Archive for June, 2011

Diseases of Summer: Ticks and Lyme Disease

Thursday, June 30th, 2011

family-time2

Summer is heating up, and there are lots of outdoor activities in which to participate. Along with the thermostat, however, there is also a rise in the deer tick population! This equates to an increase in Lyme disease, the most commonly reported vector-borne illness in America! Maryland, Virginia, Pennsylvania, Delaware and New Jersey all all “hotbeds” for this disease, comprising 5 of the top  12 states comprising 95% of all Lyme disease cases nationwide.

According to a recent post by Roberta Seldon in Boomer Health and Lifestyle, the deer tick population is a “bumper crop” this year, partly due to the wet winter in the Midatlantic and Northeast United States. Tick activity peaks in June and July, and this correlates to rates of illness as reported by the Centers for Disease Control (CDC). The CDC also reported 2009 as the second-highest incidence of disease cases, following 2007; with the estimated increase in the deer tick population, 2011 might go down in the record books as the highest year ever since the beginning of recording/reporting lyme disease (1995). The Maryland Department of Health and Mental Hygiene (DHMH) breaks down the jurisdictions even further into cases per County, with the top two counties being Baltimore and Anne Arundel, with Howard, Harford and Carroll counties being right in the mix.

What is a deer tick and what does it look like?

The deer tick, as it is commonly called, is really the black-legged tick or Ixodes scapularis. This is NOT the same as the dog tick; it is a much-smaller version with different coloration. The Canadian Lyme Disease site provides an excellent pictoral description and differentiation of the various types of ticks and relative sizes. The deer tick, especially in the nymph stage, is so very tiny and nearly impossible to see, and it is this very pinpoint little bug that causes most of the infections.

The CDC website (one of my favorites for all kinds of information related to infectious diseases and other public health topics) details the disease transmission process and prevention, diagnosis and treatment information. The site discusses many myths about the tick, its removal, the disease, its symptoms and long-term sequellae.

Did you know that the tick itself does not cause the disease? The tick carries a bacteria called Borrelia burgdorferi that has to be transmitted through the saliva during feeding. It takes at least 24 hours, if not 36 to 48  hours, of tick attachment and feeding in order to transmit the bacteria. Thus, besides various prevention techniques with appropriate clothing and wearing bug spray with DEET, it is critical to perform (or have someone else perform) a “tick-check” after being in wooded areas or areas known to have deer activity. The best way to remove this little critter is by using tweezers and grasping the head while applying gentle traction in the opposite direction of attachment. Even if you are not the environmental type but you have a dog, be sure to apply tick-prevention remedies to your pet since they can bring these critters into your home.

What are some common symptoms of Lyme disease?

The most common symptom, and the one classically associated with Lyme disease, is the bulls-eye type rash (called erythema migrans) that develops at the site of the infection/tick bite.

There is a central area of redness, and over several days, the red ring starts to migrate peripherally, followed by an area of clearing; it clearly resembles a bulls-eye target. According to the CDC, approximately 68% of those infected report this rash. The next most common symptom is joint pain that can involve one or more joints and typically migrates to various joints. Other more serious presentations include paralysis of the facial nerve (Bell’s palsy), meningitis or encephalitis, and even heart block or problems with the electrical conduction system of the heart leading to irregular heart rhythms.

The Maryland DHMH just released a video on Lyme Disease in Maryland. Dr. Katherine Feldman describes the disease.  It is a 7-minute and 23-second video with lots of good information. Please, click the link to watch and learn!

Other tick-borne illnesses:

Lyme disease is not the only disease transmitted by ticks. Ticks live on the blood of the hosts on which they feed. They can transmit a variety of pathogens via their bite and/or saliva that have been acquired from other hosts. Some of these infections include anaplasmosis, babesiosis, ehrlichiosis and Rocky Mountain Spotted Fever (RMSF). As an aside, don’t let the Rocky Mountain part fool you! North Carolina has one of the highest incidence rates of RMSF nationwide!

QUESTION: Do you know someone who has had Lyme Disease? Were there any unusual circumstances surrounding the diagnosis? Share your story so others can be more aware!

Images courtesy of:

(c) L. Gerlach on Blisstree.com

Skin Cancer Prevention: Will new FDA Rules Help?

Wednesday, June 29th, 2011

In yesterday’s post, I examined the various types of skin cancer and their prevalence in the US. Melanoma is the most deadly form of skin cancer and its incidence is on the rise. In that post, I examined some of the ways to protect yourself from the types of UV radiation that cause skin damage and cancer. One of these protection methods is the use of sunscreen. Sunscreen matters because the data is clear that sun exposure is what is causing deadly skin cancers:

  • About 90 percent of nonmelanoma skin cancers are associated with exposure to ultraviolet (UV) radiation from the sun.
  • The vast majority of mutations found in melanoma are caused by ultraviolet radiation.
  • About 65 percent of melanoma cases can be attributed to ultraviolet (UV) radiation from the sun.
  • One or more blistering sunburns in childhood or adolescence more than double a person’s chances of developing melanoma later in life.
  • A person’s risk for melanoma doubles if he or she has had more than five sunburns at any age.

Statistics from the Skin Cancer Foundation website

However, up until now, there has been very little regulation of the marketing of different sunscreens. It has been very difficult for the American public to know whether the sunscreen they were choosing was going to be effective in protecting them from both UVA and UVB rays.  There was also little way to know how much protection you were really receiving and whether the claims like “waterproof” and “sunblock” were just marketing or really claims with research behind them. Why does this matter? Check out this video from the FDA:

How the New FDA Rules Will Help

Well, some of this is going to change next summer. Last week, the FDA announced new regulations of sunscreen. If sunscreens meet the new legal standards, they can use certain marketing phrases so that consumers know what level of protection will be provided by the product. For example, “[u]nder the new labeling, sunscreens labeled as both Broad Spectrum and SPF 15 (or higher), if used regularly, as directed, and in combination with other sun protection measures will help prevent sunburn, reduce the risk of skin cancer, and reduce the risk of early skin aging.”

Image from FDA.gov

Image from FDA.gov

The FDA explains the impact of the new regulations with the following:

  • Broad Spectrum designation. Sunscreens that pass FDA’s broad spectrum test procedure, which measures a product’s UVA protection relative to its UVB protection, may be labeled as “Broad Spectrum SPF [value]” on the front label. For Broad Spectrum sunscreens, SPF values also indicate the amount or magnitude of overall protection. Broad Spectrum SPF products with SPF values higher than 15 provide greater protection and may claim additional uses, as described in the next bullet.
  • Use claims. Only Broad Spectrum sunscreens with an SPF value of 15 or higher can claim to reduce the risk of skin cancer and early skin aging if used as directed with other sun protection measures. Non-Broad Spectrum sunscreens and Broad Spectrum sunscreens with an SPF value between 2 and 14 can only claim to help prevent sunburn.
  • “Waterproof, “sweatproof” or “sunblock” claims. Manufacturers cannot label sunscreens as “waterproof” or “sweatproof,” or identify their products as “sunblocks,” because these claims overstate their effectiveness. Sunscreens also cannot claim to provide sun protection for more than 2 hours without reapplication or to provide protection immediately after application (for example– “instant protection”) without submitting data to support these claims and obtaining FDA approval.
  • Water resistance claims. Water resistance claims on the front label must indicate whether the sunscreen remains effective for 40 minutes or 80 minutes while swimming or sweating, based on standard testing. Sunscreens that are not water resistant must include a direction instructing consumers to use a water resistant sunscreen if swimming or sweating.
  • Drug Facts. All sunscreens must include standard “Drug Facts” information on the back and/or side of the container.

Information from the FDA

So what does this all mean? It means that if you want a sunscreen that will provide protection against both UVA and UVB, you need to choose one that says “broad spectrum” AND has a minimum SPF of 15. You also need to look for a time limit on the water resistance of the sunscreen. In the future, other regulations may take effect, including limiting the SPF claims to 50 since there is no evidence that a higher SPF offers greater protection. The impact of the current rules should be an easier way for consumers to know that they are getting the greatest possible protection from the sunscreen they buy.

The New Regulations Do Not Address the Safety of Ingredients

So, while the new sunscreens will make it clearer whether the sunscreen protects against both UVA and UVB rays and how long the sunscreen will remain water resistant, the regulations do not regulate the ingredients that comprise the sunscreens. The ingredients in the sunscreens have not been tested for safety. Dr. Len has written a blog on the American Cancer Society website that touches on this issue:

Many of the ingredients of sunscreens have been used for years, however the FDA acknowledged today that they have not been tested for safety using modern techniques. They did emphasize that the benefits of sunscreens containing these ingredients far outweigh the risks given their longstanding safety profile.

Nanoparticles present in sunscreen-especially those containing zinc and titanium oxides-have been another source of concern.  It is the use of “nanotechnology” that has made these effective sunscreens more acceptable since they don’t leave you with that white, pasty look that inhibited their use in the past.

Although it appeared during a news conference this morning that the FDA is satisfied at this time that products containing nanoparticles such as zinc and titanium oxides are safe when used as directed based on scientific evidence, another representative seemed a bit more cautious in his comments at second briefing held a couple of hours later by stating that nanoparticles are still being evaluated for safety.

The FDA did say they will continue to examine the science and the data regarding sunscreen ingredients, and will advise consumers promptly should they find evidence to the contrary regarding their safety profile.

One interesting outcome of the FDA’s announcement was their statement that they will be seeking further information from manufacturers and others on the safety and effectiveness of aerosol sunscreens.  The FDA apparently is concerned about inhalation risks as well as effectiveness in real-life use.  This is a sunscreen delivery method that many of us (including me) use often because of ease and convenience, and the questions regarding safety and effectiveness are certain to get some notice.

As more and more people are educated and aware of the risks of skin cancer, the use of sunscreens will presumably rise. Does it worry you that the new regulations deal more with marketing issues and confirming that the sunscreens do work effectively to minimize exposure to UVA and UVB rays than with the safety of the ingredients that provide that protection? Do you agree that since the risk of skin cancer outweighs the potential risks caused by the ingredients?

Personally, I use sunscreen and put it on my children daily. However, I also go out of the way to try to use ones that seem to have the “safest” record in terms of the chemicals involved. I also choose to use sun-shirts and other protective clothing as much as possible when at the pool or beach to minimize the amount skin I have to cover with sunscreen. Okay – honestly – it is also to minimize the amount of sunscreen smearing that I have to do every day. In order to work effectively, you are really supposed to use a lot of sunscreen all over exposed skin. As much as possible, we try to spend out time outside during the early morning and late afternoon/evening to minimize the direct exposure.

What steps do you take to protect yourself from sun exposure? What about the idea that a certain amount of sun exposure is good for Vitamin D production? What about the new FDA regulations, do they may sense? Will you shop for sunscreen differently?

Related Posts:

Skin Cancer: Types, Causes and How to Protect Yourself

Skin Cancer: Types, Causes and How to Protect Yourself

Tuesday, June 28th, 2011

Image from psvresort.com

From the (guest) editor:  Although today’s weather forecast is for thunderstorms, we should keep in mind that the summer season is upon us.  It is time to protect one of our largest organs — our skin!

–Jason

The news last week about the new FDA regulations on sunscreen had me prepared to write a blog article this week about the changes. I wanted to clarify what the new rules will mean for consumers – how to choose the correct product, what the various claims actually mean about protection, whether safety has been considered. However, as I delved deeper into the topic, I realized that the first concern has to be sun exposure and cancer in general. There is too much information – medical and legal – out there for one post. So, I am going to write a brief series. The first topic – today – will be about the startling statistics about various skin cancers. I will discuss various types of skin cancers, their prevalence and the survival and death rates from these cancers. In future posts, I plan to examine the original issue – whether the new regulations will help consumers choose a product that will help protect from some of these risks and how these legal steps may fall short of the final goal. Finally, I will look at the issue of tanning beds. Should children or teens be allows to use them? What about parental consent? There are medical and legal ramifications surrounding the use of tanning beds – I will look at a few of those. Along the way, please comment and let me know your thoughts. Or, if you are just daydreaming about enjoying summer…you can let us know that too (for my own personal idea of a great summer vacation see today’s photo).

Not All Skin Cancer is Created Equal

Personally, I tend to lump all skin cancer together in my mind. Unfortunately, whether you are putting yourself at risk for or are diagnosed with squamous cell, basilar cell or malignant melanoma makes a big difference. The rates of these diseases and the survival statistics are dramatically different.

So, first, what are these diseases?

Image from www.cancer.org

 

The National Cancer Institute at NIH explains the different types of skin cancers:

Skin cancer that forms in melanocytes (skin cells that make pigment) is called melanoma. Skin cancer that forms in the lower part of the epidermis (the outer layer of the skin) is called basal cell carcinoma. Skin cancer that forms in squamous cells (flat cells that form the surface of the skin) is called squamous cell carcinoma. Skin cancer that forms in neuroendocrine cells (cells that release hormones in response to signals from the nervous system) is called neuroendocrine carcinoma of the skin.

How Common are these Cancers?

According to the Skin Cancer Foundation, skin cancer is the most common form of cancer in the United States. Of the various types of skin cancer, basal cell carcinoma is the most common (2.8 million/year the US), followed by squamous cell carcinoma (700,000/year), and finally melanoma (115,000). However, the death rates caused by melanoma are much higher than the other types of cancer. The statistics on the Skin Cancer Foundation website are shocking (just a sampling):

  • One person dies of melanoma every hour (every 62 minutes).
  • One in 55 people will be diagnosed with melanoma during their lifetime.
  • Melanoma is the most common form of cancer for young adults 25-29 years old and the second most common form of cancer for young people 15-29 years old.
  • The incidence of many common cancers is falling, but the incidence of melanoma continues to rise at a rate faster than that of any of the seven most common cancers. Between 1992 and 2004, melanoma incidence increased 45 percent, or 3.1 percent annually.
  • An estimated 114,900 new cases of melanoma were diagnosed in the US in 2010 – 46,770 noninvasive (in situ) and 68,l30 invasive, with nearly 8,700 resulting in death.
  • Melanoma accounts for less than five percent of skin cancer cases, but it causes more than 75 percent of skin cancer deaths.

I was particularly taken by this last fact – while accounting for “less than five percent of skin cancer cases, [melanoma] causes more than 75 percent of skin cancer deaths.” This is startling because “[t]he survival rate for patients whose melanoma is detected early, before the tumor has penetrated the skin, is about 99 percent.” However, ‘”[t]he survival rate falls to 15 percent for those with advanced disease.” So the key here is clearly prevention and early detection.

Unfortunately, the melanoma incidence rate is rising annually. Melanoma is responsible for approximately 8,700 deaths a year in the US, as compared to rare deaths from basal cell carcinoma and approximately 2,500 deaths a year from squamous cell carcinoma.  And this is not just a problem for those with light skin – the Skin Cancer Foundation explains that “[w]hile melanoma is uncommon in African Americans, Latinos, and Asians, it is frequently fatal for these populations.”

Given the high incidence rate and the high survival rate for early-diagnosed melanomas, it seems key that people should know the risks factors and causes for melanoma. The better the prevention, the less likely that you should develop this type of cancer. Secondly, if you are in a high-risk category, you should be seeing a dermatologist regularly since the key to survival is early detection.

Causes of Melanoma

The CDC provides confirmation that “[s]kin cancer is the most common form of cancer in the United States” and that the incidence of melanoma of the skin has “increased significantly by 3.1% per year from 1986 to 2006 among men” and 3% among woman from 1993 to 2006.Yet, we know many of the risk factors for melanoma.

The CDC reports that “[a]bout 65%-90% of melanomas are caused by exposure to ultraviolet (UV) light.” This is the kind of radiation that come from the sun – and tanning beds (more on that in a later post). There are three different types of ultraviolet light and two of them have a role to play in changing and damaging skin cells.

The three types of UV rays are ultraviolet A (UVA), ultraviolet B (UVB), and ultraviolet C (UVC)-

  • UVA is the most common kind of sunlight at the earth’s surface, and reaches beyond the top layer of human skin. Scientists believe that UVA rays can damage connective tissue and increase a person’s risk of skin cancer.
  • Most UVB rays are absorbed by the ozone layer, so they are less common at the earth’s surface than UVA rays. UVB rays don’t reach as far into the skin as UVA rays, but they can still be damaging.
  • UVC rays are very dangerous, but they are absorbed by the ozone layer and do not reach the ground.

Too much exposure to UV rays can change skin texture, cause the skin to age prematurely, and can lead to skin cancer. UV rays also have been linked to eye conditions such as cataracts.

From the CDC website

In addition to sun exposure, there also additional risk factors to consider:

  • A lighter natural skin color.
  • Family history of skin cancer.
  • A personal history of skin cancer.
  • Exposure to the sun through work and play.
  • A history of sunburns early in life.
  • A history of indoor tanning.
  • Skin that burns, freckles, reddens easily, or becomes painful in the sun.
  • Blue or green eyes.
  • Blond or red hair.
  • Certain types and a large number of moles.

From the CDC website

Children and Adults are Not Doing Enough to Protect Themselves

Certainly, some of these risk factors are immutable, but others, like sun exposure and tanning are risks that can be avoided or at least minimized. The CDC says they have supported surveys that show that “U.S. youth and adults are being exposed to ultraviolet radiation and can do more to protect themselves. More than one-third of the U.S. population reported a sunburn in the previous year, with rates higher among men and the non-Hispanic white population.”

I found the CDC statistics troubling given how long it has been known that sun exposure and damage lead to skin cancer:

In 2005, only 56% of adults said they usually practice at least one of the three sun-protective behaviors (use sunscreen, wear sun-protective clothing, or seek shade).

  • 30% reported usually applying sunscreen (27% applied sunscreen with an SPF of 15 or higher).
  • 18% reported usually wearing some type of fully sun-protective clothing.
  • 33% usually sought shade.
  • Only 43% of young adults aged 18-24 used one or more sun protective methods, whereas 58% of those 25 years of age and older reported using one or more methods. Among men 18 and older, only 47% reported usually using one or more methods of sun protection, in contrast to 65% of women 18 and older.

Among high school students, when they were outside for more than an hour on a sunny day-

  • 11.7% of girls and 6.3% of boys reported they routinely used a sunscreen with an SPF of 15 or higher.
  • 15.9% of girls and 20.5% of boys reported they routinely stayed in the shade, wore long pants, wore a long-sleeved shirt, or wore a hat that shaded their face, ears, and neck.

Nearly 9% of teens aged 14-17 years used indoor tanning devices. Girls aged 14-17 years were seven times more likely than boys in the same age group to use these devices.

From the CDC – internal resources omitted.

The recommendations are clearly not being followed. To best protect yourself from sun damage, there are 3 simple steps:

  • Use Sunscreen
  • Wear Protective Clothing (including hats and sunglasses)
  • Find Shade

Do not forget that these tips are important whether you are at the beach or just around town and on both cloudy and sunny days. It is especially important to be careful during the peak times of 10 am to 4 pm.

Of course, “use sunscreen” is oversimplifying how to protect oneself. It is within this context that I will look into the various legal and marketing changes coming soon to sunscreens in my next post.

Did you know all of these facts about skin cancer? Did you know that melanoma was so common and so deadly, despite being very survivable when detected early?

Cancer: HIV/AIDS Patients At Increased Risk

Monday, June 27th, 2011

It is estimated that there are more than a million people in the U.S. infected with HIV.  In 2009 alone, there were roughly 50 thousand new HIV cases. There are approximately 16-18 thousand AIDS-related deaths in the U.S. each year. Although medical advancements have enabled many HIV/AIDS patients to live a relatively normal life, the truth is that the HIV/AIDS epidemic has been and continues to be a public health disaster of astronomic proportions.

As if life with HIV/AIDS is not difficult enough, researchers have also found that HIV/AIDS patients are also more prone to developing various malignancies when compared with the non-infected population. In fact, cancer is one of the leading causes of mortality in the HIV/AIDS  population. It is estimated that 30%-40% of HIV patients will develop some type of cancer during their life time.

The types of cancer that affect HIV patients can be generally divided into two groups: AIDS defining cancers and opportunistic cancers. An HIV positive patient who develops a cancer defined by the Center for Disease Control and Prevention as AIDS defining is considered to have AIDS.  These AIDS defining cancers include: Kaposi’s sarcoma, non-Hodgkin’s lymphoma, and invasive cervical cancer. Other cancers are generally categorized as opportunistic.

Researchers have found that HIV/AIDS patients have a 2-to-3 fold increase in the overall risk of developing opportunistic cancers. Not only are HIV/AIDS patients more likely to develop cancer but the cancer prognosis is worse when compared with that of non-infected patients. HIV/AIDS patients also present with more advanced cancers at the time of diagnosis and, on average, they develop cancers at a younger age.

So, why is the risk for developing cancer higher in the HIV/AIDS population? It remains unclear whether the actual virus has a direct impact on the development of malignancies. It is believed, however, that the increased incidence of cancer is due to the fact that HIV/AIDS patients have a compromised immune system, which can lead to an impaired ability to produce antibodies or inflammatory responses.

Needless to say, if you are an HIV/AIDS patient or you know someone who is, please be aware of the increased risk for developing cancer. Be proactive and pursue proper and timely cancer screening. If you are experiencing unusual symptoms, don’t automatically attribute them to having HIV/AIDS (e.g., unusual fatigue). Unfortunately, they might just be symptoms of cancer.

 

Related posts:

H.I.V. treatment advances, but what are the implications of terminating research early?

 

 

Week in Review: (June 18 – June 24, 2011) Eye Opener Health, Law and Medicine Blog

Saturday, June 25th, 2011

Eye Opener’s Week in Review

From the (guest) editor:  Good morning!  I hope that cup of coffee is nice and hot.  I find that the Eye Opener goes well with cream and sugar.  And maybe a pastry (or two).  Whatever your choice, please enjoy the week in review.  I know the writers are working hard to provide timely and topical writing for your reading pleasure.  Don’t be shy!  Go ahead and leave a comment or two and let them know you are reading along.  See you next week!

-  Jason Penn, guest editor

How Do I Choose A Lawyer? A Helpful Guide

By Brian Nash

Im not sure if anyone loves a deal quite like I do.  Im a true bargain shopper.  On Monday, Brian gave us a “two for one.”  Not only did we get a blog post, but also a free download—his white paper “Choosing a Lawyer – A primer.”  Everyone has a lawyer joke, or three in their stash, but what do you do when you need a lawyer?  Do you turn to the internet and Google?  What qualifications should you look for?  Will there be a fee agreement?  Brian covered that and more!  Read more

Don’t underestimate jurors. They really do get it – most of the time!

By Brian Nash

On scripted television, Sam Waterstein and his cadre of young attorneys can go from investigation to jury verdict in less than 42 minutes.  As you know, in the real world of litigation, the issues aren’t as cut and dry and you certainly can’t spend 15 minutes reviewing a file and march into the courtroom?  When an attorney is “in trial” he/she can spend many sleepless nights wondering if the jury “gets it.”  In other words, are they following along with the complex medicine?  Are they able to understand the ways in which the physician breached the standard of care and caused harm to their client?  Just hours after resolving a very complex medical malpractice trial, Brian provided the answer to that very question.  Read more

Dealing with Cerebral Palsy: A Resource for Parents and Family (Part III)

By Jason Penn

On Wednesday I put down the editor’s red pen, and took out my writing pencil.  I offered Part 3 of my series that I’ve written specifically for parents that are dealing with cerebral palsy.  So many families are affected by cerebral palsy yet do not have the proper resources.  In Part III I addressed the variety of medical modalities that are being used to treat cerebral palsy and its related symptoms.  Read more

Nash & Associates in the Community: Wendy Kopp and Teach for America

By Jason Penn

When we aren’t practicing law, blawging or spending time with our families, we are out in the community trying to make a difference.  On Thursday, I shared my experience meeting Wendy Kopp.  Wendy Kopp is the chief executive officer and founder of Teach For America, whose mission is to build the movement to eliminate educational inequity by enlisting the nation’s most promising future leaders in the effort. She is also chief executive officer and co-founder of Teach For All, which is working to accelerate and increase the impact of this model around the world.  Inspired by Wendy and her goal of changing the face of education, I issued a challenge to you, the Eye Opener reader.  Read more

Sneak Peak of the Week Ahead:

The Eye Opener and its writers are excited about the week ahead too!  Here’s a sneak peak of what’s in store for you:

  • Service dogs for children:  more than just a pet
  • Changes in Sunscreen:  will regulation prevent cancer?
  • HIV Patients:  Increased risk for developing cancer
  • Legal Boot Camp is back in session and Part IV of our Cerebral Palsy tutorial.

Wishing You and Yours a Great Week Ahead!

Images courtesy of:

www.imperformancecoaching.com

www.squidoo.com

http://us.cdn2.123rf.com

www.businessweek.com

 

 

Nash & Associates in the Community: Wendy Kopp and Teach for America

Thursday, June 23rd, 2011

Tai Dixon of Baltimore Teach for America and IThe Eye Opener serves many purposes.  Not only do we serve as patient advocates, but we do our best to provide information to the community on a variety of topics.  There is little else that is more important to the health of a community than its educational system.  Committed to the health of our community, I recently attended an event sponsored by the Enoch Pratt Free Library:  An intimate discussion with Wendy Kopp, author of A Chance to Make History.

By most objective standards, many of our nation’s schools are failing.  The national conversation about education has been ongoing and has resulted in a series of changes to the way we educate our children.  The people driving those changes often go unrecognized by the greater public.  Their efforts are profound, but unless you are in some way connected to the educational movement, their names are not easily recognized.  Let me introduce Wendy Kopp and Teach for America.

“Wendy Kopp is the chief executive officer and founder of Teach For America, whose mission is to build the movement to eliminate educational inequity by enlisting the nation’s most promising future leaders in the effort. She is also chief executive officer and co-founder of Teach For All, which is working to accelerate and increase the impact of this model around the world.

Wendy proposed the creation of Teach For America in her undergraduate senior thesis in 1989. Today more than 8,000 Teach For America corps members are in the midst of two year teaching commitments in 39 regions across the country, reaching over 500,000 students, and 20,000 alumni are working inside and outside the field of education to continue the effort to ensure educational excellence and equity.

Since 2007, Wendy has led the development of Teach For All to be responsive to requests for support from social entrepreneurs around the world who are passionate about adapting the model to their contexts. Teach For All is a growing global network of independent organizations pursuing this mission in 18 countries, from India and China to Brazil and Lebanon. ”

Recently, Wendy was in town to discuss the education of America’s children.  The same questions remain:  “How do we ensure that every child is provided with a top-notch education, regardless of their socio-economic status?”  “How can we empower teachers to change the lives of their students?”  “How do we ensure that education is funded at appropriate levels?”  At an event moderated by Freeman Hrabowski, president of my alma mater UMBC, Wendy provided insightful answers to these questions.  The progress made in Baltimore and Washington D.C. schools is remarkable and is in no small part as a result of the efforts of Teach for America.

The reality, however, is that Wendy Kopp, Teach for America and its supporters cannot do it alone.  Improving education should be a community goal shared by all.  So I issue the challenge to you:  what can you contribute to ensure that our children receive an excellent education?  Can you give your time?  Your wealth?  Please feel free to leave your comments below…

Credit:  www.teachforamerica.org

Related Links:      Charity begins at home:  OriolesREACH program hits a grand slam with us!

Pictured above:  Tai Dixon of Baltimore Teach for America and I.

Dealing with Cerebral Palsy: A Resource for Parents and Family (Part III)

Wednesday, June 22nd, 2011

In Part I of this series I provided a basic introduction to dealing with cerebral palsy.  I also provided Maryland parents with a comprehensive list of places that are able to assist parents.  In Part II I discussed educating children with cerebral palsy and provided a list of places to turn if you need help.  Today we will take a look at some of the medical treatments available for cerebral palsy.

Medical Treatment

Cerebral Palsy cannot be cured, but treatment can often improve a child’s capabilities. Progress due to medical research means that many patients can enjoy near-normal lives if their neurological problems are properly managed. There is no standard therapy that works for all patients; the physician must work with a team of other health care professionals to identify a child’s unique needs and impairments.  Typically, an individual treatment plan is created to addresses them.  As a general rule, the earlier diagnosis and treatment begins, the better chance a child has of overcoming developmental disabilities or learning new ways to accomplish difficult tasks.  The goal of treatment is to help the person be as independent as possible.

Treatment requires a team approach, including:

  • Primary care doctor
  • Dentist (dental check-ups are recommended around every 6 months)
  • Social worker
  • Nurses
  • Occupational, physical, and speech therapists
  • Other specialists, including a neurologist, rehabilitation physician, pulmonologist, and gastroenterologist

Treatment is based on the person’s symptoms and the need to prevent complications.  Self and home care include:

  • Getting enough food and nutrition
  • Keeping the home safe
  • Performing exercises recommended by the health care providers
  • Practicing proper bowel care (stool softeners, fluids, fiber, laxatives, regular bowel habits)
  • Protecting the joints from injury

Putting the child in regular schools is recommended, unless physical disabilities or mental development makes this impossible. Special education or schooling may help.

The following may help with communication and learning:

  • Glasses
  • Hearing aids
  • Muscle and bone braces
  • Walking aids
  • Wheelchairs

Physical therapy, occupational therapy, orthopedic help, or other treatments may also be needed to help with daily activities and care.

Medications may include:

  • Anticonvulsants to prevent or reduce the frequency of seizures
  • Botulinum toxin to help with spasticity and drooling
  • Muscle relaxants (baclofen) to reduce tremors and spasticity

Surgery may be needed in some cases to:

  • Control gastroesophageal reflux
  • Cut certain nerves from the spinal cord to help with pain and spasticity
  • Place feeding tubes
  • Release joint contractures

What is important, however, is that an individualized approach be taken for your child.

Query:  Does your child have cerebral palsy?  What medical treatments are you providing for your child?

 

 

Credits to http://www.nlm.nih.gov; www.nsnn.com

Don’t underestimate jurors. They really do get it – most of the time!

Tuesday, June 21st, 2011

I just finished a two week trial that was probably one of the most complex medical cases of my 37 year career. Since the “resolution” of the case is the subject of a confidentiality agreement, I’m not at liberty to discuss the details of the case or its “resolution.” Nevertheless, what I am free to tell you is that having tried hundreds of jury trials over my career, it amazes me just how often jurors “get it” when it comes to doing their very best to understand the evidence thrown at them and to do “the right thing.”

The case involved about 8,000 pages of medical records. Jurors heard from 8 medical witnesses ranging from surgery, to infectious disease, to radiology to pathology. This was not a case involving “Anatomy 101″; it was an advanced course in the biomechanics of the spine, neural element compression, biofilms on hardware, pulmonary hypertension, deep vein thrombosis – well, you get the picture.

After nine grueling, long days of evidence, sitting in hard, non-cushioned chairs and having to endure seemingly endless bench conferences dealing with evidentiary issues and objections that the jury was not allowed to follow, our panel patiently waited for over two hours on their final day of service while the parties to the lawsuit worked out “a resolution” of the case. The trial was to end the next day (today). They, the jurors, would finally get to speak to us, rather than having us speak to them for over two weeks.

Once the details of the “resolution” were hammered out, the judge had the courtroom clerk bring the jury into the courtroom to take their “luxurious” wooden seats. The Court announced that the parties had “resolved” the case and that the jurors’ service was now completed. Nine plus days and countless hours of sitting and listening – and now – no chance to deliberate and tell the parties who they – the jurors - thought was right in this legal battle. The judge then advised them that they had served a most important function because many times (this being one of them) the parties could not reach agreement – uh “resolution” – without them. It was further announced by the Court that if they cared to do so, they were now free to speak with the lawyers.

Rather than gather up their belongings and hustle out the door, each and every one of them remained in the courtroom to share their thoughts and observations of the trial. Once again, as has happened so many times in my career, I was pleasantly surprised  and amazed by what they had to say. Peppered with questions by the lawyers to see if they “got it,” our jurors shared their observations about key issues in the case. The told us about their “take” on the evidence involving T1 versus T2 weighted MRI’s. They accurately recounted the evidence regarding the issues of “sub-clinical infection.” They shared their individual thoughts and reflections on what role the decedent’s underlying, complicated co-morbidities played in their analysis of causation.

We’re not talking about a panel of medical experts here. We’re talking about everyday folks, who brought their common sense and varying levels of education and life-experiences to the litigation table. They “got it”!

None of the parties will ever know what the jury’s eventual verdict would have been. Nevertheless, because of the uncertainty of that verdict, the opposing sides in this lawsuit worked their way through a morass of emotion, righteousness, principles – you name it – to get the case “resolved.”

I hear so often from “professionals” that the jury system is broken. They rant endlessly that we need “professional” finders of fact to arrive at just results. Oh really! If that’s the case, then why is it that each side can have highly qualified experts, who can’t agree on the interpretation of medical evidence? Maybe – just maybe – it takes people of plain common sense, goodwill and a sense of justice to get it right.

Have jurors arrived at verdicts in my career that make you want to retire from the practice of law? They have – but on very rare occasions. When you put aside the self-righteousness of bias and advocacy and reflect on verdicts, many lawyers – I for one – appreciate that juries really do “get it” and really try to do “the right thing.”

To all the cynics out there, don’t be so unwilling to appreciate what these citizens do to advance our system of justice. Is the system perfect? Far from it, but not as far from it as many would have you believe.

Let me end by simply saying – THANKS to our citizens who made-up our jury. Your patience, attentiveness, endurance and willingness to serve is very much appreciated. You could easily have dreamed-up a way to avoid service on the jury during the selection (voir dire) process (as so many do in so many pathetic ways), but you didn’t do that. Kudos to each and every one of you. You did advance the cause of justice. You made the parties to this lawsuit take note of the fact that maybe, just maybe, their view of the case was about to be tested in the crucible of the jury room. That knowledge and the reality of an impending verdict made them step back, take a deep breath and come to a “resolution” of their dispute. Well done, Citizens! I for one applaud you.

How Do I Choose A Lawyer? A Helpful Guide

Monday, June 20th, 2011

One of the most important things you can do if you are considering a lawsuit is to spend time doing a proper search for the lawyer, who will be handling your case.

Just because a law firm or a lawyer has a fancy webpage or an eye-catching ad in your local phone directory or even a professional looking TV commercial does not mean that this lawyer has a clue what he/she is doing in the specialized areas of medical malpractice or catastrophic personal injury.

We invite you to read and consider the issues and questions raised in our White Paper – “How to Choose a Lawyer.”

If you have other ideas or questions that you believe would be helpful to our readers in their search for a lawyer, post your reply on this topic so others may benefit by your insights.

 

Image courtesy of www.quadtechint.com

 

Week in Review: (June 13 – June 17, 2001) Eye Opener Health, Law and Medicine Blog

Saturday, June 18th, 2011

Eye  Opener’s Week in Review

 

Jason Penn

From the Editor:  Today marks the end of week two as “guest” editor for the Eye Opener. I can tell you that the title “editor” is a misnomer. When it comes to the Eye Opener and its panel of bloggers, very little (if any) editing takes place. Consistently, our blawgers provide you with timely and topical posts. This week was no different. Let’s take a retrospective look at what the “Eye Opener” offered this week (and, of course, a sneak peek at the week ahead.)

– Jason Penn, Guest Editor

 

(Many thanks to Jason and all those back at the firm, who helped get the word out on some great topics this past week while I’ve been wrapping-up week #2 of the trial from hell…….Brian Nash)

July 1 – New Residents, New Rules……Again!

By: Theresa Neumann

While the loss of sleep is rarely a topic on Gray’s Anatomy (or any made-for-television medical drama), it is a genuine quandary for non-actor, medical residents. This past Monday, Theresa Neumann explored the ACGME’s limitations on the hours worked by medical residents in the United States. As Theresa explained, the overall maximum hours per week will not change; it remains at 80 hours.  One big change is the limit on the maximum continuous duty period for first year residents; this will be decreased from 24 to 16 hours.  It will remain 24 hours for residents after their first year, but recommendations include “strategic napping.” Curious about the other changes?  Read more

Newest Word on Crib Safety: Ban the Bumpers?

By: Sarah Keogh

Sleep isn’t only important for medical residents; it is also important for the smallest members of our families. As Sara Keogh explained on Tuesday, Maryland is considering regulations to ban the sale of crib bumpers. For many years, more and more emphasis has been placed on infants sleeping in safe cribs without any additional “stuff” in them. This has included the elimination of lots of former nursery staples. Baby blankets, stuffed animals, pillows and other loose items have been banned from the crib by safety experts for years. As requirements for cribs have required slats that are closer together, the utility of using a bumper to help a child from getting stuck between crib slats has been eliminated. More recently, the Consumer Product Safety Commission has developed even newer crib safety standards, including eliminating the use of drop-sides, and warned against the use of sleep positioners. Yet, despite the advice to put babies to sleep only on their backs in cribs empty of everything except a well fitting mattress and fitted sheet, many parents and caregivers persist in using other items in cribs. Now, with an increasing number of deaths associated with crib bumpers, Maryland is considering a stronger stance. Read more

Legal Boot Camp Class Four. Sean and Kristy’s Story: How a Jury Award is Conformed to the Cap

By: John Stefanuca

On Wednesday blogger Jon Stefanuca broke out his calculator:  bootcamp style.  In the state of Maryland, there is a cap on the damages that can be awarded.  But what happens when a jury returns a verdict in excess of the statutory amount?  Mathematics and law intersect.

To see the results, and a detailed explanation of how it all works, you can read more ….

 

Confusion with Advanced Directives: Palliative Care, End-of-Life and Hospice Care

By: Theresa Neumann

With the death of the always controversial Jack Kevorkian, we revisited a post by Theresa Neumann.  Breathing a little life into the post (pun intended), Theresa provides an excellent primer for readers that are facing end of life situations.  The differences are nuanced and can be difficult to understand at a most difficult time. Are you sure you know the difference between palliative, end-of-life and hospice care?  Read more

Acquired Brain Injuries: Subdural Hematomas

By: Theresa Neumann

When Humpty Dumpty fell, they were able to put him back together again.  Because our lives are nothing like a children’s nursery rhyme, when we fall, we get hurt.  A head injury is particularly serious. Have you ever bumped your head and developed a “goose-egg?” It’s truly amazing how fast that big bruise under the skin grows. That bruise, or hematoma, is from a broken blood vessel, usually a vein. The pressure from the swelling helps with clotting, along with the blood’s own clotting factors. This types of hematoma typically takes a week or more to go away. If it’s on the forehead, it’s often followed by one or two “black eyes.”  That’s because the blood tends to spread along  tissue planes, and gravity notoriously pulls everything downward causing it to pool in the eye sockets, where the blood cells degrade and their components are reabsorbed by the body. Unlike a fairy tale, however, this goose-egg can be serious.  Read more

Sneak Peak of the Week Ahead:

As I told you at the beginning, the Eye Opener’s writers continue in their efforts to provide you with timely and topical blogs for your reading pleasure. As evidenced by the above, this past week was no exception. The Eye Opener and its writers are excited about the week ahead too!  Here’s a sneak peak of what’s in store for you:

  • Service dogs for children:  more than just a pet
  • Changes in Sunscreen:  will regulation prevent cancer?
  • HIV Patients:  Increased risk for developing cancer
  • Legal Boot Camp is back in session and Part III of our Cerebral Palsy tutorial.

Wishing You and Yours a Great Week Ahead!

Images courtesy of:

www.theepochtiems.com

www.sleepzine.com

www.nailsmag.com

www.aginglongevity