagnosed HIV infections among adolescents and promote HIV prevention, the CDC recommends that healthcare providers offer HIV screening as part of routine medical care for all people ages 13 to 64. People at high risk should be tested every year, including:
Injection drug users;
Anyone who exchanges sex for money or drugs;
Sex partners of people with HIV;
Men who have sex with men;
Heterosexual people who have more than one partner since their most recent HIV test; and
Anyone who gets a sexually transmitted disease.
High schools can support that effort by including information about HIV testing in the health curricula. People familiar with the benefits and process of the testing and counseling are more likely to be tested.
For teens, I usually suggest they go to anonymous testing sites in their community to be testing, so that the test is not including in their medical record. The anonymity also gives them a little extra courage. The trick is that they cannot lose their test number for the two weeks they wait for results.
Macrodactyly is an uncommon anomaly of the extremities. It can affect both the fingers or toes which become abnormally large due to overgrowth of the tissues composing the digit. All the tissues are involved: bone and soft tissue-particularly the nerves, fat and skin. (photo credit)
Other names used for macrodactyly include megalodactyly, overgrowth, gigantism, localized hypertrophy, or macrodactylia fibrolipomatosis.
Hands are more commonly involved than feet. Most of the time (~90%) patients present with unilateral (one side affected) macrodactyly. Often more than one digit is involved. The most frequently involved digits of the hand are the index finger, followed by the long finger, thumb, ring, and little fingers. Syndactyly may be present in 10% of patients. Men are more often affected than women.
It is not known why macrodactyly occurs. It does not appear to be an inherited anomaly, but there are some syndromes (ie Proteus Syndrome, Maffuci syndrome, and tuberous sclerosis) which may be associated with enlarged digits. There are some surgeons who believe that macrodactyly is a variant of neurofibromatosis.
Macrodactyly may be either static or progressive. The progressive type is more common than the static.
In static the enlarged digit (finger or toe) is present at birth and continues to grow at the same rate as the normal digits of the hand. The involved digits are generally about 1.5 times the normal length and width of the normal digits.
In progressive the affected digits begin to grow soon after birth and continue growing faster than the rest of the hand. The involved digit or digits can become enormous.
There is no medical treatment for this disorder. It is treated by surgery. In the hand, the indications for surgery can often be cosmetic in nature as the hand can functionally tolerate a digit with some increased width and length. In the foot, the enlarged digit can make shoe fitting/wearing difficult.
Surgical treatment of macrodactyly is complex as multiple tissue layers are involved. It typically will involve debulking, epiphyseal arrest, and shortening. Multiple surgeries are the norm.
Soft tissue debulking:
This is done to help correct the width of the digit. This is often done at the same time as the epiphyseal arrest. The affected fingers are approached volarly with Bruner-type incisions/flaps. The fat is removed from the skin and the tissues are debulked.
Care is taken to preserve the ulnar and radial digital neurovascular bundles. Sometimes the enlarged nerve branches will need to be sacrificed along with the enlarged subcutaneous tissues.
When a sufficient amount of tissue has been removed, the skin flaps are overlapped and excised, which allows for tension-free closure. It needed, skin grafts using healthy skin will be done.
Debulking is often need to be done in staged procedures.
Shortening procedures:
This is done to help correct the length of the digit. Shortening procedures usually involve either surgical excision (removal) of one of the phalanges of the finger or toe, or removal of a metacarpal (hand bone) or metatarsal (foot bone).
Barsky and Tsuge originally introduced the two most described methods. Barsky’s technique involves removing the distal portion of the middle phalanx and proximal portion of the distal phalanx, thereby reducing the length of the finger while preserving the nail. Tsuge’s technique also preserves the nail by overlapping the dorsal portion of the distal phalanx with the volar portion of the middle phalanx.
Ray resection:
This may be done in progressive macrodactyly. It involved the complete removal of the digit or digits. It is also an option if there is excessive widening of the forefoot, where digital shortening and debulking procedure may not be effective.
Epiphyseal Arrest:
The timing of the this surgery is critical. An attempt to “guess” the adult finger length is done by comparing the child’s digits with those of his/her parents. When growth of the affected digits matches those of the parent, epiphyseal arrest can be performed. This in effect will stop the bone growth of the digit.
The epiphyses of the proximal and distal phalanges are the ones treated by disruption or removal. The middle phalanx epiphyses is not treated to help preserve motion at the proximal interphalangeal joint.
Other surgical options include amputation and wedge osteotomies. Amputation is reserved for patients with nonfunctioning digits or digits that are extremely difficult to correct. Wedge osteotomies are performed in patients who have digits that are grossly deviated.
Complications of macrodactyly surgery include poor healing of flaps secondary to devascularization or undue tension, nerve injury or decreased sensation, infection, stiffness, bony nonunion or malunion, and failure of the epiphysiodesis.
REFERENCES
Wood VE. Macrodactyly. In: Green DP, Hotchkiss RN, eds. Operative Hand Surgery. 4th ed. New York, NY: Churchill Livingston; 1998:533-544.
Treatment of macrodactyly; Plast Reconstr Surg. 1967; 39:590-599; Tsuge K.
Congenital anomalies of the hand; Cohen M, ed. Mastery of Plastic and Reconstructive Surgery. New York, NY: Little, Brown and Company; 1994; Upton J, Hergrueter C.
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