Willet was AWOL....PODay 360

I'm trying to catch up here so these are all the things I would have said had I been here...

1. Recently an acquaintance went to fill an RX for a pain killer prescription and the pharmacy refused to fill it. Seems the patient had filled RXs three times in the recent months for pain meds from three different doctors. He had surgery, an injured knee and was seeing a doctor for chronic headaches pain. So there were good reasons for all three prescriptions.  But the pharmacist was suspicious he was "doctor shopping" to get drugs. The following report helps explain why everyone is so concerned about this problem.

        Reuters (6/18, Kearney) reports that across the US, prescription medication and illicit drug overdoses took the lives of 44,000 people in 2013. Fifty-two percent of these fatalities are tied to prescription medications.

        The AP (6/18, Raby, Mattise) reports that West Virginia leads the US in “the highest rate of overdose deaths.” In fact, the state’s “drug overdose death rate was more than double the national average, the report says.” The report, which cited “statistics from the CDC,” found that West Virginia experienced “about 34 drug overdose deaths per 100,000” people, compared to the US “national average” of 13.4 deaths per 100,000 people.

2. For years people have been arguing about butter versus margarine on the dinner table. Growing up my family had both, my dad favored margarine and in a rare instance of rational medical opinion my mom thought butter was better. Turns out she was right!

 The FDA has given the food industry three years to get trans fats out of the food supply..

        According to ABC World News (6/16, story 11, 1:25, Muir, 5.84M), food manufacturers will have “three years to remove trans fat from their products” under the new policy.

        The CBS Evening News (6/16, story 9, 2:05, Pelley, 5.08M) reported that the policy is based on a determination made by the FDA that “no amount is safe for human use.”

        The New York Times (6/17, Tavernise, Subscription Publication) explains that the FDA “ruled...that partially hydrogenated oils, the source of trans fats, were no longer ‘generally recognized as safe,’” meaning that “companies would have to prove that such oils are safe to eat — a high hurdle, given that scientific literature overwhelmingly shows otherwise.” The agency estimates that the policy “could prevent 20,000 heart attacks and 7,000 deaths from heart disease each year.”

        The Los Angeles Times (6/17, Healy) reports that “FDA officials said Tuesday they expect few will have difficulty meeting the three-year deadline,” especially considering that “food manufacturers have steadily reduced their use of hydrogenated oils” since a 2013 announcement by the FDA that it was beginning the process of removing trans fats from the food supply.

        The Washington Post (6/17, Dennis) reports that the FDA estimates “the new regulations could cost the industry $6 billion or more over 20 years, but that savings from reduced medical care and other benefits during the same time could eclipse $130 billion,” according to an FDA economic analysis published Tuesday. Michael Taylor, “the FDA’s top food safety official,” said that “the public health benefits in this action far, far, far outstrip the cost of compliance,” adding that “it’s a very clear case where the benefits far exceed the costs.”

        Congressional Quarterly (6/17, Gustin, Subscription Publication) reports that the FDA said “it does not have plans to proactively monitor compliance, but that it routinely surveys the food industry’s use of ingredients.”

        The Washington Post (6/17, Ferdman) reports in its “Wonkblog” that the FDA’s decision is “probably the single most important change in our food supply, if not in decades then ever,” according to Michael Jacobson, executive director of the Center for Science in the Public Interest.

        According to Inside Health Policy (6/17), the policy “drew immediate praise” from the American Medical Association, which last week “adopted a policy at its 2015 Annual meeting supporting state and federal legislation banning the use of artificial trans fat in the United States.”

        Forbes (6/17, Walton) contributor Alice Walton writes that Dr. Steven J. Stack, MD, president of the AMA, said that “the American Medical Association commends the U.S. Food and Drug Administration for its decision today to remove partially hydrogenated oils, the primary dietary source of artificial trans fat in processed foods, from all U.S. food products,” adding that “we support the FDA’s move to eliminate trans fat as an important component in a multipronged strategy needed to help improve public health.”

Just chatter...PO Day 357

Enough serious talk the last several days. I really am not  obsessed with dire medical news. It must look that way though.What is it about "news" that it has to be bad to be interesting? While I live in a small town our television news comes out of a medium large city 75 miles away. The nightly news is a litany of robbery, car crashes and murder. The choice to watch local news or national news is a choice between your daily dose of violence on a local or global scale. One of the national networks tries to end their nightly broadcast on a positive note. It just doesn't work for me.

Oops, more serious talk!

Changing the subject...I am trying to water paint. I'm on the third attempt at a small portrait of  a family member when he was little. It's not going well. Catching the spark of a person is truly difficult. I'm no artist but I can do a recognizable inage of an inanimate article. But a person? Impossible!   So, what do I do if the painting comes out 'just fair?" Certainly not a Monet, not even a Picasso. Do I give it to the subject? That was my original plan. Do I keep it and hang it in some out of the way spot where no one will see it?

Is it possible that the subject might be so flattered with my effort that he will see only the effort and not the result? I wish.:)  As said, I am on my third attempt which I think is going to be my last. Each try one aspect improves and another gets worse.



And while Iam asking rhetorical questions...what do I do about my Blog? There's not a lot more for me to say about rTSA, although it is always fun to talk about oneself and your medical issues. I was highly motivated to start a new blog when the site was corrupted and there did not seem to be any way to  correct the  serious problesm I had with it. But the miracle of the Lithuanian language glitch ended up serendipitously fixing all my problems with the site. No, I have no idea why it resolved the troubles but I'll take it.  So, naturally, I am less motivated to start over.

I am not narcissictic enough to think I have something really interesting to say. But writing the blog has gotten to be a routine, a ritual so to speak. What else can I do at 3:30 in the morning? It looks like I have about 8 more days to make a decision. What to do?

Never Events...P O Day 356

Major medical-hospital errors are called Never Events. Examples would include operating on the wrong body part, operating on the wrong side of the body, and operaring on the wrong patient! In spite of systems in place to prevent these disasters, errors still occur. Mayo Clinic did an in-house investigation to try to learn why,

The obvious and predictable events contributed.

• Preconditions for action, such as poor hand-offs, distractions, overconfidence, stress, mental fatigue and inadequate communication.
• Unsafe actions, such as bending or breaking rules or failing to understand them. This category of errors includes confirmation bias, in which clinicians convince themselves they are seeing what they think they should be seeing.
• Oversight and supervisory factors, such as inadequate supervision, staffing deficiencies and planning problems.
• Organizational influences, such as problems within the organization'sl culture or operational processes.

 The committee said the staff shoud  develop a protocal like what flight crews do. There should be a time out in the operaitng room just before surgery and a check list that is gone through every time.  Poor communiction tends to be the root of the problem.  The Mayo Clinic estimates a Never Event occurs one in every 22,000 cases but in the general hospital industry the incidence is more like one in 12,000 cases. That sounds rare but nationwide that breaks down to approximately 268 cases a day!

The problem is that human beings are involved and we humans are subject to human error. We make mistakes. That's not to say having computers run things would be better, just different. Computers leave no room for decision making and  judgement but, in humans, judgement opens the door for poor judgement. Perhaps some kind of cross checking could work but I don't think there will ever be no Never Events.

Hospital Dangers... P O Day 355

I am so sleeepy I don't know if I can get through this or not. But going to try. I just hope it does not turn into "middle of the night gibberish."

According to an article in Forbes Magazine just being in the hospital leaves many patients with long term damage from post-hospital syndrone and deliriium. Delirium, affecting up to half of all elderly patients and as much as 85% of intensive care unit patients is a major hazard. Also, according to Robert Pearl, MD, it doubles the risk of death within the year post hospitalization.

The problem begins with disorienting lights, drug treatments, frequent sleep interruptions, and strange environment during the hospital stay. Often the condition is misdiagnosed as dementia.   Sixty-five percent of patients older than 65 will develop weakness in their legs and dizziness while standing as a aresult of hospitalization A third of patients readmitted with this problem will lose the ability to walk alone as a result of  weakness of leg muscle.

It may be difficult to control the total hospital experience for your loved one. Certainly, staying with them until they are well oriented is a good beginning.A daily newspaper helps the patient know what day it is and what is happening in the world. Double checking what drugs they are being given can uncover pharmaceuticals that, while keeping the patient calm, may be contributiing to their confusion. Helping them keep a journal is a good way to remember which doctors are seeing the patient. Arranging to share mealtime may encourage the patient to eat a normal diet and follow a home routine. Encouraging the patient to "wash up" and put on fresh pjs, even hospital gown, can really make a person feel better.Getting the patient up to walk a little. with assistance, helps a lot ut only with assistance.

Ideally hospitals will take steps to improve the hospital experience for elderly patients but until they do, it is up to the family.

Medical errors..PODay 354

According to the Boston Globe medical errors are on the rise  in the state of Massachusetts. There were 753 medical mistakes in 2013 and 821 serioius incidents in 2014, an increase of 9 percent. But the Department of Public Health says that is not such a bad thing, that the increase is due to better reporting, not more errrors.

This follows a rise from 444 in 2012 to 753 in 2013, a 70 percent rise in reported errors.

"The newest data show that there were 290 serious injuries or deaths resulting from a fall in 2014, a slight rise from 282 incidents in 2012, the Globe reports. The number of wrong-site surgeries decreased, from 36 to 24, and the number of wrong surgeries/procedures performed stayed nearly the same--11 and 10, respectively, in 2013 and 2014. There also were 41 foreign objects left behind during surgery in 2014, compared to 33 in 2013."

It seems as if some things are improving but some are worse. Don't we all hope that the Department of Public Health is right, that reporting incidents has improved and not that incidents have increased. BTW, Hospital errors are the third leading cause of death in the United States!

The Fat fight...PO Day 353

If you are awake in the night watching TV or just living in the USA, you have to be aware of how our society is obsessed with weight loss. I guesss it is because such a high percentage of us is overweight.

There are exercise programs and machines, food plans to control your caloric consumption, surgery to alter the digestive system, and drugs to limit appetite or change absorption. It's all iffy.

But now there is something new and more promising, something old actually. A plant used in ancient China to treat a variety of medical problems including inflammation and  fever is looking very promising. The thunder god vine (tripterygium wilfordii) produces an extract that, when tested on mice, resulted in an 80% reduction in food intake after just one week. After three weeks test mice lost 45% of their initial body weight.

The next step is to learn if it is safe and effective for people.

This just reinforces the idea that these old folk medicines have tremendous potential. The classic example is the "old woman of Shropshire" who treated local people with dropsy with leaves from the foxglove plant. "Real" medical doctors, who were not having much success with congestive heart failure (aka dropsy), beat a path to her door. Foxglove turned out to be the source of digitalis, still the pharmaceutical treatment for heart failure.

In error I filed post number 351 twice so to catch up this will be post 353.

Doctors as typists..PO Day 351

Charles Krauthammer, political commentator, author and medical doctor board certified in psychiatry,  writes in the Washington Post that America's doctors are "deeply demoralized" by the current medical  atmosphere. "Incessant interference" from insurers, lawyers and government is destroying any personal autonomy they have had in the practice of medicine.

The biggest complaint is with the EHR (electronic health record) which mandated that medical offices go paperless in January 2015. The result is that your doctor now spends more time per visit looking at and interacting with his computer, "scrolling, tapping and typing" than with you, the patient. One study found that emergency room doctors spend 44% of their time filling out forms, instead of taking care of the sick and injured. 

When we see our primary care doctor now we receive in the mail a summary of our visit a few days later. The interviewing nurse had to make our history fit the program so the details are almost always incorrect. The boxes to be checked do not include every possible complaint, remark or variant so the facts have to be fudged a little to a lot. By the time our chart reaches the doctor our physical complaints are reduced to check marks in boxes. There is no place for a narrative that previously revealed so much about the patient. There is no place for a physician who listens attentively and examines the patient thoroughly.

Dr. Krauthammer opines that the government rationale is that electronization worked for the banking 

industry so it should work for medicine as a business. So far it isn't.