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Mike Merrill, MD
I'm a doctor (internal medicine).
Interests: Crossfit Tae Kwon Do Philosophy Economics
Recent Activity
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When my grandmother got hearing aids at age 75, I suddenly realized she was a very intelligent woman. She started making timely, incisive comments in the middle of fast conversations. She started paying attention to things more. And she became funnier. She apparently had had hearing loss for many years.... Continue reading
Posted Sep 27, 2016 at Dr. Mike Merrill
The last years of life can be filled with a repeating cycle of serious illness, and recoveries that seem to restore us to a reasonable state. We can find ourselves moving from one episode of congestive heart failure, or COPD exacerbation, to another, and returning to our homes, back to... Continue reading
Posted Sep 5, 2016 at Dr. Mike Merrill
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Probably somebody out there completely understands back pain, but I haven't been able to find them, and it's not me. Nonetheless, certain things are obvious. The low back is a weak spot in human anatomy, because we vertically load weight on it. It's originally designed to hang weight anteriorly (think... Continue reading
Posted Aug 29, 2016 at Dr. Mike Merrill
I'm taking care of a very old, frail man. He can only whisper. I ask him what he needs and he says, "Don't leave." He grabs my hand, weakly. I hold it for a few minutes. Is he going to die tonight? A few minutes later his daughter comes in... Continue reading
Posted Aug 21, 2016 at Dr. Mike Merrill
A proxy is someone who your doctors talk to when you can’t. Let’s say you’re in a car accident and you’re in a coma. Or let’s say you have septic shock and you have been sedated and put on a mechanical ventilator. In these situations, the medical team needs someone... Continue reading
Posted Aug 7, 2016 at Dr. Mike Merrill
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In San Francisco recently, I walked down a few industrial streets that were lined with tents. They were all closed up, but voices emerged from a few of them. I wondered how they disposed of their human waste. There was no smell, and no sign of any dumped waste or... Continue reading
Posted Apr 3, 2016 at Dr. Mike Merrill
Being happy as an old person is a problem I deal with every day. I spend a lot of time breaking it down into easily understandable bites, for purposes of counseling my unhappy older patients, and easily implementable changes, to help them recover. A caveat is that this is just... Continue reading
Posted Mar 25, 2016 at Dr. Mike Merrill
We should get used to the idea of climate engineering, also known as geoengineering, the large-scale manipulation of the Earth's climate. This is because it's possible that, eventually, the risks of climate engineering will be smaller than what's already happening. When we try to predict what will happen to us,... Continue reading
Posted Feb 3, 2016 at Dr. Mike Merrill
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This is a guest post from Eastern Kentucky's Online Bachelor's in Occupational Safety. Shift work has become a prominent topic of interest lately, predominantly because of the progressive increase in night shift workers. Currently, there are over 15 million U.S. citizens that work full time night shifts, and it is... Continue reading
Posted Sep 6, 2015 at Hacking the Night Shift
People get treated so much at the end of life when there is little to be gained. It's not really ethical. When you're old and sick, you might become tired of the medical care process. In this situation, dying can be pretty straightforward. The hard part is beforehand, sorting through... Continue reading
Posted Sep 3, 2015 at Dr. Mike Merrill
Dear Doc Mike: I'm at a pain rehab clinic at the Mayo Clinic. Why does stretching and exercising make such a difference? Are you releasing swelling around nerves? Answer: First, you're lucky to be at such a world-class institution. There's some great research coming out of there. I wish I... Continue reading
Posted Aug 30, 2015 at Dr. Mike Merrill
Dear Doc Mike: Why does it take so long to get the results of tests to patients, regardless of their gravity? Answer: There are multiple reasons for delays. Some are reasonable, and some aren't. The time to process the test: Routine blood chemistries and blood cell tests only take a... Continue reading
Posted Aug 29, 2015 at Dr. Mike Merrill
Dear Doc Mike: What do you think an adult's vitamin D level should be? Response: I like my patients to have a level between 35 and 50 ng/dl. There are several lines of evidence to support this. We know vitamin D deficiency exists because, with only our eyes, we can... Continue reading
Posted Aug 20, 2015 at Dr. Mike Merrill
My habitual detachment fought with the agony of watching my mother die. I couldn't help thinking about the physiologic processes going on. It may appear cold to think this way, but I brought what I am to the bedside. I have been with hundreds of people as they lay dying.... Continue reading
Posted Aug 8, 2015 at Dr. Mike Merrill
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The world works on a 24-hour basis, and humans have to adapt. Unfortunately, the stress associated with night shift work has many negative consequences. These are poorly researched and therefore poorly understood. To get through the night shift, workers might be tempted to resort to medications, whether over the counter... Continue reading
Posted Jul 8, 2015 at Hacking the Night Shift
It's hard to have a good experience in the hospital. Hospital staff can be as nice as they want, but patients still are generally there for a bad reason (childbirth excepted), and generally they're in some kind of pain or discomfort, without their clothes, and, after all, the people caring... Continue reading
Posted Jul 2, 2015 at Dr. Mike Merrill
When you have a medical test, you can start a chain of events that will lead to a variety of options, and you may not want any of them. Let's say you're 85 years old and have chest pain for 15 minutes. You go to your doctor and the doctor... Continue reading
Posted Jun 24, 2015 at Dr. Mike Merrill
It's good to learn from highly effective people. Frequently they use techniques, or hacks, to keep themselves at high levels of productivity. Good doctors are examples. They function well in rapidly changing, high-stress environments. Many do quite well and avoid burnout. In a study of German physicians, researchers did structured... Continue reading
Posted Jun 10, 2015 at Dr. Mike Merrill
One element of a good death is acknowledging, publicly, that it's going to happen. I remember one patient of a few years ago, a 90-ish woman, a funny person. The first few primary care visits we had together, with her family present, were tense. We went over her most pressing... Continue reading
Posted Jun 4, 2015 at Dr. Mike Merrill
Occasionally a patient will suspect the recommendations I make, on the basis that I just want to make money. This fascinates me. Maybe they've had a bad experience with another doctor. Maybe they see the whole world as motivated by self-interest without professionalism or principle. I wish I knew more... Continue reading
Posted May 20, 2015 at Dr. Mike Merrill
Dying people don't look very good. You want to help them, to make them better. And they have specific medical problems too, and we want to help them with those problems. Something concrete is going on in the days before a person dies, like sepsis, dehydration, bleeding, or respiratory failure.... Continue reading
Posted May 13, 2015 at Dr. Mike Merrill
In my darker moments, when I see medicine turning 180 degrees on something so basic as dietary fat recommendations, I tend to wonder if we do any good at all. After all, there were those studies in the past that showed a reduction in deaths when doctors go on strike.... Continue reading
Posted May 7, 2015 at Dr. Mike Merrill
The older I get, the more I realize that the I Ching was right, and that there is a single dominant underlying tension in human life, between power and justice. The I Ching, or Book of Changes, is one of the ancient Chinese classics. It was originally used for divination,... Continue reading
Posted Apr 29, 2015 at Dr. Mike Merrill
A new article really lays out the case for the "low-fat/high-carbohydrate diet" being really bad. This is the diet recommended by the medical community from the 1980's through the 2000's. The article points out that our ancestors evolved eating large quantities of animal protein and fat, so it's probably not... Continue reading
Posted Apr 22, 2015 at Dr. Mike Merrill
I am deeply professionally shamed by the new thinking about dietary fat. Many people are now saying that fat - even the dreaded saturated fat- may not be such a bad thing to eat. Check this out, for example. That directly contradicts what the medical establishment has been saying for... Continue reading
Posted Apr 12, 2015 at Dr. Mike Merrill