Dr. A Show 26: Wrap-up

Thanks so much to Dr. Doug Farrago from Placebo Journal for being on the show. We talked about what it's like being a Family Medicine physician in Maine. Talked a little bit about his boxing career and a little bit about his practice. Of course, we talked about his book, his magazine, his blog, and his youtube channel. It's great seeing a doc utilizing all kinds of new media. I'm hoping other docs do the same in the near future.

Next week, I'll be taking the show over to Talkshoe which is another internet radio site. Our guest will be Bertalan Mesko from Science Roll. Very impressive blog if you have never checked it out before. He also hosted Grand Rounds this week. The link to The Doctor Anonymous Talkshoe Show is right here.

I'll talk more about it soon. But, it's similar to BlogTalkRadio in that to fully participate in the show, you'll need to officially register on their site for an id. What's interesting about it is that you do not have to use a phone to call in they have something called The ShoePhone - which is software you download. And, if you have a microphone or headset for your computer, you can use that to participate in the show. So, that's what is going on for Show #27. In the mean time, enjoy Show #26!

Doug Farrago, MD on The Dr. A Show

Thursday, February 28th, 2008 at 9pm Eastern Time

Join us on Thursday night for Dr. Doug Farrago who is the the self-proclaimed "King of Medicine" and is creator of the empire we know as The Placebo Journal. This is probably one of the only people in the medical blogosphere who is more connected than me.

Not only is he an author of a book and a blog, he also has a magazine and even has his own channel on You Tube called "Placebo Television." In the above video post, he talks about Dr. Robert Jarvik who was back in the news this week. He ends each video with this signoff, "Thank you for tuning into Placebo Television, where we always keep our finger on the prostate of medicine." Can't wait to ask him about that.

Take part in the chat room, which is the "show within the show." A great opportunity to interact with medbloggers you've only read about. You can even call into the show to talk and/or ask a question. See you for the show!

For first time Blog Talk Radio listeners:
*Although it is not required to listen to the show, I encourage you to register on the BlogTalkRadio site prior to the show. I think it will make the process easier.

*To get to my show site, click here. As show time gets closer, keep hitting "refresh" on your browser until you see the "Click to Listen" button. Then, of course, press the "Click to Listen" button.

*You can also participate in the live chat room before, during, and after the show. Look for the "Chat Available" button in the upper right hand corner of the page. If you are registered with the BTR site, your registered name and picture will appear in the chat room.

*You can also call into the show. The number is on my show site. I'll be taking calls beginning at around the bottom of the hour. Hope these tips are helpful!

I'm A Blogaholic: Gone

The I'm A Blogaholic blog was started almost a year ago during the whole Flea episode - and when Fat Doctor took down her blog (she did eventually come back). At the time, the blog was a great way for people to just talk about what was happening at the time.

But, as typically happens, people move forward and move on. And, that has showed in the past few months. The number of posts and the number of visitors have decreased. So, I've decided that The I'm A Blogaholic Blog has run it's course and will be taken down in the next few weeks. So, thanks for the memories!

Google YOUR private health information?

What if I told you that companies like Google and Microsoft will soon have the opportunity to handle your private medical information? Maybe this is information that you do not want anyone else to know - other than - say your doctor? Earlier this week the state of Tennessee announced a partnership with AT&T for the first statewide network to share health information.

An article in today's Washington Post states that the Cleveland Clinic, in association with Google, will be starting a pilot project that is aimed at putting personal electronic health records in the hands of consumers. (I've talked about personal health records on this blog in the past)

What Cleveland Clinic wants to do is have the ability to merge outside electronic medical records with their own system. For example, if I refer a patient up there, currently, the only thing I can do is send paper records and even x-rays up to Cleveland Clinic with the patient. How much more convenient would it be for me and the patient to have a way to send electronic records and have the opportunity to feed it into their system. That would save time and paper.

What Google wants to do is be the reservoir of all this information - and in some way, make this information available to the health consumer - meaning the patient - meaning you. That's a good idea, right? Here's the problem: What about all the privacy issues? How comfortable are you that companies like Google and Microsoft would have your private medical information?

Medical files in the care of health-care providers like doctors, pharmacies and hospitals enjoy legal protections specified by the Health Insurance Portability and Accountability Act (HIPAA). Covered files are strictly controlled, can't easily be subpoenaed, can't be exploited for profit and have to be stored securely. But Microsoft and Google aren't health-care providers.

"When you move records from a doctor to a personal health record, your protection evaporates," said Robert Gellman, author of a World Privacy Forum study on the subject released last week. He concluded that such systems "can have significant negative consequences for the privacy of consumers."

People joke about "googling" someone - like friends - or even enemies - just to see what comes up. I know my patients "google" my real name to try to learn more about me. What if MY personal medical information was in the hands of Google? What if YOUR personal medical information was in the hands of Google or Microsoft?

In this country, our privacy is pretty much gone anyway. I mean if you're out in public and do something stupid, someone with a camera cell phone records it and is on you tube within the hour. Or Flickr? Or someone blogs about it? And we've all heard of employers who have obtained this information and people are fired. But, this is invasion of privacy on an entirely new level.

Now, people from a potential boss to a private investigator would possibly have the ability to look up your most private medical and health information? This is just wrong and it's dangerous. The article says that an act of Congress is needed to require non-medical providers like Google to follow the same privacy laws that I follow and that hospitals follow. Do you think this will happen? What do you think about these tech companies holding your personal medical information?

Update: This post is less than 2 hours old, and I already have someone fired up! Check out Cathy's take on this (she's been a patient at The Cleveland Clinic).

Antibiotics overused in Alzheimer patients

Should people with Alzheimer's disease/dementia be treated with antibiotics? According to a new study, they say that antibiotics are being overused in patients with dementia and antibiotic use should be considered more carefully especially in this time of antibiotic resistant superbugs. (AP)

The study raises ethical questions about when it's acceptable to withhold perhaps futile treatment and let people die, and whether public health issues should ever be considered.

"Advanced dementia is a terminal illness," said study co-author Dr. Susan Mitchell, a senior scientist with the Harvard-affiliated Hebrew Senior Life Institute for Aging Research in Boston. "If we substituted 'end-stage cancer' for 'advanced dementia,' I don't think people would have any problem understanding this."

People wouldn't have a problem understanding this? Of course, when you paint a picture like that. Here's the question, though- What is advanced dementia? There really is no consensus definition. Of course, really end stage cases even medical students can diagnose. But, the problem is that there is a spectrum of diagnosis. Where do you draw the line between moderate dementia and advanced dementia? There is no agreement with this.

I can see both sides of the end of life debate getting ready to do battle again. Remember Terri Schiavo? Remember Baby Emilio? Remember the use of chip implants in Alzheimer patients? The use of antibiotics in dementia/alzheimer patients is just another chapter in this debate.

One side is saying that the progression of antibiotic resistant organisms can be stopped by appropriately prescribing antibiotics - meaning not those patients with advanced Alzheimer's disease. The other side is saying once you limit antibiotic treatment for people with Alzheimer's, the danger is there to start using the same argument to stop treatment of other medical conditions (like high blood pressure). What's your take on this debate? I'm curious....

The Shamrock Shake

I have been a blogging slacker for the past few days. I do have a lame excuse, though. I was on call last weekend, and I have to tell you, there are a lot of ill people out there and the hospital has been hopping for the past few weeks.

Anyway, as I was making "rounds" at McDonalds yesterday, the friendly drive-thru chap asked, "Would you like to try a Shamrock Shake?" Wow! It's only February, and our local McD's has already gotten out the shamrock shake. This is great stuff! If you haven't had this before, you have to try it.

I do admit that I like the taste of mint. So, the shamrock shake is definitely delish to me. And, as Dr. Rob has stated recently that obsessing about anything is bad. I kind of get addicted to the shamrock shake - especially when they say "for a limited time only." Anyone with me on this? What do you think?

TBTAM on the Dr. A show

Thursday, February 21st, 2008 at 9pm Eastern Time

Join us tonight for The Blog That Ate Manhattan. At the bottom on this post, you'll see an embed from ustream.tv. TBTAM has a great promo post saying we're going to talk about "Big Pharma, dissecting the medical literature, giving out free medical advice and discussing the insanity known as gyno-food blogging. Who knows, I may even resurrect the Vagina Blogging song for the occasion!" Wow! I can't wait for this interview.

Take part in the chat room, which is the "show within the show." A great opportunity to interact with medbloggers you've only read about. You can even call into the show to talk and/or ask a question. See you tonight!

For first time Blog Talk Radio listeners:
*Although it is not required to listen to the show, I encourage you to register on the BlogTalkRadio site prior to the show. I think it will make the process easier.

*To get to my show site, click here. As show time gets closer, keep hitting "refresh" on your browser until you see the "Click to Listen" button. Then, of course, press the "Click to Listen" button.

*You can also participate in the live chat room before, during, and after the show. Look for the "Chat Available" button in the upper right hand corner of the page. If you are registered with the BTR site, your registered name and picture will appear in the chat room.

*You can also call into the show. The number is on my show site. I'll be taking calls beginning at around the bottom of the hour. Hope these tips are helpful!

Just venting

I've had all this pent up frustration in me this week because of last week's show. In this video post, I just wanted to get it all out in the open and out of my system. I didn't want to contaminate Thursday night's show without (kind of) resolving in my own mind what happened last week. So, I apologize for the whinnyness (is that a word?) of this video post, but at least I feel better and I can really focus on having fun again on The Doctor Anonymous Show.....

Med 2.0 blog carnival

I'm a big fan of Bertalan Meskó and his blog called Science Roll. If you haven't checked out his blog, I highly recommend it. He has an interest in genetics and in technology. And, I'm looking forward to having him on The Doctor Anonymous Show sometime soon in the future.

Many people are familiar with the blog carnival called "Grand Rounds." But, Science Roll anchors a blog carnival called "Medicine 2.0" where there are links and stories about web 2.0's impact on medicine and healthcare. I was pleasantly surprised to be included in the most recent edition of Med 2.0.

You should check out and follow the live shows of Doctor Anonymous.

There is even a BlogTalkRadio badge over on the Med 2.0 post. Thanks so much to Berci for mentioning the show and for including a BTR badge. I really appreciate it. I'm looking forward to when our schedules can match up for you to be on The Doctor Anonymous Show. So, if you've never experienced Medicine 2.0, check it out! You'll be glad you did.

You've been traded - To Japan

It's baseball spring training time again, and I've had enough of all the talk about steroids and congressional hearings and all that stuff. I heard about the video above last night. And, it's a practical joke that had one young recruit going until the last minute.

The way the video above goes, the young pitcher is brought into the managers office and is told that he is being "traded" to Japan for a player named "Kobayashi Iwamura." You can see that this guy is totally dejected - not only because he was traded, but because he's going to have to go to an entirely different country.

His next move is to let his teammates know what the news is. Of course, his team is in on the joke. Not only his teammates, but his manager, his agent, and the press who are interviewing him at the end of this video. Finally, to save him, one of his teammates say, "You've been Punk'd." I really felt bad for the kid, but in the end, it's all laughs.

Mac users are snobs?

This is according to this video report from The Street (via Insanely Great Mac and The Unofficial Apple Weblog).

The assertions made by this report include the following: Mac users more likely to use teeth-whitening products; Mac users bought on average five new pairs of sneakers in the last year; More likely to buy organic food; More likely to frequent Starbucks; More likely to own a hybrid car; Mac users are perfectionists; Prefer to drive station wagons; More likely to pay for downloaded music.

To me, this report is pretty funny. I hardly resemble any of the characterizations above or in the report. (I'll let you sort out which ones you think I am.)

But, I will not stand for this painting of a broad brush of all Mac users. There is too much discrimination going on in this country right now. Can't I stand on my own merits? Does the computer that I use determine the person I am and how you should treat me? I think not. I will not stand for this. I am a Mac, and I'm proud of it! YAY!

Flu Epidemic

(This is a continuation of part one from yesterday)

Last night got a little better for me. The coughing was still there, but not as bad. In fact, the coughing is still here right now as I write this. The muscle aches have pretty much resolved. And, to be honest, this was the main symptom that was bothering me. The headache and sore throat are continuing to improve. It's a good thing, because I'm on call tomorrow and the weekend coming up.

As I was doing more research this weekend, I found this article from the Associated Press from February 15th saying that this year's flu vaccine is effective for only 40% of this year's flu viruses.

Infections from an unexpected strain have been booming, and now are the main agent behind most of the nation's lab-confirmed flu cases, said Dr. Joe Bresee, the CDC's chief of influenza epidemiology. It's too soon to know whether this will prove to be a bad flu season overall, but it's fair to say a lot of people are suffering at the moment. "Every area of the country is experiencing lots of flu right now," Bresee said.

If you haven't seen it already, check out the map on my previous post from the CDC which states that most of the country is under the "Widespread Flu" designation. Now, I know what everybody is going to say, "Well, Dr. A, why even get a flu shot if it's going to be 40% effective?"

The way flu vaccines work is that they have to try to predict ONE YEAR in advance what the flu viruses are going to be. For the most part, they have been right. But, as I have been seeing in interviews over the weekend, researchers have been playing the "cover your butt" game saying things like - "We predicted that sometime in the future we would be wrong and there would be a flu epidemic."

In my book, 40% is better than 0%. Here are the facts from the CDC. Every year in these United States, 36,000 people die each year from the flu and more than 200,000 are hospitalized from flu complications. These complications may vary from dehydration to respiratory failure and needing to be on a respirator or breathing machine. Now, wanna flu shot? Well, it takes weeks to get working in your system. That's why the big push is in the fall to get your flu shot.

Another interesting observation is that the popular media has not really picked up this story yet. Usually, they are all over stories like this to cause panic in the public. They usually love driving patients to hospitals and doctors offices and having patients demand flu shots and prescriptions for meds like Tamiflu.

My prediction will be that when this flu story starts to intersect with the story of the presidential primary process - that's when you'll see headlines like "Flu Epidemic" all over the place. Three states vote on Tuesday and four states vote on March 4th (including my state).

You'll see headlines like, "Disenfranchised voters have the flu - especially elderly; unable to appear at voting station due to illness." Then, you'll see candidates trying to take political advantage of the flu. I hope I'm wrong. But, if not, you heard it here first. I'm Dr. A, and I approved this message....

Gov. Strickland has marching orders

This is definitely not a political blog. But since the US presidential nominating process is going to be rolling through my state 16 days from now, I thought that it may be interesting to make a few observations. Channel surfing this evening, I saw the interview above, which I thought was fascinating.

The interview has two governors from the same Democratic Party who are supporting two different candidates for the nomination. The first is Governor James Doyle from Wisconsin (pictured to left above) who is supporting Sen. Barack Obama for the Demorcatic Presidential nomination. The second is Governor Ted Strickland from Ohio (pictured to right above) who is supporting Sen. Hillary Clinton. I have particular interest in this because Gov. Strickland was my congressman before being elected to the Governor's Mansion.

Even if you don't know anything about politics or don't care about politics, I encourage you to check out this eight and a half minute interview. I think it will summarize what is happening in this race. You'll see Gov. Doyle enthusiastically supporting his candidate. He seems very calm and more conversational.

Meanwhile, Gov. Strickland seems very tense, and at times defensive. It looks like he was given the talking points to repeat time and time again during the interview. It looks like he's been put under a lot of pressure to deliver Ohio to the Senator from New York.

Finally, the most interesting answer I saw was when Gov. Strickland was asked whether he would accept the Vice-President position if it was offered to him. "I don't want to be Vice-President," was his first response. That's telling me either that he was told to say that, or he's looking ahead to 2012 for a Presidential run of his own.

One thing that I think will definitely happen is that if Ohio does go for Hillary on March 4th, and if she is eventually elected president, Gov Strickland will be moving back to Washington - probably in a high-up cabinet position - because, basically, that's how politics works. And, if anything else, Ted Strickland is a good politician. I'm Dr. A, and I approved this message....

Influenza Case Study: ME

The following is a anecdotal case study of a guy who has influenza. I apologize in advance for the long post. But, if you want to know how it feels to have influenza, read on. As you can see from the graphic above from The Centers of Disease Control and Prevention, the flu epidemic is practically nationwide.

Here's my story. I was on call the day before Valentine's Day. A typical busy day and night - having to go back and forth into the emergency room to see people. While making rounds on Valentine's Day, I was talking with some people who said the hospital was starting to see cases of influenza. Of course, those words passed right by me because I got my flu shot last fall.

A few hours before the worst. show. ever., I was starting to feel some muscle aches in my legs. And, then, I was feeling pretty tired. But, I always feel tired after being on call. I mean, you hardly get any sleep. I was hoping to sleep things off and feel better in the morning.

The next morning comes, and the muscle aches are still there. A new symptom, a cough, appeared over night. "Oh great," I thought to myself. "I'm starting to get another sinus infection." I'm getting a little sore throat. I'm getting that typical sinus headache. I'm thinking to myself that it's Friday and I can get through one more day of work and I can nurse this sinus infection over the weekend.

My first patient in the office is at 8:30am. As each hour goes by, the aches in my legs become more and more apparent. You know the feeling of overdoing a workout after you haven't been to the gym for a while. That's what my legs felt like - only I really haven't been to the gym in a while. The fatigue was starting to become overwhelming. "Why am I so tired all of a sudden," I'm asking myself. The cough develops more during that morning. So, much so that my patients started to remark on my cough.

Then, I did something that I have almost never done before. I went home to lie down so that I could try to get some energy for and entire afternoon of seeing patients. "Four more hours," I kept telling myself. Even I can get through four more hours and then take care of this illness over the weekend.

As each hour went by, I was walking slower and slower down the hall to and from my office. The body aches were bad, the headache was pounding, the cough was overwhelming at times. At three o'clock I heard from the front desk that three patients wanted to come in right now to the office if they could. Part of me really wanted to say, "Oh yeah, I'm feeling sick, too. And, I want to go home early today for the first time ever." But, I told them ok, I'd be happy to see them.

I finally finished past 5pm. I didn't do any of the paperwork (it's still sitting on my desk). As I was leaving the office, one of the other docs said, "Sounds like the flu to me." What? I had my flu shot. But, even Dr. Val says that It Doesn't Always Work. As like other docs, I'm a terrible patient and I hate taking meds unless necessary. But, I did start Tamiflu about 24 hours ago.

Last night was tough - tougher than the night before. The muscle aches, the cough, the headache, the fever and chills, the night sweats - needless to say, I did not get too much rest. I was even up in the middle of the night to watch reruns of MASH (what a great tv show).

Now, finally, I'm just starting to feel a little bit better - at least better than yesterday. The body aches are pretty much gone. The cough is still there but not as bad as last night. The headache and sore throat are still there, but not as bad as last night. The fatigue is still kicking my butt. I've been sleeping most of the day....

Whoa. That's all I have for now. Another wave of fatigue has gotten a hold of me. I'm feeling tired again. Going back to bed. Hopefully, more to comment on soon. We'll see what tonight brings.....

Worst. Show. Ever.

I'm so mad right now that - that - I don't know what I could do. I'm just venting. You know this is what happens when I really try to promote a show. The problem started from the first minute. There was this annoying echo that I could hear. At first, I thought that one of my guests was causing the feedback, but it wasn't.

The echo really threw me off for the entire show. It felt like I was in a tunnel for the entire thing. Thanks so much to Dr. Val, Jenni, and Crzegrl for sticking with things and wanting to go forward with the show. Thanks also to Mother Jones who called into the show to add some banter.

What we found out later was that the audio from my show was cutting into the audio of another show. The host of the other show called in and explained the problem. Seemed like a pleasant chap, but what I found out later was that they were encouraging people to get into my chat room and call in to disrupt the show - that's not cool.

I haven't heard the audio yet from the other show, but that is what I've been told. I guess that other show had nothing else to talk about because they ended their show 30 minutes early. I guess after my audio stopped messing up their show, they had nothing else to talk about. But, I'll have to listen to their show to see exactly what they were talking about.

So, for those of you who listened to the show live - I really appreciate you listening. I apologize for the bad audio, and I'm sorry that the other show was disrupting things. I'm going to try to contact BlogTalkRadio to see what the problem was. If I don't get a satisfactory answer, I may have to move the show over to Talkshoe. I think they would appreciate a medblogger talk show host. Don't you think? Have a great weekend, everybody!

Estrofest Live TONIGHT

Thursday, February 14th, 2008 at 9pm Eastern Time

Finally, officially, Happy Valentine's Day, everybody. Don't forget to join us tonight for The Doctor Anonymous Show for the Valentine's Day Estrofest.

What is it and how did it come about? Well, Dr. Val, one of our panelists tonight explains it in this post. Also, scheduled to be on the show will be Jenni from ChronicBabe.com, Crzegrl, and EE. Who knows what we are going to talk about? You'll just have to tune in to find out!

Also, take part in the chat room, which is the "show within the show." A great opportunity to interact with medbloggers you've only read about. You can even call into the show to talk and/or ask a question. See you tonight!

For first time Blog Talk Radio listeners:
*Although it is not required to listen to the show, I encourage you to register on the BlogTalkRadio site prior to the show. I think it will make the process easier.

*To get to my show site, click here. As show time gets closer, keep hitting "refresh" on your browser until you see the "Click to Listen" button. Then, of course, press the "Click to Listen" button.

*You can also participate in the live chat room before, during, and after the show. Look for the "Chat Available" button in the upper right hand corner of the page. If you are registered with the BTR site, your registered name and picture will appear in the chat room.

*You can also call into the show. The number is on my show site. I'll be taking calls beginning at around the bottom of the hour. Hope these tips are helpful!

Fewer Primary Care Docs

In a shocking report (not really) released by the General Accountability Office (ie - the US federal government), they stated that there are fewer primary care docs now than there was about 10 years ago. The first thing I have to comment about is the name - "General Accountability?" - What's up with that? To whom are they accountable? Let me answer that - nobody!

Anyway, in this Associated Press article, the report goes on to say that in 2006, there were about 22, 146 American docs in residency programs across the United States. In 1995 (when I was in medical school), the number was about 23, 801. For the next few years after that, the number plateaued. Then, right when I graduated is when the fall started to happen.

"It is troubling to me that the number of Americans pursuing a career in primary care has declined," said Sen. Bernie Sanders, I-Vt. Overall growth in the number of primary-care physicians "has been totally due to the number of international medical students training in America," Sanders said. "We are increasingly dependent on international medical school graduates to meet our needs. Currently, one in four new physicians in the U.S. is an international medical graduate."

These quotes just kill me. What do you mean legislators and the federal government don't know and cannot explain why this happened? It confuses and frustrates me because they are the ones, in my opinion, that CAUSED this situation. They did choose and continue to choose to reward specialists, especially those doing procedures, the higher payments. What happened when they did that? Read on...

For specialists, the number of Americans in training went from 45,300 in 1995 to 47,575 in 2006 and over the same period international specialists grew from 11,957 to 12,611, GAO said.

Does anyone know who that is a picture of at the top of this post? That guy is Willie Sutton. That name should ring a bell to some of you - especially history buffs out there. He was one of the most prolific bank robbers of the early 20th century. When asked why he robbed banks, he is attributed with the famous quote, because "that's where the money is."

It's not rocket science. Why did the number of specialists grow during this time? Because that's where the money was (and is). Why did the number of primary care docs shrink? Because that is where the money is not. And, who is filling that primary care gap? It is international medical graduates.

I don't want to start an entire international medical graduates debate. I'm just saying that if graduates from US medical schools are not going into primary care (and that is happening), who are going to fill those residency/training spots?

So, one of these days, the legislators and the government will figure it out. Unfortunately, it will not be until medicare, medicaid, and social security go bankrupt. Or, when the voters (meaning patients) rise up and tell the government something like "Fix the Health Care System Now." Oh yeah, isn't this an election year? Maybe this year? But, probably not....

Grand Rounds

Grand Rounds 4.21 is now up and running over at HealthBlawg: David Harlow's Health Care Law Blog. If you can believe it, this is a health care lawyer and consultant handling GR this week. But, not to worry, this Valentine's Day edition is well done.

In fact, it is so well done, that I have a post in this week's Grand Rounds, and I didn't even know it. On Sunday afternoon, I wrote the post called "Love Hormone," and I thought that it would be a great edition to GR. But, when I looked at the deadline, I read that I missed it. So, being a past GR host, I remember how annoyed I was when people tried to e-mail me something past the deadline.

But, this morning, I was checking my stats and found that I was getting referrals from this week's GR site. When I clicked over there, I was pleasantly surprised to find the following link to my blog (and even more pleasantly surprised to find it in the top 1/3 of the post - great location!)

Dr. Anonymous is blogging about "the love hormone" and will have a Valentine's Day edition of his BlogTalkRadio show -- which Dr. Val tells us will be an "estrofest" featuring several women medbloggers.

So, thank you David Harlow and Healthblawg for placing my post on GR this week and thanks for promoting The Doctor Anonymous Show this week. Just for that, you are awarded a spot on my prestigious blogroll. Who says that I don't give lawyers a fair shake? Enjoy Grand Rounds this week. Next week, GR will be hosted over at the Daily Interview blog.

Happy Valentine's Day

Welcome back to love week here on the blog. Yes, I know, Valentine's Day is not for a couple of days. But, why not try to start a little discussion on this topic. In my video post above, I talk a little bit about the "controversy" surrounding Valentine's Day. I think that asking people about Valentine's Day is more controversial than asking people about politics or religion.

Do you think I'm kidding? Well, ask someone about Valentine's Day and leave me a comment about your experience. I've encountered either really happy people or really bitter people. Let me know what you find out when you ask people.

Finally, direct from the category of over-promotion, I'm going again to tell everybody about the Valentine's Day Estrofest on The Doctor Anonymous Show - Thursday, February 14th at 9pm eastern time. It's going to be a great time. Get ready to be in the chat room and even call into the show. You don't need a date. Come as you are. See you then!

Love Tragedy

Welcome back to "love week" here on The Doctor Anonymous blog. Unfortunately, this is going go be a bad news post. In fact, quite a tragedy. I didn't believe it the first time I read this story. A bride has a dream being like the movie, "My Big Fat Greek Wedding." I've seen the film - good stuff.

According to this Associated Press story, here is what happened...

Kim Sjostrom carried blue and white flowers during the ceremony — the colors of the Greek flag — as she exchanged vows with Teddy Efkarpides, a 43-year-old carpenter and Navy veteran. They had met three years to the day before the Jan. 19 wedding.

During the couple's first dance, Sjostrom complained of being lightheaded. Efkarpides thought his wife, a diabetic, needed sugar, but she collapsed. Wedding guests, paramedics and doctors at a nearby hospital were unable to revive her.

My heart just goes out to this groom and the families involved. What a sad story.....

The Love Hormone

Ok, first of all, this is not a spam post. And, I have not become a spokesman for the latest craze in the treatment of sexual problems. But, you are reading this post, aren't ya? So, here's what this is about.

Researchers at the University of California, San Diego School of Medicine are theorizing that the hormone oxytocin can be used in the treatment of disorders like schizophrenia, autism, and anxiety. In quoting this UPI article, oxytocin "is a brain chemical associated with pair bonding, including mother-infant and male-female bonds and increased paternal involvement with children."

"That's why oxytocin is sometimes called 'the love hormone,'" [researcher Dr. Kai] MacDonald in a statement. "It's said that the eyes are the window to the soul ... they certainly are the window to the emotional brain. We know that the eye-to-eye communication -- which is affected by oxytocin -- is critical to intimate emotional communication for all kind of emotions -- love, fear, trust, anxiety."

People with schizophrenia or autism often avoid eye-to-eye gaze, focus on less relevant areas of the face, and avoid meaningful social contact. The researchers theorize that oxytocin might act on the brains of patients with schizophrenia and anxiety and may ultimately increase the level of trust or emotional contact between patient and physician, or with patients and significant others.

I have no idea why this is a news story. I just found it interesting that there is an association made between oxytocin and the term 'the love hormone,' because I have never heard that before. Has anyone else? But, this being Valentine's Week, I'm hoping to get a lot of Google searches (*waving to all of you who are here from a google search*)

Also, this is a great segue into reminding you about The Doctor Anonymous Show on Valentine's Day night - Thursday, February 14th at 9pm eastern time. It's going to be a great time with medical bloggers Dr. Val, Jenni from Chronic Babe, Crzegrl, and EE.

I have the number three listened to show in the health category on BlogTalkRadio, and I'm hoping to surge to number one with your help. So, tell your friends and neighbors to join us for The Doctor Anonymous Show: Valentine's Day Estrofest. You won't want to miss it!

Welcome back Cathy!

A few weeks ago, I was saddened to find that Cathy's Place to Blog was closed. I'm happy to report that Cathy has reopened her blog and wrote a new post yesterday. Welcome back, Cathy! Please click here, drop by, and welcome her back to blogging.

Thanks again for everyone who have listened to the show Thursday night with Dr. Schwab. I also appreciate the posts written about the show including from SeaSpray, EricThePragmatic, and Sid Schwab himself. Oops, I forgot Suture for a Living.

Look out for next week. I already appreciate the promos that have already been written by Dr. Val, Crzegrl, and the Chronic Babe newsletter. Spread the word. This is going to be a fun show!

Sid Schwab Show: Epilogue

Thanks so much to Sid Schwab for being on the show. It was a really fun interview. (video post above) We probably could have talked for another hour. I'll definitely have to bring him back on the show. There was talk in the chat room about bringing Mrs. Sid onto the next show. So, that should be interesting.

We talked about how be chose general surgery as a career. He also shared some stories from medical school, residency, and his 25 years of practice. At the end of the show, we briefly talked about his book: Cutting Remarks: Insights and Recollections of a Surgeon.

The chat room was as busy as it has ever been -at times as many as 22 people chatting. So, if you have never listened to the show live - you are missing "the show within the show." I did have a few small technical glitches, but I don't think that it affected the audio at all (you can let me know otherwise).

Thanks so much to the people who called in as well. Bongi called in all the way from South Africa where is was 4am. Sid has a dream of working with Bongi some day. Dr. Rob also called in and Sid called him "The Dave Barry of the Medical Blogosphere." It was great to hear from Dr. Rob again.

Enrico checked in to give a brief update on his situation. Suffice to say that he is going to have to find a new URL - maybe we can help him find a new name for his blog (leave me a comment if you would like to help - hehe). Enrico asked the question about how to balance work and life.

SeaSpray said that she never called into a show or was in a chat room before. Thanks so much for calling in. She is a regular reader and commenter on Sid's blog. She also shared a story of how Sid helped her last year. Finally, EricThePragmatic called in and told the story of how Sid was his mother's surgeon - a touching story.

So, if you didn't listen live - why didn't you? Sheesh! Well, listen in my sidebar or click here. Also, if I can ask a favor, after you listen to the show, please rate the show and leave a comment. It will really help my BlogTalkRadio ratings.

Next week - Look out, because The Ladies invade The Doctor Anonymous Show. It is the Valentine's Day Estrofest. My guests include Dr. Val, Jenni from Chronic Babe, Crzegrl, and EE. Call your friends and wake the neighbors - This will be a fun show. Who knows what we'll talk about and what will happen? Have a great weekend, everybody!

Dr. A live TONIGHT

Thursday, February 7th, 2008 at 9pm Eastern Time

Join us tonight for Sid Schwab. At the bottom on this post, you'll see an embed from ustream.tv. This week, BlogTalkRadio has been very interesting in that the sound has not been ideal. Some shows sound like they were under water they sounded so bad. Hopefully, that won't happen to me or my guest. We'll see what happens this week.

Take part in the chat room, which is the "show within the show." A great opportunity to interact with medbloggers you've only read about. You can even call into the show to talk and/or ask a question. See you tonight!

For first time Blog Talk Radio listeners:
*Although it is not required to listen to the show, I encourage you to register on the BlogTalkRadio site prior to the show. I think it will make the process easier.

*To get to my show site, click here. As show time gets closer, keep hitting "refresh" on your browser until you see the "Click to Listen" button. Then, of course, press the "Click to Listen" button.

*You can also participate in the live chat room before, during, and after the show. Look for the "Chat Available" button in the upper right hand corner of the page. If you are registered with the BTR site, your registered name and picture will appear in the chat room.

*You can also call into the show. The number is on my show site. I'll be taking calls beginning at around the bottom of the hour. Hope these tips are helpful!

"Normal" sugars may harm diabetics

I can't even imagine having diabetes. Every day, I talk with and take care of patients with diabetes. I'm just fascinated with the technology out there to monitor blood sugars and to deliver insulin. No longer are just the syringe and the needle. There are stuff like pre-filled insulin pens and even insulin pumps that can deliver the medicine now.

In diabetes treatment, the current thinking has always been to push your average sugar level to a lower and lower number. Now, I'm not talking about too low - like hypoglycemia - but a lower Hemoglobin AIC level (the three month blood sugar level).

In what can be characterized as a stunning move, a federal government study had to be stopped because of deaths NOT due to HIGH blood sugar levels - but because of possible too LOW blood sugar levels (Associated Press)

The government abruptly halted aggressive treatment in a major study of diabetes and heart disease after a surprising number of deaths among patients who pushed their blood sugar to super-lows — findings that call into question a growing movement in diabetes care.

The study was stopped a year and a half early because they found 257 deaths in the group of patients whose blood sugars were aggressively treated. In the article, aggressive treatment meant trying to bring the long range sugar number - the HbAIC - back to a normal range (meaning to the level of a non-diabetic). The other group who were treated with more standard care treatments using current diabetic HbAIC guidelines, only had 203 deaths. Why is this? At this point, researchers are unsure.

The findings contradict previous research suggesting that the lower diabetics can make their blood sugar, the better. That had specialists cautioning Wednesday that it's too soon to know if the finding among heart patients was a fluke, or a real sign of how exquisitely tailored to each patient's risk factors diabetes care must be.

The article goes on to say that as if this point, current treatment guidelines should not be changed until further study is completed. This definitely brings up the question: How aggressive is too aggressive when it comes to treatment of blood sugars in diabetes?

Virtual Office Visits? Not Really

A friend of mine sent me a link today in which the article uses the term "virtual office visit." What comes to your mind when you hear this phrase? Well, to me, this sounds like you type in your symptoms, the doc makes a diagnosis and sends a prescription to the pharmacy for you to pick up. Simple, right?

Well, not really. Again, this is a case of the press inaccurately describing something in the text article. If you watch the video clip, it's from a national morning news show. In the video piece, the anchor and the medical reporter talk about a computer program. Yes, a computer program. No, the computer doesn't diagnose and treat.

This program actually is a communication piece between the physician and the patient. I see it as a tool to be used to communicate things like routine lab work. One of the goals at the physician's office is to try to find a way to cut down on the number of phone calls.

We see this every day. You want to let the patient know that she/he has normal blood tests that were drawn at the office last week. The office calls the patient - the patient is not home - the office leaves a message to call the office - the patient gets home just before the office closes - the office has to get the chart from the stack of charts marked "left message with patient to call back" - the lab results are communicated - the patient has some questions - a message is taken - the message is communicated to the doctor - the office calls the patient back - leaves a message on the answering maching - etc - You get the point.

Well, this program gives the doc the opportunity to communicate those lab results via the internet and the patient can check these results anytime. Of course, there are internet security issues to deal with. But, for the most part, this program looks promising.

If you read the text article, it leaves the impression that this is an "office visit" that can serve as a substitute for an in person visit. Doctors can even charge for this visit. As kind of an afterthought, the article sticks in there, "if insurance covers it" - which it doesn't.

I guess my question is this - Would you, as a patient, like this type of communication made available to you? If your insurance company didn't pay for this service, would you pay for this type of service, or are you content with telephone communication with the office. I'm just curious....

The Sid Schwab Interview

This week The Doctor Anonymous Show welcomes one of the most widely read medical bloggers around: Sidney M Schwab, MD. He is author of the blog Surgeonsblog: Wherein a surgeon tells some stories, shares some thoughts, and occasionally shoots off his mouth. Like a surgeon.

Now, not only does Sid have a blog, he also has a podcast in which he reads parts of his book. I encourage you to check it out. Also, if you're never read anything by this guy before, check out the disclaimer on his blog below, and that's a great start:

What I say here is as true as I can make it, based on my experience as a surgeon. Still, in no way is it intended as specific medical advice for any condition. For that, you need to consult your own doctors, who actually know you. I hope you'll find things of interest and amusement here; maybe useful information. But please, please, PLEASE understand: this blog ought not be used in any way to provide the reader with ideas about diagnosis or treatment of any symptoms or disease. Also, as you'd expect, when I describe patients, I've changed many personal details: age, sex, occupation -- enough to make them into no one you might actually know.

Join us on Thursday, February 7th, 2008 at 9pm Eastern Time where we will be talking about his blog, his book, and a lot more. You can also join us in the live chat room or even call into the show to ask Dr. Schwab a question. Now, it's been a couple of weeks since I've had my show. Hopefully, I remember how to do the show. We'll see what happens this time. Tune in tomorrow for details!

Personal Health Record

In addition to EMR (electronic medical record) and EHR (electronic health record), the latest three letter acronym in this area is PHR - or, personal health record. These are described in a February 4th article from the Associated Press. What's intriguing about PHRs is that they are patient-driven.

Everyone has heard of computer tax preparation software. Well, why not a health record created and maintained, not my doctors or hospitals, but by patients. Hmmmmm...... The article does take a shot at doctors for being slow to accept electronic records (although I do agree that docs have been slow to adapt certain technologies).

Doctors have been slow to switch from error-prone paper records to digital ones, so the trend promises to empower patients to take matters into their own computers.

From the front lines of American health care, I do admit that - every day - I have people bring in their blood sugar log or blood pressure log. They keep track of it on excel or other spread sheet program. Not only do patients print this out and bring it to their visit with them, they also bring color graphs which they print out on their ink jet printers. Quite impressive.

Plus, some of these devices, like home blood pressure monitors and blood sugar machines - they have a memory. So, that my patients can show me their trends for the past few hours, past few weeks, and even past few months. What would stop them from inputting this into their computer to further their personal health record.

While large hospital and insurance networks are making the switch, few private doctors have. And even then, software differences mean one doctor's system can't always share information with another's.

Hence the patient-driven trend. More than 100 vendors, from insurers to free Web sites, offer individuals or families the option of creating PHRs — records that they control.

The programs range from very simple electronic diaries to more comprehensive programs that link directly with doctors or hospitals for direct downloading of formal e-charts.

Computer vendors are taking the lead from pharmaceutical companies - direct to consumer advertising. With hospitals and now patients utilizing computer technology for health records, the community based primary care doc (ie - me) will be forced to make the huge financial investment to implement some kind of electronic record (this computer program will probably not be compatible with either the hospital system or multiple patient systems - then what?).

By the way, there is no doubt that electronic records make things more convenient for the hospital, the patient, the pharmacy, the insurance company, the regulatory agency, and others. But how about the physician? I believe the jury is still out on that one. Plus, if you treat electronic records like pharmaceuticals (Ek!), what is the number needed to treat for one person to benefit? There's an interesting question....

Dr. A on the road: Day 4

I just arrived home a couple of hours ago. It's taken a while unpacking and getting ready for work on Friday. And, how it's time to tell you what happened on Thursday - and what a day! We had our final site visit, which I found very valuable. I'm still processing the information that I have learned.

The exciting part of the day happened after that. When we got to the Cincinnati airport, we saw that our flight was on time. Our final destination is our home airport of Pittsburgh, but to get there we had to fly west to Chicago and then east to Pittsburgh. In the early afternoon, we started hearing reports that Chicago was getting hit with a snowstorm.

Right when our team got to the gate, we learned that our flight into Chicago was going to be delayed. I started getting stressed out at that point. I was starting to think that even if we got to Chicago, would we be able to get out of there and back home? Or, would our flight out of Chicago be delayed, or even cancelled.

After discussion, the team decided to ditch the flights, rent a car, and drive the 300 miles home. The entire time, we were trying to get weather reports wondering if the snowstorm was going to hit Ohio while we were on the road. We did manage to get home safely, but, I have to tell you. The past 10-12 hours has been very stressful, and I have to go to bed, because I have to go back to work tomorrow. Yeesh!

While we were on the road, we received word that the flight we were supposed to take from Cincinnati to Chicago was indeed delayed. When the flight left the gate, it went all the way out to the runway, but then was held there for about an hour. After that, the plane came back to the gate and the flight was subsequently cancelled. If we decided to stay at the airport, our flight would have been cancelled, and we would still be in Cincinnati right now.

Also, as I was scanning the news just when I got home, I see that there is a foot of snow forecast to fall in Chicago through the night. And, more than 600 flights were cancelled out of O'hare today. Of course, in hindsight, I'm glad the team decided to ditch the flights and drive home. But, at the time we were discussing, I wasn't sure what the right decision would be.