I remember the pain of being the fat person on an airplane, waiting for the stewardess to finish demonstrating how the seat belt had to be buckled. Was there really someone on the plane who had never buckled an automobile seat belt, who did not know how this apparatus was supposed to work? Sitting dutifully through the safety procedures description was a reason to squint, to ignore while seeming to listen. Then, the stewardess would hand off the seat belt example, which was really an extender. Suddenly, the fat woman could feel safe, and ignore her extender, as the belt fastened low on the hips, just like everyone else.
The “growing problem” (pardon my attempt at humor) of larger-size people is not a reason for guilt, but it is an obvious factor in the safety of transports. Obesity in America is the function of an over-processed food supply that addicts people to foods. Of this I am sure, having seen too many examples, including myself. Personal responsibility, detailed descriptions of the determinants of leptin secretion, none of these helped this morose fatty when there were only one or two in sight in any group.
Now there are more – scads more. Every time you walk into a room there are so many heavy-weights that there seems to be nothing else.
If these people are anything like I was nearly 200 lbs. ago, they want mutual support instead of guilt trips. Read more on Don’t Pick On The Heavyweights…
Filed under eating disorders, weight by on Mar 24th, 2011. Comment. 
After studying in several institutions of higher learning in several nations, I always feel strange when I learn something from television. Especially network daytime television.
When my husband attended elementary school in rural Kansas, he tells me that the school nurse checked the kids for head lice. In mine, in suburban Boston Massachusetts, it would have taken the school nurse a whole year. So in third grade, when I happened to be in public school for a little bit, my humongously obese but friendly schoolteacher checked the whole class and found two kids out of about thirty and sent them to the nurse. Me, she told me to brush my hair a lot because my curly frizz got tangled. Read more on Killing Head Lice With An (Expensive) Sledge Hammer…
Filed under Diagnosis, News by on Mar 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.
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 Mar 21st, 2011. Comment.
Finally, a way to prove what everyone suspects already. A study coming not from a medical journal, but from the much-venerated Consumer Electronics Show in Las Vegas. Patients relate LOTS better to frequent communications involving personal electronics (cell phone) than they do to infrequent communications from a human physician and his/her team of physician extenders (nursing staff, physician’s assistants, technicians, etc) and print information. For one thing, this does not exactly sound like a double-blind placebo-controlled study. It is clear to me that when electronic communication is used, these are, simply, for frequent contacts. The real problem, I think, is where we went awry and why we need all this to catch up. The doctor patient relationship has been on the skids for years. Even the most intuitive of people watchers could have guessed that when you have a relationship where interactions are both structured and hurried, not to mention far apart, the relationship follows some kind of entropy – a scientific term for disintegrating or winding down. The “doctor extenders” are of varying quality, as well as varying emotionality and attachment. This means they sometimes help and sometimes don’t. Time and time again I have told patients, “You only have to know the one, or at the most 2 or 3 (usually), diseases you have got to get through life.” When I send them to libraries, give them book titles, magazine references, whatever, it does not happen. Send it to them on their cell phone!! “Here are four months worth of medicine, one month with three renewals,” I would tell my long-suffering patients. “No, I am not going to give you a year’s worth. Even though I expect they will be normal, you really have to get those blood tests.”
When they get oppositional, I get crusty — Yes, adorable me. “Look, it is your responsibility if you cannot get in there and get them, not mine. I want you to do what is safe and good. I can only tell you. You really need to do this. I am not kidding. I cannot come to your house and remind you or even call you to remind you.”
“I can’t. I think I am taking care of most of the county.” Or then, there is sometimes the cruelest cut of all. “Of course there will be a psychiatrist here when you come back. No, it is unlikely to be me. I do not have any idea who it will be.” Read more on Phoning It In Is Better…
Filed under News by on Mar 16th, 2011. Comment.
When writing these essays, I know I tend to make myself sound like the world’s greatest psychiatrist and physician. But, hey — I am writing about myself. What do you expect?
Occasionally I will admit that sometimes I get in trouble a little. But I want to keep you reading my ramblings for a long time, so those juicy stories will be few and far between – just keep reading until you see another one.
The majority of my business now is going in to a clinical situation or private practice and telling people what they are missing and what they should be doing. It’s a funny life because people invite me to come, they pay me, and then they fight tooth and nail to keep doing what they’ve always done.
Change is a difficult endeavor. Read more on Tattoos And Hepatitis Go Together (All Too Often)…
Filed under Hepatitis C by on Mar 15th, 2011. Comment.
I am not surprised at all that the findings of this study show young people in college don’t learn much in the first two years. I don’t think they learn much in all four. I was delighted that someone has the brass gonads to take these findings and make them public.
I am not sure how a standardized test would measure critical thinking, analytic reasoning, and writing skills, but let us assume for the moment that it does at least some of that.
I spent a hunk of my career on the faculty of a few medical schools. It never would have occurred to me to try to do anything at all with those allegedly useful four years of “pre-med” college education. It was too evident to me that nothing was happening intellectually. I could not wait to get out of there and get right to medical school. I was marking time to get a bachelor’s degree, and the only reason was to get to medical school. The passion was for medicine, not for the four years of undergraduate college.
Read more on A Dearth of Knowledge and The Death of Knowledge…
Filed under Education by on Mar 14th, 2011. Comment.
I wrote not long ago about the problem with sleep-deprived doctors. Now I feel I must tell you that the person you are relying upon to perform delicate surgery may be so depressed that he’s contemplating suicide.
Why surgeons? I used to be one and maybe I can shed some light.
Of course you can’t prove causality. Maybe just the fact that a person is a surgeon doesn’t mean he is at risk. The same statement about “we can’t tell if there is something causing this or if this is an epiphenomenon” can be a criticism of almost any study, the way those invited to critique this study have spoken.
There is a problem, and this only hints at it.
Filed under Doctors by on Mar 11th, 2011. Comment.
On A Cat Aging
by Sir Alexander Gray
He blinks upon the hearth-rug
And yawns in deep content,
Accepting all the comforts
That Providence has sent.Louder he purrs and louder,
In one glad hymn of praise
For all the night’s adventures,
For quiet, restful days.Life will go on forever,
With all that cat can wish;
Warmth, and the glad procession
Of fish and milk and fish.Only – the thought disturbs him –
He’s noticed once or twice,
That times are somehow breeding
A nimbler race of mice.
MERLIN
I loved Merlin – King Arthur’s court wizard — when I was a kid and that was just about the time that Disney came out with “The Sword in the Stone.”
WOW – nearly 50 years ago!
Later I was to love the Arthurian legend in many deep and symbolic ways — love it so much that for a long time I kept a light-up, plug-in sword which was (actually, fairly easily) removed from a plastic pseudo-crystalline rainbow light-shooting stone. Doing so didn’t make me a queen of anything, though.
It is almost impossible, I think, to be human and anything more than partially literate without knowing the splendor of the Arthurian legend.
Fast forward to the present, and I am a wizard in my own way – a doctor. I wanted every patient to have the smiling sense of the Arthurian splendor that I had when I pulled that ersatz sword from the ersatz stone. Most of them did, until that piece, like many dear to me, was lost in a series of moves.
Filed under Aging by on Mar 9th, 2011. 1 Comment.
Ahh – 19 years old! It is a magical age. At least it has been my experience in public mental health clinics.
You see, almost without exception any male of 19 years who appears in my office – is a really messed up and sometimes just, plain rotten fellow.
I don’t know what it is about 19.
One of the typical cases – though legally an adult — was functionally a kid, living with his parents and acting out the same kind of adolescent rebellion that most go through at 14 or 15 and out-grow by 17.
Oh, he had it all — One of those cylinders in his earlobe, spreading a hole from a small piercing to the size of a basketball. He told me it was “tribal.” He was a music major at a local, broken down branch of the state college. He wanted to be a performance artist.
Filed under Substance Abuse by on Mar 7th, 2011. Comment.