Immediate Post Surgery Wound Care Hints

By Amy Price PhD

After surgery wound care could be better addressed. The advice is usually to ice the area for twenty minutes at a time and don't get it wet for 48 hours to 21 days depending on the procedure because of infection risks. Who are they kidding...After bleeding, being washed down with iodine and being touched,probed,cut and stitched by hands I have no personal relationship with all that I want is a bath or a shower!

The risk of infection is serious as it can travel to your bones or become systemic and cause more damage than the original problem. It can travel through open places in the wound or through the stitching which acts as a wick. Until the area has healed over it is best not to swim or use a hot tub because of bacterial risks. It is important to follow your doctor's advice for changing dressings etc. If the area becomes hot to the touch, swells rapidly,starts pulsing or you start to run a fever get your doctor's advice.

To shower after spine and cervical surgery I purchased a silicon swim cap as this is completely waterproof and less irritating than latex. I cut generous pieces which I placed over the wound and taped it in place with duct tape. For arms and legs I used umbrella bags, big ones for leg and smaller for arm areas. I placed them over top of the dressing and bandage and taped this in place. You will still need to exercise care and try not to get the area wet...a bath could be a bad idea! If it gets a little damp in spite of all precautions gently dry the area, put on topical antibiotic and replace the dressing.

If this was an emergency room visit remember emergency rooms will only stabilize you, they have no obligation to provide treatment beyond this. An emergency room visit needs follow up with a doctor. At emergency if you have tendons exposed insist on being seen by a specialist on call. I had three fingers all with tendon avulsions stitched up with no repairs. It took a year of occupational and physical therapy to get the function back. A word to the wise...if you have broken something and they have splinted, cast or wrapped it and it starts to smell bad or the exposed areas turn dark and lumpy go back to the hospital. They don't mean literally black, if it darkens substantially, swells and get worse rather than better have this checked out. With a temporary cast the swelling can cut off the circulation and the tissue starts to die. I almost lost a hand this way as I was told if it turns black come back, since it cost me 10,000 dollars for the emergency room appearance and 273 dollars for a bandage available at the dollar store.I really wasn't up for a repeat visit!

The ice is easy in principle but not so easy for the drugged and injured to apply. Some people travel for surgery and it is a considerable time before they are at home to ice. Do yourself a favor and buy some instant ice at a pharmacy before your procedure or get the surgery to supply you with a couple of extra packs for the trip home. The ice takes down swelling and eases pain while helping your body heal. At home consider the wound site. An awkward area like the elbow,knees or shoulders may be best with a bag of frozen peas which will bend to the shape. A posterior neck surgery may benefit from an emptied and refilled with water large soda bottle (don't freeze the soda it explodes). Ask a family member or friend to do ice duty day and night. If you are like me and don't want to ask anyone for anything consider that you can buy them a gift, take them to dinner or return the favor. It is an investment in your healing. Be nice to those who care enough to be available, they do not benefit from you getting an attitude because you feel bad that you need the help and being thankful can go along ways towards preserving relationships

There will be a follow up post on scar care soon. This information is for educational purposes only and does not constitute medical advice. That is your doctor's assignment.

Two Hearts, The FDA and Stem cells

By Amy Price PhD
My email informs me people are hungry for real help on finding medical providers who can offer stem cells. They want to know are stem cells a viable alternative, Can you find me quality information instead of hype, and what is your view on the FDA in this regard?

This field is moving very rapidly and what was not possible only a year ago is happeneing today.I have sen great and not so great results for orthopedic, heart, blood and some wound healing applications but it is important to realize that this therapy is still in experimental stages and there are no guarantees.

A few pioneers have moved through the opposition and fear of new therapies to pave the way for university hospitals who are now offering up stem cells in the way of research. One good example is new heart tissue grown out in Los Angeles "We seek to actually reverse the injury that has been caused by the heart attack, by re-growing new heart muscle to at least partially replace the scar that's formed," says Dr. Eduardo Marban of Cedars-Sinai Heart Institute

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A tale of two hearts summarizes this nicely. Both hearts were damaged. The first heart was in a young man whose parents are dedicated medical professionals. They waited eagerly for FDA clearance so they could take their son for a legal stem cell repair. The wait was too long and emergency surgery ensued. The young man lived but sustained brain damage and paralysis. This heart could have been repaired with adult stem cells. A company that developed the stem cell technology was less than one hour from them. The cultural mindset opinion that procedures performed outside of North America because of FDA restrictions were too risky cost them deeply.

On the other spectrum was a banker friend well known in the diplomatic community? His heart was damaged and he was urged to change his lifestyle and lose weight. He picked up over the counter diet pills later banned by the FDA and marched to the treadmill like a soldier in boot camp to the acclaim of family and treating professionals. Noticing his lips and finger tips had an ominous bluish tinge, I asked to see the pills. They contained amphetamines in the form of herbs. We urged him to see his cardiologist and to stop the pills but he chose to soldier on until a month later he collapsed on the treadmill and was taken to hospital where his chest was sawed open and major heart surgery took place as it was the only way to save his life.
The FDA found a niche because when humans are physically vulnerable they will pay or do almost anything for survival. They keep us safe from predators in the marketplace. They help us with food labels and medical warnings. Dieters have been known to ingest tapeworms, destroy their stomachs, livers, kidneys, hearts and intestines to lose a few pounds. Doctors who see patients on whom they conduct treatment for a fee will say I have to be honest with you the chances aren’t great but if it is your choice we can proceed. They are applauded for their ‘honesty’ whether the treatment succeeds or not. We say go ahead because even false hope is better than none at all. Likely none of us would hire a roofer who said I will work on your roof but because of pre-existing structural damage it likely won’t work out! The FDA has a tough job and emotional stakes run high.

On the other hand the FDA is a bureaucracy with allegiances and political agendas, not because they are necessarily evil but because this is a given for group behavior. They are shaped by society and moved by mass public opinion. They also make mistakes and if some of the lifesaving drugs we have today would have needed FDA approval masses would be dying while wars were fought that have little to do with how well something works.

Do I think most people or their doctors have enough medical training to make an informed choice about stem cells? No…but I am not sure the FDA is in a position to make this choice for the best interests of the people and I would welcome some of the transparency they have promised.

Would I consider not having FDA approval for a therapy before using it on myself or family? I would not consider a banned or illegal substance but I would have non FDA sanctioned treatment or off label use of pharmaceuticals. It has in the past improved my quality and likely my length of life. I would not consider a choice like this lightly. The risks need to be weighed against the benefits and I would have to know and trust the doctor involved whether in this country or somewhere else on the globe.

Your Own Stem Cells Cultured On Contact Lens Can Restore Sight

By Amy Price PhD

“The procedure is totally simple and cheap,” reports UNSW’s Dr Nick Di Girolamo (lead author of research study), “Unlike other techniques, it requires no foreign human or animal products, only the patient’s own serum, and is completely non-invasive. This preliminary trial was conducted on three people, two with extensive corneal damage resulting from multiple surgeries to remove ocular melanomas, and one with the genetic eye condition aniridia. The patient with aniridia had damage in both eyes so stem cells were taken from the conjunctiva area. Because stem cells have not yet differentiated into specific cells they could grow into the cells that were needed. Each patient’s sight improved significantly after only a couple of months

Here is how it works. Less than a millimeter of tissue is taken from the ocular surface of the patients own eye. It takes a couple of hours to prepare the eye and put the contact lens with the baby cells in place and the patient goes home. The stem cells are cultured on a post surgical contact lens which is then placed onto the damaged cornea for 10 days, during which time the cells are able to re-colonise and heal the damaged eye surface. Apparently it took some experimentation to find a lens that could be successfully used as a scaffold for the cells.

The scientists on this research project see this therapy as a simple way to restore sight for eyes damaged by scarring, chemotherapy and a range of other disorders. They suggest that all is needed is a simple lab and qualified medical personnel putting it within reach of even third world countries

Di Girolamo, Nick; Bosch, Martina; Zamora, Katherine; Coroneo, Minas T.; Wakefield, Denis; Watson, Stephanie L. A Contact Lens-Based Technique for Expansion and Transplantation of Autologous Epithelial Progenitors for Ocular Surface Reconstruction. Transplantation, 2009; 87 (10): 1571 DOI: 10.1097/TP.0b013e3181a4bbf2

Justice-for-All? Amy Price PhD

Illusory statements and human error can set context that overthrows justice. In my life I have seen the guilty walk and the innocent executed based on what passes for science. Probability and statistics are used as weapons promoting authority over individuals unlearned in the field with little regard for the human carnage and heartbreak that follows.
Want to see the power of optical illusions? They are not as powerful as those that can be created by illusory context. Illusions are the gap between perception and processing, they operate in all senses and we are all susceptible
I recently enjoyed a forensics experiment where we were given a cursory fingerprinting class and then were given prints to compare for accuracy. There is a commonly held 16 points of accuracy that until recently was used to determine probability...plenty of room for error, even though Sir Francis Galton says mathematically the chances of identical fingerprints are 60 billion +.
I was interested in the case of a Scottish police officer who because of mistaken identity, lost her job, reputation and was driven to near bankruptcy because her accusers needed to be right more that they cared about justice. The officer later settled for 1.75 million pounds without the agency admitting guilt. I shudder to think how little she would have recovered for personal use after all the 3 ds (denial,delay and) were exercised. In fact those that brought faulty evidence were later exonerated by the department. Of course a 273 page document explaining how to do it better was produced but I doubt the officer gets royalties...
Dr Itiel Dror shared in an interview with the BBC how he engaged forensic specialists in a study where he linked context with perception during fingerprint analysis. There was a large error rate. The video and study is worth viewing. He shows how the stage can be set for seasoned professionals to make errors
In another case a Lawyer was held in Oregon as a terror suspect, his life was derailed and finally with the words "regrettably there was an error" he was released. I doubt that fixed much for him or bought him back time that was stolen in the prime of his life. He will likely be remembered as the 'Terror Suspect" rather than for other contributions he makes.
In the experiment most of us correctly identified these prints as not matching his. What went wrong? Try it for yourself

What is the take home message? Before you render judgement or accusation really listen with a mind to hear. Your 'facts' may be clouded by context and false perception. At any rate we can choose a blame free course where together we fix the things that are broken and produce unity instead of destruction

Parkinson's Disease Stem Cell Sequel

By Amy Price PhD

I found an interesting addition to the Parkinson's post's in the form of an article from Nature. Many thanks from helpful individuals at the Open University in the UK for passing this on.

In the article in Nature Suchowersky O. Transplantation therapy for Parkinson disease: the good, the bad and the enigmatic. Nature clinical practice. Neurology. 2008 Sep;4(9):465
Parkinson disease (PD) affects an estimated 1 million cases in North America . Motor symptoms in PD initially
respond well to dopaminergic replacement medications, but because PD progresses the drugs gradually lose effectiveness after about 10 years resulting in gait dysfunction and complications such as dyskinesias
PD is not just a disorder of the dopaminergic system but involves other neurotransmitter systems which inform autonomic dysfunction, mood disorders, fatigue, pain, sleep disorders and cognitive function. Dopaminergic cell replacement, even if successful is thought capable of treating only motor symptoms.
Over 20 years ago, transplantation of fetal ventral mesencephalic cells into the putamen was
performed on a small sample of participants with reportedly good results. Regrettably further studies with larger participant pools failed to confirm the initial reports (Freed CR et al. [2001] N Engl
J Med 344: 710–719). PET and pathological analyses revealed adequate survival of grafted
neurons, and there was untreatable runaway dyskenesia. However clinical benefit was seen in
a small subset of patients, 16 years on autopsy results are available Mendez et al. showed survival of
grafts without PD pathology for 14 years in five patients (Mendez I et al. [2008] Nat Med14: 507–509). Another patient showed good clinical improvement l 5 years plus, before gradual worsening of motor function and development of gait and balance problems (Kordower JH et al. [2008] Nat Med 14: 504–506). Autopsy results from this patient 14 years after transplantation showed great graft survival but grafted neurons had pathological
changes typical of PD, including Lewy bodies and activated microglia (cell scavengers) were seen in large numbers
Liet al. reported similar graft pathology in three patients up to 16 years after transplantation (Li JY et al. [2008] Nat Med 14: 501–503). These results indicate that for stem cell therapy to be effectual long term in D research needs to be initiated to investigate the spread to youn grafted neurons and determine strategies to resolve this issue. I would hope that advancement in the area of Adult Stem Cell research will make this possible in the near future.

I am finding the stem cell story is not so new. I did hear about a very young women stricken with metasticized spinal cancer who was treated at Sloan Kettering with grown out adult stem cells taken from her own bone marrow over fifteen years ago. She is now a successful professional with no trace of malignancy in her body. I also remember twenty five years ago in Canada I knew three terminal patients who underwent adjustments to the bone marrow transplant protocol that involved growing out their own bone marrow cells. One person enjoyed a year free from blood cancer and then relapsed but the other two lived. It is strange that when I go to Pub Med , Google Scholar or even the University library there is no trace of this research performed for "humanitarian reasons"

There is also a lot of interest in the London Project where stem cell trials are close to human trials for those with macular degeneration. Pfizer is quoted as expected to announce backing of stem cell therapy, apparently with joint labs in Cambridge Mass and Cambridge UK but on the Pfizer site I didn't see this in place.

Individuals are reporting encouraging success for adult stem cell treatment where they are thier own donors particularly for orthopedic and cardiac applications. These treatments are largely privately funded. It would be great to see this in the mainstream covered by insurance and available for people regardless of income levels

A Pill For Memory? Piracetam Revisited

By Amy Price PhD

One significant problem in traumatic brain injury is that secondary cell death occurs when the injured cells block the path for the other cells to get oxygen. One product that is used extensively in other countries but not the USA is Piracetam. It is interesting that research in pub med is showing promise for efficacy in human trials. There have been rat, rabbit, and fruit fly trials available for years but there is a lot that can differ between these and seeing actual human benefit.

I used this product to good effect many years ago without side effects and am encouraged to see studies supporting its effectiveness. The alternatives available to many people with TBI as far as psychotropic meds to restore some measure of function are concerned can sometimes have unexpected reactions or be of no effect.

Piracetam has been shown to alter the physical properties of the plasma membrane by increasing its fluidity and by protecting the cell against hypoxia. It increases red cell deformability and normalizes aggregation of hyperactive platelets according to Winnicka K, Tomasiak M, Bielawska A (2005) They are saying treatment with piracetam improves learning, memory, brain metabolism, and capacity by the interaction of this molecule with the membrane phospholipids to restore membrane fluidity . The draft below is from smart publications

The positive therapeutic effects of piracetam on cognitive (memory, attention, executive functions) and motor (coordination) functions as well as the speed of cognitive and motor performance were demonstrated in a study done by Zh Nevrol Psikhiatr Im S S Korsakova. 2008 for adolescents who sustained TBI's.

Its efficacy is documented in cognitive disorders and dementia, vertigo, cortical myoclonus, dyslexia, and sickle cell anemia according to Winblad B (2005).

The results of a meta-analysis Waegemans T, Wilsher CR, Danniau A, Ferris SH, Kurz A, Winblad B. (2002) demonstrate a difference between those individuals treated with piracetam and those given placebo, both as significant odds ratio and as a favourable number needed to treat. While there may be problems in meta-analyses and the interpretation of the statistical results, the results of this analysis provide compelling evidence for the global efficacy of piracetam in a diverse group of older subjects with cognitive impairment.

This post does not in any way constitute any medical advice or recommendation. These posts are educational only to share with others some of the direction research is taking. Any medical information gained online should be supported and endorsed by your own doctor.

References:

[The consequences of closed traumatic brain injury and piracetam efficacy in their treatment in adolescents]
Zavadenko NN, Guzilova LS.
Zh Nevrol Psikhiatr Im S S Korsakova. 2008;108(3):43-8. Russian.
PMID: 18427539 [PubMed - indexed for MEDLINE]
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Piracetam--an old drug with novel properties?
Winnicka K, Tomasiak M, Bielawska A.
Acta Pol Pharm. 2005 Sep-Oct;62(5):405-9. Review.
PMID: 16459490 [PubMed - indexed for MEDLINE]
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Piracetam: a review of pharmacological properties and clinical uses.
Winblad B.
CNS Drug Rev. 2005 Summer;11(2):169-82. Review.
PMID: 16007238 [PubMed - indexed for MEDLINE]
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Clinical efficacy of piracetam in cognitive impairment: a meta-analysis.
Waegemans T, Wilsher CR, Danniau A, Ferris SH, Kurz A, Winblad B.
Dement Geriatr Cogn Disord. 2002;13(4):217-24.
PMID: 12006732 [PubMed - indexed for MEDLINE]
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More Than a Wheel Chair

I recently enjoyed a great flight with a group called Paralysed Veterans of America. People of all shapes, sizes and conditions along with dedicated physicians and carers formed a mighty team. These men were on their way to Aspen to ski and they were fun to be with. Even with missing legs,arms, spine injury, blindness, deafness or brain injury their zest for life and care for others was an example of power and unity at work.

The conversation was full of hope for new treatments, medications, regenerative medicine and ways to improve life for their fellow man. They do research,create equipment to make life easier, and help others navigate paperwork so families can put their lives back together

As we talked I learned they do more than ski and race cars. They have lobbied congress on behalf of all of us who are disabled so we are able to use commercial transportation, be treated with courtesy and receive the assistance to get from one location to another. Getting the luggage and extra equipment a disability brings from the customs hall to the next flight, or negotiating airplane steps can appreciate the complications well timed assistance can bring.If you encounter problems travelling with a disability this site can show you what to do They mentor the newcomers on the way out of the old life before the trauma into a destiny where life is not over or lessened it is just different. I heard no useless platitudes like "Get over it, others are worse off" but rather things like "Buddy have you tried this?" or "It will get better, I will go with you".

I was empowered by the raw courage in the face of obstacles others had deemed impossible and their group willingness to give life another chance. Most of these men face daily pain, memories they can not lose and disability yet their indomitable spirits did not quit and they helped each other.

I saw courage and dignity more clearly than in a military parade or in troops ready for action...these men showed us how to live after the party is over and they did it well.

To find out more about them or to donate to make these kind of trips possible see this link I like to remember that their gift of service and the price they paid allows me to walk in freedom. Life is all about giving back to the foundation. When each of us does our part the foundation will be there for us and those who come after us