Tag Archives: Diseases

Answering The Unasked Questions

Death sucks.

Yes, I realize that I am courting the obvious there, but I thought we needed to restate where we stand on the issue. Sure there are some occasions, some deaths, where the cessation of breathing is cause for celebration and I would not try to argue that.

For the most part, though, people who die don’t want to die.

Again, blindingly obvious, but stick with me. I do have a purpose to this.

See, we as civilians only have to deal with death on a fairly irregular basis. It’s not like we see it every day as part of our job. Because we, as civilians, are not doctors.

Shara Yurkiewicz is a fourth-year medical student at Harvard Medical School where she’s learning what it takes to become a physician. She’s taking classes about anatomy, about chemistry, about diagnosis of disease and all of that.

However, it’s what she’s going to learn outside of the classroom that will determine how good of a doctor she becomes. My wife, known to many as She Who Must Be Our Best Chance, also is a doctor. She’s an OB/GYN and she’s one of the best doctors I’ve ever met. Not only is she a dedicated physician, who continues her medical education every day, but she’s also got a tremendous stirrup-side manner. She connects with her patients as people, as sometimes friends.

And patients appreciate that. She didn’t learn that in a classroom, but it’s a big part of why she’s such a great doctor. Shara Yurkiewicz has plenty of time to work on her bedside manner, but, right now, she’s still learning some powerful lessons.

Thankfully, she shares a lot of those lessons with readers of her Scientific American blog “This May Hurt A Bit,” which follows her trials and tribulations as a medical student.

In a recent column, Ms. Yrukiewicz transcribes a conversation she Diversity can be accomplished with tiny, little steps and it's not all that hard, now, is it?had with a patient following his hip-fracture repair. It offers we civilians a gripping view inside the real-world learning medical students must go through to become effective doctors.

She thanks the patient for allowing her, a medical student, to watch as the surgeons worked to fix his hip. It’s a relatively bland conversation and I began to wonder why it was in her blog. Until we neared the middle and things — through no one’s fault — began to go downhill.

Very badly downhill.

I watched as they kept your eyes shut and handled your body just as gently as they had a few hours ago.

I listened to the final zip of the body bag. I don’t know who had the time to switch off the radio, but I’m glad they did.

I listened as the nurse asked God to rest your soul.

I watched you leave in a different kind of bed, to a different place. I’m not sure where.

You can learn a lot from watching. Thank you for letting me watch.

We fixed your hip, sir.

The operation was a success, but the patient died. It’s not an oxymoron, but a notice that physicians must understand the different values for success.

To become a good doctor, medical students need to understand that patients are not simply a presentation of diseases and symptoms. They are people, with lives and loves and desires all their own.

What Ms. Yrukiewicz doesn’t mention in her post is the next most important lesson a good doctor must learn: How to learn everything you can about what happened so it doesn’t happen again and then move on to the next patient, fully confident that the surgery will be a success and the patient will survive.

Her blog provides an interesting look into the world of student physicians. I’d recommend you dudes and dudettes go and give it a read. It’s always interesting to learn what the person on the other side of the white lab coat is thinking.

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Diet Difficulties

by Richard

Dieting is big business, even among dudes. Just look at all the commercials on tv lately that tout how much weight dudes can lose by signing on to an online weight-loss program.

Dieting can also be more than a little confusing. I mean, there are diets that recommend you stay away from fat. There are diets that are just as sincerely recommending you stay away from carbs and start gorging on fat and calories. Diets based on Greek culture. Diets based on consuming nothing but air. (No, seriously.) But I think that’s taking things a bit too far.

To make matters worse, science keeps coming up with different, conflicting advice with every new study, it seems. For instance, a new study is saying that the old adage that you have to cut 3,500 calories (or do 3,500 extra calories of work) to lose one pound might be more than a little wrong.

That is the conclusion reached by Dr. Kevin D. Hall and his colleagues at the National Institute of Diabetes and Digestive and Kidney Diseases. Recently they created a more realistic model of how the body responds to changes in caloric intake and expenditure, basing their calculations on how people of different weights responded to caloric changes in a controlled setting like a metabolic unit.

Their work, spelled out in a new study published in The Lancet, explains how body weight can slowly rise even when people have not changed their eating and exercisehabits.

Their research also helps to explain why some people can lose weight faster than others, even when all are eating the same foods and doing the same exercise, and why achieving permanent weight loss is so challenging for so many.

The model shows that lasting weight loss takes a long time to achieve and suggests that more effective weight loss programs might be undertaken in two phases: a temporary, more aggressive change in behavior at first, followed by a second phase of a more relaxed but permanent behavioral change that can prevent the weight regain that afflicts so many dieters despite their best intentions.

Even worse, according to them, just 10 extra calories a day can lead the average person to gain 20 pounds over 30 years. I know that doesn’t sound much, but imagine you weigh 200 pounds at 45. By the time you’re 65, when you’re struggling to hold on to your physical prowess, you’ve got 20 extra pounds to lug around. That does not make for an easy road.

In an interview with the New York Times, Hall said people who expect dramatic weight loss could be in for a bad surprise.

A more realistic result, he said, is that cutting out 250 calories a day — the amount in a small bar of chocolate or half a cup of premium ice cream — would lead to a weight loss of about 25 pounds over three years, with half that loss occurring the first year.

Many people get discouraged when weight loss slows even though they are sticking religiously to their diets, but Dr. Hall said a gradual loss is nearly always more effective because it allows the new eating and exercise habits to become a lasting lifestyle.

There’s lots more at the link. Go check it out. And put down that cookie!

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Wired To Care

by Richard

We like to think of ourselves as being beings of free will. We decide what we’ll do, when we’ll do it and why we’ll do it. Sounds good so far, yeah?

Okay, sure, there are those who argue for the importance of what was done to you in the past, or what your genes will have to say in the ongoing conversation that produces behavior, but even those determinists will say there is at least the seeming of free will in our behavior.

Well, dudes, let’s add another strike against that. But in a good way. No. Seriously.

A new Northwestern University study provides compelling evidence that human males are biologically wired to care for their offspring, conclusively showing for the first time that fatherhood lowers a man’s testosterone levels.    

The effect is consistent with what is observed in many other species in which males help take care of dependent offspring. Testosterone boosts behaviors and other traits that help a male compete for a mate. After they succeed and become fathers, “mating-related” activities may conflict with the responsibilities of fatherhood, making it advantageous for the body to reduce production of the hormone.

“Humans are unusual among mammals in that our offspring are dependent upon older individuals for feeding and protection for more than a decade,” said Christopher W. Kuzawa, co-author of the study and associate professor of anthropology in the Weinberg College of Arts and Sciences. He also is a faculty fellow at the Institute for Policy Research at Northwestern. “Raising human offspring is such an effort that it is cooperative by necessity, and our study shows that human fathers are biologically wired to help with the job.”

Yep. It turns out that the testosterone that is so helpful in you dudes going out there and securing a mate might, just might, lead to you doing stuff that’s detrimental to the health of your young dudes and dudettes. So, according to the docs, when you do procreate, your body starts cranking down on the amount of testosterone you produce. Which makes us all dull and dad.

The new study’s findings also suggest that fathers may experience an especially large, but temporary, decline in testosterone when they first bring home a newborn baby. “Fatherhood and the demands of having a newborn baby require many emotional, psychological and physical adjustments,” Gettler said. “Our study indicates that a man’s biology can change substantially to help meet those demands.”

Of course, there is good news to go along with the precipitous drop in testosterone. With less of it running around in our systems, it might give rise to fewer t-fed diseases.

The authors also suggest that their findings may provide insight into one reason why single men often have poorer health than married men and fathers. “If fathers have lower testosterone levels, this might protect them against certain chronic diseases as they age,” Kuzawa said.

So. Good news and bad news today. Not sure how I feel about this little tidbit, but it did provide something about which to think. Go read more if you’re interested.


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