Cardiovascular Surgeon Traysol Review

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Trasylol/Aprotinin is a commonly used drug during heart surgery that is known to cause serious complications.  These complications include kidney damage, an increased risk of a heart attack, heart failure, and stroke. Trasylol is a drug that has been on the market for 13 years and is used to control bleeding.  This drug is used in as many as 1 million hearts and bypass surgeries per year. Trasylol doubles the risk of kidney damage but also increases the risk of heart attack by 48%. Heart failure risk is also increased by 109% and stroke by 181%. Because it is given intravenously, most people do not even know that they are receiving it. Also, this drug is so bad they stopped clinical trials as complications exceeded 35%.

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Thoracic Outlet Syndrome

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Thoracic outlet syndrome is a condition where the nerves in the arm, the brachial plexus, are squashed between the collarbone (clavicle) and the first rib beneath. When the patient repetitively raises their arms up (as in hanging sheetrock on the ceiling) they can have numbness and nerve difficulties with their arms. That doesn’t mean an operation is indicated, however.

They can be instructed to change their job, and physical therapy can be effective. If the condition is severe it must be confirmed by doing what is called an Adson Maneuver. This involves raising your arm up in the air and all the way back to where the pulse to your wrist is cut off. The artery goes through the same area the nerves are going through and will be compressed by the squeezing action of those two bones. If this test is positive it does not necessarily mean that surgery is needed; many people can have a positive test without any symptoms.

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Hip Conditions and Knee Pain

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Knee pain with no obvious x-ray or physical exam findings should bring up a red flag to automatically check the hip. It is well known and taught in medical schools, that the same nerve-the obturator nerve-innervates both joints. Therefore, an elderly patient commonly can present to an emergency room complaining of knee pain after a fall. Then after emergency room physician review of x-rays showing a knee without any acute fractures, the patient is sent home only to return the next day with complaints of hip pain with x-rays showing a displaced hip fracture requiring a major operation. The standard of care in this situation would be to both examine the hip and to x-ray the hip at the first presentation.

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Urology and the Potential for Medical Malpractice

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I was invited to write an article about potential medical malpractice situations in Urology. I thought about several areas of urology and what the common denominators were. The two I see most frequently are … failure to diagnose and/or treat appropriately and failure of communication in an understandable and comprehensive manner with the patient and designated second (if appropriate). I have chosen to discuss the failure to diagnose, evaluate and treat hematuria (blood in urine) in an appropriate manner.

Hematuria may occur in an isolated field (no associated symptoms) or associated with urgency, frequency, dysuria, abdominal pain. Fever is variable. Abdominal distention (swelling or bloating) is also variable. Usually, the first physician seen is the PCP who will usually institute treatment for a UTI. He should obtain a urine culture as the minimal workup along with a urinalysis. If this treatment does not work or the bleeding recurs in a short period of time, a referral to a urologist is indicated.

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The Role of Joint Commission on Accreditation of Healthcare Organizations Standards

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Lawyers often ask me to explain how I use the JCAHO standards in evaluating medical malpractice cases and whether this evaluation will assist them in their pursuit of justice for their clients. I usually start my explanation with a brief history of the Joint Commission and its role in hospital operations and reimbursement.

The JCAHO was formed in 1951 by several professional organizations: the American Hospital Association, the American College of Physicians, the American College of Surgeons, and the American Medical Association. Its mission is “To continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value”. To accomplish this mission, the JCAHO has developed standards for accrediting hospitals and other types of healthcare organizations that focus on the delivery of the highest possible quality patient care as well as ensuring a safe environment for patients and staff. While a hospital’s participation in the JCAHO accreditation is technically voluntary, the federal government requires hospitals to meet their standards in order to receive reimbursement from the Medicare and Medicaid programs. Obviously, this requirement essentially mandates that all hospitals meet the JCAHO standards or one of the few other organizations that are included in this payment mandate. While the process is voluntary, it is important to understand that the standards are mandatory and that receiving a full accreditation from the JCAHO is still the gold standard for a hospital’s quality of care.

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The Benefits of a Physician Assistant Expert Witness

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Physician Assistants have been involved in the American Health Care Systems for over forty years. The American Academy of Physician Assistants was founded in 1968 as the official body representing the profession with a mission “to provide quality cost-effective, accessible health care and to promote the profession and personal development of physician assistants”. There are more than 140 physician assistant programs in the United States. The U.S. Bureau of Labor Statistics (BLS) projected that physician assistant employment opportunities will grow 50% by 2014. This will make it the fourth fastest growing profession in the country

Physician assistants are either licensed or registered in every state in the union including Puerto Rico, Guam the District of Columbia and the Virgin Islands and have prescriptive authority in every jurisdiction. Forty‐four states allow PAs to prescribe controlled substances. PAs are required to register with the Drug Enforcement Agency and possess a valid DEA number to prescribe controlled medication.

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Prostate Cancer: Delay in Diagnosis, Failed Follow Up Strategy

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Attorneys are often consulted by patients who feel that they have not been properly followed after cancer had been treated and that a recurrence could have been diagnosed earlier but was missed. Different cancers have different follow-up recommendations. For prostate cancer, PSA is the mainstay of the follow-up strategy.

One consequence of the routine adoption of PSA monitoring after treatment of early-stage prostate cancer is the identification of men with a PSA-only recurrence. In this situation, increases in serum PSA over the pretreatment baseline are often not accompanied by signs or symptoms of progressive disease. When PSA rises, the physician is often faced with a quandary. The longer one waits to perform an imaging study, the greater the chance that a recurrence can be confirmed and treatment started.

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Cancer Pain Management Negligence

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Safe and effective chronic opioid therapy for chronic cancer-related pain requires clinical skills and knowledge in both the principles of opioid prescribing and on the assessment and management of risks associated with opioid abuse, addiction, and diversion. Although evidence is limited in many areas related to use of opioids for chronic non-cancer pain, several guidelines provide recommendations developed by a multidisciplinary expert panel after a systematic review of the evidence.

Generally, narcotics are not the only modality that can be used to treat pain. Adjuvant therapies together with narcotics can be very helpful. For example, steroids and non-steroidal anti-inflammatory drugs, such as ibuprofen(Advil) can reduce the inflammation associated with tumors pressing on tissues, and certain anti-depressants and anti-seizure drugs can modify how the brain perceived pain and lessen it. There are also procedures, such as nerve blocks, that can be helpful when pain is localized.

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Life Care Planner: A Roadmap For Care

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A Life Care Plan is a roadmap for care, describing anticipated medical and non-medical needs, with associated costs, of a person with a catastrophic injury or chronic illness over an estimated lifespan. It is based on standards of practice, comprehensive assessment, collaboration with all medical professionals, and analysis of medical records.

Life Care Planner’s help patients who have suffered catastrophic injuries and illnesses, advocate for them and plan out their care. Nurse Life Care Planners work with a patient’s family, insurance company, attorneys, and others to develop a life care plan, determining the future needs, services, and costs of care for the patient over their lifetime. Many Nurse Life Care Planners work independently from the hospital system, acting as a consultant for businesses, families, or courts of law. Because of life care plans, patients’ caregivers know how often they need to schedule appointments, what to expect in terms of rehabilitation, and what the course of medical care will look like.

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Dog Bite Cases & Childhood PTSD

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Dog bites can have very serious repercussions in a child’s life and can change their behavior, functioning, personality, self-esteem, impact a child’s educational progress as well as anxiety and years of counseling. For example, this patient is a seven-year-old white female, experienced a severe dog bite on her face. This was the result of a neighbor not keeping his Pit Bull on a leash. The neighbor was subsequently arrested and charged with Child Endangerment. The patient is now left with some significant scarring on her face. She is teased about this at school and her self-esteem has become quite low. Prior to the dog bite, she was a normal little girl and did well in all aspects of her life. Since the dog bite, she has had a deterioration in functioning.

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