At age 81, I am one of “the old guys” who writes in online chronic pain support groups. I get a lot of emails from people in pain. One recent inquiry was from a lady named Marisa, who asked questions that are combined in the title of this article. The following is my response to Marisa and others.
My wife is a chronic pain patient who has multiple medical issues. I …
Why chronic pain patients and doctors are both under attack
The first thing I remember is the sound of oxygen at night.
It was my second week as a hospice nurse. I had just pulled up to a modest home on a cul-de-sac, the kind of place where wind chimes echo off empty sidewalks. Inside, a man in his seventies was dying of end-stage pulmonary fibrosis. He was surrounded by family, but it was that soft hiss—steady and rhythmic, like an …
The quiet work of dying: a hospice nurse’s reflection
I remember a patient in her early sixties who came to our clinic with subtle memory problems. She lived alone in a rural county, relied on Medicaid, and had been passed between social services and different primary care providers for more than a year. No one had ordered imaging, and there were no neurologists nearby. By the time Alzheimer’s disease was suspected, her window for early intervention had already closed.
Medicare …
Medicaid lags behind on Alzheimer’s blood test coverage
Everyone deserves informed, compassionate and respectful health care. As medical professionals, we have the profound privilege and responsibility to make a difference in the lives of others.
As a practicing Board Certified Plastic Surgeon in San Francisco, CA, I have dedicated my practice to serving trans women, trans men, non-binary and gender-diverse individuals. Through this practice, I have viewed discrimination at the most basic levels. Patients struggle to find primary care …
Why transgender health care needs urgent reform and inclusive practices
We are now waiting for sentencing in the Sean (P. Diddy) Combs trial. Onlookers reading about the trial could have various thoughts. Thoughts about how power corrupts behavior. Thoughts about how men manipulate women through violence and sex. There could be schadenfreude. There could be prurience. Me, I think about HIV preexposure prophylaxis (PrEP).
You heard correctly, PrEP. When I hear testimony about multiple partners and escorts, my concern is for …
Why the Sean Combs trial is a wake-up call for HIV prevention
A recent surge in misleading ads and AI-generated videos on social media and other online sites promoting bogus diabetes products, treatments and cures – often using fake endorsements, including from my organization Diabetes Canada – poses a serious health risk to people living with diabetes.
So far this year, Diabetes Canada has heard from at least 300 people who saw or bought fake products like smart watches claiming to non-invasively …
New surge in misleading ads about diabetes on social media poses a serious health risk
This past week, an unhinged man in Atlanta committed an atrocity. He went to the Centers for Disease Control (CDC) with five guns and killed a policeman. He blamed the COVID-19 vaccine for making him depressed and suicidal, and it is reported that he had been reaching out for mental health assistance for weeks.
Since January 2022, I have been interacting with national experts on a clinical problem that has hit …
mRNA post vaccination syndrome: Is it real?
Colorectal cancer (CRC) is the second-deadliest cancer in the U.S.; however, screening rates remain too low due to a combination of lack of awareness, patient fear, and health care system barriers. Many patients don’t realize they are at risk because early-stage CRC has no symptoms, making screening the only way to detect and prevent disease progression.
As frontline health care providers, nurse practitioners (NPs) and physician associates/assistants (PAs) are uniquely positioned …
The critical role of nurse practitioners in colorectal cancer screening
In the late 1970s, a Japanese biochemist named Akira Endo discovered a compound from fungus that inhibited HMG-CoA reductase, the enzyme responsible for making cholesterol. It was an academic curiosity at the time. No one knew if lowering cholesterol would prevent heart attacks—it just lowered a number on a lab slip.
That compound eventually became lovastatin, and in 1987, Merck brought it to market with no proof of improved outcomes—only a …
Are we repeating the statin playbook with lipoprotein(a)?
It is time we talk about a critical, yet often overlooked, factor contributing to physician burnout: attention-deficit/hyperactivity disorder (ADHD), particularly in those with high IQs and a history of academic and professional success.
Many physicians, often driven and intellectually gifted, develop sophisticated coping mechanisms that mask their ADHD symptoms for years, even decades. Their high IQ can, paradoxically, compensate for executive function deficits, allowing them to excel in demanding environments like …
Why physicians with ADHD are burning out
It is happening more often than most people realize. The same physicians who seem unshakable in the OR or clinic, the ones who handle chaos without blinking, are quietly scheduling therapy appointments. Not because they have “hit rock bottom” or cannot do their jobs anymore, but because they are realizing they do not have to slowly carry it all alone. Nor can they sustain this level of burnout anymore.
As a …
Why more physicians are quietly starting therapy
How many times have we heard “Whatever you say doc, I know you will do right by me. You always have and I know you will.” Or, “What do you think, doctor? Do you think I should do this?” Or, …
How federal actions threaten vaccine policy and trust
It’s all fun and games until your health becomes one big puzzle to solve, and little do many people know what risks and hazards might surround us during our favorite summertime activities. I learned this personally after what should have been an innocent business trip turned into a year-and-a-half nightmare for me after contaminated water made me sick. I contracted bacteria that led to a secondary chronic inflammatory breast disease. What …
Summer’s dark side: How not to dim your fun
When people think of Parkinson’s disease (PD), they often picture Michael J. Fox or Muhammad Ali, iconic figures who bravely shared their diagnoses. But the real face of Parkinson’s is much more diverse than what we see in the media, and the research that shapes our understanding of the disease has not caught up.
Despite affecting people of all racial and ethnic backgrounds, …
Closing the diversity gap in Parkinson’s research
A few weeks ago, I heard Michelle Obama say something that stopped me in my tracks:
“We have to learn to be OK with the regular days. The in-between. The parts of life that aren’t exciting.”
I thought of my kids in the back seat during a long car ride, sighing dramatically, claiming they were “literally dying” of boredom. I thought of patients sitting in a waiting room with nothing but their …
Why boredom is good for your brain and health
I first grasped the disconnect between health care professionals and the public while designing a brochure for a cornea donation campaign.
My original concept featured a young boy smiling, wearing an eye shield—an approachable image meant to encourage public participation. But the overseeing specialist rejected it. He insisted instead on a clinical close-up of a post-surgical eye, sutures and all. To him, it represented medical success. To potential donors, it was …
How health care branding can unintentionally stigmatize patients
I became a respiratory therapist at 28, after years of trying to get into nursing school. It wasn’t until a friend, an RT at my city’s only level one trauma center, said, “You don’t want to be a nurse. You want to be an RT,” that something clicked. He let me shadow for a shift in the medical cardiac ICU, and I fell in love with the work instantly.
Watching him …
Why I left health care after 11 years as a respiratory therapist
Sickle cell disease (SCD) is frequently referred to as an invisible disease and is often overlooked due to a lack of research and overall resource shortages resulting in substandard clinical care. Part of the problem is difficulty objectively identifying SCD characteristics due to lack of laboratory markers and poor objective pain indicators. This disease mainly affects African American populations. Systemic marginalization of stigmatized populations results in less funding; and therefore, …
The hidden cost of racism in sickle cell disease treatment
The phone call from my insurance carrier came in unexpectedly one morning. “We see that you’ve just been discharged from the hospital …”
I blinked. I had neither been admitted nor discharged from any hospital. When I pressed for details, the caller claimed her records showed I’d been hospitalized for more than a month. Why? For which condition? She didn’t have that information, she told me. Only the dates.
My first thought: …
Poorly targeted patient outreach is wasted outreach
When a patient walks into an orthopedic spine clinic, most providers are focused on one thing: the back. But after over a decade of caring for patients with chronic pain, I noticed something deeper lurking behind the disc herniation and spinal stenosis: depression. And it was not being addressed.
That is why I launched a quality-improvement (QI) project focused on integrating depression screening into the routine evaluation of orthopedic spine patients. …
The link between chronic back pain and depression
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