Sound Medicine -- April 19, 2003

Hosts Diane Willis and Dr. Steve Bogdewic talk to physicians and researchers about:

End-of-life care

Kidney stone research

End-of-life care

The goal of medicine is to save lives, so when a patient's death does become imminent, medical personnel can find it difficult to compassionately address his needs. Palliative care is the name for treatment some hospitals can provide dying patients, and it's a growing specialty in American medicine. We learn more from Dr. Gregory Gramelspacher, director of the Palliative Care Program for Wishard Health Services in Indianapolis. He is also associate professor of medicine at the Indiana University School of Medicine.

Dr. Gramelspacher says that although Americans overwhelmingly express the desire to die at home, only 10% to 15% of us actually do. In discussing in-home care, Dr. Gramelspacher makes the distinction between hospice care, which is bedside nursing, and palliative care, which comprises a team of physicians, nurses, and perhaps a chaplain and a social worker. It is for patients with advanced, incurable disease and focuses on the quality of life, including pain relief and spiritual care.

Palliative care, already common in Europe and Canada, is an emerging physician specialty in the U.S. Skills include managing chronic symptoms and working with a team of medical and community professionals. Actually finding such care depends on its availability at local hospitals (limited in the Midwest) and on one's insurance coverage.

Dr. Gramelspacher explains his interest in the field and his belief that even in the case of terminal illness, there is always something more we can do to benefit the patient.

Resources:

For those researching palliative care options, Dr. Gramelspacher advises checking the National Hospice and Palliative Care Organization and the Indiana Hospice and Palliative Care Organization.

Other advocacy groups Dr. Gramelspacher recommends include Americans for Better Care of the Dying, Growth House, and Last Acts.

Bill Moyers hosted a television program several years ago called On Our Own Terms that dealt with end-of-life issues.

Also read Dr. Gramelspacher's article on the dying poor published by the American Medical Association (June 2001).

 

Kidney stone research

In 1940 a physician named Alexander Randall published an hypothesis about the origin of kidney stones, but lack of imaging equipment prevented him from proving it conclusively. Now, more than sixty years later, researchers at Indiana University, Clarian Health Partners and the University of Chicago have published a paper confirming Dr. Randall's theory, changing the direction of much kidney-stone research. Our guest is Andrew Evan, PhD, professor of anatomy and cell biology at the IU School of Medicine and co-investigator of the study.

Dr. Evan says that for 30 or more years, kidney researchers have subscribed to the theory that all stones begin as crystals within the kidney and are deposited into the many hose-like structures called nephrons. It was unclear how large crystals passed through the tiny nephron, however. In contrast, the theory posited by Dr. Randall in the 1930's said that stone formation was not a nephron event but something that occurred in the surrounding kidney tissue, in a gel-like area where water and sodium concentrate, and where calcium and phosphate are handled -- and it is these internal sites of crystals that will break through the cells lining the renal papilla to become exposed to the urine where a large stone can form. Dr. Evan reports that kidney stones are often found still attached to this area in kidney, the renal papilla.

Dr. Evan says it takes 7 to 10 years for a kidney stone to become a clinical problem, and may even be as small as two millimeters. Between 5% and 10% of the American population suffers from kidney stones, a number that's increased over time in industrial world. It's unclear why, says Evan, but researchers theorize we consume more protein and salt, and we don't drink enough fluids. It's also an hereditary condition. Treatment consists of drugs to inhibit stone growth and increase fluids up to 2 liters per day -- as well as to reduce the amount of protein and sodium in the diet.

Resources:

The article Dr. Evan refers to is called "Randall's Plaque of patients with nephrolithiasis begins in basement membranes of thin loops of Henle." Journal of Clinical Investigation, March 1, 2003. Co-investigators are Dr. James E. Lingeman, from the Methodist Hospital Institute for Kidney Stone Disease in Indianapolis, and Dr. Fredric L. Coe, professor of medicine and physiology at the University of Chicago. Also read a summary of the report from the IUSM news desk.

The original article by Dr. Alexander Randall is: "The origin and growth of renal calculi, in Annuals of Surgery, 1937, volume 105, pages 1009-1027.

Dr. Evan also researches treatment of kidney stones with shockwave lithotripsy technology. Visit the IUSM Lithotripsy Web site.

Is there a medical topic you'd like us to cover? Reach us by email: soundmed@iu.edu
or by phone:
(317) 274-4848.

When a person who has agreed to donate their organs and tissue is declared brain-dead, doctors have to act very quickly to recover the organs for transplantation. Some have to be harvested while the heart is still beating. Which of the following organs or tissue need NOT be harvested while the heart is still beating?

A. Lungs
B. Pancreas
C. Cornea

Find out!

Recently, SARS was added to the list of diseases for which health authorities could involuntarily quarantine Americans. The last large-scale quarantine in the United States took place in 1917-18 during the Spanish flu pandemic, though small-scale quarantines have taken place routinely. When and how did the idea of quarantine come into being?

Find out!

Two major scientific milestones are being celebrated in April: the completion of the human genome sequencing project and the 50th anniversary of the discovery of the DNA double helix. The National Human Genome Research Institute announced the completion of the genome project at a news conference earlier this week.

Several events and observances have been planned, including hands-on demonstrations and activities at science museums across the country. In Indiana, The Children's Museum of Indianapolis, the Children's Science and Technology Museum of Terre Haute and Hook's Discovery and Learning Center in Indianapolis are participating. Activities for people of all ages include DNA model-building, DNA extraction and electrophoresis, sequencing simulation, sequence analysis, and examination of genetic traits.

But that's not Indiana's only connection. James Watson of the famed Watson and (Francis) Crick team that discovered the DNA double helix received his doctorate in zoology from Indiana University in 1950. He went on to do his postdoctoral fellowship at Cambridge, where he met Crick. The Nobel Laureate is now president of Cold Spring Harbor Laboratory in Cold Spring Harbor, N.Y.