Been Gone A While. Here's What has Happened...

I have been gone a while.
Lost my writing mojo. BUT I haven't been just sitting around doing nothing.
I rejoined Weight Watchers and lost 25-30 pounds, depending on the week.
I joined Krav Maga Illinois and learned Israeli Combat Self Defense. I became BAD ASS.
At least I thought so until I kept getting hurt. I hurt my neck this last time and that scared the hell outta me.

I took swimming lessons at the local college in the spring semester. (Spring in Chicago? Really? Not.)
My husband and I took swimming at the YMCA locally this summer- that was fun.

I taught myself how to pressure can tomatoes, tomato sauce and spaghetti meat sauce. I have owned my pressure canner for several years and was terrified to give the family botulism, but I, in my usual manner, read and read and read, and decided to start with tomatoes since they are almost acidic enough to water bath can. If you add lemon juice to the canning bottles, they ARE acidic enough. Pressure canning takes less time though. So that was cool.

I've been making lots of jam. Plum was the new one this year. I made peach, blackberry, strawberry, blueberry, and apricot.

I taught myself how to make yogurt. It's really easy and it tastes better.

My eldest left for college. He's going back in a week or two. It was weird not having him here.
HOWEVER, the towels in my house weren't all used up though. That kid can use more towels in a week than the local hotel.

My other child is becoming an artist and wants to become an animator and by gum, I think she can do it. She's really good.

I'm still in Scouts. It's "Scouts" now, not Boy Scouts. My son aged out of the program, but I really enjoy going to the meetings, and serving on the Troop Committee as the Chairman. We got to go to Northern Tier several years ago, and this year...Sea Base. I'm not going. I get seasick and vertigo, but the boys and their parents are. Looking forward to our first camping trips. I am the First Aid teacher.

I plan to get back to DoctorDiva writing. There are lots of topics to cover for my patients and myself.

I'v got my writing mojo back --I hope, anyway.
Peace.
DoctorDiva

Boy Scout Camporee with BlackHawk Council

Illinois Railway Museum

May 13-15, 2016

Disclaimer:  This is all in fun/tongue in cheek. We actually had a great time and no one suffered from hypothermia.

     The windswept prairie grass was wet and the mud sucked at our boots. The rain had slowed to a soaking, cold drizzle. The “gulag lights” at either end of the field lit up rows of tents, Boy Scout trailers and kitchen flys. Some sites had tents lined up in military precision, Patrol boxes all set up, and others were rag-tag and thrown together slap dash, like ours.

     One thing was for sure, though. I was not going to be able to sleep in my tent. The wind was so fierce it blew in the sidewall of my tent and I would be unable to sleep for fear of collapse.  The thought, “Why didn’t I bring my 2 man tent? It’s small and low to the ground!” kept buzzing around my head. 

     To add to the excitement, the air conditioning was out in my car and the windows were fogging up without it. Three teenaged boys and me, driving rain, cold air, and an hour and a half drive could have been a disaster, but I had coated the windshield with shaving cream, which stopped it from fogging up. McGyver-ing is a way of life with a 12 year old van.

     Sleeping on the bench seat of the second row of seats in the van was extraordinarily uncomfortable. I put on long johns, sweat pants, dry socks, and several upper layers, and used the extra sleeping bag in the van. I woke up with cramps in my calves, numb hands, and a headache. Benadryl helped a little, but not enough.

     Saturday morning broke with cloudy skies and temps in the upper 30’s, low 40’s. I walked to the campsite from the van, after using the Port-a-Potties, and attempted to locate propane for the stove, the coffee, and a lighter. This was a difficult task with brain fog from benadryl, sleep deprivation, and no coffee. Fortunately, I had brought a lighter, as they seem to disappear with each camping trip, never to be seen again.
Be Prepared.

     After I got the coffee going, the other parents started to wake up. Breakfast was “eggs in a bag.”  This gourmet concoction consists of eggs in a freezer bag, mushed up with  add ins, like ham or cheese, salsa, onions, peppers. You push out the extra air, and boil the eggs in the bag. Then you use the hot water for your dishes, which consist of your coffee cup, pot, and fork because you eat out of the bag.  The problem with this breakfast is the fact that you now have 10 plastic bags to throw away, and no one remembered to bring garbage bags. Hmmm.

     This is when we noticed that several of our boys were NOT prepared. One had on a short sleeved shirt and shorts and no coat, several didn't have enough layers or hats, or gloves. Argh. Clothes were traded, shared, and layered, and a clothesline was set up to dry out wet clothes at the campsite.

     By 8:30 a.m., the boys were up and had managed to feed themselves a cold breakfast, and the adults were more or less functional. We meandered over to the Illinois Railway Museum entrance to attend the opening ceremony. We were assigned groups for the boys to get the Railroading Merit Badge, and informed of the activities for the afternoon. (archery, dodgeball, air riflery, archery, and black smith-ing) as well as checking out the museum at our own pace.

     “Look, Listen, Live”  was the theme of the Operation Lifesaver. The engineer leading it told us some frightening statistics about how often someone is hit by a train in the US and how to avoid this fate.

     We learned how to identify 10 different types of railroad cars, and we saw steam , electric, and diesel locomotives.

     We saw an empty wine bottle of Beaujolais sitting on the steps of an old passenger car that had clearly been broken into and was being used by local oenophiles to do their wine tasting events in the middle of the night.

     Later the boys tried their hands at the Tomahawk throwing contest. The boys were much better at Tomahawk throwing than their parents, which changed the dynamic of the camporee completely. The parents threw the Tomahawks into the woods while the boys actually hit the targets. Granted, the parents probably hit a few chipmunks in the process, but the boys definitely had the upper hand after that.

    

   



Next was the Black smithing.
The blacksmiths were awesome.

Their rule was:  

Don’t be stupid.

     That was it.

     Don’t pick up hot iron if you drop it. Use the gloved hand to handle the hot iron. Wear your eye protection-- in other words:  Don’t be Stupid.

     Even the smallest kids were allowed to participate, and all of them made “S-hooks,” despite the parents yelling that they wanted a harpoon tip, or a candelabra. The kids seemed pretty happy with the S-hooks though, and the parents were glad to have their children back without third degree burns. It made us realize that our kids actually CAN follow directions. I offered to hire the Smithy to come live with us and to get my kid to do his chores, but he declined, albeit politely.  After all, he is a Scout. 

     Later, the sun broke through and the sky cleared… for 5 minutes. 

    

     The parents, or "Bigfoot Patrol," had a gourmet meal of beef stew made by our Scoutmaster, and the boys had walking tacos. I think we won that competition, hands down. The boys were ogling our dinners with desire. “Next time you guys can do this,” we told them.

     Of course, at bed time, the sky completely cleared causing the temperature to drop precipitously. We had frost on our tents in the morning. I was so tired, that I slept like a dead person for 8-9 hours, only awakened occasionally by my nose tip being cold, or my hands being completely numb from the positioning in my mummy bag, or my hips screaming in pain from side sleeping in a ball in one position for 4 hours in a row. But besides that, it was a great night sleep.

  


     There was supposed to be a 5 K run in the morning at 6:30 a.m. I don’t know if that actually took place because, let’s face it-what teenager actually gets up at 6:30 a.m. voluntarily? So that didn’t happen. But we got up, broke camp, and were home by 10:30 a.m. which was great, except I had to set up the tent in the backyard to dry out and do 700 loads of laundry, and dry out my son’s bag on the clothesline, and…

DoctorDiva
May 13-15, 2016

How To Read Your Electronic Medical Record Chart Notes

     Or:

I am Not an SOB! How DARE YOU!

Many Patient Portals are now allowing patients to see the progress notes that physicians write.  This can be a confusing and frustrating experience for patients. 

     One of the problems I have seen is patients taking offense at the medical terminology, thinking physicians are making a personal judgement, instead of writing objective terminology.  

     Let me explain.

     Physician's notes are generally written in the SOAP method:  

                         Subjective, Objective, Assessment and Plan.

     Subjective:  This section describes the patient's complaints. "Complaints" does not mean what it does in normal language. "Complaints" are what the patient is "complaining of" or suffering with, or what brought the patient in to begin with. Why is the patient here? 

     Part of the HPI or History of Present Illness, is the Chief Complaint.  This is the reason for the visit that the patient tells the medical assistant.  It may not be the "real" reason the patient is there, as often, patients feel uncomfortable telling a medical assistant why they are really there. 

     In the HPI, doctors use a lot of standardized abbreviations which may be misconstrued by patients, or just plain not understood at all. 

     For example, "The patient is SOB" does not mean, "the patient IS an SOB", but that the patient is "short of breath."  

     Often we use quotation marks to state exactly what a patient has told us, and then we elaborate with the Review of Systems(ROS).  

     The ROS is a litany of questions we ask to try to ascertain any other associated symptoms going along with the chief or main complaint. We generally start with weight loss or gain, rashes, sleep problems, and work our way down from the head to the toes. This litany can change based on the chief complaint. 

If it is clear the patient is suffering from a cold, we aren't going to ask about toe fungus in the ROS. 

     We also have to use very standardized, objective language. Some of this can be misconstrued as insults as read by patients, but is medically objective language. The biggest one is "obesity."  Obesity is a BMI of 30 or higher.  A BMI of ≥ 35 or 40–44.9 or 49.9 is morbid obesity. A BMI of ≥ 45 or 50 is also known as super obese.

     When doctors use these terms, they are not making a personal slur, or insult. It is a medical term. 

     Some other terms often used in the history/ROS are, 
     CP=Chest pain, 
     GERD=Gastroesophageal reflux (heartburn)
     N/V=nausea/vomiting
     C/D=constipation/diarrhea
     melena=black, tarry, sticky stool indicative of an upper gastrointestinal bleed 
          (UGI bleed) as in a bleeding ulcer.
     hematochezia/BRBPR=bright red blood per rectum-which means what it says. 
          It is often from a bleeding source in the large intestine/colon
     GI=gastrointestinal (any section of the gut, from the esophagus to the rectum)
     GU=genitourinary (anything in the genital area or urinary tract)
     MS=musculoskeletal. 
     Neuro=neurologic symptoms/signs

The next section is OBJECTIVE: the PHYSICAL EXAM.

     Here again, there are many abbreviations.

     Generally the Physical Exam starts with the Vital Signs(VS):

  BP (blood pressure), HR (heart rate), T (Temperature), O2 sat(Oxygen saturations, expressed in percentages), Weight, Height, often in centimeters and kilograms. This is not to obsurate.  This is the international standard. We use metric often in medicine. 

     Then comes the BMI (Body Mass Index).

     BMI is a person's weight in kilograms (kg) divided by his or her height in meters squared. The National Institutes of Health (NIH) now defines normal weight, overweight, and obesity according to BMI rather than the traditional height/weight charts.

    The BMI is not always an accurate indication of the patient's fitness. For example, I have seen people with BMI's over 30, and not an ounce of fat on them because they were body builders. They were all muscle. 

     Next is the physical examination. 
     We start at the top and work our way down usually. Depending on the age of the patient, the physical exam may be different, but generally for teenagers and up, it is fairly standard. There may be some differences in the very elderly, where we look at things like their ability to get up out of a chair or walk. 

     Some standard abbreviations: 

PE=physical examination
HEENT=Head, Eyes, Ears, Nose, Throat
     PERRLA=Pupils Equal Round and Reactive to Light and Accommodation-
            When we shine the light in your eyes we are looking for pupillary reactions 
     EOMI=Extraocular Eye Movements Intact. This means your eye muscles are all 
            working normally
     Pharynx:  Your mouth and throat. We describe whether it is moist, red, whether 
           the tonsils are there and inflamed, whether you have post nasal drip. What 
           your teeth and gums are like. Are there sores in your mouth/gums. Bad breath?
     EAC and TM's=External Ear Canals and Tympanic membranes-your ear canal and eardrums. We describe what they look like, whether they are blocked with 
           ear wax (cerumen), and whether the "landmarks" or the normal things we see on
           eardrum look normal. 
     Nares=your nostrils. We describe the inside of your nose and whether it's swollen, 
           whether you have a deviated septum, ulcers, polyps or growths, etc. 

Neck=Here we describe the lymph nodes and whether they are enlarged. we describe 
     them based on location in the neck. We describe the thyroid (TMG) Thyromegaly-
     is the thyroid enlarged and are there nodules on it?

     Carotid arteries=not always discussed. Are there normal pulsations/sounds?

Pulm (Pulmonary)/Lungs:  
     CTA&P=Clear to auscultation (listening with the stethoscope-no abnormal noises) 
            and percussion-no abnormal sounds when we thump on your back.
     Rales/Crackles=sounds like hair being rubbed next to your ear, or like velcro being 
           pulled apart, heard when listening with the stethoscope. Can mean many 
           different things, from pneumonia, to scar tissue, to fluid in the lungs. 
     Wheezes=wheezing.
     Rubs=a sound like grating or squeaking. It can mean there is a problem with the 
           pleura of the lungs, or outer coatings of the lungs. 

CVS/Cor/CV=Heart. 
     RRR-Regular Rate and Rhythm
     Irreg RR-Irregular Rate and rhythm.
     Regularly irreg rhythm-just that. 
     S1, S2 normal-normal heart sounds of the opening and closing of the heart valves.
     S3 /S4- these are abnormal heart sounds which can be from heart failure, or a stiff
           heart or other causes
     No m/r/g-No murmurs, rubs or gallops. This means no heart murmurs, no heart rubs
           and no abnormal S3 or S4 sounds. 
     Murmurs are often graded from I-VI/VI in intensity and by location. 
           You many see: II/VI SEM ULSB nonradiating. This means, a 2 out of 6 murmur 
           heard in systole (part of the heart cycle) at the Upper Left Sternal Border. It is 
           not heard in other parts of the chest/neck/underarm (not radiating to those parts)

Breasts: We will describe any masses, discharge from the nipple, or lymph nodes. 
     We describe the breast in quadrants:  RUOQ, RUIQ, RLOQ, RLIQ are: 

          Right Upper Outer Quadrant, Right Upper Inner Quadrant, Right Lower Outer 
          Quadrant, and Right Lower Inner Quadrant. 

Abd(Abdomen):
     NABS=Normal Active Bowel Sounds
     No HSM=No Hepatosplenomegaly-this means the liver and spleen are not enlarged
           Sometimes if the liver is enlarged, it is described in centimeters in the chart 
     No masses-means that the physician does not feel any masses. It doesn't mean 
            there aren't any masses, just that he/she cannot feel any.
     No rebound tenderness/no rebound- means when there is pain pressing down, it 
             is not worse when you let go of the pressure. This can be a sign of 
             inflammation of the lining of the abdominal cavity, if there is rebound. 

GU: Depending on the sex of the patient, the explanations vary, obviously. 
     Normal external (male/female) genitalia=self explanatory
     no adnexal masses (female)-on the internal pelvic exam done with the hands, the 
           examiner is unable to feel anything abnormal.  This can be "limited by body 
          habitus" which means the patient's adipose or fatty tissue, or strong abdominal
          muscles can make it difficult to actually feel anything.

This is not a complete list, obviously. There is the neurologic examination, musculoskeletal exam, etc. 

The NEXT section is DATA: 
     This is part of the OBJECTIVE section, and includes, labs, xrays, and other test results

THEN comes the ASSESSMENT AND PLAN:

     This is the section where the patient's "Problems" are delineated and discussed and the possibilities of diagnoses are discussed, and a plan for evaluation and management is put together. 

 PROBLEMS: These are now described through the ICD-10 coding system. 

     Within the healthcare industry, providers, coders, IT professionals, insurance carriers, government agencies and others use ICD codes to properly note diseases on health records, track epidemiological trends, and assist in medical reimbursement decisions.
     ICD-10 is frustrating because there are very specific ways to describe medical issues and there is not always a diagnosis code that perfectly pertains, so one needs to pick the BEST OPTION. 
     Also, a patient may come in with what sounds like panic disorder or anxiety. The doctor may be fairly certain this is what is going on. He/she puts in the diagnosis code of "Anxiety disorder." The patient sees this and is upset. They came in with heart racing and palpitations, and SOB (shortness of breath) and tingling in their fingers and around their mouths and are worried they will die. If the doctor doesn't explain that he/she is fairly certain this is anxiety, but is testing/evaluating for other causes also, the patient may be surprised to see this diagnosis code. 

     As a patient, one needs to understand that putting in 5 different diagnosis codes that can be summarized in a single fairly certain diagnosis code, makes the most sense and is what is required. The insurers and government want the MOST SPECIFIC DIAGNOSIS CODE.

     Also We can only put 4-6 diagnosis codes on a single "bill" to the insurance company, and if you came in with anxiety symptoms but also had something else, like a UTI, if we use: Dyspnea (shortness of breath), Palpitations, numbness, chest pain, and dizziness-all of which could be summarized under "Anxiety/Panic" attack, then we can't put the UTI diagnosis code. 

     We also order tests through the Electronic record, and these show up under the "PLAN" section of the note. You will see lab abbreviations, consult/referral recommendations, test orders like CT or ultrasounds there. 

I hope this helps a little. See my disclaimer though.

     ***This is a brief explanation. Please understand none of this is meant to be medical advice. If you have questions about your medical record, address them to your physician. I will not be answering any specific questions about your personal medical record. 
Thanks!***

DoctorDiva 
May 10, 2016

   

I AM SICK OF EXERCISE ARTICLES SHOWING SKINNY WAIFS! IT'S NOT REAL!!

I just read yet another article on How and Why exercise should become a habit featuring an underweight waif who was slightly damp, sitting in an impossibly twisted position on the floor. Oh. AND Smiling.

Seriously?

Let me tell you what the face of exercise REALLY looks like.

Exercise is sweaty, hot, and sometimes painful.

Exercise is hard. Hard to start. Hard to maintain.

Exercise requires determination and sacrifice. Let's face it. It's much easier to roll over in bed and press the snooze alarm than to get up and exercise.

THIS is what exercise looks like when you are done.
A sweaty mess--NOT some barely perspiring fashion model.
Not to mention that, GOOD FREAKING LUCK finding those cute workout clothes at your local sporting goods store when you are above size 14.

I wear MEN's t-shirts (why are women's so clingy?)
and baggy yoga pants or MEN's sweats, (again-women's sweat pants are too clingy) my hair pulled back in a ponytail. I wear a sweat shirt after I'm done because you get cold fast when you are a soaking wet sweaty mess and it's winter.

(Is that why they call them sweat shirts?-I never thought about that before.) 

Do I look like I could just go towel off and go to work? NO. 

I started this blog several years back in an attempt to lose weight by dieting. 

My cholesterol was high. I was up there weight wise. I thought a blog would keep me on the straight and narrow. It didn't and I changed the course of the blog. 

Over the years, I gained more weight and became VERY out of shape.

I HAD to get in shape darned fast for that winter camping trip with my Boy Scout's. It was held at the High Adventure camp at Northern Tier in the boundary waters area of northern Minnesota. 

I started. I got stronger. I didn't lose weight. 

I didn't care. 

That was NOT my goal. 

My goal was to NOT DIE. 

Seriously. 

It can get to be -40* F in northern Minnesota in the dead of winter. We were going to be outside all day, and some of us all night, for 4 1/2 days. I needed to be able to snowshoe and cross country ski, and hike in HUGE snowboots and 3 layers of clothes, and survive it without having a coronary. Oh, and I needed to be able to get up off the ground when I fell. And I knew that I would fall. 

As I was sweating and stretching and in pain, somewhere along the line, I realized, I LIKED getting stronger. I didn't care so much about the weight anymore. I wanted to get STRONG. I became euphoric when I was able to do the number of body weight squats and lunges in the routine I was doing. I cried (yup, for real) when I was able to do incline pushups on the stairs instead of the wall. 

My husband noticed I was getting muscles in my arms and back and shoulders and quads. I started being able to make it up 6 flights of stairs without dying at the hospital. 

So what is the secret to keeping up with an exercise plan? 

1:  You need a serious goal, like not dying on a camping trip. 

2:  You need a plan. I found Nerd Fitness Academy and used it's stepwise plan to increase my strength. I SERIOUSLY don't care if I can't do all the numbers and reps and exercises. I just do what I can and don't get discouraged.

3:  Don't get discouraged. This.  Is.  Not.  A.  Race. My goal is to be able to do a real push up by October (it's now February-and I've been at it 4 months already) 

4:  Find a support group--NOT to compete against, but to SUPPORT you. To tell you that you are amazing and fabulous and who gives a flying fig what you look like when you sweat but to say  "Holy CRUDCAKES! You did THAT today? AMAZING! RAWR!" 

5: Go slow. Don't overdo it. Don't get hurt. If you get hurt, you won't likely start up again. 

6:  Keep a log of your exercise and diet. Seriously. I do it on Google Docs. I don't share it or show it to anyone. I do it to keep myself honest. Do I count calories right now? No. Do I count points? No. Am I trying to eat more healthily? YES. I bring lunch from home, try to avoid fast food and processed food. I try to eat fruit and veggies. I try to watch my salt. 

7:  You are not perfect so don't expect it of yourself. If you mess up, you mess up. Just start all over again the next day and don't feel guilty. Seriously. Guilt doesn't help. Just try again.  AND again. AND again. And again. 

It's like quitting smoking. Mark Twain said it was the easiest thing he ever did. He did it THOUSANDS of time. 

SO, remember, exercise is a messy, sweaty, smelly, endeavor and will make you feel better. 

Do it for yourself, not for someone else. Don't expect to look like some fashion model. Just do it to feel better and get stronger. 

DoctorDiva

2/9/16

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