“…an act, a habit, an institution, a law, gives birth not only to an effect, but to a series of effects. Of these effects, the first only is immediate; it manifests itself simultaneously with its cause—it is seen. The others unfold in succession—they are not seen: it is well for us, if they are foreseen…The one takes account of the visible effect; the other takes account both of the effects which are seen, and also of those which it is necessary to foresee. Now this difference is enormous, for it almost always happens that when the immediate consequence is favourable, the ultimate consequences are fatal, and the converse.” ~ Frederic Bastiat
Treating Pain in Primary Care
“If there is ever a case for patient-centered care, it is probably the chronic pain patient, especially the older chronic pain patient,” Vega suggests.
He recalled the case of a 72-year-old retiree with chronic degenerative disease of the spine. “She also had stage IV chronic kidney disease, hypertension, and diabetes, all fairly stable and well-controlled. It would be a huge mistake to put her on chronic anti-inflammatory drugs; acetaminophen doesn’t do enough, and she has trouble accessing physical therapy,” he explained. “What really sets her free is tramadol once a day, which she takes in the morning. And then she uses acetaminophen the rest of the day. When I last wrote her the usual prescription, the pharmacy denied it, saying she didn’t have a chronic condition and was at risk for overdose. They didn’t notify me and she went 10 days without therapy. She finally called me, asking why I had withheld her medicine, and I didn’t know what she was talking about.”
Source: The Pendulum Has Swung Too Far
Welcome to another edition of Friday’s Philosophical Foray beyond Healthcare! In this Friday’s installment, we ponder Blaise Pascal’s explorations regarding the trappings of Time.
…Pascal says that man has an intimation of perfect happiness deep in his soul but is unable to attain it. Put another way, man longs for eternity but is stuck in time. According to Christianity, this time-conditioned earthly existence is only a halfway house on our way to eternal life, when time will dissolve. We are not naturally at home here on earth, and that is why the present “hurts.”
Although Pascal doesn’t spell out a solution to the dilemma, we can easily draw one. Our happiness depends on maximizing those experiences which help us escape the “treadmill” of life and find a foretaste of the eternal Now. These include aesthetic experiences, being with family or friends, and the act of simply looking at and contemplating the world in all its richness.
Yet at the same time, the mundane practical aspects of life don’t shrink into nothing—far from it.
They become the arena of service and ethics, part of the drama of life where what we do matters for eternity. Western civilization was built and sustained in part on these words of Jesus of Nazareth: “Do not be anxious about tomorrow, for tomorrow will be anxious for itself…Seek first his kingdom and his righteousness, and all these things shall be yours as well.”
Pascal, as serious a Christian as they come, would no doubt have agreed that focusing our thoughts away from the self will allow us to banish anxiety and dwell securely in the present.
Notes from a doctor with a laptop, a house call bag and a fountain pen
I thought to myself about how often specialists are in a position where they can simply declare “Not my department”, but primary care docs are then more or less obligated to pick up the ball again and do something.
Great insight and perspective by Heath McAnally, MD, MSPH, regarding the sometimes reactive, albeit good intentioned, response of gov’t and private entities to the opioid crisis. Worth the read for sure.
Pendulum swings in medicine aren’t new, but damping the oscillation rarely bears such urgency. To paraphrase the original document, we call on our leaders to:
Recognize that opioid tapering requires evidence-based careful selection, patient-centered methods, realistic goals, and close monitoring for adverse events.
Include the expertise of pain management subspecialists at every level of decision-making about future opioid policies and guidelines.
Put a halt to policies forcing opioid tapering/cessation outside the contexts of diversion or unequivocal, documented harm: benefit ratio imbalance
Dr. McAnally is a board-certified anesthesiologist, pain physician, and addictionologist practicing in Alaska (the military sent him there and he decided to stay). If he wasn’t trying to guide people in improving their own lives, teaching medical students to do the same, or writing about it, he’d probably be outdoors right now slogging up a mountain with a good friend or two.
We spend most of our lives not truly living at all but shoring up goods for some time in the future when we can enjoy them—which never comes, since we have incapacitated ourselves from enjoying the present. It’s no wonder that our waking hours are often filled with care and anxiety, rarely with serenity.
This is a well-done study that shows, in the short-term, that oral glucosamine alone does not reduce pain or improve cartilage loss in patients with knee Osteoarthritis. Keep in mind, this was a 6 month study. A longer study may or may not show benefit. But, would you take a prescription or any medication for longer than 6 months with no clear sign of improvement? The study could have been better if the authors would have studied the more common form of Glucosamine-Chondroitin-MSM. If they do that for one year, I think we could have a conclusive verdict on this.
Not sure why Medscape chose a pelvic x-ray for a story about knee arthritis, but you get the idea…