Over the years I have shared my "SOAP" notes with all of you assuming everyone knows what a SOAP note is and why it is used.

For all aspiring doctors, the SOAP note is the standard for medical evaluation entries made in clinical records. The SOAP note is written to improve communication among all those caring for the patient to display the assessment, problems and plans in an organized format. SOAP is an acronym. The letters S-O-A-P stand for SUBJECTIVE, OBJECTIVE, ASSESSMENT and PLAN.
SOAP notes are brief and to the point. For example, they give:

1--Date and purpose of the visit
2--The patient’s symptoms and complaints
3--The current physical exam: patient's height, weight, temperature, pulse, blood pressure, visual acuity, lab data and results of studies, reports, assessments
4--The current formulation and plan for the patient
S - O - A - P


1. SUBJECTIVE — These are symptoms the patient verbally expresses or as stated by a significant other.
2. OBJECTIVE — These objective observations are what the doctor assesses and include symptoms that can actually be measured, seen, heard, touched, felt, or smelled. Included in objective observations are vital signs such as temperature, pulse, respiration, skin color, swelling and the results of diagnostic tests.

3. ASSESSMENT — Assessment is the diagnosis of the patient's condition. In some cases the diagnosis may be clear, such as a contusion. However, an assessment may not be clear and could include several diagnosis possibilities.

4. PLAN — The plan may include laboratory and/or radiological tests ordered for the patient, medications ordered, treatments performed (e.g., minor surgery procedure), patient referrals (sending patient to a specialist), patient disposition (e.g., home care, bed rest, short-term, long-term disability, days excused from work, admission to hospital), patient directions (e.g. elevate foot, Return to clinic in 1 week), and follow-up directions for the patient.
Here is an example of a SOAP note:
Patient Name: Jane Doe DOB: 12/31/1961


Record No. K-6112r809

Date: 09/09/1999

S—Pt. states that she has always been overweight. She is very frustrated with trying to diet. Her 20 year class reunion is next year and she would like to begin working toward a weight loss goal that is realistic.

O—WT = 210 lbs HT = 60 “ BW = 115 lbs Chol = 255 BP = 120/75
HEENT is neg, Heart is RRR without murmurs, Lungs are clear, abdomen is soft, nontender, with active bowel sounds. Extremities reveal no edema

A—Obese at 183% IBW, hypercholesterolemia

P—Risk Factors of diabetes and heart disease discussed. Weight loss is in her best interest. She may want to consider a personal trainer. Names of local trainers given. Long Term Goal: Change lifestyle habits to lose at least 70 pounds over a 12 month period. Short Term Goal: Client to begin a 1500 Calorie diet with walking 20 minutes per day. She was also encouraged to start a resistance exercise training session. Instructed Pt on lower saturated fat food/carb choices and smaller food portions. Follow-up in one month.

Yesterday was my little girl's birthday. I remember the day I got Squirt. She came as a "buy one, get the second one half price." Who could turn away those eyes and those kisses? I took them both...Nitro AND Squirt! They have the same daddy...a stout little yorkie who did time with his daschund live-in, and then a few days later his baby momma maltise! Quite the little "run-around!"

There are so many things I love about my Squirty. Those nine little pounds of Dorkie has more love in her than most people I know. No matter what is going on she is always right there with those eyes saying "I love you!!!" She has a HUGE personality for a little dog!!! 

Squirt celebrates when I get home from work. Her whole body is wiggling from her excitement. She leaps into my arms and no matter how much her breath smells, her smiley face beams and she licks me all over. She lets me know when I’ve been on the computer too long. She also let's me know when a stranger passes by the house, when commercials come on (ALL commercials!), and actually is quite vocal ALL the time. "Shush" isn't working on her anymore!

Her happy place is snuggled up wherever I am. She loves to dance with me in the garage. I hold her tight to my chest and we twirl around to the beat of the music. Squirt may not understand the meaning of birthdays, but I do. Another year with her is a good year!

 

 

You have heard the raging political debate over healthcare reform...the politicians argue the position that it is all about "care". But have you noticed that none of them debate our country’s failing personal health. To them it is much easier to stir up the voters and divide them on how to pay for the care. The problem is much deeper than just who is going to dole out the cash. Not a single one of them has discussed the primary means to reduce health care costs; self-control. It is projected that 43% of U.S. adults will become obese and they will cost the U.S. health care system $344 Billion annually. That is a huge number.

I sound like a commercial here, but seriously, personal committment to health is the single most important predictor of our future in healthcare. With that said, I truly believe anyone can lose weight, but to restore health, we need to focus on life beyond weight loss.

Where do we start? First off, we must ignore the conventional wisdom that utilizes the food pyramid to dictate what we should eat. The food pyramid is flawed for its primary reliance on carbohydrate predominant foods. Turning the food pyramid upside down does not fix the flaw either! Basic physiology tells us that carbohydrates not immediately used for energy, are converted to fat and stored in the adipose cells of the body. What is the result? Increased obesity.

Secondly, we need to make decisions and retrain ourselves that food is not for pleasure, comfort or something to do while watching television. Food is plainly and simply fuel. Yet, I am not ignorant in the fact that food tastes good. So what is the answer? Planned splurges! Sounds good so far, eh?

Thirdly, we must not forget my favorite component...EXERCISE! By combining progressive resistance training and cardiovascular conditioning, you can train your body to be a fat burning furnace! As I have stated many times in the past, I do not advocate hours of cardio in order to burn off the excess carbohydrates that you have consumed. My approach has always been to increase muscle mass through resistance training and allow the muscle to burn off your bodyfat.

This is not rocket science. With a system of proper eating and exercise YOU become the master of your appetite and tastes — they no longer master you.

So, while the politicians argue how healthcare is going to be payed for, lets start our own healthcare policy! Prevention almost always is less costly than the cure. Remember, diet alone is not the answer. Do not forget about the importance of physical education or fitness. There is no point in doing something, if you are only going to go half way!

I want end by giving a plug to my friends who do personal training and nutrition counseling:

http://www.bodyphatbyjill.com/ is owned and managed by Jill Olsen. She can be contacted via her website, email at olsenjill@yahoo.com, or by phone at 515.778.1636

Nutrisport-Full Potential Training
9992 Swanson Blvd, Clive, IA 50325
(515) 331-2141
Nutrisport FPT offers Personal Trainer, Sports Supplements, Body Sculpting Class, Bodybuilding, and Power Lifting in Des Moines, IA.
http://www.nutrisportfpt.com/

Whether you are a pro bodybuilder or simply training at home, everyone has a "first day in the gym." And, if you ask anyone who trains how he/she was inspired, you will always get a different story.

I saw my first bodybuilder when I was 13. His name was Danny. I couldn't take my eyes off him. I had never seen such big muscles before. He would wear a tank top and shorts and every muscle seemed to burst out of his skin. He was from California and he came back to Iowa to visit his family every summer.

When I was about 15, I started looking at the magazines and noticed more and more bodybuilders. My first real love of bodybuilding came when Bob Paris was on the scene. I thought he was perfectly sculpted. He had a small waist and bubbly muscles...perfect, I thought. At the time, Tonya Knight was also an up and coming female bodybuilder. I would cut out the pictures from the muscle magazines and make a little collage on hard posterboard.

I wouldn't see my first bodybuilding show until I was 26. The following year, I entered my first bodybuilding show.

Although, I would tell you I am a doctor first and a bodybuilder second, there is no doubting my passion for both of these disciplines. There are a lot of factors that determine how successful you are at bodybuilding. Training with weights, doing cardio on a daily basis, as well as following a specialized nutrition plan are the obvious factors. But, I will not forget the help I got along the way from family and friends. I hope that I have told them enough that if they are reading this right now, they would know who they are and feel the big hug I just gave each of them!

To my readers who have never experienced a "first day in the gym," I urge you to try it on for size. I think you will find that it fits just right!

One way to understand body composition is to divide your body into three basic parts - fat, bone and lean body mass.

Fat Mass is usually referred to as body fat percentage. This number tells you how much of your total body weight is actual fat. Observing change in body fat is the best way to measure "weight" loss.

Lean Mass is everything else that makes up your weight. It includes muscle, bones, organs, water, and all non-fatty tissues. One pound of muscle takes up much less space than one pound of fat. So, as you exercise consistently and build up strength, your total body weight may actually increase. This can be confusing (and sometimes scary), but you are gaining muscle, while maintaining or even losing fat. Gains in muscle mass will increase your metabolism, thus enabling you to burn more calories during every activity—even sitting!

There are no exercises you can do to speed up fat burn in any particular area. Cardio activity, utilizing large muscle groups, burns fat all over the body. So, don’t waste your time doing lots of crunches to lose the belly fat, or boxing to lose your arm jiggle.

Scientists ascertained that there are three specific body shapes:

The android, or apple shape, is common among men. Fat deposits on the middle section of the body, mostly on the abdomen.

The gynoid, or pear shape, is more common among women. Fat is deposited on the hips and bottom.

A third type of body shape, the ovoid, does not differentiate between men and women. Here we can speak of an overall general coverage of body fat.

Fat distribution is influenced by age, genetic inheritance, race, but to a greater extent by gender-specific hormones. They are responsible for the distribution of fat on certain areas of our bodies. Estrogens, for example, which are responsible for the typical female sexual characteristics, will influence fat deposit in the "pear" format. They deposit on the hips, thighs, and belly, while testosterone will "lead" fat mostly towards the stomach and upper body.

In the United States, colorectal cancer is the fourth most common cancer in men, after skin, prostate, and lung cancer. It is also the fourth most common cancer in women, after skin, breast, and lung cancer.

October 9, 2010, I attended the Des Moines Get Your Rear in Gear 5K Run/Walk at Raccoon River Park with friends, survivors, and loved ones of survivors.

"Get Your Rear in Gear" is bigger than just a message for colon cancer; it is a message for all of us to take action, lead longer healthier lives, go to the doctor regularly, to listen to our bodies when something isn’t right and to get the right answers, regardless of age.

The event was a huge success. Included in today's post are a few pictures.





One of the reasons I have Wednesdays' off is so I can have someone do touch-ups on what is considered a work in progress! This past Wednesday, I ventured over to the Southside to get my shaggy head revitalized.  I capitalize "SOUTH" since my nurse says it has significant meaning. She and her family are all southsiders.

Below are the before and after pics from Mazza & Co Salon located on Thorton and SW 9th.

A little make-up and a new dress and I was ready for a night out on the town!

My family just got a lot furrier! It has been a VERY exciting weekend for me as I became a Godmother to the cutest little love angel, named Squeeker. She is unbearably adorable! At just 7 weeks she was brought home with mom and dad and spent most of her first day in the lap of luxery as mom lovingly cradled her all night by the campfire.

Today, we (Squeeker and I) posed for pictures. Truth be told, I am total mush bucket over this little girl.



Shortly after pictures, we all watched as Squeeks chased after leaves, big sister (Smoochie), and other imaginary things since puppies do not see very well, nor hear or smell very well either. In fact, there are many things very unique to Squeeks and other puppies just like her. Did you know that puppies cannot hold their bladders for more than about 2 hours? Or that puppies do not know when they are going to poop until it is about to come out? A puppy is like most 8 month old human babies. They sleep and they eat; and they pee after eating, playing, sleeping, and drinking. Then, they pee in between all that!

I think Squeeker is going to have a great life. She has loving parents (pleural) and loving cousins (Nitro, Squirt, and Tucker).

Meanwhile, back at home, Squirt is sacked out across my arms on my desk as I try to blog. I think she just cut a stinker. Wooeeee, stinky!

Nighty Night everyone!