April 30th, 2008 by Dr. Val Jones in Health Tips
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May is skin cancer awareness month, and Revolution Health has created an awareness campaign to help people become more educated about their risks. In a unanimous vote, I was selected as the blogger/spokesperson for skin cancer awareness – probably because I’m “the fairest in the land.” Well, the truth is I’m so white I’m actually closer to light blue – couple that with a high freckle count and green eyes and you’ve got one very high risk lady.
So I’ve decided to see a dermatologist once a year for a full skin check. I must admit that the first year I went I was convinced that I’d be biopsied into oblivion. The only way to be sure that a mole is not cancerous is to take a sample and check it under the microscope. So any doctor with a conservative eye would need to do a lot of “rule out melanoma” testing, right? Wrong. I was happily wrong. Dermatologists are trained to recognize individual freckle and mole patterns, and don’t do a biopsy unless they see an “ugly duckling” mole – one that stands out from all the others. I was so excited to escape the office with my skin in tact that I vowed to be obedient and return for a yearly check up.
If you are fair skinned and/or have had a significant amount of sun exposure in your life, or if people in your family have had skin cancer, you should definitely check in with a dermatologist to make sure you don’t have any suspicious moles. The doctor will tell you how frequently you should have follow up exams.
Here are some things you can do right now:
Find out if you’re at risk for skin cancer and learn what you can do to prevent it.
See what skin cancer looks like.
Check out my recent interview with Dr. Stephen Stone, past president of the American Academy of Dermatology, about skin cancer and about tanning salons.
Coming soon: the true story of my blogger friend who had a basal cell carcinoma removed from the side of her nose. She required plastic surgery to fill the gap, but it looks great now!This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
April 14th, 2008 by Dr. Val Jones in True Stories
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My husband has perfected the art of dry humor. He is very thin and naturally athletic and I tease him a lot because I’m not as thin or naturally athletic (ahem – yeah, I’m jealous). So we have a running joke about him being skinny.
Today I needed to find my sister’s mailing address really quickly, and realized that the only place we had saved it is my husband’s Gmail contacts list. To retrieve them I’d have to use his login and password (which I could guess at, but didn’t really want to do without his permission first). Unfortunately I couldn’t get through to him at work, so I just went ahead and logged in (correctly guessed his password) and retrieved my sister’s address.
I emailed my husband apologizing for hacking into his Gmail account without his permission. This was his response:
“That’s ok. I’m the only skeleton in my closet.”This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
April 13th, 2008 by Dr. Val Jones in True Stories
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I received a panicked call from my younger sister today. She is the mother of one-year-old identical twin girls, born slightly prematurely. During her pregnancy she had a problem with twin-twin transfusion syndrome and had to lie on one side for many weeks to ensure that both girls received an adequate blood supply. She delivered by Cesarean section and fortunately both girls have been doing well. That is, until a few hours ago.
My sister described an episode in which her daughter was in the bathtub and suddenly had one of her pupils become very large. It remained dilated for several minutes, which caused her to call her husband in to take a look. He confirmed that the eye was dilated and they decided to call me right away because they’d heard that a dilated pupil might have something to do with concussions or head injuries, though the little girl had not had any recent trauma to her head.
I tried to get a full history from them – they said she was acting “totally normally” – the usual peeing, pooping, eating checks were fine. They said she was sleeping well, not vomiting or lethargic, and that her pupil had now (after several minutes) returned to normal size. They said her fontanel was not bulging, and when I asked them to shine a light in her eyes they both constricted immediately.
My sister asked me, “what could this be?”
Ugh. I’m not a pediatrician, nor an ophthalmologist, but I do know that asymmetric pupils are usually an ominous sign. All I could think of was “space occupying lesion” but I didn’t want to scare my sister unnecessarily. All the other history sounded so reassuring (the child was well, with no apparent behavior changes, the eye had returned to normal, etc.) that I had to say that they should get in touch with the pediatrician on-call.
And here’s where things got confusing. My mother called me by coincidence just after I hung up the phone with my sister. She had been visiting with the babies for a full week, and slept next to their cribs during their vacation. I told my mom about the pupil issue, and she started relaying some potential “symptoms” that she had witnessed over the past week or so. She claimed that the baby had indeed vomited recently, that her behavior was different than her twin (more irritable and emotionally labile) and that her sleep patterns were also disrupted.
Now I was more concerned – was this early hydrocephalus or maybe even brain cancer? Would I be responsible for missing a diagnosis? I was thousands of miles away from the infants and trying to piece together a story from historians with different observations. So I called some pediatrician friends of mine and asked what they made of this. One said – “anisocoria is a concerning symptom in an infant, she needs a CT or MRI to rule out a tumor pressing on her eye nerve. She should go to the ER immediately.” The other said that since there were no other current symptoms, and the eye was back to normal, it should be worked up by an ophthalmologist as an outpatient.
What a bind to be in – I have some witnesses describing very concerning symptoms, others suggesting that everything’s fine except for a fleeting period of pupil size mis-match. I have dear friends suggesting everything from an immediate ER visit with sedation of the child and a head CT or MRI to watchful waiting and distant outpatient follow up. And I have my sister relying on my judgment (as a non-pediatrician) to tell her what to do.
Here’s what I did – I got my sister and her husband on the phone and explained to them that I take their observation of pupillary dilatation very seriously. I explained that this is not a normal event, and should be followed up by an expert to make sure that there’s no underlying cause of the eye symptoms. I also said that the fact that the baby is acting normally and the eye is no longer dilated are reassuring observations. I told them that they should keep a close eye on the infant, and that if they see any hint of recurrence of the pupil problem, or anything out of the ordinary like vomiting, inconsolability, lethargy, swollen fontanel, fever, or strange body movements or seizures, they should go to the ER immediately. In the meantime they should alert the doctor on-call to the situation and discuss everything with their pediatrician during her next available office hours.
I hope that was the right approach. I will not rest easily until the baby has been fully examined by an expert. Being a doctor carries with it a lot of anxiety and personal responsibility – at any time of the day or night your peace of mind can be uprooted by an abnormal finding relayed to you by friend, family, or patient. And if anything goes wrong – or if interventions are not achieved at an optimal speed and accuracy, this question will forever plague you: “Should I have done something differently?”
Who knew that my relaxing Sunday afternoon would be turned upside down by a dilated pupil?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
March 28th, 2008 by Dr. Val Jones in True Stories
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I lived in Texas from 1990 to 1994. I haven’t spent much time there since, although I’ve had my eye on Houston’s unfortunate distinction as “America’s fattest city” for the majority of recent years (though Chicago won the honors in 2006 if I recall correctly). Armed with this knowledge, I arrived in Houston today hoping that I wouldn’t let down the members of my weight loss group as I entered the “lions den” of poor eating habits and sedentary lifestyles.
I had missed lunch, and opted for an early dinner at the hotel restaurant. The menu surprised me in two ways: first, it featured quail and wild boar (this particular hotel chain is not known for culinary artistry – let’s just say that their recent “upscale service campaign” involved an email to me the day prior to arrival, asking if I might like anything special in advance of my arrival – like a 6 pack of Budweiser waiting for me on ice. I kid you not.) Second, they had made an attempt to highlight “heart-healthy food choices” on the menu. One item was identified as heart-healthy. Only one.
So I resisted the urge to try the local southern fare (fried catfish and hush puppies) and decided on the heart-healthy option. Here’s how the conversation went:
Server: “Welcome to XXX. May I start you off with something to drink?”
Dr. Val: [Shivering and somewhat surprised that the AC would be on so high] Well, yes, I think I’ll have some hot tea. Do you have green tea? It’s quite cold in here, isn’t it?
Server: “It’s not cold. The lights above will warm you up real quick.”
Dr. Val: [Looking up towards the track lighting above me, wondering if they could function as a sort of heat lamp.] “Oh, ok.” [Server leaves to put a tea bag in a mug of hot water and returns with it on a napkin.]
Server: “Have you decided what you’d like to order?”
Dr. Val: “Well yes. I think I’ll have the heart-healthy fish, but I was wondering if I could have a side of greens with that?”
Server: “What kind of ‘greens?'”
Dr. Val: “Well, maybe a green salad or some broccoli?”
Server: “Did you see the salads on the menu?” [I can tell she thinks I’m one of those “high maintenance Yankee women” as her voice begins to tighten.] “We have spinach salad or perhaps a Caesar?”
Dr. Val: [Now fully aware that I’m being irritating but desperately wanting to make a healthy choice.] “Yes but those are entree-sized salads and they have bacon, egg, and cheese on them. Do you have something more plain? Or maybe some steamed vegetables…” [My anxiety grows as she stares blankly at me].
Server: “Well did you see the string beans side dish?”
Dr. Val: “Yes, but they’re wrapped in bacon, and [trying hard to help her to understand my quandary] I was hoping to order something healthy… you know what I mean?”
Server: Blank stare.
Dr. Val: Nervous stare.
Server: Sighing, “well I can ask the chef to make the beans without the bacon. Not sure if he can do it, though.”
Dr. Val: “Oh that would be great, thanks so much!”
Server: [Fake smile, whisks menu from my hand, waddles toward kitchen.] 10 minutes pass.
Runner: [Appearing with a huge plate on his shoulder] “Did you order the fish?” [Surprised that anyone ordered the heart-healthy dish].
Dr. Val: “Yes, I did.”
Runner: “Ok, here you go.” [Places gigantic plate in front of me with a separate bowl holding about a half gallon of stir-fried green beans in oil. The fish has cream sauce on top of it, about a quarter inch deep.]
Dr. Val: [Remembering the phrase “Texas-sized.” I scrape off cream sauce and cut green beans into bite sized portions. I think to myself: how can anyone eat out in this state and hope to maintain a reasonable weight? I promise myself to go to the hotel gym after my meal…]
Yes my friends, the next 9 days at this conference are going to be interesting. I’ll keep you updated as I rekindle my cultural connections to Texas. And I have the utmost sympathy for Americans who live in places where eating out regularly can be hazardous to your health. Losing weight can be a fight, every step of the way, can’t it?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
March 9th, 2008 by Dr. Val Jones in True Stories
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It was really cold in NYC this weekend. Most of the little Upper East Side dogs were decked out in full coats that matched their collars, some even had booties. I spotted a couple of Italian
Greyhounds looking forlorn and trembling on their leashes. They weren’t
interested in a walk in the park on this day – they just wanted to go home to
their warm condos.
But cold as I was, I didn’t have the option to retreat. I
had come to run in the Colon Cancer Challenge with my friend Seton – a lifelong
marathon runner just finishing her second round of chemotherapy. She was in
high spirits – and laughed at my joke that this was the first race in which I’d
have a “snowball’s chance” of keeping up with her. You see, I’d always wished I could be an
athlete – but the best my genes could do is prepare me to pull the plow. So I
plod along, hoping for the day when I’ll be invited to join a caber toss – and
actually have a chance of doing something I might be good at.
But I digress.
So thousands of runners took to the 4 mile course – and as I
looked around I doubted that too many of them were actively taking chemotherapy
like Seton. She was bound and determined to run at least half of the way, and
had been training for it between IV infusions of very toxic drugs.
Seton’s husband was beaming with pride as he photographed
her at the start gate. I had vowed not to leave her side, no matter what the
pace… She had about 20 other friends who had joined the race as well and a
small handful stayed with us for the entire time. Amazingly, Seton was able to
run 3 of the 4 miles, her hands cramping in the cold, her thin legs carrying
her tingling feet past familiar landmarks. She held her head high, and never
complained – though it must have been hard for a former track star to watch people
of lesser abilities passing her on the trail. Her friends called her cell
phone every 10 minutes to find out how she was feeling/doing. They didn’t know
that it was so hard for her to even open the phone.
As Seton crossed the finish line, she held her arms up in
the air, as if she were breaking through winning tape. Cameras flashed, people
cheered, and I saw tears well up in her eyes as she tried not to show her
exhaustion. She gathered her friends around her and gave this short speech:
“I want to thank all of you for coming out and supporting me
and the fight against colon cancer today. I can’t tell you how much it means to
me to see all of your smiling faces… Although I certainly had some unlucky news
recently, I want you all to know that when I look at you, my dear friends and
family, I feel like the luckiest woman alive. I am so glad to have you all in
my life. I am truly blessed, and I’m going to beat this cancer with you all by
my side.”
There wasn’t a dry eye among us.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
