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…
Filed under depression, Diagnosis, Disease, Doctors, medicine, Mental Illness by on Nov 5th, 2012. Comment. 
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?…
Filed under Diagnosis, Disease, Doctors, medicine, News, Psychiatrists, Psychotherapy by on Oct 2nd, 2012. Comment.
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…
Filed under Diagnosis, Disease, Doctors, medicine, prescription drugs, Psychiatrists by on Sep 27th, 2012. 2 Comments.
Whitney Houston’s death might be “old news” already, but I still think her death may not have been in vain.
Because Whitney was a star, we were treated to hearsay before facts. She drank in the morning, in a public place, and according to some observers may have been behaving a bit strangely.
There is an old screener for alcoholism called the “CAGE” questionnaire. It’s named after the four questions that presumably even a primary care physician — who has little room left in an overtaxed memory — could remember. Read more on Whitney Houston’s Death May Not Have Been in Vain…
Filed under abuse, Addictions, Celebrities, Disease, prescription drugs, Substance Abuse by on Aug 23rd, 2012. Comment.
Maybe the folks who continue to argue against stem cell research are just afraid their own stem cells could beat them at a game of checkers.
Listen, I want to live forever. Not like in the song “Fame,” but like in the way that most of us would do anything to live. Or like the guy who had to leave the country to get life-saving treatment for cancer of the trachea. Now he is alive when everyone thought he wouldn’t be. It’s a treatment he couldn’t get in the States. In the States, stem cell benefits are masked by misinformation and fear.
Okay, so I had a metabolic disease that threw me into a coma and nearly killed me a few times. But here I am to talk about it. I think about it every blessed day and I find myself grateful to this universal intelligence. Yes, I am a theist. But I still live in a personal world where I would do anything to live. Read more on Stem Cell Benefits Masked By Fear and Misinformation…
Filed under Alternative Medicine, Diagnosis, Disease, Religion, Religion and Politics, Research, Science, Stem Cells by on Aug 17th, 2012. Comment.
“Concordance.” That means doctor and patient wanting the same thing. In psychiatry we call it a “therapeutic alliance.” We work for it — assuming we have the time. But if the time is not there, on some level we all know that nothing will happen.
Leave it to the pharmacists to at least touch on a reason for “lack of concordance” that nobody seems to discuss. “With increasing numbers of medications shown to do more good than harm when taken as prescribed, low compliance is a major problem in health care,” reads an unpretentious sentence in the abstract.
And people wonder why there is no “trust” between patient and doctor. Read more on Trusting Your Doctor…
Cute but deadly E. Coli
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The Renegade Doctor
Filed under Disease by on Jun 12th, 2011. Comment.
If you have a choice and are not involved in an emergency, you can improve your chances of coming out of the hospital alive if you time it right.
I have read lots of articles suggesting that mortality in American hospitals is higher around July 1, when a new group of trainees finish medical school and start in their hospital based clinical training positions. This is not just an aberration in the USA, but apparently is also true in the U. K, where the new training programs start on August 1. Another cause of in-hospital mortality has been identified — When nursing staff falls below certain target levels, patients die. I do recall that nursing schools, at least when I was close to such things, did not have the same kind of fixed scheduling for trainees that medical schools did. When nursing students were present, they always seemed to be observing and logging in time, although whenever they had procedures, they were more rigorously monitored than physicians. Read more on How To Get Out Of The Hospital Alive…
Filed under Disease, Doctors, News by on Jun 2nd, 2011. Comment.
It is a sad fact of modern life that it takes tragedy to bring important information to the notice of the general public. In this case – the death of a young person participating in sports. Read more on Sports Dangers Are Too Often Revealed In Tragedy…
Filed under Diagnosis, Disease, News by on May 24th, 2011. Comment.
Okay, let me get this straight. We are looking for new science to stop an aged population from getting Alzheimer’s and getting dependent on others for that structured “senile” type care that is expensive and — let’s be honest — usually not enough to keep people really productive.
The first of the two studies reported here is basically saying that people with lower amounts of measurable beta amyloid marker have more cognitive decline over the nine years studied. Another report on the elusive “marker” for Alzheimer’s. If someone can tell with a blood test that you got it, what are you going to do? There are several drug companies, presumably including the folks at Avid Pharmaceuticals, who sponsored the second study, for a molecule that binds to the protein that ends up in microscopically visible “tangles” that show up in biopsies and autopsies of Alzheimer’s type brain tissue. It is also reported that educated people are less likely to get Alzheimer’s. Frankly, this sort of finding is usually attributed to a “use it or lose it” analogy to the physical workout. In some ways this is true. I remember some lovely studies when I was in France that led La Nation to tell seniors to slowly practice memorizing their shopping lists, and they did indeed seem to improve their recent memory.
I also remember a study I suspect the rest of the world has forgotten, called the “Minneapolis Nun Study.” Read more on Misguided Research Is Dithering Around Alzheimer’s Again…
Filed under Alzheimer's Disease, Disease, Research by on Mar 22nd, 2011. Comment.