All posts by Douglas Lakin, M.D.

Born in Michigan, but raised in the Scottsdale/Paradise Valley area, Dr. Lakin earned his undergraduate degree at Arizona State University in 1983. Graduating first in his class of 6,000 as a Philosophy major in the Honor’s Program, he was the recipient of the Mouer Award for outstanding scholarship. He was the first person in the history of ASU to earn a coveted spot at The Johns Hopkins University School of Medicine in Baltimore, Maryland, entering in the fall of 1983. Originally intending to become a medical research scientist, Dr. Lakin developed a greater interest in patient care. Inspired by his father, Dr. Mervyn Lakin and Sir William Osler, the founder of modern internal medicine and first Chief of Medicine at The Johns Hopkins Hospital, he focused on clinical medicineAfter completing his medical school training from Hopkins in 1987, Dr. Lakin performed his Internship and Residency in Internal medicine at the University of Iowa’s Hospitals and Clinics, among the premier Internal Medicine programs in the country. Dr. Lakin excelled to the highest levels of clinical scholarship, achieving among the highest scores in the country on his Internal Medicine Board Examinations. With his training complete, Dr. Lakin joined his father in practice in 1990. Shortly thereafter, Dr. Lakin senior retired. Dr. Douglas Lakin continues his practice in the tradition of his excellent training, and provides the quality of patient care established by his father before him.

GIVE ME THE NIGHT

Yes….George Benson had it right…..with his 80’s hit ….Give Me The Night…..especially when it comes to taking your blood pressure medication

A recent large-scale study from Spain shows that taking your blood pressure medication before bed is significantly healthier than taking your medication in the morning. Other studies have hinted at this, but this study is clearly confirming what we think.

Why this works is that many body systems have a circadian rhythm that turns an late at night or in the early hours of the morning and having slightly higher dosages of medication at those times provides protection against elevated blood pressure, stroke, and heart attack.

So…from now on….take your blood pressure medications at night and get the benefits without needing additional dosing.

Read more >>>>HERE<<<<

FLOAT LIKE A BUTTERFLY…STING LIKE A ‘MAY-BEE’

I had several patients forward me the video on the new BUTTERFLY ULTRASOUND. This device, which attaches to an iphone, is a $2,000 attachment to the iphone that works as an inexpensive ultrasound unit.

I have checked it out, having become aware of it from my daughter-in-law who is in her Emergency Medicine Residency training program at UCSF.

The ultrasound has become an essential diagnostic device in the E.R., as it allows for rapid assessment of internal derangements that indicate bleeding, blood accumulation, fluid accumulation, blood clots, etc… She has become skilled at using the ultrasound in rapid fashion to assess patients with life-threatening issues and to rapidly rule-in or rule-out various conditions that would otherwise require time-consuming testing.

Although very useful in the emergency setting, it is not clear that it would be as useful in the general office setting, as the test results are not explicit enough for subtle findings or complex diagnostics. Still, in an underserved area, where excellent ultrasound is not readily available, I can see this being a game-changer (rural areas, underserved countries).

I’m a fan of technology, and the iphone is an amazing hand-held computer that has multiple uses, but for now, the Butterfly does not sting like the bee……in the general medical office just yet.

WHERE THERE’S A WHILL…THERE’S A WAY

As often happens in my practice, I have patients who tell me about the latest technology that helps with their medical condition or with issues of mobility.

The latest is the WHILL MOBILITY DEVICE which is the latest in wheelchair mobility. It’s benefits are many, but most importantly is the simplicity of it’s controls, its ability to work in small spaces, and it’s overall cool design.

I must say, my patient was raving about this device. HE had issues with a joystick due to his tremor, but this device has a simply interface allowing for more accurate ability to safely control motion,

Insurances won’t cover this device, but if you can afford it and if you need it to remain more independent, you need to get yourself a WHILL

Take a look >>>>HERE<<<

Latest excitement about medications and dementia

A patient emailed me:

Hi Doc,

Should I be concerned and switch my anti-depressant since it’s on the list of medications potentially causing dementia?  I tried other medications in the past but they didn’t work as well & I felt awful and went back to Paxil.  I’ve been on it for 18 yrs now, so maybe it’s too late. 

Good news…I found my car keys and know where they go🚗

Sue


I responded:

This is not a major concern…..there is a ‘questionable’ association…..but no proof of connection.

All medications have different kinds of ‘questionable’ statistical  associations of different sorts….Advil/Aleve…..with stroke/heart attack…..……aspirin….with bleeding issues. The list is endless.

This is a ‘sexy’ topic…so it gets quite the attention, but the over-riding focus should be on the definitive benefits you are getting now.  If they are definite in your mind, then you should continue to stay on the medication unless we hear clear-cut evidence.

D

PS…Driving your car is 10,000 times more risky then your medications.

PLEASE DON’T PAGE DR. HODAD

The headline in the NYTimes today about the failing pediatric cardiac surgery program at University of North Carolina reminded me of back in training when, as a lark, we would call the operator of the hospital and ask them to page the wards for “Dr. HODAD”……

It would be early evening…and over the pager system throughout the hospital we would chuckle as we heard….” Paging Dr. Hodad…Paging Dr. Hodad…..please call the operator’.

We were juvenile back then and we liked having a bit of fun given the crazy hours we kept. Dr. Hodad was no Hopkins surgeon….the name stood for Hands Of Death And Descruction.

Yes….there were surgeons who were considered a danger to their patients, and we would affectionately call them Dr. HODAD..……there still are around no doubt. Fortunately, they are few and far between, but self-policing among medical professionals is notoriously tricky.

That is why you depend on your primary doctor to help you find the best specialists and surgeons to treat your conditions. It is often less about going to the right doctor, as opposed to avoiding the wrong one. Fortunately, there are few of those, but you need to avoid them…and depend on us to help you avoid such an event. Just ask.


ORDER YOUR OWN GENETIC TESTING

The value of genetic testing more broadly is controversial, but I think everyone has an interest in knowing if they are at increased risk for cancer.

If you satisfy criteria for testing (positive family history that is considered ‘significant’ by insurance standards) then you can get genetic testing at our office through Myriad labs and your insurance will pay for most (or all) of the testing.

But…if you don’t qualify by specific criteria, you can order genetic testing yourself, for $225 from Millennium labs, and with a simple cheek swab, you can find out if you have increased genetic risk for breast cancer/ovarian cancer (BRCA genes) or 30 other genes associated with cancer risk.

If you are interested….order >>>>HERE<<< and tell them your physician’s name (Doctor Lakin) and they will confirm the testing is to be done and you’ll get results in 2 weeks.

THE VIRTUOSO

All areas of study and action have their virtuoso. That person who is ‘first among equals’; George Washington was most famously, known by this phrase.

So too in medicine, there are great specialists and then there are others who are acknowledged as being just a slight cut above those of highest caliber. Here in The Valley, we have so many wonderful physician specialists that it makes medical practice here a pleasure, and it gives me confidence in the care you are getting from these skilled professionals. You can access that list on the RECOMMENDED PROVIDER list on our website.

Among those who are recommended, there are some who are the virtuosos. I have found them through professional relationships, but more often from patients who have told me of someone they ran into here or in their hometown, and I have accumulated a list of them. If for some reason you need a medical or surgical virtuoso, be in touch and we’ll either have that name…or we’ll find it.

For now, enjoy this musical performance by the virtuoso who got me thinking about this topic ….accordianist Alexandr Hrustevich …something truly special.

Listen >>>>HERE<<<<

STATIN SAFETY REVIEWED AND FOUND TRUE

Despite this, there is a grass-roots effort to discredit these medications based on the concerns that they cause a multiplicity of side effects including dementia most importantly.

These has been very little signal among users that these issues are developing, and to add to the scientific understanding, the American Heart Association undertook an extensive review of the literature to reassure that these medication have an overall excellent safety profile.

Statin medications are among the great discoveries of the last century, and have had a strong impact in reducing heart attack and stroke risk in the US.

This report confirm the excellent safety record of statin medications and is consistent with my experience. These medications are safe, effective, and rarely cause side effects of concern.

Don’t miss out on one of the great inventions of the 20th Century. If you decide to avoid them…perhaps you should toss out your computer, cell phone, and the internet as well. Join the future of those who believe in the science….statins are safe and effective.

Read more >>>HERE<<<

FICTION OR NON-FICTION…YOU CHOOSE

Now that the electronic medical record is on-line and patients share in the information doctor’s kept ‘secret’ in the past, there are a lot of people who wonder about the diagnosis and comments in their chart.

Although the ideal chart would be purely a documentation of all the facts related to a patients conditions, it is in fact a much more complicated issue.

The chart serves many masters, most of which are practical and relate to insurance issues, billing, and prescription and test ordering. After those considerations, the chart is meant as an accurate repository of the medical history and to allow a quick summary of considerations that related to background health issues in the day-to-day care of the patient.

I often have a patient ask me, “Why does it say I have this diagnosis or symptom when I don’t think it is accurate?’ Sometimes they are correct and the information is there in error, but most of the time the information in contained in the chart to allow for consideration of various possibilities based on history and previous symptoms. To jog the memory, or to keep in mind as past conditions relate to current health complaints.

Doctors are aware of the potential fictional nature of the medical record, despite contending that it is an objective list of the various health issues at hand. We try our best to include all pertinent and important current and past medical history, but sometimes, the truth is a bit more complicated.

Twain remarked about something said from by friend…..”If it’s not true…it should be.”

Read more Twain >>>HERE<<<

AVOIDING A MEDICAL MAX8

I have an amateur interest in aviation so I am following the MAX 8 concerns with great interest.

Among the issues raised with the MAX 8 is the interaction of automated technology and imperfect data input. Simply put: An excellent but completely automated system can be undone by imperfect data input, resulting in automatic ‘corrections’ that amplify the error.

All of us are going to be seeing these issues of interactions of expert systems in our day to day life, and how they can malfunction with small inaccuracies of input data. It is really the problem of AI (artificial intelligence) which is so very useful, but which does not provide the judgement needed to correct errors that don’t fit in standard models.

This is exactly what an expert internist provides. Like the most-seasoned pilot, and expert clinician has seen so many variations of ‘normal’ situations that they can ignore data that is inconsistent, trusting their judgement when crucially important, over a test results that doesn’t ‘fit’.

Like Will Rodgers said long ago: Good judgement comes from experience and at lot of that comes from bad judgement. My bad judgement days are behind me (read intership, residency, and my first years in practice). Although I’m in no way ‘perfect’, I am perfecting my knowledge by having an enormous volume of experiences.

A busy doctor is ‘practicing’ all of the time. Gaining knowledge incrementally with each encounter. Every year I see a few new things that I’ve never seen before. Integrating this into my storehouse of knowledge improves my performance with time and I know it is allowing me to ‘pilot the ship’ of medicine more ideally.