He was a new patient to a community clinic. They warned me to be careful with this 48 year old, thinking he was “really crazy, schizophrenic or something.” The social worker had tried to do the intake and told me he was confusing, “not your average bear.” Strangely enough, most of my female staff already had told me they were attracted to him; an unusual state of affairs.
I was struck first by his clothes and demeanor. A little like Michael Douglas as Gordon Gekko.
This is not usually what new patients look like, schizophrenic or not, when they come in. No wonder the front desk staff already had a crush on him (“sigh!”). We didn’t get men in designer suits in these parts. Read more on Otherwise, The Patient Was Normal…
Filed under Diagnosis by on Jul 7th, 2010. Comment. 
It was a community clinic where everyone was poor and most seemed spiritless, but this woman was 55 and had fire in her eyes.
“I want the same damn medicines for three months. Write the prescription. I won’t kill myself or anybody else, and I don’t have any side effects or problems.”
She knew the routine; so I did what she said.
“I got a half an hour with you. I want to talk.”
I usually asked patients what they wanted to talk about after we had transacted the business of medication management. Sometimes I got some surprises. So I told her she could talk. Read more on Not All The Questions Are Medical…
Filed under medicine by on Jul 7th, 2010. Comment.
I was with my husband and a friendly couple, admiring the natural beauty of a mountain pass with snow capped peaks in the distance, when the other gentleman told us that a major natural food chain was removing all of the krill oil from its shelves, because the harvesting of krill was not a bio-sustainable practice.
Now I am usually pretty cool about science; looking at data, revising opinions. I have never really considered myself an ecologist, since the politics are often richer than the data. (Ask someone if they actually think the globe is getting warmer and it is not usually necessary to inquire about their political affiliation.)
I just looked him right in the eye and said “No way, this is nuts!” Read more on Don’t Worry — We Won’t Run Out Of Krill…
Filed under medicine, News by on Jul 2nd, 2010. Comment.
She was a 33 year old raven-haired exhausted woman who had probably been a beauty before she bore children, now aged 9, 6, and 4. She wanted a renewal on her sleeping pills. She did not want the antidepressant or anything else, just sleeping pills. She said that since the children all slept through the night, now she could, too. She had not only a tubal ligation at her final pregnancy, but an ex-boyfriend who was no more than a distant memory.
Her last doctor, apparently a rarity, had actually started by prescribing the sleeping pills every third night. That had not lasted more than four weeks or so. She wanted, and felt she “deserved,” sleep every night. She was convinced that was what the insurance doctors gave the rich people, so she was not going to let anybody skimp on her. Sleeping pills every night. She would not have to think about anything other than keeping a bottle by her bed and getting it into her mouth. Sleep would be automatic and life would be sweet.
The last doctor had been, to his credit, assertive enough to tell her that if this was what she wanted, she would be coming in every three months for the rest of her natural life on planet earth, to get sleeping pills. She thought that was just fine; that it was what everyone did and should do, since we had something as wonderful as sleeping pills in the world. Read more on Pharmaceutical Companies Are Stealing Our Dreams…
Filed under prescription drugs, Sleep, Substance Abuse by on Jul 1st, 2010. Comment.
The first time I found out about neuropathic pain, it was not even mine.
I was living in Amiens, above a cafe, and had adopted the boss, the patronne, as a surrogate mother. I came home late from a laboratory class one night and I tried to figure out what I was looking at with a dim light only on in back. I found this 80 year old woman in the back room with her blouse undone and an older man apparently angry at her pointing his finger. I ran in and asked him to identify himself, as I was concerned for Madame, and there was apparently some difficulty. He was nearly as old as she and they were both laughing heartily indeed. That is how I met this noble “docteur du quartier” (neighborhood doctor) who was performing what he described as an “honest and beneficial auscultation” and prescribing for her chest cold.
His whole practice was cafe backrooms. His patients the cafe patrons, who often had no cars, or no place else to go for medical care. He practiced a simple medicine, and as I advanced in school and he knew what I was learning he told me all that was too technical for him, and he would leave that to the young ones, especially the girls like me, because girls pay a lot of attention to detail and remember everything. And girls are nice and take good care of patients because they care a lot and try very, very hard. He told me not to tell anybody he said that. I never told anybody he said that until just now. Read more on Neuropathic Pain and Benfotiamine…
Filed under Alternative Medicine by on Jun 30th, 2010. 1 Comment.
I was looking at Paul Fink’s column in the April 2010 Clinical Psychiatry News, one of those newspaper format “journals” that we like to call “throwaway journals” because subscriptions are free and they summarize other journals, as they usually end up in the trash. He writes for other psychiatrists. It is possible to identify with him if you do this for a living and are sentient enough to know what is going on around you.
I always liked this guy. Older people have a lot to say when they have practiced long enough to see trends go up and down and know their fate.
If I remember correctly, he is the one who said a while ago something to the effect that psychiatry is like prostitution in that the amateurs think they know as much as the professionals. Nobody has better nailed the central difficulty of this job. Read more on Purpose and Aging…
Filed under Aging by on Jun 29th, 2010. Comment.
He was 23 years old with a rich ethnic heritage and identity that he said gave him strength. He looked like any one of hundreds, maybe thousands, of “youths” you could find on the streets. A couple of tattoos. The kind I would see when I was driving with my husband and think sometimes “wow, it was so much easier in the days of Marlon Brando movies.” I would have preferred a handsome renegade in a leather jacket to this obese, angry, unkempt person who clearly did not want to talk to anybody, including me. He was not my patient. A frustrated therapist asked me to see him because no medications had worked on him. She had expected me to come up with a miracle drug we could get samples.
He told me the same thing, over and over again, that he was doomed, that nobody could help him, that I was a nice lady, nicer than most, but I was wasting my time just like the rest of them.
He heard voices, always angry and deprecating voices, telling him he was going to die, that he was no good and deserved to be killed. Many times, in his life, he had attempted to prove the voices correct. Read more on The Devil’s Role In Mental Illness…
Filed under depression by on Jun 25th, 2010. Comment.
She was nearly thirty, dark haired and round-faced and ambitious, and wanted to be a drug and alcohol counselor, maybe. Maybe not. She had only three months of sobriety from alcohol; probably wanted to be one of those people in power. So many programs dry people out and let them “stay on” a bit. So many people use their own exaggerated stories to “help” other people stay sober. A closet industry of subjective touchy feely, trampling, as many do on my long years of difficult, mind boggling training with cheap feel-good.
Her drug and alcohol counselor had told her that she would feel rotten for a while, so she had accepted that. But she felt obligated to tell me that she had felt rotten, so I let her talk and tried to listen.
People coming off alcohol may take as much as a year to get their sleep cycle back (alcohol represses Rapid Eye Movement sleep) and to stop feeling a little bit nervous. But this was not that. Read more on Serotonin Syndrome: Less Is More…
Filed under prescription drugs, Substance Abuse by on Jun 24th, 2010. Comment.
A nurse told me, “she called the clinic and she was ranting. She must have been drunk.” I did not think she was. She was a born-again Christian who did a lot of Bible-thumping, not that Bible-thumping by itself actually prevents anyone from drinking. She was in her fifties, trying to go back to school to get a college diploma she had missed earlier in life, with marriage and children. Something spiritual and faith based. I didn’t care what she wanted to learn about, for I truly respect people who are trying to accomplish things. I just didn’t think she would want to be seen buying a bottle of anything, for she was so sensitive about a public image that did not mean very much to anybody else. I think she was sensitive about it because she lived alone and her church was her surrogate family and they lived near her. All her life was in walking distance. Somehow I just did not see her as a drinker.
“I think she did something she usually does not do when she calls us. I think she just took everything her pain doctor prescribed for her.”
I had seen this woman in the office a few days before. She told me she had not yet taken any of her pain medications that day. She was awake and alert and pleasant, really pleasant. She told me she did not sleep and so she needed some sleeping pills. She had been in the hospital for something unrelated, some kind of a minor surgical procedure. Somehow, a nurse I work with had done the research and talked to someone who had taken care of her in the hospital. She slept. Lots. Late. Missing breakfast and eating it when it was cold. She had been on a relatively low dose of pain medications for her chronic pain problem. As far as I could figure, and I had taken care of her for a while, her pain was what you call “benign” pain. I mean, and she had told me the truth on this one, she had osteo-arthritic pain.. So how did she end up on so much pain medicine, and asking me for sleep medicine which she had not received, since in the hospital she had been taking the same thing I had prescribed. Read more on It Was All Prescribed…
Filed under prescription drugs by on Jun 24th, 2010. Comment.
People who have panic disorder go to doctors to take care of it. I have had maybe hundreds of patients, more than I can count over my years of practice, who have come to me with this. Most of them do well. Usually the panic disorder runs its course.
That is not to say that panic disorder is not terrifying. Often people believe that their first panic attack is a heart attack. Often they have come to me already addicted to benzodiazepines by emergency room physicians who (understandably) worry a lot more about the immediate comfort of the patient than about the long term situation. Here is the official government take on panic disorder. Yes, find a psychiatrist you can trust. Yes, they recommend family and support groups. Good stuff, but free and easy to recommend. Yes, there is some exciting new research but as long as insurance companies and HMOs determine how people get treated, it is unlikely that research will be quickly translated into treatment.
Most people who go with the mainstream treatment do pretty well. Here is another description of mainstream treatment, a little more complete. Read more on A Real Doctor — Like House MD…
Filed under medicine, prescription drugs, Stimulants, Substance Abuse by on Jun 17th, 2010. Comment.