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Man saves wife’s sight by 3D printing her brain tumor

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Re: Man saves wife’s sight by 3D printing her brain tumor

#131

Post by triangleman »

malvim wrote: post #17
wpietri wrote: post #11

Earlier quoted context omitted.

I share your concerns with the US medical system. It is a bunch of busy, reasonably bright people caught up in an insane circus. It on average produces adequate care, but you shouldn't expect much more. Having an active and informed advocate can make an enormous difference. On the other hand, I agree that more data isn't necessarily better. There are plenty of examples. E.g.: http://www.bloomberg.com/news/2012-05-21/…

Brazilian here (and surprised to see they used Brazilian research software in a top HN story!). Couple years ago, my wife had a mass on her throat that turned out to be thyroid-related but (thankfully) benign. I had the EXACT same feeling as you, and feel we're copying the US in only the wrong aspects. "A bunch of busy, reasonably bright people caught up in an insane circus" sums it up better than I could. I'll digre…

My wife is Brazilian and she actually prefers that way of getting lab results (get it yourself) to the American way: Results are sent directly to the doctor, to encourage you to schedule and pay for another doctor's visit to have the results read to you by a nurse.

In her opinion it was a violation of patient rights when we were unable to retrieve some lab results directly from the lab. In order to do that we would have to file some paperwork with the lab company and get the results mailed to us in 3-4 weeks.

Re: Man saves wife’s sight by 3D printing her brain tumor

#132

Post by mdesq »

tsax wrote: post #70
jkokenge wrote: post #40

Earlier quoted context omitted.

It seems that health care professionals don't have a nuanced problem solving attitude. They make a diagnosis, see how this diagnosis fits into a preconceived treatment bin, then just solve from that position without understanding what's different, what's unique to each case. And, in their defense, they probably just don't have the time for that extra work. That's where I see technology as most useful....how to automa…

I come from a long line of docs, though I'm a software dev. Let me tell you that the vast majority of patients can easily be sorted into these pre-formed category bins. Rare conditions are rare by definition. Most of medicine is dreary repetition.

There's a similarity of sorts here to airline pilots. What separates the decent ones from the great ones is how they handle the rare cases. There's enough dreary repetition that it's easy to be unprepared when it counts the most.

Re: Man saves wife’s sight by 3D printing her brain tumor

#133

Post by mzs »

alphaoverlord wrote: post #101
Shinkei wrote: post #88

Wow... I really hope I didn't get to this thread too late that this just gets buried. This is a classic example of hyperbolic reporting to try and show physicians as some kind of incompetent lot whereas this 'guy working in his basement with passion and talent' figured out how to hack the entire field of Medicine. The fact is, nearly all Meningiomas are treated this way because they are overwhelmingly benign and the…

I absolutely agree with Shinkei. I had a few more thoughts, but summarizing, I worry that this is a case of an 1) incidentally found, 2) benign, 3) asymptomatic, 4) slow or non-growing mass was removed despite the recommendations of multiple neurologists and after fishing for a neurosurgeon who was willing to cut it out. The story starts with an accidental, incidental finding. The wife recently underwent thyroid surg…

We do not have all the details from that article. It might have been causing headaches or double vision for example. Partial resection was likely very good here. It's generally very slow growing. If it had grown to cause trouble later nuclear surgery could have been a more appropriate option at that point. The craniotomy approaches are what have those percentages you outlined, loss of vision, smell, or taste, as well as difficulty with speech can be complications depending on the approach used. Basically the brain has to be moved away and that causes trauma to nerves as well as which facial muscles need to be cut depending on the approach.

This new approach is intriguing. Expected anatomy would have a wrinkle of the dura near there which should lead to relatively small risk of CSF leak following micro surgery. This could prove to be a very good and more common approach in fifty years.

Re: Man saves wife’s sight by 3D printing her brain tumor

#134

Post by ursidae »

alphaoverlord wrote: post #101
Shinkei wrote: post #88

Wow... I really hope I didn't get to this thread too late that this just gets buried. This is a classic example of hyperbolic reporting to try and show physicians as some kind of incompetent lot whereas this 'guy working in his basement with passion and talent' figured out how to hack the entire field of Medicine. The fact is, nearly all Meningiomas are treated this way because they are overwhelmingly benign and the…

I absolutely agree with Shinkei. I had a few more thoughts, but summarizing, I worry that this is a case of an 1) incidentally found, 2) benign, 3) asymptomatic, 4) slow or non-growing mass was removed despite the recommendations of multiple neurologists and after fishing for a neurosurgeon who was willing to cut it out. The story starts with an accidental, incidental finding. The wife recently underwent thyroid surg…

Hi! I'm a radiologist. Don't know if there are any others commenting in this thread. My 2 cents:

The worries you outline in your first paragraph are 100% accurate in this case. The article is crap.

Re: Man saves wife’s sight by 3D printing her brain tumor

#135

Post by entropydude »

parennoob wrote: post #121
entropydude wrote: post #118

Earlier quoted context omitted.

I'm a doctor and former software programmer, so let me offer a counterpoint: I would disagree with your statement that medical people have a fatalistic passive attitude. In this case the decision is between 1) watching and waiting to see if the tumor grows and 2) acting immediately to take it out. The tumor in question is a meningioma, a relatively common tumor of the skull (meninges, to be precise) whose natural beh…

I understand your rationale for the "wait and watch" option, and agree fully with it. > "well maybe they do, but it is out of carelessness rather than a problem with there software." I think this statement precisely illustrates the point that the parent commentator has with much of the medical community. Think about what the "carelessness" of a radiologist that you're talking so flippantly about means for a family –…

Agreed, carelessness can cause serious issues. I see it sometimes but overall I would say most doctors (I in a tertiary care academic facility so obviously there is a bias) take their job quite seriously and understand the gravity of decisions they make.

It's proabably a waste of resources and time to have a 2-check method as protocol (doctors are already overworked). Often times it is present informally (radiologists/pathologists will often have their colleagus review problematic cases for agreement and neurologists and surgeons will frequently review the films)

What everyone should do is realize you can always get a second opinion and have another expert review the material.

Re: Man saves wife’s sight by 3D printing her brain tumor

#136

Post by logfromblammo »

autokad wrote: post #110
pixelcort wrote: post #108

Earlier quoted context omitted.

Couldn't this be argued of people in all professions, including software engineering? There are some who just don't care; people who just follow the process and procedure and aren't interested in the bigger picture. While I agree that technology and automation can help, in addition we should find ways to help professionals move beyond their routines.

but software engineers 'pretty much' make at most in the early 6 figures and doctors 'pretty much' start there. i'd love to give customers max 15 minutes to tell me how they want their website only to tell them this is what they are going to get because its the standard of care. why should a doctor care? they get paid weather you live or die. what happens to you basically has no bearing on their career. a doctor i kn…

They'll rue the day they purposefully restricted the available supply of skilled physicians through limitations on residency programs when those pesky technology engineers perfect the doc-in-a-box.

Even worse is when some of those guys open source it and give away the software and hardware schematics, just because they hate giving $30 co-pays and dealing with deductibles, just to get an antibiotic prescription for a viral infection.

Don't make professional problem solvers see you as a problem, or you might just get solved.

Re: Man saves wife’s sight by 3D printing her brain tumor

#137

Post by Shinkei »

tomohawk wrote: post #124
Shinkei wrote: post #114

Earlier quoted context omitted.

Patients should be informed and the process should be open and honest. And also, any physician who would balk at a 2nd opinion is not confident in his or her own course of action. That said, it's very easy to get caught up in a situation that is over your head: http://en.wikipedia.org/wiki/Dunning%E2%80%93Kruger_effect I can tell you that it took 3 years of medical school (not to mention my heavy science undergrad) t…

I completely agree that finding the "right" doctor can be very difficult. The large academic hospitals are often a good bet, but there are also, depending on what ails you, specialist hospitals that can be much better, as they tend to see many more of the specific case. You may very well be sent to the resident expert at that hospital, but that expert may be far from expert when compared to other facilities. In one c…

Yes, specialty hospital seems to be a great model. Atul Gawande talks a lot about this type of practice in his "Complications" book; a great read if you haven't seen it.

Re: Man saves wife’s sight by 3D printing her brain tumor

#138

Post by chadillac »

AceJohnny2 wrote: post #87
tsax wrote: post #70

Earlier quoted context omitted.

I come from a long line of docs, though I'm a software dev. Let me tell you that the vast majority of patients can easily be sorted into these pre-formed category bins. Rare conditions are rare by definition. Most of medicine is dreary repetition.

This ought to be highlighted, before people start an echo chamber of "doctor's don't know what they're doing!" that ultimately undermines everyone (guess what argument the anti-vaxxers use). A string of anecdotes of "I double-checked and it turned out the doctor was wrong" remains less than a trickle compared to the flood of patients doctors have to deal with, and a tiny fraction of the hypochondriacs they must deal…

This highlights the importance of a second and third opinion as well.

As the joke goes, "what do you call the guy that graduated last in his class at medical school? Doctor."

Doctor's aren't machines, they're more like mechanics, they see a symptom, use their knowledge to make an educated guess essentially, and then work from there. If their knowledge is soft it's likely an incorrect diagnoses could just be exacerbated by incorrect treatment.

Get another opinion, and then another, the next problem is deciding on siding with consensus or outlier.

Re: Man saves wife’s sight by 3D printing her brain tumor

#139

Post by stcredzero »

> Scott’s recent thyroid surgery had taught them that getting the best care requires being proactive and extremely well informed.

So, if you go to a manufacturer or a printer, and you can just leave your order and be assured you'll get excellent service, this has tremendous value. This is first rate service. It saves your mental energy and it might even save you money in the long term. Now, if you go to a manufacturer or a printer, and you know that you have to be informed and stay on top of them, you should know that you are getting crappy service. At the very least, you should be getting a discount of some kind for the hassle.

Healthcare in the US often means paying a lot for crappy service. It's even worse than dealing with mediocre manufacturers or printers, because of market distortions and lack of transparency in the system.

If anyone wants to help this doctor out with spreading the above message, this might be a way to show off your chops as a web designer or a marketer. He's local to the bay area and his website is here: http://www.truecostofhealthcare.org/

(Disclosure: He's my former PCP)

EDIT: On the other hand, it is a credit to the doctors involved, that they welcomed the husband's input and expertise.

Re: Man saves wife’s sight by 3D printing her brain tumor

#140

Post by drdeadringer »

jpmattia wrote: post #15

> Balzer used Photoshop to layer the new DICOM files on top of the old images, and realized that the tumor hadn’t grown at all — the radiologist had just measured from a different point on the image. Think about the some of the implications of that statement for a while. It really is no wonder that the softer sciences have a reproducibility problem.

> the radiologist had just measured from a different point on the image.

I had a similar experience when I was having a spinal curvature corrected. After a particular xray, several people -- a couple doctors, the xray guy, a med student or two, a mix of a couple people like this -- had measured my spine's then-current curvature and had come up with a huge range; to one, I had gotten worse... to another, I had some improvement... to the third, marginally the same with a smudge of improvement.

In the end I got the most improvement I was going to get given my specific situation and I'm happy for//with that. The point is, it was literally three measurements on the same xray from which three mutually exclusive conclusions//opinions were [literally?] drawn.

I'm therefore not surprised that there is similar with tumours.

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