Some Like It Hot.

I went to my first Bikram Yoga class on Thursday.  In short, Bikram Yoga is a series of 26 yoga poses performed in a room that is heated to 105 degrees and 40% humidity (!).

I’ve done other types of yoga before (mostly Hatha Yoga).  To be honest, I never really enjoyed it that much.  I definitely feel it’s beneficial- it promotes balance and flexibility.  What I had trouble with was the whole meditation/relaxation aspect of it.  I’m rather…Type A (to put it mildly), and always had a hard time just sitting and breathing.  My mind just starts running to the millions of other things I need to be doing, and I get all agitated…which probably means I really SHOULD be doing yoga on a regular basis, but oh, well.

I will say that I enjoyed the Bikram class, and I think I might start going on a regular basis.  Like many runners, I tend to get a bit lazy about stretching, and this class certainly will cure that problem.  The heat of the room does seem to make stretching easier.  What I found really interesting was that I didn’t feel like I was working out that hard during the class, but boy was I sore the next day!

So, here’s my overall opinion of the pros and cons of Bikram:

Pros:  The heat does promote muscle flexibility.
           The postures hit all the major muscle groups.
           There is an emphasis on balance and core strengthening.
           You get into an aerobic state just by virtue of your heart rate increasing from the heat and             dehydration.

Cons:  It’s easy to overdo it- maybe too easy.  Forcing a stretch can definitely lead to injury.
            Dehydration is a definite risk.
           Anyone on blood pressure medications, diuretics, or medications that interfere with sweating (antihistamines, especially) should not do this.
            Anyone with a history of cardiac disease or lung disease should not do this.
            Anyone who is pregnant should not do this.
So, I’ll be attending some more sessions- we’ll see how it works out.

*A big shout out and thanks to Becky for getting me started!*


Alex, Matthew, motherhood

A Plague on My House

I haven’t blogged in over a week.  That’s because I’ve been dealing with sick kids.  Poor Matthew got the horrible cold that’s been going around and has just been miserable…consequently everyone else in the house is also miserable and not sleeping.

Just as Matthew was starting to get better, Alex started vomiting.  First into the toilet, then on the couch, then on me, then in my bed.  Good times.

Now I have pinkeye.

My patients always ask me, “How do you avoid getting sick?” The answer is…I don’t. 

TGIF, and looking forward to the long weekend.

behind the scenes, insurance insanity, medicine, primary care

Behind the Scenes- Watch an Insurance Company Try to Drive Me Insane

I’ve blogged before about prior authorization forms that insurance companies make me fill out all. the. time.  Here’s another fun thing that I encounter on a regular basis.

Now, on the surface this looks like a run-of-the-mill form to approve Crestor.  There’s a backstory here, however.  This patient had been on Lipitor, and her cholesterol was well-controlled on it.  At her last visit she gave me a notice from her insurance company saying that they will no longer be covering Lipitor but will cover Crestor.  So, I changed her to Crestor at their request. Now- wait for it- they want me to fill out an approval form for a medication change that was initiated by them in the first place!!!
This is why every day I discover more and more gray hairs…
medicine, primary care

‘Tis the Season…

The season for colds and flu, that is.

I’m just putting this out there in black and white, so that everyone can see it.  I’m even going to italicize it, so that you know I really, really mean it.  Here goes…

I can’t cure your cold.  I can’t even make it go away faster than it would on its own.  Even if you have a vacation in two days and you’re flying to the Caribbean and don’t want to be sick- I STILL can’t make it better.

There.  Glad I got that off my chest.

Colds are caused by a virus, not a bacterium.  This means that antibiotics will not work for them.  Bronchitis typically does not need an antibiotic either- it gets better on its own.  Likewise sinusitis.

A cold typically lasts 10 to 14 days.  A cough from bronchitis can last for weeks, and sometime a few months.  Sinus pain and pressure can last for weeks.  A cough does not means that antibiotics are needed.  Green mucus is not a sign of a bacterial infection- that’s just the color of mucus.  A fever doesn’t mean an antibiotic is needed.  I highly recommend that everyone read this.  It’s a link to the CDC Get Smart Homepage, and is chock-full of great information about antibiotics.

Certain over the counter cold medications can be helpful.  For those without high blood pressure, Sudafed is my top choice.  Nasal saline rinses are almost always helpful.

Now, I never mind people coming into my office to get their cold checked out.  I’d hate for someone to be worried that their cold might be something more than just a virus.  It’s never a waste of my time- I’d rather someone get checked out than worry, and sometimes someone actually has an ear infection or pneumonia. Even if it’s not something like that, I typically will be able to give individualized advice about dealing with the symptoms.   However, I do ask that people trust my judgement.  Don’t get angry with me if I won’t give antibiotics.  I never give them just to appease someone- I only give them if they’re needed.  And please, don’t get angry with me if you’re still sick in a week- that’s typical.  It stinks, I know.  It’s just how it is.  If I find the cure for the common cold, I promise, my patients will be the first to know!

apps, iPhone, running

Another Great Running App

The last app I reviewed was RunKeeper, which I still love.  However, if you want to spring for the $1.99, check out the Nike+GPS app.  I’m really enjoying this one.  It lets me sync my iTunes playlist with the app itself, so I can navigate through songs without exiting the program.

It also has a neat little feature called “PowerSongs”.  At any point during the run, I can hit the PowerSong button and an “inspirational” song that I’ve chosen in advance starts playing.  It’s pretty cool- I might be dragging towards the end of a run, and I all need to do is hit a button and Gloria Gaynor’s singing “I Will Survive.”  Perfect!

I can also run against friends (virtually, of course), and post my results for the world to see on Facebook or Twitter.  I can challenge myself by setting the app to prompt me to beat my best time or distance.  The best part- when I post a personal record, Lance Armstrong or Paula Radcliffe comes on to congratulate me!

All in all- I think this is my new favorite.

medicine, primary care

Breaking up is hard to do…

When is it time to break up with your doctor?  It can be a tough decision to make.  After all, if you don’t like your experience at a store, you shop somewhere else next time.  If you go for a haircut and hate it, you find someone else.

With your doctor, it’s a bit different.  This is someone who might know some of your deepest, darkest secrets.  There is a history to that relationship.  Logistically, it is also a bit of a pain in the butt.  All of your records are with your doctor.  You might need to have a chat with your insurance company.  Then you actually have to go through the process of finding a new doctor you like.  So, when is it worth it to take the plunge?

First things first- try to articulate to yourself why you want a new doctor.  Did you have one really bad appointment, but otherwise have had good experiences?  If so, you should probably talk to your doctor about your concerns before you jump ship.  Your doctor might have just been having a bad day.  Not that that’s an excuse, but it is an explanation.  Doctors are people, too.  We get sick.  We have worries about kids and family.  However, if you repeatedly have not been satisfied at your appointments, you might want to seek a new doctor.

Is it a personality issue?  Do you and your doctor just not “click?”  If that’s the case, you probably are better off finding someone else.  You need to be able to completely trust your primary care doctor, and if you can’t be comfortable with him/her, it’s not going to work.

Is it the office staff?  Is someone at the front desk always rude?  Do you always get put on hold for 20 minutes when you call?  For these issue, I strongly suggest that you talk to your doctor.  Here’s the truth- since we’re not patients in our own offices, we often have no idea of what’s going on up front.  Sad, but true.  However, we can easily remedy many of these issues if we know about them.  So, don’t switch for these reasons.  Talk to your doc first, and give it a bit more time.  If there is no improvement in services, then it’s time to make a move.

Now the harder stuff- care issues.  By this, I mean that you have concerns about the level of care that your doctor is giving you.  This is a very tough one, because unless you are in the health care field yourself, you might not be able to accurately assess this.  The internet is changing this, however, and more and more people are reading online and educating themselves about their health conditions.  This is a good thing.  However, just because your doctor is treating you one way, and you read about a different treatment online, doesn’t mean that your doctor is wrong.  The practice of medicine is an art, and highly individualized.  If you have concerns, you must talk to your doctor.  You might even want to get a second opinion from another doctor.  A reasonable doc should never be angry about you getting another opinion. If your issues about the level of care you are getting are legitimate, you should definitely find another doctor.

Lastly, whenever you think of switching doctors, I ask you to look at yourself, too.  Have you been to doctor after doctor after doctor, never finding one who has satisfied you?  The problem might not be your doctor.  Nothing strikes dread into the heart of a primary care physician like having a patient say, “I’ve been to ten other doctors and no one has listened to me/been able to help me.”  Are your expectations of your doctor unrealistic?  I have one patient who left my practice because she wanted a personal phone call from me with all of her lab results.  Now, I do send out letters for all results, but I can’t make calls to everyone.  I review about 50 lab results a day.  If I called everyone personally, that’s all I would be able to do.

So, it’s a complicated subject.  However, I hope I’ve gotten across the one recurring theme…talk to your doctor.  The worst that can happen is that you mutually decide to part ways.


Behind the scenes- thanks for the suggestion!

We have a suggestion box in the waiting room. We’ve gotten some very helpful comments in it. Some, though, well…judge for yourself.

Now, we actually do have a television in the waiting room. We play a DVD that shows nature scenes and has soothing background music. The box that the DVD came in claims that it is clinically proven to lower blood pressure, but clearly it did not work in the case of this particular person.