Physician Heal Thyself

Let's face it, as physicians, we make the worst patients! I don't have high blood pressure! Eh, I'll go on a statin next year. My blood sugar isn't that high! Let me put off my colonoscopy until next year. And I'm not any better! For years I was struggling with fatigue. I blamed it on everything else outside of me—my job is too stressful, I have to wake up too early, I was on call, etc. And for years, my wife kept urging me to get a sleep test. There's no way I have sleep apnea, I reasoned to myself, I'm not overweight, I exercise daily, and I don't snore (at least not that badly). Finally, when I could take the fatigue no longer, I acquiesced and got my sleep test done. After the test was over, I felt stupid! There's no way I have sleep apnea! What a complete waste of time! There goes a hugh deductible thrown out the window. The next day, the result came back: I stopped breathing over 80 times that night!

Wow!

Yet, in a way, I was totally relieved! There was a possible cure for my fatigue. The first night I started using the CPAP machine, my brain started making up for years of lost sleep!—I had a crazy and vivid dream about standing on an cliff beside a frothing ocean teaming with sharks. It was so cool! That's when I realized that this was my first dream in years! YEARS!

Now I'll admit it... Using a CPAP machine is not the world's sexiest thing. But, since I am a Star Wars fan, there is something really cool about looking like a Kotobukiya Star Wars TIE Fighter Pilot! And beside, my kids dig it (and I like to chase them around the house with my mask on).

Of course, I'm just exaggerating—the mask and machine are much smaller than I anticipated! Frankly I was shocked by how far technology has come. And the CPAP machine is no bigger than a "breadbox" (whatever the hula hoop that is). It's a cinch to take on vacations.

So the take-home-message for me is this: Physician heal thyself! Before I can heal others, I need to work on healing myself first. 

So good night and pleasant dreams! Oooooooooo... SHARKS!!!!  

BMJ Study: Why is Rudolph's Nose Red

The BMJ just published an observational study explaining the redness of Rudolph's nose—evidently, reindeer have 25% more capillaries carrying oxygen-rich blood in their nasal architecture than humans. Now, I'm not sure that this investigation answers all the questions—it might answer why reindeers have red noses, but it doesn't answer why Rudolph has a luminescent one! My personal belief?—elf fairy dust.

Zombies and the CDC

It's about time that the CDC started to take Zombies invasion seriously! Geeeeesh! I mean how many people need to succumb to the vile ranks of the undead before our governmental agencies finally develop policies that protect our frightened innocent!

Teaching A Child to Ride A Bike

Ok... I know what you're thinking: what in Sam Hill does "teaching a kid to ride a bike" have to do with medicine? Well, we do have a pediatric obesity epidemic in the good old USA, and I figure that anything we can do to encourage kids to get outside and enjoy some fresh air must be a good thing. That's the official excuse.

Here's the real reason: I've been spending the last two weeks trying to teach my 5-year-old daughter how to ride a bike and I've been saying to myself between bouts of extreme dyspnea, "There must be an easier way!" Imagine a middle aged man profusely sweating while trying to hold up a frightened 5 year old who is wobbling like a drunk dude with meniere's disease on a bicycle!

Anyway, I failed again today! It ended when she fell off and scraped her hand on the pavement. She was frustrated and slightly tearful. So I went inside, wiped the sweat from my face, and looked for help on YouTube...

AND LO AND BEHOLD! THE SOLUTION! GENIUS!
(Especially since I don't have to run like a sweaty pig behind her)!

THE SECRET TIPS:

1. Lower the seat so that her feet can rest comfortably and flat on the ground
2. TAKE OFF THE PEDALS
3. Let her just practice scooting and balancing first!

AWESOME! I'm so excited to try this out tonight!

I always knew the best teacher are able to break down complicated skills into manageable bits. By simply lowering the seat and taking off the pedals, my daughter will be able to learn to balance first without worrying about pedaling, catch her own falls without having me always running beside her, and learn to do starts by herself. Lowering the seat and taking off the pedals! Simply genius!

Itchy After Seeing Scabies?

Is it me just me—or do other doctors get really itchy after diagnosing a really bad case of scabies?

The Miracle of Insulin

Have you ever stopped to wonder what a miracle insulin is? Before 1922, the death rate from type I diabetes was 100%. It wasn't until 1922 when Frederick Banting discovered insulin that hope arrived. Can you imagine that? 1922! That was not that long ago!

As doctors, we take insulin for granted. Right now, I'm going through the book The Discovery of Insulin by Michael Bliss. It's a great read! Full of suspense and intrigue! It's amazing how far we have come since the early days of Frederick Banting's discovery.

The Pain of Prior-Auths

I hate filling out medication prior-authorization forms! Luckily I don’t have to do it much since I usually prescribe generics. However, sometimes using name brand medications is unavoidable. For instance, I have one patient who is on Celebrex for osteoarthritis. She had serious GI side effects with traditional NSAIDs. And because NSAIDs may reduce the efficacy of aspirin (which the patient is taking), we decided to stick with Celebrex. SO EVERY STINKING YEAR FOR THE PAST FIVE YEARS, I go through the same song-and-dance with her insurance company. It is an unnecessary AND time-consuming AND irritating job. This last round, I wrote this on the bottom of the form:

PLEASE APPROVE HER CELEBREX FOR MORE THAN ONE YEAR!!!!! HER HISTORY DOES NOT CHANGE FROM YEAR TO YEAR!!!!  AND THIS IS AN UTTER AND COMPLETE WASTE OF MY TIME!!!! STOP BOTHERING ME!!!!!

My MA looked at me with some skepticism before faxing the form. Two weeks went by with no reply. Then I got this faxed back from the prescription management company:

CONGRATULATIONS! We have approved your patient’s Celebrex for 6 MONTHS!

Nice!!!!! I must admit though—instead of being fuming mad—I thought this was a brilliant response. Six months! That must be the best passive-aggressive response I have ever heard! I showed the fax to my partner who just laughed. I should have kept it. Then, I could frame it. Actually I should have kept faxing back the same form! Maybe I could get it down to 6 days!

Proper Inhaler Technique

This a good reminder for those of us who treat asthma...