Look Ma, I’m a Columnist Now!!!

November 26, 2009

I somehow convinced the wonderfully deluded folks over at Albuquerque’s Weekly Alibi newspaper that I know what I’m talking about, so today marks the debut of my weekly health care column, Miss Diagnosis. The award-winning newspaper appears in print and on the Web, so here’s a link to my very first piece. It goes well with a side of mashed potatoes.


Top 5

November 22, 2009

Tonight’s blog belongs in the category of sexual and mental health. It is very important for your sexual health and your mental wellbeing to compose a list of your 5 favorite hot famous dudes. I sat down with notable sister Emmy “Demmy” Dingdong to get to the bottom of this important health topic.

SEMI: Ok, Emmy, who is on your top 5 list?

Emmy: I don’t know, I’m pretty picky.

SEMI: Anybody of note can be on your top five.

Emmy: Ok…. young James Spader.

SEMI: No, the top five list isn’t a time machine. It must reflect the status quo.

Emmy: I think Ben Affleck seems pretty quality. Except for the whole J.Lo thing.

SEMI: Veto.

Emmy: You can’t veto my top five!

SEMI: I can.

Emmy: Fine. George Clooney.

SEMI: mmmmmm hmmmmmm

Emmy: I don’t know. Who else? I’m not into actors.

SEMI: Like I said, it can be anybody of note, such as New Mexico congressional hunk Martin Heinrich.

Emmy: Who is that?

SEMI: What about Ryan Reynolds?

Emmy: Yeah, him. I like the muscles on his arms. I like that he tried to date Alanis Morissette.

SEMI: Dude, you are so right. What about John Hamm, too? Remember John Hamm’s john ham?

Emmy: Yeah, he’s sexy.

SEMI: Ok, you’ve got three. We need to flesh this list out a little more.

Emmy: I don’t know. YOU come up with some names!

SEMI: I gave you John Hamm and Ryan Reynolds!

Emmy: Yeah, I guess. Do you know what the ‘multi-tasking face’ Bare Minerals is?

SEMI: No, stay on task.

Emmy: Ok, prompt me more.

SEMI: Well, you like silver foxes. What about Ed Harris?

Emmy: I will shoot you.

SEMI: I think Ed  is kinda sexy.

Emmy: Eww. Sick.

SEMI: Ok.

Emmy: Why are you writing all of this down? Stop writing. I want people to think I’m cool.

SEMI: Don’t worry. I’m just taking notes.

Emmy: I guess I don’t have a top five. Just George Clooney.

SEMI: What about Billy Bush?

Emmy: (laughs)

SEMI: Seriously, I think I’m the only one that thinks he’s kind of attractive. Him and Seacrest.

Emmy: Get help.

SEMI: Ok.

So, dear readers, you can see how a person’s Top Five is a vital part of the health history, since it can reveal underlying psychiatric disturbances. This is a very powerful screening tool, and should be used at each and every health visit to screen for mental illness.

P.S. After reading this, it’s probably impossible to believe that I got me my own NEWSPAPER column, but, lo and behold, I did, and it debuts this week. Details to be posted soon!

Addendum: We’ve since added Matt Damon and Nathan Fillion (described as “pretty cute”) to the list of potentials.


Blue Girls

November 14, 2009

As a nurse and a soon-to-be primary care provider, I am very much aware of many of the challenges faced by our nation’s youth. Witness the touching testimony of one young lady, who weaves a poignant narrative of how hard it is to dance at clubs and keep your cool around celebs unless the Jay-Z song is on. This particular tale ends happily, with our heroine overcoming her harrowing developmental milestone by moving her hips like yeah. But I can’t help but wonder she’s going to continue to overcome developmental challenges and attain optimal health as she ages. Will she receive appropriate education and support concerning sex, childbearing, safety, and personal responsibility and security? Will she choose intimacy over isolation? Will her faculties for empathy and social consciousness be nurtured? Will she have educational and occupational opportunities? Will she have access to preventative health screenings, prenatal care, and social and economic safety nets? Will she avoid substance abuse, will she exercise and eat right and maintain herself in order to achieve generativity over stagnation? Will she receive annual mammograms after 40 and colonoscopies after 50?  Medicare benefits after 65, and sensitive, age-appropriate care in her twilight years? Does our society promote integrity over despair in our senior citizens? Or do we continue to worship at the altar of youth, borrow against our futures, and funnel money into war instead of the education and health of our children and society?

I know, I know, moralizing on one’s personal blog is cliché and tiresome. And there are already countless reflections on the fragility of youth, the challenges of aging, the pervasive devaluing of the aged in our society, and the hilarities of Miley Cyrus out there. So I’m not really contributing anything new to the collective conscience with this post. But I’ve been thinking along age-related lines ever since, well, since the TV and the magazines at the gym taught me to. And now, as a nurse practitioner student, I find myself in the predictable position of providing care primarily for the baby boomer generation. And since  women utilize the majority of health care, it’s no surprise that most of my patients are middle-aged to elderly women. And so the question I get most often, as women squint at my face while I listen to their hearts or stare at my nose while I shine a light in their eyes is not “are you finding anything abnormal?” or “can I get a prescription for such and such,” but rather, “how old are you anyways?”

And when I tell them, they invariably get that tender, misty-eyed look as they remember themselves at my age and mutter, “oh, what I wouldn’t give to be your age again!”

The uniformity of this response… well, terrifies me. I am acutely aware of the fact that I won’t be this age forever, and that a future of  menopause, bone loss, indigestion, and jowls awaits me. I know my days of special treatment are numbered, that one day patients won’t look at me with misty-eyed tenderness, that I will eventually have to seriously worry about whether or not my outfits are appropriate for a “lady of my age.”

And so, in my terror, I ask my patients what it is they miss about being my age, or if they want to discuss some of the changes they have experienced. And usually blink once or twice. The misty eyes snap back into focus, and a hearty laugh escapes. “Oh honey, I’d never want to be your age again! That was a tough time. I just wish my body behaved like it was young again.”

And so we discuss exercise, diet and nutrition, bone health, sun protection, sleep habits, stress and coping, and the importance of joy, of family and friends and all that good stuff. And by the time they leave the office, they’re winking and chuckling and encouraging me to just hang in there, telling me that it gets easier, that it just keeps getting better. And so I choose to believe them, and I take good care of myself so I will be alive and well for the rest of the journey.

Caring for people across the lifespan has taught me to try to see a person in her entirety, as a child and a teen and a young adult and a middle-aged adult and an older person all at once, in order to understand the person in front of me, address unmet needs or unfulfilled development tasks and anticipate future needs. I find my ability to care for people is deepened when I acknowledge the frustrated young person behind the weathered face, or the lost elder emerging from the careless twentysomething. And I when I see people like Miley Cyrus, I anticipate the challenges they’ll face as the Jay-Z songs fade into obscurity, and I think wistfully of the Blue Girls and their future selves with “terrible tongues” and “blear eyes”. And I worry that mine will be a generation of thistle-prodders, of old women who look back and feel nothing but the ache of loss rather than the pleasures of a life well lived. Rather than standing tall to face the challenges that come with progressing through life, we pop in the earphones, turn the volume up and party in the U.S.A. Yeah-ah-ah-ah-ah-ah-ah.

By the by, this was all a very roundabout way of me telling you to take your antioxidant multivitamin in order to help prevent age- related macular degeneration.


The yeas have it

November 8, 2009

The U.S. House of Representatives narrowly passed its version of a health care reform bill 220-215 tonight, and  republican representative  Joseph Cao from Louisiana’s 2nd district, the lone “yes” vote from the GOP, emerges as the congressional darling of the moment.

Do I think this bill is good? Not particularly. Prohibiting recipients of federal subsidies from purchasing plans that cover abortion will really hurt some of the most vulnerable women and families in this country.  That’s just one of many disappointments in the bill. I hate that this is the best we can do.

But am I glad it passed?

Sure.

Now on to senate.


Shine, Perishing Republic

November 6, 2009

I’m sure that today’s headlines will mature into fodder for tomorrow’s brilliant Woody Allen film-cum-social commentary on love and happiness within the larger misery of the human condition –I mean, I can picture the scene where Cate Blanchett, impersonating Woody Allen, throws her hands in the air while exasperatedly pondering the absurdity of an American military psychiatrist opening fire on a crowd of U.S. servicepeople, killing a dozen and injuring scores more. How do these things happen? How are we supposed to receive, process, and reflect this information with our subsequent behavior, our ability to keep going and to find meaning in the broken world that surrounds us? Somehow methinks Cate Blanchett’s character will learn to love in the end, will accept the yin with the yang, will realize that for every violently deranged gunman, there are a hundred sensitive, kindly bloggers out there trying to make the world a better place. But meanwhile, back here in non-movieland, the forces that be continue to tiptoe around the fact that military suicide rates are climbing, and active and veteran servicepeople are at substantially higher risk for committing suicide than civilians (Kuehn, 2009, JAMA, 301(11), 1111-1113). As per violence, even the DOD admits that domestic violence against spouses of servicepeople is “a problem.” Unfortunately, data on rates of military suicide, homicide and other noncombat-related violence is hard to come by: searching CDC, NIH, PubMed, PsycheInfom, CINAHL and PMC databases didn’t yield much. Kuehn (cited above) determined suicide rates by extracting data from general CDC surveillence reports. I couldn’t find anything specific to the military. If you’ve got a source, lemme know!

Mental health is a hot topic for military PR right now, and the rising rates of active-duty and veteran violence and suicide has them Army boys sittin’ around scratchin’ their balls asking, “why?” That’s right. The NIH, the Army, and $50 million in taxpayer money are teaming up to investigate why soldiers commit suicide!!! Don’t get me wrong: I theoretically support suicide research and figuirng out why it happens. But in the case of  young men and women participating in and subjected to extreme violence, I think the answer is a little bit self-evident. Still, okay, okay, it’s good to study factors that protect servicepeople against suicide, because if we know what the protective factors are, we can keep asking “non-suicidal” people in the service to do our dirty work in intolerable environments without worrying that they’ll just kill themselves first. Ok, maybe that’s pessimistic of me. Maybe we’ll use the knowledge to screen for mental illness and treat suicidal ideation, or change military policy to accomodate those prone to suicide or mental illness (uh, yeah right). Or we can pile “protective factors” onto those at risk for suicidal ideation. Like how some of the first meth addicts were military pilots who were given meth in order to protect them against combat fatigue.

Today’s other headlines weren’t the counterbalancing pick-me-ups I’d hoped they’d be. Anti-abortion, anti-immigrant democrats (forgive my extreme ignorance, but I didn’t know there was such a creature) may jeopardize health reform, and H1N1 vaccines magically reached Wall Street before other needy clinics. Hey, you people who think the “honor system” is alive and well in the medical industry: I have already seen H1N1 vaccine go to members of non-priortitized groups, because someone asked nicely or somebody knew somebody or somebody was a VIP or whatever. I have objected, but some providers seem to be of the opinion that a little bit off the top won’t hurt. My most esteemed government, next time you can keep your honor system and instead hold providers accountable for each and every dose of vaccine you ship to them.

FYI: Hoarding of the swine flu vaccine isn’t just a domestic issue. It’s projected that there will be about a billion doses for the world’s six billion people.

Looking at today’s headlines makes me shake my head, and I can only borrow the thought of a visionary born a century before me (no, not Woody Allen): Shine, perishing republic.


H1Mew1

November 5, 2009

PSA:

Dudes, if you find yourself sick with swine flu, please refrain from making out with your cat. Really, it’s not fair to the cat. Also not okay to make out with when you’re sick:  Chorizo, your pet pig;  your dog MazelTov;  little children; pregnant women; pregnant children. All of these populations are vulnerable to catching swine flu. Keep your airborne viral particles to yerself!!!

Love,

The Management


In Vitro Infertilization

November 4, 2009

I don’t know about you, but my birth control experience isn’t satisfying unless I can be confident that my own immune system will be used to destroy my ability to harbor new life. Enter the promising up-and-coming antifertility vaccines, some of which target either the infamous pregnancy-sustaining hormone called human chorionic gonadotropin (hCG) or the libidinous hypothalamic henchman known as gonadotropin releasing hormone (GnRH) (Talwar, Vyas, Perswani & Gupta, 2009). Essentially, these vaccines work by stimulating your immune system to wipe these endogenous hormones from your system. Without these hormones, becoming pregnant or maintaining pregnancy is impossible. Furthermore, since cancerous cells can develop fun party tricks like hormone production and secretion, some cancerous cells (such as certain T-cell leukemias) are known to produce GnRH and/or hCG. Antibodies that target these hormones seem to help neutralize some of these cancers. Prostate growth is also stimulated by GnRH, and phase I/II clinical in Austria and India show atrophy of the prostate and improvement of prostate cancer in vaccinated patients.

As far as I can tell, interest in an antifertility vaccine began in the late ’60s/early ’70s. Significant gains were made in the ’70s and ’80s, and much of the work on the actual hCG/GnRH vaccines seems to have been done by various members of a small team of researchers out of India headed by our good friend G. Talwar (cited above.) If clinical trials continue to go well, Mr. Talwar’s baby (no pun intended) may live to see the light of the free market within the next five or ten years.

Objections to the vaccine are obvious: Groups or governments will abuse the vaccine;  vaccines  treat pregnancy like a disease; the vaccine is intended to impact populations and therefore supports a woman-blaming approach to population control; the H1N1 vaccine is actually the antifertility vaccine; since hCG is produced by a fertilized egg, the vaccine kills babies; babies conceived despite vaccination may be harmed by the antibodies; etc.

Some concerns are valid, though women’s advocacy groups will be happy to know that researchers are also making progress on an anti-sperm vaccine as well (Naz, 2009). And the rather one-sided focus on the cautionary arguments overshadows the possibility that this technology will be of enormous use in battling cancer and inexpensively, harmlessly controlling animal populations (Fayrer-Hosken, 2008). Still, one wonders whether the forty years worth of immunocontraceptive funding would have been better spent supporting sociopolitical and economic liberation of women and girls, or efforts aimed at environmental health and sustainability. Perhaps. Perhaps not. It takes more time and money to tackle population control by addressing overarching global problems like inequality, poverty, cultural and social rot, and systematic poisoning of the planet than it does to teach my immune system to bounce  any pesky hCG-secreting embryos hoping to get into my hot uterine nightclub.