Wednesday, October 26, 2016

Doctors thought he just had jock itch. Then it spread. - The Washington Post

Late Friday afternoon on Dec. 4, 2014, Stephen Schroeder was waiting to board his packed flight from Philadelphia to Las Vegas for a much anticipated long weekend with his son when his cellphone rang. On the line was an unexpected caller: his doctor, reporting test results sooner than Schroeder had expected.

Listening intently, Schroeder was flooded with disbelief as he struggled to comprehend what he was hearing. Using the lip of a trash can as a writing surface, he scribbled notes on the back of his boarding pass, making the doctor spell out each unfamiliar word. Then he sent a terse text to his wife, who was at their home in the Philadelphia suburbs, and got on the plane.

Onboard, Schroeder, then 55, fired up the balky in-flight Internet, desperate for information.

What he read over the next five hours left him alternately terrified, stunned and then, as denial took over, skeptical. "I kept thinking this must be some kind of really stupid mistake," he recalled. "The diagnosis had to be wrong."

Spokane sales manager Steve Schroeder, along with his doctors, thought he had a bad case of jock itch for more than a year. (Courtesy of Steve Schroeder)
Schroeder would discover that the pesky rash he and his doctors had dismissed as inconsequential would take over — and threaten — his life.

The experience would provide a crash course in the importance of finding experts who could provide appropriate treatment, in the necessity of learning as much as possible about a disease, and in the loneliness of coping with a diagnosis so rare it lacks a support group.

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Monday, October 24, 2016

A new divide in American death - Unnatural Causes: Sick and dying in small-town America - The Washington Post

Since the turn of this century, death rates have risen for whites in midlife, particularly women. In this series, The Washington Post is exploring this trend and the forces driving it.

Drugs, alcohol, marketing and lax federal oversight are working to defy modern trends of mortality, perhaps most starkly among middle-aged white women.

The First Fentanyl Addict | VICE

If the opiate crisis has taught us anything, it's that addiction affects everyone. An unprecedented surge in fentanyl-implicated death—across all incomes and backgrounds, obviously—has sparked public health emergencies across the US and Canada. With each fentanyl overdose reported, we're seeing ignorant assumptions about who uses drugs and why finally put to rest.

But there was a time when fentanyl was almost exclusively used by a very small group, and it had nothing to do with Margaret Wente's idea of a "typical drug addict" or poverty or organized crime. What the general public is oblivious to—but the medical community knows—is how fentanyl addiction took its roots in anesthesiology before it made its way into the mainstream.

Dr. Ethan Bryson, associate professor in the anesthesia and psychiatry departments at the Icahn School of Medicine at Mount Sinai, New York, believes it was anesthesiologists who, familiar with fentanyl's pharmacology and abuse potential, first began misusing the opioid.

"If you look at the history of morphine, cocaine, and heroin, these were all drugs which were initially developed for legitimate medical purposes, but subsequently became recreational pharmaceuticals," Bryson told VICE. "They were all experimented on with people with that access. That's well documented in history."

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Saturday, October 8, 2016

Lancet Global Burden of Disease Highlights Back Pain - The Atlantic

The newest iteration of the Global Burden of Disease study, which tracks the prevalence of deaths and diseases worldwide, contains some good news: On average people are living about a decade longer than they were in 1980. But there's a catch: Health hasn't improved as fast as life expectancy overall, which means that for many, those long, final years are spent hobbled by illness and disability.

The nature of our old-age ailments has changed in recent years. The study, published this week in The Lancet and conducted by the Institute for Health Metrics and Evaluation at the University of Washington, uses a metric called "Disability Adjusted Life Years." DALYs, as they're abbreviated, combine the number of years of life a person loses if they die prematurely with the amount of time they spend living with a disability. Think of it as time you didn't spend living your #bestlife—because you were sick or dead.

In rich countries, the number one cause of these DALYs is not surprising: ischemic heart disease, which is associated with well-known Western issues like high cholesterol and obesity. But the number two condition is a little strange: plain, old-fashioned, ever-present, low back and neck pain.

Even when you include poor and middle-income countries, low back and neck pain went from ranking 12th as a cause of DALYs globally in 1990 to ranking fourth in 2015, the most recent year. In most countries, it was the leading cause of disability. DALYs from low back and neck pain increased by more than 17 percent from 2005.

The things that make us low-level miserable are now more likely to be simple aches and pains, rather than frightening, communicable diseases like diarrhea. That's encouraging, but it's still a little sad. People all over the world increasingly live long, great lives, only to spend their golden years slathered in IcyHot.

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Friday, October 7, 2016

Your Surgeon Is Probably a Republican, Your Psychiatrist Probably a Democrat - The New York Times

We know that Americans are increasingly sorting themselves by political affiliation into friendships, even into neighborhoods. Something similar seems to be happening with doctors and their various specialties.

New data show that, in certain medical fields, large majorities of physicians tend to share the political leanings of their colleagues, and a study suggests ideology could affect some treatment recommendations. In surgery, anesthesiology and urology, for example, around two-thirds of doctors who have registered a political affiliation are Republicans. In infectious disease medicine, psychiatry and pediatrics, more than two-thirds are Democrats.

The conclusions are drawn from data compiled by researchers at Yale. They joined two large public data sets, one listing every doctor in the United States and another containing the party registration of every voter in 29 states.

Eitan Hersh, an assistant professor of political science, and Dr. Matthew Goldenberg, an assistant professor of psychiatry (guess his party!), shared their data with The Upshot. Using their numbers, we found that more than half of all doctors with party registration identify as Democrats. But the partisanship of physicians is not evenly distributed throughout the fields of medical practice.

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Thursday, October 6, 2016

A Letter to the Doctors and Nurses Who Cared for My Wife - The New York Times

After his 34-year-old wife suffered a devastating asthmaattack and later died, the Boston writer Peter DeMarco wrote the following letter to the intensive care unit staff of CHA Cambridge Hospital who cared for her and helped him cope.

As I begin to tell my friends and family about the seven days you treated my wife, Laura Levis, in what turned out to be the last days of her young life, they stop me at about the 15th name that I recall. The list includes the doctors, nurses, respiratory specialists, social workers, even cleaning staff members who cared for her.

"How do you remember any of their names?" they ask.

How could I not, I respond.

Every single one of you treated Laura with such professionalism, and kindness, and dignity as she lay unconscious. When she needed shots, you apologized that it was going to hurt a little, whether or not she could hear. When you listened to her heart and lungs through your stethoscopes, and her gown began to slip, you pulled it up to respectfully cover her. You spread a blanket, not only when her body temperature needed regulating, but also when the room was just a little cold, and you thought she'd sleep more comfortably that way.

You cared so greatly for her parents, helping them climb into the room's awkward recliner, fetching them fresh water almost by the hour, and by answering every one of their medical questions with incredible patience. My father-in-law, a doctor himself as you learned, felt he was involved in her care. I can't tell you how important that was to him.

Then, there was how you treated me. How would I have found the strength to have made it through that week without you?

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Wednesday, October 5, 2016

Max Ritvo, Poet Who Chronicled His Cancer Fight, Dies at 25 - The New York Times

Max Ritvo, an accomplished poet who spent much of his life under the cloud of cancer while gaining wide attention writing and speaking about it, died of the disease on Tuesday at his home in Los Angeles. He was 25.

His mother, Dr. Ariella Ritvo-Slifka, confirmed his death.

Mr. Ritvo talked about his work and illness in interviews on radio programs including "Only Human" on WNYC and "The New Yorker Radio Hour." His poems have appeared in Poetry Magazine and The New Yorker, and his first published volume of poetry, "Four Reincarnations," will appear in the fall.

The poet Louise Glück, who taught Mr. Ritvo at Yale, called the book "one of the most original and ambitious first books in my experience," adding that his work is "marked by intellectual bravado and verbal extravagance."

Mr. Ritvo was 16 when he learned he had Ewing's sarcoma, a rare pediatric cancer. He had gone to doctors after feeling pain in his side. At first they suspected pneumonia, but fearing something worse they took a tissue sample while he was under sedation.

He woke up in a cancer ward.

"I remember thinking, 'This is so terrible!'" he told Mary Harris of WNYC. "'I'm just a young, acrobatic, wiry, handsome bloke of 16, and it's so sad for all these old people, because they must have run out of beds and I just have pneumonia.'"

A year of aggressive treatment brought about remission, and over the next four and a half years he finished high school and attended Yale.

The cancer returned in Mr. Ritvo's senior year. He nevertheless completed his degree in 2013 and this year earned a master of fine arts from Columbia University, where he became a teaching fellow. He also served as poetry editor at Parnassus: Poetry in Review.

Throughout his illness, he rejected the clichés of being an "inspiring victim of cancer," his mother said. He counseled other families going through treatment for Ewing's sarcoma, and spoke out often about the disease and the importance of research.

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Sunday, October 2, 2016

Tom Brokaw: Learning to Live with Cancer - The New York Times

For most of my adult life I have answered the question "Occupation?" with one word: journalist. I still do, but now I am tempted to add a phrase.

Cancer patient.

Three years ago, at age 73, I learned that I had an incurable cancer called multiple myeloma. At the time the statistical life span for patients with the disease was five years.

That number has not changed, but I have. After three years of chemotherapy, a spinal operation that cost me three inches of height, monthly infusions of bone supplements and drugs to prevent respiratory infection, I am now almost as close to 80 as I was to 70 at the time of the diagnosis. I have lived 60 percent of those five years.

The cancer is in remission, and I take the word of my medical team that I am doing well and should beat the standard life expectancy. I still lead a busy professional and personal life. Biking, swimming, fly-fishing and bird hunting remain active interests — but in a new context.

Even in remission, cancer alters a patient's perception of what's normal. Morning, noon and night, asleep and awake, malignant cells are determined to alter or end your life. Combating cancer is a full-time job that, in my case, requires 24 pills a day, including one that runs $500 a dose. For me, bone damage brought persistent back pain and unwelcome muscle deterioration.

Constant fatigue is a common signature of cancer patients, which separates them from healthy friends and family members. It is also what brings cancer patients together.

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Tuesday, September 27, 2016

Reviving House Calls by Doctors - The New York Times

Surah Grumet used to be a family doctor at a clinic in the Bronx. "It always felt like I was trying to catch up," she said. "I was always falling behind, and it was so stressful. And it was really hard to bring up my two girls, to be there for them, and still be able to practice medicine the way that I wanted to."

Now, she lives in a suburb of Raleigh, N.C. She still practices medicine, but has no office or clinic. Instead, she works with a Durham-based practice called Doctors Making House Calls.

Grumet puts her girls on the school bus and gets in the car just before nine. Her patients are frail elderly people with multiple chronic illnesses: memory loss, heart and blood pressure problems, arthritis that makes mobility difficult.

Grumet works full time, but on her own schedule. She can spend 15 minutes with a patient, or nearly two hours. She's home before the school bus and completes her patient notes and paperwork while her girls do homework. She makes $70,000 more than she did when she worked in the Bronx.

How is this possible? In a world where many doctors struggle to make money seeing four patients an hour, how can they run a successful practice driving to patients' homes and spending all the time their patients need?

Before 1950, nearly half of all doctors' visits in America were house calls. But then the country began building big hospitals and luxurious doctors' offices, and doctors acquired sophisticated equipment they couldn't put in a medical bag. Medicare and Medicaid reimbursement systems made home visits untenable.

But the house call is now a better idea than ever.

To cut America's health care costs, it helps to look at the most expensive patients. Medicare spends a third of its budget caring for chronically ill people in their last two years of life. This group is growing fast, and growth will accelerate; the first baby boomers are now turning 70.

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Monday, September 26, 2016

School to give medical students hands-on training - The Portland Press Herald / Maine Sunday Telegram

The University of Vermont College of Medicine is changing the way physicians are trained by switching exclusively to a hands-on approach to learning designed to encourage students to solve medical puzzles rather than just memorizing body parts and diseases.

While most medical schools recognize the importance of active learning and use it in some of their classes, UVM is believed to be among the first in the country to commit itself to switching all its medical training to the new system.

"Shifting completely away from the traditional lectures in that way, we are not familiar with any other medical school that has done that across all four years," said Lisa Howley, the senior director of educational affairs at the Washington-based Association of American Medical Colleges, which represents 145 medical schools and about 400 teaching hospitals.

The effort will get a boost from a $66 million donation from 1942 medical school graduate Robert Larner that will provide $4 million a year in perpetuity to help implement the changes. In announcing the donation Friday, the medical school, which has about 465 students, also said it was changing its name to The Robert Larner M.D. College of Medicine.

Making the switch presents a challenge to an educational system that, especially in the early years of medical school, relied on a doctor lecturing to students from the front of the room.

William Jeffries, associate dean at the UVM medical school, points to a 2014 study in the Proceedings of the National Academy of Sciences that determined students in traditional lectures were 1.5 times more likely to fail than students taught with active learning.

"If this was a clinical trial of a new drug or a treatment, we would adopt it because we knew that the other method was inferior to the first method," Jeffries said. "We have to react to that evidence."

Here's how the process works in the new system:

In class, medical students might be given a case in which a patient is complaining of arm pain. The students would focus on which bone is most likely broken and the possible implications of the injury to the circulatory or nervous system.

"That means they have to know the anatomy, and then they have to say, 'Well, in the real world, what are we going to do with that information?" said Dr. William Raszka, a pediatrician who teaches in the medical school.

"The family doesn't come in and say, 'I think my ulna's fractured.' They say, 'My son came in, he fell off the jungle gym and he's holding his hand,"' Raszka said.

To facilitate those types of discussions, the school is removing lined-up desks from classrooms and replacing them with tables where small groups of students can apply the information they learn before class and work together to find answers to questions posed by the teachers. The rarely used books in the medical school library are going to be moved into storage and the information digitized.

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