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…
Filed under Brain, Diagnosis, Doctors by on Oct 2nd, 2012. 1 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.
I am happy — really happy — with something the state of California has done. It is a very, very good thing. They have become the first state in the nation to ban therapy that tries to turn gay teens straight. I am armed with subjective histories. My heart, if not my brain, goes to them first. My first private office in California was in San Diego and just happened to be near the center of the alternative lifestyle community of that fine burg. I heard tear-stained stories from gay guys whose parents had “suggested” therapy of this sort. One man, who saw me for treatment of a physical pain syndrome, told me how his parents wanted and believed in a heterosexual son. He cried as he told me about their “Christianity” and their desire for him to father a family. They would even try to encourage him on dates with girls when he felt “less than nothing.” Curiously enough, I remember him as being part of one of the most highly committed and long lasting dyadic relationships I have ever known. He had a loving male partner who brought him to every appointment and waited in the waiting room. When I approach a situation, I do not start with subjective data, however emotional. I look farther.
I know that the searchers of the human genome for markers for homosexuality have come up empty. This seems to mean that homosexuality is probably not genetic. It does not mean it is not biological. Last time I tuned in, people seemed to believe that homosexuality — at least in males — seemed related to stress during pregnancy. I was still back in Europe when I read that the largest number of gay males ever born in a similar set of circumstances were the male children born to women who had been incarcerated in concentration camps. Read more on Good for California! “Straightening Out” Gays Is Now Illegal…
Filed under Family, Government, News, Religion by on Oct 12th, 2012. Comment.
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)…
Filed under medicine, News, prescription drugs, Research, Science by on Oct 14th, 2012. Comment.
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.
Filed under Family, Healthcare reform, medicine, News, Public Health System by on Oct 16th, 2012. Comment.
The USA Today has highlighted a new study that says newlyweds who have “cold feet” going into marriage are more likely to divorce. I say make sure those feet are warm because divorce can be hell and children can be enveloped in that hell if you wait long enough.
I found the abstract of this study, but the dry academic summary tells me very little about the actual study. I can view a copy of the study if I pay for it, but I regard this as a low down dirty trick perpetuated by academics who want us to think their research is always worth something — which it’s not, necessarily. Notably, I am unable to access any juicy gossip points that may actually tell me something useful, such as who paid for the study.
This always seems to have something to do with results and can sometimes infer whose tenure was dependent on this thing getting published. I will also refrain from commenting on publishing papers by psychologists, other than to say that they can get away with publishing an awful lot of “questionnaire” based and “pencil and paper” studies. Medical doctor psychiatrists always seem to have to sample at least one bodily fluid to get something published.
The author of the study — Justin Lavner of UCLA — basically says that people who have “cold feet” or “jitters” at the time of the wedding are more likely to divorce later.
The study followed 464 newlyweds. He says nobody can say for sure whether folks had doubts about their partner or about the institution of marriage in general. This tells me the study could have been designed to answer this question in more detail. But as it is, we do know that 47% of husbands and 38% of wives had doubts.
After four years, 19% of women who had doubts were divorced, as opposed to 8% who did not. For men, 14% who had doubts were divorced four years later, versus 9% of those who did not. Of the 36% of those couples of which neither partner had doubts, 6% still got divorced. I basically like psychologists. Like most psychiatrists, I have learned to live in a symbiosis with them, where they do the psychotherapy and the psychiatrists do the pill-pushing. Notice, I am talking mostly about PhD psychologists and clinicians.
I’ve worked with patients who have been seen by professionals with lesser degrees. A few actually get well. At any level, most are subject to professionals who try to provide the minimal necessary to charge some sort of insurance. They are the devotees of the ‘easy hour,” people who do things like light candles and tell patients to spend an hour “relaxing” from their stress.
Read more on Cold Feet Might Mean No-Go for the Future of Marriage…
Filed under relationships by on Oct 23rd, 2012. Comment.
Prison populations continue to rise while rehabilitation efforts, if they even exist, continue to fail. We can do so much better. The Washington state prison system might just be onto something really, really good. Read more on Let’s Help Prisoners Contribute to the Greater Social Good…
Filed under depression, News by on Oct 24th, 2012. Comment.
Do Not Go Gentle into That Good Night, that old Dylan Thomas poem, is a favorite of many mature adults, including me.
Rage, Rage against the dying of the light
Let’s face it — none of us is getting any younger. And as we age, we’ve got to choose – will we rage, or will we just go gently.
I remember someone who alleged they wanted to work with me telling me they were interested in working with an emeritus neuroscientist. He was a very sharp guy, at least as far as I could tell from his academic publications. He had been with the system a long time and published much. I had not, since I’ve never seemed to fit into that system any better than most other systems.
The project fizzled for a number of reasons, not the least of which was the news that his family was up in arms because this elderly gentleman had given the overwhelming bulk of his life savings to one of those delightful online scams.
I have not checked what the country of Nigeria is doing in terms of industry, but they seem to be leading the way when it comes to these scams. They promise tremendous amounts of money, starting with an email to a recipient that purports to be a personal email but which surely has been delivered in bulk. All the recipient has to do is advance a little money to get a lot. A greed factor then takes over, and the recipient advances more and more money in hopes of a big payoff — which does not seem to happen. Anyone who has not received at least one such email is probably not a big internet user, to say the least. I have received them in three languages, and I do almost all of my internet work in English.
It has been known for a long time that old folks are most often prey to the financially unscrupulous. Personally, I think that the isolationism and diminished social function that often come with aging play at least as much a part in this as neuroscience does. But for the moment, let’s assume that at least some of the problem is a loss of judgment that comes with age. Assessing individual financial capacities may be helpful — for families and guardians and stuff — but there is a delirious amount of variability here.
The typical American solution of let’s-make-more-rules may not be the way out.
At quite a young age, I saw my Grandfather-of-Blessed-Memory tell my mother that he had a daughter in Boston – even though she was standing right in front of him. He simply could not recognize her. As she stood there crying like a fountain, I knew I was in some kind of trouble.
Read more on No More Cognitive Loss for Age…
Filed under Aging by on Oct 25th, 2012. Comment.