sanguinemare

October 8, 2015

Antibacterial Soap is not Better than Regular Soap… and learning from death

So, fun fact of the day: according to our MSTP seminar speaker tonight, apparently the FDA agrees that “antibacterial” soap is not any more effective at preventing disease transmission than regular soap, assuming both are used to wash hands properly!  Did not know that.  And to back that up, here’s an article straight off the FDA site that speaks about that, from 2013.

He also described a painful experience he had had as a clinician, where he did a procedure on a patient, and that patient ended up dying, even though he had done everything technically right.  This, in itself, was one of his lessons – that you can be technically right, but mess up intellectually.  Because, as it turns out, after that, they did a retrospective study, and apparently that patient was at high risk for bleeding out after that procedure, as they’d had a bone marrow transplant before that.  That wasn’t known at the time, but it cost that patient their life.  There are two lessons I learned from this:

The first, which is rather scary and sobering, is that as a doctor, we’re all going to make mistakes at some point.  Mistakes that may even cost people their lives.  And some of them, like the case here, won’t really be our “fault”, in the sense that it wasn’t anything that could be prevented at the time due to lack of knowledge, but in hindsight, for whatever reason – new research coming out, a new technique our clinic/hospital was not aware of, etc… we’ll realize that our decision at that point in time was what directly or indirectly, caused harm to the patient.  To be quite honest, that scares me quite a lot.  I don’t know if I can handle that. I think that would tear me apart from the inside.  And yet… if no one makes those decisions… even more people may come to harm.  It’s a tough job.  I guess time will tell.  I just pray that over the course of my career, I will be fortunate enough not to do anything so bad that it costs a life or cripples someone the rest of their time on earth.

The 2nd is that even in one’s darkest moments/worst mistakes, something good can come of it.  In this case, research that probably has saved at least a few lives since.  He recognized that maybe there was something about this patient that made them susceptible to the procedure, even though he did nothing wrong, and they went back and looked at records and realized this predisposition, and published a paper on it.  So now, anyone encountering this type of patient before this procedure will know that it is a high risk thing to do in these people, so they may be much more cautious about ordering that test to be done.  So even when making mistakes, analyzing it and building off of it may lead to research that helps others in the future.  And I guess that’s how we have to look at it, in order to keep moving forward, lest we crumble from the guilt and sadness of those we were unable to help.

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September 22, 2013

Crossfitters, beware

Filed under: Med School and the MSTP — sanguinemare @ 10:03 am
Tags: , , , , ,

Here is a great post about the dangers of overexercising, and of Crossfit in particular.  There is too much of a good thing.  This got on my radar from another medical student in my school’s facebook post, and while it’s not surprising that this happens from a physiological standpoint, I was surprised that this otherwise rare condition was so common in the Crossfit culture that the first thing a trainer would ask when hearing about someone being hospitalized was “is it rhabdo”?

A statement could be made about the fact that if trainers know about it, I certainly hope they would inform their trainees about the importance of proper rest and how to recognize when they’ve reached their limit, and if the issue is that not  all trainers know about it, then I think there is definitely a problem.  However, the only thing I can do is repost the blog post and hopefully inform both trainers and trainees alike not to let the culture of Crossfit (and other similar programs) drive one to the point of rhabdomyolysis – basically where your muscle breaks down from too much abuse and the resultant spill of proteins and contents (especially myoglobin) overwhelms your kidneys and it is potentially fatal.  Yes, fatal.

So if you notice that suddenly your muscles are suddenly weak and useless, or have suddenly swollen a day or so after a workout and are no longer the ripped, lean muscle that it was, please go to a doctor and tell them you’ve been training hard.  Better yet, don’t even get to that stage – make sure you protect yourself and rest when you need to, despite what you or anyone else might think of you.  Take care.

December 5, 2011

Interesting reads

Haven’t had much time to update lately, but here are some (semi-) medically relevant links that I’ve read fairly recently that I thought were interesting.

1.  Apparently, some people are working on growing meat from cells (called “invitro meat”) through bioreactors.  It’s an interesting concept, and would eliminate the need to kill animals for food.  I wonder if vegans are vegetarians who are currently on their respective diets because they are against cruelty to/killing of animals would be fine eating this kind of meat.  At any rate, it is much better than the Japanese poop burger solution to this problem (and this one is actually real, at least as far as I can tell :P)

2.   We’re currently studying microbiology in med school for these next couple of weeks, so this article on an antiviral therapy fits right up our alley.  As a general rule, there are lots of treatments for bacterial infections through antibiotics, but there aren’t very many that target viruses effectively, and those that do only target a specific virus, or have many bad side effects.  However, these scientists seem to have created something called a “Double-stranded RNA (dsRNA) Activated Caspase Oligomerizer” (DRACO), which basically only targets cells with viral dsRNA and causes them to undergo apoptosis (programmed cell death).  They’ve shown that it’s effective in 15 different viruses and that it does not harm normal, uninfected cells.  Pretty exciting.  I would like to see them apply this to more chronic, life-threatening viruses as well in the future though, such as HIV, hepatitis A-C, etc.  But it’s definitely a hopeful start.

3. Teaching Good Sex – This article was about a high school sex ed teacher that came up with innovative activities and ideas for his students, encouraging discussion and challenging his students to think deeper about the questions at stake.  While I’m not advocating for premartial sex by any means, I think the style of teaching is a great one – to give students a place where they feel comfortable asking hard questions and examine their own feelings, insecurities, and plain curiosities, in a safe environment.  Much better to be frank about it rather than to hide things under a corner and hope things don’t happen.  And I like how the class is a balance – it’s neither the idea of “abstinence is the only way,” nor is it the resigned attitude of “let’s talk about/pass out condoms so you guys can do it safely, since you’ll be doing it anyway.” Rather, it is a medium through which better understanding can be made.  Honestly, I think once questions and concepts are demystified and can be seen more analytically (and appreciated for its wonder), people are much more likely to make informed decisions, and less likely to do things out of (presumed) peer pressure or curiosity.  That’s my opinion on almost anything by the way, not just this topic.

4. Finally, here is a more somber article (but a great read!) one of my classmates posted on our class Facebook page (don’t get intimidated by the length of the sidebar – most of it is due to comments).  It’s an interesting commentary on how when doctors have to make life or death choices for themselves, they often choose the route with the least medical interference and go peacefully.  This is because they “know enough about modern medicine to know its limits…They want to be sure, when the time comes, that no heroic measures will happen—that they will never experience, during their last moments on earth, someone breaking their ribs in an attempt to resuscitate them with CPR (that’s what happens if CPR is done right).”  The rest of the article also addresses this discrepancy between what patients think they want, versus what is reasonable and what the doctors would advise.  There is so much hidden pressure and confusion in the system we currently have ingrained in us that contribute to the tragedies in medical care happening all the time.  We are so caught up in the idea of prolonging life, doing “everything possible” to save someone, but how do we know it would not cause undue and prolonged suffering instead?  Because of this mentality, most people don’t even realize there’s another choice.  The author mentions how “[A]mazingly, studies have found that people placed in hospice care often live longer than people with the same disease who are seeking active cures.”  Death that is pain free and with dignity.  How lovely.  I am a first year medical student, and already, if I am ever confronted with a terminal condition, I am leaning towards the choice of letting go (medically) and enjoying my last days in peace.

Happy reading!

July 29, 2011

Day 4 – “In Search of a Good Death”

Filed under: Med School and the MSTP — sanguinemare @ 12:20 am
Tags: , ,

Today’s topics covered: the US health care system, the Hippocratic Oath vs. the Physician’s Charter, the (social) history of disease, and death and dying.   My focus today will be on the last one, the title of which I have borrowed for the title of this post.

In this class, the professor wanted us to participate in an exercise/focus group.  He gave us 10 minutes to think about someone we’d known who has passed away, and say what was/would make the circumstances surrounding the death good or bad.  Here were some things that were shared today:

Good:

  • Someone’s grandpa died when they were a teen due to a heart attack.  The good things were that it was quick and at home where he was in a familiar place with family around.
  • Able to make peace with God/family, etc before death
  • Someone’s grandma stayed in a hospice her last days, which helped take off a lot of pressure and stress for the family.
  • Having an honorable/respectable death (ie army)
  • Knowing that you’re leaving a legacy, or that you accomplished something

Bad:

  •  The doctor tried really hard to keep someone’s family member alive longer, which could be good, but they were in pain for a long time, which was really tough.
  • Dying at a young age
  • Having dementia (Alzheimer’s) before death – being “gone” before death
  • Being along at the end of your life
  • Dying unexpectedly.  One example related to this was having a false expectation of how long the patient would live due to what the doctor said.  The doctor had said they’d live for 6 months to a year, and the patient died within 4 months.  Another person’s friend’s dad got shot in the head.  Very unexpected and traumatizing.
  • Death due to overmedication – the patient was given too much medicine and lost awareness/recognition of people during their last days, which shortened the amount of time the family could spend time with them.
  • Someone’s grandpa is currently declining, and they are having to deal with a lot of  unexpected medical bills
  • Feeling like you are being a burden on the family
  • Dying and leaving behind bickering siblings over inheritance
  • Not knowing what the deceased family member wanted done after death
  • One person had a bad experience with the doctor being very bad at informing the family about the death.
  • Taking your own life.  One person’s grandpa basically did that by not eating (through tubes) because that was the only thing he could control.

I was pretty surprised so many people shared their experiences.  And that there was so many people who have had to deal with death personally.  After the first couple of people, the examples just rolled right after another for the whole 10 minutes.  That probably would not have happened in my undergrad courses – people didn’t care about the classes that much to participate.  This is something I’ve noticed about medical school, at least so far.  People actually pay attention in class and are invested in it.  They participate.  (They also come to class like 30min early and stuff, which is kind of crazy, but oh well).  Returning to the topic on hand…

The people who used the focus-group method in a study came up with 6 “themes” on what makes a death “good”/”bad”:

1. Pain and symptom management – self-evident, but not always done well
2. Clear decision-making – dependent on having had prior discussions with the family/medical team about what to do in case of death.  Communication is key)
3. Preparation for death –  communication of the trajectory of illness, the potential options of treatment/location of care, ideally done with interdisciplinary teams.
4. Completion – having the “individual life review” and gaining closure.
5. Contribution to Others – a purpose to life
6. Affirmation of the whole person

Interestingly enough, a study showed that physicians apparently have a difficult time coming up with all the themes during a similar kind of focus-group setting.  Our professor was actually impressed at how “theme-rich”  we were (as vs. “theme-poor” like the physicians,) especially given how short a time we had.  He said he’d always wanted to do this experiment, because he wondered if physicians were theme-poor because medical school selects for people who tend to be that way, or if it is somehow squeezed out of people during the process of medical school (which would not be encouraging if it were true – it would imply/affirm that jadedness is an inevitable result of medical school).  I guess we at least proved that our class was not selected for theme-poor people during admissions, haha.

Death and dying, as mentioned yesterday, is not something that is often thought about at our age.  We tend to think it’s something far off in the future, and barring the few accidents that may cost a peer their lives or the passing of grandparents, the concept is nebulous, at best.  But as doctors, this will be something that is important to consider.  How to deal with the patient who has just been told about their potentially shortened life, how to come to grips with it yourself, how to approach the situation and what treatment to give.  Is quality of life more important, or is prolonging life, even if it might cause more pain?  “Suffering occurs when the intactness of being is threatened.”  People may thus be suffering, even in the absence of pain. How do you help ease the situation, and what preparation needs to be done so that in the event of death, everyone will know what to do?  How do you break the news to the family?

While on the subject of death and dying, I’ve been hearing a song on the radio a lot since I’ve gotten here (not unusual, considering this radio station plays like 5 songs on repeat).  It’s called If I Die Young, by The Band Perry.  The bridge always gets me thinking:

A penny for my thoughts, oh no
I’ll sell them for a dollar
They’re worth so much more
After I’m a goner
And maybe then you’ll hear the words  I been singin’
Funny when you’re dead how people start listenin’…

It’s pretty sad how true this is in modern society.  I just read an article this afternoon about a young girl named Rachel who was trying to raise $300 by her 9th birthday to donate to an organization to bring clean water to developing nations.  She was $80 short of her goal, but a terrible vehicle accident caused her to be seriously injured, and proved fatal.  After people heard about the accident, thousands of donations poured in, and many laud her selflessness.  But why did so few people respond to her heartfelt call when she was still alive and well?  Why do we go about our lives taking so many things for granted, thinking “oh, we can do that later, talk to that person later?”

We need to start appreciating each other more, appreciating life.  Let’s start listening now.

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