Does Standards of Medical Practice Change for a King? (2)
Continuing with the discussion of VIP medical treatment (Very Important Person medical treatment primarily affected by the importance of the person), based on my clinical knowledge and experience, I can devise a simple scenario that might easily explain the medical predicament that Mr. Sharon's physicians and family now face. I see two factors involved and perhaps both apply.
1) Would it be reasonable to assume that, in response to the thrombotic (? or embolic) CVA in a man with great social importance and responsibility and the great need not to be again incapacitated,his physicians began him on a very energetic anti-coagulation therapy, perhaps 2 or more drugs started together without careful and more prolonged monitoring of the effects of the individual pharmacologic agents?
2) Mr. Sharon, after the ischemic event, felt well and because of his personal strong will and need to resume his governmental and political functions, was not as willing as some other person to remain under careful daily anti-coagulation monitoring, couldn't find time for the necessary venipunctures and, of course, his physicians may have been psychologically oriented or pressured by Sharon's colleagues not to interfere with the "strong man". And so.. the consequence: massive cerebral hemorrhage due to inappropriate anti-coagulation program and/or inadequate monitoring of the anti-coagulation.
The scenario could be as simple as that and behind the whole story was the VIP medical treatment. Again, I must make this disclaimer--this is only a reasonable possible scenario since obviously I don't know the clinical facts.
Will we ever know if this is what happened? If we will and the scenario is correct, this should add more weight against the practice of VIP medical management that to me seems, generally, not at all beneficent to the patient. ..Maurice.
posted by Maurice Bernstein, M.D. @ 9:26:00 AM
2 comments
2 Comments:
He was on a blood thinner (low molecular weight heparin)that does not usually need to have its activity measured, unlike coumadin.
Did he have to be on a blood thinner at all? If he had had another ischemic stroke while off blood thinners I am sure every one would be condemning his doctors for not giving it.
If he was receiving a low molecular weight heparin, you are correct that partial throboplastin time or clotting time does not need to be followed as it is with regular heparin. The therapeutic dose, however, can be based on the patient's weight and in someone of very low weight or overweight monitoring is necessary until the proper dose is established. Also in additon to blood counts, platelet counts need to be done to exclude occasional thromocytopoenia due to the heparin which can cause bleeding.
We don't know if the heparin was his only anti-coagulant administered. If there was no absolute contraindication, not to give an anti-coagulent to someone suffering an initial thrombotic or embolic symptomatic stroke would be considered bad medical practice.
..Maurice.
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