Science Ain't So Bad

"Is it my imagination or is this one kinda restless?"

OW! OW! OW!

Although it’s UNUSUAL to wake up in the middle of an operation, it isn’t that rare, either.

Not to scare you or nothin’, but I’m lookin at a report in Deutsches Ärzteblatt International by Petra Bischoff and Ingrid Rundshagen. The report states that as many as one in 500 patients experience “unintended awareness” in the middle of an operation. For Massachusetts General, which does about 34,000 surgical procedures a year, that could be 78 people.

Worse for kids. Could be as much as one in 50.

Pop quiz. How many lawyers are there in the United States and what do they do for a living? (Answer: more lawyers than surgeons. More than all the doctors in the country put together. As for what they do for a living, care to guess how some of them are spending their time?)

Anesthesia isn’t just one thing. It consist of

unconsciousness (being asleep)
analgesia (doesn’t hurt)
amnesia (not being able to remember anything bad)
and temporary paralysis (can’t move)
reversibility’s good, too

All this stuff’s supposed to happen simulaneously. In fact, it’s really important that it does.

What happens when things go wrong? One possibility is that you might not be asleep when you’re sposed to be; you might feel what’s going on; you might be unable to move and,  therefore, be unable to let anyone know AND you might remember every horrible moment, later. That’s a really bad combo.

Another possibility: you might experience the pain but not recall the infinitely crappy experience. Does suffering count if you can’t remember it?

So many issues. So few trained philosophers.

Bischoff and and Rundshagen provide some suggestions to anesthesiologists and surgeons about possible steps to avoid unintended consciousness among their patients and MISTER ScienceAintSoBad fervently hopes their suggestions are heeded and lead to more tranquil surgical experiences but, all in all, MISTER ScienceAintSoBad would be a lot happier if he had never reviewed this darn paper.

Some things you just don’t want to know.

A CAVEAT

I don’t want to scare the pants off of you.

Anesthesiologists sometimes describe patients as being “light”. Doesn’t mean they’re fully awake. There’s an entire spectrum of wakefulness. Bischoff/Rundshagen describe “awareness” but don’t appear to distinguish how awake the patients are. It may well be that many of them are a little more aware than they should be but well south of  being tortured. It’s good to understand some of the things that  can happen during surgery, No need to walk around with a ripe appendix though.

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Credits for the above image (which show an operation on a US Navy ship)
This work is licensed under a Creative Commons Attribution-ShareAlike 3.0 Unported License.

DOCTORS CAN BE VERY REASSURING (1906)

THE GOOD

Life’s good, right? You’re very loved.

Money? Enough. Who needs more? Besides. Money’s not what counts. Summers are warm. Winters? Crisp. With snowball fights, skiing, and frosty branches glistening in front of the window.

It’ll always be like that. Nothing bad’s gonna happen. I Promise.

THE UGLY

Just in case my spell doesn’t work, here’s a resource. It’s for when somebody gets sick.

Very sick.

So sick that he or she runs out of options and the Doc, so optimistic and reassuring at first,  looks uneasy and emphasizes the need to be realistic. This is a place to go that’s out beyond the end of the road. Maybe it’s the next road. It’s called TrialsCentral.org . It was started  by Kay Dickersin  and a group from The Center for Clinical Trials and Evidence-based Healthcare at Brown University.

Couple of things to remember.

First, be sure you get yourself a second opinion. You’re not being disloyal. It’s a routine part of medicine. Your doctor won’t be the LEAST bit uncomfortable. He or she will be glad to make some recommendations. In fact, your Doc will also help you go over the possibilities for possible clinical trials.  You shouldn’t  feel you need to do this on your own.

Clinical trials are labeled as phase I, phase II,  phase III or phase IV. Phase I’s where they weed out the REAL stinkers. They’re looking at side effects and what can be tolerated. Mostly, they’re not looking for sick people anyway. Phase II’s where thing’s get a little more serious. They’re starting to figure out “efficacy” and trying to figure out what’s the right dose. Phase III’s where they get to spend lots of money recruiting subjects in trials in various locations around the country. These are the make/break tests that determine if it gets approved. The phase IV trials are kinda “tune ups” that’re done on drugs that are already out there.  (There are also “phase 0″ trials – ultra cautious tests on a few people. A sanity check to make sure they’re ready to do the Phase I stuff).

STUBBORN ENOUGH TO LIVE

If you’re looking for a miracle (am I mixing metaphors?) you’re interested in Phase III trials.  But. remember, even in a phase III trial with a very promising drug there’s a good chance you may be placed in a control group, meaning that you don’t get the drug or its benefits. And trials are EXPERIMENTS. They’re risky. You might have a better (short) life if you just carry on.

But you’re a gambler, aren’t you? You’re not gonna go unless you HAVE to. And you’re damn well not gonna go without a fight. Well don’t  forget that you may be able to argue for “compassionate use” (single patient access), meaning screw the science, just the drug please. Not EVERYONE wants to give a life for science.

Just a small footnote. (Well, I have to say this.) MisterScienceAin’tSoBad would never, knowingly, give you any bad advice or misinformation, but biomedical engineers don’t treat patients and don’t give medical advice. I do offer the very best information that I can but where your health’s at stake, you’ll want to verify anything you read here.

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Attribution for above image: By Anonymous [Public domain], via Wikimedia Commons

TUG OF WAR OVER A VITAMIN

A COUNTER STRIKE

Not that long ago, the well respected journal, Science Ain’t So Bad, wrote an article about vitamin D (IF YOU ONLY TOOK ONE PILL, WHAT WOULD IT BE?) It was a fine article. Thoughtful, carefully researched, and well balanced. It weighed the available information which boiled down to it’s being a pretty good idea for most people to take some vitamin D. Especially if they don’t get  much sun.  SASB’s article quoted  Walter Willett of the Harvard School of Public Health who felt that 1000 IU might be a decent dose.

Today’s paper had a new report from a panel of  the Institute of Medicine which dismissed all that unscientific crapola about how D’s good fer this ‘n good fer that. Let’s stay focused, the panel said, on what we really know. Most people do get enough of the stuff for their bones. Let’s not get crazy, said the panel.

Now what?

What you’re watching is the Ballet de Science. In Act I you saw the advocates on stage. They were all excited about the results of numerous studies, many of them preliminary, that seemed to show a) that many people are kinda deficient in the “sunshine” vitamin and b) vitamin D offers protection against lots of bad stuff.

ACT II

Now we’re watching Act II. In this act, some fancy panel reviews all the data, gets  huffy about the some of the more outlandish claims, and sounds alarmed about the ever increasing minimum requirements which were up to 5000 IU according to some authorities.

Here’s the thing. Some elements in the “scientific community” are conservative, others are bold.  The pendulum swings.

What now?

Was all that stuff about stroke, hypertension, autoimmune diseases, depression, pain, and – was it acne? – nonsense? Probably not. But, as the public got more interested in vitamin D, so did food producers. It’s showing up in a lot of the things we’re eating. If you’re getting it in your cereal AND swallowing pills, it really could be too much. And, while there’s no great evidence that high doses of D are bad, there are hints. Besides, there IS such a thing as too much of anything. Yer not gonna take a WHOLE bottle of aspirin for a headache, are you?

MISTER ScienceAintSoBad‘s not sure either, but the suggested guidelines from the panel aren’t all that far from what readers of this blog have believed were reasonable anyway (showing how smart you are to stay tuned to this channel). Maybe a little common sense and moderation works here as it does in most things. If you’re a senior citizen or live up north (or live down south but work nights or are a vampire – let’s not forget vampires) take some D but don’t be a nut case. A few hundred IUs are probably enough in most cases. Just be reasonable. OK?

CHEAPER THAN MEDICAL SCHOOL

I guess you’ve been watching all the smuggies with their smartphones.

You can live without one, right?

Till now.

Here’s an app so good you gotta buy a phone to carry the app around.

I think I’m serious.

Healthagen developed this thing called iTriage

Stunning!

iTriage’s brilliance is the way it puts a simple interface over medicine. Your phone becomes your Startrek Tricorder. The pain’s in the biceps? All the time? Just at night?

Click “look up symptoms” to search an ordered list of likely symptoms.

Once you think you know what’s causing the problem, you can “Find Medical Treatment” or “Learn About Procedures”.

You can even “Find A Doctor”.

If you don’t understand a medical term you can look that up.

I was chicken to try the “Emergency” button . Was it gonna make an entire team of paramedics materialize right out of the phone? What would I tell ‘em? Just looking?

EAR POPPER

Dear MISTER ScienceAintSoBad: My ears hurt. And they’re all clogged up. I’m 8 and a half years old. – Maggie

Maggie:

Over here at ScienceAintSoBad, we try to cheer you up. After all, it’s a mess out there where you people live.

I think it’s called the world.

Bad things happen every day. Who’s GONNA cheer you up if I don’t?

But, to be honest? Sometimes it’s tough. Even for MISTER SASB. I get letters from people, saying they need help now. I find “interesting” studies that bode well for the (distant) future.

Science advances. Patients? Not always.

I feel bad cause I love people and I wanna help. Also, I love science, in all its complexity, but I gotta admit that progress is slow. Someday there’ll be a cure for each nasty disease. I hope we’ll be able to afford it

So.

Back to Maggie.

Ear infection? Blocked Eustachian tubes? Oh my GOD! I’ve GOT something for you! I’ve actually GOT something!

Daniel Arick (New York Eye and Ear Infirmay) helped to develop a sensationally simple device which seems to work. He and Shlomo Silman patented an Apparatus for equalizing the pressure in the middle ear. They call it the “Ear Popper” (I told you I like this, right?)

You stick it in your nostril and let it release a puff of air which you swallow.

Simple, no drugs,  cheap (relatively), and very effective (about 85%).

COOLER than cool!

So. How do we rate this thing?

It’s simple but clever and it is obviously effective. Gotta give this a ScienceAintSoBadRating = 10

With a footnote.

From a strictly scientific standpoint, the data could be stronger. The long term outlook isn’t established. But, in this case, simplicity rules.

MAN, I wish I had invented this thing!