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Hospital CEO Leads By Example

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This is a great example of hospital administrator leadership (from Shadowfax):

As I exited the parking garage, I noticed a man in work clothes shoveling off the walkway to the hospital.  I was fiddling with my cell phone (actually texting the wife to let her know I made it OK) so I didn’t pay him any mind.  I was surprised when he greeted me by name, and more surprised when I looked at him more closely and realized it was the CEO of the hospital.

Shoveling snow.

At 5:30 AM.

In the garage.

The CEO.

I was stunned.  I made a little joke about how he’s been reduced to pushing a shovel, and he replied with good cheer, “Well, somebody’s got to do it, and half the staff wasn’t able to make it in, what with the roads and all.  The last thing I want is for an employee or patient to slip on their way in — that’s be all we need!”   We chatted for a minute and parted ways.  As I was finishing my text, I noticed him stop to greet a couple of nurses on their way in, and thank them for coming in to work today.

Now that’s leadership.

I bet Nancy Schlichting would do the same. Bravo, CEOs. Keep up the good work!


The Friday Funny: Begging For Food

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When Doctors Are Sent Ketchup, Not Drug Samples

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Today marks a new phase in my medical career – I’ve been sent a bottle of ketchup for my consideration. Until now I’ve received pharmaceutical pitches and drug samples for my patients… but I’ve now entered a new phase in my life. I am a target market for condiments.

And how did this purveyor of organic ketchup find me online? I was blogging about how difficult it is for patients with diabetes to avoid high fructose corn syrup these days (it seems to be a required ingredient from spaghetti sauce to peanut butter) and I explained that I was a carb conscious person myself, and had recently purchased some unsweetened ketchup as part of a sugar-avoidance strategy.

The next day a nice man asked if he could send me a sample of his own brand of ketchup, sweetened with agave nectar instead of corn syrup or cane sugar. I said it’d be fine for him to send it along, and a few days later there it was: Wholemato brand organic agave ketchup.

So I did a little taste test, comparing my Westbrae Natural Vegetarian Unsweetened Ketchup to the Wholemato brand. The Wholemato guy was right – it was head and shoulders above the other brand in terms of flavor and sweetness. Of course, it has 3g of sugar/serving, while the sugar-free version has 1g/serving. My organic Heinz ketchup has 4g/serving, and parenthetically – I went to the Heinz site and found that they have a new marketing campaign around customized ketchup labels. Kind of quirky. Who knew?

It seems that agave nectar contains ~90% fructose (if you can trust the sources online) which means that it’s “sweeter” than glucose-based cane sugar (which is 50/50 glucose and fructose, and high fructose corn syrup is 55/45 fructose and glucose). So what does this mean? Correct me if I’m wrong here but I just interviewed Penny Kris-Etherton about corn syrup and she told me that it’s the FRUCTOSE that is the real problem in terms of increasing blood lipid levels and requiring more insulin output.

So I feel really badly about the nice agave man who sent me the delicious ketchup – but the nutritionists are saying that agave is actually much WORSE for you than corn syrup if you’re a diabetic.

I don’t think that small amounts of any kind of sugar is worth fretting about (unless you have diabetes) – but trying to avoid cane sugar and high fructose corn syrup by switching to agave syrup is kind of like getting out of the frying pan and into the fire.

And with that blog post I think I’ve ended my career as a condiment tester unfortunately. Of course, I do like the taste of agave nectar. 😐

Peripheral Artery Disease: What You Need To Know

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Peripheral Artery (Arterial) Disease (P.A.D.) is an under-recognized and under-diagnosed condition, yet it serves as an important warning sign for those at high risk for stroke and heart attack. Even though we have an inexpensive and non-invasive test for P.A.D. very few people have the test done. I interviewed Dr. Gary Schaer, Director of the Cardiac Cath Lab at Rush University Medical Center in Chicago, about P.A.D. and also spoke with actor Phylicia Rashad about her family’s trials and tribulations with P.A.D. This post is devoted to Dr. Schaer’s insights on the medical aspects of the disease, and the next post focuses on Ms. Rashad’s personal story. 

Dr. Val: To set the stage for our listeners, Dr. Schaer, can you tell us what is peripheral artery disease exactly?

Dr. Schaer: Peripheral Arterial Disease is a condition where the blood vessels (that deliver blood to the legs) become plugged up with a mixture of fat and cholesterol, also known as plaque. This plaque sticks to the blood vessel walls and causes a decrease in oxygen delivery and blood flow to the leg muscles. Patients sometimes experience a burning, aching or tired feeling in their calf muscles (called “claudication”) when the blood supply is diminished. This discomfort is usually made worse by walking but relieved by rest.  It’s a fairly common problem, particularly in people with risk factors (like smoking, diabetes, and high cholesterol) for P.A.D.  It’s important to recognize when a person has P.A.D. because they could be at higher risk for stroke, heart disease, and even death.

Dr. Val: Why do you think so few people know about P.A.D.?

Dr. Schaer: It’s not as “glamorous or exciting” a disease as heart attack or stroke (as portrayed in Hollywood movies). P.A.D. is a chronic disease that is a marker for atherosclerotic plaque – which can lead to heart attacks and strokes.

Dr. Val: How does the average person know they have P.A.D.?

Dr. Schaer: You can get tested. We have a simple, non-invasive test available to diagnose this disease – it’s called the “Ankle Brachial Index.” The test basically compares the blood pressure in the arm with blood pressures in the thigh and ankle.  If there’s a significant drop in the leg blood pressure, then that suggests a blockage of blood flow or P.A.D.

Dr. Val: Who would be a good candidate for the ABI test?

Dr. Schaer: People who have symptoms of P.A.D. (claudication) should definitely be tested. However, keep in mind that about half the patients who have P.A.D. are asymptomatic, so people with risk factors like long-term smoking, age over 65, diabetes, and high cholesterol should consider having the test too. The reason why we do the test is because there are some excellent treatment options that can reduce the risk of heart attack and stroke for people with P.A.D.

Dr. Val: What are the treatment options?

Dr. Schaer: First of all, people with P.A.D. should be on an anti-platelet drug – either Plavix or aspirin. Studies have shown that these drugs substantially reduce the risk of stroke and heart attack (and heart related death) in patients with P.A.D. However, Plavix is more effective than aspirin, though aspirin is cheaper. Secondly, people with P.A.D. must not smoke. Quitting smoking is a top priority. Thirdly, underlying conditions like diabetes, high blood pressure, and high cholesterol must be aggressively managed. And finally, increasing physical activity can also reduce the risk of dangerous complications from the disease.

Dr. Val: What’s the most important thing for Americans to know about P.A.D.?

Dr. Schaer: The most important thing is for Americans at risk for P.A.D. to get tested for it. Anyone over 65 with claudication symptoms or other risk factors like smoking, diabetes, or high cholesterol should get an ABI test from their doctor. If P.A.D. is diagnosed, there are therapies that clearly reduce the risk of having it progress to heart disease, stroke, and even death. Testing could save your life.

*This post was first published at my new blog site – URL pending*

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

Remembering 9/11

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This reflection is from a previous blog post

When the president of a country dies suddenly, they say that the citizens forever remember where they were, and what they were doing, when they first heard the news.  I’ve heard people discuss their personal circumstances when they received word that President Kennedy was shot.  For some reason, that sort of news is a memory fixative, preserving individual experience along with national tragedy.

For me, 9/11 was one of those events.  I was getting off a night shift rotation at a hospital in lower Manhattan, sitting in morning report, dozing off as usual – my eye lids sticking to dry corneas, my head feeling vaguely gummy, thoughts cluttered with worries about whether or not the incoming shift of residents would remember to perform all the tasks I’d listed for them at sign out.

And as I dozed off, suddenly our chief resident marched up to the front of the room, brushing aside the trembling intern who was presenting a case at the podium at the front of the dingy room.  “How rude of him” I thought hazily, as I shifted in my seat to hear what he had to say.

“Guys, there’s been a big accident.  An airplane just crashed into the World Trade Center.”

Of all the things he could have said, that was the last thing I was expecting.  I shook my head, wondering if I was awake or asleep.

“We don’t know how many casualties to expect, but it could be hundreds.  You need to get ready, and ALL of you report back to the ER in 30 minutes.”

I thought to myself, “surely some Cessna-flying fool fell asleep at the controls, and this is just an exaggeration.”  But worried and exhausted, I went back to my hospital-subsidized studio apartment and turned on the TV as I searched for a fresh pair of scrubs.  All the channels were showing the north tower on fire, and as I was listening to the news commentary and watching the flames, whammo, the second plane hit the south tower.  I stared in disbelief as the “accident” turned into something intentional.  I remembered having dinner at Windows on the World the week before.  I knew what it must have looked like inside the buildings.

I was in shock as I hurried back to the hospital, trying to think of where we kept all our supplies, what sort of injuries I’d be seeing, if there was anything I could stuff in my pockets that could help…

I joined a gathering crowd of white coats at the hospital entrance.  There was a nervous energy, without a particular plan.  We thought maybe that ambulances filled with casualties were going to show up any second.

The chief told me, “Get everybody you can out of the hospital – anyone who’s well enough for discharge home needs to leave. Go prepare beds for the incoming.”

So I went back to my floor, recalling the patients who were lingering mostly because of social dispo issues, and I quickly explained the situation – that we needed their beds and that I was sorry but they had to leave.  They were actually very understanding, made calls to friends and family, and packed their bags to go. 

And hours passed without a single ambulance turning up with injuries.  I could smell burning plastic in the air, and a cloud of soot was hanging over the buildings to the south of us.  We eventually left the ER and sat down in the chairs surrounding a TV in the room where we had gathered for morning report.  We watched the plane hit the Pentagon, the crash in Pennsylvania… I thought it was the beginning of World War 3.

The silence on the streets of New York was deafening.  Huddling inside buildings, people were calling one another via cell phone to see if they were ok.  My friend Cindy called me to say that she had received a call from her close friend who was working as a manager at Windows on the World.  There was a big executive brunch scheduled that morning.  Cindy used to be a manager there too… the woman’s last words were, “the ceiling has just collapsed, what’s the emergency evacuation route? I can’t see in here… please help…”

That night as I reported for my shift in the cardiac ICU, I was informed by the nursing staff that there were no patients to care for, the few that were there yesterday were either discharged or moved to the MICU.  They were shutting down the CICU for the night.  I wasn’t sure what to do… so I went back to my apartment and baked chocolate chip cookies and brought in a warm, gooey plate of them for the nurses.  We ate them together quietly considering the craziness of our circumstance. 

“Dr. Jones, you look like crap” one of them said to me affectionately.  “Why don’t you go home and get some rest.  We’ll page you if there’s an admission.”

So I went home, crawled into my bed with scrubs on, and slept through the entire night without a page.  The disaster had only 2 outcomes – people were either dead, or alive and unharmed – with almost nothing in between.  All we docs could do was mourn… or bake cookies.

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

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