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! 

Monday, February 26, 2018

Flu Season May Have Peaked

So this article was in my inbox this morning from AMA Rounds (American Medical Association) and caught my eye...
CDC: flu season may have reached peak
ABC World News Tonight (2/23, story 9, 0:25, Muir) reported the flu season has led to “a disturbing number” of child deaths – 13 more have died, bringing the national season total to 97 – as infections remain at high levels in 39 states. However, “visits to doctors and” emergency departments “did tick down” according to recent reports.
        NBC Nightly News (2/23, story 6, 1:40, Holt) reported data from the US Centers for Disease Control and Prevention suggest the “season may have finally peaked.” Medical correspondent John Torres, MD, explained the CDC says “doctor visits and hospitalizations for flu are down,” a sign “that the worst is over.”
        USA Today (2/23, O'Donnell) reported CDC spokeswoman Kristin Nordlund said the new data are “encouraging,” considering the decline in visits to physicians and child deaths, down from 22 the week prior. She added, “It looks like we may have reached the peak of flu season,” but added that “it looks like we still have many more weeks of flu season to go.”
        CDC relies on network of surveillance methods to track flu The Wall Street Journal (2/23, McGinty, Subscription Publication) reported on the CDC’s flu surveillance data collection process, saying the agency relies on a network of hospitals, labs, and outpatient facilities to track the virus. This surveillance tends to capture only a portion of flu cases, and includes categories such as outpatient surveillance, hospitalizations, and mortality. Lynnette Brammer, head of domestic influenza surveillance for the CDC, discussed the agency’s use of surveillance and how effective these methods are. 

Great!  It sure has been unlike other winters from not just the number of patients coming in but also how long the illness lingers and the severity of the symptoms.  For example, I treated many folks who normally never needed inhalers who were now wheezing and needing neb treatments.

Since we are not totally out of the woods yet, please continue to wash your hands and practice good hygiene.  Easier said than done for little ones who love to put everything and anything in their mouths... but grownups do it, too.

Also, do not underestimate the importance of a good night's sleep and stress reduction.  The minute your sleep is disrupted or you are stressed... your immune system is lowered and that is when you may find yourself sick.

Some practical advice when you find yourself starting to get sick. Your throat usually starts to hurt and you get that "malaise" feeling.

  • take it easy and REST. 
  • drink LOTS of fluids (water... not just caffeinated beverages which dehydrates you... so coffee but also soda or tea has caffeine.  alcohol dehydrates you too!)
  • make sure you are eating nutritious meals... don't skip meals.  chicken broth if you are losing your appetite. stay hydrated and think about how to make the most of what you are taking in especially if you don't feel like eating
  • probiotics and vitamins if you don't think you are covering all your basics with your diet
  • do not give up exercising completely if you normally exercise... but maybe cut down on intensity based on how you are feeling. the better in shape you are the better chance you have of fighting it off quicker...
  • if needed can take Tylenol or Motrin for fever and aches and over the counter cough medicine to help relieve coughing so you can get rest
  • call your doctor if you feel you are not improving.. or if you improve then get worse again
And I wrote about the flu vaccine in previous posts.... but given our recent Superbowl Eagles win... (Go Eagles!)'s my analogy I've been using with my patients...
  • You are the Eagles team (or whatever team of your choice)...
  • The flu virus is the other team...
  • Getting the vaccine is like getting a sneak peak at the other team's plays...
  • You may not know exactly which one they will do when... but you will have more of an advantage than another team who did not see the plays
  • So... even if you do get sick after getting the flu shot... imagine how sick you'd be if you didn't get the flu shot...
That is why I always get the flu shot (to protect not just myself but my older and younger patients as well as my family)... and I try to get all my family members to get the shot.

This flu season is going down as the worse season since 2009 when Swine Flu was around. I did get the Swine Flu in 2009 and I was pregnant.  That year, we did not have the vaccine in time and I got exposed in August and was sick until November. I've never been so sick in my life before! Flu can be very serious... so glad this flu season is almost over...

Thursday, February 15, 2018

When Tragedy Hits...

So you know... I wrote that other blog the night before Valentines Day... sent it last night... but all day yesterday in the midst of the parties and fun... in the background... my heart really was in a knot . I heard the news and thought "another one??" ... but knowing this was a school setting was even more troubling to me.  I was afraid to read the details because honestly... I didn't think my brain/heart/soul could process it yet... I just needed to compartmentalize this news until I got done what I had to get done...

But last night and even this morning... I did read... and I am struck... I'm still processing...

Part of me feels a little like this is unreal...  there have been too many stories... but at a school again? It's frightening to think how little actual control we have over what happens really... and now having kids of my own it's even more frightening to me... 

My brain can't even begin to process the horror and grief that these parents must be going through...

So... I just wanted to share my "go to" verses when my mind starts to panic and worry and... basically "freak out"...

Do not be anxious about anything, but in every situation, by prayer and petition, with thanksgiving, present your requests to God. And the peace of God, which transcends all understanding, will guard your hearts and your minds in Christ Jesus. (Philippians 4:6-7)

Trust in the LORD with all your heart and lean not on your own understanding; in all your ways submit to him, and he will make your paths straight. (Proverbs 3:5-6)

I sought the Lord, and he answered me;he delivered me from all my fears. (Psalm 34:4)
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