Monday, July 8, 2019

The Challenge of Caring for a Stroke Patient - The New York Times

Kelly Baxter was 36 years old and had just moved to Illinois with her 41-year-old husband, Ted, when he suffered a disabling stroke that derailed his high-powered career in international finance. It derailed her life as well.

"It was a terrible shock, especially in such a young, healthy, athletic man," she told me. "Initially I was in denial. He's this amazing guy, so determined. He's going to get over this," she thought.

But when she took him home six weeks later, the grim reality quickly set in. "Seeing him not able to speak or remember or even understand what I said to him — it was a very scary, lonely, uncertain time. What happened to my life? I had to make big decisions without Ted's input. We had been in the process of selling our house in New Jersey, and now I also had to put our Illinois house on the market and sell two cars."

But those logistical problems were minor in comparison to the steep learning curve she endured trying to figure out how to cope with an adult she loved whose brain had suddenly become completely scrambled. He could not talk, struggled to understand what was said to him, and for a long time had limited use of the right side of his body.

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Doctors are ageist — and it's harming older patients - NBC News

When I accompanied my 85-year-old father to a doctor's appointment not long ago, his primary care physician brushed off his complaints about chronic back pain, as well as my observations about his failing memory and balance problems. It's normal at his age, he told me. When asked about the 14 different medications and supplements he's on, the PCP quickly scanned several pages in the electronic record but decided not to make any changes since other specialists prescribed them for good reason. He mentioned that he wasn't comfortable overruling another physician, though he also wouldn't take any action on his own, like supplying him with a walker.

My dad, sadly, is not the only elderly patient to take so many medications — and to have his doctor dismiss his concerns about them with a shrug. The problems start early in the drug treatment process: Frequently excluded from clinical trials are the very older adults the medications are meant to help — and whose changing physiology causes them to metabolize drugs differently. Similarly, some doctors fail to recognize when standard medication doses are only appropriate for much younger patients.

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Thursday, July 4, 2019

Scientists Are Giving Dead Brains New Life. What Could Go Wrong? - The New York Times

A few years ago, a scientist named Nenad Sestan began throwing around an idea for an experiment so obviously insane, so "wild" and "totally out there," as he put it to me recently, that at first he told almost no one about it: not his wife or kids, not his bosses in Yale's neuroscience department, not the dean of the university's medical school.

Like everything Sestan studies, the idea centered on the mammalian brain. More specific, it centered on the tree-shaped neurons that govern speech, motor function and thought — the cells, in short, that make us who we are. In the course of his research, Sestan, an expert in developmental neurobiology, regularly ordered slices of animal and human brain tissue from various brain banks, which shipped the specimens to Yale in coolers full of ice. Sometimes the tissue arrived within three or four hours of the donor's death. Sometimes it took more than a day. Still, Sestan and his team were able to culture, or grow, active cells from that tissue — tissue that was, for all practical purposes, entirely dead. In the right circumstances, they could actually keep the cells alive for several weeks at a stretch.

When I met with Sestan this spring, at his lab in New Haven, he took great care to stress that he was far from the only scientist to have noticed the phenomenon. "Lots of people knew this," he said. "Lots and lots." And yet he seems to have been one of the few to take these findings and push them forward: If you could restore activity to individual post-mortem brain cells, he reasoned to himself, what was to stop you from restoring activity to entire slices of post-mortem brain?

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Wednesday, June 26, 2019

Opinion: Patients’ families are more than just ‘visitors’ | Montreal Gazette

As a medical student, I participated in a group session to demonstrate the impact of illness on families. One patient was asked to stand, given a piece of coloured thread and asked to choose a "spouse" from the group. The chosen spouse stood too, and took the string, creating a bond. This couple pretended to have children: new string colours were chosen. The children grew up and formed their own relationships until everyone was standing with connecting strings. The room became a blend of colours, the tangled network no longer decipherable.

"Imagine someone gets sick," said the facilitator, "what will happen to all the string?"

One person sat. We couldn't maintain our hold, and the web plunged downward, pulling us all toward the floor.

My sister's untimely death in 2017 reinforced this powerful lesson. But doctors shouldn't require a family crisis to understand the family's experience of health care. Health care that focuses only on the patient, and does not engage family, is woefully inadequate.

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Monday, June 24, 2019

The Pediatrician’s Most Awkward Task - The Atlantic

When Carrie Quinn was training to be a pediatrician, she dutifully memorized the list of symptoms for meningitis. She learned the right antibiotics for pneumonia. But when she got into the clinic, she found herself unprepared for what actually concerned parents.

"What I was actually faced with wasn't seriously sick children," Quinn, who's now the executive director of the Mount Sinai Parenting Center, said on a panel at Aspen Ideas: Health, which is co-hosted by the Aspen Institute and The Atlantic. More often, it was parents anxious over what to do about their kids' behavior issues or language delays.

Ben Danielson, another panelist and the medical director of the Odessa Brown Children's Clinic in Seattle, jumped in: "You made the joke the other day that, so often, a [doctor] who finishes pediatric residency would way rather intubate a baby than talk about breastfeeding." Talking about how to parent might be one of hardest parts of being a pediatrician.

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Friday, June 21, 2019

The Need for Clinical Trial Navigators - The New York Times

Since a Phase I trial has prolonged my life for almost seven years, I find it perplexing that fewer than 5 percent of adult American cancer patients enroll in clinical studies. Why do so few people — with various stages and types of cancer — participate in research that can improve care?

One obstacle may be the baffling scaffolding scientists erect around their studies. For example, cancer is a disease of aging, but many clinical trials on cancer drugs exclude older people from participating.

One study, in The Journal of Clinical Oncology, found that older patients "are underrepresented in cancer clinical trials relative to their disease burden."

In another study on the exclusion of large segments of cancer populations, published last year in The Oncologist, researchers argued that "the criteria for participation in some clinical trials may be overly restrictive and limit enrollment."

But the problem of low enrollment is often attributed to patient resistance. The reluctance of some patients makes perfect sense to me. Fear about unforeseen side effects escalates when consent forms, like the ones I signed, state that a new regimen cannot cure but might kill patients.

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Wednesday, June 19, 2019

Rude Surgeons May Have Worse Patient Outcomes : Shots - Health News : NPR

As a group, surgeons are not well known for their bedside manner. "The stereotype of the abrasive, technically gifted ... surgeon is ubiquitous among members of the public and the medical profession," write the authors of a 2018 article in the AMA Journal of Ethics. While poor manners aren't commonly accepted in most professional circles, representations of surgeons in popular culture often link technical prowess with rude behavior, and some surgeons have even argued that insensitivity can be helpful in such an emotionally strenuous profession.

A study published Wednesday in JAMA Surgery challenges these ideas. The study, which looked at interactions between surgeons and their teams, found that patients of surgeons who behaved unprofessionally around their colleagues tended to have more complications after surgery. Surgeons who model unprofessional behavior can undermine the performance of their teams, the authors write, potentially threatening patients' safety.

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Thursday, June 13, 2019

In ‘Let Me Not Be Mad,’ a Doctor Is One of His Own Case Studies - The New York Times

There are always two experts in a consulting room, A.K. Benjamin writes in his magnificently unsettling new book, "Let Me Not Be Mad." There is the patient, and there is the doctor — "one skilled in the particular experience of symptoms, the other in investigating them, first- and third-person accounts vying for the same conceptual ground."

What happens when these accounts vie in one person — when doctor and patient are the same? Benjamin, a British clinical neuropsychologist, weaves together the stories of his patients' "unraveling minds" with his own history of mental illness. Portraits of patients suffering from traumatic brain injury or dementia open up to reveal larger aspects of clinical practice, the brain and the kind of porousness Benjamin believes his profession requires. His interest isn't merely in describing this empathy but evoking it, slightly coercively, from the reader (there's an annoying yet undeniably powerful twist in this tale that I'm trying to sidestep).

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Friday, June 7, 2019

Warning of ‘Pig Zero’: One Drugmaker’s Push to Sell More Antibiotics - The New York Times

Facing a surge in drug-resistant infections, the World Health Organization issued a plea to farmers two years ago: "Stop using antibiotics in healthy animals."

But at last year's big swine industry trade show, the World Pork Expo in Des Moines, one of the largest manufacturers of drugs for livestock was pushing the opposite message.

"Don't wait for Pig Zero," warned a poster featuring a giant picture of a pig peeking through an enormous blue zero, at a booth run by the drugmaker Elanco.

The company's Pig Zero brochures encouraged farmers to give antibiotics to every pig in their herds rather than waiting to treat a disease outbreak caused by an unknown Patient Zero. It was an appealing pitch for industrial farms, where crowded, germ-prone conditions have led to increasing reliance on drug interventions. The pamphlets also detailed how feeding pigs a daily regimen of two antibiotics would make them fatter and, as any farmer understands, a heavier pig is a more profitable pig.

The rise of drug-resistant germs, caused by overuse of antibiotics, is one of the world's most nettlesome health predicaments. Excessive use of the medicines has allowed germs to develop defenses against them, rendering a growing number of drugs ineffective for people and animals. The practices of livestock farmers, who for decades have used huge quantities of the drugs deemed important to humans, have long been viewed as one of the roots of the problem, but the role of the companies that make the drugs has received less scrutiny.

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Sunday, June 2, 2019

Tweet by Julia Loewenthal, MD on Twitter

Julia Loewenthal, MD (@LoewenthalMd)
1/21 "Is there a nurse or doctor on board?"

Clinicians—have you ever responded to one of these?

Last week I left the hospital and boarded a flight for my vacation. I then responded to the mother of all in-flight emergencies…