Sunday, April 21, 2019

Travel to Taiwan

We just returned from my kids' first trip to Taiwan and they had quite a blast! It was both a cultural experience as well as a chance to visit some extended family that they have never met. Although all the kids are older now and flying should be easier, we were still a little worried about how it would be managing four kids on such a long flight. At the end of the day... not too bad...

Here are a couple of things that stood out to me about the travel itself...

In flight entertainment is key
personal screens for movies, tv shows, and even video games...




Japanese airline has brilliant cup holder...
I wonder why all airlines have not adopted this.

Look... hardly any room to put the drinks... and so slippery it's no wonder we had so many spills!

compare to this... it's brilliant!

and even when the tray is closed, there is a place to put the drink... again... brilliant!


Japan's airport has a very mamma friendly play area and right next to it was this... 
 
 a place to make baby bottles...  a private room to nurse or pump... and a baby changing area!

Bidets with heated seats are standard
you can control the temperature of the water wash as well as the temp of the seat!

More on the actual trip later... 

Sunday, March 31, 2019

O Happy Day!

Today is a significant day. My oldest daughter, who is eleven years old, got baptized today. Since, I grew up in a Presbyterian Church and was baptized as an infant, I decided to get baptized as an adult with her today.

I was very emotional. I didn't know I was going to be this moved... but I suppose my heart was very full and the mix of sentiments just overflowed.
This is what I shared... 

--

So I grew up going to church. Childhood memories include saying the believers prayer with a VBS worker and receiving my first Bible, probably around five or six years old. I also have memories of my mom reading Bible stories from The Big Bible for Little Eyes to my sister and I before bed and praying together. We used to pray in Taiwanese …and for a while I thought God only understood Taiwanese. For as long as I can remember, I accepted that God is real. I believed that He made the universe and that He sent his son, Jesus Christ, to die for our sins. My understanding was that if I believed that Jesus died for me then I would go to heaven after I die. My prayers then went something like this, “Dear God, please help me not get too nervous when I have to get up and speak in front of people and I promise I’ll be good.” They also went something like this, “Dear God, sorry I yelled at my sister and was mean, but good thing You know everything and You know that I didn’t really mean it and good thing You are so loving and kind and will forgive me.” It wasn’t until I went to college that I realized that I was cheapening His grace and taking it for granted. This visual stuck with me. I am like a little girl playing outside in the mud and before entering God’s gigantic clean wonderful mansion, Jesus is at the front door with a towel, wiping away my mud and dirt so I can enter into His Father’s house. At first, I am super grateful, but with time, I start taking it for granted and it is as if I’m just wiping my feet on Jesus, the doorway mat, before entering.

It was in college that I realized that believing in Jesus is not just “hell insurance” as Pastor Tom likes to call it… but if I truly love God I would naturally want to please Him and do His will. But how would I know what God’s will is unless I read His Word, the Holy Bible? When I was trying to share my faith with my dorm mate I remember I could not answer a lot of his theological questions, yet I would not waiver in my faith. He accused me of having blind faith. So I was motivated to really dig in and know the Bible. My faith solidified and really grew those four years in college. At the time, I was going to a very mission-minded church, our pastor was Hudson James Taylor the IV, his great great grandfather was the famous Hudson James Taylor, first missionary to China. At Urbana ’96, I remember being so convicted about the great need for missionaries overseas that I stood when they called for us to stand before God and others to commit to the calling. I knew I was going into medicine and I imagined that I’d be a physician living in a remote underserved area, helping folks physically and sharing God’s Good News.

Well, life does not always go the way one plans, even though I really thought my plan was God’s plan. So due to a number of circumstances that I do not have time to go into detail, here I am… a physician, trying to help folks physically and share God’s Good News, here in Bucks County, wife, and mom of 4 kids. Now to be honest, it has not been easy. In fact, I tell folks that motherhood is the hardest thing I’ve ever done my entire life!  It is harder than medical school and harder than residency. It is not just hard physically, but mentally, emotionally and spiritually as well. Motherhood shines a bright light on my own ugly sins that I always knew was there… but didn’t know to this extent! Impatience… irritability… selfishness... rage. Countless times, I'm battling thoughts in my head… and like Jesus in the desert, the only way to counter these negatives is with His Truth from His Word. Even when I don’t feel like believing in the truths, I have to choose to believe that what He says is Truth so it must be true.

So when I hear, “You are a no good sinner!” I have to remember Romans 8:1-2
“Therefore, there is now no condemnation for those who are in Christ Jesus, because through Christ Jesus the law of the Spirit who gives life has set you free from the law of sin and death.”

When I hear, “You will never change. You will always fall back to your same sins.”
I have to hold on to and believe Philippians 1:6 “Being confident of this, that He who began a good work in you will carry it on to completion until the day of Christ Jesus.”

When I hear,  “You will lose this battle. Give up!” I have to believe Romans 8:37-39 “No, in all these things we are more than conquerors through him who loved us. For I am convinced that neither death nor life, neither angels nor demons, neither the present nor the future, nor any powers, neither height nor depth, nor anything else in all creation, will be able to separate us from the love of God that is in Christ Jesus our Lord.”

Growing up in a Presbyterian Church I was baptized as an infant and before going off to college, confirmed as an adult. I stood in front of my home church congregation affirming my faith in Christ. When I got to college, and after that first year of tremendous growth I remember asking my pastor whether I should get baptized again and dunked. He said it was not necessary for salvation and it was up to me. I never did it because I didn’t think it was necessary. I figured I already went in front of a church congregation, so technically already testified. But something Pastor Tom said once in a sermon struck me. He said to get baptized because Jesus got baptized. I decided ok, this is something I want to do. Since salvation didn’t depend on it, I thought it would be more special and memorable if I did this together with one of our kids, whoever gets baptized first. So I’m very pleased to be doing this today with Sierra, my oldest.

You know, as I was preparing for this, I thought about all the different mental warfare I’ve had over these years… there are many, you heard some of them. One struggle that occasionally comes up has to do with the Parable of the Sower. Some seeds get snatched by a bird or choked by thorns or fall on rocks and have no root. How do I know that I’m the seed that falls on good soil? Boy, when that condemning voice gets loud, I can almost be convinced that I must not be good soil and therefore doubt my calling to missions... doubt my calling be counted in God’s family. I realize that on this symbolic day, this act of going under water and up again... from here on forward I can think back to this day and have a concrete physical reminder of God’s Truth... that I have made this decision to follow Jesus and I am forever His sheep.

Jesus says in John 10:27-29 “My sheep listen to my voice; I know them, and they follow me.  I give them eternal life, and they shall never perish; no one will snatch them out of my hand. My Father, who has given them to me, is greater than all; no one can snatch them out of my Father’s hand.”

So I’m reminded to persevere.  Philippians 3:12-14 “Not that I have already obtained all this, or have already arrived at my goal, but I press on to take hold of that for which Christ Jesus took hold of me. Brothers and sisters, I do not consider myself yet to have taken hold of it. But one thing I do: Forgetting what is behind and straining toward what is ahead, I press on toward the goal to win the prize for which God has called me heavenward in Christ Jesus.”

And what about when I thought I was called to be a missionary somewhere remote?  Well… we’ll see… life isn't over yet. At the end of my life I want to be able to say like Paul in 2 Timothy 4:7-8 "I have fought the good fight, I have finished the race, I have kept the faith. Now there is in store for me the crown of righteousness, which the Lord, the righteous Judge, will award to me on that day—and not only to me, but also to all who have longed for his appearing."

Wednesday, March 13, 2019

Time Flies

My oldest had her last elementary sweetheart dance last Friday. This is probably the last dance she will attend where her daddy is her date...



Where did the time go?

So my youngest is in his last year of preschool. Boy, I was just thinking the other day that all the teachers probably can tell that he is my fourth and not my first . I am completely lost and so not on top of all things preschool related... it is embarrassing.

Good thing he is so on top of most things... "Mom - it's pajama day!"  "Mom - don't forget money for the eye screen!"

So we are in such a different phase of life with elementary school stuff... PTO events... school plays... district orchestra / band / choir etc. It is a fun stage and I wish I can just stop time for a bit. I'm not sure I'm ready for middle school yet.



This is a picture of my three older kids visiting me in the hospital when the youngest was born...



Tuesday, February 12, 2019

Dietary Supplements

So this is what I've been telling my patients who are on no prescription medications but a box full of "natural supplements"... there is really no one ensuring the quality of what is in those medicines... despite it being from a "reputable company"... and they usually cost quite a bit.  So I hope the FDA really does step up and start to oversee... 

Just saying... be careful... and my advice is always to have a conversation with your physician about whether or not anything you are taking is causing any harm...

This is from my AMA Morning Rounds newsletter: (American Medical Association)

 ===

FDA to increase oversight of dietary supplements

The Washington Post (2/11, McGinley) reports the Food and Drug Administration announced that it plans to increase oversight of the dietary supplements industry due to increased risks to customers, including “unlisted drug ingredients, and false and misleading claims about health benefits.” The FDA “underscored the need for greater oversight by announcing it had sent 12 warning letters and five advisory letters earlier this month to companies the FDA said are selling dozens of products that contain unapproved drugs or make illegal claims for treating Alzheimer’s and other serious diseases.”
The New York Times (2/11, B6, Kaplan) reports FDA Commissioner Scott Gottlieb, M.D., “suggested that Congress strengthen the FDA’s authority over” the supplements “industry, which sells as many as 80,000 kinds of powders and pills with little federal scrutiny.”

Friday, February 1, 2019

Hematomas

Hope your year is going smoother than mine so far! I've told this story numerous times now to different folks but I figured I'd also record it here... 

So I have spent the first month of 2019 basically recovering from a blow both physically and mentally. All because I was too cocky and did not listen to the sage advice of my nine year old. Picture this...

We were having one of those unusually warmer days during Winter Break, so we were outside. My second child was rollerblading. I thought I'd join her but soon got bored blading around the driveway. I figured I'd go around the neighborhood and get some real exercise.

"Don't go that way, mom!  It's really steep!" Having taken a spill on her bike heading that way before, my daughter warned me with concern in her eyes when she saw me going down towards our neighbors.

"Oh, don't worry. I know how to rollerblade!" I called out to her with a wave of my hand. So off I went and as I rolled past her, I gave her the thumbs up smiling from ear to ear. The next thing I knew, I was flying at lightning speed and before I could think I found myself slammed to the ground skidding down the sidewalk on my right hip and thigh.

Um. Ouch.

But I started to laugh because I realized how ridiculous I must have looked and how right my little girl was. I could not stop laughing but I also could not get up.

"Get daddy!" I shouted at my daughter. My husband who was doing who knows what around the garage finally sees me sitting on the ground halfway between our house and our neighbor's house.

"Take off your skates and walk back," he instructed me.

"Uh... I would if I could!" I hollered back.  Why would I be calling for him if I could do that? So he heads over.

"Why didn't you listen to Ashley?"

"I know... she was right... she was right..." I moaned and we both could not stop laughing. It must have been a sight because I really could not walk at the moment. My husband grabbed one of our kid's scooters and he was attempting to push me back up the hill while I balanced on it. Well it didn't work and I ended up half hobbling and half hopping on one foot to make it back into the house... I was in excruciating pain.

"Hey doesn't this remind you of that time you couldn't walk after jumping that wave?"  Where is the sympathy? Okay... maybe I deserve this one...

So you think I'd put some ice on my leg and lay low for a while. Nope. I think I was in denial. I was like "Hey Ashley, forget rollerblading but let's play some field hockey."

"I'm not sure that's such a good idea, " says my husband. Of course I did not listen to him.

"Oh, it'll only be for a few minutes. I'm fine."

Well... I was not fine because later that night I realized that I had developed a HUGE hematoma... and even now a whole month out, I'm still recovering!

What is a hematoma?

It is a collection of clotted blood within the tissues as a result of broken vessels.

What causes a hematoma?

If it appears on your leg, it is usually as a result of a fall or or a blow to the leg with a blunt object.

What are the symptoms of a hematoma?
  • pain
  • swelling
  • discoloration from the blood pooling under your skin

How do you treat a hematoma?
  • cold compress or ice pack for 20-30min following the injury to reduce swelling
  • rest
  • elevating the leg
  • light compression with a wrapped bandage
  • tylenol for pain
  • heat for 10min three times a day to help increase blood flow
When do you expect to recover from a hematoma?
Most hematomas improve on their own. However, if it is a large collection it can take months for the blood to fully absorb. Occasionally, further intervention such as draining or surgery is required. So if your hematoma does not heal in a couple of days, you should see your doctor to get further evaluated.

==
Doctors make the worse patients. I didn't do anything I was supposed to after my injury. Now in retrospect, I think I went through the five stages of grief. I was in total denial when it first happened. Then I was angry because I didn't heal immediately and I could not exercise as I had wanted when the new year started. That then sank me into depression when I realized that I am no longer in my twenties when I could fall and still get up and keep playing as if nothing had happened. There was a Saturday this month where I despondently sobbed the entire day with this truth sinking in. Finally, I think maybe I am now accepting the reality of my age and limitations. Oops... I skipped bargaining...  Oh well... my leg hematoma was the physical blow but this acknowledgement was the mental blow. 

All good... this has now given me renewed motivation to be more intentional in eating right, sleeping, and exercising. Here's to a trauma free 2019!



Friday, December 14, 2018

Blood Pressure Medicine Recalls

I have been meaning to write a quick summary of all the recent blood pressure medicine recalls. Especially with all the worried calls we've been getting in our office, I want to offer some reassurance and guidance.

Since late summer, there has been a lot of media about certain blood pressure medicines being recalled because they contain an impurity N-nitrosodimethylamine (NDMA) . 

The first FDA recall for this issue was around July 2018... but since then the list has been expanding with the most recent recall made on December 4, 2018. Here is a summary of the blood pressure medicines that are affected so far. This list is taken from FDA website:

12/04/2018Mylan  Valsartan-containing products  Detection of Trace Amounts of NDEA (N-Nitrosodiethylamine) Impurity Found in the Active Pharmaceutical IngredientMylan Pharmaceuticals
11/27/2018Teva Pharmaceuticals Amlodipine/Valsartan Combination Tables and Amlopidine/Valsartan/Hydrochlorothiazide Combination Tablets  Impurity N-nitroso-diethylamine (NDEA) in APITeva Pharmaceuticals
11/20/2018Mylan  Amlodipine and Valsartan Tablets; Valsartan Tablets; Valsartan and Hydrochlorothiazide Tablets  Contain trace amounts of an impurity, N-nitrosodiethylamine (NDEA)Mylan Pharmaceuticals
11/08/2018Losartan  Losartan Potassium Hydrochlorothiazide  Product contains NDEA impuritySandoz Inc
10/30/2018WP Westminster, more  Irbesartan Tablets, USP 75 mg, 150 mg, and 300 mg dosage forms  due to the presence of an impurity, N-nitrosodiethylamine (NDEA)ScieGen Pharmaceuticals, Inc
10/26/2018Aurobindo Pharma Limited  Irbesartan Drug  Due to the presence of an impurity, N-nitrosodiethylamine (NDEA)Aurobindo Pharma Limited
08/23/2018Torrent Pharmaceuticals Limited  Valsartan/Amlodipine/HCTZ; Valsartan/Amlodipine; and Valsartan tablets  Impurity detected in the API is N-nitrosodimethylamine (NDMA)Torrent Pharmaceuticals Limited
08/17/2018Torrent  Valsartan/Amlodipine/HCTZ Tablets  Impurity detected in the API is N-nitrosodimethylamine (NDMA)Torrent Pharmaceuticals
08/08/2018Camber Pharmaceuticals, Inc.  Valsartan Tablets, USP, 40mg, 80mg, 160mg and 320mg  Detection of trace amounts of N-Nitrosodimethylamine (NDMA)Camber Pharmaceuticals, Inc.
07/17/2018Actavis  Valsartan and Valsartan Hydrochlorothiazide Tablets  Impurity detected in the API is Nnitrosodimethylamine (NDMA)Teva Pharmaceuticals USA
07/17/2018Prinston Pharmaceutical Inc. dba Solco Healthcare LLC  Valsartan Tablets, 40 mg, 80mg, 160mg, and 320mg; and Valsartan-Hydrochlorothiazide Tablets, 80mg/12.5mg, 160mg/12.5mg, 160mg/25mg, 320mg/12.5mg, and 320mg/25mg  Detection of a Trace Amount of Unexpected Impurity, N- nitrosodimethylamine (NDMA)Prinston Pharmaceutical Inc. dba Solco Healthcare LLC
07/13/2018Major Pharmaceuticals Valsartan tablets, 80mg USP and 160 mg USP  may contain the probable carcinogen Nnitrosodimethylamine (NDMA)Major Pharmaceuticals
So what to do?

If your medication is on the recall list, you should have been contacted by your pharmacy. If you are not sure you can always call your pharmacy to find out.

The label on your medication bottle should tell you which company manufactured that medicine.

If your medicine is affected, speak with your physician for an alternative. This requires careful consultation because the type and dosage of medicine you can be switched to depends on your medical history and current health.

Also to note... the medicines on this list are all generics made by different manufacturing companies. So far there has been no recall on the actual brand name product.

Valsartan = generic for Diovan  (made by Novartis)
Losartan = generic for Cozaar (made by Merck)
Irbesartan = generic for Avapro (made by Sanofi)
Amlodipine = generic for Norvasc (made by Pfizer)

Brand name medicines cost a lot more than generics. However, with commercial insurance sometimes the company will offer coupons where the co-pay is lowered. Unfortunately, the coupons do not work with medicare patients. Again, consult with your physician about what is best for you.

Hope this helps!
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