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By Elaine Schattner, MD, on July 31st, 2011
Tonight the Discovery Channel will begin its annual Shark Week festival on TV. “Show me your teeth,” dares a singing woman, repeatedly, in the preview.
Show Me Your Teeth
I’m reminded of my thoughts on the advice — if you can call it that; it holds as a puzzle with me – from the recently-troubled Tracy Morgan as Tracy Jordan on NBC’s 30 Rock. Here’s a rerun, from last year’s ML on the same:
Dialog from Jack the Writer (Season 1, Episode 4, 2006):
Tracy Jordan: But I want you to know something… You and me, it’s not gonna be a one-way street. Cos I don’t believe in one-way streets. Not between people, and not while I’m driving.
Kenneth: Oh, okay.
Tracy Jordan: So here’s some advice I wish I would have got when I was your age… Live every week, like it’s shark week.
—-
Now, five years later, I still don’t watch the Discovery Channel by choice. And I’m afraid
See more Live Every Week Like It’s Shark Week, Again!
By Elaine Schattner, MD, on July 29th, 2011
We’ve reached the second half of our discussion on Bending the Cost Curve in Cancer Care. The authors of the NEJM paper, Drs. T. Smith and B. Hillner, go on to consider how doctors’ behavior influences costs in Changing Attitudes and Practice. Today’s point on the list: “Oncologists need to recognize that the costs of care are driven by what we do and what we do not do.”
In other words (theirs): “The first step is a frank acknowledgment that changes are needed.” A bit AA-ish, but fair enough -
The authors talk about needed, frank discussions between doctors and patients. They emphasize that oncologists/docs drive up costs and provide poorer care by failing to talk with patients about the possibility of death, end-of-life care, and transitions in the focus of care from curative intent to palliation.
They review published findings on the topic:
In a study at our institution of 75 hospitalized patients with cancer, the
See more Reducing Cancer Care Costs: Oncologists Need to Get a Grip on Reality, and Talk about Dying
By Elaine Schattner, MD, on July 28th, 2011
 I feel compelled to write at least a short note on Amy Winehouse, a young woman who was found dead in her London apartment a few days ago. I don’t like to speak ill of the dead, but the truth is I was never a big fan of her music. I wasn’t fond of her highly-stylized hair or her weirdly-curved eyebrows.
Once, when I was 17, a friend told me he always tries to see the good in people, no matter how much they behaved disagreeably. Ever since he said that, it’s stuck. Today his words come through, in contemplating Amy Winehouse’s personality and short life.
I like her for her willfulness, even though it was so destructive.
Amy Winehouse, in ‘Rehab’ Video
Not a good medical lesson, for sure – or the message most people are telling their kids upon this “teaching moment,” but not everything I care for is just how it should be.
Yes, she should have
See more Thoughts on the Death of Amy Winehouse
By Elaine Schattner, MD, on July 27th, 2011
This week I’ve come across a few articles and varied blog posts on screening mammography. The impetus for rehashing the topic is a new set of guidelines issued by the American College of Obstetricians and Gynecologists. That group of women’s health providers now advises that most women get annual mammograms starting at age 40.
Why every year? I have no idea. To the best of my knowledge, there are no data to support that annual mammograms are cost-effective or life-saving for women in any age bracket at normal risk for BC.
Pertinent also, is a recent paper* in the Annals of Internal Medicine supporting a personalized approach to BC screening and mammography for women over the age of 40, and an editorial* to go with it.
“Talk to your doctor,” is the point for patients. (Women’s breasts are not all the same.)
“Talk with your patient,” is the point for doctors: Consider your patient’s breast density, family health history
See more Mammography Update!
By Elaine Schattner, MD, on July 26th, 2011
 Last night I stayed up to watch the Big C. Really it was a sleeper, except if you get excited when Cathy’s teenage son hires a dominatrix and then can’t pay the bill.
Cathy’s son in an experimental phase, Showtime’s “The Big C”
On the cancer front, there’s nothing new to report. We still don’t know what kind of treatment Cathy’s getting. The only “medical” topic is the uncovered cost of some procedures, like $1800 for an MRI, and her husband’s lack of an insurance-carrying job.
Emotionally there’s some development in this episode. Cathy befriends a young man, another patient on the clinical trial. The two talk about life and death in a college dorm-y way. They go to his apartment and get drunk. Wow.
This can’t be as deep as it gets.
Feels like a long season, already. As I said last week, I’ll stick with the show because I said I would, for this year at least. Maybe
See more Cathy Bonds With a Fellow Patient in the Big C Season 2 Episode 5
By Elaine Schattner, MD, on July 25th, 2011
 Yours truly is busy this week, working on another writing project. This morning she got word from the Happy Hospitalist, via Google+, that a patient somewhere needs help.
…Here is a young male with a greater than 10 year history of progressive unilateral woody, nodular and odorous smelling skin changes of his calf. He has obstructive sleep apnea from significantly elevated body mass index…He has pain in his leg, which occasionally bleeds. There is no significant itching…
(For a full, disclaimed description and an instructive image, see Happy’s post.)
This story, if true, provides a good example of crowd-sourcing a diagnostic dilemma. This isn’t a “game,” played by doctors on-line who write in to say what they think is wrong in a case already solved. Rather, this is how physicians might use extant technology and free software for difficult cases, in real time, when assistance is needed.
I’ve never seen a case of Elephantiasis Nostras Verrucosa (ENV). Happy figured
See more Real-time Crowd-sourcing a Possible Case of Elephantiasis Nostras Verrucosa
By Elaine Schattner, MD, on July 22nd, 2011
This is the sixth post on Bending the Cost Curve in Cancer Care, based on the 10 suggestions put forth by Drs. Smith and Hillner in the May 26 NEJM. We’re up to number 5 on the list for changing oncologists’ behavior: by limiting further chemotherapy to clinical trial drugs in patients who are not responding to three consecutive regimens.
They’re right.
Giving one drug or combination regimen, and then another, and another, and another, to cancer patients whose tumors resist multiple regimens is more likely to cause harm than good. Oncologists need be realistic with themselves and with their patients, in a kindly way, when treatments fail.
Options to consider, besides chemo, include palliation (which can be started at any time, including before and during chemotherapy), alternative approaches (such as hormonal or immune-based therapy, for some tumors), hospice care and participation in a clinical trial, as the authors suggest, based on the patient’s
See more Lowering Cancer Care Costs by Limiting Chemotherapy in Patients Who Aren’t Responding
By Elaine Schattner, MD, on July 21st, 2011
 On the local, national and nutritional fronts:
How refreshing, in this heat, that Fairway opened a new store on East 86th Street yesterday. Coincidently, Michelle Obama’s push to eliminate “food deserts” – places where it’s hard to find affordable fresh produce and other healthy foods – was highlighted this week when several big retailers signed on to the initiative.
PHOTO CREDIT: DNAinfo/Amy Zimmer (Manhattan Local News)
There was a carnival-like atmosphere on the sidewalk outside the new store, which occupies a large, multilevel space where there used to be a Circuit City (bankrupt, closed) and a Barnes & Noble (moved). Inside, I made a rough tally of unpackaged (6 varieties), nectarines (4), plums (3), string beans (4, including a yellow variant I’ve never seen before), potatoes (11 non-sweet, + yams and “yellow yams”), onions (7), mushrooms (5), not counting the pre-packaged kinds), peppers (11), tomatoes (9) and beets (3).
You get the picture: if you’re looking for a fresh ingredient
See more New Fairway Delivers Fresh Produce to My Neighborhood
By Elaine Schattner, MD, on July 20th, 2011
 In this week’s episode, Boo!, Cathy wakes up in the morning eager and ready to start treatment on a clinical trial. The day doesn’t go well – the local treatment center doesn’t have needed information about her insurance, which can’t be tracked down on time, her 15 year old son gets in trouble at school, and her husband loses his job.
That kind of day – when it seems like everything possible that can go wrong, goes wrong – will seem familiar to many if not all cancer patients.
But the show continues to fail in providing any meaningful cancer information whatsoever. OK, I’m starting to accept the fact that ratings would suffer if the doctor gave even a 30 second mini-talk on BRAF mutations in melanoma. There will be no science on Showtime. But the scriptwriters could, at least, have included the discussion of the doctor and Cathy’s signing informed consent for the trial.
See more The Big C: Cathy Goes For Treatment
By Elaine Schattner, MD, on July 19th, 2011
 Live, from New York, it’s med-blog Grand Rounds, volume 7, number 43!
As I’m staying home for the summer, I’ve asked bloggers to share images of where they’re from, or where they go, so we could take a virtual tour together:
Washington Monument, at the U.S. National Mall, Wikimedia Commons (WC) image
We’ll start with a post from the Washington, DC-based Prepared Patient Forum, where Jessie Gruman clarifies that Engagement Does Not Mean Compliance. As Jessie says, “I am compliant if I do what my doctor tells me to do. I am engaged, on the other hand, when I actively participate in the process of solving my health problems.”
Heading north, to Philly -
Philadelphia City Hall, from the steps of the Art Museum (image courtesy of Bill Strouse)
Here, steps away from the Liberty Bell and Independence Hall, Ryan DuBosar covers a hot topic for the ACP Internist blog. In But wait! I wasn’t ready for
See more Med-Blog Grand Rounds Takes a Virtual Tour
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