Prudence and Madness

I’m hosting the 10th edition for the fourth year of Grand Rounds today at my health blog, Prudence, M.D.

What is Grand Rounds, anyway?

Grand Rounds is a weekly rotating blog carnival of the best of the medical blogosphere. Each week, usually on a Tuesday, a blogger will host in his site links to posts of different bloggers about medicine, medical life, experiences with doctors, nurses, and patients, commentaries and reviews about medical news and drugs…actually, anything that is related to medicine and health care.

So, if you’re interested in participating, just check out Grand Rounds later at my health blog, which would be available online today, November 27, 2007, 3:00 p.m. in the Philippines (and that would be about 2:00 - 3:00 a.m. EST).

If you noticed the buttoned-up shirt with neck tie for men, and the blouse and slacks/skirt for women, and the white coat, it’s the doctors attempt to accommodate the “look of professionalism”. It does look nice and it helps people to orient themselves as to who the doctors are in the hospital, though some do still make the mistake of calling everyone they see in the hospital as “nars” or “nurse” (not that there’s anything wrong in being mistaken for one. But job would be easier if people know who the doctor is).

However, according to this news article from Yahoo!, British hospitals are starting to ban neckties, long-sleeved shirts, the white coats and even jewelry for doctors in an effort to curb the spread of hospital-borne infections which are allegedly increased by wearing the aforementioned clothing.

“Ties are rarely laundered but worn daily,” the Department of Health said in a statement. “They perform no beneficial function in patient care and have been shown to be colonized by pathogens.”

The new regulations taking effect next year mean an end to doctors’ traditional long-sleeved white coats, Health Secretary Alan Johnson said. Fake nails, jewelry and watches, which the department warned could harbor germs, are also out.

Johnson said the “bare below the elbows” dress code would help prevent the spread of Methicillin-resistant Staphylococcus aureus, or MRSA, the deadly bacteria resistant to nearly every available antibiotic.

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Remember those jokes about people who died because they “forgot to breathe”?  It seemed funny because who need to be reminded about breathing?  Isn’t it automatic?  If only perhaps to force ourselves to breathe in slowly or deeply, yes, it could be controlled but not to forget to initiating it.  But “forgetting to breathe” does happen.  That is, if you have Ondine’s curse.  It is a very rare disease and affects about 300 children worldwide (though it can happen in adults too, especially those who are victims of automobile accidents).

Today I came across a blog which tells of a baby who could be the first case of Congenital Central Hypoventilation Syndrome (CCHS) or, also known as Ondine’s curse, in the Philippines*.

Janis wrote about baby Hannah, daughter of her friend and former colleague.  When Hannah was born via cesarean section, she was diagnosed to have pneumonia and doctors also thought she may have a congenital heart disease.  However, Hannah still had difficulty breathing even after the pneumonia was treated.  She has to be kept on mechanical ventilator all the time.  Tests were done, congenital heart disease ruled out, and she was diagnosed to have CCHS.  The baby needs some help right now, as treating CCHS is quite expensive, being that Hannah needs to be on ventilator all the time.  If you are willing to help, just go to Janis’ blog for the contact info and other details.

What is CCHS?   

Congenital Central Hypoventilation Syndrome is a failure of the autonomic control of breathing.

The syndrome is attributed to dysregulation of Autonomic Nervous System (ANS), which controls, among other things, breathing, temperature regulation, sweating, blood pressure regulation, and even motility of esophagus.  These are bodily functions of which we do not have voluntary control of, which means patients with CCHS do not actually “forget” to breathe.  Rather, patients do not have the rebreathing ventilatory response to changes in the amount of carbon dioxide and oxygen in the body.  Patients  fail to have the appropriate response in states of hypercapnia (excess of carbon dioxide in the blood) and hypoxia (deficiency of oxygen in the body tissues), which is to breathe.  Patients who can maintain spontaneous breathing when awake probably rely on residual peripheral chemoreceptor function.

Most patients breathe normally when awake but hypoventilate during sleep.  If the disease is severe, the infant has difficulty breathing in both wakeful and sleep states.

Continue reading this entry.