Monthly Archives: March 2013

Pet Practice

I love animals.  Pets bring so much to a household – companionship, love, lessons in loyalty, a creature to care for that forces you to be responsible for and think of the needs of others, something to force you to go outside and take walks, protection from intruders and postal workers, and countless other benefits.

My good friend has frequently opined that one of the most important reasons for families to have pets is so that children learn to deal with death.  There’s a lot of merit to that.  When the goldfish stops swimming and floats to the top of the bowl, a young child has a pretty good visual of the concept that “the fish died.”

In addition to giving us practice in dealing with loss, our longer lived, furry companions help all of us practice, on a different scale, a number of aspects of dealing with illness, caretaking, medical decision making, and navigating a medical system.

As you may have surmised at this point, our family recently had an unwelcome, up-close-and-personal brush with the veterinary medical world.  Thankfully, it looks like our sweet dog will be ok –  we just have a few more gray hairs and a smaller bank balance to show for the ordeal.  And he has some (temporary) funny fur patterns from shaving done for surgery and procedures (honestly, he looks a bit ridiculous from certain angles).  This whole process, however, highlighted for me a number of the issues we deal with when we or others we care about suddenly get sick.

First there’s figuring out that something’s wrong.  Maybe it’s subtle at first, and it might take awhile to establish that something is actually wrong.  Then there’s deciding when it’s time to call a doctor, when to visit a doctor’s office, or when to rush to an emergency room.  When sent to a specialist, there’s the question of how to know the specialist is the right one, and how to know whom to trust.

Which diagnostic tests will be most helpful?  How to weigh the costs and benefits of the tests and treatments?  Once a diagnosis has been made, what do the statistics indicate about the prognosis of that particular diagnosis?  How does an individual differ from the general statistics?  Would a second opinion be helpful?  If so, from whom?  How long is it safe to delay action while seeking other input?

All of these questions on top of the general fear that accompanies an acute, serious illness can cause quite a bit of tension and stress.  Things can feel pretty out of control.  And there can easily be a feeling of being pushed into a corner, or of being forced down a path that seems hard to modify.

Remember to breathe.  Ask for guidance from those equipped to give it.  And always question, question, question until you understand and feel comfortable.


Web Radio Conversation

Practical Medical Insights will be featured on the Conversations in Care web radio broadcast this Wednesday, March 20, 2013, at 2:00 p.m. EST (1:00 p.m. CST).  I will be interviewed by the host, Tami Neumann, and we’ll be talking about the background of Practical Medical Insights, personal medical advocacy, what I do to help my clients, and tips for staying in control of your own medical situations.  Click to hear the broadcast.  You can either listen during the live program or after the show (the same link will be available for on-demand listening after the broadcast).

As always, if you have any questions you can visit or contact me directly.


Hurry – Toothpaste Food Available for Limited Time Only

My husband and I share a favorite ice cream flavor: mint chocolate chip.  It’s been the favorite of both of us for as long as I can remember.  My parents do not share in this love of mint ice cream.  They explained to me that it reminds them too much of toothpaste.

But most people like toothpaste’s flavor.  Otherwise they’d make toothpaste taste like something different.  So I’m just going to have to put it out there that my parents are wrong on this one.  Mint chocolate chip ice cream tastes really good.  But I will cede the point that too much of a good thing can get kind of icky, and the flavor balance does need to be done well in order to achieve the ideal sweet, refreshing, not-overly-cloying minty thing.

Around this time of year, the quintessential fast-food chain offers a green, toothpaste-flavored milkshake.  According to their website, a small one (12 oz.) contains 530 calories.  It has 73 grams of sugar (no, that’s not a typo) and 15 grams of fat (10 of those grams saturated).  But they’re only available for a brief time each year, so no problem, right?  I don’t know about you, but when I’m told that something is “only available for a limited time,” I get a little panic-y if I happen to like that thing.  Better get ’em while I can!  Even if I normally don’t visit that particular food establishment, the perceived scarcity of that particular milkshake flavor is a fairly effective marketing strategy.  If you absolutely can’t stand the thought of missing out, try to share a small one with two other people – treat it as a dessert, use a spoon, and savor each spoonful.  While savoring, decide whether it’s really that good.  If you really love it, why gulp it down through a straw?  And if it turns out you don’t really love it, don’t bother eating it.

We’re also in the midst of another limited-time-availability minty item .  How can you say no to those sweet little girls sitting at the entrance to your local grocery store?  The money goes to a good cause.  And the boxes are kinda small.  And the cookies are kinda small.  And….. well, they’re Thin Mints, for crying out loud – one box a year won’t kill us.  But the whole “cookie season” idea again creates a mindset of “buy a lot of them because they’ll be gone soon,” with an accompanying “it’s ok if I eat a whole box in one day, since they’re only available in the spring.”  Not a good combination of thoughts.  Buy one box of the cookies.  Eat one cookie slowly, savoring each bite.  Notice anything about the texture and feel in your mouth?  Do you get that hydrogenated-oil-pasty/waxy/tongue-coated feeling?  I do, and for me it’s not worth the calories.  The girls accept cash donations of a couple bucks – makes you feel good, and you don’t have to eat mediocre cookies with a lousy nutrition profile.

My family recently did a side-by-side taste test of Thin Mints and yet another seasonal, get-’em-while-you-can chocolate mint cookie: Candy Cane Joe Joe’s.  We saved a box from this past Christmas season for the express purpose of comparing them to Thin Mints.  Our family was split on which one was better overall.  There was, however, general agreement that the texture and mouth-feel of the Joe Joe’s were far superior (probably because they do not contain hydrogenated oil or much saturated fat), and that the mintiness level of the Thin Mints was better (when directly comparing, the Joe Joe’s actually tasted too much like toothpaste, which none of us had ever really noticed before when eating them without a comparison reference cookie).

If you’re a huge fan of minty flavors, keep in mind that such flavors of ice cream are available year-round.  No time pressure.  You can get a small serving of hard-scoop frozen yogurt at TCBY and savor it any time of year.  And you can use mint yourself in your own cooking and food preparation, and taste the real refreshing flavor of the leaves.

Try growing spearmint on your windowsill or outside your house.  It’s really easy to do (if I can grow it, anyone can).  Chew on a leaf occasionally.  Chop some up and mix with lemon juice, extra virgin olive oil, and crushed garlic for a really delicious salad dressing.  Chop some up with parsley, tomatoes, and a little onion and maybe a little cracked wheat, and toss with some lemon juice and olive oil – voila: fresh tabouli.  Boil up a bunch of leaves for some mint tea.  Experiment.  Enjoy.  Have fun.  And you may come to love the real stuff so much that the green-food-coloring-saturated-fat-filled-seasonal-must-haves lose some of their appeal.

A Matter of Taste

You may have noticed that a fair number of my posts are about food.  This is partially because what we eat plays a large part in our overall health.  And it is mostly because I really love food.  I am passionate about food, and when I am passionate about something, I find that it’s generally easy to write about.  So you are unlikely to read many posts from me about, say, accounting.  But you’ll see plenty about health and medical topics, about my family, about music, about the great outdoors, and about food.

I come from a long line of folks with not-super-fast metabolisms.  I can’t just eat however much I want of whatever I want while maintaining a healthy weight.  And because of my medical training, as well as my special interest in nutrition, even if I did have one of those enviable metabolisms, I would still tailor my choices in a reasonably healthy direction.

Did I mention how much I love food?  My taste has become significantly more refined (read: “picky,” “snobby,” or “obnoxious” as you deem fit) as I’ve aged.  We are programmed to enjoy and crave butter, sugar and salt, but I’ve found that by practicing a few techniques, people can outsmart some of those drives and start to enjoy and crave foods that will have better long-term effects on their bodies.

One of these tricks I mentioned in my post about chili last month: go big with flavors.  Splurge on a wide variety of high-quality spices and dried herbs.   Smell them frequently.  Open jars or bags of different spices, herbs and blends, hold them next to one another, and smell the combinations.  So much of what we describe as taste is actually smell.  Our taste buds can distinguish sweet, salty, sour and bitter, but anything you would describe as fruity, floral, nutty, smokey, or a myriad of other flavors is really related to its fragrance.  Try closing off your nose for the duration of a couple of bites while you’re eating something you really enjoy, and you’ll realize how much of that taste is really due to its smell.

Practice combining herbs and spices.  Have contests with your family to see who can guess the smells of the spices without looking.  Describe the fragrances.  Describe the flavors when you taste them.  Try to discern the flavors when you eat what someone else has prepared, and see if your friends and family can discern which flavors you’ve added to the dishes you prepare.  As the richness and complexity of flavor increases in what you cook, it’s amazing how quickly you discover that you don’t miss things like added salt or sugar.

As you’re really concentrating on the flavors and aromas of what you’re eating, focus also on the texture.  What does the food feel like in your mouth?  Is it crispy?  Crunchy?  Silky?  Spongy?  Smooth?  Gritty?  Chewy?  Flaky?  Tender?  Tough?  I’ve noticed that a lot of processed baked goods (boxed cookies and cakes from the grocery store, for example) actually have a very waxy, pastey texture when you really contemplate how they feel as you chew them.  The hydrogenated oils and saturated fats give them this feel, and when you center your thoughts on it, it really doesn’t feel great.  Contrast that with the feel of a bite of a fresh honeycrisp apple.

“That’s not fair,” you may say.  “That’s comparing apples to oranges.  Well, to cookies, actually.  Not a reasonable comparison.”  Perhaps.  So try this:  take a small spoonful of Jiff or Skippy or another similar standard peanut butter, and take a small spoon of a “natural” peanut butter made with only peanuts (and maybe a very small amount of salt – like 60 mg per two-tablespoon serving).  Try the one just made with peanuts first.  Hold it in your mouth, move it around with your tongue, breathe a few times while it is still in your mouth so that you get the full aroma and flavor.  Notice how it feels in your mouth, and how your mouth feels after you swallow.

Now try doing the same thing with the Jif/Skippy or other standard peanut butter made with a long list of ingredients including hydrogenated oil.  There’s an initial sweet taste (added sugar), and it doesn’t melt quite as easily in your mouth.  There’s a bit of a waxiness or pastiness to the feel.  And after swallowing, there’s a “coated” mouth feeling.  And a bit of a plastic-y aftertaste.

If you’re not consuming frequent or large amounts of peanut butter, switching from one type to another is unlikely to have enormous health effects.  But It helps to really focus on the details of flavor and texture of food in general.  By focusing on these details, I have found that I like and crave far fewer types of foods than I once did.  My pickiness serves me well.  If I’m going to eat a cookie, it’s going to be a really good cookie.  And really good cookies are encountered much less frequently in everyday life than mediocre or bad ones, so instances of temptation are drastically reduced.



Reader Beware

I read something on Facebook last week that someone had “shared” from another source, and it really bugged me.  It started with the following:  “AFTER YEARS OF TELLING PEOPLE CHEMOTHERAPY IS THE ONLY WAY TO TRY AND ELIMINATE CANCER, JOHNS HOPKINS IS FINALLY STARTING TO TELL YOU THERE IS AN ALTERNATIVE WAY …”

I could tell that the piece was in no way connected with any reputable medical center or research institution.  But I have a medical degree.  The piece was full of scientifically false statements, and full of “health” advice that is in no way espoused by the medical establishment.  There were a couple of reasonable general tips thrown in (i.e. eat lots of vegetables, exercise daily), albeit with baloney reasoning behind them, and enough simplified statements that had partial truths thrown in that someone without a health or science background could think it was real.

So why does this bother me so much?  Fraudulent “medical” posts can do a great deal of harm.  A person believing scam posts could take substances which might hurt them, either because the substances themselves may be dangerous or because they could interact with a person’s other medications.  A person may also delay seeking medical attention when necessary because they are under the illusion that researchers at a premier medical institution have stated that eating vegetables, taking unspecified supplements, breathing deeply, and avoiding milk, sugar, coffee and chocolate will cure cancer.

So how can you tell which posts are scams and which have merit?  A great first step is to check out  They don’t always get every detail right, but they do a very good job of discerning whether a circulating article is true or false, and they provide references (and links to their references).  When I read the above post, I went to the Snopes website and typed “Johns Hopkins cancer” into the search box.  The post I had seen was in the first listed result, and was listed as “false.”  It turns out that this particular scam post has been circulating for several years.

Fake “articles” like this one take people’s focus off what research actually shows to reduce cancer risk.  Thankfully, the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins put out a detailed response to this fraudulent post:

The following is a direct quote from this page (there is much more information on the page, so please follow the above link if you’re interested):

“Several Johns Hopkins experts participated in the World Cancer Research Fund – American Institute for Cancer Research report Food, Nutrition, Physical Activity, and the Prevention of Cancer: A Global Perspective, published in November 2007, which is considered by cancer prevention experts to be an authoritative source of information on diet, physical activity and cancer. Their recommendations for cancer prevention and for good health in general are:

  1. Be as lean as possible without becoming underweight.
  2. Be physically active for at least 30 minutes every day.
  3. Avoid sugary drinks. Limit consumption of energy-dense foods (particularly processed foods high in added sugar, or low in fiber, or high in fat).
  4. Eat more of a variety of vegetables, fruits, whole grains and legumes such as beans.
  5. Limit consumption of red meats (such as beef, pork and lamb) and avoid processed meats.
  6. If consumed at all, limit alcoholic drinks to 2 for men and 1 for women a day.
  7. Limit consumption of salty foods and foods processed with salt (sodium).
  8. Don’t use supplements to protect against cancer.

Our experts recommend that people meet their nutritional needs through their food choices. While vitamin supplements can be helpful in people with nutritional deficiencies, evidence suggests that supplementation above what the body can use provides no added health benefit.”

I get forwarded hoax e-mails frequently, and see them on Facebook all the time.  Before I even turn to Snopes, one clue that tells me that an article is fraudulent is a lack of a citation or link to the original source.  Another sign is that the post begins with something to the effect of “Hey Everyone, I checked this out on Snopes and it’s true!”  Pretty much every time I see this, when I go to the Snopes site it turns out to be blatantly false.

A lot of the “warning” posts or missing person posts out there are hoaxes.  Aside from being a general nuisance, these posts can cause a boy-who-cried-wolf effect and end up causing people to just ignore all of them, even the ones that are true.

Why do people start these rumors/urban legends/hoaxes?  Some of them may be put out there to sell a particular product (e.g. “Did you know that you can cure X by simply taking 200 milligrams of Y twice daily?”), and a lot of them seem to be out there just because someone wanted to feel the power of starting a rumor.  We all have a limit to the number of issues that can take up active space in our brains – if that space is taken up by falsehoods, we may miss the true and important ones.