Dirty Places, Part 4: Hotels and Motels

An advertisement for a major motel chain once said they would "leave the light on". Let's hope it isn't a black light.

A black (ultraviolet) light is used in forensics to find bodily fluids like semen. Disgusting. I own a black light, but I really do not want to shine it around any motel or hotel room for fear of what I might find.

I once spent a night in a decent looking hotel in Mexico. There was a sign on the wall telling us not to kill the lizards that are in the room. They are harmless and help kill the spiders. That night, we threw a box of crackers off the balcony after trapping a hungry (and surprised) mouse.

On a trip through the panhandle of Idaho, we stopped at the only motel in town (called Mote - the neon "L" was not working.) There was a sign on the back of the door asking hunters to please not clean and gut fish and game in the bathtub. There was an area by room three to do that. We were in Room 3 and seriously considered getting the L out of there. I pilfered this sign and still have it.

Hotel and Motel rooms are supposed to be cleaned every day and I suspect there is some attempt to sanitize some of the hot areas like bathrooms or phones. They do change the sheets, but NOT that big bedspread that we lie on as soon as we get into the room. I shudder to think about the action that bedspread or that fuzzy, yellow blanket has seen during its lifespan.

I am not sure, but I suspect important steps are skipped from time to time in this mundane, daily procedure. I have experienced it many times.

When I briefly worked in the tundra of central Michigan, we had to go to the airport the night before in order to catch an AM flight to anywhere. On one visit to a Detroit Airport hotel (Another major, recognizable chain), I had some very interesting experiences. Perhaps the management was new or inexperienced. Perhaps the employees were reacting to their low wages or unsanitary working conditions. I don't know any reason why these things would happen to a nice guy like me...

First, we were given key cards that did not work. I returned to the front desk and was given a lesson on how to use them by Tiffany, mental age considerably less than her chronological age. She insisted on accompanying us to the room to prove that she was right and we were wrong.

The key did not work. Clearly, there must be something wrong with the lock, which incidentally worked with her master key. We went into a darkened room, unable to find a light switch. My wife headed for the bathroom, followed shortly by a scream after I found the light switch.

Apparently, someone forgot to clean this room completely, including that simple matter of flushing the toilet. Back to the front desk where I demanded a new room.

Two more key cards for a different room were issued. They did not work. Due to the lack of sleep and my increasing aggravation, I kicked the door a few times. As I ranted and raved in the hall, a boxer short clad man emerged from the room we were given. He was not happy. Back to the front desk for yet another room. Tiffany was on the phone booking more of these rooms.

Now, we were given a third room. This time, I insisted that someone come up with us to (a) confirm that the keys work, and (b) that the room had been cleaned (so to speak). This third room looked fine and my blood pressure was near stroke potential, so we waved her off so we could finally get some sleep.

Exhausted, I reclined on that ominous bedspread and leaned my head against the wooden headboard. A minute or so later, I tried to get up, but my hair was STUCK to the headboard. My mind raced as I pondered what type of sticky substance had glued me to the bed.

As I pulled away, tufts of my white hair remained firmly attached. My wife, expecting a major altercation, begged me to just let it go. It was now 2 AM. I certainly made Tiffany aware of this last and final insult and told her that I had no intention of paying for this room.

Of course, they did bill my credit card which I disputed. Four months later, after several of my annoying letters, the hotel's corporate office finally reversed the charges. Just writing this Blog ticks me off again. I really should let it go.

I always tip the housecleaning staff when I stay at any hotel in anticipation of an extra clean room. I don't know if I am wasting my money or not. I do know that when I order oysters on the half shell, that I tip the shucker FIRST. So far, no hepatitis.

I realize that we live in a world of germs, but I do not intend to be unnecessarily exposed at a hotel. If a hotel room costs a modest $100 per night; that comes out to $3000 a month for ONE room and a bath with no kitchen (I don't count that coffee maker). You would think that was sufficient rent for some decent room-cleaning.

Other than staying home or sleeping in your car, what can you do?

First, complain assertively if that room is not visually clean when you walk through that door. Second, perform your own sanitation rituals. An inexpensive can of disinfectant spray goes a long way in a hotel room. Hit the phone, night stand, headboard, lamps, clocks, bathroom counters, toilet, faucets, bathtub/shower areas, air conditioning unit, and door knobs.

I know I probably missed a few spots, but you know what I mean. You may have to open a window to air out the room after this procedure. Strip off that bedspread and blanket and throw it in the corner - there is a very good chance they have not been cleaned for months, if ever. It's okay to use the sheets and pillow cases if they look freshly laundered.

I know this sounds a bit germophobic, but until I can afford a five-star Ritz-Carlton, I am going to use three dollars worth of Lysol.

Related Topics: Guide to Summer: Summer Travel, Packing for a Healthy Vacation

Technorati Tags: travel, hotel, motel, dirty places

If you're just now joining us, you'll want to read Public Toilets (part 1), Airplanes (part 2), and Your Doctor's Office (part 3).

Water Woes

This is probably not an appropriate ALL EARS topic for the Blog, but I really need to vent.

Human beings are composed mostly of water, so it isn't an understatement to say that water is vital to all aspects of our lives. For a person who is dehydrated from vomiting and diarrhea or from working outside in 100 degree weather, water is the best medicine. Once the person is re-hydrated, they feel so much better. Water is my favorite drink, but it has be cold enough to cause that brain-freeze headache.

My brother lives in Maryland where they had 12 inches of rain in the last week. I live in Northern California where it does not typically rain at all in the summer. This has not been a problem for me since we have an ample and inexpensive water supply. We are allotted 16,000 gallons a day from our irrigation system. Although I have some thirsty landscaping, lawns, and a vegetable garden, I tend to conserve water and only use enough to keep things strategically green during the hot summer months.

Our deep well produces an adequate amount of good-tasting, cold, pure water sufficient for drinking, laundry, toilets, dishwashers, and showers. We don't have a pool and I rarely wash my car (much to the horror of my neighbor who pampers his fleet of vehicles). Needless to say, I don't really have a water problem...usually.

Last week started my much-needed vacation. We rented a beach house in San Diego with room enough for the adult kids and grandchildren who would be attending my youngest son's wedding.

The very day we were leaving, my irrigation system crashed. This was also the first day of many 100-plus degree temperatures that soared as high as 108 degrees for one day. I have a talented neighbor who told me not to worry, he would take care of the problem, likely the pump.

To make a very long and depressing story shorter, it wasn't the pump. Why? Because the pump was still on warranty and expensive items only break down AFTER the warranty expires.

It was an electrical problem, most likely caused by my arch nemesis: The Mole.

One of them apparently chewed through a spot somewhere along the 2000 feet of electrical line from my house to the irrigation canal. My only consolation in this incident was that The Mole likely fried when he bit into the 220 line, but not before causing damage that will take some big bucks to find and repair.

Moles! I wrote some unflattering comments about them in a former Blog. They apparently read it and were out to get me where it hurts.

So, while the rest of the family is enjoying the beach house, going to the zoo, and having fun, I had to fly home late last night to deal with my water woes. I will be entertaining a series of electrical contractors over the next few days for estimates.

In the meantime, I am hand-watering the brown spots, the drooping shrubs and flowers, and what is left of my vegetable garden with a hose to my well pump and hoses from my neighbor. It is a good thing that I don't have enough water to drown myself.

Related Topics: Get Fit By Gardening, Organic Gardening

Technorati Tags: mole, garden, garden pests

Dirty Places, Part 3: Your Doctor's Office

Any congregation of ill people should be considered high on the list of dirty places -- hospitals, nursing homes, and yes, your doctor's office. The Centers for Disease Control estimates that nearly two MILLION patients in the U.S. get infections in the hospital, and about 90,000 of these patients DIE as a result of their infections. Serious efforts, including legislation, have been proposed to reduce this terrible toll on human life.

Earlier this week, I spoke with a man on his way to Seattle to see his seriously-ill father. His father has a routine prostate procedure and is now fighting for his life because of a serious hospital-acquired infection.

When my wife had a hysterectomy many years ago, she spent less than a day in the local hospital. Due to my fear of infection, I wanted her home in a cleaner environment. Of course, I was able to stay home and take care of her postsurgical needs, not something everyone is capable of doing. Although a large part of my medical training was in the hospital, the bulk of my career has been in the outpatient arena, so this will be the focus of this entry - getting sick FROM your doctor's office.

In pediatrics, we have both a WELL and a SICK waiting room. We also have an isolated RASH room for children who may have chicken pox, measles, or other infectious diseases.

Although isolating the sick from the well is a good start, I feel really sorry for those parents and kids sitting in on the sick side of our waiting area. There are no rules in medicine that state you can only have one illness at a time. There is always a risk that you will come in with a cold, and go out with diarrhea...if you are not careful. We do not have a sick examination room, and a well examination room. Perhaps, we should.

We are always at odds with our janitorial service. They empty the trash, vacuum and mop the floors, wipe off the counter tops, clean the bathrooms/sinks, etc. every night. If I gave them a grade for those cursory efforts, it would not be a passing one.

Cosmetic cleaning is totally different than disinfection. For instance, if you just wipe off a counter top that had blood and urine specimens sitting on it all day, it does not remove the pathogens. It will take a chemical disinfectant to do that job. It is often left to our busy medical assistants to take this final, critical step. Not only will disinfection protect our patients, they will protect US. Controlling the spread of infectious disease is EVERYONE'S responsibility in the medical office.

When the examining room door closes, I am the one that will see contamination. I am the one that will chastise the Dads for throwing a poopy diaper in the top of the trash can (Mothers know better). I am the one that sees fresh blood on the examining table after checking a child's hemoglobin. So, I am the one that is going to need to properly clean this area after the patient leaves.

My medical assistant is supposed to disinfect the table tops before putting fresh paper on the examination table, but I still ask that the parents lay down their own blanket first when I examine a child. Not only is a blanket warmer and softer than paper, it is cleaner -- or at least, it just has the family's own germs.

It is nearly impossible to contain toddlers, however. Short of duct-taping them to a chair, they will open all drawers, try and dig through the trash can (another reason why diapers should not be in there), and try and put the little fingers in the tongue depressor or cotton ball jar.

Parents usually do a good job with this, but children are natural explorers and touch everything. My own two-year old once came in carrying a dog turd in his hand, telling me that people should never eat poop (A good rule). That little boy is now an RN in the emergency room.

I estimate that I wash my hands about 150 times per day. I wash them in front to the parents so they know it did it; after seeing their child, and again, after I leave the room just for added insurance. Additionally, I use an alcohol-based hand sanitizer.

I go through a forest of paper towels every day. In spite of my own efforts to avoid spreading microorganisms to myself and to other patients, I suspect it happens. I gave up wearing my wonderful collection of pediatric neckties after I realized that I drag it across a fair number of babies, many of which grab and chew on it.

I use alcohol swabs on my stethoscope, knowing of course, that it would take HOURS of soaking in alcohol to kill every viral or bacterial pathogen. I choose not to wear a white lab coat since I think it scares the children, but I worry about my contaminated clothes at the end of the day.

I think that I do the best that I can, but there is still ample room for improvement. Instinctively, I know that people (especially kids) are germ-magnets, so there is only so much we can do as medical providers. The rest is up to the patient or parent.

1. Assume that many things in your doctor's office are contaminated: the arms of the chairs, door knobs, faucet handles, etc. By knowing these "hot zones", you can try to avoid them, or know that you will need to wash your own and children's hands.
2. Contain your children into a safe zone where you can watch them. As natural as it is for them to be social, a doctor's office is not the place to socialize with potentially-ill children. Children are very curious, so keep them from rifling through the drawers and exploring other dangerous places.
3. Bring toys, games, books, etc. for the kids from home so that they will have something to do. Waiting room toys have been eliminated from our office to reduce the spread of infectious disease.
4. Wash everyone's hands once you get to the examining room; wash them again after you leave the office.
5. Keep in mind that most pathogens enter the body via the nose or eyes, so avoid rubbing or touching these areas with contaminated hands.

Related Topics: (WebMD Video) The Dirty Truth on Handwashing, (WebMD Video)C Diff: Common Infection is Acquired in Hospitals

Technorati Tags: germs, infection, doctors office

If you're just now joining us, you'll want to read Public Toilets (part 1) and Airplanes (part 2).

Dirty Places, Part 2: Airplanes

Several years ago, I was a Pediatric Infectious Disease consultant for the company that makes Lysol. One of the members of our committee was a microbiologist who worked for the company. He conducted a clandestine study of airplane cleanliness by secretly taking swabs from the tray tables, bathrooms, air ducts, etc. on several flights around the U.S. The results were VERY eye-opening since several of those cultures grew out coliform bacteria (bacteria from our intestinal tract), and not necessarily found just in the toilet areas. He found it on the tray tables! He also found Streptococcus, Staphylococcus, and other disease-causing organisms throughout the plane. That poor man will never be the same again. He now disinfects EVERYTHING on all his flights; carrying his Lysol Spray, of course.

Over the last thirty years, I have flown quite a bit. As a medical provider, I take a particular interest in the habits and mannerisms of others. It is difficult not to notice someone coughing at the back of your head, sneezing on the seats, wiping their snotty noses and stuffing them in the magazine pouch, or watching a mother change a poopy* diaper (assumed to be poopy based on smell alone) on the adjacent seat (or tray table!). Since there are significant penalties for cancelling flights, people think nothing about flying while they are ill. In the close quarters of an airplane cabin microorganisms can be freely shared.

Fuel costs have skyrocketed, so airlines are cutting flights and stuffing even more people in those seats. Flights turn around quickly, so the flight crew only has time to pick up the trash. They do not have time to disinfect (not the same as wiping off) the tray tables. I hope they disinfect the toilets, but something tells me this is not always done, at least to my satisfaction, anyway.

In my Blog about dirty toilets, I mentioned that I have developed an iron bladder over the years. I especially avoid using the toilet on an airplane whenever possible. With a few hundred people sharing a few toilets, they start looking like those porta-potties that you see at the county fair. If you could SEE bacteria with the naked eye, airplane bathrooms would be virtual Petrie dishes.

Unless you are flying with two other friends known to be well, there is a good chance you will be exposed to some infectious illness on your flight. Many airlines do have HEPA filters for the circulating air; some still do not. HEPA filters are good, but they will not filter the wet sneeze of a fellow passenger or the unwashed hands of someone returning from the toilet. Breathing the exhaled air of hundreds of other people in that airborne tunnel is not one of the healthiest environments I could imagine.

Some suggestions to reduce your infectious disease exposure on air flights:

1. Wash your hands thoroughly and often, and avoid touching your eyes or nose - the main entry points for disease-causing microorganisms.
2. Carry some disinfectant wipes for the tray tables and seat arms. It is a good idea to wipe down the window if you are sitting in this particular seat. There can be some odd-looking stuff on that window!
3. On short flights, avoid using the airline toilet. If you must, do so with caution. Short of wearing a Hazmat suit, you are putting yourself at risk. Again, carry those disinfectant wipes with you to the toilet and use them. After carefully washing your hands (again), use a paper towel to flush the toilet and open the door again.
4. Notice if your seat-mates are ill. If they are blowing their noses, sneezing, coughing, etc., then be extra, extra careful. If there are empty seats (unlikely), then consider sitting somewhere else.
5. Bring your own magazines.
6. Stay hydrated. When your own mucous membranes dry out, you are more susceptible to respiratory organisms. Drink plenty of WATER, especially on long flights. The air in the cabin is usually dry, so use a saline nasal spray.

When you arrive safely at your destination, you are still at risk. It is not unusual to get ill when you are traveling, since you may not have any acquired immunity to circulating diseases in other communities. We tend to develop herd immunity with our family, friends, and co-workers, but when you are traveling the herd quickly changes. Respiratory viruses (colds) can have an incubation period from 12 to 48 hours, so don't be surprised if you get one of these unwanted gifts on your vacation.

Related Topics: Bacteria Still Onboard Airline Drinking Water, Health Toll on Flight Attendants

Technorati Tags: airplanes, infectious disease, germs

If you're just now joining us, you'll want to read Public Toilets (part 1) and Doctors' Offices (part 3).

Father's Day -Hold the Neckties

We have all had "those weeks" filled with chaos. This was one of those weeks for me. (Start sad violin music here...)

• My elderly mother is back in the hospital with respiratory failure and pneumonia.
• My youngest son is getting married next week, so we are trying to get our home prepared for the house-sitter (dogs, cats, bird sitter, actually). I have yet to buy them an appropriate wedding present.
• I have a big, old operating room table sitting in my driveway (a long story!).
• My cat developed an abscess from a fight with the other cat, costing me $350 at the vet. Everyone seems to be on vacation at work, even the people who are supposed to be working.
• There is a vomiting and diarrhea epidemic in our community and my schedule is unusually impacted with an endless parade of Barfers and Poopers.
• And, worst of all, both my wife and I totally forgot our wedding anniversary. I do get credit for remembering first!
• And, I just realized that Sunday is Father's Day, a time when hard-working Dads get more neckties.

I have five adult children (two biological; three step children) and they all have angst about Father's Day. Sure, fathers would like to be acknowledged for more than our spermatic contributions to their lives, but I really do not need any more neckties. I stopped wearing them two years ago when I read a study that neckties may be a source of infectious disease spread. Bow ties apparently do not spread disease, but they just look stupid. I put the word out the kids that they could really skip Father's Day (and Stepfather's Day) this year. I will probably forget by Sunday anyway.

My father died of lung cancer when I was six years old so my own memories of him are very faint. I remember standing on the front car seat as we took a drive to visit his friend (Obviously in the era before child car seats, seat belts, and common sense.). I remember him sick in bed. I remember one huge hug when he was in the hospital. And, I remember his funeral like it was yesterday. My mother remarried a year later to someone that did not particularly care for kids (or me). He, too, died a decade or so later, so basically my experience having a father is quite sparse.

I tried to be a good father to my own children and step-children, but I could have done better. Fathers have that double-edged sword of responsibility that always hangs over our heads. We feel that we need to work hard (For some of us, too hard) to provide for our children and then they grew up while we were at work. (Insert "Cats in the Cradle" song here...) I regret that I did not spend more time just playing with them. Father's Day seems to be a remind me of times that I missed that I will never see again.

I am thrilled when I see fathers bring in their kids to the clinic. I always have to ask them their names. The mother's name is prominently located just above the child's name on the chart jacket, but not the father's. I should change that. Often shadowed by the mother, dads tend to under-estimate their role and influence. I think fathers are VERY important and I love seeing med take an active parenting role, although I do admit they are often clueless when it comes to giving a detailed medical history.

"What kind of formula is your baby using?" Blank stare. "What was her birth weight?" Blank stare. "You may want to change the baby's diaper. Oh, you forgot the diaper bag."

In the medical office, dads are often blamed for the genetic shortcomings of the children -- excessive ear wax, body hair, BO, ugly feet, etc. "He's just like his father." Well, good! At least you know you won't have to do any DNA testing. I once saw a troubled 13 year old girl; six feet tall, 150 pounds. She was seeing me because of some mysterious hair growth on her abdomen. She was brought in by her clueless, 6 foot, 9 inch, 270 pound behemoth of a Dad who had more hair than Sasquatch. Medical mystery solved.

(Start Hallmark Card music here...) So, if you are lucky enough to have a father, share some of those fond, childhood memories with him this Sunday. Tell him how much he means to you and what influence he had on your life. That's all we want. No ties.

Related Topics: Are You a Superdad?, (WebMD Video) Father's Bonding Helps Self-Esteem

Technorati Tags: fathers day, parenting

Dirty Places, Part 1: Public Toilets

If you're just now joining us, you'll want to read Airplanes (part 2) and hospitals and doctors' offices (part 3).

Someone posted on the WebMD General Health Board recently, horrified that her four-year old sat on a public restroom toilet seat without a protective cover or a lining of toilet paper. The mother was worried about all of the diseases her child may now be incubating.

Is this four-year old likely to get a Rotavirus infection (a common cause of diarrhea)? How about Herpes? I have seen some disgusting public restrooms in my life, so I can understand this mother's concern; however, exposure to an infectious organism does not necessarily mean a person will develop a disease.

The human body is well-adapted to fighting off these ongoing exposures. Germs do not typically enter intact buttocks skin from a toilet seat, but no one wants to sit on them anyway. Using seat covers and paper is fine, but it really doesn't protect you from microorganisms.

Children have a bad habit of holding on to the toilet seat, with their little fingers clutching underneath the rim. Granted, they don't want to fall in, but those little fingertips will pick up under-seat germs like Velcro.

Germs do enter the body through the nose, eyes, and mouth, usually transmitted from our own, contaminated hands and fingers. If you watch a child wash their hands, you will see that they tend to miss the fingertips -- perhaps the most contaminated part of the hands. And, those dirty fingertips will most likely be probing a nose or rubbing an eye within a few minutes.

I have to admit that I avoid public restrooms; however, the call of nature is not always convenient. Men do have a distinct advantage of being able to stand at a urinal -- a very hygienic method to urinate. Women "hover" (so I am told). Perhaps this is why women develop very strong thigh and leg muscles. I have never been in a women's restroom, but I suspect they are cleaner than a men's room.

Little boys have a difficult time reaching adult urinals so they use the stall, peeing on both the seat and floor. Children also have not developed the fine art of flushing the toilet with their feet. After thoroughly washing my hands at a public restroom, I patiently wait until someone else comes in so that I can shoot out without touching the door. If no one comes in, I must resort to using a paper towel, assuming that the door has a handle to grab.

Men will also pee just about anywhere there is a tree, and we freely teach this skill to our male children. Working outside with my three-year old grandson, he announced that he needed to go potty. Not wanting to walk to the house, I told him he could just pee behind a tree. He was absolutely thrilled about this new technique.

Several weeks later, he asked his Dad if he could potty outside, like at Grandpa's house. His Dad said okay, so Dylan promptly pulled down his pants and pooped in the front yard along a busy street.

I diagnose several urinary tract infections per week in my pediatric clinic. As part of the medical history, I always inquire about the restrooms at the schools. Many school toilets are worse than some backwoods gas stations. Some do not have locks that work or even doors for privacy. When restrooms are dirty, or not private, children won't use them.

When children (usually little girls) hold their urine, they are more likely to get urinary tract infections. Kids also do not want to waste their precious recess time peeing or standing in line at the bathroom, so they just hold it. Although I know it can be disruptive, but elementary teachers who dish out severe penalties for children who ask to go to the toilet during class time should be forced to use the kid's bathroom themselves.

Custodians usually clean restrooms at the end of the day, but it is rare that the toilets and other fixtures are disinfected.

Rotavirus infections can cause profound diarrhea and vomiting. This organism is easily spread in public restrooms and schools. As gross as this statement sounds, diarrhea tends to splash, spreading highly contaminated feces on surfaces and other fixtures. And, the dominant hand that wipes is the hand that contaminates door handles and faucets; and the hand that shakes your hand during greetings.

Perhaps this is why the Japanese bow, instead of shaking hands. While traveling in Japan many years ago, I experienced the Japanese style toilet -- a long, narrow trough at floor level requiring the user to squat. Odd, yes, but quite sanitary. Now, speaking of men peeing anywhere they want -- Japanese men in three-piece suits will pee into street in full view of the passing public. Many restrooms are unisex, so women have to file past the line of men peeing at urinals.

"We are trained not to look," our Japanese friend told us. Of course, my wife was not Japanese. She routinely looked.

In some places in Great Britain and Europe, there are high-tech pay toilets that are completely disinfected between each use. Personally, I would happily pay for cleaner toilets.

When Nature calls, we must answer. Public restrooms are a very necessary convenience, but they are not without inherent risks. Take aim and/or hover. Use your seat liners and stacks of toilet paper. And, for Goodness sake, wash your hands (and fingertips!); methodically and thoroughly; with lots of soap and running water.


Related Topics: Drug May Shorten Kids' Severe Diarrhea, What To Do About Diarrhea

Technorati Tags: rotavirus, diarrhea, hand-washing

Racism in the Medical Office

I grew up in a time where racial separation was the norm. Black people could not live in the town limits of our little Appalachian community; they had their own section. Our school was integrated for the first time in 1957 (first grade) when the smaller schools that served the black community closed. My first-grade teacher made all of the black students sit in the back of the room. The black kids seemed to be always late, since it was several miles further for them to walk to school. There was Lorraine, Betty Jane, Edmond, Jim, Tyrone, and Eugene. We were all friends.

Children do not really care about skin color; but our parents sure did. My mother was a closet racist. In other words, she thought she was open-minded and liberal, but she was not. She did not allow me to invite ALL of my friends to a birthday party, so I did not have any more parties. When I was in college in the '70s my roommate was black. I brought him home for a weekend (properly warned, of course). My mother was polite and gratuitous to Bill. She even prepared a meal of fried chicken and watermelon, much to Bill's amusement. She pointed out to Bill, a decorated ex-Green Beret corpsman, that I once had a black (she really used the word, "colored") woman baby-sit for me when I was little. Bill, not missing a beat, told her that a colored woman took care of him when he was little, too! She didn't get it.

I moved to California after finishing my medical training. This was liberal San Francisco in a very turbulent, post-Vietnam world. Peace. Free Love. And, more importantly, racial harmony (sort of). One of my favorite patients, a black woman, invited my wife and I to hear her sing at a jazz club in Oakland. I did not hesitate to take her up on that offer. As the only white couple in the club, we felt very unwelcome. During an intermission, a black man told me that I should leave. We left. Jeannie, my patient, was terribly embarrassed by this incident. Incidentally, Jeannie came in second place in Star Search several years later. She should have been the winner.

Fast forward twenty years. I now work in the Sacramento area, purported to be the most racially diverse large city in America. You would not believe the ethnic and cultural diversity of our office staff - Blacks, Asians, African (from Ethiopia), Native American, disabled, Gay, Jewish, Christian Fundamentalists, Hindi, Muslim, young, old, obese, and of course, one Appalachian hillbilly (Insert "Dueling Banjo" music here.) Our local community and population that we serve is equally as diverse, from wealthy, highly-educated Caucasians to the drug-abusing, methamphetamine-cooking crowd. We have many Lesbian and gay couples with children, grandparents (and great-grandparents) caring for their grandkids, single dads, single moms, and a few people who should not have had children at all.

My medical assistant is a wonderful, funny, and dedicated black woman - a perfect compliment to my style of practice. She has evolved over the years to be a very good partner in this busy practice, and I am pleased to have her. However, it was not without incident. Initially, any complaint that I would mention was not taken well, even though I tried to be very diplomatic in my approach. She reacted passive-aggressively by putting in patients S-L-O-W-L-Y, so that I would have to work through lunch. One day, we had a heart-to-heart talk about our relationship. She felt that I did not respect her because she was black. I told her that was not the case. I just needed to have a lunch hour, or I get very crabby.

One day, a patient complained to me that she did not want to have that black woman take her child's vital signs. When I asked her why, she said that it is her "black attitude". I responded by making sure my nurse would not participate in her child's care anymore. I asked her to see another medical provider. If she did not like my medical assistant, I would not be taking care of her kids anymore, either.

I would take my medical assistant to lunch periodically, especially now that I seemed to be getting a lunch hour again. At the local restaurant, she tells me that she feels that people are staring at her wondering why a black woman is having lunch with an old, white man. I don't know if this is true or not, but I can certainly understand that she had a life quite different than mine. Racism still exists.

One thing that I learned from gross anatomy and surgery is that we are all the same inside. In medicine, natural skin color is basically irrelevant unless, of course, it is blue.

Related Topics: New Push to End Heart Care's Racial Gap, New Fight for Racial Equality in Health Care

Technorati Tags: racial equality, racism, healthcare

Oh, My Aching Back

I vividly remember a back lecture during my medical training. The lecture was from an elderly physician (at least 90) and an icon of the community. As students, we hung on each profound word; jotting them down in our notebooks for fear that those facts would eventually turn up on a test. "The back is the most important part of the body", he said. "If it wasn't for our backs, our heads would be sitting on our butts." With that final comment, he closed his notes and left the room. I don't remember much about that lecture, but that final comment is cemented firmly in my mind.

Bad backs seem to run in our family. My brother has a bad back and 27-year old RN son recently underwent surgery for his back. About seven years ago, I was heading for the OR myself after my right leg went numb and I developed a foot drop. A foot drop occurs when there is nerve compression - your foot will flop down as you walk, seemingly out of your control.

I blame the exacerbation of my back symptoms to my long commute at that time. I had accepted a professorship at a college about a hundred miles from my home. With this lapse of judgment, I also accepted a five hour daily commute to my virtual desk job. It didn't take my back long to rebel. Obviously, as soon as my contract was up, I accepted a position closer to home. Now that the price of gasoline is twice what it was a few years ago, quitting this job was one of my better life decisions.

At that time, we lived in a home that required little maintenance. It had a small yard that I could mow in ten minutes. It was relatively new and did not need painting, and it was small enough that it limited my acquisitions. With the five kids now off to there own lives, we could not let well-enough alone, so we sold this home and bought another in the Sierra foothills, about a half-hour from our jobs. It is a beautiful property with a fantastic view, however, it requires every spare minute of my time to maintain it. I spent yesterday painting my garage/warehouse, laying more sprinkler lines to enlarge the lawn so that I can have more to mow, putting up a new shed, and tending my vegetable garden that cost more than the vegetables it is likely to produce. And, my back is killing me (again). This time, I have back pain for a different reason.

I guess my back has been troubling me since my car accident in 1976. I was stopped in bumper-to-bumper traffic in my daily commute when I was rear-ended by another, bigger car. Tragically, I had removed my seat belt momentarily to pick up a cassette tape that fell on the floor. As I was rear-ended, my car slammed into the vehicle in front, ejecting me through the front windshield, not something the body is intended to do. To make a long story short, I ended up with some permanent neck and back pains that still trouble me. Now that I am older, degenerative arthritis has come home to roost as well.

So, my high-maintenance house is a double-edged sword. It provides me with some seriously needed exercise, and the opportunity to experience periodic back pain on a regular basis. When I would see adult patients in the clinic hunched over with back pain, I would tend to judge them against myself. I figure if I could go to work, THEY can go to work. If I am not on disability, they are not going to get it either. Back pain, like many of life's misfortunes, are partly in the mind of the beholder. Sure, my back hurts, but so what.

When I worked in an Urgent Care clinic, back pain complaints filled my day. Many had true, honest-to-God pain (yes, experienced clinicians can tell), while others needed an Oscar for their performance. Some were simply trying to get out of work; some wanted to be put on disability so they didn't have to work; some needed a work note; and some were just looking for drugs.

I once had a Quasimodo-like man present in excruciating pain. After I performed the appropriate exam as well as a series of bogus tests that we throw in to weed out the malingerers, I determined that he was full of crap. Immune to his persuasive whining due to my pediatric and child-rearing experiences, I sent him on his way without the Valium and Vicodin he requested. The clinic was located next door to a large grocery store, and I just happened to see him loading several fifty-pound bags of dog food in the trunk of his car about a half hour later.

"Glad to see you are feeling better," I called out. He, of course, flipped me off. In the event that he returned to the clinic again, I made a little secret mark on his chart that indicated his drug-seeking behavior. And you thought that only DaVinci had secret codes...

Related Topics: Video: Can A Massage Improve Your Health?, Exercises to reduce low back pain

Technorati Tags: back pain, aging, arthritis, davinci code, chronic pain

Internet-Savvy Patients

This week, I have been asked to participate in a television show about the Internet and medical advice; I am not sure why.

I suspect that nearly 90% of the patients that I see in my clinic setting use the Internet for medical information. I am constantly referring people to the Internet (mostly WebMD) and debunking some of the information that they bring to the clinic for my comments.

It constantly amazes me what people consider credible resources, but I must admit that it is becoming more and more difficult to sort them out myself. The Internet is the largest collection of information in the world, but determining the credibility and accuracy of important medical information requires more than just a Google search and click.

When you do a medical topic search, try and narrow down your topic, otherwise you will likely find 1,287,476 resources. Or, start with a well-known medical site, such as WebMD.

One of the reasons that I enjoy working with WebMD is their high level of professionalism and patient-friendly search engine that is improving every day. The information you find here is both current (sometimes even hours old) and can be well-referenced to credible sources.

I was in Monterey a few years ago with my wife. We were looking out on the beautiful surf crashing into the shore when I spotted a seal-like creature swimming among the rocks.

"That looks like a harbor seal", I said. "That's not a seal. Let me ask someone."

She turned to an unidentified man standing nearby and asked him what type of animal that was. He replied that it not a seal, but a sea otter.

"See, I told you it wasn't a seal", she retorted. My first thought concerned the qualifications of the person she asked. Was he a marine biologist? Oh well, I guess it was two against one.

Some highly positioned Internet sites are totally bogus when it comes to medical information. Just because it shows up first, does not imply it is the most important source of information.

If the site collects information from you, has links to some other crazy-sounding sites, or wants to sell you something, then you should be more skeptical.

Don't get me wrong, not all sites that have sponsored advertising (including WebMD) are bad. As a consumer, you have the right to read what you came for and visit sponsored sites if you want. I look at ads in newspapers and magazines all of the time. A sponsored Internet site is no different. Without advertising, the dissemination of free information or expert-run boards would be cost-prohibitive.

University-based sites (URL ends in .edu) are often excellent sources of medical information. Although the source may seem to be non-profit, it takes resources to run a university or hospital.

Non-profit organizations (URL ends in .org), like the American Cancer Society, are another wonderful resource, but non-profit does not mean they do not need money to run their organization. It certainly does not imply that a non-profit organization is more credible than for-profit one.

Government-sponsored sites, paid for by our hard-earned tax money, can be usually be trusted, unless you are a person that does not trust the government. In all things medical, I found that the government medical sites, like the Centers for Disease Control and Prevention, or the National Library of Medicine to be among the best and most informative. Our tax dollars at work for something worthwhile.

In the clinic setting, I deal with Internet-savvy consumers every day, perhaps, in part, because Hewlett-Packard and Intel are in our backyard.

The most confrontational topic in a pediatric practice has to be immunizations and vaccine safety. On the far fringe of the non-believers are the wackos that feel that vaccines are a clandestine method that the government is using to control our minds. The more mainstream anti-vaccine advocates site fear unrealistic adverse effects on their children.

The largest of these fears is that of an association between autism and the MMR (Measles, Mumps, and Rubella) vaccine.

This controversy started many years ago when ONE published letter in the New England Journal of Medicine hinted at a possible autism association with a few patients. The author has since retracted his comments, and several well-controlled LARGE medical studies have NOT found any causative relationship whatsoever. However, once the anti-vaccine advocates latch on to an idea, it is slow to die. Meanwhile, we have outbreaks of measles and mumps in our community.

Another, recurring issue is that of mercury in vaccines. Mercury, in the form of thimerosal, was used in minute amounts in some vaccines as a preservative. Right now, thimerosal is only found in the injectable influenza vaccine.

Granted, mercury is poison and no one should willingly or inadvertently take poison, but we have to put it in the proper perspective. Where I live in Northern California, we have traces of mercury that shows up in our water system, both from natural sources and from contaminants left over from the Gold Rush Era where mercury was used in tons to help leech gold from unyielding rocks, and from people throwing their old mercury thermometers in the landfill. In generations past, mercury was a purported as a cure for venereal diseases like gonorrhea and syphilis.

Mercury is and always was a dangerous poison. I am pleased that it is not longer in pediatric vaccines, although there are no credible studies that have shown a risk to autism or any other disease. I remain a firm supporter of vaccinations.

Like the Internet, I offer my opinion and people can really take it or leave it. I am getting too old to try and please everyone. Some practitioners in my office feel threatened when patients come in waving print-outs for us to read. I barely have time during the day to pee, let alone take an hour out of my day to read some study from an unfamiliar site. I do get around to it eventually and I am quite up-front with my opinion. Again, they can take it or leave it. I am not threatened by people who do research. As a matter of fact, I welcome and encourage it. In many instances, education is much more important than medications, and there are lesser side effects.

Related Topics: Childhood Immunizations, How Blogs Have Changed The World

Technorati Tags: MMR, Autism, Mercury, Internet Health, Medical Advice