Monday, January 28, 2008

How would you treat me?

Chief complaint: The patient, who is a physician, awakened today with persistent sore throat, and now with a feeling of slight dizziness, weakness and muscle aches. Sore throat started on the return from Arizona 2 days ago. Patient had been exposed to several others with upper respiratory tract / viral syndrome symptoms while at a conference. Not prone to frequent infections, however has noticed some association between air travel and such syndromes. Echinacea (Nature Made) was immediately started, at a dose of about 1500 mg daily (250 mg every 3-4 hours), along with 1000 mg of vitamin C in the form of "Emergen-C", as well as chicken soup (lovingly home-made).
The dilemma: Your patient isn't too worried about the infection itself, as he's healthy and isn't prone to nor does he have a history of worrisome infections. His main concern is . . . should he go to work?
The process: This is a tough one for Doctor J. He knows what his mother would say - "honey, you need to take care of yourself!" He imagines his other colleagues toughing it out. He hems, he haws, he takes his temperature - that's helpful, it is 100 - still not quite enough. Finally, the answer comes in the form of a question: "If this were someone else - one of your colleagues - what would you advise them?" Easy - stay home, take care of yourself, you take care of people all the time.
The resolution: After calling and having patients cancelled for the day, and writing a contrite e-mail to colleagues (likely unnecessary but I couldn't help myself), I felt worse and worse for several hours. Temperature went up a wee bit, and down to normal since mid-afternoon with only ibuprofen in the mid-morning. Have continued the echinacea, which I'll do for the next several days. Usually I advise that patients not return to usual activities until they have a full day of improvement. In this regard, alas, I will not heed my own advise, and I will return in the morning. Hope that's OK with you.

Sunday, January 27, 2008

NYT Health Section Review

One of my sources for keeping up with what is happening in the larger culture with respect to medicine, and occasionally for being directed to what is in the medical literature itself, is through the NYT online. I go to the "Health" tab and browse through articles that have appeared there lately. Since this blog is new, its eventual form isn't quite clear, but it occurs to me to periodically add comments and links to this section, since there is such a wide variety of information available there.


1. Positive Psychology course at Harvard is discussed. Of course it's interesting to me given my work with Innerweave, and it is also reassuring in some way to see happiness getting entrenched in one of the power centers of our culture. Even questioning my/our cynicism about this trend is interesting.
2. There's a post about probiotics, which I followed to find an older article about the same topic, which I think better represents a variety of opinions and sources, while admittedly not exhausting the topic by any means. I'd also recommend a page on which has a list of links which appears interesting. Culturelle is a product recommended by many integrative physicians.
3. I liked an article I saw about losing weight - "Bringing home the bacon ...". I saw a little bit of myself in each story.
4. And this article about the DASH diet, or "Dietary Approaches to Stop Hypertension". I have rediscovered this diet after it was presented in the integrative fellowship. You won't find it on the best-seller list, but it is tried and true.
4. Jerome Groopman, MD, writes a review of "The Cure Within: A History of Mind-Body Medicine". It is a well-written review and traces some important moments in the science of Mind-Body Medicine to the current time. I loved Groopman's book "How Doctors Think".
5. Last but not least, there's been a plethora of articles lately in the wake of the Vytorin and Zetia news. The most recent one I've read is the Op-Ed today by Gary Taubes. I liked the article in Businessweek - "Do Cholesterol Drugs Do Any Good?" - which presents some very important concepts in deconstructing medical stories such as number needed to treat and relative risk. There will no doubt be a swing away from some of the group think about high cholesterol, just as there seems to be with SSRIs, and many other drug classes. It would be wonderful to see the dots get connected between direct-to-consumer advertising and overblown pharmaceutical claims. However, as one who regrets the hype about our pharma-culture, I wouldn't suggest that the same illogic exaggerate the dangers of using pharmaceuticals. The promises and cautions of most pharmaceutical and medical interventions can both be excessive. The burden, however, in keeping with the principle of "first, do no harm" must ultimately rest with the proponents of pill-popping.

Saturday, January 26, 2008


I’m in Albany, New York, back from Tucson having just finished my second residential week for the fellowship in Integrative Medicine. I’ve wanted to find a forum where I can post information for patients and others, my reactions to (mostly health and healing related) news and information, with other assorted musings and reflections that seem relevant to my life and work.

As you'll see from the bio, I have a few major things going on. Here are a few links of interest: