PegSpot

Dr Peg on Veterans Day

2010-11-15T21:40:00.000-08:00

My latest Daily Lobo article

Dr. Peg on Itching

2010-10-25T19:52:00.001-07:00

My latest Daily Lobo article

De-stress a little at a time

2010-10-19T20:51:00.000-07:00

From my Ask Dr. Peg column in the Daily Lobo newspaper.

Take Time to De-Stress

Flu Shots

2010-10-19T20:47:00.000-07:00

From my Ask Dr. Peg column in the Daily Lobo newspaper:

Should I Get a Flu Shot?

Consider NOT Considering the Source

2010-07-17T16:56:00.000-07:00

Consider the source.

That is one of those truisms for critical thinking we learned in college. Before you accept something you hear or read as truth with a capital T, look at who is saying it, and decide if they are worth listening to or not. Is this person an expert? Is this article peer-reviewed? Was the study double-blinded? Could this person be biased? Do I even like this guy?

It's a good idea, to an extent, but I submit it can get carried too far. Do you ever consider the source before you listen to what they have to say? I know I do. Oh, that guy is a Republican. I know I won't agree with him. Her? She said something nasty and untrue to my friend the other day. I know I won't believe a word she says. My husband? I'm pissed at him for something he did this morning, so anything he says today I'll take personally.

The thing is, if you filter stuff before it even gets to your brain, like this, you can miss out on a lot of good information. That Republican guy might have something reasonable to say about the gulf oil spill. The nasty gal might have just been on the rag the other day and have a great tip for sale dresses today. My husband making an observation about my behavior might just be right (I cringe to admit).

I've been practicing NOT considering the source. Try evaluating the message on its own merits. Forget the messenger. Whether it be someone's take on current events or feedback on how I come across, I'm trying a "just the facts, ma'am" approach. Is the message valid, interesting, worth considering? If so, it doesn't matter where it came from. I can learn from the message, even if I'm too biased to learn from the messenger.

If the message is worthless, let it go. Push the eject button and get it out of my mind. Easier said than done, but worth a try.

Getting rid of excess body hair

2010-01-19T09:26:00.000-08:00

My latest Dr. Peg article in the Daily Lobo.

"Did you kill anyone over there?"

2010-01-16T18:34:00.000-08:00

This is one question it is NOT okay to ask an Iraq war veteran. I know this, although I've never been exactly sure why. Best I could figure, it is because a) that is an intensely personal question, kind of like asking a stranger if they've ever had an abortion and b) because the answer is most likely "yes" and I should know that and they probably don't want to talk about the war.

Recently I have become acquainted with an army veteran of some thirteen years, multiple continents and numerous conflicts, including Afghanistan and Iraq. Thanks to his courage to look within and work hard, he has done a lot of healing from the inevitable psychic wounds of war, and thanks to his generosity in sharing, I am learning a lot from him.

I asked this vet why the question is so taboo. He explained that, during the conduct of war, you have to do things that, in our civilian society, are unacceptable. In peacetime, killing another human being is murder, and it's wrong. In war, it is the business of war. You do it because you have to, because they are the enemy. You kill people, you see people killed, you witness horrible destruction and suffering. It is what you do in combat, yet part of you whispers that if you're doing this, you must be a bad person. Sometimes, that part becomes convinced.

When you come home, you put those things, the events of war you have lived through, into a fragile compartment in your mind and protect it carefully.

If you try to answer the question, "Did you kill anyone?," all of a sudden you are forced to dig into your mind, expose that fragile compartment, and relive it. Whether you have personally killed anyone or not, you have been at war. You have participated in the conduct of combat and now you have to look at yourself in the mirror. You want to be a good person, you try to convince yourself that you are a good person, but when you see again the scenes of combat and feel the contamination of war's aftermath, you feel like a bad person. The conflict is excruciating.

I have never, thank goodness, asked a vet that question. Now I'm sure I never will.

A paid writing gig hits the 'net.

2010-01-14T22:21:00.000-08:00

Here is an article I wrote for My Family Doctor, a magazine that recently went paperless.

50 Ways on Facebook

2009-12-21T10:04:00.000-08:00

Sheila Key and I have joined the swelling ranks of midlifers doing social media and have made a Facebook fan page for our book, 50 Ways to Leave Your 40s. If you're on Facebook, please come visit our page and become a fan. If you're not on Facebook, where are you? In a cave?

Be there.

:)

The Facebook page title is the same as the book title.

Practicing Meditation for Life

2009-11-29T18:57:00.000-08:00

In my last post I wrote about practicing meditation as an end in itself. But that isn't all there is to it. The practice in meditation is practice for life. By this I mean that the skill you learn "on the cushion" can be applied in everyday life. It isn't just about sitting on the cushion and bringing your mind back to the breath over and over. It is about refining that skill for the rest of your life, life off the cushion.

Why? Why bother? What is the point?

As a beginning meditator I'll offer my thoughts. The main reason to carry the present-moment awareness skill into daily life is so that you can live this life -- as it happens -- to the max. If you are really right here, right now ALL the time (good luck with that, but it's worth trying) then you will have the full, real experience of your life. You won't be distracted from whatever is going on by ruminating over the past or worrying about the future. You'll HAVE this moment in all its glory. Or sorrow, pain, joy, whatever it is. You'll be right there, rather than some-where else or some-when else, like most of us usually are.

Another reason I have found for meditating is that the skill of bringing my mind back to the present serves me in relationships. During an interchange, if I am able to hear the other person, to see them as they are right here, right now, without past baggage or future fear getting in the way, things between us go much better. Talk about challenges! But on the rare occasion when I get a glimpse of this, I see the value.

Beyond these, there are the health benefits of meditation, which are becoming more documented with each passing day.

I'm sure I'll find more of my own personal reasons to continue meditating as time goes on. For now, this is enough to get me onto the cushion for 20 minutes each morning.

Practicing Medicine and Meditation

2009-11-13T21:22:00.001-08:00

I have been practicing medicine for about twenty years. I have always thought it a little odd that we call it "practicing." When I was a kid, that word always meant getting out my cello, rosining the bow, and playing my scales and assigned pieces. When I practiced the cello, I was aiming for a concert, or a recital. Preparing for the big event. Practice was a means to a specific end.

In medicine, there is no big event for which we're preparing. We just practice every day. There are the usual jokes, like "someday maybe I'll get it right" and so forth. But for the most part, "I practice medicine" is just another way of saying "I'm a doctor." I don't know any other profession that uses that term. Do you? A mechanic doesn't say, "I'm practicing auto mechanics." Imagine your chagrin if he did! A teacher doesn't say, "I practice education." He better not; not with my kid in his class! But nobody seems to mind that their doctors are practicing.

About a month ago I began another kind of practice: meditation. Here again is an activity for which the practice is the activity, is the point. Sure, some people say or think, "I'm meditating now" but I think most or many experienced meditators refer to it as "practicing meditation." I really like that. If I thought I were practicing for some big meditation performance, which I had to pull off without a false note, I'd have given up after the first five minutes!

Meditation is practicing. Every time I bring my attention back to my breath it is like playing a note in tune just for a moment, before my unruly mind goes stumbling all over the neck of the cello again.

Meditation Pearls

2009-11-05T19:36:00.001-08:00

I'm taking a class called Mindfulness Based Stress Reduction. Based on the work of Jon Kabat-Zinn at the University of Massachusetts, it is basically a meditation class. This is the beginning of the 5th week out of 8 weeks. Over the course of the course, as it were, the teacher has offered up some good one-liners to help us. Here they are, so far.

The mind can only be in one place at a time.
You can only change in the present.
Every thought is accompanied by a physiological response.
Consciousness is contagious.
Bring it back, baby! (the mind to the breath)

Meditation is simple and difficult. If you've ever tried it you know. Bringing my attention back to the feeling of my breath, over and over and over and over again. And again. Each time my focus comes back to the breath, thoughts roll off like water off a duck's back. For a fleeting moment I am in the present moment. Right here, right now. Then before you know it I'm off on a trail of thought again and I don't even notice it until I'm halfway to tomorrow. Oops, there I go again! Bring it back, baby!

Do that about a thousand times in ten minutes, and that's a meditation practice.

H1N1 is here

2009-11-01T08:43:00.001-08:00

It’s true. Swine flu is here. It is all over New Mexico including here at UNM. Have you had it yet? How about your friends and classmates? How many are out today with flu? I’ll bet there are at least a few, and there will likely be more next week.

We have seen lots of H1H1 influenza or “Swine Flu” at Student Health and Counseling. Since September 1st we have had over 100 cases of “influenza-like illness.” Most of these were H1N1. All have recovered. And those are just the ones who have come to the clinic. There have been many more cases where people just stay home and take care of themselves.

The virus continues to spread. It is very contagious and likes young people. Chances are good that you’ll get it, and chances are excellent that you’ll survive. Here are some tips to help you manage before, during and after you get H1N1.

Before you get sick: Get the regular seasonal flu shot. Make sure you have basic medications at home for fever, cough and congestion. Buy a thermometer, and maybe some soups and juices. Once you have flu you won’t feel like going out to the store for this stuff, and they won’t want you there spreading germs. So stock up. Try to avoid getting the flu by staying away from sick people, keeping your hands away from your face, and washing your hands often. Get plenty of sleep and eat well so your body is strong for the fight against germs.

Once you are sick: Flu symptoms are fever over 100.5, cough, body aches, sore throat, headache, chills, fatigue, and sometimes diarrhea and vomiting. If you have some or all of these you might have flu. Take to your bed! Drink lots of liquids and treat your symptoms. Expect to be out of commission for five to seven days. Please do NOT go to work or school or out to eat at a restaurant! I know students who have done all of these things. If you go out in public you are putting others at risk. Be considerate and stay away. Contact your professors by email or phone to let them know you are sick.

Should you get medical care? If you are a basically healthy person who gets the flu, you probably don’t need to see a doctor. Self treatment at home is usually adequate. If, however, you are pregnant, have asthma or other lung problems, are under 2 years old or over 65, or have any chronic medical condition, you should seek care. There is a medication called oseltamivir (Tamiflu) that is recommended for people in these high risk groups, to decrease the risk of flu complications like pneumonia.

If you are not in these risk groups, there is a small chance that you could still get seriously ill from flu. We have all heard the stories of people who died from H1N1 who had no underlying medical problem. Those stories are scary to be sure, but thankfully also very rare. It is unlikely to be you. That said, if you do get any of the following symptoms, regardless of who you are, please hustle in to the nearest emergency room:

Severe difficulty breathing, severe pain in the chest or belly, sudden dizziness or confusion, severe or persistent vomiting.

After you recover. First of all, this takes a while. As I said before, expect to be out of commission for five to seven days. That means at home resting. Even after the worst of the symptoms have passed, you’ll be weak and easily tired for several days. Take it easy. Don’t return to sports until you feel really good.

Once you are well, step outside and take a deep breath of our crisp Fall air. Stretch your strong body, look up at our New Mexico Blue sky and give yourself the gift of gratitude for your life and good health.

Doctor's Notes for School and Work

2009-10-07T21:15:00.001-07:00

What is it with teachers and employers requiring doctor's notes? It is a silly requirement that wastes a lot of everyone's time. This has become one of my pet peeves.

I work at a university. The students are paying to come here and get an education. They are responsible for their own learning. This includes, in my mind, deciding whether and when they'll go to class. If they decide that they'll get more out of reading the book than attending the lecture, that's their choice. I had a classmate in medical school that showed up only for exams (no classes) the first two years. He is now a successful physician. If students get sick and decide they need to stay home and rest, more power to them. That's probably where they belong. Home resting, letting their body heal.

When a teacher requires attendance, she is deciding for the students that the class is worth their time, every time. When she requires a doctor's excuse for absences due to illness, she is making a decision for this adult as to when they need to go see a doctor. Sometimes all a person needs is a few days in bed. Not a visit to the clinic, not a doctor to confirm that yes, in fact, they have a cold, or a stomach virus. Many of our patients know this. They get sick, they go to bed. But then, because their teacher requires a note, they come in to the clinic, wait with all the sick people (possibly catching a new germ in the process), then waste their time and ours telling us they were sick and stayed home and asking for a note. The next time they get a cold, they'll come right in, knowing they'll need a note. It sets up a pattern of unnecessary office visits and contributes to the culture of dependent patients who think they need a doctor for every little sniffle.

It's ludicrous. In my humble opinion.

H1N1 - article in last week's Daily Lobo

2009-09-16T21:27:00.000-07:00

In polite company we call it Novel H1N1. It’s the Influenza Formerly Known as Swine Flu. Originally thought to come from pigs, this flu virus is actually a mix of pig, bird and human. Believe it: only a virus could pull off that combination.

This rascal made a big splash last Spring, as you no doubt remember. After making its debut in the southern hemisphere it worked its way north, and by late summer there were so many cases the CDC stopped counting.

The media hype is hopping about this new germ, and lots of people are afraid. Since it is a new germ, and we haven’t been through a winter with it yet, there is a fair amount we don’t know. But what we do know is reassuring. Most of this comes from statistics but some comes from experience: we have already seen several cases here at Student Health and Counseling.

So far it looks like H1N1 is going to be gentler than the regular flu. Most cases of H1N1 are mild, and over with in a few days. Yes, there have been deaths around the country, but mostly in people who had serious medical problems. If you are otherwise healthy when you get the flu, you can put money on your survival.

Still, any flu can be miserable, so I suggest you don’t catch it. How to avoid it? Keep your hands off your face! That’s the best thing you can do. The flu enters your body through your respiratory system. That means through your mouth or your nose. How often do you pick your nose or your teeth? Don’t answer that. Just know that if the virus is on your hands when you touch your face, you’re toast.

Before I go further, I need to teach you a new word. Fomite, pronounced with a long O and a long I, accent on the Fo. Fomite is a medical term that means any object that can carry germs and pass them along. Fomites are things like towels, drinking glasses, pens, money. Here’s why this word matters.

The H1N1 flu is passed in large droplets. That means if a flu patient coughs, the virus flies out of their mouth in droplets. The droplets then fall onto the nearest surface. H1N1 doesn’t hang around in the air for long, unlike some other viruses that are passed in smaller, lighter droplets. How do you catch the flu then? Either you were unlucky enough to be in the line of fire when that person coughed, or – and here’s where that new word comes in – you touched a germy fomite and then touched your own face.

Think about it. Our hands are everywhere. We use them for everything. Opening doors, using a phone, handling money. As soon as you touch a fomite, your hands are host to whatever little nasties got on there from the other people who touched it. Then you wipe your nose or rub your eyes and wham. Germ transfer.

Yes, it is important to wash your hands, especially before you eat or otherwise touch your face, but washing your hands isn’t enough. The germs don’t soak in through your hands to make you sick, after all. So wash and sanitize, by all means, but mostly keep your hands off your face. If you have to touch your face, like to eat or put on makeup, wash your hands thoroughly first.

Besides washing your hands and keeping them off your face, take good care of your body in the usual ways so that your immune system is on max alert at all times. Sleep enough. Eat well. Exercise regularly. You know the drill.

If you’re already sick, please be responsible and protect others. Keep away from people! If you get symptoms of the flu, stay home! Symptoms are primarily fever, cough, and body aches. You might also have a sore throat, stuffiness or stomach upset. H1N1 typically comes on over a short period of time. Like a Ferrari that goes from zero to 60 in a matter of seconds, H1N1 will rocket you from well to miserable in a matter of hours.

If you are sick, cover your cough. Not with your hands! The latest official advice is to bend your arm at the elbow and cough or sneeze into your elbow, or the fabric of your sleeve above the elbow. If you choose to spray your germs into a tissue, fine, but then please discard the tissue and wash your hands.

The best treatment for H1N1 is rest. Your body is a pretty efficient virus-killing machine, but it needs your support. Stay in bed, drink plenty of fluids, and take medicines for your symptoms. Acetaminophen or ibuprofen for fever and body aches, dextromethorphan for cough, phenylephrine for congestion, or pick your own personal favorite.

If you decide to go to the clinic for H1N1, you’ll probably leave with nothing more than good advice. There are some anti-viral medications on the market, but so far they’re only being used for flu victims that are so sick they need to be in the hospital. Those are the folks with chronic medical problems like asthma, emphysema, diabetes and others. If you have a chronic medical problem and you get sick with flu, you should definitely seek medical care, and you might get treated with antiviral medication. But if you are the typical UNM student, young and healthy, it’s better for you and the rest of the community if you stay home.

UNM is doing its part. We’re expecting an H1N1 vaccine, probably in October, and we’re planning for campus-wide vaccinations. In the next few weeks, watch for announcements about the regular seasonal flu shots, which will be free of charge this year. Meanwhile, you’ll see hand sanitizers around campus, along with signs reminding you to wash your hands. SHAC has provided flu kits to the dorms, with thermometers, surgical masks, hand sanitizer and Tylenol. If you get the flu and you live in the dorms, LaPo will bring you "flu meals." Professors have even agreed to lighten up on asking for doctor’s notes if you have the flu.

For more information, visit our website.

Women Veterans in NM - some numbers

2009-09-13T16:03:00.001-07:00

Yesterday I spent the day at a conference for women veterans, designed to provide information and resources for everyone from WWII WACs (and there were two of them there) to Viet Nam Vets to active duty OIF/OEF (Iraq/Afghanistan) personnel, and everyone in between. Not a veteran myself, but with a blossoming interest in a second career in veteran health, I went to learn. Here are some numbers I learned.

New Mexico has 200,000 veterans. Of these 16,000 are women. That's about 8%. Of all the veterans in NM, only about 40,000 have even applied for veterans services and benefits from the state. That means three out of five vets could be getting benefits they aren't getting. At the state level, these range from a free fishing license to scholarships and property tax breaks.

More women are currently in service. Of all American active duty, 15% are now women. The women vets I met and heard yesterday were all very proud of their service and deeply loyal to their country.

The presence of women in the military has brought to light a phenomenon termed MST, or Military Sexual Trauma. This is any kind of sexual harassment or assault experienced while in the military. The Veterans Administration now has a MST coordinator at every facility in the country. Every vet, male and female, who applies for services now gets asked if they experienced MST. They can answer "Yes," "No," or "I don't want to answer." In 2007, 25% of American women vets screened answered Yes.

Of course there was discussion of PTSD, and one speaker reviewed some of the alternate terms being considered for this. There's a move to get rid of the part that says "disorder" so as to reduce any perceived stigma. "Trauma Stress Injury" was my favorite of those mentioned.

There were more numbers, like Chapter 33, which is a GI bill specially for those who serve after 9/10/2001 in OIF/OEF. And 20%, which is how disabled you have to be to receive vocational rehab on the VA's penny. And 22, which is the number of days Shoshana Nyree, the first female American POW of the Iraq war, and our guest of honor, was held before the marines rescued her. (She has a book coming out soon titled Still Standing)

Numbers can be impressive. I know I was impressed with the number of services and benefits available to veterans. I believe they have earned it, and I hope it all helps. And I know that behind the numbers and the statistics are real live women and men, some damaged so badly that no matter what number of services they get they will never heal.

ROTC Physicals

2009-08-17T18:12:00.001-07:00

I did three ROTC physicals today. ROTC stands for Reserve Officers' Training Corps. In return for financial assistance for their college expenses, students complete training sessions while in school, and fulfill a military commitment once they're out. They graduate as officers, bypassing the unlisted ranks.

My job was to make sure they didn't have any glaring physical problems or contagious diseases that would prevent them from doing the rigorous PT (Physical Training) program.

All three of these young people were vigorous, healthy and intelligent. Each had an upbeat attitude about their education and their future. They were polite and correct, answering my questions with "Yes Ma'am" and putting their best foot forward.

As I handed the finished paperwork to the last patient, he thanked me with a breezy smile. I looked at this young man, healthy and whole, and marveled that he and the others would voluntarily take this step. The first step on a path that could lead to unknown lands, to injuries of body and soul, even to death.

"Thank YOU for your future service," I responded. His face softened and this time his smile reached his eyes .

Forgiveness

2009-07-10T22:18:00.000-07:00

Forgiveness is good for your health. Really. They've done studies on it. People who are 'forgivers' have lower blood pressure and pulse, fewer physiologic stress responses, and more positive emotions. They also sleep better, are more energetic, have fewer physical symptoms and use fewer medications.

Sounds like a no brainer. Let's all be forgivers. Too bad it isn't as easy as it sounds, eh?

What is forgiveness anyway? What does it mean to forgive someone? Say somebody hurts you in some way. They say, "I'm sorry." You say, "That's okay." Have you forgiven them? What if it really isn't "okay?" What if it will never be "okay" what they did? What are you going to do?

"I forgive you" sounds like it's more about what I do to you than what is going on in my own mind. It even has a slightly haughty, patronizing tone to it, as if I'm anointing you or something. But forgiveness isn't something you do TO someone. In reality, forgiveness has little to do with the other person.

If you forgive someone, that doesn't mean you condone what they did. It doesn't mean you excuse it, or even that you think it was "okay." It doesn't mean you will forget what happened, or even necessarily that you reconcile with them. Forgiveness happens in your own mind, and is a process of letting go of the anger and resentment you have. How do you do that? You make a decision that you will not allow those thoughts to dominate your well being or mess with your peace of mind. We control our own thoughts, after all. You can decide what you will or won't think about or dwell on. Our thoughts create our experience to a huge degree.

Thoughts can open the back door for unwelcome feelings to come in. If you hurt me, I can decide to stew about it. "How dare she? I can't believe what she did! That really hurt me. Ow! She's such a *&^%!" etc etc. If I start thinking like that, anger and resentment will soon be invading and before I know it I'm hogtied in my own kitchen. Who wants that? Not I.

You cannot count on someone who hurt you to apologize, to try to make amends, or even to recognize that they hurt you. If you hold your breath for any of that, well, you'll suffocate, that's what.

Let it go.

Trisomy 18

2009-07-10T16:33:00.000-07:00

(I'm bringing this old post back up top because it is one that keeps getting comments as people who struggle with Trisomy 18 search for answers and community)
Warning: In spite of the scientific title, there won't be much science here. However, this is a sad story with gross details, so don't read it if you're squeamish.

Tarik and Caroline were having their second child. Their first was a healthy toddling boy, a lovely combination of their two cultures. Tarik and Caroline were both young, both healthy, responsible professionals on their way up. Naturally, therefore, they got in to the clinic early in the pregnancy. I was the lucky Family Practice resident that "picked them up". I'd get to see Caroline for her prenatal visits, checking her blood pressure, urine, weight and measurements to make sure all was progressing normally. I'd be the one to find the first heartbeat for her, to feel the baby's growth at each visit, to marvel with her as baby rolled and kicked inside her, to advise her about diet and exercise. Routine stuff. We'd meet every month at first, then with increasing frequency near the end. At her 36th week (out of 40 full term pregnancy weeks) I'd turn my pager on 24/7 for her, so that I'd be able to deliver the baby whenever she went into labor.

I loved OB. The miracle of a human baby growing inside another human never failed to fill me with awe. We think we're such hot stuff, such modern, technological super-beings. Our lives are filled with devices, with increasing automation and mechanical sophistication. But when it comes to bearing children, we're animals all the way. What is more bestial, more natural, than growing your young inside you, pushing them out with blood and tears, and nursing them at your teat? We in medicine do our best to technologize this experience with beeping gadgets, powerful medicines and invasive procedures. But at the core, nature is in control, a fact that charges the labor and delivery wards with excitement and fear. Birth can be a miraculous, happy event, and usually is. But it can also be a terrible tragedy, anticipation turning to anguish at the last minute.

Round about Caroline's 15th week, her uterus began to measure bigger than it should. We weren't alarmed at first. Could be mis-measurement. Could be a big kid. Could be twins...twins? There were twins in the family background. Hmmm. Since the large size persisted, we decided to get an ultrasound. Nowadays just about every pregnant woman gets an ultrasound routinely, but back then (a long 17 years ago) we had to have a reason.

By the time she got the scan, she was at 17 weeks. By then, the embryo has become an infant, fully formed but small, with weeks of differentiation behind it and weeks of growth ahead. The scans are highly sensitive, able to discern organs clearly.

There was something wrong with Caroline's infant. The heart didn't look right. There weren't four distinct, regular chambers. Further testing was advised. I met with Caroline and Tarik, gave them what scanty information I had, tried to reassure them or at least postpone panic, and suggested an amniocentesis. We didn't know what the problem was, exactly, or how bad it was. Some congenital heart defects are fixable by the surgeons. Some are not. Some are associated with chromosomal abnormalities, which is why the amnio was recommended. More frightened about the infant's condition than about having an 8" needle stuck in her belly, Caroline agreed.

If you watch crime shows on TV, you probably think that DNA results are available just as soon as the patient gets up off the table. Not so. Caroline and Tarik had to wait two agonizing weeks to discover what they were dreading to know.

The baby had Trisomy 18. An extra chromosome. Three of the #18 chromosome instead of two. Well, so what? Sounds pretty benign. After all, we have what, 46 all together? What's one extra chromosome among friends? Well, it turns out that one little #18 chromosome has more power than all the others put together. It is a tiny tornado, packing a destructive force stronger than life itself.

Half of all babies born with this condition die in the first week of life. 90% of them have heart defects. Most of them have other defects as well, including spina bifida, cleft palate, deafness, joint contractures, and mental retardation. Only an unlucky few survive beyond a matter of weeks, and those don't last much longer. The term that is branded in my brain from our meeting with the genetic counselors is "incompatible with life". Caroline was carrying a child that was incompatible with life. As soon as it hit the outside air, it would begin to die. She. "It" was a she. They could tell that from the genetic analysis too, of course. She was doomed.

After listening, reading, thinking, talking and crying together, Caroline and Tarik told me they decided to terminate the pregnancy. They couldn't face the thought of birthing a baby girl only to watch her die in agony. This was the right decision. I had no doubt, and nor did they. I offered to accompany them to the procedure, and they gratefully accepted.

They went to one of the local abortion clinics for this procedure. The doc there was very experienced in terminations at all stages of pregnancy, though of course most were done much earlier. By chance and good luck, there were no protesters outside the clinic that day. I was prepared to give them a piece of my mind if there were any. Caroline was not the typical abortion patient, and did not deserve to be hassled.

Without much delay, we were shown into the procedure room. Tarik was told to wait in the waiting room, per clinic protocol, making us all glad I had come along. The staff was kind and efficient, helping Caroline gently onto the table, talking in soft voices, explaining and reassuring. Caroline tolerated the procedure very well, holding my hand tightly and breathing deeply as the obstetrician dilated her cervix and removed the infant. Caroline didn't cry, not then.

A termination at 21 weeks is very different from one at 7 or 8 weeks, the usual time an "elective abortion" is done. The early abortions are done with suction, and the "products" just look like so much bloody mush. At 21 weeks, there are organs. There are limbs. There are bones. And the procedure is done not by suction, but by "extraction." Fortunately, Caroline and Tarik were forbidden to look at what was left of their defective baby girl. But I, as a medical provider, was invited into the side room to further my medical education. I had to steel myself, calm my heart, open my scientist mind.

Her little blue hand, curled and lifeless on the surgical towel, is forever wrapped around a tender neuron in my brain. As I looked at the pieces of this ruined life, what I felt was not revulsion or nausea, but a deep sorrow. I knew this was the right choice, the right decision for these parents and for the mutant child, for that's what she was. It was the humane, loving choice for all involved. But that didn't make it easy.

Aching in the depths of my heart, I returned to Caroline. She was resting in recovery now, out of the stirrups, and Tarik was with her. I tried my best to push my own feelings down deep, to put on my doctor face and stay calm. But when Caroline opened her arms for a hug, my humanity came crashing in, and my tears fell with hers.

Narcotic Narcissism

2009-07-03T21:09:00.000-07:00

What was I just saying about lessons you have to learn over and over?

I'm smacking my head - but gently - this week as I relearn the narcotic lesson. Patients addicted to narcotics will do just about anything to get their drug. It is a powerful poison. Normally nice people will get nasty. Shy people will haul out their inner drama queen and wax poetic. Scrupulous people will lie, cheat and steal. They don't mean any harm by it, honest they don't. They're just trying to get their needs met. And once they get their drugs, they're the picture of contrition.

If it sounds like I'm painting a large group of people with one wide brush stroke, well, I guess it's because I am, in a way. I'd be the first to declare that each of us is an individual, but, that said, I have to assert that narcotic addicts have a lot in common with each other.

Is someone who uses narcotics for legitimate pain an addict? Of course they are. Anyone who takes a narcotic in high enough doses for a long enough time becomes addicted. Physically dependent. Their body needs the drug in order to feel good, and if they don't get it, withdrawal is extremely uncomfortable. Miserable, to the point that they'll do all those things I mentioned above. They'll make raving lunatics or groveling fools out of themselves rather than go without.

As a physician, I struggle with the dueling forces inherent in taking care of a narcotic addict. I don't want anyone to have unnecessary pain. I also don't want to be manipulated. I truly believe the addict has no ill intention toward me when he/she lies or cheats to get drugs that are needed to treat the pain. At the same time, I can't help but feel angry, at the addict for deceiving me, and at myself, for being too gullible, for believing the tales and the tears once again. I also feel an irrational anger at the medical system, at the pharmaceutical companies, at the chemists who don't develop alternative medicines that are as effective and yet less harmful.

My experience with pain patients tells me that not all of us are born addicts. However, some of us are. There's a definite difference in brain chemistry between people that makes some of us far more likely to end up addicted than others. Some of my patients with acute pain, like that from a broken bone, will only take a couple narcotic pills and flush the rest. Others will still be trying for refills long after the bone is healed.

It doesn't seem fair. My lesson patient this week was injured in service to his country. His wounds are as real as his pain, and both are with him for life. Narcotics are the only meds that help. But because we have so few alternatives, he'll be a slave to their destructive seduction the rest of his days.

Lessons from Fence Wrecking

2009-06-19T10:29:00.000-07:00

This past week I've been spending some time wrecking fences up here at RMBL. The old fences, while picturesque in places, are thoroughly falling down in others. Nowhere do they do much any more to keep the cows, expected in July, out of the townsite. So down they must come. It is highly satisfying work. Not only did I get to take any aggression I had out on rotton logs, but, even more important since I can't seem to drum up much aggression up here, I got to see progress, and an end point.

As I worked today, I thought of some of the life lessons that can be learned and relearned when one is doing something like fence wrecking:

If you focus on one pole at a time, before you know it you've done a whole section.
Work with the forces of nature when possible. Gravity is your friend.
The right tool can make a big difference.
Watch the experts. They know what they're doing.
Sometimes getting the right angle works better than force.
If someone offers to help, say yes!
A little bit of rest goes a long way.
Plan ahead or you might have to move the whole pile.
You'd be surprised at the load you can carry if you have your balance right.
Share your snack!

Rocky Mountains Week 2

2009-06-17T09:26:00.000-07:00

Judd Falls, which is a LOT bigger and scarier than this picture looks!

Gothic Mountain through aspens up Copper Creek trail.

This guy was right by the road.

Sneak preview of the Maroon Bells wilderness, from Copper Lake trail.

Avalanche damage up valley from Gothic.

Critters and Tracks

2009-06-15T16:34:00.001-07:00

In addition to the deer which have become a routine part of the day, I have been fortunate to see some other critters around here too. This first guy got my attention late at night by chewing on the back door of the cabin! When I opened the door, he just looked right up at me like "Whut?" then turned slowly and ambled off.

Just outside the dining hall I was graced with a view of this red-headed woodpecker.

This is the road just below the cabin, after a rain. Can you make out tracks for human, deer, mountain bike and car? If not, sorry for the lousy pic!

What makes a great place to write?

2009-06-14T16:23:00.000-07:00

Here I am in the picturesque Rocky Mtns of Colorado. When friends heard I was coming here, they said, “Oh, what a great place to write!” A quiet cabin, a rushing river, alpine beauty, no phone or family to distract me. Nine thousand feet, up where the air is clear. Sounds idyllic, doesn’t it? And yet the words don’t just flow out of me after all. No effortless inspiration blowing in with the mountain breeze. It got me thinking.

What makes a great place to write? Yesterday while I was wrecking fences I realized two things. One, wrecking fences is a great activity to do when you need to think. You know how some people say their best ideas come to them in the shower? I believe it’s the same phenomenon. Wrecking fences, like washing your bod, is an activity that takes a fair amount of immediate concentration. Much of my brain was occupied with crowbar angles, logs, piles, lifting, hauling etc. I had to be aware of what I was doing right then and there, or I could get hurt. This doesn’t leave much brain for anything else, but it does leave some, and I think that’s when and why creative breakthroughs can happen. Your mind is so focused on one activity that the usual chatter is suppressed, diminished. What’s left over is a clear channel through which insights may pass.

The insight that passed through the brain channel that fence wrecking opened was that internal environment is much more important than external environment. Some people have their writing spot, specially set up just the way they like it, and that’s where they write. Others write on napkins, at the soccer field, in their semi truck after a day of driving. I think the one thing successful writers have in common is that, regardless of their physical setup, their internal environment is focused, calm, and alert. How you arrange that internal environment is the key to your success. Myself, I find that doing something physical first (like my current favorite, fence wrecking) seems to knock the kinks out, blow the dust off, clear my mind.

The third realization, which came to me later, for the zillionth time, is that I learn the same lessons over and over. Knowledge comes in layers, and the deeper layers carry echoes of those above them. I have had both of the above thoughts before, in different renditions. They still felt like realizations this time around. I laugh as I peel this layer, recognizing it again, wondering if I’ll ever really fully understand anything.

Gothic, Colorado

2009-06-11T20:27:00.000-07:00

I am so happy to be back in Gothic, CO, home of the Rocky Mountain Biological Laboratory. This year I am fortunate to have two whole weeks here! My role is medical advisor, which means I speak at orientation for staff and again for students, about the health hazards of life at 9000 ft in the Colorado Rockies, and how to stay healthy. When I'm not doing that, I'm updating their medical supplies, enjoying the incredible beauty, or wrecking fences!

Work Day at RMBL. It rained and snowed all day, but the intrepid fence-wreckers were not fazed! Here I am with crowbar in hand, happily demolishing the old buck and rail fence to make room for a new one.

These two greeted me outside my cabin in the early morning. Mama and yearling.

Fog on Gothic Mtn.

I never tire of this view of Avery Peak from my front porch.

Back to the Rockies!

2009-06-05T10:19:00.000-07:00

This is a resurrected post from the same time last year. I'm headed back to the Rockies this weekend! I'll expect to have fresh photos and outlooks next week. And heat in the cabin this year!

I'm so pleased to be back in Gothic, Colorado, at 9,500 ft elevation. Spring has barely begun here, as you can see. Lots of snow still on the mountains, and water pouring off all over the place. What a difference from the 90 degree high desert I left in Albuquerque!
My official role here this year is minimal as far as doctoring goes, so I'm excited to get a lot of writing work done. More pics coming, as soon as I get new batteries to replace the ones that froze last night (along with the milk in the fridge and my toes in my sleeping bag!) Fortunately, the groundsperson Robyn connected my gas tank today and there's a wall heater, so hopefully I'll be cozy tonight. If the heater doesn't work, I'll sleep with my camera to preserve the batteries!

The Wages of Spin - new video from The Happy Misogynist

2009-06-03T23:43:00.001-07:00

Disability Evaluation - a new job with new challenges

2009-05-09T22:28:00.000-07:00

I have been working an extra job lately on some Saturdays, performing physical exams for a company that contracts to the state disability determination services. Clients apply for disability, get an interview with an intake person, supply various supporting documents, and then get scheduled for a physical exam. I receive electronic records ahead of time, whatever the state has received to date, and I am given 30 minutes to talk to the client and examine them. After a very full day of appointments (last Saturday I saw 15 clients) I dictate a report on each client. My instructions are to "provide a complete history and physical" to the people who take it from here. The next steppers will review all the records, including my report, and make a decision about whether the client is disabled and, if so, how disabled.

Thankfully, the final decision is not mine. It's hard enough making some kind of statement about how each "allegation" (the official term for the medical condition that is affecting the client or claimant) impacts the health and functionality of the client. Many cases involve pain, which is very hard to objectively document.

Naturally, I can't mention specific cases here, at least not in enough detail to be able to identify anyone. I have already seen a huge variety of medical problems, from amputations to aneurysms, back pain (lots of that) to bipolar disorder. Plenty of suffering. Everyone suffers. But are they suffering enough? Enough to get a government handout? If a man has been a plumber all his life, and can no longer crawl and kneel, what should he do? Should he be required to learn a new skill after all these years? Should he kick back and live on disability payments? What about the young person who has years of productive life ahead of them? Should a car crash that leaves them with occasional or even frequent back pain ground them for life?

I don't know the answers. I do know that some of the people I examine seem very disabled, and some don't. Are there scammers in the lot? Probably. There are also frustrated hardworking people, embarrassed at their unintended impotence and wishing they were back on the job this minute. There are also bewildered disenfranchised folks without health insurance who are hoping to access health care through this particular back door into the system.

No doubt I'll have more to say on the subject with time. I'm learning a ton.

Writing an article

2009-05-07T10:31:00.000-07:00

I'm working on an article on hydration. Well, taking a break from working on an article about hydration. It occurred to me it might help me make progress if I put my process into words. So yes, this is a self-serving analysis of how one writer writes. Feel free to ignore.

My process has evolved over the years. I never planned ahead what my process would be, but it has come to a pattern that looks something like this.

Pick a topic. Either choose from a question sent by a reader or, if none have come in, pick something timely. Example: health during finals week (last week's topic, published yesterday)
Research a bunch online, using both medical and lay sites. Some of my favorites are NIH and CDC. Copy and print key stuff, or copy and paste into a research doc.
Write a terrible, rambling, ungrammatical verbal vomitage, full of sentence fragments, runons, slang, random unrelated thoughts, anything that comes to mind.
Go away.
Come back to it and look at it. Lo and behold, a flower or two arises from the garbage. Dig out the flowers and transplant them into a new document.
More verbal vomit of ideas I've digested since the last purge.
More garbage gardening.
Leave the stinking pile and move full time to the new document, pruning, filling in, spiffing up.
Go away again, preferably overnight.
Come back, tweak and polish. Done!

At the moment, I'm between Step 2 and Step 3. And this little analysis didn't provide me nearly the procrastination time I was hoping for! Dang. Oh, but that reminds me. I didn't include diversionary tactics, or time wasters, or even legitimate break taking! Just like stretching the body, I need to stretch my mind, my eyes, and my thoughts from time to time. And speaking of hydration, a drink of water is always a good idea, in addition to being a diversionary tactic. In fact, I'm getting thirsty right now...

Viral Fear

2009-05-02T20:29:00.001-07:00

Swine flu. It's in every conversation, on every mind, in every newscast. Every half day, the CDC adds states to their list of confirmed cases and updates their latest recommendations. New Mexico is not yet on the list, but I have no doubt that will change, and soon. We have several suspected cases, and after all, Mexico is our very near neighbor. Lots of travel back and forth. Just a matter of time.

Meanwhile, there's a second pandemic, a worldwide infection of that most resistant of viruses, fear.

"How scared should I be?" people ask me. Interesting question. Fear, although occasionally useful for motivating us to do something important, like get out of the way of a speeding truck, usually does more harm than good. Fear causes you to lose sleep, to get bellyaches and headaches, to get distracted from your responsibilities and your happiness. Fear is living in the future, and who knows if that future will ever materialize the way your fantasy has painted it?

I don't recommend stirring up fear, in yourself or anyone else. How scared should you be? Not scared. Responsibly behaving so as to avoid catching the swine flu, sure. Staying informed about the disease and the latest recommendations, absolutely. But there's no point in worrying about a potential future catastrophe. You're more likely to get killed in a car wreck than die of swine flu. So pay attention when you cross the road. Pay attention to your life, right now, in this moment. As one of my favorite authors says, we only have moments to live! One at a time.

Hit and Run

2009-03-30T21:42:00.000-07:00

Walk In Clinic, Case #357.

The poor kid was just riding his bike along the street, obeying all the laws, wearing a helmet, going to class. Suddenly a car pulled out from a side street and clipped his back tire, knocking him head over handlebars onto the pavement. As he lay there he saw the car drive away.

Who would do something like that? Accidentally (for I'm almost sure it was a matter of lack of attention) hit a cyclist and then just drive off? What if the kid were seriously injured?

Of course, that's probably exactly what the driver was thinking. "What if I seriously injured that kid? He'll sue me and I'll be paying the rest of my life! I better get out of here!"

The kid walked his ruined bike over to our clinic and presented his shook-up self for evaluation. I was so furious at the negligent driver it was hard to concentrate on the victim of his irresponsibility. The kid did not share my anger. In fact, amazingly, he had experienced the exact same thing before. Another hit and run! He was philosophical about it, and primarily concerned that he'd have to buy a new helmet.

I do try to maintain my faith in the goodness of the human race, and most of the time there is plenty of evidence to support it. But on occasion that faith gets challenged.

Suffering is when you want the pain to stop.

2009-03-12T21:41:00.000-07:00

Thus spake Natalie Goldberg, at a book signing I attended tonight. Her talk was about writing memoir, and she mostly read from her new book on the subject, Old Friend From Far Away.

Suffering is when you want the pain to stop. The sentence sprang out at me from the milling sidewalk throng. Ambushed, a part of me spent the rest of the evening struggling in a dark alley. What? How can you have pain without suffering? Aren't they one and the same? Why wouldn't you want pain to stop? Who wants pain?

I remember a Peanuts cartoon from years back. Lucy has to go to the dentist and she's complaining to Charlie Brown. He says to her, "You're not afraid of a little pain, are you?" Her retort is classic. "Of course I am! Pain hurts!"

Goldberg practices Buddhism. Buddhism urges us to look at life honestly, to accept what is. Sometimes life is painful. Everyone knows that. Suffering, by Goldberg's Buddhist definition, is wanting something other than what is. It could be applied to anything. As soon as we start wanting something different from what we have, we are somewhere else. We are distracting ourselves from the present, and the present is the only starting point we have. You've heard the saying, "You can't get there from here?" The truth is, you can't get there from anywhere else. The only way out is through, and the only place to start is here.

So if suffering takes me away from the present, and accepting pain is a way to avoid suffering, I'll accept pain. It's kind of hard to ignore, after all. Accepting pain doesn't mean it won't hurt. But, unlike Lucy, I know that not all that hurts is Bad. Au contraire, in fact. What is beautifully ironic, in my experience, is that the more I allow myself to feel pain, the sooner it passes. The more you hurt, the quicker you heal.

A sad and silly true poem

2009-03-06T20:37:00.000-08:00

Belly Up

Come into my office, said the boss man to the guy.
The time has come to send you home. Your work is done. Goodbye.

The company is bankrupt: it's chapter seven time.
The doors are locked, the lights are out, we haven't got a dime.

So sorry that there is no pay, no benefits, not one.
We thank you for your time, and know your time has just begun.

Clean out your desk and take your stuff, but leave your sweat and dreams.
We know its bad, but time will tell it's harder than it seems.

You're middle aged. That's life; it can't be helped. We wish you well
with resumes and dusty suits, employment lines from hell.

Now off you go. Get out of here. Go home and tell your wife.
Good luck with that. Leave the keys, and hey - have a nice life.

Mt. Taylor Quadrathlon 2009

2009-02-28T21:52:00.001-08:00

There it is...nearly 12,000 ft of intimidation. We were to traverse from bottom to top, as a team. First our biker, pumping 13 miles uphill. Then the runner, with 5 steeper uphill miles. Third, the skier (yours truly) with 2 miles of uphill skiing on skins (it's getting really steep by now). Finally, the snowshoer takes the team colors to the very top of the mountain, a mile of grueling uphill.

As if that weren't enough, the whole team has to turn around and do everything in reverse, top to bottom, ending up back in the town of Grants, NM.

Here's Sue, our intrepid biker, at the beginning of the race.

Sue was followed by Bev, our heroic runner.

Then it was my turn, trying hard here to win the sleeping bag leg of the race.
(Seriously, though, it was COLD waiting 4 1/2 hours up there at 10,000 feet!)

Finally, jaunty Patti (this is before she snowshoed to the top of the mountain and back!)

At the run/ski transition. It's far more organized than it looks! They have it all figured out, and it runs as smoothly as maple syrup in the Spring.

Patti and Peggy after the race.

Patti, Peg and Sue toast our victory - first place women's 50-59 yr old team! Go SHAC Pack!

PTSD - where does it hurt?

2009-01-28T21:36:00.000-08:00

People speak of PTSD as if it were all the same.

"He fought in Iraq and now he has PTSD." End of story, as if those 4 little letters explain it all. Oh, yes, PTSD. Now we know what he's going through.

I don't believe it. Are all physical wounds the same? Of course not. You wouldn't say, "He had a fracture" and expect his suffering to be explained. There's a big difference between a fractured pinky and a fractured pelvis. You wouldn't say, "She has a flesh wound," and leave it at that. A laceration in the leg is worlds apart from a face half blown off.

Body parts matter when it comes to understanding wounds and healing. In the same way, I think mind parts matter when it comes to wounds of the psyche. I'm not talking necessarily about sections of the brain as an organ, although there is clearly correlation between the two, but about regions of the mind. What part was hurt? What coping pathway was railroaded? What belief system was shattered? What concept of self was blasted to smithereens?

It matters.

When the body suffers a wound, it helps to know what weapon delivered the damage. What about the mind? What was the weapon, the injuring event, the final blow? We need to know. It helps assess and predict the damage. It makes a difference.

Finally, what about healing? If it is a wound of the body, do we suture? Splint and cast? Perform surgery, even, perhaps, amputate? Do we provide medicine, pills, creams, crutches? Not all treatments are equal, because not all wounds are equal. It's ludricous to think otherwise.

So too wounds of the soul. What kind of healing is right for this crushed confidence? This lacerated faith? This broken, tender self? We can't treat them all the same, with the same drug cocktail, the same kind of therapy, even the same questions. It could be as bad as trying to sew a bone. Ineffective at best, at worst, deadly.

PTSD. The wounds are as individual as the wounded.

P.S. See this blog entry and the associated blog for an eloquent view of PTSD from the inside.

Talk About Sex

2009-01-24T13:45:00.001-08:00

I do, every day. It goes with the territory when you're a doctor. Sex matters. Having it, not having it, who you have it with and how, what you do and don't do; it can all affect your health, so, for better or worse, we'll be asking about it.

There are ways and ways to ask patients about their sex life. In med school they taught us the phrase "sexually active." We were supposed to ask the patient, "Are you sexually active?" It sounds silly to me now, but it was presented as Standard Of Care. In other words, everybody does it that way. It was deemed an efficient use of time. One question, cut to the chase.

I even did that for a while, until I realized that many people had no idea what I was talking about. I'd get the blank look far too often, and end up having to ask some other way. Or they'd focus on the "active" part of the question. One of my colleagues got the answer, "Not really. I just lie there." And I heard the opposite extreme when a young man bragged, "Oh yeah! I break condoms all the time!"

So I quit asking it that way. For a while I asked, "Do you have a sex partner?" That seemed to work okay. If they answered in the affirmative, I'd follow with, "Male or female?" and then questions about how long they had been together, whether they used safe sex practices, etc. It took a lot more questions than the one, efficient, "sexually active" query, but it got the job done.

(By the way, we don't say "safe sex" anymore, did you know? Now we're supposed to say "safer sex." Nothing, after all, is 100% safe. Or 100% anything. G-d forbid someone should sue us when they get chlamydia having "safe sex!")

Another of my colleagues tried this one out: "Are you having sex?" Until one of his patients gave him a look and said, "Well, not right NOW!"

The open-ended question is a great way to ask about most things. "Tell me about your back pain," for example. But even I would feel a little weird saying, "Tell me about your sex life" to a patient.

No matter how we ask, there will always be a way to misinterpret it. Some of the medical literature uses the term "sexual debut" for someone's first time. "A woman should have a PAP smear 3 years after her sexual debut." Isn't that priceless? It sounds like there should be a huge party with gauzy dresses and tuxedos. "Introducing the sexual debutantes!"

I finally hit on an opening question that works for me most of the time. "Do you have sex with men, women, both, or neither?" Most people seem to be able to hear that one, and respond without rancor. Interestingly, I have never seen a woman act offended by this question, whether she is straight or gay. On the other hand, quite a few straight men act appalled that I would even consider the idea of them having sex with men. "WOMEN! Only WOMEN!" they huff. I wonder: is homophobia a sex-linked trait?

The other day, I finally got "Neither" in response to my question, which made me realize it isn't quite the catchall I thought it was. Was this a virgin (not as rare as you might think at the university)? Nope. On further questioning, the person revealed that they had in fact had their sexual debut some years earlier but were currently single. No sex for...hmmm lemme think...two whole weeks now!

That brings up another whole arena: sexual definitions. "Monogamy," "long term," "sex;" you'd be surprised at some of the concepts folks have. Fodder for another post.

PTSD and the Purple Heart

2009-01-23T08:44:00.000-08:00

What kind of recognition and recompense should go to servicemen and women with PTSD? Not the Purple Heart, as recent news has made clear. Is this fair? Well, let's look at it.

The Purple Heart is a medal given to those who suffer physical war wounds as a result of enemy action. This medal is not given to those with PTSD. Never has been, even when PTSD was called "battle fatigue." The criteria for the Purple Heart can be seen here:

http://www.usmcvta.org/pheart/phcriteria.htm

From that site: A wound is defined as an injury to any part of the body from an outside force or agent sustained under one or more of the conditions listed above A physical lesion is not required, however, the wound for which the award is made must have required treatment by a medical officer and records of medical treatment for wounds or injuries received in action must have been made a matter of official record.

It goes on to specifically exclude PTSD.

Canada has a similar medal, called the Sacrifice Medal, which, interestingly, specifically includes mental injury, as follows:

Eligible cases include but are not limited to...mental disorders that are, based on a review by a qualified mental health care practitioner, directly attributable to a hostile or perceived hostile action.

I'm not convinced that the Sacrifice Medal would cover all cases of PTSD, but it goes farther in that direction than the Purple Heart does.

So how important is a Purple Heart? I've always thought that the Purple Heart was kind of an odd medal. It is often spoken of with awe, as if the recipient did something outrageously heroic. What they did was get injured. Were they heroic? Absolutely. Anyone who puts their life on the line in service to their country is heroic. Even those who did not get injured. Do injured service men and women deserve something more than those who were not injured? Well, yes. I believe they deserve to be treated and cared for, at our expense. Including those with PTSD.

PTSD is a war wound. A wound of the mind, heart and spirit. An invisible wound, yet deeper than any that sheds blood.

We can argue about who gets what medal 'til the cows come home. Frankly, I think they all deserve a hero's medal. But what's more important is that those who need care, whether for wounds of the body or wounds of the mind, get what they need. If this controversy helps bring PTSD to the forefront and gets those guys and gals some help, it's worth it.

Silly Poems

2009-01-15T22:40:00.000-08:00

My favorite online community is Writer's Digest, where I visit and share experiences with a variety of writers, from beginners to published professionals. One thing some of us do is make up silly poems in a thread called Dread Poet's Society. Here are a couple of my silly efforts.

1. In response to a poster who challenged me to work less and write silly poetry more:

Work, I do, I try to heal 'em
Fractures, coughs, sore throats and boils
Rashes, warts and bumps - I feel 'em,
Freeze 'em, drain 'em, coat with oils.

All day long we poke and prod,
Look for clues and try to mend
Some docs even think they're gods
We're always humbled in the end.

Yet, as much as I adore
bedpans, xrays, splints and pills
coughs and sneezes, I want more,
A place to play, to ease my ills

The Forum calls, the poets rhyme,
their sweet abandon, free and wild
with meter foul but words divine
Each silly section makes me smile.

Who knew, when Wondo started it,
this silly thread, that it would be
a testimonial to wit
the best in WD history.
........................................................................................
2. Taking a break from "real writing"

I'm s'posed to be writing a column 'bout zits
those mug-ugly bumps that give teenagers fits

How does this thing happen? Please, doctor, help!
I'm spotty, I'm pimply, I'm covered with welts!

It's awful, embarrassing, painful and worse:
My girlfriend won't touch me; she says I am cursed.

So please, give me something to clear my skin up
I beg you, have mercy on this zitty pup!

No problem, I soothe him, the answer is clear
just do what I say, you'll have nothing to fear

Go down to the grocery and ask that new bagger
to loan you a brown paper big one, then stagger

Back home with it over your head! What? My license?
You want it? Oh, what have I done, I have no sense!

I take it all back, I was giddy from deadlines
and trying to be serious: it furrows my head lines

Please calm down, relax now, don't have a conniption
I'll cure you I promise: here is a prescription!

He's gone. Now I have to get back to my writing
Be serious, scholarly, helpful, inviting

Thank goodness for Dread Poets thread- yes indeed
a place to unwind when I'm truly in need.

----------------------------------------------------------------------

3. About exotic foods

Pickled eggs I've had, and worse
The thought of frog legs makes me purse

my lips and gag, but I would try
a fresh polk salad, loaf of rye,

some crab legs, sushi (only cooked!
I'm a doc, you know, I looked

beneath the scope, I did, and ugh
what I saw would make a slug

chuck up his breakfast, so no raw
fish for me), a monkey's paw

is taking it too far as well.
I'd like a fondue, that's a smell

that makes me smile, and want to dip
a cube of bread, then take a sip

of Chardonnay, oops there I am
back at wine! alright, then, ham,

but only finest prosciuttos
will make it past my snobby nose

Chinese I'll eat (the food, I mean)
Italian, Spanish, French cuisine

Hillbilly with okra pie
Better than a stick in your eye

But ask me to avoid Whole Foods?
That goes too far, sir, almost rude!

That place is home, my second larder
Quit I won't, I'd fight much harder

For organic foods and fresh ones
even though it uses up funds

Cheap it ain't: just ask Cheapskate
Still its always worth the wait

Don't believe me? Come for dinner
You don't like it? You'll leave thinner

Uh oh, wait a minute, what's this?
I can't stop creating bupkiss

Rhyme's Disease has taken over
Get the hook! I'm done! It's over.

Medical New Year Wishes

2008-12-31T14:31:00.001-08:00

1. Increased access and affordability of health care.
2. More self-helpers when it comes to health. People exercising, eating right, taking responsibility for their own healthy lifestyle.
3. Decreased influence of the pharmaceutical companies.
4. Cleaner air and water.
5. Greater use of integrated medicine practices.
6. Increased availability of truly dark chocolate.

Care to add yours?

Christmas in Sedona

2008-12-28T15:22:00.000-08:00

Sedona, Arizona. Land of red rock spires, ancient homes and, if you believe the loco locals, spiritual vortices. Whatever your orientation, it was absolutely beautiful there. We enjoyed hiking, running and exploring, when it wasn't snowing!

This is on the way in to Palatki ruins, which are very well protected by the National Park service.

Palatki was the only place I've ever seen "black on black" pictographs. The volunteer ranger told us these were originally white, like other pictographs, made of ground rock painted on with human hair brushes. They turned black when the soot from fires lit beneath the overhang settled into the white. He said they'll be black for the forseeable future.

The view from Jerome, a little ghost town on the side of a big hill.

Happy Holidays!

2008-12-19T22:07:00.001-08:00

To anyone who happens by,

May your holiday season be joyous and calm, and your 2009 be filled with peace and good health!

With love,

Peg

The doctor is out sick

2008-12-14T14:38:00.000-08:00

I'm sick! Started with a sore throat, progressed to body aches and fatigue, then the sinus pressure and congestion kicked in. I'm miserable! All I want to do is sleep, but my nose is so stuffed up that I have to breathe through my mouth, which dries out my throat, which hurts worse and wakes me up. If I take a decongestant pill, the nose clears up, but I can't sleep because the decongestant is a stimulant. My sinuses hurt unless I press on them constantly and take enough ibuprofen to endanger my kidneys. This is the weekend I was supposed to do all my Christmas shopping, and I don't even want to leave the house. Not only that, I'm falling behind on my training for the half marathon in January, mere weeks away! Boo hoo and waaah!

Why am I moaning out loud on a blog? Because I think there's a lesson in all this. For me and other docs, that is. I'm usually very healthy, and manage not to catch most of the germs that are coughed in my face daily. But every so often something gets me. When that happens, I invariably find myself surprised at how miserable I feel, and humbled thinking of how miserable all the patients must feel. No wonder they came in! No wonder they couldn't do their homework or sit for their exam! This sucks!

We docs tend to get a little numbed by numbers. When we see ten people with respiratory infections in one day, they blur together, and the process becomes rote. Listen to the symptoms, swab the throat, recite a list of comfort measures, make a sorry face, then go on to the next patient. Part of rote-ness is remote-ness. Distance from the feelings of the patient. I hear them moan like I did above, I see their lips moving, but it doesn't really land after a while. I nod and smile, but I don't really, well, honestly, care as much as I should.

Now I know I'm just talking about a cold here. But as I have relearned this week, even "just" a cold can be devastating in its own way. More serious illnesses are more devastating, but those can be subject to the same doctor numbness if we're not careful.

The Universe is offering me an opportunity to share an experience with my patients in order to be a more compassionate physician.

It's not an illness; it's an opportunity! Yeah, that's it! A Universal lesson.

Okay, I get it already. I'm miserable. They're miserable. Can I please get better now?

Viral vs. Bacterial ?

2008-12-14T14:29:00.000-08:00

Q:

If you are feeling “sick” is there a way to determine if you have a bacterial versus viral infection without going to the clinic? For example, temperature? Swollen glands? Green snot? Coughing up stuff?

A:

The short answer is no. There is no sure fire way to tell without going to the clinic. However, if I were a betting woman, I’d put money on a virus, and I’d win big. Viruses cause the vast majority of respiratory infections. That includes most colds, sinus infections, bronchitis, and most ear and eye infections. It includes most cases of fever, swollen glands, green snot, and coughing up stuff.

For those readers who need it, I’ll explain the difference between viral and bacterial infections. Very broadly speaking, viruses are more common, and bacteria are more dangerous. The practical difference comes in with the question of antibiotics. Antibiotics kill bacteria. Antibiotics do not kill viruses. Your body does, for free. No clinic charge, no pharmacy charge. All it needs is some rest and time.

Now, everyone has a story of going to the doctor for a respiratory infection and leaving with a prescription for antibiotics. We hear it all the time. “Last time I had the same symptoms, and I got antibiotics, and it cleared right up.” Naturally, the patient wants the same treatment this time. The truth is she probably would have gotten better anyway. The timing of the antibiotics with her improvement convinced her that the antibiotics were responsible for her recovery.

Unfortunately, sometimes doctors prescribe antibiotics when they aren’t needed, “just in case.” This causes a couple of problems. For one, it sets up a patient like the one above to expect antibiotics for viral infections. That creates busy clinics and dependent patients, who think they can’t get over a simple cold without professional help.

On a wider scale, when we carpet-bomb bacteria with antibiotics, most bacteria will get killed. But a few will develop resistance to the antibiotic, and survive. Those will multiply and create a whole new group of tougher germs. Now science has to create a stronger antibiotic to kill these super-bugs. There have been some very scary germs created by this exact scenario.

I trust I’ve made my point about viruses. But remember, I said most respiratory infections are caused by viruses. That means some are caused by bacteria. For example, the bacterium Streptococcus pyogenes causes a throat infection commonly called Strep Throat. That definitely requires an antibiotic, to kill the bacteria and prevent dangerous consequences of the infection. Some kinds of pneumonia require an antibiotic, as do some ear and eye infections and, rarely, sinus infections.

If you’re looking for criteria, I suggest the following. If you get a respiratory infection, with the usual sore throat, congestion and cough, give your body a few days to work on it. Take over the counter remedies if you like. Drink lots of liquids to keep the mucous flowing. Try a sinus rinse. But if you have a high fever, a really bad sore throat that lasts for more than a few days, trouble breathing, or symptoms that last longer than a week, come in to the clinic for evaluation. Err on the side of caution, and come in anytime if you have doubts. Call ###-#### for advice or for an appointment.

Heroin and Opiate Addiction

2008-12-14T14:13:00.000-08:00

Dear Dr. Peg,

I have been addicted to heroin for over six months now. While I have never used the drug intravenously, I still must smoke every day to function normally. I have wanted to quit since school has started but I’m so scared my school work, job and general life will suffer. I have researched multiple treatments but haven’t yet tried using one. As a doctor what would you recommend as a course of action? At the moment I am only engaging in counseling at the student health center. Thank you.

Sincerely,
Anonymous

Dear Anonymous,

You have several things going for you already. You want to quit. You have only been addicted for 6 months. You are already in counseling. Those are three giant steps along your new path, and you are to be commended. I’m going to answer your question, but first I’ll fill in some background for those who don’t know.

Heroin got its name from the fact that users feel powerful and invincible, like a hero. It is one of a class of drugs called opiates, derived from the opium poppy. Some other opiates are prescription narcotic painkillers like oxycodone and hydrocodone, Narcotics are addictive, like heroin, and are sometimes sold on the street and used illegally. Narcotic addiction is a huge and growing problem, with an estimated 2.2 million new non-medical users in 2005.

Ironically, heroin was developed originally as a treatment for morphine addiction. Oops! As soon as it was discovered that heroin was in fact more addictive than morphine, heroin
was made illegal, and remains so.

Of all the opiates, heroin is the most addictive. Called “dope,” “horse,” “smack,” and “tar” on the street, it gets into the brain easily and quickly, resulting in peak levels shortly after injection or inhalation. This is called a “rush.” After the rush, active metabolites stick around in the body for several hours, resulting in a prolonged but less intense “high” than the initial peak, described as a relaxed, contented state.

So what’s not to love, right? Wrong. The problem is, your body gets very attached to those sensations, and it complains when it can’t have them. That’s called addiction and withdrawal. Addiction leads to physical problems, discussed below. Not only that, the more you get high, the less useful you are, to yourself and to others. Eventually the addiction takes over your life, and you spend a huge amount of energy and money feeding it. You might even commit more crimes in this pursuit.

Heroin can be injected in the veins, smoked, or snorted. In the 1960’s, when heroin use was highest, most users injected it. Injection is the most efficient if the heroin is low purity, but can result in nasty skin infections and blood borne diseases like Hepatitis B and C and HIV if needles are shared. Overdose is most likely from injection, partly because the purity of the drug is so variable.

Nowadays, as the heroin supply is generally more pure and the risks of injection are well-known, more people are smoking it and sniffing it. Smoking gets it into the brain fastest. Snorting requires the least equipment but can eat a hole through your nose lining. However you get it into your body, it is highly addictive.

Lest you think you’re the only opiate addict on campus, here are some stats. According to the Office of National Drug Control Policy, in 2003 one percent of college students reported using heroin at least once during their lifetime. Another survey, done by the National Household Survey on Drug Abuse, reported that among users 17-22 years old, the rate of use was higher for college students than for non-students. The rates of prescription narcotic use are higher. Abuse of prescription drugs for non-medical purposes went up by one third in 18 to 25 year olds in just one year from 2000-2001, and most of that increase was due to OxyContin and other painkillers. This is according to the National Survey on Drug Use and Health.

Back to you. It sounds like you are still in the early stages of addiction, where you are still able to manage a job and school. You say you’re worried that your life will suffer if you quit. It is hard to quit: I won’t lie to you. But your life will suffer much more if you don’t quit but stay on what will surely become a downward spiral.

How to quit? The old tried and true is the methadone clinic, which basically replaced one addiction with another, less dangerous one. That is still available, but a new drug called buprenorphine has made narcotic addiction treatment more successful. Buprenorphine is a prescription drug, available only from health providers who have special training. It attaches to the same receptors that opiates do but has a less intense effect. The idea is to avoid withdrawal symptoms while you slowly taper down the dose, meanwhile going through counseling to help you recover from your addiction.

Ask your counselor about "bupe." And hang in there; you can do this!

Halloween Party with Albuquerque Fit

2008-11-07T08:47:00.000-08:00

Our illustrious host and hostess.

Um...remind me...Mylie Cyrus and ??

Meow!

Queen Marlene, her Holy Gail, and - hey, is that Heather Wilson?

Count Rod Dracula extinguishes his birthday candles.

Oh, do have another drink, Lady Catherine!

The Blind Date. Get it? Blind.....Date. No, he's not a fig newton.

"My moustache flies in your general direction! Ni! Ni!"

The little devil. Ain't she cute?

Coach Marc executing a perfect demi-pirouette.

Angel Tracie...pure as the driven snow. [Who's laughing? Stop laughing!]

Pretty Pixie. Notice the blind date took off his shades to check her out.

Birgitty Kitty.

Me as the scariest thing that has happened all year.

(I'm the stock market. Get it?)

Half Marathon Celebration

2008-09-21T16:11:00.001-07:00

This is the year I turned 50.

"Turned," we say, like milk turns sour, or a secret agent turns against her own side. Not the most appealing turn (sic) of events, is it?

This is the year I achieved 50. That sounds better. I reached 50. I hit 50 (hmm...no, that sounds too much like a brick wall).

I celebrated. There it is. This year I celebrated fifty years of life on this earth. As a way to mark a half century's worth of living, I decided to train for and attempt to run a half marathon. I have mentioned this before. Starting in February, by running one minute and walking for four, I increased my run time gradually with the Albuquerque Fit training program. Every week we did a little more, and a little more. Before I knew it, I was running 6 miles, then 8, then 11...

I'll get to the point. I did it! On September 7, 2008, I completed my first half marathon run, the Chips and Salsa race in Albuquerque, NM. Thirteen point one miles. I made it in 2 hours and 50 mintes, for an average of 13 minute miles. Nope, I wasn't last, either! Close, but not quite. I'm very pleased and proud. My goal was to finish, and I did it.

With only yards to go, my daughter Serena and son Derek and friend Anne came out to join me and encourage me. In this picture, I'm sandwiched between the two kids, with Anne out front egging us on.

Serena stuck with me all the way to the finish line. "Come on, Mom, you can do it!" Here she is, in the red shorts, making it look easy, while I, in the pink hat, put on a last little blip of speed (well, relatively speaking) to get across the line. I placed 177th overall (out of 194), and 7th in my age group (out of 7). Not half bad for my first time, say I.

My wonderful hubby and both my parents were also there, cheering for me and taking pictures as if I were some kind of celebrity. Talk about the power of love!

It has been two weeks since the Chips and Salsa half marathon. I took a week off, then rejoined the group, just to keep active, so I thought. Until last Saturday, when coach Mike asked for a show of hands for who plans to run the Duke City half marathon October 19. Zing! My hand was up before I realized it. And now I'm dreaming about Phoenix in January, Denver next year...

I guess I've found a new passion. It's great to have a fun way to stay fit, a goal to work toward, and an excuse for partying after!

Run for the Fallen

2008-08-24T19:35:00.001-07:00

This morning people all over the country ran a mile in honor of each fallen soldier from Operation Iraqi Freedom. Run for the Fallen is " a collective of runners whose mission is clear and simple: To run one mile for every American service member killed in Operation Iraqi Freedom...We refuse any political affiliation or agenda, but simply honor those who have fought, and those who have fallen under the American flag." They ran, across the country, a mile for every soldier, sailor, airman and marine killed. Today they ended their run in Arlington National Cemetery, and on this day they asked people all over the country to join them.
A small group of New Mexican runners gathered at USS Bullhead Park to run in honor of the 35 fallen New Mexicans. We each pinned on a named bib, stuck a flag in our hat, and ran half mile laps on the grass in the New Mexico morning sun. We were grateful to be alive, and honored to run in memory of those who lost their lives so far from home.

Tonsillar Abscess Day

2008-08-22T10:18:00.000-07:00

Warning: this post contains pus.

Another one. A day of three. This time it was three tonsillar abscesses. Unrelated, but with the same story. "I was fine until yesterday, when one side of my throat just blew up!"

When I looked in said throat, sure enough, the opening was lopsided, with one half practically obliterated by a big red bulge coming in from the side and covered in pus. Nice. Fortunately, pus doesn't bother me. Well, pus rarely bothers me, I should say. I have learned, however, not to use that word when discussing someone's throat with them. People don't like to hear that they have pus in their throat. I told one gal that and the next thing I knew I was scraping her off the floor. Oops.

So, what happened in the throats that day was that an infection dived deep, under the tonsils, like prairie dogs digging a labyrinth of safety under the earth. The result? Tissue swollen with prairie dogs. Or, rather, with Streptococci. And fluid. And pus. And pain. That s^^t hurts! People with tonsillar abscesses also talk funny, as if they have a- well, a mass in their throat, which they do. We in medicine give this the technical term, "hot potato voice." And they make a face every time they swallow, because they are in pain.

Back in the day, we used to call the Ear, Nose and Throat people to come and stick a very long needle--uh oh, there went another reader. Someone scrape her off the floor, would you? Yep, a very long needle into the prairie dog town and drain out all the sewage. Yowser. Nobody's idea of a picnic, right? Thankfully, nowadays we're much more humane. Someone figured out that the Strep dogs can be flushed out with chemicals. Mere pills! Who knew? So now we give heavy duty antibiotics, steroids to decrease the swelling, and, of course, last but far from least, narcotic pain medication. Decreases pain, misery and awareness of misery, for which the patient will thank you profusely when you see them back two days later for a recheck.

Two days later, I hardly recognized any of them, which reminded me how pain changes one's whole appearance and demeanor. Fevers down, pain at bay, and a throat as open as San Francisco Bay. Whew! Thank goodness for chemistry!

Wonder what "threebie" next week will bring?

Olympic Thrills

2008-08-19T17:33:00.000-07:00

Every time I watch Olympic games, I have at least one "Olympic Moment" of my own. This usually occurs at the end of a competition. Athletes from all over the world have just given the most they have, done the best they can do, stretched their own personal limits of strength, agility, or speed. They collapse at the finish, sweating, spent.

Somebody won the gold. That's thrilling, sure. Everyone pushed hard and achieved what I could never hope to. That's thrilling too.

But what really lifts me up is watching the athletes congratulate each other. They hug, kiss cheeks, high five, shake hands. With genuine appreciation, they are acknowledging each other's efforts and achievements. It's a moment of salutation and mutual respect.

Gives me goosebumps.

Cades Cove and Abrams Falls

2008-08-10T22:14:00.001-07:00

This is a broad view of Cades Cove, a historic area settled and farmed in the 1800's and early 1900's.

We went there to hike through the woods to Abrams Falls. Once again, evidence of water's work everywhere.
Yummy-looking white mushrooms springing out of the forest floor. Don't worry: we didn't try them!

Lichen on a big tree trunk.

The Galax plant.

Some crusty ol' tree .

And, finally, the water itself. I hate to say it, but I had to wait for just the right moment and crop the picture well to get a picture with no people in it. There were lots of folks there, from oldsters dipping their tootsies to young bucks jumping off the falls into the water below.

Smoky Mountain Run

2008-08-03T16:30:00.000-07:00

Greetings from the Smoky Mountains of East Tennessee! It is so different here from the New Mexico desert. The forests are lush with growth and rot, and the air is heavy with moisture. So heavy, in fact, that after about 2pm all we want to do is sit in front of a fan or dunk ourselves repeatedly in the pond, a murky but beloved tradition formed when my grandfather dammed up one of the hollers. My parents, who have built a lovely summer cabin here, are purists, who don't want to block out nature with something so roaring as an air conditioner. Dad looked like he might consider relenting when I reminded him that we haven't had to go down the hill to the double-seater outhouse for several years, since they installed indoor plumbing. So maybe next year they'll upgrade to temperature control! *

A 9 mile run was on my training calendar for yesterday, so I headed for Great Smoky Mountain National Park. I set out at dawn, drove to the park headquarters, silent and empty at that hour, and spent just over the next two hours running the trails nearby. I ran this trail twice, back and forth. Thanks to my esposo who gave me a Garmin GPS watch for my 50th, I could tell exactly how far I had run and how fast, in addition to my heart rate and speed. My plan was to upload photos here, but the dialup connection in the cabin won the staring contest. I'll post them after I return.

By the time I got back, drenched and depleted, the parking lot was full of tourists coming and going from the visitor's center. Some looked at me askance as I emerged, dripping, from the forest like some kind of creature of the deep. I was still on my feet, though, and proud of myself for having made my longest run yet, and all by myself.

The cabin is at the end of a one-lane gravel road. When you're here, you can imagine how life used to be in these hills, before Dollywood, before all the tourist attractions that choke the parkway. At night, the tree frog chorus screeches, and, in the early morning, the forest silence is broken only by birdsongs. These woods are old, old, old, yet in a constant state of renewal. It's oddly rejuventating.

*News flash! They got two window air-conditioning units while I was there! Bliss!

Intensity

2008-07-30T19:33:00.000-07:00

In the past five days I have felt deep joy and deep sorrow. Equally intense feelings, opposite poles. It got me thinking about the very nature of intense feelings and how, regardless of which pole they originate from, they invigorate us. Feeling anything with your whole self is being alive, painfully, exquisitely alive.

My family had a birthday party for me last weekend. The big five-oh. We finally celebrated officially, with bells and whistles. Dear friends gathered, from work, soccer, neighborhood, book club, even childhood. My kids showed a retrospective slide show they had put together. I felt lucky and loved, intensely happy, warmly alive.

Yesterday, I hugged my friends Patch and his wife Cookie, knowing it could be the last time I see Patch alive, or conscious, or talking. He'll have brain surgery on Monday to remove a recurrent tumor. Last time he came through it with flying colors. We all know it could be very different this time. Or it could be the same. I felt fear and sorrow, hope and pain. Again, intensely alive.

It seems odd to be grateful for heart-wrenching fear, yet I am. Right along with happiness and hope. I want to live this life, all of it, to feel all of it, to have every experience with my very bones. And that means being open to all of it. If you're open to deep joy, you'll get it, and the sorrow that may follow. And that is rich living. Give me no other kind.

Cat Bite Day

2008-07-25T12:14:00.000-07:00

I haven't seen a cat bite in months. Tuesday, we had two, one right after the other! Different patients, different households, different cats. One was already infected, less than a day after the bite. The patient had fever and bodyaches, all from a little puncture in her finger. The other gal's forearms were covered with scratches and bites. Her kitten wanted a cupcake, believe it or not, and was not happy to be told "no!"

Eighty percent of cat bites get infected. This is in contrast to about fifteen percent of dog bites. Surprising, isn't it? You might think those nasty canines, who chew everything from your stinky shoes to roadkill, would have mouths teeming with germs. You might think precious, preening kitty has nary a germ on her tongue. The truth is the opposite.

Finger Puncture came back yesterday, much better on a simple antibiotic. Cupcake Withholder is doing fine too. I bet it'll be Christmas before I see another cat bite.

Professional Distance

2008-07-24T21:04:00.001-07:00

I have this patient. I wish she were my friend. But, of course, she cannot be my friend, because that would violate the principle of professional distance.

You know what that means, right? A doctor isn't supposed to get "too close" to her patients. Although that phrase is not well defined anywhere, there is a tacit understanding that getting "too close" or "too involved" is bad for both parties.

Bad for the doctor because you lose your objectivity and can't think straight. Not to mention, you might end up getting hurt if there's a negative outcome. And, of course, there's the time-honored practice of putting ourselves on pedestals, which is hard to do if you're down in the muck with the patient.

Bad for the patient because the doctor loses her objectivity and can't think straight. Not to mention, it's hard to fire a doctor if they're also your friend. And, of course, there's the possibly comforting traditional role of doctor as boss, abrogating you, the patient, of responsibility, which is hard to maintain if you're equals.

All that said, albeit somewhat with tongue in cheek, I find it hard at times to maintain this distance. This patient is a case in point. She came to see me a couple weeks ago. We clicked immediately. She's friendly, casual, comfortable with herself, funny, smart. I am seeing her for a minor but persistent problem that has required her to come back several times, and each time I have a really good time, as if we were meeting socially for coffee or something. Don't get me wrong: I am treating her, and successfully too. But the treatment gives us time to chat. I even told her the story about the time I spilled trichloroacetic acid on...but that's fodder for another post.

I know we'd be really good friends if circumstances were different. It makes me feel sad.

She's moving away soon, to the other side of the country, taking dilemma and possibility with her. I wish her well, and I'll miss her.

Eight Mile Run

2008-07-21T08:36:00.001-07:00

We did it! We ran 8 miles. The longest run yet. Not only that, it was out in the country, on a rather hilly road. We started at Jemez Dam, for those of you in the know, and ran back toward Bernalillo. Here's the view from the starting point:

Coach Marc, a.k.a. "Iron Man" gives his customary safety speech. Only this one included "watch out for bulls!"

And we were off! Hard to complain about running in such beauty.

Thankfully, Scott, the photographer extraordinaire, took his photos at the beginning of the run, while we were all still smiling. That's me in the middle, with leggy Jen on my left and Coach Lori, a.k.a. "Tofu Lori," on my right.

We all finished, and were very proud of ourselves. Still hard to believe we'll be able to run half again as much in September, but I have faith.

Training for a Half Marathon

2008-07-18T09:00:00.000-07:00

Round about December last year, I started to fidget. No exercise to speak of since my car crash in August, and I was getting soft and grumpy! My neck and back were feeling enough better that I really wanted to try something, anything, to get my bod moving again. After all, I'd be 50 soon, and we all know it gets harder to get in shape the older you are!

I went to my friend Sue, a marathon runner who is 54 and looks 44, to ask her advice. See, my usual exercise "regimen" included playing adult soccer once or twice a week, and that was about it. I know the value of exercise and keeping in shape. I am an educated medical professional, after all. But, I tell you, if it isn't fun, I simply won't do it. Laps at the pool? Bo-o-o-ring! Routines at the gym? Spare me.

I wasn't sure I was up for soccer yet. The only kind of soccer that goes on here in winter is indoor soccer, which is notoriously rough and risky. I figured I better start with something kinder and gentler. I was hoping to be back in good enough shape for the Spring women's soccer season.

I might have predicted Sue's response. "Try running!" Ugh. Running was right up there with pool laps and machine weights.

"Wel-l-l," I waffled. But Sue persisted. She told me about the program and group that got her running. Albuquerque Fit.

I checked it out. Their beginner program is called In Motion. They met every Saturday for an hour, starting in January. I decided to go. The first day we "ran" a half hour as follows: run for one minute, walk for four minutes, repeat. Wow, I thought. I can do this. So I continued.

The next week, we ran for two minutes and walked for four. And so on. Bit by bit, the running time increased and the walking time decreased. We hardly noticed our muscles growing and our endurance increasing. By the end of the program, 11 weeks later, we were running for eight minutes and walking for one.

By then I was hooked. Not only did In Motion give me people to run with once a week, they gave me a proscribed schedule for running during the week. This, I failed to mention, is the other way to get me to exercise. Tell me what to do. Give me instructions, a task, a schedule. Make it so I don't have to motivate myself and I'll do it. Of course, I still have to get my own rear out the door and move it, but having a formula really helps me. Get up, go do the run, check that one off, shower, go to work.

When that program ended and the next one, Albuquerque Fit, began, I stuck with it. ABQ Fit trains you for one of three races: marathon, half marathon or 10K. The coaches, who are regular guys and gals who started just like we did, encouraged us to aim high, saying it was easier to shift down than up partway through. So I went for the half, thinking from the beginning that I'd probably end up changing to the 10K, but secretly hoping I could make the grade for the half marathon. It just seemed so perfect. This is my half century year. Running a half marathon in honor of that was fitting.

So here I am. Several weeks into it, and still hanging in there. People do drop out, by the way, naturally. But a couple weeks ago Coach Mike informed us that, statistically, of those of us who had made it to that point, over 90 percent of us would finish our target race. We had made it over some kind of hump.

Tomorrow, our long Saturday run will be 8 miles. I have never run that far in my life. But, thanks to the incremental training technique, I have run 6.6 miles, and 7 miles. My weekly totals (long weekend run plus three weekday runs) are now up over 13 miles. Now I run for a mile before I walk for a minute, because the run/walk technique is what they teach. We're aiming to finish, not to break any time records here. So far my old bod is holding up pretty well. A few aches and tweaks here and there, but --knock on wood--nothing that has laid me up.

My target half marathon is in early September. Wish me luck! I'll let you know how it goes.

Butt Boil Day

2008-07-16T19:52:00.000-07:00

Today in clinic it was Butt Boil day.

Seriously.

You know how they say things come in threes? It's true. At least, in medicine it is, or seems so much of the time. Weeks will go by with not a pimpled posterior in sight. Until suddenly, one day, boom, boom, boom! Three in a row.

Did these people know each other? No. Did they all sit on the same seat on the bus, or bench in the park? I seriously doubt it. So why did they all develop boils on their behinds today? It's a medical mystery.

We've had other odd days as well. Among others: Eye Scratch Day, Jock Itch Day, and, my personal favorite, Ingrown Toenail Day. (What can I say? I love procedures. I'm a wannabe surgeon at heart.)

Stereo Mammograms

2008-07-09T19:39:00.000-07:00

The other day, our local paper had a story about a new and improved, up and coming technique for imaging the breast. See, the way they do it now, a mammogram, is two-dimensional. And the breast, of course, is three-dimensional. Yes, in spite of all their efforts to squash it into one less dimension, it remains stubbornly round. Well, once it recovers from the mammo, that is.

This new technique involves taking two mammograms, from two slightly different angles, so as to create a stereoscope of the breast. The result is two pictures, slightly off kilter from each other. The radiologist, in order to read the two mammograms as one round image, will don a pair of those weird stereo glasses like from the 60's. I kid you not. Remember those things? Or the plastic binocular-shaped gismo that you'd pop a round slide card into and look through, to ooh and ahh at the 3-dimensional image inside.

I had to laugh. And, at the same time, shake my head. Why on earth didn't someone think of this sooner? We had higher technology for our toys 40 years ago than we do for our breasts today. What is wrong with this picture?

Give me an "A!" Give me another "A!" Give me an "R!" Give me a "P!"

2008-06-21T13:18:00.000-07:00

On the way back from Crested Butte, I stopped for the night in Gunnison, Colorado. Little motel on the edge of town, one of the few not filled up by the softball tournament that had packed the area for the weekend.

The plump young woman behind the desk said, "Two queen beds, $59."

I nodded, "Okay."

"Got any discounts or anything?"

"No." I never have discounts. If I ever manage to clip coupons, I always leave them wherever I'm not. "Oh, wait! I'm a member of AARP! Does that count?"

"Sure does," she smiled.

I was psyched! My first discount as an Elder American! Woo hoo!

I felt like I had made a rite of passage. Small, but significant.

You see, for years I heard my friends complain, "I got an invitation to join AARP! Man, do I feel old!"

As each of them passed the fifty year mark, we'd razz them. "Did you get your AARP card yet?" Ha ha ha.

So, when it came my turn to see the big 5-0 on the horizon, I decided to get pro-active. I joined them before they could recruit me. I had my membership before my 50th birthday. Embrace the change! Be proud of your age! Bounce right out of your 40s and into AARP!

And here I was, reaping the benefit already. I signed my name with a flourish and strutted down to my room.

Book Event at Blue Moon Books in Crested Butte

2008-06-17T16:48:00.000-07:00

Here are some pics from the reading and signing event at Blue Moon Books in Crested Butte last Saturday. It was a nice, intimate gathering. This is the sandwich board out front. Can you make out where it says "Tonight Only!" I love that. As if authors normally do nightly appearances for a month or something. Anyway, it made me feel special.

Here's David, the owner and proprieter of Blue Moon Books. See how he cleared off the back wall to display our book? Nice, eh? He also hopped on his town bike (everyone rides everywhere in "CB" as the locals call Crested Butte) and rode up to the liquor store to come back with wine and a 6 pack of............drum roll please...........Blue Moon Beer! He was very hospitable. Thank you David!

And here we all are - the intimate gathering of which I spoke. Five guests made it a close and casual event. That's me in the middle in purple. Some of the others are locals, some were visiting from other parts of the state. I talked a bit and read a bit and we had some nice conversation about aging and other life topics.

Thanks again to Blue Moon Books! I highly recommend this cozy shop if you're ever in the area.

Book Event Tomorrow

2008-06-13T21:13:00.001-07:00

Tomorrow at 5pm I'll be doing an author event for 50 Ways to Leave Your 40s in Crested Butte. The picture above is the Crested Butte City Hall. Probably just like it looked a hundred years ago (plus a new coat of paint).

This is a shot of Blue Moon Books from across the street. I tell you, all the buildings in Crested Butte are like this. Colorado Quaint. Isn't it great?

If you look very closely, you can see a poster for 50 Ways on the door of Blue Moon Books, just above the political action sign. I'll post more after the event. Fingers crossed for some attendance!

June 13

2008-06-13T20:56:00.000-07:00

I missed blogging last night because I was busy jamming! Turns out there are a few musicians up here, so some of us got together and did a little pickin' and grinnin'. It was a lot of fun, although I felt rather OLD when some of the students didn't recognize songs like "Down in the Valley" and "Rollin' in My Sweet Baby's Arms."

Thought I'd share a couple pics of the lab buildings. This one is the main office, the hub, where mail comes in and everyone goes with their questions and problems.

This is the General Store. In the old days, it was the Gothic Town Hall. Now they sell T-shirts and postcards downstairs, and upstairs is a museum.

Look who I saw again last evening. She's hunting right here "in town!" (That's a cabin called "Paradise" right behind her. Hey, it's all in your point of view!)

Once again, she was unfazed by me and my camera. I have yet to spy her babies, alas, although I did sit quietly outside their den for quite a while the other day. Maybe tomorrow, my last day here, I'll get lucky and see the little threesome.

This morning it was clear and cold, after yesterday's storm. There was frost everywhere, including on these growing wild cabbages.

June 11

2008-06-11T18:41:00.000-07:00

I walked to the dining hall this morning just as the sun was peeking over the mountains to the East, lighting the aspen at a lovely slant.

The RMBL dining hall where I am happily fed three times a day. At this point the sky was blue, all except for a telltale wisp of cloud to the West. We'd heard rumors...

Sure enough, by 10am the sky was lowering gray and there were even snowflakes blowing around! Brrr! I guess we were at the bottom edge of a swirling front up north. Seeing that snow lit a fire under my carcass, so to speak, and back to the heater I went, to lean on the pilot button some more. This time, success! I have heat! Now all I need is water and I'll be in paradise. They did get the part for the broken water pipe today and did some repairs but I'm still working out of water bottles and hiking to the shower.

By early afternoon, the weather had cleared. Reminded me of how unpredictable and powerful the mountains are.

I managed a run this afternoon, up the valley beyond the lab, but didn't take my camera, alas. The vistas up there...more of the same, but more so! On the way to the run is this cabin, the oldest in town, but with a recent facelift.

Last shot of the day. Can you find the marmot in this photo? It's a brown furry mammal. More tomorrow!

Another Beautiful Day in the Rockies

2008-06-10T19:19:00.000-07:00

Well, I didn't get the heater going last night. I pushed and pushed on that little pilot valve, but I just didn't have the stamina to keep doing it long enough to bleed out all those feet of air through the tiny pilot pipe. So instead, I piled on layers and went to bed. Here's a picture of everything I wore into my sleeping bag last night. Good thing too, because the outside temp went down to 21 degrees F, they said today! Cozy!

The alpine beauty here is breathtaking, every direction you look. Here is a view of my cabin (the one on the left). The little cabin on the right used to be our clinic, but now is another residence.

This is Belleview, aptly named, still covered in snow. It's the highest peak within easy reach of Gothic. The route up it, in good weather, starts beyond the skyline on the left, across a pass that is still closed due to snow.

Work Day in Gothic

2008-06-10T18:51:00.000-07:00

Today was work day in Gothic. Work morning, actually. So see that fence in the picture above? Old fashioned wood rail fence. My job, along with one other gal, was to tear down one just like it on the other side of the road and separate the poles into salvageable and non-salvageable piles.We did it in 3 hours! Yar! Gal power! See the result below:

We earned our lunch today, followed by an Ibuprofen chaser. I know I'll be sore tomorrow, but it was a lot of fun, whacking those old poles apart.

Here are some of the poles we got off the fence.

A Writer's Mountain Retreat

2008-06-09T19:03:00.000-07:00

By the way, the other reason I'm up here enjoying the rarefied air and frigid nights is to write. This is a writer's retreat extraordinaire. Incredibly beautiful surroundings, a private cabin with an espresso machine (imported by me) and a beer fridge, meals provided, and lots of free time. What more could a writer want?

Oh, and at the end of the week, I'll be doing a book signing for 50 Ways to Leave Your 40s at Blue Moon Books in Crested Butte. Saturday at 5, if you're in the area. Wine will be served. It's a great shop, small, friendly and crammed with great books.

My writing goal for the week--well, goals, really. One is to work on editing some of these very blog posts, most written a year or two ago, to get them in shape to actually submit somewhere. The second writing goal is just to practice. I have a wonderful book called Pen on Fire: a busy woman's guide to igniting the writer within, by Barbara DeMarco-Barrett. Her chapters are brief, and she ends each with a 15 minute writing exercise.

Speaking of igniting, I'm going to try (again) to ignite the gas heater in this chilly cabin. Alas, the pipes from the propane tank to the heater are about 15 feet long. That's a lot of built-up air from over the winter that needs to be bled out, a pilot light's amount at a time. I'm taking shifts.

More tomorrow!

More pictures from Gothic

2008-06-09T18:57:00.000-07:00

Looking East in the evening at Red Mountain.

Look who I spied as I walked back to my cabin from dinner! Was she scared? Not a bit. In fact:

More about my 50th

2008-06-04T19:34:00.000-07:00

(This post is from our book blog)

Last Sunday, the 1st of June, 2008, I officially left my own 40s behind.

Happy My Birthday to you!

I have to admit, in spite of coauthoring a whole book on the subject, I had some trepidation about reaching this particular milestone myself. I mean, we wrote a lot about how wonderful this time of life can be, how celebration-worthy, how joyous. And I do believe all that. I also got a little short of breath when contemplating my own passage. And I wondered: I can talk the talk, but can I walk the walk?

I'm happy to report that so far it has been just fine. I woke up that morning wondering what 50 would feel like, and was pleased to discover that, of course, it felt just like forty-nine and 364/365ths. I felt no different from the day before. *forehead smacker* Of course I didn't! We change in increments, after all, and 50 is just a number. I left my 40s the way I live my life: fairly quietly and one day at a time.

The day of my birthday I played in a soccer tournament for women over 30, and I am very proud to tell you that we won second place! Not half bad for a half century, eh? The team insisted I take the trophy home for my birthday, so now I have a daily reminder of how I started out Leaving My 40s like Way #8: Play Ball!"

Later that day (after a delicious nap a la Way #7: Pause) my wonderful husband and kids took me to dinner at my favorite gourmet pizza and salad place, then we came home, ate chocolate (an absolute necessity on any of my birthdays) and watched a feel-good movie (August Rush) together. No big deal. No fireworks. The day wound down and imperceptibly slipped into June 2.

We are planning to have a big party later in the summer, but even if we didn't, I'd be happy. I'm healthy; I have a great family; I love my work. What more could I want at any age?

My 50th birthday is today!

2008-06-01T13:47:00.000-07:00

That long-awaited day has arrived. It has carried extra significance for me, given the book I just finished co-authoring. 50 Ways to Leave Your 40s. So I should be an expert at this particular transition and sail through it without a ripple, right?

Right. However, I will admit, I had some trepidation. Fifty sounds so OLD! Yes, even after I spent two years working to co-write a book which hopes to soften that number and help people see midlife as a fine old time. I was still nervous about actually doing it myself.

I'm happy to report that I awoke this morning feeling like just exactly the same person I was yesterday. Yeah, I know, you'd think after this many birthdays I'd get it. One little day does not a big difference make. Still, I was relieved. I looked at myself in the mirror and said, "Happy Birthday, me. I'm fifty." It didn't hurt a bit.

Spent the day so far playing soccer in an Over-30 women's tournament. Not only that, our team won second place! I was psyched! They made me bring home the trophy, since it was my birthday and I had organized the team. I think it's pretty cool to have a soccer trophy to commemorate my 50th birthday.

I'm still having a little trouble wrapping my mind (and my mouth) around the words "in my fifties," but I figure that'll come. For now, I'm thrilled to be alive and healthy enough to play soccer.

Happy My Birthday to YOU!

Lorraine Feather

2008-05-17T12:44:00.000-07:00

I heard this gal on NPR this morning. She has a wonderful voice that she applies to complicated jazz tunes about simple ordinary things. What caught me was her song "Where Are My Keys?"

http://www.npr.org/templates/story/story.php?storyId=90525180

Blog on Over to 50 Ways!

2008-05-17T10:44:00.000-07:00

Just in case anyone comes to visit here, you should know that any free blog time I've had has gone to our book blog. Please come visit there!

50 Ways to Leave Your 40s Blog

Second Hand Smoke

2008-04-27T10:11:00.000-07:00

– Peggy Spencer, MD

UNM is considering becoming a completely smoke-free campus, indoors and out. Smoking is already prohibited inside the buildings and within 20 feet of the entrances. I’m a physician, not a politician, but, as a physician, I feel moved to offer information about the health effects of second-hand smoke and smoke-free workplaces.

In case you think this doesn’t apply to you, you should know that 15% of UNM students smoke cigarettes, according to a 2006 survey. Twenty percent of New Mexico adults smoke. FYI, that puts us roughly in the middle. Utah is the lowest, with just under 10% of adults smoking, and Kentucky is the highest at almost 30%. So even if you are a nonsmoker, chances are very good that you will be exposed to second hand smoke.

Second hand smoke (SHS) is made of sidestream smoke, from the burning end of the cigarette or cigar, plus exhaled mainstream smoke, from the smoker’s mouth and lungs. Everyone knows that cigarette smoke is harmful to the health of the smoker. Now we know that second hand smoke is harmful to the nonsmoker as well. In fact, SHS has higher concentrations of some toxins, due to cooler temperatures and other factors.

There are more than 250 toxic chemicals in SHS, including at least 50 that are known to cause cancer (carcinogens). SHS has been classified as a “known human carcinogen” by the Environmental Protection Agency. An example of a carcinogen in SHS is formaldehyde. Formaldehyde is used to preserve biology tissue specimens and to embalm dead bodies.

Besides carcinogens, SHS contains many toxic gases, like carbon monoxide, the deadly gas in car exhaust. Also chemicals, like hydrogen cyanide, which is used in chemical weapons, and heavy metals, like arsenic, which is an ingredient in pesticides.

The health effects of SHS on nonsmokers have been studied quite extensively, using household members and coworkers of smokers who smoke indoors. The degree of SHS exposure can actually be measured. There is a chemical named cotinine (an anagram of “nicotine”), C₁₀H₁₂N₂O, that is a unique metabolite of nicotine. In other words, it doesn’t exist anywhere except in the blood, urine and saliva of people exposed to nicotine, including second hand smokers. More about this below.

Outdoor studies are difficult to do, as outdoor SHS is difficult to quantify, but I have no doubt the evidence is forthcoming. Meanwhile, a degree of extrapolation to outdoor environments is reasonable.

SHS is a respiratory irritant. An irritated respiratory system is more susceptible to colds, bronchitis, allergies and asthma. It is also, as I mentioned above, a carcinogen, estimated to cause 3,000 lung cancer deaths per year in nonsmokers.

Smoking increases heart disease, as you probably know. So does SHS. There are immediate and long term effects. The moment you inhale SHS, the platelets in your blood become “stickier,” and the lining of your blood vessels is damaged right away also. This increases the risk of a clot forming inside your blood vessels, which could translate into a heart attack or stroke, especially if you already have vessel disease.

Long term, SHS causes heart disease just like first hand smoke. In fact, a conservative estimate is that SHS causes 35,000 heart disease deaths a year in nonsmokers. That’s equivalent to the whole UNM student body.

Babies and children are especially susceptible to SHS. Low birth weight, Sudden Infant Death Syndrome (SIDS), and respiratory infections are some of the problems that can be caused by SHS in babies.

Another group that can be adversely affected by SHS is ex-smokers. For some, even a whiff of smoke in the air really triggers their craving and makes it tough to stay quit.

If you can smell smoke, you’re second hand smoking. Will one puff kill you? Doubtful. But if you already have asthma or heart disease, it could trigger an asthma attack or a heart attack. Far more likely than instant death is temporary irritation, of mood and respiratory system, and long term gradual buildup effects discussed above.

How much is too much? The surgeon general has issued a conclusion that there is NO SAFE LEVEL of second hand smoke. The only way to really protect nonsmokers from smoke is to have separate, indoor, isolated buildings for smokers. Called “smoking pavilions” or “butt huts,” these do exist in some places.

Naturally, I would be happy if nobody ever smoked again, for the sake of their health and everyone else’s. But smoking is a legal activity, and we can’t stop people from making legal behavior choices. Since smoking affects others, however, it becomes a public health issue. Over the years, measures to protect the public from SHS have broadened in scope, from smoke-free sections of rooms to whole.

Our neighbor Arizona was the first state to institute bans on smoking in public buildings. Most other states have followed suit. Federal measures have led to smoking bans on airplanes, federal buildings and facilities that provide federally funded services to children. New Zealand and Norway have laws that all workplaces must be smoke-free. In this country, some businesses such as Nike and Scott Paper now have 100% smoke-free campuses. Over 100 colleges and universities in the US are completely smoke-free as well.

Public health policy is only as good as the health outcome. It turns out, smoking bans actually help people quit, and that is good for their health. Their coworkers and household members benefit as well. Body fluid levels of cotinine, that nicotine metabolite, have fallen 70% overall in the last 15 years. However, there are still measurable levels of cotinine in 43% of nonsmokers in the US.

The healthiest way to deal with cigarette smoke is to avoid it. Don’t start smoking in the first place. If you smoke, quit. This is far easier said than done. Tobacco addiction is extremely tenacious. Most smokers who quit take a long time and several tries to get there. But it is possible. The good news for UNM students is that there is free help available to help you quit.

My sources for this article are the US Dept of Health and Human Services, the National Cancer Institute, the Centers for Disease Control, and the National Institutes of Health.

Endorsements for 50/40

2007-12-17T09:17:00.000-08:00

Dear Friends,

The book is going to the printer this Friday! We are very excited. Meanwhile, our wonderful publisher has collected some awesome endorsements for us. Check them out:

"Good, juicy, inspiring words and ways to live as a gloriously aging soul."
--- SARK author and artist of Fabulous Friendship Festival

What a treasure trove! 50 Ways To Leave Your Forties is a joyful, irreverent (and at the same time, very reverent) enthusiastic, and incredibly informative book. The authors present their suggestions for zestful and meaningful living in wonderfully inviting ways. I loved it!

--Sue Patton Thoele, author of Freedoms After 50, The Courage To Be Yourself, and The Mindful Woman

"So far, the statistics are convincing: everyone ages. How we age, however, is largely a choice. In 50 WAYS TO LEAVE YOUR 40s, Sheila Key and Dr. Peggy Spencer serve up a delectable recipe for healthy aging that is both delicious and joyful."

--Larry Dossey, MD, author of The Extraordinary Healing Power of Ordinary Things

Dipping into this treasure trove of a book makes me want to go back in time so I can leave my 40s again. 50 WAYS TO LEAVE YOUR 40s offers so many creative ideas, so much thoughtful information and is so darn much fun, I’m sure I’d do it more gracefully, heathfully, and happily the second time. Congratulations and thanks to Sheila Key and Peggy Spencer for giving all of us a life-affirming map to follow no matter what our age.

-- Judy Reeves, author of A Writer’s Book of Days

“Sheila Key and Peggy Spencer know that a new decade of life is the beginning,
not the end, of something great. With generous helpings of wisdom and wit, 50Ways to Leave Your 40s is a recipe for joy during what comes next.”

— David Niven, PhD, author of The 100 Simple Secrets of Happy People and The 100 Simple Secrets of the Best Half of Life

The Book is Done!

2007-11-27T19:27:00.000-08:00

Finally, at long last! The infamous book is finished and on its way to the printer in a matter of days. The cover is what you see here. Publication date is mid-March 2008. Watch this space for more information and links. Post your email or snail mail address here if you want a notice when the book is available, or email me at pspencer@unm.edu. It has been a long and educational road, a lot of fun, and boy am I glad it is over! I know you'll love this book.

Urinary Tract Infections

2007-11-06T13:11:00.000-08:00

Q: Are all UTI’s caused by sex?

A: Thank you for this great question. The answer to your question is, “No, but…”
UTI stands for Urinary Tract Infection. It might also be called a bladder infection or cystitis. We see a lot of it at the Student Health Center, mostly in women. It is often related to sex, but indirectly, and not always. To explain, I need to subject you to a mini anatomy lesson. Bear with me.

The urinary tract is the system of organs that makes, collects and excretes urine. You have two kidneys, one on each side, located roughly behind your stomach. Each kidney makes urine and sends it down two tubes called ureters to your bladder, which collects it. Your bladder is located inside your body above your genitals. It is a soft, stretchy container with thin muscles in its walls. When your bladder is full, the urine is expelled from your body through another tube called the urethra. You control this process by consciously relaxing a muscle called a sphincter, which opens the urethra. Your bladder helps by contracting the muscles in its walls. The outside end of the urethra, called the meatus, is at the tip of the penis in men. In women, the meatus is on the vulva, between the vagina and the clitoris. This anatomical difference is why women get UTI’s more often than men, and why it is related to sex, as I will explain, after a mini microbiology lesson. Hang in there.

Urinary infections are caused by bacteria. Bacteria are everywhere. You think you’re clean? You probably are, but that does not mean you are bacteria-free. We share our personal space with more than 200 species of bacteria. In fact, there are ten times more bacteria in our intestines than there are cells in our entire body! Imagine that. Now, before you get all grossed out, know this. These little guys are your friends. They are called, as a group, “normal flora,” and they do lots of good. Good bacteria crowd out and kill bad bacteria. They also stimulate our immune system and help it develop, and some of the bacteria in our gut even make vitamins that we can use.

What kind of normal flora you have depends on your genetics, your age, sex, nutrition, stress and hygiene. We all have bacteria on our external surfaces and some internal surfaces, like nose, mouth, throat, intestines, and vagina. As long as they stay where they belong, there’s no trouble. But sometimes during sex, some of these critters can end up where they’re not wanted, like in the bladder. This happens more easily in women, due to the proximity of the meatus to the vagina and anus. Fluid, friction, moving body parts…use your imagination and you can see how it happens.

Sex is not the only way for bacteria to get near enough to the meatus to go in and cause a UTI, but it is the most common in college-aged people. One simple way to reduce sex-related UTIs is to urinate after sex. What this does is wash out any bacteria that have begun their sneaky trek up the urethra. Most of the time this works great. But if you find that you are experiencing burning when you urinate, blood in the urine, or the urge to go frequently, you might have a UTI. This goes for guys and gals. Please do not try to treat this yourself with cranberry juice, vitamin C or any other folk remedies. While some of these things can help you feel better, a true UTI is caused by bacteria, and the only way to kill bacteria is with an antibiotic.

Traumatic Stress Response

2007-11-06T13:07:00.000-08:00

Remember the moment you heard about the shootings on the Virginia Tech campus? How you heard of it and where you were? Your reaction? The reactions of your friends and those around you?

Reactions to traumatic events are as varied as people are. Your response may be very different from your roommate’s or your mother’s. We’ll discuss what is normal and what is not, what to do now and when to get help.

Traumatic stress reactions can be loosely divided into physical and emotional, short term and long term. Many people initially feel shock and disbelief, even denial. Also common are anger, fear, anxiety, sadness, hopelessness, compassion, helplessness, and survivor’s guilt. You may feel emotionally numb, or conversely find that you are irritable and jumpy. Your moods may change back and forth quickly. You may struggle in your mind with why this happened, trying to find answers, to make sense of the tragedy. You may worry about something similar happening here. You may have physical responses, like nausea, headache, jitters, chest pain, trouble breathing, difficulty sleeping, or decreased appetite. All of these are normal. However, if you have severe emotional or physical symptoms in these first days, please get professional help.

This is already a stressful time on campus, with finals and graduations just around the corner. A background of existing stress can magnify the effect of a major tragic news event. If you have some kind of connection to Virginia Tech, your reactions may be even stronger. For example, if you knew one of the victims, or know a student at VT, or have friends or relatives or experience in the area, your feelings will probably be more intense.

If you have a history of previous trauma, as many of us do, the news of this tragedy might bring that past trauma to the front of your mind, and you might find yourself thinking, dreaming, reliving or having feelings about the other incident. The previous incident may seem totally unrelated, or it may be a similar event. This can be unsettling at best. The severe form of this kind of reaction is called PTSD, or Post Traumatic Stress Disorder, but most cases are milder, a temporary resurfacing of memories which fade into the background again.

How can you cope with your own feelings and thoughts during this time? Connect with those you care about. Spend time with friends. Call your family. Talk about your feelings and reactions, or write about them. Post your condolences online, along with thousands of others. Above all take good, healthy care of yourself. Eat well, get as much rest as you can, exercise. Avoid the temptation to “drown your sorrows” with alcohol or drugs. Again, if you’re having severe reactions, get help.

While initial reactions to trauma may vary in kind and severity, most people return fairly soon to a competent pursuit of their normal activities. You don’t forget, but you aren’t immobilized either. An abnormal response is when you are affected to an extreme, or when your feelings or thoughts persist after the initial shock period. Next week and beyond, if you find yourself unable to concentrate or sleep well, or if you are having trouble performing your usual activities due to continuing trauma responses, please seek help.
Delayed responses to trauma can happen up to weeks and months after the initial event. Keep this in mind as you observe and care for your own mental health in the near future.

Stinky Feet

2007-04-04T11:15:00.000-07:00

Dear Dr Peg,

My girlfriend told me I have stinky feet. She thinks it might be a fungus thing and wants me to get it taken care of. I don’t notice it, but she said that her socks even stunk when she washed them with mine. I mostly wear the same pair of shoes, which my brother handed down to me, but I shower every day and put on fresh socks. I’m a clean person. Please help me. She’s sleeping on the couch.

Dear Fragrant Feet,

Your girlfriend is probably right (aren’t they always?). You likely have a fungal infection of the feet, also known as tinea (fungal infection) pedis (of the foot). This is also called athlete’s foot, but you don’t have to be an athlete to score this deal.

We all sweat, and sweat has odor. Foot sweat by itself can have a strong odor, but if your girlfriend’s socks pick up this odor in the washer, it is more likely to be caused by fungus. You said you don’t notice the odor, and she does. This is common. We adjust quickly to our own body odors and often don’t notice them, whereas others might.

There are “fungus among-us” everywhere. We don’t have as many in our dry climate as someone who lives in say, Florida, but we have plenty. Fungi (the plural form) live on and off people, and on gym mats, shower stalls, rotting logs and old food.

A fungus is a life form. It is closer to a plant than an animal, but rates its very own kingdom in the 5-kingdom taxonomy of life forms. Within the kingdom Fungi there are over 100,000 species. A few of these have a special affinity for human skin. They cause ringworm (not a worm at all), jock itch, diaper rash and athlete’s foot, among others.

The ideal habitat for certain fungi is somewhere dark, warm and wet. Shoes fit the bill perfectly. You might have even inherited your tinea along with your brother’s shoes. That’s one reason that, although I’m a big believer in recycled clothing, I don’t recommend buying used shoes (or underwear or hats for that matter). Your brother might have had his own case of resident fungus, which went on living quietly in the cracks of his shoes until your feet came along and spiced up the place, allowing the fungi to multiply and prosper. And reek.

So what to do? Basically, the approach to tinea pedis is two-pronged. First, slaughter the beasts. Second, clean up the neighborhood so their skuzzy relatives don’t move in.

Killing fungus is a fairly straightforward proposition. There are a variety of anti-fungal products available over the counter at any pharmacy. I believe the creams and ointments work on the skin better than the sprays or powders, because they stick to your skin better. The usual dose regimen is twice a day, after washing your feet. Please note: if the fungus has gotten under your toenails, making them yellow and thick, you will need medical help.

You can kill the fungi in your socks by washing them in hot water. Add bleach to whites. Do the same with your sheets. Oh, and your girlfriend’s socks. You can also spray bleach (a 10% solution in water is strong enough) on any mold or fungus you see growing in your shower.

Getting rid of fungus in shoes is much more difficult. Wash them if they’re washable. Spray them with antifungal spray and put antifungal powder in them. Best is to accept that you might have to get rid of them and shell out some dough for a new pair or two.

Keep your feet as cool and dry as possible. Change socks twice a day. Try a pair of super-absorbent odor eating inserts. Change shoes often, or go without when you can. Open shoes or sandals give your feet more air, and fresh air is poison to foot fungi.

Here’s something that might surprise you. You can have “fungus feet” with no odor at all. You know those foot and heel cracks that so many people have? We think it’s just desert dryness, but often it is really a type of fungal infection. After-shower treatment with a pumice stone and antifungal cream will clear those cracks right up. Make this a regular part of your routine and they’ll stay gone.

Having tinea pedis does not mean you are unhygienic or somehow bad. It’s just an infection. And in spite of her socks taking on your Eau de Foot aroma, your girlfriend is not likely to catch it, unless she starts wearing your brother’s shoes too. People are much more likely to get tinea from the gym than from their partner. Take the steps above and soon she’ll ditch the couch and be back in your fragrance-free bed.

Molluscum contagiosum

2007-03-21T10:27:00.000-07:00

Dear Dr. Peg,

I went to see my dermatologist a few days ago about small bumps I noticed on my penis. My dermatologist said they were molluscum contagiosum and she used a liquid nitrogen spray to freeze them off. I had 5 bumps and now they have all increased in size, popped, and are starting to scab up (as my dermatologist explained they would). Something I’ve noticed is that it seems like my penis is smaller now in its flaccid state. Is this common? Will it go back to normal size after the scabs fall off? I started to google side effects of liquid nitrogen and really got myself scared seeing things like necrosis and nerve damage. Have you ever heard of this?
Thanks. A very nervous guy.

Dear Nervous Guy,

Bottom line: liquid nitrogen treatment will not change your penis size. If that’s all you wanted to know, you can heave a sigh of relief and stop reading. If you want to learn a little more about this disease and treatments, keep reading.

Molluscum contagiosum is a skin infection caused by a virus of the same name. Humans are its only host. It is passed by skin to skin contact, or by skin to object (e.g. towel) to skin. Little kids get it from playing together and sharing toys. In adults, if it’s in the genital area, it’s assumed to be sexually transmitted. We see it quite often at the Student Health Center.

Molluscum contagiosum causes small firm bumps with waxy centers. They usually don’t itch or hurt. It can take weeks from the time of contact for the bumps to appear. If you leave them alone, they will go away eventually, but this can take several weeks to months. In the meantime, you are contagious. If you get treated, the duration of the infection is shortened, and your period of contagiousness is also shortened.

Treatment means removing the waxy centers. This is usually done with a tool called a sharp curette, with which we scoop out the center in one swift move. Yes, it hurts a bit, but only for a second. Alternatively, they can be treated with liquid nitrogen, like your dermatologist used. Nitrogen is normally a gas, at room temperature. It’s part of the air we breathe. When it’s cooled and pressurized, it is a very cold liquid. We use liquid nitrogen to treat various different skin conditions, including molluscum, warts, and small skin cancers. By freezing the lesion, we destroy most of it, and your immune system sends cleanup crews to finish up.

There are several other methods of treatment documented for molluscum, including various toxic solutions and lasers. As I said above, the bumps will go away eventually even without treatment, but since it is contagious as long as the bumps are present, I recommend getting them treated.

You asked about complications of liquid nitrogen freezing. This kind of treatment is also called cryosurgery or cryotherapy. As with any kind of intervention, there are possible complications. First of all, pain. It hurts to have tissue frozen, and the area usually stays tender for several days. Bleeding is common, under the skin as a ‘blood blister.’ Infection is possible but uncommon. If the site becomes opened or raw, cover with antibiotic ointment and a bandaid. Long term complications might include scarring, pigment changes, recurrence of the initial lesion, particularly warts, and yes, nerve damage. This last is very rare, I hasten to assure you.

The way your lesions blistered up and fell off is exactly the reaction we’re looking for. Once the underlying sore heals up, everything should be back to normal, including your penis size.

You mentioned that you did an internet search on liquid nitrogen. Let me take this opportunity to comment on internet searching for health problems. Many of our patients do this. Personally, I like it when my patients do some research ahead of time, if it is good research. I especially like it if they have new information for me and can teach me something. I would caution you, however, against sloppy googling. If you’re going to look up health conditions, use reputable sites. Googling by symptom can be especially problematic, because many symptoms can be caused by a wide variety of different illnesses. For example, fatigue can be caused by anything from stress to cancer. Dizziness can simply be from standing up too fast, or it could be from a major heart problem.

One excellent site is http://familydoctor.org. This site is created and maintained by the American Academy of Family Physicians, and can be searched by disease or symptom. A web search is never a substitute for a visit to the doctor, but it can provide you with lots of good information.

Sex in Midlife

2007-02-10T08:30:00.000-08:00

You Still Got it Baby!

Remember when we were 18 and tried to imagine people over 40 having sex? We couldn’t, right? No way those old farts could still get it on! And who’d want ‘em even if they could? Now, look at us. We are those old farts. And we’re still “doing it.” Or are we? Does sex change in midlife? Does it get better or worse? Does it even happen? Or is laundry day the only time we shake the sheets?

It turns out there is no simple answer. Midlifers are all over the sexual map. More sex, less sex, higher drive, lower drive, new partner, old partner, no partner…it’s all there. The only thing that is constant across the board is change. Our priorities are changing, our relationships are changing, and none of us experience sex and sexuality the same way we did when we were twenty-something.

For one thing, we don’t have the bods we used to have, and that takes some getting used to. Youth defines sexuality, or so the ad execs would have you believe, and one thing we ain’t is young. The mortal flesh is settling; we’re not the Gumbies of yore. But you and I know that, beneath the wrinkles and the graying hair, we are just as sexy as we used to be. Probably sexier, given a half-life of experience under our belts (so to speak).

This is not to deny the very real physical and hormonal effects of aging. Drying tissues and waning libidos are common. Don’t let that rain on your parade. Gals, pick up your favorite personal moisturizer and guys, isn’t it a bit of a relief to have your gonads out of the driver’s seat? If not, or if you need more help, please do see your doctor.

My advice is this: Treasure your sexual self. Be open to change. Communicate with your partner. And seek help if you need it.

Herpes revisited - a followup Ask Dr Peg question

2007-01-24T12:44:00.000-08:00

Dear Dr. Peg

Recently my girlfriend was diagnosed with vaginal Herpes Type 1 that I’ve given her orally. We are both pretty good kids and haven't kissed too many other people. But my question is, seeing as how it can pretty much be assumed that I’ve transmitted the disease to her, is there any danger in me continuing to perform oral sex on her? If I already have it and we know that between the two of us all we have is herpes Type 1, is there still a danger?

Dear Kisser,

This is a great question, because it brings up two issues: virus spread, and herpes in relationships. I’ll address them one at a time. In my column Curious About Cold Sores, I explained that there are two Types of Herpes Simplex viruses, Type 1(HSV1) and Type 2 (HSV2). Usually HSV1 lives on the face and HSV2 lives on the genitals. However, as you and your girlfriend so clearly illustrate, Herpes viruses are flexible, and can take up residence in either location.

I’m not sure exactly what you mean by danger, but I’m guessing you are referring to contagion. As it stands now, you have oral herpes and she has genital herpes, both HSV1. You have already passed the virus to her genitals, so continuing to perform oral sex on her won’t do anything, except make her happy. Go for it.

It is possible, but unlikely, that she could now develop oral lesions and/or that you could develop genital lesions. Once you have one established herpes site on your body, it’s rare to develop another, probably because your immune system makes antibodies to the virus. Also, now that you have HSV1, you are less likely to catch HSV2. There appears to be some cross-protection in the antibodies that are formed. Finally, people with HSV1 tend to have fewer recurrent outbreaks than those with HSV2. So you could even consider yourself lucky.

The second issue this brings up is how to handle herpes as a couple. What do you do if one of you has it and the other doesn’t? How do you talk about this with a prospective partner?

The couples I’ve known who deal with herpes in the healthiest way are those who tell me, “We have herpes.” In other words, they see it as a shared problem. They don’t expend a lot of energy trying to prevent passing it to each other, or let it put a crimp in their sex life. Their love for each other and their desire to express that love sexually overrides their worry about contagion.

I’m not suggesting you blithely rub your open sores all over each other. It still makes sense to avoid contact with open sores, for comfort’s sake if nothing else. I’m just pointing out that, for the sake of your relationship, it makes sense not to obsess about it. And medically speaking, herpes is very rarely a big deal.

If you have herpes and are in a new relationship, I think it’s only fair to inform your prospective partner before you have sex. Ideally, you’ll be close enough emotionally by that time that you can talk freely about such things, and figure out how you as a couple want to handle the situation. I realize this isn’t always easy, since our society still has lots of judgment and stigma around sex-related topics of any kind, and having a sexually transmitted infection can be emotionally upsetting. If you need help, the medical practitioners and/or the counselors at the Student Health Center would be happy to meet with you and your partner to answer questions and help you discuss it together.

Hooked on Hookah - the latest Ask Dr. Peg column

2007-01-17T11:59:00.000-08:00

Dear Dr Peg,

Some friends introduced me to Hookah smoking a few months ago, and we’ve been getting together to smoke a couple of times a week. It’s fun to hang out, and the smoke smells nice. I know cigarette smoking is dangerous, so I’ve never done it, but hookah smoking is safe, right? Doesn’t the water filter out all the bad stuff from the smoke? And isn’t hookah tobacco healthier than the tobacco in cigarettes?

-Hooked on hookah

Dear Hooked,

I’m sorry to disappoint you, but you are wrong on all counts. As usual, I’ll start with the basics.

What is a hookah? A hookah is a water pipe. Other names for hookah include nargile, sheesha, okka, kalyan and hubbly-bubbly. It is a device for smoking a flavored tobacco mixture. The mixture is placed in a small bowl at the top of the device. From the bowl, a hollow pipe leads straight down into a chamber called the base, which is partly filled with water. The pipe extends below the surface of the water. From the side of the base, above water line, a hose leads to a mouthpiece. To smoke a hookah, you light a piece of charcoal, place it on top of the tobacco mixture, put the mouthpiece in your mouth, and suck hard. The smoke goes down the pipe, bubbles up through the water into the air at the top of the base chamber, up the hose and into your lungs. Hookahs can be quite ornate and beautiful, and can cost hundreds of dollars.

Hookahs have been around for centuries, probably originating in the Middle East or India, where it is a common social custom for men to gather, smoking and chatting for hours. In the US, the hookah has become very popular in recent years, especially with young people of both sexes. Hookah smoking is promoted as an aesthetic social activity, touting the sweet smell of the tobacco and the bubbling sound of the water as pleasant, relaxing influences. A typical hookah session lasts 2 or 3 hours and involves several friends smoking from the same pipe. Commercial Hookah bars have sprung up all over the country. There are at least five here in Albuquerque, where you can go just to smoke.

What does one smoke in a hookah? Typically, the mixture is 1/3 tobacco and 2/3 flavorings. The flavorings may include molasses, dried fruit, honey and other ingredients. The resulting aroma was likened to a baking apple pie by one hookah-selling website. Sounds pretty benign, doesn’t it? It isn’t. Like many fads, it has been hyped with false claims in order to increase its popularity and profits.

What are the dangers of hookah? Tobacco is tobacco, no matter how you get it, and tobacco smoke is hazardous. In fact, hookah smokers get more smoke than cigarette smokers, and here’s why. Cigarette smoke is uncomfortably hot if you inhale it deeply. Hookah smoke has been cooled by its passage through the water. In addition, you have to inhale hard to pull the smoke through the hookah. The result is cooler smoke going farther into your lungs. Add to that the duration of a typical hookah session, and the result is huge volumes of smoke being deposited into your lungs. A study done by the World Health Organization showed that one hookah session of a mere few hours can deliver as much smoke into your lungs as 100 cigarettes. Five packs! It’s a rare cigarette smoker who gets that much in one day.

Tobacco smoke contains nicotine, a highly addictive substance that is not filtered out by the water in a hookah. In addition to nicotine, you are pulling other dangerous substances through that hose. Tar is not water-soluble, so it comes on through the pipe, the same amount in one session as in a whole pack of cigarettes. Tar causes cancer. Other carcinogens (cancer-causing agents) also make it through, like heavy metals and carbon monoxide. In fact, because of the charcoal which is burned on top of the tobacco mixture, hookah smoke has a higher level of heavy metals and carbon monoxide than cigarette smoke. Hookah smokers risk cancer of the lung, lip, tongue and bladder.

As you doubtless know by now, tobacco smoke affects the cardiovascular system, causing an increased blood pressure and heart rate, and increasing the risk of heart attack and stroke. Smoke of any kind is also a lung irritant, which can trigger asthma and allergies. And of course, there are all the second hand smoke issues to consider.

In addition to the tobacco, there are the smoked flavorings to consider. Unfortunately, nobody has yet studied the effects of inhaling dried apricots, but I would bet they aren’t all good.

Finally, think about sharing the mouthpiece. It’s like kissing everyone in the group. Hookah pipes can spread herpes, flu, strep throat, a cold, even tuberculosis. And wiping it on your sleeve doesn’t sterilize it.

I’m a big believer in social gatherings and relaxation time. By all means, gather away, and relax like crazy. But if you are concerned with the health of your young lungs, think about gathering around a cup of tea, or relaxing with exercise and a bath instead of a water pipe. And if you are already addicted to any form of tobacco, I strongly urge you to quit. The Student Health Center has people and programs to help you.

Hakomi Therapy - Mind, Body, Heart

2007-01-15T14:48:00.000-08:00

“How do you stand in relation to these many realms?” This is the literal translation of the Hopi word Hakomi, the name adopted by Ron Kurtz for a psychotherapy technique developed by him and his staff in 1980. A more modern translation might be “Who are you?” The Hakomi Method is an efficient and powerful process for discovering and then studying mind/body patterns and core beliefs as you experience them (www.hakomiinstitute.com).

Hakomi is a unique form psychotherapy that honors the interconnectedness of body, mind and heart. Drawing on concepts and techniques from Buddhism to Neurolinguistic Programming, and based on the precept that we all have innate wisdom and goodness, Hakomi provides a nonjudgemental and nourishing environment for exploring the self at a natural pace. The basic structure of Hakomi is 1) the establishment of a client-therapist relationship that allows the client to feel safe to honestly and fully explore their own experience, 2) careful observation of present life experiences, including body awareness, in a way that leads to the discovery of core material, and 3) willing modification and healing of core material to enhance growth and wholeness.

The following passage from the Hakomi Institute website describes the essential concept of core material. Core material is composed of memories, images, beliefs, neural patterns, and deeply held emotional dispositions. This material shapes the styles, habits, behaviors, perceptions, physical postures and attitudes which define us as individuals. Our responses to the major themes of life--safety, belonging, support, power, freedom, responsibility, appreciation, sexuality, spirituality, etc.—are all organized by our core material.

Some of this core material is helpful to us. Some, the result of difficult experience or trauma, limits our access to the person we want to be. Hakomi is a gentle yet profoundly powerful way to transform and heal. Visit the Hakomi Institute website (www.hakomiinstitute.com ) to find a Hakomi therapist near you.

Marathon Woman - a Bright Spot

2006-12-18T11:10:00.000-08:00

"Bright Spots" is an email column I write on occasion for our staff, highlighting something exciting or interesting the life of one of our staff.

Running for her Life

“Have you ever wanted to run a marathon?”

On a breezy Spring day in 2001, these fateful words wafted out of the radio station, rode the waves across town, and settled into the unsuspecting ear of one Sue W, age 45, transplanted Ohioan and X-ray Tech Extraordinaire. Sue looked up, cocked her head in thought for a fraction of a second, and then responded with a resounding, “Yes!”

Thus began the journey which landed her at the starting line of the San Diego Rock and Roll Marathon a day after her 50th birthday this summer. Sue and 25,000 other honed athletes. After the pistol, it took Sue six minutes of slow shuffling in the dense crowd to get to the actual starting point of the race, where she passed an electronic sensor, setting off a beep in the computer chip attached to her running shoes. Five hours and five minutes later….but I’m getting ahead of myself.

Fade back to 2001. Inspired by the cryptic but inviting radio ad, Sue put in a call to “Albuquerque Fit,” a division of “USA Fit” and the originator of the fateful message. Next thing she knew she was in training, along with 150 other hopefuls. All had their sights on the Duke City Marathon, some 6 months hence.

Larry the Evangelist (not his real name), an experienced runner and skilled coach, has been Sue’s mentor now for five years. You’ve got to figure a guy in his 60’s who is still running fifty mile races knows what he’s doing. Under Larry’s expert guidance, she and her new buddies built their strength and endurance a mile at a time. Every week, they got an enthusiastic lecture about running, hydration, injury, energy foods, clothing, or some other relevant topic, and tacked another mile onto their daily training schedule.

Fashion sidebar. Speaking of clothing, you experienced runners don’t laugh, but Sue actually thought she was all set from the get-go as far as her running wardrobe. “I’ve got shoes, shorts and a T-shirt; I can run!” she told her naïve self. Now, five years later, she laughs somewhat ruefully as she describes her closet. A whole drawer full of running socks. (She hadn’t even considered socks.) Another drawer full of running shorts, built of various high tech, lightweight, wick-away, friction-free streamlined materials. Stacks and stacks of running shoes. Shoes, yes, plural. This, after all, is the business end of marathon training, and life is rough where the rubber meets the road. Sue burns through one pair of shoes every 200 miles, which, for a serious foot soldier like her, takes a mere 3-4 months. The discards pile up, still too good to toss, but too old for serious use.

What am I forgetting? Oh, of course. Shirts. They don’t let marathoners go topless, no, not even in California. Sue has to have two large drawers for shirts. In one, she keeps the running shirts, first cousins to the shorts, with the same technically evolved construction. In the other drawer, the infamous Race Shirts. You know, the ones you get as a prize for entering the race, silk screened with the race name and sponsor logos. Those are usually regular cotton T-shirts, far too thick and heavy for running, and far too casual for social occasions, dahling. So they pile up like the worn out shoes, except many of the T-shirts have never been worn. No worries. Sue has a plan. Once she’s done running (Ha! Like that’ll ever happen) she’s going to have an afghan made out of them. By that time it’ll be an afghan big enough to cover her pool!

Back to our story. Sue discovered an immediate affinity for running, and for runners. She made fast friends with Cynthia and Lana, who have been regular running buddies since then. Sue learned quickly from Larry and from her own experience and improved rapidly, excited to run her first marathon at age 45. Alas, it was not to be. During the 10-mile-a-day section of her training, Sue pulled a groin muscle and had to give up on the marathon idea for the year. She was temporarily discouraged but not derailed. The next year, after healing and rehab, she rejoined the group. Two miles a day, three, four…onward, upward, and six months later she was at the Duke City Marathon starting line. Bang! Off they went. One mile, two, three….OUCH! At mile six, Sue suffered a torn meniscus in her knee, and her race was over. Foiled again! This time it was more serious, an injury requiring surgery and a year off from running.

Now, let me just pause and say that if you know Sue, you know what’s coming next. You know that a little thing like torn cartilage and knee surgery is not about to stop her from fulfilling her dream. Nossir! Maybe it’s that Midwestern stubbornness (eh, Barb?) or maybe it’s just Sue. If you saw the way she whipped our x-ray department into shape, you know what I’m talking about. Needless to say, she got back in the saddle. In the shoes. No, not the saddle shoes, the running…oh, you know what I mean. She went back to training.

What is it they say about the third time? Well, this time it was the charm. In the Duke City Marathon of 2004, Sue W. started, she ran, and by George she finished. Twenty six point two long miles. Five hours and ten minutes. Three of her best buddies ran with her. They were gnarly gals, all strong and tough, poker faced until they got to the finish line. There the sight of four proud husbands bearing flowers melted those marathon girls like buttah.

The success of her first marathon, far from satisfying Sue, just whetted her appetite for more. More races! More fitness! More endorphins and medals and fodder for the afghan! She was officially hooked.

In the next two years, Sue ran ten half-marathons and uncounted other races, including the dreaded La Luz trail race, which, in case you don’t know, is 9.2 miles straight up the Sandia mountains. Only for iron women and fools, you say? Not so. Would you believe that race draws out some 400 maniacs, including more than a few octogenarians? Believe it. As does the Sandia Peak race, on the back side of the mountain, which is a 7.2 mile grind up the ski slopes. Sue ran these and more, ran and ran, happier and stronger every year. And at the end of every race, there was her husband Jim. Proud, smiling, holding out a water bottle or a flower, offering a hug and congratulations to his strong and accomplished wife.

Spousal sidebar. Sue thinks the spouses should get medals too. Not only do they put up with their wives‘(or husbands’) training absences and smelly laundry, they drive the runners to the races at ungodly hours, drop them off, drive to the finish line and negotiate parking, then hang out with strangers, shivering or sweating, depending on the season, drinking coffee and making small talk, after which they greet the victors at the finish line with flowers and hugs, and then drive them back home, listening patiently to a detailed blow-by-blow of the race. Definitely hero material.

Which brings us back to San Diego, and the Rock and Roll Marathon. Jim dropped Sue off at the starting, er, scrum at 5:30 am. She was suited for action and loaded for bear. It’s a metaphor. But that does remind me to tell you about her gear. We could do a whole “gear sidebar” but I’ll spare you. Do think for a moment, though, about what your body might need in the course of a five hour, 26.2 mile run in the summer.

Fluids, of course. Sue carries one or two water bottles in loops on her fanny pack (of which she also has stacks, by the way, not because they wear out but because you gotta try out all the fanny pack styes to find out which one works best for which race). She also slows to a walk at the aid stations, which were set up every two miles or so in San Diego. Sue has settled on alternating Gatorade and water as her drinks of choice. She walks long enough to tank up, then takes off running again.

What else? Calories. You can’t expect your body to do that kind of work without giving it some fuel along the way. Here again, Sue has done her share of trial and error and success, through fig newtons, trail mix, Pay Day bars and the infamous “goo”. For San Diego, she settled on a nutritious combination of pretzels and jelly bellies. Mm mmMM! Breakfast of champions.

Besides those bare essentials, you’ve got to have a hat, sunglasses, sunscreen, Kleenex, a music source (in one ear and on low so you don’t miss an oncoming train or truck) and lastly, that most necessary of millennium necessities, a cell phone. Really. Think about it. Twenty five thousand people in this race, you’ve never been to this town before, and you have to find your ride at the other end. How better than cell phones?

Okay, back to the starting gate, and this time I won’t balk with the story.

After the pistol, it took Sue six minutes of slow shuffling….oh, I told that part already. So, off she went, into the So-Cal morning, feeling good and chatting with her pals. They chat the whole way, she told me. It’s a big part of the appeal. What do they talk about? “Everything, from underwear to men.” To men’s underwear, and women’s underwear, and runner’s underwear, and what, or whether, they wear under there. (Sue wasn’t telling, by the way. We’ll never know.)

They ran through the streets of San Diego, always with a view of the sparkling Pacific not far off. The neighbors were expecting them, and showered them (literally) with garden hose spray and offered fruit and encouragement. Because it was, after all, the Rock and Roll Marathon, there were even bands along the way, rocking out in rhythm with the racing feet. Entertainment on the run. There were also costumed racers in the crowd, including several Elvises, who greeted Sue and her pals with signature Presley phrases. “Hey, baby, lookin’ goooood!” It was an extravaganza.

It was also a very long way to go. In spite of her numerous other runs and races, this was “only” Sue’s second marathon and a marathon is a lot of work. One mile. Two. Three. …. Six miles, and there was Jim, to grab a quick kiss and give her a goose. I mean a boost. (It was a typo.) On she went, winding through the streets and into downtown, along the ocean and finally onto the military base, where uniformed soldiers, food booths, massage tables and a band would be awaiting them. As Sue crossed the finish line, worn out but still moving well, five hours and five minutes after she started, she pulled out her cell phone to call….who else? Her mom.

As soon as she heard her mother’s hello, Sue started sobbing and babbling with happiness and relief. “I made it, Mom! I made it! I finished! I’m done!”

Mom was thrilled. “I’m so proud of you!” (Moms deserve another sidebar, especially Sue’s mom, who vies with Jim for Biggest Fan award)

The woman running next to Sue overheard Sue’s call and started sobbing and babbling too. (It’s a neurochemical thing. Happens to all marathoners.) “That is so cool, that you called your Mom!” Sob, babble.

Who can blame them? Running a marathon at age 50 is a major accomplishment.
They deserve to be proud. Their families are proud. We’re all proud.

I asked Sue why she runs. She grinned at me around her Gyros turkey sandwich. “So I can eat!” And they do eat. The post-race feasts she described to me left me drooling. I even considered going so far as to buy a new pair of running shoes. But she can’t fool me. It’s about far more than the food. One look at Sue’s ruddy, youthful face and shining eyes (not to mention her awesome legs) and you can see the magic that running has worked on her body and life. I think she might even be getting younger.

What’s next? A well deserved retirement from running? Not even close! After a mere week off after San Diego, Sue is running almost daily again, and debating between --get this-- a triathalon and a fifty-miler for next year.

My guess? I wouldn’t be surprised if she did both.

More puppy pics

2006-12-10T18:04:00.000-08:00

Maya with uncle Ocho

Maya in cartoon mode

Rasta

Blood Pressure (My latest Ask Dr Peg column)

2006-12-10T17:58:00.000-08:00

Dear Dr. Peg,

While shopping at my local Smith's store, I stopped by the pharmacy to measure my blood pressure. The machine told me that it was 127/75. Is this a healthy blood pressure? Also, what's the relationship between blood pressure and cholesterol levels? What can I do to maintain a healthy blood pressure?

Dear Smith’s guy,

The short answers to your questions are: probably, nothing, and plenty. But I’m not one for short answers, so pull up a chair.

What exactly is blood pressure? It is the amount of pressure that your blood exerts on your blood vessels, from within them. You might liken it to air pressure in your tires, or water pressure in your pipes.

Air pressure is measured in PSI’s, or pounds per square inch. Blood pressure is measured in mmHg, or millimeters of mercury. This is because blood pressure cuffs originally used a vertical column of mercury to measure pressure. A pressure reading of 100 meant the mercury column was pushed up (against gravity) 100 millimeters.

There are two numbers in a blood pressure reading, the top number and the bottom number. Basically they are maximum and minimum readings. The top number,127 for you, is the systolic (say “siss-TALL-ick”) blood pressure. This is the pressure present in the arteries during systole (SISS-toe-lee) , which is the active squeezing phase of the heart’s pumping action. The bottom number,75 for you, is the diastolic (say “dye-uh-STALL-ick”) blood pressure. This is the pressure present in the arteries during diastole (dye-ASS-toe-lee) which is the inactive, relaxation phase of the heart.

What is normal for blood pressure? Pretty much anything less than 120/80 and still standing. Too low is when you pass out because of it. A person’s blood pressure changes throughout the day, depending on many factors. Your blood pressure is lowest when you are asleep, and highest when you are exercising strenuously.

If your blood pressure always reads between 120-140 systolic and/or 80-90 diastolic you could have pre-hypertension, meaning you could be at risk for developing the disease of Hypertension, or high blood pressure. In the pre-hypertension range, lifestyle changes like losing weight, exercising more, and eating less salt are often all that’s needed to bring your blood pressure down to normal.

If you get repeated readings with a systolic pressure over 140 and/or a diastolic over 90, you may have Hypertension. This is a bad thing. Imagine what would happen if you filled your bike tires with as much air pressure as you put in your car tires. Ka-blam, right? That’s what happens in your tiny blood vessels if they get too much pressure. The result is damage to all your organs, especially your heart, kidneys and brain.

What can you do to keep your blood pressure in a healthy range? Maintain a normal weight. Exercise regularly. Don’t smoke. Limit your alcohol intake, or don’t drink. Minimize your stress, or manage it as best you can.

Hypertension is sometimes genetic. If it runs in your family, you can decrease your chance of getting it by following the advice above, and by getting a professional blood pressure measurement once a year, during your yearly physical.

Blood pressure and cholesterol are not directly related to each other. High blood pressure doesn’t cause high cholesterol or vice versa. However, they both contribute to the same health problems (heart attacks, strokes, organ damage) and each alone can kill you. It behooves you to keep both blood pressure and cholesterol as low as possible. Beyond that, cholesterol is a topic for another day.

Finally, a word about supermarket blood pressure machines. Take them with a grain of –oops, I mean, they may not be exactly accurate. To maximize your chances of an accurate reading, rest first for ten minutes, then put your bare arm into the machine. If you get worrisome or wildly differing readings in Smiths, come in to the Student Health Center and let the professionals check it. Call ###-#### for an appointment.

Puppies

2006-12-06T19:49:00.000-08:00

These are my daughter's two new pit bull puppies, playing with my 8 month old mutt. I'm trying out my new camera software. This is an effect called "cartoon."

Cold Sores (my latest "Ask Dr. Peg" column)

2006-12-03T21:35:00.000-08:00

Dear Dr Peg:

I have read your Health Columns in the Daily Lobo and have found them to be very informative and helpful. I have been concerned about a health issue since school started and would like to submit this question.

Is there an unusually high number of people at UNM with cold sores/oral herpes? It seems that they are everywhere and I am afraid that I will come down with lip sores like that. I have never had one. Is there a way to prevent getting them? Why do you think so many people on campus have this problem? What is causing this?

Thank you very much.

-Curious About Cold Sores

Dear Curious,

Great questions! I’ll do my best to answer them, but first, a few basics for those who might need them. A cold sore, also commonly called a fever blister, is actually neither. I’m talking about those round, raw-looking sores that bloom on the vermilion border of the lip, which is the junction between lip and face. They aren’t caused by cold weather, a cold, or a fever. They’re actually caused by a virus, as you suggested. Herpes Simplex, to be precise. The medical term for “cold sore” is “Oral Herpes.” Like any virus, Herpes Simplex is contagious. Oral Herpes is usually passed by direct contact (kissing, oral sex) but can also be passed by sharing items like razors or towels.

I don’t think UNM students have more Oral Herpes than anyone else. I can’t give you statistics to prove this, however, because we rarely test for this condition. It’s pretty easy to diagnose just by looking at it, and the test is expensive, so students usually decline it. Having said that, I have to tell you that Oral Herpes is extremely common in this country in general. You say you have never had a cold sore, but you might be mistaken. The American Social Health Association asserts that “50-80% of the adult population in the United States has oral herpes, with as many as 90% having the virus by age 50.” Most of us get it as children, when some well-meaning but infected relative gives us a smooch and a squeeze. Nice, huh?

Now, to cut Aunt Blanche some slack, she probably didn’t have a nasty, oozing sore when she kissed you. The problem is, she could have passed it along to you even without an active sore, or outbreak. Herpes, once it gets under your skin, takes up residence deep in the root of a nerve. It can stay there forever without ever coming out, or it can venture up to the surface and wreak havoc. Unfortunately, before the havoc, i.e. the actual sore, you can shed viruses and be contagious. Some people can tell they’re about to have an outbreak because they feel tingling or pain at the site. Triggers for the virus to make a surface foray include sunburn, stress, illness, lack of sleep….yes, basically the college lifestyle. This might be why you see a lot of Oral Herpes. Students may have more outbreaks than other, less stressed adults, even if the infection rate is the same.

How can you keep from getting oral Herpes? Stay away from Aunt Blanche! Naw, but you shouldn’t be kissing anyone with a sore on their lip, or letting them kiss you. Anywhere. Herpes Simplex comes in two subspecies – type I and type II. Type I generally prefers lips, and Type II usually prefers genitals, but they’re adaptable. Either type can live in either place. And either type can be passed from one place to the other. I deliberately left Genital Herpes out of this discussion, due to space restraints and the fact that you asked about Oral Herpes, but I’d be happy to address that another time.

If you have a cold sore, avoid kissing and performing oral sex, don’t share eating utensils or cups, and wash your hands often.

If you develop a cold sore, know that it will clear up in about a week. In the meantime, you can ask your pharmacist for topical creams or ointments to soothe your discomfort, or you can come to the Student Health Center for a prescription for antiviral medication. These medications can decrease the severity of the symptoms and shorten the duration of the outbreak. Try to keep your hands off the sore. Take a pain reliever if needed, and apply ice or warm compresses, whichever feels better.The good news about Oral Herpes is that it causes a sore and that’s all. Yes, it takes up residence in your body for life, but it doesn’t damage your internal organs, cause cancer, or kill you. Ever since HIV has come on the scene, Herpes seems a lot less of a big deal.

The other good news is that many people “grow out of” cold sores. They may have outbreaks for several years after the Aunt Blanche episode, but stop having them by the time they’re adults. Adults who catch the virus may notice that their outbreaks diminish over time and eventually stop.

I hope this is helpful. If you or anyone else have more questions, email me at pspencer@unm.edu. All questions will be considered, and all questioners will remain anonymous in the Daily Lobo.

The Science of Stem Cells

2006-11-27T10:28:00.000-08:00

written for the Daily Lobo (University of New Mexico newspaper) on request for a special issue on Stem Cell research.

Immortality and unlimited potential. That’s a stem cell in a nutshell. It is an unspecialized ancestor cell, capable of living practically forever or morphing into any cell type from any tissue. Talk about power in a small package!

There are two kinds of stem cells: embryonic and adult. Embryonic stem cells come from fertility clinics. In the fertility laboratories, donor eggs are fertilized in vitro (in a test tube) and watched for a few days. After 4 or 5 days, successfully fertilized eggs have become blastocysts, which are tiny balls of cells. Some of the blastocysts are used for implantation in a woman’s uterus. The rest are frozen, destroyed or donated for stem cell research, with the signed consent of the donors. Stem cells are extracted from the center of the blastocyst and grown in cell cultures in a research lab. As long as they aren’t crowded or signaled to change, the stem cells can multiply unchanged for years. Or, given the right signals, certain genes within these cells will “turn on,” causing the stem cell to differentiate into a very specific cell type from a certain tissue. Embryonic stem cells are pleuripotent (pleuri- as in pleural, implying many, or multiple potent as in potential, meaning these cells have the potential to become any other cell in the system.

In recent years, scientists have discovered that adult humans actually retain a few stem cells. Tucked away in the lining of our intestines and the recesses of our brains, tiny swat teams of these cells huddle, breaking cover only when their home tissue is diseased or injured. These cells, also called “somatic stem cells,” help repair damage, and differ from embryonic stem cells in that they seem to be limited in their potential. In other words, unspecialized stem cells from a certain tissue can become specialized cells of that tissue, or possibly of another tissue type or two, but they are not pleuripotent like embryonic stem cells. So far, adult stem cells have been identified in brain, bone marrow, blood vessels, peripheral blood, skeletal muscle, skin and liver.

Adult stem cells have already been used in medical treatments. Have you heard of a bone marrow transplant? That is a stem cell transplant. Bone marrow stem cells become blood cells. If someone’s bone marrow is wiped out, say by radiation for cancer, they can’t make their own blood cells anymore. Give them a bone marrow transplant, and the donor stem cells take over the job, saving the recipient from catastrophe.

What else are stem cells good for? To date, the answer to this is largely theoretical, since the research is in progress. There are three general areas of research and application: regenerative therapies (like transplantation), drug testing, and development research.

The fact that stem cells can differentiate into different tissues holds promise for tissue transplants. Many diseases cause destruction or degeneration of whole organs or types of tissues. Currently, donated organs and tissues are used to replace these damaged tissues, but the demand far outweighs the supply. Stem cells could be used as a renewable source of transplantable tissues. The possibility of using adult stem cells for this purpose is especially exciting, because if one’s own stem cells could be cultured and placed back in the body, the risk of tissue rejection might be less. Some of the specific diseases being considered for these cell-based therapies are Diabetes, burns, heart disease, spinal cord injury, arthritis, Parkinson’s and Alzheimer’s diseases.

Drug testing for safety and efficacy is an obvious necessity, before new drugs are made available for medical use. At present, some cancer drugs are being tested on cells, on cancer cell lines, which are grown in a lab like stem cells. The scientific hope in this area is that stem cells can be induced to specialize into certain cell types, on which tissue-specific drugs could then be tested.

Finally, studying stem cells and the way they differentiate could give scientists a lot of information about the complex events that occur during human development, normal and abnormal. What tells cells to divide and differentiate? What goes wrong in this process to cause birth defects? What signal makes cells turn cancerous? Stem cell research is being used to understand these very complicated processes, in hopes that one day birth defects and cancer, among other conditions, might be prevented.

Exciting as these medical applications might sound, they are a long way from reality. Many fundamental questions remain. What causes a cell to differentiate? Are the signals internal to the cell or external? How do certain genes get turned on by these signals? How do stem cells remain unspecialized and self renewing for years and years? How can scientists direct a stem cell to become a specific tissue cell? How can a somatic stem cell from one tissue be used to make a different tissue? These are some of the basic questions that are being asked in research labs around the world. Only when they are answered can the medical promise of stem cells be fulfilled.

Update on "the book"

2006-11-25T21:50:00.000-08:00

Earlier this year I was invited to help with a book called 50 Ways to Leave Your 40s. It has been a lot of fun, an education, a trip with many twists and turns. Our original deadline was December 1st. However, s&*t happens, and the timeline has changed. Due to health problems in my coauthor's family, the book has been put on a back burner for the time being. We're now looking at a March 1st deadline or possibly even Fall of '07. The publisher is being very understanding.

So don't hold your breath or rush out to the bookstores just yet!

I'll keep you posted.

Scared Sexless (my latest "Ask Dr Peg" column)

2006-10-26T23:31:00.000-07:00

Dear Doctor Peg,

I’m freaking out. I went to a great party last night, and had a fantastic time, but, well, I guess I had too much to drink, and there was this really attractive person, and one thing led to another, and we had sex. We didn’t use protection. This morning I’m sober, I have a roaring headache, I feel like an idiot, and I’m terrified. What have I done? What could happen to me? I can’t believe I did that. I’m never having sex again!

Scared Sexless

Dear Scared,

What have you done, you ask? You made some choices that put your health at risk. You are clearly regretting this as you look back with the clarity of hindsight. What could happen to you? That depends on a few things.

If you are Scared Susie, you’ll be worrying about disease and pregnancy (unless you had sex with a woman, in which case you’ll still be worrying about disease). If you are Scared Sam, it’s the possibility of disease that’s making your headache worse. Let’s take these issues one at a time.

Pregnancy. For pregnancy prevention, come to the Student Health Center for Emergency Contraception. You need a prescription for this hormone treatment, but soon it will be available over the counter. The sooner you take ECP the better, but it can be effective up to three days after unprotected sex. ECP is not an abortion pill. While you’re at the SHC, you can get more information about birth control methods.

STI’s. This is the new and improved acronym for Sexually Transmitted Infections (formerly ST Diseases). There are several. For practical purposes, I’m going to divide them into two categories, curable and incurable.

Curable STI’s. These are infections that can be cured with antibiotics, after which they are gone from your body for good, unless you catch them again. Please note that most of these can be “silent,” meaning you can have them and not know it. We can find them for you, though, with blood, urine or swab tests. When they do cause symptoms, they are typically as follows. Trichomonas, or “trich” (pronounced “trick”) is a parasite that can cause an itchy, smelly, greenish discharge from the penis or vagina. Chlamydia is a bacterium that can cause burning with urination, a penile or vaginal discharge, painful sex or vaginal bleeding. We see several cases of Chlamydia at Student Health every year, especially after Spring Break. GonorrheaPubic lice (“crabs”) cause severe itching and rash in the pubic area. If you look closely, you might be able to see the lice themselves or their egg cases on your pubic hair. Crabs are treated topically with a cream or liquid. Molluscum contagiosum virus causes bumps that look and feel like hard pimples. Removing the core of each lesion, which we do in the clinic, helps the infection clear up more quickly. (“the drip”) causes a goopy, yellow discharge from the penis or vagina.

Incurable STI’s. For this group of infections, modern medicine has no cure. We can give you drugs to make you feel better, or to decrease the intensity and duration of your symptoms, but we can’t kill the viruses. Herpes causes exquisitely tender sores, in your mouth or on your genitals. Human Papilloma Virus (HPV) causes warts on your genitals, and some strains can cause cancer of the cervix. The good news about HPV is that there is now a vaccine that will protect you from the most dangerous strains. If you get genital warts, we’ll freeze them off, but unfortunately that doesn’t get rid of the virus, which usually lives about two more years under your skin. Hepatitis B, for which there is also a vaccine, can be silent or cause an illness with nausea, fever and bodyaches. And finally, HIV, which has a variety of symptom presentations and for which there is no known cure at this time.

I know that is quite the parade of scoundrels, and I’ve probably scared you worse by listing them all. However, chances are very slim that you’d have more than one or two of these after your wild escapade last night, and it’s likely that you don’t have any of them. The problem is, it can take weeks to months for these infections to show up in your body after you catch them.

So how long should you wait to be seen by a health professional? If you’re Susie, don’t wait for pregnancy prevention. Anyone else, make an appointment for “STI Screeing” with one of the SHC practitioners or the Women’s Health department. We will listen to you, examine you, educate you, and advise you. We might do labwork to find out if you’re positive for any of these STI’s now. We can tell you when to come back and get tested the next time. If you develop symptoms before your scheduled visit, come to the Walk-In clinic or make another appointment to be checked.

Finally, go easy on yourself. Everyone makes mistakes. Everyone does stupid things. You don’t have to swear off sex forever, or brand a big L for Loser on your forehead. Just take steps to be healthy now, and in the future, if you choose to have sex with a stranger, please, protect yourself.

Balloons!

2006-10-10T22:13:00.000-07:00

It's time for the annual Albuquerque International Balloon Fiesta. Every October hundreds of balloonists gather here, and the skies fill with color for a week. So far this week they've been thwarted by rain or wind most days, but today the sun came out and up they went.

These pics are actually from last year, taken from my house and from the park across the street. I'm too lazy to brave the crowds at Balloon Park and besides, why should I, with views like this? If they land right in front of my nose again this year, I'll add fresh pics.

It's a fun reason to come to Albuquerque, if you ever need one!

The Scoop on Coffee

2006-10-10T21:56:00.000-07:00

This is an article I wrote for our University newspaper, in response to a question someone sent in about coffee. They wanted to know if it is good or bad for them, whether it is true that coffee after heavy drinking protects the liver, and what about energy drinks? They said "like Tom Petty I have a Need To Know."

Dear Coffee Cat,

If you’ve heard good and bad things about coffee, you’re paying attention. And if you’re confused, there’s good reason, because the truth is, it’s both. Allow me to explain.

How is coffee good for you?

It stimulates the brain. We all know that. It’s the whole reason many people indulge. And face it: even though you are smart enough to have gotten into college, there are those times when your brain could use a little extra boost. When that big paper is due tomorrow and you’re farther behind than you thought. When it’s the “morning after the night before,” and you need to function at work. At times like these, an extra mental lift can be highly useful. There is also some evidence that regular coffee drinkers have less “age related cognitive decline” than non-coffee drinkers. In other words, they kept their “marbles” longer into their old age. (The same study, by the way, found these benefits and more with green tea.)

I’m glad you brought up the liver thing. It gives me a chance to debunk some rumors. The answer to your question is no, coffee cannot heal the liver after a long night of drinking. Coffee can’t sober you up either, contrary to popular misconception. The only thing that will get alcohol out of your blood is time, sweet time. What may be true is that – now, read this carefully – people who drink alcohol heavily, and we’re talking heavily and long enough to cause cirrhosis of the liver, can get some protective effect for their liver over the years by drinking coffee too. This is not the same thing as saying that if you binge drink all night, you can reverse the beating you gave your poor liver by going out for a latte in the morning. No. If you really want to protect your liver from cirrhosis, a far better way to do that is not to drink too much alcohol in the first place.

Finally, coffee is often at the center of meaningful social interaction. Relaxing with a friend and having a real conversation while you sip your caffeinated beverage of choice is, in my opinion, a ritual worth honoring.

How is coffee bad for you?

Too much coffee can give you uncomfortable jitters, headaches, anxiety, insomnia, and stomach and bladder irritation. Coffee aggravates the painful fibrocystic breast condition. It can affect the kidneys, acting as a diuretic (makes you pee). Coffee can increase your pulse and your blood pressure and contribute to ulcers. It can worsen PMS (now that is truly frightening!). All of these side effects are what we medical types call “dose related responses.” In other words, the more coffee you drink, the more likely you’ll suffer.

Is coffee addictive? Oh, yes. If you’ve ever been a regular coffee drinker and tried to quit, you know what I’m talking about. Headaches, drowsiness, lack of concentration and focus…those, my friend, are withdrawal symptoms. Withdrawal from caffeine, the drug of choice of millions of Americans. Whether we’re “guzzling coffee like crazy fools,” taking “big gulps”of sodas or sipping tea, we consume tons of caffeine-containing products each year. If you want to jettison your caffeine addiction, I suggest you cut your consumption in half for a week, then quit. Be prepared to feel lousy for another week, but then you should be fine.

There are some “positive negatives” to the coffee story. In other words, some bad things that coffee does not do. It does not cause cancer. It does not increase your heart disease risk. In moderation, coffee and other forms of caffeine do not have significant health risks. How much is “moderation? That depends on the person. Different people have different caffeine sensitivities. For the average Joe, 2-3 cups of “Joe” a day counts as moderate consumption.

Finally, you asked about energy drinks. Those little power cans vary widely in their ingredients, including the amount of caffeine and other stimulants. Some have a lot of sugar. Some use artificial sweeteners. Most use artificial flavors and colors. Most have less caffeine than a cup of coffee, yet cost more. Since the full health effects of food additives are not yet completely known, I myself am more inclined toward the natural stuff, meaning “the bean” or “the [tea] leaf.”

I hope this satisfies your Need To Know, Coffee Cat. Now tomorrow when it’s Wakeup Time you can enjoy your java with No Second Thoughts.

Breast Cancer

2006-09-22T20:04:00.000-07:00

Y'all know I'm helping write a book. Well, recently we got the news from our editor that they want a book half the size we thought we were writing. As a result, we've had to make some adjustments, some cuts, etc. Rather than just file my drafts in the back of a drawer to collect dust, I thought I'd at least share them here. This was going to be one on breast cancer, from a chapter called "Spurn Your Bra."

spurn bra – breast cancer DRAFT

In a chapter about bras and breasts, what is a responsible doc going to talk about? What else but that ghastly goblin lurking in the heart of every woman, that most feared of diagnoses – breast cancer. If your pulse rate just went up, count yourself normal.

By the time you’re fifty, I’d lay a confident bet that all of you have known (or been) someone with breast cancer. I can think of seven that I’ve known well, and that isn’t counting patients. One woman died from it, one died from something else, three are survivors and two are still in treatment. It’s a sobering, all-too-common reality.

But guess what? It isn’t all bad news. You’ve probably heard the statistics, the ominous “one in seven” that certainly lodged itself in my brain the minute I heard it years ago. Well, it turns out that is an exaggeration. That “1 in 7” is what’s called an “average lifetime risk.” It means that one of every seven baby girls born today would statistically get breast cancer by the time she is 70. But not all those baby girls live to be 70. Some die of other things. And some of those who died of, say, a car crash or a heart attack were counted as that one in the 1 in 7 who was supposed to get breast cancer. If you’re saying, “Huh?” by now, don’t worry. You’re not dumb. It’s the statistics that are confusing. (I had open book exams in that class in college and I still barely passed!)

More meaningful are statistics that give you your age-specific risk. In other words, given the age you are now, what is your likelihood of developing breast cancer? That’s what we all want to know, right? Here are the numbers:

A woman’s chance of being diagnosed with breast cancer is:

from age 30 through age 39 . . . . . . 0.44 percent (often expressed as “1 in 229”)
from age 40 through age 49 . . . . . . 1.46 percent (often expressed as “1 in 68”)
from age 50 through age 59 . . . . . . 2.73 percent (often expressed as “1 in 37”)
from age 60 through age 69 . . . . . . 3.82 percent (often expressed as “1 in 26”)

See, it’s not quite as big a goblin as you thought.

Still, it deserves some attention in our lives, and more as we get older. So what advice do you think I have for you? Right. Get your mammograms! Or perhaps I should say, “Get your breasts studied!” The field of breast diagnostics is changing rapidly. By the time this book comes out, some other technology may have replaced the annual mammogram. Some exciting techniques in the works already are MRI, ultrasound, digital mammography, PET scans, Electrical Impedance Scanning and Ductal lavage PAP smears. Hey, some day they’ll be able to just run a whatchacall – that thing from Star Trek – tricorder down the air in front of our body –“bleep, bleep, bleep” – diagnosing and treating in one fell swoop! But for the present, we’re stuck with mammograms.

You’ll hear different recommendations from different experts about how often you should have a mammogram, from yearly to every other year. Me, I squeeze it into my schedule (pun intended) every year, and advise my patients to do the same. I’d rather risk a few extra rays to catch that sucker when it’s still tiny and operable.

There’s also the infamous “self breast exam” which can seem impossibly technical in the exam room brochures, but really is just about getting to know your breasts with your hands. By now you’re either in the habit of this or not, but one of the basic tenets of this book is that it is possible to teach an old dog new tricks, so if you’re not in the habit, get in the habit! Put it on your calendar, make it part of your monthly “hair, nails and breasts” day, whatever works. Get help. I’ll lay another bet that your intimate partner would be delighted to assist you with a frequent breast exam. Sharing a shower is a great way to save water, get a thorough breast exam, and end up with squeaky clean breasts in the process! Men, this means you too. Guys can get breast cancer, so soap up!

And thirdly, two simple (I didn’t say easy) steps you can take to decrease your breast cancer risk: exercise more, and limit your alcohol intake.

Back to the mammogram for a minute. If you’re like me, one mammogram was one too many. But hey, sometimes we gotta suffer for the greater good, right? Given that, here, from a mammogram survivor (too)many times over, are a couple basic tips.

Schedule your mammo for a midcycle time. If you’re still menstruating, with roughly predictable cycles, don’t plan to get your breasts squashed like pancakes when they’re at their most swollen and tender. In other words, NOT when you’re premenstrual. That should be a no-brainer, but I’ve goofed on it before. Ouch!
Keep quiet. I’m one of those patients that tends to be chatty and friendly with medical staff, because I think it’s common courtesy, plus it makes the medical experience more palatable overall. But this is one procedure during which I just shut my yappy trap. The mammographer has a job to do, and the more you don’t distract her, the quicker she’ll get it done. And you DO want it done quickly, trust me. Listen to her instructions, follow them exactly, and keep your mouth shut. And just when you think you can’t stand the pressure one more nanosecond, it’s over.
Practice. Lie down in the driveway and have your spouse run over your – I’m kidding! You’ve all seen those mammogram practice jokes running around the internet I’m sure. Hilarious, right? NOT! Once a year is bad enough.

Finally, a few words about genetics. You’ve probably heard about the “breast cancer gene” and might have wondered about getting tested for it. The bare facts are these: We all have genes called BRCA1 and BRCA2. Some of us have mutations in these genes that make us more susceptible to breast cancer and other cancers. If several women in your family (close blood relatives) have had breast cancer, or both breast and ovarian cancer, or if your heritage is Ashkenazi Jewish, you might want to talk to your doctor about BRCA testing. But I recommend a dose of caution before heading into this particular morass. It’s not a straight-over, one on one correlation here. In other words, if you have the dreaded BRCA1 or BRCA2 mutation, that doesn’t guarantee that you will get cancer, nor will the absence of the mutation guarantee that you won’t. If you do have the mutation, you have to decide what you’re going to do about it, if anything. Some women have had both their breasts removed, for prevention. No breasts, no breast cancer, right? But that is major surgery that carries major risks, and it turns out that most times a mastectomy leaves some breast tissue behind. You only need one cell to develop cancer. On the other hand, it might be worth the risk to have the peace of mind. Only you can decide, and I’m just suggesting you look and think before you leap into the bottomless BRCA pit.

Sources:

The National Cancer Institute of the US National Institutes of Health

The U.S. Preventive Services Task Force (USPSTF)

Writer's Contest Result

2006-09-19T12:32:00.000-07:00

I won!

Pardon me for just blurting it out, but I couldn't help myself. I actually won first place in the Southwest Writer's Annual contest, in the category of nonficton essay!

Wow!

I am thrilled to the bone. Someone besides my family and friends thinks I can write well!

I could hardly believe it. But there it is, in print.

My first writing competition. I'm very happy.

To Cut or Not to Cut?

2006-08-20T20:42:00.000-07:00

This is a piece from 50 Ways to Leave Your 40's, the book I'm co-authoring. It's from a chapter entitled, "Love Thy Body."

“Love thy body,” we say. Well, what if you don’t? What if you, like many mid-lifers, look in the mirror and pine for days gone by and a body gone bye-bye? What if you don’t WANT those basset hound eyelids, that turtle neck or the sumo belly? And where the heck have your boobs slouched off to now?

“Hey, kiddo,” says the little voice. “You don’t have to look like this. It’s a new century! They’ve got ways to FIX you!”

It’s true. A nip here, a tuck there, a little suction and augmentation and voila! The new you. Why not? Why “love thy body” when you can just “fix thy body”?

You’d certainly be in good company. More and more Americans are pursuing their lost youth in operating rooms, to the delight of the cosmetic surgery industry, which raked in 9 billion dollars in doctors’ fees in 2005. In that year, almost two million people went under the knife for cosmetic purposes alone. This includes, by the way, a dizzying array of possible procedures, from the familiar Facelift and Tummy Tuck to the newer Butt Boost and Vaginal Rejuvenation. If you add to that the number that had “minimally invasive” procedures like Botox injections, laser hair removal and dermabrasion, the number skyrockets to over ten million men, women, boys and girls.

Why do we do this? Why subject ourselves to the risks of surgery, the likelihood of scarring, the chance of a blighted outcome, all for looks?

Clearly our society suffers from a nasty case of Youth Worship. Physical beauty is defined always in terms less than thirty years of age, and everywhere you go, big glossy ads scream "value equals looks!" But it seems to me that by midlife, most of us have done enough living to know better. We’ve learned the value of experience. We see more clearly with the perspective of years. Most of us wouldn’t be 20 again if you paid us. So why do we still try to look that way?

“Well, why not?” argues the little voice. “It’s just a little nip and tuck. It’s not like it can kill you or anything!”

Ah, but it can. You might remember Olivia Goldsmith, author of The First Wives Club, who died following a facelift operation in 2004. It was not even close to her first such procedure, which made her death from anesthesia complications all the more shocking. A month later, another death in the same hospital from the same procedure set the medical grapevine buzzing. Alas, these are not isolated incidents. The American Society for Aesthetic Plastic Surgery cites a 1-in-57,000 chance of death and a serious complication rate of less than half of 1 percent for outpatient procedures. Less than half of one percent. That means, if 2 million people had cosmetic surgery in 2005, a “mere” ten thousand of them had “serious complications.”

What complications are there? First of all, there are the usual risks from general anesthesia, which include airway obstruction, abnormal heart rhythm, brain damage, heart attack, nerve damage, paralysis, malignant hyperthermia, stroke, and death, among others. Then there are risks common to any surgery, including bleeding, infection, pneumonia, blood clots and wound separation. Cosmetic surgery adds risks of skin necrosis, asymmetry, slow healing, numbness and tingling, abnormal fluid collections, and “irregularities, dimples, puckers and divots” (http://www.smartplasticsurgery.com).

I had a patient a few years ago who stopped by on her way to the plastic surgeon’s office to show me why she was returning to him 2 months after her “boob job.” In tears, she lifted her shirt to show me her “surgical result” which could best be summed up as “cockeyed.” One breast went northwest, the other, southeast, the result of asymmetrical scarring. The surgeon would have to put her back under general anesthesia and then basically yank and pull on her “augmented” breasts until the scar tissue tore loose enough for him to try to even things up with brute force.

Still want to get that nip and tuck?

Allow me to interrupt myself a moment to say that I have the utmost respect for the Plastic Surgery profession. What they do for kids with cleft palates, trauma victims, and women who have had mastectomies is heroic. What I’m objecting to is the use of plastic surgery for mere cosmetic purposes.

There is no fountain of youth. No magic wand. Rearranging a few skin cells will not reverse the aging process. Next time you look in your mirror, mirror on the wall, consider this: wouldn’t an Attitude Boost be much less expensive and risky than a Butt Boost? Is it possible that you can “love thy body” in gentler ways, or at least “accept thy body” without cutting it up?

Clearly, I have an opinion on cosmetic surgery (in case you couldn’t tell). However, if you are determined to fight nature with a scalpel, you’re going to do it no matter what I say. All I can ask is that you think first, educate yourself on the risks and benefits of the procedure, and go to a board-certified, experienced surgeon.

And then, please, think again.

Marathon Man to the Max

2006-08-18T20:53:00.000-07:00

Have you heard about the 50-50-50 Marathon Man?

This guy, Sam Thompson, is running 50 marathons in 50 states in 50 days ! His purpose is to raise awareness and money for Katrina relief.

Yeah, sure, you say. Nice lofty goal, but he'll never make it. Well, guess what? He only has ONE MORE to go! Tomorrow he does his final 26.2 miles, ending up in Bay St. Louis, Mississippi, where he and his group of 100 volunteers help rebuild homes destroyed by the hurricane.

He even has a blog, though how he can find time and energy to write while he's running 1310 miles in 50 days is beyond me.

I'm impressed.

Addendum, Sunday August 20: He made it! Finished his last marathon yesterday. There's a nice account of it on his blog, including the fact that he'll be on The Early Show on CBS tomorrow morning. Thank you, Sam, for your inspirational journey!

PMS Blues

2006-08-09T23:15:00.000-07:00

PMS. It's different for everyone, and different for me from month to month. In the details, anyway. Now bear with me cuz I'm there now and part of it is a distinct lack of creative energy.

This month my body feels heavy and slow...like I have molasses in my arteries. Sludge. Leaden syrup, moving like a mudslide through my body. I'm walking in waist deep ocean water, against the current. Not a strong, bowl-me-over current, just enough to have to strain and lean and put some effort into going the way I know I need to go. Just enough to have to keep part of my mind always on the current. Or it's as if I hadn't slept in a few days. Know that feeling? When you know you have to keep on going but you are soooooooooo tired. The sandman is constantly, insistently calling you, a low incessant nagging voice, pulling you down, dragging at you. All you want to do is lie down and give it up, but you keep....on....going.

And that's just the physical part. Emotionally, I can go from relatively stable (in my progesterone-poisoned opinion) to a gloomy doomsdayer, which is where I dwell most of these PMS days, ready to burst into tears at a perceived slight or a friendly hug, to a raving bee-yotch I claim not to recognize. And it's like someone else is totally in control, pulling my puppet strings this way and that, watching me jerk and twitch just for their own deranged amusement.

Dolly Parton did a wonderful song called "PMS Blues." If you haven't heard it, gals, find it and listen. She clearly knows of what she sings.

"Nothin' fits me when it hits me....Got those- -can't stop cryin', dishes flyin'--PMS Bluuuuuuuues...........................oh, whadda you lookin' at?!"

Watch it with the comments. I might smack you. But I'm not responsible, if I do. It's that demoniacal puppetmaster!

PMS Peg

I Placed in a Writer's Contest!

2006-08-06T21:20:00.000-07:00

I'm so excited!

Last April I entered a writing contest that Southwest Writers has every year. I just joined them last winter, as a way to connect with other writers and wannabe's like me. Long story short, they called me on Friday and told me I placed first, second or third in the Short Nonfiction category!! They had 19 categories and over 500 entrants total. I'm thrilled! I won't find out until the awards banquet in September what place I actually won, but who cares? Top three! Yippee!

The piece I entered was one I've posted here, but I'm going to post it again, partly cuz I want to celebrate, and partly cuz I've learned a few things about punctuation since then, so I fixed it.

A Discharge by Any Other Name

4/3/06

Last week on NPR I heard Eve Ensler reading her essay on the "This I Believe" segment of Morning Edition. Ensler is the author and playwright of The Vagina Monologues . In her essay, called "The Power and Mystery of Naming Things," she said:

"Think about the word 'vagina'. I believe that by saying it 128 times each show, night after night, naming my shame, exorcising my secrets, revealing my longing, was how I came back into my self, into my body."

Vagina. Vagina vagina vagina vagina.

When I was a girl, I didn't know the names of my private parts. I don't think we even called them "private parts.” It was all vaguely referred to as "down there.” Until the day one of my elementary school classmates, who had an older sister versed in These Things, informed us knowingly that the word was "vovey.” So we called it "vovey,” when we called it anything, when we dared to even speak about it, which was never, and only in a whisper, and only to each other, of course. One bold day, a friend and I revealed to each other that our "voveys" produced a secretion, which we gigglingly dubbed "vovey goo.”

Twenty years later, I was a licensed physician with my own little girl. I knew the human body inside and out, and I was damned if my daughter was going to grow up without words for all of her body parts. I taught that kid "vulva" before I taught her "elbow.” I wanted her to be proud of her body, to be comfortable with all of it. Naming was the first step.

I knew that I had succeeded beyond my wildest dreams when she once shocked a Texas church potluck by standing in the middle of the room, pointing at each grey-hair in turn, and correctly identifying their gender by announcing, "YOU have a penis. YOU have a vulva." She was three years old.

The first semester of medical school, we learned anatomy, in the lecture hall and in the dissection lab. It was presented in an orderly fashion, head to toe. Where there were gender differences, the male anatomy was always presented first, followed by "the female version of this is..." Sure, it bothered me, but it fit in with the sexism that pervaded medical education.

When we got to the genitals, we learned the male anatomy first, as usual. I was amazed at the quantity of labels on the drawings, the number of named parts men have. Corpus cavernosum. Corpus spongiosum. Root. Bulb. Crus. Shaft. Corona. Prepuce. Glans. Four different named segments of urethra. Etcetera, etcetera, etcetera. I took notes dutifully.

Next slide. Female anatomy. Far fewer labels. Much briefer rundown by the teacher. As he prepared to switch slides, I raised my naive hand. "Excuse me. What are the names of those muscles?" I pointed to the striated bands surrounding the vagina at varying angles.

The professor looked confused. "What muscles?"

I showed him again.

"Oh. Those...uh, that....that's Vaginal Wall." Click. Next slide.

Now, wait a minute. I'm a woman, and half of my readers are probably women. Ladies, you know that is not just one big muscle there, and it's not only useful for "holding your bladder" either. I was shocked that there weren't at least three different muscle groups in the vagina. Come on! The male urethra, a single tube, has four different named segments. But one single catch-all label for the mysteries of a woman's depths? Puh-lease!

That was a long time ago, now, and I've (clearly) gotten over it. But that morning, hearing Eve Ensler, it all came back to me again, and got me thinking some more about this male/female naming discrepancy. I remembered "vovey goo" and contemplated the fact that there still isn't an official medical term for vaginal secretions. I'm not talking about slang. There's plenty of that, from "smegma" (sounds like Gollum's sister) to "honey" (nice, but not unique). I mean an unambiguous, descriptive, neutral word of its own. Like "semen.” That's a word that can't be mistaken for anything else. It has only one meaning, as far as I know. It's only a noun, and calls up a distinctive mental picture. Nobody gets confused about what you're talking about when you say "semen."

But what is the "female version" of "semen"? The closest I can come up with is "discharge." But this does not meet the criteria of specificity that "semen" does. No, "discharge" is a word that can be a noun or a verb, can apply to a vagina, a retiring serviceman, or a firing cannon. Not only that, I was taught in medical school that a vaginal discharge is abnormal. Part of the Patient Interview is called the Review of Systems. When you do this, you verbally list the body systems, asking if there are any abnormal symptoms in each (headache, double vision, vomiting blood, etc.). One of the questions is, "Do you have any vaginal discharge?" This is usually asked while shaking one's head and frowning slightly, subliminally communicating the right answer to the patient. Oh, no, ma'am. No vaginal discharge. Yuck, no!

Whereas in truth, feminine secretions are as normal as tears or saliva, or mucus.

I submit that we need a new word. A unique word for the entirely normal, benign, useful secretions that are produced in the vagina. What shall it be? We could call it "vuliva" (vuh-lye-vuh) or "vugucus" (vuh-joo-kus) , echoes of its cousins at the "other end." We could even stoop to "vovey goo,” although that doesn't sound quite neutral to me. Or, come to think of it, we could have several words. The stuff changes, you know, throughout a woman's monthly cycle and lifetime. The eskimos have their myriad words for "snow.” The male urethra has four separate words for one little tubule. Why shouldn't there be a different word for each variety of hormonally-influenced natural feminine product?

The devil is in the details. I can't think of a good word. I just know we need one. I'm open to suggestions. Once we get a good one, we can submit it to the American Board of New Anatomical Terminology, or wherever one submits these things. Then all we'll need is for Eve Ensler to say it 128 times a night for six years, and voila! Equal time in the anatomy lectures, and a new addition to the church potluck repertoire.

Never Quit Quitting

2006-07-29T15:09:00.000-07:00

For the book I'm helping to write, 50 Ways to Leave Your 40's, one of my contributions to each chapter is a section entitled "Doc in the Box: Fast (health) Food For Thought."

Here's a sample. This one is for the chapter called "Just Keep Breathing."

My goal for each of these is NOT to repeat the same old messages, but to put a spin on the old or to say something new. Any feedback is welcome.

DOC IN THE BOX

Just Keep Breathing

I am not going to insult your intelligence by lecturing you about the dangers of smoking. If you don’t know by now that smoking is bad for you, you’re living in a cave. Bad breath, lung disease, ugly teeth, wrinkles, cancer…you’ve heard all that.

Nor am I going to tell you the best way to quit. That is up to you. Different strokes for different folks, and only you know what works best for you. Cold turkey, patch, pills, switching brands, gum…all are equally effective for the dedicated quitter. If you need more information, ask your doctor or go online where there are resources galore.

No, what I’m going to do instead is acknowledge you and salute you, the smoker.You are a functioning human being, and as such, you deserve as much honor and respect as the next person. Just because you made a choice to smoke cigarettes does not mean you are bad, or weak, or a hopeless drug addict. You have included cigarettes in your life for a reason, or reasons, which are your business. People have all kinds of reasons for smoking, and all kinds of reasons for quitting. So cut yourself some slack.

If you have decided you want to quit, I salute you. As a physician, I have to agree that this is a good choice. In fact, it is the single most important move you can make in the direction of health, and will clear up all kinds of current and future ailments, starting just twenty minutes after your last cigarette.

I also understand that quitting will not be easy. In fact, quitting smoking has got to be just about the hardest task a human being can undertake, and I’m including childbirth, which is saying something. I spent 20 years of my life watching my physician father quit. He knew the risks all too well (although, to be fair, he started smoking before the risks were known), and he is a smart guy. If quitting were as easy as “just doing it,” he would have done it on the first try. But I saw him quit, restart, and quit again, repeating the cycle many times. He finally succeeded, after his first grandchild was born. I think that finally got him over the hump. That and a change in office policy that sent smokers outside in the cold like huddled pariahs. He hasn’t smoked in 15 years now (which, by the way, puts him at the same risk of lung cancer as a lifetime nonsmoker) and he still goes skiing at the age of 74 without huffing and puffing. I’m very proud of him, and grateful for the lesson I learned watching his struggle.

Dad’s story is a very common one. I’ve seen it over and over in my medical practice. It’s like the old joke, “I can quit anytime! I’ve done it hundreds of times already!” The important thing to remember is that most successful quitters get a lot of practice first.

There are a few key things that accomplished quitters have in common that I want to share with you.

First and foremost, they are ready. By this I don’t mean they understand the dangers and tell themselves, “I should quit.” That doesn’t count as “ready”. What I mean is that, like my father, their reasons to quit have finally outnumbered their reasons to smoke. The balance has finally tipped and, at that moment, the battle is more than half won.

Second, these smokers have clearly-stated reasons for quitting. It doesn’t matter what the reasons are, but the more specific they are the better. “I want to quit because smoking is bad for my health” is not as effective as “I would like to be able to walk up one flight of stairs to my apartment without stopping” or “I want to live to see my grandchildren grow up” or “I want to smell the flowers in my garden.”

Lastly, good quitters pick a good time to quit. They don’t add “stop smoking” to the end of a long list of New Year’s resolutions, after “lose weight” and “become a better person.” They also don’t try to quit in the middle of a stressful time, like a family holiday or a final exam. They understand that their resolve and their reserves are going to be sorely tested, so they maximize their chances from the get-go. Some choose a weekend when they’ll be alone. If you have quit before, you know how unpleasant you can be. You might want to protect your loved ones from your werewolf self.

Smoking is bad for your health. You know it, I know it. It would be wise to quit when you can. When you are ready, you’ll do it. You’ll tip that scale and finally succeed. I have faith in you. Never quit quitting.