Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Saturday, June 16, 2007

Sitemeter Loves Me

I seem to be blessed in the hit department.

Whenever I have a slow blogging week (the Nestling graduated from high school and even so, I managed to see about the same number of patients in 3 1/2 working days as I usually do in a regular week, leaving exponentially less time for blogging) someone digs up an old post from seven months ago, and the hits, the comments and the fur fly all over again.

I believe I've said all I can on that particular topic, so I don't plan to say anymore. People with fixed false beliefs cannot be argued with.


At Sat Jun 16, 11:54:00 AM, Blogger Alexis said...

what an interesting matrix of posts and comments to walk into! (wowzers!)

After reading everything, I took my neophytic med student self off and did my own little PubMed search, perused Up-to-Date, and consulted with the best expert I know - my father the (brilliant)pathologist (who actually lives and works relatively near to your practice, I think, though I doubt you've interacted).

After a phone call and admittedly hasty lit perusal, I have to say I agree with you - it does indeed seem that the jury is out on chronic lyme disease, though there's some decent speculation that people pre-disposed to autoimmune disorders may be experiencing some continuous post-infection symptoms along the "myofascial-neuralgic" spectrum (yeah, I know, I made that term up, but it works). Could it be akin to post-herpetic neuralgia, do you think? My father pointed out that the lab test for "acute" lyme disease isn't particularly specific or sensitive, and in an endemic area, it may be justifiable to give a short course of doxycycline based on clinical symptoms alone. But he also points out that there's no good evidence for extrapolating an already highly-flawed test for acute lyme to a potentially even less detectable chronic lyme, should it exist. "What's the point? Everyone might come back seronegative, and you'd never know if it was the test or the truth" was his direct quote.

It's sad, really, because patients want answers, and doctors want to give answers, and sometimes the two seem to create a whirlwind of extrapolations and well-intentioned-yet-unsupported explanations. If it turns out after great research and better tests that chronic lyme exists, I'm sure you'll be among the first to say "aha! I can finally help my patients!" But it's ethically amiss to make such a leap before there's evidence - it would be a cavalier treatment of someone's very real suffering.

Let this be a lesson to me, then, to be very careful what I say to my patients, who deserve nothing less than the respect of a fully-informed, honest answer (even if it's "I/we don't know.")

thanks :)

At Sat Jun 16, 12:06:00 PM, Anonymous Anonymous said...

Congrats to the Nestling!

At Sat Jun 16, 03:39:00 PM, Blogger Dr. K said...

#1: if nothing else, you should pay close attention to this comment from one of your more intelligent and well-read readers:

"No chronic Lyme?? lol and your a doctor! wow."

*smirk* Your a doctor!

At Sat Jun 16, 06:06:00 PM, Anonymous Anonymous said...

I've read several of the entries on your blog, I've got to say that I'm very impressed. All were excellent and I'm going to add you to my list of favorite doctor blogs!

Looking forward to reading your thoughts on a regular basis.

- Dean

At Sun Jun 17, 12:31:00 AM, Anonymous Anonymous said...

False fixed beliefs, eh? Well, I'm the woman who was never sick a day in my life until at age 46 I came down with TTP as the presenting face of Lyme. You may have never heard of that connection, so therefore ipso facto it must be a false fixed belief, but that particular false fixed belief of mine came into being after spending days in the New York Academy of Medicine researching my illness after my release from the hospital, because it was clear no one else was going to research it for me. Whatever my false fixed beliefs, they derive from articles in peer-reviewed science publications. You know what? I really don't know that I had chronic Lyme.For all I know, it was a coinfection such as mycoplasma or chlamydia pneumoniae or even some kind of ehrlichiosis that my body was able to clear on its own, although I never tested remotely positive for ehrlichiosis, or some kind of post-infection autoimmune reaction. Certainly all the antibiotics I took -- all oral,never IV -- helped enormously, which leads me, but not ineluctably, to the false fixed belief that there might have been lingering spirochetes. But the difference between you and me is that as far as you're concerned, anyone who disagrees with your opinion has a false fixed belief. And where does your opinion come from? Have you researched it yourself? I doubt it. I think you're just accepting what the prevailing body of ID doctors says rather than spending any time doing legwork yourself. The people who posted recently also provided links to pub Med literature -- more false fixed beliefs, I'm sure. Well, let me tell you something. My mother was the first woman thyroid and thoracic surgeon in the United States, and my grandfather was a professor of medicine at Columbia Presbyterian. When they weren't practicing medicine, they spent time with their rats, growing tumors, injecting with viruses, cutting out growths, and publishing, and questioning, and seeking to upend conventional wisdom, and always, always questioning. By the time my mother died, she had grown disillusioned with the way doctors practice nowadays -- factory medicine, she called it. Well, that may be giving you and your ilk too much credit, because in a well-run factory, someone at least reads the manual, and from what I've read of your posts, you've accepted one point of view without so much as casting an eye on the evidence provided by scientists who have published a differing interpretation. Shame on you.

At Sun Jun 17, 04:23:00 AM, Blogger MonkeyGirl said...

Wow. I'm ashamed to admit that I didn't realize that if you reiterate your opinion with more rudeness and anger than the last person, it makes you right.

And I thought the crayzees were all over in my comments section!

At Sun Jun 17, 08:37:00 AM, Anonymous Anonymous said...

Monkeygirl: I presume you're referring to my post as being full of rudeness and anger. Perhaps you've never been in the situation of lying in a hospital bed for two months with a port for plasmapheresis coming out of your chest, with the priest coming around to give you last rites, all because of two missed diagnoses -- first, TTP and not ITP as they doctors mistakenly claimed because they failed to read the chart, and then the refusal to consider tickborne disease as an underlying cause. How many retroviruses was I infected with during my 53 plasma exchanges because no one listened when I begged them to consider an infectious origin? Someone had the kindness to bring me a laptop in the hospital, and paper after paper on microbial origins of TTP came up, but the hemoncs refused to consider such a possibility. I begged for antibiotics, in particular doxycycline because a paper had come out about how doxy alone was curing many cases of TTP, but I was refused on the grounds that abx were too dangerous, all the while I was being pumped full of prednisone and thousands of people's SD washed plasma. No, I didn't contract HIV, nor HCV, but what else did I pick up that I won't know about for years? How do I know that the leaky gut syndrome that's developed since that sole TTP episode in 1999 isn't due to all that plasma that I never would have had to have if someone had recognized Lyme Disease and treated me with doxy? How do I know that the dulling of my mental faculties since then isn't due to the Fentanyl that was administered to put in a port that I wouldn't have had to have if someone had recognized Lyme Disease and treated me with doxy? Worst nightmare of all, how do I know there were no misfolded prions in that plasma? When I went in to the hospital at age 46, I had complete faith in the medical system, coming as I do from a family that counts six doctors among my immediate relatives. It took two weeks for that faith to be shattered, and not one experience with physicians since then has restored it -- although the abx from my LLMD have restored me to, say, 80% of my earlier good health. I also haven't mentioned the case of my mother, who died at age 91 after the psychologist and geriatrician worked and worked on me to let her have antidepressants, and so I finally gave in, and to make a long story short she developed if not serotonin syndrome then something remarkably similar and had to go into the hospital, where she promptly picked up acinetobacter and died. Anger? If you can't empathize, then you have lost part of your humanity. According to your profile you work in the ER, and you are very lucky, because that is the great success story of Western medicine. In a car accident, the West is where you want to be, because the impulse to relieve the suffering of the battlefield has reached its best expression in the life-saving procedures that were transplanted to the ER. But once you venture into the world of diagnosis, emerging diseases and microbes, Western medicine falls on its face. I tell my story, I provide links to pubmed articles, yet I'm just "reiterating my opinion"? You wag your finger at my rudeness and anger while in the same breath you call me a "crayzee"? You make no comment on the scientific merits of the issues? You quote no studies? No new discoveries? You post a comment whose tone is worthy of a middle school preteen girl? Yet you feel competent to pass judgment on my mental state? No wonder people despise the medical profession.

At Sat Jun 23, 08:22:00 AM, Anonymous Anonymous said...

One of my favorite cartoons is Mr Peanut wrapped if a straitjacket standing in a rubber room exclaiming "No, really, I'm a legume !".

It doesn't do any good to argue, its just diagnostic.



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