Marion Fay Miller Feather
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New York Times
a day ago
- New York Times
In Search of a Death With Dignity
To the Editor: In 'The Perverse Economics of Assisted Suicide' (Opinion guest essay, July 27), Louise Perry argues that the driving force of medical aid in dying, or MAID, is economic. This is not the case at all. The driving force in the growth of MAID is not that governments are cynically looking to save money, but rather that people want to assert more control over the dying process. Those who want to advance MAID protocols, like me, argue consistently that patient autonomy and preferences regarding care, up to and including death, should be honored in most instances. It is true that there are profound problems with the various MAID protocols used throughout the world. The challenge is to develop best practices when legalizing MAID. What we should be concentrating on is the best way to oversee these protocols, not on trying to find spurious grounds for rejecting their application. Samuel H. LiPumaValley View, Ohio To the Editor: My mom spent the last decade of her life with ever worsening dementia, the last several of those years present in body only, incapable of communicating or attending to any of her own needs and unaware of her surroundings. I know that it was an existence she would have never chosen or wanted to endure. Assisted suicide should have a place in a civilized nation. We should recognize people's right to death with a dignity that otherwise escapes them. We do a grave disservice when we declare ourselves God, the only ones capable of deciding who lives and who dies. This is a recognition of a sovereignty over ourselves. Others do not own us. Others do not always know better. Life is sometimes too hard on the body and the soul. Death is not always the enemy. Robert S. NussbaumFort Lee, N.J. Want all of The Times? Subscribe.
Medscape
3 days ago
- Medscape
Vaping Epidemic: Are Teens' Lungs at Risk?
Electronic cigarette (e-cigarette) use is rapidly increasing worldwide, especially among teenagers and young adults. Vaping, the inhalation of aerosol from e-cigarettes, has become a common practice, no longer limited to niche groups, said Neena Chandrasekaran, MD, a pulmonologist and critical care physician in Florida, in a video on Once considered a harmless alternative to smoking, vaping has become a global health concern with serious and, at times, permanent consequences. One of the most dangerous is e-cigarette or vaping product use-associated lung injury (EVALI), a potentially life-threatening condition. Vaping can cause serious and permanent pulmonary damage, as seen in the case of David, a 17-year-old student from the US. He had planned to join the Navy, but that dream ended after he developed a severe pulmonary illness associated with vaping. He was diagnosed with EVALI caused by inhaling a homemade liquid containing tetrahydrocannabinol (THC) and vitamin E acetate. David is not alone. In 2020, approximately 2600 individuals in the US were hospitalized with EVALI, and the number has continued to rise. To date, approximately 50 people have died from this condition nationwide. In Europe, additives in e-liquids are more strictly regulated, and no similar cases of widespread EVALI have been reported. However, doctors should remain aware of the symptoms, as the condition can still occur, particularly among individuals who mix their own vaping liquids. Toxic Contents e-Cigarettes function by heating a liquid containing various additives, producing an aerosol that users inhale. Although this may seem harmless, inhaling certain ingredients can cause serious lung damage. Vitamin E acetate is a common and extensively studied additive that is potentially harmful when inhaled. A study published in The New England Journal of Medicine found vitamin E acetate in the bronchoalveolar lavage fluid of patients with EVALI. The authors suggested that vitamin E acetate irritates the lung mucous membranes when inhaled, even though it is considered safe when taken orally. THC, a psychoactive component of cannabis, is also thought to contribute to the development of EVALI. In many cases, high concentrations of THC have been detected in the bronchoalveolar lavage fluid. This suggests that the risk is linked not only to vaping but also to the chemical composition of the inhaled liquid. The diagnosis of EVALI remains challenging. This clinicopathologic syndrome mimics other pulmonary conditions and often resembles atypical viral pneumonia. Common symptoms include shortness of breath, cough, chest pain, and fever. Physical examination often reveals hypoxemia and tachycardia. When patients present with hypoxemia and ground-glass opacities on chest imaging, clinicians often suspect COVID-19 or other viral respiratory infections. EVALI should be considered in differential diagnosis, particularly when patients present with typical viral symptoms but no identifiable infectious pathogens and report using e-cigarettes. Identifying the specific components of inhaled products, such as THC or vitamin E acetate, is essential for accurate diagnosis and appropriate treatment planning. Before confirming a diagnosis of EVALI, other causes must be carefully excluded, including influenza, Streptococcus pneumoniae , Legionella species, and Mycoplasma pneumoniae infections. However, this diagnostic process can be challenging. Certain indications of EVALI include leukocytosis with neutrophil predominance and elevated inflammatory markers, such as C-reactive protein, erythrocyte sedimentation rate, and procalcitonin. Chest radiography is suitable for the initial evaluation; however, CT with or without contrast is often required to identify characteristic imaging findings. Typical CT findings include bilateral ground-glass opacities resembling those seen in pneumonia or diffuse alveolar damage. Differentiation can be difficult because similar imaging patterns are present in various pulmonary diseases. In uncertain cases, bronchoscopy or lung biopsy may be necessary to confirm the diagnosis of vaping-associated lung injury. Treatment and Prognosis The initial management of EVALI generally includes empirical antibiotic treatment as a precautionary measure for community-acquired pneumonia. Systemic corticosteroids are commonly administered concurrently and have demonstrated efficacy in reducing the inflammatory response in the lungs and oxidative stress at the cellular level. Most patients show rapid improvement in oxygen saturation and resolution of pulmonary infiltrates after steroid treatment. In severe cases, such as acute respiratory failure, mechanical ventilation may be required to maintain oxygenation. One case series reported that 56% of hospitalized patients required intensive care, with 27% requiring mechanical ventilation. Approximately 1 in 4 patients developed acute respiratory distress syndrome and required extracorporeal membrane oxygenation in some cases. Despite the potential for severe illness, the overall prognosis is favorable, provided that the diagnosis is made early and e-cigarette use is discontinued immediately. EVALI is a serious but treatable pulmonary condition that should be included in the differential diagnosis of acute respiratory symptoms in individuals with a history of e-cigarette use. Early recognition and prompt cessation of treatment are essential for recovery.
Yahoo
4 days ago
- Yahoo
Louisville boy makes medical history as first patient in US with new cochlear implant
DuJuan Broadus couldn't believe how loud the birds outside his bedroom window sounded. The buzzing of the cicadas near his grandmother's home in Georgetown was almost overwhelming. Having unknowingly lived with profound hearing loss for years, the world sounded so much more colorful than the Louisville native ever imagined. In December, DuJuan, now 11, went from having 'the hearing of a World War II veteran,' as one doctor put it, to becoming the first patient in the United States to receive a MED-EL FLEX34 cochlear implant. This new technology is the longest implant on the market and is designed for people, like DuJuan, who have an unusually large cochlea, which is the part of the ear that converts sound vibrations into signals the brain interprets as sound. If doctors had used a shorter model, DuJuan's hearing would have improved, but he wouldn't necessarily have access to such a dynamic range of frequencies, said Dr. Nathan Cass, a UK HealthCare otology and neurotology specialist, who implanted the FLEX34 in DuJuan's ear in December 2024. Specifically, lower, deeper sounds are limited, Cass said. If the electrode can't reach to the end of the patient's cochlea, they'll likely hear voices at a higher pitch. 'They'll say at their (cochlear implant) activation that voices sound kind of like Mickey Mouse,' Cass said. 'But one of the things that this new technology is aiming to try to help is to try to get people to get things to sound more natural.' With the help of the FLEX34, DuJuan now hears the world, and all the background noise that comes with it, at a completely different level. For the past eight months or so, it's been a daily adventure for him to learn and put names to sounds and background noises that his brain had never registered before. 'A lot of times it was really difficult, but I got used to it,' DuJuan told the Courier Journal. 'Now I can tell that the bird is a bird. I can tell a cricket is a cricket. I can tell a motorcycle is a motorcycle.' 'I didn't even know I had hearing loss' The journey to hearing and understanding what the world sounded like started well before DuJuan ended up at UK HealthCare. When DuJuan was about three years old, his parents noticed a speech impediment. His mother has a clear memory of him pointing to a motorcycle as a child, but pronouncing the word for it similar to the name 'Michael.' One of the first lines of intervention with speech is a hearing test. Studies have shown that about one to five children in about every 1,000 has hearing loss, according to the Centers for Disease Control and Prevention. More: Confused about the COVID-19 booster? Here's what children, pregnant women in Kentucky need to know DuJuan passed that first hearing test, and from there, his parents enrolled him in speech therapy. Over time, his speech improved, and he graduated from speech therapy in the third grade. But something still didn't seem right. His grades were strong in reading and math, but his fourth-grade teacher had concerns about how he responded when she spoke to him. She wasn't sure if he didn't understand the question or if he couldn't hear what she was asking. So Jefferson County Public Schools tested him for hearing loss, and this time he failed — dynamically. He was just 10 years old at the time, and was already in severe and profound stages of hearing loss. No one had noticed up until this point, though, because DuJuan is an incredibly bright and resilient child. Without knowing it, DuJuan had taught himself to read lips. He'd become so good at it over the years, that when his mother, Letisha Broadus, spoke to him in the car, he knew to crane his neck up so that he could see her lips moving in the rearview mirror. He thought that this was something that everyone needed to do. 'I didn't even know I had hearing loss at first,' he said. 'Once I knew, I asked my mom 'what is even hearing loss?'' Heartbroken for her son but also determined, Letisha tried to find an ear, nose and throat specialist in Louisville to help. The waitlists locally were months long, so doctors referred her to UK HealthCare's Ear, Nose and Throat Clinic in Lexington, which was ranked No. 37 in the nation by US News and World Report in 2024 for that specialty. The 70-mile trip to the doctors was worth it, if they could schedule a surgery for an implant sooner. In the meantime, DuJuan used a hearing aid, which typically helps patients with low or moderate hearing loss. The day they turned it on in March 2024 was unforgettable for the whole family. 'There were a lot of tears, and a lot of emotions because he could hear things for the first time,' Letisha remembered. When the doctor stapled something to his file, DuJuan's ears caught the quick, snap-like click a stapler makes for the first time, ever. 'Wow,' he told his mom. 'That's what that sounds like.' He had so many things to relearn. 'I wasn't able to stop smiling that day' On the day the Broaduses traveled to Lexington in December 2024 for the cochlear implant surgery, DuJuan was a little nervous, of course, but also excited for what else the implant might help him hear. There are only three companies in the world that manufacture cochlear implants. DuJuan and his parents selected MED-EL, which had released the longest implant currently on the market in 2023. The Food and Drug Administration approved it the July before DuJuan's surgery. DuJuan's cochlea was 38 millimeters long, and he's in the 5-7% of the largest cochleas in the country. It's rare enough that in the eight months that have followed since his surgery, Cass has only implanted one other FLEX34 on a patient. More: Their son died by suicide. Now this Louisville couple is helping other young adults The difference in those extra millimeters, though, is crucial for patients like DuJuan. The cochlea has two fluid-filled chambers lined with tiny hairs. When a sound occurs, it vibrates the fluid in the cochlea. Those impulses are translated into electrical signals that the brain interprets as sound. The farther the implant can reach into the chamber, the more natural the sound becomes in the brain. 'The vast number of sensory cells we have there allows for some of the richness of the sounds that we can understand, and the dynamic range of the frequencies is very large,' Cass explained. When they turned the implant on in the weeks that followed the surgery, DuJuan couldn't wait to hear the world the same way everyone else does. "I wasn't able to stop smiling that day," he remembers. DuJuan is a big fan of music. The hearing aid kept him from having to listen to it on full blast, but now the voices in the songs are clearer. With a shorter implant, the rap music he enjoys might sound like Mickey Mouse is trying to take cues from 50 Cent or Kendrick Lamar. The FLEX34 helps him hear music as everyone else does. Now he has access to lower, bass notes. More: 300 people in line? How hard-to-find bourbons made Buffalo Trace Distillery a cult favorite And that's important, because DuJuan has big plans to join the choir when he starts the sixth grade at Western Middle School for the Arts this school year. He's always been a musically inclined child. When DuJuan was a baby, his mother would sing little songs to him, and he'd somehow managed to reply with the same, proper note. And while he'll have to wait until he's older before his voice lowers enough to hit any bass notes himself — in the meantime, he certainly hears them more on tune than he ever has before. More: What is a cochlear implant? Learn more about device Reach features columnist Maggie Menderski at mmenderski@ Want to learn more? To learn more about cochlear implants, hearing loss, the FLEX34 and other electrodes available for hearing loss patients, visit This article originally appeared on Louisville Courier Journal: Louisville boy first patient in US with med-el-flex34 cochlear implant Solve the daily Crossword
