Archive for the ‘Medical Topics’ Category

Island Practice

Sunday, April 6th, 2014

The Book of the Week is “Island Practice” by Pam Belluck, published in 2012. This ebook discusses in detail, the life of a doctor who has been practicing general medicine and surgery on Nantucket for decades. He is a colorful character: having no qualms about cursing when providing psychotherapy (without a license); making house calls and treating patients at his own house; allowing patients to pay their bills through bartering; not charging indigent patients at all; treating animals as well; maintaining an extensive collection of operative firearms; occasionally allowing a needy person to live with him, his wife and three kids; and engaging in other offbeat pursuits.

Nantucket, a less-than-fifty-square-mile island in Massachusetts, is a socially isolated summer vacation destination for many wealthy celebrities. However, its year-round residents also need medical care, frequently for three serious tick-borne diseases, on which Dr. Lepore is an expert. When a patient has a life-threatening condition that requires immediate treatment, the doctor has them airlifted by helicopter to a hospital in the Boston area. In times of severe weather when aircraft are not flying, he must try to save the patient himself, by doing a Caesarian section or sewing up a hole in a duodenum in a case of pancreatitis.

The author prortrays Dr. Lepore as similar to the fictional TV character Dr. Gregory House in that he is often diagnosing “zebras” (rare medical conditions) rather than “horses” (common ailments) through his intuition and then heroically curing the patient while bucking hospital rules.

Read the book to learn of the doctor’s highly irregular approach to practicing medicine, the difficulties and controversies he and his family have faced through the years, and the precarious future that medical professionals like him face, with the introduction of Obamacare.

As an aside, it appeared that this book’s thesis, stated toward the end, is that Obamacare would force doctors such as Lepore out of business. This blogger thinks that that will not occur. The wealthy will always seek out the best medical care, and pay such doctors under the table if necessary, to obtain it. They will find the loopholes in national healthcare to avoid a bad HMO. They would gladly pay the fine for not signing up for Obamacare because the fine will never be sufficiently high to be a deterrent for making their own private arrangements for medical treatment. A major argument some people– not just the wealthy– have against national healthcare– is that it is unfair to make the healthy people pay the high medical bills of the people who knowingly engage in risky, self-destructive behaviors (smoking; poor eating habits, lack of exercise) that result in preventable medical conditions or that exacerbate certain conditions (cancer, obesity, diabetes, etc.) that require expensive medical care. [By the way, this blogger's medical bills were $0 last year and have been $0 so far this year (this includes out-of-pocket expenses)-- for you curious readers.]

Brooklyn Zoo

Sunday, July 28th, 2013

The Book of the Week is “Brooklyn Zoo” by Darcy Lockman, published in 2012. This is a personal account of an internship of a PhD candidate in psychotherapy.

Lockman started her internship in summer 2007 at Kings County Hospital in Brooklyn, New York State, the final leg of training before she got licensed to practice. Throughout the book, she reveals the lingo, issues and people encountered by clinical psychologists.

A few aspects of the personalities of humans include developmental level (psychotic, borderline or neurotic), and character applicable to it (“masochistic or obsessive or narcissistic or depressive, etc.”). Patients might be diagnosed with a thought disorder, mood disorder or personality disorder, or a combination thereof. These were documented in a reference guide for psychiatry, the “DSM IV.”

During her training, the author saw what she perceived to be a disturbing trend– of treating all ailments, even ones suspected to be psychological in whole or in part, by prescribing drugs with little or no accompanying psychotherapy. The psychiatric professionals at the hospital perceived part of their jobs to be to instill “medication compliance” in patients. Lockman was taught that treatment should include “the talking cure.”

However, it is controversial how effective psychotherapy is in treating addicts, because drugs and alcohol can permanently change the brain chemistry that controls learning. Lockman describes one alcoholic patient’s case: “angry young man plus bad neighborhood plus psychosis equals short life expectancy.”

Since psychotherapists themselves are human, they sometimes cannot help but become emotionally affected by their patients. One time, Lockman realized she was biased by the socio-economic level of a patient she saw: “…upper-middle-class and white… familiar to me.” Lockman later momentarily broke down in front of her supervisor, who told her, “Never apologize for having an emotion. Just make sure you give it some thought.”

Some patients, such as a narcissistic-borderline (personality disorders) married couple, recounted stories of extreme past behaviors, some of which were laughable. The two consisted of a male narcissistic ex-convict and borderline, pregnant female who had four kids total; the oldest two had a different father. The husband had been a pimp, and had committed adultery with one of his employees. The couple ended up at the hospital because they had become physically violent with one another. They had shamelessly revealed this information to Lockman. The husband said, “I’m a shooter, not a hitter.” The wife said she had committed a bank robbery to save her kids from starvation.

Another issue the author had to deal with was the hierarchical nature of the career field. ‘We all needed somebody to buttress our professional worth.” People in different specialties put other ones down. The medical doctors feel superior to psychiatrists; psychiatrists to psychologists; psychologists to social workers.

Read the book to learn the slew of other issues Lockman had to face in her quest for experience in clinical psychology.

 

Opium Fiend

Sunday, June 9th, 2013

The Book of the Week is “Opium Fiend” by Steven Martin, published in 2012. This ebook is the personal account of an opium lover living in Bangkok in the last two decades.

The San Diego-raised author, who supported his opium habit through freelance travel writing, also had a passion for collecting antique opium paraphernalia. He considered opium smoking an art form, and its equipment, works of art.

In the mid-1800′s, there were two wars between China and Britain over the lucrative trading of the drug. When China lost, she “…grew ever more addicted, corrupt, and ungovernable. To this day, China and many Chinese around the world view opium as a dastardly British trick that kept their country poor and backward long after the British opium trade had ceased.”

In the 19th-century, Christian missionaries in China produced public outcry against use of opium when they wrote of the drug’s horrible effects from addiction. Meanwhile, bigoted white Americans, seeing opium usage among blacks and Asians, were appalled that the drug  “…encouraged the mingling of different classes and races!” These days, very few people are addicted to opium due to strict drug laws, and because it is expensive and hard to find.

An opium user actually receives a high from the vapors produced from a pipe and an oil lamp with a chimney. So as to preserve the drug’s alkaloid chemical composition, the oil used is camellia, vegetable, peanut or coconut oil, rather than kerosene or alcohol.

Read the book to learn of the way the author fooled himself into thinking he was enjoying his opium-centered life, and how he beat his addiction.

Sum It Up

Sunday, May 5th, 2013

The Book of the Week is “Sum It Up” by Pat Summitt with Sally Jenkins, published in 2012. This ebook is the autobiography of a long-time coach of the women’s basketball team at the University of Tennessee; Olympian, Olympic coach, daughter, wife, mother, etc., etc.

Summitt’s childhood consisted of doing hard labor on her family’s Tennessee farm, drag racing and playing aggressive basketball with her three older brothers. Her father was a gruff, hard worker who refrained completely from showing affection toward his family. Nevertheless, he had a passion for basketball. Therefore, in the mid 1960′s, he had the family move to a fixer-upper residence so that his daughter could play high school basketball on a very good team.

Unfortunately, the team was part of a pathetic interscholastic program that existed for girls at the time. There were many inequalities between male and female sports programs in Summitt’s generation. For one, she had to pay full college tuition, because “…athletic scholarships for women simply didn’t exist in 1970.”

At 22 years old in 1974, even when she was named head coach of the women’s basketball team at her alma mater, she was given a budget that was a fraction of the men’s team’s budget. Also, unlike a male coach, she had to play many roles in addition to coaching, such as serving as driver, laundress, ankle-taper, gym-floor cleaner, and bench assembler. Her office was at the top of five flights of stairs in a hot attic with no elevator and no air conditioning. At the same time, she was taking four master’s degree classes and was required to teach undergraduate classes.

Finally, in 1975, Title IX– which was supposed to “even the playing field” for male and female athletes– was signed into law by President Gerald Ford (according to the book). Summitt started to benefit from progress, but even in the late 1970′s, the men’s sports teams still had bigger marketing budgets and staffs than the women’s teams; plus the men traveled by airplane while the women had to drive hours and hours.

Summitt also discusses basketball as a metaphor for other aspects of life. She writes, “The point guard position in basketball is one of the great tutorials on leadership… they only follow you if they find you consistently credible… If there is a single ingredient in leadership, it’s emotional maturity.”

Read the book to learn about the coaching-career teams, victories, setbacks, comebacks and defeats; and family, health and retirement issues in the life of this overachiever.

Model Patient

Sunday, February 24th, 2013

The Book of the Week is “Model Patient” by Karen Duffy, published in 2007.  In this ebook, Duffy describes her mid to late 1990′s bout with sarcoidosis, a life-threatening illness that is difficult to diagnose.

A prolonged, severe headache was the first symptom. Numerous tests revealed that she had a growing lesion on her brain and spinal cord. This produced numbness and paralysis in various parts of her body, including her limbs. It took months before she saw a doctor who recommended treatment of steroids and chemotherapy. She writes, “I’d lost the playbook to my life. I had no idea what to do.”

Despite the psychological stress brought on by her inability to continue modeling and working as an on-camera reporter for MTV, she did her darndest to remain positive. Fittingly, she happens to have a facial feature known as “risorius of Santorini”– her cheek muscles form a natural smile, without her consciously trying to do so.

Prior to her entertainment career, Duffy had worked as a recreational therapist at a nursing home. Her job was to improve the psychological states of the residents. She continued to try to volunteer once a week there after she got sick.

Read the book to learn other strategies Duffy used to cope with her illness.

The Intern Blues

Sunday, February 17th, 2013

The Book of the Week is “The Intern Blues, The Timeless Classic About the Making of a Doctor” by Robert Marion, published in 2012.  This ebook documents the internship experiences of three medical school graduates in the mid 1980′s.

At that time, interns were “on call”– had to work eighteen to twenty-four hours in a row, usually overnight, in a hospital every three days. Every month for an entire year, the interns in this ebook were assigned to a different unit such as pediatrics, neonatal intensive care, or the emergency room, at a medical center in the Bronx in New York City.

The hospital staff was kept busy treating patients with conditions whose causes were poverty-related— people in poor health, and those who suffered physical harm from violence and drugs. Many patients and their families had psychological problems. One intern remarked, “…we have two psychotic crackheads roaming around the ER, we also had two psychotic crackheads who were paranoid and had no idea what was going on, which is a wonderful combination.”

Severely sleep-deprived, along with doing a ton of paperwork and presentations, the interns had to admit patients, keep “…track of names, symptoms, physical findings, lab results, and treatments…”  They witnessed life-or-death situations for which they felt they were not psychologically prepared. They had to tell patients’ families that their loved ones had died, make serious decisions on whether to report child abuse to the authorities (which was a whole bureaucratic process itself), deal with difficult nurses and lab technicians, not to mention their supervisors; all this, along with the extremely stressful circumstances surrounding the AIDS epidemic.

On top of that, one of the three interns became pregnant during her internship. Read the book to learn how that worked out for her, and to get an insider’s view of what it was like to be a medical intern a few decades ago.

The Cure

Sunday, January 6th, 2013

The Book of the Week is “The Cure” by Geeta Anand, published in 2008. This ebook tells the emotional, suspenseful story of how a family coped with three disabled children, two of whom were suffering from a genetic disease for which a cure is yet to be found.

In the late 1990′s, John Crowley’s daughter and son were both diagnosed with Pompe disease, a muscle disorder. Patients, with varying severity, “have imperfectly produced acid alpha-glucosidase enzyme” which results in paralysis, obstructed breathing, and, if left untreated, death before the age of five.

Even though Crowley possessed the personality, talents, skills, education and privileged background that one would think would allow him access to a life-saving enzyme to save his children, he had to face numerous obstacles. The father naturally fell into the role of entrepreneur to do so. His wife provided invaluable emotional support and around-the-clock care of the children with the help of nurses; not to mention the running of the household.

Nevertheless, lots of genetic and environmental luck determines whether patients become fully cured and/or whether the quality of their lives improves significantly, or whether they die– even when they are sufficiently fortunate to take part in a trial of a new life-saving medicine. Death would be inevitable without the medicine.

Every patient is different. There are many different criteria the U.S. Food and Drug Administration considers when deciding whether to approve particular medical products for sale. Money plays a major part in whether a new product ever sees the light of day. A young medical research company raises funds through venture capitalists, and because the whole operation carries extremely high risks, if the company achieves success– the rewards, fittingly, are also extremely high.

Scientists must do years of preclinical testing on animals to make sure a new medicine works sufficiently well before even considering administering it to humans. In the United States, possible deadly consequences and possible future litigation motivate the scientists to act with integrity by performing tightly controlled experiments, so as not to have to fudge research results.

Another aspect of drug development, is avoiding a conflict of interest such as that in Crowley’s situation. He played a pivotal role in the race to bring a medicine to market; it appeared he was doing it to get the medicine for his own children.

The estimated annual expense of the enzyme for each child was $200,000, and $1 million for all future annual medical expenses, including the enzyme, plus wheelchairs, nurses, ventilators, catheters, etc.

Read the book to learn of the Crowley family’s experiences with American biotechnology.

Cracked

Sunday, November 25th, 2012

The Book of the Week is “Cracked” by Dr. Drew Pinsky with Todd Gold, published in 2004.

The author of this ebook, a doctor, recounts his experiences treating drug addicts in a rehabilitation facility. Many of his patients were subjected to various kinds of childhood abuse that “…caused them to feel helpless, powerless, and in grave danger.” They became distrustful, and had difficulty making social connections and processing emotions. Many had parents who were addicts.

Some people are genetically predisposed to becoming addicts. One fifth of people entering rehab are addicted to marijuana, and usually, alcoholism runs in their families. People may develop lesions on the brain after just a couple of exposures to the drug ecstasy. Many people turn to shoplifting as a substitute thrill to opiate abuse in trying to quit their addiction.

At the start of addiction, the nucleus accumbens in the brain changes so that the body thinks that controlled substances such as heroin, alcohol, cocaine, etc., are necessary for survival. Beating an addiction requires rewiring some of the noncognitive parts of the brain.

Sadly, American society pressures its citizens to derive emotional comfort from material possessions, an unhealthy practice. “We forget that people feel best when they’re interacting, talking, helping, and creating with other people… face to face, particularly in times of adversity or when they’re feeling threatened.”

Read the book to learn the stories of typical addicts, the detrimental behaviors of their loved ones, and of the author’s frustrations with his patients’ stingy insurance companies.

A First-Rate Madness

Sunday, November 11th, 2012

The Book of the Week is “A First-Rate Madness, Uncovering the Links Between Leadership and Mental Illness” by Nassir Ghaemi, published in 2011. This book describes the leadership abilities of John F. Kennedy, Martin Luther King, Abraham Lincoln, various Civil War generals, Adolf Hitler, George W. Bush, Tony Blair and Ted Turner, as determined by their mental health, or lack thereof.

The author argues that most people who have mental illness are not insane all the time; they merely have abnormal moods, such as depression or mania some of the time. He claims that mentally ill political and military leaders are heroic in times of crisis, and mediocre during peaceful, uneventful times; the opposite is true for mentally healthy leaders. This concept can be applied to the corporate world, too.

“In a strong economy, the ideal business leader is the corporate type… He may not be particularly creative… all is well only when all that matters is administration… When the economy is in crisis… the corporate executive takes a backseat to the entrepreneur…” It is rare to find someone who is an excellent leader under both extreme and normal conditions.

Ghaemi contends that “…depression led to more, not less realistic assessments of control over one’s environment, an effect that was only enhanced by a real-world emotional desire…” In other words, people prone to clinical depression have a more acute sense of reality than those who are not, a concept called “depressive realism.”

When the mentally healthy leader faces a crisis, he handles it poorly, because having suffered little in his youth, he “…hasn’t had a chance to develop resilience that might see him through later hardships” and has not developed the ability to empathize. George W. Bush was one such leader. To boot, he had “hubris syndrome.” Getting drunk on power, like many mentally healthy leaders, made him “…unwilling and even unable to accept criticism or correctly interpret events that diverge from their own beliefs. Hubris syndrome worsens with duration and absoluteness of one’s rule.”

Read the book to understand the psychology behind the successes and failures of the aforementioned leaders.

High Priest

Sunday, October 7th, 2012

The Book of the Week is “High Priest” by Timothy Leary, published in 1995.  This is a personal account of a man who, in the late 1950′s and early 1960′s, developed a reputation for experimenting with brain-altering chemicals such as LSD.  He used students as guinea pigs at his Harvard University laboratory.

Some of Leary’s impressionable charges unwisely updated their parents on their religious and philosophical enlightenment; others “quit school and pilgrimaged eastward to study yoga on the banks of the Ganges.” Unsurprisingly, the parents and school administrators felt that Leary was a bad influence, and he was fired. He attempted to relocate his spiritual profiteering to Mexico, but was busted in 1963 for failing to obtain authorization to run a business there. He then took his allegedly raunchy, psychoactive, disease-spreading endeavors in the dark arts to Antigua in the West Indies.

Read the book to learn the details of this ideological character’s psychedelic research results.