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July 2, 2005

BehindTheMedspeak: Anesthesia can kill you — years after the operation


This past Monday's Los Angeles Times featured a startling — at least to this anesthesiologist — story about newly discovered risks of anesthesia.

Long story short: your risk of dying from a heart attack or cancer increases for up to two years after you receive general anesthesia; the longer the operation and the deeper the anesthesia, the higher your chance of dying.

Here's Shari Roan's excellent piece.

    Even When Surgery Is Over, Sedation's Risks Could Linger

    Death rates are higher for months afterward, studies find.

    Doctors search for a reason.

    Anesthesia is not an area of medicine most folks profess to understand.

    As one anesthesiologist put it: "The lay public has the notion that we knock people on the head and they go to sleep, and then we knock them on the head again and they wake up."

    But today, even doctors are realizing how little they know about the effects of heavy sedation.

    Since the beginning of modern medicine, doctors who administer anesthesia have largely confined their worries to the period beginning when patients are sedated and ending when they're fully awakened.

    Now, two startling studies suggest that the effects of anesthesia linger for a year or longer, increasing the risk of death long after the surgery is over and the obvious wounds have healed.

    "We don't know whether the things we do really have an effect that lasts out to a very long period of time, but there is enough evidence to suggest it might," says Dr. David Gaba, a professor of anesthesiology at Stanford University School of Medicine.

    "Even if it's a subtle and fairly uncommon phenomenon, it could affect an awful lot of people."

    About 20 million Americans undergo surgery with general anesthesia each year.

    Worries about the long-term effect of anesthesia — and the demands for additional studies — began to emerge recently when two research groups published papers linking deep sedation and an increased risk of death in the year or two after surgery.

    One study, presented last fall at the American Society of Anesthesiologists annual meeting by Swedish researchers, showed that the duration spent under deep anesthesia is a significant risk factor for predicting death up to two years after surgery.

    Although the patients in the study were undergoing non-cardiac surgery, most deaths resulted from heart attacks or cancer.

    The other study, published in the journal Anesthesia & Analgesia in January by Duke University researchers, found that longer amounts of time spent under deep sedation increased the risk of death in the year following surgery.

    The patients in the Duke study underwent major, non-cardiac surgery with general anesthesia, and again, deaths in the first year after surgery were primarily from heart attacks or cancer.

    "The idea that what we do in the operating room may impact outcomes in our patients weeks, months or years down the road is exciting," says Dr. Steffen E. Meiler, vice chairman for research in the department of anesthesiology and perioperative medicine at the Medical College of Georgia.

    Surgery experts and anesthesiologists met in Washington, D.C., last fall and at smaller regional meetings since then to discuss the findings and plan research that could answer their questions.

    So far, doctors seem to agree that the long-term effects of surgery and anesthesia can lead to deaths.

    But they don't agree on the precise cause.

    Some experts suggest that anesthesia and surgery may ignite a cascade of inflammation in the body that can aggravate heart, respiratory, cancer conditions or dementia.

    According to the leading theory — just a hypothesis for now — surgery and anesthesia trigger the release of stress hormones, such as norepinephrine, that in turn activate inflammatory responses in the body and undermine the workings of the immune system.

    Inflammation is known to worsen many diseases, including heart disease, cancer, even dementia.

    Since the first studies were published, newer research has suggested that non-cardiac surgery with anesthesia also can cause a cognitive decline in some elderly people up to two years after the surgery, says Dr. Terri G. Monk, a professor of anesthesiology at Duke who led the study.

    That data was presented last fall at the American Society of Anesthesiologists annual meeting.

    "Neither surgery nor anesthesia is a natural thing," Gaba says.

    "What some people suspect — but there is still not much evidence for — is there could be people whose inflammation processes don't come back to normal after surgery but stay revved up for a very long time."

    Surgery itself causes pain, stress and anxiety, Meiler notes.

    Then there's the anesthesia, perhaps blood transfusions, and usually hypothermia (low body temperature) during surgery — all of which can rattle the immune system in a profound way.

    Sicker, older and obese people may be at more risk for death longer after surgery.

    "What we're now starting to learn is maybe there is a zone that we've always accepted as fine before that may have some subtle effects that we didn't know about before," Gaba says.

    Although doctors must be able to blunt pain, keep a patient from moving and block awareness and memory during surgery, they also must be able to awaken the patient soon after the surgery.

    If the new findings hold up, they'll have even more reasons to give patients as little anesthesia as necessary — and to take additional measures to protect patients.

    Newer monitors that precisely gauge a patient's sedation level could help improve safety, says Dr. Michael Lew, chairman of anesthesiology at City of Hope National Medical Center in Duarte.

    Accounts of patients waking up during surgery had spurred the development of the sophisticated monitors, but even with the monitors, doctors face a balancing act.

    "What has evolved is a feeling that maybe, at times, anesthesia is not deep enough and that we need better monitors to look at the depth of anesthesia," Lew says.

    "On the other hand, Monk's study is saying if you run them too deep, you increase mortality."

    Doctors also say that giving patients certain drugs before surgery can offset the risks of death later.

    For example, beta-blockers, drugs that control hypertension, are recommended for many patients before non-cardiac surgery to reduce the risk of postoperative death.

    Beta blockers can relieve stress on the heart during surgery.

    A 2004 study, however, showed that only about 40% of the suitable candidates for the prevention measure received it.

    Two recent studies, Meiler says, show that statins given to patients undergoing major vascular surgery could protect against death after surgery by improving the patient's cholesterol levels and stabilizing plaque in the arteries' walls to avoid rupture.

    Preoperative visits between the patient and anesthesiologist increasingly may include discussions about minimizing the long-term risks of surgery.

    Certain patients may be safer with a particular type of anesthesia, for example.

    With continuing research, Meiler says, "The preoperative visit is going to reach a new level of sophistication."

Of course, as with anything there are differing schools of thought.

For example, Dr. G. M. Woerlee has written an essay entitled "The Wonders of General Anesthesia" in which he describes the experience of being put to sleep for surgery as a "vision of eternity."

Remind me not to have him do my anesthesia should I ever need it.

[via KG]

July 2, 2005 at 04:01 PM | Permalink | Comments (2) | TrackBack

Calorie Counting Jump Rope


Calorie Jump tracks the number of jumps per workout and calculates the calories burned.

“Now you can skip the counting and focus on the quality of your workout.”

You enter your weight into the minicomputer in one of the handles (below)


and the rope does the rest.

Not the jumping, booboo: that’s on you.

The 10–foot–long rope is adjustable to your style of jumping.

Assuming, that is, you have one.

Or can even achieve escape velocity off the planet’s surface.


Don’t hurt yourself; remember, the treadmill works just as well, albeit a bit more slowly.


• Simple one–button programming

• Clear display with calorie and jump counter

• Swivel–action rotater head rotates in both directions

£14.95 (€22;$26) here.

[via Jonathan Margolis and the Financial Times]

July 2, 2005 at 03:01 PM | Permalink | Comments (0) | TrackBack

Brooke Shields Strikes Back


The actress, enraged at being trashed by Tom Cruise last week on the "Today" show, launched her own cruise missile squarely at the brain–dead actor in the form of a pointed Op–Ed piece that appeared in yesterday's New York Times.

It follows.

    War of Words

    I was hoping it wouldn't come to this, but after Tom Cruise's interview with Matt Lauer on the NBC show "Today" last week, I feel compelled to speak not just for myself but also for the hundreds of thousands of women who have suffered from postpartum depression.

    While Mr. Cruise says that Mr. Lauer and I do not "understand the history of psychiatry," I'm going to take a wild guess and say that Mr. Cruise has never suffered from postpartum depression.

    Postpartum depression is caused by the hormonal shifts that occur after childbirth.

    During pregnancy, a woman's level of estrogen and progesterone greatly increases; then, in the first 24 hours after childbirth, the amount of these hormones rapidly drops to normal, nonpregnant levels.

    This change in hormone levels can lead to reactions that range from restlessness and irritability to feelings of sadness and hopelessness.

    I never thought I would have postpartum depression.

    After two years of trying to conceive and several attempts at in vitro fertilization, I thought I would be overjoyed when my daughter, Rowan Francis, was born in the spring of 2003.

    But instead I felt completely overwhelmed.

    This baby was a stranger to me.

    I didn't know what to do with her.

    I didn't feel at all joyful.

    I attributed feelings of doom to simple fatigue and figured that they would eventually go away.

    But they didn't; in fact, they got worse.

    I couldn't bear the sound of Rowan crying, and I dreaded the moments my husband would bring her to me.

    I wanted her to disappear. I wanted to disappear.

    At my lowest points, I thought of swallowing a bottle of pills or jumping out the window of my apartment.

    I couldn't believe it when my doctor told me that I was suffering from postpartum depression and gave me a prescription for the antidepressant Paxil.

    I wasn't thrilled to be taking drugs.

    In fact, I prematurely stopped taking them and had a relapse that almost led me to drive my car into a wall with Rowan in the backseat.

    But the drugs, along with weekly therapy sessions, are what saved me - and my family.

    Since writing about my experiences with the disease, I have been approached by many women who have told me their stories and thanked me for opening up about a topic that is often not discussed because of fear, shame or lack of support and information.

    Experts estimate that one in 10 women suffer, usually in silence, with this treatable disease.

    We are living in an era of so-called family values, yet because almost all of the postnatal focus is on the baby, mothers are overlooked and left behind to endure what can be very dark times.

    And comments like those made by Tom Cruise are a disservice to mothers everywhere.

    To suggest that I was wrong to take drugs to deal with my depression, and that instead I should have taken vitamins and exercised shows an utter lack of understanding about postpartum depression and childbirth in general.

    If any good can come of Mr. Cruise's ridiculous rant, let's hope that it gives much-needed attention to a serious disease.

    Perhaps now is the time to call on doctors, particularly obstetricians and pediatricians, to screen for postpartum depression.

    After all, during the first three months after childbirth, you see a pediatrician at least three times.

    While pediatricians are trained to take care of children, it would make sense for them to talk with new mothers, ask questions and inform them of the symptoms and treatment should they show signs of postpartum depression.

    In a strange way, it was comforting to me when my obstetrician told me that my feelings of extreme despair and my suicidal thoughts were directly tied to a biochemical shift in my body.

    Once we admit that postpartum is a serious medical condition, then the treatment becomes more available and socially acceptable.

    With a doctor's care, I have since tapered off the medication, but without it, I wouldn't have become the loving parent I am today.

    So, there you have it.

    It's not the history of psychiatry, but it is my history, personal and real.

July 2, 2005 at 02:01 PM | Permalink | Comments (6) | TrackBack

AWOL 1: 'The ultimate party toy' gets personal


From the inventors of the AWOL 2 — "The ultimate party toy" — comes the AWOL 1 (above), the new personal version of their proprietary alcohol inhaler.

Both devices enable you to bypass your stomach and ingest alcohol by breathing the vapors along with compressed air or oxygen.

The AWOL 2 was pricey at £1,295; the AWOL 1 comes in at £149 (€ 221;$264).

The U.K. Department of Health’s Alcohol Policy Unit says it’s no more harmful or dangerous than conventional drinking.

I suppose you’ll need to find something other than "cheers" to say as you take a hit.

Maybe it would be better to try kind of a post–hoc utterance.

How about, "I inhaled?"

Seeing as this device hails from the U.K it seems only right and fittng, don’t you think?

Here’s the company website should you want one.

July 2, 2005 at 01:01 PM | Permalink | Comments (0) | TrackBack




This excellent site lets you enter a phrase or scattered words from some song a snatch or snippet of which you recall.

It then produces a list of songs and artists which employ your sought–for phrase.

Search by lyric content, song title, album or artist.

And it's free.


Girl you know it's true.

Not to be too much more of a pain in the butt than I usually am but you might — note my use of the word "might" — consider hitting this site up before coming to me with a few random words recalled in the midst of a flashback and asking me what song they're from.


Because you know my crack research team stands ready, on high alert 24/7, waiting for your requests.

We're here for you.

[via whereisben]

July 2, 2005 at 12:01 PM | Permalink | Comments (0) | TrackBack

Song Sleuth Digital Birdsong Detective


Here’s how you use it:

1) Aim the device in the direction of a birdsong

2) In seconds software analyzes, identifies and rank–orders the prime suspects and displays the results on the screen


The device’s memory contains birdsong recordings from the world–renowned Macauley Library at the Cornell Lab of Ornithology.

The machine employs digital directional microphone technology along with advanced signal processing hardware and software to compare incoming signals with its banked recordings and find the best matches.

You can customize your Song Sleuth with modules particular to each of 14 different regions in the continental U.S.;

Each $25 module contains the songs of some 60 birds common to that region.

The device is about the size of a large pair of binoculars but much lighter, weighing in at just over a pound with batteries.

The company says it picks the correct match 80% of the time.

Hey, wait a minute — I'm 100% correct at matching birds and their songs — and I'm free.

True, my signal processing software is limited at the present time to the crow and the owl.

But it's a start.

$490 here, including one regional module of your choice.

[via Ivan Berger and the New York Times]

July 2, 2005 at 11:01 AM | Permalink | Comments (0) | TrackBack

America’s Best Ice Cream Parlors, Gelaterias and Custard Stands


Just out from Fancy Pants Press are three new guides (above): "Midwest Scoops," "East Coast Scoops" and "West Coast Scoops."

Here's a link to a much nicer looking PDF file version of the publisher's press release.

Some people can't or don't want to download a PDF file and here at bookofjoe we aim to please everyone.


Each $12.95 book profiles 55 to 60 locally or regionally owned ice cream shops chosen by the authors as the region’s best.

Driving directions, ice cream lore, photos and a glossary of ice cream–related terms are included.

Publisher Michael McGarry and co–writers Bill Meeks and Megan O. Steintrager visited about 300 stores and whittled their choices down to about 180.

Guides for the South and the mountain states are being considered.

You can get the books for $10.36 apiece at amazon.

[via Jerry Shriver and USA Today]

July 2, 2005 at 10:01 AM | Permalink | Comments (0) | TrackBack

A camera that swims with the fishes


Pentax has just come out with its Optio WP (I think that stands for "waterproof").

They're advertising it as "the only waterproof point–'n–shoot camera."

Sure, we know all about those cases you put your camera in that keep it safe underwater but how much better is having the camera itself be the waterproof case?

They're gonna sell a lot of these, especially with the great ad (below) they're running everywhere.


The one pictured is a full page from this past Thursday's New York Times.

What I especially like is that little fishie swimming in the pet store plastic bag along with the camera (top).

Pretty impressive.

Oh, I see, you want more information about the camera.

What about the goldfish?

I don't hear you asking about the goldfish.

You are so random.

Anyway — it's got 5.0 megapixels, a 3X optical zoom, and is JIS Class 8/100% waterproof "because 'splashproof' and 'all–weather' cameras just don't cut it."


You can find one here for $260 and up.

And what's JIS Class 8 mean, anyway?

FunFact: When Bill Gates gets really angry at something dumb he tells the person who's saying stupid stuff, "That's so random!"

In other words, to Bill randomness is akin to the devil at work.

Whereas here at bookofjoe randomness is not only encouraged, it is sought and, when found, worshipped.


No wonder I use a Mac.

July 2, 2005 at 09:01 AM | Permalink | Comments (0) | TrackBack

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