There are some months that seem to bring challenge after challenge to a doctor's office.
Last month was one of those.  We began with one of the doctors getting sick on a Monday
with nausea, vomiting, and diarrhea.  We were certain that it was related to some food. 
It was awful, of course.  Everyone nursed him along to get through the week.  Everyone
was glad to get to the end of the week.

On Monday, the second doctor came to work and felt somewhat tired but OK to work.  On
the first appointment of the day, she began feeling hot, flushed, and faint.  In the middle of
the first patient visit, she had to sit down quickly to keep from actually fainting.  This scared
both the patient and the nurse.  After finishing the visit, the doctor went to the restroom to
find that overwhelming nausea and vomiting had pretty much neutralized her effectiveness.

One of the nurses had gone home early on Friday for an event with her daughter and noted
that she had spent most of the weekend sick with nausea, vomiting, and diarrhea.  She was
convinced it was from food she had eaten on Thursday until now--didn't sound like anything
caused by food at this point.

Mid morning, an front office staff member announced she was feeling nauseous and faint.
She left at lunch for home.

A Second staff member announced she was not nauseated but was feeling bloated and
over full.  She made it through the day only to find herself nauseated, vomiting and having
diarrhea over night.

By the end of Tuesday, everyone in the office, doctors, office staff, nurses, had been affected by
"the bug".  Needless to say, it was a rough week for the office and our patients in addition.

We did our best, washed hands more diligently than even daily hand washing, and kept
ourselves hydrated as well as we could.

The week was nearly a total loss other than needed medical care.  Chart work piled up,
paperwork went un-done.  Patients got cared for and nearly everything else got put off.

From my heart to yours:  if this hits you, assume it is a "bug" before you assume it is
from food.  One is contagious, one is not.  Do everything you can to prevent transmission
including hand washing, alcohol surfaces, bleach appropriate areas, and eat healthy.

If anyone out there thinks that doctors don't get sick or that doctor's offices are somehow
immune to contagion, think again.  It took the office a couple of weeks to dig out of the
work that piled up during that pitiful week.

Poison Control Centers Warn of Cold Weather Dangers from Carbon Monoxide                                    

(Alexandria, VA):  The onset of cold weather greatly increases the chances for exposure
to poisonous carbon monoxide (CO) gas as consumers increase their use of appliances
such as space heaters and portable generators, warns the American Association of Poison
Control Centers (AAPCC).  Every year, hundreds of deaths and many thousands of illnesses
result from exposure to CO.

Among the numerous potential sources of CO are furnaces, water heaters, stoves, ovens,
space heaters, wood and gas fireplaces, wood-burning stoves, portable generators and
automobile engines.

"All fuel powered engines produce CO gas," explains AAPCC Board Member Edward P.
Krenzelok, PharmD, director of the Pittsburgh Poison Center.  "Although such devices are
safe if used correctly, a malfunction or improper ventilation can make these common
household appliances deadly."  

Carbon monoxide gas is lethal, even though it is colorless, odorless, and tasteless. It
may kill quickly or slowly, and the warning signs specific to carbon monoxide are also
common to the flu and food poisoning. Even when it is not fatal, carbon monoxide can
cause permanent damage to the brain and other parts of the nervous system.  Symptoms
include aches, dizziness, headache, confusion, and other symptoms also found with flu
and typical cold-weather viruses.

AAPCC suggest taking some simple steps to prevent carbon monoxide poisoning:

·   Have all of your combustion appliances and especially your furnace inspected and
adjusted before every heating season.

·   Have your chimney, fireplace, and wood stoves, and flues inspected before every
heating season.

·   Have chimneys and flues repaired as needed.

·   Do not use charcoal grills indoors for cooking or heating.

·   Do not use your oven for heating your home.

·   Do not leave your car’s engine running in an enclosed or attached garage, even if
the door is open.

·   Install a carbon monoxide alarm outside of every sleeping area in your home.

Poison control centers around the country are prepared to respond with information and
treatment advice about CO poisoning.  To reach a local poison center call 1-800-222-1222.  
More information about CO poisoning may be found on the AAPCC’s Website at
http://www.aapcc.org.

Believe while others ..
By William Arthur Ward

Partnership to Fight Chronic Disease ( www.fightchronicdisease.org 
sponsored a conference call Tuesday and below is the response from
The LA Times.

Healthcare System: the next financial meltdown?

http://latimesblogs.latimes.com/booster_shots/2008/09/health-care-sys.html

When Tommy Thompson scans the horizon, here's what he sees.
"The next catastrophe." Thompson is former secretary of Health and Human
Services under President George W. Bush, former governor of Wisconsin, and
former Republican presidential candidate. He held a conference call with
Kenneth Thorpe, former deputy assistant secretary of policy at HHS under
President Bill Clinton and now executive director of the Partnership to Fight Chronic Disease. "Healthcare has the potential of being the next calamity,"
Thompson said.

They're looking for bipartisan solutions to the healthcare mess, the main
solution being to prevent chronic diseases such as diabetes, heart disease
and obesity in a U.S. population that is seeing epidemics in all three.

Those conditions stay with a person for a long time -- or until death -- once
they hit, and chronic diseases eat up 75% of all healthcare costs. That's
three-quarters of the total $2.2 trillion spent on healthcare in the United
States. That comes to $1.65 trillion, if my online calculator serves me correctly.

That's more than two Wall Street bailouts.

America can't wait for another segment of the economy to collapse before
doing something about it, they said. "There's some concern that given the
current state of the economy, taking on healthcare might be too much,
too big," said Thorpe. "I would argue the opposite. Failure to act on the issue
of making healthcare more affordable is a recipe for disaster. This issue is too
important to ignore. As wages slow down and the deficits rise, we've got to
find places in the public budgets and in the private sector to make healthcare
affordable for families and businesses."

They suggest some major redesigns of the system, including the efficiency
of electronic medical records (which Thompson says should be government
funded to speed up their implementation) and a team approach, using nurses,
nurse practitioners and physician assistants, to prevent and control chronic
illnesses.

It's too big an issue, they said, to be anything but bipartisan.

-- Susan Brink

Former Secretary for US Department of Health and Human Services, Tommy Thompson,
published this article as an editorial in the Milwaukee Journal Sentinel.
http://www.jsonline.com/story/index.aspx?id=799679
There is a lot to agree with and think about.

Fighting chronic illness is key to health costs

By TOMMY THOMPSON

Posted: Sept. 27, 2008

These days, trouble on Wall Street and the housing crisis have Congress and the
presidential candidates scrambling for answers to fix our faltering economy.
However, there is one unexpected long-term option that can help our stalling
economy — reforming our health care system through enhanced prevention and
wellness.

Time has shown us the impact that health care costs have on our nation's economy.
Our health care bill has grown faster than inflation and wages. Last year, we spent
more than $2.1 trillion on health care —16% of our gross domestic product and the
highest proportion in U.S. history. At the same time, the disease burden also has grown.
We are sicker than ever. Chronic illnesses, such as diabetes, cancer and heart disease
and related conditions, such as obesity, affect more than 130 million Americans
(more than voted in the 2004 presidential election).

This disease burden costs us in increased absences and lost productivity at work.
However, even during these belt-tightening times, health care is not something we
can do without — and so, we need to explore new ways to stem the rising costs.
We've heard many ideas on how to do this, from universal coverage to price regulation
and supply-side limits on capacity to demand-side proposals, such as health savings
accounts. The problem is that none of these enjoys broad political support nor
effectively limits costs in the long term. Rather, they simply shift costs from one
payer to another.

The main reason health care costs are so high in this country is our chronic disease
burden is high and rising, yet we pay our doctors and hospitals based on individual
incidences of illness. Our payment system is misaligned. We are focused on sickness
and illness when we need to be focused on wellness and prevention.

Our first step must be to arrest the unchecked growth in poorly prevented and mis-
managed chronic illness, which will reduce costs, improve productivity and improve
our health. Chronic diseases and obesity are at the heart of our health care problems,
but they also show the greatest potential for savings. For example, a Trust for
America's Health report found that spending $10 a year per person on chronic disease
prevention programs would save the United States more than $16 billion annually
within five years.

Wellness programs run by employers across the country have shown that prevention
can make a significant impact on the bottom line. Here are some examples from
companies whose investment in prevention is paying off:

• Utilizing health and wellness programs, IBM has driven more than $175 million in
savings to the company, resulting in health care premiums that are 6% to 15% lower
than industry averages, with employees paying 26% to 60% less than industry average.

• In the city of Ashville, N.C., health care costs were reduced by thousands of dollars
per year per employee through an employee education program.

• With a long commitment to the wellness of its employees, the Pitney Bowes Health
Care University program has led to a 5% decrease in costs for participants over three
years vs. a 2% increase for non-participants over the same time period.

This is the direction we need to move; this is our compass. We need to continue and
increase our education of the American people about not only the health benefits
but also the economic benefits of eating healthy, exercising and not smoking. We pay
too little attention to the lifestyle choices we make, and the consequences are
catching up to us. But we can't tell Americans to "get healthy" when healthy food
and fitness options are unavailable, unaffordable or not readily accessible. As a nation,
we need to make sure that we have policies and practices in place that encourage
Americans to make better decisions for their health.

In my roles as governor of Wisconsin and secretary for Health and Human Services,
I have been at the center of a number of important health care debates. In each instance,
while faced with a great challenge, politicians from both sides of the aisle came together
to do what was right.

Instead of retreating in the face of adversity, my experience tells me that we have an
opportunity to advance and help both our economy and our health. By making changes
to how we deliver health care, we can lower costs and improve quality for all while also
improving job productivity and, ultimately, helping our economy.

Tommy Thompson is former Wisconsin governor and former U.S. secretary for Health and
Human Services. He is co-chairman of the Wisconsin chapter of the Partnership to Fight
Chronic Disease ( www.fightchronicdisease.org).

Change of Shift is up at NurseLinkUp, hosted by Keith of Digital Doorway.

http://www.nurselinkup.com/content/view/337/69/

VOTE UNTIL SEPTEMBER 29, 2008.

For those of you who are following Members Project by American Express,
The 3G Project needs your vote to become one of the Top 5 funded projects. 

Please help this very worthwhile and tested project get into the Top 5.

3G has been paired with United Way as the fulfilling organization and
we look forward to implementing it nationwide together!

To vote, go to http://www.membersproject.com/project/view/L889PY .

Only American Express card holders can vote in this phase.





And, for those of you who have already voted for us, a BIG thank you.

On Corpus Christi's North Padre Island area, I have gotten reports from
eye witnesses of a five foot storm surge before Hurricane Ike came
ashore 300 miles north.

Now, nearly one week later, it appears that one of the well maintained
public beaches there has basically been wiped clean by that storm surge. 
The parking lot has disappeared (presumably washed out to sea), the park
benches and shade covers are gone (presumably washed out to sea),
and the peer, which was substantial, is significantly damaged.   The area
where the peer met the beach has been wiped clean of rock tile and that
tile is piled up at the entrance to the beach several yards away.

The sand dunes (the natural barrier for the island) held up well and there
was insubstantial damage to structures on the island.

Additionally, and I find this fascinating, storm debris is showing up on
the beach on North Padre FROM HOUSTON.  How do they know?  Try
finding a piece of furniture with a Houston address on it.  A roof floated
by the beach this morning..............

If anyone has any doubt that they should evacuate with a hurricane
threatening their area, you need to pay attention to what's happening
now, after the storm.  Just an inkling of what it must have been like
during the storm.

 

Ahoy Mateys!

Miss Emily has posted the latest "Talk Like A Pirate" edition of Change of Shift
and aye, it was worth waiting for! You can be checking it out at:

http://crzegrl.net/?p=1357

If you be inclined to link, there be grog for ye all!

Kim
www.emergiblog.com

The daily grind after Hurricane Ike is here to stay with us for some time.

Here's a summary of information from yesterday:

http://www.msnbc.msn.com/id/26695458 news services 9/16/08.

 

Many service stations have no gasoline.

Some major highways remain under water.

More than 30,000 evacuees are still living in nearly 300 public shelters.

Roughly 2 million people in Texas alone are without power.

Ike's survivors have already walked for miles and waited for hours at supply
distribution centers.

1 million bottles of water, 1 million meals and 600,000 pounds of ice in just the
first 36 hours after the storm passed.

"That process will continue 24 hours a day," said Federal Emergency Management
Agency spokesman Marty Bahamonde. "We'll never be empty of trucks at the
staging area and the goal is to never be empty at the points of distribution."

The relief roll-out appeared to defuse tensions that had flared between FEMA
and local officials after Houston Mayor Bill White vowed to hold FEMA accountable
for delivering on its commitments.  

At Texas Southern University, lines of cars stretched two hours or longer
for bottled water and bags of ice.

Well, now the hurricane is gone and we are left with a large city with no electricity,
lots of debris in the roads, lots of people calling for help/rescue who chose to stay.

Personal reports received of families who decided to ride out the hurricane and are
now in dire circumstances.  They can't get out because of blocked roadways or
they didn't plan for enough food/water after.  Some report they will hunker down
with canned food, bottled water and no electricity ("like camping").

Red Cross volunteers are getting a much needed break today from 24 hour mass
care.  There is still plenty to do but, less frantic and slower pace.

New shelters are going up around Houston for "post hurricane mass care".  The
real disaster begins.............

Resources are very low and if you can donate even a few dollars to help with
basics such as food and water,  it will help the American Red Cross provide the material
that the volunteers can distribute to those in need.

Please help.

Thanx.

  

Watched Hurricane Ike coverage until late last night.  Finally went to bed
still not sure how significant the hit would be. 

Red Cross is running 4 shelters in our area alone and thousands of evacuees from
the Texas coast are being fed and cared for here. 

On call for medical issues.  One volunteer injured--in the hospital.

"Hurricane command center" is a room filled with phones and paper/pens and people
making and receiving calls, arranging for meals, emergency care, receiving and
distributing needed items and volunteer time and skill.  Not as chaotic as Hurricane
Katrina or Rita's aftermath but hectic enough. 

Upbeat mood--the really hard work was done earlier in the week.  Now time to
settle into the daily/nightly chores of mass care. 

Waiting to hear how long the evacuees need housing and care--Houston/Galveston
utilities are in the toilet and could be down for days to weeks. 

Friday, friends living on North Padre and Corpus Christi reported early storm surge
and the beach disappeared under water.  Not much structural damage but, wow,
300 miles south of Ike's eye, enough trouble to cause problems on the streets.

Already getting calls for medication refills from people who left in a hurry--running
out of insulin--the pharmacy was closed and couldn't pick up the refill that was
waiting. 

Know three families whose Houston based relatives decided to ride out the
hurricane.  Haven't heard about them.  Hope they're OK.

As many of my readers know, I work with the Red Cross.  I have spent the last
several days receiving and sending messages to and from our dedicated staff
and volunteers as we prepare for the challenge that Ike brings.































Shelters have been set up, there will likely be some medical triage and care to do
this weekend, food and water is being dispatched, and being "on call" for disaster.

Hotels are full in towns all across Texas as those who had the opportunity to leave,
evacuated their homes.  I hope Houston did not make a grave error in judgement
in deciding to evacuate only certain areas of their city.  And, there are a few people
who stayed on Galveston Island to "ride out the storm".  It appears those souls may
end up with houses that are house boats before it is said and done. 

I know a number of families who are either housing evacuees or expect to house
family or friends on their way out earlier in the day.  

I'll try to keep you posted on what the weekend brings.

This feels like Hurricane Katrina/Rita (as our Red Cross personnel named the two
back to back hurricanes when they hit so close together) which means we'll all go
without sleep over the next few days.

My stethoscope and running shoes............yup, they're ready.

Below is a comment from a reader after reading the posts on Divorce and
its impact on children:



I was glad to read your post. As a divorced parent and a step parent I totally
agree that the courts seem to be more worried about making the parents feel
good about themselves, than it worries about what is best emotionally for
the child/children. My step children are in the custody of my husband but had
"liberal" visitation with their mother.

They were evaluated by a psychiatrist a couple of years ago for learning
disabilities and he was appalled by the amount of instability in their lives due
to the visitation schedule.(not to mention that mom does not have them follow
any of the rules from home) I think parents in general want to feel like -if they
don't have custody then they are still a good parent, and if they do have
custody - they want to be seen as being cooperative with the noncustodial
parent. In my opinion, very few people, court included, think about what the
children actually need (not neccessarily what they want).

I was just notified by American Express that The 3G Project was chosen to be
one of the Top 25 Finalists (of 1190 submitted projects) in Members Project.

Those of us who have worked so hard on this project want to express how
honored we are to have been chosen.  We also want to thank all those who
took their time to 1) vote and 2) spread the word about the project.

We could not have done it without each and every one of our voters and
fans.

Now, we go into a second round of voting.  Only those who have (or get)
an American Express card will be allowed to vote during this round.

So, please go to the Members Project site and vote one more time for
The 3G Project.  We are one more round of votes away from funding.

With the funds, we would develop the digital web-based programming
that can be used any where in the world to teach parents, grandparents,
and children how to live healthier lives.

Thank you SO much for your confidence. 

R. Bishara, MD

The majority of men meet with failure because of their lack
of persistence in creating new plans to take the place of those,
which fail.

Napoleon Hill

For those of you who are following Members Project by American Express,
The 3G Project  still needs as many nominations as we can get. 
September 1, 2008 is the last day to nominate. 

Please help this very worthwhile and tested project get into the top 25.

To nominate, go to http://www.membersproject.com/project/view/L889PY .





And, for those of you who have already voted for us, a BIG thank you.

Below is information from a survey on smoking.  Where do you fall on this debate?

In a country where health-and-safety regulations butt heads with civil rights and privacy laws,
smoking is a hot topic. More than 7,000 internet users responded to the first AOL
Health/Health.com survey which asked six provocative questions at the heart of the
smoking debate to find out how smoking is affecting the population.  

Below please find the link and survey results. Please feel free to use the results but if you
do, please credit AOL Health and Health.com. 

http://www.aolhealth.com/condition-center/smoking-cessation/smoking-poll-results 

• Smoking and children: 47% say that smoking in a home or car around children
• should be illegal
• Public smoking: 41% want to see smoking banned in all public places
• Health insurance and smokers: 44% think that smokers should pay more for
• health insurance
• Cigarette taxes: 28% believe that taxes should be raised to make cigarettes $10
• or even $20 a pack
• Smoking in movies: Only 27% wish that all smoking scenes would be banned
• from movies
• Cigarette advertising: 44% think that all smoking billboards and magazine ads
• should be outlawed 

The poll was hosted on AOL Health from August 5 through August 22, 2008 and the
results are posted on both AOL Health (http://aolhealth.com) and Health.com.

                              

The 3G Project has reached over 430 nominations so far and counting.
That puts us at about spot #27 of 1189 projects submitted.

Thank you for all those who have voted to date.

We need lots more votes to go and have until August 31 to do it.

Please nominate this innovative project that could have a global impact.

Also, see the video that describes the project.

                               

Believe in yourself and there will come a day when others will have
no choice but to believe with you.

Cynthia Kersey 


                       

No one would remember the Good Samaritan if he'd only had good
intentions - he had money, too.

Margaret Thatcher

You can also become a fan of The 3G Project on Facebook and help spread
the word about this unique health ed program by asking your network of
friends to vote. Search "3G Project" or click on the following link:
http://www.new.facebook.com/pages/The-3G-Project-Tots-Teach/23288271870?ref=nf

Thank you!

        

At last check, The 3G Project is the top nominated in Texas.  We still
need lots of nominations to make the top 25.  Please, keep nominating
this worthwhile and innovative project.

And, to those of you who have already nominated us, Thank You!



           

I'd like to tell you about a proposal submitted to Members Project. It's called
"The 3G Project" and with your support it could get funding from American
Express. To nominate this project for funding, please go to
http://www.membersproject.com/project/view/L889PY

Members Project is an exciting initiative that brings people together to make
a difference in the world. It's simple. People go online to share ideas for
projects - and ultimately vote on which projects get $2.5 million in funding
from American Express.

In 2007, Members Project provided clean drinking water to children all
across Africa. What will Members Project do this year? The decision is yours.

Please nominate this project.

The first step is to get into the Top 25 Projects nominated.  Then, the top 5
projects, which will receive funding, are to be chosen in September.
Show Your Support By Going Online And Nominating "The 3G Project"
by August 30, 2008.

Go To http://membersproject.com/project/view/L889PY

Children are our future and The 3G Project can help hundreds of families
improve their health.

The New England Journal of Medicine, July 24 issue had another
article on genetic profiling.  This time the article details a bill that was
signed into law by the President forbidding insurance companies from
excluding individuals from their health plan when they have a known
risk factor for a particular disease--that is, a family history or positive
genetic markers for a disease.  Protection is left out of this legislation for
individuals who have been diagnosed with a disease already.

Interestingly, those who have been difinitively diagnosed are those
that are getting medical care and have a better chance than most
at early detection and prevention of advanced or catastrophic disease.

The real question is, how serious are medical insurance companies about finding
disease early and eliminating the possibility of disastrous illness.  Otherwise,
there will continue to be a fear of disease detection by the US population
and the "bottom line" attitude.

It is the opinion of many of my patients (based on their experience with
insurance) that providing access to medical care has not only become
secondary but, that limiting and preventing access to medical care is the
primary goal.  And, ironically, although medical insurance companies are
supposed to be in the business of providing access to medical care, many 
patients feel that because many companies are publicly traded, the
primary goal seems to really mostly be profit making. 

    

I'd like to tell you about a proposal submitted to Members Project. It's called
"The 3G Project" and with your support it could get funding from American
Express. To nominate this project for funding, please go to
http://www.membersproject.com/project/view/L889PY

Members Project is an exciting initiative that brings people together to make
a difference in the world. It's simple. People go online to share ideas for
projects - and ultimately vote on which projects get $2.5 million in funding
from American Express.

In 2007, Members Project provided clean drinking water to children all
across Africa. What will Members Project do this year? The decision is yours.

Please nominate this project.

The first step is to get into the Top 25 Projects nominated.  Then, the top 5
projects, which will receive funding, are to be chosen in September.
Show Your Support By Going Online And Nominating "The 3G Project"
by August 30, 2008.

Go To http://membersproject.com/project/view/L889PY

Children are our future and The 3G Project can help hundreds of families
improve their health.

This reader has several questions about medical school, medicine, and a life
taking care of people.

Thank you AS for asking the questions and giving me the opportunity
to provide some of the answers.

AS writes:

Hello,

I know that you must be busy but I saw this as a great opportunity to get some
much needed information. I am a freshman in college and thus about to decide
where I would like my life to go. I am looking to go into Pre-med, but there are
some questions I was wondering about concerning being a doctor.

One concern I have is that I am very torn between the artistic side of me and the
part that loves science and medicine. I feel that if I choose one, I am giving up
the other and I want to make the right decision. I am very interested in the field,
in the science aspect and also because doctors have been such a help to me when
I seriously ill,  but sometimes I am not sure that I could hold up to the rigorous
demands and schedule of medical school and medicine itself.

I am a very good student and can memorize well, but the prospect of someone's life
resting in my ability to remember information is frightening.

What is the typical schedule a doctor has ( length if shifts, typical hours)? I noticed,
through reading your blog, that you have children. This is encouraging to me
because in the future, I know I may want to have a family but I was very concerned
that becoming a doctor would not leave me any time to be at home. Is it ever
difficult to find free time or family time?

Another question I was curious about is if you had a hard time when you first had
to work the ER. This seems like it would be a very difficult thing to face, not only
because of the sometimes gruesome nature of the situation, but also because of
the need to be able to come up with snap diagnoses.

A final question I have is if you ever had  doubts about your profession during the
hard intern/resident stage or, even now, when things get rough.

Thank you for your time and also for your blog. It is very interesting and a great
way to get a look at a doctors perspective

                                                                           sincerely
                            
                                                                                             A.S.

ANSWERS

1.  With regard to your artistic side, many physicians are artistic.  Many of them
play musical instruments, sing or paint.  That is entirely consistent with what
you will find among other physicians.  Those who are physicians have decided
to make being a doctor their vocation and their artistic side their hobby.  Being
artistic can really help you be a "human" doctor and relate to patients better.
It can also help with the creative side of medicine that requires a doctor to make
decisions with pieces of information that may not look like much to other people.

2.  Yes, training is very rigorous although, in the US, accreditation agencies have
demanded less hours for residents overall.  You will still face many long hours of
work.  I always found that the best policy was to get regular exercise and a good
diet to help keep up my energy.  It really is amazing that if you are dedicated to
what you are doing, you will find the energy.  It is mind over matter.  You will be
fatigued and sometimes sleepy but, most residents have learned how to master
their fatigue and have learned to focus their minds on the task at hand. 

Keep in mind that there is training (internship, residency, chief residency, fellowship)
and then there is being in practice.  These two things are different and the
schedules are different.  Read on.

3.  There are no "typical hours" for doctors.  The great thing is that there are many
settings you can pick from when you start your career today.  And, as far as
having children, make them a priority and you will find the time.  But, make sure
you have a partner who can understand your committment to medicine and
who is willing to share daily tasks (cooking, cleaning, picking up the kids, shopping,
etc. etc.).

Residencies are tough--period.  It is necessary training and you deal with it.

As for real life practice hours, it really depends on the field you choose. 
It also depends on the setting in which you decide to practice.  For example, if you
decide to go into Obestetrics and Gynecology(Babies and Women), your
schedule will depend on when the baby decides to be born.  Most doctors
have partners to share "on call" hours so that they do get a break periodically.
If you are in private practice, you are it if you are on call.  If you work in a large
teaching hospital or large clinic, doctors will usually work "regular days" (that
might start as early as 5-6am and may last until 8-9pm) for 3 to 4 days in a row and
then be "on call"--meaning they are the person to call if a patient has problems
in the overnight hours. 

The more rigorous specialties tend to be surgical (General Surgery, Neurosurgery,
Orthopedics, etc.) because people hurt themselves and can require surgery at
any time of the day or night.

Less rigorous specialties (as far as schedules) might include Dermatology and
Ophthalmology, again, depending on the practice setting.

These days, there is even beginning to be a differentiation of doctors
by whether they practice in hospitals (hospitalists) or in clinics (outpatient care). 
Doctors who work in outpatient clinics see patients only in clinics.  If a
patient needs to be admitted into the hospital, they will arrange for the
hospitalist to care for the patient while they are in the hospital. 

Primary Care (includes Family Practice, Internal Medicine, Pediatrics) is primarily
practiced in clinics now with support from hospital based doctors in most locations.
These specialties usually have fairly predictable hours in this type of setting with
work being mostly 8am-5pm and paperwork time after.

4.  Working in the Emergency Room is only one mandatory rotation during Medical
School.  All residents have to learn to negotiate the ER during Internship and
Residency because that is where many patients come into a hospital.
Your concern of having someone's life in your hands and having to make rapid
decisions is "Hollywoodized".  You would not be allowed to hold that much power
until you have learned to make many decisions on your own.  Also, not everyone
wants to work in the ER unless they want to specialize in Emergency Medicine
(a very stressful field with one of the highest rates of burn out in the medical
profession).  So, don't stress about working in the ER.  It is one experience out
of hundreds that you will have along the way.

5. As far as doubts, read about my moment of doubt in Medical School.
The bottom line is, if you feel it is your calling to be a doctor, you will find solutions
along the way for many of your concerns.  If you are having really grave doubts
about committing, you might consider some other degree in the health
professions that would allow you to care for patients without the extended
and difficult training program of an MD.

Examples might include Physician's Assistant, Nurse Practitioner (for nurses),
Nursing, or one of the "Therapies" such as Physical Therapy or Occupational
Therapy.  All these fields provide patient care but are less rigorous in training
in terms of time spent in school and time spent in residency training.

Good luck A.S.  Let us know what you decide.

Below is a press release about a working group formed to tackle
Medicare reform.  It is self explanatory.

for immediate release

 

CENTURY FOUNDATION ANNOUNCES NEW WORKING
GROUP
ON MEDICARE REFORM

 

Group Featuring Nationally Prominent Physicians
and Public
Health Experts Will Explore Ways to Improve Care
While
Reducing Waste

 

July 22, 2008, New York, N.Y.—The Century Foundation (TCF) today announced
the formation of a new Working Group on Medicare Reform. TCF, a nonpartisan
public policy research foundation, has assembled a group of prominent physicians
and health care experts from around the country to assess the current state of
Medicare and make recommendations to reform and strengthen one of the nation’s
most effective and enduring public programs.

 

The Working Group will be directed by Maggie Mahar, a fellow at the Century
Foundation, author/editor of  the highly respected blog Healthbeatblog.org
(www.healthbeatblog.org), and author of the widely acclaimed book Money Driven
Medicine: The Real Reason Health Care Cost So Much (Harper/Collins, 2006). She
notes that a unique aspect of this panel is its composition. “This Working Group
is composed primarily of physicians and public health officials, because they know
better than anyone what’s wrong with the system and what’s needed to fix it,”
she said. “They also were chosen for this panel because they each have a reputation
for being professionals who put patients first.”

 

Working Group members include:

 

• Christine Cassel, MD

President and CEO of the American Board of Internal Medicine

      and ABIM Foundation

 

• Peter Eisenberg, MD

Medical Director, California Cancer Care

 

• Ezekiel J. Emanuel, MD, PhD

Chair, Department of Bioethics

            National Institutes of Health

     

• Elliott S. Fisher, MD, MPH

Director, Center for Health Policy Research
The Dartmouth Institute for Health Policy and Clinical Practice
Professor of Medicine and Community and Family Medicine, Dartmouth
Medical School
Senior Associate, VA Outcomes Group, White River Junction

• Diane Meier, MD, FACP

            Director, Hertzberg Palliative Care Institute

            Professor, Geriatrics and Internal Medicine,

Mount Sinai School of Medicine, New York

 

• James E. Sabin, MD 
  Director, Ethics Program, Harvard Pilgrim Health Care
  Clinical Professor, Departments of Ambulatory Care/Prevention and Psychiatry,
• Harvard Medical School
    
• Steve Shortell, Ph.D., M.P.

Dean, School of Public Health,

      University of California, Berkeley  

 

• Robert M. Wachter, MD 

Professor and Chief of the Division of Hospital Medicine
University of California, San Francisco
Chief of the Medical Service, UCSF Medical Center
Editor, AHRQ WebM&M (http://webmm.ahrq.gov) and Patient Safety
Network (http://psnet.ahrq.gov)

 

The Working Group will create a blueprint for reform based on recommendations
in the Medicare Payment Advisory Commission’s 2007 and 2008 reports. They
will analyze the recommendations with the goal of refining, explaining, revising, or
adding to them in ways that would strengthen the system. Among the issues they
will consider will be:

 

• revising Medicare’s physician fee schedule to pay more for primary care,
• palliative care, and co-ordination and management of chronic diseases;
• rethinking Medicare’s fee-for-service system to reward doctors for quality,
• not volume;
• creating an independent Comparative Effectiveness Institute that reviews
• head-to-head testing of drugs, devices, and procedures to ensure that they
• are effective; and
• identifying and rewarding hospitals that provide better outcomes and higher
• patient satisfaction at a lower cost while helping other hospitals meet benchmarks.

 

Mahar believes that strong successful Medicare reform could be used as a demonstration
project for national health reform. “As I see it, the larger goal of Medicare reform would
be to show that lower cost and higher quality do indeed go hand in hand,” she said.

 

The Working Group plans to report its recommendations later this year.

 

For more information about the Working Group or for media interviews with Maggie
Mahar, contact Christy Hicks at hicks@tcf.org or 212-452-7723. Read Mahar’s
blog at www.healthbeatblog.org. Learn more about Century Foundation work
in Medicare and Healthcare reform at www.tcf.org or www.healthpolicywatch.org. 

 

 

The Century Foundation conducts public policy research and analyses of economic, social, and foreign policy issues, including inequality, retirement security, election reform, media studies, homeland security, and international affairs. The foundation produces books, reports, and other publications, convenes task forces and working groups, and operates seven informational Web sites. With offices in New York City and Washington, D.C., The Century Foundation is nonprofit and nonpartisan and was founded in 1919 by Edward A. Filene.

                            

Strength is the ability to break a chocolate bar into four pieces with
your bare hands - and then eat just one of those pieces.

 

Judith Viorst

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.

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. 

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.

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

The price of excellence is discipline.

The cost of mediocrity is disappointment.

 

William Arthur Ward

 

Michael Phelps in the 400 IM

                            
                            

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

                                   

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."

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...........

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.

 

                                


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.   

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.

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


                            

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
 

 



    

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."

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.

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.


                           

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

Abraham Lincoln

                        

    

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?

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).

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.