September 2nd, 2009 by KerriSparling in Better Health Network, Health Tips
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I wrote a quick status update on Facebook, after receiving the Solo demo in the mail and then meeting with the local Animas rep for lunch to discuss pump options. My brain was buzzing with questions.
And the flood gates were opened. Lots of comments, lots of perspectives, and lots of people who had great information to share. Turns out I’m not the only one who has been thinking about this. 🙂
I’ve been a Minimed pumper for almost six years now, and have never had an issue with Minimed customer service or the pump itself. When my pump broke two years ago, their customer service department took my call at a few minutes before midnight and a new pump was overnighted to me. I have no problems with the color, the size, or the functionality of my Minimed 522.
But two things happened that made me think about switching. One was the CGM upgrade, which I tried for ten weeks and still didn’t have any semblance of success and/or comfort with. (Thankfully, the Minimed CGM works fine for some diabetics, so it’s not just me. Appears to be personal preference.) And the second was that I haven’t seen many changes at all in the six years I’ve been pumping with Minimed (starting with a 512 and now a 522). The CGM component was a big one, but for people who aren’t using that feature, there isn’t much going on as far as upgrades that mattered to me.
So even though Minimed has been good to me, I’m on the prowl.
With Cozmo off the market, my options are limited. I’ve given a lot of thought to Omnipod, and while I love the idea of no tubing, I don’t like the idea of a larger device stuck to me for the duration. I also don’t like the idea that if I lose the PDM, I’m screwed as far as dosing my insulin. It’s important to note that I’ve never worn an Omnipod, so I’m purely speculating. And Omnipod works great for lots of diabetics that I know, and even some cute kiddo ones. But it’s not about the product – more about my personal preferences.
The Solo pump demo arrived in the mail yesterday and that thing appears to have both the tubeless delivery that I’d prefer and also the ability to disconnect the bulk of the pump, but it’s not a working model and with pregnancy goals on the horizon, I’d like to make a change sooner rather than later, if possible. Still, Solo has a lot of promise and coulda been a contenda. Could still be one, depending on their timeframe.
I’ve looked at Animas, too. The Ping seems to be my top contender for several reasons, but the main one is the meter doubling as a remote control for the pump. I’ve written countless times about my desires to have the pump reasonably concealed, and when my 522 is stashed in my bra at a dressy event, reaching for it to access the buttons turns me into a female, diabetic version of Mr. Bean. I like that the Calorie King info is stored in there. (The Dexcom/Animas integration, whenever that happens, is also a nice future-state.) I also like the option to take a hundredth of a unit. Precision is a nice option. I’m not sure how I feel about the infusion sets they use (sampling some this week) or what it might be like to use their user interface, but I want to see for myself. Thankfully, pump reps are all about hooking us up with samples so we can see if we want to make a full transition.
But then there’s the whole money thing. And the insurance thing. And the “closet full of supplies” thing that will be rendered sort of useless if I switch. And the “do I want to wrangle with a new device” thing. There’s also the “you can always go back” thing. And the “pumping isn’t permanent” thing. And the “if you continue to put weird phrases in quotes, people will get annoyed” thing.
There’s a lot to consider. And I’m excited to see what options are available to me. But there’s only so much information I can get from “official company representatives” and websites. If you’re a pumper, what are you using and why? If you’re thinking about going on a pump, what factors are playing into your decision? And if you’re like me – currently pumping but thinking about changing pump providers – what would you do?
Your feedback is, without fail, among the top resources I’ll be using to make my decision. So thanks in advance, and power to the pumpers!!
*This blog post was originally published at Six Until Me.*
September 2nd, 2009 by Dr. Val Jones in True Stories
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This post is a “Dr. Val classic” – first published in early 2007.
***
Internship, for those of you who may not know, is the first year of residency training. It is the first time
that a doctor, fresh out of medical school, has responsibility for patient care. The intern prescribes medications, performs procedures, writes notes that are part of the medical record, and generally learns the art of medicine under the careful watch of more senior physicians.
Internship is a frightening time for all of us. We’ve studied medicine for 4 years, memorized ungodly amounts of largely irrelevant material, played “doctor” in third and fourth year clerkships, but never before have lives actually been put in our hands. We know the expression, “never get sick in July” because that’s when all the well-intentioned, but generally incompetent new interns start caring for patients. And so, we tremble as we begin the new stage in our careers – applying our medical knowledge to real life situations, and praying that we don’t kill anybody.
I’ll never forget my first day of internship. I must have drawn the short straw, because not only was I assigned to the busiest, sickest ward in my hospital (the HIV and infectious disease unit), but I was on call that day (so I’d be working for 24 hours straight) with the most hated resident in the program (he had a reputation for treating interns poorly and being arrogant to the nurses). As I reviewed my patient list, I noticed that the sign out sheet (the paper “baton” of information handed to you by the last intern who cared for the patients – meant to give you a synopsis of what they needed) was supremely unhelpful. Chicken scratch with diagnoses and little check boxes of “to do’s” for me. I was really nervous.
So I began to round on my patients – introducing myself to each of them, letting them know that I was their new doctor. I figured that even if I couldn’t completely understand the sign out notes, at least by eye-balling them I’d have an idea of whether or not they were in imminent danger of coding or some other awful thing that I figured they’d be trying to do.
My third patient (of 15) was a thin, elderly Hispanic man, Mr. Santos. He smiled at me when I came
in the door – the kind of lecherous smile that a certain type of man gives to all women of child bearing age. I ignored it and introduced myself in a professional manner and began to check his vital signs. I was listening to his heart, and I honestly couldn’t hear much of anything. There was a weird, very distant beat – something I wouldn’t expect for such a thin chest. The man himself looked awful, but I really wasn’t sure why – he just seemed really, really ill.
My pager was going off mercilessly all night. I wondered if this was how the nurses got to know the characters of their new interns – to test them by paging them for anything under the sun, tempting us to tip our hand if we had tendencies to be impatient or disrespectful. But in the midst of all the “we need you to sign this Tylenol order” pages, there came a concerning one: “Hey, Mr. Santos doesn’t look good. Better get up here.”
My heart raced as I rushed to his bedside. Yup, he sure didn’t look too good. He was breathing heavily, and had some kind of fearful expression on his face. I didn’t really know what to do, so I decided to call the resident in charge (much as I was loathe to do so, since I knew he would humiliate me for bothering
him).
The resident appeared in a froth – “Why are you paging me? What’s wrong with the patient? Why do you need me here? This better be good!”
“Um… Mr. Santos doesn’t look too good.” I said, frightened to death.
“What do you mean ‘he doesn’t look too good?’ Can you be a little bit more specific” he said, sarcasm dripping from his tongue.
“Well, I can’t hear his heart and he’s breathing hard.”
“I see,” said the resident, rolling his eyes. He marched off towards the patient’s room, certain to make an example of me and this case.
I trotted along behind him, hoping I hadn’t been wrong in paging him – trying to remember the ACLS
protocol from 2 weeks prior.
The resident drew back the curtain around the man’s bed with one grand sweep of the arm. “Mr. Santos,
how are you doing?” he shouted, as if the man were deaf.
The man was staring at the wall, taking in deep, labored breaths of air. I saw that the resident immediately realized that this was serious, and he placed his stethoscope on the man’s chest.
I approached on the other side of the bed and held his hand. “Mr. Santos, I’m back, remember me?” He smiled and looked me straight in the eye.
He replied, “Angel.” (in Spanish) Then he let out a deep breath and all was silent.
The resident shook the man, “Mr. Santos? Mr. Santos?!” There was no response.
“Should I call a code?” I asked sheepishly.
“Nope, he’s DNR,” said the resident.
I was flabbergasted.
“Yep, you just killed your first patient. Welcome to intern year.”
As I thought about his cruel accusation, I was comforted by the fact that at least, as Mr. Santos released his final breath, he thought he had seen an angel. Maybe my presence with him that night did something good… even though I was only a lowly intern.
September 2nd, 2009 by KevinMD in Better Health Network, Health Tips
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by Steve Perry, MD
I recently read a post by Dr. Bob Sears which listed several “Vaccine Friendly Doctors” in Colorado and across the nation.
As a pediatrician and vaccine advocate, I thought I’d be on this list. I am “vaccine-friendly doctor” who works with moms and dads to find the best health care plan for their babies. I read the information on both sides of the issue and weighed the science against the emotional worry that so many parents feel about vaccines. While I always recommend vaccination by the CDC schedule, I always listen to parents concerns.
But, much to my surprise, I was not on this list. After a looking closer, I found that those on the list are a small population of physicians that are “friendly” to the “alternative” or delayed vaccine schedule outlined in Dr. Sears’ The Vaccine Book. The delayed vaccine schedule calls for a drawn-out vaccine plan based on Dr. Sears’ beliefs on calming parental vaccine fears. This delayed schedule has no research or science backing it, it is simply one pediatrician’s opinion.
The biggest medical problem with the delayed schedule is that it leaves babies open to disease for a longer period of time. If a baby is vaccinated by the CDC’s tried, tested and true vaccine schedule, that baby will have immunity to over 14 diseases by the age of two! With the CDC recommended schedule, babies visit their doctor five times in the first 15 months and receive protection against up to 14 diseases in as little as 18 shots if using combination vaccines, or as many as 26 shots if using individual antigens.
We immunize children so young against these diseases because infancy is the time period that kids are MOST vulnerable to life-threatening diseases. The people at greatest risk of dying from vaccine-preventable disease are the very young and the very old. We vaccinate to save lives.
On the delayed schedule, by 15 months of age children will have only received immunity against eight diseases. They miss out on measles, rubella, chickenpox, Hep A, and Hep B. By 15 months, children on this delayed schedule are given 17 shots and visit the doctor’s office 9 times – almost twice as many visits to the doctor as the CDC schedule.
Beyond Dr. Sears advocating for a medically untested vaccine schedule, I was dismayed at his classification of physicians like myself who vaccinate according to the CDC schedule. Because we follow the American Academy of Pediatrics and the CDC’s vaccine guidelines we are “unfriendly” doctors? Because I am following the science of my colleagues I am an “unfriendly” doctor?
This type of misinformation is damaging to families and physicians. It is the power of words that plant seeds of doubt in the minds of parents to fear vaccines. It’s this misleading information that manipulates parents into feeling that they are bad parents if they don’t question the safety and validity of vaccines.
As a pediatrician, I know it can be confusing for parents who get so much information about vaccines every day online and on TV. We all want to be informed advocates for our children’s health. Reading a balance of both sides allows parents to make an informed choice.
The best place to start the conversation about vaccines is with your pediatrician or by reading reputable sites like the Colorado Children’s Immunization Coalition at www.childrensimmunization.org. This non-profit does not accept donations from pharmaceutical companies and works to improve childhood vaccination rates across Colorado.
The reason I became a pediatrician was to protect children from illness and disease. Dr. Bob may only define “vaccine-friendly doctors” as those who promote his book, but the overwhelming data on the effectiveness and safety of vaccination makes it easy for us all to become a vaccine-friendly community. I hope that parents take time to read information on both sides of the issue, brings their questions to their physician and makes fully informed decisions about their child’s health.
Steve Perry is a pediatrician at Cherry Creek Pediatrics in Denver, Colorado and co-chair of the Colorado Children’s Immunization Coalition’s Policy Committee.
*This blog post was originally published at KevinMD.com*
September 2nd, 2009 by AlanDappenMD in Primary Care Wednesdays
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My early childhood memories hit and miss like a receding dream until four years of age when I boarded my first airplane flight. Our family landed in Mexico City to live. The experience was the first of many jolts which awakened my dreamy complaisant memory.
Within weeks I started kindergarten. That first day was filled by my ceaseless crying. Much to my relief, I had mastered the art of playing hooky by the next morning. A week later I matriculated into the American school. Scary but at least fifty percent of the day was in English. It wasn’t long before a Mexican classmate invited me to his birthday party, complete with a piñata. I was too young then to understand that a piñata holds as much in life metaphors as candy and little did I realize then that this metaphor would resurface again in my life decades later as the efforts to reform the embattled U.S. healthcare system.
Like so many things that first year in Mexico, the piñata held excitement mystery and possibility. At that first party I was an eyewitness to a mob. The instant the piñata broke open the school of piranha-like children devoured the innards so fast that I was left dejected, clutching only a little scrap given to “the gringo” by some benevolent adult.
At the next party, when it was piñata, time, I was in the mix; I dove in before the final coup de grace and caught a piece of the bat. My strategy turned upon being first one in but missing the bat, only to learn that this transferred the piñata to the one embracing almost all the candy. I was jumped, kicked, whacked, gouged, and crushed to smithereens while all those greedy hands and bodies piled on me and plied the precious treasure for my hands. Once again I emerged with tears and a few scraps.
Finally by the fourth party I’d gotten adept with the bat and with a super satisfying whack disintegrated “the Toro” to shreds. Pay dirt at last. By the time, my blindfold was off, the scrum was well underway. The school of hard knocks was one more time teaching me a lesson.
Few activities can compete with a piñata party in a child’s imagination. It offers the opportunity of unimaginable candy treasures. After years of practice and experience the master can be picked from the crowd. This child can be seen as cool, calm, and collected. They bat early, never trying to break the treasure open but enough to soften it up. Once back in the pack they make subtle repositioning moves as the batter swings in different directions blindly thrashing at the swaying and bobbing papier-mâché animal idol. At the right moment they dive into the scrum usually coming up with a lot of candy. Winners keepers losers weepers. That’s the rules.
There are many strategies at the piñata party, the imagination of greed can get the best of you when all those marbles (or candy or money) sit inside that single collective pot.
Fifty years later I cannot help but reflect that the rules and spiritual lessons gained within the piñata experience are very applicable to the US healthcare system. With thirty years of healthcare experience I remain awe struck at observing the same sets of behaviors demonstrated at children’s piñata parties.
Be you the patient, doctor, hospital, pharmaceutical company, lawyer, supplier, coder, consultant, or insurance company, each party fully play out their perfect, “what’s in it for me” expression, “Don’t worry what this is costing, we’re just attacking the piñata. Everything in the party has been fully covered. Cracking a few of heads to reach the object of my desire is just good party fun, no offense.” We have become piñatas inside of piñatas, with of course the patient metaphorically becoming the ultimate piñata, after all the party is thrown for each and every one of us willing to pay entrance to the ever increasingly expensive party.
Next week I will start with my personal experience and then move to the global great American health care healthcare piñata gala bash. Let me get the party invitations sent out and also invite you to attend the grand gala 2009 healthcare piñata party.
I’ll let you bring the pinata to my party if I can bring mine to yours.
Until next week I remain sincerely yours in primary care,
Alan Dappen, MD
September 1st, 2009 by Gwenn Schurgin O'Keeffe, M.D. in Better Health Network, Health Tips
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Nielson Wire yesterday posted a summary of a Scarborough Research study that may surprise you. According to the study, teens actually know what “being healthy” means. As reported by Nielson Wire, “92 percent percent of teens aged 13-17 say that health and a healthy lifestyle are important and when asked to give themselves a “health report card,” 76 percent of teens gave a grade of B- or higher.”
Also of interest in the report is where teens get their health information. As opposed to using social networking, as we’d expect them to do given how important a role it plays in their lives, teens turn to parents first and then true internet searches second.
(source: Nielson Wire as seen in Scarborough Research report)
I don’t doubt that on some level our teens know they need to live a healthier lifestyle and desire to do so. But, all we have to do is look around any of our towns to know the majority of our teens are not living they healthy life…not yet. So, why the discrepancy? What needs to happen to help teens live the healthy life they desire?
The discrepancy may have a few root causes:
1. Unhealthy families: many of these kids have parents with weight issues…the apple doesn’t fall too far from the tree so they may not be getting the encouragement to “live healthy”.
2. Lack of time for true exercise – while many teens are in sports, sports participation isn’t the same as true exercise and many kids don’t burn the calories many parents think they are burning.
3. Not knowing how to be more healthy.
4. The hurried child syndrome where childhood has become so busy there isn’t time for proper meals.
5. Not understanding their own bodies unique nutritional needs. The needs of a growing teen are different than they were when they were younger kids, especially as growth slows down. Our teens need help learning to eat more like adults and to eat in moderation and with the concept of “balance”. This will only happen if we lead by example and also have open conversations with them about food. This will also only happen if we serve food they enjoy eating!
How can we help our teens live the healthy life they desire?
1. Talk to your teen and really listen! Find out how your teen wants to eat and exercise. A friendly world of warning…it may differ from your own views but if that is how your teen wants to be healthy, help your teen with that goal because the teen years are the start of the eating and exercise paths for life.
2. Lead by example. Look honestly at how you eat and exercise and do what you need to to be more healthy.
3. Slow down the pace of the family week so there is time for family dinner each and every day.
4. Get every one in the kitchen cooking. I’ll be writing a lot more on this as the year goes on but I can tell you that a family who cooks together, becomes more healthy together!
5. Have your teen help you with the weekly family menu planning.
6. Consider a gym if you can afford it…teens love working with trainers and joining classes. Most communities have programs that are very affordable as do the local YMCAs.
7. Don’t by the junk if your teen asks you not to…that’s like having cigarette packs on the table when someone is trying to quit smoking.
8. Keep healthy snacks around such as fruit, veggie sticks, granola bars.
9. Talk to your pediatrician and address any medical issues if there are any that may be interfering with becoming more active.
10. Be encouraging!
The teenage years are when our teens are supposed to spread their wings and amaze us. If good health is where their wings are trying to take them, then our job is to hop on that path and tackle any obstacle in their way.
*This blog post was originally published at Dr. Gwenn Is In*
