26 October 2008

Time for an FDA recall alert

Well, I suppose that with this sort of thing, you just have to try it out for a few years, and see what happens.

There has been a worldwide (of course) recall on the HeartMate II Left Ventricular Assist System, which have been in use since November of 2003. The failure rate has been deemed unacceptable. Apparently the leads that connect the pump to the controller wear down significantly enough to affect pump function. "The estimated probability of the need for pump replacement due to percutaneous lead damage is 1.3% at 12 months, 6.5% at 24 months and 11.4% at 36 months." (as per the FDA site) THAT is significant!!

Left ventricular assist devices are essentially used to buy time for "CHFers" (Congestive Heart Failure patients) who are awaiting transplant, or they may even be used indefinitely in patients who are not candidates for transplant.

11 October 2008

(Not So) French Toast

Those of you that have looked at the recipes here before have probably realized: I am not much of a sweets person. I am much more of a savory eater, and therefore, a savory cook. So, I guess it should not come as too much of a surprise that this morning's breakfast was what is commonly known as a sweet food, turned not-so-sweet.

Best served with some grilled sausages (you can use veggie sausages, if you prefer), this makes for a really quick, simple breakfast. By the way, the way I prepared the sausages:

slice up an onion and let the slices cook in a pan over a low flame for a good 10 minutes or so in a small amount of olive oil
add a healthy splash of balsamic vinegar
add the sausages in slices and let that cook over a (really) low flame until the sausages are browned

On to the bread...

You need:
3 eggs
1C milk (I used 2%, but anything, including soy, would be fine)
bread (4-5 large slices or 9-10 small)
healthy pinch of salt
1t marjoram
1t sweet savory

(I used dried herbs, as my Aerogarden has not yet produced its crop. By all means, if you have fresh, use them... and feel free to play around with other herbs.)

You do:
1. In a rather shallow bowl, beat together eggs and milk. Add salt and herbs; beat some more.
2. Start heating up a skillet over a low-medium flame. I used a le Crueset grill, to make everything pretty, but any skillet will do. Don't forget to coat with olive oil or non-stick spray. Alternatively, you can bake these--see below.*
3. Throw the slices of bread into the mixture and let soak--at least 1 minute/side.
4. Once the bread is saturated, and the grill is hot, place the slices on the grill so that they do not touch one-another. Cook until browned on both sides.
5. If you have more than one batch, they will keep warm in an oven at 250F.

Voila--not so French, but very nice.

*Now, for baking:
1. Preheat an oven to 425F.
perform steps 1 and 3 above
2. Prepare a baking sheet with non-stick spray.
3. Place the bread slices on the sheet so that they do not touch one another, and place into the preheated oven for 6 minutes or so.
4. Flip the slices and place back into the oven for an additional 5-6 minutes.

That is all. Very simple, quick, and tasty.


08 October 2008

Never, not once. until yesteday

I am not proud. I am, in fact, rather ashamed. But the other emotions I feel are anger, distaste, and, quite frankly, dread.

I took the gentleman from this post to the OR last week... last Monday, to be exact. He was a mess. I have never seen anything like it. A grown man, mid-40s, strong (as far as looks--very muscular, fit), handsome, even... quivering uncontrollably at the sight of an IV needle. No joke. It took 5 of us to hold him down, after a lot of begging and bargaining, that is, to sssslide that little 20 into one of the hoses on his arm.

The surgery itself? I was so happy. I took off the distal phalanx routinely, looked at the middle phalanx--SOLID. No signs of infection. Surrounding skin? Healthy. Beautiful. The closure? I gotta tell you, I was so conscious of this man wanting to get back to work, I did not even allow a little dog ear. The whole surgery (minus starting the IV) went so smoothly, I was thrilled that he was coming for his first post op visit yesterday.

By the way, he called the day after surgery about some papers he needed to get filled out for work, but that was it. Smooth sailing. No calls about pain, nothing.

I explicitly ask all of my patients to leave their surgical dressing on until they see me at the first post-op visit. I tell them, reinforce it with their loved ones and write it in capital letters on the discharge papers. It is really, really rare that these orders are not followed. Seriously, my patients know I mean business.

So, I was almost confused when my friend came in with no dressing. Not even something he threw on at home, which some people try to fool me with. (Trust me, a surgeon ALWAYS knows their own dressing.) When I asked him what happened and when? He answered that the night of the surgery (!!!) the finger was itching him, so he took off the dressing so he could bite it (!). Then, over the past week, he remained with no dressing, going about his business (although he assured me he stayed in the house) changing his baby's diapers and the such, but NEVER ONCE WASHING HIS HAND!!!!

He complained (now, in my office, as he waved the swollen digit around) that the pain was tremendous. I asked him why he never called. I was calm, at first, when I reminded him that he called about his papers, but never mentioned any of this. My eyes were met with a blank stare.

I asked him to wash his hands now, in the office, with soap and water. As soon as he finished, he turned to me, "Why is there pus coming out?"

I looked in disbelief, at the same time realizing that it was the only explanation: he had a wound infection, which explained the tremendous pain and swelling. When he washed his hands, he dislodged some dirt and blood that was covering the wound, and now the pus was pouring out.

I told him that I would need to take out at least a few sutures and open the wound to let the pus drain. It was the only way to get rid of the pus and the pain. He started moaning and crying (crying, with tears streaming down his face). This is when the fiasco started. I called my medical assistant into the room. We are both small women. He is a tall, muscular, fit man. After wrestling with him for about 20 minutes, I asked my MA to call our administrator in. A man, pretty much the peace keeper, but not much larger than us. The amazing thing is that the whole problem was that this patient was truly, magnificently AFRAID. He was not aggressive to me or anyone else; he just would not allow me to do what I needed to. The whole procedure, on a cooperative patient, would take less than 1 minute. Really. Start to finish.

With this man, it took an hour and a half. Every five seconds, he was ready, and then he would freak out again. Taking out 3 sutures took 45 minutes. (I left the rest for another day.) He had on 5 layers of shirts, which he started taking off one by one. (I really kept thinking that he was going to be sitting in front of me nude.) He had on two hats (I am not joking). Once he finally let me do what I needed to do, it really did take exactly 2 seconds (scissors into wound, spread, done).

The thing that I find worst of all is my reaction. After the first 30 minutes of begging and cajoling, trying to mesmerize him into cooperating... I lost it. I really did. I was screaming at him. I have never done that. I feel awful. I was cursing, too. Not pretty, not professional. Really, really awful. I cannot stop thinking about it, replaying it in my brain. I cannot justify it. All I can say is that I really just wanted to do right for this man, and he would not let me. On top of that, I had patients piling up outside, so I felt pressured to get a move on. I even told him (and this I truly meant with all my heart) that if I had known that this was how things would go, I would have come in on my day off so I could spend as much time as necessary with him--even the whole day, if I had to. Unfortunately, that was not the case here.

The only good thing, well 2 good things: 1. When all was said and done and the dust settled, he thanked me. I mean, the man knows I really was trying to do good for him, NOT to hurt him. He understands he brought this on himself. 2. We called him today, and he said he is feeling much better with less pain. He is doing the wound care that I instructed him on.

No matter, I am seeing him again on Friday. He is one of the patients that I would move in with, if I could.