Justia Lawyer Rating for Robert D. Kreisman

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A hospital’s neonatal intensive care unit is the triumph of modern medicine’s investment in technology, pharmacy and know-how, says Dr. Rahul K. Parikh, a pediatrician in Walnut Creek, Calif. Dr. Parikh wrote an essay published in a recent edition of the New York Times.

Dr. Parikh points out that babies born somewhere between 23 and 26 weeks of gestation, or what’s called the limit of viability, are placed in the NICU. In the 1960s, when the first NICUs opened, premature infants had a 95 percent chance of dying. Today, they have a 95 percent chance of survival.

Now we face a difficult choice, Dr. Parikh says, one not unlike that facing physicians who take care of adults near the end of their life: whom to fight for and whom to let go. The decision says volumes about how we have come to regard the tiniest, frailest of patients.

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Hip fractures are a significant risk for the elderly, often forcing a victim into a wheelchair and even a nursing home. A new study has found that the elderly who have eye surgery to remove cataracts and improve their vision also significantly reduce their risk of breaking a hip in a fall.

The study reports that the sickest among older people and those in their early 80s experience nearly 30 percent fewer hip fractures in the first year following cataract surgery.

A relatively safe outpatient procedure with a high success rate, cataract surgery may greatly enhance the quality of life among the elderly, improving sleep, enabling them to be more engaged and mentally alert and curbing depression.

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A new study raises questions about whether surgery for early-stage prostate cancer is really necessary — or even advisable. This particular surgery, which often leaves men impotent or incontinent, does not appear to save the lives of those newly diagnosed with the disease, according to a study published in the New England Journal of Medicine.

The study concludes that many men with early-stage prostate cancer would do just as well to choose no treatment at all. A report on the study was carried in the New York Times.

The findings were based on the largest-ever clinical trial comparing surgical removal of the prostate with a strategy known as “watchful waiting.” They add to growing concerns that prostate cancer detection and treatment efforts over the past 25 years, particularly in the United States, have been woefully misguided, rendering millions of men impotent, incontinent and saddled with fear about a disease that was unlikely ever to kill them in the first place. About 100,000 to 120,000 radical prostatectomy surgeries are performed in the United States every year.

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We look to our surgeons in emergencies when we are in pain and need intensive medical attention. Surgeons must obtain written consent from the patient before any operation. The surgeon should fully explain the procedure and perform only what he or she explained to the patient.

Those steps were not followed in the case of T.P., who was awarded $2.397 million by a Cook County jury in a suit against Northwestern Memorial Hospital and Dr. Michael A. West, who performed surgery on her in 2006. T.P. underwent emergency surgery for treatment of cancer when all she actually needed was bed rest and antibiotics.

This case was reported in the July 13 edition of the Cook County Jury Verdict Reporter.
T.P. came to Northwestern Memorial Physicians Group complaining of flu-like symptoms on Aug. 14, 2006 following a recent trip to Jamaica. She was sent by ambulance to Northwestern Memorial Hospital, where she remained for 30 hours. Her condition improved there, but Dr. West, then the hospital’s chief of trauma surgery, decided she might have cancer based on what he considered an unusual appendix on a CT scan. He conducted no biopsy or pre-surgical work up and never told T.P. of his tentative diagnosis.

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More than 40 million American women are the primary caregivers for a sick person, very often their husbands. According to a recent New York Times article, when a caregiving wife runs into a friend, acquaintance or even a relative, the most frequently asked question is, ”How is he doing?” The Times reports that people often forget to ask about the wife, who may be struggling to juggle a job and child care as well as patient care.

She faces disruptions in her work and social life, sleep habits, exercise routine, household management and financial situation. She may also be stuck with cleaning up bathroom accidents, servicing medical equipment and fulfilling challenging dietary requirements.

And as one expert put it, for some wives, caregiving is ”a roller coaster ride from hell,” with each day bringing new challenges, demands and adjustments. Diana B. Denholm, a psychotherapist, wrote about the life of a caregiver in her book, ”The Caregiving Wife’s Handbook,’‘ recently published by Hunter House.

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Good news for people who have suffered cardiac arrest: Your chances of survival are higher than they were ten years ago.

That is the conclusion reached in a recent study and reported in the journal Circulation.
Researchers who completed the study theorized that the survival rate is higher now because of changes in hospital treatment and the way bystanders respond when a person collapses.

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A jury has awarded an 84-year-old woman resident of a nursing home $6.5 million following a fall from her bed.
The resident, V.C., was a known fall risk because she had suffered a stroke. She had been living at Stanleytown Healthcare Center. Her personal care plan called for her to use bed and chair alarms.
V.C. rolled out of bed when she attempted to go to the bathroom. She fell, breaking her left shoulder and hip.

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A consortium of 55 hospitals in the New York region has launched a campaign to aggressively identify sepsis for early treatment. Hospital administrators say the campaign is needed because sepsis, a leading cause of death in hospitals, can at first look like less serious ailments.

The new campaign was recently highlighted in a story published by the New York Times. The Times story focused on Rory Staunton, 12, who suffered what seemed like a minor cut on his arm while diving for a basketball during a gym class. The P.E. director at his school applied Band-aids to the cut, and Rory went about his normal routine. That night, he told his parents about the incident in the gym, did his homework and went to bed.

The next day, he started vomiting, spiked a high fever and reported pain in his leg. His parents brought him to a pediatrician, who referred him to the emergency room at NYU Langone Medical Center, where he was treated for upset stomach and dehydration. Doctors prescribed fluids and Tylenol and sent the boy home.

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As the U.S. population ages, increasing numbers of people are taking care of elderly relatives. The Bureau of Labor Statistics has released a new study that reports that, in the past three months, 39.8 million Americans have provided unpaid care to someone over 65 because of a condition related to aging.

A story on the recent report was published in the New York Times.
According to the U.S. Census Bureau, about 78 million American children were born between 1945 and 1964 in the years following World War II. Now those children are heading into their golden years, starting retirement and facing some of the illnesses usually associated with old age. Many of their caregivers will be their sons and daughters.

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The New York Times has reported that long-time use of prescription antacid drugs can result in certain illnesses, including severe anemia, bone fracture and infections. The medications can be especially dangerous for older patients, who are urged to used them as briefly as possible.

The Times cited the example of a medical student, Jolene Rudell, who fainted; she assumed that the stress of being in medical school had caused her to pass out. Two weeks later, she lost consciousness again.

Blood tests showed Rudell’s red blood cell count and iron level were dangerously low, even though she is a hearty eater (and a carnivore). Her physician pointed to another possible culprit: a popular drug used by millions of Americans to prevent gastroesophageal acid reflux, or severe heartburn.

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