First Success in Face Transplantation

Folks have waited with baited breath as a year has passed since the first face transplant was performed in France. Today, the surgeons claimed the procedure a success as the woman was shown with the ability to smile. Twice, her body came close to rejecting the face, harvested from a brain-dead donor. It's fortunate that she claims not to have had psychological trouble from seeing someone else in the mirror, "all I see is me."

I'm only troubled that she's continued to smoke, even if it's in moderation. It could lead to blood vessel hardening that could possibly harm the transplanted face's blood supply, and speed rejection. I'm also concerned about the lifelong anti-rejection medications that could possibly increase her risk for cancer.

Here's to wishing her well, it's certainly remarkable what these plastic surgeons have accomplished. Congrats!

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Recall of Complete MoisturePLUS multipurpose contact lens care solution and Active Packs

The FDA and Advanced Medical Optics, Inc (AMO) announced a nationwide recall of 183,000 units of its 12 ounce Complete MoisturePLUS multipurpose contact lens care solution and Active Packs distributed in the United States after contamination was detected in Japan of these units produced in China. Bacterial contamination compromised sterility and although none have yet been reported, it may have serious health consequences, including eye infection and microbial keratitis. Recently, serious complications from fungal keratitis caused the recall of similar Bausch & Lomb products, a competitor of AMO.

Symptoms of an eye infection include irritation, redness, pain, tearing, increased light sensitivity, blurry vision, discharge or swelling. Should you experience these symptoms, please remove your lenses and consult your eye care provider immediately.

For more information:
131 others commenting on this at Google News...
A list of the 18 lot numbers affected in the FDA release...
New York Times

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Grand Rounds Volume 3 Number 9 is available

Dr. Anonymous welcomes all readers to this week's Grand Rounds Volume 3 Number 9, highlighting 9 of the best of 27 excellent health care stories, and 18 other submissions, including mine (thanks!).

The most touching of the bunch is fellow Healthline blogger Ken Troffater's story of the extraordinary support of a pregnant mother by her incredibly brave 11 year old son. It brought tears to my eyes as well.

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Anatomy of an Mid-Air Emergency

DING DING DING, WOULD ANY DOCTOR ON BOARD RING YOUR ATTEDANT BUZZER? I shake off my near slumber and go running towards the back of the plane. Two freaked out stewardesses jab their fingers at the closed bathroom door, and I wonder why if someone's having a medical emergency that they'd leave them in there. Knocking gingerly, I hear repeated retching, and there I find hovering over the toilet a young woman pale and vomiting up her guts with the most severe abdominal pain she's every experienced (and she's had 2 kids). I use my toddler tumbling lessons to reach my foot over to flush the toilet and bring the crying woman outside. As I turn towards the galley corner I find a neonatologist standing sheepishly wondering why he wandered back since he usually takes care of the littlest infants smaller you can imagine. I'm glad to see him, if not for more than moral support.

I laid her down on the jump seat with a bucket beside her head, and raise her legs to get some blood to flow back to her pale sweaty face. Her crying calms a bit, enough to explain her pain is upper belly pain like heartburn, but worse than she's every had, radiating to her back. A flash of horror passes the back of my mind as I remember a case of a young woman dying from aortic dissection, suddenly and without warning. This is remote enough a possibility that I come back and focus on the most likely reason for her symptoms, food poisoning. In fact, what was more in the forefront of my mind was the same kind of retching I myself had on the plane after enjoying a bistro platter of raw seafood while playing hooky from med school, stealing away to Paris where my girlfriend (now wife) was studying. At least this woman had the decency of containing the products of her efforts to the toilet, whereas I'd spoiled the whole galley with my gifts a dozen years ago.

With her color returning, I called for "the kit". Can you believe the medical kit has cardiac resuscitation meds? What use is that now that the defibrillator's been replaced by and AED (automated electronic defibrillator) which doesn't give me a quick look of her rhythm. I'm hoping I won't have to use any of those meds, and instead gave her 25 mg phenergan in her right buttock (with a stewardess preserving her dignity with a blocking curtain), hoping she wouldn't retch into the back of the jump seat. Fortunately, in a few minutes her mid-epigastric pain quickly improved (acid from the vomiting), only to find she still had left lower quadrant pain. My concern then turned to a possible ectopic pregnancy or a ovarian cyst, and my concern increased when in another 10 minutes her pain greatly improved, possibly representing it having burst since the pain so magically improved.

Good thing the neonatologist was there, who up to that time played assistant to me -- handing me gloves, meds, syringes and needles. It was my turn to serve, and we switched places. There was no tourniquet, so I ran back to my seat to grab my computer power cable, and cinched off her left arm, eliciting a howl such that I loosed the cinch a bit. After he got the IV in, I wondered why the saline wasn't running in, and instead blood was drifting into the IV tubing. I realized then why it's nice to have nurses do your IV's. They don't forget to undo the tourniquets after you start the IV.

As her blood pressure improved with the IV fluids flowing in, I had a chance to catch my breath before the stewardess handed me the phone: it was the pilot. He had the grand plan to let all of the passengers off before paramedics tended to my patient. I had to bicker with the pilot to let her off first to get whisked off to the nearest ER. Burst ectopics or ovarian cysts can bleed a lot and patients die quickly!

As we left the plane to meet the ambulance, a funny thing was that I knew one of the paramedics - I'd worked with one of them in a summer camp together. We reminisced as they loaded her onto a gurney to wheel off to the elevator bringing them back to the tarmac to jet off to the ER. I was just glad I kept her alive and got her into good hands.

Lessons to those who get sick in flight:
1) tell the doc who sees you that there's a complete medical kit
2) tell the doc to tell the pilot exactly the degree of risk of immediate danger you're in
3) ask for more docs if the one seeing you doesn't seem to be completely comfortable tending to a medical emergency. On our flight there were 3 docs, other than the neonatologist, there was a cardiovascular surgeon, who would be very handy if we needed to crack your chest to massage your heart, but that wouldn't be too useful without the intubation supplies missing from the medical kit. You want the ER doc, family doc, or general surgeon taking care of you, someone attuned to subtle changes in patients with dire emergencies.

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Margaret Chan appointed to lead World Health Organization

My ethnic pride welled today as I learned that Margaret Chan has been appointed to lead the WHO World Health Organization. My parents are from Hong Kong and my dad may have known her from his medical training and practice there. Dr. Chan received criticism on her "technicality" of managing the SARS epidemic in Hong Kong but otherwise has been roundly praised for her work in Hong Kong and more recently in the WHO.

Cheers to a fellow Cantonese doc!

Others commenting: 496 more congratulating at Google News...

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11 million Perrigo Acetaminophen 500mg Pain Reliever Caplets Recalled

I conference call for 8 hours with 7 emergency room physicians every Thursday, working on Sutter's electronic medical record for EDs, Epic ASAP. Today, the hottest news is the 11 million generic caplet Tylenol recall of private labeled Perrigo "Acetaminophen 500mg Pain Reliever Caplets" due to contamination with metal particles. That means that pharmacies, distributors and grocers that relabel Perrigo acetaminophen under their own brand possibly have their bottles contaminated. This is an FDA class 2 recall, which is voluntary for the manufacturer due to the low risk of harm to patients ingesting contaminated capsules. Still, I wouldn't want to be eating metal with my pain reliever. I wouldn't want any more hassles while going through airport check-in, although I suspect the amount of contaminated acetaminophen I'd need to ingest to set off alarms would kill me from liver failure first. I'm surprised it's not more widely publicised since acetaminophen is one of the most commonly used pain relievers, and you have to look at the fine print on your bottle to see if yours is from an involved lot number. You may want to even ask your nurse if the acetaminophen they're giving you to take while in the clinic or hospital is from an affected batch since major healthcare distributors are involved as well.

Click here for:
Involved pharmacies, distributors & grocers
Batch numbers
Perrigo Co.

via AP/SJ Merc, AP/topix, and 889 articles at Google news.



Photo credit: Matt Browne

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FDA video: Ibuprofen Interferes With Aspirin's Heart Protective Benefit

I've blogged before that you should:
- take your daily dose of immediate-release low dose aspirin at least 30 minutes before you ever take ibuprofen and possibly any non-steroidal anti-inflammatory drug (NSAID).
- Otherwise, you should wait at least 8 hours after taking a dose of ibuprofen before taking your daily aspirin dose, in order to avoid preventing the heart-protecting anti-platelet effects of aspirin.

Now, the FDA has come up with an online podcast video describing this same information. Watch and learn! Click on one of the following options:

- Windows Media Closed Captioned
- RealPlayer Closed Captioned
- Windows Media Cable/DSL
- RealPlayer Cable/DSL
- MPEG Download. (Right-click and pick 'Save Target As' to save to disk.)

via FDA MedWatch Safety Alert – Ibuprofen and Aspirin taken Together – September 8, 2006

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Grand Rounds Volume 3 Number 7 is available

Grand Rounds is the weekly roundup of the best health weblog posts, and this week it's hosted by Rita Schwab of MSSP Nexus Blog.

By clicking through, you will find short summary links to the writing that each individual health writer considers to be their best writing from this past week.

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Mercury Containing Flu Vaccine Allowed in Californian Children Under 3 Through Dec 14 2006

Although there is no proof linking thimerisol containing vaccine to autism or other diseases, Governor Schwarzenegger signed AB 2943 so that effective July 1, 2006, vaccines containing specific levels of mercury cannot be administered to pregnant women and children under the age of 3. Due to the current delay of delivering flu vaccine, Secretary of the California Health and Human Services Agency yesterday granted an exemption through December 14, 2006 with the caveat that thimerosal-free product should be used whenever possible.

Vaccine delivery delays occured due to multiple facors:

• one experienced poor growth of one of the viral strains which delayed completing production
  
• one vaccine supplier decided against production
  
• the American Academy of Pediatrics determined that children younger than nine years of age should receive two doses of vaccine this year because of two new virus types in 2006-2007 vaccine. This doubled the amount of vaccine necessary for children age 6 months to 3 years old who received vaccines last year, whereas physicians expected that children who had received the vaccine in the past would not need a second dose.

This will come as welcome relief for Pediatricians and Family Physicians scratching their heads trying to figure out how to immunize these children with 2 doses one month apart, when they haven't received any yet. Unfortunately, there's a delay in the delivery of thimerisol containing vaccine for the first reason listed above. Fortunately the flu season doesn't kick in usually until January, and it takes a week or two for antibody production to ramp up to protect you. Here's to hoping the deliveries get here soon.

Ironically for my clinic, Palo Alto Medical Foundation, we have plenty of thimerisol-free vaccine but are delayed in receiving our thimerisol containing vaccine. You can't win, eh?

via CAFP, CA HSS...

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Hopes for Breakthrough in Diarrhea Treatment

In the profit driven world of drug companies, one newcomer stands out since it is a nonprofit. The Institute for OneWorld Health, based in San Francisco, announced a $46 million grant from the Bill and Melinda Gates Foundation to develop new treatments for diarrhea. I'm particularly passionate about this, having spent a summer in medical school fighting diarrheal disease in infants by promoting breast feeding in rural Texas. When you've seen the miraculous recovery of a vomiting lethargic dehydrated infant after just spoonfuls of oral rehydration therapy (ORT), you too would yearn for more help for these children.

OneWorld Health will try to find a drug that would enhance ORT by assisting the intestines' effort to absorb fluid. Founder Dr. Victoria Hale recently received one of the MacArthur Foundation’s genius awards, and I have high hopes for their efforts.

via NYT...

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