The Restoration of Eyesight through Stem Cells

Taylor Binns experienced a slow degradation of vision through time due to complications with contact lenses. It began four years ago, where Binns described the early symptoms as intense eye pain and blurry vision. The cause of the symptoms was not then known by doctors, with Binns' vision gradually getting worse, and eventually becoming legally blind.

A Queens University student of commerce, Binns was finally diagnosed with a rare eye disease known as corneal limbal stem cell deficiency. It is essentially a disease that replaces normal, healthy cells with scar tissue, creating eye ulcers that cloud over the corneas, further explaining the intense eye pain and loss of vision.

Doctors recommended that Binns receive a new kind of procedure to rid him of the disease: a limbal stem cell transplant. Healthy limbal stem cells from a donor were Binns' best chance at regaining his vision. When in search for a matching donor for the transplant, doctors found that the ideal candidate was his younger sister, Victoria.

"Within a month he could see 20/40," says ophthalmologist Dr. Allan Slomovic. "His last visit he was 20/20 and 20/40."

Taylor Binns is now able to do the things he once did before losing his vision, and has now reportedly become interested in medicine. He is now on track to becoming a medical doctor and hopes to specialize in ophthalmology.

More on this story can read here: http://www.ctvnews.ca/health/ontario-man-s-sight-restored-with-help-of-stem-cells-1.1088888

UPDATE: Research Project (4)

The research paper that we had submitted in April had been under review up until last week. The team received an e-mail from a representative of the journal saying that revision in certain areas is required. With that being said, there is more work to be done before the paper can be published. The research continues...

Doctors' Fees for Medical Services to be Cut in Ontario

If Ontario is to see a decrease in its $16-billion deficit throughout the next few years, Premier Dalton McGuinty believes it is necessary to make cuts from health-care costs (1). These cuts are specifically aimed at the fees doctors are eligible to charge for their medical services, leading to an overall (but ostensibly “slight”) reduction in their income.

The province plans to make a total of $338-million in health-care cuts, in which the money is “likely to be reinvested in primary care” over the next few years (1). Regarding a few specialties, it has been said that large cuts have been made to their service fees, whereas smaller cuts were made to the rest.

We can look at a couple of factors that will inevitably play out soon after these economic decisions commence: firstly, as the Canadian Medical Association had pointed out, doctors will likely move to jurisdictions where their services are worth more (or are on the rise) rather than stay in the province where they are declining, even slightly (1). Such doctors may turn out to be on the younger end of the spectrum, where they enter a profession with enormous debts inherited from medical school fees.

Secondly, with a decrease in their income, doctors may be driven to see more patients to reconcile for their losses, pushing forth a heavier workload on a professional whom initially works hard.

The fact that the potential $338-million made from health-care cuts is said to likely be reinvested into primary care sounds uncertain. If this reinvestment does not occur in primary care, then we are simply diminishing our health-care system.

References

(1) http://www.theglobeandmail.com/news/opinions/opinion/the-doctor-will-still-see-you-now/article2443975/

Automatic Consideration for Organ Donations in Canada: Should this be in Effect?

More than a handful of Canadians die every year while waiting for organs (1). More organ donors would inevitably decrease this death rate; so, what’s the problem? The problem seems to be that we are uncomfortable with the subject as a whole. While many of us are more than happy to sign up for organ donation, a questionable portion of us do not, either because we do not make the time for it, or for the more popular reason – it’s frightening to think about one’s own demise. Although there is no problem with the latter, the main issue here is that we do not feel motivated to register.

If we could flip the system, like over 20 countries in Europe have done, Canadians could automatically be considered organ donors unless they go out of their way to take their names off of this donor list (1). By doing it this way, the government would still have the consent of Canadians, who do not wish to donate their organs, and would have many more organ donors versus that of what we currently possess.

This system is called a “presumed consent model,” and is said to hold organ donation rates that surpass those of the Canadian system’s (1). The Canadian Liver Foundation suggests that there will be no improvement in our current organ donation rates if we do not adopt a presumed consent model (1).

It is a secure plan, really. If a few more lives can be spared each year by simply flipping the system, I do not see how this is even debatable. If people feel that their rights are being taken away from them (which is false), then they can have their names taken off the list. There really is no difference with the system, other than the government’s presumption being that one is perfectly fine with having their organs donated when they are deceased.

References

(1) http://www.ctv.ca/CTVNews/Health/20120525/presumed-consent-organ-donation-120525/

UPDATE: "Articles" Tab Added

A page that displays all the articles I have written for this blog has been created. Check it out: Articles

Cutting Back on Refugee Health Benefits

Jason Kenney, the Citizenship and Immigration Minister of the Conservative Party of Canada, had made an announcement last month that would involve changes in our health care system: the Tories are "scaling back" on refugee health benefits. The primary argument used to justify this political action is the fact that Canadians have (for too long) paid for benefits for refugee claimants that are more superior to what they themselves are entitled to (1).

The Interim Federal Health Program (IFHP) provides basic health care coverage to those who are protected, those who claim refugee status, and others who do not qualify for provincial/territorial coverage. $84 million was spent on this program last year, which also includes the coverage of supplemental health services like medications, dentistry, optometry, and mobility devices. It was said that most Canadians, through their provincial/territorial health plans, are not granted coverage for the aforementioned services, hence the reason behind the government's desire to make the cuts for refugee health benefits, which will be in effect as of this June. (Coverage for some refugees will only be given for medications and immunizations if there is a threat to public health) (1).

The "scaling back" on refugee health benefits is expected to save the government ~$100 million throughout the course of five years. "With this reform, we are also taking away an incentive from people who may be considering filing an unfounded refugee claim in Canada," said Kenney. "These reforms allow us to protect public health and safety, ensure that tax dollars are spent wisely and defend the integrity of our immigration system all at the same time" (1).

Opposing parties have called this "scandalous behavior" (1). Many also assume that the government is doing this mainly because of the false nature of refugee claimants - that is, people who claim refugee status but do not face any danger in their home countries. If this were the case, then the Tories would be making the assumption that there are more fraudulent claimants than honest ones.

The argument made against this suggests that the majority (who are refugees and need their current benefits) are being deprived of what they are entitled to, all due to the ignorant belief that most of them are frauds.

Furthermore, it is thought that the Tories are attempting to create a bad image for refugees so that Canadians will be happy with the political decisions being made (2). In other words, Canadians are being made to believe that most refugees are bogus.



CRITICISMS

An example used to criticize the decision was that of diabetic patients who will not be covered for insulin, meaning they'd have to either "pay or go without" (2). Many believe this could lead to a long-term disaster, where people with chronic diseases will only get worse without coverage and will eventually be forced to seek urgent care, which they will be entitled to according to the new policy (2). It seems that this plan can potentially backfire, as we would be spending more for urgent care than we would to help avoid the problems all together before they reach such a level of severity.

It is also acknowledged that these refugees come here to start a new life, and without the coverage they had been receiving prior to June 2012, it will only prove to be much more challenging for them to adapt, as they may have health issues that do not quite meet the "urgent" category and thus will not be covered.

CONCLUSIONS

There is no doubt that this new policy will cause some setbacks for refugees who come here with the intention to begin a new life and leave their previous experiences of hardships behind. I feel that, for those who are true refugees, adapting will not be so problematic as some may expect - they will still be entitled to the same health benefits as most Canadians possess (the same Canadians who pay taxes that support the refugee benefits). A common question asked repetitively regarding this topic is: "why should refugees receive better benefits than Canadians through a Canadian health care system?" A fair question to ask, and perhaps the main thought that drives myself to support the new policy.

According to Citizenship and Immigration Canada, "refugee claimants... who are unable to pay for health care are eligible for benefits under the IFHP until they become eligible for provincial/territorial or private health plan coverage" (3). Although we'd like to think that all refugees are in desperate need, we cannot leave out the many that take advantage of our system. Kenney's announced policy cutbacks will ensure that only the honest refugee claimants will come to Canada, leaving the frauds to seek "aid" elsewhere.

It's Canada first. As "mean-spirited" as this notion may seem, taxpaying Canadians are the contributors to the health benefits for refugees, and should have (at least a sense of) equality in their health care. As per what Kenney had announced, refugee claimants are not being deprived of health care, but instead will no longer be entitled to the supplemental services (which most Canadians do not receive either). We are simply looking for ways to avoid being taken for granted while spending our tax dollars more wisely, and this may turn out to be an effective method by all means.

References

(1) http://www.cbc.ca/news/politics/story/2012/04/25/pol-refugees-health-coverage.html
(2) http://www.cbc.ca/news/canada/story/2012/05/11/f-refugee-doctors-medical-care.html
(3) http://www.cic.gc.ca/english/refugees/outside/resettle-assist.asp

UPDATE: Research Project (3)

The leading professors of the project had recently finished writing the paper and submitted it to an educational journal. It is now under review, and I am pleased to say that I am being credited as one of the authors/contributors of the study. I feel that I must wait until the paper is actually published in the journal before inputting its title here, and so we will play the waiting game...


For more information on this research project, visit: Research & Publications.

UPDATE: "About" Tab Added

I have added an "About" tab that functions as a descriptive page of what this journal entails. I will continue to add to it whenever necessary. Check it out: About

Breast Cancer Screening: When Should it Begin?

Dr. Karl Kabasele, CBC's medical specialist, has taken the opportunity to answer health-related questions through Your Community Blog. The question for this week was: "When should I start getting screened for breast cancer?"

Although detecting any sort of cancer early is essential to surviving the disease, Dr. Karl gives specific ages for breast cancer screening under two categories: average and high risk.

For those with average risk, "the best evidence tells us that regular mammograms are a good idea between the ages of 50 and 74. On the other hand, if you're at higher risk of breast cancer... you may need to start having mammograms earlier than age 50."

He concludes by saying one should review the possibilities of getting the disease with one's doctor, and to "come up with a personalized plan for breast cancer screening."

Knowing your individual risk mainly revolves around the history of cancer within your family. So, if it is very common, then you may be at higher risk.

References

(1) http://www.cbc.ca/news/yourcommunity/2012/04/ask-dr-karl-when-should-i-start-getting-screened-for-breast-cancer.html

Volunteering at the Local Hospital

After receiving the registration papers to the hospital, it took me a grand total of two months to meet all the requirements demanded by the organization: I had to get two tuberculosis shots, two measles, mumps & rubella (MMR) immunization shots, blood work, and two reference letters by qualified referees. It was all worth it, though: I got a call back within a week after submitting my application. My medical experience begins in the day surgery department where I am to comfort patients through subtle conversation when requested to do so. Among other things, I am also to bring them water, change bed sheets, and other simple tasks.


I asked for close patient contact, and this particular placement seems as though it is just the right fit for me. Maybe I'll be granted the opportunity to get some "shadowing" in as well... We'll have to see how that works out.

The interview conducted by the volunteer office manager was interesting: four of us were interviewed at the same time. We were asked basic questions like "why do you want to volunteer here, and what do you hope to gain from this experience?" When it was my turn to answer that specific question, I had said, "I'd like to learn more about myself, and whether or not medicine as a professional field is really for me. How else am I to really know? For too long, I have focused on attempting to convince others that I would fit in to this industry, but I think the one I truly need to convince is myself. That is why I am here - to provide answers to these personal questions of mine. It is the next essential step for me." As you may have noticed, I did not mention anything about my "desire to help others" as I felt this is obvious and it would be said by the other three - and it was. I took a different route and was happy with my response overall. Besides, if one is interested in volunteering at a hospital, chances are that one "likes to help others."

Avoiding the straightforward (and redundant) answers to these questions is something I've been practicing. Moreover, instead of staging what I am going to say for the sake of the interview, I have learned to put a lot of thought into my goals, that way I come off as natural, and not staged. I feel this will be especially important for the medical school interviews when the time comes.

UPDATE: Research Project (2)

The second data collection process (a part of the SIG project) has just recently concluded, thus beginning the next coding phase. This means that the research assistants (myself included) will be inputting the results from the previous data collection into a spreadsheet, where we will then identify patterns that support our hypothesis - this, of course, being that the non-ELLs outperform the ELLs on the math task due to language barriers shared by the ELL population (if this is still the case).

For more information on this research project, visit: Research & Publications.

Administered Botox Injections by Unlicensed Doctors

Beware of the fraudulent “practitioners” that offer Botox injections at health spas in Vancouver. According to a news story on CBC News, spa staff members who aren’t physicians are offering (and administering) Botox injections to customers.

Right now you’re (probably) thinking: “who in their right mind would accept Botox injections/prescriptions from anyone other than a physician?”

That’s just the thing – these spas have fake certificates all over their walls claiming that certain staff members are fully qualified physicians, or “doctors,” (1). (If Dr. Joe doesn’t have credential letters at the end of his name on his certificate/degree, then how are we supposed to know what kind of doctor he is? He probably isn’t one).

Health Canada asserts, “Botox should only be prescribed and administered by a physician” (1). Any other method of prescription “would be considered to be a contravention of the Food and Drugs Act…” meaning it would be against the law (1).

And how did these fraudulent practitioners get their hands on Botox if they aren’t registered physicians? According to one of these workers, he claims that he buys his Botox online and without a prescription (1).

The ultimate question stands: how are they getting away with the impersonation of a physician? Surely, these people have been charged at least, right? Negative. According to Dr. Martin Braun in an interview with CBC News, “Unfortunately the College of Physicians is only regulating physicians right now. When I’ve asked them to look at this, they say it is far too expensive and beyond their mandate” (1).

CBC News presented a few tips for protection against fraudulent prescriptions of Botox:

Check the bottle. The bottle of Botox should have a bilingual hologram label on it that says “Allergan.” This is the only company that makes Botox that is marketed in Canada (1).

Avoid coupon deals. Doctors in Canada aren’t allowed to discount prescriptions. Avoid these “deals” (1).

This information was extracted from CBC News.

References

(1) http://www.cbc.ca/video/#/News/Health/1244503490/ID=2196948934

A New Way of Measuring Blood Pressure

That old conventional way of measuring one’s blood pressure may experience a (universal) change due to a relatively new find in research. Rather than simply measuring one arm for blood pressure, a new study suggests that measuring both arms should now be standard procedure as the inconsistent measurements in the two may lead to a diagnosis of an otherwise “clinically silent” disorder. Evidence discovered by the researchers show that differences in both arms correlate with increased risks of peripheral vascular disease (PVD) and cerebrovascular disease. Moreover, with the inconsistent measurements in each arm, the risk of one experiencing a cardiovascular death is increased by 70 per cent – and the risk of death by any cause is increased by 60 per cent (1).

This is important information not only for physicians, but for patients’ very own knowledge. Some physicians may not hear or read about this new find, and so a patient, upon learning about this study, should inform his/her physician of the new method, as it could save one’s life.

THE RESEARCH

The study was led by Dr. Christopher E. Clark of the University of Exeter in the UK. It is a detailed review of 28 blood pressure studies, and was published by The Lancet on Sunday (29-01-12) (1).

WHAT IS PERIPHERAL VASCULAR DISEASE?

Peripheral vascular disease (PVD) is considered to be the most common disease of the arteries. The vessels are essentially clogged with “fatty materials” which cause the arteries to harden, narrow and weaken over time. This condition may even eventually affect the heart, which is then known as coronary heart (or artery) disease (2).

WHAT IS CEREBROVASCULAR DISEASE?

Similar to PVD, but affects the blood supply to the brain (1).

Visit the sources below for more information on the study, the new method of measuring blood pressure, and of the two diseases.


References

(1)  http://www.ctv.ca/CTVNews/Health/20120129/measuring-blood-pressure-in-both-arms-could-save-lives-study-120129/

(2)  http://www.emedicinehealth.com/peripheral_vascular_disease/article_em.htm

The Understanding Partner

I think it's safe to say that one of the many components of being a pre-med/medical student include having an understanding significant other. It’s mandatory, in fact, if one wishes to preserve that relationship. This is perhaps one of the most important things for me, as I’m in a long-term relationship (seven years this September) and often talk about my medical school plans with my girlfriend.

At first, as I suspected, she did not like the idea because it meant that after four years of undergrad, I would continue on to the MD program for another four years. We always discuss marriage and having kids, and with medical school being a big part of my plans, the goals of marriage and children may have to come to a halt. If we’re married, we’d also be living together, and with me being a medical student I won’t have time for a job. This means she would be the only source of income. The problems continue to accumulate. This is why having an understanding partner is very important.

It is essential for your partner to completely understand everything about the medical school procedure. One must also consider the long hours of residency and even the career itself. Medicine isn’t known to be a great career for people who wish to be family-oriented. A lot of one’s time will be put into working long hours – this is inevitable. So your partner must be just as aware as you are about the rigorous studies that will lead you to such a demanding profession.

With understanding comes support, and support makes up a large portion of what a pre-med/medical student requires during the long haul of gaining entry into medicine.

UPDATE: Research Project

I've added a somewhat in-depth description of the research project I've been involved in since August. For more details on this project, visit the Research & Publications tab, or click here.

Featured Work: Atul Gawande’s "Complications"

What better way to prepare for the great medicine trek than to begin by reading about the field itself? With literature being one of my passisons, reading books authored by experienced physicians provides me with significant insight regarding my future interests. I’ve started with Complications by Atul Gawande, a general surgeon at the Brigham and Women’s Hospital in Boston, staff writer for The New Yorker, and associate professor at Harvard Medical School and the Harvard School of Public Health.

Upon finishing Part I of III, I can say that my perspective on the field has changed for the better. Dr. Gawande seeks to explore some of the flaws and limitations of medicine that are seldom mentioned in the real world due to the potential controversies that could arise following such discussions. He presents personal experiences he underwent as a general surgery resident that include a variety of shocking patient stories. Among some of the larger stories are minor anecdotes of patient deaths due to mistakes made by residents, experienced physicians and errors by faulty machinery. Mistakes in any career are inevitable – but in medicine, mistakes can (and will) cost lives.

SUMMARY: "WHEN DOCTORS MAKE MISTAKES"

Among the cases mentioned was that of an anesthesiologist’s friends who brought their eighteen-year-old daughter to the hospital to have her wisdom teeth pulled under general anesthesia. According to Dr. Gawande, a breathing tube was inserted into her esophagus instead of her trachea (a “relatively common mishap”) but went unnoticed. The patient was deprived of oxygen and “died within minutes” (Gawande, 2002, p. 64-65).

Dr. Ellison (Jeep) Pierce, the aforementioned anesthesiologist and friend of the patient’s family, was elected vice president of the American Society of Anesthesiologists in 1982, granting him a long-awaited opportunity to do something about the death rates in the field (65). Around the same time, ABC aired a program that put the specialty under fire. They warned the public of all the potential mishaps in the field to anyone who was about to be put under anesthesia, and presented a few “terrifying” cases that had occurred at the time (65). Pierce put into effect the focus on these critical errors in his specialty and sought out professional aid from Jeffrey Cooper, an engineer and lead author of a paper published in 1978 entitled Preventable Anesthesia Mishaps: A Study of Human Factors (65).

Cooper spent most of his time analyzing the operating room and observing the anesthesiologists when he began to notice the poor design of the anesthesia machines. As mentioned by Gawande, “a clockwise turn of a dial decreased the concentration of potent anesthetics in about half the machines but increased the concentration in the other half (66).” Cooper borrowed the technique known as “critical incident analysis (used in the 1950s to analyze aviation mishaps) in order to learn how equipment may be one of the major factors in anesthesia mishaps. This technique involved receiving honest reports of any sort of error occurring in the OR and identifying the patterns which lead to such faults. Cooper had collected three hundred and fifty-nine errors, considering this “the first in-depth scientific look at errors in medicine” (66).

Cooper found that the most common problem consisted of maintaining a patient’s breathing – a result of an “undetected disconnection or misconnection of the breathing tubing, mistakes in managing the airway, or mistakes in using the anesthesia machine” (66-67). Moreover, Cooper identified other factors such as “inadequate experience, inadequate familiarity with equipment, poor communication among team members, haste, inattention, and fatigue” (67). Funding was directed into research on reducing the number of error occurrences which eventually led anesthesia machine designers to discuss safety. Dr. Gawande asserts that “it all worked” (67). “Hours for anesthesiology residents were shortened” and machines were improved through complete redesigning (67). This, of course, marks one of the greatest achievements in anesthesiology known to this day, with credit given to the late Dr. Ellison (Jeep) Pierce and Jeffrey Cooper – pioneers in medical safety.

CONCLUSION

Dr. Gawande presents many fascinating stories in Complications; a work that I’d recommend to anyone who is interested in medicine, whether through a pre-medical perspective or simply through curiosity of the industry itself. I will present additional reviews in the near future regarding this book when I have finished Part II and III.

References

Gawande, A. (2002). Complications: A surgeon’s notes on an imperfect science. New York, NY: Picador.