posted
Pulsing is sometimes done with IV rocephin to try and avoid the gallbladder sludging, which is a known side effect. This is thought to work because of the slow replication time of this spirochete.
The problem with newbies attempting this kind of treatment is that they will not know all the ifs, ands, and buts that go with it. Like an Rx for actigall with rocephin to try to avoid the gallbladder problem. Some people have lost gallbladders from rocephin treatment.
Then there is the herxheimer effect, which newbies will not understand. This can result in therapy stopping, assuming an allergy. Read up on herxheimer reactions, known also in syphillis and relapsing fever. Managing a herx can be challenging.
Another thing is that if patients have a high germ load, hitting it with a full dose of IV might cause a really serious herx, ER type reaction. This is why some doctors will start entirely untreated patients with lower doses and ramping up. If your patient has had oral abx previously for her lyme, then that might have knocked down the germ load enough to go on to IV with less trepidation.
These are all reasons to read the treatment guidelines suggested by others. Treating lyme and coinfections is not for the faint of heart.
Posts: 8430 | From Not available | Registered: Oct 2000
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posted
This link is to a presentation at a recent Lyme conference. For Newbies and Oldies alike it is a very good summary of testing and treatment options.
posted
I want to quickly address some of the negative posts that my questions have generated.
First, I do not feel the need to "prove" to anyone that I am a medical physician anymore than I would ask any of you to "prove" anything you write. But, if anyone really really cares, pm me and I'll reply from my medical address, which should quell any doubts.
That being said, I also want to quickly give you a sense of what medicine is truly like...the medicine that patients don't see. And, though I don't share these sentiments, this is what I saw in medical and residency on a daily basis. There is no patient any (with minimal exceptions) physician wants to see less than a CFS or Fibromyalgia patient. I would probably say the same applies to chronic lyme. I don't think any physician would say this to anyone besides another physician, but this is a lesson that I learned very clearly in residency. Also, as a general rule, many physicians, especially the older generation hate the fact that the internet has empowered patients to become more educated about their disease and ask more insightful questions. It changes the medical dynamic from that of a paternal role to one more of a colleague, and many physicians are not able to deal with this.
Where I trained (at a major academic center) there is only one type of physician that is respected - one who works for another academic center. It seems like all LLMDs are not affiliated with major hospitals, rather being in private practice. Even worse for the medical community these physicians (to a large part) don't take insurance. I would venture to argue that a large number of doctors view their actions not of benevolence but rather of greed. Selling fish-oil to desperate patients who want nothing more than a doctor who will listen to them and validate their diagnosis. Seems to me like a lot of LLMDs do this and provide validation - but at a huge financial cost to the patient. They are lumped into the same boat of disrespect reserved for medi-spa doctors.
So, I hope that explains a bit more of the lessons I was taught throughout my training. I hope that nothing I have said is taken as disrespectful, because this was not my intention. I can imagine no greater horror than having a disease like this and repetively running into physicians who treat these patients like those with whom I trained.
If anyone wants to read more about the "behind the scene medicine" I would recommend reading House of God, which is a book we were given our first day of medical school.
Posts: 7 | From MD | Registered: Jul 2008
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daise
Unregistered
posted
Ditzy MD:
I've had enough of you.
If you're a doctor, then you are a typical duck. Quack!
northstar
Frequent Contributor (1K+ posts)
Member # 7911
posted
MdMD has not read the info provided, has not done any research on the role of omegas, studies of nutritional deficiencies in borreliosis, biochemistry of the organism,
or any tick borne diseases, has not gone to any conferences to discuss his concerns with his medical peers, and seeks out help from patients, and now disparages llmds, not all of whom recommend or sell those omegas.
Draws conclusions without evidence or research.
quote: Also, as a general rule, many physicians, especially the older generation hate the fact that the internet has empowered patients to become more educated about their disease and ask more insightful questions.
It changes the medical dynamic from that of a paternal role to one more of a colleague, and many physicians are not able to deal with this.
So this becomes the doctors' personal problem, not the patients'.
Diagnosis: Possible deficits in critical thinking skills, repetitive thoughts, rigid and inflexible thinking, inability to adapt to changes, lack of sensitivity, and may benefit from counseling. ($300.00, thank you, pay at at the front desk, since I don't accept insurance)
Northstar
Addendum:If you want to read more about the "behind the scene lyme and tick borne disease experience" I would recommend reading "Cure Unknown", which is a book I wish was published when I first became ill, and I wish I had read prior to all the useless visits and insults from gp's and other specialists.
Our education runs a little backwards: we experience first, then learn. It is the school of hard knocks.
Posts: 1331 | From hither and yonder | Registered: Sep 2005
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posted
To those who have attacked me personally and called me offensive names such as "troll" and those who have cursed me and said much worse via private message, I wish you nothing but the best and have said a prayer that you feel better and continue to improve.
I came on this board to get some insight. I have read numerous articles over the past several days and know far more about lyme disease than I had previously.
I try to treat my patients with care and compassion. I recently spent several days learning about CFS, and communicated with Dr. Montoya from Stanford. I started a patient of mine on Valcyte (at her request) and was as disappointed as she was when the randomized double blinded trial he ran failed to show a significant improvement.
It is easy to criticize others, and I have been hurt by some of the private messages I have received. However, I applaud those of you who have graciously taken your time to provide me with data from studies and trials. Thank you.
Posts: 7 | From MD | Registered: Jul 2008
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posted
I would treat your CFS patient with antibiotics. I would bet my life it was Lyme and or co-infections. Same goes for any Fibro patient.
Posts: 81 | From Nashville Tennessee | Registered: Oct 2006
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posted
I understand what you were trying to say when you said that you wanted to help the people on this site "understand what medicine was truly like... the medicine patients don't see."
Unfortunately, many of the people on this site are already excruciatingly aware of the sentiments you mentioned. They did not need you to tell them that this is the way many, if not most, physicians feel. Having worked in an academic medical setting, I realize the truth of your words in general; most of the people on this site have experienced them first hand. Obviously, I understand that you did not mean it applied to every single physician.
Truth be told, who would want to treat fibromyalgia, CFS or other syndromes without a known cause or cure? Being presented with a patient like this brings to light the limitations of medicine and probably makes some physicians feel inadequate. As a result, many respond by believing that "there must not really be anything wrong with this person... I learned all about disease, etc.. in medical school and THIS ISN'T THE WAY IT WORKS. THIS DOESN'T MAKE SENSE."
Although it is true that many ILADS doctors are solely in private practice and do not accept insurance, it is not universal. I know very few ILADS doctors at all; the one I do know is an associate professor with a major academic center in the region, accepts insurance, and publishes in peer-reviewed journals. He has colleagues at prestigious institutions such as Johns Hopkins who quietly applaud what he does but say, "Don't include me in anything; my institution is too conservative."
Posts: 129 | From Virginia | Registered: Feb 2008
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sixgoofykids
Honored Contributor (10K+ posts)
Member # 11141
posted
Thank you for explaining how doctors look at other doctors, that is something we could not know without being told. I do not understand why people aren't taking you as genuine, other than perhaps they are misreading what you are saying.
It doesn't help that on occasion we are harassed on this board. I don't take your posts to be that way at all.
It is a difficult disease and I had no medical professional believe me or treat me with respect until my LLMD. I had 45 out of 75 symptoms and was bedridden. I also had a CDC positive test. I STILL got a diagnosis of Somatization Disorder.
Though I understand the peer pressure you are explaining, I think it's horrendous. Those are the doctors who must be in it for the money as I don't see any compassion on their part.
-------------------- sixgoofykids.blogspot.com Posts: 13449 | From Ohio | Registered: Feb 2007
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posted
Why can't someone who has questions ask them without being attacked? Whether the individual is a "troll" (a very juvenile term), or a legitimate doctor (I do believe they are), why do some board members feel they have the right to harass others.
Daise's comments were not only rude, but demeaning as well. I DO NOT believe that the Maryland MD was trying to do any harm. I believe he or she provides us with an insight that only doctors are privy too. Just because he is asking questions that most of us have asked ourselves at one time or another, doesn't mean they need to be demoralized. What about the old addage "If you want respect, you need to give it." Well, that certainly is not the case here.
This board has such great potential and could be a wonderful and informative site, which I am sure we all agree that is what lyme sufferers need. But, how ignorance and hostility take over on posts which don't always agree with the general mindset is proposterous.
This will do nothing to prove credibility for those who are suffering with this awful disease.
Posts: 157 | From connecticut | Registered: Feb 2007
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daise
Unregistered
posted
Tonysgirl:
quote: You wrote:
Why can't someone who has questions ask them without being attacked? Whether the individual is a "troll" (a very juvenile term), or a legitimate doctor (I do believe they are), why do some board members feel they have the right to harass others.
Daise's comments were not only rude, but demeaning as well. I DO NOT believe that the Maryland MD was trying to do any harm. I believe he or she provides us with an insight that only doctors are privy too. Just because he is asking questions that most of us have asked ourselves at one time or another, doesn't mean they need to be demoralized. What about the old addage "If you want respect, you need to give it." Well, that certainly is not the case here.
This board has such great potential and could be a wonderful and informative site, which I am sure we all agree that is what lyme sufferers need. But, how ignorance and hostility take over on posts which don't always agree with the general mindset is proposterous.
This will do nothing to prove credibility for those
Because he or she is a troll--look at the inconsistencies. Look at the slams. Look at the IDSA-type garbage. Quack!
posted
A GP in the UK is at the very bottom of the pecking order.A Private Consultant of any illness is very highly regarded , is way above them and would not be belittled , whatever they cost , as you have done.
If you are at the bottom of the pack, then this remark would be out of order , a consultant is superior to a GP but THEY KNOW that.
Posts: 153 | From England | Registered: Jun 2008
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sixgoofykids
Honored Contributor (10K+ posts)
Member # 11141
posted
Daise, I don't think they're slams .... I think he seems to be genuinely trying to learn about Lyme and is coming from knowing little about it ... only the info on maybe one slide in a med school class.
We don't have tone and facial expression here. You can't judge him to be a "troll" from what he's written. He sure seems genuine to me .... even if he weren't, I would want to error on the side of helping.
-------------------- sixgoofykids.blogspot.com Posts: 13449 | From Ohio | Registered: Feb 2007
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posted
This will likely be my final post, as this had degraded into a session of name-calling, which was not my orignal intention and arguing back and forth is simply a waste of time.
I came to this site to get not only some medical information, but also a sense of the community. After reading, searching the literature, and discussion with some well educated posters (who appear to the the majority), I have decided my beliefs that will guide my practice.
I am not asking you to agree with everything, nor do I expect you to do so. Each person is entitled to their opinion, and others need to respect that. With that in mind, these are my personal beliefs.
1) I believe in the existence of acute lyme and it's constellation of symptoms. I believe that in the majority of patients, early lyme can be effectively treated with a limited course of oral antibiotics.
2) I believe in the existence of chronic lyme that may develop in a subset of patients who were caught early, but failed treatment (wrong med, wrong duration, wrong dose...etc). I also believe in the existence of chronic lyme in patients who were never treated.
3) I believe that our current laboratory tests are of limited value in the diagnosis of lyme disease, and believe the diagnosis is a clinical one rather than one based purely on lab studies.
4) I believe that, given #3, spending singificant out-of-pocket money for "boutique" testing is irrational if it will not change the treatment plan (i.e. a decision to treat has already been made) with the possible exception of it serving as a requisite for insurance coverage.
5) I have always believed that CFS is triggered by an infectious etiology. I have suspected, and still believe, that it is more likely a virus, but am willing to accept the plausibility of lyme disease as a trigger. Ultimately, I believe that multiple viruses +/- lyme disease (or co-infections) initiate a cascade that is compounded by our immune response to the pathogen.
6) I remain uncertain whether long term symptoms can be attributed to ongoing infection vs. a post-lyme (or alternatively CFS) inflmatory syndrome. I am even less certain whether it would be adviseable to treat these patients with long term antibiotics, which are not without the potential for serious risk. I admit that some patients with chronic symptoms do seem to improve with long term antibiotics, but whether this is do to killing of pathogens, the placebo effect, length of time (i.e. it's not the 12 months of antibiotics that led to the improvement but simply the fact that 12 months have passed), or some of the well known anti-inflamatory or neuromodulating effects of antibiotics is unknown. Despite my uncertainty, I would be willing to try a patient with these symptoms on antibiotics if he/she wanted to give them a try.
7) I believe that chronic disease is a horrible cross to bear. I think it is even worse to feel poorly and search for answers and be told "it is all in your head." I think that it is normal to be self-defensive and reluctant to talk openly for fear of judgement.
8) I believe that our current understanding of chronic disease is limited. I believe that the medical community, with a few exceptions, has not developed a treatment model to effectively care for patients with chronic disease and that a large number of physicians do not treat patients with this constellation of symptoms in an appropriate manner. Whatever a physicians personal beliefs on the existence/treatment plan for seronegative long-term lyme disease, patients still need to be treated with a level of respect that is too often lacking in modern medicine.
9) I believe support groups, whether online or in person provide valuable services, validation of symptoms, and are invaluable in treatment.
10) I believe some individuals and companies use the fear and desperation that goes hand in hand with chronic disease to generate profits for themselves by selling treatments that ultiamtely amount to little more than fish-oil by marketing them to the CFS and lyme disease populations.
11) I believe that some people on this board attribute every symptom under the sun to lyme disease, and ignore other more likely causes (i.e. the burning sensation in your chest is attributed to lyme disease and the possibility of an unrelated cause like acid reflux is ignored).
12) I am concerned that people believe that feeling worse after starting a new medication is ALWAYS a "herx" and that this is always a good thing. I am concerned that people are ignoring well documented medication side effects and other adverse reactions, and by doing so putting themselves at potential risk.
Well. I think that is all I have to say. To conclude, thank you to the well educated, well meaning people I have met.
To those who have been less welcoming, I have told myself that your behavior is a reflection more of your illness and the treatment you have received from the medical community than a direct personal attack on myself.
Thank you all. God bless and take care. I wish you success in your road to full recovery.
Posts: 7 | From MD | Registered: Jul 2008
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AliG
Frequent Contributor (1K+ posts)
Member # 9734
posted
Just a note with regard to LLMDs not accepting insurance:
I realize that insurance companies will tangle doctors up in so much red tape, trying to get "approvals" for patient treatment and payment for services outside of the IDSA guidelines (who's authors are guilty of fostering and perpetuating the attitudes of which you speak and are now in the process of being rebuked), that they would make it impossible for those specializing in Tick-borne Disease to keep up with current studies, do research AND effectively treat complex patient presentations.
I am glad you are choosing to honor your profession by trying to place the needs of your patient above the dogma that was taught to you. I think that it speaks volumes for your character that you are willing to examine the contrary evidence and think for yourself.
I think that many of those doctors don't realize that the emotional harm they inflict on those who have had unrecognized Lyme & co-infections or under-treated disease actually counts as "harm". They do the medical profession a grave disservice with their attitudes.
It's very sad indeed.
-------------------- Note: I'm NOT a medical professional. The information I share is from my own personal research and experience. Please do not construe anything I share as medical advice, which should only be obtained from a licensed medical practitioner. Posts: 4881 | From Middlesex County, NJ | Registered: Jul 2006
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posted
Thank you Maryland MD for giving us the time and opportunity to explain our circumstances further. Please do not feel "put off" by what a few rogue individuals have posted. I do believe quite a few of us appreciate your interest.
Thanks again.
Posts: 157 | From connecticut | Registered: Feb 2007
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sixgoofykids
Honored Contributor (10K+ posts)
Member # 11141
posted
You are right, it's not always a herx, sometimes it's a side effect. When talking with my LLMD we try to determine which it is. Generally a herx is pretty clear ... it's a worsening of Lyme symptoms. Meds generally have pretty documented side effects. At least in my own case, the herxes have been pretty clear.
As far as time passing, that's an interesting perspective. I have tried to get off meds and quickly declined. In my case, I was undiagnosed and untreated for 34 years. I had symptoms come and go over that time.
Finally I caught another illness, got re-bitten by another tick (got babesia from it), and was under a lot of stress. This pushed me over the edge and I became VERY ill.
I think when it's this established and there are this many coinfections (borrelia, bartonella, babesia) and other illnesses (heavy metal toxicity- lead, and parasites), it just takes a long time to heal. Same as you would with syphilis, the cousin of Lyme Disease.
You may even learn more about Lyme by studying syphilis. They are very similar in the progression of illness and the symptoms.
People here may blame everything on Lyme, but the doctor's don't ... my LLMD does look for what might be causing a symptom. He did a very thorough differential diagnosis.
Actually, I had an endoscopy that showed acid reflux ... and this acid reflux has cleared with treating specifically the bartonella and the parasites.
Thanks for sharing what you've learned over the past couple days.
-------------------- sixgoofykids.blogspot.com Posts: 13449 | From Ohio | Registered: Feb 2007
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"Because he or she is a troll--look at the inconsistencies. Look at the slams. Look at the IDSA-type garbage. Quack!
Don't post when you haven't read his posts. "
I am embarrassed by the way this person has been treated here. If you think he/she is a troll, how about you just scroll on by? They are NOT hurting anyone.
I cannot see any malevolent motives behind this person's posts. It is a complete waste of time to accuse and interrogate the person.
We have no right to sit here on this board and degrade and whine about "ducks", then when one MIGHT come here for information, blast them outta here based on preconcieved notions that they MUST be the "enemy."
This is just shameful. Do people feel like they "scored" when they chase a possible "troll" away? Is there some secret society that awards you a trophy for doing so?
Whoever this person is, they have done NOTHING that would harm anyone.
Grow up.
-------------------- Positive 10 bands WB IGG & IGM + Babesia + Bartonolla and NOW RMSF 3/5/09 all at Quest
cottonbrain
Frequent Contributor (1K+ posts)
Member # 13769
posted
while it may be true that MarylandMD has "done no harm" directly, we do have to be ever vigilant of people who may, through arrogance or well-meaning misunderstanding,
further propagate misinformation about Lyme Disease and coinfections.
This particular poster started a thread on the premise of "discussing" our misguided understanding about the need for testing. She / he then ended the discussion by saying
that we had hurt her on a personal level -- but you will note that NONE of her opinions changed from the beginning of her post to the end, despite many people's generous efforts to
provide educational material. She summed up her sentiments by stating [paragraph breaks my own -- she did not observe suggestions to break up the text]:
"I remain uncertain whether long term symptoms can be attributed to ongoing infection vs. a post-lyme (or alternatively CFS) inflmatory syndrome. I am even less certain whether it
would be adviseable to treat these patients with long term antibiotics, which are not without the potential for serious risk. I admit that some
patients with chronic symptoms do seem to improve with long term antibiotics, but whether this is do to killing of pathogens, the placebo effect, length of time (i.e. it's not the 12
months of antibiotics that led to the improvement but simply the fact that 12 months have passed), or some of the well known anti-inflamatory or neuromodulating effects of antibiotics is unknown."
This statement is a RED FLAG -- the suggested reading material was ignored but the IDSA attitude remains.
MarylandMD, I truly do not intend this to be a personal attack; I know what that is like -- for sixteen years I have been berated and ridiculed at the hands of over fifty non-LLMD's.
At first my big ego was pulverized; but out of its ashes were born compassion and humility. Perhaps just saying so means I must ask myself if my ego is getting in the way again. Perhaps you will ask yourself this same question.
Posts: 1173 | From USA | Registered: Nov 2007
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daise
Unregistered
posted
And ... more objected--not just me. But it has to be spelled out further:
AliG, Tails, Tickedoffin NC, Keebler, Fuzzy Slippers, (Northstar? Can't remember,) and Cotton, besides Tincup and Treepatrol and the nasty PM's--by his or her admission.
You never read this thread--yet slammed me! No one else--but me.
Come on!
I know it can be hard to tell where some posters are coming from. But not this one.
He was advised to go to ILADS website several times--yet he did not. That is huge! So he sought medical information ... from us?
He reeled-in some ill patients with Lyme, claiming he wanted information. He would not even go to the ILADS site.
Clearly, in his reversal seen in his last post, he ended up slamming we who come to Lymenet!
And he or she claims to be a doctor!
And some of you STILL fell for it and still don't get it--and slam me. Just me. Even when he or she all but proclaimed in the last post the attitude: Ya, you stupid people with Lyme.
Troll, plain and simple. A troll's work is to harm a blog.
I think this person's intention was to stir up trouble, doctor or not
I followed the whole post and he/she did make several inflammatory remarks along the way.
Regardless, this is a patient support site, not a site for a doctor to come tell us if he/she believes we are sick or not
been there, done that...
BTW - I am not a doctor but worked in several hospital settings prior to my illness very closely with physicians
I have an understanding of what would be considered "appropriate behavior"
and a "doctor" coming to a patient support forum to start a "healthy debate" or whatever maryland md said in their 1st post about the validity of our illness, diagnosis, and treatment
is highly unprofessional and completely inappropriate - if this person wanted to learn more about treating Lyme medically (which I agree would be great)
there are many professional avenues available to pursue this goal - which we freely shared and this person apparently chose not to pursue
additionally, marylandmd did elighten us with the fact that Western medical training leaves something to be desired
I am in complete agreement on that one!
-------------------- "We must be willing to get rid of the life we've planned, so as to have the life that is waiting for us" - e.m. forster Posts: 921 | From PA | Registered: Jan 2004
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posted
How very typical , to summarize without any PERSONAL experience. I have been confronted with know it all's time and again,who think they know what this monster feels like in my body , this one seems to have all the answers . This is the type I am trying to avoid.
Hence, I came on this forum for a bit of fresh air, people who know how it really is. I won't have the wool pulled over my eyes, so to me somethings not right in my opinion.
This is not a MD , I believe this is a fake, unless proven wrong. Then I stand to be corrected . This is not meant to offend any on this board as to there own opinion.
Posts: 153 | From England | Registered: Jun 2008
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posted
Hi MarylandMD, I sent you a "PM" private message.
Whether or not you believe MarylandMD is a "Troll" (which is a pretty childish term to use...we are all (for the most part) adults here.) If you believe he/she is a troll, simply do not respond to their posts. It seems many of us (including myself) believe this is a legit. doctor wanting to learn about Lyme for their patient.
What kind of impression do you think MarylandMD has of Lyme patients now, after the way he/she was treated on this thread?
>.....This is how Lyme patients get a bad name, this is why some mainstream doctors use derogatory terms like "Lyme wackos" and the like. It's a select few that ruin it for everyone.
Goodluck MarylandMD, I hope you are able to find the resources to help your patient recover.
-JKMMC09
Posts: 371 | From CT | Registered: Jun 2008
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-------------------- "We must be willing to get rid of the life we've planned, so as to have the life that is waiting for us" - e.m. forster Posts: 921 | From PA | Registered: Jan 2004
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METALLlC BLUE
Frequent Contributor (1K+ posts)
Member # 6628
posted
I think you've learned quite a lot since your original post and I've seen progression to a point where I am satisfied with your current beliefs. I feel confident knowing you'll advance further on your own, and that you'll refine the knowledge your currently have.
Excellent work sir. Remember, message me if you need those studies and additional data. I've been collecting the abstracts for a couple years now.
-------------------- I am not a physician, so do your own research to confirm any ideas given and then speak with a health care provider you trust.
The House of God is a satirical novel by Samuel Shem (a pseudonym of the psychiatrist Stephen Bergman), published in 1978. It portrays the psychological harm done to medical residents during the course of medical residency in the early 1970's.
Storyline
Dr. Roy Basch is an intelligent, naive junior resident (i.e., intern or "tern") working in a hospital called the House of God, after completing his medical studies at the BMS ("Best Medical School").
He is poorly prepared for the grueling hours and the sudden responsibilities without good guidance from senior attending physicians.
He commences the year on a rotation supervised by an enigmatic, iconoclastic and wise senior resident who goes by the name The Fat Man.
The Fat Man teaches him that the only way to keep the patients in good health and to survive psychologically is to break the official rules.
The Fat Man provides his residents with wisdom such as his own "Laws of the House of God" (which amount to 13 by the end of the book).
One of his teachings is that in the House of God, most of the diagnostic procedures, treatments, and medications that are received by the patients known as "gomers" (see Glossary, below) actually harm these patients instead of helping them.
Basch becomes convinced of the accuracy of the Fat Man's advice and begins to follow it. Because he follows the Fat Man's advice and does nothing to the gomers, they remain in good health.
Therefore, ironically his team is recognized as one of the best in the hospital, and he is recognized as an excellent intern by eveyone, even though he is breaking the rules.
Later, Basch must leave the Fat Man's team for a rotation with another team. He is supervised by a more conventional resident named Jo, who, unlike the Fat Man, follows the rules, but ironically, unknowingly hurts the gomers by doing so.
Basch survives the rotation with Jo by claiming to perform numerous tests and treatments on the gomers while in reality he actually does nothing. These patients again do well, and Basch's reputation as an excellent intern is maintained.
The book also details the great amount of hard, distasteful work the residents must perform, the sometimes poor working conditions, their lack of sleep, their lack of time to spend with friends and family, and the emotional demands of the work.
During the course of the novel, working in the hospital takes a psychological toll on Basch. His personality and outlook change, and he has outbursts of temper.
He has adulterous trysts with various nurses (portrayed in great detail) and Social Service workers (nicknamed the "Sociable Cervix"). and his relationship with his faithful girlfriend Berry suffers.
A colleague, Wayne Potts, who had been constantly badgered by the upper hierarchy and haunted by a patient, named Lazlow and nicknamed "The Yellow Man" for his fulminant necrotic hepatitis, who goes comatose and eventually dies because Potts had not put him on steroids early on, commits suicide.
Basch becomes more callous, and he secretly euthanizes a patient, a man called Saul the leukemic tailor, who had gone into remission once but was back in the hospital in incredible pain and asking for death.
Basch becomes more and more emotionally unstable, until finally his friends force him to attend a mime performance by Marcel Marceau, where he has an experience of catharsis and recovers his emotional stability.
By the end of the book, it turns out that the psychiatry resident, Cohen, has managed to inspire almost the whole year's group of interns and two well-spoken policemen, Gilheeney and Quick, to pursue a career in psychiatry, and that the terrible year has convinced most of the interns to receive psychiatric help.
The book ends with Basch and Berry vacationing in France before he begins his psychiatry residency, which is how the book begins as well. But even while vacationing, bad memories of the House of God haunt Basch.
He is convinced that he could not have gotten through the year without Berry, and he asks her to marry him.
Laws of the House of God
1. GOMERS DON'T DIE. 2. GOMERS GO TO GROUND. 3. AT A CARDIAC ARREST, THE FIRST PROCEDURE IS TO TAKE YOUR OWN PULSE. 4. THE PATIENT IS THE ONE WITH THE DISEASE. 5. PLACEMENT COMES FIRST. 6. THERE IS NO BODY CAVITY THAT CANNOT BE REACHED WITH A #14 NEEDLE AND A GOOD STRONG ARM. 7. AGE + BUN = LASIX DOSE. 8. THEY CAN ALWAYS HURT YOU MORE. 9. THE ONLY GOOD ADMISSION IS A DEAD ADMISSION. 10. IF YOU DON'T TAKE A TEMPERATURE, YOU CAN'T FIND A FEVER. 11. SHOW ME A BMS (Best Medical Student, a student at the Best Medical School) WHO ONLY TRIPLES MY WORK AND I WILL KISS HIS FEET. 12. IF THE RADIOLOGY RESIDENT AND THE MEDICAL STUDENT BOTH SEE A LESION ON THE CHEST X-RAY, THERE CAN BE NO LESION THERE. 13. THE DELIVERY OF GOOD MEDICAL CARE IS TO DO AS MUCH NOTHING AS POSSIBLE.
Context and impact
The book takes place during the Watergate scandal, and follows such events as the resignation of Spiro T. Agnew and the stepping-down of Richard Nixon.
The book is very likely autobiographical, as the BMS is a thinly veiled Harvard Medical School (commonly called HMS), and The House of God representing the Beth Israel Hospital now a part of Beth Israel Deaconess Medical Center, one of the HMS-affiliated hospitals in Boston, Massachusetts.
It is very likely that some details have been exaggerated (such as an orgy in the resuscitation room), and towards the end of the book events take on a semi-hallucinogenic tone, both of which can be taken as a depiction of the effects of chronic stress and sleep deprivation.
In any case, upon its appearance, many American doctors felt that "The House of God" resonated with their own experiences during their internship training. However, according to the author, many older physicians were offended by the work.
Glossary
Several of the terms common to the jargon of junior hospital staff were widely popularized by the book:
To turf (verb: to find any excuse to refer a patient to a different department or team)
To bounce (verb: a turf that has returned to its first department)
Gomer (noun: "get out of my emergency room" - a patient who is frequently admitted with complicated but uninspiring and incurable conditions)
LOL in NAD (noun: "little old lady in no apparent distress" - an elderly patient who following a minor fall or illness, would be better served by staying at home with good social support, rather than being admitted into a hospital with all the iatrogenic risks of modern medicine.
Compare "NAD" = "no abnormality detected" (used to record the absence of abnormal signs on examination).
Zebra (noun: a very unlikely diagnosis where a more common disease would be more likely to cause a patient's symptoms - from the common admonition that "if you hear hoofbeats, think horses, not zebras").
Cultural references
In-jokes abound in the work. One of the principal characters is Eat My Dust Eddie, a doctor so-called because of the saying embroidered on his jacket.
His name is often abbreviated as EMD, which is also the acronym of the feared terminal cardiac event electromechanical dissociation, otherwise known as pulseless electrical activity.
In 1984, a film was made out of the book but never released in theaters or on VHS/DVD. The film was shown on HBO a few times, mostly as filler in non-peak hours.
It starred Charles Haid as The Fat Man, Tim Matheson as Roy, and featured Ozzie Davis as a doctor-turned-patient. Michael Richard was also in the film, playing Dr. Pincus.
The TV medical sitcom-drama Scrubs features numerous references to The House of God, which was reading material for some of the show's writers.[1].
"Turfing", "Bouncing" and "Gomers" occasionally feature in the show's dialogue, in the episode My Balancing Act, Dr. Cox quotes the Zebra rule ("Newbie, do you happen to know what a zebra is? It's a diagnosis of a ridiculously obscure disease when it's much more likely that the patient has a common illness presenting with uncommon symptoms.
In other words, if you hear hoof-beats, you just go ahead and think horsies -- not zebras.") and in the episode My Student J.D. quotes the medical student rule ("A famous doctor once said, "Show me a med student that only triples my work, and I'll kiss his feet".").
There is an interesting article in the AAFP journal on professionalism in Family Practice. It speaks of the current lacking among practitioners and makes suggestions for improvement.
I had read this article and am certain that, had my LLMD read it, he had taken it to heart because, from what I could see he is the "poster child" for medical professionalism.
That book could very well be the reason for the need for the AAFP article and it's reading during medical training would explain a lot for the attitudes frequently encountered by people who present with many strange and seemingly inexplicable symptoms.
I DO try to see things from both sides and I understand that it is much easier to dismiss a patient and just hope they'll get better on their own or go away, when a doctor really can't find the answers with tests because of the flawed testing.
Thank you for sharing that and I hope that the IDSA guideline review will shed more light on this plight and lead to a better understanding for ALL physicians.
You are willing to treat your patient and that is noble in light of what you've been taught. I hope that your patient DOES prove to be one that has Herxheimer reactions and a WB that converts to positive. I think that would be very rewarding for you to have that experience as an open-minded physician.
I pray that you are able to help your patient get well.
Please also test your patient for any possible co-infections as it is very important to address them, if the patient is to truly get well.
May God bless you & guide you. Ali
-------------------- Note: I'm NOT a medical professional. The information I share is from my own personal research and experience. Please do not construe anything I share as medical advice, which should only be obtained from a licensed medical practitioner. Posts: 4881 | From Middlesex County, NJ | Registered: Jul 2006
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AliG
Frequent Contributor (1K+ posts)
Member # 9734
posted
Aside to others:
There is nothing this poster has said (IMO) that could definitely, beyond the shadow of doubt, indicate that s/he is NOT actually a doctor.
Everything that has been said IS what is taught in med school. That is why we have the problems we do.
On the off-chance that s/he truly is an MD, I am not willing to take the chance of harming another's chances of having their PCP enlightened and gaining the help s/he needs.
If it is actually a troll, there are great links and a lot of good info in this thread that many can use for enlightening other MDs they may encounter who might be persuaded to consider a Tx trial.
just my thoughts......
-------------------- Note: I'm NOT a medical professional. The information I share is from my own personal research and experience. Please do not construe anything I share as medical advice, which should only be obtained from a licensed medical practitioner. Posts: 4881 | From Middlesex County, NJ | Registered: Jul 2006
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posted
What a shame so many contributors had to be so negative. And some quite harsly. The Maryland Doc wasn't asking any personal information regarding other Dr's names or contributors names. So what difference does it make if you believe them or not. And how do you know s/he didn't go to all the sites that were listed. I did. There are a lot of people on here that have a wealth of information, why wouldn't a medical professional want to access that.
Posts: 21 | From california | Registered: Jul 2008
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Keebler
Honored Contributor (25K+ posts)
Member # 12673
posted
-
MarylandMD:
Thanks for stopping by. I appreciate your long last post - and the time to become somewhat acquainted with TBD.
I just have a couple thoughts:
1. (a smile here will be okay) From what I've studied - and lived - I don't think there is a placebo effect with lyme. I really tried for that many times.
I would even say I felt better than I did just to hope it would work. I studied hypnosis and retrained my speech to use only happy terms. Nice try but it was denial disguised.
And (is this thought #2 ?) - many researchers are learning more about various stages of infection. For those of us who never got treatment (even with 3 positive TBD western blots and severe illness) naturally, we hope to find it, treat it and get our life back.
Still, hey . . . if someone can actually help soggy immune systems without using steroids, I'm listening.
My guess is that it's multifaceted and with more support for the liver.
I, too, have been troubled by the "herx" - still, with liver support such as milk thistle and good self-care, that can be minimized. I also know of a few LLMDs who will not treat so intensely as to have a herx result.
(Ask ILADS's about the research of Martz, a recently retired LLMD from Colorado who, himself, had a dx of ALS but when it was found to be wrong dx and that lyme was present, he treated for lyme and got well enough to go back to work before he retired to write up his research notes.)
So, I hope we all continue to learn more. Oh - I don't think we even touched on why lyme / TBD patients seem to have elevated mercury more so than the general population. One of the ILADS doctors has looked at that but I forget which one.
Sure enough, when tested 3 times, mercury was always elevated. So, as we all here have come to know, that is another aspect of all this that must be addressed.
I had forgotten to post one more article that I've recently encountered. I'll couple it with another that I did previously post, but they go so well in tandem, that it's good now to list them as a pair.
Thanks again for coming here. I hope the next stop is to watch the ILADS DVDs of conferences. I learned so much from seeing these doctors - hearing them - discuss.
And, if you have felt unwelcome here sorry. It happens to some of us here, too. If you have felt pressure to learn more (please, please, please) it is because we want to become well and we need doctors. That need grows by the day.
Too many here are self-treating in the absence of good doctors, health insurance or for other reasons.
We, here, have had to learn but, believe me, this is not the job I had envisioned while struggling through grad school.
We need doctors. Good doctors who are expert and know spirochetes and babesia and all the TBD inside and out. Thanks again for taking a look in the window.
Health to all. Soon.
-
[ 11. July 2008, 07:35 PM: Message edited by: Keebler ]
Posts: 48021 | From Tree House | Registered: Jul 2007
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Keebler
Honored Contributor (25K+ posts)
Member # 12673
The excellent article below explains a lot about what chronic neuroborreliosis can do. It also details other chronic stealth infections, such as Cpn - and others - that should also be assessed in all chronic patients, especially those with neurological symptoms.
Cpn also has various cycles and forms (cyst, etc.) and different drugs address different stages. As with Bb, Cpn also requires combination treatment to address all the forms and phases.
Much more research from Vanderbilt can be found at the patient site below.
Your "beliefs" seem reasonable to me, albeit I think that you came to them rather quickly given that it has been two days since your first post. I am not certain what, if anything, this means.
Nonetheless, you have developed reasonable beliefs.
My concern is... what do these beliefs translate into in actual, day-to-day medical practice? Have you considered this? More important than your individual beliefs will be your behavior (to include not only your demeanor and compassion, but your actual practice of medicine) when presented with a patient who defies the accepted norm. Many physicians share your beliefs, which on the surface appear reasonable and rationale, but the way they actually practice medicine does not match these stated beliefs.
Typically they do not recognize that their stated beliefs are somewhat inconsistent with their actions.
Three alternative ideas to consider regarding your beliefs... first, there is a real possibility that fibromyalgia and CFS are triggered by bacterial infections that render the individual's immune system more susceptible to viral infection. The viral infection is what is "measured" and therefore believed to be the ultimate cause.
Second, for most treatments, the placebo effect occurs in 20% or less of patients... the vast majority of patients and/or study subjects DO NOT experience the placebo effect. Were I a betting man, I would not bet on placebo.
Third, each day (not literally) there is more evidence that post-Lyme syndrome (if there is such a thing) is not an accurate description of chronic or late-stage Lyme whether treated or untreated. There are numerous animal models, using both dogs and monkeys, that demonstrate that a better way to formulate MOST cases is active infection as opposed to an inflammatory cascade and/or autoimmune reaction of some type. New data is emerging almost constantly.
There will be a paradigm shift regarding Lyme disease fairly shortly, in the big scheme of things. For many people, however, it will be too late.
Again, good luck to you.
Posts: 129 | From Virginia | Registered: Feb 2008
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He admits he was taught almost nothing in medical school about such diseases. He apparently did not consult any of the sources of information we suggested. He arrived quickly at a belief system that doesn't seem to be based on any real information, then. How often have we seen this in action in doctors' offices?
I hope he does try to help his patient, and finds that actual information and experience of others who already do this job will be needed. And then he goes and gets the help he needs to best serve his patient.
But doctors are busy these days and who knows if this doctor will take the time.
Posts: 8430 | From Not available | Registered: Oct 2000
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Marnie
Frequent Contributor (5K+ posts)
Member # 773
posted
The doctor's posts were educated and reasonable and he was met here with suspicion and hostility by some.
You all may have lost a future ally.
If I was in his shoes, I wouldn't touch a lyme patient with a ten foot pole given his experience with several (thankfully not all) lyme patients here.
We ALL need to educate others, NOT insult others.
You catch more flies using honey. Be nice if you want help.
Some doctors, a few, DO indeed welcome learning about the "latest" from their internet savy patients and family members:
[ 12. July 2008, 01:22 AM: Message edited by: Marnie ]
Posts: 9481 | From Sunshine State | Registered: Mar 2001
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AliG
Frequent Contributor (1K+ posts)
Member # 9734
posted
Keeping you in my prayers. Ali
-------------------- Note: I'm NOT a medical professional. The information I share is from my own personal research and experience. Please do not construe anything I share as medical advice, which should only be obtained from a licensed medical practitioner. Posts: 4881 | From Middlesex County, NJ | Registered: Jul 2006
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Kudzuslipper
Frequent Contributor (1K+ posts)
Member # 31915
posted
Maryland MD! Please stay on the board. I wish you were in my area. You sound like a fantastic open minded physician. I am truly impressed you have taken the time to come here.
I agree with most everything on your numbered list.
I've stopped being mad but now realize medicine is an art and a lot of trial and error. A smart pcp who is willing to work with a patient is worth a lot of respect.
Posts: 1728 | From USA | Registered: May 2011
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Keebler
Honored Contributor (25K+ posts)
Member # 12673
posted
- Maryland MD is long gone. Very old thread.
He / she posted just 7 posts, all between July 7 & July 10, 2008. -
Posts: 48021 | From Tree House | Registered: Jul 2007
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