My New York Beauty

When I decided to sent RL Bates an antique quilt square this summer, I was not expecting anything in return, just the joy of having an excuse to sort through and touch all the wonderful old pieces of fabric I found sitting on a folding table at the Eagles Mere Antique Fair one gorgeous summer day.

To my surprise and joy, RL responded by making me my very own quilt! ( Go and see it, then come back.)

The quilt is based on a pattern called “New York Beauty”, which is apparently one of the more difficult patterns for a quilter to execute. Thought to have been first made sometime in the 1840’s, the pattern is a radiating crescent that immediately brings to mind the crown on the Statue of Liberty. Of course, that statue was not created until 1876, which makes the similarities between the pattern and the statue even more fascinating to me, as if it’s creator somehow knew that this quilt design would hold meaning for centuries to come.

Now, I have my New York Beauty to hang on the wall as a continual reminder of our Lady of Liberty and of the promise we have made, and I think sometimes forgotten, to the world. I am also reminded of the wonderful friend I have never even met who has been so generous with her time and talents and made me this wonderful quilt.

Give me your tired, your poor
Your huddled masses yearning to breathe free,
The wretched refuse of your teeming shore
Send these, the homeless, tempest-tossed to me
I lift my lamp beside the golden door.

Need a Diaphragm? Good Luck with That.

UPDATE – JANSSEN PHARMA HAS DISCONTINUED PRODUCTION OF THE DIAPHRAGM. SEE LATEST INFO HERE.

Ortho stopped manufacturing the latex diaphragm in Dec 2007, in anticipation of releasing a new non-latex silicone diaphragm this year. Unfortunately, the new diaphragms will not be available till at least November, according to an Ortho service rep I spoke to today. At this point, I can’t find a diaphragm anywhere for my patients. No other manufacturer’s diaphragms are available from any wholesalers to the pharmacies I contacted.

For now, I’m sending my patients to Planned Parenthood, since they have a bit of a stockpile for now at least. If anyone has any other reliable source, let me know and I will post it here at Diaphragm Central.

Hopefully Elaine’s diaphragm is still in good shape, although she may want to cut back a bit on unnecessary usage so it doesn’t wear out before the new ones are available.

Just Another American Healthcare Story

He had the flu and visited an urgent care center. They told him over the phone that it would cost around $100. His bill? $450 for a 5 minute visit with the doc, who told him he had the flu and sent him home. David is more than willing to pay the quoted fee of $100, but they want the whole $450.

I happen to agree with David. He was quoted a fee over the phone that seemed reasonable for a service that was not above what he told them he was coming on for, and he is willing to pay it. The hospital should take his money and be happy. I know my office would have.

But David’s story is about so much more than the fee. It’s emblematic of everything that is wrong with our healthcare system.

Let’s see just how many of America’s healthcare’s problems we can find in his story. I found five – how many others can you find?

1. He does not have a primary MD

So he went to a hospital urgent care center for something his family doc could have handled. As a result, he got socked with a facilities fee that was more than twice the doctor’s fee.

Lesson learned (and it’s an expensive lesson) – Establish a relationship with a primary doctor. That first visit you make to get that relationship going is worth every penny in long term return, both financially and physically.

We won’t get into the fact that there is a primary care doc shortage, because David’s reasons for not having a primary doc seem to be more financially motivated. But it’s not unlikely that if he were motivated to find a primary MD, he might have trouble finding one and would have ended up at Urgent Care anyway.

2. He waited 2-3 hours for a 5 minute visit.

The doctor spent maybe 5 minutes with him, listened to his heart and his lungs, took his temp, then told him “You have the flu, there’s nothing I can do for you, go home”. His response “Nice. I guess I knew that already.'”

Now, once could argue that the diagnosis was clearly correct, since he indeed recovered on his own at home, and that 5 minutes was all it took to make that correct diagnosis and get him on his way home. And if he had been able to walk right in for that 5 minute visit without a wait, I suspect he would have been relieved and happy. But to wait that long and walk out feeling as crummy as you were when you went in is a recipe for dissatisfaction, no matter how right the doctor’s diagnosis was.

Of course, there are others who waited in emergency rooms who were not lucky enough to walk out…

3. This is a very healthy guy who he can’t get a preferred insurance rate from United because he is “too thin”.

He is 5’10” and 145 pounds. Sounds just Mr TBTAM to me. Healthiest man I know. He rode his bike to the Urgent Care Center! But because David is on his own purchasing insurance, he gets stuck being the actuarial table poster child. Something is terribly wrong when the healthiest among us can’t get affordable insurance.

4. He pays $100 a month for catastrophic insurance but has a very high deductible, and does not go to the doctor for “minor things” because he can’t afford to.

But minor thing become big things. This is the problem with high deductible plans as a cheap alternative for folks who can’t afford better plans. They wait till minor things get very serious. Then they head to the ER. And get stuck paying even more towards their high deductible.

5. If David had been insured by United, the Urgent Care Center would have accepted much less than what they were asking him to pay for his visit.

The highest fee charged an uninsured patient should be the highest negotiated insured fee. But if it were, the insurers would start lowering their fees even further. So providers play the game of raising their charges to justify the contracted rates with managed care. It’s a game whose rules have to be re-written.

This is just one man’s healthcare story.

It’s not even a big story. Nothing terrible exciting happened. There were no catastrophes, no near-deaths, and everyone made it out alive. It’s just another day in the life of an American trying to get decent healthcare in a system that doesn’t work.

If we can fix things for David, we will have gone a long way towards fixing healthcare in America.

Diet Update – Week 13

Thirteen weeks and 25 pounds down.

Things have slowed up a bit, and that sawtooth pattern is largely due to weekend eating off the program. I’m trying to decide if I will continue this pattern of being off on weekends, or just plow through and get this over with sooner. I’m really good at breakfast and lunch on the weekends, but tend to overeat still at dinner, and have been allowing myself desserts and occasional wine. At this rate, I’m probably looking at hitting goal in June 09, a bit later than initially planned. But doing the math, I’m losing about 2 pounds a week, which is a healthy way to do it.

Although the losses came more slowly this past month, I feel as if I “consolidated” myself at this lower weight during that time of slower loss. I’m getting used to this new body, and liking it. My clothes fit better, and some in fact are getting too big to wear anymore. I don’t want to shop just yet, so my wardrobe is a bit limited. But I don’t mind.

I definitely have more energy. I sort of bound up the 15 steps to our bedroom and occasionally find myself taking the steps into our apartment building two at a time. I’m more likely to head out myself at night for milk or shampoo instead of asking Mr TBTAM. And at work, I’m practically floating between exam rooms during busy office hours.

I’ve stopped tracking my exercise and obsessing over how often and how long, but it’s about 3-4 times a week at this point. I find myself wanting to work out if I have a free hour, because I know how good I will feel afterwards. We are lucky to have a full gym in our apartment building, so I can really squeeze in a quick workout almost anytime. The elliptical machine is really fun, and I can work up a real honest-to-goodness sweat if I play the right tunes on my IPOD. Earlier darkness is limiting my bike rides to the weekends, and soon the cold weather will stop that as well. Bummer.

One negative is that my migraines are worse than ever. I don’t know if it is because I am in negative calorie balance, spending too much time at the computer, not hydrating enough, or just going through the awful season-change cycle that so many of my fellow migraine sufferers are reporting right now.

As far as food goes, I’m working on protein muffin recipe for weekend breakfasts. I made the third permutation today, and it’s almost there. Look for the recipe next weekend if all goes as planned.

Every Blog Needs a Bouncer

Dr Wes has been dealing with some legal troubles related to comments on posts in his blog. While he declines to give details, we know that he was subpoenaed to appear in court regarding comments on a post in his blog. He fought the subpoena, and won. But the fight cost him financially, and it appears, emotionally. He’s now re-thinking his commitment to blogging.

But blogging, as I’ve found, also exposes one to malicious verbal attacks and subpoenas. As such, it is risky. There is no question that placing one’s online self in the world for all to see adds vulnerability and potential liability. When I told a colleague Friday about my recent predicament he responded, “Why the hell would anyone want to blog?”

I hear you, Dr Wes. I too have withstood malicious comments and personal attacks both in my comments section and on other blogs. It doesn’t feel good, and never fails to shock me to realize just how un-civilized other human beings can be.

But I say keep on blogging, Dr Wes. We need you voice. Your blog is one of the best medical blogs out there. Your clinical opinions, commentary and insight are unique and important, and no other blogger or mainstream media outlet can replace the contributions you’ve made to the conversation about cardiac electrophysiology.

I have to be honest, however, and say that I was surprised at some of the comments you’ve let stand on your blog. I would have hit the delete button almost while I was reading such comments, bounced them right the h_ off my blog, and never looked back. Heck, I’ve even closed comments on blog posts when the side conversations there got out of hand. After all, it’s my blog, my voice and my reputation. I’m going to control it as best as I can, and if that means some folks don’t get invited back, well, that’s my prerogative. They can always start their own blogs.

Because a medblog is not a chat room. I see it as more of a seminar that the med blogger hosts. The role of the commenter is to provide external context if the blogger fails to do this, to support and expand the argument or to provoke and to show opposing viewpoints if they exist. Not to trash, malign, libel, slander or defame.

That kind of behavior has no place on my blog.
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I got my bouncer from Wikipedia Commons, a free image source on the web

My EMR and I

It’s only taken Grunt Doc four days to fall in love with his new electronic medical record (EMR).

It took me a bit longer that that.

But then again, I was never the head over heels type of gal. My feelings for my EMR were more of a slow burn than a raging passion, and we’ve had out ups and downs. We’re more like Hepburn and Tracy than Romeo and Juliet, sparring and fussing with one another, but always ending with a grudging mutual respect and admiration.

And, like any good Tracy-Hepburn movie, our story has had a few scary moments. But each time, my EMR rescued me from the edge of the precipice.

Take, for example, the patient who forgot to tell me about the DVT she had since I had last seen her 6 months ago. I was about to prescribe birth control pills for her, and saw a few visits with a hematologist in her encounter list. A quick perusal of those visit notes tipped me, and I immediately changed the script to a progesterone-only pill. Of course, if the hematologist had updated the problem list and history portions of the chart, I would have caught it upon opening her record. Or better still, if my EMR had found that history itself and popped up a warning flag when I wrote the prescription. But there I go complaining…

There was the time I somehow missed that my patient’s pap was abnormal. But I get a monthly summary print out of abnormal paps from our lab, and caught it on that review. Of course, the EMR does not actually distinguish normal from abnormal paps – the results are still just a text field. It takes the path lab to do the compiling of the list for me. But I’m not complaining, am I?

How about the fact that I can check patient labs and do my charting work at our cottage, allowing me to get out of the office a bit earlier on weekends, or even work from home on the occasion? Now that’s a real benefit of my EMR! Of course, I can’t place radiology orders from home, though I still can’t understand why…

And speaking of radiology orders, why doesn’t my EMR remember the appointment date and not send me an overdue test notice until after that date? And why can’t it print out a med list for my patients when they arrive, since most of them forget to tell me about at least one med that they are taking? Or present me a better summary sheet upon opening a chart, or god forbid, let me design that first view myself?

There I go again, throwing plates at the EMR I love.

Because I really do love it, you know.

Most of the time.

Confessions of a Self-Help Junkie

It’s the self-help book to end all self-help books.

It’s called Confessions of a Self-Help Junkie and it’s written by my friend Linda Pruce, a self-described holistic speech therapist whose blog Enter the Circle is one of my favorite web destinations for biting wit, personal insight, feminist opinion and all around woo-woo.

Confessions chronicles Linda’s downward spiral into self-help hell and the resurrection that resulted from her realization that she was looking in all the wrong places for the truth she needed. Which, as Dorothy would say, was right in her own backside… I mean backyard…(Read on, you’ll get the reference…)

Readers of Linda’s blog willl recognize her unique writing style that blends self-deprecating wit with no-holes-barred frank personal insight –

I officially became a self-help junkie in September of 1998. I was sitting on my bed, minding my own business, breastfeeding my newborn and wondering whether it would be wrong to smoke a cigarette while nursing. As I was figuring out the logistics of this dilemma – Could I reach my cigarettes without breaking the baby’s seal on my breast? Could I blow the smoke towards the window instead of up the nostrils of my daughter? And, how do you explain a burn mark on the check of a 6-week-old?– I caught the start of Oprah’s fall season.

But don’t let Linda’s humor fool you – underneath that wit is a wise woman with lot of great advice. Take, for example, this passage on finding the seat of one’s self, or as Linda puts it, your “Authentic Soul Self” or A.S.S –

Finding your A.S.S. is just the first step and the easiest part of your journey. Once you find your A.S.S., you will need to pull your head out from inside it. This, otherwise known as enlightenment, is what most people are attempting to do – and is probably the hardest thing to achieve.

Confessions meanders through the world of enlightenment, taking choice bits from here and there, creating a salad of thoughts, advice and wisdom for the woman seeking peace and fulfillment. Along the way, it sometimes ventures dangerously close to the self-help world it derides, and I can’t say I completed any of the tasks or lists offered to me. But, after all, a Junkie loves nothing better that a fellow addict to shoot up with, and I know Linda couldn’t help herself but to lay out a few lines of self-help smack for her visitors. But hey, it’s her party…

The best parts of the book for me were when Linda tells us her story – how she learned, for example, to ask the universe for what she needed. (Once I figure out what I want, I’m definitely gonna’ try that for myself.) Or how she figured out why Sundays were always so stressful for her and her family, and then made it better. Or the simple rules for living she learned from her Grandma (who sounds suspiciously like mine).

Beautifully illustrated by Kristen Smedley with graphic design by Tomara Arrington, Confessions of a Self-Help Junkie is not only a great read, it’s a work of art. Too bad it’s not available in other than electronic form, or Oprah could put it on her coffee table. It’s that beautiful.

You can download the first chapter for free from Linda’s blog, or buy the e-book online. Then tell your friends, who’ll tell their friends, who’ll tell their friends, and if that whole Six Degrees of Separation thing really works, Oprah is sure to hear about it from Kevin Bacon.

Congrat’s Linda!

G-Spot Collagen Injections

Niko enjoys the bouncing cab ride a little more than she expected.

They call it the G-Shot. Collagen is injected on top of the G-spot (if it exists) to enhance its size. The G-Shot was invented by a Doc in LA (of course) who claims it enhances sexual arousal and gratification.

I hadn’t heard of the G-shot till yesterday, when OBS Housekeeper emailed me asking if it was for real. Apparently, Niko had her G-spot enhanced in the season opener of Lipstick Jungle. Talk about product placement – it was a silly plot angle that really made little sense in an episode that was about much more serious issues.

But what about it? Is the G-Shot legit?

Smells like a racket to me.

My definition of a racket? Any expensive medical procedure (in this case $1850) not covered by insurance, whose clinical outcomes have been reported on a website and in the media instead of a peer review journal. Not to mention those three little words that should set alarm bells ringing whenever you read them in conjunction with an invasive medical procedure -“Results may vary”.

Is the G-Shot safe?

The shot uses FDA-approved collagen, which, if administered correctly (into the vagina and not into the urethra), should be relatively safe. Urologists for years have been using collagen to “bulk up” the urethra as a treatment for urinary incontinence, although that treatment has yet to be proven to have more than limited efficacy.

But take a look at this partial list of possible complications from the G-Shot website –

Bleeding, Infections, Urinary retentions, Accelerated collagen re-absorption, No effect at all, Allergic reactions, Hematoma (collection of blood), Collagen site ulceration, Urethral injury, Hematuria (blood in urine), UTI (Urinary Tract Infection), Urinary Urgency, Urinary Frequency, Increased/worsening nocturia (waking up several times at night to urinate), Change in urinary stream, Urethral vaginal fistula (hole between urethra and vagina), Vesico-vaginal fistula (hole between bladder and vagina), Dyspareunia (Painful intersourse), Need for subsequent surgery, Alteration of vaginal sensations, Scar formation (vaginal), Urethral stricture (abnormal narrowing of the urethra), Local tissue infarction and necrosis, Yeast infections, Vaginal Discharges, Spotting between periods, Bladder Pains, Overactive Bladder (OAB), Bladder Fullness, Exposed Material, Pelvic Pains, Pelvic Heaviness, Collagen injected into the bladder or urethra, Erosion, Fatigue, Damage to nearby organs including bladder, urethra and ureters, Alteration of bladder dynamics, Post-operative pain, Prolonged pain, Intractable pain, Failed procedure, Varied results, Psychological alterations, Relationship problems, Decreased sexual function, Possible hospitalization for treatment of complications, Lidocaine toxicity, Anesthesia reaction, Embolism, Depression, Reactions to medications including anaphylaxis, Nerve damage, Permanent numbness, Slow healing, Swelling, Sexual dysfunction, Allergy to Collagen material, Collagen migration, Nodule formation

and you tell me – Are these risks you are willing to take for a procedure whose “results may vary”?

But what about the product testimonials?

Ah, the product testimonal. The hallmark of every new product marketing campaign. There is nothing that sells a product better than a woman with a story to tell who is being paid to tell it.

Product testimonials are not proof of efficacy. They are nothing more than a single person’s experience with a product or procedure. Even if it is a true experience, the circumstances are not controlled for other variables that might be effecting the outcome, including the placebo effect. And there has to be a significant placebo effect of G-spot enhancement.

Think about it. Suppose you are someone who actually believes the G-spot exists, making you a bit impressionable to start with. Now, I’m gonna’ put something into your vagina that you will be able to feel. It might be a bit uncomfortable, but not very much so. Or, as Niko says when Brooke Shields asks her if she is in pain – “I don’t know what I’m in, all I know is that I can’t sit through a 2 hour dinner.”

But what if I’ve told you that the uncomfortable sensation is really a sexual sensation? (Ah, the fine line between pain and pleasure..) Now, every time you notice the sensation, you’re going to naturally think about sex, aren’t you? And the longer the sensation lasts, the longer and more often you’re gonna’ be thinking about sex. In fact, you’re thinking about sex a lot more than you normally do. All the time, actually. And every time you have sex, that little bump I made is going to get knocked around, reminding you of what a sexy gal you’ve become, reinforcing those positive sexy feelings you are experiencing, and wait a minute – was that a multiple orgasm you just had?

Now, suppose instead that I injected a lump of collagen into your vagina and told you that it might make you feel uncomfortable. That sitting might be difficult for a few days. That there are potential side effects such as pain with intercourse or painful urination you’ll need to watch out for.

Now imagine how you would feel every time the cab you’re sitting in goes over a pothole. Scared? Annoyed? Angry?

See? The power of suggestion. In this case, not a placebo, but a nocebo effect.

Bottom Line

If the G-Shot proponents want to prove it really works, then they need to run a placebo-controlled clinical trial. It’s easy enough – one group gets the g-shot, another gets an injection of saline into the same spot, and the third group gets an injection of collagen into some other spot in the vagina.

I’m not holding my breath waiting for the trial. Nor should you.

Instead, I’d take that $1850 and spend it on something that will make you feel good about yourself. Maybe a food delivery diet. Maybe a dance class or a new bike. Or that trip to France or night course you’ve been thinking about taking for years.

Because if you’re feeling good about yourself, then feeling turned on isn’t that much of a stretch.

And that’s because your biggest erogenous zone is not the G-spot.

It’s your brain.

Diet Update – Week 9

I’ve lost 20 lbs since starting this little adventure on July 15.

Last week, I tried a different Zone diet food delivery service. (It was a bit cheaper) While I continued to lose weight, I did not like the food – it was fresh, but it was basically diet food. Every dinner was dry broiled fish or chicken and flavorless steamed veggies. Every lunch was a dry salad. The portions were huge, but there are only so many steamed vegetables and raw cabbage slaws a person can eat.

So I’m going back to my first Zone Diet food delivery plan, with it’s variety and flavor and smaller portions, (and incredible muffins) and sticking with it till I’m down to my wedding weight. If things go as planned, I’ll be there sometime in early spring.

It’s actually a good thing I have so much weight to lose, because it’s gonna’ take that long for me to relearn how to feel hunger, how to learn what to do instead of eat when I am stressed, and how to deal on my own with food cravings that seem to be either hormonally or carbohydrate mediated (or both).

This weekend, I went a bit out of control. I was between delivery plans, on my own and into the progesterone phase of my HRT cycle. It really scared me how quickly I went back to my old habits, and it was such a relief to have my food show up for me at the door on Monday morning.  I’m back in the saddle again, though 2 pounds heavier than I would have been if I hadn’t gone off program.  I think the hard part about what I am doing is going to be keeping the weight off once I am off this food delivery. 

I’m continuing to bike in Central Park (thanks, Linda for pushing me to do the second loop and Mr TBTAM for always being willing to come along…), walking (thanks Sarah for getting me going) and using my bike on errands rather than taking the car or bus. When I visited my friend Jane at the beach last weekend, I brought my bike with me and our visit became a nice long bike ride instead of a nice long eat and drink fest. (Thanks, Jane for going along with the plan!)

If When I get to goal, it will be as much due to my wonderfully supportive friends and family as it will be to my own efforts.

What’s Wrong with this Picture?

Hey guys, C’mon now! I thought we Medical Bloggers were a new voice, not just another vehicle for more of the same.

Letting Big Pharma sponsor your lunch organizing meeting at the Blogger Expo? You can’t afford a sandwich?

Congrats to the group on what sounds like a great meeting otherwise.

(Photo from Emergiblog)

Pubic Hair Dye

That’s right. It’s called Betty – Color for the Hair Down There”. Its the solution to that vexing problem faced by greying gals, redheads and bottle blondes who get outed when intimacy reveals their true colors.

I’m surprised someone didn’t come up with this idea sooner. Too bad they didn’t, because I suspect pubic hair dye is a product idea that’s come a bit late to the market. My own market research on the latest trends among women in styling of that area would suggest that there’s not much hair left down there to dye…

But let’s just say you’re a bit behind the times in that area, and feel the need to coordinate your colors. Should you consider Betty?

Is Betty Safe?

The manufacturer claims the product is “specially formulated to avoid irritation”, has natural ingredients with flowery herbal names, and “no ammonia or parabens”. But Betty does contain PPD – that’s paraphenylenediamine, the chemical found in almost all hair dyes. PPD is listed as high hazard on the Cosmetic Safety Database and is the ingredient responsible for most allergic skin reactions to hair color. PPD-enhanced henna tatoos can cause extremely severe skin reactions.

Pubic hair borders on some very sensitive areas of the body. The hair near the midline comes precariously close to the mucosal surfaces of the inner labia – skin that is almost like the inner surface of the lips on your mouth. This kind of skin would be much more permeable to the chemicals found in hair dye and certainly more likely to be irritated.

My advice would be to avoid this product.

Don’t Dye For Me

And please, please, don’t think about dying your pubic hair to impress your doctor, as Ralph seems to have done…

I love it! I have salt and pepper hair and a gray beard. Some grey down there and now it’s black. I can’t wait to shower at the health club or go to my doctor for a check up. I know he won’t say anything but he will think Wow hair so black down there. – Ralph (testimonial from Betty website)

We docs don’t care what color your pubic hair is.

Really.

In This Election, The Winners are the Children

International Medical Corps Program “Saving the Lives of Malnourished Children” has been chosen as one of 25 projects eligible for receiving up to 1.5 million dollars in funding from the American Express Members Projects.

Members and on-members alike can cast a vote on the American Express Site for their favorite project. The project with the most votes receives $1.5 million, 2nd receives $500,000, 3rd $300,000, and 4th and 5th $100,000.

So head on over before September 29th and cast your vote. Just one click could save hundreds of children’s lives.