May 3rd, 2009 by EvanFalchukJD in Better Health Network, True Stories
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My younger brother is an executive producer of the show “Nip/Tuck” and an executive producer of soon-to-air Fox show “Glee.“ Last year, he almost died.
It started when he woke up one day with numbness on one side of his body.
His doctor ordered an MRI. It found bad news: a tumor in his spinal cord, high up in his neck. He was referred to a neurosurgeon.
The plan was straightforward, but dangerous. First, radiation. Then, his spinal cord would be carefully cut open to remove the tumor. He was told he could end up paralyzed, or dead. Concerned, he called me, and we started a case at Best Doctors.
One of our nurses took a history, and we collected his records. Two internists spent hours reviewing them. The records noted our family history of a kind of malformed blood vessel. Our grandfather had hundreds of them in his brain when he died at 101, and our father has dozens of them in his. I have one in my brain, too. This was in my brother’s charts, but none of his doctors had mentioned it.
An expert in these malformations told us a special imaging study should be done to rule this out as a cause of the problem. Best Doctors gave that advice to my brother and his doctors. They agreed.
The test showed this was precisely what he had.
Quickly, the plan changed. He still needed surgery — if the malformation bled, it could also paralyze or kill him. But there would be no radiation, which might have caused the very bleeding we feared. Even if that didn’t happen, the surgeons were prepared to operate on a tumor. They would have been surprised to find a delicate malformation there instead.
In the end, his surgery went well. He is having a good recovery and is busy with his new show. But his case is a constant reminder of how important it is to have the right diagnosis, and how easy it is for things to go wrong.
Even in Hollywood.
March 17th, 2009 by Dr. Val Jones in Humor, True Stories
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As some of my Twitter friends already know, I had a bit of a scare a few days ago with my cat. I know that I more-or-less promised not to let this blog degenerate into cat talk (and for the record I love dogs too), but please indulge me because I think there’s a larger lesson to be learned.
A few days ago I was emailing away on my computer when I heard an odd thud behind me. I turned around to find my cat lying on her back with one leg fully extended, her pupils dilated, and a fine tremor in all four legs. This lasted for about 10 seconds and then she jumped back onto her feet and walked away as if nothing had happened.
My husband denied giving her any catnip, and since I hadn’t seen this odd behavior in her before I decided to keep a close eye on her. About an hour later she was walking across the floor when she suddenly raised her back rear leg, hopped a few steps, flopped onto her back and did the same weird leg extension, trembling, and let out a bizarre yowl.
That buys her a trip to the vet – and I started running my differential diagnosis through my head. It seemed to me that she was having some kind of focal seizures – and I wondered if she could be in renal failure (she had had a UTI earlier in the year) with metabolic encephalopathy, or perhaps a small tumor that had started to trigger some seizure activity. The episodes seemed to resolve completely in between episodes so I didn’t think she was having a stroke, she also wasn’t continuing to limp and when I pressed on her bones she didn’t flinch so I didn’t think she had broken anything. I called the vet and when asked for the “chief complaint” I was just as helpful as many ER patients:
Dr. Val: My cat’s ‘acting weird.
Receptionist: Could you be more specific?
Dr. Val: Well, she’s acting like she’s had catnip, but she hasn’t.
Receptionist: Uh huh… And what do you mean by that?
Dr. Val: She keeps falling on the floor and stiffening her rear leg. Then she gets up as if everything’s fine. This seems to be happening every hour or so.
Receptionist: I see. And is it possible that she could have eaten something toxic? Do you have poison lying around the house?
Dr. Val: Not that I’m aware of.
Receptionist: Well it sounds like you should bring her in. Can you be here in 15 minutes?
Dr. Val: Wow, that’s not much time. But I can try! I think she might be having seizures…
And so with the vet’s office being 15 minutes away, you can imagine the frenzied efforts that ensued – I managed (single handedly) to put together a cat carrier and stuff the “seizing” feline into it and hoist her onto a cart and push her down the city sidewalks, much to the amusement of onlookers, who probably fully believed that I was a cat-abuser, hearing the pitiful cries coming from inside the cage.
To make a long story short, I explained to the vet-on-call what I’d witnessed, and suggested that my cat might have a brain tumor. Luckily for me, the vet did not blindly take my diagnosis for granted, but performed her own physical exam.
The conclusion?
Vet: Dr. Jones I don’t believe your cat is having seizures. She has a subluxing patella.
Dr. Val: Um, so you’re saying that her knee cap popped out of place?
Vet: Pretty much, yes. That’s why she flops on the floor and stiffens her leg. She’s trying to get the knee cap to slide back into place. It’s a grade 3 subluxation, which means it pops out easily, but still goes back into place on its own.
Dr. Val: How do we fix it?
Vet: She’s a surgical candidate. We can create a divot in her femur to help keep the knee cap in the right groove.
Dr. Val: Wow, we don’t do that for humans. Are you sure that will work?
Vet: Well, you can try glucosamine. It will reduce the inflammation.
Dr. Val: Glucosamine doesn’t reduce inflammation in humans – and there’s no conclusive evidence that it improves joint health either. Isn’t this more of a mechanical problem that needs a mechanical solution?
Vet: [Becoming irritated] Yes, well you can see our orthopedic specialist. She’s not board certified though – but she has a lot of experience with these kinds of things.
Dr. Val: Well, is there a board-certified orthopedic veterinary surgeon that we could consult with? How much do you think that would cost?
Vet: There’s an animal hospital in Friendship Heights. I’m sure their surgeons are all equally well qualified. I guess the procedure would cost around $2000.
Dr. Val: Wow, $2000 to put a divot in a cat’s femur? Gee… I don’t know…
Vet: You should also know that your cat needs her rabies shot.
Dr. Val: She needs another one?
Vet: Yes, they need one every year.
Dr. Val: How likely is a house cat to get rabies? Are there rabid mice that could get into our condo?
Vet: [Scowling] It’s the law. All cats must get a rabies shot every year. There is one rabies shot that can be given every three years, but it’s been associated with osteosarcomas in cats. Would you like to give her that vaccine?
Dr. Val: Uh, no. But seriously, where is my cat going to catch rabies?
Vet: Maybe she’ll catch it from the other pets at the animal hospital when she goes for surgery?
Dr. Val: [Visions of Cujo dancing in her head] Well, that doesn’t sound like a very safe place to take her.
Vet: Would you like to buy some glucosamine?
Dr. Val: No thanks, I think I’ll go now.
***
I learned a few things from this amusing interaction:
1. People should try not to make diagnoses beyond their level of expertise. (Brain tumor versus subluxing patella? Yikes.)
2. Vets do not necessarily practice evidence-based medicine. (Glucosamine for a subluxing patella?)
3. There’s a lot of money in cat vaccines.
4. Cash-only practices are quite lucrative. My little visit cost $300.
What do you think I should do with/for my poor cat?
October 9th, 2008 by Dr. Val Jones in Expert Interviews
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I’ll admit it – when I was a kid, I admired Dr. Bones (McCoy) of Star Trek. He was a no-nonsense kind of guy who was very clear about his areas of expertise (“Damn it, Jim, I’m a doctor, not a spaceship engineer.”) But best of all, Dr. McCoy had special healing gadgets that he could wave over people for diagnostic and therapeutic purposes. Those “tricorders” fascinated me – and I always wished I could have one myself.
And now my dream could actually come true: advances in focused ultrasound technology (FUS) make non-invasive surgical procedures possible. I attended the very first international symposium about this new technology, and learned some very exciting things.
First of all, Dr. Ferenc Jolesz gave a riveting key note address about the history of focused ultrasound technology, and why modern advances have made this treatment modality feasible. Scientists have been fantasizing about heating tissues with sound waves since 1942 when the first ultrasound experiment was conducted on a liver tumor. Unfortunately back then, imaging studies (beyond X-rays) had not yet been developed – so it was virtually impossible to “see” one’s target.
However, now that magnetic resonance imaging (MRI) machines are capable of displaying our innards in exquisite detail Read more »
September 18th, 2008 by Dr. Val Jones in Celebrity Interviews
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Methacillin resistant staphlococcus aureus (MRSA) is a deadly bacterium that is becoming more and more common inside and outside the hospital setting. No one is immune, not even babies like this one who died from an unknown exposure. Seven-time NBA All-Star Grant Hill has also experienced the ravages of MRSA. I interviewed him about his near-death experience.
Dr. Val: Tell me about your recent experience with a severe staph infection.
Grant: I got my MRSA infection in 2003, afterI had a surgery on my ankle in the hospital. I had never heard of MRSA before and it was a very scary ordeal(at certain points, I didn’t think I was going to make it)and it took me a long time to recover. Dealing with my own infection made me realize just how severe MRSA could be. I want to make sure others do not have to go through what I went through. I got lucky with my infection because the doctors recognized it and we were able to treat it. I will always have scars on my ankle from the infection, so I never really forget what I went through and how lucky I was to survive.
Dr. Val: How common are staph infections among basketball players?
Grant: I don’t know exact statistics regarding basketball players, but the scary thing is, now it’s not just in hospitals. Now you’re finding MRSA infections in community settings like gyms, schools, homes and locker rooms. So there is definitely a need for conversation about this, and also about ways to prevent it.
Dr. Val: As an insider, what kind of behaviors have you observed that might put players at higher risk for contracting MRSA?
Grant: One thing I have learned through all of my injuries is that tomorrow is never really promised. As athletes there are so many ways that we can get injured, we can’t underestimate something like MRSA, especially because there are easy ways to prevent it. It’s important for players to know that MRSA can be spread by sharing athletic equipment, towels and razors. To help stop the spread of MRSA in locker rooms and on sports teams, players need to wash their hands frequently and stick to using their own personal items. They also need to know that when working out, they should keep a towel down between them and shared equipment. When it comes to locker room surfaces, those should be disinfected with a bleach solution. I am very conscious of all these prevention methods in my life, because I realize how important the prevention side of it is.
Dr. Val: Now that you’ve had a staph infection, what precautions do you take to prevent re-infection?
Grant: All those little things my mom used to tell me to do still ring true. I make sure to wash my hands frequently and cover any of my cuts -I keep a whole stash of bandages in my locker. I also keep my towels to myself and disinfect with a bleach solution, that’s really easy to make. It only takes a few minutes out of my day to take these steps, but I know first-hand that it can make a world of difference. You know, I often find myself telling my daughters the same things because as a father, it is important that I keep my family safe and healthy.
Dr. Val: What should athletes know about MRSA and what advice do you have for them?
Grant: Athletes of all ages should be encouraged to hit the court or the field and have a good time while remembering the easy prevention steps. Because I have spent so much time not playing, due to injury, I am having so much fun just playing. Everyone should remember that theycan help prevent the spread of MRSA easily, so no one has to waste time on the sidelines.
Dr. Val: What’s the most important thing that you’d like to tell Americans about MRSA?
Grant: Wow, how much time do you have? I really want people to realize that MRSA is a serious infection. As I’ve mentioned, before I got it and I hadn’t even hear about it. My ordeal really opened my eyes to this and that it can affect anyone! The scary truth is that more deaths each year are caused by MRSA than AIDS. But, there are easy things people can do to help reduce the spread of MRSA. This includes: washing your hands frequently, not sharing your personal items like towels and disinfecting with a bleach solution. There is more information and tips about how to prevent getting MRSA, including a playbook of prevention, at stopmrsanow.org.
*This post was originally published at my other blog site – URL pending*
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
August 25th, 2008 by Dr. Val Jones in Uncategorized
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As with any profession, surgery has its share of both wonderful surgeons, and not so wonderful ones. I thought I’d share an example of each that I found in my blog reading:
A Bad Surgeon
An on-call oral surgeon comes in to see a patient with Ludwig’s Angina – a serious dental infection that spreads under the jaw and can cause loss of the airway, and upon seeing that the patient is “self pay”, says we should transfer him since he is “penniless” and could never afford to follow up with him in the office! When told by the ER doc that he cannot transfer a patient for that reason, he then turfs the case to ENT – who is understandably disgusted as well, but agrees to see the patient. By the time this happens 6 hours later, his infection has worsened and he has to go the ICU, get intubated and trached due to loss of his airway. FINALLY at this point the oral surgeon takes him to the OR – he is still trached and in the ICU three weeks later – this might have been avoided if he were operated on sooner.
A Good Surgeon
We were on vacation and noticed a suspicious red swelling on my son’s leg. We made an appointment at a local pediatric care center, and the physician assistant determined it was an abscess that needed to be drained by a surgeon. The PA was very calm and reassuring, and quickly made an appointment for us with a local surgeon. We drove over to the surgeon’s office, and everyone there, from the receptionist to the nurse to the surgeon himself, was friendly and supportive. My son was extremely nervous about the prospect of having both shots and surgery, and the staff, especially the surgeon, did a great job calming him down. After it was all over, my son even commented that the surgeon was so nice, almost like a grandfather, and that he liked how he explained everything to him before he did it.
I myself have received care from both good surgeons and not-so-good ones. All I can say is that a physician’s character really does make a difference in the kind of care you’re likely to receive. When seeking a good surgeon, ask a physician whom you trust to make a recommendation. Birds of a feather flock together in healthcare and in life.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
