tag:blogger.com,1999:blog-18417906644820870852024-03-24T02:09:50.985-05:00Simply HealthyUnknownnoreply@blogger.comBlogger81125tag:blogger.com,1999:blog-1841790664482087085.post-29880883334233261192015-07-22T15:26:00.002-05:002015-07-22T15:26:22.468-05:00An Ounce of Prevention...<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-size: small;"><span style="font-family: Calibri;">The next foundational principle is prevention. Prevention is based on the idea that if you
can find a disease state early in its progress, it is infinitely more easy to
treat than when it has time to progress to the full blown condition. With this practice patient survival goes
up. There are several traditional types
of prevention.
<o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-size: small;"><span style="font-family: Calibri;">First, primary preventions are methods to avoid the occurrence of
disease or to help people resist disease.
An example of this would be vaccination, healthy diet, exercise, and
avoiding smoking. This is the area where the biggest gains can
be made in a population. If people are
pursuing a healthy diet and lifestyle, a disease (if not completely eliminated),
can be prevented for many years more than if this prevention had not taken
place. In the case of vaccination, over
the last several decades this practice in the USA has all but wiped out polio,
measles, mumps, and other conditions common to past generations. Cleaning up the public water supply is also a
primary prevention that most of us don’t even think of, but this has also
eliminated many waterborne diseases from our
country.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-size: small;"><span style="font-family: Calibri;">Next, secondary prevention is designed to detect and address an
existing disease before symptoms start.
We measure your blood pressure when you come to the office and if we find
too high a number we will offer treatment.
If the blood pressure is up but you have not had any other symptoms or
damage from the high blood pressure, treatment at this early stage could prevent
or delay damage that would have occurred without it. Other examples would be yearly blood tests
looking for elevated blood sugar, prostate cancer, or kidney disease. All are easier to treat that when they have
had years to progress unnoticed.
<o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-size: small;"><span style="font-family: Calibri;">Lastly, tertiary preventions are efforts to limit the negative
impact of a disease a person already has.
Rehabilitation programs after a heart attack or stroke would be an
example of this type of prevention. They
seek to maximize function and help the affected person find ways to regain as
much as they can after an illness is suffered.
<o:p></o:p></span></span></div>
<br />
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<span style="font-size: small;"><span style="font-family: Calibri;">Each of these prevention categories is important. They have extended the life expectancy of
people all over the world. So my message
to the readers of this blog would be…first do as much as you can with your diet
and exercise to prevent disease. Obesity
and sedentary lifestyle is linked to so many of our most common disease
states...cardiovascular disease, diabetes, high blood pressure, some cancers,
depression…the list goes on and on. Get
up, get out, and find ways to enjoy healthy food and activities. Next, come to your doctor for your
preventative visits. It is one time each
year to make sure you are doing all you can to prevent or find early
disease so that it can be addressed
before it becomes a bigger problem. And
lastly, if you have a problem, please come for regular visits to monitor your
condition and discuss with us ways to make improvements in your level of
function. </span></span></div>
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-family: Calibri;">Maria Motta FNP/BC </span></div>
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<o:p></o:p></div>
Unknownnoreply@blogger.com4tag:blogger.com,1999:blog-1841790664482087085.post-89178133520359408972015-05-19T14:24:00.002-05:002015-05-28T09:13:57.812-05:00The "Rest" of your Health<div class="MsoNormal">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgw4J2MvhXoHIDoUJykDFH0iOXIhATTbVtEPgQ2DPEv5FWfajEDNeXw1PZRgcBu0a9bTRqfORvVW9QIUOKytAar3sXTusvZabiwhiv422AcyvvVvK7CpGLkthyphenhyphenyZPxL_0LkzLi1ylTGqP3L/s1600/sleep.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgw4J2MvhXoHIDoUJykDFH0iOXIhATTbVtEPgQ2DPEv5FWfajEDNeXw1PZRgcBu0a9bTRqfORvVW9QIUOKytAar3sXTusvZabiwhiv422AcyvvVvK7CpGLkthyphenhyphenyZPxL_0LkzLi1ylTGqP3L/s400/sleep.jpg" width="400" /></a>The third foundational principle of health is “REST”. In my conversations with patients I have
found that many people do not value sleep and rest (especially in the United
States). Our culture seems to tell people
that if they are not filling every moment of the day with activities they are
not successful. This can lead to a
feeling of exhaustion and may result in a breakdown of health over time. Many people do not know that adults needs (on
average) about 7-8 hours of sleep per night and that there are fairly easy
strategies they can use to make their sleep time more restful and
satisfying. These strategies are
collectively called “sleep hygiene”. Some
highlights include keeping the lights low for about an hour before going to
bed, limiting caffeine and other stimulants for about 4-6 hours before bedtime,
and getting about 30 min of exercise early in the day. One of the best times of the day to be active
is between the hours of 5-7 PM, preferably outdoors. The last rays of the day’s sun will stimulate
the melatonin producing pineal gland in the brain. This keeps your sleep-wake cycles on the right
track so that it is less likely that you will wake in the early hours of the
morning. Also, there is ongoing research
about the health benefits of getting enough sleep. At this point a connection of sleep and
learning is well established. In
addition, newer findings show that getting less than 6 hours of sleep each
night, over time, leads to problems with obesity, cardiovascular disease, poor
mood, and difficulty controlling blood sugar.
It makes sense as sleep should account for about one third of our 24
hour day!<o:p></o:p></div>
<br />
<div class="MsoNormal">
In addition to sleep, time for the mind to rest is very
important. When the brain experiences
stress it needs time to recover, just as the body does. If the body runs five miles and then rests,
it will become stronger for the next run.
When the mind experiences stress and has time to recover and reflect, it
will likewise enhance learning, peace, and reset for the next challenge. Some restful strategies for the mind are:
time for sitting quietly and reflecting (meditation and time in nature), yoga,
or listening to music. The mind needs
time to drift and imagine. Many also use
prayer as a time to meditate as well. Unplug
your favorite electronic device, take some time to reflect. What is good for the mind is good for the
body!</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Maria Motta FNP</div>
<div class="MsoNormal">
Michael Fuller MD<br />
<o:p></o:p></div>
Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-1841790664482087085.post-42149420168453337272015-04-19T23:53:00.003-05:002015-04-19T23:53:54.526-05:00An opportunity to serve.I have a new adventure in my life personal life. As most of you know, I am a member of The Church of Jesus Christ of Latter-day Saints. I was recently asked to serve as a counselor to our new Stake President, the ecclesiastical leader of our church in the St. Louis region covering 8 different congregations. I am excited for the challenge. For those who may be interested, I felt impressed to share my feelingss about the process on my personal blog page, <a href="http://www.fullerfamilyfunnyfarm.blogspot.com/" target="_blank">My Fuller Feelings</a>.<br />
<br />
This will not replace my occupation as your physician. I will continue to work full time and plan to do so for many more years to come. I am grateful for the team I have in place now to help do that job even better than before. Please let me know if you have any questions.Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1841790664482087085.post-44419919299641527782015-04-13T17:35:00.002-05:002015-04-27T05:26:54.845-05:00The Foundation of Exercise<div class="MsoNormal" style="background-color: white; color: #222222; font-stretch: normal; margin: 0in 0in 10pt;">
<span style="font-size: small;"><span style="font-family: Georgia, Times New Roman, serif;">This is the second installment from Maria regarding foundational principles for health. The first was on nutrition and now I
would like to share some thoughts about nutrition and its connection with
exercise. </span></span></div>
<div class="MsoNormal" style="background-color: white; color: #222222; font-stretch: normal; margin: 0in 0in 10pt;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: small;">Our bodies are designed to feel
stress (hunger, sleep, desire…) and then we are designed to expend energy to
overcome or satisfy whatever is creating the stress we are
experiencing. In the past
if we were hungry we would have to catch something to eat, or walk into the
woods to gather food, raise crops, walk to the places where food was sold,
etc. We would have to run
away from danger or stand and fight. All of these activities
took energy and this was not only a way to get food or survive danger, but these
activities played a role in burning off some of the calories we took
in. </span></div>
<div class="MsoNormal" style="background-color: white; color: #222222; font-stretch: normal; margin: 0in 0in 10pt;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: small;">Today that process is short
circuited. We can get
into our cars and drive to get food, which burns very little
calories. Also the
calorie density of foods today is much higher than when we ate foods that were
directly from nature. There were no machines to process our
food, but rather we had to process them ourselves. If we wanted a tortilla, we would
have to pick the corn, mash it up into flour and then make and cook the
bread. This would be a
several hour process and burned many calories. Now all we have to do is open the
package and put on our favorite toppings (also processed for
us). </span></div>
<div class="MsoNormal" style="background-color: white; color: #222222; font-stretch: normal; margin: 0in 0in 10pt;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: small;">Processing really robs us of a
very natural way to burn energy and get nutrition. A simple example is when we drink a
glass of apple juice vs. eating an apple. If we eat the apple the sugar we get
from the apple is more slowly introduced into the body as the stomach works to
separate the sugar from the fiber of the apple. The glass of juice is already broken
down so our body has less to do and the sugar hits the blood stream faster and
all at once. This theme
is repeated over and over again with so much of the processed food consumed in
the US and around the world. </span></div>
<div class="MsoNormal" style="background-color: white; color: #222222; font-stretch: normal; margin: 0in 0in 10pt;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: small;">Moreover, our brains are
designed to want high calorie density, because when food was scarce the higher
calorie content made it more likely we would survive famine to live and have
babies;continuing the species. Thus, it is very hard for us to
refuse foods that are the highest in calories because we are fighting our
evolutionary brain design. It is important to understand this so
that as we are working on keeping our weight under control we can understand
what drives us and how we are designed to become and stay
fit. </span></div>
<br />
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<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj-EXzpRjS0nV3or08aBWPQ3CE_ubjJcWZedjhW-VpfAC8oAmvtL5p8Fi1_XHQf9fAQ7wYO8dPfU9CfffmwAykWBIamvLtRY7xzDm6tD8Vpgvd_8tCyEeMkezG1pyMSsWUaRqprMJmvgQ6y/s1600/Tiger+chase+Cartoon+4-20-15.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj-EXzpRjS0nV3or08aBWPQ3CE_ubjJcWZedjhW-VpfAC8oAmvtL5p8Fi1_XHQf9fAQ7wYO8dPfU9CfffmwAykWBIamvLtRY7xzDm6tD8Vpgvd_8tCyEeMkezG1pyMSsWUaRqprMJmvgQ6y/s1600/Tiger+chase+Cartoon+4-20-15.jpg" height="278" width="400" /></a></div>
<span style="font-family: Georgia, Times New Roman, serif; font-size: small;">Finally, much of our stress is
more emotional than physical as it may have been in days past. In the past if we ran from a tiger or
physically fought to defend our lives (assuming we survived) we would not only
burn calories, but grow stronger and increase our stamina. Today we run and fight emotionally
and that is not the way our bodies are designed to relieve stress. Thankfully, our bodies cannot tell
the difference between running from a tiger who may want to eat us, or running
on a treadmill, or walking around the block, or riding a bicycle, or
dancing. In these ways we
can use our bodies to eliminate some of the chemicals we produce as a response
to stress. We can help
resolve stress through physical activity because this is what we are designed to
do. If we don’t do this
our stress response can turn against us and lead to health
deterioration.</span></div>
<div class="MsoNormal" style="background-color: white; color: #222222; font-stretch: normal; margin: 0in 0in 10pt;">
<span style="font-family: Georgia, Times New Roman, serif;">Maria Motta FNP</span></div>
<div class="MsoNormal" style="background-color: white; color: #222222; font-stretch: normal; margin: 0in 0in 10pt;">
<span style="font-family: Georgia, Times New Roman, serif;">Well said, Maria. I agree with everything she has said here. Understanding the biologic underpinnings of our body helps explain why it is so hard to lose weight. It is impossible to do it without a combined effort in regards to healthy eating and vigorous, regular exercise. </span></div>
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<span style="font-family: Georgia, Times New Roman, serif;"><br /></span></div>
<div class="MsoNormal" style="background-color: white; color: #222222; font-stretch: normal; margin: 0in 0in 10pt;">
<span style="font-family: Georgia, Times New Roman, serif;">Dr. Fuller</span></div>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1841790664482087085.post-16228247792367442502015-03-03T15:47:00.002-06:002015-04-07T12:03:00.168-05:00Health Foundations<div class="MsoNormal">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhj_8EIWdK-mFBzgdwsUoLiBl_Qjy8_bdjA9NF-qlBMiMXm69LzTJjMeO8mu6J-FQW8KYS_Gq0eu4wohuero_ak-_coGqpM4G8ZBwPB4PeMsywku9jR4khme8ZqHUCoUqQRfKx_NA0QFCQP/s1600/MD.+Home+4-5-2015+Visit.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhj_8EIWdK-mFBzgdwsUoLiBl_Qjy8_bdjA9NF-qlBMiMXm69LzTJjMeO8mu6J-FQW8KYS_Gq0eu4wohuero_ak-_coGqpM4G8ZBwPB4PeMsywku9jR4khme8ZqHUCoUqQRfKx_NA0QFCQP/s1600/MD.+Home+4-5-2015+Visit.jpg" height="317" width="400" /></a>For this month’s blog post I wanted to first give an update
on how things are going with my new practice arrangement. As introduced in last month’s post, I now
have Maria Motta FNP working with me.
Her assistant, Rachel along with Michelle who you all know well and Kym
form a true team to help take care of you, my esteemed patients better. I couldn't be happier with how things are
working out. Maria is a wonderful
addition. She is allowing me to offer
additional services to my patients. She
begins seeing patients at 7:30 AM every day.
I suspect that many of you who work will appreciate those hours,
allowing you to not miss work for a routine appointment. I am available to her to answer questions by
phone but this allows me to continue to see my patients who are in the
hospital. As you may know, there are not
many physicians who still see their patients who are admitted. I feel strongly that I want to continue to
offer this service. No one knows my
patients better than I do. I feel
confident that I am the best one to deliver care that is needed at the most
critical times of someone’s life. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Maria will also be starting a monthly educational class for
those who are having the hardest time controlling their diabetes. We are working together on the curriculum and
be making invitations soon. You do not
need to have poorly controlled diabetes to attend. If any of you are interested in attending,
please let me know. <o:p></o:p></div>
<div class="MsoNormal">
Other benefits of my team approach is freeing up time for me
to visit my most vulnerable patients in their homes. I have been able to six different patients so
far with plans to do others. I have long
since desired to find a way to do this.
I am glad that it is finally happening.<o:p></o:p></div>
<div class="MsoNormal">
For those of you who have met Maria, you know what a great
person she is. I encourage the rest of
you to welcome here with open arms. I
have asked Maria to share some ideas she has about healthy living with
you. Similar to the simple facets of
good health I have outlined previously, she has labeled these her “Health Foundations”. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
In sports there are foundational elements that apply to
players across all levels of development weather a beginner or a major league
star. They are basics that, if done
right, create a solid athlete who is able to instinctively make decisions that
result in the best plays. Health
foundations are very similar. So, once
you have a routine to follow the basics, then health and happiness have a
greater chance to follow. I believe
there are five foundations for a healthy life and I want to make sure all my
patients are aware of these elements. In
this way, as a team, we can try to head off health problems or work on
following a path that leads back to health when you are ill. The elements are: <b>Nutrition</b>, <b>Exercise</b>, <b>Rest</b>, <b>Peace</b> <b>of</b> <b>Mind</b>, and <b>Prevention</b>. You may be
thinking “nothing new here”… but I want to argue that doctors and nurses spend
most of their time treating health problems that develop as a result of a
dysfunction in one or more of these areas.
Medications and treatments have a valuable role to play in care of
patients, but I want you to know that <b>YOU</b>
ultimately have a lot of control over <b>your
health</b>. Over several blogs I want to
begin to address each of the elements in more detail and, because we are all on
the same team, I would like to hear from you about the positive ways that you
approach your health.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b><u>First up: Nutrition
(part one)<o:p></o:p></u></b></div>
<br />
<div class="MsoNormal">
Many patients have very little knowledge about what to eat
so they follow traditions instilled by their families and those that are
propagated by the media (including fast food commercials and those selling diet
books). Over time what to eat has been
debated vigorously and the argument goes on even today. I want to send a clear message that the earth
has been providing products since the beginning of time that provide adequate
nutrition for life. In the present age
we have drifted away from eating the whole foods the earth provides in favor of
highly processed and altered substances.
I’m not interested in imposing restrictions, but rather want to
encourage you to find whole foods that you like and then providing information
about health benefits these foods can provide.
Most importantly, I want you to develop your own healthy way to get the
nutrition you need. I want to share my
recipes with you and am interested to see what you can find to share with
us. I would like for you to review the new
simplified recommendations from <u>www.myplate.gov</u> to build a plate of
health and to think about building a “rainbow of food” for nutrition. These show pictures of what should be on the
plate (both types of foods and amounts) and remind you to seek out multiple
colors of foods to get all the micronutrients you need for your best health. These are easy steps to remember and can be a
fun way to approach healthy eating. <br />
<o:p></o:p></div>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1841790664482087085.post-63967065566013825282015-02-16T10:52:00.001-06:002015-02-16T10:52:26.931-06:00Mickey and the Measles<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjwYyDnYoGF9iUY2twNjPTPNAy3wac_zrCONOAPZuPcT0P-oK4r5t0r1rivoZGRKSo1-hG08oatpQbDHEZe5Ll0PSkxSukv1FDAxmd4lRjK7m7UU6HeBG5kloaGcKARa4SjQCDVNFECcIQI/s1600/Mickey+Mouse+3-14-2015.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjwYyDnYoGF9iUY2twNjPTPNAy3wac_zrCONOAPZuPcT0P-oK4r5t0r1rivoZGRKSo1-hG08oatpQbDHEZe5Ll0PSkxSukv1FDAxmd4lRjK7m7UU6HeBG5kloaGcKARa4SjQCDVNFECcIQI/s1600/Mickey+Mouse+3-14-2015.jpg" height="315" width="400" /></a><span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">We are currently experiencing a measles epidemic in the United States. I have received many questions regarding immunity and vaccination. Let me answer those questions for you here in my blog space.</span></div>
<b id="docs-internal-guid-08e1f511-934c-aea7-688c-396925fcef35" style="font-weight: normal;"><br /></b>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Earlier this year measles was introduced into our country by way of visitors to a certain theme park based on a famous rodent. Mind you there are several diseases that can be spread through such animals but we are pretty certain that the incident case was a person visiting from another country where the disease is more prevalent. According to the CDC, from California the outbreak has spread to 17 states and there are over 120 people as of February 6th. It is important to realize that almost everyone that has come down with the infection was not previously vaccinated.</span></div>
<b style="font-weight: normal;"><br /></b>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Vaccination occurs through the combined MMR vaccine which includes not just measles but also mumps and rubella. One dose of the vaccine confers immunity to 93% to the individual. A second dose more than 28 days later increases that percentage to 97%. Here are answers to frequent questions that I have been asked:</span></div>
<b style="font-weight: normal;"><br /></b>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Should I be revaccinated? </span></div>
<b style="font-weight: normal;"><br /></b>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">High risk individuals (health care workers, international travelers, those with a low immune system and those that live in close quarters such as dorm rooms) should receive two doses of the vaccine. If you were born before 1948 a booster vaccine is not required.</span></div>
<b style="font-weight: normal;"><br /></b>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">How do I know if I am immune?</span></div>
<b style="font-weight: normal;"><br /></b>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Look for your old vaccination record. If there is documentation of two doses, no further vaccination is required. If not the choice is to proceed with vaccination again or to see your physician to draw lab work to check for immunity. It does not hurt to receive a third dose of vaccine.</span></div>
<b style="font-weight: normal;"><br /></b>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Where can I get the vaccine?</span></div>
<b style="font-weight: normal;"><br /></b>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">For adults, many offices do not carry the vaccine, such as ours. The county health department is a good resource for vaccines. I recommend looking there first. </span></div>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">What are the signs of measles?</span></div>
<br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">Almost all patients have fever, a significant cough, lots of drainage from the eyes and nose and a diffuse rash. If you think you may have measles, please call your doctor. Make sure you alert the staff so that you can wear a mask if you need to come to the office, thus protecting others that you may come in contact with.</span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1841790664482087085.post-55097422295126267782015-01-23T16:52:00.003-06:002015-01-23T16:52:34.819-06:00A Whole New World<div class="MsoNormal">
<o:p> </o:p>After a long sabbatical, I am writing my blog again. My goal is to post monthly. Welcome back to myself and all of you. Recently as I have thought about how best to
deliver patient care I have come to the realization that I cannot continue to
function as I have. The demands of
primary care have increased greatly in the last five years. More and more of our time is taken to process
referral requests, obtain authorizations for medications, call insurance
companies to obtain hospitalization approval, etc. In addition, insurance companies including
Medicare are beginning to change the whole structure of physician
compensation. In the past we would
receive payments from insurance companies according to what transpired as part
of a patient visit. While that is still
mostly the case, in the future, it seems clear that we will get paid to take
care of a panel of patients, regardless of whether they come to the office or
not. We will receive compensation
according to the severity of the health conditions that they have and how well
they are cared for. </div>
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<o:p></o:p></div>
<div class="MsoNormal">
As such, it is now necessary to create a system that can
track high risk patients, watch over the most vulnerable ones, and improve
communication between doctors as well as patients and their families. It is quite apparent to me that I cannot do
this on my own. It is all that I can do to take care of the patients that come
through the door each day, let alone all those who are not present. I view my choices as either entering “Boutique
Medicine” which would limit my panel and require yearly supplemental payments
of upwards of $2000 per patient, or of creating a team of health care workers
to join together in maximizing the overall health of my patient panel. I have personal and ethical problems with the
first option. I have decided to pursue the
team approach. <o:p></o:p></div>
<div class="MsoNormal">
I have put a lot of thought and effort into this endeavor
and I am quite excited about it. It has
rejuvenated my career and look forward to putting it into practice. Let me introduce my team.<o:p></o:p></div>
<div class="MsoNormal">
It begins with me.
You will not lose me as your physician.
You all know me. I will keep a
very hands on management style to your care.
Michelle has been my assistant for eight years and is invaluable in helping me take care of you. She has worked extremely hard. She deserves more help and I am pleased to
introduce the newer members.<o:p></o:p></div>
<div class="MsoNormal">
Kym Jackson has been a very valued employee here at
Associated Internists as a medical secretary for the last 16 years. She will now be my team’s dedicated
secretary. She will be verifying appointments, fixing my schedule, processing
referrals, scanning documents as well as other duties. We are very excited that she is now dedicated
to my panel of patients.<o:p></o:p></div>
<div class="MsoNormal">
I have also hired a nurse practitioner, Maria Motta, to
assist me in seeing patients. I asked
her to write a paragraph, introducing herself:<o:p></o:p></div>
<div class="MsoNormal">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiDfCc78WI_5H6nscO1myvWSS7yEIW_l4YRV2Ii0kW2-e5yEDMKVMF4bVwaXPcdhdmy9OfZHBBu0mGpXhS6ai-4lISF_evJlc6orEk3loLTDe1YTBfWax4Cw6CM9niNRuypnrXffAy92SXS/s1600/Maria.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiDfCc78WI_5H6nscO1myvWSS7yEIW_l4YRV2Ii0kW2-e5yEDMKVMF4bVwaXPcdhdmy9OfZHBBu0mGpXhS6ai-4lISF_evJlc6orEk3loLTDe1YTBfWax4Cw6CM9niNRuypnrXffAy92SXS/s1600/Maria.jpg" height="320" width="213" /></a>“I am a family nurse practitioner, a graduate from Maryville
University. I am so pleased to have an
opportunity to get to know you all and have a chance to join with Dr. Fuller to
provide excellent and compassionate medical care. <o:p></o:p></div>
<div class="MsoNormal">
I have been a nurse in the St. Louis community for the last
twelve years and I have many years of experience in the field of sleep medicine. Also, I have experience in the urgent care
setting as well as family medicine.
Importantly, I have a special interest in the use of diet and physical
activity to build physical and emotional health and will seek to promote these
in our practice.”<o:p></o:p></div>
<br />
<div class="MsoNormal">
Maria will be able to help see you for physical examinations
as well as routine and sick visits. She
will be starting earlier than me, at 7:30 AM which will likely be a more
convenient for many of you. She, like me,
has a passion for health and prevention.
I cannot be more pleased that she is joining with me. She too will have an assistant to help in the
office. Her name is Rachel. Please extend a warm welcome to them when you
are in the office. I would love to hear
your feedback. Let me know what questions
you have. <o:p></o:p></div>
Unknownnoreply@blogger.com2tag:blogger.com,1999:blog-1841790664482087085.post-27442319287800114742013-04-13T06:44:00.002-05:002013-04-13T06:44:26.823-05:00La Casa de Salud<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjiU45gP0W7Ni5hfClC8JyHxI8kh0slIjGR1RUAgVhsUOeO1sz_e4LZqz5RZIK71r-j9PrEz9AdE_UV6coZ3g0uSMLy9QyV6ODRXIqeXQHCBjdr_bCW6ozyheXH0Z7jLoMcT6im316Rgaht/s1600/FF8D3269-704D-47D6-A234-6AF4CD91C1C6.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjiU45gP0W7Ni5hfClC8JyHxI8kh0slIjGR1RUAgVhsUOeO1sz_e4LZqz5RZIK71r-j9PrEz9AdE_UV6coZ3g0uSMLy9QyV6ODRXIqeXQHCBjdr_bCW6ozyheXH0Z7jLoMcT6im316Rgaht/s400/FF8D3269-704D-47D6-A234-6AF4CD91C1C6.JPG" width="371" /></a>"Hormiga," said the young Guatemalan girl as she grabbed my finger and pointed to an ant on the ground. "Yerba," she said, pointing to the grass. Having recently arrived in the country, I was wet behind the ears and scared to death. Only 19 years old, I decided to serve a mission for my church for two years. It was my first Sunday in the country and though I studied Spanish in school for 5 years and intensively for eight weeks prior to my arrival, being in Guatemala seemed to be a whole new game. Everything came much quicker, words seemed to be all joined together and I was having a hard time understanding what was being said. While my companion, Elder Castellanos (a guatemalan himself) was speaking to the leader of the congregation, the bishop's eight year old daughter tenderly took me by the hand and taught me words in Spanish. Her acceptance of me, a foreigner in her land, warmed my heart. I immediately grew to love the people of Guatemala. I later had the opportunity of working with Mexicans, Dominicans, Puerto Ricans and others. It was during these two years as a missionary that I knew that I wanted to pursue a career as a physician.<br />
<br />
Having done well in school and loving the challenge of solving problems, I Initially studied to be an engineer in college. During my mission years I came to desire to be in a field where I could interact with and bless the lives of others as well. There were many times when we would visit people in hospitals who were sick and I enjoyed my efforts to be of help. I began to think of being a doctor and on returning home, I changed my course of study and pursued medicine as my career. After completing my residency training at Barnes Hospital here in St. Louis, a friend of mine introduced me to a fledgling Spanish speaking medical clinic called, "La Clinica." It was held in the bottom of a Methodist church. Though primitive, it grew into a respectable organization. Unfortunately when the economy took a nose dive in 2007 the funding dried up and the "La Clinica" was no longer viable. In its place came "Casa de Salud" (translated Home of Health). St. Louis University has been a generous sponsor and I have continued to be a volunteer physician as before.<br />
<br />
I view these efforts as essential to my overall development as a person, as an essential part of my health, really. I don't really give that much. I am only there, a few hours, once a month, and I share the knowledge that I have been blessed to acquire. In return, I am showered with appreciation, compassion and care. I can see in the patient's eyes gratitude for my efforts. I feel wanted and that perhaps I am making a small difference in another's life. Doing so without being payed monetarily changes the interaction dramatically. I find that as I give of myself, I leave with more than I had before. Sure there are days when I am already exhausted and I don't relish the thought of driving down and extending my day but once there, my spirits rise and I leave refreshed. At some point in my life when my children have all left the house, I will probably increase the time I spend at the clinic but for now I keep it simple, I try to stay balanced. <br />
<br />
The image of that sweet Guatemalan girl is never far from my mind. Last week, I put my daughter on a plane as she begins a journey to Brazil. She too has decided to be a <a href="http://www.sisterfuller.blogspot.com/">missionary</a>. We are so proud of her and I know that by dedicating her life in serving others, she will come to know the beautiful person that she is even better than she does now. She will find her own little girls that will reach out to her, taking her by the hand and bless her life. A life of giving brings out the best in all of us.Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-1841790664482087085.post-48022597820755307752013-03-17T09:34:00.002-05:002013-03-17T09:34:51.956-05:00Touching Lives<div style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiIK2rDb7bCPUvXzwksUDwMIfj67QBuWvVmttbfGS1fFxWKlCjPIsRfaWS3rlLfsFcVaW5u_6VvqNMBu7jwuv7H3yvD84Pzs3EcXWHPYHpLsq_qBrnRBuvydB5vTnmA3brYIIY52jtS4btc/s1600/remember.JPG" imageanchor="1" style="clear: right; cssfloat: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="343" psa="true" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiIK2rDb7bCPUvXzwksUDwMIfj67QBuWvVmttbfGS1fFxWKlCjPIsRfaWS3rlLfsFcVaW5u_6VvqNMBu7jwuv7H3yvD84Pzs3EcXWHPYHpLsq_qBrnRBuvydB5vTnmA3brYIIY52jtS4btc/s400/remember.JPG" width="400" /></a>"A mensch, do you know what a mensch is?" I had to admit that I had no clue but it didn't sound good. With the ever present twinkle in his eye, Aaron declared that my education was insufficient and that he would take it upon himself to teach me the important words to know in Yiddish. It was the least that this good old Jewish boy could do for his "mormon" doctor. Through the next few years we grew closer together as he overcame lung cancer, struggled to control gout and progressively deteriorated as his emphysema progressively sapped his body of strength. Knowing he could not live forever, we discussed his goals for the end of his life. He did not want to linger on machines but he was certainly not wanting to give up on life either. At the end it was a massive heart attack that took his life. He was rushed to the hospital, the cardiologists tried to open up the blockage but his frail body could not take the damage and he did not make it back up to the intensive care unit. Not knowing these details at the time, I was on my way to see him and happened to meet his family in the lobby of the hospital and learned that they had been called urgently to come up to the ICU. I ran up the stairs before them, only to learn of his demise. It broke my heart to turn and notify his loving family of his passing. Tears were shed together. As I told his daughter how much I cared for him, she responded, "he loved you, you were such a mensch." To what seemed to be harsh sounding consonants those years before, now rang with sweet praise. What an honor!</div>
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<br /></div>
A few short days prior to saying goodbye to Aaron, I had to also say goodby to Thomas. I dare say that was not his given name, having been born in China, being a soldier in the Japanese War many years ago. He and his wife have lived in St. Louis for a very long time. Though they hold on to their beloved Chinese traditions, they have readily embraced America and love being here. He worked as a Chinese cook. We made it through a severe staph pneumonia together, managed his diabetes but watched him slowly decline in strength the last six months or more of his life. We tried physical therapy, adjusted his medication but at the end it was a simple fall that sealed his fate. It resulted in a fractured hip and then a devastating stroke that left him partially paralyzed and unable to safely swallow. He had previously made his wife promise him that she would not let him "rot in a nursing home" but now she was being told that he must have a feeding tube placed and that he would have to be cared for in a facility. Together we had heart felt discussion about end of life care. We agreed that his care should be tailored to making his last days as comfortable as possible, not making those days last as long as possible. Hospice services were arranged and he was able to pass relatively peacefully at home. On my shelf in my office sits a jade colored plaque inscribed with Chinese characters. It sits as a reminder of the sweet spirit of that noble man. He gave it to me about a year prior to his passing. When I asked him what it means he said, "Good Doctor." I call it my doctor trophy.<br />
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The last farewell that I will share started with Shirley and ended with Millard. Having dealt with repeated lung issues, Shirley was declining and was adamant that she did not want to go back to the hospital ever again. Her family called me in a panic on a weekend, as her breathing had become worse and she was struggling to breath. They wanted desperately to do something for her but did not want to go against her wishes. I told them that I would meet them at her house and arrange for nurses to come by. I then called the hospice team and arranged for them to meet me there. My wife was out of town, so I brought my boys with me to the visit. I calmed the family's fears and promised that their wife and mother would not be allowed to suffer. The hospice nurses did a wonderful job and she was allowed to stay at home until the end. That night as we turned to leave their home, her husband, Millard, turned to my boys and told them how grateful he was to me, their "angel" father. His kind words to my sons deeply touched my soul. Over the next 5-6 years, Millard himself slowly declined. Once an avid cyclist, he was discouraged by his inability to get around as he would have liked. He had to give up his beloved home. He made the best of his situation, taking up his oil paint brushes which had long laid dormant. In the last few years of his life he completed portraits of his dear wife, his two children and of himself. I saw him regularly, keeping an eye on his kidney function but in the end his old body just started to give out. He developed Parkinson's which made it difficult to move around. I received a call from his daughter who told me he had become too weak to even go downstairs to eat. I told her I would stop by. He knew it was the end. We arranged for the hospice nurses to come again. He did not last long, passing quietly at home.</div>
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<br /></div>
It is hard to say goodbye to these friends I have made, patients of mine. My whole goal as a physician is to keep people healthy but at the right time, my job is to relieve suffering, to minimize pain as well. Success is often measured in the quantity of life but one's quality is equally as important. I view my interaction with my patients as a wholly satisfying experience. Each one touches my life for good. I certainly feel that I receive more than I could ever give. I wanted to pay tribute to all of my patients, those who have left us and those still living. To touch a life is a sacred experience, a solemn honor that I take seriously.Unknownnoreply@blogger.com3tag:blogger.com,1999:blog-1841790664482087085.post-31565285556145435222013-02-08T07:54:00.000-06:002013-02-15T16:22:04.876-06:00Give it a Rest!<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiQc5SEY5B8PfHhiAN8Dl5hCXnK8GJYrxwFviASD46zqqh6ayFlnKbSOv-aOe0mkEHemg2oKoTFoiHQaC2_3o5zZO7tvgpsLdAGe3u-PcWHi6tisBTxshDz0nk__qnPpGyiAHoDiWBCDwm0/s1600/give+it+a+rest.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiQc5SEY5B8PfHhiAN8Dl5hCXnK8GJYrxwFviASD46zqqh6ayFlnKbSOv-aOe0mkEHemg2oKoTFoiHQaC2_3o5zZO7tvgpsLdAGe3u-PcWHi6tisBTxshDz0nk__qnPpGyiAHoDiWBCDwm0/s320/give+it+a+rest.JPG" width="317" /></a></div>
We are all busy with work, home life and everything in
between. We don’t have time to get
sick. It is such a nuisance. We tend to slog on; catching some extra
rest when we can, hoping to recover quick enough that our daily routine is not
interrupted. You may be like me
and subconsciously consider the lack of days missed at work as a badge of
honor, a symbol of toughness or even superiority. Most of the time this strategy works well and we get back to
health fairly quickly. The human body
has an amazing capacity to regenerate and recover from illness. There are times, though, that it is
time to shut it down, stay home, and rest.<br />
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
There are two reasons to stay home when ill.<span style="mso-spacerun: yes;"> </span>The first is to prevent the spread of
disease to others.<span style="mso-spacerun: yes;"> </span>This is
especially true if we work around those who are very young or very old.<span style="mso-spacerun: yes;"> </span>As much as your boss wants you at work,
if you infect five coworkers, it will make the situation exponentially worse.<span style="mso-spacerun: yes;"> </span>Your exercise buddies at the gym will
appreciate not being exposed as well.<span style="mso-spacerun: yes;">
</span>Most viruses are infective within the first 4-5 days from the time that
symptoms occurred.<span style="mso-spacerun: yes;"> </span>If a fever is
present and has resolved, that is usually a good sign that the immune system
has the infection under control and the person is no longer infectious.<span style="mso-spacerun: yes;"> </span>Apart from Chicken Pox or Tuberculosis
which can be transmitted through airborne particles, most diseases require
contact with mucous.<span style="mso-spacerun: yes;"> </span>Good hand
washing is essential to prevent spread.<span style="mso-spacerun: yes;">
</span>Make sure to avoid coughing in your hand.<span style="mso-spacerun: yes;"> </span>Use your elbow or an handkerchief.<span style="mso-spacerun: yes;"> </span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The second reason to stay home is to allow your body the
rest that it needs to recover.<span style="mso-spacerun: yes;"> </span>A
high fever above 101.5 degrees, dizziness, vomiting, diarrhea and shortness of
breath are all signs that indicate a more severe illness.<span style="mso-spacerun: yes;"> </span>It is important to not only rest but
especially to stay well hydrated.<span style="mso-spacerun: yes;">
</span>Dehydration makes muscles more likely to cramp and will slow the
recovery.<span style="mso-spacerun: yes;"> </span>A simple way to judge
hydration is to look at your urine.<span style="mso-spacerun: yes;">
</span>If it is not a pale yellow, more water is needed.<span style="mso-spacerun: yes;"> </span>Going to the gym in this phase of
illness is likely to make it all worse.<span style="mso-spacerun: yes;">
</span>Listen to your body.<span style="mso-spacerun: yes;"> </span>Give
it a chance to work its magic.<span style="mso-spacerun: yes;">
</span>When the illness starts to turn for the better, increasing your activity
is good but it must be done gently.<span style="mso-spacerun: yes;">
</span>A gentle fifteen minute walk on the treadmill will stimulate the flow of
blood and lymph, the circulation of which will speed recovery by delivering
your white blood cells where they need to go and flushing out the toxins that
are building up from the disease.<span style="mso-spacerun: yes;">
</span>An hour of hard core spinning will deplete your energy stores,
exacerbate dehydration and likely trigger a relapse.<span style="mso-spacerun: yes;"> </span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Illness always occurs at a bad time.<span style="mso-spacerun: yes;"> </span>There is never a convenient time to be
sick.<span style="mso-spacerun: yes;"> </span>Hopefully the suggestions
above will help guide you to a quick recovery as well as keeping those around
you free from disease as well.<span style="mso-spacerun: yes;">
</span>Remember, the next time your body cries out, “Give it a rest!,” listen
up.</div>
Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-1841790664482087085.post-77988256919690206802013-01-20T19:54:00.000-06:002013-01-20T19:54:18.800-06:00The Road to SuccessIs it quitting smoking? Losing weight? Giving up ice cream? Starting an exercise program? What is your new year's resolution? We all want to improve but the lack of results can be frustrating. "The road to hell is paved with good intentions." This was apparently penned in 1855 by Henry G. Bohn. If you are like me, the list of things in your life that need improving is rather daunting and yet every year we try again to improve. How can we make lasting change? How do we keep our latest resolution from adding to the cobblestones on the road to failure?<br />
<br />
You may have noticed that this is not being posted on January 1st. My resolution this year is to update my blog once a month. What can I say? At least it is not January 31st. The first key to lasting change is to pick a reasonable and achievable goal. Planning to exercise every single day for an hour would be ideal for all of us....but achievable for almost none. Make sure there is enough flexibility to achieve the desired outcome. I have resolved in the past to not eat any ice cream. Those resolutions clearly failed but I found a way that works for me (see my post <a href="http://simplyhealthy4u.blogspot.com/2012/01/earning-my-ice-cream.html">"Earning My Ice Cream"</a>). It is also important to tackle our shortcomings one step at a time. Choose just one and work on it first (see <a href="http://simplyhealthy4u.blogspot.com/2011/05/make-every-step-count.html">"Make Every Step Count"</a>). Take a bite out of it and chew it one day or week or month at a time. There are many people who need to lose fifty pounds to be healthy. That is a big number and seems so unattainable that most will not even try. Breaking down the goal helps to realize how to achieve it. Over a year, losing one pound a week will result in a fifty pound weight loss. That is even giving you two weeks of no weight loss! To lose one pound a week requires a 500 calorie change each and every day. That means eating less or exercising more but the difference needs to be 500 calories. Setting the goal to lose fifty pounds is admirable but it is doomed to failure if one does not start each and every day with, "How can I get to get rid of 500 calories today?" <br />
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Broadcasting your resolution is another way to aid in your success. Tell everyone around you what you are doing. Yes, it is scary but it holds us accountable. Not being willing to share your resolutions is the first sign of failure. In fact, it is planning to fail before you even begin. Instead of shaking in fear that you might disappoint a loved one, use them for support. They will encourage you, be more patient with you and help you. In fact, finding a resolutions that can be done with a partner will increase your chance of success (see <a href="http://simplyhealthy4u.blogspot.com/2011/05/buddy-system.html">"The Buddy System"</a>). I am grateful to my patients who have said, "We miss reading your blog." It has given me the encouragement to make the time to start writing again.<br />
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Ultimately, if lasting change is going to be implemented, the resolutions have to be meaningful enough to change who we are. The resolution must invoke a revolution. Temporary change will not suffice. We need make the leap of faith from saying, "I want to quit smoking," to "I am a nonsmoker," or from "I want to exercise more" to looking in the mirror and affirming, "I am an exerciser." For me, it is changing my mindset from being a doctor that occasionally writes in a blog to being "A blogger." This does not happen over night and requires persistence. Failure will happen; we will stumble and fall. Falling is not failing. Quitting is failing. Those on the road to success have one thing in common, they have all gotten up after having fallen and continued the race. Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-1841790664482087085.post-4355259152537673842012-11-05T08:52:00.002-06:002013-01-25T10:10:49.858-06:00Big Brother<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhEMllG1EwhDSIlGFtOX7bS7OXBymWRz3rFVWgfEo-ava_rCW4zhIqqhmuOXcfShBwH0t1K3_jAXDmmsRk6YMRyIalLfMFqAEtTYlHWJy9vSTj-pccxnqbo_l8V4CBZ9RuAgzktVjBBdsPp/s1600/caught-+U.S.+Capitol+Control.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhEMllG1EwhDSIlGFtOX7bS7OXBymWRz3rFVWgfEo-ava_rCW4zhIqqhmuOXcfShBwH0t1K3_jAXDmmsRk6YMRyIalLfMFqAEtTYlHWJy9vSTj-pccxnqbo_l8V4CBZ9RuAgzktVjBBdsPp/s320/caught-+U.S.+Capitol+Control.JPG" width="289" /></a>On the eve of our national elections many are pondering the role of government in their lives. We rely on our government for many of the basic necessities of life. I am grateful to never have gone to bed at night worried that I could be bombed. Likewise, the ability to turn on a tap and drink clean water is a privilege I take very seriously having lived for a year in Guatemala when younger. The roads I travel, the electricity I use almost constantly, the schools my children attend are all a result of my citizenship in this great country of ours. Additionally what makes our country great are the freedoms we are granted. I am free to pursue whatever path of education and vocation I desire. I am free to live wherever I want. I can write such a blog as this and not worry about voicing my opinion. That said, the delicate balance between taking care of its citizens and granting them freedom can at times be a tricky one to maintain. <br />
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Let me illustrate. As a country the freedom of being able to drive wherever we want is tempered by speed limits, stop lights, qualifications of sobriety, seat belts and the mandate to have car insurance. What may be viewed as protective laws by one could be construed as invasive antidemocratic abuses by another. Such debates and concerns are also being raised in regards to the health of the population.<br />
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There are many social, moral and even economic reasons to improve the health of our citizenship. A healthy society is a more productive society. Disease and disability is a significant financial drain on the government. Achieving health reaches in to all areas of government. More than delivering health care to the sick, health is fostered by reducing poverty, improving education and maintaining a safe water supply. Do we as a society have a moral obligation to care for the sick? What if it is illness that could have been prevented by healthier life styles? Who bears the burden of such choices? Those are not always easy questions to answer.<br />
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An obvious example is tobacco use. By now, I would hope that we all know the dangers of smoking cigarettes. I feel the government has done a good job of educating the public whether it be through packaging requirements, advertisements and to the youth in schools. I, myself, spend a fair amount of time educating about its dangers as well as encouraging patients to quit and assisting them do so. I have noticed, however, that the success of my efforts improves according to the price of a pack of cigarettes. More heed my words when there is an economic reason to do so. Is it right for our government to impose extra taxes on substances that degrade health? Before all you nonsmokers cry out, "Yes!," think of proposals to tax sugared beverages. How far can this be carried?<br />
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Is the health of our population the responsibility of society or the individual? Certainly, as stated above, our society has a stake in our overall health. Is it possible to legislate health? How is that balanced with the freedom of choice? Is it more important to safeguard the best interests of society or the freedoms we enjoy even if that means allowing the citizens to make choices may not be in the best interest of society? There is a movement afoot that is shifting the personal responsibility of health from the individual to his or her physician. In the past, we doctors, were viewed as personal healthy consultants. Advice is given to patients for healthy living all the time but the consequences rested solely on the patient. A diabetic patient who does not check blood sugars, does not follow a proper diet and takes the prescribed medication only sporadically, will suffer the consequences by developing the consequences of the disease. Society, however, is coming to the understanding that the cost associated with a poorly controlled diabetic is born not only by the individual but also by the insurance agency and those who must pay the premiums. <br />
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These agencies are now shifting the cost of the disease to providers. There is both a carrot and a stick approach. We currently are rewarded when a high percentage of our patients achieve measures showing good diabetic control. We lose that bonus when that number drops lower. It is pretty clear that in the future, reimbursement from insurance agencies will be dependent upon these markers and that doctors will have to give money back to these agencies if the population of patients they care for are not doing well. <br />
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I have chosen the term insurance agency very carefully. There are measures within "Obama Care," that encourage just what I have described. However, before, we cast a disparaging vote in regards to the tyrannical oppression of our government, I think it is important to realize that these ideas are being espoused and acted upon with insurance companies as well. Regardless of the outcome of this week's election, such measures will be enacted. I suspect that as a consequence, some patients will find it harder to find a doctor. Many physicians, tiring of the excessive regulations and now financial risk, are moving to non insurance models such as concierge medicine. In such a model the patients are back to assuming the risk for their own health. These are interesting times in which we live. Your health is assuming a bigger audience than you ever imagined. How we decide to cope with these issues as a society is likely to be debated for many years to come.Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-1841790664482087085.post-61239309306550041502012-10-28T17:20:00.001-05:002012-11-05T08:56:42.175-06:00The Glycemic Index<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg55LqHjZeE9jb8-iunjB2kPnUuH6_JnFS9ESBqfQZ_c3HtnLooKaXJQgB9y-VgBvU_NmVw7npVUw19hvDrLTbWej6yNtBUabHIovvTRi257fJjW0di1GfQl-y4m4SZHP3Kr8euHaGaY0Q3/s1600/glycemic+index+illus.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="282" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg55LqHjZeE9jb8-iunjB2kPnUuH6_JnFS9ESBqfQZ_c3HtnLooKaXJQgB9y-VgBvU_NmVw7npVUw19hvDrLTbWej6yNtBUabHIovvTRi257fJjW0di1GfQl-y4m4SZHP3Kr8euHaGaY0Q3/s400/glycemic+index+illus.JPG" width="400" /></a>This is a term used fairly frequently but is not often understood. Simply put, it is a measure of how much sugar gets into the blood stream for a given food. The scale is set by pure sugar, or glucose itself which is given the value of 100. Other foods are rated in comparison to it. Table sugar, which is sucrose, is composed of two glucose molecules bonded together. Therefore, on a per molecule basis it would have a glycemic index of 200. The glycemic index should also be viewed in the context of the glycemic load. This is the actual amount of sugar that one ingests.<br />
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Let me illustrate an example. A typical soda contains about 39 gm of sugar and has a glycemic index approaching that of pure glucose. Fruit also has a high glycemic index but the sugar found in fruits and vegetables is from a molecule that has one glucose molecule bonded to a galactose molecule. Only half of the amount of glucose is delivered to the blood stream as regular sugar. In addition, fruit has vitamins, fiber and water to go along with the ingested carbohydrate, all of which is healthy. A typical orange has 12 gm of sugar. It is unlikely that someone will eat three oranges at a sitting, but that is what it would take to equal the glycemic load of one soda. It is, therefore, important to interpret the glycemic index appropriately. I give my patients free range on the amount of fruits and vegetables they eat. Even my diabetics. It is hard to ingest enough fruit to cause any significant damage.<br />
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Apart from fruits and vegetables, the glycemic index can be very helpful. Most foods are fairly obvious. Starches can be a big source of dietary glucose. Potatoes, bread, rice and pasta need to be watched closely. Many breakfast cereals are quite high on the glycemic index. As a rule, the heartier grain, the coarser the starch, the better. Brown rice is healthier than quick, white rice. Seven grain breads are much better than processed white bread such as Wonder Bread. It makes sense. The harder it is for the body to digest the food, the less sugar gets delivered to the blood stream. <br />
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Now that you know the basics, head off to a <a href="http://www.health.harvard.edu/newsweek/Glycemic_index_and_glycemic_load_for_100_foods.htm">web site</a> and start looking up foods. There may be a few surprises for you there. Remember to keep it simple. Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1841790664482087085.post-70196414687465196522012-10-20T08:19:00.002-05:002012-11-19T08:44:40.887-06:00Harnessing Hay Fever<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjw8ZXo9nMwl8H2a2vkWAkN4E-30LB8CfeuCp5tac1Cfh7vAuGZ2V9c5dGq03H8YHBFFmhwEBHVw6x2aJVynpjsTiEv0xCmbhe-kXpEL0inFh-JN9qZIl6jR3IzW-9Mz7yKmgWcV6Zu6AEx/s1600/allergy.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="316" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjw8ZXo9nMwl8H2a2vkWAkN4E-30LB8CfeuCp5tac1Cfh7vAuGZ2V9c5dGq03H8YHBFFmhwEBHVw6x2aJVynpjsTiEv0xCmbhe-kXpEL0inFh-JN9qZIl6jR3IzW-9Mz7yKmgWcV6Zu6AEx/s400/allergy.JPG" width="400" /></a>The itchy eyes, sneezing, nasal drip and tickle in the back of the throat are all well known to sufferers of hay fever or "Allergic Rhinitis." What is not commonly understood is how fatiguing this condition can be as well. People suffer from allergies because their immune system recognizes a foreign substance (antigen) that usually enters the body through the nose and mouth. A primed immune system will bind that antigen by a histamine receptor to what is called a Mast Cell. The interaction causes the Mast Cell to release histamine into the blood stream, resulting in an immediate release of inflammatory products which trigger swelling of the lining of the nose, throat and eyes. This is what causes that runny nose and watery eyes. The work required to create this inflammation is very fatiguing. In fact, any medical condition that causes inflammation will cause fatigue. Sufferers of Multiple Sclerosis, Rheumatoid Arthritis or Chron's Disease know this well. In fact, it is very common for a patient with pneumonia to still feel fatigued weeks after the cough has gotten better.<br />
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Most sufferers of allergies do just that; they suffer through it. I'll admit that I am usually one of them. Keeping them under control, though, can help you feel more energetic and less miserable. Let me explain the different treatment options and the rationale for each so you can decide what is best for you. The most commonly used medicines are the antihistamines. This includes Claritin (loratadine), Allegra (fexofenadine), Zyrtec (cetirizine), and Benadryl (diphenhydramine) to name the most common ones. They block that initial triggering event discussed above. Logically, the sooner they are used, the better they will work. If you wait till you are full of fluid, they will keep your allergies from getting worse but they will not help for what you have already been exposed to. The horse is out of the barn in this case and it is too late to close the door. During a bad season it may be best to take the medicine on a daily basis. They can work quite well intermittently if given prior to an exposure. I have used them effectively prior to wood working, mowing the lawn or going to a friend's house who has a cat. The medicines are all available over the counter now and most have a generic form which makes them less expensive. The main draw back is that they themselves can be fatiguing. The least sedating is Claritin and Allegra, followed by Zyrtec. Benadryl is the most sedating. There are also antihistamine nasal sprays and eye drops. Those are not sedating at all but have to be used more frequently.<br />
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Nasal steroids reduce the inflammatory response from the histamine release. They can be used with or without the antihistamine. Since they are absorbed right in the nasal passage, almost none of the medicine enters the bloodstream, making them quite safe. The draw back to these medications is that many people do not like squirting medication in their nose and they are quite expensive. Thankfully, one of the best ones, Flonase (fluticasone) is now available in generic form. They do all require a prescription. If used daily over many weeks or months, the lining in the nose can become too thin and result in nose bleeds. Stopping the medication for 1-2 weeks will solve that problem. They do not work quite as well as antihistamine medications on an as needed basis. Many use them for a few weeks out of the year during a bad season.<br />
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Allergy shots are the most effective way of reducing long term symptoms. They induce tolerance in the immune system by introducing a small dose of antigen on a regular basis. Over time, the immune system becomes desensitized, similar to what happens with teenage boys when their mother speaks to them. The trigger is still there but nothing registers. There are some obvious drawbacks to injection immunotherapy (allergy shots). First, they are given by injection. Second, if the dose of antigen is too high, it can induce a more serious reaction in the whole body so they must be given at the doctor's office. Third, they have to be administered weekly for the first few months and then monthly for many years. The hassle factor can be a big impediment. Lastly, if you move to a new area, you have to start all over. The injections only work for the antigens in your current environment.<br />
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There are other possible ways to help your allergies as well. The simplest, of course, is avoidance. That may not always be the best course of action, however. There is some evidence that children born and raised in the city have more allergies than children born in the country. There is likely a critical age in the developing immune system where exposure induces tolerance rather than activation. The science behind this has not been completely worked out yet. Some have suggested that ingesting unfiltered bee honey can help. When bees return to the hive, they not only bring the nectar to form honey but also lots of pollen. The rationale is similar to that of injections but instead of sensitizing to very specific antigens, this would in theory sensitize to a more broad range of them. For this to work, it should be unfiltered honey from local bee keepers to make sure that the antigens are ones that exist in your own environment. There are likely many antigens that would not be covered by the honey, such as animal dander or dust. <br />
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I hope you find this informative. Thanks to Debbie for the requested topic. If you have specific questions that I did not touch, on please let me know.Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1841790664482087085.post-74586245011132071352012-10-14T10:15:00.002-05:002012-10-14T10:15:37.007-05:00The Right of Vice?<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiTAepH0ajAlHs2Cl_nGJAxaOte5aXVLGBS8mermiUbe2o9LFMGm3OfNl5Vcony0xrkpJT-0RDXkQu3xVuct7hlqRgm9QTFzIBmYI5mlbG7_Uc0iZHKB9SmGOeNNwasCqPgtWMxujsBm8na/s1600/bill+of+rights.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiTAepH0ajAlHs2Cl_nGJAxaOte5aXVLGBS8mermiUbe2o9LFMGm3OfNl5Vcony0xrkpJT-0RDXkQu3xVuct7hlqRgm9QTFzIBmYI5mlbG7_Uc0iZHKB9SmGOeNNwasCqPgtWMxujsBm8na/s320/bill+of+rights.jpg" width="300" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">The Bill of Rights</td></tr>
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<span style="font-family: Georgia, Times New Roman, serif;">A patient comment recently had me thinking of the Bill of Rights. It has been a little while since I took a government class so I decided to brush up on my history a bit. As you may remember better than I, the Bill of Rights references the first ten amendments to the Constitution, specifically outlining the personal rights and freedoms that our government guarantees. It ranges from the right of free speech, to the right to bear arms, including the right of a fair trial, to name a few. </span><br />
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<span style="font-family: Georgia, Times New Roman, serif;">The comment that sent me on my historical inquiry was, "Everyone needs a vice, right Doc?" It was in response to one of my encouragements to eat healthier. It was said so authoritatively, I thought that it must be included in the bill of rights. Now as I read through the list, the only one that might qualify is the eight amendment which reads, "Excessive bail shall not be required, nor excessive fines imposed, nor <i>cruel and unusual punishment</i>." I suppose many may feel that taking away their chocolate, soda, ice cream, beer or cigarettes may constitute "cruel and unusual punishment," but I don't think that was what the Founding Father's had in mind. </span><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEitIqgkfFMnZlYOfv3Wi4stNQTdYJLckwS4sHpqy1W55KJbhPA6UWIElOBI3uZNaRVNAvJl3-CItXcl-VrcZa_4ORTZYZBVReuETyM0dxRNpM8lCNtdIvD8X7k_0jgXbHgRjH3qLsTV5I6f/s1600/vices.JPG" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><span style="font-family: Georgia, Times New Roman, serif;"><img border="0" height="313" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEitIqgkfFMnZlYOfv3Wi4stNQTdYJLckwS4sHpqy1W55KJbhPA6UWIElOBI3uZNaRVNAvJl3-CItXcl-VrcZa_4ORTZYZBVReuETyM0dxRNpM8lCNtdIvD8X7k_0jgXbHgRjH3qLsTV5I6f/s400/vices.JPG" width="400" /></span></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Georgia, Times New Roman, serif;">What is Your Vice?</span></td></tr>
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<span style="font-family: Georgia, Times New Roman, serif;">According to one of my favorite sources of information (Wikipedia), vice is defined as follows:</span><br />
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"<b style="background-color: white; font-family: sans-serif; font-size: 13px; line-height: 19.200000762939453px;">Vice</b><span style="background-color: white; font-family: sans-serif; font-size: 13px; line-height: 19.200000762939453px;"> is a practice or a behavior or </span><a href="http://en.wikipedia.org/wiki/Habit_(psychology)" style="background-color: white; background-image: none; color: #0b0080; font-family: sans-serif; font-size: 13px; line-height: 19.200000762939453px; text-decoration: none;" title="Habit (psychology)">habit</a><span style="background-color: white; font-family: sans-serif; font-size: 13px; line-height: 19.200000762939453px;"> considered </span><a href="http://en.wikipedia.org/wiki/Morality" style="background-color: white; background-image: none; color: #0b0080; font-family: sans-serif; font-size: 13px; line-height: 19.200000762939453px; text-decoration: none;" title="Morality">immoral</a><span style="background-color: white;"><span style="line-height: 19.200000762939453px;"><span style="font-family: sans-serif; font-size: x-small;">, depraved, or degrading in the associated society. In more minor usage, vice can refer to a fault, a negative character trait, a defect, an infirmity, or merely a bad habit." </span><span style="font-family: Georgia, Times New Roman, serif;"><span style="font-size: x-small;"> </span></span></span></span><br />
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<span style="background-color: white;"><span style="line-height: 19.200000762939453px;"><span style="font-family: Georgia, Times New Roman, serif;">In this context, do we have the right to a vice? My answer to the patient and to you is "No!" What we do need are good habits. We need to set up routines that edify our body and soul, not tear it down. It has been shown that it takes on average twelve weeks to create a habit. When embarking on a new diet or exercise regimen, the first three months are the most critical. It is much easier to exercise when it is a foregone conclusion that has already been ingrained as opposed to a vigorous internal debate that has to be endured each and every morning. </span></span></span><br />
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<span style="background-color: white;"><span style="font-family: Georgia, Times New Roman, serif;"><span style="line-height: 19.200000762939453px;">We all have habits. Look at the ones in your life. Fortify the ones that make you stronger and eliminate the ones that hold you down, the vices. Rather than being constitutional guarantees; your vices guarantee declining health. Get rid of them!</span></span></span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1841790664482087085.post-60854691385056695552012-10-03T08:48:00.001-05:002012-10-03T08:48:25.925-05:00The Science and Art of Medicine<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj3Zo230pCkPb06ZS811tf6naO3NCchI4Jk00vrei-jZJW2EX2ySuAYf7wU6MO_dLc5JQOGBEpl8lLcJDAxbWDjxrOrUylDjhtkxQpFyVQZ6XaH1we4eRYH2SidTHJSLdcJp-wMq4YIzl6C/s1600/injection.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj3Zo230pCkPb06ZS811tf6naO3NCchI4Jk00vrei-jZJW2EX2ySuAYf7wU6MO_dLc5JQOGBEpl8lLcJDAxbWDjxrOrUylDjhtkxQpFyVQZ6XaH1we4eRYH2SidTHJSLdcJp-wMq4YIzl6C/s320/injection.jpg" width="320" /></a>Terrified, on my mother's lap, gasping for each breath. The doctor's office seemed a rather scary place to a seven or eight year old. I can remember hearing frightening words such as "admit to the hospital" or "let's try this shot." As poorly as I felt, I didn't even worry about getting the injection. I just wanted to feel better. I can't remember the pain of the shot but I can certainly remember my heart pounding nearly out of my chest. I had been given an injection of epinephrine (adrenaline). Even more terrified, I clung to my mother. My breathing slowly improved and thankfully I was able to go home. Though I am sure I had been in many before, this is the first time that I can remember being in a doctor's office.<br />
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A few years later I was in a different office. It seemed similar, though less terrifying than the first. I lay on the examining table on my back. The doctor placed vials of serum on my chest and then held my ankles. Somehow he could feel differences in my legs and would make notations in his chart. From this he concocted serum that my father than injected into me once a week to treat my seasonal allergies (no, he is not a physician and yes, it was terrifying). I was not a happy patient. I had no trust in this homeopathic doctor's evaluation and resented each shot. To this day, my mother is convinced that it helped us even in the face of the rude quacking noises coming from her sons' mouths. <br />
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These two experiences of mine illustrate a common occurrence in the practice of medicine. As much as we have learned about the human body and how it functions, there is much we do not know. Even in the face of accurate knowledge we often lack adequate treatments for some conditions. That adrenaline injection I received is no longer considered to be an acceptable treatment for asthma. Thankfully, the science has progressed, and the treatments have gotten better, less toxic and more efficacious. The second treatment I received may still be offered in some corner of our society but has fallen out of favor. Such treatments are not studied nor evaluated. Therefore, there is no improvement. They are discarded only to be replaced by some other theory. I have little patience for proposed treatments that claim they offer something "your doctor doesn't want you to know about," claiming a conspiracy theory between scientific medicine and the pharmaceutical companies. If someone comes up with a valid proposal, it will stand up to the rigors of scientific investigation. Refusing to study such treatments is tantamount to snake oil in my eyes.<br />
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I am not suggesting that only FDA approved medications should be used in the treatment of health conditions. If you have read my previous posts, you know that I am all for avoiding medications through healthy habits. Regular cardiovascular exercise has been studied extensively and has found to be beneficial over and over again. It is getting people to actually make such a habit that is difficult. Being able to show patients the studies that support my claims helps me to make my point. One of the favorite parts of my job is eliminating a medication due to a patient having changed his or her behavior. Seeing people lose weight, stop smoking and drop their cholesterol or blood sugar values is very fulfilling. Writing prescriptions to treat chronic conditions that could be otherwise controlled, if a patient would just change their life style, is frustrating. <br />
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I am grateful to be in a profession that forces me to keep learning. We still have many inadequacies as a profession, offering "adrenaline" type treatments with the hope that better alternatives are on the way. As much as we learn and as advanced as our treatments become, though, it is important not to lose sight of the basic tenets of good health. Nothing will ever substitute for eating a healthy diet, getting plenty of regular exercise and keeping our stresses in check with balanced living. Remember, keep it simple.Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1841790664482087085.post-20927850552938042642012-09-23T06:58:00.001-05:002012-09-24T13:04:38.287-05:00My Balancing StickI have hit a lag in my posting. I appreciate all of you who have noticed. Sometimes it is hard to know if it is being read. Part of the reason for my lag is that I am running out of ideas. I would love some feedback. What would you like me to discuss? I have had one request for migraines, so I will be thinking about that topic. Another reason for my lag is due to a consuming project that has been taking up almost all of my free time for the last six weeks. In fact, it is the topic of this post. <br />
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The premise for "Simply Healthy" is just that, to keep health simple. My four pillars are watching what goes in, to keep moving, maintaining balance and to ask your doctor about the rest. I haven't touched too much on maintaining balance and will do so today. As I talk to my patients and ask about their lives I have come to appreciate that we all have stress. It comes in different forms. It may be family related, work related, money related and often healthy related. We all have times when it is worse than others. How we manage it makes all of the difference. Taking our mind off of the cause of our stress is essential. Exercise is one of the best ways of doing that. Another great way is to have a hobby or special interest. Mine turns out to be wood carving.<br />
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As a young boy scout I was introduced to "whittling." I loved using my pocket knife to make spears and arrows. Making a chain out of a stick was more difficult but quite rewarding. I never thought about doing more until about eight years ago when I decided to try and carve the nativity scene on a walking stick. It was my first attempt to carve a human form. I got hooked after that. I started to find myself looking at arms and legs in a new way, paying extra attention to where the muscles came together and fit in with the body. I would look at all the noses that came my way to try and decide which one I would use on my wise man. At first, I used a simple exacto knife. I finally found a friend who also carved and he introduced my to "real" tools. I started to collect not just knives but gouges, and bits to fit on my rotary tool and an electric chisel. When I am working on a project my whole focus is centered on that piece of wood. It is a great way to take my mind off of the stress of work. I love the feel of the grain and get great satisfaction when a piece turns out well.<br />
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My recent project is for my wonderful parents. They recently completed fifty years of marriage. We have four children in our family. Each of us are married and we all have four children. My oldest child married this April so that makes a total of 27 people in our family. About a year ago I decided to carve something for my parents but couldn't come up with an idea. One night I literally woke up with the idea for my project. A verse in the fifteenth chapter of John came to mind where Jesus declares, "I am the vine and ye are the branches." I envisioned creating a walking stick with vines wrapping up the stick, each leaf representing a member of our family. I love working with cedar which has a red inner core. I thought the stick would look great if I carved down to that red core and making the branches and leaves out of the outer white wood. This symbolizes our family, tied together, centered on Jesus Christ. With that in mind, I went out in the woods on my in-laws property and found a cedar tree that had been knocked over but was still alive. I cut it down, sawed off the many branches and stripped the bark. I let it sit in the basement for about six months prior to working on it. I decided that I wanted each leaf to be centered on one of the knots in the wood, which would tie it to the red core. I traced out my leaves and vines, counting over and over to make sure I had all twenty seven of them on the stick. I would like to say the project then started in earnest but I didn't do much on it for many months after that. I tend to work better when I have a deadline. As the summer approached and the anniversary date started getting near I got more serious about the project. At times in the beginning I nearly gave up on it, feeling it wasn't turning out as I had envisioned it but I kept at it, modifying the details as I went along. <br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgRRRcsJKqyWKqN2jqKHW9sTPEu8qa3uApC1QgY9pALOLubc4_fnf_3-dxH2c7CabxmLbb9_P0EVHTylhQFEgxNljuV0AzBDWbVYSGTLexKQutrPL8UU2QBCw29BOxGjS0jqG4LkhWh_5AD/s1600/stick.jpeg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgRRRcsJKqyWKqN2jqKHW9sTPEu8qa3uApC1QgY9pALOLubc4_fnf_3-dxH2c7CabxmLbb9_P0EVHTylhQFEgxNljuV0AzBDWbVYSGTLexKQutrPL8UU2QBCw29BOxGjS0jqG4LkhWh_5AD/s320/stick.jpeg" width="320" /></a>I took it to every outside event that I went to, using the time at camp-outs, soccer games, and cross country meets to work on the project. Several weekends ago, in its nearly completed stage, I took it to a scout retreat. I was mostly sanding at this point. Being around hundreds of scouts and leaders, many of whom had made walking sticks in the past, made me feel like a rock star. I was pleased to see the response of those that wanted to see it and ask about how it was made. The final task was the most rewarding of all. After finally completing the many hours of sanding it down to a smooth sheen, I applied teak oil to the wood. As I had hoped, it made the red core jump out of the wood, bringing out the grain and the knots. I love how it turned out. <br />
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I know that this is not too "medical," but thought that many of you would enjoy seeing and hearing about my project. It truly is a stress reliever. We all need to have a stress relieving outlet besides the television set. If you are feeling overwhelmed by life, pull out that old guitar, paint brushes, knitting sticks or whatever else it is that you love to do but may have put aside for awhile. It is not just good for the mind, it is good for our health. Unknownnoreply@blogger.com6tag:blogger.com,1999:blog-1841790664482087085.post-28028666004644313962012-07-24T11:21:00.000-05:002012-07-25T19:25:08.670-05:00Safe in the SummerWe work all year long, saving our pennies to go on that family trip. This is the time of year when we break with routine, let loose and just have fun. We may not be thinking of our health when we are packing our suit cases and on our way but we all have likely experienced a vacation gone bad due to illness. This week I offer three simple suggestions to ensure a healthy happy vacation.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjuNrSiDk7P5UlwPSt6YjUly9xV8MdfHpj3xrwETfpn1BS26xhWQJyLw3R2hxfupVfAVnpesvNbWNlkpgaaP-fyi8tu8cnRm6Kxi887LzHMXQY0LN0NjHK3CEmRhrcQuMftcJRqdGRmeeHD/s1600/sun+screen" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="270" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjuNrSiDk7P5UlwPSt6YjUly9xV8MdfHpj3xrwETfpn1BS26xhWQJyLw3R2hxfupVfAVnpesvNbWNlkpgaaP-fyi8tu8cnRm6Kxi887LzHMXQY0LN0NjHK3CEmRhrcQuMftcJRqdGRmeeHD/s320/sun+screen" width="320" /></a>First is likely the most obvious. Beware of the sun. Many of us spend a great deal of time inside all year long. We work in offices, not fields. Our body is not used to the sun. I have seen my son turn into a swollen red lobster before my eyes. He is old enough to give him the tube of sun screen and allow him to take care of himself. Too often, the excitement of the beach, mountains or other activities overwhelms him and he doesn't take the time to prepare. No, we don't need to use a truck full of sunscreen but it really does work. Preparing before hand is helpful as well. Plan to be outside on the weekends at least. Some sun exposure is good and needed. I do not recommend tanning beds. <br />
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It is not just the sun's rays that can affect us. It's heat can cause us to dehydrate through sweat and evaporation. Out of our routine, we usually do not drink as much precisely at the time when we need to drink more. I find it interesting that the time of year with the highest rate of kidney stones is September and October. The reason is that it takes on average three months for a stone to form and those who don't drink enough water in the summer time pay the price in the fall. If you travel by plane, bring an empty water bottle with you. Fill it up when you get past security. If you will not be near a drinking source, make sure you plan to bring plenty of water with you. Staying well hydrated will keep your energy level up, prevent headaches and muscle soreness.<br />
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One of the most common reasons I see patients in my office after they have been on vacation is for foot pain. Many spend a lot of time on the feet when on vacation. Make sure that you are preparing before you leave. It is just one more good reason to stay active and to exercise. Make sure you bring footwear that will help, not hurt. If you are staying at a place that has a freezer, take one of those water bottles mentioned above and freeze it. When you get back at the end of the day, roll your feet over the bottle on the floor. It will help cool off inflammation and stretch out the tissues in the feet. <br />
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Have a great summer time. Hopefully by taking a few minutes to prepare for the sun, by staying well hydrating and by taking care of your feet you will be able to both enjoy your vacation without having to pay unnecessary consequences later.Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1841790664482087085.post-15974581865089379092012-06-23T14:57:00.002-05:002012-06-23T14:57:27.954-05:00What's Your Number?<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgzRY2jx-toMpkCpVr3sgrBYdtfujENtDsBVSUMsmdQU0bSGuOy0uH1pTsXHo5m7NTfr8rgFlgyrbCEyuG4j-w_qozBtoEM9LFPxhXhxPJ3UMz1Nu18_U8pcwGuP6mC5cswKXj1viJYhk81/s1600/Triathlon.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="243" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgzRY2jx-toMpkCpVr3sgrBYdtfujENtDsBVSUMsmdQU0bSGuOy0uH1pTsXHo5m7NTfr8rgFlgyrbCEyuG4j-w_qozBtoEM9LFPxhXhxPJ3UMz1Nu18_U8pcwGuP6mC5cswKXj1viJYhk81/s320/Triathlon.jpg" width="320" /></a>I participated in a sprint triathlon today at Innsbrook, here in MO. It was a beautiful day, sunny and warm and not too hot. What a blessing! I had some time to think during the race and came up with a few questions. All of the participants in the race are marked with two numbers. One is the race number we are registered under. The other is our age, on the back of the left calf.<br />
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The first number doesn't say much to a general observer, other than how committed we were to the race. The numbers are ordered by when we signed up. I was number 595. There were only about 610 participants, so that tells everyone that I committed to this race quite late in the process. The other number seems to garner more attention. It is our age. The race is started in several heats or waves according to age and gender and which course is being competed in (there was a long and a short course). The start is in the lake swimming. No one is really paying any attention to the numbers of others in the water. Most of us are trying to just not drown. However, on the bike and on the run portion of the race most of us will glance at the person's age that we are passing or who is passing us. <br />
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I notice that if I am passed by a man with a 55 on his leg, I tend to push a little harder and try to stay up with him. I don't pretend that I am going to win the race, but I would like not to be passed by someone older than myself (though that did happen twice today!). Here's my question: If we all walked around with our blood pressure and cholesterol numbers on our forehead, would it change our behavior? I think it is worth a thought or two.<br />
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Many of us are rather competitive at heart, but not all. Some tend to be more fatalistic and feel that it is all out of their control. It doesn't really matter what someone else's numbers are, does it? I guess if that other person were a loved one we might be more inclined to try and assist and support them if we saw that they weren't so good. Would seeing other's numbers spur us to better habits? It might. The most obvious benefit to me is that it would ingrain in all of us what the normal ranges are. I know what they are but I do this for a living. I deal with these numbers every day. These are numbers we should all know. It is most important to know our own numbers but it doesn't do much good to know just one number without having a value attached to them.<br />
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Here are the ranges:<br />
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Optimal Borderline Bad<br />
B/P: <130/80 130-140/80-90 >140/90<br />
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Cholsterol:<br />
Total <200 (depends on the breakdown though)<br />
HDL (good) >45 35-45 <35<br />
LDL (bad) <130 130-160 >160<br />
LDL (for those with diabetes or heart disease:<br />
<70 70-100 >100<br />
Triglycerides <150 150-200 >200<br />
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So look at these numbers closely. What are your numbers? If you are not in the optimal range, talk to your doctor about how to improve them. In the race of life we win by being healthy. We can all be winners. It is easy to get discouraged. One of the greatest things about participating in a triathlon is that there are many spectators who cheer loudly for all of the participants. It really gives a boost. Let's all cheer for each other. Don't give up if you are discouraged. Keep running and keep trying. Your health is worth it.Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1841790664482087085.post-3819747183512446972012-06-20T16:41:00.002-05:002012-06-20T16:41:54.982-05:00Super Size This!We live in a day of convenience and ease. Have you ever seen the process our pioneer fore bearers went through to just make soap? It took about a week of stirring pot ash over a fire, separating impurities and repeating the process over and over. Think about the work to eat a piece of bread. The wheat was often grown by the family itself. Fields had to be seeded, crops had to be cut. The grain was taken into town to be milled into flour. The rest of the ingredients had to be procured. The dough needed to be kneaded and allowed to rise. The oven had to be heated by a fire until the correct temperature was achieved. We don't even think twice about such things now. We walk down an isle, plop items in our cart, wave a piece of plastic and go on our merry way. <br />
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Not long ago, most professions in our country required physical labor. This is not the case any more. Even farmers are not as active as they once were. Vast tracts of land can be plowed from an air conditioned cab on large equipment. A farmer patient of mine recently told me that in ten years he suspects that most farms will be worked by unmanned equipment. Many of us spend a large part of the day sitting in front of a computer screen. Our cars take us right to the doorstep of almost any destination. If we have to walk more than 100 feet after parking, we get cranky. I know because I hear it from my patients all the time.<br />
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My point is this, most of us cannot live our lives and expect to be active enough to stay healthy. Obesity is a huge problem world wide and especially in our country. My patients ask for pills and hope beyond hope that the latest dietary supplement will truly help them lose weight. I talk to them about diet and exercise and most people recognize that what I am saying is correct. It is one thing to know it; it is another to do it. Let me share with you, two ways to view your day to maximize your health.<br />
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First of all, you must move. The reason why we eat is to provide fuel for our muscles. If we don't use our muscles, there is no reason to eat. Here's my offer: you only have to exercise on the days that you eat. Now of course we all eat every day, but every time you open your mouth for a bite you should think about how much activity you have done for the day. I have a daughter that was a swimmer up to and all four years of college. While in training, I have seen her and her friends eat more calories than I can imagine eating myself. That is OK, they needed those calories. Conversely, I have seen her bypass a dessert, saying "I didn't swim today, I can't eat that." She has figured out that we must earn every bite that we take.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhgY3KUzV9Ka6idGwVGESK9WwVeOCEBmVE3GAh77lWYVpTQ3hBqsw9Y6axM0GrWJDXHE39VLQa3leXzb8F0jWYBpNbjcz2LtZRfy2PNwzFMgp4oYxPZHYtUhFns5VJ1_7ciiwKsdzaI8rk3/s1600/Super+Size" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="390" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhgY3KUzV9Ka6idGwVGESK9WwVeOCEBmVE3GAh77lWYVpTQ3hBqsw9Y6axM0GrWJDXHE39VLQa3leXzb8F0jWYBpNbjcz2LtZRfy2PNwzFMgp4oYxPZHYtUhFns5VJ1_7ciiwKsdzaI8rk3/s400/Super+Size" width="400" /></a></div>
The last point I want to make is this: eat all the fruits and vegetables you want. Even if there was no exercise in your day, you can sit down to an all-you-can-eat buffet with fruits and vegetables for all three of your meals. No one ever died from super-sizing their fruits and veggies. It is recommended that we get 4-5 servings a day. Not a week, a day! More is even better. Use it for a snack. A banana or other piece of fruit in the morning is a great way to start your day. A salad will often be 2-3 servings of vegetables. If you get the munchies before bed, eat a few grapes. Sure it takes more effort to buy the fruit. I know that it is more expensive, but it is worth it. Go ahead, super size it!Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1841790664482087085.post-14107869480387014832012-06-10T22:18:00.000-05:002012-06-10T22:18:39.913-05:00The Hippocratic Oath for You<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhdxDwPqLGcJRtN0GyQ5p6hLQvgyMUltH3wczfZb5uzOWTCOS3VSValI6xcX5FNmBqMqkpSZKjJNJFgQzbgyn7JlSzsvrJ2-snx8A-1om9fRHigbapwwU22rvuIeSDDK6DDLKKoaoPHOf85/s1600/Hippocratic+Oath" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhdxDwPqLGcJRtN0GyQ5p6hLQvgyMUltH3wczfZb5uzOWTCOS3VSValI6xcX5FNmBqMqkpSZKjJNJFgQzbgyn7JlSzsvrJ2-snx8A-1om9fRHigbapwwU22rvuIeSDDK6DDLKKoaoPHOf85/s320/Hippocratic+Oath" width="310" /></a><span style="font-family: Times, 'Times New Roman', serif;">It is customary for medical school graduates to take an oath as they graduate from school and enter the profession of medicine. This practice stems from Hippocrates, widely consider the father of western medicine. There are many facets of the oath ranging from answering to deity, providing free medical education, practicing confidentiality, not working beyond our expertise, proscribing abortion and avoiding personal relationships with patients. The most widely known tenant is in regarding doing no harm. The original version states:</span><br />
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<span style="background-color: white; color: #333333; font-family: Arial; font-size: 14px; line-height: 17px;">I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice (<a href="http://www.pbs.org/wgbh/nova/body/hippocratic-oath-today.html">www.pbs.org</a>).</span><br />
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<span style="color: #333333; font-family: Times, 'Times New Roman', serif;"><span style="line-height: 17px;">I recently saw a patient who told me she was trying to apply the Hippocratic oath to her own body, meaning she was trying to first, do no harm to her body. As I thought about that concept, it sat rather well with me. I spend much of my day as a physician preaching the admonition to first do no harm and second do your body right. </span></span><span style="color: #333333; font-family: Times, 'Times New Roman', serif; line-height: 17px;">Harm comes in many forms. The human body is an incredible organism capable of self repair and growth. For most of us, if we give it the chance to work right, we will have the means to live a long, healthy life. If the body is forced to deal with self inflicted damage, it's defenses will wear down and it won't have as much energy to spend on normal processes to keep the body going strong. </span><br />
<span style="color: #333333; font-family: Times, 'Times New Roman', serif; line-height: 17px;"><br /></span><br />
<span style="color: #333333; font-family: Times, 'Times New Roman', serif; line-height: 17px;">The easiest form of harm to conceptualize comes from that which we ingest. This ranges from that which we eat as food, the medicine that we take and the supplements that we consume. I have discussed all of these previously in earlier posts (see categories: watch what goes in). Illicit drug use, cigarette smoking and alcohol consumption are the most important toxins to get a handle on. Each is truly a poison and will only lead to harm. Other chemicals such as caffeine and artificial sweeteners are less dangerous and not as well understood but should be avoided or limited at least. The more food we eat off of bushes, picked from trees or dug out of the ground, the better off we will be (God's food). The less processed food (that which comes out of cans, boxes and wrappers) we consume, the less toxins we have to process (Man's food). Keep it simple and keep it healthy. </span><br />
<span style="color: #333333; font-family: Times, 'Times New Roman', serif; line-height: 17px;"><br /></span><br />
<span style="color: #333333; font-family: Times, 'Times New Roman', serif; line-height: 17px;">Harm also comes in the form of exposure to infectious diseases. Those we do not follow safe sexual practices may harm themselves for the rest of their lives. Good hand washing skills are important to limit exposure. Simple measures such as coughing into the crook of one's elbow instead of the hand may not keep us from being ill but it may for our close contacts. Using helmets on bikes and motorcycles and seat belts in cars can be life saving. Being smart about sun exposure and using sunscreen is another simple measure to avoid harm. </span><span style="color: #333333; font-family: Times, 'Times New Roman', serif; line-height: 17px;">We can do harm to our bodies by getting too little sleep. Stress, likewise, can adversely affect our health. </span><br />
<span style="color: #333333; font-family: Times, 'Times New Roman', serif; line-height: 17px;"><br /></span><br />
<span style="color: #333333; font-family: Times, 'Times New Roman', serif; line-height: 17px;">Lastly, there is sometimes a need to experience short term harm for beneficial long term effects. Avoiding a prescribed medication due to possible side effects, while ignoring a serious health condition can cause serious harm in the future. Exercise also falls into this category. Muscles and bones get stronger, only after first being broken down, thus the adage, "no pain, no gain." Again, our physical body is a marvelous structure. You are the steward of this great gift. Will you take the oath? Will you accept the challenge? First, do no harm.</span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1841790664482087085.post-58785808748530575022012-06-01T12:57:00.000-05:002012-06-01T12:57:59.693-05:00Using "E-Cigarettes" to quit smokingAs part of my duties as a volunteer teacher at Washington University, I periodically have medical residents (doctors in training) spend a month with me at the office. I have been fortunate to have Dr. Seema Mahale with me this month. She will be entering the practice of medicine in a few weeks and has been wonderful to work with. I invited her to write a post for my blog. She graciously accepted. I hope you enjoy!<br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjj0Rp-cFJB21PPEeH4Hmf3IjqcRLS96fbjlZaO1JyFWY_jGbe_v2mk3veoVOFjizsQRJ4nyWyTN4IQj7Ib9MV1UP7k7758A9-RIzB_ARUNPR0zX7KbZWNpw1Hka_tm7GuH6XdipQnnEh2p/s1600/electronic+cigarettes+200+PPI++5-30.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="282" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjj0Rp-cFJB21PPEeH4Hmf3IjqcRLS96fbjlZaO1JyFWY_jGbe_v2mk3veoVOFjizsQRJ4nyWyTN4IQj7Ib9MV1UP7k7758A9-RIzB_ARUNPR0zX7KbZWNpw1Hka_tm7GuH6XdipQnnEh2p/s320/electronic+cigarettes+200+PPI++5-30.jpg" width="320" /></a><br />
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Dr. Mahale's post:</div>
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As I was walking by a kiosk at the mall, I was approached by
a salesperson selling E-cigarettes.
While I didn’t buy into the man’s pitch that I will look very
sophisticated and cool with an e-cigarette, I couldn’t help but wonder if and
how this new device could be used to help people stop smoking. </div>
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First I needed to find out how e-cigarettes work. It turns
out there are several different styles available, but the main idea is there is
a network of metal filament heated by a rechargeable power source that heats a
liquid reservoir. A vapor then is created that the user can inhale. The liquid
is made up of water, flavorings and nicotine. </div>
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Unfortunately, there have not been many studies done to see
the potential beneficial use of E-cigarettes and there are differing opinions.
The FDA looked at many different brands of E-cigarettes and studied the
content. They found there were traces of tobacco specific impurities that are
associated with adverse health effects. Their report also notes there is no way
to predict the amount of nicotine actually delivered when inhaled. The FDA also
feels E-Cigarettes may even promote younger generations to start smoking since
it is a new device. Based on this, the FDA does not feel E-cigarettes can be
used for smoking cessation.</div>
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However, a small study done by Boston University School of
Public Health found that E-cigarettes are much safer than real cigarettes.
While E-cigarettes do contain carcinogenic components, the amount is 1000 time
less than real cigarettes. The study goes further to suggest that E-cigarettes
can be used as an aid to stop smoking as it mimics motions that one does while
smoking. </div>
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There is no doubt that smoking is bad for you. It increases
the risks of several disease such as cancer most notably lung cancer, heart
disease, emphysema and poor circulation. However, it is very difficult to stop
smoking, as it is one of the most addictive substances available. Therefore, I feel it is important for one to
realize all the different modalities available to help kick the habit. Some combination
of counseling, support from family and friends, medications (such as Chantix
and Wellbutrin), and nicotine replacement (patches, gums, etc.) are needed for
one to be successful to be become smoke free. </div>
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I feel E-cigarettes can help people stop smoking and most
importantly by using E-cigarettes people are not exposed to such harsh
chemicals. The bottom line is a person should pick the method that works for
them the best. While it may take multiple attempts, quitting smoking is the
most important things you can do for your health. </div>Unknownnoreply@blogger.com5tag:blogger.com,1999:blog-1841790664482087085.post-7691450965811395552012-05-27T19:53:00.000-05:002012-05-27T19:53:21.467-05:00In Memory..<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh7MnenPSxr2rwGbWl5PRmiErp6CT9m577R_LMdhdCHZ8xG0prn1-m8tAqK5bOL4usJlsU9fIWf_qhDpXyMm3ykeJ7TfqOEE5AtoSBvCNFsivx-xx1KeKeLHEJ1XwPCZ7JAa0OMdfZB3yP6/s1600/loved+ones+illustration" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="392" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh7MnenPSxr2rwGbWl5PRmiErp6CT9m577R_LMdhdCHZ8xG0prn1-m8tAqK5bOL4usJlsU9fIWf_qhDpXyMm3ykeJ7TfqOEE5AtoSBvCNFsivx-xx1KeKeLHEJ1XwPCZ7JAa0OMdfZB3yP6/s400/loved+ones+illustration" width="400" /></a><span style="font-family: Georgia, 'Times New Roman', serif;">As hard as I work, as hard as I study and learn, as much as I want to do what is best for my patients I know that every last one of them will die. Does that make my efforts futile? Of course not. Promoting good health enhances life now, each and every day. It helps us function well in our older years. It is not my goal as a physician to make some live as long as absolutely possible but it is for them to live as well as possible. There comes a time when added minutes and days do not add to added quality of life. Even when we understand that a love one is suffering and lingering, it is still hard to say goodbye. It is in these heart gripping moments when we achingly say goodbye to the ones we love that we grieve the most. These goodbyes are especially hard when life is cut short unexpectedly. Grief may turn to despair and even depression. While we must go on with our own lives, I am grateful to have a day set aside to reflect on those who have passed before us, a time to celebrate the memory of their lives and the impact they have had on our souls.</span><br />
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<span style="font-family: Georgia, 'Times New Roman', serif;">As a physician in training, I always figured that as I became more experienced, handling the death of my patients would get easier. Having now been in practice nearly fifteen years, I can testify that the opposite is true, it is exceedingly more difficult. To sit at the bedside of a patient that is now a dear friend, look them in the eye and say good bye for the last time is heart wrenching. To be someone's physician is an honor and a privilege. I always hope to say goodbye with no regrets, having done the very best that I could. </span><br />
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<span style="font-family: Georgia, 'Times New Roman', serif;">As difficult as it is to say goodbye as a physician, I recognize that it is immeasurably more so as a family member. Even when the loved one is clearly suffering, their departure leaves a void in our lives. My own personal belief in a God and of the resurrection takes the sting out of death to some degree. I am not sure how I would feel without such beliefs and am grateful for them. Dr. Russel M. Nelson, a notable cardiothoracic surgeon, now a leader in my church recently said the following,<span style="background-color: white;"> "<span style="color: #2f393a; font-size: 13px; line-height: 18px;">If the body’s capacity for normal function, defense, repair, regulation, and regeneration were to prevail without limit, life here would continue in perpetuity. Yes, we would be stranded here on earth! Mercifully for us, our Creator provided for aging and other processes that would ultimately result in our physical death. Death, like birth, is part of life" (<a href="http://www.lds.org/general-conference/2012/04/thanks-be-to-god?lang=eng">April 2012</a>). </span><span style="color: #2f393a; line-height: 18px;">Granted, it would be easier if God would just take us up in a twinkling of an eye, but that is not the way of life. There are lessons to be learned at the end of life, both for those who leave as well as those left behind.</span></span></span><br />
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<span style="font-family: Georgia, 'Times New Roman', serif;"><span style="background-color: white;"><span style="color: #2f393a; line-height: 18px;">I would, therefore, like to pay tribute to my dear friend, patients, who I have grown to love and are no longer with us. Each in his or her own way has taught me life lessons. I am grateful to have been their physician and hope that the happy memories of their lives will sustain their loved ones who still miss them dearly. Happy Memorial Day!</span></span></span><br />
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<span style="background-color: white;"><span style="color: #2f393a; line-height: 18px;"><span style="font-family: 'Trebuchet MS', sans-serif;">Editor's Note: I would like to acknowledge Daniel Pearlmutter, a patient friend and professional illustrator who graciously offered to provide the art for this post. I am thrilled that he has taken an interest in my blog and know that you will enjoy his work.</span></span></span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1841790664482087085.post-24255689893291123492012-05-21T17:00:00.001-05:002012-05-21T17:00:03.054-05:00Family Heroes<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjC-CjkZkb-95j7Nb38o-f0eQGVRVl1Lmi_z6WgnS0xi-LF2tl3pZAJv7WqR81QMMQYc-aaFKB__epZt_09NGAyWzG1vFK_AwQLyEPUJzbb4qqj7-OxflFUpVqcUzDF4wWU0SH66p7cGePt/s1600/care-of-elderly.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="178" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjC-CjkZkb-95j7Nb38o-f0eQGVRVl1Lmi_z6WgnS0xi-LF2tl3pZAJv7WqR81QMMQYc-aaFKB__epZt_09NGAyWzG1vFK_AwQLyEPUJzbb4qqj7-OxflFUpVqcUzDF4wWU0SH66p7cGePt/s320/care-of-elderly.jpg" width="320" /></a>As a teenager, it was common for me to come home to having a grandparent in the house. Both my father's father and my mother's mother spent time with us toward the end of their lives. When I was nineteen years old, I lived for a year as a missionary for my church in Guatemala. A severe knee injury cut short my time with the wonderful people I grew to love there. I returned home to have my anterior cruciate ligament repaired. My mother talked Grandma into coming to stay with us by saying that I needed her there to nurse me back to health. On my first day out of the hospital she told me of being a young woman and working as a nurse's aide at the local hospital. Sponge in hand, she scrubbed me, telling me how she had been taught to "wash down as far as possible, then wash up as far as possible, and then washing possible." I grabbed her hand and said, "Grandma, I'll take care of possible." As Alzheimer's Dementia would later rob her mind of memories, I cherished the times we spent together. Later, coming home from college, she loving looked at me and declared, "I used to know you!" Her overall concern was that she did not want to be a burden to her family. She spent time with all four of her children. The bond and memories with Grandma was more than worth any burden caused by her care. <br />
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My grandfather also spent time with us. Towards the end of his life, heart failure sapped his strength. Ultimately he was done in by a fall which resulted in a subdural hematoma-bleeding around the brain. He became too much to handle for my parents alone and ultimately spent his final days in a nursing home. It was a difficult decision to make. The care received at the end of life is a decision that affects generations. I have an elderly couple in their mid 90's. The wife has Alzheimer's and the husband has been weakened by aspiration pneumonia and a blood clot to his leg. They became too frail to live on their own. An attempt to live with a daughter in a far away western state resulted in agitation and delirium. The decision was made to bring them back to their home and their granddaughter now oversees their care. She works full time during the day and spends every night with them. The family has hired care givers during the day. This loving granddaughter is spelled by her husband on the weekend. I am amazed by her dedication. I have no doubt that they have received better care than they would in any institution.<br />
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Family heroes come in many shapes and sizes. Another patient of mine is a widow with no children of her own. Her mind has slowly slipped, though she is loathe to admit to any problem. She saw her husband decline from Alzheimer's and is terrified of having the same happen to her. Her nephew has taken it upon himself to direct and guide her care. He persists patiently despite my patient's unwillingness to admit to needing any help. <br />
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I feel strongly that our society is blessed by generations living together and spending time together. Benefits are seen not only to the elderly in need of assistance and care but also to the youth who are able to get to know their grandparents better. Nursing homes will always be needed to provide care that can not otherwise be given. I want to salute those who stand up and take on the challenge of caring for loved ones. They are healthcare heroes Who are your family heroes? Share with me your stories.Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-1841790664482087085.post-32898502036995598192012-05-13T15:52:00.004-05:002012-05-13T15:52:50.886-05:00Fact or Fiction: High Cholesterol-Part 2<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiCSlMFXAD34PA77wYI1RypApYkEZjCXHKX7MQfbhoRJ8G9sMnU0FeQMEWgiNGB5Cn76gudKVuXSdSIA4IEC0qQ3n_UofOoVxgFZVv4k0jEV76ks87Zd-L89oAttxLoYLBadsjdzUFd2WKZ/s1600/images.jpeg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiCSlMFXAD34PA77wYI1RypApYkEZjCXHKX7MQfbhoRJ8G9sMnU0FeQMEWgiNGB5Cn76gudKVuXSdSIA4IEC0qQ3n_UofOoVxgFZVv4k0jEV76ks87Zd-L89oAttxLoYLBadsjdzUFd2WKZ/s1600/images.jpeg" /></a><span style="font-size: x-small;">"I was in for my annual physical two weeks ago and the letter you sent me said that my cholesterol reading had increased from 210 to 216 over the last year. You said you wanted me to come back in 6 months to get retested. My questions are:<o:p></o:p></span></div>
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<span style="font-size: x-small;">1. I take one 900 mg fish oil tablet a day - would it be beneficial to double that?<o:p></o:p></span></div>
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<span style="font-size: x-small;">2. Some of the "natural" remedy information indicates that cinnamon tablets are helpful - any thoughts on that?<o:p></o:p></span></div>
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<span style="font-size: x-small;">3. My wife wants me to take "Cholest-Off" which is advertised as an all-natural means of reducing LDL numbers - would that be worth trying?<o:p></o:p></span></div>
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<span style="font-size: x-small;">4. Any thoughts on the Juice Plus program and if that might help?<o:p></o:p></span></div>
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<span style="font-size: x-small;">5. I eat a fair amount of peanut butter at lunch and drink 2% milk most nights for dinner - is that a problem?<o:p></o:p></span></div>
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<span style="font-size: x-small;">I am eliminating or reducing my favorite vices - brats and ice cream sandwiches - probably a good thing no matter what my cholesterol number is." Name Withheld</span><br />
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The last post described what cholesterol is and how it can be damaging. I want to go back to this email and discuss some of the issues that were brought up. <br />
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Let's start with fish oil. It has been observed that a diet high in fish consumption is protective for heart disease. Now to be clear, seafood itself is not healthy, it is fish. Crab, lobster, clams and other shell fish are actually bad for us. It is the fish that swim that are healthy. For many of us it is tough to eat fish 3-5 times a week. For that reason it was thought that purifying the oils contained in fish could be used as a supplement. Sure enough, fish oil has been shown to lower cholesterol, specifically the triglyceride fraction. Within the last few months a study has come out that looked at whether or not this would lead to a decrease in the rate of heart attacks. Those in the study had the expected improvement in their triglyceride levels but unfortunately there was no benefit in the heart attack rate. It is only one study but it is the best information we have so far. My feeling is that if you sit down to a big steak dinner and pop a fish oil tablet, you are not going to do yourself any good. One of the good things about eating fish is not just the oil but it is also the fact you will not be eating something else that is not healthy.<br />
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What about cinnamon tablets? Quite simply, I have seen no data in regards to cholesterol lowering effects of cinnamon. I have seen modest data in regards to lowering blood sugar. The effect is quite small. Avoiding sweets will have a much greater effect on lowering blood sugar than ingesting a little bit of cinnamon. <br />
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Moving on, let's discuss "Cholest-Off." This is a plant based sterol put in margarine that has been shown to lower cholesterol levels. It has actually been around for several decades. The effect is not huge but it has been demonstrated. If an oil spread is going to be used, it is best to pick one that works for you, not against you. It has also been put into capsules aswell. I have no problems with "Cholest-Off."<br />
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The next item is "Juice Plus." The idea behind this product is to get the benefits of multiple servings of fruits and vegetables in a few capsules. I know of no data showing that it helps cholesterol levels. It is high in vitamins. My biggest concern is that people will take these capsules and fail to eat fruits and vegetables. If so, the food they do eat is more likely to be of a lesser quality. Eating fruit and vegetables is more than getting vitamins. It is filling up with good fiber and an excellent source of water. The more whole food and fruit that we eat, the better off we will be. I do not endorse this product though it is safe. Let's make sure and get our 4-5 servings of fruits and veggies in a day.<br />
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What about peanut butter and milk? Peanuts are a decent source of protein but peanut butter is usually about 70% fat by calories. It is not the worse thing that can be eaten but if one has high cholesterol, there are better alternatives. In regards to milk, it is all about the fat. Two percent is better than whole milk but not as good as skim milk. I drink nothing but skim. I think it tastes great. Your taste buds will adjust, you don't need the extra fat.<br />
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The last paragraph on this email is my favorite. Nothing we have discussed so far will make a difference at all if the brats and ice cream sandwhiches are still being eaten. I can think of nothing worse for cholesterol than brats. It is like a wrapper for fat. Ice cream has the distinction of being the deadly double. It has both fat and sugar in it. No amount of cinnamon, fish oil, Cholest-Off, red yeast or even Lipitor will negate eating poorly. It is not rocket science, it is quite straight forward. If we use our common sense over our taste buds we will be "simply healthy."</div>Unknownnoreply@blogger.com0