Thursday, May 31, 2007

Christmas is coming...

The perfect gift, for that hard-to-buy-for person!

Amazon is now selling home AEDs!!!

AEDs, or Automated External Defibrillators, are now available in a home model. AEDs are portable medical units that contain the equipment needed to shock a failing heart into rhythm, or at least attempt to do so. (CLEAR!!) You've probably noticed them at the malls and airports. There's been some movement to put them in all sports facilities as well, down to Little League fields.

But now you can get your very own, for home use. For a paltry $1,175 (on sale!), you're now prepared for whatever an ailing heart that walks into your house might deal you. Uncle Jim looking a little grey? Grandma moving a little slow? Dad complaining of chest pain?

And it even comes with a free gift: a thermometer. What's the thought process here? Now the AED can tell you that Aunt Bertha really has kicked it, and maybe the thermometer can tell you how long it's been?

Monday, May 28, 2007

Ouch, Tinky-Winky!

Award for most poorly-worded headline of the day:

Poland to probe if Teletubbies are gay

I can't believe we're still talking about this...

I don't get no respect...

As a family doc, I'm not in the business of 'saving lives', at least, not Hollywood style. I don't crack chests, intubate, perform emergency surgery to remove ischemic bowel, or prescribe chemotherapy. As such, I don't expect the high drama that accompanies such procedures and specialties (part of why I decided against emergency medicine.)

But sometimes...

Older patient, multiple documentations on her chart of refusal of mammography from prior physicians. Would have taken 3.7 seconds to recommend it again and note again on the chart her refusal, as had been done multiple times before. But, deciding that I had a good rapport and an opportunity, I took the extra time to discuss the procedure, the benefits, and the increased chance of cure with early diagnosis. She reluctantly accepted the referral.

Early ductal carcinoma. Removed in it's entirety with a lumpectomy. No nodes. For all intents and purposes, she's cured.

I'm so pleased for her, so tickled with myself for taking the time. You always want to, but don't always do it.

So the next time I see her, what do I get?

"That surgeon saved my life."

Now, granted, he's a great surgeon. If I got breast cancer, in his hands I'd be.

But dammit, I saved her life. He just did what any talented surgeon would do.

If I wanted the high drama, I would have chosen a different specialty. But sometimes, a little appreciation would be nice.

Friday, May 25, 2007

Why I don't prescribe diet pills...

Over the counter weight loss pills generally contain some sort of stimulant, sometimes caffeine. Frequently cause side effects such as nausea, palpitations, anxiety. Can be dangerous to take for people with heart conditions. I generally recommend against these.

The two prescription weight loss agents recommended by the FDA are Meridia (sibutramine) and Xenical (orlistat), which is soon to be sold without a prescription under the name Alli. I'm not against either of these pills, however, I have yet to prescribe them once. Once I tell patients that:

1. Insurance often doesn't cover.
2. Weight loss at one year averages 15-20 pounds (compared to 8-10 for placebo), and decreases thereafter.
3. Xenical's list of common side effects include excessive gas, oily discharge, and fecal incontinence.

No one will bite. I can't say I blame them. If there was a weight loss pill that could get you 30-40 pounds, I think people would go for it. But most people weighing 300 pounds can't get real excited about 287, when it means taking an expensive daily pill with side effects.

So it's not that I won't prescribe diet pills, but I don't.

Monday, May 21, 2007

Viagra for jet lag?

Research is suggesting that Viagra may be helpful to mice with jet lag. The researchers had to manipulate the dose after encountering a certain side effect. (Another job I'm glad I don't have: checking for rodent woodies. See, health care isn't that bad.)

Kinda brings new meaning to "Honey, I'm home!"

Sunday, May 20, 2007

SiCKO

Michael Moore, director of "Fahrenheit 9/11" and "Bowling for Columbine", premiered his new film "SiCKO", at the Cannes Film Festival yesterday. I'd like to say I was important enough to have been there, but my services as a soccer mom were in demand anyway. (We won both 6/0!)

Anyway, if you haven't seen Mr. Moore's films, they're eye-openers. If you tend to be politically left-leaning (as I am), you'll probably enjoy them. I do find him to be a touch on the sensationalist side for me, but hey, it's Hollywood. Anyway, in this film he takes on the health care industry, and my prediction is that it'll be a real hoot.

Maybe next year when Brad and Angelina call I'll be able to make time in my busy schedule to fly to France.

Wednesday, May 16, 2007

A new disorder?

My experience this week with an unstable bipolar patient has me thinking about the disorder. Bipolar disorder refers to a mood disorder in which patients experience not only severe depressions, but also episodes of mania. Mania is difficult to understand if you haven't seen it, and is truly remarkable.

You know those days where you feel like you can do anything, conquer the world? If you take your most energetic day, multiply by 10, and then snort cocaine, you've got mania. People in manic episodes can't sleep, get very delusional ("I'm the president"), and make very impulsive decisions, like spending thousands of dollars in a day. It can be a debilitating disorder. Seeing a person in an acute manic episode is awe-inspiring, if you use awe in a "holy sh*t" kind of way. I have a lot of respect for it as a disorder, the way a surgeon has respect for dead bowel.

There are a lot of people diagnosed as bipolar whom I find very non-awe-inspiring. They're impulsive. They do the things the rest of us think about but don't do, like tell off the boss, run up their credit card bills, get into barfights. The dumbasses of the world. They can't maintain relationships, keep jobs, save money, or raise their kids. In a nutshell, they act like your average teenager, well after the time when that behavior is developmentally appropriate. (This is also a good time to point out that I highly object to the frequency with which teenagers are diagnosed as bipolar.)

Now, I'm no psychiatrist, but it seems like there's a HUGE difference between these two patient populations. Shouldn't we be calling them something different?

Here's your chance, readers (all 3 of you). I propose DDMD - Dumb-Assed Decision Making Disorder.

Let's get some input! C'mon, show me some love. I don't want to have to name names.

Sunday, May 13, 2007

Crocs and sharks and bandits, oh my!

I'm not a thrill-seeker. I find it hard to understand people who are. But there are thrill-seekers, and then there are lunatics.

Martin Strel is a lunatic. He has a history of swimming rivers, big ones, including the Danube, the Mississippi and the Yangtze in China. Hmmm...after you swim the Yangtze, what's left? The Amazon.

So here's why this guy is a nut:

1. Deadly whirlpools
2. Flesh-eating piranhas
3. Multiple types of poisonous snakes
4. Crocodiles
5. Bull sharks
6. Candiru fish (these little treats climb up the urethra when one urinates, then implants a spike and begins feeding on surrounding tissue)
7. Hippos
8. Roving bandits

Any one of those would have been enough for me to decline. What's wrong with the YMCA pool, anyway?

He ended up swimming 3,272 miles in 65 days, losing over 30 pounds during that period of time. His team rode along behind him dropping blood and raw meat into the water so as to draw the various predators away from him.

What's next? According the Mr. Strel, the Nile is too tame. He actually referred to it as "a small creek". Maybe he'll have to start tackling oceans.


Amazon Swim 2007

Friday, May 11, 2007

I'm just a girl....

Shameless plug for commercial site:

I love Zappos.

For a small-town gal, being able to get that selection of fabulous shoes delivered to my door, OVERNIGHT, is liberating.

Their customer service is fabulous. And they'll honor any price of any other website (as long as the cheaper site has your size and color).

The fact that Zappos now sends me handwritten thank-you notes may mean that I've gone a bit overboard. But it's been fun.

Tuesday, May 8, 2007

Lost in HIPAA-land

HIPAA stands for the Health Insurance Portability and Accountability Act. It's the reason you have to sign that piece of paper every time you see your doctor, or have any interaction with any health care professional.

HIPAA was a well-intentioned law, tho sometimes misinterpreted. And, in defense of the health care industry, sometimes it's a tough line to walk. For example, if a doctor calls the hospital from home for information, how do they know who is who, as it would break HIPAA regulations to give information to those not entitled to receive it, ie family members, nosy neighbors, etc. So it can at times be an annoying hurdle, especially for those who don't understand the regulations fully (myself included, at times.) However, the overinterpretations can be ridiculous at times.

I had a HIPAA run-in recently. I needed to draw some stat labs on a patient, around closing time for the office. So, as I often do, I hand-wrote on the lab slip "Please call results to 867-5309". Not really, that would be Jenny. But I put my cell number on the slip so that I would get the results, not the on-call doctor.

So that evening I get a call.

"Hi, this is the lab. I have your stat results."

Great, let me have 'em.

"Except, how do I know it's you?"

What?

"You know, the HIPAA stuff, how do I know it's really the doctor?"

Buddy, you called me.

Friday, May 4, 2007

Time for your cleaning...

The American Heart Association has released new guidelines regarding prevention of endocarditis during dental and other procedures. Essentially, almost no one needs it anymore. See the details here.

For those unaware, there has long been a concern that the introduction of bacteria to the blood stream during dental cleaning could lead to infection of the heart, leading to disastrous consequences. People thought to be at higher risk included those with prosthetic valves, congenital heart defects, and the much more common "leaky valve". It has long been thought that the risk of infection was quite overblown, but due to liability concerns you'd NEVER find a dentist to touch your teeth without premedication with an antibiotic, if you had any history suggesting a valvular problem. Hopefully that will all be able to change now.

Fewer unneccessary antibiotics is always a good thing.

Wednesday, May 2, 2007

They're not just for men...

My breastfeeding rates are horrible. Just horrible.

I'm only a family doc, so I don't do a ton of peds. Maybe 20% of my practice. And this last 2 weeks there was an anomaly - I got three newborns, two of whom were breastfeeding. Unheard of for me.

Because of my practice situation, I don't often see my babies till the decision has been made. I don't hospital round, and I don't do OB (shudder), so my newborns usually hit my office at about 2 weeks. And I would estimate that 80% are bottle fed. It may be closer to 90%. I wonder if I would be able to intervene a bit if I did newborn nursery rounding, but my feeling is that the decision to nurse or not is made far in advance of the trip to the hospital.

My patient population is predominantly white, lower income. There is a TERRIBLE stigma against using the female breast as anything other than a sexual object. There's lots of "He doesn't want me to", with "he" being the unsupportive, unemployed sperm donor. The most common response I get from our staff regarding breastfeeding is "Ewww." Fortunately, they don't say this to patients, but I'm quite certain that gets communicated at some level.

Patients often won't consider trying. Those that do cave (understandably) the first time that newly-christened Meemaw (that's "grandma" out in the sticks) says "That baby ain't getting enough milk", which also seems to happen before I see the kid. Any potential confidence new mom had is shot, and baby gets enfamil lipil, formula of choice for our local WIC office.

But, this week, I had two new nursing moms. Two slightly yellow babies. One is going to do great, she's got a great grandma (who adopted her so never nursed), and one who I think is only going to make it another week. Just a gut feeling.

Here's hoping.