THE DOCTOR BLOGGER

Doctor Blog-How Much Alcohol Is In Your Drink?

DrRima Bishara — Tue, 22 Jul 2008 16:29:20 GMT

To follow is a press release addressing alcohol use and container labeling to help consumers decide how much they alcohol they are getting in the drinks they are choosing.

NCL Challenges Myth that Some Alcoholic
Beverages Are
“Safer” and “Less Potent”

New Initiative Underscores Need for New Alcohol Label

Washington, DC; July 16, 2008 – For the many Americans confused about the
potency of different alcoholic beverages, one of the most respected national
consumer organizations has this important message: it is a myth that beer and
wine are not as strong as the typical cocktail. Standard serving sizes of all
alcohol beverages -- beer, wine, and distilled spirits -- are equal in alcohol
strength and their effect on the body.

Because even the most basic information about alcohol content is not clearly
and consistently listed on the labels of beer, wine and distilled spirits products,
the National Consumers League is going public with Alcohol: How It All Adds Up,
a new initiative challenging the myth that some alcoholic beverages are “safer”
and less “potent” than others. According to the League, this belief is pervasive
and linked with the overconsumption of alcohol and the permissive attitudes of
some parents about underage drinking. In an opinion poll commissioned by the
Center for Government Reform, 88% of parents mistakenly concluded that beer
is safer than liquor.

“Without ready access to information about the amount of alcohol they are
consuming, many Americans believe that beer and wine offer a ‘soft’ option and
can be consumed in greater amounts than so-called ‘hard’ liquor,” said Sally
Greenberg, Executive Director of the League. “We are trying to give consumers
the basics about the alcohol content of different alcoholic beverages, but the
real answer is government action to require standardized and complete labeling
information on beer, wine and distilled spirits products. Consumers should know
how many calories, carbohydrates, and other nutrition information are in a
standard drink. They have it for nonalcoholic beverages, food, and nonprescription
drugs. It is time for this information to be on the labels for alcoholic beverages.”

The Meaning of a “Standard Drink”

While renewing its calls for the Alcohol and Tobacco Tax and Trade Bureau to
make information about the alcohol content per serving a requirement on alcohol
labels, the League is attempting to fill the void with a new guide that tackles one
of the most important concepts for consumers to grasp – what constitutes a
“standard drink.” Research commissioned by the League finds 54% of Americans
don’t know there is such a thing as a “standard drink,” even though a large
majority of state drivers’ license manuals and national and state public health
agencies use the “standard drink” concept to explain responsible drinking.

As the guide explains, the common denominator for a “standard drink” of beverage
alcohol is 0.6 fluid ounces of pure alcohol. Based on this amount of alcohol, a
standard drink consists of a 12-ounce bottle or can of regular beer (5% alcohol),
a 5-ounce glass of regular (dinner) wine (12% alcohol), and a 1.5 ounce drink of
80 proof (40% alcohol) distilled spirits or liquor (either straight or in a mixed drink).

“It shouldn’t take a calculator to know how much alcohol you are consuming,”
Greenberg stated. “Better labeling is badly needed to tell how many ‘standard
drinks’ are in a particular product. If consumers can tell from the label how many
standard drinks they are consuming, they can learn their limits and avoid
exceeding them.”

Misperceptions Contribute to Underage Drinking, Binge Drinking

As part of its initiative, the National Consumers League is also calling on parents
and community leaders to address underage drinking, reporting that parents
often underestimate how early drinking begins, how much alcohol their adolescents
consume, and the risks involved. According to the National Institute on Alcohol
Abuse and Alcoholism (NIAAA), three-fourths of 12th graders, more than two-thirds
of 10th graders, and about two in every five 8th graders have consumed alcohol.
Compounding the problem, research commissioned by The Century Council finds
that 65% of underage youth who drink obtain alcohol from their parents, their
friends’ parents, older friends and older siblings or have easy access to alcohol
on college campuses.

“Parents need to understand that one can of beer or one wine cooler has roughly
the alcohol equivalence of one shot of vodka,” said Greenberg. “Believing
otherwise undermines and runs counter to all we know and all we have done
to prevent underage drinking.”

While underage drinking is associated with motor vehicle crashes, major injuries
and delinquency problems, what is not well understood is its link to binge drinking,
which NIAAA defines as a pattern of drinking alcohol that brings blood alcohol
concentration to 0.08 grams percent or above. For the typical adult, this pattern
corresponds to consuming five or more drinks for men, or four or more drinks
for women, in about 2 hours. Consumption at this pace can also result in alcohol
poisoning, a serious condition that can lead to choking, coma and even death.

“Study after study shows that parents have the most influence over their teen’s
decision to drink,” Greenberg said. “Parents should be a role model for their teen
about responsible drinking, whether they drink or not. This means talking regularly
and often about drinking alcohol, including how to resist the peer pressure that
can lead to underage and binge drinking.”

New Tools for Consumers

To improve Americans’ alcohol awareness, the National Consumers League is
making available a new Alcohol: How It All Adds Up guide and a series of information
sheets about alcohol content, alcohol labels, and binge drinking to consumers,
community leaders and health professionals. These materials are available in
downloadable form on the League’s Web site, www.nclnet.org.

About the National Consumers League

Founded in 1899, the National Consumers League is America’s pioneer consumer
organization. Its mission is to protect and promote social and economic justice
for consumers and workers in the United States and abroad. NCL is a private,
nonprofit membership organization. For more information, visit http://www.nclnet.org/.

Drunk Driving Is Clear In Any Language.

Doctor Blog-More on Diabetes Lifestyle

DrRima Bishara — Mon, 14 Jul 2008 20:19:09 GMT

One of my readers writes the following comment and question:

"In today's fast growing lifestyle, industrial professional like, IT, health, education
or defense, wherever they work, are prone to diseases like Diabetes, heart attack,
etc, i think yog could be play a very significant role in this regard. And meditation is
also a better idea.

What would you suggest, to lead a safer life with Diabetes."

I have posted on Diabetes before including the following entries:

1. Insulin Pumps
2. Ten Things to Know About Diabetes

The bottom line with Diabetes is that a diabetic can either control the disease
or the disease will control their life.

This means some adjustments in lifestyle that mainly have to do with a
committment to living a "budgeted" life and knowing how much and when
to eat and to exercise. Everything else can work around these things.

What I mean by a "budgeted" life is that diabetics have to eat at similar
times of the day, similar amounts and similar kinds of food at meals.
Also, they need to exercise and need to do so at regular times
and for similar amounts of time each time.

So, a sample diabetic day would include breakfast at 7-8am, lunch at 12-1pm,
supper at 5-6pm and possible snacks before bed if necessary to modulate
sugars at night.

Exercise might be walking for 30minutes each evening at 7-8pm after supper.

Relaxation, as my reader suggests, can be helpful in controlling stress which
tends to raise sugars unnecessarily. There are many forms of relaxation
ranging from sitting in a quiet corner and reading a book and to music on
CD's and tapes to listen to in an effort to reach a relaxed brain wave pattern.

Dean Ornish, a physician who now lives and practices in San Francisco, has
pioneered non-surgical treatment of cardiovascular disease. He has proven
that with dramatic lifestyle changes that include diet control, exercise, and
relaxation techniques, that even the most severe disease can be improved
to some degree.

Doctor Blog--Death of a Giant

DrRima Bishara — Mon, 14 Jul 2008 19:33:21 GMT

Dr. Michael Debakey died over the weekend. He probably contributed more
to medicine in the 20th century than any other physician. He was well known
for his work ethic and passion in caring for his patients.

Read the full story and his impact on medicine.

Doctor Blog--Enterprise

DrRima Bishara — Tue, 08 Jul 2008 12:18:23 GMT

Jim Rohn is an amazing life and success coach. He has spoken for years
about opportunity and how to manage life.

The following entry comes courtesy of AsAManThinketh.net which provides
daily inspirational quotes and stories.

Creating Opportunity

By Jim Rohn

An enterprising person is one who comes across a pile of scrap metal and
sees the making of a wonderful sculpture. An enterprising person is one
who drives through an old decrepit part of town and sees a new housing
development. An enterprising person is one who sees opportunity in all
areas of life.

To be enterprising is to keep your eyes open and your mind active. It's
to be skilled enough, confident enough, creative enough and disciplined
enough to seize opportunities that present themselves... regardless of
the economy.

A person with an enterprising attitude says, "Find out what you can
before action is taken." Do your homework. Do the research. Be prepared.
Be resourceful. Do all you can in preparation of what's to come.

Enterprising people always see the future in the present. Enterprising
people always find a way to take advantage of a situation, not be burdened
by it. And enterprising people aren't lazy. They don't wait for opportunities
to come to them, they go after the opportunities. Enterprise means
always finding a way to keep yourself actively working toward your ambition.

Enterprise is two things. The first is creativity. You need creativity to see
what's out there and to shape it to your advantage. You need creativity
to look at the world a little differently. You need creativity to take a
different approach, to be different.

What goes hand-in-hand with the creativity of enterprise is the second
requirement: the courage to be creative. You need courage to see things
differently, courage to go against the crowd, courage to take a different
approach, courage to stand alone if you have to, courage to choose
activity over inactivity.

And lastly, being enterprising doesn't just relate to the ability to make
money. Being enterprising also means feeling good enough about yourself,
having enough self worth to want to seek advantages and opportunities
that will make a difference in your future. And by doing so you will
increase your confidence, your courage, your creativity and your self-worth,
your enterprising nature.

To Your Success,
Jim Rohn

Doctor Blog--Excellence vs Mediocrity

DrRima Bishara — Tue, 08 Jul 2008 08:38:34 GMT

The price of excellence is discipline.

The cost of mediocrity is disappointment.

William Arthur Ward

Michael Phelps in the 400 IM

Doctor Blog--I Learned........

DrRima Bishara — Sun, 06 Jul 2008 13:35:20 GMT

I learned that the only way you are going to get anywhere in life is to
work hard at it. Whether you're a musician, a writer, an athlete or a
businessman, there is no getting around it. If you do, you'll win. If you
don't you won't.

Bruce Jenner

Doctor Blog--Priorities During Major Disasters--Who and How

DrRima Bishara — Wed, 02 Jul 2008 12:11:23 GMT

This comment comes from one of my readers named Heather. She writes
about Dr. Anna Pou in New Orleans in the days after Hurricane Katrina hit.

She brings up an interesting point which is that our priorities as a nation
are reflected in this case. I would have to agree, unfortunately.

The questions brought up include how to triage in the setting of massive
natural disaster, who is responsible, how to address limited resources,
and how to determine how they are distributed (or who determines
distribution).

It is a discussion worth revisiting. Let me know what you think.

"I think if anyone should have been under attack it should have been the
doctors that left those patients alone to die. I do understand that, given
the circumstances, they were fighting to save themselves, however, it is
the duty of any doctor to put their patients first. If, in this case the doctors
had not left and stood by that duty...the situation never would have
happened. Those nurses, along with Anna, were very courageous for
what they did.

It is disgusting to be a 23 year old and see that, in a
profession I hope to one day be in, this is what happens when you
stand by your obligations.

We could very well point blame to anyone in that situation, including,
FEMA, and the United states government for not responding sooner,
or actually having a stable plan of action in place for a crisis such as this.
It makes me afraid of anything else that could possibly happen and for us
to not be prepared for. Why not prosocute the President of the United States?

It is so ridiculous living in the hypocracy of the United States at times.
We can send soldiers out to kill and be killed, spending trillions of dollars
a day to do it...however, when a doctor, who is willing to sacrifice themself
to save another persons life, does the best she can in given circumstances
and for the comfort of the patient, she is put on trial for murder..remind you..
everyone else decided to run when faced with disaster.

Everything is such a mess, and no one seems to have the right direction/or
priorities at this point. I think the point I am trying to make is that this case
stems far beyond Anna Pou and those 3 nurses that acted in such a heroic
manner. It stems back to what our priorities are as a nation."

Doctor Blog--"Genetic Profiling"

DrRima Bishara — Mon, 30 Jun 2008 20:46:42 GMT

I recently had a conversation with a woman in her mid 30's who has
been diagnosed with breast cancer. She was unaware of any family
history until her diagnosis when a long lost relative revealed that
two aunts had been diagnosed with breast cancer in their 50's in
the past.

The discussion was in a social setting so she was sharing from her
sense of life view at this point in her experience.

The subject of genetic testing came up. She has a very young daughter
who now is at greatly increased risk of contracting breast cancer herself.
The question that is pressing my friend is whether or not she should have
genetic testing herself and whether she should have her daughter tested
as well.

Her concerns are real. What if the little girl has positive genetic markers?
What would an insurance company who is looking at increased revenue
for publicly traded investments going to view her child's positive genetic
marker? Will there be a "pre-existing condition" exclusion whereby the
little girl may be excluded from health or life insurance with such a
marker on her record? What is the price of genetic testing? Does a
doctor have to order the test or can a lay person ask for the test if
they are paying out of pocket?

Well, The New England Journal of Medicine from June 26, 2008 has an
article which addresses "genetic profiling". The article is entitled:
Polygenes, Risk Prediction, and Targeted Prevention of Breast Cancer.

The authors look at the potential use of genetic markers to "profile"
women at risk for breast cancer and thus create a personalized
screening program. The idea is a good one in theory: figure out
who has the gene that increases risk of disease and then be more
aggressive in screening the person at higher risk for the disease--
the earlier the diagnosis the better the chance for cure.

The article is based on the theoretical application in the United Kingdom
which has a National Health Service Program to set guidelines for
disease prevention and treatment that are used for clinical decision
making. The authors acknowledge the chasm between the theory and
the application even in a system like the one in the UK.

The question would be how would something like this apply in the
United States where, at present, there is a for profit health care system
for working Americans? That is, what is the incentive for an insurance
company to provide coverage to a woman who tests positive for a
gene which significantly raises her risk of breast cancer compared to
her peers? What is to prevent insurance companies from using genetic
profiling to deny claims related to markers as "pre-existing conditions"?
For profit, publicly traded health insurance companies appear to have a
primary interest in profits for investors, many times at the expense of the
patient. It seems that genetic testing would make it easier for insurance to
"screen out" of their plans individuals with negative genetic profiles in the
pursuit of profiteering.

In fact, my friend is so fearful of the implications to her daughter's future
healthcare coverage that she does not even want to mention it to her
physician or her daughter's physician for fear that ANY mention in the
record of a discussion about genetic testing would be picked up and used
to "profile" her daughter's health risk.

How sad that a working woman who becomes ill in the United States has
so little confidence in health insurance companies and, in addition to her
illness, has to deal with the fear of medical insurance being withheld from
her daughter as a result of her own illness or genetic link to her child.

Meanwhile, the CEO's of many for-profit medical insurance companies earn
millions in salaries and millions more in stock options or profit sharing.

Let me know what you think of this issue...........

Doctor Blog--Playing the Piano? Impossible!

DrRima Bishara — Sun, 22 Jun 2008 21:03:59 GMT

More on Dr. Ruth Pitts.

For those of you who read the entries on the importance of music
to children and for brain development and who also read the
interview with Dr. Ruth Pitts, watch the video below and you will
see her play a piece by Liszt.

She has a total of 5 (five) fingers on both hands.

Doctor Blog--The Impact of Music on Children

DrRima Bishara — Sun, 15 Jun 2008 22:42:01 GMT

To get a real world perspective on this subject, I interviewed Dr. Ruth Pitts,
a very well respected and revered professor of piano in her community.
She recently received the Piper Award for lifetime achievement in music
education.

The interview was conducted in writing and is presented as edited for form
only.

Please read carefully what she says. Also, be sure to read the last part of
the interview as you will be amazed at what you learn about her.

You are a piano teacher and have been for most of your career. What would
you say are the most important things kids get from learning to play an
instrument and the piano specifically. Why do you think music is such a powerful
medium?
Important things children derive from learning to play the piano:
a. Children develop the discipline of practicing to make something better-so
important for everything they will ever do!
b. Children develop eye-hand coordination as well as coordination of shoulder,
hand and finger muscles.
c. Children learn to express their feelings within the context of a work of art.
d. Although there is still some concern about the validity of the tests, it seems to
be the case that the study of music does enhance a child's I.Q. and consequently
other studies as well.

If you were counseling new parents, what would you tell them about music for
their children? Is it important for children just to hear music or, is it important for
them to play an instrument?
I think music is an essential part of a child's development. It helps them to become
living souls; the knowledge and skills they gain provide an area of enjoyment for the
remainder of their lives.

What advantage does piano have over other instruments (if any that you see)?
What instrument would you suggest for most children?
Piano is the basis for all of the instruments. Certainly any instrument study is better
than none, but the piano requires learning both clefs and coordination of both hands
(and ultimately feet as well); hence once they have learned the piano, they can transfer
this knowledge to any other instrument.



What are the things that music provides that other media (reading, art, TV,
computers, etc.) does not?
It is important that they hear, of course, but learning to produce music themselves is
so very important. (see above).

What age group do you teach?
I teach 5-year olds through 12th grade at home and college students at our local
community college.

What are your goals for your students when they are 10 and under?
To learn to read music; to perform artistically enough to give themselves pleasure; to
develop a love for music; and to be able to play well enough to get some praise for
their accomplishments.

Is there a particular age at which you recommend that children begin learning
music or a musical instrument?
I normally suggest at least 2nd grade (when children have learned to read a little
and have learned the importance of staying with the same things for 20-30 minutes)
unless the parents have a little background in music and have time to spend with
them in their practice at home.

Are there certain habits that music cultivates? Are there certain habits that
children have to cultivate to learn music?
Their dedication and willingness to spend the hours it takes to learn it well. Also their
ability to listen to themselves to see if they are really making beautiful music and not
just playing notes, and then critique themselves and make it better! Listening skills;
the ability to focus; the ability to critique themselves and the ability to accept criticism
as well as praise.



How hard is it to learn an instrument? Does it get harder or easier with age?
Not hard, but it does seem a little harder for older adults, particularly if they have never
had any exposure to it as a child.

What role do parents have in music education? What role would you like to see
them play?
It is especially important for a very young child to have much help from parents.
Older children may not need the constant help, but they still need support and nurturing.
It is very important for the parents to set aside a regular practice time just as they set
a time for homework, sports, church, etc.

You have a physical impairment that most people would consider completely
disabling as far as playing an instrument. What are the things that you want people
to know about your commitment to piano despite your impairment?
I have never really considered myself handicapped. My parents thought I probably
couldn't learn to play the piano. (Both of them were very musical. Dad, who was a
Baptist minister, had a lovely tenor voice and had been in a traveling college quartet.
Mother was offered a scholarship to Julliard in piano and was the organist at the church.)
However, at the end of the 3rd grade my teacher called to tell them how much they had
enjoyed my performances on the piano every Friday at their talent shows. My parents
then found a teacher and a piano, and no questions were asked or exceptions made.
I have never known real problems. Of course there are a few things I can't play (big chords,
etc.), but I am usually able to figure things out so that most people would not know that
I have a disability unless they watch me play. I was playing for Sunday School and church
after I had taken lessons about a year. I never had special training, just good old regular
teaching!

How has your impairment influenced your decisions for a career?
The only influence was in a round-about way. I had wanted to go to Africa as a
medical missionary, but when I came to Baylor and started corresponding with the
Foreign Mission Board, I found that they did not send handicapped people (of course
at that time there would have been no one to fix my brace or artificial limb), and I was
very sad! My friends and teachers all began to tell me that I really should look at a career
in music because I was quite good at it. Then I became so involved in music courses, choir,
etc. at Baylor that I didn't have time for anything else. The next thing I knew Dean Sternberg
called me into his office and asked if he could recommend me for a National Defense Education
Act scholarship for a Ph.D. in music at Peabody. I said that would be fine, although I had
never considered getting a doctorate, and I felt sure that I wouldn't get it. The rest is history.
I love piano and all kinds of music, and I love working with people.

How did your impairment influence your children?
I don't think my disability ever affected my children much. The only thing I ever remember
hearing from Billy was when a child asked him why his mother had only 2 fingers on one hand
and 3 on the other, he responded that it was so she could teach piano to other children
that had only 2 fingers on one hand and 3 on the other! Of course I have never had that
opportunity! Both of my boys play beautifully. Bill, of course, has little time for it as a
cardiologist, but he loves being able to sit down and play when the opportunity is there.
Jimmy is a concert pianist and teaches piano at SFA University.

Doctor Blog--The Current Medicare Debate

DrRima Bishara — Sun, 15 Jun 2008 22:41:21 GMT

Chris Stewart posted this information about the current Medicare debate.
Chris is with a clearinghouse for information about fighting chronic disease.

The link is http://promisingpractices.fightchronicdisease.org/

He forwards this information:

Baucus & Grassley Debate Medicare on AARP's Blog

In a unique event, Senators Max Baucus and Chuck Grassley - the Chairman and Ranking Member of the Senate Finance Committee, the Committee in charge of Medicare in the Senate – have taken to the blogosphere to debate competing pieces of legislation with regard to Medicare. Below you'll see each of them explain their respective bills to readers of AARP's ShAARP Sessions blog.

If you are so inclined, we would greatly appreciate you weighing in on the debate, regardless of what side you fall on in the complex issue.

Sen. Baucus: Going the Extra Mile for Seniors http://blog.aarp.org/shaarpsession/2008/06/senator_baucus_going_the_extra.html

Sen. Grassley: GOP Medicare Bill Preserves Access to Quality Healthcare http://blog.aarp.org/shaarpsession/2008/06/senator_grassley.html

Senator Baucus: Going the Extra Mile for Seniors (Category: Health Care)

The following statements from Senators Baucus and Grassley regarding their competing Medicare bills are unedited and do not reflect AARP's position.

The laws governing Medicare have a big influence on seniors' access to health care, and on the quality of the care they receive. As Chairman of the Senate Finance Committee, I've introduced the "Medicare Improvements for Patients and Providers Act of 2008" to update Medicare laws and make the program work better for every single American senior. It's the best bill Congress can pass for seniors this year.

The Baucus bill starts by helping more low-income seniors get help with their Medicare premiums. It has incentives for more primary care doctors to take Medicare patients. It allows for more preventive care in Medicare, to keep seniors healthier, and lowers co-payments for mental health services. It provides more money to rural hospitals, ambulance services, and other facilities to make sure seniors get quality care no matter where they live. It cracks down on shady marketers selling seniors on private plans they don't need or want. And it makes sure local pharmacists get paid promptly for dispensing medicines under the drug benefit, to keep affordable medications available everywhere.

The Baucus bill is responsible, too, paying for these improvements with smart savings found elsewhere in Medicare. It's important for you to know that these savings in no way endanger any senior's access to health coverage, health care, or medical equipment. Rather, savings come from strengthening the rules applied to private fee-for-service plans – which are paid 17 percent more than the amount paid to other Medicare providers – and by reducing overpayments to wheelchair and oxygen providers, who sometimes receive more than 1000 percent of the cost of the equipment they supply. In most cases, these changes will even reduce seniors' out-of-pocket co-payments while also saving taxpayer dollars.

The President threatens to veto this bill, but I believe Congress should do the very best it can for seniors, and pass the Medicare bill that does the most for all who use the program. The Baucus bill goes the extra mile – particularly for rural and low-income seniors – while giving doctors a decent payment increase that won't explode costs or inflate premiums. And the Baucus bill saves money in Medicare without endangering anyone's access to care. I'll work with other Senators and even the White House to get a good bill signed into law. But the Medicare Improvements for Patients and Providers Act is the right start to make Medicare better for every American senior.

Senator Grassley: GOP Medicare Bill Preserves Access to Quality Health Care (Category: Health Care)

If Congress doesn't act, the physicians who treat Medicare patients will face a 10.6 percent pay cut, effective July 1. Such a dramatic cut would very likely hurt older Americans' access to their doctors. A big number of doctors might stop dealing with Medicare altogether.

The Republican bill prevents the cut and gives a small payment increase to keep doctors serving Medicare patients. The physician payments are the same as in the Democratic leaders' bill. Neither bill is more generous than the other to doctors.

The Republican bill has several other Medicare improvements. It increases payments to doctors who report quality data to the government to help link payments with quality. It promotes value-based purchasing, e-prescribing to reduce medication errors, and electronic health records. It includes responsible proposals to preserve Medicare access in rural areas, including much-needed payment improvements for rural hospitals and home health care. It returns the ownership of oxygen equipment to the supplier, not the beneficiary, so the beneficiary doesn't have to get the equipment serviced. It cracks down on abusive sales tactics by Medicare Advantage plans and makes plan quality information available to beneficiaries for comparison shopping. It improves cardiac and pulmonary rehabilitation, renal care, diabetes prevention, and outpatient therapy. It extends programs to help low-income seniors and families.

Unlike the Democratic leaders' bill, the Republican bill does not:

*cut payments for power wheelchairs;

*reduce payments for oxygen;

*make large, unwarranted cuts to Medicare Advantage, altering policy decisions designed to maximize patient choice;

*eliminate the fund that Congress specifically created to help avert future physician cuts; or

*expand eligibility for low-income Medicare programs, which although well-intentioned, would increase long-term entitlement spending and expand coverage under an already fiscally challenged program.

Maybe most important, the President will sign the Republican bill. The President would veto the Democratic leaders' bill. Meanwhile, the Democratic leaders walked away from bipartisan negotiations and put a timely outcome of this effort in jeopardy. The Republican bill does everything Medicare beneficiaries need to protect their access to doctors and prevent a physician revolt. There's nothing in it that Democratic leaders would find objectionable if they put aside their political lens and looked at it as Medicare beneficiaries and taxpayers.

Doctor Blog--Quote for a Lifetime

DrRima Bishara — Fri, 13 Jun 2008 10:04:31 GMT

People may fail many times, but they become failures only when
they begin to blame someone else. Experience is determined by
yourself -- not the circumstances of your life.

Gita Bellin

Doctor Blog--Music and It's Impact on the Human Brain

DrRima Bishara — Mon, 09 Jun 2008 22:06:41 GMT

Music is everywhere. It is arguably the only universal language. It
crosses all verbal, age, religious, cultural barriers. Music has a profound
effect on humans and learning music is a value that every parent
should encourage for their children. To further educate my readers
about the importance of music, I've put together a summary in this
entry that can outline why music is so important and how it can be
used as a tool for education.

What is music? It is a language.-- a form of communication.
Music has a language (tonal) component as well as a mathematical
(rhythmic) component.

Music reaches human brains through the ears. Auditory signals are
routed to the brainstem, then to the thalamus, and finally to the
auditory cortex in the temporal lobes on both sides of the brain.
However, research indicates that processing and learning music
probably affects many other parts of the brain (presumably because
it is such a complex activity).

For a more detailed explanation of the auditory system, click on:
http://www.brainconnection.com/topics/?main=anat/auditory-anat

For a detailed lecture on YouTube about the auditory system, click on:
http://www.youtube.com/watch?v=brOcjvubJoY

"The Mozart Effect" is a theory that states that spatial reasoning
improves after listening to Mozart's music. The original experiment
was done in 1993 by Rauscher and Shaw from University of California
at Irvine.

Unfortunately, other researchers have tried to replicate the experiment
and have found no such effect.

Rauscher and Shaw did another experiment in 1997 comparing children
who received keyboard lessons with those receiving voice lessons,
computer lessons, and no lessons. They found improvement in
spatial-temporal reasoning among the children who took keyboard
lessons only.



A Canadian program created by the Royal Conservatory of Music,
(Learning Through the Arts or LTTA) followed elementary children
for 3 years. It incorporated art, music, drama, and dance into regular
elementary school science and math curriculum. This program reported
that math scores rose significantly among those students who were
included in the program compared to students attending schools
where the program is not used.

Many articles have been written about music, its effect on the brain,
and how music affects us from birth to adulthood.

In an upcoming entry, I'll include an interview with a lifelong music
educator who has instructed small children through adults in the
language of music.  We will get a view of her perspective on the
role that music can play in a person's life.

For a good summary of the research and conclusions go to:

http://www.veezyon.com/video/science-technology/music-and-the-mind/74/

http://faculty.washington.edu/chudler/music.html

http://www.edu-cyberpg.com/Music/musicsmart2.html

http://educ.queensu.ca/~arts/research_reports.html

Doctor Blog--Fighting Chronic Disease

DrRima Bishara — Mon, 09 Jun 2008 22:06:31 GMT

Write up of Health Care Conference by Chris Stewart. He writes:

"Dr. Val and the Voice of Reason"

http://www.revolutionhealth.com/blogs/valjonesmd/the-missing-link-in-h-14167

The Missing Link In Healthcare Reform
Posted on 06:45PM (EDT) on 2008-06-07

I recently attended a half day conference, "Fighting Chronic Disease: The Missing Link
In Health Care Reform" sponsored by Emory University and the Partnership to Fight
Chronic Disease (PFCD). It was an extremely well run event with an all-star political
cast: Tom Daschle, Dick Gephardt, Dr. Mark McClellan, and Nancy Johnson were present.
The key medical players included Dr. Nancy Nielson, president-elect of the AMA, and
Dr. Otis Brawley, CMO of the American Cancer Society.

The purpose of the conference was to raise awareness about the cost of chronic
disease - it accounts for at least 75% of healthcare spending, and 80% of that could
be avoided with lifestyle interventions. Shocking, isn't it? Any discussion of reducing
medical costs needs to begin at ground zero - getting Americans to adopt healthy diet
and exercise habits.

One of the most entertaining panelists was Chris Viehbacher, the president of North
American Pharmaceuticals at GlaxoSmithKline (GSK). Chris is a gifted speaker with a
charming Canadian accent - and could probably be the head of a debate team. We
had the chance to speak about lobster fishing in Nova Scotia during one of the breaks
since we share a common Maritime heritage. He offered some amusing analogies about
our healthcare system, and made some points that bear repeating here:

"Half of the people in the US have some sort of chronic illness. Health insurance is like
having car insurance when 50% of people are having accidents. Of course nobody
can afford it."

"We need to keep employer-based healthcare because when employers have 'skin
in the game' they have the incentive to promote healthy behavior at a local level.
Monolithic government programs aren't good at influencing people at the individual
level. Employers know each of their employees by name, they are invested in their lives,
they provide childcare services and other benefits to them, and each employee's health
affects their bottom line. Employers are a critical force for promoting and facilitating
healthy behaviors."

"Alternative energy sources aren't that interesting when gas is $1/gallon. But when
gas hits $4/gallon suddenly everyone is very interested in alternative energy. The
same goes for healthcare. It takes a cost crisis to bring it to everyone's attention.
And now the audience is listening."

Doctor Blog--Tip of the Day--Exercise

DrRima Bishara — Sat, 07 Jun 2008 19:12:32 GMT

One way to get more results with the same amount of time spent is
to exercise with a weight belt on. You might find one of these at a
sports store in your community. The weight can be variable depending
on how much you can tolerate. Increase the weight as you are able to
handle.

By carrying weight, you can burn more calories while spending the same
amount of time exercising, in general. It can also help build muscle
which burns calories faster than other tissue.

Advantages to weight belts:

-There is no irritation to wrists or ankles such as with wrist or ankle weights.

-There is no irritation to any specific joint.

-It weighs down the axial skeleton which is what many women need to help
strengthen bones in the spine and hips--the most vulnerable to osteoporosis.

Doctor Blog--Smoking and Peer Pressure

DrRima Bishara — Thu, 22 May 2008 07:55:16 GMT

Most of the time, when someone says "peer pressure", there are negative
overtones. In the May 22, 2008 New England Journal of Medicine, researchers
with the Framingham Heart Study detail their findings of how groups of
people smoke together and quit smoking together. The title is
"The Collective Dynamics of Smoking in a Large Social Network".

Smokers are most likely to be influenced to stop smoking by a spouse who
quits smoking, a friend who quits, a co-worker who quits, a sibling who quits,
in that order.

The strength of the influence is highest from a spouse and lowest from a sibling.

The conclusion is that smoking behavior spreads through close and distant
social ties and that smoking cessation occurs in groups.

Smokers were found to be increasingly marginalized.

The implications are that there would be a public health impact with policies or
programs that target groups of inter-related smokers (smokers can be
encouraged to stop smoking by peer pressure).

Who says peer pressure is bad?

Along the theme of parenting that seems to keep cropping up at this blog,
how might a parent apply this information as they are raising their children?

I suppose the most obvious first choices would be to encourage children to
choose tobacco free friends and to make home a tobacco free environment
for those who live there as well as those who visit.

Doctor Blog--Quote of the Week

DrRima Bishara — Wed, 21 May 2008 09:44:17 GMT

Self-respect is the root of discipline; the sense of dignity
grows with the ability to say no to oneself.

Abraham Lincoln

Doctor Blog--Manners, Again.

DrRima Bishara — Wed, 21 May 2008 09:43:17 GMT

I completed an entry about Manners earlier this year. Interestingly,
The New England Journal of Medicine, May 8,2008 issue, has an article
entitled "Etiquette-Based Medicine" written by Michael W. Kahn, M.D.,
a psychiatrist at Beth Israel Deaconess Medical Center and an
assistant professor of psychiatry at Harvard Medical School.

He suggests that there needs to be more emphasis on "good manners"
rather than compassion in physician's interactions with their patients.

Primarily, his comments were targeted toward hospital based medicine.

So, rather than addressing attitudes among physicians, there would
be checklists that would address behavior. Examples:

1. Ask Permission to enter the room and wait for an answer.
2. Introduce yourself and show an ID badge.
3. Shake hands (wear glove if needed).
4. Sit down. Smile if appropriate.
5. Briefly explain your role on the team.
6. Ask the patient how he or she is feeling about being in the hospital.

I'm curious what a patient might think of this checklist. And, if a patient
were asked, how would they want a physician to behave? Would a
patient prefer good behavior or good manners over compassion?

What do you think?

Doctor Blog--Incest Dad

DrRima Bishara — Wed, 14 May 2008 17:36:43 GMT

Incest dad, as he seems to have become known in the media, is a great teaching
moment for parents and future parents alike. He kept his daughter in a dungeon
with no windows beneath his house for 24 years and fathered seven children
with her. He and his wife apparently adopted 3 of them to raise as their own.

For a Full Story, Click the following link:
http://www.cnn.com/2008/WORLD/europe/05/08/austria.fritzl.ap/index.html

He is quoted as having said: "I must have been crazy....I cared for them...."

In bits and pieces, reports of his story are as follows:

His reasons for locking her up: she misbahaved.
His reasons for keeping her locked up: scared he'd be apprehended.
His reasons for fathering children with her: unclear.
His reasons for coming forward: he took care of the family and he cared about them
(one of the children got deathly ill and required hospitalization--he apparently
    feels he was benevolent in allowing the child medical care). I believe he
    said something like "I could have killed her and burned her body and
    no one would ever have known".

Having had nightmares about this situation, here are the questions that I would
think might come up in a person's mind while examining the relationships
that make up this family:

Grandchildren to grandmother--why was this OK with you?
Grandchildren to victim mother/daughter--you were powerless. Where does that
leave me? What is going to happen to us now? I had no idea the sky was blue.
Grandchildren to grandfather/father--why did you think this was OK?
Daughter to mother--my having 7 children in a dungeon and giving 3 of them up
for adoption to you was the right thing to do?
Daughter to father--so you believe you are benevolent? What now, since I have
no knowledge of how to care for my family in the real world and I have no
education or job skills?

Since the stated trigger for this horrific case was the daughter's apparent
misbehavior (with parents who punish a child by locking her up, the definition of
misbehaving might need clarification), let's have a discussion about handling
misbehaving children, especially in the teenage years.

(Let me say ahead of time, incest and the pathology behind it, is way beyond the
scope of this entry. Since parenting is a topic that is of interest to my readers,
I will limit the discussion to that topic alone at this point).

Let's think about all the options available for teaching a child how to behave
"properly".

How about positive reinforcement: you do this, I'll give you that. You don't do this,
you don't get that.

Starting young with the Parenting With Love and Logic philosophy of life's
natural consequences and allowing children to feel them early in small doses
while they are safely at home with loving parents.

Negotiating behavior for the big things as kids get older and more capable of
independent behavior: you can have a car but you have to pay the insurance.

Group parenting with other parents of a child's friends who can be eyes and
ears when mom or dad aren't around.

Tough Love approach: you do this forbidden or undesirable thing, you lose
financial or some other type of support--best for older children, I would think.

The Fresh Baked Cookies approach: have a batch of chocolate chip cookies
ready to pop in the oven as the misbehaving child is threatening to run away--
the idea is that the smell of fresh baked cookies would overwhelm the desire to flee.
Theoretically, this would work beautifully with young children. Although this
might sound simplistic, children really like the comforts of home assuming they
are not being abused.

Get professional help if you can't figure it out. There are resources in almost
every community for families with big incomes, little incomes, no incomes.
Get Help.

Love them and smother them with hugs and kisses. It has been reported that
parents tend to stop hugging and kissing their teenagers perhaps because of the
sometimes extreme emotional challenges they present. Teenagers crave
affection like any other child and those who give advice on parenting suggest
parents simply grab them and hug them even as they squirm. They need it.
(Teenagers request that this be done when their friends are safely out of sight).

Doctor Blog--About Choices in Healthcare

DrRima Bishara — Wed, 14 May 2008 17:03:29 GMT

One of my readers sent me a link to this piece by Ted Nugent. It comes
on the heels of the piece on chronic disease. I thought I would include it
to see what you, my readers, think about this topic.

This is, of course, one opinion among many.

Ted Nugent lets his voice be heard.

Doctor Blog--The Cost of Chronic Disease

DrRima Bishara — Sat, 10 May 2008 21:49:19 GMT

I received this communication from Chris who works with the
Partnership To Fight Chronic Disease Blog Outreach.

Chris writes:

I wanted to make sure that you saw this Revolution Health interview with former
Surgeon General Richard Carmona. Dr. Carmona has some interesting things to
say about the costs associated with chronic disease.

Here is the link:
http://www.revolutionhealth.com/blogs/valjonesmd/a-surgeon-generals-o-13214

Thanks.

-Chris

Partnership To Fight Chronic Disease Blog Outreach

Doctor Blog--Mother's Day

DrRima Bishara — Fri, 09 May 2008 07:10:05 GMT

HAPPY MOTHER"S DAY!

Doctor Blog--Quote for the Week

DrRima Bishara — Thu, 08 May 2008 17:51:49 GMT

It is not the cards you are dealt but what you do with them that counts.

Anonymous

Doctor Blog--How to Help Myanmar Cyclone Victims

DrRima Bishara — Tue, 06 May 2008 17:02:27 GMT

The cyclone that hit Maynmar has devastated the region beyond what was
initially reported. There was a storm surge after the cyclone which
contributed to the horrible outcome.

The link below will take you to the most recent information. Approximately
22,000 are estimated dead and 41,000 missing. The area is difficult to reach
and aid has been slow to arrive.  Millions are without shelter.

http://www.msnbc.msn.com/id/24478247

If you would like to help, go to one of the links below.

American Red Cross
International Response Fund
P.O. Box 37243
Washington, DC 20013
(800) HELP-NOW
http://www.redcross.org

InterAction at (202) 667-8227 or http://www.interaction.org. This link lists
multiple agencies that are accepting aid if you have a particular preference
in how to donate.

Myanmar is also known as Burma. Click on the link to get more information
about the country.

Location:

Wikipedia has a great section detailing Myanmar's history, geography, and government.

Doctor Blog--Music and Children

DrRima Bishara — Thu, 08 May 2008 17:51:26 GMT

Hello to my readers.

The past several days have been taken up with multiple events both in and out of town.

I have been slowly putting together information about the importance of music
in a child's life and this can be the first entry to highlight music.

Let me share with you some of the quality that children are capable of producing
given encouragement and time.

This child is 9 years old. She played for and won an international competition and
will be rewarded with a recital in New York.

Click the link below for the performance.
http://www.youtube.com/watch?v=HGMAm-P4vGs

This child is 11 years old. He also played for and won an international competition.
He will be rewarded with a recital in New York, at Carnegie Hall.

Click the link below for the performance.
http://www.youtube.com/watch?v=C90vSI2NR08

Doctor Blog--Never Choke in a Restaurant in the South

DrRima Bishara — Mon, 21 Apr 2008 19:34:07 GMT

The following was forwarded to me by one of my readers. It is priceless.

*****************************************************************

Two hillbillies walk into a bar. While having a shot of whisky, they talk about
their moonshine operation.

Suddenly, a woman at a nearby table, who is eating a sandwich, begins to
cough. And, after a minute or so, it becomes apparent that she is in real distress.

One of the hillbillies looks at her and says, 'Kin ya swallar?'

The woman shakes her head no.

Then he asks, 'Kin ya breathe?'

The woman begins to turn blue and shakes her head no.

The hillbilly walks over to the woman, lifts up her dress, yanks down her drawers
and quickly gives her right butt cheek a lick with his tongue.

The woman is so shocked that she has a violent spasm and the obstruction
flies out of her mouth. As she begins to breathe again, the Hillbilly walks slowly
back to the bar.

His partner says, 'Ya know, I'd heerd of that there 'Hind LickManeuver' but
I ain't never seed nobody do it!'

Doctor Blog--There Comes A Time....

DrRima Bishara — Mon, 21 Apr 2008 19:30:01 GMT

There are patients and then, there are patients you can't forget.

It has been my privilege to care for 2 such patients of mine over the past
several years. This week, I learned again, what an impact illness can have on
a family and the lives around the person who is ill. I also re-learned how
it looks to pass through chronic illness with grace and humor.

One of the patients is the mom. Let's call her A.

The other patient is the daughter. Let's call her B.

B was run over by a car when she was a young child and survived, albeit with
a number of problems, including loss of proper use of her legs, significant
brain damage, and visual problems. She has been well cared for. She lives
alone as an adult with her mom living right next door, available for any issues.
B is now middle aged.

B loves cats of all shapes and sizes and has a great sense of humor. A couple
of months ago, she was confronted by a delivery man while taking her morning
walk in the neighborhood. "Do you like what you see?" he said as he dropped
his pants and underwear in broad daylight.

She describes looking at his groin, then looking him in the eye and saying
"NO!" as she walked away. She thought it was really hilarious that he thought
she might fall to his wiles. He's now in jail...............

Over the past several months, it has become apparent that something is going
wrong. After sub-specialty consultations and testing, it appears B has a
cerebellum that is shrinking significantly. The implications are not good.
There is no treatment.

A, her mom, is now making arrangements to find ways to spend more
quality time with B while she still can. They are two of the most jovial and
centered individuals that I see despite the illness that has challenged them
They never enter nor leave the office with anything other than an upbeat
attitude.

The last visit brought howls of appreciation from B because my nurse was
wearing a Scooby Doo shirt. B loves Scooby Doo. We thought we might
have to have the nurse give up the shirt for a minute there.........

What I appreciate most about these two very special people, is their close
bond and their respect for each other. They are practical and they keep moving
forward. "There is nothing better to do!" is the attitude. And this in the face
of tragedy and challenge.

There are those who deserve a "tip of the hat", a standing ovation, a statue
of some kind to commemorate their lives.

A and B will always have my gratitude and respect for their example and their
ongoing and daily laughter. After all, the tears can fall another time.

Doctor Blog--Medical Insurance for Profit

DrRima Bishara — Mon, 21 Apr 2008 19:19:18 GMT

The past couple of weeks, I've received 2 demands by insurance to
justify the use of hydrocodone for patients over the age of 64.

They say that their data indicates this medication is "not indicated/approved" for the
older population.

This medication is a low level narcotic often used in the setting of chronic pain.
One particular patient has rheumatoid arthritis and has been on this medication
for years. The medication controls the pain so she can perform daily activity.

So, hypothetically, a drug that has a generic formulation, that is effective, and
that relieves suffering and pain, cannot be given to this patient because she has
now become older than 64. Or is it something more sinister, like insurance
trying to nickel and dime customers to death.........literally.

What shall we do with this patient? Push her over a cliff in her wheelchair?

Perhaps medical insurance companies that aim for profits can explain to the
American public what people can look forward to as they get older.

I'm not talking about heart transplants. I'm talking about a generic (cheap) pill.

Of course, Viagra is covered by the same plan.........

Doctor Blog--"What I've Learned" by Dr. Michael DeBakey

DrRima Bishara — Tue, 20 May 2008 09:24:52 GMT

At the age of 99, Dr. DeBakey, the venerable heart surgeon from Houston who pioneered
several procedures that have been life saving for heart patients, reflects on what he has
learned.

I've outlined the article but, for the full text from MSN by Cal Fussman, go to the link below.

http://men.msn.com/articlees.aspx?cp-documentid=6564495&GT1=32001

One of the rarest things that we do is think.

There are questions that I'd like answered.

If world leaders were doctors, I think they would be more concerned with the welfare of people.

In any good society, every member should be interested in the health of every other member.

What advice would I give a doctor preparing for surgery? ....walk into the right operating room.

I've done more than sixty thousand heart operations.... I've been fortunate in that I need
very little sleep.

Okra is the key to good gumbo.

I'm not sure I can answer that question specifically. But ...lots of doctors took the position
that you shouldn't try it. You've got to push ahead in spite of them. I learned that lesson early.

I don't think the difference between ninety-nine and a hundred is important.

I scheduled my last operation when I was ninety.

If you had a heart problem right now and needed an operation and I was the only doctor
around, sure, I'd do it.

The best lesson my mother taught me involves an orphanage we had in town. One Sunday...
she had put one of my favorite caps inside. I immediately protested...She told me I ought
to be glad that I could give up the cap. I never forgot that.

Being compassionate, being concerned for your fellow man, doing everything you can
to help people—that's the kind of religion I have, and it's a comforting religion.

You can never learn enough.

It's important for a patient to go into an operation with confidence.

The worst thing, of course is when the patient dies during the operation. You die a little
every time that happens.

There was a historian in the fourteenth century who wrote a book...the tribes that have
difficulty feeding themselves are lean and healthy, and those that have plenty of food are
fat, lazy, and unhealthy.

People often use words in a loose way that covers over what they're talking about.

The doctor who operated on me only a few years ago was one that I trained.

Never had a symptom. The pain came like a bullet out of the blue.
Part of me was doing a diagnosis on myself—which, as it turned out, was correct. Aortic dissection.

I was a little surprised to find myself recovering after the surgery.

During my recovery, I played possum. Then I'd argue with them about the therapy.

I guess it's hard to be my doctor.

If you’re interested in helping people then consider getting a associate degree in nursing online from one of our accredited healthcare schools such as the prestigious Allied College.

Doctor Blog--Splenda

DrRima Bishara — Sat, 19 Apr 2008 09:14:22 GMT

This week, an older patient came in to have a third degree burn looked at after
having spilled hot coffee on her thigh.

Initially, I thought it was a run-of-the-mill type of problem until I started talking
to her.

She had poured herself a cup of coffee (hot, of course) and, since she sits in
a wheelchair most of the day (she has rheumatoid arthritis), she put the
coffee cup on her thigh to add the creamer and Splenda to it. She was
steadying it with one hand and reaching for the Splenda with the other.

When she poured the Splenda into the cup of hot coffee, it began to foam.
A lot. It foamed enough that it created a volcano effect and her hot coffee
literally exploded onto her thigh.

She started developing blisters almost immediately. Fortunately, her Home
Health Nurse came in at just about that time and was able to give her
First Aid right away.

She told me that she contacted the company that produces Splenda and
they confirmed that this type of thing has been known to happen.

Another friend of hers also confirmed that a similar incident had
happened to her as well.

So, for those of you who use Splenda, you might be very careful when you
add it to a hot liquid. Also, be very careful to keep a hot cup of anything as far
away from skin as possible while preparing the beverage.

Let your friends and family know to take great care.

If you know of any other incidents, please incude them in the comment
section of this entry.

Doctor Blog--Ten Things to Know About Diabetes

DrRima Bishara — Thu, 03 Apr 2008 19:10:54 GMT

Of all the entries I've written, the one on Diabetes and Insulin Pumps has
generated the most comments.

To follow is more information about Diabetes and ten things a diabetic
needs to know to prevent injury to organs and to live a full and
healthy life.

1. There are multiple oral medications now available that can be used to
control sugar levels. Insulin is not a necessity in adult onset diabetes.

2. Insulin is not, as is thought by many lay people, a choice of "last
resort". In certain cases, it is ideal and recommended. When used
in the proper setting and in the proper pattern, it can be the best
thing for a diabetic.

3. The ultimate goal is to control sugar levels and keep them as close
to the normal range as possible. The lower the sugars, the less chance
of end organ damage (end organ being the heart, eyes, kidneys, blood
vessels, nerves, etc.).

4. Diabetics that do the best eat and exercise in a regular pattern.
This poses a challenge for those who prefer a random, spontaneous
existence but can really make the difference between well controlled
or poorly controlled diabetes.

5. A diabetic diet is the best diet for everyone actually. Because our
society in general has developed a taste for rich, fatty foods, it seems
like a sacrifice to cut back on sugar, fat, and salt. But, truth be told,
if everyone were on the balance of foods that diabetics should follow,
we would all be healthier and closer to our ideal weight.

6. Remember portion control. The trick is not only what to eat but
also how much to eat. A quick reference is that the closed fist is a
close approximate serving size for an entree for the owner of the
fist.

7. Always carry something that has sugar in it with you if you are diabetic.
This might sound contradictory to the diet of low sugar but, it is very
important if you are being treated for diabetes because you might
have a too low blood sugar and need access to food instantly. If you
have nothing to eat, you might lose consciousness before you get help.

8. See an eye doctor (MD Ophthalmologist) regularly (at least
once per year) to prevent permanent eye damage. Treatment for
diabetic side effects to the eyes has come a long way in the last
20 years and preventive treatment is much better than salvage
treatment.

9. Ask your doctor or their nurse for information if you don't know.
One of the biggest mistakes diabetics make is assuming that what
is happening to them is just something they have to put up with.
Ask.

10. Be prepared to check your sugars daily, possibly several times
per day while you are becoming familiar with the treatment of
diabetes. Learn how to operate a glucometer and write your
sugars down along with the time you checked the sugar. When
you are still learning how to care for yourself as a diabetic, it can
also be extremely helpful to write down what you ate at a particular
meal so you can compare your intake with the sugar level that
follows.