Thanks to the expertise and also the dedication of the medical professionals who treated them when they needed it most, twins Mario and Pablo, Margarita, Carlos and Ángel saved their lives or overcame rare disorders. These are their particular stories, which highlight the high level of health in our country.
Case 1: To the operating room before birth
Pablo and Mario are two and a half years old and underwent a complex intervention in the uterus. Her mother, Tamara Fernández Calle, had her pregnancy complicated with twin-to-twin transfusion syndrome . In this disorder, fetuses share placenta and blood connections, but a failure in these causes one sibling to pump blood to the other. The result is that the donor twin does not grow enough, barely urinates, runs out of amniotic fluid, and may die from lack of oxygen. The receptor, for its part, develops abnormally; urine to try to reduce the excess blood it receives, which creates a lot of amniotic fluid. Overexertion can affect your heart.
“This problem, when it occurs before viability, leads to the death of both in the vast majority of cases,” explains Eugenia Antolín, head of Ultrasound and Fetal Medicine at Hospital La Paz in Madrid and the patient’s doctor. However, there are times when it has a solution thanks to endoscopic surgery . Using a minimally invasive technique, fetoscopy, placental vascular connections are laser coagulated to restore adequate blood flow. It is not a frequent intervention, but at Hospital La Paz, about fifteen a year have been carried out for five years.
The diagnosis is usually made between the sixteenth and twenty-second weeks of pregnancy . “Although better results are obtained when it is intervened after twenty weeks, sometimes, the severity of the picture requires action at earlier gestational ages. It is a complex intervention, but we are specialized in it”, emphasizes Dr. Antolín.
The chances of survival are between 75% and 85% for at least one twin, and 55% to 60% for both. Neurological sequelae are below 5% and are often related to premature delivery. In Tamara’s case, the operation was carried out in the twenty-third week of gestation. She remembers that she remained calm, “because she knew in whose hands she was”. Once the problem was resolved, the pregnancy continued normally. Pablo and Mario were born with two kilos of weight and healthy.
Case 2: The martyrdom of an infected prosthesis
Margarita Cuétara, 53 years old and living in Puebla (Mexico), has returned to interpret her role in La casa de Bernarda Alba , the play by Federico García Lorca. She underwent surgery on her hip several times until the prosthesis became infected in one of them . The pain accompanied her for months. “A painful lump appeared on the scar from the operation, and one day it burst. I had another surgery, but a month later the wound reopened and I returned to the operating room for a cleaning. Without success ”, details the actress.
In the midst of that ordeal, coincidentally, his brother read a report on Manuel Villanueva, a virtuoso of world traumatology , director of Avanfi and of the Unit for Hip and Knee Prosthesis and Prosthetic Spare Parts of the Beata María Ana de Jesús Hospital, in Madrid. After a conversation with the specialist, Margarita put herself in his hands. “She arrived in Barajas from her transoceanic flight with her clothes stained with pus, she was consumed by the disease, but she kept a live look and conveyed a dignity and a desire to heal that impressed me,” recalls Dr. Villanueva.
Infection in prosthetic operations represents one of the most important and devastating complications. It is very rare in a first intervention, since it occurs in a maximum of 3% of patients, although the percentage increases when they have to be repeated or the tissues are severely damaged.
The goal of treatment is, in the words of the specialist, “to eradicate the infectious process and maintain the function of the limb.” To achieve this, a two-stage treatment is carried out. In the first surgery, the contaminated tissue is removed, a temporary prosthesis coated with antibiotics is implanted and spacers are placed to keep the joint active. Once the infection has been solved, the definitive implant is carried out.
“People see me walking normally and it seems incredible to them. I even dance, yes, with caution ”, recalls the patient. Cases like yours are extraordinary, since most people who go through an operating room have no problems.
These operations were rare before, but now, as Dr. Villanueva points out, they are in high demand: “First, because the success rates have risen, given the superspecialization of surgeons and improvements in materials. But, above all, because prostheses give excellent results. They are not to be feared, they do not last, as everyone thinks, only ten years ” . Those of the knee can reach twenty and those of the hip even twenty-five among patients under 55 years. The incorporation of new ultraporous metals that allow better fixation to bone is expected to make these results the norm or even improve in the near future.
Case 3: Living without dying of sleep
The tenacity is the best quality that defines Carlos – the name is fictitious. He lives in Palma de Mallorca and has learned to swim against the current. “If I didn’t have narcolepsy, it would be a prodigy, because the effort would spread much more to me,” he says. His condition is the most serious of hypersomnias, disorders characterized by constant and involuntary drowsiness and uncontrollable and frequent daytime sleep attacks .
Eduard Estivill, director of the Estivill Sleep Clinic in Barcelona, states: “It affects between two and seven people in every 10,000. 88% develop the first symptoms before the age of 35, but sometimes it takes a long time until they are diagnosed. “. For Carlos it all started when he was twelve, although the nightmares and hallucinations came earlier: “I played tennis, and on the way to the courts I fell asleep in the car. In one game I noticed how my body became paralyzed from the waist up. These attacks lasted a few seconds, “he explains.
Drowsiness affects all narcoleptics, and cataplexy, seven out of ten. 25% of the latter suffer hallucinations at the beginning or end of sleep and only 5% suffer from paralysis. ” Cataplexy consists of the sudden and reversible loss of muscle tone during wakefulness , triggered by an emotional cause, such as joy, fear or surprise. It can affect some or all muscle groups and immobility lasts from a few seconds to half an hour “, reports the expert.
A typical situation of the disorder occurs in basketball or tennis players, such as Carlos, who notice the sensation of loss of strength in their arms at decisive moments. The thrill of trying to win can provoke the attack. If no one knows that the cause is the disease, the affected person comes to think that it is no longer useful for practicing that sport, which triggers frustration.
In one of the medical tests to find out the origin of his problem, Carlos fell asleep. The suspicion that he suffered from a sleep disorder was immediate, and his family doctor recommended that his parents see a specialist. Doctor Estivill applied a treatment against the symptoms, since there is no therapy that ends the disease: “We prescribe drugs against drowsiness, hypnotics to sleep better and drugs that control cataplexy.”
In addition, good sleep routines are essential, including stable schedules and daytime naps. “Carlos is stabilized and comes to controls every six months, but we maintain contact by mail, which allows us to solve small problems,” he adds. For this specialist, the emotional aspect of the patient and his environment is fundamental: “In this case, we have had the collaboration of an exceptional family, who have given absolute support to the treatment.”
Carlos wants to be a doctor. His guardian angel, Dr. Estivill, predicts a great professional future, “since he can carry out most activities despite the limitations imposed by his illness. He will not be able to be a motorbike or Formula 1 racer, but also we treat people who are doctors or artists and live happily . ” After the experience, his patient is clear: “My life would never have been the one I have and the one that awaits me without his care.”
Case 4: When the heart stops beating
He wanted to be a policeman and to pass the oppositions he attended his training sessions at a sports center in Alcorcón (Madrid) on time. Ángel Lázaro, twenty-six years old, was running on the treadmill when he fainted from a cardiac arrest . This is how he recalls it: “Everything I know has been told to me. I don’t remember anything. I have always practiced a lot of sport and, although I smoked something, I never suspected that this could happen to me.” Fortunately, the center had purchased an automated external defibrillator (AED). The device allows the patient to be resuscitated with an electric shock that restores the heart rhythm.
Ventricular fibrillation – the worst of arrhythmias – and ventricular tachycardia are the most common causes of arrests . We all have in our minds the image of the Sevilla footballer Antonio Puerta, who was struck down in a match. It is not an isolated case. In Spain, 24,000 people of any age, sex or physical condition go through this experience every year. Only one in twenty survives thanks to immediate care.
For more than a decade, AEDs have been installed in companies, stations, gyms or department stores with the aim of increasing survival. Half of the patients would save their lives if they were properly cared for in the first three or four minutes after the event.
“The probability of achieving a successful defibrillation is reduced by 10% for every minute that its application is delayed ,” recalls José Luis Zamorano, head of Cardiology at the Ramón y Cajal Hospital in Madrid, and Ángel’s doctor. Every second counts. Consciousness must be restored to the patient, and what is more important, ensure their quality of life. “It is about ensuring that the affected person continues to have a full social and work activity,” says Dr. Zamorano. We must bear in mind that, when the heart stops, the oxygen carried by the blood stops reaching the tissues, including those of the brain, which can cause irreversible damage.
Carla Lázaro, the patient’s sister and cardiologist, comments: “He was very lucky. Not only because the attention was immediate, but because I was able to access the record of the defibrillator and I verified the good work that had been done.” For this reason, specialists insist on the importance of training everyone in the use of these devices . If it is not done, they are of no use.
As a safety measure, an implantable cardioverter-defibrillator (ICD) was placed . Located under the skin and fat, and sometimes under the pectoral muscle, this device detects heartbeat problems. It combines the functions of a pacemaker and a defibrillator. The former is carried out by applying small, painless and generally negligible low-voltage pulses. If there is a new cardiac arrest, it performs its second role with more intense shocks, also known as shocks. The patient perceives them as a strong blow and can be painful. “I can no longer be a police officer, but I continue to exercise and lead a normal life, controlled by a great medical team. The truth is that in my case there was a family history of cardiac arrest, but we did not notice it,” Angel adds.
Photography: courtesy of Tamara Fernández Calle
Illustrations: José Antonio Peñas
