As a whooping cough epidemic hits California, you may be asking yourself, “hey, weren’t we all vaccinated for that?” Even as the headlines imply a Victorian-level outbreak of hacking and coughing, perhaps you’re looking around and wondering where, exactly, this epidemic is located. And what you should know about whooping cough to protect you and yours.
Here are some fun, weird, and sometimes worrying tidbits to know about whooping cough. Pass them on to friends and co-workers – because an epidemic of knowledge is a GOOD thing to spread around:
1) Hey, you got vaccinated, and your kids did too – doesn’t that mean you’re protected? Um, no. Pertussis (the medical name for whooping cough) vaccines are actually kind of puny, and don’t last that long. Strange, but true. The original pertussis vaccine schedule was designed to protect the most vulnerable – the very young. So, to get a good baseline level of protection, your baby gets many pertussis shots, one after the other. But even after a solid start of many boosting shots, the pertussis vaccines are only effective for most people for about 5 years. That’s why your kid gets another booster around kindergarten. So before recent changes in recommended vaccinations, most of us lost our solid baby-hood protection around age 10-11. Hence the recent outbreaks. But now, because of outbreaks that are appearing across the country, the CDC has recommended that a pertussis shot be included in every tetanus booster given to every adult. Without it, even if you had a documented case of the disease, your immunity will gradually disappear…
2) I’ve never heard anyone whoop in my entire life. So how can “experts” say there’s whooping cough breaking out all over? Fact is, you don’t have to whoop to have whooping cough. If you want to hear the misery and classic sound of whooping cough, go here. The “whoop” happens when the infected person desperately tries to inhale at the end of a truly miserable bout of uncontrollable coughing. The classic “whoop” sound is believed to be more common in a person who got no vaccinations, or only one as a baby, or has lost all their immunity. Partial immunity seems to mean that people get milder versions of what is, really, a hideous infection. What’s more, the whoop occurs way late – after days to weeks of sickness, as the coughing seems to get relentlessly worse. Pertussis can be found by medical tests, so disease-trackers, even without the whoops, can know who’s getting it, and where.
3) I’m supposed to take antibiotics for a runny nose? You’ve GOT to be kidding me. Whooping cough has a strange and nasty presentation, one that seems designed to fake out everything you’ve ever been taught about how to deal with colds and flu. It begins with a typical runny nose. Then (sneaky sneaky), the runny nose seems to go away after a few days. The cough begins, but it’s not so horrible at first. Kind of like what you’d expect from a typical, seasonal upper respiratory infection. But then, right when you think you should be getting better, the spasms of coughing begin. We’re talking whole-body, snot-running-down-the-face, have-to-leave-the-meeting, holding-your-side, unable-to-catch-your-breath nastiness. These bouts will gradually worsen over time, striking at any moment, often at night, leaving a healthy person bent over, drenched in sweat and gasping. For many many people, this type of coughing hell leads inevitably to vomiting. Even in a hallway of the office, even on a street corner. It’s that involuntary. AND, it goes on and on. For weeks and weeks. THAT’S what it’s like a normal, healthy person. Imagine how this type of thing can affect someone with a touch of emphysema. Or a frail set of chest muscles. Or a frail set of chest muscles. Or a tiny, too-young-to-be-vaccinated baby (warning: graphic and heart-breaking image here). People can indeed die from it, or from the pneumonia that you can get on top of it.
4) Won’t my doctor know if I’ve got whooping cough? Somewhere around weeks two or three, if you despair and go to the doctor, a typical exam will show…nothing. Even a really good doctor is likely to send you home with an inhaler (even if you don’t have asthma) and tell you to try using it to see if the inhaler will “break” the coughing spells. But only a doctor who’s aware of pertussis outbreaks and takes the time to listen to ALL your symptoms and how long they’ve been going on will recognize that what you have is probably whooping cough. Sadly, there’s no medicine to stop pertussis once it’s truly set it. Taking the antibiotics for whooping cough AFTER you’re had it for a couple of weeks (which is when most people drag themselves into see the doctor) does nothing. If you diagnose pertussis in the first week, taking the antibiotics then may reduce how long you are infectious to other people. BUT, keep in mind, there’s hope for the people you know and love! If a person is exposed to a true case of pertussis, and starts to have the runny nose stage – THEN, if you take the appropriate antibiotics in the first 72 hours, you can nip the whole nasty disease in the bud, right there and then (although a recent review of the few studies to support this practice resulted in an “insufficient evidence” to completely verify it works).
So you heard it from me, and I’ll back you up – there is, indeed, despite everything you’ve ever been told by every doctor your entire life, one and only time in medicine when it truly is appropriate and useful to take antibiotics for a runny nose. To kill off whooping cough before it begins.
5) What do you mean, I should get a tetanus shot if I’m a smoker? That’s just crazy. Well, no. Not any longer. Anyone who’s a smoker, anyone with lung disease of any kind, anyone with breathing troubles for any reason – you’re exactly the person who wants to be sure to stay up on your tetanus boosters. Because NOW, with the recent whooping cough outbreaks, your garden-variety tetanus booster comes with a pertussis booster added on! If you’re in a risk group of any kind, you don’t want to let your whooping cough immunity lag.
So spread the word! (and not the germs…).
What do you think? Is whooping cough the sneakiest meanie to hit the streets in a long time? Do you think you had it…and never knew it? Sound off in the comments section. Remember – general medical information is NOT a replacement for medical care – if you have questions, concern or confusion about whooping cough, see your doctor. Doc Gurley is the only Harvard Medical School graduate, ever, to be awarded the coveted Shoney’s Ten Step Pin for documented excellence in waitressing, and is a practicing board-certified internist. You can get more health posts at www.docgurley.com, or jump on the Twitter bandwagon and follow Doc Gurley. Also check out Doc Gurley’s joyhabit and iwellth twitter feeds – so you can get topic-specific fun, effective, affordable tips on how to nurture your joy and grow your personal wellth.
The news that Dr. Marcus Conant has quit practicing medicine is a blow to healthcare here in the Bay Area. And a sad symbol of all that is wrong with healthcare – and in particularly, the way we treat primary care practitioners – in America today. It would be hard to find a doctor more symbolic of the best of medicine than Marcus Conant – a man willing to devote his life to caring for people who, at the time, no one wanted to care for, a person who is a powerful advocate for not only his patients, but for all those affected by a devastating and stigmatizing disease, and a practitioner willing to devote himself to the tremendous amount of life-long-learning needed to not only transition into a lower paying field (from Derm to primary care), but to stay up on developments as the stakes rose as treatment became vastly complex and life-changing.
But Marcus Conant is also, sadly, not an isolated case. More and more doctors have fled medicine. And more have fled California, in particular. The numbers are dwindling both due to dissatisfaction and justified retirement. Primary care practitioners – family practice docs, primary care docs, and internal medicine docs – are more and more only represented by an older generation of physicians who entered the field before the twin pressure of gutted pay and mega-hassles meant fewer and fewer sane people would choose it as a career.
So if you are one of the many whose doctor has given you the sad news that he/she is leaving the practice of medicine, what should you do?
1) Don’t delay – the number of people in the Bay Area who are taking new patients into primary care is shockingly small. When you add to that the restrictions that your insurance (if you’re lucky enough to have it) is likely to impose, plus the wait time for an appointment, you need to start working the phones. Taking this step is surprisingly hard for many patients. Some of the reluctance may be due to a grief reaction, some may be due to a depression about starting all over again with another doctor (and airing all your issues – health and otherwise with a person you don’t yet know if you can trust). And part of it may be from past poor experiences with healthcare providers. If you tell yourself you may need to roadtest a few doctors before you find a good one, sometimes that can free you from thinking that first visit is an “all or nothing” high-pressure event.
2) Get your script down – your retiring doctor will likely be very happy to give you as many refills as possible on chronic meds, in order to help you buy time until you get a new provider. Be warned, however, that for some truly-important items (like pain meds), getting advance refills won’t be possible. If this situation applies to you, ask your doctor frankly if there is a provider who can provide a transition role for you as you transfer your care. Even if such an arrangement is possible, patients with controlled pain medication needs are the ones who have to be most efficient about arranging a new doctor – hopefully one who will support your existing pain regime. No matter what your prescription needs are, don’t be fooled into thinking getting refills means you have more time to find a new doctor. You want to be fast out of the gate getting a new provider, and not fall into the trap of thinking more refills means you have more time – a change in your health status without a provider can leave you vulnerable to a truly bad outcome.
3) Get referrals sorted – it is a nasty surprise to most patients that an authorized referral to a specialist may not be covered by your insurance if your provider changes or leaves before you get to see the specialist. It was a nasty surprise to me (and you might think a doctor would know) when my personal Derm appointment was denied reimbursement (I got socked with a tidy $300+ bill) NOT because the referral was inappropriate, and NOT because I didn’t follow all the correct steps. It was denied because my provider left before Derm could see me, and my “new” provider hadn’t written the referral. My “new” provider agreed it was an indicated referral, but that change-in-care was all an insurance company needed to deny payment. If possible, when you know your provider is retiring/leaving, do your best and enlist their help in getting specialty tests and referrals done prior to the leave date.
4) If you’re left hanging – with the aging primary care doctor population, and the high burnout rate in this field, many patients aren’t given much, if any, advance notice. Sometimes a sudden health crisis means you learn that your doctor is gone the day you show up for your appointment. What can you do? First, get copies of all your health information. Then work the phones – including calling your insurance coverage to see about having your care transferred in a timely manner to available providers. Sometimes what is best is getting ANY healthcare provider, not necessarily the best. Once you’ve got someone to be your doctor, you can then look around for a better fit.
5) Grieving – you may be surprised at the amount of emotion you feel when your doctor leaves (whether he/she left by choice or not). Relationships with doctors, particularly those that have survived for many crisis, or years of health issue, as Dr. Conant’s patients undoubtedly experienced, can be more intense than we, as a society, often recognize. Give yourself time to grieve, and to remember. But don’t let those emotions keep you from getting a new provider. Fast.
Remember, your doctor will be grieving too – even if he/she chose to leave. No doctor makes that choice easily, or without some emotional fallout of their own. And he/she wants, more than anything, for you to be in the best of health.
Do you have any tips or experiences to share for when your doctor quits? Post them in the comments section below.
It finally happened. Last night, in a close vote along party lines, the Senate failed to block a scheduled 21% cut in Medicare pay to doctors. While there’s nothing less appealing than a doctor whining about their pay, keep in mind that this Medicare pay cut now means that your primary care doctor will be paid less than your SuperCuts hairdresser. Minus the tip.
I’m serious. The pay range among types of doctors is huge - and is often even a shocker for doctors themselves. While surgical specialists can easily be making a million a year, I found, for example, that I’d get paid, as a full-time private practice internist at a premiere medical group, in a job with two weeks of vacation, lots of after-hours call, and tons of medical liability…(wait for it)…50% less than our local elementary school principal (who gets summers off, a three-week winter break, and a day that ends at 2:30pm). And she’s rarely sued. Cut THAT pay by 21% and you’re talking serious trouble getting an appointment with anyone. Ever.
Nickled and died?
So how are the few remaining primary care doctors coping? Some are advocating airline-type fees for all kinds of activities (including for writing doctor’s notes, having forms filled out, and returning emails). Some docs apparently haven’t waited for the long-threatened Medicare pay cut. Here’s a letter from an insured patient – a Doc Gurley reader who’s also an advanced-degree healthcare professional – which just may illustrate the future of your healthcare [note: letter has been edited for length and to ensure confidentiality]:
Good morning, Doc. I just wanted to share an extremely disappointing experience I had yesterday.
I’ve begun looking for a new internist to see. So, with the list of doctors on my health insurance plan narrowed down to female internists within a 20 mile radius of home, I called around to find one who is accepting new clients.
To make a long story short, my first appointment was an hour long, but I never received a physical exam. The doctor’s P.A. saw me. She took my history, explained the “concierge service” plan to me and listened to my heart and lungs, period. Now this special “concierge service” costs $1,800 a year, this year. It offers the opportunity to see the doctor within 2 days of calling for an appointment. Without paying the extra out-of-pocket concierge fee, patients see the P.A. only. The P.A. is only around 3 days a week. When the P.A. heard another exam room’s door open she interrupted her spiel to duck out and bring the doctor in to shake my hand and see if I had any questions to ask about the “concierge service.” I took the opportunity to explain that my doctoring needs are pretty simple. This doctor explained that if I signed up for the “concierge service,” I could see her within a day or two. I had the distinct impression that everything about her practice was about raking in the $$$$, certainly not much about personal contact, and who knows what kind of medical care, really. Oh, for the $1,800 one also gets the good doctor’s cell phone number, so one can leave messages with questions on her answering service, and she’ll return a call up to 8:00 in the evening.
I came away furious, and I’ll be damned if I pay into her racket! It felt more like extortion to me – pay me big bucks out of pocket, and I’ll let you see an actual doctor. It took me a month to get this initial appointment at this practice, and I’m pretty sure I don’t want to try to work with this doctor. I guess I’m back to square one, with the list of preferred practitioners on the insurance company’s panel, and a new question to add to my phone interview: “Do you have a ‘concierge service?’”
Signed, Extorted in Extremis
So is there anything wrong with this arrangement? There’s no law against it. Heck, since reimbursement for P.A. visits is significantly lower, insurance companies are likely to be very happy with this approach – at least in the short run. And with many for-profit insurance companies, the short run is what it’s all about. And if all doctors in an area take this same approach, your insurance becomes just a way to see a P.A. – never a doc. Should you have to pay extra to be cared for, personally, by your insurance-assigned doctor? P.A.s have worked with doctors for many many years – but even when the arrangement works well, there’s always been a “common sense” understanding that patients who are complicated should be seen by the doctor. At least a few times. What if the only patients who can personally see the doc, no matter how complex or serious the problem, are the ones who pay the extra fee? Concierge arrangements have also been around for a while. But the “understanding” was that concierge service was an optional upgrade you could choose – not a mandatory fee you must pay to have access to your assigned physician.
Hmm, how long do you think it will be until you get weighed at the clinic door to see if you’re over your limit for your medical baggage?
What do you think? Should doctors implement fees for insured patients? Should you pay extra for access? Sound off in the comments section. Doc Gurley is the only Harvard Medical School graduate, ever, to be awarded the coveted Shoney’s Ten Step Pin for documented excellence in waitressing, and is a practicing board-certified internist. You can get more health posts at www.docgurley.com, or jump on the Twitter bandwagon and follow Doc Gurley. Also check out Doc Gurley’s joyhabit and iwellth twitter feeds – so you can get topic-specific fun, effective, affordable tips on how to nurture your joy and grow your personal wellth.
Summer vacation is breaking out all over. But maybe not for you. Perhaps you’re trapped in a cube-farm, forced to play prairie dog just to stand up to stretch your legs. Perhaps you’re now struggling with life while the kids are out of school – and wishing you could be “off” too. Or maybe you’ve got some time coming, but every time you look at airfares you have to go lie down in a quiet room and do some Lamaze breathing to get over the shock.
Summer also inspires us to make changes for our health. Maybe you’ve begun to realize that now may be a great time to give the old noggin’ a little stimulation – hey, even Esquire discussed it in their article about the care and keeping of “Your Brain, Your Heart, Your Balls” [Doc Gurley caveat: forget the article's "suggested" blood tests for brain health - they're not standard of care and there's no clear data about treatment interpretation/implications]. But when you’re exhausted and feeling left out of the excitement of summer, it can be hard to think of even what to read. Nothing seems appealing.
If you’re looking for a great way to escape, and give your brain a vicarious, entertaining work-out, consider grabbing hold of Cara Black’s latest Paris thriller. Known for her amazing ability to transport readers to the rich sensory experience of Paris, Cara’s latest book even takes you into actual, secret, behind-the-scenes parts of the Louvre. Not only can you feel like you got to spend some time in Paris, you’ll get to go to places no one else you know has ever been. AND your brain will thank you for it. AND a little “escape” may be just what you need to reduce some of the pressures of your day.
Check out this conversation with acclaimed novelist Cara Black, as she explains how she works her tele-transportation-to-Paris neuro-magic. Then buy your virtual ticket to the experience at Book Passage. Paris and back, first class, all for the price of book. Bon voyage!
Obligatory conflict-of-interest disclaimer: Doc Gurley does not receive any compensation of any kind from either Cara Black, her publishers, or Book Passage. Nothing, other than the joy of the purchased-book reading experience, that is. Do YOU know of some get-out-of-your-everyday-rut suggestions for summer reading? Or brain-training fun? Sound off in the comments section. Doc Gurley is the only Harvard Medical School graduate, ever, to be awarded the coveted Shoney’s Ten Step Pin for documented excellence in waitressing, and is a practicing board-certified internist. You can get more health posts at www.docgurley.com, or jump on the Twitter bandwagon and follow Doc Gurley. Also check out Doc Gurley’s joyhabit and iwellth twitter feeds – so you can get topic-specific fun, effective, affordable tips on how to nurture your joy and grow your personal wellth.
Against the backdrop of a rapid decline of California whites into the minority, and with a California Democrat asserting that the Arizona immigration law was fueled by white supremacists, and the New York Times reporting that the California G.O.P. governor’s race will be defined by immigration, the battle lines seemed to have hardened on this issue. So is there a reason for trying to find some empathy across this (border-wide) divide? Empathy is a classic example of one type of emotional intelligence. “Emotional intelligence” has become the catch-phrase for the types of neuro-physiologic behaviors that we, from a scientific and educational perspective, often don’t test for, or, many would say, value. Empathy is, in other words, the odd neurologic ability to project yourself inside the skin, thumping heart, rage-shaking hands, and stinging eyes of another human being. Kind of amazing, isn’t it, when you think about this trans-body teleporting talent we all can have?
How do you learn or develop or encourage this type of skill? Numerous studies have shown that it is a learned, not innate behavior – you don’t come out of the womb thinking how tough that must have been for your mom. Like all neurologic functions, once you acquire the skill, using it in interesting and novel ways is what keeps it sharp. [And, yes, one study did recently show that brain exercises do not make you smarter, but against that one result are numerous studies that show that exercising your neurologic skills DOES keep you from losing what you have, and can often make you sharper at the specific skill you're using.]
Watch this fascinating interview with the acclaimed author, David Corbett, to see exactly how one talented person tried to achieve, with skill, on a national stage, the ability to get inside the skin of another person’s experience and life. It’s entertaining, directly related to the volatile Arizona debate, and a great reminder that it takes some creativity and work for anyone wanting to keep or improve their emotional intelligence.
Then head over to Book Passage to buy his book, Do They Know I’m Running? His book is getting a LOT of buzz – for all the right reasons. And what better way is there to indulge in some summer thriller reading, and at the same time, stimulate your mind outside the many narrow boxes we see around us?
Is there a role for emotional intelligence in the Arizona debate? Can you really get inside another person’s skin just from reading? Sound off in the comments section. Doc Gurley is the only Harvard Medical School graduate, ever, to be awarded the coveted Shoney’s Ten Step Pin for documented excellence in waitressing, and is a practicing board-certified internist. You can get more health posts at www.docgurley.com, or jump on the Twitter bandwagon and follow Doc Gurley. Also check out Doc Gurley’s joyhabit and iwellth twitter feeds – so you can get topic-specific fun, effective, affordable tips on how to nurture your joy and grow your personal wellth.
The BBC reports that Indian men have smaller penises. Smaller than international condom standards, that is. A two-year study in India of 1,200 men, measuring the length and breadth of their penises, found that 60% of men had penises that were between 3 and 5 centimeters smaller than international condom standards. There were already studies showing that a whopping 1-in-5 times a condom is used in India, it either tears or falls off – a truly unacceptable failure rate for anyone, but even more alarming in the country with the highest number of HIV infections.
Given the health and contraception implications, the body of literature (so to speak) on penis size and condom size is surprisingly (ahem) small. Most of the existing studies were done in men who have sex with men (with an eye to AIDS prevention by increasing condom satisfaction/use) but there’s no reason to think the situation’s any different for men batting for the other team. One study looked at penis size and condom size by basing penis size on the man’s self-report of size (normal, above average, below average), and then asking about infections, behaviors, and condom problems. They found:
Doc Gurley & Byron, a 7-foot plush penis, from the Dept of Public Health’s Healthy Penis Campaign
“Though most men felt their penis size was average, many fell outside this ‘norm.’ The disproportionate [higher] number of viral skin-to-skin STIs (HSV-2 and HPV) [among men with larger than average penises] suggests size may play a role in condom slippage/breakage. Further, size played a significant role in sexual positioning and psychosocial adjustment. These data highlight the need to better understand the real individual-level consequences of living in a penis-centered society.”
(can I just say – I loved finding that phrase buried in a dusty pile of medical tomes…).
Another study looked at condom dissatisfaction and size (again, among MSMs) and found that there was a correlation, including reported condom failure rates for men who said they had larger than average penises.
One prior study actually lined up American men and measured them (a study done, of course, by urologists – the plumbers of the male reproductive tract). The theory was that small penis size is why young men complain about condoms so much. This study (http://www.ncbi.nlm.nih.gov/pubmed/11182344) measured flaccid and erect penis size in a group of young men (18-19) and compared sizes to older men (40-68). Young men had shorter flaccid penises, but slightly longer and thicker at the base penises when erect. Unexpectedly (to the urologists), the size of the glans didn’t change at all with age.
So are custom-condom sizes, or even custom-fitted condoms, the way to go? Or come? One study compared standard condoms to custom-fitted condoms and found less breakage and more satisfaction with a custom-condom, particularly for men with larger penises. The study did, however, show alarmingly more slippage in the custom-fitted condoms, particularly on withdrawal.
This custom-condom failure issue is so counter-intuitive, and so important, let’s take a moment to look at the study. [Brace yourself: Raw data in-coming: OBJECTIVE: This study compared failure rates of a standard-sized condom and a condom fitted to a man's penile length and circumference and assessed users' perceptions of condom acceptability and confidence in the efficacy of both condoms. METHOD: Using an experimental crossover design with Internet-based daily diaries, 820 men who wore at least one of each condom type reported outcomes and perceptions of condoms used during vaginal and anal intercourse events for which they were the insertive partner. RESULTS: Breakage for fitted condoms (0.7%) was significantly less than for standard-sized condoms (1.4%). When assessed by penile dimensions, significantly less breakage of fitted condoms than standard-sized condoms was observed among men in the middle circumference category (12-13 cm) during anal intercourse (1.2% versus 5.6%), men in the larger circumference category (> or =14 cm) during vaginal intercourse (0.6% versus 2.6%), and men in the longer length category (> or =16 cm) for both vaginal (0.5% versus 2.5%) and anal (3.0% versus 9.8%) intercourse. More slippage upon withdrawal after vaginal intercourse occurred with fitted condoms among men in the middle penile length (1.9% versus 0.9%) and circumference (2.2% versus 0.7%) categories. CONCLUSIONS: Fitted condoms may be valuable to sexually transmitted infection prevention efforts, particularly for men with larger penile dimensions. That fitted condoms slipped more for some men provides insights into the need for unique educational materials to accompany such products. Findings also highlight the need for participatory approaches between public health, condom manufacturers, and the retail industry to integrate fitted products into our work successfully.]
So the jury is still out on whether custom condoms are the way to go. But when it comes to getting the right condom size, custom or not, the unspoken problem here is a man’s self-reporting/self-selecting of size when choosing a condom in a semi-public purchase interaction. Other studies showed that self-reported penis size is strongly correlated with self-esteem, and, as I mentioned above, studies have shown that guys report that they’re “normal” way more than, statistically, they can be (kind of like everyone being above average in Lake Wobegon). What guy wants to be a petite penis? This leads, inevitably, to what I’d call the Starbucking of condoms. “Small” becomes “tall.” Before you know it, “medium,” will be “stallion with a hard-on” and “largish” will be “The Humpback.”
With those kind of names, who wants to be just “tall”? And then, oops, we’re back to the condom failure problem all over again…
So where does that leave Indian men and their publicized penile measurements? As the BBC article points out:
“Indian men need not be concerned about measuring up internationally according to Sunil Mehra, the former editor of the Indian version of the men’s magazine Maxim. ‘It’s not size, it’s what you do with it that matters,’ he said. ‘From our population, the evidence is Indians are doing pretty well. With apologies to the poet Alexander Pope, you could say, for inches and centimetres, let fools contend.’”
What do you think? Is condom sizing a health, or a marketing issue? If you’re a woman, would you ask your partner to trade a less-breakage (possibly less infections) off-the-rack (har) condom for a more slippage (possibly more pregnancies) custom condom? Sound off in the comments section. Doc Gurley is the only Harvard Medical School graduate, ever, to be awarded the coveted Shoney’s Ten Step Pin for documented excellence in waitressing, and is a Board-certified, practicing internist. You can get more health posts at www.docgurley.com, or jump on the Twitter bandwagon and follow Doc Gurley. Also check out Doc Gurley’s joyhabit and iwellth twitter feeds – so you can get topic-specific fun, effective, affordable tips on how to nurture your joy and grow your personal wellth.
It’s the time of year when spring cleaning actually seems attractive. The sun is sparkling, the windows beg to be opened.
But what if you’ve got so much stuff the whole idea just makes your stomach knot up? What if you’d love to wipe down those walls, but you know you would have to spend so much time moving things to get to the wall, there’s no point in starting? What if you’d really love to have people over for a deck-side al fresco meal, but you’re ashamed of the mess – and overwhelmed by how long it would take to clean the place up? What if your recurring nightmare is that a co-worker might, without any warning, drop by your home – and you might accidentally open the door – outing your shame to people who aren’t really your friends and forever changing the way they see you?
In other words, with the sun twinkling through lime-green leaves and the world enticing you to open your home, perhaps you’re starting to wonder if, like those hoarding folks on TV, you might have a problem with your relationship to “stuff.”
Are these warning signs that you’re becoming a hoarder? Do you need help? Or should you get help now – before you need help? And how, exactly, do you go about changing your relationship to your stuff if the idea of tackling it just makes you want to sit on the floor (since the chair’s covered in clothes) and cry?
First, keep in mind that you’re not alone. Not by a long shot. Despite the intense shame you may feel about messiness and clutter, it helps to know that a whopping chunk of us struggle with these issues on a seriously impacted level – as many as 2-5% (or one in twenty people). Which means there are many, many more of us who are somewhere along a spectrum – people who could benefit from some preventive or supportive help to bolster good habits.
Second, always remember to be kind to yourself – treat yourself the way you’d treat a beloved family member or friend with the same issue. Whether a person’s life challenge is overeating, overspending, clutter or any one of our society’s many shame-filled struggles, I strongly believe that self-hate is a big part of the problem. To tackle this, or any other deep life-change issue, we should all work to accept ourselves, and then approach the problem like it’s, say, a house remodel – something to productively address, step-by-step with expert advice along the way. Something we want to do to improve our lives. And not an emotional stick to beat ourselves with.
Third, it helps to understand the components that contribute to the problem, even if you personally don’t have a clinical-level problem. The reason for this is that it helps you understand factors that can push ourselves to worse or better tendencies. Here, at NPR, is a nice interview about the topic. It’s worth a read – but one of the most useful things it points out is that there are usually at least three factors at play when someone struggles with this issue: a) a kind of magical attachment to things and their relationship to our sense of selves and our past, b) a lack of experience in feeling the discomfort of discarding things – which allows the person to realize that the discomfort is fleeting and bearable, and c) a problem with organization, probably because of being more of a visual thinker, and less of a categorical thinker. One of the reasons I like this interview and the article that follow below it, is the fact that each of these facets of the issue can be seen as tips for how to improve your own relationship to stuff.
Fourth, know some good resources for the issue. Check out this website for hoarding. And even if you don’t have a level of problem like the site addresses, it can be, again, a good source of knowledge, insight and tips. There are also numerous good sites and products for dealing with clutter.
Finally, here are tips I’d suggest for people who are somewhere along the spectrum of dealing with “stuff.” Even if it’s a big financial stretch, consider hiring a weekly or twice-weekly house-cleaner for a 3-6 month period. It’s cheaper than therapy, forces you to get things somewhat tidied before they arrive and, once the cleaner leaves, you may find yourself inspired to invite people over, or even motivated to do some deep clutter-purging. Also, consider joining forces with others. There are many support groups for clutter-busting. We’re wired to succeed when we work together. If nothing else, it greatly diminishes the toxic shame factor that overwhelms and undermines so many of us.
Does your house make you cringe? Is messiness the new criteria for excluding or shaming people? Do YOU have tips for helping deal with “stuff”? Or insight into why we find ourselves in this position? Sound off in the comments section. Doc Gurley is the only Harvard Medical School graduate, ever, to be awarded the coveted Shoney’s Ten Step Pin for documented excellence in waitressing, and is both a Board-and Bored-Certified internist. You can get more health posts at www.docgurley.com, or jump on the Twitter bandwagon and follow Doc Gurley. Also check out Doc Gurley’s joyhabit and iwellth twitter feeds – so you can get topic-specific fun, effective, affordable tips on how to nurture your joy and grow your personal wellth.
Randomly we hear in the news about a person who steps forward – often when others don’t – to take a heroic step of altruism. It was a shock to me to discover that my brother, this week, was that person. Dan, a teacher, was driving my young nephew after school when he saw a car engulfed in flames, with five or so people watching it burn. Dan saw what he thought was the silhouette of a person in the driver’s seat of the burning car, pulled over, ran to ask the bystanders if that truly was someone sitting in the flaming vehicle – and was told, “yes.” Three of the five people had already called 911.
A stock photo of a burning car – not the one my brother ran to, although his description makes it sound the same…
My brother ran to the car, and had to crouch down to gulp a clean breath of air, then, holding his breath, cover his hand and grab the blistering door handle and give it a yank. Dan pulled a very young man out of the driver’s seat by the guy’s armpits. The young man was ashen and covered in blood, and Dan didn’t know if he was still alive or not.
As my brother dragged him away from the flaming car, which had begun to make popping sounds, some teens that my brother had taught pulled over and ran to help. Dan told them to hurry, the car might blow, and to help him drag the young man to a place behind a dumpster in case it did.
When the fire trucks, and ambulances, and police arrived, it turned out the poor guy had been shot in the head. It’s still not clear how the car became engulfed in flames, and an arson squad is on the case. The young man was taken to the trauma hospital and stayed in critical condition. He stayed that way long enough for his family to say good-bye, and then to choose to donate his organs to save the lives of many more people. He passed away after only a couple of days.
You can see the link of Dan being interviewed and the family thanking my brother here.
Why are humans altruistic? How is it that we care enough to step forward into danger, or to donate, in the midst of grief, the ultimate gift of life from our loved one?
When I told my brother how proud I was of him, his reply was that he just couldn’t stand the idea of standing and watching a person burn to death. And he really couldn’t stand the idea of his very young son watching his father stand there, watching a person burn to death. And all he could keep thinking was how young the guy was – that he could be his own teen daughter, my teen daughter, that they were about the same size.
Sometimes it is, as my brother described it so well, a part of the way we see ourselves, a deep core of who we are and what we value.
Sometimes it is purely the incredible ability that we all have to put yourself into the skin of another person – to feel their crackling heat, and their heart-shuddering fear. Altruism, you could say, is a form of neurologic teleportation – you inhabit another person’s senses and feel the world from their driver’s seat. It is an amazing gift that’s freely available to us all. But we must exercise it, or it, like any other neurologic function, will atrophy over time.
So what about you? And me? How do we exercise our altruism urge?
Maybe some of you are thinking, well, sure, that kind of heroic crisis happens in the news every so often. Maybe, like me, you thought it was the kind of thing that only happens from time to time in New York subway stations. Never in small suburban by-roads.
My brother would now tell you otherwise.
Maybe you can, like the victim’s family, make a choice for life in the midst of death. But donating your loved one’s organs isn’t a situation we’d want to wish on anyone. You, however, can sign up yourself now!
Instead, how about taking small steps? Last week I tweeted about the joy of going to the GAIA fundraiser to help people living with HIV/AIDS in desperately poor Malawi. Once you dive in and discover this world – you keep looking around for the catch. For the price of a dinner out, you get a fabulous meal, celebrity sightings, and that wonderful thing that is (in the words of MasterCard) absolutely priceless. The warm glow of altruism. I even felt the heat of it across the country when I learned about my brother.
So NOW, before you think any further about it, go to the Episcopal Charities website and buy a ticket to the May 21st Night of Light. What a deal! A night of fabulous food, marvelous music (even dancing!) and, by God, you get to do all this INSIDE Grace Cathedral – a once in a lifetime opportunity. Only $100 total. Cheaper than a meal, a movie and a babysitter. Think of the way you’ll feel, the joy you’ll get from not only a lovely evening but a chance to feel good about yourself afterward. And a chance to end real poverty close to home.
I’ll be there – so come up and say hello. Maybe, as the music swells, together we can do a joyous dance to the glories of altruism. Or, if you’re feeling flush, you can pony up for one of the $1,000 tickets and we can sit and share stories over dinner. I hope to see you there.
Do you think altruism comes naturally? Sound off in the comments section. Want to learn more ways to flex your altruism muscle? Stay tuned for the next articles in this series. Doc Gurley is the only Harvard Medical School graduate, ever, to be awarded the coveted Shoney’s Ten Step Pin for documented excellence in waitressing, and is both a Board-and Bored-Certified internist. You can get more health posts at www.docgurley.com, or jump on the Twitter bandwagon and follow Doc Gurley. Also check out Doc Gurley’s joyhabit and iwellth twitter feeds – so you can get topic-specific fun, effective, affordable tips on how to nurture your joy and grow your personal wellth.
It’s hard to look at the mug-shot of the 60-year-old woman charged with tampering with forensic drug evidence (basically, stealing police-confiscated cocaine) without wondering how things got to this point. I mean, surely they weed out the felons, and the known addicts, and do a background check, and then make you pee in a cup before they even hire you for a job like this. Right?
So just exactly how can it happen that a person changes, in a few boring decades – and we’re speaking theoretically here – from being a tech with a decent job and whopping benefits, to a rattled addict snorting residue off the counters?
Well the answer may be found in a nasty little insider secret that’s not commonly known – not even among many people who work in the field. Just to be clear, we’re not talking about a theory, but something that’s been well-studied, verified, and documented.
Just not, ahem, publicized…
What is this nasty little secret?
For years, researchers have shown that people who work with any addictive substance on a regular basis – including nurse-anesthetists, anesthesiologists, people who train narcotics/military dogs, and forensic lab techs – these people are silently and unknowingly dosed, on a regular basis, with the measurable, highly addictive substances that float in the air at their work.
Cocaine
Does the whole idea of invisible floating addiction sound like a plume trail of paranoia to you? Let’s take some specific examples. One of the more chilling, early studies in this field was of your friendly anesthesiologists. Turns out that breathing a bit of the downstream exhale of sedated patients started, after a few years, to get to him (or her). Studies showed that not only were many anesthesiologists unknowingly dosed with measurable amounts from breathing the exhale of patients, but they also actually went into symptoms of withdrawal over the weekend. The anesthesiologists weren’t, for the most part, consciously aware of what was going on – they just reported that they really did not feel like themselves until a few hours after they were back at work Monday morning.
Kind of disturbing to think of your life being on the line after a weekend car-crash as your local anesthesiologist rushes into your emergency operation with a bad case of the shakes, isn’t it?
For more info on second-hand addiction among anesthesiologists, check out here, here and here. And it’s not just narcotics that are a problem. Small amounts of cocaine have been used clinically to reduce blood loss in many kinds of surgery. Measurable levels of cocaine by-product have been found in the urine of not only the patients, but also the doctors who performed ENT surgery.
When it comes to forensic workers, studies have shown that measurable amounts of metabolized cocaine by-products can be found in their urine just from normal work-day activities [here and here, among others]. Twenty-nine years of that, and I’m betting you might find yourself jonesing more than the average grandma. Even when this effect was discovered, you may notice, if you look at the studies, that when it comes to taking protective measures for workers, the talk is about “minimizing” exposure. NOT eliminating exposure. Among dog-trainers, urine by-products of measurable amounts of cocaine were proven to be found even after the usual protective steps (gloves, mask) were taken. Measures have been implemented to dramatically reduce occupational exposure to these microscopic amounts of addictive substances. But we all know that not every department is as well informed, or as conscientious, as they might be.
Clearly, when it comes to committing a crime, no one takes anyone else’s hand and makes her do it. When that cocaine was placed on a scale, no gun was put to anyone’s head. But perhaps, if a lab tech has been working in the field years and years before these studies were released, or if a department wasn’t up on the latest exposure/addiction research, or wasn’t conscientious about enforcing personal protective measures, well, maybe this travesty of justice isn’t completely as one-sided as it might seem.
Just saying…
Do you believe there is an occupational addiction? If so, should that, in your book, be a mitigating factor in this on-going forensic meltdown? Sound off in the comments section. Doc Gurley is the only Harvard Medical School graduate, ever, to be awarded the coveted Shoney’s Ten Step Pin for documented excellence in waitressing, and is both a Board- and Bored-Certified internist. You can get more health posts at www.docgurley.com, or jump on the Twitter bandwagon and follow Doc Gurley. Also check out Doc Gurley’s joyhabit and iwellth twitter feeds – so you can get topic-specific fun, effective, affordable tips on how to nurture your joy and grow your personal wellth.
Here’s an unfiltered, honest-to-God report from an amazing woman. Cheryl is an occupational therapist who was a part of my Haiti team when we went in February. She was so moved by what she saw that she came back, immediately organized her own team (this time of all volunteer occupational/physical therapists), and headed right back for another week this month. So for anyone wondering what’s up, how Haiti looks to an unbiased source, what has happened to all those people who got amputations, and if there’s been any change from the aid sent – here’s what the situation’s like, as of now, amid the devastation of Haiti.
“Hello Friends,
I finally have some time to write as I am getting ready to go to the airport. Our time here was very productive and I feel we served the patients well that we saw. We had 3 teams of 2 therapists that went into hospitals, clinics, and antennae. I went to satellite clinics called antennae that are set up throughout Port au Prince with the mission to serve ongoing rehab patients with primarily orthopedic problems. The patients we saw had the worst injuries any of us have seen. Most of them had nerve damage either from being pinned under buildings or from the severe swelling that ensues after severe compression. None of these patients had use of their hands so we did a lot of splinting to position and try to regain motion. The culture here is that if you have an injured part you do not use it at all, for the most part they have not moved their arms since the earthquake so we also did a lot of adaptive devices to allow them to start using their hand for activities like eating and writing. This part of the treatment was such a joy to see their faces when they could actually use their hand, they were shocked. We worked with a rehab organization called Handicap International, they have presence in 14 locations throughout PAP and found all the arm injuries and funneled them to us in 3 general locations. We were the first team to implement this type of focus and they were thrilled with the results. There were definitely glitches that needed to be worked through but by Tues we had systems in place and things ran smoothly. We have established connection with HI now and we are in the planning phases of setting up a surgical/therapy team to start treating the cases that will need reconstructive surgery (which is most of the patients we saw). Pam, a therapist on our team is taking the lead on this and has done these types of trips in the past.
The amazing Cheryl, bringing joy and love to our Haiti host, Natasha, on our February trip
We have seen God’s hand on our trip and our team. It rained only one day and no one on our team even had a minor illness. We were all able to stay hydrated although the temperature yesterday was 97 with high humidity.
The school we are staying at is beautifully run and we were blessed to be able to stay in a classroom rather than pitch our tents on the grass. It has been a real joy working with people from all over the world who have a heart to serve the people of Haiti.
What can I say about the people we served…….we saw some with a quiet resolve, some with high hopes, and some severely depressed. The nationals we served with were such a joy and we had the best translators I have experienced on a missions trip. The stories we hear from the Haitians vary when we ask them about their feelings about the government but they all agree that things are moving too slowly and they feel more needs to be done to start re-building the infrastructure. The situation here has definitely improved since February. I see more demolition started, there are construction workers hired by both the US govt and private NGOs that are removing rubble but this is pretty sparsely seen. People have started to set up little stores in their sheet villages and life is moving along but there are still so many people unable to work and therefore unable to provide the basics for their families. There are still many sheet villages that do not have tarps to protect them from the rain.”
Do you think aid is being directed efficiently in Haiti? Are you wondering what’s happening now, almost four months after? Share your thoughts and info in the comments section. Doc Gurley is the only Harvard Medical School graduate, ever, to be awarded the coveted Shoney’s Ten Step Pin for documented excellence in waitressing, and is both a Board- and Bored-Certified internist. You can get more health posts at www.docgurley.com, or jump on the Twitter bandwagon and follow Doc Gurley. Also check out Doc Gurley’s joyhabit and iwellth twitter feeds – so you can get topic-specific fun, effective, affordable tips on how to nurture your joy and grow your personal wellth.
Doc Gurley is a Board-certified Internist physician and the only Harvard Medical School graduate to have been awarded a Shoney’s Ten-Step Pin for documented excellence in waitressing. Find out more.
![Reblog this post [with Zemanta]](http://img.zemanta.com/reblog_e.png?x-id=c261bb34-3be5-43be-ac40-b72405172107)
![Reblog this post [with Zemanta]](http://img.zemanta.com/reblog_e.png?x-id=60770f12-c983-4b75-bf38-b22ec6cb4c6d)
![Reblog this post [with Zemanta]](http://img.zemanta.com/reblog_e.png?x-id=1f2f9c49-eaf5-4ede-aeab-72a1c9aced66)
Doc Gurley is a Board-certified Internist physician and the only Harvard Medical School graduate to have been awarded a Shoney’s Ten-Step Pin for documented excellence in waitressing. 
Recent Comments