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Archive for the ‘Miscellaneous’ Category

Monday, May 21st 2012

A Surgeon Is A Surgeon

A Laredo dentist is on the hot seat for Medicaid fraud and practicing medicine without a license. Insurance fraud is an everyday thing unfortunately and worth a further post. What I find incredible though was the dentist’s defense of his cosmetic surgery procedures – including tummy tucks and breast augmentations,

The dentist argued that he was “qualified to perform the challenged procedures because he is a surgeon and, under the Texas Medical Practice Act, ‘the terms “physician” and “surgeon” are synonyms,’” according to court documents. But in August 2009, he “pleaded guilty to seven counts of the third degree felony offense,” reported the Fort Worth Star-Telegram in a blog post accompanied by curious artwork. He received a five years in prison for those crimes, but had his sentence suspended and was placed on probation.

I suppose he has some know how and it certainly does not rise to the level of this incredible story I read last year from Florida.

A transgender woman in South Florida faces charges of practicing cosmetic surgery without a license, after police say she injected an unwitting patient’s buttocks with a handful of unsafe substances, including tire mender Fix-A-Flat

[...]

The injection took place in a residential setting, where Morris shot a mix of cement, glue, mineral oil and tire sealant into the woman’s buttocks

The “practitioner” in this case was paid $700 for a butt injection; an attempt at a fuller behind for cosmetic reasons. Needless to say the patient required hospitalization. A part of my libertarian side says we should open up the practice of medicine. As a patient you should be able to cipher through the claims of all practitioners, go over their creditionals and if you want to pay someone to do something to you, then go for it. Then you read stories like the one from Florida and rethink it.

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Saturday, May 12th 2012

Talking About Sudden Health Issues

I love patient blogs. I love the personal narrative as a patient, hearing patients tell their stories. Especially concerning sudden, acute life altering health issues. It’s not watching a train wreck; it is uplifting and motivational. I once heard Jill Taylor speak and while I was underwhelmed with the performance as a public speaker (no offense) I did enjoy her book talking about her experience recognizing she was having a stroke to being a patient to recovering.

Senator Mark Kirk, the man who followed Roland Burris who followed Barack Obama in the United States Senate, details his similar experience as a stroke patient in the Chicago Tribune.

The medical team at Northwestern, in consultation with my family, decided to operate. Sunday evening, Dr. Fessler and his surgical team removed a 4-by-8-inch section of my skull to relieve the swelling. I am told that I woke up on Monday morning and asked for my BlackBerry, although I have no recollection of that now.

Over the next two days, the swelling in my brain did not go down, and Dr. Fessler and Dr. H. Hunt Batjer operated again, removing the dead portion of my brain as well as more bone to allow for more swelling. Since that second surgery, I have been on a steady course of recovery. Two weeks later, the removed section of my skull was replaced and my head was back in one piece. A week after that, I transferred out of Northwestern’s intensive care unit and moved into the Rehabilitation Institute of Chicago, just a few blocks away. For the past two months, I have been working for hours each day to regain my ability to walk and other motor functions.

I was very fortunate that the stroke affected the right side of my brain. While I could not at first move the left side of my body, my cognitive and speech functions were not impaired. With a lot of work and a lot of help, I have been slowly regaining movement on the left side of my body.

Throughout this time, I have been blessed with great care from some of the finest health care workers in the world. Jesserine, “Jazz,” one of my nurses at RIC, has become a great friend. I do not know what I would have done without her skills and professionalism. Jazz and her colleagues saved my life and have facilitated my recovery in more ways than I could list.

Not the most personal of memoirs but a good read.

I’m a little surprised the Senator got such an aggressive and early decompression. There is good evidence for aggressive, early hemicraniectomy in large non-dominant middle cerebral artery strokes to circumvent the effects of swelling, see here and here. The thing that surprises me, just inferred from his own piece in the Tribune, it seems like he was awake and talky leading up to the surgery. If that’s the case certainly not a patient, at that point, suffering from a malignant MCA stroke. Then again the fact they went back to the operating room for further decompression days later…

I guess all to take away is I should play physician from afar and based on a 1000 word article in the newspaper. We all remember this.

But you should read Senator Kirk’s piece and remember, as he employs, remember American Stroke Month.

Friday, May 11th 2012

MRI Safe

Neurosurgery loses a lot of MRI. It uses a lot of MRI in the urgent setting. Care of the central nervous system is where MR has altered care the most and where quick and efficient access to MR for acute issues has become widely available; rightly. Patients with symptoms of stroke, SCI, cauda equina injury, intracranial mass lesions with herniation syndromes. These are situations where stat access to MRI has proven invaluable and nowadays is essentially standard of care.

And so I am surprised by the number of patients I see who have symptoms that would dictate stat MR scans but who have contraindications to MRI. Patients with ICDs or pacemakers or SCS or other implants or who are claustrophobic or who are morbidly obese and won’t fit on the table. Running into this problem often, I’m excited about a prospective study looking at MRI use in patient’s with supposedly non-compatible pacemakers, the Magnasafe Registry.

This group gave an oral presentation of early results at the Heart Rhythm Society meeting. As the Medscape write up notes,

Among 500 patients undergoing scans, there were no deaths, device failures, generator-lead replacements, losses of capture, ventricular arrhythmias, or electrical resets, according to Debra Doud, MD, of the Scripps Clinic in La Jolla, Calif.

[...]

Current guidelines state that MRI is contraindicated in patients with cardiac devices, and Medicare has not reimbursed for MRI scans performed in patients who have a device in place. Doud noted that Medicare has since begun reimbursing for such scans as long as the patient is enrolled in the registry.

Considering the large number of patients with cardiac devices, the aging of the population, the increasing indications for cardiac devices, and the strengths of MRI in examining soft tissue, “the availability of being able to perform these exams in this patient population is extremely important,” Doud said in an interview.

I’m interested for this study to complete. The idea that implantable devices should limit access to such a now important medical technology, especially in this day and age.

Wednesday, February 1st 2012

Expanding The Definition of Brain Death

I still love The Onion

Monday, October 3rd 2011

The Commercialization of Fear & Health

This is just wrong.

Also I found it via Reddit.

Monday, May 30th 2011

Self Trepanation

I suppose there is a long history of physical mutilation in the service of somehow fulfilling some self guilt or for some religious purpose or for improving oneself. And even a history of trepanation to such ends. But modern day self trepanation, the act of drilling a hole into your own head, has to be one of the most bizarre and off the wall acts.

A Hole In The Head: Do-It-Yourself TrepanationWatch the top videos of the week here

I can promise you there is nothing to the idea of permanently increasing the blood-brain volume.

Tuesday, May 24th 2011

What’s Appropriate Online

In the surprisingly narrow and inbred world of health care social media there is minor drama at the moment. Over on 33 Charts Dr. Vartabedian decided it prudent to highlight what he, and some others, feel was unprofessional behavior within the social media space.

There really are two separate issues within this hoopla.

The first is the very real argument over whether this particular instance crossed some line and over what, in broader terms, constitutes professionalism in social media use. Social media is a broadcast form of communication as the average health care provider has never had access to before and it necessitates new standards. That discussion has and is taking place elsewhere and isn’t for this post.

The second issue, and the one that really has prompted this post, is the way this incidence was presented and the discussion moderated.

I’m not really sure what Dr. Vartabedian was trying to achieve with his post on 33 Charts. He seems to imagine the post as a place for discussion over what constitutes professionalism in social media use. As a process towards consensus and a learning experience. I hope I’m not assuming too much when assigning him those intentions with his post.

He asks,

Is it unprofessional? Decide for yourself.

[...]

What say you?

[...]

No agenda here. Just creating sorely needed dialog.

A reasonable goal, if that was the focus.

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Wednesday, August 25th 2010

God Complex

I just wrote a lengthy piece on, essentially, why I deserve to be paid more. Despite that, I swear my head isn’t getting big.

God forbid something happens and I never attain “neurosurgeon status,” say I can’t pass my boards or something, and all of this in hindsight looks like bluster. The point is, no matter what I was aspiring to I think my arguments for the pay gap stand and have little to do with what ego I have.

Sunday, August 15th 2010

Final Fantasy Opera

I thought I’d start my return to posting with something completely off topic and geeky.

I am a huge fan of Nobuo Uemtasu, a Japanese composer who has turned compositions for video games into an art form. Time magazine named him an innovator for the coming century several years ago and his work on the Final Fantasy series has spawned a number of concert tours. Above is a group of professional performers and the Royal Stockholm Symphony Orchestra performing an act for an opera which Uematsu wrote for an early Final Fantasy game.

Saturday, April 3rd 2010

The World Is Just Awesome

Life is incredible.

Consider that the thesis of this post. It is a rehashing, I’ve posted a post similar to this before, but since I continue to be lucky to be alive and because I can’t find that original post I’ll rehash the point of it.

I’m sorry to share a commercial for a television station to make my point but the ad expresses a truth wrapped in a production quality that I can’t find elsewhere.

It is a beautiful day outside, I am so lucky and blessed to be alive. And while I’ve been comparatively blessed the whole of my life and, only in brief truly experienced suffering, as it should be defined when looking at the range of human experience, I feel comfortable in claiming the impressiveness of humanity.

The fact that life or the rest of the natural world or human achievement somehow seems common place is depressing. The universe is incredible and wonderful. The mere fact life exists at all is something amazing. I think that a single day of life, even one filled with suffering, would be worth it for the observations and the experience in general.

I love the whole world.