Paraquat and Parkinson's DiseaseIt sounds like an exotic fruit, or perhaps a cute little pet name, but touching or eating paraquat dichloride (paraquat) can result in nasty consequences. This toxic substance has a significant history, but more recently, has been linked to Parkinson’s disease. As a result, the herbicide has been subject to litigation. In this blog post, we’ll take a look at paraquat and the emerging lawsuits.

What Is Paraquat?

Historically, paraquat has had two main uses. First, and sadly, it’s been an effective way of committing suicide. Ingesting just one sip could result in death. In fact, when South Korea banned the herbicide in 2011, its overall suicide rate fell 10% and its suicide rate by herbicide or fungicide dropped by more than 46%.

Retired Army Ranger Chet Sechrest and I continue our conversation on the potential for hearing damage in the military, the crucial need for proper hearing protection, and 3M Earplugs:

image-300x200Clay: So Chet as a medic you would supervise and train soldiers in the proper use of hearing protection? But you also said the Army beat into your heads the importance of protecting your hearing in whatever you were doing in the field?

Chet: Absolutely. In fact, for a long time, they had the annual hearing exam requirement. And it was like a pre-deployment requirement, you couldn’t deploy unless you had your hearing exam for that year. So the command was interested in tracking, hearing issues, to make sure that you know, not everybody’s going to go deaf. Does that make sense?

3M Earplugs and Hearing LossYou likely know there is massive litigation emerging around 3M Company’s Combat Arms, dual-sided earplugs. These 3M Earplugs were sold to the U.S. government and distributed to members of the military in a huge contract over a period of 12 or 13 years. And many lawsuits have been filed recently that allege that these 3M Earplugs were defective, and they left thousands and thousands of soldiers with permanent hearing loss or tinnitus. It’s called noise-induced hearing damage. So my friend Chet Sechrest will talk about the unique ways that soldiers are exposed to loud noises. And it’s not always what you think; it’s not simply shooting a rifle or getting trained and the use of weapons or rifles, but also it could be serving as a mechanic for heavy engines, or being exposed to loud tanks or other industrial equipment. And as Chet points out, it could also simply be taking rides on very loud helicopters over and over again without the proper hearing protection. But that’s enough of an introduction. Let’s get to my Q&A with Chet Sechrest.

Clay: Chet was an Army Ranger and a member of Special Forces. He pulled three tours of duty in Iraq. So Chet, how long did you serve in the military?

Chet: I served a total of 27 years and nine months in the military.

iStock-518657244-300x286After news broke that Zantac (the brand name for ranitidine) was linked to cancer, a large wave of lawsuits started making their way into state and federal courts. Many of these cases have been consolidated into the Zantac multi-district litigation, or MDL 2924.

The Zantac MDL is still in the early stages of litigation, but the court just handed down two major decisions that could dramatically undermine a majority of the cases and claims.

We’ll go over these two decisions, but before we do, we need to provide a little context. We’ll start with outlining the defendants and claims in the Zantac MDL, then discuss a legal concept called “preemption.”

Elmiron and Pigmentary MaculopathyElmiron is a drug used to treat interstitial cystitis. Most of you don’t know what interstitial cystitis is, and that’s a good thing. Unless you are a urologist, you wouldn’t have reason to know about the condition . . . unless you suffer from it. But if you suffer from interstitial cystitis, you probably know a lot about it. In this post I am going to describe the condition, then discuss Elmiron, the only FDA-approved drug to treat the condition, and finally highlight the latest studies indicating that Elmiron may cause pigmentary maculopathy, which can cause vision loss or even blindness.

Interstitial Cystitis

iStock-636100698-300x200Interstitial cystitis is a painful bladder condition. Interstitial means situated within but not restricted to one organ or tissue, especially fibrous tissue. Cystitis means an inflammation of the urinary bladder. Urinary tract infection is one example of cystitis. Interstitial cystitis causes the walls of the bladder to become irritated or inflamed. This leads to bladder pressure, bladder pain, and pelvic pain. Interstitial cystitis is one of several conditions labelled painful bladder syndrome.

Firefighter using AFFF foamFirefighters have a host of tools available to them to fight fires. Some of these are simple, like high-pressure water. Others are more state-of-the-art, like forward-looking infrared handheld cameras and aerial drones. One of the special tools in a firefighter’s arsenal is aqueous film-forming foam, or AFFF. This “fire foam” has served as a highly effective fire suppressant for about half a century. Unfortunately, exposure to this substance has been linked to serious health problems, including cancer.

Let’s take a closer look at AFFF, its relationship to cancer and what it means for those who might have been exposed.

What Is AFFF?

Today I finish my conversation with Physical Therapist Amy Dougherty on specific problems that may arise with metal-on-metal artificial hip failures:

Clay: Over the past ten years you have seen a lot of metal-on-metal hip implants. Several years ago an attempt was made to put a metal-on-metal artificial hip together, and that was supposed to last forever, or last a whole lot longer, and it turned out that it was problematic. And I know you have had many patients who have had that [implant]. What did you see out of the metal-on-metal hip implants when they were failing?

Physical therapist assisting patient after hip replacement surgery.Amy: Again, the first cardinal sign that I saw was chronic pain, an inability to weight bear normally through that joint. So even after normal hip replacement, the patient should be able to weight bear through it. It should not feel like they collapse on that hip, and so a limp that never resolves or an inability to get away from an assistive device. So, I had a patient in her 50s that could not get off a walker. She was 50. She was playing tennis five days a week before she had her hip replaced. Yes, with the metal-on-metal she suffered metallosis and she had an overt failure of that joint replacement. She was a candidate for this new [metal-on-metal implant], now widely known to be a bad device, because she was so young, active, fit, and healthy. It was supposed to last for longer. It was supposed to allow her to have more function larger range of motion, less risk of dislocation and all of those things. So as we know, that did not really work out so well.

Let’s dive back in to my hip replacement surgery conversation with Physical Therapist Amy Dougherty, who discusses what sports to avoid after hip surgery and what it feels like when a person suffer an artificial hip failure:

Safe and Unsafe Activities and Sports

Clay: What are some sports that you would discourage [after hip replacement surgery]? I know there is a huge range of results and people who are dealing with certain physical issues. But are there any sports you’ve seen as a physical therapist that you say “Do not do this after hip replacement surgery?”

Physical therapist helps patient recover from artificial hip surgery
My friend Amy Dougherty is a physical therapist in North Carolina and operates Outer Banks Physical Therapy. She is a graduate of the University of North Carolina at Chapel Hill (where I also attended college and law school). She is an outstanding physical therapist and is beloved by her patients on the Outer Banks. Amy answers many of your questions about hip replacement surgery, metal-on-metal artificial hips, and the problems that have arisen from these hip products.

Clay: I want to focus on hip replacement surgery and I know you work with patients who are dealing with that kind of surgery every week. So let me start by asking what are a few reasons a person might need a hip replacement surgery?

Amy: You know, the most common reason is arthritic changes in the hip. So basically arthritis, that is the most common reason. Other reasons can include things like trauma. Some people have congenital mal-alignments where, it is basically called dysplasia where through the process of their development in utero and then following their bony surfaces of the femur, that is the long thigh bone and the acetabulum which is in the pelvis. They do not form correctly, so they might have ill-formed femoral heads. They might have ill-formed or ill-shaped acetabulum. So, the ball and the socket are not really designed well to weight bear. So, a lot of folks that, especially in a young population, that have early onset hip replacements. It is more likely the result of some type of congenital dysplasia. It could be a trauma. So, but arthritic changes is the number one reason and I have total hip replacement patients in my clinic every day. Very popular surgery, yes.

Patient's medical records and personal injury cases
Health care is an industry that, for the most part, is pretty quick to make the most of new technology. One such area is medical records.

With the increased capabilities and reduced costs of computers, networks and electronic storage, electronic health records (EHR) are primed to take full advantage of what information technology has to offer the medical field. These advantages can include better cost efficiency and improved patient care.

That’s one reason why Congress passed the Health Information Technology for Economic and Clinical Health Act (HITECH Act). This law set out to promote the use and adoption of EHR and medical information technology.

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