Leg Operation

I was skiing last week in Italy but sadly a good friend of mine crashed on her skis on day two of the week and broke her fibula and tibia (shinbone); for anatomy of the leg go to http://www.nlm.nih.gov/medlineplus/ency/imagepages/8844.htm. She was taken down the mountain in what I like to call a 'body bag' which is, for those who haven't skied, a one man sledge on skis with someone skiing at the front (check out my facebook photos since I have had the experience of being in one!). She was then admitted to the medical centre in Sauze D'Oulx (the town we were staying at) and then moved to a hospital 40km away at the base of the mountain range in Susa.

In that holiday I learnt so much that I can't actually put it into one post. Firstly it's usually me who is the one breaking bones; having broken both my wrists (one of them twice and having an operation to put pins in), and my right collar bone a couple of times (one of which was whilst on a skiing trip with the same friends)... so usually I am used to being carted into hospital and dealing with the situation in my own way...but this time it was someone else and I had to take up a different position. I felt that I needed to care for them and help them having been in the situation before and did my best by making her comfortable on the slopes for the hour that we waited for medical attention.

Once she was out of sight down the slope (in the blood wagon) it didn't feel like it was over because the rest of us (6 left) had to get down the mountain safely and back to the chalet to get items for her to take to hospital if need be...she did need the things and ended up staying in hospital for a full week, entering on Sunday, operation on Wednesday and leaving the following Sunday.

In her operation she had a rod/nail put in place down the inside of her tibia... "Intramedullary (IM) rods are used to align and stabilize fractures. IM rods are inserted into the bone marrow canal in the centre of the long bones of the extremities (e.g. femur or tibia)" (http://orthopedics.about.com/cs/brokenbones/g/imrod.htm). There is a video that I found of surgery where this happens at (http://tinyurl.com/7p4ajq7), not for the feint hearted!

On the day after the operation I went down to see her for the first time since the accident and it was really nice to see her in a lot less pain than she had been before the operation, because I had been told that she had been uncomfortable due to the lack of movement she had and the caring she had received. In European hospitals there isn't the care that we get in the UK. They don't have nursing staff going around and washing everybody (or even simple things like brushing teeth) and making them comfortable. They come, do what they have too i.e. change a drip, and go away again. What I really noticed was the lack of what's called 'bedside manner' that the staff had, to them it was a job and that's it, there was no attempt at co-operation at all, or even trying to get over the language barrier by using hand signals.

The final point I will make is how I felt in the hospital. When I was there I was so glad to see her and to see that she looked so much more comfortable compared to being on the slopes and being taken down the mountain in a sledge. But something came over me as I stood there looking at her and all the drips and the flasks around her as if I had lots of thoughts and they all came out at once. It was as if I had held something inside me for a whole week...but I still can't explain it! Maybe it was the stress of the week, trying to keep everyone happy and laughing and it all caught up with me?!

But she is home now and in the best of care from her family. For those interested I also found a clip of an amputation (once again, not for the feint hearted) http://www.youtube.com/watch?v=lmlj8OafOwc.

Legionnaires' Disease

Legionnaires' disease is a disease that "causes serious pneumonia (lung infection)" (http://tinyurl.com/83p7449) and is caught by "breathing in droplets of water which contain Legionella bacteria. The illness is fatal in some cases" (http://tinyurl.com/83p7449). However, the Legionella may not always lead to Legionnaires' disease, in some cases it can lead to "Pontiac fever. This is when the bacteria cause a flu-like illness but it is not usually serious" (http://tinyurl.com/83p7449).

The history of where the name for Legionnaires' disease came from is when; "in 1976 an outbreak of pneumonia occurred among American legionnaires (ex-servicemen) who attended a conference. 221 people developed pneumonia and 34 died" (http://tinyurl.com/83p7449).

The Legionella bacterium "thrives in water, and is often spread through water droplets from cooling systems, shower heads and taps, but cannot be spread from person to person" (The WEEK 15th October 2011) with around "35°C being the optimum temperature" (http://tinyurl.com/83p7449). So, "In the UK, and in many other countries, there are regulations on how to maintain water supplies and air conditioning systems used in large buildings" (http://tinyurl.com/83p7449). This therefore limits the risk of Legionnaires' disease in the countries where water system regulations are in place.

The statistics (all from http://www.primec.co.uk/stats.htm);
-1980-2001 there were 150 to 250 cases reported to the scheme each year.
-From 2002 onwards, that number climbed; with over 550 cases in 2006.
-Hospital Episode Statistics for 2005–2006 showed that over 300,000 cases of community-acquired pneumonia (CAP) were admitted to hospital in England. Over 293,000 were never specified further; studies demonstrate that a significant proportion of these can probably be attributed to Legionnaires’.
-The unusually high case numbers in 2006 occurred predominantly over the summer months.

The idea that cases predominantly happened in the summer months of 2006 follows the evidence that the Legionella bacteria thrive in water with an optimum temperature of 35°C (most likely achieved in the summer months).

The reason why I picked up on this story is because last year (August 2011) "nine people who were diagnosed with Legionnaires' were found to have travelled to Corfu, Greece" (The WEEK 15th October 2011). This shows that there is a risk where you travel; even in the European Union where there are a number of regulatory bodies. But don't be worried because it is a very rare disease and has a very low risk in the United Kingdom.

The story of the nine cases that I mentioned were followed up by the United Kingdom's Health Protection Agency and the story of how they tried to find the source of the illness can be read at this URL; http://news.sky.com/home/uk-news/article/16084823.

The Last Month

In the past month I have reported on a number of issues that have been prevalent in the media. The issues of the "Should Doctors Strike?" and "Assisted Suicide" were both cases which involved ethical issues. The post that I enjoyed writing most was "Cardiothoracic Surgery" mainly because of the videos but also because of the surgery side, which requires huge amounts of skill.

I have learnt so much in the past month about the medical world by doing this blog but have also learnt that I am only scratching at a tiny part of the huge surface that is the medical world. I realise this every time I write a post; when I'm try to back up what I am saying with quotes and ideas from leading doctors and scientists I find myself with a wall of academic papers, newspaper articles, published research and people's opinions but know that I don't have the time to wade through all of it to find out what I need... I resign myself to the fact that I can't wade through and understand everything there is in this world!

As it goes ethics are extremely important in medicine (although the most boring part of Biology AS!) because everything that a doctor does will be scrutinised by the hospital he works in or even by the media if the mistake is bad enough.

For example, even today, a story came out about assisted suicide. The man in question is a severely disabled man who "wants the court to rule that a doctor should be able to help him to die" (http://www.bbc.co.uk/news/uk-16957125). The man suffers from 'locked-in syndrome' where the "patient is mute and totally paralysed, except for eye movements, but remains conscious" (http://www.bbc.co.uk/news/uk-16957125).

So the question is; let him die or not?
From the doctors perspective it's a firm "no" (in all cases of assisted suicide) because of the Hippocratic Oath taken by all doctors to swear that they will practice medicine ethically. The man could be taken to Dignitas to die peacefully, but the doctor will not be allowed to take him, the family would have to take him. Doctors cannot be seen to take someone to die; it would be a media storm. The sad thing is that the doctors personal opinion cannot be known to influence his duty to keep patients alive, even if they believe the patient has the right to die if he wants too.

From the family point of view it would most probably be "yes/no". Yes, because they must be in so much emotional stress and pain and to be put out of their pain might be the best thing for the family as a whole. But on the other hand, this man is someone's son, maybe husband and uncle; he is part of the family, a living human being. It would be devastating for the family to lose him, so they may say no and take side with the doctors.

Whatever decision is made, this is an extremely sad case but is one that has come up before and will come up again in the future, the question is, what is the right thing to do in the circumstances?

Hospital: Weekend Death Rates

I picked up on news today that patients are more likely to die if they are admitted on a weekend compared to a weekday. This has come after a study was carried out in "the Journal of the Royal Society of Medicine" (http://www.bbc.co.uk/news/health-16868428).

Let's look at the stats (all from http://www.bbc.co.uk/news/health-16868428);
1. Research was carried out by UCL (University College London), UEA (University of East Anglia) and Birmingham University.
2. It covered more than 14 million hospital admissions and 187,300 patients who died within 30 days of being admitted (during 2009/2010).
3. For every 100 deaths on a Wednesday there were 116 on a Sunday.
4. The results were consistent with data from 254 not-for-profit hospitals in the United States, which they also analysed.

So the obvious issue here is that more patients are dying on the weekend than in the weekday. This is maybe because of the lack of senior medical staff/consultants working on the weekend; as suggested by Professor Domenico Pagano on the BBC website. The lack of senior staff could have a major impact because of the experience that they offer in emergency situations; experience that can only come with time for junior doctors.

Another issue is what action to take now that this study has been carried out. What really needs to happen is that there needs to be more experienced doctors in the hospitals or close enough to the hospitals to be there in an emergency rather than on call (not very practical though). If there are more consultants consistently in the hospitals over the whole week, then the death rate should theoretically be lowered, based on the idea that experienced staff around means less deaths (but not no deaths).

It would be interesting to get some statistics on the mortality rates against the number of consultants and junior doctors working on the wards to see if there is a correlation between mortality rate and the experience of the staff on duty.