Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Latest Posts

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.*

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*

A Day In The Life Of Type 1 Diabetes: Glucose Control Burn Out

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 (bastard), 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 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 I’m trying to regain control.  I don’t have this nailed down and perfected, but I’m trying.  Is that the wrong thing, in your opinion?” Read more »

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

Pavlovian Response To The Sounds Of Diabetes

It’s that well-worn tale of Pavlov and his crazy dogs, the ones that he trained to expect treats whenever a bell was rung.  And whether or not the treats were offered, the dogs learned to respond by salivating, waiting.

Diabetes has made me one of Pavlov’s dogs.  But instead of the chimes of a bell triggering salivation, it’s the sound of the Top Gun theme song coming from my insulin pump, making me check the status of my battery.  Or the sound of my Dexcom letting loose with a BEEEEEEEP!, making me reach for my glucose meter.  The sounds of diabetes are so ingrained in my brain that I don’t think before responding.  My reaction to certain sounds is visceral.

Sometimes the sounds of my diabetes are subtle – Read more »

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

Celebrating The Anniversary Of A Diabetes Diagnosis With A Pump-Shaped Cake

A few weeks ago, I posted a photo and part of an email from a reader who had made an insulin pump-shaped cake for their daughter’s birthday.  In that magical way of the Internet (where cats haz a cheeseburger and lovely little bean people talk about diabetes), another family with a kid pumping insulin caught the post, and baked up a little bolus of their own.

So, to kick off Diabetes Month here, I connected with Gwyneth’s mom, and Gwyneth emailed me her perspective on what it’s like to mark her first diaversary, which is TODAY.  At the start of Diabetes Month.  How’s that for timing?   Read more »

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

Latest Interviews

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…

Read more »

Caring For Winter Olympians In Sochi: An Interview With Team USA’s Chief Medical Officer Dr. Gloria Beim

I am a huge fan of the winter Olympics partly because I grew up in Canada where most kids can ski and skate before they can run and partly because I used to participate in Downhill ski racing. Now that I m a rehab physician with a reconstructed knee I…

Read more »

See all interviews »

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.

***

Click here for a musical take on over-testing.

See all cartoons »

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…

Read more »

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…

Read more »

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…

Read more »

See all book reviews »