Second-tier, off-label treatments for anxiety

Meds
October 10, 2019

In previous posts, we have reviewed the use of selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), as well as the off-label prescribing of gabapentinoids, for treating anxiety disorders. Anxiety is such a ubiquitous problem that it is not surprising that many other compounds have been used off-label as well.  In this posting, we will review some of the common ones: propranolol, mirtazapine, and quetiapine.  …

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We have to do better than DNR tattoos

Physician
October 9, 2019

Returning from my week of vacation, I was greeted by the usual stack of mail, faxes, forms to be signed, throwaway journals, and a fully loaded group of in-basket messages that had piled up in the electronic medical record that needed attending to.

One of the pieces of mail was an unsolicited package with a bright red label on it, along with …

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Burnout in fashion and medicine: A fashion designer turned physician compares notes

Physician
October 8, 2019

“Fashion Is Moving Too Fast, and It’s Killing Creativity,” by Veronique Hyland, talks about burnout in the fashion industry. As a former Fashion Designer turn physician, my curiosity was piqued. If you substituted the word “medicine” for “fashion,” the title would be just as relevant to the medical industry, as it is to the fashion industry. Yes, medicine is moving too fast, and it’s killing creativity and our doctors. Burnout in the fashion industry stems from the need to …

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Advice to a pregnant surgical resident

Physician
October 6, 2019

As a profession, we’ve yet to standardize maternity leave and breastfeeding allowances for women. Given the length of medical training (seven-plus post-graduate years), timing (prime reproductive years) and slow increase in the ratio of female to male surgical residents, females choosing to start families during training are particularly afflicted.

We just celebrated my son’s first birthday. I had him during one of the busiest years of my surgical residency, and it’s …

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Avoiding late-stage dementia with advance directives for stopping eating and drinking

Conditions
October 6, 2019

On October 1, 2019, Nevada began allowing individuals to avoid living in late-stage dementia. The new statute recognizes the legitimacy of an advance directive that instructs health care providers to stop hand feeding food and fluid by mouth. Individuals have already been completing such directives in New York and Washington. The Nevada law is the first that explicitly authorizes such instructions.

Growing …

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MKSAP: 54-year-old woman with flushing of the face

Conditions
October 5, 2019

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 54-year-old woman is evaluated for flushing of the face of 1 year’s duration. These episodes occur two or three times per week and last about 30 minutes. She went through menopause at age 50 and is on estrogen and progesterone hormone therapy. She also experiences episodes of anxiety, …

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What it means to be an attending physician

Physician
October 4, 2019

Dr. Ryme had been retired at least thirty years from medicine when he met me, his last pupil. I was a freshly minted doctor, and he became the first teacher of a new course at my new school called “Life as an Independent Doctor.”

At our first office visit, after telling me his life story, he quizzed me, “And furthermore, Dr. Braun, you’re an attending physician now. You are no longer …

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Using low-dose naltrexone to treat pain

Meds
October 2, 2019

Lori Pinkley, a 50-year-old from Kansas City, Mo., has struggled with puzzling chronic pain since she was 15.

She has had countless disappointing visits with doctors. Some said they couldn’t help her. Others diagnosed her with everything from fibromyalgia to lipedema to the rare Ehlers-Danlos syndrome.

Pinkley has taken opioids a few times after surgeries, but they never helped her underlying pain, she said.

“I hate …

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How we got from 18th-century tinctures to the opioid crisis

Meds
October 2, 2019

Americans have always loved their medicines and sought them out actively to cure whatever ailed them. Their interest ranged all the way from “staying well” to “feeling better.” Productivity in this hard-charging, pull yourself up by the bootstraps society required activity, and it’s hard to be active when you’re sick.

In the 18th-century in Germany, England, France, and Switzerland, men practicing pharmacy saw their retail operations as the …

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An expensive treatment may be a victim of its own widening use

Meds
October 1, 2019

Medical treatment has knocked down tumors in 6-year-old Easton Daniels’ brain, but the drug used also wiped out his immune system.

To bolster his immune function and help keep him healthy, he has visited a hospital for intravenous infusions of immune globulin about every month for the past year and a half.

But in early July, his family was stunned by a letter from Cincinnati Children’s Hospital: “All of Easton’s appointments canceled …

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Do physicians really need such extensive training?

Education
September 30, 2019

Last year the American Association of Nurse Practitioners announced a $2 million campaign to further expand independent practice, which they already have in 22 states. The relatively new doctorate of nursing (DNP) has led to a confusing scenario where nurses are indeed doctors, just not the kind you think of when you see a white coat. The profession (well, its money-making institutions) has fought hard to keep people confused.

Doctors are …

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This doctor defines himself as a Christian, not a physician

Physician
September 29, 2019

What is life? It’s the cumulation of the daily processes all wrapped up into one, filling the void of each day. These processes coalesce hour by hour, filled with demands, expectations, current crisis, and bills to pay. Life is a full-contact sport, each hour brimming with all-encompassing activities, expectations, and trivial pursuits. We live every second to its fullest, squeezing every ounce of information and productivity only to repeat it …

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4 reasons why physicians should hire a financial advisor

Finance
September 27, 2019

I’m a big proponent of do-it-yourself investing. In the age of index funds, many investors can manage their own investments at very low cost.

And fees you pay to a financial advisor could be used to invest and grow your nest egg.

But that’s not to say that I believe that no one should have a financial advisor. There are many situations where it can be beneficial to hire a financial …

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The keyboard is the sworn enemy of physicians

Tech
September 26, 2019

During one long ago very hot Washington, DC summer, at the suggestion of my parents, I enrolled in a typing course that was given at our elementary school.

This was the summer between sixth and seventh grades, and there were lots of things I would’ve preferred to have been doing, but my dad, who started out in advertising, felt that touch-typing …

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Who actually owns your medical records?

Physician
September 25, 2019

I was in a discussion with a group of patients about how difficult it is for patients to get access to their own medical records. It was initiated after one of my patients was refused copies of her recent hospitalization. There is much confusion out there about who actually owns the record and how it is allowed to be accessed. Most people are aware of HIPAA, the regulation set into …

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Black market pharmaceuticals target immigrants

Policy
September 25, 2019

The bootleg medications were smuggled across the border and sold to mostly Latino immigrants in public spaces throughout Los Angeles — at swap meets, parks, beauty salons and makeshift stands outside mom-and-pop grocery stores.

The drugs were cheap, and the customers — mostly from Mexico and Central America — did not need prescriptions to buy them. Some of the products featured brand names and colorful packaging that immigrants knew well from …

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