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Latest Posts

When Diabetes Requires Mad Scientist Experimentation To Get Blood Sugars In Target Range

Hoping I hit a balance as lovely and even as depicted in this here clip art from 1994.I do not enjoy basal testing.  Even though I sometimes go six hour clips without having a snack (thanks, Birdy and your busy ways), something about knowing I can’t eat or exercise makes me want to do a 5K while simultaneously chomping down on some soft serve.

But when I noticed that I was going to bed at a completely normal blood sugar, but waking up in the 180 – 220 mg/dl range for three days in a row, I knew I needed to do some basal tweaking.

Making adjustments to my overnight basal rates always skeeves me out.  I’m a very deep sleeper (as evidenced by the fact that Siah prowling around on the bed all night doesn’t wake me in the slightest, but makes Chris say “We’re sleeping with the door SHUT tonight,” in the morning), and I have a very healthy fear of overnight low blood sugars.  My symptoms of a low on the overnights used to be this body-drenching sweat, but since the birth of my daughter, that symptom has all but disappeared.  Now, I don’t have any symptoms at all.  Blood sugars of 60, 50, and lower don’t even register until I prick my finger and go, “Oh.  I guess I’m low?” Read more »

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

Accountable Care Organizations (ACOs): HMOs With Lipstick?

Thousands of articles have been written about forming ACOs. Millions of dollars have been spent by hospital systems to try to form an ACO. Healthcare policy consultants have discovered a new cash cow.

Hospitals systems are wasting their money. They think the return from owning salaried physicians’ intellectual property will be more than worth the cost.

  1. Thousands of physicians have been confused by the concept of ACO.
  2. Many have felt ACOs are an attack on their freedom to practice medicine the best they can.
  3. Many have rejected the concept because they feel they will have to be salaried by hospital systems.
  4. Many physicians do not trust President Obama or Dr. Don Berwick.
  5. The Stage 2 ACO regulations are not easy to understand. They are more ominous than the stage 1 regulations.

The two core stated objectives for ACOs are:

(1) Reducing healthcare costs.

(2) Preserving and improving quality.

The stated objectives are laudable. The government regulations and controls are confusing. Read more »

*This blog post was originally published at Repairing the Healthcare System*

What Women May Not Know About Their Fertility

I can’t tell you the number of times women in their mid 40’s come to me and announce “Well, I’m ready to get pregnant”. Putting off pregnancy is understandable in our times. Women are building their careers, moving and traveling, going through a series of “Mr. Wrongs” and looking for the best baby-daddy. Women have thought that fertility was a given and they could get pregnant when the time was right. But, sadly, what they haven’t been told is the cruel trick of nature. Fertility doctors know…after age 29 your chance of having a baby without medical treatment is diminishing every year. After age 40 there is a precipitous drop.

To bring that fact home, check this out. A woman age 19-26 has a 50% chance of getting pregnant during any one menstrual cycle if she has intercourse two days prior to ovulation. For women age 27-34 the chance was 40% and after age 35 it drops to 30%. And at 40 you are only 1/2 as fertile as you were at 35. That is a sharp drop off! Read more »

*This blog post was originally published at EverythingHealth*

I’m No Superman

essential-qualificationsI love this ad.

I was about this age when I decided to become a nurse.

Maybe a little older.

I was holding a book instead of a teddy bear.

I wouldn’t have been caught dead in that cap, though. Even in those days I knew how to make a totally cool nursing cap out of paper.

That looks like a pillowcase.

Sometimes it’s hard to remember why nursing sounded like a good idea.

********************

You don’t realize it’s happening.

You set a goal and you do what you have to do to get there.

For awhile, you manage to do it all.

Nine semester units.

Working 24 hours a week.

No sweat.

Been there, done that.

Lived through it.

*****

But things start piling up.

Work needs you to pick up some hours.  Coworkers on leave, folks needing time off.

You say yes, because when you need time off, they will make sure you get it.

Only your body isn’t cooperating.

You are in bed for the night at 1600.

And up at 0530.

Then you can’t fall asleep before you go in at 1900.

So you’re up for 28 hours. Straight.

Twice in one week.

That worked when you were eighteen.

It kills you at fifty-one.

*****

So you work, and work is uncharacteristically busy.

You start getting depressed four hours before you go in.

Then you start getting depressed because you have to work the next day.

Your coworkers are getting on your nerves.

You are really getting on their nerves.

You hit the ground and twelve hours later you sit for the first time. In the car. For the ride home.

To sleep for ten hours so you can go back and do it again.

Before your one day off.

That you sleep through.

*****

You fall behind in class; the professors are cool and allow you extra time for the assignments.

Which you need because you are so exhausted you cannot think.

But you won’t give less than an “A” effort so you stress and research and study and fine-tune and finally turn in the missive 48 hours after it is due.

Only to discover your classmates managed the assignment in two paragraphs.

How the hell did they do that?

*****

You start to lose it.

You don’t leave the house on your time off.

You stay in sweats all day and don’t bother to fix your hair.

Your husband thinks you are having a breakdown because he hears you laughing hysterically one minute and bursting into tears the next.

Except it’s not a breakdown, you are just watching “Scrubs”.

(Why the hell did they kill off LaVerne? Idiots.)

You start scanning the ads for a desk job. Part-time. Days. No weekends.

No blood. No pain.

No death.

*****

I’ve been here before.

The demon is back.

I’m in full blown burn-out.

But no major life changes.

Not this time.

I know what to do.

No more extra shifts.

The money is nice. Sanity is nicer.

No more twelve-hour shifts. Kudos to those who can do them.

I can’t.

No summer school.

I’m 12 units away from a BSN.  I can graduate in the Spring of 2010. I gain nothing by sacrificing my mental health to do it by December.

*****

I’m scaling back, I’m taking a break.

For the next few months, it’s all about me.

More visits to Starbucks to read blogs.

More visits to Starbucks to read novels.

More concerts.

More mini-vacations. Son’s graduation. Nascar race in Sonoma. BlogHer in Chicago.

*****

I wish I could do it all and be it all and have it all.

It’s hard to face the fact that I have limitations.

But, I know,

I’m no Superman.

And that is a major bummer.

I’m No Superman

*This blog post was originally published at Emergiblog*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

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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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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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

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…

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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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