Okay, I have this vivid memory of sitting with a bunch of colleagues in a doctors’ lounge in Beauvais, France, trying to figure out why we had inflicted upon ourselves the punishment of studying medicine and then practicing it for a living. There were a couple of guys who wanted to be missionaries; really religious folk. Others discussed the exalted status of the doctor in the community, the money that went with it, etc. When it came to a choice of specialty, there was a lot of discussion, even then and even in France, about the difficulty of the studies, of developing a practice, of making a living. Rarely there was a feeling of passion. This was viewed as naive. I remember a woman who wanted to go into oral surgery because she believed that the human spirit was lodged in the teeth (Really). A woman who wanted to be a cancer doctor because her mother had died of cancer far too young. And there was me, the “brain freak,” granted there was a Jewish idea of public service and healing humanity. But my passion for the brain was (and is) real. How it works and what it does to behavior are things I find passionately consuming as well as sacred. Some of the French doctors laughed; others just smiled. I guess they figured I would grow out of it.
As I write this, I am wearing a heart-shaped wristwatch, with a picture of a sagittal section of the human brain. Read more on “Marijuana Doctors”…
Filed under medicine, News by on Nov 10th, 2010. Comment. 
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 Nov 9th, 2010. Comment.
She was an administrative type, accompanying me to a meeting to which I did not particularly want to go. I had told her about some particularly useless drugs that had been FDA approved since I don’t remember when, and she asked me the question that covered everything.
“Why doesn’t the FDA work?” Read more on Estelle On Why The FDA Is Screwed Up…
Filed under big pharma by on Nov 8th, 2010. Comment.
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 Nov 5th, 2010. Comment.
Some of the most vivid and memorable lectures I sat through in medical school were about bacteriology. Our professor was a woman who was a consultant to the World Health Organization and who returned from assignments with dramatic first person stories about how she had collected trachoma samples from children in darkest Africa, and would thus help prevent their blindness.
She told us about Cholera, a horrible disease that killed quickly by diarrhea and subsequent dehydration. A disease of poor hygiene that was found where people lived in congested settings and hygiene was tough to maintain. Did not even need antibiotics to save most of the lives; just hydration and electrolytes. An illness apparently easy to prevent; there were pills to sterilize the water, simple public health interventions. But none of us were likely to ever see it. We would all practice in civilized countries, like France. Vive la France. Read more on How Cholera Showed Up In Haiti…
Filed under Disease, politics, Public Health System by on Nov 4th, 2010. Comment.
He was a pale faced, somewhat overweight 50 year old with a tired demeanor. He had a treatment resistant depression and I had asked his primary care physician to run some tests. He complained of not just lower back pain, but pain in all his joints, and I wanted to rule out autoimmune illness; things like rheumatoid arthritis, or even lupus. I also told him to review his pain meds with the doctor.
He claimed 8 months of sobriety from what had once been a pretty heavy alcohol habit. Who knows what is real or true? He had told me he had a couple “little relapses,” not unexpected in that sort of problem.
“The doctor says I am an addict and I am going to die from my pain meds, because I take too much of them. I told him if he would give me better ones or stronger ones, I would not have to take so much. It is his fault. I really hurt.” Read more on Death By Pain Pills…
Filed under depression, prescription drugs by on Nov 3rd, 2010. Comment.
The current litany is “The economy is bad and I need more money just to get by.” Patients tell me they are about to get evicted or starve to death. I know nothing about benefits or their politics, except that governmental entities have no money either and this route is harder.
A lot of people seem to think that their lives would be better if they were plugged into a job that fit them as well as a plaster cast fits a fracture. But instead, they usually tell me there are no jobs at all. I try to slip in a little bit of useful advice, but obviously personal experience is limited. I don’t even have a really good answer for the patients who say “you have a job. Lucky you. You can’t understand what I am going through.”
There are patients who amaze me with their resourcefulness. Mostly, the manics or hypomanics; depressed people seem more likely to get “stuck.” Read more on Brainpower Helps In Hard Times…
Filed under Brain, depression, politics by on Nov 2nd, 2010. Comment.
One of the major stories of 2010 was the move toward health care reform — “Obamacare.”
Although the name should be “Obama insurance”, there were several instances where the government made efforts — or made noises that there would be efforts — at controlling what they perceive as an obesity epidemic.
This included removing soda and candy machines from schools, major warnings against high-fructose corn syrup (neither of which I have a problem with) and making it mandatory for calorie counts to be listed on menus in several states (which left me scratching my head).
Read more on Politically Correct Dieting and The Obama Children…
The FDA has declined to approve the weight-loss drug Qnexa, which I wrote about a couple of months ago.
Generally, diet drugs are more danger than help. But my opinion on that matter is already on the record.
Filed under News, prescription drugs, weight by on Oct 29th, 2010. Comment.
I had never seen this slightly disheveled 52 year old woman before and she was crying her heart out. Her father had died 24 hours earlier from what she could only call an “all over the place” kind of cancer. His struggle had been long and hard and she thought she had done a good job of preparing herself psychologically. But still, the depth of her grief was pretty immense, so I managed to get her to talk. She said that all her life, she felt she had never been able to please her father, and now she knew she never would. He wanted all kinds of academic achievements and prestigious jobs for her, none of which she got. It simply made her feel like a failure.
Well, even though I am mainly a “pill pushing mama” to the world, I wanted desperately to say something to ease her pain. It would not help much if I told her the truth of what is going on, that she was crying not for dad, but for her own feelings of inadequacy. Read more on Pleasing Daddy — And Failing…
Filed under End Of Life, Family by on Oct 29th, 2010. Comment.