Stem Cells and COPD: What You Need to Know.

I enjoy fielding questions from patients. Yes, I sense you’re rolling your eyes, but really, anything that I can answer that helps keep them out of the hospital is, I feel, time well spent. Recently though,  I’ve been fielding a number of questions that have me concerned. These questions often have a leading tenor about them like, “are you using stem cells for COPD yet?” The questions imply that stem cells are the de rigeur treatment for COPD. Now I may not be at the leading edge of any fashion, but being unfashionable in my treatment regimens? Never!

I can’t blame anyone for wanting to seek out treatments for COPD. It is after all, a leading cause of death and illness in the U.S. And it’s widely regarded that the changes caused by COPD/emphysema in the lungs are permanent. While there are now several different treatment options for emphysema/COPD, very few can prolong life. So if I had a family member with emphysema, I might naturally seek out treatments for COPD that go beyond the usual treatments, and with all the hype surrounding stem cells, why not take a look?

What people find when they google “stem cells and COPD” is in a word, distressing. It’s a fantasy world full of promises of health, healing, and better breathing. Equally distressing are the things that people who visit these sites aren’t recognizing: the greed, lies, lack of ethics, illusions, and misleading claims. Continue reading “Stem Cells and COPD: What You Need to Know.”

Flash Mob Medical Research

It was my second day of residency, and something was afoot. As I made my way around my first rotation on the cardiac floor, my medical senses were tingling. There was something strange happening to all of my patients, I saw. As I peaked over my cohort’s shoulders, I secretly saw that it was happening to their patients too, though they hadn’t seemed to  notice. Only I did, and I was going to report it to my senior. Together we were going to report it to the New England Journal of Medicine, and I was going to win the Nobel Prize of Awesome Doctor. Yes, I alone noticed that all of the patients on the floor were somehow inexplicably breathing at the exact same respiratory rate. Not only this, but they were breathing fast, at a rate of 20, clearly something must be causing all of them to do this. Surely this could not have been due to documentation error, since all the of the other vital signs seemed to vary, it was only the respiratory rates which seemed to stay the same among all the patients.

 That day was more than 10 years distant, I still don’t have my nobel prize, and New England Journal isn’t returning my calls. The answer to the question that I posed back then about a phenomenon I now see daily is only too easy to find. It sits in every hospital ward, at the end of the hallway. There a  bank of mobile machines that is wheeled around the ward to check vital signs sits recharging in wall outlets. As nurses and assistants scramble to administer medications, change bedsheets, turn patients, answer call lights, help patients around the halls, answer the phones, answer family questions, speak with clinicians, and pass food trays, they wheel these devices to their patients’ bedside. They quickly first attach a blood pressure cuff and press the cycle button. As the cuff inflates, they attach a finger sat monitor from the same machine  which takes a few seconds to get a reading. As this is taking a reading, they ask the patient to open their mouth and insert a temperature probe to get a temperature. Around this time, the BP cuff says “error”, so they cycle it once more. While this cycles, they now have a reading for temperature, and the finger monitor gives them readings for oxygen saturation and heart rate.

They have a few paper towels left over from feeding the patient in the next bed, so they start jotting down numbers in it, and just as they finish this, they get a reading from the BP cuff, which they write down as well. They would like to put this in the computer right away, but in the hallway call light buzzers are sounding, somebody wants to get up. Another person wants their pain medications, the radiology suite wants the patient in the next bed sent for their ultrasound immediately.  But wait aren’t they supposed to be fasting for that test? And there’s 4 more patients who need to have their vital signs checked.

So several moments later, as the nurse finally sits down to enter all the vital signs into the chart, values will be entered for heart rate, blood pressure, temperature, oxygen saturation. But since no respiratory rate was checked, the default number of 18 or 20 is often entered. Why is the respiratory rate not checked?

Because the Mr. Vital Signs machine does not check respiratory rate. Continue reading “Flash Mob Medical Research”

The Relationship Between Cystic Fibrosis Exacerbations and Environmental Pollution.

If you don’t know this about me by now, I need to confess something, I’m a bit of a geek. I love  Star Trek (all of em), and I regularly check the NASA website  to see how the Voyager pairs are doing. And yes, of course  I follow the Mars rover’s twitter feed, who wouldn’t?.  So as I was perusing my issue of Chest recently, there was a study that really got my attention. It wasn’t only because of the incredibly important  issue of Cystic Fibrosis and identifying what causes exacerbations. It was the novel way that the authors identified air pollution as a factor that contributed to CF exacerbations.

Air pollution has long been thought to play a role in leading to lung disease. Air pollution is also thought to contribute to exacerbations in people with known lung disease such as asthma, COPD, and Cystic Fibrosis. However, these correlations have been difficult to show,  and have primarily depended upon looking at admission rates for people with exacerbations  of lung disease during periods where there is a known environmental anomaly or excess pollution. Unfortunately such conditions are not very predictable.

A study published in this month’s issue of  Chest showed an intriguing relationship between  air pollution and exacerbations of cystic fibrosis. What was intriguing to me about this study was not only that the authors showed a relationship between CF exacerbations and environmental pollution, but also how they set about demonstrating an association between the two.

They first went back and identified  2204 individual CF exacerbations that occurred at their institution in Belgium. Using the patients’ home addresses, they  calculated concentrations of  particulate matter, ozone, and nitrogen dioxide the patients would have been exposed to around the time of their exacerbations. Continue reading “The Relationship Between Cystic Fibrosis Exacerbations and Environmental Pollution.”

Bridging Anti-coagulation is Dead! Long Live Bridging Anti-coagulation!

I am interrupting my current obsession with Top 5 lists  to bring you this important announcement: Peri-operative anti-coagulation, (also known as bridging anti-coagulation) is done! Is it time to stick a fork in it?

Right now you’re probably wondering, what the heck I’m talking about, and why you should consider it important. Currently hundreds of thousands of people throughout the country are on the oral blood thinner coumadin (also known as warfarin) to prevent a blood clot. For those who are on it long term, having a procedure can be problematic, as stopping the drug can increase the risk of blood clots, while continuation of the drug increases the risk of bleeding with surgery. Thus many patients undergo a process known as “bridging” wherein the coumadin is stopped  several days before the surgery, and a short acting injectable blood thinner is substituted so that the blood thinning effect of coumadin has time to wane before the surgery. This practice has been perpetuated without very clear evidence that it decreases the risk of blood clots or bleeding, and without much certainty about which people on coumadin need to be “bridged”. Recently, researchers sought to shed some light on this question by pooling together data from several smaller studies looking at patients who underwent bridging  to determine what the various risks and benefits of bridging might be.  The study  “Periprocedural Heparin Bridging in Patients Receiving Vitamin K Antagonists” was published  in the Journal Circulation and has received much attention, as it should have as it was co-authored by my former mentor (shout out Dr. Kaatz!) but also since it is the first large scale study of its kind. Continue reading “Bridging Anti-coagulation is Dead! Long Live Bridging Anti-coagulation!”