"Normal" sugars may harm diabetics

I can't even imagine having diabetes. Every day, I talk with and take care of patients with diabetes. I'm just fascinated with the technology out there to monitor blood sugars and to deliver insulin. No longer are just the syringe and the needle. There are stuff like pre-filled insulin pens and even insulin pumps that can deliver the medicine now.

In diabetes treatment, the current thinking has always been to push your average sugar level to a lower and lower number. Now, I'm not talking about too low - like hypoglycemia - but a lower Hemoglobin AIC level (the three month blood sugar level).

In what can be characterized as a stunning move, a federal government study had to be stopped because of deaths NOT due to HIGH blood sugar levels - but because of possible too LOW blood sugar levels (Associated Press)

The government abruptly halted aggressive treatment in a major study of diabetes and heart disease after a surprising number of deaths among patients who pushed their blood sugar to super-lows — findings that call into question a growing movement in diabetes care.

The study was stopped a year and a half early because they found 257 deaths in the group of patients whose blood sugars were aggressively treated. In the article, aggressive treatment meant trying to bring the long range sugar number - the HbAIC - back to a normal range (meaning to the level of a non-diabetic). The other group who were treated with more standard care treatments using current diabetic HbAIC guidelines, only had 203 deaths. Why is this? At this point, researchers are unsure.

The findings contradict previous research suggesting that the lower diabetics can make their blood sugar, the better. That had specialists cautioning Wednesday that it's too soon to know if the finding among heart patients was a fluke, or a real sign of how exquisitely tailored to each patient's risk factors diabetes care must be.

The article goes on to say that as if this point, current treatment guidelines should not be changed until further study is completed. This definitely brings up the question: How aggressive is too aggressive when it comes to treatment of blood sugars in diabetes?

Virtual Office Visits? Not Really

A friend of mine sent me a link today in which the article uses the term "virtual office visit." What comes to your mind when you hear this phrase? Well, to me, this sounds like you type in your symptoms, the doc makes a diagnosis and sends a prescription to the pharmacy for you to pick up. Simple, right?

Well, not really. Again, this is a case of the press inaccurately describing something in the text article. If you watch the video clip, it's from a national morning news show. In the video piece, the anchor and the medical reporter talk about a computer program. Yes, a computer program. No, the computer doesn't diagnose and treat.

This program actually is a communication piece between the physician and the patient. I see it as a tool to be used to communicate things like routine lab work. One of the goals at the physician's office is to try to find a way to cut down on the number of phone calls.

We see this every day. You want to let the patient know that she/he has normal blood tests that were drawn at the office last week. The office calls the patient - the patient is not home - the office leaves a message to call the office - the patient gets home just before the office closes - the office has to get the chart from the stack of charts marked "left message with patient to call back" - the lab results are communicated - the patient has some questions - a message is taken - the message is communicated to the doctor - the office calls the patient back - leaves a message on the answering maching - etc - You get the point.

Well, this program gives the doc the opportunity to communicate those lab results via the internet and the patient can check these results anytime. Of course, there are internet security issues to deal with. But, for the most part, this program looks promising.

If you read the text article, it leaves the impression that this is an "office visit" that can serve as a substitute for an in person visit. Doctors can even charge for this visit. As kind of an afterthought, the article sticks in there, "if insurance covers it" - which it doesn't.

I guess my question is this - Would you, as a patient, like this type of communication made available to you? If your insurance company didn't pay for this service, would you pay for this type of service, or are you content with telephone communication with the office. I'm just curious....

The Sid Schwab Interview

This week The Doctor Anonymous Show welcomes one of the most widely read medical bloggers around: Sidney M Schwab, MD. He is author of the blog Surgeonsblog: Wherein a surgeon tells some stories, shares some thoughts, and occasionally shoots off his mouth. Like a surgeon.

Now, not only does Sid have a blog, he also has a podcast in which he reads parts of his book. I encourage you to check it out. Also, if you're never read anything by this guy before, check out the disclaimer on his blog below, and that's a great start:

What I say here is as true as I can make it, based on my experience as a surgeon. Still, in no way is it intended as specific medical advice for any condition. For that, you need to consult your own doctors, who actually know you. I hope you'll find things of interest and amusement here; maybe useful information. But please, please, PLEASE understand: this blog ought not be used in any way to provide the reader with ideas about diagnosis or treatment of any symptoms or disease. Also, as you'd expect, when I describe patients, I've changed many personal details: age, sex, occupation -- enough to make them into no one you might actually know.

Join us on Thursday, February 7th, 2008 at 9pm Eastern Time where we will be talking about his blog, his book, and a lot more. You can also join us in the live chat room or even call into the show to ask Dr. Schwab a question. Now, it's been a couple of weeks since I've had my show. Hopefully, I remember how to do the show. We'll see what happens this time. Tune in tomorrow for details!

Personal Health Record

In addition to EMR (electronic medical record) and EHR (electronic health record), the latest three letter acronym in this area is PHR - or, personal health record. These are described in a February 4th article from the Associated Press. What's intriguing about PHRs is that they are patient-driven.

Everyone has heard of computer tax preparation software. Well, why not a health record created and maintained, not my doctors or hospitals, but by patients. Hmmmmm...... The article does take a shot at doctors for being slow to accept electronic records (although I do agree that docs have been slow to adapt certain technologies).

Doctors have been slow to switch from error-prone paper records to digital ones, so the trend promises to empower patients to take matters into their own computers.

From the front lines of American health care, I do admit that - every day - I have people bring in their blood sugar log or blood pressure log. They keep track of it on excel or other spread sheet program. Not only do patients print this out and bring it to their visit with them, they also bring color graphs which they print out on their ink jet printers. Quite impressive.

Plus, some of these devices, like home blood pressure monitors and blood sugar machines - they have a memory. So, that my patients can show me their trends for the past few hours, past few weeks, and even past few months. What would stop them from inputting this into their computer to further their personal health record.

While large hospital and insurance networks are making the switch, few private doctors have. And even then, software differences mean one doctor's system can't always share information with another's.

Hence the patient-driven trend. More than 100 vendors, from insurers to free Web sites, offer individuals or families the option of creating PHRs — records that they control.

The programs range from very simple electronic diaries to more comprehensive programs that link directly with doctors or hospitals for direct downloading of formal e-charts.

Computer vendors are taking the lead from pharmaceutical companies - direct to consumer advertising. With hospitals and now patients utilizing computer technology for health records, the community based primary care doc (ie - me) will be forced to make the huge financial investment to implement some kind of electronic record (this computer program will probably not be compatible with either the hospital system or multiple patient systems - then what?).

By the way, there is no doubt that electronic records make things more convenient for the hospital, the patient, the pharmacy, the insurance company, the regulatory agency, and others. But how about the physician? I believe the jury is still out on that one. Plus, if you treat electronic records like pharmaceuticals (Ek!), what is the number needed to treat for one person to benefit? There's an interesting question....

Dr. A on the road: Day 4

I just arrived home a couple of hours ago. It's taken a while unpacking and getting ready for work on Friday. And, how it's time to tell you what happened on Thursday - and what a day! We had our final site visit, which I found very valuable. I'm still processing the information that I have learned.

The exciting part of the day happened after that. When we got to the Cincinnati airport, we saw that our flight was on time. Our final destination is our home airport of Pittsburgh, but to get there we had to fly west to Chicago and then east to Pittsburgh. In the early afternoon, we started hearing reports that Chicago was getting hit with a snowstorm.

Right when our team got to the gate, we learned that our flight into Chicago was going to be delayed. I started getting stressed out at that point. I was starting to think that even if we got to Chicago, would we be able to get out of there and back home? Or, would our flight out of Chicago be delayed, or even cancelled.

After discussion, the team decided to ditch the flights, rent a car, and drive the 300 miles home. The entire time, we were trying to get weather reports wondering if the snowstorm was going to hit Ohio while we were on the road. We did manage to get home safely, but, I have to tell you. The past 10-12 hours has been very stressful, and I have to go to bed, because I have to go back to work tomorrow. Yeesh!

While we were on the road, we received word that the flight we were supposed to take from Cincinnati to Chicago was indeed delayed. When the flight left the gate, it went all the way out to the runway, but then was held there for about an hour. After that, the plane came back to the gate and the flight was subsequently cancelled. If we decided to stay at the airport, our flight would have been cancelled, and we would still be in Cincinnati right now.

Also, as I was scanning the news just when I got home, I see that there is a foot of snow forecast to fall in Chicago through the night. And, more than 600 flights were cancelled out of O'hare today. Of course, in hindsight, I'm glad the team decided to ditch the flights and drive home. But, at the time we were discussing, I wasn't sure what the right decision would be.

I'm featured on Viddler!

I just got home from my week long trip (I'll be talking more about that soon). I just checked my inbox and found a message that my Super Bowl video is right now being featured on Viddler's front page. YAY! If it is no longer there, you can always click here or here to also check it out.

Thanks so much to Viddler for featuring my video. I definitely recommend this site to anyone out there who is doing or is considering doing video blog posts. This is a great site, pretty easy to use and navigate, and the community over there is fabulous. "Me Todays" are fun and I'm looking forward to doing more of them in the future!

Dr. A on the road: Day 3

I finally go home later today - YAY! Since, there is no radio show this week, I (kind of) substituted this with the video post above (even with my phrase, "Beyond the Blog" included. This is also a video I'm including in the Viddler "Me Today" group.

The travel day was surprisingly calm and efficient on yesterday. As I remarked in yesterday's post, I thought that we would definitely have problems going into and/or getting out of Chicago. Fortunately, the weather cooperated, and I think we arrived in Cincinnati on time.

After a quick break at the hotel, our group went to dinner at a place called Newport on the Levee which is actually on the "Kentucky" side of Cincinnati. The restaurant was called Mitchell's Fish Market - excellent food. Great food and great company. That complex looks relatively newly built. I wish I had more time tonight to explore more of that place. Oh well, maybe another time.

One more site visit this morning. It'll only be a quick visit, and then the journey home. The last hurdle will be traveling through Chicago O'Hare one more time this week. On day one, the delays were frustrating. On day three, there were no delays. What will happen today?

Dr. A on the road: Day 2

I recorded this quick video this morning before leaving the hotel. (See video above) I apologize up front, because since I have little time this morning, the video quality may not be that great. I had to sacrifice quality for time, so the images may not be as clear as previous videos. When I get to my final destination today, I'll may re-encode the video and may re-post it later.

Anyway, I know people are curious about my comments about the electronic medical record. In talking with these people from our site visit yesterday. I have a little better understanding of kind of what happened. Initially, the marketing on EMR was similar to other computer products - computers will make the life of a doctor easier and will save time.

Well, that may not necessarily be the case, at least initially. There is definitely a learning curve, and it may take more time to see a patient than just using paper. And, until you really learn the system, it may make things much more complicated than what you were used to previously. So, now, I definitely have a better understanding of the physician backlash to this thing.

They gave me more to think about as I journey onward to the next hospital. If we ever get to our next destination today, the next visit will be a quick visit tomorrow. Then, finally, back home tomorrow night. Of course, you can keep track of my travel pains through My Twitter Feed. And, maybe I'll have another video post tomorrow morning. Thanks again for all of your comments and e-mails the last couple of days. Talk to you later!

Show cancelled

I really feel bad about this, but I'm going to have to cancel the show for this week. My plan was to pre-record some material and play it for you on Thursday night, since I'm not going to be available live to do the show. I'll be on a plane on my way home at the usual time for the show.

Unfortunately, instead of recording stuff for the show this week, I've been in my hotel room trying to recover from my illness that hit me right when this trip started - really a bummer. I've been able to do the required work stuff on this trip, but all my other free time here has been in bed sleeping.

If I get some strength, I may record a quick video post about my time here away from home. I know that some of you out there are curious about my opinion/experience about electronic medical records. So, hopefully, I'll be able to do that tonight or tomorrow.

From a travel standpoint, tomorrow is going to be a bugger. Here is the weather forecast for Chicago O'Hare International Airport for tonight and tomorrow - Ek!

A WINTER STORM WARNING REMAINS IN EFFECT UNTIL 9 AM CST /10 AM EST/ WEDNESDAY.

NEAR BLIZZARD CONDITIONS... PARTICULARLY IN RURAL AREAS...WILL GRADUALLY IMPROVE LATE THIS EVENING. A BAND OF HEAVY WIND DRIVEN SNOW PRODUCING VISIBILITIES NEAR ZERO IN SPOTS...WILL MOVE OUT OF THE AREA BY MIDNIGHT. AS THE SNOW ENDS VISIBILITIES WILL IMPROVE...THOUGH SOME MINOR BLOWING OF THE FRESH FALLEN SNOW COULD CONTINUE OVERNIGHT.

IN ADDITION TO THE SNOW...WINDS WILL CONTINUE TO GUST OVER 50 MPH AT TIMES. THESE VERY STRONG WINDS WILL COMBINE WITH THE BITTERLY COLD TEMPERATURES TO SEND WIND CHILLS PLUMMETING TO 20 TO 30 DEGREES BELOW ZERO BY MORNING.

A WINTER STORM WARNING MEANS HAZARDOUS WINTER WEATHER WILL MAKE TRAVEL VERY HAZARDOUS.

So, again, to keep track of my travel pain tomorrow, tune into My Twitter feed. The plan is for our team to leave the hotel right after daybreak for the trek to airport number one. Hopefully, we won't be delayed too much trying to get to O'Hare. What happens after that, who knows?

I'm sick

I can't believe that I'm out of town and this is happening to me. This stomach flu thing is still going. I mean, it's a little better this afternoon verses last night. I'm now back at my hotel room, and I'm back in bed trying to get comfortable.

The meeting today went pretty well, and I'll talk about that soon. Actually, the information in my head is still spinning. I do find it a little bit distracting with my illness. 

I'm even considering canceling the show on Thursday night, because I'm not really feeling very entertaining right now. Sorry for all the whining, hopefully, I'll be feeling better soon....