Wednesday, February 28, 2007

Pain Management Dilemma

The Washington Post came out with an article on Tuesday with the attention grabbing headline, "Doctors Warned About Common Drugs For Pain: NSAIDS Tied To Risk Of Heart Attack And Stroke." The American Heart Association came out with a statement discouraging use of Cox-2 inhibitors because of it's association with heart attacks and stroke.
"In the past, many physicians would prescribe the Cox-2 drugs first," said Elliott Antman, a professor at Harvard Medical School who led a group of experts assembled by the heart association to study the issue. "We are specifically recommending that they should be used as a last resort."

"This is a very firm statement we are making," he added. "It is our belief, hope and desire that physicians will take our advice, and by doing so it is our belief and hope that we will reduce the number of patients who suffer heart attacks and strokes."
Now, I have no problem with this. My patients have been scared off from these drugs with all the press coverage that has been surrounding these drugs, that the mere mention of these drugs during an office appointment sends the patient running away.

Here's where I start to have a problem with the AHA statement....
Patients should be treated first with nonmedicinal measures such as physical therapy, hot or cold packs, exercise, weight loss, and orthotics before doctors even consider medication, said the AHA scientific statement published in the journal Circulation.

Patients who get no relief after those measures have been exhausted can be considered for drug therapy, but doctors should try drugs only in a certain order, the statement said:

"In general, the least risky medication should be tried first, with escalation only if the first medication is ineffective. In practice, this usually means starting with acetaminophen or aspirin at the lowest efficacious dose, especially for short-term needs."

While most patients are likely to be helped by those drugs, a smaller number may need to try a drug such as naproxen. Patients who require additional help should be given other nonprescription painkillers such as ibuprofen, and only after that option has been exhausted should physicians consider Cox-2 inhibitors, Antman said in an interview.
I can tell you as a primary care physician, most of our patients already do the non medication therapies even before seeing me. In addition, they have already tried a number of over the counter antiinflamatory therapies. When they come to me, they are usually looking for the next step up in therapy. Then, when I introduce the idea of the Cox-2 inhibitor, they balk. So, now what? Hold that thought....

In doing more research on this topic, I ran into an article entitled, "The Poor Management of Pain." It talks about how physicians do a poor job at managing chronic pain, especially with the reluctance in using opioid/narcotic medicines.
It is seemingly a no-win situation. On the one hand, the more you treat pain with opioids, the more likely you will be investigated by state or federal authorities. But, on the other hand, the less you treat pain with opioids, the greater your chances of being sued for civil damages on the grounds of undertreatment.

“Lawyers are lining up right now...looking for cases of poor pain management,” according to remarks given by Bill McCarberg, MD, director of the Chronic Pain Management Program at Kaiser Permanente in San Diego and an assistant clinical professor at the University of California, San Diego, who also serves on the board of the American Pain Society. “Whenever you encounter litigation against doctors for pain management, it is never because...we do not allow the patient to get a muscle relaxant...It is always about opioid management. We get sued because we’re not using opioids.”
So, on a daily basis, I'm constantly challenged on how to adequately treat my patient's pain. On the one hand, there are antiinflamatory medications which have the dangers of heart attack and stroke - News Headline: Doctors Warned About Common Drugs For Pain. On the other hand, there is the use of narcotic pain mediciations which have the dangers of addiction and tolerance - News Headline: Doctors Do A Poor Job At Pain Management. I apologize for the whining, but sometimes all this stuff really makes my head spin.

Tuesday, February 27, 2007

Obesity = Child Abuse?

Connor McCreaddie, pictured with his mother above, is a pleasant 8-year-old boy who lives north of London. British authorities are so concerned about Connor's 218 pound weight that they are considering taking the child into protective custody unless mom "improves his diet." (
An unnamed health official was quoted as telling The Sunday Times that taking custody of Connor would be a last resort, but said the family had repeatedly failed to attend appointments with nurses, nutritionists and social workers.

"Child abuse is not just about hitting your children or sexually abusing them, it is also about neglect," the official was quoted as saying.
Child abuse? Now, I admit, I don't know all the details on this case (other than what is in this article). But, child abuse? I know that this boy is overweight. I would even agree with classifying him as clinically obese, but characterizing this as child abuse? I think that's a little of a stretch, don't you think?
Dr. Colin Waine, the director of the National Obesity Forum in Nottingham, England, called Connor's lifestyle "extremely dangerous," adding he is at risk of developing diabetes in his early teens, and cardiovascular and nervous system problems in his twenties. "He's really at risk of dying by the time he's 30," Waine said.

Pediatrician Dr. Michael Markiewicz agreed. "I'm not saying they can't care for him, but what they are doing is through the way they are treating him and feeding him, they are slowly killing him," he said.
Now, don't get me wrong. I am not endorsing this style of parenting (or lack of parenting). And, again, I have to give the disclaimer that I am not a parent myself. But, if childhood obesity equals child abuse leading to taking a child away from a parent, can you imagine the volume and amount of protective custody cases that would take place in the United States?

According to the Institute of Medicine, NINE MILLION children in the United States over six years old are considered obese. From what I understand, the foster care system is overloaded right now. To add another nine million children would add chaos to chaos.

One more thing to think about. What if childhood obesity was changed to childhood asthma? And, the childhood asthma was caused by secondhand smoke, say, from the parents? According to the American Lung Association, "An estimated 400,000 to one million asthmatic children have their condition worsened by exposure to secondhand smoke." Would you consider this child abuse? Are parents "slowly killing" their children as the pediatrician suggests above?

Sorry for the diatribe, but here's my point. Yes, this is an unfortunate situation for this young man. But, for the government to get involved in this situation is riduclous. There has to be another way to solve this other than to separate a mother from her son.

Update (3pm eastern time): Apparently British authorities have backed away from their position to try to remove Conner from his mother - For now...

I also posted a video blog on this same commentary. Check out my sidebar and click on the link to my livevideo site. Videoblogging is still tough, but a new challenge that I'm working on.

Monday, February 26, 2007

Original Wendy's To Close Friday

It's the end of an era. The picture above is Dave Thomas, founder of the Wendy's restaurant, standing in front of the original Wendy's in downtown Columbus, Ohio. On Friday, this first Wendy's restaurant will close its doors for the last time. (Columbus Dispatch)
"This was a painful decision," Denny Lynch, a spokesman at Wendy’s headquarters in Dublin, said yesterday after confirming the move. "The store is a walking history of the company."

Wendy’s had put off the decision to close the restaurant at 257 E. Broad St. for years, and acted only after determining that the building would require a costly upgrade.
As you probably know, I've lived in Ohio most of my life. And, I've been to Columbus lots of times. Unfortunately, I had no idea the first and original Wendy's was in downtown Columbus. If I did, then I would have visited there often.
Dave Thomas, who died in 2002, opened the restaurant Nov. 15, 1969, as Wendy’s Old Fashioned Hamburgers. It was named for his 8-year-old daughter, Melinda Lou, whose nickname was Wendy. The chain now has 6,600 stores.
In many cities across the United States, many businesses are fleeing from the downtown area. Columbus is no different. There used to be a science center right across the street from this particular Wendy's, and then they moved as well.
The restaurant had its own set of problems. It lacked a drive-through, had limited parking and was not open in the evening because of the lack of dinner traffic.

The flagship store’s closing will have far more sentimental impact than any financial effect on Columbus or on Wendy’s, said Richard Steckel, economics professor at Ohio State University.

"A lot of people had their first dates there, and the people who work for the company are definitely attached to it," he said. "It’s always sad to see a landmark like that go, but it’s the nature of capitalism."
I definitely have mixed feelings about this. When people want to keep something just for a sense of tradition or sentimentality, I'm pretty harsh on them. "Sometimes you have to let go of the past and embrace the present and look to the future," I sometimes say to people.

Even when people say that Dave Thomas himself would have agreed with this move, it doesn't make me feel any better. Maybe a new restaurant will be built and all the memorabilia will be placed there? Of course, the restaurant would be built in the suburbs and not in downtown, because that's probably what Dave would want anyway - For better business...

Saturday, February 24, 2007

Girl Scout Cookie Rant

For the love of pete, please say it ain't so! What the heck is this world coming to? How do you define America - Baseball, Mom, Apple Pie, and the Girl Scout cookie (Thin mints, thank you very much).

Yes, it's that time of year again, ladies and gentleman. It's the time of year where all is right with the world. Yes, there's a war on terror going on. Yes, there is poverty and hunger taking place across the world. But, to escape this reality, what do we have? We have the Girl Scout cookie.

People think I'm nuts - and they may be right. But, if you want to properly participate in binge eating (as I do sometimes), then you need the Girl Scout cookie (Thin mints, thank you very much).

But, alas, friends and neighbors. As I was scanning the news today, I ran across a story which stopped me in my tracks. A story which made me cry out, "Oh no! The Girl Scouts caved in, too!"

Beginning this year, ALL Girl Scout cookies will be trans fat free. (Apparently, some GS brands are already trans fat free.) According to this AP article, the scouts want "to add an element of health consciousness to their annual bake sale."
Initial feedback has been positive, said Anna Ho, who organizes sales for Troop 805 in Parsippany, N.J.

"People are saying, 'It's about time,' said Ho. "Everybody is conscious of the trans-fat issue ... My own sister used to rub me in the ribs sometimes and say, 'When are you going to go healthy?'"
Uh, excuse me? But, if I was going to choose something healthy, I would not choose GS cookies. I would choose something like fruits and veggies to snack on.

This is an appeal to the Girl Scout leadership. Please, please, please leave in the trans fats in your products. How could I ever live without those darn trans fats in my favorite Girl Scout cookies? (Thin mints, Thank you very much!)

Thursday, February 22, 2007

Serbian Surgeons Gone Wild

While this story may sound like a television show, this is a real deal. Sometimes, you can't make this stuff up. I cannot add any more comedy to this, so I'll quote it verbatim below.
BELGRADE (Reuters) -- A routine appendix operation in Belgrade went badly wrong when two surgeons started fighting and stormed from the operating theater to settle their dispute outside, the daily Politika reported Wednesday.

Surgeon Spasoje Radulovic was operating when his colleague Dragan Vukanic entered and made a remark that started a quarrel, said the anesthesiologist on duty.

"At one moment Vukanic pulled the ear of the operating doctor, slapped him in the face and walked out," she said.

Radulovic followed and an all-out fight ensued, resulting in bruises, a split lip, loose teeth and a fractured finger.

The operation was completed successfully by the attending assistant doctor.
Now, the Doctor Anonymous blog has just received the exclusive footage of this altercation from Belgrade, Serbia. The video is pretty grainy. I guess it's from a security camera in the operating room. What's a security camera doing there? Who knows?

But, because I'll do anything for all of my readers, and I'll do just about anything for ratings, here is the Doctor Anonymous exclusive footage of the fighting video. Enjoy!

Wednesday, February 21, 2007

Ash Wednesday

With this being the first day of lent, this day already has a type of reflective flavor. But, for me, it's an especially reflective day. I remember it like it was yesterday.

It was the day that the above movie opened, and it was on Ash Wednesday. I was looking forward to seeing The Passion, and then, that afternoon, I received a letter. It was a letter from an attorney. It was a letter requesting medical records regarding a case that I was involved with 12 months prior.

It was a letter which sometimes starts the process which ends up in a court room. The accusation? Malpractice... Beginning that day, I could not sleep for months as that case went through my head again and again. I learned more about the legal system than I ever wanted to know.

Of course, I cannot talk about the particulars because of patient privacy laws. But, suffice to say that this day changed my professional and personal life forever. So, that's why Ash Wednesday is especially reflective for me....

Monday, February 19, 2007

Happy Mardi Gras

I know it's tomorrow, but I wanted to get a head start on things. Yes, that's me behind the mask above. HA! I've never been to New Orleans for Mardi Gras or South America for the carnivale celebrations. But, those are on my To-Do list for sometime during my lifetime. If you're looking for a party today, head on over to morgEpalooza! It's his birthday today, and he's only had about 50 posts over there today (he's been quite busy). Wish Morgen a Happy 40th Birthday!


Sorry I haven't posted in a few days. Over the weekend, I offered to help with a project related to work. Unfortunately, this project will take up some of my blogging time (ek!). Don't worry, I'm not going anywhere. I just wanted to let everyone know that I may not be posting as much as I usually do. I'd share what it is, but it's dull and boring to describe. I look forward to a new challenge and a new opportunity for my time and talent. I'm still a blogaholic. But, in the next few weeks, I may be reading blogs more than writing posts....

Thursday, February 15, 2007

Court of public opinion

I was struck by a story recently featured on Kevin, MD (interesting comments on this post as well). A patient in California goes to a plastic surgeon, has a procedure, and is not satisfied with the results. So, what does she do? She tells everybody about it. But, here's the twist, she's using the internet, with an interesting website name, to express her opinion.

This story has been going through my head, especially with my recent experience with "the haters." And, I apologize to those of you out there who are sick and tired of me talking about this. But, there is going to be a time, sooner than I think, that a patient around here is going to find out that the wildly popular (LOL) Dr. A is their physician.

According to this news story, patients are well within their 1st Amendment rights to express whatever they want about poor medical care. But, physicians are not able to respond because of the federal privacy rules. That's kind of scary if you ask me.

Now, trying a case in the court of public opinion is not a new thing. I realize people have been doing this forever. But, now, this takes on an interesting twist when the internet is involved. Potentially having my name and reputation smeared internationally is not something that I thought of when I applied to medical school.

Finally, on a lighter note, and from the "Dr. A is a hypocrite file" (*cough*), here is a video blog (not by me), talking about her adventures with her favorite cellular phone company (at least she's not talking about me). Enjoy!

Wednesday, February 14, 2007

Bestest blog carnival

Yes, that's right. The theme for the Bestest Blog carnival is Valentine's Day. Who better to host this week than Cathy who is still trying to dig out of her house even in the midst of the snowstorm still going on! Thanks for including my submit.
Dr. A. gives a unique take on SEXY. Do you think "sweat" is sexy? Does it turn ya on? Well, apparently some people think so. Read Dr. A.s post, "Sweat as an Aphrodisiac" and don't forget the colorful comment section.
In case you don't know, a blog carnival is a bunch of posts, written by different authors, brought together by a host/hostess. Sometimes there is a theme to the carnival and sometimes there is not. But, there is always great writing in blog carnivals like this one.

Mine was kind of a light hearted post. But, there are many touching stories in the carnival this week. I would encourage you to check it out. The Bestest Blog of All Time sponsors this carnival.

Tuesday, February 13, 2007

It's beginning to look a lot like Christmas...

The problem is that it's the day before Valentine's Day. Yeesh! The picture above is from the National Weather Service. All the pink (some people would call it lavender) has been designated "Winter Storm Warning." Here's what this means from NWS (Sorry about the capital letters. It's from their bulletin):





I know my friend Cathy is feeling the pain. She's got a Blizzard Warning (that's the red above). So, be careful out there in the Buckeye state today. The only people that like this type of weather live in Alaska and are in the Iditarod sled dog race. I guess it could be worse. I could be living in upstate New York. Yeesh!

Monday, February 12, 2007

Seasonal Affective Disorder

As I was writing this last week, I looked outside my office window and the bank said it was -2F and the wind chill was somewhere between 10-15 degrees below zero. Bottom line, it's cold, baby! (Picture credit: FridayEve)

In the past, I wasn't a believer in Seasonal Affective Disorder, or SAD. I thought it was as believable as global warming. (Oops! I'm going to get comments on that one.)

People describe this time of year as the "doldrums of winter," where it's just cold, cold, cold as opposed to the "dog days of summer," where it's usually hot, hot, hot.

Around here, people's patience is short and tempers are flaring. A lot of people describe this as having "cabin fever." Maybe it's just this seasonal affective disorder after all. Here's a brief essay from Katie Couric.

In this article from, it describes SAD in kind of a comical way:
If anyone accuses you of being a surly misanthrope between the months of November to February, you can justify yourself with words to the effect of: "Sorry, but I'm suffering from a biochemical imbalance of my hypothalamus triggered by a melatonin deficiency in my pineal gland. So get off my back!"
Is this really a medical condition that requires treatment, specifically medication treatment? There's this report from last summer advocating med treatment for SAD.

What most people ask me about is the mysterious "light therapy" for SAD. "What's so magical about light therapy, doc?" I admit I don't know all about the research on this and the biokinetic process, but in my anecdotal experience, this light therapy thing may actually work.

My question is this: Does blogging count as light therapy? How about excessive television viewing? Hmmmmm.... I'll have to work on that. I'm not a card carrying SAD believer, yet. But, if this cold snap continues around here, I'll have more data to make an evaluation.

Friday, February 09, 2007

Sunday Naked Sunday

No, this is not the porn spinoff of the U2 song called, "Sunday Bloody Sunday." (Gotta love that U2.) Kind of picking up where yesterday's story left off...

This Associated Press story is from Amsterdam, Netherlands (naturally). For those of you who like to exercise in the buff, have I got a Dutch gym for you. Beginning March 4th, Fitworld gym in the town of Heteren will be offering the first Naked Sunday for its patrons.
"I heard that some other gyms are offering courses on 'pole-dancing' as a sport, so I thought: Why not bring something new to the market?" [gym owner Patrick] de Man said.
Is this guy's name really "de Man?" I don't believe that, but oh well. If you're worried about things being sanitary, the gym policy will be for nude exercisers to put towels down on weight machines and to use disposable seat covers while riding bikes.

Boy, does that make me feel better! And, if you sign up now, your second month is free. Yeesh! I'm all for tolerance, but a nudist gym? Where are the nudist saunas and hot tubs? Oh yeah, I forgot. They're next door - It's Amsterdam. Have a great weekend!

Thursday, February 08, 2007

Sweat: An Aphrodisiac?

You may have heard the phrase, "Never let them see you sweat." Well, there is new evidence that smelling sweat, yes smelling sweat, may be your ticket to gettin' the ladies. What am I talking about?

In this week's issue of The Journal of Neuroscience, researchers at the University of California, Berkeley, are studying how humans use chemosignals to attract one another. Rats, moths, and butterflies are all known to send chemosignals to secure mates. (Scientific American online). The researchers used androstadienone, a constituent of sweat, and studied the effects of how smelling this would affect the women subjects.
The researchers exposed 21 subjects to 30 milligrams of androstadienone and to yeast, which is not in sweat but has a similar olfactory sensation. The participants took 20 sniffs of each in two separate trials.

The researchers measured physiological vital signs like body temperature, skin conductance, ear pulse, blood pressure, respiratory function and cardiac rate throughout the experiment.

The results: smelling the androstadienone increased positive mood, total physiological arousal and sexual arousal, which grew with longer exposure.
I wondered why all those guys I see at the gym all the time have an active social life. It couldn't be because they're fit and trim and muscular and I'm fat and inactive and flabby. Nah! It's all in the sweat, dude!

So, guys, as an early Valentine's Day tip from Dr. A, it's not about jewelry. It's not about roses. It's not about chocolate. And, it's not about a romantic candle light dinner.

Wanna date? Then, go to the gym and workout so much that the ladies will be all over you. Probably, they'll be calling an ambulance or your mommy because you'll over do it on the treadmill (see picture above). But, at least, you'll be sweating, and that's all that matters. Happy Valentine's Day! HA!

Wednesday, February 07, 2007

Nat'l love your patients day

Did you know it was National Love Your Patients Day? Yeah, I didn't either. I heard it on the radio this morning and, just now, a patient mentioned it to me. What does that mean for the rest of the days of the year, that we don't love our patients? Saying stuff like this potentially has implications - just ask Joe Biden.

Anyway, in doing some research on this, this day was conceived by an ER doc in Maryland. You can read more in this press release. But, here's a quote:
"This day was born out of the need for a more compassionate system of health care in this country. We need to restore the heart and humanity of medicine," [the physician] says. "We're reminding doctors and other health professionals, whose jobs are increasingly influenced by technology and insurance companies, about what is most important in health care: patients, and their values and dignity."
I really shouldn't be hard on the guy. It's a good idea to remind us to "love our patients." Trying to make the doctor/patient relationship less advisarial is always a good thing. So, as I journey onward today, I will wish everyone a happy National Love Your Patients Day! It's the least I can do....

I'm done

That's right. I'm done! I'm done with the whole "boo-hoo-hoo"-feeling-sorry-for- myself, self-pity, crawl-underneath-a-rock, attitude. I just got back from the fortress of solitude (LOL), and I've decided that it's time to get back to blogging! By the way, do you like the new template?

On day number two of my blog life back in June '06 (feels like a million years ago), I talk about the Safety of Anonymity. It took seven months for me to accept the reality that anonymity really doesn't exist on the internet.

Yes, I did something really stupid to challenge this. Making and posting a video blog was not the brightest idea - especially if privacy was something I wanted to maintain. I know that I brought some of this on myself. I definitely accept full responsibility for this mistake. But, I don't regret it, and (for now), my video blogs will remain up.

When it comes to hate mail, many of you have told me to just forget about it and journey onward. Here are some similar thoughts from SaboCatGirl and Addumb. Maybe in a sick and twisted kind of way, it's a compliment. I also was referred to a video on youtube talking about a case of internet harrassment.

Finally, I want to thank everyone who sent so many supportive e-mails and comments. I apologize for not responding to each and every message. But, you have to know that it meant more to me than you'll ever know....

Oh, if there's one thing I hang onto,
It gets me through the night.
I aint gonna do what I don't want to,
Im gonna live my life.
Shining like a diamond, rolling with the dice,
Standing on the ledge, show the wind how to fly.
When the world gets in my face,
I say, Have A Nice Day!

Thursday, February 01, 2007

The Myth of Anonymous Blogging

The Fall of a Blogger: Doctor A now stands for Doctor Arrogant. You could also call me Doctor Naive. On YouTube and LiveVideo, they call them the haters. Over here I've heard them called bullies. They are nameless and faceless people whose sole purpose in life is to bring people down.

The media's job is to build people up only to tear them down. And, let me tell ya, there are a lot of people out there to help with the latter. You can do what you can to try to fend them off, but they will get to you eventually.

I thought I could stand up to them with a vblog, but the wrath of the haters is just too powerful. I thought I was the smartest kid in the class, but little did I know how many clues I left lying around my blog for people to locate me.

Both friends and enemies have e-mailed me in the last twenty-four hours. All of them have successfully listed my real name, place of employment, medical school, state medical licence number, and my memberships in professional associations.

All of them told me they knew this information BEFORE my first vblog. They were just waiting for the right time to let me know. One e-mail even included a picture of my office building (I think it was taken yesterday).

Let this post serve as a message to all those "anonymous" bloggers out there, particularly medical bloggers. No matter how careful you think you are about your information, there's someone out there who can learn everything about you.

I've never had this happen to me, but this only thing I can think of is the feeling of identity theft when that happens. I'm a very shy person in real life, and my privacy is something that I hold very dear. So, an incident like this has shaken me to the core.

I don't know what I'm going to do. Part of me wants to continue to spite the haters. But, I tried that once, and look where it got me. I'm going to have to do some soul searching while all this emotion works out of my system.

I very much appreciate everyone's support and well wishes during this week (has it only been a week since this has happened?). Unfortunately, it cannot overcome the hate that I've been receiving during this same period of time.

I need some time to think and see if I come back to blogging. Blogging is definitely not fun right now, and is causing MORE stress than work. I don't need that. That being said, I've decided that the Doctor Anonymous blog will be taking a brief hiatus. But, I shall return, maybe....