Archive for the ‘Multiple Sclerosis’ category

Doctors Don’t Know Anything

March 16, 2012

My apologies for slacking on writing posts recently…little preoccupied with my own life, but we’ll get to that in another post perhaps. Today, though I wanted to discuss doctor’s lack of knowledge about so much! Recently I saw my neurologist and had a follow-up MRI for the MS symptoms I experienced last year. A year ago, I had an MRI that showed multiple lesions, and a few weeks ago, I was told by my doctor that most of the lesions were gone and there was nothing new! Great news, right? Here is the conversation that my doctor and I had:

Doc: So your MRI looks a lot better…a lot of the lesions are gone…
Me: You sound surprised. Is this what you were expecting in the course of treatment?
Doc: Well, sometimes this happens…
Me: Do you think it’s the medication I’ve been taking?
Doc: Perhaps…
Me: Do you normally see this in MS after starting treatment?
Doc: In some cases…
Me: Can you tell me anything definitive?
Doc: Possibly…

Ok, the last two lines were made up, but you get the idea. My doctor really could not tell me whether I am getting better because of the medication I am taking, the lifestyle changes I’m making, the cinnamon I’m eating, or just the course of the illness. I do understand that MS is an unpredictable illness and often times it is difficult to predict whether symptoms are related to specific findings, as well as response to treatment. In fact although I complain (from a patient standpoint) I also have the perspective of a physician. As a psychiatrist, there are many unknowns about mental health, including its etiology, let alone its treatment. We rely on research studies for evidence-based treatment options, but sometimes there just isn’t any data. We then have to rely on our own or others’ clinical experience to guide us. I often start patients on antidepressants, and the patient improves. Did the patient improved from a placebo effect, the medication, the support and counseling, or even exercise? Hard to say in some cases.

Despite my questions, I am of course happy to be doing better. I feel confident enough that the medication I am taking is helping to some degree, so I will continue to take it. But it’s just a guess.

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Really Destigmatizing Mental (and Medical) Illness

October 1, 2011

Recently I was asked to speak with a large group of resident physicians after one of their colleagues committed suicide the week prior. It was a hard discussion to have for a couple of reasons, including the fact that I had never done such a thing before. I had, however, gone through the same experience when I was in residency training–a colleague committed suicide when I was in residency as well. It was an event that impacted those that knew him, as well as those that did not. This is sadly a topic that is not discussed much–depression and suicide in physicians. Part of the difficulty in confronting this issue, is of course that doctors have a hard time asking for help for their own mental health. However, doctor’s rates of depression and suicide are higher than the general population–but on the other hand they have lower rates of cardiovascular disease.

One of the things I have personally struggled with during my training in medical school and residency, was dealing with depression. Unfortunately, although I was in a psychiatry residency, talking openly about being depressed was still a no-no. What it will take to destigmatize depression is being able to discuss it openly. So although it is hard, I will start in this forum. I have been depressed in the past. Finally after some time, at the encouragement of a friend years ago, I sought really good help for myself, and now I am a completely different person than I was back then.

I was also diagnosed with multiple sclerosis six months ago. This is another issue I have been struggling with, but in the past couple of months I feel I have been able to get a good handle on it, in particular by managing the things I still have control over. One of the things that I have learned though, is that I have an easier time talking to friends about having MS; I never talked that openly about depression. I was worried what others would think of me, that I would appear weak, and so on. I felt that way despite knowing so much about depression and why it happens, how it’s treated, and how it affects people. It has been a struggle dealing with all my health issues, but I’m so glad I’ve had the determination to do it. That being said, I’ve needed a lot of help along the way, and for that I’m grateful too.

If you think you might be depressed, tell someone. Ask for help. If the situation were reversed, wouldn’t you help the person asking? It’s hard to manage these things alone. Happy mental health everyone!

Misinformation By Celebrities

July 11, 2011

I’ll admit it–I love Dr. Drew. I’ve watched most of the episodes of Celebrity Rehab and can’t wait for a new season. If you don’t know, Dr. Drew is an internist with a focus on addiction medicine (although I’m not sure if he’s board certified in that specialty or not). He does not focus on neurologic conditions as far as I know, so when I heard him misspeaking about multiple sclerosis, I was bothered. I think celebrities do have a certain obligation to use their fame responsibly. That’s why I find it irritating when I hear celebrities, in particular celebrities who are physicians–which there are a few–who speak authoritatively on topics while providing wrong information!

This started recently while I was browsing the National MS Society website, which had a link to Dr. Drew’s blog, back in May when he interviewed Phil Keoghan (the host of Amazing Race, one of the better reality shows out there). Apparently Phil Keoghan biked across the country and raised half a million dollars–it’s not clear why he picked MS as his charity cause (as he notes in the interview, he only found out afterwards that he has a cousin with MS), but whatever, he was trying to do a good thing with his celebrity. What really bothered me was Dr. Drew’s use of the term “la belle indifference.” He explained it as the “positive attitude” that so many people with multiple sclerosis seem to have.

First of all, that term refers to the indifference (or unawareness) that patients have with something called “conversion disorder.” I find this term very offensive when misapplied to MS patients for a couple of reasons. The thing is, a lot of MS patients walk around and look perfectly healthy, because their symptoms are neurologic. You can’t necessarily see numbness, tingling, fatigue, depression, dizziness, or weakness. So–when you don’t look sick, there’s a sort of pressure to act like you’re not sick. It seems that if you act like you’re sick, people around you don’t really get it.

Now–this term, la belle indifference, refers to people who are converting psychiatric symptoms like anxiety, for example, into a neurologic symptoms. An example is the “hysterical” woman who believes her legs are paralyzed and she can’t walk. When she’s tested, her muscles work fine, though. It used to be thought that this was “all in the head,” and not necessarily in the brain, but recent research is starting to show that certain neurologic circuits are impaired in this disorder. Usually conversion disorder is short-lived (hours to days), and improves when the underlying stress improves. Patients with this disorder typically have poor insight, and use a defense mechanism called “la belle indifference” in which they feel like everything is okay, in order not to deal with the distress that would accompany acknowledging their problem.

I don’t know if that explanation makes sense, but I’ll tell you, that as a psychiatrist who is very familiar with MS, it is particularly bothersome to hear this term misapplied because of the implications of the term–that MS symptoms are “in someone’s head,” and the reinforcement of the pressures MS patients have to pretend that everything is fine. No one can tell someone how to feel, but making assumptions about one’s feelings makes it harder to express them.

Just some food for thought–thanks for reading.