Posted by MarkinBoston on January 10, 2001, at 21:16:44
In reply to Re: Stuff., posted by SLS on January 10, 2001, at 18:10:26
> I don't understand what you mean in the clause, "so each subcatagory is yet smaller".Blipers who later respond.
Blipers who don't later respond.
Non-blipers who would have responded.
Non-blipers who don't later respond.are the sub catagories, and you were concerned about "missing" on the middle two exception groups. So, overall, you're helping the vast majority of patients.
As to me and my doc. She and I have had an on again off again relationship for almost 10 years. I go a year or two between major episodes when I start having cognitive and memory problems, stay on high dose Effexor until I can't stand the apathy, sweating, and anorgasmia after I'm "cured". Motivation returns, subtlely anhedonia and dysthymia creep up and some period of job stress or SAD brings on another major. She knows I fall into the repeat customer catagory and am not just calling to say hi, so out comes the full assault. We've talked about staying on meds full time, but it hasn't been attractive until seeing John's cocktail. I'll shift over to it when I tire of Effexor again.I also wish doctors would treat obesity aggressively. The mortality risk is there like depression and should also be aggressively treated. "Eat less, exercise more" is about as helpfull as "think positively" works for us. Pull out some big guns: speed + thyroid + anabolic steroids + a diuretic anti-hypertensive with close management to get someone feeling better and feeling like exercising, while they establish healthier behaviors.
Using the above, without the thyroid to reduce my depression had a pleasant side effect for me. I felt better and got back to my pre-depression exercise habits, increased lean tissue, decreased adipose tissue, and had a net loss of 30 lbs. - in two months. A kick start like that is great, like the adjuncts JohnL mentioned, and not meant to be a long term solution.
With the diet industry at $23B, what doctors have to offer is truely lame. A kick start now and then is far better than the downstream consequences of diabetes, coronary disease, and myriad problems. This is valid preventive medicine like anti hypertensives or statins. Women can take non androgenic anabolic steroids. They are weaker, and the benefit is less.
The bigger problem is the reefer madness type campaign against steroids and diet pills is resulting MD ignorance about proper use of the former group of meds and reluctance to use either. I stumbled upon the MSN dieting chat group and it was 99.9% women, many of whom were >100lbs overweight and many of the 300+ lb. considering stomach stapling despite mortality risks. God, are steroids so bad that major surgical procedures like this are safer and cheaper? Long term success for this surgery were not good either - plenty of women gained the weight back and then some.
Depression with its elevated cortisol and reduced seratonin are risk factors for obesity, hypertension, and arterial disease. Worse, as men age, cortisol and estrogen rise, GH and testosterone decrease, increasing risk for depression and the others. These things can be managed and cost less than hospital admissions. Remember the AMACO transmission ads? "You can pay me now, or you can pay me later," with the implication that later was going to cost much more.
I accepted some weight gain from AD meds as an OK trade-off. I'm less accepting that tradeoff now.
Docs are starting to get more aggressive treating depression. A friend is a resident in Burlington VT. After having seen twice, men in the ER with self-inflicted gunshot wounds, she said she aggressively treats depression now, especially in men.
poster:MarkinBoston
thread:51307
URL: http://www.dr-bob.org/babble/20001231/msgs/51422.html