Happy Birthday Randy!

This weekend I had the distinct pleasure of celebrating my sister's 50th birthday.  When Randy was born, just 9 1/2 months after I arrived, my parents were told many sad things about Down's Syndrome children.  To their credit, my parents decided to raise her (not place her in an institution) and to fully integrate her into our family.  Though they were told she was "uneducatable and only partially trainable" she now reads on a 4th grade level, can do simple math, cooks a spectrum of foods, and can challenge most people on tv trivia!  When I was young, I had to cope with the notion that her probable life expectancy was only 20 years (at that point, most Down's Syndrome children were institutionalized and died of institutional diseases, not their Down's).  During college, she would come to visit me at Brown and while I went to classes, she would befriend everyone in the dorm, even some I barely knew.  Her charm and congeniality was infectious.

For nearly 25 years, Randy has lived semi-independently in a group home and worked steadily.

There is no doubt, having Randy as part of my family has influenced much of who I am.  My career in medicine is probably related as well.  If so, that's one more reason I have to thank her, as it has been a wonderful and rewarding career.
What lies in Randy's future is unknown.  Statistically, she has a high chance of early Alzheimer's but otherwise, her longevity and well being is probably very similar to others her age.  I look forward to celebrating many more landmark birthday's with my very special, "baby" sister!

Great News-Insurance Premiums on the Rise

Great news-California just approved double digit rate hike for insurers  there.

I thought we were in a recession...I thought the cost of doing business might be level...I know most California residents are not seeing double digit increases in their salaries.  The rate increases were granted to a spectrum of  insurance carriers including the Blues.  The current health reform legislation caps administrative costs starting in 2012-seems they are grabbing every dollar they can before things get tight.  What is the likelihood any of this will be passed on to direct health care providers?

Selfishness: Why I Blog

To be honest, I started this blog at the suggestion of a friend as a way to raise interest in (and sales of) a book I had edited (Heart of a Lion, Hands of a Woman: What Women Neurosurgeons Do).  As best I can tell, the site has been pitiful in this regard.  So why did I continue? Part of the answer is that I can't stand GIVING UP (not a neurosurgeon's nature) so I wanted to figure out how to "succeed."  So I did a little studying (of other blogs), I asked questions and I set my own goals.  Perhaps I also saw the blog like the journal I kept for many years-though a blog is obviously more public.  Another motivation may have been that I have been told many times that we, as physicians, have so many poignant stories to share about our patients (all which we swear we will remember until retirement when we have the time to properly record them).
I have come to realize that blogging forces me to filter everything I do through a different, noncomplacent lens.  Now as I pass my day as a physician, citizen, parent, child, wife I find infinite connections to write about.  It forces me to SEE my patients-their lives, their struggles, their grief through an entirely new filter-and I really think it has made me a better physician and person.

Looking at my statistics (yes, I just figured out how to do this) I am humbled and amazed in some months this blog has more than 500 views! The map view shows visitors from four continents and always the surprise at what brings the most viewers to this space.  
Many of life's journeys start on one road and detour to another.  I searched for a way to bring the outstanding and deserving voices of women neurosurgeons  to a wider audience and found a new vehicle for inner discovery.  Thanks for all those who join me (past and future) on this wild ride.

Fool me Once

Fooled me
Last summer, all summer
Out late
Many lies
Wasted work
The graduate! Ha!

Fooled me
Freshman blues
More lies
Wasted time
Opportunity lost

Fooled me
Said you blundered
Wanted help
Change would come
Had ideas

Fooled me
Summer home
Big plans
Getting it right
Taking control

Fooled me
Deceit everywhere
Where to turn?
What to do?
Is it too late?

Fooled me
Once, twice
Again, again
Fooled me
Me Fool


George Bush: Fool Me Gaff (must watch!)

Is this right?

Had a patient today who I have been working up for back and neck pain.  She has been on high doses of narcotics for many years (something called Opana-always a red flag to a neurosurgeon).  This woman is rail thin, has no neurological deficits and essentially normal MRI scans.  Her heavy doses have been routinely prescribed by her PMD while she has never done a day of PT or real pain management-she also has not worked in more than 4 years...am I missing something here?
Another patient same day-obese, injured lifting at work, maintained with just narcotics and "rest" for 15 months-exam normal, MRIs normal-only seeing a chiropractor who she swears does wonders...but not miracle enough to return to gainful employment and stop drawing workman's compensation.

Sojourner Truth suffered from serious back pain

The estimated annual cost of workplace low back injury in the US is between $50-100 BILLION!!! These account for 1/4 of all claims.  Studies show if out of work just 6 months, there is a 50% chance of return to full time work.  After 1 years that number drops to 25% and after 2 years nearly 0%. (Bureau of Labor Statistics)
I don't mean to pick on these two women, rather to use them to illustrate how our system is broken-

• Too many physicians find it easier to just give narcotics than deal with the challenge of a more comprehensive approach
• With increasing time constraints, it is simpler to complete paperwork (even if annoying) than to confront the patient
• Maintaining the status quo is less trouble than challenging the patient to lose weight, start exercising, and retrain.

I would never want to penalize an employee truly injured at 

work but within the realm of low back injury, the "state of the state" needs significant improvement.

How far have our treatments come?

End of Life: Should we Mandate?

Recently I floated the idea that one requirement of Medicare enrollment should the completion of some type of "End of Life" document-at a minimum a Living Will and a Health Care proxy (with a regular renewal/update also required).  Everyone knows that too many health care dollars are spent in the last hours, days and months of life because (just a few of many reasons):

• No discussions have ever been had with the one who becomes critically ill (too depression, too sensitive, too...)
• Family members dislike the burden of decision making (are we killing Mom/Dad?)
• Physicians are ill-trained to confront the challenging issues
• The unexpected too often happens

The idea was largely either ignored or dismissed because:

• Promoting this will seem "cold", uncaring
• We can't impose this sort of thing, it is too individualized
• How could we enforce??

Recently, a California Study clearly demonstrated that using end of life documents that are carefully constructed does indeed save tons of money AND improve patient and family comfort with the end of life process. Has the time finally come for such a mandate?  I think the answer is YES.

Further reading:
Daily Finance: Costs Too High
Kaiser Health News
Cost of Death Video

Green Hospitals: Too Much Trash

Finally some early signs that making hospitals more environmentally friendly is no longer "fringe business."  Recently, the NY Times highlighted the challenges facing American hospitals in reducing the enormous amount of waste.  As any surgeon knows well, the operating room is fraught with disposable items where re-usables were standard a decade ago.  In addition, many items that have not been used at all just get tossed!  As the article points out, much of this has been done in the name of patient safety-with the unmerited fear of reprocessing.  In addition to the shear volume of trash, medical waste is three times as expensive as regular refuse to process.  In an era when we recycle so much (think plastic containers into decking), healthcare lags way behind.
There are some people who are looking to turn this trend around.  For physicians, nurses, architects, health care workers or interested patients can join the Green Hospital Movement and access many educational materials and learn how you an make a difference in your own community.  Another good resource for healthcare professionals is Teleosis.
Isn't it time we all got onboard?