medicine

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The psychological ability to adjust to chronic medical illness is an area where there has been very little study.  Lately, I find myself working mostly with this population of people.  I’m noticing that some adjust very well and some do it very poorly.  It depends on a lot of factors.

The situation is clearest when the illness we’re talking about is back or neck pain.  Back pain, more than neck pain, has been clearly correlated to the presence of major depression.  If a person walks into the office crying and says they’re having trouble controlling what’s going on, it’s a pretty sure bet we’re dealing with depression.

Most back pain patients aren’t prepared for the kinds of life adjustments they are required to make.  Generally, many will need to switch from a job that has involved lifting or other physical work to a job that is more sedentary.  Quite honestly, most back pain patients are in no way prepared to do this.  Mostly, this is because anything that is sedentary is going to require a higher level of education.  Most of the folks I’m seeing are not highly educated, so the back pain leads to incapacity. Read more on Adjusting to Medical Illness…

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By every measure, America is hanging onto its first world status by a thread.  And even that is arguable.  We have been in slow decline toward third world status for the last 30 years.  And nothing speaks to this reality more than this country’s poverty rates. It is sad that poverty is measured in percentages and indices that are debatable at best.  As in many news stories, an effort is made to personalize — to render concrete — these elusive numbers.  The happiness of the person who found free fruit but could not afford it at Walmart, cited at the end of the article, is a touching story. These are the stories of real poor folks, who have seen me as patients, in rural northern California. Folks like the married couple, both of whom were on active army duty in both Iraq and Afghanistan.  They left their kids with their parents while they served.  They wanted to continue serving, but were informed they could not because of “military cutbacks.”  They asked for job direction from VA counselors who were no help, and finally both found minimum wage jobs.  Their new wages combined total less than 1/4 of their military salaries, but they still make too much to qualify for insurance.  They own some land — from the family – where they are living with their children in their parents’ houses.  They are wondering how they are going to pay for their children’s medical care. Like the young man who has impacted wisdom teeth and back pain from a serious accident at a saw mill.  Something ran amok and tons of wood fell on his back. He cannot pay for either dental care or an operation on his back.  His family has chipped in for medical marijuana.  He has no idea of how to do anything except stay home, in pain, depressed, and stoned. Or there’s the older woman on oxygen who cannot lift her tank and has a bag of pills she cannot lift either.  She needs me to hold her hand while she limps with great pain into my office.  She has a broken hip but until she is old enough for Medicare — a year or so — mostly her friends shop for her and bring her everything she needs.  What she really needs is an operation on her hip but has no idea how to pay for it.  I tell her to ask her doctor for some kind of a device to assist ambulation.  She says a cane is not enough and nobody will pay for a walker; certainly not for a wheelchair. Some people think Obamacare might help but have no idea what to do until then.  I have seen unemployed young people who are glad they are still on their parents’ health insurance. The kinds of things I am seeing are the kind of things that missionaries see in third world counties.  I know some physicians who have been discouraged from that kind of work, simply because people need basic food and shelter before they can be cured or managed.  From what the people above tell me, they do not seem to have these things, either. Hanging on by a thread to our first world status?  No.  The thread has broken and we are third world. Now.

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In the National World War II museum, it is easy and even triumphant and pride-generating to look back and see some of the scientific advances made during World War II.  There’s no doubt that science is advancing.  But I wonder if our ethics can keep pace.

I am fairly proud of Teflon.  And synthetic cortisone is widely used and may have saved plenty of lives. It’s a steroid that knocks down the action of the immune system.  When a medical substance becomes cheaper and easier to use and known to the public, then it runs a real danger of getting overused.  Most concern about overuse is focused on illegal steroids taken by athletes.  Nevertheless, everything that can be helpful and fast may make things worse. One example would be the over-prescribing of steroids to kids with allergies.

Penicillin had been invented before WWII, but its use did not become widespread until WWII.  Of course, it took people awhile to find out about the ability of bacteria to develop resistances to antibiotics.  This has led to newer and stronger antibiotics, which would not be the worst thing in the world. Unfortunately, the excessive use of antibiotics has led to untreatable infections, such as methicilline-resistant strep and an untreatable strain of tuberculosis. Read more on Science and War (and Ethics)…

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I enjoy having friends, like just about everyone does. But that’s not why I’m in this business. When a patient needs help, I will do my best for them every single time.  And if a few colleagues get bruised egos along the way, so be it.

She was a 53-year-old woman, but I don’t think she even would have liked to hear me to refer to her as a woman.  We’re talking about someone who was short and stout and wore the kind of cap one would expect to see on a newsboy during World War I.  She wore a very male looking zipper jacket, and told me she had the name of the other woman to whom she had dedicated her life tattooed on the back of her neck.

Regardless of all this, her face was red and she was crying. She told me she was chronically suicidal and never thought about anything else.  Despite being medicated, her depression seemed to have gotten worse. Read more on What is there to Treat?…

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Ever heard of capitation?  In healthcare, it can mean that a clinic makes more money by following more patients.  Payments are per person, rather than per service.  I guess I shouldn’t be surprised, then, that they refused to dismiss this guy from their care.

He was a 32 year old young man who was diagnosed with an anxiety disorder.  He had been working independently as a pool cleaner but he couldn’t stand it anymore.  He was always nervous.  As a matter of fact, this man was nervous about everything he did.  Perhaps it was a generalized anxiety disorder, but surely something a great deal more.  He wasn’t having panic attacks, and he exhibited far more than the usual one or two things found in generalized anxiety disorder.

I tried to start him on some medications — as much as I didn’t like the medications he had been started upon.  He had been given regular Xanax in slowly increasing doses.  As nervous as he was, he wasn’t stupid.  He said, “It’s really funny.  The medication makes me sleep, but it sure doesn’t stop me from being nervous.” Read more on The Nervous Pool Cleaner…

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I have spent as little time as possible on the staff of hospitals.  The interface between doctors and administrators has always seemed to be dominated by petty politics.  People are interested in money, and secondary to that, some vague sort of reputation or power.

A large and prestigious Midwestern hospital used to have a certain kind of meeting every few months.  This hospital had only the vaguest of University associations — just enough to make it look academic and research oriented.  I knew perfectly well it was neither.

It was a luncheon meeting of the medical staff and a few administrative types — uncommonly well-catered. There were about 25 folks, but only two other women who looked as uncomfortable as I was.

The meeting was to discuss certain hospital statistics, including some case details.  As the meeting agenda was passed around, the head of the hospital reminded us of the meeting “rules.”  We were gently reminded that no recordings were permitted and neither were extraneous notes.  We each received an agenda, which were carefully counted out as they were distributed.  We were told that at the end of the meeting they would be collected — and counted — before any of us could leave. Read more on Hospital Accountability Is An Ideal (Not Always Reality)…

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As it turns out, this whole bit about the use of antibiotics in livestock and poultry is a complex issue.  It’s well beyond anything that anyone would guess at first blush.  The best online summary is the position paper put out by Food Marketing Institute.  Curiously enough, it doesn’t have a year on it.  Based on the references, I’d guess it was probably around 2005.

The Food and Drug Administration has approved the use of therapeutically low doses of antibiotics in feed.  However, very few studies were conducted.  They decided that giving little bits of antibiotics to animals would help avoid illness.  What this means in practical life is that they will grow faster and produce more meat prior to being slaughtered and eaten.

Everybody agrees that using too many antibiotics in humans can cause humans to become resistant to those antibiotics.  This has been blamed on everything from patients who want a prescription for an illness that isn’t caused by bacteria to doctors feeling they need to give a prescription to justify their fee.  This kind of talk has been around for a long time. Read more on Antibiotics in Livestock Feed Endanger The Entire World…

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Britney Spears doesn’t make the news much anymore.  Her career is probably still going strong, but her wild ways and scrapes with the law are old news.  The media has latched on to new starlets and scandals, and they will never run out.

However, I noticed recently a story about conservatorship of this once-superstar (perhaps now only a mega-star?), and wanted to take the occasion to talk about this very serious legal step of conservatorship.

Miss Spears’ father is her conservator, and he wants her boyfriend appointed as a co-conservator over her well-being, and this might be a sign that he’s getting ready to marry her.  There is something very wrong with this picture.

People having conservatorship over other people should not be taken lightly. Read more on Brittany Spears, Conservatorship and the Abuse of Power…

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I read a joke once about a husband’s preemptive strike in the bedroom.  He walks in holding two aspirin and a glass of water.  When his wife asks what it’s for he says it’s for her headache.  She replies “But I don’t have a headache.”  “Gotcha!”

Headaches are no fun, so we might as well get a little chuckle at their expense.  And if you suffer from sinus headaches, there might be quick and inexpensive relief your doctor hasn’t shared with you.

Listen, I have had allergies since I was small but sinus headaches have been rare.  That is, until I got my complete dental implants.  They have wildly improved my quality of life, but I have had more intense and regular sinus headaches as a result.  My surgeon had removed teeth prior to the implants and freely admitted he had been up in my sinus area.  He said I could see an ear nose and throat specialist if the sinus headaches became too much of a problem.  He tried to ignore my laughter as I told him I could fix this myself. Read more on What Your Doctor May Not Tell You About Sinus Headaches…

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Take two Tylenol and call me in the morning? Research now suggests that our emotional and physical pain are interrelated. Maybe Tylenol really is good for more than just headaches.

This is the dichotomy between even the best experimental science and real life as we clinicians see it.

Who has not seen a kid put his or her hand on the umbilicus and say “my tummy hurts” when he or she doesn’t want to go to school?  That child is likely trying to avoid something unpleasant like a bully or a difficult assignment.  Oh, our beliefs in the separation of body and mind are so deeply engrained that adults might even think they are faking.  But perhaps children are just more open and direct. Read more on Mind-Body Connection Proven at Last?…

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