Burn and Rave

I tried cooking mussels with some friends recently.  My mom usually uses frozen boxed mussels that are already halved, but I decided to go fresh and buy live mussels.  Along the way, I learned a few lessons on how to prepare fresh mussels.  My friends and I immediately soaked the mussels in water with a sprinkle of salt after getting home from the grocery store.  Some of the mussels immediately opened up to spit out the sand.  Others remained closed.  Then we realized that we need to sort through the mussels to figure out which ones were bad and toss them out before going any further with the cooking.  ??  Call mom.  She said that the bad mussels have cracked shells and are open.  Oops.  It was hard to tell which mussel was open because it was actively spitting out sand and which one was open because it was dead.  We should have sorted them before setting them in the water.  Lesson learned, but for now we decided to just toss the cracked mussels and give the other ones the benefit of the doubt.  After washing the mussels and stir frying them with minced garlic and butter, we set them on a plate to serve.  Wow, the mussel flesh sure was tiny, a quarter the size of the frozen ones even though the shell sizes were the same.  They ended up being delicious, but second lesson learned here is to just use the frozen ones.  No sorting required.  No confusion and disappointment with the size.  Next time I’ll use frozen mussels, which can be preapred faster and will leave me more time to play with the seasoning and style.

I’m working with my friends on analyzing Obama’s healthcare plan so I’ve got a working list of resources.  Check them out if you’re interested as well.

From the Source, Obama’s website:
Overview/Blueprint, p12-13 on pdf (p22-25 on actual paper).
http://www.barackobama.com/pdf/ObamaBlueprintForChange.pdf
More details.  I found it helpful in explaining some things I didn’t understand.
http://www.barackobama.com/pdf/issues/HealthCareFullPlan.pdf

From the Urban Institute’s Health Policy Center:
Mostly analyzes cost and coverage issues.
http://www.urban.org/publications/411754.html

The Health Care Blog:
Analyzes the plan section by section and compares it to Clinton and McCain’s plan.
http://www.thehealthcareblog.com/the_health_care_blog/2008/03/a-detailed-anal.html

Forbes.com: written after Obama won, has good what happens next section.
http://www.forbes.com/2008/11/05/obama-healthcare-plan-forbeslife-cx_rr_1105health_print.html

WebMD: also written after Obama won.
http://www.webmd.com/news/20081104/obama-wins-what-it-means-for-health-care?print=true

American Academy of Pediatrics: their requirements for a comprehensive policy covering children.
http://aap.grassroots.com/election2008.access/
Log into your local library’s pubmed to get full access to this article

Am Assoc of Family Practice: Medical Home and reallocation of reimbursements.
http://www.aafp.org/fpm/20070900/38them.html

American College of Physicians:
Shortage of PCP’s (demand outweighs supply).
http://www.acponline.org/advocacy/where_we_stand/policy/primary_shortage.pdf
Five positions papers with comparison to Obama’s plan.
http://www.acponline.org/advocacy/where_we_stand/election/
All policy papers.
http://www.acponline.org/advocacy/where_we_stand/policy/ 

More coming.

I’m a distance runner.  Put me out on path by icy patches of Lake Michigan in the middle of winter, and I’ll go.  My white puffs of frozen breath keep a regular pace for at least eight miles.  But not even eight minutes into an indoor fitness class on it’s last day and I am defeated, marching in place and gasping for air while the girl next to me, who’s braved the last 10 classes, keeps jumping and hopping.

This was my second time in a fitness class.  When I use the gym, paid for by a mandatory university fee, I usually get on the elliptical or the stationary bike in the weight room, but a couple weeks ago, after years of posting up the schedule of free group fitness classes in my room, I decided to trade my old routine for an aerobics routine.  I attended an hour of step kickboxing which was intense, but manageable since I’ve taught dance aerobics before and dabbled in tae-bo.  Enter 45 minutes of the Super Circuit class, just a few days ago.  I don’t what it means, but sure sounds fun.

PUSH-UP POSITION! SQUAT! JUMP! TWENTY MORE TIMES!

After five, my pace slowed and my legs struggled.  After ten, lactic acid was spewing into my legs and I decided it would be better to march in place than to collapse.

PUSH-UP POSITION! LOWER IN FIVE!

Before the instructor counted an emphatic “ONE!” my body was already pressed to the floor having already advanced “five.”  Ahh, feels good to rest.

HEY!  IF SHE CAN DO IT, SO CAN YOU!

Oops.  My instructor peered at me between the columns that held up my foot-high step and caught sight of my cheating strategy.  And I realized that she was wrong.  The other girl can do it, but I can’t because I haven’t been training with these muscle groups and exercises all semester long.  I also realized that the last day of a fitness class was the wrong time to join because apparently the intensity accumulates and I was a weak link here.  That was a couple days ago and today I’m still leaking lactic acid in my legs, in my arms, and in my abs.  Maybe I should stick to running outdoors until the classes resume next semester.  Yes.  I’ll start running when I recover and am not crying “ouch” to every little turn of my body.

I just got my flu shot today.  Have you?  I haven’t had a flu since I can remember.  I had myalgias and chills from a viral cold once, but not long-lasting enough to be the flu, but it makes sense that I get immunized so that I become an asymptomatic carrier of the flu virus and inadvertantly pass it on to an immunocompromised patient in the hospital.  Well, as the nurses at the hospital roamed the hallway recruiting victims for the student nurses to use their super shot-giving skills on, I reponded with my resident and bared my upper left arm.  My pulse went up as the alcohol swab cooled and cleaned my skin.  My resident stood watching and smiling and cheering me on.  I quietly began to hyperventilate as the needle approached my arm from the corner of my eye.  Then my breathing stopped for about 4 seconds as I got stung.  Sigh.  “Hold this,” said the student nurse pointing to the gauze over my tiny puncture wound.  Soon she slapped a bandaid over the access point.  A regular beige bandaid.  Long gone are the days when I wouldn’t have been ridiculed for requesting a cartoon bandaid, however, not so gone are the days when the thought of getting rewarded with a simple cartoon bandaid would have appeased my nervousness.  As a person of initiative, I’ve decided that I can take this remedy into my own hands and take a bring-your-own-bandaids approach.  Rather than hopelessly wait for the nurse to whip out a Sesame Street or Scooby Doo bandaid from the carts in the cold, impersonal clinic rooms, I’ll just bring my own stash, my own makeshift prescription to quell a senseless fear.  Can’t wait for my next trip to Walgreens.

No excuses
Only one day into my psychiatry rotation, I have already encountered a depressed patient who confided that he was lonely despite reporting that he tried to foster friendships and sought opportunities to meet people.  People in his life seem to have turned on him or involved themselves with substance abuse leaving this patient behind as he chose not to participate.  Other times, strangers he met at social events never led to further contact as those strangers always seemed to already have their own lives and be busy with their own friends. While I hypothesize that this patient may have some personality disorder and poor judgment, I think that his loneliness is real and completely preventable.  6 billion people on this earth.  There is no reason anyone should feel lonely.

Well-connected
Remember the six degrees of connection, where everyone is connected to one another by at most six people?  That means that within a six-person circumference, we will very well know someone who feels isolated or lonely.  That means we all have the proximity to prevent loneliness.

Ask
The first step to helping a lonely person is to recognize the loneliness.  Some people might start behaving isolated, but others hide it and require a few caring questions to draw out the truth.  Take the time to catch up with friends or even people you might peripherally know through other friends. 

Do
By finding out enough about someone to see their loneliness, half the battle has already been fought since the preceding interaction already decreased their time feeling lonely.  But don’t leave someone on the battle ground once you have found them.  Chat with them a few more times, hang out at the gym, go out for lunch or coffee, and introduce them to other people you know well or peripherally to spread out the responsibility of the support network. 

Grateful
Having seen the crumbling or absent support networks over the last few days, I am very grateful for having so many people I can count on.  My parents and family are reasonable, loving, and caring.  My church and fellowship are another staple for friendships and encouragements.  And of course with the people I meet through school, my limited social life is pretty lively.  I’m glad I’m not lonely and I don’t take that for granted anymore.  I hope no one (outside of being my patient) I know is lonely either because I will ask and do.

Wow, there is so much going on in the world right now - wall street, health care reform, hospital bankrupcy, china’s tainted milk (among other things like politics for one).  I have so much to burn and rave about, kind of exploding with opinions and questions here.  Can’t do much about it right now, though, since I’m studying for a pretty important test.  But even if I had time, burning and raving according to Dylan Thomas’ poem “Do Not Go” was not just about expressing strong feelings.  It was about action.  He was fiercely begging his father to fight illness and the death bed until the very end.  That’s what I wish I had time for.  To fight for the better water and product quality and health care for everyone, to donate and deliver my unworn clothes and other excesses to not some agency but my neighbors in need.  The more news I hear of how screwed up the world is, the more I want to burn and rave for one little corner at a time.  It really sucks to be tied up with this studying right now.  On the other hand, if I burn and rave for my test and do well, I might just be in a better position to burn and rave for my patients and neighbors.  It’s all about picking one’s battles and right now I suppose the most prudent one to fight is the online question bank.

Do not go gentle into that good night,
Old age should burn and rave at close of day;
Rage, rage against the dying of the light.

Though wise men at their end know dark is right,
Because their words had forked no lightning they
Do not go gentle into that good night.

Good men, the last wave by, crying how bright
Their frail deeds might have danced in a green bay,
Rage, rage against the dying of the light.

Wild men who caught and sang the sun in flight,
And learn, too late, they grieved it on its way,
Do not go gentle into that good night.

Grave men, near death, who see with blinding sight
Blind eyes could blaze like meteors and be gay,
Rage, rage against the dying of the light.

And you, my father, there on the sad height,
Curse, bless me now with your fierce tears, I pray.
Do not go gentle into that good night.
Rage, rage against the dying of the light.

Pediastar.blog.com

Excel in Pediatrics

Welcome medical students and pediatric residents. You”ll find tips and resources here on how to excel in your pediatrics rotation and residency. Learn how to examine a screaming toddler, useful QBanks, interesting cases, targeted advice for various specialties, and advice on how to advise the parents and patients.

I morally oppose pay for performance for teachers, doctors, and now students!  Yes.  There was an article this morning in the Chicago Tribune about pay students for getting good grades.  I find it depraving that the society can no longer trust that teachers, doctors, and students are doing their best, but rather have to pay people extra for doing what they are hired to do anyway. 

People are not rabbits, so the government, the hospitals, and the schools should not wave the promise of cash like carrots as a way motivating factor.  We need to bring back integrity, where people will do their best no matter who’s watching, no matter how much they are getting paid.  As a pediatrician, I could probably work in Iowa making a cushing $300,000 in private practice or making $100,000 in an urban underserved community, which is my intention, but either way I plan on giving patients the best care possible, ordering the tests I think will direct treatment and management, and always offering prevention guidelines.  I am ashamed of my medical profession for leading legislators to think that offering monetary incentives will improve care, and shame on the legislators for treating us like rabbits.

The people advocating paying students say that suburban middle class parents have use this method for many years to motivate their own children, so since the parents of many inner city students can’t afford that allowance, the government is going to step in to help.  Well, I think the government can do a lot more than treating the students like rabbits to help.  My mother NEVER gave me money for good grades, and coming from an Asian family, it was just expected.  Sadly, society doesn’t expect great things from the youth today.  In fact, here’s a book about challenging today’s youth to do hard things, to get up and do something.  Speaking of books, what a novel idea, to encourage parents to take their children to their local library to encourage curiosity and learning.  During my family medicine rotation in an inner city clinic, more than 90% of parents didn’t have plans for their kids this summer, specifically no plans to go to the library.  Other great resources that already exist are museums and the zoos.  Admission is free with a pass from the library.  What a novel idea it is to put the responsibility of raising kids back into the parents’ control. 

Chicago should put the money into a campaign to educate moms and dads on free resources they can use to get their kids interested in school and society.  Don’t give that kid with a “C” $20 like he’s a rabbit.  Challenge his parents to take him to the library so he can read about rabbits or the zoo to see zebras and lions.  Recognize outstanding community leaders who can inspire the students to be more than hip hop stars and basketball players.  Teach the students that life can be more than just going after the carrots.  It’s about working hard, helping other people, and striving to make the world a better place.

Isn’t that why people become teachers and doctors?  Well, I challenge not just the doctors and the teachers, but really, all humans to strive to do their best at any task they take on at work or at home or in their church.  Do your best not because you’re getting cash, but because you can and you care.

Chubby infants are absolutely adorable.  I enjoy shaking their chubby cheeks and bellies until they laugh.  However, when I see a chubby kiddo above the age of 2, like visibly obese with a double chin, I speak my mind like “HELLO!?!? Mommy, your kid (and probably you too) are FaaaAAT.”  Alright, I’m playing pediatrician in the emergency room right now for a med school rotation, so I’m not mean like that.  I truly care about the patients and their parents, both in their health and their feelings.

“Sweetheart, you’re beautiful, but I’m concerned that you are overweight and are at risk for scary diseases.  Have you started on a plan to lose weight with your pediatrician?”

Maher EJ et al reveal in Pediatrics that 12% of children starting kindergarten in their study of more than 15000 subjects are obese.  A major protective factor was prior participation in nonparent daycare, so being with their parents is a risk factor for obesity.  Parents are the culprits in the crime of childhood obesity.  The mechanism of how that happens is my theory: by not being good role models in their dietary and activity behaviors and by showering their children with “love” (overfeeding with milk and healthy food or just plain bad food such as soda, candy, and cake). 

If the patient is old enough, (more than seven), I’ll tell them with the above line.  Regardless of age, however, I’ll then follow that by turning to the parent(s) and repeating myself that children need to eat more than five fruits and vegetables a day and need to be active, not watching too much tv or playing video games.  Otherwise they will be die inside out.

Yeah, I use pretty strong words because I want to shake those culprits up.  Only then may I have a slimmer of a ray of hope at getting the parents to consider changing.  I know that I’m in the emergency department to take care of urgent matters, I’m not a miracle-maker.  However, as studies show that suggestion by health care providers can affect patient intentions to increase fruit and vegetable intake and to stop smoking, I use every opportunity to grill into the patient and parent’s minds that their fat culture needs to change.  I say it with a smile, lots of heart, and lots of experience in healthy heart choices.

As of January 1, 2008, the city of Chicago is taxing water bottles.  I just found out.  I am so outraged.  The obesity epidemic is plain in sight.  The “your momma’s so fat…” jokes aren’t even jokes anymore.  They are the truth and yet Chicago legislators think that it is socially responsible to tax water when most parents already prefer soda and juice over water because the sugar spiked drinks are much cheaper.  I think there is no faster way to change the trend of bulging wastelines by changing the price of soda and juice: make them more expensive than water.  Much of the lay public doesn’t know that pop is so bad for them, that pop has 13 teaspoons of sugar which means bad teeth, health problems, diabetes, and leg amputations.  However, much of the lay public does know that buying the cheaper drink is healthy for their wallet.  The government needs to cater to that if they had any moral ethics in helping people become healthier.  I am going to contact medical societies and my state legislators about this awful tax.  Change will be difficult, of course, because there’s also no faster way to lose campaign funding and resources than to hit the big pop and juice companies where it hurts, in the flashy greens.  I’m going to try anyway.  It’s a vicious cycle.  People stop drinking water and buy pop because the government decided to tax water bottles to fill it’s budget.  Then people get sicker and need more money for healthcare from public aid and once again the government will need to increase taxes to fill the gap in budgetting healthcare needs.  They tax cigarettes.  Why not pop?