An ICU Love Story: A Reload

I have posted more than 850 articles and stories over the years since this blog’s inception, which in a few months, will be 10 years. It’s quite a popular practice in the media to have reruns or replays. Even social media have their “throwbacks.”

I would like to repost a throwback story/article once in a while, not that I am running out of ideas or stories, for as a matter of fact, I have more than 30 unfinished articles in my draft bin. But sometimes, I just want to relive a bygone moment, or perhaps give a new breath to a favorite story from the past.

Here’s a reload of a love story that I witnessed a few years ago:

Making Things Right

“I just want to make things right.”

That was what my patient told me. Wanting to make things right. Don’t we all? Here is his story.

He was in his 50’s, and he presented to the hospital with leg swelling and worsening shortness of breath. After initial work-up in the Emergency Room, he was diagnosed with blood clots in the legs and lungs (veno-thromboembolism). A serious condition.

His chest CT scan also showed a lung mass. After further work-up, which includes a biopsy, it was found to be cancer. Cancer in itself is a risk for developing blood clots. A bad prognosis.

After more work-up, it was determined that the lung cancer was far advanced. It has spread to the bones, liver, and lymph nodes. A grim outlook.

During his hospital stay, his condition deteriorated and was transferred to the ICU.

I approached him as he lay in his ICU bed. Knowing the severity of his condition, I asked him about his “code status.” That is, what he wants us to do if in case he cannot breathe on his own, does he wants us to place a tube down his throat and have a machine breathe for him? Or if his heart stops, does he wants us to shock his heart or pound on his chest to try to resuscitate him? Or does he wants us to just let him go peacefully?

There was a long pause before he replied, as he breathed heavily under the oxygen mask. “I want everything done,” he finally answered. “I want everything done, until I have done one thing. I want to get married.”

Get married? Did I hear him right? Was he of a sound mind or was he confused and hallucinating?

As he continued talking, I ascertained that he was very alert and not confused at all. I did not ask why he wanted to get married, but he explained to me the reason why. Perhaps he saw the quizzical look on my face.

“I just want to make things right,” was his reason. Apparently, he was living-in with his girlfriend for twelve long years. He wanted to make their union legal. This would make her girlfriend the legal decision-maker for him if he becomes incompetent. And she would also inherit his estate without questions, when he dies. But more so, he just wanted to show her how he loved her over the years, but did not quite made it to the altar. Now, he was “making things right.”

Two days later, there was a wedding ceremony in our ICU room. A bride, a groom, a chaplain, and a couple of witnesses. That was all you need for a wedding. Of course there was a gown too. But it was the groom who wore it, for I’m not pertaining to a wedding gown, but rather a patient’s hospital gown.

There was many well-wishers too, courtesy of the ICU staff.

The patient’s son was also present. I believe he was his son from a previous relationship, and he came from out-of-state to visit his very ill father. He was probably expecting to attend a funeral, but was surprised that he was attending a wedding instead.

A few days after the wedding, our patient’s condition improved that he was able to be transferred out of the ICU to the Oncology floor. Perhaps, getting married gave him hope and a different outlook in life, and willed himself to get better.

He was started on combined regimen of radiation therapy and chemotherapy. Hope springs eternal.

Two weeks later, his condition started to decline once more. He grew weaker and weaker. His respirations became more and more labored. This time, he told us, he does not want to be resuscitated if his heart stops or if he cannot breathe on his own. I guess, he already accomplished his one wish, and now he was ready.

Then one day, he quietly faded away at the break of dawn. And he left a newly wed bride, a widow.

Cancer stumps hope. A so familiar refrain, sadly to say.

Yet love conquers all.

**********

(*This story was originally published in July of 2011; featured photo was taken a few weeks ago.)

A Battle Within

There is a raging war inside of me. The resulting blaze and smoke of this battle is evident while I am shaking and crouching under my blanket.

It all started a few days ago when the enemy gained unwelcome entrance to my domain. Perhaps these intruders escaped from another territory by a sneeze in which they could travel up to 20 feet at 100 miles per hour, and they usually travel as a mob with 40,000 others of their gang.

They got a foothold on my borders through my nasal and airway passageways. It’s really difficult to close all the entryways unless I quit breathing all together. The invaders then broke through my barriers and overwhelmed my sentinels. I should build a border wall and have Mexico pay for it. Hah!

As soon as there was a breach in my initial defenses, my border guards alerted the headquarters and radioed for back-up. They have identified these infiltrators and relayed their profile to the central intelligence.

The headquarters searched the database if I have a pre-fabricated artillery specific for this certain enemy. But lo and behold this “common” enemy is not so common after all, as it probably continues to change its appearance and structure to outwit my defenses. So my system staged an all out war to fight this common cold.

The first to arrive into the battle field are the big boys, called the macrophages. They are the biggest soldiers among my army of white blood cells. These big boys are like Pacmans as they hunt and engulf these viral invaders.

a macrophage in action (image from the web)

But the enemy has hijacked some of my manufacturing plants. They infused their DNA into my own cells and they are replicating themselves using my own factories and resources. The Pacmans cannot eat them all as they are too many now and they continue to multiply. Good thing my defenses have more tricks under their sleeves.

As soon as the macrophages got an exact profile from the captured intruders they send signals to the headquarters, my bone marrow, to have the rest of the cavalry released.

One of the most effective fighters are the B-cell lymphocytes. They are part of a line of my white blood cell army. These cells uses the information of the enemy’s profile and they start building specific missiles, a protein called antibody, to fight these particular intruders. Once these virus-seeking missiles are constructed they are launched into the system to seek and destroy every infiltrators.

antibodies attacking a virus (image from the web)

Some of these specific antibodies are stored into memory cells. So the next time this specific virus intrudes again, my body already has the pre-fabricated missiles ready to launch to fight them back.

Another important battalion of my soldiers are called the T-cell lymphocytes. These are elite fighting machines, like the SWAT or the Navy Seals. They don’t just track and kill the enemy but also destroy cells that harbor them. With some named as “natural killer T-cells” you know that these are badass soldiers.

Go, go, go my army and defend the motherland! And die you infidels!

There are also some foot soldiers that are deployed to the area of the breached wall. They have fortified the defenses there, and as a result the lymph nodes around my throat are swelled up, a sign of an ongoing battle in that area.

Besides the chills and runny nose, so runny I can’t keep up, I also started having this paroxysmal cough. I got out of my bed and went to the bathroom. I hacked up a phlegm into the sink – a nasty purulent and rusty mess. Then I realized that part of that purulent mess are dead bodies of my white blood cell soldiers. They have laid down their lives for the cause.

So before I flush down the purulent mess deep into the sink, I thanked them for their sacrifice, and as a grateful nation I fired up the canons and gave them my 21-cough salute.

After hearing my cough, my wife suggested that I should take some medicine to relieve my symptoms so I can have a better night sleep. Being hard-headed as I am, I said no to the medicine and just trusted that my body will take care of itself as I crawled back under the covers.

The next morning, I don’t feel as awful as the day before. Perhaps my army is winning the war, and they are rounding up the remaining stragglers, and cleaning up the residual wreck and ruins of the hard-fought battle. I guess I will live.

This is another victory for my immune system. But I’m not ready for a victory march and parade as of yet. I think I’ll take it easy and still stay in bed today.

Grateful to see another morning (photo taken with an iPhone)

(*Credits to my immune system and also to the Immunology class in my medical school)

Fevered Musing

I called in sick. I have not done that a lot. In fact, this is the first time I did it. Many times, I just grit my teeth and willed myself to work, even if I felt like I was ran over by a truck.

I have this notion that doctors should not get sick. For who will take care of the patients? But am I really be of help or be more of harm if I go to work, while I myself is sick? After much deliberation, and after foregoing the feeling of guilt, I made the call.

Don’t get me wrong, I am no superhuman. In fact, I get sick more often than my wife. She chided that I am built poorly and of cheap quality materials. During my childhood days in Manila, we call our classmates who get sick easily “Made in Taiwan.” We pride ourselves to be “Made in Japan” or “Made in USA” if we’re the only ones left standing. Nothing against products from Taiwan. Accept it or not, we Filipinos sometimes can be racist. I am sure being made in Taiwan nowadays does not have that connotation.

I am trying so hard not to get sick. I exercise regularly, and I try to eat healthy, and I even got my flu shot. But I still got sick. Being a physician, when you’re dealing with ill patients all day, and they are coughing in your face, it’s just a matter of time that you’ll get it too. Plus we are in the middle of the flu epidemic and it is particularly bad this season.

I am in bed for 2 days straight now. I know, that in itself can make my head hurt. I am popping Advil every 4 to 6 hours round the clock, just to get relief from the fever and the body aches, even though I don’t like taking medicine.

I isolated myself in our bedroom, as I asked my wife to sleep in another room, so she’ll not get what I have. This is not the time for ‘sharing.’ I also put on a mask whenever I go out of the room, and ate separately away from the table.

I was having chills and fever when my thoughts wandered into the times in the past, when I was also sick in bed.

I was in our home in Manila, with high fever. I was still so young, that I don’t go to school yet. My body was full of red spots that were very itchy, and I’m trying my best not to expose them. (Bawal daw mahanginan.) I believe I got the measles. My mom would continuously put a wet towel in my head to try to lower my temperature. But despite of that, I was to the point of hallucinating, that my mother said I was seeing things that were not there.

Then there was the time I was in Kindergarten, when I again had a fever, and one side of my face swelled up. I looked like a squirrel that has an acorn in one of its cheek. I had the mumps. My folks painted a bluish gooey something on my face. It is a concoction of clay, blue dye and vinegar, which was a popular folklore remedy for mumps in the Philippines. My classmates in Kindergarten stopped by our house to visit me, and they saw me with my painted blue puffed-up cheeks.

I know, I know, you may be asking, why did I get both the measles and mumps when I was a child. Why was I not vaccinated? Were my parents against vaccination? Not really. I was just born before the era when MMR (Measles, Mumps and Rubella) vaccine became available worldwide. It was later offered in our school when I was older, I think I was in Grade 2 or 3. My classmates and I lined up and I received those injections despite my silent protestation as I was scared of needles.

There were several other times that I was sick as a child with colds, and my mother would put Vicks Vaporub in my chest and back. Even in my nose, when my nose was clogged up and could not breathe. She would also put Vicks Vaporub in my feet and then put socks on me, telling me that will help my fever. For many Filipinos, Vicks Vaporub and White Flower ointment were a cure-all treatment for any ailment. To this day, I hate the smell of them.

Now that I have the MD degree after my name, I know that the blue paint on my cheek and the Vicks Vaporub on my feet perhaps caused nothing to help my sickness. But perhaps just the fact that I am loved and my parents were showing they care, the best that they know how, was enough to make me feel better. And that eventually healed me of my illness.

Many times, showing people that we care for them, is enough to relieve them of their malady. I know I have plenty of that in my home as a child, and in my home now. Even when I feel terrible with this illness, I know that I am being attended to, not necessarily by a medical team, but more importantly by people who really cared for me. In fact, I still have the cup of salabat on my night lamp stand that my wife brought me this morning, and I could already smell the sinigang that she is cooking.

I was having chills when I glanced outside the window.  Snow is now falling softly. I am not going anywhere. More reason to snuggle under the covers the whole day.

IMG_6308

(*These thoughts were concocted 3 weeks ago. I think I got influenza, and I was house-bound for 5 days. Photo taken with an iPhone.)

 

 

Concert in the ICU

Inside ICU room 34* of our hospital, there is an ongoing musical performance. One young man is playing an instrument and another young woman is singing.

Music therapy is a burgeoning field of science. We have known since the history of man, that music has a healing property. During Biblical times, young David was summoned to play his harp whenever King Saul of Israel was stressed and troubled. Pythagoras, Plato and Aristotle all wrote about how music affects health and behavior.

Now, modern science and current medical studies back this up. In Harvard’s Health Blog, one article mentioned that music therapy can aid pain relief, reduces side effects of cancer therapy, restores lost speech in people who suffered stroke, and improves quality of life for dementia patients among other benefits.

One study from Austria conducted in General Hospital of Salzburg, has found that patients who are recovering from back surgery had increased rates of healing and reported to have less pain when music was incorporated into their rehabilitation process. I consider Austria a leading authority in music science, after all that’s the country where great classical composers like Mozart, Strauss, Schubert, Czerny and Haydn all came from.

Several years ago, when I was doing my Critical Care Medicine training in New York City, we had a music therapy team that plays to our patients in the ICU. The team, composed of a flutist, a violinist and a cellist, would go from room to room in the ICU and would play for about 5 to 10 minutes in each room. Even if the patient was medically sedated or comatose, they would do it anyway. It was soothing for us medical staff as well, when they come, as we got to listen to their music.

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ICU music therapy (image from wakingtimes.com)

Since music therapy is the in-thing right now, I even told my daughter to look into a career in this field, that is if she would be interested, since she is pursuing a music degree. Perhaps I can have my own therapy someday.

Back to our ICU 34, the mini-concert though is not done by our hospital’s music therapy team, for we don’t have an official team like that as of yet. The music is being performed by the patient’s son and daughter who are both college-age and are both enrolled in music degree.

The son is playing his French horn, and the daughter is singing. The daughter even composed a special song for her mother, our patient, and would sing it for this special occasion.

However, their mother, who is only 44 years of age, is not going to wake up again. Not even with the beautiful music rendition from her children or any music therapy session on earth for that matter. She suffered a devastating head bleed which caused her to be in perpetual comatose with no hope of meaningful recovery. She is just being kept alive by life-sustaining machines.

The whole family agreed, that their mother would not choose to live a life in a vegetative condition like this. So they decided that they will take her off all life support. But only after they perform their mini-concert in her presence. They would like to dedicate their music as a send off, as she passed on beyond this world.

Sometimes music can be a therapy too for the broken-hearted and for those who are left behind.

(*ICU Room number was purposely changed)

 

Huwag Kang Puputok

Siguro lahat tayo ay may kakilalang tao na malakas magpaputok. Hindi rebentador o kaya baril ang ibig kong sabihin. Ang tinutukoy kong putok ay iyong nakakainis na amoy mula sa katawan. Sa ibang salita, body odor o B.O.

Kung ikaw ang may putok, sana makatulong sa iyo ang artikulong ito.

Isang senaryo sa Pilipinas: nasa loob ka ng jeepney.  Dahil sa sobrang init at trapik ay tumatagaktak ang pawis ng lahat. Tapos, may mamang sumakay at sumiksik sa tabi mo. Pag-arangkada ng jeep, itinaas ng mama yung kanyang braso para humawak. Sakto naman yung kanyang kili-kili sa mukha mo. Pag-hinga mo, boom! Parang gusto mo nang tumalon sa jeep, o kaya’y ilawit ang iyong ulo sa labas at pipiliin mo pang suminghot ng maiitim na usok ng jeep at bus, kesa mamatay sa putok ng katabi mo. Naka-relate ka ba?

Ano ba ang sanhi ng putok?

Ang medical term sa putok o anghit, ay bromhidrosis. Ito at ang masangsang na amoy dahil sa pawis. Ang pawis ay mula sa sweat glands. Maaring tanungin mo, bakit ba ginawa ng Diyos ang sweat glands kung ang magiging sanhi lang nito ay anghit?

Ang sweat glands ay importante sa kalusugan at mismong buhay ng tao. Ito ay para sa thermoregulation ng ating katawan. Kung hindi tayo papawisan tayo ay mag-o-overheat at maaring mamatay, parang makina ng kotse na kailangan ng tubig sa radiator para hindi pumalya. Kaya’t sa ayaw mo man o gusto, hindi lang si Andres Bonifacio, kundi tayong lahat ay anak-pawis.

Isang klase ng sweat glands ay ang apocrine glands. Maraming apocrine glands sa axillary area (kili-kili) at pubic area. Maliban sa pagse-secrete ng pawis, ito ay nagse-secrete din ng hormone, na ang tawag ay pheromones. Ito ay may kakaibang amoy. Ang pheromones ang siyang naamoy ng mga hayop, para ma-attrack sa kanilang ka-partner. Ito ang dahilan kung kaya kahit sa malayo ay nakakaakit ang paru-paro, baboy-damo, o aso ng kanilang kalaguyo.

Pagnagbinata at nagdalaga na ang tao, dumadami ang apocrine glands at secretion nito. Pero sa ating tao, hindi gaya sa hayop, hindi masyadong kailangan ang pheromones upang humanap ng ka-partner. Kasi may on-line dating site na (aha-ha). Isa pa, mas mabisa siguro ang bulaklak at chocolates kesa pheromones para sa tao.

Balik natin ang usapan sa pawis. Sa katanuyan ang pawis ay walang amoy. Ngunit kapag may mga bacteria sa ating katawan, na nagre-react sa ating pawis o hormone na galing sa ating sweat glands, lalo na sa apocrine glands, sa halip na walang amoy, nagkakaroon ng mababantot na mga chemical. Mga chemical tulad ng ammoniaE-3-methyl-2-hexanoic acid at 3-hydroxy-3-methyl-heaxnoic acid, (konting chemistry lesson lang po). Ito ang isang sanhi ng putok.

Minsan ang ating diet, gamot, mga toxins, metabolic disorders, at ibang sakit, tulad ng liver at kidney failure, ay nagdudulot rin o nagpapalala ng mabahong amoy ng ating katawan.

Ang bromhidrosis ay maaring makaapekto sa kalusugan. At sa kalusugan din ng ibang kawawang taong makakaamoy. Pero maliban sa pisikal na kalusugan, ang taong may bromhidrosis ay maari ring magdusa ng social isolation at low self-esteem. Sino nga bang gustong mag-hang-out sa taong may putok?

Anong dapat gawin, o ano ang mga lunas sa isang taong may bromhidrosis?

1. Maligo ng regular.

Malaki ang nagagawa ng personal hygiene sa putok. Dahil may kinalaman ang bacteria sa masangsang na amoy, mababawasan ang bacteria sa katawan kung maliligo ka nang regular. Hindi ko sinasabing maligo ka nang apat na beses isang araw, pero sikapin kahit minsan sa isang araw. Maari ring makatulong ang pag-gamit ng anti-bacterial soap.

2. Gumamit ng anti-perspirant at deodorant.

Ang anti-perspirant ay nagpapabawas sa pagpapapawis. Ang common ingredient ng mga antiperspirant ay aluminum salt. Ang “tawas” na popular na ginagamit para sa anghit ay hydrated aluminum potassium sulfate, at ito’y mabisang anti-perspirant. Ang deodorant naman ay mga pabangong nagkukubli sa mabahong amoy. Marami sa mga produkto ngayon ay magkasama na ang anti-perspirant at deodorant.

tawas

Kryptonite? No, Tawas Crystal!

3. Hair removal

Dahil ang buhok ay maaring mag-trap sa bacteria, maaring makatulong ang pag-aahit ng buhok sa kili-kili. Kaya pwedeng slogan: May anghit? Mag-ahit!

4. Palitan kaagad ang damit na pinagpawisan.

Panatilihing tuyo ang katawan. Hindi sa dahil ikaw ay mapupulmonya kung matuyo ang pawis. Pero mababawasan ang mabahong amoy-pawis kung huhubarin mo kaagad ang basang damit na pinagpawisan mo. Isa pa, gusto ng bacteria ang mabasa-basang environment.

5. Iwasan ang mga pagkaing may maaamoy na spices.

Siguro naobserbahan mo na rin na may mga pagkaing amoy kili-kili. Hindi ko ikinakaila na masarap ang mga ito. Subalit kung amoy kambing ka na, bawasan mo na siguro ang mga maaamoy na spices tulad ng curry, cumin, sibuyas at bawang. Pero pwedeng rason na OK lang mag-amoy bawang, kasi at least walang aaswang sa iyo.

6. Huwag manigarilyo.

Hindi sa nagpapabawas ng pawis ang hindi paninigarilyo. Pero ang sigarilyo ay isang sanhi ng mabahong amoy. At mabahong hininga. May B.O. ka na nga, may bad breath ka pa, eh kawawa ka nang talaga.

7. Removal of apocrine glands.

Sa malalang bromhidrosis, ay maaring i-offer ng mga duktor ang pagtanggal ng apocrine glands. Maari itong tanggalin sa pamamagitan ng surgical excision, liposuction, o laser therapy. Hindi dahil nabasa mo rito ang laser therapy, huwag mo sanang tangkaing na sunugin ang iyong kili-kili. Please consult your doctor.

Hanggang dito na lang at sana ay may natutunan kayo. At tandaan, hindi lang sa Bagong Taon po bawal magpaputok!

(*photo of tawas from the web)

D-ficient

I went to see my doctor last week for a regular annual check-up. I know I see a doctor everyday when I look in the mirror, but I still need to see a “real” doctor once in a while. Someone who will assess my health objectively and truthfully tells me if there’s something wrong.

I don’t have any medical condition nor am I on any prescription medications. I am not having any symptoms either. Besides, I am doing my best to live healthily – I eat reasonably and I exercise regularly. In other words, I try to practice what I preach.

Yet despite of the things I can control, there are things I cannot. The track record of men in my family is dismal. My father died at the age of 50, my paternal grandfather not much older than that, and my maternal grandfather did not even reach 40. That’s the genetics I have to contend with. Therefore I need to be proactive.

After my doctor examined me thoroughly, including the dreaded digital exam up you know where, he commended me for staying healthy. All is well, or so I thought.

He also requested a number of blood tests which a couple of days later, he sent me the results. All of them were good, except for one.

My vitamin D level is low. What?! How? Why?

Vitamin D is most well-known as essential for strong bones, but research have found the importance of vitamin D in protecting against a host of health problems as well, including cardiovascular diseases, cancer, autoimmune diseases, infections, and even cognitive disorders.  Cognitive function? Is that why I am getting forgetful?

Major symptoms of vitamin D deficiency include bone pain and muscle weakness. I have none of those. However, for many people, the symptoms are subtle.

What may be the cause of vitamin D deficiency? It can occur for a number of reasons.

If you follow a strict vegan diet, you may be predisposed for this, because most of the natural sources of food with vitamin D are animal-based, like fish, egg yolks, liver(ew!) and milk. I am not a vegan nor a strict vegetarian, but I admit we eat mostly plant-based food at home. Once in a while I splurge on hamburgers, especially if I’m tired from my call. I am not a fan of milk though.

However even if you’re a strict vegan, you can still get plenty of vitamin D if you have enough exposure to the sun. Our body makes vitamin D when our skin is exposed to sunlight. The rays of the sun, specifically the ultraviolet-B (UV-B) convert a chemical (7-dehydrocholesterol) in our skin, into vitamin D. If you live in northern latitude where UV-B rays are filtered from atmosphere, specially in the winter, then you may need longer sun exposure.

I admit, I am guilty of not much sun exposure. It’s not that I shun the sun for fear of getting dark. On the contrary, I don’t agree with many Filipinos trying so hard to be fair-skinned by avoiding the sun and using whitening products. Why can’t we be comfortable in our own skin?

I don’t get enough sunshine just because I spent most of my days indoors due to my long work hours. Even if I do run outside, I usually do it early in the morning just enough to see the sun peeking in the horizon. Plus if it is cold, I use running gears that mostly cover my body, long sleeves and all, to keep me warm, so not much skin are exposed to the sun.

Another predisposition for lack of vitamin D is if you’re dark-skinned, which I am. The pigment melanin reduces the skin’s ability to make vitamin D in response to sunlight exposure. Some studies show that older adults with darker skin are at high risk of vitamin D deficiency.

Other predispositions for vitamin D deficiency are people with kidney disease as their kidney is less able to convert vitamin D to its active form, and people with digestive tract disorder that affect their intestine’s ability to absorb the vitamin from their food. I don’t think I have either of those.

So my doctor then prescribed me a hefty dose of vitamin D pill to be taken every week. But I wish he prescribed me something else instead, which I believe is what I really need.

IMG_1063

This is what I will prescribe myself: morning walk on a beach and enjoy the tropical sun once a week.

If only I could.

(*shadow selfie photo taken at a beach in Palawan, Philippines)

 

 

 

Frankenstein Medicine

For this week, I have been spending 8-9 hours a day inside the classroom and in the simulation laboratory trying to learn something new. Never too late to learn a new trick, even for an old dog. Though I admit I was almost half asleep in some of the lectures.

The hospital where I have affiliation with, will have a “new” intervention available as soon as next month. This treatment is called Extracorporeal Life Support (ECLS) or also known as Extracorporeal Membrane Oxygenation (ECMO). So they are training us doctors (critical care specialists, cardiologists and thoracic surgeons), as well as nurses, respiratory therapists and perfusionists, so we can have this life support system off and running.

In a simplistic way, ECLS entails placing large tubes to suck out the blood from the patient. Then having the blood run into a machine where it will be bathed with oxygen and then pumped back into the body. ‘Extra’ means outside, and ‘corporeal’ means relating to body, thus out-of-body life support.

Does this mean the patient will have out-of-body experience?

For patients, whether kids or adults, whose organs have failed for one reason or another, especially the heart or the lungs, can be placed on this life support system to sustain them and keep them alive and buy some time. The use of this intervention is not by all means the first line of treatment but rather of a last-ditch salvo. But it definitely has saved lives, and more and more advanced centers are offering it. Our hospital will be one of the first to provide it in our state.

ecmo

baby on ECLS (photo from the net)

ECLS is not really a new procedure. This has been done for several decades now. Except before, the intervention is only limited to short period of time, like several hours only. The main use of this before was in the operating room during cardiac surgery. They run the blood out of the patient’s body and through this machine, while the surgeon stop the beating heart and tinker on it. I can imagine the heart surgeon singing Sting’s “Be still my beating heart” while he operates. Then the machine is shut off once the heart is beating again.

Now ECLS is also being used outside the operating room, and people are placed on this life support while in the Intensive Care Unit. They can be on this for a few days, a few weeks, or sometimes even months – while their own body and organs recover, or while they wait for a new heart or a new lung, or both, or until “kingdom come.”

Of course the complexity of this intervention is beyond what I can explain here, not to mention the immense cost to the already burdened health care system and the sensitive ethical questions involve, like who to place or who not to place, or when to continue and when to stop. Are we playing God?

While we are doing the training, one of the trainee commented with a sinister smile, “we are Dr. Frankenstein.”

Is this as close as we get to Frankenstein medicine? I don’t think so. We have not created a monster. Yet.

 

Not Running

The annual Des Moines Marathon is less than 3 weeks away. And I am in no close form to run it.

For the past 5 years, I participated in this yearly event, running the half-marathon (13.1 miles). This year I learned that a classmate of mine from medical school who is also now living in the US, but in another state, is participating in this run. Even out-of-towners are joining this event, not to mention some elite runners as well.

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(photo taken during Des Moines Marathon 2013)

Participating in this annual race keeps me committed on my running and hopefully this keeps me fit and healthy, which is the ultimate goal anyway.

I know it is not hard to find a hundred reasons to stop running and it is so easy to fall off the wagon, and stop exercising at all. Doing this half-marathon at least once a year keeps me motivated. Or unable to button my pants, or an innocent yet honest remark from my kids about my bulging belly, will also do the same.

If I follow the running gurus’ advice, like the Hal Higdon’s training schedule (click here) on how to prepare for the half marathon, my long runs should be at least 8 to 10 miles by this time. Adhering to these recommended training schedules assure you that you cross the finish line on race day without killing yourself. But I loosely follow those schedules anyway.

Yet, even if I am not on track in my training for the half-marathon, there’s no urgency for me to train hard. The truth is I was not even training at all. I have not run a distance of more than 3 miles for the past couple of months. I am indeed slacking.

Why? Have I lost the motivation? Have I resigned and accept my bulging midsection? Not at all!

About 3 months ago, I learned that on the weekend of the scheduled Des Moines Marathon is the date that my kids will have their piano competition. And I will not miss the world for that. So we will be out-of-town at that time, and thus I cannot do the run.

So I forgo on my training.

However last Sunday, just to challenge myself, I push to run 5 miles in less than an hour, and I felt good about it. Next weekend, if I can run 7 or 8 miles, then it is as if I am ready to run the half marathon, even if I am not doing it.

Just because.

A Stinky Cure

Several days ago, I was called to co-manage a patient that was admitted in the hospital. The patient was quadriplegic, paralyzed from the neck down, due to a neck injury he sustained several years ago.  Our service was consulted for he had a tracheostomy and has been on a home ventilator.

However, he was hospitalized not for a primary pulmonary issue. He was admitted for a scheduled transplant.

In this day and age of modern science, organ transplantation is almost an ordinary phenomenon. Kidney, liver, pancreas, heart, lung, bone marrow, cornea and skin are among others that are being transplanted. There’s even recent news reports of patients receiving total face transplant.

Not too long from now, brain transplant will be a reality. Do you need one?

But the patient that we were consulted was not scheduled for any of the organ transplant that I mentioned above. Do you care to guess what he was planned to have?

Spinal cord? Spleen? Appendix? Nah.

By the way, maybe someday we will find out what appendix are really for, and not just for the surgeons to operate on.

Back to our patient, what transplant did he need?

He underwent a fecal transplant.

Yes, you read it right. Feces, as in stool or poop. In vulgar term, sh*t.

But why you may ask, anybody needs a fecal transplant. Can’t they make their own poop?

Fecal transplant is now an available treatment for people who are suffering from severe and refractory Clostridium difficile infection. What the poop on earth is that?

Clostridium difficile is a bacteria. It’s infection can happen when a patient has been on antibiotics. The strong antibiotics that we use, kill the “bad” bacteria, but unfortunately, it can also kill the “good” bacteria we have in our colon. Yes, many of the bacteria in our body are considered “good” bacteria, especially in our gut, that keeps us healthy.

So once these good bacteria are killed, this can cause overgrowth of these super evil bugs, the Clostridium difficile, and they wage a coup d’ etat in the gut’s bacterial colony. This cause the problem. The takeover of these rogue bacteria is manifested by severe diarrhea, nausea, vomiting, abdominal bloating, fever and sometimes overwhelming sepsis, shock and even death.

Clostridium difficile can be treated with specific antibiotics, but then again, antibiotics are double edge sword as it may cause more problems. So one of the newer method to fight this is providing a new bacterial colony.

Thus the fecal transplant, or also known as fecal microbiota transplant. The good bacteria in the donated stools restores the healthy colony and community of bacteria in the colon.

Currently, there are undergoing studies evaluating this treatment for other gastrointestinal disorder besides Clostridium difficile infection.

How is it done? Do we tell them to eat sh*t? No, it’s more sophisticated than that.

The fecal material from a donor, is inoculated or sprayed directly inside the colon through a colonoscope. However, under development right now is fecal material in pill form. Poop pills! What a stinker.

Where do we get the donor feces? Good question.

The donors are healthy volunteers who out of the goodness of their hearts (or guts?) want to share their…..you know what. No kidding. My gastroenterologist friend told me that most of the donors of the fecal matter available in the US are from college students of a prestigious university in Cambridge.

Maybe you want to be a donor too. They may even pay you for your precious donation. Some people donate blood, and some donate sh*t.

poop in lab

(photo from usnews.com)

Fecal transplantation most of the time is done as an outpatient, and does not need hospitalization. However, since our patient was on a ventilator, it was felt that the rigorous colonic prep plus the conscious sedation during colonoscopy may be too taxing for him, so he was admitted for observation.

I would say he had a successful transplantation. He went home the next day, pooping happily ever after.

Life’s Worries

A couple of weeks ago, I took care of a patient who was admitted in the hospital for shortness of breath. She has COPD (CDOP if you’re obsessive-compulsive), a disease due to smoking, and went into acute respiratory failure.

The patient was really struggling to breathe thus the Emergency Room doctor placed her on a non-invasive positive pressure ventilator (NIPPV), a device similar to CPAP used by people with sleep apnea, to provide assistance in her respiration. She was then transferred to our ICU.

On the first day that I rounded on her she was still on the NIPPV and unable to talk much, as it was almost impossible to talk with that mask on, for it’s like having a blower in your face. I would not be able to hear her clearly anyway even if she wants to speak. Though I examined her thoroughly, I limited my history-taking to questions she can answer by yes or no.

The next day she was much better and we have weaned her off the NIPPV. She was sitting in a chair, breathing much easier and looking comfortable.

I pulled up a chair and sat beside her and talked. She admits she has been diagnosed with COPD for years, and has even been on oxygen at home. But sadly to say she continues to smoke. Damn cigarettes! I guess old habit never die.

I told her that it was vital that she quit smoking. Yet in the back of my mind, she has done quite good despite of her bad habits, for she was 84 years old after all, and she still lives independently, all by herself.

Then when I asked her how can I help her quit smoking, she relayed to me that she smoke because she was stressed out.

What? She was eighty-four years old and still stressed out? She should be relaxing and enjoying life, or whatever is left of it, at this age.

That was when she told me that she has not gotten over the death of her husband, whom she was married for sixty-one years. He died three years ago. I suppose the heartbreak never heals when you lose somebody you love and lived with, for that long.

If we only peel off our prejudgment and peer behind the puff of cigarette smoke, we will learn that these people are hurting inside.

Then she said that she was also worried about somebody she knew longer than her husband. She was worried about her mother.

Her mother? What?!!!

Wait a minute, was my patient confused? Too much medications maybe? Was she having ICU delirium? Or does she have the beginning of dementia perhaps?

But as I talked to her more, I ascertained that she was very lucid and of clear mind. She was indeed worried and stressed out about her mother, who has been in and out of the hospital for the past several months.

Her mother was 103 years old!

I came out of the ICU room with a smile. I was ever so determined to help my patient get well. And maybe if I can get her to relax and convince her to quit smoking, she will live more than 103.

IMG_2226

view from the hospital’s corridor

(photo taken with an iPhone)