Tuesday, 8 October 2013

The Good, The Bad or The Common? Help your doctor help you

I have found during my training as a doctor that medicine is just as much an art as it is a science. Few things are absolute or 100%. New studies come out daily, which change the way we practice. Different countries, even provinces may follow different guidelines. It is not that one is necessarily wrong, or the other is right… it is just different.

When patients go to the doctor, say for a headache, doctors are trained to formulate a differential diagnosis. Most of the time we cannot guarantee 100% what is going on. Investigations may need to be done, and follow up appointments made. Treatments may be attempted, stopped and then reassessed many times. When formulating a list of possible diagnoses, most physicians include things that are common and things that are life threatening (even though it may be unlikely). Next time you go to the doctor with an issue, say abdominal pain, here is a little mnemonic to help the visit go smoothly. Being less vague about a complaint will help the doctor arrive at a diagnosis, which in turn will get you the appropriate treatment faster. There are a lot of different ones to use, but this one is relatively easy to remember - OPQRST.
Say you are going to your doctor for abdominal pain:

O – onset
             -When did the pain start? What were you doing? Was it sudden/gradual onset?
P-provocation and palliation 
            -Does anything make it better or worse?
Q- quality
           -What does it feel like (sharp, dull, constant, intermittent). Any other symptoms?
R – region and radiation
           -Where is the pain? Localized or everywhere? Does it radiate anywhere?
S- severity
           -How bad is the pain? Some doctors use a scale - 0 (not bad) to 10(worst pain of your   life). 
T – timing
            - How long has the pain been going on? Has it changed? Have you ever had this pain before?

Hope this helps with your next visit to the doctor! 
Diagnosing a classmate in the early days of training :)

Wednesday, 2 October 2013

Yoga for Depression and Anxiety!

I apologize for not posting in a while, but I have a flurry of ideas that should keep the blog going for the next couple weeks.

Last week, our Integrative Medicine course director held a journal club where we discussed this article:

Saeed SA, Antonacci DJ, and Bloch RM. Exercise, Yoga and Meditation for Depressive and Anxiety Disorders. Am Fam Physician 2010; 81:8.

To summarize the article, yoga has shown to benefit individuals with depression at a therapeutic level comparable to that of cognitive behavioral therapy (CBT) and some medications (the mainstays of treatment). It has also demonstrated benefit in individuals with anxiety, however there is far less data available on this subject.

I've never really been one for yoga, but after reading this article it really made me consider giving it another shot...not to mention how relaxed I felt after we participated in an hour of yoga followed by a guided meditation. Residency is definitely a busy time and yoga seems to have the ability to help with "de-stressing".

While I wouldn't recommend quitting any current treatment regimens for depression or anxiety without talking to your doctor, if you suffer from either of these, consider adding yoga as an adjunct.

Namaste, right?

Paddle board yoga can be fun too :)

- Lindsey