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: 9424 | 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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