In yesterday’s edition of the WSJ, Jonathan Kellerman, a noted author and clinical psychologist wrote an opinion piece entitled the “Health Insurance Mafia.”

I thought this article was somewhat simplistic but all the same interesting because it shows a way out of the Healthcare mess. It points to the fact that the route out of all this might be through Health Savings Accounts.

Please click here to read this article.

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It’s been a while since I posted. However, it is better late than never so, here we go. I shot this interesting clip in the OR of the heart fibrillating.

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A 66-year-old is 6 years out from a heart transplant. He presents with endocarditis of the aortic valve with fistulae into the right atrium and the pulmonary artery. He has an abscess around the aortic valve. He also is in renal failure neccesitating hemodialysis and has mental status changes. The patient is taken to the operating room where after several hours later, attempts to replace the aortic valve and ascending aorta fail. He passes.

A 23-year-old with a history of meningomyelocele, who is s/p VP-shunt placement shows up in the ER due to malfunctioning of the shunt. It has apparently stopped draining. At presentation, the patient was unresponsive and was in pulmonary edema. Prior to arriving in the OR for revision of the shunt, the patient arrested and was successfully resuscitated. She is however now posturing. Even after placing a drain to relieve the pressure, the mental status does not change. The family insists on everything being done. The medical staff obliges. Vasopressors, nitric oxide, the works. Four days later, with no improvement in sight, care is withdrawn.

All across the US, healthcare dollars are being spent on cases that are best described as futile. There is the ‘the-doctor-saved-the-day” attitude that forbids physicians from seeing the reality of the situation. Then also is the fear of legal action. Physicians are not willing to give patients and their families an honest and frank opinion. Whatever it is, we cannot afford to keep spending money that way. We either start policing ourselves or Universal Helathcare is going to force us to rethink our ways.

I have used activated Factor VIIa (Novoseven) off-label about ten times since 2002 and each time I am amazed at how effective it is in stopping intractable bleeding after prolonged cardiopulmonary bypass.

The drug was approved for use in Hemophiliacs but it has found use off-label as a great hemostatic agent. Maybe the FDA should consider it’s use outside hemophiliacs.

There is data out there showing  small but possible risk for thrombembolism. Also, it seems to work better if used early in the bleeding episode.

jnkdg

I have always been very impressed by the strength of people with deep religious beliefs - my dad, Tony Dungy, Joe Gibbs etc. There are those who don’t see the place of religion in medicine and they have a point. A physician needs to be objective in managing a sick patient.

Patients on the other hand seem to benefit from  strong faith. One may argue that it makes them accept whatever come their way without question. Somehow, this argument makes such patients seem infantile. I argue that the opposite is true. The deeply religious patient is extremely confident and very helpful in decision-making. They sometimes push physicians to consider aspects of the case that may seem esoteric.

Jen is 20-years-old. At age 15, she was diagnosed with Hodgkins Lymphoma. With chemotherapy, the disease went into remission. She married when she was 20 and a year later, they had a wonderful baby girl. She was also diagnosed 6 months later with Acute Myeloid Leukemia. I met her when we gave her anesthesia for several procedures. She is the nicest person with a great husband.

On one of the walls in her room, she had several posters with Bible verses on them. One poster though really stuck with me. It was handwritten and a picture of it is below:

In spite of all she has and is going through, there was a sense of hope and confidence about her that was just extraordinary. Her level of maturity was noteworthy.

Does faith and medicine work together? In this case, I sure hope it does.