Posts Tagged ‘Blue Baby’

Oprah is not your friend

June 13, 2009

I occasionally see a web page or get an e-mail petition imploring TV talk show host Oprah Winfrey to do a show about kids with Congenital Heart Defects (CHDs). I’m convinced these pleas are a wasted effort – Oprah Winfrey is not going to come riding to the rescue.

Why? It would seem that CHDs would be a perfect topic for Oprah’s show. The majority of her audience is female, most of them in their childbearing years, and CHDs occur in 1 out of every 125 live births. It sounds like a perfect fit.

But to understand why CHDs will never be featured on Oprah, you have to understand how that type of show works. No matter the subject, the writers approach it in a limited number of ways. The most used approach is The Host Has All The Answers. Typically, a guest will have have a problem. Oprah is going to listen, and then suggest a course of action. She’ll then call on an expert seated in the audience, who will agree completely. After all, The Host Has All The Answers. It’s all nice and neat and we can be on the way to a better existence in an hour.

Heart Defects aren’t solvable in an hour. A lot of times there aren’t answers – we have ideas about why children are born with bad hearts, but nothing is certain. My mother followed all of her doctor’s suggestions, she didn’t smoke or drink (Never did and still doesn’t, so it couldn’t be due to “residual effects”) and yet I was born with a defective heart. Many other people can say the same thing. So, Oprah, how do we prevent Heart Defects? We can’t follow that line of thinking  – because then, our host won’t have the answers.

Another popular approach is I Have A Problem: The host acts a conduit to connect a person with an unsolvable problem with an expert in the field. (Our host will make the initial suggestion or their staff will search for the expert, a variation of the Host Has All The Answers technique.)

That won’t work because a CHD at birth, even if expected, triggers a crisis response. The instant the child is born, the clock starts ticking. Get Oprah involved? I’m sorry, we’re heading for the helicopter pad right now. As soon as we land at University Hospital, we’re going straight to the Operating Room.

I’m highly doubtful that open letters, web pages, or petitions will influence Oprah to present our stories on TV. And I’m worried that if we were to appear, we would be presented as Victims or with a “You poor thing!” attitude. If that were to happen, don’t invite me – I don’t attend pity parties. They never serve good food and the music is crappy!

So no, appearing on Oprah is not high on my priority list.

Teamwork

November 28, 2008

blalock-thomas1

These two men did pioneer work on blood loss and shock. They developed heart surgery procedures that are still in use. Odds are, you have only heard of one of them.

Vivien Theodore Thomas was born on August 29, 1910 in Lake Providence, Louisiana. After graduating high school in 1929, he planned to attend Tennessee Agricultural and Industrial State Normal School, (Now known as Tennessee State University) with hopes of becoming a doctor.

He had been in school two months when the stock market crashed, causing him to lose his part-time carpentry job. Forced to drop out of college, Thomas still found work as a Lab Assistant at Vanderbilt University Medical School, working for surgeon Dr. Alfred Blalock. Although hired to sweep floors and clean out cages, Vivien Thomas impressed Dr. Blalock with his intelligence. Blalock was so impressed that he trained Thomas to be his Surgical Technician.

Thomas began assisting Blalock in the study of shock during surgery. Shock is caused by a sudden drop in blood flow through the body, and can be fatal. Working together, Blalock and Thomas developed ways to prevent shock from occurring during an operation. By World War II most of their theories were in use, saving the lives of countless injured soldiers.

In 1941, Dr. Blalock was hired by Johns Hopkins Hospital in Baltimore, Maryland, to serve as the hospital’s Chief Surgeon and as a Surgical Professor in the Hopkins Medical School. The doctor asked his trusted assistant to go with him, and Thomas agreed. But while Blalock was responsible for training every surgeon in the school, Thomas had to enter the building through the service entrance. He was also listed on the hospital payroll as a handyman.

The two men respected and trusted each other, but were hardly equal. At one time, Blalock was paid ten times more than Thomas. Often the doctor hired Thomas to serve drinks in his home during a social event. And never was Thomas allowed in the Operating Room.

It was at Johns Hopkins that the two men met Dr. Helen Taussig. Taussig had been hired in 1930 to oversee the Cardiac Clinic of the Harriet Lane Home, (Hopkins’ children’s hospital) and quickly grew interested in “Blue-Baby” diseases.

Usually, blood coming into the heart is routed first to the lungs, where it absorbs oxygen. The oxygen rich blood then goes back to the heart, where it is pumped throughout the body. Blue Babies are born with a badly formed heart or blood vessels that cannot provide enough oxygen to the blood. Their skin has a distinctive blueish tinge, especially in the fingertips. At that time Blue Baby diseases were incurable, and almost all of the patients died very young.

Dr. Taussig approached Dr. Blalock with an idea: if a Blue Baby’s heart couldn’t provide  oxygen to the blood naturally , then why couldn’t a surgeon re-route the major blood vessels? Taussig’s plan was interesting but extremely dangerous. The operation would have to take place near the heart, and heart surgery was so risky it was almost never recommended. Any accidental damage to the heart would have to be repaired within 4 minutes, or the patient died.

Busy with his teaching duties, Blalock asked Vivien Thomas to work out the details of how such an operation could be done. Thomas began by studying medical textbooks, drawings and diagrams of hearts, and even real hearts taken from dead bodies. Then he operated on dogs, intentionally creating Blue Baby hearts in them. Later he would operate again, repairing the heart and making careful notes of everything he did. It was a slow process, learning exactly what had to be done.  Many dogs died, and several of the surgical tools he needed didn’t even exist. Quite often, Thomas would invent them.

X-rays of the patient were another problem. X-ray films provide a good still photograph of the workings of the body. But Taussig preferred to use a fluoroscope. A fluoroscope image is best described as “X-ray TV”– It provided moving images of the interior of the body. If the patient accidentally moved, so did the picture. There was no way to record the fluoroscope image, so the three doctors would have to study their patient’s fluoroscope scans carefully and commit them to memory.

At last they felt they were ready, and Taussig began to search for a proper patient. On November 29, 1944, they operated on a little girl named Eileen. Although fifteen months old, Eileen only weighed nine pounds.

Thomas had planned to be in the observation room, watching the operation. Blalock said no – he felt more comfortable with Thomas close enough to give him advice. In preparation for the operation, Thomas had performed the procedure over 100 times on animals. Blalock had been taught the procedure by Thomas, but had actually done it only once. Breaking all the rules of the time, Thomas entered the operating room and guided  Blalock through the operation.

Eileen’s heart never stopped beating and her blood vessels were only as thick as a  matchstick. After about 90 minutes, Blalock was finished. Everyone held their breath as he removed the last clamp from a blood vessel. After a long pause, Helen Taussig said “Al, the baby’s lips are a glorious pink color.”

Proven to be a success, Blalock’s team performed nearly 300 operations in less than a year. Surgeons came from around the world to study Blalock’s new surgical procedures, only to learn that Thomas was the expert, not Blalock or Taussig. Still, the operation was known as the “Blalock-Taussig Shunt,” named for the surgeon who performed it and the doctor who suggested it.

Blalock retired in 1964 and died four months later. For six years, Thomas continued to teach but took on no major project – almost as if  he were in mourning. But as the 1970’s began, more and more African-Americans were entering the Hopkins Medical School. To them, Vivien Thomas was not just one of their teachers, he became their mentor. And just as he had guided Blalock so many years before, Thomas’ advice and support guided a new generation of doctors through medical school.

Thomas died in 1985, just a few days before his autobiography was published.* Today, Vivien Thomas is almost unknown to the general public. But Dr. Alfred Blalock never forgot him. If someone stood too close to his right shoulder during an operation, Blalock would tell them to back away. “Only Vivien may stand there.”**

* Thomas’ autobiography has been reissued with a new title: Partners of the Heart: Vivien Thomas and his work with Alfred Blalock. A hardback copy of the original title, Pioneering Research in Surgical Shock and Cardiovascular Surgery: Vivien Thomas and his work with Alfred Blalock is usually valued at over $100.

** This photo has been identified by Johns Hopkins archivists as being a photo of the third Blalock-Taussig Shunt taken in early 1945. Dr. Helen Taussig normally would have been in the operating room but is not identifable in this photograph.

Throwing my Readers Some Bonz!

October 5, 2008

This post may be a bit unfocused, as I really don’t have any ideas about what to write about today. My weekend has been full of “normal” activities, if you can call counting small pieces of candy normal. I bought a large glass jar with an airtight lid and a five pound container of Bonz – small (two centimeter long) pieces of candy shaped like little bones. They come in five different colors: red, white, blue, yellow, and orange. For a Halloween festival prize, I’ve sorted out all the orange Bonz, counted them, and filled the jar. Now if some lucky child can correctly guess the number of Bonz in the jar, they win the jar!

A much easier question to answer is “What kind of candy does Steve eat?” At least until the end of the year, the answer is going to be “Bonz!” I’m tempted to buy another airtight jar and use the red, white, and blue Bonz to make a 4th of July “Guess the Number” prize. With a good seal they should stay fresh until then.

As you can see, the life of someone with a severe heart defect can be shockingly boring. And I like it that way! The trick is to learn all you can about your defect, and your body. The second one comes only from experience, and could change at any time. But once you figure yourself out, you’ll have a good idea when something is “just irritating”, “normal for me” or just plain wrong. And then you can deal with it.

I think the first time that I realized that something was wrong with me was in the early 1970’s. I was less than eight years old, maybe less than six. We owned a white station wagon – make and model, I have no idea – and we had some kind of a dinner at the church. It was pretty much over, all of our dishes were loaded, daddy was sitting in the drivers seat, and I was playing in the back. I planned to crawl over the seat, but I slipped and went face first into the metal bar that you pressed if you needed to lower the back seat for more room.

WHAM! I literally saw stars.

Daddy looked back at me. “You’ve busted your lip,” he said. “Come here so I can clean you up.”

He was wiping my face with a handkerchief when I glanced up into the rear view mirror. I couldn’t see the cut (it must not have been bad, because I don’t have a scar) but I could see my bloody mouth.

My blood actually looked blue. Holy cow! Even when you are Cyanotic, you blood isn’t blue… a darker shade of red, perhaps, but not completely blue. But that is what it looked like to me. Remember, I was “knee high to a grasshopper” (Interpretation for non-Southerners: I was really young!) but that is the way I remember it.

I bring this up because I dreamed about that car last night. I dreamed that my brother had wrecked his car and had been given an old white station wagon as a loaner until his car was fixed. He came by the house with it, angry that he had been assigned such an old set of wheels. My mother commented that we used to have a station wagon just like that, way back in the day, and my father said “I actually think that’s it!”All my medication causes me to have some… interesting dreams!

And finally, be sure to check the blogroll for a new resource. I’m calling it “Medical Publications” but it links to pubmed.gov., which is part of the National Institutes of Health (NIH). If you receive government funding for your medical research, it must be published on pubmed.gov and be accessable to anyone. So go to the homepage, type your search term into the search box, and you’ll be presented with a list of available works on the subject. They will be very technical and full of “med-speak”, but if nothing else, you can see where major research is being done and contact them if you need further assistance!