Archive for February, 2011

Pregnancy Gingivitis: Simple ways to avoid risk for you and your baby.

Friday, February 25th, 2011

I recently came across a website that offers a lot of really good advice for parents-to-be, and I’m happy to promote it on our blog. You may want to visit The Pregnancy Zone and bookmark it for future good reads. If you are a long-time reader of our blogs, you know by now we are really into sharing health and safety information with our readers. As we say on our Twitter page, we are lawyers trying to get the word out so you never need people like us

A recent post on The Pregnancy Zone brought to my attention a condition that, quite frankly, I was not all that familiar with - pregnancy gingivitis. Gingivitis is probably a condition that you are already familiar with. Simply put, it is a form of periodontal disease, which involves inflammation and infection that destroys the tissues that support the teeth, including the gums, the periodontal ligaments, and the tooth sockets. What I didn’t realize is that it has a real potential risk for moms-to-be and their babies. Watch this video by Dr. Jaimie Johnson for a better understanding of why it is important to not overlook this basic element of your prenatal care.

httpv://www.youtube.com/watch?v=c8Uip6hr3vM

So why is this so important? Premature delivery is the primary reason.

At least a couple of major studies have shown that there is a link between gum disease and premature birth. Researchers of one study who published their results in The Journal of the American Dental Association found that pregnant women with chronic gum disease were four to seven times more likely to deliver prematurely (before gestational week 37) than mothers with healthy gums.

Mothers with the most severe periodontal disease delivered the most prematurely at 32 weeks. The researchers’ study did not address if treating gum disease would reduce the risk of preterm birth, adding that more studies need to be conducted to answer this question. Their main findings, however, support the results of another study that also showed that premature, underweight babies were born more often to mothers with gum disease.

Source: WebMD:

What also drew my attention to this topic was a story of a mom, who suffered a stillbirth at full term. The best cause for how this could have happened, according to her doctors, was that the bacteria from her dental condition had directly affected the placenta, leading to the death of her fetus in utero.

What is a bit disturbing about the WebMD post is the statement that the study “did not address if treating gum disease would reduce the risk of preterm birth, adding that more studies need to be conducted to answer this question.” Clearly, some blogs and videos on this topic indicate that there is a treatment-risk reduction benefit. It does seem to make common sense, doesn’t it?

Would love to know if you have any information to share about any other studies, ongoing research and the like on this topic. Sure seems that – at a minimum – getting good dental care during your pregnancy is sound advice and surely worth the effort in case there is a direct cause-effect-treatment relationship perhaps is the case.


The daily struggle of raising a disabled child

Thursday, February 24th, 2011

Parents must cope with daily concerns of special needs children

Like many parents, I am blessed to have healthy children.  I take it for granted that my kids are smart, active, well-adjusted.  I don’t even have to think about their health other than the occasional cold or earache or sprained ankle. Others are not so fortunate.

This past weekend I was reading in Maryland Family Magazine an article about a local college professor who wrote a book about raising a son with severe autism.  After writing the book, he assumed that a major publisher would have interest. He ended up being turned down by some agents who told him that without a happy ending or a cure, there was no way they could market the story. Apparently, the public wants stories about disability to have a Hollywood ending. (A publisher finally did come along that agreed to publish the book).

This, in turn, made me think of a good friend of mine (I’ll call her Jane), who has a disabled son (autism spectrum) in addition to three normal children. I hesitate to use the words normal and disabled for two reasons:  1) we live in a politically correct world where deciding what label to apply to anything means stepping into a social minefield; and 2) on the spectrum of mental or physical ability, it can be difficult to say what exactly is normal versus abnormal. I never want to suggest that children with limitations are abnormal. Some parents even bristle at the term “disabled.” Others use the more cumbersome term “neurotypical” rather than the term “normal.” You can see that it can be hard to discuss the topic of disability when we don’t even have terms we can all agree on.

Jane and I often discuss our kids and parenting. She has been very candid with me in describing how incredibly hard it is to raise a disabled child. She believes that no one really wants to hear the negative side of raising a child with special needs. Like the publishing agents that the professor encountered, some people only want to hear about the inspirational side of the story. Truth is, there is not always a happy ending or miracle cure when raising a disabled child, be it autism or cerebral palsy or paraplegia. These are life-long disabilities. There are happy moments, of course, as well as accomplishments both major and minor, but for parents raising a disabled child, it is a daily struggle to make sure that the child gets the medical care and therapy and attention that he or she needs. Parents undertake this monumental and thankless task not because they hope for some Hollywood ending, but because they love their child and they do what they need to do, even if they never knew they had such strength and determination in them.

It’s not all negative, of course. Jane tells me all the time how much she loves her son and how he has taught her so much about herself and about life. She says she cannot imagine who she would be without her son. At the same time, however, she also feels a lot of pain and loss and regret about what she and her family have had to sacrifice in order to care for her disabled son. The daily struggle can truly be overwhelming at times. Jane believes that parents often feel unable to express these feelings for fear of being branded a less-than-stellar parent. As she told me, “There isn’t a safe place to express one’s own doubts about being able to effectively take care of another person who requires so much care. It’s daunting, hard and stressful and for some reason it’s not completely OK to admit that.”  Jane is careful about the sentiments she expresses in public versus those she tells to her friends:

There is the aspect of autism that you are allowed to talk about versus not allowed. I’m allowed to admit it’s hard, but I can’t really say how hard or I’m too negative. I’m just supposed to say it has changed my perspective and I’m blessed.  It has changed my perspective but I’m not blessed. Shut up about being blessed.

While disabilities are all different and every parent’s story is unique, there is a common thread that runs through them all – raising a disabled child takes its toll on the parents and the family as well as the child. The challenges can be enormous. Some of the more common challenges include:

  • Financial:  Finding ways to afford medical care, therapy, services;  working with insurance companies and various state agencies;
  • Educational:  Struggling with teachers and school administrators to make sure that your child is getting an appropriate education and Individualized Education Program or IEP.
  • Medical:  Finding doctors who are willing to take the time to listen to your concerns and diagnose your child; getting referrals to specialists; sorting through the myriad hoops of insurance; finding therapies that work for your child;
  • Social:  The loss of normal everyday activities like going out to dinner, taking trips, seeing friends; not having anywhere to turn to talk about what they are going through.
  • Marital:  A couple often experiences difficulty because of all the other stresses that are created by having a disabled child, as well as the substantial time investment that is required.
  • Family: Other children in the family can be affected because mom and dad have to devote so much time to the disabled child and because the family’s usual routine and activities are disrupted; money can often be tight.
  • Psychological: Many mothers experience feelings of guilt, wondering if it was something they did during pregnancy that caused their child to have this disability.
  • Legal: Figuring out what rights you and your disabled child have, what services you are entitled to.

I can’t say enough about those parents who take on these challenges on a daily basis.  It is difficult to even imagine the level of devotion and commitment that is required.  I welcome all parents to share their stories — the good and the bad — so that the rest of us can try to better understand the reality of raising a disabled child.  In future blogs I will talk about some of these challenges in more detail and where parents can turn for assistance.

Image from metroparent.com

New Treatment Holds Promise for Patients With Spinal Cord Injuries

Wednesday, February 23rd, 2011

According to a recent article in Medical News Today, Functional Electrical Stimulation (FES) can significantly reduce disability caused by spinal cord injuries. The study was originally posted on line in the Journal of Neurorehabilitation and Neural Repair.

This relatively new treatment applies small electrical impulses to stimulate paralyzed muscles. The treatment has been shown to measurably improve a patient’s ability to pick up and hold objects. Dr. Popovic and his team concluded that FES should be used in conjunction with traditional physical therapy.

To see how this works, here’s an incredible demonstration by Children’s Hospital of an FES bicycle.

httpv://www.youtube.com/watch?v=27vIfWdB3wk

Here are some key facts about this study:

  • FES therapy uses low-intensity electrical pulses generated by a pocket-sized electric stimulator.
  • Unlike permanent FES systems, the one designed by Dr. Popovic and colleagues is for short-term treatment. The therapist uses the stimulator to make muscles move in a patient’s limb. The idea is that after many repetitions, the nervous system can ‘relearn’ the motion and eventually activate the muscles on its own, without the device.
  • The randomized trial, believed to be the first of its kind, involved 21 rehabilitation inpatients who could not grasp objects or perform many activities of daily living. All received conventional occupational therapy five days per week for eight weeks. However, one group (9 people) also received an hour of stimulation therapy daily, while another group (12 people) had an additional hour of conventional occupational therapy only.
  • Patients who received only occupational therapy saw a “gentle improvement” in their grasping ability, but the level of improvement achieved with stimulation therapy was at least three times greater using the Spinal Cord Independence Measure, which evaluates degree of disability in patients with spinal cord injury.
  • Based on their findings, the study’s authors recommend that stimulation therapy should be part of the therapeutic process for people with incomplete spinal cord injuries whose hand function is impaired.
  • Dr. Popovic’s team has almost completed a prototype of their stimulator, but need financial support to take it forward. Dr. Popovic thinks the device could be available to hospitals within a year of being funded.One limitation of the study is that the research team could not get all participants to take part in a six-month follow-up assessment. However, six individuals who received FES therapy were assessed six months after the study. All had better hand function after six months than on the day they were discharged from the study.
  • Dr. Popovic stresses that FES therapy should augment, and not replace, existing occupational therapy.
  • Another study, now underway, will determine whether stimulation therapy can improve grasping ability in people with chronic (long-term) incomplete spinal cord injuries.

If you or a loved one suffer from spinal cord injury, please consult with a physician about FES. In conjunction with physical therapy, this non-invasive medical procedure promises tremendous benefits to patients with spinal cord injuries. If you are aware of other studies or treatment relating to rehabilitation from spinal cord injuries, we encourage you to share your knowledge with our readers.

What you need to know about digital vs. film mammograms

Tuesday, February 22nd, 2011

In a recent report published in the journal Radiology, the findings of a research group from Barcelona, Spain, provided women and the medical community with some key information about the use and efficacy of digital mammography. As reported in DoctorsLounge, the researchers, headed by Maria Sala, M.D., Ph.D, concluded that digital mammography had a lower false-positive rate than screen-film mammograms; however, there was “no significant difference in the cancer detection rate between the two, according to [the] study.”

If you are unfamiliar with this new technology, here’s a video presented by WellSpan HealthSource. See what they believe some of the benefits are for digital mammography.

httpv://www.youtube.com/watch?v=_TLhjsFeQDg

Here’s the statistical information regarding false-positive and detection rates between these two modalities of mammograms.

The researchers found no significant difference in the cancer detection rate between the two modalities, with the screen-film detection rate at 0.45 percent and digital at 0.43 percent. The false-positive rate for screen-film mammography was 7.6 percent but for digital mammography the rate was 5.7 percent. Digital mammography also had lower recall rates and was less likely to result in a false-positive result leading to an invasive procedure. The lower false-positive risk remained even after results were adjusted for women’s characteristics, screening program characteristics, and time trends.

Who should undergo digital mammography?

Dr. Michael Wu, of the Palo Alto Medical Foundation, has an informative post on the issue of who the best candidates are for digital versus film mammography. He gives a synopsis of the groups, as reported by The New England Journal of Medicine, who are the best candidates to undergo digital mammograms.

Those who benefited:

  • Women < 50
  • Women with dense breast tissue
  • Women who were premenopausal or perimenopausal.
  • Those who did not appear to benefit:

  • Women > 50
  • Women post-menopausal
  • Those without dense breast tissue
  • Dr. Wu’s post also addresses issues such as cost effectiveness and radiation exposure differences between the two methods of digital and film mammograms. What may be of interest to many women is that the actual technique (which I understand can be painful for many women) is the same. Perhaps further development of devices and systems will lower this problem – hopefully – in the future. Needless to say, the discomfort for 20 – 30 seconds is far outweighed by the benefits of early detection of breast cancer.

    3-D Mammogram recently approved by FDA

    It was also recently reported by PRNewswire that the FDA recently approved the first 3-D digital mammogram (tomosynthesis scans) system. Hologic, Inc., a leader in the development, manufacturing and distribution of medical devices, including medical imaging systems and the company whose system won this approval, ran a series of clinical trials using this new 3-D mammography system.

    Undoubtedly beaming with joy over having his company’s product be the first to be approved, Rob Cascella, President and CEO of Hologic, has this to say about this new medical weapon in the fight against breast cancer:

    Our Dimensions 3-D takes advantage of all of the benefits of digital mammography and quite simply makes it better with the combination of fast, high quality 3-D breast imaging. We believe tomosynthesis has the potential to change how screening and diagnostic mammography is performed, and over time will prove invaluable to the earliest possible detection of breast cancer and in the reduction of unnecessary diagnostic interventions.

    it will be very interesting to see if the recent study in Spain by Dr. Sala and his colleagues is taken further by his group or other researches to examine whether this newer 3-D technology will further change the landscape in lowering false-positive rates or – even more important – increasing the early detection rate for breast cancer.

    Some basic, highly disturbing facts about breast cancer:

    The PRNewswire release also provides the following information about breast cancer:

    One in eight American women will develop breast cancer sometime in her lifetime. In 2009, an estimated 192,370 new cases of invasive breast cancer were diagnosed among American women, as well as an estimated 62,280 additional cases of in situ breast cancer. Over 40,000 American women died from breast cancer in 2009. Only lung cancer accounts for more cancer deaths in American women. The stage at which breast cancer is detected influences a woman’s chance of survival. If detected early, the five-year survival rate is 98 percent. At this time, there is no sure way to prevent breast cancer, which is why regular mammograms starting for most women at age 40 are so important.

    This video by one of the country’s premier institutions for cancer treatment, MD Anderson Cancer Center, provides some very useful information and some excellent suggestions for undergoing a mammogram.

    httpv://www.youtube.com/watch?v=Y-GmNmPeqHQ

    Readers’ Information

    There is no doubt that many physicians, researchers and women have exceedingly superior knowledge of these techniques, systems, risks and benefits, and the like. Have any of you been involved in this research? Have you  had or do you know someone who has undergone digital mammography? What information can you share with our readers about this new technology? We invite you to share this information and spread the word by sharing this post with you friends. As we always say, being an informed patient is essential to improving your health and survival.

    Lap-Band (Weight Loss) Surgery: is it for you? FDA clears new Allergan system and opens door to more patients

    Monday, February 21st, 2011

    The FDA recently approved Allergan’s Lap-Band weight loss surgery (which is a form of what is known as bariatric surgery). By its 8-2 vote, the FDA cleared the way for patients who are significantly less obese (BMI of 30) than those who would have qualified for weight loss surgery before this recent approval.

    Knowing that this controversial clearance vote was on the horizon, major news networks aired stories on the pro’s and con’s of “broadening the base” of patients, who would now qualify. Here’s a report by ABC News’ Diane Sawyer in December 2010. (Sorry about the lead-in ad. If it were not a good report, I would have found something “ad-less” to present the issue!)

    With the FDA’s announcement came somewhat of a firestorm of criticism. As reported locally in the Baltimore Sun (actually written by Thomas H. Maugh II of the Los Angeles Times), the approval has raised “concerns” by many in the medical community, who fear that this surgery will now be seen as a “quick fix” to the obesity plague in this country.

    “I’m very concerned,” said Dr. Ted Khalili, former director of bariatric surgery at Cedars-Sinai hospital and founder of the Khalili Center for Bariatric Care in Beverly Hills. “You can’t be driving down a street and have a flashbulb go off and think that this will be an easy fix.”

    What Dr. Khalili seems to be referring to is a marketing drive that directs patients to clinics that perform the procedure using the Allergan device. Here’s (to the right) a photo that shows exactly what this is all about.

    Patient deaths following procedure lead to litigation in California

    Maugh reports in his piece in the LA Times that four patients have died following the Allergan lap-band procedure. Lawsuits have followed. In a related article by another Los Angeles Times reporter, some details emerge.

    Laura Faitro of Simi Valley died July 26, 2010, five days after surgery at Valley Surgical Center in West Hills. Three other patients have died shortly after surgery at an associated center in Beverly Hills, relatives have alleged in lawsuits and interviews.

    Supporters speak out as well

    While there are many who have decried the FDA’s approval and the lowering of the qualification standards to undergo this new lap-band procedure, there are certainly those who are in support of its potential therapeutic effects:

    For those with Type 2 diabetes, the Lap-Band could be an immediate fix. “This operation takes about an hour, and two days in the hospital, and these people go off their diabetes medication. It’s unbelievable,” Dr. Walter J. Pories, a professor of surgery at East Carolina University and a leading researcher on weight-loss surgery, said in this L.A. Times report.

    All surgery – including this new lap-band procedure – has significant risks

    Whether one should consider taking advantage of this new procedure is a matter between the patient and his/her surgeon. After advising that not all risks or complications of undergoing this new procedure are listed in its website overview, the product’s manufacturer, Allergan, provides the following information:

    Placement of the LAP-BAND® System is major surgery and, as with any surgery, death can occur. Possible complications include the risks associated with the medications and methods used during surgery, the risks associated with any surgical procedure, and the patient’s ability to tolerate a foreign object implanted in the body.

    Band slippage, erosion and deflation, obstruction of the stomach, dilation of the esophagus, infection, or nausea and vomiting may occur. Reoperation may be required.

    Rapid weight loss may result in complications that may require additional surgery. Deflation of the band may alleviate excessively rapid weight loss or esophageal dilation.

    While many people seem to be intrigued by a “quick fix” surgical method of weight loss, some necessary clearance hurdles stand in the way – and should! Allergan is requiring all surgeons who want to order and perform surgery with the manufacturer’s new device “to first complete a comprehensive proctorship and training program, have advanced laparoscopic skills and (we believe this is key) have the staff and resources needed to comply with the long-term follow-up requirements of obesity procedures.”

    I would add here that in our experience of handling lawsuits involving catastrophic injuries and death claims following bariatric procedures, issues relating to selection of proper surgical candidates and post-procedure follow-up and compliance have many times been at the core of these cases.

    Not a “quick fix” replacement for exercise, diet and possible medication

    As anyone who has been involved in any manner with issues relating to bariatric, weight-loss surgery, this is not the first step to be taken toward losing weight. Sure, it sounds enticing to go into a clinic or hospital, have a one hour procedure, and all your weight issues are a thing of the past. First of all, that is not how this works at all. Pre-procedure clearance does and must be taken seriously and not be a mere sham.

    There is no doubt that there is a financial benefit for the providers of this procedure; it is reported that it will cost approximately $25,000 for the device, surgeon and operating room costs. It is also said that many insurance policies may cover all or part of this cost. That being said, even Allergan cautions that this is not a drive-by way to achieve weight loss. Read its Lap-Band System Fact Sheet and Lap-Band Labeling and Safety Information if you are interested in knowing more about the indications, alternatives, risks, benefits and advantages of this newly approved system. In addition, make certain that the surgeon you are consulting meets the qualifying standards of the manufacturer. Ask questions – it’s your body, your life.

    As a side note, in case you are wondering if your BMI qualifies you for consideration of this procedure, here’s a handy BMI calculator made available online by the National Heart Blood Lung Institute – Calculate your BMI.

    Know anyone who has had this or other forms of weight loss surgery?

    If you or someone you know has undergone a procedure involving this new device by Allergan, share your story with our readers. If you or someone you know has undergone bariatric surgery, we also invite you to please share your story of how this worked for you or those you may know. Has it changed your or their life? If so – for the better or worse?

    Why do so many patients die when their in-hospital alarms go unheard or unheeded?

    Thursday, February 17th, 2011

    ICU alarm monitor

    Sunday’s edition (February 13, 2011) of the the Boston Globe online (boston.com) tells a chilling story of how many times the alarms used to monitor patients go unheard and unheeded by medical staff leading to death or catastrophic injuries for patients throughout this country. The story, which was a two part series (for the second installment, see For nurses, it’s a constant dash to respond to alarms) by Globe reporter Liz Kowalczyk, narrates numerous incidents in which alarms simply went unnoticed, ignored or unmonitored. Numerous other issues such as lack of education of hospital staff as to how to properly connect the devices, failures to realize the batteries had gone dead, turning the alarms so low in volume they could not be heard, taping over amplification systems to avoid the “annoyance” of the alarms and the like are also chronicled in this series. While it is documented by an analysis of the FDA’s database of adverse events involving medical devices that 216 patients died nationwide between 2005 and mid-2010, it is also certain that this number of alarm-related deaths is probably much higher. The ECRI Institute, which was hired by the Globe to analyze the FDA database, believes that the health care industry under-reports these cases to the FDA.

    Some examples of alarm-related deaths

    Since links to the Globe’s original articles are provided above, I will not go into the level of detail that is otherwise available through reading the original reports. Here is a sampling of the types of “alarm failures” leading to patient deaths:

    • staff misprogrammed complicated monitors
    • staff had forgotten to turn the monitors on
    • batteries had gone dead leading and failed to function (one instance where a man had a “flat line” for more than two hours that went undetected)
    • defective wires or connections on the monitors
    • malfunction or design flaws in the monitoring devices
    • staff ignored the device warnings because of “alarm fatigure

    Alarm Fatigue

    According to one computation at Johns Hopkins Hospital in one 15 bed unit as to how often alarms go off during the course of day, it was documented that there were 942 alarms per day – “about 1 critical alarm every 90 seconds.” There is no doubt that the number of alarms and the clinical settings in which they are used have increased over the years. As Ms. Kowalczyk noted, “[W]ith the use of monitors rising, their beeps can become so relentless, and false alarms so numerous, that nurses can become desensitized – sometimes leaving patients to die without anyone rushing to their bedside.”

    In some cases, busy nurses have not heard or ignored alarms warning of failing batteries or other problems not considered life-threatening. But even the highest-level crisis alarms, which are typically faster and higher-pitched, can go unheeded. At one undisclosed US hospital last year, manufacturer Philips Healthcare, based in Andover, found that one of its cardiac monitors blared at least 19 dangerous-arrhythmia alarms over nearly two hours but that staff, for unexplained reasons, temporarily silenced them at the central nursing station without “providing therapy warranted for this patient.’’ The patient died, according to Philips’s report to federal officials.

    Keep in mind that many of these alarms are not only audible in the patient rooms; they also sound at the central nurse’s station. In some instances, hospitals have put up hallway speakers for nurses to hear the alarms more readily. In other facilities, in addition to audible alarms, various pieces of critical data information (e.g. heart rhythm, heart rate) are visible on displays at nurses stations and in some places, it is reported, “on brightly colored scrolling signs in corridors.”

    The article quotes one nurse at Boston Medical Center, who addresses some of the issues at the heart of this “alarm fatigue” phenomenon.

    Everyone who walks through the door gets a monitor. We have 17 [types of alarms that can go off at any time. They all have different pitches and different sounds. You hear alarms all the time. It becomes...background

    False Alarms - the cry wolf issue

    It is well known that some alarms can go off when a patient sits up, coughs, turns or makes other normal movements. According to the Globe report, "'[s]ome studies have found that more than 85 percent of the alarms are false.” I have no idea how this statistic was compiled, but even if it is accurate (which is debatable), that still leaves dozens if not hundreds (if not thousands) of alarms going off daily in every hospital throughout this country that are an indication of a patient in need of rapid response life-saving care.

    Another nurse is quoted by the Globe in expressing both the frustration and the need for attentiveness when the alarm goes off. “You have to respond to the alarm[, b]ut there are some days when you feel you’re just running from alarm to alarm. It can be exasperating.”

    The Fix

    The short answer appears to be: there is no easy, quick fix. Here are some of the measures institutions have taken to address this problem:

    • working with engineers at prestigious institutions (e.g. MIT’s work with Boston’s Children’s Hospital) to develop more sophisticated monitors to identify true crisis alarms.
    • hiring of dedicated monitor technicians and/or nurses, who man the central nurses’ station to triage alarms.
    • specialized education programs to avoid misprogramming or connection mistakes due to lack of knowledge by staff
    • establishing tighter standards of which patients should be connected to alarmed monitors – to cut down on the “background noise” of alarms.
    • replacement of old equipment for more advanced, accurate alarm/monitor systems
    • implementation of new programs in-hospital to require bioengineers to check the monitors daily to make sure they are working properly.
    • implementation of standardized settings on machines so that alarms are not turned so low they are non longer audible. (One case of a patient death was attributed to staff turning the the “vexatious” alarm down to a 40% of full volume – no one responded to an arrhythmia alarm for 40 minutes because no one heard the reduced volume alarm during that time.)
    • changing batteries every day in monitors to make sure they are, in fact, charged and working

    The Blame Game

    As you might suspect, the finger-pointing that takes place after a patient is found dead or severely injured is rampant. As the Globe reports, “Initially, hospitals almost always blame the monitor’s alarm for not sounding when it should have, according to reports. But the company investigations show the assertion is often false.”

    In 40 of the cases reviewed by the Globe, the alarms did not sound, usually because the staff had not properly programmed or turned on the machines.; in only eight cases was there a malfunction or design flaw.

    [I]n nearly 100 cases, manufacturers ere unable to determine exactly what went wrong, often because they didn’t have enough information, or they told federal regulators they still were reviewing the death.

    Where to from here?

    While I certainly don’t have to contend with the incessant noise of alarms going off all day long, nor am I required to jump away from what I’m doing to respond to a false alarm, I can’t help but think that in a health industry as advanced as ours allegedly is, there must be some steps that can readily be taken so that others don’t die because some nurse has “alarm fatigue,” or a battery died, or the volume was turned down too low to avoid the annoyance of the alarm or some other ill-conceived and unacceptable reason.

    What suggestions do you have for the healthcare industry to deal with this problem? Have you ever worked in a setting where this is a problem? If so, how did you and/or your institution deal with this issue? There are a lot of smart people in bioengineering and in our health institutions; why is this still such a problem in a country that claims to be so advanced?

    Image by ectopicinteractive.com

    Baltimore Loses a True Sports Legend and a Gem of a Man – Ernie Tyler

    Saturday, February 12th, 2011

    Ernie Tyler - Baltimore Orioles Legend (photo by daylife.com)

    Friday, on the way to the office, the news came across my car radio that Orioles Great, Ernie Tyler, had died. For those of you not from Baltimore or who don’t follow the Orioles, you might ask: “Who is Ernie Tyler? What was his ERA, or his batting average, on base percentage…?” Well, those were not statistics that were associated with this legend of Baltimore sports. You have no doubt heard about Baltimore’s Iron Man – Cal Ripken, Jr., who was drafted in the second round by the Orioles in 1978, played his final game on October 6, 2001, and set the all-time record for consecutive games played at an astounding figure of 2,632. Now you should know about Baltimore’s other Iron Man – Ernie Tyler, who put-up a bigger consecutive games number than Cal – 3,769.

    Why haven’t you heard about this Iron Man? Why hasn’t he been featured by national media? Maybe because Ernie was one of those behind the scenes people, without whom the game would not be the same. The irony is, however, that Ernie really wasn’t behind the scenes; he was front and center at every Orioles game – he was the Orioles’ “umpires attendant,” who performed his job with grace, diligence and panache for over 50 years!

    Sure, I saw Ernie performing his job whether I was sitting in my seat at a game or watching from my couch. I didn’t know the man personally, but every Orioles fan must have that feeling that they did know Ernie. He didn’t perform his tasks of delivering new balls to the home plate umpire with a unique flair or in some attention-grabbing outfit. When a foul ball was lying listless in the dirt behind home plate and needed to be removed so the game could play on, there he was, with what is described by former Oriole’s great, Mike Boddicker, as his “meat hooks” hands, swooping down on the ball, with his “side-to-side trot” in one graceful movement so the game could resume without delay. We all know that balls need to have the shine treated before games so that pitchers can get a better grip.

    Ernie Tyler mudding-up the ball (photo by The Daily Record)

    Well, it’s estimated that Ernie mudded-up over 350,000 balls for the games he oversaw. But stats are not what Ernie was all about. They belonged to the man, but he belonged to the fans of the Baltimore Orioles.

    The “other Iron Man” breaks his streak for “the Iron Man”

    If you want to get a glimpse of what this man was like and why he is revered by Baltimore fans, just ask yourself: how and why did Ernie’s consecutive games streak end? The answer: when Cal Ripken, Jr. was inducted into the Hall of Fame, he asked Ernie to attend. Having faithfully performed his duties from 1960 to 2007, without missing a game over that span of time, Ernie elected to break “the streak” and attend the celebration in Cooperstown, N.Y. Once the festivities were over, he dutifully returned to his place near the Orioles dugout and continued to do “his thing” for the next few years. Ernie was still snatching foul balls and replenishing the umpire’s supply of fresh balls, he had mudded-up well into his 80’s.

    Loved by so many and now to be missed by all who knew him

    The stories of Ernie and his love of the game, the Orioles, its players, its fans, the city of Baltimore and most of all his family are chronicled in today’s edition of the Baltimore Sun and need not be repeated here. For those of us who only “knew” Ernie from afar, he nevertheless left an indelible mark on our lives. He touched us – and I simply cannot be alone in this feeling – in a very special way. His passing brings to mind stories my father used to share with me as a boy of his growing up in Brooklyn and living next to players from the Brooklyn Dodgers. Time spent on the porch and sharing stories of the Bums, who walked the streets and worked the same jobs as many of their adoring fans. Ernie reminds me of a man of that era – a real baseball man, who lived and breathed the game and brought a smile to the faces of countless baseball fans. A legend among the gods of baseball – in his own special way.

    Many have left the game with grace; some with not so graceful an exit. Many have touched the souls of countless fans of America’s sport. Those plaudits are usually reserved for the men who play between the lines from April to October each year. But when a man such as Ernie Tyler passes, a very special word of praise and thanks is in order. So – thank you, Ernie!  We’ll miss you dearly. You are a sports legend of a special kind; the kind of legend that permits the game to pass from generation to generation with grace and charm.

    Related Stories

    Tyler was the real Mr. Oriole…

    Late Orioles umpires attendant Ernie Tyler was like family…(Peter Schmuck)

    New Microchip Promises to Make Life Much Easier for Paraplegic Patients

    Friday, February 11th, 2011

    Hope for those with paraplegia?

    Researchers in the U.K. have developed a revolutionary microchip muscle stimulator that will enable patients with paraplegia to exercise multiple muscles at the same time. According to the Engineering and Physical Sciences Research Council (EPSRC), the microchip developed by Professor Andreas Demosthenous from University College of London and his team is truly unique.

    The microchip chip is small enough (approximately the size of a child’s fingernail) that it can be implanted directly into the spinal canal. Unlike previous models, the new implant incorporates the muscle stimulator and the electrodes into a singular unit.  The unit is properly sealed to protect against moisture, which could lead to corrosion of the electrodes.

    The creation of the implant has been made possible by new laser processing technology, which enabled researchers to micro-pack all components into one unit. With this new laser technology, researchers were able to cut much tinier electrodes from platinum. The electrodes are then folded into a 3D shape that resembles pages in a book. Each electrode can be wrapped around a nerve root. The electrode is then welded to the microchip located in the spinal cavity.

    Because the implant comes with multiple electrodes, which can be connected to multiple nerve roots, it is capable of controlling entire muscle groups. In patients with paraplegia, the devise can be used to stimulate or trigger multiple paralyzed muscles at the same time. Researchers also claim that the new device will also be used in patients with bladder or bowel incontinence.  Because the device has multiple electrodes, some electrodes can be connected to nerve roots that control bladder muscles or nerves that control bowel capacity.

    Although all of this may sound a bit scifi, the implant will be available for pilot studies sometime this year. If you or someone you know is paraplegic, this research is worth following. It clearly promises to offer life-chaining benefits to patients with paraplegia. If you know of other research on similar devices, we’d love for you to share that information with our readers. We’ll try to keep an eye on the progress and implementation of this device from the UK and keep you posted if and when developments occur.

    FDA warning to healthcare professionals: use sterile prep pads!

    Tuesday, February 8th, 2011

    Sterile Prep Pads

    On February 1, 2011, the FDA issues a News Release about the use of non-sterile alcohol prep pads in certain clinical situations.

    “Non-sterile pads are not intended to prep patients prior to procedures requiring strict sterility measures and should not be used on patients with a depressed immune system, to prep patients for catheter insertion, or to prep patients prior to surgery.”

    This reminder/warning was issued in the wake of a recall on January 5th of all lots of alcohol prep pads and swabs manufactured by The Triad Group of Hartland, Wisconsin citing concerns about the product’s potential contamination with Bacillus cereus, a bacterium that can be harmful to humans.

    While I guess we all need reminders now and then, do healthcare professionals really use non-sterile pads for pre-procedure prep when sterile technique is called for? Isn’t this basic training?

    We have heard over and over again about the problems with infection control in medical facilities. Isn’t this a basic way to improve infection control – using sterile prep pads when doing open or penetrating skin procedures? Oh my!

    While we in law deal with the end-result of failures to use “sterile techniques” – including the basic concept of using sterile pads - is this really such a problem in the healthcare industry that the FDA needs to remind providers to use the right kind of pad?

    A number of our readers are members of the healthcare profession. Tell us – please, is this really a problem in the industry? Are there not basic protocol, stock control, safety measures in place that deal with this apparent problem? The rest of our readers either have been a patient or have a family member who’s been a patient; have you ever encountered a problem with an infection because your provider used the wrong type of prep pad?

    Image from dailymed.nlm.nih.gov

    Baltimore Abortion Ordinance Declared Unconstitutional – How Did We Get Here and Why?

    Saturday, February 5th, 2011

    Pro-Life and Pro-Choice Advocates

    Last April, we posted a blog regarding a Baltimore City ordinance, which required local crisis pregnancy centers to post signs in their clinics disclosing that they did not offer abortion or birth control services if, they in fact, did not offer such services. Because of this requirement, many clinics chose to post separate notices informing the public about clinics that offered abortion services. Consequently, the Archdiocese of Baltimore, filed a lawsuit in the Federal District Court, seeking to have the ordinance declared unconstitutional.  One of its arguments was that the City should be prohibited from compelling speech by requiring the clinics to post signs.

    On January 28th, 2011, District Court Judge, Marvin Garbis, ruled that the ordinance violates the First Amendment of the U.S. Constitution and, as such, is unenforceable. In his opinion, Judge Garbis wrote: “Whether a provider of pregnancy-related services is ‘pro-life’ or ‘prochoice,’ it is for the provider — not the Government — to decide when and how to discuss abortion and birth-control methods.” According to the opinion, “[t]he Government cannot, consistent with the First Amendment, require a ‘pro-life’ pregnancy-related service center to post a sign as would be required by the Ordinance.”

    The dynamic of this litigation is fascinating, revealing nonsensical and unpredictable aspects of the abortion debate.  One could argue that the original passing of the ordinance was fueled by an underlying “pro-life” attitude.  After all, why would the City require clinics that don’t offer abortion services to publically state that they don’t offer abortion services? My personal opinion is two-fold: 1) to discourage individuals in need of abortion services from seeking abortion services, and 2) to reveal to the public the number of clinics that don’t offer abortion services in order to paint a picture that the public is generally pro-life (this is particularly true because the ordinance did not require clinics offering abortion services to post notices that they offered such services).

    Interestingly, the ordinance backfired. Some of the clinics required to disclose that they did not offer abortion services chose to inform the public about other clinics where abortion services are available. There is nothing wrong with that, right? Well, apparently the Archdiocese did not think so, and, in my personal opinion, here is the real reason why: As soon as it became apparent that many of the clinics could simply choose to post notices about other clinics, which offered abortion services, it also became apparent that the ordinance was de facto prompting free advertising for abortion services all over the city.

    I can’t imagine that the Archdiocese was too thrilled about that. Hence, the litigation ensued and the opponents of the ordinance prevailed on an argument, which is commonly and usually made by the “pro-choice” side of the abortion debate. At the heart of Judge Garbis’ opinion is the notion that the government should not legislate morality or religion. On January 28th, the Archdiocese and other “pro-life” groups prevailed on an argument, which has undermined and discredited the “pro-life” position for decades. How ironic!

    Have you have been following this litigation in Baltimore City? What are your thoughts? Was Baltimore’s ordinance misguided or spot-on? Will Judge Garbis’ decision be reversed or upheld on appeal?

    Photo from foxnews.com