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@justOncology

~ Musings on health, illness & evidence based medicine

@justOncology

Tag Archives: doctors

One More Monitor

04 Tuesday Sep 2012

Posted by @JustOncology in Uncategorized

≈ 1 Comment

Tags

digital health, doctors, George Sledge MD, medicine, Oncology Times, Per Chance to Dream, Quantified Self, science of sleep

By Richard Just, MD

At about 3:30 PM, I sat down in my family room, raised my feet onto an ottoman, and conked out until 5:00 PM with a copy of a medical journal in my lap.  My wife nudged me on her way out to meet a friend for dinner. When I’m sleepy, my first reflex is to check my continuous glucose monitor (CGM) for a high blood sugar level.  Nope.  95 and steady.  As they say on the beer commercial:  “It don’t get any better than this.”  I also wear (as in attached to my body, not my clothing) an insulin pump and a heart monitor. Neither of those could offer help in this situation. So I turned to my newest monitoring system: LARK (Editors Note: see Wired’s ‘How Lark Went From Idea to Apple Store in One Year‘).  According to the accompanying app on my iPhone, my “time asleep needs work”, meaning I should be averaging 8 hours of sleep per night, but I’m only getting 6.  LARK suggested I go to sleep earlier and at the same time each night.

My wife and I often drive up to L.A. for the day, a 300 mile round trip.  Lately, especially on our return trips to Escondido, I’ve been almost nodding off at the wheel.  A lot more serious than falling asleep in my family room!!  On these occasions, my wife is not so gentle in rousing me.  In June, she’d had enough and marched me down to the local Apple store to purchase a specialty device called LARK.  Because she is hearing impaired and doesn’t pick up many audible wake-up alarms, Dee Dee bought LARK primarily for the wristband which pulsates at a scheduled time.  While I also use this new silent alarm system, I am more interested in the objective data the accompanying app provides about my sleep patterns. Using this data, I’m alerted to possible corrective actions I can take to improve performance throughout the day.  I can also share this data wirelessly via Facebook or Twitter.

Coincidentally, in June, when I bought the device, Dr. George Sledge authored an article on sleep (“Perchance to Dream”, Oncology Times, June 25, 2012, pg 28), and a second article entitled “Decoding the Science of Sleep” appeared in the Wall Street Journal, August 4-5, 2012, pp 1-2.  Both document how common sleep disorders are. To illustrate, the annual number of prescriptions written for sleeping meds last year was about 60 million.  And studies have demonstrated that these pills don’t work.  Unfortunately, they can impair short-term memory so that people believe they slept better than they actually did.  So poor sleep habits “can also be a data problem” in that the medicated individual can’t really remember how well or poorly they slept.  Devices like LARK can collect this information for us, and supply analysis for possible solutions.

Before you can designate something as abnormal, it has to deviate from what is considered normal. A. Roger Ekirch, a Virginia Tech history professor, spent 20 years researching sleep and provides the seminal work defining “normal sleep”.  He found that, until about 200 years ago, our normal sleep pattern was divided into 2 phases:  the “first sleep” started just after sunset and lasted until just after midnight, when the person would wake up for about an hour, then fall back into the “second sleep” ending with the rising sun.  The time between the two episodes of sleep was spent reading, praying, contemplating dreams or having sex.  This normal sleep pattern was totally altered by Thomas Edison and the electric light.  The result is that about 20% of our general population has some type of sleep disorder.  We’ve become a “wired and tired” society.

Dr. Sledge estimates that 45% of cancer patients have insomnia.  Some are afraid to fall asleep as they might not wake up (“somniphobia”).  Sleep disorders tend to be intertwined with other problems, especially fatigue, depression, and pain, “making it hard to tease out cause and effect.”  For example, I saw a patient today with multiple myeloma who said his main complaint was fatigue.  On further questioning, he was taking longer naps during the day because he didn’t sleep well at night, sometimes taking an Ambien.  When this didn’t help, his primary care physician tried Lunesta, which didn’t work at all.  Turns out he wasn’t sleeping because his Velcade-induced neuropathy only bothered him at night.  Fortunately, this patient has a good memory and an attentive wife, who happens to be a nurse.  So we were able to figure out the problem without a device like LARK. But most situations are not this straight-forward, and data-driven solutions can be quite beneficial.

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Doctors, Patients & Social Media

14 Wednesday Sep 2011

Posted by @JustOncology in Uncategorized

≈ 1 Comment

Tags

community, digital media, doctors, elder wisdom, health, innovation, Just Oncology, medical education, medicine, oncology, participatory medicine, patients, physicians, San Diego, social media, twitter, wellness

A recent report released by QuantiaMD aka @QuantiaMD and the CareContinuum Alliance (CCA) aka @CareContinuum is worth note. The survey was conducted by Frost & Sullivan in collaboration with QuantiaMD  and the Institute for Health Technology Transformation.

‘Social media’ was defined to include: “not only social networking sites like Facebook and LinkedIn, but also professional and patient networking communities specific to the medical field, blogs and sites such as YouTube”).

Executive Summary

Physicians are highly engaged with online networks and social media. Nearly 90% of physicians use at least one site for personal use, and over 65% for professional purposes. Overall, clinicians express significant interest in the potential applications of social media to their professions – whether via online physician communities, online patient communities or sites that could facilitate physician-patient interactions. A group of “Connected Clinicians” is using multiple social media sites for both personal and professional uses. These clinicians are the front-runners in applying social media to medicine, and are most eager to use it to positively impact patient care. Key take-aways from our study include:

• The vast majority of physicians are already using social media; Facebook tops the list for personal use, while online physician communities are driving professional use.

• Physicians familiar with online patient communities believe they positively impact patient health; however, awareness of these sites is low.

• Some 28% of physicians already use professional physician communities, with the highest enthusiasm around using them to learn from experts and peers.

• Clinicians see the potential in online interactions with patients to improve access to and quality of care, but concerns around patient privacy, liability and their compensation for such activities must be addressed.

• There is significant need for secure, convenient forms of electronic communication that clinicians can use to communicate with each other, and with patients.

• Over 20% of clinicians use 2 or more sites each for personal and professional use; these “Connected Clinicians” are the most eager to use social media to improve health care.

• There are opportunities for constituents across the health care system to use social media as a tool for improving patient care.

Our study included 4,033 clinicians and was conducted in August of 2011 on QuantiaMD. QuantiaMD is the leading mobile and online community serving over 125,000 physicians with opportunities to learn from, and exchange insights with, their peers and experts in their fields.

To read the full report, click here.

A big ‘h/t’ to both QuantiaMD & CCA!

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The ‘incident’

My life was essentially on autopilot. My oncology practice was very successful; in fact, too successful. All my time and energy was devoted to keeping pace with the increasing demands of the profession. Other pursuits, be they personal or professional, always seemed to take a back seat. My main unfulfilled passion was writing.

On January 7, 2011, everything changed. I had a new bovine aortic valve and three new coronary artery grafts. A life altering event, to say the least. Fortunately my recovery has been uneventful, and I had no evidence of muscle injury. So I’m extremely grateful for the pre-emptive surgery, and since I’m back to work on a part time basis, I now can devote some of my attention to writing.

For the past several years, a colleague, trusted advisor and friend of mine, Gregg Masters, had been prodding me to “just do it”, i.e., just start blogging, podcasting and life streaming my experiences in Medicine. He pointed out the value of my 36 years in clinical practice of hematology and medical oncology as 'elder wisdom' currency in relative short supply. In truth, there is certainly a lot to write about as the clinical knowledge base has grown enormously, to the point where management of all this information requires computers. Fortunately, technology has developed at a rapid rate also so that we can not only mine all this data to obtain meaningful information, but better disseminate it to each other, health plans (including government) and especially our patients. With the advent of social media including Twitter, Facebook and You Tube, this flow of information becomes a two way street allowing physicians to listen as well as talk. On a personal note, my wife published daily status updates during my surgery and through the post-operative period on a website called Caringbridge. She posted pictures as well as narrative. Colleagues, relatives, friends and patients had a window opened to them as to how I was doing, and they in turn wrote back notes of encouragement that touched me deeply.

When Gregg and I thought about it, his background not only in 'web 2.0' (social media) but perhaps more significantly his considerable experience in the business aspects of medicine brings value into the conversation as well. In today’s environment, physicians are constantly reminded that we not only are responsible for all aspects of caring for patients, but we are running a business as well. Years ago, I remember reading an excellent book called “The E-Myth Physician” by Michael Gerber. One of the chapters was devoted to the subject of “Money”. So Gregg’s knowledge complements my clinical background resulting in the birth of JustOncology.com.

Certainly there is no shortage of topics to discuss. Utilizing a variety of media: blogging (which addresses my passion for writing), audio and visual interviews with as many of the stakeholders in cancer care as possible, we hope to provide a forum for discussion of problems facing us. From these interactions, the desired outcome is to identify solutions that can only come from a collaborative effort.

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About

JustOncology.com is a joint publication of Richard Just, MD, aka @chemosabe1 on Twitter and Gregg Masters, MPH, aka @2healthguru on Twitter.

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