TWAS THE WEEK BEFORE CHRISTMAS

Twas the week before Christmas and all through my town,
People were frantic, but nowhere a frown.
Hy-Vee and Fareway were stocking with care,
In hopes that the blizzard would soon be there.

The children were excited and nestled in their beds,
While visions of steep hills danced in their heads.
And mommy in her apron, and daddy in his cap,
The DOCTOR was on call, but settled for a nap.

When out on my lawn, there arose such a clatter,
The dogs sprang from the couch to see what was the matter.
Away to the window, I walked with my phone,
I wondered if tonight, the cops would soon groan.

The moon shown its light on some new fallen snow,
The green grass was at ease for spring would soon flow.
When what to my wondering eyes should appear,
It is no suprise, it's the neighbors scraping with fear.

With the snow falling, and wind so fierce,
I knew in a moment, the sirens would soon pierce.
More rapid than rabbits, the parents would run,
They whistled and shouted, and slipped on their buns.

And then in a twinkling, I looked to the sky,
I knew from above, Jesus stood by.
For my friends and family this is the season,
I don't have to tell you, Jesus is the reason.

New Years Resolution

Losing Weight--No Simple Resolution

It is mid-November and it has been unseasonably warm. Many of you put up Christmas lights this past weekend. Perhaps you have even created your list of New Year's resolutions to include losing weight for a spring cruise. Just saying that you want to lose weight isn't going to provide the impetus to do it. Instead, approaching your fitness goals by evaluating why and how fit you want to be, is the answer to your resolution. In other words, envision what you want to achieve through fitness, write it down (i.e. I want to lose 10 pounds), and finally, make a game plan.

First off, each person needs to define what “health” means to them. For most people, they are interested in health in order to pursue other things they are passionate about in their lives. As mentioned above, some want to get in shape for that all-important spring cruise. Find out where you stand in terms of fitness.

Another important aspect is that you should “want” to be healthy. Choosing your health means comprehending what it will take to get there—usually, a lot of hard work and difficult lifestyle changes. I have found that many people, once informed of the effort needed, will realize they don't want it that badly. I would have to agree that it is better to know that now, than to fail with fitness regimens when your heart is not really in it.

Once you define what your health and fitness is to you, and you have chosen to be healthy, it is now time to create the game plan. The game plan will be unique to each person, depending on the personal vision of health. In other words, there is not a diet or exercise program that is universal. Some things may seem very unconventional to a bodybuilder like me, but totally “right” for a stay-at-home mom. I believe there are some common ground components, however. For instance, you need strength building, stretching, and aerobics, in any good exercise program.

If you are having trouble getting started or do not think you have the time, I have listed a few things that may help get you on track.

1.      Stay consistent with your workouts. Try not to skip. If you are going out of town for a few days, map out a walking or jogging program where you will be staying. Google some routine exercises that can be done in a hotel gym or your hotel room.

2.      Begin your day with your workout. The sooner you get it done, the less likely you are to have other obligations get in the way.

3.      Plan your workouts ahead of time. This will save you time and make you less apt to quit midway through when you do not know what to do next.

4.      Write a daily blog or post a daily entry on Facebook or Twitter regarding your exercise routine. When others know about your accomplishments, you will feel more accountable and motivated to stick with your routine.

5.      Multi-task during your cardio session. I like to check email on my smartphone or make lists on my memo app for things to do later. Use this time wisely so you are not getting anxious about what you need to do next.

6.      When the rush of the season is getting to you, try to allocate a section of your day for relaxation. Read a book, read a daily devotion, or simply sit quietly.

Finally, be mindful of your progress and make any necessary changes and adjustments along the way. Health and fitness is not a static process, but one that needs to be evaluated on a regular basis.

I hope this has helped set the ball in motion to a healthier lifestyle. Stick with your IronLadyDoc and see where we can go together! Take your health Center Stage!

TAKE YOUR HEALTH CENTER STAGE

Not to beat a dead horse about the lack of primary care doctors, but I want everyone to realize this FACT...there IS a lack of primary care doctors. It has been well documented that fewer and fewer medical students are choosing to enter primary care specialities, such as family medicine. The truth is, our friendly leaders in the White House have also been reviewing statistics on this same subject. So, one of the many ways Mr. White-House is trying to encourage more family practice docs, aside from giving them our tax money to go to medical school (oops, that is top secret information), is to expose more medical students to family medicine, such as by requiring them to do a clinical clerkship in a family medicine office. I guess the logic is that if they see how great and fulfilling it is to be a family doctor, then more of them will want to go into it as a career.

As well-intentioned as this may seem, there is no better way to turn off medical students from going into primary care than by having them see first-hand how frazzled, frustrated, and overworked a primary care doctor's life really is. In fact, have them rotate through our local walk-in clinics and they will see first hand how it works...check in patient, take back to room, give pill, collect money, send out the door, go to the next room and do it all over again. Never mind that their blood pressure indicates risk for stroke or heart attack, or that their weight puts them at risk for diabetes.

But, if you really want students to go into primary care, have them rotate through an office where there is enough time to talk with patients, where doctors are not overworked, and where both doctors and patients are happy.

One of the worst pieces of advice I got in medical school was to guard my ‘professionalism’ – which meant, act like a talking robot. I think he worked for Mr. White-House. Hogwash! Doctors are all unique, and the better patients get to know us, the better they’ll sort themselves into good matches with their primary physician.

Will family medicine survive? Of course it will! Society is going to get the health care it wants and deserves, and medical students are going to get the medical career they want and deserve. Make no mistake: We are not  helpless pawns in the current system. When given a choice, patients will go where they receive quality care.

One month ago, I embarked on a quest to serve my patients. The many who know me and the many who will get to know me, will find it refreshing that I am someone who is not simply on a mission to get in and out of the exam room and who prefers to address the actual problems instead of throwing pills at them.

So, in an effort to "guard my professionalism" and maintain my Hippocratic Oath (an oath historically taken by physicians swearing to practice medicine ethically and honestly) I have decided, with the help of some very special people, to create my solo medical practice.

I thought it appropriate to name my practice, "Center Stage Primary Care", because realistically, my hope is that you will allow me, to help you, take your health "center stage." Each patient no matter what age, will learn about overall health and wellness.

I will focus on diagnosing and treating conditions of all ages while emphasizing preventative medicine. I will refer patients, when appropriate, to specialists and/or to hospitals for tests, further treatment and therapy. Most importantly, I will focus on YOU, the patient!

My new address:1601 NW 114th St Suite 142, Clive, IA 50325. For now, you may call 515.222.3151 to schedule an appointment. When you hear the receptionist say, "Central Iowa Orthopeadics," don't hang up. You have the right number. Let Kerri, Jodi, Pam, or one of the other fabulous girls in the office welcome you and schedule your appointment. And, just between you and I, thank them for giving us a home so we can help each other take your health CENTER STAGE!

Official start date is October 15, 2012 provided no delays in my credentialling.

Are You Ready for a Doctor Shortage?

I believe the projected doctor shortage caused by the Affordable Care Act will drive primary care into two opposite tracks:

• The “Apex of the Pyramid” Track
• The Concierge Medicine Track

Each is a distinct and logical response to the patient overload from the doctor shortage that is rapidly approaching. Each points out gaping holes in our medical education that must be addressed. Concierge medicine has an additional powerful force acting in its favor.

 

The American Medical Colleges estimates that there will be a doctor shortage of 63,000 doctors by 2015 and 130,600 by 2025 in the wake of the SCOTUS decision to let the Affordable Care Act stand. This doctor shortage is caused by a tidal wave of newly insured patients has to be served somehow and US Medical Schools and Residency Programs cannot supply anywhere near these numbers of new physicians in this short of a time frame.

 

How will healthcare markets respond to this doctor shortage – especially with regards to primary care? I see two likely options.

 

1) Volume Driven: Doctor as apex of a care pyramid

In the more traditional practice structure, the doctor shortage will force the primary care physician to become the leader of a care team supervising a number of physician extenders who provide the majority of the hands on services. The skill and experience of the physician will be saved for the more complicated and severe cases seen that day.

 

The majority of the doctor’s activity will be devoted to leading and coordinating the care provided by the pyramid of N.P’s and P.A.’s who are their direct reports.

 

The challenge to this model is the complete absence of functional leadership skills training in most medical school and residency programs. 30-50% of these physician’s time will likely be spent in leadership and management activities for which they are not prepared on graduation.

 

2) Service Driven: Concierge Medicine/direct care model

 

As the doctor shortage worsens, the typical patient will begin to notice they are only seen by a physician on rare occasion. A certain percentage will become willing to pay for that privilege. I suspect this will quickly grow to a huge new demand for concierge medicine services, where you pay a reasonable monthly fee to guarantee you are always seen by your doctor.

 

As the doctor shortage continues to worsens, I believe a larger and larger segment of our population will become willing to pay to continue to see their primary care doctor as they do today and their only alternative will be concierge medicine.

 

The huge popularity of concierge medicine will have another important driving force – the office duties of the concierge medicine physician are exactly the opposite of those in example #1 above.

 

In a concierge medicine practice, the physician is often seeing less than 15 patients a day, providing direct patient care and continuing to have meaningful personal relationships with their patients.

 

 

Let me know your thoughts. Which direction do you think medicine is going?

John Galt Speech

A John Galt Speech For Direct-Pay Physicians
“You demand to know what has happened to us, the physicians you thought you controlled. You have cried that our sins are destroying the world and you have cursed us for our unwillingness to practice the virtues you demanded. Since virtue, to you, consists of sacrifice, you have demanded more sacrifices at every turn. You have sacrificed all those evils which you held as the cause of your plight. You have sacrificed justice to mercy. You have sacrificed independence to unity. You have sacrificed wealth to need. You have sacrificed self-esteem to self-denial. You have sacrificed happiness to duty.

“While you were dragging us to your sacrificial altars, we physicians who value justice, independence, reason, and self-esteem – we finally came to see the nature of the game you were playing, which we had previously been too innocently generous to grasp. And we have chosen to play no longer.

“All the physicians who have vanished from your system, the doctors you hated, yet dreaded to lose, we are gone from you. Do not cry that it is our duty to serve you. We do not recognize such duty. Do not cry that you need us. We do not consider your need a claim. Do not cry that you own us. You don’t. Do not beg us to return. We are making our own way, apart from you.

“In your cynical attempt to control the healthcare system, you have coerced us – with your threats to our livelihood, threats of massive fines, threats of jail – to abandon our sacred obligation to our patients. Society must come first, you say. The needs of the collective are paramount, you insist. We must do what the experts tell us to do, you demand. And in the process you have destroyed the doctor-patient relationship which is the backbone of our profession. You have reduced physicians to ciphers, to puppets. And you have reduced our patients – the living, loving, hoping, striving people who come to us, who place their trust in us and their lives in our hands – to interchangeable members of a vast herd. You have demanded that we guard society’s interests, and abandon our sick to their own devices in your cruel and parsimonious healthcare system.

“Your process is now firmly established. Your methods have been legislated by Congress, embodied in volumes of rules, regulations and “guidelines” (strictly and ruthlessly enforced), upheld by the courts, and finally (and most tellingly) sanctioned as being entirely “ethical” by your allies, the leadership of our own professional organizations. You have made the healthcare system untenable for doctors who value true medical ethics.

“You have placed us into a position where we must either resign ourselves to an unethical, demeaning, health-destroying style of practice, or get out. We have gotten out.
“We have gotten out. We have left your Program. We refuse to sacrifice ourselves for you any longer. We will not sacrifice our livelihoods, our morals, our independence, our minds, or our patients for your bastardized idea of virtue.

“We will practice medicine in the only manner that still permits us to behave ethically toward our patients, in the only way that we can honor the true doctor-patient relationship, in the only way we can legitimately regain the title of professional. We have chosen to be paid directly by the people to whom we provide our services, by the people to whom we dedicate ourselves as professionals. We have chosen to cut you out.

“To argue that direct-pay practices are unethical – to argue that any innovation that would somehow restore both our professional integrity and the patient’s rightful advocate is unethical – is completely upside down. This argument only reveals your own inner corruption. We are taking the only pathway that remains to us to restore the true foundation of medical ethics, to restore our profession – to always place the patient first.

“To argue that direct-pay practices threaten the general welfare completely ignores reality. We are doing the only thing we can do to begin restoring protections that people are supposed to have when they are sick and facing a healthcare system that is utterly bent on withholding their care whenever it can be gotten away with.

“To argue that direct-pay medicine will create a two-tiered healthcare system is absurd on its face. It provides a mechanism by which at least some of your intended victims can escape the deadly obstacles you have laid before them. Saying that it amounts to a two-tiered healthcare system is as absurd as arguing that slaveholders were wrong to free their slaves before Emancipation, because doing so would create an elite subpopulation of former slaves; that until all slaves are freed, no slaves should be freed. But when a few slaves were freed and walked the earth as free men, that action was not only ethical, but it also showed others what was possible. Over time, it created a widespread expectation for freedom that eventually could no longer be ignored, and that, at huge cost, was finally fulfilled.

“You wouldn’t understand this – you who already know everything, you whose experts already have all the answers – but any innovation that can potentially spare patients from some of the harm you have in store for them will necessarily be applicable to only a few patients at first. That is how disruptive processes work. In your proposed perfect system, of course, disruptive processes are anathema – because they disrupt. But in the real world disruptive processes are creative processes, processes of growth, processes of rejuvenation, processes that create opportunity. This is why you always try to suffocate disruptive processes, with your cries of “unfair!”

“Disruptive processes always begin as niche products or services, attractive only to a few high-end users; too expensive or too marginal for the vast majority; ignored, ridiculed or castigated by current providers. But if at their core they are offering something fundamentally useful, they will slowly demonstrate their worth – and eventually all the potential users will see the light, and demand for the product will become explosive. At this stage the means are invariably found to make the new product affordable and available to meet the demand, while preserving the core benefits. And when that happens, the traditional providers (who never saw it coming) are suddenly out of business.
” We are a disruptive process, and the process we are disrupting is yours.

“We are not playing your game any longer. We will no longer be victims; we will no longer subject ourselves to your attempts to make us guilty. We will no longer walk, heads bent down, to your altar of sacrifice.

“You no longer have any hold on us. We have done our time. We are getting out. If we decided to leave medicine and open a road-side fruit stand, or become lumberjacks, or just spend our time puttering around in the basement, you would have no objection to that. So by what right do you object if we hang out our shingles, and see a few patients who voluntarily come to us, using their own resources to do so? You can have no rightful objection to such a thing. So be quiet about it, or admit to your own corruption.”

The Butterfly Effect

The last few days I have noticed something new in my backyard garden. I kept seeing these "dragonflies" whisping past me. I thought to myself, there are a lot of dragonflies back here. I had not seen them much since my days growing up on Lake Okoboji.

As I took a closer look and watched them fly about, these were no dragonflies! They are hummingbirds! Call me silly, but I had never seen a hummingbird before. I noticed, then, that my neighbors had hummingbird feeders...those red feeders stuck on the kitchen windows to attract them. I googled on the types of plants that hummingbirds liked and found that I had some wonderful plants for them to nourish themselves.

And the butterflies....wow, so many butterflies. This year I planted two new butterfly bushes. Let me tell you...if you plant it, they will come! Butterflies are amazing. I named my first Monarch "Petie". I swear Petie came back to see me every summer when I was a kid growing up on West 9th street. He knew just where to come. He would land on my finger and I knew it was him...not changed one bit from year to year.

Are you aware that in 1963 Edward Lorenz presented a hypothesis to the NY Academy of Science stating that a butterfly could flap its wings and set molecules of air in motion, which would move other molecules of air, in turn moving more molecules of air--eventually capable of starting a hurricaine on the other side of the planet? Lorenz and his ideas of the "butterfly effect" were laughed out of the conference.

Thirty years later, it was no suprise that professors came to the conclusion that the butterfly effect was authentic. Soon after, it became law.....The Law of Sensitive Dependence Upon Initial Conditions. And it encompases more than just butterflies...it includes people as well.

You and I make moves whose effects ripple through the lives of others everywhere...just like the butterfly that flaps its wings to move molecules. You can look back as far as the eyes can see and you will find that one thing can be traced back to another, and another, and another. And how far forward would we need to go in your life to show the difference you will make. Everything you do matters and many lives will be shaped because of something you and I do today. No one is created equal. All our abilities are in no one else. And you may not know it, but you and I have had an effect on someone else. We will never know when and how, but it happens.

My Monarch friend, Petie, changed my life. A couple flaps of his wings moved molecules of air, and those molecules moved more molecules of air, and so on. There was not a hurricaine, but those movements affected me. Petie will never know how much I love monarchs or nature or those silly "dragonflies" I see in my backyard. You just never know....

Ahhhhhhhh, the quest for “Center Stage"................

You may wonder why bodybuilders put themselves through agony for 4-5 months of the year, loneliness, and in some ways discrimination by the general population.

And, you might ask, why would anyone in their right mind place pictures on a web page that remind them every day of how painfully out of shape they have become? Well, to tell you the truth, lots of people need to see the transformation of their body through time, dedication, and hard work, to know that it can be possible for them.

 

I recently read an analysis by Alan Solomon, Strength Quotient and Performance, and have come to the realization that how we project who and what we are, is our performance in life itself. It is all about “attitude.” I have found in myself, as well as in others, that we pass through several sequences from negative to positive and from ineffectual to mastery. It appears that one setback or discouragement can sometimes bring about a lack of motivation, which results in our sinking back to a state of apathy. On the other hand, encouragement and assistance from others can provide the necessary strength to persevere.

In bodybuilding as in all other endeavors, one will have a lot of obstacles to overcome, but once they find that their efforts are showing positive results, they push harder, finally reaching their high point of self-confidence.

Unfortunately, one may reach another breakthrough……...the disheartening realization that their efforts are not good enough. Then, the mind wanders and you become frustrated only to find that if you persevere and concentrate, you will grow into a state of “getting there.”

As you see, everything we do is a step backward, but two steps forward. This is the process of “self-mastery” as Mr. Solomon so accurately describes in his analysis.

As you progress toward center stage, try to push yourself through the sequence from negative to positive. I know you can do it if you set your mind to it. See it and get after it!

August 8, 2012 — University of Chicago chief pediatric surgeon Donald Liu, MD, PhD, saved the lives of 2 children in the rough waters of Lake Michigan August 5 but lost his own life when he drowned after the rescue in southwestern Michigan.
The 50-year-old surgeon, who had gained a reputation for adapting minimally invasive surgical techniques to children, was reportedly pulled underwater by a rip current after entering the lake to help two 12-year-old boys who fell out of a kayak amid high waves. The youths made it safely to shore, according to police in Chikaming Township, Michigan, where Dr. Liu and his family were apparently spending a weekend getaway. Both boys were friends of the Liu family, the Chicago Tribune reported.
A coworker called Dr. Liu a hero. John Alverdy, MD, professor and vice chairman of surgery at the University of Chicago medical school, said it was no surprise that Dr. Liu would jump into the choppy waters when he saw the boys struggling.
"As a surgeon, he literally grasped children from the brink of death," Dr. Alverdy said. "I'm sure if he were here today, he'd say, 'I was just doing my job. That's why I'm here. I'm not going to watch kids die.' "
The thought perhaps reflects Dr. Liu's own words earlier this year. He was quoted in a "Top Doctors in Chicago" profile in the January issue of Chicago magazine as saying, "At the end of the day, the biggest impact you can make in anything is through kids."
"Servant of Mankind"
The University of Chicago medical school has lost "one of its most outstanding faculty members," Dr. Alverdy said, calling Dr. Liu a "fantastic surgeon, great educator, and brilliant researcher who was a servant of mankind."
Dr. Liu, who was board certified in both general and pediatric surgery, joined the University of Chicago surgery department in 2001 and became section chief of pediatric surgery and surgeon-in-chief at the university's Comer Children's Hospital in 2007. His medical achievements included performing lifesaving trauma surgery on children and helped redesign laparoscopic surgical instruments for use in children and infants, Dr. Alverdy said.
Another colleague, Daniel Teitelbaum, MD, a professor of surgery at the University of Michigan, Ann Arbor, said, "He made significant contributions to minimally invasive and laparoscopic surgery for infants and children with imperforate anus and gastroesophageal reflux disease, as well as for pediatric cancer." He said he helped train Dr. Liu during his pediatric surgery fellowship at the university's C.S. Mott Children's Hospital from 1995 to 1997 and remained a close associate.
In 2006, Dr. Liu resected a hepatoblastoma in a 2-kg preterm infant using a linear stapler, which also simultaneously minimized bleeding by sealing the liver — a novel approach at the time, according to a University of Chicago press release. In addition, Dr. Liu used minimally invasive surgery to treat pediatric patients with conditions ranging from median arcuate ligament syndrome, pectus excavatum, and gastroschisis to life-threatening abdominal adhesions.
Volunteered in China
Dr. Liu also developed a collaboration between Comer Children's Hospital and the Shanghai Children's Medical Center in China, where he lectured and helped train and mentor junior faculty there. "He was Taiwanese and went yearly to China, to Shanghai, and other hospitals," said Dr. Teitelbaum, who accompanied him on one of those medical trips years ago. "He was quite passionate about that."
His work in China earned him an award from the Shanghai government and an endowed chair at Shanghai Jiao Tong University School of Medicine. He grew up in Taiwan, the son of 2 physicians.
In his research, Dr. Liu studied Hirschsprung's disease, the pathogenesis of necrotizing enterocolitis, and how an infant's dietary intake can alter the intestinal microbiome.
He received his MD and PhD in immunology from Jefferson Medical College at Thomas Jefferson University in Philadelphia, Pennsylvania. He then performed an internship and general surgery residency at the Hospital of the University of Pennsylvania, where he met his wife, Dana Suskind, MD. His widow is also a professor of surgery and pediatrics at the University of Chicago and is the director of the Pediatric Cochlear Implantation Program. Together they have 3 children from 7 to 13 years of age.
Dr. Alverdy said Dr. Suskind is "devastated" by the loss of her husband. The Chicago Tribune reported that she attempted cardiopulmonary resuscitation on her husband after emergency responders pulled him from the water, but she was unable to revive him.
In a university-prepared statement, Jeffrey Matthews, MD, professor and chairman of surgery at the University of Chicago, said of Dr. Liu: "That he died the way he lived, while saving children, is somehow consistent and heart-wrenching at the same time."

Motivation for Exercise

Ask Dr. J—How can I stay Motivated?

Question: Dear Dr. J, Every time I start an exercise program, eventually it fades out of my life and I stop doing it altogether. Can you give me some ideas on how to avoid this? Is it bad to start again, stop again, start again, stop again, etc.?

Answer: Sticking with your exercise program regularly and consistently is your best bet for overall health. While there's no specific danger in starting and stopping over and over again, it's important to set personal goals and identify what motivates you to exercise. Even if there's been a long lapse in your sessions, you should do your best to get back to regular exercise as soon as you can.

The first thing you need to do is find out what motivates you. For some, it's disease prevention. For example if a close family member has been affected by heart disease, diabetes, arthritis, osteoporosis, or cancer, that may be what motivates you to stay healthy and avoid the same path. Regular exercise reduces your risk of developing these and other diseases and will help you maintain a healthy body weight.

For others, living longer could be a motivator. Research has shown that exercise may extend the years of your life. It can greatly enhance your quality of living, too, by making regular day-to-day physical activities such as climbing stairs, carrying groceries, and vacuuming easier.

Now, the most important thing is getting started and sticking to it. How one starts an exercise program usually will dictate whether you stick with it. If you have started programs in the past only to quit a month later, pay careful attention to setting realistic goals. For example, don't try to run a marathon or lose 10 pounds in a month. Begin slowly and try a number of different exercises.

 

You also can try my favorite technique of all………VISUALIZATION! Picture yourself enjoying your workout and then feeling great when you've finished. Then, picture the body you want. Go ahead…….tell me this does not motivate you to keep it up.

If boredom is hindering your routine, try doing new exercises, pick a new sport, or recruit an exercise partner. The key is finding something you like and sticking with it.

Something else I like to do is distract myself during exercise. This works especially well for cardio activities. Distractions, such as reading, listening to music, or watching television while you work out, can also help keep you motivated. Try exercising at a different time of day, or break up a workout schedule to include aerobic exercise in the morning and strength training at night.

Overall, it's important to not get discouraged if you miss a week or two of exercise. It's never too late to get started again. When your program gets derailed, try to figure out what went wrong and learn from your mistakes. Best of luck and keep training hard and smart!

If you have diabetes and peripheral neuropathy, it's critical that you carefully control your blood sugar levels. High blood sugar over time damages the blood vessels and nerves in your legs and feet. Fortunately, a good diet and regular, moderate intensity exercise can help improve your body's use of insulin, get your weight under control, and improve blood sugar.

Adopting healthy eating and exercise habits is "tremendously important" because it keeps blood glucose (blood sugar) levels under control. There is considerable scientific evidence that lifestyle changes can prevent the development and slow the progression of microvascular complications. In addition, exercise like walking can relieve the pain, probably because it improves circulation.

To change your lifestyle:

• Get regular physical activity. Ask your doctor for an exercise routine that is right for you. Aside from helping you reach and maintain a healthy weight, exercise also improves the body's use of insulin and improves circulation. It also strengthens muscles, which improves coordination and balance in muscles that may have been weakened due to decreased nerve activity. Your doctor can get you started on an exercise program that won't be hard on your feet -- like walking, swimming, biking, or yoga. You may need to limit exercises that do stress your feet, such as running or aerobics. People with neuropathy -- especially those with bone deformities -- should always wear well-fitted shoes to avoid pressure sores and ulcers on the feet.
• If you smoke, stop. Smoking makes circulatory problems worse, which is thought to be one cause of neuropathy, and worsen the symptoms of peripheral neuropathy. Smoking also greatly increases the risk of heart disease in people with diabetes. Talk to your doctor about ways to quit smoking. Often, people turn to counseling and to drug therapy, such as nicotine patches, gum, or other aides. Antidepressants can help reduce cravings and help control pain from neuropathy at the same time.
• Carefully limit alcohol. Excess alcohol intake can worsen neuropathy and make it hard to control your blood sugar levels.

Eat a Balanced Diet

To keep blood sugar as close to normal as possible, it's important to follow the right meal plan. A well-balanced diet can make a big difference. You might want to consult with your doctor or a dietitian to learn what foods are best, when to eat, how much to have of each food, and what to avoid.

You will need to keep close track of the carbohydrates you eat since they have the most immediate effect on your blood sugar. Carbohydrates are in these food groups:

• Fruit
• Milk and yogurt
• Bread, cereal, rice, pasta
• Starchy vegetables

You should eat plenty of fiber since it plays a role in the digestive process, reduces heart disease risk, and can improve blood sugars. Choose from:

• Fresh fruits and vegetables
• Cooked dried beans and peas
• Whole grain breads, cereals, and crackers
• Brown rice
• Bran products

It's important to eat foods that are low in fat. Good choices are:

• Lean meats. Bake, broil, grill, roast, or boil - never fry
• Low-fat dairy. That includes cheese, milk, yogurt
• Low-fat vegetable cooking spray
• Low-fat margarines and salad dressings

Avoid high-sodium foods which can cause high blood pressure:

• Salt
• Boxed mixes of potatoes, rice, pasta
• Canned meats
• Canned soups and vegetables
• Processed and packaged foods (lunch meat, sausage, bacon ham)
• Salty snack foods

This is not my usual place to speak about financials, but recently this has become a topic of major significance. More specifically, I am talking about your financial advisor. Your financial advisor must put your interests first.

The problem is that many, but certainly not all, financial salespeople are compensated based on the fees and commissions they generate.

So, how do you know if your financial  advisor is acting in your best interest? There is a term called "fiduciary". Fiduciary signifies that the advisor is legally bound to act in the best interest of their investor clients.

Make sure your financial advisor is a registered fiduciary. Some brokers, however, will tell you that they are able to act as both your fiduciary and salesperson...alternating between the two (typically depending on which role pays the most) without taking 100% fiduciary responsibility 100% of the time.

You can take the following steps to safeguard your assets:

1. Require all financial professionals working with you to sign fiduciary aggreement. Ask your attorney to draft the agreement and have it notorized.
2. Ask your financial professional how he or she is compensated.
3. Request a financial advisors' rerferences and ask those references whether they found that advisor honest and competant.

These simple steps will truly show who is willing to act as your fiduciary and act in your best interest.

What is it about Dreams???

I want to touch on a book that I just finished reading. It starts out a bit drab as it discusses the psychological work of Carl Jung. You may remember studying him during your early college years. Then, it gets into some really interesting analogies from the Bible. In the book, Dreams, God's Forgotten Language, author, John Sanford draws on the work of Carl Jung to show how dreams can help us find healing and wholeness and reconnect us to a living spiritual world.

Dreams traces the role of dreams in the Bible and how God speaks to us. Carl Jung, the founder of analytical psychology, pioneered a whole new outlook on the way we tick. He peered into our darker spaces and our dim, forgotten corners.

To start, lets discuss our shadow. If you stand facing the light, you will cast a shadow. Unless, you turn and look on the floor behind you, you will not be aware of the dark shadow following you. The shadow is the part of our personality, which is in our background, of which we are usually unaware. Similar to Eckhart Tolle’s idea of “the ego,” our shadow is the part of ourselves we want to hide from the world...our mistakes, guilt, failures, insecurities and demons that we bury under a carefully crafted ego of armor.

So the shadow is our angry side, our weakness, our sickness, our primitiveness, our sensuality, our rebelliousness, our inferiority...whatever it may be about ourselves of which we are most afraid and would rather not face. The shadow slinks around and most often we would rather die than have someone say we are like them.

Where do we see our shadow? In our dreams. It appears as the sinister or inferior figure of our own sex. The more we try to remain unaware of it, the more it manifests itself. To understand the shadow, we can contrast it to the persona. The persona is the front we put on. It is a form of adaptation to the society in which we live. Most often, we come to identify with the persona. We think we are the person whom we would like to appear to be. The shadow stands in direct contrast.

From a Christian perspective, our dreams reflect the life process at work in us that seeks to make us aware of Christlike totality or wholeness. So, it is not a matter or "either or", but of "both." We cannot give our shadow a full license, but instead, we become one with our good side and reach out  and intergrate our lower nature. This solves the "Christian Problem."

To learn more, consider reading Dreams, God's Forgotten Language by John Sanford. You will see illustrations of dreams and visions in the Bible and you will also see how we, as Christians, have suppressed our shadow and have literally become "split."

Glycemic Index

• In the past, we used the terms simple and complex to describe carbohydrates
• The problem some complex carbs caused a rise in blood sugar similar to simple carbs
• Now we use the term Glycemic index
• Measures how fast food is likely to raise your blood sugar
• Glucose is given an arbitrary value of 100 and other carbs are given values relative to glucose
• The impact a food will have on blood sugar depends on many factors such as:
• Ripeness
• Cooking time
• Fiber content
• Fat content
• Time of day
• Blood insulin levels
• Recent activity
• Particle size
• Low glycemic index foods are those values less than 55—these are foods that as they are digested produce a low, slow blood sugar response
• Intermediate glycemic index are those values between 55 and 70
• High glycemic index are those values greater than 70—these foods are quickly broken down in the intestine and cause the glucose level to rise quickly
• GI, however, tells you only how rapidly a particular carb turns into glucose. It tells the quality of the carb. It does not tell you how much of that carb is a serving for a particular food (quantity)
• Glycemic Load takes quantity of available carbs into account. Glycemic load equals the GI times the number of carb grams in a food

Lets be careful!!!!!!!! The worth of any food cannot be measured by a single number, but a single number can tell you a great deal about how the carb in that food affects blood glucose levels. For instance, the number tells us nothing about the nutritional value, vitamin/mineral content, or fiber content. The numbers can be misleading. Some worthless foods like diet soda have low numbers and nuts, for instance, have higher values.

• Meal planning:
• Hulless barley in the rice cooker sweetened with splenda and cinnamon
• Bread is near 100 on the GI, but using a different grain such as corn, soybeans, oat bran, or barley are good choices. Burgen Soy Lin in the lowest GI bread available
• Pasta substitutes include Shirataki noodles in the refrigerated section. No need to boil them….simply heat up and eat. Any other high fiber pasta is appropriate to substitute
• Cereals such as Mc Cann’s Irish Oatmeal which are steel cut oats instead of rolled oats
• Chips such as Trader Joe’s Soy and flaxseed Tortillas
• Veggies
• Nuts such as walnuts
• Dry roasted Edamame and frozen variety in place of higher glycemic veggies (peas, carrots, corn)

HEALTH INSURANCE DOES NOT EQUAL HEALTH CARE

Health insurance doesn't automatically lead to health care. Today, the average American life expectancy is close to 80, and the fastest growing segment of the American population is adults 85 years or older. While there may not be an actual fountain of youth, we are continually re-defining old age and pushing the limits of lifespan further and further.

Increased lifespan may sound like a dream come true. But it may be a nightmare in progress. Unless we assume far greater responsibility for our health, current increases in longevity spell decrepitude and financial disaster for millions of Americans.

If rates of disease and disability continue at their current levels, America will become a nation of sick, senile, disenfranchised, impoverished seniors, with too few resources to care for them and astronomical medical costs that will cripple our economy.

For example, the average American over the age of 65 suffers multiple chronic conditions, including hypertension, diabetes, arthritis, hearing and vision disorders. This group accounts for one third of all health care spending, one third of prescription drug use and 40 percent of doctor visits.

Over 25 percent of those 85 or older require institutional care. Unless the economic structure of the nation is substantially re-vamped, Medicare will run out of funds by 2029. Suddenly, the idea of living 100 years or more loses some of its luster.

Unfortunately, health care in the U.S. is currently in crisis, and many people have lost confidence in medicine. Medical services are expensive, and insurance is becoming prohibitively costly. And with more and more doctors dropping out of one insurance plan or another, especially government plans, there is no guarantee that you will be able to see a physician no matter what coverage you have. Of course, we're promised by the Obama administration that universal health insurance will avoid all these problems.

Obamacare is facing a perfect storm. First, there is an ongoing court battle to determine the law’s constitutionality. This legal challenge, now at the federal appellate court level, is sure to reach the Supreme Court of the United States, the question being when, not if. The Obama administration is clearly in no rush to see this happen, because if the court rules against them, it will have a major impact on the 2012 election. By 2014, most of the features of the bill, including the individual mandate, will be instituted, the Independent Medicare Advisory Board will be in place, and millions more patients will be signing up for Medicaid or receiving subsidies for individual private policies or paying penalties. Once our health-care delivery system is significantly altered by these provisions, it will be much harder to repeal or remove them.

In terms of the individual mandate, Obamacare’s biggest deception remains the use of the term “health care” in place of “insurance.” For Obamacare is not only unconstitutional in compelling a patient to buy a product, it is also suspect from a public-health perspective since having insurance does not guarantee access to health care.

If the federal government believes it must ensure health care for all as a public protection, much as a mandatory vaccine protects the public from an emerging disease, then the government must do so by providing the doctors, nurses, and clinics to deliver this care. Doctors have long understood that health insurance of all kinds interferes with — rather than promotes or enables — the practice of medicine.

What may be an option to private insurance is getting beaten down by the White House. Health insurers are adjusting their financial underpinnings to guard as best they can against any major reduction in profits. The public needs to be aware of this and take what measures they can to offset the increases in premiums, co pays and deductibles.  Sadly, Congress is looking to limit rather than expand Health Savings Accounts and Flexible Spending Accounts, which if adopted by more in the middle and upper class could go a long way to easing the hikes being imposed on businesses and individuals by health insurers.  Expansion, not reduction of HSA and FSA accounts should be part of real health reform.  Sadly this Congress and President are not about limiting costs to tax payers, but increasing those costs unnecessarily .

Keep your eyes and ears peeled for more information over the upcoming 6-9 months. Educate yourself. Read about your options. Take a stance for YOUR health care. Vote in 2012!