I appreciate how you've framed and shared the discussion with Lilly, Mary. Like any discussion, this could have gone in so many different directions! The art of curating the discussion as an amalgam is so good. I'm saving this one because the kidney discussion is probably the best explanation I've heard to date.
On a personal note - one of the best ways I learnt more about what each food had was via the MyfitnessPal (back in 2017) I soon realised how much sugar, salt etc were in each food AND how much salt was in many of the UK Marks and Spencer convenience foods. https://www.myfitnesspal.com/
There’s a bit of Lilly in all of us, especially post Covid. Funny how those of us who are usually *not* team players struggle more; I think it’s generational. Lilly seems like a late boomer/early GenX and to gain trust is the most important thing over explaining stats. I’m not sure I would still be sober today if Doc Collins told me the statistics of opiate use disorder when I got sober 26 years ago.
Jim, I would be interested in hearing more about your last sentence if you felt like saying it. I agree that trust is such an important issue, so easy to lose. Lilly is 68 now. Mid boomer.
Of course! Opiate use d/o has a very low “success rate” compared to other drugs of abuse; some journals back then when the opiate crisis was just rolling suggested 1-2% of us would remain sober. I had fantastic treatment at the Cleveland Clinic under Dr. Collins, who took no crap. I was also under the care of chronic pain rehab since it was chronic pain that started opioid therapy that led to my addiction. Interestingly I never used most drugs of abuse even though immersed fully in the music business. Never did coke, barely drank, weed made me paranoid (smoked it three times over my whole life and horrible experiences each time). Had I not figured out that alcohol and Percocet made for lengthening my script, I am not sure I would have gotten sober. Thank God I did before OxyContin got big. I had already learned to eat fentanyl patches (original formulary), and manipulate many docs for IV Demerol. It was easier to find docs to manipulate since I was well known both as a solo artist and guitarist for John Mellencamp here in Indiana. I’m always happy to share my story because it’s helped a lot of folks. That’s why I changed careers - got sober and decided THAT was what God wanted me to do! Now I have the joy of helping others and I love music more than ever!
I love this so much! My brother is a recovering heroin user. Sober over 20 years. It can happen to anyone, anytime. I’m so grateful he’s still with me. I love him so much. Thank you for sharing.
Another excellent doctor patient visit. What struck me in the end was when you told Lilly to call if any problems. Where I live and I imagine for many now, doctor's offices don't answer their phone anymore, and you're darned lucky if they call back. Notes sent via patient portals is the only way some will communicate or their pat explanation--go to the ER even when not necessary.
Lilly's surprise about the hidden salt in processed foods is a fantastic, almost comical, illustration of how much we don't know about what we consume, even when we think we're being careful. I went through the same thing with sugar!
I sympathize with Lilly regarding her issues with trust. After spending most of my life following the advice of doctors and government with regard to diet, I was seriously unhealthy and obese. When going on Medicare Advantage, my PCP continued to recommend drugs and diet that I knew to be incorrect. Now that her practice is owned by the insurance company, the trust has eroded completely. I go in for the mandatory assessments, but follow my own practices that have made me prescription-free and healthier at 78 than at any other time in my life. I don't blame the doctors, only a system that is badly broken.
Thank you, Gerridoc! Trying to figure out how to find time even in my fictional world to explain the pathophysiology of the benefit of low salt to Lilly.
Remember how a few weeks ago I wrote a bunch about urine formation? Well, I got to use about six of those words in this essay. Satisfying.
Those are very difficult concepts to explain. They are challenging for medical students and residents to grasp. Unfortunately they are often poorly taught.
Great question, Jim! Diuretics can contribute to actual gout, not just gout-like symptoms. I am going to hold off on answering this because it’s quite complicated.
I appreciate how you've framed and shared the discussion with Lilly, Mary. Like any discussion, this could have gone in so many different directions! The art of curating the discussion as an amalgam is so good. I'm saving this one because the kidney discussion is probably the best explanation I've heard to date.
On a personal note - one of the best ways I learnt more about what each food had was via the MyfitnessPal (back in 2017) I soon realised how much sugar, salt etc were in each food AND how much salt was in many of the UK Marks and Spencer convenience foods. https://www.myfitnesspal.com/
Thanks Mary!
Great layman’s explanation of the complex fluid balance the kidneys perform. Your cat is cute. I’m glad you could work with your daughter!
Thank you! Me, too!
There’s a bit of Lilly in all of us, especially post Covid. Funny how those of us who are usually *not* team players struggle more; I think it’s generational. Lilly seems like a late boomer/early GenX and to gain trust is the most important thing over explaining stats. I’m not sure I would still be sober today if Doc Collins told me the statistics of opiate use disorder when I got sober 26 years ago.
Jim, I would be interested in hearing more about your last sentence if you felt like saying it. I agree that trust is such an important issue, so easy to lose. Lilly is 68 now. Mid boomer.
Of course! Opiate use d/o has a very low “success rate” compared to other drugs of abuse; some journals back then when the opiate crisis was just rolling suggested 1-2% of us would remain sober. I had fantastic treatment at the Cleveland Clinic under Dr. Collins, who took no crap. I was also under the care of chronic pain rehab since it was chronic pain that started opioid therapy that led to my addiction. Interestingly I never used most drugs of abuse even though immersed fully in the music business. Never did coke, barely drank, weed made me paranoid (smoked it three times over my whole life and horrible experiences each time). Had I not figured out that alcohol and Percocet made for lengthening my script, I am not sure I would have gotten sober. Thank God I did before OxyContin got big. I had already learned to eat fentanyl patches (original formulary), and manipulate many docs for IV Demerol. It was easier to find docs to manipulate since I was well known both as a solo artist and guitarist for John Mellencamp here in Indiana. I’m always happy to share my story because it’s helped a lot of folks. That’s why I changed careers - got sober and decided THAT was what God wanted me to do! Now I have the joy of helping others and I love music more than ever!
I love this so much! My brother is a recovering heroin user. Sober over 20 years. It can happen to anyone, anytime. I’m so grateful he’s still with me. I love him so much. Thank you for sharing.
That makes my day!
Another excellent doctor patient visit. What struck me in the end was when you told Lilly to call if any problems. Where I live and I imagine for many now, doctor's offices don't answer their phone anymore, and you're darned lucky if they call back. Notes sent via patient portals is the only way some will communicate or their pat explanation--go to the ER even when not necessary.
Lilly's surprise about the hidden salt in processed foods is a fantastic, almost comical, illustration of how much we don't know about what we consume, even when we think we're being careful. I went through the same thing with sugar!
You don’t know what you don’t know!
I sympathize with Lilly regarding her issues with trust. After spending most of my life following the advice of doctors and government with regard to diet, I was seriously unhealthy and obese. When going on Medicare Advantage, my PCP continued to recommend drugs and diet that I knew to be incorrect. Now that her practice is owned by the insurance company, the trust has eroded completely. I go in for the mandatory assessments, but follow my own practices that have made me prescription-free and healthier at 78 than at any other time in my life. I don't blame the doctors, only a system that is badly broken.
Louise! Such a good name for a cat. Mary….I love what you write. Glad the tick wasn’t a problem. ❤️❤️❤️🐈⬛🐈⬛
Thanks! Me, too!
Excellent explanation!
Thank you, Gerridoc! Trying to figure out how to find time even in my fictional world to explain the pathophysiology of the benefit of low salt to Lilly.
Remember how a few weeks ago I wrote a bunch about urine formation? Well, I got to use about six of those words in this essay. Satisfying.
Those are very difficult concepts to explain. They are challenging for medical students and residents to grasp. Unfortunately they are often poorly taught.
Why do diuretics raise uric acid levels and contribute to gout-like symptoms?
Great question, Jim! Diuretics can contribute to actual gout, not just gout-like symptoms. I am going to hold off on answering this because it’s quite complicated.
Have you noticed that diuretics can elevate uric acid levels?
Yes!
And aren’t they hard on the kidneys?
Under what circumstances?
I’m not a doctor.
I’m just asking.