Category: health care

A Study Shows Mindfulness Is Non-Inferior to SSRI for Anxiety Disorders And What the Heck Does That Mean?

I ran across this study showing Mindfulness Based Stress Reduction (MBSR) is “noninferior” to escitalopram in the treatment of adults with anxiety disorders.

I passed my Biostatistics course in medical school—barely. I have been practicing MBSR daily (for the most part) since 2014 when I really needed to address my struggle with burnout. I’m probably a worrier but I doubt I have a clinically significant anxiety disorder. I’m admittedly biased in favor of MBSR. Otherwise, I wouldn’t still be practicing it after about 10 years.

On the other hand, I don’t have a great handle on the statistical concept of noninferiority in clinical studies. I found a little YouTube presentation on it and I think I’m a little more comfortable with it now. I said “a little bit.” I’m not taking questions.

Reference:

Hoge EA, Bui E, Mete M, Dutton MA, Baker AW, Simon NM. Mindfulness-Based Stress Reduction vs Escitalopram for the Treatment of Adults With Anxiety Disorders: A Randomized Clinical Trial. JAMA Psychiatry. 2023;80(1):13–21. doi:10.1001/jamapsychiatry.2022.3679

When Should Psychiatrists Retire?

In answer to the question in the title, I’ll confess right away I don’t know the answer. The impetus for my writing this post is the Medscape article about an 84-year-old physician who was forced to take a cognitive test required by her employer as a way of gauging her ability to continue working as a doctor. She’s suing her employer on the grounds that requiring the cognitive test violated the American with Disabilities Act (ADA), the Age Discrimination in Employment Act, and two other laws in her state.

I didn’t retire based on any cognitive test. I recall my blog post “Gauging My Readiness for Retirement,” which I posted in 2019 prior to my actual retirement. In it I say:

I spent 4 years in medical school, 4 years in residency, and have worked for more than 23 years as a psychiatrist, mostly as a general hospital consultant. Nothing used to jazz me as much as running around the hospital, seeing patients in nearly all specialties, evaluating and helping treat many fascinating neuropsychiatric syndromes, teaching medical students and residents, and I even wrote a book.

On the other hand, I don’t want to hang on too long. When people ask me why I’m retiring so early (“You’re so young!”), I just tell them most physicians retire at my age, around 65. I also say that I want to leave at the top of my game—and not nudged out because I’m faltering.

In it, I mention a blog post written by a physician blogger, Dr. James Allen. The title is “When Physicians Reach Their ‘Use By Date.’ At the time I didn’t make a link to his post because the web site was not listed as secure.

Since that time, the web site has become secure, and you can read the post here. Dr. Allen lists anecdotes about physicians who ran close to or past their “use by” date.

Dr. Allen’s point is that we often don’t realize when we are past our “use by” date. That applies to a lot of professions, not just medicine.

There’s been a shortage of psychiatrists for a long time and it’s not getting better, the last I heard. All in all, I’m OK with the timing of my retirement.

I note for the record that I have not seen any mention in the news that the Rolling Stones have ever been required to take a cognitive test to continue working. I also want to point out that they are around 80 years old and their 2024 tour is sponsored by the AARP, the organization formerly known as the American Association of Retired Persons. I heard that the Rolling Stones new song, “Angry” is up for a Grammy.

I doubt anyone is angry about the obvious fact they’re not even thinking about retiring.

New CDC Campaign to Help Health Care Worker Burnout

The JAMA network published a brief report on the new CDC campaign to help health care workers reduce burnout and encourage well-being. An excerpt:

“Rather than focusing on what individual clinicians can do differently to improve their well-being, a new campaign by the National Institute for Occupational Safety and Health (NIOSH), part of the US Centers for Disease Control and Prevention, aims to reduce health care worker burnout by encouraging hospital leaders to implement organizational changes and offering them tools to do so.”

New Step Platform for Climbing Stairs Exercise!

Yesterday we got the new aerobic step platform for cardiovascular health enhancement exercise. As I reported in October, climbing stairs can be very helpful in promoting cardiovascular health. This article summarizes the findings. At least 5 flights (around 50 steps of 10 stair steps) is said to be beneficial.

I climbed a lot of stairs in my career as a consulting psychiatrist in an 800-bed hospital. I don’t do anything close to that now, but I exercise pretty much daily. It limits my wardrobe.

My step counter app will track my stair step climbing on regular stairs in our house. However, it won’t count the steps I do on the step platform. It doesn’t really matter. I count everything else I do when I exercise, even on my anti-Peloton stationary bike, since the digital computer for monitoring my fitness level never worked. I also count the number of throws when I practice the 3-ball cascade juggling pattern (a hundred, often with 2 or 3 different sets of balls).

You can adjust the height on the platform by using risers, which can go up to 8 inches. That’s the usual height of the risers on regular stairs.

It’s not a Stairmaster by any means—but then it doesn’t cost $3,000 either.

Darned Rhinorrhea Interrupting People

I’ve been having a runny nose recently that is intermittent and often related to eating hot foods. I have to get up from the dinner table and blow my nose, especially if we’re having hot soups or chili. I’ve been making fun of it, saying it’s caused by the nasal hair condensation index. You could also refer to it as Darned Rhinorrhea Interrupting People (DRIP). I looked it up on the internet and getting a runny nose is pretty common when eating and after other activities. It can happen just from getting older.

It turns out that there is a connection to eating certain kinds of hot and spicy foods called gustatory rhinitis. I never had this problem until the past month or so.

Recently, I get this even while juggling. And there is something called exercise induced rhinitis. It’s been known for over a hundred years.

I always notice I have a drippy nose when I come in the house after shoveling snow. It’s just snow melting from my nose hairs.

But I never got a runny nose from eating chili until a month or so ago.

And I found out there’s this thing called geriatric rhinitis. It can be caused by a number of things like (hold on to your tissue!) gustatory rhinitis. There are a number of other common causes including allergies, certain medications, and extraterrestrial abduction. Those darned ETs are forever sticking implants in peoples’ noses. There is a tendency to believe geriatric rhinitis needs some kind of specific treatment, such as anticholinergic sprays, immunotherapy, and a nasal cork stopper implantation procedure under general anesthesia in the outpatient Ear, Nose, and Throat surgery center. It costs only $50,000 per nostril (not covered by most insurance). ENT surgeons use a device with an Artificial Intelligence module, which can detect the difference between your nose and your eye with 50% accuracy.

Jokes aside (for a fraction of a second), I’ll admit a thought crossed my mind (an infrequent event) that I might have a cerebrospinal fluid leak, which is caused by a tear in the meninges into the sinuses and nasal passages. The fluid is thin and clear. Nasal sprays don’t stop it and you should seek medical attention if you can’t remember your name or find chunks of cerebral cortex in your Kleenex.

This blog post does not constitute medical advice and if you have DRIP, you should contact your nearest Voodoo practitioner.

Food for Thought

I’m giving a shout-out to a couple of child psychiatrists, one I know only from a blog, The Good Enough Psychiatrist. The other is an assistant professor in the University of Iowa Child Psychiatry Dept. I’ve never met her.

Since Jenna gives her name in the About Me section of her blog, I’m going to call her that because it’s easier. Jenna writes many thought-provoking posts, but I really admire the one titled “Amae.”

Dr. Ashmita Banerjee, MD wrote an essay titled “The Power of Reflection and Self-Awareness.” It’s published on line in the Mental Health at Iowa section of The University of Iowa web site.

As a relatively recently retired consultation-liaison psychiatrist who is also a writer, I feel a strong connection to them. In addition to being very glad that extremely talented persons are filling the ranks of a specialty which suffers from a serious manpower shortage, I get a big kick out of reading what really smart people write.

Here’s where a geezer retired psychiatrist starts kidding around. Jenna, a fellow blogger, is used to my habit of deploying humor, admittedly often as a defense. Dr. Banerjee doesn’t know me.

What is it about these essays that reminds me of the X-Files episode “Hungry”? It’s a Monster of the Week episode from the monster’s perspective. This monster looks like a human but sucks brains out of people’s skulls. He’s conflicted about it and even sees a therapist. But in the end his dying words were, as Agent Mulder shoots him down, “I can’t be something I’m not.”

If you read Dr. Banerjee’s essay and followed one of the links, you would have caught the clue that I actually read it because I consciously substituted the word “What” for “Why” in the previous paragraph. I could have as easily asked why instead of what—but it’s less helpful in gaining self-awareness.

And I haven’t sucked anybody’s brains out of their skulls in, what, over two weeks now! Upon reflection, I’m very aware of being incorrigible. Food for thought.

Jenna’s description of the Japanese concept of the word “amae” and Dr. Banerjee’s examination of the Japanese word “kintsukuroi” fascinated me. What made both writers consider human emotions using a language which captures the nuances so deftly?

I was a first-generation college student. There was a time in my life that a path to medical school seemed impossible. At times I probably thought I was trying to be something I’m not.

I’m just grateful for the new generation.

CDC Educates About Covid-19 Variants

Sometimes I see news about Covid-19 variants. They typically sound alarming. The CDC has posted an update on Covid-19 variants that is reassuring. There will always be variants. Not all will be serious threats. According to the update:

“While new variants like BA.2.86 and JN.1 attract attention, right now, 99 percent of SARS-CoV-2 variants are part of the XBB group of the Omicron variant, which is what this year’s updated vaccines are based on. CDC is continuing to track the spread and impact of BA.2.86 and JN.1, as well as other variants as they come and go.

For as long as we have COVID-19, we’ll have new variants. Nearly all represent relatively small changes compared with previous variants. CDC and other agencies monitor for impacts of new variants on vaccines, tests, and treatments, and will alert the public quickly if anything concerning is detected. Most of the time, new variants make little to no impact.

Regardless of the variant, all SARS-CoV-2 viruses spread the same way. So it’s important to protect yourself and others by staying up to date with COVID-19 vaccines, improving ventilation and staying home when you’re sick.”

CDC on How to Get Flu, Covid-19, and RSV Vaccines

The latest update on how to get the respiratory viruses vaccines is updated on the CDC website. Highlights:

  • “f you have insurance, these vaccines should be free to you in most cases.
  • Adults without health insurance or adults whose insurance doesn’t cover all COVID-19 vaccine costs can get an updated COVID-19 vaccine for free through the Bridge Access Program.
  • Most children can get recommended vaccines for free through their family’s insurance or the Vaccines for Children (VFC) Program.
  • How COVID-19 vaccines are being distributed changed in September 2023 when these products moved to the commercial market, but there is still plenty of vaccine supply.
  • Flu, COVID-19, and RSV vaccines may be given at the same visit.”