Happy Easter

Just wanted to let everyone know that I'm not going to be posting for next few days. I may also be doing some blog maintenance. Back soon....

Is depression really depression?

It is not often that I compliment the media. But to give them credit, they have increased the awareness of mental illness in our culture - particularly depression. Whether it's television, movies, radio, or print, I think they have done a good job of decreasing some of the stigma that was out there 30-40-50 years ago.

In a study released in this week's Archives of General Psychiatry, researchers state that 1 in 4 people characterized as depressed are in fact struggling with "normal mental fallout from a recent emotional blow, like a ruptured marriage, the loss of a job, or the collapse of an investment." (New York Times) What?

One of the tools that I have used in the past are some simple one page depression screening tests. Many primary care offices use these checklists - whether they are administered by a nurse or even self-administered by the patient. These checklists can open the door to discussion with the patient/client. Researchers state that these screening tests do not take into account "normal mental fallout."

"Larger and larger numbers of people are reporting symptoms on these checklists, and there's no way to know whether we're finding normal sadness responses or real depression," said Jerome C. Wakefield, a professor of social work at New York University and the study's lead author.

Normal sadness response verses real depression? Mental illness is confusing enough (clinically) with terms like depression, dysthymia, mania, hypomania, generalized anxiety, panic, obsessive compulsive, bipolar, PTSD, and others.

Dr. Darrel Regier, director of research for the American Psychiatric Association, said, "I think the concern this study raises is real, and that we do need to be very careful not to overdiagnose a normal, homeostatic response to loss and call it a disorder."

I think this study will allow physicians and other mental health professionals to brush off depression as only a reaction to a "normal" sad event. This will lead to underdiagnosis (and delayed treatment) of depression. So much has been done in the early identification and discussion of treatment, that I fear this study will negate part of this progress, and allow depression denial to return.

Blogcast number 5

Two days in a row. Can you believe it? Another non-medicine and kind of introspective blogcast. Robert commented on the volume level of the file. Hopefully, I improved things a little bit. So much so that the computer fan may even be a little distracting on the audioblog. I'll keep working on the technical stuff.

Muddy left a great comment about the reasons why people blog. I reflect a little bit on why I started blogging and why I continue to blog now. The self-reflective aspect was interesting to me, but may not be interesting to everyone who listens. So, I won't be offended if you want to pass on this post.

I'm kind of enjoying the five minute unscripted format of this type of audioblog/blogcast. At least for me, it mixes up the medical commentary I do on the text blog with the personal commentary on the audio blog. We'll have to see how this thing evolves....

Just FYI, the audio file itself is about 7.5MB to download and it is in MP3 format. Enjoy! Here's the link to Blogcast #5.

TB patient in jail

I believe one of the reasons many physicians take up anonymous blogging is to complain about non-compliant patients. If a patient does not follow my recommendations, it's pretty simple. We agree to disagree and I ask the patient to find another physician. Most of the time, that works out.

Here's a story which I find very interesting. It definitely has public health implications, and is sparking quite a debate about an individual's civil rights verses the health of the public.

Robert Daniels has been in an Arizona jail since last summer. (Associated Press) He has not been charged with a crime, but what he does have is a drug resistant case of tuberculosis. It is so resistant, that it is considered untreatable. Why is he in jail? Here's why:

County health authorities obtained a court order to lock him up as a danger to the public because he failed to take precautions to avoid infecting others. Specifically, he said he did not heed doctors' instructions to wear a mask in public.

Though Daniels' confinement is extremely rare, health experts say it is a situation that U.S. public health officials may have to confront more and more because of the spread of drug-resistant TB and the emergence of diseases such as SARS and avian flu in this increasingly interconnected world.

"Even though the rate of TB in the U.S. is at the lowest ever this last year, we live in a globalized world where, if anything emerges anywhere, it could come to our country right away," said Mark Harrington, executive director of the Treatment Action Group, an American advocacy group.

So, the debate is what to do with this guy. On the one hand, you have a non-compliant patient who refuses to be treated. An individual has the right to refuse treatment, right? And, on the other hand, you have someone with a highly contagious disease which is incurable. You let this guy out of jail, and he will definitely infect the public, and then what do you do?

I'm all for personal sovereignty, but if this guy was in my little county jail, there would be no way that I would let this guy out. I mean, he is choosing not to be treated. There are consequences to choices, and I think remaining locked up is a small price to pay for preventing a TB epidemic.

Blogcast number 4

A little bit different post today. Yes, I'm trying audioblogging again. I'm still calling it a blogcast, but I'm not that happy with the name. It's not really a podcast. I've heard podcasts, and this audio file is not as good as some podcasts out there.

Anyway, there's no medicine in this blogcast today. I talk about blogging, specifically, my challenge in trying to keep the blog fresh and not stale with the same ideas/format.

Here's the question I pose on the blogcast: What do you do to keep from getting blog burnout? Take a blog break? Post on different subjects? Sometimes start an entirely new blog?

I close my blogcast by mentioning two of my favorite podcasts. My Three Shrinks: Great information and great banter. I can't wait for the next podcast. The Dashing MD: He's a surgeon in training on the west coast of the US. He has interesting patient stories.

Just FYI, the audio file itself is about 6MB to download and it is in MP3 format. Enjoy! Here's the link to Blogcast #4.

Gmail Paper: April Fools!

Funny stuff from Google/Gmail today. As I log out of my Gmail this morning, I see the ad below. It's worth checking out. Kind of funny....
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New! Introducing Gmail Paper

Everyone loves Gmail. But not everyone loves email, or the digital era. What ever happened to stamps, filing cabinets, and the mailman? Well, you asked for it, and it’s here. We’re bringing it back.

A New Button Now in Gmail, you can request a physical copy of any message with the click of a button, and we'll send it to you in the mail. Simplicity Squared Google will print all messages instantly and prepare them for delivery. Allow 2-4 business days for a parcel to arrive via post. Total Control A stack of Gmail Paper arrives in a box at your doorstep, and it’s yours to keep forever. You can read it, sort it, search it, touch it. Or even move it to the trash—the real trash. (Recycling is encouraged.) Keep it Secret, Keep it Safe Google takes privacy very seriously. But once your email is physically in your hands, it's as secure as you want to make it. Learn more about Gmail Paper

April fool's day

Above: April Fool's Day Joke gone bad. (Cartoon credit) Yes, I know it's tomorrow, April 1st. But, in some parts of the world, it's already April 1st, so there!

I ran into this interesting article on Yahoo news of the top pranks pulled off on April Fool's Day. I haven't heard of all of these, but here are the interesting ones (to me):

-- Sweden in 1962 had only one television channel, which broadcast in black and white. The station's technical expert appeared on the news to announce that thanks to a newly developed technology, viewers could convert their existing sets to receive color pictures by pulling a nylon stocking over the screen. In fact, they had to wait until 1970.

- In 1996, American fast-food chain Taco Bell announced that it had bought Philadelphia's Liberty Bell, a historic symbol of American independence, from the federal government and was renaming it the Taco Liberty Bell.

Outraged citizens called to express their anger before Taco Bell revealed the hoax. Then-White House press secretary Mike McCurry was asked about the sale and said the Lincoln Memorial in Washington had also been sold and was to be renamed the Ford Lincoln Mercury Memorial after the automotive giant.

-- Burger King, another American fast-food chain, published a full-page advertisement in USA Today in 1998 announcing the introduction of the "Left-Handed Whopper," specially designed for the 32 million left-handed Americans. According to the advertisement, the new burger included the same ingredients as the original, but the condiments were rotated 180 degrees. The chain said it received thousands of requests for the new burger, as well as orders for the original "right-handed" version.

-- In 1992, US National Public Radio announced that Richard Nixon was running for president again. His new campaign slogan was, "I didn't do anything wrong, and I won't do it again." They even had clips of Nixon announcing his candidacy. Listeners flooded the show with calls expressing their outrage. Nixon's voice actually turned out to be that of impersonator Rich Little.

-- Noted British astronomer Patrick Moore announced on the radio in 1976 that at 9:47 am, a once-in-a-lifetime astronomical event, in which Pluto would pass behind Jupiter, would cause a gravitational alignment that would reduce the Earth's gravity. Moore told listeners that if they jumped in the air at the exact moment of the planetary alignment, they would experience a floating sensation. Hundreds of people called in to report feeling the sensation.

I've done my share of practical jokes (the good ones I'll never admit to). But, there's always the standard changing the office furniture while someone's on vacation thing. I mean, nothing close to the level of punk'd, but stuff I thought was amusing. Any funny practical joke stories out there?

Happy Doctor's Day

Very funny at the hospital this morning. I walked into the doctor's lounge, and saw this breakfast set up. Don't get me wrong, it was the same continental breakfast stuff that is seen at every morning meeting, but the table was dressed up a little bit and a sign saying, "Happy Doctor's Day!"

Then, walking around the floors this morning, it was hilarious! People everywhere were snickering, "Happy Doctor's Day!" Hard to know who was geniune, and who had a busy night working and they're waiting to give report and go home to sleep.

But, an interesting start to my day. But, hey, it's Friday, and the weather is beautiful around here today. Of course, it's supposed to get cold and rainy tomorrow for the weekend. But, who cares! It's Friday, baby, and maybe this doctor will be able to cut out of the office early. Well.... A doc can dream, can't he? Have a great weekend everybody!

Salmonella Easter Chicks

Did you know that some people give kids little baby chicks as Easter gifts? (Image credit) I had no idea that this was happening. When I was a kid, I was content with an Easter basket with lots of chocolate and sweets in it. And then, the traditional annual Easter egg hunt. Now, that was a good time!

In this Associated Press article, the Centers for Disease Control and Prevention report that the giving of birds to kids, especially for Easter, may carry the danger of salmonella infection. Ew!

"This time of year, when everyone's wanting to give their kid a baby chick or baby duckling, that's when we start to see these outbreaks in people not accustomed to handling farm animals," said Charles Hofacre, a University of Georgia professor of veterinary medicine.

Salmonella is an infection that causes diarrhea, fever and vomiting. The bacteria live in the intestines of chickens and spread through their feces, which can cling to a bird's feet or feathers, even if it looks clean.

Children get sick by touching the birds and then putting their hands in their mouths. Young children are more susceptible than most adults, and those under 5 should not handle baby birds, officials said.

The article goes on to report recent salmonella outbreaks and how some states have passed laws discouraging giving small birds as Easter gifts. Who knew it was so common to give small birds this time of year? I guess I didn't.

So, for those of you out there who observe Easter, think twice before getting that baby chick for that young child in your life -- Better to stick with the Easter bonnet, Easter basket, and Easter candy. You'll be glad you did....

Hummer infatuation

There's nothing in the health headlines that interests me right now. So, I'll talk about this. For the past two weeks, I've kind of been "car sitting." But, of course, what you see above is not a car.

Although I don't know why, I've always been fascinated by the hummer as a production/consumer vehicle. It's completely impractical. I mean, it's huge! It only gets about 14 miles to the gallon. Yet, I've always wanted to drive one.

And, I have for the past two weeks while my friend (my new best friend, HA!) has been out of town on business. She gets back this weekend, when she'll find out that I've only put about a gazillion miles on the thing over the past two weeks.

I'm no car expert, but, to me, it's a nice ride. The color is red, like the picture above, and has black leather seats inside. I've also never experienced satellite radio before. I had no idea that satellite radio has a gazillion stations - but great sound. I could get used to that.

But, after two weeks, I think my infatuation with this vehicle is slowly dwindling. I was very interested at first, but now, I'm looking forward to getting back to my car this weekend. I wonder what this thing can do off-roading? I guess I have a couple of days to find out. HA!