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

Latest Posts

Book Review: Glori, A Different Story

I met the author of Glori: A Different Story(Nicole Lynn Hannans) here at Revolution Health a couple of months ago. She is a vibrant, beautiful young woman who had a child in her late teens. Nicole explained to me that the vast majority of America’s teen pregnancy resources are dedicated to prevention. Once a teen becomes pregnant, there is very little support for next steps. For this reason, young mothers have difficulty completing a college education and are often trapped in a lifelong cycle of poverty.

As a young African American woman, Nicole was determined not to become a statistic. Despite all the odds, being homeless and surrounded by her boyfriend’s drug dealing business, she managed to escape that life and attended The College of William and Mary as a single mom. She wrote Glori: A Different Story, to inspire other pregnant teens to go and do likewise – knowing that no matter what the odds, an unexpected pregnancy does not prevent women from achieving their potential in life.

The story begins with Nicole as a carefree teen, enjoying outings with friends and flirtations with guys. In preparation for her prom, she ponders her date options. She decides, against her better judgment, to go with a charismatic “bad boy” football player whom she suspects may be dealing drugs. But she finds his charm irresistible and he persuades her that her fears are unfounded.

Soon Nicole is dating this young man (RaKeim) and is deeply attached to him. Sadly, her life begins to spiral out of control as she realizes that all of her suspicions were correct – he is a crack dealer trying to live the life of a big time “gangster.” RaKeim is narcissistic, unfaithful, abusive, and obsessed with money. Nicole gets pregnant, moves out of her home to be with RaKeim and cannot seem to come to grips with who he is rather than whom she hopes he will be.

While reading the book, every fiber in your being wants to scream, “Get out, Nicole, he’s no good for you! Run!” But RaKeim knows just how to play with her emotions, and she is reeled back in time and again. A prophetic statement from a doting aunt punctuates the madness of homelessness and crack fiends: “It takes time to get a relationship out of your system.”

And it did take several years for the RaKeim poison to work its way out of Nicole’s life. The turning point came one night when he tried to steal their baby, and then broke down the apartment door and beat Nicole. After menacing calls, being threatened with a gun, and in-person harassment, Nicole came to realize that she would never be safe. The police were unwilling to issue her a restraining order without further proof of RaKeim’s potential for violence. She had to handle this one alone.

As luck would have it, RaKeim was in and out of jail, which gave Nicole some relief from his behavior. During that time she graduated with high honors from the College of William and Mary, enrolled in a Master’s Program, got a job working with sick children at NIH, and found love again.

Nicole’s straight forward account of her struggles makes a few things quite clear: 1) women are not adequately protected by current domestic violence protocols 2) psychopathic men have an uncanny ability to manipulate their victims 3) overcoming the odds is a matter of will, determination, and very hard work and 4) a mother’s love for her child can inspire her to achieve greatness.

If you’re interested in learning more about Nicole’s life, please check out her website at www.nicoleink.com Her book is aptly named: Glori: A Different Story, and I hope that it inspires many other young moms to reach for glory – and to triumph over adversity.

*** Join Nicole’s Group – Click here***

Further resources for teenage moms:

The Healthy Teen Network

Planned Parenthood

Girl Mom

National Family Planning & Reproductive Health AssociationThis post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

How My Husband Gets My Attention

Ok, I’ll admit it – I spend a lot of time on the Internet. Sometimes I ignore my husband while I’m blogging or emailing folks in the evenings or weekends. I know I need to find better “life balance” and give at least my immediate family (kitty and hubby) the right amount of attention.

Regular readers of my blog know that my husband is a funny guy. Lately he has really outdone himself. When I’m deep into a blog post or an email and he wants me to listen to him, he has taken to pulling on my “doctor-heart strings” by announcing that he has a certain disease or condition that needs attention. Of course, my husband is not a physician, so he isn’t sure how to use all the medical terminology that he hears here and there. This is what he said yesterday when I was on the Internet:

Hubby: Help!

Dr. Val: Mrpmph.

Hubby: Help! I need help!

Dr. Val: Hrmph, sigh.

Hubby: Help! I have antalgic encephalopathy!*

Dr. Val: (Cogs and wheels turning as I consider what that fake disease would actually look like). Ha, ha, ha! Ok, honey I get it – you need a hug and some attention.

*For non-doctors: “antalgic” is almost always used to describe a limp to alleviate pain when walking. “Encephalopathy” means degeneration of brain function. So I guess a person with antalgic encephalopathy would be walking funny due to some sort of brain infection/disorder.

How does your significant other get your attention?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

My Doctor’s Going to be on Good Morning America!

Faithful readers of my blog will recall my effusive praise of my family physician, Dr. Alan Dappen. He is boldly going where few physicians have gone before – offering affordable care to the masses with a transparent fee structure and access to him via phone and email. How is it possible? This is what a doctor can afford to do when he has almost no overhead – he doesn’t have to pay multiple staff to transcribe coding and billing or fill out reems of documentation to satisfy third party payers. He doesn’t have to see patients in person to fill a prescription or otherwise change their management (because payment is not contingent upon a physical exam). No, he gets paid for what the patient actually needs - whether that’s an in-person visit, an email, or a phone call. And the cost for the average person is far lower than a monthly insurance premium would be. A high deductible plan (for potential catastrophic events) and a pay-as-you-go relationship with Dr. Dappen is all that many people would need for good, affordable healthcare.

Well, Good Morning America has caught wind of Dr. Dappen and is featuring him tomorrow morning (Wednesday, May 28th) between 7:30-8:00am. I’m really pleased that he’ll receive more attention this way. Of course, I knew he was great before they did. Do I get credit for finding him first?

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Quote of the Day

My husband said this after contemplating his accidental role as softball captain for his work team:

“I think I’m a closet extrovert.”This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Why Men Don’t Write Advice Columns

A friend of mine sent me this fake advice column entry (“Dear Walter” instead of “Dear Abby”). I’m so sorry that I don’t know who the original author is, but I’ve seen it around on some blogs. Let me know if you think it rings true!

Dear Walter:

I hope you can help me here. The other day I set off for work leaving my husband in the house watching the TV as usual. I hadn’t gone more than a mile down the road when my engine conked out, and the car shuddered to a halt. I walked back home to get my husband’s help.

When I got home I couldn’t believe my eyes. He was in our bedroom with the neighbor lady.  I am 32, my husband is 34, and we have been married for twelve years.

When I confronted him, he broke down and admitted that they had been having an affair for the past six months.  I told him to stop or I would leave him. He was let go from his job six months ago, and he says he has been feeling increasingly depressed and worthless. I love him very much, but ever since I gave him the ultimatum he has become increasingly distant. He won’t go to counseling and I’m afraid I can’t get through to him anymore. Can you please help?

Sincerely, Sheila

***

Dear Sheila:

A car stalling after being driven a short distance can be caused by a variety of faults with the engine. Start by checking that there is no debris in the fuel line. If it is clear, check the vacuum pipes and hoses on the intake manifold and also check all grounding wires. If none of these approaches solves the problem, it could be that the fuel pump itself is faulty, causing low delivery pressure to the carburetor float chamber.

I hope this helps.

-Walter

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Latest Interviews

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 »

Caring For Winter Olympians In Sochi: An Interview With Team USA’s Chief Medical Officer Dr. Gloria Beim

I am a huge fan of the winter Olympics partly because I grew up in Canada where most kids can ski and skate before they can run and partly because I used to participate in Downhill ski racing. Now that I m a rehab physician with a reconstructed knee I…

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 »