A Medical Student Blog

Unofficial thoughts on medicine and medical school

Fish Oil Saves Babies

 Dear All, 

If I had to pick one nutrient to tell you about, I’d probably start with fish oil and omega-3 fatty acids: get yourself a good bottle, or eat some flaxseeds, or wild deep sea fish!  Now.

But before I go on, you should know that I’m heavily biased.  Right now, I’m in a pediatric surgery lab at the Children’s Hospital of Boston, and the team here has seen firsthand how fish oil can save babies with short gut.  Plus, Dr. Bruce Bistrian, an esteemed professor of medicine and clinical nutrition, has been very kind to take about three hours explaining to me how fish oil works biochemically.  So, I guess you could expect that I’d be excited about fish oil.   But I am also aware that when people get excited, they can get incredibly carried away, like some authors of “superfoods” or “miraculous detox” books that you bump into at a bookstore. 

That said,  special things do happen, and I wanted to tell you a short story about it.  But I hope I don’t get carried away, and I hope can be objective…  

Prior to 2005, children with short gut, or more formally, “short bowel syndrome,” had a very difficult life.  Many of them couldn’t eat because their guts were too short, due to birth defects or injury.   Because their intestines weren’t functioning, nutrients had to be given intravenously through a process called “parenteral nutrition.”  Everyday, the children had to live with needles stuck into their veins in order to receive liquidized food formula – it was highly unpleasant.

The hope was that, while on parenteral nutrition, the babies’ guts could get healthy enough to start absorbing food.   Ever so often, however, the gut just never recovered, at which point the baby would have to rely on parenteral nutrition for an indefinite period of time.

When that happens, the outlook immediately dims.  Patients on long-term parenteral nutrition often develop serious liver problems that lead to death from liver failure.  The only option at that point would be a liver transplant.  It’s an option, but not a cure, and waiting on the transplantation list can be excruciating for parents.  If the babies did not get the transplant, they would die; this was the conventional wisdom for decades. 

But when 2005 came around, a medical team here in Boston with an inclination for fish decided they were going to give babies none other than…fish oil.  You might be wondering, where in the world did they get that idea?  And if it’s such a great idea, why did it take so long to figure out?  The team did previously test the idea on mouse models, which showed promise.  But perhaps more importantly, when faced with an emergency, you find new avenues of inspiration? 

I’m not sure what was the catalyst, but what I do know was that the fish oil worked.  Once the medical team started pumping omega-3 fatty acids into the babies’ veins, their livers started to heal — so much so that even extremely ill patients who were waiting for liver transplantations no longer needed transplants! 

All of the above that I said is true, and, at least for me, it’s exciting to learn about.  But I did want to take a step back and point out that more research needs to be done — randomized controlled trials, larger studies.  And I think it’s important to point out that patients with short gut — even if they are on fish oil and are doing much better than anyone could ever expect — still have to fight courageously.  Their families still have to be very supportive, and sadly, some patients, regardless of their omega-3 fatty acid status, will pass away from other health complications related to their short gut problems.  

Nevertheless, things are encouraging.  It’s not often that you’ll find a serious article, published in a serious medical journal, begin with the word “reversal” when describing the effectiveness of a treatment.  Typically, treatments don’t “reverse” disease.  They “ameliorate,” or “improve outcomes.”  Editors are usually careful to save lofty words for only the most dramatic encounters.   In this case, when it came time to submit the report of fish oil for publication, this was the title: “reversal of parenteral nutrition–associated liver disease.” 

And without any changes, the editors accepted it.

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August 8, 2007 Posted by | Health news, Nutrition | , , , , , , | 4 Comments

Surgical Errors Part I: Leaving Tools Inside the Patient’s Body (by accident)

        Dear All,                                                          4/3/07 

I went to a talk by Dr. Atul Gawande, a surgeon, author and professor at Harvard.   For those of you who have never heard of him, he’s a young, up-and-coming rock star in the medical world.  (He’s in his early 40’s, which by surgeon standards, is young). 

I think we are intrigued because he’s intelligent, well-spoken, friendly, handsome and has a shock full of black hair (most surgeons are either bald or graying by forty).   Med student guys want to be like him, med student ladies want to marry him.  Well, something like that…

And then the writers admire him too for his eloquence — he was a finalist for the National Book Award.  Today, he was here to promote his new book, Better, which is on medical performance and errors.  After his lecture, there was a huge line of eager students waiting to get their copy of Better signed.  I felt like such a groupie as I waited in line to ask him a few questions about one of his papers called “Risk factors for retained instruments and sponges after surgery,” published in the New England Journal of Medicine (NEJM 2003 Jan 16;348(3):229-35).  

In this study, his team looked at several hundred cases of surgeries and tried to figure out how in the world doctors could do something as “stupid” as leave a sponge in a patient’s body.  It’s one of those things that you probably have heard about and would make you shake your head in disbelief.  I wanted to post a Youtube video on this topic, but because of the potential explosiveness of the issue (i.e., I didn’t want to my surgical professors to fail me for getting it wrong) I thought it best to double-check.

Dr. Gawande was gracious, answering my questions while signing books at the same time.  He pointed out, “it’s not for lack of trying.”  The surgical team hand counts the instruments and double-check, triple-check all the time to avoid this error, and it doesn’t happen often.  But the problem is that, when it happens, the consequences can be life-threatening.  Plus, the surgeons who do so feel terrible and the media makes them look–well, stupid.

The point that progressive healthcare policy experts — such as Dr. Gawande and Dr. Don Berwick — are trying to make is that, often, the error is not caused by ‘stupidity’ and ‘clumsiness.’  Instead, it’s the problem of the structure of the healthcare delivery system.  Perhaps, doctors are overworked, hospitals understaffed, budgets are cut (to name a few possible reasons).  Nobody tries to be clumsy — most doctors are trying their hardest not to be.  The solution ought not to be blame, but rather to find out why the errors are happening.  Often, the answers are simple (and that’s why I hope to post up a lot of them in this blog, so that you can share with your family and friends easy, but powerful tips).

Dr. Gawande points out three risk factors that can explain in large part why doctors leave tools in the patient’s body.  The first one is if the patient is obese — it can be tricky to perform surgery on someone who has a high body mass index.  The second is when there is an emergency procedure that needs to be done — as you can imagine from the frantic scenes you’ve seen on ER, it’s tough to keep track of everything.  The last factor is when there is a change in the surgical procedure; for example, if the surgeons originally thought they were going in to remove the appendix but found a surprising cancer instead. 

The solution to prevent tools getting left inside the body is simple: take an X-ray before the patient wakes up from recovery — if there’s anything left in the body, you just quickly take it out before it causes any harm.  It’s simple, almost common-sensical — but unfortunately, not enough surgical teams are making it common practice.

So please keep this in mind if you or your family friend needs surgery.  And if your doctor has any questions, you can pull up Dr. Gawande’s article and show it to them – if you need a copy e-mail me and I can help you find one.

Best wishes!

April 26, 2007 Posted by | Health news, Surgery | , , , | 8 Comments