Diagnosis

0

Recent research by the Centers for Disease Control and Prevention’s National Center for Health Statistics has confirmed a longstanding trend — namely that whites live longer than blacks pretty much consistently, and have for a long time. People have attributed this to the increased difficulty of containing blood pressure in black people — probably a genetic difficulty– which leads to increased rates of both stroke and of heart disease. Both have long been established as being deadly. Plenty of well meaning people have at least tried to deal with this. One of the well-meaning people is me. Many times I have seen people of color for other reasons, checked their blood pressure, been concerned, and referred them to appropriate blood pressure followup by general medical personnel. Of course, I have no way of knowing how many (if any) went where I told them, but I tried.  

I mean, I would tell them, “If there is something extra that can be done to make sure you are around for a  few more years, to see the grandchildren grow a bit or whatever is precious, then it should be done.”   I usually have no problem getting the person to agree, at least in my presence. Menthol cigarettes are a different kind of issue, and therefore a little tougher to be unequivocal about. Read more on Ban Menthols? Our Government To The Rescue!…

Filed under Addictions, Diagnosis, Disease, Government by on . Comment#

0

THE PLACE: Medical school, France
THE TIME: 1975

I have survived the “concours,” a competitive examination that I would compare to an intellectual equivalent of “American Gladiators” and through human dissection, the anatomical study of a human who previously walked the Earth.

An Accurate Diagnosis Is The Basis Of All Treatment

An Accurate Diagnosis Is The Basis Of All Treatment

Now our class is now going to start doing medicine with real, live people.
The excitement is great on our first day of an immense multispecialty class that will take the year, called “Semiologie.” The best English equivalent I can think of is “diagnostic signs.” We each receive notebooks and documents throughout the year that are signed off on by professorial-level clinical teachers who are doctors and have practices.

Read more on Nothing Happens If The Diagnosis Is Wrong…

Filed under Diagnosis by on . Comment#

0

“I wants me some of them-there antidepressant pills.”

He was a 47 year old good old boy of the sort I had treated in Oklahoma and other rural parts west –a real cowboy. He had herded animals and done the rodeo and all of that.

No, he had never seen a psychiatrist before, ever.  He had been out crying on the front porch, and it was a next door neighbor who had somehow convinced him that there were medications and he did not have to tell his whole life story to get pills. Well, maybe that would work with a general practitioner, but he was not only disappointed but also angry that it was plainly NOT going to work with me. Figuring he had been had, he broke down and told me the story.  I could understand at once why he had been reluctant to get into this, for we went through half a box of Kleenex while he gave me a plot that was worthy of a tear-jerky country song. Read more on A Cowboy’s Lesson — Antidepressants Won’t Work Well With Alcohol…

0

Mostly everyone who knows me knows I love performance of “funny” things, had a brief run as a stand-up comic, all of that.  But once when I told one of the nurses who I had been working with that I wanted to learn more about “clowning” — meaning classic clowning, costume, makeup, like at the circus — it was plain from her facial reaction that I had struck terror into her. She stammered, “I hope you are not going to do any of that stuff here. I am really scared of clowns.  I ran away from one when I was little and clowns still make me really uncomfortable.” Of course I told her I would not do anything that could scare her. I have to admit this affliction was unknown to me in the world of psychiatry.  I guess it just isn’t anything anybody would come in and request treatment for, at least not yet.  I suppose they would just avoid circuses.

They call it coulrophobia, and it is allegedly ranked among the top ten most common specific phobias by somebody, although I certainly could not find it in any such list.  I have never seen a patient who came in with this one as the chief complaint, which means people probably see some kind of non-medication prescribing health professional if they see anyone at all.  I mean you can find people on the street or among your friends who are uncomfortable around something — fear of spiders or fear of open spaces. Those are far more likely to be in the top ten.
Read more on Fear of Clowns…

Filed under Diagnosis by on . Comment#

0

My weakness for the “classical arts,” in a world where “beats” pass for music and random words pass for poetry, is known to anybody who knows me. There are a couple of people who discuss classical arts with me in secret, at work or play. Like the opera “Carmen.”  I think it is the favorite of a lot of people.  Even though it was written in French by Georges Bizet, the use of traditional Spanish musical songs and dances gives it more snappy tunes than even George M. Cohan could cram into one show.

I was minding my own business and singing the habanera to myself. “For love is like a gypsy child/ who has grown up without any rules…”

I told a counterpart in my own profession. “Carmen is a model to all Spanish borderline personality disorders.  A perfect model.” Read more on Borderlines In Song And Story…

Filed under Diagnosis, Personality Disorders by on . Comment#

0

She was 28 and pretty and sweet and came in for depression.  It was only systematic questioning that confirmed she was manic-depressive. Actually her next-door neighbor had seen a television show on manic-depression and had made the diagnosis a couple of years before, long before this woman had ever seen a psychiatrist.  Her episodes had curiously enough been regarded more as amusing than as dangerous, so nobody had ever done anything about treatment.

By the time I knew anything about her, she had already had one child, and was pregnant with her second.I always believe in coordinating forces with the obstetrician/gynecologist when caring for a pregnant woman.I rarely get phone calls returned, but this is the way it should be, especially if someone has brought up the question of psychotropic drugs. She had never seen a doctor; her first child, and this one, had been delivered by a nurse practitioner midwife. The one thing I am absolutely sure this woman did better than any physician (except me) is answer phone calls. She was obviously thumbing through the old chart on the other end of the line when she told me: “After the birth of her last child she ran after her husband with a kitchen knife.  She destroyed a bunch of stuff in the house.  We did not know whether or not to believe the husband.  After all, he had a serious history of drug abuse.  They were sent to counseling; there is nothing more in the notes.”

It took all I had to keep from yelling into the phone at the top of my lungs. Read more on “Postpartum Psychosis”…

Filed under depression, Diagnosis by on . Comment#

0

She said she was depressed and anxious.  She was 38, large, and animated, with almost glazed over excited eyes, and talking a mile a minute.

Every person who tells me he or she is depressed gets asked the necessary questions to determine if he or she has manic-depressive illness, otherwise known as bipolar illness. The only way to determine this that I know about is by asking.  Nobody who is depressed and comes in for treatment of same is going to spontaneously volunteer the info I need to make the diagnosis. Read more on Bipolar Could Be Misdiagnosed As Depression…

Filed under depression, Diagnosis, Disease by on . Comment#

0

We can’t pick our diagnoses like we pick what outfit we are going to wear.

I remember an encounter where the psych symptoms had political overtones, although I’ve handled plenty of other cases that had the same resistance to being diagnosed.

“I’m scared of this bipolar thing,” he said.  “Everyone I know who has it is really sick — like crazy — and I’m not sure I want to take medication for it.” Read more on Great Manics of History…

Filed under Diagnosis, Personality Disorders by on . Comment#

0

I was working in psychiatry at one of those university medical centers, in a big city in the middle of a sparsely populated state. This 54 year old Caucasian farm wife had been referred to me by a surgeon — a rare state of affairs, since most of the surgeons I knew at that time and place did not believe in psychiatry and would not have referred a patient unless out of desperation.  No note, no phone call to the front desk of the psychiatry clinic, no nothing.  She just walked in and explained that the surgeon had basically kicked her out and said she was crazy. I asked her why they sent her.  Her answer is so burned into my consciousness that I can give it verbatim these many years later.

“It really bothers me that I don’t have a belly button.” Read more on Somatization Is Something To Talk About…

Filed under Diagnosis by on . Comment#

0

She was 29 and I thought she was beautiful, although nobody else did, I am sure.  No normal scales in my clinic could weigh her, but I would put her between four and five hundred pounds.  Except for someone who brought her to see me ( I think, in the back of a pickup truck, but I did not press the issue) she did not leave the house. Others did her shopping, she had some kind of public assistance.

She was on the standard medication for her depression as well as her panic attacks; paroxetine (Paxil) 40 mg, to lower their intensity and frequency, and a little bit of Xanax, which is supposed to stop such attacks in their tracks.  She used it sparingly, hardly at all — no really — she did not use it.  It did not work.  The most addictive medication doctors give for this sort of thing and she didn’t even want it because it didn’t work.   I love this woman, I loved her candor.  She told me the last  psychiatrists had renewed these medications for the last six months,  even though they didn’t work.

What was wrong??? Read more on Panic and Diabetes…

Filed under depression, Diagnosis, weight by on . Comment#