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Friday, September 12, 2008

Star Trek

I love the reference to Star Trek. I have been a little too busy lately so I haven't had time to post much. I haven't seen the show for years, so this quote will be a little off: Kirk says, pleadingly to the ship's doctor: "Come on Bones, you've got to more." Bones replies in a curt and frustrated manner: " I am doing the best I can! What do expect Jim, I'm just a simple country doctor!"

Such is the position I find myself in. Abandoned by the ivory tower experts. All alone in the end zone as they say. Suddenly I have had to become an expert in: bacteriology, immunology, neurology, imaging technologies-including nuclear medicine, antibiotics, antibiotic cocktails, drug interactions and anti-malarial drugs just to name a few. I am still treating hypertension, diabetes, performing minor office surgery and the other standards of family practice medicine.

We are not in Kansas anymore Toto. I am outside the box. Way outside the box. To quote or paraphrase Joe Biden: "First you have to make sure your feet are firmly planted, then stand steadfast." I can't afford to be wrong. I've got to be right 100% of the time. I ignore this reality otherwise it would be hard to function. "Thanks for your support. Thanks for all the fish." (A Hitchhikers Guide to the Galaxy).

Yes, Flagyl works well by mouth. It is not clear that macrolides or tetracyclines work better intravenously than by mouth. Bicillin, long acting injectable penicillin may be a good alternative to Rocephin. It has been used to treat syphilis for eons. It is hard to know why different drugs work better for different patients. Nonetheless, that is the clinical reality.

Congressional luncheon September 24, sponsored by Turn the Corner Foundation with director of "under Our Skin" and author of "Cure Unknown". The host will be the National Capital Lyme and Tick-Borne Disease Association. For kicks look up website: Check out the picture and the caption.

As has been oft said: History would be a great thing if only it were true. The sad thing is that the same thing can be said of things which are happening now. History in the making?

It's Friday. I've lost it. Give me a break: Last quote, the X-files: "The truth is out there somewhere."

Cheers everyone


dogdoc said...

Doc, I'm really worried about you- you sound exhausted this week. Do you have a good LLMD? Maybe its time to try a new cycle of stuff. Ok- mother hen done. I'm up monitoring a four year old who woke up from nap with a high fever and a few stiff/sore neck- peds say its nothing to worry about. Let me off now, I've had enough. But such is not to be. We deal with what we are given. As have you- very well I might add. You have, while dragging your behind and fighting the fog like the rest of us, managed to do the incredible. Learn all of this, fight everyday for your patients, take on the worst. Deal with legality, the fear. Deal with being out on a limb and being "it" for so many. There is noone to refer to (save folks people can't afford). The box isn't all its cracked up to be- most of medicine lies outside of the box. Just with this, you have to avoid the sharks outside of the box. Have you and your lawyers talked with Leila Zackrison and hers by the way? I know you don't want to go there, but if you need a credible witness with the Ivory tower missing what you had gotten now well confirmed, let me know. We owe our lives to you. We need to get you fixed, get these guys off your back, and get that dream of the ivory tower and Lymes docs working together with the other specialties in a Lymes center going. You know how much Bones managed to conquer as a simple country doctor- you have exceeded that in spades. Kinda makes you wish for diabetes and hypertension, doesn't it? You can't be 100%- noone is. But if you do the best you can, you are good enough to make a difference in so many lives. You have saved mine. You don't have to have all the answers- sometimes in the muddling thru a case, you learn so much. You can fix them if they "are not dead yet" ( reference to Monty Python- my brothers age is showing). Hang in there- fight this stuff. All of it. You are on a limb, but look what you are managing to accomplish- how many lives have you saved with this stuff? How many people would have gone under eventually without your help? This stuff gets you in the end and gives you hell while its working on it. You are winning- come on, before this you couldn't win all the time. Medicine is not that way- think of your father with his clinical wisdom. Without you, people like me and my family would be goners. The fat lady ain't going to sing today, thanks to you. Can't always prevent her- some things you just can't fix. But if you do what you can and try really hard, you can fix a lot more than what you think.
Did you find the reference on Plaquenil I gave you in "Some people are really sick" ? Also, I am hearing good things on lay person blogs about Bicillin, Biaxin or favorite macrolide, and metronidazole combo's. By the way, the great Dr B is lecturing in Unionville, Pa on Sat Sept 20th ( I hate trying to spell his name). I also think that is enough tonight. The truth IS out there, and you are finding it. Is it time for that PICC line, by the way? Sorry, can't get the momma hen out of me. You have done so much for me and all those I love. I would very much like to see you feeling what you have given me. I have always said way too much- good night, I have to get up and fix my patients tommorrow. Please be well.

Unknown said...

You should be proud of yourself. You are the one who really takes reponsibility as a doctor. Ivory tower means nothing if they only know how to repeat the textbook and guidelines without thinking.

dogdoc said...

Just a thought in the way out dept. If I were going to bioengineer a new bioweapon, I would not use tick bourne transmission. Too inefficient. I would alter to include lateral or verticle transmission. Guess what I was reading about the other day in the genome and plasmid mapping of Borrelia... It seems the Borrelia picked up some Treponema sequences a while ago. Bacteriophage or... Beam me up Scotty.

Lyme report: Montgomery County, MD said...

If you want to get crazy look up Lab 257 (I haven't read it) and/or Plum Island. My political leanings will be clear in a second. If you wanted the population to be so demented that the would vote for Bush twice and think Palin is great, perhaps a little spirochete enchephalopathy could go a long way. Brave new world stuff. A new sort of bioweapon would not kill, it would render people dumb and docile so that their minds can be easily manipulated. I am tired!

Lyme report: Montgomery County, MD said...

Perhaps you shouldn't mention the names of certain low profile docs. I know all about the board issues of all the docs, including the one you mention. I have personally spoken with many of them. Some docs make me look way inside the box by comparison; need I say more.
The only response from the board is one of deafenly silence. Today I do wish that Scotty would beam me up!

dogdoc said...

Don't know anywhere near what you do. I was only going on a public response that sounded middle of the road and a win I thought it said. Not sure I want to know about some of the stuff- enough things to keep me awake at night as it is.
Personally, I think you are very in the box and sensible. I have found research to back up everything you do as well as anecdotal evidence written by other LLMD's. I don't follow the legalities the same way- but I have read a lot of research.
The thing I haven't found the research to support are the current guidelines to support serodiagnosis of Lymes esp after acute period and to support the theory that Lymes does not become chronic- in fact, chronic stages are well known and described. So just who is out of the box?
Captain, unfortunately the transporter is broken and Scotties working on it. We'll need to make do here.