Medical Practice

A Toolkit for Cancer Patients

Massachusetts Senator Ted Kennedy’s recently-diagnosed brain cancer has resulted in a flurry of coverage, not only of his personal situation, but of medically-related issues as well.

Among the most helpful is this article from CNN. Senator Kennedy is in a position to acquire the best medical care possible; most of the rest of us must rely on lesser resources. Reporter Elizabeth Cohen has provided a great blueprint for acquiring the best level of care possible.

Post-cancer diagnosis steps outlined in the CNN article include:

1. Get basic information about your cancer
2. Pick a doctor
3. Learn how to read your lab reports
4. Find alternative medicine for cancer
5. Find support groups
6. Find clinical trials
7. Figure out how to pay for all this

The article argues, quite wisely, I think, for following these steps in this order. It’s full of helpful links and well worth checking out.

Above all, every patient, whether a Kennedy or Jane or John Doe, must accept and remember that there is only one person capable of ensuring quality health care for him- or herself. That person is you, the patient. Illness is one of those times in life when knowledge really is power.

High Tech Medical Practice Reflections

First Partial Face Transplant – 2 Year Follow-Up

isdin6.jpegIn November 2005, Isabelle Dinoire, a 38-year-old woman whose face was mauled by her dog, received an historic face transplant at the Centre Hospitalier Universitaire d’Amiens in France. Two years later, her doctors have published a follow-up study of her case in the New England Journal of Medicine.

According to the NEJM article, Mlle. Dinoire “the patient is very satisfied with the results of the transplant”. She is able to eat, drink, and speak normally; it is said that, with make-up, her surgical scars are no longer evident. The results do appear to be remarkable:


The picture on the left is NOT a post-transplant image; it’s from 2001, four years before the face transplant, when Mlle. Dinoire was 34 years old. The middle picture is from November, 2006, one year post-transplant. The right picture is of Mlle. Dinoire in June, 2007, eighteen months post-transplant, showing her natural face, without make-up.

isdin-chart.jpegThe post-surgical journey has been difficult. Mlle. Dinoire has suffered several bouts of rejection and one of kidney failure. She has battled infections; she must, of course, take immune-suppresents for the rest of her life. The return of functional abilities has exceeded expectations, though. This chart (left), from the New England Journal of Medicine, tracks the changes throughout the first six months; her abilities now far exceed those noted here.

isdinpostop.jpegMlle. Dinoire’s case is controversial for many reasons. One of her doctors initially reported that she had attempted suicide; Mlle. Dinoire herself confirmed this in an interview with a London newspaper. Her injuries occurred when her dog was trying to rouse her from unconsciousness following the drug overdose. (Her donor did commit suicide, adding another layer of emotional complexity to the case.)

Mlle. Dinoire, a single mother, has a history of depression, and had been unemployed for a year prior to the incident. Criticism has been leveled at her doctors, who, some feel, may have chosen a particularly vulnerable patient for this historic operation.

Long-term, the physical problems alone may prove overwhelming. Notes The Washington Post:

Maria Siemionow, director of plastic surgery research and training at the Cleveland Clinic, which has been planning to do face transplants, expressed concern about Dinoire’s “unexpectedly aggressive immune response.” Scientists need better ways to prevent rejection of large, complex tissues such as faces, she said.

Siemionow, along with others, also expresses concern about the psychological implications; no psychological study has been published in connection with Mlle. Dinoire’s treatment.

isdin-doc.jpgBritish filmmaker Michael Hughes has made a documentary of the surgery; Mlle. Dinoire allegedly signed a deal for movie rights to her story earlier this year, netting (according to one account) over $400,000 (USD). The Hughes documentary is reviewed here (in French).

Whether Mlle. Dinoire’s pioneering venture will prove worthwhile over time remains to be seen. The potential scope of this experiment is breathtaking, yet it cannot help but recall the innocence and irony of Miranda’s words in Shakespeare’s Tempest:

O brave new world
That has such people in’t!


The Tin Noses Shop

The Origins of Plastic Surgery

Medical Practice

The Origins of Plastic Surgery

trench.jpgFew people alive today (at least in the USA) fully understand what the phrase ‘in the trenches’ meant during World War I. This photo, from an upcoming exhibit at the National Army Museum in Chelsea, UK, illustrates the vulnerability of the soldiers who fought in that terrible war. Deep earthen walls protected bodies, but left heads and faces unprotected, resulting in deadly and disfiguring injuries.

before.jpgNew Zealand surgeon Harold Gillies, sent to France in 1915, radically changed the previous approach to these injuries, which had involved little more than stitching up the wounds. While treating his patients, Gillies developed techniques which ushered in the modern era of plastic surgery: drawing flaps of healthy skin into tubes to grow more skin for grafting; using bone and cartilage to provide structure under the skin; instituting grafting procedures that involved stages rather than one massive graft.

“We remember the dead, but we don’t remember the wounded, the people who had to go on living,” exhibition co-curator Samantha Doty says.

after.jpgThe NAM exhibit features previously unseen images of these literally faceless men, and documents Gillies’ work. For these soldiers, appearance was far more than a matter of self-regard, or of vanity. The crudity of previous methods of treating these injuries not only resulted in death, but created such severe disfigurements in survivors that the ‘cure’ actually caused disabilities. Gillies’ field work, though not always as successful as shown in these pictures of William Spreckley, changed the way these injuries were treated forever.

Faces of Battle opens on November 10; the BBC online has a series of images from the exhibit.

Via: medGadget

Related: The Tin Noses Shop

At Home DIY Everyday Gear Medical Practice

Make A Medical Record Book, Part 3 – Tips and Tricks

In Make a Medical Record Book, Part 1, I described the parts of a medical record book, and in Make a Medical Record Book, Part 2, how to use it at a medical office. Here are some additional tips and tricks for making your medical notebook as useful as possible.

At Home DIY Everyday Gear Medical Practice

Make A Medical Record Book, Part 2 – How to Use It

In a previous post, I described the components of the medical notebooks I use for my dad and family. The notebook comes along on every medical appointment, and this is how I use it.

Before each appointment, I fill out a form I made on my computer and printed up in advance. It’s my Medical Appointment Record form, which goes in Section 2. I’ve typed in cues on the page (date, doctor’s name, current symptoms, any questions or concerns). Before we go, I fill in the blanks. This ensures that we have a clear idea of what we want to know and that we’re organized and able to use the appointment time effectively.

At Home DIY Everyday Gear Medical Practice

Make a Medical Record Book, Part 1 – Putting It Together

Life got a lot simpler for us when I made a medical notebook for my dad. His interest in accurately reporting relevant events and symptoms at any given medical appointment has always been minimal, and some days I was just too frazzled to rely on my own already overclocked brain.

An inexpensive three-ring binder from an office supply store made it much easier to keep information flowing and doctor visits productive. After I made Dad’s, I went home and made one for each member of my family.

Medical Practice

Bristol Stool Form Scale

Image of the NHS Bristol Stool Form ScaleThis post is about excrement. Yes, I’m afraid you read that right. Those readers who are surfing while dining, who are suddenly feeling faint of heart, or who are simply disinterested are hereby excused, and invited to scroll down to less scatological posts. The rest of us will explore the uses of the Bristol Stool Form Scale.

Medical Practice

Prosthetics in the Real (British) World

Sally Young, a Blogger from the UK, has written a self-described “rant” about prosthetics. Sally lost a leg to cancer in 2005, and writes about the changes and events of her life since. Her real-life post about her own experience acquiring a prosthetic through the NHS (British National Health Service) is an interesting counterpoint to my post about high-tech comesis (specifically, silicone coverings for prosthetics) like the one used by Heather Mills. Sally’s Blog is called Out on a Limb: Life After Cancer; her article’s called Grrrr.

Medical Practice

Conceiving a Baby – Fertility in Men with Spinal Cord Injuries

A Stethoscope on a TableI’m old enough to remember the good old days when doctors knew everything, and were mightily insulted if anyone suggested otherwise. I’m smart enough now to recognize that medicine has changed plenty since then, and that it’s patients who had better know as much as possible about their own medical needs. No way a modern doctor will, or can, bring the same focus to your situation that you can and must.

Medical Practice Wheelchairs

Rant — “You Ain’t No ‘Count to Me”

So, Medicare has denied my dad’s claim for a powerchair. They need to know whether it’s a sale or a rental. The supplier of the powerchair, which was delivered and PAID FOR last July, apparently failed to mention this when they submitted the claim (two months later).