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. 
Putting scientists in prison because they did not accurately predict the danger of an earthquake and communicate it to the people is without precedent – at least as far as I can find. And it’s probably not a terribly good idea. I guess the lawyers will appeal this one, but there is something else going on.
Junior High geography was pretty colorful at my prep school. We studied the world, particularly the modern world, with a teacher who held us completely spellbound. She had used all of her summers for traveling and showered us with rich discussions of the Mediterranean. She painted a picture of a sun-drenched Italy that I found hard to connect to the ancient stories I heard about in Latin class. Read more on Legal Punishment When Scientists Fail to Warn of Earthquake…
Filed under News, Prisons, Science by on Nov 6th, 2012. Comment.
Strange, that the meningitis-tainted steroids in Tennessee make me think of the chocolate bar case from Oklahoma. Two young, and it seemed to me, perfectly honest if somewhat histrionic young women who found worms in their Hershey bars — the hard way. Both were unemployed and mothers of several children each, and one was pregnant. They were enjoying their chocolate bars in a dark room by the light of the TV set when one noticed something funny. Comparing experiences, the other one agreed that the bars tasted “off.” Turning on the lights (and — pardon me — spitting out the foul tasting candy) they saw a horrible sight. The almonds were infested with worms. Oh, it was scary, and one in particular told me she started throwing up, and had lost weight. She had developed some sort of a phobia for chocolate bars in general, and had poor sleep, and was 3 months pregnant. They both had the classic signs of Post Traumatic Stress Disorder — they could not stop thinking about and reliving the ordeal, they developed an avoidance of any chocolate or other type of candy bar, and they had a violent “startle” reaction if they encountered a TV commercial or if somebody they saw in public was eating a candy bar. Now the expectant mother did not particularly want to medicate for fear of damaging her unborn child, and that was fine with me. I recall we tried to use a little relaxation, or NLP (neurolinguistic programming), or anything, really, non-medical to calm down this young lady. We succeeded, at least somewhat, but not entirely. She did tell me that the Hershey bar had “been around” for a little, but I was unaware of any expiry date existing for Hershey bars; checked some at the supermarket, and never saw a date. Read more on Meningitis and Hershey Bars…
Filed under medical errors, News by on Nov 9th, 2012. Comment.
Topic: Research Fraud
For someone who has been a part of many clinical trials, I will be the first to admit that I have very little training in research design or statistics. Oh, the hours I’ve spent surreptitiously curled up on the sofa of a doctors’ lounge or my own apartment, thinking that somebody paid somebody a lot of money to write “science” so I could figure out how and why I would know things. It pretty much worked. There were a few mentions of statistics at my delightfully thorough prep school, but there was not so much as a word at medical school. The research types were always hanging around medical school settings — their brains rented and services bought by the medical side of things — as they did not make much money. We did receive some wonderful instruction from clinicians as to how to evaluate research literature and decide how to apply it to our practices.
I have a vivid memory of an endearing shy and spindly instructor during a course required for incipient biologists at Boston University. He had Jewish afro hair, coke bottle bottom glasses, and a more than passing resemblance to a young Woody Allen. Oh, how he despaired that we were mostly going to be money-chain doctors as opposed to truth-chasing scientists. I remember that once, and only once, did he reach fiery intensity in that class. “Nothing will be published unless the probability that it actually shows what it is supposed to show is greater than 19 out of 20, that means p>.05. But nobody wants to admit what that really means.” Oh, how silent we were, on the edge of our chairs. Read more on Research Fraud Isn’t Reported To The Public…
Filed under Government, Research by on Nov 14th, 2012. Comment.
Army veteran Galmiche, who served his country for 20 years, was diagnosed with post-traumatic stress disorder in 2002. He says he worked with a counselor and took medication for years, but did not find relief from his symptoms until he was matched with a PTSD service dog.
The first time I met a patient with a service dog was when I was doing social security examinations, as a psychiatrist. The woman was about 60 years old, motherly and white-haired, and she told me that she was nervous about the interview and was being treated for an anxiety disorder. She did not think she could “make it” unless I saw her with her “service dog.” Many years before, when my allergy to dog-hair was in flower, I would have declined. I had since treated it effectively with alternative methods, so I told her we could try it. It was a tiny dog, the kind my husband would call a “barfy” dog. The dog had the cutest little blue coat with very official looking embroidery — including the wheelchair picture that is usually used to mark places that are reserved for such vehicles. The little dog wouldn’t stop staring at me. I did a customary and very basic psychiatric interview. I started with questions that involved little or no stress, like name and diagnosis. Eventually, I ramped up to questions about the topics that generated anxiety, such as past traumas. The pooch stood on its hind legs while she rubbed it vigorously, staring at me. I stared back. Read more on Service Dogs for PTSD Veterans…
Filed under Mental Illness, military, News, PTSD, Service animals by on Nov 15th, 2012. Comment.
By now, I think most folks who care about snack foods have heard that Hostess Brands is folding. This the “twinkie,” as we know it will go the way of all flesh, which is also the way of all cake, which is to say, gone. I will admit that I have bought some Hostess Cakes for private consumption of late, mostly because the clinic I worked at in Redding was only a couple of doors from the Hostess Pastry Outlet. I got some orange cupcakes, mostly because my parents did not feel any cupcakes were worth the trouble if they were not chocolate. Whenever there are “rules,” real or postulated, people enjoy trying to break them. There is something basal that has drawn people to Twinkies. Since I was a tot in school, but I never gravitated toward them myself. The flavor seemed too Aryan, somehow. And there was something dairy in that cream-filled middle, which made them incompatible with the Jewish dietary laws that ruled my life back then. Read more on Twinkies Away!…
Filed under News by on Nov 20th, 2012. Comment.
“How in the world do you know how to say that in French?” I asked my hostess, in French. The reason for that was simple — we were in France and she was French. In fact, she was my closest friend at that time and in that place. As I look back, she was one of the best friends I have ever had, in a basically friendless world where I have received few favors. She told me — as we stood in front of a cranberry display on the Market of the Rue Mouffetard, in Paris — that she had learned the word when she had been on the team that discovered that DNA (and not protein) was the hereditary material. Afterward she had a year of sabbatical in Cleveland, Ohio at the Case Western University, and they grew cranberries somewhere around there. Her friends had known that this strange little fruit did not exist in France, so they showed it to her, and somehow they had tested and exchanged vocabulary, just as I had with her.
Although I had been born in suburban Boston, I had not seen cranberries growing in a bog until a high school road trip. My class had traveled to see Plymouth Rock, and the reproduction of the Mayflower (so tiny — they must have been really cramped) and other such things I had been told existed no other place on God’s green Earth except for Cape Cod. I was glad I had my French friend to help me break such myths of chauvinistic rubbish. How strong the myth had felt, how deeply I had believed it, and for so long. Read more on Canneberges?…
Filed under Family, Holidays, News by on Nov 22nd, 2012. Comment.
It is very hard for straightforward and presumably honest medical researchers to give us much of anything objective about something that has been labeled “alternative medicine”. Maybe there should only be two kinds of medicine. Good and not good; helpful and not helpful. I was minding my own business – well, as much as ever — when I found an article about chelation as a preventative for heart disease. It basically says that chelation seems to “work”. But it also seems that some people are ashamed to find this out and don’t want too many people to take advantage of this as a treatment option. This makes about as much sense as most of what I have read recently about medical research, but I do have one way to put it in context. I have spoken at some alternative medicine meetings where I have proselytized about the effectiveness of high dose vitamins — chelated, to pass the blood-brain barrier. I have been told that I would be skewered by colleagues. Colleagues never seem to have much worried about what I have to say. As a matter of fact, the world seems to have a pretty bad track record as far as listening to what I say. Read more on Chelation As Preventive Therapy for Heart Disease…
Filed under Disease, medicine, Research by on Nov 26th, 2012. Comment.
I recently got hold of a copy of Dr. Atkins’ Vita-Nutrient Solution; a book by the same Robert C. Atkins, M.D. who invented the “Atkins Diet” –mainly known as the low-carb diet. I was impressed by his general erudition and review of the literature. He had even visited with various luminaries of alternative medicine. Here was a guy who was capable of writing a pretty complete vitamin and mineral prescription for almost any chronic illness that was part of an internal medicine practice.
In a section titled “My Own Transformation,” he tells how, when he was devoted to mainstream medicine, he found a diet that worked for him and for most folks. He had found it in the Journal of the American Medical Association, which is perhaps the most mainstream medical journal that exists. He wrote his first book about that diet. He was shocked when a consensus panel from the American Medical Association was critical. After all, he had been relying on medical literature which had been reviewed by peers and validated in every way that academics respect and deserve when they have done work. He started questioning these professional “edicts” and found himself squarely in the world of nutrition-based therapeutics. I have believed for a long time that most psychiatric disorders, maybe all, are the result of a genetically transmitted limitation of the ability to metabolize nutrients. There is plenty of evidence for this. Read more on Yes, Virginia — Cannabis IS Medicine…
Filed under Alternative Medicine, Doctors, medicine, News by on Nov 29th, 2012. 1 Comment.
Drug company lobbyists still rule this country, even under a president who promised us something different. I am sorry it took me so long to find out about the threats and deals made by the White House to get drug companies on board with Obama’s healthcare overhaul. Apparently, it was released by Republicans at the end of May. Read more on Even Obama is Ruled by Drug Companies…
Filed under medicine, politics, prescription drugs by on Nov 30th, 2012. Comment.