I'm Jammin'! Bob Marley and Peach Jam.

This has been the year for canning. I am now a canning expert. I've scalded myself, figured out that you need  filtered water for lactofermentation, decided that homemade jam is a gift worth giving.

There is comfort in receiving a homemade gift.  I think it's the realization of the time put in, the fact that the gift is not perfect, and that it's personal. I made potholders for Christmas last year as gifts. People loved them. I give jam and pickles as "I appreciate you" gifts, or for housewarming gifts, or for hostess gifts when I'm invited to someone's home. Usually the people who receive the homemade gift are blown away.

I think homemade things make one think of their grandmother's kitchens, snapping beans and shelling peas on the front porch, sweating in the kitchen while the water bath is sterilizing/canning the pickles and jams and chutneys that are being put up for the winter. Comfort. Warmth.








Listening to a patient and letting them talk is akin to a homemade gift. 







Most patients have a story to tell around their illness. Not all of the details are important to the doctor, but if the story is interrupted, important details may be lost. We doctors are taught to let the patient talk, to tell their story, and if we do, it should only take about 3 minutes. Then we are asked to say, "Is there anything else? "


I hope to give you the homemade gift of a few minutes to tell me your story.

DoctorDiva
9/2/14

How To Count Your Period Cycle Length or "Am I normal?"

"DoctorDiva, I think there's something wrong with me. I've been getting my period twice a month some months."

"What was the first day of your last two menstrual cycles?"

"Well, DoctorDiva, I came on in the beginning of the month, went off a week later and came on again at the end of the month! There must be something wrong!"

"How many days do you bleed?"

"Well, I bled heavily for two or three days, then I spotted for another five days. Then I got my period again two and half weeks after that! What's wrong with me?"

"There is absolutely nothing wrong with you. You are completely and totally normal. Do you know how to count your cycle length?"
 

"Well, no. I mean, you should only get your period once a month, right?"
 

"Well, do you keep track of the first day of your period?" 
"I thought you counted from the END of your period."

I have this conversation more than twice a week.

 

http://www.pcosjournal.com/hormones-normal-menstrual-cycle/

WHO should CARE?


Well, if you want to know when you're going to ovulate, (when the egg pops out of the ovary and is ready for Mr. Sperm to sweep in and fertilize it), or don't want to get pregnant, or want to know if you ARE pregnant, you need to know when your period started.

See the picture up there. Yeah, I know. Ugh. Science. Right?

Look at the uterus picture. There's blood in there, and all the hormones, estrogen, and progesterone are low. That's your period. The blood comes out and the uterus is empty.

Then the estrogen goes up and then LH and FSH from the brain tell the ovary to pop out an egg. POP!! Out comes the egg, and it moves into the fallopian tube.

The blood starts to build up again and forms a really cushy nutrient rich lining inside the uterus where  the fertilized egg can set up house.

 If no sperm succeeds in it's quest to fertilize the egg, the progesterone levels and estrogen levels drop and BAM! Your period. Again.

If you know how long the time is from the first day of your period, to the next first day, you have your "cycle length."

Again, Who Cares?

YOU DO.  If you know that your period cycles are pretty regular, like 28 days or 32 days or similar, You can predict when your next period is going to be by counting forward from the first day of your period by your cycle length.

Also, if you want to know when you're ovulating, you count backwards by fourteen days from when your NEXT EXPECTED PERIOD is due and Bam!

Knowing the first day of your period is also how we figure out your due date for pregnancy.

 Now with so many people having smart phones with calendar apps, it should be fairly easy to keep track of your menstrual cycles.There are APPS for that!.

In general, that we talk about a 28 day cycle being "normal" but in reality,
"Normal" is a range.
 "Normal" is different for different people.

 Some people bleed every 21 days, some every 35 days, and some vary all over the place from 28 to 21 to 35 days or even skipping. That's not normal, and might be caused by a medical condition.

So, Are you normal?
Ask your Doctor.

DoctorDiva
July 22, 2014




 

This is An Important Camping/Hiking with Children Post

 ThrillWriting: Hug-a-Tree: Keeping Our Youngest Characters (and our real-life kiddos) Alive in the Woods with Jacquie Beveridge

I am following an amazing writer, Fiona Quinn, on Twitter.
She writes a blog on how to write. She researches specific situations and becomes an expert. Then she educates writers so they write more accurately. 

Many of you know I am involved in Boy Scouts and LOVE to camp. 
I have never run across this technique of pre-hike preparation. 
This is simply brilliant and will save lives. I thought it was too important not to share.
Please click on the link below:



ThrillWriting: Hug-a-Tree: Keeping Our Youngest Characters (and our real-life kiddos) Alive in the Woods with Jacquie Beveridge

Grief Pickles

I'm on another culinary bender.

I cook and craft when I'm stressed. It's safer and healthier than drinking.

My Father passed away July 1st, exactly 14 weeks after my mother died. My sister was the main caregiver and is an amazing person. I live half way across the country, and last saw them right before my mother died. 

My kids were off at camp when he died. While picking them up I stopped at a roadside farm market and bought 5 lbs of blueberries and several pounds of pickling cucumbers. I needed to cook.

Cooking to Cope. Should be a separate blog, eh?

 I've made about 10 pints of blueberry preserves since that first disastrous episode of  "scalding while sterilizing." I'm big on alliteration today.
(see previous blog post on Blueberry preserves)

Since then, I've learned a few things: 

1.) The canning rack will sit up on it's handles on the sides of the canning pot and so I don't need to reach deep into the pot to take out my sterile jars. There is less risk of dropping them and splashing myself with boiling water.

2.)  I have two different types of jar tongs. I can grab a jar sitting on its side easily without dropping it. 

3.) I use a candy thermometer to gauge the temperature of the jam

4.) I use a very tall pot to cook the jam so it doesn't foam up and boil over the top


But now: 

Pickles.

I've always wanted to make pickles. As a child, one of my favorite memories was going to Ernie's deli in Rutherford, New Jersey. He had a barrel of sour dill pickles behind the counter. My sister, friends, and I would save up to buy a pickle (25 cents each pickle) and have Ernie slice it up into the requisite number of slices. We amused him to no end. Most kids bought chips, cookies, gum, and candy. 

We bought pickles. 

I miss them. I can't get really good sour dill pickles in a barrel easily here in Chicago. 
Yes, I miss my parents too, even with all the baggage, and this is a way to remember my childhood and cope. A weird substitute?---- Yes. I'm not apologizing or explaining.

SO, I purchased perfect pickle cucumbers at the grocery store and decided I was going to try my hand at making CANNED pickles. I read a bunch of recipes and made a batch of bread-and-butter pickles and a batch of garlic dill pickles. 

Bread and butter pickles

The bread and butter pickles were AWESOME. 
The dill pickles were good but they were soft, and not exactly what I was looking for.


 Next, I made refrigerator garlic dill pickles with other vegetables as well as cucumbers.  My favorite pickled vegetable turned out to be the carrots. They were similar to Lalo's Mexican Restaurant's pickled veggies. I've also tried pickled cauliflower and I'd like to try pickled peppers.

The refrigerator pickles were close to what I was jonesing for, but no cigar. They were crisp and garlicky, but not the same as the sour dill pickles in the barrel from Ernie's Deli.

 So I've taken a plunge and have purchased a fermenting jar.

I've been reading all about making fermented sour dill pickles and since the weather's going to be cool next week, (Thank you Polar Vortex-the weather pattern that just keeps on giving)  I think this is as good a time as any to make them. If the weather gets too warm, pickles ferment too quickly and go bad.

 Wish me luck.

I hope I don't give myself Ptomaine poisoning. 

#BanBossy--Teaching my Daughter How to Resolve Conflict

I got a call from my daughter's Bestie's  Mom, C. "Did you know that E and M are not speaking to each other?"

"No. What gives?" I asked.

"I'm not sure," said C. "I think it has something to do with a misunderstanding about the movie last week."

A little background here.

E asked me if I could take her and M to the movie on Sunday. There were a group of girls going to see "A Fault in Our Stars."
I said, "Yes, but I'm going too. You're too young to be unaccompanied by an adult."


Saturday afternoon, some of the girls were on Skype and informed E that the movie activity had been moved to THAT night, Saturday. E asked me if she could still go.

"What about M? Have you called her to see if she can go too?"

"No, but I'm going to do that right now."

E tried to call M but was unable to reach her. She left a message. We went to the movie. It was a gaggle of teenage girls watching a tear-jerking movie that I was unprepared for and ended up sobbing into my popcorn  butter laced napkin. The girls were comforting each other as one of the main characters died a tragic young death.

Back to the phone call:
C was concerned because her daughter, M, wasn't supposed to walk home alone from school (E & M walk home together), and E and M weren't speaking and so M went to the library so C could pick her up after school.

 "What should we do?" She asked

"I think the girls simply don't know what to do to resolve this and so they're doing nothing, which means not speaking to each other. What are you doing tonight?" I asked.

We made arrangements to have dinner together with the two girls. I decided I better read a little bit about conflict resolution with teenagers and girls. I found this cool thing called #BanBossy. It's about teaching girls how to be assertive-instead of aggressive. It teaches using "I" statements when one is trying to resolve a disagreement or conflict.

For example, "I feel (insert emotion) when you (insert action other person has done to offend). Please (insert solution to said problem).

The Girl Scouts  have an entire lesson plan on this that is in a PDF form. Here is a brochure for leaders: 

 http://girlscouts.org/banbossy/pdfs/BanBossy_Leadership_Tips_for_Troop_Leaders.pdf

Here is the lesson plan:

http://girlscouts.org/banbossy/pdfs/BanBossy_Girl_Scout_Troop_Activity.pdf 

 I looked at it quickly and threw off an email to C asking her whether she thought this was a good thing to use with the girls.  We texted and emailed and decided to try it.

Dinner went well. We chit-chatted but the girls were not really looking at each other or saying much. C and I were asking questions and engaging each others child in conversation. After we had finished eating I whipped out the Girl Scout lesson plan and so did C.

We  started talking about how sometimes it's really hard to talk to someone when you're upset with them.  Learning how to argue fairly is a skill.

 We reminded the girls that there are going to be days when they don't even like each other but friendship is a commitment and requires work. You don't just abandon a friendship because of a disagreement. 

C & I opened the lesson plan. Part of it was to engage the girls by asking them about instances where they've had problems at home or at school and how they could use this new technique of using "I" statements to resolve the issues.

The floodgates opened as the girls relayed to us that they had been having a conflict with one particular girl all school year long. They had brought it to their teachers attention during a special session called "Advisory," but things had not changed.

We were able to practice, doing some role playing and the girls spoke to each other respectfully about their misunderstanding, and resolved the problem.

We reminded them that this is going to be something they have to practice. It doesn't come naturally to talk to each other this way, but learning how to resolve conflict is a skill set that needs to be taught, and learned. 

I was reminded that my daughter, although she is a young woman, still needs me to teach her life skills.

I was also grateful that C felt comfortable calling me and bring up the problem. Without her intervention, neither girl would have learned the other's side of the story, and it would have been a tragic loss of friendship.

Doctor Diva 6/21/14

Red Shirts Vs. Klingons OR Calor,Rubor, Dolor & Tumor

Yes, Here I go with the doctor speak again.

Inflammation.

It's a buzzword lately, but it's been discussed since the Greeks started thinking scientifically.

One of the very first things they taught us in medical school were the following terms:
Rubor--redness
Dolor--pain
Calor--heat
Tumor--swelling

These are the cardinal signs of inflammation.
You can also add:

functio laesa--loss of function.

Little did I know that this was my first Latin medical language lesson.
I spent a large amount of time with my medical dictionary at my side during my first year of medical school. Most definitions also had the Greek word, in Greek, next to the word. I was very glad I took ancient Greek in college for a semester. It gave me an instant leg up on medical language-- but I digress.

Inflammation is caused by not only infections, but by foreign bodies; injuries to an area like a cut,  broken bone, or crush injury; by cancer; by allergies; and by autoimmune states (attack of self by mistake); by toxins; and by radiation.

It gets pretty complicated. I want to keep it simple.
We may get more complicated if you want, down the road, but let's lay the foundation.

So let's say you get a cut. First it gets red and warm, and painful, and swells and you stop moving it because it hurts. Why does that happen? 

The cut activates a whole cascade of inflammation.

 First, cells at the site of injury recognize a problem and send out a chemical signal that causes the blood vessels around it to open up and get wider. That increases the size of the surrounding highways (blood vessels) for the blood cells and fluid and special chemicals and proteins to get to the site of the injury to wall off invaders, and close up a bleeding wound.

All of the extra blood flow and leakage of proteins and cells causes the wound to ooze, and to get red and to feel warm, and the area to get puffy.

Foreign Invader or "Klingon"

 Also, all of this extra swelling causes some of the bacteria and fluid to get swept up into the lymph blood vessels (lymphatic vessels) which travel to lymph nodes and make them swell up also.  Hence, swollen "glands" when you have a pharyngitis or sore throat.

In the lymph nodes, other immune responses start up. There are special white cells there that get activated when they recognize a foreign invader. (Let's call the foreign invaders the Klingons, and the white cells the "Red shirts"). I think of the lymph nodes as battle stations for the white cells to gather to help with inflammation. (For non Trekkies-In Star Trek, the good guys in red shirts always die. Klingons are one of the bad guys).

Anyhoo, the white blood cells are directed by chemicals released at the site of the injury to the affected area.

Activated WBC or "Red Shirt"

There they line the blood vessel walls. Then they squooge (a scientific term) through the blood vessel walls into the tissues around the wound. Once there, they kind of help direct the show, releasing more chemicals to attract other white cells to the area.  
They recognize the Klingons, and put up tractor beams to pull them in and suck them into the USS Enterprise where Captain Kirk makes out with a pretty girl, Oh, never mind. 




 Okay, where were we?  Oh yeah.

The white cells eat the bad guys, or release chemicals that cause the Klingon to blow up. 

There are also chemicals that cause fibrin to be released. Fibrin is kind of like a fishing net thrown over the wound, and platelets then get caught in the net and cause the wound to stop bleeding by closing up the wound with a clogged up fishing net. 

Some of the white blood cells, the neutrophils, are the real "red shirts" of the process because they often die at the end of the inflammatory process and form pus. So when you have a pus pocket, or a boil, or abscess, you have the remnants of a colossal battle between the Klingons and Red shirts.

The Red shirts will win if the pus is drained and the inflammation goes away.

Anyway, there's a lot more to it, but I decided to keep it simple today.
Maybe, later on, we'll get more specific about all the different types of white cells, their jobs, the chemicals they release, and the immune and clotting systems.

Live Long and Prosper. 

Doctor Diva

Fun with Doctor Language.

Use a Word and Make it Yours 

or

Fart Jokes ALWAYS Help You Retain New Words.

Today, we are going to use common "doctor dialect" and translate it and use our new words in our every day speech. To "own" a new word, you need to use it in a sentence.


 I tried dictating this post but my word recognition software made quite a mess of it. I suspect that the garbled language my dictation software misunderstood, is what my patients hear too.


Let's begin:

The suffix for inflammation is "-itis."
rhino means nose. I always liked that one because it was pretty obvious. A rhinocerous has a big
nose.
W.C. Fields had "Rhinophyma"--a bulbous red & enlarged nose.People used to equate it with alcoholism, but really it's just part of a disease called "rosacea."

"Rhinitis" equals inflammation of the nose.

 "Allergic rhinitis" is an allergy that make your nose swell up or itch.

 
A "Diverticulum" is a finger like outpouching of the colon.  Diverticulitis is an inflammation or infection of a diverticulum.

 The Abdomen is the entire belly area.

But, we don't say "abdominitis". Instead, we use the name of the organ that is inflamed. For example,  the lining of the abdominal cavity is called the Peritoneum, so:

 peritonitis=inflammation of the lining of the abdomen
AND:
 appendicitis=inflammation of the appendix
 hepatitis=inflammation of the liver

Okay. So this is pretty dry, right?
Let's spice it up a little.

 When you get a scab we call it an "eschar". What's underneath it, the little divet in the skin is called an "ulcer" or "ulceration".

If we follow through on this we could call potholes "asphalt ulcers."

(Doesn't that sound scientific?)

 In the large intestine,  if you get a lot of ulcerations we call it  "colitis".

 Here in Chicago when the roads are very potholed and there are hubcaps flying all over, we call it 

 "winter". 

 BUT we COULD call the potholed nightmares that pass for roadways in Chicago "diseased".  

They have 

ULCERATIVE ASPHALTITIS.

Tailgating annoys me no end because it's rude, annoying, and extremely dangerous.  I think we should rename it: "RECTUM RIDING."

 Some people have poo for brains. How did it get there, you might ask?
Well, those people must have a conduit to get poo from their colon to their brain (cerebral cortex). I say that those people have a colo-cerebral shunt.

Okay, here's a fun one for those of us who are still amused by farts. (And really, who isn't deep down?)

The technical term for passing gas  is "flatus" or "flatulence".

Urinating is "micturating".

Having a bowel movement or pooping is "defecating".

(Most people know that one.)

SO,  someone who is a gasbag or talks too much has flatulence breath.

Logos means "words". And we all know "diarrhea" is running at the bowels. Put the two together and you get logorrhea--Someone verbose or who is very talkative.

Belching or burping in "doctor" is "ERUCTION"
.

I like using the word "ERUCTION" in public because it always gets confused with other words-- you know, like "ELECTION".

(What? Seriously? Are your minds in the gutter AGAIN?)

So, Let's use our new words in a sentence or two. Here's a little scenario/story using many of our new words.

That guy driving behind us has a colo-cerebral shunt! Did you see how he was rectum riding me? Then we hit that patch of asphalt ulcers and one of his tires blew out. 

He pulled over, got out of his car, and lit up a cigarette.  He walked around his car checking his tires, but when he bent over, there was a simultaneously huge eruction and loud passing of flatus.

 (I almost micturated in my pants laughing.)

Well, who knows what he was eating earlier. It must have been something good because those bodily vapors went shooting up in flames towards the heavens, lit by a spark from his cigarette. 

He started swearing like a sailor as the police pulled over. They took one look at his rhinophyma and figured that he was an alcoholic (although that's not really true). 

They made him do the breathalyzer test.

Suddenly he doubled over in pain, holding his abdomen. The police called for an ambulance and we later found out he'd had emergency surgery for appendicitis. 

So, the moral of the story is:

Don't tail gate, don't smoke, and don't drink or you'll end up with a big nose, horrible gas and a flat tire.

The End

SEE HOW MUCH YOU LEARNED?