Tethered

Tethered to your soul,
My heart will always be,
As journeyed birds go,
Over mountains and sea.


When music drifts around,
Blessing the air with kisses,
You whisper a sweet sound,
Then joyful my heart is.


Justus Turner Peters MD
5/6/16

Making a Bucket List

I am going to start knocking things off my bucket list.  Foreign travel is high on the list of desires, and going to Italy as Team USA physician at the Tricolore Games in Italy started it all. 

I do want to hunt grouse, get a tailored suit on Savile Row, climb the Matterhorn, like every other man in the world, but I really need to get moving.

I am taking life by the horns right now.  The divorce knocked some reality into me, a real sense of mortality tested my soul.  Death is just as natural as life, and having been around it in the emergency room knocks some proverbial wherewithal into my life.

Life is short and can end quickly anytime, anywhere.  Carpe Diem, seize the day.  Kiss the girl, make love in the rain.  Ride my horse on a beach.  Ride my motorcycle to Sturgis.

Act in a play, sing in a show, dance on a stage, and smile all the while.  When can you perform?  Doing the French Taunter during Spamalot was the funnest time for me.  Dance with my daughter in a talent show.

Dress yourself up, ignore fashion code, learn an instrument, read the Bible.  Be true to yourself.

Going to China and Spain this year makes me very happy, and it is about damn time.  I am 40 years old, and I want to see the world.  Now it is time.

Night Sweats for a Year

Having mystery medical cases prompted fascination with me as long as I can remember.  One of the more recent mysteries involves a symptom as baffling as it is vague.

A middle aged man with history of diabetes, hypercholesterolemia, and hypertension came to me with complaints of night sweats nearly every night that is bothering him.  He reports it is consistent and chronic, happening for past year.  He denied fevers, but had intermittent chills, but the main thing is that he would nearly soak his bed sheets every night.

Night sweats can point to a number of problems, but the number one major issue is that the immune system is "revved up" for some reason.  The immune system is like the police force of the human body.  It is constantly trying to keep the body calm, therefore it fights infections or inflammation, cancers, or foreign objects--much like keeping society from rioting.

On examination, he had a chronic back pain in the middle of his back, but not to palpation.  He did have a mild discomfort with deep palpation in his epigastric region.  His lab findings showed slight elevation in liver enzymes.  I ordered the Liver ultrasound, and we found that he had a thickened gallbladder wall, cholecystitis, or inflamed gallbladder.

After he had it removed, his night sweats ceased, and he felt much better. 

This is a good example of not assuming "it's just hormones," when you have night sweats. 

Sometimes Doctors Forget how to treat Pain.

Pain treatment has been utilized multiple millennia ago.  Some of the written records can be found in stories such as Homers' Odyssey.

Homer wrote, "presently she cast a drug into the wine which they drink to lower all pain and anger and bring forgetfulness of every sorrow."

Opium has been written about as far back as 1500 BC in the Ebers Papyrus.  Chinese and Indian trade historical notations show Opium used to treat excessive crying in children, used with Hemlock to have a painless death, and treats anxiety, depression and mood disorders.

Opioids have a long history in the United States and has been relegated by the medical industry and the FDA for years.  As with any abuse of a relegated substance, problems arisen with opioid abuse has created a stigma--a barrier between doctor and patient.  The culture of pain relief is associated with psychological pathology, which sometimes decreased otherwise harmonius relations between patient and physician.

Most physicians now want to "turf" their pain patients to Pain management physicians because of the clamp down from the FDA and DEA on prescription abuse. 

The anti-pain med culture has spread to patients who have not experienced acute pain before, and are fearful of the side effects.  To them I reassure that true pain treatment doesn't make someone addicted to pain meds.  It seems those who don't have pain and use pain meds for the high, get addicted more easily.

But I have seen the vast improvement in the quality of life in an individual who suffers from chronic pain who utilizes pain meds appropriately.  I have seen the relief in hundreds of pain patients.  I hope doctors learn about the history of what physicians are, and what we do.  What we did best was treat pain.  Even in the current technological advancements of medicine, lets not forget how to treat pain.

A Rash of Spring Rashes?

Recently a rash of weird allergies have been taking place in Somervell and Hood County. People with very hyper-immune systems, mine included, have suffered from allergic or atopic dermatitis.



People with very hyper-immune systems who suffer from asthma or autoimmune disorders, usually have weird rashes on their skin for many reasons, and thus have aptly named "sensitive skin." 


Typically the best things to do generally are to make sure that you skip laundry detergents unless they are hypoallergenic, and have no dyes or perfumes.


Bathing in hot water really upsets the skin.  Try Lukewarm or even cool water.  The skin loves it.  Wearing cotton clothing is best for sensitive skin.



Medical treatment depends on how severe the rash is, and can include a combination of creams as well as medications. Conservative therapy with over-the-counter medications such as Cetirizine, or Loratadine, both are 2nd generation anti-histamine agents and don't cause sedation, is the first line mainstay.


Prescription oral medications such as Atarax or Hydroxyzine 25 mg by mouth every evening is commonly used.  It is way stronger than Benadryl and can stop the itching, but has a major side effect of sedation. 


Itching damages the skin almost to the point of disrupting the epithelial barrier.  If scratching to the point of bleeding occurs, it is vitally important to apply an antibiotic ointment to the wound and keep open areas covered with bandages.


Keep your your skin moist and out of the sunlight makes it healthy and happy.  Use a light moisturizer such as Laroche which has an SPF 15 rating.  Enjoy the Spring!

Words of Love I Wrote to My Ex-Wife when we were Married.

A Journey

 

She fills my waking moments,

With sweet honey tasting cherish.

She finds my heart with love,

 As wide as the seas above.

She goes further for me,

 Than endless eternity.

She makes my world go round,

 Than any being ever found.

 She gives me whole heartedly,

Her blessings to infinity.

She heals my lasting heart,

That from her I could never part.

She loves me endlessly,

As if today was the end of me.

She touches ever so soft,

To send my heart aloft,

She brings me soul to feed,

My desires, wants, and needs.

She hopes, and laughs, and cries,

 In times of love by and by.

 She longs for me each day,

 And loves anew in her sweet way.

She learns unselfishly,

And teaches the pride in me.

She sees me dear and strong,

 For me she eternally longs.

 She loves me and loves me,

So much it hurts thee,

And all I need is her,

 To cherish and love forever,

 And happiness I found to be,

The love of Donnette for me.

 

Justus Peters MD

 



A European Lunch is Relaxation

After spending time being Ft. Worth Sister Cities' Team USA physician for the recent Tricolore Games at Regio Emelia in Italy, I learned a bit about Italian culture that really is therapeutic.

All the stores close for 2-3 hours for lunch.  No shopping, no stress.  Just sit in the sun, drink a wine, and feel the breeze.  That is what I call living.  Enjoying the minutae of experience.  Rewarding yourself with quiet time.

Savoring food with each bite, and memorizing each sip of wine, watching people go by--all brings the body down to earth.  Stress hormones decrease.  The heart is happy.  Inevitably, the stomach becomes happy.

A happy gut, and a happy heart make a happy mind.  A mind that is relaxed can then focus better.  A happy mind can change the body.  It is amazing what the mind can do for the body.  But right now, I am just going to sit on the porch at my house on top of the hill with a great view, and enjoy an Italian Cabernet.

Treating Anxiety without Drugs

Having grown up with a language disorder because of my hearing loss, I often developed some social anxiety during school.  My nail bitten fingers constantly yearned for manicures.

After graduating high school, and getting my first digital hearing aids, I quickly learned to deal with anxiety in other ways.  I started running in nursing school, and increased to marathon training, which gave me complete and total relaxation in all settings. 

As a medical doctor in the emergency room, I meet a lot of patients who suffer from PTSD, Stress Reaction, Anxiety disorder, and Major Depressive Disorder.  While it is easy to diagnose and treat these symptoms with medicine, I often overlook a more conservative approach to the treatment of these problems. 

A recent article in the American Family Physician noted a systemic review of 19 randomized controlled trials, (RCT [the best kind of research study]) showed that cognitive behavior therapy (CBT) or relaxation training, alone or in combination, can be used to treat anxiety in adults. 

The authors also found that music therapy reduced anxiety in older adults.  This is a very good thing.  It is wise to focus on some conservative therapy prior to initiating medical treatment for a wide variety of illnesses.  I am excited to add this regimen to my management of these patients. 

Greatest Thing Since Sliced Bread

I have been doing Emergency Medicine full time since August of last year.  This has enabled me to do two things. 

One is to be a better father to my kids.  Before in clinic, I didn't see my kids much, didn't eat lunch with them, took them on Daddy dates sparsely, and effectively helped ruin my marriage.  Now I have full days and multiple days off where I can learn to be someone else. 

If I want to learn a dance or song and play piano, I can do it.  If I want to read a book, I can finish it.  I am laid back now, and feel like I have some time to do things that make myself happy. 

I can belt out some scary lyrics on the Karaoke machine to the delight of my kids who somehow amazingly still think I am the greatest thing since sliced bread.  And this has enabled me to do another thing. 

Be comfortable in myself.  This is important for I have fallen victim to feeling persecuted all my life while trying to impress other people, to win favor with other people, or to "get ahead."  My personal journey has led me here, and now I think I can cruise into my more mature years with a light heart.

I wish this for everyone, that you have a light heart.  Be well, healthy and safe!