Tag Archives: medical

First-World Problems: My Trip to the Dermatologist

Perhaps it’s a vanity that comes with being 30-something. I’ve noticed some scarring (hyper-pigmentation) on my chin and neck from years of cystic acne. It only flares up once every few months, and when it does, it’s painful. What I went to see the dermatologist about, a week ago, was to get a cream to make these scars a little less noticeable.

I hadn’t been to this particular dermatologists office before. The last time I saw a dermatologist, it was to get an annual mole screening, since I’ve been taught to keep an eye on them. I’ve not been to a dermatologist for cosmetic reasons since I was a teenager, and I don’t remember getting anything that particularly worked.

From the moment I stepped into the waiting room, I felt inadequate. Surrounding me were ads, brochures, lists of options for letting me know that though SOME women were OK with wrinkles, brown spots, discoloration, etc, I didn’t have to be. WHAT A RELIEF! Wait – I think I was OK with some of these things before… HUH? I could tell that this was going to be an interesting visit.
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Modern Medicine

From a recent article in the New York Times, Mind Over Meds:

A psychiatric interview has a certain rhythm to it. You start by listening to what your patient says for a few minutes, without interrupting, all the while sorting through possible diagnoses. This vast landscape of distress has been mapped into a series of categories in psychiatry’s diagnostic manual, DSM-IV. The book breaks down mental suffering into 16 groups of disorders, like mood disorders, anxiety disorders, psychotic disorders, eating disorders and several others.

I’ve sat in on over 200 of these types of interviews, thanks to my work, briefly, at a psychiatric hospital. Though I’m not trained as a physician, I’ve had my DSM-IV at the ready, and took it upon myself to learn the diagnostic criteria, talk with the members of the treatment team (PhD’s, RN’s, MD’s) and learn about the intricacies of mental health, from diagnosis to treatment.

This article, by Daniel Carlat, a psychopharmacologist, details his experience in the field of psychiatry that is different from his father’s (who was also a psychiatrist.) To sum, this shift in education has been away from learning talk-therapy and practicing talk-therapy with patients, and instead, going down a list of symptoms and finding the medication to match the symptomology. The therapy, he says, is then left “to a professional lower in the mental-health hierarchy, like a social worker or a psychologist.”

This was a common complaint from my clients, when I worked outside of the hospital with the court system. My clients (who were all on public assistance) wanted to talk to an MD for not just their medications, but for therapy. What they often got was an ARNP for their prescriptions, and a Masters level therapist, who even then, would not be their major point of contact. (There are still people lower on the food-chain, such as Bachelor and Associate Degree level case managers.) Dr. Carlat writes, “The unspoken implication is that therapy is menial work — tedious and poorly paid.”

Dr. Carlat, though, came to a realization that there is more to treating his patients than simply diagnosing, medicating and referring. He notes that studies show that “about three-quarters of the apparent response to antidepressants pills is actually due to the placebo effect” and that non-biological therapy (talk therapy) can also be an effective treatment.

I’ll let you go over and read the rest of the article – which is full of insight into the way psychiatry is being practiced, including some of his anecdotal experience of changing his routine with his patients. This story is informative not just to other psychiatrists, but to other people practicing medicine. Healing is not just about finding the pill to match the symptom. Sometimes healing is about standing by, bearing witness, listening, and understanding that we don’t have all the answers.

I’d say some of the best medicine is a human connection. That’s not profitable, though, is it?

“no association between the amount of saturated fat consumed and the risk of heart disease”

My husband has been telling me this for years. This is contrary to everything that has been shoved down our throats as Americans.

In March the American Journal of Clinical Nutrition published a meta-analysis—which combines data from several studies—that compared the reported daily food intake of nearly 350,000 people against their risk of developing cardiovascular disease over a period of five to 23 years. The analysis, overseen by Ronald M. Krauss, director of atherosclerosis research at the Children’s Hospital Oakland Research Institute, found no association between the amount of saturated fat consumed and the risk of heart disease.

This has come up time and time again over the past few years. Dietary intake of fat does not equal fat/cholesterol in the blood and body. Instead, our consumption of carbohydrates seems to be the problem.

I’ve been trying to lose weight through one system or another for at least 20 years. This means that this goes back to middle school, if not grade school. I remember once my mother took me to a dietition. I had to be in middle school, and I remember it well. I sat in the office while this woman gave me an incomprehensible plan. She tried to tell me it was really easy, and what I remembered from her during that time (and what I remember now) was that she told me that it was the amount of FAT in the foods I was to watch out for.

I was ecstatic to realize that Entenmenns made a FAT FREE coffee cake. After all, zero plus zero plus zero equals zero, right? Never mind the fact that it might have 12 servings per cake, and each serving was probably about 200 calories. I could sit and eat the whole cake for ZERO fat.

A month later (I think) was my first weigh in, and I gained a pound or two. She was flustered, if I remember correctly, and rather perturbed. I told her that I did just as she said, watched my fat intake. Apparently, I had missed something in her magical equation.

I’m not the only one. If you look around, there’s fat free and reduced fat products everywhere, and they’re also loaded with carbs. Another problem is that portion control is out the window. No one really knows what a portion looks like, or what satiation feels like – well, except for a few, perhaps. I would never advocate for a carb-free lifestyle, or even extreme carb restriction.

However, I did lose a majority of my weight thanks to making decisions to pass on the bread basket or tortilla chips at restaurants, and make a choice of what carbs I really want vs. other foods I really want. I ended up eating a lower carb diet by accident.

We don’t entirely understand how the body works. We have many researchers looking at this question, but there are many unanswered ones. What we eat doesn’t get instantly transferred into energy, fat, muscle. There’s a process. Some people’s bodies metabolize differently. Some medications throw this process for a loop. It’s not just scientists that have a problem with understanding how we metabolize things, it’s also people in the holistic healing industry (which I’m honestly a fan of, though with that industry the science is sometimes questionable.

I come back to the basics. Eat real food. If you eat meat and dairy, you’re eating the suffering of the animal. (I say this not to convince you to be a vegetarian, because I’m not – but that the stress hormones that build up in stressed animals make for untasty animal products, not to mention, unhealthy and requiring more antibiotics and that doesn’t sound like something I want to eat.) You eat the nutrition that the plants are grown in. Good soil makes a difference. Eat mostly plants and foods with very little processing. Try not to eat a single food that has more than 5 ingredients. (This is more a fun challenge.)

There is no magic pill, but that’s my next post.

Where your relationship can be a pre-existing condition…

A few people have posted about this, but I thought I’d share with you. SEIU (Service Employees International Union) posted on Friday that “Insurance companies have used the excuse of “pre-existing conditions” to deny coverage to countless Americans.”

What’s that?

I remember hearing about this before, but had conveniently forgotten it due to the fact, that as with many things, I’m privileged enough to not have been in a DV relationship, and that kind of privilege can lead people to ignore the very real discrimination going on against others who aren’t as privileged.

Bottom line folks – I’ll say it again. Speak up. If not for you, for someone else. Let the insurance companies, doctors offices, hospitals, politicians, friends, family, etc. know how you feel about health care in America. If you have a specific issue with your health care, your coverage, your condition, write it out and send it to all of the above. Use social networking tools to get the word out. Corporations get away with this stuff, in part, because WE let them get away with it. If you sit back and say, “this doesn’t impact me,” and stay silent until it does, when the time comes, it may be too late for you.

Placebos are Awesome

It’s not that the old meds are getting weaker, drug developers say. It’s as if the placebo effect is somehow getting stronger.

Some of you may have seen this article in wired about the placebo effect, but if not – I highly recommend it.

Now, after 15 years of experimentation, he has succeeded in mapping many of the biochemical reactions responsible for the placebo effect, uncovering a broad repertoire of self-healing responses. Placebo-activated opioids, for example, not only relieve pain; they also modulate heart rate and respiration. The neurotransmitter dopamine, when released by placebo treatment, helps improve motor function in Parkinson’s patients. Mechanisms like these can elevate mood, sharpen cognitive ability, alleviate digestive disorders, relieve insomnia, and limit the secretion of stress-related hormones like insulin and cortisol.

I stand by my previous assertion that placebos are my favorite drugs. It may be nothing but lactose in those little blue Bioron vials, or brandy and water in the Bach Flower Essences, or lumps of rock in a quartz pendant – but if it makes me or anyone else feel better, I’ll take it.

There’s obviously no assurance that homeopathic remedies will work better than allopathic remedies, and when facing life or death, I’ll go for the substance with the most verifiably, scientifically sound data from clinical trials. However, it’s going to be another doozy of a flu season, I’m guessing. I’ll take my FDA approved vaccine with a side of Oscillococcinum.