Forget Meds Much? Carry A Spare.

How many times have you forgotten your medication at home? Or forgotten to take it with you before you headed out for dinner or an outing? Or if you take your medication at home, how many times have you gotten home late, past the time you are supposed to take your meds?

For those who have to take their medication when they are not at home, forgetting to pack them seems to be a common problem.

That's why I tell patients to pack a spare. If you're on long term medication. It's best to keep two sets of your Rx in your bag/wallet just in case you happen to forget to pack your medication. This set should only be used 'in case of emergency' and you should still pack a set to use daily.

There are lots of ways to keep spare meds:

• pill boxes
• key chains
• altoid tins (line with saran wrap or tissue)

 Just remember to use your spare meds before the expiration date! This could be easily avoided by using them before moving on to a new bottle.

Salud!

Affordable Healthy Eating - Tomato Okra Sautee

Since doing health education modules with community members on hypertension, I've become especially interested in feasible, actionable ways of encouraging everyone to eat healthier. The DASH-sodium diet seems especially successful in helping people of African descent improve their blood pressure by encouraging increased fruit and vegetable consumption and decreasing salt.

Though I know healthy eating guidelines and recipes are available all over the internet, not many cater the the community with which I presently work -- low-income, African-American/Caribbean-American individuals. I hope to present some healthier/affordable options to the meals commonly eaten in this community which can be enjoyed by all!

Today's meal: Tomato Okra Sautee

• 2lbs okra diagonally sliced
• 1 tomato diced
• 1/8 of an onion
• pinch of sea salt
• pepper
• 1tbsp olive OR canola oil
• italian seasoning (or dried oregano)

To skillet on medium heat, add olive oil, let it heat for 1-2 mins, add onions and tomoto. Sautee for about 3 mins. Add okra. Add pinch of salt, black pepper, dried seasoning. Stir. Remove from heat 2 mins later (or longer if you prefer softer okra).

This is done in less than 10 mins! and can be served with brown rice.

I usually just eat it by itself, because it's sooo good!

This dish is about 3 of the recommended 4-5 servings of vegetables required daily.

Bon Appetit!

Healthy Eating Plate

I'm swooning over Harvard School of Public Health's direct challenge to USDA's MyPlate. I love...

• that it is annotated -- I mean, shouldn't that be obvious, USDA?

• that it stresses WHOLE grains and HEALTHY proteins.

• that the glass is filled with water and not dairy

• That it notes foods to avoid and limit

• That it includes staying active!

Great job HSPH! I think I'll be adopting this for my health education spiels instead. 

Photo credit: Harvard Health Publications. http://www.health.harvard.edu/blog/harvard-to-usda-check-out-the-healthy-eating-plate-201109143344

Twitter-thumb : Social media-induced DeQuervain's Syndrome

As I type, my extensor pollicis brevis tendon is screaming for mercy. I am forced to take several (unwanted) breaks to ease the uncomfortable mix of pain and weakness that is sometimes accompanied by the uncanny twitching of my thumb and fingers. I am suffering from a terrible case of twitter-thumb. Bilateral twitter-thumb.

The Hidden Power of Health Fairs

There is nothing like a good community health fair (HF). Away from the formal, detached sterility of the office this is an opportunity to meet patients on their turf. No longer adorned with white coat, power outfit and accompanying entourage, physician meets patient as just another member of the community, an equal almost. With a backdrop of blaring music, sweltering heat and flavorful eats people young and old gather, eager to commune in the name of health. Meeting in this context fosters rapprochement between patient and doctor. The once hierarchical encounter is no more. In this habitat, doctor and patient are in fellowship.

I enjoy health  fairs because they provide the perfect merger of public health and medicine. At one instant I am advising a patient on her individual health needs; in another instant I am addressing a group  on health topic salient to the community. At health fairs doctors, nurses, community organizers, nutritionists, peer educators, farmers, pastors, teachers work in tandem for the community's improved health. At these events I see my work as integrally woven into the fabric of the community's identity and goals and there are few things more powerful than the feeling of contributing to a much larger whole.

The (FM) Revolution Will be Tweeted!

If you're in medicine and on twitter and haven't come across the #FMRevolution hashtag, you must be, like the Geico commercial says, living under a rock. Since March 2011, Family Medicine has been taking the twitterverse by storm. What first started as the "Family Medicine T-shirt Revolution" at a California Family Medicine summit in 2010 has now turned into a fulfledged campaign to debunk misconceptions about the specialty, dispel misgivings about pursuing the field and to advocate for primary care as a cost-effective specialty with proven results in improving health outcomes . The revolution has been rallying physicians, residents and students nationwide to the cause.

...and mentorship

Harvard MSIV, Nate Favini, did an excellent commentary on Dr. Pauline Chen’s NY Times article entitiled, “The Hidden Cost of Medical Student Debt”. Mr. Favini aptly added lack of economic diversity and personal motivation as key elements that affect medstudents’ desire to pursue primary care, in addition to debt. Both articles made strong cases and I suggest we add another to the list of factors contributing to med student interest in primary care -- mentorship.

Memories

I recently rediscovered some of my clinical rotation musings. Enjoy...

||||4.7.10||||

Since my last writing I've moved from no longer wanting to be a surgeon to falling in love with pediatrics. I often wonder to what extent students' specialty decisions are influenced by their rotation experience. My pediatric experience was phenomenal. The most organized rotation I have seen yet. But more than the syllabus and organization of the rotation, were the people. For the first time, I saw myself in these attendings and residents. I saw qualities that are dear to me being reflected in these individuals -- advocacy, service, compassion. I saw an environment where residents and attendings shared mutual respect, not chilling fear or measured disdain. The atmosphere was one where I was always excited to be there, where I welcomed the challenge. Had I done my rotation elsewhere, would I have felt the same way about pediatrics?

Do As I Say, Not As I Do

I’ve heard patients say, “How could she smoke and she’s a doctor?” Alarmed and bewildered by the fact that an agent of health could partake in one of the most harmful acts of bodily destruction. In medical school, a sizable number of my classmates smoked and I always found it so counter-intuitive, mind-boggling that they would be learning about smoker’s lung in pathology and on class breaks would huddled outside the lecture hall sucking on their cancer sticks. These same colleagues would then be encouraged to exhort smoking cessation in our clinical skills session while we all sit, simulated patient included, in a room rife with the heaviness of second hand smoke. One would assume that there should be a direct correlation between knowledge on a topic and healthy decision-making but we know all too well that that is not the case. As Thomas Goetz states, fear of illness is not sustainable motivator for positive change in health behavior and that is true even if you’re a physician. It has certainly been true of me.

Yes! Take notes at the doctor's office.

As a recently minted physician, I am often on the receiving end of the gripes and grouses about the medical profession. Often I get complaints of office visits that are too short, doctors who seem too preoccupied to hear their patients' complaints, medical bills that are too high and medications that do nothing but cause adverse effects. On the other hand, I can't count the number of times I have left the exam room, convinced I have gotten the most complete and accurate information from the patient only to be confronted by the attending on something I had 'missed'. Really?!?!? I just asked her that and she denied having chest pain one week ago! The truth is, patients are often intimidated and confused by the whole medical experience and in this state are even more likely to forget the details of their medical history, thus creating a less than ideal environment for optimizing health.  Something needs to be done to improve the doctor's visit, both for patients and for physicians.

Blackened Tilapia dinner

Gotta Love The Babies

Me: Okay Jonathon, the virus caused you to vomit a lot and now you're dehydrated. We need to get your fluids back up to par, so we'll have to place you on an IV drip. You'll be brave and allow me to do it right?

10 year old: (bawling, tears running down face)Nooo!It's gonna hurt! Mommy, she's gonna stick me!

(After 5 mins of successfully consoling him)

Me: OK, you're brave, you're strong, it's just a little stick, then the pain goes away.

10 year old (no longer crying): OK, I'm ready

(First attempt: he flinches. Unsuccessful)

(Second attempt: he flinches again. Unsuccessful)

(On third attempt...)

10 year old: Are you new here? How come you can't get it in yet?

-----------------------------------------------

Seeing Jamaican patient and 4 year old son at Ob-Gyn clinic.

Me: Okay mom, we're going to have to draw some blood to check your blood sugar level.

Patient: Okay Doc

(I get supplies, begin advancing venipuncture needle)

Patient's son: No! Don't juk mih mommy!

Back in (somewhat) full force.

I started this because I wanted to write. I wanted to express myself. But like many other things. Procrastination/life got the better of me and I neglected to follow through on my promise to myself. So here I am again, attempting to get it started, trying my best to make the best of it. I've taken a month of to regroup, recuperate from the madness of the past several months. I am praying for a future of success and future of organization, peace, of financial prowess. Each day is indeed a blessing I give thanks for where I've come.

From object to subject

It is important to care. To stop, get out of one's own self-involved space and listen, look, experience the world as the patient does. Today some of our residents were berated for just that. For treating patients as routine. For filling out the checklists, doing the minimal required and not truly assessing the patient in her (I'm on OBGyn service) wholeness. It's something physicians get criticized for regularly, but it really takes going against the grain to do such. The way we report cases and approach an individual is indeed depersonalized and sterile. "Patient is 34 year old female complaining of .... G1P0, previous C-section...." I wish I could convey the tone in which it is presented too. Often times it seems that patient is object, rather than subject of the medical conversation. It has been some months since I've been in clinical rotations and I still find it hard to present. Perhaps it's because I have not mastered organizing the systematic process in my head but the fact that I find it hard to separate my inclination to have a connection with the patient from the depersonalized nature of presenting may also be a contributing factor.

Contact Me

Twitter: @drperipatetic

Disclaimer

Always get medical advice from *your* doctor. Thoughts expressed here are all my own and should not serve as a substitute for visiting your physician.

About Me

MD::MPH::Artist::Activist intrigued by stories of the medical experience, healthcare politics, meded, global health and art. Excited by social media's power to teach, engage and change. I ruminate on these topics in this blog.

Surgery

Today surgery began. The transition is bitter more than sweet. I remember dreaming of being a neurosurgeon when I was a child, writing about it in my personal statement for college. But now, it seems so far away. Medicine is a place where you find yourself. You spend a significant amount of time interacting with varying personalities, adjusting to new teams of people, new environments. You can never get too settled or too comfortable and so you're always forced to question, who you are, what you're about and to prove your worth, if not to anyone else, to yourself. And I find myself today, wishing I was still in internal medicine, wishing I had done more, taken more from the experience and dreading the famed personalities of the surgical house staff. Of course, waking up early is also not something I'm excited about, but that aside, I fear my laid back nature will be ruffled in the coming 12 weeks and I pray my soul can bear the struggle. I find myself, out of character and instead of being my usual optimistic self, I dread the coming weeks. I pray for blessings, peace and guidance in all my forthcoming doings.

The beginning

12 weeks have gone by and I should have been writing an article a day but that didn’t happen. What’s new? Time flies when you're having fun, they say, or time flies when you're tired, disorganized and scared. I'm pretty preoccupied with the future -- with deciding how what specialty fits into my life plan (or fits my emotional and egotistical desires that day) and when I should take step 2, step 3, which residencies to apply to, worrying about my visa status. Instead of just studying now. I have to admit, I enjoy planning my not so distant future and obsessing over it, but I also need to save some of that energy up for the situation that's right before me - rotations. It's week 11 of 12 for IM, my first rotation as an MSIII and fortunately, I'm not burnt out yet. I'm tired, but not burnt out (I think). I still enjoy meeting patients, hearing their stories, figuring out their problems and navigating the galaxy of differentials, diagnostics and treatments. But I'm really good at finding the joy in things and that sometimes can be a curse. It makes decision-making difficult because I'm unable to find subjective reasons that would help me rule out or rule in certain factors. I can only hope, that in the next year, I can be truly honest with myself, truly understand myself to know what I would be most fulfilled with in the future.

Expired

This week my patient died. She was 76 years old. Chinese lady. Brought in because of a UTI and found to be in respiratory distress. I met her, tubes down her throat, respirator injecting air into her lungs every 3 seconds, unconscious. Unaware of her present state - her inability to breathe on her own, her incontinence and the massive swelling all over her tiny body. She was oozing fluid as she was most likely protein deficient and had developed edema as a result. The fact that she was on normal saline did nothing to ease this either. She died at night. I wasn't there, but I can't help but wonder the cause of her death. Could it have been pulmonary edema? She was edematous in all other places, why not the lungs too? Coming to work the next day and hearing that she had expired left me somewhat dejected for the rest of the day. Of the four days she had been in the hospital, no family members had ever come to visit. She died alone, cold, swollen on a hospital bed. Who knew the fulfilling life she once lived?! I said a prayer. That in passing on, she be blessed.

In contrast, the next day, another patient passed. This Chinese lady was surrounded by family even before her passing. They took shifts so she was always in the company of a dear family member throughout the day. When we rounded, her granddaughter was there. She could not be more than 22 years old. She flew in from Europe to be at her ailing grandmother's bedside. The day she died, There were at least 15 people in that room, solemn and red-eyed. They had expected it and had made peace with what transpired. Even in this sad moment they chose to thank us, the medical staff, profusely for taking care of their grandmother, mother, sister. She died, not connected to a web of tubes and IV lines, but rather, on the last of her own natural breath.