Tag Archives: Medicine

Book Review: Cook County ICU by Cory Franklin

I am a big lover of medical memoirs and stories from doctors and other health care workers. A few weeks ago, I was browsing an eBook store I don’t normally go to, because Kobo has become harder to search and browse. I discovered Cook County ICU by Cory Franklin in the medical biographies and memoirs section. Because that eBook store doesn’t accept PayPal, I bought the book at Kobo anyway. I knew I wouldn’t be able to review it till today, because of the #Write31Days series, and I really had to keep myself from speeding through it. Of course, if I’d finished the book earlier, I could’ve scheduled my review, but in a way I was trying to keep myself from finishing the book too soon and getting bored afterwards. I just finished the book tonight.

Synopsis

An inside look at one of the nation’s most famous public hospitals, Cook County, as seen through the eyes of its longtime Director of Intensive Care, Dr. Cory Franklin.

 

Filled with stories of strange medical cases and unforgettable patients culled from a thirty-year career in medicine, Cook County ICU offers readers a peek into the inner workings of a hospital. Author Dr. Cory Franklin, who headed the hospital’s intensive care unit from the 1970s through the 1990s, shares his most unique and bizarre experiences, including the deadly Chicago heat wave of 1995, treating some of the first AIDS patients in the country before
the disease was diagnosed, the nurse with rare Munchausen syndrome, the first surviving ricin victim, and the famous professor whose Parkinson’s disease hid the effects of the wrong medication. Surprising, darkly humorous, heartwarming, and sometimes tragic, these stories provide a big-picture look at how the practice of medicine has changed over the years, making it an enjoyable read for patients, doctors, and anyone with an interest in medicine.

Review

Like the synopsis says, the stories in the book are mostly fascinating. I loved learning about the first surviving ricin poisoning victim and the suicidal biochemist. These obviously have got to be the first stories I mention, because I’m fascinated with (and deathly afraid of) poison. I grinned at the duke of Spain being mistaken for an alcoholic and the resident calling for a stat (as soon as possible) dermatology consult because “the rash might be gone tomorrow”. I almost cried with pity for the medical student asking a “stupid” question in a conference with some of the area’s top doctors (which turned out to be a really smart question later on). Most times, I felt eager to find out how each story unfolded. Even if the title explained some things already, as in the chapter on the disease that turned out to be AIDS, I found there were fascinating turns in the stories.

Dr. Franklin seems to intend his book to be a testament to the old-fashioned doctor-patient relationship. He ends the book by recounting some recent changes in the practice of medicine, like the change from covenant to contract in the doctor-patient relatiosnhip and the increased part money plays. He sounds a bit bitter at this point, because he considers the changes mostly negative but says we cannot go back. I have to mostly agree with him here, even though I am mostly a 21st-century patient so don’t know the era in which Dr. Franklin practised. Some things have improved. Like, when AIDS wasn’t known yet, doctors and nurses didn’t wear gloves when drawing blood, and Dr. Franklin is terribly lucky that none of his team treating the early patients were infected. In this sense, protocols help. That being said, things can go too far, and they probably have.

Despite HIPAA and similar laws, I know even today there are practitioners of “romantic medicine”, as 20th-century neurologist A.R. Lurija originally called it and as continued in the English language by Oliver Sacks. What I mean is, there are still doctors who will listen to their patients’ stories rather than just their immediate health concerns. That doesn’t mean all will publish books on their patients, but I’m sure some will. In this sense, medicine as a human-centered profession is not doomed. Cook County ICU is a great example of a fascinating book of interesting medical cases brought to life.

Book Details

Title: Cook County ICU: 30 Years of Unforgettable Patients and Odd Cases
Author: Cory Franklin
Publisher: Chicago Review Press
Publication Date: September 2015

Mami 2 Five

Common Myths About Irritable Bowel Syndrome

In 2013, I was provisionally diagnosed with irritable bowel syndrome (IBS) after no other cause for my chronic abdominal pain and alternating diarrhea and constipation had been found. I don’t have a severe case of it, having mild to moderate abdominal pain a few times a week but rarely severe pain. I am usually not significantly disabled by my symptoms either. I also happen to respond quite well to mebeverine (Colofab), an antispasmodic that relaxes the bowel muscles. Nonetheless, it is frustrating that there are still many common misconceptions about IBS. Here, I will share some of these.

1. IBS is just a fancy way of saying abdominal pain. It is true that the diagnosis of IBS is commonly based on symptom assessments and exclusion of other disorders, since there is no laboratory test to prove someone has IBS. However, IBS has many symptoms other than abdominal pain, and besides, the abdominal pain suffered by IBS patients is chronic and can be severe. It is not like, if you have bowel cramps for a day, you have IBS. Other core symptoms of IBS are diarrhea and/or constipation, feeling bloated, straining or urgency to defecate. Many sufferers have additional fatigue, acid reflux, etc.

2. IBS is all in the head. It is unclear what causes IBS, and stress could be a factor. That doesn’t mean it’s all in the head though. Stress can cause physical symptoms that are no less real just because stress causes them. It is also correct that IBS is associated with problems in the communication between the brain and the gut, but that could be both a brain and a gut problem. For example, people with IBS may be hypersensitive to abdominal discomfort. This however does not mean they choose to be in pain or are overreacting. It is an interplay between biological and psychosocial factors that cause people to experience the symptoms of IBS.

3. There is no clear definition of iBS. Like I said, there is no test for IBS, but there is a definition. For several decades, the Rome criteria have been in use for determining who has IBS. These criteria require that patients have had recurrent abdominal pain or discomfort at least three days per month during the previous three months that is associated with two
or more of the following:


  • Relieved by defecation.

  • Onset associated with a change in stool frequency.

  • Onset associated with a change in stool form or appearance.


When these criteria are met, only limited tests are recommended based on the individual’s situation. In my own case, it was hard to determine whether I met these criteria, as my pain certainly wasn’t relieved by defecation and I wasn’t sure of the other two.

4. IBS is caused by poor diet and lifestyle. Just [insert lifestyle habit or diet here] and you’ll be fine. While some people have food sensitivities that contribute to their abdominal discomfort, others do not. Also, indeed, some people find that exercisng more, not drinking alcohol, not smoking, etc. helps them. Others do not. Besides, even for those who do find that their diet or lifestyle contributes to their IBS symptoms, it may not be easy or may even be extremely hard to adjust their lifestyle or diet. I for one seem to be sensitive to sugary foods, but, as regular readers of my blog will know, I cannot seem to stop eating too much candy.

5. My [family member’s, friend’s, …] IBS was cured by [intervention], so yours can be cured too. Every person with IBS is different, and because many things contribute to IBS symptoms, there are many possible treatments. Mebeverine, the antispasmodic I use on occasion, has few side effects, but also is not very effective with most people. I am lucky that it helps me somewhat, but others wll not find relief from their symptoms with it. Same for diet, lifestyle changes, other medications (eg. antidepressants), psychological interventions, etc. They work for some but not othes.

6. IBS is the same as inflammatory bowel disease (IBD). Inflammatory bowel disease refers to Crohn’s Disease and ulcerative colitis. These are diseases which cause chronic inflammation to the digestive tract. Though some IBS sufferers have minor inflammation, especially if their symptoms set on after infection, it is not nearly as bad as with IBD. I for one had elevated calprotectin, an inflammation marker, when I was first tested for this. This led the doctor to think I might have IBD and get me a colonoscopy. Turns out I didn’t have IBD and on later tests, my calprotectin was normal again. It could’ve been I had an infection contributing to my symptoms.

7. IBS increases the risk of colon cancer. This is another difference between IBS and IBD: while IBD patients have a markedly increased risk of developing colon cancer, IBS patients do not.

8. IBS is not a serious concern. It is true, like I said above, that IBS does not cause cancer or suchlike. However, that doesn’t mean it’s not serious. Many people with irritable bowel syndrome find their symptoms to be severe and disabling. Besides, because IBS is so often misunderstood, many people experience social stigma. This can lead to further suffering. Get educated and stop stigmatizing people who have IBS.

Everyday Gyaan
Mums' Days

Vitamin B12 Deficiency: The Invisible But Treatable and Worryingly Common Disease

In the summer of 2012, I suffered from severe, persistent fatigue and episodes of lightheadedness. I went to my doctor, thinking I had iron deficiency anemia once again. My hemoglobin was always normal, but the ironn itself, which is necessary in the production of hemoglobin, had often been low. This time around, however, the cause of my fatigue was vitamin B12 deficiency.

Vitamin B12 deficiency is relatively common but used to be underestimated. It affects between three and six percent of the population, becoming more common as people age (Allen, 2009).

Vitamin B12 deficiency is usually diagnosed through a blood test. A deficiency is defined as a serum level of B12 below 148 pMol/L or 200 pg/mL (Allen, 2009). My level at the time was 120 pMol/L, which my doctor said was “not very low”. This may be so – I have met people on the B12 deficiency foundation forum with levels of 25 or less -, but it’s still cause for concern. Besides, my methylmalonic acid (MMA) was also elevated, which Allen says is the “gold standard” for diagnosing B12 deficiency.

Symptoms of B12 deficiency can be diverse. I only had tiredness and lightheadedness, but you may also experience rapid heartbeat or breathing, pale skin, sore tongue, weakness, an upset stomach, diarrhea or constipation. If B12 deficiency is not treated, it could lead to nerve damage. In fact, Chris Kresser, a natural health specialist, thinks that some symptoms common in the elderly, such as cognitive decline and lessened mobility, may in fact be due to untreated B12 defieciency. Kresser also cites a much higher prevalence than Allen, but this seems to be due to bias.

It is the Dutch B12 deficiency foundation’s position that, unless you’re eating strictly vegan, the cause of B12 deficiency is most likely malabsorption and you need to insist on injections. Malabsorption can, according to WebMD, be due to various causes, such as atrophic gastritis (where the lining of your stomach becomes very thin), pernicious anemia, Crohn’s or Celiac Disease, etc. However, eating a vegetarian diet with few eggs or dairy, as I did, can also cause low B12 levels. I went with injections anyway because I hated the taste of the tablets.

It is also the B12 deficiency foundation’s position that measuring serum levels after you’ve been using injections, won’t be useful. In my case, I was given blood tests after the round of injections anyway, and these showed my B12 level was elevated in fact. It dropped to normal within a few months and stayed within the normal range until at least my last blood test in December of 2013. I eat meat again, so it could be that my low consumption of animal products, even though I wasn’t strictly vegan, was causing me to have a B12 deficiency.

Reference

Allen LH (2009), How Common Is Vitamin B12 Deficiency? American Journal of Clinical Nutrition, 89(2):693S-696S. DOI: 10.3945/​ajcn.2008.26947A.