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Posts Tagged ‘death’

of a preventable/ unnecessary plastic surgery death in a young woman in Massachusetts.  In this instance – yet again – the ‘surgeon’ performing the breast augmentation wasn’t a surgeon at all – he was a “family practitioner”.

He may be a doctor – but specialty specific training is an absolute must – along with board certification.  Medical doctors (in medicine specialties) as opposed to surgeons spend only a very limited time in the operating room during medical school, primarily as observers.  This is not adequate preparation!

Board certified specialty trained surgeons on the other hand, spend years training in the operating room – performing surgeries under the direct supervision of more experienced surgeons before completing their surgical residencies.

Please do your homework – as we’ve discussed in several previous posts; research your physician and evaluate all health claims.  Your life, health and well-being are a stake.

 

 

 

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Why Colombia for medical tourism/ surgical tourism?

Here are several of the reasons I have decided to focus on Colombia as one the emerging destinations for medical tourism:

1. It’s close to the United States (and North America): direct flights to several cities in Colombia are only 2 – 3 hours from Miami, Orlando and many other southern US cities.
This should be first and foremost in people’s minds – for more than just consumer comfort. Those coach-class seats can kill.
The risk of venous thromboembolism (VTE), a potentially fatal complication of air travel (and other stationary conditions) is very real; and this risk increases dramatically with flight duration. Flights to Asia can be anywhere from 16 to 20 hours – which is an endurance test for even the healthiest and heartiest of individuals.

This risk for DVT/ VTE which can lead to pulmonary embolism, and death is enhanced in elderly people, people with chronic diseases (diabetes, lung diseases, etc.), obesity and people who have recently had surgery.   Some data suggests this enhanced post-surgical risk may persist for up to 12 weeks. While there are treatments to prevent thromboembolism or blood clots, none of these strategies are fool-proof. (Some of these safety strategies for air travel are mentioned in the above attached links).

Proximity – Close to the USA/ North America:
-Cheaper flights (all the flights to Asia are in the thousands – and you shouldn’t be travelling alone)
– Shorter flight duration (safer, more comfortable)

2. Cost:
This includes medical travel costs as briefly mentioned above. Most cities in Colombia are relatively affordable for other travel accommodations (though this is sometimes included if medical tourism packages/ planning are used.) This is in addition to the known cost-savings of medical care outside of the United States, which is the main reason behind the popularity of medical tourism. For example, a recent CT scan at a local hospital cost around $250.00, versus several thousand.

For actual surgical procedures, the savings are much greater. Heart surgery in the USA ranges from $80,000 – 180,000.. of course, if you have good insurance – your costs are much lower.. If, of course, you have good insurance – and insurance doesn’t cover everything!
In Colombia, heart surgery costs around $12,000 – and most cardiac programs  (and other surgeons/ hospitals) here accept American insurance – so your 20% co-pay is going to be a lot more reasonable..

3. Similar culture, similar values, similar ideals – yes, the language is different (but many people and providers speak English) but the underlying primary core values, and core medical values are the same. This means, that while the US medical system is plagued with problems – some of these problems are related to our values such as the sanctity of life, and the preciousness of life.. That value is shared here – which is important – since that is not the case in many places – even western europe where medicine, surgery and expensive treatments are rationed, and sometimes denied – particularly to people over the age of 65.

Medical providers, nurses, and staff here care about their patients the same way, we do at home.. And arguably, in most cases, the doctor- patient relationship is a lot closer, and more personal here. Doctors want and expect patients to contact them – they give patients their email and cell phone numbers on their business cards, for just that reason, and they aren’t put out or annoyed if you use it.. (I know, I’ve been with doctors when patients call.)

4. Surgical proficiency, medical education, and available resources – this is the primarily reason I am currently here in Bogota, Colombia; the high level of skill and training among surgeons in Colombia. These doctors are professionals in the highest sense of the word, and have attended well-known, well-respected and accredited institutions. In many cases, these surgeons are at the forefront of emerging technologies, that are just now becoming popular in the USA.
As far as medical technology goes – many of the doctors, and hospitals I visited have the latest technology, which rivals if not beats what I’ve seen in the US. (Now, for those of you who have never stepped inside a rural hospital in the United States – you would be surprised at what resources they do and DON’T have.) Americans in general, and American medical professionals tend to view the world from this little bubble, thinking that we always have the latest and greatest – even when we know it’s not always true. It may have been true twenty years ago, but sadly, it’s not always true now.

Come back for part two – and we’ll discuss Why not India, why not Thailand.. (but in the meantime, here’s some food for thought)

* Antibiotic resistant infections of any sort (MRSA, VRE) are still fairly rare in Colombia.
Superbug Hits UK from Medical Tourism from India

Indian Resistant Bacteria from Medical Tourism

More articles/ links on SuperBug

Of course, to be fair, our own food supply contributes to this problem too..

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Cardiology takes another hit with recent news discussing the increase risk of death from inappropriate ICD discharges: ie. getting shocked when you don’t need it. This has been in the literature before, but I’m re-posting another article from Cardiosource for you. Probably not the best findings considering that the device manufacters paid for the study.

Inappropriate shocks from ICDs ‘common’ and lead to greater risk of deathCONTACT: Amanda Jekowsky, ajekowsk@acc.org 202-375-6645
January 24, 2011

Despite the benefits of therapy with implantable cardioverter-defibrillators (ICDs), inappropriate shocks from the devices are “common” and place patients at a greater mortality risk. These were the conclusions drawn by a Dutch research team that examined the incidence, predictors, and patient outcomes of inappropriate ICD shocks in a large, real-world patient population. Published in the February 1, 2011, issue of the Journal of the American College of Cardiology, the study showed that inappropriate ICD shocks were more than just painful and psychologically disturbing—they also impacted patient survival.

Implantable cardioverter-defibrillators—which provide an electric shock whenever they sense an abnormal heart rhythm—have shown to provide a “substantial and significant” mortality reduction for high-risk patients with cardiovascular disease, the authors wrote. However, realizing that the treatment “still has drawbacks,” the team decided to examine inappropriate shocks delivered in response to rhythms other than life-threatening ventricular tachycardia or ventricular fibrillation.

Seeking to evaluate ICD implantation outside the setting of a clinical trial, researchers from Leiden University Medical Center in the Netherlands examined the medical records of all patients who had an ICD implantation at the hospital from 1996 to 2006. Specifically, the team analyzed how often inappropriate shocks occurred, what characteristics were associated with inappropriate shocks, and how inappropriate shocks influenced patient outcomes. The team’s main follow-up period was 41 months (±18 months), but they also recorded data at one year and five years. Patients treated with an ICD met the international guidelines for ICD implantation developed by the American College of Cardiology, the American Heart Association, and the European Society of Cardiology.

Of the 1,554 patients who had complete records, 13% (204) (95% confidence interval [CI]: 11% to 14%) experienced an inappropriate shock during the main follow-up period, which led to a total of 665 inappropriate shocks. The cumulative incidence of inappropriate shocks “steadily increased” across the extended follow-up period, reaching 18% of patients at 5 years (95% CI: 15% to 20%).

After conducting Cox proportional hazards regression, the team found that several factors independently predicted the occurrence of an inappropriate shock, including an age of younger than 70 years; a history of atrial fibrillation, nonischemic heart disease, or nonuse of statins; and the occurrence of appropriate shocks. The main cause of inappropriate shocks was misdiagnosis of supraventricular tachycardia, which occurred in 155 (76%) of the 204 patients.

In what the authors considered “the most important finding,” patients who experienced inappropriate shocks had a higher risk of all-cause mortality. A total of 298 (19%) patients died during the follow-up, and after adjusting for potential confounders, the research team found a 60% increased risk of death after experiencing a first inappropriate shock (hazard ratio [HR]: 1.6, 95% CI: 1.1 to 2.3; p = 0.01). The risk of mortality increased with each subsequent inappropriate shock, up to an HR of 3.7 after 5 inappropriate shocks.

According to study author Martin J. Schalij, M.D., Ph.D., the study’s finding that inappropriate ICD shocks impact mortality is a “serious issue” which necessitates “that greater efforts be made to lower the number of these shocks.” He notes that while two other analyses—both conducted as part of ICD clinical trials—have shown an association between inappropriate shocks and increased mortality, the current trial is the first to do so in a large, general-patient population.

“We need to make sure we are implanting ICDs in the appropriate patients, but often the patients that need ICDs most are also at risk of inappropriate shocks due to the misinterpretation of other fast heart rhythms that are not themselves lethal,” said Ralph G. Brindis, M.D., M.P.H., president of the American College of Cardiology and senior advisor for cardiovascular disease, Northern California Kaiser Permanente. “We suspect over time, increasing sophistication of the ICD programming will help minimize these episodes of inappropriate shocks.”

Reducing the number of inappropriate shocks may prove challenging, however. The researchers found that despite improved technology in ICDs, patients who underwent implantation between May 2004 and 2006 were at a greater risk of experiencing inappropriate shocks than those who received their ICD between 1996 and May 2004. Acknowledging this “paradox,” the authors wrote that evolving guidelines on who could receive ICDs may have caused more critical patients to receive the device in later years, ultimately increasing the number of inappropriate shocks experienced.

Although the researchers could not determine the exact cause of the increase, still more must be done to stymie this trend, noted Dr. Schalij. “It is not acceptable that so many patients suffer from inappropriate shocks,” he stated. “ICD therapy must be improved, through both patient-tailored programming of the devices and the development of superior algorithms to allow ICDs to better determine false alarms, such as supraventricular arrhythmias.”

The study authors reported they received research grants from GE Healthcare, Bristol-Myers Squibb Medical Imaging, St. Jude, Medtronic, Boston Scientific, Biotronik, and Edwards Lifesciences.

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Everyone knows this already – but finally some scientists sat down and worked it out for the rest of us:  Obesity Kills!

Seems like a pretty timely article: Obesity Increases Risk of Deadly Heart Attacks – over on WebMD..

Here I am in Bogota, spending much of the week with Bariatric surgeons; discussing procedures, outcomes, meeting patients..

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I’m still here in Bogota – meeting with surgeons, touring hospitals, researching facilities..

Read an article on-line today that highlights the importance of unbiased, third-party review:

From an Associated Press article on Comcast this morning:

Woman dies after buttocks injection at Pa. hotel
16 hours ago

PHILADELPHIA — A woman who had a cosmetic injection in her buttocks at a hotel near the Philadelphia airport died early Tuesday, prompting a police investigation.

Detectives said the woman and three companions traveled from London and were staying at the Hampton Inn in southwest Philadelphia. Two of them had traveled to the city in November to have their buttocks enlarged and, on Monday, one received another injection while the other had a hip augmentation.

Detective Joseph Murray said the 20-year-old woman who had the buttocks injection later complained of chest pains and trouble breathing. Paramedics were called, and she was taken to Mercy Fitzgerald Hospital where she died. Her name was not officially released.

The results of an autopsy by the Delaware County medical examiner’s office haven’t been released.

Police were seeking two people involved in the cosmetic procedures. They said they believe the procedures were arranged over the Internet.

“We’re not quite sure right now if that person performing that procedure is licensed or unlicensed,” said Lt. John Walker of the Philadelphia police southwest detectives division. “We’re still working that information right now.”

Walker said investigators were also awaiting test results to determine the substance used.

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So – these people flew across the Atlantic – to be treated in a HOTEL room by people who may/ or may not (probably not) be doctors based on information from the INTERNET..

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