Tuesday, November 22, 2005

Rice Water Logorrhea

"So tell me why you think this guy is a good candidate for Lipitor."

"Well, HMG CoA reductase inhibitors have a good lipid profile of lowering LDL cholesterol and raising HDL. While some may choose niacin for it's HDL improving properties, it needs to be increased slowly over weeks to prevent overwhelming niacin flush, and this patient does not have very good compliance. However, in the future, two-drug therapy of a statin and niacin may be needed to blah blah blah..."
I've come to cherish nights like this. I'm enjoying the sweet, sweet sound of boy-band pop wafting up from our downstairs neighbor on the shoulders of a carton-worth of Lucky Strike smoke. It's all so very American. Unfortunately I haven't had the chance to introduce myself to them as they spend so much of their time procuring the 'sweet leaf' and running out to their respective Audis in the morning. I once dropped a bag of groceries outside their door, and while picking them up the neighbor I lovingly refer to as "YellowGrin" rushed out the front door grimacing with a pen in her teeth. It was as though she was in an old western, about to get an arrowhead removed from her shoulder after a raid on the moonshine silo. That is the most I've seen of her.
"Okay, so what do we do about..."

"... not that it is that common any more, but one must really be aware of niacin deficiency. Pellagra. That's what it is called. The classic triad is dermatitis, diarrhea, and dementia. Some would include 'death' as the fourth 'd', but it is in poor taste as no respectable triads have four items. It would be a quad... no, make that a tetrad. Plus death is not really a blah blah blah... "
Anyway, I've just finished a night of loading up on raw information for my Family Practice rotation. I spent the first night of the rotation learning everything about cholesterol, diabetes, high blood pressure, and asthma. I've never cared for expanding my mind or helping patients, but now, after my first day of FP, I've cornered myself into a endless spiral of helping and learning.
"Yes, but what about his..."

"... spent days observing patients with significant neural damage and defects and would occasionally stroke their feet with his reflex hammer. Those with upper motor damage would extend and fan their toes in response to this stimulation. The medical community named this reflex after this physician. This man: Joseph Jules François Félix Babinski. Now you know.. the
rest of the story..."
But most importantly, FP covers more than just diabetes, hypertension, hypercholesterolemia, and asthma... no really, it does. It covers 75% of every other specialty as well. This has forced the usually unflappable and well versed DocAmazing to confront his tremendous ignorance in the management of just about everything. I can only be described in this context as unwell versed and flapped.
"...while the onion simmers in the bacon fat. You may be tempted to stir the onions, but the light browning is best achieved by leaving them alone. Start the milk simmering on low to medium heat and add the cubed blah blah blah..."
So now I've resorted to unleashing volumes of information each time diabetes, hypertension, hypercholesterolemia, or asthma comes up - frequently referring to any trivia slightly related to those four diseases. My doctor is currently afraid to even make eye contact with me for fear that I may spout off the diagnostic criteria for moderate persistent asthma. But, even I know this can not last.
"...it wasn't long after that I realized that that was neither the time or the place to make thrusting motions at the rabbi. However, the rest of the bris went along with out a hitch, and several phone calls later I blah blah blah..."
I'm hoping this will hold him at bay until I discover different ways to treat infections rather than following the DocAmazing law of: If the head and lungs be illin', give Amoxicillin, and everything else is done in by a dose of ciprofloxacin.


Anonymous Diddy said...

mmmmmm... bacon fat

7:17 AM, November 29, 2005


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Sunday, November 06, 2005

My ward has 3 Jesuses and an FBI secret agent


I like psych. This bothers me because I've got too many preconceived notions about psychiatry and psychiatrists to unlearn. But as time goes on I'm finding that the docs actually know stuff about internal medicine and are pretty thoughtful, and that many of these patients would be pretty destructive to themselves and others without treatment. Furthermore, many treatments, including electro-convulsive therapy, actually seem to work without dulling the patients' personality.


Much of psychiatric treatment is more palliative than curative, and many 'successful' patients must be on medications for the rest of their lives. I don't know how I'd feel about getting into a profession where most people are never 'healed'. But regardless, against all of my previous rants, psychiatry is on my list of possible professions.

My feelings could also just be delerium from having to commute 3 hours a day. I will definitely enjoy my next rotation, where the clinic is just ten minutes from my house. Maybe then I'll actually get back to meaningful weekly posting.


Anonymous Anonymous said...

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7:27 AM, August 26, 2006

Anonymous Anonymous said...

Hey, I'm sooo glad I found your site, it's great...I hope you do go in to psychiatry, I think you would be good at it...you have the required sense of humor and sensitivity...thanks!


11:15 AM, March 02, 2007


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