medicine

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She was a friend.  Other people sometimes live their entire lives in one place and keep friends for life, but she was more distant, clinging to me loosely, trying to live off free advice.  Like almost all the friends I have in one particular region, she was a therapist. Not a bad thing to be, and I believe her to be a competent therapist. But she had the same problem most people in my age group have.  She wanted help fighting it.

I suppose the name for it these days is “cognitive loss for age.”  Not Alzheimer’s, that “presenile”  (the earliest cases described by Kraepelin himself was in mid-fifties) dementia, but getting older.

Mainstream medicine comes up with names and categories and prescriptions, that may or may not offer significant clinical improvement. The human spirit comes up with, well, at least a little good anger. If there is one piece of poetry I quote more than any other, it is Dylan Thomas “Do not go gentle into that good night/Rage, rage, against the dying of the light.” Of course this brilliant Welsh poet, the way I heard it, died of alcohol poisoning in New York; not exactly how I plan to rage against the dying of my light. Oh, how many people who have tried to feed me alcohol I have told I cannot afford to lose any brain cells by that method.  I need everything I have to continue to live by my wits. Read more on Advice From A Poet About Memory Loss…

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It was a community clinic where everyone was poor and most seemed spiritless, but this woman was 55 and had fire in her eyes.

“I want the same damn medicines for three months.  Write the prescription.  I won’t kill myself or anybody else, and I don’t have any side effects or problems.”

She knew the routine; so I did what she said.

“I got a half an hour with you. I want to talk.”

I usually asked patients what they wanted to talk about after we had transacted the business of medication management.  Sometimes I got some surprises.  So I told her she could talk. Read more on Not All The Questions Are Medical…

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I was with my husband and a friendly couple, admiring the natural beauty of a mountain pass with snow capped peaks in the distance, when the other gentleman told us that a major natural food chain was removing all of the krill oil from its shelves, because the harvesting of krill was not a bio-sustainable practice.

Now I am usually pretty cool about science; looking at data, revising opinions.  I have never really considered myself an ecologist, since the politics are often richer than the data.  (Ask someone if they actually think the globe is getting warmer and it is not usually necessary to inquire about their political affiliation.)

I just looked him right in the eye and said “No way, this is nuts!” Read more on Don’t Worry — We Won’t Run Out Of Krill…

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People who have panic disorder go to doctors to take care of it.  I have had maybe hundreds of patients, more than I can count over my years of practice, who have come to me with this.  Most of them do well. Usually the panic disorder runs its course.

That is not to say that panic disorder is not terrifying.  Often people believe that their first panic attack is a heart attack.  Often they have come to me already addicted to benzodiazepines by emergency room physicians who (understandably) worry a lot more about the immediate comfort of the patient than about the long term situation. Here is the official government take on panic disorder. Yes, find a psychiatrist you can trust. Yes, they recommend family and support groups.  Good stuff, but free and easy to recommend. Yes, there is some exciting new research but as long as insurance companies and HMOs determine how people get treated, it is unlikely that research will be quickly translated into treatment.

Most people who go with the mainstream treatment do pretty well. Here is another description of mainstream treatment, a little more complete. Read more on A Real Doctor — Like House MD…

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I have had a couple of emergency room admissions as a patient; usually, I was out cold or damned close to it. Sometimes I think I was just in pain or so uncomfortable or so horrendous that I blocked out the memory entirely. Other people, people who seem to know something about medicine, did tell me about things that I did not remember.

Putting their accounts together with what I did check out or do remember, I am convinced that nothing wrong or horrible was ever done to me in an American emergency room. Not in my late teens and early twenties when I worked in an emergency room in downtown Boston, although many of the technologies we now take for granted were not
available then.

I have never been cared for in a French emergency room, except for the time the left half of my face and windpipe swelled up because of an acute allergy to some rare species of white celery that grows in France. I was taken to the emergency room because I felt quite ill indeed. But by the time I got there the symptoms had gone away. They delegated an advanced medical student (perhaps more accurately, a young intern) to talk to me and I was sent home with no treatment, except being told never to eat that rare kind of celery again, which I have not. I do, however remember that interview in some detail. I can tell you, from that interview as well as from my studies, that French doctors, and probably others who study in countries with similar systems, do not think the same way that American doctors do. Read more on American Medicine: Good at Acute Care But Lousy With Chronic Illness…

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The place was Billings, Montana.  I was living with my husband in a posh downtown hotel.  Sounds nice, doesn’t it?

Oh yeah – I forgot to mention that it was the dead of winter.

You are probably wondering why the original “California Dreaming” girl would take off from a winter haven like Palm Springs to frost over in Montana – and the answer is the only one that would account for these circumstances: Somebody needed help.

Like the Lone Ranger, I could not refuse – and besides, it was a heck of a challenge.

cold day in hellThe twist is –- I was helping out a managed care insurance company.  A huge one.

So now we have the makings of a first class mystery.  Renegade Doctor rushing to help out managed care corporation in the coldest part of the country when she could be warming her tootsies in the balmy desert oasis.

Let me go back and set this in perspective. Read more on Cheap And Accessible Medicine Is Worthless If It Is Shoddy…

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