Nurse Laura LaCroix was meeting with one of her many homeless patients in a downtown Dunkin' Donuts when he mentioned that a buddy was lying in agony in the nearby woods.
"You should check on him," said Pappy, as the older man is known. "But don't worry, I put him on a tarp, so if he dies, you can just roll him into a hole."
LaCroix called her boss, Brett Feldman, a physician assistant who heads the "street medicine" program at Lehigh Valley Health Network. He rushed out of a meeting, and together the two hiked into the woods. They found Jeff Gibson in a fetal position, vomiting green bile and crying out in pain from being punched in the stomach by another man days earlier.
Feldman told him he had to go to the hospital.
"Maybe tomorrow," Gibson replied.
"Tomorrow you'll be dead," Feldman responded.
Months later, the 43-year-old Gibson is still in the woods, but this time showing off the six-inch scar — for a perforated intestine and peritonitis — that is evidence of surgical intervention. He greets Feldman warmly. "You're the only person who could have gotten me to the hospital," he says. "You're the only person I trust."
Pappy and Gibson are "rough sleepers," part of a small army of homeless people across the country who cannot or will not stay in shelters and instead live outside. And LaCroix and Feldman are part of a burgeoning effort to locate and take care of them no matter where they are — whether under bridges, in alleyways or on door stoops.
"We believe that everybody matters," Feldman says, "and that it's our duty to go out and find them."
More ...
https://www.washingtonpost.com/national/health-science/in-the-woods-and-the-shadows-street-medicine-treats-the-nations-homeless/2017/11/21/6ef037e8-ca54-11e7-b0cf-7689a9f2d84e_story.html?
Thursday, November 23, 2017
Wednesday, November 22, 2017
Skin Cancers Rise, Along With Questionable Treatments - The New York Times
John Dalman had been in the waiting room at a Loxahatchee, Fla., dermatology clinic for less than 15 minutes when he turned to his wife and told her they needed to leave. Now.
"It was like a fight or flight impulse," he said.
His face numbed for skin-cancer surgery, Mr. Dalman, 69, sat surrounded by a half-dozen other patients with bandages on their faces, scalps, necks, arms and legs. At a previous visit, a young physician assistant had taken 10 skin biopsies, which showed slow growing, nonlethal cancerous lesions. Expecting to have the lesions simply scraped off at the next visit, he had instead been told he needed surgery on many of them, as well as a full course of radiation lasting many weeks.
The once sleepy field of dermatology is bustling these days, as baby boomers, who spent their youth largely unaware of the sun's risk, hit old age. The number of skin cancer diagnoses in people over 65, along with corresponding biopsies and treatment, is soaring. But some in the specialty, as well as other medical experts, are beginning to question the necessity of aggressive screening and treatment, especially in frail, elderly patients, given that the majority of skin cancers are unlikely to be fatal.
"You can always do things," said Dr. Charles A. Crecelius, a St. Louis geriatrician who has studied care of medically complex seniors. "But just because you can do it, does that mean you should do it?"
More ...
https://www.nytimes.com/2017/11/20/health/dermatology-skin-cancer.html?
"It was like a fight or flight impulse," he said.
His face numbed for skin-cancer surgery, Mr. Dalman, 69, sat surrounded by a half-dozen other patients with bandages on their faces, scalps, necks, arms and legs. At a previous visit, a young physician assistant had taken 10 skin biopsies, which showed slow growing, nonlethal cancerous lesions. Expecting to have the lesions simply scraped off at the next visit, he had instead been told he needed surgery on many of them, as well as a full course of radiation lasting many weeks.
The once sleepy field of dermatology is bustling these days, as baby boomers, who spent their youth largely unaware of the sun's risk, hit old age. The number of skin cancer diagnoses in people over 65, along with corresponding biopsies and treatment, is soaring. But some in the specialty, as well as other medical experts, are beginning to question the necessity of aggressive screening and treatment, especially in frail, elderly patients, given that the majority of skin cancers are unlikely to be fatal.
"You can always do things," said Dr. Charles A. Crecelius, a St. Louis geriatrician who has studied care of medically complex seniors. "But just because you can do it, does that mean you should do it?"
More ...
https://www.nytimes.com/2017/11/20/health/dermatology-skin-cancer.html?
Tuesday, November 21, 2017
The Power of the Placebo - Slate
Every so often, a new study comes along that challenges conventional wisdom in medicine or science. When the conditions are right, these studies can generate a lot of attention in both the popular press and the medical community. In early November, one of these such studies, called the ORBITA study, was published in the Lancet by a group of cardiologists.
The authors had set out to ask and answer a simple question: Does placement of a small wire mesh (called a stent) inside the artery that feeds blood to the heart (the coronary artery) relieve chest pain? One might ask what was novel about this question. The truth is that there was and is nothing novel about the question. The novelty was in the methods the authors used to answer the question: They conducted a prospective randomized controlled clinical trial, or RCT, the gold standard of research. The best RCTs compare the effect of the active intervention to a placebo and the best of the best keep both the subjects and the investigators blind to the intervention. The authors managed to do this for stents and chest pain, something that had never been done before, and in doing so, they had the best chance of preventing the placebo effect from skewing the results.
More ...
http://www.slate.com/articles/health_and_science/medical_examiner/2017/11/what_to_do_if_you_have_a_stent.html
The authors had set out to ask and answer a simple question: Does placement of a small wire mesh (called a stent) inside the artery that feeds blood to the heart (the coronary artery) relieve chest pain? One might ask what was novel about this question. The truth is that there was and is nothing novel about the question. The novelty was in the methods the authors used to answer the question: They conducted a prospective randomized controlled clinical trial, or RCT, the gold standard of research. The best RCTs compare the effect of the active intervention to a placebo and the best of the best keep both the subjects and the investigators blind to the intervention. The authors managed to do this for stents and chest pain, something that had never been done before, and in doing so, they had the best chance of preventing the placebo effect from skewing the results.
More ...
http://www.slate.com/articles/health_and_science/medical_examiner/2017/11/what_to_do_if_you_have_a_stent.html
Sunday, November 19, 2017
What if You Knew Alzheimer’s Was Coming for You? - The New York Times
Six years ago, at age 49, Julie Gregory paid an online service to sequence her genes, hoping to turn up clues about her poor circulation, blood-sugar swings and general ill health. Instead she learned she had a time bomb hidden in her DNA: two copies of a gene variant, ApoE4, that is strongly linked to Alzheimer's. Most Americans with this genotype go on to develop late-onset dementia.
"Alzheimer's was the furthest thing from my mind," Ms. Gregory told me. "I never thought I was at risk. When I saw my results, I was terrified."
When Ms. Gregory consulted with a neurologist about how to delay the onset of illness, he had four words for her: "Good luck with that." After all, no drug had proven effective in reversing Alzheimer's disease. And preventive measures like diet and exercise, the neurologist told her, would do no good.
Ms. Gregory is not the sort of person who pops into your mind when you think of Alzheimer's — youngish, healthy and sharp-minded. But she represents a type of sufferer we are likely to encounter more and more: those grappling with the looming threat of the disease rather than the disease itself.
More ...
https://www.nytimes.com/interactive/2017/11/17/opinion/sunday/What-if-You-Knew-Alzheimers-Was-Coming-for-You.html?
"Alzheimer's was the furthest thing from my mind," Ms. Gregory told me. "I never thought I was at risk. When I saw my results, I was terrified."
When Ms. Gregory consulted with a neurologist about how to delay the onset of illness, he had four words for her: "Good luck with that." After all, no drug had proven effective in reversing Alzheimer's disease. And preventive measures like diet and exercise, the neurologist told her, would do no good.
Ms. Gregory is not the sort of person who pops into your mind when you think of Alzheimer's — youngish, healthy and sharp-minded. But she represents a type of sufferer we are likely to encounter more and more: those grappling with the looming threat of the disease rather than the disease itself.
More ...
https://www.nytimes.com/interactive/2017/11/17/opinion/sunday/What-if-You-Knew-Alzheimers-Was-Coming-for-You.html?
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