Wednesday, January 9, 2013

Day 207 - the cold continues

Let me start by telling you about yesterday. I did lots of running around for my various jobs, including getting my plants from my old office. I was astonished that only one of them, the baby tears which I was not really too attached to, had died. Anyone who has been in my office in Bedford knows about the black bamboo and how it drops leaves. You could have followed its trail from my old office to the back door to my car. If I had rolled down the window, you could probably have followed it all the way to my office at Home, Health and Hospice. I will take a photo tomorrow so you can see the graceful way it arches across the other plants in the window. It is an extraordinarily good looking plant if you don't mind the mess.
At the end of my day, I went up to Dartmouth to the medical staff meeting. Steve talked about the new compensation model which was interesting because this was my first time at a meeting where I was a specialist and not a primary care doc. He also discussed the various changes afoot in health care payment and what they might mean to Dartmouth, etc. At the end of the meeting, he announced that it was nice to have me back and everyone applauded. I'm not sure I've ever been applauded before just for being alive. It was very touching and made up for a lot of the nuisance of leukemia, not by itself, but the whole way I have felt so embraced and appreciated and loved by my medical community through the whole thing. I feel very fortunate. Thank you.
Today, I am still recovering from my cold. I am more tired than I like to be on my days off, but I guess that's because I don't have as much reserve as I used to have. I will probably temper my enthusiasm for increasing my hours at work because of today's tiredness. I think my current fatigue is a mixture of cancer and cold related fatigue. They say that the best remedy for cancer related fatigue (another CRF) is actually exercise. I think that's true. I did force myself to go for a three mile walk and that actually seemed to help. The dog was more tolerable afterwards too.
There has been some journal reading going on recently. The 1/2/13 JAMA has a couple of interesting things in it. There is a nice essay called "Mind the Outcomes" about how sometimes expensive diagnostic tests that do not change the treatment are not really worth doing. She talks about her sick cat and how she was able to make better choices for the cat than for herself and how the veterinarians might have something to teach human medicine about cost consciousness. The next article I found interesting was about the difference in blood flow after glucose versus fructose in parts of the brain related to appetite and reward. The summary is that glucose ingestion lit up (on functional MRI) the brain in a way suggestive of more satiation than the fructose. Humph. interesting. The next interesting article was a population study of SSRIs in pregnancy in Denmark. 1.6 million singleton births showed in multi-variable analysis that there is not an increased risk of still-birth, neo- or post- natal death associated with SSRI usage in pregnancy. The summary reminds "decisions about the use of SSRIs during pregnancy must take into account other perinatal outcomes and the risks associated with maternal mental illness." Exactly what I've been saying to my patients for ages. The final interesting (IMHO) article has gotten tons of publicity. It is the one that found overweight (where many people such as myself live) is associated with significantly lower all-cause mortality than "normal" weight. Higher BMI than overweight raises mortality risk again. Oops! time to readjust the BMI charts?
For me, for tomorrow, I will wish for courage to revise my previous opinions and wisdom to see when it's needed. I think that's a good wish for any of us, so I'm going to wish that for you, too.

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