White Coat Underground

Writer’s block and open thread

I sometimes feel that if I don’t crank out two posts a day, I must have “lost it”, whatever “it” is. But I’ve got the shpilkes and I have to write something.

The end of the week is hard. Wednesday and Thursday are long days for me, and after I put my kiddo to bed Tuesday night, I often don’t see her again until Friday night. This isn’t cool at all. She start kindergarten in a few weeks, and I’m trying to arrange my schedule so that most mornings I can get her up and get her to school before I go to work. That’ll mean getting up earlier and fighting with a cranky kid, but it’ll probably be worth it.

I’m a pretty accommodating dad, but there’s no way I’m doing this her way—her way is for us to ride the bike to school.

Hmm…that sounds like exercise. I wonder if I can get this one by the spouse? It would mean changing my schedule around more, and being on the road when there’s lots of traffic, so I’m not sure it’s the safest option…

Anyway, bike or no bike, it’ll be more time with the kiddo.

Next topic: some dude has been coming around the comment section, trolling around new and old posts whining about his pet topic, which seems to be micronutrient deficiency. He is demanding that I prove to him that Americans do not suffer significant micronutrient deficiencies.


The data are awfully weak. Some special populations are prone to iron deficiency, B12 deficiency, and a few other little things. Relative vitamin D deficiency is pretty common in northern latitudes. But there’s little data that I’m aware of that supports the idea of wide-spread, significant micronutrient deficiencies in the U.S.

This dude cited the recent NHANES data about sugar consumption, but his citation didn’t support his conclusions.

Look, I’m not saying it’s impossible. This has a veneer of plausibility. We know, for example, that if you’re a drunk who only drinks beer and barely eats, you may suffer significant vitamin deficiencies. But widespread? I dunno. If you’re going to make that kind of a bold assertion, you’d better be able to back it up with more than just a “but I said it’s true!”

Americans may not be malnourished, but we’re certainly improperly nourished. We (OK, I) eat too damned much, and a lot of that only moderately resembles actual food. I. Want. Pizza. Lots of it.

But as my partner says, tomorrow, you won’t care how good it was.

OK, the thread is open for whatever absurdity you wish to use it.

Comments

  1. #1 MS2
    August 27, 2009

    I am curious how much do you think MDs should be paid? On the one hand there is extensive training, exhaustive hours, and a product which can seemingly be miraculous. On the other we are essentially profiting off of sickness and the misfortune of others. Where is the middle, should it be the median income of our patients, or more comparable to the business executive with an MBA? What about number of procedures, patient satisfaction, patient longevity etc… Any thoughts?

    Thanks,
    MS2

  2. #2 Cuttlefish
    August 27, 2009

    Tomorrow I drive my last child off to college.

    Waking up to get a cranky kid ready for kindergarten is one of the best possible investments of your time. It pays in so many ways, short term and long.

    And the crankiness is not a given.

    And you are up, sometimes, when the dew and the fog make the world a completely different planet, one you get to share with the (non) cranky kid, who shares her/his eyes with you, so the world is all the more amazing.

    And I also bike in to work… only one broken collarbone in … well, we moved here so the first child would have kindergarten, and he is now a college Junior… so biking in traffic is not so bad, and definitely worth the time with growing kids.

    Yesterday’s child is remembered far better than yesterday’s pizza–but then, I have had some memorable pizzas, too.

  3. #3 Nospil1
    August 27, 2009

    To: MS2–“we are essentially profiting off of sickness and the misfortunes of others” The docors didn’t create the sickness and misfortunes. Rather they provide the care, solace, treatment. and sometimes cures that few others, if any, can. The underpayment of PCPs is close to a disgrace.

    Nospil 1

  4. #4 Catharine
    August 27, 2009

    Actually, most Americans probably are malnourished. Not undernourished, but malnourished, yes.

    The ‘whining, trolling dude’ may have an agenda that you find tiresome but maybe he also has legitimate questions. Clearly he is asking the wrong person.

    Nice to know that you value/respect your readers.

    (Es iz nit geshtoygen un nit gefloygen!)

  5. #5 PalMD
    August 27, 2009

    Nu? another straw man.

    Catherine, if you have a point, make it with data. I don’t care about agenda, i care about people tossing their nads around making unsupported assertions—like you. You seem to have a hypothesis…lay the nads on the table and give us some data. WE likes data.

  6. #6 Donna B.
    August 28, 2009

    Some of my most memorable times with my children happened in a car. I’m sure I made a huge carbon footprint driving my children to a private school that was not only not in their district, but in the next county. It was 30 minutes in the morning, 30 in the evening… some 20 years ago.

    But, the conversations. Oh my they were delicious. Even the lack of conversation is one of my favorite memories.

    My youngest, 5 and 6 years younger than her siblings was (is!) a non-stop talker. One evening, after two after-school events and a trip to the grocery store I was exhausted and suggested a round of “The Quiet Game”. My older children were just as tired as I was and anxious to get home, but their kindergarten sister lasted only three minutes.

    For the remainder of the 30 minute trip, she presented us with a monologue that required great restraint to not respond to… but responding would have just ruined it. Every few minutes she reminded us that she had lost the game and everybody could talk now, but it was obvious she didn’t need us to spur her comments on anything and everything.

    My pride in her ability to talk non-stop for 30 minutes was only surpassed by my pride in my older children for not breaking their silence.

    Enjoy every minute you can with your child because the memories last a lifetime.

    Thank you for the opportunity and reminder of something that happened so long ago that still makes me laugh.

    Oh… the youngest daughter is now a successful lawyer :-)

  7. #7 Donna B.
    August 28, 2009

    I want to add the lawyer daughter, when asked in the 3rd grade to write a story, which the teacher expected to be 1 page long, produced a 20 page handwritten epic.

    All this raving about the youngest doesn’t mean the oldest wasn’t capable of entertaining me also. When she was 15 (and eligible for a driver’s license in our state at the time) she was logical in presenting a well-thought out verbal presentation of why she was mature enough to get a driver’s license. Unfortunately, she ended it with “Mom, will you cut up my spaghetti for me?”

    Hey… you sorta invited me to talk about kids here, didn’t you?

  8. #8 Catharine
    August 28, 2009

    Straw man? Point? Unsupported assumptions? Like me? Huh? You win. I have no idea what you are talking about. The only thing even close to an “assertion” that I made is that you failed to make the distinction between undernourished and malnourished. You don’t need a bunch of data to figure that out, just a dictionary.

    You can pretend to be a data slut all you want, but would you even know good data from bad data if they slapped you in the face? The ability to practice medicine is different from the ability to evaluate scientific literature. Some physicians are able to do both, but not many. Most have to rely on the authority of those actually doing the work, which in not necessarily a bad thing, I’m just sayin’…

    Actually, I do not have a hypothesis to put forth for your careful scrutiny. And the fact that in the past you have made assertions such as ‘if you’re not starving, you’re not doing it right’ makes me wonder if you apply your high standards for evidence based claims to yourself.

    I am pleased that “WE likes data” as opposed to, let’s say, voodoo, but data alone will only get you so far. The important thing is how those data are interpreted. And we’ll all be better off if that job is left to those with an open mind; those more interested in learning the truth than being “right.”

  9. #9 JohnV
    August 28, 2009

    “The only thing even close to an “assertion” that I made is that you failed to make the distinction between undernourished and malnourished. You don’t need a bunch of data to figure that out, just a dictionary.”

    “Actually, most Americans probably are malnourished. Not undernourished, but malnourished, yes. ”

    Sounds like you asserted that most Americans are probably malnourished.

  10. #10 Nic
    August 28, 2009

    Biking is a great idea and it’s really neat that your daughter suggested it. If you are uncomfortable in traffic, I really recommend looking into a class from the League of American Bicyclists. I consider myself a hardy commuter, and I found the class very useful and enjoyable. I think they offer a course specifically aimed at adults biking with children.
    /yes I became a LAB instructor this year so I am biased

  11. #11 Dianne
    August 28, 2009

    But as my partner says, tomorrow, you won’t care how good it was.

    But you’ll want more pizza. Is the stress of not ever getting what you want worth the weight loss? Is it even healthy or conducive to weight loss (stress hormones tend to make people retain weight)? Maybe start having pizza on an occasional basis so that you get what you want sometimes but not so much that you get into trouble with weight. Also rare treats tend to be more enjoyable than the same thing on a daily basis. (Of course, you know what they say about free advice…)

  12. #12 PalMD
    August 28, 2009

    I’m actually pretty good about not denying myself…

    I allow myself pretty much anything I want on the weekend, but I’m also trying to avoid to many sweets because they make me crave more of the same.

    As much as I love pizza, if i start, it’s hard to stop. So during the week, i try to avoid it altogether. Most of the time I’m not feeling as hungry as I’d thought i would.

  13. #13 Pierre Biron md, Pharmacology Professor
    August 28, 2009

    In support of Catharine: “The high prevalence of suboptimal vitamin levels implies that the usual US diet provides an insufficient amount of these vitamins.”, “Most people do not consume an optimal amount of all vitamins by diet alone.” and “We recommend that all adults take one multivitamin daily.” So say 2 Harvard Medical School MDs:
    http://jama.ama-assn.org/cgi/content/full/287/23/3127

  14. #14 PalMD
    August 28, 2009

    Thank you for the citation, which is more of an opinion piece than actual data.

    A more complete evaluation of the clinical literature has failed to show benefit to vitamin supplementation (http://scienceblogs.com/whitecoatunderground/2009/04/take_vitamins—its_magic.php), but like I said, the idea is not implausible, so not ridiculous on its face. It does, however, lack support at this point.

  15. #15 daedalus2u
    August 28, 2009

    I left a couple of links over at the Isis thread on sugar and the AHA. It takes a couple of days for your physiology to adjust to step changes in the consumption of carbohydrate and fat. I think you would do a lot better by averaging your food consumption over the whole week and not allow yourself to binge on the weekend. In other words, if you ate more during the week, you might not feel compelled to binge on the weekend, and if you didn’t binge on the weekend you might not feel compelled to starve yourself during the week.

  16. #16 Joe
    August 28, 2009

    How about walking your daughter to school? Or, driving part way and then walking? Bicycles are more efficient (better “caloriage”); but for the same distance (not considering a speed-demon) walking provides more exercise and allows people to talk more easily. I gave up on cycling a long time ago because of flat/soft tires. I have never had those problems with my Keds.

  17. #17 labratty
    August 28, 2009

    I’m taking a break from writing a paper for class on brown adipose tissue. I bike to work, and pick up kiddie on the bike afterwards. More traffic yes, more fun, hell yeah! :) They love it. Bike it.

  18. #18 Dianne
    August 28, 2009

    Since it’s an open thread I’m going to change the topic and see if I can get any interest…Informed consent: Is it even possible for a person without a medical background to truly give informed consent? Sometimes it seems that questions in medicine are so complicated it’s almost impossible to explain them without distorting the information…or making any treatment too scary to contemplate. Take, for example, taking aspirin. Possible side effects include erosions in the stomach, increased risk of bleeding-including death through excess bleeding*, kidney failure, hearing loss, severe asthma and anaphylaxis…sounds like a crazy thing to take. The reason we suggest it to so many people is that the benefit of decreasing the risk of intravascular coagulation generally outweighs these risks. But if I knew little about medicine and someone tried explaining all that to me I’d still be thinking, “Uh, what was that about bleeding to death again?” at the end of the conversation.

    *I’ve seen at least one case of a young man who ended up in the ICU with an intractable nosebleed-leading to a hemoglobin of less than 6-from aspirin effect. At least, we never did find anything wrong with him except ASA effect in his platelets and the bleeding stopped promptly when fresh platelets were given. Totally negative hematologic workup later on.

  19. #19 khan
    August 30, 2009

    I simply can not have pizza or potato chips in the house. I will eat them until they are gone and feel like crap for a day or so after.

  20. #20 davidp
    August 31, 2009

    I cycled my kids to school, first with a trailer then a tag-along, for years. Incidental or commuting excercise like this is great for both parents and kids. Cycling has also helped my kids be more ledd dependent on parents driving them everywhere, and reduces our environmental impact.

    OTOH, looking after 5 bikes can be a pain at times.

  21. #21 catgirl
    August 31, 2009

    I just want to congratulate you on trying to spend more time with your kid. It really is a shame that you often don’t see her for days at a time. When I was little, there were plenty of nights when I never saw my father at all because he worked late and went on a lot of business trips, and it was bad from my point-of-view. I had plenty of friends with divorced parents, and they still saw their dad (or mom) more often than I saw my dad. It really is important and worth the schedule change. My own dad used the excuse that he was working a lot to earn more money so I could have more things, but it’s just not a good trade-off. I’m not accusing you personally of doing that, but never make the mistake that earning money for your kids is more important than spending time with them.

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