The Power of a House Call

My first experience with a house call was as a patient. The memory is still burned into my soul. Dr. Moats would make house calls for $5. I know that sounds like a lot of money, but that also included medication. Of course, this was a house call made in 1957 in a small, rural Pennsylvania community called Fairchance. My mother had called him because I was very sick and feverish. Even at age six, I knew that Dr. Moats had a reputation among children as a "shot doctor".

No matter what you had, Dr. Moats always seemed to have a shot for you. We wouldn't even go to his house to sell him magazines.

I distinctly remember pacing back and forth, looking out of the window for his big black car. Then, it happened. There he was with that black bag of his. My heart jumped and I ran to find an appropriate hiding place.

Yes, under the bed. No one will find me there.

My sanctuary was short-lived, however, and I was quickly discovered. Perhaps my breathing gave me away, or maybe, the heat signature from my fever. Either way, they found me.

My mother fished under the bed and tried to grab me. I scurried to the other side, only to have my leg grabbed by my nemesis -- Dr. Moats. With great effort, he slowly tugged my struggling body from under the bed, quickly exposed my clenched buttocks, and before I knew it, there was that sharp prick of a needle.

He allowed me to go back under the bed. No need for a physical examination. A shot of penicillin cured everything.

Jumping three decades later, I was on the other side of that encounter. My patient was a 30-year-old woman with severe brain damage and schizophrenia.

When she had to come to my office, we had to arrange it after hours. She would scream uncontrollably, terrified of leaving her home. I just hated to put her through this.

Ginny was only four years old when she went in for a routine tonsillectomy. Something went wrong during the anesthesia and her little, normal brain was irreversibly damaged. Her dedicated mother has never left her side. Then, it hit me. There was absolutely no reason why I couldn't make a house call. I can examine her in a familiar setting. It is on my way home. Her mother was both shocked and thrilled that I would do this. So, I dusted off my old black bag (just like Dr. Moats!) and headed for my car.

I arrived at their home, finding this woman completely calm and sitting on the couch. I was able to perform my exam without the usual struggle and screams. It went perfectly. The mother was so grateful that she loaded up a box with vegetables from her garden for me.

It reminded me of times past, when medical care was often reimbursed with things other than money. I would like to see the IRS take 30% of a tomato! As I was leaving with the box of veggies, she said, "Do you eat turkey?"

"Yes, of course," I answered, "but, I don’t want you to give me a turkey."

She insisted and headed for the kitchen. I expected her to return with a big frozen turkey in a bag, but what I heard instead, stopped me in my tracks. It was the unmistakable sound of gobbling! She entered carrying the biggest damn LIVE turkey that I have ever seen in my life.

"I can't eat him. He is like a pet," she said. This was really cool. I could eat him. As a boy, I once shot a turkey, cleaned it, and had it for Thanksgiving. "Sure," I said, "I will take him." I couldn't wait to see the look on my wife's face when I came home with this guy!

I am sure it will be similar to the looks I got from other motorists, as I drove home with this big turkey sitting on the back seat of my Volvo, gobbling away out of the partially-open window.

To make a long story a bit more digestible, I could not kill and eat him. He lived happily in my back yard, not unlike a dog, ate me out of house and home, chased the cat, and pooped on my deck for about two years until I moved. Not wanting to bring Tom to the next house, I gave this now sixty pound behemoth to my neighbor, who assured me HE could kill and eat him.

Tom died about four years later, living a full and peaceful life at the Folsom, Calif., petting zoo. My neighbor couldn't eat him either.

About ten years ago (maybe longer), I had the pleasure of meeting the real Patch Adams, a very interesting character made famous by a movie of the same name, and played by Robin Williams. Patch said that he can learn more about a patient in one house call than he can by a dozen office visits. I couldn't agree more. Patch actually required a house call on all his new patients.

From that one home visit, I learned of the profound dedication of a loving mother, committed to caring for her child, even though that child is over thirty years old. I saw a house rearranged for a person of special needs. I felt the awesome power of a simple, easy-to-make house call. And, I got a turkey and a great story out of it.

Every person (or patient) has a story if medical providers only take to time and make the effort to discover it. What we see in the office is not really a true representation of a person. A fifteen minute office visit is not enough time to truly embrace the wonderful complexity of the human soul. Medical providers must remind themselves that we are caring for PEOPLE, not just human afflictions.

Related Topics: Integrative Medicine Resource Center, 7 Key Traits of the Ideal Doctor

Technorati Tags: housecalls, Patch Adams, doctors

Ear Infections can easily be misdiagnosed

It is amazing how often middle ear infections (otitis media) are misdiagnosed by medical professionals.

I recently attended the Advances in Pediatrics conference that had hundreds of clinicians from all over the country. During a workshop on otitis media, participants were asked to provide a diagnosis of various eardrum slides using an Audience Response System (ARS) -- a wireless device so that people can anonymously answer questions. The slides were shown on a screen, thousands of times bigger than life, accompanied by a brief clinical description.

The medical providers in the groups had 15 seconds to provide a diagnosis -- more than the average time we actually look at the ears. A computer analyzes the responses and the results are projected on the screen. In the vast majority of cases, as few as 50% of the clinicians got the correct answer. Transferring this data to the doctor's office or emergency room would indicate that you may be misdiagnosed half of the time. Why is that?

First, there is a wide range of clinical interpretation by medical providers as to what constitutes a middle ear infection. Some clinicians felt that any red eardrum in a feverish child is otitis media and required antibiotics. Not true. Pink or red eardrums do not necessarily mean there is an infection. Feverish children can have red eardrums. Crying children can have red eardrums. Basically, any child with a flushed, red face may have a corresponding flushed, red eardrum.

Second, many clinicians are cutting corners doing quick, cursory examinations. An accurate diagnosis of otitis media is not rocket science, and the diagnostic criteria are well-known and published:

1. The eardrum needs to be OPAQUE. In other words, you should not be able to see through it during an exam. The normal eardrum is translucent, like a frosted shower door.
2. The COLOR of the eardrum may be red, yellow, or cloudy. Many times, a true otitis media is more likely to be yellow, than red.
3. The eardrum should be BULGING. If the eardrum is not bulging out from pressure behind it, there is only a 7-10% chance that it is a bacterial infection.
4. Most importantly, the eardrum must have REDUCED MOBILITY, as observed using a pneumatic otoscope. An otoscope is the device that a medical provider uses to observe the ear; the pneumatic attachment is a little bulb syringe that is used to puff air against the eardrum so that movement can be seen. A middle ear infection would have an eardrum that did not move very well, if at all. This most important diagnostic step is the one most frequently skipped by medical providers, even though it only takes a few extra seconds.

Third, many clinicians are diagnosing ear infections by the seat of their pants. They are not even seeing the eardrum! A mother told me that she watched an urgent care physician look in her child's ear without even inserting the otoscope tip in the ear opening; he only looked at the skin of the outer ear! Additionally, people can have significant wax in their ears completely obscuring the eardrum.

There is absolutely no way to accurately diagnose an ear infection without seeing the eardrum -- simple as that. Not all clinicians are skilled at removing excess wax from ears, but they should be.

Patients should hold their medical providers accountable for Standard of Care practices. You and your children deserve to have a complete medical assessment, resulting in an accurate diagnosis.

1. Did the clinician take a thorough medical history?
2. Did the clinician do a thorough examination? Did they examine more than just the ear that was hurting? Did they take the time to clean out any obstructing earwax? And, more importantly, did they take the time to use a pneumatic otoscope?
3. When asked, did the clinician allow YOU to look in your child's ear through the otoscope? The doctor may be put off by this request, but ask anyway. You may not be skilled enough to validate the clinical findings, but with a little practice and a home otoscope, you can develop those skills. I have been a long-time advocate of people having and using home otoscopes. If the doctor refuses to let you see the eardrum, just tell him/her that you will check it when you get home, with your OWN otoscope. I bet that will get their attention.

Related Links: Kids' Ear Infections: Antibiotics vs. Waiting, In Praise of Earwax

Technorati Tags: Ear infection, Otitis media, Misdiagnosis, Audience Response System

Pacifiers - The Good, the Bad, and the Ugly

I find daytime pacifiers annoying. When I see older children in my clinic with a pacifier sticking in their mouths, I often just reach over and pull them out. During the day, children need to talk, or at least learn to talk. It is very difficult to verbalize when they are sucking on a piece of latex.

A decade ago, teenagers were even sucking on pacifiers, much to the horror of their parents. There is even a hard candy-shaped pacifier that I absolutely refuse to buy for my grandchildren, pacifiers that whistle, and even pacifiers made of sterling silver.

There are pacifiers that record body temperature - something that is really not that important to constantly monitor. At a recent meeting of the American Academy of Pediatrics, I picked up a pacifier with an attached reservoir to put medications. Very clever, but not really needed.

My anti-pacifier bias probably stemmed from my childhood. My brother, eight years my younger, was addicted to using them. He had them in his pockets and around his neck on a string like some kind of bizarre bandolier that had the potential to strangle him. He religiously used them well beyond the first grade.

My own children used them for a while as infants, but they preferred to have food in their mouths instead. Kids do like them, and they do help for those fussy or colicky times, but like all good things, there is a bad side. Sucking is a basic and natural instinct.

Dentists were never fans of the original-shaped pacifiers (or thumbs, for that matter) due to their potential to cause dental malocclusions. Fortunately, most children give up the pacifiers and thumbs well before the age of four to five, when damage to the permanent teeth or jaw could occur.

More ergonomically, natural-shaped pacifiers are now commonplace. However, I must say that I have never seen a human nipple take that odd shape. I recently saw some novelty Billy Bob pacifiers with buck teeth already attached to them, so parents can find out how those chronic pacifier-users are going to appear in a few years.

I am less militant about nighttime pacifiers for infants, especially now, due to the results of a recent SIDS (sudden infant death syndrome) study. This California-based study found that infants under the age of one were less prone to SIDS if they were pacifier-users, even if they slept in less-than-ideal positions (like on their tummies or sides) or settings (such as soft bedding).

For years, we have recommended putting infants only on their backs and on hard bed surfaces for SIDS prevention. Now, the American Academy of Pediatrics has now recommended pacifier use to the preventative guidelines.

Now I have a minor dilemma. If pacifiers help prevent SIDS, I am all for it. However, there is a well-known association between pacifier users and a higher incidence of middle ear infections.

About five years ago, a Finnish study found that children who stopped using pacifiers regularly after the age of six months had more than a third fewer middle ear infections than children who use them. The association is felt to be due to negative middle ear pressure created by the sucking action. Pacifiers, especially those that are inadvertently shared in day-care, can be a vector for the spread of microorganisms, including many that cause ear infections.

A compromise and a suggestion: Allow children to use pacifiers at bedtime or nap time until age 10 to 12 months. After that, it's time to consider taking them away. Younger children will often give them up relatively easily; older children may experience more of a psychological struggle.

Not every method will be successful, but here are a few suggestions to help an older child give up the pacifier habit:

1. Create a Pacifier-Free Zone. Allow them to suck away in their rooms or in their beds, but do not permit them to bring them into other parts of the house. This is not unlike requiring smokers to smoke outside.
2. Don't buy any new ones, but be careful that they don't choke on pieces that begin to fall off the old, ratty ones.
3. Offer rewards. Exchange the pacifier for a healthy snack, or distract them with an interesting toy or project.
4. Make it fun. In children who understand money, start with a supply of nickels. For each time that they want to suck on their pacifiers, they have to pay YOU a nickel for the privilege. At the end of a pre-established time frame, they can keep all of the nickels they have left.
5. Positive Encouragement. When you see your child NOT sucking on a pacifier, call it to his attention and tell him how proud you are. If you are using the nickel method, give him a random nickel or other reward from time to time when you see him not using it.
6. When the time is right, create a fun bon voyage party for the pacifiers. Tie them to a helium balloon and send them airborne, or better yet, meet the weekly garbage truck and present them to the trash collector. Allow children to observe those pacifiers being dumped in the truck and drive away...for good.

Related Topics: Why American Kids Go To Hospitals, Sleeping with a Pacifier Lowers SIDS Risk

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Biting Toddlers

We have discussed both snake bites and spider bites on the Blogs, but no discussion about bites would be complete unless we mentioned humans that bite. Now, I am not talking about Mike Tyson biting off an ear, or Marv Albert who likes to bite, I am talking about toddlers.

Being a toddler is really not a happy time for them. Bigger people always seem to keep them from doing what they want. For toddlers, life itself sometimes bites.

Other than screaming, whining, or other irritating defense mechanisms, the more aggressive toddlers often hit and bite to get their way. As a matter of fact, biting is much more common in children with slow verbal skills. Perhaps, biting is just their way of communicating. Toddlers will attacks siblings, seemingly unprovoked, and even strike out at Mom from time to time.

I have a wonderful video of an idyllic Christmas morning. My children are unwrapping gifts, when suddenly my two year old spies a tape player that Santa gave my five-year old. He immediately wanted it but was quickly thwarted by my clever daughter. Suddenly, he launched himself through the air, hands in claw-like form with teeth bared. They landed tactfully on her head and began some rather disturbing biting! I love Christmas.

Decades later, we were helping to rear two of our grandchildren, a challenging two-year old at the time, and a six year old. Dylan was a fiery redhead with a personality to match (see the Blog on "The Wiener Dance") and was cared for during the day by a wonderful mother who had four others about the same age (Bless her heart), including a set of triplets.

My wife is a PA that works in family practice in the same community. One afternoon, she sees a little two year who had a bite on his arm. During the course of gathering information, it was mentioned that he was bitten by a little red-haired kid at day-care. Humm, could it be? Yes, she was seeing one of Dylan’s victims. The bite was really nothing and she assured the Mom that Dylan did not have rabies. A week later, she saw Dylan as a patient, having been bitten back by his nemesis, Joey, one of the triplets!

Miss Kathy, the day-care provider, is quite skilled at dealing with this behavior. The punishment is a brief incarceration in a crib, quite mortifying to a toddler, especially when it is in full-view of his non-biting colleagues.

Surprisingly, this was the end of the biting for Dylan and Joey, having accepted detente - the fact that biters often get bit back.

Children who engage in biting behaviors should be managed with gentle and persuasive behavior modification. This method may sound silly, but praising toddlers for NOT biting really works. "I am so proud if you for not biting Joey anymore.”

Of course, time-outs are appropriate for the occasional lapses in judgment. Although it is tempting to imitate the toddler's aggressive behavior and bite 'em back, too, but this is not the way to do it. Like most annoying childhood behaviors, encouragement will work better than yelling, and rewards and kisses for good behavior will work better than any punishment.

Related Topics: New Clue on How Babies Learn Words, WebMD Video: Your Baby's Vision

Technorati Tags: toddlers, biting, child development

Snake! More on animals that bite

Remember that song,

"I don't like Spiders and Snakes..."

Well, that was written about me. My last blog addressed spider bites, but I still have snakes, dogs, and toddlers to discuss.

Last summer, I was returning home with my grandson from a little outing. My excited wife ran up to me and said not to say anything to the kids, but we have a huge rattlesnake in the garage. She stated that she saw it, heard it rattle. By the length of her outstretched arms, it was estimated to be in excess of six feet long and nearly six inches in diameter.

Sounded like an Anaconda to me; or perhaps a Python! Either way, as a man, I was delegated to the task of ridding the snake from our garage. I momentarily felt like St. Patrick.

My garage has not seen a car in over ten years. It is the depository of everything that will not fit in the house, including boxes headed for Goodwill, extra washer and dryer (in case one of our adult children need it), and just about anything else you can imagine. Big Foot could hide in our garage and not ever be found.

A snake would likely find ample hiding places in my urban jungle. So, I began to remove items from the garage, not unlike cleaning out King Tut's tomb. Box after box was carefully removed in an effort of find this huge rattlesnake. My heart stopped several times at the sight of a garden hose and a black sprinkler pipe.

Then, I saw the snake. Apparently, sometime between the time my wife saw it and now, the snake had lost about four feet in length (And they say men lie about the size of things!), was considerably thinner, and the rattle had dropped off. Or, perhaps the rattlesnake was cleverly wearing a gopher snake suit!

To this day, my wife (who was hiding in house during the search) thinks that I am lying about the snake's true identity.

Several years ago, we had a little patient that was bit by a rattlesnake...in his living room while watching television. The snake had entered an open door and was under the couch! That will give you nightmares.

Growing up in Pennsylvania, we had our share of visiting rattlesnakes and Copperheads. Among children, the frenetic cry of "Snake!!" was heard on nearly every outing to the woods. In the little Appalachian town were I was born, we even have an annual SnakeFest, where for a few dollars and some borrowed boots, you can mingle with some rattlesnakes and copperheads in a snake pit.

Personally, I have never been bitten, mostly because of my highly advanced skill at jumping or madly running away. And, I was never stupid enough to jump in that snake pit. Most of the people in my town that had been bitten by snakes sort of deserved it. They were trying to catch them, hold them, or even dance with them. Yes, we had Pentecostal Snake Handlers in our community - a religious sect that uses serpents (and poison) in their church services. I did not attend that church, but I did witness a service once. Unbelievable. You gotta love us Hillbillies.

About 8,000 people in the U.S. do sustain a poisonous snake bite every year; but only 12-15 fatalities occur. More people die from allergic reactions to bee stings (about 90-100 per year); however, that is out of two million people getting stung.

Statistically, about 15% of all snake bites occur from venomous snakes, the top four being the rattlesnake, the copperhead, cottonmouth (water moccasin), and the coral snake), but only two-thirds of those involve true envenomation. All snake bites are cause for concern, both to the person bitten and to the medical provider treating them.

A quick trip to the ER is in order for the appropriate antivenin and supportive care for shock. Many times, people will kill the snake and bring it with them in a bag or box for proper identification. I don't even like looking at snakes, even dead ones, but a quick look is necessary just to say, "Yep, that's a rattler, now get it outta here!" I sure do not want to be injecting antivenin for a gopher snake bite.

Snakes serve a vital ecological place in our world and should be left alone (unless they are in your garage). An occasional misdirected snake will surely encounter an equally-misdirected human from time to time. Medically, we have the technology to deal with it. Socially, we have long way to go.

Related Topics: Outdoor Safety 101, Health and Safety Guide for the Home

Technorati Tags: snakebite, rattlesnake, homesafety, firstaid

Spider Bites - Not all are Itsy-Bitsy

We share this planet with many different creatures, and some of them bite (including our own species, but that is another blog). Animal bites are listed among the more common reasons that people seek medical care or advice, and my practice is no different.

High on the list of biters, and certainly high on the fear factor list, is spiders. First, the bad news: It has been estimated that there are about 20,000 species of venomous spiders that live in the United States. Non-venomous Tarantulas are now popular pets among strange people (my opinion). If you add in visiting spiders from abroad that hide in your luggage or stowaway on banana boats, there are more alien species out there. Since our WebMD members are from all over the world, you have my sympathy. I saw a spider in Australia the size of a bird! And, as much as I would like to float down the Amazon, there are spiders there that nightmares are made of.

Now, the good news: Most American spiders lack the fangs capable of penetrating our tough skin or to produce a poison strong enough to cause harm to humans. There are two spiders in particular that can cause some serious harm...even death. The most well-known of these spiders is the infamous Black Widow (there is also a Red Widow and a Brown Widow). Personally, I don't like to get close enough to determine their current marital status. The other is the Brown Recluse spiders. Both of these nasty arachnids can cause a painful bite, tissue damage, and even death. Most serious and rare, fatal reactions occur in curious people who live closest to the ground. I am talking about children.

Getting a true description of the biter is important since there will not be a police line-up. The Black Widow is a glossy-black spider about the size of a quarter (counting those eight legs). They have an hour-glass shaped marking on the bottom of their abdomen, usually red or orange. They love living in piles of firewood, under steps, or in dark garages and basements. They have an attitude not unlike my first-grade teacher, and will bite with little provocation. They will not chase or hunt you down, however. The Brown Recluse is smaller and brown, of course, with a violin-shaped marking on the back, hence their other name, the Fiddle Back Spider. Personalities of individual spiders vary, just like people, but you don't want to mess with "The Fiddler".

If you or your child encounters a harmless spider, leave it alone. Personally, I try and kill the poisonous ones that I find near the house or play areas. I hope this does not offend the Buddhists or PETA, but I am not brave enough to develop a capture and release program or try and rehabilitate them against biting me or my grandchildren. I pay the mortgage. They are squatters, so they gotta go. Yes, I believe that all of God's creatures have a right to live, but just not under my stairs.

If you are bitten by a spider that is not on the bad list, you will most likely just get a painful, itchy red spot, not unlike an ant or insect sting. Even some Black Widow or Recluse bites may not cause more than a painful, local reaction. If the spider is having a particularly good day and you are lottery-lucky, it may not inject venom. These two venomous spiders produce a bright red bump within a few hours that will evolve into some local tissue damage called necrosis. The surrounding skin may be purplish-black and eventually ulcerate - a nasty-looking wound that can take months to heal. It may even leave a permanent scar as a reminder of your close encounter. Tissue damage from a Brown Recluse may even require plastic surgery or a skin graft.

A Black Widow envenomation will cause systemic reactions - muscle cramps, abdominal pain and rigidity, rapid heart rate, sweating, nausea, vomiting, or, in my case, screaming like a little girl. Because Black Widow spider bites have the potential to kill this is a true emergency. It is 911 and Emergency Room time. Children can have a mortality rate as high as 50%, so this is not something to procrastinate about. Antivenin is available for Black Widow bites, and it should be administered promptly. There is no antivenin for the Brown Recluse, but there is emergency treatment.

Have I sufficiently frightened you? I bet that I am going to have some good dreams tonight...

Related Topics: Preventing Poisoning in Young Children, Kids Vulnerable to Medicine Mishaps

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You can't please (or change) everyone

Medical providers walk a very thin line when it comes to confrontation. I have always considered myself sort of a consultant when it comes to people's health issues. I don't go out looking for diseases to cure; they walk into my office all by themselves.

Like any consultant-for-hire, I try to the best job that I can by cost-effectively diagnosing the problem and providing a course of therapy that will hopefully rectify the problem at hand. My job is really similar to being an automobile mechanic.

Unfortunately, humans are really not as simple as cars. Today, I couldn't get my car started, so I had to consult a mechanic. My fear was that he will probably be rude and condescending, overcharge me, and do a bad job. However, he was pleasant, intelligent, and highly-experienced. He diagnosed my car problem quickly as a blown fuse, charged me 45 cents to replace it, and made me a customer for life. Additionally, I will refer everyone I know to him.

The reason I bring this up is that many patients enter a medical practice with a chip on their shoulders, perhaps jaded by bad experiences in the past with other clinicians. They may be upset because they have lousy health insurance, upset because medications cost too much, or angry because I would not treat them over the phone. I can't really blame them, but I can certainly feel the tension in the exam room as soon as I walk in.

Early in my career, I would be intimidated by a hostile or confrontational patient, but after thirty years of clinical practice and 150,000 or so patients under my expanding belt, they don't bother me at all. As a matter of fact, I welcome the challenge to win them over.

Unless a medical provider can overcome human personality barriers, there is no way to achieve an optimum medical outcome. Medicines do not cure disease. It takes a partnership to do that. As a consultant, I can offer reasonable solutions to a medical problem, but it is the patient who must embrace the treatment plan. If not, we have both wasted our valuable time.

If a person appears angry about something when I enter the examination room, it is up to me to determine if my office is part of the problem. I can't remedy bad insurance, but I can defuse just about any issue involving my office (and there are plenty of them). Unless I confront the patient's anger FIRST, I will not have an effective patient visit. Many times, their anger is just displaced. They may be just having a bad day. We have all been there.

Most human afflictions have simple solutions. You have Strep Throat; I have penicillin. You are allergic to penicillin; I have erythromycin. Erythromycin makes you sick; I have azithromycin, and so on. Pretty easy once you know how. Human behaviors, on the other hand, are very difficult to modify.

Most of the things that are killing us today are related to our adversive behavior not microorganisms. Smoking, obesity, illicit drug use, and not wearing seat-belts are all examples of human behaviors that can have fatal outcomes. When someone is paying for my advice they are going to get it...like it or not. This is where the thin line of confrontation gets tricky.

A patient comes in with a sore throat thinking it is Strep. After a focused exam and a rapid strep test, it is determined that his sore throat is not strep. If I detect the smell of cigarette smoke or see a pack of cigarettes sticking out of his jacket pocket, I am not going to miss a golden opportunity for a very teachable moment.

A viral sore throat is not going to kill this man, but the cigarettes will. It's Confrontation Time. Like it or not, this man is going to get both barrels of my anti-smoking speech. He has probably heard it many times before, but maybe, just maybe, I will be the one who will get through to him.

Medical providers love to save lives. While not as dramatic as defibrillating someone's stopped heart, getting someone to give up smoking clearly saves a life. Without confrontation change is unlikely.

So, next time when your medical provider gets on your case about a behavioral issue don't leave in a huff and change doctors. Be glad that he or she was assertive enough to call it to your attention. Be glad that you have a medical provider who cares. This is what you are paying for and what true medical care is all about.

Related Topics: 7 Key Traits of the Ideal Doctor, Smoking May Hinder Alcoholism Recovery

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Shingles by any other name is still Herpes

No one likes to hear the word "herpes" mentioned during a medical visit, since it tends have all of those negative sexual connotations. I rarely just blurt it out to patients. We use those nicer words for herpes: shingles, chicken pox, cold sores, or fever blisters.


Chicken pox, a herpes viral infection, was once considered a rite of passage for most children. Now, the routine varicella vaccine will prevent most of these cases, and even protect you against shingles. No one seems pay attention to cold sores, another herpes-type infection. Shingles will make a person take notice.

Shingles by any other name is still a form of herpes. There are many different kinds of herpetic infections, but questions regarding plain 'ol Shingles is one of the most frequent postings that occur on the WebMD General Health Board. Why?

Because in the United States, nearly 100% of adults have detectable herpes antibodies by the time they are 30 years old. Humans are the only source of infection, so we caught it from someone. In other words, nearly all of us have already been exposed and have the latent virus present in our bodies. The virus is just hanging around, living quietly in a nerve bundle, and suppressed by our immune systems.

For the vast majority of people, this virus will remain dormant for our lifetime. As we age or our immunity status changes, up to 10-20% of the population may experience the pain of herpes zoster (shingles). More than 66% of the people who develop herpes zoster are over the age of fifty; about five percent of the cases occur in children under the age of 15. Over a half of a million people will get herpes zoster this year in the U.S. In people who are immune compromised by HIV or undergoing cancer treatment with chemotherapy or radiation, the risk of getting herpes zoster increases eight-fold and can cause fatal complications.

If you have had chicken pox in your lifetime, you are considered immune just to chicken pox. Getting exposed to this herpes virus again may trigger activation and lead to a nasty case of shingles. Think about that when you send your child with chicken pox over to Grandma's house. Chicken pox is VERY contagious. Herpes Zoster is only about a third as contagious.

Herpes zoster involves nerve pathways. In the first stage of the illness, people will experience strange nerve pain, such as burning, stabbing, prickly, numb, or tingling. Some people complain that the area itches intensely. People may also experience headaches, malaise, or flu-like symptoms. No matter what, the early symptoms of herpes zoster certainly get your attention for about 3-5 days (sometimes as long as two weeks) before the characteristic skin blisters develop.

The skin lesions of herpes follow a nerve pathway and appear as groups or clusters of tiny, clear blisters (vesicles), often with an angry red or bluish base. Because zoster follows a nerve pathway and nerves do not cross the midline of the body, zoster will occur on just one side of your chest...your face...or your back...your leg...or your butt. Less commonly, they can occur in your mouth, your ear (Ramsay Hunt Syndrome) or genital area. A serious, sight-threatening form can involve the eye and always requires an immediate consultation with an ophthalmologist.

The typical course of a herpes zoster infection lasts two to three weeks, assuming you have a good immune system, but there is always a risk of developing PHN - Post-Herpetic Neuralgia. PHN is nerve pain that persists long after the zoster has resolved and is more prevalent in the elderly or people with eye involvement. Herpes zoster, like a bad relative, can also show up again and again throughout your lifetime.

Antiviral drugs like acyclovir and others may reduce the severity of herpes zoster it taken early. Pain medications are usually necessary. Moist dressings of water or saline can be soothing and help the inevitable pain. Capsaicin cream (made from the hottest chili peppers!) is also used for managing the pain of PHN.

Herpes zoster is incurable, but it is treatable. And, many herpes infections, like chicken pox, it is preventable by vaccine.

Related Links: Herpes Viruses (Including the Chickenpox Virus) and the Eyes, Shingles Vaccine Works In Large Study

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HPV and Doraldo

Several years ago, my wife and I volunteered for a medical mission in Jamaica. We saw hundreds of patients in a small clinic in Runaway Bay. All day, we saw a stream of people with untreated hypertension, diabetes, eye infections, cataracts, and skin infections. One afternoon, I had to pleasure of seeing a little boy by the name of Doraldo. He had a very hoarse voice, almost unintelligible. Thinking that he had laryngitis, I asked his mother how long that his voice has been hoarse. She told me that it had been hoarse for the last six or seven years, and it was getting worse. He was even having problems breathing and was smaller than his stated age of 13. (He looked about 8).

There was something about this little boy that touched my heart. Like many hard-working people in Jamaica, Doraldo's parents did not have the financial resources to have proper care. The mother did take him to a specialist years ago, but was told he needed surgery for warts on his vocal cords. If you listen to a patient long enough, they will often reveal the diagnosis. In Doraldo's case, it was laryngeal papillomatosis. When Doraldo's mother was pregnant with him, she also had genital warts (HPV - human papilloma virus). During birth, this virus was transferred to Doraldo's vocal cords and throat. These cancer-causing warts robbed him of his voice and were slowly choking him to death. Without surgery, Doraldo would eventually die. I promised I would try to help.

When you are a medical volunteer, it is not possible to help everyone, but I discovered that it is possible to help just one...

My first job was to find an experienced ENT surgeon. Less than a week after my return home, I attended an otolaryngology lecture with the department of audiology at the University where I was teaching at the time. After the lecture, I asked the surgeon if he would be willing to see Doraldo if I could get him to the U.S. Without hesitation, this man not only agreed to see him as a patient, but told me he had experience in this disorder, rarely seen in the U.S. This physician was once a volunteer on the hospital ship, Hope, when it was docked in, of all places, Jamaica.

Getting Doraldo a visa to come to the U.S. was the biggest obstacle, and it took nearly a year and dozens of letters before the State Department allowed him to come for surgery, but I finally got the okay. Doraldo needed to go to the U.S. Embassy in Kingston for an interview.

I met with the hospital administrator to negotiate the use of an operating room. Again, an angel must have been present, because the hospital agreed to provide care at no charge. As a matter of fact, they gave me the name of a local travel agency used by the hospital. Two days later, the owner of the travel agency called me to say that they would cover the plane tickets for Doraldo and his mother.

Doraldo and his mother stayed with me for a few weeks. He had a successful surgery to remove the papillomas from his larynx and returned home to Jamaica. His grandmother bought him a guitar. Doraldo wanted to sing again. Ya, Mon!

This summer, a new vaccine may be released that is nearly 100% effective against HPV - the virus responsible for nearly all cervical cancers of women, and of course, perhaps the strain of virus that nearly took the life of Doraldo. It will be recommended to all girls from the age of 10 to 13, and hopefully will protect them throughout their reproductive lives. If this vaccine is as successful as the clinical trials suggest, we may be in the last generation that will have cervical cancer. Right now, the vaccine will not be given to boys and men, but that recommendation is likely to change.

Related Topics: Cervical Cancer Vaccine: The Good, Bad and Ugly, Cervical Cancer Vaccine Nearing FDA Review, Cervical Cancer Vaccine: Will It Soon Be a Reality? (Video)
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Fear of Blood!

The average adult has ten pints (about 5 liters) of blood surging through them accounting for up to 7% of our body weight. Newborns only have about a cup. Children are somewhere in between, increasing blood supply as they grow. Blood is the fluid of life, so why are we so frightened when we see it?

Because of AIDS, hepatitis B, and other blood-borne pathogens, many adults are justifiably fearful of spilled blood. It only takes a speck of fresh blood from a person with hepatitis B to infect an unimmunized person. This is a true reason to fear blood. Fortunately, most people do not have hepatitis B, but that does not mean we should not always be careful. All medical providers practice Universal Precautions to protect themselves from possible blood borne diseases. All people should have a hepatitis B vaccine.

Fear of blood begins in early childhood. Kids often scream when the see a drop of blood during a routine hemoglobin check. My three-year old once ran wildly through the house, holding up a red hand, yelling BA-LUD! When I rushed to her side, I notice that this blood was actually red ink from a broken marker. When I pointed this out to her, she simply said, "Never-mind", and went back to playing.

With the exception of normal menstruation, blood is supposed to stay inside us - inside those blood vessels. When human tissue becomes injured, it may bleed; a lot. In children, it seems that the amount of blood may be inversely proportional to the size of the hole created. In other words, the tiniest scalp laceration could make your two year old appear to be a bomb victim. Most parents and day-care providers apparently do not know this, based on the number of unnecessary 911 calls. It is very embarrassing when a pack of paramedics arrive and no one can find the hole that caused the bleeding.

Children look to adults for strength and comfort. When kids see trusted adults and parents running around in some kind of frenzy, they panic too. My advice to all parents would be to assess first, and panic privately. It is okay to scream like a banshee inside, while appearing calm and collected on the outside.

Some childhood injuries cause ASR (Adult Sphincter* Reaction), a term that I made up for the tightened-butt response. This is where normally controlled adults simply "lose it" (hopefully not full bladder or bowel control). Large, gaping wounds that actually may not bleed very much will cause ASR. Obvious fractures will do it, as well those baseball-sized head goose eggs on a toddler forehead. All of these are sphincter modifiers. (* The sphincter is the essential muscle that keeps our bowel and urinary openings naturally closed.)

A frightening, but harmless blood episode is the subconjunctival hemorrhage. This is an innocent rupture of the tiny blood vessels overlying the white part of the eye, often a consequence of vomiting, sneezing, coughing, breath-holding, eye rubbing, or even straining for a bowel movement. This bloody-looking eye is not sight-threatening and will heal spontaneously in a week or so.

Nosebleeds are another cause for concern. The most common cause of a nosebleed is nose-picking. Kids practice some serious, deep-digital penetration, trophy-hunting nose-picking, not the innocent, clandestine nose-picking practiced by adults at red lights. Other causes include a dry environment, colds, and allergies. Once the nose bleeds, the body will stop the bleeding by forming a scab. Unfortunately, scabs do not stick very well to the very vascular, mucous lining of the nose, and can feel more or less identical to the elusive booger. When probing fingers hit this scab, the nose will surely bleed again, and the healing process will be repeated.

When a parent tells me that their child has had twelve nosebleeds this week, I usually assume that it is ONE nosebleed that has happened twelve times. Stopping a nose bleed is usually simple, but the bleeder must be patient.

Simply hold pressure on the bleeding site by compressing the side of the nostril that is leaking. Hold it firmly for at least five, if not ten minutes WITHOUT PEEKING to see if it is still bleeding. If it doesn't stop in that time, insert a tightly rolled piece of tissue or toilet paper into the nasal opening (not too far) and apply pressure again for the same amount of time. This usually does it. It is not necessary to tilt your head back so the blood drains down your throat; to pinch the top of your nose, apply ice to your neck, or other worthless techniques that people use.

An unwritten goal of life is to preserve our most vital fluid - our blood. Let's all be careful and try to keep it inside, where it belongs.

Related Topics: Safety Measures Around the Home, Baby Walker Injuries Drop

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Oral Antibiotics

Oral Antibiotics - Taste is Important (at least to kids)

Children have very odd and discriminating taste. I will never understand why a 10- month-old will refuse green beans, making a face like you were feeding them Thai food, but they will happily crawl away and munch on a dead fly or eat cat food. My own daughter developed a particular fondness for Dog Yummies.

When it comes to oral antibiotics, children can be extremely picky. Since some prescriptions can cost over $80, you don't want them spitting out $10 worth when you try and give it to them.

Cost...Taste...Convenience...Efficacy. These are all important features of an antibiotic choice. For medical providers, efficacy is the most important. There is no sense in giving an antibiotic that tastes good if it isn't going to work.

Cost is very important to parents, especially if the choice is not covered by their insurance, or requires a high co-payment. Convenience is another parental preference. Parents love the once-per-day or all-at-once dosage schedule, but often this is not the optimum treatment for some infections. We have virtually eliminated the old four-times-per-day dosage schedule in pediatrics because compliance is nearly impossible for busy, working families.

Any antibiotic, no matter how efficacious, is worthless in the bottle. In order for it to work, it has to be transferred into the child. This is where taste comes into play. Children love the bubble gum taste of amoxicillin. It is a very good drug, and is still the treatment of choice of most uncomplicated middle ear infections, even though its effectiveness is being challenged.

Lorabid was on the top of the list in a published antibiotic taste test (performed much like a wine-tasting), but it is not very effective. Omnicef is efficacious and tastes very good (a strong strawberry with just a hint of aftertaste), but it can be pricey and not always covered under some insurances.

The worst tasting have got to be some of the rarely-used cephalosporins, especially Ceftin. I tried it once and the taste is still a painful memory. Unfortunately, it works well if you can get the kids to swallow it.

Other than bribes, threats, squirting it down their throats, what can a parent do to improve compliance?

1. Allow your medical provider to do the prescribing. The best-tasting or cheapest antibiotic may not be appropriate for your child. Avoid trying to influence the selection choice by saying that he loves the pink one or you want Zithromax because it is so convenient. Medical treatment is not like a restaurant.
2. Discuss costs and insurance issues. HMOs that select a formulary do not take into account taste or convenience, only cost and efficacy, usually in that order. Sometimes, paying a higher co-payment for a second-tier drug choice is worth the extra cost.
3. In children over the Age of Reason (no, not age 30!), prepare them for the taste of the medicine. It is okay to play up the taste a bit, but don't say it tastes great if it doesn't. We all creatively lie to our kids. When my son refused medicine, I told him it would make him stronger (bigger muscles); my daughter was more eager to take medicine when I told her it would make her hair shiny.
4. Children respond to choices. For instance, in the clinic I give them a choice of taking a liquid medication or getting a shot - an easy choice. At home, give them a choice of one teaspoonful (assuming this is the dose) or FIVE teaspoonfuls.
5. Use one of those tiny juice box straws to suck up the proper dose. This method will often bypass some of those discriminating taste buds. For babies or spitting toddlers, don't try to inject the entire dose in their mouth at once, especially when they are crying. This could cause them to aspirate or vomit. Just give a portion of the medicine in the sides of the mouth, wait for a swallow, and then give more. Repeat this process until all of the medication has been swallowed.
6. Offer a chaser. Mary Poppins said that a spoonful of sugar helps the medicine go down. There is really nothing inappropriate with using a spoonful of something tasty to cover up the medicine aftertaste. Chocolate syrup will mask the taste of most of the nasty antibiotics. Don't mix it with the medicine but have it on a separate spoon to take immediately after they swallow the proper dose of the antibiotic.
7. FlavorRx is a service that many pharmacies now offer. For about a dollar, you can flavor any antibiotic and most liquid medications to a more palatable form. The company provides a chart that will suggest the best flavor for a particular medication.
8. Don't mix antibiotics with juice, milk, or food unless you have a proven track record with your child. Instead of one teaspoonful of nasty medicine, you could inadvertently create eight ounces of some pretty foul milk or juice that will be a lot more difficult to administer. Check with your pharmacist before trying to mix food with medications since some drugs may lose their potency by doing this.
9. Take ALL of the medication prescribed. Never stop an antibiotic early when the child is feeling better. Completing the course of antibiotics will help prevent antibiotic-resistant strains of bacteria.
10. Never SAVE leftover antibiotics for the next infection. Not only will you incompletely treat the original infection, you will most certainly not treat a second one. Antibiotics that have lost their potency are biologically dangerous since they are not strong enough to completely kill a pathogen.
    
    A study of 220 women who were asked if they have given their children antibiotics before coming to the clinic. All but one woman denied doing it. The children's urine was then analyzed for antibiotic residuals and over 70% had antibiotics detected. It is time to get rid of that two-year-old bottle of amoxicillin in your refrigerator door.

Related Topics: Know When Antibiotics Work, Reducing Medication Costs

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In Honor of Mrs. Reeve

As I watched the news this morning, I heard that Dana Reeve, the widow of Christopher Reeve, had passed away due to lung cancer in her early 40's. Mrs. Reeve did not smoke. Although I do not know the type of lung cancer that she endured, I do know that she fought bravely for her life.

There have been heartening advances in oncology, but yet the limitations of science are quite obvious when people succumb to this devastating disease. A measure of a person's life is not by the number of days that they have spent on this earth, but rather what they have done with those days. Mrs. Reeve was a devoted mother and wife, and she continued her late husband's tireless campaign on spinal cord injury research. The world is truly a better place because of the Reeves. My heart goes out to her children and family, because I know how they must feel.

My own father passed away at age 37, also of lung cancer. Unlike, Mrs. Reeve, my father was a smoker and a victim of asbestos exposure. In the late 1950's, no one realized that the asbestos that we put around our heating ducts, on our shingled houses, and in our oven mitts, would someday cause cancer.

Lung cancer was not unusual in our small Pennsylvania town. In addition to my father, three of my uncles and my grandfather also died from it. This coal mining and coke oven area had more industrial smog than Eastern Europe. It literally rained down on our little town. The hydrogen sulfide fumes smelled like rotten eggs. We heated our homes with coal.

To make matters worse, both my mother and stepfather smoked so much that there was a blue haze that hovered a few feet from the floor of our living room. I suspect I inhaled the equivalent of a pack a day from the time I was a baby. I consider myself fortunate to have escaped lung disease from this exposure.

Mrs. Reeve once stated that life is not supposed to be fair. As a medical provider, those words are dear to me. I couldn't agree more.

Related Links: Indoor Air Pollution: Are You At Risk?, Screening, Treating, & Surviving Lung Cancer

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Online medical information - what works?

For virtually any disease or medical condition, WebMD has a dedicated community message board run by a health professional. For over seven years, I have run the Ear Disorders Board. More recently, I agreed to share the General Medicine Board. And now, I have become a WebMD Blogger.

My association with WebMD has been one of my more enjoyable and rewarding jobs. As a primary care clinician, I answer numerous medical questions every day - during office visits, in the halls, and on the phone. My medical group recently made a commitment to become paperless, so those questions stream in daily on my desk computer. When I think about, answering postings on WebMD is really no different...or is it?

Actually there is a BIG difference. In my practice, I can pull up medical records and review them. Most questions come from patients that I know and have examined many times in the past. On WebMD, the health professionals are virtually blind as far as medical history is concerned - we do not know the medical history and very little, if anything, about the person who is posting.

We do not know in what part of the world they live - WebMD is a GLOBAL site. There can be significant cultural, educational, and international differences that health experts must take into consideration... that is IF the poster tells us they are in China or Mozambique.

We often do not know the AGE of the person posting, but we do get some clues, like "Dude...I gotta question!" Teenage patients have entirely different health issues than a geriatric patient.

And we often do not even know the SEX of the person posting. We can often get a clue from the sign-in name, but not always. Needless to say, women have different parts than guys, so when someone asks about abdominal pain, we are often at a loss.

Most importantly, we have absolutely NO way of examining anyone, so when someone asks about the red bump on their butt, I have no way of seeing it. Many board members offer to send digital photographs, but if you use your imagination for a moment on the wide range of questions we receive, you can see why this is not permitted.

You call your doctor at 8:00 AM and ask them to call you back. Rarely, will they call you back at 8:15AM. You may not hear back until lunch or after the clinical day is over. On WebMD, it is nearly impossible to offer a real-time response. Health experts may be in different time zones, may not be surfing the web at 3 AM, or sitting in front of their computers waiting for a posting. Although every health expert would like to offer profound advice to every question…instantly, it is unrealistic to expect it to happen. I always have this fear that I will read, "I just cut off my ear...it is really bleeding. What should I do?"

Third-party postings are quite common. Mostly, wives are posting about their non-compliant and stubborn husbands, girlfriends are concerned about their boyfriends, moms are concerned about their kids, and kids are concerned about their parents. Co-workers in Ohio ask questions about their next door neighbor's aunt who lives in Florida. It is hard to get the story straight from the person themselves, let alone second or third or tenth-handed.

We can't make diagnoses. We can't write you a prescription. We can't order diagnostic tests or treat you. And, not all people like or accept what we health experts have to say. So why do people post, and why do health expert do this? One of the greatest rewards on WebMD are postings from grateful people -- people that you have never met, yet have touched their lives in a positive way with kind words or thoughtful insight into their medical concerns. Postings from people who are no longer frightened or confused by what their doctors said or didn't say.

This is why we do it...

Related Topics: Support groups for people quitting smoking, Ask WebMD Medical Experts

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For Crying Out Loud: Why?

In one week, I had three different mothers drop their babies. The Moms were absolutely distraught (the kids were fine). One slipped out of an infant seat and landed on a tile floor. One wiggled and slipped out of her arms and landed on the floor. The last one tripped on some steps and dropped her baby on the concrete.

Last summer, a woman had her baby in an infant seat with one of those big carrying handles. She sat the baby about three tiers up on a wooden bleacher while she watched her daughter's soccer game. A mindless teenager tried jumping over the baby to get down and accidentally hooked his foot on this handle. In an instant, the mother sees her 2-month-old hurled through the air in her seat. She landed, uninjured, about ten feet away in the dirt. The thoughtful adolescent turned and said, "Sorry", and kept on running. Many of the startled audience, having witnessed this airborne baby, cried.

Studies with gorillas and chimpanzees show that animals also respond to cries of their young. Recordings of a baby chimpanzee in distress will cause universal angst in adult chimpanzees, but records of cries of play and joy will be ignored. New parents quickly learn that there are many different types of crying, too. There is a different cry when a child is ready for a nap, or is hungry, or when a two-year-old sibling pokes them in the eye. And, of course, there are the cries associated with pain and illness.

It is perfectly normal for healthy newborn babies to fuss and cry about two to three hours per day, reaching a peak around age six weeks. By age three to four months, babies only cry about an hour or so per day. By age five to six months (my favorite age), babies grin and smile more than they cry. If parents can avoid a nervous breakdown for the first 3-4 months, it will get a lot easier, at least for a while. Beyond the age of one, most crying is in response to frustration. As children react more and more to their environment, they quickly learn that you will not let them play with the steak knife they found in the open dishwasher or have a cookie before dinner. Whining often replaces crying as the child ages. The period of whining can last long into the adult years.

Without doubt, the most likely cause of inconsolable crying in a baby during the first two months of life is COLIC. Colic is the Rule of Threes: A child under three months who cries more than three hours at a time, more than three days a week, most likely has colic. Colic is often assumed to have an abdominal origin, since babies often have distended tummies, draw up their legs, and blare out some loud, impressive farts. Colic occurs most often in the evening.

One of our good friends recently adopted a baby that cried for hours nearly every night. Out of compassion, my wife and I offered to give them some respite care by watching the baby one night when they went out to dinner and a movie. We were experienced medical providers and parents, having raised five children, so colic was not a big deal.

After about three hours of rocking, cuddling, and trying to console this child, I was ready for the looney bin. There are tons of grandmother-prescribed home treatments and medications that are used for this self-limiting condition (colic is not a disease), but Tincture of Time is the great healer. When children reach the age of 3-4 months, colic miraculously disappears.

Parents do have reasonably good intuition when they feel something is medically wrong when a child is crying. This type of crying is different and parents know it. I couldn't begin to list the number of medical problems and conditions that can cause a child to cry. Common problems, like ear infections, top the list and even more uncommon problems, such as a hair tourniquet (a piece of Mom's hair gets accidentally wrapped around a digit). When the child is ill and the cause of the crying is not obvious, a medical provider should be consulted.

Related Topics: Prolonged Infant Crying: Sign of Trouble?, New Techniques to Calm a Crying Baby

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Doggone Good Medicine

I took the day off from work today because one of my family members became ill. He has been throwing up all night and acted listless. My wife thinks it is because he has been chewing on some of our wood railings or ate the cat food. Either way, this is not normal behavior, even for Herman, our Sheltie.

I took him to the vet this morning and I just received the good news. The x-ray showed that he is only constipated and has to have an enema. This is going to be an expensive visit, but when it comes to giving a dog an enema, it's worth every penny. In medicine, I get used to people poop, but I am not a big fan of dog poop...on my shoes, in the yard, and definitely not by an enema.

Growing up in a small, rural town it is not unusual to know just about everyone. Throughout our lives we have many, many friends - close friends, former friends that we have not seen in years, people that we consider friends but don't really know where they are now, school mates, etc. It would not be difficult to name people that I consider my close friends.

What about the friends you have not seen since childhood? Do you think you remember them all? Probably not, but I bet you could name every DOG that shared your life. This blog is dedicated to Spot, Suzie, Ranger, Casper, Jason, Trina, Brandy, Max, Melanie, Ayla, Chelsea, Maggie, and Herman the Constipated.

We are all aware of service dogs, such as guide dogs for the blind. There are also dogs that are trained to help the deaf, letting them know when the phone rings, or wakes them up when someone is at the door. Dogs have been trained to help physically impaired people with simple tasks. And, of course, we have dogs that help keep us safe by protecting our property, sniffing out explosives, rescuing people buried in rubble or avalanches, and helping the police find hidden drugs or bodies.

Dogs are great medicine, too. They are our loyal friends, empathetic therapists, dedicated teachers, and healers of our soul. And, they ask for very little in return for enriching our emotional health. When we bought our first Sheltie many years ago, the breeder socialized the puppies by taking them weekly to nursing homes. There is an indescribable bond between the elderly and their pets, and studies have proven that canine companions are extremely beneficial. Our first Sheltie died last year at the ripe old age of 17. Herman, now age 7, was her canine companion (and, of course, my companion and friend).

It is time to go pick up my colon-cleansed dog. I know I will have a lot of explaining to do since he thought he was only going for a ride.

Related Topics: Health Benefits of Having a Pet, See Spot, Get Happy

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For Crying Out Loud: A Good Thing

As adults, crying is viewed as an expression of intense emotion. Women (at least my wife) cry quite easily. She absolutely loves Hallmark commercials. My brother, who works for Hallmark, will even tell her about a commercial that is coming out soon, and she will cry. The tears start rolling as soon as the crying music starts.

On the other hand, men are stealth-criers. Men pretend it is their allergies or they are coming down with a sudden cold during a movie. So, most people cry when we are sad, in pain, frustrated, or even when we see and hear something beautiful, like a baby's first cry.

Babies will cry when they are hungry, frightened, frustrated, have gas/colic, and when they are sick or in pain (immun