“the lady with the f—ing lamp”

From Big Train

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progress

My first PT appointment was on Tuesday. I was evaluated, measured, and all that. I left and the therapist changed my exercises (from the last time I was in PT, about 28 months ago), so now I have three total that I’m doing.

My second PT appointment was today. It’s water therapy. Interesting, and somewhat surprising since I didn’t realize my ankles would still take a bit of a burden in the pool. I was sort of hoping the water would get us around that. But no. I kept having to stop and roll them.

I had a different therapist from the one I saw two days ago. She started by asking “So have you noticed any improvement since your evaluation?” I laughed out loud at her. I didn’t mean for it to be a bitter laugh, truly, but progress since Tuesday? That seems a bit ambitious.

fuel for the fire

Another Lyme headline. The part that spooks me is the third paragraph.

(excerpted from the Stamford Advocate)
Medical board approves probation, fine for controversial doctor
Associated Press
December 18 2007
HARTFORD, Conn. — A New Haven pediatrician who has been praised by patients but criticized by the medical establishment for the way he treats Lyme disease was reprimanded, fined $10,000 and placed on two years probation by state regulators Tuesday.

The Connecticut Medical Examining Board voted unanimously to impose the sanctions after concluding that Dr. Charles Ray Jones violated care standards by diagnosing Lyme disease in a boy and his sister and prescribing antibiotics based on a phone conversation with their mother, months before he examined them in May 2004.

The board also found that Jones broke standards by failing to reconsider his diagnoses of the children after lab tests came up negative for the tick-borne disease, which can cause painful arthritis, meningitis and other serious illnesses if not treated promptly.

Board members further concluded that Jones was wrong to prescribe antibiotics for nearly a year without repeat exams and without any arrangement with another doctor, because the children lived in Nevada, to monitor for any side effects of long-term antibiotic therapy.

Hartford lawyer Elliott Pollack, who is representing the 77-year-old Jones, said he will appeal the board’s decision.


Other things aside for a moment, I know it’s hard but try, consider that part of the board’s ruling was based on the finding that Dr. Jones “broke standards by failing to reconsider his diagnoses of the children after lab tests came up negative for the tick-borne disease”. I thought that a Lyme diagnosis was supposed to be more based on clinical presentation than lab values. What crazy Lyme-loving website did I get that from? The CDC, among others.

Lyme disease is diagnosed based on symptoms, objective physical findings (such as erythema migrans, facial palsy, or arthritis), and a history of possible exposure to infected ticks. Validated laboratory tests can be very helpful but are not generally recommended when a patient has erythema migrans.

On the CDC Lyme website, this passage continues with a helpful link to the current, detailed recommendations on serological testing for Lyme. If you do click there, what you get is a report called “Recommendations for Test Performance and Interpretation from the Second National Conference on Serologic Diagnosis of Lyme Disease”.

The Second National Conference on Serological Diagnosis of Lyme Disease was in October of 1994.

I’m going to let you all do the math. You’ll do it faster than me. I nearly had to count it out on my fingers…good thing it wasn’t much older or I’d have run out of fingers!

My point. There are two, or one somewhat bifurcated one depending on how you look at it. My point is that the CT board’s finding engenders and perpetuates too high a level of confidence in serological testing for the clinician dealing with the realities of Lyme presentation. The board’s level of confidence would be well founded if the testing had improved much in the over 13 years since the “current” test performance and interpretation recommendations were made. It has not. I wonder now as I so often do when I read the latest Lyme fueled controversy story (or maybe more appropriately, the latest controversy fueled Lyme story) – Can’t we do better than this?

New word

Pubalgia.
It nearly rolls of the tongue, doesn’t it? At least it does when you compare it to “osteitis pubis” or “pubic symphysitis”. Here’s hoping mine doesn’t get worse than the current moderate, intermittent “pubalgia”. Got a shot in the hip today for the outer and posterior aspects of this whole pelvis/hip pain issue and while it wasn’t painful, it sure was not comfortable. I don’t even want to think about a shot in the pubic symphysis.

On the plus side, my ortho surgeon referred me for water PT this time. My town has a public pool with a heated therapy pool which you can only use if you have a documented need for it. I’m hoping the PT note will take care of that so I can finally get some damned regular exercise. I’m not accustomed to being so laid up. I used to walk all over the place, did two miles of strolling without batting an eye, occasionally worked out (cardio mostly although some ab work as well), and went dancing now and then. These days, taking a flight or two of stairs is like a damned olympic event for me.

Sound self pitying? It’s not. Just an accounting of the limitations, facts of life now. Water exercises will help in that I can maybe get some muscle tone back without worsening the joint pain in my ankles, knees, and hip. I’m approaching this with a hopeful attitude. Let’s see how it pans out.

under pressure

Stressed? You will be next Monday!
PRNewswire, via Scientific Blogging
LONDON, December 6

According to the results of a recent survey, if the festive pressures haven’t got to you already, they will do next Monday – it’s officially the most stressful day of the year.

An independent survey, commissioned by healthcare provider, HealthSure, has revealed that the British public will be at its most stressed on Monday 10 December between the hours of 8am and 10am.

You can read the whole article at the link through the title above. I wonder if anyone’s done similar research for the U.S.

Haiku

For reasons irrelevant to the nature of this blog, the topic of Haiku came up recently. A search online for more info on it has revealed two fun things.

One is this site, which is nice and has information on teaching and writing haiku.

The other was mention of random haiku generators such as this one. In playing with the haiku generator I discovered the option to change the vocabulary list it draws on. “Golf” vocabulary was an option. To my disappointment, medicine and health were not categories, nor does it seem they are in other generators I found. I think I might have a christmas project.

Until then, here’s a hand made health haiku, a coda for the extra long ragweed season which has managed to overlap with the post-thanksgiving-travel cold going around at work.

Allergy or cold
Kleenex hide     cough drops
No. Empty foil packs