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Let's Talk About "All In Your Head"

If I had to vote for a phrase, just 4 short words, that cause more problems in our society than most others it would be these:
All in your head.
To hear these words as a person with medical symptoms brings about such a cascade of thoughts. Anything from "My doctor doesn't believe me" to "Are my symptoms really happening?" with corresponding emotions of anxiety, confusion, anger, even rage.
I spend a lot of time undoing the damage these 4 words can do in the patients I see. They've been told, either directly or indirectly, their disease is psychologically based. And that means it's really not that bad, that they should just get over it and move on. It's a running thread in most of the patients with any "functional" diagnosis I've seen, such as irritable bowel syndrome, but also appears in those with "organic" conditions - those diseases perceived as real like inflammatory bowel disease.
These 4 words are part of the fundamenta…
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Medical PTSD

“It is just an illusion here on Earth that one moment follows another one, like beads on a string, and that once a moment is gone, it is gone forever.”  - Kurt Vonnegut, Slaughterhouse Five 
A few years ago, my gastroenterologist wanted me to have something called an esophageal manometry to better understand how my newly diagnosed eosinophilic esophagitis may have been affecting how the muscles in my esophagus were functioning.  I work with the guys who wrote the book on esophageal disease, and these guys do a lot of manometries. I know all about esophageal manometry.

My mind immediately went to images of a small bowel enteroclysis I'd had at least a decade prior. My body grew tense and it was almost as if I was back in that cold room with the cold metal table and the cold radiologist, who just didn't believe me when I told her how bad my gag reflex was before she placed a tube down my throat to inject my small intestines with barium.

It took what seemed like forever to get th…

Precision Patient

Precision medicine, or "a medical model that proposes the customization of healthcare, with medical decisions, treatments, practices, or products being tailored to the individual patient" is on fleek.

Or fire, or lit, because fleek is so 2017.

This is what happens when a Gen X'er tries to use the language of those under 25.

Online, at a conference, or even in your doctor's office, you've probably heard this buzzword. If you're an MD reading this, I'm sure you've heard this term used in various circles and may have even used it yourself with patients or in a presentation.

Precision medicine is exciting. Because, SCIENCE!

It seems every year, medical technology is advancing exponentially in how we understand disease and is going to save a lot of lives and reduce a lot of pain and suffering. How can you NOT be excited about precision medicine?

In my world of Crohn's disease, things like "therapeutic drug monitoring" and "biomarkers&quo…

Patient Burnout

As I sit down to write this entry it's 4:42 in the morning. I've been up since around 2:30. Insomnia is nothing new to me, if anything it's odd for me to go more than a month without it. I guess that makes it a frenemy of sorts. Tonight I assume I woke up because I fell asleep in my almost-4 year old son's room because he wanted me to lay with him and I'm a sucker for that kind of thing.  Even though young children sleep like they're the star of a 1980s kung fu film.

I often scroll through Twitter when I'm up early and I keep seeing stories about the epidemic of physician burnout. I'm glad this is being talked about more openly. It's not a new concept, but the way our health care system is run these days seems to be piling on more and more mundane bullshit and physicians are growing weary, to put it mildly.  I even did a study in burnout in gastroenterology back in 2011 (Link: which is still my favorite …

When I'm 64

As I approach my 43rd birthday this December, I've been thinking about what life might be like in a couple of decades.  Not a mid-life crisis, there's no new convertible in my garage.  My kids will hopefully be functioning adults. I'll be contemplating retirement.  The usual stuff most people face as they age.

I'm thinking about what the hell is my digestive system going to look like when I'm 64?

(For the young readers, "When I'm 64" is a Beatles song.  The Beatles are a pioneering rock-n-roll band from the 1960s.  They're on Spotify.)

If you haven't read my blog before, I have 2 chronic digestive diseases - Crohn's disease and eosinophilic esophagitis.  Neither are great things to have, but I am fortunate to have what I'd consider relatively mild to moderate disease.  For some people these diseases are a complete shit show.  I've had 1 surgery and 1 hospital stay.

But CD and EoE are somewhat progressive.  When I'm 64, I'll…


I've been thinking a lot about how we live in an era of infinite access to infinite information (thanks, internet tubes!) yet we still fall into many of the well-established psychological laws, if we can call them that, of human behavior.  Don't worry, this isn't going to be some drawn out post on social psychology. Wikipedia is great for that.

I want to talk about bubbles.  Information bubbles, that is. And how each one of us lives in one to some extent, no matter how educated or enlightened we see ourselves to be. And even if we know we live in said bubble, it takes being shown information that directly conflicts with how you think things are, or should be, and the result is you feel kinda ew - the technical term for "ew" being cognitive dissonance.

I live in a bubble.

In my bubble is the world of academic medicine, academic health psychology, and a circle of psychologists dedicated to people living with chronic digestive illness.  I live in Chicago, a major me…

Hey Guess What? There Are Mental Health Concerns Other Than Depression and Anxiety

Greetings! This post may come across as my being bitchy or complaining about something important, especially in the critical advances being made in integrating mental health into the understanding of and care for people living with chronic medical diseases. People who know me well would never describe me as bitchy. Ok, they might.

But, if I get one more fucking paper to review that studies "Anxiety and Depression" in patients living with inflammatory bowel disease (IBD) I'm going to start yelling.

Or maybe I'm yelling now. Into the ether via a MacBook screen and drinking a mug of what's really 2 cups of coffee, let's be honest.

Hear me out.

I've been one of the biggest proponents of incorporating mental health into IBD patient care. Since the early 2000s, my sensei master, Dr. Laurie Keefer, is doing amazing things. First at Northwestern and now in New York at Mount Sinai managing their IBD patient medical home. As is my partner in crime, Dr. Megan Riehl a…