Don’t Just Do Something…

“Everywhere you go, always take the weather with you,
Everywhere you go, always take the weather…”
– Crowded House

Have you noticed that as soon as the weather changes, humans try to shield themselves from it?

Initially everyone is out, car windows are wide open. A week or two later, every car that goes by has the windows rolled up. Restaurant outdoor patios, after the initial period of elation, sit empty as we choose ”inside please” to dine in the artificially cooled air. Dining areas inside are often far too cool, hence we bring a sweater. The other day I was sitting on the beach and a neighbor glided by me on the water, standing on her paddle board, her slight body glistening with sweat. She looked up at me and shouted “It’s so hot!” It never crossed her mind to jump in the water. Surely the water is too cold or too hot or too mucky or too something!

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Ask Dr. Annie K.

A new feature on Love+Medicine!

Here is where I take questions from you, my wonderful readers.
Any subject is fair game. Questions may be sent anonymously.

Ask A Question


 

Today I was asked an interesting question I’d like to share.
A patient asked me:

“Is there a such thing as broken heart syndrome?”

 

LoveAndMedicine_BrokenHeart

Broken heart syndrome is, sadly, a real malady. It is also known as Takotsubo cardiomyopathy.  Takotsubo, a type of octopus trap (!), was first described in Japan in 1990.  When someone suffers from an event that causes stress, it can take a toll on the heart. The stressor can be from any type of sudden news or confronting situation such as

  • loss or illness of someone close – a relative, friend, pet
  • intense fear – public speaking, while engaging in high risk sports
  • severe pain
  • rejection
  • domestic violence
  • receiving bad news – such as a cancer diagnosis
  • witnessing an accident
  • sudden financial loss
  • a surprise

Scientists believe that the event causes an increase in the “stress hormone” called adrenalin. Adrenalin causes the heart to overwork and eventually weaken, particularly the left ventricle. Clinically, it looks just like a heart attack. The patient complains of the typical symptoms of chest pain and shortness of breath. A complete work up to rule out a heart attack is needed, STAT! An EKG may show signs of a heart attack but in broken heart syndrome there are actually no blockages in the arteries surrounding the heart! Cardiac enzymes may increase, like in a heart attack, but the increase is small. Heart cells are merely “stunned”, they are not killed like in a heart attack.

The illness occurs almost exclusively in women, generally between the ages of 58-75. The good news is that it is reversible and most patients are better in one-two months. In rare cases it can be fatal, if the patient develops heart failure as a result of the weakness of the heart.

As humans we are very adaptable, but some situations are devastating to such a degree that, as we see, the heart can indeed be broken. No one should be alone while experiencing extreme physical and emotional stress. Even if the incident appears trivial and doesn’t warrant this degree of sadness, this is no time for judgement. There is no timeline for overcoming loss- so silly how we learned in medical school, one month of grieving for every year together- everyone is different. Be there, for as long as it takes.

 

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Why We Need To talk About Sex

Love+Medicine Pillows

recently gave a lecture to a group of physicians about the importance of talking about sex with patients. I believe it should be an integral part of an evaluation of an individuals’ overall health and well-being. We receive so little training about this in medical school. An article was recently published in the New York Times (3/20/2016) entitled “When Did Porn Become Sex Ed?” People are not talking to their parents, their children, or their doctors, so they turn to the Internet.

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1217 Miles

As part of my work as a psychiatrist, I did a stint in Telepsychiatry. This is providing psychiatric care via Skype, to those in need, to individuals who do not have physicians that are easily accessible. Montana, called ‘Big Skype Country’ in jest, is one of those places.  There is a major shortage of physicians there and I was recruited to see patients via computer in an outpatient facility in Montana.

I received my license to practice medicine in Montana after a few months. my laptop was programmed to see patients and made HIPPA compliant (the Health Insurance Portability and Accountability Act, for protecting sensitive patient data). I removed all of my Brett Favre and Green Bay Packer photos from the wall and replaced them with my medical diplomas to serve as a more appropriate Skype backdrop as I sat at my desk at home.

I was skeptical. Would I be able to “connect” with my patients, to recognize all the subtle nuances that are so crucial to diagnose and treat patients? As psychiatrists, we have no blood tests, procedures or sophisticated means to make a diagnosis. We rely on self report, on our own perceptions and clinical judgment.

The experience montanathere was fascinating and I feel like I really made a difference. Instead of driving for 3-4 hours or waiting months for an appointment, they came to me. I wrote this poem to convey my thoughts about my work there.

 

1217 Miles Between Us

 

Strangers facing each other
On a screen.
A leap of faith
taken by both sides

Many have never seen
their reflection on a computer screen,
They are reassured.
She is there,
You just cannot touch her.
They talk.
Asked about what they eat,
how they shit and
how they sleep.
Asked about
crimes,
prison,
alcohol and drugs.
Passion,
intimacy,
work and
family.
They talk and
the barriers of miles fall.

Grizzlies, black bears, floods and spiders.
And ‘green cards’,
their psychiatric diagnosis
a license for medical marijuana.
Extolling the merits
of Mary Jane,
to calm shattered nerves.

In the end of the day
it is love and work.
Love and work.
Not enough of either, or too much work
1217 miles
and yet,
Love and work
unite us
as the central theme.

40 minutes later
we part.
They marvel at the technology,
in their own ability
to open up.
To a total stranger.
Twelve hundred
seventeen
miles
away

Written by Anne Koplin, MD

 

Lung Cancer: A Lonely Place

Ever since I was diagnosed nearly 10 years ago, my life has gained a sense of surrealism. I am not exactly sure how to be. There are few guidelines for those of us who are faced with our own death in such a concrete way. Even before my diagnosis, as the daughter of a holocaust survivor and a mother who died within four months of her lung cancer diagnosis, I already understood the urgency of enjoying life to the fullest.

I worked hard and played harder. As a doctor, I never felt the need to measure my worth by my income. I refused to work like crazy, to be seduced by the money I could make by squeezing more and more patients into my schedule. I passionately traveled the world, absorbed different cultures and tried to bring a sense of connection to whatever room I entered.

Now, when I head out the door, I know that friends and acquaintances will scrutinize me, looking for signs that things are changing. Does she look tired? Has she lost weight? How are you doing?  Then they can report to others that they saw me and give their analysis.anne looking into future

I am 58 and surrounded by people complaining about this and that; peri-menopausal woes in particular, insomnia, weight gain, back pain, wrinkles. Admittedly I have little tolerance for those benign concerns these days. As time since my diagnosis grows longer, I may also join them in worrying about these things, thinking at times “hey, I’ve lived this long, maybe I should try botox?” Stress about aging is a lovely, welcome luxury. Nothing compares to a spot on a chest x-ray, a lump in the breast, a suspicious mole.

Lung cancer is a tough one. It isn’t breast cancer with a massive support system, pink ribbons, tons of research money. Is it because it’s a boob thing? When it comes to lung cancer patients, survivors are few. Early detection and treatment options are not even close to those available for breast cancer patients. Almost everyone knows someone who died the painful, horrifying death that is associated with lung cancer. In Dr. Christine Northup’s best selling book on women’s health, lung cancer does not even appear in the index, while it is the number-one cancer killer among women  – more than all of the reproductive cancers combined. The number is rising, particularly among non-smokers. I wrote a letter to Dr. Northup, noting this serious omission, but predictably never received a response.

Our society is built on planning; we are penalized with high fares if we decide last minute to hop on a plane. We work and work to save for the future. We live with the delusion that we have the luxury of putting things off. When I retire, when the children leave, when I can get a bigger pension, whatever it is. ‘Save the Date’ notices appear more than 6 months before an event. All I can say is that I don’t buy green bananas.

Since my diagnosis, I understand that the future is now. I wake up every morning and first try to shake off the post-traumatic thoughts of my illness and months of treatment. I know each day is a challenge, trying to be ‘normal’ when nothing is normal anymore. I am grateful to wake up, to delight in the achievements of my children, to continue to explore the world as long as I can. I feel empowered to call others out on actions I find hurtful. I have a stronger voice.

I can begin my lifelong dream to write, and although I never imagined I’d be writing about this, I may never write about it again. This marks the start of that dream.