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First Uterus Transplant in US: Be Careful What You Wish For

Today, the Cleveland Clinic announced that they performed the first uterus transplant in the United States. According to the New York Times, the operation, took nine hours, and used a uterus from a deceased organ donor. Here is more information from that article.

The recipient, 26, is not being identified to protect her privacy
The patient will have to wait one year before trying to become pregnant, letting her heal and giving doctors time to adjust anti-rejection medications
The transplant is only Temporary: The uterus will be removed after the recipient has had one or two babies
The ethics committee at Cleveland Clinic has given it permission to perform the procedure 10 times, as an experiment. Then, it will evaluate whether it will offer this as a "standard procedure"

I first wrote about the possibility of the uterus transplants almost 10 years ago on the old Doctor Anonymous blog, and it was by far one of the most popular posts on the DA blog. I still have many of the same questions 10 years later. I'll quote from that blog piece below, and I also invite you to read the comments from back then, which I think still apply today.

Medical Questions: Anti-rejection transplant drugs are powerful stuff. Yes, we have some data which states that the pregnancy rate for transplant patients are "not much worse than for the general population. Can this data be correlated to uterine transplant patients? How much do anti-rejection drugs cross the placenta barrier? What would be the effects to the fetus/baby? What about the 3D Printing of a uterus? Can/should this be done?
Moral Questions: You have to know that this will be another platform for the abortion debate to take place (especially so in this US Presidential election cycle). Presuming the transplant goes ok, what if the pregnancy goes awry? What if the life of the mother is at risk and/or the life of the fetus/baby is at risk? Both sides of this debate will definitely make their points of view known.
Legal Questions: The malpractice attorneys are preying, er, praying that this procedure becomes a "standard procedure" as outlined above. The liability here is huge. The potential for medical problems are everywhere starting wtih the transplant itself, then the pregnancy, then the potential complications of anti-rejection drugs.
Not to mention the Financial Questions: Who is going to pay for all of this? I know I'm going to get hate mail saying, "Hey Jerk, isn't life priceless to you?" There are some estimates that one fertility treatment alone can cost $25,000 dollars. But, then there's the first surgery of the transplant. At least two fertility treatments, removal of the uterus (according to the Cleveland Clinic protocol above), the anti-rejection medication, and a lot more. I forsee more feedback for me, "You don't know what it's like to be told that from a medical standpoint, you can NEVER have the possibility of the pregnancy and childbirth experience."

As I said 10 years ago, I'll say again. I'm pessimistic that the uterus transplant will become a "standard procedure" for a number of reasons. Just because it looks like it can be technically done, I don't think they should be done. I think there are still too many unanswered questions to proceed further...

Zika Virus In Stark County, Ohio

For weeks now, the national and international news has been scattered with stories about what is called "Zika Virus." But, for me, the story has increased relevance for me, as it was announced by the Ohio Department of Health, that Ohio has its first two cases of Zika Virus, one in the Cleveland area, and the second case in Stark County, close to where I live.

My fear is that there may be some kind of panic that may start to set in as news of the Stark County case starts to make the rounds locally. I remember when the Ebola story really started rolling in the fall of 2014. And, then there was a local connection in close-by Akron, the story really took off around here. But, alas, Ebola is not Zika. However, do local people know that yet?

Why my local peeps SHOULD NOT panic about Zika Virus (yet):

It's Still Winter, Dude: Even though it's been milder than last year (what an understatement that is), Zika is spread my mosquitoes and they need a warmer climate. Now as spring gets closer, this story becomes more interesting.
People Rarely Die of Zika: This is not Ebola, and don't let people make you think differently
Zika is not airborne and is not spread by casual contact

Why people SHOULD be concerned about Zika Virus:

There is no test for Zika Virus: Well, that's not very accurate. There is no local testing for Zika. The only way to get testing done is through the CDC.
There is no Zika vaccine: Politicians like President Obama are pushing for quick development of a Zika vaccine. But, in reality, we probably won't see one for at least 2 years.
Possible association with Guillan-Barre syndrome (GBS) which is a rare disorder where a person's own immune system damages nerve cells, causing muscle weakness, and sometimes paralysis (CDC). It not has been proven if Zika causes GBS, but officials in Brazil are investigating.

So, I'll be watching closely as this news cycle continues, especially for more Ohio cases. But, for more information, I recommend these links: CDC has an entire section of their website devoted to Zika, an article from Lifehacker, article from Columbus Dispatch, article from WKBN-TV, article from Canton Repository.

Cold Weather Actually Causes Colds

Every time the weather gets cooler, a common question that I receive is this, "Does cold weather cause colds?" In the past, I have always said, No. However, there has been some new research by Yale University scientists published in the Proceedings of the National Academy of Sciences. (Reuters, NBC).

There were two interesting findings from this research. First, the common cold virus replicates quicker in colder air that is surrounded by warmer air, like in the nose. Secondly, in cooler temperatures, this can lower the immune system, and increase your chance to catch a cold. Now, this research was done in mice. So, it can be difficult to make the leap to humans. Yet, it's still interesting research.

I was interviewed by WKBN television in Youngstown, Ohio on January 14, 2016 and asked the question, "Can The Cold Give You A Cold?" I encourage you to read their report at this link, and to check out my TV interview below and at this link. Enjoy!

2016 Influenza Season: Slow So Far

Since it is the end of January, we're right in the middle of Influenza season. Fortunately, the Centers for Disease Control report that Influenza activity has been for the most part "minimal" (as of January 16, 2016). Our local community has matched national trends in that our community has not seen a lot of Influenza cases this season. However, the peak of flu season is right now for another 4-6 weeks. So, a flu epidemic could still potentially happen.

I was interviewed by WKBN television in Youngstown, Ohio on January 29, 2016. During my chat with the news reporter, I emphasized that it's not too late to get your flu shot. At our office, we have been seeing a lot of "flu-like" symptoms including cough, congestion, sinus pressure/congestion, and other symptoms. However, there have been few positive tests for Influenza. Why is that important? That is important because the treatment is different, and it is very important to make an accurate diagnosis so that appropriate treatment can be made.

So, in addition to getting your flu shot, there are some other steps that you can take to help spreading illness, according to the Ohio Department of Health: Wash your hands with soap and water; Covering your cough; Avoid touching your eyes, nose, and mouth; Staying hydrated; and Exercising regularly. And, don't forget: Get Your Flu Shot!

American Family Physician Podcast: Check It Out

For the past couple of months, I've been watching a podcast roll out talking about the American Family Physician journal. The podcast is written, recorded, and produced by the residents and faculty of the University of Arizona College of Medicine, Phoenix Family Medicine Residency. Check out their page at this link, and subscribe on iTunes at this link. Also follow @AFPPodcast on twitter!

In addition to great discussion about articles in the journal, the podcast also features a cool musical theme and also an opportunity for medical students and residents to participate in the podcast by reading their closing credits. In these early episodes, they have interviewed a couple of our friends including Dr. Jay Lee and Dr. Jennifer Middleton.

I thought it would be fun to try to read the credits myself and to try to get an interview on their wonderful program. In the video clip below, I discuss this with our friends Dr. Gerry Tolbert and Dr. Kim Yu. An audio clip is also included for your reference. Let's Do This America!

New Blog Look

Happy New Year 2016! With a new year comes a new start. I have really enjoyed this Squarespace platform in that there are some new templates every few months to check out. For those who are curious, this one is called, "Momentum."

It's no secret that I've been in a social media creation "block" for the past few months. But with January 2nd, comes new chances to start again. I've been doing a lot of thinking lately about how to make 2016 the best year ever. Writing will hopefully be part of the solution. What will this year bring? Who knows? But, I know I will make every effort to make this the best year ever. Happy New Year!

2015 Texas Academy of Family Physicians Meeting

As I usually do, I'm sitting in the airport, on my way home from another meeting. I always enjoy collecting my thoughts and processing what has happened at a conference. My thanks to the Texas Academy of Family Physicians (TAFP) for the opportunity to speak on Family Medicine Advocacy using Social Media. I was honored to be a part of a Family Medicine Leadership course that has been "reimagined" from one about a decade ago. TAFP also announced a year long leadership course named the "TAFP Family Medicine Leadership Experience."

During the leadership track yesterday, many questions came to my mind. Can you really teach leadership? Can people learn leadership, or is it something that you're born with? I guess what it really comes down to is that, yes, there are some leadership skills that can be taught. We talked about this during the sessions, but here what I think are some essential elements to a successful leadership course:

Basic Leadership Literature: We talked about a variety of books that people recommended including Good To Great by Jim Collins, books by John Maxwell, books by Malcolm Gladwell, books by John Maxwell, Emotional Intelligence by Daniel Goleman, books on American history, Physicians as Leaders by Perry Pugno & Mindi McKenna, and many more.
Access To Leadership Stories from People In Your Industry: In this case, it was fascinating hearing stories from three TAFP past presidents, two of whom were also the president of the national academy. Not only did I get a sense of leadership history in our speciality, they also talked about missed opportunities, and what they learned from them. For me, not only do I learn from the successes of others, but also I learn from their mis-steps.
Leadership Is Learning By Doing: In medical school, when it comes to performing procedures, the saying goes: "Learn One, Do One, and Teach One." All day, you can sit in a classroom and talk about tips and tricks, and you can hear stories from others. But, when it comes down to it, leadership comes down to practical application.

All that being said, here is the number one litmus test to know if you're a great leader: The Dance Floor Test. If you're at a party with fun music, can you get your non-dancing friends and colleagues out to the dance floor? If you can, then you're a great leader. How about that? LOL

It has been so much fun for me to visit different state chapters and see how they organize and conduct their meetings. TAFP reported that they had record attendance this year, of which I fully take credit for (hehe). This fabulous meeting is a credit to the awesome TAFP staff along with the Family Physician leaders. Check out the pics below...

Physicians Forgotten from Health Is Primary & CVS Collaboration

At the National Press Club this morning, the Health Is Primary campaign (also knows as Family Medicine for America's Health) announced a "collaboration" with CVS Pharmacy and Minute Clinics. In their press release, they state "This initiative will advocate for patient access to coordinated, continuous care and help to ensure that all consumers will have access to a primary care provider."

Initial reaction among some of my social media contacts has been negative. Some stated that it's a "money grab" by CVS under the guise of promoting "America's Health." Organizations like the American Academy of Family Physicians (AAFP) have been watching retail clinics closely. AAFP even says this in their Retail Clinics policy statement: "While retail clinics may provide a limited scope of health care services for patients, this can ultimately lead to fragmentation of the patient's health care, unless it is coordinated with the patient's primary care physician."

And, I think that this is where the Health Is Primary campaign is going with this. I mean, retail clinics are not going away, it would be foolish to try to combat them, because the American public finds value in these clinics, and partnering with them is not a bad thing. You'll see the relevant tweets below from the National Press Club event.

However, there are three initial key questions that I'd like to ask as I was thinking about this morning:

What happened to Physicians in this Health Is Primary, CVS, and Minute Clinic collaboration? In the entire 400 word press release, guess how many times the word "Physician" was used: Just once in the title. Meanwhile, the word "provider" was used six times. According to published reports, $20 million dollars have been committed for the promotion of Primary Care, Family Medicine, and (what I thought was) Family Physicians. Even on the FMAHealth website, it states, "A New Initiative Sponsored by Family Medicine." Are the eight Family Medicine organizations feel like they're getting their money's worth when they read this press release?
What about the Independent Practice Nurse Practitioner? Now, don't get me wrong, I'm not anti-Nurse Practitioner. We have a nurse practitioner and a physicians assistant who work in our office. However, I believe that the physician is the leader of the health care team, and the NP/PA providers should have a collaborative agreement. Now, current status of collaborative agreements are not perfect, and needs reform. However, in reading this press release, it seems like Health Is Primary is ok with any primary care provider, including the independent practice nurse practitioner. I would ask clarification on this.
What about future CVS Health & Minute Clinics future collaborations? Did you know it's National Nurse Practitioner Week? And, our friends at the American Association of Nurse Practitioners are promoting their advocacy points like the aforementioned independent practice nurse practitioner. Why do I forsee a press event next week with the AANP, CVS, and MinuteClinics? What would be the response of the Health Is Primary campaign?

Now, I haven't talked with anyone from Family Medicine for America's Health. These thoughts are just from their press release today and the tweets below from their National Press Club event this morning. Their challenge now is to their marketing, messaging, and communication of this collaboration.

Family Doctor Week in Canada

Thanks to the Alberta College of Family Physicians (ACFP) for letting me know that November 9-14, 2015 is National Family Doctor Week in Canada. Shout out to my Canadian colleagues! Also check out more pics and videos from their site below. Use the twitter hashtag #FamilyDocsRock to amplify the message, and also check out FamilyDocsRock.Ca

From the ACFP website: "A Family Doctor-Patient relationship is often times one of the most trusted in health care. It is a relationship that both the Doctor and Patient have been nurturing since the patient's first visit - and often the patient's first encounter with the health care system."

About a month ago, ACFP sent me the t-shirt and hat above with this message: "This year, the ACFP is supporting our Family Doctor Week in Canada campaign by sending a thank you to key people who have been pivotal in advancing Family Medicine in Canada and abroad. Please accept this small token of appreciation for your work." Thanks so much ACFP, and you know I'd post about it, and take a selfie, right :)

What a great idea! I see my friend and colleague Dr. Jay Lee from #FMRevolution also received a shirt (see below). I wonder if any of my other Family Medicine social media peeps received a gift from ACFP?

Imitation is the most sincere form of flattery, right? I'm thinking ahead to World Family Doctor Day, which is every year on May 19. Wouldn't it be cool if the worldwide community of Family Medicine was able to coordinate a message for that day using social media? I guy can dream, can't I? Who can I get to help? Hmmmm.....

Live From #Wonca2015 Istanbul Turkey

This week, the 20th European Conference of the World Organization of Family Doctors took place in Istanbul, Turkey. Over the past few months, I've become more and more interested in Family Medicine around the world.

In the first video below, I interview our friend Dr. Kyle Hoedebecke on Thursday, October 22, 2015 live from Istanbul. In our interview below, we discuss the Preconference meeting that was organized by the Vasco Da Gama Wonca group, wrapping up the Polaris Preconference prior to the recent AAFP Global Health Conference, and promoting the 2016 Wonca World Conference which will be in Rio De Janerio, Brazil. In addition to the you tube video, you can also download the audio podcast here as well.

At the bottom of this post, you'll see a video of a Social Media session at the #Wonca2015 meeting. I watched it live on periscope at 7am on Friday, October 23, 2015 when it was 2pm in Istanbul. You'll also see the audio podcast, which you can download here. And, finally, you'll see key tweets from this fabulous session. In addition check out the youtube site for the meeting. Enjoy!