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A couple of the research blogs I follow lately have had some insight that really struck me as they fought off dualism in regards to the thorny issue of psychological vs. physical addiction and the brain, arguing that the elimination of mind and body distinctions is a good thing, as addictive pathways are real, physical represented by neuronal circuits.

This is an interesting argument, that collapsing psychology to the brain mechanisms brain can erase stigma by medicalizing it and making it a matter of physical function.    In addiction it makes quite a bit of sense.  We know what part of the brain is being stimulated, that dopamine reward pathways are building and feeding the habit.  The derogatory statement, “It’s all in your head,” remains technically true, but loses its bite when you can explain it in such a real and tangible way. Read the rest of this entry »

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Few things in medicine are harder than trying to explain to a patient that you don’t understand what is going on.  As is common, I recently had an adolescent patient that had either psychosomatic stroke symptoms or actual acute resolving weakness exaggerated by anxiety.   As we very gently let him down, we explained that we could not find a physiologic reason for his weakness, now better, and that we would likely never know what caused it.  All the patient often hears in these conversations is a booming, “It’s all in your head.”  So it was under these conditions that the patient caught me off balance.  “How can you not know, you have been studying this stuff for your entire life?!” 

Avicenna, Islamic physician and philosopher

Avicenna, legendary Islamic physician and philosopher

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In Child neurology we are required to do a year of adult neurology. This is a year of complete culture shock. Children’s hospitals and adult hospitals are two completely different worlds. It is interesting to see the adult neurology residents complain about how chipper and upbeat the pediatrics people are. This is an odd complaint, until you realize adult neurology residents feel completely out of their comfort zone in knowing how to manage the patient. fear and discomfort are only augmented by sleep deprivation and being pulled in several directions at once, as you tend to be on call, Perhaps they can be forgiven when they really find it difficult to draw enthusiasm when awoken at 3am to hear about some “kiddo.” For me, being out of my element with adult patients is an even greater culture shock. Going from chipper to somewhat cynical and demanding is worse than the other way around.

The culture shock is particularly profound the Neuro ICU. For one thing, it is a prime site for so many spectacularly horrific things. While children with neurlogic problems can be heartbreaking, somehow I manage to deal with it. There is something about dealing with severe traumatic brain injury, brain tumors, stroke and brain hemorrhage all day that is particularly soul killing. The place is just saturated with death and loss. It was here I came to understand the phenomenon in medicine that is gallows humor.

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I have an admission to make. I have not seen a primary care physician in 5 years. As a resident the excuses come easy. Getting the smallest of chores can become a mammoth task in the face of an 80 hour work week. However, the fact remains, the things I really want done, get done, seeing a doctor does not. I even have really good reasons to see a doctor. I have tests that really should be done once every few years. I have had real problems that I have shoved aside, little things here and there that probably should really be checked, but deep down I don’t want to do it. Why is this? Read the rest of this entry »

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