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Mon Nov 20 21:32:17 GMT 2006

>From: "Bjorn, Pret" <pbjorn at emh.org>
>Reply-To: "Trauma &amp; Critical Care mailing list" 
><trauma-list at trauma.org>
>To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
>Subject: RE: Interesting Promotion of Steroids for SCI
>Date: Mon, 20 Nov 2006 16:07:29 -0500
>
>Hey, you just leave Suzanne Somers OUT OF THIS!
>
>Pret

There is an NEJM letter from some years back about a repetitive motion 
syndrome variously called "Suzanne Somers Synovitis" or "Thigh Trimmer 
Tendinitis". After MRI and other imaging revealed no pathology explaining 
the patient's lower extremity pain, the treatment team boldly took a 
history. The patient had been thigh-trimming for several hours daily.

>
>-----Original Message-----
>From: trauma-list-bounces at trauma.org
>[mailto:trauma-list-bounces at trauma.org] On Behalf Of Ronald Gross
>Sent: Monday, November 20, 2006 3:18 PM
>To: 'Trauma &amp; Critical Care mailing list'
>Subject: RE: Interesting Promotion of Steroids for SCI
>
>Here is a thought - I bet this guy is a medical school colleague of the
>wonderful medical expert named Suzanne Somers........
>
>HMMMMMMMMM.............
>
> >>> "Robert Smith" <rfsmithmd at comcast.net> 11/20/2006 2:43 PM >>>
>Andrew,
>
>Your post made me curious enough to Google Dr. Young, as you probably
>did.
>The parts of his CV available on the internet are a little confusing to
>me
>as it appears he finished medical school in one year. As far as I can
>tell
>he did two years of training after receiving his MD. So again as far as
>I
>can tell he has not practiced as a neurosurgeon and does not seem to
>be
>actively involved in the clinical care of spinal cord injury patients.
>A pub
>med search lists 11 citations for him. He is not the lead author on any
>SCI
>research in that search. He does have other citations on other sites.
>For
>instance he is listed as the 12th author on a study with Bracken in
>2000 JOT
>about controversies in methylprednisolone and SCI. As I don't know Dr.
>Young
>and am not familiar with his work, all this could be wrong.
>
>The only reason I sought information about Dr. Young was because the
>forceful nature of the comments attributed to him in your post made me
>curious about "where he was coming from". From my association with
>practitioners in both acute and rehab, I know that everyone wishes
>desperately for something that will give the families and patients
>some
>degree of hope. But sometimes there isn't any and false hope is worse
>that
>none. If I were a family member of an acute SCI pt. and read those
>comments,
>I might be very angry if high dose steroids were not given to my loved
>one.
>As a more informed clinician I might be very glad and respectful of
>the
>thoughtful care if they were withheld.
>
>Rob Smith
>
>Robert F. Smith, MD, MPH
>Attending (Vol), Dept. of Trauma
>John H. Stroger Jr Hospital of Cook County
>Associate Professor of Emergency Medicine, Rush University
>
>-----Original Message-----
>From: trauma-list-bounces at trauma.org
>[mailto:trauma-list-bounces at trauma.org]
>On Behalf Of Andrew J Bowman
>Sent: Monday, November 20, 2006 11:24 AM
>To: Trauma List
>Subject: Interesting Promotion of Steroids for SCI
>
>Found this while trolling the net.
>Very strong sounding advocate for steroids in SCI.
>Andrew
>
>Acute Spinal Cord Injury
>
>
>14 April 2003
>
>
>Wise Young, Ph.D., M.D.
>
>W. M. Keck Center for Collaborative Neuroscience
>
>Rutgers University, Piscataway, New Jersey 08540-8082
>
>Email:  wisey at pipeline.com, http://sciwire.com
>
>
>
>I receive many calls and emails from people and families with spinal
>cord
>injury.  It is better today compared to 1977 when I took care of my
>first
>spinal-injured patient and had to tell the family that there was
>nothing
>that we could do.  Here is what I say to families now.
>
>
>.  Focus on solvable problems.  Make sure that methylprednisolone is
>given
>within 8 hours after injury (this drug may improve recovery by 20%).
>Find
>the best and most experienced surgeon.  If the spinal cord is
>compressed,
>make sure that it is decompressed as soon as possible.  Prevent
>complications by insisting on aggressive care of lung, bladder, and
>skin.
>Start rehabilitation as soon as possible.
>
>
>.  Recovery is the rule and not the exception in spinal cord injury.
>Most
>people recover some function after spinal cord injury.  On average,
>people
>with "complete" injuries recover 8% of the function they had lost,
>compared
>to 21% if they received methylprednisolone.  People with "incomplete"
>injuries recover 59% of lost function, compared to 75% if they
>received
>methylprednisolone.  Recovery takes a long time and work.  Many people
>recover function for 2 or more years after spinal cord injury.
>
>
>.  Do not give up hope.  Most scientists believe that it is not a
>matter if
>but a matter of when therapies will be available to restore function
>in
>spinal cord injury.  Clinical trials are testing therapies to restore
>function after injury.  Weigh potential risks and benefits carefully
>before
>participating in such trials.  Remember that the therapies will get
>better
>over time.
>
>
>What to ask your doctor?
>
>
>Families and friends often don't even know what questions to ask the
>doctors.  Here are some questions to ask in the first hours after
>injury:
>
>
>.  Was methylprednisolone given?  This is the high-dose steroid (30
>mg/kg
>intravenous bolus followed by 5.4 mg/kg/hour for 23 hours if it is
>started
>within 3 hours and for 47 hours if between 3 to 8 hours after injury).
>It
>should not be started more than 8 hours after injury.  Clinical trials
>have
>shown that this treatment improves recovery by about 20% when given
>within 8
>hours after injury but does not help when started more than 8 hours
>after
>injury.  While methylprednisolone is not a cure, every little bit
>helps.
>Complications are minimal.
>
>
>.  What is the level and severity of spinal cord injury?  The
>consequences
>of spinal cord injury depend on the level and severity of injury.
>Surgeons
>determine injury levels from the fracture site on the spinal column.
>This
>may differ from neurological level determined from sensory and motor
>loss.
>Spinal cord injury causes loss of sensation and voluntary movement
>below the
>injury site.  If the person has motor or sensory function below the
>injury
>level at the time of admission, the likelihood of substantial recovery
>is
>high.
>
>.  Has the spinal cord been decompressed?   The spinal cord injury
>usually
>results from fracture of vertebral bones that compress the spinal
>cord.
>Continued spinal cord compression increases tissue damage and reduces
>functional recovery.  If the neck or cervical segments are fractured,
>traction may straighten out and decompress the vertebral column.  Chest
>or
>thoracic fractures cannot be decompressed by traction.  Surgery may be
>necessary to decompress and stabilize the spinal cord.
>
>
>.  Has anticoagulation been started?  Blood clots may form in the legs
>and
>migrate to the lungs.  This is a serious complication that can be
>prevented
>by giving anticoagulants such as heparin or coumadin.  It may be
>necessary
>to place a filter (Greenfield filter) in the vein to the heart to
>catch
>clots.
>
>
>.  Pulmonary, bladder, and skin care?   Spinal cord injury may
>compromise
>breathing and coughing.  After cervical spinal cord injury, artificial
>respiration may be necessary and pneumonia is common.  Spinal cord
>injury
>paralyzes the bladder and a catheter must be placed in the bladder to
>drain
>urine.  Continued pressure causes skin sores called decubiti.
>Cushioning
>vulnerable areas and regular turning prevents this.
>
>Some frequently asked questions and answers
>
>Families and friends often search the Internet and encounter a
>bewildering
>array of information that is often out of date and contradictory. Here
>are
>some commonly asked questions and quick answers:
>
>
>.  Will he/she recover?  Recovery is the rule and not the exception
>after
>spinal cord injury.  The probability of recovery is high, especially
>after
>"incomplete" spinal cord injury.  Clinical trial data indicate that if
>a
>person had even slight sensation or movement below the injury site
>shortly
>after injury, they will recover an average of 59% of the function they
>lost
>and, if they receive high-dose methylprednisolone, they will recover
>an
>average of 75% of what they had lost.  People admitted to hospital with
>no
>motor or sensory function below the injury site recover an average of
>8% of
>the function they had lost but will recover an average of 21% if they
>received methylprednisolone.
>
>
>.  How long will recovery take?   Recovery takes a long time.  Most
>recovery
>occur within 6 months but many people continue to recover function for
>a
>year or more.  A recent poll of the CareCure Community suggests that
>61%
>recovered function more than one year after injury.  In another poll,
>16-18%
>of people who are "complete" spinal cord injury recovered additional
>function 3 or more years after injury.  A recent study detailed how
>Christopher Reeve recover function over 7 years after his injury.  So,
>recovery frequently continues for years after injury.
>
>
>.  What experimental clinical therapies are available?  Several
>clinical
>trials are assessing therapies that are applied within 2 weeks after
>injury.
>These include activated macrophages (which may help repair the injured
>cord), alternating currents (to stimulate regeneration), and AIT-082 (a
>drug
>that may stimulate growth factors and stem cell proliferation).  The
>macrophage trial is limited to people with "complete" thoracic spinal
>cord
>injury and requires surgery.  Please consider the risk and benefits of
>the
>trial carefully, including the risk of moving somebody to another
>center.
>
>
>.  Do therapies have to be applied shortly after injury?  Several
>experimental therapies are aimed at restoring function in chronic
>spinal
>cord injury, when recovery has stabilized a year or more after injury.
>These include 4-aminopyridine (a drug that increases excitability of
>demyelinated axons), porcine fetal stem cell transplants (stem cells
>from
>pigs), and olfactory ensheathing glial transplants (cells from the
>nasal
>mucosa or from olfactory bulbs).  Other experimental therapies are
>being
>planned, including drugs and chemicals that block growth inhibitors.
>Thus,
>there will be many opportunities to participate in clinical trials.
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Interesting Promotion of Steroids for SCI