Cuba and Florida

The relationship between Floridians and Cuba is often contentious. Many fled the Caribbean nation in the late 1950s at the beginning of the Castro dictatorship.

In Haiti, I have worked with several physicians from Cuba. Health care in Cuba is delivered by physicians hired by the state and paid approximately $50 per month. Physicians are responsible for all the people living in a particular geographic area. Many of the high tech tools that we have become accustomed to in the US are lacking.

Historically, Cuba has isolated itself and continues to prohibit many basic freedoms. Cubans cannot travel nor speak freely.

A recent bill passed in the Florida legislature prohibits companies with business operations in Cuba or Syria from obtaining any state or local contracts valued at more than $1 million. The goal of this bill is to place pressure on Cuba to allow free trade or remain isolated from the rest of the world.

I am personally in favor of isolating Cuba. While it is clear that they now need the support of capitalist countries like the United States, they continue to remain communist and denounce the American way of life.

How do you feel?
Should we open further trade with Cuba?
Should we encourage Americans to spend American dollars while vacationing in a communist dictatorship?

Kidney Transplant Chain

Over 90,000 people in the United States are waiting for a kidney to become available for transplantation. While many friends and family members are willing to donate a kidney, they are often not an appropriate tissue match. A kidney transplant chain provides an alternative, lifesaving route.

The chain begins when a person is willing to donate but may not be a match for their intended recipient. The potential donor agrees to donate to a perfect stranger who may be a match in return for that recipient having a person willing to donate to someone else. This process repeats itself until the original recipient receives a kidney.

Recently, 30 people received kidneys in a chain. The chain included ex-boyfriends, former prom dates and close friends all willing to pay the steep price of admission to this special group.

The logistics for this complex chain are handled by an ex-Marine named Garet Hill through the National Kidney Registry.

Sadly, chains like this have become a necessary means of making organs available. Many Americans have not committed to becoming organ donors upon their demise. Their reasons for burying healthy organs vary, but none are based on logic, religion or science.

Many European countries consider everyone an organ donor unless they specifically "opt out" of organ donation. This has increased the number of organs available in those countries while alleviating some of the bizarre obstacles to donation.

How do you feel? Should organ donation after death be understood unless someone opts out?

Creating a Culture of Safety

I recently had an opportunity to interview Dr. Amy Ship on the Healthy Rounds radio program. Dr. Ship is a primary care internist at Beth Israel Deaconess Hospital and assistant professor at Harvard Medical School. She recently published a column in the New England Journal of Medicine that addressed the responsibility of physicians to inquire about safe habits among our patients.

Specifically Dr. Ship addresses the topic of texting while driving and other distracted driving practices. She points out that physicians already direct patients' health habits regarding smoking, diet and sexual practices safe driving should be an extension of that responsibility.

Interestingly, a recent law was passed in Florida prohibiting physicians and specifically pediatricians from asking if there are weapons in the home and if they are safely secured. This law was passed despite the rising number of gun-related injuries in children.

In conclusion, it is the responsibility of all adults, and not just physicans to work toward creating a "culture of safety" by directing the behavior of children and setting a good example.

Do you think physicians should inquire about guns in the home?
What ideas do you have toward creating a "culture of safety" in America?

Bicycle Safety

I have recently spent time in the Tampa Bay area as part of my annual spring training tour. I have been consulting for the New York Yankees for fifteen years and this year, I have also been invited up to Lakeland, Florida to discuss the early recognition and treatment of concussion with the Detroit Tigers medical staff.

While here, two bicyclists have died from injuries after being hit by motorists. A total of 15 bicyclists have died in the Tampa Bay area since July of 2010. This situation has captured my attention because it may indicate that we should expect more injuries in Connecticut this year as weather warms and gas prices soar.

I am also alarmed by the fact that despite the usual precautions of wearing a helmet, making yourself visible and remaining alert, many may still be harmed. The reason for many of these incidents is distracted driving. More drivers are now texting, or trying to make a call while operating a vehicle. In the split second that these drivers divert their attention away from the road, bicycle riders can be hit and severely injured.

The only recourse is for bicyclists to be vigilant at all times and to avoid riding in traffic when possible. If we are to encourage bicycling as an alternative means of transportation, communities must crack down on distracted drivers and create safer bike lanes for travel.

What ideas do you have for safer bicycle travel?

A Pulmonary Embolism Can Strike Anyone

Tennis champion Serena Williams was recently hospitalized for treatment of a life-threatening pulmonary embolus. While it may be surprising to hear about a world class athlete being stricken by a condition typically associated with inactivity, athletes can be particularly susceptible to this condition.

A pulmonary embolus is the result of a clot traveling through the circulatory system and lodging in the lungs. There it will obstruct blood flow to the lungs. These emboli usually originate in the veins of the lower extremities as a thrombosis.

Symptoms of a pulmonary embolus include; chest pain, shortness of breath, unexplained coughing and rapid heart rate. Each year 600,000 Americans suffer a pulmonary embolus and 60,000 of these patients will die.

Traveling long distances, dehydration, trauma, immobilization, oral contraceptive use and family history are all risk factors. Many of these factors are common among injured athletes.

Ms. Williams has recently had two surgeries for a foot injury and has been wearing an immobilizing brace. The event occurred shortly after a transcontinental flight. Fortunately, her condition was treated quickly with anti-coagulant (blood thinning) medications.

The best way to prevent pulmonary emboli is to stretch often when traveling, remain well hydrated and be aware of symptoms.

Pulmonary emboli can affect anyone, but a few simple steps can avoid serious injury.

Stroke, Migraine Or Seizure

Recently, TV news reporter Serene Branson suffered an episode of slurred, unintelligible speech and facial weakness while reporting live at the Grammy Awards. This event was a frightening demonstration of an evolving neurological process. The question was what was the process?

Many brain injuries including stroke, migraine, seizure and concussion initiate a cascade of events known as "spreading depression." These events are based on an electrical imbalance resulting in transient symptoms. In the case of stroke, the symptoms are often permanent.

Ms. Branson's symptoms were part of a condition known as migraine with aura. Stroke-like symptoms are the prodrome of a severe headache to follow within 20 to 30 minutes. These striking symptoms fortunately subsided.

Stroke symptoms of abnormal speech, facial asymmetry, and weakness on one side of the body require urgent medical attention. Although the eventual diagnosis may be more benign, any delay can increase the likelihood of permanent deficit.

Abusive Behaviors

Two recent Healthy Rounds programs dealt with the topics of domestic abuse and bullying.

Dr. John Foley, a cardiologist from Norwich, Connecticut, is a frequent lecturer on the topic of domestic violence and partner abuse. There are roughly 8.5 million incidents of intentional partner violence (IPV) each year. IPV is not restricted to adult heterosexual couples. It is often seen among dating teens and in same sex relationships. Some examples include physical injury or threats, sexual assault, psychological abuse and economic control. If you suspect someone you care about may be in an abusive relationship open a line of communication by asking if they are being abused. Although they will most likely deny it at first it is important for them to know you care and they can come to you when needed.

Dr. James O'Dea is a clinical psychologist at the William W. Backus Hospital. We recently discussed the alarming rise in school bullying. Each day approximately 150,000 young people fear going to school because of bullying. In the past, bullying consisted of verbal confrontation, physical violence or written messages. In the Internet age bullying has entered a new and much more harmful dimension. If bullying is suspected contact the child's school. Each school should have a process for dealing with bullying that involves everyone in the building including teachers, security, kitchen workers and janitorial staff.