Archive for the ‘News Reports’ Category

Autism and Wandering – a constant struggle

Wednesday, August 3rd, 2011

I have written before in this space about special needs children, including children with autism. This week I want to turn my attention to one aspect of autism – wandering – and some of the ways parents and schools are trying to keep kids safe. Wandering is something I really had not heard of before, but I’ve since learned that it is a serious danger to children with autism or other cognitive deficits. It is also a major source of stress to parents who are constantly worried about their child wandering off.

All children have a tendency to wander away from their parents at times. When my daughter was two, I lost her at Sports Authority. I thought she was standing right next to me while I was looking at something, then I looked down and she was gone. After a few frantic minutes – and with the quick help of the store employees – we found her all the way on the opposite side of the store looking at balls. She was perfectly fine, but it was terrifying for me.

For reasons that are not well understood, children with Autism Spectrum Disorder (ASD) tend to wander more than non-autistic children. As reported by the Child Mind Institute and others, a recent study by the Interactive Autism Network has finally tried to quantify what has traditionally been more anecdotal evidence about wandering.

According to the responses from more than 800 parents, roughly 50 percent of children between the ages of 4 and 10 with an ASD wander at some point, four times more than their unaffected siblings. The behavior peaks at 4, almost four times higher than their unaffected siblings, but almost 30 percent of kids with an ASD between the ages of 7 and 10 are still eloping, eight times more than their unaffected brothers and sisters.

Autistic children seem to wander for two basic reasons. One is to find something they like, such as their favorite pond or playground; and one is to get away from something they don’t like such as a stressful school environment. It’s not really running away, at least as that term is usually used to describe a child who decides to leave home because of some real or perceived injustice at home. A majority of parents in the study described their child as happy and focused when they wandered off. It is usually a matter of the child being drawn to something that he or she likes. One child referenced in the Child Mind story had a fascination with exit signs. One day at school, the boy wandered off through the woods toward the highway to find his favorite exit sign. Thankfully, a good Samaritan picked-up the boy and returned him to where he belonged.

The danger for children is very real. While concrete statistics are difficult to come by, drowning seems to be the biggest danger (there are some who believe that autistic children are drawn to water). Children can also wander into traffic. Of course, when any small child wanders alone there is the risk of getting lost or being abducted. To further complicate matters, thirty-five percent of families in the study reported that their child is never or rarely able to communicate basic identifying information such as name, address and phone number. This obviously makes it harder for a wandering child to get back home. Even older or more high-functioning children may – due to their social anxiety – be reluctant to seek out help or cooperate with someone who is trying to intervene.

Wandering represents a challenge to schools because it can be very difficult to monitor a child all day long, especially during class changes and recess. The problem, however, also occurs at home. Wandering occurs not just during the day; night-time wandering is an especially big fear for parents of autistic children. Some children have been known to get up in the middle of the night, undo the deadbolt on the front door, and walk-off into the night. The terror of finding your child gone in the middle of the night is unimaginable. Some parents have installed deadbolts higher up on the doors, some have installed alarms that go off if the door is opened. Some parents have gone so far as to have their children wear tracking devices that send out a signal that can be pin-pointed. While all of these techniques can help, there are no sure-fire methods of preventing wandering. It is a constant worry for parents.

The autism community has taken action by getting the Center for Disease Control’s safety subcommittee to assign a specific medical code for wandering, which will be in conjunction with the diagnosis of ASD. By doing this, it is hoped that doctors will more readily recognize wandering as a legitimate diagnosis that they can address with the parents or other caregivers (the new code applies to adults with ASD as well). The American Academy of Pediatrics is also preparing a fact sheet to educate doctors on the topic so that they can better work with parents to try to reduce the incidence of wandering. The new code may also make it easier for parents to seek reimbursement from their insurance companies for alarms and tracking devices, and it may make it easier for parents to argue to their schools that a one-on-one monitor is needed as part of the child’s Individualized Education Plan (IEP). The new code takes effect in October 2011.

Lori McIlwain, Chairwoman of the National Autism Association, recently discussed how to deal with wandering:

The best overall strategy is a multi-tiered approach, which includes educating the child about safety and dangers using whatever means of communication works, including social stories, language and/or visual prompts. It’s also important that caregivers—and schools—work to understand what is causing, or contributing to, the wandering or bolting behaviors so that any triggers may be addressed or eliminated.

Have any of our readers had any experience with wandering? I’d like to hear your stories as to how you deal with it and how it affects your life.

Related Nash and Associates Links:

Dogs a Huge Help to Special Needs Kids

The Daily Struggle of Raising a Disabled Child

Many Parents Still Believe Vaccines Cause Autism

 

 

Photo courtesy of: Issueswithautism.com

Can a Simple Image Guide Good Nutrition?

Tuesday, June 7th, 2011

Image from www.choosemyplate.gov

Last week, the USDA unveiled the new MyPlate image to replace the outdated food pyramid. When I first saw the new image, I felt a welcome relief at the simplicity of this concept. The plate seemed like the iPhone of the nutrition world. Simply and intuitively designed – replacing a complex chart of recommendations with something that even a busy person could use in their every day lives.

As an individual and as a parent, I have worked hard for the last 5 or more years to dramatically change the buying and eating habits in our household. We buy most of our food, at least during the months from May until November, at the farmer’s markets around town. We try to buy most of our meat, eggs and dairy products from local farms. For the food that we purchase from the supermarket or from restaurants, I make a conscious effort to buy mostly real foods that are not full of preservatives, additives or other unidentifiable ingredients. Despite these efforts, it can still be a challenge to make sure that my meals are nutritionally well rounded.

My favorite feature of the new design MyPlate is that it is accessible even to the youngest children. Most people in this country eat their meals off plates, or at least are familiar with them. The idea of how much food to put on the plate and in what proportions resonates with me. Perhaps this image will also have the secondary effect of acting as a wake-up call to any Americans who are currently eating their meals primarily on the go, in their cars, or as undefined snacks constantly throughout the day (“grazing” as my father used to call it in our house).

Secondary Benefit of the Plate Image? Perhaps People will Focus on Sitting Down to Meals

To me, the take home message in the new image is that the healthiest option is to eat real meals, sitting down, preferably with others. These meals should be loaded with vegetables and fruits, with the addition of grains and protein. I suspect that the new USDA plate does not look like the plates of most Americans today at the average meal. Many, myself included most of the time, eat meals with more grains or proteins covering the plate than vegetables or fruits most of the time. However, this seems like a very achievable change to make. As long as we can help people get access to vegetables and fruits (outside the scope of this post – but there have been plenty of things written about how much easier it is in this country to get cheap meats and carbs than fresh fruits and veggies), then it seems simple with this guide to adjust your plate to be half covered in vegetables and fruits each meal.

Easy Enough for Kids and Busy Parents

Image from Zazzle.com

The other reason I like this image, besides its simplicity, is that it is easy. A child could easily use this as a template to fill their plate. Moreover, there are already a ton of children’s plates on the market that are easily divided…perhaps there should be similar plates for adults – I suspect someone is marketing this as I type. In case you were worried, someone has already developed the “Bacon My Plate” items. But, the point is that if you are a harried parent in today’s busy world, you may be searching for easy healthy foods for your kids. Well, perhaps the answer is here, just make sure that you fill the plate according to the guidelines and voila – dinner is ready.

Entire USDA MyPlate Website Devoted to Tips and Tools

What is less obvious from the media coverage in the last few days about the USDA MyPlate announcement is that the recommendations are not just in the image. The USDA has created a complete website and brochure that detail the recommendations much more thoroughly.  It also includes a number of interactive tools that help you evaluate the food group, calories and other details about particular foods. There are tools to help you plan meals, specific recommendations for toddlers and pregnant/nursing moms, advice for weight loss and other tips. A few of the other tips from the USDA brochure that I found especially important:

  • Make half your plate fruits and vegetables
  • Eat red, orange, and dark-green vegetables
  • Eat fruit, vegetables or unsalted nuts as snacks – they are nature’s original fast foods.
  • Switch to skim or 1% milk.
  • Make at least half your grains whole.
  • Vary your protein food choices.
  • Twice a week, make seafood the protein on your plate.
  • Use a smaller plate, bowl, and glass.
  • Stop eating when you are satisfied, not full.
  • Keep physically active.

These are just a few of the recommendations that accompany the new MyPlate image. There are lots more details available online. One of the recommendations that I was given when my son was a baby, just learning to eat finger foods, was to provide him with a rainbow of foods. Again, I think that the image works! If you feed your children (and yourself) a variety of different colored foods (and I am talking natural colors – think cherries, oranges, yellow peppers, spinach, blueberries, eggplant – not artificial colors…not fruit loops) throughout the day and week, you will provide a natural array of different vitamins and minerals without having to worry about reading labels.

Thoughts?

What are your tips for healthy eating? Do you like this new image? Do you think that it will make any impact on the obesity crisis?

Related Posts:

Does Nutrition Info on Fast-Food Menus Really Make a “Choice” Difference?

Decreasing Obesity Risks in Children: Another Benefit of Breastfeeding

Can Religion Make You Fat?

Ovarian Cancer – five tips to make sure you get the medical care you need

Wednesday, May 11th, 2011

Did you know that more than 21,000 women are diagnosed with ovarian cancer in the U.S. each year? An astonishing 15,000 women die from ovarian cancer each year. Despite numerous advances in healthcare, the mortality rate for ovarian cancer has not improved in the last 30 years. Simply put, ovarian cancer is the deadliest of all gynecologic cancers. If the cancer is diagnosed in its early stages (i.e. before it spreads to other organs), the five-year survival rate is about 93.8%. However, if it the cancer is diagnosed in its later stages, the five-year survival rate is about 28.2%.

There is no question that ovarian cancer is quite deadly and that early diagnosis and treatment is key for survival. There is an abundance of information about ovarian cancer online and in other written sources. Simply put, take the time to familiarize yourself with the symptoms of this terrible disease. Let’s share with you some information, which I believe can make a difference. Call it a male lawyer’s perspective, if you will. I’ve seen what happens when early detection should have happened, but tragically did not.

1. Examine Your Medical History

Whenever the possibility for ovarian cancer exists, consider your medical history as you discuss your symptoms with your physician. If you are having symptoms consistent with ovarian cancer, take the initiative and discuss your symptoms and history with a gynecologist as opposed to your primary care physician. Make sure to tell your physician if you have any cancer history. Don’t forget to include information about any family history of cancer (parents, siblings, etc.). Of particular importance is any history of breast or ovarian cancer, although any cancer history is relevant. Unfortunately, women with a personal or family history of ovarian cancer or breast cancer are at a higher risk.

2. Understand and Appreciate Your Symptoms

Although your physician is likely to talk to you about ovarian cancer, it is always a good idea to familiarizer yourself with the signs and symptoms of ovarian cancer before your doctor’s appointment. Many of the symptoms of ovarian cancer overlap with the symptoms of cervical cancer. Therefore, if you are experiencing symptoms of cervical cancer, you and your physician should also discuss the possibility of ovarian cancer. We have seen cases were a physician will consider one or the other but not the possibility of both cancers. Here are some of the more common symptoms of ovarian cancer:

-          Irregular uterine bleeding

-          Abdominal  and/or pelvic pain

-          Abdominal fullness or bloating

-          Fatigue

-          Unexpected weight loss

-          Fatigue

-          Headaches

-          Frequent urination

-          Low back pain

Watch this video for more information about symptoms of ovarian cancer:

httpv://www.youtube.com/watch?v=fH9N4auMblE

 

Watch this video for more information about symptoms of cervical cancer:

httpv://www.youtube.com/watch?v=HHA_0HsjeBI&feature=related

3. Is it a solid mass?

If your radiographic studies reveal a mass, make sure that you get a clear answer as to whether the mass is solid or fluid-filled.  A fluid filled mass will typically turn out to be a cyst. It could also be a blocked fallopian tube (i.e., hydrosalpinx, hematosalpinx, pyosalpinx). Generally speaking, a fluid filled mass is less likely to be malignant. However, if your radiographic studies reveal a solid mass, especially one that arises from an ovary, the possibility of ovarian cancer must be seriously considered. If you are found to have a solid mass, talk to your gynecologist or primary care physician about consulting with a surgical oncologist.

4. Should you have a CA 125 blood test?

CA 125 is a protein. It is a tumor marker or biomarker for ovarian cancer because it is more prominent in ovarian cancer cells. The CA 125 test is a test designed to test the levels of CA 125 in a patient’s blood. Elevated CA 125 levels can be indicative of ovarian cancer. If your CA 125 levels are elevated, you and your physician should seriously consider the possibility of ovarian cancer. An elevated CA125 should prompt your physician to order additional radiographic studies, including a CT of the abdomen and pelvis, an ultrasound of abdomen and pelvis, a PET scan or even a CT pyelogram. You should also consider consulting an oncologist or a surgical oncologist. If you are found to have a solid mass and your CA 125 level is elevated, time is of the essence for further investigation and surgical intervention.  Ask your doctor about other tumor markers that can be tested.

5. Who is reading your ultrasound?

Many patients who present to their gynecologist with symptoms of ovarian cancer will initially undergo an ultrasound. A great number of gynecologists will themselves perform and interpret the ultrasound. Here is the problem. With all due respect to gynecologists, they are not trained ultrasonographers or even radiologists! Ultrasounds can be particularly difficult to read. This can be due to the patient’s position and, more frequently, the size of the patient. In heavier patients, a pelvic ultrasound can be quite limited if one is trying to visualize the ovaries, discern the presence of mass, or determine whether the mass is solid or fluid-filled. So, if your gynecologist is the only person to read your ultrasound, the result is potentially quite devastating. The mass could remain undiagnosed, and you may be told to come back if your symptoms get worse. The ultrasound may be interpreted as limited, and, for whatever reason, your gynecologist may simply neglect to order a more sensitive study (i.e. a CT scan). Instead, he or she may choose to monitor you for any further deterioration of symptoms.

In yet another instance, if the ultrasound is limited, a solid mass may be confused for a fluid-filled mass. Under these circumstances, you may be asked to follow-up in six months. The problem with all of these permutations is delay, and you cannot afford delay with ovarian cancer. Make sure that your radiographic studies, whatever they may be, are read by a skilled specialist in the interpretation of whatever study you undergo.

As we always say, be your own patient advocate and be an informed patient. Be an active participant in your medical care by being informed and by demanding the care you require. Having an understating of the types of mistakes that can be made during medical treatment is simply prudent.

Please share your familiarity or experience with ovarian cancer treatment. What do you think women should watch out for should they find themselves afflicted by this terrible disease?

For more information, see our other blogs:

Ovarian Cancer – Early Intervention is Key, What You Must Know…

New study links gene to ovarian cancer and may assist in early detection 

Ovarian Cancer – The Smear Test Won’t Tell You Much

 

Image from cancersyptomspage.com

Dogs a huge help for special needs kids

Monday, May 9th, 2011

Dogs and kids just seem to go together. Whether it’s running around the yard and roughhousing or just sitting quietly watching TV together on the sofa, dogs seem to gravitate toward kids. For some special needs kids, however, dogs are more than just a friend and play buddy; they are actually a daily caregiver.

The idea of service dogs for disabled children is a little-known yet burgeoning niche in the world of special needs. Everyone knows about service dogs for the blind. I have to admit that until recently, I had never even considered service dogs for other disabilities, let alone children. Then a friend of mine whose son is autistic mentioned that she was thinking about getting an autism service dog for her son. I was puzzled. Her son suffers from sensory processing disorder so I didn’t understand what a dog would be able to do for him. Kids with autism usually don’t have physical handicaps. But as I talked to her and started reading up on the topic, I found that well-trained dogs can be a huge help to autistic kids, as well as kids with other disabilities.

For autistic children, service dogs don’t offer specific physical assistance, but are highly trained in behavior disruption, which is a major component of autism. As any parent of an autistic child can tell you, behavior disruption is common. It can be different triggers for different children, but the common denominator is that something (usually something benign to most of us) sets off what we laypeople would call an emotional or physical meltdown. This can be a mild tantrum or can be a full-blown one complete with collapsing on the floor and shrieking. Trying to calm an autistic child in the throes of such a meltdown can be a major challenge. It turns out that a dog trained to recognize such behavior and engage the child is a highly calming influence on the child. The dog essentially soothes the child and comforts him or her, shortening the duration and severity of the meltdown, and also cutting down on the number of meltdowns. Rather than getting overly focused on whatever it is that is bothering him or her, the child seems to focus on the ever-present dog and can bypass what otherwise might trigger a reaction.

The dog also gives other support that is less tangible but equally important – giving the child something to focus on if distracted, providing companionship, and assisting with developing friendships with other children. Special needs children are sadly often excluded by so-called normal children which can add a tremendous feeling of isolation for such children. Having a service dog helps break the ice with new kids and provides a constant companion when other children are not around.

Physically, a service dog also helps protect the child and keep him or her safe. One major concern with autistic children is that they are easily distracted and may not think as logically as other children.  They are more prone to wandering off in public because they get distracted by something and follow it, even if it takes them into traffic or near a dangerous body of water.  They may decide to leave the house alone for no apparent reason, even in the middle of the night. Service dogs are trained to restrain the child and act as a second pair of eyes on the child, which is a huge asset to the parents.

Legal fight over service dogs in school

A great piece of news recently came out of Oregon involving an autistic boy named Scooter Givens and his service dog, Madison. For years, Scooter’s parents fought their son’s school for the right to have the dog attend school with him under the ADA (American with Disabilities Act). The school fought back. Finally, the school backed down and agreed to at least try to allow Scooter to bring Madison to school with him. They are starting with part-time hours and working up to full days. If Madison can keep Scooter from having meltdowns, it should be a win-win for both the school and the family.

Cost and Availability

Service dogs are not cheap, nor are they readily available. A well-trained dog can cost  upwards of $20,000, depending on the level of training that is required (which is why my friend is not heading out this weekend to buy one). While this may seem excessive, the cost is actually justified when you realize that it can take six months or more of intense work  to properly train a service dog. That is months of food, shelter and paying a trainer to spend  hundreds of hours training each dog, as well as the additional training time when the dog is matched with the family. It is a labor-intensive process. However, there are ways to meet the cost. Many training facilities seek outside funding to help defray the costs of training, which lowers the ultimate cost to the family. Some families will actually do fundraising themselves to try to pay their portion of the cost. Even with this approach, however, the sad fact is that service dogs are unfortunately out of reach for a large number of people, especially when you consider the other high costs of raising a special needs child.

Other disabilities:

In addition to autism, service dogs are trained to care for people with other disabilities – deafness, mobility issues, and one that I found absolutely fascinating – seizure disorder. Dogs are trained to assist people who suffer seizures by getting the telephone and medicines, and keeping the person physically safe during a seizure. Some dogs can even go so far as to anticipate an oncoming seizure and alert the person to lay down in a safe position before the seizure starts. How the dog knows this is anyone’s guess. So far, science has been unable to explain it. Some researchers theorize that during the earliest phase of a seizure, the person’s electrical brain activity subtly changes a person’s odor which the dog detects. Dogs have a sense of smell that is 300 times stronger than what we have. While this may be the explanation, no one knows for sure so it remains a fascinating mystery.

If you are interested in a special needs dog, there are a number of organizations out there for you to consider. Here are just a few:

4 Paws for Ability:  http://www.4pawsforability.org/

North Star Foundation:  http://www.northstardogs.com/autism.shtml

Dogs for the Deaf:   http://www.dogsforthedeaf.org/index.php

Have any of our readers had any experience with special needs dogs?  I would love to hear your stories.

 

Photo from staplenews.com

 

 

Week in Review (May 2 – 6, 2011): The Eye Opener Health, Law and Just Interesting Stuff Blog

Saturday, May 7th, 2011

From Brian Nash (Editor)

We appreciate your stopping by to see what this past week’s posts covered in the world of law, medicine, health and safety – and then some.

You’ve been told you need to undergo treatment. The doctor tells you (hopefully) the risks and benefits of what’s being proposed. You’re wondering – “Is this my only choice?” In a non-emergency situation you usually have a choice you may not have considered – a second opinion. Theresa Neumann’s piece this past week addresses this usually available but very under-utilized resource for patient’s facing this situation.

Sarah Keogh writes about a topic that makes a lot of sense – when you stop and think about it. Who are the people on a hospital’s medical team that are with you more than anyone else? Your nurses, of course. Just how does a nurse’s working conditions not only affect him or her – how does it affect your health? Read Sarah’s piece and find out.

Asthma affects the lives of 20 million people in America. It does not discriminate since it affects the young, the old and all in between. This past week, Jon Stefanuca, who has been immersed in a case involving a young man who tragically died as a result of asthma shortly after being discharged from a local hospital, shared his “4 tips” to make sure you get the health care you need when you have an asthma problem. If you or someone close to you has asthma, take the time to consider Jon’s suggestions. As always, if there are some suggestions you could share with others, please do in the comments section.

Recently our firm started using QR Codes on our business cards. I’d heard about them but wasn’t quite sure what they were all about. After a little bit of study and discussion, I was amazed at what they can do – you will be too. So many now use their phones and mobile devices as their primary means for connecting with the world via the internet. Just download a free mobile application, snap a picture using the app and the QR Code will whisk (at a blazingly fast speed) you away to more information than you can imagine. Jason Penn, who was the first to get his QR Code business card, was apparently fascinated by this new technology, so he wrote a post this week about it and shares with you some interesting information about some others who have been using it for some time now.

Our Posts of the Past Week

Medical Second Opinions: An Under-utilized Option for Patients

By: Theresa Neumann

Today’s medical world is vast with various technologies, treatments and options.  So, if a patient is diagnosed with a medical condition, and doctor A recommends treatment A, what keeps the patient from seeking a second opinion? This is an interesting phenomenon.  After performing intake summaries and client interviews for quite a while now, it still amazes me how many people have bad outcomes from surgery simply because they never requested a second opinion. Second opinions are not simply reserved for surgery, though; cancer treatment options, medical therapies for chronic conditions like rheumatoid arthritis or inflammatory bowel disease….read more

 

Working Conditions for Nurses Impact Patient Health

By: Sarah Keogh

I suspect that anyone who has spent even as much as one day or night in a hospital knows just how critical the nursing staff is in the , health, care and comfort of a patient. A compassionate and personable nurse can put a patient at ease and help them feel better in ways that go beyond just medicine.

Recently, I wrote about how different schedules impact nurses’ lives and how they cope with shifting from day to night schedules. This week, I was drawn to write about nurses again after seeing an article on medicalnewstoday.com that spoke about a study done by the University of Maryland School of Nursing.  Read more

Having an Asthma Problem: 4 Tips for you to use to get the medical care you need

By: Jon Stefanuca

Did you know that approximately 20 million Americans suffer from asthma?  Every day, about 40,000 of them miss school or work because of this condition. Each day, approximately 30, 000 experience an asthma attack.  About 5000 patients end up in the emergency room. Asthma is also the most common chronic condition among children. Can there by any doubt it is a very serious and potentially deadly medical condition that needs equally serious understanding and attention? The good news is that with proper education and treatment, most asthmatics have active and productive lives.

Bronchospasm and inflammation: the key features of asthma

This chronic airway disease has two primary features: bronchospasm and inflammation. Bronchospasm refers to the mechanism by which airways become narrower. In asthmatic patients, the muscle within the wall of the airway contracts, thus narrowing the lumen (a cavity or channel within a tubular structure) of the airway and causing respiratory obstruction. Inflammation refers to the process by which the wall of the airway becomes thicker in response to inflammation, which also causes the lumen to narrow and produce respiratory obstruction. Bronchospasm is usually treated with….read more

Bar Codes, QR Codes and More: The Intersection of Life and Technology

By: Jason Penn

The business cards I ordered arrived yesterday.  I tore into the package to do the usual inspection.  Is my name spelled correctly?  Is the card stock heavy enough?  Did they use the desired typeface?  Yes. Yes. And Yes.  But I needed to ask one additional question: Does the QR code link correctly?   I know what you are thinking:  What is a QR Code and why is it on your business card?  Let’s try an experiment. Read more…

Don’t forget, however – you can learn about Jason but just using your QR Code reader right now….

Sneak Peak of the Week Ahead

That was it for last week. What’s coming in the week ahead? Here you go -

  • Mike Sanders has a piece about our wonderful canine friends and how they are being used for those with special needs.
  • Sarah Keogh will be investigate the role and responsibility of our schools to warn parents about potential health problems involving their children
  • Jon Stefanuca will be taking a look at ovarian cancer and suggesting some key issues to discuss with your physician
  • Jason Penn will be telling us more about stroke and a very interesting problem that his research has revealed
  • I will be writing about a brand new project we are starting to take our social networking to a whole new level – stay tuned.

Again – many thanks to all who stopped by. Take a few minutes, read our posts and maybe have some interesting topics for discussion this weekend after reading last week’s Eye Opener.

Have a great weekend, Everyone!



Hungover Surgeons: Watch Out! There Is Nothing Between You and Their Scalpel!

Friday, April 29th, 2011

If you need surgery, you might want to ask your physician not to drink the night before the surgery. According to a recent study, surgeons are a lot more error-prone when operating after a night of drinking.  Sixteen medical student (residents) and eight surgeons participated in the study. They were each asked to perform simulated laparoscopic surgeries without any drinking the night before. Then, they were all invited out to dinner and were asked to drink alcohol as they pleased until they felt intoxicated.  The next day, each participant was asked to perform the same simulated surgeries, and the results were quite surprising.

Each medical student had made an average of 19 errors during surgery.  Their sober counterparts made an average of eight errors. On a side note, the fact that so many errors were made even without any drinking is not making me feel warm and fuzzy at all.  It can take one error, not eight or 19, to seriously injure a patient.

The licensed surgeons did not do much better. The ones who drank had about a 50 % spike in the error rate. Wow!  So, if you see your surgeon ordering yet another Brain Hemorrhage ( 1 part peach schnapps, splash of Irish cream, and a dash of Grenadine) the day before your surgery, you might want to buy him a Virgin Bloody Mary.

Just how prevalent is alcohol abuse among surgeons?

What is the practical importance of this information?  If alcohol impairs surgical performance and alcohol abuse is common among physicians, how safe are we as patients? A number of studies seem to support the conclusion that physicians are more likely to abuse alcohol than other professionals. For example, a study published in the Journal of Addiction, examined trends of alcoholism among male doctors in Scotland. Apparently, as many as 50% of the doctors found to have health problems liable to affect their professional competence were also found to have a drinking problem. According to the same study, the higher rate of liver cirrhosis among doctors suggests that doctors are at a higher risk for alcoholism.  Maybe it has something to do with the wide availability of quality scotch.

Another study published in the Journal of the American Medical Association analyzed the rate of substance abuse among U.S. physicians. Apparently, they are not that different from their Scottish counterparts.  According to this study, U.S. physicians are more likely to consume alcohol than other professionals. I guess one good piece of news for us patients is that, although physicians were as likely to have used illicit drugs in the past, illicit drug consumption was found to be less among practicing physicians. That conclusion, however, may depend on your definition of illicit drug use. According to the same study, physicians are more likely to self-medicate with various drugs that can be just as addictive and impairing as some of the illicit drugs. By the way, it appears that physicians prefer opiates and benzodiazepine tranquilizers to “self-medicate.”

With this in mind, consider the number of surgeries that a surgeon performs a week. While the number may differ depending on the specialty, location, and other factors, many perform multiple surgeries. I have personally met orthopedic surgeons, for example, who perform as many as 5-6 surgeries a day.  If you accept the proposition that surgeons like their booze and that the average surgeon operates multiple times a week, how frequently does a surgeon end operate after a night of intoxicating frivolity?

Should hospitals regulate for patient safety?

This seems to be the ultimate inquiry. Additional research may be necessary to correlate these two variables. After all, no one wants to be operated by a surgeon whose lifestyle makes him 50% more likely to make a mistake. Nevertheless, even absent such information, hospitals and surgeons should take to heart the results of the study.  It might even be prudent for hospitals to enact regulations to prohibit surgeons from drinking the night before scheduled surgeries.

I am unaware of a single hospital that has enacted such a regulation.   Are you aware of hospital regulations designed to prohibit surgeons from drinking the night before scheduled surgeries?  Do you know of any proposed legislation in this regard?  More importantly, if you advocate for such regulations, tell our readers how to get involved. Patients Against Drunk Surgeons (PADS) may be a cause worth fighting for.

 

Image from thegospelcoalition

Laughing Gas Making Its Way Back Into The Labor And Deliver Department

Thursday, April 21st, 2011

According to a recent article published by MSNBC, laughing gas or nitrous oxide is making its way back into labor and delivery units in American hospitals. Although laughing gas has long been used as a pain relief in various countries, including Canada and the U.K., it has lost its popularity in the U.S. Well, maybe not for much longer.

It appears that a number of hospitals are now considering making laughing gas available as a pain relief measure for women in labor. A hospital in San Francisco and another in Seattle have been using laughing gas in their labor and delivery units for a while. Hospitals like Dartmouth-Hitchcock Medical Center plan to offer laughing gas to laboring mothers in the immediate future. Dartmouth-Hitchcock’s plan is currently being reviewed by the federal government, and arrangements are presently being made for the procurement of delivery equipment for laughing gas. Vanderbilt University Medical Center may begin offering laughing gas as well later this year.

History

Laughing gas is not a new pain relief method. Its use had become very common in hospitals when Joseph Thomas Clover invented the gas-ether inhaler in 1876. Particularly, its use in the labor and delivery setting had been very common before the introduction of epidural and spinal anesthesia. Because laughing gas is unable to eliminate pain to the same degree as epidural or spinal anesthesia, it simply could not compete with the more sophisticated pain relief alternatives, which entered the marker in the 30s and 40s.

What is laughing gas?

Nitrous oxide, commonly known as laughing gas or sweet air, is a chemical compound with the formula N2O. It is an oxide of nitrogen. At room temperature, it is a colorless non-flammable gas, with a slightly sweet odor and taste. It is used in surgery and dentistry for its anesthetic and analgesic effects. It is known as “laughing gas” due to the euphoric effects of inhaling it, a property that has led to its recreational use as a dissociative anesthetic.

Laughing gas as an important pain relief alternative

Although laughing gas can only take the edge off pain, it just might be an important alternative to other more conventional pain relief methods. The patient does not have to rely on an anesthesiologist to administer the gas. The patient can herself choose how much gas to administer at any time. The effects of the gas are not long-lasting. Therefore, the patient does not have to recover in a post anesthesia care unit. Importantly, there is no associated loss of sensation and motor function during the delivery process. As such, the gas does not interfere with the woman’s ability to breath and push during labor. Laughing gas is also not known to have any adverse effects on the baby in utero.

The administration of laughing gas does not require any invasive medical procedures. By contrast, consider epidural anesthesia: An epidural requires that an epidural catheter be threaded into the epidural space, which is only about 2 mm wide. Any mistake and the consequences can be catastrophic. Epidurals have been known to cause spinal cord injury secondary t0 toxicity, spinal cord infarcts, severe hypotension, paraplegia, epidural bleeding, and even death. None of these complications are associated with the use of laughing gas.

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According to Suzanne Serat, a nurse midwife at Dartmouth-Hitchcock Medical Center:

We have a number of people who don’t want to feel the pain of labor, and nitrous oxide would not be a good option for them. They really need an epidural, and that’s perfect for them. […] Then we have a number of people who are going to wait and see what happens, and when they’re in labor, decide they’d like something and then the only option for them is an epidural but they don’t need something that strong. So they would choose to use something in the middle, but we just don’t have anything in the middle.

Nitrous oxide may just prove to be that middle option for many women who prefer to give birth without the use of powerful and potentially dangerous analgesic/anesthetic agents. If you are an expectant mother, ask your obstetrician if nitrous oxide is a pain relief option that may be available to you during labor.

Image from cartoonstock.com

For more information about epidural anesthesia and epidural complications, you may want to read these posts too:

Having an epidural when you deliver your baby? 3 Questions to ask the doctor!

5 Questions to Ask Your Obstetrician Before You Go to the Hospital

Epidural Analgesia – What Should an Expectant Mother Consider? What are the risks?

Robot Anesthesiologists?

Tuesday, April 19th, 2011

robotic intubationFor anyone contemplating serious surgery, it can be a scary endeavor. From going through it myself and talking to others, I know that the main fear we have going into it is that the surgeon will make a mistake during the surgery, or that we will develop serious complications such as a hematoma, infection, etc. that leads to death or paralysis. While these are very real risks of many forms of surgery, there is another aspect of surgical procedures that gets less attention from patients – the anesthesiologist. While it may get little notice from patients, anesthesiology is a highly complex field of medicine in which doctors (and certified nurse anesthetists) train for years to be able to do it well. This post will focus on just one aspect of anesthesiology known as intubation, and a new development in robotics that may improve the procedure.

What is intubation?

At its most basic, intubation is the process by which the anesthesiologist places a thin plastic tube into the patient’s windpipe to maintain an airway or to facilitate mechanical ventilation. While this is done in a variety of serious medical situations, it is almost always done during major surgery when the patient is under general anesthesia. During such surgery, the patient is rendered unconscious and is unable to breathe on his or her own. Therefore, the anesthesiologist has to essentially breathe for the patient during the surgery, either using a ventilator or sometimes compressing a bag that replaces natural breathing. The process of intubation allows this artificial breathing to take place. Because intubation itself is a painful procedure (remember – a tube is being inserted far down your throat), the patient is usually given paralytic drugs (drugs to induce paralysis) before intubation. This is a key point we’ll come back to later.

Risks of Intubation

While it may sound as simple as sliding a tube down the throat, intubation carries its own risks separate and apart from the risks of anesthesia itself (risks from anesthesia can include death, paralysis, brain damage and a whole host of other less serious injuries). With intubation, there are minor risks such as chipped teeth, lacerations in the gums and sore throat. However, there are many more serious risks as well, including perforation of the trachea, mistakenly placing the tube down the esophagus (a more common occurrence than you might think), aspiration of stomach contents, vocal cord injury, decreased oxygen and elevated carbon dioxide, and nerve injury. Intubation is a serious procedure that requires a high degree of skill and training to do it well and safely.

What if the tube does not get placed properly?

Inability to secure the airway is a major problem in intubation. To understand why, you have to remember that before the tube is placed, the anesthesiologist paralyzes you with drugs. Therefore, before the tube is placed, you stop breathing on your own. It is then critical that the tube be placed quickly and accurately to ensure that you don’t suffer from a lack of oxygen (or ventilation – the exchange of oxygen and carbon dioxide). So what happens when the anesthesiologist has trouble getting the tube in? It just so happens that I have some personal familiarity with that scenario.

A few years ago I had back surgery. The surgery itself was not complex as far as spine surgeries go (it always amazes me how surgeons are able to describe cutting open your back and operating on your spine as casually as they might describe changing a light bulb). It essentially consisted of trimming off a small piece of disc that was pressing on my spinal cord and causing pain to radiate down into my leg and foot.  I was in and out of the hospital the same day, but of course I was under general anesthesia so I had to spend a couple of hours in the Post Anesthesia Recovery Room (PACU) to make sure that I was not suffering from any ill effects of the anesthesia. While waking up, and still groggy, the anesthesiologist walked up to me and said, “I just want to let you know – you were really hard to intubate. If you ever have surgery again, be sure to tell your doctor that you’re really hard to intubate.”

I asked the doctor what he meant by that. He told me that because of the anatomy of my mouth and throat, he had had a really difficult time getting the tube into my airway. Keep in mind, the tube was placed down my throat after I was given drugs to paralyze me. Even in my post-anesthesia addled state, I knew enough to ask the obvious question – what would have happened if he couldn’t have gotten the tube down in time? He was casual in his response. “Oh, we would have given you drugs to wake you back up.” How comforting. My next thought was, “Maybe you could have checked my anatomy out before you gave me paralyzing drugs.” I didn’t ask that because I am sure they did check me pre-operatively.  That is standard procedure before giving anesthesia to make sure that the anesthesiologist knows the patient’s anatomy and can anticipate problems. Apparently, my anatomy was a little more vexing than he had bargained for. However, he was finally able to get the tube in and the surgery went well.

The use of robotics

Because of the ever-present risk of serious complications, researchers are always working on improving intubation to minimize risk. It has always been a hands-on procedure that depended on the skill of the individual performing it. Now we may be moving into a whole new world of intubation thanks to advances in robotics.

Medical News Today is reporting that Dr. Thomas Hemmerling of McGill University and his team have developed a robotic system for intubation that can be operated via remote control. According to Dr. Hemmerling:

The [device] allows us to operate a robotically mounted video-laryngoscope using a joystick from a remote workstation. This robotic system enables the anesthesiologist to insert an endotracheal tube safely into the patient’s trachea with precision.

The system is still in development. It has been widely tested with mannequins that mimic human anatomy, and clinical testing on patients has now begun. Dr. Hemmerling hopes that the new device will allow anesthesiologists to intubate patients using less force and higher precision, which should help to improve patient safety. Even with the use of robotics, I would think that intubation, including pre-operative assessment of individual anatomy, is going to require close hands-on involvement in order to ensure that it is done safely and properly, but it is always exciting to see what was once science fiction being used in real-life surgeries.

What you can do

While robotic anesthesiology is still down the road for most of us, there are still things you can do to minimize your risk of injury. Before agreeing to surgery, most of us do a good job of vetting our surgeon – how experienced he or she is, how many similar procedures he or she has performed. How many times have you heard a friend describe his or her surgeon as “the best?” Yet virtually no one who has been a patient – at least in my experience – makes any inquiry into the experience level of the anesthesiologist, even though a mistake by this person can render you paralyzed or brain-dead (or even dead) in a matter of minutes.

If you are planning on undergoing serious surgery, I would encourage you to discuss the anesthesia care with your surgeon. Find out ahead of time who your anesthesiologist is going to be (if that’s possible), and discuss your situation with that person. No doubt you will be evaluated by the anesthesiology team before your surgery, but it may well be the same day as your surgery, and it will feel like just another routine matter like signing a few forms. Keep in mind, however, that anesthesiology is just as important as the surgery itself. Stay informed and ask questions. Treat your pre-operative session with the anesthesiologist as if your life and health were depending on it – it just may!

And as for robotics, I’m curious what your comfort level would be if your doctor suggested using a robot to intubate you? Would you be willing to try the procedure, or would you prefer the traditional hands-on, human approach?

Image from “Today’s Medical Developments”

Should you sue a healthcare provider? Some guidelines to help you decide.

Thursday, April 14th, 2011

Recently, a CNN article titled “Harmed in the Hospital? Should You Sue?” described the story of a two-year-old baby with a septic infection who waited about five hours in the emergency department before being seen by a physician. The child ultimately needed several amputations as a result of the delay in medical treatment.

Using this tragic story as a point of reference, the article suggests a number of criteria to help patients decide when to sue and when not to sue a health care provider. For example, the article correctly suggests that a patient who has not sustained injury should not sue a health care provider even if the health care provider’s conduct might have been negligent. In medical malpractice cases, a plaintiff seeks monetary compensation for injuries. If there are no identifiable injuries, there simply isn’t a case for medical malpractice.

However, most of the remaining recommendations in the article seem to suggest that a patient can make an educated determination about pursing a medical malpractice case without the advice and counsel of a skilled medical malpractice attorney. While this may possible in some cases, a well-considered determination about the merits of a medical malpractice case is difficult, if not impossible, to make without the guidance of a skilled attorney.

The decision to sue is never an easy one. Engaging in litigation is costly, time-consuming, stressful, and emotionally draining. This is particularly true in medical malpractice cases where a plaintiff’s own physical injuries or the death of a loved one is the subject of litigation. As a consequence, the decision to sue a health care provider must always be well-considered because of the impact the lawsuit might have on the patient, the patient’s family and the defendant health care provider.

Is deciding if you really have a case a “do it yourself” project?

In this vein, the article suggests that a patient should always consider whether her injuries are the result of the alleged negligence or some other unrelated factors. This consideration is particularly important when the patient’s pre-existing medical conditions cause or contribute to the alleged injury. In such instances, however, unless the patient has sufficient medical knowledge and, perhaps some legal knowledge, it may be difficult, if not impossible, to determine the actual cause of the injury.  In most instances, these determinations should be made by a skilled health care provider in the relevant medical specialty in consultation with a skilled medical malpractice attorney. By extension, to suggest that a patient should be able to make this determination on her own is frankly impracticable in most instances.

What’s the process for determining if you have a real case

Therefore, whether or not a patient ultimately decides to pursue a lawsuit, it is prudent to seek counsel from a skilled medical malpractice attorney. Many attorneys offer free initial consultations. More importantly, most attorneys will  (or should) undertake  a thorough investigation of a potential medical malpractice case before a decision to file suit is made. This process involves an internal review of the medical records. Often times, this is done with the assistance of an in-house medical expert. If  an investigation passes the threshold in-house review, the records are then reviewed by outside experts whose sole purpose is to determine the quality of care rendered and whether any of the alleged injuries are related to the care that is being criticized.

This multi-layered review can amass a tremendous amount of information, which in turn can help a patient decide if it is worth pursuing a lawsuit. All of this detail and information is provided to a patient at no cost where contingency fee agreements are in place (generally speaking, under a contingency fee agreement, the client is not responsible for any costs, unless the attorney is able to recover a monetary sum. If recovery is made, the costs are deducted from any such recovery.).

The article further recommends that a patient consider if the injuries are of a type which would be considered within the acceptable risk for a given medical procedure. Yet, another recommendation encourages patients to evaluate if the care rendered was within the standard of care. All such recommendations, although very appropriate, are vague and ambiguous absent context. A mother whose baby was not timely delivered should not be expected to know how to interpret fetal monitoring strips. A patient who undergoes a hip replacement surgery should not be expected to know the proper surgical technique. A patient whose cancer remained undiagnosed should not be expected to know how to interpret blood tests or to read MRIs or other diagnostic tests.

Therefore, the suggestion that a patient should carefully evaluate the merits of his/her case should not be interpreted to mean that a patient should do so without the guidance of a skilled medical malpractice attorney. There is an important distinction between investigating a case and pursing a case.  Just because you decide to employ a lawyer to investigate a medical malpractice claim on your behalf does not mean that you or the lawyer have committed to filing a lawsuit. With this in mind, it is important to realize that medical a malpractice attorney can be a great resource even if the client ultimately decides not to pursue the case. If you are unsure about whether you have a case or you are uncertain about the strenght of your case, take advantage of the resources and counsel of a skilled medical malpractice attorney.

How to tell if a lawyer is really a specialist

Throughout this post, I have emphasized skilled medical malpractice lawyer. Admittedly, sometimes it’s simply not that easy to tell from advertising or websites which attorneys are really specialists in medical malpractice investigations and litigation. If you have doubts, ask questions! Most people are pretty savvy and should be able to tell if the lawyer they are considering has a real grasp of the medicine and the law – both of which are required to be a skilled medical malpractice lawyer. Remember, you are entrusting your case to someone you really don’t know.

You ask questions in your daily life’s affairs and form judgments on whether or not you would entrust your childcare to some, which mechanic you’ll let fix your car, which home repair specialist you’ll permit to enter your home and do needed repairs. You get a sixth sense feeling sometimes as to whether or not the one your talking to (i.e. interviewing) will be a good fit for the task at hand. Why should it be any different with a lawyer, who claims he or she is a medical malpractice specialist. Just as we constantly preach about choosing a doctor, make informed decisions after asking the right questions.

If you need some guidance on what questions to ask, take a look at the White Paper we posted on our website – “Choosing a Lawyer – a Primer.” Hopefully, this will help you make an informed decision before you sign that fee agreement.

Related Posts:

The Reality of Medical Malpractice Lawsuits: Demystifying and Dismantling the Medical Profession’s Arguments

Every bad outcome and injury does not a malpractice case make! Some practical advice.

 

Deadly Super Bugs on the rise.

Wednesday, April 13th, 2011

Health scares are common and are many times overblown. However, the evolution of bacteria that are resistant to antibiotics (dubbed Super Bugs) is a very real and growing danger. Yahoo Health is reporting that two especially dangerous bacteria – MRSA and CRKP – are becoming resistant to all but the most advanced antibiotics, which is posing a major health threat.

Klebsiella is a common type of gram-negative bacteria that are found in our intestines (where the bugs don’t cause disease). MRSA (methacillin-resistant staphylococcus aureus) is a type of bacteria that live on the skin and can burrow deep into the body if someone has cuts or wounds, including those from surgery.

The reason for this new resistance is likely over-use (which includes mis-use) of antibiotics by health care providers (with likely some contribution from use of antibiotics in animals). For a few years now, there has been a growing recognition that doctors are over-prescribing antibiotics, i.e., routinely prescribing antibiotics when they are not necessary. For example, in 2005, U.S. News reported a Harvard study that revealed that doctors routinely prescribed antibiotics for sore throats in children when they were not indicated. A 2007 study indicated that Dutch doctors (whom are generally considered more careful in their use of antibiotics) routinely prescribed antibiotics for respiratory tract infections when they were not indicated.

The Problem with “Overuse”

The danger this poses is that antibiotics – even effective ones – typically leave some bacteria alive. These tend to be the stronger or more resistant bacteria, which then leads to the development of more and more resistance. This occurs in a single individual body in which a patient may have less response to an antibiotic after earlier use of that same antibiotic, but because of the easy spread of bacteria in our world, it also occurs on a global scale. For certain strains of bacteria, doctors are becoming hard-pressed to treat these infections.

CRKP – worse than MRSA?

Thankfully, MRSA is still responsive to several antibiotics so it is still considered a treatable infection. CRKP, however, is of more concern because it is only responsive to Colistin, which can be toxic to the kidneys. Therefore, doctors have no good options when treating CRKP. While so far, the risk of healthy people dying from MRSA and CRKP remains very low, the most vulnerable of us (the elderly and the chronically ill) remain at risk because of their lowered immune system and because the elderly are in nursing homes or other long-term care facilities where infections tend to spread more easily than in the general community.

CRKP has now been reported in 36 US states—and health officials suspect that it may also be triggering infections in the other 14 states where reporting isn’t required. High rates have been found in long-term care facilities in Los Angeles County, where the superbug was previously believed to be rare, according to a study presented earlier this month.

It is essential that we rein in the casual use of antibiotics before we are left with infections that have no cure. Doctors must be better trained to know when antibiotics are necessary and when they are not. For example, antibiotics are useless against viruses (such as the common cold), but how many of you have been given an antibiotic by a doctor “just in case” or because your symptoms have gone on slightly longer than a typical cold would last? It is unfortunately a more common occurrence than we realize. The past success of antibiotics has naturally led doctors to want to give them to patients to relieve suffering. No one wants to turn down a patient who is seeking relief.  However, it makes no sense to give antibiotics to a patient who has no bacterial infection or whose illness will clear up on its own.

Patient Awareness is key

The problem, however, is more than just educating doctors. Patients share some blame too. We – the public – need to learn that antibiotics are not always needed, which can be a difficult lesson to learn when we’re sick. Everyone knows that antibiotics are a quick and effective remedy against common bacterial infections. Antibiotics have saved countless lives over the years and have relieved untold human suffering. So naturally, when we are sick (or our child is sick) and we go to the doctor, we want to see results. We want something that will alleviate the pain and symptoms, not simply be told to wait for the illness to run its course. Sometimes, however, that is the best course when you consider the side-effects of antibiotics and the dangers of over-use. That being said, who wants to hear that when you’re in pain and want relief? It is very easy to demand of doctors that they use all available means to treat a sick child. Doctors need to be able to stand-up to patients and educate them on why antibiotics are not necessarily the best course of treatment in a specific situation.

Don’t kill the good ones!

Doctors also have to teach patients that antibiotics are not targeted killers.  The body contains a lot of good bacteria that are vital to our body’s functioning.  Antibiotics kill those bacteria as well, which some researchers believe can adversely affect health by allowing harmful bacteria to proliferate.  (If you have seen “probiotocs” advertised on certain food products – like yogurt – that is an attempt to introduce good bacteria back into your body.).

Some basic steps to take

In order to protect yourself (or a loved one), good hygiene remains the most effective method of remaining infection-free.  Thankfully, neither MRSA or CRKP are transmitted through the air.  They are typically transmitted through person-to-person contact, or else through hospital equipment such as IV lines, catheters, or ventilators.  If you have a loved one in a hospital or nursing home, be vigilant with your hand-washing and those of the healthcare providers caring for your loved one.

Also, if you are a patient who has been prescribed antibiotics, follow your pharmacist’s orders scrupulously and take the medication in the proper dosage and for the proper amount of time.  Stopping antibiotics too soon can leave bacteria alive, which contributes to the evolution of more resistant bacteria.  You may feel better and want to stop the medication, but it is important to take the full dose.

So – now that you know the risks of over-using antibiotics, are you willing to forego antibiotics when you are sick in order to do your part for the greater good?

UPDATE: (Editor – Brian Nash) Within an hour of posting Mike Sander’s blog on MRSA (and CRKP), I came across a tweet about Manuka Honey is being used for dressings to fight the spread of Super Bugs – particularly MRSA.

Researchers now believe that it can also put a stop to the rates at which superbugs are becoming resistant to antibiotics.

Anyone know of this practice being used in your area hospital or clinics? Does anyone know if this really works? If so, most interesting and useful. Here to spread the word – how about you spreading it too?