Dr. Dan's Notes
September 2019 - Tendonopathy
August 2019 - Toenails
Invite Harry the mushroom to your party. He is a fungi (fun guy)
Many times, the toe nails get real thick and deformed. This is called onychomycosis and is caused from a fungus. (not a fun guy) I usually trim these nails in a certain way to keep them from hurting or from wearing out socks and shoes. The treatments for onychomycosis all take about 6 months. There are pills and these have a chance of hurting your liver so you should be monitored for liver changes during these treatments. There are topical liquids you put on the nails and these include prescriptions, tea tree oil, vicks vaporub, and some compounded medicines made in special pharmacies. The topical prescriptions may also affect your liver but the vicks and tea tree oil have not been shown to affect your liver. If your toenails bother you, let me know and we can figure out what is best for you.
Ingrown toenails. The reason we don't get ingrown fingernails is probably because we do not wear shoes on our hands. Ingrown toe nails can be a very painful experience and can get infected. In diabetics, it could lead to an infection that could even lead to an amputation. Please do not ignore this condition.
Properly fitting footwear is a very important factor in preventing ingrown toenails. if the toe box, the part of the shoe over your toes, is too small, that naturally would tend to guide toenails to grow inward.
Proper trimming of the nails is also very important. If you trim your nails too short, this can cause them to grow inward. Also, it is generally helpful to trim the toenails straight across and not curved like you would your fingernails. That is not always the case but as a rule it generally applies. I have to do a different therapeutic trimming technique sometimes.
If attend to your sore toe early, it is less likely to need surgery and removal or ablation procedures. I used to do a lot of standard toenail removals and partial removals with or without chemical or electrical ablation which is a method of burning the part of the nail that grows in in order to prevent the ingrown toenail from coming back. I, recently have been able to do a modified technique which has a shorter recovery time and does not require that I put shots into your foot and toe. The trick is to get it tended to early.
Remember, the goal is to be functional (everything works) and comfortable (nothing hurts). What else matters? Don't ignore your feet and come in early so we can get things fixed the easy way.
As Always, I am at your service.
August 2019 - Hospice Care
No Joke today just a quote from a Mentor of mine, Dr. Henry Strobell: “Cure and Care have the same root in Greek. You cannot do one without the other.”
The medical term for hospice care is Palliative Care. It is not a last ditch effort by any means. Decades ago that may have been the case but now, statistically, it has been shown that the sooner Hospice is started, the longer and more pleasant the lifespan of the patient.
The alternative to Palliative care is Curative care. When there is little chance of curing a condition like in emphysema, or cancer, or even some types of dementia, Palliative care does everything possible to make the person live as long and as well as possible. I have had patients on Hospice for over a year and then get better and get off of Hospice.
It is true that one needs a diagnosis that, if the disease takes its normal course, the patient will die in six months. But with the extra care from the Hospice team, pt’s often do very well for a longer time. The Hospice team consists of doctors, nurses, social workers, chaplains, pharmacists, personal aids and volunteers.
Hospice pays for the medicines associated with the Hospice diagnosis and for any equipment needed to care for the patient’s Hospice diagnosis. Because it is a team effort and your doctor is included in this team as well as the medical director of the Hospice, each patient has very individualized care. Physical therapy is not included in Hospice coverage but all procedures that will increase the patient’s wellbeing including certain transfusions and surgeries are included.
Included with Hospice services is a thing called respite care where a patient can be put in a nursing home or other inpatient facility for a short while to improve the patient’s condition or even to help the family and caretakers continue to provide that patient’s needed care. Home health requires a patient to stay at home except for certain appointments. With Hospice there are no such limitations.
One usually does not think about the severe strain on the family of a patient with a severe illness until it hits. Hospice is there to help the family as well. It is a team to help every way possible for physical, mental, social and spiritual wellbeing for the entire family group.
One can revoke Hospice at any time but that is not the best way to use this service. Hospice may not be for everyone but the Hospice team is there to answer questions and to evaluate the patient to identify every need that can be filled.
August 2019 - MRSA
A while back, I was helping my mom balance her check book and I ran across an entry that said “ESP”. I asked her if she was taking a course in extrasensory perception or something like that. What is this entry for ESP? “Oh,” she said, “That stands for ERROR SOME PLACE”
Acronyms like ESP or MRSA can get confusing.
MRSA stands for Methylocillin Resistant Staphylococcus Aureus and it is a skin infection that is hard to get rid of. It is resistant to many antibiotics and requires special treatment. It is most commonly found in hospitals and in nursing homes, but less often in the community. Sometimes it can be treated with oral antibiotics but sometimes it needs to be treated with IV antibiotics.
Staphylococcus is a type of bacteria. There is a form of Staphylococcus on all of our skin surfaces right now all the time. We are all colonized with a type of this bacteria called Staph. Epidermitus. Staph epidermitus does not cause infections and actually can prevent some skin infections by occupying the places where the bad bacteria want to go and blocking them. That is the same way that probiotics work. Staphylococcus Aureus is another story but even with Staphylcoccus Aureus, antibiotics can help to resolve most of these infections. MRSA is a small subset of Staph that has become resistant to many antibiotics including a strong form of penicillin called methylocillin. Streptococcus is another sort of bacteria and as you can guess it is what causes strep throat. We can talk about that later.
August 2019 - Heat Injury
A person told me that he was going to fly to the sun. I asked how would he keep from being burnt up. He said he would go at night.
We have had quite a few heat injuries this summer that have led to hospitalizations. Heat injuries can lead to serious consequences and even death.
The number one way to help avoid these situations is to drink plenty of water and avoid too much time and exertion in the heat.
Soda actually can make the situation worse.
Beer, wine or spirits definitely can make it worse.
Tea is a diuretic…. it makes you pee. Tea may be better than soda, but not as good as water.
Gatorade, Powerade, Koolaid, Lemonade, are all very good. The World Health Organization (WHO?) has a formula for rehydration that is not much different from half strength Gatorade so that drinking a glass of Gatorade followed by a glass of water would be fairly equivalent and is a good idea.
The first symptom you get with dehydration is a headache. I learned this first hand when I was an Airman First Class in the Air Force in the Survival school. Two glasses of water have been shown to get rid or a majority of headaches. If your pee is yellow, you are dehydrated until proven otherwise. That’s what our Sergeant always told us and it worked.
Dehydration has the symptoms of headache and concentrated urine as well as feeling very tired and even a little like you have the flu.
Heat exhaustion means you cannot maintain adequate cardiac output in the heat stress environment and is very serious.
Heat stroke is where your body is already shutting down, you have stopped sweating and it is a medical emergency.
The treatment for all of these is rapid cooling. Using evaporation by wetting the patient down is a very good idea. always call for medical help and the potation needs to be evaluated even after the crisis is past.
July 2019 - Swimming Pool Safety
My brother called me and told me that he now has a pen that will write under water….. but it also writes other words so that pen may not be so special.
The four major risks around swimming pools are drowning, infections, chemical injuries and sun injuries. Statistically more infants and toddlers drown in bathtubs or even buckets than in swimming pools. An infant can drown in as little as one inch of water. Water wings on toddlers arms are not an acceptable floatation devices for toddlers according to the AAP and the USPHTS. Your toddler should never be more than an arms length away from you around open water. It only takes a second and often there are no second chances.
Otitis externa is a swimming pool ear infection. Often, one can get these infections from just being in the wind and not getting water in your ears. Ear infections can be treated and prevented easily. Swimmer’s ear solution is nothing more than a 50/50 mixture of vinegar and alcohol. It doesn’t matter the type of vinegar. The alcohol can be rubbing alcohol or even vodka. One puts about three drops of the solution in each ear right after swimming. Additionally, one can prevent ear infections by putting. A couple drops of mineral oil or baby oil in the ears before swimming to protect the ear canals from the water. This. Is not a substitute for the swimmer’s ear solution of vinegar and alcohol to be used right after swimming.
Pools usually have chemicals added to the water to prevent infection and to prevent bacteria growth. Young children are notorious for getting into things they should not be exposed to so extra care in protecting the children from these chemicals is warranted. It is rare that the chemicals cause problems when used properly but eye irritation and some skin irritation happen occasionally.
Sun damage can be a problem, not just from sunburn but from the development of some types of skin cancer later on in life. Actinic keratosis, melanoma, squamous cell carcinoma are the three most common skin cancers. Actininc Keratosis is a pre cancerous lesion and the treatment is very simple and painless most of the time.
May 29, 2010
A cowboy walks out of a bar in Oklahoma and finds his horse missing. He returns inside to announce furiously that if his horse is not back in its place by the time he finishes this next beer, he will be forced to do "what I had to do in Texas!"
Fortunately the horse is returned by the time he finishes his beer and he gets up on his horse ready to ride away. The bartender says: "What did you have to do in Texas?"
He replies: "I had to walk home."
So often we fear what we don't understand. Medicine is full of things we don't understand — like insurance companies, medical jargon, side effects of treatments or medicines and the normal reaction of the body to disease and injury.
I really don't think we will ever understand insurance companies but with the others we can get a handle on from time to time. One of the scariest things I can think of is cancer. When I say that word in my office, patients hear nothing more the rest of the day.
Cancer is when the cells become rude. They are rude because they no longer respect the space of the other cells surrounding them and push their way into places they don't belong. On the membrane, the skin of the cell, are receptors that stop the reproducing and growing mechanisms of that cell when it touches another. This keeps us from becoming all bumpy in the wrong places. When a cell touches another, it is supposed to stop growing. When this doesn't happen we can get a tumor.
A tumor is a lesion — a growth that should not be there. They can be harmless, benign, or they can be malignant and dangerous. When parts of the tumor get into the blood and spread around the body it is called metastasis. We have filtering mechanisms, lymph nodes, around the body that catch things in the blood that are not supposed to be there. In lymph nodes, there are 'nk cells', natural killer cells that kill abnormal cells, and 'macrophages' that eat bacteria and damaged cells. Additionally in the lymph node filter system are 'b-cells' that put antigen markers on the surface of the cells so that the 'nk cells' and 'macrophages' can find the abnormal or damaged cells and take care of them appropriately.
There are many more defenses that God gave to our body to protect us as well.
So now you know about antigen markers, lymph nodes, metastasis, benign vs malignant tumors and generally what is cancer. And I always thought that a 'tumor' was an additional pair — 2 more.
Don't make me do what I had to do in Texas!
May 9, 2010
Happy Mother's Day to all my friends of that persuasion.
Last evening I attended the Carbon Texas VFD Benefit Dinner with my mother — and the "Band-Aids" entertained the folks. Below are a couple of snapshots from the performance.
May 5, 2010
I have gotten this e-mail many times and it's worth posting.
If we could shrink the earth's population to a village of precisely 100 people, with all the existing human ratios remaining the same, it would look something like this:
- 57 Asians
- 21 Europeans
- 14 from the Western Hemisphere, both north and south
- 8 Africans
- 52 would be female
- 48 would be male
- 70 would be nonwhite
- 30 would be white
- 70 would be non-Christian
- 30 would be Christian
- 89 would be heterosexual
- 11 would be homosexual
- 6 people would possess 59% of the entire world's wealth and all 6 would be from the United States.
- 80 would live in substandard housing
- 70 would be unable to read
- 50 would suffer from malnutrition
- 1 would be near death; 1 would be near birth
- 1 (yes, only 1) would have a college education
- 1 would own a computer
The following is also something to ponder...
If you woke up this morning with more health than illness...you are more blessed than the million who will not survive this week. If you have never experienced the danger of battle, the loneliness of imprisonment, the agony of torture, or the pangs of starvation you
are ahead of 500 million people in the world.
If you can attend a church meeting without fear of harassment, arrest, torture, or death you are more blessed than three billion people in the world.
If you have food in the refrigerator, clothes on your back, a roof overhead and a place to sleep...you are richer than 75% of this world.
If you have money in the bank, in your wallet, and spare change in a dish someplace ... you are among the top 8% of the world's wealthy.
If your parents are still alive and still married ... you are very rare, even in the United States and Canada.
Sooooo.............Work like you don't need the money, Love like you've never been hurt, Dance like nobody's watching, Sing like nobody's listening.
Live like it's Heaven on Earth.
April 27, 2010
A Chinese gardener was getting water from the river every day in twp pots tied to a pole which he carried over his shoulders. One pot was new and one was an old cracked pot that leaked.
The old cracked pot was embarrassed that it leaked water the entire way from the river to the garden, spilling water along the road from the river. One day the old pot told the gardener that the gardener should not use him because he was worthless in that he leaked water all the way from the river to the garden. The gardener asked the old pot to look at the road and tell him what he saw.
The old pot noticed that one side of the road was barren but the other side was full of beautiful wild flowers. The gardener told the old pot that was his intention all along and the old pot's worth was more than what was readily apparent — it was the fact that the old cracked pot leaked that made him valuable in the first place.
The gardener was watering the wild flowers using the talents that only the old pot had.
Some times worth is anything but apparent. God uses us to His own ends, not ours.
The smile you give a stranger often has much more value than you know. The help you receive from another is often more help to the giver than the receiver.
Remember that when you are talking to your cracked pot friends — like me.
April 5, 2010
A mother hears her little boy saying his addition tables: 1+1 the son of a bitch is 2, 2+2 then son of a bitch is 4, 4 + 4 the son of a bitch is 8…
She asks him where he learned that language and he says his teacher told him. She calls the teacher and complains about this quoting what her son had said and the teacher said "Oh no! I said 1+1 the sum of which is 2".
There is hearing and then there is hearing. Often times, even with hearing aids, one cannot make out words in a noisy environment. Hearing aids increase the volume but not necessarily the clarity.
Did you know that Alexander Graham Bell was originally trying to invent a hearing aid and came up with the telephone instead?
There have been many advances in hearing aid technology even in the last decade but we're still not there yet. Audiologists are hearing specialists. ENT specialists (ear, nose and throat) are Physicians. They work together to maximize your hearing.
When I was a Flight Surgeon on Active Duty, one of my many jobs was to oversee the hearing protection program. At the present time, there is little to be done to restore healthy ears and that makes hearing conservation sooooo important.
I have not found anything in medicine or acupuncture yet to help tinnitus, ringing in the ears. When a service member presented with hearing loss and failed the hearing test, we had to send him for a MRI of the head to rule out a cochlear tumor and if that was fine we made an appointment with him to see the audiologist. Often the service member had to change jobs to preserve the hearing he or she had left. Some got disability.
In fact I saw three of them coming out of the audiologist office after getting hearing aids one time and the first said: "It's windy." The second said: "No, its Thursday." The third replied: "Me too, Lets get a beer."
You got a bonus joke today. 1 + 1 the…
March 29, 2010
An elderly couple is on the couch and the husband offers to get ice cream for both of them. The wife asks for sprinkles... and chocolate syrup. He says he'll get that too.
She says "You better write it down. You know how bad your memory is."
He grumbles "I can remember" and returns after a long time with bacon and eggs.
She says "See! I knew you would forget!" He says "what did I forget?!" She says" the toast."
The best way to keep your memory sharp is-- uhm--uhm -- Just kidding.
The best way to keep your memory sharp is to keep using it. Crossword puzzles, Sudoku, learning to play an instrument, reading, learning new languages, etc. can help.
Studies using PET scans (positron emission tomography scans) have actually shown the best new things to learn are languages and listening to Mozart. The worst thing to do is sit and watch TV all the time — even educational programs. The TV is too easy for your mind to take in and your mind does not exercise while being hypnotized by the screen. That is why it has been used so successfully as a babysitter over the last couple decades. I love watching movies like everybody else but to keep your memory sharp you need something to help you stretch.
Another thing to keep your memory sharp is exercise. By increasing the blood flow to your brain, you help keep your blood pressure under control and decreases the risk for stroke. You can get a stroke if your blood pressure is too high or too low. Little mini-strokes are called TIA's and patients often recover from them completely but TIA's contribute to memory loss. TIA's can also come from blows to the head and cause memory loss and dementia. It's kind of like what one sees in the "punch drunk fighter" like Mohammed Ali after his career. So no boxing even if you win.
We will all lose our short-term memory to one extent or another no matter what we do. The trick is to make it as little as possible. If you find yourself forgetting, try some of the things mentioned above and it is not cheating to carry a notebook in which to write things down.
Don't forget the toast.
March 25, 2010
A Zen Master gave $5 to a New York hot dog vender and said "Make me one with everything"
The hotdog vender gave him his hot dog with a sly smile.
The Zen Master said " Hey! what about my change?"
The hot dog vender said "Change must come from within"
Mysticism has a way of catching our attention. Acupuncture has a cloak of mysticism around it which I will try to simplify somewhat today.
The "I Ching" (pronounced almost like itching), and the "Tao de Ching" (pronounced dow-day-jing) are two of the most important Chinese writings and have helped to shape all of Chinese culture, and even more so, the practice of acupuncture.
Five Element Acupuncture (you know, the one where I smell your feet) is the most complicated of the types of acupuncture and reflects the concepts of both the I Ching and the Tao de Ching. There are patterns in nature that can be classified into five phases: Fire (summer), Earth (harvest), Metal (fall), Water (winter), and Wood (spring). Just as the seasons blend into each other so do these states blend into each other in our bodies. These patterns in our bodies are called "CF''s", but I think it is more fun to call them "superpowers".
As a doctor, it is very important to listen to patients and to the hints that the body gives us. When I can determine the proper "superpower", I will know the best set of points to use for each individual patient. Each CF pattern, or "superpower", is not related to personality. Rather, it is related to the way your body adapted to stresses in your very early life after you were born. Some habits are hard to break. You can not determine a patient's "superpower" without the four aspects: the color of the skin near the eye, the sound of the voice, the odor of the sebaceous glands (that's why I smell your feet), and the emotion underlying the temperament.
These all are actually undercurrents and traces of color, sound, odor, and emotion that float just under the surface — so it takes much training to detect them.
There are also 12 different pulses that are felt as undercurrents of the western medicine pulse that take much training to be able to recognize as well.
After determining the pattern, the doctor checks for blockages in the electrical circuitry in the body. Anyone who has ever touched (much less peed) on a hot wire fence knows that the body works on electricity. When the electricity, which the Chinese call Chi (pronounced chee in Chinese and key in Japanese), is not right, the body is not right. That is how you determine which acupuncture points to use within each pattern.
Each patient is unique and therefore, a "Wood" patient would heal easier using a wood pattern and a "Fire" patient would heal better using a fire pattern.
Remember, we are all unique.
You know how to catch a person? Unique up on him or her.
March 10, 2010
A rich Jewish lady who could go anywhere in the world for vacation decided to see the new Swami in India. Her assistant said "But you will have to travel 18 hours by plane, two days on a bus and hike the rest of the way up the mountain and even then you will be only able to say 3 words to him! Are you sure you want to do this?" She said yes and traveled by plane, bus, on foot and waited in line for 3 days to say three words to the new Swami in India.
When she got to the head of the line she was reminded about the three word rule and was admitted to the Swami's presence whereupon she said: "Harold — Come Home!"
Last week I was at the national hospice convention learning how to better help all of us as we approach the end of our lives — and pay our taxes. Both are inevitable. However, all I wanted to do was go home. I learning about pain control, symptom control, and don't forget the regulations, but I know the answers are at home. I'm not talking about the houses we live in or the towns we are from. I'm talking about the way God wants us to be all the time, accepted and forgiven.
Pain is the most common symptom that is presented in my practice. Pain is a lack of acceptance by the mind or body and it subsequently causes discomfort. The skin doesn't accept the thorn's piercing. The ego doesn't accept the insult. But as when the thorn is removed, the skin heals, when we forgive we are free of the pain as well. These topics were discussed extensively at this conference.
It is often impossible to separate physical and emotional pain because these two cause each other. The only cure is forgiveness on the scale of the whole person in body, mind and spirit. It gets better when we are home — accepted, loved and forgiven. There is only one way to be accepted, and that is to accept, and one way to be forgiven and that is to forgive.
I don't have all the answers, but I know who does. God wants us happy and safe, but we have to do it His way, not ours.
"Harold — COME HOME!"
February 24, 2010
In English class I was taught that a double negative would mean a positive. Like “not ever” would mean “always”. But a double positive would not mean a negative…
Like I’m gonna believe that.
In Medical school I was taught that you had to sterilize wounds to get them to heal. We would use hydrogen peroxide, alcohol and iodine on wounds all the time. Now the current thinking is to “not use anything on a wound that you wouldn’t put in your eye”— like baby shampoo or other mild soaps. This is because when we kill the germs, we also kill the healthy tissue that is trying to heal.
Other things that have come up in regard to wound healing are Anodyne therapy and Hyperbaric treatments.
Anodyne is using light at about 920nm wavelength to stimulate nitric oxide receptors in the blood vessels to increase blood flow to areas in order to heal wounds and other injuries more quickly. Nitric oxide receptor stimulation is the same physiology that makes Viagra work. So if your wound gets a little stiff — don’t worry,
Hyperbaric treatment is breathing oxygen at 2 or more times the pressure of our atmosphere at sea level (called being at depth) to increase the amount of oxygen at the wound site so that the cells involved in healing will be able to function better. Unlike Anodyne, this does not depend on blood but just on the fluid.
At the beginning of the hyperbaric therapy era, early researchers bought a pig from a farmer, brought it down to depth (put it under high atmospheric pressure) — transfused out all of its blood — replaced it with salt water (saline) — and it did fine. It looked very pale but had no problems even though it did not have a drop of blood in its veins. They then transfused the pig's blood back into the pig and brought it back to surface pressure and sold it back to the same farmer.
This one really is true — to the best of my knowledge.
February 15, 2010
The bartender asks the farmer, "Hey, why are you sitting in a bar getting drunk on this beautiful day?"
Farmer: "Some things you just can't explain. But, if you must know, today when I was milking my cow she knocked over the bucket with her left leg just as the bucket was full."
Bartender: "What's the big deal?"
Farmer: "Some things you just can't explain. I tied her left leg to the left post with some rope. Then I sat down and continued to milk her. She took her right leg and kicked the bucket over so I tied her right leg to the post on the right. I sat back down to milk her but just as I got the bucket full, the stupid cow knocked over the bucket with her tail."
Bartender: "Wow, you must have been pretty upset."
Farmer: "Some things you just can't explain."
Bartender: "So then what did you do?"
Farmer: "Well, I didn't have any more rope, so I took off my belt and tied her tail to the rafter. At that moment, my pants fell down and my wife walked in.
"That's why I'm here — some things you just can't explain."
Some things you really cannot explain — like laser therapy. I could tell you the jargon about mitochondria, nitric oxide receptors and magnetic fields, but that hasn't shown me to my satisfaction that the theories are valid. I'm scheduled for another course that may shine some light on laser light therapy — sorry for the pun — and I can tell you about it when I get back in April.
For now, I just see the fact that wounds, neuropathy and other pain including sinus headache pain get better very quickly in my office when I use laser light. It even works for acupuncture instead of needles sometimes.
The Germans are way ahead of us in this field and I have gone to some of their workshops but they can only tell me how to do it and not why it works — some things you just can't explain.
I'll get back to you
February 8, 2010
A hypnotist was hypnotizing an entire auditorium full of people when he dropped his watch. He said "shit" and it took a week to clean up that auditorium.
People say: "No one can hypnotize me." And that's true. Hypnosis is self-induced. The hypnotist can guide one during hypnosis and can assist one in entering the hypnotic state, but you will not do anything under hypnosis that you would not do otherwise.
Can you feel the clothes on your body? (... before I asked you about it?)
If your answer was no, you are normal. The fact is that we need to filter out many sensations during our days or we will get overloaded.
Hypnosis is just redirecting which sensations we filter.
God made our body, mind and soul very well. We often limit our abilities. That is why, when these limitations are lifted, it seems so remarkable. The abilities were there all along.
February 1, 2010
On my first date I was met at the door by my date's intimidating father who told me to wait on the couch. Their big Great Dane dog sat next to me. As I waited, I got more nervous and I accidentally passed gas.
The father called out "DUKE!" and I thought — good boy Duke, stay here in case I have another incident of gas — which happened right away and the father called out again "DUKE!".
The third time I passed gas the father said "DUKE! — get away from that boy before he S*$#S on you!"
Sometimes we have more hot air than others. Certain conditions like sinusitis for example will create more mucus in the respiratory tract which gets swallowed and reacts with the stomach acid and releases methane which comes out as flatus on one end or belching on the other. Stomach viruses and AGE — (That's acute gastroenteritis—not getting old) — have a similar effect. Vegetables like beans, cabbage and cucumbers, or even drinking soft drinks with carbonation, will bloat one us as well.
There are some over the counter measures to decrease gas. After a fatty meal, if one has problems with — you know — flatus, it may be a sign of gallbladder problems.
At any rate, after you turn forty: never trust a fa… flatus.
January 25, 2010
A mother walks into the bathroom where her thee-year-old is sitting on the toilet. He is tapping himself on the top of the head with the palm of his right hand. The mother asks him what he is doing and he replies: "Well, I can't poop and this works with the ketchup bottle."
Constipation is a symptom of dehydration which is usually the result of drinking less water than your body uses. On hot days we use much more water than we think. Every breath carries away moisture and sweat can evaporate faster than we notice it.
Other symptoms of dehydration are headache, irritability, back pain, faintness or light-headedness. I have seen all these in survival training when I was on active duty in the Air Force.
Dehydration can also contribute to heat exhaustion, heat cramps and heat stroke. Heat stroke is life threatening because the body stops sweating and if the body temperature gets too high brain damage may start to happen.
The treatment for heat stroke, as well as heat exhaustion and heat cramps is to cool down the body and hydrate with water, Gatorade, kool-aide or lemonade — but not beer please. Beer, or any other alcoholic drink, will make you more dehydrated and that is the reason for hangover symptoms. That's right: hangovers are from dehydration.
Prevention is much more effective. Your body will tell you if you are adequately hydrated. Usually if you can pee clear urine 2 times in a short span of time, you are hydrated — unless you've been trying to hydrate with beer — which will always make you pee clear urine.
January 18, 2010
You know, having a smoking section in a restaurant is kinda like having a peeing section in a swimming pool.
Swimming is a big part of summer — especially for us kids. Last summer I got swimmer's ear and it stopped my swimming abruptly. I had forgotten the easiest way to prevent swimmer's ear. Before going into the water put in a couple of drops of baby oil in each ear, and after getting out of the water use several drops of swimmer's ear solution in each ear.
Swimmer's ear solution is simple to make. Mix equal parts of rubbing alcohol and vinegar and you have it. Using this technique sure beats staying out of the pool for a week.
As always — hydrate with water, Gatorade lemonade or kool-aide until your pee is clear two times in a row. There are worse things than being "all wet".
January 11, 2010
I was talking to a patient in the hospital the other day and mentioned I had some serious matters to discuss with her and that we needed to not be disturbed for a little while. She immediately proceeded to push the nurse call bell. I asked her why she did that.
"Because we needed to not be disturbed for a little while," she replied, "And I know that whenever I push that button nobody comes in for 30 minutes."
I hate being in the hospital — especially when I'm sick — almost as much when I'm working there. I guess no one really likes being in the hospital. It's usually nicer at home. If you, or one of your family, have serious illness, it can be completely exhausting for the patient and the family at home or in the hospital or nursing home. I know from when we were caring for my father at home and now my brother is seriously ill. It takes its toll on the whole family.
I've been so glad for those who help us with the care of our family members with chronic, long term, illnesses. They make such a difference. Patients need the care and families need a break now and then.
There are two types of home care, Home Health and Hospice. Home health is shorter term than hospice and offers physical and occupational therapy, plus nursing care and nursing assistance with activities of daily living until the illness passes. There are some illnesses that do not go away or that we do not have a cure for. In some cases we may have a cure, but it would be too hard for the patient to endure the treatment or some other extenuating circumstance stands in the way of pursuing curative therapy.
In this instance we call on palliative medicine and hospice to treat the whole patient, body, mind, and spirit to keep the quality of life of people as optimal as possible. These services are not only for the patient, but also for the entire family and support group. The heavy weight of illness is not a load we have to bear alone whether we are a patient, a family member or a caregiver — or all three at the same time, which is not infrequent.
The biggest waste is to have help and not use it and therefore have those we love or ourselves suffer needlessly. After all, we are here to serve one another just as Jesus washed his disciples' feet, we are to care for others and allow others to care for us.
Thank you to all of those people who care for us in our weakness.
January 4, 2010
A patient came into my office crying and saying that her heart doctor told her she had to take these pills for the rest of her life. I asked her why she was crying. She said: "He didn't give me any refills!!!"
Refills are a tricky business. If everything has been the same for a long time and all the signs and symptoms are normal, it is easy to give refills. If things are not just right, it may be better to check with the doctor sooner.
In any case, it is a good idea to see your doctor at least once per year even if everything is fine. I tend not to give repeat refills over the phone — but I try to give refills for as long as is safe after I see the patient in the office.
If there are new symptoms, by all means, the safest thing to do is see your doctor.
December 28, 2009
And so the little boy said: "How is giving me a shot down there going to help my sore throat?". Well he was to the point at least.
Have you ever wondered how my acupuncture works? Those of you who have experienced it have noticed that I rarely start sticking needles in the part that actually hurts — and I have heard many of you say "So you're gonna make it hurt in my leg so I don't feel my back right?"
Not really. God really did a good job putting us together. It's a shame we lost the instruction manual.
The answer to how acupuncture works is muscles and electricity. Anyone who has touched a hot wire fence can tell you that our muscles respond very well to electricity. Our muscles actually control almost all of our bodily functions. We know about our skeletal muscles that move our arms and legs, etc. But our eyesight is controlled by the small muscles in our eyes, our hearing by the small muscles in our ear, that hold the three ear bones together. (It's strange to think of having bones in our ears isn't it?)
Our blood pressure is controlled by the muscles in our arteries, our glands secrete using muscles, our breathing is controlled by so many muscles it's hard to name all the things they do.
Thinking may not be controlled by muscles directly, but anyone who has had a muscle tension headache will tell you that muscles certainly influence thinking, and thinking is all about moving electricity anyway.
The Chinese developed acupuncture over 3000 years ago. They did not know about bioelectricity so they called it Qi (pronounced like the first syllable of Chia plant or Cheetos — you know, chee).
When we are injured or even threatened to be injured, we flinch and get muscle spasms which were designed to prevent further injury. The same as when we hear a sudden loud noise, our shoulders come up. That particular reflex protects our neck from any sudden danger.
If this spasm doesn't go away, the body does not function normally and illness follows. The needle is designed to short circuit these spasms and allow the body to return to normal functioning. The acupuncture points are located where the Qi or bioelectricity tends to get backed up. That is why a treatment is more uncomfortable when you are more ill or injured. There is more electricity to unblock.
Acupuncture is as diverse as western medicine. I was one of first doctors to be certified by the American Board of Medical Acupuncture. I'm trained in over 25 distinct types of acupuncture, and still learning more so that I can better serve you.
December 21, 2009
Did you hear about the dyslexic (a condition where one sees words backwards) agnostic (one who doubts there is a God) insomniac?
He lays awake at night wondering if there really is a doG.
Sometimes there's nothing better than a good night's sleep. There are reasons for insomnia and one of the biggest is stress and anxiety. Easier said than done to get rid of that nowadays, huh? However there are measures to take to rescue your beauty sleep. One of the best ways to alleviate that condition is good "sleep hygiene". No, that doesn't mean taking a bath before bed — but for some people it helps.
Sleep hygiene is a set of habits that train your body to associate the bedroom with sleeping. The first thing to do is to make your bedroom a place for sleeping. Make sure you have shades to make it dark. Do not have a TV in the bedroom. Make your bed as comfortable as possible by regularly turning the mattress. This will help your back as well. Most of all, take anything out of the bedroom not associated with sleeping (or that other thing).
Do not read in bed if you have insomnia. You will start to associate reading instead of sleeping with your bedroom. If you cannot sleep after an hour, get up and leave the bedroom. You can read or watch TV in another room. Get a drink of water before getting anything to eat at night. Often our bodies confuse the hunger and thirst signals in our brain. If the water doesn't work, sometimes a small snack will help. Night is the worst time to eat if you do not want to gain weight.
There are some over the counter products to use for insomnia if these measures don't work. Melatonin, Valerian root, and tryptophan containing foods like — you guessed it — warm or cold milk.
Tylenol PM works by using an antihistamine drug called diphenhydramine or benadril. If you have a problem with antihistamines, please do not use Tylenol PM or Benadryl.
Finally, if nothing else works, there may be something more complicated in play — you may need to stop thinking about doGs (just kidding). You may have a physical problem that needs to be looked after.
Insomnia can lead to unwanted weight gain and even to obstructive sleep apnea where you do not breathe right when you are laying down.
Sometimes you need to see your doctor.
December 14, 2009
Remember Bubba and Boudreaux? They both survived their last episode but fate got them later.
I can still hear Boudreaux's unforgettable last words: " HEY BUBBA, WATCH THIS ! "
Have you ever seen anyone squirting lighter fluid onto lit coals? The fluid can ignite and the flame travel up the stream and into the can of lighter fluid and explode. Unfortunately this happens way too often and it is always way too costly in human suffering and medical bills and lost work and wages, etc. JUST DON'T DO IT
If you get less severe burns there are some things you can do. DO NOT PUT BUTTER ON A BURN. The best is cold water. Sometimes shaving cream (not mentholated) can serve as a good sterile dressing that will not stick to the wound, will keep air away from the wound and can help with the pain. It is easily removed in the ER.
In general it is a good idea not to break the blisters, although the doctor may decide to do this to prevent further damage. Keep the wound clean. Wash with as much water as you can. If it is an acid burn, just wash with water. Do not put anything on the wound to neutralize the acid as this will make the wound hot from the chemical reaction and possibly make it worse. Acid stops burning when it is removed from the area so flush it off!.
Alkali or base chemical burns continue to burn even after the substance is removed so medical attention is required. Flushing with water is safe except in very rare cases that you are not likely to encounter except in labs or industrial compounds.
So when in doubt for any chemical burn, flush with clean water and get to a definitive care center.
December 7, 2009
Bubba and Boudreaux were camping when a snake bit Bubba when he was peeing. You know where he got bit unfortunately.
Boudreaux called 911 and asked them what to do. They said to cut 2 small holes over the puncture marks from the snake fangs and suck the poison out with your mouth but be sure not to swallow the poison. After the call, Bubba asked Boudreaux what they said.
Boudreaux told him, "They said you're gonna die".
DO NOT CUT PEOPLE UP IF THEY GET SNAKE BIT!!! DO NOT SHOCK THEM WITH BATTERIES EITHER!
It used to be common practice to do the above procedures, but we also used to commonly use leeches and bloodletting and even surgery for ulcers instead of antibiotic therapy like we do now.
The best tool for treatment of snakebite in the field is a set of keys to a vehicle that can get you to the emergency room quickly and safely. We now have antivenom at our local rural hospitals and if needed we have helicopters to get you to the nearest ICU.
By the way, the common medicine for Copperhead bites is benadryl.
Keep the patient as calm as possible so that the poison does not circulate around the body quickly. Do not put a tourniquet on the patient but keep the bitten part of the body lower than the rest. A tourniquet can make it necessary to amputate a body part later and when a tourniquet is removed, the surge of venom in that part of the body may put the patient into shock.
IDENTIFY THE SNAKE IF AT ALL POSSIBLE BUT DON'T GET BIT AGAIN CATCHING OR KILLING THE SNAKE. Poisonous snakes in North America can be distinguished by their heads, but dead snake heads can bite you due to their primitive nervous system. Don't get bit by a dead snake.
Remember, prevention is better than a doctor visit. Be careful.
November 30, 2009
A husband asks his wife if she wants him to bring her some ice cream. She says, "Yes please—oh, and add some sprinkles—and some chocolate syrup. You better write it down. You know how bad your memory is."
He replies that he can remember and sets out to get the ice cream.
He returns with bacon and eggs and she says, "See — I told you."
He says, "what did I forget?" She says, "The toast."
Memory is a fleeting talent. We will all loose it to some degree if we live long enough. Dementia, on the other hand, is a disease and there are ways to help prevent it.
First, keep your mind active. Learning new things or doing crossword puzzles or other puzzles, is very good for this. Keeping a notebook or electronic note pad is an excellent idea to keep yourself on track. Getting plenty of rest as well as exercise.
Avoid over eating to avoid obesity which zaps energy out of you every minute of every day. DON'T SMOKE !!
Alzheimer's disease is one of the many forms of dementia. There is also multi-infarct dementia which is caused from repeated small strokes or traumas to the head like what Mohammed Ali, the boxer, has. Keeping your blood pressure under control is crucial to avoid this type of dementia. The previously mentioned practices can help keep your blood pressure lower as well.
Being around other people is very important as well as having your alone time. In short, balance out your life and don't just sit down in front of the TV. Live and don't wither away. However, the very best way to help prevent dementia is to have a purpose in life.
There are always those less fortunate than you and me that could use help. To help someone else more often helps us more than those we are trying to help — and don't forget the toast!
November 23, 2009
A carpet layer had just finished carpeting a large room when he saw a bump in the middle of the carpet. He felt in his pocket for his cigarettes and found them missing. Instead of tearing up the whole carpet, he just tapped the bump down with his hammer and went out to his truck. — where he saw his cigarettes sitting on the seat of his truck.
About that time the owner of the house came around asking everyone if they had seen her canary. Oops !
DON'T SMOKE!! Especially don't smoke canaries.
If you do smoke already you probably know smoking is one of the hardest addictions to quit. Some patients I had when I was in training have told me that quitting smoking was harder than quitting drugs like heroin and cocaine. I can believe it.
I smoked when I first joined the military. It was hard to quit but being tobacco free is worth it. IF YOU DON'T SMOKE NOW, DON'T START. Save that money and in a year or two use it to buy a car instead.
The hardest part of quitting smoking is that it is mixed into every part of your life. You have a cigarette with your coffee, or while driving, or while talking on the phone, or with any number of things you do every day. You have a cigarette after eating and the good feeling you get from your meal is now associated with the cigarette instead. You feel good talking to friends on the phone and the cigarette again gets the credit.
So now when you try to stop smoking, your body and brain tell you that you will not have those good feelings again without a cigarette and that makes quitting smoking, very hard. This is what I call "smoking and".
To alleviate the problem of quitting "smoking and", which is nearly impossible, we need to change "smoking and" to"just smoking".
When you smoke, "just smoke". Smoke outside, not in the car or in the house. Do nothing but smoke. Do not talk on the phone or drink coffee or water. Do not speak to anyone while smoking. Excuse yourself, finish your cigarette and then resume what you were doing. Smoke as many cigarettes as you feel the need to smoke. The more you "just smoke", the easier it will be to quit when you are ready.
This will break the association between smoking and everything else and is the first step in quitting. If you cheat at "just smoking" you are just wasting your time because a little "smoking and" is as powerful as a lot of "smoking and". If you are going to cheat at "just smoking", you might as well forget about it helping you quit smoking.
There are patches advertised to help quit smoking, but if you smoke with the patches on, you could have a stroke or heart attack!
This happened to a cardiac surgeon I worked with when I practiced in Corpus Christi, TX. The patches have nicotine. The cigarettes have nicotine. Nicotine makes blood vessels smaller so less blood can flow. If this happens in the heart it becomes a heart attack — in the brain it becomes a stroke. Be careful.
There are other things to help quit smoking and you can ask your doctor about these. The cheapest and most effective method I have found so far is "just smoking".
If you have suggestions, I would be glad to hear them.
November 16, 2009
Have you ever heard of a Lepigator? One end is the head of a Leopard and the other is the head of an alligator. It's the most ferocious animal in the world!
You may be wondering how it goes to the bathroom. It doesn't. That's why its so ferocious !
If you have ever had kidney stones, you will know what it feels like to be a Lepigator. It is more painful than having a baby — so I've heard — over and over.
The stones are made of salts that are filtered out by the kidney, and if they get concentrated, they will become sharp stones in your plumbing. A real good thing in this case is to prevent becoming a Lepigator in the first place by drinking lots of water. If its too late for that, there are some things we can do — but it will still probably hurt quite a bit.
There are medicines to help the plumbing stretch so the stones will pass and there is pain medicine — which can then cause other problems. There is also a procedure called lithotripsy which is using sound waves to break up the stones into gravel.
I think I like the prevention better. It's good to drink water.
If you do get a kidney stone — or as doctors call it, renal lithiasis — it would be a good idea to filter your urine to catch the stone when it comes out. You can use several layers of cheese cloth for a filter or get a special filter from the pharmacy. We could then find out what the stone was made of and be better able to prevent another stone from occurring.
If you get too many stones, they may damage your kidney or urethras (your plumbing). Best thing is to — as Sondra, my wife, always tells me — drink plenty of water — and don't become a Lepigator.
Sometime Last Summer
Swarm isn't it? I could tell because a bee flew into my doorbell the other day. It was a hum dinger. I told it to beehive itself but it stung me anyway. That took guts — all of the bee's guts.
The bee's stinger with the venom sac are wrenched from the bee's body and after it stings you it goes off to die with a big hole in its behind — but the stinger in you.
Wasps on the other hand can sting multiple times because their stinger is the way that it hunts. Wasps can even poke you with their stinger but not inject any venom. You are too big for it to eat and it can save its venom for its prey.
With bees it is preferable to remove the stinger without pushing the rest of the venom from the venom sac into your skin. This can be done by scraping the stinger off with a card or a knife. DO NOT GRASP the stinger apparatus itself with fingers or tweezers.
The proteins in both wasp and bee stings are made of protein and can be "denatured", or made safe, by using vinegar or another mildly acid solution like diluted bleach [1 to 5 solution]. It does not take much to make those proteins loose their sting — and full strength bleach will hurt you more than help you.
If you develop itching, swelling, more pain, or especially shortness of breath, you may be allergic and need medical attention right away. If you turn out to be allergic to bee, wasp or ant stings, you should get an epipen — which is a life saving medicine in case you get stung again. Your doctor should prescribe a quantity of two epipens and you need to keep them handy, out of the heat, and make sure they are not expired.
Allergies only happen after having been exposed previously. The very first time you are exposed to something you will not be allergic. You may have a reaction of another kind but allergic reactions only happen after the body has been exposed previously.
Remember— beehive yourself.
Here When You Need Us.
Gorman, TX 76454
Gorman, TX 76454