Monday, October 30, 2006

What's Your Groundhog Day?

Watched Groundhog Day this weekend.

Bill Murray plays Phil Connors, an obnoxious TV weatherman, who is sent to a small town in Pennsylvania to cover the Groundhog ceremony. This is his 5th year covering this event, and he despises both the town and the people. In the movie, Phil gets stuck in time on February 2nd, Groundhog Day, where he has to relive the same day he despises over and over again.

His reaction to the day changes with time. After getting over the initial shock, he is thrilled with the realization that with no tomorrow, he can't be held responsible for what happens today. So he steals, philanders, gorges on food he's "not supposed" to eat. He goes on daily dates with his producer, learning all her likes and dislikes and then remembering them the next time around. By the time he's been through several dates, their dates are "magical" - he seems to know and like everything she does, as if they were true soul mates. (Makes one wonder about soul mates! :D) Yet something always goes wrong at the end of these dates.

As the novelty passes, despair begins to set in, until he decides that he's tired of the repetition and tries to end his life. Multiple times. And wakes up after each suicide event at 6am the morning of February 2nd. With time, the despair passes, and he sets out to make his time meaningful. He learns different things (piano, ice-carving), soon becoming quite proficient. He takes to treating the participants in his never-ending day with kindness. He slows down and has the time to help those he comes across - a young child falling out a tree, a choking man in a diner - and learns that there are those that, try as he may, he cannot save (homeless man on the street.) As a changed man, Phil now garners the respect of many members of the small community, and as a byproduct, gets the attention of his producer. They end up having the best of their many first dates, and the next day, he finally gets to move on to Feb 3rd.

It's unclear what caused the time warp. And perhaps some might enjoy the "moral" of the story. But all these details aside, I think all of us have parts of our lives that are very similar to February 2nd. Granted, our days are not exact replicas of the day before, but just step back and look at your life. How many of us are stuck on the same road/highway going to work? How many of us walk in and out of the same office building day after day? Stop by the same grocery store on the way home after work. Wake up to the alarm at the same time of day? Work with the same (or similar) people day in and day out?

While the small details of our days may change, there is a certain monotony to life that's captured in Groundhog day. Life may not be a continuously thrilling journey. It may not even be pleasant at times. But it's less about what life is like than what our attitude is like. The important thing is how we interface with the life we live.

Like Phil, if we let the little things bother us, we may have a miserable time and dread work/people/life. But if we understand that all days are but variations on a theme, we can choose to enjoy the entire song rather than get stuck on a few notes... and perhaps the greatest gift we can give ourselves is peace of mind - with ourselves, and with this strange and marvelous thing called life.

photo credit

Thursday, October 26, 2006

The Two Ends of Human Life

We recently were asked to see an elderly gentleman with advanced dementia who had a rash. The rash itself was unremarkable, but the interaction was sobering. Dementia patients range from the cheery, unaware types to the ornery, suspicious types. This gentleman was extremely anxious and during the entire interaction, his concern was that he would not be fed. He kept on pleading that we not forget to feed him, and that we not let him go hungry. While it was clear that he was well-taken care of with an outstanding nursing staff, it was heartbreaking that his mind remained in a place where he was in constant fear of not getting his next meal.

Colleague had a patient with congenital erythropoietic porphyria. This is one of the types of porphyrias where children are exquisitely sensitive to the sun and develop extreme sunburns, blistering, and subsequent mutilation of sun-exposed areas (often face and hands).

Staring at some of the pictures of this disease makes one think twice about prenatal testing and genetic counseling. While this disease is usually not fatal, there are a number of other genetic diseases that do have a horrible prognosis for the affected child.

I used to think that I wouldn't get prenatal testing, because I'd be unable to go through with an abortion, but am no longer so sure. It's good to have principles to live by, but sometimes things aren't so black and white. Perhaps one can create more suffering by giving birth to a child with an early fatal disease...

PS - Have nothing against women who chose to have abortions - I firmly believe it is an individual's choice and respect their decision. Also, am just processing thoughts. Not meant to incite rabid comments from either extremes...

photo credit

Wednesday, October 25, 2006

White Coats

I had the brilliant idea today to iron the white coats. As a student, we never gave much thought to the condition of our white coats. The dirtier the were, the more "hard-working" you were. Or so we told ourselves. When it needed a wash, I'd use the local dry cleaners... who had time to make it look good? Now that I'm making the big bucks (!!) as a resident, thought I'd try to save some money by doing it myself...


One hour later, am happy (sad?) to report that after a burn and two close calls, both white coats are ironed. Well, less wrinkly than before. They still have these wrinkles that don't want to come out... not sure why.

At least we now know that it's a good thing I was born in my generation and not the one before, and that I'll have to think twice before opening a dry cleaning business... good things to know. :)

photo credit

Sunday, October 22, 2006

Surgery, While Awake

One of the fun parts about our surgery procedures is that the patient is awake the whole time. Unlike the controlled operating room setting, where the patient is out cold, you never know what can happen.

Like the time when the patient reached his arm up to scratch his nose, right next to the gaping hole we were trying to sew up. Very sterile field, I tell you.

Or when you're working next to the mouth, and a talking patient means a moving target for the suture needle.

You know you're good when the patient starts snoring. Or is that just a sign of old age and chronic sleep deprivation? Probably just good local anesthesia.

The best is when a patient falls asleep and wakes up in the middle of the procedure with no recollection of what they are doing on the table. Classic.

The really neat part, though, is the amount of time you get to spend per patient. Unlike regular dermatology clinics, where you've got at least four patients scheduled per hour, once you've started to cut, time is no longer an issue. You take as long as you need to close up.

Some patients have quick procedures. Others have more bleeding because of their medical conditions or because of blood thinners. Whatever the case, you still have a good half hour to hour with each patient. Who can talk back to you. So assuming the area of interest isn't right next to the mouth, you can learn a lot about that person and their life in that hour. Talking to them helps distract the few really nervous patients, but it's also fun to learn more about what who these people are. You learn that Mrs. X was one of the first women in the air force. And Mr. Y was a famous costume designer for Vegas showgirls before retiring rich. Or that Mr. Z used to be an Alaskan who would winter in Australia. Such a wonderful variety of patients come through our doors, and it's a pleasure to get to learn from them all.

photo credit

Wednesday, October 18, 2006

Are You Suffering From Tunnel Vision?

Overheard conversation between a young professor and a resident:

Professor: I've been thinking about buying a house.
Resident: Really? That's nice. What are you looking for?
Prof: I don't know. A nice three, maybe four bedroom place.
Res: What's wrong with where you live now?
Prof: Well, I want to buy, not rent.
Res: But isn't this a bad time to jump into the housing market?
Prof: Who knows where the market is going to head. I've got to have a nice place like all the other attendings. I'd like a really nice one, but not sure if the current salary can afford it. I bet private practice salary could afford a place I'd like.
Res: Why are you looking for a place with so many bedrooms?
Prof: I don't know. I'm single now, but if you're going to buy a nice place, might as well get several bedrooms.

What prompts an intelligent single woman into thoughts about buying a full-blown house because "all the other attendings have nice places?" Call it "sweating the small stuff." Call it "blowing things out of proportion. I call it tunnel vision. We all run the risk of tunnel vision. I'd like to introduce you to this common syndrome.

Something happens at school. Or at work. Or at home. School/work/home occupies a good amount of your waking moments, which magnifies the importance of all that is said and done in these environments. You have (a little) free time, which gives you time to mull on the event, further increasing it's significant and importance in your life. Before long, the event has become THE EVENT, and you no longer realize that THE EVENT is really only capitalized in your own little world.

For example:
1) Is there a co-worker at work that drives you up the wall? Can't stand his brown-nosing ways, or how he steps on whoever he can to try to get to the top? Sure, the guy's a farthead, but you've also got tunnel vision. What he does at work may affect you, and maybe he'll step on you to try to get ahead, but when you're on your deathbed, will that matter?

2) Remember the first person who broke your heart? How you moped for days (weeks, months, years)? How you never thought you'd get throug it? Well, look where you are today. You're all better. You had tunnel vision. Sure, you still remember it, and it was a big event in your life, but it definitely was not THE earthshattering event that you thought it was at the time. (At least, I hope not!)

3) Does driving raise your blood pressure through the roof? Can't stand people who drive too slowly, or too fast, or don't know what they're doing? Take a deep breath. You're suffering from tunnel vision. In the end, it doesn't matter if little old lady in front of you is driving way too slow. Sure, you might arrive at work a few minutes late, but ten years later, do you think this is still going to matter?

4) Remember that big midterm or final you studied for? Or the SATs? Or MCATs, GREs, LSATs, boards? It was such a big deal how well you did on that test. Or trying to pick the PERFECT college or job? Tunnel vision, my friends. When you turn forty, do you think any of this is going to matter?

These are just a few examples of tunnel vision. It's a pervasive syndrome in all our lives. The solution? We really need to get out more. School/work/home needs to occupy a smaller portion of our lives so that we can have a healthier, more balanced view of life. Volunteer - give, get, and don't waste time thinking about things that don't matter. Or just take time for yourself, where you step away from it all. Drop all the baggage that you've picked up in your life. Leave all the stressors behind. Try to look at what's bothering you from a different angle. Perhaps then you can see the tunnel you've been stuck it. Get out before you get used to the darkness in there!

Buffalo in Yellowstone National Park. Look, Mr. Buffalo's losing his fur. He could just focus on the bald patch and worry that he's going to loose all his hair. But Mr. B's too smart to get tunnel vision syndrome. What's a little hair loss when there's all this good grass to munch on? Besides, he's got plenty of hair to spare...

Sunday, October 15, 2006


Earlier this month, a gunman opened fire in an Amish school and killed five school girls before committing suicide. The Amish response to this carnage was to forgive the gunman.

It was an unexpected response. Perhaps due to media exposure, we're most familiar with the smoldering anger that families of victims often nurse for years, intent on seeking revenge for the wrongs inflicted upon their loved ones. It's sad to see this when it happens, because one can see the sorrow, anger, and hatred literally eat away at these people. After all, thoughts of anger and hatred will never harm the perpetrator of the crime, but will always harm the bearer of these thoughts. The resulting sleepless nights and anger-filled days poisons in ways that eventually make people unrecognizable from who they were before.
But it's easy to stand back and say that the nursing of these negative emotions only cause further harm and thus should not be done. If one of our loved ones was the victim, dare we imagine that we know how we would we respond?

So the Amish response was very unexpected, and thoroughly humbling. They did not have to travel the usual sadness and anger filled road before reaching the destination of forgiveness. They grieve, but forgiveness is so a part of who they are, that it too was a natural immediate response to suffering. They were able to see beyond themselves and their families, and understood that they were all victims. The gunman suffered, and the gunman's family suffered. Their forgiveness allows not only compassion for the perpetrator but compassion for themselves; it allows their community to heal.

These are a peaceful people who truly live their faith, and their willingness to forgive serves as an example that all of us can learn from. Perhaps, if we were more like our Amish brethren, hatred and war could be a thing of the past.

photo credit

Friday, October 13, 2006

The Fear of Loneliness

Just saw the movie "Because of Winn-Dixie." It's the story of a motherless young girl and her father who have just moved to yet another new town. She is lonely until she finds a stray dog that lead her to unlikely friends, and bring together this motley group of similarly lonely souls. While the actual movie itself was OK, the topic of loneliness was addressed well.

There are a few friends who have recently been through divorces. All in their twenties. While the divorces were ugly, now that they are alone, they find themselves very lonely and find it difficult to readjust to a single person life. Then there are other friends who have never been married, but yearn to find that right person so they can get married, because then, "they'll never be alone."

Sometimes it seems like we spend so much of life trying to get away from this thing called "loneliness," that we'd rather do anything - find anyone, put up with anyone, look the other way, to stay away from this unknown. Yet what is loneliness? Although surrounded by people, we went through the pain of birth alone. And though the fortunate ones may be surrounded by loved ones on their deathbed, we all face death alone. Even during our lives, we work and live amongst so many people, and while we can share joys and sorrows with loved ones, the day to day, minute to minute experiences are experienced by only one person.

When did we develop this enormous fear of loneliness, and why? What exactly are we afraid of? What can we learn from those that do not fear but cherish being alone - the mystics and ordained, or even the lay people who draw their faith and energy from solitary communion with their spiritual tradition?

Early morning view from a cabin in Yellowstone park. Sepia is a wonderful medium.

Thursday, October 12, 2006

Away Fecal Matter, Away!

So this post is along the lines of a prior post:

Did you know that you can get a rectal ulcer from constipation? Actually, you can get a lot of bad things from constipation. Nausea, vomiting, abdominal bloating, severe abdominal pain, even fecal impaction, where someone is going to have to glove up and do this!

But the pressure from all that feces can actually cut off blood supply to certain areas of the large intestine. No blood supply = dead tissue that sloughs off = ulcer. Which can lead to intestinal bleeding and anemia. So if you're constipated, don't sit on it. Fiber and water... fruits and veggies are your friends!

Not to prolong this unappetizing subject, but did you know that there is a medical chart used to categorize feces? It's called the Bristol stool scale, which was found on a google search for a decent picture of said product. Am not sure who uses this scale (we definitely were not taught this in school!) - perhaps the gastroenterologists??

Also, have you seen the fake poop gifts? Saw them in a souvenir shop in Vegas. They were pretty realistic, except for the plastic googly eyes on them, and the fact that they came in a nice box... too bad there's isn't a internet picture to show ya'll!

photo credit

Wednesday, October 11, 2006

Pat Yourself on the Back - You Deserve It!

Decided that I'd reply to the comments on the previous post in a new post. Is that kosher? Thought it might be easier than having a reply comment that is five times longer than most people's long comments! :)

As I mentioned on Moof's blog, while the admiration is nice (thanks!) knowing stuff in medicine is no more admirable that knowing another field really well. Put me in a courtroom and I would have no idea what to do. Same in a classroom full of 8th graders. How does one keep an airport bathroom clean? Or keep a city's sanitation system running smoothly? We all have our specialized areas of knowledge, and some fields happen to get more credit than others. But every field is difficult to master, so everyone should give themselves a pat on the back for what they know.

The other thought is that "what" we are depends on who we're dealing with. A 'physician' is someone you see when you get sick in the hopes that the person has something (knowledge, treatment, etc) that can make you well. And that physician is only a physician in relation to a patient. While we refer to people in general as "Dr. So-and-so" outside of the clinic/hospital setting, that is for convenience sake. Just as saying Josh's mom, or Kathy's son. If there were no patients, there would be no title of "doctor." If there were no Josh, there would be no "Josh's mom." So "doctor" is merely a role we assume in our interaction with others in certain situations (outpatient clinic) and not in others (grocery store), just as we assume the role of daughter in the presence of our parents and mother in the presence of our children. Which means that although society traditionally gives physicians a lot of respect, which is greatly appreciated, being a physician is really no more admirable than being a trucker, or a receptionist. We all give back to society in the ways we can, and no one way is more admirable than the other. And physicians should always remember their teachers - both professors AND the patients - have taught them all they know. Those who forget this run the risk of having their heads become bigger than most doorways. Please knock some sense into me if you see signs of that happening. :)

Did that make any sense? Sorry for the rambling - am running on less sleep that usual... :)

This is a picture from the beautiful Bryce Canyon National Park. These hoodoos were just amazing.

Monday, October 09, 2006

The Brain Is a Sieve.

If you haven't yet been to Michelle Au's blog, you should check it out. She's a anesthesia resident in NYC who also happens to have a great sense of humor that really comes across in her blog. The following was lifted from Dr. Au's blog:

"And half the time even when I do try to read something for academic's sake, I can't really seem to retain it once I turn the page. This is problematic. I am turning stupid."

Oh, how this resonates with all residents.

The 1st and 2nd year of medical school are pure studying, where one tries to figure out what medicine is all about and how to possibly learn all the things you're expected to know. At the end of 2nd year is the first part of the medical licensing exam. The formal name is United States Medical Licensing Exam: Step I, but it's usually referred to as "step I" for short.

Now, there's three parts to the licensing exam, and if you pass all three parts, you can officially apply for a U.S. medical license. But Step I is usually considered the most important part of the licensing exam, because the score that one gets on it is used as part of the residency application process. Much like SATs are used for college. (Yes, my friends, it never ends...)

Different medical specialties view the Step I score in different ways. These are gross generalizations, but usually the specialties that have many positions to fill every year care less about the exact score, and just want to know that you passed Step I. For the more competitive specialties, you usually need to score as high as possible, because some programs have automatic Step I cutoffs that are used to try to narrow down the number of qualified applicants.

A "passing" score on Step I is around 180. I've heard that some programs used 230 as their screening score, which means that if you score below that, your application is never reviewed. Some people say that creating a "cutoff" is unfair, but when you are a program with one or two positions a year, and more than four hundred people apply each year, there's just no way to flip through four hundred applications and do them justice. Hence the cutoff.

So Step I scores are important. Step II is taken during the 4th year of medical school, and Step III is taken during/after the internship year. There is a saying that you need to study "two months" for Step I, "two days" for step II, and "bring a #2 pencil" to pass step III. Not because the tests get dramatically easier, but because by the time you take step II and step III, you've already matched in your residency of choice, and the scores no longer matter. You just have to pass.

Because of all the studying done for Step I, your medical test-taking, trivia-winning brain is really at its apex. From there, all those little tidbits you so painfully crammed in for the test disappear from memory, so it's not uncommon to run across a term, know that you once studied it for Step I, and actually once knew it, but now have no idea what it means. A lot of the material memorized for Step I is really test-taking fodder; much of it has little clincial application, so is pretty useless on a day to day basis. So while you gain more clincial experience, all that clinically-less-useful book knowledge falls by the wayside, and you always have the uneasy feeling that you're getting dumber by the day. Because, after all, you once knew more factoids than you do now, right? And clinical acumen isn't easily assessed, so it's easy to forget that this has replaced all the less useful book knowledge.

The end result is the feeling that the brain has become one big sieve. The rate of information loss its just a matter of how big or how little your sieve holes are, and how fast (or slow) you're pouring the water (new material) in. Water in, water out.

photo credit

Sunday, October 08, 2006

Kunming's People

The Chinese Mid-Autumn Festival happened a few days back, which brought back memories of a past trip to Kunming. We had a great time in that part of China. The scenery at the Stone Forest was dazzling (see right) and the whole experience was memorable, but the best part was the yet untainted essence of KunMing city. You could feel it in her people - from every day people on the street to the vendors to the restaurant workers. Whereas in Beijing, many in the tourism trade had perfected the crass side of their craft - street vendors yelling, tugging, ripping off foreigners, Kunming felt slightly more sheltered from the ugly side of trying to turn a profit at all costs. Words can't capture all the little things that created this impression.

The most enduring memory from that time was the sense that although Kunming was a big city, it still had a community feel. After a delicious dinner one night, we decided to go for a stroll in the center of the city. We ended up in beautiful Green Lake Park. It was a peaceful moon-lit night and we strolled leisurely past willow trees, enjoying the fresh night air, when from somewhere in the park, music started. The different yet somewhat familiar sounds of traditional Chinese instruments aroused our interest, and following the sounds led to three white-bearded elderly gentleman with their home-brought chairs, enjoying each other's music. The music attracted many of the park visitors - a good thirty locals, ranging from mid-age to elderly, who gathered to listen to the music. As we stayed to enjoy the music, the locals began dancing to these folk tunes, and they were just really enjoying themselves. The music drew more and more locals (on their evening walk) to the area, and the dancers welcomed the new members into their dance. How neat is it that a few people just got together to play music and an impromptu gathering formed?

photo credit

Saturday, October 07, 2006

Funeral Songs

I'm honored to be tagged by Moof for my first meme! :)

Let's see, songs for my funeral... It was actually a good experience to try to think this through. Brought a lot of other thoughts to mind, that life is short, precious, and should be cherished. That we should live like today is our last day (in terms of letting go of all the little things, not letting things faze us). That we should never take tomorrow for granted.

Those that suffer at a funeral are the loved ones that must pick up the pieces and move on. So these are some songs meant to tell them that everything is as it should be, and that they are very loved. And a closing song of Native American flute music to be used for meditation, healing.

Here's the list:

Time of Your Life by Green Day

Kiss the Rain by Billie Myers - Kiss the rain, whenever you need me, kiss the rain, whenever I'm gone too long

Live Like You Were Dying by Tim McGraw - (absolutely love this song...) some of the lyrics: love deeper, speak sweeter, live like you were dying

Somewhere, Over the Rainbow by Israel Kamakawiwo'ole - when sung by Iz, this song takes you above and beyond...

Dawn's Mirage: Ancestral Home by Carlos Nakai

Now, time to tag people:

Ellie Finlay

The Wests

The Hagans



sunset picture of a surfer statue on Waikiki beach

Thursday, October 05, 2006

Just Pass It On...

Wanted to write about a nice experience at the grocery store. Picture a stooped, elderly woman slowly pushing a cart down the aisle. My first thought was, poor lady, I wonder if she needs any help? But she wasn't doing anything that needed any help so we just passed each other by. (How come, in smaller towns, I'd have no problem going up to her and asking, but in big cities, if you do that, you'd probably get the look of - who are you and what do you really want?)

Anyways, after browsing through the ice cream selection and grabbing a couple of boxes, went to get in line. Who did it happen to be but the elderly lady. She was next in line and about half way through unloading the groceries, when she looked up and said - "that's all you're getting? Go ahead of me!" I said no need, wasn't in a hurry, but she called the grocery clerk by name and said "ring her up before you start mine." A little embarassed, I moved up in line and thanked her. These were her words: "Not a problem. Just pass it on." What a beautiful phrase. Just past it on. I'll definitely remember her words the next time I'm in the situation where I can pass it on.


Saw a med school classmate who chose to do General Surgery at Big University Hospital. The poor girl had switched services from Trauma surgery to Neurosurgery that day. She had been on Trauma call the day before the switch, meaning she had been up at 4:30am, no sleep the whole day, and now was the sole resident for a packed, all day neurosurgery clinic. And at 6PM that day, she still had 5 more patients to see. Inhumane. This is after the "80hr work week" rules - can you imagine what went on before the rules were implemented?

picture of horse and buggy at Jackson Hole, WY

Monday, October 02, 2006


How time flies.

We're into the fourth month (phew!) of the residency year. Almost a third of the way through. Amazing.

There's still a lot of reading to be done, and if I were one to despair, that'd be happening every night. After all, it's quite daunting when you read about one disease and come across references to other diseases that you never knew existed.

It is interesting though, to realize that at least some of the new vocabulary is sticking. The fact that I don't reach for Stedman's when reading: Superficial and deep perivascular and periadnexal lymphocytic infiltrate, dermal mucin, with follicular plugging, and that I actually have a sense of what they're trying to say, is a good feeling.

Because this stuff can get a little overwhelming, it's easy to forget how amazing it is that our brains are plastic enough to learn such different things. And being at the cusp of closing the internal medicine chapter and beginning dermatology allows for an interesting perspective on some of the sillier "side effects" of becoming fluent in a medical specialty.

1) Basic English skills go down the tube. The more "work reading" there is, the less "fun reading" there is. Which means that spelling and grammar, at least what most people would recognize as such, deteriorate. As a kid, avid reading meant constant exposure to words used in every day language. The eyes became a sort of spell check, because if you wrote or typed something and it didn't look right, it was obviously mispelled. Well, many of those common English words are not found in a medical text, so have been mispelling for some time now. Quite embarrassing.

Grammar is also different in the dermatology world. For example, when one wants to describe an object, you usually use one adjective. Sunny day. Yellow flower. Being the descriptive field that it is, it is the norm to find sentences filled with adjectives. Quite against grammar rules somewhere, I'm afraid. Here's one of the shorter examples: Erythematous, lichenified, excoriated plaque. That's like saying Yellow, large, sturdy sunflower, and calling it a good sentence. Yet that's how the textbooks read, and that's how we talk to one another. Silly, no?

2) Medicine is very particular about how things are done. After taking a careful history and examining the patient, the goal is to distill what you have seen and heard into a "presentation," short, succinct, yet able to convey to the listener exactly what you saw and what you think is going on.

Think of it like this. In an ideal world, if you went into a room and saw a black cat sitting on the examining table, you'd come out and probably say,

"there's a black cat on the table."

Simple enough. But in medicine, you're not supposed to jump to the conclusion that what you saw was, indeed, a black cat. Instead, you should describe what you saw in an objective way, and have a list of possibilities of what kind of animal it could be. For example, you would come out of the room and say

I just saw a small, black, four-legged animal with whiskers. It could be a cat, a dog, a hamster, a rat, or a baby cow.

However, if you're adept at what you do, your description of the animal would use "key words" that would subtly tell the listener, who's seen quite a few black cats in his day, that you just saw a black cat. As in:

I just saw a small, black, four-legged animal with green eyes. She is often described as having many lives, enjoys rodents, and is most popular around Halloween. The most likely animal is a cat, however, you can never exclude dogs, as they can be the great imitator.

Basically a convoluted way of saying "I saw a black cat." The key words are like a secret language that people "in the know" share. Sometimes it's silly, when you have to try and describe a wart as "small skin-colored, verrucous or filiform papule" instead of just saying the patient has a wart. Other times, because you're the newbie to the specialty, you may have just seen a cow, which has its own buzz words, but since you've never seen a cow before, you're left fumbling for the right wording - four-legged, uh, large, uh, udder-looking things, etc.

beautiful flowers on the island of Hawai'i (anyone know what kind of flower?)

Sunday, October 01, 2006

Alternative Medicine

There's been a lot of neck and upper back stiffness in the last year or two. Some have chalked it up to stress. Sure, there were a lot of sleepless nights while on call. Even if you're not paged, there's always the awful feeling that you could get woken up at any time, which puts all five senses on perma-alert. Sure, there are long days, on your feet from early morning until late evening. Very little upper body exercise at work too, unless you count the half lift of arms to type on a keyboard. Sure, you're stressed, trying to do good by the patient, learn as much as you can, and not seem like a complete doodle to your attendings. But EVERYONE has stress. Not everyone (at least that I'm aware of) has neck and upper back stiffness.

So, you say, maybe it's a function of age and aging. Perhaps. But is it? Many people may develop these and other problems as they age, but is it truly a normal part of aging, or are we all using our bodies the wrong way, and thus developing these problems? Can chronic misuse be the confounder? I've seen enough healthy, vibrant 90 year old people to say that this cannot be normal aging.

Deep-tissue massage really loosens up the neck/back muscles. It allows one to feel how a back truly should feel, and in contrast, it becomes clear that the stiff back that we always live with is pathologic. So if I were to get a massage once a week, I'd probably be able to prevent worsening of the neck/shoulder tightness. Heck, if I could get it once a day, it'd be even easier to prevent worsening. But the key is prevent worsening. Massage doesn't get to the root of the problem. Whatever I'm unconsciously doing on a day to day basis is causing the problem, and getting massages are like applying little band-aids to a wound. Sure, it temporarily feels better, but the band-aid falls off soon, and will need to be reapplied. Meanwhile, the wound festers away because it was never truly treated.

Some might say I need to go see a doctor. I can tell you exactly what would happen - there's nothing medically wrong with me that allopathic medicine can treat. I've got tight, stressed muscles. I don't even have pain. If I did, I'd get the usual - take ibuprofen, rest, heat, relax. Again, all band-aids. And perhaps some people would be content with band-aids. After all, if you had pain, applying them in quick enough succession, you might even forget that the problem was there. Until it worsened because you never treated the problem. I want to know why this is happening. How I can correct it. I've seen enough chronic pain patients to want to do something about it now. I'd never wish chronic pain on the worst enemy.

So here's a documented foray into alternative medicine. Mind you, my bias is that I'm very open to this field, probably more so than some medical colleagues would like. I think medicine should be complementary, with alternative methods working hand in hand with allopathic means. Each has its strengths and weaknesses, and knowing how to use both of them means one is a more trained physician, one that is better equiped to help their patients heal. Allopathic physicians are often taught that only the hard-core, scientifically proven data is worth knowing and using. And while I agree that this kind of data is wonderful, I'd like to venture that there are plenty of things in every day allopathic medicine that are FAR from evidence-based. And that while some of the explanations of how alternative medicine works may sound like a crock of excrement, I say that you shouldn't toss the method because one practitioner, or even a group of them, gives an inplausible theory of how it works.

All scientists have been wrong at one time or another in their hypotheses and theories. It is human nature to want to try to explain how something works, and the explanation itself may be wrong until the day we know enough to correct the explanation, but if it works, it works. J.J. Thompson, the discoverer of the electron, theorized the plum-pudding model of the atom, which we now know is incorrect. But though his explanation was wrong, it provided the stepping stone for further scientific thought about the actual state of an atom. Would you have wanted to be the one to throw away the atom because Thompson "obviously" didn't know what he was talking about? Probably not.

If you have neck/back stiffness or pain, my hope is that some of the methods I'm looking for can become useful for you.

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