December 27th, 2007 by Dr. Val Jones in News
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A hat tip to KevinMD’s guest blogger, JoshMD for this great link. The British Medical Journal offers a short historical analysis of 7 common medical myths, sometimes perpetuated by physicians themselves:
- People should drink at least eight glasses of water a day
- We use only 10% of our brains
- Hair and fingernails continue to grow after death
- Shaving hair causes it to grow back faster, darker, or coarser
- Reading in dim light ruins your eyesight
- Eating turkey makes people especially drowsy
- Mobile phones create considerable electromagnetic interference in hospitals.
To find out why each of these commonly held beliefs are either untrue or unsubstantiated, check out the original journal article. It’s a lot of fun.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
December 17th, 2007 by Dr. Val Jones in True Stories
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For more than a decade, I successfully avoided a visit to the orthopedist for a chronic elbow problem. Today I reluctantly decided, on the advice of a friend and orthopod, to go to the hospital and find out once and for all what could be causing my elbows to lock during certain exercises.
The process took 4 hours, all told. I registered at the clinic, then proceeded to the radiology suite to wait for some X-rays. There was a long line of legitimate-appearing X-ray candidates before me – some in casts, others in slings, still others limping pitifully. I was just fine and pain free, feeling a bit guilty – as if I might be wasting resources.
I glanced at the films as I put them in a folder to take back upstairs to the clinic – they looked perfectly normal. “Oh, boy.” I thought, “young Caucasian female complaining of elbow locking for 15 years, now with normal X-rays.” I bet the orthopedist is going to roll his eyes at me. I was escorted to an examining room where I sat on a table across from my normal X-rays, clipped on a light box.
A trim and athletic gentleman in his mid 60’s introduced himself to me. He had crystal blue eyes and short white hair… and disproportionately large hands (kind of the way Michelangelo’s David does). I was sure that I was the healthiest person he’d see that day. He glanced at my totally uninteresting elbow X-rays, took a deep breath and raised a skeptical eyebrow as he asked me to describe my difficulty.
“Well, when I’m at the gym, my elbows lock at about 15 degrees from full extension during certain exercises. It’s always during the eccentric phase of muscle contraction, and usually during a lat pulldown or seated row. If I rotate my forearm there’s a snap and the discomfort disappears and I can resume the exercise.”
He was impressed by the specificity of my description, and asked me to demonstrate the problem. I felt a little bit silly, but attempted to keep a straight face. Seeing that we were not going to be able to reproduce the problem without counter weight, the good doctor jumped in to simulate the exercise by pulling on my arm. I pulled back, and we soon realized that he was unable to apply a force strong enough to trigger the problem. In fact, I pulled the poor man off balance and nearly dropped him on the floor.
After a few more maneuvers he concluded that he had no idea whatsoever what the problem might be. He told me that since the X-rays were normal there was probably nothing to worry about, and that I might consider avoiding lifting weights in “clanky gyms filled with smelly, sweaty people.”
He dictated his note in front of me, highlighting my excellent health, unusual strength, and completely benign X-rays. He seemed to relish the whimsy of the fact that he was no physical match for me (a smallish blond woman) and added that I was unlikely to be damaging my elbows at the gym.
His advice, as I had anticipated, was to “stop doing the things that trigger the locking” and to consult him if I developed any neuropathic pain or effusions. He added that I reminded him of his daughter.
Well, it was an amusing interaction – but somewhat unsatisfying. It made me think of all the times that I wasn’t sure what was wrong with my patients, and how disappointed they were when I had to tell them this. Medicine is an inexact science at times – and the best that we can do is rule out the really bad stuff, and shrug when the rest remains unclear.
Have you had a problem but couldn’t find a diagnosis? Do tell…This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
December 15th, 2007 by Dr. Val Jones in Health Policy, Opinion
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More healthcare dollars are spent on end-of-life measures than perhaps any other single expense. About 25% of Medicare’s 2.8 trillion dollar budget is spent on care for people in the final year of life. That works out to be about $2500/person/year that we spend on government funded end-of-life care. Medicare spending overall is closer to $10k/person/year in this country… and given that the average household pays $6K in taxes/year… you can see that we’re in a real pickle when it comes to healthcare spending (and that’s just for Medicare).
In a recent blog post, PandaBearMD suggests that it’s time to “put granny down.” This gallows humor speaks to what the medical community has been been discussing in more academic terms. Here are some interesting sound bites (click on links for full references):
Terminally ill patients should be treated outside of acute care facilities. …Acute care hospitals are, by definition, set up for handling acute conditions – trauma, childbirth, orthopedics, heart attacks, etc. Terminal illnesses are not acute conditions, and therefore should be treated in a facility or setting that is chronic-care oriented.
The technological advances that medicine has witnessed in the last few decades are no more apparent than in the ICU. Yet when used inappropriately, this technology may not save lives nor improve the quality of a life, but rather transform death into a prolonged, miserable, and undignified process.
Hospice care can reduce the cost of end-of-life care by 30% or more (though this is debated).
“We don’t operate in a closed health care system, where there is a fixed number of dollars for health care, and thus the need to choose how to allocate those dollars,” said Dr. Weissman. “Our health care system is open-ended, which is why the cost of health care goes up every year. So we’re not making a tradeoff of spending more on the elderly and thus not using those resources on children’s care.
While it is fairly obvious that we deliver a lot of unnecessary, costly, and heroic medical care at the end of life, determining how to ration this care is fraught with moral and ethical dilemmas.
What sort of population-based rules should we institute to govern access to acute care services at the highest level? Would limiting care to people based on age or comorbidities sit well with Americans? Imagine that you’re 65 – just entering retirement and expecting to enjoy another 20 years of life – and you’re disqualified from top tier medical treatments because of your age. Who has the right to judge your worthiness of top medical technology?
I know of an elderly woman who accidentally took too many diuretics over the period of two weeks. She became delirious and was admitted to a hospital where the doctors assumed she had end stage Alzheimer’s disease and sent her home with hospice care. Another doctor later discovered the error, rehydrated her and she returned to her usual state of health. It was a close call for that “granny.”
My parents are in their late 70’s and in excellent health, enjoying book writing and traveling. I asked them to read PandaBear’s analysis of end-of-life care in the United States – and how billions of dollars are spent on heroic measures for the frail elderly.
My mother said tersely, “I hope I die in Europe.”
My father replied, “Whether you’re old or young, it’s nice to be alive.”
But I can’t help but think of that patient who was sent home with hospice care for delirium caused by severe dehydration. Will we turn our backs on the elderly and not carefully consider their differential diagnoses simply because of their age? As long time tax payers, are they not the most deserving of access to top technologies if so desired?
This is one tough dilemma – and the best I can advise is that we each create living wills, and save our own money for that rainy day when we need critical care, but are ineligible based on some future population-based rule to save money on futile care. In that case, the wealthy would always maintain access to the best care available.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
December 8th, 2007 by Dr. Val Jones in Medblogger Shout Outs, True Stories
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There’s nothing sadder than the death of a child. Young hopes and aspirations are snuffed out long before they can ignite their potential. That’s why the Make-A-Wish Foundation is doing their part to make sick childrens’ dreams a reality – to bring a sense of joy and fulfillment to kids whose days are cut short by illness.
I had the chance to participate in making a child’s wish come true earlier this year. I blogged about it here. It was a really moving experience for me and all involved – we helped a young terminally ill boy fulfill his dream of being President of the United States for a day. Amazingly, the White House even provided a real motorcade to shuttle him around. I got to play the role of paparazzi.
An EMT student blogged about another Make-A-Wish recipient whose dream it was to become a fireman. This story is also very touching. Here’s an excerpt:
There he stood, a father watching his son’s fantasy come to life. Sometimes, the deepest pain brings the greatest happiness.
William is usually outgoing and exuberant. Not Saturday. Saturday, he was awestruck.
Powers gave William a badge and the firefighters lined up to shake his hand. As they finished introducing themselves, William lifted the badge a few inches off his lap.
“He’s showing you to let y’all know he’s a fireman now,” said his mother, Marion Bussey.
Powers reached into a bag, pulled out a hat, and gave it to William. Then he gave the boy a shirt and yellow helmet as the rest of the firefighters looked on.
William leaned toward his mother and smiled. “Mom, I like this,” he whispered.
Tears formed in Bussey’s eyes and rolled down her cheeks.
“William is our hero and you guys are his hero,” she said to the firefighters. “He doesn’t have to say he wants to be a fireman anymore.”
What happened next wasn’t scripted. Maybe it was coincidence. Maybe no explanation exists.
William’s parents and the dozen firefighters looked at William and said the same words at the same time: “You are a fireman.”
William lifted his right hand and placed it on his forehead.
“I am William McKay,” he said, “and I’m an official fireman. Thank you.”
Then he saluted.
The firefighters looked at each other, tears welling in their eyes. They began crying. Some left the room. Others dabbed their eyes with tissues. William’s family began crying. Hospital staff began crying. Almost everyone began crying.
But not William. He had no reason to cry. He was the happiest boy in the world.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
December 4th, 2007 by Dr. Val Jones in Expert Interviews
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I recently interviewed Dr. Cliff Bassett about asthma in women and he gave some interesting insights into gender differences associated with this disease. I’ve summarized our conversation below – or you can listen to it here.
The CDC reports that 9% of women have asthma compared to 5% of men. I think that’s a very important finding and I’m not sure if women know that they’re at higher risk than men. The good news is that asthma is completely treatable, although sadly we have as many as 4000 deaths per year in this country attributed to asthma. We’re doing a better job identifying those with severe asthma, and the death rates are decreasing.
Women need to understand that even a small amount of weight gain (as little as 5 pounds) can add up to a much higher risk of death for women with severe asthma. So weight management is very important for those with more challenging asthma symptoms.
Women are more likely to be hospitalized due to an asthma attack than men. And interestingly, up to 40% of women report that their asthma symptoms get worse just before and after menstruation. So for women it’s important to keep a symptom diary, so that if there’s a regular worsening of asthma during menstruation, they might need to be treated more aggressively (perhaps with steroids or other medications) during that time of the month.
The new asthma guidelines (from the NIH) emphasize understanding asthma triggers as the foundation of prevention. It’s much safer to avert an asthma attack than to have to treat a full blown one. So it’s really important for women with asthma to figure out what might trigger their symptoms, and avoid those triggers as much as possible.
Now that it’s winter time, most environmental triggers are of the indoor variety. Over 100 million US households have pets. The most common pet is the cat, and up to 10% of people with allergies develop specific allergies to cats. If an individual suspects that she has a pet allergy, she should see an allergist to get tested to confirm that. Avoidance measures are important, though there are medications and allergy immune therapy (allergy shots) that can help with pet allergies.
Cold dry air can be an asthma trigger in some individuals, especially if they’re engaging in outdoor physical activity. Warm ups and cool downs can help to head off an asthma attack in the cold, though it’s always a good idea to have a rescue inhaler handy.
**Listen To Podcast***This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
