Diagnosis

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I don’t think we plan what our real specialties are going to be.

I frequently tell patients I am an expert on getting through menopause now that I have been able to come through my own relatively unscathed.

I became somewhat of an expert on Asperger’s because I diagnosed many elements of it in my father and just about all criteria in my brother.

They both carried additional diagnoses of bipolar (a.k.a. ‘manic-depressive’) illness.  Neither one was in any way typical.

Both surely had their problems in life.  My father was assisted considerably by his domineering mother who gave him lots — I mean lots — of direction.  She even helped him choose a wife — my mother — who took care of the things in life that were difficult or even impossible for him. Read more on From Sandy Hook to Santa Barbara — Asperger’s Syndrome And Violence…

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I am an expert on this — Anti-overweight discrimination.

First, from my practice.  I remember a woman in her forties I saw in Oklahoma for a routine antidepressant renewal who told me that she had a cardiac condition and had been to her primary physician (this is back in the prehistoric days when I took insurance) and he had told me it was her own fault she was overweight and she was risking her life by doing nothing about it.

She was not suicidal.  She told me she would never see that doctor again.  And she was not going to take any heart medicine. Read more on Anti-Obesity Discrimination and Obesity Treatment…

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Lady Gaga had to cancel some shows because she has Synovitis. Can you get that from wearing raw meat?  Just checkin’.  Actually, I know a little something about this. Synovitis, I mean.  Not the wearing meat part; I much prefer to eat mine.

Go back to me at 18.  Yes, I know it was a long time ago.  But there are some things you do not forget, like my first days in the emergency room at the ancient and venerated Massachusetts General Hospital.  It had been open since 1811.  I read the log; the first patient was a French sailor — ships could dock at the front door, then — with what was politely referred to as a “social disease.”  It was a work-study job assigned to me as an undergraduate, allegedly pre-med, at the sprawling Boston University. They laughed when I said I was going to be a doctor. I took people’s wallets from their pockets, looking for identification and insurance cards and I was good at that nefarious profession.  I loved the moments when it was quiet up front and I could sneak back to an operating or treatment room, stealing a generally useless tidbit of medical knowledge.  Such tidbits seemed so precious then. I remember sneaking back to the cast room when a handsome, muscled, orthopedic surgeon was casting a leg.  He was laughing at me, like everyone else.  He told me to ask him questions. The lady with fake blond hair, whom he was casting, was laughing, too.  “Go ahead, honey.  Ask him questions.” I asked him, I guess she hurt her knee.  “How do you know how high up and how low down to build the cast?”  Above and below the injury.  Knees were kind of a mess, but you always worried about the articulations above and below.  The orthopedist was not particularly articulate.  I started thinking that any idiot could be one, and medical school should not be that hard to get into. I thanked him and turned to leave when he hit me with something I have never forgotten.  “Casts are easy.  Broken bones are easy.  The tough stuff is soft tissue.  Nobody knows a damned thing about soft tissue injuries.  They act like they do, but they don’t.”  I repeated my thanks, and felt bad that I had to slip back to the front desk and the business of who people were and who paid for all this.  Read more on Lady Gaga’s Synovitis…

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The medicating of Americans for mental illness has continued to grow over the last decade.  And while that’s not exactly a news flash, I have seen no approach as fresh as the one taken by the folks at CrazyMeds”.

They are not doctors.  They are presumably patients or potential patients, then, just as some doctors are or should be.  Their approach is so fresh that I am amazed to notice the grain of truth in it.  This is the same way I felt when I visited the Psychiatry Kills” Museum in Los Angeles, operated by the Scientology folks.  They had a distorted view, but I saw where they were coming from. Read more on Psychotropic Drugs, According to their Users…

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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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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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I don’t think I know anyone who can say they’ve never had a headache.  And some have them often enough that they’re given about as much attention as a hiccup or a sneeze.  But sometimes, a headache can be more than a headache.

I was in Minneapolis doing a rotation in neurology through a university headache clinic. A lot of people were referred through primary care physicians and some even from other neurologists.  They were strange headaches to them, but headaches that were frequently seen by these university neurologists in Minneapolis.

I remember seeing a professional football player who had cluster headaches with such intense pain that it brought him to tears.  There were many middle aged and older people, but there’s one girl I remember in particular. She was 23 years old and was given to me to see with no pre-screening. Read more on Headache or Tumor…

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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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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…