Category: health care

Shoveling Through Retirement Thoughts

I was just musing on Philip Rivers. You know about him. I blogged recently about his coming out of retirement to play quarterback for the Indianapolis Colts. I guess you already know this, but he retired again.

Unlike Philip Rivers, I’ve not even considered coming out of retirement since I left my position at The University of Iowa Health Care (UIHC) over 5 years ago. I never looked back.

But that doesn’t mean I never think about looking back. I look back a lot and that’s mostly because I’m an old guy. I was a consulting psychiatrist in the general hospital.

Anyway, occasionally I search my name on the web and laugh at what comes up. I never went to Baylor College of Medicine, much less graduated from there.

I did a few things when I was a doctor. Not all of them were about work, but most of them were.

Those who know me know that I always hated Maintenance of Certification (MOC). I checked the American Board of Psychiatry & Neurology website and my MOC contribution to continuing education is still there. It’s a clinical module on Delirium, which a lot of doctors and other health care practitioners see every day in the hospital. Dr. Emily Morse worked on it as well. She’s still working at UIHC.

I co-edited a book about consultation-liaison psychiatry with my former chair of the Psychiatry Dept, Dr. Robert G. Robinson, may he rest in peace. It’s “Psychosomatic Medicine: An Introduction to Consultation-Liaison Psychiatry.” You can buy it on Amazon—please.

I wrote a case report on catatonia caused by withdrawal from lorazepam (a benzodiazepine), and it’s still available. It was first published in Annals of Psychiatry.

But one of the things I’m proudest of doing was writing a short article for the University of Iowa Library for Open Access Week.

In it, I tell a short anecdote about my lofty (OK, a better word is “greedy”) thoughts about how much money I could make shoveling snow. I was just a kid and I never made it outside to shovel anybody’s walk because I was too busy calculating my income. I wrote that way back when I had another blog, The Practical Psychosomaticist. The photo of me shows my Leonard Tow Humanism in Medicine pin fixed to my lapel—another thing I’m proud of. By the way “Tow” rhymes with “Wow.”

Libraries have always been my one of my favorite places to hang out. Anyway, I’ve got more time to do things like hang out in general. I think Philip Rivers will adjust.

Re-introducing The Good Enough Psychiatrist, Dr. Jenna Cheng

Sena just found a blogger psychiatrist who wrote the blog “The Good Enough Psychiatrist,” and her former blog link is still on my blog site. Dr. Jenna Cheng has a new blog and podcast, and it’s called “Attached and Enlivened Psychiatry.” The link is on the menu.

The featured image for this post is the Kintsugi pottery picture, which I first learned about from her blog and later blathered about back in September this year some more, relating to my link between it and blues music. She actually hit the like button on it.

When you get a chance, by all means check out the podcast that Dr. Cheng and Dr. Patrick Kelly run. “It’s called Good Enough Shrink, which rings a bell. I listened to “Münchausen and Münchausen by Proxy: Harming Self and Others to Play the Sick Role.” They did a great job!

Special Mention on Dr. George Dawson’s Post Today

I just want to send a link to Dr. George Dawson’s post The Phenomenological Suicide Assessment – The Legacy of Dr. H. It’s a great Christmas gift to teachers and learners everywhere. Happy holidays to George and everyone else.

See Me at the Neckademy Awards About This Neck Massager

Sena bought some device for neck and shoulder massage called the Shiatsu cordless heat massager today. She tried it and then wanted me to try it. I’m not up for massagers of any kind, especially after seeing the extraterrestrial massage torturer I posted about early this month, “So, Is This Anything?”

She didn’t want it for various reasons. It doesn’t get warm enough, it’s difficult to hold on to it, and has this general weirdness that’s difficult to describe. That’s why I made a little video about it. Sena made me do it.

Thoughts on Comebacks

I watched the first half of the Colts vs 49ers game last night and I thought Philip Rivers didn’t look half bad for a 44-year-old guy who’s been out of the game for five years. Did you know he has 10 kids? OK, now that I’ve got that out of my system and that would be, what—the 44th time you’ve heard that since he took the field?

So what the Colts lost? His big family was up in the stands going crazy, cheering him on.

I read an article this morning which had Steve Young saying he could make a comeback at his age—which is 64. I couldn’t believe it. The same story mentions that George Blanda played for the Oakland Raiders when he was 48 back in 1975.

It got me wondering whether I could make a comeback as a general hospital consulting psychiatrist. Could I gallop up 6-8 floors of University of Iowa Health Care? You bet your bottom dollar—I couldn’t.

It’s hard to retire. Every once in a while, I miss hiking up and down the hospital with my camp stool, deftly swinging it around and sitting with the patients and families, telling medical students and residents all kinds of lies (I mean “wise old adages and pearls of clinical wisdom”).

I get a kick out of just wondering what it would be like. I get a vision of myself with a big, golden glowing aura of greatness around my head—until I come to my senses. Hey, nobody’s going to pay me a quarter million dollars to run the consult service for the few months I’d be able to limp around the hospital, falling off my camp stool when my legs go numb or the chair breaks.

It’s not like I can just throw a football like it’s nothing after 5 years. I’d have to prove I still have enough clinical smarts to figure out how to introduce myself (Hi! I’m Philip Rivers and you need to go long!”).

The Maintenance of Certification Circus is still a thing and it’s worse. I’m not saying doctors don’t undertake the arduous task of essentially retraining to be what they once were—because that’s not good enough anymore.

Last night, the camera caught Phil more than once being just as hard on himself as he was with other members of the team who weren’t in the right spot at the right time. Most physicians are perfectionists and if you’ve been out of the game for a while and you try to squeeze back in, you could wind up mumbling to yourself, “They don’t make footballs like they used to!”

I didn’t stay up for the second half of football game. It wasn’t because of anything Philip did or didn’t do on the field.

I just can’t stay up that late nowadays.

Big Mo Blues Show Christmas Music Featuring Peter Green

Last night was the second time John Heim (aka Big Mo) introduced the song “Silent Night” by Peter Green and the Men in Blue using the title in German, “Stille Nacht.” He also played it last Friday night, saying “Stille Nacht, Heilige Nacht” in what sounded like perfect German. I immediately liked this version.

I might be remembering this wrong, but when I was a kid, I think I somehow got assigned to sing “Silent Night” when I went out caroling (in a horse-drawn sleigh, no less!) with the members of our church. It’s a good thing smartphones weren’t around to record that.

I remember last week trying to find it on the Big Mo Blues Show playlist but I couldn’t. Then I tried to find it by searching the title in German. I forgot or didn’t hear the name of the band. I gave up looking for it and I wondered why he said the title in German.

So, after I heard it again last night and looked for it on the playlist, I found it right away on the web.

I have never heard of Peter Green, so I looked him up and found a Wikipedia article about him. His original name was Peter Allen Greenbaum. I found out that Greenbaum is a German surname (originally Grünbaum which means greenery or green tree. As an aside, Heim is also a German name. It means “home.” For many people (just listen to his Shout-Outs list!) the Big Mo Blues Show is home.

Those are just observations I find interesting and maybe point to a clue why Big Mo pronounced the title of the song “Silent Night” in German.

Anyway, the Wikipedia article doesn’t say anything about Peter Green’s ancestry. He was born in 1946 in London and died in his sleep at the age of 73 on Canvey Island, Essex.

He was a gifted blues rock guitarist and singer-songwriter and was founder and original leader of the band Fleetwood Mac. He was a very influential figure in the British blues movement. Some thought he was greater than the other often-mentioned blues guitarist, Eric Clapton.

Peter got some coaching early in life from his older brother but was essentially self-taught by the age of 11. In the mid to late 1960’s people were calling him “The Green God” which was similar to what many were calling Eric Clapton (“God’).

Around 1969(70) Peter started to develop signs of mental illness and during the 1970s he also used LSD several times. Eventually he was diagnosed with schizophrenia. Like other people who develop psychiatric illness, it was probably difficult to settle the chicken/egg question of which came first. He attributed much of his mental health issues to his use of LSD. He was hospitalized and treated with electroconvulsive therapy (ECT) in the mid-1970s.

However, by the 1980s, he returned to the music scene. He was inducted into the Rock and Roll Hall of Fame in 1998. He was described as being more interested in expressing emotion in music rather than displaying dazzling technical skill. He influenced many musicians.

Merry Christmas!

Dr. Susan Shen University of Iowa Psychiatrist Wins Prestigious Avenir Award for Research!

This just in! University of Iowa Psychiatrist Dr. Susan Shen, MD, PhD, is an assistant professor of psychiatry at The University of Iowa Carver College of Medicine and, hold on to your hat, she’s the first female psychiatrist, the first from Iowa, and only the third psychiatrist overall to receive to win the Avenir Award (French for “future), a highly competitive grant!

The $2.3 million dollar grant will help fund her lab’s research into the underpinnings of substance use and psychiatric disorders. The grant is administered through the National Institute on Drug Abuse (NIDA), one of the National Institutes of Health (NIH).

Give Dr. Susan Shen a big shout-out!

New Do it Yourself (more or less) Electrotherapy for Depression at Home!

OK, so the title is a little provocative; on the other hand, this is my take on a legitimate treatment for depression that was just approved by the FDA only last week. A company called Flow Neuroscience is marketing the newly approved FL-100 device for treatment of depression and their website definitely has their marketing skills down. And I definitely was reminded of a TV commercial about removing your own appendix.

That’s my smartass joke, but hang on, there’s more to it than jokes. I had to search around a while to find actual FDA web evidence that they actually did approve the FL-100, but I was saved by the reliable and trustworthy Psychiatric Times article about the FL-100 with references that I could verified the FDA’s approval.

So, I’m a retired psychiatrist and I was a clinician educator type doctor, not a neuroscientist, but I can read the FDA approval document section XV. Conclusions Drawn from Preclinical and Clinical Studies (starts on page 12). It boils down to, yeah, this device’s probable benefits outweigh its probable risks.

The Effectiveness Conclusions subsection on effectiveness outcomes at Week 10 contains what sounds like realistic answers: “The medical literature lacks consensus regarding what constitutes a clinically significant or meaningful between-group difference in HDRS-17 scores. As such, the clinical significance or meaningfulness of the between-group difference of -2.3 points on the HDRS-17 scale has not been established. Nevertheless, the 2.3 point between-group difference helps support the view that FL-100 provides probable benefit.”

I’m not familiar with the EQ-5D-3L scale of health-related quality of life but the summary says:

“The EQ-5D-3L measures a person’s health-related quality of life by assessing five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. There was no between-group statistical difference in EQ5D-3L scores at Week 10. The EQ-5D-3L frequently fails to detect mild depressive symptoms, as individuals with subclinical depression often select “no problems” on the anxiety/depression dimension. The insensitivity of EQ-5D-3L is documented in the literature.”

I happen to think that comparison of medical treatments with psychotherapy is a good idea but: “Data were not provided regarding FL-100 used adjunctively with psychotherapy or with psychotherapy and antidepressants.”

The device has no recommendation for use with patients with treatment-resistant depression:

“Patients who previously had an inadequate clinical response to two or more antidepressants at an adequate dose and duration were excluded from the study, limiting the evidence for use of the FL-100 in a more treatment resistant population.”

The potential risks are first degree skin burns if you’re not careful with the electrodes, headaches, and scalp pain. The benefit is modest but outweighs the risk.

You can use the device at home under the supervision of a clinician—they don’t do house calls so you’d presumably do this by zoom call. You can also get advice through an app on your device, which may or may not be a monotonal AI. You pay $500-800 and there won’t be any answers to questions about insurance coverage until at least next spring. But it’s being used by tens of thousands of people in Europe and beyond.

So go ahead, take your own appendix out (just kidding; put that jack knife away!). Did you know that at least one guy actually did that? A Russian surgeon, Dr. Leonid Rogozov managed it in 1961 while he was stranded in Antarctica.

It’s just my opinion, but the headset could be more stylish.

Tango Boxing a New Hybrid Sport?

Here’s how I got off on a tangent about Tango Boxing, which honestly did sound like a hybrid sport combining dancing the Tango and boxing, you know, like chess boxing, in a ring with gloves and sustaining head injuries and dancing the Tango. I was amazed when I at first misread something in an article in Medical News Today about how to live to be 100 after age 80.

In the article some fitness person actually said: “From tango to boxing and everything in between….” I read it too quickly and thought she said “From tango boxing and everything in between.” You’re not going to give me a hard time about misreading that are you? It could happen to anybody, no matter how old you are.

Anyway, it set me down the rabbit hole and I even managed to confuse the AI assistant Gemini (give me a break, I never ask for this joker to help me; it just pokes its nose into all my internet searches) yet here’s what it said on one of my searches for Tango Boxing (my question was “is tango boxing about a combination of boxing and dancing the tango?”):

“Yes, “tango boxing” is a form of fitness class or exercise that combines elements from both tango dancing and boxing techniques. 

It is not a traditional martial art or a specific, established combat sport. Instead, it is a workout designed to provide a low-impact, full-body fitness experience, leveraging the unique aspects of each discipline for exercise and well-being. 

Key Aspects of Tango Boxing

  • Combination Workout: It blends the core elements of boxing (punches, jabs, crosses, hooks) with basic tango dance movements (box steps, pivots, coordination drills).
  • Focus on Fitness: The primary goals are to improve physical fitness, including cardiovascular endurance, strength, flexibility, balance, and coordination.
  • Rhythm and Timing: Both boxing and tango require a strong sense of rhythm and timing, and the workout emphasizes developing these skills for effective movement and body control.
  • Mind-Body Connection: The class format is designed to engage both the body and mind, as learning the routines and movements requires focus and quick thinking.
  • Improvisation and Expression: Much like traditional tango and individual boxing styles, the fitness class allows for personal expression and improvisation within a structured format. 

This type of class, sometimes marketed as “Tango Fitness,” is a creative way to stay active and healthy, offering a unique alternative to standard gym routines.”

That’s the danger of AI and it could not be clearer why it’s answers should not be appearing at the top of any web search result. And you can’t turn it off.

Here all I was doing was chasing down my mistake and you see how easily AI gets misled. Some would call this an example of an AI “hallucination” although I prefer to think of it as confabulation.

I found out later that the Tango involves doing something called a “box step.” Those of you who know the Tango know what I’m talking about, even if I and AI don’t. Actually, let me correct that; AI could describe the Tango box step, which involves a dance pattern that forms a square on the floor.

So far am I OK? There’s no such hybrid sport as Tango Boxing? On the other hand, who can forget Muhammad Ali dancing around his opponents in the ring? He actually did sort of dance.

When all is said and done, the main point is how to live to be 100 years old and still be cool, strong, graceful, and joyful.

What’s the Skinny on a Vaccine that Might Prevent or Slow Down Dementia?

You don’t want to just take my word for it but there seems to be conflicting messages on a live, attenuated shingles vaccine called Zostavax.

One message is that “the live, attenuated herpes zoster (HZ; shingles) vaccine” might prevent or slow down dementia, especially in women according to a study in Wales and Australia. The article doesn’t mention the name Zostavax (the trade name for the live, attenuated herpes zoster vaccine), which according to a Wikipedia article was “discontinued in the U.S. in November of 2020.”

The other message is that partly because of several lawsuits against Merck (the manufacturer, which faced a lot of Zostavax lawsuits) regarding possible severe, potentially life-threatening side effects alleged to be associated with it, production and marketing of the vaccine was discontinued in the United States as of 2020. The other reason was that Shingrix, a recombinant form of the vaccine, was developed.

Shingrix is said to be superior to Zostavax, although it is also associated with some side effects.

I don’t know why I don’t find any FDA or CDC notifications that Zostavax is no longer available in the United States. Both agencies have archived approval notices still on their websites.

CIDRAP doesn’t mention that residents of the U.S. can longer get Zostavax (in other words, the live attenuated vaccine against shingles) as of 2020.

One of the problems I find with web-based information is that some of the entries can be confusing. I found several articles on line from law firms including one which posted a report on November 14, 2024 that two Black Box Warnings were published by the FDA about Zostavax. I could find only one safety warning on the FDA website (not labeled as “Black Box”) and it was about the new recombinant vaccine, Shingrix. It’s been associated with Guillain Barre Syndrome (GBS) and it’s dated March 24, 2021—a year after Zostavax was removed from the market in the U.S.

OK, as an old retired doctor, my bottom line on this issue of live, attenuated herpes zoster vaccine being touted as an agent that could delay or prevent dementia is that it would be a lot more helpful to me as a consumer to know the whole story about the product. It might be scientifically interesting but it’s moot because the product is not even available in this country and for good reason. And even if it were, would the potential risk and benefit assessment be favorable to recommend its use? And how does this affect the ongoing disagreement dividing the country about the safety and effectiveness of vaccines? Only about 20% of Iowans are even getting the flu shot this season so far.

One thing people could do which might slow down some of the cognitive impairment is to take up the game of cribbage. As far as I know, it has almost no detrimental side effects unless you insist on playing the muggins rule.