It only takes one to make a difference

http://www.latimes.com/news/local/la-fi-anthem-20100716,0,5284043.story

If you are too lazy to read the whole article, here is a quick rundown:

-insurance firm wants to up rates 39%

-a hospitalized math GENIUS goes, "wtf mate?" and works while he is sick in his hospital bed

-Genius man finds a weird error and reports it to the insurance firm

-insurance firm canceled the original 39% price hike and is now increasing rates by an average of 14%

Win: genius

Fail: insurance quality assurance

But seriously... wtcrap. A small firm out does a multi-billion-dollar company and does better error checking than the company that knows its own system best... and this error isn't about pennies and nickels... it's about TENS OF MILLIONS OF DOLLARS. that is HUGE! And especially in this new era of the Obama healthcare reform (or better known as insurance reform), missed errors like this adds up and becomes a ridiculous burden on the consumers and government.

Assessment:

1. Insurance companies suck.

2. WTF? were the insurance companies doing their job?

3. "Yes, let's just cut corners on these numbers, we won't pay for it anyways"

Plan:

1. Investigate all insurance company's book keeping

2. Maintain better control of for-profit insurance firms (I guess that's what ObamaCare is for)

3. Possibly to decrease healthcare cost and insurance overall, limit litigation awards on the MD side to decrease defensive medicine... but that's a whole different story....

4. Maybe just socalize healthcare completely... that will solve everything...

Yes, I am talking to you Patient BMI 79

Seriously, lose weight. Yes, for the women, having extra fat cells increases your chance of getting cancer of the breast or endometrium... and for the men, you could get breast cancer, or worse, you will end up with boobs.

All jokes aside, I have really felt frustrated with dealing with obese patients. Could you really just take care of yourself, just a tiny bit? Why let yourself go and get yourself categorized as obese or morbidly obese (yes, that's a BMI of 40+) and with that categorization, all the health problems that come with it?! Just imagine... a 5 foot 7 inches person weighing TWO HUNDRED AND FIFTY FIVE POUNDS. That's like me, but DOUBLE my weight.

Sadly enough, most patients in the hospital are these patients. They are obese patients with X number of medical issues, and they go into surgery for Y, go home and resume the vicious cycle until something happens where the medical system can no longer prolong their life. I have seen a few rare instances where patients make a complete 180 and change their lifestyle and are now living better than ever. And that makes me feel like I am doing something. But for everything else, you either become jaded, or your paycheck is big enough where you don't care, or you are just really optimistic and truly care despite the fact.

Assessment:
1. Obesity is a big contributing factor to MANY medical problems
2. Healthcare isn't about saving lives, it's about prolonging a life that should have technically ended
3. Losing weight would save yourself so much in the long run
4. Healthcare dollars are being wasted on those who depended on the system because they are unable to look after themselves

Plan:
1. Somehow get people to lose weight, or let darwinism handle it
2. Create a practice that takes care of people who take care of themselves, or seek practice in a setting where medical care is appreciated
3. For the health care reform, create caps on health insurance coverages BASED on the effort of the patient (i.e. patient gets treatment, but then still does not work for a healthier lifestyle, then coverage will eventually run out)
4. Create a big hole and......

Earth Day!

Yes, today is Earth Day.

Just another reminder for us all to be mindful in how we use disposable things in our day to day life. Yes, everything has an environmental impact. Yes, one person making lifestyle changes can make a difference. Yes, the problem is very real.

How does this affect our health? Simple. Pollution, waste, and negligence will impact the environment negatively and it will all come back around to bit us in the butt by providing us an enviroment harmful to our health.

What can YOU do? Simple.

-Recycle. Plastic, paper, alumium cans.

-Use napkins or towels in the bathroom? Grab 1 or 2 instead of 3, 4, 5, 6, 7... I have seen people grab about a 3-foot long piece of paper towel to simply dry their hands in the bathrooms. Overkill.

-Get by by using less to do the same amount. I am sure there are ways in which you can do the same task using less resources. Like shower for 5 minutes instead of 10.

-Drink water from a reusable bottle instead of buying bottled water. Water is water, it might taste a little different from bottler to bottler, but it is all the same, you will get used to it (or just be content with it) and you pee it out anyways.

-Promote awareness. Long-term enviromental damage is not something to be taken lightly or think that we won't be directly affected by it (that's just being selfish).

-Make simple changes. See how easily one can make a difference.

Exercise Prescription: just do it

Want patients to actually do something when you tell them to exercise for their own good? Write them a prescription for it!

http://www.webmd.com/fitness-exercise/news/20090417/exercise-prescription-coming-your-way

This is AN EXCELLENT PRACTICE to get used to. Typically, patients come to their doctor with a complaint and expect to leave the office with SOMETHING in their hands, the solution. Usually, it would be a prescription for an actual drug that you can pick up at the pharmacy.

Here, the complaint can be anywhere in series of other health problems caused by being overweight. Therefore, it follows that the solution is to lose weight via exercise!

The beauty of this is that the patient can't even complain that they didn't get a "prescription" from the visit. Sure, they can grip and demand an alternative. But! I am sure that to anyone's "medical expertise" that the best solution to the problem is indeed EXERCISE and not a simple pill they can pop once a day.

The effect is two-fold. You treat the underlying cause, and this will ameliorate the presenting complaints over time. Two birds, one stone, right? It is much better than managing ONLY the complaint with a drug and dismissing the true problem.

Exercise. It works. It's cost-effective. It's simple.

Write it. Sign it. Tear it. Give it.

Lose weight without doing anything!

Looks like there IS any easy way out.... but not just yet...

Researchers have found that you can activate brown fat to help burn off white fat!

http://www.webmd.com/diet/news/20090407/can-brown-fat-make-you-thin

What does this mean? America can keep with their sedentary and lazy life style, and just pop a pill and everything will be alright. Unless the increased calorie burn increases your appetite, and hence, you eat more, negating its effect.

Flip side: Popping pills could prevent obesity overall, lowering the prevalence, and therefore, less chronic problems would result. Maybe some good can came from this after all? Sure, less work for all of us. Then we can deal with patients with REAL medical problems, ones they didn't set themselves up for.

Cardio and NSAIDs don't mix

Just something I picked up from our renal module.

You know how drinking and driving don't mix? Well, the same applies for doing cardio workouts and NSAIDs, or non-steroidal anti-inflammatory drug. 

The reason being is that when you undergo sustained cardio workout, such as running, the blood is shunted, or displaced from your kidneys to tissue with currently higher oxygen needs, such as your leg muscles and heart. Because of this, the blood pressure in your kidneys drop, decreasing its ability to filter your blood. As a regulatory mechanism to maintain sufficient filtration pressure, the vessels in the kidneys constrict to increase the pressure. However, under conditions of excessive vessel constriction, it will essentially cutoff blood flow to the kidneys, and now the kidneys will be oxygen deprived and begin to die.

To prevent this from happening, there is a counter-regulatory mechanism to keep the vessels from closing off too much. A compound called prostaglandins, which causes dilation of the vessels, is produced when there is reduced blood flow to the kidneys. However, NSAIDs inhibit prostaglandin synthesis and therefore adequate blood flow is not able to be reestablished.

Repeated bouts of this kidney abuse, and you can say goodbye kidneys and hope you can get a transplant.

Now, why might you be taking an NSAID? Perhaps, you have some kind of inflammation, such as a tendon which has gotten irritated from repetitive movements, such as sustained running resulting in tendinitis of an ankle tendon. Funny thing is this happened to me in my training for a half-marathon coming up... so it's a good thing I found out about this early enough before serious harm was done.

Friends don't let friends do cardio on NSAIDs...

Final exam grade woes

So yesterday I got my exam grade back for the GI module... and needless to say, I didn't do so hot. I got by but what the heck, I studied for it fairly rigorously and I felt pretty confident that I knew the material, but it didn't amount to anything on the exam...

Am I the only one who feels like this?

It is super discouraging and is telling me that studying has no effect on the outcome, so I would almost be better off not studying as hard and enjoying some time to myself everyday, no? I hope it is not the case that the amount of studying I am doing now is the bare minimum I need to do to just pass the class........

However, in the end, it doesn't matter... honors or just passing. It all comes down to the USMLE anyways. I've been doing qbank questions for the GI module and it isn't too bad, so I hope that is more reflective of the fact that my studying is amounting to something at least... I just hope my downward trend this year doesn't carry over to the boards coming up... yikes.

They say to do well on the boards, you should do WELL in your class... well that is certainly not the case for me. They say, don't study for boards ahead of time, and that what you learn in class is what will be relevant to the boards... Each organ module grade tells me that I have to study harder for the next module, but this time around, my grade for GI just told me that I suck at life. Something isn't working and something has gotta change. At this point, I just hope I crush the step 1.

I have so many goals with my medical career, and I am just afraid that these stats are going to hold me back. lame.