Deb; short term memory depression vs stress; gasping; intuition and your doctor

[Guest guest]

Deborah;

I'm voting for allergy - but in some cases and allergy reaction can be

triggered and the culprit itself is long gone - our sensory reactions are

not 'normal' so even if nothing is found the rash may still be an

'allergic' one. The gall-bladder is an organ we have in common only with

the rat, which is why it is so good to use on lab experiments - function

has to do with bile production. Used to be as popular a reason for surgery

as appendicitis but seems to have become less popular - it is one of the

less well understood organs, like the appendix, tonsils and spleen, life

can go on nicely without it.

Doctors can be just as vacuous as the rest of us (especially when tired and

underpaid). Last year my 'rash' was met with dismissiveness - I also had

fever - two doctors and nearly a week later the next doctor I saw

immediately identified it as pettichael hemmorage (less evident by then

since it was starting to fade). Now I know if it blanches (pales) when

pushed down it is not a hemmorage those stay red pressed or not. You may

never know what you have, ride out the wave and get home, sounds like

hubby does a spectacular job keeping and eye on you. Try ice packs to get

body temp (which may or may not be a fever) down.

The last dream I remember (ref: crusty eyes), was of my eyes having dried

up inside my head I woke up with crusted eyes and was frightened to open

them and find my dessicated eye-balls, since then I've used eye drops

constantly.

Is everyone not just a bit quick on wanting everyone who 'seems' depressed

on anti-depressants?? It is only depression if real-life events are

insufficient to cause depression - only those will react to meds. For

instance you cannot cure grief with meds, just time and talk therapy. Short

term memory loss happens with many other 'stressors' such as sleep

deprivation, illness, anxiety, exhaustion and pain. My memory is adversely

affected by pain and sleep deprivation it stops as soon as those are dealt

with. Too many doctors won't deal adequately with a patient's pain and

discomfort - I forgot which of you knew someone with ALS, he improved

markedly when given more control over morphine for pain even gaining

abilities thought to have been lost.

I've slacked off from the voice exercises and am paying for it (at least I

hope this is the reason), my tongue seems to be blocking much of my

windpipe and I often feel as though my head is kept under water, if I open

my mouth a bit an consciously push my tongue forward air rushes in nicely,

but I have to make it a fully conscious effort - does this happen to

others, is there something surgical (like shortening the tendons) that can

keep the tongue from sliding back when it shouldn't?

New meds still no adverse affect and no loss of bowel control (no.1 fear),

and the pain is dying down slowly.

_____________________________________________

Came accross these two articles today, thought they were poignant:

New York Times

November 9, 2001

Separating Death From Agony

By Jerome Groopman

BOSTON - Not long ago, a cancer specialist I know faced a situation that

chilled those of us who care for people with terminal illness. A young

woman close to death lay suffering in a hospital bed, her husband at her

side. Her leukemia had defied bone marrow transplant and experimental

drugs. She had begun to bleed into her lungs and was gasping for air.

Months earlier, following common practice, the oncologist had had a frank

discussion about dying with the woman and her husband. The greatest terror

for her, as for most other patients, was that the final days of her life

might be spent in unrelenting pain. An understanding was reached among the

patient, the doctor and the family that if the time came when there was no

real hope of surviving and she faced only pain and debility, no

extraordinary means would be taken to sustain her and sufficient doses of

drugs like morphine would be administered to ease the pain, even if that

meant reducing her breathing or lowering her blood pressure and thereby

expediting her death.

That time had clearly come, but when the doctor ordered morphine, a

respiratory therapist at the bedside vehemently objected. He asserted that

the morphine, because it inhibited her breathing, was nothing more than a

thinly veiled disguise for physician-assisted patient suicide. The

patient's husband, aghast, reiterated the promise given to his wife. The

doctor was not deterred and prescribed as much morphine as was required to

alleviate the painful suffocation that occurs when the lungs fill with

blood. Within a day the young woman peacefully died.

The physician felt that he had fulfilled his moral and professional

obligation to relieve suffering, and the family was satisfied that their

loved one's death occurred with as much dignity as possible. But the

respiratory therapist then accused the physician of nothing less than a

crime, and the husband of being an accomplice. The charge was judged

unfounded first by a hospital review board and later by the district

attorney's office. Yet the step by Attorney General Ashcroft this week

in response to Oregon's legalization of physician-assisted suicide could

have dictated a different outcome.

Mr. Ashcroft authorized the Drug Enforcement Administration to take

punitive action against physicians who prescribe lethal drugs for

terminally ill patients; the doctors' licenses would be suspended. This

action, which is being challenged by the state, represents a striking lack

of understanding of how physicians help patients to die, and it risks

making the last days of the terminally ill a time of panic and pain rather

than calm and comfort. While this legal policy may be directed at a single

state where patients can obtain prescriptions for the lethal drugs under

certain circumstances, Mr. Ashcroft endangers what has become a

compassionate, if tacit, mode of dying throughout the United States.

Nothing could be further from the truth than Mr. Ashcroft's statement that

a federal drug agency could readily discern the " important medical, ethical

and legal distinctions between intentionally causing a patient's death and

providing sufficient dosages of pain medication necessary to eliminate or

alleviate pain. " In fact, it is medically impossible to dissociate

intentionally ameliorating a dying patient's agony from intentionally

shortening the time left to live.

In the case of the young woman with leukemia and pulmonary hemorrhage, the

doses of morphine needed to ease her suffering also depressed her

breathing. And death is rarely a gentle process of simply closing one's

eyes. Rather, there are potent physiological reflexes, graphically termed

" agonal. " Narcotics like morphine are essential in dampening these death

throes, and in doing so, they facilitate death.

Mr. Ashcroft's action also threatens the very essence of the hospice care

that in recent years has allowed so many terminal patients to die at home,

with doctors and nurses easing the passage through the prudent use of pain

medications.

Some opponents of the attorney general invoke states' rights, arguing that

federal agencies should not meddle with Oregon's law. This skirts the more

fundamental issue. Helping nature take its course is not criminal, and it

should be outside governmental regulation. Decisions about when and how to

die are best left to patients, families and health professionals, not

legislators and litigators. Committees of doctors and nurses already exist

in hospitals and hospices that can exercise sound judgment in controversial

cases and advise on the parameters for the process of dying.

If the Justice Department's action is a political bone thrown to religious

conservatives, it shamefully miscasts health professionals as disciples of

the devil rather than angels of mercy. If it represents an earnest attempt

to protect the dying, it in fact makes them more vulnerable. Death will

ultimately come, but without the skilled hands of physicians and nurses to

ease the release of the soul.

______________________________________

INTUITION: Does your doctor use intuition?

An old time hunch is a good partner for science, says prominent med school

teachers.

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USA Weekend. May 12-14, 2001 page 14. By Ann Japenga.

FOR THE FIRST TIME, prominent physicians are declaring that intuition--

nowledge not based on conscious reasoning or test results -- is alegitimate

medical tool.

" I'm a rationalist and a scientist, " Harvard Medcial School professor and

author of Second Opinions: Stories of Intutition and Choice in a the

Changing World of Medicine. " But there have been many instances when I've

had a deep sense about a patient that is not informed directly by lab

tests. It is a gut sense. "

This gut sense is gaining ground: On Wednesday, the annual meeting of the

conservative American Psychiatric Association will hear about intuition

from Los Angeles psychiatrist Judith Orloff, author of Dr. Judith Orloff's

Guide to Intuitive Healing.

At UCLA, where she is an assistant professor, Orloff is coaching psychiatry

resident Meredith Sagan in intuition-based medicine. " I can't image how I'd

practice medicine without intuition, " Sagan said. " This is the direction

medicine is heading. "

Some see it veering in the opposite driection. Over the past decade,

enthusiasm has grown for " evidence based " or " outcome-based " medicine --

the use of tests and treatments proven through rigorous research.

Manged-care companies maintain that evidence-based medicine will reduce

costs. Yet Harvard's Groopman says intuition also saves money. Example: A

man with bone-marrow failure was being treated with blood transfusions. In

an intuitive leap, Groopman determined the patient would benefit from added

testosterone (the hormone is vital for production of red blood cells in

men). Soon the man required only a third as many transfusions.

" My intuition saved this patients' insurance company hundreds of dollars

per unit of blood, plus all the hospital and nursing costs that go with

transfusions, " says Groopman.

At the University of Virginia, associate professor Slawson, M.D.,

teaches that skilled physicians are like skilled musicians. A physician

needs to be grounded in science but also must have the ability to

improvise. The result, according to Slawson: " Good clincial jazz. "

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How to find an intuitive physician

Doctors Judith Orloff and Jerome Groopman say an intuitive doctor will...

Take time to listen: Inutition isn't majic. It relies in part on a

heightened sensitivity to subtle verbal and non-verbal cues expressed in

ordinary conversation.

Encourage second opinions: An intuitive doctor realizes medicine has hidden

dimensions and accepts that another doctor may be able to tune into aspects

of your case he or she has overlooked.

Honor your hunches: about your well-being, even when they seem irrational.

In the most effective collaborations, your doctor will graft his intuition

onto yours.

Keep up with science: Some doctors may rely too much on intuition. Each

week, a wealth of new scientific information is available to doctors; yours

should take advantage of the lastest studies. " Intuition shouldn't be an

excuse for not keeping up, " says Haynes, M.D., editor of the journal

Evidence-Based Medicine.

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