Ellecia Small received a kidney transplant at the University of Mississippi Medical Center in November 2009.

Less than three months later, Small, 31, of Canton was dead.

Kinyata Johnson, of Alabama, who received the same donor's other kidney, is partially blind and needs constant care, said Jackson attorney Joe Tatum.

"He thought it would help him, but he was better off before the kidney," Tatum said.

Small's family and Johnson now have separate lawsuits seeking an unspecified amount of damages against Mississippi Organ Recovery Agency and UMC, with Tatum as their attorney.

The kidney transplanted into Small came from a donor who had been diagnosed with encephalitis, according to her lawsuit in Hinds County Circuit Court.

"Both defendants were aware that the kidney donor was infected with encephalitis before the subject kidney was transplanted into Ellecia Smith. And as a result, Ellecia Small, developed severe encephalitis, neurological damage and died," the lawsuit says.

But MORA and UMC are denying the lawsuit's accusations and further say in court papers that Small's death was attributed to her previous medical conditions.

"While we're sympathetic to the patients, their families and the health care professionals involved in this tragic incident, we're unable to comment on pending litigation," UMC spokesman Jack Mazurak said.

The Clarion-Ledger was unable to get a comment from MORA.

Small and Johnson were among four people who received organs from the infected donor.

In 2010, when the situation became public, UMC said the parasite was identified after the fact by the Centers for Disease Control and Prevention in Atlanta as Balamuthia mandrillaris, a free-living soil amoeba that causes encephalitis, or inflammation of the brain. No commercially available test exists for the parasite, UMC officials said then.

They also said then that the parasite had never been identified in an organ donor before and never been transmitted in an organ transplant previously.

Nor had any case of the parasite previously been diagnosed in Mississippi.

Very sad for the recipients, but there was no test for the parasite. I was once involved in a case of Mad Cow Disease (Creutzfeldt-Jacob) diagnosed in a lady that received a cornea transplant. Some of these recipients have been waiting a long time and some never get a transplant. If we have to begin testing for all these off the wall illnesses, the organs will never be used. More on the waiting list will die waiting.

How to Exercise

Exercise and keeping your body active is important even if you have endured the amputation of a limb. Amputations of a part of the leg or foot may be necessary due to peripheral vascular disease and diabetes, which hinders blood flow to the lower limbs, causing part of the tissue to die or become necrotic. Other reasons for an amputation include an accident or injury that severely damages the leg. You will require physiotherapy after your surgery to learn how to exercise the affected leg and become mobile again with the help of a prosthetic limb or wheelchair. Even if you cannot walk, it is important to exercise your sound leg to maintain healthy circulation and prevent blood clots. Your doctor will advise how soon after surgery you can begin an exercises. Once you have been given the go-ahead, try these exercises.

Range of Motion

Step 1

Lie flat on your back on an exercise mat with your arms at your sides. Keep your hands palms down on the mat for support. Use a pillow to support your amputated leg if that is more comfortable.

Step 2

Slowly lift your unaffected leg off the mat as high as possible. Keep your amputated limb motionless. Hold your leg in the air for a count of three to five, while keeping your toes pointing straight ahead and stretching your leg as much as possible.

Step 3

Move your leg in a circular motion in the air. Bring your leg back down on the mat and relax. Raise your leg again and move it from side to side five to 10 times.

Step 4

Return to the starting position and rest before repeating the entire exercise, completing 10 to 12 repetitions. This exercise helps to relieve leg cramping that may occur from sitting or being in a wheelchair for long periods of time. It also improves circulation and leg flexibility.

Muscle Tone

Step 1

Sit up straight in your wheelchair or a sturdy chair. Loop the elastic exercise band around your toe and grip the handles tightly in each hand.

Step 2

Raise your leg so that it is extended straight out in front of you. Bend your leg at the knee to bring it as close to you as possible. Pull back on the exercise band handles by bending your elbows and bringing your hands close to your chest. You may need to lean back slightly.

Step 3

Remain in this position and extend your leg out straight again. The resistance from the exercise band should make this difficult and work out the muscles in your leg. Hold this position for a count of three to five. Relax, lower your leg and continue the exercise 10 to 15 times.

Balance

Step 1

Stand up straight and hold the back of a heavy chair or a table with both hands for support. If you wear a prosthetic leg, remove it so that the weight of your body rests on your sound leg.

Step 2

Let go of the table or chair and spread your arms out to balance the weight of your body on your leg. Maintain this position for a count of 10 or more.

Step 3

Hold the table or chair again and relax before doing the exercise five to 10 more times. You can also hold a broomstick straight in front of you in both hands to help you balance.

One limb becomes much more important when you are missing the other. For good orthopedic health it is important to maintain strength and flexibility of the sound leg in order to maintain long term mobility. The exercises also improve muscle tone needed to help with return circulation.

The US winner of the James Dyson Awards has been announced. Cadence, by Art Center College of Design student Seth Astle, is a prosthetic limb and pedal system that makes cycling more accessible for below-the-knee amputees. It offers a full range of motion, and better efficiency than traditional prosthetic limbs. The Cadence prosthetic “has an elastomeric band that collects energy while riding, giving the cyclist added muscle strength.  As the foot rotates, kinetic energy snaps the foot and leg back up and around to the top.  By combining the pedal and prosthetic, the cyclists can clip into the pedal, allowing more control and ease of use.”

The split toe design allows the rider to see where he or she need to clip into the pedal, and the special pedal design allows the rider to unclip with a back pedal motion.  Without the muscles in the lower leg, a traditional pivot release pedal system is very difficult for amputees.

As the US winner Seth will receive $1,400 and move on to the international final, announced in November. His design will also be featured in a display at the London Olympics next summer.

For more information about cycling with a prosthetic leg, check out Amputee in Action (based here in Greenville, SC). The site points out that, according to the Amputee Coalition of America, “there are approximately 1.7 million people living with limb loss” and “one out of every 200 people in the U.S. has had an amputation.” If a product like Seth’s can help a percentage of those people to experience the joy of cycling, it is certainly worthwhile.

I find it interesting that the pedal was combined with the prosthesis for cycling. I am excited to see this design and hope it does well in the international final in November.

Check out all the cool stuff to help around the home. These technology helps aren't just for seniors. My catastrophic injured patients need these home modifications and aids for independent living too.

Thursday, April 7, 2011

Neuros Medical's Electrical Nerve Block Showing Significant Amputation Pain Reduction in Early Study

Filed under: Neurological Surgery , Neurology , Orthopedic Surgery , Rehab , Vascular Surgery

Neuros Medical of Cleveland, Ohio has developed patented Electrical Nerve Block technology for modulating peripheral nerves. The technology, which consists of a pacemaker-like device and leads stretching to the target nerve, was tested in a study involving five people with chronic amputation pain. Four of the participants reported significant, and even complete, reduction of their pain.

From the announcement:

Study participant Darren W. said, “My pain was gone, something I have not experienced since my amputation. I was able to sleep completely through the night, my first pain-free sleep in several years.” Participant Claude G., also experienced considerable pain relief, and said “the reduction of my pain was amazing, provided a feeling of freedom, and allowed me to work in my woodworking shop for hours.” The study was led by Dr. Amol Soin of the Kettering Health Network Innovation Center and the Ohio Pain Clinic. “Providing such significant pain relief for the patients is outstanding,” said Dr. Soin. “A complete reduction is often unheard of, however the high frequency electrical nerve block technology showed the ability to do so, safely and consistently, and the strong potential it holds for patients suffering from chronic pain is very encouraging,” he added.

Press release: Neuros Medical Announces Successful Feasibility Study...

Neuros Medical...

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A Boston surgeon who performed the wrong procedure on the hand of an elderly woman has disclosed the excruciating details of his error in one of the nation's most prominent medical journals.

Dr. David C. Ring, a hand and arm surgeon at Massachusetts General Hospital, described in the latest issue of the New England Journal of Medicine how a series of personal and system-wide mistakes led him to operate incorrectly on the hand of a 65-year-old woman with a painful “trigger finger.”

“Just imagine the worst thing that’s ever happened to you and that’s how it feels,” said Ring, 42, of the surgery mistake that occurred about two years ago. "I don't want anybody to make the same mistake I made."

Ring’s public admission is rare in a field that typically cloaks doctors’ errors in anonymity, if not secrecy. Patient safety advocates praised Ring’s seven-page mea culpa as a necessary step to reversing rising numbers of wrong-site surgeries and other errors.

“My immediate reaction was ‘Bravo!’” said Dr. Helen Burstin, senior vice president for performance measures at the National Quality Forum, a safety coalition famous for pioneering a list of what were once called “never events,” medical mistakes that should never occur.

“I thought it was exceptionally brave,” she added.

1. Health highlights
   1. 

      Surgery error leads doc to public mea culpa

      Dr. David C. Ring, a Boston surgeon, described in the latest issue of the New England Journal of Medicine how a series of personal and systemic mistakes led him to conducting the wrong surgical proceedure on the hand of a 65-year-old woman.

In 2008, the most recent year with complete records, 116 wrong-site surgeries, up from 93 in 2007, were recorded by the Joint Commission, a national hospital accrediting agency. Preliminary reports logged 137 wrong-site surgeries from March 2009 through June 2010. That’s despite more than a decade of attention to the issue following the landmark 1999 Institute of Medicine report titled “To Err is Human.”

Series of mistakes led to error
Ring, along with colleagues at Massachusetts General and Harvard Medical School, detailed the series of missteps that led to the wrong operation in the patient whose ring finger on her left hand was stiff, painful and sometimes got stuck in a flexed position, a condition known as "trigger finger."

The patient, a Caribbean native who spoke only Spanish, was the last operation on a day that included three major surgeries and three minor surgeries, Ring wrote. No interpreter was available, so Ring, who speaks Spanish, was asked to translate for her.

Stress was high because several other surgeons were behind schedule. As a result, the patient was moved to a different operating room at the last minute, with different staff, including the nurse who had performed the pre-operative assessment.

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Ring spoke to her in Spanish, which was mistakenly interpreted by a nurse in the room as a “time out,” the safety pause for the medical staff aimed at double-checking surgical sites, but no formal check occurred. In addition, there was a change in nursing staff in the middle of the procedure and a bank of clinical computers that diverted nurses’ gazes away from the patient.

Ring performed a carpal-tunnel-release operation, instead of a trigger-finger-release procedure. 

“About 15 minutes later, while I was in my office dictating the report of the operation, I realized I had performed the wrong procedure,” Ring wrote.

Ring quickly notified the staff, the patient and the hospital’s safety team and asked the patient if she wanted him to perform the correct surgery, which she did.

‘Blame and shame culture’
Although he apologized to the patient, waived her fees and successfully performed the correct surgery, Ring said nothing could undo the mistake. But by writing and talking about it publicly, he hoped to break the silence that still surrounds doctors’ errors — and prevent them in the future.

“We’re transitioning from the blame-and-shame culture,” Ring said. “This is not something you sweep under the rug.”

Disclosing the details of the mistake will help others learn from Ring’s experience, said Dr. Peter Pronovost, a surgeon and medical director of the Center for Innovation in Quality Patient Care at the Johns Hopkins University School of Medicine.

“It’s only by understanding this richness that we will be able to defend against this,” said Pronovost, a renowned patient safety expert. “He should really be applauded for his courage.”

Ring acknowledged that he’s risking his reputation among colleagues and, more importantly, among patients.”

“They will say, ‘I’m glad he didn’t do the wrong surgery on me,” he said.

Massachusetts General Hospital officials reviewed the error, reemphasized safety protocols and coached Ring and others involved in ways to avoid specific mistakes in the future.

“I hope that none of you ever have to go through what my patient and I went through,” Ring wrote to his medical colleagues. “I no longer see these protocols as a burden. That is the lesson.”

As for Ring’s patient? Hospital officials offered her a settlement within weeks of the event. However, her son told Ring she’d “lost faith” in the doctor and that she’d seek future care somewhere else.

© 2010 msnbc.com Reprints

I have been meaning to write a blog post on this ever since I read about this earlier last month. I am so pleased to see this Boston surgeon go public in what is typically swept under the rug. I work with a medical malpractice attorney who tells me of a surgeon who routinely made mistakes, but was always quick to apologize and miraculously was never sued. In this case, the patient sought treatment elsewhere, but the important lesson is his public confession and steps to prevent this in the future. As we see from the description from the article, things are not always black and white. We are human and sometimes errors occur.

For the life care planner, note this lady's statments about how her life in the wheelchair forced her to look up all the time, to miss out on being outdoors with the wind in her face, and not being able to hug another heart-to-heart.

That is why technology like this is so essential. From Berkley Bionics, the eLegs are expected to be in select rehabilitation centers around the nation by the middle to end of 2011. The hope is to eventually refine the product for home use by the end user.

There are many standing wheelchairs out there and this is one concept. The chair is designed for the young, active paraplegic.

The standing chair is used for both physical health; maintaining bone health, relieving pressure points, etc., but also for mental health. It allows the user to stand at eye level with others rather than being looked down upon to converse.

As a life care planner, I often include standing wheelchairs for my spinal cord injured patients. It allows more freedom of movement. The user can reach cabinets and things that were out of reach before.

To designer, Tim Leeding, keep up the good work!

Patients who have a better understanding of their illnesses are likely to be healthier.

Technology such as social networking sites, e-mail, personal health records, home monitoring devices and patient portals have made communication between patient and doctor not only more convenient but also more meaningful.

Patients are able to do more independent research, making them better informed. They can compare costs, exchange information with other patients, and bring that knowledge back to their physicians. Technology even can allow physicians to monitor a patient's health without a visit to the office, creating more time to see sicker patients.

This is from an article from the American Medical Association. Participatory technology includes email, personal health records, patient portals to allow access to records, social networking sites, home monitoring devices, and electronic medical records. The Joint Commission is encouraging patients to get more involved with their Speak Up! campaign which I highly recommend. Let's all urge our patients to educate themselves about their diagnosis, their medications and the side effects, treatment plans and recommended diagnostic testing. We will all be better off for it.