Thursday, April 30, 2009

Masks DO Help Against Swine Flu

I heard a bit of irresponsible journalism on the radio today. A reporter stated that people should wash their hands regularly to prevent infection/transmission of swine flu, but that masks were useless.

Now I agree that hand washing is probably MORE important than wearing a mask, but a mask can still help! I'm specifically concerned that someone who thinks that they are infected with swine flu may decide to fore go a mask because they think it doesn't make a difference. If you are infected, wearing a mask is of utmost importance if you are going out in public, which you hopefully aren't, because a proper mask will prevent the transmission of your germs to everyone around you.

If you aren't infected, wearing a mask can help stop germs from getting into your body, but unless you are in an environment where you are in close proximity to infected individuals (like you work in a hospital) you probably are at a lower risk of infection. Most infectious agents do not remain in the air for long after they are expelled by their host (i.e. after a person sneezes). Of course if you want to play it safe, why not put the mask on. Better yet, get the mask companies to make designer masks that make you look like a superhero.

Baby Formula Made Wrong!

We were told about a case today where a mother mixed up her portions when she was making formula for her newborn. Instead of mixing 1 part formula powder with 2 parts water, she mixed 4 parts formula with 1 part water. The baby ended up dying with a blood sodium level above 200 mmol/L (normal levels are around 140 mmol/L).

The poor baby was basically poisoned by salt...

Wednesday, April 29, 2009

Insurance vs. Diagnosis

Imagine a scenario where you suspect you have a debilitating illness. You have had scary symptoms, like shaking uncontrollably and randomly losing your balance, for almost a year. You have never seen symptoms like this before and you are scared. Your latest symptoms provide more insight into your disease and the doctor says that he finally has an idea what may be the diagnosis.

To confirm the diagnosis he must do some imaging. However, if he does the imaging and the imaging supports the diagnosis, then your medical record will show that you have a chronic condition. Your doctor advises you to get disability and health insurance before you get the imaging done because it will be much easier and cheaper if you get the insurance while your records say that you are healthy. However, this means you will have to wait for several more months before you know if you actually have the disease.

Did the doctor do the right thing in this scenario? He is giving his patient the opportunity to acquire affordable insurance before he confirms the diagnosis. If I was the patient, this is the scenario I would prefer. However, there are patients out there that are very anxious and want to know what their illness is immediately. For them, that anxiety outweighs the potential benefit gained from getting their affairs in order.

As usual, the right answer in this scenario is to present all the information to the patient and let them decide...even if it seems like the patient may be making life harder for themselves with their decision.

Tuesday, April 28, 2009

What Makes Swine Flu So Dangerous?

Unless you've been disconnected from the global news for the past few days, you've heard of swine flu. Swine flu is basically the flu in pigs caused by a specific strain of influenza. The influenza viruses are a family of viruses that infect mammals (including people) and birds.

There are multiple strains of the influenza virus. Different strains have slight differences in their genetic code, which result in massive differences in the virus' features. Different strains are often specific to different species and some are better at hiding from their hosts immune system than others.

Influenza viruses are most dangerous when they are first able to infect a new host species. For example, our bodies have seen human influenza for years and our immune system has learned how to fight it. This is why most of us only have flu like symptoms for about a week after we are infected with human influenza. However, our bodies have never seen swine influenza because we aren't pigs (feminists may disagree with half of that statement). Thus, when swine flu is first able to infect humans, the virus is incredibly good at making us sick because our immune systems don't know how to fight it.

Swine flu has the potential to be a pandemic because it may be difficult for our immune systems to fight, which means it would be able to easily spread from person to person.

A very important point to remember is that all the infected patients in Canada have had mild symptoms, so this virus may not be as dangerous as we are fearing. However, it is responsible for over 150 deaths in Mexico, so health authorities are justified in their concerns about swine flu.

Sunday, April 19, 2009

Listen To Your Patients...Even If They Seem Crazy

We learned a valuable lesson in patient care last week. We were told about a patient who was visiting a city on business and wound up in the hospital. He was waking up from general anesthesia to hear his doctor order him a course of heparin (heparin is a blood thinning agent). Upon waking up and hearing the order the patient demanded not to be given heparin, stating there was an article about how heparin was contraindicated in his condition in some journal from the 1980's. When asked how he knew about this article, the patient said he know about it because he wrote it. This was how the story was told to us; however, I do suspect that since this patient was waking up from anesthesia, the language may have been more colourful and a shade more disrespectful because the attending physician completely ignored the patient. My guess is the doctor thought the patient was still hopped up on the drugs he was given and his comments were just lunatic ramblings.

Turns out this patient was our professor and a doctor himself. Also turns out that he actually did write that article and knew what he was talking about. He almost bled to death because his doctor ignored him.

Saturday, April 18, 2009

Why Male Medical Students Get The Shaft

Believe me, I'm thankful I'll never have to push a tiny person through my genitalia after growing it for 9 (really 10) months, I'm also happy living without a monthly hormonal cycle, but sometimes you miss out on good learning experiences being a guy.

At my school, we work with family doctors once a week throughout the year. Most of us go in pairs, often one guy and one girl. Almost every girl who comes in for anything uniquely feminine (yeast infection, pap smear, breast exam, etc.) will only see a female student. This double standard does not cross genders because male patients seem to be more than happy to talk about erectile dysfunction or drop their trousers in front of either a guy or a girl.

This dichotomy does not affect most of us because we will eventually deal with these illnesses in the hospitals when we are 3rd year students; however, it would probably be better for everybody if we gained some practical experience sooner rather than later. If you reach the point where a urinary tract infection has put you in the hospital, do you really want a medical student who has never talked to a female patient about anything "feminine" before?

The students who are really hurt by this discrimination are the male students who are interested in OB/GYN. There aren't many, but those few miss out on clinical experiences that may decide their future careers.

Saturday, April 4, 2009

Hemoglobin is Proof of God II: Carbon Dioxide Transport

If you came to this series of posts hoping to find a rigorous theological debate regarding the existence of an omnipotent power...I'm sorry to disappoint (not really).

Carbon dioxide (CO2) is a metabolic byproduct of aerobic metabolism. Aerobic metabolism is our bodies' primary method of energy generation and it produces a large amount of CO2. This CO2 is released from our bodies into the external environment through our lungs, which will be discussed in a later post. This means that our blood has to transport CO2 from our tissues (e.g. your calf muscle) to our lungs.

There are 3 methods of CO2 transport:

1) CO2, like oxygen, is transported as a dissolved gas in blood plasma. This accounts for 2-10% of our blood's total CO2.

2) CO2 can bind to hemoglobin (and other blood proteins) and be transported to the lungs with the hemoglobin. A single CO2 binds to a single hemoglobin molecule (remember this is different than oxygen, 4 oxygen molecules bind to 1 hemoglobin molecule). This accounts for 5-10% of our blood's total CO2.

3) CO2 can be converted to bicarbonate (HCO3-) by an enzyme called carbonic anyhdrase. The chemical equation for this reaction is: CO2 + H20 -> H2CO3 -> H+ + HCO3-. This reaction is reversible. 80-90% of our blood's CO2 is transported as bicarbonate.

Note: An important concept to understand for future posts will be Le Chatelier's principle
, with regards to concentration, and how it applies to the above equation.

The next post will discuss how gas is exchanged in the lungs.

Friday, April 3, 2009

Hemoglobin is Proof of God I: Oxygen Transport

If you came to this series of posts hoping to find a rigorous theological debate regarding the existence of an omnipotent power...I'm sorry to disappoint (not really!).

Hemoglobin is a protein found in red blood cells. Hemoglobin consists of four subunits and each subunit can bind to a single oxygen molecule. This is the main method of oxygen transportation in our bodies, 98% of our blood oxygen is bound to hemoglobin. If we didn't have hemoglobin, we would die because our organs would suffocate, they would not get enough oxygen (at least you would leave a pretty corpse).

The remaining 2% of the oxygen in our blood is dissolved in the blood fluid (note: if the idea of gasses dissolved in fluid confuses you, think pop (soda for the americans), the bubbles in pop are created because carbon dioxide is dissolved into the drink at the manufacturing plant).

Hemoglobin is, in a sense, a perfect protein. It has several properties that make it an optimal molecule to help with gas exchange. This series will cover several background topics, culminating in a final post explaining these optomized properties.

The next post will discuss carbon dioxide transport in the blood.