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A Surgeon Watches Helplessly As His Patient Dies

Sometimes different people see the same thing from a slightly different angle, giving a completely different perspective. In my line this can turn out to be quite macabre.

It was one of those cases. It was probably hopeless from the beginning, but he was young and we had to give it a go. As soon as the abdomen was opened everyone knew things were bad. There was blood everywhere. It took a while to even see the damage to the liver because I needed to get rid of the blood in the abdomen before I could see anything. However, once I saw the liver even I was shocked.

The liver was ripped apart with one laceration dropping down to where the IVC sat menacingly behind it. It seemed to spit and splutter at my efforts to bring the bleeding under control in defiance of me. But I did what I could as fast as I could. At times like this the unsung hero is the anesthetist. If he can’t get fluid and blood into the patient fast enough, no matter what the surgeon does, it will be in vain. That day the anesthetist was great. Somehow he kept some semblance of a blood pressure in the patient against overwhelming odds. Read more »

*This blog post was originally published at other things amanzi*

Annual Ovarian Cancer Screening Does More Harm Than Good

In a large multicenter study enrolling over 70,000 women, annual screening with transvaginal pelvic ultrasound and ca125 blood testing did not reduce deaths from ovarian cancer, and in fact led to an increase in complications due to screening.

Investigators in the NCI-sponsored Prostate, Lung and Ovarian Cancer (PLCO) Screening trial randomly assigned over 78,000 women age 55-64 years of age to either annual screening with transvaginal pelvic sonograms for 4 years plus CA125 testing for 6 years or usual care at 10 study sites across the US., and followed the groups for up to 13 years. Over that time period, ovarian cancer rates in the screened group were 5.7 per 10,000 person-years vs 4.7 per 10,000 persons-years in the usual care group, with 3.1 deaths vs 2.6 deaths per 10,000 person years, respectively. Over 3000 women had false positive screening results, a third of whom had surgery and 15% of those operated on had a complications from their surgery. Deaths from other causes did not differ between the groups.

The investigators concluded that annual screening for ovarian cancer does not reduce mortality, and in fact caused harms among women with fals positive abnormal results.

This is not the first study that failed to find efficacy for ultrasound and ca125 in reducing mortality from ovarian cancer, but Read more »

*This blog post was originally published at The Blog That Ate Manhattan*

How To Treat Horse And Donkey Bite Wounds

Earlier this week this tweet from @prsjournal caught my eye

Most Popular: Management of Horse and Donkey Bite Wounds: A Series of 24 Cases: No abstract available http://bit.ly/lgNkCS

I missed this article when it came out in the June 2010 issue of the Plastic and Reconstructive Surgery Journal.  As I have covered fire ant bites, cat bites, and snake bites.  Fellow blogger Bongi has written about hippo bites.  It’s time to cover horse and donkey bites.

Dr. Köse, Department of Plastic and Reconstructive Surgery, Harran University Hospital, Turkey and colleagues presented a retrospective evaluation of 24 patients treated for animal bites (19 horse and five donkey bites) from 2003 to 2009.  The head and neck were the most frequent bite sites (14 cases), followed by the extremities (8 cases) and the trunk (2 cases).

The article is very short, representing their personal viewpoint and experience. Read more »

*This blog post was originally published at Suture for a Living*

One Organ Donor, Seven Recipients

New York Times article highlights transplant donor and recipients at New York-Presbyterian Hospital

Organ Donation Checkbox

UK NHS Organ Donation Checkbox

As organ transplantation has advanced and improved in recent decades, more and more patients’ lives are saved every year. But the most pressing problem in organ transplantation has yet to be solved: the shortage of donor organs available to the thousands of people waiting on lists for a new kidney, liver, lung, heart, or other organ. People who intend to donate may not indicate their wishes to family members before their death, or families are reluctant to make that decision in the midst of profound grief and loss. For others, donating an organ was just never something they knew much about or even considered.

When they do choose to donate a loved one’s organs, families usually remain anonymous, as do those whose lives they save. Perhaps that is why articles like the one in the New York Times on May 16, 2011, touch and inspire readers so deeply. This version of an increasingly common story captures the essential soul-searching, as well as the profound gratitude, hope, and solace, that marked the meeting of Mirtala Garcia and the people who received her husband’s organs. Read more »

*This blog post was originally published at Columbia University Department of Surgery Blog*

Hardened Breast Implants (Capsular Contracture): A Reader Question

I have had a capsulectomy due to capsular contraction, but now it has returned. I want an explant because they are uncomfortable and look unnatural. My doctor said that since the capsulectomy did not resolve the issue, he recommends having an explant and waiting about 6 months to a year. After my body has healed properly, he said that I can get implants again and will not get capsular contraction again. Is this accurate? Am I less likely to get capsular contraction or will I be free of capsular contraction? I’m also looking for a doctor experienced in explants.

The subject of hardened breast implants (Capsular Contracture) comes up frequently as it is the leading cause of long term dissatisfaction with breast implants. If your breasts tend to hurt or look unnatural, you likely have severe encapsulation (Baker Grade III or IV.) When contracture redevelops quickly after capsulectomy (assuming the operation was thorough,) this is worrisome as it may indicate a high tendency for recurrence. The main question when severe contracture is present is whether or not a cause can be identified. Bothersome contracture doesn’t happen to all patients. This kind of reaction is associated with cigarette smoking, bleeding, infection, silicone gel implants, poor soft tissue coverage and radiation exposure as well as a previous history of contracture. Some of these issues can be minimized in an attempt to reduce the tendency for encapsulation. Preventing the problem is the best solution. Read more »

*This blog post was originally published at Truth in Cosmetic Surgery*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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