Dr. Toby

Antibiotics, bronchitis, sinusitis and the common cold

2012-01-17T05:19:00.000-08:00

I am a simple family doctor. But I lay claim to being a specialist in warts, sore throats, colds and flu. Everyday, all year long I see patients with congestion, sore throat, sinus pain, chest congestion and cough. I know the common cold.
Many people think they know the common cold. Runny nose, sore throat, cough and congestion that goes away in 3 or 4 days right? Not quite. Although many colds do run their course in just a few days, the majority that I see last 1, 2 or even 3 weeks. It is still a common cold even after 2 weeks.
The medical profession is inconsistent in this regard. Although we all know the dangers and the uselessness of antibiotics for colds, we continue to prescribe. But, we change the illness. We diagnose sinusitis, bronchitis and otitis. Daily I will see a patient who says, "I just wanted to be sure I wasn't getting sinusitis or bronchitis." The fact, you do have sinusitis and bronchitis! The definition of sinusitis is inflammation of sinuses, bronchitis is inflammation of the bronchioles. This happens with almost every cold.
When then do you need antibiotics for sinusitis and bronchitis? Rarely. If you are in day 3-5 of an illness, the sinuses will be full and you will have pressure. This is the normal course for a virus. If you are day 14 and you are developing a new fever, you have sinus pressure on one side you may need an antibiotic. Bronchitis? There is no indication for an antibiotic. If you have cough, fever and on exam you have lower respiratory findings and on xray you have markings, you have pneumonia need an antibiotic.
Overuse of antibiotics has led to MRSA, VRE, C. diff and other bacteria that can not be treated by usual antibiotics. Antibiotics cost you money and give you diarrhea. If your doctor tells you to treat your cold with Tylenol and rest, thank him or her, skip the pharmacy and go right back home to bed!

Love. Truth. Self-discipline

2011-05-27T15:13:00.000-07:00

Our teen group discussed core values for a Christian. The group meandered for awhile and stumbled upon a profound set of core values for a Christian.

Love. Truth. Self-discipline.

Yes, there are many important virtues: patience, kindness, faithfulness. But, can't these all fall under love? If we have love we will grow in virtue. Truth directs our love into the right direction. Self discipline gives love and truth legs so we can love in word and deed.

As David and I drove home, we listened to a speaker recalling the early Christian practice of rescueing Roman babies. The Romans would leave an unwanted baby out in the elements to die. Christians would find and save those babies taking them as their own.

What values did those Christians need to act that way? Love. Compassion for the child. Truth. They believed that life is a gift from God and not to be tossed aside. Self discipline. They had to go find the child and nuture that child for a life time.

Who knew?! It's the flu!

2009-09-28T18:43:00.000-07:00

Flu season is in full swing in September thanks to school and swine.

Swine flu has been slowly percolating on our homeland since it's first appearance in NYC several months ago. It is now moving freely released to the general population at the opening of school this Fall.

It's really gone well with public health efforts. Initially we were all worried appropriately that a novel virus released on a naive population could wreak havoc. Shutting down schools at the first of the year helped cool the spread. Screening children at summer camps kept kids from sharing the virus with bunk mates. This has all set the stage for the advent of the vaccine for H1N1 virus. The effect has been a wave of cases of flu-like illness in September. A small wave is better than a tsunami!

I 've seen several cases in my office this month. The illness starts with sore throat, nasal congestion, cough and fever. It has been a mild one week illness in most cases. Asthmatics can have a worse time and the elderly of course can have more severe disease. When the vaccine is released for swine flu, it has been suggested that the elderly not get the vaccine because they may have immunity from viruses long ago. Interestly, I haven't seen many older adults with flu-like illness. Hmmm.

How Fit Feels

2009-05-26T19:54:00.000-07:00

On the wall of a crowded nurses station was posted a photocopied phrase, "Nothing tastes as good as skinny feels". I want to change that to "nothing tastes as good as Fit feels". When I am at my best training for a marathon is the month before. I've usually gotten down to my low weight for the year and run 26 miles a week. I'm fit and it feels good. When I think about over eating, I realize the gross feeling from eating will envelope the temporary taste.
Debbie and I lost weight and exercised regularly in anticipation of our cruise this past winter. We have continued to try to eat healthy and exercise not just to reach a goal weight or be "The Biggest Loser", but to be healthy and fit.
This is a common refrain from my patients. After trying a crash diet for the past week and a half, they lament that they can't lose weight. For most, dieting is about losing weight. Lost for most is the idea of eating, exercising and living healthy. Fitness is a word learned and left in our PE 101 class in university. My advice for weight loss challenged dieters is thus: exercise and eat right for the next year then tell me how you feel. Deb and I have been doing our best to encourage each other for the last 9 months. I know, fit feels good.

Jon and Kate Separate?

2009-05-25T17:44:00.000-07:00

Tonight, four million viewers will be invited to listen to Jon and Kate's anticipated conversation about their marriage. Amidst rumors of marital infidelity on both sides, Jon and Kate in a People magazine interview both separately declared their dedication to their children. "No matter what's happening between Jon and Kate, they are clearly going to rally around the kids," says a source close to the family in the People article. "I will not fail my kids," Kate said. "I will do anything to protect my family," said Jon.
I was recently talking to a 19 year old friend about parenting. He was telling me some thoughts and worries about being a father. He is very thoughtful and dreams of someday being that father that loves, cares and is there. He's studying me and others. My young friend watches how I handle my three kids and likes what he sees. I encourage him to learn from what I and others do well and from our mistakes.
But, I advised, first carefully consider the mother of the children and how you can be a good husband. Learn how to love your future wife and build a marriage that will last a lifetime. That is the best thing you can do for your children. Give them a happy home with a mother and father that love each other and love them.
Every parent will make the "I will do anything for my kids," endorsement. Problem is that many parents lack the foresight and ability to do that. Take for example the dozens of single mother's in my practice who every other weekend hand their precious little ones over to the care of someone for whom they have only contempt. I hear the stories of apathy and poor care by father's who are marginally involved in the children's lives because they have "moved on" or have another woman in their lives. The mother at this point is helpless to protect her child. He has the kids for the weekend. Would you like to have a beautiful baby someday and have that child spend half of her life in the care of your worst enemy. No one ever wants that. But, that is exactly the situation of so many men and women I see in the office. If you have a child and separate from the other parent, you will have to share that child. Talk all you want, but if that person is a nutjob, you are helpless. You may find yourself powerless to make good on your promise to protect your kids because they are out of your care and you are not there.
Thus, I get tired of adults who are getting ready to divorce and rip their children's lives in two, saying, "I will do anything for my children." We have normalized divorce in this country. Many have minimized the effect that a divided home has on kids. Yes, I know the reality that half of all marriages will fail. Yes, I understand that when two people can't live together it may be better to part. People currently going through divorce or separation have to do the best they can. It's a tough situation and I feel for those people. What I am pointing out to all the young adults dreaming about a family is this: if you will do anything for your children, start now. Choose the mother or father of your children carefully, be the best spouse you can be. I'm happy my friend is planning and dreaming. He is working today to build a family tomorrow.
I don't know what will happen with Jon and Kate. I don't even watch the show. I do know that if they separate, they will have a tough time fulfilling their dreams with their children.

Bristol Palin's Graduation by Fire

2009-05-25T17:06:00.000-07:00

Bristol Palin has discovered that being a Mom is a lot harder than being a teenager. She's discovered that diapers and formula are expensive. The daughter of Alaska govenor, Sarah Palin, spent prom night at home taking care of her 5 month old son. She did however, make her graduation and now spends the summer days pushing a stroller and evenings working babysitting to pay for baby stuff.
I know this teen has had quite a ride during her Senior year. She spent the summer and Fall in the national spotlight as her mother rode the Republican ticket as the Vice Presidential nominee. Her pregnancy and relationship with the father of the baby have been publicized and scrutinized. Bristol deserves a reprive from public conjecture of her personal life. So why am I going on about her? Because she wants to be a lesson to other girls, "Girls need to imagine and picture their life with a screaming newborn baby and then think before they have sex. Think about the consequences", Bristol said in People magazine June 1, 2009. "If girls realized the consequences of sex, nobody would be having sex. Trust me. Nobody." Bristol now uses her experience to talk to other teens about sex. She does a mainly abstinence message but also discusses and encourages birth control. "I don't think anyone realizes that it really can happen to you, like, in an instant", she told a People reporter.
Bristol is showing the resiliency of a Mom. She has come through the struggles of the past year and is using her experience to grow personally and reach out to others. This is true virtue, true character. I applaud her for working to pay the babies expenses, staying home to care for her baby and still finding a way to help teens. Thank you Bristol for sharing your story and reminding kids that abstinence is the best option. Now my hope and prayer for you is that you can raise your baby, pursue a career and live your life in the privacy you deserve.

Swine Flu....(PC version "H1N1 influenza") ((My apologies to pigs))

2009-05-03T20:27:00.000-07:00

Swine flu is similar to influenza A that circulates among humans every winter. So far in the US, it's virulence is no worse than winter time flu. The worry is that this is a new virus for humans and thus we are immunologically naive. Our immune systems have seen several influenza A viruses and each Fall, most of us get a flu shot and we are ready for the inevitable spread of the contagion. With swine flu, there is no vaccine yet and this being a novel virus, we are doubly unprepared.
At first glance, the world reaction seems a bit overdone. But, consider the above and also realize that without control measures, this virus might be spreading much quicker. Public awareness and isolation of cases, along with selected closures of public facilites may just buy us time for a vaccine and prevent many illnesses. This is public health in action.
Don't panic, the virus seems fairly tame. But do wash your hands and stay home if you get sick.

How far will Ellen Goodman go to make herself readable?

2008-07-08T19:34:00.000-07:00

Ellen Goodman, syndicated columnist, recently offered a diatribe on abstinence-only education and loving fathers, equating them philisophically to hymen restoration. Briefly, she notes that in France, gynecologists are offering hymen restoration surgery to restore the appearance of virginity. The appearance of virginity in the marriage bed is important to many cultures especially Muslim. She goes on to denigrate abstinence only education and parents teaching their children sexual purity. "And consider the father-daughter Purity Balls dotting the country. At these deeply creepy events, fathers promise "to cover my daughter as her authority and protection in the area of purity".

A couple questions for Ms. Goodman. "Would you allow your 5 year old to surf the internet for pornographic chat rooms?" Okay, let me assume you said, "No". If I am correct, you just exerted authority over your child's purity. Can you do that as a parent? Yes! You should. We all have a duty to protect our children from what we as parents believe to be harmful. Now, a 5 year old surfing the net is a far cry from a teenage girl comtemplating sexual experimentation. So, my next question, "When is it right to let your child loose to experiment sexually?" Come now, when are you going to let your daughter stay over at her boyfriends house for the night? Will you allow it at 10? I doubt it. 12? Still, I hope not. 14? 16? What is your line to drop your authority for your daughters well being? Certainly you won't allow her at 14 to go to the 21 year old boyfriends apartment? Of course not, that would be illegal...and would you add immoral? if you agree that this would be illegal and immoral, you have just again exerted your authority over your teenage daughter and pressed your own beliefs on her.

Face it, we all teach our children our beliefs and we protect them from what we think harms. That is what makes us loving, caring parents. So, tell me then what is so creepy about a father that teaches his daughter to wait for marriage to have sex? Is it really so much different from what you do? What's the difference? A couple of years in age for the daughter and a partner that will or will not commit to caring for your daughter.

Wait, I think I understand. You got "creeped out" by the idea of a father "covering" a daughter. Did you think that meant something bad? True, I wouldn't have picked that term because I know many people, like you did, would read some physical, sexual implication to the term. It's too bad actually. People can't understand the pure love of a father for a daughter. I want nothing but the best for my beautiful, amazing, brilliant 10 year old daughter. I will protect her from harm. I will teach her to wait for marriage for sex. I will allow her to make her own decisions and give her independence as she grows and learns. I will love her no matter what decision she makes about her sexuality. In a world so deficient of good fathers, why would you criticize those who truly love and care for their daughters. You are right, we need a repair for our whole culture. Why not start with repair of your column?

The Seeking Heart

2008-01-26T21:27:00.000-08:00

Francis Fenelon a 17th century Catholic priest from France is one of my greatest mentors today. There are several people living and deceased that inspire me. Eino Kivasalu, a man that I spoke to maybe six times left this earth, but lives in my memory as a man who saw people through God's eyes. Dr. John Patrick, a physician, researcher, ethicist and theologian, shows me deeper paths of thought that lead to a fuller knowledge of God. I've never met Dr. Patrick. My dad lives out his life with generosity and a heart that only wants to do what is right.

But Fenelon, he speaks to my soul. I've read the Bible and known it since a child, Fenelon tells me what I should do to follow the Word. "The Seeking Heart", is a timeless collection of letters Fenelon wrote to many people that he was mentoring in the late 1600's. So practical and true are his teachings that they sound as they could have been written last year. He lived a live of poverty and service to others. He calls all to abandon self and worldly entangelments to give themselves fully, completely to God. Here's a paragraph from one of his letters...

"Often what you offer God is not what He wants. He usually wants that which you dread giving Him. It is Isaac, the well-beloved, that He wants you to give up. What He is after is what comes between you and Him. He will not rest, and neither will you, I might add, until you have given Him everything . If you want to prosper and enjoy God's blessing, don't hold anything back from Him. What comfort, freedom, and strength there is when nothing stands between you and God."

The Rocket and 'Roids

2008-01-25T21:13:00.000-08:00

I just can't help but comment on the Rocket. I've always admired his durability and wondered about his drive. You see, a guy who will postpone time with his family indefinitely makes me wonder. He doesn't need more money. Why not hang it up and spend time with your kids and wife? I'm a little biased against him after watching his actions and attitude over the Mike Piazza beaning. He seemed indifferent that he had skulled a man. Then the next time he faces Piazza, he goes inside again! This time saws off Piazza's bat which shatters. He caught the barrel with its sharp broken edges and flings it toward Piazza! Again, he acted like no big deal. The Rocket is one of the greatest living arguments for bagging the DH and letting pitchers stand in the batters box.

But that's not what I'm writing about. Lidocaine. He said the only thing that his trainer injected was B12 and lidocaine. B12? Makes no sense. Except that it's commonly given to old people. It's largely placebo unless you have pernicious anemia, a condition I doubt he has. Even then, why give it in the locker room? You can get it anytime. At home, the doctors office it's usually given once a month. I know he's gone traveling frequently, but still why go to the trouble of carrying the bottle to the locker room and have the trainer inject? Ok now lidocaine. This is a topical local anesthetic. Catch that a local anesthetic. You don't just give a guy a shot in the rump of lidocaine. In sports it would rarely be used to kill the pain of an injured joint for one or two hours to make it through a crucial game, ie Kurt Schilling of the Red Sox. Remember during the World Series when he had a painful ankle? They injected him before the game probably with marcaine (same as lidocaine but lasts longer). This would have been done by a doctor, likely an orthopedist, and injected into or around the joint. That is not something "joe trainer" is going to do. It also puts the joint at particular risk. You are numbing the joint and can't feel if you are doing more damage. You'd only do that if the WS was on the line.

Finally, the tape. You once again get a feel for the cold indifference that Rocket has for his former trainer and friend. McNamee is a man on the firing line. He's the rat telling all. But not because he wants to tell. Remember he denied knowing about steroids until he was under oath. He had to tell the truth. What did he have to gain by ratting out his former bosses? Nothing! He had everything to loose. Do you think he'll work in the Majors again? Will he ever work again? He doesn't have stockpiled millions to live on and now probably wonders how he'll take care of his family. Worse, he could land in jail. So, he finally gets to talk to his old friend, the Rocket. Is there any concern for his old trainer? Not a smidge. Just a calculated attempt to get McNamee to recant on tape and use it against him.

Steroids, Supplements and Bonds

2008-01-23T19:59:00.000-08:00

Barry Bonds grabbed the headlines once again as his lawyers claim the indictment against him for lying to a grand jury was too vague. Bonds lawyers say that the charges are multiple and may be equivalent to double jepardy. Hmmmm. Why not object to the indictment on the grounds that you told the truth? Prosecutors claim they have positive test results for steroids and other performance enhancing drugs that Bonds used. Bonds told the grand jury that he didn't use them.

There's an easy way to find out if Bonds used human growth hormone. Ask the equipment manager. When a person produces too much hgh in their body, it produces a condition called acromegaly. The features of acromegaly are an enlarged bulbous nose, thick stout hands and increased size of the head. If someone took supplements of hgh over a prolonged time, they would have some of the same features. Now I've never seen Bonds in person, but even on TV I can tell his melon has grown a few sizes. As adults, we can still grow in many ways like a bigger gut or caboose. But, the bean is a part of our anatomy that just doesn't change much over the years. Thus, ask the Pittsburgh Pirates equipment manager from Bonds rookie year what his helmet size was and then find his current size. If it's increased.....

Our culture likes to see people get in trouble. It's like we won't have any fun if Bonds and McGwire are clean. What kind of office talk does that make? We are quick to blame and condemn. But, the steroid users are only doing what a majority of Americans do regularly, take supplements. Okay, most Americans are not lying, cheating and illegal when they take supplements, but the concept that we need something more is common.

When I go to the gym to work out, I am fascinated by the small circles of teen to twenty something men in the locker room chatting about what supplement is best to take after a workout. Many aspiring muscle men in the locker room pull a large container of powder or capsules from their gym bag and head to the water fountain after pumping iron. My patients take ginko, fish oil, rose hips, melatonin, creatine, black cohash, CoQ10, Vit C, B, A, E, kelp and garlic. I know of no solid reason to take any of the above supplements. Yet, some people think they can do better by taking something someone put in some pill.

If average Joe American is reaching for supplements to help him do better, is it such a stretch to think that World class athlete American reaches for something a little more?

I've watched medical studies for twenty years and still have not found convincing evidence that any supplement gives any significant benefit beyond a healthy diet and regular exercise. Want to reach for more? Put down the remote and the Oreos and go for a run!

Have Yourself a Simple Little Christmas

2007-12-06T17:59:00.000-08:00

Tired of all the hussle and hassle of Christmas? I find it interesting when people ask me, "Are you ready for Christmas?". "Was I supposed to do something?" They then assume that my wife does all the shopping. But, I truly don't have a long list of things to do for Christmas. Two years ago I gave up outside lights. I realized that lights meant a Saturday afternoon without the kids. That's not what the holiday is about!

This year we are trying to shorten the gift list for the children. We want to make it less about stuff and more about the birth of Jesus. We try to spend a little time in the weeks before Christmas to observe Advent, the coming. One night this month we will have a family meeting on who we will help this Christmas. We'll have one trip to the Rescue Mission to deliver food for their Christmas dinner. I am also going to have the kids help me make my end of year giving list. Usually, I make the decision as I do my December bills at the office. But, we are a family and all the kids need to be in on the giving. It helps us all to remember that when we keep Christmas simple, we can do more for others.

Maybe the worst holiday faupaux of all is that we don't send out Christmas cards every year. Occasionally when we get a good picture of the family, we send out a letter and a card, but it probably won't be this year.

I usually proclaim a last shopping day for Christmas a week or two before the grand day. That way we can all be done and enjoy the season more. Deb and I still procrastinate and spend almost the whole night Christmas eve wrapping and preparing. This year we'll try to get to bed before midnight, but I'm not counting on it.

Christmas is a joyous time when as Christians, we remember the birth of our Lord. We also look forward to His coming again and pledge ourselves to live each day for Him. It's a time to show that in giving and loving.

I Lost it on Ebay!!!

2007-08-04T20:08:00.000-07:00

I had the best of intentions. I have to recertify my Internal Medicine Boards this year. In November, I'll sit for a test that covers all of medicine. This is no "chip shot". Internists are proud people. They believe we should know all of General Medicine and everything a specialists knows. So, I am studying.

I study best listening. I listen to everything in my truck driving to work. The ideal tool for me an Internal Medicine study system that I bought in book form for $560. There is an Audio Companion to this study that sells separately. It's perfect. Study questions, reading material and audio to listen in the truck. Perfect except for the price. Now, I've already spent $1600 just for the privilege to take the test, $560 to order the printed study material and now.....the Audio Companion, about 20 CDs, costs $1200!!!! Harry Potter on CD would probably sell for less than $100! But 40 hours of boring medical talk for over a thousand.

I was just about to make the call when I thought...ebay! A week ago I lost the first bid because we away from home. Then two days later, I bought a set only to find that the seller was going to "burn me a set and send it right out". (That's illegal.) I told him no and got my money back. Then I found just what I wanted, the original CD's in their carrying case and in great condition. I waited 4 days for the auction. And had the high bid until 5 seconds before it ended when I was outbid. A week of waiting and trying and bidding and buying, I wanted those CD's ! I lost it. I whined, I sniveled, I paced the room, I raised my voice and generally put on a pitiful pout in my living room in front of my wife and kids. Okay, it only lasted about a minute, but it was a good tantrum.

Materialism gets inside of us. My desire for those CD's crept inside of me and when I lost the bid, I lost my cool. Peace comes only from accepting what I have and realizing that what I have is exactly what God provides. I've calmed down now. The CD's aren't all that important. Except that they remind me that chasing after material things never gives contentment. The books are enough for now. There will be another day and maybe next time I won't lose it on ebay.

It's a Camp Hunt kinda summer

2007-07-08T19:47:00.000-07:00

I'm feeling premature empty nest. My son, 14 years, is off to camp this summer. Not just a week or two, but 4 weeks! My 12 year old son left yesterday for his 3 week stay. In a week, my 9 year baby girl will be off for 2 weeks. I miss 'em.
They are going to a good place. The site where Debbie and I first met and where I counseled and directed the camp 4 summers. Camp Hunt is a wonderful little christian youth camp. Kids sleep in rustic cabins, no electricity and the show house is a short walk away. They wake to a trumpet blowing revelee and clean their cabin and do cabin work details. They play sports, go to Bible class, arts and crafts and finish the day with a campfire. It's a place where a kid can be a kid. It's a place where the kids are loved because the mission of all the staff is to share the love of God.
My kids dream about camp all year. They count down the days. They miss it when they come home again. They make friends, they have fun, they swim, they find acceptance, they find God.
So, I'm a little lonely this week. My kids are pretty fun and they aren't here. But, I warm my heart with the anticipation of happy smiling faces and tales of camp when the summer ends.

More pictures of Kids...

2007-06-30T21:00:00.001-07:00

Drew and David played together on a U14 boys soccer team this Spring. We didn't win too many games, one to be exact. We had a very young team and every game, our boys would come to the sideline at halftime saying,"They've all got beards and tattoos!". Yes, this picture is in front of a corn field.

This is Davey about 2 seconds before he hit his first home run. Notice the white and gold soccer shoes.

Davey's Big Day

2007-06-30T20:23:00.000-07:00

The Whitestown 'A' Little League All-Stars played their first game in the District 10 tournament against cross-town, New Hartford. After a few errors in the top of the 2nd, Whitestown was down 3-0. David batting in the six spot led up the bottom of the 2nd with a shot over the left-center fence. His first homer ever! It was just the spark the team needed. The photo is David being mobbed at home.
In the 4th inning Whitestown was still behind 3-2. David came up to bat with the bases loaded and hit a gapper into right-center field for a double and 2 rbi's. New Hartford tied it in the top of the sixth 4-4. In extra innings, David came up with one out and no one on base. He hit a single to left. After two walks, David came home on a ground ball to shortstop and beat the throw to the plate to win the game, 5-4. Davey went 3 for3 plus a walk, 3 rbi's and two runs scored.

It was Davey's big day. Tonight before bed, I was talking to him in his bedroom when he commented,"I got mobbed at the plate twice today!" This day will live long in a little boy's dreams.

Wal-Mart gets it right

2007-03-06T19:22:00.000-08:00

I'm not a Wal-Mart fan. K-mart with it's messy empty aisles is quiet and more my taste in department stores. But I'm not anti-Wal-Mart either, and their pharmacy has figured it out. Leave it to the "dime-store" genius to take over the pharmaceutical world too.

As far as pharmacies go, Wally has been second rate; an "also-ran". It hasn't the reputation or prestige for most Americans to put their health in Wal-Mart's hands. But financial forces are becoming even more important to the American patient. Prescription medicines have been exploding for the past twenty years. It's wonderful. We can live better and longer with the medical revolution. It comes with a price that the patient usually pays.

Really, it's understandable. Medicines are expensive. Think about this. Every diabetic in this country should be on at least 3 drugs. One for sugar, one for kidneys, and one for cholesterol. That's the standard of practice. Most diabetics are on more. Everyone with heartburn or reflux can completely control their symptoms with meds. The rate of heart attacks and strokes is greatly reduced by controlling blood pressure and taking cholesterol meds. Treatment for rheumatoid arthritis has never been bigger. Depression and anxiety have many medicines with few side effects that really help people feel better. There's even two new meds for restless leg syndrome, several for leg cramping, one to rub off warts, five to treat cold sores and your choice of three for male sexual difficulties! You got a problem, there's a medicine.

Listen, I'm not a drug pusher. I'm all for non-medicinal treatments. My point is simply that there are many, many new medical treatments and the list is growing. So how do pharmacies handle this? They make a ton of money. Is it any wonder we have a new Eckerds, Riteaide and Walgreens on every corner?

I practice financially responsible medicine for the good of all. We have to be financially responsible. Don't tell me it's okay to prescribe only the brand names because your insurance covers it! That's probably the number one reason your copays and premiums are sky rocketing. Expensive brand name meds are one of the biggest reasons so many can't afford to even have insurance. I write for generics every chance I get. But it doesn't always help.

Cefuroxime is a good antibiotic for sinusitis and ear infections. It is now available as generic. I paid about $20 for a prescription last fall. I wrote the same prescription for a patient the next week and they told me it came to $150! I bought Doxycycline a year ago for almost $20 dollars...it really only costs pennies and should have been $5 or less. Many big name pharmacies just don't get it. They gauge patients with minimum fees for some generics and charge very high prices depending on the insurance. I really can't figure it out. Why would Amoxicillin ever cost more than $5?

Wal-Mart quit playing the pricing game and came up with a $4 generic drug list. Every med on the list is $4 for a month supply. There are a couple hundred very good, useful meds on the list. Almost every category of medicine is on the list. It's simple. Patients no longer have the anxiety of wondering, "What in the world will this med cost me?". I've already switched some cash strapped seniors to all meds on the Wal-Mart list. They like it. One patient had four meds that totaled over $300/ month as branded meds. All switched to generics at Wally World...$16.

If you don't want to support the department store giant, I suggest you go to your favorite pharmacy and ask them to do the same thing. They can if they stop playing the game and charge only what it really costs. You will also do your part to slow down medical inflation in this country.

Valentine's Day

2007-02-13T23:13:00.000-08:00

Have you ever heard married couples talk about how they grow to love each other more everyday? Or that they are more in love now than the day they were married almost 200 years ago? When I was younger, I used to think they must not have had a very good wedding day!

One week ago, I wrote our love story. K-Love radio had a contest. They chose five love stories that listeners sent and Mark Schultz will take one of those stories and write "The next great love song". From the moment I wrote the story, I've felt an extra thump in my chest, a little extra charge of excitement, a little more passion. I didn't tell Debbie that I had written the story. We planned to go out to dinner Friday night and there I would read it to her and tell her that I had sent it to K-Love. I didn't really consider the possibility it would be chosen or even be a finalist. But, 2pm Friday at the office, my office manager Lori confronted me as I came out of a room. "I want to read the letter!" A patient had just called to tell her that my letter had been read on K-Love! My wife didn't hear it on the air, so she still didn't know.

I waited until that evening. We were all ready to go out for our date. Grandma and Grandpa were already at the house to watch the kids and we had the radio going. I told my son Drew to keep the radio on so that Debbie could hear in case I was selected. I whispered in her ear as we stood in the living room listening to them read off the five finalists, that I had sent our love story. They had already named 4 of the 5 and I started to resign myself...until they read my name. Our living room erupted! The kids, Deb, the grandparents and I all had a good jumping up and down party.

Deb still hadn't heard the story. I read it to her in the truck before we left for dinner. She liked it. She loved it. Turns out that wives really enjoy this romantic stuff. We've been electric ever since. Every look we share has a special gleam, every touch a spark, every embrace a little longer, every kiss more passion. This has been a fun week leading up to Valentine's Day. But, we have the extra anticipation of waiting for tomorrow morning to find out if our story will be the next great love song on K-Love! It has truly been the best Valentine's Day ever for us, and it's still just Feburary 13th.

Okay, back to where I started. For the past five years, our love has grown and deepened. It was all triggered by a marriage class we took at church. It helped us drive out our secrets and discuss openly our needs. We began to truly seek to meet each others needs or as we like to say, "complete each other". I see Debbie now as a continuation of myself, my own body, my own mind. I am the same to her. If she does something I don't like, how do I get mad at myself? I see her little short-comings as an opportunity to complete her. So I don't yell when she leaves her bathrobe on the floor, I pick it up. When I'm late from work, she doesn't complain, she fills in for me. We are a team. We work together. We love together. We have one goal: to love each other as God has loved us.

In marriage we are privileged to see a glimpse of God's love for us. God is the lover of my wife's soul. I just try to mimic that love as best as I can. When I see the love and sacrifice Debbie gives me, I understand that God loves me even more. The love affair of our marriage is upstaged by the lover of my soul. As we see and feel God's love, we pour out more love to each other. Our love grows and flourishes, watered by God's spirit.

So, yes, I am one of those old folk who say, "I love her more today than the day we were married."

I see my wife again for the very first time...

2007-02-13T23:08:00.000-08:00

(Summer 1987, Camp Hunt)

On a warm summer morning in 1986, I saw my wife for the very first time. I had just finished my second year at Harding University and had flown a thousand miles from home to spend the summer as a counselor at Camp Hunt, a Christian youth camp in Upstate, NY. Being a "home body", I didn’t like traveling away from my home and family in Oklahoma. But, a friend from Harding, Bob, talked me into 6 weeks of camp in the green hills of central New York.

By providence, another friend from New York told me about a girl that was to be a counselor with me that summer. He had been to Camp Hunt and knew several people from the area and just a month before I left, he told me about Debbie. Brown hair, cute, short, a lot of fun and a devoted Christian; was how he described her. She was someone special from the way he talked. I knew that I would look for her that summer.

When I flew into NY, Bob picked me up and I entered the countryside. I marveled at the beauty of cornfields, cattle and farmhouses on rolling green hills and meadows. Camp Hunt was set on a hill overlooking a valley of trees and more farms. A large green wooden building stood in the center of the camp and served as the messhall. A cut tree erected in the grounds served as a flag pole and just behind the flag pole, the lodge. Deihl Lodge was a picture of camping Americana. Surrounded by pine trees and painted brick red, it also stood over the valley. Inside was dim lighting and musty smelling furniture in a common room where we had our counselors meetings.

It was here. I sat miles away from home, not sure what I was getting into. I sat on the old dusty couch and while others visited around me, I gazed out the open door facing east and the morning sun. There was a mist in the valley that was slowly rising and dissipating in the warmth of the sunlight. My trance-like state melted away as she walked into the doorway.

I knew it was her right away. Her smile, auburn hair, small nose and freckled face were immediately recognizable; Debbie. But it was the warmth and kindness and joy she carried that told me this was the girl I had heard about. As she stepped into the lodge in front of the morning sun, sun beamed through her hair and danced around her smiling face, the face of an angel. Never had the sun been adorned with such beauty as when my future wife carried it’s rays around her.

I can’t say I knew then that I was going to marry this bright, happy girl, but I knew I’d try. The vision above soon ended as her boyfriend walked into the lodge behind her. But, 6 weeks of counseling camp and then attending Harding together in the Fall, our friendship grew. We took a class together, "Hebrew Poetry". Studying together, we memorized verses from Psalms and Song of Solomon at the college Laundromat. Our fondness for each other was natural and pure. Our first kiss was on a Sunday evening standing on a sidewalk and under a light on the Harding campus in January 1987. We were married June 25, 1988 at the Church of Christ in Utica, New York. We now live just 25 miles from Camp Hunt. We often spend a week or two in the summer teaching Bible class at camp. I often venture back to the lodge and look out the doorway to the valley below. But, many times my mind doesn’t see the beauty of the valley, instead I see my wife again for the very first time.

The Simple Life

2007-01-28T20:23:00.000-08:00

Tonight in our living room, I had the kids all read a Bible verse. Emma read two verses that she had learned in Sunday school today. The last words in the verse were, "associate with the lowly...". As I tried to explain "lowly", we used the word simple. At first my daughter thought this was a bad word to use about someone. Indeed, often it is used to describe someone mentally slow. But, simple is someone not tangled in the fast pace of materialism. Simple is one who takes people at face value and assumes the best about others. A simple person takes care of his own business, but always has time to help others and never enough time to criticize. A simple life doesn't have to have the latest gagets or see the movie release on opening night. In fact a simple person doesn't always have something to do and enjoys the peace of the moment.

A few minutes later, we were all still sitting in the living room when our two cats started to play with the same string. There was alot of good natured sparring between the two year olds. One cat crawled through a magazine rack to attack the other. They alternated between swatting at the string and taking a shot at each other. There was no TV playing, no phone ringing, no music playing, no Gameboys beeping, no keyboard clicking. Just the family in the living room where we found ourselves all laughing and watching two cats playing with string. I think that was a little taste of the simple life. I kinda like it.

The Final 0.001 mile

2007-01-27T22:14:00.000-08:00

I didn't realize how well I did on my first marathon until I ran my second.

January 6, 2006 went exactly as I had planned. I got up on a cold Floriday morning and ran 26.2 miles averaging 11 minute miles. I ran almost the whole way, taking a short 9 minute walk on mile 23. I struggled to keep running those last few miles, but crossed the finish with a small burst of speed. It was hard, but just as expected.

January 7, 2007 was a warm, humid day in Orlando, Florida. The kind of weather you want when you go south to escape the New York winter. I ran in shorts and short sleeve shirt. After the first mile I was drenched in sweat. By mile 5 it was dripping off my hat brim. At home in the cold, I can do up to ten miles without taking water. By mile ten, I was taking two cups, one water and one poweraide at every station. On mile 16, my stomach ached from the fluids I was drinking, but the sweat kept pouring. It was then that I could not longer keep up a steady run. I tried to find a rhythm by running two minutes and walking two minutes on miles 18 - 20. Each time I ran, my chest burned, my abdomen ached and my legs screamed. By the time I'd finish a minute of running, I'd be so drained of energy that I could barely walk. By mile 21 the running became so painful and draining that I had to hope I could sustain a walk the rest of the 5 miles to the finish.

I knew that I may have to walk a good part of the marathon, but I never dreamed I'd be looking at the plush Disney grass on the roadside and dreaming about falling on the ground and resting. If I had taken that grass nap, I wouldn't have gotten up and I wouldn't have finished. It's funny, but almost like a car's gas gauge, I could tell how much strength I had left. I wasn't sure if I could even finish by mile 23. At this point, the majority of marathoners are walking it home. Many, like me, still managed short running spurts.

I've felt my legs cramp many times on long runs in the NY cold. But, with 2 miles left, they were not only tight, but were giving me quick painful stabs in the calves. As long as I simply walked and kept an even pace, I could make the finish. But, then came the last mile. Everything in me wanted to run at least some of it. As I circled through Epcot, crowds cheering us on, I kept trying to break into a little run. Each time I took a few longer running strides, by left calf spasmed sending sharp pain up my leg. Each spasm brought my run to an abrupt halt as I stretched the calf and resumed my walk. Before the final stretch, I tried a couple more times but pulled up from the pain and spasm. One runner slowed to ask if I was okay.

The final 100 feet. Surely I could run that far. Maybe I could take small enough steps that my calves wouldn't rebel. I started a painfully slow jog to the finish and made it...85 feet. Just far enough away from the finish that I couldn't quite crawl across, my left calf squeezed hard into a tight ball that wouldn't let go. I hit the ground, paralyzed with the pain. As the calf pulled my Achilles, my toes involuntarily pointed away from me. I tried my self to reach my toes and pull them back toward me to stretch the calf and stop the spasm. After what seemed like a full minute of futile attempts, I call for someone to help. A volunteer came and offered me a wheelchair, "No, just push on my toes!" It worked. With me lying on my back, feet in the air and a Disney Marathon volunteer pushing down my toes, the spasm let up, until he let go. For 5-10 minutes, we'd stretch only to have it re-spasm as soon as they let go. Another volunteer came and massaged the calf. Finally, it stopped long enough for me to get on my feet and walk the last 15 feet across the line.

26.199 miles and the most painful was the last 0.001 mile. I don't really have a moral to all that. Maybe just seems a little more glorious to write about it.

Cut the Cards!

2007-01-23T19:33:00.000-08:00

Watch out! The doctor is about to give financial advice and divuldge some personal laundry.

I've heard it a million times, "Cut up those credit cards!". I've even advised patients to cut up their cards. (Family docs do everything from sore throats to financial advice!) But not me! I don't have a problem with overspending. Now ten years into practice and still making credit card payments, I have to admit my problem. "Hi. I'm Dr. Toby and I overspend with my credit cards."

I shocked my wife one month ago in the middle of Christmas shopping season when I took my credit card and hers and ceremonially cut them into tiny pieces. I declared, "If we don't have the money. We don't spend it." How many times did we look in our checking account and find we were getting short at the end of the month and say, "Okay, use the credit card for that purchase." The truth is, it happened almost every month.

Our credit card abuse started with good rationalization. We were in medical school and living on Deb's teaching salary. If we wanted to go out to dinner with friends, but didn't quite have enough money, we used the card. We took a trip to Disney. A well deserved break from school and put it on the card. As the card balance mounted, we knew we'd be able to pay it off as soon as I started medical practice. Life would all be fine when we started in practice...

I made a very average family doc salary when I started. But, because of the card debt and medical school debt and undergrad debt, our standard of living only went up slightly. The only thing that changed from residency to practice: we could now afford a modest home mortgage and a car payment. That's it! The money was just as tight. In essence, I had mortgaged our future during med school so we could live better during school.

We were diligent and after five years, we paid off the credit cards. What a relief! Things should have been easy. And they were better for awhile. But, we had never learned the lesson of living within our means. We still pulled out the credit card anytime a special event came up or we were short at the end of the month. So, because of overspending, we built up a new credit card debt within two years. Fortunately, I had also saved some money during that time. I used it to pay off the credit cards again. Two more years and again, we built up another card debt we couldn't pay off.

I may be dumb, but I'm slow... We will now only spend money that we have in our account. We will also build up a savings account. If we want something special and don't have enough in checking, we will prayerfully consider using our savings, instead of a credit card. We have cut back on our spending and we are making our monthly spending fit our income.

In a way, our savings will be our "credit card". Look, I know this is obvious stuff here. I've heard it said many times by financial advisors. Have a savings account for the unplanned expenses or special purchases. I guess I always thought that's why we had a credit card.

Fewer Abortions?

2007-01-22T20:58:00.000-08:00

Have you noticed that many people who support abortion rights also advocate that we should have fewer abortions?

Why? If your belief is that abortions are morally acceptable then why would you think there should be fewer. This is a position many politicians have taken in the past and present. It was also the position an editorialist took in our Sunday paper. Believe me, I too want fewer abortions and have no problem joining these people in working together so that fewer abortions are needed in this country.

By the very statement that there should be fewer abortions, are you not assuming that there is something wrong with the practice? Is this just moral relativism in action? I can only conclude that these people do find that abortion is not a good thing. Otherwise why decrease?

I don't mean to belittle anyone. I simply want to point out that even those who support abortion feel that there is something not quite right about it. Is this not incoherent?

I believe in life from conception. It's the only thing that makes sense to me as a medical doctor. There is no place after conception to draw a line and say life starts here. Implantation? It's the same cells just moved about 10 cm from where they started. Heartbeat? It's romantic, but a heartbeat is not a criteria for the definition of life. Viability? We all depend on each other. Just because a child depends on it's mother doesn't disqualify the child as a life.

When you answer the tough questions, like "When does life begin?", you can develop a coherent world view. I have answered that question for myself and I act on it in my life. I do not try to force that belief on anyone. I will share it with anyone who wants to listen. Thanks for listening.

Parenting?

2006-12-26T21:00:00.000-08:00

As a pediatrician, I have ample oppurtunity to observe parenting. Recently, a parent was in with his toddler. As we were talking, the father corrected his toddler who immediately questioned and challenged his father. The father repeated his command to the toddler who then began to negotiate to modify the command. The father came back with a choice to either follow the command or be punished. The toddler was not ready to be overcome, so pulled out his best card. He started crying. Now it was the father who started to re-negotiate the terms of compliance to the command. It seems now the father would be satisfied if the child agreed not to break his command the next time. The father also encouraged the child to not cry and suggested he could get a lollipop if he was good the rest of the time in the office. The toddler quickly agreed and held up his part of the bargin by no longer crying (until he deemed crying necessary again of course). The command and correction the father originally gave was never again mentioned and the offered punishment was withdrawn as an option by simple ommission. My response to this exchange was to correct the father. When I pointed out to him that his original command was never obeyed and that he allowed his child to call the shots, I was met with...you guessed it...excuses and negotiations. No matter who is looking or where you are, it is important that your child recieve a calm, consistent and confident response. Calm is first and key. Expect your child to mess up! You know he will. So why do we act to angery and shocked when it happens? Expect the mistakes. Be ready to respond calmly. Don't change your mind. Be consistent. A child has to learn to trust you. It is much easy to deal with a parent who sticks to their word. If you say you are going to punish then do it! Don't say it if you don't intend to follow through and keep your word. Don't beg and negotiate with your child. Parent with confidence. You are the authority. You have a precious gift from God. And as the keeper of this gift, you have the duty and God given responsibility to instruct and discipline.

Warning: Some Sexual Content

2006-09-07T20:00:00.000-07:00

You know me better than that!

One of my children who I will not name has a knack for some pretty funny comments. He learned the facts of life young from his mother and me. He has a good understanding of things and some pretty good questions.

At eight years old at the dinner table, he asks, "Dad did you and mom ex three times?" I didn't understand, "What?". "Did you and mom ex three times?", he repeats. "I still don't know what you mean", I said. This time slower so I could understand, "Did..you..and..mom..ex..three..times?". Finally, my older son has to interpret, "Daaaad, he wants to know if you and mom had sex three times because there are three kids!" Ohhhhhhh! After being taken back for a second, I gathered myself and replied, "No, David, much more!"

A couple of nights ago at the dinner table (again) with my older sister and my parents present he gave us another gem. He was about to start school and would have to be getting up a lot earlier in the morning. My mom trying to convince him that getting up early wouldn't be so bad said, "Well, you can get on the bus and have fun talking with your friends." To which the quick reply by my son, "You mean sleeping with my friends." As the double meaning sunk in, he started to shake his head, "No, no, no, no...." My sister nearly had to be resuscitated after laughing so hard.

Really, sex is not a common topic in our home. Those two events were about three years apart. But, when the subject does come up, our kids have no problem talking to us openly. Probably, because we have talked openly to them.

If you want advice or ideas on talking to your kids, write me.

Time to say Goodbye

2006-08-24T20:57:00.000-07:00

I said goodbye to a patient and friend of eight years. She was one of my first patients in the first year of practice. I still remember her first visit to my office. She had many special needs and she asked me if I thought I could handle her medical problems. I must have said "yes", because she became a patient. The fact is, I didn't always know what to do for her special needs. But, we worked through some tough times together. Often disagreeing, often not knowing the answer. We struggled in a losing battle for a body that was destined to fail soon.
Unfortunately, I mostly saw her at the worst parts of her life and finally the end of her life. Her life was very difficult. Pain and disability kept her shackled to a hospital bed the majority of her last years of life. In the end, she just wanted to be left alone to die. It was hard to stop trying to help her "get better". For her, ''better"would have been just more suffering. I didn't cause her death, I just stopped making her tortured body continue to function against it's will. It's so difficult as a doctor to hold back the technology to keep a body alive. To hope for a few more days for my patient. Maybe more time to be with family, one more trip home, another chance to reconile with God. But, sometimes the only thing to do is just to say goodbye.

The Right Tool

2006-07-29T17:51:00.000-07:00

I'm a tool guy. I love tools. The more the better. There's nothing like getting into a job, finding a tough problem and fixing it with just the right tool. I spent a week with a coping hand saw trying to cut 4 inch crown moldings and make the corners just right. After multiple failures, I bought a Dewalt 10 inch compound mitre power saw. You never saw crown molding corners so perfect!

This past week, my wife and I took a camping trip together. We rented a space at Wellesley Island State Park, pitched our tent, built a fire, cooked and camped. Now people tent camping are roughing it, but most still bring some luxuries like propane cookers. Not me. Give me some wood, an axe, a match and a few stones on the ground, I'm cooking on an open fire! Many campsites have a grill for your open fire. Not this place, it really was just a half circle of rocks on the ground. I would have had alot of trouble if I hadn't grabbed a metal cooking grate just before we left.

I bought this metal grate for our previous gas grill. The grill died and I never used this $18 metal grate from Kmart. I kept the reciept for awhile to return it, but it never happened and the grate sat on the back porch for two years. Until last week when this little metal grate found it's purpose in life. It was the perfect size to set on the rocks and set up my open stove/oven at the campsite. Because of that metal grate I was able to make chili, cornbread, biscuits, spaghetti, eggs, bacon, sausage and toast pop tarts. I thoroughly enjoyed every moment of using the metal grate. It sat on my porch until just the right moment and was the key to cooking during our camping trip. It was the right tool for the job!

God must smile down on us the same way when we allow ourselves to be used for His will. Don't get me wrong, I think we are much more than just a tool to God. We are His children. But, we are also His hands and feet to do His purpose. When we serve others, when we help the helpless, when we feed the hungry, when we heal the sick, we are doing His will. I can't help but wonder if He doesn't look at us at that moment and think, "That's exactly what I wanted you to do." I feel His pleasure when I do His will. When I am the right tool in God's hands.

Another of my greatest satisfactions is a well manacured lawn. When it's been mowed, trimmed, edged and clippings all cleaned away, there's nothing that looks better, especially if I did the work. A job well done is one of life's best pleasures. Recently, I started bringing my kids to my office to help me mow and clean. My son David did the mowing, my daughter Emma used a pressure washer to clean. It was twice as nice to see my kids doing a good job. I took great pleasure in watching my children doing what I wanted them to do.

As God's children, there's nothing better than to hear Him say, "Well done".

Human Embryo Stem Cells

2006-07-29T17:44:00.000-07:00

Below is my response to an editorial in our local paper. The editorialist is syndicated and I can't remember where she is from... The comments below will be published in our paper July 30, 2006. toby

Ellen Goodman, “Speak loudly and carry a big wedge”, calls the ideology of human life, “loony”. Since President Bush’s veto of a law to allow the use of more human embryo’s in research, many have ridiculed rather than dialogued his decision. This really is not a difficult ethical discussion. We all understand the idea that “the ends do not justify the means”. Doing something that is wrong because it may have a benefit is still wrong. So, if you say that embryonic stem cell research is okay because it may cure diseases, it still doesn’t justify doing something that is ethically wrong. Ok, you say that we have to take the “greater good”. The lives of people suffering diseases versus frozen embryo’s, as Ms Goodman states. The ethics of greater good comes into play only if there is no other ethical principle involved. In this case, you are chosing the greater good over a human life. Let me play devil’s advocate. I’ll take that ethical principle, greater good over human life. An eighty year old has kidney failure and requires dialysis three times a week. It’s really to the greater good if we terminate that dialysis and use that money to research diabetes and Parkinson’s….That doesn’t sound too good. It really doesn’t sound that good when the eighty year old is your parent. But, it is the same ethical standard being used to justify a greater good over the human life of an embryo.
There is no denying that those cells left over from in vitro fertilization are human. There is no question they are alive. Human embryonic stem cells are human life. On what ethical principle do you wish to terminate that life? I’m a doctor. I will hold human life in the highest regard at all levels. If our society decides to downgrade and qualify human life, it will effect you one day. The ethical standards on human life that are being discussed now will be applied to other humans someday. As for Ms Goodman, you’d do better to discuss intelligently rather than ridicule such a grave discussion on human life.

Ethical Relativism in Action

2006-02-27T21:26:00.000-08:00

New York city is developing a diabetes registry through the health department. It's goals are noble. To track a disease growing in epic proportions. To offer advise to practicing clinicians on treatment of diabetics. To educate diabetics and help them manage their disease.

How can the health department intervene and do this? By violating your privacy and disrupting the doctor patient relationship. Under this program, private clinical laboratories will send diabetic lab results to the health department. An Internal Medicine News report says that, "the health department will begin providing clinicians with information on their patients with diabetes, as well as contacting those patients whose results indicate poor glycemic control...Eventually the health department may also provide more intensive services to those with the highest A1c levels."

Sounds okay. But think! Your doctor orders a blood test. You go to a private lab. The results should only go to your doctor and to you! Now the health department is taking those results which are protected health information without your consent. Then, they plan to try to educate you without your consent and all this with your tax dollars. So, I get your lab results. You and I meet in the office and we go over the results the next week. We discuss the meaning of the lab and adjust your medicine or diet or exercise based on those results. Now maybe a month later the health department is going to send both you and I a letter letting us know your lab results! In fact, a nurse from the health department might even call to educate you about diabetes. What a great public service. What is the nurse going to tell my patient that I have not already covered? I meet with my diabetics every 3 months. We do labs regularly. As their doctor, I am responsible for their diabetic care.

Here is an example of ethical relativism. Rather than saying from the very beginning, "No, we can't do this because it violates patients' privacy and undermines the doctor-patient relationship." Instead we get,"We feel the potential benefit in light of the epidemic condition outweighs any risk to privacy." Dr. Lynn Silver in a recent Internal Medicine News article.

Risk to privacy? It's not a risk, when you have already violated that privacy! When you look at anyone's health record without their consent, it's done, over. Privacy has been violated. Ethics are not a balance of risk versus benefits. Ethics are ideals. Right and wrong. Not "We feel". Anyone can "feel" anyway they want. If we go by our feelings, we have no ethics at all. There are ethical absolutes. Patients deserve privacy.

The NYC diabetic registry is a clear violation of ethical standards. And once again highlights that there is no replacement for a patient-doctor relationship.

The terminally ill want control.

2006-02-06T22:39:00.000-08:00

Studies from Oregon show that many who seek assisted suicide under the Oregon Death with Dignity Act, do so for a sense of control. "They are really focused on what is coming down the road, how intolerable it will be, and how it will make their lives not worth living", according to Dr. Linda Ganzini of the Academy of Psychosomatic Medicine.1 In another study, cancer patients cite a growing dissatisfaction with medical care as a reason to seek assisted suicide.

Many would use this to support assisted suicide. The rationale would be giving patients back control of their lives and ultimately their death.

But, what is the ethical principle in that argument? Patient autonomy. Patients have a right to control their own lives. They should have a caring physician that helps guide them through complicated medical decisions. They should understand the medical decision making and have a trust in their doctor in explaining medical treatments. Patient autonomy is an important medical principle that should guide many ethical decisions.

Now, look at other ethical principles involved. The value of human life. When patients are given a prescription for a lethal drug, then patient autonomy has superceded the value of human life. Patient autonomy has become a higher ethical principle than human life. Using the argument that assisted suicide gives patients back control is relavent, but only one point in a larger debate. Am I acting ethically by giving a patient control when that act also puts a value judgement on his life indicating that his life is no longer worth living?

"First do no harm." An ethical principle for physicians contained in the Hippocratic oath. Patient autonomy has now also superceded a very basic, necessary ethical principle in the patient doctor relationship. As a doctor, I am called to help. But in my rush to help, I must be sure that I do not cause harm to my patient. We are healers. We are defenders of life. You want a doctor who is intent on doing what is best for you. Assisted suicide makes us take the opposite position, ending life.

Also, a physician has an ethical obligation to preserve life and alleviate pain and suffering. When the physician assists in suicide, it is no different than the role of executioner. Compare execution and assisted suicide. Both have a physician administering a lethal drug. Both are done as painlessly as possible. Both require that the patients life is no longer worth living. In execution, society has decided the patient should not live. In assisted suicide, the patient has decided that their life is not worth living. By participation, the physician has agreed that the life should end and in effect made a value judgement on a human life.

Recent court ruling about Oregon's Assisted suicide law has put it back in the news and open for debate.

footnote 1 taken from "Internal Medicine News" Feb 1, 2006.

Worth Waiting 4

2006-02-06T22:20:00.000-08:00

In my previous post, I highlight a "patient". It's really not one patient. I have actually seen that same clinical situation so many times that the patient is really dozens of patients put together. But that patient is the one that inspires me to speak out on sexual abstinence. That down face of disbelief and broken dreams is one I'd like to stop seeing.

The young man with his first case of genital herpes has already read the internet. He knows what may lie ahead. His consultation with me only confirms the information he recieved last night reading about herpes simplex virus. He also faces a dilemma. He can pass that on to his next partner. Condoms may decrease transmission of herpes, but not much. Estimates range from 0-50% reduction in transmission of herpes when using a condom. Taking a medicine everyday may also decrease viral shedding and tranmission to a partner. But even with precautions, sex has become at best a gamble and at the least very complicated. He understands now that abstinence is a very good choice. Now, when I suggest that he remain abstinent until he is ready to commit his life with one person, it makes more sense. Someday he will find one woman who will understand the risk, love him as he is and stand with him for life.

Reality reveals truth.

It's these realities that I try to bring to life in stories I present when speaking with "Worth Waiting 4". This dynamic group of speakers has the power to enable teens to embrace abstinence. It's a healthy choice. It's a safe choice. That's what I truly enjoy. Seeing kids before they are in my office. I want them to see reality before they experience it themselves.

Reality Reveals Truth

2006-02-06T21:55:00.000-08:00

I occasionally speak at schools or churches about sexual abstinence with a group called "Worth Waiting 4". We present the case for sexual abstinence until marriage. It is a strange idea to many teens especially when they have already experienced the sexual events on a liberal college campus. Sex is seen as a right. The messages on campuses is not that sex is wrong, but suppression of sexual expression is the problem. Our stuffy morality is keeping people from freely expressing themselves.

But reality has a way of revealing truth.

The male college student that I treat for genital warts has come to an ethical dilemma. While treating the warts, I counsel on HPV. Human papilloma virus is the most common sexually transmitted disease in the country. Studies vary, but the rate is 30-50% of all sexually active people are infected with HPV. It causes cervical cancer in women. It is the cause of many repeated pap smears, colposcopy and cervical treatments to prevent cancer. Most people don't know they have it. Only a small percentage develop warts. But, this young man knew he had HPV. Condoms have little or no effect on preventing the spread of HPV.

Sex will potentially spread a disease to his next partner. What does he do? I didn't answer the question for this young man. The truth of reality was much stronger than my words.

The Way It Should Be

2005-12-09T20:05:00.000-08:00

Last post I wrote about my nephew's thousand dollar cut on the chin. My brother took him to an ER because they were new in town and didn't have a doctor yet. The bills for a little cut and some glue approached a grand. Ironically, less than 24 hours later, I got a page from one of my patients with a cut on the forehead.

I was just heading for the shower after an evening at the gym and a long week of work. My pager went off, "Casey 2yo cut above eye". When I made the call back, the grandmother answered and said they were on the way to the ER. "Call them and have them go to my office." She got them on the cell phone and redirected them. I was dressed and on the road to the office in 10 minutes. It took about 5 minutes to place two stitches in the little boys forehead to repair the laceration. Set up and clean up another 15 minutes. I'm not sure what my charge is for a one centimeter laceration repair. Maybe $150 and insurance will give me about $100.

That's the way it should work. I say this not to boast, but to let people know that it can be better. Having a relationship with a good family doc can make a big difference. It saved about $900 tonight. Better yet, the boy walked out with a bouncy ball, a lollipop and two relieved parents.

One Grand Laceration

2005-12-08T19:01:00.000-08:00

My nephew is a boy's boy. He scares kids who are rough and tumble. Built like a miniature body builder, he can run over almost any obstacle. He did just that at school recently and sustained a cut on his chin.

Lacerations on the chin are a right of passage for young children. Everything is full speed, no holding back, wide open play. So, when they go down, often the hands do not break the fall and the next available appendage does. The chin often takes the fall. When a child gets his first (or second or third) chin laceration, it shouldn't be a big deal. Trip to the doctor. A little glue, maybe a stitch or maybe just a butterfly bandage.

When my brother picked my nephew up from the school nurse, he was told to see the doctor right away. Being new in town, they had no doctor to see. They were told no family doctor would see them urgently. A trip to the ER. When the doctor in the ER unwrapped the nurses bandages, the cut was rather unimpressive. They almost just left the ER to self treat. But, the doctor suggested just a little glue and they could be on their way.

It's now three weeks later, and the bills are coming.
One trip to ER: $500
One consult with doctor: $200
Something else that would take a medical legal degree to decipher: $300
Making sense out of medical billing: Impossible

I'll be quick. Hospitals bill $500 for a short trip to the ER because they can. Most everyone has a "cover-all" insurance plan. So, we usually just pay a $50 copay and never question the rest. They charge $100 for a tube of super glue for the same reason. Doctors have set fees. The above would probably be "laceration repair 1 cm". No mention that it was less than five minutes to apply glue.

I know I ragging on my own profession, but really, a thousand bucks for a little cut on the chin???? I encouraged my brother to make a little noise about the bill. Letter to ER director and Hospital administration. When you see an outragous bill you should do the same. I may even get a couple letters!

I knew I could run the first ten miles...

2005-10-21T22:50:00.000-07:00

In training for a marathon, I have one long run each week. Each long run is a little longer than the last. On my twelve mile run, I knew I could run the first ten miles because I had done it before. So, when my body was tired and weak at ten miles, I talked to myself. "This is why I ran today. Not for the first ten miles. I knew I could do that. But the eleventh and twelfth miles, that is why I run today." Those last two miles are the slowest and most painful. But, without the last two miles, I've done nothing special.

"You have heard it said, 'You shall love your neighbor, and hate your enemy.' But I say to you, love your enemies, and pray for those who persecute you. In order that you may be sons of your Father who is in heaven;...For if you love those who love you, what reward have you?" Matthew 5:43-47

Jesus calls me to do the same in my life. "Toby, I knew you could love your family and friends. But, I called you to love even those who aren't kind to you." I can easily smile and take great care of a patient who is courteous and thankful. It's no bother to spend extra time with the lady who baked me a cake. I'm simply doing what is expected when I serve the patient who pays a fee. But what of the angry, impatient and those that could never repay me. Can I spend my time, effort and courtesy on the ungrateful? That is exactly what God wants from me.

You see, He did the same for me. I am not perfect. Far from it. I have wronged God so many times that I could never count the sins. But, He still loves me. "But God demonstrates His own love toward us, in that while we were yet sinners, Christ died for us." Romans 5:8

There is my strength and my hope. It allows me to run the extra miles. It allows me to forgive and love others just as God loves me.

It’s Time We Had a Little Talk...

2005-10-08T18:15:00.000-07:00

When do we have the talk?
Sex education for your children should come from you. Unfortunately, the world is going to give them a warped opinion of sex. It is important that parents establish as the source of information at an early age. Age 7 or 8 years is still a time of innocence. They have heard little from peers and hopefully have been protected from the influence of media. This is a great time to teach God’s design for sex and marriage. They are very accepting and open at this age. If you tell them where babies come from they will believe you completely and see you as the expert on the topic.
It is also at about 7 years that kids become a little more curious about where they came from. You may have told them that babies come from Mommies tummy. You may have even explained that babies come when two people are married. But now, they will want to know how that baby got in there.

How can I start?
Take opportunities when your kids ask questions. Answer just enough to satisfy the question. You don’t have to launch into an entire talk when they just ask a simple question. “Mom, where to babies come from?” The answer may be as simple as, “from mommies tummy”. “How does the baby get out?” “From the vagina, the opening between mommies legs”, might be a little tougher to say but might very well answer their question.
For the big talk, make it special. Go out to lunch. Find a private place away from home to read a book and talk. Then go do something fun together. They need to know this is a special talk just for parent and child. When I talked to my son, went got up on a Saturday morning went out for breakfast, then to my office where we could talk in quiet.
Get a good book. “Before I Was Born” is a great book by Carolyn Nystrom that teaches sex as God’s plan for marriage. The illustrations are realistic and tasteful. The language straightforward. A warm-up book is “The Story of Me” by Stan and Brenna Jones. This book talks about reproduction without describing intercourse. It answers the questions of where did I come from and God’s special plan for each child. If you’re not quite ready for the big talk, this one might ease you into the talk more gradually. I also used “The Story of Me” to read to my 4 year old daughter. It’s a great introductory book for the younger kids. Both of these books are short and meant to be read out loud to your child. “How to talk to your child about sex” by Linda and Richard Eyre is a how-to book that you can read on your own for tips. This is for those who like to completely prepare. Most parents just need to get the courage up and have the talk.

What if I can’t answer all their questions?
You will. You are the expert. You gave birth to your child. Be confident and open. If they truly ask a technical question that stumps you then tell them you will find out and give them the answer. Remember you want them to come to you for these questions.

What if my kids are older?
Don’t put it off any longer. Up in with the “Before I Was Born Book” and get your feet wet. If your child is over 7 years, start planning now.

A Sweet Birthday

2005-10-05T10:27:00.000-07:00

My child attended a Bowling birthday party recently. When i arrived to pick her up I was (if you know me you'll be shocked) early. So, I sat and watched the kids. Most on first arrival were savoring the sweet sugar powder of Pixie Sticks. Remember tilting your head back and letting the sugar drop on the back of your tongue? Kids still do the same thing. It was not long before cake time. There was chocolate cake and just in case some one didn't like the cake, a dozen cupcakes were offered to the kids. It was no surprise that ice cream cups followed soon after the cake. I enjoyed half a cup of chocolate ice cream.

When I got up to dipose of the ice cream cup, I noticed the remains of cheese pizza and several near empty pitchers of soda. As I took my seat again, my child came to me with candy bars. "Have one daddy! There's a huge bowl of candy for us." Despite my protests, she left me with a KitKat. I did not eat it. As the party ended, the kids all got a nicely decorated goody bag. In the bag was...candy. Lollipops, candy bars and more candy bars because the the bowl of candy bars was emptied into the goody bags.

Let's take inventory here. Soda, pizza, pixie sticks, candy bars, cake, cupcakes, ice cream, lollipops and more candy bars.

Do you think we have replaced having fun at a party with having food?Think about the next party you go to. Are you playing games or just mingling while you eat?

Our desire for snacks has even crept into sports. Watch a kids soccer game. The children run on the field for 20 minutes and then some parent thinks they need a snack at half-time! Can your child not go an hour without eating? I've coached soccer for five years. When parents insisted on a half time snack, I made them bring orange slices. Now with older kids, 10 and 11 year old, I have no snack for the soccer team.

Children will only eat what we buy for them. Please be careful what you buy your kids.

Abstinence Only Sex Education

2005-10-03T20:29:00.000-07:00

I recieved an email from my professional organization, The American Academy of Pediatrics. They were urging me to write and oppose "Abstinence only sex education". Here's my reply...

I am a fellow of the AAP and I support and participate in abstinence only sex education. Here's why...

Kids need to hear both sides. They NEED to hear the abstinence message. If I tell them that abstinence until marriage is a great choice and I made that choice myself it is a strong message for abstinence. But, if I add to that; "just in case, use a condom and have safer sex" it waters down my message. Someone else will make the condom message. There are plenty of organizations making the safer sex message. Trojan condoms send it all over TV. I'm not needed in the chorus of people making the safer sex message. I make the case for abstinence. (this only applies to a program I do for public schools and churches, not how I approach my practice.)

Next, I truly believe in the abstinence message. Do you accuse me of distorting statistics on condoms? You tell me the effectiveness of a condom in preventing HPV...HSV...Chlamydia...from all the studies I have reviewed it is not good. Condoms are 80-90% effective in preventing HIV with near perfect use. Kids need to know that a condom does help prevent HIV. But you try to look a kid in the face who just developed genital warts all over the penis and suprapubic area that a condom would have prevented that infection. Tell my young women who are being smart and using condoms and being careful with who they have sex, why they now have primary genital herpes. Yes, even smart kids following the safer sex message still get STI's.

Next, we as doctors and scientists have left the emotional factor out of the equation. Everytime a kid has sex they bond with someone emotionally and physically that will likely end in a breakup. This does not help them in future relationships. It only helps them to develop defenses that hinder bonding with someone for a lifetime.

I volunteer my time to speak to kids about abstinence. Our program recieves no federal money. It recieves no public money. I am happily married for 17 years. I have only had sex with my wife. I have zero chance of STI. That's as healthy as it can get. Why wouldn't we want to promote this idea? Some kids want this choice. They need to hear that it is possible. They need to hear that others wait for marriage. They need a strong message for abstinence.

Compete for your child's heart

2005-09-22T21:15:00.000-07:00

Question everything! That was my attitude as I waded into parenting 12 years ago. Why does the milk have to be warm? I like a cold drink. Why do they need to learn to self-comfort? They are babies for heaven's sake! No swimming after eating? No singing at the table? You get the idea.

I am continuing to question as my boys are pre-teens. It is during this time that kids in our culture become even more independent. They spend more time with peers than they do with parents. They spend more time with teachers than with parents. They stay up talking to friends on the phone or instant messaging. Their next companion is often the TV. Most kids get an hour or two of quality time with the television. Even worse, many take that time of TV in social isolation in their bedroom. Parents aren't even joining them to guide and help select TV shows. Equal to the TV is electronic games. Gameboy, Playstation, Gamecube or computer games, they all serve as tutor for children and compete for their time.

We are then hit with the constant message,"Keep your kids busy. Keep them out of trouble." So we race from gym to soccer to baseball to tai kwon do. Parents, if you have a good home, there is no need to keep them busy! Keep them home. Let them have free time. Let them do work around the house. Read to your pre-teen. Do book night. Eat dinner with them every night. Don't put them in activities just to keep them busy. They don't need busy, they need you.

Is it normal that kids and parents start to grow apart at this age? Many call it gaining independence. It's not independence! It's a growing indifference to their parents. Kids respect parents less at this age. Many parents are troubled by the fact that their children won't do what they are asked to do. A child becomes disobedient at this age because we have lost their heart. We've allowed them to become busy with friends, sports and games without spending time playing with them and time teaching them.
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Parents, get back in the game! Parent and child growing apart in the pre-teen years is not the norm. Compete for your child's heart. There will always be something new to compete for your child's interest and time. There will only be one you. And that is exactly what they need.

Heartbeat

2005-09-22T20:58:00.000-07:00

I watched a 7 week gestation heart beating today. What an amazing, intricate, delicate little structure. A rhythmic flicker on the ultrasound screen keeping a perfect pace at 160 beats per minute. Eyes are forming, nose is growing, fingers are getting longer, but on ultrasound it's the heart beating that makes us catch our breath and feel the presence of a new life in our midst.

Even more amazing is how early the heart is working. We can regularly see the heartbeating at 5 weeks gestation. Since gestational age is from the last menstral period and conception is usually 2 weeks after the last period, that means the heart starts when the baby is 3 weeks from conception.

This is a fetoscope picture of a living 7 week gestation baby. We all looked like this once!

Sex Education Starts at Home

2005-09-05T20:03:00.000-07:00

Sex is one of the greatest gifts God has given us and our children need to know that fact.
Growing up I had all the wrong sources for sex education. A kid on the play ground drawing stick figures in the dirt explaining the anatomy. At 8 years old the 9 year old from up the street showed me a magazine with pictures. There were countless conversations with my junior high peers who waxed eloquent on the subject.

Thankfully a good book from Tim and Beverly LaHaye and a marriage seminar in college helped me to rewrite my notions on sex.

When my oldest turned 7 and a half, I explained to him the facts of life. I used a couple of wonderful books. "The Story of Me", by Stan and Brenna Jones is a prep for 4 to 7 year olds. It explains God's plan for marriage and family and some of the anatomy and where the baby grows inside the mother. It does not go into the act of sex. "Before I was Born", by Carolyn Nystrom is a delicately illustrated book that reviews God's plan for a man and a woman and describes the act of sex.

My son and I spent an hour or so at the quiet of my office one Saturday as we read the book and talked. The purity of the moment was my gift from God to show me His true intentions for sex. My son didn't think anything bad about sex. He had no notions from his peers. The first time he ever heard about sex it was explained as a loving act between a loving married couple. He knew it was good and from God.

Since that time, I have been able to talk openly to my son about sex when the topic appears on TV or conversation. Don't get me wrong. Those times are few. I don't burden him with more than he needs to know. But he understands when others talk dirty about sex or otherwise inappropriately that there is a better way.

When is the best age to talk to your child about sex? Start young. Age 4 or so when the opportunity arises to talk about marriage and the love shared between a man and a woman. Teach that a child comes from that bond. My daughter read, "The Story of Me" from age four and it was a favorite for awhile. I remember one especially memorable moment when Emma 4, David 7 and Drew 9, all sat around me on the couch to listen to the book again.

The best age to learn the anatomy of the act of sex is 7 or 8 years old. It is possible at this age that they have not heard things from other kids. They also start trying to figure it out on their own at this age. They know a baby comes from a mommy's tummy but want to know how it gets out and how it got there. A brief conversation or simple book at this age answers that question. Coming from you a parent puts you in the position of expert on the subject and the source of further information for your child.

Musing on Forty

2005-08-10T21:55:00.000-07:00

Gabor and I during the summer of '86. The best summer of my life was spent at Camp Hunt in central New York. But that was an earlier post. Just wanted to share a picture or two.

I'm turning forty tomorrow. Remembering the past, I put on my tape of "December" by George Winston. The sounds of the music take me back to summer '86. Some people have popular hit music or a rock song that reminds them of the past. For me it's the hypnotic melodies of George Winston's piano.

Camp Hunt

2005-08-05T19:51:00.000-07:00

Did you spend a glorious week at summer camp as a kid? I did and still do. From the age of eight until twenty, I spent at least one week every summer at Osage Christian Camp. It was the absolute highlight of my year. Sports, games, singing, eating and friends were important, but the most important was a spiritual awakening. I was raised by my parents to have faith in God. My parents live that faith everyday and will continue until they die and go to be with God. But, it may have been at camp that Faith came to life in me. Faith in God became my own faith in those days away from home and at camp.
At age 20, I spent my first full summer away from home and at Camp Hunt. I fondly remember it as the best summer of my life. It was 1986 and I had just finished my second year of college. A good friend from school, Bob Ritchie, begged me to go to New York and be a counselor for a summer. I was a real home-boy and I wasn't too eager to spend my summer vacation away from home. But, I went and experienced summer in New York. Maybe it was the cool crisp summer evenings, or the fresh soft breezes and lush green farmland. Maybe it was the closeness formed by a group of about twenty counselors and directors working as a unit to run a camp program for about 60 kids every week. Maybe it was a friendship with a fellow counselor named Gabor and our summer playing, talking and dreaming. Maybe it was the kids who stole my heart or the girl, my future wife, who later that year stole my heart.
I spent the last week at Camp Hunt teaching a Bible class. My greatest joy was watching my three beautiful children who are now campers. I also enjoyed walking the hills, woods and meadows and remembering the best summer of my life.
I hope you too have memories of magical summer years ago...

Daniel Diet

2005-07-24T21:36:00.000-07:00

After the "Boilermaker" the largest 15k race in America.

Daniel 1: 12 "Please test your servants for ten days, and let us be given some vegetables to eat and water to drink."

Daniel is cool. He stands up for what he believes and he believes in God. Even when faced with death by burning, he didn't flinch. When the music played and the King demanded that he bow to the idol, Daniel stood. When faced with a crisis and a mystery, Daniel went to his knees in prayer and trusted in God. When told he could no longer pray to God, he kept on praying.

But eating only vegetables and drinking water, that I can relate! I have trouble sticking to a reasonable lowfat diet and still having a few special foods. Giving up sweets, soda and meat is hard for me. That is how Daniel could do all the other things in his life, discipline. He did not allow food or any other thing to rule his body or soul. He was committed to serving God in every aspect of his life.

I have thought for a long time about a 10 day Daniel Diet. I started last week eating fruits and vegetables and more water. I've already modified the Daniel Diet. I've eaten a small amount of lean meat and an occasional diet soda. It does feel good. I've started to loose my craving for sweets and I already feel more energy. I may not choose to go strict veggies and water, but I am working to have the discipline of Daniel so that food does not rule my body.

Embrace Bald

2005-07-23T20:52:00.000-07:00

My son David and I compare hair.

It was three months ago while my older, long-time bald brother was cutting my hair that he remarked,"I've never seen a tweleve hair cow-lick!" This of course referring to my stylish twist of hair that has recently been reduced to just a few lonely wayward follicles. It was my brother who helped me finally make the plunge and go short.
That was then. I have since embraced my baldness. For those of you who aren't, I'll give you a couple word pictures of how it feels to be liberated from hair. After working in the yard with heat and humidity, a nice long cool shower. The way your teeth feel after a cleaning and you keep feeling smooth clean teeth with your tongue. That first time you slide into bed between fresh, clean, cool sheets. On a day with triple digit heat, the first plunge into the pool. That's how my head feels!
I've also learned how to cut my hair myself. I was getting a little long two weeks ago and wanted to be clean cut for a road race the next day. I used a 2 or 3 attachment on the electric shears and buzzed myself. I liked it. So tonight, I decided I was getting a little long again so I went with no attachments. The closest setting on the clippers. I learned to start at the back of the head and shave forward so the hair ends up in the sink not the floor. It is also important to stop moving the clippers forward BEFORE you reach your eyebrow.
Oh well.

Skeptical Medicine Part II

2005-07-15T21:37:00.000-07:00

So why the difference in professionalism among health care workers? First,we live in a world of materialism. From that culture comes people who see medicine as a high paying profession with prestige. The motivation for entering medicine has changed. Notice ads for nurses. High pay and benefits are prominently displayed. It's almost cliche' in our culture that doctors drive the best cars and belong to the country club. Add to this mix medical paraprofessionals. Care attendants, medical technicians who are often on the front line of patient care but without the least bit of instruction in the privilege of their postion.

Anyone in the medical field has the role of helper, healer. Patients come to us for help. They by the very nature of the relationship are vulnerable. They are sick and in need of physical help. They open their intimate details of their life and health to all in the medical field. They are symbolically and even physically naked before the health care provider. How can we take this responsibilty lightly? As a doctor I am in the most sacred position in care. Patients expose their body and soul and trust that I will hold that in the highest confidence. I can not and will not be seen publicly complaining or disparaging my patients. In fact, I refuse to allow myself to talk negatively about my patients even in the private community of other health care professionals.

There is the problem. We hold patient's information private from the outside world, but if a patient is difficult or demanding, we feel the right to complain to the next medical professional. Why complain about a difficult patient? Isn't that part of their problem? Part of their illness? Part of the reason they seek help from us?

Next, we have lost the meaning of altruism, helping others. If we are only kind to the polite patients who pay us for our services, are we really helping others? If they compliment us, wait for us patiently and are kind to us we are kind because they have given us something. It is simply an exchange of goods and services. But, when we help the difficult, irritable or angery patient and show them compassion and kindness, then we are truly helping someone who can't pay us back. When we give more than we recieve then and only then are we helping others.

Most important, many have no basis to serve others beyond themselves. I help others because God wants me to help others. God wants me show His love to others. I feel compelled to serve. It is my reason for living. I have one purpose in this life. It is to show others the kindness and love of God that was lived by Jesus. I work for something bigger than myself. I can put my pride aside and shake off insults or abuse it's not about me. In years past, doctors and nurses especially often trained at Christian based hospitals that emphasized our duty to serve God by serving others.

I hope that your care is always kind and compassionate.

It is a priviledge to care for people. When someone comes to me for care, it is the highest complement. They trust me to keep their secrets and to keep them alive. T

Skeptical Medicine

2005-07-07T19:34:00.000-07:00

Listen to the halls of the hospital or the doctor's office. What do you hear? Often quiet reassuring voices comforting those in need. Often gossip, complaining and negative talk about the patients. The talk may not be different from any other place of work. Many people complain about their job. In medicine our job is caring for people. Are we allowed to talk about our work like any other job?

I'm on the inside, so I hear the chatter. The nursing station where the staff discuss the patient in room 8 who is asking for another blanket. Another describes how the patient in room 4 asked to see her doctor. The two nurses at the end of the station go over the Sunday paper and discuss sales. The nursing supervisor is standing at the desk trying to arrange for more help at the next shift. Everyone makes comments about being "mandated" to work overtime just a couple of days ago.

At the another hospital I heard,"It's not my problem!". A nurse said this loud enough for the entire hall to hear. The beepers on the telemetry floor had alerted that a patient had just shown a dangerous heart rhythm. The patient was actually from the nursing unit down the hall. So, it was not intended for this nurse. It wasn't her job to monitor the patients on the next unit. However, all that the family members and visitors standing in the hall heard was her statement of indifference.

We work in a fish bowl. Nursing units are open and public. Visitors usually have plenty of time to watch, observe health care in action or inactive. Health care workers have become comfortable and callous in this enviornment. They will talk loud enough for any to hear. Next time you visit the hospital you will see this in action.

You will also see caring, compassionate and professional people. The nurse who works hard to check your meds, get you water and diligently keeps the medical record. What makes the difference? Why do you see disgruntled, complaining people in the caring field while others are models of professionalism?

I'm all better!

2005-06-09T21:02:00.000-07:00

June 9, 2005

The cough is almost completely gone and my breathing is better. I spent a couple hours in the heat (90 degrees!) working and did well. So, I'm about day 18 of the illness. It was about day 15 when I was wondering if things were going down hill and I needed to take an antibiotic.

The day after I wrote about this illness (see previous post), I saw a patient with the same illness and the same timeline. I'm still a scientist at heart. So, I gave him the antibiotic and I continued with no treatment (he was happy to recieve treatment). I'm better and waiting to see if my patient is better. If he is better, did the antibiotic make him better? Or, would he have gotten better anyway?

Often is the case with colds and bronchitis. Viruses often take two weeks or more to run their course. Unfortunately, we usually want a cure in a bottle after about one week. Do we really need that antibiotic to get better? Most studies show that for bronchitis patience is usually the best medicine.

A Taste of My Own Medicine

2005-06-07T22:18:00.000-07:00

May 31, 2005
I have a head and chest cold! A very typical run of the mill viral illness that people consult with me about daily. I have a rattle in my chest and I'm coughing alot today. So, this evening after catching the last inning of my son's baseball game, I took a couple of puffs of Albuterol. Our family then went to eat. At the restaurant, I felt unusually dizzy when getting up. I felt a little winded. Then I checked my heartrate and it was 90 beats per minute. My heart was pounding out of my chest.
I couldn't quite figure out what was happening to me. But, I ate my meal and tried to shake off the feeling. It was not until we were out in the parking lot that it hit me. I was having an expected side effect of the albuterol. When I got home I laid down in bed with my heart still beating 90 bpm. It took a good two hours for the heart pounding and restless feeling to go away.

June 7, 2005
I still have the chest congestion. This am I spent a little time working in the yard only to find myself short of breath and with a little chest pain. I decided not to run today because of my lack of wind from this chest cold. I also started to wonder if I should take an antibiotic.
So here I am two weeks into a head and chest cold facing the same question many of my patients face. Do I go to the doctor and get an antibiotic. Almost all illnesses like mine are viral. They start with running nose, congestion, cough or sore throat. The sinuses fill up in the first 3 days causing some pressure, low grade fever and achiness. The next several days the shift goes to the chest. Cough is more prominent in the second week. Yellow phlegm from the nose and bronchial tubes is common. The cough can become a prolonged irritant cough even as the congestion continues.
Antibiotics are usually useless in any part of this illness. But, it is possible for bacteria to invade already damaged respiratory linings and cause further illness and even pneumonia. It is also during this second week of illness that we get sick and tired of being sick. We want anything to get rid of this illness. Patients say, "I waited to see if it would go away..." "I've put up with this for 2 weeks..." They, we, want a cure!
So, as I type this and listen to the rattle in my chest and the mild pain in my chest and harsh cough, I wonder if I should help myself to an antibiotic?

Fat, Slow, Bald and Running a Marathon

2005-06-02T19:44:00.000-07:00

I've never been fast. I just wasn't made for speed. But, I can trudge! Trudging is a cross between plodding and trotting. When I run I am slow and consistent. I am made for a marathon.

I starting running regularly December 2001. I always felt like my body wouldn't be able to handle long distances. The most popular race in my home town is a 15k. Too long for most novice runners. So I thought. They have 10,000 runners every year. It's the big talk from May to July, "Are you running the Boilermaker?". Young and old, fast and slow run this race. So, 2002 I ran my first Boilermaker. Then that fall another race, 14K. Then the next spring, my brother Greg and I ran a half marathon in Nashville.

I'm consistent in that I never just completely stop running. I always keep in touch. For the past month I have run about once a week. Not enough to stay in shape, but I still haven't quit! This week I'll get 3 or 4 good runs. This will be the month I start really ramping up for the Disney Marathon January 2006.

I'm not just doing this to run. In fact, I'd rather just run the shorter distances and keep my knees intact. I'm doing this to raise money and awareness for Carenet. Carenet is an organization that helps women in crisis pregnancies and also works to prevent pregnancies.

The first function of Carenet has been peer counseling for women in need. Most of the women who come to Carenet are pregnant and don't know what to do. Most don't want an abortion, but feel in some way pressured to have an abortion. We've found that most of the women who come, want to have their baby, they just don't feel like they have a choice. Some feel pressured by a boyfriend or family to end a pregnancy. Others just aren't sure how a new baby will fit into their life. Carenet provides acceptance, compassion and material aide for the women. Counseling and the relationships formed help lead the women to change lifestyles and choices that led to an unwanted pregnancy. My wife is one of these counselors.

Both my wife and I also enjoy speaking to young people in a program called "Worth Waiting 4". This program gives a strong case for abstinence until marriage. We educate and challenge kids to wait on sexually activity. We also do a program called "No Way Know How". This is a program for 5th-6th graders on refusal skills and respect for self and others. Our culture repeatedly pounds the message of sex into the minds of kids. We offer a prospective that they won't see on TV.

I believe strongly in this work. I invest much time and effort volunteering for Carenet. Now, I'm going to go the extra mile (26 miles). If you would like to know more about Carenet write or visit their website www.care-net.org/ If you'd like to sponsor me in my run, send a dollar a mile or ten bucks a mile!

Carenet
2414 Genesee Street
Utica, NY 13502

memo: Marathon for Life, Taylor

Thanks!

Running for weight loss?

2005-05-31T20:25:00.000-07:00

This recent post from Active.com says what I try to say on a regular basis. If you want to lose weight, don't just rely on exercise. You must decrease your food intake to lose weight. Example, if you go for a three mile run three times a week and maintain your exact same calorie intake, you will burn enough calories to lose one pound a month. Not many people will settle for a quarter pound weight loss per week. On the other hand, your diet may currently be 3000 calories a day. If you start an 1600 calorie a day diet, you will drop about 8 pounds per month! To lose weight, you must diet and exercise...

Running for weight loss? Prepare to be patient
By Maureen McKinney, Medill News Service
Chicago Daily Herald
5/2/2005
In a recent TV commercial, a portly, middle-aged man walks gingerly up to the scale at his local gym. The scale reads 249 pounds. He sprints feverishly once around the gym and not so gracefully steps back on the scale. His face falls when, not surprisingly, the scale still reads 249 pounds.
The point of the clever ad is clear: Americans want a quick fix when it comes to everything, and that includes physical fitness.
As the much-anticipated spring thaw sets in, many suburban dwellers are choosing running as a way to quickly trim off pounds and create a lean silhouette.
They pack the trails of area parks and forest preserves, their breath forming white clouds before them on cold mornings as they huff and puff through their exercise routines.
But is running a fast solution for weight loss?
Time and patience
According to those who specialize in exercise physiology and nutrition, the answer is no. While running is a very effective way to shed pounds, this transformation takes place over time and requires patience.
"That is probably one of the biggest problems that people have when starting any exercise," said Kevin Davis, a fitness specialist and personal trainer at Loyola University's Center for Health and Fitness in Maywood. "They don't see results right away, and so they quit."
Davis added that a one-mile run, which takes a new runner 10 minutes, does little for weight loss or cardiovascular health, though it's a positive start.
"In order to get full health benefits, you need at least 30 minutes each time," he said.
Longer, slower runs
Statistics from the Weight Loss Control Registry, a research group that studies people who have successfully lost weight and maintained their weight loss, point to the need to consistently burn 2,800 calories through exercise each week in order to successfully lose weight. Rather than fast, exhausting runs, weight loss at this level requires longer, slower runs -- about 25 to 30 minutes -- spaced three or four times throughout the week.
In other words, a longer run at a slower pace will burn more calories than a short run at a faster pace.
Rate of weight loss declines
Starting weight also plays a substantial role in how many calories are burned during a run, according to research from Elizabeth Sadler of Vanderbilt University. For example, a 220-pound man who goes for a two-mile run will burn about 150 calories, while a 120-pound woman will only burn 82.
In order to lose a pound, the body needs to burn about 3,500 calories. A 180-pound person running for five miles each day will lose around five pounds per month. However, as runners lose weight, they begin to burn fewer calories per mile and weight loss begins to stabilize.
Put simply, it begins to take more time to lose more weight.
"The biggest problem for new runners is that you can't just wake up and do it," said David Patt, chief executive officer of the Chicago Area Runner's Association. "It takes time and training like anything else, but people don't want it to take forever."
And Patt should know. He lost 60 pounds over the course of three years when he took up running and began to change his lifestyle.
"You eat differently when you start running," he explained. "Your body doesn't crave the same foods you ate before. It's a process and your body gets used to it, but there is no magic pill."

Remembering

2005-05-30T22:23:00.000-07:00

Today we remember those who gave their lives for our country. Abraham Lincoln set this day apart so that we would remember and so that their lives may not have been given in vain. Our country remains free and fights for the rights of other people all over this world. What other country has a such a bold history of standing up for the oppressed? Our country is not perfect. We can argue that things could be done differently. But, I for one am proud of our country and it's history. Today I especially remember the brave men and women serving even now. They leave their family and home to work. They sacrifice for us. I pray that God will protect them and bring peace.

Euthanasia

2005-05-18T20:00:00.000-07:00

I'm confused. The doctor is not supposed to be confused. But, dealing with life and death in your own family is more difficult. Still, I have to make the decision. Do I assist my cat of 16 years to a peaceful death?

First, you have to understand that I really like this little guy. We go way back. My first year in medical school a friend of mine who was in dental hygiene bought a cat. She decided that she couldn't keep Boomer so begged me to take him. Maybe it was the cool name, Boomer. Maybe she was just so persistent asking me to take him. Or maybe because she gave me cat food, litter box and $5 to take Boomer. Debbie always had a cat at home so she was excited. I was a dog lover and was only going to tolerate the furry rodent. But, the little kitten was cute...

It wasn't long until we were best buds. I spent many hours in our duplex apartment studying for med school. I had a large study table set up in the laundry room. Boomer made a habit of sitting on my shoulder or wrapping around my neck as I sat at the table studying gross anatomy and biochemistry. Sometimes he'd get jealous and come down on the table and curl up on my books for a nap. That usually led to a little wrestling match as I moved him so I could read my book and he took it as a chance to pounce on my hand.

Four years of med school, four year residency, eight years in private practice and three children later, Boomer is still our constant companion. He sleeps on our bed most every night. The kids have grown up petting, carrying and chasing poor Boomer. They have never known a home without our cat. Deb and I have had Boomer for 16 of our 17 years of marriage.

He's sick now. He started with a small growth on his forehead 18 months ago. A few trips to the vet revealed that it didn't respond to antibiotics or steroids and xray and biopsy were inconclusive. But, I knew that with the slow growth, Boomer had a tumor. Today there's still a firm nodule on his nasal bridge. But worse it produces fluid that swells the nasal bridge and forehead to grotesque proportions. Twice I have drained the fluid only to see it re-accumulate within a week. His breathing is loud and sometimes labored. His activity is down. He often just sits and stares. He still eats, but has difficulty finding the litter box. At times he seems perfectly content rolled up in a ball sleeping on the couch in a small sliver of sunlight shining through the window.

But, he is very sick. He bleeds constantly from his nose. We are careful not to pet the swollen area because it seems tender. I have enough sedative to send him to the grave in a deep easy sleep. But, it still sits on my desk as I wonder if I can do it.

Read a good book lately?

2005-05-12T20:18:00.000-07:00

A close friend was recently looking for a racey romance novel to read while on vacation. I asked my wife that night for the most romantic "christian novel" she had at home. She gave me "Redeeming Love" by Francine Rivers. I gave it to my friend the day before she left for vacation.

Words have power. Words woven into stories can move emotions and change lives. My wife and I have found great joy in sharing novels. As a child, I never read a book. In fact, I was in my late twenties before I read my first full size novel, "This Present Darkness", by Frank Peretti. So, I would never have thought I'd be reading outloud to my wife at bedtime and on vacation. She's actually the big reader. When we are driving cross country on vacation she can read for hours as I drive.

About two years ago, Deb and I were traveling without the kids. We met other family members at a hotel and we were the first ones to arrive. We checked into our room and found that the hotel had lost electricity. We were alone in the dark in a hotel room far from home. So, of course we found a flashlight and spent the next two hours in our room finishing the novel we had started on the trip. Experiencing good, meaningful novels together has brought us closer still.

I wasn't sure if my friend would read the novel I gave her. When she returned, I so happy to find that she loved the book! I have another friend who gives me books. I had asked to borrow a book that he had recently read. When I said the obligatory, "I give it back when I'm done.", he said to keep it or give it to someone else. I have always taken great pains to stamp or write my name in my books. He reads them and gives them away. What a nice idea. I've quit stamping my books.

Handcuffed in Florida

2005-05-09T13:41:00.000-07:00

St. Petersburg, Florida-

A 5 year old girl was taken into custody by police in handcuffs. The kindergartener was having a bit of a tiff. There was a 30 minute video of the little girl’s fit circulating recently. I missed it and only today read a newspaper account of the girl walking around the room knocking things off of tables, off walls and hitting teachers. She was only subdued with effort by police and handcuffs.

You gotta laugh just a little at how ludicrous the whole situation has become. Teachers are so afraid to touch a child in our sue happy country that they will simply walk around the room telling this girl that this behavior is “unacceptable” while the girl ransacks the room! I feel for the teachers because their hands are literally tied. But, when the alternative is calling the police, how about a reasonable thing like physically restraining the girl. It sounds like the time has come to train a few teachers in each school on how to safely overpower and restrain a gradeschooler. This sort of thing is done regularly in pediatric psychiatric wards.

“I knew she’d sue....” Didn’t you? You know who I mean, right? The victim of course. The one who was wronged. The girl’s mother is suing the police. They may have been in the worst position of all. Called in to subdue a 5 year old! What do you do? The teacher couldn’t control her so she called the principal. The principal obviously couldn’t handle her. She came up with the “reason with the child that this is unacceptable” idea. So, the police have to fix the problem. Are they trained in hand to hand combat with toddlers? They had to come up with a solution, right away, on the spot. I guess they did what they knew how. Cuff ‘em.

Of course the best solution, which comes with the luxury of armchair coaching, would be to empty the whole room. Kids all leave with their own belongings. Clear the place out except for one teacher to make sure the girl doesn’t hurt herself seriously. Call the Mom. Get her up there stat. When she arrives, the teacher leaves the room and then lock the girl and her mom in the room until the whole situation is controlled.

Which is really the solution anyway. Parents need to spend more time with their kids instructing and disciplining. Instruct, discipline, repeat. The problem is not our kids. When a child is a problem, it's the parents that need counseling and coaching. Look, none of us got classes or step by step lessons on parenting. It's time for parents having trouble to swallow pride and go back to learn how to parent correctly.

Kakuka

2005-05-06T19:02:00.000-07:00

Kakuka Breath

Wonder why your toddler or young child has that awful breath? Parents often ask me with some hesitancy and embarrassment, “Why does my son’s breath really, really stink?” There’s lots of reasons.

1. Poor dental hygiene. Put a stopwatch to your kids tooth brushing time. If it’s less than two minutes, they probably aren’t doing an effective job. Help toddlers with the brush. Most toddlers just can’t effectively reach all the teeth.

2. Less juice more water. Water cleanses and moistens the mouth and keeps the bacteria count down.

3. That sorry cold that just won’t go away. If your child has had a runny nose for the past week, she is probably doing a lot of mouth breathing that dries the mouth and odor. If the snotty nose has gone on for two weeks and now you are seeing some fevers, she may have a sinus infection and infected mucus doesn’t smell so good.

4. Is he a mouth breather? Some people are born with small nasal passages and will chronically breath through the mouth. This leads to chronically dry mouth and proliferation of bacteria, poor cleansing and odor.

5. Allergies. A chronically stuffed snoot can as above lead to mouth breathing and dryness.

6. Dental carries. Multiple cavities or dental abscess may produce odor. The pain from carries may cause poor hygiene and bad breath.

7. Kakuka. Although currently not a medical term, my sister Terri (Aunt Teetee), would always exclaim to her many nephews and nieces when they jumped on her bed in the morning, “You have Kakuka breath!”. I’m sure you’ll agree, Kakuka is the perfect term for morning breath.

Censored Movies!

2005-04-29T07:41:00.000-07:00

Paul McMasters is First Amendment ombudsman at the First Amendment Center in Arlington, VA. The following is a letter to the editor of our local paper after they published his Op-Ed, "No room for movie censors in marketplace of ideas".

My family uses movies edited by “Clean Films”. We love being able to watch movies with great content, ideas and differing views of life without having to listen to curse words or view nudity. My wife and I have three school age children. And yes, we protect them from obscene material as we see fit.

In Paul McMasters Op-Ed piece he fears such editing will stop the flow of diverse thought provided by movies. How does editing out the F-word from “Saving Private Ryan” keep me from understanding the horror of war? If they cut out a particularly graphic scene will I miss that war requires incredible self sacrifice and courage?

We recently watched as a family the entire three film series “Back to the Future”. We received the second and third from “Clean Films”, but wanted to start watching so rented the first “Back to the Future” locally with original content. This was a fun, interesting even thought provoking movie. We talked about and let our imaginations fly for a couple weeks about time travel. The only change with the edited versions we watched was the petty curse words were removed. Why would I choose to let my kids listen to 50 mindless, immature and totally pointless curse words that our family finds offensive? Now, because of sanitizing companies such as “Clean Films” I have that choice.

Paul McMasters also points out the “filtering” ability of the human mind. He seems to indicate that we can simply mentally edit or deconstruct offensive visual and auditory stimuli. To the contrary, the human mind has an incredible ability to permanently record pictures especially ones that are emotionally disturbing or sexually arousing. Heard frequently, auditory stimuli in the form of language becomes a part of our spoken language.

The company our family has chosen to edit movies fits our standards. There are other companies out there. If the government stops them from editing, then our family will go back to simply not watching most of what Hollywood puts out. What will that do for the exchange of ideas that Mr. McMasters seems to be worried about? We will still choose what to watch.

Excessive Excess

2005-04-16T21:45:00.000-07:00

I had just finished overeating at a Crackerbarrel restaurant in Tennessee. I sat outside on a rocker while my boys played checkers and Deb and Emma went to wash hands. I watched as person after person walked by obviously having experienced the same over indulgence. Just about that time, the largest, most beautiful recreational vehicle drove in front of us. It was huge! Then as it finally passed by us, I saw the trailer. It was matching with the same paint job and half the size of the RV. I've never seen such a large RV. Wow!

Just a few days earlier, I filled my Dodge Durango up with gas in Upstate New York. I was amazed the total bill came to $54! The gas was $2.50 a gallon. What I realized immediately after was the most amazing. I paid the money. I didn't hesitate. I didn't wonder if I could afford to buy the gas. I just bought the gas. Just like millions of Americans, the rise in gas prices won't phase me. Sure I'll moan about it to friends, but I'll still drive my SUV. And I won't have to sacrifice anything!

We have so much. I look at our homes, our cars, our stuff. I thank God for His blessings. I pray He will make me content with what I have. I pray that I will give more to those who are in need. I pray that I can teach my kids contentment with what they have. I once again increase my efforts to keep my life simple. I don't need a larger home. I don't need a different vehicle. My kids don't need the newest toy or gadget. What God has provided is sufficient. I don't need to eat out as much. A simple meal at home with family will provide my needs. A meal at home shared with friends will be to His glory.

"I must decrease so that He may increase." The Gospel of John

I Love You Catapult!

2005-04-16T21:31:00.000-07:00

I stayed with my brother Greg in Nashville this weekend. They have a new trampoline in the backyard. Yes, we pediatricians are supposed to be warning people of the dangers of trampolines. But these new trampolines are quite safe with padding and netting protecting all possible dangers. Anyway, the kids had a great time. It seemed also that Greg and I were in great demand. Each time they went to go jump, they begged one of the Uncles to come jump too. After a few jumps I realized why they so desired our company.

It so happens that Greg and I have enough girth and mass to send them flying if they jump near us and time their bounce just after our bounce. It really was funny. My kids and nieces and nephew jumping and giggling with an occasional scream of excitement when they hit the bounce just right and the trampoline sent them flying. Once I got past the fact that they mostly wanted a "fat boy" to catapult them I quite enjoyed the play. But the high point was my oldest exclaiming, "I love you catapult!".

The children will rise up and call him blessed.

Run!

2005-04-13T21:12:00.000-07:00

Run as if your life depended on it! It does. It cures headaches, fatigue, palpatations, shortness of breath, obesity, heart disease, depression and insomnia. Some of my patients have come to expect it. The short pep talk on exercise comes no added charge on most visits. The one best thing you can do for your health is exercise. Everyone needs it, so few do it. Exercise.

Doctors are notorious for cutting off patients in mid-sentence. But, I usually can't resist when I get a long winded response to the question, "Do you exercise?". No one, absolutely no one says, "No". Instead I get a long explanation of usual daily activities rationalized to be exercise or an even longer explanation of good intentions. For this I have to cut in and explain that people who don't exercise have the longest answers to the question. To avoid this humiliating exchange in my office, I'll offer the following list of what not to call exercise.

1. Walking the dog. Running the dog, yes. I've seen people walking the dog. Usually they are stopped watching the dog do it's business. Call it a stroll, a time to get out of the house and relax, but not exercise.

2. Playing with the kids. Can't think of a better use of your time, but even keeping an active toddler out of trouble won't break a sweat.

3. Walking when the weather is nice. If that's your level of dedication, forget it. We live in New York! The weather is rarely nice.

4. Shovel the sidewalk. Don't get me wrong, it can be strenuous to shovel wet snow. But, it doesn't snow five times a week year round. It also only takes about five minutes, just enough to get the heart rate up and then stop. If that is your only exercise, you are looking for a heart attack, not preventing one.

5. Gardening. Love the flowers. Wonderful rest for the mind. Therapeutic and relaxing. It's closer to meditation than it is to exercise!

6. Walk to get the mail everyday. Unless it's through the snow 5 miles and up hill both ways, it isn't enough.

7. Mow the lawn. Pushing a mower for 45 minutes isn't bad, but it's once a week at the most. On further questioning, some people actually include a riding mower in this category of exercise.

8. Golf...in a cart. Get real!

Exercise means getting the heart rate up, breathing hard and sweating. It means you have to change your clothes after the activity because it was a good workout. If you don't need a shower it probably wasn't exercise. It must be regular. At least three times a week, better if it's five a week. Run, swim, bike, treadmill, stepper, tennis, gym workout, Curves, brisk walking, cross country skiing, snow shoeing, hiking, basketball, golf carrying your bag 18 holes, touch football, roller blading, soccer, aerobics video, spinning class, I could name another 20 good activities. I hope you can name a few good exercises you do next time you visit your doctor.

Parenting 101

2005-04-05T21:41:00.000-07:00

Addendum to "What's Missing"

2005-04-05T19:21:00.000-07:00

I posted "What's Missing" a few days ago. This week, I spoke to a child who suffers from anxiety symptoms. The child is smart, has loving parents and does well in sports. After talking about school, home, grades, sports and family, he said, "I just don't know. It just feels like something is missing."

Dr. Taylor's Rule

2005-04-04T21:23:00.000-07:00

My rule of divorce and re-marriage is this; if you have divorced and have children, you may not re-marry or share a house with someone else until your children are grown.

I repeat this "rule" everytime I can to my patients because I see countless broken hearts when people try to start another family. I see children tossed back and forth from home to home trying to adjust to their parents choices. I see adults leave one bad relationship to jump into another bad relationship.

If you have a broken home, why do you think you can do better the second time around? Not only have you proven that you can not hold a marriage together, but now you have the following handicaps on the next "family": an ex-spouse, child support battles, child custody legal battles, children, children who are adjusting to parents who are divorced, children who are forced to involve another parent figure in their life, children who are forced to "adjust" to your choices.

It's tough to go through divorce. It's tough to raise your kids in two different homes. Your children need all your attention. Your first priority is to them. That means waiting on a relationship for yourself.

What's missing?

2005-03-31T20:10:00.000-08:00

A fellow healthcare provider, a nurse practioner, asked me recently,"Why are there so many young people with so much stress, anxiety, depression and insomnia?" She went on to ask,"Is there something missing? Is there something wrong with this generation?"

I am daily reminded that there are many, many troubled young people today. When I was in high school, there was that one kid who had problems and was on medications. Today, one out of five in your college class may be on a medication for depression or anxiety (that came from a very brief chart review at a local college). Are we simply identifying problems that used to be swept under the carpet? Is it more acceptable to talk about problems with your doctor? Maybe it's because now we have so many effective medicines that we are using them more.

But today is different than yesterday. When I grew up, there was no internet, cell phones, cable TV, VHS not even personal computers! Maybe all these gadgets are consuming our time. Do we no longer have time to sit and talk to people or read a book? Certainly there are more vices today. Drugs and alcohol were common in my day, but today even more common. Abuse of drugs and alcohol can only lead to more problems and troubled young people. The pressure to have sex earlier and more often must add stress to many. Date rape was a term coined only a few years ago.

Homes are different. Teenagers are much more likely to come from a re-modeled family. Instability in the home must be difficult for a young person's mental health. Just when they are trying to discover themselves, their world at home may fly apart when Mom and Dad divorce.

Never before has it been more important to look good. Watch any reality TV show or American Idol. Only the beautiful and strong survive. It only adds pressure to us soft, oblong shaped people to be narrow, angular and firm.

Could it be a loss of spiritual foundation? If there is no God, young people are left to find meaning for their life. Many will spend many years in hedonistic pursuits and wind up empty when it comes to true fulfillment. Is it a lack of absolute truth in the universe? If God is not real, then morality is only what we decide to make it. And people have very different ideas of morality. A lack of spiritual answers may be what's missing.

Take control of your health insurance.

2005-03-25T21:05:00.000-08:00

I would love to see everyone sign up for a MSA (Medical Savings Account) or HSA (Health Savings Account). In my previous two posts, I highlight the basic flaws of managed health care. First, the insurance companies are trying to tell me how to best care for you. Please, just let me do my job and pay me a fair price! Second, when people get an "all expenses paid" health insurance, they become consumers. They want to get their money worth. That's not the idea of insurance. Insurance is to cover the unexpected expenses in life that you can not cover yourself.

A Medical Savings Account is in conjunction with a major medical insurance. With most companies, you can pick your level of risk or deductible. On our plan, a $5,000 deductible per person and $10,000 per family per year will cost about $350 per month premium. Compare that to managed care policy at $850 per month premium! You can save $500 per month to spend as you wish. Now, the idea is that you put that $500 per month into an MSA.

MSA's are tax deductible up to about $6,000 per year. If you take them directly out of your check, it is pre-tax. There are several products out there. Many are just like any interest bearing checking accounts. You write a check for medical expenses and it comes out of you MSA. Others allow you to use a debit card, Mastercard. You put money in the account and to access the money for health expenditures, you simply present your debit Mastercard. Cool huh?

Here's the best part, you decide how to spend your money. If you want brand name medicine, go ahead. If you want generic, just ask your doctor. No forms to fill, no prior authorization. You want dental coverage? Use your account for any medical expense. I have a couple patients who are using their account to pay for their treadmill. Try to get an insurance company to cover that! Also, you still have the collective bargining of your insurance company. For example. I may charge $50 for an office visit. But, you have Blue Cross Blue Shield MSA. We process your visit with BCBS. You have not met your deductible, so you are responsible for the bill. However, BCBS only allows $40 for an office visit. You only pay $40 because BCBS has a contract with me to allow a certain fee for services. This is especially important when you pay for x-rays and labs.

The down side is that you have to plan. You must be discipled and put the money in your MSA so it is there when you need it. You have to be ready to spend up to your deductible if you have a major health problem. A one week stay in the hospital and you will have to reach your deductible. After you reach the deductible, the insurance covers the rest.

If your family is healthy, you may get $6,000 in your account and stop contributing for awhile. Use the money for other things. Ask your employer to give you the option for a MSA or HSA. Take control.

Who's spending your health care dollars? Part II

2005-03-25T20:45:00.000-08:00

In my previous post, I try to point out that managed care has many "middle men". A big part of your health care dollars are spent by your insurance company trying to manage your care.

Now, I want you to consider who is being insured by these types of companies. Realize that in one way, insurance is a collective group covering each other. Your money goes to cover other people who use more health care dollars than you do. Here's what these people say in my office...

"No, I don't want to get Prilosec over the counter ($20). My copay is just $10. Can you write for the prescription brand? (Nexium $150)"

"Order everything you can on my blood work, I got insurance."

"I know you think it's okay, but could I get a Cat scan to be sure?"

"Can you write my prescription for two tablets a day instead of one. That way my insurance gives me twice as much for one copay."

"I can't come to your office and miss work tomorrow. I'm going to the ER to get my ears looked at tonight."

"Can you charge this visit differently so my insurance will cover it?"

In managed care, there is little fiscal responsibility placed on the patient. A $5 copay does not slow most people's consumption of medical goods and services. Instead, insurance companies put dis-incentives on the doctors for over utilization. This puts doctors on the side of insurance trying to keep costs down.

Bottom line today; there are many people using your health care dollars by consuming medical goods and services.

Where am I going with this? Read the next post to see.

Who's spending your healthcare dollars?

2005-03-24T21:39:00.000-08:00

What do most people want from health insurance? From my experience, most people want to be "covered". By "covered" they mean everything paid for. They want $10 doctor visits and $5 copays for medicine. They want 100% paid for hospitalization and x-rays. They want all their healthcare at their disposal with little or nothing out of pocket. But, what are they paying for?

Premiums for my employees are almost $800/ month. That is a basic managed care product. Copays for doctor visits, ER visits and medicines. Most everything else is covered. Some plans cost $1000/month. That's a lot of money each year for a healthy family of four. If you kick in about a thousand a year out of pocket, you and your employer have just given over $10,000 dollars a year to healthcare. Who gets all that money? Let's look...

Managed heatlh care means that nurses, a doctor and even trained lay persons review your care for appropriateness. If I think you should have a CT scan to see if you have kidney stones, my nurse must first call a number wait 15 minutes to have someone from your insurance company decide if you really need to have that CT scan. There you go, give a few of those dollars to that nurse or trained lay person to make sure I order the right test.

When I admit you to the hospital for a gallbladder attack, a nurse from your insurance company will review your chart to make sure you need to be in the hospital. The nurse will read the chart the first day in the hospital and each successive day to make sure you couldn't go home sooner. If she thinks you can go home on the first day after you had you gallbladder out, she'll have the insurance company doctor call me and ask could I please send you home. Now there's a big job, big salary. Give a few of your health care dollars to the nurse and doctor to watch your hospital admission.

I deal with dozens of insurance companies. Each one wants to make sure that I treat asthma, congestive heart failure, diabetes and high blood pressure by the latest standards. To help me learn these standards, they send me in the mail brochures, pocket reminders, articles and papers. Since each insurance company wants to do their job educating me I get dozens of information packets on how to treat asthma. Share a few of your healthcare dollars with the graphic designer who produced those slick packets for me.

While we are at it, let's not forget the accountants who hold back a percentage of my payments until the end of the year. At the end of the year your insurance company does a random chart audit at my office. They look and make sure you got your mammogram done, cholesterol checked and several other items of preventive care. If they give me a good grade, they will go ahead and give me a percentage of the percentage of the money they've been holding back from me for taking care of you. Shell out a few more dollars for the ones who grade my charts.

Forms. You're going to need to spend a few of your healthcare dollars on forms, because I fill out a lot of them to get your prescriptions approved. I fill out forms and copy your chart so your insurance company can see if you have a pre-existing condition. There are also forms called referrals for when I'd like you to see a specialist.

So far, I've only talked about your healthcare company. They get a large chunk of your $10,000 a year. Next post I'll talk about some other people who use a portion of your healthcare dollar.

Please save my little girl.

2005-03-20T18:40:00.000-08:00

Terri Schiavo's feeding tube was removed Friday. Her mother is now pleading for her child's life. "We laugh together, we cry together, we smile together, we talk together", her mother told reporters yesterday.

We've heard reports from doctors that she is in a "vegatative state". See my earlier post for this dicussion. I've seen video of Terri that shows reaction. I've also heard a neurologist give the opposite opinion of Terri's state of health. This neurologist's opinion is that she responds to voice, understands voice and can obey requests.

I've learned from watching many families of disabled individuals that the love and care they display goes far beyond science. Regardless of which doctor you believe, there is a family that loves Terri Schiavo. They don't just speak their love, they act. They are ready to care for her and help her.

But now Terri's mother is begging us to help. "Please, please, please save my little girl."

Donation after Cardiac Death

2005-03-20T11:41:00.000-08:00

In my previous post I described organ donation after cardiac death. The following are my ethical concerns.

The first ethical concern of any doctor is to preserve life. "First do no harm" is part of our oath as physicians. Can any of this process harm my patient? Giving anticoagulants obviously can harm. In most cases it is a safe medical therapy. Most patients who have chest pain or a suspected heart attack are placed on IV anticoagulation, heparin. This happens thousands of times everyday in the US. But, along with the risk of bleeding or stroke, there is a benefit to the patient. For the patient taken off of life support, there is no benefit to that patient. There is risk of complications.

Counterpoint, if the person or their family has decided to donate organs, they may also accept that risk for the benefit to another person.

Second, my responsibility as a doctor is to the patient I am attending. No "greater good" for society can outweigh my responsibility to you, my patient. When a decision for donation after cardiac death has been made, suddenly the attending physician must balance good of the patient versus good of others who may benefit from organ donation. Giving anticoagulation is an example. I must do something that will not benefit my patient but will benefit others. Also, there will be a very real desire to treat for the benefit of others. After life support has been removed, the organ harvest will only occur if the patient dies within 60 minutes. A team of transplant specialist wait in the next room. Your patient is breathing once every 15 seconds. It's almost an hour. Do I push 10mg of morphine to ease his suffering and thus hasten his death and pronounce death within 60 minutes instead of 61 minutes? Sound like a silly notion? It's not. There will be much well meaning pressure to help 6 suffering people on the transplant list and to end the suffering of the poor soul in front of you about to breath his last. It's called euthanasia. And doctors will be put directly in that situation.

Third, a family's time with their dying loved one will be taken away. They will be given time to say goodbye and then will be taken away to stay in an OR for their last breath. Not all hospitals will follow this protocol. Some plans call for the patient staying in the ICU until death with the understanding that the family must give way quickly when death is pronounced to take the patient to the OR. No one likes to watch death. It is a labor of love to sit by the bed, hold their hand, pray, talk, sing; while the loved one is struggling and gurgling for breath.

The bottom line of all these is that the doctor is placed in a position that compromises his attention to his patient. Do these concerns outweigh the potential good of donating organs? Does organ donation help a grieving family and dying patient who truly wishes their organs to go to some good?

Donation after Cardiac Death

2005-03-14T20:04:00.000-08:00

I want to describe the latest trend in organ donation and hear your thoughts.

There are 81,000 people in this nation waiting for an organ donation. An average of 17 of these people die each day. In 2002, organs were donated by 6,617 of 14,000 potential donors (46%). The US Department of Health and Human Services is leading a national movement to encourage hospitals to achieve donor conversion rates of 75 percent.

Organs usually come from cadaveric donors. These are people who are on lifesupport and are declared brain dead. The brain will not recover, but the organs continue to function on lifesupport.

Donation after cardiac death is a new way to collect organs. This occurs when a doctor and family of a patient decide to remove lifesupport from a terminally ill patient. In this case the patient is not brain dead. The doctor has decided that the patient has no reasonable hope to survive and that lifesupport is only prolonging death. At this point, if the family agrees, the patient can be taken to the operating room where a transplant team is standing by. In the operating room, the attending physician will remove lifesupport, inject blood thinners and wait for the patient to die. When there has been five minutes with no heartbeat or respirations, the patient is declared dead by the attending physician and the transplant team signaled to come into the room.

The decision to remove lifesupport is heartwrenching for a family. Not only do they have to deal with the loss of their loved one, but also the burden of "pulling the plug". It is important that their doctor guide them through this and help make that decision for them. I approach it by finding out what the family wants to do if the medical care becomes futile. I also usually already know what the patient would have wanted by our relationship. Then, I take the burden away by making the decision of when our efforts have become futile. It's very important that the patient's family and doctor trust each other.

Now add to this delicate time, a transplant coordinator who now wants to know if they can take your loved ones organs. How would you feel? Would you feel a sense of purpose knowing the organs would give others life? Would you be suspicious of your doctors motives?

On my next post, I'll discuss ethic concerns of donation after cardiac death.

Condom Effectiveness

2005-03-09T21:40:00.000-08:00

A funny thing happened on the way to the website today.

The Centers for Disease Control has published several links on condom effectiveness in the past few years. www.cdc.gov/nchstp/od/latex.html Most of the information about condom effectiveness can be seen summarized in an National Institute of Health paper written in 2001. This paper is based on a major meeting in 2000 to discuss all the relevant research on condoms and make consensus statements. The CDC has since taken this NIH summary and placed their own "spin". Take a look at the site above and tell me if you don't feel pretty safe with a condom between you and the world.

Granted, we all have our bias. So, here's my "spin". The best study to date shows the effectiveness of condoms against HIV to be 85%. Against gonorrhea causing PID, condoms reduced the risk by 55%. It's sketchy, but condom protection against chlamydia is "little or none". The outlook is better for the disease trichomonas, women will have 30% fewer infections if they use a condom. For syphilis the range is 0-40% fewer diseases transmitted when using a condom. For HPV, the transmission rate is the same with or without a condom. Protection against herpes is unclear, but using a condom likely gives little or no benefit.

Does that sound safe to you? The CDC has used descriptions such as, "highly effective" instead of saying 15% will still get HIV even if they use a condom consistently! Or using a condom "can reduce your risk" of getting gonnorrhea (45% will still get it), chlamydia (little or no effect) and trichomonas (70% will be infected).

See the summary at www.niaid.nih.gov/dmid/stds/condomreport.pdf

Terri Schiavo

2005-03-07T20:53:00.000-08:00

I felt my heart pound in my chest and a catch in my throat watching the videos of Terri Schiavo. www.terrisfight.org There are several video clips of her responses and actions. The videos speak volumes of truth.

When all we hear is persistent "vegatative state" on the news, we get the picture of someone lying still, eyes closed, blank, empty, gone. We think we know what we mean by the term "vegatative state". The USA Today said, "a medical condition called a vegatative state". Actually, it's not a medical term. It is not accurately or consistently used or defined in medicine. I've heard the words coma used to describe her. Coma makes me picture a withdrawn, void, shell of a person. That's what the print media is giving us.

Watch some video. Go to the website. She opens her eyes. She smiles. She responds to her mother. She has excitement in her eyes as she listens to music. She seems to understand instructions. This is not the picture I had from the newspapers.

But that is not what moved me the most. I was touched. No heartbroken to see the tender love of a mother. In at least two of the videos, Terri's mother is shown talking and caring for her daughter. This woman loves her child! I would be sad to see Terri die. But, I would feel sick, to see this mother lose her child. I'm a father. I know that no matter how disabled my child became, I would love them. I would care for them night and day. It's my nature as a father. The drive to care for and protect my children is stronger than my drive to live! There is nothing earthly I wouldn't sacrifice to care for my kids. For this reason, I relate to Terri's mother.

Every person has the right to die without invasive medical intervention if they so choose. The problem comes when the person has no ability to make that decision known. Then it is left to the next of kin to help their doctor decide. When in doubt, most will give their loved one every chance to live. Terri Schiavo's case is difficult because she left no written "living will" or "health care proxy". If she had either in place, there would be no dispute. A "living will" and "health care proxy" are easy forms to fill out. I have them in my office and my patients can sign these anytime. Without those written instructions, the courts are left to decide who should speak for Terri, her husband or her parents.

Michael Shiavo is the legal guardian as her husband. He believes she would not want to be kept alive in her current condition. Her parents simply want to be able to take Terri into their own home and care for her.

Monica (not her real name) is 23 years old. When she was 6 years old she had severe seizures and brain damage leaving her severly disabled. She can not walk. She can not talk. I can not make out any meaningful facial expressions. She has a tracheostomy and she has a feeding tube. From the video, Monica is more disabled than Terri Schiavo. Monica is my patient. She has a loving mother and father who take incredible care of her. They have no other life but caring for their severly handicapped daughter. They never complain. They never question. They just love her, kiss her, hug her, talk to her, feed her, dress her and change her. They would never give it up. They would never turn away from her. I couldn't comprehend doing anything to harm their little girl. If I were to suggest removing her feeding tube (I never would) they would fight me with every breath and every moment with all their strength.

So will Terri's mom and dad.

Watch the video. You will too. www.terrisfight.org

Trampolines and things

2005-03-03T17:17:00.000-08:00

(This is a contiuation of the previous post.)

Rocco was a funny, happy, loved Italian young man. At 30 he was single, but had family all around him. He was especially close to his mamma and brother. The first time I met him at the hospital, he was glow in the dark yellow. He had jaundice. An uncommon consequence of heavy alcohol consumption is hepatitis. Alcoholic hepatitis causes the liver to be unable to breakdown blood products, thus bilirubin builds up in the blood causing the yellow color of the skin called jaundice. He was young and drinking heavily on weekends and having a few on weekdays. I took care of him in the hospital and advised him to quit drinking completely. He didn't. Over the next three years I watched him fall apart from every possible complication of drinking. Cirrhosis, bleeding varices from the esophogus, ascites (fluid in the abdomen), delerium tremens and alcoholic dementia. He died in his early 30's. He could never defeat his addiction to alcohol.

Unfortunately, I have watched that story over and over again. By now I can predict when an alcoholic has less than a year to live by simply looking at their labs. I can't give you their real names, but I still remember each of their faces. People who are now gone because of the ravages of alcoholism.

How many more lives are hurt by a family member who is alcoholic? For every one that died, there are 20 more that have "only" the family and social problems related to their alcoholism.

How many more are no longer with us because of drunk driving?

I watch many Christians who display their freedom by drinking socially. I don't. I can think of no other substance in our society that is the root of so much pain and death. I want no part of it.

Trampolines, Walkers , Four Wheelers and Tobacco

2005-03-01T21:42:00.000-08:00

Ask a pediatrician what her most despised objects are and at the top of the list will be trampolines, walkers and four wheelers. (Up North replace four wheelers with snowmobiles.) During my pediatrrc residency at Arkansas Children's Hospital, trampolines meant broken clavicles, humerus and ulnas. Walkers are feared because they allow toddlers who were meant to stay in one small place on the floor, access to the whole house. They tumble down stairs, pull on electrical cords hanging from the kitchen counter, put their fingers in electrical sockets and touch heaters. Four wheelers and snowmobiles produce major trauma in little bodies. Also in my residency I worked on our transport service. We often went to rural Arkansas to pick up broken bodies thrown or trampled by a three or four wheeler. When you see such pain and suffering caused by using an object or an activity, you tend to transfer some anger and dislike to the object or activity.

I don't like trampolines, walkers and four wheelers.

I hate alcohol and tobacco.

There has never been a moment in my eight years of private practice that I wasn't watching a patient of mine dying from smoking. It's slow, painful and pitiful. The first was a man who came to my office in the first week of my practice and a chest xray revealed a large pneumonia and lung cancer. He walked into my office that day, but he never walked home. In the hospital he became weak. He and his wife were of Eastern European decent. They spoke little English. She couldn't understand how her hard working husband couldn't get up and walk home. He died in that same hospital a few months later.
Another, Tony was a wonderful, loveable guy. In his sixties he looked eighty. In the last 2 years of his life, he was in the hospital about 8 times. At home he wore oxygen and could barely walk to the bathroom without gasping for air. He spent his days driving. Behind a wheel he could move about and get his mind off his constant struggle for air. As his lungs failed, he slipped from consciousness into a hypercarbia coma. His last day was peaceful unlike the last years of struggle. Lung cancer emphysema both are awful ways to die.
Yet, countless young people still pick up their first cigarette. The addiction is so strong. I've looked several patients in the eye and told them they have less than a year to live if they continue to smoke only to see the resigned helplessness in their eyes. They know the addiction is too strong.
I hate tobacco. More later.

Fooseball and Parenting

2005-02-28T19:34:00.000-08:00

My boys love sports and competition. For the past five years since David was 5 and Drew was 7 I have battled an overzealous competitive drive. It was about then that we started with whiffle ball games in the back yard. David is an excellent pitcher and Drew has a head for the game. It was usually Dad against Davey and Drew. We had many great games on Saturday afternoons or weekday evenings as the sun was setting.
But, almost every game was peppered with frequent crying spells and anger outburts. Arguments over calls, wails that "he cheated", the despair of "I quit" and the agony of defeat always put a damper on our fun. In fact, it was a down right chore for me to go out and "play" with the boys. I spent most of my time massaging hurt feelings and breaking up fights. Each summer I'd think maybe next spring they'll be better, maybe next year will be fun. But each whiffle ball season for five years has come and gone with about the same amount of poor sportsmanship.
Then tonight we played fooseball. It's winter in New York. The basement is in full swing for games and activities. It's also winter break so the boys have had a full week of fooseball. We have a great wooden table with detailed fooseball men. The boys have had friends over to play and played each other dozens of times. Tonight after supper, I was their next victim. Dad against boys. First game I held my own but lost 10-7. Second game they were laughing, I lost 10-4. Third game Dad goes down 10-2. Fourth game I start to cheat. I'm holding not only my men, but also theirs. That's when it struck me. They're laughing their heads off! I'm laughing. We're having a great time. After beating me three more games even with me trying everything possible, I laid down on the couch with sore hands and watched in amazement as my boys played game after game without arguing.
I teach my patients the three C's of parenting; Calm, Confident and Consistent. I never thought I'd have to be consistent for five years to see a change in my boys.

God's Word is Sharper

2005-02-26T17:22:00.000-08:00

Last night we had several men from our church to create a worship mission statement and guidelines for those who serve. We met in our living room in front of a bright fire in the fireplace.
We started by recounting several examples of worship. Solomon at the dedication of the temple. He got on his knees and lifted his arms to heaven and led the people of Israel in prayer. King Hezekia and King Asa both destroyed idols, restored worship of God and led the people bowing down in worship. King Josiah after restoring the temple and finding the books of law, read the books to all the people. In Revelations chapter 4 the elders cast down their golden crowns and said, "Holy, Holy, Holy is the Lord God almighty!". These are all great stories. The king stories are in 2 Chronicles if you want to read.

There were two main truths gathered from these readings. God is exalted. We are humbled. We decided to have our worship mission statement incorporate those two ideas. After a half hour of discussion we came up with something like this, "Our mission as worship leaders is in humble submission to God and His word to praise, adore, exalt and lift Him up."

Then we found 1 Peter 4: 11
"Whoever speaks, let him speak as it were the utterances of God; whoever serves, let him do so as by the strength which God supplies; so that in all things God may be glorified through Jesus Christ, to whom belongs the glory and dominion forever and ever. Amen."

'nuf said. God as always says it best. We scratched our mission statement and replaced it with 1 Peter 4:11.

What's Your Calcium Score?

2005-02-24T15:29:00.000-08:00

You are going to be hearing a new buzz phrase soon, "calcium scoring". Inevitably others like "what's your calcium score?" will follow.

Calcium scoring refers to a technique to calculate your heart disease risk based on a high speed CT scan. A CT scanner will take images of your heart and reconstruct the images to make a 3D picture of your heart and coronary arteries, the vessels that feed the heart. CT scans can see calcium that may be building up inside your arteries. Another name for this is plaque. As the calcium or plaques build up, the artery becomes more narrow. When an artery narrows down completely, the heart that it feeds suddenly does not get blood flow. Thus, a heart attack.

The problem in the past with taking pictures of the heart has been the same as trying to take action photos. The heart is always moving. Now, new CT scanners are fast enough to capture pictures of the heart. The calcium deposits will be measured and compared to standards to obtain your calcium score. The highest scores will be referred to the cardiologist for further testing such as cardiac catheterization.

The advantage of this test over stress tests is speed and ease. The pictures are taken in seconds and the whole exam may take just 15 minutes. The drawbacks are that it is new and knowing what to do with the scores will be hit and miss at first. I think alot of people with a high calcium score will have a cardiac catheterization at first until more experience is obtained with this technology. Another negative is that this is not a dynamic test like a stress test. Laying on a table doesn't tell you how your heart is performing. The last disadvantage will be cost. Here in Utica, New Hartford Scanner is offering the test for $250 cash. On the internet I saw another advertised for $500. Insurance will not cover it yet. My guess is alot of people will lay down the money.

Maybe the best aspect of this test; a normal scan. If the scanner sees no calcium or you recieve a very low score you can be pretty happy about a good heart.

So be ready for the next watercooler topic at work. No longer will people be content just to brag about their Lipitor lowered cholesterol level. Those same people will be sporting their latest "calcium score". Here's a good site to further explain the test.

http://www.newportbodyscan.com/GuidetoCoronaryCalciumScoring.htm

What's up with Celebrex?

2005-02-21T21:12:00.000-08:00

With the voluntary withdraw from the market of Vioxx and the news questioning Celebrex's safety, many are worried.

Here's what happened. In March 2000 Merck, the makers of Vioxx, became aware of the results of the VIGOR study. This study looked at the gastroentestinal effects of Vioxx at 50mg (twice the normal dose) and naprosyn at 1500mg per day. While Vioxx was gentler on the stomach, the rate of cardiac events was slightly higher than with naprosyn. But, because previous studies had shown no cardiac effect and this was with higher than normal doses of Vioxx, the drug stayed on the market and Merck continued with three large studies to further look at the effectiveness and safety of Vioxx. The APPROVe study was to look at the effect that Vioxx had on colon polyps. It was a 3 year, prospective placebo controlled trial. At the half way point, Vioxx had no higher cardiac events than did placebo. However, at 3 years the cardiac events were twice as high in the Vioxx group compared to the placebo group. Within one week, Merck voluntarily withdrew Vioxx from the market.

In December of this year, the National Cancer Institute halted a trial that showed Celebrex taken at 400mg twice a day had 3.4 times the risk of heart disease as placebo. Celebrex at 200mg twice a day the risk was 2.5 times higher than placebo. This led to warnings and caution about use of Celebrex at usual lower doses.

This week the New England Journal of Medicine will release these studies along with a third that shows Bextra also increases the risk of heart disease versus placebo. We now have evidence to say there is a class effect. Vioxx, Celebrex and Bextra all belong to a class of medicines known as Cox-2 inhibitors. It is now important to discuss the use of these medicines with your doctor. In most cases these medicines should be stopped. In cases of disabling arthritis only helped by one of these meds, a decision could be made to stay on the medicine.

Worth Waiting For

2005-02-17T20:34:00.000-08:00

Deb and I are presenters for a program called Worth Waiting For. We do a sexual abstinence presentation to schools and churches. The group reaches over a thousand teens each year. Tonight we had a meeting of all the presenters. What a wonderful time! We had about 15 young people from several different area churches all gathered in our living room talking and praying together. I gave a presentation on the ethics of life discussing "When does life begin?". We discussed embryonic stem cell research. Bethany, our program director, had a great survey and discussion on Millenials, the generation born from 1982 to present. We are trying to understand the teens that we are speaking to. We finished with a discussion of commonly asked questions. After we present our abstinence program to churches we often have a girls only and guys only Q &A session. The questions are almost always the same. "Am I still a virgin if...?" "Is masturbation wrong..." "What about pornography..." We have developed some biblical answers to those questions after wrestling with them over the past few years.

It is such an honor to work with so many commited Christians who are pursuing purity in every aspect of their lives. Tonight we talked and prayed about how we can wrap up God's word in parables for our school presentations. We have always felt incomplete teaching abstinence in schools without being able to teach them about God. I've always felt that to be an unavoidable handicap. After all you don't get to heaven by being abstinent from sex. You get to heaven only through Jesus. I do believe that the Holy Spirit goes with us and even though we can't say His name, He works His power. We speak truth. I think they see something different in our presentation that I pray makes them seek out the Truth.

If you would like to know more about how to start an abstinence program in your area let me know. If you'd just like materials for a one time presentation to your Youth, email. If you are in this area and want us to present to your church or school write.

Direct to Consumer Advertising

2005-02-15T16:42:00.000-08:00

My brother doesn't like the Cialis ads. You can see his blog from yesterday, Homeward Bound, Brent Taylor. What have Cialis ads done? From my perspective it adds five minutes to the end of probably a third of all my visits from men. Usually as I'm about to walk out the door "the problem" is mentioned. What bothers me is the number of healthy men asking for meds for erectile dysfunction. They seem to believe it will give them enhanced performance. Let me just say now, Cialis, Levitra and Viagra all restore dysfunctional erectile dysfunction and that's all! They do not make you into Superman! There, I feel better. All the fuss is because the pharmaceutical companies are marketing directly to consumers. If it weren't for all the fuss, I could screen my patients for erectile problems and discuss the medication with the appropriate patients.

Another effect of media on medicine came with the arthritis drugs; Vioxx, Celebrex and Bextra. These medicines are anti-inflammatory meds that are easy on the stomach. Their effectiveness is similar to Advil or Aleve. I think they are great drugs. Good arthritis treatment with much lower risk of stomach ulcers or gastritis. The only draw back; $150 per month compared to $5 for Advil. When the big three Vioxx, Celebrex and Bextra first came out and were marketed to consumers, I had most of my patients asking for the new arthritis meds. I discussed their effectiveness and cost. I encouraged patients to stay with Advil or Tylenol or Aleve if they worked well. Amazingly, the vast majority were not happy with the old meds. They wanted the new expensive ones. Now most insurance companies weren't going to just shell out over $100 per month for a new drug. They produced hurdles. I filled out hundreds of prior authorization forms for all my patients who just couldn't get by without Celebrex or Bextra. Suddenly there were all kinds of side effects to the old standbys. Advil hurts my stomach. Tylenol just doesn't work. I spent hours on the phone with patients and insurance companies trying to resolve the arthritis med question. Do they need Celebrex? Can they get by with Aleve? The insurance company wants them to try three generics before they will pay for Bextra. I handed out thousands of samples for those who couldn't get their insurance to cover Vioxx. Stocks soared, commercials aired, insurance companies whined, patients called and many, many worked the system and my office to get their new arthritis med.

Vioxx causes heart problems. Celebrex in high doses may cause heart problems.

You'd never believe how many people suddenly are doing just fine on Tylenol. I asked one lady on the phone how she was doing with her Celebrex. "Oh, I stopped that when I heard the news. I'm just taking Tylenol whenever I need to." It's amazing how a little bad news about a drug can weed out those who really don't need the medicine.

There are a few of my patients who really get a big benefit from Celebrex or Bextra. Without it they couldn't function. They have elected to stay on the medicine. Funny, if there had never been any media hype to market these drugs and no hype about their side effects, I think these people would be the only ones I would have precribed to begin with.

Blessing our children

2005-02-12T19:33:00.000-08:00

I have so much to do. So much to accomplish. I could say I had a good couple of days. I spoke to three classes of 5th grade boys on Friday on what it takes to be a man. Deb and I took a group of 12 kids sledding today at Camp Hunt. We had a great time fashioning a "taboggon run". But didn't feel like I'd done much until tonight. Sometimes those of us who work with youth short change our own kids while trying to help others.

Debbie and I spent 20 special minutes with each child tonight. With Emma we snuggled with her in bed and read a story and talked and prayed. There's something special about having Mom and Dad reading to you at night. After I said a prayer with her, she didn't ask me to stay longer or for another book or for water. She had everything she wanted and peacefully said, "Have a good night Daddy" as I left the room.

David was next and he likes a good back rub. We got the fire going and as Debbie rubbed lotion on his back, I read the Psalms to him. He relaxed and was quiet. Quiet is a big thing for a 10 year old boy. He too went back to his bed content. Drew we sat in front of the fire and read Proverbs and Mark chapter 4. Deb rubbed his hands with lotion and he rested his head on my shoulder. He started to doze when we sent him sleepy eyed back to bed.

I too am content. God made me to bless my children. When I fulfill my Maker's plan then I am at peace.

You may have a case of Differentialitis

2005-02-08T22:22:00.000-08:00

I’ve been writing about medical fear. The observation of mine that most of the patients I see come not with an illness, but with fear of an illness. I counsel and give reassurance. I’ve found there is a true art to this medicine. The best reassurance is my experience and confidence which of course improves with time. I’ve also learned to speak straight with my patients. Sometimes the medical field makes patients paranoid of illness by giving them every possible scenario that could happen. In our desire to educate patients we often give too much information only to make them worry about what else might happen.

An example is a patient with chest pain, cough and congestion. I have a long list, differential diagnosis, of possible reasons for chest pain. A patient often will say, “I have this chest pain doc. What is it?” To which I reply, “After I ask you about twenty questions I’ll give you an answer.” My interview and examination take me through my long list of possible etiologies eliminating one at a time until I reach a conclusion. “You have a chest cold and pleurisy, which is inflammation of the chest wall caused by the same virus that caused your chest cold. You’ll get over it in about a week.”

The problem comes if we, the medical professional, start to think out loud. “You have chest pain. I don’t think it’s your heart because it occurs mainly when you cough. But, if the pain becomes more constant or you become short of breath call me or go to the ER. Sometimes acid reflux can cause chest pain like this. Maybe you could try some Mylanta next time it occurs. Sometimes these chest colds turn into pneumonia. If you start to have high fever and difficulty breathing be sure to call me. But, you probably just have pleurisy and a chest cold.” The patient leaves without an answer and trying to remember all the things he should call back for. His real problem becomes differentialitis.

Why do we often talk this way? Because we hate to be wrong. If we tell you all the possibilities of what your illness could be then we weren’t wrong. Because we aren’t really sure. You need to have a doctor you trust to give you his best impression and allow him to adjust if your symptoms change. Because we are afraid of being sued. If we tell you every possibility and warn you of every symptom that might indicate something worse, we can write it in the chart and won’t be held liable in a court of law. Again, if you can trust your doctor and your doctor is open to talk to you anytime you don’t have to go over every differential at the office visit. It’s important that patients feel free to call their doctor more than once about the same problem. The doctor needs to make his patients feel welcome and at ease when they consult at the office or on the phone.

I saw a toddler yesterday with cold symptoms. I interviewed the mom and examined the child. I told the mom her baby was okay with a cold virus. Call if it changes. She did. Today she called to say the baby coughed most of the night and cough syrup didn’t help. I asked if the baby seemed to have trouble breathing. She said yes, a little labored. I had her bring the baby in again. On exam the baby was about the same. I gave them a little medicine for cough and wheeze. I know that RSV, respiratory syncitial virus, is circulating now. Babies often have wheezing and trouble breathing with RSV. I explained that on the second visit. The mom didn’t have to worry about all the differential diagnosis. She felt comfortable enough letting me worry and bringing the child back if there was even a small change.

I hope you have a physician you can call on. If you are my patient, I hope you feel comfortable calling me.

2005-02-07T20:51:00.000-08:00

Toby and Debbie

Memories of a Patient

2005-02-06T15:48:00.000-08:00

I was at a local store today checking out a close-out sale (I found some good ski-bibs for the boys!). At the check out a woman approached me, “Hi Dr. Taylor do you remember me?”. I always need a little help which I’m quick to ask for. She is the daughter of a patient who passed away this past year. Molly (not her real name) was a delightful woman. Diabetes and failing kidneys kept her weak and tired, but her mood was always good, always patient. It seemed every time she was in the hospital it was a weekend that I was running a local race. She’d ask me about my running, about my kids, about recent vacations I’d taken, about church. I enjoyed sharing some of my life with her.

The five years I knew her she was a shell of the woman she once was. An active woman in her church, she went there regularly for worship and to work. She loved to sing and raise the roof. Her face glowed and I’d catch a brief glimpse of her glory years as she spoke of worship. In the hospital she rarely ate hospital meal. Her dedicated daughters would regularly bring her “good food” from home. On one visit to her house to check a wound on her head, I smelled fried chicken that rivaled my grandmother’s. It was her husband in the kitchen. He waved to me from the kitchen doorway with oven mitts. The aroma from the kitchen enveloped the home with warmth and pleasure.

Molly was black, I white. But we had so much in common in family styles. Both raised to love and praise the Lord, we shared a joy of being at church. She understood that when she was in the hospital I wasn’t going to round until after church. We both have loving extended family. The commitment to care for Molly at home even when her kidneys failed was a testament to her legacy. One of her daughters, a nurses aide, cared for her from the time she got off work until the time she left for work. Many times her daughter even left work to come care for her ailing mother. I could always trust her assessment of her mother. If Molly needed to go to the hospital her daughter would let me know and she was always right.

Peacefully she passed one day this past summer. Seeing her daughter at the checkout brought back rich memories of a matriarch who's strength showed in her family and lifted her up even when her body was weak and failing.

Media and Health

2005-02-05T16:41:00.000-08:00

Yesterday’s posting mentioned how TV adds to health care knowledge. This morning I turned on the TV and the first thing I saw was a story about a 40 something woman. She was attractive, fit exercising regularly. She had a good diet. She had no family history of medical problems. She didn’t smoke. On the screen she was a picture of health. But she still had a massive heart attack.

She survived to tell her story. When they returned to the studio, the talk show host had an older gentlemanly appearing doctor to tell us all the signs and symptoms of a heart attack. They went on to tell us to go see our doctor for screening. The message? Don’t let this happen to you! Do something about it! They also (just I described yesterday) put messages up on the screen highlighting how many million heart attacks occur each year in the US and symptoms to watch. It was an excellent program to promote health fear.

But, I think it really highlighted what I said yesterday. Life is fragile. The are no guarantees. If that woman the picture of health can have a massive heart attack then what about me? It also highlighted the other fact. People are looking for security.

Please don’t think I’m down playing the role of medicine. It’s my business. The information the cardiologist on TV gave is the same I have given verbatim to my patients day after day. It is important to check your cholesterol and do something about it. It’s extremely important not to smoke. Exercise regularly. Eat right. Many heart attacks can be prevented. Many cannot. Life is fragile. Take excellent care of your body. Find security in God.

A Heart at Peace

2005-02-04T18:35:00.000-08:00

Each summer the West Nile virus makes it’s headlines in Upstate New York and each year I retrieve a text and review the signs and symptoms of the illness. It’s interesting that I am looking up that information not to go looking for the disease, but my motivating factor is that dozens of people will come to me with various symptoms and wondering if they have the West Nile virus. This illness is especially fearful because it’s vector is the mosquito. Anyone who spends time outdoors is susceptible. To compound the problem I am confronted with the fact that some minor complaints may actually be the West Nile virus. There is nothing to do for an individual with low grade fever and headache and is otherwise functioning well. There is no treatment available. Why then do they come? One source is the local news. The TV will interview a local expert. At the end of the segment they run a list of symptoms across the screen and the statement, “if you experience any of these...” You already know what it says, “...call your doctor.”

I don’t mind calls and visits for reassurance. I enjoy seeing my patients. They want information. They trust my word. I never criticize anyone for coming to see me. But is the fear necessary? Why do we need to now the details of every illness? I think part is the feeling of control. We all want to think that we can do something to prevent a serious problem. If we just diagnose it early enough we can do something. We all want to feel that we don’t have to die. We have the power to stop illness.

When you have the worst headache of your life with fever to 104 and delirium, do you really need that list of symptoms on the TV screen to think to call your doctor? Sick people usually have no problem making it to the doctor. That being the case, do we really need well people worrying about and watching for all the signs and symptoms of disease. Maybe it’s enough to know that when you are sick your doctor will help you.

I don’t think we can change the media’s efforts. I don’t want to change it. I think it highlights a basic need. The need to feel secure. Secure in our health. Secure with our lives. A feeling that I can’t get a serious illness. It can’t happen to me. What I would like to change is the source of my patients security. Our security comes not from a healthy body but from a relationship with our Creator. Only then can we truly have peace.

Proverbs 14:30 A heart at peace gives life to the body.

2005-02-03T23:02:00.000-08:00

Toby and Debbie on recent trip to Focus on the Family

Paranoid America

2005-02-03T22:09:00.000-08:00

Am I treating fear or disease?

“He’s acting okay, but he’s been sick now for 5 days and I just wanted to make sure he’s alright.” I hear that line a couple times a day. A mother is worried and wants to make sure her child doesn’t have an ear infection or pneumonia. The child is usually playing with the toys and chattering away.

Of what are parents afraid? Things they can’t see like ear infections. Stories they have heard from a neighbor who’s child had similar symptoms and the doctor told them pneumonia. The story on the news of the child who was normal and ended having leukemia. Maybe they need an antibiotic. The teacher at school said a lot of kids have this and you should take your child to see the doctor. Her mother-in-law insists the child doesn’t eat enough and there might be something wrong with his immune system.

“I have a bump on my privates.” This line comes to me fast and furious. I had two college students today with concern that they picked up a sexually transmitted disease. “My joints ache. I hurt all over.” A common refrain especially from women. Worried they have lupus or rheumatoid arthritis they come with relatively minor complaints seeking knowledge. And yet another, “I got a rash and read on the internet that it could be a sign of AIDS!”

Paranoid America. Are we a people afraid of dying? Are we so afraid of illness that we are not living? Does fear of illness effect people everyday or do I just see the rare occasion when worry gets the best of a person. Is there so much information out there that we make ourselves crazy?

Today I encountered almost every scenario above. I spend very little time diagnosing and treating disease. Instead I spend much time calming fears. For the next couple posts, I’m going to discuss the factors that make Americans obsessed with illness.

Iraqi Freedoom

2005-02-01T08:44:00.000-08:00

It was a big day in Iraq. The first time to have free elections. I watched for the first time in weeks the evening news and was happy to see good news. After a day at work and isolation from the news, I headed to the TV and said a brief prayer that God would keep all our soldiers and all Iraqis safe on this important day. In the next brief instant I felt God put a jab of conscience through me. Why hadn’t I been praying for days, weeks, months fervently for their safety?

The prayer of a righteous man...

We all cringe each time we hear the news or pick up the paper. How many dead today? I have vague but real memories of the same as a child with Vietnam. It seemed every evening news was headed with a count of casualties and pictures of war. So for many of us who remember, it’s painful to watch again.

Why the cost?

But as I reached the TV I was greeted with good news. There was no report of suicide bombings. No attacks. I said another heart felt prayer of thankfulness. They showed three women, daughter, mother and grandmother. Three generations of Iraqi women voting for the first time. I saw a 79yo Iraqi who walked a mile being helped on each side by two men taking one slow step at a time. The determination on his face. The joy he showed when he came out of the polls. There was dancing in the north as people voted. This was an area where 10 years ago the Sadam regime used deadly gas attacks to kill thousands.

Who will pay the price?

I also saw a story that especially touched me. An oral-facial surgeon from California spent 10 months on duty in Iraq as a reservist. When he came home he signed up for full time duty in the Army. He has a wife and two boys. He left a $2 million dollar a year practice. He’s going to go back to Iraq and save lives. Another story of a father and son both in the Navy. Both in active duty in Iraq. With such self sacrifice, who am I to complain about a tax bill?

I am praying more for this war. I want to see it end soon. But not before the security of a nation is complete.

My Christmas Miracle

2005-01-30T14:49:00.000-08:00

Every Christmas I struggle to find a “daddy” gift. Debbie does most of the shopping and I’m sure I could leave it all in her hands and the kids would do just fine on Christmas morning. But, each year as the final week approaches I get that feeling that I should get something for the kids. I admit to several years of uninspiring gifts. I can’t even remember what I gave them. But this year I did it! I have to credit God’s direction and prodding because I’ve been lacking in this department for some time. This year’s success in gifts for the kids was His.

As I wandered Wal-Mart in a material daze, I saw row after row of toys that I knew from past years would simply pile up in the basement. What could I give them that would be significant? Memorable? Fun? It came to me; my time. Instead of just any toy, I decided to find something that I could do with them one at a time.

A model rocket was the first to catch my fancy. Assemble, learn about launching and the trip to the park to launch all add up to some great time with David. We’ve had two launch days so far. The first day was 0 degrees F with wind chill somewhere below. But, we had a big park with snow covered field and few spectators who were sledding on the hill nearby. Debbie stayed in the van with video coverage. We had 3 successful launches that day! It was an event. It was exciting. David thought it was cool. Today we had two more launches. This time and even bigger crowd of kids and parents sledding and 30 degree weather. The rocket goes so high you almost can’t see it and then reappears spinning with parachute breaking it’s fall. We had half dozen boys chasing it down.

Drew got a model ‘56 Chevy from his uncle Greg. We made it over Thanksgiving break. Now we have a ‘74 Datsun and a ‘67 Camaro to put together. He loves a challenge and has the patience to see a model to completion. We haven’t done them yet, but the anticipation is still fun.

Emma was tough to buy a gift. Girl stuff just isn’t my strong point. Debbie usually covers that. But for less than $10 I got a color by numbers set and a kid’s scrapbooking kit. We’ve already had a few coloring and scrapbooking sessions together.

Well, that’s it. My Christmas miracle. Discovering a gift that lasts for my kids. I hope and pray you have the same success. If you do, please write me soon. I need ideas for next year!

Toby

Sanctity of Human Life Sunday

2005-01-29T22:12:00.000-08:00

We are recognizing Sanctity of Human Life Sunday today. It was actually last week. But I was at the Plymouth Alliance Church in Sherrill, NY to speak to them for SOHLS. I had a wonderful time worshiping with them. And I always love a chance to speak about issues of life and abortion. God’s word is full of references to children in utero. God speaks of in utero children the same as post partum. One of my favorite references is Luke 1.

In this chapter we learn of the miraculous conception of both John the Baptist and Jesus. The physician, Luke, gives us medical detail not found elsewhere. Elizabeth secluded herself for five months and it was during her sixth month of pregnancy that Gabriel appeared to Mary. Gabriel again gives the month of gestation of John the Baptist. “And behold, even your relative Elizabeth has also conceived a son in her old age; in her sixth month. For nothing will be impossible with God.”

Luke goes on to tell us that Mary went with haste to the hill country of Judea. Now if Zacharias was performing his duties in the temple in Jerusalem, I’d assume their home was in or around Jerusalem. Regardless, it was in Judea. Mary traveled from Galilee in the north about 80 miles if you draw a straight line on my map. Even in a hurry, it likely took Mary 5-7 days to reach Elizabeth.

There were two surprise and excited people at the arrival of Mary. First, John leaped for joy in his mother’s womb. God attributes emotions and the ability to sense the enviornment to the in utero John. Second, Elizabeth cried out with a loud voice, “Blessed among women are you, and blessed is the fruit of your womb! And how is it that the mother of my Lord should come to me?”

When does life begin? It’s an important question today. It’s not going to be debated enough. It’s not even going to be answered by our society. Relativism is rule. Each person has the right to decide for himself. There is no absolute truth. But, ...God leaves no doubt.Elizabeth makes it clear Mary is already pregnant, “and blessed is the fruit of your womb!” And at 5-7 days gestation, Jesus is referred to as “Lord”. John sensed his Lord’s presence.

At 5 days gestation, the baby is in the morula stage. A sphere of cells just starting to move and form tissue. In my college courses it was called an embryo. Today a new term has been invented, “pre-embryo”. It’s a term used to de-humanize human embryo’s suspended frozen in time and left over from in-vitro fertilization. It’s a term for the stage of human life that many feel is okay to research and destroy. It’s the stage in life that to many is not life and not a unique person. What a contrast to God’s word. People we have to realize that stem cell research is destroying human life.

Joseph and Forgiveness

2005-01-27T22:02:00.000-08:00

My first blog posting, I'll jump off my brothers post. R.T. Kendall wrote a wonderful book, "Total Forgiveness". He uses the story of Joseph to document true Biblical forgiveness. Joseph was wronged. Despised by his brothers,he was sold into slavery. Compounding the pain was the fact his father suffered the loss of his child. In Egypt, Joseph overcame the odds and found a good position as a trusted servant in a good house. Even here when he could have thought life is improving, he is wrongfully accused and sent to prison. Now even less a slave, a prisoner. In prison God still uses him to interpret dreams. When he successfully interperts the cupbearers dream he asks to be remembered when he is restored to his position. Then what happens? Anyone? He sits two more years. Joseph hit rock bottom and wallowed there two years. Why? What was God doing? To find the answer, we must look at Joseph before and after prison.
After prison he was generous and kind to those who wronged him. He showed them love. He even showed his brothers how to face their father. He gave them the exact words to say to their father. Wow! What a relief to the brothers. After the initial shock of seeing Joseph alive, the brothers had two concerns. One, what will Joseph do to us. Joseph answered that quickly as he hugged, cried and then ate with them. Two, what are we going to tell our father? Genesis 45:9 "Hurry and go up to my father and say to him, 'Thus says your son Joseph, "God has made me lord of all Egypt; come down to me, do not delay." No accusation. No "wait til I tell Dad!". The brothers wouldn't know what to say. Joseph gave them the words.
Before prison Joseph was at the least naive and at the worst arrogant as he wore his father's coat and told of grandiose dreams. It's subtle and by our standards minor, but in prison Joseph had not yet forgiven those who wronged him. Genesis 40:14-15 Joseph tells the cupbearer, "Only keep my in mind...for I was in fact kidnapped from the land of the Hebrews, and even here I have done nothing that they should have put me into the dungeon." Joseph still carried the wound. He still had the pain of bitterness. Maybe it took two more years for God to win his heart over and for Joseph to totally forgive those who wronged him.
Why do I say this? If Joseph had spent those two years in bitterness and self pity he could not have responded the way he did when faced with his brothers. He didn't spend those two years plotting revenge. He didn't spend those two years feeling sorry for himself. He spent those two years slowly breaking down his own will and putting himself into God's hands. Only a man at peace with God could say to his brothers,"do not be grieved or angry with yourselves, because you sold me here; for God sent me before you..."