Monday, December 4, 2017

Duty, Honor, Country: Motto for West Pointers

Duty      Honor      Country

Those three words constitute the West Point motto.  They are included as part of The Academy Crest which is a component of West Point class rings.  I see that crest as well as my 1968 class crest daily when I put on my ring. Below are a few reflections about how those three words have come to have unique meaning to West Pointers.

The history and traditions of West Point, the Corps of Cadets and the United States Army are summarized for incoming cadets in a book called Bugle Notes, much of which we had to memorize as plebes (first year students).

The Cadet Prayer becomes a significant reminder about the three words in the motto and their meaning:  "O God, our Father, Thou Searcher of human hearts, help us to draw near to Thee in sincerity and truth. May our religion be filled with gladness and may our worship of Thee be natural.
Strengthen and increase our admiration for honest dealing and clean thinking, and suffer not our hatred of hypocrisy and pretence ever to diminish. Encourage us in our endeavor to live above the common level of life. Make us to choose the harder right instead of the easier wrong, and never to be content with a half truth when the whole can be won. Endow us with courage that is born of loyalty to all that is noble and worthy, that scorns to compromise with vice and injustice and knows no fear when truth and right are in jeopardy. Guard us against flippancy and irreverence in the sacred things of life. Grant us new ties of friendship and new opportunities of service. Kindle our hearts in fellowship with those of a cheerful countenance, and soften our hearts with sympathy for those who sorrow and suffer. Help us to maintain the honor of the Corps untarnished and unsullied and to show forth in our lives the ideals of West Point in doing our duty to Thee and to our Country. All of which we ask in the name of the Great Friend and Master of all.

Duty:  What one ought to do.  The essence of duty is explored and understood and acted  upon during the cadet years and throughout a lifetime of service to the nation.  Oughtness is a compelling anchor for the study of the human condition.  Duty is an easier concept than oughtness to ponder/discuss.

Honor:   "Strengthen and increase our admiration for honest dealing and clean thinking, and suffer not our hatred of hypocrisy and pretence ever to diminish.... Make us to choose the harder right instead of the easier wrong, and never to be content with a half truth when the whole can be won."
"The harder right" and the "whole" truth are challenges throughout life.  The Cadet Prayer, The Corps and The Alma Mater reaffirm the meaning of the motto for West Pointers.

Country:  The United States of America.  At West Point we agreed to "To support and defend the Constitution of the United States against all enemies, foreign or domestic..." on our first day as New Cadets.  That oath meant a lot then and now.  A commitment to America was a continuous part of the West Point experience and the aftermath.

Saturday, October 28, 2017

Medical Stewardship for Family Medicine

What health care model might get us beyond "Statin Sluts", Incidentalists, Inflictionists, or Bonus-Based Physicians - all of which I've written about in previous Dr. Synonymous blog posts?

I believe we're poised for an era of Medical Stewardship, appropriate use of scarce, valuable medical resources.

Medical Stewardship.
More later.

Friday, July 28, 2017

July 27, 2017 My 47th Anniversary: Leaving for Vietnam

I often reflect on my Vietnam Service.  Every July 27th I remember the day I left Dayton, Ohio for Travis AFB in California.  We flew out of Travis to Alaska to Japan to Vietnam.  I came back in late July 1971.
I frequently reflect on the 20 members of my West Point Class of 1968 who died in Vietnam as a result of injuries incurred during their service.  We now have others who are dying of cancer from toxic exposures to Agent Orange, etc. while serving in Vietnam.
War changes people on a continuing basis over a lifetime.

I flew helicopters for the 45th Engineer Group in I Corps, from the DMZ to south of Quang Ngai.
travel vietnam Quang Ngai.  I loved flying OH58A and UH 1 helicopters.

I pray for those who served and were affected by the Vietnam War (actually a "Conflict").

I'm still learning about the meaning of the Vietnam service daily.

Three Dr. Synonymous blogs each year focus on Vietnam.  Here are the last three anniversary blog posts:  departure-for-vietnam-46-years-ago.   vietnam-departure-45-years-ago       another-vietnam-personal-anniversary

Monday, May 1, 2017

Hypermobile Spectrum Disorders in Family Medicine: New Hope for Patients & Doctors

"How does it hurt that bad?" " What is the pathophysiology?" " What is my differential diagnosis?"
These are questions that occur to a family physician when evaluating a patient with problems that include excruciating pain.  With a big push to prescribe fewer to no opiates for pain, physicians are shying away from patients who hurt.  We seem to be developing an aversion to pain and suffering, a surprising paradox for a profession that was invented to prevent and/or treat pain and suffering.

The updated categorization of connective tissue disorders by our genetic friends offers hope (and confusion) to those who want to better diagnose and treat disorders that include a pain component. International Classification of EDS and HSD

The Ehlers Danlos Society does an excellent job of staying on top of and communicating about Ehlers Danlos Syndrome (EDS).  They have quickly updated to inform their members and interested others about the new definitions and diagnostic criteria for EDS and Hypermobile Spectrum Disorders (HSD).  What is HSD?

How might we assess joints for hyermobility? Assessing Joint Hypermobility

What does this mean to patients and family physicians?

More later in this series about EDS and HSD

Thursday, April 27, 2017

Ehlers Danlos Syndrome in Family Medicine: Painful Surprise

Ehlers Danlos Syndrome:  Rare? Not so Rare? Not even Rare?  Pain, Pain and Pain.  It drips with clues to the possible presence of a connective tissue disorder.  When I was in medical school, the more likely term was collagen vascular disease.  Marfan's Syndrome became the poster child for this group of diseases/conditions.  Now it should be Ehlers Danlos Syndrome (EDS).

Coming in at 1 in 100 persons (per Dr. Nielson- EDS wizard at the University of Cincinnati, with whom I strongly agree), it races by hemochromatosis and others as a disease to know to provide care for patients in Family Medicine.  Every Family Physician has several patients with this diagnosis that hasn't been made.

The categorization of EDS types was reorganized in March of 2017 for better understanding.  The term Hypermobility Spectrum Disorders is added to better understand EDS and that which is beyond EDS.  It will take a while for physicians to get acquainted with the clarification.  Most family physicians are not aware of the prevalence of EDS in their daily practices, especially patients with pain syndromes.

What is Ehlers Danlos Syndrome?

From the EDS Society:  "Ehlers-Danlos syndromes are a group of connective tissue disorders that can be inherited and are varied both in how affect the body and in their genetic causes. They are generally characterized by joint hypermobility (joints that stretch further than normal), skin hyperextensibility (skin that can be stretched further than normal), and tissue fragility. (For information about the hypermobility spectrum disorders, please visit “About HSD”.)
The Ehlers-Danlos syndromes (EDS) are currently classified in a system of thirteen subtypes. Each EDS subtype has a set of clinical criteria that help guide diagnosis; a patient’s physical signs and symptoms will be matched up to the major and minor criteria to identify the subtype that is the most complete fit. There is substantial symptom overlap between the EDS subtypes and the other connective tissue disorders including hypermobility spectrum disorders, as well as a lot of variability, so a definitive diagnosis for all the EDS subtypes—except for hypermobile EDS (hEDS)—also calls for confirmation by testing to identify the responsible variant for the gene affected in each subtype."

Per Genetics Home Reference Definition

What are the types of Ehlers Danlos Syndrome?

Chart of Types of EDS with detailed definitions.