68. Bedside Manner

Experts tell us that sharing personal experiences improves our "bedside manner."   My recent experience with this advice:

Sheila talked about her addiction to peanut butter: "I start out thinking I'll have just a half-sandwhich, then before I realize it, I have finished one and started another."  I said the same thing happens to me and then added, "It has be crunchy of course."  "Of course." I then said something about how peanut butter has probably been a major factor in her remarkably good health at age 74.

Teresa mentioned how much she likes Dr. Pepper: "When I want a shot of caffeine, I grab a diet Dr. Pepper; that seems to do the trick. "Without doubt," I said, "the best diet soda." Then a description of how she lobbied to have DDP in the office coke machine.  One line was allotted, always the first to empty.  Later I went down to the clinic's employee lounge.  The two rows reserved for DDP were empty.  All the other rows in the machine were full.

Is anyone out there paying attention?

67. Drugs, Pain and Death

FDA approval means that a drug has demonstrated safety and efficacy.  Recently The FDA pulled Darvon, aka propoxyphene, from the market.  Studies 30+ years ago demonstrated that Darvon provided no more pain relief than placebo, but safety issues have been more controversial.  Now with 10,000 deaths atributed to its use, the FDA decided to remove it.  No tears shed.

A leading pain expert wants the same judgement on Demerol, aka meperidine: "It's toxic and sedating." Toxic as in seizures, etc.

When I was working at small hospitals without anesthesia support (i.e., no epidurals), we offered Demerol, with many takers.  Efficacy is not questioned here as was the case with Darvon, and safety concerns are complicated.  Metabolites (compounds produced as the body breaks down Demerol) are long-lasting, something you don't want in a pain killer because of the temptation for both provider and patient to keep increasing the dose for episodes of acute pain, unaware that several hours later the additive effects of Demerol and its metabolites can be life-threatening.  My currently hospital/clinic don't allow its use.

Demerol may have been the final (though certainly not the only) cause of Michael Jackson's death.

66: Getting Old Is No Fun

Just about as close to verbatim as my memory allows:


"I'm 70 but don't look it, except I use a walker.  Now don't get me wrong; I'm not going to go out and kill myself, but I wish the good Lord would take me.  I feel and act like a 60 year old... I don't feel old"   


Medical problems include seizures, emphysema, incontinence, bipolar disorder, breast cancer.