Prior Authorizations, Drug denials, and Big Brother IS Watching.

This is a rant.

Doctors are getting inundated with prior authorization forms for prescription drug refills this year.

• Drug companies are limiting the number of pills per month, even if the pill doesn't come in the right dosage and the patient has to take two pills a day or the larger dose is too big to swallow, so they need to take 2 smaller pills.  They will only approve one pill a day unless you get prior authorization. Prior Authorization is a form the doctor has to fill out, reviewing ALL the other medications you've ever taken in that class, and why you have to have that specific drug in the quantity you need it. 
• Drug companies are denying certain generic drugs now, in favor of OTHER generic drugs.
• Drug companies are sending us lots of letters for patients whose drugs will no longer be covered in 2016 with suggestions on which drugs to change them to. 
• Insurance companies send us letters telling us that our patients aren't taking their drugs as prescribed based on refill pick ups. I get those in big envelopes with 10-20 patients to review.
• insurance companies are sending us reminders that our diabetic patients should be on a certain type of blood pressure pill and on statin drugs, without understanding the nuances of the patient's medical problems. Sometimes you just CAN'T for a MYRIAD of reasons.
• Insurance companies are driving us NUTS. 

If you think big brother isn't watching, think again. 

I suspect that in the future, patients will be held responsible for a larger premium or portion of their bills based on adherence to therapy, medications, weight loss, diet and exercise and follow up appointments. 

I have to prove that my Medicare diabetics are checking their sugars by having a copy of their blood sugar logs in the chart

I have to fill out a form giving the diagnosis, diagnosis code, and last Hemoglobin A1C and justify why my Medicare patient is testing their blood sugars more than once or twice a day.

If a Medicare patient is getting home care, I have to fill out a "Face to Face Encounter Form" on which I need to explain the LAST office visit (within 90 days of start of therapy) and why the patient is home bound. Then, the latest slap in the face is that they don't BELIEVE us that we saw a patient on such and such a date. We now have to send a COPY OF THE LAST NOTE with the form. 

I understand that fraud is prevalent. I've reported it myself. Home Care is rife with fraud. It drives me NUTS that the doctors who are honest and hard working are getting buried by paperwork. It is MADDENING!

I am part time. 

I spend at least 15-20 hours a week doing paperwork. This is in between seeing patients in the office, going to the hospital, and making the occasional home visit. 

I don't get paid for paperwork or phone calls. 

A lot of the paperwork is solely to make insurance company's bean counters happy. It is to fill out flow sheets, document that our patients have had all of their health maintenance procedures (vaccinations, colonoscopies, mammograms, Bone densities, PSA's, lipids, glucoses, etc.) so they can decide what form of payment they will provide to the organization. It's all couched under patient safety, and it IS helping, but really, do I need to be a clerk? 

Instead of collating that information on their own through the use of shared claims data, they make physicians become clerks. 

I am a highly paid clerk. 

Just so you know, when it takes 1-2 weeks for me to fill out your YEARLY FMLA form so you don't get fired for taking off work for that pesky asthma attack or killer migraine, that is why. 

I am drowning in  paperwork. 

DoctorDiva 12/19/15

Spring Forward/Fall Back and Stop Messing With My Clocks, Dad!

"My watch is haunted." 

I watched the jeweler's face to see how he would react but he must have heard it all and kept a blank expression. He nodded and said dryly, "I think that is out of my field of expertise."


I should start from the beginning.  Every year at the changing of the clocks, my father would try to convince us that we were gaining an hour when we were losing an hour or vice versa. He had elaborate arguments to convince us of his brilliance and he was tenacious and very convincing. Of course, we were little kids at the time and were easily confused. 

As we got older he would call us twice a year to remind us how much sleep we were losing or gaining. After we were grown we learned not to argue with him because it gave him nothing but glee and irritated the crap out of us.

Last year my mother died and exactly 16 weeks later my father, who was still in the same nursing home, also died. My sister was their primary caregiver. One day she called me up and said, "I hope you're sitting down. I think Dad is haunting me. It's actually kind of funny."

She had gone into her bedroom to get something, came out and looked at the microwave clock and it was an hour ahead. She reset it and thought nothing of it until a day later when her coffee pot clock jumped ahead an hour. She thought, "Hmmm, that's odd." 

THEN, she started having problems with Dad's anchor clock. It was in her living room and the clock was starting and stopping. She changed the batteries, but it kept happening, so she yelled out into the ether, "OK dad. I know you're here. Stop f**king with my clocks!" 

She called me up to tell me the story and no sooner did she start telling it to me, while she was on the phone with me---the anchor clock stopped. After she hung up, it started up again.

I had started having my own clock issues before she called me. I had this really nice watch that I had bought myself. It started and stopped so I took it to the jeweler and he replaced the battery. It worked for a day or two and stopped again.  I brought it back and he replaced the battery again and cleaned it. He figured the first battery was defective or maybe there was some schmutz inside the workings. I took it home and it worked for about a week and then it stopped again. This was the point where my sister called me and told me what was going on. 

Meanwhile at my office, the clocks in my examination rooms and office kitchen stopped working. Batteries were replaced, and the clocks refused to function. It was weird.

Fast forward a couple of weeks: I'm in the jewelry store and my watch is still not working. I hand to the jeweler and tell him that my watch is haunted. 

"We'll have to send it to the factory. It'll be expensive. Do you still want to do it?"  He gave me a price and I said, OK.

I got it back after Christmas and it worked for a week and then it stopped again. I didn't go back.

I started wearing my my mother's old watch which has a nice big face and a secondhand. I haven't had a single problem with it. My sister says that she hasn't had any problems with her clocks lately either. I wonder if my dad just wanted me to wear my mother's watch and/or to remind us that he was still around. 

My parents and I didn't part on great terms. I wonder if this is his way of making me remember them with a smile on my face and a laugh.

Oh and by the way, next year when you spring forward and you get that extra hour of sleep because the clock is a whole hour ahead, think about my dad.

DoctorDiva 12/8/15

Nerd Fitness Academy

Working Towards Fitness for Boy Scout's Northern Tier Camping Trip

Many of my regular readers know that I am a Boy Scout.
Yup. I am an adult member of Troop 39 Chicago. I am also the Troop Committee Chair.

This year our troop has really expanded it's possibilities. We have an excited and dynamic parent base, with skill sets that really are making this troop bloom. Our Scoutmaster is getting the troop on the straight and narrow as far as advancement and Eagle Scout work.

Why do I mention this in a post about Nerd Fitness? Well, because I have to get in shape FAST.
My troop is going to a high adventure camp in Ely, Minnesota to do winter camping over the Christmas break. I have to be able to walk/hike/snowshoe/cross country ski and I could not even THINK about it 4 weeks ago.

I looked for a way to improve my deep knee bends and stumbled across a video by Nerd Fitness Academy. This woman Staci, showed you how to do modifications for people like me with a bad knee.
http://www.nerdfitness.com/blog/2014/03/03/strength-training-101-how-to-squat-properly/

I looked further into this "Nerd Fitness Academy" and found there is this whole website program that you can join that works like a game with points and quests as you improve. Being a consummate nerd, I decided to give it a shot. The $100 joining fee seemed a little steep, but I really needed to do this, and boy, am I glad I did.

https://www.nerdfitness.com/

I started out unable to do a deep knee bend at all. Lunges? Fugetabout it. Push ups? Hah.
I decided to do the Body Weight Workout. I learned modifications for all of the exercises, pretty much, because I couldn't do ANY of them.

Jumping jacks and jumping rope are a nightmare after you've had children. Jump. Squirt. Jump. Squirt. So I learned WALKING Jacks and different modifications. BAM! Stayed Dry.
I learned the BOX squat in which there is a small box or for me, a step stool under your butt in case you can't get up. I learned a split lunge, holding on to a chair. I learned wall push ups. I learned knee planks.

It's been a month, and I can now do 3 sets of the exercises with modifications. I'm working towards stair pushups (lower than the wall but not yet on the floor) and I can do 10 squats in a row now. I am working towards real planks.

I've lost an inch in my waist, an inch in my hips, an inch in each thigh, and I've gained a half inch in my neck.
My weight is the same, but my clothes fit better.
I can climb to the sixth floor at the hospital without stopping now. (I die, but I can do it).

I FORCE myself out of bed at 5 a.m. most mornings to do this. I tell myself, "You will feel better if you do this." Every other day I do the Body Weight work out and in the "in-between" days I walk at least a mile, or do the treadmill on an incline, or do some weights that I bought. I've worked up from 2 lb weights to 5 lb. weights. Woot!

Nerd Academy just put out Nerd Yoga and I started that too, to keep the boredom down and let me tell you, it's not impossible. They give you modifications for this too.
https://yoga.nerdfitness.com/getting-started/

So here is the thing I learned. Even though my knee has arthritis and sharp shooting pains in it when I started this whole process, by starting slow and steady, doing the modifications and slowly strengthening the muscles around the joint, the pain is almost gone. Seriously. I feel so much better. I can squat down onto the toilet without plopping down. (I'm 6 feet tall). I can squat down to get stuff off the floor now. I can walk 3-4 miles without dying. (My dog is so happy.) My husband is loving that I'm exercising because he was worried for my health.

SO. All you out-of-shape nerds out there! Find your thing! Start doing it and make yourself climb out of bed to do it Every Freaking Day!
You will NOT find the time if you don't MAKE the time.
I work crazy hours. I just get up at 5 a.m. now and exercise until 6 (I put on the coffee first, of course.)
I do it in my basement, with the following equipment:
a dining room chair
a step stool
2, 5, and 10 lb dumbbell weights
a yoga mat

I have a treadmill, but I don't need it. I plan to walk outside as much as I can.

JUST DO IT!

DoctorDiva
11/21/15

Misha Collins & The Fight or Flight Reaction of a 15 year Old Fangirl

Misha Collins and the Adrenaline Letdown of a 15 Year Old....

I took my daughter to the Supernatural Convention in Chicago this past weekend October 23-25. We had tickets for Saturday and Sunday. Ellie was very excited to see the actors that she really admired, in particular Misha Collins. She enjoys his quirky sense of humor and kind and funny approach to life.

We had seats so far back that the actors looked like faces on bodies but without a lot of distinguishing characteristics except their height and voices. I decided to get Ellie a photo op with Misha Collins dressed in his character Castiel's costume so she could see one of her heroes close-up, and because some of the money went to RandomActs, a charity Mr. Collins started.

Ellie was so excited that she made a clay keychain in Castiel's likeness. It was pretty cute but she was very bummed out because the wings broke off before she got a chance to give it to him. I got swept up in the fandom too and made him a goofy looking fleece hat since he works in Vancouver and it's effing cold up there. 

All day long Ellie was getting more and more anxious about this whole process and I looked at the number on our ticket and it was number 310. I knew we were going to get about 10 seconds for the photo and not be able to talk to him. As we were standing in line Ellie put herself in her Buddhist prayer pose trying to center herself and calm down because she was so excited. I kept reminding her he's just a guy who puts his pants on one leg at a time. She didn't want to hear that, and in fact was sort of mortified that I would say it anywhere within his hearing distance. I knew that the guy was exhausted and just trying to get through the next 15 minutes to the end of the line of photos. He wasn't listening to what people were saying around him.

Our turn came and Ellie told him that she had made him a keychain. He thanked her and I gave him the hat which he put on and we took the picture and it was over in like 10 seconds. They tried to give me back the hat but I told them it was for him. 

After we left the photo room Ellie completely melted down. The adrenaline rush was just too much for her 15-year-old soul. She started crying and sobbing with the overwhelming adrenaline rush and let down. She was happy and so excited that he accepted her gift and might even use it to put his keys on it. AND she couldn't believe he said, "Thank you." 

She asked me how I could be so calm. I told her it's because I'm a doctor and I deal with people all of the time and I get to see famous people naked. I made her laugh---It's not true, but it was funny. (I kind of felt sorry for Misha Collins because he looked completely done in.)

That experience made me think, what do celebrities do with all of the gifts that they receive from their fan base? Do they keep them? Do they throw them in the garbage? Do they donate them? Do they go through them and pick out the coolest stuff to keep? 

 I didn't want to burst Ellie's bubble because she was so very happy but I suspect that a lot of the things they get are put in boxes and donated to charity. I couldn't tell her that though because she put some work into this gift, she made it with her own hands, and then got to give it to her favorite celebrity. 

Some fantasies you have to believe in. If Misha Collins ever happens to read this, I hope you got some sleep that night and thanks for saying "thank you" to my daughter. It meant the world to her. Oh, and I hope you wear the hat in good health (You know, since I'm a doctor and all.) And enjoy the keychain Ellie made. 

That's Dr. Mushy to You

On Being Bullied

A little background:

I grew up in a bedroom community of NYC in the 60's and 70's. I was the eldest child of two parents who were both the eldest children from families who were so incredibly different from each other, it's amazing they stayed married until Death "did them part."

My parents met in the Navy. My father was there because, well, he had to be. After finishing college it was either join the Navy or be drafted into the Army, and he chose OTS (Officer's Training School) for the Navy. His father and his father's best friend enlisted during WWI by lying about their ages.  My Grandfather eventually became a Paterson cop and according to my father's legend in his own mind, one of the only honest cops at the time.

My Grandfather was too old to enlist again for WWII so he was made the Civil Service Chief for Paterson, and ran all the Air raid siren drills-- because they were near the coast of NJ and who knew when the "Krauts" would attack. My Dad knew what all of the enemy planes looked like from underneath. He was ready.

Just to give you a flavor of my father, he was Archie Bunker before there WAS Archie Bunker. He had the typical NJ accent with the "Dees, Dats, Does, (pronounced like the animal doe), and Dems" and "Axe" instead of "ask," and "eckscape," instead of "escape". They happily declared themselves "Shanty Irish" in contradistinction to those bourgeoise "Lace Curtain" Irish, who thought they were "the shits." (Why "the shits" was good, is beyond me.)

My mother was a Southern Belle. A "Georgia Peach." That's what my father called her when he first met her. She was from a well-to-do family from North Carolina, who originally made their money in black walnut and saw mills in South Carolina in the 1800's and early 1900's. Her father was a GP-general practitioner- a now unused term for a doctor who could do anything. He did home births, kitchen table tonsillectomies, surgery, and whatever else was needed to be done. Farm accidents, Croup, TB, whatever needed doctoring, he did.  He also was a drug addict and a mean son-of-a-bitch, according to my mother.  Also according to my mother, he allegedly used morphine and barbiturates, and uppers and downers, and beat his wife and kids. He died before I could know him. Small favors.

As a result, my mother was depressed, mean, and likely bipolar, which would explain her father's self medication, as bipolar is very much a hereditary disease.
She ran away to join the Navy to get out from under her father's controlling thumb. He made her go to an all girl's college in Georgia. She wanted to go to UNC and to become a doctor, and this school was all about preparing fine upstanding upperclass women for marriage. Her college chemistry professor actually told her that "women have no place in medicine" and flunked her on purpose-or so she said.


So this is all background to the story of my beating up TW in 4th grade.

I was a complete and total nerd, with no social skills. I was more comfortable around adults, and had  a very hard time in school, socially. I was smart and didn't know how to keep my mouth shut. I had no control over my temper, because no one had taught me. My father's motto was "fight and be somebody."  Fighting and screaming were the only forms of communication my parents really excelled at. My parents were always upset or angry about something or someone in the outside world. They would rail against the establishment. They held the rest of the world in disdain, and would say, at the end of the day, "Lock the door and pull up the drawbridge. Keep the world out." They really wanted a moat. Seriously. Filled with alligators. They hated people. They often hated each other. There was some conversation, but mostly it was my parents telling me that I didn't know what I was talking about and yelling at me, each other, and the TV- So that was how I learned to communicate.

As you can imagine, I got the shit kicked out of me on a regular basis. I earned the nickname, "Mushy," in third grade when I got frustrated over the Iowa tests and started crying, and the ink on the test book ran, and the teacher made me stand up in front of the whole class to hold up the soggy and tear streaked book to a fan to dry it out. My third grade teacher was Mrs. Campbell. I hated her for making me stand there in front of the fan, and I still hate her to this day because she told us there was no Santa Claus. "No one here still believes in Santa Claus, right? You all know he's not real, right?" (No, I did NOT know and was laughed at for years afterwards for believing. It was THIRD GRADE for God's sakes. Couldn't she keep her mouth shut and let the parents decide?)

My parents got sick and tired of my coming home with ripped clothes and tear streaked cheeks, because Vinny or Timmy or Michael or Richard almost daily beat the crap out of me after school on the way home. The school wouldn't do anything because it was after school and not on school property. The parents would talk to their kids (Mom was on the PTA and knew everyone and talked to their parents) but it never stopped. So they got the "Great Idea" that I should become a black belt in Judo and learn how to beat the bullies up so they'd stop.

The problem with this whole scheme was that Judo is a defensive sport, not to be used to beat the shit out of the mean kids, and I was a complete and total spaz. I had absolutely no coordination, nor did I have any inclinations towards sports. I was always the last kid picked in gym for teams and my arms and legs were growing faster that my body, and I was fat and gangly all at the same time.

My father's buddy taught the Judo class in the high school gym. I got a judogi (the white uniform for Judo) and dutifully learned how to shoulder roll, and how to trip people, how to push and pull at the same time, and importantly, how to land without getting hurt.

One sunny afternoon in fourth grade, TW, my arch enemy, started in on me. We were just off the school grounds and I was surrounded. So, I decided, enough is enough. I yelled, "Hi Ya Ching" (who the hell knows where I got that, but yes, I screamed it loud and clear), grabbed the front of his shirt, pushed him while tripping him over my lower leg and knocking him down to the ground, where he split his head open on the edge of the sidewalk.

Then I ran home.

I felt horribly guilty. I didn't know if TW needed stitches, or how badly I'd hurt him. I felt guilt and relief. I thought the bullying would all end because my Dad said that if you beat up a bully, they always back down.

Yeah, not so much.

He continued to bully me all through high school, and taught all the other kids to yell, "MUSHY!" as I walked up or down the stairs out of earshot of the teachers, just to torture me.

I stopped taking judo. I never got a black belt.
I'm still a spaz.
I learned in college and medical school how to act like I didn't care what people said, and soon, I didn't.

At my 10th high school reunion, one of my arch enemies, who was now actually a really nice guy, thought he was going to be funny. I was dressed in a black cat suit with a long red riding jacket, and I looked amazing. (This was before having kids completely destroyed my body). He looked me up and down appraisingly, and said, with surprise in his voice, "MUSHY!"

I turned to him, smiled, hugged him, and whispered in his ear, "That's DR Mushy, to you."

Do Your Homework Before Your Doctor's Appt! Be Prepared!

Any long time reader of my blog knows that I am a Boy Scout, AND previously a Girl Scout. 

Both have the motto:  

Be Prepared!

When you make an appointment to see your doctor, you usually have a specific issue in mind. Either it's an appointment for a physical/wellness visit (often required by work) or you have a problem or two, or three, or four. Your physician has no idea why you are there.  Usually we get a cryptic "Chief Complaint" written at the top of the chart by the medical assistant. These can include the following: "Wellness visit" or "sore throat" or "suture removal" or "knee pain" and the like. When we walk into the room, we assume that that is for what you are being seen.

YOU need to inform your physician why are you there at the very beginning of the appointment. 

A wellness visit is anywhere from 30 minutes to 45 minutes (depending on the doctor) and does NOT include care of new medical problems. It should cover routine health maintenance issues. These include lifestyle counseling, immunizations, screening tests for sexually transmitted infections, Pap smears, mammograms, Bone densities, and colon cancer screenings, and genital and prostate examinations.

Routine follow-up visits are anywhere from 10 minutes to 20 minutes, depending on the physician, and depending on the problem you bring to him/her.

Most physicians are not trained on how to limit their appointment visit times. 

Docs feel bad telling their patients they only have 15 minutes and they can't address all of their issues in one appointment. Patients on the other hand, often want to get as much as they can for their 15 to 20 minute dollar. They try to cram as many problems as they possibly can into that 20 minutes. This is unfair to the physician and to the patient. 

Physicians need to give the amount of time required for each problem in order to do a good job BUT also feel the pressure to stay on time for their patients. 

Patients on the other hand often are unaware that they are inconveniencing another patient by making their doctor run over time, AND they personally hate to be put into an exam room half an hour late for their own appointment.

You see the difficulty, don't you?

Successful Doctor's appointments require planning by you, the patient.

 If you're going to do this right remember that your physician can only manage one to three problems well in that short period of time depending on the difficulty of each problem. Also, your priority of what's the most important problem and the physician's, may be  diametrically opposite. For example, you may not think much of the pain in your chest when you take a deep breath and be more worried about your knee pain. Your physician however, it is definitely more worried about the chest pain when you take a deep breath. 

Physicians are trained to look for life-threatening problems and to deal with those first. 

You also need to be prepared with your medication list complete with dosages and how often you take your medicines. Walking into a physician's office for a follow up without knowing what medications you're on is dangerous. Physicians know that a patient may have seen multiple doctors. Medications often get changed at the cardiologist's office, pulmonologist's office, or by an interchange required by insurance. You need to be prepared by bringing an up-to-date list of your medications with you to each and every appointment with each and every physician. Even better is to bring the bottles with you. Don't forget vitamins, herbs, supplements, and inhalers and injectables (think insulin).

When you move to a new city and have to get a new doctor you need to also be prepared with your medical records. If you haven't been able to get records copied and sent to your new physician, at least have the physician that you used to go to give you a copy of your face sheet from your electronic medical record. This should include your past medical and surgical history, family history, allergies, medications, immunizations, and health maintenance tasks like mammograms bone densities colonoscopies etc. Don't forget that your DENTIST needs these records too.

If your doctor doesn't have and electronic medical record, ask for copies of your immunizations, and preventive services flow sheets. This should include your last mammogram, prostate exam, PSA (if done), Pap smear, bone density, and colon cancer screening. YOU can write up your OWN past medical/surgical/family history. Write down if you ever smoked, how much and for how long. If you drink alcohol, how many drinks a week do you have? Do use use any prescription or street drugs for recreational use? Let your doctor know!

In summary:

• Know how long your appointment is 
• inform your physician in the first minute of the multiple medical problems that you are bringing to him/her, 
• respect the time limit, 
• know your medications, 
•  AND 
• if you see a new physician, bring a snapshot from your old physicians electronic medical record to inform him or her of your past medical history.

DoctorDiva

Strawberry Jam, Hobbies, Retirement, and Your Legacy

It's that time of year again.
It's the time when the local fresh fruits-strawberries, blueberries, peaches, apricots, etc., are coming into or just going out of season.  That means it's TIME TO MAKE JAM!



Last year I got a tad carried away with canning and pickling.  I found out that my office manager worked for a Michigan farmer at a local farmer's market on the weekends. She convinced me to try the strawberries from Kenny's farm.
The difference in the flavor and color of farmer Kenny's strawberries compared with the (now I know) CRAP from the grocery store was incredible.

So, I made strawberry, blueberry, apricot, peach, peach melba jams, bread and butter pickles, refrigerator pickles, dill pickles, lactose fermentation style pickles. It got ugly.

Hobbies keep me sane. Okay, sort of sane.

Alright, they keep me busy.

So here is the thing I've noticed:
When my patients retire, if they don't have a hobby or any interests outside of work, they get depressed. Their spouses, who DO have hobbies, get mad at them because the new retiree is looking to their spouse to keep them entertained. They follow their partners around the house saying things like, "Whatcha' doin'? Can I help? Want to go do something? Can you make me lunch?"

There is resentment, anger, and divorce or at least, miserable retirement.

Here is my advice:

Get a hobby. Make cakes. Go camping and hiking. Start fishing.

It's important to your mental health, and your marriage/partners/friends. It makes you more interesting to be with and talk to. It keeps you busy.

Set a schedule daily. Get up at the same time every day and go to bed at a reasonable hour.
Don't watch TV or play computer games all day.

I (obviously) make jam. I quilt. I write. I procrastinate on all of them, but when I finish, I have an amazing sense of accomplishment. I also have a sense of the past and of the future. When I make a quilt, or a photo-book,  a novelty birthday cake, or write a story, that is something that will be left behind when I die so no one forgets me--for a while, anyway.

(Okay, they won't have the cakes or jams left behind. I don't want people to save those. Maybe they can remember how I made those and keep the traditions going for future generations-instead of getting ptomaine poisoning from eating decades old jam)

 My ego feels better when I know that I've left a legacy of memories/objects/recipes/stories/quilts behind.

My Daughter is "Fan-girling" Supernatural. I Feel Old

When I was a kid, being a fan meant watching David Cassidy or Bobby Sherman on TV. It also meant getting all of their albums and playing them on an endless loop until our parents took away our record players in self-defense. It meant having posters of our favorite heartthrobs on the wall and swooning over them. It meant joining a "fan-club" and getting 8x11" glossies signed by some poor intern. 

In college, being a fan meant listening with your friends to 8 track tapes in the dorm room while you pretended to be sophisticated drinking Rolling Rock beer(of course we were 21).

The entire landscape of fandom has shifted with the advent of the Internet. I had no idea how much, until my daughter, 14, informed me that she was a "fangirl". I learned that "fan -girling" is a verb describing what we used to call "swooning." Now, fans get to interact with their actor/actress/musician crushes in ways that we never even dreamed of. There's Twitter, Instagram, Facebook, Snapchat, Whosay, Tumblr (I still can't figure out why it's spelled wrong) and a whole bunch of other social media sites where fans can view photos, gifs, and fan art, 24/7.

The only way I ever got to interact with my college musician crushes was to play their music or to watch their TV shows, go to concerts, or read fan magazines. Now, my kid can follow their favorite actor, actress or musician on Twitter and read all kinds of pithy comments by them or by their fans. The fans can interact with each other which brings an entirely new aspect of parenting a teenager. Who are these people that she interacts with in these fandoms?

I went on a search and destroy mission to make sure that things were safe in my daughters world. Turns out my daughter is a huge fan of Supernatural, a television show that has been on for 10 seasons and is renewed for an 11th. She was always talking about Jared Padalecki, Jensen Ackles, and Misha Collins. I became obsessed with figuring out what this "fan-girling" was all about and who these people with odd names were.

I started by watching the show. I "binge-watched" it on Netflix and soon found myself completely absorbed by the story. It doesn't hurt that I actually like paranormal stuff. 

My daughter mentioned that there were all kinds of YouTube videos of "cons" (conventions) where the actors were at meet and greet types of activities. I had no idea what a fan convention was until last year when I took my daughter and two of her friends to Con + Alt + Delete here in Chicago. It is an anime convention. I ended up sitting around in the lobby most of the time as I had absolutely no interest in Anime, but I saw that lots of other people did. They came dressed as their favorite Anime characters. This is known in the vernacular as "cosplay." Some of them performed very elaborate dance routines and sang and danced in the lobby. There were professional videographers there recording every second of the "con."

I started watching the Supernatural conventions on You Tube

and soon realized what my daughter found interesting. The actors in this show are real people. They're married, have kids,and talk about their very normal, very funny, lives.  They use their platform as actors to raise awareness and fundraise for causes that they're passionate about-- depression, mental illness, etc. 

http://2.bp.blogspot.com/-yWztLV2vIuI/VAZIW4yOvYI/AAAAAAABgDE/ENhE0UTEuyM/s1600/supernatural.jpg

And then, there's Misha Collins. He's probably the most unique individual I've come across in a long time.

Misha Collins is a goofball. He has a unique and most eccentric point of view. He can go off on the most incredible tangents and keep you laughing. He uses his popularity to rally his fandom to do good. 

http://www.randomacts.org/images/promote/getInvolved/RA_badge_supporter.jpg

He  started www.randomacts.org, a 501C3 company to get people to be nice to each other--to look around them and see who needed something and then to do something about it. It doesn't have to be some gigantic active philanthropy--it can just be picking up trash, or helping out some homeless people, or singing a song to somebody who needs a song sung to them, or reading at the library. Just any act of giving. It's actually kind of cool.

Then there is  GISHWHES. The Greatest International Scavenger Hunt the World Has Ever Seen. Yet another fun outlet of weirdness meant to rally people together from all walks of life to do strange and odd things like making wedding dresses out of feminine hygiene products. While they're at it they also are raising money for Random Acts.
https://www.gishwhes.com/

His latest endeavor was to rappel 17 stories down the side of a building in California in order to raise money for Shatterproof, an organization that is looking to raise awareness about alcohol and drug addiction.
http://support.shatterproof.org

I have to get my kid credit. If she was going to join a fandom, she picked a good one.

I feel less worried, although it is a bit concerning how rabid some of these fans are. I don't think I would want to be a famous celebrity, always looking over my shoulder for the paparazzi or crazed fans. My daughter seems to take her "fan-girling" in stride though. She has informed me that she does not obsess about the actors she admires, and mostly goes out and does things with her friends, like riding bikes, learning how to take the bus around town, and doing her art. 

It's great having a kid with a good head on her shoulders. 

Quiche. Don't Do It OR How NOT To Make Quiche

How NOT to Make Quiche.

I admit it. I occasionally have Delusions of Grandeur. My latest delusion was that I could just whip up a quick bacon and asparagus quiche. I thought to myself, "What a wonderful, quick dish to put together for my family."

There was spring asparagus in the produce section of my local grocery store. It was pencil thin and gorgeous. None of this would have happened if I hadn’t  seen that green goddess of temptation. That asparagus was singing it's siren's song to me. Tall, thin and green, it was a reminder of the spring we had not yet seen in Chicago. I’ll admit it. I lusted after that asparagus. Instead of passing it by, I found myself answering it's siren's song. I picked it up and placed it lovingly into my cart, protecting it from harm.

I thought to myself, "Why should I make this hard on myself?" I bought pre-made refrigerated dough, smiling at my smart time saving decision.

I wanted my beautiful asparagus to be cradled in the lap of a luxuriant custard. I grabbed some light whipping cream, deluding myself by thinking, "At least it's not heavy cream.”

I unpacked all of my ingredients after I got home, remembering to leave the pie dough out at room temperature. In the past, I had always forgotten to do this and was very proud of myself for remembering this time without reading the package. I whipped out the bacon from the refrigerator, and began the process of slowly cooking it in my cast-iron skillet, the way my mother had taught me. While it was cooking, I thinly sliced up a shallot, and cut my asparagus into 1 inch pieces, throwing away the hard ends into my compost bucket.

I needed the formula for the custard so I consulted the great international brain. That was my first mistake. The recipe I found said to put heavy aluminum foil over the piecrust in the pie pans and cook it at 450°F for eight minutes, then to remove the heavy aluminum foil and cook it for five more minutes. They specified not piercing the pie crust with a fork. I followed the instructions.

The aluminum foil pulled off a fair amount of piecrust with it. But still, I was not daunted. It was okay if it wasn't perfect. I pulled out the finished piecrust from the oven. One was in a glass pie pan and the other in a flimsy aluminum pie pan. As I removed the flimsy pie pan, it twisted and bent, spilling hot pie crust all over the chair next to my kitchen table. I cursed and lamented loudly, until my teenaged son came into the kitchen asking, "Ok, what did I do THIS time?"

I pulled it together and remembered that I had a pie crust mix from an apple orchard we frequent in the fall. This was becoming way more of a project than I had anticipated, but I was determined to please the asparagus gods.  I read the instructions for the crust. CRAP! All of my butter was frozen! Still, I thought, "I can do this. I mean, how hard is it to make piecrust?"

The asparagus gods laughed.

I chipped away the frozen butter into the flour mixture and almost broke the blades of my pastry cutter cutting the butter into the flour.  I remembered if that you put too much water into the dough, it makes gluten, and therefore, rock hard crust. I had heard an editor from Cook's Illustrated on NPR, pontificating that vodka worked to moisten pie dough because vodka did not form gluten with flour. I thought this would be a neat time to try this out.

Vodka does not really cause pie dough to come together very well. Just Sayin'. I ended up adding 3 tablespoons of cold water.

I had remembered reading somewhere that if you added dried kidney beans on top of the crust, it keeps it from bubbling up. So...I did. But without a barrier between the pie crust and the beans.

Don't do that.

After I picked out the hot beans from the now mushy, torn up crust, I decided to just patch it up and use it anyway. At this point, I just wanted it over.

I sprinkled the grated smoky Gouda (this, BTW was a GREAT idea) onto the crust, added the sautéed shallots and asparagus, and liberally sprinkled it with bacon, poured the rosemary custard mixture over the top, and baked it for 45 minutes at 375°F. I ended up with one quiche with store bought crust, one with a less messy homemade crust, and one that looked horrible with patched up crust.

This whole thing took me three hours more than I had allotted for this project.

A few take home points from this.

1.      Buy extra pie crust.

2.     Make more filling than you think you need. Teenagers love bacon and I had to fend them off.

3.     If you Make your own pie crust, DON'T use frozen butter. DO use vodka:water 50:50 to wet it. The crust was flaky and wonderful

4.     Don't put dried kidney beans on your crust.

5.     Put flimsy aluminum pie plates on a cookie sheet so you don't spill dough all over the floor.

6.     If anyone knows how to precook dough without it bubbling up or sticking to the aluminum foil, I would love to know.

7.     MOST IMPORTANT, Asparagus is dangerous. It's like the siren's song of spring. Lash yourself to the shopping cart and keep on moving, or you'll end up like I did, sweating over piecrust in a delusional attempt to make quiche.

The END

The bottom is refrigerator dough. The top obscured one...It wasn't pretty but it tasted good.

First Aid and CPR

Boy Scouts, CPR and First Aid Training

Once again, I am going to discuss Boy Scouts, but I want to thank Brittany Jones, a Red Cross teacher who came to our troop last night and taught all the boys and their parents and leaders CPR.

CPR, or Cardio Pulmonary Resuscitation, is a skill that every single person who is able to get down on the floor on their hands and knees, should learn. The Red Cross trains more than 9 million people in life saving skills a year.

Why CPR?

CPR could save your family member’s life. CPR could save YOUR life.

CPR courses teach you how to do CPR and how to use an AED –Automated External Defibrillator. These are machines which can “shock” a person’s heart back into rhythm. Seconds count when someone’s heart has stopped. AED’s are found in schools, airports, and many private businesses. It is important that all people using AED’s be CPR certified. Also, it is important that the batteries be checked and the AED’s be periodically checked that they are functioning.

The more people who are CPR certified, the more people could be saved. You may be depending on a stranger to save your or a family member’s life. It’s not just enough that YOU get certified, but to encourage as many people as you can to get certified.

Many businesses are giving employees a bonus if they get certified.

Our troop spent the last month learning First Aid. We were preparing for a First Aid Meet, and I am happy to announce that we tied for second place out of 7-8 participating troops.

I can’t tell you how impressed I was with the boys though. They took this on and really got prepared. They can be first responders in an emergency. They know how to assess a scene for safety; how to call 911 and what to say; how to assess the people injured and triage them. They know how to do splinting and bandaging, how to make a stretcher, how to do a 2 man carry, how to treat snake bites and insect bites. They know to check for Medic Alert bracelets. 

Last year, in 2014, the TV journalist Ann Curry, was hiking in NY State when she broke her ankle. A Scout Troop from New Jersey (Yeah! New Jersey!) came upon her and asked her if she was okay. She wasn’t, and they splinted her ankle, and made a stretcher to bring her down off the treacherous path to get to safety and help. The boys had been training for this as part of their normal rank advancement, and they knew what to do.

See this blog post by Bryan on Scouting about it:

http://blog.scoutingmagazine.org/2014/05/09/new-jersey-scouts-help-rescue-nbc-journalist-ann-curry/

If you haven’t already, consider donating to either or both, the Boy Scouts of America, and the American Red Cross.

Below are photos from the First Aid Meet. 

Chicago Fire Department sent a First Responder Team of Firemen/EMT's and a Paramedic to the First Aid meet to show the boys their Trucks and EMS equipment. 

Thank you to the Chicago Fire Department Engine Company 78 for coming out and working with our Boy Scouts. 

The Landline as a Useful Diagnostic Aid

(The names in this story are changed to protect people's privacy. Do not use this as a template for diagnosing your own health problems. This is a story, albeit true, and is an unusual case. See your own doctor for any health problems.)

The Landline as a Useful Diagnostic Aid

The elderly Puerto Rican gentleman—for he was a gentleman—was dressed to the “9’s.” He was bedecked in a fedora and dressed in a suit and tie. He was accompanied by his wife and daughter. The daughter was there as a translator. She had been a medic in the army, was an EMT presently, and was going to nursing school at our hospital.

Mr. T didn’t speak much English. Mrs. T seemed to understand but was embarrassed to speak.  Their daughter, Angelica, was a bright and energetic 40 something year old who loved to talk.

“Dad’s been coughing for well over six months. Sometimes he coughs until he vomits. He’s short of breath too. He hates coming to the doctor’s so we had to drag him here under threat of death,” explained Angelica.

Before she could even say anything else, my brain switched on to the pathways for chronic cough. Chronic cough is a different animal from acute or even subacute (6 weeks to 3 months) cough. I could already rule out things like run of the mill bacterial pneumonia. I started thinking about the common things, like reflux, or post nasal drip. It’s funny how after you’ve been in the business as long as I have, you can skip ahead in your brain formulating possible diagnoses while the patient is still speaking.

I ran through my Review of Systems, considering other things like autoimmune disease, drug effects, occupational exposures, and chronic infections like TB and fungal infections, and of course--cancer.

All of the answers to my queries were, “No.”  

No fever or chills. 

Appetite okay but the coughing fits kept him from catching his breath so it was hard to eat.  

No, he hadn’t lost any weight. 

No, no swollen glands.

The cough was dry and spasmodic. No, he had never smoked cigarettes or anything else for that matter.

Angelica had listened to his lungs. “I hear a lot of crackles. Loud crackles. But I don’t think he’s in heart failure. He doesn’t have any swelling. I don’t hear a gallop rhythm and his heart seems okay.”

Crackles are a sound in the lungs that can be caused by any number of things—fluid from heart failure, scar tissue, pneumonia.  

Fine crackles sound like rubbing hair between two fingers next to your ears. 

Coarse crackles sound like pulling two pieces of Velcro apart. 

Fine crackles are often fluid in the tissues of the lungs, and Velcro crackles are often scar tissue in the lungs. People who sand blasted forms in steel mills, or were bakers, worked in cotton mills, worked with asbestos or other occupations where fine dusts were inhaled, get Velcro crackles from damage to the lungs.

Mr. T had never done any of those dangerous jobs.

Sure enough, when I examined him, he had Velcro crackles.

He admitted to shortness of breath with less and less exertion over time. He couldn’t do the things he enjoyed, like long walks, or working out, because he was short of breath all of the time.

He wasn’t on any medication that could cause scar tissue, like amiodarone. I did blood work and a physical exam

looking for autoimmune diseases like rheumatoid arthritis. Everything was negative.

The chest xray and subsequent CT scan of the lungs revealed a thickening of the tissues in the lungs—interstitial lung disease.

Pulmonary function tests (breathing tests to see if people have wheezing, or problems with the lung tissues being too thick) revealed that his lungs were stiff, and oxygen wasn’t getting across the thickened tissues.

I sent him to my husband who conveniently happens to be a pulmonologist.

He couldn’t figure out the cause either. That's saying something because he is one of the smartest people I know. 

Meanwhile, Mr. T was getting worse.

His daughter called me one day to discuss his case. We were going over the test results, talking about where he was born, whether he had ever gone spelunking (fungus from caves can cause lung disease), whether he’d worked on a farm (silo’s have fungus in them) and whether anyone else in the family was sick, etc.

Suddenly I heard a squawking in the background.

“Angelica, is that a parrot I hear?” I asked, suddenly excited.

“Yes.”

“Does your father have a parrot?”

“Yes, he’s had one for years! He loves his parrot!”

“I know what’s wrong. Get the parrot out of the house immediately and get your father to the office. I need to do a blood test to send to Northwestern for special testing.”

I called the specialist at Northwestern to get instructions on how to send the test. We sent it once, and it got lost.

We drew it again and had the daughter deliver it in person.

A couple of weeks later, we still hadn’t heard and called the lab again. The results were positive. Mr. T had hypersensitivity pneumonitis to parrots. We had sent an avian antigen panel testing for antibodies to different birds, but in particular to parrots.

We were fairly certain of the diagnosis before we got the results back and started Mr. T on high dose steroids, with miraculous improvement.

My husband STILL uses the case to illustrate the importance of taking a pet history and for listening for ALL of the clues, even over the phone.

And THAT is how I diagnosed Avian antigen hypersensitivity pneumonitis over the phone.

Michele Carlon, MD

DoctorDiva

http://www.adsrex.com/wallpapers/animals/parrot/parrot_3.jpg