Facial Transplant Getting Closer
While the medical world debates the ethics of such a procedure, a surgical team from the Cleveland Clinic has received approval to interview prospective patients.
When the operation is undertaken, it will obviously chart new ground in both medical and ethical practices. The physicians involved claim the surgical abilities and understanding are there and that their only effort is to give a “new life” to a grossly disfigured individual. They insist that ethically the procedure has no relationship to merely straightening a nose, jutting a jaw or smoothing facial lines.
Leader of the team is Dr. Maria Siemionow, director of plastic surgery at this world-class hospital. Their purpose, she says, is not merely to beautify, but to give a person with a disfigured countenance -- due to accident, birth defect or disease -- a chance to come out of the shadows where she or he may now live.
A surgical team from Holland’s Utrecht University -- hopefully to be teamed with surgeons from the University of Louisville, where America’s first hand transplant was performed in 1999 -- is seeking approval to undertake a facial transplant procedure in the Netherlands; no ruling to date. Surgeons in Great Britain and France have also sought approvals; all have been denied.
Till now grossly-damaged faces have in effect been “resurfaced” by skin from other parts of their body. The results, usually after countless operations on the individual, have been haphazard at
best...simply because the various intricate elements of our face usually can be “patched” to work in some manner, but rarely made to appeal to the outsider’s eye. Nothing seems to open, close or move exactly as it should, so almost all these patients remain socially isolated.
The facial transplant operation will obviously test the surgeons’ abilities to the utmost. The selected donor cadaver in one operating room will have his or her face literally peeled away with a level of epidermis and some underlying fat, nerves and blood vessels attached. Meanwhile surgeons in an adjoining room will remove the living patient’s damaged facial tissue and prepare for application of the new face. Best estimate is that the total procedure will take up to sixteen hours.
And that is only the beginning! Recuperation will take months which, if all goes 100% according to plan, will still be filled with unknowns and uncertainties. For example, it is almost impossible to factor in the change in appearance if some element of the patient’s skull is imperceptibly different from that of the donor; will the skin still stretch across tight as a glove? What will the effect of anti-rejection drugs be to the immune system ...and will it work in an area of the body that is so visible, so complex, so fragile?
Free Software for MDs Promotes EMR
It is generally accepted that the many small physicians’ offices, who say they can’t bear the cost and the “aggravation level” of installing an EMR system is one of the major reasons that paper records still hold such a dominating position in the overall healthcare field. It is estimated that only between 20% and 25% of Americas’ 650, 000 doctors in private practice are currently using electronic medical records.
In an effort to sign up more private practitioners in the EMR revolution that many have let pass them by, Medicare is tentative-ly offering doctors’ offices, free of charge, the software of a system called VistA-Office. It is a simplified and scaled-down version of the larger and more-complex VistA software system that has been used with reportedly great success for over twenty years by the Department of Veterans Affairs’ hospitals and clinics. Those that work with the VistA system generally give it high praise, simply because it is basically trouble-free, operates so efficiently and reduces possible errors to bare minimums. In fact, an organization called WorldVistA was founded in 2002, mostly by VA employees so intense in their praise that they want to see it used throughout the world. The organization will reportedly play a large advisory role in a hoped-for private practitioner changeover to VistA-Office.
Problem is, the VistA system generally is difficult to install. So Medicare has worked with its vendors and contractors for the past three years to develop a version that is easy to install and maintain by computer technicians. This apparently has been accomplished.
Better still, the original VistA system was developed with tax-
payer dollars…so it is almost-totally in the public domain. Some small users fees will apply upon installation by vendors, but it is estimated that their cost at most will be 10 % of what could have been expected just a year ago to get such a proven system professionally installed and operating effectively in minimum time. And cost is a major element in this overall program; Medicare estimates that a five-practitioner medical office can save in excess of $100,000 by choosing VistA-Office software rather than a commercial product. And with a system at least as good -- most likely better -- than anything else on the market. Quite an incentive, even for the most-cautious.
The vendors like it, too. Though their installation and maintenance charges will be relatively small, it opens their area of business opportunity to the hundreds of thou- sands of medical offices that simply wouldn’t talk to them before.
Now we have to wait and see if the doctors buy in!
........On a more localized level, the governor of Arizona recently signed an executive order designed to make electronic medical records standard procedure throughout the state by 2010, four years ahead of the current federal goal.
An Arizona Health-e Connection has been formed and has until next spring to develop a “roadmap” for healthcare IT that will enable providers, insurers and patients to take the first steps in electronic interaction and sharing of health data.
To date, only two states and a handful of regions have even reached initial planning stage for electronic record-sharing.
Fake Medicines Become Big Business
Counterfeit medicines are fast becoming items of choice for organized crime. Last year, for example, the British announced they had closed down a London factory which was producing half a million bogus Valium, Viagara and steroid pills…every day. This was followed by an announcement they had confiscated a large but untotaled amount of fake Lipitor as it was being shipped into the port of London. And finally they have announced the seizure of thousands of so-called Viagara pills merely being stored in the quiet seaside towns of Brighton and Chichester.
The Brits reported that, in addition, raids on distribution centers have become too numerous to mention…and that in these raids they found some imitations of so-called “lifestyle drugs”, along with great numbers of imitations of serious medicines targeted to patients with cancer, AIDS and other illnesses. Some of these products might do the job, most won’t.
The FDA announced that it too was struggling. It had initiated 58 counterfeit medicine investigations in 2004; in 2000 they initiated just six.
The World Health Organization estimates that fake medicines have become a giant $30 billion a year business around the globe …between 5% and 8% of the $550 billions in medicines distributed worldwide each year. Apparently its growth engine is internet ordering. Criminals caught in the act have admitted that fake pharmaceuticals are a better business than narcotics… because they cost so little to produce that, markups can be huge, even when sold at prices that are a fraction of the legitimate brands.
For example, the recently-introduced sleep-aid medication Lunestrafor, has been hailed as the first of a new and better type of sleeping pill. Its so-called “generic version” (eszsope-clone) is already advertised on the internet by RxMex at 25% of the brand’s advertised cost.
At first the pharmaceutical industry has been loathe to talk about this epidemic of fakery, but now feels it must go on the offensive. Many are now taking direct action against the websites that are the main distributors of imitations to consumers. Their main hope seems to be in the new radio frequency tracking system (RFID) chips that will soon be incorporated in legitimate packages of the products.
Hoping to Harness Croc Power
Scientists have known for years that one of nature’s most-fearsome beings posses an immune system far more powerful than man’s. Then studies in 1998 found several antibodies in the reptile’s blood supply that killed penicillin-resistant bacteria such as staph. A month or so ago, scientific tests concluded that these antibodies were able to kill a good deal of the HIV virus. Now the race is on to see what else crocodile blood can attack and, with its help, what other cures can be achieved.
Secret seems to be that crocodiles have an immune system which is even more pro-active than our own. It directly and immediately attacks bacteria from the very moment the “little monsters” enter the big monsters’ bodies. And their immune system’s attack apparently is as brutal as the crocodile seems to be to us: it attaches itself to the bacteria and literally tears at it until it explodes.
An Australian team is currently collecting blood samples from wild and captive crocodiles, both saltwater and freshwater dwellers. Hope of course is that, somewhere in the future, scientists will be able to isolate the killer antibodies and eventually create a synthetic version of them for use in caring for humans.
State-of-the-Art IT
“Wi-Fi” stands for wireless fidelity and is an expression we are seeing more and more these days. Basically it refers to any products tested and certified by the Wi-Fi Alliance as interoperable (on the same radio frequency) with equally-certified networks or hardware, even though each is produced by a different manufacturer.
“Wi-Fi Certified”, incidentally, is a registered trademark of the Wi-Fi Alliance, a global non-profit industry association with more than 200 member companies. Over 2,000 products have been certified over the past five years.
Robotics Are "Into" Surgery
This year about 200,000 men will undergo radical prostatec-tomies, which are usually tied to too-many possible problems and an often-long recovery period. The da Vinci laparoscopic system, used sparingly for close to four years by effectively one surgical team, is apparently now ready to take much of the fear and sometimes long recovery periods out of the picture in a variety of prostate operations and urinary tract procedures. The system uses a super-computer and robotic instruments guided by the skilled hands of highly-trained surgeons in a procedure that works better, finer, closer than mere mortals can.
Unlike typical laparoscopic surgical instruments -- which only give the surgeon a two-dimensional field -- the da Vinci system supplies three-dimensional vision of the surgical field. The da Vinci’s small hand-like instruments are actually more facile than human hands; they can rotate 360 degrees and bend at a 90 degree angle. Which is clearly invaluable when the surgeon is working in the smallest of places in one of the most delicate spots in a man’s anatomy…where “safe space” is measured in millimeters.
Many post-op side effects -- such as abdominal bleeding, nausea and bloating seem to be virtually eliminated. The chances of impotence and incontinence are vastly reduced.
The New Jersey urologists who make up the da Vinci team have recently taught the procedure to urologists at Johns Hopkins, Cornell, the City of Hope Cancer Center and several other major hospitals across the country.
Then there is “Penelope”, a robot that recently became the first such unit to act as an independent surgical aide during an operation. Responding to verbal commands from the surgeon, Penelope selected and supplied -- with her mechanical and magnetized hand -- clamps, forceps and other instruments. Then, “viewing” the procedure through her digital mechanical eye, the robot retrieved the instruments as soon as the surgeon placed them on a tray.
Her software is programmed to double-check and double-count the instruments in use. And to actually “think ahead” to anticipate the instruments that will be requested next.
The Dark Side of MRIs
The wonderful, sometimes life-saving, machines that have moved the science of radiology so far seem to be getting just a bit more accident-prone as they get increasingly familiar. It’s not the machines themselves; it’s the people around them who -- just for a moment -- ignore the gigantic power of their magnets. Which can easily lead to flying objects occasionally zipping through the air and into their interiors.
Major problem is that the magnets are never shut off, even after office hours. Pulling the switch will not affect them because their power comes from highly-cooled helium; so their magnets can only be shut down after the helium is carefully -- very carefully -- vented. That’s why scanner makers offer extensive safety training and strict advice on how to build and protect the rooms and people in which they sit. Most of these rooms are in hospitals, but some are in storefronts or other lightly-monitored buildings. And there is the rub.
Today there are over 10,000 MRI units in the United States, most under 24/7 strict safety control. It’s the word “most” that the insurers are worried about because, currently, there are no specific rules guiding the installation and maintenance of MRIs. There is the story of the police officer who burst into an MRI room, ignoring procedure. His sidearm was literally ripped out of its holster and hit the magnet, discharging as it did so. Luckily no one was hurt, but that goes under “near miss” if anything does. Then there are the dozens of stories of repairmen working on some completely-separated problem in the area of the machine. Watch out for flying tools!
The bloggers reportedly have pictures on the internet of floor polishers, chairs, even a gurney-and-patient wedged into the scanner’s opening.
One shows a firefighter in Germany, metal hose still in hand, sucked into the “mouth” of an MRI; he was answering a call about a small blaze elsewhere in the building.
Understandably the American College of Radiology seems to be moving ever-closer to requesting that the feds develop strict guidelines for MRI use.
First "Diabetes Alert" Dogs
The most seriously-ill diabetes patients remarkably often don’t get the slightest warning when their blood sugar level unexpectedly comes crashing down; and results can be fatal. Now the first six of what is sure to be many diabetes-sniffing service-dogs has joined their master or mistress in graduating ceremonies at Canine Partners for Life of Chester County, PA.
Just the latest in the long list of help for disabled humans that is delivered by canine caregivers. Currently there are reportedly fifteen organizations that train medical-assistance dogs. No one is quite sure how the dogs sniff out or simply “feel” the coming incident or seizure, but there is little question that the right dog comes up with the right diagnosis almost every time. (Occasional erring on the side of caution is easily forgiven.)
It takes about two years of pre-training with each animal before it meets its “partner”. This is followed by a three week period of bonding between the person and the dog. One new-graduate dog reportedly recognized seven dangerous seizure conditions in his owner-to-be during just this three-week period. Each dog effectively selects his or her own “warning” method and is then trained to use it exclusively. Favorite method seems to be to stop -- directly and firmly -- in front of their owner and refuse to budge!
Cost of training is steep; about $20,000 per animal, but the new owner is only asked to pay $900 at graduation. Canine Partners is non-profit and seems to make do on the donations that come in through fund drives and as a result from articles like this. Currently the average waiting period before adopting a Canine Partners’ dog is about a year.
New Hope Fighting Migraines
Sufferers that are afflicted with these horrible headaches often say “You can’t imagine the pain.”. The onset of the pain usually announces itself -- usually without adequate warning -- with an “aura” followed by a piercing and debilitating stab. The pain almost always settles on one side of the patient’s head and often behind the eye. Most times they are accompanied by nausea, vomiting and acute-sensitivity to light. Some recede in hours, many stay with the sufferer for a couple of days. The pain is rarely lessened by aspirin, Tylenol and their medical kin that traditionally promise headache relief. Most of them are marginally affected at best by exotic drugs such as Pfizer’s Relpax.
Migraines, the most common type of “vascular” headaches (which include the equally-debilitating “cluster” headaches) have been studied for decades but with few and all-too-small break- throughs. Some doctors blame them on diet; others blame it on red wine or stress or inadequate sleep. All agree on just one basic fact: that 75% of migraine suffers are women. No one knows why.
For some time neurologists have been reaching outside the “headache” field for tools to combat these horrible headaches. Beta blockers are currently high on the list of preventatives; they work for a surprisingly-small number of patients. Calcium channel blockers seem to have a similar level of success. Narcotics are prescribed in the most-severe cases.
Now doctors at the Headache Clinic in Houston’s Methodist Hospital have come up with what on the surface just may be an effective plan, using drugs not normally targeted to the illness. They are currently treating a number of their patients with a combination of Topamax tablets -- originally designed to combat epilepsy -- and the nasal spray Zomig. The tablets are taken on a regular schedule; the spray is used as soon as possible after that first “aura” announces the coming of the pain.
Though the combination has not totally eliminated the patients’ migraines, report is that most now find them few and not nearly as severe. It is still too early to tell how effective such a treatment will be, but migraine suffers at least seem to have more concentrated -- perhaps more-imaginative -- effort on their side.
Medical Minutia
Hippocrates, born on the Greek island of Cos in 460BCE, is of course best-known for his physicians’ oath; but he was much more than a wordsmith. In his time, illness was too-often believed to be caused by evil spirits or disfavor of the gods. He accurately described a number of disease symptoms, namely pneumonia and childhood epilepsy. He initiated the belief that the brain, not the heart, was the center of the body’s “universe”. He also fostered the then-radical medical belief of the need for proper rest, good diet and cleanliness.
Hippocrates traveled throughout Greece practicing and teaching, finally creating a medical school on Cos. He apparently followed his own rules of good health and lived well into his 80s.
Transcription Tips
Non-words often stem from a dictator trying to use a 'real' word in a different tense or form. A non-word should be edited without changing the meaning of the sentence.
EXAMPLES: Emesis is a real word meaning "to vomit" or the "act of vomiting". "Emesed" and "emesing" are NOT words; edit to vomited and vomiting. Nares is a real word meaning the external orifices of the nose, also called nostrils. Naris is a real word meaning one of the external orifices of the nose. "Nare" is NOT a word; edit to naris or nostril.
Syncope is a real word meaning a temporary loss of consciousness or faint. "Syncopized, syncopial, syncopizing" are NOT words; edit to had syncope, was syncopal or is experiencing syncope, respectively.
If your spell check sends up a 'red flag,' grab the 'red book' and look up the word (or root word) to be sure it really is a word, or correct form of a word, and if not, edit to the correct word or word form.
Auditing the News
New Jersey hospitals exceeded the national average in 17 of 29 quality measures; this according to a study published in The New England Journal of Medicine. The study also showed that the state is ahead of most others in issuing “report cards” on care for specific conditions. Conclusions were based on information received from more than 3,000 hospitals, including most of the country’s full-service acute-care institutions.
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Johnson & Johnson has signed on as sponsor of both the 2006 Winter Olympic Games in Italy and the Summer Games in China. J&J reportedly is negotiating to be a healthcare products partner with more than 20 teams.
J&J, incidentally, is increasingly extending its global reach in the far east. It has become the largest multinational healthcare company in China…with 3,000 employees and extensive manufacturing plants and research facilities.
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In just six years, Medicaid has increased its coverage from 34 million to close to 50 million people. Reportedly an additional ten million are eligible for the service but haven’t signed up.
Today one in three Americans are covered by Medicaid, Medicare and military/federal employees health plans.
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John Grady Matrisciano, MD is an internist, a diabetes specialist and a cartoonist. He uses his free website CartoonMD to supply “Medical information that goes down easy”; facts that help adults and children understand “…the medical conditions that affect you and your loved ones.”
His site offers free posters -- presenting hard facts in terms even kids can understand and absorb -- available for downloading. He also offers live presentations, with customized material if needed.
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According to the Pharmaceutical Care Management Association, one secret of creating a manageable Medicare prescription benefit program could be tied to mandatory mail-order fulfillment, which could add up to an amazing $86 billion saving in ten years.
The group’s recent study concluded that drugs currently purchased through the mail are roughly 10% less-expensive than “store bought”. One of the reasons is that the labor-handling cost of filling a prescription is $5.00 at the pharmacy and only $2.50 mail order. Best estimate is that just a quarter of Medicare benefi- ciaries currently purchase their prescriptions through the mail.
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In another study, the Commonwealth Fund set the price of a establishing a national health information network at $156 billion over a five-year period. Plus an annual yearly operating cost of close to $50 billion. The complete study was recently published in the Annals of Internal Medicine.
Though some experts are overwhelmed by these numbers, others were quick to effectively say it is worth it for two key reasons. That it will easily pay for itself down the road…that it will lead to great forward strides in quality-of- care and patient safety.
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CMS latest idea on how to cut the sharply rising cost of Medicare: “Health Coaches”. Their job is to advise chronically-ill patients on the steps to take to bring their health up to the best-possible level and to keep it there.
Eventually the program will reach 180,000 chronically ill fee-for-service Medicare recipients over a three-year period...Health Coaches will work one-on-one with patients…making sure they take their meds and keep their doctors fully aware of their changing conditions. Available as a free advisory service, and with a 24/7 “hot line”.
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Big numbers and big praise at the Kaiser Permanente first ever User’s Conference of their HealthConnect Electronic Medical Record. The big numbers are that it is projected as a $3.3 billion, 10-year program…designed to translate patient data into a format that assures quick and easy access to approved medical and health information personnel. It is up and running at Kaiser’s Colorado facilities…and is scheduled to be rolled out in the Bay Area as you read this.
The big praise came from Dr. David Brailer, the government’s IT chief, who told the 500 conference attendees that Kaiser is now in position to lead the rest of the nation in ways to manage America’s healthcare IT system.
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According to a study recently reported in the Proceedings of the National Academy of Sciences, pain-sensing nerves react to the sulfur-based chemicals found in garlic, onions and their ilk by releasing chemicals which stimulate blood vessel dilation and inflammation. Scientists hope further study will help them learn more about how arthritis and other muscular problems develop …which will hopefully lead to better medications and cures.
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