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Showing posts from 2018

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…

That Time I Became Allergic to Benadryl

Hey, what's up?  Enjoying your summer?  It's been a pendulum swing between 98 degrees with 6000% humidity and 65 and raining here in Chicagoland. Climate change?  What?  Nah.

Today I'm going to change gears from my usual digestive system talk and move on over to a different thing - allergy.  In my repertoire of medical doctors is an allergist/immunologist, whom I was sent to when my gastroenterologist suspected I had eosinophilic esophagitis. 
Spoiler:  I do.
A very recent study, like last month recent, suggests that EoE is a "late manifestation of the atopic march."  The atopic march?  When did that become a thing and why does it sound kinda ominous, especially given today's political climate?
Thankfully it's simply the tendency for a person who develops some sort of an allergy to go on and develop other allergic conditions as they age.  Like a fine wine.  Typically this starts with eczema as a baby, which I have no idea if I had.  I don't think I di…

Everyone Can Fall Down the Rabbit Hole

A few months ago my 3 year old son uttered the words, "I hate you, mommy."  It was after I yelled at him for doing something wrong, which I've long forgotten what exactly the source of our exchange was. But I certainly can remember those words. I can hear them in my head if my brain decides, at random moments, to replay them.

My intellectual, clinical psychologist brain can explain this for days. He's 3, he doesn't know what he's saying, he learned the word hate somewhere else, presumably at preschool, as I discourage its free use in our house. He's using it to express his anger not his true feelings toward me because once he self-regulates (psychobabble for calms the F down) he tells me he loves me.  Blah blah blah.

Regardless of all that knowledge and shit I have from too much education, those words destroy me emotionally.  Maybe they hit me harder because of my profession because my head goes to all the subsequent pathology he'll surely go on to de…

You Should Totally Meditate

So, have you tried meditation?  Because it's AMAZING.  It's a simple and effective way to fix essentially any problem you have.  You just need to breathe and clear your mind and your issues will simply fade away.  That's all there is to it!  Just breathe and clear your mind and your issues will vanish.

Can't concentrate?  Meditate!
Got pain?  Meditate!
Falling behind at the tech office?  Meditate!
Failing your class?  Meditate!
You name it, meditation can fix it.  And it's EASY.  Just ask anyone who's tried it.
I've asked people who've tried it. Turns out it's not so easy, it doesn't fix everything, and many people give up on it too soon because they feel like they can't do it.  But if you Google "meditation benefits" you get 500 health stories about how good it is for you and how you're missing out if you don't meditate on the regular.  Yet very few of them actually get into the weeds of learning this skill.  
That's right…

The Long Shot

I don't even know where to begin as my head is still spinning with the news I received today.  So I'm just going to put it out into the ether:

Entyvio (vedolizumab), which I started for my Crohn's disease about 6 months ago, did what no other approach has:  cleared my eosinophilic esophagitis. 

But wait, isn't Entyvio a drug for inflammatory bowel disease?  Yes.

Is Eosinophilic Esophagitis a type of inflammatory bowel disease?  Nope.

Are IBD and EoE related at all?  As far as we know today, no.  There are very few overlapping cases.

So WTF happened?

Without getting into the biomechanics of a drug that's way over my pay grade in medical understanding, my gastroenterologist had a theory that the way Entyvio works would block the cascade of eosinophils (a part of your immune system, a type of white blood cell) through it's magical way of selectively keeping my immune system from attacking my digestive tract.

She was fucking right.

Since being diagnosed with EoE in ear…