palmd | February 8, 2009In 1999, during my intern year, Hurricane Mitch struck Central America. As stated below, I wanted to become involved. The program director of my residency was kind enough to view this as a worthwhile educational experience. This is my diary from the trip.
Beginning
The idea to go to Honduras came about in a way that may or may not be unusual. I have no way to judge, never having done it before. I had of course heard of the disaster of Hurricane Mitch. As I listened every day on the radio, I thought about all of the potential deaths that could be avoided by simple medical care. One day on NPR…
palmd | February 8, 2009It's generally a bad idea to assault the religious beliefs of your friends, neighbors, and relatives. That being said, sometimes it's unavoidable. My being Jewish is hard for some people, who feel that just by being me, I am denying their Lord and delaying His return (and before you start tossing No True Scotsmans at me, this has indeed happened more than once). Still, unless someone is directly pestering me with their religion (you know, by posthumously baptizing my grandma or something), I leave them be.
But what about quasi-religious beliefs? A great deal of alternative medicine is…
palmd | February 7, 2009The movement against vaccination is old---very old. All medical interventions require scrutiny. Like any medical intervention, vaccines require systematic investigation before deployment, and monitoring during their use. Still, vaccines have done more for public health than most Westerners under the age of fifty can imagine.
Inoculation and vaccination have been vilified in many ways, from interfering with the will of God, to being a vast conspiracy to infect [insert ethnic group here] with [insert disease here], to a cause of autism.
There have been "bad" vaccines, and when this has…
palmd | February 6, 2009I don't usually see these guys during the day, but this one was caught (barely) by PalMom and PalKid.
palmd | February 6, 2009Apparently, it's time once again to remind people why vaccination is important. Pertussis ("whooping cough") is a nasty vaccine-preventable illness that is highly contagious and can be deadly to little ones. And it's making a comeback. The Michigan Department of Community Health is tracking this disturbing trend:
Michigan saw a significant increase in reported cases of pertussis (whooping cough) in the second half of 2008 compared to the first half of the year, prompting officials to remind parents and doctors of the importance of vaccinating infants as well as teens and adults against…
palmd | February 5, 2009Returning phone calls isn't my strong suit. I'm not sure what it is, but I'd rather just take the calls as they come, whenever possible. I usually let my patients know to have me paged if they need anything important, so it's not unusual for me to hear from my patients at odd times. It's a bit more unusual for me to have patients show up at the office without an appointment. I always squeeze people in if they call, but it's a little harder if they just walk in (and the staff hates it---I guess it throws them off their game). So when Mr. Y showed up one morning, it was a bit of a surprise…
palmd | February 5, 2009MarkH has Part IV of Choosing a Medical specialty up at denialism blog. Go and read.
palmd | February 5, 2009A delusion is usually defined as "a fixed, false belief". Anyone can be wrong, but to persist in being wrong despite all the evidence is the hallmark of delusional thinking. In their latest senseless rant at HuffPo, infectious disease promoters David Kirby and Robert Kennedy, Jr. cling to thin strands of tainted reality as the gaping maw of insanity opens beneath them.
Of course, delusions are very closely related to lies. The only difference is that liar doesn't believe his bullshit, while the psychotic does. It's hard to know where K and K fall. There latest article, entitled, "Autism…
palmd | February 5, 2009Reproductive ethics is a field I'm not all that familiar with, but it's been a big deal lately, so I've been thinking about it a bit. The American Society for Reproductive Medicine has a few broadsheets on ethics, which are actually rather helpful. Reproductive medicine is a great field for looking at ethical problems. Let's examine two of them to learn something about the ethics of the field (and of course, about ourselves as well):
Parental factors, that is, facts about the parents, may be important in reproductive medicine. When doctors become part of the reproductive process, someone…
palmd | February 5, 2009I don't have a lot of software (computer is broken, working in the cloud), but here's a slightly annotated picture of my back:
To orient you, I'm facing left, the blocky thingies are my vertebral bodies. Hopefully this helps.
palmd | February 4, 2009It's a tradition in the blogosphere for more popular blogs to help out the little guys.
But only once a year. Usually in February.
Many blogs have very liberal blogroll policies: you link me, I link you. Since I moved into the new space here, I've been very lazy conservative with my blogroll, trying to keep it uncluttered. I've finally figured out how I'm going to organize the darn thing. I've set up a tab at the top of the page that leads to the full blogroll, so just go there and leave your link in the comments with a brief description, and I'll add it on (reciprocity is all I ask…
palmd | February 4, 2009So I was checking out my incomming links on sitemeter and I found a great one. You see, fake diseases alway bring out the wackos.
This is the thing about medical wackos. Not only do they think that they have diseases that no real doctor thinks exists, but they think everyone else must have it, too.
Niels, a guy who I've had to ban before for hostile comment spam, and whose designation on his own board is, appropriately, "Ultimate Member", has this to say about my back woes:
this time, i believe karma has already taught him the lesson he needs to learn (sounds like he has lyme disease...…
palmd | February 4, 2009So, what's up with low back pain? Well, here's what's up with mine:
To quote from The Book of Pal:
Just below the L4-L5 disc, behind L5 vertebral body on the
right side, there is evidence of a large extradural soft tissue density
measuring approximately 1.5 x 0.8 cm in its maximum vertical and
anteroposterior dimensions respectively. This has the appearance of a large
extruded disc fragment within the epidural space, compromising the right L5
nerve root.
And we say, "Amen."
An MRI of the lumbar spine consists of hundreds of images; I've pulled one out for you. It turns out that science is…
palmd | February 3, 2009She sat on the exam table looking tired an cranky. Otherwise there wasn't much to note about her appearance---not young, but not old; not thin, but not fat; she didn't smell of smoke or have pet hair on her clothes. A glance at her demographics sheet confirmed that she was middle-aged, domiciled, and employed---and uninsured. But why tired and cranky?
She's been wheezing for weeks and this was her second visit to the doctor for the same problem. She has been using her short acting inhaler every few hours, with some temporary relief, but she's run out. It's hard for her to sleep at night…
palmd | February 2, 2009One of the frequent complaints I hear about real medicine is that it is dangerous. Of course, it's true---so is riding in a train, but it sure beats walking. And that's the danger of this particular fallacy---yes, medicine is a sharp tool, but it's also an effective tool, so we must use it properly. And this is where the tools of evidence- and science-based medicine can give us a hand.
The potential harms of modern medicine must be approached carefully. If they are ignored or approached in an ineffective way, we'll miss an opportunity to save lives. This comment is typical of the type of…
palmd | February 2, 2009I gotta admit that I just don't get it. Perhaps it's my overly narrow world-view, or perhaps it's my lack of imagination, but I really don't get it. Let me explain.
I've got this horrid pain in my back and leg. It's searing, aching, gnawing. My foot is numb, but still hurts. It tingles, feels heavy, and it's weak. Sometimes it feels like electricity is jumping through it, sometimes like little worms are crawling in it. Being a curious person, I look for ways to explain this.
I'm sure this horrid crawling feeling could be explained thusly:
Perhaps there are actual worms crawling…
palmd | January 30, 2009A patient broke the news to me. There is a massive recall of generic drugs made by a single company, Ethex Corp, a subsidiary of KV Pharmaceuticals. The company makes many of the popular generic drugs that I prescribe every day, such as generic extended-release metoprolol.
This is a really big deal, and I'm pretty angry that I had to rely on a patient to tell me. Generic medications have revolutionized the affordability of essential care, and are usually a good thing. Also, insurance companies push them, and hard, offering incentives for their use, and penalties for using branded drugs…
palmd | January 29, 2009A long time ago (in blog years) I wrote a series on alternative medicine over at my old Wordpress blog. It's time to dust off the old post and get back to some basics.
What is alternative medicine, anyway?
That's a great question. I know it is, because I asked it. I get this question almost daily. The secret answer is that there is no such thing as alternative medicine. You don't believe me? Why not--I am a doctor.
There are several ways to define alternative medicine, and sometimes it is contrasted with "complementary medicine". CM refers to treatments that "complement" traditional…
palmd | January 29, 2009It started a few weeks ago---a dull ache in my lower back, more on the right, worse with sitting for prolonged periods of time. I did my usual stretches, although not as much as I should have. The pain waxed and waned, until a few days ago, when the pain escalated suddenly, preventing me from standing up straight, and making even a trip to the bathroom an unwelcome adventure. Two nights ago, I lay in bed awake, pillows wedged at strategic points, hoping to find some comfort, any comfort.
And then all hell broke loose. My back spasms loosened up a bit last night, so I got a few essential…