What Important Now?

Emma Watson's UN speech

2014-09-22T19:30:00.001-04:00

The actress launched the “HeForShe” campaign, to call on men to speak up for oppressed women everywhere. Her speech was applauded with a stand innovation, and I hope to follow the progress of her campaign.

Watch Clinic

2014-07-28T21:29:00.001-04:00

Some days I just feel like doing some handiwork and this time I found my watches that needed some fixin'.

I took the batteries out, ordered new ones on amazon.com and replaced a watch bracelet.

Now I have 3 functioning watches.

Ready to be fashionably on time at the hospital!

Intern's first day

2014-07-18T21:22:00.004-04:00

Our everyday fighters

2013-07-31T07:59:00.004-04:00

Rehabilitation patients

Nature's music

2013-06-25T23:10:00.000-04:00

Documentary: The Business of Birthing (2007)

2013-06-21T08:55:00.002-04:00

Rain Man: a look at the autism spectrum

2013-06-12T21:46:00.001-04:00

Learning about death, as a medical student

2013-05-13T01:27:00.002-04:00

The stories I heard the Hospice nurses talk about:

"I saw the two (husband and wife) holding hands while they were sleeping last night"

"Suzie called her hair stylist so she could be blond in her casket, because blondes have more fun."

"Marie tried on several outfits, laid down with her hands crossed upon her chest and asked me (the nurse) for my opinion on her best casket look."

"Peter, has grabs today he was grabbing everyone's asses and boobs"

Many medical schools do not require a rotation in Palliative Care, or they may offer an elective 1 week rotation. I was fortunate to have a required 2 week rotation in Palliative and Hospice Care through which I shadowed the whole hospice/palliative care team.

I have to admit that I was a bit apprehensive about this rotation. I am in my mid twenties, in my third year of medical school and have never seen a person actively dying. I was afraid of how I would react because it was unknown to me. Our social and urban lives have brought us to live apart from our grandparents and death is rarely talked about. Death remains a taboo topic.
I do remember, however, finding my dog actively dying as a child. I must have been around 12 years old. I remember it being summer time with the sun shining bright that day. I went over to pet his flank as he was lying on one side and I suddenly felt something strange underneath his thick leonberger coat of hair. Maggots. My dog and dear companion Mouth (short for Vermouth, pronounced "moot") was letting himself die, and he was being eaten by maggots, alive. Thinking back, he did not seem in any pain, he was just lying calmly on the ground. I remember immediately understanding something was wrong, tears came to my eyes and I ran up to the house to get my parents. My parents took care of Mouth leaving my sister and I in the house. They came back a few hours later to tell us that they took Mouth to the vet and that he was put to sleep because he was dying.

Today, reading a Washington Post article entitled "Our unrealistic attitudes about death, through a doctor's eyes" made me think about my experience during my palliative acre rotation and self reflect on my own experience of death. The article stated that mass urbanization has not been the only thing to alienate us from witnessing death. " In 1850, 70% of white elderly adults lived with their children. By 1950, 21% of the overall population lived in muligenerational homes, and today that figure is only 16 percent. Sequestrating our elderly keeps most of us from knowing what it's like to grow old." With the average life expectancy for the United States being 77.97 years in 2012 compared to 47 years in 1900, modern medicine has "invented old age".

Working in the hospital, I have heard time and times again how families wanted to do everything for their loved one from tracheotomies to putting them on a ventilator or if the patient isn't eating anything starting artificial nutrition through tube feeding. Who could blame them may you ask? The WP article pointed out that "doing something often feels better than doing nothing. Inaction feeds the sense of guilt-ridden ineptness family members already feel as they ask themselves, 'Why can't I do more for this person I love so much?'"

On my gastroenterology rotation, the GI doc told me when he gets consulted for a PEG tub placement he goes to talk to the family and meets the patient and often waits 2-3 days before he places it. Inconsiderate? NO. He told me that through his experience, many of these patients either die in that time span and putting them through this torture is unnecessary.

"Suffering is like a fire: Those who sit closest feel the most heat; a picture of a fire gives off no warmth. That's why its typically the son or daughter who has been physically closest to an elderly parent's pain who is the most willing to let go. Sometimes an estranged family member is "flying in next week to get all this straightened out." This is usually the person who knows the least about her struggling parent's health; she'll have problems bringing her white horse as carry-on luggage. This person may think she is being driven by compassion, but a good deal of what got her on the plane was the guilt and regret of living far away and having not done any of the heavy lifting in caring for her parent." (WP)

"At a certain stage of life, aggressive medical treatment can become sanctioned torture." (WP)

Being a medical student, searching for the right diagnosis, at times makes us forget about our patient. Experiencing a patient actively dying is a humanistic, humbling, one of a kind experience that I am thankful to have had during my medical education. Working with the palliative/hospice care physicians, the nurses, the social worker, the music therapist and reiki volunteer have all made me aware of not only the services that Hospice can offer, but better prepare me as a future physician to open dialogue about their loved one on the taboo topic of death.

"We've committed ourselves to relieving suffering, not causing it." (WP)

The Death of Leonardo da Vinci in the arms of Francis I
Megageot, 1781
Oil on canvas

The Dreaded Rectal Exam

2013-05-07T23:46:00.001-04:00

As I was waiting for a senior resident, I was taped on the shoulder by another resident: "Rectal in room 3" he said. First off, I did not know this resident. Two, I burst out laughing, how couldn't I.
I had overheard from fellow students that the residents used medical students to do all their rectal exams in the Emergency Department (ED). The myths were therefore true.
Although, I would like to think, that I am recruited for this daunted procedure for my dainty little hands and short nails.

Many times, I find myself sliding the curtain to meet the patient for the first time: "Hi, my name is E, I'm a medical student, and I am going to be doing your rectal exam."
Needless to say that the thrill coming from both parties is palpable.
At times, the patient was not even aware that he/she was going to be getting a digital rectal exam...only to contribute to the shock factor.

Just remember: "Get your finger out (!) and get on with it immediately."

[As a side note, ALL my patients are relieved after the rectal and ALL have told me me how it was not as bad as they had though. So for all men starting at age 50, go get your prostate checked! And before you are able to count to 3 it will be over, I swear!]

New Betta Fish!

2013-04-10T22:42:00.002-04:00

One of the secretaries at a family practice clinic gave me this plant, a philodendron, which broke off her larger plant and she had it grow roots. I was super excited to bring home a new plant! She told me that it would be very nice to get a beta fish and put it in with the plant in a vase.

*ponder ponder*

So after I got off of work, I went to Goodwill and found a nice vase for $1, oh yea! Two days later, I walked to the pet store around the corner and bought a betta fish after observing them in their tiny little cups to purchase one that was moving around. I chose a dark blue one and of course named him "Blue".

I have him sitting right in front of my computer to be distracted and relaxed :) Blue has fun swimming around the roots and always tries to squeeze through the narrowest areas. Actually, this betta fish is a lot more active than I had anticipated!

And, if I ever need someone to watch him if I happen to travel, I can just take the vase to them, easy right?

If Men Could Menstruate

2013-03-21T20:56:00.001-04:00

by Gloria Steinem

Living in India made me understand that a white minority of the world has spent centuries conning us into thinking a white skin makes people superior, even though the only thing it really does is make them more subject to ultraviolet rays and wrinkles.
Reading Freud made me just as skeptical about penis envy. The power of giving birth makes "womb envy" more logical, and an organ as external and unprotected as the penis makes men very vulnerable indeed.
But listening recently to a woman describe the unexpected arrival of her menstrual period (a red stain had spread on her dress as she argued heatedly on the public stage) still made me cringe with embarrassment. That is, until she explained that, when finally informed in whispers of the obvious event, she said to the all-male audience, "and you should be proud to have a menstruating woman on your stage. It's probably the first real thing that's happened to this group in years."
Laughter. Relief. She had turned a negative into a positive. Somehow her story merged with India and Freud to make me finally understand the power of positive thinking. Whatever a "superior" group has will be used to justify its superiority, and whatever and "inferior" group has will be used to justify its plight. Black me were given poorly paid jobs because they were said to be "stronger" than white men, while all women were relegated to poorly paid jobs because they were said to be "weaker." As the little boy said when asked if he wanted to be a lawyer like his mother, "Oh no, that's women's work." Logic has nothing to do with oppression.
So what would happen if suddenly, magically, men could menstruate and women could not?
Clearly, menstruation would become an enviable, worthy, masculine event:
Men would brag about how long and how much.
Young boys would talk about it as the envied beginning of manhood. Gifts, religious ceremonies, family dinners, and stag parties would mark the day.
To prevent monthly work loss among the powerful, Congress would fund a National Institute of Dysmenorrhea. Doctors would research little about heart attacks, from which men would be hormonally protected, but everything about cramps.
Sanitary supplies would be federally funded and free. Of course, some men would still pay for the prestige of such commercial brands as Paul Newman Tampons, Muhammad Ali's Rope-a-Dope Pads, John Wayne Maxi Pads, and Joe Namath Jock Shields- "For Those Light Bachelor Days."
Statistical surveys would show that men did better in sports and won more Olympic medals during their periods.
Generals, right-wing politicians, and religious fundamentalists would cite menstruation ("men-struation") as proof that only men could serve God and country in combat ("You have to give blood to take blood"), occupy high political office ("Can women be properly fierce without a monthly cycle governed by the planet Mars?"), be priests, ministers, God Himself ("He gave this blood for our sins"), or rabbis ("Without a monthly purge of impurities, women are unclean").
Male liberals and radicals, however, would insist that women are equal, just different; and that any woman could join their ranks if only she were willing to recognize the primacy of menstrual rights ("Everything else is a single issue") or self-inflict a major wound every month ("You must give blood for the revolution").
Street guys would invent slang ("He's a three-pad man") and "give fives" on the corner with some exchenge like, "Man you lookin' good!"
"Yeah, man, I'm on the rag!"
TV shows would treat the subject openly. (Happy Days: Richie and Potsie try to convince Fonzie that he is still "The Fonz," though he has missed two periods in a row. Hill Street Blues: The whole precinct hits the same cycle.) So would newspapers. (Summer Shark Scare Threatens Menstruating Men. Judge Cites Monthlies In Pardoning Rapist.) And so would movies. (Newman and Redford in Blood Brothers!)
Men would convince women that sex was more pleasurable at "that time of the month." Lesbians would be said to fear blood and therefore life itself, though all they needed was a good menstruating man.
Medical schools would limit women's entry ("they might faint at the sight of blood").
Of course, intellectuals would offer the most moral and logical arguements. Without the biological gift for measuring the cycles of the moon and planets, how could a woman master any discipline that demanded a sense of time, space, mathematics-- or the ability to measure anything at all? In philosophy and religion, how could women compensate for being disconnected from the rhythm of the universe? Or for their lack of symbolic death and resurrection every month?
Menopause would be celebrated as a positive event, the symbol that men had accumulated enough years of cyclical wisdom to need no more.
Liberal males in every field would try to be kind. The fact that "these people" have no gift for measuring life, the liberals would explain, should be punishment enough.
And how would women be trained to react? One can imagine right-wing women agreeing to all these arguements with a staunch and smiling masochism. ("The ERA would force housewives to wound themselves every month": Phyllis Schlafly)
In short, we would discover, as we should already, that logic is in the eye of the logician. (For instance, here's an idea for theorists and logicians: if women are supposed to be less rational and more emotional at the beginning of our menstrual cycle when the female hormone is at its lowest level, then why isn't it logical to say that, in those few days, women behave the most like the way men behave all month long? I leave further improvisation up to you.)
The truth is that, if men could menstruate, the power justifications would go on and on.
If we let them.

(c) Gloria Steinem, Outrageous Acts and Everyday Rebellions. NY: NAL, 1986.

Birth Culture through Photography

2013-03-10T17:20:00.000-04:00

I just started my obstetrics and gynecology rotation, and I look forward to helping deliver a newborn! Here are visual perspectives of birth culture and experiences around the world offering a compelling use of photography.

Birth Culture

Cultural expectations and practices of birth vary around the world.

http://www.nytimes.com/slideshow/2013/03/09/opinion/sunday/20130310_EXPOSURES-ss.html?smid=pl-share

Engraving Class: artists in the making

2013-03-10T11:24:00.002-04:00

My mama and I took an engraving class in France. As we sat down in "an atelier" we observed all the prints on the wall around us. Our professional engraving teacher had explained all the different techniques and their results in print done by other advanced students in the studio. So many different styles, so many ways to superimpose for different print results.

A plate of zinc was put in front of us; let the drawing begin!

Me: "Mama, I'm going to draw a naked woman."
Mama: "Ooooh, OK...."

It was a lot of fun as we got to learn and take part in the whole process and even take our prints home at the end of the class! Here are some pictures of artists in the making.

Our engraving teacher

Mama concentrated

Drawing

Acid wash

Layering for the printing process

Printing!

Ta da!

Eating Healthy for Better Skin

2013-03-06T10:04:00.002-05:00

In my battle against acne in my mid 20s, I am turning to a change in diet! Stress from medical school, bad hours during surgery and 2 months of out-rotations had me turn to hospital and on the road comfort foods such as chicken fingers, Mc Donalds fries and burgers...I am guilty!
After scrubbing in on open surgery cases and being fascinated with gut peristalsis (motility), I do want to reward my gut with good HEALTHY things :)

Time to detox!

Let's see how the internet can help one chose wisely at the grocery store, and how one can incorporate new items in their daily diet. Here are the top 5 links when doing a google search for "diet for good skin".

"Recent studies show that high-glycemic foods such as refined grains and processed sugars–the mainstays of a typical Western diet–may, in fact, trigger breakouts.

Here’s the problem: High-glycemic fare such as french fries, breakfast cereal, white bread, and soda boost blood sugar too quickly–and the pancreas responds by making extra insulin to bring those sugar levels down. As an unintended consequence, the insulin also signals the sebaceous glands to manufacture and secrete sebum, the oil-like substance that’s carried to our pores via hair follicles. In proper quantities, sebum is a good thing; it flushes out dead cells and keeps your skin lubricated. But too much causes the bacterium P. acnes to over-propagate and jam up the hair follicle. The result? Whiteheads and blackheads on your forehead, chin, and cheeks.

In addition, what Americans don’t eat may prove equally problematic for their skin. For instance, with 97 percent of our grain intake coming from processed rather than whole grains, we don’t get enough of the fiber, zinc, and vitamin B6 that can help curb acne. And the vast majority of US adults fail to get their daily allotment of fruits and vegetables–seven to nine servings–leading to a shortage of blemish-blocking vitamins and antioxidants. Overconsumption of omega-6 fatty acids from processed foods and vegetable oils, coupled with too little of the anti-inflammatory omega-3s found in salmon, walnuts, and flaxseeds, compounds the problem, since inflammation (already implicated in heart disease, diabetes, and prostate and breast cancers) may very well damage our largest organ, the skin, as well.

4 acne-zapping foods

1. Whole grains. When it comes to thwarting acne-causing inflammation, fiber-packed whole grains work like a charm. “Whole grains carry a lot of antioxidants,” says Logan. “They also stabilize blood sugar and prevent insulin spikes.” But be careful when perusing grocery store aisles for whole-grain items–crafty label lingo can make a loaf of bread or box of pasta seem like a healthy choice, when in reality it carries only a small percentage of whole grains. Logan advises checking a product’s nutrition info to make sure it’s high in fiber and low in sugar. Even better: Forget wheat and give ancient grains like quinoa and millet a try.

2. Fish. Heralded as the premiere source of omega-3 fatty acids, cold-water, oily fish are loaded with anti-inflammatory eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). The Clear Skin Diet lauds oily fish such as mackerel, salmon, anchovies, and sardines as the most potent choices for blemish-free skin.

3. Green vegetables. Packed with inflammation-fighting nutrients and loads of antioxidants, most green leafy veggies contain plenty of fiber, which helps slow the rise of blood sugar after eating.

4. Purple and deep red foods. According to The Clear Skin Diet, foods containing anthocyanins are high in antioxidants and help maintain blood flow to the skin, promoting optimum cell turnover (essential for keeping pores clear). Acai, pomegranates, purple carrots, black grapes, and beets are all great choices.

Proven complexion perfecters

Pile these on your plate. All pack nutrients essential for healthy skin.

Strawberries, citrus fruits, red peppers, broccoli

Beauty benefit: a smooth texture

Eat-right evidence: Vitamin C, plentiful in this produce, is vital for the production and formation of collagen, skin's support structure, says Toby Amidor, R.D., director of nutrition for DietTV.com in New York City. And a strong support layer helps smooth what's on top and prevent wrinkles, she says. Aim for: two 1-cup servings of fruit and 1 cup of red peppers and/or broccoli a day

Sunflower seeds and almonds

Beauty benefit: sun protection

Eat-right evidence: These seeds and nuts are loaded with vitamin E. Collectively, antioxidants act like an army, protecting skin from UV-spawned free radicals. But E is on the front lines; skin's top layers contain high levels that guard cells' outer membrane so cells stay healthy. Plus, strong membranes hold water in, keeping skin hydrated. Aim for: 2 tablespoons hulled seeds or 23 almonds daily

Dark orange, leafy green and red veggies

Beauty benefit: a fresh complexion

Eat-right evidence: Squash, sweet potatoes and spinach are full of the antioxidant beta-carotene. Your body converts it to vitamin A, which regulates cell production and turnover so skin's surface is smooth, says Valori Treloar, M.D., coauthor of TheClear Skin Diet (Cumberland House Publishing). Carotenoids may also decrease skin's sensitivity to sun. Aim for: three 1-cup servings a day

Fortified cereal, lean meat, pork, poultry, oysters

Beauty benefit: a youthful glow

Eat-right evidence: You'll get zinc and iron, minerals key to skin functioning. Zinc contributes to cell production, plus natural cell sloughing, which keeps dullness at bay. Red blood cells need iron to carry oxygen to skin, helping give you a glow, says David Bank, M.D., a derm in Mount Kisco, New York. Aim for: 1 serving of cereal (a cup), 1 palm-sized serving of meat or poultry or 3 oysters per day

Water

Beauty benefit: dewy skin

Eat-right evidence: Skin cells contain mostly water, and if you're dehydrated, skin will look and feel parched, too. But you needn't chug 8 cups a day; University of Pennsylvania researchers found no studies to back up the recommendation. Simply ward off dehydration—and dryness—by drinking when you're thirsty. Aim for: 6 cups a day. It's a good starting point, says Keri Gans, R.D., of NYC.

Smart skin suggestions

New research hints at these foods' beauty power, but effects aren't totally proven yet. No need to wait, though; the goodies are part of a healthy diet.

Wild salmon, Atlantic mackerel, walnuts

Beauty benefit: fewer wrinkles

Eat-right evidence: These fish and nuts, plus fortified eggs, are bursting with omega-3 fatty acids, which fight inflammation in the body caused by sun and stress. "Inflammation produces free radicals, and free radicals contribute to aging by attacking collagen," says Susan Taylor, M.D., a dermatologist in Philadelphia. But research still needs to connect the dots definitively and show that the anti-inflammatory abilities of omega-3s translate to younger-looking skin, she says. One study did find that older people who consumed more fish and veggies over their life had fewer wrinkles than those who ate more meat, the Journal of the American College of Nutrition reports. The research didn't focus solely on fish, however; vegetables' antioxidants, for example, may have been a factor. Aim for: two 5-ounce servings of fish per week; on other days, 1 oz of walnuts or 2 omega-3 eggs

Whole wheat and grains

Beauty benefit: clearer skin

Eat-right evidence: In the past, derms have maintained that unless you wipe greasy fingers on your face, food doesn't cause zits. But some are rethinking the party line: Australian researchers found that a low-glycemic diet (more whole grains, protein and produce versus refined carbs such as white bread) may reduce acne. One explanation: Low-glycemic foods keep insulin steady, and refined carbs and sugar spike it. The surges may boost production of androgens, hormones that, when elevated, can cause zits. After 12 weeks of a low-glycemic diet, subjects' pimple counts dropped 20 percent, a study in The American Journal of Clinical Nutritionnotes. More studies are needed to prove the link, but no doctor will discourage you from eating whole grains and veggies! Aim for: 3 servings a day (one serving equals a slice of bread or 1/2 cup cooked grains)

Today's special: gorgeous skin If your complexion could choose everything you ate for the day, here's what would be on the menu, says Keri Gans, R.D., who put together this plan.

Breakfast

1 cup whole-grain, fortified cereal such as Total
1 cup skim milk
1 cup sliced strawberries or 1 medium grapefruit
1 cup green tea

Lunch

Grilled chicken sandwich
5 oz chicken breast
2 slices whole-grain bread
2 slices tomato
1 leaf lettuce
1/8 of avocado
1 tsp mustard
1 medium apple

Dinner

5 oz wild salmon
Spinach salad
2 cups fresh spinach
1/2 cup sliced red bell pepper
1/2 cup chopped tomato
1/2 cup broccoli
Toss with 1 tbsp each olive oil and balsamic vinegar
1 medium baked sweet potato

Snacks/dessert

8 oz nonfat plain yogurt or 1 part-skim string cheese
1 oz sunflower seeds
1 small orange or 1 cup baby carrots
1 oz dark chocolate or 1 glass red wine

Beauty treat or trouble?

Guess if the following foods are good or bad for your skin—and find out the reasons why.

Sweets

Trouble Chowing candy and other sugary snacks may make you feel like a kid, but it's likely aging you. The rush of glucose into your bloodstream sets off a process known as glycation, in which sugars attach to proteins and form advanced glycation end products (AGEs). These molecules naturally build up in skin as you get older, but the more sugar you eat, the more AGEs you have. Bad news: They cross-link with collagen and elastin fibers, making the normally resilient tissues weak or inflexible, Dr. Bank says. And skin that doesn't bounce back easily leads to wrinkles and sagging. In fact, the study showing fish lovers had fewer wrinkles revealed the opposite for those with a sweet tooth.

Dark chocolate

Treat Although there might be some truth to the claims that sugar-laden chocolate contributes to acne (and wrinkles), the high-quality, dark variety—70 percent or more cocoa—may actually be good for your skin. Preliminary studies found that cocoa's flavonols (a potent type of antioxidant) can help increase blood flow, supply skin with oxygen, improve skin hydration and reduce sun sensitivity. But dark chocolate is high in calories, so treat yourself to only 1 oz a day.

Milk

Trouble Got acne? Milk may not be doing your skin good. Three new studies have found a connection between teens' milk intake and pimples. This could potentially translate to adults; however, it's not been proven. More research is under way, but the probable explanation is hormone-related. Androgens naturally found in milk (even organic versions without added hormones) may add to a drinker's own level of androgens, which are associated with oily skin and acne. Milk also raises insulin levels and contains growth factors that act like insulin, Dr. Treloar says. Both may lower the production of molecules that bind to and deactivate hormones—meaning there may be more free-roaming androgens able to cause pimples. It's too early to prescribe a dairy ban for anyone zit-plagued. But it may be worth experimenting with a milk-free diet if you have excessive, stubborn breakouts, Dr. Treloar says. (Be sure, however, to take a calcium supplement with vitamin D.)

Spicy foods

Trouble Rosacea sufferers know to avoid five-alarm meals. But if you have fair, sun-damaged skin, hot-and-spicy foods may lead to the condition or to a red, blotchy complexion. "UV exposure weakens blood vessel walls. If your skin then repeatedly flushes, which swells vessels, they may not be able to shrink back down," Dr. Treloar says.

Wine

Treat Reds are rich in polyphenols, antioxidants that help fight skin-damaging free radicals. But sip no more than one glass a day, says Katherine Brooking, R.D., of NYC. Excessive alcohol halts your body's release of its antidiuretic hormone. As a result, you make extra visits to the ladies' room and end up not only feeling dehydrated, but having skin that looks dry, with a dull tone and more visible wrinkles. So enjoy wine in moderation—and make a toast to great skin!

Clear skin diet: Foods that bring acne relief

To eliminate blemishes, you'll want to drink more water, eat more vegetables, stay away from fried foods and alcohol and opt for foods rich in Omega-3 fatty acids.

Besides the obvious like more water and vegetables, what else can help my skin?

Some people who suffer from acne and other skin disorders have poor digestion, especially with dietary fats, which may cause skin pores to clog. Taking dietary supplements like digestive enzymes and apple cider vinegar may help. Aloe vera juice also helps with digestion as does supplementing with zinc and B vitamins.

Also, azealaic acid cream is well-known in alternative medicine circles for being a highly effective antimicrobial.

Distribution of Wealth in North America

2013-03-05T19:48:00.001-05:00

WHAT WE THINK, what we project it to be ideally, AND WHAT REALITY REALLY SHOWS US...

Breast Cancer Ad

2013-03-05T17:51:00.002-05:00

And to please the ladies a breast cancer advertisement that features hot guys. Just like we like them! Good marketing twist, however.

A Billboard makes Water through Osmosis in Peru

2013-03-04T18:50:00.001-05:00

Without You (Sahel Hunger Crisis) - David Guetta ft. Usher

2013-03-01T22:23:00.002-05:00

Health CheckUp's by the Decade

2013-02-02T15:00:00.000-05:00

The Perfect Dump

2013-01-26T20:52:00.000-05:00

Do you talk about your poop? Have you ever taken a picture of your poop? I can answer yes to both of these questions, yep yep.
I remember one time, a guy friend of mine admitted he could not take a dump in public bathrooms and would seek out the, one, isolated bathroom in the building in order to be in peace while he did number 2. But that wasn't it: he would also extract himself from one pant leg in order to adopt a wide stance.

Anyhow, what I have truly enjoyed during my month on gastroenterology is the way patients describe their excrement; in a medical setting.
As excrement goes by many names and curse words in every language, I wanted to share how my patients have described their poop to me.

Here is goes: "my stools are...

regular
loose
formed
bloody
chunky
pearls
hard
mucousy
blood tinged/streaked
tarry
stick to the bowl
accompanied of bright red blood
hurt
sink
amorphous
explosive
tan in color
float
odorous
on a schedule: "between 3-4pm and 9-10pm"
different shades of brown
intermittently hard and soft
skinny

The better you keep track of your bowel movements, the more information you give your doctor helps in determining what is going on. So no need to be shy. Pooping and passing gas are normal and healthy, and healthy digestion is mirrored by healthy bowel habits! Have I said the word health enough?

Some people use excrement to build homes, some animals use it to mark territory or attract prey, some people paint with it or recycle it as fertilizer. Our waste product is more than important for proper sanitation and to keep diseases from spreading. Now let's be polite and talk about our poop!

No more wasting water with each flush!

Article: Young tech-savvy docs want a real life, but don't call them slackers

2012-12-26T19:03:00.001-05:00

'Not without my iPad': Young tech-savvy docs want a real life, but don't call them slackers

BY LINDSEY TANNER, THE ASSOCIATED PRESS SEPTEMBER 2, 2012

ADVANCE FOR USE MONDAY, SEPT. 3, 2012 AND THEREAFTER - In this Tuesday, Aug. 14, 2012 photo Leana Wen, of Boston, who is doing her medical residency in emergency medicine at Harvard-affiliated Brigham and Women's Hospital and Massachusetts General Hospital, stands in front of a bed in the emergency department at Brigham and Women's, in Boston. Wen chose emergency medicine because the hours are more flexible than those of primary care physicians. (AP Photo/Steven Senne)

CHICAGO - Don't call today's young doctors slackers.

True, they may shun a 24/7 on-call solo practice and try to have a life outside of work.

Yet they say they're just as committed to medicine as kindly Marcus Welby from 1970s TV, or even grumpy Dr. House.

The practice of medicine is in the midst of an evolution, and millennial and Gen X doctors seem to be perfectly suited for it and in some ways may be driving it. The federal health care law is speeding some of these changes, too.

"It's a fortunate accident," said economist and health policy expert Robert Reischauer. "The two will reinforce each other."

These doctors embrace technology and teamwork. They like electronic medical records and smartphone apps. And they like sharing the load with other doctors on the team.

Emal Nasiri and Leana Wen are part of the new breed.

Nasiri, 32, is a medical resident at the University of Oklahoma in Tulsa. He likes the idea of working in a large health plan group where doctors, specialists and other medical staff work as teams, with easy access to patients' electronic medical records. That kind of setup is more likely to be "wired" than smaller practices, and Nasiri can't imagine working without his iPad.

"The older guys carry around little pharmaceutical books" when going room-to-room visiting hospitalized patients, Nasiri said. He thinks that's less efficient than being able to quickly view patients' electronic charts and online drug information.

Wen, 29, will soon finish a residency in emergency medicine at Harvard-affiliated Brigham and Women's Hospital and Massachusetts General Hospital. She's also a newlywed whose husband is an information technology project manager.

"I want to have a balanced life that includes having time for my family," she said.

She chose emergency medicine because the hours are more flexible than those of primary care doctors. That will allow her to work part-time in the ER and follow her other passions — teaching, research, writing and blogging about empowering patients to get the best medical care.

Wen finds her smartphone as handy as her stethoscope. Its apps help her quickly figure out proper medicine doses for critically ill patients, or translate medical instructions for Spanish-speakers. That means she doesn't have to wait for a hospital translator to arrive, and she thinks it makes patient care safer.

She says those who call doctors with outside interests less committed have "a fairly limited world view."

"We need doctors who 'just' practice medicine, but we also need these other doctors who can improve medical care on the larger scale. It is also better to have those taking care of you to take care of themselves and their families, so I would argue that it is a healthier ... and in some ways, more balanced workforce that is emerging," Wen said.

Dr. Darrell Kirch, president of the Association of American Medical Colleges, thinks these new doctors have a broader view of medicine and life than their predecessors, and calls that a positive trend. "I see no evidence that indicates that their ethical commitment is any weaker, that they care any less for patients," he said.

When Kirch graduated from medical school 35 years ago, he envisioned starting a small solo practice, like many of his peers. A mentor steered him into research and work at an academic medical centre. But that was not the norm.

"A typical model was of a male physician who plunged into medicine and was supported in doing that by a totally supportive spouse or partner who often gave up any work aspirations of their own," he said.

Newer doctors often have working partners and both share responsibility for raising children or caring for elderly parents, he noted.

Consider some statistics:

— When Kirch graduated in 1977, only about 20 per cent of medical school graduates were women; now nearly half are.

—1 in 5 male doctors and 44 per cent of female doctors employed by medical groups worked part-time last year, according to an American Medical Group Association survey. That compares with just 7 per cent and 29 per cent respectively in 2005.

—New doctors in their first year of medical residency training can no longer work 24-hour shifts. Since last year, they've been limited to 16-hour shifts. Stricter limits began in 2003, cutting residents' maximum weekly hours to 80, to improve grueling schedules and reduce medical mistakes.

— A 2011 survey of final-year medical residents conducted by national physician recruitment firm Merritt Hawkins found that only 1 per cent wanted to work as solo practitioners, running their own small medical offices.

—Rising numbers of medical school graduates are seeking training programs in high-paying specialties offering flexible hours; emergency medicine and anesthesiology saw some of the biggest increases in this year's medical resident match program.

Those two specialties are popular among young doctors, who on average face more than $150,000 in medical school debt. The others are radiology, ophthalmology and dermatology, all offering better pay and work hours than primary-care medicine.

Also rising in popularity are hospitalists, a specialty that didn't even exist a generation ago. For decades, internists and other primary-care doctors have typically provided part-time care for their patients when they were hospitalized. Increasingly, hospitalists have taken over those duties full time. They often work several 12-hour shifts in a row, with an equal number of days off — the so-called seven on-seven off model.

Dr. John Schumann runs the internal medicine residency program at OU-Tulsa; among the 14 young doctors who finished the program last year, nine became hospitalists, Schumann said.

Nasiri, the tech-loving resident, is also considering hospitalist work.

He's getting married in November and says the long stretches of time off would be more family-friendly and allow him to pursue hobbies, including snowboarding.

He views technology as improving efficiency so that "spending less time doesn't necessarily mean less dedication or worse patient care. More experience with years doesn't necessarily mean better doctors if the older generation isn't keeping up with newer treatment modalities and approaches to patient care."

Kirch, of the medical college association, agrees. When he visits campuses and asks students how they differ from his generation, "they almost always point to the readiness with which they embrace technology."

He's noticed another trend on those visits. Schools used to show off vast medical libraries, "taking pride in how many volumes were sitting on the shelves," Kirch said.

Now, less is more. At one of the newest medical schools, the University of Central Florida in Orlando, "they point with pride to one small room near the entrance, and in that room they hold the books and journals that cannot be accessed online." Their goal, Kirch said, is for that room to be empty.

___

Online:

American Association of Medical Colleges: http://www.aamc.org

National Resident Marching Program: http://www.nrmp.org

WakaWaka Power

2012-12-12T16:24:00.002-05:00

Brad Pitt-- first Man to represent N 5 of CHANEL

2012-12-11T18:53:00.004-05:00

ADHD in Pediatrics: Are we overmedicating our youth?

2012-12-09T12:02:00.000-05:00

During my Family Medicine and pediatric rotation, I saw many teenagers coming n with the same story about their lack of concentration in school and performing tasks. In the pediatrician's office parents came to complain about their young aged children not being able to sit down and concentrate on their homework for the day. Only the pediatrician I shadowed distributed the the Vanderbilt questionnaire to both the parents and educators. With this questionnaire the physician can tell if there are any discrepancies between the behavior of the child at school and in the classroom and this helps to classify this behavior as hyperactive, attention deficit, a mix of both attention deficit and hyperactive disorder (ADHD) or oppositional defiant disorder (ODD).

As everyone knows, children can have very different behaviors at school and at home. Therefore, getting both parents' input from both mom and dad AND the educator will help in the diagnosis of the child's disorder.

An interesting study came out this week in the NIH of MENTAL HEALTH journal:
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Science Update • December 03, 2012

Psychotropic Medications Are Prescribed Appropriately Among U.S. Teens, National Study Finds

Prescribed psychotropic medications are not being misused or overused among U.S. youth, according to a study using nationally representative data sponsored by NIMH. The study was published December 3, 2012, online ahead of print in the Archives of Pediatric and Adolescent Medicine.

Background

Source: iStock Photo

Psychotropic medications affect the brain chemicals associated with mood and behavior. Some studies and media reports have raised concerns about their use among youth. However, much of the concern stems from information found in anecdotal reports, small clinical samples, or insurance databases rather than on representative samples of U.S. youth with clinical assessments of emotional and behavioral disorders. Studies from regional community samples have found widely varying rates, which can lead to skewed perceptions. For example, different studies have found a wide range of stimulant medication use for attention deficit hyperactivity disorder (ADHD)—from 7 percent to 72 percent—likely due to methodological and regional differences. As a result, it has been difficult to get a clear, accurate understanding of medication use among youth.

Kathleen Merikangas, Ph.D., of NIMH and colleagues collected information on specific medication use in the National Comorbidity Study-Adolescent Supplement (NCS-A), a nationally representative, face-to-face survey from 2004 of more than 10,000 teens ages 13 to 18.The teens were asked questions that helped to ascertain information about mental disorders and service use. A previous report published in October 2010 using data from the NCS-A indicated that about 20 percent of U.S. youth are affected by some type of mental disorder during their lifetime serious enough to affect their functioning. In this most recent analysis, the researchers examined patterns of prescribed medication use among youth who met criteria for a wide range of mental disorders. Psychotropic medications that were examined include antipsychotics, antidepressants, and stimulants.

Results of the Study

Among those youth who met criteria for any mental disorder, 14.2 percent reported that they had been treated with a psychotropic medication. Teens with ADHD had the highest rates of prescribed medication use at 31 percent, while 19.7 percent of those with a mood disorder like depression or bipolar disorder were taking psychotropic medication. Among those with eating disorders, about 19 percent were taking a psychotropic medication, and 11.6 percent of those with anxiety disorders reported taking medication. Very few youth reported use of antipsychotic medications. They were most frequently used by youth with severe bipolar disorder (1.7 percent) or a neurodevelopmental disorder such as autism (2.0 percent).

Approximately 2.5 percent of teens without a diagnosed mental disorder were prescribed a psychotropic medication. Among these youth, 78 percent reported having a previous mental or neurodevelopmental disorder and associated psychological distress or impairment.

Significance

The data suggest that most adolescent youth who are taking psychotropic medications have serious behavioral, cognitive or emotional disturbances. The findings also showed that youth being treated by a mental health professional were more likely to be receiving appropriate medication as opposed to those being treated within general medicine or other settings. However, more research is needed on medication use among children younger than age 13.

Reference

Merikangas K, He J, Rapoport J, Vitiello B, Olfson M. Medication use in US Youth with Mental Disorders. Archives of Pediatric and Adolescent Medicine. Online ahead of print Dec 3, 2012.

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Are we undermedicating our children??? Is medication the solution to getting our children's behavior under control?

OR Are there any other ways to channel our children's energy?

Yet, just last year, there was a shortage of ADHD medicine available...

My geriatrics rotation

2012-12-06T22:31:00.001-05:00

Drawing by Emilie Prot