Heart disease is an ailment that afflicts millions of Americans.   Doctors are well equipped to deal with patients who are at high risk for heart disease.  Unfortunately there are a lot of people who are in that broad middle category of either being neither high risk nor low risk.  Those people need to be monitored and their physicians need to keep a close eye on the various numbers that may apply if they fit into that category.

Heart Disease Signs/Symptoms

Those people that are at this intermediate risk for heart disease typically have the following signs/symptoms:

• blood pressure between 129/89 and 139/89
• LDL level of 100-130
• HDL level of less than 40
• two or more of the following risk factors- family history of heart disease, high blood pressure, high cholesterol, diabetes and smoking.

In a publication by the Virginia Hospital Center in Arlington, Virginia, Dr. Notarianni of that hospital recommends three (3) different screening tests for patients that fit into this category:

• a fasting lipid profile
• high-sensitivity C-reactive protein test (CRP)
• CT scan for calcium score

The fasting lipid profile tests for cholesterol.

The CRP tests for inflammation, which is the underlying cause of heart disease. 

The CT scan for calcium takes an image of the heart to detect calcium deposits in the coronary arteries.  These calcium deposits are an early sign of hardening of the arteries.

It is those people who are in this intermediate risk category that have good reason to be screened by this testing.  If the heart disease condition progresses beyond the intermediate level, then it becomes more difficult to deal with.

For more information on cardiac issues and medical malpractice , see the other pages on this site.

for more personal injury news and views visit, Brien Roche Law

Ophthalmologist-Common Eye Problems

Common eye problems that arise in people over 40 are such things as cataracts, macular degeneration, glaucoma and floaters.

Cataracts are small clumps of protein that form on the lens making it cloudy.  This can result in a loss of vision.  This vision loss cannot be corrected through glasses or contact lenses.  The clouding effect is the actual cataract.

Although there is no cure for cataracts, surgery can be an effective treatment.  The surgery consists of lens replacement. 

The patient needs to decide whether or not to go with a basic mono-focal lens that will allow the eye to see clearly either close up or at a distance or a premium lens, such as one that corrects astigmatism or even a multi-focal lens that can potentially restore the full range of vision without glasses.

The lens replacement consists of making a small opening in the cornea which is the front part of the eye, inserting a high frequency ultrasound probe to break up the cloudy lens, vacuum out the particles and then implant a clear artificial lens.

The lens is one of the few parts of the body that is not the recipient of any blood supply and as such it can be removed without any risk of the body rejecting it.

This form of lens removal can also be accomplished through a laser-assisted surgery that uses a computer-guided laser to deliver the pulses of energy to perform some of those steps.

Ophthalmologist- Macular Degeneration

Macular degeneration is the degeneration of the macula.  The macula is the tiny area near the center of the retina which is in the back of the eye.  The retina is that part of the eye which produces the sharp images that we are able to see.

Damage to the macula knocks out what is called “central vision” although it may not affect what is called “outside vision”.

This macular degeneration can come in forms that are described as either dry or wet.  The dry form progresses slowly over a period of many years.  The wet form occurs when new blood vessels under the macula leak blood and fluid.  This latter form of macular degeneration is more aggressive and can cause severe vision loss.

The standard treatment for wet macular degeneration is to use anitbodies to help prevent the growth of leaky blood vessels.  Although there is no cure for this condition, either dry or wet, supplements of high levels of antioxidant vitamins and minerals can slow down the progression.

Glaucoma has traditionally been defined as increased pressure within the eye.  Some researchers now believe that glaucoma is actually a neurological disorder associated with nerve cells in the brain that degenerate.  For many years doctors believed that glaucoma was simply increased eye pressure which could be treated by reducing the pressure.  Although eye pressure is a risk associated with glaucoma, there are other characteristic changes such as loss of peripheral vision and damage to the optic nerve that now seem to be more characteristic of glaucoma.  Glaucoma can cause blindness. 

Treatment for glaucoma typically is eye drops to lower the pressure.  Surgery can be recommended in some instances to improve the flow of fluid out of the eye, thereby controlling pressure.

Those people are most at-risk for glaucoma are those over 45, have a family history, are either near-sighed or far-sighed, are African-American or Hispanic, or people who have either diabetes, migraines or low blood pressure.

Another common ophthalmological problem is what is called ”floaters”.  These floaters are strands that seem to swim across the field of vision.  They are very common as you get older.  Typically they are just an annoyance.  They are caused by bits of gel that are within the vitreous fluid within the eye peeling off and floating around the inside of the eye cavity.  Most of the inside of the eyeball is filled with this vitreous fluid.  The vitreous fluid is what provides shape and also acts as a shock aborber for the retina, which is the main visual component of the eye at the back of the eye.  These bits of gel that are floating  around cast shadows on the retina and that is what appear to be these floaters.

A sudden increase in the number of floaters paired with flashes of light or the appearance of a veil over the field of vision is something more significant and could be a potential warning sign of retinal detachment.  That requires immediate treatment.

For more information on medical malpractice, see the other pages on this site.

for more personal injury news and views visit, Brien Roche Law

Antioxidant product liability is not exactly the rage these days.  There is however a good bit of information floating around about the use of antioxidants and how beneficial they are.  More antioxidants however are not necessarily better.  The research in fact has shown that how you consume the antioxidants can make a big difference in your overall health.

Antioxidants are not vitamins.  Some of them are but some of them are also minerals.  Some are also enzymes.  Enzymes are protein molecules that facilitate chemical reactions in order to allow your cells to properly function. 

What antioxidants do is to essentially block the action of free, unstable chemical fragments that can cause harm.  These fragments can cause cells to grow and reproduce abnormally.  Your body produces these fragments during exercise and also during the process of converting food into energy.  In addition such things as smoking, drinking alcohol, being exposed to sunlight and also to certain environmental contaminants such as pesticides can trigger the production of more of these fragments.  Antioxidants, especially those in fruits, vegetables and whole grains counteract this process.  There is fairly well-accepted data that people who consume a greater amount of antioxidant-rich foods have a lower risk of certain disease processes.

Super Antioxidants

The idea that some fruits are so-to-speak “super antioxidants” is not true.  All fruits are healthful in this regard and should be combined.

There is also a great deal of focus on food supplements.  The problem with food supplements is that they are not food.  The data as to these food supplements suggest that they really do not provide any significant benefit. 

In addition the concept that more is better is not necessarily true in regards to antioxidants.  Too much can be problematic.  In particular, capsules that are labeled as “megadoses” of antioxidants can actually be harmful in that they may increase the production of these fragments, especially in people who drink alcohol or smoke.

Many of these products that are labeled as being rich in antioxidants also contain high levels of sugar and fat.  In general you should avoid processed food and if you are looking to increase to your vitamin E content then eat an ounce of dry roasted almonds.

Product Liability

For more information on product liability, see the other pages on this site.

for more personal injury news and views visit, Brien Roche Law

Hand Injuries

Hand injuries, whether they come in the form of bruises, breaks or cuts, can frequently be tricky.  There are a number of surgeons who hold themselves out as hand surgeons.  Many of them are cosmetic surgeons who also do hand surgery. 

As a general rule you are probably better served by having an orthopaedic surgeon who specializes in hand surgery perform any hand surgery for you.  Cosmetic surgeons may have certain skills as far as hand surgery but most of them do not have the in-depth training that the orthopaedic surgeons do who specialize in hand surgery.

One of the more common symptoms of a hand injury is significant bruising.  That bruising can be a sign of a fracture.  Bruising simply means that there is a pool of blood underneath the skin.  That bleeding can come from a break in a bone or other types of underlying injuries.

One of the more common treatment modes for hand injury is a splint.  In some instances splints can be harmful.  In particular they can be harmful if they are not used properly or if they are worn too long.  Fingers, like many parts of the body, cannot be stationary for long periods of time.  If they are then they tend to freeze up. 

Breaks in the bones in the hand frequently are treated with the insertion of very small screws.  The insertion of these screws allows movement to begin more quickly with less stiffness.  Once that movement can begin then typically physical therapy is prescribed in order to help the patient regain the full range of motion.

Another common finger injury is what is called a “mallet injury”.  This frequently manifests itself through a rupture of a tendon at the end of the finger.  That prevents a person from fully straightening the finger.  This type of  injury can be from a basketball injury to the tip of the finger where the ball hits the end of the finger or other types of blunt injury.  A mallet injury is treated with a splint and occasionally with surgery.

Other more significant injuries that involve the hand are fractures to the wrist.  Symptoms typically include bruising, swelling, pain, limited motion and inability to lift things.  Sometimes these fractures are difficult to see, in particular if the injury is to the thumb side of the wrist.  This is called a “scaphoid fracture”.  These are difficult to see on X-ray because they frequently do not show up until about 10 days after the injury.

For more information on hand injuries, see the other pages on this site.

for more personal injury news and views visit, Brien Roche Law

A communication failure among health care providers can be devastating to the patient. This is most critical during a hospital stay. In a recent Washington Post article of April 30, 2013 an incident is recounted where a gastroenterologist came in to a patient and reported that the patient had an obstructed kidney. The internist came in thereafter and reported that “We don’t know what’s wrong.” Shortly thereafter the social worker came in and said “You are good to go home.”

If these various providers had simply talked to each other the patient would have received one bit of information that hopefully would have been correct.

The problem is what is called “coordination of care”.  Nobody seems to be in charge.  As this same article indicates, that is the dirty little secret about health care.

This same article reports that it is estimated that between 44,000 and 98,000 deaths from such medical errors occur each year.  Likewise a 2010 federal report stated that 15,000 Medicare patients every month suffer some significant harm in hospitals.

Many hospitals have attempted to control the information flow by the hiring of what are called “hospitalists”.  A hospitalist typically is a internal medicine doctor.  These physicians are supposed to manage the patients’ care, coordinate the various specialists, manage medications and generally oversee the care of the patient and the transition of the patient from hospital to home or hospital to another facility.

The problem with the use of hospitalists is that many of them are simply overworked.  Most of them report a safe workload as being up to 15 patients but according to a survey from Johns Hopkins University School of Medicine 4 in 10 hospitalists that were interviewed struggled with excessive workloads.

In many hospitals these hospitalists  work 7 – 15 days in a row on shifts of 10 – 12 hours each in order to provide some continuity of care to the patients.

What is most disturbing is the lack of proper communication flow especially when things are not going as planned i.e., some medical error has occurred.  It is not at all unusual for the physicians at that point to close ranks and communicate only limited information to the patient for fear of implicating another physician.

The Joint Commission which is the national hospital accrediting group has attempted to develop some guidelines to assist hospitals in communicating well. 

A patient’s best mechanism of maintaining communication flow probably is to have his or her own advocate who can interact with the physicians.  Ideally this advocate should be some person with medical knowledge who can ask the appropriate questions, inquire into such things as fall safety, what medications are being used and their interaction, any planned surgery and the need for such.  With such an advocate the level of miscommunication certainly is reduced.

For more information on communication failure and medical malpractice , see the other pages on this site.

for more personal injury news and views visit, Brien Roche Law

A research team from Johns Hopkins University School of Medicine recently reported on their analysis of data from the National Practitioner Data Bank maintained by the federal government as to the primary cause of medical malpractice claims.  What they found was that misdiagnosis was the most common cause.

In this study, the physicians involved examined 25 years of malpractice payments as reported through the data bank.  What they found is that misdiagnosis is the most common, the most costly and also the most deadly of all medical errors.

A few examples of serious instances of misdiagnoses include mistaking an ectopic pregnancy for appendicitis, mistaking an aortic dissection for severe heartburn or mistaking a brain stem stroke for an episode of dizziness.

The research team reviewed 350,000 different malpractice cases. 

In 41% of the cases the misdiagnoses resulted in patient death.  The average payment for these successful misdiagnosis cases was $389,000.  The highest category of claims were obstetrical claims which averaged $695,000.

To some extent the fear of misdiagnosis has led physicians to overtreat.  This is seen frequently in emergency rooms where people who come in complaining of dizziness frequently are going to get a CT scan of the head.  Nationwide these scans cost millions of dollars and in most cases are useless.

For more information on misdiagnosis and medical malpractice see the other pages on this site.

for more personal injury news and views visit, Brien Roche Law

Hospital safety is a pressing issue especially since more than 180,000 people die every year from hospital errors.  Those errors come in a number of different forms.

It is estimated that nearly 6,000 egregious errors occur every month among Medicare patients alone.  By egregious errors, it is meant operations on the wrong limb or instruments left inside a surgical wound.  This data comes from the U.S. Department of Health and Human Services.

There is an organization in Washington, DC entitled the Leapfrog Group which is a non-profit which assesses hospitals on national standards of safety, quality and efficiency.

According to one study put out by the Institute of Medicine, approximately 400,000 drug-related injuries occur each year in hospitals. 

There are a host of things that hospitals either can do or, in many instances, are doing in order to improve overall patient safety: 

• To reduce medication errors, the use of a computerized provider order entry system forces doctors to enter prescriptions into the computer electronically thereby eliminating transcription errors.  This system also calls for bar coding so that the patient’s bracelet is scanned to ensure that the right patient is getting the medication.  This system also allows new drug orders to be checked against the patient’s existing medication record for possible interactions or allergies.
• In order to reduce the nearly 100,000 that die per year from hospital infections, many hospitals have implemented new safety procedures in terms of central line infections.  A central line is a catheter that is used to provide a patient with medicine or nourishment.  If that central line becomes contaminated it can be devastating.
• Many hospitals are also using disinfection units that employ ultraviolet light to kill germs in hospital rooms.  There is also available electronic screening tools to pick up early signs of infection in the blood.
• Before any surgical procedure is performed it is the custom in many hospitals to have what is called a “timeout”.  During this timeout each person who is within the surgical area identifies himself, they verify the patient’s name, they verify the type of surgery that is being performed and they verify the surgical site.   In most instances that surgical site is actually marked with a marker so as to confirm that everybody knows where the correct site is.  Until that process is completed the surgeon cannot touch the instruments. 
• In addition another technique employed to prevent sponges from being left behind in the surgical site is that sponges may be tagged with a radio frequency chip.  Before the patient is actually closed up, the surgeon waves a wand over the body so as to make sure that there are no sponges left inside.
• Having an intensivist monitor every patient in the Intensive Care Unit reduces the risk of death in these critical care units by up to 40%.
• Some simple nursing procedures that can help improve patient safety are to place necessary supplies for each patient actually in the patient’s room.  That way the nurse does not need to leave the room in order to find the necessary supplies. 
• The “hand-off” procedure of one nurse to the next nurse frequently is done out of the presence of the patient thereby drawing the nurse away from the patient.  If this procedure is conducted in front of patient, then the patient not only has the opportunity to meet the new nurse coming on duty, but the patient’s condition is actually reviewed in front of the patient with the patient providing necessary input.
• Hospital rooms can be negatively pressurized so that the air from contagious patients is expelled from the building instead of circulating within the HVAC system.
• Another simple technique is to construct hospital rooms identical one to the other so that people coming into the room needing to find necessary supplies only have to look in one place because in every room they are stored in the same place.
• The so-called “Patient Safety Alert System” is one where anyone within the health care team can report a potential danger to a patient.  If that person makes the report, a physician may be informed of it but if the physician is expressly told, there can be no reprimand or negative behavior toward that reporting person.  If a physician violates that his privileges may be revoked.
• Some hospitals have adopted the novel approach of actually admitting errors to patients promptly, issuing an apology and in some instances offering a settlement.

For more information on hospital safety and related personal injury issues see the other pages on this site.

for more personal injury news and views visit, Brien Roche Law

Affordable medical care is an issue for all of us.  In particular, it can become an issue for someone who is injured. 

Medical costs drive an estimated 60% of personal bankruptcies across the country.

The Affordable Care Act (also called “ObamaCare”) mandates that every state set up health care exchanges where people in need can buy affordable health insurance.

One mechanism through which this coverage is obtained is through what are called public community health centers.  At these health centers, patients pay on a sliding income scale and in some instances may not have to pay anything.

Another alternative is to see a nurse practitioner.  In some states nurse practitioners are allowed to practice independent of doctors.  In other cases they practice under the supervision of a doctor.  A nurse practitioner is a registered nurse who has received additional training beyond nursing school.  They are qualified to give physical examinations, stitch wounds, prescribe medication and manage certain chronic illnesses.  In many cases they can provide the same quality of care as a medical doctor.

There are also available what are called “Health Fairs” that are sponsored by churches, malls and various corporations around the country.  At these health fairs they frequently offer free screenings for blood pressure, cholesterol, glaucoma, bone density and other things.

One final thing to consider in terms of obtaining affordable health care, is that once you obtain the health care that you need, if the bills are not within the range of your payment scale, you can hire a medical care advocate who will negotiate with the health care provider to reduce the bill.  The medical care advocate charges a percentage of what that person saves you.

We all know that affordable medical care is critical; not only for people who are injured but for all of us.  For more information on personal injury issues, see the other pages on this site.

for more personal injury news and views visit, Brien Roche Law

On April 17, 2013 a fertilizer plant in Texas exploded.  The fertilizer plant had no sprinklers.  It had no fire walls.  It had no water deluge system.  Safety inspections at the plant were, at best, sporadic.

It so happens that small fertilizer plants across the nation are overseen by a number of governmental agencies; each with limited jurisdiction and therefore basically operating with their blinders on as to other potential violations.

The source of the explosion in this case was ammonium nitrate, which is the chemical used to build the bomb that blew up the federal building in Oklahoma City in 1995. 

What is particularly lacking in the regulatory scheme are any guidelines as to how close a facility like this can be to residential neighborhoods.  There is no federal agency that determines how close such a facility can be to population centers.  That is left up to to local zoning authorities.  In the state of Texas zoning is typically de minimis and as such it is not unheard of to have a plant such as this in close proximity to schools and houses.

The damage from this particular blast destroyed an apartment complex, a nursing home and houses in a 4-block area. 

The particular fertilizer company in this case not only stored but also distributed and blended fertilizers including chemicals such as anhydrous ammonia and also ammonium nitrate.  This is used by farmers throughout the central Texas area. 

This particular plant had been previously cited by the US EPA for not having an up-to-date Risk Management Plan.  That particular violation was resolved and the company submitted a new plan in 2011.  That plan however expressly stated that the company was not  storing or handling any flammable substances.  In addition the plan did not list fire or explosion as a potential danger.  It is the ammonium nitrate, which is a solid granular fertilizer, stored at the facility that was the source of the explosion.

For more information on product liability see the other pages on this site.

for more personal injury news and views visit, Brien Roche Law

Alcohol intake has been a subject of discussion for many years.  An article from The Washington Post on April 9, 2013 addresses five (5) things to know about drinking. 

Moderate alcohol consumption is typically defined as being two (2) drinks a day for a man and one (1) drink for a woman.  A drink is typically defined as being eight (8) ounces. 

The reason for the difference between men and women is the volume of body water that they carry.  Men have more body water.  That results in slightly lower blood alcohol concentration.  This applies regardless of what the size of the woman may be.  For instance even a larger woman cannot necessarily consume more alcohol safely.

Many people think that occasional binge drinking is not harmful.  The evidence suggests that binge drinking probably is more harmful than regular consumption.  People that binge are about 50% more likely to have a stroke over ten years than those who drink alcohol moderately or not at all.

Drinking also seems to be associated with increased rates of cancer of the mouth, esophagus, pharynx, larynx, liver and breast. 

In addition another study has indicated that heavy drinking of four (4) or more drinks per day is associated with a five (5)-fold increase in the risk of certain cancers.

There are some alcoholic beverages that certainly may have some beneficial effect.  Red wine is generally thought to have some benefit in preventing cardiovascular disease.  One study however indicated that men who drank nonalcoholic red wine actually saw a significant decrease in blood pressure.  The belief is that this is probably due to the concentration of polyphenols which are a type of antioxidant that is in the grape skins.  This same benefit can probably be obtained from simply drinking grape juice.

It is also pretty well established that alcohol does not mix with many prescription medications; in particular with those used to treat heart or blood pressure disease, digestive problems, diabetes, anxiety or depression. 

The rule of thumb of course is moderation.  A moderate amount of alcohol of any type probably is not going to have any significant adverse impact but overindulgence may.  Moderate consumption is defined above.

For more information on alcohol issues and vehicle accident, see the other pages on this site.

for more personal injury news and views visit, Brien Roche Law