Examined

I’m guessing more than 90% of us have never even heard of it. If you’ve ever left a primary care checkup with a bunch of “borderline” results flagged in your chart, you are in good company. Maybe your blood pressure was a little off like 134/82, or your blood sugar was creeping up to a Hemoglobin A1c of 5.8, or your understandably hurried doc mentioned an elevated kidney number — we’ll keep an eye on that creatinine of 1.4. Drink more water and don’t use ibuprofen, ok?

I think this kind of rocks. Just type in your ZIP code, and voilà! I was up until 2 AM last night, working like some mad scientist with tech and coding that does not come naturally to me. My inspiration? A lot of smart people in the know are heralding an early start to the influenza season here in the US. But this is based on the smallest of little bumps in flu tracking, and does not reflect increased flu across the country. Supposedly the current Covid wave has crested nationally.

Most of my patients are either getting updated Covid shots routinely, or summarily waving them off. Sometimes they stop me mid-sentence as I recommend them, their eyebrows furrowed, with a look of disgust, like I just told them to strike up a match and smoke. I’m done with Covid shots! On one level I get that. Covid is not what it used to be, and the natural psychology after a pandemic is to move on.

There it sat, neglected, on the stairs down to the basement. That Cologuard box and the personal reckoning with animal biology it entailed. Completing it had become a daily avoidance. For months. Personal confession aside, as a primary care doc I try to help otherpeople with their own colon cancer screening options, avoidance, and sometimes protracted loathing.

I’m reposting the third piece I ever wrote here on Examined, just a couple weeks after deciding to do this public writing. It got 1 like, and about 300 views. It’s a reflection written 5 years ago about the day that had occurred 20 years prior, on the occasion of 9/11/2021, with the pandemic still churning destructively. The USA had just finished finally pulling out of Afghanistan.

Can we learn from the disparate legends of Lebron James, Odysseus, and Dolly Parton? I spend a lot of my tedious days tending to flat numbers, diagnoses, and complaints. Medical records can read like banal corporate meeting notes. They chart events and conditions over days, weeks, and years in a kind of two dimensional Cartesian plane. But rarely do we have the time, energy, or inspiration to step back and contemplate the multidimensional, epic poetry within each person’s life.

Perhaps you missed baseball’s All Star game here in Philly this summer. Me too, but I did see the homerun derby. Hometown All Star Kyle Schwarber almost won. Fortunately, All Star medical organizations have hit this home run collaboration on fall respiratory vaccines.

I’m starting to receive more questions again, both from patients and readers of this primary care Substack: Should someone my age get another MMR shot? What the hell is “presumptive immunity?” I was born after 1967 (and therefore got the modern MMR shot), but I only see one MMR on my childhood vaccine record? What’s up with that? Should I get my measles antibody levels checked? What if my titers are not good? Does that mean I’m going to catch measles?

If you’ve been following the Pennsylvania measles story in the media, chances are that you’ve been baited into parsing details about the exact nature of the two measles deaths recently reported instead of seeing the big picture. That’s the point. That’s the whole game. Here’s what happened. I used Claude and Perplexity to help me document this across the internet, and to draft as accurate a version of this post as I could.

I’ve been fielding some questions about the newly approved mRNA flu shots from Moderna that are due out any day now. I’m honored when my patients value my opinion, I’m excited by mutual curiosity, and honestly, I’m quite thrilled when anyone still wants vaccines after all the shenanigans. An Examined subscriber even wrote to me last night: What are your thoughts on the new mRNA flu vaccine for the senior set? Many thanks. Here are my thoughts as a primary care doctor, Nell.