Medicine and its related products and regulations

I have recently cared for two white men in their 60’s to 70’s in I.C.U. who  
have had very sudden onset of symptomology. Their courses were similar in that  
they were approximately the same age, race, and both had very noncompliant  
pulmonary systems. Their ventilatory pressures were in the 45cm range.  
TV=1000cc, FiO2=100%, IMV=24, and PEEP=6cm. Their SaO2 was about 72% on these  
settings. Regardless of the amount of suctioning, repositioning, or sloshing of  
these patients, I could not get their ABG’s much better than a pCO2=64 and a  
pO2=58. {Another interesting thing about these men was that they could not be  
sedated for very long at a time. They both required frequent high doses of  
vercuronin, morphine and diazepam with an increase in frequency as they  
approached the end of the course of their disease process. Incidentally, they  
both had the same physicians, and their open lung biopsies showed only "acute  
diffuse pneumonitis with thrombi."

     If anyone has had similar cases, please forward a message on this echo  
conference. Negative hx of cotton mills or gins, coal mines, fungal infections,  
or gases. The first gentleman was a lawyer who liked to garden and the other  
was a farmer. If they could have been exposed to the same pesticides I could  
draw a parallel, but the lists given to the M.D.’s had nothing in common. The  
autopsy reports were negative.

–  
Uucp: …{gatech,ames,rutgers}!ncar!asuvax!stjhmc!375!12!Ernest.Parker
Internet: Ernest.Par…@f12.n375.z1.fidonet.org

Links

• Amethyst Jewelry
• Fashion Jewelry
• Birthstone Jewelry
• Unique Man Ring

   A number of years ago, I got some mercury from school, and played around
with it – holding it in my hands, et al. I was very careful not to get any
of it in my mouth, and washed my hands after (I think). Would this cause
any problems? I only handled it for a few hours…

   I’ve not noticed any brain damage so far… (Even though some people
reckon I never had a brain!)

Re: Underweight…

   I’ve gotten some "Weight Gain" pills – which are made by
"Nutra-Life", and contain the following ingredients…

   Calcium Phosphate
   Freeze Dried Liver
   Whey Protein Concentrate
   Calcium Caseinate
   Skim Milk Powder
   Whey Powder
   Egg Albium
   Malted Milk Powder
   Brewers Yeast
   Torulla Yeast
   Ferrous Sulphate
   Pollen
   Thiamin
   Riboflavin
   Nicotinamide
   Pentothenic Acid
   Vitamin B6HC1
   Silica
   Magnesium Stearate
   Vitamin B12 (Cyanocobalamin)

   This seems like a bit of a weird combination, just for a "vitamin"
pill. There wouldnt be much protein in these quantities, so I am
wondering if one of the other contents improve metabolism, or
something like that… Any of these ingredients dangerous? Does this
product help any?

Steve!

–  
Uucp: …{gatech,ames,rutgers}!ncar!asuvax!stjhmc!3!681!853.1!Stephen.White
Internet: Stephen.Wh…@p1.f853.n681.z3.fidonet.org

I am a senior medical student at UTMB Galveston, and I am interested in doing a  
4 week externship in space medicine or space medicine research. I plan to call  
NASA and check the medical literature this week, but if there is anyone on this  
ECHO who is involved in or knows about this subject and can give me any leads,  
I would appreciate it.

———————–Don Elazar————————-

–  
Uucp: …{gatech,ames,rutgers}!ncar!asuvax!stjhmc!106!12!Don.Elazar
Internet: Don.Ela…@f12.n106.z1.fidonet.org

In a message to Boyd Ostroff <30 Jan 90 18:11:00> Gerard Rejskind wrote:

 GR>        I’m explosively allergic to cats, so I’ll be very interested in
 GR> any comments on treatment. My experience is that Seldane, which works
 GR> wonders for another allergy (grass, from mid-June to mid-July) does not
 GR> work against cats. Up to a point I can control the cat allergy with
 GR> phenylephrene hydrochloride drops, but if I lose control of it I can be
 GR> ill for days.

Gerard-
You might ask your physician to prescribe intranasal steroids (Brand
Names such as Beconase or Vancerase here in the states).  These work
very well with low toxicity.  Unfortunately, they are relatively
expensive and do _not_ treat acute attacks, but rather must be used
constantly, prophylactically.  I use beconase myself two-four times a
day depending on season of the year and exposure to allergens.  It works
wonderfully on the nose, but has _no_ effect on eye symptoms.

Regards,
Steven

–  
Uucp: …{gatech,ames,rutgers}!ncar!asuvax!stjhmc!273!905.999!Steven.Davidson
Internet: Steven.David…@p999.f905.n273.z1.fidonet.org

Is anyone here familiar with the case of the drug smuggler that was involved
in the plane crash and was discovered to be carrying several condoms of cocaine
in his intestine during surgery following the crash?

What are the current ethical beliefs of the M.D.’s on this echo and others  
that you work with in regard to informing the "authorities" about surgical
findings?

If you were the surgeon of record what would you have done in this case?

If you were the patient in this case how would you expect the surgeon to  
behave?  or other hospital personnel?

I don’t think there is a "right" answer but since I’ve not worked in emergency
surgery in years I’m curious as to how much change there has been in the way  
these issues are handled…

–  
Uucp: …{gatech,ames,rutgers}!ncar!asuvax!stjhmc!116!3000.1!Steve.Head
Internet: Steve.H…@p1.f3000.n116.z1.fidonet.org

I wonder if any of you have any experience with treating a hiatal hernia.
Since October I’ve been experiencing chronic indigestion and upper abdominal
pain.  I finally went to a Gastroenterologist in November and he diagnosed it
as Esophogeal Reflux Disease.  He prescribed medicatin (Pepcid 40 mg. daily)
and told me to stay away from alcohol, coffee, tea, chocolate, and fryed foods.
After being on the medication and being very careful with my diet for two weeks
I called the Doctor to let him know that my symptoms had not improved.  He
then decided to schedule me to have a gastro endoscopy.  I decided I didn’t
want to have that done and asked if an upper GI would be appropriate.  He
reluctantly agreed to prescribe an upper GI and an abdominal ultra sound.
The results were a hiatal hernia.  All else looked OK except that after not
having eaten for 14 hours before the test, the upper GI showed that there was
still food in my stomach.  The Doctor now seems very concerned about the fact
that my stomach is very slow to empty.  He now wants to do a gastic emptying
scan where you eat chicken livers treated with radio isotopes and then have
pictures taken every 15 minutes for 3 hours while you digest it.  I asked if
the medication could have slowed my digestive processes, or possibly stress
since I was very nervous when I had the upper GI, or possibly the fact that I
went to bed less than two hours after eating dinner the night before the upper
GI.  The Doctor says none of these factors have any influence on digestion.
I hate to go through any more tests unless it is absolutely necessary, and I
get the feeling that this doctor is test crazy (He did a blood workup on me
the first time I went to see him despite the fact that I had a complete blood
workup done less than two months before and I gave him the results of those
tests.)  The medication that he has precribed (Pepcid) does not seem to be
alleviating any of the indigestion or upper abdominal pain.  The Doctor also
now tells me that there must be some other problem since hiatal hernias do not
cause stomach pain.  Do any of you have any experience with hiatal hernias?
Any advice would be appreciated.  Thanks.  Marlene

In a message of <29 Jan 90 11:52:41>, Mike Bross (1:300/10) writes:

 MB>    I have read your posts with interest, and would appreciate your
 MB>comments on the question of whether elective surgery to prevent acute
 MB>glaucoma is worse than waiting until one eye suffers an attack.
 MB>    My wife has been examined by an opthalmologist each year for
 MB>three years because she has an acute iris-cornea angle (coded 1) in
 MB>each eye.  She has been told that she might have to deal with an
 MB>attack of acute-angle glaucoma at any time, but that since even laser
 MB>eye surgery has risks, it is best to wait and see if she ever really
 MB>needs the surgery.  We are wondering how risky elective iridotomy is,
 MB>compared to what can happen during the usual delay between onset of
 MB>symptoms and treatment.  And whether, if she flies across the country
 MB>without having had preventive treatment, it would be advisable for
 MB>her to have oral pressure-reducing medicine with her.
 MB>    Whatever comments you make about elective iridotomy (in the
 MB>absense of any acute-angle glaucoma attack) will be appreciated.
 MB>
 MB>    Mike Bross

This is something that can be argued about over coffee for hours and no  
solution will result.  In competent hands – laser should not pose a problem.  
Until (and if) she receives such treatment – yes, she should carry such  
medication.  The risk of such an attack is small but it’s higher than the risk  
from laser – in my opinion.

Leo Bores, M.D.

–  
Uucp: …{gatech,ames,rutgers}!ncar!asuvax!stjhmc!14!Leo.Bores
Internet: Leo.Bo…@f14.n114.z1.fidonet.org

How is traction (to treat bone fractures) being used in this instance?

A picture on page B1 of Friday’s New York Times has a caption
that begins "Leidi Cardenas, 8 years old, with both legs broken
and one in traction…" She is seen lying on her back, her right
leg in a cast that appears to go at least from the toes up to
the knee. A sheet obscures the rest of the leg, which is lying
flat on the bed. Her left leg, however, is suspended by a sling
around the calf such that the thigh is maintained in a vertical
position. Thigh and knee are =bare=, but there might be a cast on
the foot, though it’s difficult to see for sure. Calf is
obscured by the sling.

To the this layman, traction is usually associated with a cast,
so the photo rated a double-take. At the library, an orthopedic
dictionary, under the heading "Traction," identified, among
other types, "90-90" traction, used to treat "femoral
fractures," but was otherwise uninformative.

Actually, a series of questions:

1.  In early December, my orthopedic doctor sent his assistant (not a
doctor) to take his appointment with me.  The assistant is a sports
trainer, and when I questioned the seeming irregularity, he assured me
the doctor felt he was competent to take over this kind of visit
(progress report, approving refills on prescriptions,
modifying/continuing physical therapy).  I was billed for a normal
doctor visit.  Is this (a) normal and to be expected, (b) unprofessional
but tolerated, or (c) unprofessional and time to get another doctor?

2.  The assistant in the above case OK’d my starting biofeedback
training.  This had been suggested by another doctor (rheumatologist)
and kept cropping up in the literature I’d been reading on managing
chronic pain.  The orthopedic doctor and the assistant had both
commented on the high degree of muscle guarding in my back, and the
biofeedback technician (clinical psychologist with appropriate training
and license) confirmed that biofeedback has been used to help bring the
muscle guarding under conscious control to reduce the recurrence of
debilitating spasms.  The assistant asked what I needed from them, and I
passed on the info from the insurance company – "letter of medical
necessity" and so forth.  He said no problem, made several notes in his
notebook, and told me he’d get the letter right out.  I told him I would
be starting the biofeedback training right away.  Note:  he did NOT
say "I’ll have to run this by the doctor".  Question:  did his verbal
assurance, given his claim of being authorized by the doctor to take the
appointment with me, obligate him/them to give me this letter?

3.  The same doctor has not been returning my phone calls.  I have
called on average twice a week for the past two months, trying to find
out what happened to this letter I’ve never gotten, without a single
return call.  I even scheduled an appointment just so I could talk to
him, but got his associate instead (who knew nothing about my case
except what was in the chart, which he was reading as I spoke to him).
Is this (a) normal and to be expected, (b) unprofessional but
tolerated, (c) unprofessional behavior and time to get another doctor?

I am in the position of having around $800 of biofeedback bills that I
cannot submit to the insurance company, and still no letter from the
doctor!  I set up an appointment next week, and emphasized to the
nurse/receptionist that I wanted to see my doctor and not anybody else;
I also put the biofeedback training on hold until I could straighten
this out.  What more can I do?  And if (when I finally see the doctor)
he won’t give me this letter for some reason, do I have any recourse in
paying the $800 worth of bills for the biofeedback I started?

Andrea Frankel, Hewlett-Packard (San Diego Division) (619) 592-4664
        "wake now!  Discover that you are the song that the morning brings…"
______________________________________________________________________________
UUCP     : {hplabs|nosc|hpfcla|ucsd}!hp-sdd!andrea
Internet : and…@sdd.hp.com (or andrea%hp-…@nosc.mil or @ucsd.edu)
CSNET    : andrea%hp-…@hplabs.csnet
USnail   : 16399 W. Bernardo Drive, San Diego CA 92127-1899 USA

Well, the IBD mailing list is now a reality.  It should appear in the
next version of the list-of-lists which is posted on a regular basis.

The IBD mailing list deals with topics related to IBD (Inflammatory
Bowel Diseases).  These include Crohn’s disease and Ulcerative Colitis.

Administrative items including requests to join the list should be
sent to IBDlist-requ…@mvac23.uucp (IBDlist-request%mva…@udel.edu).

Items for the list itself should be sent to IBDl…@mvac23.uucp
(IBDlist%mva…@udel.edu).
                         - tom
—
internet     : mvac23!tho…@udel.edu  or  thomas%mva…@udel.edu
uucp         : {ucbvax,mcvax,psuvax1,uunet}!udel!mvac23!thomas
Europe Bitnet: THOMAS1@GRATHUN1
Location: Newark, DE, USA                          
Quote   : Virtual Address eXtension.  Is that like a 9-digit zip code?

–
The UUCP Mailer