News Column

THE PULSE: There's a new surgical procedure in town

August 19, 2014

By Courtenay Edelhart,, The Bakersfield Californian

Aug. 19--NEW DEFIBRILLATOR SURGERY: For the last three months, Phil Inglis walked around with a life vest on. Not a life jacket used for boating, but an external defibrillator designed to shock his heart back to a steady rhythm if it started beating erratically.

Such vests are generally just a temporary solution until an implantable cardioverter defibrillator, or ICD, can be surgically placed inside the body, usually in the chest or abdomen.

Those devices can and do save lives, but they aren't without risk.

On Tuesday, Inglis became the first patient in Kern County to get a new, less complication-prone ICD that the U.S. Food and Drug Administration only approved last year.

Inglis, 65, of Bakersfield, wasn't happy about having to have surgery, but he figured if he had to do it, he wanted the most cutting edge technology.

"They've been doing this on the coast for a while. Why not here?" he said while recovering at Bakersfield Memorial Hospital. "Why should we have to go out of town to have it done?"

ICDs have been used since the 1980s to treat irregular heart rhythms, heart failure and cardiac arrest, but they have pros and cons.

Internal defibrillators are battery operated. Taking one out to change a battery is nasty business because over time, scarring fuses the device to surrounding tissue.

Very young people may have to have several batteries replaced over the course of their lives, subjecting them to multiple highly invasive surgeries.

Dialysis patients present another problem. ICD wires that lead to the heart can become infected. In such instances, the heart could get infected, too.

That's a scary prospect for people already at high risk for infection because their blood is regularly exposed to machines that take over the cleaning work of failed kidneys.

Boston Scientific's Subcutaneous ICD System does not place an electrical wire in your heart, rib cage or blood vessels.

Instead, the device is surgically inserted beneath the left armpit, and a wire is tunneled under the skin in a backward L-shape that runs horizontally and then up the sternum, or breastbone.

That location away from the heart gives that vital organ less exposure to potential infection, and batteries can be replaced with a far less invasive surgery.

Another bonus is that it doesn't inhibit arm movement, as some other ICDs can.

Doctors can monitor the device using WiFi to determine if it needs a new battery or how often it has delivered an electrical shock, which only happens as needed to correct arrhythmia.

"This is a huge advancement," said Dr. Jared Salvo, the cardiac electrophysiologist who performed the surgery. "I can't emphasize enough how much of a game changer this is."

The device is not a pacemaker, however, so someone who needs ongoing, rather than sporadic, intervention wouldn't be a good candidate for it.

KHS PASSES QUALITY TEST: Kern Health Systems is one of six health plans in California that met the acceptable performance level in all six quality indicators during HEDIS 2013.

Healthcare Effectiveness Data and Information Set, or HEDIS, is a tool used by more than 90 percent of America's health plans to measure care and performance. It is administered by the National Committee for Quality Assurance, a private nonprofit organization dedicated to improving health care quality.

All Medi-Cal managed care health plans must participate.

FELLAS, IT'S TIME TO STEP UP: This isn't surprising, but it's depressing.

Parents are better off having daughters if they want to be cared for in their old age, according to a new Princeton University study that suggests women provide as much elderly parent care as they can, while men contribute as little as possible.

"Whereas the amount of elderly parent care daughters provide is associated with constraints they face, such as employment or childcare, sons' caregiving is associated only with the presence or absence of other helpers, such as sisters or a parent's spouse," said study author Angelina Grigoryeva, a doctoral candidate in sociology at Princeton University, in a statement issued Tuesday.

According to the study, daughters provide an average of 12.3 hours of elderly parent care per month as compared to sons' 5.6 hours.

"In other words, daughters spend twice as much time, or almost seven more hours each month, providing care to elderly parents than sons," said Grigoryeva, who will present her research at the 109th Annual Meeting of the American Sociological Association.

The study also indicates that in the division of elderly parent care among siblings in mixed-sex sibling groups, gender is the single most important factor in the amount of assistance each sibling provides.

Grigoryeva's paper relies on data from the 2004 wave of the University of Michigan Health and Retirement Study, a longitudinal panel study that surveys a nationally representative sample of more than 26,000 Americans over the age of 50 every two years.

WHAT YOU'RE SAYING ON SOCIAL MEDIA: Here's the latest buzz from The Californian's social media platforms:

Reacting to news that the death of Robin Williams had boosted calls to suicide prevention hotlines: Emily Shapiro, Facebook: "It is my hope that people suffering from depression and other forms of mental illness will finally get the treatment that they need. If we as a nation open our hearts, minds and ears to them, then the rate of suicide might diminish and that is a great thing indeed."

Comment at /TBCHealth or tweet at us: @TBCHealth.


(c)2014 The Bakersfield Californian (Bakersfield, Calif.)

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Source: Bakersfield Californian, The (CA)

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