b.cognosco

Where leaping to conclusions is my primary form of forward motion.

Most Popular

Book Reviews

Recently

Tuesday, May 15, 2007

Why You Need To Be As Smart As Your Doctor

Posted by:  Terry Frazier at 2:38 PM  | Permanent Link  | Trackback URL | 
Categories: Health, Health and Fitness, Technology

Wednesday, May 9, 2007

Why Your Doctor Should Read Wired Magazine

I’m often complaining about doctors, the archaic practices of med school, and healthcare in general. But some doctors actually get past the drudgery and pain of spending half their waking hours dealing with dysfunctional bureaucracy with enough imagination intact to actually keep getting better at what they do.  How do you know if your doctor has imagination and energy for growth? Maybe they read Wired magazine, or even have a blog like Clark Venable. The sad thing is this stands out because it is so rare.

I'm a Better Anesthesiologist Today Than A Year Ago

At the end of this busy week I began to reflect on how this week was different than an average week would have been even a year ago.  It was different both for me and for a significant number of my patients.  Hopefully, it was as good for patients as it was for me.

For the first ten years after I finished my training I did not believe nerve blocks for extremity surgery were worth doing.  Surgeons didn't want to wait for me to do them or for the blocks to 'set up.'  Blocks failed a certain amount  of the time. There were complications that just didn't happen when 'numbing the big nerve.'

My thoughts on all this changed, not because of a journal article or discussions with a colleague, but because of an article in Wired magazine.  The Painful Truth was an article on the use of regional anesthesia to improve medical care to our wounded soldiers in Iraq and Afghanistan:

Now Buckenmaier is leading a group of army doctors and nurses determined, as he puts it, "to drag the military kicking and screaming into the 21st century." His team believes the future of wartime pain control is a new form of anesthesia called a continuous peripheral nerve block, which takes a more targeted approach by switching off only the pain signals coming from the injured limb, leaving patients' vital signs and cortical functions unimpaired.

The applicability to civilian anesthesia was obvious.  In my hospital, when someone gets a knee replaced, the surgeon usually blindly injects a large amount of local anesthetic in the general vicinity of the femoral nerve and we dope them up with morphine.  Patients are in the hospital for three days largely for pain control issues, all the while at risk for nausea, vomiting, respiratory depression, etc.

I took a second look at regional anesthesia and decided to use it in my practice again.  This week two elderly ladies had total shoulder replacements after having interscalene blocks. They were pain free for the rest of that day.  Six of my patients had knee replacements after femoral and sciatic blocks.  They had no pain until the next morning.

With catheter techniques, these pain-free intervals will be measured in days instead of hours.  The surgeons are giving us the time to do these techniques because they are hearing about how good they are for patients at their own national meetings.  My colleagues who 'didn't do blocks' have learned to do simple femoral nerve blocks and want to learn others.

It was a good week for me because I love seeing patients do well. It was a good week for my patients (whether they knew it or not) because they trusted me enough to let me poke them with a needle once or twice to make their recovery that much easier.  By next year I hope to be placing catheters and doing infusions.  Thanks, Trip Buckenmaier.

Posted by:  Terry Frazier at 10:39 PM  | Permanent Link  | Trackback URL | 
Categories: Health and Fitness

Monday, April 30, 2007

New Prostate Cancer Test Show Promise

"We've been able to show that blood levels of it are low in normal individuals and high in prostate cancer, and that it distinguishes between cancers that are confined to the prostate and those that have spread outside the gland," explained study lead researcher Dr. Robert H. Getzenberg, professor of urology and director of research at Johns Hopkins University's James Buchanan Brady Urological Institute, in Baltimore.

His team published its findings in the May issue of Urology.

[...]

Spotting especially life-threatening prostate tumors is "the holy grail" of diagnosis, he said. Current PSA testing cannot distinguish between cancers that will grow so slowly that they pose no danger to life and those that require quick action. The hope is that the ECPA-2 test will identify men whose slow-growing cancers make them candidates for "watchful waiting" rather than immediate surgery or other treatment.

Posted by:  Terry Frazier at 10:40 AM  | Permanent Link  | Trackback URL | 
Categories: Health and Fitness

Syndication

Contact

 

Presence

 

 
 ICQ

 

 

 

www.flickr.com More of GratefulZed's photos

This Page was last updated: Wed, 02 Jul 2008 22:06:57 GMT