Top 10 | iMedicalApps

Our "Top 10″ section contains some of our favorite medical App rankings, along with App comparisons and other favorite posts.

http://www.imedicalapps.com/top-10/

iMedicalApps.com - iPhone, iPad, and Android Medical App Reviews and Commentary

iMedicalApps is an independent online medical publication written by a team of physicians and medical students who provide commentary and reviews of mobile medical technology and applications.  We receive over 300,000 views a month by the medical community.  Reviews and commentary are based on our own experiences in the hospital and clinic setting and creative and content control are strictly managed by the medical professionals running the site.

http://www.imedicalapps.com/

Surgeon educates over 100,000 through iTunes podcasts aimed at medical students | iMedicalApps

One of the beauties of mobile medical education is how quickly you are able to distribute multimedia content, especially if it's free.  This is due to the ubiquitous nature of certain platforms, such as iTunes, on every iOS device — over 120 million of them.  These mobile devices have significantly lowered the barrier of entry for medical professionals wishing to reach millions of individuals.

A University of Alberta professor and surgeon, Dr. Jonathan White, decided to make 10 to 30 minute iTunes podcasts of his lecture material in order to reach his students at a different level.  His medical students feel the free Podcasts are more captivating, and enable them to consume a greater amount of content when they are short on time:

Dr. White states he has reached 120,000 individual people since starting the podcasts in 2008 on iTunes.  Whether those individuals are medical students or patients, he isn't sure — but his content is aimed at students in the health care profession.

The podcasts themselves are informative, concise, and even entertaining.  They are divided into chapters, enabling you to listen to only the portions you want, such as treatment or etiology.  While listening to the short podcasts won't make you an expert in the particular disease pathology, they are definitely at the level of a medical student, and possibly an intern.

They cover subjects ranging from GI, such as Diverticular Disease, to Cardiology, such as Aortic Dissections.  Overall, the podcasts are extremely easy to download to your iPhone, iPod Touch, or iPad, and are a great form of mobile medical education.  If you don't have an iOS device, you can listen to them via iTunes and the Surgery101 website.

The Podcast usually occurs on a weekly basis, and there are currently over 35 episodes thus far.  We encourage our readers to check out Dr. White's website, and to subscribe to his podcast.

Website: Sugery101.org

iTunes Surgery 101 Podcast link

Source: CBC News

http://www.imedicalapps.com/2011/03/surgeon-101-itunes-podcasts/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed:+iMedicalApps+(iMedicalApps)

BioMedLib™ search engine: Search the biomedical literature, for the most relevant articles.

BioMedLib provides several information services, which are delivered to you via email, free of charge.

1. "Who is Publishing in My Domain?": Put BioMedLib to work to monitor the biomedical literature for you. This service keeps you updated on research published on the very same topic as your own article, so that you can stay afresh and ahead in your field. This literature-monitoring service takes your article, and periodically sends you articles in the same domain as your article. Sign up here.
2. "Updater": You submit one or a few keywords, and this service will send you periodic updates on the most relevant articles matching your query. Sign up here.
3. "Article Summarization": This service takes your query (a few keywords) and periodically sends you a concise summary of the latest and most relevant publications, so that you can review new research developments quickly and more efficiently. Sign up here.
4. "You Are Cited": This is BioMedLib's citation-notification service. This service sends you list of articles citing your publication. Sign up here.
5. "Free PDFs": Free full-text PDFs of articles for your query. You submit keywords, and this service periodically sends you articles with free full-text PDFs for your query. Sign up here.

http://bmlsearch.com/

The Hard Reality of Cancer Treatment - NYTimes.com

Months into Ruth's treatment for breast cancer, after she had completed her chemotherapy, she needed a break. So did I. We cobbled together our airline miles and made plans for a short break in the Caribbean.

One long flight and then a change to a 10-seater and up in the air again. The small plane was hot and Ruth took off her Courtney Love travel wig. Her hair had started faintly coming back — as our friend Steven put it, the blond shoots of her re-emergence. Signs of life.

The little island's runway suddenly came into view as we cleared the saddle between two hills and started to dive bomb. It looked like the pilot would either hit the tarmac or plunge into the ocean. I clutched the armrests and blurted out, "I think we're going to die." Ruth responded as she gazed out her window at the blue sea, "Wouldn't that be ironic?" We hit hard, the plane rattled, and we came to a safe stop.

When we got back from our vacation, our next appointment was with radiation oncology. It was supposed to be routine, no surprises. We'd be in and out of the doctor's office in an hour, her radiation treatment would get scheduled, and then I'd take her out to dinner.

Radiation treatment is the most passive part of cancer treatment. For a few weeks you show up every day for your dose, which takes a few minutes, and then you go home. And at least at Memorial Sloan-Kettering Cancer Center, where Ruth was being treated and I am a doctor, the whole process runs like the Swiss railroad, precisely on time.

After a few minutes, we were put into an exam room and in came the medical resident — a trainee only a few years out of medical school. Polite and personable, he looked like he was going to get us efficiently through this part of the process.

A few questions, a quick exam, a visit from the attending doctor, and we'd be gone. We sat there well rested, ready for the next and final phase. I was even a little tan.

"Now, I just want to review your history with you,'' the young doctor began. "Last fall you felt a lump. And then in October … Dr. Cody felt it … Later the biopsy showed … and the surgery … and the pathology showed … and then chemo … And they first gave you …"

Ruth stopped him. "You don't have to go through this all," she said. "It's all in the record."

He nodded. Then he went right back to reciting her history. The dates, the events, all in a list, one by one.

When he said "October 1st," I saw my friend and colleague, Dr. Chip Cody, touching my wife's breast and heard him deliver the news. When he said "surgery," I remembered Ruth waking up from anesthesia. "Feels like I just got off the overnight to London," she had mumbled. A groggy dehydrated disorientation. Then she threw up.

By the time the young doctor was done, maybe three minutes had elapsed, and he had rattled off every white knuckle spin of the roulette wheel. The lymph node assessment, the bone scan to determine if the cancer had spread beyond the reach of the surgeon, the heart tests as part of her clinical trial, the inspection for whether the tumor was fueled by estrogen and progesterone hormones, and the tests to see if it would respond to the drug Herceptin.

Every single test and finding affected what treatment Ruth would get and what our chances were for the future. The minutes, the hours, the days, the weeks, the months that had passed since that sunny Wednesday morning when the suspicious lump was diagnosed as cancer.

The resident didn't realize how absurd and unfeeling it was to distill the hardest year of our lives into such a condensed narrative, which to me amounted to saying, "Well Odysseus got on the boat, stopped a few places and then reunited with his wife."

He was oblivious to the agony he was causing us as he perfunctorily rattled off the events, even though he had doubtless gone through the same routine many times with many other patients.

Over the years, with my white coat on, so have I, and I have never thought about the effect it might have when I do it. Recounting a patient's history: it's just something that we doctors do. Part of our routine.

But at that moment, in that small office with no windows, about 500 feet away from where I am doctor not husband, I realized how badly I had misjudged what the year would be like, and how poorly prepared I was for it.

When we first fully understood Ruth's diagnosis, I had instinctively pulled out a calendar, just as I had when we found out Ruth was pregnant. I counted the days and weeks, and the breaks in between, factored in a few delays, and concluded" "Seven months. Next summer this will all be over."

My plan was to just hold my breath until then. Just seven months.

It had seemed to work at first. Ruth and I had tackled cancer like a to-do list, ticking off each item and moving to the next step. But we didn't realize how the grind of symptoms and fears and steps of treatments would slow time's passing, or how each step, although we finished it, would never be quite tucked away.

It was only after listening to the doctor's rote description of her diagnosis and treatment that I realized how wrong my approach had been. If I kept holding my breath through this long hard year, I would end up like Shelley Winters after her long underwater swim in "The Poseidon Adventure." Present, but quite dead.

Because the truth is, I couldn't hold my breath and wait for cancer to be over. Each step couldn't be left behind as it was conquered. We couldn't go through treatment and then back to our life because the cancer and the treatment was and always would be our life.

It was a hard landing.

Dr. Peter B. Bach writes about his wife's breast cancer diagnosis and treatment.

http://well.blogs.nytimes.com/2011/03/29/hit-by-the-reality-of-cancer-treatment/?pagemode=print

Anorexia, Bulimia, Binge Eating Affect Older Generation Too - NYTimes.com

More than 10 million Americans suffer from anorexia, bulimia and other eating disorders. And while people tend to think such problems are limited to adolescence and young adulthood, Judith Shaw knows otherwise.

A 58-year-old yoga instructor in St. Louis, Ms. Shaw says she was nearing 40 when she decided to "get healthy" after having children. Soon, diet and exercise became an obsession.

"I was looking for something to validate myself," she told me. "Somehow, the weight loss, and getting harder and firmer and trimmer and fitter, and then getting recognized for that, was fulfilling a need."

Experts say that while eating disorders are first diagnosed mainly in young people, more and more women are showing up at their clinics in midlife or even older. Some had eating disorders early in life and have relapsed, but a significant minority first develop symptoms in middle age. (Women with such disorders outnumber men by 10 to 1.)

Cynthia M. Bulik, director of the Eating Disorders Program at the University of North Carolina, Chapel Hill, says that though it was initially aimed at adolescents, since 2003 half of its patients have been adults.

"We're hearing from women, no matter how old they are, that they still have to achieve this societal ideal of thinness and perfection," she said. "Even in their 50s and 60s — and, believe it or not, beyond — women are engaging in extreme weight- and shape-control behaviors."

Younger or older, patients tend to engage in the same destructive behaviors: restricted eating, laxative abuse, excessive exercise and binge eating. And the trigger is often a stressful transition — in a young person, perhaps going away to college or living through her parents' divorce; in later years, having a baby, sending a child to college or going through her own divorce.

"I think there is a probably much higher percentage than we've been able to identify," said Tamara Pryor, clinical director of the Eating Disorder Center of Denver, who has been studying about 200 cases of midlife eating disorders. "I think out there in the workaday world there are a large percentage of women who just fly under the radar. They are subclinical and you don't question them, because in so many other areas of their life they look so functional."

One concern, she and other experts say, is that as women get older they are more adept at concealing the problem, and symptoms may be attributed to aging rather than to an eating disorder.

For instance, when a thin adolescent stops menstruating, doctors typically raise questions about weight and eating habits. But in Ms. Shaw's case, they assumed it was early menopause. When she developed anemia and osteoporosis, they didn't guess that the true cause was years of malnourishment.

And though one doctor suggested that Ms. Shaw looked as if she needed to "eat a cheeseburger," most praised her efforts to keep her weight down and her commitment to exercise.

"One of the things we're working very hard to do is to make sure this stays on physicians' radar screens so they can recognize and distinguish between menopause-related changes, real health problems and eating disorders," Dr. Bulik said. "Often they don't ask the question because they have in their mind this stereotypical picture of eating disorders as a problem of white, middle-class teenagers."

For Ms. Shaw, diet and exercise overtook her life. She spent more and more hours at the gym — even on family vacations, when she would skip ski outings with her husband and sons in favor of workout time.

"None of my friends, my ex-husband, no one ever said anything," she said. "It was no one's job to fix me, but I wish someone had said to me: 'I miss you. You're gone. You're so obsessed.' "

Finally, a yoga instructor sounded the alarm after Ms. Shaw had twice fallen, breaking an elbow and then later her pelvis. "There's nothing left of you," the instructor told her. "Only you can decide if you're going to change that by feeding yourself."

More ...

http://well.blogs.nytimes.com/2011/03/28/an-older-generation-falls-prey-to-eating-disorders/?

GlassHospital

This blog is created and hosted by John Henning Schumann.

I am a general internist and medical educator at the University of Chicago.

I work as a primary care doctor for adults on the south side of Chicago, and I train residents and medical students in both Internal Medicine and Medical Ethics. I have served in medical center administration working to improve patients' experiences at hospitals in Boston and Chicago. I serve as faculty co-chair of the university's human rights program.

The goals of GlassHospital are as follows:

1. To provide transparency on the workings of medical practice and the complexities of hospital care.

2. To illuminate the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician.

3. To demystify medicine.

http://glasshospital.com/

More young doctors choosing careers in primary care - Chicago Sun-Times

After years of avoiding careers in primary care because of the relatively low pay and long hours, medical students are showing greater interest in family medicine, internal medicine and other primary care-related fields.

And health-care reform is at least part of the reason.

Every March on "Match Day," thousands of graduating medical students learn where they will spend the next three to seven years training in the specialty of their choice. This year, the number of medical school seniors matched to family medicine residency programs rose 11 percent over 2010 — the second year in a row enrollment has grown, according to the National Resident Matching Program.

Two other primary care-related fields — internal medicine and pediatrics — also saw enrollment gains.

In fact, internal medicine was the most popular specialty chosen by students from both the University of Illinois at Chicago College of Medicine and the University of Chicago Pritzker School of Medicine this year.

The trend is encouraging, given that the United States is expected to face a massive shortage of primary care doctors. The American Academy of Medical Colleges estimates that the nation's physician shortage, previously projected at nearly 40,000, will grow to 63,000 the year after most of the federal Affordable Care Act goes into effect.

Still, health-care reform has played a role in luring medical students back to primary care fields, with provisions that would increase Medicare reimbursement to primary care doctors, raise Medicaid payments for certain services and expand debt foregiveness programs for medical students willing to work in underserved areas, said Dr. John Prescott, the academy's chief academic officer.

New efforts to improve health-care delivery in ways that "produce great results for patients and are also very satisfying for physicians" have sparked renewed interest in primary care as well, Prescott said.

Eric Chen, a U. of C. medical student who will be doing his residency at Oregon Health and Science University, said that "dialogue about health reform" was a big reason he wanted to go into family medicine. "There are a lot of high-level thinkers that are trying to rethink health-care delivery, and I want to be part of those conversations," said Chen, of Palo Alto, Calif.

UIC student Jamie Brewer was drawn to internal medicine because she said "it's obvious that there's a need in that area," and being a primary care doctor is "about more than just fixing the problem and sending the patient home."

"You're able to work with the patient from the beginning and teach them how to be better able to manage their own medical issues," said Brewer, of Calumet Park, who's headed to the University of Chicago Medical Center. "I like that aspect of treating the whole patient."

http://www.suntimes.com/lifestyles/4529695-423/more-young-doctors-choosing-careers-in-primary-care.html

Today's Hospitalist magazine: jobs, news, trends, and career advice for hospitalists.

Today's Hospitalist is a monthly magazine that reports on practice management issues, quality improvement initiatives, and clinical updates for the growing field of hospital medicine

http://todayshospitalist.com/index.php?b=home

Notes from Dr. RW - physician blog

Originally a traditional internist, I became a hospitalist in the early days of the "movement." I'll be writing about clinical topics, mainly in hospital medicine. Occasionally politics and other stuff creep in.

http://doctorrw.blogspot.com/

Breakthroughs in Mobile Technology for Medicine - WSJ.com

Eric Topol felt a twinge of nostalgia when he stopped carrying around his trusty stethoscope.

It didn't last long.

Dr. Topol, a cardiologist in San Diego, carries with him instead a portable ultrasound device roughly the size of a cellphone. When he puts it to a patient's chest, the device allows him to peer directly into the heart. The patient looks, too; together, they check out the muscle, the valves, the rhythm, the blood flow.

"Why would I listen to 'lub dub' when I can see everything?" Dr. Topol says.

The $8,000 device—called the Vscan, made by GE Healthcare, a unit of General Electric Co.—is just one entry in the booming field of mobile-health technology. In an era where many medical schools hand out iPods along with dissection kits, Dr. Topol, the chief academic officer for Scripps Health, a San Diego-based nonprofit health-care network, says smartphone apps, wireless sensors and other innovative tools hold "transformative potential."

He and other physicians say the technology can not only improve diagnoses and treatment, but also revolutionize how doctors and patients think about health care. Mobile tools allow physicians to monitor vital signs, note changes in activity levels and verify that medications have been taken, without ever seeing a patient face to face.

That means fewer office visits—and fewer hospitalizations, since even very ill patients can be monitored from afar. For their part, patients can monitor their health in real time, gaining access to an unprecedented amount of data that will allow them to "take charge of their own health care," Dr. Topol says.

Kelly Morris, a mother in Union Grove, Ala., sees the potential most clearly in a red plastic tag she clips to her daughter's shirt each morning. One side of the tag reads: "In Case of Emergency." The other instructs responders to text a unique PIN to the number 51020. Anyone who does so will receive a text offering detailed instructions for 13-year-old Michaela's care. They'll learn, for instance, that her particular form of epilepsy does not respond well to the most common seizure drugs and that certain medications make her manic.

"These are things I would like an emergency team to know," Ms. Morris says. "It gives me the ability to say what I want to say, even if I'm not there."

Another feature of the $10-a-year service allows trained medics, who are given special access codes, to pull up a preprogrammed list of the patient's emergency contacts. The medic can swiftly notify them all—by automated text, email or phone call—that the patient is being taken to a specific hospital.

The technology, called "invisible bracelet," was developed by Docvia LLC of Tulsa, Okla. In addition to the red plastic tags, the company sells key fobs and stickers that can be attached to ID cards and that carry the same instructions about texting a PIN in case of emergency.

Eyes on the Road

Emergency responders are also on the front line of another innovation: a wireless ambulance-monitoring system developed by GlobalMedia Group LLC, a developer of telemedicine hardware and software based in Scottsdale, Ariz.

The TransportAV system, which costs about $30,000, uses a small video camera, digital stethoscope and microphone mounted on a stretcher to transmit live images of the patient to the treatment team waiting in the hospital emergency room. Paramedics and nurses in the ambulance can send close-up images of wounds, real-time video of the patient's response to various treatments, and audio of heartbeats and respiration.

Such monitoring isn't all that crucial for short ambulance rides. But specialized facilities like Cincinnati Children's Hospital Medical Center often pick up patients in other states, four or five hours away. Hamilton Schwartz, an ER physician at Cincinnati Children's, says the system lets him see the patient for himself, instead of having to rely on an ambulance nurse to describe symptoms by cellphone. Dr. Schwartz can then order treatments en route, brief the ER team or prepare a surgical suite for the ambulance's arrival.

Dr. Schwartz has been using the system on a trial basis for several months and says his "gut feeling is that it's great." He has launched a formal study to determine whether doctors who use this technology order different treatments from those who simply hear the patient's symptoms described.

IPhone Diagnostics

When the patient is in the hospital and the physician is on the road, a different type of long-distance monitoring is needed. The Mobile MIM system, approved last month by the Food and Drug Administration, lets doctors use their iPhones to view images from sophisticated hospital tests such as MRIs and CT scans. Developed by MIM Software Inc., of Cleveland, the program reproduces the scans with enough clarity and fidelity that physicians can make diagnoses via smartphone.

Yuko D'Ambrosia, a Denver obstetrician, uses an iPhone for another purpose—keeping track of her patients' labor.

Nurses on the labor and delivery floor routinely use sensors to monitor the fetal heart rate and the mother's contraction patterns and oxygen levels. In days past, Dr. D'Ambrosia would call the hospital every hour or two to ask a nurse to describe the data being spit out by the sensors.

"Everyone uses different terminology," she says. "I would have to spend a few minutes trying to tease out what that heartbeat looks like." If she wasn't satisfied with the nurse's description, she'd drive to the hospital to look at the graphs and charts in person.

Now, however, Dr. D'Ambrosia uses an application called AirStrip OB to pull up that information on her iPhone. With a couple of taps, she can view, in real-time, all the data from the sensors strapped to her patient's belly. If she spots danger signs, she can order a Caesarian section by phone, so the patient will be prepped and ready for surgery by the time she gets to the hospital.

Hundreds of hospitals nationwide use the system, developed by Airstrip Technologies of San Antonio, Texas.

The California Hospital Medical Center in Los Angeles has adopted a more elaborate patient monitoring system, EverOn, for critically ill patients.

The system consists of a sensor-studded mat that is placed under a patient's mattress. Nurses program the device to alert them if any of the patient's vital signs drop to a level that they deem worrisome for that individual.

If that happens, the EverOn wirelessly transmits an alarm that goes off at the main nursing station on the floor, in the patient's room, and on nurses' smartphones or pagers.

"We've had a lot of saves on close calls," says Jamie Terrence, the hospital's director of risk management. "The nurse gets in there before we have to call code blue for cardiac arrest."

The mat, made by EarlySense Ltd. of Dedham, Mass., can also be set to send nurses reminders at predetermined intervals, so they don't forget, for instance, to turn a patient regularly to prevent bed sores. Installing the system throughout a typical 30-bed hospital unit costs about $230,000, with annual maintenance costs of about $50,000.

Other monitoring devices abound.

Sotera Wireless Inc. in San Diego is developing a wristband sensor that tracks vital signs—including blood pressure, cardiac rhythm, even activity level—and sends wireless alerts to the doctor at the first sign of trouble.

AT&T Inc. is developing "smart slippers" with pressure sensors to detect any changes in the wearer's gait that may signal a health issue or increased risk of falling. If such changes are detected, a transmitter is supposed to notify the patient's doctor.

And myriad smartphone applications promise to help patients do everything from monitoring their blood glucose to taking their pills on time.

So much information, so readily available, can have a downside. "We could create a whole culture of cyberchondriacs," says Dr. Topol, the cardiologist in San Diego.

He acknowledges, too, that something will be lost when most face-to-face visits with physicians are replaced by wireless exchange of data. "We're getting virtual touch, rather than actual touch," he says.

But Dr. Topol says in his own practice, he's found that many patients are more willing to make lifestyle changes that keep them healthy when they can monitor the consequences of their actions in real time. A doctor can talk "until he's blue in the face," he says, but it sometimes takes cold, hard data to motivate a patient.

Technology "can create anxiety," Dr. Topol says, "but it's also empowering."

http://online.wsj.com/article/SB20001424052748703559604576174842490398186.html

Think Like A Doctor

The purpose of Think Like A Doctor is to help healthcare consumers like you become even better patients by improving the relationship with your physician. The best way to do this is by thinking like your doctor.

http://www.thinklikeadoctor.com/welcome.html

Think Like a Doctor (The Winner) - NYTimes.com

Yesterday, I challenged readers to solve a complicated case of a little girl losing her hair.

More than 1,200 readers weighed in with diagnoses that included a too-tight ponytail, toxins on the girl's violin, autoimmune conditions, eating disorders and even the go-to disease of the doctors on "House," sarcoidosis.

As of late last night, six readers came up with the right diagnosis, although several others came came very close. And the answer is . . .

Final Diagnosis: Pompe disease.

Patients with Pompe (pronounced pom-PAY, like the ancient city) disease have significant trouble breaking down glycogen, the stored form of our main energy source, glucose. Glycogen is most abundant in the liver and in muscle, where it's stored as an emergency form of energy. But in order to be used, the glycogen has to be broken down into glucose via an enzyme.

Patients with Pompe disease, an inherited condition, make defective enzymes or don't have the enzyme at all. Pompe patients become tired easily and have little endurance because they can't get the extra energy from glycogen; they simply run out of gas. More important, the unused and unusable glycogen is left inside muscle and liver cells, and ultimately the build-up of these glycogen fragments destroys the cells.

The consequences of untreated Pompe disease are devastating. Patients quickly become wheelchair bound, and even breathing becomes difficult. (The most severe form of this disease was portrayed in the 2010 Harrison Ford film"Extraordinary Measures." )

A drug that replaces the defective enzyme was approved by the Food and Drug Administration in 2006. Patients who get this medication may be able to slow and sometimes reverse the devastating consequences of this disease.

Readers' responses:

Hundreds of readers weighed in on this case. Some were doctors, but many were not. Some walked us through their thinking; others just laid their proposed diagnosis out for all to see. Only a handful of readers got the right answer.

B. Mull, a physician from Orange County, Calif., was the first to solve the puzzle, submitting his diagnosis at 4:32 a.m. (1:32 a.m. his time), four hours after the case went up. He wrote:

She definitely has a muscle disease. Most likely toxic, autoimmune, or metabolic. There is no obvious toxin however… And what metabolic myopathy has hair loss? I'm putting my money on POMPE DISEASE.

Later that afternoon, a comment came in from Lisa in Minnesota, who proposed that it was "Pompe disease for the muscle issues." Lisa is not a doctor, but says she has worked with people with this disease and recognized the signs.

These two readers, a doctor and a non-doctor, were the first two to figure out the diagnosis. Both will get the prize, a signed copy of my book, "Every Patient Tells a Story."

Four other readers posted answers over the course of the day suggesting Pompe disease, including Sandra from Paulinia, Brazil, Wombat MSIII, LS from NYC, and KH from Houston. Strong work, you guys.

Several more readers deserve honorable mentions for coming very, very close to getting the right answer. All identified the disease as one of the glycogen storage diseases. Pompe is only one member of this family of diseases. Good work for picking the right family, but it wasn't quite specific enough.

I was hugely impressed by the thoughtfulness of comments that were posted. Several made me laugh — I think they were supposed to — and many made me think about how toxic the world we live in can seem. I was amazed by the range of diagnostic suggestions. A few times I even had to look up the proposed diagnosis.

One of the difficulties of this case derived from the fact that the symptom that brought the child to medical attention was less important to making the diagnosis than the results of the blood tests that showed abnormal liver and muscle enzymes.

And while hair loss isn't a key symptom of Pompe disease, the patient tells me it's a very common symptom among the many with Pompe disease that she has come to know since her own diagnosis just over a year ago. Since starting treatment, her hair has not been falling out in her hands the same way she complained about to her mom a lifetime ago.

How the patient's doctors made the diagnosis:

When Dr. Rand, the liver specialist, got the elevated C.P.K. muscle-enzyme test back, she referred the family to Dr. Carsten Bönnemann, a pediatric neurologist now at the National Institutes of Health who specializes in diseases of the muscle.

When Dr. Rand described the case to him, he suggested a test she had never heard of — an ultrasound of the muscles. Normal muscles look dark, nearly black, on an ultrasound. But when the ultrasound wand was put over the patient's thigh muscles, instead of looking black, the muscles looked granular, like the kind of static you see on a TV between channels.

This suggested to Dr. Bönnemann that the muscle might be infiltrated with something else. And the only way to figure out what that something was, he explained to the patient's parents, was to take a biopsy. And indeed, the biopsy suggested that the girl had Pompe disease, which was confirmed by genetic testing.

Back to the patient:

When Dr. Bönnemann broke the news to the girl's parents that that their daughter had Pompe disease and that she inherited it from them, they were devastated. How could they have passed on to their child this disease they'd never even heard of?

But there was more. Because this was a genetic disease, there was a chance that one or both of their other children could have it as well. Testing showed that their 12-year-old son did not have it; their 16-year-old daughter did. When her parents told her, the girl put her head down and cried.

Both girls now get an intravenous infusion of a synthetic version of the enzyme they need every two weeks. The results have been remarkable. Although neither of the girls thought of themselves as weak, they were. The younger daughter can now do three sit-ups; she had never been able to do a single one before she started therapy. The older daughter, now 17, bragged to me that she could pick up a full gallon of milk with one hand — something she couldn't do before she started treatment.

"Every day is kind of a struggle for these girls," the mother told me not long ago. "It's with us every day. Psychologically and practically."

In addition to the medication, the children have to stick to a reduced carbohydrate diet and go to physical therapy a couple of times each week. But, says mom, "They don't let this disease slow them down." Moreover, catching the disease this early has allowed the young women to start treatment and may protect them from some of the worst consequences of the disease.

http://well.blogs.nytimes.com/2011/03/24/think-like-a-doctor-the-winner/?partner=rss&emc=rss

Hospital staff showed utmost compassion to dying son | Comment | London Free Press

There has recently been a very end-of-life sad case at Children's Hospital in London that may have left a difficult, uneasy feeling among some people. Based on my family's long experience with this hospital, I believe the hospital and the dedicated staff there have been unfairly portrayed by some.

My son Eddie had been relatively healthy, despite nearly dying the first few months of his life. We were quite involved with the medical community, though, due to his very severe cerebral palsy, and the complications that can often accompany such a disability.

In early 2009, Eddie began monthly admissions into hospital. They would last between a few days and several weeks. With each admission Eddie's symptoms became more complicated to treat.

In September 2009, Eddie commenced Grade 9 at Mother Teresa secondary school in London. On Sept. 28, an ambulance was called to the school to transport Eddie to Children's Hospital. He was again admitted to the same floor to be with the same staff who had come to know him so well.

It became apparent, after a week or so into this admission, that Eddie might not be released from hospital. We as a family had to prepare ourselves for what might happen. A father and mother were soon to lose a son, and a sister was about to lose her only sibling, her twin brother. The doctors and nurses did their utmost to keep Eddie comfortable.

We met with the palliative care specialists who work at the hospital. This team is made up of very experienced staff, including doctors, nurses and social workers who work daily with families and their dying loved ones.

It is a sad fact, but children die every day, and this group of dedicated professionals do their very best to prepare all involved.

After all efforts were exhausted to treat Eddie, we again met with the palliative care team.

Also in attendance was a pediatrician from Children's Hospital who had treated Eddie for a number of years. She had come in on her day off to help us come to terms with what was happening. I repeat, she was not working, but came in on her own time.

We were assured all efforts would be made to keep Eddie comfortable and free of pain. His body was indeed shutting down, and no further treatment was available. It was time for God to take him.

We were set up in a room on Eddie's usual floor. Beds were brought in for us to allow for some sleep, if that were at all possible. We simply did not want to leave Eddie's side.

Over the next few days, Eddie was assigned some exceptional nurses to give him care. They knew, coming into the hospital for their shift, that they would be dealing with a family in pain, and a child who was dying. They showed remarkable compassion and ability. This was difficult not only for us, but also for the caregivers. Every effort was made by the doctors and nurses to prepare us for what would undoubtedly be the worst thing that we had ever experienced.

On Oct. 13, 2009, Eddie died. Doctors and nurses who had cared for Eddie came into the room throughout the next few hours to offer their condolences. Some sat and talked with us for some time, knowing the emptiness we felt was excruciating. We will always be grateful for their support and kindness.

A few days later at the funeral home visitation, several doctors, nurses and therapists from the hospital came to offer their condolences.

We have also received phone calls from some of the nurses we had come to know, inquiring about our family's well-being, since his death.

This indeed shows the concern that Children's Hospital staff have for families dealing with end-of-life circumstances.

Their compassion exhibited a level of morality that is beyond reproach. At times they are not given credit that they so definitely deserve.

Rob Herlick is a London resident.

http://www.lfpress.com/comment/2011/03/25/17751316.html

Frequent churchgoers frequently fatter – The Chart - CNN.com

Young, religiously active people are more likely than their non-religious counterparts to become obese in middle age, according to new research. In fact, frequent religious involvement appears to almost double the risk of obesity compared with little or no involvement.

What is unclear from the new research is why religion might be associated with overeating.

"Churches pay more attention to obvious vices like smoking or drinking," said Matthew Feinstein, lead author of the research and fourth-year medical student atNorthwestern University Feinberg School of Medicine. "Our best guess about why is that...more frequent participation in church is associated with good works and people may be rewarding themselves with large meals that are more caloric in nature than we would like."

The new research, presented at an American Heart Association conferencededicated to physical activity, metabolism and cardiovascular disease, involved 2,433 people enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) study.  The group was tested - at first between 20 and 32 years old - for various cardiovascular disease risk factors such as diabetes, hypertension, and smoking.  Those same tests were repeated in the same group over the next 25 years.

The results were mixed for many risk factors for cardiovascular disease, but as researchers analyzed the data, one disparity stood out.  Those who reported attending church weekly, or more often, were significantly more likely to have a higher body mass index than those who attended infrequently, or never.

Kenneth F. Ferraro, author of similar studies linking obesity with religion, suggested that marriage may have played a role in the weight gain.

"The time period studied is when many Americans get married," said Ferraro, director of the Center on Aging and the Life Course at Purdue University.  "We know that weight gain is common after marriage and that marriage is highly valued in most religious groups.  Thus, one wonders if the results could be partially due to religious people being more likely to get married earlier and then gaining weight."

Those church potlucks probably don't help either.

"There's certainly a church culture around eating," said Erik Christensen, a pastor at St. Luke's Lutheran Church of Logan Square in Chicago, Illinois. "What I see among congregants in their 20s and 30s is they are very fit and what I see among congregants in their 50s and 60s is disproportionate obesity."

Christensen suggested that the virtual disappearance of church-sponsored baseball and basketball leagues may be part of the problem.  He added that the decision to attend church is sometimes made at the expense of being involved in athletic or recreational activities.

But he kept coming back to that culture of eating.

"What's ironic to me is that in my congregation we are working on a childhood obesity initiative and spend a lot of time thinking about weight and food," said Christensen.  "We sit and have a potluck and talk about obesity."

Yet another irony is the number of studies suggesting that religion and faith are actually beneficial for health.  Recent studies suggest that a "relaxation response" in the brain among people who pray, meditate, or engage in otherwise relaxing activities may alleviate anxiety and stress. Stress is implicated in many illnesses.  Other studies suggest an association between church-going and longevity.

"On the whole being religious has been shown by many studies to be associated with better mental health, lower smoking rates, lower mortality rates and better overall health status," said Feinstein.  "There are a whole lot of things religious people are doing right, but it's just this specific area where there appears to be room for improvement."

The upshot of the new research, said Feinstein, is that knowing there may be an obesity problem among church-goers provides a captive audience for intervention.

"The real value of the study is not understanding why," said Feinstein.  "What this study does is highlights a group that could potentially benefit from targeted anti-obesity initiatives. That's exciting because there is a lot of infrastructure already in place in religious communities."

http://thechart.blogs.cnn.com/2011/03/24/frequent-church-goers-frequently-fatter/