Saturday, June 13, 2009

Folk remedies - hiccups

I've been avoiding this blog for a while due to my hiatus from the professional world, but that will be changing soon ... so I figure I'll try to kick up this blog again.

If any readers out there have medical questions, or questions about being a doctor, or questions about the process of becoming a doctor (with respect to the educational pathway and training itself, or the mindset changes associated) - lemme know, I'll give 'em a shot and/or try to direct ya somewhere helpful.

In the meantime, back to work!

My training (to date) has been along the traditional path for "western" medicine. After the usual pre-med curriculum in college, I went to an accredited medical school, got my Doctorate of Medicine (M.D.), and then began residency. When being compared to the primary alternate system of medical education in this country, which results in a D.O. (Doctor of Osteopathic Medicine), the traditional route is referred to as allopathic.

Allopathic medicine has the connotation of being a more scientific approach and trusting of proven medicines and surgeries. Osteopathic medicine is known for taking a more holistic approach to illness, embracing alternate therapies, and emphasizing body mechanics and the musculoskeletal system in health and disease. Homeopathic medicine is yet another form of alternate treatment, which involves administering infinitely-dilute medicines to treat various symptoms.

With little exposure to folk remedies and some of these other treatment regimens, my faith tends to lie with allopathic medicine. That does not mean that I discount alternative treatment modalities, however. And with respect to "mind-body medicine" - whether one considers it the placebo effect or something "more real," the power of the mind is clearly important in healing.

When it comes to "proven" treatments, however, it doesn't matter to me what the original source is. Did you know aspirin was developed from a bark that was chewed to relieve headache? Penicillin was found from mold on bread. And there are countless others. If something works (and, importantly, if it does no further harm) - why not embrace it?

This holds true especially for the really tough problems that traditional medicine does not have a good solution for yet. Like hiccups.

Everyone has their own favorite folk remedy for hiccups... but do any of them really work? Hold your breath, drink a glass of water, get surprised, stand on your head - nothing seems to work consistently. Traditional medicine doesn't have much to offer besides muscle relaxers and tranquilizers - heavy hitters for a small (but annoying) problem.

My wife introduced me to a new one that she learned from a friend - and so far it is 2 for 2 for my own hiccups:
Place some sugar on your tongue and let it dissolve - do not chew or swallow it. Not quite sure why it works, but I'll keep using that while it does!

Let me know about your experiences!

Friday, February 13, 2009

Weight Loss Principles -- for free

Sorry it's been so long since I've written on this blog... life keeps marching, and if you don't keep up things rapidly get left behind. Will revive this forum into something more applicable to general questions about medicine, becoming a doctor, and various anecdotes from my training. In the meantime, here's a post about a topic many people are interested in -- and many others are trying to make a buck off of. But (theoretically), it should be pretty straight-forward without being expensive. Of course, I myself have been wanting to lose weight and "working at it" for about 8 months now -- with poor results. Somewhat puzzling, considering the apparent simplicity:
  1. Consume fewer calories than you burn.
  2. Drink plenty of water.
  3. Make nutritious food choices.
  4. Exercise at least 30 minutes per day, as many days per week as possible.
...and then the hardest one,
  1. Be consistent (my downfall!).
Here's a brief run-down of how all these things can work together.

#1 is obvious, and a basic effect of our physiology -- you CANNOT FAIL to lose weight if you are taking in fewer calories than you burn. You have to pay attention to both sides of that equation though; starving yourself is not a wise way to go, it can slow down your metabolism. Burning calories comes from activities of daily living, as well as from exercise. So get off your couch, use the stairs, walk from a further parking spot -- all those things can help.

I do NOT put any stock in these weight-loss schemes involving "fat-blocking" and "detox" and drugs that "speed-up metabolism." There is no short-cut. Inducing malabsorption can have a role under close medical supervision (and is one intended effect of bariatric surgery), but should not be attempted on your own and with over-the-counter weight-loss aids. Most of the weight-loss gimmicks out there are just that -- gimmicks. Save your money for healthy food.

#2 is often overlooked. Not only is water essential for our bodily processes, it can also reduce hunger and keep you feeling full. Instead of reaching for that 4th cup of coffee (caffeine can dehydrate you) or that calorie-rich soda or latte (we often forget to consider calories from our beverages), make it a point to drink plenty of water throughout the day. You should drink enough to *prevent* thirst, not just to quench it. Especially important if you are exercising or dealing with a hot environment. And water is free (from the tap), and less expensive than Starbucks if you prefer bottled water.

#3 is a pretty tough one in our day and age. Everyone wants the fast, cheap, easy solution to meals on the go. Eating healthy is rarely cheap, and can become boring if you don't make the effort to try creative recipes. At least consider replacing unhealthy snacks with fresh fruit and whole-grain items -- the less processing the better. Try to have a bowl of fresh, cleaned fruit available for those times you would reach for a donut or muffin. Chop up celery, carrots, and broccoli (or other veggies) and keep them in visible containers in the fridge, or throw them in your packed lunch, for a quick, filling snack with a satisfying crunch. Some people invest in programs like Jenny Craig or Weight Watchers -- if you need the extra help with meal choices and have the money to burn, try that. Otherwise, just remember to:
  • take small portions
  • stop eating BEFORE you feel full, and
  • DON'T EAT when you are not hungry -- no boredom- or social-grazing.

#4 really requires a change in behavior. Not only do you have to make time to hit the gym, take a vigorous walk, or play an exercise tape / DVD, but you need to make it a regular part of your day. Don't just phone it in, but also don't overdo it too quickly and injure yourself. Start off slowly, and gradually challenge yourself at a level that is comfortable but works up a good sweat. If you are morbidly obese, see how long you can walk before getting out of breath, and work toward increasing your endurance before jumping into an exercise routine that might be dangerous.

#5 is why most people cannot do this well on their own (including me). It supposedly takes about 2 weeks to develop a habit. Work toward all these changes together -- but if you fall off the wagon in one respect, don't throw in the towel and revert to all your old habits. Pick yourself up, dust yourself off, and realize that "today is the first day of the rest of my life -- again." One reason these group programs seem to work a bit better (Weight Watchers, etc.) is because of the support system. If you can hook up with a work-out buddy or enroll friends and family as your coaches, they can help keep you on track. But don't let an inconsistent work-out partner or a fellow dieter caving-in to cravings throw you for a loop. Be strong for yourself, and have a back-up plan for meals or exercise if you are afraid of being tempted toward bad habits.

Most important with this aspect -- examine your current habits and see where you most often go wrong. For me, when I stay up late trying to get work done, I find myself munching to stay awake, and craving foods that are not healthy. Readjust your schedule so you go to sleep before the late-night munchies hit you. Have a bottle of water at hand, and drink plenty to fill-up before meals and snacks. Eat slowly, so you have a chance to feel full before you've scarfed-down everything in site. Eat off smaller plates, so you take less food. Don't automatically finish what is in front of you -- especially at restaurants. Plan to take half home, or split a meal with your dining partner. If you insist on eating in front of the TV (like me), don't keep eating just because the program is still on. When you condition yourself like this, you tend to ignore internal signals of satiety and keep eating while the TV is on. When you break a good run of days working-out, restart it as soon as possible to keep the habit alive. And mix up your exercise routine to keep it interesting, and to minimize overuse injuries.

And finally, evaluate your progress weekly. Jumping on the scale every day will not show you much -- too many variables from water retention and digestive processes.... A good goal should be to lose a couple of pounds each week (anything more will likely just be water weight), so monitor your efforts and adjust diet and exercise as needed. For real weight loss, you may need to bump exercise up to 60 minute sessions. You may not see results right away, but remember that muscle weighs more than fat -- if you are building up muscle it may reduce your expected weight loss. Regardless, you should notice an improvement in your endurance. And note that increased muscle-mass should result in higher metabolism -- helping you along your path to weight loss.

Get plenty of sleep (hey, you can even burn *some* calories doing nothing!), and you will feel more energized to attack each day and avoid temptation. Will post more on this topic in the coming months. Best of luck!

Tuesday, January 02, 2007

Close enough for government work....

Officially started my stint on "night float" at the county hospital today. I have yet to complete an actual rotation here, but (thankfully in terms of preparing for the experience) I have subbed-in for about a week a couple months back. I have a feel for how things work here at County, although I am not yet adept at getting things to happen.

I'll have plenty of time to learn - this is the first of at least three months I'll be putting in here. This first one is a little different too - "night float" is basically the on-call service from 6pm to 6am. Thankfully I won't have any consulting duties (seeing inpatients from other parts of the hospital that may need surgical intervention of sorts) - it is purely caring for current surgical patients on the floors. And no "rounding," getting vital signs and doing daily notes on the patients. But in trade-off, I'm responsible for several surgical services' patients all at once, not knowing much about their background or current problem other than the two or three lines signed-out to me as I start my shift. And the other trade-off is the derangement to my schedule - I'll have to figure out when to sleep and when to get business done and when to spend quality time with my wife.

Working at County is in itself quite the experience - being government-run and offering care to any that come knocking. It will offer quite a lot of learning, as many patients can be quite ill or quite unique in their presentations. But the inefficiencies and other frustrations will be quite the downside, as I have already experienced in my brief time on a prior rotation. Hopefully I can channel that into working out each day when I get home - killing two birds with one stone and improving my health as a side effect. At worst maybe it will counter-act the rise in blood pressure I can almost already feel...

Hello, Nurse!

(mostly from a prior composition:)

I heard all throughout medical school (from multiple sources) to trust the nurses, utilize their input, keep them part of the team. I never thought I'd have a problem with that. And for the most part, they have been really good to work with. They really HAVE saved my ass - especially on my Cardiac Surgery rotation. As a bleary-eyed intern with no experience, it's nice to have ANYONE experienced who can remind you of what to look for and how to proceed when a patient is starting to look less than stable. There are really some great nurses at Rush University Medical Center.

And then ... there are some that make you cringe. I've been paged in the middle of the night for some of the most ridiculous questions and requests: "can you renew this medication that will expire in the AM?", "Do you know why this patient is a VIP?" I've been called to patients' rooms for "emergencies" like chest pain or shortness of breath - only to find it was a hiccup or mucus plug (ie, cough) or some other extremely transient state that any reasonable 2nd-year medical student would have not been alarmed at. Been called to put in orders on a patient that were already in, but the nurse didn't bother looking for them on the printer. Been informed by nursing that they were blatantly ignoring my order for giving a patient a fluid bolus because they were afraid the patient would become fluid overloaded - despite dropping urine output and raising heart rate (two cardinal signs of hypovolemia).

Needless to say, there is quite a range in the quality of the nurses we end up working with. And unfortunately there is almost no correlation with their personality or friendliness. I've been duped too many times already by confusing good people skills and sociability to quality nursing. And - surprisingly - there's not much of a correlation with how vocally the nurse advocates for the patient and the quality of care. "The squeaky wheel gets the grease," but sometimes pushing for action for patient A is distracting from the care needed for patient B.

I don't mean to rip on nurses - they are a more-than-critical component of patient care. They are actually the ones that perform the majority of day-to-day medical care for the patients, addressing fluid and medication administration, personal hygiene, wound care, monitoring vitals, as well as getting the patients up and about and prepared for procedures and tests. Not to mention addressing the social / spiritual needs of the patient, and advocating for anything left off in routine medical care. On rounds and during the day, I probably spend an average of 10 minutes TOTAL with any given patient - whereas the nurse is dividing his or her time among roughly 2-6 patients over an 8-12 hour shift. It is very fortunate indeed that nurses are available to advocate for the patients that they do get to know better than I. And sometimes there is surely cause for them to question doctors orders, especially given that interns have such limited patient care experience, whereas some nurses have been on the wards for decades.

And when I get to interact with a nurse that is working to collaborate on patient care, in a manner that is constructive and educational for all involved, it's a thing of beauty that I treasure. The system working, efficient, all the cogs in alignment. We're all the better for it, and it benefits the patient to the utmost.