30 September 2010

calling names

I just ran across a blog written by a family practice resident, pontificating "What's in a name?" I find this to be an interesting topic, as I have struggled with it myself in the past.

This, I feel, is very generational, as well as regional. ie: I am much more comfortable calling my colleagues by their first name when they are close to my age (by which I mean within 20 years). However, my soon to be partner is 73, and although I call him by his first name in private conversation with my guy (always preceded by a pause and followed by a giggle), you can bet I call him Dr when speaking to him. (He, by the way, calls me everything from "gorgeous" to "sweets..." although generally, he calls me by my first name. In case you wonder, I don't mind--his demeanor is such that it completely does not sound crass or degrading.) I also have a neurologist friend who is about 3 years shy of being my parents' age. When he asked me to call him by his first name, it took a while (and several slip ups) to get used to.

As for regional: I did my med school clinicals all over the states, followed by residency/ fellowship in the East. I can tell you that in the midwest, it is much more common for Drs to introduce themselves by their first name to other healthcare professionals. It is understood that they, in turn, will be introduced as "Dr" to patients. As soon as I came to the East Coast, it was Drs all around. This makes me often feel pretentious, so I will frequently introduce myself by my first and last name, followed by my specialty. I let them decide what to call me. And, for the most part, I will eventually correct them to call me by my first name in private.

As for patients, I am not too interested in being buddies, so I introduce myself as Dr. Older patients appreciate the formality, for the most part. Although, I have had elderly patients insisting on knowing my first name--and then calling me by that name--which made me feel a little like I was talking to my grandparents. Also, being young and attractive, I have been hit on by patients (of all ages), and I believe that introducing myself as "Dr" nips that possibility in the bud--sometimes. On the other hand, introducing myself as my first name invites that kind of discussion.

Of course, things will be a little different very soon. I think that at my new position, I may introduce myself to patients as first and last name, and let them choose... or maybe the first name will suffice. Cancer is a place where it's nice to have a buddy.

20 September 2010

Prisoners and Food... and punishment

I have to admit, I am having very mixed feelings.

Yesterday, my guy and I went to our local farmers' market, where I picked up a throwaway magazine on local foods. Leafing through it, I found an article that caught my eye: "On the Line: Correctional Dining."

Before I got there, I read the editorial page. There had apparently been an article a few months ago which caused quite a stir. The editor pointed out the article to which I alluded above, and said that he "expect(s) much controversy surrounding it." I thought to myself, "Yes, from all of those human rights groups, I am sure, to protect the poor prisoners."

Then, I read the article.

I have to say, I am not sure what to think. Let me explain: I never realized that the prison system uses food as punishment. Apparently, there are three levels of punishment. In brief: if a prisoner is cited for a "level I infraction," (s)he may lose visitation rights. A tier II infraction may get them to solitary confinement. Tier III, however, may get the prisoner the joy of eating "the loaf."

Now, nowhere in the article do they state what the said loaf actually contains. However, apparently the prisoner has to have medical clearance to "go on the loaf" for all of the digestive disarray it causes. It is served simply, with water and boiled cabbage "to aid digestion." Of course, with the internet at my fingertips, I had to see if I could find out what is in this mystery concoction. The best I could do, was this recipe and report from NPR. I have to say, there has to be more to it, as this really sounds not all that bad. I mean, it doesn't sound gourmet, by any stretch, but not too horrid, either.

My initial thought was, "What the hell do I care what they eat--they are PRISONERS, after all. Let them eat bread and water for all I care." That being said, here is my quandary: Another (quiet, minuscule) portion of the original article mentioned that the rates of obesity, diabetes and hypertension are on the rise in prisons.

Damn, it makes sense. They are not getting nutritionally sounds meals, so diet-based diseases are rearing their ugly heads. (There are apparently quite a few prisons that try to cut costs by only serving breakfast and dinner Friday, Saturday, and Sunday. This forces inmates to fend for themselves--often in the form of ramen noodles and freeze-dried foods from care packages. beef jerky, anyone? hmmmm, salt, fat, sugar, and more salt) This pulls more of our tax dollars to treat these people. Their diets don't change, and it's a vicious cycle. In fact, the article goes so far as to state that if a prisoner cites that they have religious requirements for food (halal, kosher, or vegetarian, for instance), they are immediately under suspicion... for, although those meals are not significantly more nutritious, they are minutely more expensive to manufacture.

If we went for prevention instead of treatment, we would inevitably spend a lot less. Well, this, of course, works for health care all around. Unfortunately, when you can get a taco at Taco Bell for 89 cents, why should you shell out four bucks for a dozen farm-fresh eggs... or $2.50 for a bunch of kale, for that matter, which you will have to then (oh, horror!!) cook!!

The United States public has, sadly, been lulled into a sense of instant gratification, sugar rush and fat/ carb coma included. But I digress...

Wouldn't it make more sense to have these prisoners spend some of their time tilling soil and producing their own food? That way, they would get more nutritious fare, but at the expense of work hours, not tax dollars. I mean, the inmates that behave are allowed to work in the kitchen. They just have to account for any utensils or can lids that they use or discard. The same could be done for garden/ farm work. Prisoners take classes, attend workshops... this would be just another offering.

I know, I am a dreamer...

17 September 2010

They are not alone!!

Apparently, there are more "sport supplements" which are being recalled. This is in addition to yesterday's shocker.

There is this one, for Advanced Muscle Science. Also, this recall from Fizogen is in effect.

All for the same key ingredient: aromatase inhibitors (AI). oh, brother.

The FDA has told Fizogen and Advanced Muscle Science that the particular AI "does not meet the definition of a dietary ingredient." Well, it's good that the Food and Drug Administration recognizes this.

16 September 2010

Holy CRAP!!

Wow, I am about to sound terribly naive, but... here goes:

OK, so being a breast oncoplastic surgeon, I am quite familiar with the medication Arimidex (generic: anastrazole). This medication is used as adjunctive therapy in post-menopausal breast cancer patients whose tumors manifest estrogen receptor positivity. In short, the medications decreases the amount of estrogen that a woman's body makes. The less estrogen that is present, the less the cancer "feeds," and this slows down or altogether stops cancer growth.

In case you think that this medication is the "white knight" in the middle of the dark nightmare of breast cancer, don't forget that it has its own host of risks. In fact, the active ingredient will chomp away at bone, leading to osteoporosis (why we are crazy about bone density tests and why dentists hate it when we use this--it can cause mandibular necrosis) and it can cause liver dysfunction (why we check liver function when you are on it).

Imagine my surprise, when I got this FDA alert today: G.E.T. Issues Vouluntary Recall of ArimaDex. Not only is voluntary misspelled, but I was aghast that Arimidex was misspelled... and then I actually READ what was in front of me. First off, I don't know who "G.E.T." (Genetic Edge Technologies) is, but Arimidex is made by AstraZeneca. The real shocker is that this (ArimaDex) medication "may (actually) contain an Aromatase Inhibitor." Oh. My. God.

The same active ingredient that is in the breast cancer drug is now available OVER THE COUNTER in your local sports supplement store!!!! In fact, I cannot place enough exclamation points behind that sentence. I am beyond appalled, flabbergasted... I don't even know the correct word. I think I want to cry, in fact.

I just googled this stuff, and it actually says that this is an "Estrogen blocker...(that has) been shown to enhance and maintain testosterone levels." um, well, yes. Even Amazon is selling it.

Please, please, spread the word--this is NASTY stuff. And yes, it has all of the risks I mentioned above... and more: kidney failure, adrenal insufficiency, not to mention decreased sperm function.

12 September 2010

geniuses... and seriously smart people

I had to share this story with you, so you could laugh, shake your head, or both. Apparently, some real savant was testing the wit of his local men in blues. Probably not a good idea to play with their toys... especially right under their noses!

And then there are the Romanian fortune tellers, who as far as I am concerned, are truly visionary. Again, they won the fight to avoid tax payment... and with solid reasons. nice.

02 September 2010

no one left behind

Just in case you thought that Whole Foods qualifies as a "local, small farm." It does not, and certainly the Whole Foods chain is not immune to its own FDA recall.

Granted, this is a preemptive recall of sorts--no one has reported getting ill, yet. But, during "routine sampling," the cheese in question was found to be contaminated with Listeria monocytogenes and Staphylococcus aureus.

buy local, know your food, support small farms

01 September 2010

watch out, furry ones

While the rest of the world blogs about docs stuck in chimneys (seriously?! what a dumb-ass) and fancy new google tools (well, not entirely new), I'd like to turn your attention to this: ANOTHER FREAKIN' CAT FOOD RECALL!!

I don't know why this aggravates me so... oh, yeah, because their livelihood is in our hands--completely. And, wouldn't you know it? Salmonella is the culprit, yet again!

As for the huge egg recall, I'll just say, "I told you so." Yes, I have been touting the benefits of buying from local, small farms for a long time. Yes, it may be a little more expensive, but what price is your health? I speak from experience--I have had Salmonella poisoning before. Once on vacation: bad Chinese, and once more recently: the tomato recall. Granted the vacation bug was so, so much worse than the tomatoes, but, then again, I ate only one of the tainted fruits.

As for the Iams? Again? Iams cat food was recalled previously, and not that long ago--in fact, just a month ago. grrrrr