PechaKucha

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Twenty images and for each image twenty seconds to say what you want to say, for a total of 6 minutes and 40 seconds of sharing.  PechaKucha, which in Japanese means “chit-chat,” first began in 2003, and has spread around the world as a way to share ideas in a concise and creative format. Our own Gallery One in Ellensburg has been hosting PechaKucha evenings every four months since 2014. If you have the opportunity to attend a PechaKucha evening, I highly recommend it- it is fun, stimulating, and a great way to connect with your community.

Each Pecha Kucha has a theme, and in March the theme was “on being human.” I was invited to do a presentation, and I would like to share it with you:

https://www.pechakucha.org/cities/ellensburg/presentations/on-being-human-perspectives-as-a-doctor-and-as-a-patient

 

Hope you enjoy it!

Spread The News

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Not on the news today-
a child got to play. No,
not on radio, TV or social media feed-
a garden, a kid planting a seed.

2017
first time ever
deaths from Measles worldwide dipped below 100,000.

You won’t see it on a president’s tweet-
little kids played on the street. No,
no juicy gossip, headlines and politicians taking heat-
look around and see, less wheelchairs on the street.

2017
all time low
15 people in this world afflicted with Polio.

A tribute to science,
a gift to humanity:
Vaccines lessen death and disability.

Spread the news.

 

Chickenpox Is Not A Party

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Sick child with chickenpox, sad girl looking back.

Kids love parties and play-dates, and parents enjoy both organizing them as well as socializing with each other as their child is joyfully engaged with friends. After a high energy afternoon of play and socializing, parents and children return home to recover and begin the next day anew. It is a story repeated every day across America- a happy story.

I would like to address a different kind of party, the “chickenpox party,” where parents bring their children together in order to expose them to chickenpox, an infectious disease caused by the varicella virus. While the party begins the same with the theme of happy kids and socializing parents, it has a different ending in which children return home to later develop chickenpox.

The rationale behind a chickenpox party is that by experiencing the natural disease, a child develops natural immunity to the virus, which some feel is better than immunity from the vaccine. While this reasoning may seem appealing, please consider how the decision to join a chickenpox party can impact the health of your child as well as others in your community.

  1. When a child- or a person of any age for that matter- has active chickenpox, they experience a disease. Chickenpox can sometimes be mild, but is typically a moderate illness that lasts one to two weeks and is characterized by fever, headache, fatigue, and a rash of blisters that covers the body. Most children who have the infection miss 5-6 days of school or daycare. When a child receives the vaccine, they do not suffer from the disease.
  2. Complications of chickenpox can be serious. The most common complication of chickenpox is a bacterial skin infection, which at a minimum requires antibiotics. When the bacteria enter the body through one of the many ruptured blisters to cause a bloodstream infection, children need hospitalization for treatment. Meanwhile, the leading cause of death from chickenpox is pneumonia and a brain infection called encephalitis. Before the advent of the vaccine in 1995, 10,000-12,000 children were hospitalized and 100-150 children died every year in the United States from chickenpox.
  3. There are people in every community who are vulnerable to serious complications from chickenpox, such as babies, pregnant women and people with a suppressed immune system. Infants less than a year old are at an increased risk of severe disease, and since children are not routinely vaccinated until a year old they are vulnerable during this first year of life. In addition, varicella infection during pregnancy can be devastating to the developing fetus, causing birth defects and miscarriage. And lastly, a person with a suppressed immune system is at high risk of severe disease or death from varicella infection. Immunosuppression is increasingly common in medical care these days as people receive immunosuppressive medications for cancer, Rheumatoid Arthritis, or Crohn’s Disease for example.
  4. The varicella vaccine is 90% effective in preventing chickenpox, and immunity (protection) is typically long lasting. While it is possible to get chickenpox despite having received the vaccine, when this happens the infection is very mild. Of profound significance, the varicella vaccine is 100% effective in preventing serious complications and death from chickenpox.
  5. The natural course of varicella infection is such that following the initial infection, the virus lays dormant throughout one’s life. If the varicella virus reactivates in adulthood it causes “shingles,” which is a localized, painful blistering rash. A third of adults experience shingles during their lifetime. Almost as a special bonus to receiving the vaccine, research has shown that those vaccinated with the varicella vaccine tend to experience a milder case of shingles in adulthood compared to those who have had the “natural” infection.

A party to spread an infectious disease that could otherwise be prevented by a safe and effective vaccine is not my kind of party. Instead, my suggestion for a chickenpox party is to have a party to celebrate the vaccine and good health. Bring your vaccinated kids, have a great time, and go home without disease and suffering. Share happiness and health with each other rather than a viral infection. This is the type of happy story medical practitioners hope to see within our communities, as well as across America.

 

Flu Season Fence Sitting

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Winter comes every year, and so does influenza. The influenza virus causes a predictable epidemic every year that sweeps through our country and takes the lives of 12,000-56,000 people. Many people are surprised to learn that influenza is consistently within the top ten causes of deaths in our country each year. Doctors have little to offer in effective treatments to combat the virus- preventing the disease with vaccination is our best defense.

Fortunately, when I recommend the influenza vaccine most of my patients receive it, and in doing so reduce their risk of severe illness. However, every year there are a number of patients who turn down the vaccine, patients that readily get other vaccines without a second thought. While they may see the benefit of vaccines in general, they sit on the fence when it comes to the flu shot. From my perspective, patients turn down the vaccine because of personal experiences, emotions, or the influence of social media. Unfortunately, science does not factor into the decision.

With this in mind, for those who are uncertain about the influenza vaccine for whatever reason or source of information, please consider these common situations and hear out my science-based response. Mull it over for the next time the influenza vaccine is encouraged for you.

“I have never had the flu. I don’t need it.”

For most years, any one individual is not likely to get ill with influenza. However, all it takes is one severe influenza infection to result in hospitalization or death. I like to think about this as I think about the use of seatbelts. Almost everyone puts on a seatbelt when they climb into a car to drive on the interstate freeway, and yet it is rare to be involved in a serious accident. We wear seatbelts to save our life in the unlikely event we are in a serious car crash. The same is true for influenza and the influenza vaccine: most of the time you won’t get influenza, but if you do, the vaccine could save your life.

“My relative/friend/someone-I-know got the flu shot and was sick all winter.”

The flu shot does not protect us from the many common cold viruses that circulate every winter. Most illnesses that occur after the flu shot – whether it is the next day or a month later- have nothing to do with vaccination. The influenza vaccine is not a live virus and cannot cause disease. The influenza vaccine should not be your scapegoat.

“I heard on the news that the vaccine is only 40% effective. I don’t want to bother getting it if it won’t help.”

Within this comment is a very important notion to discuss and clarify. It is true the influenza vaccine is not as effective as most of the other vaccines we have available. For example, the Measles vaccine is 97% effective in preventing Measles while the influenza vaccine is only about 40% effective most years. The very important concept to share is that protection from the flu vaccine is not an all-or-nothing, back-or-white situation. The vaccine almost always provides some level of protection. A better way to think about immunity from the influenza vaccine is in degrees or shades of color. For example, the vaccine may not prevent you from getting sick with influenza, but it may make the difference between missing work and spending a week in the hospital. Similarly, it may make the difference between becoming hospitalized verses respiratory failure and death. In other words, although the vaccine is not as good as we would like, it can still make a critical difference to save yours or your loved ones life.

If you are on the fence about the flu shot, think it over. The influenza virus comes every year without fail and causes thousands of deaths. The vaccine is our best defense and may save your life. Sitting on the fence won’t help you fight influenza, but the vaccine will.

Storm Clouds Parting

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Wrapped in three blankets, beads of sweat on her forehead, she shivered, sat up, laid down, and rolled over in a futile attempt to find comfort. An emesis bag in her shaking hand, she looked up from her sunken eyes and said in a soft voice, “I can’t go on living like this…. I need to do this for my kids.” A year ago this young woman had an operation and was prescribed oxycodone; her postoperative recovery was complicated which resulted in more pain medications. Then she had dental work done- more pain pills. Meanwhile, the oxycodone helped numb difficult feelings from stressful life events. She soon found if she did not take them, she felt terrible. When doctors became reluctant to prescribe the medications, she bought them on the street. The pills were expensive- heroin was cheaper. She never intended to become addicted; she never thought it could happen to her, but it did.

My patient is not alone: America is in the midst of an opioid epidemic. Addiction to prescription opioid drugs (oxycodone and hydrocodone, for example) and heroin is at a record high and continues to increase. There are currently 2 million Americans addicted to pain medications and 500,000 addicted to heroin. Every day 90 to 100 people in our country die from overdose. The number of people addicted to opioids each year continues to rise, and there does not seem to be an end to the epidemic in sight. It is as if there is a dark storm cloud over the country, a cloud we all wish would just go away so we can see the sun again.

To add to this gloomy predicament, the majority of those addicted to opioids are young, typically in their 20s and 30s, and there is often no cure for this disease. Addiction to opioids is a chronic disease, characterized by remissions and relapses over a lifespan.

Just as there is no simple cure for opioid addiction, there is no one solution to reverse the current epidemic. Solutions to our opioid epidemic will take time, persistence, and a variety of interventions over many years. We need the help of the companies who make the medications,  healthcare providers who prescribe them, and you, a potential recipient of pain medications. Here are a few ways in which we can all work towards ending this epidemic:

1. Pharmaceutical companies should stop heavily marketing the symptom of “pain” and their prescription pain pills. Historically the pharmaceutical industry has successfully popularized medical problems through advertising when there is a drug to sell, be it for insomnia, erectile dysfunction, or low testosterone, for example. The stakes are too high to push treatment of pain with opioids.
2.  Doctors, physician assistants, and nurse practitioners have to reduce the number of prescriptions they write for opioid medications. Since 2010, the number of opioid medication prescriptions written in America has steadily declined, which is terrific news. Despite this trend however, healthcare providers in America currently prescribe four times as many opioid medications as doctors in Europe. Having more pain pills in circulation enables more people to become addicted to them.
3.  Patients who receive prescription opioid medications need to be more careful with these powerful medications. Research has shown that 57% of people who become addicted to opioids begin their path of addiction after having first received opioid medications from family or friends. If you are prescribed pain pills by your doctor, do not share them with others. In addition, store unused medications where they cannot be stolen, or better yet, dispose of them.
4.  Communities need to de-stigmatize opioid addiction. Addiction is a disease, not a moral failing. Like the young woman I have described, people who become addicted are our neighbors and our friends’ children. It is important to acknowledge that anyone can become troubled by opioid addiction and that everyone needs our support.
5. If you or someone you know becomes addicted to opioid medications or heroin, there is help in the form of “medication assisted treatment.” Buprenorphine, or “suboxone,” is a medication that doctors can prescribe in an outpatient clinic setting that enables a person to live a normal, addiction free life. These medications help but can be expensive; tell your representatives in government to support policies that fund opioid addiction treatment. In addition, to be allowed by the FDA to prescribe Suboxone, physicians must complete an eight hour trianing course that can be done at a live conference or online. Encourage your healthcare provider to pursue training in order to prescribe this life changing medication.

Ending America’s opioid epidemic will take time and action in a variety of ways. Reversing the epidemic will require efforts from pharmaceutical companies, our government, healthcare professionals, as well as individuals such as you. It will truly take a concerted effort. We are all in this together.

My patient received her first dose of Suboxone that day. An hour later she was no longer shivering, perspiring or vomiting. She looked exhausted, but relaxed. “You look a lot better, I commented.” She looked up at me and wearily replied, “At least I don’t feel like I’m dying anymore.”

The following day she returned to the clinic for follow up. I entered the room to see a happy and extremely grateful young woman; she smiled and said, “I feel normal now.” Her skin had a rosy color and was bright with light. While my patient will need continued treatment with Suboxone for many years, or even her entire life, the dark cloud of addiction had departed in the exam room that afternoon. The sun was shining bright.

Everyday Heroes

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The image of Ellensburg as a heart in the middle of Washington is captured beautifully at Dick and Jane’s Spot near downtown Ellensburg. I love the notion that we- collectively and as a community- are a heart.  Amazing, courageous, inspirational individuals.

There are heroes all around us. Every community is full of amazing individuals who show great courage in the face of adversity as they live their lives from day to day. Ellensburg is no exception.

On a recent lazy summer afternoon during a backyard party, I had the privilege to connect with a friend who has been battling cancer for several years. This past year has been perhaps one of the most difficult for her- the cancer has spread, and a cure is not possible. Intelligent, articulate and accustomed to contributing to her community, she is no longer able to work but instead is immersed in the intense world of cancer treatment.

“I don’t feel very amazing,” she said in response to my statement that she was. “Oh but you are very amazing,” I replied. “ You have approached a difficult situation with grace, courage, a sense of humor and determination. You are very amazing.” She looked at me almost as if I was describing someone else.

“These amazing people don’t see it- they don’t realize they are heroes,” I thought to myself.

A hero is one who “shows great courage.” In my experience, the heroes I see in healthcare are numerous, and are the last to see they are exceptional. A privilege that comes with my work as a physician is that I come face to face with heroes everyday.

Recently, for example, I saw a man with multiple sclerosis who was struggling to maintain his independence in the face of worsening muscle weakness. He had worked hard all his life performing manual labor. Despite his body failing him, he has pushed on and continued to work, because in working, he feels whole. At a recent visit with his neurologist, my patient was told he may not be able to drive any longer- a necessity to his work. “What happens now?” he said as he stared at the ground, determined to find some way forward.

On that same day I met with a woman, who in the midst of grieving the sudden loss of her husband, experienced a stroke. Her passion in life is playing her musical instrument, and the stroke weakened her arm and impaired her coordination. “Our symphony has to play Beethoven’s 9th soon which is very difficult. I’m going to play it, but it won’t be pretty.” Although she lost her husband and then was knocked back by a stroke, she rose to her new challenges and strove to live her life fully.

And to finish the afternoon, I met with a young man and his mother. This well-loved man in his early 20’s had his life in front of him, but was now in the throws of heroin addiction. He was unable to take the steps he needed to regain his life. His mother was doing her best to support him despite seemingly endless painful setbacks. She was sad, discouraged and heartbroken, but each day did what she could to help him and mustered hope that her son may someday regain his life.

These are my heroes: people with cancer, multiple sclerosis, strokes, drug addiction. These are people right here in our community, individuals who draw from their inner strength to manage disease and disability.

And a remarkable quality common to these unique individuals is that, as a general rule-of-thumb, they all do not see that they are amazing. They take one day at a time and do their best to make the best of profound and difficult health circumstances. One step in front of the other- that’s what is on their minds.

These are American heroes, right here in Ellensburg. They don’t see that they are all remarkable, but of course they are. Next time you see one of them, help them look up from their daily struggles to see the sun and see the reality that they are our heroes.

Tell them they are amazing.

Our Relationship With Science

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On Earth Day this year, “The March For Science” was a organized as an effort to show support for science. People gathered and walked in cities and towns across America as well as around the world.

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Walking alongside thousands of other people in Seattle, I felt almost as though I was part of a meandering river of people flowing through downtown, filling the banks of a two way street. There were children and adults of all ages carrying a diverse array of placards that highlighted the importance of science in our lives. Be it biology, chemistry, ecology, physics, or medicine, science was the unifying theme. I carried two cardboard signs to illustrate gifts of science near and dear to my heart: “Science cures cancer, ” and “Vaccines save lives.” As I walked I reflected on the role science plays in our society, and how it supports each of us everyday, in a multitude of ways. I also reflected upon the support we in return, give to science.

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As a physician, nearly everything I do is because of science. Whether it is the stethoscope I use, the medications I prescribe, the diagnostic tests I order, or even how I make medical decisions, it is the result of science. Science encourages a manner of thinking that is invaluable: the scientific process is a method of thinking that utilizes objective evidence, and helps separate the useful from the useless. We live in an era where information is in excess, and the way scientists evaluate information helps illuminate the truth, and provides me with the tools I need to practice medicine. As I walked not far from the Seattle Cancer Care Alliance, through the busy downtown and beneath the Space Needle, I wondered if our relationship with science has become a one way street. In other words, while science supports us every day in most everything we do, do we as a society in return fully support science? I wondered if we take science for granted- if we have begun to pick and choose what to support depending on how it fits into our existing belief systems, or how it aligns with our lifestyle.

The most obvious example that came to mind is “Climate Change.” Scientific research consistently supports the notion that because of fossil fuels – and the subsequent accumulation of greenhouse gases- Earth’s climate is warming. However, these findings have often been met with skepticism, because supporting climate change frequently is at odds with a lifestyle and economy that relies heavily on cars and a society founded upon energy consumption.

Another common scenario – one I encounter every fall- is beliefs regarding the influenza vaccine. It is not uncommon for patients to readily accept every vaccine I offer, except the influenza vaccine. Research has clearly shown that receiving the flu shot significantly reduces the chance of hospitalization or death from influenza. Despite this knowledge, the reasons I hear from patients for not receiving the vaccine are diverse and not based on logic: “I don’t believe in the flu shot,” “I never get the flu shot and never get the flu, so I don’t need it,” or simply, “I don’t do the flu shot”, end of discussion.

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The common theme between these examples is the tendency to selectively choose what scientific data to believe depending on how the information aligns with lifestyle or preexisting beliefs . It is almost as if science has become a buffet, and individuals take the data they want and skip that which is undesirable or inconvenient.

As a society we cannot afford to have a buffet style, inconsistent perspective when it comes to science. Science may reveal concepts that challenge- or be at odds with- existing belief systems, but that’s how science is and always has been. Facts are facts. To pick and choose facts depending on what may be convenient to believe is dangerous. As a cancer survivor, I am alive because of science, and without the benefit of science to aid me in my work as a physician, many more of my patients would experience suffering and premature death.

Science truly supports each and every one of us, every day. The time has come for all of us to acknowledge this truth, and the time has come to consistently support the scientific process and to be open minded to the conclusions it reveals. A supportive relationship should be a two way street.