Toxicity and The Risks of Environmental Lead Exposure

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Lead is a naturally occurring element and does not break down. This means that lead will change chemically over time which influences its exposure but it will still be recognizable as lead. Lead used hundreds of years ago is still potentially available as a toxic chemical. Current regulations published by the USEPA are not eliminating all of the potential exposures to lead. Lead waste piles from mines and smelters dating back to the late 1800’s have been found to still present a lead exposure hazard. Lead-containing water service lines can be found in large older cities and water passing through the lines can present hazards to residents. Lead is still present in air from open combustion. Lead-based paint although now eliminated from use still has presents problems, especially for young children. Renovation work for remediation of lead-based paint must be done using the regulatory requirements of the EPA otherwise residential exposure to lead dust can result. Lead can be present in foods. All of these sources contribute to the total body burden.

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Involve Your Medical Experts Early For Optimum Case Outcomes

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“I Probably Should Have Contacted You Sooner…”

This opening line, on the phone or in office, strikes apprehension in your medical experts—or any expert, for that matter. Involving your experts as early as possible can quickly identify non-meritorious cases, save time, streamline case issues, improve case outcomes and the attorneys’ bottom line.

I recall a medical malpractice case several years ago involving a malfunctioning piece of life support equipment and multiple medical and nursing professionals, as well as falsified medical documentation.  By the time the attorney contacted me late in the process as a Nurse Expert, the medical equipment company had been excluded from the case, and it was too late to include several of the medical and nursing professionals responsible for significant breaches in the standard of care.  

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Breast Implant Surgery Gone Wrong

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Breast surgery that utilizes breast implants is very common and includes surgery for both cosmetic and reconstructive diagnoses.  As in all procedures, informed consent is a very important component in preparing the patient for surgery.  Lack of sufficient informed consent before a procedure that uses breast implants can reach the level of malpractice.

A patient consulted with her Plastic Surgeon about having a breast augmentation.  As a 4’ 11” person who weighed 96 lbs., she told the doctor that she currently wore a 32 a bra and wanted to be augmented so she could wear a 36 D bra.  She was very concerned about the possibility of implant rupture; she did not want to face the extra expense this would cost her.  Her doctor assured her that he could surgically place implants that would give her the size she wanted and told her that, although he had never seen a patient with ruptured implants, if the implants did rupture, her insurance company would cover those costs.   She had the surgery performed but was very unhappy because her bra size was only 34B, much smaller than her desired size.  Also, 5 years later one of the implants ruptured, requiring removal and replacement.  Her insurance company did not cover the costs of that surgery and she had to pay for this surgery out of pocket.

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Dialysis Unit Communication: Real Time or Real Problem

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Dialysis Unit Communication: At present, there are more than 6500 dialysis centers in the United States that provide life-saving care for patients with end-stage renal disease (ESRD) requiring renal replacement therapy.  This often thrice-weekly form of treatment has become commonplace in virtually every major city and suburb in the US.  Dialysis care is almost universally provided by Nephrologists (physicians specializing in the diagnosis and treatment of kidney diseases) in close collaboration with a team of health care providers that includes specially trained dialysis nurses technicians, social workers, and dieticians.  Dialysis care is now considered sufficiently routine that the Nephrologists need not be present during each treatment.

Potential Consequences of Dialysis: As with any procedure, hemodialysis carrels a small but significant risk of complication including infection, low blood pressure, and bleeding.  The risk of choric blood loss is real, even under ideal conditions; however, blood loss may also be acute, especially in patients with plastic dialysis catheters that are susceptible to accidental disconnection during or after the dialysis procedure.

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Mild Hyponatremia: New Risk of Memory Changes, Gait Disturbances and Death

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Hyponatremia is defined as a lower than normal serum sodium concentration using routine laboratory testing of serum electrolytes.  Although chronic hyponatremia below 120 mEq almost universally prompts medical investigation, milder forms are usually overlooked or disregarded as being of little clinical significance. Recently, mild-moderate hyponatremia (i.e., a serum sodium concentration >125-135 mEq/L) has been associated with distinct symptoms as well as with increased mortality after hospitalization.

What causes hyponatremia? Many conditions are associated with chronic hyponatremia, the single most common electrolyte abnormality.  These include inflammation in the brain or lung, cancers, thyroid disease, kidney disease, heart failure, and several categories of medications such as oral hypoglycemics (used in patients with diabetes mellitus), narcotics, diuretics, and antidepressants, particularly those agents referred to as selective serotonin receptor inhibitors (SSRI agents).

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Saving Your Malpractice Case

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The Fact Pattern

A 62-year-old male, Mr. Block, was in good health and had been a patient of Doctor Byrnes for many years. The patient had a history of rectal polyps which were removed in the operating room on several different occasions. The polyps continuously recurred despite adequate resection by Doctor Byrnes. The patient was compliant in every way and had a good relationship with Doctor Byrnes.

During a routine yearly visit, Doctor Byrnes found another rectal polyp. It looked suspicious and worrisome for a possible malignancy. Doctor Byrnes felt that a wider, more extensive local resection would be necessary. He told this to the patient, and the patient understood and agreed. Doctor Byrnes told Mr. Block that he (Doctor Byrnes) was now referring his operative patients to his younger associate, Doctor Madding. Doctor Madding examined Mr. Block. Doctor Madding concurred with the diagnosis and the proposed treatment plan. He established a rapport with the patient, explained the treatment plan and discussed potential complications with Mr. Block. In fact, Doctor Madding met twice with Mr. Block and did his best to explain the upcoming operation and tried to put Mr. Block at ease.

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The Two Most Dangerous Aspects of General Anesthesia

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The two most dangerous aspects of general anesthesia are at the beginning, which is called the induction phase, and at the conclusion, which is called the emerging phase.

The general anesthesia patient has the endotracheal tube inserted into their windpipe. The anesthesiologist needs to view the vocal cords to be sure that the tube is passing between them and therefore into the trachea, the windpipe, and not behind it into the esophagus, the food pipe. Furthermore, when the endotracheal tube is probably inserted and its balloon cuff is inflated, then the anesthesiologist must listen to the chest to hear that the breath sounds are equal on both sides, and observe the exhaled carbon dioxide monitor be sure that it is recording exhaled air at 4%, versus room air which is less than 1%.

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Laparoscopic Cholecystectomy

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The gallbladder is a bile storage organ which is attached to the bottom surface of the liver. It stores bile which is an emulsifier for fat, and after a fatty meal, a hormone causes the gallbladder to contract, squeezing the bile into the common bile duct, the main bile duct, and from there into the first part of the small intestine, the duodenum. The problem with bile storage in some patients, particularly women who are over the age of 40, overweight and have had children, the stagnant bile can form gallstones. This can cause severe pain, and sometimes infection.

The modern way to remove a gallbladder is using the laparoscope. Small incisions are made into the abdomen, the gallbladder is grasped at its top surface, and the connection between the gallbladder and the common bile duct, the cystic duct, must be must be observed to be sure that the common bile duct is never injured. An injury to the common bile duct results in a serious lifelong disaster, with scarring and repetitive obstruction of bile flow, resulting in jaundice, liver failure, and sometimes infection.

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