Flash Mob

This is a cool "flash mob".

The orchestra assembles gradually while the piece is being played.

The piece is Ravel's Bolero.

http://www.classicalarchives.com/feature/dont_miss_this.html

Put down that cigarette, Virginia!

Smoking, Heart Disease and Women

I just read a scary statistic:  women who smoke have a 25% higher risk of heart disease than men who smoke.  This risk is increased 2% per year for every year that a woman smokes. 

The article was a review written by Dr. Rachel Huxley from the University of Minnesota in Minneapolis.  It was published in the Lancet.  That’s a pretty respectable journal.  The articles that were reviewed were from all over the world. 

Dr. Huxley thinks the risk could be even higher, because women tend to smoke less than men.  They also tend to under-report their smoking. 

She also noted twice the risk of lung cancer in women vs. men in these studies.

So, put down that cigarette, Virginia!

A Little Too Sweet

What Happens if You Don’t Control Your Blood Sugar

I have a lot of patients who have “adult onset diabetes”, now known as Diabetes Mellitus II (DMII) or “sugar diabetes” (in the south).  Many do not know what a “normal” blood sugar should be.  I cringe inside when I hear “but my sugar is only 350”. 

Some of my patients are first introduced to diabetes when they are pregnant.  This is called gestational diabetes.  We test ALL pregnant women for this.  Elevated glucose during pregnancy can cause very large babies, birth defects, stillborn babies, difficult labors, increased cesareans, and newborns with many different problems.  Women with gestational diabetes often have DMII later in life. 

DMII is a relative insulin resistance.  This is often related to excess weight, sedentary lifestyle and aging.  You can also have a family tendency towards diabetes. 

Diabetes out of control increases the risk of problems in the small vessels.  This includes heart disease, kidney disease and disease of the small vessels in your eyes.  We also see problems with the nerves in your hands and feet.  Diabetics don’t heal well after injury or surgery. 

Also note that smoking and blood pressure problems make all of this worse.

Depending on your lab, your fasting blood sugar should be 110 or less.  Your two hour after eating should be about 140 or less.  There is a test called Hemoglobin A1C (HgbA1C) that checks how much sugar is stuck to your red blood cells.  It is a measure of your sugar over the last three months.  It should be less than 6.5 or so.  Remember that these results vary some from lab to lab. 

How can you get “a little less sweet”?  Not by being grumpy.  You need to listen to your doctor.  You may get sent to the nutritionist.  Diet is the first challenge.  Some people can manage to change things by losing weight and getting rid of the high cholesterol, high sugar foods that we Americans like to eat.  {Guilty!}  Frequent small meals with higher protein and complex carbohydrates will help keep your blood sugar stable. 

Exercise helps, too.  It burns that sugar, burns fat and increases muscle mass.  Muscles use up more energy even in the resting phase. 

Some of us need medicine.  It is not a failure.  It is a way of protecting your body from itself.  Most doctors will start with pills.  There are several different kinds.  If you have problems with one, don’t give up.  There’s usually something else to try.  Giving Insulin and checking your blood sugar have become much easier in the last few years. 

Let’s have the sweetness in your disposition, not your blood sugar!

http://en.wikipedia.org/wiki/Diabetes_mellitus

http://diabetes.webmd.com/risk-factors-for-diabetes

Feel Good

Everyone has days when they are a little down. 

I recently made a list of some of the things that make me feel good.  I read it today, and felt better.

Here are some of those things:

 *Pictures of puppies and kitties with cute captions.

*A soft, warm comforter

*Hugs from my kids

*Sunny days after lots of rain

*A good book

*A good concert - either one I sang in or one the kids played in

*Laughing at movies

*Movies with cartoons first

*The way my kids' faces light up when I walk in the room.
*Warm, sleepy kid hugs
*The way a nice clean baby smells
*Baby giggles
*Bubble baths
*Candlelight
*Early morning silence with a cup of coffee
*Rainbows

*Watching the marching band and recognizing them. (Especially if you are related to some of them and they are getting better each week)
*Hot chocolate at football games on cold Friday nights 

That’s a partial list for me.  I recommend that you take five or ten minutes and make your own list.  If you are creative, find a way to make a photo or project that you can use to lift your spirits. 

I feel better already.  (Hurricane Irene is depressing me.) 

Autism, ADD, and a Football Game

What Were They Thinking?

My band kids played for their first football game last night.  They are still in high school.  They played an away game on a Thursday night.  I’m not sure exactly what time they got home, because I fell asleep in my chair.  It was sometime after 11 PM.

This morning, I couldn’t get Three Speed moving.  He was in his STOP mode.  Mr. Impatient got up at 5:06, did his breathing treatment, made his lunch, and was ready to go by 5:30.  School starts at 7:45.

I woke up in the chair about 4:30 in the morning, and was taking my night time pills when Mr. Impatient came downstairs.  I still had to take my shower and get dressed.  So I fell asleep waiting for it to be time to wake up Three Speed and Tall Guy. 

I still had the PB&J sandwich to make for Mr. Impatient.  He’s on strike about making them for himself.  Gotta love autism.  And there was no caffeine containing soda in the refrigerator except the energy drink that Three Speed needs to get him motivated in the morning before his ADD medicine kicks in.

Then we were late.

We ran into the next door neighbor (figuratively) on the way out the door.  One of her dogs died of cancer the day before yesterday.  She was walking two others.  We had to stop for a quick hug. 

Mr. Impatient was perseverating all the way to school about being late.  Breathe, Mom. 

Now, what was the school system thinking scheduling that danged football game so late?????

Perils of Phone Calls

There have been situations where my receptionist has stepped out or been sick over the years.  Someone else has been drafted to answer the phone.  Interesting things have happened.  This is my take on what would happen if someone else answered the phone.

Office Nurse – This happens in a lot of offices.  Sometimes the message is OK, sometimes you have to call back to make an appointment because the nurse has no idea at all how to work the computer. 

Doctor’s Mother – You might get a message taken, you would probably get some good advice, and you would probably have a nice homey chat.  If the doctor is Jewish, you would get a recipe for chicken soup; Italian, a recipe for lasagna; Cuban, the best black bean recipe……

Doctor’s Father – A quick message and a hang up.  At least if it was my Dad.  Miss you Dad.

Doctor’s Husband – if they have been married for a while, he’s probably pretty good at taking messages without getting involved and NOT giving any advice.  My husband actually worked in the office for a while and is great at making appointments, etc.

Doctor’s Kids – one of the funniest skits I ever saw on The Cosby Show was when Dr. Huxtable’s oldest son answered the phone (at home).  He asked the person on the other end all the appropriate questions to determine that she was in active labor.  He sent her to the hospital, then told his Dad that Mrs. X was on her way to the hospital.  I LOVED IT.  {My kids won’t answer the office phone.  They might answer my cell if I can’t get to it fast enough.  They only say things like “Hold on for my Mom.”}

Doctor – nobody else is there.  She is not going to admit it is her unless she is really new at this.  She will make up a name and maybe an accent.  That’s how my pseudonym, Maryellen Smith, came about.  I learned that, if people knew it was me answering the phone they would expect a free visit. 

One day Maryellen Susan Smith (MESS) was born.  I borrowed her from someone else.  They used to blame her for everything that went wrong at an organization she worked for. 

“Maryellen must have done that.  That’s OK, I can fix it.” 

It works well when I don’t want anyone to know it’s me.  She has “worked” in my office for years now.  She even gets mail on occasion.  I tried to retire her, but the new pseudonym didn’t work out as well.  So she’s back.  In fact, she has even written articles for a web site called associatedcontent.com (now part of yahoo).

I worked in offices in college.  Maryellen does a pretty good job of answering the phone and taking messages.  She does NOT give out any medical advice.  I guess I’ll keep her until I retire. 

Triplet Stuff #1

Why Did You Have Them So Close Together?

My triplets are fraternal.  That means that they all developed from different eggs.  That happens sometimes when you have in vitro fertilization, or even when you don’t, and have multiples.  Anyway, they are genetically as different as if they were from different pregnancies.

They look like brothers, but are slightly different in size and weight.  They have looked like “stair-steps” since they were preschoolers.  I loved the question from the elderly woman who wanted to know “why did you have them so close together?”

Later on, Mr. Lasermed decided on what we now think is the best answer:

Because once the first one came out, the others wouldn’t stay in!

(Triplet parents are welcome to give me other answers)

Scope of Practice

We in medicine talk a lot about our “scope of practice”.  I think that people outside of our world have no idea what the heck we are talking about.  I’d like to explain what us doctors mean by this, so if you hear this phrase you aren’t surprised. 

I think “scope of practice” has replaced “specialty”.  Back when doctors still made house calls in their horse and buggies, delivered babies in the family bed and got paid in chickens, they pretty much covered all specialties of medicine.  When you were the only doc for 300 miles, you had to do it all. 

Things changed.  We have new fangled drugs and machines and huge quantities of knowledge in all the different medical specialties that keeps changing daily.  It’s practically impossible to keep up in one specialty, much less all the fields of medicine. 

Our training programs have gotten longer and longer.  Lots of specialties even have sub specialties.  The subspecialties even have subspecialties these days.  Of course, you have to go to a special center to see a super sub specialist.  Out in the areas where docs are scarce, there tend to be more “general-specialists”. 

When you pick up the phone book, you might do a little research about what some of those specialties are before you make that call.  Most times the receptionist will be fairly nice when they answer the phone and you have called an inappropriate office.  But you should hear what they say when you hang up. 

Some help:

Pediatrics:  kids – usually up to age 18.  May precede a subspecialty

Internal Medicine: grown-ups – usually starting after age 18

Obstetrics (OB): pregnant women

Gynecology (GYN): women’s reproductive organs

Urology: kidney, bladder and male reproductive organs

Gastroenterology: the digestive tract

Cardiology: the heart and circulatory system

Ophthalmology: eye doctors

Otolaryngology: ear, nose and throat

Rheumatology: joint and connective tissue diseases

Orthopedics: bone and joint problems

So, if you’re a man with back pain, please don’t call an OB/GYN.  {It happened again today.}

Another Office Conundrum

Princess calls all our patients the day before their appointments to remind them about their appointment.  It is very common for doctor’s offices to do this.  Why, you ask?  Because people forget that they made the appointment.  They don’t come to the office.  We sit around looking at each other.  Other patients who could have come in for appointments can’t come in.  Besides, it costs us money every time someone doesn’t come in.  That raises the price for everyone else. 

What happens when Princess calls? 

Her favorite thing is to talk to the person who made the appointment.  They confirm it.  Everyone is happy.  This is a rarity.  Her next favorite is to get the machine and leave a message.  This is more common.

I hear a lot of grumbling about numbers that are “not in service”.  Another complaint Princess makes often is that mailboxes are full.  We have people that won’t answer their phones at all.  We have people that answer the phone and say they have no idea who that person is. (????)

My personal favorite is when Princess calls someone and they deny ever having made the appointment.  Princess is the only one that makes appointments.  So she KNOWS that the person made it.  She won’t let anyone but the patient make an appointment.  She knows it wasn’t the mom or the husband.  I don’t treat Alzheimer’s patients. 

Several years ago I instituted a “missed appointment fee”.  If you don’t show up, there’s a charge.  This covers part of the time we waste when you aren’t here.  It’s also a stimulus to keep your visit.  I think that’s why people say they have no idea what Princess is talking about.  

Yeah, right! 

You can’t be seen until you pay that fee.  Most patients have no intention of ever paying it.  I’m so sorry.  That’s how I get rid of patients who are unreliable.  My cardiologist told me I need less stress.  This helps me, but I’m a little worried about Princess’s blood pressure. 

The “S” Word

We have some “different” bad words at my house. 

One of my children is autistic.  This does not have anything to do with his intelligence.  If we could actually get an accurate IQ test, he would probably score somewhere in the genius level.  Just don’t ask a “why” question.

When my kids were small, we developed some special words that are forbidden.  My children are not allowed to use them.  There are occasional interesting situations.  I sometimes will use the words when driving.  This usually occurs when I have been cut off a couple of times.  So there were three little 8 year olds rushing in the house screaming, “Daddy, Mommy used the ‘I’ word!”

For your reference, the words that I would like to have removed from people’s vocabulary – and I did try to remove from the vocabulary at my house are:

the “S” word – stupid

the “I” word – idiot

the “R” word – retarded

I find there is no reason to use them except if someone isn’t watching when they drive. 

Medical Office Quandaries #2

“Oh, by the way”

          On my way out the door after first talking to a patient, then doing an exam, then developing a treatment plan, there is sometimes a dreaded phrase.  “OH, BY THE WAY….”  Mind you, I think the office visit is complete.  I’m thinking about prescriptions and charting and a myriad of other things.  {Squeezing in a bathroom break, a quick lunch, maybe getting to the kids band concert this evening – you know!}

          Put on the brakes.  Stop everything.  Ms Wantsitall Patient has had my undivided attention and her appointment is over.  Now she has something else she needs to have taken care of. 

          Lots of times this is followed by something “simple” like

·        “it hurts when I have sex”

·        “I have trouble holding my urine”

·        “I forgot to have you look at this spot”

·        “I have a discharge”

          None of these problems can be solved with a quick answer.  All of them take a whole visit.  I have to explain this to this woman, who often gets upset.  She thinks she can get this problem solved now since she is here at the office.  She doesn’t want to pay for another visit. 

          I have to explain that she needed to tell me before she had her examination.  I might take a quick look at the spot if I have time and schedule her to come back for a biopsy or to see a dermatologist, but the rest of those are things that need special exams. 

          So, tell the receptionist everything you need to have checked.  Tell the person that puts you in the room everything that is bothering you.  Make a list if you need to.  Put the most important things on the top.  The doctor is only going to have time to deal with one or two of your problems.  You need to plan on making another visit if you have more issues.  Then your doctor won’t have more blood pressure or stomach problems. 

The Triplet Pile On

          The first day of school has me going down memory lane.  When my boys were little, I would come home to an enthusiastic greeting.  Three toddlers would wobble across the room as fast as their little legs could carry them.  It became a “hug Mom” fest. 

          Then it became a “climb Mom” fest.  I had little bruises all over my legs and torso from where their toes dug into my flesh.  I quickly learned to sit down on the floor.

          We had “pile on Mom”.  It came with lots of giggles, hugs and tickles.  I loved it. 

          I miss it now.  But the boys are all taller than I am.  Giggles are now baritone and bass.  I still get hugs.  Sometimes they are group hugs.  Now if I could just get them to use that baby lotion again.  Aahhh, that lovely baby smell…..

Mama’s First Day of School Blues

(Kindergarten version)

I’ve got the First Day of School Blues

Kids are Gone to School Blues

Got the breakfast

Packed the backpack

Packed the lunch

Drove to school

Said “I love you”

Dropped them off

First Day of School Blues

Miss ‘em already

Cried all the way home

They’re so brave

Can’t wait for school to be out

First Day of School Blues

(High School Version)

School started today

Yeah!

Office Phone Calls #1

“I need to talk to the doctor”  

Poor Princess takes these phone calls all the time.  And I know that she’s not the only doctor’s receptionist that gets these.  Our phone will ring. 

Ms Wantsitall Patient : “I need to talk to Dr. Lasermed.” 

Princess: “She’s with a patient.  Can I help you?” {I’m back on my computer writing articles for this blog}

Ms Wantsitall Patient: “I need to make an appointment.”

I have been getting phone calls just like this for longer than some of my readers have been alive.  Can any of you tell me why you would ask to speak directly to the doctor if you need to make an appointment?  I am absolutely mystified.  Still.  After over a quarter of a century of practice. 

Princess doesn’t let me touch the appointment book.  She says I don’t know what I’m doing. 

She’s right.

Caffeine – The good, the bad, the ugly

I have often joked that, if caffeine ever becomes illegal, I will have to join Caffeine Anonymous.  I just can’t start the day without my cup of coffee.  A caffeinated soft drink or two will do in a pinch.  It really does wake me up and help with focus.  But is it healthy?

Health Issues:

Does Caffeine Cause Insomnia?

That depends on how much you consume, and how close to bedtime you consume it.  It takes about 5 hours to get rid of 50% of your caffeine.  So, not drinking caffeine too late in the day or not drinking pots of coffee will help you sleep.

What about bones, heart and cancer?

Lots of studies have been done about caffeine and its health effects.  There does seem to be some increase in calcium loss in women who drink a large amount of coffee (7 or 8 cups or more a day).  This may be increased if you are older.  Now, insurance companies have tried to convince me that my patients are “elderly” when they are over 60, but I’m NOT buying it.

Caffeine may increase blood pressure and heart rate in some people who are sensitive.  So you should discuss caffeine with your doctor if you have high blood pressure.  Various studies related to cancer have shown little to no risk of any kind of cancer in coffee drinkers. 

What about pregnant women?

Studies have shown that large quantities of caffeine may increase your risk of miscarriage.  Please discuss this with your physician if you are pregnant or plan on becoming pregnant. As a guideline, try to limit to one to two cups of coffee per day.  Remember that caffeine does cross the placenta and crosses into breast milk.

What about kids?

Kids seem to be able to process caffeine the same as adults.  Some are more sensitive than others.  They may be irritable, excitable, anxious, or sleep less.  Limiting their caffeine seems like a good idea.  Do we really need them to be irritable etc???

How Much Caffeine is there in your favorite Beverage?

·         Brewed Coffee – 90-200 mg per 8 oz

·         Brewed Decaff Coffee – 2-12 mg per 8 oz

·         Espresso – 100 mg per 2 oz

·         Instant Coffee – 30-170 mg per 8 oz

·         Brewed Tea – 40-120 mg per 8 oz

·         Energy drinks – 75-280 mg per 8 oz

·         Cola Drinks – 35-54 mg per 12 oz

·         Chocolate -  5.5-35.5 per 1.7 oz

What happens when you quit?

If you go cold turkey (shudder), it depends on how big your “habit” is.  If you drink a significant amount, you may very well have

·         Headaches

·         Fatigue

·         Anxiety

·         Irritability

·         Difficulty concentrating

·         Depression

·         Flu-like symptoms

Been there, done that.  Best way to “quit” caffeine is to wean down.  Second best way is to go away by yourself for about a week.  You should be human by the end of the week. 

Source for caffeine values:

http://www.mayoclinic.com/health/caffeine/AN01211

Personal Note:  I need to tell you that Tall Guy made me coffee yesterday morning without being asked.  He even remembered my favorite way to have it – sweetener and some raspberry flavor.  What a lovely way to spend a Saturday morning.  I love my kids. 

Your Cholesterol is WHAT?

I recently had several episodes of chest pain, shortness of breath, and an irregular pulse.  I’ll tell you more about that later.  Let’s just say I’m feeling a lot better.  Anyway, I got to go visit my trusty medical doctor, Dr. Internist.  I had some lab work done, and my numbers were (blush, blush) not so good.  I’m doing research on how to get them better.

I thought I would start with a little bit of research I have done on lowering cholesterol.

Soluble fiber can reduce the absorption of cholesterol into your bloodstream.  Adding 5-10 gm of soluble fiber a day decreases your total and LDL cholesterol.  Soluble fiber is found in foods like kidney beans, apples, pears, and barley.  Your total should be 25 to 35 grams.

FOODS

One way to cut out some cholesterol is oats.  If you eat cooked oatmeal, 1 ½ cups has 6 gm fiber. You can add fruit for more fiber.  Oat cereal is also helpful.  Read the box for fiber and sugars.

Another way to lower your cholesterol is to get omega-3 fatty acids.  The best source is fish.  You should try for at least two servings a week.  Fish highest in omega-3s are mackerel, lake trout, herring, sardines, albacore tuna, salmon and halibut.

You should bake or grill your fish to avoid adding unhealthy fats.  Another source of small amounts of omega-3 fatty acids are flaxseed and canola oil.  Supplements are available, but are not as healthful as natural sources.

Nuts are also helpful in reducing cholesterol.  They are rich in polyunsaturated fatty acids.  They are also rich in calories.  Be careful how they are prepared, as many are heavily salted or sugared.  My sources recommend walnuts, almonds, hazelnuts, peanuts, pecans, some pine nuts and pistachio nuts.

Olive Oil can lower your bad (LDL) cholesterol but leave the good (HDL) cholesterol stable.  Limit to about 2 TBSP per day.

Cut back on total fat, saturated fats and trans-fats.  Store bought cookies, crackers and cakes, margarines are high in trans-fats.  Meat, full fat dairy products and some oils are high in saturated fats.

Eat more complex carbohydrates instead of simple (get rid of the white stuff and simple sugars).

OTHER HABITS

Green Tea lowers the bad cholesterol and raises the good.  It also helps prevent your body from absorbing cholesterol in the intestines

Make your coffee with paper coffee filters to filter out the Kahweol and cafestol in brewed coffee that raise bad cholesterol.  (Who knew???)

Don’t smoke.  Smoking reduces the good cholesterol and makes your blood clot more. 

Frequent small meals also help reduce cholesterol.  Especially if you increase your fiber. 

Alcohol in moderation can help lower cholesterol.  This means one beer or glass of red wine for a woman and two for a man maximum in a day.  Remember that there are other health risks to alcohol consumption.  So you don’t get to have the whole 6 pack or whole bottle of wine.  Yeah – use a regular size glass.  No cheating!!!!

Exercise also helps lower your cholesterol. 

Then there’s medication.  But I will have to go back to Dr. Internist for that.  I would rather impress him with my skills at changing my lifestyle. 

So, I’ve been working on all the diet changes.  And getting moving.  Puff!  Puff! 

You learn something new every day!  I did!

These sources also recommend:

http://www.mayoclinic.com/health/cholesterol/CL00002

http://www.webmd.com/cholesterol-management/features/11-tips-to-cut-your-cholesterol-fast

Say what?

You never know what your insurance company is going to do.  This is a story from Australia about a man who was supposed to schedule for hand surgery and......
http://www.theage.com.au/victoria/congratulations-sir-youre-pregnant-20110819-1j19p.html

The latest in OB / GYN.....

“It’s Just a Form!”

At the end of a visit, Ms  Wantsitall Patient hands me a form she needs to have filled out for school. 

“Dr. Lasermed, can you please fill this out for me.  I need it so that I can play on my sports team.”

“When is your first practice?”

“After school today.”

“When you booked this appointment for your birth control refill, did you tell Princess that you needed a Sports Physical?”

“Why, no.  I figured you could just fill out the form.  After all, I come to you every year!”

Every doctor has this conversation with a patient on occasion.  We dread them.  There is nothing that is “JUST A FORM”.  Every form takes time to fill out.  Your doctor may or may not have the information that is needed to fill out the form.  The doc may or may not have the time in the middle of a packed schedule to fill out the form. 

Every one of us will take a deep breath when we hear “JUSTAFORM”.  Most of us have started charging for the extra time that it takes to fill out those blankety – blank things, unless you schedule a visit especially for your form. 

A sports physical in my county requires a vision test, a hearing test, a urine test, reflex tests and several other things that are NOT part of a routine GYN exam.  I have to get out equipment that I don’t usually use.  Do you remember when the last time your gynecologist routinely looked in your ears? 

There are a variety of forms we get.  Disability forms.  Handicapped license plates.  Medical Equipment.  Medication that was denied.  None of these forms are short.  None can be done by anyone but the physician anymore.  And none are covered by your medical insurance, Medicare or Medicaid. 

I have written articles about this before on another web site called associatedcontent.com.  I write as Dr. Maryellen Smith.  These two articles may expand a bit on this topic.

New Doctor’s Office Fees:  http://www.associatedcontent.com/article/5637318/new_doctors_offices_fees.html?cat=5

Things Insurance Companies and the Government have Changed About Medicine: http://www.associatedcontent.com/article/5658628/things_insurance_companies_and_the.html?cat=5

Anyway, next time you need a form filled out, let the person who answers the phone know in advance.  They will let you know if there is any fee for this, and allow the doctor extra time if necessary to fill out your form.  It will keep the doctor much happier. 

You might get an extra lollipop or sticker on the way out!

Medical Office Quandaries

I’m so glad that I usually don’t answer the phone at my office.  My receptionist takes a lot of interesting phone calls.  She earns her Diet Pepsi hourly.

I am a gynecologist.  That’s a doctor that deals exclusively with women and women’s problems.  So, when a man calls the office, it’s either a

·         salesman

·          husband

·         wrong number

·         member of my family – husband or kid

So when a man calls the office and asks to make an appointment, my receptionist is a little confused.  She asks what they want to make an appointment for.  She is thinking it might be a business thing. 

No.  These men want to make a medical appointment.  She has to gently explain to them that they have called the wrong kind of doctor.  Since she is a nice person, she will often ask the nature of their problem and give them a referral.

We joke between the two of us that she should tell them that they don’t have the correct parts.  If we’re having a silly day, we get really specific. 

She got three calls in one day last week.  I love to listen in.