El Rincon del Dr. KakaWate

  The point of this quick blogpost is to see how many responses I can get from people with Migraine and hopefully help each other out with a friendly discussion.  If you have not been to this blog before, let me tell you a sentence about me.

I am a 32 year old Cardiologist recently exploring the potential of social media in healthcare.  As someone with Migraines, and after having 3 episodes in a week last month, I decided to look  for other patients that can share their experiences with me and hopefully help each other out.  If I get enough info I will do a quick statistical analysis and  see if there is a pattern of a “better” particular regimen/treatment/prophylaxis and share it here in MEDBONSAI.

I am not expecting many people to contribute but who knows. Maybe  their are other ones like me, curious,  looking for an answer. So if you can RT the message it will be helpful to all of us.

So let me start (you can use this format if you want to share your experience)

My name is Christian, 32 year old male; Prophylaxis with Propanolol 10mg BID which worked great for me in the past. As rescue treatment I use Sumatriptan 50mg prn but does not always work and many times gives me moderate nausea.  I try Tylenol, Excedrin, aspirin, ibuprofen and they are useless for my headaches.  Since Sumatriptan gives me nausea I think I will try Rizatriptan next. Any recs? Leave your comments below.

Update:  I will try to answer anyone who has a question or a post, but remember I do this as a Patient giving recommendation from my experience to another patient. I do not plan to substitute your Doctor or PCPs judgement.  If you read someones post and think you can provide some insight or help, please do. This is the point of this blogpost. Help each other out!

Summary Points of 6/8/2011 can be found in Dropbox link:

http://dl.dropbox.com/u/28605177/Migraines%20a%20Social%20Experiment.docx

Thanks!

When facebook started we were  a little skeptical  but then started to adopt it, we started befriending people and  tagging them on pictures. You started what? TAGGING…  Ohh Boy… My eyes saw the world in a different way the first time I heard the concept.  I am a very friendly person, but just as I enjoy being with  friends, I enjoy being by myself the same way. I could and still can,  spend a weekend alone, playing video games, reading, exercising, and not feel that my weekend was wasted. Many of my colleagues don’t share my personality and love going out.  When they do  go out and enjoy themselves, every now and then they take pictures.  Later or at that same moment, pictures get uploaded to facebook, flickr, foursquare, you name it.  The problem is sometimes these  pictures are judged by eyes that should not really be seeing them. They do not understand the concept in which they were taken.

So call it paranoia but a few years back,  I decided to  limit  the amount of pictures taken of me as well as limiting WHO took the pictures to a certain extent.  Before the internet became popular, a picture or comment was something only shared by a few.  A picture, now, if  uploaded, is something shared by thousands  but the context is still only shared by a few.

So I “Googled”  Social Media Etiquette for Doctors and  found the article below

American Medical Association

AMA Policy: Professionalism in the Use of Social Media

These are just a couple of the points mentioned rest can be found in previous link.  I selected a couple and decided to comment on them. Here they are;

 (a) Physicians should be cognizant of standards of patient privacy and confidentiality that must be maintained in all environments, including online, and must refrain from posting identifiable patient information online. 

R: Clear as water. No comment

(B) When using the Internet for social networking, physicians should use privacy settings to safeguard personal information and content to the extent possible, BUT 1)  should realize that privacy settings are not absolute and that once on the Internet, content is likely there permanently. Thus, 2) physicians should routinely monitor their own Internet presence to ensure that the personal and professional information on their own sites and, to the extent possible, content posted about them by others, is accurate and appropriate.

R1)  So now think back if you have ever had a compromising picture taken, be it old or recent. Remember, anyone who has access to it could upload it to the internet without you even knowing and not think about the repercussions it could have, photographs are taken of us without even knowing.  Will you or are you modifying the way you behave with people in parties or social events because of this concern? Do you think twice before having a picture taken because of the possibility the context is misinterpreted?  I could continue asking questions all day.

Even more Concerning

R2) Routinely monitor internet presence? LOL… GOOD LUCK ON THAT ONE, yes since we ALL have the time to do this… I think what this means is the following; Routinely have SOMEONE else monitor your internet presence and pay them for this task…Maybe it will be Mr. Google, or maybe an application done by third party incorporated to Facebook or maybe just maybe a lucrative company arises that will offer this service to you (maybe it exists already).  Ex. Hey Dr. X, we are a company that monitors your internet presence and for $5,000 a year you’ll have a system screening any “red flag” events  that involve you and delete it. Which if you think about, it could be double edged sword… Another possible scenario could be… starting to pay an  “Internet Presence Liability Insurance”!? Oh Great…

(c) If they interact with patients on the Internet, physicians must maintain appropriate boundaries of the patient-physician relationship in accordance with professional ethical guidelines just, as they would in any other context. 

R: No comments.  Simple to do I guess.

(d) To maintain appropriate professional boundaries physicians should consider separating personal and professional content online. 

R:  In other words start creating  another  Facebook, Foursquare, Yelp, Flickr and Twitter account for work, or don’t share any personal information in your social media accounts, think twice about the jokes you now say.  This basically contradicts the purpose of the whole social media concept in my opinion. Another option could be just to start behaving like a Tibetan Monk…It seems like Social Media is not that social after all? Yes this is an extreme, but some need the extreme scenario for an idea to sink in. Sometimes I do…

So, back to the question… Can Social Media make you Anti-Social? In other words is social media affecting the way you behave in the real world?

Just to be clear… I am in FAVOR of Social Media in healthcare, but as someone new to it, I am recommending people who are getting into it to be mature and cautious on how they approach the matter.  As an example I am recommending many of my colleagues to start deleting some of the pictures they have in FB before it is too late but most likely it is too late for some of them…  Am I exaggerating? I do not think so but we can always agree to disagree and have a conversation. That is what blogs are for.

Thanks for Reading 😉

The point of this small post is to;

1)      Show the potential of Twitter to my colleagues

2)      Showing thru #1 ,that even though Residents keep hearing that Troponin-I levels are not affected by Kidney disease, this is a controversial subject, and from a Cardiology perspective, we see in the majority of cases a slight increase of Troponin levels with normal CK and CKMB levels in the setting of impaired kidney function.

Being in the Cardiology Consult service we usually get called to evaluate elevation of Troponins in patients with kidney disease with;  Negative EKG changes, Negative cardiac symptoms etc.  The residents in the hospital have heard several times in conferences given by another department that “Troponin I is not affected by kidney function”.  Not a single Cardiologist I have spoken to agrees with this comment.

Even though I tell them this, they always shoot back the argument “We had a conference where …”. So being new to twitter, I decided to give it a try.  I would try  to contact a World-Renown expert to give me his opinion on this.  So I decided to contact Eric Topol. You did WHAT?! Yes, I know it is overkill, but I just wanted to prove two points. I could contact Eric Topol quickly thru Twitter and get an answer to my question.

I am sure Dr. Topol might have thought this was an absurd question but he  humbly answered promptly, proving 2 points.

1)      Twitter can be a AMAZING  tool if you learn to use it correctly.  If Dr. Topol took time to answer this simple  and “absurd” question it is very likely that he would be more thrilled to share his knowledge with a more difficult and challenging one.

2)      Troponin-I elevation in kidney disease is a controversial subject, so please, when you consult cardiology do not tell them that Kidney function does not affect it.

Eric J. Topol, M.D. is a noted American cardiologist, geneticist and innovator. He is the Director of the Scripps Translational Science Institute in La Jolla, California, which is a National Institutes of Health funded flagship grant, to accelerate research to change medicine.^[1] He also serves as the Chief Academic Officer for Scripps Health, a Professor of Translational Genomics at The Scripps Research Institute, and was recently named The Gary and Mary West Chair of Innovative Medicine.^[2] In addition, he is a Co-Founder and serves on the Board of the West Wireless Health Institute as Vice-Chairman.^[3] He is also the Editor-in-chief of theheart.org.^{[4] “http://en.wikipedia.org/wiki/Eric_Topol”}

Please fell free to add any comments in the section below. Thanks!