On Call

I had an interesting page on call this week. Unfortunately it was at midnight. Someone who was worried about a sudden onset of Tb. Seems had been sick for a while (2+ weeks), coughing, green stuff, miserable all around. Then developed chest pain, sharp, stabbing, worse by far with coughing, always on right side.

Seems this person had been in rehab recently, had a positive PPD, and a negative CXR, but was concerned she might now have Tb.

Of course, she didn't think to come in and see her PCP during usual hours. Admittedly she did call and was prescribed Zithromax over the phone, but had only taken one dose, several hours earlier.

I never get this....why do people expect the instant cure? I do understand the quick jump to the worst thing you can think of, like cancer, or in this case, Tb. I also don't get why this sort of thing always becomes an emergency at odd hours. Never during the daylight. We all get calls at 2:00 a.m. from people with pain for six weeks who just can't take it any longer. I've stopped asking why now from these people. I've never had a reasonable response. I think some people just live life on a different clock than the rest of us. 2:00 a.m. is mid-afternoon for some....

Funny business, this medicine thing....



Science, Schmience

So I had a patient last week who came to me asking about something she had heard about on the radio, something for osteoarthritis, found only in health food stores, that is 'supposed' to work wonders and stop the disease. She was eager to try this, without any more information. I can't remember what it was, but I do remember I had never heard of it, either bad or good.

This same person has been refusing to take Zocor or similar for her lipids for years. This is despite my best efforts to discuss the science behind my recommendation, and the science behind the potential negative effects of statins, which is her big concern. She has heard 'bad things' about statins.

So this is an example of my patient getting and trusting the medical advice from the mass media more than her chosen doctor. This is an almost daily occurance. What does that say about me?? Should I feel insulted or somehow inadequate as a doctor that I can't convince her to take what I know is in her best interest (at least statistically)?? Or is it a larger problem with medicine as a whole, and the distrust we have engendered?? Or is it a societal problem due to the overexposure of the media, which seems to have invaded all our lives in the last decade or so.

I don't know. I just plug along, taking each patient one at a time, trying to tell them what I think is best for them, and basing that on the best available information medicine has. I think that is what they are paying me for. But it is still frustrating and difficult.



Back on Track?!

When I started this blog, it was to be a forum for me to talk about what was in my mind. Admittedly, I was taking narcotics at the time, so my thinking was blurred, but the whole blog thing seems blurred to me.

Obviously, I've spent alot of time, and I am spending alot of time on addiction and my recovery, but I want to include pertinant medical information about patients I've seen, and other aspects of my medical practice.

I feel as though I been too focused on addiction this past couple of weeks. But I have more in that area, though I feel as though going more into internal medicine makes more sense.

What do you out there want?? Feedback time, make it real please.



Drug Companies

I am getting more and more disgusted with the big pharmaceutical companies. I believe they are only out to maximize profits.

I think they made up the diagnosis of osteopenia, in order to sell more Fosamax like drugs, there is no science to suggest osteopenia leads to fractures

I think they are behind the move to lower standards for hypertension. Hypertension has traditionally been the disease that we treat that costs the most...in other words, for every event saved by treating hypertension, we spend more money than almost any other disease (due in part the the huge numbers who are treated to save one event). Now they want to increase the number who need treatment by lowering the standards...how much will this cost...any science behind this?? Nooooo...only a 'panel of experts', the vast majority of whom have significant financial ties to the drug companies.

We need to get the drug companies out of the media, out of sponsoring studies, etc. Perhaps they could all contribute to a pool that is used to study various meds completely independant of the companies themselves.

And now I read that they are sponsoring some Dermatology residencies.....is that the fox in the henhouse or what!!!

Next week, a story of rehab, prostitutes, and a half-way house, with alot of addictive thinking mixed in....keep coming back



Puzzles and Meth

Wow, it was quite a trip to see the tweakers work on puzzles.....It seems even clearer to me now that the current drug of choice for the twenty-something crowd is meth. Not many of us older guys had gone down that road. And some of the stories I heard made me glad. I'm sure I would have loved it, and my bottom would have been so much farther down.

I also saw some permanant damage that I believe the meth caused. Several with paranoid and very compulsive behaviors that were not improving off the drug. I fear for their recovery.

Keep coming back...



Drugs of Choice

So what did I learn in rehab?? Well, I learned that tramadol causes seizures. I knew it did, after I had one, but everyone I met who was addicted to tramadol had also had one. 100%. This is something that the drug company doesn't tell you. They (Ortho-McNeil) also told me the drug was non-addicting. They even presented me with a reprint that proved it.

I'm here to tell you that they are wrong. It is very addictive, just like any opiate. It creates tolerance, has withdrawal sx, etc. That's why I no longer trust drug reps, or drug companies AT ALL!! I must say, I did like the enhanced sexual performance I got from it, but according to my rehab buddies, that was a fluke. They didn't get that perk. I guess we are all different.

In the end, I am appreciative that I did have that seizure, as it started me down the road to recovery, which has been the best journey I've ever taken. Just wish I could have got here some other way.....



How much Vicodin is too much!!

So, I learned many new and interesting things in drug rehab. For instance, I met several people who were taking like 45-55 Vicodin a day. That's like 20+ grams of acetominophen!!! I could not believe these people were alive!! Granted, their LFTs were abnormal, but were no worse for wear otherwise...amazing.

Also amazing to take 55 Vicodin and still function.......I guess function is too generous a word for where these guys were at. That's why they were in rehab!!! And I was totally unaware you could buy that many Vicodin over the internet...shipments of several thousand a month...wow...no wonder we have a problem with prescription drug dependancy in this country.

More to come.....



I'm Baaack!

So, after a four month absence, I'm back in the saddle!!

You might ask where I went.....I might answer...and if I did, I would say rehab.

Yep, I am an addict and I went to rehab. That was quite an experience, to say the least. But now I am back home (rehab was an inpatient thing you see) and back at work full time. I'm donating body fluids on a regular basis, and going to AA.

Anyone else out there with a fun rehab experience recently?? Let's talk about it...




I hate eBlogger....what is wrong with this system....Must move blog....must find better site.....must not explode....must not hit monitor with fist....must check xray of hand...

End of Life Stuff

With the death this morning of Terri Schiavo, it gets me to thinking about end of life issues. I completely agree with Terri's husband, that to go on living like she was, is no way to spend a life, and now that she has expired, my former Catholic, now Protestant beliefs tell me that she is in a better place, released from her physical limitations and impairments.

I am outraged that the Congress of the USA, as well as the President of the USA, felt that they were entitled to meddle with the personal decision, and therefore liberty, of a single American citizen. This country is based on the right to make decisions for ourselves, even when they are not in the best interest of the individual. The laws in this country clearly state that the spouse of an incapacitated person is felt to best know the wishes of that person, and therefore has the right to make the decisions for that person.

These same Congressmen were up in arms about the sanctity of marriage just a few weeks ago, when same-sex marriage was on the table, and now they want to subvert the intimacy of marriage in this case and override Terri Schiavo's husband. What hypocrites!!!!

As for myself, I have discussed the issue with my wife, and we are clear. Just so there is no question, I have tattooed the words, 'Shock x1, then DNR' on my chest, and I am actively seeking a ENT to tattoo my throat with the words 'Do Not Intubate!! Ever'

What do you think out there in bloggerland!!!???



Don't Give Up on Me Yet!!

I've been out of town. I'm working on new post...should it be a medical story, a medical issue, or a 'humourous antecdote'??

Check back soon!! I promise!! Trust your doctor!!

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