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V.19 No.22 | 6/3/2010
The second free glass of Pinot Noir
Whitny Doyle, RN

Miss Diagnosis

Seduction of a Nurse

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V.19 No.21 | 5/27/2010

Health

Vitals and Bits #3: The Appendix

At the beginning of each new shift, certain members of the hospital staff will receive a pair of freshly laundered scrubs to wear while working. If you’re one of the lucky ones, you’ll be handed a pair of ancient scrubs that have been laundered a billion times. Over time, the unforgiving hospital washing machines pulverize the stiff green scrub material to unbelievably soft oblivion. Old scrubs that are nearing retirement are much more comfortable and better fitting than the awkwardly crisp new scrubs. They’re like a treasured, paper-thin vintage tee shirt. Unfortunately, just like a perfect vintage tee, the ideal pair of worn scrubs is a pretty rare find.

One night while I was working night shift in the newborn nursery, I noticed that one of my favorite pediatric residents had managed to get his hands on a pair of the old soft scrubs. The thing about the soft scrubs, though, is the decades of laundering have also shrunk them to about three quarters of their previous size. My resident, who we shall henceforth refer to as Dr. Abs, kept tugging at the hem of his shrunken scrub top, since it was an inch or so too small for him.

Like many residents, Dr. Abs liked to pass the time during a slow night shift by telling dirty jokes with us at the nurses’ station. That night, around 3:30 a.m., Dr. Abs succumbed to a fit of yawning after delivering the punch line to some filthy joke about Tipper Gore. As he yawned, he raised his arms over his head and the hem of his short scrub top untucked itself and traveled northwards. The five nurses hanging around the desk were held spellbound for the few brief seconds that his bare, toned abdomen revealed itself. I couldn’t help but notice a finger-length scar on his lower right abdomen.

“Is that where Tipper Gore bit you?” I asked him, pointing to the scar.

He glanced casually down at the scar.

“Actually, I had to leave my appendix in Thailand a few years ago,” he replied.

The appendix is an enigmatic segment of bowel-like tissue that juts off of the colon, near the place where the small intestine meets the large intestine. The appendix does not perform any digestive function, and so there are a few theories out there as to just why the heck we have an appendix anyway.

The older argument is that the appendix is vestigial, meaning it used to be an organ that served a purpose in our ancient humanoid ancestors but lost its function as modern humans evolved. Newer theories propose that the appendix, which is a rich reservoir of lymph tissue and healthy intestinal flora, plays a role in immunity and digestive health.

Whatever function the appendix may or may not serve, people who have had theirs removed seem to do just fine without it. In fact, the appendix is a relatively high-risk accessory to be sporting on one’s colon. The appendix has a nasty habit of becoming inflamed or infected, which is the case when someone gets appendicitis. Appendicitis is life-threatening, since an inflamed appendix can rupture. A ruptured appendix spills a slew of bacteria into an abdominal cavity that’s supposed to remain sterile. This means people can become septic and die if their appendix decides to go all supernova on them.

As it turns out, my pediatric resident’s appendix had ruptured while he was vacationing in Thailand. Although he was a medical student at the time, he didn’t put two and two together and waited until he was on the brink of death before dragging himself to a medical clinic in the small Thai village where he was staying. The staff at the clinic recognized what was happening right away, despite a pretty significant barrier language. They started antibiotics and transported him to the main hospital for surgery with lightening speed. He was in surgery that same day, and remained in the Thai hospital for almost two weeks while he recovered from his surgery.

After telling us his story, Dr. Abs stood up and stretched one more time.

“These scrubs are so comfortable,” he said mid-yawn. “They feel like pajamas. I’m going to have to take them off if I’m going to be able to stay awake.”

Five grinning nurses nodded in agreement.

V.19 No.14 | 4/8/2010
Nancy Ridenour, dean of UNM’s College of Nursing, had a hand in crafting portions of the nation’s health reform bill.

Health

The Reform Prognosis

How will New Mexicans be affected? An insider explains.

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V.18 No.51 | 12/17/2009

Miss Diagnosis Uses Drugs to Prove a Point

In a country where practicing medicine has become nearly synonymous with prescribing and dispensing medication, it’s no surprise that the pharmaceutical industry has a prominent place in the health care reform debate. The controversy over whether to allow importation of prescription drugs from abroad has jeopardized the weird alliance between Big Pharma and health care advocates. Obviously, allowing foreign drugs in has serious economic implications for drug-makers and consumers. But a report regarding contaminated drugs published in the Thursday, Dec. 10 edition of the Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report highlights safety concerns as well.

According to the report, 54 Nigerian children died from contaminated acetaminophen (the same drug as Tylenol) in a children’s teething medication. The medication was contaminated with diethylene glycol (DEG), a toxic alcohol used illegally as a cheap substitute solvent in drug manufacturing. The contamination resulted from failure to comply with safe manufacturing processes.

I’d like to give us all a moment to imagine the response if 54 American children had died from drug poisoning.

The report may bolster the position of those against the proposed amendment to allow importation of prescription medications from abroad approved by the Food and Drug Administration. The CDC stated “countries that inadequately implement safe manufacturing standards, poorly enforce quality controls, or lack adequate training programs remain at risk for medication-associated poisonings.” The FDA’s ability to ensure safe manufacturing practices abroad remains uncertain.

However, before people jump on the notion that foreign countries represent a unique risk to drug safety, it’s wise to consider the issues surrounding drug safety in our own country. For instance, New Mexico's Attorney General Gary King completed a $10 million settlement against drug-maker Eli Lilly for illegally promoting the use of their anti-psychotic medication Zyprexa in children. Although it is legal to prescribe medications for unapproved or “off-label” uses, it is not legal to market them for off-label uses. Earlier this year, the company plead guilty to promoting the drug's unapproved uses and concealing serious side effects like weight gain and diabetes.

In my humble opinion, drug-makers are as powerful as consumers allow them to be. Though many drugs are absolutely necessary for saving or sustaining life, I’d hazard a guess that most aren’t. Though I’m certainly not anti-medication (hey, I practically live on Ibuprofen for a week out of every month), I don’t believe medications should be the first line of defense against all of our ailments. For example, there’s no harm in medicating your teething child with hugs and kisses and soft things to chew on rather than a bioactive elixir with serious side effects. It’s easy to see why weighing the risks and benefits of medication use is so important. It’s also easy to see why drug companies must be held to extremely strict standards when it comes to marketing and disclosure of risks.

Still, cost should never be a reason to deny someone a needed medication. Rather than importing drugs, which opens a whole new can of regulatory worms and broadens the carbon footprint, perhaps financial regulation of domestic companies would be more prudent.

In any event, we can all hope decent regulatory efforts at ensuring safety and affordability of necessary medications succeed. At the same time, let’s encourage our couch-riding, medicated masses to trade the remote for real friends and the La-Z-Boy for a pair of jogging shoes. This way, we can all jazzercise our way into a future of cardiovascular fitness and mental well-being. That would do more for the health of our nation than any pill.

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