February 12th, 2009 by Dr. Val Jones in Humor, True Stories
Tags: Amputees, Inactivity, Metro, Obesity, Physical Medicine And Rehabilitation, Shutting Down, Walter Reed, Wounded Warrior, WRAMC
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I volunteer at Walter Reed Army Medical Center (WRAMC) a half-day per week. I’m inspired by the soldiers in the occupational and physical therapy center, and am continually amazed by their abilities. The other day I watched a soldier with an artificial leg climb a rock wall better than I ever could, and marveled at a man who had both legs amputated above the knee – he was ambulating almost without a limp, and with the help of a straight cane alone.
As I watched these wounded warriors learning how to maximize their functional abilities – I overheard a staff member explain the reason why the Walter Reed hospital building is closing in 2011.
Apparently WRAMC is built on land owned by the District of Columbia. In an effort to subsidize the over-budget subway system, the city purposefully disallowed sufficient parking spaces to be built on the WRAMC site. The idea was to force staff to take the subway to WRAMC. The closest subway is a 20 minute walk from the hospital.
In addition to the limited parking, DC imposes a height restriction on all buildings in the district – they cannot be taller than the Washington monument. Therefore as Walter Reed grew and expanded, they could not add any floors to the hospital, but had to construct additional buildings on campus.
And so, in about three years time, Walter Reed will shut down, moving their remaining staff to the Navy hospital in Bethesda, Maryland where there is plenty of parking and no building height restrictions.
I’m not sure what the total cost of moving the army hospital to the navy center will be, but I’m guessing in the hundreds of millions. How much did the staff complaints about not wanting to walk to work play into all of this? I don’t know, but I’ve seen them drive in as early as 5:30 am to get one of the few parking spots. This attitude is consistent with Americans’ general unwillingness to adopt an active lifestyle, and it’s costing us all so much more than we realize.
It’s possible that laziness dealt the final blow to Walter Reed: a facility created to get people active again after war injuries.
How Ironic.
February 4th, 2009 by Dr. Val Jones in Humor, True Stories
Tags: Calling Someone Doctor, David Kroll, Doctor, Dr. Val Jones, Humor, M.D., Personal, Ph.D., Physician, What Does The Title Doctor Mean, What Is A Doctor, What's In A Name
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My friend and fellow blogger David Kroll just wrote an interesting post about the use of “doctor” as a title for a wide range of expertise, including medical. The discussion reminded me of the usual misunderstandings associated with my title…
Typical Val conversation with lay strangers:
Dr. Val: “Hello, I’m Dr. Jones…”
Person: “Oh, hi Dr. Jones. What kind of doctor are you?”
Dr. Val: “A medical doctor.”
Person: “Oh, so you’re like, a pediatrician?”
Dr. Val: “No, my specialty is rehabilitation medicine.”
Person: “Oh, my uncle has a drug problem. He’s been in and out of rehab for years. I’m so glad that there are people like you willing to help addicts.”
Dr. Val: “Uh… Well, actually my specialty is focused on physical rehabilitation – like patients with spinal cord injuries, amputations, strokes, car accidents, etc…”
Person: “Oh, so you’re a physical therapist?”
Dr. Val: “No, I’m a physician. But I work closely with physical therapists.”
Person: “So you’re a REAL doctor?”
Dr. Val: “Yes, I went to Columbia Medical School…”
Person: “Well, you don’t LOOK like a doctor.” [See example here]
Dr. Val: “Uh… thanks?”
***
Dr. Val: “Mom, why don’t people believe I’m a medical doctor?”
Dr. Val’s Mother: “Well, you picked an oddball specialty, dear.”
Dr. Val: “What’s oddball about helping the disabled population?”
Dr. Val’s Mother: “Well, you know ‘rehabilitation’ usually conjures up ideas of drug rehab.”
Dr. Val: “Yeah, my specialty has the weakest PR in all of medicine. Nobody knows what we do.”
Dr. Val’s Mother: “At least people don’t think you’re a hypnotist.”
Dr. Val: “What?”
Dr. Val’s Mother: “Did I ever tell you about the time I was on an elevator with someone at a Spanish literature convention?”
Dr. Val: “Uh…”
Dr. Val’s Mother: “My tag said ‘Dr. Sonia Jones, member of the American Association of Hispanists.’ A woman in the elevator with me was staring at my name tag and finally blurted: ‘Are you here with the convention?’ And I said, ‘yes.’ And then she responded: ‘Could you hypnotize me too?!'”
December 27th, 2008 by Dr. Val Jones in True Stories
Tags: AMD, Central Serous, Dr. Val Jones, Laser, Macular Degeneration, Myopia, Near-sightedness, Ophthalmology, Personal
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Fortunately for me, my recent brush with the healthcare system was not as frightening as Dr. Dappen’s (he blogs here every Wednesday and recently had a mild heart attack). However, it was provided me with some amusing blog fodder.
Last week I was minding my own business, planning to purchase a new batch of contact lenses from a local optometrist, when I was required (under threat of withholding my lenses) to undergo a vision exam. Much to my disappointment, my right eye was not behaving itself, and refused to correct to 20/20 despite a good deal of lens fiddling on the part of the doctor. A slit lamp retinal evaluation followed, and the optometrist concluded that my right eye’s macula “looked like an 85-year-old’s.”
Well, that was not the most welcome of observations. I asked for the differential diagnosis (being that I’m quite a few years away from 85) and wondered how I’d developed macular degernation. He suggested that it could also be a “central serous” which is (apparently) a stress-related swelling of the macula that requires no treatment and usually resolves on its own.
“So basically you’re saying that my eye could be ‘bugging out’ because of stress.” I said. “And you’d like me to see an ophthalmologist just in case it’s something worse and equally untreatable?”
“Right.”
So I made an appointment with a local ophthalmologist – one of the few working on Christmas Eve – and was sorry to have him confirm that there was indeed something wrong with my retina. He even ordered an eye angiogram (I didn’t know those existed, but it makes perfect sense) and I was injected with a vegetable dye. Photographs were taken through my dilated pupils at regular intervals as the dye wound its way through my retinal vasculature.
“It’s not a central serous.” He said with a serious tone. “And you can see the macular defect here on this photograph.”
“So my right eye is like an 85-year-old’s?” I asked, wondering how I’d been so fortunate to have one part of my body on the aging fast-track.
“Well, not exactly. I think it’s unlikely to be age-related macular degeneration. You probably have retinal thinning caused by your nearsightedness.”
“You mean all that straining to see the chalk board wore out my retina?”
“No. What I mean is that your eye is supposed to be shaped like a baseball, but yours is an egg shape. So your retina is stretched thin and is starting to wear in your macula area.”
“Well can you suck out some of the vitreous gel and shape my egg back into a baseball?”
“No. Unfortunately that doesn’t work.”
“How do you know?”
“The Russians tried it in the 1960s.”
“Ok, well how do I take some of the tension off my stretched out retina?”
“You can’t.”
“Well if I lose weight or eat carrots or exercise, or stop wearing contacts, or get lasik… would any of that help?”
“No.”
“So there’s nothing I can do to prevent further damage, and nothing to repair or treat it.”
“Right.”
Pause.
“I don’t like this condition.”
“Well, you’ll have to come and see me once a year so I can monitor the progression. Sometimes the body responds to the retinal damage by growing blood vessels in the area, and that can cause further visual deficits. But we can zap those new vessels with a laser and decrease the damage.”
“So my eye might overgrow with blood vessels like weeds in a garden.”
“It might. But it also may stay exactly the same for the rest of your life.”
“Well, the uncertainty is anxiety-provoking.”
“I’ll see you in a year. You’ll probably be fine. Don’t worry. Oh, and if you see any ‘floaters’ or flashes of light, come in to see me immediately.”
“What would that indicate?”
“A retinal tear that would need laser therapy right away. People with thin retinas can have spontaneous tears. Just keep that in mind.”
“Um… ok.” I said, smiling feebly.
So here I am, with one wonky eye, not knowing if it will get worse or remain the same indefinitely. There’s nothing I can do but watch the progression once a year with an ophthalmologist. Like so many patients, I’m in a gray zone where prognostication is a challenge and reversal of disease is not possible. I have one 85- year-old eye. May it bring me wisdom, courage, and more empathy for patients.
December 24th, 2008 by Dr. Val Jones in True Stories
Tags: Cardiology, Doctokr, Doctokr Family Medicine, Dr. Alan Dappen, Heart Attack, MI
1 Comment »
By Alan Dappen, MD
Twas days before Christmas and all through the house
The doctor was pacing, not telling his spouse.
“It can’t be my heart for it’s healthy and strong;
I exercise, eat right and do nothing wrong.
I’m hurting, I’m worried, have lingering doubt
I guess that I really should check this thing out.”
I did and the doc said, “Sadly it’s true,
That nobody’s perfect and that includes you…”
So starts my tale about life’s infinite ironies. This past week, I, “the doctor,” became “the patient.” My story is classic, mundane, full of denial, of physician and male hubris that it merits telling again. Like Christmas tales, there are stories that are told over and over again hoping that lessons will be learned, knowing they might not. I was lucky. I was granted a pass from catastrophe and this favor was handed to me by my medical colleagues and all who supported me.
My story began six months ago while playing doubles tennis with friends. Suddenly I felt the classic symptoms of chest pain. “This is ‘textbook’ heart pain,” I thought. “A squeezing/pressure sensation dead center in the chest.” Running for shots made the pain worse and stalling between points helped. My friends soon noticed a change in my behavior.
To my chagrin, they refused to keep playing. Instead, they wanted to call for help. Indignant, I informed them that the chest pain was caused by my binge-eating potato chips before the match – a fact only a doctor could know. The sweating was clearly from playing. I was younger and healthier than anyone there. The pain subsided while we relaxed and joked about “the silly doctor who thinks he doesn’t need help.”
In the next week, the discomfort returned often when I exercised, which I regularly do, including jogging, biking, swimming, and weekly ice hockey and tennis matches. Every activity provoked the pain. “Stupid acid reflux!” I thought, contemplating giving up my favorite vice –coffee. Keeping the secret from my wife was easy; she was traveling for business.
Over the next several days I started aspirin, checked my blood pressure (BP) regularly, drew my cholesterol, rechecked my weight. All were normal. Finally I plugged myself into an electrocardiogram (EKG), with the “nonspecific changes” results not reassuring me. I went to a colleague for a stress echocardiogram, and passed. “See!” I congratulated myself. “It was just reflux.”
For five months, all went well, with no memorable pain. But on December 10 “the reflux” came back. On the sly, I restarted aspirin, pulled out the home BP monitor again, and considered cholesterol-lowering drugs “just in case.”
Saturday night into early Sunday morning I played ice hockey. This time the pain was worse. With my team short on substitutes, I played the entire game. I dropped into bed exhausted and pain free at 2 a.m., only to be nagged throughout the night with persistent discomfort. I nearly slept through a morning meeting with a medical colleague at Starbucks. To avoid increasing my “reflux” pain, I passed on coffee.
By noon, a feeling of overwhelming inadequacy enveloped me. I withdrew, and my wife, Sara, asked what was wrong. I had to confess to her – and myself – of the reality of the pain in my chest. Sara coaxed my answers from me with non-judgmental techniques learned from years of experience.
“What advice would you give a patient calling you with these symptoms?” she asked.
“If it was anyone else, I’d send them to the ER,” I responded, wanting to stall longer. “I want to check my EKG at the office.”
Once there, she helped me with the wires, hooked up the machine. She turned the screen toward me with the interpretation to read: “anterior myocardial infarction, age undetermined, ST- T wave changes lateral leads suggestive of ischemia.”
“Stupid machine,” I thought, “there must be something wrong with it.” I insisted Sara redo the EKG. The second reading was the same. I leaned my head into my hand, not willing to believe what I saw. “Sara, let’s do it one more time…please.”
She asked, “What would you tell your patient to do?”
“Call 911.” I said quietly. The words hung there. At last I handed her the keys, saying, “Drive me to the ER.”
So went the gradual erosion of my denial, emerging into a new reckoning. After a catheterization, the cardiologist used a stent to open my 95% blocked coronary artery. Despite all I did to ruin my chances, modern medicine delivered me a “healthy” heart. This holiday season I got a second chance.
Eating healthy, exercising regularly, sleeping well, being happy, praying regularly, even being a doctor does not save us from the inevitable… sooner or later we are all patients. Healthcare is a critical social asset that must be done right, must be affordable, must offer as many of us in America a second, even a third chance. May we all be thoughtful and willing to compromise to achieve this end. Amen.
November 30th, 2008 by Dr. Val Jones in True Stories
Tags: Dr. Val Jones, End Of Life, Engage With Grace, Palliative Care, Paul Levy, Personal
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The successful “Engage with Grace” campaign resulted in ~95 bloggers promoting end-of-life care discussions with family members over Thanksgiving. Paul Levy called it the first “medical blog rally on the Internet.” I wonder how many readers took the challenge?
I spent Thanksgiving with my sister (mom of 3) and brother-in-law in Michigan. After our dinner (with the kids tucked in for the night) we enjoyed a glass of wine and a game of Cranium (if you haven’t tried this game yet, you might want to pick one up in time for the next group of holidays – it’s like Pictionary, Charades, Trivial Pursuit, and American Idol wrapped into one). I looked for an opportunity to “pop the question” on end-of-life issues.
During a brief lull between rock song humming I casually inquired about whether or not my sister and brother-in-law had a living will. They said they hadn’t thought of it but agreed that it would be important to have one. We discussed various scenarios related to organ donation, end-of-life care, and cremation vs. burial preferences. Things degenerated a bit as I asked what their individual preferences might be for resuscitation under special circumstances (it was almost like a scene from Monty Python – “So, if you had no arms and no legs and you had a 10% chance of normal brain function recovery, would you like to be tube fed? How about if you had one leg and half an arm and a 5% chance of mental recovery? What about if you had 1/2 a liver, no spleen, and only one eye worked, but you COULD do math questions?”) We all had a good laugh at the black humor, but recognized that something important underlay the jesting. There is no doubt that we each had a 100% chance of dying at some point during our lives.
And then something unexpected happened – my brother-in-law looked me in the eye and said, “If anything happened to us, we’d really love it if you took our children and raised them as your own.”
I was very touched and happily agreed to do so. I replied with a wagging finger, “Now this doesn’t mean that you should take up helmet-free motorcycling…”
We all had a good chuckle and returned to Cranium, each feeling a little richer for the experience – we knew how we’d like to be cared for in case of critical illness, and I’d become the proud new godmother of 3.
