MedFriendly Medical Blog

Monday, October 10, 2011

Exercise & Eat Fruits & Veggies All You Want: You're Still Going to Die

It is well known that eating fruits and vegetables and maintaining a regular exercise routine provides various health benefits to the body. It is also well known that this is not easy to do because there are so many other tasty food competitors out there and so many leisure activities that do not involve exercise. If it was easy or preferable to eat vegetables over other types of snacks, children’s books and TV shows these days would not be trying to convince children that eating a carrot tastes just as good as a chocolate chip cookie. Even Cookie Monster can’t say that with a straight face.

The reason why so many people need to listen to music on a jog, jog with a partner, watch TV on a treadmill, or read a book while on an exercise bike is because they are trying to distract themselves from an activity that is usually not that fun on it’s own. That being said, there are some people who enjoy running on it’s own due to their body being sensitive to the release of endorphins (pleasure producing chemicals) but this is an experience I have never had, despite doing my fair share of jogging and trying without success to get high from it (i.e., joggers high).

While I am all for exercising, try to get my fair share of it, enjoy eating fruit (in fact, I just had some grapes), and like some vegetables, I also like sitting in my reclining chair, eating pepperoni pizza, and eating fried food. I try to keep it in balance, not going too far to either extreme. This is consistent with my view that the ancient Greek philosophers got it right when they said that life is best lived when lived in moderation. In other words, don’t do too much in excess but also do not deprive yourself.
If you are reading this and absolutely love exercising every day and eating nothing but a vegetarian or vegan diet, then that’s great and this blog entry does not apply to you. But if you do not like it or do these activities under the false belief that they are going to cause you to live until you are 100, and/or automatically going prevent you from getting a serious disease such as cancer, then this blog entry does apply to you. The fact is, life is short and no matter how many carrots or apples you eat or laps you run, you are still going to die. What’s worse is that you could die from a cause that has nothing to do with diet or exercise (e.g., a car accident). Also, following a strict diet and exercise routine may do nothing at all to stop a spontaneous cancer from developing or from dying before your natural life expectancy.

My dad was a good example of the above. He religiously ate a salad every night and exercised almost every night after working a grueling full-time schedule. When I asked him why, he stated he was trying to prevent cancer. At age 59, he was diagnosed with esophageal cancer despite the fact that he never abused alcohol or had gastroesophageal reflux disease. He was dead within a year. I’m willing to bet that if he knew this was going to happen that he probably would have ate a few more junky snacks and watched a few more DVDs with a bowl of buttered popcorn. My maternal grandmother on the other hand, had the worst possible diet imaginable and smoked like a chimney, yet lived until age 78. I would never advocate the lifestyle she lived but the point is that while you have some control over your mortality, that control is limited and not absolute.

Famous exercise guru, Jack LaLane, is another good example. He avoided meat (except fish), avoided snacks, ate only two meals a day (skipping lunch), ate raw vegetables, egg whites and fish for dinner, ate hard-boiled egg whites, a cup of broth, oatmeal, and soy milk for breakfast, and he exercised for two hours a day. And after all of that…he still died of pneumonia.

Some will counter that LaLane would never have lived as long as he did (age 96) if it was not for his diet. Maybe. Maybe not. Unfortunately, genetics plays a major role. For example, many people do not know that his mother lived until age 89 and I am willing to bet she did not follow the same type of diet and exercise routine as her son. Sometimes, luck (or lack of it) also plays a role. For example, there are many people who go for a jog on a busy road, get hit by a vehicle, and either die or suffer a severe traumatic injury. And there have been a slew of people who have died from eating cantaloupes and other fruits and vegetables due to contamination with deadly bacteria (such as e. coli). The same can happen with other food products of course, but realize that fruits and veggies are also one of them.

My last point has to do with people who are either a) torturing themselves by eating bean sprout sandwiches, tofu burgers, and dry rice cakes when they would rather eat something tastier or b) working full-time and coming home to spend several hours exercising at the expense of some other activity they would rather do (e.g., family time, watching a movie, playing a game). Realize that life is short in the big scheme of things and that you should feel free to treat yourself once in a while and relax.

In the end, eat healthy for the most part and exercise, but don’t feel like you can never eat a piece of fried chicken or skip a day or two at the gym because you are afraid that it is going to kill you. It’s when unhealthy foods form the main part of your diet and a sedentary lifestyle becomes chronic that these pose a health risk. Be smart, live a balanced life, and enjoy the many tasty foods and leisure activities that life has to offer because you never know when it is going to end.

Disclaimer: The comments in this blog entry should not be taken as medical advice but are personal opinions of the author. For medical advice, please seek that from your physician.

Related Blog Entries:

1. When Fruits and Vegetables Kill
2. Michael Clarke Duncan Turns Vegetarian, Loses Weight, and Dies of a Heart Attack
3. How Fruits and Vegetables Killed Steve Jobs

Sunday, October 09, 2011

Ten Alternatives to Corporal Punishment

Yesterday, I wrote a blog entry entitled “Why Corporal Punishment is Wrong.” At the end of the article, I stated that I would describe my top ten tips for effectively teaching children good behavior and discipline without hitting them. Without further ado, here they are:

Instill a good sense of moral values with your child from a very early age. Teach the Golden Rule (“Treat other people the way you would want to be treated”) as the basic principal underlying personal interactions. Remind children of this whenever they violate the Golden Rule and remind them that they would not like it if someone behaved to them in the way they just behaved to someone else.

Model positive behaviors when you are upset. Try not to scream, curse, or physically act out in front of the child so you do not model the very behaviors that you do not want the child to do when upset. No one is perfect and you will occasionally slip up, but when you do, admit the mistake. It is frustrating and confusing for a child to see double standards in behavioral expectations and rules.

If the child makes a mistake in behavior (e.g., does not say thank you) correct it immediately and explain what was wrong and why.

Teach the child that there will be consequences for undesirable behaviors in the form of privilege withdrawal. Try to use a warning first unless the undesirable behavior is particularly problematic. Many children will tell you that this is actually the worst type of punishment because they do not want their toys taken away from them, do not like being grounded, do not want their phone or ipod taken away, etc.

Follow through with threats of consequences. If you say you are going to take a privilege away but do not follow-through with this after an undesirable behavior, then the child is not going to believe you and will continue with the behaviors. Ideally, a warning will ultimately suffice to modify behaviors because the child will learn that you mean business when you issue a warning. Do not give in to temper tantrums as the child will only learn that this is an effective way to get out of the punishment.

Only allow the child to get the privilege back by doing something positive and desirable rather than just giving it back the next day or later in the day.

Talk with the child about why the privilege was taken away, what he/she did that was wrong, why it was wrong, and how to handle the situation differently next time. Tell the child what they need to do to get the privilege back, to apologize to anyone who was affected by the behavior, and most importantly, always tell them that you still love them and give them a hug at some point. It is important that you have a positive bond with the child to most effectively provide discipline.

Reward the child for positive and desirable behaviors. This can be spontaneous at times but also consider implementing a system in which the child earns points for positive behaviors. Earn enough points and the child receives an award (e.g., 10 points earns a cookie). The points can be in the form of tangible objects (marbles, tokens stored in a jar) so the child can monitor progress better. Points can be taken away for undesirable behavior and regained with positive behaviors. For more information on this topic, do an internet search for “token economy.”

Talk with your child from an early age about societal expectations and demands. Teach them from an early age why learning, reading, staying in school, and staying out of trouble are important. Teach them about staying away from drugs, alcohol, cigarettes, other children who get into trouble, and age-inappropriate violent media. Talk with them about the consequences of bad behaviors and/or a poor education in childhood and adulthood (e.g., suspensions, jail, homelessness, low income). The content of these conversations will obviously depend on the child’s age.

Surround the child with positive role models. This can be real role models such as parents, siblings, other family members, and friends but can also apply to positive fictional role models on television (e.g., He-Man or Franklin as opposed to Jason and Freddy Krueger).

Saturday, October 08, 2011

Why Corporal Punishment Is Wrong

Corporal punishment, the technical word for physically striking someone (usually a parent striking their child) as a form of discipline, simply makes no sense. Many people like to dispute this by saying something such as “I had a spanking when I was a child and I turned out ok so it could not have been that bad.” Well, sure, maybe you turned out all right in the end, but that does not mean that punishment was the reason. After all, people overcome all sorts of adversity during childhood such as poverty, serious, medical illnesses, and being bullied, but that does not mean that those were good experiences. While we all need to learn to deal with the many adversities that life throws at us, there is no need to create an additional needless adversity for children that is within our control to stop.

The context of this blog entry is that today, a man in Orlando Florida, was arrested for humiliating a child (that he was not even the parent or legal guardian of) on a video he posted online by shaving off the child’s hair, threatening him with a belt, beating him with a belt, and then making him do push-ups and sprints as a form of boot camp. This was all done because the child got in trouble in school and the man was concerned that the child would go to prison one day. Valid concerns. Invalid approach…which is why he was later arrested. While this man’s behavior may have been considered acceptable 20 years ago, today it is considered a form of child abuse.

It is important to always keep in mind that children are physically and emotionally fragile and that early childhood experiences shape the child’s personality and teaches them how to interact with the others and what to expect in relationships. The main way this is learned is through the parent-child interaction. When a parent strikes a child several things occur:

It causes fear in the child towards the parent. “Good,” you may say. “I want the child to fear me so he/she will listen.” But children do not need to suffer physical trauma to induce fear and respect for you. If you have established proper boundaries with the child and he/she knows that you are the boss, simply raising your voice slightly or looking at them wide eyed with a serious look could be enough to send the message that you are not happy and that the child needs to listen and take you seriously.

It causes anger in the child…towards you. No one likes to be hit and because of that, the child will not like the source of the hitting.

It will damage the attachment that the child has with you because of points one and two. Some withdrawal from the parent is likely. Think about your own life. Would it be easy for you to have a good relationship with someone who was hitting you and causing discomfort, pain, and/or injuries?

It teaches the child that it is appropriate to respond to anger with physical violence. Think about it. You are upset at the child. You then model to the child that the way you are going to handle that is by hitting him/her. So, when the child goes to school and another child upsets them, he/she may respond by striking the other child in response.

While the above focuses on physical abuse, this is often coupled with emotional abuse (e.g., calling the child degrading names). This just adds insult to injury and ruins the child’s self-esteem, while also contributing to additional feelings of anger, sadness, and anxiety. Tomorrow, I will describe my top ten tips for effectively teaching children good behavior and discipline without hitting them.

Friday, October 07, 2011

Inspiration if Diagnosed with a Serious Illness

If you or a loved one were diagnosed with a serious medical illness, particularly a terminal illness, it is very easy to get depressed, particularly if you read statistics on the internet on how long you are expected to live. The famous scientist, Stephen Jay Gould, found himself faced with a prognosis on 8-months to live after being diagnosed with a particularly deadly form of cancer known as mesothelioma. To read more about mesothelioma see this entry on asbestos.

After the diagnosis, Gould wrote a brief essay that came to be a source of inspiration for many people in similar situations. He lived a productive life for twenty years after the diagnosis. Not bad for someone given eight months to lived. Below, I have reproduced Gould’s essay, entitled “The Median is Not the Message.” Please read it over, share it with friends, and most importantly, pass it on to anyone you know of who was diagnosed with a serious medical illness (particularly cancer).

The Median Isn’t The Message by Stephen Jay Gould

My life has recently intersected, in a most personal way, two of Mark Twain's famous quips. One I shall defer to the end of this essay. The other (sometimes attributed to Disraeli), identifies three species of mendacity, each worse than the one before - lies, damned lies, and statistics.

Consider the standard example of stretching the truth with numbers - a case quite relevant to my story. Statistics recognizes different measures of an "average," or central tendency. The mean is our usual concept of an overall average - add up the items and divide them by the number of sharers (100 candy bars collected for five kids next Halloween will yield 20 for each in a just world).

The median, a different measure of central tendency, is the half-way point. If I line up five kids by height, the median child is shorter than two and taller than the other two (who might have trouble getting their mean share of the candy).

A politician in power might say with pride, "The mean income of our citizens is $15,000 per year." The leader of the opposition might retort, "But half our citizens make less than $10,000 per year." Both are right, but neither cites a statistic with impassive objectivity. The first invokes a mean, the second a median. (Means are higher than medians in such cases because one millionaire may outweigh hundreds of poor people in setting a mean; but he can balance only one mendicant in calculating a median).

The larger issue that creates a common distrust or contempt for statistics is more troubling. Many people make an unfortunate and invalid separation between heart and mind, or feeling and intellect. In some contemporary traditions, abetted by attitudes stereotypically centered on Southern California, feelings are exalted as more "real" and the only proper basis for action - if it feels good, do it - while intellect gets short shrift as a hang-up of outmoded elitism. Statistics, in this absurd dichotomy, often become the symbol of the enemy. As Hilaire Belloc wrote, "Statistics are the triumph of the quantitative method, and the quantitative method is the victory of sterility and death."

This is a personal story of statistics, properly interpreted, as profoundly nurturant and life-giving. It declares holy war on the downgrading of intellect by telling a small story about the utility of dry, academic knowledge about science. Heart and head are focal points of one body, one personality.

In July 1982, I learned that I was suffering from abdominal mesothelioma, a rare and serious cancer usually associated with exposure to asbestos. When I revived after surgery, I asked my first question of my doctor and chemotherapist: "What is the best technical literature about mesothelioma?" She replied, with a touch of diplomacy (the only departure she has ever made from direct frankness), that the medical literature contained nothing really worth reading.

Of course, trying to keep an intellectual away from literature works about as well as recommending chastity to Homo sapiens, the sexiest primate of all. As soon as I could walk, I made a beeline for Harvard's Countway medical library and punched mesothelioma into the computer's bibliographic search program. An hour later, surrounded by the latest literature on abdominal mesothelioma, I realized with a gulp why my doctor had offered that humane advice. The literature couldn't have been more brutally clear: mesothelioma is incurable, with a median mortality of only eight months after discovery. I sat stunned for about fifteen minutes, then smiled and said to myself: so that's why they didn't give me anything to read. Then my mind started to work again, thank goodness.

If a little learning could ever be a dangerous thing, I had encountered a classic example. Attitude clearly matters in fighting cancer. We don't know why (from my old-style materialistic perspective, I suspect that mental states feed back upon the immune system). But match people with the same cancer for age, class, health, socioeconomic status, and, in general, those with positive attitudes, with a strong will and purpose for living, with commitment to struggle, with an active response to aiding their own treatment and not just a passive acceptance of anything doctors say, tend to live longer.

A few months later I asked Sir Peter Medawar, my personal scientific guru and a Nobelist in immunology, what the best prescription for success against cancer might be. "A sanguine personality," he replied. Fortunately (since one can't reconstruct oneself at short notice and for a definite purpose), I am, if anything, even-tempered and confident in just this manner.

Hence the dilemma for humane doctors: since attitude matters so critically, should such a sombre conclusion be advertised, especially since few people have sufficient understanding of statistics to evaluate what the statements really mean? From years of experience with the small-scale evolution of Bahamian land snails treated quantitatively, I have developed this technical knowledge - and I am convinced that it played a major role in saving my life. Knowledge is indeed power, in Bacon's proverb.

The problem may be briefly stated: What does "median mortality of eight months" signify in our vernacular? I suspect that most people, without training in statistics, would read such a statement as "I will probably be dead in eight months" - the very conclusion that must be avoided, since it isn't so, and since attitude matters so much.

I was not, of course, overjoyed, but I didn't read the statement in this vernacular way either. My technical training enjoined a different perspective on "eight months median mortality." The point is a subtle one, but profound - for it embodies the distinctive way of thinking in my own field of evolutionary biology and natural history.

We still carry the historical baggage of a Platonic heritage that seeks sharp essences and definite boundaries. (Thus we hope to find an unambiguous "beginning of life" or "definition of death," although nature often comes to us as irreducible continua.) This Platonic heritage, with its emphasis in clear distinctions and separated immutable entities, leads us to view statistical measures of central tendency wrongly, indeed opposite to the appropriate interpretation in our actual world of variation, shadings, and continua.

In short, we view means and medians as the hard "realities," and the variation that permits their calculation as a set of transient and imperfect measurements of this hidden essence. If the median is the reality and variation around the median just a device for its calculation, the "I will probably be dead in eight months" may pass as a reasonable interpretation.

But all evolutionary biologists know that variation itself is nature's only irreducible essence. Variation is the hard reality, not a set of imperfect measures for a central tendency. Means and medians are the abstractions. Therefore, I looked at the mesothelioma statistics quite differently - and not only because I am an optimist who tends to see the doughnut instead of the hole, but primarily because I know that variation itself is the reality. I had to place myself amidst the variation.

When I learned about the eight-month median, my first intellectual reaction was: fine, half the people will live longer; now what are my chances of being in that half. I read for a furious and nervous hour and concluded, with relief: damned good. I possessed every one of the characteristics conferring a probability of longer life: I was young; my disease had been recognized in a relatively early stage; I would receive the nation's best medical treatment; I had the world to live for; I knew how to read the data properly and not despair.

Another technical point then added even more solace. I immediately recognized that the distribution of variation about the eight-month median would almost surely be what statisticians call "right skewed." (In a symmetrical distribution, the profile of variation to the left of the central tendency is a mirror image of variation to the right. In skewed distributions, variation to one side of the central tendency is more stretched out - left skewed if extended to the left, right skewed if stretched out to the right.)

The distribution of variation had to be right skewed, I reasoned. After all, the left of the distribution contains an irrevocable lower boundary of zero (since mesothelioma can only be identified at death or before). Thus, there isn't much room for the distribution's lower (or left) half - it must be scrunched up between zero and eight months. But the upper (or right) half can extend out for years and years, even if nobody ultimately survives. The distribution must be right skewed, and I needed to know how long the extended tail ran - for I had already concluded that my favorable profile made me a good candidate for that part of the curve.

The distribution was indeed, strongly right skewed, with a long tail (however small) that extended for several years above the eight month median. I saw no reason why I shouldn't be in that small tail, and I breathed a very long sigh of relief. My technical knowledge had helped. I had read the graph correctly. I had asked the right question and found the answers. I had obtained, in all probability, the most precious of all possible gifts in the circumstances - substantial time. I didn't have to stop and immediately follow Isaiah's injunction to Hezekiah - set thine house in order for thou shalt die, and not live. I would have time to think, to plan, and to fight.

One final point about statistical distributions. They apply only to a prescribed set of circumstances - in this case to survival with mesothelioma under conventional modes of treatment. If circumstances change, the distribution may alter. I was placed on an experimental protocol of treatment and, if fortune holds, will be in the first cohort of a new distribution with high median and a right tail extending to death by natural causes at advanced old age.

It has become, in my view, a bit too trendy to regard the acceptance of death as something tantamount to intrinsic dignity. Of course I agree with the preacher of Ecclesiastes that there is a time to love and a time to die - and when my skein runs out I hope to face the end calmly and in my own way. For most situations, however, I prefer the more martial view that death is the ultimate enemy - and I find nothing reproachable in those who rage mightily against the dying of the light.

The swords of battle are numerous, and none more effective than humor. My death was announced at a meeting of my colleagues in Scotland, and I almost experienced the delicious pleasure of reading my obituary penned by one of my best friends (the so-and-so got suspicious and checked; he too is a statistician, and didn't expect to find me so far out on the right tail). Still, the incident provided my first good laugh after the diagnosis. Just think, I almost got to repeat Mark Twain's most famous line of all: the reports of my death are greatly exaggerated.

The above essay is copyrighted by Stephen Jay Gould.

Thursday, October 06, 2011

Pale Skin and Vitamin D

If you have pale skin like me, you know that the sun can feel like your arch-enemy. Summer time means lathering up with sunscreen and wearing a hat to avoid getting scorched. Sometimes, it seems that no matter how hard you try, you later find an area of sunburn on you. Some of the burns will make you look more lobster-like than others.

Shade is your best friend and many times it is just easier to stay in doors. The benefit about not exposing yourself to more sun is that you reduce exposure to harmful ultraviolet rays that can cause skin cancer. The flipside, however, is that by avoiding the sun, your body will not convert it into vitamin D. While vitamin D is found in some foods such as salmon, milk, and cheese, you may not get as much from your diet than you need. Many people would be surprised to know that there are very few foods in nature that contain vitamin D. So, it probably should not have come as a surprise that when I went for a routine blood test last year, that I had a low vitamin D level. The solution is easy: vitamin D should be available at your local grocery store or pharmacy as a supplement.

Why should you care if your vitamin D level is low? Well, for one, vitamin D helps build strong bones so you are more likely to suffer broken bones if your vitamin D level is too low. More importantly, low vitamin D levels can also contribute to heart disease, cancer, multiple sclerosis, and diabetes mellitus.

So, if you are one of my pale and pasty friends out there, get your vitamin D level checked and if it is low, talk with your doctor about how much of a supplement you need. You do not want to overdo it in the reverse direction and take too much vitamin D because that can be harmful as well. As the Greek philosopher, Plato, once said, do things in moderation.

Suggested reading: Vitamin D For Dummies

Related blog entry: Too Much Calcium Can Hurt Men's Hearts
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Wednesday, October 05, 2011

More EXTREME Body Parts: Part 2

Diversity in the human body and other living things is a fascinating topic. Last month, the most popular blog entry was on extreme body features. Due to the popularity of that entry, I decided to do some more research and bring you some more amazing extreme body parts. So…here we go again (all Guinness World Record holders).

1. WIDEST MOUTH: This is Francisco Domingo Joaquim "Chiquinho" from Angola. His mouth is 17 inches wide. By the way I am a Pepsi fan so this picture should not be seen as an endorsement for Coca Cola.

2. LARGEST BREASTS: This is Annie Hawkins-Turner (aka Norma Stitz). The around chest-over nipple measurement is 70-inches. I’ve spared you some other pictures but if you dare, you can search on-line for more.
3. LONGEST NOSE:

This record belongs to Mehmet Ozyurek from Turkey. This schnozz measures 3.46 inches long. I’d hate to be near one of this guy’s sneezes.

4. LONGEST FEMALE LEGS: This record belongs to Svetlana Pankratova of Russia which are 5.9 inches. ZZ Top sure would have loved to have her for their Legs music video.

5. SMALLEST WAIST: This waist belongs to Cathie Jung, coming in at 15 inches. It almost looks unreal, which is what makes it all the more amazing.

6 & 7. LONGEST MALE AND FEMALE FINGERNAILS (EVER): These belong to Melvin Boothe (now deceased) which were 32 feet and 3.8 inches. To the right is Lee Redmond whose nails measured 28 feet and 4.5 inches. I’m guessing they don’t use computers.

8. TALLEST LIVING MAN: This is Sultan Kosey from Turkey. He is 8 feet, 3 inches tall. Here he is with…Al Roker! Guaranteed Al asked him how the weather was up there.

9. TALLEST LIVING WOMAN: This is Yao Defen from China. She is 7 feet, 7 inches tall. I’d like to see her take on Yao Ming in a game of one on one.

10. WIDEST TONGUE: This is Jay Sloot from Australia, who has a 3.1 inch tongue width. One wonders if Gene Simmons is jealous.

Want more? Click for even more and more extreme body parts.

Tuesday, October 04, 2011

When Patient Advocacy Becomes Patient Enabling

Physicians, nurse practitioners, nurses, psychologists, physical therapists, and a whole host of other health care professionals entered their respective professions to help people. One part of being an effective health care provider is to advocate for your patient when they need it. If your patient (who is a mechanic) broke his arm and needs a note for the employer for a few weeks off, you provide it. If your pediatric patient (who suffered a severe traumatic brain injury) needs you to write a note regarding academic accommodations, your write it. If your stroke patient needs you to write a letter of medical necessity to the insurance company for why they need extra physical therapy for rehabilitation of a weak limb, you write that too. This is just common sense and while it can be seen as advocacy it is also sound practice.

Where patient advocacy starts to become problematic and can lead into patient enabling, is when there is: a) a lack of objective biomarkers to indicate the presence of a pathological physical condition and/or b) the patient is pursuing some form of compensation (e.g., disability application, workers compensation claim, no-fault insurance claim, and/or litigation). By objective biomarkers, this means that there are no significant abnormalities on blood tests, x-rays, MRI scans, physical exam, or other objective measures. When a and b are both present, the risk of patient enabling increases significantly.

In such cases, the health care provider is often left to diagnose, treat, and manage the patient based purely on subjective symptoms. The provider may also be asked to fill out disability paperwork (even on the first visit), fight insurance company denials for expensive tests, and be asked to refill pain medication prescriptions. While it may be easier to go along with these requests, if you are a healthcare provider how do you know that the patient is not exaggerating their presentation, that you are actually treating the true source of the problem, that you are not causing more harm than good in the process, that you are not enabling abnormal illness behavior, and that you are not enabling someone’s financial goals as opposed to medical treatment goals?

This is a topic that rarely commented on in clinical notes or discussed with the patient. There are several reasons why this is the case, including but not limited to: a) an automatic proclivity among some providers to believe subjective symptom reporting is accurate based on a belief in the inherent truthfulness of others, b) a belief that reinforcing and “validating” symptoms helps the patient feel like someone cares and is thus more important than questioning if the symptoms are accurate, c) helping patients is equated to prescribing and ordering diagnostic tests targeted to each specific symptom, d) not realizing that the presentation may be exaggerated by failing to integrate evidence-based research findings into case conceptualization, e) not utilizing objective measures of treatment progress (or lack thereof), f) fear of complaints and litigation, g) it takes too much time to address, and h) not realizing that there are ways to more objectively and comprehensively evaluate exaggeration.

As a caveat to this discussion, I want to be clear that there are patients with only subjective symptoms who may have a genuine medical problem that objective tests did not detect. A famous quote about this drives the point home “absence of evidence is not evidence of absence.” To be more accurate, however, the phrase should read, “absence of evidence is not always evidence of absence.” This is because many times a medical test is negative because there really is nothing medically wrong. In other words, many times, “absence of evidence actually is evidence of absence.”

This post should not be read to imply that patients with subjective symptoms, negative objective test results, and who are pursuing compensation should not be treated and advocated for. These types of decisions will always depend on the specifics of the particular case. However, in general, health care providers need to exercise much greater caution in such cases than in the ones described in the first paragraph.

A few tips are as follows.

1) Use objective measures of treatment progress and require/request this of others who you refer the patient to for treatment. If the patient is not improving with a certain plan of care, it is time to change direction rather than continuing the same treatment for months to years. You may be surprised to find when doing this that the patient is actually reporting worse symptoms over time. If so, it is time to consider why and change course.

2) Consider if the patient’s presentation significantly exceeds what would be expected based on scientific knowledge of the condition. If the presentation is not biologically plausible, it is time to consider a psychological explanation for the presentation, reexamine the diagnostic impressions, treatment, and advocacy efforts.

3) Do not feel compelled to immediately fill out disability paperwork or other paperwork supportive of compensation requests without having some data to support your position. If a physical limitation is described as disabling, refer the patient for a functional capacity evaluation. If the patient claims cognitive impairment, send the patient for a neuropsychological evaluation so the role of psychological factors can be explored. These types of evaluations can provide very useful information about the reliability and validity of the patient’s symptoms that is based on objective data and supported by peer-reviewed research.

4) Use data from the above evaluations to help guide decision making. For example if you find out the there is overwhelming evidence that the patient’s presentation is exaggerated, malingered, and/or caused by psychiatric as opposed to neurological problems, it is time shift the care to a psychiatric focus and only treat physical symptoms that can be objectively verified.

5) Consider the possible harmful effects of continued treatment without employing reliability and validity checks. For example, if you are treating a non-existent attention problem with a neurostimulant you can be raising the patient’s blood pressure to dangerous levels. If you are keeping patients in physical therapy for gait imbalance who are not improving and who have a non-physiological gait pattern, you are restricting access to care for patients with genuine medical problems who need the service. The same applies for ordering diagnostic tests (e.g., CT scans which expose patients to radiation) that have very little chance of yielding any new information given what is already known about the case.

In sum, health care providers best help patients by using objective data to guide case conceptualization, treatment, and advocacy efforts. Sometimes, you need to be skeptical, sometimes you need to say no, sometimes you need to say something the patient may not want to hear, and sometimes you need to decide and communicate that there is nothing else you can do. This can all be done in a polite, caring, and respectful way. It does not mean that you have failed if all of your patients do not get better. Some will never get better and some do not want to. It’s just the reality of working in the modern day medical system.

Monday, October 03, 2011

Guest Blog Entry: Are You a Helicopter Parent?

Today's guest blog entry is written by Dr. Tanya Gesek. Dr. Gesek is currently a Visiting Assistant Professor at Syracuse University. She has worked as a middle school psychologist, in residential care for children, in county mental health, and has always maintained a private practice in some form or fashion. She is also the current President of the Central New York Psychological Association. Her guest blog entry discusses parenting, teaching responsibility to children, and helicopter parents (parents who hover like a helicopter over their children whether it is needed or not).

Are helicopter parents becoming a thing of the past? I sure hope so. Last spring I received an email from a parent asking about their child’s grade on a test. The parent wanted to know what their child could do to improve their grade. Right now you may be thinking, “That is not so bad.” Well what if I told you that I teach at a major university? Yeah, now you are with me.

The trend has likely predated my professional career, but I have been amazed in my work with both college students and younger children in my private practice, at how much parents do for their children. For some reason, we parents have come to think that our job is to make our children happy, all the time. Whatever happened to facing the challenge? Do we even use the term “buck up” anymore?

Yes, it is much easier to tie their shoelaces for them. Homework goes a lot smoother when you hold the pencil. Your child will be more content if they never hear the word “no”. There are less tears when everyone gets the first place ribbon. Your house will be much cleaner if you just do the chores in the first place.

But what you will also have is a grown up that does not know how to deal with frustration, a college student that cannot troubleshoot a really busy week, and a future employee that falls apart if they get critical feedback from their boss.

I have never heard of a child dying from disappointment and rarely hear my adult friends complain that they had to problem-solve for themselves as children. Being a resilient adult includes facing challenges, dealing with disappointment and “bucking up”.

Sunday, October 02, 2011

And the Top 5 MedFriendly Blog Entries in September Were...

Below are the top 5 most popular blog entries for the month of September. This will be a monthly feature of the MedFriendly Blog and gives readers a chance to catch up on the most popular blog entries they may have missed. Overall, a good month for the MedFriendly Blog. As the blog becomes more popular, page views will increase. Please post a comment if you have blog entry suggestions. Here is the Top 5 list:

1. Amazing Images of Extreme Bodies and Body Parts: This is the clear winner with 76 page views. People love the visuals. I’ll try to put up more images next month.

2. Guest Blog Entry: Chakras 101: This was the first guest blog entry since the MedFriendly Blog relaunched. It came in a close second with 57 views. Will a follow-up to this entry be in the works? Stay tuned.

3. White blood cells promote cancer: Cancer will always be an interesting topic for readers. But hearing that white blood cells many play a role in the disease? Definitely of interest. Comes in at 43 views.

4. Abandoning Alzheimer’s Disease: My Response to Pat Robertson. This was my response to Pat Robertson’s advice that a husband of an Alzheimer’s patient should divorce her after putting her in custodial care. It was featured on the popular medical blogging site, KevinMD. Comes in at 42 page views.

5. What to do if You Can’t Afford Medications: A helpful primer for patients on this topic. Comes in at 41 page views.

Saturday, October 01, 2011

Is Asbestos in Your Children's Crayons?

Is asbestos is your children’s crayons? Can asbestos cause cancer and other serious illnesses? How much asbestos was released into the air on 9/11/01? What is asbestos anyway?

You’ve all heard of asbestos, know to stay away from it, but do you really know what it is and why it so dangerous and deadly? Do you know what to do if it is found in your home and who to contact for inspections and possible removal?

Find out the answer to these questions and more on the brand new asbestos entry on MedFriendly.com. This entry was created after months of research and represents the most detailed and comprehensive article on asbestos on the internet today. The entry was created to commemorate the 10 year anniversary of MedFriendly – where medical information is easy to understand.

Friday, September 30, 2011

The 10 Year Anniversary of MedFriendly.com

October 2011 is the 10 year anniversary of MedFriendly.com. I’ll be going out to celebrate with my family and reflect on how much hard work has gone into this lifelong project of mine. I figured I would reflect a little here on the past 10 years, how it all started, and where things go from here.

I remember the beginnings of the website idea like it was yesterday. I was driving with a friend in Ft.Lauderdale, Florida, where I was attending graduate school. The person I was driving with told me that his girlfriend had a website that she made about psychology.

“Really?” I asked, “How did she do that? She must know a lot about computers.”

“Nope,” the person replied. “She just bought some books and taught herself.”

Immediately, I thought to myself that it would be fun to have a website about something. I had no idea how to make one, but if someone else could pick up a book and figure out how to do this, I figured that I can too. I won’t repeat how I decided to create a medical website where medical information is easy to understand, because that is all described here.

Upon reflection, a few embarrassing admissions are in order. First, I initially avoided computers when they first became popular. To understand how much I avoided them, I was still using a Brother Word Processor in 1998 to write reports in college. That year, I met my future wife and she introduced me to programs such as Microsoft Word and AOL.com (the 3.0 version!). Man, do I feel old writing this. Fortunately, I was a quick learner and within a few years, she was coming to me for computer questions. Within three years, in October 2001, I had taught myself HTML (hypertext markup language) which is the code you write to make a website. MedFriendly.com was born.

Learning can sometimes be a painful process, especially when technology is in its infancy. If you were ever to see what a MedFriendly website page looked like when it first began compared to what it looks like now, it is like the difference between night and day in terms of design and functionality. Changing all of the pages to modify the format took an intense amount of work since each page is uniquely customized. Back then, you were also forced to work at a desk because there was no wireless internet. Nowadays, it is so much easier to be able to have mobility and work on the website from anywhere in the house.

Initially, there was never any intent to make money with MedFriendly. It was a fun interested way for me to learn, share knowledge, and teach others along the way. It still is. But over time, advertising opportunities arose that would have been foolish not to take advantage of. I experimented with various options. Initially, most pages on MedFriendly had links to books to books on Barnes and Noble.com but sometimes the links would change and instead of having a picture of a medical book on the page, I was left with a big red X in it’s place. I also could not always find a book to match the page content. In addition, not many people were buying the books and eventually, it just was not worth the hassle. I tried a similar arrangement with Amazon.com and with another company I cannot remember that sold medical supplies. For similar reasons, these arrangements did not work out.

Then Goodle AdSense came out and revolutionized the online advertising industry. Now, all I needed to do is place the same ad code on all my pages, and Google targets advertisers to the specific content on my page. Quick, easy, and profitable. That relationship has endured, has grown to this day, and will continue to evolve.

Over the years, I’ve been fascinated to see which of the thousands of entries on MedFriendly that people gravitate towards. For some reason, no matter what medical condition I write about, the term feces has been the #1 term on for over five years. I think this may because the entry is somewhat humorous, but is mostly because it covers a topic that people have healthcare questions about but may be embarrassed to talk to their doctor about. Solution: search the internet. The second most popular type of entry is anything that has to do with blood test results, which makes sense given that people are curious about what their blood test results mean. And, people really like detailed content. Long entries, with a lot of detail, are far more popular than brief entries that provide definitions of descriptive medical terms.

In that vein, there will be a focus in the future on adding more entries with detailed content. The goal is to continue to provide information that laypeople and medical professionals find useful, is easy to understand, covers interesting topics, and does so in a way that sets it apart from any other website on the internet.

Tomorrow, to commemorate the 10 year anniversary of MedFriendly, I will unveil a major new detailed entry that has been months in the making on a topic that is medically, legally, and historically fascinating. Come back tomorrow to see what it is. Thanks to the readers and fans of MedFriendly for helping make it a popular healthcare website! Here’s to another 10 years!

Thursday, September 29, 2011

Waking Up with a Live Grenade in Your Face

This is an amazing story. Imagine selling some food on a street corner, minding your own business. All of a sudden, you hear an explosion. Stunned, you turn around to see what it was and an object hits you in the face. You get knocked down. Your face is burning. You touch it. You check your hands. Blood.

The next thing you know, you wake up in an ambulance. There is something in the right side of your face. You figure it’s a rock. The doctor examines you. It’s a live grenade fragment that was supposed to explode when it hit you but it did not. You need it removed. But there’s a problem. If people try to remove it and it explodes, everyone within a 32 mile radius will be blown to smithereens.

This sounds like something from a Hollywood movie or the TV show, 24. But it is exactly what happened to 32-year-old, Karla Flores, from Mexico. Fortunately for her, a brave team of medical professionals saved her. They moved her away from the other patients and medical volunteers were sought to treat her. Four brave people volunteered: three doctors and a nurse. Two explosives experts also consulted.

Only local anesthesia could be used to cut a hole into her trachea (windpipe) to help her breathe during the surgery, as she could barely breathe before the surgery or swallow her own bodily fluids. The military doctors guided the doctor and the grenade fragment was removed. She is left with a massive facial scar and half of her teeth missing, but at least she is alive. The medical staff should receive some type of award and recognition for incredible bravery.

Wednesday, September 28, 2011

My Take on Michael Jackson's Death, Propofol, and His Doctor

Propofol…also known as Diprivan. Many people reading this may not have heard of the drug that played a major role Michael Jackson’s death on 6/25/09, but now that has all changed. His doctor, Conrad Murray (a cardiologist), who ordered the drug for Michael Jackson, and who is now on trial for involuntary manslaughter (causing the unintentional death of another, in this case due to negligence), ordered the drug for Michael Jackson and made it available to him.

What people need to understand about propofol is that this is not a pill you get from your pharmacist or buy off the street. This is a very powerful medication you get in a surgery room to render you unconscious. It is a white, milky liquid that looks like Milk of Magnesia. It is so mind altering that it is referred to by doctors as Milk of Amnesia. In fact, Jackson reportedly referred to it as his “milk.” I’ve been given this medication many times when I was younger for various surgical procedures. I remember watching the doctor push the medication in and telling myself that I would see how long I could mentally resist its effect. Within 10 seconds, I was out cold…every time.

Now, the trial needs to play out of course and people are innocent until proven guilty, but there is no getting around the fact that people simply should not be administering this medication outside of a surgical setting, where anesthesiologists (not cardiologists) are on hand to closely monitor the patient. Why? The drug is so powerful that it slows the heart rate down and can make it impossible to breathe without use of a respirator. Keep in mind that Michael Jackson was found in full cardiac arrest by paramedics.

On top of using propofol, Michael Jackson was also using several other sedating medications (lorazepam, diazepam, and midazolam). You are probably familiar with lorazepam and diazepam since they are usually marketed under the name, Ativan and Valium, respectively. Both are typically prescribed in pill form to treat acute anxiety but have other uses that cause sedation (e.g., insomnia treatment). Midazolam is sometimes marketing as Versed. It is a very powerful medication that is sometimes also used in surgical centers for sedation. He also had lidocaine in his system, which is a local anesthetic medication commonly used in dental offices. Lastly, he was using ephedrine, which is a stimulant medication.

All of these medications were found in Michael Jackson’s system when he died, with propofol and lorazepam in the greatest amounts. Just taking one of these medications has a powerful effect on the body. Imagine the effect of combining all of them. Also, Michael Jackson had a history of taking many other powerful prescription medications, most of which were again sedating and mind altering in other ways.

If you want to get a sense of exactly how Michael Jackson sounded with these medications in his system, just listen to how he sounded on Dr. Murray’s cell phone recording. You do not need to be a doctor to understand that something was wrong here.

So, would anyone reading this then order forty more bottles of propofol for Michael Jackson? Well, that is what Dr. Murray is said to have done. He also used non-standard CPR by not doing this on a hard surface and not using both hands for compression. According to testimony today from a bodyguard who was present at the time of Jackson’s death, Dr. Murray asked if anyone knew CPR. How a cardiologist administering propofol does not know CPR has go to be one of the most ridiculous things I have ever heard.

Testimony today was also that Dr. Murray did not call 911 right away but called Jackson’s personal assistant instead, saying he had “a bad reaction.” That may be the understatement of the year. He also tried to get the assistant to remove the propofol from the room, according to testimony today. Thankfully, Dr. Murray’s license to practice medicine has already been suspended in California. However, Dr. Murray has more to worry about now than the judgment of a state licensing board.

Tuesday, September 27, 2011

Waking Up Alive in a Morgue

Everyone has different fears but one fear that is probably universal is being buried alive. The next closest thing would be finding yourself locked in a morgue refrigerator, wrapped in a plastic body bag…while you are still alive. I first read about a story like this earlier in July 2011, when an 80-year-old man awoke in a morgue refrigerator in South Africa after being sent there due to a presumed death from an asthma attack. Twenty-one hours later, when the man awoke and realized something was wrong, he began screaming and morgue workers thought that the noise was a ghost. The man was rescued after it was realized the voice came from a real person. He was then taken to a hospital and discharged in stable condition. Needless to say, the man was traumatized, had difficulty sleeping, and had nightmares.

Well, now it has happened again…this time to a woman in her 60s in Brazil, who was pronounced dead from pneumonia after suffering two strokes. In this case, the woman’s daughter came to see her mother in the morgue and gave her one final hug. When doing so, she realized her mother was still breathing. The hospital was notified but this was after the poor woman had spent two hours in a plastic bag. The patient was immediately put back on life support. The nurse who first checked her vital signs was fired.

It is reassuring that this has not happened in the United States yet but it may just be a matter of time. My concern is that there may be too casual of an attitude towards death and that the evaluations of these patients were not done as carefully as they should be. In many cases, where people have advanced directives to keep them alive at any circumstances, there would usually be an objective way to test to see if the person was truly dead – an absence of electrical activity of the heart as measured by an electrocardiogram.

However, some people have advanced directives that they should not be resuscitated and so they may not be hooked up to such electrical tests. This often happens in nursing homes, for example. In such cases, a nurse usually checks the pulse and respiration (breathing). This should be double checked by another nurse. In hospitals, a doctor usually does this. It is very hard to imagine, if the nurse or doctor took their time doing this assessment, how a person can be declared dead when they are alive because they would be breathing and have a pulse, even if both were decreased. These issues need to be taken more seriously because what happened in these two cases should never happen anywhere.

Monday, September 26, 2011

Medical Blogging and Patient Privacy

Running a medical blog has become much more challenging over the years. It has always been understood by medical and health care bloggers that you should never post information that violates a patient’s privacy. In other words, do not post patient’s names, photographs of patients, or any other information that can specifically be used to identify them. However, changing patient demographics (e.g., gender, age) and limiting the information discussed such that the patient would not be directly identifiable by others was a way to still discuss important lessons learned from specific cases via social media.

But recently, things have changed. For example, I am aware of specific recent policy implemented by some health care organizations that any employee who has a social media account (e.g., Facebook, Twitter) or a blog cannot post information related to a specific patient case even if the patient is the only person who may be able to identify him/herself based on the information posted. One way around this is getting consent from the patient, but sometimes you may not think to write about a specific situation months of years later after reflecting on it.

In those cases, retrospectively obtaining consent is unrealistic and can seem unprofessional to the atient. For example, imagine making this kind of phone call:

“Hi, Mr. Jones, this is Dr. Smith. I saw you at General Hospital a few years ago. Yes, yes, I’m doing good. How about you? Good. So anyway, I was wondering if you could give me permission to write about your case on a blog I run.”

One of the medical blogs I like to follow is KevinMD. One of the main features is that it shows a collection of the top medical and healthcare blog postings from the internet each day. I was perusing some of these entries last night and I was interested to see that there are still many doctors posting about specific patient cases. These are good posts. Excellent posts. Posts to learn from.

But I fear we are increasingly going to reach a point where these types of posts decline in frequency, either for fear of litigation for arguably violating patient privacy (even if the patient is the only person who can identify him/herself) or for fear of termination by an employer. Personally, I’ve decided to take the safe route and not report on any specific patient cases from my current place of employment. But I am curious what other medical and healthcare bloggers think about this and how they are handling (or plan to handle) this potential limitation in blog posting at present or in the near future.

When considering these recent restrictions, I think back with a smile to the days where you could open an old medical text and see pictures documenting specific medical conditions in patients, full face and all.

Saturday, September 24, 2011

How I defeated low back pain

Anyone who has suffered from low back pain knows how debilitating it can be. I have had low back pain in the past but several months ago I had the worst low back pain of my life. It was impossible to sit anywhere without being in significant pain and when it was at its worst, I could not find a comfortable position to sleep in.

I could literally not lift my left foot up to move it into the car or to put on my socks. Sometimes, I was stuck on the ground and could not get up. It was terrible and demoralizing.

I tried all of the common remedies: back bend stretching exercises, pain medication, yoga exercises, lumbar rolls, use of a back brace, etc. Some of these remedies had worked in the past, but this time, they only provided very mild relief or none at all. I knew that the cause was most likely my posture. Being 6 foot 6 and 250 pounds and having a job that requires constant sitting, there is constant pressure exerted upon my back all day. Although that was a problem, the bigger issue was that I had a leather sofa that I would sink into at night and sometimes fall asleep in. This was throwing my back out of alignment eventually causing the disc to slip out and press upon the nerve.

The only place I could find at home that gave me any type of relief was sitting in a reclining chair and leaning backwards. It was terrific because it allowed me to sit while taking the pressure completely off my lower back. I could even fall asleep in it without aggravating my back. I immediately realized that I had to move this chair into my living room and use this as my new seat at night. For a few days, it was also my new bed. No more sinking into leather couches.

By making this change, it helped put my back into alignment. I also bought a new Shiatsu massager for my work chair and I was able to check out both orthotics and braces from an As Seen On TV store. The massager is helpful when a flare up occurs but I have not needed to use it since using the recliner chair. Nevertheless, I still keep the massager over the chair because the knobs press into the lower part of my back and force me into an upright position during the day. Another thing I did to help was to get up out of my chair and take a walk around the hall several times a day, making sure I was standing as straight as I could.

The point is that posture plays a huge role in low back pain and you can get into bad habits that cause this problem. One way to relieve and rid yourself of the pain is making major changes to your posture by getting rid of bad habits. Now, I can play basketball again with my kids, paint for a few days without back pain, and sleep in my regular bed without pain.
The interesting thing is that no one I had ever spoken to, including a physician, had ever mentioned trying to relieve back pain by using a recliner chair. It was such a simple solution but one that I discovered myself and wanted to share with you. Please pass it on to anyone you know with low back pain.

Friday, September 23, 2011

Spontaneous human combustion

If you have never heard of spontaneous human combustion, it refers to cases in which a person is found burned to death (usually in bed) with no apparent external cause. The furniture around them is typically intact and not burned. Some theorize that there are people whose bodies suddenly catch fire due to some mysterious factor unique to them (such as abnormal levels of concentrated gas or alcohol) or paranormal explanations such as ghosts. While paranormal explanation may sound very mysterious, they do not withstand scientific scrutiny. Importantly, while many cases may have appeared to have no external cause, an actual external cause of ignition has later been found.

I remember watching a TV show about this a few years ago and the best explanation was the wick effect. That is, a source of flame (such as a burning cigarette), burns the clothing of the victim in one area, splitting the skin and releasing fat from under the skin. The fat is then absorbed into the burned clothing, and acts like a candle wick. The burning can continue for as long as the fuel is available. This hypothesis was successfully demonstrated on the show with a pig. With that being said, some debate whether this process can occur in humans and cases continue to pop up now and then.

If you have not heard of a specific case, below is a report of a case of spontaneous human combustion reported several days ago by Nick Collins at The Telgraph.

Man 'spontaneously combusts'
Spontaneous human combustion has long been the stuff of fiction, endorsed by eccentric scientists and employed by novelists including Charles Dickens as a convenient plot twist.

But yesterday the most unlikely cause of death, in which people burst into flames without any external source of ignition, was given official sanction when Irish coroner found a pensioner had burned to death for no apparent reason.

Michael Flaherty, 76, was found dead at his home in Galway last December after a neighbour heard the smoke alarm in his house go off in the middle of the night.

But while his body had been burned to cinders, fire officers who attended the scene were astonished to find nothing else had been damaged apart from the floor below him and a patch of ceiling above.

There were no signs of any devices which could have ignited the body, and no indication of foul play, officials said – Mr Flaherty's body appeared to have simply cremated itself.

Officers who attended the scene claimed they had never seen anything like the extraordinary case, and the inquest heard fire officers were unable to give any explanation for what sparked the blaze.

Recording his verdict, west Galway coroner Dr Kieran McLoughlin was left with little option but to become the first coroner in the country's history to record the unusual verdict.

He said: "This fire was thoroughly investigated and I'm left with the conclusion that this fits into the category of spontaneous human combustion, for which there is no adequate explanation."

Spontaneous human combustion was a phenomenon first described by Victorian doctors, who suggested the body could suddenly go up in flames as a divine punishment for alcoholism.

Other explanations for the unexplained combustion of the body include the influence of ghosts or other paranormal entities, the production of unusual concentrations of gas, or external factors like cigarette sparks.

In the 1850s Charles Dickens, the novelist, attracted controversy after Krook, a rag and bottle merchant, spontaneously combusted in Bleak House.

The mystique of the theory is heightened by the striking similarities between documented cases. In many instances the body is found reduced to ash while the arms, hands and legs remain, and in several others the victim is completely consumed while nearby objects such as furniture remain untouched.

In one example, a Welsh policeman who found the victim's body noted that the fire appeared to have come from within her abdomen.

The latest case bore many of the hallmarks of the classic case – the victim was found on his back by the fireplace, with his head intact but the rest of his body entirely consumed.

Fire experts said the evidence suggested the fire had not been the source of ignition.

Bob Rickard, of the paranormal magazine the Fortean Times, told the Telegraph: "It has become rare now, I have not heard of a case for a couple of decades. But what is even more interesting to me in this case is it is the first time I can remember that a coroner has come out and announced a verdict of spontaneous human combustion.

"Normally they try to leave an open verdict or try to express it in some other way."

Mr Flaherty's family said they were satisfied with the investigation, the Irish Independent reported.

Thursday, September 22, 2011

Top 10 Ways to Tell if You Need To See a New Doctor

As a patient care provider and someone who is occasionally a patient myself, I am going provide some suggestions on ways to know when it is time to consider seeking a second opinion or time to seek a new health care provider. This top 10 list is taken from personal experience.

The number one reason to seek a new healthcare provider is when the treatment you are receiving is not working. This may seem obvious but sometimes, people continue to remain with the first treatment provider they come into contact with because they “feel bad” that the provider may be offended and sometimes just fall into a pattern where they are going for “treatment” without realizing that their symptoms have remained the same or worse for years. The patient needs to care about him/herself first. With modern healthcare being as busy as it is today, the provider will likely be too busy to get upset about some patient attrition now and then.

The healthcare provider is more concerned about discussing himself that talking about you. I will never forget going to see an ear, nose, and throat (ENT) doctor once who literally would not stop talking about himself and his own accomplishments for the first 10-minutes of our interaction. It is a bad sign that the provider will not be sufficiently focused on the patient to provide proper evaluation and management.

The healthcare provider does not want to order tests that can aide in better diagnostic decision making (such as magnetic resonance imaging) because they “don’t want to fill out all of the forms.” This is different from not wanting to order tests that would not be helpful. If a surgeon did not want to fill out forms to order a test that can clarify the diagnosis, for example, would you feel confident that this person would take the time to take put the sutures in properly, or would they possibly, leave a scalpel inside of you? I would not want to take the chance.

You are rarely being seen by the doctor but are almost constantly being seen by a physicians assistant or nurse. Not that there is anything wrong with physicians assistants or nurses because they do play a very important role in health care, but if you are seeking the care of a specific healthcare provider and are rarely ever getting to see that individual (and you are not getting the care you believe you need as a result) this is a good sign that it may be time to make a switch.

The provider becomes defensive and angry when asked polite but challenging questions. No health care provider is always correct with diagnostic decision making or managing treatment. Patients should feel like they can have an open and honest discussion with the provider which includes asking questions about possible alternative diagnoses, treatments, or inquiring about information gathered from popular news sources. Provided that the questions are asked politely and without the intention of being antagonistic, there is no need for the provider to become upset. There is no need for a patient to feel scared to ask questions of their physician, nurse, psychologist, etc.

Feeling rushed. Healthcare is best when the provider is able to take the time to listen and understand the patient’s problems. When the provider gives off signals (e.g., frequently checking the clock or a watch, sighing when questions are asked, walking towards the door, cutting off questions) that he/she cannot spend much time with you, it may be time to consider seeking the care of someone who can.

When the provider makes decisions that turn out to be harmful. An example of this would be going to a pediatrician for a child with respiratory problems and constantly being told it is probably due to allergies despite the fact that the child has no known allergies and has not improved with allergy medications or a nebulizer. Due to the delay in taking the parental report seriously that the problem is likely more than allergies, the child develops pneumonia and is hospitalized. Situations like these are reasons switch providers. While no health care provider is free from making mistakes, this does not mean you have to stay under that provider’s care.

The provider has decided upon your course of care before evaluating you. This one sounds hard to believe but it happens sometimes. I had a situation once when I went to a doctor, he saw my chief complaint, and filled out two medical scripts before talking to me or evaluating me. Medication and other treatments should be based on a discussion with the patient and an evaluation.

The provider is not really listening to you. If you go to see a health care provider and he/she is too busy doing other things while you are trying to explain what is wrong with you, it is a bad sign that the provider is not paying sufficient attention to detail to provide optimal care. Examples include writing out another patient’s medical notes or prescriptions, typing text messages, or sending emails when the patient is trying to explain the reason they are there. While some people are good at multi-tasking, attention to detail decreases and errors increase when multi-tasking occurs. The provider should be focused on you, and only you, when you are in the evaluation room together.

Lastly, research your healthcare provider on your state’s online licensing board’s website. You would be surprised how many are still practicing despite being the focus of serious investigations, reprimands, and recipients of prior disciplinary charges for actions that violated standards of the licensing board (e.g., improper note keeping, fraudulent billing, poor medical care). An internet search on popular search engines can also be helpful as some physicians move to another state if a license to practice has been removed from a prior state of residence. Online searches can also reveal prior criminal acts or charges. It is important to be careful with on-line searches, however, because you need to be sure that the person you are reading about is the same person as your health care provider and not someone else with the same name. In addition, be wary about information from health rating websites that are purely written by former patients, because they can be biased towards negative reviews which may not accurately reflect the qualities and attributes of the person you are seeing.

Wednesday, September 21, 2011

Attack of the killer cantaloupes

Sometimes, trying to eat healthy does not always work out in the way intended. It's ironic that the person who decided to eat a candy bar or a bag of cheese doodles wound up faring better than some people who chose to snack on some cantaloupe. What some fans of the rounded green melon did not know is that a large batch of cantaloupes were contaminated with a bacteria known as Listeria monocytogenes. It is rare for this bacteria to infect humans but when it does, it is known as listeriosis. So far, as many as 68 people have been infected and 11 have been killed as from eating cantaloupes infected with this bacteria.

How can this happen, you ask? Many assume that fruits and vegetables are always safe because we are taught to eat them in plentiful amounts and favor them over processed foods. While that general recommendation still holds true, people need to be aware that there will always be a small risk when eating fruits and vegetables just as there are when eating meat. With meat, however, if you cook it enough, you will generally kill the harmful bacteria. With fruits and vegetables, however, it is sometimes impossible to reduce the risk of contamination ahead of time because it is usually eaten raw.

It is important to understand that there are harmful bacteria that live in the soil and one such type of bacteria is Listeria monocytogenes. It lives in the soil because it loves to eat dead plant matter. When the bacteria enter a fruit such as cantaloupe, they can be passed on to someone who consumes the fruit. Once in the body, the bacteria changes, can enter cells, and can even enter the blood if the immune system does not control it. That, in turn, leads to sickness. If it enters the brain, it can lead to death.

Newborns, the elderly, and people with weak immune systems are most likely to contract listeriosis, in addition to pregnant women. If pregnant women become ill, the fetus can also become ill and die. The most common symptoms of listeriosis are fever and muscle aches and vomiting.

Cantaloupe and bacteria are both "all natural." The take home message is that "all natural" does not always mean good for you and safe.To read more, see here.