Abbreviations Drive Me Crazy

Photo Credit: Martin

Before one can begin the practice of medicine, a provider must learn a new language. It used to be Latin, but now it is even more complicated...we just use Latin abbreviations! There is nothing like abbreviating a dead language to totally confuse your patients. Doctors and pharmacists used these codes for centuries so that patients would not know their "secret language." It was really not just for saving time, although writing BID for "twice per day" (Latin) is a lot faster.

We use a few unauthorized and derogatory abbreviations in medicine, too, such as FLK (funny-looking kid), or PIA (pain in the ass). I once inquired what "TM" meant on the corner of a patient chart at a private clinic. The doctor informed me that that meant "Trouble-Maker." This code was used for hostile or assertive patients that tried to sue him, wrote a nasty letter, or caused him personal grief. Rather than dismiss them from his practice, this was just a code to remind him to be extra nice. We routinely used the code "DS" on charts at an urgent care facility. This meant "Drug Seeker," and was a reminder NOT to prescribed narcotics or buy those stories that "my kid spilled my codeine down the sink," or "I am allergic to ibuprofen and acetaminophen. I can only take Vicodin."

No longer do people have colds; they have URIs (upper respiratory infections). If your patient has asthma and you don't want to label them with this perpetual diagnosis, you can call it RAD (reactive airway disease), or simply put SOB (not what you think!). SOB means "shortness of breath." So, when you read your chart and see that you are described as a "47-year-old woman with SOB," they are not referring to your husband who came along.

Everyone knows that MD means "Medical Doctor." When we deal with arrogant, know-it-all physicians, we say that means "Me, Doctor." I once saw a very young woman working in a dubious clinic with a name badge that had MD listed after her name.

"You are quite young to be a doctor," I asked.

"Oh, that stands for Medical Director. I am the clinic manager." I had to inform her that that misrepresenting yourself as a doctor is kind of against the law. Doing sports physicals at a local junior high, I had to spend extra time one day explaining to a young man that Dr. Martin Luther King was NOT a physician. He didn't believe me.

RN means "Registered Nurse," but it could also mean "Registered Nutritionist." MA means "Medical Assistant," but it is also Master of Arts. PA means "Physician Assistant," but it could also mean Public Accountant, or Poop Analyst, depending on what you are doing at the time. When I put PhD after my name, it tells the world that I have a doctorate. It also means "Piled Higher and Deeper."

The Internet is worse. When I first started working for WebMD on the Ear Disorders Board, someone would post LOL. I had no idea it meant "laughing out loud." In the medical world, it meant "little old lady." Every so often, someone will post an abbreviation that means absolutely nothing to me. Rather than seem stupid and ask for clarification, I simply ignore them. There are THOUSANDS of abbreviations that our text-messaging and chat room teenagers are using right under our noses, such as "P911" (Parents are in the room), or POTS (parents over the shoulder).

Several years ago, when my middle step-son was in college, he was heavily involved in the Human Powered Vehicle project - a high-tech bicycle used for competition. He proudly wore his HPV Team tee-shirt to a party. A girl came up to him and told him how proud she was that they have a support group. See, HPV is a major venereal disease - human papilloma virus. He didn't get a date that night.

Some chat slang codes are older, well-established ones, such as TGIF (Thank God, It's Friday), BYOB (Bring Your Own Bottle), or WWJD (What Would Jesus Do?). Others are more elusive and require a chat slang dictionary.

I must admit that I was born in 1951 and am considered an old fart now. We didn't use a GPS, PDAs, or MP3s. We didn't have DVDs, but we did have LPs, and our friends got VD. And, we drank RC and ate SPAM, instead of deleting it.

EOD (End of Discussion).

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Technorati Tags: abbreviations, slang, chat, medical practice, health and wellness

Here Comes the Sun -- Watch Out!

Last week, I saw a teenager for a chief complaint of back pain. He was a very fair-skinned, young man with reddish hair and many freckles. When he removed his shirt for the examination, my eye immediately saw an odd-looking black skin lesion on his right shoulder. He is coming back today so that I can remove it. There is a very good chance that this is a melanoma - a malignant skin cancer.

My own brother visited a dermatologist last year because he was concerned about a mole. The dermatologist was not concerned about the mole, but he was worried about a dark pigmentation on his chest that my brother did not notice. It turned out to be a melanoma.

I have two red-haired grandchildren that spend a considerable amount of time in the sun. The nine-year-old plays baseball and the two-year-old is always outside or slowly cooking through the window of the car. In the last month, both of them sustained significant sunburns on their faces. While my daughter-in-law claims she puts sun block on them and insists on hats, it still happened. Fair-skinned, red-heads are considered the highest risk for sunburn. As little as thirty minutes of unprotected exposure can result in a significant sunburn.

The Southern hemisphere, particularly Australia and New Zealand, are leaps and bounds ahead of the U.S. in preventing sun-related cancers. Although topless or nude beaches are not uncommon in Australia, the vast majority of beach-goers are adequately protected from the burning rays of the sun. Children typically wear full-sun suits covering the torso and half of the arms/legs. They also were big hats that have a brim covering their necks. Hats are such a part of their attire that children may be excluded from school if they forget their hats. Many of the citizens of Australia and New Zealand are descendents of immigrants from England, Scotland, and other European nations who are noted for their fair-skinned people. A few generations is not sufficient time for evolution to develop sun-protective changes.

Nearly all cases of melanoma occur in people that report a severe sunburn in the past, perhaps even in childhood. Some recent studies show that there may be a five-times greater chance of getting melanoma after a severe, blistering sunburn.

Individuals who are prone to sunburn and those who have children who are in this same category need to be proactive.

• Stay out of the sun, especially from 10 AM to 2 PM when the sun is strongest. Although this sounds simplistic, you can't get sunburned inside (unless you go to those tanning salons).
• Remember that sun can reflect off of water or snow, doubling your exposure.
• The best sunscreens in the world are not as good as clothing - wide-brim hats and long-sleeve cotton clothing. Some people can even burn through clothing, however.
• Use a sunscreen that is at least 30 SPF (Sun Protection Factor) and re-apply it often. Use water-resistant sunscreens when swimming. Babies under 6 months old should not use sunscreen that contains PABA.
• Stay hydrated. Ultraviolet rays penetrate more on dry skin.

Inspect your own skin carefully and get a loved one to inspect the areas you cannot see. Any suspicious skin lesion, especially darkly-pigmented, spreading lesions in sun exposed areas, should be brought to the attention of your medical provider or dermatologist.

If you do get sunburned, what is the best treatment? One dermatologist recommended that medical providers not prescribe pain medications for preventable sunburn. She said that pain is important so that people remember NOT to do it again!

• Like all burns, cool it down. Cold compresses are helpful.
• Ibuprofen and aspirin are both anti-inflammatory and can be very helpful if given early and regularly during the painful phase of a burn. Many medical providers will even prescribe systemic prednisone, a potent oral steroid, for sunburn.
• Topical steroid creams, like hydrocortisone cream, are not that helpful according to the studies; however I often recommend that the creams be kept in the refrigerator and applied sparingly.
• Severe, blistering sunburn may need the services of a medical provider.

Severe sunburns can result in melanomas appearing years or even decades later. Promptly treated and monitored, melanomas can be managed, but often can result in deep, unsightly scars. Ignored, or untreated, melanomas are mostly likely fatal.

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Technorati Tags: sunburn, melanoma, sunscreen, red-head, health and wellness

Bad Drivers - A Significant Health Hazard

Photo Credit: Trent B

The number one cause of death and disability in the adolescent population has nothing to do with biological organisms - it is motor vehicle accidents. In my own small, rural high school class, I lost at least three of my friends to automobile accidents before we graduated. Although teen drivers are more likely to have an accident, bad drivers occur at every age.

When my youngest son got his driver's license at 16, he asked to borrow the car to drive to school (about 2 miles) for his first solo outing. Although he only had his license for one day, I gave my blessing. On the way to school, he rear-ended a State Farm Insurance agent (we have that insurance, but it wasn't our agent). The agent's boyfriend was an attorney!

The day we had to put our dog, Herman, to sleep, my wife got a speeding ticket in a construction zone. She was crying and zoning out and drove 45 MPH in a 35 miles zone. She was picked out of a pack of five cars and given a ticket. When the officer noticed that she was crying, she informed him that it was not about the ticket, it was about the death of a friend, he still gave her the ticket. I bet if she said it was our dog, he would have had more sympathy.

I commute about fifty miles round trip to our clinic. Just about every day, I encounter bad drivers. I see people reading books, women putting on make-up using the rearview mirror, eating tacos, and of course, the endless array of cell phone gabbers. You can always tell when someone is on the cell phone because they are in the fast lane going about 10-15 miles under the speed limit and flow of traffic, completely oblivious to the hazard they are causing. There are singers (I sing in the car) and even dancers (I don't dance). I particularly like to see the nose-pickers; especially when they see you looking at them.

One day, I followed a man in a car, trying to reach an elusive kid in the back seat. The kid would scurry from side to side just out of reach of the angry father. A few minutes later, a belt was being randomly whipped behind him trying to beat his child. Man, can't you just pull to the side of the road?

People whip in and out of traffic trying to get a car length ahead. Drivers will aggressively tailgate you until you get out of their way, even though you are driving the speed limit. One of my biggest peeves is the motorcycle drivers that think they are in some kind of Hollywood movie. They can legally go between lanes in stopped traffic. Their sudden engine noise frightens the crap out of me.

Now, I am not without sin myself. My last speeding ticket was in the most rural area of northern Michigan (the U.P.). I was the only car that probably passed that way for hours, and likely woke up the policewoman as I buzzed buy at a mind-boggling, heart-stopping 60 MPH in a 50 MPH zone.

"Don't you know this is a deer area?" she said.

She was right, since I hit one a few hours later going under the speed limit. The deer was speeding, however.

I have had my share of road rage incidents. I really don't mind getting the finger, but I do mind people trying to kill me. One day, I followed a car that had gasoline pouring out behind the license plate. Clearly, the woman did not replace the gas cap when she filled up. As she drove up the freeway on ramp, I drove along side her in the adjoining lane, got her attention, and informed her. This act of kindness was not appreciated by the person behind me who had to slow down for a few seconds. Instead of just flipping me off, he decided that he should chase me down the freeway, pull in front of me and slam on his brakes. In an effort to avoid this nut-case, I quickly exited the freeway. He followed me. Of course, as luck would have it in these volatile situations, I got a red light. He stopped behind me and I saw him jump out of this car. I was able to make a quick (legal) right turn and evade him before he was able to get back in his car.

On my way home one day, I was sitting in bumper-to-bumper traffic for hours. When I finally reached my exit, I noticed a dozen police cars, a lot of yellow taped-off areas, and a body covered up. Apparently, an angry driver with his teenage son in the passenger seat, chased down another driver that cut him off and shot him.

Nearly all of us, when we are in the grocery line, allow a person with one item to go in front of us. I do it all of the time, unless that one item has a pack of cigarettes or beer. (They can wait.) This is just common courtesy to other humans who share our planet. When we get behind the wheel of the car, we need to extend the same courtesy. Let the idiots go in front of you. Don't react when they flip you the finger. Don't try and escalate a minor situation. Let it go. Remember that psychos drive cars, too. It is more important to arrive home...alive.

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Technorati Tags: bad drivers, automobile accidents, road rage, cell phones and driving, health and wellness

A New Puppy - The Natural Antidepressant

Photo Credit: Rod Moser

As many of you know, I recently lost my seven-year old canine companion, Herman, as a result of a tragic accident. Dogs become such important members of your family, when they die, it can take time for those wounds to heal. Some dogs are just extra-special and touch your heart and soul. Herman was one of them.

Working in medicine, we deal with tragic losses quite often, so you would think I would be used to it. You NEVER get used to it, but you can certainly learn to deal with these sudden, tragic events.

I am a firm believer that situational depression does not usually need medications, so I rarely prescribe them for patients. We should not hide from our natural feelings or try to mask them with drugs, unless of course, the depression is profound. Personally, I have never taken an antidepressant, not even during some of the saddest periods in my life. I have taken an occasional anti-anxiety medication, during some of those white-knuckle, high-turbulent air flights. It sort of keeps me from screaming and running down the aisles. Most of the times, I just close my eyes and imagine that I am in a car driving down a very bumpy, potholed road...like those in Mexico, or Michigan.

When you lose a beloved pet, people are very supportive. I received dozens of comments on my Blog, on the ENT Board, and from friends. Dog lovers know other dog lovers, so we support each other.

The question that always arises is the issue of getting another pet. Although you cannot really replace a loving pet, we can certainly learn to love another. Some people (my wife, included) did not want to get another dog. We have a lethargic, ten-year old Sheltie that is about as exciting as a stuffed animal. Although Maggie is a sweet dog, and the mother of Herman, she is really not the kind of companion that I need. I want a dog that chooses to hang out with me; to go for rides in the car; that will sleep on my feet and become excited when I come home.

There is something to say for the simplicity of a pet-free household: No pet sitters when you go on vacation. No poop mine fields in the grass. No veterinarian bills. Someone once said that life really begins when the kids leave the house and the pets die. I don't really believe that I am ready for a life without the companionship of a dog. I started my search for a new puppy.

I first called the breeder that I knew. She did not have any puppies. Then, I searched the newspaper. I found a breeder located about five hours from my home and checked out the web site. She had a litter of puppies that were nine weeks old; born on my grandson's birthday - a nice coincidence. Finding a good breeder is important when looking for a quality puppy. Never buy a dog from a puppy farm. I informed my wife that we were going to have a road trip.

About ten hours and hundreds of miles later, we arrived home with our new dog. Her name is Lexi. Lexi is the name of a character on a BBC series that takes place in Scotland called Monarch of the Glen. Since Shelties are really called Shetland Sheepdogs, a Scottish name is quite appropriate. Lexi is also short for Lexapro, a popular antidepressant medication. Since Lexi is my antidepressant, the name was a perfect fit.

Already, I feel better.

Related Topics:

• WebMD Video: Pets and Health
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Technorati Tags: pets, depression, loss, Shelties, health-and-wellness

Mother's Day Remembered

I went to college in West Virginia, and often drove past the little church in Grafton where Anna Jarvis celebrated the first Mother's Day on May 10, 1908. Next year, it will be the 100th anniversary of this important celebration, so maybe I will try to be there. My mother is 86 years old and is in a nursing home. She has dementia and does not remember that she has three sons most of the time. She gets mixed up and thinks my older brother is her late husband. She is our mother nonetheless. This is a picture of my mother about a year before she entered the nursing home.

My mother came from a very large Appalachian family. She is seated on the bottom row, next to my grandfather. Note that my uncle in the top left does not really have a disproportionately large head. Since he was in the military at the time of this photo, his picture was "pasted" in.

One year, our five children each picked out a tree to plant in our yard, from a palm tree to a mulberry. We selected an appropriate spot and they dug the hole (sort of). Even though we no longer own that house, most of those trees are still thriving. The mulberry tree is so big and poorly trimmed now that it took over most of the side yard. The palm tree is nearly thirty feet tall, and the Japanese maple tree is beautiful. The nectarine tree died when it was so laden with fruit that it split down the center.

Last night, two of our adult children, their spouses/significant others, and grandchildren took us out to dinner at a local steakhouse. The kids that could not make it to dinner sent cards and called. The gathering was nice, but the venue had a lot to be desired. The place was unbelievably noisy, the service was lousy, and my lamb was raw. I never did get my baked potato, but it wasn't my day. It was Mother's Day.

Last year, we had a Mother's Day breakfast at a very crowded local eatery. While we were waiting for a table, someone had sat out some folding chairs in the parking lot for the mothers and grandmothers who were also waiting. I noticed a 60ish woman sitting in one of those chair light up a cigarette. Disgusted by the smoke blowing my way, I moved a bit upstream.

A few minutes later, a little boy about three to four years old emerged from the restaurant with his family. Immediately, he noticed the woman smoking and he walked up to her.

He pointed his little finger right at her face and explained, "You should not be smoking!"

"I know, honey," said the woman, "Smoking is bad."

Waving his accusatory finger with the fury of a Pentecostal preacher, he shouted, "You are gonna die!" Then he said it again, louder and with even more conviction. His embarrassed family quickly led him to the car. I walked away, too, so that she would not hear me laughing.

The woman was speechless and put out the cigarette. Now, that is a Mother's Day to remember.
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Technorati Tags: Mother's Day, health-and-wellness

International Connections

Photo Credit: Rod Moser

The world is a very big place, but it becomes smaller when you open up your homes (and hearts) to people of other countries and cultures. One of the most rewarding and enjoyable events in our family was to have exchange students from Japan. This was over twenty years ago.

Our first exchange student was Tetsuya, who was about 14 when he was exposed to our five children and very wild and chaotic home. Tetsuya only lived with us for three weeks, but the bond we formed has endured through the years. Tetsuya has returned many times for visits, and we have visited him and his parents in Japan once. He is a part of our family. This week, Tetsuya, now in his mid-30s, came back for another visit. This time, he brought his wife, Mayumi, and his little girl, Yui, to meet his American parents (and grandparents).

Yui is two and half years old and is unbelievably sweet. From the moment we picked them up at the airport, she has been singing. Although she is just learning to speak Japanese, she sings the theme song for Alice in Wonderland (in English, of course), the ABC song (first part in English, last part in Japanese), and so forth. Although a bit shy at first, typical of most children of her age, she warmed our hearts.

To honor their recent visit, we planted a beautiful Japanese maple tree. Yui helped. As both this little tree and little girl grow, we hope to take many more pictures near it. Someday, we hope that Yui will come as an "exchange student," and stand underneath her tree.

Our second Japanese exchange student was Kyoko, who is now a physicist specializing in gamma ray research. She has also returned to our home many times, with either her sister, Eriko, or their mother for visits. Kyoko's last visit was several months ago. On one occasion in the past, Kyoko, Eriko, and Tetsuya all came at once. It was just us and eight children.

As our biological children and Japanese children grew into adulthood, their individual relationship continued. When one of our children, Alex, graduated from college, he and three of his friends decided to travel around the world before starting their life careers. Armed with a credit card and the tireless enthusiasm of youth, the four of them leap-frogged around the globe for three months. One of their last stops was Japan, where they crowded in with Tetsuya and his parents for a few days.

The exchange student program is wonderful. If you would like your family to experience a different culture first-hand, without leaving your home, I could not recommend it higher.

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Technorati Tags: exchange students, travel, Japan, health-and-wellness