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Stephen C Schimpff's Blog (101)

Mesothelioma – A Poorly Understood Cancer

Today is national mesothelioma awareness day which is fitting because so few know what mesothelioma is or its impact on its victims. Mesotheliomas are rare tumors caused predominantly by exposure to asbestos. This cancer is hard to diagnose early and harder still to treat effectively but there are advances coming and multi-disciplinary care along with good palliative care can markedly improve overall treatment.

 

They mostly occur on the lung lining (pleura) but can…

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Added by Stephen C Schimpff on September 26, 2011 at 3:22pm — No Comments

Complex, Chronic Illnesses Last a Lifetime and Consume 70% of the Healthcare Dollar

Medical care is organized to treat acute conditions but the need today is to prevent, diagnose and treat chronic illnesses. Unfortunately, we are sorely lacking in a good chronic care management system. this will be the first in a series of six posts on this issue.

 

Our medical care system has developed over decades and even centuries around diagnosing and treating acute illnesses such as pneumonia, a gall bladder attack or appendicitis. The internist gives an antibiotic for…

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Added by Stephen C Schimpff on September 8, 2011 at 4:42pm — No Comments

Your Lifestyle Can Prevent Sudden Cardiac Death

Adhering to a moderate yet healthy lifestyle can reduce the risk of sudden cardiac death by about 90% according to a new study. It is well known that high blood pressure, high cholesterol, and diabetes correlate with coronary artery disease. Life style factors do as well – a combination of a Mediterranean style diet, moderate regular exercise, appropriate weight  and non smoking all correlate with less coronary artery disease, less stroke, less high blood pressure, less diabetes, less…

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Added by Stephen C Schimpff on July 23, 2011 at 8:10am — No Comments

AIDS Stages of Care – Three So Far; Will Number Four Come Soon? It All Depends on Finding A Vaccine

It was just 30 years ago in June 1981 when the first cases of what came to be known as Acquired Immune Deficiency Syndrome (AIDS) were published by the Centers for Disease Control (CDC) in its Morbidity and Mortality Weekly Report (MMWR.) These were men who had a wasting illness and died of unusual infections, ones of the types seen mostly in “immunocompromised hosts.” These were infections with which I was very familiar in my work treating and preventing infections in aggressively treated…

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Added by Stephen C Schimpff on June 29, 2011 at 9:30am — 1 Comment

Improving Cancer Patient Care While Markedly Reducing Costs

It is often difficult to appreciate that improving the care of patients can actually reduce the costs of care. Last year Dr H Brody wrote in the New England Journal of Medicine (vol 362, p283-5) about “Medicine’s ethical responsibility for health care reform – the top five list.”  In essence he challenged physicians to be first to find ways to rationally reduce health care costs by identifying the top five tests or treatments in any given specialty or subspecialty that could be markedly…

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Added by Stephen C Schimpff on June 8, 2011 at 1:52pm — No Comments

Using Genomics to Improve Treatment of Lung Cancer

Drug companies can use genomics to create targeted drugs like imatinib (Gleevec) and trastuzumab (Herceptin.) Physicians can then use the results of genomic studies to guide prescribing. As discussed in prior posts, a person with Philadelphia chromosome-positive (i.e., having the BCR-ABL translocation with its aberrant tyrosine kinase) chronic myelocytic leukemia will likely respond to Gleevec. And a woman whose breast cancer shows high levels of the Her2neu receptor will likely respond to…

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Added by Stephen C Schimpff on June 3, 2011 at 11:33am — No Comments

Mitral Valve Repair Without Open Surgery – Exciting Development in Medical Devices

The mitral valve separates the heart’s left atrium from the left ventricle. When the ventricle contracts to send blood to the aorta and out to the body, the mitral valve closes to prevent blood rushing backward into the atrium and back to the lungs. The mitral valve can become stiff and tight, called stenosis or it can become unable to close tightly, called regurgitation. Once the regurgitation becomes sufficiently severe to cause heart failure, the death rate reaches about 5% per year. Most…

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Added by Stephen C Schimpff on April 20, 2011 at 5:16pm — No Comments

Ultraprocessed Foods Lead to Chronic Illnesses

Much of today’s foods are “ultraprocessed,” lead to obesity and its ultimate diseases such as diabetes, coronary artery disease, hypertension, many cancers and worsening of diseases such as osteoarthritis.

 

Ultraprocessed foods originate from just a few grains, namely corn, wheat and soy but these then undergo extensive chemical and mechanical manipulation resulting in compounds that humans have never eaten before. Just look at the ingredients list on many store products and…

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Added by Stephen C Schimpff on April 18, 2011 at 9:51am — No Comments

Surprise – Adolescent Obesity Leads To Later Heart Disease and Diabetes

Well, probably not a surprise at all. The seeds of coronary artery disease (CAD) are laid down early and over long periods. But given our current pandemic of obesity beginning in childhood, should we worry about an epidemic of chronic disease like diabetes and CAD in the years to come? The clear answer is a resounding “Yes.”

 

There has been a long term study of military men in the Israeli Defense Force. An article in the New England Journal of Medicine, April 7, 2011 reports…

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Added by Stephen C Schimpff on April 11, 2011 at 5:52pm — No Comments

Bringing Down the Costs of Medical Care

It is currently popular for government officials to single out the insurance companies for the rising cost of healthcare. Not that the insurers are without fault but the real reasons for cost increases are rarely addressed and therefore not appreciated. We are a country with an aging population (“old parts wear out”) and of many adverse behaviors (e.g., overweight, sedentary lifestyle, stress and 20% still smoke.) Combined, these are driving a rapid increase in chronic diseases such as…

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Added by Stephen C Schimpff on March 27, 2011 at 8:45am — No Comments

Surviving Cancer As A Teenager – It’s Not Just The Treatments

When Clarissa was 13 she entered Johns Hopkins Hospital to be treated for relapsed acute leukemia knowing full well that she had only a 40% chance of survival. Today she is 16 and in excellent health. But it took 2 ½ years of incredibly rigorous treatments to get there. Equally importantly it meant riding an emotional roller coaster for her and her parents. 

Clarissa had been treated for leukemia when she was 2 and had been fine for a decade when the relapse occurred. She found there…

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Added by Stephen C Schimpff on March 14, 2011 at 3:25pm — No Comments

Palliative Care Teams – A Big Improvement in Quality of Life

During the healthcare reform debate there was the unfortunate reference to “death panels.” No such thing was ever in the proposals but it meant that an important part of medical care was set aside as too “toxic” to discuss. But end of life counseling is very important. Indeed it is good to have realistic discussions at the beginning of a serious illness; indeed it is only fair to the patient and the patient’s family.

            Palliative care (I don’t like the term; it seems to…

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Added by Stephen C Schimpff on February 21, 2011 at 4:22pm — No Comments

“Protocol Medicine” – It Is Time For Doctors To Recognize Its Value

We hear that doctors do not like “protocol medicine” – they do not want to follow a “cookbook” when every patient is different. It is not a good understanding of the issues.

 

Some years ago when I worked in a branch of he National Cancer Institute and then the University of Maryland Cancer Center, we admitted many patients with acute leukemia. The treatment approach including the necessary special tests to obtain, chemotherapy drugs, steps to prevent infection, prevent kidney…

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Added by Stephen C Schimpff on February 9, 2011 at 3:25pm — No Comments

The Incidence Of Kidney Failure Due To Diabetes Is Down – But We Should Not Be Pleased

Diabetes mellitus is the most common cause of kidney failure that progresses to end stage renal disease (ESRD,) meaning that the person requires dialysis or kidney transplant. ESRD is chronic and life long, is complicated to treat, has a major negative effect on quality of life and the costs are high.

So it was good news when the Centers of Disease Control reported that the incidence of ESRD among diabetics had declined by…

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Added by Stephen C Schimpff on January 18, 2011 at 3:23pm — No Comments

The Shingles Vaccine Really Works But Many Older Folks Don’t Receive It - They Should

Herpes zoster (or shingles) is caused by the same virus that causes chicken pox. Zoster increases in incidence with advancing age. It is estimated that over 1 million Americans get shingles annually with the resulting acute discomfort and often chronic pain thereafter. A vaccine was introduced by Merck in 2006; the initial studies of 38,546 patients indicated that it reduced the incidence by about 50% and for those who still got shingles, the severity was lessened substantially. But…

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Added by Stephen C Schimpff on January 14, 2011 at 3:51pm — No Comments

To Scan or Not To Scan for Early Lung Cancer

Lung cancer is the most common cancer other than skin cancer. The survival rate is still dismal so early diagnosis presumably could make an impact. Chest x-rays just do not have the sensitivity to find early lung cancer. Computed tomography (CT Scans) can detect very small lesions in the lung. Another study has now been completed and it was able to find many early cancers.…

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Added by Stephen C Schimpff on January 12, 2011 at 3:36pm — No Comments

Hospitals are Unsafe - There Are Still Plenty of Preventable Medical Errors

Over the past ten years and since the publication of the Institute of Medicine landmark book “To Err Is Human” there have been many attempts to reduce preventable medical errors which are estimated to take about 100,000 lives per year – perhaps many more. The question is whether all of this effort has had a substantial clinical impact.

The results of a recently published study are therefore concerning. A…

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Added by Stephen C Schimpff on December 14, 2010 at 11:54am — No Comments

Two Treatments For Macular Degeneration – At Wildly Divergent Costs

Age-related macular degeneration (AMD) is the leading cause of blindness in the United States. More than 1 million Americans have neovascular or “wet” AMD and a slightly lower number have “dry” AMD which often progresses to the more severe “wet” form. Since this is a disease of aging, we can expect many more cases as the population expands in the coming years.



Neovascular AMD appears to be related, at lease in part, to excess production of vascular endothelial growth factor… Continue

Added by Stephen C Schimpff on December 8, 2010 at 2:25pm — No Comments

Replacing the Aortic Valve Without Open Surgery!

Aortic stenosis (a narrowing and hardening of the heart’s aortic valve) is not uncommon among older individuals. It begins without symptoms and progresses for years but, about 50% will die within 2 years once the fitst symptoms develop. The standard approach is to surgically replace the aortic valve which will improve both heart function and survival. Unfortunately, about 30% of symptomatic individuals cannot undergo surgery because of older age, other heart problems or other medical conditions… Continue

Added by Stephen C Schimpff on December 1, 2010 at 10:50am — No Comments

Teamwork Improves Surgical Safety and Reduces Mortality

Like the cockpit, the operating room (OR) is fraught with high intensity, high complexity, high velocity, and high stakes. And as a capital intense location which serves as the financial engine of many or not most hospitals, there is pressure to use the OR efficiently. Like the cockpit, there is hierarchy, and a deep culture which includes strongly held rituals and customs. Unfortunately, there are also errors of omission and commission which lead to adverse outcomes including patient… Continue

Added by Stephen C Schimpff on November 14, 2010 at 9:04am — No Comments

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