DOCTOR IN TEXAS

http://autoaccident.podserver.info/ - new site

2011-03-25T23:16:00.000-07:00

http://autoaccident.podserver.info/

McAllen health care among most expensive in nation, magazine says

2009-09-20T13:21:00.000-07:00

http://www.themonitor.com/news/mcallen-26989-among-most.html
"

McALLEN — A story in this month's New Yorker magazine reveals that McAllen is one of the most expensive health-care markets in the country, with Medicare spending an average of $15,000 per enrollee here - nearly twice the national average.

The article, penned by surgeon, writer and Harvard Medical School professor Dr. Atul Gawande, explores why Medicare costs per enrollee are so much higher here than almost anywhere else in the country.

Only Miami, which has higher costs of labor and living, has higher per-capita Medicare costs than McAllen.

The story relies heavily on anonymously sourced doctors, as well as economists and analysts, who ultimately suggest that the "entrepreneurial spirit" of medical professionals here - who often collect fees for referrals and perform tests and procedures that may not be entirely necessary - plays a role in the high costs.

Gawande compares McAllen with El Paso, another border city with similar demographics. He notes that from 2001 to 2005, critically ill Medicare patients here received nearly 50 percent more specialist visits than those in El Paso.

McAllen patients received one-fifth to two-thirds more gallbladder operations, knee replacements, breast biopsies and bladder scopes than those in El Paso, the author writes, and Medicare paid for five times as many home-nurse visits.

"The primary cause of McAllen's extreme costs was, very simply, the across-the-board overuse of medicine," Gawande reports.

"(M)cAllen and other cities like it have to be weaned away from their untenably fragmented, quantity-driven systems of health care, step by step," he concludes.

The local medical community's reaction to Gawande's story was "irate," said Dr. Linda Villarreal, an Edinburg internist and former president of the Hidalgo-Starr County Medical Society.

"If you're looking at the cost of medical care delivery, you have to incorporate a lot of issues (regarding) how things are done in our area," she said.

Villarreal said Medicare costs are high here largely because of doctors' fear of malpractice suits. Those fears continue despite a 2003 tort reform law that put a $250,000 cap on non-economic damages.

"In spite of tort reform, in Hidalgo County, we still practice ‘legal medicine' - it involves covering your butt," Villarreal said."

HEALTH CARE IN MCALLEN TEXAS IS SOME OF THE HIGHEST IN NATURE- WITH POOR OUTCOES

2009-09-20T13:17:00.000-07:00

http://usproxy.bbc.com/2/hi/americas/8137085.stm

Texas town's healthcare puzzle

By Katty Kay
BBC News, McAllen, Texas

McAllen hospitals have state of the art equipment

In the country that reveres the free market, competition is supposed to drive quality up and costs down.

But not in healthcare - and not in McAllen, Texas.

In the past 15 years, this sleepy town has reinvented itself as a boom place for modern medicine. Wherever you look there are hospitals, clinics, and laboratories.

In the same period the cost of healthcare has soared faster here than anywhere else in the country.

The 'McAllen problem'

McAllen, on average, now spends $14,946 (£9,263) on healthcare for every patient enrolled in the government's Medicare scheme, almost double the national average of $8,304 per Medicare enrollee.

Patients in McAllen certainly receive more tests and treatment for their money. Research by the Harvard doctor Atul Gawande for a recent New Yorker article found that critically-ill elderly patients in McAllen received 50% more specialist visits than in another Texan town, El Paso, which is some 800 miles (1,200km) away.

Doctors in McAllen ordered 20% more abdominal ultrasounds, 30% more bone density studies and 550% more urine-flow studies to look for prostate problems, Dr Gawande reported.

But the extra dollars and extra tests do not appear to translate into better care. Hospitals in El Paso - which has a similar population, but spends just $7,504 per Medicare patient - recently performed better than McAllen hospitals on 23 out of 25 health indicators.

Thanks to Dr Gawande's New Yorker article, the crisis in McAllen has even caught the attention of President Obama: the puzzle of why some places spend so much on treatment without providing better healthcare is apparently known in the White House as the "McAllen problem".

So what exactly is causing the problem?

We spoke to Dr Lester Dyke, a McAllen heart surgeon. He believes the fusion of business and medicine here has gone too far, and that profit rather than patient need drives many decisions.

To see thoracic surgeon Lesterm Dyke's analysis, please visit THIS LINK

More Fetus in Fetu

2009-09-19T15:08:00.000-07:00

http://www.thefetus.net/page.php?id=290
Definition
A fetus-in-fetu is an encapsulated, pedunculated vertebrate tumor. It represents a malformed monozygotic, monochorionic diamniotic parasitic twin included in a host (or autosite) twin (see Etiology below). Characteristically the fetus-in-fetu complex will be composed of a fibrous membrane (equivalent to the chorioamnionic complex) that contains some fluid (equivalent to the amniotic fluid) and a fetus suspended by a cord or pedicle. The presence of a rudimentary spinal architecture is used to differentiate a fetus-in-fetu from a teratoma, since teratomas are not supposed to develop through the primitive streak stage (12-15 days). This last criterion has been considered too stringent by many authors who regard a rudimentary body architecture (metameric segmentation, craniocaudal and lateral differentiation, body coelom, “gestational sac”)11,21, or the presence of an associated fetus-in-fetu22,23 as equivalent criteria. Although teratomas can achieve striking degrees of differentiation by the inductive effect of adjacent tissues on one another24-27, they do not present the criteria mentioned above.

Also, http://thewelltimedperiod.blogspot.com/2005/06/fetus-in-fetu.html
"

Believe it or not, a 16-year-old boy was carrying its twin brother inside his body!

Doctors at the Bangabandhu Sheikh Mujib Medical University (BSMMU) yesterday operated on the boy named Abu Raihan and found a foetus-in-foeto--the term for such unborn foetus--weighing 1.5 kilograms.

The foetus was found with grown up hair, legs and the genital although the development of the head and brain was very little. It also had two teeth and two slightly developed hands.

It is a matter of surprise how a boy could carry a living "child" in his body without any uterus! "We were prepared for such a surprise," said Prof MA Majid of the surgery department. "Medical science says it is possible but this is the first such case in my professional life," said the former head of the surgery department of Dhaka Medical College Hospital.

From 9:00 am to 1:00pm a seven-member board conducted the operation and it was a successful operation, he said, adding that the boy is now out of danger and will not face any problem in future."

Fetus in Fetu, Man living with his twin within him

2009-09-19T14:59:00.000-07:00

Man With Twin Living Inside Him -- A Medical Mystery Classic
http://abcnews.go.com/Health/story?id=2346476&page=1
"Living in the city of Nagpur, India, Bhagat said he'd felt self-conscious his whole life about his big belly. But one night in June 1999, his problem erupted into something much larger than cosmetic worry.

An ambulance rushed the 36-year-old farmer to the hospital. Doctors thought he might have a giant tumor, so they decided to operate and remove the source of the bulge in his belly.

"Basically, the tumor was so big that it was pressing on his diaphragm and that's why he was very breathless," said Dr. Ajay Mehta of Tata Memorial Hospital in Mumbai. "Because of the sheer size of the tumor, it makes it difficult [to operate]. We anticipated a lot of problems."

Mehta said that he can usually spot a tumor just after he begins an operation. But while operating on Bhagat, Mehta saw something he had never encountered. As he cut deeper into Bhagat's stomach, gallons of fluid spilled out -- and then something extraordinary happened.

"To my surprise and horror, I could shake hands with somebody inside," he said. "It was a bit shocking for me." "
more
" Removing the Mutated Body

One doctor recalled that day in the operating room.

"He just put his hand inside and he said there are a lot of bones inside," she said. "First, one limb came out, then another limb came out. Then some part of genitalia, then some part of hair, some limbs, jaws, limbs, hair."

Inside Bhagat's stomach was a strange, half-formed creature that had feet and hands that were very developed. Its fingernails were quite long. "
and
"A Mutated Body Within a Body

At first glance, it may look as if Bhagat had given birth. Actually, Mehta had removed the mutated body of Bhagat's twin brother from his stomach. Bhagat, they discovered, had one of the world's most bizarre medical conditions -- fetus in fetu. It is an extremely rare abnormality that occurs when a fetus gets trapped inside its twin. The trapped fetus can survive as a parasite even past birth by forming an umbilical cordlike structure that leaches its twin's blood supply until it grows so large that it starts to harm the host, at which point doctors usually intervene.

According to Mehta, there are fewer than 90 cases of fetus in fetu recorded in medical literature."
ending with
"Fetus in fetu happens very early in a twin pregnancy, when one fetus wraps around and envelops the other. The dominant fetus grows, while the fetus that would have been its twin lives on throughout the pregnancy, feeding off its host twin like a kind of parasite. Usually, both twins die before birth from the strain of sharing a placenta.

Sometimes, however, as in Bhagat's case, the host twin survives and is delivered. What makes his case so unusual is that no one suspected Bhagat had a twin inside him for 36 years.

Bhagat said he was very much relieved after his operation. He was not interested in knowing what Mehta did to him or seeing what he had removed from his abdomen.

"He didn't want to see it because it was looking very ghastly," Mehta said.

Avoiding the Gory Details

There was no placenta inside Bhagat -- the enveloped parasitic twin had connected directly to Bhagat's blood supply. Right after the surgery, Bhagat's pain and inability to breathe disappeared and he recovered immediately.

The case may have been a medical miracle to doctors, but to Bhagat his condition had been a source of shame and misery. All his life, people in the village where he lived had mercilessly teased him and told him he looked pregnant. Ironically, they were right in a way. "

Fetus in fetu

2009-09-19T14:57:00.000-07:00

http://www.springerlink.com/content/14m097361n252406/
"Fetus in fetu is a rare disorder. Its embryopathogensis and differentiation from teratoma has not been well established. It is a parasitic twin of a diamniotic monozygotic twin. Here we report, two cases of fetus in fetu with review of literature. In case report 1, a 2-year-old boy was referred for asymptomatic lump in abdomen since birth. X-ray showed the mass in the abdomen with some calcification and fluid inside. CT scan reported a heterogenous mass in the retroperitoneum with bony malformation. CT showed presence of three vertebrae in it. After surgically excising the mass and opening the sac it showed presence of trunk and two limbs with one of the limbs having a nail. Histopathology showed presence of GI tract. In case report 2, 4 month female was found to have lump in the abdomen by housemaid while bathing. X-ray showed a soft tissue shadow while ultrasonography revealed cystic mass arising from right kidney. CT suggested cystic mass with calcification not arising from kidney. During exploration whole mass was excised and there was frank fetus inside it. Histopathology confirmed presence of four vertebral bodies with germ layers. Although fetus in fetu is rare condition, correct diagnosis using imaging can be made before surgery. Complete excision is curative."

CANCERS AND EMBRYOS, WHAT DO YOU DO WHEN YOUR FETUS IS A CANCER

2009-09-19T14:55:00.000-07:00

http://www.nature.com/news/2002/021106/full/news021104-8.html
"Cancer creates embryo" "Scientists have grown mouse embryos from cloned brain tumours, they revealed yesterday. The remarkable results imply that drugs that mimic cloning might one day help to treat the pernicious cancer." So, scientists have grown murine (mouse) embryos from cloned brain tumours (tumors). So, what if they could create a HUMAN embryo from a cloned brain cancer of a human. Should they, or stated another way, are they murderers
if they destroy a cancer which could have become an embryo ?
"How a Tumor Is Like an Embryo"http://www.technologyreview.com/biomedicine/19667/
"It's now increasingly apparent that one mechanism, quite possibly the dominant mechanism, involves the ability by the cancer cell to resurrect early embryonic behavioral programs. [In the embryo, these programs] normally enable different tissues to form and depend on the ability of embryonic cells to move from one site in the body to another. This movement in the embryo is superficially similar to metastasis. The way cancer cells acquire this embryonic trait of being able to move throughout the organism depends on their ability to resurrect these early embryonic behavioral programs, which they do through their ability to induce the expression of early embryonic transcription factors [proteins that control the expression of a large number of genes]."

But, maintaining this "save human life at all costs" nutty idea, what about a MALIGNANT TERATOMA ? What is a malignant teratoma ? The tissues of a teratoma, although normal in themselves, may be quite different from surrounding tissues, and may be highly disparate; teratomas have been reported to contain hair, teeth, bone and very rarely more complex organs such as eyeball,[citation needed] torso,[citation needed] and hands, feet, or other limbs.

So, a malignant teratoma may contain HUMAN tissue, have the quality of life, contain tissues, including but not limited to HAIR, TEETH, BONE and perhaps eyeballs, torso, hands feet, or other limbs. It is a cancer, and can have teeth, hair, bone, eyeballs, torso, hands, feet, or other limbs. Now, since the right to lifers, if they believe a fertilized OVUM is a person, certainly would think this cancer is a person, after all, it is alive, has human DNA and all the rest. Since these things can kill the mother, it is natural for a mother to want it removed.
Would a right to life woman want this malignant teratoma transplanted into her womb? Or, would a right to life man want this precious little mass of human life , would he wanted it taken out of the mother and put in his wife in order to save this "human life"?

CAR WRECK TREATMENT

2009-09-19T14:35:00.000-07:00

Yes, we treat folks hurt in auto accidents, and acceptance of patients with regard to car wrecks, similar to folks injured in workers compensation cases, is on a case by case basis. I think watching some of our videos about car wrecks, helps to set the tone for our approach.

Doctor in Texas

2009-09-19T13:57:00.000-07:00

Welcome to the blog for our DOCTORINTEXAS.COM website at
http://www.doctorintexas.com