Sunday, November 18, 2018

Update on Probiotics

Winter came early this year! Here's a picture of my car as I was leaving work the other day... I was not prepared for the sudden storm!

So with the cold season comes an upsurge of sniffles, cough... sickness ranging from sinus infections, bronchitis, pneumonia to the flu. As antibiotics get prescribed, many take probiotics in hopes of warding off side effects such as diarrhea or yeast infections. While there is some evidence of promise that probiotics would help, one should consider carefully whether or not the benefit outweighs potential harm.

Here are a few things to consider and an update on this topic since my previous post in 2012.

First of all, what are probiotics?
- foods or supplements that contain live bacteria and yeast that are considered "good" bacteria and can alter the bacteria in the gut

How do probiotics work?
- your gut is full of bacteria but when "good" bacteria gets wiped out, for example during a course of antibiotics, this can cause GI issues like diarrhea
- the idea is probiotics replace these "good" bacteria to help restore gut function to normal or to prevent the imbalance in the first place

When are probiotics being used?
some common uses include the following:
- during antibiotic use to prevent diarrhea or yeast infections
- during late pregnancy and baby's first six months to prevent allergies / eczema
- in low birth weight infants to prevent NEC (necrotizing enterocolitis)
- in patients with diarrhea caused by viruses
- in patients with IBD (irritable bowel disease) to lessen symptoms
- in patients with IBS (irritable bowel syndrome)
- in patients trying to lose weight
- in patients with depression and/or anxiety

Does it really work?
- promising evidence that it can benefit antibiotic induced diarrhea in healthy persons
- not enough data to show prevention of allergies or NEC
- bottom line is more research needs to be done in all areas

What are the potential risks and down sides?
-  since there is no FDA regulating the over counter products, the amount of bacteria and type of bacteria in the different products can vary so much and may not match what the label is claiming
-  even if the labels match the content of the bottle, the different types of probiotics vary widely and how they may help certain conditions also vary widely so it is difficult to determine which would benefit someone in which situation
-  there is even question whether your stomach acid would make the probiotic ineffective by the time it reaches your gut, so it may not be effective at all
-  there is risk for an immunocompromised individual to become very sick from the active bacteria being introduced

So bottom line is there is not enough research and data studying all the different risks and potential side effects of taking these supplements. Best to discuss with your health care provider whether or not you would benefit and to proceed with caution.

Wednesday, October 3, 2018

Flu Shots Time

It's that time of year again to get your flu shots!

I read this on American Medical Association newsletter and thought I'd share...

---

Leading the News

U.S. saw most flu deaths in over a decade last winter

The New York Times (10/1, McNeil) reports that “more than 80,000 Americans died of the flu in the winter of 2017-2018, the highest number in over a decade, federal health officials said last week.” Although 90 percent of those deaths were in people over age 65, “the flu also killed 180 young children and teenagers, more than in any other year since the Centers for Disease Control and Prevention began using its current surveillance methods.”
The Cleveland Plain Dealer (10/1, Washinigton) mentions that last season’s flu vaccine “was about 40 percent effective, said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health,” adding that “there’s no way to predict if the upcoming flu season, which runs October through spring, will be better or worse, experts say.” The article says researchers are developing a universal flu shot in tandem with a seasonal vaccine, and “there’s also a new, fast-acting drug that appears to shorten the duration of flu symptoms” and is under FDA review with a decision expected soon.  

Monday, August 27, 2018

Beaches at the Turks vs Disney

So I am a fan of Disney... its magic works on me. Been to both World and Land... and probably will go back after they complete Star Wars Land and that super cool Star Wars hotel... BUT... this past week I was reminded why we rebooked our vacation at the Beaches in Turks two years ago when we went for the first time... and rebooked again during this trip for 2020...

Here is my comparison between these two very different types of vacations... both which I love... but also comparing these two in particular because they cost about the same for our family... as opposed to national park vacations or camping trips which we also love! So.. for the $$... here are the differences between the two...

The Planning...

For a Disney vacation, I start planning on an excel spreadsheet as far as 12 months ahead. I know I am a little crazy.

I research and plan out all the dining first because some restaurants are super hard to book. For example, the last time we went, I wanted to book a dinner at Be Our Guest and although I tried exactly 180 days prior to arrival, I couldn't because it was full! I had to book a lunch instead. How can the restaurant fill up so fast on the very day we're allowed to book? Apparently, I didn't realize there is this 180 + 10 days rule for folks staying at a Disney Resort. So folks who checked in a whole week before our first check in date is booking reservations on days that we overlap. How complicated is that? Basically, I'll have to set a notification for 180 days before arrival and try to book towards the end of my stay to increase chances. 

Now the other tricky part in planning out the time is trying to match up the fast pass rides with restaurants that are in certain parks on the same day. With four kids, I like to save on not using park hopper tickets if I can help it. Boy, I'm tired just thinking about it all but since I am a planner, I actually find it fun to strategize. It is all part of the vacation experience!

With that said... there is something truly refreshing about going to the Turks with little to no planning at all. Since I am a planner, I did make a smaller excel file where I listed out all the restaurants and tried to arrange it so that we could hit as many of the 22 dining options on site as possible. That's right... 22 restaurants that are delicious and all included! Reason for the planning is because some of the restaurants are only open for dinner and I was trying not to overlap. But now that we have tried just about all of them, next time we could skip some and just pick our favorites to go back to multiple times. Out of all 22 restaurants, only Kimonos requires a dinner reservation. It serves Japanese cuisine where the chefs not only cook in front of you but entertain with Carribbean style singing too!


Since there is no need to sign up 6 months ahead for dining and 2 months ahead for fast passes etc... we basically just showed up on day one and made our reservations for the entire week that day. In fact, since we have four kids, we were limited to housing in the Itialian Village which is all concierge. So perhaps we had it even easier because our concierge basically made our dinner reservation, snorkel trip, and glass bottom boat trip reservations for us at check-in.

The Kids Camp...

Okay, so it is a family vacation and the point is to spend quality family time together... but it is nice to have the option for the kids to get dropped off at Kids Camp if we choose to. It is not for everyone and we do not leave our kids there the entire day every single day... but it really was a treat to have two hours here or there so my husband and I can dine or kayak together. 

My kids actually all enjoyed the camp. My oldest is very social and she likes to meet and make new friends. Our second was in her same group so at the very least they always had each other. My older son seemed to enjoy it too. Look... they had a xbox room, water slides, and a place where they could get unlimited ice cream and cotton candy. They even organize boat trips, snorkeling trips, beach and pool games etc. if you choose to participate. My youngest complained at drop off but at pick up always had something exciting to share... a snake tattoo on his arm, stories with Elmo, cooking with Cookie Monster, riding the choo choo train to a kids dance party etc. 


I know... *shake head* playing video games when there is a beautiful Carribean beach outside... not my idea of time well spent...
 
We dropped the kids at camp for dinner two of the nights in our week stay. They combine the groups for dinner so our kids got to see each other. Then they always had a fun activity like S'mores by a camp fire or a pajama dance party. My older two got to stay up later to watch two of the night shows. I went to watch it with them and was pretty impressed with the entertainment. First show we saw was Jungle Book Live and the second was Alice in Wonderland. They had very catchy songs and dance so my daughters left the show singing the songs all night. I couldn't get the tunes out of my head either!


At Disney, unless we pay extra or bring along a babysitter or grandparents... (which we didn't do the last visit) my memory of that trip was 24/7 nonstop interaction with my four kids... every... single... day... for the entire week! I love my kids but 24/7 every single day for an entire week can be a little draining. There were some long hot days of standing in line for rides, character photos, or trying to get to the next fast pass or to our dining reservation on time. 

Contrast that to sipping unlimited frozen drinks by the pool or on the beach and just laying around. Even if our kids were not in Kids Camp, they were swimming in the pool or playing in the sand and I was actually relaxing! To be fair, my kids are older now and maybe it would not be so relaxing if our youngest was still an infant or a toddler... but my recollection of this past week was a whole lot of relaxation!


The Dining...

Both Disney and Beaches have excellent dining options. 



There could be a whole other post just on food alone... but in a nutshell... I felt like we had more flexibility at Beaches. Since you don't have to make reservations except for Kimonos, we were able to change our mind and switch restaurants or go at a later time than planned if the day was going in an unexpected way.  But of course I made my Disney schedule such so that it was so inflexible. That was my fault and you don't have to do it that way. I just chose to because I wanted to hit certain restaurants and it would have been very difficult to eat at those restaurants if I didn't plan the way I did. So for my experience... dining at Beaches was much more laid back.

In fact, dining at Beaches is very much like dining on a cruise ship. It is all-you-can-eat and all included! Except instead of just 4-5 restaurants on board a ship, you have 22 to choose from. You can eat two dinners if you have the room and go back for unlimited ice cream or cotton candy at Bobby Dee's until 11p.

Unlike a cruise ship or Disney, Beaches also offers unlimited drinks and frozen drinks which are all included... for adults and for kids...


The Activities...

At Disney, it is all about the rides and the characters...

 

At Beaches, it is all about the pool, the water park, the water sports...



...and of course the beach! Turks has one of the best beaches I have ever been to. I think my favorite is still Horseshoe Beach in Bermuda...
Turks is a close second. I love the super soft and white sand. No small rocks or shells to hurt the feet or bunches of seaweed to tangle the ankles, and the water is crystal clear!

I just reread my post from two years ago after we went to Beaches for the first time. I think my kids got more out of the experience this time around because all four can now swim pretty well and participate in many more of the water sports. 


So that's the thing... we booked this year's trip back then because they offer a pretty decent discount on top of whatever discount is online... still pricey but the memories made are priceless... and now that we've tasted this sweetness... we're kinda hooked!   

Thursday, July 19, 2018

Tandigm Health Scholar

"What year are you?" I was asked last night as I was checking in for a scholars recognition dinner. I stared back in confusion for a few seconds. What year am I? Are they referring to residency year '07... med school year '04.... college '97... ?? I haven't been asked what year am I in a long time! Oh!  They are actually referring to the fact that I'm a new 2018 Tandigm Scholar. I have a year associated with myself again!

So what is a Tandigm Scholar? My boss had been encouraging me to apply for this since he found out about it. "Do you still have medical school debt?" he asked me. Do I ever! I'm on a 30 year repayment program... even if I do get this scholarship, it will only make a dent.

As they put it on their website, Tandigm Health aspires to "enhance primary care physicians to provide the finest possible care to patients". Physician led and clinically focused, their mission is to create a new paradigm of healthcare quality and value for patients. As part of this endeavor, they created a Tandigm Scholars Program to offer financial assistance for primary care physicians with significant educational debt. According to projection reports, our country is facing a serious shortfall of primary care physicians. Tandigm Scholars Program intends to encourage medical students to enter this high demand field and help them succeed by easing the burden of school loans. It also provides tools and data for primary care doctors to better serve their patients and to recruit and retain top-tier physicians. The aim is to bring primary care back to the center of healthcare delivery.

I tell my Penn medical students all the time how our field is in dire need of quality, passionate, and competent new doctors. So few graduating medical students are choosing primary care. I think back to my fourth year in medical school when I voiced my desire to enter primary care and was actually discouraged to do so. Why? I love what I do and would not change my decision if I had to do it all over again. What other field provides such breadth of experience and yet personal and deep interactions. Constantly being challenged and stimulated, my mind revels in the problem solving aspect of the job. At the same time, my heart basks in the rewarding relationships built over time, the meaningful connections. From advising new mothers on nursing their newborns to providing palliative care to grandparents, I am stretched. From cutting out moles, freezing off warts, suturing up cuts, or injecting joints, there is never a dull moment. I truly enjoy my work.

Now the program allows the scholars to work with mentoring physicians to perform a project aiming to research an area in healthcare where improvements made could increase efficiency and boost quality care to patients. Last night, we listened to the previous year's recipients explain their findings. It was both intriguing and inspiring. I had a hard time falling asleep because of all the ideas and thoughts swirling in my head. To be honest, up to this point I was starting to feel bogged down by logistics and demands... just the day to day paperwork... ins and outs.. dots and checks... But this program is forcing me to step out of my zone and examine everything in new light. I have renewed motivation to ponder... to ask questions... to seek answers.

When I was applying, my husband asked if I really wanted to add more to my plate that already seems so full. Yes.. my plate is full. It is filled with wiping spilled milk, resolving disputes, kissing scraped knees, hugging little bodies... driving to piano lessons, driving to sport games... answering questions, answering phone calls... scheduling... planning... being a wife, being a mom, being a daughter, a sister, a friend, a doctor... It is full. I cannot deny it. And yet... my personality is such that it thrives on full.

I've been telling folks that I feel like I'm coming out of a mom cloud. My body stretched in pregnancy and then tied to nursing every 3 hours for years and years is finally free to be just mine again. My mind affected by countless nights of interrupted sleep resulting in fragmented thoughts is finally able to string together coherent ideas. So being a Tandigm Scholar is exciting to me. Not only do I see it's value and potential to help my personal patients in my clinic but also in the greater scheme of healthcare.

I don't know... maybe I do tend to take on much and underestimate the time and energy things require. However, I am a big picture person. That is why I have four kids... because although it's a little crazy now, down the road I see the fun, the blessing, the joys. So although it may be adding to my plate, I am honored to be a Tandigm Scholar and thankful for the renewed passion it is giving me. I'm reminded of why I chose to become a doctor in the first place. My desire to help, to transform, to make a difference is reawakened. So here we go!

Thursday, July 12, 2018

101 on Calf Strains

So I've been thinking about writing this post for some time now but I finally am throwing it together.

In May, my husband and I took a trip to the Dominican Republic for some rest and relaxation away from our four kids. We were celebrating our 16 years of marriage. 

Well, you know you are getting old when you pull a calf muscle on the last day of the trip requiring wheelchair service at the airport! It was not only the severity of the injury that threw me into disbelief but how I acquired the injury. I wish I could say that I was climbing to the peak of some mountain or playing an extreme water sport... but no... I merely jumped a wave at the beach and landed wrong.

Now, I've pulled muscles before. It would hurt and I might have to limp and put less pressure on the affected limb. However, this injury caused such sharp, unrelenting and debilitating pain that froze me on the spot. It took a whole lot of effort to maintain balance and not topple over from all the crashing waves indifferent to my mishap. I could barely move without excruciating pain and yet I needed to make my way back to our umbrella and lounge chair so I could nurse my wound.

There really was no one near me in the water, but a whole bunch of folks laying out on the beach. It must have been high tide or something because the waves were massive. Pride and embarassment prevented me from calling out right away to my husband. I really did not want to draw attention to myself.  Who pulls a muscle on a beach while jumping waves? I peered at his figure in the distance... watching him get his lounge chair ready for a nap. I was sending telepathic messages to his brain... "Come on... look over here... I need you to come over! Don't make me call out!" So now... aren't couples supposed to be so connected that they can communicate without actual words? Well, not in our case. After staring and willing him to come over for what seems like an eternity... and even frantically waving my hands like a mad person... I gave up. I had no choice. I would be stuck out there forever if I didn't call out. Sigh. So I did... reluctantly... but even after he finally looked my way, it took another eternity for him to figure out that I needed him to come out where I was... in the middle of all the waves. Well, I wasn't going to yell out across the sand for all to hear that I was stuck and couldn't move and needed help to get back to our chair. Oh I'm mortified just recalling how ridiculous that whole scene must have looked!

Finally, back in our chair... I then had to doctor myself. Flagged one of the attendants to bring me ice, found pillows for leg elevation, then sent husband to buy an ace bandage for compression and ibuprofen for pain. It was so not fun being the patient and so inconvenient to not be able to bear weight on that leg. We found a random bamboo stick for me to use as a crutch and I had to hobble to dinner and hobble back. It was even difficult to pack that night because shooting pain would freeze me every time I flexed my foot. Even now I have a hard time believing how seriously I injured my leg.
So there are basically 3 grades to a muscle strain:

Grade 1
  • torn muscle affects only a few of the muscle fibers, maybe 10%
  • mild pain and can also get a cramp
  • symptoms last few days to few weeks

Grade 2
  • more fibers are damaged but muscle is intact
  • moderate sharp pain at time of injury
  • may have resultant swelling and bruising
  • will limp due to pain and weakness
  • symptoms lasts 4-6 weeks
Grade 3
  • complete rupture of the muscle
  • pain severe and immediate
  • unable to walk on affected leg
  • considerable bruising and swelling
  • may have bulge in the calf above ruptured muscle
Treatments include...
  1. Rest
  2. Ice
  3. Compression
  4. Elevation
  5. Medication (like ibuprofen/advil/motrin)
  6. Crutches
  7. Heal Pad
  8. Exercises
  9. Sports Massage (by trained professional stretching and preventing scar tissue
  10. Ultrasound (usually by physical therapist to help blood flow)
I was not sure if I had sustained a Grade 2 or Grade 3 strain at the time. Now that I've fully recovered, I believe it was only a Grade 2. But really... I still can't get over that it was merely from jumping a wave!

So I've instructed many patients before about this but I suppose I need to listen to my own advice... the older one gets the more time one needs to warm up and stretch. For sports, yes... but to go to the beach?? See-rious-ly... it is no fun getting old...

Tuesday, May 8, 2018

Tribute to Teachers

This week is Teacher Appreciation Week and today was Teacher Appreciation Day. The kids at our elementary school are doing little things every day this week to show the teachers how much we appreciate them.




Driving around and listening to all the inspiring teacher stories on K-Love motivated me to add my little tribute.

When I think back to my school years... many teachers stand out in my mind. I really could fill pages if I were to sit here and list all the various ways particular teachers have touched my life.

Well, here is just a small small glimpse...  few gems of memory that stick out and make me smile...

Mrs Merrill - 5th Grade Teacher at Dutch Neck
-  read to us after lunch... just loved it!
-  gave out jolly ranchers for reciting the Gettysburg Address by memory
-  taught us all the bones of the body from cranium to phalanges using rhyme and rhythm
-  taught us geometry facts with song and rhythm as well... 
"the area of a tri-an-gle is... the base times the height... divided by 2"

Mrs Long - 6th Grade Teacher at Dutch Neck
-  showed us Ben Hur in class as well as a bunch of other movies... but I particularly remember Ben Hur
-  had a hamster pet in class and we took turns taking him home

Mr Enz - Elementary School String Teacher
-  he pretty much taught me how to play the violin

Mr Glass - Elementary School PE Teacher and Freshmen Field Hockey Coach
-  PE was my favorite class. I had so much fun! Loved all the sports and games... and I loved the Presidential Fitness Challenges
-  He recruited me and my good friend, Kathleen, to play on his freshmen team in high school
-  He always ran with us.. the long runs, the suicides, diagonals, and sprints at the end of practice!
-  Whenever it rained and folks started to complain... he'd say "Hey, skin is waterproof!  I shower, don't you?"

High School French Teacher - wow, I can't remember his name... but I still remember what he looks like!
-  taught us a song to remember the verbs that conjugate with etre
-  funny, funny teacher... made learning French fun

Dr Chen - 11th Grade Physics Teacher
-  motivated us by writing our names on the board if we get over 90% and another section if we get 100% (LOL prob not a motivator for everyone but it worked for me)
-   she used these two silly character names to illustrate physics word problems and though I can't remember the names I still remember the problems!

Mrs Mauro - High School Orchestra Teacher
-  let us hang out at her office before school, during lunch, after school...
-  let us hang out at her house after prom!
-  took us on an orchestra trip to DC
-  witnessed me hit my R eye with a music stand and sent me to the nurse, then to the ER to get 5-6 stitches
-  was also my homeroom teacher another time when I got hit with a field hockey ball in the R eye. I had the eye covered with a patch but she made me show her... then sent me to the nurse, who sent me to the ER... again!

Mrs Hussong (knew her as Ms Jung originally) - PE Teacher as well as Field Hockey and Girls La Crosse Coach
-  inspired me to give it all, never give up, and fight to win
-  4 memorable seasons of high school field hockey which became such a love and important part of my life...
-  would never have played girls la crosse if it weren't for her!

Oh.. I'm sure I'll think of more if I were to keep going...

Now, I send my kids to elementary school and I know they have wonderful teachers pouring out to them. I'm so grateful for all the teachers out there showering the kids with love, inspiring them... giving them hope and a future.

Thank you, teachers!!!


Friday, May 4, 2018

May the Fourth


May the fourth be with you!

Figured today would be a good day to post this blog that I had written a while ago after we came back from our Star Wars Cruise.



I wanted to list all the reasons why we loved our Disney Cruise Star Wars at Sea experience… but really it came down to the simple fact that we are Star Wars fans.

in case you can't tell, that's a view of the death star from our porthole virtual window

Highlights from our Star Wars Day at Sea…  

·      Watched all the Episodes from I-VIII of course…

·      Darth Vader and Storm Troopers paroling the boat…. throughout the day instead of the captain announcing usual cruise information, we may hear an Imperial guard letting us know that they have taken over command of our ship

·      Our kids received jedi training as padawans and then lightsaber dueled with Kylo Ren and Darth Vader…  


·      Joe acted out his dream of wearing a mask and role playing Vader with a bunch of kids in the ship’s atrium as cruise employees directed scenes from Episodes IV V and VI…

·      Interactions with all the classic characters… C3PO, R2D2, Chewbaca…

·      Entertained by all the other crazy fans on board the ship and marveling at how fanatic some are… my favorite costume was seeing someone dress up like Jabba the Hut…

·      Star Wars themed stage shows and fireworks at the end of the night…


Now, I’ve been blaming my husband for getting our four kids so into Star Wars. My husband is a fan. I mean, there are those who like Star Wars… I like Star Wars… but then there are true fans. I will not bore you with the details and the list of Star Wars toys from models to legos to whatever 3D puzzles that he has from way back when…  but I will highlight that he has made an actual light saber. I believe it is Luke’s saber from Episode IV.  All the materials used to make this saber were the materials used for the prop in the movie.  I thought this was “most impressive” since this was made back in the days before google was widely popular. Somehow he got all the parts through ebay or something to put it together. It always makes me smile when visiting friends would admire it and ask him to turn it on. It doesn’t turn on. It’s a prop. But if you want one that turns on we got like 20!  In fact, the groomsmen and bridesmaids in our wedding party each pulled out a lightsaber during our wedding reception as a surprise to us and had a little duel in front of our guests. We were introduced as husband and wife for the first time walking out to the Star Wars theme music... of course.  Our bridesmaids each slayed our groomsmen after a grueling fight… and then we had our first dance.
So our kids like Star Wars. They quote quotes and know all these random facts from the movies.  Sometimes I hear my youngest walking around humming the Kylo Ren theme song as if it is his entrance background music… (he was Kylo Ren for Halloween this year... but still… little weird)



When my third child is having a melt down, we now start asking him Star Wars trivia questions as a tactic to distract him and reset him. He and I are working on using the force to move garbage cans and using the mind trick on folks to make them do what we want… (this skill is not yet mastered)

Our girls are not as into Star Wars as the boys… but they know more trivia facts than I do about all the movies.  We have watched all 8 episodes (multiple times) as well as the spin off movie, Rogue One… and now we are eagerly waiting for Solo to come out later this month…

But confession… I actually didn’t realize just HOW huge a fan I am until it dawned on me that I was getting just as excited as the kids. I actually get goosebumps during that beginning Star Wars intro... you know… when the awesome John Williams music blasts on and you see the writing scroll down on the big screen? Total goosebumps… and I giggled in glee when Han Solo and Chewbacca stepped onto the Millenium Falcon for the first time after years… I think what it is for me is nostalgia!  I’m a very nostalgic person and I need to give credit and applause to John Williams because his brilliant music score compliments the story like no other.  His music remarkably elicits those feelings of nostalgia and adds so much depth and emotion to each character.  I am so glad that he will be composing for Episode IX.

So the rest of the cruise was great as any cruise experience goes… Disney does take it to a slightly different level when it comes to service and making your kids feel like royalty. The shows at night stand out in quality and entertainment. The food was delicious as expected but even more extraordinary were the intricately detailed themed restaurants. The water slide was fun though pools were a bit small and crowded… hard to expect more when on a boat…

  

Overall… it was fun and my youngest keeps asking to go back on the “Star Wars Boat”.  We’ll see… May the Fourth be with you all and tomorrow is Revenge of the Fifth! 
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