Month: December 2020

Be your own advocate, but DON’T be your own doctor.

These are words to live by right there. I am always encouraging patients to advocate for themselves. I think that every patient should be master and commander of their own destiny. It is so important that you listen with your eyes and ears open at every doctor’s appointment. Take notes and read everything that your doctors give you. At least attempt to understand what your doctor is telling you or ask questions until you do. Insist on clarification if you don’t. Pay attention, even if you don’t like what the doctor is saying, especially if you are getting news that you don’t want to hear. If you are getting any kind of unfavorable news, it becomes even more important to buckle down and concentrate so that you can be a part of your own management plan. If you disagree with your doctor’s diagnosis and plan, communicate that, in the right way, and talk about it together. Make sure that you have given him or her ALL the necessary information that you can think of, even if you think it doesn’t matter. Ask questions! I never understand when my colleagues complain about patients asking questions. I am like bring it on! I love questions! It means that you are actually interested in your own health and what I am telling you. I am actually more concerned if you don’t ask. Plus, if I have a problem with a patient asking questions, that poorly reflects on me if anything. So, please ask away.

So we have discussed how to advocate for yourself as a patient. Now let’s discuss the difference between advocating for yourself and trying to be your own doctor. When a patient advocates for themselves, they are being an active participant in their own management. They are agreeing to a team participation relationship between themselves and their physician. They are vested in their care. This is a good thing. Sometimes, patients cross the line and try to be their own doctor. This is when things get tricky and potentially harmful. Show of hands: who has done this before? I think we all have at one time or another, myself included. There are many different strategies that we use. 1) We self- diagnose with the aid of our friends or Doctor Google and seek our own treatment. 2) Sometimes we use left-over medication instead of seeking help or advice. 3) Sometimes we are so set on our own self-diagnosis that we call the doctor’s office and insist on a particular course of treatment and refuse to come in because we are sure that we are right. Then we lash out at the doctor for not instantly responding to our requests of convenience and daring to ask us to come for an appointment. 4) Sometimes we convince ourselves that nothing’s wrong and delay our treatment because we are either afraid or “don’t have time to bother with it.” I think that physicians in particular are guilty of this last one. We spend so much time caring for others that we don’t make the time to make sure we care for ourselves. It really is self-defeating because, if we don’t take care of ourselves and assume a patient role at times, we won’t be around to care for others.

All of these strategies have the potential to bite you in the proverbial ass at the end. I strongly advise against it. Mind you, I am all about patients being aware of their own bodies and health history. On top of that, I am always listening when a patient gives me their diagnosis and I take it into consideration. However, the bottom line is, when you are too close to a situation(i.e you trying to diagnose you), it is nearly impossible to always make the right decision. The chances of you being wrong are greater than the chances of you being right. You just can’t be objective. The decisions we make for ourselves are automatically imbued with our own agenda and baggage: We are worried about missing work. We don’t have time to go to the doctor. We don’t have time to stop. There are deadlines that we are worried about missing. We are afraid. When you “let your doctor in” on the decision making process, you bring back the objectivity that is crucial in determining the right diagnosis and treatment. When a patient comes to me with an issue, I am able to evaluate it with a clear head with objective information. My initial job is to get to the root of their issue and come up with a plan. I have the luxury of not having to be preloaded with concerns about their external factors until I have come up with a diagnosis. Let me clarify. I do not mean that I don’t consider their schedules or other life issues, I just mean that I don’t have to let it slow me down in terms of their diagnosis.

Now that we have described what it means to be your own doctor, let’s talk about why it is a bad idea. First and foremost, you just get it your own way. You slow down the path to diagnosis and treatment, if not cure. Second, if you are wrong, and there is a good chance that you could be, it could literally mean the difference between success and failure, life and death, etc. Third, you are not giving your doctor a chance to actually do their job. They did go to medical school after all and it was probably a more thorough training experience that what Dr. Google or your friend has. Let them get their ( and your) money’s worth out of it! Fourth, trying to be your own doctor can be really isolating and frustrating and often you have gone through multiple incomplete treatment options first when you could have just gone to the doctor and gotten the correct treatment the first time. If the risk of wasting time was your deciding factor in not going to the doctor, you just negated it by wasting your own time. Just don’t do it!

I fully realize that doctors need to step it up and not force this situation either. We are not free of accountability here. We need to try to work with your schedule. It’s not always possible though. We need to have same day appointment availability slots if possible. We need to make sure our staff is answering phones regularly when you call with questions when we are busy with patients. We need to make sure that we answer our phones when you have after hours concerns. I get that. It’s not just a one-sided issue. I make every effort to fulfill all of these criteria. But, none of these convenience and safety steps can make any difference unless you at least try to reach out in the first place.

Have a great day everybody!

Dr. Katz

I can’t seem to get anything done!

My sense of time seems really off lately. And by lately, I mean the whole last 7 months or so. I have found myself having difficulty reconciling the fact that I have the appearance of more time, without actually being able to accomplish more. I keep thinking that I know that I have more time on my hands because I can’t run off and do half the things that I used to. My weekends are no longer taken up by sporting events, concerts, dinner outings, or much of anything really. That means I should be able to get all kinds of leftover crap done, doesn’t it. Yet, I find days going by lately when I feel like I didn’t really accomplish anything. How is that possible? Granted, I probably set myself up for failure with my overachieving list of goals to accomplish that significantly outpaces the number of available hours. I have to own that part. But, usually I can get at least some of it done. I spent a long time pondering this little puzzle with no helpful insights until now. I finally figured out where my thought process was going astray.

I was thinking negatively in terms of my lack of physical accomplishments and looking for concrete physical barricades to my goals. I hadn’t stopped to consider the mental barriers to productivity that we all have been suffering from lately. It really hasn’t been about the lack of time. In truth, with the lack of activities available, I have had more physical time to accomplish more things: I just haven’t wanted to and it is ok to admit it out loud. With all of the stress around me lately, I just plain old have run out of mental energy to stay productive all the time. I have run out of things that I want to clean. I have run out of ways that I want to use to fill my time. I have subconsciously made myself a pact to take a step back, relax and sometimes just be. To my surprise, I realized that this was not necessarily a bad thing! This is just me practicing self-care without realizing it. I am trying to conserve what’s left of my mental energy for when I really need it, not when I am just trying to keep constantly busy. I am trying to rejuvenate and refresh. This is ok! I have to give myself permission for this and I would suggest that you do the same. Stop finding new things to beat yourself up for. A million things do not need to be accomplished every single day. Sometimes there needs to be a day to just breathe. Pummelling ourselves with endless, impossible to finish tasks will not reset or fix the out of control tension going on in the world today. Overscheduling ourselves just to say that we are doing something is actually doing more harm than good. I think we need to relearn how to just sit every now and then. It’s only when we stop moving for a second that we can actually appreciate what we have.

Have a great day everybody!

Dr. Katz

Has everyone lost their minds?

I just want to start off by saying WHOAH people! What is happening to everybody? Where did logic go? Where did common sense and understanding go? In just the past 24 hours I have seen people finger pointing, yelling at each other, shouting about conspiracy theories, threatening others, protesting, and panicking. That is a ton of unfriendly verbs right there. There is nothing good that is going to come from any of it. What’s simmering underneath all of it? : the pandemic and the politics swirling swirling around it. Let me take a minute and give you my honest perspective on it. Let me also be clear that what I am going to say is based on facts and personal observations. I am not here to sway you, convince you or otherwise change your direction. I just want to give you something to consider. If it happens to help you press pause on panic and anger, fantastic! If it doesn’t, it needs to be said anyway.

Ok here goes. I am here to tell you that Covid 19 is a real virus in the Corona virus family, which is the same family of viruses that cause the common cold. As you know, there is an infinite variety of viral mutations that can cause a cold and thus, we will probably never have a vaccine for it. Some of us will go down like a wildabeast for weeks with congestion, trouble breathing, coughing and even fevers. Some of us will get a little runny nose for a few days to a week and that’s the end of it. A small group of high risk people may even die from it. Now here comes Covid 19, a corona virus. It can mutate like other Corona viruses. It is ridiculously contagious like a cold. The vast majority of people that get it will have bad cold symptoms. Some people will be completely symptom free. A small subset will get seriously ill and may even die. This is crazy scary right? Of course it is. That’s a natural response. But, let’s put it in perspective. There is a certain subset of unfortunate people that are more at risk for everything due to comorbid conditions. These are the folks that need to always be careful, whether there is a pandemic going on or not. When you do the actual math on the covid thing, with verifiable numbers, the death rate is extremely small. I get it, even one death is too many. Of course it is. I am just saying that it is my opinion that our reaction and response to Covid perhaps should be in better proportion to the actual statistical risk it poses. We deal with many infectious and terrible things that can kill people every single year and they have not instigated a world mess of this proportion. I seem to recall complaining about the “latest shitty upper respiratory illness” as it blows through the world every year. In my lifetime alone we have had AIDS, H1N1, SARS, ebola, and the year round outbreaks of flu. I have news for you. AIDS and the flu have not miraculously disappeared, just because we are not talking about them. They are not the cool kids anymore, but I can remember being inundated with all kinds of bits of information each time one of these outbreaks started and feeling momentarily overwhelmed, but then we all went on. We didn’t shut down the economy and add financial despair to the shoulder weight of an already distressed country. We didn’t wipe out all other news and saturate all of our overwhelmed receptors relentlessly for months.

Let me be clear. I know this virus is real. I work in three different hospital systems. I have seen everything from the icu patients to the asymptomatic patients and everyone in between. Half of my family has had it….all have survived thank goodness but other people I know haven’t. One of my favorite people in the world died of Covid. But guess what, every time I have found myself scratching my head on why someone died, I realized after investigation that they actually had a comorbid condition that adversely affected their Covid path. It just makes sense. These cases we hear about in which someone died unexpectedly, I am willing to bet that the vast majority of the time there was an underlying condition as well. Just because we don’t hear about it or the person didn’t know, doesn’t make it not true. I think in the case of Covid, it’s all the things we don’t know or feel sure of that get to us the most. We hope a vaccine is coming, but it won’t be universally available for awhile yet. When it is, I am sure that some people will refuse it like they refuse everything else, even though we have all been clamoring for one for months. How does that make sense? It’s like we want to be able to control a decision about something, anything, just to say that we did whether it is good for us or not since we all feel so out of control.

So what am I really saying is that I think the whole pandemic has provided us with a view into how quickly everything can go wrong with misleading information. It has showed us how forced panic is not the way to go to convince people to follow guidelines. It has showed us that leaving people to their own devices without clear communication leads to nothing but chaos. It has showed us that when we come at people from all sides with negative and oppressive tactics, we don’t even allow them the opportunity to make good decisions. We have got to get it together and do things and think things based on actual facts and reintroduce common sense into this global scenario. Otherwise, we are just not going to make it through this.

Hang in there.

Dr. Katz

We are all tired.

Hey everybody. Show of hands…who seems to be tired all the time lately? I bet there is a ton of you. No matter how much sleep you get, no matter how well you eat, no matter how much caffeine you drink, that thick blanket of fatigue just never leaves lately. But why? My guess is that this persistent exhaustion isn’t actually just physical, it’s emotional as well. I mean sure, I am one of the believers that constant mask wearing puts you at risk for CO2 retention and respiratory acidosis, which can cause fatigue, but I know that is not the whole story.

So, why are we so exhausted? There are ten basic causes for fatigue that are the most common. Some of them we do to ourselves and some of them we have no control over. Let’s review.

The first one is poor diet. If you eat a diet full of refined sugars and carbs, you will be totally wiped out because all you get from that is short energy bursts followed by crashes. Likewise, if you are trying to diet and you are not actually getting enough calories to keep your body going, you will simultaneously just drain your own energy reserves throughout the day. On the other hand, if you eat a well balanced diet with no meal skipping, you will stay fueled the whole day!

The second one is using electronics before bed. I am totally guilty of this one. I mean, who is not filling their heads with the latest anxiety-causing social media right before they want to go to sleep? Sometimes it is the only time that we feel like we can “catch up” on the world right? Did you know that using electronics before bed turns up your fight or flight response which increases your pulse and blood pressure for several hours? It also decreases your melatonin levels. Both of those things are sure to keep you up longer. Ideally, you should aim to “unplug” at least three hours before bed time to give yourself a fighting chance.

The third one is sleep apnea. Sleep apnea happens when you literally stop breathing multiple times during the night, even if you don’t know that you’re doing it. This happens because your airways close while you are sleeping because of extra soft tissue. Not sure if this applies to you? Ask your bed buddy, if you have one, if you are keeping them up at night with your intense snoring. If the answer is yes, talk to your doctor about it and get treated.

The fourth one is anemia. If you are anemic with low hemoglobin, your red blood cell count is low and they are not getting enough oxygen and therefore you are tired all the time. The most common cause of anemia for women would be iron deficiency from menstrual blood loss. Some symptoms of anemia might be skin pallor, elevated pulse, fatigue or weakness. If you think you are anemic, talk to your doctor before self treating.

The fifth one is diabetes that is undiagnosed or poorly controlled. Diabetes causes excess sugars to stay in the bloodstream instead of going into the muscle where they can be used for fuel. As a result, you stay fatigued all the time. Some symptoms of diabetes could be frequent urination, excess hunger, excess thirst, and fatigue. If you think you might have diabetes talk to your doctor.

The sixth one is dehydration. We are all racing around lately without stopping just to try and keep up with the world around us. One sign of dehydration could be darkening of your urine when you go to the bathroom. If you notice, start increasing your fluids and see if it changes. We need to take the time to drink water frequently throughout the day. Experts say that we should aim for at least 3.7 liters(15.5 cups) a day for men and 2.7 liters( 11.5 cups) per day for women. How many of us are even close to that? I better get drinkin!

The seventh one is too much caffeine intake. I think that the world in general is guilty of this nowadays. There is no dietary recommendation for caffeine. It can be found in some medications, chocolate, caffeinated teas and sodas, and energy drinks. While caffeine can give you a temporary boost, it doesn’t last. How much caffeine is too much depends on the person. The effects of too much caffeine include increased blood pressure, elevated heart rate, premature heart contractions, and headaches. With caffeine, it really is a vicious cycle. You start drinking caffeine because you are tired. The caffeine then makes your body race and you get more fatigued. Then you find yourself “needing” more caffeine. Then when you try to wean yourself off of caffeine, you can get ridiculous headaches as it washes out of your system. In an ideal world, I would say don’t even try it in the first place. Mind you, I am saying this as I am sipping my dollar sized McDonald’s coffee.

The eight one is a chronic infection of some kind, most commonly a bladder infection. If you have been recently treated for a bladder infection and have no other symptoms except a lingering fatigue, go back to your doctor and get rechecked. You could have some infection left over.

The ninth one is thyroid issues. The thyroid is that little gland in your neck that literally has it’s fingers in multiple body functions, not the least of which, your metabolism. If your thyroid is underactive(hypothyroid), that could slow your metabolism and make you feel really sluggish. It could also affect your skin and make it difficult for you to lose weight. If your thyroid is really underactive, you might even notice a bulge in your neck and have trouble swallowing. If you think you have thyroid issues, call your doctor and get checked.

Last, but definitely not least, depression and stress are a major cause of fatigue. At least 25% of people suffering from depression report fatigue and a loss of appetite, in addition to the classic depressed mood that we think of. This is the one that I think is really affecting all of us right now with the the state of the world like it is. Depression causes feelings of sadness, anxiety or hopelessness for an extended period of time. People who are depressed often have sleep problems, which only add to the fatigue. Stress stimulates our flight or fight response which overtaxes our metabolism and can leave us feeling worn out and tired. Who doesn’t feel all of those things right now? The world is just not the same. We feel out of control. We feel like the joy has been sapped out of all our favorite things. We are spending a lot of energy looking for someone to blame for how things are instead of using our energy to deal with it. In my practice alone, the percentage of patients that I am helping with depression has risen 75%. This is a real problem and we need help.

So, we have talked about the causes. For the first nine, the strategy is fairly obvious: treat the underlying condition and the symptoms should resolve. Correct the lifestyle slip ups and the symptoms should get better. The last one, depression and stress, is a much harder mountain to climb. There is no one strategy that works for everyone because it is not a straightforward issue. You know what my first suggestion is going to be: talk to your doctor! Clue them in to what is going on with you and maybe they can help. Talk to your family and your friends. Maybe they are feeling the same way! Support each other the best we can! Seek counselling and therapy. I know that I personally have a list of counsellors ready to help at my office at any one time. Don’t try to tackle it all on your own! There is no harm, no foul, and no defeat in seeking help. The real battle is lost when you don’t take advantage of the resources around you and something terrible happens. Then the consequences spread like ripples on a pond, not only affecting you, but everyone you care about as well. Make sure you take the time to realize your own importance, especially now. No one can do that for you. I will make you a promise right now, we doctors are here for you.. We understand and we are tired too, but we will always be here.