Finding Nemo is one of my favorite Disney-Pixar cartoons. Not only does it have a cute story line, but it’s full of medical themes – consider the movie’s namesake with a congenitally deformed fin (Nemo), the shark with addiction problems (Bruce), and the blue tang fish with memory impairment (Dory). Even Nemo’s captor turns out to be a dentist! But when I think about the scene where the fish attempt escape from the dentist’s tank by plugging up the filter system to get him to remove them for cleaning, I always think about kidneys. Yep, you heard me right. Kidneys.
Kidneys are fairly under appreciated organs. They filter waste out of 200 liters of blood each day, much the way a fish tank’s filter system purifies its water. Most of us probably don’t even notice a fish tank filter when we gaze at the plastic plants, pebbles, and colorful animals inside the tank – just as we don’t give our kidneys a second thought until they cause us problems.
But the reality is that an astonishing number of people will develop chronic kidney disease (CKD) in their lifetime, largely due to complications from diabetes. An estimated 26 million Americans have CKD, and the majority don’t even know it. Our fish tank filters are failing slowly – and the build up of “algae and grime” just doesn’t cause symptoms until very late in the failure process.
Since March is Kidney Awareness Month, I thought it would be a good time to reflect upon the hard work that our little guys are doing each day. Beyond filtering drugs and chemicals from the blood, kidneys balance body fluids and electrolytes, create Vitamin D, regulate our blood pressure, and produce hormones that stimulate our bodies to produce red blood cells. In fact, anemia can be one of the first signs of kidney failure, and may be experienced as generalized fatigue. People with CKD often suffer from anemia, which can be treated with dietary changes, oral iron, IV iron, or blood transfusions depending on disease severity.
So whether or not you’ve been feeling fatigued, why not ask your primary care physician to check your kidneys next time you’re there for a check up? A simple blood test can identify many kidney diseases early on – so that you can take steps to keep your filter system healthy for life. Just ask Nemo – being in a dirty fish tank is no way to live.
For more information about CKD and anemia, please check out this infographic:
Concerns about plastic safety have been growing over the years, and the media has stepped up its efforts to expose potential dangers associated with plastic compounds such as bisphenol A (BPA) and phthalates. The problem is – there is very little scientific evidence linking plastic to human harm, and no credible evidence that our current typical exposures to BPA poses any health risks at all (so say the health agencies of the United States, Canada, the European Union, and Japan). But that’s not a very exciting story, is it?
Instead, what we often hear in the news is that microwaving our plastic containers or drinking from plastic water bottles could be dangerous to our health… and that BPA-free containers are better for baby. But where did the media come up with these ideas? I asked Dr. Chuck McKay, a toxicologist and emergency medicine physician at the University of Connecticut, to explain how safe levels of exposure (to various chemicals) are determined, and how to know if news reports are based on scientific evidence. I hope you’ll listen in to this educational Webinar.
Some of my favorite take-home messages from the Webinar include what I call “just becauses”:
1. Just because you can find a substance in your urine doesn’t mean it’s harmful. (Asparagus anyone?)
2. Just because an animal reacts to a substance, doesn’t mean that humans will. (How often have you caught a cold from your dog?)
3. Just because extreme doses of a substance can cause harm, doesn’t mean that tiny doses also cause harm. (Consider radiation exposure from riding in an airplane versus being near ground zero of a nuclear strike).
4. Just because something has a theoretical potential to harm, doesn’t mean it will. (Will you really be attacked by a shark in 2 feet of water at your local beach?)
5. Just because someone conducted a research study doesn’t mean their findings are accurate. (Do you really believe the Cosmo polls? There’s a lot of junk science out there!)
For an excellent review article of the high-quality science behind plastic safety, please check out this link. In the end, there are far more important health concerns to worry about than potential exposure to plastic compounds. And throwing out all your plastic containers may not even reduce your exposure to BPA anyway… A recent study found that people had higher concentrations of BPA in their urine when they followed a plastic-free, organic diet! Their exposure was actually traced to ground cinnamon, coriander, and cayenne pepper. Who knew?
When I first started blogging in 2006, the medical blogosphere consisted of a small group of physicians, nurses, and patient advocates. We knew each other well, and spent time each day visiting our favorite blogs and posting personal comments of encouragement and insight. We developed real friendships, and were optimistic about our brave new online writing frontier. We thought we could change the healthcare system for the better, we believed that our perspectives could influence policy, and we were sure that our writing could help our patients lead healthier lives.
I remember with great fondness the medical blogger conference that I attended in Las Vegas in 2009. It was the first time I’d met most of my blog friends in real life (IRL) – it was like seeing your favorite pen pals after years of correspondence. We talked all night, had marveled at how a love of writing had brought together a surgeon from South Africa, an ER nurse from California, and a Canadian rehab physician, among others. We figured that social media was the glue that held us all together. Since then, I am sad to say that for me, the glue has lost its stickiness due to dilution by third parties and a glut of poor quality content dividing attentions and exhausting our brains’ filter system.
Fast forward 7 years and most of my email correspondence is from strangers wanting to embed text links in my blog, people selling SEO services, or PR agencies inviting me to provide free coverage of their industry-sponsored conferences and webinars. I can’t think of a single friend who has left a comment on my blog in the past three months. Sure we see each other’s updates on Facebook and occasionally on Twitter, but I can’t remember the last real conversation we’ve had. Social Media has become irreversibly cluttered, and I’ve never felt more isolated or guarded about the future of medical writing.
My thoughts on this subject gelled when Twitter announced that LeBron James was following me (along with a select 80,000+ others). Obviously, LeBron has no idea who I am, and I’m almost certain he had nothing to do with his Twitter account following me. He, like many others, has outsourced his online relationship-making. It’s the ultimate irony – using social media to distance yourself from others, while maintaining an appearance of engagement. Sort of like sending a blow up doll of yourself to a party.
So what keeps some people going on these social media platforms? Perhaps it’s the allure of influence – the idea that many people are listening to you gives a sense of importance and meaning to your efforts. But take a cold hard look at your followers – do you know who most of them are? Or is there a large group of “hotchick123” type Twitter accounts counted among them? I used to block followers who didn’t seem real or relevant, but it became so much of a chore that I couldn’t keep up. I was overwhelmed by the Huns.
One could argue that my social media fatigue is my own fault – I didn’t screen my followers properly, I didn’t follow the “right” people, I haven’t curated my friendships with as much care as I ought to… But I know I’m not alone in my pessimism. A recent Pew Research poll suggests that people are leaving Facebook at a rapid rate. And as far as Twitter is concerned, it’s not for everyone.
I guess the bottom line for me is that social media isn’t as much fun as it used to be. I miss my blog friends, I miss the early days of being part of an online community. I don’t write as much as I used to because I don’t know my audience by name anymore. This “party” is full of strangers and I don’t like the familiarity that continues in the absence of true friendship.
Time to spend more of my energy on my patients, family, and friends IRL. And that’s a good lesson for a doctor to learn…
Although most doctors say they believe in the immediate free flow of information from physician to patient, the reality is that many hospitalized patients don’t receive a full explanation of their condition(s) in a timely manner. I’ve seen patients go for days (and sometimes weeks) without knowing, for example, that their biopsy was positive for cancer when the entire medical staff was clear on the diagnosis and prognosis. So why are patients being kept in the dark about their medical conditions? I think there are several contributing factors:
1. Too many cooks in the kitchen. During the course of a hospital stay, patients are often cared for by multiple physicians. Sometimes it’s unclear who should be the first to give a patient bad news. Should the news come from their primary care physician (who presumably has a long standing, trusting relationship with the patient) or the surgeon who removed the mass but doesn’t know the patient well? In many cases each assumes/hopes the other will give the patient the unpleasant news, and so the patient remains in the dark.
2. Family blockades. It often happens that a patient’s spouse or family member will request that news of an unpleasant diagnosis be delayed. They argue that it would be best for the patient to feel better/get stronger before being emotionally devastated by a test result. In some cases the family may be right – grief and shock could impair their participation in recovery efforts, resulting in worse outcomes. Cultural differences remain regarding how patients like to receive information and how families expect to be involved in care. American-style, full, immediate disclosure directly to the patient may be considered rude and inappropriate.
3. Uncertainty of diagnosis. Sometimes a clear diagnosis only develops with time. Biopsy results can be equivocal, the exact type of tumor may be unclear, and radiology reports may be suggestive but not diagnostic. Some physicians decide not to say anything until all the results are in. They cringe at the prospect of explaining uncertainty to patients, and without all the answers they’d rather avoid the questions. What if it looks as if a patient has a certain disease but further inquiry proves that she has something else entirely? Is it right to frighten the patient with possibilities before probabilities have been established?
Although sensitivity must be applied to the nuances of individual care scenarios, my opinion is that patients should be immediately informed of their test results and their physician’s thought processes at every step along the diagnostic pathway. Family member preferences, however well-meaning they are, cannot trump the individual’s right to information about their health. If physicians are unclear regarding which of them should break the news to a patient then they should confer with one another and come up with a plan ASAP.
The right time to tell the patient the truth is: now. To my colleagues who avoid giving patients information because it is personally uncomfortable (often leaving me or other third party to be the messenger), I have two words: “man up.”
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 feel connected to my peers during the most stressful time of my training. So when I was invited to review Shem’s “bookend” to House Of God, it was with a sense of eagerness and nostalgia that I accepted the challenge. How had the author’s thinking developed since the launch of his first blockbuster in 1978? I hoped to find a kinder, gentler Shem, perhaps looking back on his career in medicine with a sense of grace and dignity. I wanted the pomp and cruelty of his training to fade away into a kind of “it was all worth it in the end” conclusion. Alas, I was jarred into a very different reality.
The Spirit Of The Place is a gruesome portrayal of American suburban decay, mixed with some unexplained hostility towards non-Jewish Americans and those with conservative values. The hero of the book, Orville Rose, escapes his mundane American life for a two year adventure with Doctors Without Borders in Europe. He soon is ensconced in a carnal relationship with a gold-digging, alternative-medicine practicing, Buddhist, Italian yoga master who later dumps him for a Swiss banker. Orville returns from Italy to his home town of Columbia, New York, to sort out his family affairs after his mother’s death. She has arranged to transfer all of her wealth to him if he agrees to live in his childhood home for a full year and thirteen days – a fate almost worth than death.
Columbia is a horrific place, filled with poverty, violent crime, summer mosquitoes, and winter ice storms. The central medical figure is an aging general practitioner (Bill Starbuck) who regularly prescribes a kind of snake oil for various life-threatening ailments (Starbusol). Orville sees this physician as a kind of avuncular mentor, excusing his gross medical malpractice as simply “old fashioned.” Bill soon asks that Orville take over his practice while he goes on a much needed vacation, which turns out to last over a year. Orville is stuck being the only GP for a town of about seven thousand. He soon becomes overworked and overwhelmed. But that doesn’t stop him from falling in love with a single mom and polio survivor who was secretly asked by his dying mother to mail Orville letters (written in advance) after her demise. These letters are filled with venom and manipulative accusations (paging Dr. Freud).
The plot makes the reader predisposed to feel empathy for the protagonist, but Shem so exposes Orville’s character flaws that he is nearly entirely unlikable. Every tender moment in the book is derailed by some sort of unpleasant comment or thought. Take for example, the death of Dr. Starbuck. Orville is at his bedside in the ICU, explaining how important it is to treat patients with dignity, even when they are unconscious. He gently whispers that it’s ok for Dr. Starbuck “to let go” and provides one last facial shave as the man drifts off into his final breaths. And in the middle of this, what does Orville also think to himself?
“…Bill’s groin, the purple crowned penis that had had its share of adventures in repayment for his tending the whores on Diamond street. ‘Two dollars a housecall, Bill, and you never came away empty-handed.’ He took out his comb and combed Bill’s thin hair, gray lines on a shiny dome.”
And then there’s the awkward sex scene where Orville describes kissing his lover’s limb shriveled from the polio virus. I’ll save that one for your imagination.
The point, we are left to assume, of this depressing exploration of human defects (from the physical to the emotional, and at every level of organization – from the family unit to the city government and even national and international politics) is to promote tolerance and understanding of the human condition. Unfortunately the book is more likely to suck the last breath of optimism and hope out of you. The darkness has consumed the light, and with little to admire in any character portrayed in The Spirit Of The Place, it is difficult to read. In fact, it took me over two months to complete it.
That being said, Shem is an excellent writer. And for those who enjoy wrist-slitting fiction, this may be just the book for you. I was personally quite astonished by Abraham Verghese’s exuberant cover jacket blurb:
“An incredible and heartfelt story… The Spirit Of The Place entertains, satisfies, and affirms; it is beautifully conceived and brilliantly executed.”
Clearly not everyone agrees with my analysis. I’d be curious to know which one of us is crazy – me, Verghese, or Shem?
I suppose Shem would say we all are, and that’s the point…
It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…
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I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…
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…
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…
Finding Nemo is one of my favorite Disney-Pixar cartoons. Not only does it have a cute story line, but it’s full of medical themes – consider the movie’s namesake with a congenitally deformed fin (Nemo), the shark with addiction problems (Bruce), and the blue tang fish with memory impairment (Dory). Even Nemo’s captor turns out to be a dentist! But when I think about the scene where the fish attempt escape from the dentist’s tank by plugging up the filter system to get him to remove them for cleaning, I always think about kidneys. Yep, you heard me right. Kidneys.
Concerns about plastic safety have been growing over the years, and the media has stepped up its efforts to expose potential dangers associated with plastic compounds such as 
When I first started blogging in 2006, the medical blogosphere consisted of a small group of physicians, nurses, and patient advocates. We knew each other well, and spent time each day visiting our favorite blogs and posting personal comments of encouragement and insight. We developed real friendships, and were optimistic about our brave new online writing frontier. We thought we could change the healthcare system for the better, we believed that our perspectives could influence policy, and we were sure that our writing could help our patients lead healthier lives.
Although most doctors say they believe in the immediate free flow of information from physician to patient, the reality is that many hospitalized patients don’t receive a full explanation of their condition(s) in a timely manner. I’ve seen patients go for days (and sometimes weeks) without knowing, for example, that their biopsy was positive for cancer when the entire medical staff was clear on the diagnosis and prognosis. So why are patients being kept in the dark about their medical conditions? I think there are several contributing factors:
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 feel connected to my peers during the most stressful time of my training. So when I was invited to review Shem’s “bookend” to House Of God, it was with a sense of eagerness and nostalgia that I accepted the challenge. How had the author’s thinking developed since the launch of his first blockbuster in 1978? I hoped to find a kinder, gentler Shem, perhaps looking back on his career in medicine with a sense of grace and dignity. I wanted the pomp and cruelty of his training to fade away into a kind of “it was all worth it in the end” conclusion. Alas, I was jarred into a very different reality.
