Tag Archives: Health and Wellness

Let’s Talk About Getting Pregnant

I was so tempted to title this post something more search engine friendly. “Contraception, Birth Control, Natural Living, Sexual Health, and Gender Inequality” has enough buzzwords for several posts. Instead, I have this idea for a series called “Let’s Talk About _______”, which is convenient for me because I get to fill in the blank with whatever issue has been on my mind lately. And by that, of course, I mean whatever I have been forced to memorize by my medical school overlords. First things first. If you are my mom, my wife and I are not pregnant.

Now that that’s out of the way, let’s get into this. We live in a sad world where unwed teenagers drop out of high school to have kids after the father bails on them, while older, wealthy, loving couples are unable to have kids and so spend TONS of money on fertility treatments. Some of the most pertinent subjects of women’s rights involve access to birth control, abortion, and equality in the workplace. I want to talk about at least two of those before I have to study again.

First up is birth control. The Catholic Church is well known for drawing criticism on this subject. Since I attend a Catholic school, I have heard the reasoning behind their stance at least once (sex is about babies and bonding, and you shouldn’t have one without the other). As much as I like to support the church, I think they have missed the mark here. First of all, the Bible doesn’t speak directly against birth control. Yes, there are verses about the blessings of having children, but no direct instructions about how many kids to have or the manner in which they should be conceived. The guiding principles from the Bible all stem from its constant theme of the sanctity of each life. Some birth control medications have an effect that could potentially destroy a fertilized egg. There are those who consider that destruction of a life, and so they can’t support taking birth control medications. This is an argument I can understand, but don’t entirely agree with.

A few days ago I sat through a lecture on FAM: Fertility Awareness Methods. The idea of FAM is for women to track their cycles, knowing when they are infertile or potentially fertile, and taking appropriate reproductive measures. This is a system used by couples who won’t or can’t use hormonal birth control for religious or health reasons (people unwilling to use synthetic hormones in their bodies, adverse reactions to the medication). There are a number of ways this system can be implemented, of which I will spare you the details (I have found that when I describe things to others who aren’t immersed in bodily fluids each day, I should usually stop right before I say the word “mucous”).

Fundamentally, hormonal birth control and FAM are the same thing: attempts to not be pregnant. I don’t have problems with either of them. Frankly, they are both good ideas. There are a lot of advantages for me, my wife, and our future children if they aren’t born for a few more years. It’s not that we are afraid to have kids (ok maybe a little), it’s our goal to love them and give them our best, so we want to wait. For that reason alone, and for couples like us, I like birth control.

Like most things in medicine, we discover that we CAN do things way before we talk about whether or not we SHOULD do them. There are scenarios that made me question the concept of birth control. Examples: government enforced birth control (China). The Catholic Church said long ago that the widespread use of birth control would lead to increased promiscuity. Why do we place the burden of birth control on the woman? (The answer, of course, is that women are the ones who get pregnant, but stick with me here). Why don’t men have that responsibility? Why make everyone wear Kevlar instead of making the guns shoot blanks? At the end of the day, birth control is a tool, and it’s one worth using. Side note: I have a friend in medical school who is Catholic and did the FAM thing after they got married. Their baby is due next month.

The sad part about the whole lecture I attended was that we forget about how incredible children are. The whole discussion treated kids like a chore, some sort of duty imposed on people to attend to eventually. Having children is a huge event, something that we celebrate every single year.

This brings me to the last subject, one that I have meant to write about since the State of the Union. Obama said that “Women make 77 cents for every dollar a man makes”, implying of course that women are somehow unfairly paid less for doing the exact same thing as men. When you compare all men and all women that work 30+ hours a week in the United States, you will reach the shocking conclusion that men do, in fact, make more than women. Is this a vast sexist conspiracy to degrade women, or is it a reflection of our workforce? Consider this. Men are more likely to be CEO’s, neurosurgeons, or to work in high paying but dangerous or remote jobs (oil drilling). Women have significant presences in those fields (CEO of Yahoo, for example), but are more likely to own small businesses or work part time. So in that “fact” we go thrown in our face, we had 80 hr/wk neurosurgeons and executives being evenly compared to elementary school teachers. There’s no gender inequality there, that’s just economics. Also, we don’t value a woman’s work at home in terms of income. If a woman stays home to take care of their two young children, she won’t get a W2, but has done some inherently valuable work. If she were to get a job, they would have to pay for childcare, increased living expenses (gas, food, clothes) and account for the decreased time with the kids. There’s huge value associated with a “Homemaker”, and no way to measure the value of a woman who brings new life to the world.

There are even indications that a “gap” is beginning to form the other way. Girls tend to do better in math and science than boys, and have brains that mature much more quickly after puberty (up to several decades, some say). I was lucky to be a guy during medical school admissions. My class is 50/50 male/female, but the applicant pool was 40/60 male/female. It seems as though men are becoming progressively dumber, while women become smarter.

That’s probably where I should stop. I think I can pick up here when I start my next post. Judging by my schedule, I should have that up by May.

Thanks for reading! Sorry for no pictures!

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Let’s Talk About Drugs

Maybe the timing is coincidental. Maybe studying pharmacology so much lately is making me more attuned to notice stories and posts regarding drugs and disease. Or maybe there has legitimately been a lot of really terrible Facebook posts, links, and comments lately (at least on my Facebook page). When someone on Facebook posts a story and claims “this is why I will never get my kids vaccinated!” I sometimes die a little inside. I would love to dissect their claim, present some objective evidence, and state my own claim in a reasonable manner, but we all know how that goes. Instead, I have turned to my blog, where I will be presenting some of the more common statements I’ve seen and the reasons why they are ridiculous. We’ll start with….

1. Doctors overprescribe drugs. They need to stop throwing pills at problems. They put my friend on too many drugs and he developed all of these side effects. Etc.

As seen in:

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Yeah…I’m pretty good at MS Paint

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First things first: it is very possible to be taking too many drugs. We had an entire lecture on this last week. It’s fine to be on a handful of drugs, but if you have a patient routinely take 10+ pills per day you are going to run into problems with side effects, compliance, and drug interactions. So why is it that patients accumulate so many medications? Why do doctors consistently prescribe drugs for patient complaints?

Probably because that’s what they are trained to do. And because it works. I am not attending medical school to learn how NOT to prescribe drugs. I’m learning how to harness the incredible therapeutic potential available to me and every modern physician. There are so many drugs that work so well at fixing common problems I would be remiss as a physician if I didn’t prescribe.

Example: If a 48 year old man comes into my practice for a check up, and I notice he has high blood pressure, I have two options. I can tell him he needs to eat healthier, exercise, and drink less alcohol. Over time, this would make him healthier and lower his blood pressure. Of course, very few patients will actually do this. He is most likely to walk back into my clinic a year later and tell me that he was busy at work, tried walking but hurt his foot, and otherwise didn’t get any healthier. And he was exposed to an extra year of uncontrolled high blood pressure, increasing his risk for serious problems later on in life.

I could also give him a prescription for Lisinopril. He could take a pill every morning, his blood pressure will go down, whether or not he improves his lifestyle, and I improved his chances of living a longer, healthier, happier life.

The trap of this example is when a patient comes in with an upset stomach, so I give a script for that. They take it and their stomach is better but they feel dizzy and sick, so I give another script for that. That’s usually when people start experiencing really bad symptoms from taking too many drugs. Do people think that the doctors were intentionally trying to hurt people with these medications? There’s nothing nefarious here. The intention was always to treat.

2. If I vaccinate my kids they will get autism. It’s unnatural. I don’t want to expose them to those terrible things. It’ll do them more harm than good.

As seen in:

This has come up a few times lately, especially after we watched Jenna Mccarthy on the Rockin New Years Eve a few weeks ago. I’d like to start by saying that if you are taking healthcare advice from a Playboy model, please re-evaluate your life and see an actual physician immediately. Vaccinations do not cause autism. I’ve looked at the evidence for it, and its pretty slim. For the rest of this article, however, I’ll assume it could (I’m feeling generous). People who don’t vaccinate their children are susceptible to two fallacies. First, that by avoiding vaccination they are somehow protecting their kids from exposure to the pathogens that cause disease. Second, that vaccination is primarily intended to protect their child specifically.

Ever heard of a kid with polio? Rotavirus? Smallpox? Probably not in recent memory. How about whooping cough? Few Americans (or none, in some of those cases) ever develop these diseases. The reason isn’t that the disease doesn’t exist anymore, but instead that vaccination has prevented the pathogen from causing disease. Viruses and bacteria are everywhere. Always watching. Always waiting. Just kidding, but there are way more of them than us, and our immune system clears them very efficiently ever day. If you don’t vaccinate a child against a disease, that doesn’t guarantee that they will never see that pathogen. It just handicaps their immune system if they should ever come across it.

Second, vaccinations aren’t exclusively intended for your child specifically. The key here is a concept called herd immunity. If you prefer to think of the human race as something different than a herd, call it population immunity. When the herd is vaccinated (say 95%) against a disease, only 5 out of 100 members will be susceptible to developing a disease. Should one of them acquire the disease, their chance of spreading it is low, because only 4 of the remaining 99 members can acquire it. If the herd is unvaccinated against that disease, however, one member acquiring it will cause a rapid spread through the herd. There will be a few members who are naturally resistant (there is always a small percentage of people with natural resistance to some disease), but the rest of the herd will be devastated. Getting your child vaccinated is less about their protection than it is for the rest of your kids class. Some vaccines don’t matter for kids, but for adults. Children don’t develop symptoms when infected with Hep A, but they can spread it to adults, where it causes serious illness.

This is what comes to mind when I think of “herd immunity”

3. I’m so worried that I have the swine/avian/llama flu! Everyone is going to die!

Actually probably so. If there is a total disaster to worry about, it would be a mutated influenza virus. We all remember the H1N1 outbreak a few years ago, and ever more recently new mutations like last years H7N9 virus caused concern. Should a strain of influenza develop easy transmission between humans as well as the ability to easily cause disease or death, it will be scary. Influenza changes and evolves quickly enough already, which is why there is a new flu shot every year. Millions of people died in 1918 during an influenza outbreak, where massive global troop and refugee movements allowed it to ravage the world. Despite the present lack of a world war, we have a constant state of travel and mobility, both internationally and regionally. Scary scary.

4. Have you heard about all of these new resistant bacteria? MRSA, VRE, CRE? It’s going to be the end of medicine!

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Surely you have heard of these new “super bacteria”. Are they scary as well? Yup. Are they the end of modern medicine? Nope. That link above was shared by a friend but written by a lawyer. Antibiotic resistance is certainly a problem, but it’s one that we will solve. I have had antibiotic resistance pounded into my head for the last six weeks. When to use antibiotics, when to hold them, how to identify resistant strains, combination drug therapies, etc etc. I can remember a high school teacher from years ago talking about MRSA, how terrible it was, and how that would be the end of modern medicine. Multiple resistant bacteria have developed since then, nastier than MRSA, even. Why am I not worried as much about CRE? First, because its nosocomial (acquired while in a hospital). These super bugs don’t exist everywhere around the world. They usually only infect people with extended hospital stays and invasive therapies (like catheters). Second, they will be beaten as well. People far smarter than me are always working on drugs to combat these resistant strains that develop. A resistant infection is never a good thing, but in order to find yourself developing one of these you would probably already have had something pretty serious going on.

What do you think? Let me know in the comments below or at sortadrwordpress@gmail.com

Thanks for reading

Amazing Reasons You Stay Alive

Welcome to day 2 of NaBloPoMo! Today’s post discusses my favorite subject: our bodies. If you don’t consider yourself a “science person” please stick around because A) this is interesting B) it will make you sound smart someday in the future and C) I promise I will make it fun. It’s a longer post (at least 25 tweets long) but it’s worth it! Let’s go.

1- Exposure Control

Think about this. For all animals, exposure to the environment is both absolutely required for survival and incredibly dangerous. We MUST get food and oxygen from the environment, but we need to protect ourselves from all of the hot/cold temperatures, radiation, toxins, and dangerous aspects of our world. The main way we do this is generally called homeostasis, which I have talked about briefly before, but it essentially means maintaining a cozy internal environment regardless of what’s going on outside. Your skin does a fantastic job of keeping water in (or out), blocking most UV radiation, regulating temperature, etc. Everything inside your skin is air conditioned in the summer, heated in the winter, and packs a light sweater in the spring. Keep in mind that your skin is aided by many other organs/body parts, like your muscles, blood vessels, and organs themselves.

While we are nicely protected from the outside world, that has its downsides. Too much isolation and our ability to gather the necessary materials to survive is severely diminished. Like drinking through a stir straw when you’re really thirsty, you need access to the dangerous world to survive. Our bodies are able to give us both access AND protection. While our skin keeps most everything out, our main avenues for food and air are the intestines and lungs. We absorb these inside of our body, but it helps to think of the lungs and intestines as hollow tubes of “outside” that temporarily pass into our protected “insides”. The lungs have small sack-like structures called alveoli that fill with air and are surrounded by blood vessels. This is where we unload CO2 to breathe out and load up on O2 from outside. By doing this process via millions of alveoli, we have the surface area of a tennis court available for gas exchange in a lung the size of a softball (or youth league football).

This will be important here in a minute

Surface area is the key here. Trees have leaves with great surface areas to enable photosynthesis. Microbes need huge surface areas relative to their tiny size to obtain nutrients. Humans have a lousy exterior surface area compared to our size, and we can’t breathe through our skin like frogs. Gas exchange in the lungs occurs like two lines of people trying to simultaneously leave and enter a building through a revolving door. How do you speed that up? Build more doors. Our lungs are so good at gas exchange for the same reason Sonic has great ice in their drinks. The ice is crushed, so it melts more quickly, cools down your drink faster, and keeps it cooler than big old cubed ice. That reason is lots of surface area. Your small intestine is important for absorption of all the delicious food you eat, but it is actually about 22 feet long, allowing you to pull everything you need to survive from your dinner and get rid of the rest.

Recycling –

This is one of the things I have learned in medical school so far that has amazed me. Your body is incredibly efficient. The mechanisms by which we convert food to usable energy are very good. Compare that to a light bulb or car engine, both of which require tons of energy and turn just a fraction of their input to output (with most energy given off as heat). The other amazing part is that when a cell dies, it doesn’t get flushed and ejected overboard. Nope. The cell is degraded, chomped up by other cells that have a striking resemblance to Pac-Man, and it’s parts get sent to other cells for them to use. This efficiency is great for us as a species, but if you are reading this blog you won’t ever need these superpowers. I am sitting about 10 feet from about 30,000 calories worth of food, ready to be eaten. This efficiency is probably left over from the days when people had to work or hunt for food as a survival mechanism. Regardless, we are great at it.

Efficiency at work!

Brains!

What makes us unique as humans, compared to other animals? Brains! (maybe thumbs). Why do we have huge heads? Brains!

You get the idea. As humans, we have enormous skulls and enormous brains to keep inside them. Everything else comes naturally after that. I could go so many directions with this discussion, but I will stick to the highlights.

Humans give birth to helpless little useless babies, while other species give birth to babies that can walk on their own within hours. Why? Babies have huge heads and need to get out before their heads are too huge. Why? Brains.

I have actually used this picture in my blog TWICE now!!

Most of our senses are average at best, often terrible, compared to the rest of the animals. Our vision is decent, but many of us would be blind without glasses/contacts. Our sense of smell is bad. Our hearing runs from average to awful. Taste is pretty good, and our sense of touch varies. In addition, our bodies are quite fragile, we are comparatively weak, and we run slowly (but can run for a long time). So how are we at the top of the food chain? Brains!

Compared to any bird (or dragon), our sense of vision is pathetic. What makes us special is that our eyes feed data to an enormous visual cortex that interprets and understands the world around us in a way that is unmatched by any other animal. Without going in to detail about the mechanics of sight, it is interesting to me that we perceive two things incredibly well: contrast and movement.

Compared to any kind of dog, our sense of smell is terrible. Mine is especially terrible, after spending four weeks breathing formaldehyde fumes I really can’t smell much of anything. Our sense of smell is cool because it is unfiltered. Most of our senses (except smell) pass through a structure called the thalamus, an awesome part of the brain that decides what gets your attention and what doesn’t. My elbows have been sitting on my desk while I have been typing for around thirty minutes, but I didn’t realize it until I started typing about it because I was desensitized to it. The thalamus is like a filter/switchboard operator/control tower for the billions of signals fighting for your brains attention. Smells, however, get to skip that step. That’s why you can smell something, even faintly, and BAM!!! You can instantly remember some event from long ago with incredible clarity. Smelling things is like a nostalgia machine. I read a book about World War 2 veterans who talked about certain smells that would bring back powerful memories of terrifying moments in war and could induce panic attacks, even decades later. It’s a powerful sense.

A powerful sense with a weakness for Febreze

The last thing I want to touch on about our brain is the fact that we don’t really have any idea how it works. We understand what it’s made of (neurons). We know where it is. We also know what certain areas do (mainly by observing what stops working after an accident).What we don’t understand is how our billions of neurons can interconnect and give rise to a supercomputer. Computers are great at math and repetitive logic tasks, but their ability to interpret and assimilate information is no where near the ability of our brain to do the same thing. Our brains also give rise to a personality and emotions, and that doesn’t make sense. When did that mass of neurons develop the ability to love? How did you develop the ability to have compassion on others?  That’s where the mystery still is.

As always, thanks for reading. Feel free to comment below or email my face directly at sortadrwordpress@gmail.com

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Rusty Iron

After gorging myself on a delicious, satisfying, probably diabetes-inducing dinner, I sat down and proceeded to study for about an hour and a half. This is pretty typical for me, since I don’t study well late at night and prefer to relax and spend time with my wife in the evening. I also go running in the evening, since my part of the country boasts disgusting heat and humidity for 90% of the summer. To compensate, I run at dusk. I could run in the morning, I realize, but I’m lazy and want to sleep, so that never works.

So two hours after the carb fest I called dinner, I laced up my shoes and headed out to a nearby trail to put in my nightly run. Since moving a few weeks ago, I have managed to run at least 4 days a week, even on some days where I just wanted to sleep, play Xbox, or otherwise vegetate myself for a few hours.

What a happy potato….wait…is that cannibalism?

I have been attempting to retrain myself in this whole running endeavor. It used to be that my “shortest” run was 3 miles. Anything less than that didn’t count as running. This was probably drilled into me by years of high school cross country. I am trying to adjust that setting to 4 miles, a run that I can usually fit in right under 30 minutes. Usually. Not lately. See I am now almost exactly two months removed from the Ironman. I can no longer say “I just did an Ironman” and value size my meal at Chick-fil-a (I still value size, I just come up with different reasons).

Who’s hungry?

I am now at the point where I must stop “recovering” and begin “exercising”, and that means running. Why? It’s simple. I don’t like swimming, and the pool is 6 whole minutes from school, and that’s way too far out of the way. Also, I don’t really like swimming. Cycling is time consuming. What I can accomplish in an hour of running would take about 3 hours to accomplish on my bike, unless I ride it on the trainer, which is also pretty boring and hard to justify unless it’s snowing outside.

Yet another problem: after the Ironman, I did not do a good job of recovering. In the two weeks immediately after the race, I went out on two or three bike rides with my very persuasive wife and some friends, and those did NOT go well. Stupidly, I also tried multiple times to go for short runs and loosen up, also without success. I had no rhythm (thank God for spell check, I never get that word right on the first try), couldn’t keep a tempo or pace, and everything hurt. I realize now I should never have done that. One bike ride in particular prompted me to declare the need to not bike for a while. I think that was about a month ago, and I just now am beginning to feel the slightest desire to cycle during the fall. Maybe some shorter rides on the weekend with my wife will be fun.

Back to point, which is that this combination of Ironman “recovery”, starting medical school, and generalized chaos in my life has led me to become fat. Just kidding, I’m not fat, just much heavier and slower than I have ever been (AKA fat). Which is why this daily four mile run started out at a crawl. The first evening I tried it I ended up walking quite a bit of the hills. Yesterday I finally ran it in 29 minutes and felt pretty good the whole time. I’m enjoying running, and will need to run some more to compensate for all of the sitting I’ve been doing.

That’s the last part of this picture. A typical day for me now involves at least 6 hours of sitting in lecture, a few more hours of sitting while I study, and then to relax after all of that I will sit in a different place and do other things like blog or watch Netflix. Combine this new sedentary schedule with my pathetic weakness for carbs and sugary drinks (sweet tea, Dr. Pepper) and I am well on my way to becoming a fatasauraus. Ultimately, I need a race in my future to get me motivated, preferably another marathon. It’s hard to motivate myself for that quite yet, so I will just work on speed and strength on my own. In the process, I may just fall in love with running all over again.

Note: You may have noticed that I posted twice today! That does occasionally happen, since I sometimes finish two posts in a day from draft. Also, I tend to post most often when there are other pressing things in my life I need to be putting off until later (like this first exam coming up).

Thanks for reading!