Monthly Archives: December, 2008

Healthcare Blooper of the Year

This one goes to, after much thought,  the incident portrayed in the following video:

Its easy to see why this one gets the award when you take into consideration the following:

  1. The patient waited in the emergency room for 24 hours.
  2. She had collapsed for 1 hour before any action was taken.
  3. The utter indifference shown by other patients and staff.
  4. To cap it all, this did not occur in a third-world country!

Just for the record, the patient died of deep vein thrombosis. Read more in my earlier posting on the incident here.

Next Posting: Healthcare Blooper of the Year – Malaysian version

My Top Ten Health Stories of the Year

Now that we are near the end of a tumultuous year, it is appropriate to take a look at  the important health events that occurred this year. Here’s my take on the top healthcare events of 2008:

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The transplanted trachea(wind-pipe) seen in yellow

1. Organ transplants using one’s own cells – Claudia Castillo, a 30yr old woman living in Barcelona, was the first person in the world to receive a full trachea (or wind pipe) organ transplant grown entirely from her own stem cells. This meant that she did not have to take lifelong medications to prevent her body from rejecting the transplant.

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Diagram showing the parts replaced (Cleveland Clinic photo)

2. Face transplant – In early December, surgeons at the Cleveland Clinic embarked on a marathon, 22-hour procedure in which they transferred 80 percent of a face — including eyelids, bone, teeth and a nose — from a cadaver to a living female patient. This raised eyebrows because it was done to enhance quality of life rather than to prolong it. More important, unlike stem-cell transplants, the patient will have to be on lifelong drugs to suppress rejection since the parts came from another person.

3. CPR Revisited – I wrote here about the new way of doing resuscitation when you see someone collapsing on the street. Now more changes are afoot. Paramedics in Arizona are using a new CPR method. They skip the breathing step and instead, alternate two minutes of chest compressions with a single shock from a defibrillator. Physicians in Arizona reported that the new regimen has tripled the long-term survival rate, which went from 4.7 percent to 17.6 percent.

4. Food Safety- the melamine scandal from China, with 52,000 requiring hospitalisation and with 6 dead, overshadowed the salmonella outbreak in the US  blamed on contaminated chilli peppers which caused 1,400 to be hospitalised. Nevertheless, food safety concerns will become increasingly important in the future.

5. Blood Testing to Detect Down’s Syndrome – One of the best ways to confirm Down syndrome before birth is by amniocentesis, which down_syndromeuses a needle to remove a sample of the amniotic fluid from the distended womb. But needles can be nerve-wracking and the procedure carries a 1 in 200 risk of miscarriage. Now, a new genetic test (SEQureDX) may be able to pick up the disease with a simple blood sample from the mom-to-be.

6. More Stem-Cell Advances- Alzheimer’s Disease has no cure, no vaccine and no way of diagnosing conclusively when the patient is alive. Now, the discovery of 4 genes said to cause this debilitating disease has enabled scientists to  accelerate stem cell research efforts to grow new cortical neurons that can replace damaged ones in the brain.

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The magic pill?

7. The ‘Magic’ Cholesterol Pill- In late November, the JUPITER research trial showed that rosuvastatin reduced heart attack, stroke and hospitalization and other markers for heart troubles by 56 percent. The authors of the study concluded that the drug was so effective that it should even be given to people whose cholesterol was normal but had high C-reactive protein levels, a signs of inflammation in the body. I am still a believer that lifestyle measures (diet,exercise,no smoking) is the real mainstay for lowering cholesterol.

8. ..And The One That Didn’t Work-The ENHANCE research trial pitted the cholesterol-lowering drug simvastatin against the popular combo-drug Vytorin, which had both simvastatin and ezetimibe (Zetia). But instead of proving the vytorinpower of the combo, early data showed that Vytorin was no better at reducing the thickness of blood vessel walls than simvastatin alone. I covered this in some detail in an earlier posting here.

9. New Vaccines – Not that well known among the public, several vaccines have been proven to be effective in combating cancer, although they were not originally designed specifically for that purpose. A case in point is the Hepatitis B vaccine, useful in preventing liver cancer. Read my posting here.

10. Making Healthcare Affordable & Accessible- this is a tall order for most governments and formed the defining issue in the US Presidential elections. Till today, no clear strategic plan has been formulated. Countries worldwide will grapple with rising costs, insufficient manpower and new diseases; all of which ensure that healthcare costs cannot be reduced, much less contained.

Food For Your Thoughts(2)..

seasons-greetings2“Most people are worried about what they will eat between Christmas and the New Year. What they should be concerned about is what they are going to be eating between New Year and Christmas”.

-my message to all.

Season’s greetings and have a happy healthy New Year!  :-)

Health Alert(6): More Weight-Loss Pills Banned

The U.S. Food and Drug Administration is alerting consumers not to purchase or consume more than 25 different products marketed for weight loss because they contain undeclared, active pharmaceutical ingredients that may put consumers’ health at risk.

weight-loss-lies

Impressive weight-loss ads such as this detract the consumer from the dangers of using some slimming drugs

Included among the list are quite well-known ‘slimming pills’ and ‘slimming drinks’ marketed on the Internet as ‘dietary supplements’ or containing ‘natural’ or ‘herbal’  supplements. FDA said some of these products also contained sibutramine (a controlled substance),  phenytoin (an anti-seizure medication), phenolphthalein (a solution used in chemical experiments and a suspected cancer causing agent) and rimonabant (a drug not approved for marketing in the United States).

The last-mentioned drug was highlighted in my last post on health alert here. Marketed in many countries in the Far East as Accomplia, it was withdrawn by the European Union in October 2008 because of the high incidence of depression and suicides amongst users.

For a full list of the drugs affected by the ban, go to the FDA News.

Smoking – It’s Not Cool Anymore

Trendy teenagers who like to see what’s in store next year should look at the latest findings regarding what high school kids in the US think about smoking. Teen smoking rates have dropped in 2008 to a level lower than in the early 1990s.  Take a look at a survey of adolescent behaviour conducted by researchers at the University of Michigan at the MTF website.

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Declining Trend in Smoking Among American Teenagers (MTF website)

Many teenagers have negative attitudes toward cigarette smoking. The vast majority said they’d rather not date someone who smoked and two-thirds said that “becoming a smoker reflects poor judgment,” according to the survey. “That’s a very important message,” say University of smoker_teenage1Michigan researchers. “For years and years, the industry pitch was that smoking makes you sexy and attractive to the opposite sex. It turns out the absolute opposite is true. It projects a negative image, for both girls and boys.”

What are the reasons? Its certainly not because of difficulty in getting cigarettes, as the majority noted. Could it be the healthy messages are hitting home at last? Or is this a passing fad?

I’m not complaining..as a cardiologist, I’ve seen enough of the ravages of smoking to probably rank it as public murderer number one.

A New Face To Face The World

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Leader of the team, reconstructive surgeon Dr Maria Siemonow(centre) replacing 80% of the patient's face in a marathon session - pix courtesy of Cleveland Clinic

The newspapers worldwide were awash with the news of a near-total face transplant performed at Cleveland Clinic,USA. This has no doubt set up a wave of excitement among audiences on the real possibility of being given a completely new face. The reality is,  this remains a remote possibility for the masses.

First, some background info on this landmark case. The patient, a woman (name and age withheld by family request) suffered severe trauma to the face leaving only 20% of the face intact (upper eyelids, forehead, lower lip and chin were left). A 30-man team took 22 hours for this surgery, which itself took 20 years to prepare, said the lead surgeon. The face was obtained from a deceased female donor, whose family consented to the transplant.

Why is such an operation a distant possibility for the public in general? The above details already give part of the reason – the enormous amount of time, manpower and cost that will be taken up for such a surgery. Apart from that, such recipients will have to be on powerful immuno-suppressive medications for the rest of their lives and suffer the consequences of their side-effects, the most important being infection. And don’t forget..you need a person to donate his/her face.  That explains why, worldwide, there has been only 4 such operations since the first was performed in 2005.

For Those Studying Medicine…(6)

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Good communication skills increase rapport with the patient

“What’s happened to the enlarged spleen in Bed 10?”

How often have you heard a doctor say this to medical staff?  Engrossed in the technicalities and the medical paraphernalia of the disease and its cure, many doctors tend to forget that behind the medical problem is a live human being, with emotions and real feelings. Unconsciously, they have depersonalised the patient and treated them just as an object.

One of the qualities of a good doctor is that they do not forget that they are always communicating to another fellow human being with emotions and feelings. And this includes good bedside manners like greeting the patient on approaching the hospital bed..each time and every time!

Of Defiant Dictators, Denial & Diarrhoea..

COMMONWEALTH ZIMBABWE QUIT

Mugabe - still a force at 84

You might argue that Robert Mugabe has used verbal diarrhoea to barricade his political position as the long-standing self-proclaimed President of the Republic of Zimbabwe, but his sequencial statements that there is no cholera outbreak  (Nov 2008) followed by his statement that it is now controlled (11 Dec 2008 here) and lately his accusation that Western powers were using cholera as a biological weapon to launch  “a calculated, racist, terrorist attack on Zimbabwe”, smacks of a strong sense of denial.

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Vibrio cholerae - death within days

Denial…that 60,000 are suffering from cholera and 600 have died, with many more to come. Why cholera? In essence, the organism that causes cholera, Vibrio cholerae, is just one of the many micro-organisms which cause food-poisoning. However, the effects on an individual are devastating because this bacteria produces a deadly poison, an enterotoxin, that within 1 day of swallowing contaminated water, will cause extensive damage of the lining of the intestines which in turn leads to large volumes of watery diarrhoea leading to extreme dehydration and death.

Beyond all that, cholera existing in any country reflects on the low socio-economic status of that country; where insufficient healthcare resources are present, where there is a breakdown of adequate sewage and water facilities and where there is political instability.

Essentially a disease spread by the fecal-oral route, this is a polite way of saying that infection-laden stool from one person finds its way into the mouth of another person. This can occur indirectly when there is contamination of drinking water by sewage, as in Zimbabwe. While awaiting medications, people there would do well to boil drinking water and practise handwashing, both being cost-effective and efficient ways of preventing spread of disease.

Long May You Live…Live A Long Life

Take  note of the world’s oldest population.. The world’s highest percentage of people living 100 years or more are found on Okinawa Island,Japan. In Okinawa, 28.6 per 100,000 people are over 100 years old, compared with 8.9 for Japan and 3.0 for the USA.  Not only are they physically active even in their 90s, they are generally positive-thinking and contented. You can watch a short CNN video on the lifestyle of Okinawans here.

So what’s the secret? This has caused many a gerontologist to study the reasons for their longevity. Many have done so and their findings can be summarised as follows:

  1. A diet low in fat, salt and sugar- take a look at their typical food pyramid:

    okinawa_diet_food_pyramid1

    You Are What You Eat - the Okinawa Diet

  2. Plenty of Exercise – many are in their 90s and still run, dance or climb trees to pick fruits. Exercise is meant to be enjoyed and this is enhanced by doing it in community groups. This includes mental exercise -keeping one’s  brain active.

    okinawa_seikichi_uehara96_karatemaster

    96 year-old Seikichi Uehara, karate master, showing his pupil a thing or two

  3. No smoking – quite in contrast to the rest of the Japanese.
  4. Moderate or little alcohol- but plenty of green tea.
  5. Good stress management -the closely-knit community provides interactive psychological support and faith which promotes a strong feeling of optimism and positive outlook. There is plenty of mental activity and each is inculcated with a feeling of purpose in life.
  6. Access to good dental & medical healthcare- regular medical check-ups are the norm.
  7. Adequate nighttime sleep of at least 6 hours.

With the above measures, in Okinawa, the incidence of cancer, heart disease and Alzheimer’s is practically unknown, which is quite amazing.

okinawa_laughter2

Laughter-the best medicine

Based on my observations of elderly patients, one additional feature for longevity which seems to be also a norm is having a good sense of humour. After all, laughter is the best medicine and the positive effects on health is certainly no laughing matter! A study by the University of Maryland Medical Center showed that average blood flow typically increases 22 percent during and after bursts of laughter compared to a decrease in blood flow by 35 percent during mental stress.

Those caught in the rat-race will surely identify that their  deleterious lifestyle is the root-cause of ill-health and disease and many can learn a point or two from Okinawa’s elderly..

Lose Your Job, Lose Your Healthcare

What’s the connection between losing your job and losing your health? Plenty. Apart from bringing in feelings of worthlessness, anxiety, depression and even suicidal thoughts which all affect one’s health (Worry About The Health of the Economy..and about the Economy on Your Health), many are now finding that their healthcare benefits also go out the window once they lose their jobs. The group insurance benefits provided by their employers, which they had taken for granted and had provided for their healthcare needs previously, have left many unemployed in a state of renewed anxiety as to how to fund their future hospitalisation needs.

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Going Into Hospital - the smiles can turn to a frown if you are uninsured

The New York Times highlighted 07 Dec 2008 that, of the 10.3 million Americans now unemployed (an increase of 36% since the beginning of 2008), the vast majority did not have health insurance;  and only 4.4 million were having unemployment health insurance. There are now 46 million uninsured Americans who have to pay out of their own pockets (if they can) should they need madical attention.

health_insurance

Stark Reality - rise in health insurance premiums outstrip Inflation and Earnings in most countries

So what’s the message for the rest of us? Take out your own health insurance policy while the going’s good. Remember, the belief that ill-health will only happen to the other person is not for real. Even more important, at the rate of  relentless healthcare inflation (8-12% per year), you only need to be hospitalised once to realise that it can burn a huge hole in your pocket. Many private health insurance companies now even insure people up to age 70 and beyond. Get some useful tips on taking a health insurance plan from my earlier posting here.

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