Sometimes, when I was taking care of patients at a community clinic – whether in Oklahoma or Kansas or Massachusetts or even California – I would get students or assistants of some sort. Nurses, nursing students, a physician assistant, physician assistant students, students from nearby colleges who are training to be medical assistants, or sometimes some kind of doctor extender I’d never heard of or didn’t understand would be assigned to me or rotate from a pool of available helpers.
Of course, I would always like them to actually get some knowledge from me. Sometimes that was the toughest thing for me to do. They needed to both pay attention and have a few functioning neurons. Although I usually figured out a way to quiz them a bit, they usually seemed, if I ended up running into them days or weeks later, to remember me as the one who was fun and told stories and paid attention to them.
Sometimes, they do remember certain things I would consider “rituals.” One of my best known rituals is “The standing O” – Literally rising from my desk, applauding and shouting “BRAVO!” if someone did something I considered exceptional. You know, like a standing ovation for an actor or musician. Read more on “Standing O” For Birth Control…
Filed under Contraception by on Feb 2nd, 2011. Comment. 
It’s hard for many who know me to believe – and it is even hard for me to believe – but from a very early age, I loved the brain.
Looking at my professional path, one can see that everything I’ve done has been related to the brain (with a few side trips, of course). I tell most people now that my change from neurosurgery that ultimately landed me in psychopharmacology was a result of personal maturation. After all, I once believed that most medical problems had mechanical, or near mechanical solutions.
The OBT (Olivier-Bertrand-Tipal) frame -- Conventional stereotaxy makes use of a frame attached to the patient's head.
I once believed that a hematoma drained, using squishy squeegie apparatus, just like my mother of blessed memory would have used to baste the Thanksgiving turkey.
The truth of the matter is that I had become convinced slowly that a brain, once touched or handled, changed in immeasurable ways. My own dexterity seemed piteously inferior to the task of brain manipulation. It was not fear — at least I do not think it was. It was more a sort of reverence for the complexity of that which I struggled to lay my hands upon – literally to manipulate. Read more on Messing Around With The Brain Is Serious Business…
Filed under Brain Surgery by on Feb 2nd, 2011. Comment.
I think it was in my first practice, straight out of residency, that I learned about sleep apnea. He was a private patient, a man about 40, who had his sleep apnea treated when some enterprising ENT (Ear, Nose and Throat doctor) fried his too-large tonsils.
Within the day or two it took the surgery to heal, he came to the office to tell me that his symptoms of anxiety and depression were totally gone. Well, if I had trouble breathing, I would be anxious and depressed too. You want to get that oxygen, continuously.
Even if the tests , which technology has simplified over the years, show that you’ve got plenty enough oxygen in your blood, the fear of losing oxygen has got to be significant. I remember, even as a little kid, with hay fever attacks, what it felt like to gasp for air. I can only start to imagine what it is like for those who gasp for air in the middle of the night.
So at a later time, a different patient shows up, a 53 year old man, and he tells me he wants some Xanax or at least some Ativan. I have someone count his respirations — 14 in a minute, not too bad. He is using the muscles in his neck to hike up his chest to breathe. He has recently stopped smoking, much to his credit, but still has a solid diagnosis of COPD, (chronic obstructive lung disease) and this guy got it in spades, but the question remains does he have sleep apnea?
We are lucky. His diagnosis was confirmed by a sleep study. This means someone had to watch and measure him all night. He is still shocked that I made the diagnosis just by asking questions. Not that it is hard to tell what is going on. I heard a little bit of wheezing without a stethoscope.
First things first — I was not going to prescribe anything that could depress his heart or breathing. That meant no Xanax. To say that he was not happy with me was — at best — a gross understatement.
Then I got up the guts to tell him the truth. “Until we treat your sleep apnea, your anxiety and depression are NOT going to get better.”
Now when I first started telling this to people, the relationship between depression and anxiety and sleep disorders may have been something someone could debate. Not now.
Read more on Sleep Apnea Links To Depression, Anxiety…
Filed under Sleep by on Jan 31st, 2011. 2 Comments.
I remember my first time and I shivered with anticipation.
Resident Physicians Don't Get Much Sleep
A kindly matron showed me the tiny bed and told me with a wink that I probably would not get much sleep that night. It was an old bed and had seen a lot of use by a lot of people, but it would be special for me this night.
She was right – I was only able to steal a couple of hours of sleep. But it was what happened when I wasn’t sleeping – and my colleagues congratulated me and cheered me on. Read more on Sleepy Doctors — An Unnecessary Danger…
Filed under Doctors, News by on Jan 29th, 2011. Comment.
For the kids who can’t manage to keep appointments — let alone blood tests — there are lots (and I mean lots) who qualify for the anti-psychotics that are also FDA approved as mood stabilizers.
Those who know me as The Renegade Doctor sometimes get the mistaken idea that I am against all prescription drugs and that pharmaceutical treatment should always be avoided. That could not be further from the truth. I believe in the proper treatment for the proper condition. At times, I may disapprove of the methods and conduct of “Big Pharma,” but I will always use the best treatment for my patients – especially if it is FDA approved and a legitimate indication.
My favorite mainstream choice in the above example is usually arapiperazole (Abilify). The case study I’ll share with you is a patient who sometimes hears some voices and would like to get rid of them. So that is the medicine I offer this 22 year old hip hop composer with one of those cylindrical “spreaders” that resembles a manhole cover in his right ear lobe (I wouldn’t have picked it myself, but he told me his girlfriend thought it was real hot). Now sometimes this drug is stimulating and people have trouble sleeping. So my usual suggestion with this would be a touch of Benadryl (diphenhydramine) – an over-the-counter allergy pill – which causes drowsiness and could help him sleep. It’s even available in those “99-cent” stores that dot the countryside. Read more on Promethazine On The Street…
Filed under Substance Abuse by on Jan 28th, 2011. Comment.
One usually thinks of a doctor as one who gives out prescription – sometimes much too easily. I’m often known as the doctor who declines to push drugs.
I take these things seriously. I’ve studied long and hard and know what drugs can do – both positively and negatively. If the risks outweigh the benefits, I can be down-right stubborn. However, I’ll always have an alternative that can help.
I’m reminded of one case where a woman wanted Chantix (varenicline) – a prescription medicine FDA approved to help people stop smoking — and I said “No.” To my knowledge and experience, the drug has some problems. The last patient I saw who was already taking Chantix asked me for a renewal. I told her that the symptoms of which she was complaining would probably disappear completely if she got off the Chantix. I never saw her a second time. Read more on Its Not Only The Smoking That Can Kill You…
Filed under prescription drugs by on Jan 27th, 2011. Comment.
Much to the dismay of my very traditional mother of blessed memory, I decided very early in life that I didn’t want to have children. Times have changed and I have a whole civilization to care for. Besides, the genetic soup is so complex in my family that the chances of heartbreak are at least as great as the chance for joy.
So no — I am not raising children. Still, I am exposed to people who do and I have to wonder what the heck is going on with them.
I was one of those rare kids who actually had a copy of some “original” Grimm’s Fairy Tales — the ones with lots and lots of gore.
Perhaps it was a safer and more innocent time then, for the most frightening things I see on television now are not images of an on-going war, but reportings on allegedly legitimate news about shootings within a few miles of where I am watching in San Diego. And not only the atrocities committed by handguns and assault rifles, but even repeated assaults with paintballs within a few streets of where I live. Read more on The Threat Of Disney’s Princesses…
Filed under Role Models by on Jan 27th, 2011. Comment.
He had tried to hang himself, and had managed to break some veins, maybe fracture a little cartilage, by the time his wife discovered him. It had been touch and go, I suppose, and a long time in the intensive care unit, but he had truly cheated death.
This 55-year old highly-credentialed university professor didn’t look the part of a depraved rapist — little or no hair, red-faced, bashful, perhaps — but that very accusation caused him such despair that he tried to take his own life.
A student had accused him of this horrible “impropriety.“
Obviously, these charges of sexual misconduct shamed him severely. He maintained that the charge had been trumped up. The woman who had accused him had indeed some kind of a psychiatric history.
It is not uncommon for women to make this sort of accusation.
He told me he did not want to hate women. He also told me that he had a female judge.
I cannot help but think of the E.M. Forster novel “A Passage to India” which draws as accurate a psychological picture as anyone could of the sort of young woman who could make such an accusation.
Strangely enough, I could find essentially nothing about this as part of the psychological literature. I did find a lawyer who had started a blog online, and said that this was a very large and essentially ignored problem. Read more on False Rape Accusations — Who’s The Victim?…
Filed under Uncategorized by on Jan 25th, 2011. Comment.
Full Disclosure – I don’t strictly spend my time-off at the opera or watching Masterpiece Theater or reading Proust in the original French.
thanks to technabob.com
Oh, I do have a wonderful appreciation for doing such things, but I also spend some of my time playing Tetris. Honest!
I won’t say I’m obsessive, but the game is really quite fun and challenging. However, I actually met what I thought was the first “tetris psychosis” I had ever seen. The 43 year old bipolar actually told me he was addicted to Tetris. Read more on Tetris Psychosis — It Could Happen…
Filed under Brain by on Jan 24th, 2011. Comment.
There is no evidence of chelation curing autism.
NOTE: CLICK THE CARTOON AND SEE IT FULL-SIZE TO READ THE LAST PANEL
The field of alternative medicine is as wild and woolly as the old west. There are all kinds of people doing all kinds of things. Some are studied and tested, some are intuitive, and some seem to come from Uranus.
So it is no surprise that the FDA occasionally cracks down on some of the most flagrant offenders.
Please listen to someone with a lot of formal training and many years of experience in clinical trials and many treatment modalities — There are no miracle cures. If there really were, I think I could have a handle on them by now.
One hot button recently is autism. And one of the biggest misconceptions is that it is just mercury poisoning. Believe me (and a million other medical experts) – it is NOT.
There are plenty of people around who want to believe in the magic bullet. Somehow this goes hand-in-hand with believing that doctors and drug companies are hiding things that are wildly effective.
Truth, science, and the American way are effective. People are always devoted to things that will make them a lot of money. They may even convince themselves that they are on the way to miracles. Old fashioned values like responsible experimentation, even responsible observation … the heck with it.
I will not expostulate. I see it all the time. Some of my colleagues – and I mean trained and licensed MDs – seem to settle on one treatment and think it fixes everything. I suspect it is because they are basically lazy and cynical, but that may not be fair. But in my years of practice I’ve seen docs who give everybody thyroid hormone, others who firmly believe in vitamin D, the apostles of Prozac, and other things too bizarre for me to really believe. Read more on Denial, Wishful Thinking And Chelation…
Filed under Alternative Medicine by on Jan 21st, 2011. Comment.