Friday, January 10, 2014

Never trust a bioethicist (?)

More on the case of Jahi, the little girl who died because of a tonsillectomy and bad post op care.

The disability group Not dead yet points out that there are reasons that the public confuse brain death, coma, and vegetative state (where the person is awake but not 'alert"). They link to this article on the problem LINK discusses cases where people recovered

and their point on blacks distrusting the medical profession is another point rarely mentioned in the coverage. Again LINK

Thursday, January 9, 2014

YUM>>>Cod liver oil

Pale skin was a genetic aberation that began 10 thousand years ago. So why did it spread in certain populations? Because of the high rate of maternal deaths from ricketts: if you had pale skin, you absorbed more vitamin D. (The Eskimos ate seals and certain fishes whose oil contained the vitamin   or ate cod...the story of cod liver oil and rickets prevention here. ).

Science vs Religion? No...minorities mistrust physicians

LATimes mentions that the treatment of a "brain dead" girl is behind the family's refusal to stop treatment. But aside from sardonically saying the family wants a miracle, they don't bother to discuss religion.

But one has to wonder at the haste of the hospital to disconnect life support.

And how much is due to the family being black, and minorities (blacks, Hispanics, AmerIndians) suspect the medical profession isn't eager to treat them properly. Given the Tuskeegee study, or the Red Lake Strep study, where six cases of renal failure developed because they didn't bother to treat mild cases, I don't blame them. (The latter wasn't publicized, but I worked there).

And one has to wonder how brain death was diagnosed.

And one has to wonder if malpractice was behind the girl's death. I speak from experience: When I was in a famous Boston hospital for ", female surgery", I was disconnected too soon, and ended up with a cardiac arrhytmia from a low oxygen level...they raced to do an EKG  before they put me on oxygen.

When I had repeat surgery elsewhere, and woke up in pain, the nurse offered me a pain shot, which I refused saying I might stop breathing. (i.e. a repeat of the hypoxia episode of my first operation). She huffily said: That's what WE are here for, and promptly walked away to care for another patients, leaving me along for the next ten minutes...proving my case that if I had hypoventillated, she'd be elsewhere.

The understaffing of recovery rooms is a rarely mentioned problem behind this, and several other cases where families were pressured into stopping treatment.

And of course, there is the problem that lay people don't distinguish between severe brain damage, PVC, and brain death...and alas, sometimes doctors assume that if you might (might is the key word) end up with brain damage, you are better off dead.

This is all discussed in the C2C video I linked to yesterday.

one addendum: Wolfensburger has a lecture that showed a photo of a "brain dead" boy (on a respirator) enjoying a swim in his family's swimming pool, six months after he was called dead by the doctors.

Wednesday, January 8, 2014

Reviving a dead brain


until the copyright cops find it...this is a Coast to Coast am discussion on the new techniques being used for severely brain damaged people.

a UKGuardian article here

I remember the Christmas when Mrs. WhiteBull came out of her coma...after being given amantadine to prevent influenza. Or after her family had just finished a novena to Blessed Kateri Tekawitha. Take your choice.

right now, there is a big case about a brain dead girl in California whose parents refuse to stop treatment. I feel for them since dead is dead.

The problem? Who did the tests? (the medicines given after surgery can cloud the diagnosis) (The hospital is up for a big lawsuit, but it will be larger if she lives) (The family is black, and many minorities just don't trust hospitals).

Sunday, January 5, 2014

Obesity epidemic

Years ago, the anti population crowd was predicting widespread famine, but today the real problem is...obesity.

From the UKMail:

A third of adults across the world are now classed as obese or overweight.
A global ‘explosion’ means that 1.46 billion adults across the globe are obese or overweight - meaning they have body mass indexes greater than 25.

Read more:

and the fattest country? Mexico... Why Mexico? maybe because AmerIndians have a high rate of metabolic syndrome...which is why we docs who worked for the IHS on the US reservations became experts at diabetic control....

Jane Austen's doctors

JaneAusten website links to an article on medical care in the Regency era of England.

mainly for later reading.

The practice of medicine in the late 18th to early 19th century was still hit and miss, with too many people dying from the treatment by doctors and apothecaries that was designed to save them.
If Jane Austen died of Addison's disease, one wonders how they diagnosed it...true, before the advent of antibiotics, TB going to the adrenal gland and destroying it...nowadays, most cases are probably mild cases from those given steroids which turn the adrenal glands off...and of course JFK had a mild form of Addison's disease, which didn't bother him most of the time but under the stress of back surgery almost killed him. His case was written up in the medical literature...and no, taking "steroids" didn't make him a drug addict or hyper: The dosage was small...although when as a doc I had to give more than 40 mg of Prednisone for asthma etc. I would warn my patient that it might make them hyper...

Note the part that surgeons evolved from barbers: and even today, surgeons in the UK are called "Mister",  not Doctor.

vaguely related item:

I follow the series "sherlock" and Dr. Watson, an "army surgeon" is called "doctor" and in series three is working as a general physician...I'm going to have to check up in the book if he is a surgeon or physician...

Royal Quackery

English Historical Fiction Authors blog has a long article about the British monarchy's support of homeopathy.

My take? Sometimes it might work, but without scientific double blind studies, who knows?

If it indeed works on the immune system, such studies could be done on animals quite easily.

But never mind: Placebo works well on neurotics who see a fatal disease in every ache and pain.

No, I am not really ridiculing neurotics: I am one myself, and my body has a lot of these problem (allergies, painful periods, mood changes, sensitivity to the environment, aches and pains), but my mother's family was from Germany, and the idea is that you grin and bear it. The advantage is that you cope with a lot of stuff that stops others (I didn't realize how much pain I had from my endometriosis until after I had surgery, and had less pain post op than I did during a normal period).

The bad news is that sometimes your body just can't be flogged to work anymore, and you collapse. This has happened a few times when I was working, and I just could not move and collapsed into tears: Making others think I was "emotional" or lazy... not too exhausted to think or work.

There is a macho part of medicine, where you are supposed to work until you drop, never mind that you can't think or make mistakes. The Libby Zion  case in New York finally cut down the hours interns etc had to work, because she died because the resident didn't realize that the antidepressant she was on was an MAO inhibitor, which has a lot of drug interactions (this was in the days before Prozac) she died after being given the wrong medicine.

The "debate" whether or not fatigue interferes with medical work still goes on, ironically (It's about money> too expensive to hire enough people)...

Wonder how many people die because of this? Or because regulators/HMO's make you work your tail off and see so many people you don't have time to think or have a short non medical conversation with the patient, who often doesn't bring up what they are really worried about until they are headed out the door...

I'll give a comparison: in the US Army, when in the National Guard, guys would tell of going to drill with colds, coughs, or even broken ankles (with or without pain medicine)..

But when I did a short stint at an Airforce base ER, anyone who needed anything stronger than Sudafed and Tylenol was forbidden to work. Why, I asked. They aren't that sick...and was told "well, we work with nukes. even a little mistake, and there goes Kansas City..."