November 12th, 2010 by John Mandrola, M.D. in Better Health Network, Humor, Opinion, True Stories
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I loved my old status. Perhaps, reveled in it would be a better description. I was a crotchety, generic medicine-only doctor.** Sadly, my status changed today. Dabigatran (brand name Pradaxa) was the culprit.
It was a little nerve racking. I wrote the order, looked at it, thought it out again, talking to myself: “John, are you sure you don’t want to do it the old way? [pause to think] No, I am embracing the new.” And then, I closed the chart and handed it to the nurse.
“What’s that? Pradaxa?” asked the nurse. “Stop the Lovenox? You sure?” My face must have told the story.
Eight days had passed since dabigatran’s approval. “That’s plenty of time to mourn warfarin’s demise,” I thought. Enough studies, enough blogs — it was time for the rubber to hit the road. Read more »
*This blog post was originally published at Dr John M*
October 9th, 2010 by John Mandrola, M.D. in Better Health Network, Health Tips, Opinion, True Stories
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It’s been a very busy few weeks. Medicine is like that — seldom is “business” steady. Like rainy weeks in the southeast when you think it will never be sunny again, there are weeks when you think everyone’s atria are fibrillating. So there were shocks, and burns, and wires installed. The heart rhythm was rocking, and so were we.
But in all this fury two cases stand out as a reminder that in spite of, not always because of, what we doctors do, the human body can right itself — like it did before their were drugs, procedures, and surgery. (Keep this quiet, though.)
Case 1: A semi-emergent consultation for atrial flutter (AF’s crazy sister) came in. “Something has to be done, Dr. M,” was the message. She was symptomatic and scared (not necessarily in that order), but after a bit of simple doctoring (a pill), the heart rate had slowed and the symptoms abated somewhat. Then after a heavy dose of an AF doctor’s greatest weapon, reassurance and education, we mutually decided on one of my secret treatments for acute AF/AFlutter: A deep breath, a chair, a book, and time. Just in case, though, a cardioversion (shock) was set up for the next morning. I knew that since this was a first episode, that given some time the heart may right itself, without any fury.
Bingo. The text message came the next morning: “Cardioversion cancelled. Patient converted to sinus rhythm right after you saw her yesterday.” (Grin.) Read more »
*This blog post was originally published at Dr John M*
September 26th, 2010 by John Mandrola, M.D. in Better Health Network, Health Tips, True Stories
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“It was the best of times, it was the worst of times…”
An intermission, the curtain has closed on youth, but the next act awaits.
Caring for hiccups of the heart, like atrial fibrillation for example, often throws me in front of the mirror, of middle age that is, and sadly the reflections show imperfections. Since I am middle aged myself, there are my own experiences. But everyday at work, on my job site, I see the effects of these same middle-age experiences on the atrium of my patients. The results are often profound. So must be the pressures.
I read a passage in the wee hours of the quiet morning, in the dark, with a flickering book light. It grabbed me. It is from Elisabeth Strout’s Pulitzer Prize-winning, Olive Kitteridge. Read more »
*This blog post was originally published at Dr John M*
June 2nd, 2010 by GarySchwitzer in Better Health Network, Health Policy, News, Opinion, Research
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A couple of health journalism gems you shouldn’t miss just because they were published over the holiday weekend:
Natasha Singer of the New York Times had an important piece, “When Patients Meet Online, Are There Side Effects?,” about privacy concerns when social networking sites like CureTogether.com and PatientsLikeMe.com offer online communities for patients and collect members’ health data for research purposes.
John Fauber of the Milwaukee Journal-Sentinel published another in his “Side Effects” series on conflicts of interest in healthcare. This one was about doctors vouching for the drug Multaq for treating atrial fibrillation without ever having seen all of the data.
The Minneapolis Star Tribune began a “Too Much Medicine” series. Health editor Dave Hage informs that they’ve been working on this project for nearly a year with plans for a few more installments in coming months, each covering different ailments and procedures that are over-used or under-proven. (Unfortunately, I think the series is only available in the print editions.)
*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*
March 31st, 2010 by DrWes in Better Health Network, Opinion, Primary Care Wednesdays, True Stories
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It’s very generous of Sanolfi-Aventis’s marketing department to make this offer for me to serve as an “advisor” for dronedarone (Multaq), but seriously–I was a bit skeptical that they wanted my “feedback on the reasons for and against utlilization of Multaq® in the appropriate patient as well as to understand communication and educational needs with regard to Multaq® and the atrial fibrillation state in general.”
Where were they when the drug launched? Might it be because this drug hasn’t quite been the blockbuster they’d hoped for?
But, of course, I’d never be swayed to use more of this drug by such important consulting work. No, really.
P.S. Sanolfi-Aventis marketers: Please update your prescriber database with my correct workplace.
–Musings of a cardiologist and cardiac electrophysiologist.
*This blog post was originally published at Dr. Wes*
