Tuesday, July 25, 2006

my DSM-IV code right now is 300.00, generalized anxiety disorder NOS

it was actually the second day of my psych rotation, but yesterday all we did was get our badges and watch a HIPAA video. i'm on the women's unit, which is both good and bad, being that women scare me in general and i have no experience with violent mentally ill women.

this morning we walked over to the unit, and had to go through a guard's station and about 10,000 locked doors. some of them you look yourself, and some lock automatically, but i can't remember which is which, so tomorrow will be interesting. as soon as we walked into the unit, the patients were lined up to go to breakfast. "oh, we got some white girls!" said one of the patients as we walked in, and everyone laughed, myself included. it was the pseudo clarice starling moment i had been waiting for.

as in all of mental health, everyone smokes, even the staff. i quit smoking in april and if anything, this reaffirms my decision because i realize how nasty smoke smells on people and everything else. even the air is hard to get used to, but the heat might have something to do with that.

the patients are for the most part non-threatening and just about everyone is quite respectful. most of them are trying to get to a step-down unit, so they know they have to behave. we saw about 6 of them today and they all had schizophrenia, which is my reading assignment for the night. since this is a forensic unit, all of them have been deemed NGI (not guilty by reason of insanity), incompetent to stand trial or need to be here for their parole. there's a good mix of crimes, and not all are here for manslaughter, which makes me feel better.

at first i was scared to turn my back to them, thinking that if i did, i'd get shanked. but then i noticed how the staff are not all paranoid, and i got way more relaxed, although i still got nervous when we were out in the yard and they were hovering around us. my classmate was really on edge, having never been exposed to psych patients before. i hope she gets through this month ok.

in reading their charts, i've seen some themes in mental health care within the prison system that i'm going to research a bit and write more about this month. i have to watch what i say very carefully (hence this dry ass post), but i expect to learn tons about how we treat our mentally ill criminals and how they are eventually rehabilitated.

our psych attending is young (um, like 3 years older than me) and is an alumnus of our school. he loves psych mainly because "people do get better". the money and chill lifestyle don't hurt either. will i lose the bet with my dean, who said i was destined for psych? i still feel like i like everything else, that going into psych is a waste of most of my education. i just can't stand the thought of going into the wrong field and things sucking for the next 30 years.

Tuesday, July 18, 2006

fourthmeal- the crispy, crunchy, cheesy and chewy road to diabetes

i'm in my last week on the endocrine service, and having seen my fair share of patients about to lose pieces of their lower extremities, i've been thinking a lot about all the little ways we seduce ourselves into insulin resistance and the big DM.

one of the most interesting recent ad campaigns lately is the taco bell fourthmeal concept, which comes complete with a sexy, sims-esque website where one can run amok for hours "rochambelling" other nacho cheese lovers or making special soft drink mixes a la the mr. pibb and orange soda suicides of 7th grade.

i can see why taco bell would want us to eat another meal and wants us to eat it with them. but do you think they did any legal research into corporate responsibility before they started their ad campaign? my best friend the lovely litigator says that even though there aren't any specific laws they could be sued under, it's still really irresponsible to market a new meal when it's obvious we all eat to fucking much already.

some scary data on diabetes, courtesy of the american diabetes association:

Total: 20.8 million children and adults -- 7.0% of the population -- have diabetes.

Diagnosed: 14.6 million people

Undiagnosed: 6.2 million people

Pre-diabetes: 41 million people

1.5 million new cases of diabetes were diagnosed in people aged 20 years or older in 2005.

these numbers don't include those with insulin resistance or impaired glucose tolerance (known as pre-diabetes on the street), conditions which are not considered diabetes themselves, but have a high rate of progression into diabetes.

now i dig taco bell (although i dig del taco even more), but it's such transparent manipulation that it turns my stomach.

the new hummer ads with the slighted soccer mom and the emasculated tofu-lover makes me feel the same way. they aren't online but i'm sure you'll see them soon enough if you haven't- the tofu guy bit played like 2 minutes ago while i was writing this and watching the "spice capades" episode of good food. we all know that ads like these are meant to provoke, and playing on the obvious insecurities of your likely customers is cheeky enough to work like gangbusters. of course i should buy a huge laughingstock of a car because i feel all small and shamed! it's like i never left de mille junior high after all! thanks to my big new fuck-off hummer i'm in my happy place again...

ok, back to fourthmeal. so we're eating all the time thanks to that hideous word snack, plus we're eating crap from places like taco bell (and del taco). but that's not enough! we need another meal, late at night, when we are likely to be drunk and in that state where we don't give a shit who we sleep with, much less how many calories we consume. no longer do we have to feel bad about eating so late, it's legitimized because the taco bell people told us so, right on the drive-thru menu board.

why not a fifthmeal? or eighthmeal? shit, why not just throw an NG tube of taco bell nacho cheese in and have perpetualmeal?

we know that eating too much and too many of the wrong foods can lead to diabetic conditions. so why are we still bombarded with shit like fourthmeal? why are people still eating hotpockets?

there is more media about healthier lifestyles, but so much of it is hollow, like the "Mediterranean diet" brochure i got in the mail from kaiser with my cholesterol results (don't ask, it involves family history and ikea meatballs). the letter said, "read this brochure and get your blood tested again in 6 months". no follow up with the doctor, no call, nothing. it's a start, but any effective lifestyle changes require better monitoring than a letter. kaiser wants to tout their preventative care while still providing the socialist masturbation they call managed care, which precludes any attempt at the necessary communication for said lifestyle changes. if the biggest private health provider can't be bothered to get on the lifestyle changes bandwagon and mean it, we're all potentially on the highway to metformin hell. and for every step forward that we make to educate the public and help stop diabetes before it starts, things like fourthmeal (it's ok! eat another meal, because you're hungry! very hungry!) add up to pushing us back.

we have to become resistant to suggestions that we eat more often, eat with our emotions and eat more cheesy bacon with bacon and cheese, and cheesy bacon-blasted ranch dressing. so many people still don't really believe that obesity and diabetes are linked, and that untreated diabetes leads to renal failure, blindness and getting your fucking feet cut off. health professionals need to take a tougher stance, and say something to every patient, every time, even if they don't have any of the signs yet. at first when i saw my attendings talking to patient's families about their own diabetes risks and flat-out saying things like "you're overweight, you need to lose weight and eat better because what is happening to your family member could happen to you", i was floored. but we have to try, make people uncomfortable, make them look at their father's leg stump, make them think. ultimately, it's us or taco bell.