27 June 2011


Erik Compton was diagnosed at age 9 with cardiomyopathy, an enlarging of the heart that hinders its ability to pump blood. Three years later in 1992, he received a new heart and took up golf as part of his rehabilitation. That heart failed in 2008, and he had another transplant.

Through it all, he kept trying to make it to the PGA Tour, not as just the "guy with two heart transplants" who received the odd sponsor exemption or made it through a Monday qualifier, but as a full tour member.

The 31-year-old Miami player, once the top-ranked junior in the country, pretty much wrapped up that membership Sunday in the rain-delayed Mexico Open, rallying to win his first Nationwide Tour title -- and first victory since turning professional in 2001.

This tournament has kind of summed up his life. He is set to play the PGA Tour's AT&T National this week in Pennsylvania on a sponsor exemption. There was a lot of adversity to overcome in this tournament just like what he dealt with personally. To win this is everything to him. He never thought he would play golf again, at least not at this level, and he proved to himself he is more than just a guy with two heart transplants.

Compton closed with a 7-under 65 at El Bosque Country Club to finish at 17-under 271, two strokes ahead of Richard H. Lee . The two-time All-American at Georgia earned $126,000 to jump from 15th to second on the money list with $215,709, nearly guaranteeing a 2012 PGA Tour card as a top-25 finisher on the developmental tour. He also has made $83,962 this year in four PGA Tour starts.

He does get a lot of opportunities to play in PGA Tour events because of his story. But now that he has won out here and pretty much secured his tour card that he should get into events on that alone. And he has been playing professionally since he was 20 years old and never won, so he feel like it's a monkey off his back.

Compton had eight birdies and a bogey in the final round. He birdied the par-4 16th to get to 17 under, then parred the final two holes for the breakthrough victory.

The guys who see him inside the ropes see him as a regular golfer. But at the end of the day when he put his head down he realize how lucky he is. To be able to say he will be playing on the PGA Tour only four years after his heart transplant is unbelievable. He doesn't really know what his future is in life. Hopefully, he can get a win out on tour now.

Compton was only conditionally exempt on the Nationwide Tour at the start of the season, but quickly earned special-temporary membership. He tied for fourth in the season-opening Panama Championship and had another fourth-place tie in April in the Fresh Express Classic.

To start off the season like he did set up the ground work. This win has put him over the top. This is exactly what he needed. To think of what he went through and to have all the support and love of everyone around him, it's almost unreal.

After opening with rounds of 68 and 70, Compton shot a 68 on Sunday morning in the completion of the rain-delayed third round to begin the final 18 holes two strokes behind leaders Lee, Matthew Giles and Peter Lonard .

Lee needed a birdie on the par-5 18th to force a playoff, but bogeyed the hole for a 69.

Will Wilcox (68) was third at 14 under, a stroke ahead of Giles (71), Roberto Castro (65), James Nitties (68), Chris Baker (68) and Kyle Thompson (70). Lonard finished with a 73 to tie for 11th at 11 under.

16 June 2011


Dr. Smith can almost set her watch by her disease: Twice a day, she gets a fever and the already arthritic joints in her arms and hands, legs and feet abruptly, painfully swell even more. During the evening flare, even the tendons in her feet puff up, rope-like worms just under her skin.

The rest of the day, her joints are so stiff that the once robust Maryland physician frequently uses a scooter to get around. Just shaking hands hurts the 47-year-old.

Inflammatory arthritis is disabling Smith but exactly what kind and what caused it to attack suddenly is a mystery. Nor do her fellow doctors know what treatment to suggest next. She's tried all of today's arthritis medications with little relief.

Say arthritis, and people tend to shrug it off as a rite of passage of aging. The reality is much more complicated. Arthritis encompasses 100 different conditions and affects about 46 million people in the U.S.

Osteoarthritis - where cartilage gradually erodes with the wear-and-tear of aging - is by far the most common type.

But inflammatory types - such as rheumatoid arthritis, psoriatic arthritis, lupus - occur when something makes the immune system run amok and attack the body's own tissues, eating away cartilage and eventually harming bone. It can strike at far younger ages.

Smith's saga highlights not just how much doctors still have to learn about arthritis, but how devastating a severe case can be.

"It totally stripped my identity," says Smith, whose illness cost her career as a cardiologist and her love of sailing. "I just don't think people realize how debilitated you can be, and young."

She uses humor to help cope, nicknaming her scooter Bella and joking that "I know I'm going to turn into a pumpkin each night" when that 7 p.m. flare sends her to bed.

Infections sometimes trigger inflammatory arthritis, and that's what probably happened with Smith. She'd just returned from a business trip to India in December 2008 when she came down with a fever, fatigue and pain in her shoulder and knee. Antibiotics didn't help.

A month later, Smith became short of breath and both legs swelled. An emergency hospital admission prompted a battery of tests for infections, even super-rare ones she might have encountered abroad. Again, nothing. Maybe it was cancer? Nope.

Then the joints in her wrists and hands began swelling. Soon she couldn't lift a glass. Swelling and pain moved to her ankles and toes.

Her joints had the classic look of rheumatoid arthritis, a disease that affects 1.3 million Americans and that can begin with a low fever and fatigue.

But it wasn't a slam-dunk diagnosis. Blood tests check for specific markers of the disease, such as a substance called rheumatoid factor, and Smith's results were negative, something that occurs occasionally.

More important, a variety of drugs hit the market in the last 15 years that can rein in the disease and target some of the immune cells doing the damage.

But drug after drug failed, and the illness was spreading to her elbows, knees, hips, even her jaw.

Within a few months, she was on leave from her cardiology job. She couldn't walk up the stairs at home and moved to a one-floor apartment that's walking - or scootering - distance from her new job in aging research at the disability-friendly National Institutes of Health.

She even had episodes of an irregular heartbeat, as inflammation struck part of the heart.

Then six months ago, she started having those bizarre twice-a-day flare-ups. When she joined some friends for a vacation in France recently, the flares just switched time zones.

That's not typical rheumatoid arthritis, leaving in question Smith's diagnosis and what to do next.

While Smith's case is extreme, it's not unusual for inflammatory arthritis to become debilitating so quickly, especially in young or middle-aged women. When an infection is the suspected trigger, patients desperately want to know which bug even though it's usually long gone by the time joints swell, leaving rogue immune cells in its wake. Most cases of inflammatory arthritis are not curable but they are treatable in this day and age.

Smith gets modest relief from very high doses of the steroid prednisone, along with injections of the drug Kineret that targets an inflammation-causing protein named interleukin-1.

She's still hopeful scientists will point her to better treatment as she enters an NIH study. Researchers will videotape her evening flare-ups and try to measure what role that interleukin-1 is playing.

And while she wants to know what's fueling her disease - "I'm as geeky as most cardiologists" - her bigger frustration is how few services help arthritis patients with daily functioning: "I need to know how to open the fridge."


The Veterans Health Administration has informed its hospitals and clinics that transgender veterans are eligible for hormones, care before and after gender change surgery, and mental health counseling as part of their regular benefits.

In a directive issued Thursday, the VA reiterated that its facilities are not permitted to perform genital or breast surgeries on veterans in the process of changing genders.

But the agency confirmed that transgender patients are entitled to routine health care that takes their special needs into account and to transgender-specific treatments such as hormone therapy and non-surgical, supportive care for complications of sex-reassignment surgery.

In accordance with what it termed "the respectful delivery of health care," the VA also instructed medical personnel at its 950 health care centers to refer to transgender veterans in conversation and on medical records by the gender pronoun they prefer, regardless of whether they have undergone surgery.

The policy also applies to veterans who appear to be one gender but whose sex chromosomes indicate they are another, a condition referred to as intersex.

Transgender activists have been pressuring the VA for years to make such a statement. They maintain care of transgender veterans varies too much from facility to facility, with some easily accessing the full range of care and others being denied all services.

It doesn't create anything new. It just says to treat these veterans like you treat all veterans, but for trans vets that's really huge.

The VA quietly posted the directive on a section of its website reserved for new directives, but has not commented on it.

A Navy veteran who lives in San Diego, has been happy with the treatment she has received through her local VA facility, but said she knows of other transgender veterans who were refused not only hormones and the psychological counseling that is a precondition for sex reassignment surgery, but regular checkups.

She felt it's going to be a huge boon to veterans who are not getting any care at all or are not getting appropriate care. She also stated that you have to be able to treat the whole person, and now the VA is telling them, you can't separate out the transgender component and you can't only give care that is not trans-specific.


In the aftermath of the Joplin tornado, some people injured in the storm developed a rare and sometimes fatal fungal infection so aggressive that it turned their tissue black and caused mold to grow inside their wounds.

Scientists say the unusually aggressive infection occurs when dirt or vegetation becomes embedded under the skin. In some cases, injuries that had been stitched up had to be reopened to clean out the contamination.

The Centers for Disease Control and Prevention said Friday that it was conducting tests to help investigate the infections, which are so uncommon that even the nation's largest hospitals might see only one or two cases a year.

A representative from the CDC said that to his knowledge, a cluster like this has not been reported before. He also stated that this is a very rare fungus, and for people who do get the disease, it can be extremely severe.

Three tornado survivors who were hospitalized with the infection have died, but authorities said it was unclear what role the fungus played in their deaths because they suffered from a host of other serious ailments.

These people had multiple traumas, pneumonia, all kinds of problems, so it's difficult to say how much the fungal infections contributed to their demise.

The infection develops in two ways: when the fungal spores are inhaled or when a tree branch or other object carrying the fungus pierces the flesh.

Most people who get sick by inhaling the spores already have weakened immune systems or diabetes. But healthy people can become sick if the fungus penetrates their skin. The fungus blocks off blood vessels to the infected area, causing tissue to turn red and begin oozing. Eventually it becomes black.

If diagnosed in time, the infection can be treated with intravenous medications and surgical removal of affected tissue. But it's considered exceptionally dangerous, with some researchers reporting fatality rates of 30 percent for people infected through wounds and 50 percent for susceptible people who breathe it in.

Small numbers of cases have been reported after some disasters, but it's the particular circumstance of the wound - not the disaster itself - that creates the risk.

The Missouri Department of Health and Senior Services has received reports of eight suspected deep-skin fungal infections among survivors of the May 22 twister, which was the nation's deadliest single tornado in more than six decades. All of the patients had suffered multiple injuries.

Also Friday, Joplin officials raised the death toll from the twister to 151, a figure that includes the recent deaths of the three people who had the fungus.

A doctor at the hospital treated five Joplin tornado victims for the infection, which is formally known as zygomycosis (zy'-goh-my-KOH'-sihs). In 30 years of medical practice, he said, he had seen only two cases. Both involved patients with untreated diabetes.

Joplin officials say more than 1,100 people have been treated for injuries after the storm, many of them from objects sent flying by the twister.

These were very extensive wounds and were treated in the emergency room as quickly as possible.

A week after the tornado, patients began arriving with fungal infections.

Doctors had to reopen some wounds that had been stitched closed because the injuries had not been adequately cleaned.

After the infections set in, doctors could visibly see mold in the wounds. The infection rapidly spreads, and as it does the tissue dies off and becomes black because it doesn't have any circulation. At that point the tissue has to be removed.

The fungus invades the underlying tissue and actually invades the underlying blood vessels and cuts off the circulation to the skin.

15 June 2011


A combination of giving patients more information about their conditions and better managing their medications can slow the revolving door of Medicare patients in and out of hospitals by about 20%, a study released Monday shows.
Researchers determined that physicians often did not have a complete list of medications that other doctors had prescribed for a patient, so they prescribed drugs that reacted badly with the patient's other medications. Most often, patients did not understand the care they were receiving or needed.
This information can help hospitals better cope with part of the health care law that will force them to repay Medicare for the cost of patients who are readmitted to a hospital within 30 days of their previous stay, researchers said. Previous research showed that one in five Medicare patients returns to the hospital within 30 days of a previous admission.
It costs Medicare $17 billion a year to pay for patients who are readmitted to the hospital within 30 days of their last stay.
The change takes effect in October 2012, and includes re-admissions for heart failure, heart attacks and pneumonia within 30 days of a previous stay. More diseases will be added to the list.
It also turned out to be true that more people were sent home than to long-term care.
The researchers compared 862 patients who entered a rehabilitation center in Boston from June 2009 to May 2010. Patients enter skilled nursing facilities when they are not sick enough for a hospital nor well enough to go home.
Researchers asked patients with congestive heart failure if they would want more surgery that might extend their lives or if they preferred less-invasive treatments. Some chose to manage the symptoms instead of continuing more expensive treatments. Often, patients and physicians had not talked enough for the doctor to realize the patient did not understand his or her medical condition.
Doctors talked to patients who had been admitted more than three times within the previous six months about palliative care, or care that manages symptoms with the understanding that the patient would not recover. They also gave patients copies of all their medications so they could provide that information to future doctors.
The center changed policy so a nurse and pharmacist each checked prescriptions after a doctor saw a patient. They provided details of care so patients could serve as a safety check.

01 June 2011


Studies confirm that children are too often being prescribed unnecessary antibiotics. Every year nearly one million children are being prescribed antibiotics for asthma, even though guidelines do not recommend it. A Michigan Cerebral Palsy Lawyer commented that he has warned his clients about possible problems.
Pediatricians should be reducing unnecessary antibiotic prescriptions, but according to this data pediatricians are prescribing them way too often
Why doctors are prescribing antibiotics for asthma is not clear. One reason might be that doctors treating severe asthma attacks feel the need to cover all their bases by also prescribing antibiotics.
Sometimes parents may ask doctors to give their child antibiotics, but it doesn't seem to be a big factor. It may exist to some degree in clinical practice, but probably does not happen all that frequently, certainly not in one in every six visits for asthma.
The one encouraging finding was, when asthma education was delivered as part of the visit, antibiotics were less likely to be prescribed. When asthma education was not part of the visit, 19% of the time antibiotics were prescribed, compared with 11% when asthma education was given.
This suggests that if families and patients are educated and explain the causes of asthma that this will hopefully reduce unnecessary antibiotic prescribing.
The dangers of over prescribing antibiotics are that it promotes the development of antibiotic-resistant bacteria and there are side effects for the drugs themselves.
The report was published in the May 23 online edition of Pediatrics.
For the study, the team used data from the National Ambulatory Medical Care Surveys and National Hospital Ambulatory Medical Care Survey to see the rate of antibiotics prescribed for children between 1998 and 2007.
Over that time, there were some 60.4 million medical care visits for children with asthma for which no prescription for antibiotics was warranted. However, antibiotics were prescribed 16% of the time, the researchers found.
Primary care doctors were most likely to prescribe antibiotics, while emergency department doctors were least likely to prescribe them.
Other factors that were linked with increased antibiotic prescribing included use of inhaled corticosteroids and being treated in the winter, the researchers noted. However, when visits to primary care doctors included asthma education, the rate of antibiotic prescribing went down.
In a second study in the same journal, Belgian investigators found similar over prescribing of antibiotics to asthmatic children. These researchers found children treated with asthma medications were 1.9 times more likely to also get a prescription for antibiotics, compared with children not treated with asthma drugs. In fact, 35.6% of children who were prescribed asthma drugs were also prescribed antibiotics, the researchers found.
This finding highlights the need for educational opportunities to inform clinicians that such co-prescription should be limited.
These articles indicate that asthma medications and antibiotics were very commonly prescribed in tandem both here and in Belgium, which conflicts with domestic and international recommendations that point out that antibiotics have no routine use in the care of asthmatics.
Antibiotic overuse confuses patients and family. They don't understand the true nature of asthma as an inflammatory, not an infectious disorder. In addition, over prescribing antibiotics entails personal and societal risks.
Not only are the drugs expensive, but they can also have risks such as side effects, drug interactions, and allergic reactions. Although the overuse of antibiotics is being reduced, there is still a need to continue further to get the number down.