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By Elaine Schattner, MD, on November 2nd, 2010
Today’s Annals of Internal Medicine includes new results for the CLOTS (Clots in Legs Or sTockings after Stroke) Trial. Not-quite acronyms aside, it’s an interesting study with implications for many patients at risk for deep venous thrombosis (DVT).
compression stockings — NIH image (Medline Plus)
This U.K.-based study, involving 3114 patients in 112 hospitals in 9 countries, used ultrasound to evaluate possible DVTs in legs of people after they’d been immobilized upon suffering strokes. Patients were randomized to receive either thigh-length or below-the-knee compression stockings while recovering in the hospital. The main result was that 98 of 1552 (6.3 %) of patients who received thigh-length stocking and 138 of 1562 (8.8%) of patients with below-the-knee stockings developed DVT. This difference is highly significant (p = 0.008).
The twist is this: in a separate, extensive recent Cochrane review the investigators compiled data from multiple randomized studies of stockings in stroke patients and
See more What Not to Wear In the Hospital While Recovering From a Stroke
By Elaine Schattner, MD, on October 20th, 2010
A student clued me in on an old take on therapeutic phlebotomy: the classic 1978 SNL skit, Theodoric of York (Season 3, episode 18), stars Steve Martin (as the barber, Theodoric of York.). It also features Dan Aykroyd (as William), Gilda Radner (as Broom Gilda), Jane Curtin (as Joan), John Belushi (as a hunchback) and a youthful Bill Murray (as a drunkard).
Theodoric of York
It’s a very funny skit when it’s not too gory, with some insight into the history of medicine.
But it’s also a sad reminder about the early deaths of Belushi, a promising actor who died at 33 years from heroin and cocaine toxicity, and of Radner, a wonderful comedian who died at 42 years from ovarian cancer.
As for modern, therapeutic phlebotomy -
In the U.S. and most other places, trained physicians, nurses and other providers perform this procedure routinely using sterile techniques and other precautions. (Checklist, anyone?) Typically a pint or so of
See more Classic Saturday Night Live on Bloodletting, and Barbarism
By Elaine Schattner, MD, on October 8th, 2010
 Over 400 Nigerian children have died from lead poisoning this year…lead poisoning is sometimes called plumbism, stemming from plumbum, the Latin term for lead (Pb, atomic number 82), a metal used by plumber. A rarer term is Saturnism, based on the metal’s association with that planet and ancient Roman god.
See more A Lead Poisoning Outbreak in Nigeria, Plumbism and Anemia
By Elaine Schattner M.D., on September 11th, 2010
 In some ways this seems like a pro-active, well-intentioned policy that could save lives. On the other hand, as discussed in the NEJM piece, the new screening policy raises a host of challenging issues: * how will colleges inform minor players’ parents about results? * how will the schools handle players’ privacy?…
See more Perspective on Screening for Sickle Cell Trait in Student Athletes
By Elaine Schattner M.D., on July 15th, 2010
A few years ago my family took a trip to China. Even before we arrived, I learned something about an unfamiliar health care culture. What I observed en route was that many of the older passengers on that long flight to Beijing were getting up from their seats and stretching. Not just once, but regularly and systematically – they were doing slow motion, isometric calisthenics on the airplane.
I took notice of their behavior first because it seemed a simple and inexpensive, albeit strange example of preventive medicine. Second, as a hematologist who cared for patients with blood clots upon traveling, I pondered the risks and benefits of their on-board exercises. Third, as a patient who’s had a blood clot, or deep venous thrombosis (DVT), I thought maybe I should follow their example.
Thrombophlebitis — the old term for DVT – happens when a vein (as opposed to an artery) gets clogged with platelets and fibrous proteins. These tend to
See more Avoiding Blood Clots During Long-Distance Travel
By Elaine Schattner M.D., on January 23rd, 2010
January, the coldest season in my vicinity, turns out to be National Blood Donor Month. This designation, a legacy of the Nixon administration (Proclamation 3952, Dec 31, 1969), I learned last week. Besides, blood’s hot.
See more Blood Matters
By Elaine Schattner M.D., on January 18th, 2010
Giving blood is something that’s close to my heart. When I was 14 years old, I received seven units of packed red blood cells from strangers… Today, thousands will donate blood to honor the birthday of Dr. Martin Luther King, Jr… The holiday presents, also, a special opportunity to gather much-needed registrants for the National Marrow Donor Registry…
See more Why Give Blood?
By Elaine Schattner M.D., on January 10th, 2010
This afternoon I found a Tweet from a colleague, a journalist who happens to be a mom in my community: Tweet from SuSaw: “RT @JenSinger: Hey, baby. What’s your blood type? Nothing against the Big Pink Machine… http://ow.ly/URkg As a trained hematologist (blood doc), oncologist and breast cancer survivor, I couldn’t resist checking this out. Here’s what I discovered…
See more Moms Tweet About Blood and Cancer
By Elaine Schattner M.D., on December 21st, 2009
Last week I received an email from a former patient. He has hemochromatosis, an inherited disposition to iron overload. His body is programmed to take in excessive amounts of iron, which then might deposit in the liver, glands, heart and skin. He mentioned “some amazing videos on hematology and hemochromatosis and genetics” he’d discovered on YouTube. This is the future of medicine, I realized. … Whether physicians want their patients to search the Internet for medical advice is beside the point. We’re there already, whether or not it’s good for us and whether what we find there is true.
See more Information Overload
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