What I’ve learned in the last twenty-five years with type 1 diabetes:
- Some of what “they” said is wrong. It just is.
- There are times when “they” make a good point, and it’s up to us as patients to figure out what information we react to.
- The needles don’t hurt as much now as they did then. Lancets have become smaller and sharper, syringes can make the same claim. Insulin pump sites, once they’re in, usually go without being noticed. Same goes for Dexcom sensors. (But “painfree” is a misnomer and so subjective that medical device advertisers had best just steer clear of that word entirely. All needles pinch at least a little bit.)
- Progress isn’t always shown in tangible technological examples. Sometimes progress is being able to look at a blood sugar number without feeling judged by it. Or to look in the mirror without wishing you were different.
- There is life after diagnosis.
- Diabetes is sometimes funny. It has to be. Read more »
*This blog post was originally published at Six Until Me.*
Here’s my column in the March issue of Emergency Medicine News.
Second Opinion: Be Smarter Than Your Brain
“Everyone is a drug seeker. Why does everyone want to be on disability? I’m so tired of lies. Great, another lousy shift. I wonder who will die tonight? I’m so sick of suffering. I’m so weary of misery and loss. I hope this never happens to my family. I’ll probably get sued. Being sued nearly drove me crazy. This job never gets easier, only harder. I have to find something else to do; I can’t go on this way. I think I’m going crazy. I don’t have any more compassion. People hate me now.”
These are only a few of the wonderful thoughts that float through the minds of emergency physicians these days. Sure, not every physician has them. But I know our specialty, I know our colleagues, I hear from doctors around the country and I see that fear, frustration and anxiety are common themes.
Older physicians fantasize about career changes, and younger ones are often blind-sided by the hard realities of practice outside of their training programs (where their work-hours and staffing do not necessarily reflect the world beyond).
We are crushed by regulations and overwhelmed by holding patients, often put in situations where we are set squarely between the devil and the deep blue sea. “Spend more time with your patients; see them faster. Don’t let the ‘psychiatric hold’ patient escape; why are you using so much staff on psychiatric patients? See chest pain immediately; why didn’t you see the board member’s ankle injury as fast as the chest pain?”
In all of this mess of emergency medicine, we often find ourselves frustrated and bitter. But is it only because of our situations? They are admittedly daunting. But is our unhappiness merely the result of the things imposed on us? Or could it be more complex than that? Lately, I have come to wonder if our thoughts are perhaps worse enemies than even lawsuits, regulations, or satisfaction scores. Read more »
*This blog post was originally published at edwinleap.com*
I’d like to talk about how rodents, relationships, and riding relate to overall health and wellness.
This idea comes from a nicely-written New York Times piece entitled, “Does Loneliness Reduce the Benefits of Exercise?” Here, Gretchen Reynolds reviews a few intriguing studies about how relationships may affect exercise, stress hormone levels, and intelligence. The combo caught my eye.
Anyone who pays attention to wellness knows that exercise produces more flexible arteries, more durable hearts, and leaner body shapes. These benefits are obvious, and honestly, sometimes a bit tiresome to write about.
To me, a far more interesting — and lesser known — benefit of regular exercise is that it might make us smarter. Here’s where the rodents come into the story.
As was summarized in the New York Times piece, when researchers allowed rats and mice access to running wheels they observed (a) that they all ran, and (b) those rats that did run scored better on rodent IQ tests, and actually grew more brain cells. This is a striking finding because nerve cells — unlike blood, GI and skin cells, which turnover rapidly — grow very slowly, if at all.
But that’s not the entire story. The Princeton researchers wanted to know whether the rat’s social relationships could have measurable biologic effects.
It turns out that rodents — like humans — are quite social. So social, in fact, that in these trials the brain-growing effect of exercise was blunted when rodents lived alone. Compared to rats and mice that lived in groups, those that were kept in isolation failed to grow new nerve cells in response to exercise. And importantly, isolated rats produced higher levels of stress hormones than those who lived in groups, even though both groups ran the same distance. Read more »
*This blog post was originally published at Dr John M*
[Recently] I came upon a Jan 24 op-ed, “A Fighting Spirit Won’t Change Your Life” by Richard Sloan, Ph.D., of Columbia University’s psychiatry department. Somehow I’d missed this worthwhile piece on the sometimes-trendy notion of mind-over-matter in healing and medicine.
Sloan opens with aftermath of the Tucson shootings:
…Representative Giffords’s husband describes her as a “fighter,” and no doubt she is one. Whether her recovery has anything to do with a fighting spirit, however, is another matter entirely.
He jumps quickly through a history of the mind cure movement in America: From Phineas Quimby’s concept of illness as a product of mistaken beliefs — to William James and “New Thought” ideas — to Norman Vincent Peale’s 1952 “Power of Positive Thinking” — to more current takes on the matter. These ideas, while popular, are not reality-based.
In his words:
But there’s no evidence to back up the idea that an upbeat attitude can prevent any illness or help someone recover from one more readily. On the contrary, a recently completed study* of nearly 60,000 people in Finland and Sweden who were followed for almost 30 years found no significant association between personality traits and the likelihood of developing or surviving cancer. Cancer doesn’t care if we’re good or bad, virtuous or vicious, compassionate or inconsiderate. Neither does heart disease or AIDS or any other illness or injury.
*Am. J. Epidemiol. (2010) 172 (4): 377–385.
The New York Times printed several letters in response, most of which point to pseudo-evidence on the matter. All the more reason to bolster public education in the U.S. — people won’t be persuaded by charismatic, wishful thinking about healthcare.
It happens I’m a fan of Joan Didion’s. I was so taken by the “Year of Magical Thinking,” in fact, that I read it twice. Irrational responses — and hope — are normal human responses to illness, disappointment, and personal loss. But they’re not science. It’s important to keep it straight.
*This blog post was originally published at Medical Lessons*
Reuters Health reports that more than a quarter of Americans taking antidepressants have never been diagnosed with any of the conditions the drugs are typically used to treat, according to new research published in the Journal of Clinical Psychiatry. An excerpt:
“We cannot be sure that the risks and side effects of antidepressants are worth the benefit of taking them for people who do not meet criteria for major depression,” said Jina Pagura, a psychologist and currently a medical student at the University of Manitoba in Canada, who worked on the study.
“These individuals are likely approaching their physicians with concerns that may be related to depression, and could include symptoms like trouble sleeping, poor mood, difficulties in relationships, etc.,” she added in an e-mail to Reuters Health. “Although an antidepressant might help with these issues, the problems may also go away on their own with time, or might be more amenable to counseling or psychotherapy.”
*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*