Saturday, June 22, 2013

Poem - Do Not Resuscitate

Do Not Resuscitate

I can say
your father is dying.
I can say
wishing will not make it so,
belief doesn't change a thing.

I can say
love does not conquer all,
miracles are pretty stories told in church,
the movies you saw as a child are lies,
blind hope is not a recipe for success,
underdogs usually lose,
death is not the worst thing, it is just
the last thing.
But for you that is not true.

I can say
we have to pretend
that we can bring him wheezing
back to you like an old accordion,
chest pleating in and out,
singing his customary songs,
oxygen bumping its hurdy-gurdy way again
through his ancient heart.

But how can I tell you how
someone will shout down the hallway, kneel
frantic on the bed,
lean his fists against that old breastbone, sharp, frail,
one onethousand, two onethousand, and count it out.

I can say
we should not do this.
He will never be the same.
I can say
if it were my father.

I can say
do not confuse resuscitation
with resurrection, although
neither works particularly well.

You look like you are drowning,
pallid and slow in the waiting room's
underwater light.

So. Tell me.
Tell me again.
Tell me about your father.

Brenda Butka, MD

(From Jama, October 24/31, 2012- Vol 308, No. 16)

Tuesday, June 11, 2013

Morning After Pill Now Available Without Prescription

The U.S. Justice Department has dropped its appeal to block a ruling by a New York Federal Judge to allow easy access, over-the -counter purchase of the "Morning After" pill for birth control. The emergency contraceptive, named for women who either got caught without a contraceptive, or the condom broke, is called  Plan B One-Step.  (I guess that is when plan A fails.)  Plan B is a one dose pill of 1.5mg levonorgestrel that reduces the possibility of pregnancy.  It is to be taken within 24 hours of unprotected sex and the drug’s principal effect is to prevent ovulation, but it may also make the lining of the uterus less hospitable to a fertilized egg.

The controversy about Plan B began when HHS Secretary, Kathleen Sebelius, invoked her authority over the FDA, who had approved the drug for purchase from a pharmacy without a prescription.  Ms. Sebelius, in an unprecedented move, stated that prescription dispensing requirements should not be removed for women of all ages.  She believed younger teens should not have access to the pill without a prescription.  Many lawmakers were surprised by this reaction and criticized the Obama administration of placing politics ahead of science.

Margaret Hamburg, FDA commissioner said "There is adequate and reasonable, well-supported, and science-based evidence that Plan B One-Step is safe and effective and should be approved for nonprescription use for all females of child-bearing potential".

The go-ahead for Plan B will be welcomed by medical groups such as the American Academy of Pediatrics and the American Congress of Obstetricians and Gynecologists and the Society for Adolescent Health.  They had denounced HHS' decision and said, "As physicians who care for our nation's children, it is our responsibility to protect the health of our teenage patients, and an unintended pregnancy can have significant implications for adolescents' physical and emotional health."

Women who have unprotected intercourse have about one chance in 20 of becoming pregnant. Those who take Plan B within three days cut that risk to about one in 40.  According to the New York Times, as of now, half of all pregnancies are unplanned, more than 40 percent of children are born to unwed mothers, and 1.2 million abortions are performed every year involving one in every 50 women of reproductive age.

Margaret Sanger would be happy.

Sunday, June 9, 2013

Answer to Image Challenge

The answer to the image challenge this week is #1 - Atherosclerosis.  Most of you got the right answer because you obviously know that the diagonal crease seen in the earlobe is known as "Frank's sign".  The sign was originally described as a marker for coronary artery disease, with a moderate sensitivity ( approximately 48%) and specificity ( approximately 88%).  Frank's sign has been associated with other cardiovascular risk factors like atherosclerosis.

Good job, readers!  How many of you have looked in the mirror at your own earlobe?

Thursday, June 6, 2013

Komen Suffers For Its Blunder

How do you wreck a beloved brand?  Just look at Susan G. Komen Foundation For the Cure (Breast Cancer) and remember what a well-known brand they had.  From pink ribbons to breast cancer walks and gala events, corporate and individual sponsors were happy to give to such a worthy cause.  The "Race for the Cure" was catchy and easy to promote.

 Fast forward to January 2012 when Komen foolishly bowed to social conservatives and announced they would "defund" Planned Parenthood because of the highly political abortion issue during the last Presidential race.  The Breast Cancer Foundation decided not to pay for screening mammograms for poor women through Planned Parenthood.

The backlash was rapid, strong and widespread on Facebook, Twitter and other social media.  The Komen board of directors reversed their decision within a few days.  Two top executives at Komen Foundation resigned and apologies were rendered.  But that wasn't enough to keep the brand that women loved from becoming an ugly testament to politics and money.

Now Komen has canceled charity walks in seven cities in 2013 and 2014 that failed to meet fundraising goals.  These were previously top revenue sources for the breast cancer charity and drew the most dedicated supporters, many who also support Planned Parenthood.

Many are asking why CEO Nancy Brinker is still at the top of this organization.  Months after the controversy,  Brinker's handling of the situation became a case study in how not to manage a crisis. A press release said that Brinker "plans to move to a new management role focusing on revenue creation, strategy and global growth...when the search for a new senior executive has been completed."  (What doublespeak!  I thought that was the role of the CEO,  but never mind)

That was 10 months ago.  Oh and by the way...she got a 64% pay raise this year.

So maybe it's the economy and financial uncertainty that is affecting Susan G. Komen Foundation.  Of course, the fact that Avon's Breast Cancer walks are proceeding would suggest that the Planned Parenthood debacle is still haunting the organization.  This should be a warning to politicians and organizations everywhere that women will rise up and defend what they believe in.  Social networking brings a new awareness and bonding to the Community of Women.  (my caps!)

Wednesday, June 5, 2013

Medical Challenge

This weeks Challenge from the New England Journal of Medicine is a good one.  Check out the photo (click on it to see closer) and make your best guess as to the diagnosis.  The answer will be posted tomorrow so put your answer in the comment section and check back to see if you are a good diagnostician!

What condition would cause this ear abnormality?

1.  Atherosclerosis
2.  Fabry's disease
3.  Gout
4.  Hashimoto thyroiditis
5.  Ulcerative colitis

When to Use Urgent Care

We all know that Emergency Departments are over-crowded with long waits and exorbitant fees.  Free standing Urgent Care is a great solu...