NationStates Jolt Archive

http://news.bbc.co.uk/2/hi/health/7542404.stm
'DIY' kidney machine saves girl

A baby dying from kidney failure was saved when her doctor designed and built her a dialysis machine from scratch in his garage.

Millie Kelly was too small for conventional NHS machines, so Dr Malcolm Coulthard and a colleague constructed a scaled-down version.

Two years later, her mother Rebecca says she is "fit as a fiddle".

She, and Dr Coulthard, from Newcastle's Royal Victoria Infirmary, now want the machine to be available to others.

I just can't thank him enough for saving my baby's life
Rebecca Kelly

The job of the kidneys is to 'clean' the blood, and if they fail, a dialysis machine can do this job instead.

Millie was born with a condition called gastroschisis, in which her bowels developed outside her body.

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During an operation to correct the problem, her kidneys started to fail, and her birthweight, at just over 6lb, meant existing NHS dialysis machines, even those designed for children, were too large to be used.

Rebecca was warned that Millie was unlikely to survive.

However, Dr Coulthard, together with senior children's kidney nurse Jean Crosier, devised a smaller version, then built it away from the hospital. Millie was connected to the machine over a seven day period, allowing her own kidneys to recover.

Metal box

Rebecca, from Middlesbrough, said: "It was a green metal box with a few paint marks on it with quite a few wires coming out of it into my daughter - it didn't look like a normal NHS one.

"But it was the only hope for her - even when she got hooked up to the dialysis machine, they said that every hour was a bonus.

"She's fine now, a normal two-year-old - I just can't thank him enough for saving my baby's life."

She said that there was an opportunity for other babies to benefit from similar machines.

The machine is still in use, helping babies in similar circumstances to Millie, but Dr Coulthard told the Newcastle Journal newspaper that an official version was needed.

"This machine is only being used on the tiniest, earliest babies where there is nothing else that can be done.

"But if we had a machine that we could use much more freely, then we would be able to deal with many more babies and have a much greater chance of saving lives."
I love when doctors are ingenius and come up with things to save lives even when the usual doctor might write them off.

We need to encourage this kind of free thinking. Certainly a new dialysis machine for little babies needs to be officially built. It'd help a great deal, I can imagine.

I think some people are amazing but then I also think we could all be pretty amazing given the right challenge.

Lovely story.

http://news.bbc.co.uk/2/hi/health/7542404.stm

I love when doctors are ingenius and come up with things to save lives even when the usual doctor might write them off.

We need to encourage this kind of free thinking. Certainly a new dialysis machine for little babies needs to be officially built. It'd help a great deal, I can imagine.

While this is a great story, to play devil's advocate a bit:

What if this homemade dialysis machine hadn't worked, or even worse, had caused the baby's condition to detereorate even further? The doctor would have been sued into oblivion. There's a reason why doctors don't tend to stray from the tried and true. The usual doctor would write this kind of thing off because of the enormous risk involved.

While this is a great story, to play devil's advocate a bit:

What if this homemade dialysis machine hadn't worked, or even worse, had caused the baby's condition to detereorate even further? The doctor would have been sued into oblivion. There's a reason why doctors don't tend to stray from the tried and true. The usual doctor would write this kind of thing off because of the enormous risk involved.

It's the UK. Things aren't so litigious, so it probably wasn't an issue.

It's the UK. Things aren't so litigious, so it probably wasn't an issue.

True. But the overall reason why you don't often see stories about outside-the-box thinking in the medical field is because of the enormous risk of litigation. At least in the US.

True. But the overall reason why you don't often see stories about outside-the-box thinking in the medical field is because of the enormous risk of litigation. At least in the US.
It's funny, but this story shares a fair a basic idea in common with the invention of the first operating dialysis machine. That was built by a Dutch doctor called Kolff in WWII, under Nazi occupation and out of bits of downed Messerschmitt. Of the 16 people he treated with it, only one survived longer than a few days to make a full recovery. Where's the similarity? Well, without dialysis, people with knackered kidneys tend to die very quickly. Kolff continued to test his dialysis machine because he knew that without it those 16 people were definitely dead. The same was true for this baby. In cases like this where there really is no hope, perhaps last ditch efforts like this should be praised and not punished.

While this is a great story, to play devil's advocate a bit:

What if this homemade dialysis machine hadn't worked, or even worse, had caused the baby's condition to detereorate even further? The doctor would have been sued into oblivion. There's a reason why doctors don't tend to stray from the tried and true. The usual doctor would write this kind of thing off because of the enormous risk involved.
the baby would have died.

as long as the doctor had no access to a machine that worked on neonates AND had full consent of the parents, he was in the clear no matter where he was.

True. But the overall reason why you don't often see stories about outside-the-box thinking in the medical field is because of the enormous risk of litigation. At least in the US.
Aye, well huzzah for the NHS, basically. Although people are increasingly becoming more yankesque in terms of suing people (EUGH), here in England at least, the NHS is very highly regarded, and no assumption would be made that any other course of action could have been taken, or it would have been taken before we needed to go all Scrapheap Challenge on the issue.

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I had to wipe away a tear at that one.

That's a good job done by the doctor.

While this is a great story, to play devil's advocate a bit:

What if this homemade dialysis machine hadn't worked, or even worse, had caused the baby's condition to detereorate even further? The doctor would have been sued into oblivion. There's a reason why doctors don't tend to stray from the tried and true. The usual doctor would write this kind of thing off because of the enormous risk involved.
Without knowing much about medical machinery, I would bet that doctors in the United States have access to the proper resources. Yet another reason not to be constrained by NHS equivalents.

Without knowing much about medical machinery, I would bet that doctors in the United States have access to the proper resources. Yet another reason not to be constrained by NHS equivalents.
the scary part being that the article says they still use this garage made dialysis machine.

Without knowing much about medical machinery, I would bet that doctors in the United States have access to the proper resources. Yet another reason not to be constrained by NHS equivalents.

Really? I've had a bit of a look online and I can't find anything that matches this. Given that the UK has a few very specialised neonatal unit I would imagine they would have one if they are made and the article specifically states it's the only one in the country.

the scary part being that the article says they still use this garage made dialysis machine.
Well, it's proven to work, so why not?

Well, it's proven to work, so why not?
jury rigged is good for an emergency. properly made properly calibrated equipment is best for normal usage.


....or is the term jerry-rigged?

jury rigged is good for an emergency. properly made properly calibrated equipment is best for normal usage.


....or is the term jerry-rigged?
Jury-rigged, I think. And yes, I agree. I imagine the doctor and the family of the child who first benefited from the machine are probably lobbying the NHS to properly develop a similar one, and, getting nowhere, have decided that the logical next step was to bring the issue to the public's attention.

However, in the meantime I see nothing wrong with the original machine being used provided that basic steps are taken to ensure nothing goes wrong (i.e. sterilisation, etc), and that the doctor covers his ass by getting parents to sign some sort of document to say they won't take any action against him if things go wrong.

Really? I've had a bit of a look online and I can't find anything that matches this. Given that the UK has a few very specialised neonatal unit I would imagine they would have one if they are made and the article specifically states it's the only one in the country.
I'm not surprised that there aren't volumes written about neonatal dialysis. But if you can transport the neonate to a specialized care center, I would think that they will have this sort of equipment.

Here's a link to part of a paper that talks about it in an offhanded sort of way...
http://neoreviews.aappublications.org/cgi/content/extract/6/8/e377

I'm not surprised that there aren't volumes written about neonatal dialysis. But if you can transport the neonate to a specialized care center, I would think that they will have this sort of equipment.

Here's a link to part of a paper that talks about it in an offhanded sort of way...
http://neoreviews.aappublications.org/cgi/content/extract/6/8/e377
there are volumes but they are not available online except as a short abstract. from what i can see a newborn or preemie that requires dialysis has a very high chance of dying.

there are volumes but they are not available online except as a short abstract. from what i can see a newborn or preemie that requires dialysis has a very high chance of dying.
That's what I've found, too. Here's an Italian paper (http://icvts.ctsnetjournals.org/cgi/content/full/7/1/116?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=fig&searchid=1&FIRSTINDEX=150&resourcetype=HWFIG)that is printed in full and has references. It's not an unknown procedure and any hospital with a neonatal care center should have the machinery. I'm sure that not every hospital can take care of neonates, however. My thought is that it's a rarely performed procedure, thus not likely to be widely supported by a NHS. Just a dollars and cents decision.

Anyway, kudos to the doc that developed the machine. I'm sure he didn't make any friends with the bureaucracy, though.

I'm not surprised that there aren't volumes written about neonatal dialysis. But if you can transport the neonate to a specialized care center, I would think that they will have this sort of equipment.

Here's a link to part of a paper that talks about it in an offhanded sort of way...
http://neoreviews.aappublications.org/cgi/content/extract/6/8/e377

That was my point. The article states that the home built machine was the only one in the country that can be used on neonates as small as the one it was created for.

I understand that you're not a fan of socialised medicine but even the commie funded NHS can afford to by required machines if they are made.

and here i thought i could go on about how Stargate SG-1 kicks MacGyvers ass... oh well...

good story though

While this is a great story, to play devil's advocate a bit:

What if this homemade dialysis machine hadn't worked, or even worse, had caused the baby's condition to detereorate even further? The doctor would have been sued into oblivion. There's a reason why doctors don't tend to stray from the tried and true. The usual doctor would write this kind of thing off because of the enormous risk involved.

Eh, well, to capitalism, and letting the Doctor and Nurse patent and produce their machine so that other infants can survive.

That was my point. The article states that the home built machine was the only one in the country that can be used on neonates as small as the one it was created for.

I understand that you're not a fan of socialised medicine but even the commie funded NHS can afford to by required machines if they are made.
I think the more appropriate wording is "... if they decide the benefit is great enough." That's what rationed health care is all about.

I would have thought that in all of the United Kingdom, there would have been one neonatal care center that could have been used. We have one here in the backwater town of Atlanta, surely the worldly folk of London can do better than zero.

Anyhow, I don't see much future in this line of discussion. We will be joining the lines of those that wait for care soon enough.

I think the more appropriate wording is "... if they decide the benefit is great enough." That's what rationed health care is all about.

I would have thought that in all of the United Kingdom, there would have been one neonatal care center that could have been used. We have one here in the backwater town of Atlanta, surely the worldly folk of London can do better than zero.

Anyhow, I don't see much future in this line of discussion. We will be joining the lines of those that wait for care soon enough.
now im wondering if the doctor hasnt opened a can of worms.

by making his little garage dialysis unit he created a new standard of care--infant dialysis--that was denied for everyone before this. i little millie gets dialysis how to you deny it to little johnny?

I think the more appropriate wording is "... if they decide the benefit is great enough." That's what rationed health care is all about.

I would have thought that in all of the United Kingdom, there would have been one neonatal care center that could have been used. We have one here in the backwater town of Atlanta, surely the worldly folk of London can do better than zero.

Anyhow, I don't see much future in this line of discussion. We will be joining the lines of those that wait for care soon enough.

I'd actually love to have Fass weigh on this discussion. Is this technology universally accessible outside the NHS?

now im wondering if the doctor hasnt opened a can of worms.

by making his little garage dialysis unit he created a new standard of care--infant dialysis--that was denied for everyone before this. i little millie gets dialysis how to you deny it to little johnny?
The quintessential question of managed care... How do you limit care and still make it seem fair?

I'd actually love to have Fass weigh on this discussion. Is this technology universally accessible outside the NHS?
i was wondering that too.

since its available in the US, i would expect it to be available in every major hospital and every regional children's hospital in the country.

this town of 9000 people has a small hospital and im pretty sure would not have it. but a newborn with that kind of trouble would be airlifted to the university hospital in albuquerque where they do have it.

i was wondering that too.

since its available in the US, i would expect it to be available in every major hospital and every regional children's hospital in the country.

this town of 9000 people has a small hospital and im pretty sure would not have it. but a newborn with that kind of trouble would be airlifted to the university hospital in albuquerque where they do have it.
From the article :

"her birthweight, at just over 6lb, meant existing NHS dialysis machines, even those designed for children, were too large to be used."

It's not that we don't have dialysis machines for children, this was just an exceptionally weedy baby. 6lbs is a small child indeed.

From the article :

"her birthweight, at just over 6lb, meant existing NHS dialysis machines, even those designed for children, were too large to be used."

It's not that we don't have dialysis machines for children, this was just an exceptionally weedy baby. 6lbs is a small child indeed.
yeah i got that.

although a 6 lbs is a common weight for a newborn. smallish but not (otherwise) dangerously small.

in the US there are times when premature infants get dialysis.

I'd actually love to have Fass weigh on this discussion. Is this technology universally accessible outside the NHS?

I can only speak for Sweden, but the neonatology ward I did my rotation at saved children far sicker and far, far smaller (we're talking less than a kilogram in weight), quite regularly. The ward itself, while at a university hospital, was not in any of the larger towns. Although, we did not achieve the third lowest infant mortality rate (3.2/1000 live births, as compared to the UK's 4.8 and the USA's shocking 6.3) and second lowest under-five mortality rate (4.0/1000 live births, as compared to the UK's 6.0 and the USA's 7.8) by not being good at child care...

In any case, I do think it's hilarious to see certain USA people poopoo the UK's NHS in this matter (which I do think is peculiarly reported on - I have a very hard time believing that they built a machine from scratch), which still saves more children than the USA's much costlier (non-)system. In fact, this little child would have had a significantly higher risk of death had it been born in the USA, rather than in the UK, and that's especially depending on the financial status of its parents...

I can only speak for Sweden, but the neonatology ward I did my rotation at saved children far sicker and far, far smaller (we're talking less than a kilogram in weight), quite regularly. The ward itself, while at a university hospital, was not in any of the larger towns. Although, we did not achieve the third lowest infant mortality rate (3.2/1000 live births, as compared to the UK's 4.8 and the USA's shocking 6.3) and second lowest under-five mortality rate (4.0/1000 live births, as compared to the UK's 6.0 and the USA's 7.8) by not being good at child care...

In any case, I do think it's hilarious to see certain USA people poopoo the UK's NHS in this matter (which I do think is peculiarly reported on - I have a very hard time believing that they built a machine from scratch), which still saves more children than the USA's much costlier (non-)system. In fact, this little child would have had a significantly higher risk of death had it been born in the USA, rather than in the UK, and that's especially depending on the financial status of its parents...
Statistics are wonderful tools to find things that need attention. By themselves, they mean almost nothing. We can most certainly not make any conclusions with only these numbers. As is usually the case, further investigation into WHY the mortality numbers are so high would be interesting, but tedious, so it's better left to people that care a little more than I do.

Completely apart from any statistic is the fact that all managed care is a dollars-and-cents operation. What is allowed is determined by cost and benefit ratios. It doesn't surprise me to read that Great Britain doesn't have a neonatal dialysis machine, if there is no overwhelming need for them. It's not a good business decision to buy and maintain one.

http://news.bbc.co.uk/2/hi/health/7542404.stm

I love when doctors are ingenius and come up with things to save lives even when the usual doctor might write them off.

We need to encourage this kind of free thinking. Certainly a new dialysis machine for little babies needs to be officially built. It'd help a great deal, I can imagine.

For some odd reason I thought this might be a thread on the new season of House.

I see I'm sorely disappointed.

For some odd reason I thought this might be a thread on the new season of House.

I see I'm sorely disappointed.

Hey! I'm going to Delhi next week. I might have some free time to do touristy things. Any suggestions? Besides the Taj, that is.

Hey! I'm going to Delhi next week. I might have some free time to do touristy things. Any suggestions? Besides the Taj, that is.

I've never actually been out that far east. Most of my tourism's been in Gujarat and Mumbai. But I've heard good things about the Red Fort, and about Humayun's Tomb, which some believe served as the inspiration for the Taj Mahal, and neither of them will require a trek out to Agra.

This might help with some ideas: http://www.hotels-delhi.com/tourist-attractions-in-delhi.html

I've never actually been out that far east. Most of my tourism's been in Gujarat and Mumbai. But I've heard good things about the Red Fort, and about Humayun's Tomb, which some believe served as the inspiration for the Taj Mahal, and neither of them will require a trek out to Agra.

This might help with some ideas: http://www.hotels-delhi.com/tourist-attractions-in-delhi.html
That's the second recommendation that I've had for the Red Fort. I tried once before, but the city was closed for elections.

If you really want to imagine something spooky, just think about a city the size of New Delhi with no cars in the streets, not a soul in sight, every retail place closed... It really did look like the place was deserted.

That's the second recommendation that I've had for the Red Fort. I tried once before, but the city was closed for elections.

If you really want to imagine something spooky, just think about a city the size of New Delhi with no cars in the streets, not a soul in sight, every retail place closed... It really did look like the place was deserted.

That is fairly spooky, though I've incorporated similar imagery in su-horror games I've run in the past, I can't say it's the sort of thing I'd be comfortable with in real life. Hmm, though I have been in Philly during major snowstorms, when the only people on the street were idiots like me who felt like heading the diner with people at 3 AM in 0 degree weather

But yeah, I've heard the Red Fort is worth checking out. Also, though this is likely too soon to affect your plans, India Day is coming up. I think many highly Indian American populated areas are having parades this Saturday.

Hey! I'm going to Delhi next week. I might have some free time to do touristy things. Any suggestions? Besides the Taj, that is.

I was lucky enough to spend a month there last year and did some good 'non touristy' things. TG me if you want and I'll give you some ideas and maybe send some photos.

India Gate on a Sunday is not to be missed for the sheer mass of humanity enjoying picnics and cricket. Some other places I went to were Jama Masjid, Hanuman Mandir and Bangla Sahib for a Sikh blessing

I was lucky enough to spend a month there last year and did some good 'non touristy' things. TG me if you want and I'll give you some ideas and maybe send some photos.

India Gate on a Sunday is not to be missed for the sheer mass of humanity enjoying picnics and cricket. Some other places I went to were Jama Masjid, Hanuman Mandir and Bangla Sahib for a Sikh blessing
Somewhere along the line, I lost my homepage. TGs don't work. But, these suggestions are good ones and I really don't expect to have more than a day, or so to do anything on my own.

These firefighting trips are usually about 16 hours of work every day, or more, if the customer is willing...

Thanks.

Without knowing much about medical machinery, I would bet that doctors in the United States have access to the proper resources. Yet another reason not to be constrained by NHS equivalents.

I don't think the USA has a dialysis machine that would work on an infant less than six pounds. But if you want to make the assumption that they do, and then use that as an argument against public healthcare, we should be clear that you are basing your argument on something that you don't know is true.

I think the more appropriate wording is "... if they decide the benefit is great enough." That's what rationed health care is all about.

Right. That's why in the US, you have insurance companies dictating medical policy. Why do you guys let adjusters decide these things instead of doctors?

I would have thought that in all of the United Kingdom, there would have been one neonatal care center that could have been used. We have one here in the backwater town of Atlanta, surely the worldly folk of London can do better than zero.

Anyhow, I don't see much future in this line of discussion. We will be joining the lines of those that wait for care soon enough.

You're not really claiming that the UK doesn't have any neonatal wards, are you?

Statistics are wonderful tools to find things that need attention. By themselves, they mean almost nothing. We can most certainly not make any conclusions with only these numbers. As is usually the case, further investigation into WHY the mortality numbers are so high would be interesting, but tedious, so it's better left to people that care a little more than I do.

Completely apart from any statistic is the fact that all managed care is a dollars-and-cents operation. What is allowed is determined by cost and benefit ratios. It doesn't surprise me to read that Great Britain doesn't have a neonatal dialysis machine, if there is no overwhelming need for them. It's not a good business decision to buy and maintain one.

We can make conclusions based on these numbers, like the conclusion that this child would have had a higher chance of dying in the USA. You may not like the numbers, but that's too bad.

As for your dollars and cents argument, I can only say that the UK, like every other OECD nation, spends less on healthcare than the US, and has a more successful healthcare system.

The quintessential question of managed care... How do you limit care and still make it seem fair?
Well, if you're in America you limit care based on what the parents can afford. Which is apparently a fairer way than NHS according to the Myrm Bible.