September 17th, 2007 by Dr. Val Jones in News
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Physicians have known for at least 40 years that infectious bacteria (like staphylococcus aureus) can be transmitted on clothing. And now, as part of a comprehensive plan to reduce hospital infection rates, Britain’s National Health Service has recommended against physicians wearing white coats.
An interesting research study showed (back in 1991) that the dirtiest part of physicians’ coats are the sleeve tips and pockets. But surprisingly, coats that were washed at 1 week intervals and coats that were washed at 1 month intervals were equally capable of transmitting bacteria. Now that multi-drug resistant bacteria have become so common, they too can hitch a ride on coat sleeves and make their way from patient to patient.
During my residency, I clearly remember being horrified by the grunge I saw on my colleagues’ coats, all hanging up together on hooks outside the O.R.s. and in various parts of the hospital. I used to wonder if they were spreading diseases – but comforted myself that many bacteria need a moist environment to survive – so while the coats were certainly filthy, by and large they were not moist. Unfortunately my self-comfort was somewhat ill conceived – gram negative bacteria (like E. coli) do indeed need moisture for survival, but many viruses and gram positive bacteria (they usually live on the skin) do just fine in a dry environment. Other studies have confirmed that stethoscopes also carry a high bacterial load if not cleaned between patients. In fact, in reviewing some research studies for this blog post, I found that researchers have analyzed everything from hospital computer keyboards, to waiting room toys and patient charts. Infectious bacteria have been cultured from each of these sites.
Which leaves me to wonder: can we ever create a sterile hospital environment? Not so much. Although I agree that infections can be spread by white coats, and that a short sleeved clothing approach might help to reduce disease spread, I’d like to see some clear evidence of infection rates being reduced by not wearing coats before I’d prescribe this practice uniformly (pun intended). Bacteria can be spread on any type of clothing, by blood pressure cuffs, by stethoscopes, by dirty hands, by hospital charts… and we certainly can’t dispose of all of these. What would be left?
White Coat Rants (a wonderful new ER blog) describes the “ER of the future” – adhering to all the possible safety concerns of oversight bodies. Take a look at this whimsical perspective on what it would take to make the Emergency Department truly “safe” and imagine what it would take to make the hospital totally sterile.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
September 16th, 2007 by Dr. Val Jones in Health Policy, News
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I was glad to to hear from Wendy from wendysbattle.com … like my friend, she is battling stage IV colon cancer. Unlike my friend, she lives in Ontario and has no assistance to pay for her chemotherapy. In a jaw dropping video from a cancer press conference in Ontario, Wendy and 2 other colon cancer patients testify about being denied coverage for standard of care colon cancer therapy. Wendy says that Ontario has valued her life at less than $18 thousand dollars.
In a recent interview with Senator Mike Kirby, I learned that one of the major problems facing the Canadian healthcare system is the cost of expensive new drugs. The universal system was designed to have patients pay out of pocket for their medicines and have the government cover almost everything else. When this health insurance strategy was created, drugs were very inexpensive. However, with all of the technological advances in medicine – diseases like HIV/AIDS and cancer have become chronic, manageable illnesses with expensive treatment price tags. And now, the lack of drug coverage is shifting unmanageable costs directly to the patient. Sadly, Wendy is one of many victims of lack of drug coverage in Canada.
All this to say that the grass is not really greener in Canada – especially for cancer patients.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
September 13th, 2007 by Dr. Val Jones in News
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My friend and fellow blogger, Kelly Close, tipped me off to a very powerful new diabetes awareness ad campaign that begins today. These will run as TV commercials and Internet ads. I thought they were really thought provoking and original. They feature every day scenarios (like a boating trip, ordering food at a restaurant, and greeting a new dog) and then reveal the hidden danger in each “innocent” situation. Then they go on to say that you don’t have to be taken by surprise by diabetes, as there is a test (hemoglobin A1C) that can give you a glimpse into the future.
As many as a third of people who have diabetes are unaware that they have it. As many as 80% of diabetics do not know what their hemoglobin A1C level is. These are shocking statistics for a disease that is treatable, and complications that are preventable. If you haven’t been checked for diabetes and you have reason to suspect that you might be at risk for it (you are substantially overweight, you have diabetes in your family, or you have symptoms of diabetes such as abnormal thirst and frequent urination) please go to your primary care physician for a check up. Diabetes is one disease that we can control well and sometimes cure – but ignoring it could result in kidney failure, blindness, amputations, and heart disease. Let’s take these TV ads to heart and get blood sugar under control in America.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
September 10th, 2007 by Dr. Val Jones in True Stories
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I was having lunch in a DC garden hideaway with some colleagues from Revolution Health when the subject of 9/11 came up. We all agreed that it was one of those events that everyone remembers vividly, no matter where they were in the world at the time. Each of us took turns telling the others where we were and what we were doing on that fateful day. Each person’s account was moving and personal. My story follows… [insert fuzzy dream sequence graphics here]
I was getting off a night shift rotation at a hospital in lower Manhattan, sitting in morning report – my eye lids sticking to dry corneas, my head feeling vaguely gummy, thoughts cluttered with worries about
whether or not the incoming shift of residents would remember to perform all the tasks I’d listed for them at sign out.
And as I dozed off, suddenly our chief resident marched up to the front of the room, brushing aside the trembling intern who was presenting a case at the podium at the front of the dingy room. “How rude of him” I thought hazily, as I shifted in my seat to hear what he had to say.
“Guys, there’s been a big accident. An airplane just crashed into the World Trade Center.”
Of all the things he could have said, that was the last thing I was expecting. I shook my head, wondering if I was awake or asleep.
“We don’t know how many casualties to expect, but it could be hundreds. You need to get ready, and ALL of you report back to the ER in 30 minutes.”
I thought to myself, “surely some misguided small aircraft pilot fell asleep at the controls, and this is just an exaggeration.” But worried and exhausted, I went back to my hospital-subsidized studio apartment and turned on the TV as I searched for a fresh pair of scrubs. All the channels were showing the north tower on
fire, and as I was listening to the news commentary and watching the flames, whammo, the second plane hit the south tower. I stared in disbelief as the “accident” turned into something intentional. I remembered having dinner at Windows on the World the week before. I knew what it must have looked like inside the buildings.
I was in shock as I hurried back to the hospital, trying to think of where we kept all our supplies, what sort of injuries I’d be seeing, if there was anything I could stuff in my pockets that could help…
I joined a gathering crowd of white coats at the hospital entrance. There was a nervous energy, without a particular plan. We thought maybe that ambulances filled with casualties were going to show up any second.
The chief told me, “Get everybody you can out of the hospital – anyone who’s well enough for discharge home needs to leave. Go prepare beds for the incoming.”
So I went back to my floor, recalling the patients who were lingering mostly because of social dispo issues, and I quickly explained the situation – that we needed their beds and that I was sorry but they had to leave. They were actually very understanding, made calls to friends and family, and packed their bags to go.
And hours passed without a single ambulance turning up with injuries. I could smell burning plastic in the air, and a cloud of soot was hanging over the buildings to the south of us. We eventually left the ER and sat down in the chairs surrounding a TV in the room where we had gathered for morning report. We watched the plane hit the Pentagon, the crash in Pennsylvania… I thought it was the beginning of World War 3.
The silence on the streets of New York was deafening. Huddling inside buildings, people were calling one another via cell phone to see if they were ok. My friend Cindy called me to say that she had received a call from her close friend who was working as a manager at Windows on the World. There was a big executive brunch scheduled that morning. Cindy used to be a manager there too… the woman’s last words were, “the ceiling has just collapsed, what’s the emergency evacuation route? I can’t see in here… please help…”
That night as I reported for my shift in the cardiac ICU, I was informed by the nursing staff that there were no patients to care for, the few that were there yesterday were either discharged or moved to the MICU. They were shutting down the CICU for the night. I wasn’t sure what to do… so I went back to my apartment and baked chocolate chip cookies and brought in a warm, gooey plate of them for the nurses. We ate them together quietly considering the craziness of our circumstance.
“Dr. Jones, you look like crap” one of them said to me affectionately. “Why don’t you go home and get some rest. We’ll page you if there’s an admission.”
So I went home, crawled into my bed with scrubs on, and slept through the entire night without a page. The disaster had only 2 outcomes – people were either dead, or alive and unharmed – with almost nothing in between. All we docs could do was mourn… or bake cookies.
What were you doing on 9/11? Join our forum to share your stories.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
September 7th, 2007 by Dr. Val Jones in Health Tips
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Is it safe to eat microwave popcorn? In case you missed it, a surprising new case of diacetyl lung damage
(so-called popcorn lung) was discovered in a patient who is a popcorn fanatic.
He reported eating 2 bags of artificial butter flavored popcorn per day
for years on end and began to notice shortness of breath.
My bottom line: avoid diacetyl, don’t avoid popcorn. Popcorn itself is
not harmful or dangerous (unless you’re under age 5 and are at risk of
choking or inhaling it) – just make sure it’s not laced with chemicals.
Five years ago the New England Journal of Medicine published a study linking a popcorn chemical (diacetyl) to a serious lung condition in 8 popcorn factory workers.
The lung condition, also known as bronchiolitis obliterans, is an
inflammatory reaction to diacetyl that can reduce lung capacity by as
much as 80%. Certain people who inhale too much of the chemical form
scar tissue as a reaction, making the lungs stiff and causing cough and
shortness of breath.
In this week’s case, the astute pulmonologist examining the popcorn addict remembered the 2002 NEJM article, and thought to ask him about popcorn exposure as part of her work up for his breathing complaints. As it turns out, his exposure to popcorn chemicals is the likely cause of his lung damage. Sadly, though, once the scarring occurs there is no way to return the lungs to their original state of heath. The only known treatment for popcorn lung is a lung transplant.
There has been incredible interest in this story because microwave popcorn is a part of most of our lives. The United States is the single largest consumer of popcorn worldwide, and we purchase over 1 billion pounds of unpopped corn per year. We naturally wonder: could this happen to me? Am I (or my kids) at risk?
First of all, I think that diacetyl should be avoided by all consumers of popcorn. ConAgra, the parent company for Orville Redenbacher and Act II, has agreed to immediately remove this chemical from its artificial butter flavored popcorn. Nonetheless, we should scrutinize the labels of any popcorn that we intend to purchase to make sure that it doesn’t contain diacetyl.
Second, the good news is that not everyone’s body forms scar tissue in reaction to this chemical. In the same way that we’re not all allergic to the same environmental agents, our bodies are not all going to respond to diacetyl by developing lung scarring. That said, why tempt fate by inhaling fumes that have harmed a small number of people?
Third, it does seem that it requires prolonged and high exposure to diacetyl to be at risk for popcorn lung. So if you’re not a buttered popcorn maniac (consuming several bags per day for years on end) your risk is extremely small, even if in the past you’ve eaten the occasional microwave popcorn containing the chemical.
If you are looking for alternative healthy snack options check out this link.
Hope this post allows some of you to breathe easier!This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
