The Last Word On Nothing

Guest Post: Affair of the Heart: II. Neglect Not So Benign

By: Colin Norman | October 13, 2014

This is the second post in Affair of the Heart, a series that takes place at the intersection of a highly-experienced science writer and the medical system.

A few months after my brother almost died from an aortic dissection, when his aorta began to break down right where it emerges from the heart, I was in the office of a respected Washington cardiologist to get myself checked out.

He ordered a stress test, which I completed with no sign of any problems—I was a dedicated runner, after all. But when I asked him whether a stress test would indicate precursors to aortic dissection, he agreed it probably wouldn’t. That would require an echocardiogram—ultrasound imaging that shows the structure of the heart and aorta and, thanks to the Doppler effect, displays the flow of blood through the heart chambers and major blood vessels in hues of red and blue. It so happened that an echo machine was available in his office at that moment, so I had the procedure there and then. The cardiologist left to see another patient, saying he would be very surprised if the echocardiogram showed any abnormalities.

The next morning, however, he called to say the imaging had turned up something: a mild dilation of the aortic root. He prescribed a beta blocker, a drug that lowers blood pressure, slows the heart rate, and reduces the strength of the heart’s contraction, relieving some of the stress on the aortic root. And he recommended a follow-up echocardiogram in 6 months.

The follow-up echo apparently showed little or no change, and another one a year later also showed no further dilation. So I became complacent. I let the time between supposedly annual imaging stretch out a couple of years–or more. Continue reading →

The Last Word

By: Ann Finkbeiner | October 11, 2014

October 6 – 10

This week was devoted to being Off Our Meds, looking calmly and as rationally as possible at scary issues in medicine.

Ebola is about as bad as it gets, and no vaccines or drugs. Guest Robin Mejia suggest we learn some R numbers: “for each day that we’re not effectively isolating people . . .the job of stopping the outbreak, turning it around, gets much bigger and much, much more difficult.”

Sometimes, says Erik who’s a cradle Christian Scientist, the placebo effect, which everybody says is powerful but nobody knows how it works, might just be a doctor and patient talking to each other.

Do you want to know a diagnosis that’s uncertain? do you want to await certainty? and what’s your doctor supposed to do about this? Cassie tells the most godawful story, commenters argue with her.

Richard got very sick. Doctor was seen, tests were done, hospitalization was had, doctor seen again: “Finally, he spoke: ‘Medicine is an art, not a science.’ Screw you, bub. I’m the writer here. You’re the empiricist. So let’s go: What’s the diagnosis?”

Guest Colin Norman retired, then decided to stop ignoring his family history, then began his medical education. In the last post of the series Off Our Meds, and the first post in the series Affair of the Heart, he takes us with him. Next in the series is this Monday.

Off Our Meds: Guest Post

By: Colin Norman | October 10, 2014

Affair of the Heart: I. A Brush with Death

This is the last post in the series, Off Our Meds, in which LWON examined some scary issues in medicine but didn’t resort to fear mongering because we didn’t have to, medicine being scary enough as it is.

This is also the first post in Affair of the Heart, a series that takes place at the intersection of a highly-experienced science writer and the medical system.

Before I retired as news editor of Science magazine last year, I promised myself I would never become one of those old men who go on and on about their ailments. Yet here I am, starting a series of posts on my unexpected journeys through the medical system. My excuse? At 68 I don’t consider myself an old man, and after more than 40 years in science journalism, I can’t resist the urge to tell a good science story. Cutting-edge genetic research, pioneering surgery, the propensity of high-resolution imaging to come up with troublesome “incidental” findings, family genetics, the cost of medical care, and a bit of negligence on my part—they all feature in this saga.

After a lifetime of good health, aside from old rugby injuries and wear and tear on the knees from a half-century of running, it was something of a shock to learn earlier this year that I have two scary medical “conditions,” as the doctors like to call them: an aortic aneurysm that requires some serious cardiovascular re-plumbing, and a pancreatic cyst that has a potential to develop into an invasive cancer. Most people who have either of these silent lesions—and that turns out to be a surprisingly large number—are blissfully unaware of them until it’s too late. I’m lucky: It looks like I have a chance to deal with both of them before either deals with me.

Let’s start with the aortic aneurysm. That’s the part of the story that involves some personal negligence. Continue reading →

Off Our Meds: Doctor Knows Best

By: Cassandra Willyard | October 8, 2014

This week LWON presents “Off Our Meds,” an examination of some scary issues in medicine. We won’t resort to fear mongering, because we don’t have to. Medicine is scary enough as it is.

The woman came to Scott Haig, an orthopedic surgeon, because she had a lump on her collarbone. Usually these lumps are caused by arthritis or an infection, but this one felt odd. It was rubbery, and didn’t seem tender. Haig wanted to do a biopsy, a surgery that usually requires general anesthesia. But the woman didn’t want to be knocked out. So they struck a bargain: Haig would do the surgery with the woman awake, if she agreed to have an anesthesiologist present in case she needed to be sedated.

The surgery went off without a hitch. Haig took a section from the woman’s lump and sent it to the pathology lab. But before he could close up the incision, he needed to know that the pathologist had what he needed to make a diagnosis. So together they waited. As the minutes ticked by, he tried to make small talk. Finally the intercom crackled to life.

The pathologist began to speak, and so did Haig. He tried to tell Jose to call the phone. But the intercom only allowed one person to talk at a time, and Jose was already delivering bad news. “Jose, shut up,” he thought, or maybe even said. Haig can’t remember the exact words Jose used to describe the woman’s cancer – malignancy or tumor or neoplasm – but the diagnosis was clear to everyone in the room, including the woman on the operating table. Naturally, she panicked. Continue reading →

Off Our Meds: The Theater of Medicine

By: Erik Vance | October 7, 2014

This week LWON presents “Off Our Meds,” an examination of some scary issues in medicine. We won’t resort to fear mongering, because we don’t have to. Medicine is scary enough as it is.

I still remember my first trip to the doctor. I was 18 years old and doubled over in terrible stomach pain. And when I walked into that office, I truly didn’t know whether to expect a monster or a wizard with a magic wand.

Yes, the decimal point is in the right place. Before 18, I had never been to the doctor. I was raised in Christian Science and beyond the legally required vaccinations, never went to the doctor. Contrary to popular belief, Christian Scientists aren’t forbidden from going to the doctor, they just – you know – don’t.

Partly it’s because of religious belief but partly – and here I can speak only for myself and a few family members – it’s fear. Fear of the unknown, fear of cold metal instruments, fear of losing control.

Fear, in short, of the theater of medicine.

Continue reading →

Off Our Meds: Guest Post: The Ebola Numbers

By: Robin Mejia | October 6, 2014

Welcome to “Off Our Meds,” a weeklong series in which LWON examines some scary issues in medicine. We won’t resort to fear mongering, because we don’t have to. Medicine is scary enough as it is.

Last week, over at The Atlantic, Jacoba Urist wrote about a truism in journalism: deaths closer to home matter more.

This sounds ugly but makes sense intuitively. We feel the death of a loved one in a completely different way than a death across town, let alone a death across the country. It’s not surprising that news coverage reflects a similar ethos.

Proximity is both geographic and cultural. Think of the racist old adage from across the other Atlantic: “1000 wogs, 50 frogs, and a single Briton.” And, Urist writes, violence and novelty play into newsworthiness, too. “A tornado that kills schoolchildren is horribly sad; a young man who guns down kindergarteners holds a mirror to the society in which he lives.”

This means that pretty much all factors are working against good coverage of the Ebola epidemic right now. Until last week, Ebola had only hit countries that most Americans have never even contemplated visiting. And the bump in coverage caused by the diagnosis in Texas has been more about the disease hitting the U.S. than about the thousands dying in Africa. Continue reading →

The Last Word

By: Ann Finkbeiner | October 4, 2014

September 29 – October 3, 2014

You think a place like L.A. just happened to sprawl like that? that our various civil and environmental messes just happened? Nope, says guest Erika Schoenberger, a lot of times we planned ’em like that.

An evocative argument over whether Native Americans came over the land bridge, as the white guys think, or sprung right up out of the earth, as the Native Americans think. Craig says, don’t choose, have both.

Jessa is walking across the ice one day, sees enormous and beautiful dogs running fast straight at her, thinks to herself, “Those don’t look like dogs,” and sure enough, they’re not. A redux post that I’m delighted to see again.

Second guest of the week — LWON is lucky in its guests — Laura Paskus moved to the Southwest, watched the Rio Grande turn from a grand river to a ghost river, a dust river. But she’s not giving up on it.

Helen walks to work now. It takes longer. She’s happier for it. It’s more interesting, what with the plants, the bugs, and the busted-up piano. She stops and plays the piano.

Walking With Open Eyes

By: Helen Fields | October 3, 2014

My commute is the best part of my day.

I know this is not normal. I live in the Northeast megalopolis. Commuting means drivers who are great at texting but unfamiliar with turn signals. Commuting means listening to people paid to be “funny” on drive-time radio. Commuting means waiting on a crowded platform for a train that might come and might have air conditioning.

When I started a full-time job three months ago, I decided to try walking to work. My office is in the next suburb up, one metro stop away; it takes me 15 minutes on public transportation, or 35 on foot.

I start by crossing the entrance to the metro station—a little awkward, going perpendicular to the inward flow of business-dressed people. I pass pretty houses and unremarkable apartment buildings. The way continues along the rail lines, where weeds grow wild and you can tell if a kid with a can of blue spray paint came through last night. I walk past a community college and a community garden, past a row of body shops, then finish in a low-rise stretch of restaurants and car rental agencies. Continue reading →