I haven't been too proficient at posting on my blog. Everyone should be pleased to know that I am spending time being a physician and caring for my family. Certainly, an appropriate trade-off.
I would like to remind everyone to get a seasonal flu vaccine. Certainly, we have them in the office and, of course, the local pharmacies are pushing them as well. The indications for the pneumonia vaccine have been modified, as has been the recommendations for the Shingles vaccine. Pneumonia vaccination is recommended now for smokers as well as those with chronic medical conditions and those over the age of 65. Shingles is appropriate beginning at age 50. There is more scientific data for over the age of 60 but it is reasonable to get it earlier. We all know people who have suffered greatly from shingles. If you are not sure if you had the Shingles, you should still get the vaccination. There isn't information for prevention if you have already had the outbreak. It may be reasonable to vaccinate if there is a decent amount of time since you had the outbreak to get the vaccination- I imagine 5 years or so.
I hope to send emails out reminding to get a flu vaccine and make an appointment.
RW
http://www.RobertJWolfMD.com
Thursday, October 11, 2012
Monday, July 2, 2012
Within All of Us
As the Fourth of July approaches, we need to take a minute and think of those who have given their lives and given of themselves for the greater good. I have enjoyed two books recently written by former Navy Seals. I was struck by their selflessness and willingness to give to "the greater good". They speak of the world and priorities of life that are bigger than they are. They run toward crisis when human nature drives us in the opposite direction. Jumping on a hand grenade to save the platoon is instinct. Their devotion to their fellow brothers and sisters is more than admirable.
How frequently do we feel sorry for ourselves? We think of our little world and focus on issues that, in perspective, are relatively minor compared with the world's conflicts, the homeless people and animals, the raging fires in The West, etc.
Let's give thanks for what we have and realize there are so many people who are worse off. Let's think of the military and be thankful for what they do. Without the freedoms we have, we would be in such misery that life would have a different meaning. We would be fighting to survive, at the least.
The Wounded Warriors Project http://www.woundedwarriorproject.org is an agency everyone should visit. There are many other organizations helping the military and their families. We should also remember the dogs of the military as their lives have been dedicated and sacrificied for us. http://www.militaryworkingdogadoptions.com
Finally, let's take this spirit and find it in ourselves to better our days and those who's lives we touch. As I tell my little boy, Jonathan, " there is nothing you can't do"!.
Happy 4 th
How frequently do we feel sorry for ourselves? We think of our little world and focus on issues that, in perspective, are relatively minor compared with the world's conflicts, the homeless people and animals, the raging fires in The West, etc.
Let's give thanks for what we have and realize there are so many people who are worse off. Let's think of the military and be thankful for what they do. Without the freedoms we have, we would be in such misery that life would have a different meaning. We would be fighting to survive, at the least.
The Wounded Warriors Project http://www.woundedwarriorproject.org is an agency everyone should visit. There are many other organizations helping the military and their families. We should also remember the dogs of the military as their lives have been dedicated and sacrificied for us. http://www.militaryworkingdogadoptions.com
Finally, let's take this spirit and find it in ourselves to better our days and those who's lives we touch. As I tell my little boy, Jonathan, " there is nothing you can't do"!.
Happy 4 th
Friday, May 11, 2012
WHAT'S IT GOIN' TAKE?
This past week has been a "feel-good " week- it is not too common to inspire a patient to the point of lifestyle change and improvement. For every one success unfortunately there are many that still struggle.
For any change (present company included), you have to internalize what you want to change and, as I tell my patients, feel it within your soul. You have to get it, live it, and place it into the heart!
I have a 59 year old gentleman who is not a big fan about coming to the office. He has high blood pressure, and elevated sugar. After his last physical we talked about the consequences of uncontrolled health issues. He was already on blood pressure medicine with a need to increase the strength and possibly add on medicine for sugar/diabetes. We talked about lifestyle changes. He admitted that he really has not thought about what he eats and he has very little exercise. Being that he works from home, we instituted a lifestyle change. He is trained in statistics and enjoys data collection. We incorporated his strengths that he uses day-to-day at work into his lifestyle "make-over". He started charting and tracking his calories, grams or fat and salt, etc- He journeled his efforts and the results are amazing !! In February he weighed 207 and now 170. His blood pressure was 198/90 and now 130/66. He was particularly nervous in February and his average blood pressure prior was 170/80. Regardless, this is impressive.
I recommend thinking about what you do everyday with exercise, eating, and living. I have said that keeping a log and reflecting on the regularly will really help to bring to light what we are doing right and not so right.
If we don't watch ourselves, heart disease, stroke, diabetes, kidney failure, etc can happen. So I say, " what will it take to make a change?" Don't wait till trouble knocks on the door....
I received a birthday party invitation from one of my patients today. It read, " I survived to celebrate another birthday!". This is 47 year old who had a very unusual presentation of an aneurysm in his lower abdomen. I thought is was some stomach flu. With perseverance, we made the diagnosis and after emergency surgery, he avoided a potentially life-ending rupture. Cheers!
For any change (present company included), you have to internalize what you want to change and, as I tell my patients, feel it within your soul. You have to get it, live it, and place it into the heart!
I have a 59 year old gentleman who is not a big fan about coming to the office. He has high blood pressure, and elevated sugar. After his last physical we talked about the consequences of uncontrolled health issues. He was already on blood pressure medicine with a need to increase the strength and possibly add on medicine for sugar/diabetes. We talked about lifestyle changes. He admitted that he really has not thought about what he eats and he has very little exercise. Being that he works from home, we instituted a lifestyle change. He is trained in statistics and enjoys data collection. We incorporated his strengths that he uses day-to-day at work into his lifestyle "make-over". He started charting and tracking his calories, grams or fat and salt, etc- He journeled his efforts and the results are amazing !! In February he weighed 207 and now 170. His blood pressure was 198/90 and now 130/66. He was particularly nervous in February and his average blood pressure prior was 170/80. Regardless, this is impressive.
I recommend thinking about what you do everyday with exercise, eating, and living. I have said that keeping a log and reflecting on the regularly will really help to bring to light what we are doing right and not so right.
If we don't watch ourselves, heart disease, stroke, diabetes, kidney failure, etc can happen. So I say, " what will it take to make a change?" Don't wait till trouble knocks on the door....
I received a birthday party invitation from one of my patients today. It read, " I survived to celebrate another birthday!". This is 47 year old who had a very unusual presentation of an aneurysm in his lower abdomen. I thought is was some stomach flu. With perseverance, we made the diagnosis and after emergency surgery, he avoided a potentially life-ending rupture. Cheers!
Friday, May 4, 2012
I'm Back..Life is Crazy
It's been a few months since I had a chance to post on this blog- Happy Spring !!
In our business, like any other business, it is important to train and plan for the future-
I went to The American College of Physician's Meeting in New Orleans a couple weeks ago. We need 50 hours of continuing medical education yearly.
Iron levels seem to be a hot topic- Ferritin is a blood marker for iron levels and can contribute to not feeling well, even with normal blood counts ( not being anemic)- It has been shown that high-level athletes' performance improves if their iron levels are raised from low/normal to normal levels.-even without anemia.
I just ordered a ferritin level on a lady in the office with medical issues and complaints of fatigue- Her ferritin a year ago or so was low. It will be interesting to see how it comes out. She may benefit from iron supplementation. My dad just got diagnosed with colon cancer ( he will be fine) and his ferritin level was low; even with a transfusion he had trouble walking 20 feet; we gave him IV iron and after two doses, he started feeling better; I think Ferritin will be a hot-topic, just like Vitamin D.
I have taken numerous emergency room calls at Glenbrook Hospital to keep our patient flow-The hospital is having trouble getting doctors to accept new patients being admitted via the emergency room to the hospital. These on-call doctors, of which I am one, are either getting burned out or are being bought by the hospitals becoming employees; The pool of doctors willing to take call for the ER is dropping; Medical Group doctors of The North Shore System are not encouraged to attend patients in the hospitals (including their own personal patients)- What happened to continuity of care and being there for your patient when they get ill and are hospitalized?
Everyone tells me to pull back and regain life-enjoyment and satisfaction (heck, I tell my patients this everyday)- I have done that and have restarted my workouts, nutritional support, etc., but the problem is that the Government is changing the way we will be getting reimbursed and how hospitals will be doing their business. It is difficult to plan for the future and make a business plan if the future is not certain; How do you play the game if the rules keep changing? Needless to say, I have been wiped and exhausted maintaining my quality care medicine, office operations, personal life, etc.
Be nice to your doctor(s)- we are all working hard to take care of you and trying to survive in the meantime! We are not going to the golf course ( at least I am not);
New things in the office include adminsitering Prolia- this is a medicine for osteoporosis; It is a painless every 6 month injection that slows down bone loss and enhances, as a result, the laying down of normal healthy bone- it is pretty neat as it uses monclonal antibodies. Everyone needs weight bearing exercise; Vitamin D intake 400-1000 IU's daily, Calcium 1000-1500mg daily !
One last tidbit- I treat alcholism through my practice; Vivitrol is a medicine that blocks the effects of alcohol on the brain- similar to when we used to plug doorlocks with toilet paper as a prank on our friends ( at least I did). Alcohol blocks the door lock so alcohol (the key) can't get it- I have been using this medicine for years and have saved a handful of lives- not only does it block alcohol so the positive effects are not felt, it also stops the OCD/thirst/desire over time.
I saw a lady for her 2nd injection the other day- prior, she was very well known in the ER as a frequent flier alcoholic; always coming in for intoxication and withdrawal; Since the first injection last month, she had one relapse- she drank two bottles of wine and tossed the third down the drain; She got disgusted, stopped drinking and went on with her day- Why is this huge? Her prior drinking would have led to 6-7 days of contiuous drinking with intoxication and a visit to the hospital; One day of drinking without the trip to the emergency room, no intoxication, and moving on with life !- I expect that over time she will stop dirnking altogether; This is a one year program; WOW ! Exciting for her-
I hope to contribute more and hope all of you enjoy reading it; My tallies show 260 people or so have ready my blog since I started...
In our business, like any other business, it is important to train and plan for the future-
I went to The American College of Physician's Meeting in New Orleans a couple weeks ago. We need 50 hours of continuing medical education yearly.
Iron levels seem to be a hot topic- Ferritin is a blood marker for iron levels and can contribute to not feeling well, even with normal blood counts ( not being anemic)- It has been shown that high-level athletes' performance improves if their iron levels are raised from low/normal to normal levels.-even without anemia.
I just ordered a ferritin level on a lady in the office with medical issues and complaints of fatigue- Her ferritin a year ago or so was low. It will be interesting to see how it comes out. She may benefit from iron supplementation. My dad just got diagnosed with colon cancer ( he will be fine) and his ferritin level was low; even with a transfusion he had trouble walking 20 feet; we gave him IV iron and after two doses, he started feeling better; I think Ferritin will be a hot-topic, just like Vitamin D.
I have taken numerous emergency room calls at Glenbrook Hospital to keep our patient flow-The hospital is having trouble getting doctors to accept new patients being admitted via the emergency room to the hospital. These on-call doctors, of which I am one, are either getting burned out or are being bought by the hospitals becoming employees; The pool of doctors willing to take call for the ER is dropping; Medical Group doctors of The North Shore System are not encouraged to attend patients in the hospitals (including their own personal patients)- What happened to continuity of care and being there for your patient when they get ill and are hospitalized?
Everyone tells me to pull back and regain life-enjoyment and satisfaction (heck, I tell my patients this everyday)- I have done that and have restarted my workouts, nutritional support, etc., but the problem is that the Government is changing the way we will be getting reimbursed and how hospitals will be doing their business. It is difficult to plan for the future and make a business plan if the future is not certain; How do you play the game if the rules keep changing? Needless to say, I have been wiped and exhausted maintaining my quality care medicine, office operations, personal life, etc.
Be nice to your doctor(s)- we are all working hard to take care of you and trying to survive in the meantime! We are not going to the golf course ( at least I am not);
New things in the office include adminsitering Prolia- this is a medicine for osteoporosis; It is a painless every 6 month injection that slows down bone loss and enhances, as a result, the laying down of normal healthy bone- it is pretty neat as it uses monclonal antibodies. Everyone needs weight bearing exercise; Vitamin D intake 400-1000 IU's daily, Calcium 1000-1500mg daily !
One last tidbit- I treat alcholism through my practice; Vivitrol is a medicine that blocks the effects of alcohol on the brain- similar to when we used to plug doorlocks with toilet paper as a prank on our friends ( at least I did). Alcohol blocks the door lock so alcohol (the key) can't get it- I have been using this medicine for years and have saved a handful of lives- not only does it block alcohol so the positive effects are not felt, it also stops the OCD/thirst/desire over time.
I saw a lady for her 2nd injection the other day- prior, she was very well known in the ER as a frequent flier alcoholic; always coming in for intoxication and withdrawal; Since the first injection last month, she had one relapse- she drank two bottles of wine and tossed the third down the drain; She got disgusted, stopped drinking and went on with her day- Why is this huge? Her prior drinking would have led to 6-7 days of contiuous drinking with intoxication and a visit to the hospital; One day of drinking without the trip to the emergency room, no intoxication, and moving on with life !- I expect that over time she will stop dirnking altogether; This is a one year program; WOW ! Exciting for her-
I hope to contribute more and hope all of you enjoy reading it; My tallies show 260 people or so have ready my blog since I started...
Thursday, February 23, 2012
EXERCISE ANYONE ?
Getting the healthy lifestyle going is probably one of the most difficult things we all try to accomplish- we are almost into the third month of the year and what happened to our resolutions? I have completed my fourth workout this week and have the motivation to forge on-
Here are some helpful tools :
Firstly, schedule the exercise as an appointment. We all make our appointments so this shoudn't be any different-morning, over lunch, on the way home, before bed- whatever works for you- be consistent and accountable to your schedule.
Secondly, don't conquer the world and plan a three hour workout- it won't happen- 15-30 minutes three to four times a week is more productive than an hour once a week- there are many workouts to choose from; Find something you enjoy and go from there- I will comment on some exercise routines from bands, to high intensity training, to yoga with my next blog; I don't care what you do, but do something and move !! Start easy and for a short duration- I was thrilled I got out of bed at 6 AM and went downstairs- that is a victory in of itself-
Next, journal your exercise and eating- No one has to see this but you- keep a daily log of what you do for activity- the type of activity, duration, and your preception of effort you expended; it will be interesting to track this over time and see your improvement. Do the same thing with eating- each meal and snack- what you ate; how much (small, medium, large, x-tra), how about adding whether you were hungry or not ( that is for the emotional eaters)- It is amazing what feedback you can gain from just doing this. Again, no one has to see this- I hesitated but forced myself to write down a food cheat I ate- it's ok to cheat but when you write down what you eat, it's amazing what we put into our bodies.
I have a website I started to help me with my training program ...the more we can connect and engage with others I think it helps keep the motivation ( at least that is what I am trying to do)..
-http://beachbodycoach.com/drrob2fit
-http://myshakeology.com/drrob2fit
Here are some helpful tools :
Firstly, schedule the exercise as an appointment. We all make our appointments so this shoudn't be any different-morning, over lunch, on the way home, before bed- whatever works for you- be consistent and accountable to your schedule.
Secondly, don't conquer the world and plan a three hour workout- it won't happen- 15-30 minutes three to four times a week is more productive than an hour once a week- there are many workouts to choose from; Find something you enjoy and go from there- I will comment on some exercise routines from bands, to high intensity training, to yoga with my next blog; I don't care what you do, but do something and move !! Start easy and for a short duration- I was thrilled I got out of bed at 6 AM and went downstairs- that is a victory in of itself-
Next, journal your exercise and eating- No one has to see this but you- keep a daily log of what you do for activity- the type of activity, duration, and your preception of effort you expended; it will be interesting to track this over time and see your improvement. Do the same thing with eating- each meal and snack- what you ate; how much (small, medium, large, x-tra), how about adding whether you were hungry or not ( that is for the emotional eaters)- It is amazing what feedback you can gain from just doing this. Again, no one has to see this- I hesitated but forced myself to write down a food cheat I ate- it's ok to cheat but when you write down what you eat, it's amazing what we put into our bodies.
I have a website I started to help me with my training program ...the more we can connect and engage with others I think it helps keep the motivation ( at least that is what I am trying to do)..
-http://beachbodycoach.com/drrob2fit
-http://myshakeology.com/drrob2fit
Saturday, February 11, 2012
So what did the doctor say ?
Researchers conducted exit interviews of patients to measure the degree of comprehension that is retained and lost upon leaving the examination room. Results concluded many patients do not remember what the doctor just said.
I started using a new medicine that is a topical application to the underarms. I am very careful to always explain how to use the product and all the informatin that is required with a new prescription. The medicine requires one pump from the bottle onto an applicator cup. The cup is then positioned under the armpit to apply the medication. This past week, a patient didn't understand why the medication was flowing onto the floor- well, he filled the cup to the rim with the gel and, as he was applying it to this tender area of the body, it poured onto the floor. Today, another patient was complaining that this product leaks. He was squeezing the application bottle directly to his armpits. Gravity had the upperhand in this situation too. Not only did these patients get the instruction from me, I had sent them home with material to read.
What are the steps that we as physicians need to take to provide instructions that will enhance compliance and understanding ?
1. Simple medication dosing regimens (ie: once a day; small tablet sizes, easy to swallow or apply; convenient devices to remind dosing- med box, alarms)
2. Simple verbal instructions with written literature to review after the office visit; This should be given to both patient and an accompanying friend, family member, advocate (see my previous blog on advocates)
3. Ask for "teach/tell-back" so the patient can repeat back what was just explained
4. Assess patient beliefs, ethical issues, religious or other convictions that can bias a treatment plan. Some patients cannot understand nor read what is being explained due to literacy deficits. The medical team needs to be sensitive to these issues as they impact a patient's wellbeing
What are the steps a patient needs to take to insure that the information passed on from the physician is properly communicated and to make the office visit most effective ?
1. Prepare a list of questions and concerns to discuss with the healthcare provider. This is a good way to also take notes as the issues are being addressed
2. Keep a current medication list including the name(s) of the doctor, pharmacy information and a list of allergies. This can serve as a safety measure with the office medical record
3. Ask questions pertaining to anything that is not clear- this is not a time to be uncomfortable about speaking up
4. Ask for a written copy of the explanations and instructions for reference
5. Bring an advocate with you for backup
The medical team consists of patient, patient advocate (as appropriate), and healthcare provider.
some interesting help in this topic
http://journals.cambridge.org/abstract_S0033291700048558
I started using a new medicine that is a topical application to the underarms. I am very careful to always explain how to use the product and all the informatin that is required with a new prescription. The medicine requires one pump from the bottle onto an applicator cup. The cup is then positioned under the armpit to apply the medication. This past week, a patient didn't understand why the medication was flowing onto the floor- well, he filled the cup to the rim with the gel and, as he was applying it to this tender area of the body, it poured onto the floor. Today, another patient was complaining that this product leaks. He was squeezing the application bottle directly to his armpits. Gravity had the upperhand in this situation too. Not only did these patients get the instruction from me, I had sent them home with material to read.
What are the steps that we as physicians need to take to provide instructions that will enhance compliance and understanding ?
1. Simple medication dosing regimens (ie: once a day; small tablet sizes, easy to swallow or apply; convenient devices to remind dosing- med box, alarms)
2. Simple verbal instructions with written literature to review after the office visit; This should be given to both patient and an accompanying friend, family member, advocate (see my previous blog on advocates)
3. Ask for "teach/tell-back" so the patient can repeat back what was just explained
4. Assess patient beliefs, ethical issues, religious or other convictions that can bias a treatment plan. Some patients cannot understand nor read what is being explained due to literacy deficits. The medical team needs to be sensitive to these issues as they impact a patient's wellbeing
What are the steps a patient needs to take to insure that the information passed on from the physician is properly communicated and to make the office visit most effective ?
1. Prepare a list of questions and concerns to discuss with the healthcare provider. This is a good way to also take notes as the issues are being addressed
2. Keep a current medication list including the name(s) of the doctor, pharmacy information and a list of allergies. This can serve as a safety measure with the office medical record
3. Ask questions pertaining to anything that is not clear- this is not a time to be uncomfortable about speaking up
4. Ask for a written copy of the explanations and instructions for reference
5. Bring an advocate with you for backup
The medical team consists of patient, patient advocate (as appropriate), and healthcare provider.
some interesting help in this topic
http://journals.cambridge.org/abstract_S0033291700048558
Friday, February 10, 2012
We all need advocates especially as we get older and medical issues become complex. There are many times we encounter complex diagnoses and evaluations. Family members can add information that helps clear the fog for the medical team.
I remember an older lady who had fallen and was complaining of neck pain. Her son insisted something was wrong with mom. At first glance, this was another case of an older adult who had fallen and tripped- not an unusual situation. After performing a deeper investigation, we discovered that she suffered a stroke from a clot that came from her heart. She had a growth on the heart valve that created a traveling clot to the brain. We ultimately sent her for heart valve surgery and she is fine to this day.
I have to admit that the son's persistence advocating for mom helped us reach the ultimate diagnosis and formulate a successful treatment plan. These experiences keep us, as healthcare providers, humble (or at least should).
I recommend everyone have a spokesperson, especially as we get older. The advocate should be equipped with a current medication list, advanced directives/power of attorney for healthcare document, and have easy access should an emergency arise.." you never know"....
I remember an older lady who had fallen and was complaining of neck pain. Her son insisted something was wrong with mom. At first glance, this was another case of an older adult who had fallen and tripped- not an unusual situation. After performing a deeper investigation, we discovered that she suffered a stroke from a clot that came from her heart. She had a growth on the heart valve that created a traveling clot to the brain. We ultimately sent her for heart valve surgery and she is fine to this day.
I have to admit that the son's persistence advocating for mom helped us reach the ultimate diagnosis and formulate a successful treatment plan. These experiences keep us, as healthcare providers, humble (or at least should).
I recommend everyone have a spokesperson, especially as we get older. The advocate should be equipped with a current medication list, advanced directives/power of attorney for healthcare document, and have easy access should an emergency arise.." you never know"....
Wednesday, February 8, 2012
Introduction
This is our first blog entry. I would like to use this format to communicate with my patients and anyone else who is interested on relevant topics that I encounter in my daily work. The science of medicine changes all the time and this medium will enable a flow of information that I think will be valuable. More to come soon...
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