Posted by: drrozkaplan | January 16, 2012

Welcome to doctorswrite

Welcome to doctorswrite.

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Posted by: drrozkaplan | January 16, 2012

Time to Move On

I don’t know if anyone logs on to this site anymore.  I haven’t posted in a very long time.  I sort of lost steam for a variety of reasons:  1.  I was writing other things

2. I had no regular schedule for blogging and I went from posting frequently to not posting for weeks, to posting now and then.  I don’t think this was helpful

3. Here’s the main issue:  This blog was set up in conjunction with the release of my book, ‘The Patient in the White Coat’ in 2010.  Other than just getting out there and writing, I had no focus for the blog, and I wrote about a lot of different things.  I started to feel like the world didn’t need one more person just yakking about this or that.

So I am beginning a new blog.  It’s called doctorswrite and the URL is doctorswrite.wordpress.com.  So check it out.  It’s focused on one of my great loves in life: Narrative Medicine.  It’s basically stories about practicing medicine, comments about issues in medicine, and medical information hopefully presented in a fun and accessible way.

Hope I’ll hear from you through doctorswrite!

Posted by: drrozkaplan | June 4, 2011

Creativity

I continue to avoid blogging.   I haven’t figured out adequately what this blog is really about.  So I will ask anyone who is reading it:   does it need to be about one particular thing?  It’s mostly health and wellness, but sometimes I just get random.  Is that okay?  Is random useful?  Do people get something out of the ‘random’ thoughts?

I am doing the ‘Artist’s Way’ program, a 12-week self-guided course by Julia Cameron to help let go of creative blocks and move forward creatively in all aspects of life.  It’s kind of like doing a meditation course, but it focuses on creativity.  I am not yet sure how it is serving me, but I’m only a week in.  As part of the program, I am asking myself what I want to create, and it seems like this blog would be part of that.  What do I want to create in this blog?  I think a forum for reading about health and wellness and overall life balance, which in my mind are completely connected.  You can’t be well without finding the balance of work and love, pragmatism and creativity.  You might not be sick, but you won’t be completely well, either.   Creativity doesn’t have to be writing, or sculpting or any traditionally artistic pursuit, really.  People can be creative in whatever work life they have chosen, in their family lives, in their recreational activities.

Right now, I need to be applying creativity to my business. I need to do some revamping of our office management and procedures because things aren’t working so well administratively/financially.  This is a new thing for me, as I have always just done what I had to, administratively.  It’s not my strong suit.  But I have to make it better.  Thus, thinking creatively, outside the box.

I always have tried to put creativity in my WORK:  medicine can be, and I will argue should be, a creative pursuit.   I have to create the right milieu for each patient, come up with creative solutions to help patients follow through in pursuing good health.  Sometimes I make things up as I go along.  Not diagnoses, at least not on purpose.  But treatment is an art form.  Yes, there are the ‘standard of care’ medications and procedures.  I will always try to follow them- ‘evidence-based medicine’ as it is now called.  It is important to know what works statistically and to give patients the best care from that perspective.  But so much of what we do in medicine is beyond that.  How we deliver information:  the diagnosis, the options, the progress report.  How we help patients make decisions:  hands on, hands off- personally I think the doctor and patient should act as a team whenever possible, but that is not always reality.  Some patients decide for themselves and disregard my guidance, others want someone to decide for them completely.  How we prioritize issues.  How we interpret what patients tell us.  There are so many nuances.  That is the art of medicine.  We can’t turn it into a machine that takes data, churns out a diagnosis, chooses a treatment and moves on to the next case.  If we did that, we might as well just be computers.  That seems like what some insurers and politicians think about medicine.  But it will never work for the patients.

So there’s my morning rant on the creativity behind medicine.  My writing is a whole other story.  Stay tuned.

Posted by: drrozkaplan | April 27, 2011

Modern Medicine

Apparently, I am becoming a dinosaur.  So is the other doctor in my practice.  And we have ‘earned’ the disdain of some Ivory Tower, academic doctors, by continuing to practice primary care medicine in the way we have done for the last 2 decades.  We actually spend time talking to our patients, getting to know who they are as people, as members of the community and as fellow humans.

I almost cried after reading a New York Times article from April 22, entitle ‘Family Physician Can’t Give Away Solo Practice’.  It chronicles the travails of Dr. Ronald Sroka, a Family Practice physician in Maryland, who has provided care to the people of his community for the last 32 years.   He knows many of the details of his patient’s lives, as well as every detail of their medical histories.  He writes in paper charts and calls his patients back himself when they leave messages that they are sick or have questions, even if it is after hours or on a weekend.  He rounds on his sick patients in the hospital himself.  But the kind of care he offers is rapidly bing replaced by large practices in which patients rarely see the same doctor on consecutive visits, and for which hospital care is provided by ‘hospitalists’- doctors who specialize in inpatient medicine and staff the hospital in shifts 24/7. Now, as he is thinking of retiring, he can’t find anyone to take over his practice.  He can’t sell it.  In fact, he can’t give it away.  It’s not the kind of practice younger doctors are looking for, and it’s not where the social, political and financial forces are leading medicine.

Okay, I am not quite a Dr. Sroka.  I am not in solo practice; I do have a partner.  We are not in Family Practice; we are internists, so we don’t do pediatrics or obstetrics.  We do general medical care of adolescents and adults.   Under duress, because it became impossible to keep up with the fast-paced care in the hospital while seeing patients in our office all day, we have been referring our hospitalized patients to hospitalists for the last 18 months.  We are aware that our paper charts are going to have to be replaced by Electronic Medical Records soon, very soon.  In order to finance the technology and staff that will be required to run the practice of the future, we will also have to move faster, see more patients in a day, maybe talk with them a little less.

We, and our patients, are entering this transformation kicking and screaming.  While data shows that larger practices may provide a more uniform level of preventive services and fewer unnecessary tests, we still believe that the emotional rapport we have with our patients, and the fact that they can depend on us to be there for them on a continuing basis, is profoundly healing.  We ourselves have had the experience of having our medical histories taken by a doctor who is sitting behind a computer screen, attempting, with frustration, to listen while also filling in the template in his or her electronic medical record, and found it an impersonal, maybe even slightly degrading experience.  Our patients often complain that the hospitalist doctors who round on them when they are inpatients  know nothing about them and don’t communicate with them.  Yet there is no place to hide.  Changes in Medicare and other insurance, along with other political and professional forces are going to pull us into the ‘modern’ way of practicing or we will not survive as physicians.

“Those of us who think about medial errors and cost have no nostalgia- in fact we have outright disdain- for the single practitioner like Marcus Welby,” the NYT article quotes Dr. David Rothman, president of the Institute on Medicine as a Profession at Columbia University, as saying.

Wow.  That’s  harsh.  Not all of us out here in the community providing care in smaller, more intimate settings, who know our patients well, are making medical errors and ordering unnecessary tests.  In fact, at least some of us are maintaining our board certification through rigorous recertification processes, reading pertinent medical literature, using technology to find the most up-to-date information, and earning more than the required continuing medical  education credits.  On top of that, we DO know our patients well, and consequently we can communicate effectively with them to prevent unnecessary tests and procedures.  We actually take thorough histories and examine our patients.

If you want to know about patient satisfaction, patients  in more impersonal settings who don’t feel their doctor knows and understands them are likely to tell you they are less satisfied with the quality of care.  Healing doesn’t happen only on a cellular or anatomical level.  Patients clearly have nostalgia for the ‘hometown’ private practice doctor.  They want to be known, to be seen, as well as to be diagnosed and treated.

Ultimately, I have no answers.  I hope that I, personally, can find a way to be a doctor in the 21st century, using electronic health records and giving my patients the benefits of cost-effective, evidence-based medicine, while continuing to feel that medicine is my calling, not just my job, and that patients are more than just bodies with broken parts.  If that makes me a dinosaur, then so be it.

Posted by: drrozkaplan | March 31, 2011

Global Fat Phobia

Headline on the front page of the New York Times today: Fat Stigma is Fast Spreading Around the Globe.   While in the U.S. and many European cultures, thin has been the beauty ideal for decades, now many of the countries that appreciated fuller figures are changing their tunes.  Why?  Well, this article suggests that global awareness of the health risks of obesity have begun to alter cultural preferences.  And while, in fact, it is true that rates of hypertension, diabetes, heart disease, and some cancers may be lower in thinner people, this shift may be causing a new form of suffering.  Obesity, rather than just being looked at as a health issue, is being stigmatized.  “Fat” = “Lazy”.  “Overweight”= “Sloth”.  Discrimination against larger people is well-documented in this country:  obese people are given the short shrift with hiring, promotion and salary.  Jokes about fat people are widely accepted.  Not to mention the social stigma, which cannot always be quantified or even qualified.

Anyone out there who has tried to lose weight (I’m not including people who lose weight accidentally because of illness or other situations) knows that it is often extraordinarily difficult.  Our bodies fight against us when we cut calories, going into ‘famine’ mode and decreasing metabolism.  Our culture is food-obsessed and the majority of holidays and social gatherings center around food.  There are mixed messages and unhealthy foods at every turn.  And healthier food, such as fresh vegetable and fruit, and lean meat. are much more expensive that simple carbohydrates and items loaded with high-fructose corn syrup.  Add to these factors that we don’t really understand obesity very well.  We know that there are people who are genetically predisposed to obesity, and we know a few other things, like eating less will generally cause weight loss, but we really don’t know how to help people achieve weight loss goals, and it isn’t  clear that overweight is equally dangerous for everyone.

So, while awareness of the health risks of obesity is important and positive in theory, the ‘education’ that is being provided and the information being spread may not meet it’s intent.  We’ve known the risks of obesity in the U.S. for a long time, and yet, as a nation, we have become more obese over time, not less.  And we’re cruel to fat people.  Is that what we want to see happen in other nations, as well?

As a child, and even as a young adult, I don’t remember thinking much about the whole food and eating thing.  I ate when I was hungry and stopped when I was full.  I knew, by the time I was in college, that it was important to get regular exercise, so I tried to do that.  But I don’t remember being obsessed or overwhelmed by food choices and worries about weight.  Now, admittedly, I remember knowing some people with eating disorders in high school and college.  But for me, there wasn’t much to think about when it came to eating.  It was as natural as breathing.  But now, it seems that even those of us with less food ‘issues’ are bombarded with messages all day long, every day, about proper nutrition and better forms of exercise, and how to make our bodies look perfect… and I even find myself getting caught up in all this at times, despite everything I know.

I’m completely in favor of promoting good health.  But in some of the countries affected by this new ‘fat stigma’, there are many other, more pressing, public health issues to address.  I can only hope that good intention doesn’t translate into promotion of eating disorders and dangerous dieting, but my instinct says it’s already too late.

Posted by: drrozkaplan | March 24, 2011

Take this Drug and Call Your TV in the Morning

I am thoroughly dismayed by the number of television commercials that I am seeing for prescription drugs.  I am certainly in favor of free speech, and happy for my patients to be educated about the medications they take, but direct-to-consumer advertising for medications that must be prescribed by a doctor seems entirely counterproductive to me, especially since the commercials are anything but educational.

In the past couple of evenings, I have watched television for a total of 2 1/2 hours, and in the time, saw commercials for powerful immunosuppressant agents for rheumatoid arthritis and psoriasis, hypnotics (sleep medication), antidepressants, atypical psychiatric drugs, antiinflammatory agents, cholesterol-lowering agents,  and potent gastrointestinal acid suppressors.  None of these medications are first-line treatments for the problems they address; they are all the kind of drugs that should be prescribed only  after careful consideration with a doctor- one’s primary care doctor in some cases, and in others, way down the road after consultation with a specialist, when more benign options, including life-style changes,  have been exhausted.

I won’t mention any of these medications by name, but I bet, if you watch any TV at all, you’ll recognize these scenarios:

1.  Someone with insomnia now sleeping soundly, with fluorescent butterfly wings.  Butterflies waft effortlessly across the bedroom.

2. A stick person with a ball and chain to represent depression not in full remission.  When the figure moves, the heavy ball drags him (or her?) into a deep hole.

3. A wind-up wooden doll, which the ‘patient’ uses to demonstrate how she feels she has to ‘wind herself up’ just to function with her depression.

4. A good-looking, physically fit older man in jeans walking and playing Frisbee on the beach with his dog, meeting up with other dog-owners and yukking it up.  Presumably without his arthritis medicine, he wouldn’t be outside, he would have no social life, and his dog would be neglected and unwalked.

5. A woman with psoriasis going to a school reunion.  Apparently,  because she takes her immunosuppressant, her otherwise unsightly psoriasis is well-controlled, so she is not nervous about seeing people from decades ago.  And her lovely skin gets her a man:  she goes to the reunion alone, but leaves with a handsome guy.

I don’t doubt that the medications in question help some people.  But the implication is that if you have the condition the medication addresses, but are not taking the medication, your life is not as good as it should be.  The commercials instruct viewers to ‘ask your doctor.’  Well, fine, you can ask your doctor, that’s a good idea.  But a certain proportion of people have now been brainwashed to believe that this is the drug they need and nothing else will do.  Hopefully, their doctors will take the time and have the patience to explain why they are not on this treatment, if it is inappropriate, and those patients will understand.

Then there is the other component of these commercials:  the disclaimers and listing of complications and side effects. Things like ‘adverse effects include seizures, worsening of depression, and increased risk of suicide’  and ‘tell your doctor if you have high fevers and rigidity as this may be a life-threatening complication.’  ‘Side effects may include gastrointestinal bleeding which may be serious and lead to death.’   ‘ Eating, walking and driving while unconscious have been reported.’  After hearing these sorts of things, there are people who are so terrified of medications that they refuse to take them.  Even if they really do need them.

One more thing.  How much do these TV ads cost?  I really don’t have the vaguest idea, but I know it’s a lot.  Medications, especially brand-name medications in the U.S. already cost way too much.  Drug companies are cutting back on all kinds of marketing for both legal and financial reasons:  no pens with drug names for doctors, no more trips and fancy meals to try to lure physicians to prescribe specific medications.  And I wholeheartedly agree with those restrictions.  Why, then, is it okay to try to sell the drugs directly to the consumers, when the cost of advertising pushes the cost of the medications up considerably?

Education is good.   Patients should know their options and they should know the potential side effects of their medications.  There are risks and benefits to just about everything out there.  But I think it is our job, the physicians’ job, to give proper education, tailored to a given patient’s conditions and needs, not the job of the pharmaceutical industry to market to the masses.

What do you think?

Posted by: drrozkaplan | March 19, 2011

Family History

I’m going to go to the doctor in a couple of weeks, not because I’m sick, or even for a checkup, but to deal with my ‘family history’.  A lot of  people who know me would think that means I’m going to a psychiatrist.  Yeah, my family was/is pretty crazy, at least on my mother’s side, but most of those people are dead now.  There was my Aunt Mabel, who talked to her toaster; my Great Uncle Irving, who was so depressed that the only thing anyone remembers about him is that his favorite saying was ‘don’t worry, nothing will be alright’; my grandmother who, at 90, with no significant physical ailments, decided she was just done, and ‘took to her bed’, ringing a bell for the servants when she wanted something, randomly firing her caretakers and then demanding that they stay, and generally terrorizing anyone she could from her place under her blankets.

But no, despite the fact that I was scarred for life by all the bizarre behavior in my family, I am not going to see a psychotherapist this time. I am going to a Preventive Cardiologist, because I would like to live longer than either of my parents did.  My father, a true intellectual and also a savvy businessman, died at 75 of a conglomeration of cardiac and neurological problems.  He had coronary artery disease at a young age, and had a triple bypass at 60.  He was never quite the same emotionally or cognitively after the bypass surgery; at that time people were just becoming aware of the negative effects of being placed on cardiopulmonary bypass during the surgery, and I think his decline after that was a combination of those effects and depression from loss of youth and health, and from taking early retirement from his very stressful job, something that in theory should have been good for him, but in practice, killed his spirit.

My mother had a sadder story.  She died way before my father, at 62.  She was seemingly healthy, other than some high blood pressure.   She woke up one morning, looked at my father, and said, ‘call 911, I’m dying.’  And then she did.  We never found out the exact cause of her death.  Somehow, despite the rather odd circumstances, my father, raised an Orthodox Jew, talked the coroner out of doing an autopsy.  So she could have died from a massive heart attack or a massive stroke.  Either way, some catastrophic vascular event occurred.

A lot of people in my father’s family had cardiac or vascular problems.  My father knew his cholesterol was high, but there were few medications for such a thing then.  He didn’t pay much attention to his diet until after the coronary surgery, and he was sedentary all his life.  Exercise wasn’t even on his radar screen.  My mother, on the other hand, came from a family with great longevity- her parents lived well into their 90’s as did her aunts and uncles.  I know for a fact that her father, my grandfather, ate scrambled eggs and charred toast every morning, smoked cigarettes when he was young and then a pipe later, and ate ice cream every night.  Still, he lived a very long, very healthy life.  My mother’s blood pressure control was questionable, but she had no cholesterol problems, quit smoking in her late 20’s and, unlike most of the women of her cohort, exercised regularly.  My brother, 20 months older than me, has high blood pressure and high cholesterol, despite the fact that he is not overweight.  He is on medication for both and seems to be fine, but he is only 52.

So I turned 50, and started thinking that it was time to address my risk for heart disease and stroke.  Like my mother, I have migraine headaches.  There is a correlation between ‘classic migraine’, the kind of migraine that is accompanied by flashing lights or other neurological phenomenon, and heart disease.  But I have ‘common migraine’- I just get the headache, and there’s no proof that common migraines are associated with heart disease.  Still, migraine in general can be related to stroke.  Unlike my mother, my blood pressure is quite low.  Up until fairly recently, my cholesterol was fine, but it’s slid into the abnormal range over the last couple years, despite my normal weight, regular exercise, and usually careful diet.  I look more like my father’s side of the family (the heart disease side) than my mother’s side.

Of course, as most doctors would be, I am tempted to assess and treat myself.  I did start a baby aspirin a day, despite lack of hard evidence that it prevents cardiac events in women.  But I figured it was pretty harmless, so I went ahead.  I upped my exercise a little.  But then I had some funny chest pain while exercising, which made me nervous. My assessment, and my husband’s, was that it was muscular, because I could press on my chest and make it hurt.  But we probably shouldn’t be the ones to decide that for sure.  I’m not sure what to do about my cholesterol.  The data on treating levels like mine is all over the place, and depends on all the other risks a person has.  I don’t want to take powerful medicines that may have side effects if I don’t need them.  But I also don’t like having untreated high cholesterol with my family history.

So, I will make a trip to a specialist- someone who makes these decisions for their patients all the time.  It’s the right thing to do.  I may be able to accurately assess the risk of my patients, but I’m having trouble with my own because I lack objectivity.  Completely. Still, part of me feels like this doctor visit is very neurotic.  After all, I’m fine, and there is an awful lot of over-testing and over-treatment that goes on in the prevention world.  Yes, I’m a skeptic, after all.  Despite the fact that I prescribe all kinds of tests and medication, I am all too aware that not every situation requires intervention, and I am against overly-aggressive medical care.  It’s all a judgment call, and I will have to trust my doctor’s judgment.

I have to remember this:  If I don’t take care of myself, I am a bad example to my patients.  I’m no good to anyone if I am not healthy.  So this time, I will bite the bullet and put myself in someone else’s hands. Hopefully the adage ‘an ounce of prevention is worth a pound of cure’ will apply this time.

Posted by: drrozkaplan | March 14, 2011

Living for the Weekend

I had a really good weekend for the first time in a long time.  I’d kind of forgotten that weekends were meant to be fun, since this fall and winter were full of not-so-fun weekends.  Many of them got spent doing things that just had to be done.  Usually errands, including grocery shopping (which I hate), cleaning, cooking (don’t like doing that so much either, although at least I get a sense of accomplishment when a meal comes out well), laundry (ugh), and other assorted drudgery.  This past fall was also marked by college visits and interviews for my daughter, which, while infinitely important, are serious time-sucks and can get quite tedious for us parents.  There were obligatory parties and gatherings during the weekends during the holiday season.  There were weekends when my husband was ‘on service’, meaning that much of both Saturday and Sunday was spent making rounds in the hospital, so I was left to manage the household. If I recall correctly, there were also a lot of weekends this winter when the weather was very bad, so we were  either housebound or out shoveling snow.  And then just as it looked like we’d made it through the worst of the winter two weeks ago, I spent four days, including the weekend, with the flu.  Yes, I did have a flu shot, and of course I wash my hands like a maniac, but nevertheless, I had the fever, cough, and awful body aches that only Influenza can provide.  My very kind and loving husband, who insisted it was okay not to avoid me while I was ill, then contracted the same thing, and was sick through last weekend.  We canceled social engagements both weekends and barely did anything; clearly the right thing to do, actually the ONLY thing to do,  but also not fun.

So this weekend, with everyone back to a modicum of health, and with the possibility of spring in the air, fun was rediscovered.  The weekend was kicked off on Friday evening when my daughter and I went to the TLA to see Grace Potter and the Nocturnals.  I have to admit that I don’t usually go to rock concerts with my kids, or rather my kids ordinarily wouldn’t go to a rock concert with me.  But my daughter, a high school senior, and I do share some of our musical preferences.  Not all, but some.  I discovered Grace Potter on WXPN a number of years ago and have quite a bit of her music on my ipod.  My daughter listens to my ipod in my car, and really liked this music.  In fact, it was she who told me when tickets went on sale for this concert, and she asked if I would go with her- a big compliment if you don’t get too suspicious that her motive was getting me to pay for the tickets (which of course I did).  Anyway, we went.  In case you haven’t been at the TLA, let me describe:  small, standing room only, gets hot and crowded, especially during a sold-out show, as this one was.  I was a little apprehensive going with a 17-year-old, knowing that her capacity to stand for hours would exceed mine, precluding the idea of leaving early, and knowing that the show would last past midnight, way beyond my usual bedtime.  But we had a blast:   Grace Potter gave an amazing show, and the place was full of people of all ages, just really enjoying the music.  I asked my daughter afterwards if I’d embarassed her, since I, along with everyone else my age, danced and sang along with abandon, but she said no, that I hadn’t, and that really was the ultimate compliment.

I slept late on Saturday, something I never do.  I should do it more often.

Larry and I did some errands, but not the objectionable ones, and we moseyed around, stopping to hang out at the Apple Store and play with all the gadgets we imagine some day owning.  Or not.  The big thing was, we played.  We had nowhere we needed to be, and that felt good.  Later I re-potted some houseplants and we walked the dogs.  No rushing.  Then we went out to dinner with new friends at a restaurant we’d never been to before.

Of course, we did have to grocery shop and do the laundry today.  Unfortunately, those things just keep needing to be done.  Over and over and over.  But it wasn’t so much of a burden after spending time doing things we enjoyed, and we still had plenty of time for exercising and reading the New York Times later.

I don’t know how so many weekends got away from me with no quality time or activities over the last months.  I do know that I’m going to try not to let that happen anymore.   We all need some relaxation and recreation, fun and novelty, and just plain downtime, especially if we expect ourselves to be productive and efficient and creative during our work time.  Otherwise, we just start slogging along, and everything becomes an unpleasant chore.  I often feel I need to be constantly productive, but that mentality seems to end up thwarting me in the end.

So here’s to having fun and sleeping late.  Sounds like what our kids do.  Maybe it’s time to be a little more like them.

Posted by: drrozkaplan | March 4, 2011

Reasons or Excuses

Hi, I’m back.  I don’t know from what or where.  I just wasn’t in blogging mode for a while.  I kept telling myself that I ‘should’ write a blog post, but no good ideas were coming to me, and I don’t want to just write junk to fill up the page.  I felt a little guilty for staying away, but instead of giving in to the guilt, I decided to suspend judgment.  It made me really think about legitimate ‘non-doing’ versus avoidance or procrastination.  I wasn’t just taking time off from the blog, but I wasn’t really writing much in general.  I’ve always set a standard for myself to write just a little bit each day, even if it was just ‘morning pages’- the 15 minutes of free writing I would do, of course first thing in the morning, if possible, which sometimes turn out to be the beginnings of an essay or story, or additions to something I’m working on, but more often than not, are just a bunch of drivel.  Well, I’d stopped even doing morning pages, and I had a million reasons why.  But were they reasons, or excuses?  How do we decide when we’re cutting ourselves needed breaks versus when we are making excuses for not following through on our commitments?

So my reasons (or excuses) for not writing:

1.  My life is interrupting my life.  I’m almost sure this is an excuse and not something legitimate, since life is always an interruption.  Yes, the dog threw up and there’s a floorboard loose in the entryway and I had to take my daughter to the doctor.  But next week, there will be new problems to deal with, and the laundry and dishes will never stop piling up, and meals will always need to be shopped for and cooked.  If life is going to be a reason, then I’ll never write.

2.  I was sick.  Now this, at least for a few days, was a legitimate reason.  I hardly ever get the viruses that are going around, probably because, after raising children and working in a medical practice for over twenty years, I’m immune to most things.  However, last week, I got hit with a flu-like virus that took me down hard for 4 days.  I lay in bed for at least 3 of those days, barely able to move because I was so tired from coughing up pieces of lung and because every muscle in my body hurt.  The hours just ticked by in my DayQuil and NyQuil-induced catatonia.  But I got better, and yet still have been having trouble summoning the motivation or creativity to write anything.

3.  I continue to encounter absurdity more regularly than most people I know.  While this should give me fodder for story-telling, it instead has me baffled and mentally fatigued.  Each time one odd episode ends, a new one seems to begin.  I wonder why I can’t have a run of uneventful weeks.

Yesterday, the dog grabbed a raw chicken breast that I was about to put in a pan.  He ran from me, and growled when I came near him.  So I got a large barbecue fork and lit out after him, thinking I would use the fork to wrest the chicken from the dog’s mouth.  Just then, my daughter and her boyfriend walked in the door.  They still think that I was trying to pierce the dog with the fork.  Every time I try to explain, they look at me and shake their heads, as if to say, “that’s what they all say…”

Last week, my son called from his study abroad program in Germany.  It was 10 pm our time; 4 am his time.  He wanted my husband to Google map the town he’s in, find the intersection he was at, and tell him which way to go to head towards the University.  When we asked him why he was wandering alone and lost at 4am, he told us he had just been released from police custody, after he was arrested for allegedly beating up a drunk guy and stealing his jacket.  The police apparently suspected him because a) he was carrying a jacket and b)he was outside.  Once it was determined that, in fact, he had not committed this crime, they told him to leave, but refused to take him back to where he’d been hours earlier when they picked him up.  Sadly, I was not even disturbed by this story.  It seemed perfectly ordinary to me.  I worry about that.

4.  My husband caught the virus I just recovered from, so not only have I been trying to take care of him (I say trying because he is terrible at being sick and it’s hard to get him to accept help), but I also have double duty with household and dog maintenance.  I realize now how much he had to do last week when I was sick, and really, how much we both do, and how we depend on each other.  Despite all this, however, I have had some free time, because he’s been asleep in the evenings, leaving me time for writing.  I just haven’t taken the time.

5.  Once I haven’t written for a while, I’m just out of the habit.  And I think this is really the crux of it.  I AM procrastinating.  Just like exercise, I need to re-establish the habit, flex my writing muscles and get back in condition.  It’s hard.  It means using will, persevering, facing fear of failure.  Fear of writing drivel. Fear that nothing creative is in there, and there never will be again.

As with anything in life, the way we spend time is a matter of establishing priorities and then being true to them.  My highest priorities have to be the people I love and my profession.  These are areas of absolute obligation, as well as labors of love.  But writing is up there, too, because it keeps me sane.  I think sanity is a good priority.  So if this post seems like drivel, I hope you’ll cut me some slack.  I need to restart somewhere, no excuses.

Posted by: drrozkaplan | February 3, 2011

In Defense of Caffeine

Yesterday I heard about a study conducted on the effects of caffeine on thought process.  The quick version of the results:  women who consume coffee in the workplace have enhanced performance and clearer thinking.  In contrast, men’s thinking became more disorganized and they were less efficient and less productive.  Now, since I heard this on the news and have not seen an article detailing the study methods or how the conclusions were made, I can’t give any assessment of whether this is accurate.  But it made me just a little bit happy.  Not so much to know that caffeine causes men to fall apart, but because it confirms my own perception that my Grande Latte (okay, sometimes my triple shot Grande Latte, when I’m really tired) makes my morning better, and that cup of coffee or green tea after lunch really does give me a little lift.

There are people in my life who criticize my caffeine habit.  They are convinced that it is going to cause my demise.  I laugh and say  “a girl has got to have one little vice.”  Really.  Otherwise, I’m so clean-living it’s kind of nauseating.  Healthy diet most of the time, exercise, practically no alcohol, regular hours–how boring would these people like me to be?  I keep telling them, the evidence just isn’t there for coffee as a toxin.  Look how long it’s been around, and how few coffee-related deaths are reported!  You’d think if it was such a danger, we would have figured it out by now.   Some of these anti-caffeine zealots say it’s like tobacco: the coffee-bean growers and Starbucks baristas all have a conspiracy to keep the dangers a secret.  But I just don’t buy that.

Alright, total disclosure.  As a physician, I must give the medical information.  There are people who SHOULD NOT be drinking coffee.  People with gastroesophageal reflux (GERD) and some related GI problems.  And I will admit, there are a lot of people with GERD.  People with palpitations and heart arrhythmias that are increased by caffeine.  And, obviously, people with insomnia.  Many people with insomnia tell me that they know it’s not caffeine that’s causing the problem, because they stop drinking coffee at 2 or 3 pm.  But that doesn’t cut it, because caffeine has a very long half life.  If you are an insomniac, you should cut yourself off after that first morning cup.

Barring those medical conditions, however, there is no proof that coffee harms us.  And believe me, people have been trying to prove that coffee is dangerous for decades.  There were the studies trying to prove that it causes pancreatic cancer.  Disproven.  There were studies trying to prove it caused diabetes.  Disproven.  In fact, up to 6 cups a day, it seems to improve glucose metabolism.  (After 6 cups, all bets are off, but I’m not suggesting that any of us be extreme.  Six cups is a lot.  Really.  Enough.) There were studies trying to implicate coffee in hypertension.  Even those were not successful in showing much of an effect.

So relax over that morning cup, at least if you’re female.  If you’re male, well, maybe you should consider your job performance.  Sorry, guys.

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