Daily Rounds: Tricky Meningitis Treatment; Cholesterol Falls; Sordid Screening Sales; Old Health Aides

Fungal infection poses challenges to patients, officials (The Boston Globe) - "After seven days in the hospital, the part-time mayor of Somersworth, N.H., was back home Tuesday, where a machine pumps a powerful antifungal medication into his veins five hours a day. The drug causes liver inflammation, and for the first 30 minutes of each treatment, images flicker across his eyes. Spencer’s situation illustrates many of the challenges public health officials, physicians, and patients are grappling with in the outbreak: Fungal meningitis is usually exceedingly difficult to diagnose, and the treatment is risky and arduous. Spencer waited more than two weeks after his epidural ­injection on Sept. 19 to seek medical care. In part, that was because he and his doctors ­attributed his initial symptoms to the injection itself, which he received to ease pain from ­spinal stenosis caused by an old Coast Guard injury.’’

Cholesterol is falling in adults, study finds (The New York Times) "Cholesterol levels in adults are falling, and changes in the amount of trans fats in the American diet may be part of the reason, new research suggests.The findings, published Tuesday in The Journal of the American Medical Association, were celebrated as something of a triumph by health authorities, who said the data showed that the nation had reached its 2010 goal of getting the average total cholesterol level in adults below 200 milligrams per deciliter. Researchers examined a nationally representative sample of tens of thousands of Americans over the last two decades and recorded a decline of 10 points in average total cholesterol — to 196 mg/dL from 206 mg/dL."

On the sordid sale of screening tests (The Atlantic) - "A patient I'll call Mildred came to her appointment and handed me a report from a medical screening fair at her church. She wanted to know what to do about it. The print-out said that she had a "mild" blockage in her carotid artery. They told her to discuss it with her primary care doctor (me). You may have seen the advertisements in your local paper, or even on your local hospital's website. Ads that boast "Important screening tests that COULD SAVE YOUR LIFE. All for $129! NO DOCTOR'S ORDER NECESSARY!"I love America and the free market. I love companies that make a buck with hard work and ingenuity. I love the idea that people are free to spend their money on whatever they want. I'm even open to the idea of DIY medicine. But I don't love when innocent people get fleeced in the name of bad medicine that pretends to be good. Worse yet, when it happens at church."

Home health aides often as old as their clients (NPR) - "In a red brick rambler in a Maryland suburb of Washington, D.C., Onether Lowery begins her daily shift as a caregiver. She skillfully helps 86-year-old Rosalie Lewis into her electric wheelchair, holding her from the back, then bending over to ease her down. It's an impressive feat: Lowery herself is 80 years old. "My mother, she was 89 when she passed away," Lowery says. "I took care of her and I just fell in love with older people. I get along with them very well." As America ages, its 2.5 million home health workers are graying right along with the clients they care for. And by all accounts, these older workers are especially well suited to the job."