C. Everett Coop

To honor (sort of) the former Surgeon General of the United States and fellow anti-smoking advocate, I have officially assigned his name my new construction project. Dr. Koop is very talented and well-spoken pediatric surgeon and has probably never had a real coop named after him. The "C" in this case stands for chicken. I have called my new chicken coop C. Everett Coop. I was going to call it Chicken Ranch II, but I think there is a Nevada brothel by that name.

http://www.flickr.com/photos/bigbold/ / CC BY 2.0

On my recent days off, I decided to construct a chicken coop and covered enclosure. Not only will I be able to get fresh eggs (eventually), I will have a ready source of manure for my floundering organic garden that was recently destroyed by an unseasonable hail storm. I also read a recent article in Newsweek or Time (I can't remember since I get both) about feeding chickens flax seed so they will lay eggs that are high in Omega 3 fatty acids! I am going to get some super-eggs.

My research indicates that a four chickens will lay about 20 eggs a week. Since it is just my wife and I, I decided that I needed fourteen chickens, to allow for some attrition. Doing the math, that would mean that I would get about 70 eggs a week; close to six dozen. This will be enough to supply the neighbors and feed our adult kids and grandkids.

We live on about three acres so finding a place for the coop away from the house was quite easy. It would be nice to have real free-range chickens, but their life expectancy would be relative short since we have an abundance of hawks, who love free-range chickens. We also have a wide variety of other chicken-eaters, like coyotes, raccoons, possums, bobcats, and one mangy-looking cougar that visited the neighborhood a few years ago. I am sure the coop will be attracting them. My pregnant Sheltie was very interested, too. She spent a great deal of time yesterday herding them around the chicken yard.

My first job in coop construction was to make the entire enclosure predator-proof. It is four feet off of the ground, well-ventilated, and built better than my house. It even has a Plexiglas skylight. The enclosure is made with welded aviary wire, buried deep on the bottom to discourage the diggers, and completely covered over the top for those circling birds of prey. I figure that I spent about $400 on construction costs; the equivalent of 200 or so dozen eggs.

On Father's Day, there was a Chicken Sale at the local feed supply – buy five chickens at 33% off and get the sixth chicken free. I spent about $25 on the chickens. You can't beat that deal. I bought 14 young chickens of four different types, all purported to be good egg-layers. It is going to be several months and a few hundred pounds of chicken feed before I see any eggs, but they have been doing quite well on the manure part.

As a child in rural Pennsylvania, my grandmother always had chickens. I would love to gather the eggs. In high school, I worked the summer and weekends at a game farm, raising bobwhite quail (about 10,000 of them!) and ring-necked pheasants. In the winter hunting season, it was my job to "salt" the corn fields of a paid hunting reserve so hunters could (attempt to) shoot them. I would dump about 24 quail in a heap and they would just sit there until the hunting dogs made them fly. As cruel as it sounds, most of the hunters were such bad shots that only about a thousand of them were killed by the end of the season. I know; I was the one that had to clean them. The rest of the quail and pheasants just flew away and apparently lived a long and happy life.

We had a quail hen house, so it was my job to collect these tiny eggs. We put them in a cool environment until I had a few hundred. I would then put them in the incubators and count the days. About half-way through the gestational period, I would candle the eggs to see if they had a chick or not. It didn't take long for hundreds of these little birds to be swarming around. From egg to mature bird only took a few months.

I am just assuming the most of my chickens are girls. You really can't tell when they are still young. I don't really plan on having a rooster in my hen house, so I am not going to have to deal with baby chicks. If I do get a rooster out of that group of chicks, at least he will be far enough away from the house that he will not wake me up early.

Because they are only about a month or so old, I have been keeping them inside the coop, but now that the weather is a blistering 102°, I have allowed them out in their covered enclosure. At first, they were reluctant to walk down their ramp, but now, they love it. I gave them some lettuce from the garden (it was too bitter to eat anyway) and they had a picnic. I watered down their shavings today to help cool the area. Chickens do not regulate body heat very well, so they are sensitive to both cold and heat, but particularly heat. The chickens will be used as layers. I certainly don't want them roasting just yet.

More Tidbits from the Medical Literature

H1N1 Flu (Swine Flu) Now Upgraded to the Highest Pandemic Threat

For the first time in over 41 years, the World Health Authority has declared this new strain of swine influenza, a global pandemic. This disease has now spread to over 74 countries with over 30,000 (reported) cases with some deaths. Millions more are assumed to have been infected, however. In the normal (annual) seasonal flu epidemic, about 250 to 500 thousand people, mostly the very young and very old, will die worldwide. When I was six years old (1957), two million people died. The pandemic of 1968, when I was in high school, killed a million. This is actually small compared to the 1918 Flu Pandemic that killed 40-50 million. WHO warns that the flu pandemic has the potential of infecting up to two BILLION people worldwide.

Although there have been numerous conflicting opinions, one really knows how this will end. Will this first wave of the H1N1 virus mutant to a more lethal, virulent strain in the next 6-12 months? Health authorities are planning the worst-case scenario. Things may get bad – very bad. The first batch of swine flu vaccine is nearly ready, so expect the demand to be high.

In my own practice, flu fear has dwindled. No more frightened people showing up "flu-related". Fear may drive action, but complacency could be our worst enemy.

Government (finally) takes regulatory control over the tobacco industry

It always seemed strange to me that the government subsidized the tobacco industry, while simultaneously paying for much of the $100 billion in tobacco-related health costs. For as long as America grew tobacco, this industry has been running amok in my opinion, starting with the suppression of data on tobacco addiction and overall health hazards. This new bill will help the government regulate tobacco, as well as how it is advertised to new, younger customers.

I spent my entire childhood avoid secondary smoke exposure. Unfortunately, the exposure was cut in half for a few years after my father (age 39) died of lung cancer. My mother remarried a cigar smoker, and the blue cloud of smoke returned. As long as I can remember, I have been a vocal, anti-smoking zealot; to my family and, of course, to every patient that smokes. If I smell tobacco, see cigarettes in a purse or pocket, they will not leave my office without a stern lecture. That's the way I take control. As far as tobacco products are concerned: Gone would be Good. Read on about the new (unregulated) electronic cigarettes.

Hats Off to WebMD

The Internet has changed the way consumers share and find health information. Gone are the days when books, often outdated by the time they were published; and misinformed friends and relatives were the only sources of health information. A recent survey found that over 60% of adults go on-line for health information. The leading health information site is (and always will be) heavily-trusted WebMD. Although I have worked for WebMD for nearly a decade, I have yet to tap its seemingly-unlimited health resources. In a time where inaccurate, false, and misleading information floods the Internet, it is comforting to know that sites, like WebMD, are a button-push away.

Many people have lost their jobs (and health insurance) and are relying more on self-care skills now, using the Internet, especially WebMD, as a valuable, educational resource. WebMD is not there to replace your medical provider, but is certainly one of the best places to go for accurate health information.

Electronic Cigarettes – Who needs them?

Electronic Cigarettes are the rage in China and Japan. It looks like a cigarette. It lights up. It has nicotine to give the user this lift/buzz that they seek. It does not emit secondary smoke to annoy non-smokers. They are expensive, but then again, so are cigarettes. Manufactures claim they have all the advantages (what advantages????) of smoking without the hazardous, cancer-causing chemicals. Really? There are no well-controlled, scientific, or medical studies to back up those claims; just assumptions. What happens if children start using them? Nicotine is really not an innocent chemical. It speeds up the heart, increases blood pressure, and a dozen other things. Nicotine is addictive.

As a child, smoking parents were common. Cigarettes were relatively inexpensive; as little as 30 cents a pack. Doctors smoked. People in the movies smoked. Teachers smoked. Cool people smoked. All we had were candy cigarettes to hang off our lips and pretend to be cool, blowing pretend smoke in the air. Some kids thought candy cigarettes were so cool that as soon as they could, they started smoking real cigarettes.

Electronic cigarettes may not cause cancer, but who needs them? I guess we will soon have electronic cigars or pipes; maybe even some electronic donuts so we can eat them and not get fat.

I agree with the health experts on this one. Don’t buy them and don’t blindly trust the sellers claim that they are harmless.

Related Topics:

• Swine Flu Information Center
• Get FDA Consumer Updates
• Find Help Quitting Smoking

Shots Hurt! How to Ease the Pain for Kids (and Parents)

It breaks my heart to give injections to kids, but they are definitely necessary. Vaccinations save lives and sometimes we must give an injection of an antibiotic. Either way, shots (usually) hurt and kids know it. Before kids turn two, we are poking them with needles about twenty times.

Pain is always in the mind of the beholder. I have seen infants goo and smile as they were given multiple vaccinations in their thighs. I have seen big ‘ol high school football players beg and plead, trying to get out of a tetanus shot. Yesterday, a teenager fainted during a routine vaccination and hit her head on the floor. She had been hyperventilating in anticipation of the injection.

As a child, our small town doctor would make house calls. It seemed that no matter what you had, he would always seem to find a (painful) shot to give you, like penicillin. An injectible antibiotic that we often use is called Rocephin (Ceftriaxone sodium). This one can really hurt and sting, unless it is mixed with lidocaine, an anesthetic agent. Mixed with sterile water, this one will definitely get your attention. Often used to treat sexually-transmitted diseases, I have known ER docs that will use the sterile water mix so it WILL hurt, reminding the recipient to use safe sex practices next time.

In the 1950s, school and public health nurses would come to our classroom and give routine vaccinations. I can still see some of my classmates freaking out about them. Some would try and run away and others would cry. The crying would increase in intensity as soon as the alcohol swab was used. Some would just stand there, stoic and in shock, as the school nurse administered them.

The armed services are notorious for their group vaccination efforts. They line those frightened recruits up like cattle and use pressurized air injection guns to give multiple injections. Like the traditional needles, air injections can hurt just as bad; sometimes worse if they move. Air injection guns can tear the skin.

Some people like shots. Some of my Hispanic patients actually ask for shots, feeling that injections work faster and better than the same medication in pill form. An old osteopath that used to work in our group gave ALL of his patients, at every visit, a shot of vitamin B12. Of course, unless you had pernicious anemia, this shot was just a placebo, but his patients always seemed to feel better after their vitamin injection.

Insulin-dependent diabetics have to give themselves shots once or several times per day. At first, many are reluctant to do stick themselves, but after a short while, they are no longer bothered by doing this simple procedure.

Parents are now refusing vaccines more and more. Unfounded fears of autism and even fears of subjecting their kids to pain are common reasons. The pain of most injections is usually brief. The fear and anticipation of getting a shot is often worse than the shot itself. Our medical assistants give injections all day long. They are fast, efficient, and often over before the kids know it, but there are still some things that we can do to minimize the discomfort.

A Baker's Dozen Things That Can Be Done to Reduce Injection Pain

1. Attitude plays a big role. If the parent AND the medical provider are supportive and calm, the child will feel confident and will not nearly be as frightened.



2. What’s in a name? The word "shot" is really a scary word for kids under age 7 or so. Bad guys are "shot". I use the word "booster" when they need to get a vaccination, or sometimes I call them "power boosters" since the vaccinations help them get strong. Booster is a much nicer word.



3. Choices. Children tend to like choices. If a child is going to get one injection, I ask them if they "Would like a shot or a booster?" Then I ask if they would like ONE or TWO (they only need one). I can extend the choices to "Would you like a big needle, or the little, tiny needle that we use for babies?" Or, "Would you like it in your arm, leg, or EYE!" When given those choices, they will pick (a) one booster, (b) with the baby needle, and (c) in the arm or leg, NOT the eye.



4. Honesty. Will it hurt? I always answer honestly and say, "Sometimes. But, if it does, all you need to do is tell the nurse, and she will take it out right away!" Think about it.



5. Empathy. Tell them that you understand that they don’t want any shots but in order to go to school, you have to have it.



6. Distraction. Do what you can as a parent to distract them from any anticipated pain from the injections. Hold your baby or child snuggly; reassure them that you will be help. Babies who are breast fed while they are getting vaccinations tend to cry or react less, or you can nurse the baby afterwards to calm them down. When I have to inject a toe for a toenail removal on a teenager, it can be quite painful. I have noticed that the ones who bring their music on iPods have less pain response.



7. Order of Shots. Nurses need to give the least painful shot first. A new Canadian study found that when you must give the DTaP vaccine (diphtheria, tetanus, and pertussis) and the Prevnar (pneumococcal conjugate) vaccine at the same visit, giving the less-painful DTaP first is much easier on the kids.



8. Give a little sugar. Newborns boys getting circumcised require an anesthetic injection in the penis (ouch!). Several studies have shown that a sweet liquid (sugar water) placed in a nipple, that the babies are unusually calm. Under six months old, a pacifier can be dipped in a sweet liquid for a sweet distraction. A sugar-free lollipop, usually after the injection, is a good bribe for younger kids.



9. Numbing medicines. EMLA cream (lidocaine-prilocaine) or cooling sprays can be used to temporarily numb the skin for injections. These are particularly helpful for planned blood draws or when a child may need an intravenous injection. EMLA needs to be put on an HOUR before the injection, and of course, applied to the site where the injection will be made. The cooling sprays only last precious seconds, so the nurse needs to be fast – very fast.



10. Direct Pressure. A little plastic device called a Shot Blocker creates a bit of "neurological confusion" to those pain sensors on the skin. There are some tiny spikes on the back of the device that will block much of the pain of an injection. And, of course, rubbing a recently injected site can also help afterwards. I once saw an old nurse slap a teen's butt real hard before giving a gluteal injection. It worked, although he was a bit surprised.



11. Tylenol? Many parents will give a dose of Tylenol (acetaminophen) before coming in for routine vaccinations. Personally, if I were getting five shots, I don’t think that Tylenol would really help my pain, but many parents feel that it does.



12. Not all vaccines are "shots". The FluMist influenza vaccine is a good example of an effective vaccine that does not require a needle. It is expected that more and more vaccines will have non-injection alternatives in the future.



13. Use Combination vaccines. More vaccines in one syringe; one needle is really the goal. We now routinely use a five-in-one vaccine containing the DTaP, Hib, and polio vaccines. My dog and cat gets a seven-in-one vaccine, but of course, animals are not children. More combination vaccines are on the horizon, but they need to be well-tested before giving them to our children.

Until we have those painless, Star Trek-like "neck injections" that cure just about everything, medical providers will still need to needle around from time to time. We can help the kids, but for the rest of us, my advice is to just Grin and Bare It.

Related Topics:

• Easy Way to Ease Infant Immunization Pain
• Unvaccinated Kids Getting Whooping Cough
• FAQ: Children's Vaccines

Do I have breast cancer? Would you please check my earwax and smell my armpits?

Medical discoveries are often made accidentally, like the bread mold that hallmarked the discovery of penicillin. Researchers are always finding interesting associations between diseases and examination findings. Some tend to be so unusual and bizarre that few people even believe them. A recent association between the quality of earwax and armpit odor to breast cancer risk is one of those.

Primary care clinicians see a lot of earwax. If there is such a person as a Cerumen Connoisseur, that would be me. The quality, consistency, and even the amount of earwax (cerumen) a person makes is really genetically determined. Asians tend to have dry, flakey earwax, whereas people of African descent tend to have more-sticky, wet earwax. Why? It just is. I really don’t pay that much attention to this normal, protective coating for the ear canal, as long as it is not in my way for examining the eardrum. If there is a wax impaction, I will remove it. If not, I leave the earwax where it belongs.

People are unusually troubled by the appearance of any earwax. They put earwax in the same disgusting category as snot or toe jam. Most people consider earwax yucky or dirty and feel it should be routinely removed by Q-tips… NOT. I am constantly defending the protective qualities of normal earwax and beg people to give up this unnecessary and potentially-dangerous Q-tip habit.

Now Japanese researchers feel there may be a genetic link between breast cancer risk and extremely-unpleasant underarm odor and wet ear wax. Now, before you go sniffing your pits and digging in your ears to see if you have wet earwax so you won’t have to have a mammogram, read on.

I have been to Japan. Even on those crowded subways and trains, I can’t really recall a body odor problem (unlike Europe!). Granted, I was about a foot higher in altitude than other people, but cleanliness in Japan is a virtue and perhaps using deodorant is more routine. I was approached by a person handing out samples on a crowded street corner in Shibuya. She was giving out samples of a cerumen spoon – a little, dangerous-looking instrument for scooping out excessive wax. This would be much more dangerous than the dangers imposed by the soft, cotton-tipped "wax packers" that Americans use. I guess if you scooped it out, you could certainly look at it to see if it was wet.

According to Kathleen Doheny of WebMD Health News, Japanese researchers studied a gene called ABCC11 (Remember this; it will be on the test); variations that are known to be associated with an increased risk of breast cancer. They actually developed a 30 minute DNA laboratory test to check for this gene variation. I have no idea if this test will become common practice and used as an important screening test in future. The study is fascinating to me – a lover of bizarre and obscure research.

I wonder how the researchers determine if someone has extremely smelly armpits, say versus just smelly armpits? I see a lot of patients with very smelly feet. I wonder if that is linked to anything. I don’t anticipate I will be doing a study on that anytime soon.

Related Topics:

• Weird Body Quirks: From Brain Freeze to Hiccupping
• Breast Cancer: Are You at Risk?
• Living Better Newsletter - Wellness news to keep you healthy and strong!

Breeding Lexi

Her little snout was sticking through a hole in the fence sniffing the air. She was frightened and whining; trying to get out. I felt like crap leaving her there, but if we are going to successfully breed our Sheltie, this is what has to be done. I called the breeder later in the day, and Lexi was hiding in their backyard, occasionally coming out to sniff the place where I was standing. That comment really made me feel super-guilty.

Lexi is a bit over two years old now and the younger of my two dogs. The older Sheltie, Maggie, is over 14 years old, blind, deaf, and arthritic, but still hanging in there. Maggie is the mother of my favorite dog, Herman, who tragically died about two years ago. I bought Lexi a few weeks after Herman died. Lexi, short for Lexipro, was my canine antidepressant and has served that purpose well.

Lexi went into heat about ten days ago. We wanted her to have just one litter of puppies before having her spayed. We have been waiting for the right time, and summers are the best time. We located a male, owned by the same breeder that we used so long ago for Maggie. His name is Connor, a very handsome, intelligent, and regal-looking male sable Sheltie. When Lexi and Connor are together, they look like twins.

Like in the past, we have our puppies (assuming the breeding is successful) promised out to family and friends. We are very choosy as to who will get one. My brother in Maryland has requested one. He almost took a puppy from Maggie's litter 12 years ago, but chickened out at the last minute. He even arranged to fly back to Maryland with the puppy. This time, I expect I will have to drive to Kansas and meet him half-way to make the exchange. I would not want to ship a little puppy by air. Our neighbor with three children would like one, too. He has a fenced yard with lots of room for an active dog to roam and the kids seem very nice. The kids are patients in my practice. And, of course, I will keep a puppy, even if there is only one. Maggie is getting very old and does not tolerate the energy of the younger dog, so a new puppy will give her a break and be Lexi’s companion.

Having a litter of puppies is not something everyone should do. It is a lot of work, but those little Sheltie puppies are so darn cute. I held Herman from day one and he was the best dog ever. I really want to do that again - pick out my puppy, or better yet, have the puppy pick out me. Herman had chosen me.

My medical assistant called me over the weekend. One of her four dogs, all pit bulls, had a litter of eight puppies. This was an unplanned, but not unexpected pregnancy, since none of her dogs are spayed or neutered. We have never had any problems finding good homes for our Shelties, but a pit bull puppy, although cute, tends to grow into a very large, often cantankerous animal. Caesar Milan, the Dog Whisperer, loves pit bulls. Any dog, given enough love and care, will become a long-time companion.

I hesitated breeding a dog again for several reasons. Knowing that there are lots of pets at the shelter, I thought about calling Sheltie Rescue. Many of those dogs have been traumatized or not carried for very well. If I was retired and home full-time, I would adopt an unwanted adult dog. Adopted dogs often do have well-established adult dog habits, and those habits may not be compatible with my other pets. I have two shelter cats; one belongs to my wife. The other cat belongs to Lexi. Yes, my dog has a cat. They love each other hang out most of the day. At night, Lexi sleeps in our room. The cat sleeps where ever she wants. If she happens to be outside, she will peer through the window and call for Lexi to come out. They take turns chasing each other to the point that Lexi can now climb up certain trees.

Conner and Lexi successfully bred (twice), so 63 days from now, we should be having a litter of puppies. I will be prepared with a new whelping box and changing my work schedule so we will be home with them for the first month so they will be well-socialized. We have hired our 15 year old granddaughter for the month of August to be the puppy-sitter. She is in 4H and is thrilled to participate. If I can arrange it, I would like to bring the puppies to a local nursing home so they can be handled by lots of people.

It has now been a week since the breeding and Lexi is doing well; enjoying the enhanced prenatal diet (she is now eating like a horse) and the extra exercise. Prenatal care is just as important for dogs as it is for people.

I will keep all of you posted.


Related Topics:

• WebMD Video: Reading Dogs
• Pet Symptoms: 6 Signs of Illness in Your Dog or Cat
• Pets: Healing With Love
• Living Better Newsletter - Wellness news to keep you healthy and strong!