December 4th, 2010 by Elaine Schattner, M.D. in Better Health Network, Health Tips, Opinion, True Stories
Tags: A "Good" or "Strong" Patient, Breast Cancer, Chronic Illness, Dismissing Symptoms, Doctor-Patient Communication, Dr. Elaine Schattner, Empowered Patient, General Medicine, Medical Lessons, Minimizing Symptoms, New England Journal of Medicine, Oncology, Patient Empowerment, Patient-Doctor Relationship, Patient's Internal Conflict of Interest, Patients Who Don't Mention Symptoms, Patients Who Think They're Complaining, Patients' Apathy, Patients' Guilt, Patients' Worry, Respect for the Doctor, Serious Illness, Telling Your Doctor About Symptoms, Thinking Symptoms Aren't Worth Mentioning, Treatable Symptoms, Under-reported Symptoms
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To complain or “be good” is an apparent dilemma for some patients with serious illness.
Yesterday I received an email from a close friend with advanced breast cancer. She’s got a lot of symptoms: Her fatigue is so overwhelming she can’t do more than one activity each day. Yesterday, for example, she stayed home all day and did nothing because she was supposed to watch a hockey game in the evening with her teenage son and other family members. Her voice is weak, so much it’s hard to talk on the phone. She has difficulty writing, in the manual sense — meaning she can’t quite use her right arm and hand properly.
“It’s something I would never mention to the doctor because it is very subtle,” she wrote. “But it has not improved and if anything has worsened over time.”
There are more than a few possible medical explanations for why a person who’s receiving breast cancer therapy might not be able to use her right arm. But that’s not the point of today’s lesson. What’s noteworthy here is that the patient — an educated, thoughtful woman who’s in what should be the middle of her life and is trying as best she can to survive — doesn’t think these symptoms are worth mentioning. Read more »
*This blog post was originally published at Medical Lessons*
December 4th, 2010 by Shadowfax in Better Health Network, Opinion, True Stories
Tags: Alcohol Abuse, Baltimore, Chicago, China White, Cocaine, Dr. Liam Yore, Drug Abuse Economics, Drug Addicts, ED, Emergency Department, Emergency Medicine, Emergency Room, ER Doctor, Heroin, Illicit Drug Use, Inner-City Hospital, Meth, Movin' Meat, Oxycontin, Shadowfax, Street Drugs, Substance Abuse, The Corner, Xanax
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I’ve discovered over the years that I really like economics. I never took an econ class in my entire life, since I was pretty focused on the life sciences, but I’ve picked up a fair amount informally over the years. Fortunately I have a strong background in statistics and math, and I’ve done a lot of reading on economics. I wouldn’t say that I have any special level of understanding or credibility on the topic. Perhaps it should be noted that my wife took away the checkbook for good reason. But I enjoy it as a topic, as something to read about and a powerful tool for understanding how the world works.
One consequence of being an ER doc is that you are pretty close to “the street,” and I don’t mean Wall Street. I mean the folks living and scrounging on the streets. As a matter of functioning in the job, you learn the street jargon, you learn what drugs people are using and why, and what the effects of those drugs look like.
The other day I saw a middle-aged guy brought in for acting really weird. Though everything in his social history argued against it, he just looked like he was on meth. I checked a tox, and sure enough, it came back positive. He strenuously denied any drugs, but eventually gave in and admitted the meth use.
I remember in residency walking through downtown Baltimore with a fellow resident and our spouses, and we amazed them by serially identifying the likely drug of choice of the various street people we passed, based on casual observation of their behavior. It’s just what we do. Baltimore was a heroin town. Read more »
*This blog post was originally published at Movin' Meat*
December 3rd, 2010 by Bryan Vartabedian, M.D. in Better Health Network, Opinion, True Stories
Tags: 33 Charts, Anatomy, Apple, Doctors, Dr. Bryan Vartabedian, How Medicine Has Changed, How Medicine Won't Change, iPad, Medical Schools, Medical Students, Medical Technology, Medical Training, Medicine and Change, The Practice of Medicine
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I just can’t imagine life today as a medical student. Every medical publication in the palm of your hand. The capacity to create an audience and publish at your own will. Real-time dialog between students, faculty, anyone. Global reach from your phone. It’s mind-boggling really.
This is in stark contrast to my experience. My world was centered on index cards, textbooks and pens with different colors. We communicated via Post-it notes on the door of the student lounge. There were no apps and our only game was foozball. As a first year I scheduled time to compose H&Ps on the library’s only Macintosh II computer. This was plugged into the new Apple LaserWriter with WYSIWYG. Hi tech we were. We thought.
Being distractible and restless, I’m going to guess that if I had access to the communication platforms and tools available to today’s students, I might not have made it through. The inputs must be staggering and I imagine that discipline with personal bandwidth has become a critical key to survival. Read more »
*This blog post was originally published at 33 Charts*
December 2nd, 2010 by RamonaBatesMD in Better Health Network, News, Opinion, Research, True Stories
Tags: Double-Hand Transplant, Dr. Ramona Bates, Dr. Richard Edwards, Hand Or Arm Transplantation, Jeff Kepner, Limb Rejection, Limb Transplant, Loss Of Limbs, Louisville, New Limbs, Otto Bock DynamicArm, Patient Satisfaction, Prosthetics, Rejection By The Body, Suture For A Living, Tammy Chinander, The Jewish Hospital Hand Care Center, Transplantation Surgery
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Dr. Richard Edwards, a chiropractor from Oklahoma and the nation’s third double-hand transplant, was recently in the news again. This time it a report that he “may lose the fingertips on his right thumb and pinkie because his body started to reject the new limbs.”
Dr. Edwards’ surgery was live tweeted when it was done in August by Louisville surgeons at The Jewish Hospital Hand Care Center.
Jeff Kepner, the first patient in the United States to receive two hands simultaneously, experienced an episode of rejection which was dealt with successfully.
Rejection is never a good thing in a transplant patient no matter which organ or body part is transplanted. Even though I applaud the advances being made, we must always consider the cost of the proposed treatment and ask: Is there a better option for this individual? Read more »
*This blog post was originally published at Suture for a Living*
November 28th, 2010 by Dr. Val Jones in Health Tips, True Stories
Tags: Alexandria, DC, Dr. Val Jones, Exercise Program, Faith, Fitness, Fitness Instructor, Fitness Together, Personal Trainer, Physical Fitness, Self-Improvement, Strength Training, Virginia
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Since March I’ve been working out with a fitness instructor. She is the toughest, most motivated coach I’ve ever known. Sadly, today was our last day together because she’s beginning maternity leave and I’m moving out of the area. I was reflecting on what made her such a great trainer, and I think the essence was her undying belief in everyone’s ability to improve. Each exercise was a chance to do better than last time — to perfect one’s form, do one more repetition, or to slow the speed of a lift or increase the resistance involved.
She never let me slack — she told me she believed in me, that I could do better, and that she didn’t care how many reps I did, I had to do them the right way. There were times that I just wanted an “easy” workout, or when I’d ask for understanding: “Klaudia, can we ease up on the cardio a bit today, I just ate lunch?” I’d ask. “That’s okay,” she’d smile, “I have a bucket for you right here if you need it.”
Frequently she’d time me racing repeatedly up and down seven flights of stairs… Read more »
