Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Latest Posts

Your Dog May Be Your Best Personal Trainer

Earlier this week there was an article in the NY Times by Tara Parker-Pope  –Forget the Treadmill. Get a Dog. — which states in a more elegant way what I have been saying for years now.

……Several studies now show that dogs can be powerful motivators to get people moving. …..

Just last week, researchers from Michigan State University reported that among dog owners who took their pets for regular walks, 60 percent met federal criteria for regular moderate or vigorous exercise. …….

A study of 41,500 California residents also looked at walking among dog and cat owners as well as those who didn’t have pets. Dog owners were about 60 percent more likely to walk for leisure than people who owned a cat or no pet at all. ……..

I have called my dog Rusty my personal trainer.  He never lets me off the hook.  We walk daily regardless of the weather (hot, cold, rain, snow). Read more »

*This blog post was originally published at Suture for a Living*

A Patient’s Contagious Confidence And Endless Possibilities

In a recent post I wrote why patients are the most important part of the medical team, and my colleagues, Elizabeth Cohen, Kevin Pho, MD, Donna Cryer, JD, and Carl R. Sullivan, MD, shared their insights as well. Today, Ginger Vieira, a patient living with type 1 diabetes and celiac disease, says:

“You, as the patient, are the most important part of the medical team because you are the one who makes the daily decisions, who balances your disease around dinners, soccer games, long hours at work without enough time to check your blood sugar and eat lunch. You are the one who takes the knowledge you learn from your doctor and fits it into your everyday life. That’s a huge role, and it’s never easy.”

Ginger Vieira shares her story about the challenges and how her positive attitude is allowing her to lead a life she thought was off limits.

Contagious Confidence, Endless Possibilities

By Ginger Vieira

“Don’t let anyone tell you that you can’t do something.” My twin brother, Pete, said this to me several months ago. I wrote it down on an index card and taped it to my bathroom mirror. Funny thing is, it’s never been other people telling me I can or cannot do something. The loudest voice I hear is my own.

When I was diagnosed with type 1 diabetes in the seventh grade over eleven years ago, the first list that ran through my head was the list of things I probably couldn’t do anymore. I couldn’t eat ice cream without first counting the grams of carbohydrates in the bowl and determining how much insulin I needed. I couldn’t play basketball anymore (at least, that’s what I thought). I couldn’t buy candy and popcorn with my friends when we go to the movies without feeling overwhelmingly guilty about eating such diabetic-off-limits food. The list of foods, activities, dreams and goals I thought were off-limits seemed endless. Read more »

*This blog post was originally published at Health in 30*

Faith, Fitness, And The Principle Of Daily Self-Improvement

Since March I’ve been working out with a fitness instructor. She is the toughest, most motivated coach I’ve ever known. Sadly, today was our last day together because she’s beginning maternity leave and I’m moving out of the area. I was reflecting on what made her such a great trainer, and I think the essence was her undying belief in everyone’s ability to improve. Each exercise was a chance to do better than last time — to perfect one’s form, do one more repetition, or to slow the speed of a lift or increase the resistance involved.

She never let me slack — she told me she believed in me, that I could do better, and that she didn’t care how many reps I did, I had to do them the right way. There were times that I just wanted an “easy” workout, or when I’d ask for understanding: “Klaudia, can we ease up on the cardio a bit today, I just ate lunch?” I’d ask. “That’s okay,” she’d smile, “I have a bucket for you right here if you need it.”

Frequently she’d time me racing repeatedly up and down seven flights of stairs… Read more »

Why The French Don’t Go To The Gym

gettinbigwithrivaroxaban 300x187 Work out in a Gym? The French say Sacre Bleu!Like their counterparts in other first-world countries, French people know about the health benefits of exercise. And French culture has emphasized, even worshipped, good looks (which these days translates to “fit and trim.”)

So it’s surprising that the French avoid fitness centers as vigorously as factory-produced croissants. But they do.

According to the International Health, Racquet and Sportsclub Association, just 5.4 percent of French people were members of a fitness club in 2008. That’s substantially less than their counterparts in Italy (9.5 percent), the UK (11.9 percent), and Spain (16.6 percent).

“It appears that more people are sitting in cafes smoking cigarettes and drinking coffee than working out … the French don’t see fitness as a lifestyle,” American-born fitness consultant Fred Hoffman told MSNBC. Hoffman has lived in Paris for two decades. Read more »

*This blog post was originally published at Pizaazz*

Home Or Office, Women Can Get Fit Anywhere

By Barbara Ficarra, RN, BSN, MPA

Good news: You can get fit and toned anywhere with simple exercises.

My good friend works at a major company in NYC and she’s fortunate since she’s able to hit the gym on her lunch hour. If you have a job that allows you the time to go to the gym, that’s great. Not everyone is that fortunate.

As women we have so many responsibilities and we’re so busy. Trying to juggle work, family and friends can be a struggle and it’s not always easy to find time to exercise.

Truthfully, you don’t need to belong to a gym to exercise. Just keep moving. Whether you’re a stay-at-home mom or if you sit behind a cubicle, it doesn’t matter who you are. There are simple exercises that you can do anywhere.

I asked fitness expert Karen Ficarelli to share some simple tips to help keep you toned, whether you’re at home working or at the office. Karen suggests these easy moves to help tone your butt, thighs, calves, abs, waist, back, arms, shoulders and thighs. Read more »

*This blog post was originally published at Health in 30*

Latest Interviews

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

How To Make Inpatient Medical Practice Fun Again: Try Locum Tenens Work

It s no secret that most physicians are unhappy with the way things are going in healthcare. Surveys report high levels of job dissatisfaction burn out and even suicide. In fact some believe that up to a third of the US physician work force is planning to leave the profession…

Read more »

See all interviews »

Latest Cartoon

Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.

***

Click here for a musical take on over-testing.

See all cartoons »

Latest Book Reviews

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

Unaccountable: A Book About The Underbelly Of Hospital Care

I met Dr. Marty Makary over lunch at Founding Farmers restaurant in DC about three years ago. We had an animated conversation about hospital safety the potential contribution of checklists to reducing medical errors and his upcoming book about the need for more transparency in the healthcare system. Marty was…

Read more »

See all book reviews »