Sunday, March 28, 2010

Common sense battles bipartisan politics

Obama's monumental health insurance reform finally made it into US law this past week. Unfortunately, this victory for Obama (and the American people, in my opinion) will be tainted by political strategizing.

Before the bill was finalized, the senate was given the opportunity to put forth amendments to the bill. These amendments would then be voted on by the senate and if any amendments won a majority vote, they would be instated into the bill. However, if any amendments were instated into the bill, this would mean the bill was changed (obviously) and that the congress would have to vote on this changed bill once again. Thus, the Republicans, who have realized that they cannot stop this bill from becoming law, decided to make numerous amendments to stall the bill in bureaucracy. However, since the Democrats have a majority number of seats in the senate, they could form a united front and prevent any amendments from winning a majority vote.

One amendment put forth by Senator Coburn, who is a physician himself, was that the bill should bar insurance coverage of erectile dysfunction drugs for sex offenders. A majority of the Democrat senators voted against this amendment. I'm guessing that they voted against the amendment because they wanted to avoid Republican stall tactics and not because they believe sex offenders should have erectile dysfunction drugs covered. Thus, an amendment that should have been made to the bill was not. You can bet that this political strategizing by the Democrats will result in the Republicans using the votes against the amendment as a smear campaign during the next election, but more payers will be paying for erectile dysfunction drugs for sex offenders.

It is unfortunate when politics gets in the way.

Sunday, March 21, 2010

Why do you get a black eye after you break your nose?

If you get punched in the arm hard enough, you will develop a hematoma (bruise) localized to the area of trauma. So why is it that you can get a black eye after breaking your nose?

When you break your nose, you damage adjacent blood vessels that release blood into the surrounding area. This is the same mechanism that results in a localized hematoma. However, the skin on your face has a looser layer of connective tissue underneath, which makes it softer than your skin elsewhere. The blood released from your broken nose can flow more easily through this loose connective tissue and often pools beneath the eyes. This blood then oxidizes, darkening and resulting in a black eye.

Sunday, March 14, 2010

Why does yawning unplug your ears?

Your middle ear is an air tight cavity that is isolated from your outer ear (and the outside world) by your tympanic membrane. Your middle ear does connect to the outside world via your eustachian tube, which joins your middle ear to the back of your nose (actually to your nasopharynx). This tube is normally collapsed, allowing your middle ear to remain air tight, but it does open when you yawn or swallow.

The reason your ears get "plugged" when you are in an ascending or descending airplane is because a pressure differential forms between your middle ear and the outside world. When you yawn, your eustachian tube opens and this allows the pressure between the two to equalize.

And that is why yawning "pops" your ears when they are plugged.

Tuesday, March 9, 2010

Why does the flu cause aches and pains?

Nobody wants to catch the flu. Millions of people get vaccinated against the latest flu strains every year because they don't want to suffer through the misery the flu brings. One very common symptom that most patients with the flu complain about is deep body aches and pains.

If you think about the life cycle of a flu infection, it is actually surprising that the influenza virus (the virus that causes the flu), which primarily lives in your respiratory tract, can cause pain throughout your entire body. In reality, the influenza virus itself is not directly responsible for this pain. The pain occurs because your immune system releases inflammatory chemicals (cytokines) while fighting the influenza infection. Some of these cytokines cause your own body's cells to produce an enzyme called cox-2, which creates chemicals called prostaglandins. Prostaglandins have many functions, but one is to sensitize your nerves to pain...causing that aching sensation that comes with the flu.

At first glance, you might ask why would our own immune system hurt us. That's a good question and no one really knows the answer. I suspect that these aches and pains may have evolved to force us to rest when we are sick, so maybe our immune system is hurting us so that it can help us by fighting off the infection faster?

How to give a good lecture: state your objectives

Lecturing is a skill that is in short supply. Unfortunately, university policies don't prioritize lecturing when hiring professors. Most professors are offered positions at universities because of their talent as researchers; however, good research does not imply competent teaching. This may not be true in all faculties, but it is certainly the case in science, engineering, and medicine.

University policy often dictates that professors must spend a certain number of hours lecturing students. I do certainly see the validity in the policy; it would be ridiculous if you had a world renown professor working at a university and none of the students were given a chance to learn from him/her. However, forcing professors to lecture when they are astonishingly bad at it is a recipe for disaster.

In medicine, we have had many lecturers, some good, some bad, some terrible. There are often many common flaws that are ruinous to any lecture and one of them is not starting off the presentation with a slide stating the lecture's objectives.

We need to know what we are supposed to learn from the talk before you start lecturing. If we don't, we can't filter the vital information from the extraneous or esoteric. If we can't filter out the unnecessary, we are overwhelmed with the overload of information and it all becomes white noise. Remember, in medicine, we have a lot of information that we need to absorb...if you don't help us prioritize, we will resent you for it and not learn properly.

It really isn't hard, just give us bullet points on the information in your lecture that you think is absolutely essential for us to retain. Then, even if you are disorganized and jumping around from topic to topic (which you shouldn't be doing!), we know when we can relax and when we absolutely have to take the time to note specific details you may have forgot to put in our note package.

Thursday, March 4, 2010

Mental Illness and the Resume Gap

Mental illness is probably one of the challenging diseases to live with. Yes, it is a disease; if you have mental illness, you are sick, no different than being sick because you have leukemia or hepatitis. However, if you had leukemia or hepatitis, people would acknowledge that you were unwell and probably rally around you for support. Unfortunately, society's stigmatization of mental illness results in many mentally ill people being shunned by their closes friends and family.

Mental illness is also very challenging to treat, partially because we do not fully understand the physiology behind the disease and it is difficult to fix something when you do not know how it is broken, but also because mentally ill patients do not often realize that they are sick. Mental illness can distort the way your brain interprets reality; thus, mentally ill patients may hallucinate without realizing that their hallucinations are not real. Many of these patients are unwilling to take anti-psychotic medication because they do not believe that they are sick and they do not want medication to alter their brain chemistry, which they think is healthy/normal.

Patients who have had mental illness in the past can also face many problems once they have recovered from the disease. Recently, a patient made a presentation to our class about her battle with mental illness and mentioned how difficult it was for her to find employment after her illness was finally being adequately treated.

She became mentally ill and refused to take medication for several years because she believed that her hallucinations were based in reality and thought that medication would needlessly cloud her brain. She basically believed that she was healthy and the medication she was being asked to take to treat her mental illness would, in fact, make her mentally ill. During the time she was mentally ill, her hallucinations prevented her from being able to keep a job. After years of being untreated, her husband finally convinced her to take medication. Shortly after that, her hallucinations stopped occurring and she was able to function normally again.

This woman was ready to get her life back and, for her, a major part of getting her life back included returning to the work force. Fortunately, in Canada, we have laws that prevent employers from asking prospective employees if they are mentally ill (actually the law prevents them from asking any health related questions). Unfortunately, there was a huge, unexplained gap of unemployment in this patient's resume which spanned several years. Thus, she would be forced to either lie or tell the interviewer that she was ill for an extended period of time. How many employers are going to hire a person who was chronically ill for several years? Now, if she was completely honest and told them about her mental illness, how many would hire her then?

This resume gap is a huge problem for patients who were once mentally ill and are now healthy and trying to live a normal life. Finding work with an unexplained period of unemployment is incredibly challenging. This results in many of these patients being forced to work in the mental health sector where the stigma around mental health is obviously significantly lower. In larger cities, this may be a reasonable means of reintroducing mentally ill patients into the work force. However, in smaller cities, there may not be a mental health team, or the teams may be very small and not looking for new members. How are mentally ill patients in these cities or towns supposed to return to the work force?

This is a major problem because meaningful employment is an important aspect of many people's lives in terms of determining their self-worth. People who are returning from mental illness often need to feel productive. If they do not, it is incredibly easy for them to slip into depression, for which they already have an increased susceptibility.

Until the stigma around mental illness subsides, this resume gap is a small issue that will be causing huge problems...