Sunday, January 29, 2012

Medical Drama vs. Reality; Nursing & Physician Degrees; Hemorrhoids; Tylenol & Sleep Meds

As we discussed many issues during the radio broadcast Friday January 27, 2012, this blog will be a bit scattered.  I guess that is how medicine is though, as it encompasses many issues... in fact probably many more issues than you realize.  If any of this bores you, please pass the info on to a friend, as I am certain that someone in your life can benefit from this knowledge if not yourself!

First, there is the issue of how realistic medical dramas are.  Well, during medical school I was a St. Elsewhere addict, & so I am biased that it was a great show!  To my recall, it was pretty realistic, showing the dilemmas of doctors in training.  I recall my favorite episode in which one of the residents (a doctor in his specialty training) had lost his wife due to a head injury.  His teacher, an older more experienced doctor was trying to offer some comfort, & told him a story.  The elder doctor stated that when he was a young boy he had asked his father "why do people die," to which his father had replied, "that, son, is why you should become a physician."  The teacher then commented, "I now know how people die, but I still don't know why."  It was this sort of deep emotional drama that made me love that show, & I do believe it more fairly represented medicine than the newer shows.  ER was of course very realistic in appearance as they were the first to use that special camera that allowed 360 degree filming of the actors as they moved about to save people in the ER.  This did make you feel like you were right there, which was great if you like ER drama.  But, all of medicine is not like that, & in fact I HATE the ER!  To me it is nerve-racking.  I prefer to keep people healthy so they can hopefully avoid the ER, & then I can too!  Over time, ER became less realistic & that likely lead to its cancellation.  Bring in House.  Now, I must admit that I have only watched it once or twice, so it's probably not fair for me to judge, but I do know that if a doctor has an addiction problem, his is commanded to get treatment or his license to practice medicine is revoked.  If he takes pain meds responsibly, I guess he might get away with it, but apparently that is not the case with Dr. House.  Also, we live in a time when most doctors do not own hospitals, & as such we are all dispensable.  If a doctor is guilty of misconduct, either with a patient, a nurse, another doctor, or a hospital administrator, he is reprimanded, & if the conduct continues he is "kicked off" staff.  There are actually groups of our peers who review our work & our conduct (Peer Review Committees), & who thus have the right to remove our privileges at the hospital.  A lot of what happens in these medical dramas is based on some fact, but of course it is hyped-up to sell the show.  If you think you learn something medical on one of these shows, be sure to run it past your doctor to check it's accuracy!  For me, some of the frustration of watching these shows lies in the fact that they often get some of their medical facts WRONG, as well as the fact that I do not lead the glorious life that they often portray.  Contrary to popular representation on these shows, the hospital does not run amuck with personal affairs & sex does not happen in the closets! 

Robert wanted to know about nursing degrees, & as I said, I have never been a nurse, so I am not the best to answer that question.  I do know that there are levels of education in nursing, from LPN to RN, & within the RN there are "diploma" programs & "degree" programs.  RN's can get a Bachelor's degree (BS), or they can go on to get a Master's or even a Doctorate (PhD).  Many RN's are continuing their education & becoming ARNP's, which are nurses who function independent of doctors... they can run their own practices with some limitations, but basically serve as primary care "providers" much like myself.  I would advise you to speak with someone in nursing to sort out the differences, but I do know that a profession in Nursing is definitely a good one!  There is a shortage of nurses that is expected to worsen as our population ages, so it seems that there should be guaranteed employment in this field.

Skip asked about the difference between a doctor who has an MD vs. one with a DO.  Again, I am an MD, so I am not that knowledgable about the DO program.  I believe that we train similarly, with 4 years of medical education for each program.  But I think the DO program has a 5th year of training as they learn not only what we learn, but additionally they learn manipulation much like a Chiropractor.  I often wish I had that knowledge and expertise, as I think I would be more effective at evaluating & treating many of my patients' musculoskeletal problems!  One must also realize that the doctor that one becomes is more based upon your Residency training than on your medical school training.  That is to say that medical school is probably very similar program to program as this is basically learning medical literature & facts.  On the other hand, residency training  involves hands-on training, as well as the application of critical thinking.  I trained at a hospital where there were only 2 residency programs, Family Practice & Ob-Gyn.  As such, I feel I had great training as there were no Internal Medicine residents or ER residents or Surgery residents with whom to compete.  I basically was the Internal Medicine resident when I did that "rotation," so I learned a lot!  Every residency is unique, & in fact some DO doctors do their residency training in an MD program!  Such is the case at Bayfront Medical Center where I trained with several DO's.  Now that we are in private practice, I am certain that we practice very similarly despite our different medical school training.  Again, I encourage anyone who is interested in becoming a physician to study hard & apply for MD & DO programs both.  Go to which ever one accepts you, & become the best doctor you can, as ultimately the doctor you become is up to YOU!  And by the way, medical school applicants do not all need to have degrees in science.  The Admissions Committees for medical schools like diversity, & you can get into med school with a degree in Liberal Arts, Political Science, Landscape Architecture, or just about anything for which they give a Bachelor's degree.  The Committees know that diversity in background leads to diversity in doctors, & this leads to new discoveries in the field of medicine.  So do the science prerequisites, but study what you love, & apply!  Also, if you don't get in the first time, try again... I got in after my second application, & I know people who got in after a third try!

Hemorrhoids... a literal pain in the ***!  These are basically varicose veins in the anus or rectum.  This means that they are veins that have become overstretched & thus hold too much blood.  If you could see them, they look just like the varicose veins in one's legs.  They can occur to people of all ages & don't care if you are male or female.  They are the result of increased intra-abdominal pressure, so they often occur during pregnancy, or when someone does heavy lifting or straining.  Thus if you do heavy lifting at work or during work-outs, you should wear a belt around your waist like those worn by Home Depot employees.  This helps take the pressure off of your bottom side, & also helps lessen the chance of getting a hernia which is also due to too much intra-abdominal pressure.  If you have constipation, this too can cause hemorrhoids, so try to keep your stools soft & don't strain to have a bowel movement!  Be sure to take a stool-softener (like Colace), but avoid laxatives as they are addicting to the bowel & can lead to a need for more & more laxatives over time.  There is one safe laxative which I freely recommend to my patients... Miralax.  I guess that means "miracle laxative," as it is safe to take daily!  It is Glycerin, which is a slippery substance, & as your body does not absorb it, it basically mixes with your food & helps it to slip through your intestines more easily.  Note that it should be taken daily & not just when you are constipated... as that is a little late, based upon it's mode of action.  Back to hemorrhoids... they can also form due to prolonged sitting, so lay down or get up... don't allow the pressure of your body to press down on your rectum too long!  And certainly don't sit on the toilet too long, as this position allows for a lot of pooling of blood in your rectum/anus.  If you must sit for a long time to have a bowel movement, sit on the toilet with the top DOWN so it supports your bottom side, & only open it when you are truly ready to have the BM!  We all know that the symptoms of hemorrhoids involve pain or itching in the rectal area, as well as perhaps bleeding (usually with a BM, but sometimes even without) or a lump in the anus area.  Be sure to have a doctor or other qualified medical professional take a look as sometimes rectal CANCER can have the same symptoms!  Treatment involves changing your behavior regarding straining, & the over-the-counter meds, including things that numb (or anesthetise) such as Pramoxine which is found in Proctofoam, or vasoconstrictors (which shrink the tissue) such as Phenylephrine which is found in Preparation H.  There are stronger forms of these meds which your doctor can prescribe, & often they include a steroid to shrink the tissue.  I usually prescribe Proctofoam HC which includes Pramoxine (to numb) & a steroid (to shrink).  Don't forget the good old-fashioned Sitz bath... just run some warm water in the bathtub & sit in it!  This increased warmth increases circulation to the hemorrhoid & helps heal the tissue with healthy new blood.  And if all else fails, or if you just don't want to deal with recurrences, consider surgical type options.  This includes the Ultroid procedure mentioned by Scott.  He called in to say he had this non-invasive in-office procedure with great results.  Talk to your doctor or google to see options, though the Ultroid looks great as this procedure is done in an area of the rectum where there are no nerve endings, thus there should be NO PAIN!  The websites indicate that insurance usually pays for this procedure & it only takes about 10-15 minutes to complete... makes me think it should be done sooner rather than later!

Irene wondered if taking Tylenol PM every night was bad for her.  She uses it each night to help her sleep & is concerned about taking the Tylenol as she knows it is bad for her liver.  Well, first we should understand that Tylenol PM is a drug which contains TWO drugs: Tylenol (=Acetaminophen) and Benadryl (=Diphenhydramine).  Tylenol is a pain reliever, whereas Benadryl is an antihistamine which also causes sleepiness.  If Irene takes Tylenol PM just to help her sleep, I would recommend that she get pure Benadryl, as she probably does not need the Tylenol component unless she has pain which interrupts her sleep.  Remember, if you take over-the-counter meds, they too have side-effects.  It is a good idea to discuss any meds or herbs that you take frequently with your doctor, just to be sure they are safe & to be sure the doctor is not concerned as to why you need that product often.  Tylenol should not be taken in doses greater than 1,000 milligrams at once, & no more than 3-4,000 milligrams per day.  They recently suggested that 3,000 mg per day should be the max, so I guess that has been down-graded.  Regardless, remember that Tylenol is toxic to the liver, so even in low doses it can be dangerous if you have liver disease, if you drink a lot of alcohol, or if you take a lot of medications which are metabolized by your liver.  Again, speak with your doctor or Pharmacist who can help you decide what is your safe dose!
And lastly, in honor of January which is National Blood Donor Awareness month, we thank those of you who can & do donate blood!  America uses 44,000 units of blood per day to help those who have bled or who have anemia due to chronic illnesses, cancer treatment, surgery, etc.  Only about 1/3 of the population is able to donate for one reason or another, so the other 2/3 of the population depends upon your generosity!  So thank you!!!  And if you want to donate, please contact your local Blood Bank to see if you are qualified to donate... & while you're there, see if you can register to be a bone marrow donor as well!

Here's to our health!


Tune in Fridays for the Let's Talk Medical with Doctor Gigi radio show!  We're on about 3:30-4:00PM Eastern time on WTAN 1340-AM or on where you can listen live or to the PodCast version!


  1. Hey Doc My daughter Kayleigh has complained several times about abdominal pain that seems as if someone is stabbing her and it hurts her in her back as well. We have taken her to the er and they ran a few test and ruled out appendix as well as bladder and kidney's. It seems to get worse if if she doesn't stick to almost a liquified diet. It re-occurs about every four to five day's usually as she feels better and tries to eat something more solid. Would you have any suggestion's of where would should look next? Your input is greatly appreciated.

    Love Rusty A.

  2. Well, I would start with considering an ulcer (stomach) as that can make her stomach hurt (usually in the middle, just between the lower ribs), as well as radiate pain straight through to her back, & it often worsens with food. Perhaps she can try taking Prilosec or Zantac to decrease production of stomach acid, which will allow the ulcer to heal. Also, google "anti-reflux measures" as these hints will help decrease reflux (which is the backwards movement of food & ACID from the stomach up into the esophagus) which can lead to esophageal irritation resulting in esophageal spasm (& thus pain) when she eats. Some of these measures include: eating frequent small meals; limiting acidic foods, caffeine, peppermint, & spearmint; limiting alcohol & anti-inflamatory meds like Advil, Ibuprofen, & Aspirin; & not laying down for at least 2 hours after eating. Certainly this is all just "guess work" without an exam, lab tests, etc., so if these things do not help within a week or 2, she should see her primary care doctor... & if that is not helpful, see a Gastroenterologist (GI doctor), as she might need an upper endoscopy (=EGD) or other studies. Good luck & keep me posted!