6/23/2010

Dr. Oppenheimer


People We Know

(continued)

DECEMBER 2005
In Memoriam: Edward Anthony "Tony" Oppenheimer, MD, FCCP (1937-2005)
Dr. Oppenheimer in Japan, 2005Our readers will be saddened by news of the death of Dr. Tony Oppenheimer, who died of complications of multiple myeloma in November. Many of you knew Dr. Oppenheimer through his extensive email practice on respiratory matters related to neuromuscular disease, begun after he retired in 2000 as Chief of Pulmonary and Critical Care Medicine, Southern California Kaiser Permanente Group. Others experienced Dr. Oppenheimer firsthand as their superb physician at Kaiser, while many of us knew him as a delightfully philosophical and engaging friend, colleague and mentor.
As a member of IVUN's Medical Advisory Committee, Dr. Oppenheimer provided thoughtful and comprehensive contributions to IVUN publications and careful review of its pulmonary articles. He worked diligently, but gently, to educate ventilator users and their families, to ensure that they became accepted as equal partners in the decision-making process about the use of assisted ventilation.
Dr. Oppenheimer understood the technology and the power of the Internet early on and utilized it to the fullest to educate other health professionals about assisted ventilation. His utmost concern about quality of life issues reflected his belief that users of long-term assisted ventilation at home could live the best possible life.

"Tony epitomized the patient-physician partnership through his work with people who use ventilators longterm in the home care setting. Tony was an 'R.D.' or 'real doctor,' balancing expert medical care with humor, generosity and compassion. He was also a true advocate for ventilator users," states Judith R. Fischer, who collaborated with him on several articles for respiratory care journals and for IVUN's quarterly newsletter, Ventilator-Assisted Living.
Richard Daggett, President of the Polio Survivors Association, Downey, California, whose association enjoyed Dr. Oppenheimer's talks on post-polio respiratory problems, says, "Polio survivors have lost a good friend. Dr. Oppenheimer provided us with valuable, often life-saving information about pulmonary issues. He was always accessible and generous with his time. He will be missed, both personally and professionally."

David Ronfeldt agrees. "As Dr. Oppenheimer's patient since 1979, I found Dr. Oppenheimer
(I usually called him 'Chief') to be an excellent doctor, skilled at my post-polio respiratory issues, and a fine, sturdy, positive fellow to be around. He was always interested in what else was going on, and always ready with an engaging smile. He listened, he cared, he advised sensibly, he never stopped learning, and at crucial moments he took extra steps that turned out to matter."
Ismail Tsieprati, who has ALS and has used tracheostomy positive pressure since 1990, and his wife Cheryl remember "Dr. Oppenheimer's deep love for people and how he took joy and pride in the success and well-being of others. He loved to help others and never stopped giving of himself - the greatest humanitarian we have ever known. He touched our lives profoundly, and we'll always be grateful for the excellent care, the encouragement, the hope and the support he gave us throughout the years. The world has lost a great man. We have lost a dear friend."
Professionally, Dr. Oppenheimer was Associate Clinical Professor of Medicine at UCLA's School of Medicine. He was also a member of the California Thoracic Society, the American Thoracic Society and a fellow of the American College of Physicians and the American College of Chest Physicians. www.post-polio.org/ net/peo2.html

The Polio Crusade

THE POLIO CRUSADE IN AMERICAN EXPERIENCE A GOOD VIDEO THE STORY OF THE POLIO CRUSADE pays tribute to a time when Americans banded together to conquer a terrible disease. The medical breakthrough saved countless lives and had a pervasive impact on American philanthropy that ... Continue reading..http://www.pbs.org/wgbh/americanexperience/polio/

Erradicación de La poliomielitis

Polio Tricisilla Adaptada

March Of Dimes Polio History

Dr. Bruno

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A 41-year-old man developed an acute illness at the age of 9 months during which, following a viral illness with headache, he developed severe weakness and wasting of the limbs of the left side. After several months he began to recover, such that he was able to walk at the age of 2 years and later was able to run, although he was never very good at sports. He had stable function until the age of 18 when he began to notice greater than usual difficulty lifting heavy objects. By the age of 25 he was noticing progressive difficulty walking due to weakness of both legs, and he noticed that the right calf had become larger. The symptoms became more noticeable over the course of the next 10 years and ultimately both upper as well as both lower limbs had become noticeably weaker.

On examination there was wasting of the muscles of upper and lower limbs on the left, and massively hypertrophied gastrocnemius, soleus and tensor fascia late on the right. The calf circumference on the right exceeded that on the left by 10 cm (figure1). The right shoulder girdle, triceps, thenar eminence and small muscles of the hand were wasted and there was winging of both scapulae. The right quadriceps was also wasted. The wasted muscles were also weak but the hypertrophied right ankle plantar flexors had normal power. The tendon reflexes were absent in the lower limbs and present in the upper limbs, although the right triceps was reduced. The remainder of the examination was normal.

Figure 1

The patient's legs, showing massive enlargement of the right calf and wasting on the left

Questions

1
What is that nature of the acute illness in infancy?
2
What is the nature of the subsequent deterioration?
3
What investigations should be performed?
4
What is the differential diagnosis of the cause of the progressive calf hypertrophy?

Answers

QUESTION 1

An acute paralytic illness which follows symptoms of a viral infection with or without signs of meningitis is typical of poliomyelitis. Usually caused by one of the three polio viruses, it may also occur following vaccination and following infections with other enteroviruses.1 Other disorders which would cause a similar syndrome but with upper motor neurone signs would include acute vascular lesions, meningoencephalitis and acute disseminated encephalomyelitis.

QUESTION 2

A progressive functional deterioration many years after paralytic poliomyelitis is well known, although its pathogenesis is not fully understood.2 It is a diagnosis of exclusion; a careful search for alternative causes, for example, orthopaedic deformities such as osteoarthritis or worsening scoliosis, superimposed neurological disorders such as entrapment neuropathies or coincidental muscle disease or neuropathy, and general medical causes such as respiratory complications and endocrinopathies.3

QUESTION 3

Investigations revealed normal blood count and erythrocyte sedimentation rate and normal biochemistry apart from a raised creatine kinase at 330 IU/l (normal range 60–120 IU/l), which is commonly seen in cases of ongoing denervation. Electromyography showed evidence of denervation in the right APB and FDI with polyphasic motor units and complex repetitive discharges, no spontaneous activity in the left calf and large polyphasic units in the right calf consistent with chronic partial denervation. Motor and sensory conduction velocities were normal. A lumbar myelogram was normal. Magnetic resonance imaging (MRI) scan of the calves is shown in figure2.

Figure 2

Axial T1 weighted MRI scan (TR 588 ms, TE 15 ms) of the calves, showing gross muscle atrophy and replacement by adipose tissue on the left, and hypertrophy of the muscles on the right, with only minor adipose tissue deposition

QUESTION 4

The differential diagnosis of the progressive calf hypertrophy is given in the box.

Causes of calf muscle hypertrophy

Chronic partial denervation

  • radiculopathy

  • peripheral neuropathy

  • hereditary motor and sensory neuropathy

  • spinal muscular atrophy

  • following paralytic poliomyelitis

    Neuromyotonia and myokymia

  • Isaac's syndrome

  • generalised myokymia

  • neurotonia

  • continuous muscle fibre activity due to: chronic inflammatory demyelinating polyradiculopathy, Guillain Barre syndrome, myasthenia gravis, thymoma, thyrotoxicosis, thyroiditis

    Muscular dystrophies

    Myositis

    Infiltration

  • tumours

  • amyloidosis

  • cysticercosis

    Link here