Do as we say. Not as we do.

As a physician I spend a lot of time discussing sleep hygiene. Which is similar to our regular hygiene but somehow harder to pull off. Every morning I floss, brush, shower, deodorant and then coffee. I have the routine down to a science. But sleep hygiene has hard for patients to get consistent with. This is the idea of doing things in a routine to promote restful sleep. Go to bed around the same time. Put your Iphone away. Turn off the TV. Make sure you are in a cool dark room. Before getting married make sure your partner does not snore or will at least wear a CPAP.

Yet physicians often have the worst sleep hygiene. It starts in medical school and then gets worse in residency. We have to be at surgical rotations at 5 AM. And I worked 30 hour shifts as a resident physician. After a 30 hours shift you were then expected to sit through a lunch time lecture. Here we are preaching sleep hygiene but treating ourselves like machines that do not need sleep.

I work in a practice with 4 physicians. Which means I am on call 25 percent of my life. I tell patients to put their phone away and hide it across the room. Yet I turn my ringer up so that I wake up in case of an emergency. Doctors do shift work. I have heard of emergency room doctors making separate walled in rooms with special walls to reduce noise so that one can get good sleep during the day.

It is time for self care. The CDC recommends that all adults try and get 7 hours of sleep. We need to make changes. I am going to turn off my computer earlier and make sure I get to sleep at a good time. Luckily hours have been changed for residents trying to get them more sleep. Physicians overall are known for pushing themselves but we need to realize that a well rested physician is a better physician. Sleep deprivation can affect our focus, mood and productivity.

We need to realize that there is only so much we can do in one day. But sleeping 7 hours should be one of our first priorities. I am done now. Going to take a nap.

The Doc is In

Debates

Debate Club

I was not in the debate club during high school but I have learned the art of the debate. And no, I am not running for office. I enjoy a good discussion but it is difficult to debate issues that are not debatable.

During my day my main goal is to be a good listener. Process symptoms and develop an evidenced based plan. But at times I debate. I explain why a Zpack is not needed for a viral upper respiratory infection. I discuss the issues behind opiates for back pain.

Patients at times want extra tests and imaging that is not needed. I try to explain the evidence and risk/benefits behind tests but they do not always care. No, I do not need to check your for systemic Candida or your thirteenth Lyme test. Yes I realize that you are tired and are having trouble losing weight but there may not be some rare hormonal imbalance that we have missed.

I try to remain evidenced based. I listen and process all the information. Then I present my assessment and plan. Then, at times, the debate begins.
But in one respect I have given up. Debating the flu shot. No it will not give you the flu. Yes, a coworker of yours may have gotten the flu shot and then died a year later. But is was not from the flu. But at the end of the visit when I ask if you want the flu shot I do not have the time in my day to debate. Not the flu shot. There is no debate. The flu shot helps save lives. I have had almost one patient per year die of the flu.

What I need is more time. I want to debate . Not politics but why everyone over 6 months should get the flu shot. In medicine we have so many things to discuss and document it has limited our time to debate.

Differences with my wife and the Flu shot. Two things that I will not debate. Get your flu shot.

The Doc is In

Juicing

The medical world always has a new answers to old questions. We are given recommendations to get a certain amount of fruits and vegetables daily to stay healthy. But it is hard to get them in. That is until we decided that we could just shove them all in a JUICER.

Is juicing healthy? We know that drinking too much fruit juice is not healthy for you. Fruit juice is packed with simple sugars. They refer to athletes that are taking steroids as being juiced. Also probable not that good for you.

But juicing can be a healthy alternative. It is basically meal replacement. We can add a little kale, broccoli, strawberries and apples and there you go. You have a nutritious meal replacement. Diet companies have been selling “healthy” meal replacements forever. If you make the decision to replace breakfast and/or lunch it could very well be a good replacement. If you prepare yourself a juice for breakfast that is full of veggies than it is absolutely a better alternative to a breakfast sandwich or donut.

Can one live off of juicing alone? Maybe. But who wants to. We do not get all the fiber and nutrients when we grind down certain veggies into juice. Also too much fruit added can actually make a drink very high in sugar. I like to eat. Food has texture. Veggies have texture.

Being healthy with eating is all about routine. Use meal prep. Stay in a regimen. If you want to juice make it a part of your health conscious. Kale smoothies are delicious but allow the vegetables to be eaten in their normal state at times.

The Doc is In

Kid’s Parties

Let’s all admit it your kids birthday party is terrible. We have a bunch of kids run around Bounce U or some other similar type venue for an hour followed by crappy pizza. We go because we want little Johnny to make friends though. We wander around chatting hoping to find someone to chat with that will not make you feel like a bad parent. What they do not usually have is booze.

There are slides and trampolines and ball pits. Here is the bad news. They did a study in ball pits in a physical therapy practice. What did it find? A lot. It found 31 bacterial species and one species of yeast. Enough stuff to give you pink eye, UTI, upper respiratory infections and even bloodstream infections.

Yet if you invite. We will come. I will allow my kids to jump around the dirt, drool and feces that is lurking.

Not at my house. Not for our party. My kids get a pool party. And open bar. Kid’s parties are terrible. But they do not have to be.

Double Dipper

I am focused on not spreading germs. Most times. I wash my hands all day long. I give out vaccines. I cover my mouth when I cough. And I make out with my wife less when I have a cold sore. But I have a flaw. I am a double dipper. If you have blue cheese or BBQ sauce or veggie dip. I will double dip every time. I cannot control it. So if you see me coming hold your salsa.
The Doc is In

Laughter

If you want to live a healthy life you need to laugh. Laugh every day. Studies have shown that daily laughter may improve overall health. Laughter may stimulate your organs and increase your intake of oxygen. It helps modulate your endorphins and expel the negative energy. Laughter may increase your bodies production of your own endorphins. And it may even improve your immune system over time. Make sure you have funny friends. Or even a funny doctor. You could be lucky enough that your deacon makes you laugh. Watch more stand up or Seinfeld. You should also not smoke or eat at McDonald’s or do heroin. But do not forget that laughter is the best medicine. Unless you have a urinary tract infection. Then antibiotics are the best medicine.

The Doc is In

Doorknobs

Before becoming a physician doorknobs did not mean much. We use them to open rooms. But as a physician we use them to leave a room. Doorknobs often make us think of entering. Entering a world or a home or somewhere you have never been before. In my job it means so much more.

I spend my days trying to listen to patients. Get a complete history. Then examine. Followed by the creation of hopefully a thoughtful assessment and plan. All of this mixed in with clicking and pointing on a computer. Then the visit ends and on to the next patient. Most times I try and complete my note before I leave the room. Until I reach for the doorknob.

As my hand firmly grips the doorknob to leave often there is one last complaint. Often it is a more worrisome complaint than anything we had discussed during the visit. Why did it wait until I was leaving? Do I now have to sit back down and start over? How far behind am I currently?

But do not worry. Either way I will get comfy again and make sure that nothing important gets missed. But please to patients of the world when doctors say “what brings you in for a visit today?” Let me have it. Do not wait until I can hear the wheezing of a patient in the next room to pull me back in.

Yet it goes differently when men have a question as I finally have my hand on the doorknob. I already know your questions. No – We do not have any Viagra samples. Yes – I will send a prescription over to your pharmacy. Maybe – Will it be covered? No – I have not had any recent patients with erections lasting longer than 4 hours.

Doorknobs are dangerous. Whether you are culturing whatever virus/bacteria live on the ones in my office or if as a physician you rush out as a final question is being asked.

The Doc is In

Pride

June is Pride month, where around the country events take place to honor the LGBT community. It is an opportunity to celebrate their dignity and equality while bringing awareness to issues that they face daily.
How does “The Church” or Faith community measure up in how we love our LGBT friend?
Five years ago I had the honor of supporting one of my closest friends as the best man when she married her wife. There was a ton of support from Christians I spoke with but it also prompted plenty of pushback. I prayed and wrestled with this choice earnestly and in the end I have peace that love and Jesus won that day.
I am not writing this blog to defend my choice or to rewrite theology. I have been taking a course put together by The Center for Faith Sexuality and Gender and I feel very encouraged by the approach of Pastor Preston Sprinkle, I promise that is his real name. He says that as a church leader it is more important for me to know and lover real LGBT people and pour into their lives, than it is for me to know every verse in the Bible that mentions same sex relationships. Amen brother.
Do you know how many LGBT people had a connection to the church at some point in their lives? Can you guess how many of them have stories of being hurt, mistreated or outright abandoned by that same church? That’s rhetorical … my favorite viewpoint that Pastor Sprinkle offers is that it is not “the churches theology that needs to change, it’s their posture.”
I believe that we can walk hand in hand with people as they experience life, which includes sexual orientation. The church should be a safe and compassionate place for the LGBT community, not one of torment.
See even though my BFF lights the menorah it’s not our theology that has hurt her, but words from actual Christians that have made her feel like the church doesn’t want her there. I argue that not only do we want her, we need her there. She has loved me when I was most unlovable, and forgiven me at my most unforgivable. Called me out when I was wrong and humbled me in life’s greatest victories. She is a caring, compassionate friend and doting Aunt to my girls. She has shown me the kind of love the Bible says we should show each other.

I challenge fellow Christ followers to pray earnestly to have a heart that honors God and loves people, just like Jesus did.
Love you Bone!
The Deacon Speaks

Mom Guilt

We all feel some guilt in our lives at one point or another. Maybe it’s because you haven’t been to the gym in a while, or because you had two pieces of pie instead of one, or maybe you’re a mom like me an you suffer from “mom guilt.” Mom guilt is BRUTAL! If you are a working mom like me, I’m sure you are always wondering if you’re doing enough for your kids, if you’re giving enough at work, or to your spouse. It is a constant struggle and not easy to find balance.
This afternoon my youngest came home from school and asked my why I wasn’t at her play today. I stared blankly into her big brown eyes and silently wondered, “what play?” Suddenly images of the flyer on the fridge that read “Kinder Play – 2 pm” flashed into my brain. OMG. I missed it. How could I possibly forget? I am the worst mom on the face of the earth. I was immediately consumed by guilt and convinced myself she would be scarred for life. I quickly said “oh honey, I am so sorry I missed it. I had a meeting and I could not make it.” LIES, total LIES. Truth is, I didn’t have the courage to tell her I forgot. What would she think of me??
But, we often underestimate our kids. My sweet 5 year old little girl looked up at me and said “it’s ok mommy, you were at the other 2 plays and I know you love me, I forgive you”
She hugged me and skipped out singing Old Town Road…I stood there speechless.
Forgive me? How can she forgive me? I can barely forgive myself. The fact is, she already knew everything I needed her to know. she knew hos much I loved her, and without and without her even asking she forgave me. She showed me the grace that I could not show myself. Maybe instead of beating myself up, I could learn something from her. Even as a Christian who knows God’s grace, it’s often easier said than done.

We all try to be the best parents we can be, but we will undoubtedly fail at times. Instead of carrying around the guilt, let’s remind ourselves it is OK to fail, especially when we learn from it. I’m learning to give myself a break once in a while and I hope you can too.

Let’s go have a second piece of pie.

Mrs. Deacon

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