Dr. Thompson's Blog

Getting a Second or Third Opinion On-Line

If you have a question about advice or a diagnosis you have been given by a physician, it  is always wise to get a second or third opinion. It could even save your life. There is a lot of misinformation on the Internet, but also some excellent information. One of the best resources is the Mayo Clinic at www.mayoclinic.com. I now refer all neuromuscular cases to Dr, Selcen at the Mayo Clinic because there are few well trained neuromuscular specialists in the U.S. Other countries do a far better job than we do with these patients. For information about cancer, the American Cancer Society is worth checking but I would want to check with another oncologist about any cancer diagnosis. I did this for my daughter when she was diagnosed with breast cancer. Sadly, the care she received at the Cancer Center ins New Mexico was very bad resulting in her death. WebMD is usually an excellent source www.webmd.com. Specific diseases have web sites such as the American Diabetes Association, www.diabetes.org.

If you can get a second opinion from a MD, who is a specialist in the disorder you want to know about, that is best. Never be afraid to do lots of research and ask a lot of questions. When I was in private practice and wanted answers, I always called one of the top specialists in the field. I  found this an easy thing to do. Usually the top experts are most generous with their time. I still help people around  the world find specialists for children or  adults with neuromuscular disorders and am glad to do so.  

Masks, Social Distancing, and the Corona Virus

I am puzzled by all the people who are demanding that everything be opened when the corona virus is so lethal and catching. I live now in a beach town and am amazed at all the people without masks, eating, and strolling around in groups. Don't they have any idea of what the virus can do? I guess they have never had to care for a patient in an ICU struggling to stay alive.  I have British friends who remember the World War II bombings as small children and the fear they had. We have been protected from all the wars this country has been involved in because they have not been on our land.  My father, brother, and husband were in the military and I know the toll it took on them.  My older brother was never the same after the second World War. 

We all would like things to get back to normal, have people get back their jobs and be able to pay their bills. But unless we do what is necessary to stop the spread of the corona virus, it is going to be a long haul. If everything is open too early, the country and all of us are going to pay a high price. Trump is not worrying about lives being lost but about the economy. His re-election is all that matters to him. As a physician I find that appalling when I have had to work so hard to keep many people alive. As parents and grandparents, we know  the lives of our children are at stake and we  must be very careful to follow the safety procedures which have worked well in some other countries.

Red Blanket Hospital Patients

When I was a Stanford Medical student, we treated all patients the same. Part of my training was at the excellent San Francisco County Hospital. We saw everything from tuberculosis (a whole ward) to Syphilis, Gonorrhea and even Leprosy. Now many medical students are just seeing routine heart and other patients except for the Corona virus. I wish they could have the wonderful experience we did at the two hospitals where we were trained. Now I am told by physicians that many medical schools and hospitals are mainly catering to the rich and affluent. These patients are given red blankets on their beds to distinguish them from those who do not have their wealth. I find that appalling. I realize that particularly now with the corona virus that hospitals are losing money because they are not able to do the elective surgeries that they did previously. How sad that plastic surgeons are no longer able to do all their cosmetic procedures for which they charge a great deal. I say this in jest because I have cared for many poor and disabled children and teens, many of whom have little or no money or good health coverage. 

Every individual has the right to good medical care and the idea that  people with wealth receive better care than others makes me very angry. That is not what medicine should be about. Having worked in a big London hospital, I saw no difference in how rich and poor patients were treated. Of course, those in the government receive the best of care, I am sure.

Not only do red blanket patients receive  excellent medical care, but they also are given gourmet food, have deluxe rooms and many other special services. Perhaps this pandemic will change the way we provide medical care in the U.S. so it is more equal. I certainly can hope.  

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Why Are So Many Medical Students and M.Ds Committing Suicide?

The suicide rate  among male medical students and physicians now in the U.S. is now 40% greater than the general population.  Sadly, the suicide rate among women medical students and physicians is 130% higher. In my medical school class at Stanford, two of our classmates committed suicide. Of course at that time there were just 2-3 women medical students  in each class. Now they constitute more than 50%. One of the reasons I suspect is today the students have no idea how difficult their days and nights can be. The students and residents today also don't know how different it is from when I was a medical student and resident. We worked every other day for 24 hours, whereas today, I am told, the students are on call at night only every three days. 

In thinking about what is going on I have a feeling that because the medical schools are just accepting A students, many of them come from private schools, families with money, and have no idea what the real working world is like. Several in my class did what I did to be able to go to medical school. I worked after school and summers from the time I was in my teens to be able to afford Stanford. Even though  a professor at Scripps College established a scholarship at Stanford  for me to go to undergraduate and medical school, I still had to pay for transportation etc. My father's top salary as a professor at Pomona College was $7000 as head of the department. My scholarship is still there for a woman who wants to become a doctor. What a great gift Miss Eyre gave me. 

Another reason I suspect the women are committing suicide is that they have no balance in their lives. It is all medicine and dating, having fun etc. are not things they have figured out how to do. 

Long-Term and Nursing Home Care

With all the recent corona virus deaths in nursing homes, this would be a  difficult time to decide what to do if a parent or elderly relative can no longer live at home. If someone is able to stay in their own home with a live-in caretaker that would be the best. However, finding the right  individual can be very difficult. When my father had a stroke after my mother died, my brother and I looked at several options for his care. He did not want someone living in the house to care for him, so we found the best nursing home we could. It was close to Pomona College where he had been a professor, so old colleagues and friends could visit him. We also paid extra for him to have a private room. He probably got better medical care than most of the  patients, because my brother was a hospital administrator and as a physician, the on-calI doctors knew I checked every two weeks on his care. I was working in Northern California and my brother was in Arizona, so we took turns visiting as often as we could.There are two sources for help if you need to find good long-term care. One is the Medicare website at www.medicare.com that has a nursing home comparison site. The Assisted living Federation is at www.alfa.org or 1-703-691-8100. it is important to ask about what  medical care is available and if possible speak to some of the patients.

I have always paid for my own long term care insurance because long-term care can be very expensive. By checking and re-checking on a parent or  relative's medical care and  also speaking with the medical personnel, your relative should get the best care possible. 

 

 

Fear and the Corona Virus

This is a very hard time for many families, particularly if they have lost a loved member of their family from the terrible Corona Virus. Having gone through the polio epidemic as an intern at Children's Hospital in San Francisco, I saw what a disease can do to families.  I learned long ago that you have to make yourself go just one day at a time. I was impressed that Governor Andrew Como of New York had assembled a mental health group where people could call a special number and speak to one of the professionals. Older people who remember the depression, the various wars the country has had or lost someone have learned to value each day. My much loved daughter died nine years ago this Saturday from breast cancer after receiving terrible medical care in Santa Fe at a so-called Cancer Center. I miss her greatly but am glad she had a rich, full life doing wonderful art and running a business. I keep in touch with her husband and two step-children, who now are married and have babies. By reaching out to other people, we can help them and ourselves  I hope that when we have a new president we will all have learned lessons which can bring us together as Republicans and Democrats, so we take better care of each other. Helping someone does make the days go more quickly I have found and there are many lost, lonely people who greatly need our help. 

Benign Hypotonia is not a Diagnosis

Neuromuscular disorders are frequently misdiagnosed in the U.S. because there are few neuromuscular specialists in this country. I have found that even some medical textbooks list Benign Hypotonia or Congenial Hypotonia as specific diagnoses. Even with all the genetic studies that neurologists usually order the correct diagnosis may not be made. In the last weeks, I have had e-mails from parents in Ethiopia, London, the east coast in the U.S. and Australia asking for help in finding a neuromuscular specialist. Fortunately , Professor Sewry and Professor Dubowitz in London always respond to my requests for names of  specialists. They have been good friends  from the times I spent working in Hammersmith Hospital in London, where they were formerly based. 

If an accurate diagnosis is not made, there can be no true genetic counseling and if there is new medication, as in the case of spinal  muscular  atrophy, a baby or child can not be given the medicine. 

I realize there is a great deal for medical students to learn these days and neurological training is not popular because neurologists do not make the money that specialists like plastic surgeons etc. make. 

If as a parent you have a baby or child with muscle weakness, you want to see a neuromuscular specialist, not a general neurologist. A large series of genetic tests are usually not necessary and certainly should never be the first thing that is done, A muscle biopsy using a local anesthetic and a CPK  or CK (outside the US) may be the only tests that are needed to make a diagnosis. 

Preventing Parasites in Pets from infecting your Children

Veterinarians can make a big difference if they are sure the parents of children who have dogs or  cats for playmates understand about the parasites that animals can transmit. The principal parasites are roundworms, tapeworms, and hookworms. Little children who  play in a yard barefoot are at risk for picking up parasites. If they play with their pets and then put  hands in their mouth, this can be a source of contamination. Some kids eat soil, grass or other areas contaminated by  parasites' eggs. 

One way to prevent infection is to have your pet or pets routinely dewormed. It is important to know that hookworm larvae can penetrate the skin. One study showed that 80% of parents had no idea that parasites were a problems with their children's pets. People who have pets spend billions of dollars on their animal which is far more money than is spent on children in the U.S.

One important fact is if pets are kept free from fleas, this can help prevent tapeworm infection. Also litter boxes need to be cleaned regularly  and hands washed afterwards. 

 

What is Needed to see a Specialist outside an HMO

If your HMO will not refer you to a specialist who is part of the HMO, there are several things an outside specialist will need. When you make the appointment, the secretary should know you have medical records at an  HMO and also be told if there are any X-rays, CT scans or MRIs. All of these can be sent and received by e-mail. It is important to check that the secretary has make the request and the records and other things have been received. You may have to check several different times before your appointment because some secretaries are very efficient, others are too busy and some don't  want to make the effort.  You want to be very pleasant at first, but if nothing has been done, you may have to become assertive. 

I had one parent who wanted her child to see by a specialist in another town. The HMO was not willing to help her in any way, so she resorted to an article in her local paper and as a final desperate attempt to get the appointment and records sent, she had her friends and family join her and  they picketed outside the the HMO facility. She was a former teacher and  a mild, pleasant woman. However, since she felt her daughter's life was at stake no measure was too hard for her. She got the appointment and the records transferred! 

Questions to ask your Doctor about a new Rx

Now that many doctors are limited to 8.5 minutes to see a patient, it is important for all patients to make sure they understand what to do when a new medication is prescribed. Be sure you know the name of the medicine and why it is being prescribed. It is important to know when to take it, ie. one, two, or three times a day and in the a.m  or p.m.  Also,  should you take it on a full or empty stomach? Is alcohol O.K. to  drink  with the Rx or not at all?  If you have any reaction should you call the doctor or what do you do? Are there known side effects?  Also you want to know if there is a cheaper generic form because many doctors have no idea what a medication costs. I remember when my good, long-time eye doctor prescribed a lotion for my itchy eyes. It was over two hundred dollars for a small tube and I did not buy it. I am sure he had no idea of the cost. 

A major problem that often occurs, particularly when a patient is taking several different drugs is that there may be interactions and problems  with some of the drugs. I have called pharmacies many times when a new medication was prescribed for patient and found that it interacted badly with a drug they were taking. This was true for children with seizures and other disorders. Sometimes doctors don't bother to ask if a patient is taking other medications and  don't check with a pharmacist to be sure there  are no bad interactions. A friend's mother was taking over 20 medications, so she took all the drugs to an excellent pharmacist and he was appalled. It took a while to get the different doctors her mother saw to straighten it all out.