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Showing posts from 2019

Removing the heart from health care: an experiment

I delight in learning my patients' stories and giving them exactly what they need when I take care of them in the hospital. Who they are and what is the best approach to their problem is the primary mystery to be solved, my Sherlock Holmes moment. This is why, if somebody asks me, I will tell them that doctoring is the best job in the world. The opportunity to connect fully with another human being and use my heart and hands and brain to help them is a profound gift and a sacred trust. When I'm not so overwhelmed that I can't function, that is.

Lately at work, with the recent flu epidemic and the collateral illness that a hard winter has brought on, my job as a hospitalist at my local rural hospital has become rushed and nearly overwhelming. I cut corners in ways that I hope will not compromise patient care. At times I dream of retiring, forgetting that I'm a doctor, letting the skills I've been collecting over these 30 years drift away like objects at a garage sa…

Poop wars and the commercialization of fecal transplant

The New York Times is interested in fecal transplant. This is the euphemistic term for taking feces, poop, crap, sh*t, bowel contents from one person and putting it into another person. There are various procedures for doing this, from drying it and putting it into capsules to making it liquid and introducing it by enema, nasogastric tube or colonoscopy. It is a remarkably effective treatment for a wide range of illnesses which appear to be related to an unhealthy gut biome (bacterial community.)

Politics:
The New York Times has published several articles about it in the last few years including a recent one in which they introduce the politics of fecal transplant (also "fecal microbiota transplantation" or FMT). Apparently several companies have been working on ways to monetize human excrement for medical use. At the same time, doctors have been using do it yourself concoctions and a non-profit in Cambridge Massachusetts has been packaging a fully screened selected-donor po…

Oral or intravenous antibiotics for bone and heart valve infections?

Antibiotics are a miracle, killing the bacteria that might otherwise kill us. They are also dangerous, with side effects that can be fatal as well as merely annoying. They kill good bacteria as well as bad ones, disturbing the delicate balance of the bacterial communities with which we share our bodies.

Intravenous antibiotics can work quickly to forestall life threatening blood stream infections and can reach high levels in the blood and penetrate structures such as bone, eventually eradicating infections that might hide out and cause chronic infection. Oral antibiotics, however, are also very powerful and are sometimes absorbed so well that they are just as effective as intravenous (IV) ones.

Whether to use oral or IV antibiotics is based on several considerations, but we usually believe that infections on the heart valves or in the bone or joint or artificial joints require IV antibiotics. Long term treatment with IV antibiotics can be logistically difficult. Consider these two pret…