Opining Online

First thing I read today was in a doctor’s office waiting room. I was thrilled that he’d put out a recent copy of the Southern Medical Journal. Surely, I didn’t understand some of the terms used, but if I’d chosen Glamour, I wouldn’t have understood why any of the content was important.

One article was about a 17 year old Hispanic male who had a reaction to concurrent treatment for HIV and active TB. I was mainly horrified that one so young led such a life where he was exposed to either. So very, very sad.

Another was about a 61 year old woman who unknowingly aspirated a hazelnut. I think I remember the nut and the age of the woman correctly. My first question was how one could unknowingly do that. Then it noted that other than the breathing problems that prompted her to get treatment, she had no other health problems except schizophrenia. Perhaps that explains the unknowing part.

The take-home message for me from that article was that aspirated foreign objects are relative rare in adults, but quite common in children, especially ages 5 and under. The most commonly aspirated objects are nuts; the most common nut is the peanut. Note to parents: no nuts until after age 5.

Online, I’ve been reading mostly health or science topics too. Crooked Timber has a great post, Fat Hominid, on fad diets and evolutionary psychology. The comments are good too. If you can stomach reading about eating rodents and insects.

Then I surfed on over to ScienceBlogs where I eventually found a link to Encephalon #49 at Neuroscientifically Challenged. It’s always amused me that we must use what we’re studying to learn about the brain. And yes, I’m easily amused.

Unbelievable. In order to decrease the number (ie, costs) of emergency C-sections, UK news reports that statins will (?) be prescribed in the last three months of pregnancy. Supposedly, a low cholesterol count increases the ability of uterine to contract decreasing length of labor.

Oh, and did I mention that this is for obese women? Because of course your cholesterol is high if you’re obese! Why, it’s just a given, right? And did anybody mention that an increase in cholesterol and triglycerides is normal in pregnancy regardless the mother’s weight?

But what is the cost of slightly reducing the number of emergency C-sections? Why it’s just deformed babies, some so severely they die within a month of birth.

It’s time to put a stop to the “war” on obesity. It’s killing us.

How I would have loved for The Anchoress to be wrong. Her prediction:

Someone - probably Keith Olbermann or Chris Matthews - will go completely over the top and say that the Kennedy illness will not mark the “end of Camelot…how fitting that it is being revived this very night by Barack Obama, Ted Kennedy’s handpicked successor to the enduring legacy,” or some such gag-inducing nonsense.

Unfortunately, she was not wrong. She accurately predicted the media malignancy that will make Ted Kennedy’s serious illness “all about Obama.”

Brain tumors, malignant or benign, are not about politics. This is a man’s life, his future quality of life, the ordeal his family will endure - that’s what we’re talking about here, not his past mistakes and foibles and certainly not about the next Democratic nominee, whoever that might be.

I’m also a bit disgusted about the “pre” eulogizing being done by some of Kennedy’s democratic colleagues. He’s not dead yet and from all the reports seems to be as alert and cognitive as ever. Imagine what it must feel like to hear your funeral years before it might happen.

That’s the breaking news on Fox right now. The “expert” they are speaking with is Dr. Michael Baden, a forensic pathologist. He says that most brain tumors in older people are benign, citing meningiomas.

He also made it sound like the surgery to remove any old meningioma is a breeze, patients recover and go on with life as before. Well, as the proud owner of a meningioma, I say not exactly.

For one, he’s a pathologist, not a surgeon. He probably doesn’t have many of his patients complaining about complications.

Second, he’s not a neurologist or neuropsychiatrist. He is probably as familiar with the physical structure of the brain as either one, but… perhaps he’s not as familiar with the peculiarities of minor damage to any area of the brain.

The thought that Kennedy might have a brain tumor has crossed my mind several times since I heard the news of his hospitalization. Mine was discovered when I thought I had a mini-stroke, or TIA. I was worried enough that I sat in the ER for 5 hours after all symptoms subsided to find out. I think Kennedy got, um… more aggressive treatment than I did.

For his sake, I hope it’s a meningioma, I hope it’s small, not near any major bloodworks, and that radiation is considered as the first course of treatment. This isn’t about politics, I wish him well.

Here’s one shot of my brain tumor, before radiation treatment.

UPDATE: AP is reporting that Kennedy’s tumor is a malignant glioma. Not good news.

At least some part of the body gets better with age. John McCain’s campaign should jump on statements like 

“It may be that distractibility is not, in fact, a bad thing,” said Shelley H. Carson, a psychology researcher at Harvard whose work was cited in the book. “It may increase the amount of information available to the conscious mind.”

and

“A broad attention span may enable older adults to ultimately know more about a situation and the indirect message of what’s going on than their younger peers,” Dr. Hasher said. “We believe that this characteristic may play a significant role in why we think of older people as wiser.”

and

“If older people are taking in more information from a situation, and they’re then able to combine it with their comparatively greater store of general knowledge, they’re going to have a nice advantage.”

Obama should be worried that the article indicates that an ability to ignore distractions, though quicker, ultimately results in assimilating incomplete information. In his case, I think it is not only a desire to not be ”distracted” but also an ingrained part of his temperament.  

via Instapundit

From the inimitable Dr. Boli:

Now observe that we could, without altering the lists at all, change the headings above the lists to “Things That Are Healthy to Eat” and “Things That Are Not Healthy to Eat.” The correspondence is perfect. Things that taste good are things that are healthy to eat. It follows, of course, that the things that taste best are the healthiest to eat.

My Plan!

Not “MY” plan, my friend Sarah’s plan. I’m not that ambitious or diligent.

Ed Cone writes about the importance of men getting tested for possible prostate cancer. First of all, it’s a blood test (PSA) that indicates whether further examination and testing needs to be done.

While acknowledging “that packaging the words “prostate” and “cancer” in one soundbite creates a phrase of uncommonly low conversational appeal, a compact cluster of social taboos,” he neatly lays out why the conversation needs to be held.

As unpleasant a conversation as it might be, it beats a national conversation on race and gender.

Bill Jempty of Wizbang has chosen Mississippi State Representatives W. T. Mayhall Jr, Bobby Show, and John Read to receive his Knucklehead of the Day award.

These three morons have sponsoring the following legislation:

An act to prohibit certain food establishments from serving food to any person who is obese, based on criteria prescribed by the state department of health; to direct the department to prepare written materials that describe and explain the criteria for determining whether a person is obese and to provide those materials to the food establishments; to direct the department to monitor the food establishments for compliance with the provisions of this act; and for related purposes.*****

(2) Any food establishment to which this section applies shall not be allowed to serve food to any person who is obese, based on criteria prescribed by the State Department of Health after consultation with the Mississippi Council on Obesity Prevention and Management established under Section 41-101-1 or its successor. The State Department of Health shall prepare written materials that describe and explain the criteria for determining whether a person is obese, and shall provide those materials to all food establishments to which this section applies. A food establishment shall be entitled to rely on the criteria for obesity in those written materials when determining whether or not it is allowed to serve food to any person.

House Bill 282 was introduced Friday, Feb. 1.

Sandy Szwarc, of Junkfood Science fame asks:

Is this a tongue-in-cheek bill, meant to point out how absurd the war on obesity has become? Or do lawmakers actually believe the myths that gluttony is the cause for obesity and that it is the government’s role to force people to eat and live how it deems best?

Rep. Mayhall answered her question that the bill was serious, though regrettably (hallalujah!) he doesn’t believe it will pass. He hopes it will call attention to the problem and what obesity is costing the Medicare system.

What is obesity causing the Medicare system? Someone want to give me some hard figures on that? I don’t want “but it must be costing because fat people are unhealthy!”

My first diagnosis of fibromyalgia was in 1992. Antidepressants helped, I sort of “got over it” and went on with life. I still had those “trigger points” in the shoulders, knees, shins, ankles, etc., but as long as nobody pinched or pressed there I was fine.  Then, in 2000, my PCM of the day, said (when I winced at her pushing on my lower shins and said that one doctor had said that was from fibromyalgia) that she didn’t “believe” in fibromyalgia. End of discussion. I’ve tried not “believing” I felt pain, but dammit, the pain was still there, as was the overwhelming fatigue. Since I was first diagnosed with it in 1992, the only thing I’ve found that really relieves the pain is a combination of Strattera and Lexapro.

I’ve not mentioned “fibromyalgia” to any other doctor since the one who didn’t “believe” in it because I don’t want to be classified as a nut case or drug seeker. Also, I do not believe that fibromyalgia is the cause of all my pain. I think I also have a pinched nerve or something that causes sudden, extreme, but thankfully short-lasting pain in my legs.

My main problem - as mentioned in “I am my own PCM” is the lack of opportunity to discuss multiple aches, pains, symptoms, etc., with my doctor in one single visit. Appointments are generally limited to “what, specifically, is bothering you today?” That really doesn’t lend itself well to “well… several things and could they possibly be related?”

I do have a verified diagnosis of arthritis and I wonder which pain is caused by that. I classify my wrist, shoulder, knee, and ankle pain to it… but shin pain? I dunno… and apparently neither do most doctors. Why does the shoulder and knee pain differ when somebody squeezes either body part (a typical occurrence at Southern family reunions) from the more ordinary “oh god, I’ve overused this joint today” pain?

Bottom Line: I don’t know what the hell’s wrong with me, but articles like “Drug Approved. Is Disease Real?” don’t help answer the question. Note that the addition of Straterra to my normal drug regimin has almost eliminated the need for Tylenol and Naproxen. The only drawback is the tendency of Straterra to cause dizziness. Unlike most folks, I have a benign brain tumor that (though dead through radiation) may cause dizziness.

hmmm…. what side effects of what up with do I put?

A while back I wrote about being my own PCM. There, I implied that was not a good thing. As I think upon it more, I’ve decided I was wrong. Not only am I my own PCM, I darn well should be. Who — besides me — is more interested in my overall health and well-being? I should leave that up to anyone else than me?

No. I have to take responsibility for myself and my health.

As I’ve experienced a few dizzy spells the last few weeks, I’ve decided to take a good look at my medications. There are 8 (eight!!) prescription drugs I take daily. Could it be possible that while there are no “serious” interactions among these drugs, that some combination is causing me to feel dizzy?

My Tricare Prime PCM relies on the computerized comparison of these drugs to determine “compatibility” and, I suppose the MTF pharmacy does also. Yet, my body is unique and may react differently than normally expected.

I’ve decided to do my own research into each drug I’ve been prescribed and then I will go over those results with my PCM, whoever he or she may be at the time I finish.

No Relief in Sight

Clinicians and researchers have long remarked on the link between opiophobia and undertreatment of pain. In a 1966 pharmacology textbook, the psychiatrist Jerome H. Jaffe, who later became Richard Nixon’s drug czar, noted that patients who take narcotics long enough develop tolerance (a need for larger doses to achieve the same effect) and physical dependence (resulting in withdrawal symptoms). But he cautioned that “such considerations should not in any way prevent the physician from fulfilling his primary obligation to ease the patient’s discomfort. The physician should not wait until the pain becomes agonizing; no patient should ever wish for death because of his physician’s reluctance to use adequate amounts of potent narcotics.”

It’s been going on a long time and should end now.

Fat, I am.

Why? One reason is I eat & drink the wrong things - I can’t eat too much of anything since I had banded gastroplasty and have about a 4 bite limit on solids, less on lean meats. The limit is higher on liquids, but not infinite. So, most of my weight is probably under my control. But what about that part that is due to inheritance? My mother, and my grandmothers on both sides were obese.

There’s plenty of evidence that genetics plays a role in obesity. I thought I’d gather some links here to show how varied and scattered that evidence is, as well as how ineffective current “treatments” are.

CORRELATION OF OBESITY TO THINGS UNRELATED TO BEING AN OVEREATING COUCH POTATO

Continue reading “Fat, Fat, Fat”

It seems it’s difficult to overcome the effects of binge drinking no matter how long one has been sober: “The more we have binged — and the younger we have started to binge — the more we experience significant, though often sutble, effects on the brain and cognition.”

Much of the evidence for the impact of frequent binge-drinking comes from some simple but elegant studies done on lab rats by Fulton T. Crews and his former student Jennifer Obernier. Dr. Crews, the director of the University of North Carolina Bowles Center for Alcohol Studies, and Dr. Obernier have shown that after a longstanding abstinence following heavy binge-drinking, adult rats can learn effectively — but they cannot relearn.

When circumstances change, they lack the ability to respond appropriately to new circumstances. They’ll keep going back to what worked before even though time after time it no longer works.

As Shakespeare once pointed out without the benefit of studies on lab rats, “O God, that men should put an enemy in their mouths to steal away their brains!”

Psychiatrist Paul Steinberg offers some realistic and possible resolution for the New Year:

1. Stop after one or two drinks. Studies of the Mediterranean diet have shown that one or two drinks on a consistent basis leads to a longer life than pure teetotaling.
2. If you must binge, start at age 40, not at age 16… Just as youth is wasted on the young, so perhaps is alcohol.
3. If you have binged excessively when younger, follow it up with some regular exercise. Get those brain cells regenerated.

I think I’m getting better. I got an appointment at the clinic yesterday and am on a different kind of antibiotic.

I have a tendency to bash military health care at times, but I have to report two good recent experiences. First, a visit to the Urgent Care Clinic at Moncrief Army Community Hospital, where I was seen quickly, given some relief immediately and sent away with medicine - no extra trip to a pharmacy.

Unfortunately, the medicine didn’t work well enough, or the strain of the 850 mile drive home simply made me worse. So, the day after Christmas I call Barksdale and my description of symptoms (and the fact that they could electronically access the visit to Moncrief) got me an appointment yesterday morning.

I’ve learned that you don’t simply call and ask the appointment person for an appointment. They rarely have any, but they will always get you a call back from a nurse who has much greater appointing powers.

This makes twice, yes that’s TWICE in a row that I’ve seen my assigned PCM! Maybe things are settling down there and she will be around for a while.

The Weight Story No One Wants to Talk About

The implication of these finding, which barely registered in the news cycle, are significant. They suggest that most American need not worry about being too fat, since most mortality is associated with BMI’s in excess of 35. Even mine is nowhere near that!

The findings suggest that the continual message from the government and the public health community to lose weight or to be as thin as possible lacks a credible scientific basis. And they suggest that it is those who weigh too little whose plight deserves attention.

Not that I couldn’t stand to lose a ::cough:: few pound ::cough:: but I’m fairly healthy for my age. I have slightly elevated blood pressure which would probably be normal if I quit smoking, no heart blockages (confirmed by a cardiac cath, because I did flunk two stress tests. The cardiologist informed at the time that many women flunk those tests because their breasts interfere with the readings.)

My main health problem is still the benign meningioma which I chose to treat with radiation instead of surgery. The symptoms will have to get much, much worse before I’ll let anyone drill into my skull and play around with what little brain I have left.

It’s not like I planned it this way. I grew up with the idea that one had a family doctor they saw regularly for checkups, shots, broken bones, and skinned knees. That’s what I looked for when I was older. I have no opposition to specialists, but I would have preferred the continuity of seeing the same doctor each time I go. I really would like to have a primary care manager.That’s not happening under Tricare Prime. I’m assigned to an MTF (military treatment center) and since I’ve been in the plan - 2 years now - I’ve been assigned to five different PCMs. I had 3 visits with the first, 2 with the second, 0 with the third, 3 with the 4th, and one with the current one. Two of these assignments have lasted less than 6 weeks. Three of these visits were for actual illness, the others were to get medication refills. Each new PCM wants to “see” me before refilling scripts I’ve been on for years, or before putting me on an alternate generic because the DOD has made a new deal with a different drug company.

None of these doctors ever had the chance to get to know me, or for me to know them. The MTF has a nice electronic medical records system, but it’s time-consuming and limiting. The doctor or PA is facing the computer, not me.

Before a visit, I do or consider all the things Christine recommends in Preparing for a Doctors Visit. My list of medications includes OTC stuff, meds I previously took, who prescribed them, why I no longer take them, dates of the above, etc.Not only do I write out questions I want to ask, but I include objectives I want to meet during the visit. Those are most often, get a refill written or get a referral to a specialist. Never have I discussed long-term medical goals with any of them. They know as well as I that we may never see each other again.

The closest I’ve come to having continuity of care is always getting the same internist when I’m hospitalized (luck of the draw) and the ongoing relationship I had with my radioncologist. But who wants to go the hospital or have radiation treatments to get a little continuity of care?This is why I am my own PCM. As Christine writes, “You know your body best, and you need to be your own advocate in the doctor’s office.”