October 14th, 2007 by Dr. Val Jones in True Stories
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I had dinner with a physician friend of mine who works in New York City. She told me an interesting story about her last couple of days at work…
A patient of hers was in the hospital on a fairly high dose of steroids to treat an autoimmune disorder. He was generally a very even tempered and friendly person, but was a little bit grumpy when she visited him on rounds that evening. He was complaining of slight shortness of breath and some mild stomach pain – and that the hospital food was bad. His labs from that morning were all normal, and he had no fever or abnormalities in blood pressure or heart rate.
On sheer gut instinct, my friend ordered a CT scan of his abdomen right away. Lucky she did, because this gentleman had a perforated colon (from ruptured diverticulae) with air under his diaphragm, causing shortness of breath. Because he was on steroids, the body’s usual response to early sepsis was blunted. He was rushed to the OR where surgeons corrected the problem. In this situation, if it weren’t for a gut instinct, this patient may have died.
I think this case illustrates how important it is to know your patients, to take their concerns seriously (especially when they’re on medicines that could minimize serious symptoms), and if something doesn’t seem right (even if lab tests and vital signs argue otherwise) you should listen to your gut. Sometimes instinct is smarter than science.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
September 4th, 2007 by Dr. Val Jones in News
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I subscribe to Eureka Alert Breaking News – and although a lot of their press releases are on small studies of questionable relevance, I do think that some of the basic science research is provocative. Let’s see if I can pique your interest with the best of this week’s Petri dish news:
1. Tylenol may inhibit bone growth? A small study conducted at the University of Granada suggested that bone forming cells (called osteoblasts) were inhibited by a Tylenol bath. As far as pain killers are concerned, we’ve known for a while that non steroidal anti-inflammatory medications (NSAIDs) may indeed inhibit bone growth. But since Tylenol is not an NSAID, we were hoping that it would not adversely affect bone healing. Could this mean that Tylenol is not so great for bone surgery pain after all? That’s a stretch… but an interesting question.
2. Can you clean blood with a laser? Boy it sure would be nice to be able to kill all the potential viruses in blood used for transfusions. Apparently there’s a new pulsed laser technique that shows some promise in fracturing viruses with laser vibrations. So far, the laser was successful in reducing bacterial viruses by 1000x. Next up? Let’s see what the technique can do to Hepatitis C and HIV viruses.
3. Skinny people might have a “skinny gene.” Scientists have been studying a gene called Adipose (Adp) for over 50 years now. It was first discovered in fat fruit flies (I kid you not). Apparently if the Adp gene doesn’t work well, the flies become fat and “have difficulty getting around.” Worms, mice, and humans seem to have the same gene. Further analysis might unlock the secret to the genetics of thinness. Or maybe we should just eat less and exercise more?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
August 21st, 2007 by Dr. Val Jones in Uncategorized
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I had an interesting dialog with Dr. Bruce Campbell recently. In his blog he described a patient who lost about 60 pounds after losing his sense of taste. The patient had undergone radiation therapy for throat cancer, and in the process lost his ability to taste food. He soon lost interest in eating, and eventually dropped 60 pounds – not from the cancer, but from the side effect of radiation therapy. In this case there was a happy ending (his sense of taste eventually returned and he regained some of his weight) but it made me think about the relationship of flavor to obesity.
Just as I was musing on this very fact, a new research study was published in the journal Neurology. It suggested that unexplained weight loss was an early warning sign of dementia. They speculate that this could be linked to another early sign of dementia: loss of the sense of smell. Of course taste is largely a function of smell, so we can easily understand how people lose interest in eating when they can’t enjoy the flavor of food.
Wouldn’t it be interesting if we could temporarily alter a person’s sense of taste in order to affect weight loss? I doubt I’m the first to think of this… has anyone else heard of such a strategy? Surely this would be a little bit less invasive and dangerous than bariatric surgery.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
August 17th, 2007 by Dr. Val Jones in True Stories
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I was pleased to receive an email invitation from Dr. Jon Mikel from Unbounded Medicine to blog about surgery. He writes,
“Please feel free to post anything related to surgery,
like surgical procedures, mistakes during surgery or during your training,
lessons learned, tips, first operation done solo, memorable operations,
memorable patients, jokes, your point of view about surgery, or even why you dislike surgery or surgeons (if that is the case).”
As my mind wandered through all the possible posts I could prepare, I settled on a touching story that highlights the life of a wonderful surgeon named John Schullinger. Dr. Schullinger was the surprised recipient of one advanced case of intussusception in a 10 month old baby girl. The baby was shipped to him from a distant general hospital where they didn’t have any pediatric surgeons to take the case. On arrival the baby was moribund – septic and seizing, with an abdomen distended with gangrene.
Dr. Schullinger explained the gravity of the baby’s condition to her mom, promised not to give up on the baby, and took her to the O.R. for a bowel resection. Against all odds – and having to resect everything from the terminal ileum to the sigmoid colon – the baby made it through. A jubilant mother thanked the surgeon, and promised to keep in touch, though the family would be moving out of the country.
Every Christmas, the baby’s mom sent Dr. Schullinger a card from Canada – detailing her daughter’s growth and accomplishments and thanking him again for saving her life. Each Christmas he responded with a hand written note, expressing his pleasure with the child’s progress.
This ritual continued each year for 25 years until one day the young woman went to visit the surgeon and thank him in person. She was interviewing for medical school at Columbia, the same institution where Dr. Schullinger had saved her life nearly a quarter century earlier. It was a tearful reunion and touching for both surgeon and patient – because they could see how operations can change lives, and how babies that you operate on can grow up to be physicians who help other babies.
Dr. Schullinger saved my life – but his influence reached far beyond his technical skills in the O.R. His compassion and faithful follow up responses to my mom showed me what being a doctor is all about. My fondest hope is that I’ll live up to his example.
So for all you surgeons out there… you work longer hours than most others on this planet, you sacrifice your lifestyle to serve others, and yet you rarely see how your work impacts families long term. I am here to thank you on behalf of all those who can’t or don’t – please take courage from this story. You never know if the patient you operate on will come back and take over the scalpel for you one day…
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
August 13th, 2007 by Dr. Val Jones in Expert Interviews
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I came across an interesting weight loss invention this weekend that proposes to allow people to have their cake and eat it too. Scientists have constructed a kind of plastic intestinal condom to block digestion of food. Since gastric bypass surgery essentially reduces food absorption while decreasing stomach size, this removable plastic lining could act as a sort of non-invasive alternative to such a permanent procedure. Sounds intriguing?
Well, before we get our hopes up, it’s always best to check with the gastroenterologists. I dropped Dr. Brian Fennerty a note to ask him what he thought of this proposed weight loss solution. His response was enlightening – “The Endobarrier Gastrointestinal Liner is potentially very dangerous as it may block the pancreatic duct and cause pancreatitis, dislodge resulting in bowel obstruction, or ulcerate. There are no comparative trials and as such I would consider it investigational at best.”
Why is blocking the pancreatic duct scary? The pancreas is a little organ that should get a lot more respect, in my opinion. It produces enzymes that are secreted into the intestine to break down food – I like to think of the pancreas as a bag that contains acid as strong as Alien blood (those of you who’ve seen the movie will get that reference). Basically, the pancreas can liquify a steak – so plugging up the exit route for those enzymes is a really bad idea. You can imagine why pancreatitis is so painful.
And then there’s the risk of the liner getting loose and wadding up in a plastic ball and blocking your bowels, or the risk of the plastic irritating the intestinal lining and causing an ulcer which could bore a hole straight through your gut.
Well, I don’t mean to resort to scare tactics here… but honestly, this procedure has serious risks that one doesn’t really get from the media’s article on the subject, “New Procedure Could Help Millions.” So be careful out there folks – always check with your doctor before you try something new to lose weight. I’m afraid that diet and exercise are really the safest options out there.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
