Thursday, December 29, 2011
Well the nutritional information is handy, you say. Technically, that’s true. You can go to the company’s website and view the nutritional chart but how many people are really going to do that when they make an impulse decision to pull through a drive thru on the way home from work? Not many. You can look in the restaurant for the nutritional information but it is not always displayed prominently and is not a viable option for someone going through a drive thru. In addition, even if you do look at the nutritional chart, there is usually so much information crammed into it that it is difficult to make sense out of it all when you have people breathing down your neck or tailgating you to make a selection because everyone is starving.
What we really needed is some type of guide that people can use and have readily available to make quick snap decisions about fast food selection at various restaurants. If you search the internet or flip thru magazines at the grocery store, you will find many articles entitled “Top 10 Worst Fast Foods” or some such thing. The articles usually list 10 fast foods to avoid and provide an option about something else to eat instead. I usually have a few problems with these articles. The first is that they all seem to come to different conclusions on which fast foods to avoid and do not tell the reader exactly how the foods were selected and ranked. Second, I can’t tell which restaurants were or were not included in the analyses. This is where MedFriendly enters the picture.
Being a scientist at heart, I thought it would be interesting to create a quick and easy formula and reference for people searching for ways to make better fast food selections. I wanted the public to know how I developed the formula so it can be reproduced by anyone and to let everyone know which restaurants were subjected to analysis. In creating the formula, I decided to take the six most common nutritional concerns that people have (total calories, saturated fat, trans fats, cholesterol, sodium, and carbohydrates), add them together and divide by six. This yields an average score that I have termed the “UnHealthy Index” or the UHI. Higher UHI scores reflect unhealthier foods.
I did not use total fat in the equation because not all fat is bad for you. For example, cashews are high in fat but mostly in monosaturated fats, which is good for the body. Thus, I decided to stick with the two types of fat that are the worst for you: saturated fat and trans fat.
In deciding where to start with these analyses, I decided to start with my favorite food of all: pizza. Pizza does not tend to be analyzed in the articles I have previously reviewed. Although I tend to buy from local mom and pop pizza vendors, sometimes I will call or visit the occasional pizza chain. As best as I can ascertain, there are really four mega pizza chains: Pizza Hut, Domino’s Pizza, Papa Johns Pizza, and my favorite (Little Caesars). Then, there is Sbarro’s Italian Eatery, where it always feels like I’m spending one hundred dollars for a slice of pizza at the mall. So I decided to look at Sbarro's too but unfortunately their website and stores do not provide nutritional information at the time this article was written. In fact, they've been telling me for a year now that they would have the nutritional information up soon and it is still not there. Read into that what you will. And lastly there is Pizzeria Uno. Although they don’t deliver, it’s a popular pizza destination and worthy of analysis.
Each pizza restaurant will be subjected to objective nutritional analysis and a handy reference with the results will be provided for you. When all restaurants have been analyzed, a final comparison between all of the above restaurants will ensue. It is this that I have deemed the Great Pizza Battle and it is the opening salvo to the Fast Food Wars, only on MedFriendly.com. Come back Sunday for the first analysis....Domino's Pizza.
Wednesday, December 28, 2011
Tuesday, December 27, 2011
Some things to note on the new homepage: Now, there is no longer a separate page for the top 10 list as they are listed on the bottom right of the page. To bring more people to this blog, the top right of the home page will have a link to the most recent blog entry. This will allow for better integration between MedFriendly.com and the MedFriendly Blog and will provide the home page with dynamic content. The most commonly used links are listed on the top left of the page and other links are located in the "Other MedFriendly Features" section. Nice new buttons for the MedFriendly Facebook and Twitter account are included.
Special thanks to those of you who provided feedback on the new site design, especially my wife who provided critical input that helped shape the look of the site.
Sunday, December 25, 2011
|Just a quick note to wish all of the MedFriendly Blog and MedFriendly.com readers a very happy, healthy, and joyous holiday season.|
Friday, December 23, 2011
Thursday, December 22, 2011
Neuropsychologists specialize in objectively assessing the relationship between brain functioning, thinking, emotions, and behavior – all of which can be affected in the early phase of concussion recovery. This is done through a series of specialized tests, records review, interview, behavioral observations, and application of statistical knowledge. Neuropsychologists also have much more time to spend with their patients than physicians due to the nature of the evaluation.
Neuropsycholgists have been instrumental in developing published return to play safety protocols and have routinely made return to play decisions prior to the passage of this legislation. Neuropsychologists developed the most popular computerized cognitive assessment programs that are used to make return to play decisions, have played a leading role in researching concussion for the past 25 years, and have published textbooks on the topic. A neuropsychologist from New York (Dr. Thomas Kay) was the senior contributor of the American Congress of Rehabilitation Medicine’s operational definition of concussion. Nearly all major college and professional sports organizations include neuropsychologists in their concussion management program and most states that have passed similar legislation allow neuropsychologists make return to play decisions.
Concerns were expressed to the sponsors of this bill and the Governor’s office about the exclusion of neuropsychologists before its passage. Neuropsychologists were assured that neuropsychologists would still be able to play a role in these assessments that would be used by physicians. However, some school districts are only allowing return to play decision to be made from a specific list of physicians (e.g., pulmonologists, orthopedists, pediatricians) who do the entire assessment without any input from a neuropsychologist. If the child’s own pediatrician is not on the official list of providers, he/she may not be allowed to provide clearance to return to play.
Due to this potential safety issue and the new restriction upon a psychologist’s scope of practice, we urge parents and concerned citizens to contact Senator Hannon, Assemblywoman Nolan, Governor Cuomo, and their local representatives to tell them that you strongly support allowing psychologists to be included in a bill that allows them to make return to play decisions following concussion. as an update to this article, please see How New York Fumbled the Ball on Concussion Management.
Monday, December 19, 2011
All newly created pages will have this new design. The main MedFriendly home page is still being redesigned and will hopefully be up within a week. Please feel free to let me know how you like the new look if you have not done so already.
Sunday, December 18, 2011
In comparison the general idea behind the UK’s compensation system of all personal injuries, including head injury, and following traumatic brain injury, is to provide the claimant with enough compensation so that they are in the same position they were prior to the road traffic accident. To note, when referring to the UK law in this article, what is meant is the law in England and Wales, since Scotland and Northern Ireland have different compensation laws. The process works as follows: Expert evidence is acquired from experts within medical and non- medical fields. The award is again based on pain, suffering and loss of amenity, by assessed through referencing guidelines, previous, similar cases, which are concluded, and the personal circumstances of the claimant. When discussing financial losses, these are defined as past and future loss of earnings, medical expenses, treatment, equipment need, and accommodation. For a brain injured claimant, the largest section of an award is the cost of their future care, be it at home or in a different setting, i.e. a rehabilitation unit. Rehabilitation has a strong focus within the UK’s compensation process, and is based on encouraging both claimant and defendant to work together and asses the injured individual’s rehabilitation needs.
Friday, December 16, 2011
1. NEWT GINGRICH: Gingrich lists 13 main ways he would improve healthcare, which include various specifics. This includes use of tax credits, purchase of insurance across state lines (to improve competition), expanding choices in Medicare, customizing state Medicaid systems, establishing a high risk people to cover the sickest uninsured citizens, preventing insurers from cancelling insurance on people who are very sick or giving them discriminatory rates, extending health savings accounts, rewarding the best healthcare provided at the lowest cost, taking steps to reduce healthcare fraud (e.g., electronic medical records), medical tort reform, reforming the FDA, helping people find information on price and quality of healthcare, and investing in medical research.
2. MITT ROMNEY: Romney lists six main ways he would improve healthcare, which alos contain various specifics. He states that would begin his Presidency by granting an executive order to states to opt out of Obamacare, ask Congress to repeal Obamacare, and emphasizing reforms at the state level. The second area Romney cites involves focusing on the states by block granting funds for Medicaid patients and the uninsured. He also promotes a tax deduction to allow people to purchase their own health insurance. His fourth main idea is reforming federal regulations such as allowing people to purchase insurance across state lines. His fifth idea is medical tort reform. Lastly, he promotes the use of health savings accounts.
3. RON PAUL: He pledges to repeal Obamacare (although you need Congressional support for that), allow purchase of insurance across sate lines, provide tax credits and deductions for all medical expenses, exempt terminally ill patients from the employee portion of the payroll tax, provide payroll deductions for close family members of terminally ill patients, medical tort reform, preventing Medicare & Medicaid funds for being used for other purposes, allow all Americans to open health savings accounts, promoting alternative medicines and supplements, and preventing a national database of personal health information.
4. MICHELE BACHMANN: She states that she will repeal Obamacare, stabilizing Medicare for future generations,promoting medical innovation and personal choice, promoting competition in the healthcare market, and empowering health care providers to make decisions about the shape and form of your health insurance.
5. JOHN HUNTSMAN: While his website contains sections on jobs and the economy, national security, foreign policy, energy security, and financial regulatory reform, there is no section on healthcare.
6. RICK SANTORUM: While his website contains information on defending the taxpayer, American exceptionalism, faith and family, Iran, and other topics, there is no section on healthcare.
Interestingly, the two candidates with no clear distinct section on healthcare on their websites are generally running lowest in the polls.
Thursday, December 15, 2011
4. NEUROIMAGING: In moderate to severe TBI, the results of neuroimaging are critical to deciding how to manage the patient. For example, if a bleed is large enough, this might require neurosurgery to remove pressure on the brain. This sometimes requires repeat brain scans in the acute injury phase to monitor the size and effects of an intracranial lesion (e.g., a brain bleed). In MTBI cases, initial neuroimaging results in the ER do not show abnormalities between 90 to 95% of the cases. Thus, after an initial negative brain CT scan, clinical management of the MTBI patient is often based on subjective symptoms (e.g., headache) rather than objective findings.
5. COURSE: In moderate to severe TBI, the recovery course is well-defined and empirical, with the most drastic improvement occurring in the first six months, additional recovery over the next six months, and slower recovery up to 18 to 24 months. In mild TBI, the course of recovery is clear for the vast majority of people which would suggest that most recover within a week to a few months. However, the course of recovery for those who experience persisting symptoms (more than three months) is less clearly understood.
6. OUTCOME: As noted above, outcome is strongly related to acute injury characteristics in moderate to severe TBI cases and it is generally an exception when psychological factors confound outcome (although this certainly can occur). Conversely, in mild traumatic brain injury, outcome is poorly related to acute injury characteristics. Rather, non-injury related factors tend to be the most predictive of outcome. Examples of non-injury factors include litigation/compensation-seeking, psychological distress, pre-injury psychiatric history, post-injury stressors, substance abuse, and various other psychosocial issues.
7. DISABILIY: In moderate to severe TBI, disability (a form of outcome) is more clearly attributed to injury severity, the functional neuroanatomy of the injury, and resulting impairments. In mild TBI, there is a less clear association between the clinical presentation of the patient and the degree to which neurological and psychological factors play a role.
These examples show that one cannot speak of traumatic brain injury as if it has the same meaning across the severity spectrum. The media and health care providers are strongly encouraged to clearly distinguish between mild and moderate to severe brain injuries when discussing this topic with patients and the public.
Wednesday, December 14, 2011
Unfortunately, what often happens is that findings from patients with moderate to severe TBIs are misapplied to those with injuries on the mild end of the spectrum. As Dr. Michael McCrea (2008) writes in his evidence based text, moderate to severe TBI is a completely different animal than mild TBI (also known as concussion). There are many examples, which are nicely summarized in McCrae’s text and the interested reader should read that book for specific references supporting the statements below. Some of these examples are presented and expanded upon below to help better inform the public.
1. USEFULNESS OF SEVERITY GRADING TOOLS: In moderate to severe TBI, there are measures available that are useful for grading the severity of the injury whereas the scales on the mild end of the spectrum are not as helpful. The most commonly used severity index is the score on the Glasgow Coma Scale (Teasdale & Jennett, 1974) which assesses level of consciousness. The scale ranges from 3 to 15 points and provides a way to rate patients on their eye movements, motor responses, and verbal responses. The TBI classification scheme based on the GCS is as follows: 13-15 (mild), 9-12 (moderate), and 3-8 (severe). While a significant injury and/or alteration in consciousness is required to obtain a GCS score between 3 and 12, the same cannot be said for the mild end of the TBI severity range. For example, consider a person who merely bumps his head into a wall with a minimal degree of force that was not significant enough to cause a brain injury. Assume, however, that the person develops a headache and is concerned that he has a brain injury, causing him/her to go to the ER. When the person goes to the ER, he/she is physically examined and a GCS score of 15 is assigned because there were no abnormalities with eye movements, motor responses, or verbal responses. According to the criteria above, a GCS score of 15 is equated with a mild TBI. Clearly, however, this example shows a GCS score of 15 does not always equate to brain injury.
2. ACUTE INJURY CHARACTERISTICS: In moderate to severe TBIs, the acute injury characteristics are the strongest predictors of outcome. In mild TBIs, there is only a limited correlation between acute injury characteristics and outcome. For example, in mild TBI, a brief and transient loss of consciousness is not strongly predictive of outcome. Conversely, loss of consciousness in a severe TBI patient, which could last for weeks and beyond, is strongly correlated with outcome. One of the problems is that acute injury characteristics are not as clearly documented in MTBI cases because of a lack of witnesses and the transient nature of the event. For example, a mild TBI patient may lose consciousness for a few minutes but if no one was present to witness this, it cannot be confirmed. Conversely, in a moderate to severe TBI case, LOC usually lasts long enough such that paramedics or some other observer would be able to confirm its presence.
3. CRITERIA FOR DIAGNOSIS: The criteria for diagnosing moderate to severe TBI tends to be more consistent throughout the literature compared to mild TBI. The criteria used to diagnose MTBI are largely based on self-reported subjective symptoms (e.g., altered mental status) without collaborating and/or objective data (e.g., witnesses, neuroimaging findings). In moderate to severe TBI, objective data are often sufficient enough (e.g., diffuse bleeds throughout the brain) such that self-report is not required to make the diagnosis.
Come back tomorrow for part 2, in which more distinctions will be provided.
Tuesday, December 13, 2011
The word “malingering” comes from the French word “malinger” meaning “poor or weakly” as these are the characteristics feigned or exaggerated by the malingerer. Malingering has been documented as far back as in the Bible when David feigned insanity to escape a king he was afraid of. There have many books written about malingering and thousands of research articles written about it.
Also see: Why Sports Leagues Need to Pay Attention to Malingering.
Monday, December 12, 2011
Things were much simpler back then. But, as always happens, technology improved and more advanced website design features began getting implemented into websites. These design features became impossible to render without more advanced computer knowledge. Lacking such knowledge (my only computer class was in the 3rd grade on massive cathode ray tube monitors) I kept finding creative ways around this problem and managed to keep the site looking fresher as the years went by.
Over the past few years, I integrated a centralized database system which serves all of the advertisements you see on MedFriendly (except the blog). This way, if an advertiser changed their ad code throughout the site, I did not need to go to every page and fix it. All I had to do was change the ad code in the database. To use a database, I needed to change all of MedFriendly page extensions (except the home page) from .html to .php5. It was a great deal of work and when it was finally done, although I solved one problem, I had inadvertently created another. Pages loaded slower and Google did not rank .php5 pages as highly as .html pages. This means less visitors to the site.
Converting all of the pages back to .html files the way I had them was unthinkable. Not without a new approach. Fortunately, technology has advanced to the degree that there are many good options out there today and I am now working with what is known as a content management system. This will allow me to create the highest quality web pages with a very professional look and will allow me to easily control all aspects of the site from a single master location. Pages will load much faster, the site will be more secure, and I will be able to add so many new features to the site that the sky is the limit. I have begun working on this project today and will update readers here on the progress. Since this project is so massive, there may be days where a blog entry can’t get done, but it is all for the greater good. MedFriendly simply has to modernize to stay relevant and I am dedicated to doing that. I appreciate your readership and support and would greatly appreciate hearing ways you believe the site can be better such as new features you would like to see. Stay tuned.
Friday, December 09, 2011
RECOMMENDED BOOK: When Darkness Comes: Saying "No" to Suicide
Wednesday, December 07, 2011
Don’t let the bedbugs bite. What used to be a funny phrase uttered to children before tucking them into bed has now become a serious concern for people sleeping in hotels, college dorms, hospitals, shelters, and in their own homes. This pandemic has made many consider staying home from a vacation or enrolling in online classes for college. But what are bedbugs anyway, what do the bites look like, and what can you do to get rid of them? Below is a pictoral guide that gives you some of these answers.
First, here is a picture of a bedbug (also known as Cimex lectularius) under the microscope. The purple looking structure is a needle-sharp body part known as a proboscis, which is inserteded into the host’s skin (human or animal) and allows it to feed on blood for about three to five minute. The bedbug injects saliva into the wound that contains anesthetic (pain reliever) to prevent the host from awakening and anticoagulant to keep the blood from clotting.
Here is what a bedbug looks like when magnified without distorting the color although this picture is also magnified:
Bedbugs are actually very small (less than or equal to a half a centimeter) but you can see them without a microscope if you are a keen observer. As you can see from the picture they are flat-shaped and do not have wings. They can be brown or whitish but after drinking blood turn a rusty red color as a result, like this:
tick. Unlike ticks, they then fall off the host, crawl into their hiding place, and digest their meal. They sometimes leave blood stains along the seams of mattresses but can also leave dark droppings behind as well.
The first sign that a bedbug has bitten you are red itchy bites that look like this usually on the arms or shoulders, sometimes in straight rows:
The bites don’t usually need to be treated but they can get infected, especially when scratched. In this case, or when the skin reaction is more severe, seeing your doctor can result in treatment. This can be treated with antiseptic lotions and/or creams. Creams with corticosteroids may be used to decrease inflammation. Creams with antihistamines may be used to decrease the itching. These creams can also be used if there seems to be an allergic reaction or if the skin reactions get bigger like this:
Although most common in developing countries, they have been present in North America more due to increased international travel. They can live for 10 months and can go weeks without food. The good news is that bedbugs do not appear to carry or spread human disease.
How to get rid of them? Get rid of mattresses and box springs infested with bedbugs. You can also cover the bed with a plastic mattress bag to trap the bugs. Infested clothes and bedding should be washed in hot water and dried on high heat. Any furniture of cracks (e.g., in wood floors or doors) should be cleaned and vacuumed as should suitcases. Calling an exterminator is another option. If you use your own insecticide (e.g., in cracks of floors or bedframes) this should not be applied to areas that result in direct skin contact.
Tuesday, December 06, 2011
MedFriendly will be featuring some entries from time to time highlighting what some classic medical texts showed about various medical conditions in the late 1800s to early 1900s. The first entry is about the skin condition, psoriasis. Psoriasis is a common condition that many people have which causes redness and irritation. It usually causes thick red skin with flaky silver-white patches. It is a lifelong condition that can go away for a long time but later return. It often occurs on the elbow but can occur anywhere. It can be a rather unsightly condition. What many people do not know is that it can actually be disfiguring.
Below are some pictures of psoriasis from an 1899 text called Atlas of diseases of the skin by Dr. Franz Mracek. Here is a leg:
Monday, December 05, 2011
FEVER: Headache with a temperature over 100 degrees.
EPIDURAL HEMORRHAGE: An epidural hemorrhage is bleeding outside of the outermost layer that covers the brain. Symptoms include a headache with a head injury in the past few days, in addition to feeling unusually drowsy, and/or vomiting, or feeling nauseous (sick to one's stomach). No temperature over 100 degrees Fahrenheit (F). If this applies to you, it is an emergency, and you should get medical help immediately.
HEAD INJURY: Headache with a head injury within the past few days, without feeling unusually drowsy and/or vomiting, or feeling nauseous. No temperature over 100 degrees Fahrenheit (F). A continuous headache is common following a head injury.
RAISED PRESSURE IN THE EYE: Severe pain in and around one eye, blurry vision in that eye, and nausea or vomiting. No temperature over 100 degrees Fahrenheit (F). No head injury within the past few days. If this applies to you, it is an emergency and you should get medical help immediately.
SUBARACHNOID HEMORRHAGE: A subarachnoid hemorrhage is bleeding between the first two layers that cover the brain. Symptoms are headache, nausea and vomiting, as well as two or more of the following symptoms: dislike of bright light, drowsiness or confusion, and pain when you touch your chin to your chest. No temperature over 100 degrees Fahrenheit (F). No head injury within the past few days. No severe pain in and around one eye. If this applies to you, it is an emergency and you should get medical help immediately.
INFLAMMATION OF ARTERIES IN THE HEAD: Nausea and vomiting as well as a sudden throbbing pain in the side or sides of the head. No temperature over 100 degrees Fahrenheit (F). No head injury within the past few days. No severe pain in and around one eye. No dislike of bright light, drowsiness or confusion, or pain when you touch your chin to your chest. If this applies to you, it is an emergency and you should get medical help immediately.
MIGRAINE HEADACHES (see section above on different types of headaches for description): Nausea as well as disturbed vision that occurs with vomiting, followed by pain on one side of the head. No temperature over 100 degrees Fahrenheit (F). No head injury within the past few days. No severe pain in and around one eye. No dislike of bright light, drowsiness or confusion, or pain when you touch your chin to your chest. No sudden throbbing pain in the side or sides of the head.
DRINKING TOO MUCH ALCOHOL: Experience of a similar headache while waking up the past several days or more out of the past week. The headache occurs only when drinking a lot of alcohol the night before. No temperature over 100 degrees Fahrenheit (F). No head injury within the past few days. No nausea or vomiting.
TENSION, BRAIN TUMOR, OR HIGH BLOOD PRESSURE: Experience of a similar headache while waking up the past several days or more out of the past week. The headaches do not occur only when drinking a lot of alcohol the night before. No temperature over 100 degrees Fahrenheit (F). No head injury within the past few days. If the pain is in the back of the head, tension or high blood pressure is a more likely cause than a brain tumor. If nausea and vomiting is present and the headache reoccurs and is experienced while waking up, this indicates a brain tumor. If the group of symptoms mentioned in this paragraph applies to you, it is an emergency and you should get medical help immediately.
SINUSITIS: Sinusitis is inflammation of air-filled openings (known as facial sinuses) in the bones surrounding the nose. Symptoms are a current or recent stuffy nose and a dull pain and pain to the touch around the eyes and cheekbones that worsens when bending forward. No temperature over 100 degrees Fahrenheit (F). No head injury within the past few days. No nausea or vomiting. No similar headaches while waking up the past several days or more out of the past week.
COMMON COLD: Headache and a current or recent stuffy nose. No dull pain or pain to the touch around the eyes and cheekbones that worsens when bending forward. No temperature over 100 degrees Fahrenheit (F). No head injury within the past few days. No nausea or vomiting. No similar headaches while waking up the past several days or more out of the past week.
NERVOUSNESS, TENION HEADACHES: Headache and feeling tense or under stress and/or having poor sleep. No temperature over 100 degrees Fahrenheit (F). No head injury within the past few days. No nausea or vomiting. No similar headaches while waking up the past several days or more out of the past week. No current or recent stuffy nose.
STRAIN ON NECK MUSCLES: Headache that occur after reading or doing work that requires you to be close to something, such as sewing. No temperature over 100 degrees Fahrenheit (F). No head injury within the past few days. No nausea or vomiting. No similar headaches while waking up the past several days or more out of the past week. No feeling tense or under stress and/or having poor sleep.
COMMON CAUSES SUCH AS: Hunger, drinking more alcohol than usual, being in a stuff, noisy, smoky area, exposure to strong sunlight. Headache, with the common causes just mentioned, occurring in the 12 hours before the headaches began. No temperature over 100 degrees Fahrenheit (F). No head injury within the past few days. No nausea or vomiting. No similar headaches while waking up the past several days or more out of the past week. No feeling tense or under stress and/or having poor sleep. Headache does not occur after reading or doing work that requires you to be close to something, such as sewing.
MEDICATION SIDE EFFECT: Headache in addition to taking medication and/or taking birth-control pills. No temperature over 100 degrees Fahrenheit (F). No head injury within the past few days. No nausea or vomiting. No similar headaches while waking up the past several days or more out of the past week. No feeling tense or under stress and/or having poor sleep. Headache does not occur after reading or doing work that requires you to be close to something, such as sewing. The common causes mentioned in the last section have not occurred within 12 hours before the headache began. You should talk to your doctor if you think a medication side effect is causing your headache.
Sunday, December 04, 2011
As a result, some doctors have resorted to having patients sign contracts to prevent them from publishing any commentary or writing anything disparaging about their experience with the doctor. One New York City dentist (Dr. Stacy Makhnevich) did just that recently and then threatened to sue a patient (Robert Lee) who wrote a negative review on a website about her. The patient stated that the dentist billed him $4766 after sending the necessary paperwork to the wrong insurance company and refusing to hand the forms over so he could submit them himself, instead referring him to a third party who charges 5% of the total bill for the service. For each day the negative review remained online line, $100 was allegedly charged to the patient from the dentist.
The case reminded me of a situation that happened to me once, which is why I never sign any contracts anymore that say I cannot complain about the service I received, no matter how complaining is defined. To make a long story short, I was moving from Oklahoma to Buffalo (a 24 hour trip) in 2003 and decided to ship one of my cars. Almost every car carrier charged $1000.00 for the service. One company charged only $600.00. You just had to send in a non-refundable $200 deposit and sign a contract that you agree not to harass them with complaints. No problem, I figured, and so I sent in the check. Problem is that the person running this supposed car shipping company never picked up the cars and would make up a million excuses as to why. Customers would call and complain and after a few calls he would cancel the contract due to what he called “harassment.” He would pocket the $200.00 on everyone he did this to and make a significant amount of money. Eventually, he pulled this scam on an FBI agent and was caught, prosecuted by the Shasta County District Attorney’s Office, convicted, and sent to jail.
The moral of the story is not to sign contracts like this and to do some research on who you are spending your money with if a deal looks too good to be true. If all I would have done was a simple Google search, I would have found a national news story describing what he did to the FBI agent and never would have signed the contract and sent in the money. It was a life changing experience for me in terms of lessons learned and I share it here so some people don’t need to learn it the hard way.
Friday, December 02, 2011
Since the earliest days of human civilization, war has been a regular and repeated phenomenon that destroys lives and tears societies apart. In its earliest days, a war required the mobilization of every member of a given state, and its ultimate victory or defeat promised to forever alter the fabric of that civilization. Then, for several centuries during the Middle Ages, the Renaissance, and the Industrial Revolution, war reverted to a more small-scale affair among professional armies. Countries won, and lost, and gained territories, but life for the average person continued unchanged.
The past century has seen a return to total war – one that involves every member of society. World War I and World War II were momentous and bloody events that defined a generation for anyone living in an affected country. Together, the two wars killed millions upon millions of people and completely altered the course of modernity.
But the World Wars also ushered in tremendous advancements, many of which would not have occurred – or, at least, would not have occurred as quickly – without having war as a stimulus. On a technological level, advancements were made in nearly all aspects of military engagement: planes and naval ships were improved, the atomic bomb was developed, and communication lines were strengthened. Furthermore, on a medical level, the war ushered in the widespread use of penicillin, various immunizations, and gas masks in response to chemical attacks.
The medical advancements seen in World War II come as little surprise, considering that millions of injured and sick soldiers were being treated by some of the smartest doctors and scientists out there. Consequently, such advancements realized in the face of a major war can be seen as a silver lining amidst all the death and bloodshed. While companies such as Huntingdon Life Sciences are always pursuing the latest medical breakthroughs, it is during a time of war when the full resources of society and of the federal government get behind this endeavor.
So what, then, are the medical advancements coming out of our current wars in Iraq and Afghanistan? While neither engagement can be described as a total war, both conflicts have been among the costliest in history, and they have both made use of countless technological advancements. With Iraq coming to an end and Afghanistan winding down, it is a good time to start considering the medical improvements that these wars may leave as their legacies.
The two main medical advancements of our current wars come in the areas of mental health and prosthetic limbs. For years, veterans suffering from Post-traumatic Stress Disorder (PTSD) upon arriving home from combat were brushed aside, their problems not fully understood. These days, veterans with PTSD are usually diagnosed and provided treatment. But the recent wars in Iraq and Afghanistan brought that treatment to a new level: thanks to medical advancements in the realm of diagnosis and drug treatments, the U.S. military is better equipped to identify those veterans with PTSD and work to help them readjust to society.
Advancements in prosthetic limbs have been equally beneficial to a different type of injured soldier returning home. Although casualty rates in Iraq and Afghanistan have been far surpassed by other American wars, the injury rate is high and veterans are arriving home with limbs that have been amputated or blown off by a bomb. In past wars, these veterans would have had little recourse but to learn how to live without that limb. This is no longer the case. As a result of advancements in biomedical engineering, veterans can be retrofitted with prosthetics that act – and even look – just like a natural limb.
These advancements will continue to benefit civilian society long after the wars are over and the soldiers have arrived home. While the life lost during a military engagement is almost always senseless and unnecessary, we can take heart in the fact that generations of people will benefit from the medical advancements that come out of it.
Thursday, December 01, 2011
1. The SHOCKING Ingredients In A McRib Sandwich: This popular entry had 253 views. A must read if you are even thinking of ordering the McRib.
2. 10 Easy ways to Improve Your Mood and Outlook on Life: Check out this entry to put a smile on your face and add a little pep to your step. 102 page views this month.
3. Does Your Kids Cereal Contain BHT or BHA – An Ingredient on Jet Fuels? Mine Did: My cereal cabinet looks a lot different since I wrote this. 99 page views this month.
4. Woman Injects Cement& Tire Sealant Into Woman’s Backside: The pictures tell the story. 92 page views this month.
5. Why Neuropsychological Testing is Helpful in Dementia Evaluations: As a neuropsychologist, this makes me happy that 91 page views were recorded and it cracked the Top 5.
Wednesday, November 23, 2011
Most human exposure to radiation is from medical procedures such as X-rays, CT scans, and mammograms. Radiation can be measured in a unit known as millirems. The According to the U.S. Nuclear Regulatory Committee, the average American is exposed to 620 millirems of radiation, with 310 miilirems coming from the environment. If you receive a whole body CT scan, you receive 1000 millirems of radiation, which is much more than the yearly exposure. Get a CT scan of the chest and you received 700 millirems, again more than the yearly dose. Dental x-rays? Well, they only give you 1.5 millirems. However, there is level of radiation that is technically “safe” since the health effects of radiation are cumulative. That is, the more radiation you are exposed to, the worse of an effect it has on your health.
So, there is some degree of radiation exposure you will get no matter what. But why expose yourself to any extra radiation? One source of needless radiation you can avoid are full body scanners at airports. These are known as backscatter scanners. It had traditionally been thought that these scanner expose you to very low levels of radiation (e.g., .005 to .01 millirems). The Transportation Safety Administration insists this level is safe (e.g., 1000 such scans is equal to 1 chest x-ray) , but the non-profit investigative journalism organization, ProPublica, insists that the U.S. government glossed over cancer concerns as it rolled out these scanners and that the radiation exposure level is much higher. Researchers at Columbia University have said that the machines emit 20 times more radiation that originally estimated. The Inter-Agency Committee on Radiation Safety indicated that pregnant women and children are particularly at risk by these scanners.
On 11/14/11, the European commission announced new policy that they would ban these types of scanners due to concerns about health and safety. Instead of using X-ray scanners, they are replacing them with millimeter-waver scanners, which use low energy radio waves. Due to the low energy, these scanners do not have the power to cause genetic mutations and thus should not cause cancer. On 11/21/11, the head of the TSA reneged on his prior plan to re-study the safety of the scanners, stating they were safe. Not being a radiation expert, I really don’t know who is right. But I do know that I can at least opt out of these scans and that is what I did the last time I went to the airport. The result is a pat down but I found the whole experience easy to deal with. At least I know did not expose myself and my family to needless radiation. And just in case you were wondering, metal detectors at the airports do not expose you to x-rays or damaging forms of radiation.
Tuesday, November 22, 2011
Fortunately, a co-worker witnessed the abuse and reported it. But it makes you wonder what would have happened if the witness did not report it or if there was no witness. If the patient had severe dementia, she likely would not have the cognitive abilities to report the crime and if she did report it, it is likely that no one would have believed her due to her medical state.
Having more staff present in nursing homes increases the chances that a witness will be present. Having a witness present, though, is not enough if the witness is scared to report what he/she has seen. This is why hospitals, nursing homes, and other medical facilities should have anonymous abuse reporting mechanisms that are well publicized.
It is ideal to have responsible family members present to visit the elderly in medical facilities because staff would be less likely to abuse a patient who they know have family members who are keeping an eye on the patient and have a close relationship with hospital workers (particularly those in senior positions) and who are advocating for them. Unfortunately, patients with no family members who are isolated are the ones most vulnerable to abuse because they have no one to look out for them. Checking over a loved on for unexplained bruises, cuts, or other marks on the body should be done regularly. Reasonable explanations (e.g., slip and fall) for marks on the body (e.g., black and blue) should have some confirmatory documentation in the medical record. Suspected abuse should be reported immediately so that it does not continue to occur.
Monday, November 21, 2011
While trying to save money is generally a good idea, it is not a good idea when it comes at the expense of picking someone not qualified to provide the desired medical service – in this case, plastic surgery. When trying to find a new doctor, I have put together a brief set of tips on how to do this in a way to minimize dealing with a charlatan. One of the tips I did not mention in that article was to walk away if the person does not physically appear professional to you. This is admittedly subjective and starts to enter into somewhat controversial territory, but if I am going to a plastic surgeon and she walks in with giant feathers dangling from her ears, I am likely walking away. I say this based on a picture of the person (Oneal Ron Morris) above who allegedly posed as a plastic surgeon and injected the concoction of toxic substances. Of course, I don’t know if she was wearing these earrings or some other odd form of apparel when the patient met her, but if so, it is a red flag.
I have used the word “she” above but “he” is the more accurate word to use because Morris was a man who identifies as a woman. Given that Morris was allegedly presenting as someone who can improve another person’s body curvature, I would personally be concerned if I saw that the doctors own body curvature looked like this.
When seeking a plastic surgeon, it is best to have one who is board certified because this provides an additional safety net. A board certified doctor (from a reputable organization) is one who has been vetted by his/her peers to have the appropriate training and education to perform a specialized service and has passed a rigorous examination(s) in the particular specialty area. For physicians, the main board certifying authority is the American Board of Medical Specialists, which oversees the American Board of Plastic Surgery.
Another tip is to find out if the plastic surgeon has privileges at the hospital. This is important because hospitals do background checks on their doctors. If the doctor says he/she has hospital privileges at a particular hospital, call the hospital and confirm this if you have doubts.
Another tip is to find out if the plastic surgeon has privileges at the hospital. This is important because hospitals do background checks on their doctors. If the doctor says he/she has hospital privileges at a particular hospital, call the hospital and confirm this if you have doubts.
Sunday, November 20, 2011
Many may feel that they do not want to offend the patient and so they go on and give the hug even though they may not feel comfortable. In my opinion, this is the wrong choice. For starters, hugs, unlike handshakes, are sometimes intimate gestures. You hug your spouse during intimate moments but you do not shake your spouse’s hand. A hug is much more informal compared to the handshake, which results in a slippery slope.
As health care providers who need to be objective, it is important to maintain some boundaries that maintain the doctor-patient relationship (add any healthcare provider you want to in place of doctor). Hugging patients blurs those boundaries. For example, it will be more difficult to tell patients news they may not want to hear (but need to hear for their sake) if they begin to see you more like a friend or family member than a professional.
Another problem is that in this day and age, concerns about lawsuits and patient complaints are more prevalent than ever. The concern in this case is that the meaning of a hug can be misconstrued by a patient as meaning something more intimate than was intended. In addition or alternatively, some accidental touching to sensitive body area can occur during a hug that is misinterpreted by either person. This can raise concerns of sexual harassment as the person can claim that the touch was unwelcome. This is more likely to occur if the health care provider initiates the hug. It is more likely to occur when the hugger is a male health care provider and the recipient is a woman or a child. Female to female and female to child sexual harassment claims are much less common. This means that female health care providers do not need to worry as much about a sexual harassment claim based on hugging patients but the crossing of professional boundary lines issue remains.
When a patient tries to initiate a hug, my response is to simply say in a nice and respectful way that I am not allowed to hug patients because it crosses a boundary line. Then I offer my hand for a handshake. This can admittedly result in some slight embarrassment on both sides, but it is better to be safe than sorry. This solution is better than one that a supervisor once told me he used, which was to say “I think you need to get your hugs from somebody else,” which sounded too rejecting to me. If the patient insists on hugging you and lunges on you, it is best to document this clearly in your clinical note and explain that this cannot occur again.
The advice I provided above also applies when interacting with patient family members. That being said, there may always be a rare exception depending on the case and circumstances.
Friday, November 18, 2011
For anyone watching the news in the past few weeks, these allegations come in the wake of the Notre Dame child sex abuse scandal that rocked the country. People have once again been reminded about the dangers of sexual abuse. The ways sexual predators operate were best exposed, in my opinion, during the recurring MSNBC special known as “To Catch a Predator” by Chris Hansen. In it, Hansen documented how sexual predators lured child victims online and came to their home to engage in sexual relations, thinking that the children’s parents were gone.
Regardless of whether the allegations against Bernie Fine are true, people must be wondering what they can do to keep their children safe some sexual predators. A few suggestions are listed below.
1. TALK TO YOUR CHILDREN: If a child is inappropriately touched, he/she needs to feel comfortable discussing it with you. It is an uncomfortable topic for sure, but if you have an established relationship with your child such that the child can feel free to come to you and discuss any topic, good or bad, the child is more likely to come forwards if something inappropriate occurs. From a young age, children need to be told that if anyone touches their private parts or touches them in a way that makes them feel uncomfortable that they need to tell you about it as soon as possible. Make sure your children know never to go somewhere with a stranger and that if a stranger grabs them, that they should try to scream, get away, and run to an area of safety. Let your child know in advance that if a predator threatens to harm the parent if he/she tells of any abuse, that the parent will actually be ok and to tell someone anyway.
2. SEARCH ON-LINE SEXUAL OFFENDER REGISTRIES: Check your state’s online sexual offended registry, such as this one in New York. These registries allow you to see if there are sexual offenders living in your area, what their names are, where they live, and what they were charged with. Once you know where they are, you can make sure your child knows not to go there.
3. BE VIGALENT: Be mindful of where your children are. Do not let them stand at a bus-stop alone. Do not let them spend alone time with adults you do not know. Do not let them veer away from you in public places, such as the mall.
4. COMBATING GETTING LOST: If your children get lost in a public place, they can become easy pretty for a sexual predator. Make sure they know what to do if lost, such as seeking out a cashier or police officer and providing that person with a name, address, and phone number.
5. SPEND TIME WITH YOUR CHILDREN: Sexual predators try to prey on the most vulnerable children, which includes people who do not see their parents much. Thus, if you spend frequent time with your child, that is time that no one else will be doing so.
6. COMPUTER AND PHONE USE: Be aware of what websites your children are viewing (e.g., check the history log), install filters that prevent visits to adult websites, limit, ban, or closely monitor participation in social media sites (Facebook, Google+, MySpace, Twitter) based on the child’s age, and tell them to not develop relationships with strangers on-line, give out their phone number/address, or meet strangers from on-line (or the newspaper) in person. Make sure your child knows that strangers on-line may pretend to be people they are not. Monitor text messages and pictures your child sends for inappropriate content.
7. DO NOT GET OVERLY COMFORTABLE WITH STRANGERS: Sexual predators are typically charming. You may believe that you know the person and feel comfortable because he/she is nice, but neighbors, babysitters, priests, teachers, coaches, and even family members can be sexual predators in your midst. Do not let your guard down and be very careful who you chose to leave your child alone with. Do not allow taps on the buttocks, touching of the legs, tickling, or other inappropriate touching to go on if your feel it is inappropriate.
8. USE FEMALE BABYSITTERS: Sexual predators are almost always men. Thus, your child is likely to be safer with a female babysitter.
9. TEACH SELF DEFENSE: Teach your child some self-defense strategies to use if a sexual predator makes threatening physical advances to a child.
10. SECURE YOUR HOME: Keep doors and windows locked. This is crucial. Many sex offenders state after being caught that if a door entering the house was locked that he/she would likely have moved on. If you can, have a dog or dogs that bark when strangers come.
Thursday, November 17, 2011
1. REMEMBER THAT THINGS CAN BE MUCH WORSE: No matter what type of situation you find yourself, you can almost always think of a way in which it could be much worse. For example, if you get into a car accident and your door gets dented in, you can be upset about the damage, receiving a ticket, and the inconvenience of filing an insurance claim. It’s easy to focus on these problems but not keep in mind that you and the other driver were not injured in the accident, that you did not need to go to the hospital, that the car is still drivable, and that there was not more expensive damage. When you take the time to recognize that there are so many things you have to be fortunate about, it helps put stressful situations in proper perspective.
2. REMEMBER THAT THERE IS ALMOST ALWAYS A SILVER LINING: Bad situations happen but there is almost always a silver lining present, even if you can’t see it right away. For example, when I was first shopping for a house, the deal ended at the last minute because the home inspector found mold in the attic. It was a very bad day for sure, but it caused me to expand the house search and find a much better house in a better development. Try to keep the silver lining in mind when something bad happens.
3. WORK SOME FUN INTO YOUR WEEK: At least a few times a week, you should work some type of fun activity into your week, such as watching a movie or favorite TV show, going to a game, listening to good music or a favorite talk show, socializing with friends, going to a favorite restaurant, etc.
4. HAVE SOMETHING TO LOOK FORWARD TO EACH DAY: While you should at least do something fun a few days a week, try to have something to look forward to each day that you like to do from the section above.
5. HAVE A HOBBY: Hobbies make life interesting and they usually provide a good escape from the doldrums of daily life. Great hobbies include collecting things, doing something creative, video games, sports, reading, and much more.
6. SMILE & LAUGH: Try to find something that makes you smile laugh. It does not need to be public laughter if you are not comfortable with that, but try to watch a comedy, listen to a comedian, listen to a comedic radio show, pick up a joke book, or spend time with someone who makes you laugh. Laughing just makes you feel good.
7. STAY AWAY FROM PEOPLE WHO BRING YOU DOWN: We all know who these people are. The ones who love to say things to push your buttons, people who are insulting, people who tell you that you are not good enough. Stay away from these people as much as possible and stay near people who are nice, encouraging, and generally have positive things to say.
8. EAT WELL: It is difficult to define “eating well” because by using that term, you may assume all I mean is to eat fruits and vegetables. Actually, what I mean by it is to eat a generally healthy diet with natural foods and avoiding artificial chemicals. Keeping your body as pure as possible helps you feel better. BUT, I also strongly believe people should be allowed to treat themselves and get that pepperoni pizza they have been craving or ending the week with a cookie dough ice cream Sundae. You only live once, should not completely deprive yourself, but should also not overdo it. As the Greek philosophers said, moderation is the key in life.
9. REMEMBER WHO IS IN CONTROL: Always remember that while you cannot always control what happens to you, that you are the only person in charge with how you think about it and react to it. A feeling of loss of control is a major reason why many people develop significant emotional disorders. Remember that the way you choose to think about something will determine how you feel about it.
10. STAY AWAY FROM NEGATIVE LANGUAGE: Remove extreme negative words such as “can’t,” “impossible,” and “must not” from your vocabulary. For example, if you tell yourself that you “can’t” accomplish your goals, that it’s “impossible” to succeed at something, or that you “must not” make a mistake, you will create self-fulfilling prophecies and be very upset when you make an error. The fact is that most goals are attainable with hard work and that everyone makes mistakes. View mistakes as opportunities to learn and improve yourself in the future rather than as long-term sources of grief. Try to move on fast, remember that tomorrow is another day, and that