Feeds:
Posts
Comments

Posts Tagged ‘medicine’

I’ve been thinking about immunity lately. Why is it that some of us never seem to “catch” a cold? While the rest of us succumb to the slightest bug going around. Why did I develop an anti-immune disease (Guttate Psoriasis) at 60 that normally shows up at 30? Maybe it’s just that since we returned from Mexico, illness has descended on my house like a plague. Today, Bob was diagnosed with pneumonia, about a week after I started feeling “normal” again. Ah, the wonders of antibiotics.

It’s well known in my family that the Flapper gave Bob the original hospital bill of my birth when we married. She stayed in the hospital for 11 days in 1948; remember I was baby number six, and the only one born in a hospital, so the doctor thought she needed a rest. My parents were charged a dollar a day for the nursery, $11 for my care and feeding. And at the bottom of the hospital bill was a section for penicillin charges. Antibiotics were so new, they had an important, separate spot on the bill!

WWII brought us not only the bomb, but the quick development of antibiotics. Eisenhower wanted enough penicillin to treat his soldiers after the Normandy invasion and so the original strain, discovered in England in 1929, had to be made and marketed on a mass scale in the United States after we entered the war.

On March 14,1942, the first patient was successfully treated for strephtococcal septicemia with U.S.-made penicillin. Half of the total supply produced at the time was used on that one patient. By June 1942 there was just enough available to treat ten patients.

Just 10 patients in 1942! According to legend history a good strain was found on a moldy cantaloupe in Illinois and our Army doctors (along with Merck) managed to synthesize 300 billion units by D-Day 1944. Pretty amazing in just two years. Which is why our parents were so hypochondriacal. The Greatest Generation grew up without antibiotics, afraid of every cold and scratch their children suffered because in an instant, the grim reaper might appear at anyone’s door. My foster father Jim often talked about his sister who died when her older brothers were swinging her, holding her arms and legs, upstairs in the attic. Just fooling around, having fun. A splinter in her back became infected and that was that.

Which leads me to another kind of immunity, something called “psychological immunity.” In this Atlantic article http://m.theatlantic.com/magazine/archive/2011/07/how-to-land-your-kid-in-therapy/308555/ the author tries to explain why our 20-30 year old adult children are so unhappy, even though their parents did everything they could for them…and there’s the answer. We parents are doing too much, and not allowing our children to learn some pretty simple lessons – like picking yourself up, brushing yourself off and deciding that that wasn’t so bad and I can take care of myself alright. “Well intentioned parents have been metabolizing their child’s anxiety” for so long that once they are unleashed on the world, they don’t know how to handle its ups and downs.

It’s like the way our body’s immune system develops,” he explained. “You have to be exposed to pathogens, or your body won’t know how to respond to an attack. Kids also need exposure to discomfort, failure, and struggle. I know parents who call up the school to complain if their kid doesn’t get to be in the school play or make the cut for the baseball team. I know of one kid who said that he didn’t like another kid in the carpool, so instead of having their child learn to tolerate the other kid, they offered to drive him to school themselves. By the time they’re teenagers, they have no experience with hardship. Civilization is about adapting to less-than-perfect situations, yet parents often have this instantaneous reaction to unpleasantness, which is ‘I can fix this.’

It’s hard not to try and fix everything. It looks like it will take more than chicken soup this time to get Bob back on his feet. Thank you General Eisenhower! And thanks to the universe for our last, hopefully, snowstorm.

IMG_0259

 

Read Full Post »

Had a short talk with Bob yesterday about Philip Seymour Hoffman. And we both thought it’s a shame, but not for all the general reasons everyone’s been talking about, like his life and character and talent. Because ever since some 19th Century chemist decided he could change morphine into heroin –  thereby making it much more euphoric, easier to administer, lasting longer and with lower dosages – people have been overdosing on this drug. A drug that is still used medicinally in the UK…because for really sick, terminally ill people, there is literally nothing like it. It is the opiate on steroids! For many years people, I mean ordinary brothers and sisters, mothers and fathers, black, white and brown, have been dying for/on heroin for over a century.

What’s different is that now another celebrity has died of addiction. But really, what’s different? A bag of heroin costs about $10 and an oxycodon pill costs $40, so that’s different. PSH had the money to go out and buy a week’s supply of heroin, he didn’t have to perform a sex act on the street to get high, so that’s different.

Doctors are encouraged to “Treat Pain,” nurses have us rank our pain on a scale of 1 to 10, in fact in some states if a doctor or NP doesn’t “treat our pain” he/she can be sued. There are whole buildings being built to deal with pain management in health centers across America. So in the same way we’ve become aware of the dangers over overprescribing antibiotics, doctors need to become more aware of the addictive powers of pain killers. Because for some of us, as Jim Carrey said of PSH: “For the most sensitive among us the noise can be too much.” 

I might say after knee surgery, “That pill makes me feel funny,” so I stop taking it. But the addict, probably 10% of the population, has a part of the brain that recognizes that narcotic in a primal center of their neural cortex, the addict says, “More please.”  Someone I knew well once said, “There are no 50 year old junkies.”

But here is a conversation we need to start in DC. Why not make Naloxone (aka Narcan) available over the counter? This is a miracle drug which can bring a dying, overdosed person back to life, and instead of waiting until an EMT or ER doc is available to administer it, which is often too late, why can’t families and friends of addicts purchase the drug as a nasal spray to keep in their home? Well they can in a program in MA, oh God I love that state! I knew it when they went for McGovern!

The problem has become more urgent: Heroin overdose deaths in the U.S. nearly doubled over the last decade, from 1,725 in 1999 to 3,278 in 2009, according to the Centers for Disease Control and Prevention. During the same period, deadly overdoses from opiate-like drugs, including painkillers, have nearly quadrupled, from 4,030 to 15,597. Naloxone works by blocking certain drug receptors in the brain. It has no effect on alcohol or cocaine overdoses but can be used against such painkillers as OxyContin, Percocet and Vicodin. http://www.huffingtonpost.com/2012/04/26/naloxone-drug-overdose-antidote_n_1456531.html

There was no one with PSH at the time of his overdose, so having Naloxone nearby may not have helped him. But once the rest of the country follows MA’s lead, we may get the chance to save more lives, because I believe recovery is possible. One day at a time. read more: http://healthland.time.com/2012/04/13/naloxone-debate-fda-hears-testimony-about-making-an-overdose-antidote-nonprescription/

Philip-Seymour-Hoffman1

Read Full Post »

This morning I devoured my first cup of coffee with the Love Bug on my iPhone. Oh Facetime, how wonderful you are! She kissed me and carried me around with her while she cruised the living room, demonstrating her superior walking technique. I wish they could return to the Blue Ridge this weekend for our next wedding, but the Groom is on call every other night in the MICU. Great Grandma Ada and Great Grandpa Hudson are coming South to see a Big Chill daughter tie the knot in Richmond. Her fiancee was is a Marine, “…once a Marine always a Marine. There are no former Marines”

Who doesn’t love men in white gloves and dress uniforms holding an arch of swords? Unfortunately, we’re not sure if that arch will be there due to the government shutdown. We also had planned to take Hudson, who is a woodcarver and an ex-Baptist minister who officiated in 2010 at the Bride’s wedding, J&M  0622to the National WWII Monument in DC after the wedding. Gpa Hudson is an 86 year old WWII vet and has wanted to see the memorial since it first opened. We may have to storm the barricades next week if the Park Police are still guarding the gate. Listen for my Tweets people, if I’m arrested with Ada and Hudson get us a wheelchair and a lawyer!

It’s bad enough that Ted Cruz and his ideologic idiots have been holding our government hostage over their ever-moving concerns about affordable health care and debt ceilings, but it becomes meteorically worse when they try to claim this memorial as their own and blame our President for its closure…it almost made me sick in fact. It’s not only sightseeing that has been curtailed for 14 days, this shutdown has left “…vital drug trials on hold, which is a matter of life and death for some patients.”

Yes, life and death, real people who cannot participate in life-saving treatments because the NIH has stopped accepting new patients. 75% of their staff are sitting at home while 15% of their patients who cannot start a treatment protocol are children. The GOP can make up fictional scenarios like “death panels,” but they are so much better at creating real tragedies for the 99% of us.

Under normal circumstances, 200 patients at NIH enroll in clinical trials each week, 30 of whom are children. While 12 exceptions have been made for the most critical cases, this still leaves hundreds of sick patients and families stuck waiting until Congress can settle its differences. http://www.bbc.co.uk/news/world-us-canada-24525913

So that comes out to about 400 people so far, who may not have a month or two to wait…two weeks after giving birth a young mother diagnosed with stage 4 sarcoma had her application for a clinical trial delayed. Michelle Langbehn has started an online petition on Change.org in order to pressure Congress and has over 140,000 signatures:  “I speak for everyone battling cancer when I say we don’t have time to wait.”  http://www.change.org/petitions/help-me-fight-cancer-and-stop-the-shutdown

Crossed swords it seems are the least of our problems. We need to vote the old guard out, get money out of politics and organize policy makers who will speak to the wide breadth of our country, with common sense and dignity for all. I can’t wait to see the new documentary “Inequality for All.” http://inequalityforall.com I’m usually pretty optimistic about life, I like to think we can take our country back, from the fringe GOP. Fingers crossed.

 

 

 

 

 

 

Read Full Post »

This morning it’s overcast and calm. Only the first ridge of mountain is poking up between the clouds. Not like yesterday, when we woke to a clear day and another mass shooting, this time closer to home at the DC Naval Yard.  And if you happened to miss the physician, Janis Orlowski, who treated some of the survivors make her heartfelt plea to end gun violence, here it is:

“There’s something evil in our society that we as Americans have to work to try and eradicate,” she said, adding that “I would like you to put my trauma center out of business. I really would. I would like to not be an expert on gunshots.” She added: “Let’s get rid of this. This is not America.” http://www.theatlanticwire.com/national/2013/09/watch-dr-janis-orlowskis-moving-plea-against-gun-violence-after-navy-yard-shootings/69471/

If you don’t work in  a trauma center, if you’re not an ER doctor or nurse, you may have watched or listened to the incident unfold with a cynical eye. It’s just another crazy person; didn’t they have to go through a metal detector?; how did the shooter obtain clearance to enter a secure DOD facility? But if you’ve actually seen what a bullet can do to a body, if you’ve had to race against time to save a life, if you’ve had the heartbreaking job of telling someone’s family that your patient, their loved one, has died, well then you understand the problem.

And the problem is GUNS. The epidemic is gun violence. Because that is what’s evil in our society, it isn’t the mentally ill person who believes that a voice is telling him to shoot up a school or a movie theatre. Mental illness affects many of our families and friends, that is inevitable, it’s been around since time began, or Cain and Abel if you prefer. People who suffer from mood disorders through those with paranoid schizophrenia can seek treatment, they can live a normal life. We are the Prozac nation after all.

What we cannot escape is guns – they are sold in parking lots, and online, as if they are candy. They are glorified in film and on TV. I’ve said this before, I don’t need to know why some one entered a Naval facility with a rifle and picked off his victims from an upper landing in a beautiful atrium – the motive really does not matter. Let’s ask ourselves why our legislators could not get a simple background check law passed. Because as we saw yesterday, having more guns inside a facility isn’t the answer.

Yesterday we were a nation in shock again. When I walked out to my car I saw this. photoHow could this happen? Was it another angry bird that flew into my car’s window, a hunter’s gun shot, a deer antler? I live in the woods, nothing was taken, so Bob and I picked up thousands of pieces of shattered green glass. And I thought about the survivors of the Naval Yard shooting, the people who saw the carnage up close and personal.

Today I’ll have my window replaced, but I wonder how long it will take the survivors to put the pieces of their lives back together. And when our nation will stop electing puppets of the gun lobby. Or are we immune now to this, even after small children are massacred in their classrooms, have we become habituated to shock?

Read Full Post »

This is an addendum to the last blog post, courtesy of the Bride and TN Poison Control Center. I guess this is not such a new recreational drug. She has seen many teens die in the ER and her husband has seen the results as well in Vandy’s ICU. Molly has also been called “bath salts.”

04-04-11 What is in Molly’s Plant Food? (one of the latest recreational drug rages to affect Tennessee’s teens and young adults)

Question of the Week
April 4, 2011
What is in Molly’s Plant Food?  (one of the latest recreational drug rages to affect Tennessee’s teens and young adults)
Molly’s Plant Food is a synthetic hallucinogenic amphetamine marketed as a “plant food” that contains ingredients that produce highs similar to Ecstasy. Molly’s Plant Food is usually purchased at a convenience store and is packaged in a capsule form with a cost of $8-$12 per capsule. The product label warns “not for human consumption”; however it is packaged in a psychedelic colored wrapper and several Internet web sites and chat rooms refer to the product as “legal ecstasy”. The active ingredient is mephedrone, which is not a scheduled (DEA) drug, therefore making it legal.
Over the past six months, The Tennessee Poison Control Center has received an increasing number of calls from emergency departments regarding symptomatic patients who have ingested or snorted Molly’s Plant Food. Clinical effects include euphoria, anxiety, paranoia, agitation, tachycardia, hypertension, delusions, diaphoresis, and weight loss. The treatment is supportive with intravenous fluids and benzodiazepines. Signs and symptoms have lasted an average of 24-48 hours.
This past week brought good news. Under an emergency court order sought by the Tennessee Agriculture Commissioner and the Attorney General, sheriff narcotic detectives have been removing the products from convenience stores in Rutherford County. Since Molly’s Plant Food is titled a “plant food”, it must be registered with the state as a fertilizer (the purported use of Molly’s Plant Food) and clearly list its ingredients. Molly’s Plant Food has neither been registered nor are the ingredients listed on the package.
This question prepared by Marilyn Weber, CSPI, MSN, RN Tennessee Poison Control Center
images

Read Full Post »

This is a morality tale. It’s about trust and medicine and more.

This morning I was trying to figure out what’s happening with Morning Joe? Mika looks mad all the time, and Joe is always elsewhere, thankfully in a split screen from time to time with his audio turned off. When I heard this health writer talk about the rule of 7. He heard a drug rep say that it usually takes 7 visits, face to face, with a doctor in his/her office, before said doctor will trust them…in other words they need to be able to talk about their kids’ soccer games so that the rep can pitch his reasons for prescribing their high priced drug over another. At least that was what I inferred from his use of the word “trust.”

This was an aside, they were talking about the low polling numbers for Obamacare at the moment, but of course Joe had to complain about doctors in general on their iPhones while dealing with patients. About not listening to their patients, about young doctors not looking them in the eyes. Fear and loathing in medicine, that’s the GOP war cry. But let’s extrapolate. If you need to see someone 7 times before they can trust you, maybe a patient also needs to see their doctor 7 times before the patient can trust the doctor?

I didn’t want to write about this, but my MIL Ada thinks I should. She is a lively, active octogenarian. She is still working as a marriage counselor, and traveling the world, but she’s been feeling tired lately, getting leg cramps, and hates to complain. Let it be said, when Ada visits us it’s a whirlwind of activity and her home is usually teeming with friends “dropping by.” So her base level for “tired” may mean she only had one big event this weekend so she decided to clean the refrigerator and invite people over for a pool party. But a recent doctor visit had her worried, her liver enzymes looked high.

So Ada gathered all her drugs in a basket, and went to her pharmacist for a look-see. It turns out, she was double-dosing on a cholesterol medicine. Her internist had taken her off the name brand Lipitor, and prescribed a generic, only Lipitor kept getting refilled right alongside the same exact drug in its generic name!

This, her trusty second opinion doctor/son Bob told her, accounts for the liver problem and her tiredness. And, Bob told her, he sees this ALL THE TIME in the ER. Elderly patients on a cornucopia of drugs complaining of symptoms that to a trained acute care specialist look like drug interactions…and so in ERs all across the country, doctors and nurses are sifting through a patient’s drug record right alongside caring for trauma and stroke and heart attack patients.

I’ve learned that doctors rarely “write” prescriptions anymore – they are emailed to a pharmacy. So where did this system fail my Mother-in-Law? Was Lipitor taken off the doctor’s list of drugs, or did the pharmacist, or pharmacy tech who read the new email Rx just add the generic without thinking? How many other patients are suffering?

Technology is supposed to add fail-safe measures to health care, but how do you build “trust” with a machine? Maybe, just maybe talking and listening to a patient is more important. Here is Great Grandmother Ada, with her “little” doctor.

IMG_0829

Read Full Post »

You know that part in the Officer Krupke song of West Side Story, when the character says, “Hey, I gotta social disease!”?

http://www.youtube.com/watch?v=pq28qCklEHc

O God, why do I think of life as one long musical comedy? Well I guess it’s better than a Shakespearian tragedy. I was listening to all the talk yesterday about how the AMA has now classified obesity as a disease. Here is what they said at their annual meeting:

“RESOLVED, That our American Medical Association recognize obesity as a disease state with multiple pathophysiological aspects requiring a range of interventions to advance obesity treatment and prevention.”  http://www.npr.org/blogs/health/2013/06/19/193440570/ama-says-its-time-to-call-obesity-a-disease

So, supposedly, if insurance company clerks agree with this assessment, they will pay more doctors for actually taking time to sit with patients and counsel them about the dangers of obesity, and how to fix and/or prevent it from happening. Sounds lovely in writing doesn’t it? So of course I had to ask my doctors what they thought…granted, this will apply to mostly family practice docs, but still.

“Probably just they’ll start covering more gastric bypass surgery,” the Bride said. She takes that global, public policy point of view, citing economic and social issues with our American widening of the collective belt.

“It’s good for the health of the country,” Bob says. More people will be able to access treatment and more insurance companies will have to pay for that treatment. One caveat he mentioned was similar to the Bride’s concern for an increase in gastric bypass surgery and lap bands – citing the fact that no surgery can be done without risk. He also wondered aloud if more drug companies will now push their efforts into finding the wonder drug for weight loss; you know, instead of curing cancer or AIDS.

Semantics – it’s all in a word and how we phrase something. Addiction was always thought of as a social disease. Alcoholics and drug addicts just needed to stop, just put the glass or the needle down for good, cold turkey. In this interview with Russell Brand, we get the sense of its (drugs and alcohol) complete and total mind/body control. http://www.spectator.co.uk/features/8857821/fixing-a-hole/

“I cannot accurately convey the efficiency of heroin in neutralising pain. It transforms a tight white fist into a gentle brown wave, and from my first inhalation 15 years ago it fumigated my private hell. A bathroom floor in Hackney embraced me like a womb, and now whenever I am dislodged from comfort my focus falls there.”

The problem with food is that we need it, we can’t just put it down and stop eating. We can join a 12 step group and leave our bar-hopping days behind, but we still need to sit down at a dinner table. In Mika Brzezinski’s new book, she talks about her struggle with anorexia and her friend’s struggle with obesity as if they are 2 sides of the same coin. https://mountainmornings.net/2013/05/07/and-all-that/ So then it makes sense, if anorexia is considered a disease worth treating, why not treat obesity?

On a lighter note, the Love Bug is absolutely perfect! At her latest pediatric appointment (9 and 1/2 months), her  height/weight charting shows her to be at the 68th percentile for weight, and 84th for height. “Yeah, I’m tall, you got a problem with that?”IMG952245

Read Full Post »

The first night in Nashville I left my book club book in the car. Not wanting to go downstairs and back outside in my nightgown, I picked up a little paperback I found on the bedside table, The Spirit Catches You and You Fall Down, by Anne Fadiman. Little did I know how much I would enjoy reading about the Hmong people of Laos…currently living in California.http://www.nytimes.com/books/97/10/19/reviews/971019.19konnert.html

It’s a story about seizure disorder, and about the many ways modern medicine can fail a refugee population. Cultural dissonance is bound to happen when doctors want to order invasive tests for a baby who’s only problem is that her older sister slammed the door coming in and so an evil spirit invaded her body. For the Hmong, animal sacrifices, amulets, and strings around the wrist should cure her, but instead her parents, who speak no English, are supposed to dose her with a varied cocktail of drugs many times a day. You can see where we’re going.

But it’s not all medicine. I’m almost done with the book and I’ve had quite a history lesson on Southeast Asia. I was talking about the book to one of the Bride and Groom’s friends, an academic internist at Vanderbilt. She said it was required reading in her medical school. “Which medical school did you go to,” I asked. “Yale,” she said.

This morning, after working all night, my ER doctor asked me to read this article.
http://www.theatlantic.com/magazine/archive/2013/05/how-not-to-die/309277/

Have no fear, yes, it is about dying. Let’s face it, the spirit eventually does leave us and we all have to think about this stuff, unless of course denial works for you. It’s about a doctor who becomes an educational/documentary film maker. He makes short films that actually show people what advanced dementia (among other maladies) looks like, and he tells us to have “The Conversation” with our doctors:

“In the health-care debate, we’ve heard a lot about useless care, wasteful care, futile care. What we”—Volandes indicates himself and Davis—“have been struggling with is unwanted care. That’s far more concerning. That’s not avoidable care. That’s wrongful care. I think that’s the most urgent issue facing America today, is people getting medical interventions that, if they were more informed, they would not want. It happens all the time.”

Which made me think. Sometimes, even when you speak the same language, you still can’t communicate.
black_hmong

Read Full Post »

I remember the first time I went to see my regular doctor at UVA for a general physical exam. The Bride had recommended him and it turns out he is a real life Dr McDreamy. Handsome and smart, plenty of time to answer my questions, not in any rush to shoo me out the door. Maybe this is what academic medicine is all about? I was surprised that he ordered tests for blood and bone density, mammography – and he didn’t actually touch me. I guess my Irish ancestors get the prize for giving me all the right numbers in blood pressure, and remember I didn’t come in with a problem. But my first surprise was the nursing assessment before Dr McDreamy walked in; she asked me if, “I feel safe at home?”

Bob tells me that this is a relatively new question in the battery of things we patients must divulge when we are putting our lives into the hands of someone. I understood, I suppose if I was a battered and abused woman maybe I’d feel safe enough here to break down and tell? It made me wonder what protocol they use if a woman or man answered that question in a different way. How much do we drink, do we smoke, and btw how do we feel in our home? I remember when Bob worked on a baby who had drowned in a hot tub. I’m pretty sure they weren’t asking questions back then about pools and hot tubs.

Last month I accompanied the Love Bug to her 4 month Peds check-up. How’s the nursing going, sleeping? And political junkie that I am, I thought about the small battle that was waged last year to gag doctors in FL. Legislators there were fighting to silence their pediatricians’ general wellness questions; in particular, one question, “Are there guns in the home?” Yes sir, politics has slipped inside that HIPPA protected wall of the doctor/patient relationship – one I liken to a priest/confessor – and is yet again telling our health care professionals what to do.

“The way some doctors see it, asking patients whether they own a gun is no more politically loaded than any other health-related question they ask. So when a Florida law that prohibited them from discussing gun ownership with patients passed last year, they moved to fight it. A federal judge issued a permanent injunction blocking enforcement of the law in July.” http://www.npr.org/blogs/health/2012/11/27/165985266/taking-aim-at-restrictions-on-medical-questions-about-gun-ownership

I relaxed. I thought this will never do, it just can’t happen, if a federal judge in FL blocked this inane law, then it’s over. But no, it isn’t over.
http://edition.cnn.com/video/#/video/bestoftv/2013/01/09/ac-acosta-gupta-health-care-guns.cnn?iref=allsearch

A little known 5 sentence provision was slipped onto the end of the Affordable Care Act. Legislators agreed to slash the language of the bill until all health care professionals could do was ask about guns – there is to be

NO documenting of their conversation about guns,
NO collection of data on guns, and
NO research on gun ownership as it relates to injuries…

Legislators argued and preened around the policy, taking out the part about doctors being jailed if they so much as ask about guns, or even losing their license. As many as 8 states are still fighting to reinstate this criminal provision. Remember the good old days when all we worried about was a transvaginal ultrasound? http://edition.cnn.com/video/#/video/bestoftv/2013/01/09/ac-acosta-gupta-health-care-guns.cnn?iref=allsearch

Why should we care? 1 in 5 deaths of children in our country under age 20 is directly related to firearms – 1 in 5. In a 2 year study, for children ages 5 – 14, guns were shown to be the third leading cause of death. And now, the powerful NRA has basically stopped all research into this public health and safety problem. Let the newspapers print the names and addresses of gun owners. How many more rights are we willing to give up for the almighty money of the gun lobby?

Here is a picture of the graffiti that has appeared on our new bridge over the Rivanna River. “Love” on one side, and “Peace and Faith” on the other. I hope it stays there for awhile, that free speech travels upriver.
photo

Read Full Post »

« Newer Posts