March 18th, 2007 by Dr. Val Jones in True Stories
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Always do right. This will gratify some people and astonish the rest.
–Mark Twain
My favorite writer of all time is Mark Twain. His keen observations and uncanny ability to combine wisdom and wit makes his writing incredibly entertaining, don’t you think? I thought it would be fun to take a few of his quotes and illustrate them with true stories from my mental archives.
Today’s quote is about doing the right thing. I remember a case where a young internal medicine intern was taking care of a 42 year old mother of 3. The mother had HIV/AIDS and had come to the hospital to have her PEG tube repositioned. Somewhere along the way, she required a central line placement, and as a result ended up with a pretty severe line infection. The woman’s condition was rapidly deteriorating on the medicine inpatient service, and the intern taking care of her called the ICU fellow to evaluate her for admission to the intensive care unit.
The fellow examined the patient and explained to the intern that the woman had “end stage AIDS” and that excessive intensive care management would be a futile endeavor, and that the ICU beds must be reserved for other patients.
“But she was fine when she came to us, the line we put in caused her downward spiral – she’s not necessarily ‘end stage,’” protested the intern.
The fellow wouldn’t budge, and so the intern was left to manage the patient – now with a resting heart rate of 170 and dropping blood pressure. The intern stayed up all night, aggressively hydrating the woman and administering IV antibiotics with the nursing staff.
The next day the intern called the ICU fellow again, explaining that the patient was getting worse. The ICU fellow responded that he’d already seen the patient and that his decision still stands. The intern called her senior resident, who told her that there was nothing he could do if the ICU fellow didn’t want to admit the patient.
The intern went back to the patient’s room and held her cold, cachectic hand. “How are you feeling?” she asked nervously.
The frail woman turned her head to the intern and whispered simply, “I am so scared.”
The intern decided to call the hospital’s ethics committee to explain the case and ask if it really was appropriate to prevent a young mother from being admitted to the ICU if she had been in reasonable health until her recent admission. The president of the ethics committee reviewed the case immediately, and called the ICU fellow’s attending and required him to admit the patient. Soon thereafter, the patient was wheeled into the ICU, where she was treated aggressively for sepsis and heart failure.
The next day during ICU rounds the attending physician asked for the name of the intern who had insisted on the admission. After hearing the name, he simply replied with a wry smile, “remind me never to f [mess] with her.”
The patient survived the infection and spent mother’s day with her children several weeks later.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
March 13th, 2007 by Dr. Val Jones in News
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For those who are faint of heart, please do not click on this link (via KevinMD). This poor man living in Eastern Europe developed a rare disorder (called Lewandowsky-Lutz dysplasia) where he had growths appear on his hands and feet starting at age 14. Many years later the growths are quite disfiguring and difficult to remove.
Some speculate that this may be similar to a warty disorder in rabbits. Either way, it is a little disturbing to me that this condition could be triggered by a virus. Viruses, of course, can be quite contagious…
Any dermatologists out there want to weigh in?
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
March 3rd, 2007 by Dr. Val Jones in News
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A Canadian news story piqued my interest today – apparently, a man living near Edmonton, Alberta was bitten by a bat during his sleep. Curiosity got the better of me as I tried to recreate the scenario in my head. First of all, “vampire bats” (the kind that feed on the blood of livestock) don’t live in Canada, so this little guy was probably a generic “brown bat.” Brown bats are shy creatures who live on insects primarily, so we know that this bat was in a pretty wacky frame of mind to boldly mistake a sleeping human for a beetle.
Stranger than the behavior of this culinarily confused little mammal, was the behavior of the sleeping victim. Apparently he was unconcerned by the bite and went back to sleep afterwards, never seeking medical attention. I don’t know about you, but if I woke up in the middle of the night with any wild animal sinking its teeth into my flesh, I’d probably not shrug and roll over.
Anyway, the sad news is that this man didn’t get his life-saving rabies shots. Rabies is a very serious condition with a 50% mortality rate! The rabies virus (transmitted through infected animal saliva) wreaks havoc on the brain and nerves. The CDC describes it:
Early symptoms of rabies in humans are nonspecific, consisting of fever, headache, and general malaise. As the disease progresses, neurological symptoms appear and may include insomnia, anxiety, confusion, slight or partial paralysis, excitation, hallucinations, agitation, hypersalivation, difficulty swallowing, and hydrophobia (fear of water). Death usually occurs within days of the onset of symptoms.
Isn’t it strange that “fear of water” is part of the rabies syndrome? I’d like to get an explanation of that one from a neurologist…
Anyway, human cases of rabies are quite rare (about 7000 cases/year in the US) and are usually caused by raccoon or skunk attacks. So if you come face to face with a raccoon or skunk “gone wild” my advice is to run away. But if you do get bitten, please go to the hospital immediately and get your rabies shots. You can prevent progression of the disease.
Now, if you’re curious to see if you’re in a rabies “hot zone” check out the CDC’s skunk and raccoon tracking maps (can you believe that someone’s job is to create these?)
And for a good spoof of dangerous animals – check out Dr. Rob’s recent warnings against the common goat. You can tell that he must enjoy Monty Python style humor.
Are you an animal lover? Know of some funny websites or links about animal antics? Do share!
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
February 22nd, 2007 by Dr. Val Jones in News
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Recent research suggested that circumcision may reduce the rate of HIV transmission by 50% (foreskin cells are particularly vulnerable to infection with the virus). In response to this news, adult men in Uganda and Kenya have been undergoing the procedure in the hope of reducing their risk of HIV infection.
Some young boys in Kenya were actually expelled from school for not being circumcised. Their parents were asked to bring them back to school once the deed was done.
HIV rates have decreased in Uganda from 15% to 5% after aggressive public health initiatives raised awareness of the importance of safe sexual practices. This is an incredibly positive achievement.
One would hope, however, that circumcision in infancy would become the preferred target age for future procedures.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
February 21st, 2007 by Dr. Val Jones in News
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Malaria is caused by a crafty little parasite that has become resistant to many medicines. But now researchers at Northwestern University have discovered a chink in its armor – a blood pressure medicine called propranolol. Who knew that a common beta-blocker used to treat hypertension might provide the death blow to such a scourge?
Usually, malarial parasites infect their host’s blood stream through a mosquito bite, and then congregate in the liver and pounce on red blood cells as they pass by. They have a way of adhering to the red blood cells via certain surface receptors (beta 2 adrenergic receptors linked to Gs proteins). They latch on to the red cells and then burrow into the cell and hijack it in order to reproduce inside it. Then, like the horror movie Alien, once they’re fully grown (into “schizonts”) they burst out of the cells and roam free to repeat the process all over again.
Now propranolol happens to block the Gs proteins, which effectively makes it impossible for the parasites to attach themselves to the red blood cells (which they need to use to reproduce themselves).
So what’s the caveat to of all this? Well, folks don’t know they have been infected with malaria until they have symptoms, and the symptoms include high fevers and low blood pressure… so giving someone a medicine that lowers their blood pressure even further might not be a good idea.
The other caveat is that propranolol works like a charm in the test tube, and in mice, but we haven’t yet tried it out in humans who have malaria.
Still, it seems to me that a little bit of propranolol might go a long way to preventing malarial infections in at risk populations. I’ll be interested to see what further studies show!
And if you’re interested, I’ll create a few more blog posts about parasites and other creepy crawly human invaders… Just let me know if you can handle more of this!
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
