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An interesting discussion: Are O.J.’s problems all in his head?

Last evening I had an interesting conversation over dinner with a pathologist whom I had never met before. One topic on which we discussed was a news item that we discovered we both had recently seen on television concerning. O.J. Simpson. “The Juice” as he was known is, of course, the ex-professional football running back, who was acquitted of murdering his wife and her friend in what was called “The Trial of the Century.” Simpson, also an actor and car rental pitchman, is serving a prison sentence in Nevada for armed robbery.

I ate dinner at a place called BJ’s Restaurant and Brewhouse, a chain that started out as a pizza place in the Bay Area of California and has spread nationwide. This one is in Pearland, a suburb of Houston. Dinner was several blocks from my hotel in a nice little, walkable, shopping center. I was by myself and so I sat at a table for two,  which was joined by about three other tables for two. It was a subdued place despite the three large TV screens in the bar. It had equal, extensive menus for both food and drink, which as expected, offers many different labeled and crafted beers.

This fellow walked in and asked if anyone was sitting at the next table and we struck up a talk that lasted for more than half an hour. It turned out this guy is a pathologist. I think the profession has become widely known for the forensic pathologists you see on the CSI and NCIS television franchises. Actual pathologists are either specialized medical or osteopathic doctors. This gentleman said that while he had done autopsies in the past his time is spent nowadays at the Texas Medical Center, as he called it, taking “whatever body parts a doctor removes.” His specialization are the ones who examine the cell tissues and other items taken in biopsies and surgeries to determine if they are benign or malignant. Since I learned a little about medicine from the time I spent as an EMT and now that I feel as if I spend so much of my time going to doctors, it seemed he enjoyed talking to someone who appreciated the man’s job. He had no airs like people sometimes think doctors may have when, many times, the physician is trying to compartmentalize to determine what’s wrong with you.

I don’t know what we were talking about when the doctor mentioned the story about O.J. Simpson. I told him yes, I had heard it too and thought how the subject of O.J. Simpson seemed like a bad penny that wouldn’t go away. The most recent O.J. installment is that a renown neuropatholgist has perhaps staked his career on the possibility Simpson might be suffering from a disease known as “CTE,” which stands for chronic traumatic encephalopathy.

Dr. Bennet Omalu first published research about CTE while he worked as a forensic pathologist in Allegheny County, Pa. The Nigerian-American physician found this disease in football players who had sustained multiple concussions. The disease can only be diagnosed for now on dead people, thus Omalu has made a pretty bold pronouncement.

The research on CTE touched off numerous lawsuits filed by families of NFL players and has led to a nationwide discussion on the dangers of concussions, from Pop Warner leagues to the pros.

Omalu said in an interview with ESPN that he would “bet my medical license” that Simpson has the disease. Different personality changes such as violence and poor impulse control are signs that one might have CTE as are other factors, according to Omalu. The former medical examiner has said he had not spoken with Simpson.

My “dinner companion” said that he was just as shocked as anyone else that the disease has led to as many lawsuits as it has. And he raised an eyebrow on Omalu’s contention concerning Simpson. I think we both concluded that most people realize, or should, that having a blow to the head isn’t a good thing. I suppose that for so long people thought that helmets and other protective gears worn by football players would keep players from more serious injuries. That may have led to a false sense of security. In reality, a number of factors are cited why that is so, Among the reasons is the fact that players are bigger and stronger than before. Weight training for football players isn’t just for college and pros anymore. It’s like the reverse of the saw, “the bigger they are, the harder they fall.” In reality, the bigger the are, the harder they hit.

I enjoyed my conversation with the doctor. It was an interesting way to spend a little time out of town, not to mention the pale lager and bison burger I consumed, “served with a side of tangy slaw tossed with Baja vinaigrette and topped with green onions,” according to the menu.

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VA medical care perseveres despite a few challenges. Some timely and others … ?

More often than not the Department of Veterans Affairs manages to deliver adequate to exceptional health care for former service members. This is done despite many challenges. Just a few examples:

  • A history of inadequate funding. In addition to the incredible numbers of jackasses and fools the American public has elected to Congress, the type of funding for the VA itself does not encourage planning for a steady stream of dollars. That is because the VA does not have full mandatory funding. Much of the veterans healthcare program comes from discretionary funding over which congressional members can wheel and deal to get pork barrel dollars for their districts. Full mandatory spending does not seem likely in the near future. And the Continuing Resolution that was passed to keep the government running expires on Dec. 11. That is something I don’t want to think about.
  • The clusterf**k that George W. Bush, Dick Cheney et. al. got us into will likely send more veterans to war and return them home — with various health and mental problems — which strains the budget even more.
  • The dead weight from the high-dollar VA executives who, while relatively small in number, will continually find reward for their greed. Meanwhile, what does that do for the rank and file?
  • Timeliness. The wait for appointments have improved though not uniformly. Medicines that are shipped in the mail get lost. Why can’t you just get more medicine to replace what hasn’t arrived? Sometimes you can. Lost in the mail is still a problem and not just with meds.

So, I give the VA give a pass for many of the screw-ups I have seen during my time as a VA patient and as a journalist who covered the Department for nearly a decade. That isn’t easy though.

My patience is tested on a number of occasions when I have to drive around for 45 minutes to an hour at the Michael E. DeBakey VA Medical Center in Houston to find a parking place in just one parking lot. The Houston VA has signs that announce something to the effect of: Good news. We are building a new parking structure. But in the meanwhile take advantage of our valet service.

I don’t want wait another hour for a valet to take my auto. I don’t like other people to drive my 17-year-old Toyota Tacoma. It has to last me for some time and I would not at all like someone screwing up my pickup.

The VA phone system in Houston has long been a contentious issue with me. It does seem to have slightly improved. I am afraid to say that, though, because I am afraid something will screw it up. I think a lot of myself, huh? Well, a VA counselor playing psychiatrist gave me a diagnosis as having a “narcissistic personality disorder.” I guess that makes me a narcissist then. Yep.

Finally, today in the mail I received one of the “new” cards from the VA reminding me of my appointments. These two cards are printed on all four sides and are held together by a perforated strip. They replace the old letters notifying veterans of appointments.

On the side with my address it says: “Dated Material — Open Immediately.” This makes me think: “Are they going to send the VA Police to arrest me because I didn’t open the card immediately?”

So I opened it within 30 minutes or so, only to find:

“ALERT! Unfortunately, your upcoming appointment has been cancelled. This appointment is cancelled: Date :Thursday, Nov. 5, 2015 … “

Oops.

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The internet and the ‘medical student syndrome’

Ed. note: Once again I have been editing after posting. This time I have been receiving help from Japan. So, hold on to your laptop, I might just edit some more.

There is a study I would like to see, and if you have seen such a study, please send it to our e-mail address. This study would gauge how people value (or no) that be-all-end-all tool, the internet. The study I’d like to see would measure quality of information and whether one often finds the quantity of the results too overwhelming. For instance, asking a question formed as such:

“How well does information you receive from the internet help you understand subjects you research?

A. The information is usually helpful in understanding a subject.

B. The information is occasionally helpful.

C. The information is mostly confusing and does not help me understand.

Think about the questions and answers regardless of how well they are constructed. I would pick B. That does not bode well for the internet if a representative sample of users — and definitely not an internet-based query — come to the same conclusion.

I have found the “information superhighway” can cause a 40-car-collision of data overload. In life before the internet I had similar experiences.

I came to that conclusion some 15 years before I ever heard the word “internet” and first used a rudimentary internet connection in my work as a journalist. When I first began training as an emergency medical technician, I had no idea that training would lead to what is a somewhat well-known syndrome.

Some call it “Medical Student Disease” while others describe it as a syndrome rather than a disease. You say potato. I say tuber. Some in the medical profession prefer to call it “nosophobia.”  While that term seems as if a person is afraid of noses — and I’ve found a few scary schnozzolas in my time — the term denotes a fear of illness. Apparently, someone felt that future doctors should not be characterized as hypochondriacs. Hey, if the shoe fits, oh wait, we’re getting off on the wrong foot here. Someone call a podiatrist!

I’m not an EMT anymore. I let my certification lapse almost three dozen years ago. But I was pretty much a hypochondriac for a little while. I finally came to the realization that I am not having this or that problem. No knee problems or back problems or heart problems. I had the majority of those medical experiences in more recent times with the exception of the latter.

I had several tests this year on my heart. It is practical that a man now 60 years old — ugh, that still is a little hard to accept — have testing done on their ticker. This is especially so because several family members had heart problems. I have had high blood pressure, controlled, with medicine for almost 20 years. I’m diabetic. I’m overweight. I haven’t touched any form of tobacco in 15 years. But the bad news is I may have problems with breathing because I smoked two packs a day for about half of 25 years.

Over the last year I’ve had three different types of cardiac testing. The first was an echocardiogram. It appeared to show a slight enlargement in the left portion of my heart. My cardiologist at the VA said that the enlargement was not anything of major alarm. Yeah, but it’s not his heart.

I had shortness of breath upon landing in Albuquerque, N.M. back in July. Upon deplaning I walked up into the jet way and upon reaching the waiting area I had to stop and catch my breath. My breath was already waiting in the Super Shuttle. I experienced breathing problems a few times in ABQ, which is right at a mile high in elevation. I did some reading on the internet and found that even though altitude sickness is found in people somewhere above 8,000 feet it can be seen in people below that altitude. One also has to realize I left a place just a few feet above sea level for almost 30,000 feet while flying in a jet airliner. And I never came down, so to speak, until I returned Southeast Texas,

The shortness of breath also became a reason for the docs wanting a bit more testing.  About two weeks ago I had an “imaging” stress test. This is where one is injected with a medicine that makes your heart beat more rapidly. My heart was not beating very fast. The cardiologist suspected a blood pressure medicine was causing the slow pulse. I quit the meds and my pulse was back to normal.

On Monday I had a “nuclear” stress test. This test involves a radioactive camera injected via IV inside one’s blood and allows pictures to show a much better view of inside the heart. Better than the outside looking in, I suppose.

I got my test results today via email from a physician assistant in the cardio department at the Houston VA. I immediately began looking on the internet for answers — more results than I probably needed —  that explained what the PA was actually saying. I understood that the testing had what was called a normal “ejection factor.” Looking it up on the internet I found the percentage that was given in my results is normal. But what were reputable internet sites also explained that a normal result does not mean a patient cannot also have had so-called “silent heart attacks” or congestive heart failure.

I was getting back into “medical student syndrome” mode with a bit of a furrowed brow when my cardiologist called and told me the test showed my heart was normal in how well the heart pumps with each beat. He said these pictures showed a much better view than the previous echocardiogram. What that means is I have no apparent heart problems. So what do I do? I just wait and see if I have any other symptoms of heart disease.

My relapse of nosophobia or whatever one cares to call it was brought on today by the internet. That and a little more information than I likely needed, or at least information that made sense. The only problem I have now is that I am obsessing over noses. Where’s Barbra Streisand when you need her?

 

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I brake for accident victims

Yesterday was pretty odd. I may write more about a couple portions of yesterday that deserve more thought and time. I’ll just leave it at that before I start explaining myself.

I stopped to get a late lunch at James Coney Island in east Houston after visiting the VA Hospital for more tests. Upon leaving I eased onto the far outside lane of the Interstate 10 access road. It looked like smooth sailing as a long line of cars were interested in the lanes which turned left and underneath an overpass of the street that intersected. I saw one reason for the cars turning left.

There was someone flat on his back in the middle of the access road just maybe a few feet from the cross street. I drove by the person. I looked at him and looked at what was a crushed bicycle on the side of the road. There was at least one young guy who stood next to the victim. But that was about it. I decided to stop and see what, if anything, I could do.

As I later explained to a Houston cop and a volunteer firefighter who stopped at the scene, I was once certified as an emergency medical technician for about 10 years. There didn’t seem to be much I might do that would help this young man on his back, helmet on his head, and a cell phone to his ear. The prostrated young cyclist was laughing when I approached him. That unnerved me for just a second. But he was telling someone on his cell who might have been his mother that he had been hit by a truck. Then he started crying. I quickly saw why.

The other young man, who was standing, was on the phone as well. It sounded as if he was trying to tell 911 what was happening. It turned out that this fellow was driving the truck that struck the man on the ground. I quickly saw that the victim’s right foot was not where a normal foot might be had he been merely lounging on the access road. His foot was a good 30 degrees from normal. It’s very likely his ankle was either broken or was dislocated.

I tried and succeeded in asking the victim if he was hurt anywhere other than his foot or leg. He said it was just his leg.

I couldn’t help but notice that his bicycle helmet had some kind of black marks on it. These may have been a portion of the tire tracks from the yellow truck that hit the bike rider. I didn’t touch his helmet. I didn’t touch anything. This is because, first, do no harm. I wanted him as immobile as possible so the ambulance people could get him on a back board and onto the “bus.” I did try to look in his eyes. I looked for signs of a possible head injury because it seemed at least a bit of the helmet seemed to have taken a hit. His eyes looked okay and nothing, not even blood, seemed as if it was coming out anywhere. That could be a bad sign, or a good one.

A fire truck finally came up with what I knew were paramedics. I asked the cop if he needed me for anything else. He asked if I saw the accident and I told him I didn’t. I decided it was time to get going. The officer thanked me for stopping.

I didn’t know what to say to the victim. I started to walk off but said something like “Hey, take care, bud.” The victim said: “Thank you, sir.”

Those words made it seem like I had done something to help. Well, I guess I did in just being with the victim and taking an interest in him. Whatever it was, he seemed to appreciate whatever I did to help.

What a day. I have a feeling the injured guy was going to be okay once he was all looked over and fixed up by the medical people.

I took away a couple of lessons from that scene. First, if you are in doubt as to whether or not to stop for an accident then maybe you should stop. You don’t have to go into full rescue mode. Second, and this one is for me as well: wear a helmet.

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I may be right for all I know, but you may be wrong.

An article caught my attention this afternoon concerning  wrong diagnoses by medical professionals. Now I am no medical professional. I was an EMT for 10 years, so if you ask me how to splint a broken femur, I could probably tell you how it was done 30 years ago. And so, indeed, I am no professional medical person but I probably fit the bill as a professional patient.

The article of note from NBCNewscom.com is titled: “Getting it Wrong: ‘Everyone Suffers an Incorrect or Late Diagnosis.'”

The National Academy of Medicine, whatever that may be, says pathologists and radiologists need to be more involved in a patient’s diagnosis. The Academy, as the former Institute of Medicine calls itself, says it can’t quantify the number of erroneous diagnoses but they know it is high. Because the Academy says so, damn it to hell! I suppose it’s like Justice Potter Stewart said in the 1964 Supreme Court decision on obscenity: Jacobellis v. Ohio, “I don’t know what obscenity is but I know it when I see it.”

Actually, that is not what Stewart said, or wrote, exactly.

 “I shall not today attempt further to define the kinds of material I understand to be embraced within that shorthand description [“hard-core pornography”], and perhaps I could never succeed in intelligibly doing so. But I know it when I see it, and the motion picture involved in this case is not that, Steward said”

In reality and back to medicine, the Academy did report that 5 percent of Americans receive the wrong diagnosis in outpatient care. And 10 percent of autopsies show patients who were misdiagnosed. On and on it seeps like a morphine drip.

The report goes on to say that the number of autopsies have dropped because insurance does not cover the, ahem, procedure. The study went onto say radiologists and pathologists should be more involved in clinical care. Okey dokey. So they really don’t fault the medical professionals, instead the report just, well … I’m not totally sure what the reports are implying. More autopsies? I don’t know about the rest of the world but in Texas, postmortem studies are supposedly performed on all patients who die an unwitnessed death. Likewise, I think, the same goes for those whose lives end violently. One only may guess where the supposition goes. No, not up there. I said supposition, not suppositories.

In reading this NBC article on the report, one may understand its point while others do not. For instance, the common mental picture one forms of pathologists are that they sit around looking for tiny cancers all day when they aren’t cracking open someone’s rib cage with a Skill saw. Likewise, one might imagine radiologists sitting around all day looking at X-rays or MRIs. No on both counts.

A good friend of mine is what is known as an interventional radiologist. He is a professor at a medical school and teaches his specialty to budding radiologists. But he likewise uses his skills to save lives. Says the Society for Interventional Radiology:

 “(Interventional radiologists) offer the most in-depth knowledge of the least invasive treatments available coupled with diagnostic and clinical experience across all specialties. They use X-rays, MRI and other imaging to advance a catheter in the body, usually in an artery, to treat at the source of the disease internally.”

Here is a little known fact, to me at least. These highly-trained radiologists were the inventors of the angioplasty and catheter-delivered stents which were originally developed for treating peripheral arterial diseases. Pretty neat stuff it is. Had my friend not have been in the field of interventional radiology, I probably would have learned it off the street from some first-year med student selling professional journals with racy X-ray pictures. That’s a joke son!

I see a whole broader issue as far as wrong diagnoses leading to super-wrong outcomes. I go to the VA for my health care and bless their hearts, they love their electronic patient records. Some medical pros must sleep with the records they love them so much. Some of them do not read past the first page of the computerized charts. That’s for another day though, maybe.