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The Different Kinds Of High Blood Sugar

High blood sugars come in three different tiers for me:  No Big Deal (NBD), Tricky Little Sucker (TLS), and What The Eff (WTE).

No Big Deal (NBD) highs are the ones I see when I first hear the Dexcom BEEEEEEEP!ing.  They are the 180 – 240 mg/dL highs, where I’m cruising out of range, but not so far outside that it takes hours to correct.  The NBD highs are usually mild in their symptoms (kind of thirsty, sort of tired, maybe wouldn’t have noticed if the Dex hadn’t hollered) are thankfully short in their duration, so long as I’m on the ball about keeping tabs on my blood sugars.

Tricky Little Sucker (TLS) highs are obnoxious pieces of garbage that hang on for hours.  These highs are the ones where you hit anything over 200 mg/dL and just ride there for hours.  HOURS.  Like you can undecorate the Christmas tree and pack up all the holiday nonsense back into the attic and STILL find yourself rolling outside the threshold.  They’re the ones that Read more »

*This blog post was originally published at Six Until Me.*

Kansas Hospital Uses Interesting Tactic To Recruit Physicians To Its Rural Area

A rural hospital on the verge of closing because of problems retaining its rotating door of physicians offered two months of leave for missionary work to keep a more stable roster. It worked, according to a profile written by the Associated Press.

All employees at Ashland Health Center in Kansas, from maintenance staff to the doctors, get two months off to do missionary work in other countries or other volunteering duties for the community. The move has attracted socially minded physicians and their families, many of whom had backgrounds in missionary work already and wanted an environment to keep doing it. The recruitment was developed with support of the Via Christi medical residency program in Wichita, which is sponsored in turn by the University of Kansas School of Medicine.

It’s not the only effort underway in Kansas. Read more »

*This blog post was originally published at ACP Hospitalist*

The Principles Of Moisturizing Your Skin

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When I was in medical school on my dermatology rotation, we joked that all skin treatments boil down to three decrees: If it’s wet, dry it. If it’s dry, wet it. And if in doubt, use steroids.

Some other time I’ll discuss the “drying” of skin, or the use of steroids (which are not, by the way, the kind of steroids taken illegally by athletes!) Today I’ll cover how to keep the skin “wet” – and some principles of moisturizing.

Skin is our first line of defense against disease. Bacteria, viruses, parasites – dangers lurk everywhere. But our epidermis (the outer layer of our skin) blocks them almost always. When people have inflamed skin, the epidermis becomes disrupted and infectious particles can enter their body.

The key to keeping the epidermis intact is keeping it moist. Now, I’m talking about moisture just below the surface of the skin (within the epidermis), so the outside surface doesn’t feel wet. There are molecules within the epidermis that Read more »

*This blog post was originally published at Making Sense of Medicine*

When Breaking The Rules Is The Right Choice

The call never should have been made.

It broke every proscribed rule.

After all, I was not on call. Thanks to the wonders of computer technology, it was very clear that I was being covered by my colleague. And yet, despite this, it came.

“Dr. Fisher, I’m so sorry for calling you at home, but I received a call from Ms. X, the wife of your patient Mr. Y. who said she really needed to speak to you about her husband… she seemed quite concerned and insisted I call you…. I told her I’d see if I could reach you at home… I’m so sorry, but it sounded urgent… I have her number, could I connect you?” Read more »

*This blog post was originally published at Dr. Wes*

Considering A Non-Fatal Patient’s Quality Of Life

Why is it easier to talk about quality of life with patients who are dying? Why don’t we factor these considerations into the decision-making for patients with conditions that aren’t fatal?

The presence of a terminal illness serves to focus everyone’s attentions. Widespread cancer metastases? Concerns about tight blood glucose control fade away. End-stage liver disease? Blood pressure control doesn’t matter so much any more. Bony pain from prostate cancer? Narcotic and sleeping pill addiction doesn’t even occur to anyone. I find it far more problematic to deal with patients with debilitating but non-fatal conditions when treatment options are perceived as limited because of co-existing diseases that produce so-called contraindications to certain medications.

I have a patient in his mid-70s with severe pain from osteoarthritis. Several fractures and a couple of unsuccessful joint replacement surgeries haven’t helped matters. Several years ago he found that a little drug called Vioxx worked extremely well for him, reducing his pain considerably and allowing him to do pretty much watever he wanted. As we all know, however, that drug was pulled from the market because of an unacceptable increased risk of heart attacks and other untoward cardiovascular events. Interestingly, Read more »

*This blog post was originally published at Musings of a Dinosaur*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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