Prime Time Prognosis: House

SPOILER ALERT:
I've cut out all the false leads, personality politics, and longing glances between Foreman and Thirteen in last night's House (TK NOT REALLY LAST NIGHT) and taken the clip right to minute 37, wherein the medical mystery is solved. If you've DVR'd this episode to watch later... don't watch now.


SYMPTOMS:
cyanosis (blue coloration of the skin due to insufficient oxygen)
spontaneous pneumothorax (collapsed lung)
increased interstitial markings on lung CT
liver bleeding into her abdominal cavity/ liver failure
severe itching
cardiac tamponade (fluid in the sac surrounding the heart)

DIAGNOSIS:



FACT OR FICTION?
This is slightly terrifying, and I say this as a body-positive feminist not afraid of a little menstruation. But how realistic was the diagnosis?

Typically, endomitriosis is the deposit of endomitrine cells, typically found in the uterus, outside of the uterine cavity. (Since endomitriosis is the condition of having uterine cells form outside of the uterus, calling it "ectopic" --meaning out of place-- is somewhat redundant.) While most cases occur somewhere in the pelvis, it's not unheard of for a patient to develop endomitriosis in the liver, lungs or other parts of the body, though usually only in one spot.


Polite Dissent offers this analysis:

There have been documented cases of endometriosis being spread due to surgery, however, in all these cases the patients had endometriosis before surgery, and it was that endometriosis that was spread, not normal endometrial tissue that became endometriosis.
My biggest problem with the endrometriosis solution is the time ... The endometrium takes 3 -3½ weeks to slowly build up in thickness before sloughing off to start the menstrual cycle. Endometrial tissue does not go from nothing to suddenly-detectable-everywhere one day before the cycle starts. If she that much endometriosis to cause all the symptoms she had, there would have been plenty of evidence on the first CT.
Why had she been symptom free the previous 7 months?

He also notes that the liver failure wasn't properly explained.

Did you have problems with this diagnosis? Have you ever suffered from spontaneous, all-over menstruation? Sound of below.

10 Ways To Cut Medical Costs

When it comes to cutting budgetary corners, health care is the one place you probably don't want to scrimp. But there are ways to cut down on ancillary costs without putting yourself at risk.

1. Ask if there's a less convenient drug.

Some big-ticket drugs, like the osteoporosis-fighter Boniva, offer the same medical benefits as less expensive generics, but with a convenience factor thrown in. For instance, you only have to take Boniva once a month instead of one a week - jacking up the price by almost $100. If your insurance charges more for brand names, you could be missing out - especially since doctors don't always offer the generic over the name brand. This TK study shows how often.

SAVINGS: $30 (Assuming a higher co-pay for brand name drugs)


2. Don't insist on an MD.
Don't be seduced by the white coat. In some cases you'll be better served with a nurse practitioner, pharmacist, or nutritionist. TK MORE

SAVINGS: TK


3. Question everything.
In order to keep their malpractice insurance down, doctors sometimes go a little overboard on tests: MRIs, echocardiograms, stress tests... be sure to ask what, exactly, the tests are for, and how necessary they are.

SAVINGS: TK

4. Shop around.

A study at Washington University in St. Louis found that surgeon's prices varied widely - even within the same hospital. It may feel tacky to discuss the price of a procedure when your health is on the line, but the difference could be thousands of dollars. If you have to get the surgery anyway, why pay more?

5. Create a master file.
Your parents lied: there is no "permanent record" that follows you through life. It's not true for your high school misbehavior and it's not true for your medical history. Take control of your information by tracking and storing copies of all tests, medications, and procedures you've undergone. This prevents medical goose chases, duplicated tests, and other time wasters that can cost you money.

TK 5 MORE. THE FORMAT AND SOURCING WILL BE SIMILAR TO THIS ARTICLE I WROTE A FEW YEARS AGO:

Drug Resistance On the Rise. Do The Finns Have the Answer?

Hate to heap on more bad news about the general decline of world affairs, but you know what they say: don't kill the blog aggregator.

There have been more and more reports about a growing resistance to antibiotics and vaccines; many of these articles, like the TIME piece, have a "no need to get worried yet, but..." tone.

That may be because there's no real risk to the individual patient at this time. However, the stories combined indicate a troubling prognosis for the country as a whole. For instance, the antibiotic-resistant strains of Neisseria meningitidis discussed in the NEJM resist not to the drug used to treat people infected with N. meningitidis, (which causes meningitis and sepsis) but to inoculate people who may have been exposed to the sick patient. This is comforting if you're a person with meningitis, but not great if you're a public health professional trying to prevent an outbreak. And while the reported incidences of resistant N. meningitidis is pretty small, that's only because very few states test for drug resistance, so it's hard to tell how many cases we're actually dealing with.

Moreover, there's really not much an individual can do - and health journalism loves nothing more than an "actionable" tip. Yes, you should only use antibiotics prescribed to you, and use them exactly as prescribed (that means finishing a 30-day course of drugs even if you feel better on day 19). But what's really needed is a system that helps us track where and when resistant strains of bacteria and viruses appear, and a unified plan amongst the nations doctors to help prevent over-prescription of antibiotics and vaccines.

Mike the Mad Biologist over at ScienceBlogs makes the case for such a system by comparing our methods Finland's national health care system. (Making sure to note that he's "not talking about how health care is paid for ... but a uniform system of record keeping and informatics protocols.")

Of course, make noises that sound like nationalization and people tend to freak out. That's what happend when President Obama provided funding in the stimulus to fund the much maligned National Coordinator of Health Information Technology position. That person would oversee the digitization of health records, making this type of data collection easier. (That's not the only benefit of having records digitized - doctors could received up-to-date medical information in real time (not, as the Bloomberg article implies, order doctors on how to proceed) and records could be easily accessed between hospitals (so that if you break your leg in Tahoe, the ER doc has access to the record from your primary care physician in Atlanta). Both should cut down on medical errors and administrative red tape - a benefit to you in the short term. Meanwhile, the ability to monitor national uses of medications will benefit us all in the long term.

For that to happen, however, the project will need a lot more money and a lot more time. Until then, be prepared to read a lot more "no need to worry, but..." stories.



Photo of N. meningitidis © 2006 Kenneth Todar University of Wisconsin-Madison Department of Bacteriology

The Consult: News from the Web

Tips on health insurance for the unemployed: The New York Times

Scientist discover stem-cell alternative The Washington Post

Economic woes make for sleepless nights MSN

Lead in children at its lowest level in years Newsday

Washington state to allow assisted suicide AP

Sebelius Reduces Abortion, Annoys Pro-Lifers.

Kansas govenor Kathleen Sebelius will be tapped to run the Department of Health and Human Services tomorrow, a move that's been rumored since poor Tom Daschle had some trouble with his QuickBooks. Some health policy wonks were disappointed that the new chair won't have Hill experience, which will be helpful when trying to wrangle Obama's health care initiatives through Congress. Overall, however, she's winning praise from various and sundry pundits, editorial boards, and politicos.

You know who isn't happy with this pick? Pro-lifers. Which is weird, since they're normally so upbeat.

Sebelius shares the newish Dem party line of "safe, legal, and rare" when it comes to terminating pregnancy. Under her leadership, Kansas abortions have declined by 8.5 percent (which pro-lifers like); a decline Sebelius credits to adoption incentives (also good), extended health services for pregnant women (g00d), sex ed (eh), and other family support (so far, so good). However, she did veto legislation that would require women to get a court order before they get an abortion (FAIL).

(She also hosted an event at the governor's mansion with a Kansas gynecologist under investigation for violating state abortion laws -- and who had won the dinner at an auction benefiting a women's political group.)

Expect conservative leaders with strong anti-abortion ties to make Sebelius's confirmation difficult, and hope that other topics - like her attempts to make medical care more accessible for children and low-income parents in Kansas - aren't overshadowed.

Just in case they are, here's a list of her record on medical issues:

*As state insurance commissioner, she

cast herself as a consumer champion by pushing to protect patients from rationed care by health maintenance organizations and rapid discharges by hospitals. She declined campaign contributions from the industry she regulated and, in her boldest move, rejected the 2002 purchase of the state’s largest insurer, Blue Cross and Blue Shield of Kansas, by Anthem Inc., based in Indianapolis. No other state insurance commissioner had blocked such a sale, but Ms. Sebelius argued that it would result in higher premiums for Kansans. Litigation ensued, and she ultimately was upheld by the State Supreme Court. (New York Times)

Sebelius also sought to require insurance companies to cover birth control for women. Insurance lobbyists and anti-abortion groups opposed the proposal, and it died in the state Legislature.
She also cut state workers' compensation rates by more than 11 percent, when the industry wanted a more than 4 percent increase. And she has argued that patients should be allowed to sue insurance companies over their decisions. (AP)

*Last week, she proved her commitment to health care when signing the new state budget. Considering her name had already been circulated to replace Daschle, she wasn't likely to make any big cuts.

Sebelius signed into law a bill that reduced the Kansas budget by about $300 million to address a $6.4 billion deficit, but the legislation in large part avoided reductions in spending for health care programs, such as Medicaid. (Medical News Today)

* Other health-related initiatives as governor:

Sebelius has tried twice to raise Kansas's cigarette tax to expand medical coverage. Both times she was thwarted by Republican legislators, who objected to the tax increases and wanted a more market-based solution.
She was successful in having Kansas join a multistate consortium that allowed Kansans to order prescription drugs from Canada, Britain and Ireland, often at a lower price than in the United States. She also has added tens of thousands of children from low-income households to state health programs. (Washington Post)

This Week In: Caffeine

Caffeine is one of those substances, like soy or beta-carotine, that has a constantly evolving relationship with the headlines. One week coffee is a miracle elixir, the next it's a hot cup of death. This week is one of the good ones.

Researchers from the University of Washington in Seattle (naturally) proved what previous studies had indicated - that caffeine can protect against sun damage. They showed that, in mice, caffeine causes cells damaged by the sun to self-destruct - especially damaged cells that might go on to cause skin cancer.

These studies aren't tried and true guidelines: they're often done in people with pre-existing conditions or risk factors, on mice, or with extremely high doses of caffeine. Still, there's a lot of confusion about what caffeine can or can't do, so we compiled some recent (within the last five years) caffeine-related research from research aggregator Newswise.com. Here's what we know - and what we don't.

The Good:
Improves memory in women (American Academy of Neurology)
Helps muscles refuel post-workout (American Physiological Society)
Protects against eyeball spasm that can lead to blindness (British Medical Journal)
Lowers risk of type-II diabetes (Archives of Internal Medicine)
Associated with lower risk of alcohol-related liver disease (Archives of Internal Medicine)

The Bad:
Increases miscarriage risk (American Journal of Obstetrics and Gynecology)
Increases non-fatal heart attack risk in those with rare gene variation (Journal of the American Medical Association)
Can trigger a heart attack in sedentary individuals with high risk factors (Epidemiology)

The Fake:
Does not increase hypertension in women (JAMA)
Does not affect birth weight or length when consumed by pregnant mothers (though the miscarriage link should override this particular concern) (BMJ)
Does not increase breast cancer risk (Archives of Internal Medicine)


With all the conflicting info, it's hard to figure out whether you should put the latte down or double your dose. If you're healthy, the answer is closer to what you mother told you all along - everything in moderation.

photo by Omar_MK, courtesy of Creative Commons,

Dot Com Diagnosis: Or, How to Use the Internet For Research Without Totally Freaking Yourself Out

So you’ve got this cough. It’s kind of tickly, it’s kind of phlegm-y, and it’s just not going away. Should you make a doctor's appointment or just drink more fluids? Considering everything else is available online, from car repair advice to sex tips, why shouldn't the internet be able to answer this question? Point, click, and twenty minutes later, you’ve narrowed it down to TB, a ragweed allergy or the remains of a calcified twin lodged in your larynx.

The Web is full of answers to your basic and not-so-basic health questions – and it’s also full of thousands of red herrings, zealous crackpots, and flat-out lies. Using the internet wisely will help you take control of your health, save on medical costs, and ease nagging fears. Browsing without borders, on the other hand, can can lead to paranoia, hysteria, and time lost at your next doctor's appointment.

The next time you turn to your laptop for medical advice, keep these tips in mind:


1. Stay off the forums
At least until you have a diagnosis. Medical sites like WebMD and MayoClinic.com are great for finding a diagnosis or learning more about your condition, but once you know what you're dealing with, online support groups can provide helpful answers to practical questions.

However, if you don't have a diagnosis yet, the forums may be overwhelming. "A lot of times the forums become mini case studies where you get a lot of personal information," says Sarah Bass, PhD MPH, an associate professor of Public Health at Temple University. "They'll say, 'I’m not taking that medication because it made me do XYZ, so you shouldn’t take it either.' " Until you know what you're dealing with and have a chat with your doctor about options, trolling the forums can be a case of information overload. And because these groups are safe spaces for people with confirmed diagnosis to vent their fears and frustrations, going int without a confirmed diagnosis make make you more worried than you need to be.

2. Know what you're looking for.
Before you go online, clearly define your search parameters. That way, you're less likely be swayed -- or feel phantom pains - by what you read online. "If you know you’re a suggestible person, it would be a good tool to write down what you’re really concerned about and a list of your symptoms before you go on a wide-open search," says Roger Harms, MD, medical editor-in-chief of MayoClinic.com.

3. Remember that hoof beats equal horses, not zebras.

4. Determine the validity of the site.
You wouldn't take medical advice from a guy working out of the back of a van, so don't waste time on sites of uncertain pedigree.

TK 6 MORE OPTIONS

The Consult: News from the Web

Bacteria in human spit is consistent across continents, which could influence our understanding of diet and medical conditions worldwide. Reuters

New drug combo may beat drug-resistant TB. Newswise

The most unhealthy canned good ever? Consumerist

The future of food. Portfolio

10 questions you should ask before your colonoscopy. NYTimes

Second DC-area teen dies of the flu. Washington Post