National Ammo Day

National Ammo Day

Today is National Ammo Day. It’s not a bank holiday, and it’s not on most calendars.

Time for me to visit Cheaper Than Dirt.

Wedding Surprise

CNN.com – Wedding surprise: Dad in from Iraq – Nov. 17, 2003

Nice! Enjoy reading this.

Best complaint of the night

in my ER was the person with back pain:” the beds at the jail were too hard”.

I couldn’t make this stuff up if I tried.

Weather

Had some delightful people over the other evening to play my wifes’ favorite game, Bunco. Don’t bother looking up the rules, they seem to change from house to house, and that seems to be part of the fun. I digress.

One of the guests is a meterologist, and I picked his brain for a while, and he showed me what he considers the best weather site on the internet: Unisys Weather.

I’m adding a link to Fort Worth weather in the sidebar, for no reason other than I find it interesting.

Dr. Winters has Blogged again

richard[WINTERS]md

I mention it here, as you might have missed it.

MilBlogs Webring

I have been allowed to join the Milblogs Webring, and I’m pleased, and not a little surprised. My approach to joining any group was described (Groucho?) years ago, the ‘I would never be a member of a club that would have me as a member’.

I had a tour through the webring, by clicking the next buttons on the pages, and found several well-done blogs of different styles, and I liked them all. I invite you to click through, as I have already seen several I will be adding to my daily-read list.

Fort Worth Flu

Today, a patient tested postitve for Influenza on our rapid-flu test. So, the flu has made it here, already.

From the CDC, it’s predominately the type “A” flu this year: CDC-Influenza

So, what to do? Since it’s 98% type A, what to choose? I prescribed Tamiflu, out of habit, but told the patient that it would maybe make them better one day faster, which is the limit of the effect of the anti-influenza drug effects.

I wish I’d been a touch more prepared. A couple of hours later, when I was less busy, I called one of the large chain pharmacies and did some retail pricing. And, it was surprising: Tamiflu, 5 days$79.95; amantadine, 5 days, $8.99.

Wow. As amantadine will cover 98% of the flu out there, and the benefit is being ‘better’ one day sooner, this year amantadine is my drug of choice.

CDC Antiviral drug info.

Home Defibrillator?

Alerted by Sleepless in Midland, I read this Popular Science | Philips HeartStart Home Defibrillator article.

An AED (Automatic External Defibrillator) is a device which, when correctly applied to an unconcious victim, analyses their heart rhythm, and if it senses a ‘shockable’ rhythm it delivers a potentially lifesaving jolt to the heart, checking again, etc.

Philips Medical is a maker of excellent medical devices, though I have no personal knowledge of their AED’s. AED’s are now in most airports, in a lot of convention centers, sports complexes, on first-responder fire engines, and some police cars. (The defibrillators in ambulances are manual, as the Paramedics are trained to read the rhythms on their own).

AED’s do save lives. However, they are an answer to a very very narrow cause of sudden death, those people who sustain a Ventricular Tach (heart beating abnormally, and too fast, not pumping blood) or a Ventricular Fibrillation (heart quivering, not beating at all) arrest. If your patient has one of those, this will help, though survival to leave the hospital is still low (there’s a lot of heart damage before this kind of arrest). (An exception to the large damage argument for those who are electocuted, I suppose).

Unfortunately, the vast majority of people who collapse, even from heart attacks, wouldn’t benefit from this shock. They may benefit from CPR, but, again, usually the damage has been done.

As for a home AED, I wouldn’t spend the money. There are people who are naturally prone to these dysrhythmias (abnormal heart rhythms), but we now have implantable defibrillators, like pacemakers, for those folks. I suppose, then, the medically justifiable market for this device would be people prone to Vtach/fib arrest who are either awaiting an implantable defibrillator (countries with waiting lists and without a hungry plaintiffs’ bar), or those who refuse the implantable defib but still want to live.

This is marketing run amok, in my opinion.

Hang Them

Read the article, wherein unscrupulous medical equipment vendors have bilked Medicare out of more than $160 million.

CNN.com – AP Exclusive: Wheelchair scam nets millions – Nov. 11, 2003

Fraud from the government is theft from you and me.

Happy Birthday Marines!

Bloodletting reminds me this is the 228th USMC birthday. Happy Birthday, Marines!

I spent only 4 years with the USMC, and those as a squid, but value the time served with them. And the celebratory Marine Corps Ball is not to be missed.

Hoo Rah, Devil Dogs!

HIPPA Hoopla

From Overlawyered: Medical privacy madness, cont’d comes an excellent summation of how I feel about HIPPA.

And Overlawyered is added to the blogroll.

Continued Comment Commentary

I have, finally, applied geeksblog’s MT comment closer. The result to you: nothing, really, except that after a week or two people cannot leave comments. Although this will inconvenience the casual viewer, my regular readers will not be affected (thanks, mom!).

( I have currently closed down to one week, but hope to expand to two open weeks). I love comments, but question the value of a comment posted 12 months later (many are spammers).

Please keep commenting. Sorry to go on about it, but the few comment spammers out there take up more of my time than they’re worth. This should help me, and ultimately you, valued reader.

Stapler Scapegoated in Death

Stapler cited in gastric bypass death

DURING THE course of a standard laparoscopic gastric bypass surgery, a widely utilized staple gun apparently malfunctioned, leading to a significant complication, Brigham and Women’s Chief Medical Officer Andy Whittemore said in statement released by the hospital. The relationship of that complication and her ultimate death remains at present unclear.
(the patient), a 37-year-old woman from Lawrence, Massachusetts, died two days after the Oct. 21 surgery, which involved reducing the size of her stomach.
While the cause of death has not been established, the hospital is working with the family to fully understand all issues bearing on her outcome, the hospital said in the statement.

Hmmm. The article doesn’t say when the ‘stapler malfunction’ was recognized, but it seems odd they’re pushing it so hard as the cause of the patients’ death.

I’m not a surgeon, and I’m fortunate in that there are very few super-fancy medical devices used to directly treat my patients, so I don’t have to worry a lot about how to recover from gadget malfunctions.

As I recall from my surgical intern days, a GIA (GastroIntestinal Anastomosis) stapler is an alternative to a hand-sewn anastomosis; the stapler does it quickly, with a nice, pretty row of staples, and it’s quick; a hand-sewn connection requires more time. I’ll let surgeons educate us as to which has the higher complication rate (Cut-to-Cure, that’s your bait). (Aside: I know one surgeon whose practice is largely gastric bypasses, and even laparoscopically does hand-sewn anastamoses. Quickly.)

Seems that this hospital is working hard to pin the blame on the hardware, but the surgeon is ultimately responsible. Captain of the ship doctrine, and all that. The only time that there should be some shared blame is when the equipment malfunction cannot be discerned until later.

This blame-shifting is unseemly. I think if my company sold GIAs it’d be a hell of a long time before Brigham & Women’s got any of my hardware.

Plaque Reducing Drug

“Liquid Drano&reg for the arteries”
In this MSNBC story, there’s a promising report of a very preliminary study of a drug that shrinks cholesterol plaques:

In the study, 36 patients who had had heart attacks or severe chest pain received weekly intravenous infusions of the substance for five weeks. Eleven patients received dummy treatments.
At six weeks, imaging tests showed the patients receiving the synthetic protein had a visible 4 percent reduction in plaque buildup in their coronary arteries. There was no significant change in the placebo group.

The study was funded by Esperion Therapeutics Inc. of Ann Arbor, Mich., a small biotechnology company that makes the product.

Espersions’ website says they have 4 different engineered molecules in testing, so it’s not clear which one worked in this study.

A 4% reduction in a plaque may not seem like much, but that’s a big change over 5 weeks. It’ll be interesting to see whether a longer-term treatment changes the rate of plaque reduction.

Also, the unintended consequences will need evaluation, as well. The cholesterol is transported to the liver ‘for elimination’, which is normally how it’s done. However, rapidly sending this much cholesterol to the liver could have interesting side-effects, like an increase in gallstone formation, for one thing.

But, this is an interesting breakthrough. Let’s hope it pans out.

Some business evals of Esperion: Forbes and Yahoo.

Comment Spam

I’ve just installed a feature to grab and whack some of the more flagrant comment spammers. I mention this because, if you try to comment and get whacked, it’s a glitch and I need to know about it, so please just email me if it locks you out.