Here’s a decent primer on the healthcare reform proposals (via The New York Times). Even better, peruse what doctors, nurses, and other clinicians are thinking via this week’s Grand Rounds, hosted by the inimitable Dr. Rich at Covert Rationing Blog.

Also, a primary care doc makes a list of the problems he took care of on one random day (also via NYT). Interesting post, which I’ve thought of doing in the past as way of showing a slice of what family doctors might see on a “typical” day.   I’m in a practice model like most family docs that expects me to be much busier than this doctor, so my list would probably be over 100 unique medical issues per day, not including phone calls.  Some patients have over 25 unique issues alone – I don’t know how they manage, but I think the concept of a medical home and a good primary care foundation in this country would help.  More time would also be wonderful.

If you are exercising regularly as part of a weight loss program, then good for you. Studies have proven the value of exercise in reducing cardiovascular disease, preventing and treating diabetes, sustaining cognition, enhancing the immune system, and even reducing the risk of getting certain cancers. But narrowly considered, does exercise really help people lose weight? Not as much as you might think.

Most doctors and health agencies tell people that exercise is a key component of weight loss.  The American Heart Association and the American College of Sports Medicine issued new guidelines in 2007 urging 60 to 90 minutes of physical activity a day.  Add in kids, a full time job, and trimming your fingernails before they become unsightly claws, and you’ve got little time left for sleep.  Is getting that much exercise an evidence-based solution?

A recent study, published this year by PLos One, looked at 464 overweight women, and divided them into four groups. Women in three of the four groups were asked to work out with a personal trainer for 72 minutes, 136 minutes, and 194 minutes per week, respectively, for six months.  Women in the fourth group acted as a control and were told to maintain their usual routines.  All the women were asked not to change their dietary habits.

Continue reading →

There’s a terrible scream down the hall, followed by a crashing sound, a summation of metal and drywall and flesh colliding. I run down the hall and open the door. I watch in horror as a body seizes on the unyielding floor. His back is arched, an invisible meat hook hoisting him sadistically upwards. He’s not breathing. Every muscle in his body is contracting simultaneously, and it seems as if his chest is about to explode. His eyes are buried deep in some internal possession, darting about, scanning an unseen inferno, and summoning him from this hell feels impossible. Powerless, I hold the back of his head as it repeatedly mashes my bony fingers into the floor.  I use my free hand to dial 911. The blitz is contagious, and I struggle to keep my own voice unshaken. At some point I must have also yelled for help, because it is finally flowing into the room.

I’ve seen a few seizures, and I find them extremely upsetting. There is something about the uncontainable shudders and vanishing of consciousness that humiliates the human condition. To look at another person, gone while sleeping, can bring a calming peace of mind. But to be riveted in terror at the spectacle of another body convulsing, mutinously, its master imprisoned somewhere deep within, is supremely disturbing. You can’t reach that person, and in that moment you don’t know if they’ll be coming back.

The tetany and violence subsided, but were immediately replaced by awful snoring sounds, gurgling with spit and blood from a bleeding tongue. We rolled him over to one side so that he wouldn’t choke on his own fluids, and gradually some consciousness returned. And then there was a startled look, a waking confusion of where am I and what the hell are you all doing to me? A frightened, wide-eyed pushing away of people and their calming consolations in this ugly reawakening followed. He couldn’t remember the preceding minutes of his own life, and it was 2001 in 2009. But slowly, minute by minute, he resettled in his own skin, reclaiming dominion over the sore muscles and wracked bones that had just betrayed him.

You can’t fault those who believed that seizures were due to possessions, demons, or other spirits, and did what they thought might help. Those who persecuted and even killed epileptics deserve special scorn in our collective human history. Watching a man convulse through an ostensible spiritual evisceration, and then witnessing his merciful return, elicits in me a shuddering awareness of the fragile and miraculous hold we have on our own consciousness in the world.

I read an interesting article at Wired about the 10 worst evolutionary designs in animals, and decided that I would briefly comment on a few evolutionary challenges that we, as humans, often find ourselves grappling with.  As with most things in life, nothing is black and white, and what may seem like a bad design is actually found to contribute something advantageous.  I know what you’re thinking already… but the haunting beauty versus evolutionary utility of the “unibrow”, as most conspicuously worn by Frieda Kahlo, will be explored at a later time.

#1. The Appendix – if you were asked to think of a useless part of the human body, chances are the appendix would get the most attention. It is a small pouch that branches off the main intestinal tract and can be responsible for appendicitis, a potentially fatal condition if not treated. Appendicitis occurs in 7% of people. It is commonly thought that the appendix is a vestigial organ, existing as an evolutionary remnant with little useful purpose. More recent studies and speculation have looked at whether the appendix might help with immune function, especially in children, or in restoring good bacterial gut flora after diarrheal illness. Surgeons used to remove the appendix routinely in any abdominal surgery, but now many do not. The appendix seems to have arrived in our evolutionary ancestors for digestive purposes, but has perhaps found a new use in bolstering immunity.
Scorecard: Appendix, originally an evolutionary loser, making a comeback lately

Continue reading →

When I think of the many decades she’s endured I marvel at the momentum that sustains and impels her through time. She walks slowly and deliberately, with a grace that only arthritic joints and battle worn cerebellums can command – at once imperial as a queen, and familiar as a grandmother. When she calls the women at the front desk “my girls,” no one blinks, and despite her agonies she is rarely caught without a smile.

How old is she?

The average age of all the cells in the adult human body is only about 10 years at any given time.

A number of cells, like those that line the gastrointestinal tract, only survive about 5 days before being shed. Other cells, like those that comprise skeletal muscle, are turned over in about 15 years.

But the ones that constitute who we really are, the true keepers of our stories, are the neurons of the cerebral cortex, which live as long as our bodies live. They are the fire, the pulsing electric substance that assembles meaning itself. They are the keepers of purpose, the ninety year-old torches that enlighten an old woman’s path through an otherwise dark night and day.

She is patient as I burst through the door looking frazzled from the impossible pace. She brings no material gifts, but instead shares her wit, optimism, and memories. Her skin is ancient, her heart spills more with each beat, but her mind is fortunately sharp. I wish I had more time to listen to her stories, to all the stories, born up by countless regenerations and reinforcements.

We are just passing thunder clouds, lifted by shifting substance, full of lightning for a while.

I read an interesting article in one of my medical journals (American Family Physician) about the therapeutic uses of magnesium, ranging from preeclampsia to migraines.  The article also discussed the consequences of magnesium deficiency.  Studies estimate that 75% of Americans do not get enough of the element in their diet, and that the general mineral content of our food is declining.

Early signs of magnesium deficiency are quite nonspecific and overlap with thousands of other conditions, but include loss of appetite, nausea, vomiting, fatigue, and weakness. As levels decrease further, numbness, tingling, muscle contractions, cramps, seizures, personality changes, arrhythmias, and even coronary artery spasms can occur. Severe deficiency can lead to low potassium and calcium levels, each of which can cause serious problems as well.

Conditions that have been associated with low magnesium levels include poorly-controlled diabetes, malabsorptive disorders like Crohn’s Disease and celiac disease, alcoholism, and older age.  Taking diuretics and certain antibiotics can also decrease magnesium levels in the body.  Studies have linked magnesium deficiency to heart attacks, congestive heart failure, hypertension, and angina, but evidence is still too sparse to recommend its use for these problems.

Continue reading →

I read a great article in the New York Times tonight entitled “Our Scars Tell the Stories of Our Lives.”  It was written by Dana Jennings, a reporter for the New York Times who is courageously sharing his fight with prostate cancer.  In the article, Jennings tells the stories behind the various scars on his body, moving from the light-hearted nicks of his childhood through the more existentially challenging surgeries of his adult life.

I think some of his words resonate with a post I wrote on my old blog, that was then republished by The Science Creative Quarterly.   I share a kindred appreciation of the power of the human scar as both a mark of regeneration and a talisman of story, so I’d like to republish my post (and hope it might be seen by Dana Jennings, and considered a validation from an amateur writer of the many wonderful ideas he’s written!).

Please note that the actual “patient” described is a hybrid character I created to convey my thoughts about the many scarred people I’ve seen, including myself.

Cicatrix

When I would see her thin chart full of medical fluff perched upon the door I’d take a deep breath and relax before heading in. Hers were easy visits. Colds, allergies, acne. Sometimes we’d end her appointment talking about her college. Had she picked a major yet? Did she lead the soccer team in goals this year? But as I opened the door to the examining room that day I could smell the bottled air within was tainted with misery. Tears, snot, and even her cold sweat drifted in the small space, and as I sat down there was really nothing else to say. “What happened? Are you okay?”

The young woman was trying not to sob. It hurt her too much. She grasped at her ribs to keep them from inflating as she tried to calm her heaving diaphragm. “Oh God,” she said. “Look what’s happened to me.”

I pulled my small stool from under the counter and wheeled it over to where she was sitting crumpled and broken. Her face had cuts all over it. There were purple bruises on her forehead, shoulders and legs. Brown hair ran down her face and stuck like muddy straw to her wet cheeks. A thick cast had been molded around her left arm. Another immobilized her right leg. Every muscle in her body seemed to be firing at once, holding her rigid and motionless to prevent the obvious pain of movement. “Ow, ow, ow . . . damn it!” she said while choking back another sob.

Continue reading →