Wednesday, December 31, 2008

Medical New Year Wishes

1. Increased access and affordability of health care.
2. More self-helpers when it comes to health. People exercising, eating right, taking responsibility for their own healthy lifestyle.
3. Decreased influence of the pharmaceutical companies.
4. Cleaner air and water.
5. Greater use of integrated medicine practices.
6. Increased availability of truly dark chocolate.

Care to add yours?

Sunday, December 28, 2008

Christmas in Sedona

Sedona, Arizona. Land of red rock spires, ancient homes and, if you believe the loco locals, spiritual vortices. Whatever your orientation, it was absolutely beautiful there. We enjoyed hiking, running and exploring, when it wasn't snowing!

This is on the way in to Palatki ruins, which are very well protected by the National Park service.

Palatki was the only place I've ever seen "black on black" pictographs. The volunteer ranger told us these were originally white, like other pictographs, made of ground rock painted on with human hair brushes. They turned black when the soot from fires lit beneath the overhang settled into the white. He said they'll be black for the forseeable future.

The view from Jerome, a little ghost town on the side of a big hill.

Friday, December 19, 2008

Happy Holidays!

To anyone who happens by,

May your holiday season be joyous and calm, and your 2009 be filled with peace and good health!

With love,


Sunday, December 14, 2008

The doctor is out sick

I'm sick! Started with a sore throat, progressed to body aches and fatigue, then the sinus pressure and congestion kicked in. I'm miserable! All I want to do is sleep, but my nose is so stuffed up that I have to breathe through my mouth, which dries out my throat, which hurts worse and wakes me up. If I take a decongestant pill, the nose clears up, but I can't sleep because the decongestant is a stimulant. My sinuses hurt unless I press on them constantly and take enough ibuprofen to endanger my kidneys. This is the weekend I was supposed to do all my Christmas shopping, and I don't even want to leave the house. Not only that, I'm falling behind on my training for the half marathon in January, mere weeks away! Boo hoo and waaah!

Why am I moaning out loud on a blog? Because I think there's a lesson in all this. For me and other docs, that is. I'm usually very healthy, and manage not to catch most of the germs that are coughed in my face daily. But every so often something gets me. When that happens, I invariably find myself surprised at how miserable I feel, and humbled thinking of how miserable all the patients must feel. No wonder they came in! No wonder they couldn't do their homework or sit for their exam! This sucks!

We docs tend to get a little numbed by numbers. When we see ten people with respiratory infections in one day, they blur together, and the process becomes rote. Listen to the symptoms, swab the throat, recite a list of comfort measures, make a sorry face, then go on to the next patient. Part of rote-ness is remote-ness. Distance from the feelings of the patient. I hear them moan like I did above, I see their lips moving, but it doesn't really land after a while. I nod and smile, but I don't really, well, honestly, care as much as I should.

Now I know I'm just talking about a cold here. But as I have relearned this week, even "just" a cold can be devastating in its own way. More serious illnesses are more devastating, but those can be subject to the same doctor numbness if we're not careful.

The Universe is offering me an opportunity to share an experience with my patients in order to be a more compassionate physician.

It's not an illness; it's an opportunity! Yeah, that's it! A Universal lesson.

Okay, I get it already. I'm miserable. They're miserable. Can I please get better now?

Viral vs. Bacterial ?


If you are feeling “sick” is there a way to determine if you have a bacterial versus viral infection without going to the clinic? For example, temperature? Swollen glands? Green snot? Coughing up stuff?


The short answer is no. There is no sure fire way to tell without going to the clinic. However, if I were a betting woman, I’d put money on a virus, and I’d win big. Viruses cause the vast majority of respiratory infections. That includes most colds, sinus infections, bronchitis, and most ear and eye infections. It includes most cases of fever, swollen glands, green snot, and coughing up stuff.

For those readers who need it, I’ll explain the difference between viral and bacterial infections. Very broadly speaking, viruses are more common, and bacteria are more dangerous. The practical difference comes in with the question of antibiotics. Antibiotics kill bacteria. Antibiotics do not kill viruses. Your body does, for free. No clinic charge, no pharmacy charge. All it needs is some rest and time.

Now, everyone has a story of going to the doctor for a respiratory infection and leaving with a prescription for antibiotics. We hear it all the time. “Last time I had the same symptoms, and I got antibiotics, and it cleared right up.” Naturally, the patient wants the same treatment this time. The truth is she probably would have gotten better anyway. The timing of the antibiotics with her improvement convinced her that the antibiotics were responsible for her recovery.

Unfortunately, sometimes doctors prescribe antibiotics when they aren’t needed, “just in case.” This causes a couple of problems. For one, it sets up a patient like the one above to expect antibiotics for viral infections. That creates busy clinics and dependent patients, who think they can’t get over a simple cold without professional help.

On a wider scale, when we carpet-bomb bacteria with antibiotics, most bacteria will get killed. But a few will develop resistance to the antibiotic, and survive. Those will multiply and create a whole new group of tougher germs. Now science has to create a stronger antibiotic to kill these super-bugs. There have been some very scary germs created by this exact scenario.

I trust I’ve made my point about viruses. But remember, I said most respiratory infections are caused by viruses. That means some are caused by bacteria. For example, the bacterium Streptococcus pyogenes causes a throat infection commonly called Strep Throat. That definitely requires an antibiotic, to kill the bacteria and prevent dangerous consequences of the infection. Some kinds of pneumonia require an antibiotic, as do some ear and eye infections and, rarely, sinus infections.

If you’re looking for criteria, I suggest the following. If you get a respiratory infection, with the usual sore throat, congestion and cough, give your body a few days to work on it. Take over the counter remedies if you like. Drink lots of liquids to keep the mucous flowing. Try a sinus rinse. But if you have a high fever, a really bad sore throat that lasts for more than a few days, trouble breathing, or symptoms that last longer than a week, come in to the clinic for evaluation. Err on the side of caution, and come in anytime if you have doubts. Call ###-#### for advice or for an appointment.

Heroin and Opiate Addiction

Dear Dr. Peg,

I have been addicted to heroin for over six months now. While I have never used the drug intravenously, I still must smoke every day to function normally. I have wanted to quit since school has started but I’m so scared my school work, job and general life will suffer. I have researched multiple treatments but haven’t yet tried using one. As a doctor what would you recommend as a course of action? At the moment I am only engaging in counseling at the student health center. Thank you.


Dear Anonymous,

You have several things going for you already. You want to quit. You have only been addicted for 6 months. You are already in counseling. Those are three giant steps along your new path, and you are to be commended. I’m going to answer your question, but first I’ll fill in some background for those who don’t know.

Heroin got its name from the fact that users feel powerful and invincible, like a hero. It is one of a class of drugs called opiates, derived from the opium poppy. Some other opiates are prescription narcotic painkillers like oxycodone and hydrocodone, Narcotics are addictive, like heroin, and are sometimes sold on the street and used illegally. Narcotic addiction is a huge and growing problem, with an estimated 2.2 million new non-medical users in 2005.

Ironically, heroin was developed originally as a treatment for morphine addiction. Oops! As soon as it was discovered that heroin was in fact more addictive than morphine, heroin
was made illegal, and remains so.

Of all the opiates, heroin is the most addictive. Called “dope,” “horse,” “smack,” and “tar” on the street, it gets into the brain easily and quickly, resulting in peak levels shortly after injection or inhalation. This is called a “rush.” After the rush, active metabolites stick around in the body for several hours, resulting in a prolonged but less intense “high” than the initial peak, described as a relaxed, contented state.

So what’s not to love, right? Wrong. The problem is, your body gets very attached to those sensations, and it complains when it can’t have them. That’s called addiction and withdrawal. Addiction leads to physical problems, discussed below. Not only that, the more you get high, the less useful you are, to yourself and to others. Eventually the addiction takes over your life, and you spend a huge amount of energy and money feeding it. You might even commit more crimes in this pursuit.

Heroin can be injected in the veins, smoked, or snorted. In the 1960’s, when heroin use was highest, most users injected it. Injection is the most efficient if the heroin is low purity, but can result in nasty skin infections and blood borne diseases like Hepatitis B and C and HIV if needles are shared. Overdose is most likely from injection, partly because the purity of the drug is so variable.

Nowadays, as the heroin supply is generally more pure and the risks of injection are well-known, more people are smoking it and sniffing it. Smoking gets it into the brain fastest. Snorting requires the least equipment but can eat a hole through your nose lining. However you get it into your body, it is highly addictive.

Lest you think you’re the only opiate addict on campus, here are some stats. According to the Office of National Drug Control Policy, in 2003 one percent of college students reported using heroin at least once during their lifetime. Another survey, done by the National Household Survey on Drug Abuse, reported that among users 17-22 years old, the rate of use was higher for college students than for non-students. The rates of prescription narcotic use are higher. Abuse of prescription drugs for non-medical purposes went up by one third in 18 to 25 year olds in just one year from 2000-2001, and most of that increase was due to OxyContin and other painkillers. This is according to the National Survey on Drug Use and Health.

Back to you. It sounds like you are still in the early stages of addiction, where you are still able to manage a job and school. You say you’re worried that your life will suffer if you quit. It is hard to quit: I won’t lie to you. But your life will suffer much more if you don’t quit but stay on what will surely become a downward spiral.

How to quit? The old tried and true is the methadone clinic, which basically replaced one addiction with another, less dangerous one. That is still available, but a new drug called buprenorphine has made narcotic addiction treatment more successful. Buprenorphine is a prescription drug, available only from health providers who have special training. It attaches to the same receptors that opiates do but has a less intense effect. The idea is to avoid withdrawal symptoms while you slowly taper down the dose, meanwhile going through counseling to help you recover from your addiction.

Ask your counselor about "bupe." And hang in there; you can do this!

The Authors of "50 Ways" Interview on KCHF TV

50 Ways to Leave Your 40s TV interview with Phoenix' Pat McMahon