Tuesday, August 14, 2007

When the lioness finally rears her head

A recent 'discussion' over homelessness on this site has gripped me like a tick. It won't let go. Not that I'm not reminded of homelessness every day when I pass the McDonald's on Ashland & Fullerton (?) or after work at the expressway ramp. But the homeless population I never see are the families and there's a good reason for that.


According to the report, "Family Homelessness in Our Nation: A Problem with a Solution", by the National Alliance to End Homelessness, families are the hidden homeless population. This is why the city of Chicago's recent 'survey' of homeless is a load of poopy diapers.Add to that, news from the Sun-Times that the Guv, G-Rod, considers homeless shelters 'pork'.

In their report, the National Alliance used Washington, DC, our wonderful nation's capital, as the example, but then also reports state and national data points. Here are some highlights to ponder:

  • 30% of children in the foster care system have a homeless or unstably housed parent;
  • A housing subsidy, at a cost of $6,805 per year, is a significantly more cost effective way of dealing with lack of housing than placing children in foster care at approximately $17,000 per year;
  • 5 million families receive federal assistance to pay for housing, but there are at least twice that many families eligible for such subsidies that do not receive them because of lack of funding;
  • In 1971 there were 300,000 more affordable units than there were low-income families who needed them;
  • In 2001 there were 4.7 million fewer units than families;
Abuse in the home is one reason families become homeless. Despite what naysayers may say, abuse is a very complex cycle to break. Mostly because those being abused are often broken of their will and separated from loved ones. One brave mama tells her story:

I left after a 'minor' beating, meaning no skin breaking/bleeding,and no kicking. He 'just' pushed me into a wall, smacked me really hard several times and knocked me down. This was in response to him coming home and finding me on the phone. He had recently stopped taking the phone with him when he left and allowed me to use the phone again, so I thought it was ok to use the phone when he was gone. I was wrong in that belief and I paid for it that day.


I say this was a minor beating because prior to this much worse had occurred. I had been thrown down a flight of stairs and lost a baby, I had my head banged on the sidewalk leaving me with multiple fractures to my skull, and I had been held hostage, duct-taped, and threatened with a hatchet in front of our child. So why was the 'minor' beating the trigger for me to leave? One reason is it was the proverbial straw that broke the camel's back.


A bigger reason was my daughter I-bop's response. Usually after he beat me he would storm out. I would cry and she, age 3 at the time, would rush to console me, hugging me and patting my face. I lived for those moments of kind touch from someone and felt my daughter was the only person who cared for me in the world. This time she looked at me sobbing and shook her head, and turned away. She actually turned her back on me, hunched her shoulders, and started playing with her toys. Her whole body language conveyed, You are a sorry woman and you get no more pity from me. It was like being doused with cold water. I saw clearly for the first time how it all was negatively affecting her. The hunched shoulders were a clear sign because that was how she was whenever he was around; all hunched over and afraid. It occurred to me that my child was also afraid of...me. and I understood why she would be, because she saw, at 3 years old, that she couldn't depend on me or trust me to keep her safe. She saw that I couldn't even keep my own self safe. I saw clearly for the first time that my child deserved better. My child deserved a chance.

Read the rest.


How fragile is the support system for families? So fragile that word got out that the only shelter for families in Massachusetts had burned down and the blogosphere was a fire with outrage. It wasn't, but it was the only one for a certain population.


Women are keenly aware, even if we live in a state of denial, that we are often living on the edge of poverty. Whether due to losing our job, getting so sick we can't work, losing our partner due to divorce or death, we just know. I have a good paying job, but I couldn't afford to stay here if my partner died (insurance will help). In today's tight economic reality, even couples are one paycheck or accident away from poverty.


Homeless moms and dads are a part of this community. To say that they don't deserve our help or respect is to deny that it could ever happen to us. We who are hard working. We who are highly educated. We who would never chose to be homeless.


As mothers we are even more aware that sacrifice ourselves on a daily basis for our kids. Whether we stay up a few extra hours to get laundry done, bake that last batch of cookies, or skip out on that much needed massage because well, someone needs to cuddle, we sacrifice. We want the best for our kids and society tells us that means two parents and a nice home. Why would we leave that?


I have a friend whose mother chose to be homeless instead of staying with someone who abused her and the kids. And for that, I thank her, because she saved three kids and herself. I thank the shelter who helped them get on their feet. But I hate to think that if she had to make that decision today, my friend and her brothers might be very different people.


X-posted from The Red Thread at Chicago Parent

Technorati tags: homeless, feminism, family

Blogging, Microblogging and Facebook

Steve Rubel of MicroPersuasion comments on a recent trend -- he blogs less and spends more time on Twitter ("microblogging" in 140 characters or less) and Facebook.

It seems like the "influentials" in the tech blogging world are also moving in the same direction. Has the blogging peaked or has it just become relatively more mainstream?

Among medical bloggers, Joshua Schwimmer also uses Twitter and has transformed KidneyNotes into a collection of selected links. He writes 2 other blogs -- Tech Medicine and EfficientMD, and has a profile on LinkedIn.

It will be interesting to see how microblogging (Twitter) and social networking (Facebook) will shape the future of medical blogging as we know it.

References:
When Less is More and More is Less. Micro Persuasion, 07/2007.
Newbies Guide to Twitter. ChrisBrogan.com, 08/2007.
Identity Through Online Lifestreams. Micro Persuasion, 08/2007.
Image source: Twitter.com.

Monday, August 13, 2007

Would you like to see Dr. Google or Dr. Microsoft for your personal health records?

According to the New York Times:

Microsoft’s software powers more than 90 percent of all personal computers, while Google is the default starting point for most health searches. People are increasingly turning to the Web for health information and advice. A Harris poll found that 52 percent of adults go to the Web for health information, up from 29 percent in 2001.

"Today, only about 20 percent of the nation’s patient population have computerized records. Under federal law, people can request and receive their personal health data within 90 days. But the process is complicated, and the replies typically come on paper, as photocopies or faxes."


Adam Bosworth talks about GoogleHealth. Image source: AlphachimpStudio, a Creative Commons license.

More or less, the current equation is as follows:

Microsoft = personal computer
Google = Internet

Both Google and Microsoft are reportedly preparing products aiming at the potentially huge market of personal health records.


A screenshot of Google Health. Image source: Philipp Lenssen, a Creative Commons license.

Microsoft’s offering is scheduled to be announced this fall, while Google’s will probably be introduced next year. The launch of new software products frequently faces multiple delays and missed deadlines -- Windows Vista is a good example. Most likely, "Dr. Google" or "Dr. Microsoft" will not be available to see you before 2008-2009.

Update 10/06/2007:
Microsoft launches an online personal health record portal called HealthVault.com.

References:
Dr. Google and Dr. Microsoft. NYTimes.
Google Health Prototype. Google Operating System.
First Google Health Screenshots. Philipp Lenssen.
Who's your patients' best friend? Google!
Google Finds Correct Diagnosis in 58 % of Cases Published in NEJM
Google, M.D. In Action
Google, M.D. In Action - Part II
"Google, M.D." at the Clinic
Image source: Doctors Using Google by Philipp Lenssen, used with permission.

Related:
Microsoft HealthVault and Google Health - The 'Coke and Pepsi' of Online Health (PHR). ReadWriteWeb, 10/2008.
Google now wants to diagnose your disease, offers differential diagnosis based on 10 sites and Wikipedia http://goo.gl/SD1qM

Birth Control Ninja

The last week was crazy at my house, but things worked out fine and I was able to meet a friend (who moved to the burbs, traitor) Saturday night for The Second City's Girls' Night Out: Touched Up at the Metropolis in Arlington Heights. First, I love Second City. I rarely see improv if my friend from Brooklyn, who is an improv junkie, isn't in town. Second, I met my friend while we were serving on the board of the Chicago chapter of NOW many moons ago. Thus, you have the expectations set. Funny and Feminist. Yes, we are too both!

The audience was 90-95% women, but letmetellya, it was not a man bashing show at all. In fact, I'd say that it was pretty harsh on us gals, so guys, feel free to join your partner at this show. BUT, women, this show was pretty funny and well, the title says "girls night out" and I do believe in following directions.

My favorite skits included a marriage therapy session where the wife tells a story, the husband recounts it, and well all know he isn't really "listening" to her. It goes on and on until a fairly good punch line. But honestly, the best punch line came 10 seconds after we stopped clapping when a woman in front of me asked, "Are we really like that?" Um, yes.

Claudia Michelle Wallace sings an outstanding love song to Barak Obama. Sorry, I didn't take notes, but I remember that I didn't stop laughing.

There was also the skit where the one man in the show talks to his fellow white hetero males aka Republicans (that's what he said, not me!) about voting for Hillary. Yes, Hillary. Why? Because if she wins, us chicks can stop whining about discrimination. Kinda like when people say the country is color-blind because Condi Rice is so powerful. Um, yeah...

The worst skit had to be the pseudo-lesbian aka really drunk hetero BFFs deciding to have sex. It winds its way to a breast cancer scare! Sorry to spoil it, but come on, breast cancer? So wrong on many levels, including having the audience sit far too long in silence before a really bad punchline.

Overall it was a good show and worth the drive out and back. I guess if the suburbanites can drive to North & Wells, I can drive to AH. And you'll have to see the show to figure out the title of this post. Or buy me a martini.

GNO runs August 2 - September 1, 2007 and tickets are $25. Shows are on Thursdays 7:30 p.m., Fridays 8 p.m., Saturdays 7 p.m. Grab your tickets here.

Technorati tags: Second City, Improv, Arlington Heights, Girls Night Out, comedy, feminism

U.S. Life Expectancy Shorter Than 41 Countries

According to the National Center for Health Statistics, the life expectancy in the U.S. is shorter than 41 countries including most of Europe and Japan.

Dr. Christopher Murray, head of the Institute for Health Metrics and Evaluation, comments that "something's wrong here when one of the richest countries in the world, the one that spends the most on health care, is not able to keep up with other countries."

What are the likely causes?

- High prevalence of obesity in the U.S.
- Racial disparities
- Relatively high infant mortality rate
- 45 million Americans lack health insurance

The life expectancy ranges from 82.6 years in Japan to 39.2 years in Swaziland - see the map. Many of the countries with the lowest life expectancies, e.g. Swaziland, Botswana, Lesotho, Zimbabwe, Zambia, Mozambique, South Africa, Central African Republic, and Namibia, are suffering from very high rates of HIV/AIDS infection, with adult prevalence rates ranging from 10 to 38 percent (source: Wikipedia).


Life Expectancy Falls In Pockets of U.S. WSJ Health Blog. In the the animation, greener equals longer life expectancy.

References:
A color-coded map of the world’s most and least emotional countries http://bit.ly/Ytxx6B
U.S. life span shorter. Associated Press, 08/2007.
List of countries by life expectancy, from Wikipedia, the free encyclopedia.
World’s Best Medical Care? NYTimes, 08/2007.
U.S. life expectancy lags behind other countries'. CNN.
Image source: Wikipedia, GNU Free Documentation License.
How low can you go? Megan McArdle, 08/2007.
Life Expectancy Falls In Pockets of U.S. WSJ Health Blog, 04/2008.

Should mesalamine be stopped prior to noncardiac surgery to avoid bleeding complications?

A 53-year-old Caucasian male with a past medical history of Crohn's disease, hypertension, hypercholesterolemia, osteoarthritis and atrial fibrillation takes mesalamine (Asacol) to control his diarrhea. His other medications include atenolol, warfarin and simvastatin. He also takes oxycodone and acetaminophen prn for hip pain. The physical examination is normal apart from irregularly irregular cardiac rhythm. The electrocardiogram shows atrial fibrillation with heart rate of 67 beats per minute. His exercise tolerance corresponds to 6 METs.

The patient is seen by an internal medicine physician for preoperative evaluation one week prior to surgery for total knee replacement for osteoarthritis of the left hip.

The patient inquires whether she should stop mesalamine to avoid bleeding complications during surgery. His primary care physician told him that non-steroidal anti-inflammatory drugs (NSAIDs) may increase the bleeding risk.

Should we stop mesalamine to avoid bleeding complications during surgery?

No.

Mesalamine (Asacol) does not affect platelets the same way aspirin and other NSAIDs do.

According to one study, there was not effect on platelet aggregation during normal treatment with 5-aminosalicylic acid when given at a dose of 1.5 gm po qd or even after IV administration. All in vivo and in vitro tests were negative for inhibition of platelet aggregation in contrast to the inhibition seen with aspirin (acetylsalicylic acid). Authors concluded that treatment with mesalazine does not constitute a hazard to patients with IBD in regard to prolonged bleeding time caused by an influence on platelet aggregation or fibrinolytic activity.

This is one of the series of perioperative questions I will answer on this web site. They will be submitted as clinical vignettes to the Cleveland Clinic Annual Perioperative Summit next year. This year's summit is in September and several of the perioperative cases in nephrology will be presented as posters and published as abstracts in the Cleveland Clinic Journal of Medicine.

References:
Lack of effect of 5-aminosalicylic acid on platelet aggregation and fibrinolytic activity in vivo and in vitro. Winther K, Bondesen S, Hansen SH, Hvidberg EF. Eur J Clin Pharmacol. 1987;33(4):419-22.
Image source: Wikipedia, Free Documentation License.

Updated: 12/14/2009

Sunday, August 12, 2007

Medical University of South Carolina Launches a Comprehensive Podcast/Videocast Portal

Medical University of South Carolina (MUSC) Health Podcast portal features both audio and video podcasts:

"Our audio podcasts are hosted by various MUSC faculty, physicians and special guests. These podcasts cover a wide range of current health topics, featuring MUSC patients, physicians, and staff. Listen to patient stories, learn about new procedures being offered at MUSC, and hear the latest news on how to stay healthy."

Cleveland Clinic also offers Free Audio and Video Podcasts for Health Professionals and patients.

Link via Medical Lecturer.