medicine

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As you may have heard me say before, not all doctors are saints.  Patients often tend to revere doctors — of which I heartily approve! But as with any group there are always bad apples.  And if not all of the apples are bad, there are also incompetent ones.  Sometimes they are well-meaning.  Sometimes they are just hoping nobody catches on so they don’t lose their livelihood. But I am definitely NOT anti doctor, anti medicine, anti prescriptions or anti anything else.  I know there is good and bad everywhere. Unfortunately, in medicine, the bad or the incompetent can mean the death or suffering of innocent people.

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I just did one of those continuing medical education courses — in psychiatry, my very own field no less. It says that people who get a bout of depression are twice as likely to get a bout of back pain. What I read is a meta-analysis.  That means some clever person who probably needed the publication on his (or her) resume did a statistical (and critical) analysis of research other people did. This a noble attempt to asymptotically approach “the Truth and the Light” on a subject. It is also a delightfully erudite way to do research and get a publication without using a lot of time and money that the author had to scrape up.

Look, the relationship between depression and low back pain is something I have seen from every imaginable angle. As a neurosurgeon, it did not take me terribly long to figure out that surgery was not a very good solution for back pain. Of course, we rigorously restricted ourselves to operating focalized sciatica.  Cases where we could reasonably infer that an intervertebral disc seemed to be compressing a distinct (lumbar) nerve root that formed part of the sciatic nerve (plexus) that descended from the spinal cord to the leg and foot. There was the physical examination.  If someone were lying flat on his (more rarely, her) back and their straight leg was raised toward the ceiling, pain would appear on a trajectory anatomically consistent with one of those nerves. This was the sign of Laseque.  And we took it to be as solid as money in the bank. Read more on Depression and Low Back Pain…

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How low can you go? Stealing drugs from veterans?  I am a proud U.S. veteran, prouder still to consider myself a veterans advocate. I’ve seen too many veterans in pain.  I don’t think people who haven’t been there realize how much war is hell. They were stolen by a doctor.  A credentialed anesthesiologist.

I remember when I was first hitting dating bars and such, it was not uncommon for a  non-doctor to wear a T-shirt that said “trust me; I’m a doctor” that I guess was supposed to induce young women into the early stages of romance. Read more on Stealing Drugs And Eliminating Health Care…

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She was an active patient, who I am still trying to see once a week until I direct her in how to survive and flourish in the universe. She was in her forties, depressed and anxious.  She had “a little panic attack,” some chest pain and the feeling her breath was cut off. I wasted no time sending her to an Emergency Room, (or, if she really did not feel it was that bad, to an Urgent Care — what we used to call it a “doc in a box”) because it is cheaper, sounds less foreboding, and any doctor who is sentient and has a pulse and is on duty would send her to an Emergency Room if anything was really wrong.

Chest pain or tightness or shortness of breath or a “tight feeling, like a vice” could always be a heart problem, and could always be life threatening until proven otherwise.  I tend to send  even the most mild discomforts of this nature, that people had for years to primary physicians for a “cardiocentric examination.”  For “auscultation,” the old fashioned Latin-origin word for a good listening to the well as generally an electrocardiogram and sometimes even an echocardiogram.

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I find a lot of things I like in the New York Times. This article resonated with me as few others. First, there is the purpose of the human profiled.  Changing medicine into data science?  God save us all.

Sometimes I feel the best thing I do for a patient is to be human.  Just to have the pretension (a pretension which I do not take lightly) of being one human being in a room with another human being, trying to make them feel better.  This does more, I think, to make most of my patients “better” than all of the pills I have spent years studying about. All those years studying normative use of medications on large populations of humans.  And they work enough to please the powers that be.

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Too many Americans can’t afford to and simply do not–take their medicines as prescribed. That estimate is based on information from the (American!) Centers for Disease Control). I have had patients come into my office who take their medications –in both cases, for life-threatening infectious diseases — only every other day, simply because that is all they can afford. I explained to each one individually the idea of the half-life of a drug. They only stay in your body for a certain length of time, then they leave your body in waste products.  That is why taking a drug every other day is not really effective. They both gave me almost exactly the same response — It was all they could afford, and it was probably better than nothing. Read more on Big Pharma Is Capitalism Out Of Control…

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If you were alive and in America in 1971, you probably heard John Denver sing “Take Me Home Country Roads.”

The lyrics start:

“Almost heaven, West Virginia…”

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“In spite of everything I still believe that people are really good at heart. I simply can’t build up my hopes on a foundation consisting of confusion, misery, and death. I see the world gradually being turned into a wilderness, I hear the ever-approaching thunder, which will destroy us too, I can feel the sufferings of millions and yet, if I look up into the heavens, I think that it will all come right, that this cruelty too will end, and that peace and tranquility will return again.”
― Anne Frank, The Diary of a Young Girl

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I was about three years old when I enjoyed tending our backyard with her.  I had been a marvel to her, since she was a little girl, earning her keep as an agricultural worker in the Ukraine, it what was then known as Russia.

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My husband loves showbiz stories.  He was an avid movie fan while I was studying medicine, which meant he had a whole world to introduce to me, since my education at prep school including being somehow given the impression that cinema was a degenerate form of entertainment, compared to other arts. So my husband was piddling around on the internet when he told me some things about Wally Cox, the comic, and his friend Marlon Brando. I couldn’t imagine two people more-opposite and was surprised to learn what he told me.

Read more on Who You Are — and Who You Present Yourself As…

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