Category Archives: Science

Science

“Aftershocks” – why we try to better understand arrhythmias

Today while looking for other cardiac electrophysiology blogs (let me know if you find any — I cannot), I came across an article called “Aftershocks” by Elizabeth Ann Bartlett. Here are some excerpts:

In the four years I lived with an automatic implantable cardioversion defibrillator (AICD) while waiting for a heart transplant, I had only a few episodes of being shocked. But in each I was fully conscious and shocked multiple times. My experiences, some of which are described below, were horrific. I learned well the power of electricity not only to heal, but to harm.

I should note, however, that my experience with an AICD, although not unique, is not typical either. [ This is a bit of an edge case, sort of a worst-case scenario, and as she mentions, technology has improved since this was written. –Brock ]
…
Lub dub, lub dub, lubdub, lubdub. Faster and faster and faster. Boom boom boom boom POW! What was that? It nearly threw me to the floor. POW! again. It threw me to the bed. POW! What was this pain, this devil, this evil tormentor, in my chest? And then it stopped. Finally, it dawned on me that my defibrillator had gone off.

My heart had slowed a bit but was still racing. My husband called 911 and my neighbor, Nancy, a cardiac nurse. As paramedics struggled to get IV lines in, I felt myself slipping away. I’m going now, I thought, but no, BAM! There it was again. A stretch of calm, into the ambulance. BAM! BAM! Calm again. BAM!

BAM! Make it stop! Make it stop! BAM! I pleaded with God to end the torment, one way or the other.

I was shocked 16 times on the way to the hospital. Shocked into submission. I found myself begging for amiodarone.

This is truly terrifying to read. Every time her device was set off, it not only caused her pain, but damaged her already failing heart by literally blowing holes in the cells (electroporation). As highlighted by this slide from my CEP basics page, even in non-edge-case patients the psychological aftereffects of defibrillation are a real problem:

Psychological aftereffects of defibrillation
The paper mentioned in the slide is here.

Even eight years after the device was removed, says Bartlett,

the shocks, at least the physical sensations of them, still come on occasion. During the time the AICD was implanted, I was diagnosed with post-traumatic stress disorder from the shocking episodes; but I could not be treated with the normal therapy of removing myself from the situation—the perpetrator lived inside my body. I have suffered from flashbacks and nightmares, though these episodes have lessened over time.

Actual physical sensations of being shocked have hit me out of the blue—standing in a grocery line, teaching a class, in my early waking moments. A bright flash of lightning will bring it all right back. Other AICD patients I’ve known have experienced the same phenomenon.

She describes a defibrillator as a “torture device that [she] came to fear almost more than the death from which it supposedly was saving [her].”

It was almost certainly saving her. The fact that she has lived to be picked up by the paramedics in both episodes recounted in the article is good evidence of that. Nonetheless, the devices need to improve. Device manufacturers have pushed the envelope of improvement given the current knowledge of the heart and its problems. We have to better understand the problems and how to circumvent or eliminate them before the devices can improve much more.

And that’s what we’re working on.

Pushing for more open access

There was an article on the BBC site, uh… several months ago (playing catch-up here) about a renewed push among the scientific community for open access to research results and publications.

The lack of such open access is for me a major pet peeve. The problem is simply this: all of the credibility is currently entrenched in old, slow, and expensive publishing houses. Journals take a while to build up a reputation, and nobody wants to publish in a journal with no reputation. It’s no good for one’s own credibility, and a sure-fire way to shoot oneself in the foot with regards to getting grant money.

Now, the Public Library of Science (PLoS) is making a little bit of head-way, but it’s taking a while to bootstrap for the reasons mentioned above.

So, enough complaining.

I have a plan. Unfortunately it’s in the early planning stages. It’s been stewing in my mind for 13 or 14 months, but I’ve finally put together an outline of the plan on paper, and will be running it by progressively larger groups of people, starting tomorrow with my lab. Once I’ve got the rough edges smoothed out a bit, I plan on posting it here. We need to move away from the outdated model that’s currently well-entrenched, and even unnecessarily emulated by PLoS. At the same time, scientific integrity must be maintained. It’s an interesting challenge.

Mmm, pie.

I was just reading a scientific paper, and it mentioned a pie chart in one of its figures.

“mmm,” I thought, “Pie.”

I miss Fafblog and its weekly dose of Friday Pie-Blogging. I’ve been planning to start Friday Heart Blogging, and it will start this evening.

100-Word Rants by Dave

Dave (who shall remain lastnameless) is the father of a friend and co-worker of mine. He’s a tall, friendly guy with a resonating voice who, in minutes, can have everyone at a party on their knees laughing so hard they can’t breathe.

Imagine my joy at being told some time ago that he now has a blog.

Dave writes a lot of ad copy. As he puts it in his description on blogger,

Decades of writing prose to fit the oddly-shaped blotches of greeking with which designers decorate their pages have left me with the freakish ability to write to an exact word count. Hence, the one hundred word rant. A fast-talking radio guy could read one of these aloud in thirty seconds. If you can read without moving your lips, you can do it quicker.

While not quite as side-splitting as his more prolonged in-person rants and stories, the rants so far have at the very least been amusing. It’s worth checking out for a once-a-week compressed look at a wide range of subjects. Go subscribe now:


100 word rant

“Live foods” woo at the Yabba Pot

There’s an organic vegan foods place right down the street from me. They have tasty and healthy foods, and the prices aren’t bad. On my first visit there, actually at another location due to renovations, I read some woo on the menu about the enzymes in raw foods and their healing effects, as well as the harm caused by chemicals produced when foods are cooked. I could kind of see a point there, but it’s a weak point.

The second time I visited, then nice and close to my apartment in their normal location, I was waiting at the register, staring over the woman working there’s shoulder, where I found a sign with big letters exclaiming that “Doctors kill people” or some other such nonsense. I should go take a picture. It then quoted very selectively an article from the Journal of the American Medical Association (commonly JAMA) on death from iatrogenic causes (i.e. death caused by a health care provider’s mistake(s)). Combined with other BS written in the menu and various places throughout the store, the conclusion the customer should make is clear: Doctors are wringing you for money and sometimes killing you and you fall right into their trap when you don’t eat raw (live) foods.

Imagine how I felt as I handed over my School of Medicine (I’m a grad student in the SoM, not a medical student) ID for my student discount.

To you, dear readers, the folly of all of this should be self-evident. Firstly, how many people would even be alive to die of iatrogenic causes without modern medicine? That’s not to say that mistakes aren’t made, or to excuse them, but indicting the whole of modern medicine and abandoning it to imbibe solely in raw foods is lunacy. Secondly, who published the article? The JAMA! It’s a self-policing article! If anything that should inspire more confidence in modern medicine, not less.

Despite my love of good vegetarian food, that’s not a place that gets my money anymore.