Antibiotics for Chronic Low Back Pain??? Really???

Okay, this is, in my humble opinion, pretty damn interesting.

For years, I’ve felt (and discussed with my patients) my belief that there is just something fundamental that we (the collective “we” of the medical community) are missing when it comes to understanding back pain.

One of the fundamental truths of medical practice is that whenever you see a lot of different treatments being used for a problem, most likely all of them have pretty darned similar less-than-stellar results. It makes sense, when you think about it. If there was one treatment that had great results and stood out from the rest, well then that is the treatment that would be used almost all of the time. Since however, treatment A is little if any better than treatment B, which is little if any better than C, and D, etc., oftentimes the choice of treatment ultimately boils down to individual preference based upon factors such as where one trained, statistically insignificant anecdotal experiences, etc.

Well, back pain is a lot like that. Lots of different types of medical (and pseudo-medical) practitioners out there seeing patients for back pain, doing lots of different types of “treatments”, and for the most part results are pretty similar, and often pretty disappointing.

Fortunately, for acute back pain, most of the time, it gets better regardless of what is done or isn’t done. This occurs in about 90% of cases if I recall correctly (and I’m too lazy to google this right now). There are some general guidelines out there for conservative care, that if followed seem to work out pretty well for most folks, regardless of whether they go see the family medicine doctor, the neurosurgeon, the chiropractor, the school nurse, the local voodoo specialist, the massage therapist, their priest, etc., or if they go see nobody at all. It just gets better in most cases. In most cases it just doesn’t make a damn bit of difference.

Now that isn’t to say that if you have acute back pain you should avoid going to the doctor (If you’re wondering if you should go see your doctor for this, or any other cause, go see your doctor!). “Most” is not synonymous with “All”. Every once in a while, acute back pain is from some particular specific cause that may indeed respond quite differently depending upon what is or is not done for it. I know I’m biased as a family physician, but I think this is one of the great values of have a good relationship with a primary care doctor. He/she can help separate the zebras from the horses.

Anyway, it’s all well and fine to say “Thankfully most acute back pain will get better.” But what about those cases that don’t get better? What about those folks who go on to develop chronic back pain? Well that is a different kettle of fish altogether.

Chronic back pain is serious business. As with acute back pain, there is a veritable slew of various people offering all sort of treatments, etc. A lot of people suffer for great lengths of time. A whole lot of loss of quality of life, productivity, money,…you name it. People desperate for relief often find themselves repeatedly on the operating table being cut open, developing dependence upon habit forming narcotic pain medicines, etc. It really can ruin people’s lives. Some folks fortunately get relief with surgery, but for too many, their problems get no better and/or only get worse. It can lead to long term disability, loss of income, destroyed relationships, etc. It truly can be tragic.

As I mentioned at the start of this post, I’ve always been bothered with the nagging feeling that when it comes to back pain “We just aren’t getting something.” Heck, most likely it’s more like we just aren’t “getting” a bunch of somethings. I truly believe that when it comes to back pain (and a whole lot of other stuff), someday in the future, people will look back upon those of us practicing medicine today and snicker a bit, marveling at how stupid and silly we are about a lot of things. We do this ourselves, smugly looking back upon medical practice a century or two ago and laughing at some of the silly notions they had, so I suppose it is only fitting that folks in the future do the same to us.

So, what’s the point of this post? Why, after a pretty long period of inactivity has Dr. Sam decided to bother to log onto his blog and blather on like this?

It has to do with this article and this article.

You can go read them for yourselves (and I recommend you do, as it is quite fascinating), but in a nutshell, some (awesome) folks in the frozen north (Denmark), spent years looking into the possibility of bacterial infection being behind a substantial number of cases of chronic low back pain, and it looks like their hunch was correct. This is a BIG DEAL folks!!!! In that second article linked, it shows how they were able to successfully treat a pretty substantial number of chronic low back pain sufferers with a simple antibiotic.

This reminds me a lot of the story of the Aussie doctors who proved that most stomach ulcers are related to a bacterial infection (Helicobactor pylori). Completely changed the practice of medicine.

If this chronic low back pain stuff pans out, it too will be practice-changing and will make a HUGE difference in the lives of a HUGE number of people. Kudos to our Danish friends!!! I agree with the brit doc quoted in the first linked article who was talking about this stuff being potentially Nobel Prize worthy.

Anyway, go read the linked articles. This is good stuff!!! Yay Science!!!

Cheers,

Sam

Makes a great Christmas Gift!

Do you want to get a great Christmas gift for book lovers?

If so, then you should definitely go grab a copy of Liberty Frye and the Witches of Hessen, by J.L. McCreedy!


This is a modern-day fairy tale about a young girl from Mississippi who gets lured to a foreign land over her Christmas break, to meet relatives she never knew existed.  Unbeknownst to her, this is all part of a sinister plot by an evil witch and our heroine, Libby, falls right into her clutches.  Libby will have to rely on her wits and courage, and just a bit of luck if she hopes to save not only herself, but also those most dear to her.

If you’re looking for a fun and exciting Christmas thriller, then I can’t recommend this book strongly enough.  Available in both print and Kindle versions!

Go get your copy today, and remember to include it in your holiday gift shopping list!

 

Is U.S. Health Care Really So Bad?

Anyone who knows me or reads this blog knows that I have a lot of opinions on the U.S. health care system and environment and that I definitely see a lot of room to make it better, more enjoyable for all involved, and more cost efficient and more effective.  I’ve bloviated extensively about this stuff in the past.

That said, I know that it also has the potential to get a lot worse. I think it is no secret that the Affordable Care Act, affectionately known as Obamacare, will in my opinion make things much worse. I anticipate no real improvements in health care outcomes. I anticipate no real improvement in costs. In fact, I anticipate the opposite. I expect costs to go up dramatically and outcomes to likely get worse over time. Of course the supporters of centrally planned government controlled nanny statism will do everything they can to skew the numbers, divert blame, etc. They’ll do all they can to shift costs, etc. At the end of the day however, people aren’t stupid. Most of them instinctively know if their lives are getting better or getting worse.

These same sort of dishonest tactics have been used for years and are nothing new. Fortunately, common sense sometimes prevails however and deflates these bags of hot air. As an example, I remember through the early 1980′s hearing every night on the television news about how bad things were and how much worse they were under the Reagan administration. All sorts of “statistics” and “facts” were trotted out nightly by the “impartial and unbiased” news media to prove to all of us dumb Americans how much worse off we all were under Reagan. Well, I remember during his campaign for re-election in 1984, Reagan managed to counter all of their well planned hogwash with a simple statement to the American people. He said (and I’m paraphrasing here, rather than go look up the exact quote) “Ask yourselves this one simple question. Are you better off now than you were 4 years ago?” Reagan (running against Walter “Fritz” Mondale, who was the Vice President during the “spectacular” Carter years), not only won the election. It wasn’t even close. Out of 50 states, he carried 49. The only one he failed to win was Mr. Mondale’s home state of Minnesota.  (To be fair, Fritz also managed to win over the voters in D.C.  Shocking, I know.  It almost seems to suggest that folks inside the beltway might be slightly out of touch with the rest of the country.  Weird huh?)

Well, I think we are starting to see a similar thing with regards to Obamacare. Supporters of this Bolshevik wet dream, are simultaneously trotting out all sorts of “statistics” and predictions to try and tell us how wonderful it will be and how much better off all Americans will be. At the same time, in order to support their position, they constantly try to compare American health care with other countries to show just how terrible health care in America is.

One thing some of them love to do is trot out “statistics” from the OECD (Organization for Economic Cooperation and Development) showing how the U.S. ranks so poorly on measures such as infant mortality, premature death, and life expectancy. One blogger even went so far as to say in regards to recent the Supreme Court support of facism decision upholding Obamacare,

The saddest element of this whole kerfuffle is that liberals and policy wonks are celebrating the survival, by the thinnest of margins, of reforms which in the best-case scenarios will leave the US with the worst access to health care and health insurance in the OECD, with the highest cost per capita in the developed world, and with the worst outcomes in the industrialized countries. The passage and survival of the ACA are big wins, but they still leave the US with the worst health care in the world, and one party is hell-bent on dragging us backwards. So I will celebrate the win and spike the football and all that fun stuff, but tomorrow morning we’ve got to get up and keep working to reform our system further. Because what we have is not good enough.  (emphasis mine)

I’ve said for years that using these numbers to argue that U.S. health care is inferior is beyond stupid for a myraid of reasons. Well, this morning I read an article entitled US health care: A reality check on cross-country comparisons, in which the authors H.E. Frech and Stephen T. Parente do a pretty good job of demonstrating why this is.

From the article,

It is overreaching to interpret country-specific variation in health outcomes as a measure of health care system productivity. In reality, the country-specific estimates reflect all differences in country-level influences, whatever their source and measurement issues. As econometrician William Greene stated in a similar context, there are considerable differences among countries that masquerade as inefficiency. More carefully calibrated research is necessary to identify these differences.

I thought it was a good read and recommend folks to go check it out for themselves via the above link.  Kudos to Professors Hech and Parente!  Job well done.

Anyway, with regard to Obamacare, as I’ve mentioned, I think hoping it will fix what ails the U.S. health care system,  is akin to throwing gasoline on a fire in the hopes it will douse the flames.  If it survives the upcoming political circus this fall, I will be very happy if my fears are proven wrong and Obamacare makes U.S. health care all sunshine and lollipops rather than the conflagration I anticipate.  Still, I ain’t holding my breath on that one.

Cheers,

Sam

Liberty Frye and the Witches of Hessen getting some notice

I’ve mentioned before that my wife has self-published her novel, Liberty Frye and the Witches of Hessen (link for it to your right. Go get your copy today!).

Well, in the vast sea of self-published books, it is difficult to get noticed, but her wonderful story is slowly starting to get some notice.

In April, it was featured at Note Worthy Releases. The reviewer (the site owner’s 15 year old daughter)  there had the following to say.

Four out of Five Stars -

I loved it, couldn’t put it down! I liked the innocence of the main character Libby.It is a very original story, fast paced and exciting. It was funny in some places that made me laugh out loud. The author created a magical and breathtaking world. I would love to see a sequel.

Thanks for such kinds words towards my wife’s story and I couldn’t agree more!

If you like to discover new authors and aren’t afraid to step into the world of exploring indie authors, you should really go pay a visit (or twenty) to Note Worthy Releases today.  It’s a great site that features a lot of great writers!  Thanks to Dawn Smith, who runs the site!  You’re doing a great job!

I also want to take a moment to say thanks to Glenn Reynolds who runs the Instapundit.com Blog.  I’ve been a long time reader and fan of this blog and last week I sent an email to Glenn asking if he wouldn’t mind mentioning my wife’s book on his site.  He most graciously did mention it, and that day was by far the busiest sales day for my wife’s book at Amazon.  Thanks Glenn!!!

 

More Stem Cell Stuff

University of Georgia and Department of Defense have developed a gel the call “Fracture Putty” which contains stem cells. So far in lab rats, it has shown dramatic improvement in healing of fractures.

Read about it here

As a physician, I’m pretty excited about all of the recent stuff I’ve been seeing about stem cells.

I’m really hoping some of this stuff makes it into mainstream medicine soon.

 

Tropical Storm Jasmine

I get it.  This is the tropics and this is hurricane season in the Southern Hemisphere.

Still, this constant rain is starting to get a bit old.

 

My Awesome Wife Is Publishing Her Novel

As (both of the) regular readers of this blog know, my wife and I left the United States about a year ago in order to go live overseas for a while.  We had quite a few reasons for doing this, but overall, it was a desire to get out of the rat race of middle class America for a while and sort of “reset” our lives a bit.  We did this once before when we moved to Germany for a year and after being back in the U.S. for five years, we were overdue for a change.  So, in a bit of a whirlwind, we packed our bags, put our house on the market, and moved to a tiny island nation in the South Pacific.  To say the pace of life here is different than it was in the U.S. would be a bit of an understatement.

I’m still practicing medicine, but my patient population is quite a bit different than it was back in the states.

My wife is still doing consulting work for her clients back in the states (via really really slow and unreliable internet), but has scaled this back dramatically in order to pursue one of her main dreams in life, which is to be a writer.

She’s just put her debut novel “Liberty Frye and the Witches of Hessen” up on Amazon via the Kindle Direct Publishing program, and although my opinion is obviously somewhat biased, I gotta say I think she’s written a great story.

She got the inspiration for this story while we were living in Germany and walking and riding our bikes through the old stomping grounds of Jacob and Wilhelm Grimm (i.e. the Grimm Brothers).  A lot of people don’t realize that the original Grimm Brothers’ Fairy Tales were not the sugary cartoons full of sunshine and lollipops that were presented to us as kids.  In reality, the original tales were full of horrible people and terrifying creatures doing unspeakable things.  In a word, they were scary.

This story of my wife’s sort of returns to those original fairy tale roots a bit, but at the same time she keeps it just tame enough to be safe for kids to read (or have it read to them) without having bad nightmares.

If this sounds like a story you’d like to check out, just hit the link at the upper right of this page.  Amazon Prime members can download it for free via the Kindle Library Lending Program.  For everyone else, it’s still a heck of a bargain!

So go check it out and if you like the story as much as I do, leave some positive reviews for it and tell your friends, etc.  My beautiful wife would like to do this writing thing full time and I’d love for her to be able to do so.

Cheers,

Sam

 

Attacking Leukemia with T-Cells

A report published today in the New England Journal of Medicine details a potential new treatment not only for Leukemia but for other cancers as well.

Go read the full report for further details, but in a nutshell, researchers at Univ. of Pennsylvania harvested T-cells from patients with Chronic Lymphoid Leukemia.  They then genetically modified them to target the cancer cells, as well as modifying them so that, unlike in previous similar trials, the modified cells would proliferate and persisit in-vivo.  They then transfused the cells back into the patients.

While this is a VERY small trial, the results were beyond delightful. 

Lets hope the better funding they are almost certain to receive leads to something remarkable.

Kudos to science!!

 

Well Damn!

Although Mrs. DrSam and I have set sail on the lifeboat and are no longer residing on the Mississippi Gulf Coast, we still consider it home and are saddened whenever we hear of folks having a hard time there.

First Hurricane, Katrina, then the BP Oil Spill, Now the Oyster Harvest is getting drowned by Mississippi River flooding in the Mid-West.

To all my former neighbors getting hurt by this, I wish you only the best.  Here’s hoping you guys catch a break soon.  You’re long overdue!

 

Beer Washed Pillow Cases. Hmmm.

I just read an interesting post over at the Geeky Housewife blog.

Apparently she read in some magazine from Rachel Ray that if you wash your pillow cases in diluted beer, it’ll help you sleep better at night.  She is planning on conducting a home trial herself.

The very thought of thus wasting perfectly good beer already has me thinking I’ll probably be losing some sleep over this.  Here in the lifeboat, beer is a precious comodity and not to be wasted!

She also says that the article claims that the beer must be a “hops variety”. While I’m not a dogmatically strict prosthelytizer of the Reinheitsgebot, I do feel that if it ain’t got at least some hops involved, it ain’t really beer! (Now I know that some shiners also use the term “beer” to refer to the fermented mash prior to distillation, but we all know that ain’t the sort of beer we’re talking about here.)

Having not read the magazine article myself, I’m assuming they’re recommending a beer that has a more pronounced hoppiness such as an IPA , for instance.   These guys occassionally make some stuff that’s hoppy enough to erode the enamel off your teeth.  Just kidding.  But yeah, that’s a hoppy beer.

Rather than watering down and diluting beer for this purpose, I think the housewife should just save some time and use straight Budwiser or one of it’s many watery clones (Corona, Miller, PBR, Coors, etc).

Anyway, I am looking forward to reading the promised report of her findings from her home trial.

Cheers!

Hot Coffee and Hot Tea May Protect Against MRSA

This is an interesting study that was recently in the Annals of Family Medicine.

Basically, the researchers wanted to find out if there was any association between drinking Hot Tea and/or Hot Coffee and levels of nasal colonization with MRSA.

Their findings do suggest that drinking Hot Coffee and/or Hot Tea may decrease the likelihood of nasal MRSA colonization.

I think it would be premature based on this study to draw anything conclusive, particularly with regards to the “Why” of any such protective effect, but it’s an interesting study nonetheless, and I think one that warrants further investigation.

Onomatopoeia

Onomatopoeia is when a word sounds like that which it describes.  Examples might be “Buzz” or “Rustle” or “Meow.”

I don’t know if there is a similar word which labels that which happens when a person describes something in such a way that his very description ends up being an example of that which he describes.  It’s sort of like circular logic in a way, I suppose.

Anyway, I observed this phenomenon in defintion number two for “Speak Truth To Power” over at urbandictionary.com.  It made me laugh.  Those on the left may not find it so amusing.  Of course, power rarely does when having truth spoken to it. :-)

Cheers!

Is The Ivy League All It’s Cracked Up To Be?

William Deresiewicz has an interesting essay titled The Disadvantages of an Elite Education over at TheAmericanScholar.org, which I think is worth a read.

I did not personally attend an Ivy League school.  I have no idea if I would have ever been accepted to one had I applied, but I never really had any desire.  That’s not a sour-grapes statement.  It’s just a realization at an early age that I am miserable when surrounded by the sort of folks who do attend such institutions…the sort of folks upon whom Professor Deresiewicz comments.

That said, there are times when I wonder if I missed out on something with regards to the intellectual environment.  This essay seems to give some reassurance that perhaps I didn’t really miss out on all that much.

Anyway, a lot of the elitist dynamic he describes sounds very similar to stuff I’ve observed in many other walks of life.  Ultimately, I think the real take home message is that kids going to Ivy League schools are basically guilty of being human, just like the rest of us.  They are just as myopic and tribalistic as any “uneducated” and “primitive” savage in the third world.

That’s not intended to take anything away from their accomplishments, their intellect, their work ethic, etc.  It’s just to reiterate Professor Deresiewicz’s point that just because they are “better” at some particular task (i.e. academic achievement), does not accurately translate to them being somehow “better” humans than the rest of humanity.  Doesn’t mean they’re worse either.  They just are what they are.  Again, just like the rest of us.

Samoan’s driving on the left. Why?

So, a few weeks ago I got back from spending a month in Samoa and Fiji. Interesting places. Perhaps I’ll blog a bit more with some observations on them in the near future.

Today I just want to make one curious observation. Apparently, for as long as anyone can remember, cars drove on the right in Samoa (this is “Western Samoa” I’m talking about, as opposed to American Samoa). For some reason however, their wacky PM pushed to change all that. In September 2009, Samoans were all forced to start driving on the left hand side of the road. There were a lot of protests leading up to it and predictions of widespread mayhem, but fortunately, things went pretty smoothly.

Why did the PM push for this?  He claimed it was to make used cars cheaper in Samoa by taking away the need to import (left-hand drive) cars from North America and by encouraging Somoans living Down Under in Aus and NZ to ship cars back home.   He also vaguely claimed it was “To bring Samoa more in line with other Pacific nations.”

Personally, I suspect it was really more about xenophobia on his part, which his secondary reason seems to allude to.  While in Samoa, it seemed there were almost daily comments from him in the local newspaper that smacked of a real chip on his shoulder against the U.S.   In fact, there was quite a number of  “chip on the shoulder” sort of xenophobic comments in newspaper editorials etc.  These comments were extended towards pretty much all foreigners, not just Americans.  The Chinese seemed to be at least as big a target for such comments.

I think I understand where a lot of these comments are coming from, but I’d love to hear from some Samoans with their thoughts on the matter.

p.s. Apparently, as a follow up to his road wackiness, the PM is now pushing to have Samoa’s time zone changed.  He wants to move the international date line to the East a bit so that Samoa will jump 24 hours ahead, and no longer be on the same “business day’ schedule with the U.S.   I guess that’s one way of leading his country into the future. :-)

Remote Control Endoscopy Camera

Researchers in japan have developed a remotely controlled miniature camera that can be used for endoscopy.

It looks a bit like a tadpole.  It appears very similar to the “capsule endoscopy” cameras that came on the scene several years ago.  With those, you basically swallowed a camera that was encased in a clear pill shaped container.  This thing passively moved along your gastrointestinal tract snapping pictures until you pooped it out.

With this new gizmo from Japan, it’s not a passive journey.  It has a little mechanical tail sticking out of it with which a doctor using a joystick can control it and basically pilot it through your GI tract.

It can apparently be inserted from either end….i.e. via your mouth or your “other end”.

According to this article, it was originally tested on dogs and is now ready for us.

Some potential advantages I see are the ability to get pictures within places not really reachable with current endoscopes…i.e. the small intestine, and also, I would imagine this procedure would likely need less anesthesia/sedation perhaps.

The potential negatives I see are 1. This thing getting stuck somewhere and requiring surgery to remove and 2. This thing causing a perforation, illeus or intususception.

Still, overall it looks like a pretty cool device to me.

Follow up on Operation Gunwalker

After my last post, on Operation Fast and Furious, AKA Operation Gunwalker, I’ve tried to do some internet searching to get up to speed.

Unfortunately, my satellite internet access here on the lifeboat aint what it was on dry land so it takes a lot longer to find much out.

This is exacerbated by the fact that this issue seems to largely be relegated to burial by the mainstream press.

From the little bit I have been able to read, Operation Fast and Furious, AKA Operation Gunwalker appears to be a potential scandal of Watergate proportions.

Here’s a link to a post on Glen Reynold’s site which discusses this issue of Operation Fast and Furious. 

I think they are right in calling for a more transparent investigation of this mess.

Operation Fast and Furious

What the heck is up with this!?!?!?

Being in the middle of the Pacific the past several months, I guess I’m not too up to speed on U.S. news items.

Just today, I started becoming aware of this whole brewing scandal known as Operation Fast and Furious, AKA Gunwalker.

From the little bit I’ve read, I have a feeling this is going to turn into quite the headache for the White House….as it damn well should!

FDA Chantix Warning

And right on the heels of my last post about the FDA warnings on Actos and Avandia and the inevitable lawsuits to come….here’s a new FDA warning about Chantix and increased cardiovascular risk.

Chantix lawsuit anyone?

Here’s my page on Chantix from a couple years ago.  Enjoy.

Cheers!

FDA Warning On Actos

The FDA has come out with some new warnings about Actos and it’s association with bladder cancer.

You can read about it here.

It wasn’t too long ago that they came out with warnings about another drug in the same family, Avandia. That one has serious cardiovascular concerns.

I’m sure it won’t be too long before we start seeing a bunch of advertisements from lawyers wanting you to join lawsuits related to Avandia and Actos.

I know lots of doctors will fear being named in these lawsuits related to Avandia and Actos and will stop prescribing them.  It’ll make life a little more difficult for the drug reps who are tasked with convincing doctors to use these drugs.

Cheers!

Lifeboat Calling

Hi Everyone! I’m still alive.

I realize I haven’t posted anything in what seems like forever. I think the last time I posted, the Saints had just won the Superbowl and as expected Hell froze over.

As some who know me know, I’ve long used the analogy of building a lifeboat in case the metaphorical ship I’m a passenger on goes down. That “Ship” basically represents life in America, life as a primary care physician in America, etc.

Well, over the past couple years, construction on the “lifeboat” has been in full swing. Finally a small prototype was felt to be ready for a test run about a year ago, and it was finally “put in the water” back in February of this year.

So far, the test run is going pretty well, and life is good floating out here in the middle of the Pacific Ocean.

Those who know me well, will understand all of the cryptic talk in this post.

Those who don’t know me well really ought to get to know me. I’m a nice guy, and I just might share some “lifeboat” plans.

Cheers,

Sam

How ‘Bout Dem Saints!!!!!

GEAUX SAINTS!!!!!!!!!

After many long years of hoping, praying, rooting, and ultimately echoing the chorus of “Just wait til next year!”, I am delighted to observe that “Next Year” has finally arrived!!!!

 What an awesome game to cap an awesome season.

 Way to geaux Saints!!!!  Way to Geaux!!!!

 Who Dat? Baby!!!!

Jim Morrison and Debbie Harry Collaboration. Who knew?

Just cool stuff here.  I like it.

Joe Wilson 1. Michael Moore 0.

So I came across this link on an online forum I frequent.

It’s basically a story about the impending closing of a dialysis clinic at Grady Memorial Hospital in Atlanta.

 The gist of the story is one of human tragedy.  There is a substantial number of folks who depend on this dialysis clinic to stay alive who will now be forced to find an alternative.

 That won’t be easy for many of them to do however because so far, this dialysis clinic has been treating them for free.

 According to the story, about two thirds of the patients who have been receiving their dialysis there are illegal immigrants, presumably most of whom have their origins south of the U.S. border with Mexico. (they did mention one illegal immigrant from Ethiopia)

 Because they are here illegally, they have no insurance and also have no public health care benefits (i.e. medicaid and/or medicaid).  So Grady has been forced to eat the cost associated with treating them.

 Those who are not here illegally ALL have Medicare paying for their dialysis.

 Between the two groups this dialysis clinic has been costing Grady about 2 million bucks a year in losses.  Overall, Grady is losing about 33.5 million bucks a year and therefore has to find places to cut costs.  This dialysis clinic is squarely in their cross-hairs.

This sucks for everyone involved.

Illegal immigrants or not, these are people and this is a real and potentially life-ending situation for them.

That said, I don’t really know what the solution is (but I do propose one idea at the end of this posting). Grady is mostly a tax-payer supported institution.  Is it fair to expect the taxpayers in this country to continually pay for the care of people who are here illegally?  Fair or not, can we afford to do this indefinitely?

On the online forum where I found this link, the overall tone from the left was that this story represented our need for universal health care in the U.S. so that these folks would be covered illegal immigrant or not.  They use this article to argue for supporting Mr. Obama’s plans to reform the health care system in the U.S.

 Perhaps Joe Wilson was right.

 The thing I was wondering about however is this:

 Why are these folks even here in the first place?  I don’t mean that as in Why do we allow them to be here, but rather, I mean Why do they even want to be here? 

According to the folks on the left, everyone knows that U.S. health care sucks.  After all, we spend more per capita than anyone else and have dismal health outcomes such as lower life expectancy and higher infant mortality. Right?

If you are sitting in Mexico or Honduras or El Salvador, etc. and need dialysis, why the heck would you illegally sneak across the border to receive your health care here? 

Michael Moore says our health care here sucks.  He says that you can get great health care in the socialist utopia of Castro’s Cuba.  I’m sure that if you come from Mexico, it’s probably easier to get into Cuba.  I’m sure the proletariat there would welcome fellow proletarian brothers with open arms.  No need to sneak across the dessert under darkness of night.  No need to pay smugglers to get you past the U.S. border patrol.  No need to learn a new language.

 Why didn’t these folks in need of dialysis simply immigrate to Cuba instead?

 So here’s what I propose.  The article claims that there are about 90 patients dependent upon this outpatient dialysis clinic.  The article claims that about two thirds of them are illegal immigrants without any sort of insurance.  The other 30 or so patients have medicare and medicaid and therefore should be able to afford for care in other facilities.

 That leaves about 60 or so folks.  Just about enough to fill a small airliner.

 How bout putting them on a small airliner and giving them a one-way ticket to Cuba?

Hell, I’d even be willing to chip in for a one-way ticket or two provided one of them has Michale Moore’s name on it.  :-)

Problem solved.  Next!

Cheers,

Sam

Putting things into perspective

Dr. Crippen at NHS Blog Doctor has a pretty good post today.  (Well actually, he often has pretty good posts, but I sometimes have trouble getting through his British accent. :-)

 Take a look here.

Ha ha ha. I know how you feel dude!

Is Multiple Sclerosis Caused By Low Vitamin D?

It has long been known that genetics and environment play a part in risk of developing MS.

It has also long been known that risk of MS goes up as people live further and further from the equator.

Now a study has come out showing that proteins activated by Vitamin D interact with genes on Chromosome 6 that have been shown to have the strongest effect on development of MS.

Specifically, people carrying a copy of the gene variant DRB1*1501 are more likely to develop MS.  Those carrying two copies of this variant are even more likely to develop this devastating disease.

This study suggests that the aforementioned proteins that are activated by Vitamin D bind to the DNA sequences adjacent to the DRB1*1501 gene and alter it’s function.

On the surface at least, this seems to make sense.

Adequate skin exposure to particular wavelengths of ultraviolet radiation in sunlight is a major source of Vitamin D in humans.  Folks living further from the equator tend to get less of this exposure, and tend to have lower levels of Vitamin D.

So, it certainly would not surprise me if Vitamin D is playing a role in the increased MS risk seen in these folks.

You can read more about this study here.

There is a lot of debate regarding Vitamin D, effects of low levels, appropriate testing guidelines, appropriate guidelines for “normal blood levels, appropriate treatment of high levels, etc.

Perhaps, if there is any interest, I’ll devote a future post to some of these issues.

How ’bout it readers?  Would you like to see a more detailed post about Vitamin D?

Cheers,

Sam

Everything Is Peachy in Jolly Old England

My last post commented briefly on Tanzania’s Nationalized Healthcare System.

Now I’d like to give a link to a really super duper facet within the oft touted UK National Health Service. 

That’s right folks.  Nothing to see here.  Just move along.

I can’t wait until the Obamessiah brings a great system like this to the Colonies!

Tanzania, What A Swell Place!

Tanzania began nationalizing their healthcare system in 1975.

Private medial practice was outlawed in 1980.

You can read a bit about it here.

Recently, the Tanzanian Prime Minister, Mizengo Pinda, ordered the suspension of issuance of licenses to traditional healers.

You can read about this here and here.

So, not to make too much light of the plight of these truly unfortunate people, but I’m left wondering about something. 

Are the services of these traditional “healers” covered under their nationalized healthcare scheme?????

Godspeed to you, Mr. Pinda.  I don’t think you need to appologize at all for your remarks.  If anything, they do not go far enough!

Read more about this disorder here.

Sometimes You Just Shake Your Head In Amusement

fake-id.jpg

The sad thing is that around here, this thing might actually work!

I think I’m Starting To Understand Joe Biden’s Enthusiasm

Saw this story when reading the news this morning.

It’s a story that I couldn’t help smiling at.  Basically it talks about all the hanky panky that is going on at The Villages.

To those who have never heard of The Villages, it is basically a gigantic gated retirement community in Florida, where wealthy older folks can spend their golden years hanging out by the pool, golfing, and apparently, according to this story, engaging in all sorts of lascivious behavior.  And why the heck shouldn’t they???

Dr. Sam says “Good for you Granny!”

Anyway, the story immediately made me think of this video that was making it’s rounds on the interwebs a few months ago.

Glad to know we have such sober leadership taking over in D.C.

Eh, Canada, Hate to Butt In, Butt….

Interesting article here.

In a nutshell, it’s an article about a recent development in the enchanted land of The Great White North.

Apparently our friends in The People’s Republic of Cannuckistan passed a law that basically says that airlines can’t charge an extra fare on domestic flights for passengers who require an extra seat because they need to be accompanied by a personal attendant due to a medical condition, or for folks whose butts are too big to fit in a regular airline seat.  This new law is affectionately known as the “One-Person, One-Fare” rule.

This left the airlines in a bit of a quandry.  How to determine who qualifies for a free second seat due to their obesity?

They basically had three choices. Continue reading ‘Eh, Canada, Hate to Butt In, Butt….’

Baclofen For Addiction Treatment?

Saw an interesting blurb on the internet this morning about a French physician who claims that Baclofen, which is a drug normally used to treat folks with spastic muscle disorders, was able to cure him of his addiction to alcohol.

Here’s a link to a brief story on it.

It would be nice if subsequent research shows this to be of benefit.

Drug addiction is a terrible thing that tears people’s lives apart.

Hmmmmmm……..I wonder if Baclofen could help eliminate my craving for junk food?????

He, She, It. Which is it???

Story here

.

No Shortage of Stupid Ideas Out There

Interesting story here

So local law enforcement here on the Mississippi Gulf Coast wants to get a law passed authorizing all sorts of non-physicians to institute a 72 hour medical hold on any person that they “think” is mentally ill.

The folks they would propose giving this authority to would include cops, park rangers, border patrol agents, and social workers.  I’m not sure if they will also include the guy who waits on me at the Taco Bell drive thru, but I don’t see why not.  He’s got about as much medical education and qualification as a lot of the aforementioned folks, I reckon.

No need to get the doctors involved any longer! Yippeeee!!!!

I guess these morons are under the false assumption that all a doctor does when he institutes a 72 hour hold is lock the person in a room and “observe” them. Continue reading ‘No Shortage of Stupid Ideas Out There’

About Electronic Health Records

So I was out walking in the cold early this morning in my never-ending Battle of the Bulge, when an idea occurred to me. Amongst all the heated debate on healthcare reform over the past few years, one thing I have consistently heard from multiple sources is a call for greater implementation of electronic health records.

As a physician, I have heard many folks not involved in providing healthcare decry physicians for not embracing this great panacea, as though a profession which typically dwells on the cutting edge of technological achievement when it comes to diagnostic and therapeutic modalities is for some mysterious reason determined to remain total luddites when it comes to maintaining records of their patients. Continue reading ‘About Electronic Health Records’

Thanks, Dude!

I had a patient today tell me that he actually read fully my posts about weight loss and was putting the stuff there into action.

He even downloaded a program called Lose It for his iPhone that was helping him keep track of calories and weight.

I don’t own an iPhone, but he showed me his and the program looks pretty cool.

So far (only a couple weeks) he’s loosing weight right on track.

That was pretty gratifying.

Thanks, dude!

More Natural Cures for Blood Pressure

Hi Folks,

I know it’s been about forever and a day since I posted anything here.  Sorry about that.  No real excuse other than life just keeping me a little busy.

I keep telling myself, “Self, you need to get busy and post some stuff!”

Every now and then, I’ll see some news story or something and think to myself that it looks like a good topic for a post, but then it seems I get distracted and it slips into faded memory.

Anyway, I saw this interesting story about blood pressure and it gave me a bit of a laugh, so I thought this was as good a topic as any to break the drought of posts.

Enjoy.  Sorry for the smell.

I’ll try to do a better job with updates!

Cheers,

Sam

Racial Disparities in Health Care and Cashing in on Medicare

John Goodman had a nice blog post today.  I typically enjoy reading his stuff and recommend it to my readers.

After reading his post linked to above, particularly the very last paragraph just above his signature, take a look at this MSNBC story.

Cheers,

…Sam

Hat Tip to Happy

Singapore

A while back I wrote a series of posts about health care reform and in one I mentioned the system in Singapore as one which we in the U.S. should look at as a good model to work from when considering ways to improve our own.

Well, today the Happy Hospitalist has a post which links to another article about the system they have in Singapore.

Give it a read and tell me what you think.

Smart bird!

Calico CatNot sure why exactly, but this story really made me smile

Lost Parrot Gives Vet His Name and Address

It made me think of an experience my wife and I had during my medical school days in Jackson, MS.

One day, my wife came home and discovered a calico cat on the front porch of our house. It was a really beautiful cat with an extremely sweet disposition.

She petted it a bit and then went inside, figuring it belonged to a neighbor and would go home soon.

Well, the cat continued to stick around….for a day or two, so we decided to see if we could track down it’s owners.

It had a collar with a rabies vaccination tag.

So my wife called the veterinary clinic that was listed on the tag to see if they could use the tag number to locate the owner.

The clinic was located in south Jackson in what is essentially a nearly exclusively African American neighborhood.

The receptionist answering the telephone took the tag number from my wife and put her on hold while she looked up the owners name in her records.

A few moments later she came back on the line and my wife heard her say “That’s not yo’ kitty.”

My wife responded “Oh, I know she’s not mine. That’s why I called you. I found her on my porch and I’m trying to locate her owner.”

My wife heard her start giggling and say “No, that’s not yo’ kitty.”

Realizing she was not being understood, my wife responded, speaking a little more slowly “I know it’s not my kitty. I’m trying to find out whose kitty it is.”

They went back and forth like this a few more times with the receptionist getting increasingly giggly and my wife getting increasingly frustrated.

Finally, the receptionist between giggles cleared things up by telling my wife, “You don’t understand. I’m trying to tell you the cat’s name. Her name is ‘Nacho-Kitty.’   If you bring her down to the clinic, we can contact the owner for you and return their cat to them.”

(Maybe you had to be there, but usually when my wife tells this story, people give her a funny look.

I think maybe in our overly-P.C. society they think she is being racist and making it up or something, but my wife is by far the least racist person I have ever known. I honestly know nobody with a more pure, kind, and accepting heart.

She’s just relaying the story as it happened.)

HT for the parrot story to BadHabit.
Picture credit.

Dr. Sam’s Modest Proposal (with apologies to Jonathan Swift)

http://www.washingtonpost.com/wp-dyn/content/story/2008/04/27/ST2008042702198.html?hpid=topnews

http://www.nytimes.com/2008/04/26/washington/26farm.html?ref=us

You know, this whole sub-thread just gave me a great idea.

Everybody keeps complaining about the cost of health-care.

How bout if the govt just starts giving me a check every month to NOT see patients.

I’d give them a deep discount. They could pay me say 50 bucks for every patient that I don’t see, as opposed to what those patient visits would otherwise cost, which would usually be greater than 50 bucks.

So the govt. would save money on every patient by simply paying me to NOT see them.

If they agree to this, I could really ramp up my productivity a lot too.

I bet that once I get in a groove, I could probably NOT see at least a thousand patients a day.

I think I’ll write this up as a proposal for a demonstration project and submit it to Medicare.

Where’s your face?

Mail BoxDear Doctor Sam,

Why don’t you show your face on your website. What’s up with the pictures of the back of your head?

Sincerely,

Curious

Well Curious, that’s a great question.

Other than the obvious answer which is that my face ain’t all that pretty, it’s all about preserving the thin veil of anonymity.

I know it isn’t much of a veil and that any truly determined person would have very little difficulty discovering my identity, but it’s something at least.

Let’s face it, there are a lot of nutjobs out there who might not like some opinion I write or whatever and I really don’t want some potential stalker or axe-murderer to know what I look like.

I suppose it could be argued that an axe-murderer would likely sneak up behind me in order to strike his blow and that I therefore am showing him exactly what to look for by showing the back of my head, but I guess that’s just a chance I’ll have to take.

Anyway, there’s no super secret here. Maybe someday I’ll reveal my full name and face, but for now, I prefer to maintain a little bit of privacy.

Hope that satisfies your curiosity!

Cheers,

…Sam

Ask Dr. Sam

Mail BoxHi Folks,

Sorry it’s been a while since I’ve posted anything. I guess I’ve been a bit busier than usual recently.

Also, quite frankly, I just haven’t had much inspiration.

I did do a brief addition to the disease index with an article on Erectile Dysfunction, but otherwise, drsamonline.com has been a pretty quiet place the past week or two.

I had hoped by now to have more articles in both the disease and medication indexes, but I think perhaps I’ve been a bit too ambitious here. Writing these articles is pretty labor and time consuming and there really is a virtually unending number of diseases and medications to cover.

All of this has caused me to do some thinking about the direction of this website.

One thing I find myself doing a lot of is answering people’s questions. This occurs in my clinic, on the internet, and just in my general life itself. People ask my advice and opinions on all sorts of things, not just their health care. In large part, this dynamic was some of my motivation for starting this website.

One of my main goals was to cut down my work over time. Rather than verbally answer the same questions over and over, I figured I could just create a website where I could put that information and then refer people there to find their answers.

In reality however, I find that this has increased my work. Now I am writing articles and still having people ask me the same questions. I also find myself receiving emails at my drsam@drsamonline.com address from folks seeking my advice.

Until now, I’ve typically just been engaging in private correspondence with these folks by replying to their emails.

It dawned upon me however that some of these questions and queries for advice I receive might benefit others who read this blog so I thought I’d create a new blog category and occasionally post these questions and my responses to them as actual blog posts. I’ll call this category “Ask Dr. Sam”.

The beauty of this concept I think is that with the ability to leave comments on blog posts, other readers can also chime in with their input and advice.

The other thing that dawned upon me is the idea that perhaps other folks might like to try their hand at writing some articles for the disease and medication indexes.

I’ve already got some examples of the sort of format I’d like these articles to take. The goal with them is to put information in simple easy to understand words so that the average person can educate themselves a bit.

So what do you folks think?

Any of you interested in trying your hand at writing some articles?

Any of you interested in getting my thoughts on some particular subject?

If so, just shoot me an email at drsam@drsamonline.com.

If you submit an article or a question, I’ll take a look at it and if it seems like something appropriate for this website, I’ll publish it for you.

For the articles, if you wish to remain anonymous, then let me know. If however, you wish to receive credit for your work, I’ll be glad to put your name on it.

Anyway, I look forward to hearing from folks and seeing how this pans out.

Until then, cheers!

…Sam

The Slippery Slope of Drug Addiction

drug paraphernaliaToday, I’d like to touch upon a subject that I think in some way affects us all.  I’m talking about the continually unfolding disaster of substance abuse in this country.

As a physician, I see the effects of drug addiction and abuse on pretty much a daily basis.  There is hardly a day goes by that I don’t have at least one person either come in to the clinic or call my nurse demanding I write a prescription for their favorite controlled substance.  I typically politely decline.

The problem is certainly not confined to prescription medications either.  Currently the big problem in this neck of the woods seems to be related to methamphetamine, though crack coccaine is pretty big around here too.  None of this is meant to ignore other substances.

After a while, you sort of get a sixth sense about these folks and can usually spot them pretty easily.  A lot of times, I can spot them before I even see them, simply from what is written in the chart, what their presenting complaint is and how it is worded.

The E.R. docs have an even greater exposure to this stuff than I do as a family medicine doc.

It doesn’t take long for most folks in the medical profession to become somewhat cynical towards these patients.  Hang out with some doctors or nurses long enough and you’re almost certain to hear them complain about their latest drug-seeker, or that disruptive crack-head they saw the other day, etc.

I’m not immune to this either.  The fact of the matter is that a lot of these patients genuinely are a disruptive pain-in-the-asses.  They usually take up an inordinate amount of time trying to convince you to do something you’ve already told them you won’t.  They are often quite rude, and often use foul, abusive, and occassionally threatening language.

It’s not hard to lose sight of the fact that in spite of all this, they are still people.  Most of them have family who love them and are worried about them.  Most of them have dreams and aspirations.  Most of them did not spend their early childhood dreaming of someday being an addict.

I’m not some touchy-feely left-wing pansy trying to make excuses for them or condone their behavior.  What they are doing is wrong.  They need to stop.  They need help.  Unfortunately, they are not usually too interested in receiving any help.  They usually just want that next hook-up.

What got me going on this subject today was something I read from a member of another internet forum I sometimes visit.  The guy posting this put a different light on the addict than what we usually see.

His is a story that I felt should be shared.  I asked his permission to post it here and he kindly gave it.

Here goes.

” Truthfully, I do have some sympathy towards addicts. my only experience with a crackhead/crackwhore.. My ex-wife’s younger sister, she was 16 or 17 at the time, and my ex wasn’t my ex yet.

Sis was dating a slightly older guy, seemed pretty nice. Parents were parents, they weren’t pleased that she was dating, but that’s what having a daughter is all about. When they met him, he said all the right things.

A little dating, a little experimentation with drugs (pot, ecstasy) apparently resulted in her to going to a party with him and people that she didn’t know. He got her high, and then gave a her a little crack. Over the next few weeks, he gave her a little more and a little more. just led her down the trail to addiction. all free, nobody suspected a thing.

She got hooked, then he wanted her to pay for her habit. She emptied her piggy bank, she emptied her bank account, not enough. Small things disappeared around the in-laws house. They didn’t notice.

They noticed her change in behavior, she was irritable (okay, more irritable), she was defensive, she wasn’t home. They didn’t know yet that she quit her job. Joe Blow kept giving her crack (discounted prices). She was hooked.

She stole more, she gave away her car, parents reacted wrongly (tried to confine her to house, gated community), and then they kicked her out. Instantly regretted that, but then they couldn’t find her to bring her back and get her proper help. They didn’t yet realize what was going on, just attributed it to her going through some rebellious stage.

She had no more money, she had no access to money. Joe Blow became her pusher and her pimp. all of this in less than a month.

Parents found her, brought her home, tried to get her help. a week or two later, she emptied mom’s very expensive jewelry case (after breaking into a locked room) and disappeared again.

Two weeks later they found her again, , in this short period of time she went from a beautiful young woman to an emaciated, much older looking, worn-out person.

This time, they put her in a program, in a home.

I was there to see their anguish throughout the entire ordeal. I helped them search the streets, try to keep her company when she was home, visit her in the rehab center. She did manage to overcome her addiction, but afterwards she was devestated.

She knew what she had done, the whole family needed counselling (but they didn’t get it, which was surprising to me). The last that I heard from her, she had her life back under control and was going to college. But she was scared about how she’d react in new situations with less help. She did join NA and hopefully everything has gone well for her since.

So, I can feel sympathy for addicts. Sis and her family had everything, loving, close-knit family, very secure financially, and this still happened, and was hard as hell to reverse..”

More On Spam (or should I say Moron Spam?)

Turkey SpamThis is a pretty new blog and I am a relatively very new blogger.

When I started this website and blog, one of my main goals was to simply expose myself to this cyber-world and get some experience and learn a bit about creating internet content.

Many/most of my blog posts have been excessively wordy, but I realize that this is part of my learning experience. All of them have been heartfelt. All of them represent countless hours of research and work.

As with most new blogs, my internet traffic has been less than stellar. This hasn’t really surprised me too much.

I read one statistic that stated that there are approximately 175,000 new blogs started every day. So, I know that no matter how great a writer I might be (which I know I am not), it’s going to take some time to get any sort of meaningful traffic.

So, with all that in mind, I must say that I was somewhat amused with my most recent post which I put up a little over a week ago. It was the one titled Fax Spam in which I briefly talked about an annoying though somewhat humorous fax I received advertising some sort of male sexual enhancement product being sold at the website www.ready4her.com.

Of all my posts, this was the one I put the least effort or thought into. It was just a brief little blurb I typed out in about 10 minutes for fun.

Wouldn’t you know, it has garnered more traffic so far than all my other posts combined.

My traffic is still certainly pathetic, but this was a real head-shaker.

The most fun part of the whole thing was in the comments section of that post. I have learned that there are definitely some real loons out there in internet land.

Anyway, I thought I’d try a little experiment here and provide a small sample of the email spam I have received today just to see what happens.

If you are reading this, then thanks for your participation in this experiment in human behavior.

Here goes.

This first one is a spam email I received from “Anita Kaiser“. It’s subject line is titled BEST PRICE ! Buy Cialis, Viagra online NOW – and save 50% your money !!!

The body of the email reads as follows.

Hello !

Now you have the opportunity to save your time and money!

With US based online p,h,a,r,m,a,cy store you can buy any meds you
need!

Forget about p/r/e/s/c/r/i/p/t/i/o/n/s and doctors. Now you save your
time.

Forget about high prices at local stores.

M/e/n/’s H/e/a/l/t/h
A/n/t/i – D/e/p/r/e/s/s/a/n/t/s
P/a/i/n R/e/l/i/e/f
W/e/i/g/h/t l/o/s/s

Go visit: http://jyigegg.com

HVFQBKVAZXPJULRRVAKRX

Next in our experiment is the following spam email I received today from “Ernest Calloway“, though his return email address is Brian@steamsteel.info.

By the way Brian, if my publishing of your email address generates some spam for you, well you know, Karma.

Anyway, the title of Brian’s, er I mean “Ernest’s” email is “re: (no subject)

Ooh, now that’s original. Hey, do you think he was trying to fool me into thinking he was actually responding to an email I sent him? Oh Ernest, you’re so clever!

Anyway, the body of his email reads as follows.

Hey, want to get those bills under control for good, it’s easier than you think. We will help you.

Go here http://steamsteel.info/Brim/ this is your solution.

Now, after “Ernest’s” scintillating email, I was really looking forward to the next one which looked suspiciously familiar. Its subject line was very similar to the one Ernest sent. It was simply titled “(no subject)” and was sent to me by Louise Hinson. Interestingly, like Ernest above, her email address, Sara@bellfleece.info, didn’t really seem to match up with her name.

Oh and Sara, that Karma thing applies to you as well.

The body of her message is where she and Ernest bore the most striking resemblance however and it was as follows.

Hey, want to get those bills under control for good, it’s easier than you think. We will help you.

Go here http://bellfleece.info/Orchestral/ this is your solution.

So these are three little slices of spam I’ve dined on today and thought I’d share them with you. I’m curious to see what sort of response they generate.

Let’s see!!

Cheers,

…Sam

Fax Spam

Fax SpamWow.  This was a new one for me.

About 20 minutes ago, this came over the fax machine at my clinic.

I know the picture quality isn’t so good as I took the pic with my cell phone camera, so I’ll type what is written.

It is a fax from LBI, INC. of Toronto, Canada and was sent by “Tod

The subject is “Re: our last conversation

Under the comments section it says

“Sorry, my cell battery went on me.

The pills I use Work Better than Viagra & you don’t need a prescription because it’s herbal.  That alone saves you $100 for a doctor visit.

This website gives out FREE samples

[w.w.w.READY4HER.com]

I’t very, very effective, you’ll be happy you tried it.  The Free Sample offer can end anytime so I’d get it now while you can.”

For what it’s worth, I don’t know Tod, nor have I had any cell phone conversations with him.

At the risk of revealing too much information, I will also state here for the record, that I have no personal need for any product of this sort.  The plumbing is still fully functional so far!

I know a lot of folks routinely receive this sort of spam via email on a regular basis. This is the first time I’ve ever received any via the fax machine, however.

Since I am the only male working in my clinic, the girls all had a good laugh and told me that this fax was obviously for me.

I’d sure like to know who gave Tod our fax number.

You can’t really see it in the picture above, but Tod has wisely blocked his number from appearing on the fax copy.

Anyway, hope you all have a laugh at this, and I hope this isn’t the first in a new wave of spam.

On a positive note however, perhaps this is just the sort of thing to drag the medical profession kicking and screaming into the 21st century and convince us all to get rid of the fax machines.

 Cheers,

 …Sam

In a Vial, Crocodile

SchnappiI saw a sort of neat story on the BBC News website about researchers in Louisiana who are taking proteins from alligator blood and trying to use them to develop new antibiotics.

Other than handbags and good eating, alligators are mostly just a bit of a nuisance in these parts.

I think it would be great if these researchers are successful in their quest.

Of course, natural selection being what it is, I’m sure that MRSA (Methicillin Resistant Staphylococcus Aureus) would likely eventually evolve into GRSA (Gator Resistant Staph Aureus).

By the way, the picture above of the little alligator is one I took back in 2003 at the Dauphin Island Sea Lab Estuarium.

He always sort of reminded me of Schnappi, the darling of German MTV, when my wife and I were living over there in 2004-2005.

(Oh, and before some smarty-pants feels the need to correct me, I do know the difference between alligators and crocodiles, but “See ya later, alligator” didn’t seem nearly as original for the title of this post.)

It’s a Teenage Wasteland

Teenage wastelandI think I’ve mentioned it before in other posts in this blog, and I tell it to my patients all the time. It bears repeating here.

The overwhelming majority of the stuff I tell my patients when it comes to staying healthy doesn’t require the letters “M” and “D” after one’s name.

Most of this stuff is basic common sense that the average fifth grader knows. Eat your vegetables, get enough sleep, exercise, don’t smoke, don’t do drugs, don’t sleep around with scuzzy strangers, etc., etc., etc.

I’d say probably 95% of what I do as a family physician falls into this category. (Now that other 5% however, well, that’s a different story. That other 5% represents years and years of hard work in medical school and residency and clinical practice experience.)

Anyway, there was an interesting article in the April issue of the journal Pediatrics titled Characteristics Associated With Older Adolescents Who Have a Television in Their Bedrooms.

The conclusions in this article seem to fit very nicely into my 95% “Duh, a fifth grader could tell you that,” category.

Basically, they compared older teenagers who had televisions in their bedrooms with those who did not.

In the words of Gomer Pyle, “Surprise, surprise, surprise!”

What they found was that those with televisions in their bedrooms tended to watch more television, have less physical activity, lousier eating habits, etc.

So parents, here’s a no-brainer for you: Do your kid a favor and get the television out of their bedroom.

Okay, so now here’s an even bigger no-brainer for you. Get the damn boob-tube out of your own bedroom as well.

Want to take it even a step further? Get the darned thing out of your house altogether.

Okay, I realize that may be too big a step for most folks. If it’s too big a step for you, then at least turn it off once in a while and go get some exercise.

(In the interest of full disclosure, I will say that my wife and I do have a television in our living room, but we almost never watch it. We used to have cable service, but we decided to have it disconnected about a year ago. We don’t have any sort of antenna and therefore we have absolutely no channels to watch.

I have to say, I’ve never been happier. We are saving money by not paying a cable bill and our lifestyle is much healthier. We eat better, exercise more, read more, interact with each other more, you name it. We do occasionally rent a movie and watch it, but our television otherwise remains off. We have no intention of ever going back!

I highly recommend this to anyone reading this blog.)

Cheers,

…Sam

Hands Only Cardiopulmonary Resucitation (CPR)

L’Inconnue de la SeineThere was an interesting story on MSNBC.COM about hands-only CPR.

As a physician, every two years I get re-certified in Basic Life Support (BLS), which is essentially what most folks know as CPR,  as well as Advanced Cardiac Life Support (ACLS), which is essentially what they try to portray in shows like “E.R.” when everyone is dramatically yelling  stuff like “Give him an amp of epi, stat!”.

Since finishing residency, I no longer practice any obstetrics (for reasons discussed in my medical liability and malpractice reform blog post), so I no longer get re-certified in Advanced Life Support in Obstetrics (ALSO).

I have never gotten certified in Advanced Trauma Life Support (ATLS), which is something that the surgeons and ER docs all get certified in. I don’t do ER medicine, so I haven’t really been able to justify the extra expense and time involved with getting this certification. I keep thinking perhaps I will get it someday though, as moonlighting in the local ER may be something I’d like to pursue in the future.  For now though, I’ll leave the chest tubes and tracheotomies and such to others. Continue reading ‘Hands Only Cardiopulmonary Resucitation (CPR)’

A Plan For Intelligent Health Care Reform Part 7…Medical Liability and Malpractice Reform

Dewey Cheathem & HoweStoogesOkay, I promised to address the 800 pound gorilla , known as the broken medical liability system in this post.

Regardless of what all the parasites who are currently getting fat off the current system will try to tell you, the civil liability system in this country is a disaster.

Anyone with half a brain and a lawnmower can see this.

A lawnmower?

Yep.

Continue reading ‘A Plan For Intelligent Health Care Reform Part 7…Medical Liability and Malpractice Reform’

A Plan For Intelligent Health Care Reform Part 6

Singapore SlingSingapore Sling Okay, if you read Part 5 of this series outlining what I affectionately call The Dr. Sam Plan, you know that I promised to offer a quick blurb here in Part 6 about what I envision as a meaningful way to deal with the 800 pound gorilla, known as the medical liability crisis.

I’ll have to do that in Part 7 instead.

First however, I need to offer a brief little addendum to Part 5. 

Continue reading ‘A Plan For Intelligent Health Care Reform Part 6′

A Plan for Intelligent Health Care Reform Part 5

To recap parts 1-4, so far in this little series, I’ve just been laying some groundwork, pontificating sort of non-specifically about where I think the main problems lie with our health care system and where I think the direction of reform should go.

In a nutshell, I think the major problems boil down to a whole lot of interference with the traditional doctor-patient relationship from outside forces such as third party payers (government and insurance), bureaucratic regulating bodies, a civil liability system that seems to have been designed by Jackie Chiles, and other outside industries such as the pharmaceutical industry, compliance industries etc.

I have compared our health care system with our veterinary health care system and made the contention that the veterinary system is vastly superior in many areas primarily due to a relative lack of such interferences. I contend that it is because veterinarians operate in a nearly free market system where the relationship between the veterinarian and the patient/owner is a direct one, without third party payers or as much government, corporate, or civil liability interference and fears, veterinarians are much more responsive to the needs and demands of their clients and clients are much more responsible with the money when it is coming out of their own pocket. They are much less apt to make needless visits to the ER and demand expensive tests and medications when there is not some nebulous third party footing the bill.

I have also mentioned that within this relative laissez-faire environment there are also some problems that become apparent in the form of people’s too frequent inability or unwillingness to pursue appropriate medical intervention due to financial considerations.

With this post I intend to finally start delving in with some ideas for bringing all this stuff together to try to come up with some solutions for creating a plan for intelligent health care reform. Continue reading ‘A Plan for Intelligent Health Care Reform Part 5′

Please Quit Smoking

Hi folks.

I still haven’t finished my series on health care reform which starts with A Plan For Intelligent Health Care Reform Part 1, and continues with parts 2-4. There are indeed more parts coming, but those posts tend to run long and are somewhat labor intensive not only for me to write, but I’m sure for you to read.

Also, mine is not a blog dedicated solely to health care system reform, but rather has a mission to touch on many more topics. I don’t want folks who are looking for advice on how to stay healthy, or who are looking for commentary of recent medical news and breakthroughs, etc. to get turned off of this blog by encountering a never ending stream of posts containing my long-winded pontifications about how to fix a health care system so broken that it’s repair has been the dominant topic of every presidential election for the past two decades.

So, this brief post will not be about health care reform. Rather it is a follow up post to my previous stop smoking post. This is probably my shortest post so far I think. It is here really to just provide you with a link to another blogger whose writings I find valuable and enjoy reading. He has written a post titled Smoke Scream.

If you are a smoker and are contemplating quitting, please read this post. I sincerely hope it will help influence you to quit.

That’s it for this post (told you it was short). More health care reform pontification coming up soon!

Cheers,

…Sam

A Plan for Intelligent Health Care Reform Part 4

Okay folks, in part 3 of this series on my plan for intelligent health care reform, I promised to try and keep this 4th post a bit shorter. I will endeavour to do that.

Up till now, I’ve been basically pointing out problems with our health care system, and also ranting about all the horrible plans and ideas being floated out there in the mainstream media and political land to “fix” them.

Not to sound like a broken record, but if you haven’t read parts 1-3 in this series, please do so now so this one will make a bit more sense and be read in context.

Anyway, to bring folks up to speed since it’s been almost a week since my last post, this whole series owes it’s life to an editorial I read in the Journal of Family Practice in which the editor, Jeff Susman, outlines his pleasurable experience with taking his dog to the veterinarian.

Continue reading ‘A Plan for Intelligent Health Care Reform Part 4′

A Plan For Intelligent Health Care Reform Part 3

If you haven’t read A Plan for Intelligent Health Care Reform Part 1 and Part 2 yet, please read them first, before proceeding with this post.

Sorry for the delay in getting this 3rd post up folks. The blame for that lays partly with a surge in activity in my off-line life concomitant with my fighting a nasty cold. (Also, I’ve recently been helping my friend get her website and blog about bargain wine reviews up and running. Go check it out if you get a minute. She’s got a pretty nice site I think.)

This stupid virus and my busy life only receive part of the blame however, as the bulk of the reason for my delay boils down to simple inertia on my part. When trying to piece together this third post in my mind, I have quite frankly been a bit overwhelmed by the complexity.

Continue reading ‘A Plan For Intelligent Health Care Reform Part 3′

A Plan For Intelligent Health Care Reform Part 2

Okay, as promised in yesterdays post, A Plan For Intelligent Health Care Reform Part 1, today’s post will basically just be a cut and paste of the letter I sent to Dr. Susman in response to his editorial entitled, “What if it’s cancer?”If you havent read the editorial, please do so before reading my letter below, as things will make a bit more sense that way.

Continue reading ‘A Plan For Intelligent Health Care Reform Part 2′

A Plan For Intelligent Health Care Reform Part 1.

Like most physicians, I’m usually a fairly busy fella. That’s one of the big reasons that this blog is typically only updated a couple times a week, rather than daily (or even more frequently), like a lot of blogs.

When I’m not in the clinic seeing patients, or trying to navigate through the massive bureaucracy associated with that, I try to read the latest professional journals to keep up with the latest research etc., so I can practice the best medicine I can.

This past weekend was one of those moments and I sat down to read the latest issue of the Journal of Family Practice. I often like to read the editorials and letters to sort of get a feel for how others in the profession are thinking.

So, what does that have to do with health care reform?

Well, the editorial in this latest Journal was of particular interest to me, and in it I think I see the makings of a plan for intelligent health care reform for the U.S.

Continue reading ‘A Plan For Intelligent Health Care Reform Part 1.’

Natural Cures for High Blood Pressure

SphygmomanometerSo, as I’m surfing the web earlier today, I happened upon the “Health & Healing” discussion forum at www.craigslist.com, which is basically a typical fun Internet free for all.

Lots of folks with lots of opinions on there.

Anyway, I came across one post from a user going by the name of “dlwhiz” that expressed the following.

“I need to find natural cures for high blood pressure. Anyone have a cure, pills are not working, they make me sick.”

There was of course a plethora of answers from all sorts of folks. These anonymous Internet posters offered all sorts of advice basically ranging from “Quit being so lazy, get some exercise!” to “Use some different medicines” to “Try these great herbal remedies!” (I’m paraphrasing here to capture the general tone of most of the posts…these aren’t actual verbatim quotes)

Some of the answers I read were better than others, but most of them had one glaringly huge flaw, one which as a physician I saw immediately and which I think most physicians would similarly pick up on immediately.

What was this horrible flaw?

Continue reading ‘Natural Cures for High Blood Pressure’

What you eat does matter!

whole wheat pasta and vegetablesHuh, this post title sounds different than what you emphasized in your last two weight-loss posts Dr. Sam?

I thought you said it was all about the calories.”

If that’s what you thought, go read those posts (The Hacker’s Diet and How to Lose Weight) again, a little more closely.

What I was emphasizing with those posts was that when it comes to losing weight (fat), it’s primarily all about the calories you consume.

I don’t want this message however to be misinterpreted as saying something along the lines of “As long as the calories are where they need to be, eat whatever the heck you want.”

That is most definately NOT my message.

Continue reading ‘What you eat does matter!’

More on How to lose weight. The Hacker’s Diet

Gates

If you remember in my How to lose weight post not too long ago, I gave you the zero dollar answer to that million dollar question.

That post ended up being about the equivalent length of a 13 page Microsoft Word document.

It seemed to me like an awful lot of writing to get across my basic message regarding fat loss, a message which is virtually overlooked in the myriad of diet books out there.

In a nutshell, my message is something along the lines of “While what you eat is important and you should definitely strive to make healthy foods the mainstay of your diet, and while getting plenty of exercise is important and you should definitely strive to get plenty of good exercise, when it comes to gaining or losing fat, all of that is trumped by the more important concept of how much you eat. When it comes to gaining or losing fat, it really is all about the calories you consume.”

Continue reading ‘More on How to lose weight. The Hacker’s Diet’

New Treatment for Alzheimer’s

Sometimes I like to surf around news sites in other parts of the globe to get a better feel for what’s going on in other countries, as well as how the foreign press is presenting what’s going on here in the U.S.

In my opinion, access to folks in all the far flung places of the world is the greatest thing about the Internet.

Anyway, I was buzzing around the website for England’s The Daily Telegraph the other day, reading all the news that’s “Fit for Brits,” when I came across an interesting story about some breakthrough medical research being done at UCLA on Alzheimer’s Dementia.

Here’s the story titled UCLA drug aids Alzheimer’s patient ‘in minutes’. Please give it a read, and then come back here. It’ll only take a minute or two.

Continue reading ‘New Treatment for Alzheimer’s’

AAFP’s “Medicare Stop the Cut” Campaign… an unexpected rant against socialized medicine

Okay, the following is a totally political rant. If you aren’t interested in a bunch of political ranting about socialized medicine, or the problems with Medicare funding, etc, (which, by the way is probably indicative of sanity and common sense on your part) then you should probably skip this post as it will most likely just irritate you. There is nothing in it that is informative about any particular medical topic or anything. It is not categorized under the “How to stay healthy” or “Silly Fun Stuff” categories for a reason. Disclaimer over with now. If you read further, don’t say you weren’t warned.

Continue reading ‘AAFP’s “Medicare Stop the Cut” Campaign… an unexpected rant against socialized medicine’

Vacuum treatment for Heart Attacks

This will be a quick post, which I think is only fair considering the Epic War and Peace style dissertation I put the readers through with my last post on How to Lose Weight.

This is just a sort-of follow up to my post about Penumbra.  If you remember, at the end of that post, I posed a couple of questions about potential other uses for this technology.

One of those other uses I wondered about was whether or not this treatment could be used for occlusive arterial conditions other than strokes, such as heart attacks for instance.

Well, it seems I’m not the only one who considered this sort of idea.  A study published in today’s New England Journal of Medicine titled Thrombus Aspiration during Primary Percutaneous Coronary Intervention shows very promising results from a study in the Netherlands looking into just just this sort of thing.

As promised, I will keep this post short by avoiding going into a lot of details about this study.  Hit the link above if you wish to get into the nuts and bolts of it.

In a nutshell however, the Dutch researchers compared doing a conventional stent placement in a heart attack victim vs first using a device (that sounds very much like the Penumbra device) to vacuum the clot out of the blocked coronary artery prior to placement of a stent.

They found that using the vacuum technique resulted in better perfusion and outcomes compared to conventional stent placement alone.

How To Lose Weight

Bathroom Scale

Today is Mardi Gras, and down in these parts (less than an hour from The Big Easy), Mardi Gras is a big deal.

For those not in the know, Mardi Gras is French for Fat Tuesday, and in these parts Fat is something we are quite familiar with!

The U.S. has a huge and growing obesity epidemic and New Orleans is pretty much the tip of the spear.

Fat is something we have in abundance, not only around here, but pretty much nationwide. It’s not just a problem confined to the U.S. either. The obesity epidemic is starting to catch on in the rest of the world as well.

Fat is like an annoying relative that just doesn’t want to go away. So let’s talk about this.

It seems like everywhere you look, there’s a new diet plan or secret weight loss pill or hypnotic technique or special tea from the Far East.

Getting rid of fat is a national obsession!

So, how do you do it???

That’s the million dollar question.

Dr. Sam is here to give you the zero dollar answer!

Continue reading ‘How To Lose Weight’

Disease and Medication Index Added

Hi folks,

This is just a quick note to point out a couple new links in the sidebar on the right. These are the Disease Index and Medication Index.

Each of these will take you to a page which will (eventually) have alphabetically listed links to other pages which will have information about particular disease conditions and medications.

As of this writing, I have a sample page in each one.

For the Disease Index page, there is a link to a page describing Giardiasis. This is information that is a cut and paste that came from the Centers for Disease Control website.

For the Medication Index page, there is a link to a page describing Amoxicillin. This is info that is a cut and paste that came from wikipedia.

Continue reading ‘Disease and Medication Index Added’

Here’s the “One Semester of Spanish Love Song”

Okay, this post has absolutely nothing to do with medicine, the healthcare system, medical practice or anything of the sort.

In a sort of tangential, really-making-a-stretch way however, it does have to do with staying healthy.

There’s an old saying that says “Laughter is the best medicine.” There’s even a good bit of empirical evidence to back that up. Here’s just one example.

Continue reading ‘Here’s the “One Semester of Spanish Love Song”’

Future Plans for the Blog

I’m still in the total newbie stages of this blog thing.

Yesterday, I finally received my order from Amazon that included the book WordPress For Dummies.

I’m quite excited by this as I hope to be able to greatly expand my abilities with this software and make this blog much more useful and much more user friendly.

Right now, what I’m hoping to do is use the software for more than just blogging. I want to use it as a content management system.

I’m hoping to create indexed pages that aren’t blog entries but that are rather stand alone pages that provide information about specific subjects. Things like information about specific diseases, treatments, medications, etc. Continue reading ‘Future Plans for the Blog’

Penumbra

I just read an interesting story about a new treatment for occlusive strokes.

The device is known as Penumbra and is being put out by the company of the same name Penumbra, Inc.

From the story I read, and from my brief visit to the company website, it looks like it might have promise to treat some stroke victims who otherwise would be sort of out of luck.

Basically, from the description, this is a catheter type device that is threaded into the femoral artery (The great big artery in your groin that feeds blood to your leg), and is worked in retrograde fashion up the aorta and then into the appropriate arteries (carotid, etc.) until reaching the site of the blocked artery inside the skull. It then acts basically like a vacuum cleaner and sucks out the blood clot that is blocking the artery and causing the stroke.

Continue reading ‘Penumbra’

Yes, you CAN quit smoking!

“Doc,” he said to me with all sincerety, “I’d really like to quit smoking but I just can’t.”

How many times have I heard that ridiculous statement???

Of course you can quit smoking.

It may not be easy, but absolutely YES YOU CAN!

Continue reading ‘Yes, you CAN quit smoking!’

How to stay healthy

Okay, this will be a generalized, common sense post. It’s not intended to go into a lot of detail, but is intended to be more philosophical in nature.

Here’s the deal for staying healthy.

Think of your health as being like playing a hand of poker.

The cards you are dealt…..those represent your genetics, and those things life throws at you that are beyond your control.

How you play those cards represents your lifestyle…how you respond to life….in essence what you choose to do or not do with the body you have.

Continue reading ‘How to stay healthy’

Welcome to drsamonline.com

Hi everyone. As you may have guessed, I’m Dr. Sam. See my “about me” link for further details.

This is the first of what I hope will be many posts.

This is my first foray into the world of blogging, so please bear with me as I learn the ropes.

My obvious goal with this blog is to reach people.

I’m a practicing physician and find that on an almost daily basis I seem to have less and less time to really discuss issues with my patients. Issues ranging from their specific medical problems to problems in society as a whole.

There is an endless flood of bureaucratic hurdles that get between me and my patients.

This is not just true for me, but for pretty much all doctors these days.

I think this is disastrous.

My goal for this blog is to make up for this somewhat.

Continue reading ‘Welcome to drsamonline.com’







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