Sidesaddle Sidebars - Musings

Impact

H&M's impact seems to be quite varied across our illustrious lot. For me, the impact was more subdued. I think this was partly because of my expectations of a skills training rather than an insight building program for lack of a better descriptor. But, I think that it was mostly due to being fortunate enough to have had very similar if not identical exercises in my youth and in different organizations in my past, sans horses of course. In attempting to think about the things we did from the perspective of someone who was never exposed to arm-brain type activities or delineating between perceptions and interpretations, I can see how these things could be very powerful. And, I can certainly appreciate the link between insight, self-awareness, and being in control of one's nonverbal communication. On the flip side, as someone who appreciates the subtle techniques of nonverbal communication with humans, I think that a horse's reliance and sensitivity to nonverbal communication gives a great opportunity to hone one's nonverbal skills. And I hope that future classes further use the horses' sensitivity more as a tool in that regard.

Feeling Inspiration

Sometimes it is hard to know what sticks with you, which memories will persist and which will fade away. So 2 months out is not a bad time to check in and see what's still bouncing around between the gyri. And I must say, the memory that seems to be the strongest was feeling the horse breathe beneath me during out bareback ride. Perhaps because it was unexpected, perhaps because it was something new, perhaps because it was a different kind of connection made. Not quite the same as feeling ribs expand with your hands, definitely not the same as listening through a stethoscope.

O-O-O-OKlahoma! See One, Do One, Teach One - B Kane, MD

Oklahoma, where the wind comes sweepin' down the plain
And the wavin' wheat can sure smell sweet
When the wind comes right behind the rain.

...and where Medicine & Horses starts its outward journey

About 6 months ago Dr. Carlos Garcia, University of Oklahoma Derm Surgery, called me at 7 AM on a Saturday. It seems an 80 year-old patient of his, who boards her horses with his, told him about Medicine & Horses, saying he -had- to do the program. (The rrrrrrrest of the story, infra vide.)

Lo and behold, Dr. Garcia followed through on this plan at every step and this weekend I had the pleasure of going out to OU to teach M&H. The idea is that they will establish an ongoing course there, a good start for my "M&H Appleseed" vision of having M&H programs at 100s of med centers.

On the plane out there, I was reminded of Forrest Gump's homily, "Life is lahk a box o' chocklits. You never know waht yer gonna find." We had made fairly detailed preparations--I sent the syllabus and advised on details of water, snacks, etc. But I allowed for the possibility that the venue would be highly unsuitable, that we wouldn't have enough appropriate horses, that the students wouldn't get the point (that they were just coming to please Dr. Garcia, in whose hands their residency match rests to some extent, so I imagined.) I also fretted and fretted about whether and how to include Dr. Garcia in the proceedings--whether as a particpant or as a leader. The latter was going to be hard to do, with his never having even seen the exercises before. But I only had the one day for him to see one, do one, teach one.

Long story short--will post more later, we had a fantastic day! Eight med students, a derm resident, a derm attending, 2 TV stations, 2 local newspapers, and the University press.

Exhilarating and exhausting. More later, as I have to go to Webb to teach our last M&H class of the quarter.

Comfort

Though not a specific topic of today's exercise, I found myself reflecting on the cooperative versus authorative role we can have as a physician.

I have tended to be a very cooperative physician, unlike many cardiologists. This feels good to me because I feel respectful of the patient. And frankly, most of my patients love it MOST of the time. But there are times my patients want to be "told" what to do--and sometimes it feels a bit uncomfortable for me. Now comes the horse part...horses that are "bossy" are comforting to the other horses--it means that they will be taken care of. So I have recently been stretching my usual patterns and become more "bossy", especially as it regards lifestyle changes. It seems patients need to be able to say to others, something on the order of "MY doctor wants me to exercise every day", or "I'm on this diet plan because my doctor wants (demands) it this way"--in other words, it seems to be comforting to them to have me a be somewhat demanding or bossy in this regard. When I'm on the trail with one of my horses, they feel comforted when I sit tall and ready to help them through any unfamiliar obstacle. So while I still don't want "bossy" to become part of my dominant personality characteristics, I now see where some variant of this quality can be comforting to patients and effective in eliciting necessary change.

Madison, the PMU Rescue--or Why I Don't Use Premarin - by B Kane, MD

Madison lived much of her life penned up like a veal calf in the service of the pharmaceutical industry.

Madision is a HUGE bay horse--brown body, black mane, tail, and lower legs. We always use her on the first day of Medicine and Horses due to her big, pushy, possessive personality. She is one of the stars of the Emmy nominated NBC-TV Medicine and Horses News Video.

Madison is also a PMU rescue. PMU stands for PREgnant MAre urINe. Sound familiar? Premarin. Premarin is a hormone made from mares who are kept constantly pregnant, constantly confined in tiny quarters, like veal calves. "PMU foals," as they're known, (and eventually the mares) from this ghastly process are often simply disposed of if no one rescues them. Kudos and blessings to Webb Ranch for rescuing Madison!

Premarin is used for hormone replacement therapy (HRT) for, especially, post-menaopausal women. When I was in clinical practice, I virtually refused to prescribe Premarin due to the cruelty to horses.

In 2002, in an almost karmic adjustment, the results of the NIH Women's Health Initiative--15,000 women--showed that HRT actually -increased- heart disease and breast cancer. The study was even stopped due to early results. Premarin fell into disfavor as physicians and patients rethought risk factors and the physiology, psychology, and philosophy of normal aging and menopause.

It would have been a nice karmic readjustment if Wyeth, which makes Premarin and also some widely used and highly beneficial horse medicines, had approved our grant application for funding Medicine and Horses. But they declined. And anyway, Stanford now has a strict policy against pharma phunding.

Still, every time I see Madison, I hope that doctors and menopausal women will shun Premarin in favor of synthetic and "natural" alternatives.