Big apple fat

Usually when you mention the word "trans" in New York City, you mean something completely different. But, right now, NYC's hottest "trans" is trans fat. Why? Because earlier this week, the New York City Health Department proposed a near ban on trans fat in NYC restaurants. As you already know, trans fat is found in fast food, cookies, cakes, and basically anything I think is good to eat.

"Trans fat causes heart disease. Like lead in paint, artificial trans fat in food is invisible and dangerous, and it can be replaced," New York City Health Commissioner Thomas Frieden said in a statement. (quote from Scientific American)

In the following quote from SFGate.com, by proceeding with a ban of one substance seen to have health concerns, this sets the precedent and opens the door to a laundry list of possibilites of future food bans.

There's also the issue of what should be banned. What about high fructose corn syrup? Sodium? Cases have been made that they're just as harmful as trans fats. Should we put a cap on the number of calories that people are allowed to order in a restaurant?

I always love when the government tries to legislate behavior. By making trans fat, in a sense, illegal, doesn't it then make it more attractive? This may seem silly, but I see drug dealers turning into trans fat dealers. They would hang out outside of NYC's swankiest (is that a word?) restaurants with one side of the raincoat with cheap Rolexes and the other side with illegal donuts to bring into restaurants. Sales of crack, heroin, and meth will fall off dramatically in favor of french fries.

The other thing I can't wait to see is "New York's Finest" food police. Can't you see the TV show right now? "Tonight at 8pm - Dr. A stars as Detective Emeril (BAM!) - In Cold Food Files." Bon Appetit, NYC. Pass the donuts!

Resources

This story from the Hamilton Spectator kind of hits home for me. It talks about a small hospital and what hospital administration does to try to improve the hospital and the community.

Why wouldn't Hamilton Health Sciences (HHS) put more money into emergency rooms to attract and keep doctors? Why wouldn't HHS top up emergency physicians' salaries to ensure stability and appropriate levels of service? It makes good sense.

Especially for small hospitals and small communities like this one and like mine, there are limited resources and priorities have to be made on where and how resources are managed. I'm all for getting the best docs and building the best facilities, but there are consequences to that.

The problem with emergency staffing seems to be double-edged -- crummy working conditions and pay that's not great. HHS has chosen to address those issues to ensure adequate emergency services.

Don't get me wrong. I'm not trying to lead you down a path here - especially with my posting yesterday of paying docs more. Like I said above, my small community and my small hospital are going through this right now.

On the one hand, having the best and most modern facilities can attract docs and other medical professionals to our small town and hospital. Who doesn't want to work with the latest and most technological toys?

On the other hand, something has to give. Sometimes that means pay freezes and/or pay cuts to the rest of the staff whether it be nursing, respiratory, secretaries, custodians, etc. Or, short staff situations. This can have effects on patient care and hospital morale, and other areas. I don't have the perfect solution. I'm curious what you think.

Question: If you were CEO of a small hospital with very limited resources, how would you help insure the best medical care for your community?

Family Docs Rock!

I'm Dr. A, and I approved this message... (Story from WBAL-TV in Baltimore)

WASHINGTON, D.C. -- A rally was held in Washington D.C. Wednesday to bring attention to a shortage of family physicians.

The American Academy of Family Physicians said they want Congress to increase medical payments to family doctors.

They also said they want voters to question candidates about health care.

A workforce report by the group showed the number of family physicians has dropped by 50 percent as younger doctors opt for specialties that offer better pay.

Grand Rounds

GR 3:1 is hosted this week by Enoch Choi, MD from Tech Medicine. I wasn't aware that GR has been going now for 2 years. Congrats to Nick Genes. Anyway, Dr. Choi is kind of having a "Medical BA meeting" over there with appetizers and everything else. I'm under the "Who's Hot and Bothered" section.

Dr. Anonymous considers the FDA a bureaucracy without merit and next week's Grand Rounds host thinks clinical trials are sometimes without merit as well.

Got back home late from DC last night. Can't believe I'm back at work today. Oh well. Checked the site meter and it was over 400 yesterday, thanks to all of you! That's the highest it's ever been, at least for me. I haven't had a chance to review all the comments and my e-mail yet. Hopefully, I'll be able to do that in the next couple of days. However, I'm on call tomorrow. Sheesh! Thanks for coming to the DC BA meeting yesterday.

BA in DC

I'm Dr. A, and I'm a blogaholic. Welcome to the latest edition of the Blogaholic Anonymous meeting. What is Blogaholics Anonymous all about? Well, this is only for those who are hopelessly addicted to blogging. If you're not, then stop reading this right now! LOL

As you already know, this edition is from Washington, DC. I did not get to see everything here, but I will take you on my short walking tour - all I could do in a few hours. Below are some reflections as I walked around the city.

White House: I wanted to come here first. Regardless of your politics, if you've never seen this place up close, you must make a point to someday. The first observation I made was all the people. Just to be funny, if I was President (yeah right, like that would happen), one day, I would run out on the balcony, and yell, "Hey! All you people, get off of my lawn!" Maybe that wouldn't go over very well. I tried to take a tour inside, but they absolutely did not want any cameras in there. And, traveling by myself, I guess I couldn't go in.

Of course, there were the obligatory protestors. Don't get me wrong, not belligerent, just wanting to make a statement. It was nice to see some cub scouts doing some cleaning in the park across from the White House - wonder what those scouts were thinking. As I went from the north lawn to the south lawn, I saw more people. Even people playing football and soccer, "Yeah, let's meet up Saturday afternoon on the south lawn for our game." Very cool.

Washington Monument: This was my first sight as I was driving into the city Friday night. It is as majestic in the daytime as it is at night. You really don't know how tall this structure is until you're at its base. I did not get to go to the top of the monument because all of the viewing tickets were already given out for the day. This a good point to see a lot of the other monuments. Looking north, you see the White House. Looking south, you see the Jefferson Memorial. Looking east, you see the top of the capitol building. And, looking west, you see the Lincoln Memorial and the World War II Memorial. I guess I should have figured it out, but all the monuments are national parks. And, what do people do in the park, they play sports. An interesting sight seeing people play sports with the backdrop of the monuments.

World War II Memorial: I've seen this on television, but have never been there before. It's definitely a beautiful place with all the fountains and all the people talking about their experiences during the war. I saw many families there and many veterans talking to their grandchildren about their life experiences. What a perfect location between the Washington Monument and the Lincoln Memorial.

Lincoln Memorial: The reflecting pool lies between the WWII Memorial and the Lincoln Memorial. I even saw some airplanes in the sky above, as they go to Reagan National Airport. As I was walking to the monument, I imagined all the history that has taken place here throughout the years. Then, suddenly, I had my Martin Luther King moment. I saw him on the steps of the memorial and I imagined all the people surrounding the reflective pool. I had to pause - quite moving.

One of the things I didn't realize was all the steps to climb to get to the top of the monument. I realize I'm really out of shape, but I felt it was quite an achievement for me to get to the top of the steps. The first thing I did was look back east to see the Washington Monument, its image in the reflecting pool, and the capitol building in the background. Felt very patriotic at that moment, and a smile came across my face.

Vietnam Veterans Memorial: In contrast to the WWII memorial, where there was a lot of energy and noise, this place was very solemn and quiet. People have told me this before, but it doesn't really hit you until you're there. There's no glitz; there's no glamour; just names on a wall. Kind of felt like hollowed ground starting at one end of the memorial and descending to its midpoint and then walking up and out of the memorial again. People left flowers. People used pencil and paper to trace the names of their loved ones from the wall. Powerful sight to see.

Capitol Building: I just had to take a break after that. I got some water and made my way back past the Washington Monument and walked to the Capitol. This was a long way (for me), so I found a bench near the metro/subway station. As I sat there for a few minutes, it was interesting to see the people come up from the subway station, especially the children, as they saw the monuments for the first time. I also noticed many international people in the city. I heard a lot of languages spoken, and you could tell that they were happy and proud to be here - the home of democracy. Americans definitely take democracy for granted, and that was emphasized to me in observing these people from other countries.

Final Stops: Continuing walking east, I saw the Library of Congress and the Supreme Court. I didn't realize the size of the court door until I walked up all the steps and saw it for myself. There were some students gathered in front of the Supreme Court building talking about how to effect change and the impact of court decisions. Who says American students don't know anything about how their government works? I finally got some food at Union Station, which is a fully working train station for those who do not know. As I was having lunch, I saw travelers rushing into and out of the building, much like an airport. I was so tired, that I took the subway back to the hotel.

For the visual part of my essay, I encourage you to check out my Flickr file and leave some comments as well. I hope you enjoyed a quick walking tour of Washington. I'm on my way back home later today. Thanks for checking in!

Oxymoron

Before I leave the hotel for my DC day, here's a quick news story. The US Food and Drug Administration could do a better job at reviewing drugs. No, that's not news.

Here's the news story: The Institute of Medicine, the people who stated that between 50-98 thousand people die each year from hospital errors, released a report Friday criticizing the FDA about how it reviews drugs, according to this report. Don't get me wrong, the FDA itself ask for the review.

Newly approved drugs in the U.S. should carry a warning that their safety isn't guaranteed, the medications should be reviewed in five years, and they shouldn't be advertised for two years, according to a report released Friday.

The report, released by the U.S. Institute of Medicine, said the Food and Drug Administration hasn't done enough to oversee new drug safety. The institute said the medications should carry a symbol, such as a black triangle, indicating they might not be safe. It also suggests agency rules be enforceable with fines.

Ok, let me get this straight. They want to put a warning that the safety isn't guaranteed? Why not put the same statement here that's on all herbal medicines: "This medication is not intended to diagnose, treat, cure, or prevent any disease." In fact, I believe that this puts more regulations than on herbal medicines.

"This report should be a watershed moment for FDA reform," said [Iowa Senator Charles] Grassley. "Public safety is at stake, along with the credibility of our nation's drug-safety agency."

FDA reform? Gimme a break. This is government bureaucracy. No one in this town that I'm sitting in right now has the courage and the political clout to do anything about it. The FDA is a good punching bag and the status quo will remain after all the hype. It's kind of like saying United Nations reform. Yeah right...

On the road

So, I've been in DC for about three hours already. I thought about walking around a little bit, but I was a little tired when I got here. For those of you with Google Earth, you can find my exact location. I'm at 775 12th street NW. Do you see me waving?

Some people detest driving longer distances. I thrive on it. I had my iPod going and I may have driven a little above the speed limit a few times *smile*. Plus, people may think I'm nuts, but I enjoy big city driving - except for all the one way streets. For those who are not familiar with Washington, DC, there is a huge highway that goes around the city called the beltway.

I'm from a small town, and traffic to me is driving around my town at lunch time where the one main street has cars all over. But, some people would say that the DC beltway is nuts. Cars and trucks everywhere - weaving in and out and across three lanes of traffic. For me, really a good time! Don't worry, I got here safe.

The first thing I had to do was blog about it. I do admit that I felt like quite the loser sitting in the bar virtually by myself having my chicken sandwich and beer. No sympathy, please. This is only night one. There are a lot of good times to come (I hope).

Tomorrow, I'm going to try to visit with some friends that I have here. If that doesn't happen, then I'll walk around the city a bit. I haven't been here since I was a little kid. Right now, instead of getting needed sleep, I'm going to check my e-mail now and read through some of my comments, which I have neglected for the past few days - I'm Dr. A and I'm a blogaholic. Thanks for everybody checking in. I appreciate it!

Grand Rounds

Grand Rounds 2.52 is up and running at Tundra Medicine Dreams. Actually, it was up and running yesterday, and I'm a little slow in posting this. The Tundra PA is from Alaska and has done a great job of organizing all those links and adding some fabulous pics from tundra land.

In case you don't know, Grand Rounds is the showcase of the medical blogosphere and it's posted every Tuesday. It's so good, I'm not allowed to post anything there. HA! Just kidding. If you've never experienced GR before, I encourage you to check it out.

As usual, on call was busy last night. If I'm up to it, maybe I'll bring a story to my blog later. Feel like I'm running on empty a little bit. Should be an interesting day. Is it the weekend yet?

Transplant

You're definitely going to think that I'm making this one up...

The Seattle Post-Intelligencer posted on their website the first successful penis transplant ever reported in a medical journal. This occurred in China and here's the quote from the article itself.

The Chinese doctors could not be reached for comment, and their report does not explain how the 44-year-old man lost his penis. It says only that "an unfortunate traumatic accident" left him with a small stump, unable to urinate or have sex normally.

Surgeons led by Dr. Hu Weilie at Guangzhou General Hospital performed the transplant in September 2005, a hospital spokesperson said Tuesday. The penis came from a 22-year-old brain-dead man whose parents agreed to donate his organ.

Update: MSNBC is now reporting that the transplant had to be removed because of "severe psychological problems experienced by the man and his wife." Oh well...

In a related story, Lorena Bobbit announced the opening of her first beauty salon in Beijing last weekend. When asked about the city's nightlife, she said, "I've had a great time here. The men in China are kind of kinky and I like that."

Hospice

Work has been especially tough the last couple of weeks or so, because I've had three patients who eventually requested and received hospice care. A very simplistic way of putting it is that hospice care is end of life care.

Sometimes there is an acute event, like a stroke, and sometimes it's a long drawn out illness, like dementia/Alzheimers. Trying to guide a patient and family through this process takes a lot of time, patience, and emotion. It's not an easy process, but a necessary one.

Not everything is wrapped up in 30 or 60 minutes like you see on television. In some cases, this process can take days and even weeks. I constantly have to remind myself to report the facts of the case. For example, "the heart/kidney function is improved or worse verses yesterday," or, "it is a significant stroke affecting motor and/or sensory and/or speech function."

I can't even imagine what my families are going through, because it's not my loved one in that hospital bed. My job is to stay as objective as I can in reporting the medical condition of their family member.

Things can get a little tricky when I'm asked something like, "What if this was your mother or grandmother, what would you do?" Or, "What if I was your mother or grandmother, what would you do?"

When the patient or family open the door for me, I try to be as honest with she/he/them as I can. Even though it may sound like I'm giving up when I recommend something like hospice, if I believe the long term prognosis is poor, they deserve to know that. If there is possibility for recovery from their illness, I'm honest and let them know that as well. Hospice is not appropriate for everybody.

It's even tougher when it's one of your long time patients whom you have seen slowly deteriorate or someone whom you saw last week in your office who had an acute event and no longer the person you remember. In most cases, a rapport was built so that I had an understanding of how heroic/aggressive the patient wanted to be close to the end of life. Obviously, one of the tougher parts of my job.

I do have the satisfaction in that for most of my patients I will do what they want me to do, because we've talked about it. My tribute to them will be to carry out their final health care wishes whatever they may be...

I'm on call today/tonight. You know the drill by now. I'll be back in a day or so to pick up where I left off. Keep on blogging for me. More soon...