#teledoctor

[scifigeneration]

From science fiction to telemedicine: the surprising 150-year history of long-range medical treatment

by Debbie Passey, Digital Health Research Fellow at The University of Melbourne

In 1874, a surgeon in South Australia telegraphed wound care instructions for a patient 2,000 kilometres away. A few years later, in 1879, a letter in The Lancet medical journal suggested physicians use the telephone to cut down on unnecessary patient visits.

As the telephone and telegraph spread, the idea of telemedicine – literally “healing at a distance” – inspired science fiction writers to conjure up new ways of treating patients across great distances.

Real-world technology has developed in tandem with scifi speculation ever since. Today, certain kinds of telemedicine have become commonplace, while other futuristic tools are in the offing.

The radio doctor and the teledactyl

In his 1909 short story The Machine Stops, English novelist E.M. Forster described a telemedicine apparatus that, when telegraphed, descends from the ceiling to care for patients in the comfort of their home. His story is also the earliest description of instant messaging and a kind of internet – both important for real-life telemedicine.

In 1924, Radio News magazine printed a cover story showing the future “Radio Doctor”. The cover depicts a physician examining a patient through a screen. Although the magazine story itself was a bizarre fiction that had little to do with a radio doctor, the imagery is evocative.

In a 1925 cover story for Science and Invention, US writer Hugo Gernsback describes a device called “The Teledactyl” (from tele, meaning far, and dactyl, meaning finger). The device uses radio transmitters and television screens to allow a doctor to interact with a patient. The added twist – the physician touches the patient using a remotely controlled mechanical hand set up in the patient’s home.

Gernsback was a futurist and pioneer in radio and electrical engineering. Nicknamed the “Father of Science Fiction”, Gernsback used fictional stories to educate readers on science and technology, and often included extensive scientific details in his writings. He helped establish science fiction as a literary genre, and the annual Hugo Awards are named after him.

From seafarers to spacefarers

The radio was important for early telemedicine. In the 1920s, physicians across the globe started using the radio to evaluate, diagnose, treat, and provide medical advice for sick or wounded seafarers and passengers. The radio is still used to provide medical consultation to ships at sea.

In 1955, Gernsback returned to the idea of distance medicine with “The Teledoctor”. This imaginary device uses the telephone and a closed-circuit television with mechanical arms controlled by the physician to provide remote patient care. Gernsback said the doctor of the future “will be able to do almost anything through teledoctoring that he can do in person”.

In 1959, psychiatrists in Nebraska started using two-way closed-circuit televisions to conduct psychiatric consultations between two locations. This is considered one of the first examples of modern-day telemedicine. Early telemedicine networks were expensive to develop and maintain, which limited broader use.

In the 1960s, NASA began efforts to integrate telemedicine into every human spaceflight program. By 1971, a telemedicine system was ready for trial on Earth – in the Space Technology Applied to Rural Papago Advanced Healthcare (STARPAHC) program. Using a two-way television and radio connection and remote telemetry, the program connected Tohono Oʼodham people (then known as Papago) with nurses and physicians hundreds of miles away.

The internet and a pandemic

It wasn’t until 1970 that the word telemedicine was officially coined by US doctor Thomas Bird. Bird and his colleagues set up an audiovisual circuit between the Massachusetts General Hospital and Logan Airport to provide medical consultations to airport employees.

From the 1970s onward, telemedicine started gaining more traction. The internet, officially born in 1983, brought new ways to connect patients and physicians.

Satellites could connect physicians and patients across greater distances without the need for two-way closed-circuit televisions. The cost to develop and maintain a telemedicine network decreased in the 1980s, opening the door to wider adoption.

In his 1999 science fiction novel Starfish, Canadian writer Peter Watts describes a device called the “Medical Mantis”. This device allows a physician to remotely examine and perform procedures on patients deep beneath the ocean’s surface. In the early 2000s, NASA’s Extreme Environment Mission Operations started testing teleoperated surgical robots in undersea environments.

The evolution of telemedicine has kept pace with advances in information and communication technology. Yet, throughout the 1990s and early 2000s, telemedicine remained little used.

It took the global COVID pandemic to make telemedicine an integral part of modern healthcare. Most of this is consultations via video call – not so far away from what Gernsback envisioned a century, though so far without the robotic hands.

What’s next? One likely factor pushing real-world telemedicine to match the dreams of science fiction will be developments in human spaceflight.

As humans progress in space exploration, the future of telemedicine may look more like science fiction. Earth-based monitoring of astronauts’ health will require technological breakthroughs to keep pace with them as they travel deeper into space.

[summerlovedfm]

Got a diagnosis from the teledoctor that i have moderate viral bronchitis so i uh yeah i am staying home tomorrow so i’m gonna just write starters and do drafts and asks in between sleeping tonight and tomorrow so.....pls love me :pleading:

[extended-play]

doing ym first teledoctor apoointment alone,,, what the freak

[telehealthpeoplepets]

Work hard. Believe in yourself. And make it happen!

[undercoverduggarblog]

.

[ghostlynb]

I am out of ssris. My doctors office is still closed. My prescription does not have a refill. I couldn’t drive to go get it if it did. I have a handful of CBD gummies to keep calm and then I’m just alone with my serotonin imbalance again.

[danismm]

1954. Teledoctoring replaces inefficient house calls.

[atyraah]

We are bringing care to the comfort of your home. Now, book your appointments from your home. For more info - Partners: +91 95975 56147 visit- www.atyraah.com

[occultpuppy]

Also, great news as a nonbinary creature with PCOS, my visit with the obgyn went SURPRISINGLY well! Was incredibly nervous as it's been way too long, think 10+ years, since my last check up and not only did I receive a stable/clean bill of health for what I got going on BUT I also received a crap-ton of cool info. My doctor is even willing to just give me a sterilization procedure with no hoops to jump through, no asking my partner for permission or having to seek out a church or therapy.

I literally cannot express to you all how blindsiding it was to have a doctor not only advocate for me but with me as well. All the doctors I've had in my adult life have not felt like this and I wish other doctors were more like her.

Next major doctor find is primary care and then the unicorn of getting the autism diagnosis as an adult afab. I already hate how hard it's been from the first searches. Might have to go the teledoctor route which is okay I guess if it gets results but I hate how much eye contact it forces. Feels like its pulling teeth out of my head when I got zoom appts

[destinationtoast]

Because things just haven’t been exciting enough lately.

New personalized emoji 👍

So we've been sheltering in place here in the Bay Area for what feels like eons but has been a couple days. When the announcement went out, I decided to move in with my partner and his polycule. They have a guest house.

I tried to move the cats with me.  Starting with Bennet, because she has somehow become the most cuddly and affectionate of all my kitties recently, and she was sitting in Mrs. Toasty’s lap curled up on a towel.  It seemed like it would be easy.

Bennet, however, wasn't having it.

We failed to completely cover her head in a towel. She fought free enough to fasten onto my thumb with a great deal of force and tenacity. I sprained my wrist trying to yank my hand free. She let go just long enough to get a better, more dangerous grip on my thumb. After a long time, she let go.

Pretend it's raspberry jam if you're squeamish.

I cleaned the wound, then sat on the floor and cried over my sucky life choices that led me to traumatize both myself and my shyest cat, and my sucky options. I ended up leaving the cats at my place and still moving to my partner's. In part because now my dominant hand was now unusable and I need help with stuff.

Thumb swelled up within a few hours. I called a teledoctor and got antibiotics that I started at 3am. He wanted me to go to the ER but I figured they have more important issues right now. He said to go to urgent care the next day if needed.

It was needed. A second teledoc insisted, even though my instinct was to stay out of the way of the medical professionals in this time of overwhelming need.

The urgent care I went was doing intake and triage and some treatment in the parking lot. Masked and gloved people met us as we arrived and told most to stay in cars. Those with any respiratory symptoms (or recent history of international travel, or contact with someone diagnosed with COVID-19) were either treated in their car or -- if they were in bad shape -- sent to a separate ward.

I was quickly directed into the normal urgent care area, where it was just me and a woman who dislocated her shoulder. It was very fast and efficient.

The doctor was very concerned about my hand.  She took X-rays and prodded me a bunch, and she made very concerning faces and noises durning the exam.  She gave me even more antibiotics -- a shot in the butt -- but told me to keep taking my pills, also.  And she gave me a wrist splint and sling as well.  Then she referred me to a hand surgeon.

Really?  I asked.  It’s not really that bad, is it?

Just go to the hand surgeon, she told me.  He’ll evaluate further.

Fine.  Back to the hospital the next day, then.  They stopped me at the main hospital entrance and quizzed me on my symptoms and history.  The international travel questions had gotten more specific since the day before.  I passed and was allowed in.

The hand surgeon made more bad faces.  He scheduled me for surgery a few hours later.

While we waited, we went to visit my kitties.  Winter and Tico were cautiously friendly, having not been recently ambushed.  Bennet was hiding under a large chest in my room that I swear only has like 2 inches of clearance from the ground.  She did not emerge at all during the couple hours we were there.  But she did stare accusingly at me. 

I went back to the hospital.  The masked bouncers had added new questions about whether I’d been on a cruise ship.  I passed the test again, then went inside and had HAND SURGERY.

I AM A BLUE MUMMY!!!

The surgery wasn’t bad.  But the shot they gave me in my thumb beforehand -- to deliver local anesthetic -- was horrid. I screamed FUCK!!!! about fourteen times.  (The doctor told me not to move; he didn’t tell me not to scream obscenities.  Technically, I obeyed his orders.)  

Doctor: You did a good job. Me: No I didn’t. Doctor: Yeah, you’re right, you didn’t.  At least there’s nobody here today to hear you and be scared.

(Later, they gave me a second shot to finish numbing me, and it wasn’t nearly as bad.  I got to literally say to the doctor, “Look at all the fucks I didn’t give,” and it was a great moment.)

The doctor sewed me up and sent me home.  A couple days later, I’m recovering quite well, and being well cared for by my partner et al.  I’m still working on reconciling with Bennet, though, who I hope will forgive me in less than the four years it took her to warm up to me the first time around.  😿  I am really, really trying not to stress about that too much, and hoping that she’ll remember soon how much she discovered she enjoyed cuddling and being pet as soon as she relented and tried it.

Anyway, we’re managing okay here, for the most part... taking it a day at a time, and appreciating those days that don’t involve going to the hospital.  I hope you are also, on the whole, hanging in there, and mostly doing 👍.

[whereanimalscross]

The realization that I actually need to be checked out by a doctor sucks. I dunno if I should just like — guess I can try to have a teledoctor get be a referral to a specialist at least

[mjalti]

the appeal of marrying a doctor has significantly diminished ever since I got my health insurances app to visit a TeleDoctor. I now realize I just wanted comfort and ease and not to wait 5 hours in line for a clindamycin script. Back to loving people for their personalities I guess.

[telehealthpeoplepets]

Did you miss the deadline to sign up for corporate medical benefits?

Did you recently leave a job and now you’re without benefits for you and your family ?

COBRA is expensive!

Contact us today -

www.TelehealthPeoplePets.com

Unlimited Telehealth access for your household (up to 7 people). Phone or video chat with a doctor or specialist 24/7/365. $0 copay!

$70/month covers the family for unlimited doctors and behavioral/mental health therapists as well as veterinary care for all of your pets.

Choose doctors only for $40/month for the family.

1200+ doctors in the U.S. All doctors hold multiple licenses in multiple states. If you need an Orthopedic or Gynecologist or Gastroenterologist or any other specialist, they are available for consultation.

HIPPA compliant

Have a doctor in your back pocket

www.TelehealthPeoplePets.com

Ask about our Tele-Veterinary service for all of your pets!

[theouijagirl]

Have you had any symptoms of coronavirus, but u think it was just a cold or flu? Did u get tested for coronavirus? I was having severe chills, aches in my legs, fever, and sudden coughing last night but I am better now, but still have a cough and am fatigued. I am afraid to go out and test.

Personally I haven’t. I had the flu in January which led me to have a really bad cough for a few weeks after, but from what I’ve read it really doesn’t sound like the coronavirus at the end of the day.

You should have a support line or teledoctor/nurse you can call near you. Tell them your symptoms and they will tell you what to do. If they tell you to get tested then so be it. It’s far more dangerous to not get tested and not know, because then if you do have it you’ll pretty much be spreading it to everyone you come into contact with. 

[drcelestemd]

Each summer, ophthalmologists(eye doctors) notice at least a 30% increase in eye injuries for the season. Most of these injuries are related to physical injuries that occur in or around the home. For example, if you are mowing the lawn or completing house renovations, you can get a wood chip, rock, stone, trash, etc pop up into your eye causing irritation, laceration, bleeding, or other damage. The best way to prevent eye injuries when working around the house is from the use of eye goggles. They are very inexpensive but so worth the protection. Protect your eyes with goggles for all outdoor lawn manicuring and house renovations. . . . . . #doctorcelestemd #doctorceleste #doctor #doctorlife #doctordoctor #doctorslife #doctorsofinstagram #blackdoctors #doctors #physician #urgentcare #urgentcarephysician #femalephysician #africanamericanfemalephysician #medicine #medicalmogul #virtualmedicine #telemedicine #teledoctor #teledoc #conciergemedicine #conciergedoctor #professional #health #healthcare #wellness #healthy #healthylifestyle #healthyhabits #exercise

[endlesssummer77]

CICO works (with help from Contrave)

I'm never doing a fad diet again. Over the course of the past 5 months, I've slowly, but surely, lost a little over 30 lbs. How? CICO and contrave.

Contrave has changed my life. I know that sounds a little dramatic, but it's true. I can't believe it took me so long to get started on it. I'd had an almost-full bottle (120 pills) that Mom let me have last year when I visited for Christmas. She had gotten them prescribed because she wanted to try them out, but couldn't tolerate the side effects (she said they made her really irritable 😒).

Anyway, I was curious but skeptical. Contrave contains bupropion (antidepressant) and naltrexone (opioid antagonist), and not a single stimulant - or anything else that's been well-studied for weight loss. I'm not one to bother with OTC diet pills (they're pretty much all the same anyway) because they're unregulated and unproven, but I have been on phentermine a few times. Unfortunately, phentermine treatment is limited to 12 weeks at a time, and the awesome appetite suppressant effects diminishes quite a bit after the first few weeks, anyway.

I had a general idea of how contrave could work (background info: I have a formal education in human anatomy & physiology, biochemistry, introductory pharmacology, and human pathophysiology):

1. Naltrexone blocks endogenous opioids from attaching to opiate receptors, an action which mediates a dopamine response (dopamine is fundamental to the brain's reward center and the development of addiction). By blocking these receptors, one could theoretically reduce or eliminate the biochemical process that reinforces addictive behavior. This has already been extensively researched as a treatment for alcoholism.

2. Bupropion is an NE (aka adrenaline) and dopamine reuptake inhibitor. This means that bupropion prevents the "stop" of NE and dopamine activity, which leads to a whole bunch of other effects. Bupropion is chemically related to amphetamines, which explains this effect on certain neurotransmitters, but it also stimulates the release of 2 other molecules, alpha MSH and AGRP, which are involved in a lot of autonomic processes in the body, including regulation of appetite and energy expenditure. Most research that exists has focused on the psychological effects of bupropion as it is normally used to treat depression and to help people quit smoking.

So here's the interesting part:

Those 2 other molecules that are stimulated by bupropion? They each play a vital role in explaining how bupropion could be effective for weight loss:

a) alpha MSH does a lot of things, including appetite reduction and increases in energy expenditure (metabolism). Theoretically then, you could take just bupropion for weight loss right? Well, no. Like nearly every physiological process in our bodies, the cells that release a-MSH have a self-limiting feature to stop the whole process from going on indefinitely. Otherwise, humans could run out of energy needed to live.

b) This limiting feature works because cells release AGRP at the same time as a-MSH. AGRP's only function is to attach back to the cell that released it. When enough AGRP has attached, a signal is sent inside the cell telling it to stop producing both a-MSH and AGRP.

This basically means that no matter how much bupropion you take, its weight loss effects are going to be limited by your body's natural processes.

So back to my point, how does contrave work, exactly? I've already explained how it can help reduce appetite and increases metabolism via release of a-MSH, and how this process is self-limited by the concurrent release of AGRP. Theoretically, if we could find a way to eliminate or block AGRP without affecting a-MSH, then the potential of bupropion for weight control could be significant.

Well, here's the kicker... AGRP IS A TYPE OF BETA ENDORPHIN!

It's an endogenous opioid! This means that the sites AGRP attach to on a cell can be blocked by naltrexone without limiting a-MSH!

FYI, I didn't know any of this stuff until this past weekend, when I basically gave myself a mini neurochemistry lesson using articles available on PubMed. And sorry, I didn't bookmark any of them to use as references here.

Back to the story -

When I began contrave, I wasn't expecting much of anything. The bottle sat in my kitchen for a few months before I gave it a go, and even then it wasn't for weight loss. My psych was planning on possibly adding bupropion to my regimen anyway, so I figured I may as well try it out. Here's how things went:

Side effects are minimal due to the titration (slow increase) in dose that is prescribed to most people. The only thing I noticed was a short period of GI discomfort (nausea mostly) a few hours after taking a pill, but this stopped happening after about a week. It's probably due to the opioid receptors found in intestinal walls (something new I learned from my weekend of "research" lol) which affect intestinal motility. This is why opioids cause constipation, while opioid withdrawal produces nausea and diarrhea.

Price: you can go to the contrave website and get connected to a teledoctor who can write you a Rx (I used this service when I ran out of the bottle my mom had given me; consultation was $45). You can choose to have it sent to a local pharmacy, or use their preferred mail pharmacy, which charges $99 total to ship you a month's worth of medication. I chose this option because retail pharmacy prices are much higher. Total price: $144.00 first month, $99 monthly afterwards.

Insurance: most plans do not cover weight loss medications; mine certainly doesn't. The teledoctors they use also do not accept any insurance.

Regimen: you titrate up every week, starting with 1 pill/day during the first week (90mg bupropion+8mg naltrexone) until you get to 4 pills a day (360mg bupropion + 32mg naltrexone, all extended release).

Weight loss: at first, I had almost no faith that contrave would be effective for weight loss. I started off eating a 1200 cal/day (loosely tracked) and working out 1x a week. I'm still doing that, actually. I should also add that I used to crash diet a lot, often restricting myself to 500 cal a day, so I honestly didn't believe that staying under 1200 cal a day would actually do anything. Because of this irrational belief, I avoided the scale a lot. At some point - when I was up to 2-3 pills/day - I began to notice that I could go long periods of time without wanting or needing food. Even when I was physically hungry, eating felt like more of a chore. A few weeks after that started happening, some coworkers began commenting on my weight loss, which totally surprised me. I finally got the courage to weigh myself, and I was DOWN. 15. POUNDS. This all over the course of about 3 months.

Obviously, I was very encouraged by that, so I decided to continue with it. I'm basically doing the same now as I was then - 1200 cal/day (loosely) plus 1-2 days/week intense workouts (mostly CrossFit). It's now been 5 months and I'm down 32.6 lbs, to be exact.

Contrave has changed my life. It's like my brain has been reset; the damage done by all those years of starving and bingeing has been reversed. I have a normal relationship with food now: I eat when I'm hungry and stop when I'm satiated. I prepare nearly every meal I eat, which has eliminated almost all unhealthy, overprocessed foods from my diet. I'm trying to up my activity level, but I'm extremely busy with a full time job and another degree that I'm pursuing, leaving me pretty sleep-deprived during the weekdays. But weight loss is mostly diet, anyway.

I am more hopeful now than ever that I can achieve lasting weight loss. And the best part is that there's really no reason I can't be on contrave indefinitely, or for at least a few years. Bupropion is a medication that's already taken on a long term basis without issue. Naltrexone can damage the liver so it is typically not used long term; however, this effect has mostly been observed in people taking much higher doses of naltrexone (300mg+). Contrave contains a much smaller, extended release dose (32mg in 4 pills) that is even less than the dose used to treat alcoholism (50mg).

I'll update again when I remember to, lol. Hopefully I'll be down another 30 lbs 😁