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Parents Get Tattoo In Support Of Their Diabetic Son

I was just making preparations for the top 2011 posts I’m planning to write in the upcoming days when I bumped into this cute story about a diabetic kid who felt ashamed to wear the insulin pump so his parents got insulin pump tattoos.

Some parents get tattoos of their child’s name, but Philippe Aumond and Camille Boivin went one better.

In a show of solidarity, they each have an image of an insulin pump tattooed on their abdomens, declaring that they are “forever linked” to their son Jacob.

“It is a great thing for him, and we were thrilled just to see his smile when he saw those pumps. It made our day, that’s for sure,” said Boivin, 36, from the family’s home in La Sarre, Que.

*This blog post was originally published at ScienceRoll*

Diabetes, Jet Lag, And Adjusting To The 24-Hour Clock

I traveled by small, wooden plane.  The flight from Boston to London took just over six hours.  The time change was five hours ahead of Boston, so when we landed at 6 pm, I was only ready for lunch.  The trek from London to Dubai was almost seven hours, pushing the clock ahead a full nine hours from Boston, making my head hurt because how was it Wednesday morning when I was still on Tuesday’s timetable?

(I wrote about the impact of changing time zones for an Animas column last month, but I seriously had no idea what I was in for when I decided to take the trip to Dubai.)

That first day there, the Wednesday, everyone gave me the same advice:  “Don’t go to sleep.”  (It felt like A Nightmare on Elm Street.)  “Work through the exhaustion and just go to bed on Wednesday night on Dubai time, and you should be good the next day.”

For the first few hours after landing, Read more »

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

Making Discoveries About Type 1 Diabetes From Long-Term Survivors

It’s hard to imagine what it was like to live with type 1 diabetes 80 years ago. Insulin was a brand new and relatively untested drug, the only way to check blood sugar levels was by testing boiled urine, syringes had to be sterilized, and needles sharpened by hand. Couple those challenges with the common complications of diabetes—heart disease, kidney failure, nerve damage, blindness, and more—and life expectancy for someone with type 1 diabetes wasn’t that long.

Spencer M. Wallace, Jr., was diagnosed with type 1 diabetes in 1931, at age 7. He’s now an active 87-year-old who plays golf several times a week. He isn’t alone as a long-term survivor. Since 1970, almost 3,500 men and women who have lived with the disease for a half century have been recognized by the Joslin Diabetes Center in Boston with bronze 50-year medals. Forty-five of them Read more »

*This blog post was originally published at Harvard Health Blog*

Paying Diabetes The Attention It Deserves

Diabetes?  Isn't any of this unicorn bullshit.Two weeks ago, I was in the emergency room for some severe stomach pain, down on the lower right hand side of my abdomen.  After consulting with Dr. Google, I realized that it could be appendicitis.  Knowing I was heading to Toronto the next afternoon, I didn’t want to take any chances with this pain.  So I headed off to the ER (conveniently, the one my best friend works at) to check things out.

Looooong story made Twitter-esque short, I didn’t have appendicitis.  I just had some rogue stomach pain.  However, while I was at the hospital, I asked to have my A1C run.  I figured I was there, they were already drawing blood, so what’s one more vial?

“Can you guys grab an A1C while you’re at it?” I asked.

“Is your diabetes under control?”  asked the doctor.

“Um … define control?  I wear a pump, I wear a CGM, and I’m very aware of my disease.  But I’ve been having a hard time juggling things lately, on just about every level, so I’m pretty sure my A1C is crap.”

The doctor shot me a very rude, very judgmental look.  I shot one back at him.

“I’m asking you to run an A1C because Read more »

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

Researchers Explore New Methods Of Testing Blood Sugar

My fingers hate diabetes. Several times a day they get poked with a sharp, needle-like lancet. The drops of blood they give up tell me how my blood sugar roller coaster is doing. That’s really important information I need to determine whether to eat, exercise, or give myself some insulin.

It would be such a treat to check my blood sugar (glucose) without pricking a finger, squeezing out a drop of blood, and placing it on a small test strip attached to a meter. Help may be on the way—though I’m not expecting any big breakthroughs for another few years—as researchers across the country explore prick-free ways to measure blood sugar.

Here are three interesting approaches. Read more »

*This blog post was originally published at Harvard Health Blog*

Latest Interviews

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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How To Make Inpatient Medical Practice Fun Again: Try Locum Tenens Work

It s no secret that most physicians are unhappy with the way things are going in healthcare. Surveys report high levels of job dissatisfaction burn out and even suicide. In fact some believe that up to a third of the US physician work force is planning to leave the profession…

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Latest Cartoon

Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.

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Click here for a musical take on over-testing.

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Latest Book Reviews

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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Unaccountable: A Book About The Underbelly Of Hospital Care

I met Dr. Marty Makary over lunch at Founding Farmers restaurant in DC about three years ago. We had an animated conversation about hospital safety the potential contribution of checklists to reducing medical errors and his upcoming book about the need for more transparency in the healthcare system. Marty was…

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