Hey Hey HEY 26 year old!!!!!

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The olden days

Five minutes nostalgia - good live version of this classic

Psychology of being sick

We are learning that people who become ill/hospitalized frequently have similar psychological reactions to their conditions, all of which to some degree are helpful, but become maladaptive when they stray too far from the mean. I was surprised at how similar these defenses and personality traits were to the ones I noticed during my time in sales, its funny how simple we are. When I read this chapter I'm constantly reminded of different customers, I think we all should have to do sales at some time in our life, convincing someone that they need something is the best type of psychological education you can get, and if you're good, you can get paid to do it. So here are the defenses: regression, denial, anxiety, depression, and anger. Each must be dealt with differently, later then dominant personality traits.

Regression: where a patient reverts to a more childlike way of thinking, they can become excessively passive. Its important to explore the reasons for this behavior with the patient, try to alleviate their fears by information and reassurance.

Denial: unconscious repression of a frightening situation that wards off the anxiety that may come along with it, can lead to delays in treatment and refusal of necessary treatments/tests. Best dealt with by introducing new information to the patient and observe how the patient incorporates and retains. Its best not to confront the denial, unless there is an emergency.

Anxiety: anxiety is a natural and necessary psychological state as a result of being ill. Too much fear, worry, and rumination however is maladaptive. In this case, elicit the specific nature of the patients fear, provide them with accurate information regrading this, and be reassuring where you can be. "there are excellent treatments" etc... given that there actually are! Don't lie.

Depression: kind of like anxiety, except with a pinch of guilt, because the patient feels somehow responsible for the illness and experiences the loss of function. Major depressive episodes are not normal, and have higher rates of not cooperating with any treatments. In this situation, its best to clarify the nature of the depression, correct any distorted notions, and reassure where it is possible.

Anger: Many people are angry at being ill. They can become hostile, paranoid and accusatory. Check for neurological issues or substance abuse, a major contributor to anger/violence. Best practices for managing angry patients are: First, prevent them from hurting themselves. Second: minimize conflicts which helps patients retain a sense of control

Third: Acknowledge anger and concerns (this is customer service type stuff)

We are also learning about a whole host of personality traits that come out with illness:

Dependant personality: these patients have fears of abandonment, lookout for unrealistic expectations of unlimited care. They may be disappointed or frustrated when something inevitably falls short of their expectations, can be demanding.

Use:

Gentle limit setting

Token compensation - trade a "tip" for good behavior or more patience

Consistency - dependent patients do better with a consistent predictable hospital visit.

Controlled personality traits: these patients are highly orderly and conscientious, need to have as much information as possible, and are heavy on the minute details. Taken to a compulsive degree they can become oppositional.

Use:

Logical explanations, they respond well from being participatory in their care. These patients can be gratified by acknowledging their exact natures "I can see you are discerning and intelligent, how would you best prefer to be informed regarding the nature of your test results?"

Self-dramatizing: naturally magnetic, charming people, long on emotion, short on specific detail. Overly familiar, needing to feel "special". Patients tend to deny the severity of their conditions.

Use:

Tread the line between the familiar and reserved, make them feel special.

Long-suffering: usually have a lifelong history of suffering, self sacrificing relationships, feel as burdens to others, appear modest and humble, and want love and acceptance but feel they may not deserve it. They view their condition as much deserved, beneath the self-flagellation look for attempts at attention and control.

Use:

Acknowledge the suffering! Acknowledge the suffering! Place the suffering in the context of all they do for others.

Suspicious traits: distrustful of doctors/nurses, tests. Somewhere on the paranoid spectrum, fear becoming exploited. Being sick and vulnerable can be a crisis because it lowers their defenses. Openly suspicious and critical.

Use:

Detailed information, including risks and benefits. Do not try and dispel their paranoia, that will only reinforce it. They are looking the "gotcha", acknowledge their concerns!

Superior personality traits: Patients can be self-important, self-centered, condescending. Look for it to be cloaked with a "patronizing false humility". They demand the best specialists, frequently engage in splitting - idealize one person while castigating another

Use:

Realize the narcissism protects them from realizing their own fragility and dependence. Inquire about the accomplishments, emphasize your own expertise and demonstrate self confidence, they need to believe they are receiving the best.

Aloof personality: Unemotional, reserved, indifferent, distant, detached, unconcerned. Look for avoidance of eye contact. Can be odd, extraordinarily concerned with either dietary habits or hyper-religious.

Use:

Respect the need for privacy!! Mirror their detachment by displaying a tempered interest. Don't try and be friendly or you will be appear intrusive and the patient will withdraw further.

Its all sales, everywhere I go, I see the same thing- our motivations are suprisingly similar. Whether you're trying to sell cutlery, booze, personal training, ketchup, or medical opinions - people all want the same two things: to be loved and to have control.

I like this

This is the best brain buster I have ever heard...

There are 1,001 envelopes before you. All of them are filled with a harmless powder, except for one which is filled with deadly anthrax. You must locate this envelope. You have only ten live mice that can be used to sample the powder from the envelopes. However the anthrax toxin will take the whole night to kill any mouse that samples it, thus you must figure out a way to use the mice tonight, there is not enough time to wait for one to die before using another. There is enough powder in each envelope for any mouse to sample any number of envelopes. How can you find the envelope containing the anthrax by the morning? Think hard, the post office is counting on you.

I couldn't get this, but when I found out the answer I started laughing aloud because it was so beautifully easy - that solution -whoever thought of it - that is the truest form of intelligence, I find the solution gorgeous. I just didn't have the perspective to see it - its funny about how perspective changes the experience. WHAT AM I NOT GETTING??!! :)

Types of pain

Just got back from a run, very tough really was able to push it today, had a funny thought about nature of pain. I learned in lecture that pain is divided into the actual physical stimulus and the emotional interpretation of that sensation. Also, that my body's opioid receptors primarily act to moderate the emotional aspect of pain, not so much the blunting of the negative physical sensation. How paradoxical that one could theoretically be in pain but not "feel it" because of the cortical emotional interpretation that says "this doesn't matter". This afternoon I experienced a beta-endorphin release after my run, and my body's natural receptors for these ligands were stimulated in response to the physiological stress of the cardiovascular demand from my run. My emotional experience was euphoric despite the fact that my body actually hurt which is interesting because its seemed the primary function was not to remove the physical pain of my lactic acidosis and and shortness of breath, but to alter my perception, and you know what? I felt flippin great despite being sore and tired. It could be that in the context of a painful stimulus, the cortex may interpret this as "necessary to survival" and so a more direct way of persevering despite pain generating actions (which is a bellwether for tissue damage) is not deadening nociception at the extremity but instead altering the conscious perception by creating a positive emotional reaction to it. Could be the basis for the old saying "hurt so good", but soon after experiencing joy while in pain because of the molecular shell game played by my opioid receptors it dawned on me the power an opioid addiction must have over its host. You take this exogenous substance (heroin, morphine, codeine, hydrocodone) and you start tapping those receptors and experiencing intense emotional highs (technically undeservedly because you haven't outrun any lions so to speak) meanwhile your life slowly goes to pot. But everytime you take the drug your body's receptors don't know that its being stimulated by something external, and those wise old opioid receptors that the brain trusts start whispering to your cortex, "its ok, its ok this pain is necessary for survival, your doing great. How can I be so sure? I know this because I'm being activated, if I wasn't, I wouldn't be able to tell you this... keep going the pain doesn't matter" And ultimately therein lies the rub with addiction and most other things in life - there is no free lunch! Not in physics, not in chemistry, not in economics, and not in biology. Ultimately, its not a real high (real meaning helpful to you and your cause) unless you bought it with blood sweat and tears (i.e. - just escaped with your life, real hard run, worked real hard, got the payoff). So I'm left wondering if you can override those false stimulations with a Zen like top down cortical mandate which would essentially be like saying, "no no - i know the pill is a lying - i didn't earn this high, it was brought to me falsely therefore I wont perceive it, its not helping me survive." But I don't think this is possible because that seems like a quite a cognitive circus trick - blocking the opioid action using some type of preemptive frontal cortex inhibition - I doubt if the wiring is even there for that.

P&S Rugby 2009

no time to write...

very busy,

but check it out>>>>!!!!

hot off the press

immunology is an exploding field right now because:

-much of pathology is traced back to improper immune function

-research protocols are clean, effective, and yield great results

-genetics are very much behind the etiology of automimmune

-rational drug development for the immune system has less hurdles than other systems because many treatments can be effected from the bloodstream without having to access difficult tissues and spaces

med school has picked up the pace, there is not time to both write and read...

Poem

I found a book of poetry on the mailroom floor. I opened it randomly and read the first poem as I rode up the elevator. It reached me, so here it is...

The happy ones are almost always also vulgar;

happiness has a way of thinking

that's rushed and has no time to look

but keeps on moving, compact and manic,

with contempt in passing for the dying:

Get on with your life, come on, buck up!

Those stilled by pain don't mix:

with the cheerful, self-assured runners

but with those who walk at the same slow pace.

If one wheel locks and the other's turning

the turning one doesn't stop turning

but goes as far as it can, dragging the other

in a poor, skewed race until the cart

either comes to a halt of falls apart

-Patrizia Cavalli

Officer v Gentleman

A prominent law professor was arrested the other day. He is black, the cop is white. The story has captivated many in the nation because it is so rich with content. I will add my opinion now (everyone else is doing it).

If you have been living under a rock for the last month- Here are the details

This story is interesting to me because it appears to be a modern day recapitulation of race relations during the civil rights era. But there is something inherently positive about this event (I'll explain) if we seek to understand each party and not find fault.

Gimme a...

White cop: Hard nosed blue collar white guy from the Boston area. Probably honest, but sees the world in binary (good/bad), and uses cognitive shortcuts in order to be a successful cop.

Black professor: Well educated, a professor of law at a world class institution. Highly prestigious and intellectual, nevertheless protected from most of the bad in this country by the ivory tower.

Here is my take. Both are at fault. Could the professor have acted in a way so as not to be arrested? Yes. Should he have been arrested despite his behavior? No. This encounter seems to have triggered the worst in both of these respectable people, both pillars of society, and I'm speculating here, but what got both of them heated was the fear of what each one of them represents to the other. Once they reacted to each others role in society- KA-BOOM!!!- national news

I'm going to take some creative liberty, but here are the characters' motivations.

White guy

First the white guy. Maybe he comes from a blue collar background. Many times I have seen people and communities in lower socioeconomic status area tending to be more segregated, whites keep with whites, blacks with blacks, latinos with latinos and so on. I experienced this growing up in my hometown and later on in the working world. And so maybe the cop comes from a police family, a modest background and he is used to being around mostly white people, probably he is exposed to bigots within his own race. Its not an easy world, and people don't go into law enforcement for the money so life gets stressful sometimes. Add to that, in Cambridge lies Harvard, an institution of great wealth, elitism, and status. In the minds of many Harvard = wealth, status, and power, things most will never have, himself included. So maybe there is some resentment between a civil servant and this huge institution that excludes his kind, and moreover he is conservative and the ivy league school is criticized by conservatives for being liberal, privileged, and insulated - read- entitled.

Black guy

Now the black guy. He's a bit older. Maybe his parents saw it through the worst of the civil rights movement. He's old enough to probably even remember some of the injustices personally. In fact he's experienced a lot of injustice in his life because he's black. Despite the racism, he rose above it, he soldiered on because he was smart and persevered. He's a law professor so he deals in arguments. He is facile with words and logic, and in time he is embraced by an institution that is relatively free of institutional racism (ivy league school). Despite having "arrived" at the top of his profession as it were, the memory remains, the memory of the civil rights movement, especially the memory of the negative role law enforcement played during that time. So even as far has he has risen, and though he can function in an unbiased way professionally (part of the reason law attracted him in the first place) he is still human. He still has an unconscious mistrust for law enforcement.

Scene:

At the house, they are looking at one another. It must have been a strange encounter. Two people who never would have otherwise crossed paths in life forced to interact with each other on what would soon become a national stage.

Remember playing with magnets as a kid? Did you ever try to find that distance between them where the force of attraction increases exponentially and overwhelms them both and snaps them together. Thats what I think happened. There were on the brink and parting company, it was almost a non-event. Then something happened. Only those two know what happened. It could have been a look, or word, or an intonation, so much of communication is nonverbal, I wonder what triggered it. But when it did you had both people acting out their scripts. The man of letters and argument - using his "power" against him, words and status as a weapon. Lashing him verbally, full of memories of the bad white cops of the past. This triggered the cop, I work all this hard, I actually protect you, and this is the thanks I get, thats it I'm using my "power" against you - I'm arresting you.

End scene.

The media reports the story, and the flood gates are opened. Is there racism in America? Yes, of course. Ironically, probably not in this instance. I don't believe the learned professor was arrested because he was black, I believe he was arrested because his words rightly or wrongly injured the cop, and the cop retaliated.

I believe this event presents us with the a great opportunity to move race relations forward. Enter Obama. See, this is what I like about Obama, he's canny. I think by virtue of being biracial he's equipped to psychologically undertake both perspectives. Whatever identity struggles he went through as a biracial youth have paid massive dividends, he is a race relations C3PO, fluent in both black and white perspectives. He invites both guys to the White House to have a beer and bury the hatchet. Awesome! This is how problems should be solved, open and honest communication. Not endless lawsuits and arrests. What do you think the two guys could learn about each other? This "beer at the White House" should be the slogan for learning about our differences. I hope both sit down and honestly say what was in their hearts that day. It would take a lot of courage but it would help us all to know, and it would forward the country. This country is changing so rapidly that who knows where we'll be in 20 years, but if we jump on these opportunities to learn about each other on level ground, we make the world a better place for our children, which is the only population available for the future. The opportunity to set an example of forgiveness and understanding is right on the table, it could be an historical event. This incident, as incendiary at it seems on face value, could actually metamorphose into a blessing. I hope it does.

P.S. - you know what i've observed that is good for race relations? education and solid homes. i have observed that people of different races are more likely to be actual friends (that means call you up and hang out outside of school/work/locker room/etc) when both parties are more educated or have solid family structures, stable home, money, food etc... Not exactly a groundbreaking observation, but isn't it funny how our backgrounds sometimes give us away??

Blind taste test.

It seems the more things change, the more they stay the same.

Check this out. Here is a new drug up for approval. It is called tesofensine, and it is seeking FDA approval by a Danish pharmaceutical concern NeuroSearch (NEUSF). The drug initially began as a potential Alzheimer's or Parkinson's treatment. Soon it came to light that tesofensine wasn't doing much for these diseases, but oddly enough resulted in significant weight loss and elevated mood. NeuroSearch next changed the application and sought approval for tesofensine as an anti-obesity, possibly anti-depressant treatment. The mechanism of action of this molecule is a CNS biogenic amine reuptake inhibitor (serotonin, norepinephrine, dopamine). 5 bucks to anyone who can name the most famous biogenic amine reuptake inhbitor of all time?

Say hello to my little friend:

Get it yet?

Here is tesofensine:

It seems tesofensine bears an uncanny resemblance to its more infamous South American cousin, cocaine, aka, snow, blow, yeyo!, aka Bolivian marching powder, aka candy cane, or Bernie's gold dust, that renowned alkaloid of the coca plant. Look at the similarity in these two molecules, they are basically the same, the functional groups are the same, with the exception of tesofensine being maybe a little more lipid soluble w/o the ester linkages in the R groups coming off the ring, so I'd be willing to bet it crosses the BBB and has greater CNS availability.

Isn't it funny that a "legitimate" pharmaceutical concern is seeking approval of an analogue of the most famous weight loss anti-depressant molecule of all time?? People lost weight on tesofensine? I don't believe it!! Jeez, why don't we just legalize and regulate cocaine already?

1. more tax $$

2. less prison time for everyone, (save $$)

3. demystify it for the youth so they can see it for what it is

4. put cartels out of business saving $$$ from drug war

$

$$$

$$$$$$

$$$$$$$$

get it? thats what its apparently all about

$$$$

Epilogue

A quick web search uncovered the tesofensine direct consumer marketing campaign:

UPS worker shot in cold blood

UPS shooting

This is a tragedy, the delivery man shot in cold blood, during work, at 10 AM. The incident is the next heart-breaking installment of what has been an ultra violent summer here in northern Illinois. As the article indicates, they have one suspect in custody, and are looking for the second. This story troubled me because it brought out a side of myself that I normally don't experience. I thought, what if this had happened to one of my loved ones??? Would I be consumed with anger? Thoughts of revenge? Would I be occupied with thoughts about getting my own justice?? The answer was an overwhelming yes.

I know the old adage an eye for an eye, tooth for a tooth, leaves everyone blind and toothless, and I'm read up on the reasons for/against the death penalty - but when the rubber hits the road of a human tragedy, I don't care, I totally understand why families of victims go for the death penalty. If someone intentionally, and in cold blood critically maimed/killed one of my family members - I think I just might find the needed release in dispatching the killer into the next world myself. Strong words I know, especially since I'm a medical student, oh well, at least I'm not in it for the $$$. Lets see, maybe the killer expresses remorse, thats one thing, remorse if forgivable. But what if the killer doesn't express remorse? What is right? What's the ultimate utility of taking another life? Aside from possible benefits to society by deterrence, reduction in the tax burden yada yada. What is the utility to the victim for taking the life of the killer? Thats the question I would try to answer.

State tax info

The following states have no state income tax for individuals:

Alaska - no sales tax either- the state is completely run on petroleum industry revenues

Florida - the state sales tax is between 6.5 - 7.0% depending on your county, no tax on food or prescription drugs (Rx)

Nevada - sales tax between 6.5 - 7.75% depending on your county, no tax on food, Rx

South Dakota - state sales tax 4% everywhere you go! No tax on food/Rx

Texas - state sales tax is 6.25%, no tax on food/Rx

Washington - state sales tax, 6.25%, no food, Rx taxes!

Wyoming - state sales tax is 4%, except if you're buying food, Rx- then there is no tax.

Special mentions go to:

Arizona - 4.54% for incomes >150K

Colorado - 4.63% of Federal taxable income

Connecticut - 5.0% I was surprised by this, compared to its northeast neighbors, its a steal.

Illinois at 3%, but I happen to know that its being raised to 5% next year, there is a huge budget deficit in my home state.

New Mexico - 4.9%

North Dakota - 3.81%>82K, 4.42%>171K, 4.86%>372K

Pennsylvania - 3% flat, not bad.

Utah - 5%

And the most tax oppressive states in the union? Check this out:

Hawaii State income tax: Income >150K 10-11%!!!!!!!!!

Think life will be better in Oregon? Income>175K, Oregon state income tax a whopping 11%!!!!!!!!

30 years old

Its my thirtieth birthday, and I had this big plan to write about my life so far. To take some time to engage in guided reflection because turning thirty is a supposed to be a milestone or something like that. To tell you the truth, there are a hundred other things I'd rather be doing right now... (studying micro/pharm/path for next year, going over my flight plan and practicing touch and goes, reading the PDLI quarterly report, shooting free throws, doing the xhtml tutorial, exercise, cleaning up my garden, sending the water sample to the lab, planning my orientation group or the rugby schedule, shadowing physicians, calling my girlfriend, reading that folder of articles on cognitive enhancement, playing with my friends' kids, playing piano/guitar, planning a trip on the cheap, thinking of how to start a new business, chatting with loved ones about their lives, laughing, learning, understanding!!!) so I guess thats the message at this point- the most rewarding feeling is productive activity, to be doing something -living. I'm so thankful for my thirty years of life and health. Moreover, I realize that you can't fit it all in, you have to sacrifice good things, there's only so much time, get busy living, use it wisely.

Gotta run!