Category Archives: Medicine

A Hidden Epidemic

In my first job out of residency, I worked with another new physician.  Let’s call him Bill.  Bill was a warm, caring and generous, but highly anxious, person. He worried about everything: every patient he took on, every decision he made, every lab that was even remotely out of range.   My partners and I also suspected there were things going on in his personal life that were troubling him but we wanted to remain professional.  We didn’t want to pry or to make him feel uncomfortable.  We figured he was just like many of us… trying to sort out his new role as physician, finding a way to make it fit into his life.  Then one day Bill didn’t show up for work.  We contacted his family, who lived out of state, and they hadn’t heard from him.  Later that day, Bill’s body was discovered in the river.

In our last all provider meeting, we discussed the new regulations requiring health care providers to have a certain number of hours of training regarding suicide.  As the requirements and options for training were being laid out, I couldn’t help but think of Bill and of our medical profession as a whole.  The figures are frightening.  The equivalent of nearly 2-3 medical school classes of physicians die by suicide each year.  Male physicians are about 1.5 times and female physicians about 2.5 times more likely to die by suicide than the average person.  Not only do we need to undergo training for suicide risk detection and prevention for our patients, but, it seems, we desperately need it for ourselves as well.

The role we have chosen for ourselves is difficult.  It has many rewards, of course, but it also can take its toll on self and family.  As a group, we tend to be harder on ourselves than we are on others.  We hold ourselves to sometimes unrealistic and unhealthy standards.  We are excellent at delayed gratification and dedication to others before self.  We want to please and have a hard time saying no.  We put our lives and families and finances on hold to complete our training and to build a practice, only to be met with what sometimes feels like a lack of appreciation for our efforts.  And the ultimate goal of our calling, the development of a close and caring relationship between doctor and patient, is eroded by the seemingly endless administrative duties which are taking over our day-to-day lives.  And if we do ultimately feel like medicine is not the right place for us, we often feel stuck  – without other skills, saddled with huge debt, and lacking time to pursue other options.

We need to begin to care for ourselves as we care for our patients.  We would never suggest that our patients work 60-80 hour weeks, skip meals, get too little sleep, defer family time for more hours at work, take only a few weeks of maternity or paternity leave, etc.  This is not a humane way of living and it is unsustainable.  We need to support each other as coworkers and in an organizational capacity in pursuing quality of life in the workplace and at home.  Our emotions – all of our emotions – are not weaknesses.  They are part of what makes us human.  We need to acknowledge this as a profession and work to get rid of the stigma that surrounds mental health issues in healthcare providers.  And, finally, we need to be there for each other if one of us is struggling.

Some of us worry that reaching out for help would be an admission of weakness or would signal to others an inability to practice in the best interest and safety of our patients.  So we don’t reach out.  Many of us have long office hours and spend more hours after work completing charting and don’t see a time to be able to attend counseling sessions.  So we don’t reach out.  But we have to find a way to break down these barriers to care.  Below are some of the resources available to us that are confidential and will work around our hectic schedules, we just have to be willing to get started.

None of us can travel this road alone.  If you are struggling, please reach out and let someone help you.  After all, wouldn’t you do the same for another in need?

·        The Spokane County Medical Society (SCMS) Foundation offers a Wellness Program which is staffed by psychiatrists who specialize in treating medical professionals.  There is complete privacy and confidentiality (providers are referenced by number only and providers can either choose to go to the psychiatrist’s office or there is a separate room with a separate entrance at the SCMS offices that facilitates anonymity).  For SCMS members, the  1st 8 sessions are free.  Sessions are contracted at lower rates for non-members.  Mental health providers are available 24/7 by pager and can be reached at 509-720-6000 (if not immediately available, a message can be left which the recording states will be returned within 10 minutes).  You can find out more about the SCMS Foundation programs at www.spcms.org.

 

An Open Letter to Mr. Trump and Mr. Kennedy

Dear Mr. Trump and Mr. Kennedy,

Are you serious? I mean, are you really serious – a committee to investigate the effectiveness of vaccines? What do you think science has been doing for the last 220 years? We are going to spend millions of dollars and precious hours that could be better spent, I don’t know, say… working on securing peace in the Middle East or developing a realistic and actionable alternative to the Affordable Care Act (which, by the way, I happen to like and don’t feel needs replacement but, perhaps, improvement). This is ridiculous!

We (I really want to say “you” but I’m trying to be inclusive here) must have an unbelievably short collective memory. Do you not remember smallpox? Do you not remember polio? Do you not remember the Influenza pandemic of 1918, which affected 1/5th of the world’s population and killed more people than died in all of WWI? 50 million people died! That’s million, with an “M”! Why do we not see these horrible plagues anymore? Because of vaccines, that’s why! But, somehow, even though many people – healthy people – still die of the flu every year, this doesn’t feel like a current concern. Maybe it’s not sexy enough of an issue. I would stake my career on the fact that, if there were an Ebola outbreak and people were bleeding out of their eyeballs and dying left and right, every single person out there would stand in line to get a vaccine if one was available. Maybe the flu and other vaccine-preventable diseases just aren’t scary enough.

How pretentious and elitist of us. This move, to question the utility and benefit of vaccinations, is a luxury of the wealthy. You do not see the people of third world countries or those in our own country who are just scraping by, living paycheck to paycheck, questioning the benefit of vaccines. To them, this is a life and death situation. Whether to vaccinate is a make or break decision. For those out there who don’t have access to adequate health care or can’t afford the medication or the doctor bills to treat an illness, having a family member get sick can be catastrophic. They can’t afford to take time off of work to nurse their child or themselves back to health. So, what happens? Kids get sent to school during illness. Adults continue to go to work during illness. And illness spreads.

It feels like I spend half my day trying to convince people to get vaccinated. As a family doctor, who cares for a largely middle to upper middle class patient population, I get a lot of questioning patients. In 2015, after growing frustrations with how much effort was expended addressing this issue, and not feeling fully prepared to answer all the concerns that my patients had, I took the time to do my homework. I took every doubt, every reason that I have heard not to vaccinate, and addressed each one in turn. I wrote an article about it called An Ounce of Prevention and you can read it if you are so inclined, or you can do your own research. You will find, as I did, what we as people of Science and Medicine already knew. Vaccines are safe and vaccines save lives!

What I know to be true in my heart of hearts and what I see to be true in my everyday practice, is that population health and individual health are inseparable. If you choose not to get vaccinated, so be it. You are an adult. But know that your choice puts others at risk. We vaccinate not only to protect ourselves but also to protect the more vulnerable in our community. Or maybe you don’t care about those more vulnerable and at risk individuals.

Make your own personal decisions, but don’t deny the right to this lifesaving health intervention to others and don’t waste our time and dollars setting back the clock to the 1700s.

Sincerely,

Gretchen LaSalle, MD

On the Wrong Side of History

I had expected tears today. I had hoped for tears of joy… tears of love and gratitude for a woman who has given her life’s work to making the world a better place for others. A place where, no matter what color or religion or sexual preference or disability or socioeconomic background you come from, you are given the same rights and privileges and opportunities and responsibilities as everyone else. I had wanted to cry tears of joy for all of the little girls out there who would know that they could grow up to be anything they wanted to be, if they were just willing to work hard enough. I am so grateful to Hillary Clinton for giving us such a wonderful example of what intelligence, hard work, dedication, openness and acceptance, caring, and a life in service to others can mean to so many.

What I cry today, though, are tears of sadness, of shame, of anger, and of frustration. How can this country, people that I love and believe to be intelligent, big-hearted individuals, vote for a man who represents such vitriol and hatred? He has publicly ridiculed people with disabilities, espoused hateful and xenophobic rhetoric, shown blatant disrespect for women, those in our military, and those that are different. How can those people that I love, who have children of their own, whom I presume want to teach values of tolerance, love, and respect of others, how could they vote for this man? What do you tell your children about why you would put such a person in the Whitehouse? I so dearly hope that this man’s talk was just that, talk. That he used the media and talking points to his advantage to gain access to this highest of offices but that his true intentions and actions will not be as divisive and hateful as he presents in his public face to the world.

This election has wreaked havoc on all of us. We have been so polarized. For years I have not wanted to participate in political discussions. I want to love people because of what’s in their hearts and how they treat others, not because of their political leanings. I respect others rights to feel the way they feel and to vote their conscience. But, today, I admit myself disappointed in so many, whose vote for Donald Trump was like a slap in the face. My parents (a heterosexual couple and a lesbian couple) taught me to love everyone, to fight for those who can’t fight for themselves, to care for all people and to devote my life to service.   They taught me that I was smart and good and could do anything I set my mind to and I have taken that message to heart, spending my life as a physician, caring for others. I grew up knowing, deep down in my soul, that love and caring for others is THE most important thing. Love is love no matter what color or gender or religion. We are born knowing only love. We are taught hatred. I fear, America, that we have voted on the wrong side of history today – that we have voted for hate.

Today, I am grieving. I am grieving for my relationships, some of which have suffered because of this election. I am grieving for our children who have to see this superficial, bigoted, misogynistic man as our country’s leader. I am grieving for the immigrant families of this country who are working so hard to make a life for themselves and who will live in fear from this day on. I am grieving for my patients who only recently have been able to get health care, either because of inability to afford it or because of pre-existing conditions. I am grieving for those of color and for those in the LGBT and transgender community, who have fought so hard for equality and acceptance.

My only consolation is that, now that the office of President and the House and Senate are Republican controlled, there will be no one else to blame if change for good doesn’t happen in this country. No more obstructionist tactics. Now they must get to work, proving that their ideas will move us in a better direction. I sincerely hope that they, that we, can be successful together.

Today I will grieve. I will allow myself that. But tomorrow, I will continue to teach my children a message of love for diversity and respect for all. I will go on in service to others and fighting to get my patients the care that they deserve. I will try, every day, to make the world a better place for myself, for my children, and for you and your children. Today I grieve, but tomorrow begins the work of repair and healing and there is a lot of work to be done.

 

Ugh. Vertigo.

I am unfortunately inspired by recent events to write about Benign Positional Vertigo.  May you never suffer it but, if you do, here are some very important things to know.  First, you are not dying.  For the rest, read on.

 

Ugh. Vertigo. Or more accurately, Benign Positional Vertigo – BPV. I would not wish it on my worst enemy. Well, come to think of it, maybe I would. Can you imagine an entire army suddenly overcome with the inability to walk a straight line, falling over left and right, and vomiting if they do anything but stay completely still? Maybe that would be a good tactic to use against your enemy. There you go, US government, a nonlethal defense tactic, offered up by yours truly. Now, all you have to do is figure out a way to induce vertigo.   This may prove difficult, though, as we still don’t know what causes it. There are lots of theories… head trauma, change of altitude, fluid in the inner ear, etc. Get to work and good luck!

I remember my first bout of vertigo very vividly. I rolled over in bed and looked at my clock and it was moving left and right. I tried to sit up and the whole room was spinning. It was as if I had been drinking heavily the night before, with all the repercussions but none of the fun. I tried to walk to the bathroom and fell over. I crawled on my hands and knees to the bathroom where I promptly threw up. But there was no relief after vomiting, like when you have a stomach bug and you feel better after having thrown up. Nope. The room was still spinning and I still felt like death warmed over. The strange thing about vertigo is that, other than all the spinning and the vomiting, you feel totally fine. You are suddenly completely unable to function even though the rest of your body is working well.

You can see why people end up in the emergency room with this condition. It is totally frightening. As a family doctor, I recognized this for what it was. I remembered my teaching on vertigo and was able to match my classic symptoms to that diagnosis. Your average non-medical person, though, has got to think they are dying. And when you go to the ER, especially as an elderly person, with the inability to walk and vision change and vomiting… what are you going to get? You are going to get the million dollar work up, that’s what you are going to get. After all, it could be a stroke or a hemorrhage or a brain tumor.

Luckily, there is a simple test that the doctor can do to tell if this is BPV. Though you, as someone suffering from vertigo, are not going to find it very pleasant. Basically, we lay the person back, turning their head to one side and then the other (This is called the Dix-Hallpike maneuver). In someone suffering from an acute attack of vertigo, this is going to induce the symptoms of spinning and nausea. Not so much fun. But the doctor, in being able to reproduce the symptoms with this maneuver, and in watching your eyes start to move in an atypical rotatory pattern, can diagnose BPV without a huge workup.

Thankfully, there are some pretty easy steps to take to get this to stop. The theory is that there are little cells in the inner ear (you’ll also see them referred to as “rocks” or “crystals”) that are supposed to be aligned a certain way. In BPV, these cells somehow get out of alignment. The treatment, apart from giving you a nausea medicine so you don’t continue to throw up, is to get the cells back into alignment. We do this with a type of physical therapy for your inner ear, called Vestibular Rehab. If you are someone who gets very nauseated with vertigo, you will have to get your anti-nausea medication (we commonly use Meclizine, sold over the counter as LESS DROWSY Dramamine or Bonine) on board first or else you won’t be able to do the therapy exercises. The first time this happens, we usually refer someone to a Vestibular Rehab therapist to demonstrate the maneuvers (called Epley’s Maneuvers) that can then be done at home. It is important to pay attention to what side tends to trigger the symptoms (meaning, when you turn your head to the left or to the right, which side brings your symptoms on the strongest?) as the rehab exercises are geared towards a particular side, left or right. Once you can control the nausea, and put yourself through rounds of these exercises, you will be able to stop the vertigo episode in its tracks. Afterwards, you may be left feeling a little bit off balance. We recommend that you don’t lie flat or let yourself turn to your affected side during sleep for a week after one of these episodes, so as not to allow recurrence.

As a sufferer of vertigo, I can tell you that these exercises work and you don’t have to wait for a full-blown episode to do them. Vertigo can recur so, if you start to get a sense that trouble is brewing, you can put yourself through your exercises before you even get a severe case of spinning and nausea.   My advice – keep the exercises and some meclizine in your nightstand (I even carry meclizine in my purse so it is with me at all times). You never know when one of these episodes is going to hit. Don’t suffer needlessly. These episodes, left untreated, can last many days – many days in which you are completely incapacitated. Learn the exercises and do them. Trust me. You will thank me later!

Disclaimer:

Don’t diagnose yourself! The first time this happens, a medical professional should see you for proper diagnosis. BPV presents fairly classically, but there are much more serious conditions that can present similarly so get checked out!

The Super Talents of Doctor Mom!!!

Able to nurse one cup of coffee for an entire day.

Able to sleep in uncomfortable positions at any time or place.

Able to work terms like “aortic aneurysm” and “poop” into the same sentence.

Able to help the kids with their “new math” while simultaneously calculating days to next refill for Oxycodone.

Able to cheer on her little soccer player (“Great job, buddy!”) and keep her other kids from losing life and limb (“Get down from there this instant!”) while taking weekend call (“No, not you Mrs. Jones.  Yes, you may be having a heart attack.  Please call 911 and go to the ER immediately.”)

Able to defer all bodily functions until patients and children are taken care of and then…

Able to find peace and solitude behind any locked bathroom door.