Saturday, May 18, 2019

For patients, a caregiver’s compassion is essential - The Washington Post

The 34-year-old man lay in his ICU bed for over a month — dependent on a breathing tube and artificial respirator to stay alive. The patient knew his life hung in the balance, as he was a physician himself. Some days the suffering was so intense that he contemplated ways he could unplug the machine on his own.

Now, nearly 50 years later, that patient, Edward Viner, an oncologist who served as chief of the Department of Medicine at Cooper University Health Care in New Jersey for more than two decades, reflects on how he was able to survive such a harrowing experience.

It was the nurses he calls his "angels." But it was not all of his nurses. When it was time for shift change in the ICU, Viner says he felt that he could detect almost immediately if the nurse coming on duty truly cared. He could tell some nurses cared deeply, but some did not.

"When my nurses cared," he distinctly remembers, "I knew that shift would be a positive experience and that their compassion would help me fight on and help save me."

With all of Viner's knowledge from a lifetime of treating patients, does he really believe that his nurses' compassion changed his outcome? Is there data to back up the claim that caring can make a difference and that health-care outcomes are not just dependent on how much health-care providers know, but rather how much they care? We do not raise this consideration on ethical or emotional grounds, but rather on the basis of medical science.

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The Night The Lights Went Out - Deadspin

I am the least reliable narrator when it comes to the story of my brain exploding. This is because, from the time right before I suffered a freakish brain hemorrhage last year to the time I regained full consciousness roughly two weeks later, I remember nothing. My mind is an absolute blank. It's like the fabled pause in the Nixon Tapes. I was not here. That time of my life may as well not exist. Oh, but it did.

I remember hosting the Deadspin Awards in New York the night of Dec. 5 and then heading over to a karaoke bar for a staff after-party, where I ate some pizza, drank a beer, sang one song (Tom Petty's "You Got Lucky," which would soon prove either fitting or ironic, depending upon your perspective), and that's it. After that comes a great void. I don't remember inexplicably collapsing in a hallway, fracturing my skull because I had no way to brace myself for the impact. I don't remember sitting up after that, my co-workers alarmed at the sight of blood trickling out of the back of my head. I don't remember puking all over Barry Petchesky's pants, vomit being one of many fun side effects of your brain exploding, as he held my head upright to keep me from choking on my own barf. I don't remember Kiran Chitanvis quickly calling 911 to get me help. I don't remember getting into an ambulance with Victor Jeffreys and riding to an uptown hospital, with Victor begging me for the passcode to my phone so that he could call my wife. He says I made an honest effort to help, but my circuits had already shorted out and I ended up giving him sequences of four digits that had NOTHING to do with the code. Flustered, he asked me for my wife's phone number outright. Instead, I unwittingly gave him a series of 10 digits unrelated to the number he sought.

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Thursday, May 16, 2019

How Tiger Woods Won the Back Surgery Lottery - The New York Times

Few would have predicted that Tiger Woods would be playing in the P.G.A. Championship this week. He had three failed back surgeries, starting in 2014. He had taken opioids. His astonishing career seemed over.

Then he had one more operation, a spinal fusion, the most complex of all, in 2017. And last month he won the Masters, playing the way he used to.

An outcome like his from fusion surgery is so rare it is "like winning the lottery," Dr. Sohail K. Mirza, a spine surgeon at Dartmouth, said.

The idea behind spinal fusion is to remove a disk — a ring of fibers filled with a nerve-cushioning jelly that joins adjacent spine bones — and fuse the spine together, a procedure that almost inevitably means trading flexibility for stability and, the patient hopes, an existence with less pain.

That was all Woods was looking for when he decided to go ahead with fusion as a last resort — a "normal life" is how he put it. He got that and much more, including a new green blazer, though the lesson that most surgeons say Woods's experience teaches isn't that fusion surgery is a panacea but how much active rehabilitation and physical therapy the procedure requires for it to work.

"If you look at it simplistically, what does fusion do? It provides mechanical support," said Dr. Charles A. Reitman, co-director of the Spine Center at the Medical University of South Carolina. "If they are missing mechanical support and that is the pure cause of the problem, then they will get better."

People with a broken spine, for example, or scoliosis, which is severe spinal curvature, or spondylolisthesis, in which vertebrae slip out of place, tend to have terrific results, he said.

But those are a tiny minority of fusion patients. The vast majority of fusion procedures are performed on patients with one or more degenerated disks, disks that are worn out, dehydrated, stiff and friable. And when those disks move, patients' backs can ache.

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Wednesday, May 15, 2019

#Herpes, #Crohns, and #Depression: Meet the People Making Their Chronic Illnesses Instagram-Friendly - Daily Beast

Late last month, Theresa Eternity took a selfie. It wasn't out of the ordinary for the 22 year-old from Victoria, Canada, who frequently catalogues her many hair colors (pink, blue, green) on Instagram. But this photo was different: sporting a houndstooth blazer, crimson red lipstick, and fully bald head, Eternity announced to the world that she has alopecia.

"It's pretty vulnerable when you can't hide behind your hair, you're there for the world to see," Eternity wrote in an accompanying caption. "Sometimes I open my front camera and I look just like a thumb... but that's okay, because I'm learning and changing what femininity means to me."

Eternity punctuated her 150-word disclosure with 13 hashtags, including #alopecia, #alopeciaareata, and #bigbadbaldie. She joined over 750,000 people (and probably more than a few bots) who have used #alopecia to classify a confessional post. These communities of patients inspired Eternity to share her own story.

After visiting multiple doctors who ran tests for everything from thyroid disease to iron deficiency, Eternity was diagnosed with alopecia areata. In medical circles, the chronic condition—which causes hair to fall out in patches—is considered more of a cosmetic nuisance than a health crisis.

"They were lax in sympathy and empathy," Eternity told The Daily Beast. Her physician unceremoniously ended the appointment by suggesting she see a dermatologist. Not satisfied, Eternity turned to Instagram support groups where she found a community that understood her pain.

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The (A.I.) Doctor Will See You Now - Daily Beast

You've done it before: Perhaps you have a weird rash or feel a little strange, something beyond the usual flu or back pain. You Google it, becoming part of the 75 million Americans who use WebMD each month to check symptoms, rule out conditions, or to go down a hypochondriacal rabbit hole (unsurprisingly, "cyberchondria" is a real thing).

According to a BMJ study, online symptom-checking websites provide accurate diagnoses roughly half the time, amounting to millions of people worrying unnecessarily or, worse, breathing a sigh of relief when something's actually wrong.

But what if artificial intelligence could accurately diagnose you—and save you a trip to the doctor's office?

It's not a crazy idea. The UK has integrated an AI-powered healthcare system called Babylon into its National Health Service, separating patients with urgent needs from those with more run-of-the mill illnesses.

And it's simple. If you type, "I have a cough and fever. What's wrong with me?" Babylon's AI will ask for more details and run through a list of other possible symptoms to determine whether you should go see a doctor or whether you can buy over-the-counter meds and send yourself to bed.

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