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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:

isdintriple.jpeg

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!

Related:

The Tin Noses Shop

The Origins of Plastic Surgery

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Reflections Uncategorized

Back for Real

My dad has had his ups and downs over the past month or so, but his situation is stable for now, and (not incidentally) so is mine. GearAbility is back!

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Reflections

Update

My dad has made it through this crisis and is back at his nursing home. He’s been warmly welcomed by the staff, who are working hard to keep his recovery on track.

New posts won’t appear for another week or so while we all re-group and see how things go.

Thank you, everyone, for your kind thoughts and comments.

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Reflections

Hiatus

GearAbility is on hiatus for the time being, owing to serious medical problems my dad is experiencing. Posts will return as soon as feasible.

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Reflections

The Tin Noses Shop

Images of a WWI Soldier with a Facial Disfigurement and with a Facial ProsthesisSmithsonian Magazine’s February 2007 issue has a fascinating article called Faces of War which discusses methods of dealing with the devastating facial disfigurements suffered by soldiers who fought in World War I, and the medical personnel and artists who first pursued ‘modern’ facial prosthetic techniques.

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Reflections

Cats, Comfort and Death

Image of Grey and White Oscar the CatSeveral stories illustrating the empathetic nature of cats have been making the media rounds this past week. The story of Oscar, written up in the venerable New England Journal of Medicine and reported by medGadget is one of the most compelling. Oscar, a two-year-old, lives in a nursing home and makes it his business to comfort residents during their last hours of life.

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Reflections

Indidental Death in a Jail Cell

NOTE: The link in this story may not be work-safe, as it will take you to the website for NORML, the National Organization for Reform of Marijuana Laws.

In October, 2004, a 27-year-old man named Jonathan Magbie died in a Washington, D.C. jail while serving a ten day sentence for marijuana possession. From NORML’s site:

Magbie was sentenced to spend ten days in jail on September 20, 2004 after pleading guilty to one charge of marijuana possession. Though prosecutors had recommended probation, the judge in the case ordered Magbie to serve jail time – noting that the defendant had told pre-sentence investigators that he would continue using marijuana because it made him feel better.

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Reflections

Dementia

I was shocked when, for the first time, a medical professional used “dementia” as a clinical diagnosis when discussing my dad. I’d seen all the signs, but, even so, “dementia” meant raving to me, and I thought I knew the difference. I had seen Dad hallucinating, in the past, after various surgeries, when he was still under the influence of anesthesia. That was dementia. The mental blips, the careless actions cited by the therapist were . . . what? Forgetfulness? Inattention? Willful disinterest? They could be anything, I thought, but surely not dementia.

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Reflections

Love and Death

Caring for my dad has been much more difficult recently because we’ve been facing some of the same emotional issues with our animals.

Last month, my spouse and I lost, to death, a cat we’d rescued only a year and a half earlier. Suzume had been only a day or two from death when our daughter saw her in our yard; she was starving and almost unable to walk. She weighed six pounds then; she was skeletal, her skin like leather in all the many places where fur was missing.

Within a few months she was up to thirteen pounds, a different cat entirely; the sweetest and most purely loving one we have ever owned. For nearly a year she did well, and then began losing weight: It was clear that she was far older than the vet had originally thought. Cared-for, well-fed, and well-loved, she was dying of old age.

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Nursing Home Reflections

Therapeutic Recreation For Those Who Will Not Play

Image of Interlocked HandsMy dad is gradually recovering from his recent hospital stay, and the recreation department at his nursing home and I are once again frantically trying to figure out what we can do to keep him engaged both in social activities and in anything that will keep him using, in particular, his hands and his mind in ways he’s not used to.