Caffeine crazy

I've mentioned before about how much I like Diet Coke. My (non-blog) friends joke with me all the time about potential withdrawl symptoms if I'm not carrying my Diet Coke.

However, I had no idea what a fad and craze they are these days, especially with younger people. I remember in college a drink called Jolt cola and their claim to fame is having twice the caffeine as regular coca-cola. This definitely helped me though many an "all-nighter" preparing during final exam week.

According to Cnn.Com, "Thirty-one percent of U.S. teenagers say they drink energy drinks, according to Simmons Research. That represents 7.6 million teens, a jump of almost 3 million in three years." This fact really amazed me. This is a $3.4 Billion industry. Sheesh!

Unfortunately, caffeine overdose reports are becoming more and more frequent - mainly because of the combination of caffeine and other chemicals like alcohol and drugs. I'm just starting to see this in my small community. But, apparently, this becoming a major problem in the larger cities.

"Young people are taking caffeine to stay awake, or perhaps to get high, and many of them are ending up in the emergency department," said Dr. Danielle McCarthy of Northwestern University, who conducted the study. "Caffeine is a drug and should be treated with caution, as any drug is."

How much caffeine do energy drinks contain? A University of Florida study found that some products, although served in cans two-thirds the size of a standard can of Coke, contain two to four times the amount of caffeine as that Coke. Energy drinks are unregulated in the United States, but the authors of the University of Florida paper suggest warning labels for them.

Ok, here we go. Let's now regulate the thing by putting warning labels on them. This is an entire rant in itself. Have warning labels really been effective when placed on things like cigarette packages, alcohol bottles, and music CD covers? C'mon, gimme a break.

But, I digress. Following review of this article and talking with some of my emergency department colleagues, I was really enlightened on the increasing trend of caffeine overdose and caffeine combinations with alcohol/drugs. I think I'll try to talk with my patients to see how prevalent it is in my community.

Election day rant

I'm probably one of the approximately 40% of registered voters that will actually vote in US elections in five days. However, I just cannot take it anymore especially in these areas...

Negative Ads: I've read the studies that negative ads are more effective than the "touchy feely ads." But, every ad on television, in the newspapers, and on the radio? Every single ad is saying, "This candidate is bad because blah, blah, blah. Vote for our candidate." Did you know that $160 million has been spent on negative ads verses only $17 million on positive ads. This just makes me sick.

Special Interest Groups: These groups paint candidates one way or another on a single issue, usually a hot button or controversial issue - whether it's corruption, national security, immigration, abortion, minimum wage, stem cell research, or whatever. It really doesn't matter what the complete picture of the candidates views and beliefs are. If you disagree or agree with a particular candidate on a single issue, then you must vote for or against this person. Do politicians and election campaigns think that we're uninformed? Do they think we would base our vote on one single issue? That's a pretty arrogant view. Unfortuanately, through the years, we have been lulled into voting in this manner. I don't know how to change the tide on that.

Apathy in the Electorate: I even talk with people at work either at the hospital or at our office. No one really cares. There are actually few people going to vote. I can't understand why. Voting in this democracy is a privilege that is taken for granted. What if the government started limiting the right to vote? What kind of uproar would happen?

This is a nation of immigrants, including my parents. I remember when my parents became naturalized citizens. It was one of the most memorable days of my life and in their lives. I was in high school and we learned together about our democracy and how our government works. They have voted in every single primary election and general election since then. That started over 10 years ago. I think about that when I think about skipping an election.

"The decisions are made by the people who show up." I've heard that saying again and again in one setting or another. And, it is so true. This is my public service announcement from all of us here at the Doctor Anonymous blog (basically me) -- VOTE!

Don't be part of the problem. Be part of the solution. Be proactive. I know it's easy to complain and be frustrated and think that your vote doesn't count. It's easy to think that your vote won't make a difference. I think of all those people around the world who are told what to do, how to think, and basically how to live. I don't ever want to live like that. Go to the polls on Tuesday, you'll be glad that you did. I'm Dr. A, and I approved this message....

Quid pro quo

I just read TJ's comment about yesterday's post and I found it very interesting.

I believe that antibiotics are over prescribed in many cases; but at the same time, I also feel that many times people go to the doctor unnecessarily as well.

And since they do show up in the doctor's office, I think that pressure is then applied to the physician to make sure that the patient leaves the office with a prescription in their hand. Mostly because the patient expects to leave the 'establishment' with *something*.

Kind of like a "thanks for your business" kind of thing.

Of course, I'm sure that Dr. A doesn't do that.

Now, I may be accused of interpreting this as "a joke," but this comment brings up an interesting point that I wanted to address. According to dictionary.com, the definition of quid pro quo is something that is given or taken in return for something else.

Something physicians talk about a lot is patients expecting to receive an antibiotic. Something physicians do NOT talk about is their tendency of writing for an antibiotic instead of explaining the rationale for holding off. Less than two months ago, there was an article in a prominent primary care medical journal that sums up things very well.

In one study, up to 50 percent of parents had a previsit expectation of receiving an antibiotic prescription for their children, and one third of physicians perceived an expectation for a prescription.3 Because of these expectations and the time constraints on physicians, prescribing an antibiotic may seem preferable to explaining why an antibiotic is unnecessary. However, researchers have found no association between receiving an antibiotic prescription and satisfaction with the office visit. What does impact satisfaction is whether patients understood their illness after the visit and whether they felt that their physician spent enough time with them.

So, in a roundabout way, I'm saying, yes, some doctors, for whatever reason, decide to write for the antibiotic. I agree with TJ that some docs see it as a business move ("If I don't give them the antibiotic, then they will switch doctors to someone that will.") Some see it as a way to save time ("I'm running two hours behind. And, if I write for the antibiotic instead of explaining why not, then I can keep from getting further behind in my schedule.") Or, some other reason.

Update: Kevin, MD linked to this follow-up post as well (Thanks! That's two days in a row for me.). He also said that I "hit the nail on the head." (aw shucks). A couple of interesting comments on his site to check out.

NaBloPoMo

Thanks to rdl for the heads up on this one. Did I miss a meeting somewhere? I guess it's National Blog Posting Month - Does Hallmark make a greeting card for this? I also read about this on the Frectis blog (thanks also for the info).

I don't even know if I can still "officially" get in this, but I liked the Yoda logo. So, the logo is in my sidebar, I sent an e-mail to fussy about my interest, and here we go! I've needed a little blog motivation, and maybe this is it. I know, hard to believe from the self-proclaimed blogaholic!

In other blogging news, I'd like to thank Technorati for finally updating my blog. I contacted them again and again, but got no response. According to my latest profile, I was just updated two hours ago - after not being updated for 93 days - how does that happen?

During my first week of blogging, I was ranked at 1,382,557. Now, I'm pleasantly surprised that I have a whopping 323 links. Before today's update, my links placed me around 120,000 on their blog rankings. Now, I'm in the top 30,000. Whoo-Hoo! High fives everywhere.

Riddle me this, Batman? How do I only have 27 links on the TLB site? Interesting.

Finally, I'd like to thank Kevin, MD for picking up my post yesterday and linking it to his site. I believe that he's got about 2500 visitors a day. What an audience! I'm jealous.

Free antibiotics

You've probably have heard what Wal-mart is doing with the price of prescription drugs - Rob even talked about it yesterday.

Now, to up the ante, regional stores/pharmacies are offering FREE drugs. What do I mean? In last Friday's Columbus Dispatch, there's a story talking about Mejer and Giant Eagle (regional pharmacies), in selected parts of Ohio, offering selected free antibiotics.

Don't get me wrong, you still need a prescription from a doctor (or other health profesional with prescription writing privileges - How politically correct is that?) for this. But, apparently, you bring the prescription to the pharmacy, and BANG, here's your antibiotic - now go and feel better.

From a cost standpoint, I think this is a good thing. Generic drugs are ridulously overpriced! Some of my patients have told me that rarely the name brand drug is the SAME price as the "generic."

From a patient care standpoint, I see this as a real problem. Wal-mart had the right idea, kind of, with offering some discounted chronic medicines - like blood pressure medicines and antidepressants. But, offering antibiotics?

Many studies have shown that you don't need an antibiotic every time you get a respiratory infection. And, I even admit, if I'm on the fence for a diagnosis, I err on the side of possibly a bacterial infection, and I prescribe the antibiotic.

For years, doctors have been warned to "just say no." And, we're seeing the complications of these decisions - mainly drug resistant infections.

So, docs out there, have the courage to stand your ground and explain the difference between bacterial and viral infections. And, if you're a patient, try to hold back your wrath if your doc doesn't give you that antibiotic and wants you to have the viral infection "run its course, because antibiotcs wouldn't help anyway."

SF Pics

Back in the saddle again -- Let me tell you, I could really get used to taking time off. I don't think I have felt this rested in a long time. Boy, did I need it because I think my entire patient pool called today.

Don't get me wrong, I did feel the love from my patients. It was just a little overwhelming. I couldn't help but crack a smile everytime a patient said, "I'm glad you took some time off, because you deserve it. But, I'm so glad you're back!" I was so relaxed that it didn't bother me, at the time, to explain that our office totally used up our flu shot supply while I was gone (no rant from me, yet, on this).

I'm on call Wednesday. I don't even think I remember what it is to be on call. LOL! I think I was last on call about two weeks ago - an eternity in my work life. We'll see how Wednesday goes.

Since I've gotten back, I haven't had the time to post the pics on my Flickr page -- until now. I definitely learned from last time with my DC pics. Who has the patience and time to look at 82 pictures? Certainly not me. I just wanted to test out my Flickr pro account.

So, this time, only 15 pictures for your to peruse. Before you ask, no, you will not find Dr. A in this set. The digital camera ran out of battery before I could take any pictures of me. Believe that? I didn't think so. I'll be a while before I go out of town again, so enjoy the pics!

Time travel

What a long day yesterday. We left our San Francisco hotel at around noon to make our way to the airport. We told our taxi driver that we were going to the airport. "San Francisco airport?" the driver asked. All of us looked at each other and kind of told ourselves, "Duh!"

Our driver then told us that Oakland airport was about the same distance from our hotel and one time he took a passenger all the way to SF airport only to find out that the person was flying out of Oakland airport. Interesting.

All of us thought that it would be a heavy travel day and there would be long lines at the airport. But, we checked in without incident and went through the security line with no problem.

Our first snag occurred when we were told that our departure from SF would be delayed for an hour. Unlike when we had a straight flight to SF, we had a connecting flight going home. So, we began to worry about missing our connecting flight in Chicago, and maybe losing our luggage.

Four hours later, we landed in Chicago. The flight attendant told the plane to allow those with connecting flights off the plane first. Of course, no one listened. So, we had to negotiate from our 50th row seat to other passengers that we had to rush to our connecting flight. Most people were reasonable, but there's always that one person whose life is always more important than yours.

Luckily, the airport has an outside shuttle bus which takes people from the "c" concourse to the "e" concourse, where our gate was. There would be no way that we could walk that entire way in the five minutes we had to change planes. But, we made it home, with all of our luggage, ok.

It was past midnight when we landed at home airport. Someone said, "It's really 11pm anyway with that time change thing." Oh yeah, I forgot that daylight savings time ends and we had to turn our clocks back.

What an interesting concept. Some bureaucrat determines what time it is and has the power to "time travel." In doing a quick search, I found an interesting article describing the history of daylight savings time. And, Congress passed a law last year that will extend daylight savings time in 2007. (NPR)

These last 10 days have been very relaxing. Not looking forward to going back to work tomorrow, but I know I have to. Thanks for the great feedback on my blogcasts. They were fun! Don't know when my next one will be. A different change of pace from the written blog.

Blogcast 3

I'm leaving San Francisco around midday for home. We have a connecting flight through Chicago tonight. And, everyone knows the risks of possibly missing your connecting flight home and/or your luggage not making it back to your home airport. So, this will be an interesting travel day.

But, before all that, I recorded blogcast 3 last night - and obviously posting it today. I don't know if these are getting better or worse as I do more of these. I guess you can be the judge of that. Enjoy DABC3.

Fashion Police

I've talked about professional dress before on my blog - whether it be to wear or not to wear a lab coat, or to wear or not to wear a tie.

Now, the board at the East Lancashire Hospitals NHS Trust have taken this to an entirely new level (high or low depending on your opinion). They are proposing a dress code banning things like novelty socks. The Daily Mail article states that employees could face disciplinary action if socks had "characters [such] as Homer Simpson, Mr Blobby and Wallace and Gromit."

Distractions of inappropriate dress should be limited, it added. Novelty socks fall foul of the new code along with see-through clothes, clothing that is too tight or too loose and plunging necklines.

Plain black or navy blue socks are deemed suitable but socks can be left off in hot weather. The board is recommended to accept the new uniform policy.

Is this the same hospital that is promoting the modesty gown? I'm curious. Doesn't the modesty gown promote cultural sensitivity and tolerance? Why can't tolerance extend to my Homer Simpson socks? Doh!

Blogs & Myspace

Two interesting articles I read this morning. I picked up the complementary USA Today outside my hotel room and read an article called, "Students, officials locking horns over blogs."

The article reported three school districts taking disciplinary action against students because of statements made on a blog -- this included one student being expelled from a school in the Indianapolis, Indiana area.

As you can imagine, this has re-sparked the free speech and first amendment debate. Can school districts discipline students for statements made on a blog? Can a student go over the line when making free speech statements? Who determines where that line is? Apparently, the courts are now getting involved and will contribute to the debate.

For me, in reading this article, I support what these school districts did. I agree that there is a fine line between the perceptions of venting frustrations and criticism and the perception of personal attacks. I also agree that school districts have the right to preserve the learning process the best that they can despite comments made by students. This attorney disagrees...

Says [Tom] Clarke, the San Francisco attorney: "Sometimes I'm very surprised how paranoid school districts are about what is said about teachers. That seems to be a focus of a lot of their concern, that nobody bad-mouth their fine, exemplary teaching."

What if the shoe was on the other foot? What if a teacher was perceived to be overly critical of a student? Does the teacher have free speech rights, even if a case could be made that it was constructive criticism?

You know the answer to that one. This teacher would be sued for student harassment, a demand would be made for the teacher to be fired, and maybe even to have the teaching license to be removed. You can’t have it both ways, and that’s how I see these cases going.

The second article I read this morning was from the hotel complementary Wall Street Journal. It describes people completely removing their listings from social sites like myspace and facebook in the article titled, “MySpace, Bye Space” (free article on wsj.com today only). There are two reasons people are starting to rebel: ads and spam.

There's no question, however, that MySpace's recent popularity has brought with it a proliferation of spam that has annoyed some users. Many advertisers take advantage of the "friend request" function and send out requests that are really just advertisements.

And programs have cropped up that can automatically send mass friend requests to MySpace users -- in short, a new generation of email spam. Sites with names like FriendBot.com and FriendAdder.com sell the programs starting at $19.95.

There was a time when I considered getting a myspace listing to try to further promote my blog. I think I’m comfortable passing on that idea now. It’ll be interesting to see if there is a trend over the next few months of myspace profile deletions because of ads and spam.