family practice issues and general life events

Archive for December, 2011

My grandma doesn’t know who I am

This post is both sides of my life smashing together. Last night, I went out to dinner with my grandparents. Since I have moved away, it has been a little over two years since I have seen them. Two years ago, I noticed a significant change in my grandmother’s memory, but she knew who I was. Last night, she no longer remembered me.

I know this for sure, because when my father went to get her in the front of the restaurant (My grandfather had dropped her off up front and went to park the car), while she probably recognized him, she talked to me like anyone would to someone they didn’t know coming up to them. And it broke my heart. It wasn’t that I didn’t expect it, it is just when reality slams you in the face, it does hurt even being a clinician. As a clinician, I watch the heartbreak of families as their loved ones drift into a world where they might or might not be remembered. Where something as simple as ordering can no longer be taken for granted. I noticed that my grandfather took care of that for her, ordering both her meal and a drink. And through dinner, I noticed flashes of the grandmother I remember. The one from 10 years ago, when I stopped coming home nearly as regularly.

She seemed to enjoy seeing my children, but she enjoyed them as you would children in a park, distant, without any other connection to them. As for me, I know she was coached somewhat, and related me to my father, when she realized that connection she became kinder, but I could tell despite mechanisms she had in place, I was not in her current memory. Probably because I am not the same as the grand daughter in her memory of 20 years ago.

Two years ago, I am fairly certain she knew who I was. Didn’t have a clue regarding my youngest. But did seem to remember I had one child, and was pleasant and talkative. Last night, she was fairly quiet. Didn’t say much. I can only imagine what kind of world she is living in.

She was well educated. She went to both college and graduate school I only found out about the graduate school because when I was waiting for acceptance to medical school, I had started applying to graduate schools and chemistry. And when I mentioned that I was applying to the University of Michigan, she said “That’s where you grandfather and I met in graduate school.” She went back to school throughout my junior high and high school years, learning Japanese, and I don’t really know what else, but education was important. Which only makes this sadder and more terrifying.

I don’t know what my grandfather goes through on a daily basis. He seems actually a little more to me, than he has in recent years. He also is quieter. Whether it is due to watching his wife of 61 years slowly lose all of their memories or if it is that his children have grown up and moved away as their grandchildren have, I don’t know. But it is a sad story. It was sad when I talked to my patients and their families. IT is sadder now that I see my once vibrant, happy wonderful grandmother become only a shadow of what she used to be.


Give the gift of health

As Christmas approaches I think about the one thing we should all attempt to give our children- and that is the gift of health.  This does not pertain to those poor children with diagnosis such as cancer, chronic illnesses, or other disease states that have nothing to do with habits that you can control.  Instead this focuses on the rest of the population who can do something to help prevent medical conditions.

Childhood obesity is on the rise.  Mostly due to the readily available fast food culture and the decrease in the physical activity of society overall.  This is not a condemnation of McDonald’s.  I believe in the free market, and if the free market demanded salads and low calorie alternatives, McDonald’s would have one answer within a week and possibly a whole new menu within six months.  But the public does not demand it, so there is no change.

No the answer lies on the parent.  I know, easy scape goat.  But who is ultimately responsible for teaching the child, mom and dad.  And most eating habits are learned at an early age, before the child even enters school.  There is nothing built into the child that makes it demand McDonald’s before it can walk or talk.  In fact, if you never take it to McDonald’s requests for it are limited.  Sure they might see commercials on television, but if you limit the amount of television they watch, there would not be a request.  You may substitute any other fast food establishment you desire in for McDonald’s the story is all the same.

In the parents’ defense, in many poorer areas processed and fast food is cheaper and easier to obtain than fresh fruits and vegetables.  It can be done, it only takes more effort.  And lately I am finding that most parents of obese children that I see, know nothing about serving sizes, how many servings a day or the differences between good calories and bad calories.  Somewhere along the line, this information was lost.  Frequently the parent of a 14 year old tells me how much the child has eaten, and seems surprised when I tell them that is too much food.  And in reality, trying to teach a 14 year old good eating habits (or anything else for that matter) is like hitting your head against a brick wall.  It doesn’t do much good and you end up with a headache.

I like to use the hand as a guide for serving size.  While not exact it is a lot more understandable than gram, ounce or other measuring device.  A hand is always accessible.  Smaller hands, smaller serving sizes

The other thing lost, and probably the bigger problem, is exercise.  While XBOX 360 and Wii have created games that help increase the movements with video games, they do not fully replace the playing baseball in the street, riding your bike until dark, or just having fun playing games with one’s friends.  This I am not faulting parents for not letting your kids out by themselves.  I don’t either.  But unfortunately this fun running without a care has disappeared thus eliminating the burning of calories.  In fact it has probably been replaced in many instances with a bag of Cheetos in front of the television, so not only are we not burning calories we are now increasing the amount we are not burning.

Additionally, parents are under the impression that large amounts of juice is good for the child.  First of all if it is not 100% juice, you might as well give the child a coke.  Secondly, no child needs more that 2 glasses of juice (8 ounces) a day, the rest is just empty calories.  Milk should be limited to 3 glasses (24 ounces total) daily.  Water should make up the rest.  And neither children nor adults need any of the sports drinks unless they are actively pursing a sporting activity.  If you are running a race, ok have a gatorade or a G2.  Sitting on your couch – well you don’t need that 240 calories, you have not lost enough carbohydrates to justify drinking any sports drink.

And I don’t care how hyper your 2 year old is, Mountain Dew is not the same as Ritalin (just because they both are technically stimulants).  You can’t diagnose ADHD that young, current accepted age is 6 with some more recent studies saying 4.  However, they are not the same thing.  Not unless you are hiding the Ritalin in a Cocoa Puff anyway.

Additionally, stop giving coca cola in a baby bottle.  First of all, if they are still drinking out of a bottle there is NO good reason for a Coke.  Talking to the dentists around here it is a toss up between coke in a bottle or putting the two year old to bed with a bottle of juice as being the biggest culprits for tooth decay at a young age.   And unfortunately the earlier we teach these habits, the more ingrained they become

This blog is not anti- any of these foods.  I like the occasional trip to McDonalds, and having pizza delivered when you don’t feel like cooking are nice conveniences.  Additionally, one of the biggest motivators for children is to be like their parents.  So you as a parent need to practice good health.  Eat healthy, with junk food in moderation.  Eat what a serving size is.  Drink plenty of water.  Drink alcohol only in moderation.  Exercise. Find some activity you enjoy doing.  Do it as a family if you can.  Or just find something that you love for exercise and encourage your child to do so.  Don’t smoke, or if you do quit.  Tobacco use in parents is the greatest risk factor for teen to start smoking.  All of these are things that you can do to help encourage a healthy lifestyle in your children.

Please don’t expect the government to help.  Their help has included concepts such as the food pyramid of the 1980’s which many of us grew up with, found later to be flawed and possibly lead to obesity, corn subsidies which has led to an increase in the cost of lean meats, and makes it so that fast food outlets and food manufacturers have cheap, unhealthy products to sell at a cheap cost.  Schools don’t have the time, and from the words of many of my parents their meal options could not be counted as healthy.  And as I was told by one parent, her son was allowed to go back for thirds in the free lunch program at school.  Even overeating healthy foods can lead to obesity when coupled by lack of exercise.  So the answer goes back to the parents.  IT both starts and ends at home.  Please give you child the gift of health, and help change the trend of childhood obesity.  Don’t make me have to talk to another child and explain why their eating habits are killing them.



Urinary Tract Infections

With all due respect to the doctor lecturing about urinary tract infections, but they are not a fascinating topic. While there is more than enough information to fill an hours lecture, and it is very applicable to my practice, I find my mind wandering, and my ADD needing to do something else, so I can absorb the information I need.

However, it is definitely an important topic. Especially in my female population. I would estimate that at least two patients a day come into my office with urinary symptoms. An with the rise of antibiotic resistance due to a combination of improper prescribing and patient’s not taking their antibiotics properly, it is very important. While I don’t usually culture on the initial infection, I do insist on a urinalysis. However, there is an increasing amount of resistance for those I have cultured.
And not always is there an infection in the case of those having symptoms. Probably about 25% of the time in my practice, the symptoms are more of an urethral spasm without infection.

And for those that are infectious need to complete their course of treatment. Even though the symptoms resolve, there are still bacteria lingering. And those that survive incomplete treatment become stronger more difficult to treat later, and those that complain about recurrent infections, but did not complete their treatment have only themselves to blame.

So my advice to you to prevent such infections include the following:

1. Drink plenty of water. This will help to flush the kidneys and bladder and make it more difficult for the bacteria to take hold.

2. Females all need to urinate after sex. This will help to remove any entry of bacteria.

3. Decrease the frequency of bubble baths

4. Decrease the amount of caffeinated drinks. They do nothing for hydration and only help to dehydrate you

5. Finish any course of antibiotics prescribed. It doesn’t matter if you are taking it for pneumonia or ear infection. Not completing the course only increases resistance.

6. Wipe front to back. Wiping in the other direction could potentially introduce new bugs to the urinary tract.

So anyway, it is not fascinating but it is important. And if you do these simple steps you can potentially prevent several infections.

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