Sweet Potato Enchilada Casserole

Some people have "life lists." You know, things you want to do before you it's too late. But me? I have a food list: things I want to make and eat before it's too late! And boy, it is getting awfully long these days.

I decided to tackle one small item today: enchiladas. A friend and classmate of mine (the amazing Wendy!) made some awesome enchiladas earlier this week that inspired me to try my own batch. I also just happened to have some corn tortillas lying around (thanks LeAnne!).

I adapted this recipe from Paul McCartney's "Ob-La-Di" enchilada recipe. I had never made enchiladas before, but these were amazing. Instead of rolling individual enchiladas, I used the tortillas as layers, similar to how you would use noodles in lasagna. The result? A delicious and easy enchilada "casserole."

I topped it off with some tofu "sour cream" and fresh cilantro. Usually I'm not a big fan of vegan sauces made from tofu, but this "sour cream" was delicious. It even got Ash's seal of approval -- which, as you know, means everything. :) Enjoy!

This makes about 9 servings.

For the Sauce

• 1 cup tomato sauce
• 1 cup water
• 1 large onion, chopped
• 2 garlic cloves, minced
• 1 tsp. chili powder
• 1/2 tsp. ground cumin
• 1/2 tsp. oregano
• 2 Tbsp. cornstarch dissolved in 4 Tbsp. water
• small bunch cilantro, chopped
  

For the Filling

• 1 cup black beans
• 1 cup pinto beans
• 1 cup cooked sweet potato, chopped
• 1 onion, chopped
• 1/4 tsp. cumin
• 1/4 tsp garlic powder or 1 tsp. minced fresh garlic
• 1/4 tsp. black pepper
• 1 1/3 cups salsa
• 1 cup steamed kale
  
• 6 tortillas

Directions

Pre-heat the oven to 350ºF. Place all the sauce ingredients, except for the cornstarch, in a small pot and cook over low heat, covered, for 20 minutes. Stir in the cornstarch and cook until the sauce thickens.

In the meantime, prepare the filling: Mix the beans, onion, sweet potato, kale, cumin, garlic, pepper, and salsa.

Fry the tortillas in a bit of olive oil for a couple of minutes.

I used a 6"x6" baking dish. Add a little sauce to the bottom of the dish. Add 2 tortillas (you might have to rip one into a couple of pieces to make it fit.) and top with a bit of the filling. Add more sauce. Repeat these steps for another layer. Top the final tortillas and top with more sauce. Bake for 35-45 minutes.

For the "sour cream" (Adapted from the Veggie Table)

• 1/2 block tofu
• 2 Tbs lemon juice
• 3 Tbs canola oil
• Salt to taste
  

Process all of the ingredients in the food processor until smooth. Transfer to the covered container and refrigerate for up to four days.

Cheap fast food "enticing people to eat more because they think they're saving money when they're really buying heart disease"

"Fake foods are more affordable. It's enticing people to eat more because they think they're saving money when they're really just buying heart disease."

References:
10 Questions for Jillian Michaels. TIME, 2010.

Couple addicted to the internet let their baby starve to death while raising a virtual daughter online

From BBC:

A South Korean couple who were addicted to the internet let their three-month-old baby starve to death while raising a virtual daughter online, police said.

An autopsy showed her death was caused by a long period of malnutrition.

The couple had become obsessed with nurturing a virtual girl called Anima in the popular role-playing game Prius Online.

Some psychiatrists still have doubts if Internet addiction exists but it looks pretty much for real in this video:



References:

S Korea child 'starves as parents raise virtual baby'. BBC.

How do you blog?

A nurse writing a paper for school focusing on the value of blogs for advanced practice nurses asked me the questions listed below. It would be great if you can post your own answers in the comment section below.

How many blog post do read a week?

The blog posts and news items from the RSS feeds are about 2,000-3,000 per day = 20,000 per week.

You read blog posts about?

The big five among the general medical journals (NEJM, JAMA, Lancet, BMJ, Annals of Int Medicine) plus 10 allergy journals, plus Medscape, Reuters Health and WebMD.

How many new topics do you personally post under each sub heading, i.e. Endocrine, Cardiac, etc each week?

1-2 blog posts per day, for example, cardiac topics once a week, endocrine topics once a month.

Some helpful references:

5 Tips to Stay Up-to-Date with Medical Literature

How to deal with the information overload from blogs, RSS and Twitter?
Image source: public domain.

"I'm a Medicare doctor. Here's what I make"

From CNN:

Dr. Schreiber sees 120 patients a week - 30% of them are enrolled directly in Medicare, while another 65% have private insurance plans that peg their payments on Medicare's rates. Only 5% pay on their own.

Medicare pays between 63-72% of the costs for Schreiber's patients.

Four billing codes make up the "bread and butter" of claims submitted to Medicare:

- The first code represents a simple visit, which might include blood pressure and cholesterol checks. Schreiber gets about $44 from Medicare for the $70 fee he charges.

- The second and third codes correspond to a sick visit, when he spends 15 to 20 minutes evaluating a patient for symptoms such as coughing or shortness of breath. Schreiber charges $92 for a sick visit, of which Medicare pays about $58.

- The last billing code is a complex visit. "This is where a patient comes in with many problems like heart disease, hypertension, diabetes," he said. Such a visit requires about 30 minutes of his time.

Schreiber charges $120 for these visits, and Medicare pays $88 of that.

References:

Medicare backlash: A primary care doctor lays out his costs. CNN.

Image source: United States one-dollar bill. Wikipedia, public domain.

"Doctors should blog with their real name." Agree or disagree?

From KevinMD:

"Martin Young still has "nagging doubts about doctors who post blogs or replies about healthcare issues without giving their names.

My blog as an extension of who I am as a doctor, putting a carefully considered face to the experience of caring for the sick, as a means of drawing attention to issues that do not get into medical journals. As do most other doctors who host their own blogs.

I often look at those replies to my postings that are anonymous and think, “Who are you? Why do you think the way you do? Why will you not put a name and face to your thoughts?” My personal belief is that the anonymous person may lack conviction, confidence or courage.

I would not accept a referral from an anonymous doctor, or give advice to one. In the same way, I may read anonymous replies to my postings, but they carry much lower weight."

Although I encourage physicians to blog under their own name, I do not think we should "force" them to do so. They should not feel obliged to host their own blog either if they can use such perfectly reasonable free services such as Blogger.com by Google and WordPress.

I assembled a short list of suggestion for medical bloggers several years ago. Here it is:

Tips for Medical Bloggers

- Write as if your boss and your patients are reading your blog every day
- Comply with HIPAA
- Consider using your name and credentials on your blog and other social media accounts
- If your blog is work-related, it is probably better to let your employer know.
- Inquire if there are any employee blogging guidelines. If there are, comply with them strictly.
- Use a disclaimer, e.g. "All opinions expressed here are those of their authors and not of their employer. Information provided here is for medical education only. It is not intended as and does not substitute for medical advice."
- Get your blog accredited by the Heath on the Net Foundation

References:

Why doctors should blog with their real name. KevinMD.
How to write a medical blog and not get fired?

As A Busy Physician, Why Do I Even Bother Blogging? http://goo.gl/fSF3 - Excellent summary.

Image source: public domain.

Twitter comments:

@DrJenGunter (Jennifer Gunter): depends on blogging agenda.

@DoctorNatasha (Natasha Burgert): I blog and tweet with my real name because it keeps me accountable to my work, honest with my patients, and real with my intent.

@DrElizabethLee: I sign my name to anything I write.

@DrVes: Doctors need to understand the basics, and address the irrational fear of using social media.

Chickpea "Tuna" Salad

I know this is going to sound like a weird question, but here it goes. Do you ever crave foods that you dislike? Well, let me rephrase it. Do you ever find yourself craving something that you have already tried and know that you hate? Hmm, maybe it's just me then.

I have always disliked the taste of fish -- even back in my pre-vegetarian days -- and the smell doesn't help either. My mom used to tell me a story about when I was little. Apparently we went into a store that sold fresh fish and as soon as I entered the door, I threw up.

I used to work at a sandwich bar back in my college dorm and I would have to smell the tuna salad all day. The weird thing is I started to want it, even though I knew I would think it tasted bad. I finally gave in and tried a bite, and sure enough, I thought it was gross. However, the next day, there I was again... wanting more.

The same weird experience happened to me the first time I tried Kombucha. I didn't like the vinegary taste and thought it smelled weird. But, by later that day all I wanted was more Kombucha. Ashley thought I was crazy. "Didn't you say that was the stuff that tasted like &%*$? You want more of it? Really?" Well, Kombucha won me over, but the tuna never did.

Yet, here I am making a mock tuna salad. I came across this recipe on Compassionate Action for Animals. I really liked this salad, but it's probably because this was very different from real tuna salad. I'm not sure if that will excite you or disappoint you. Either way, this was satisfying on sandwiches and on top of salads as well. I only used about 1/3 of the vegan mayonnaise that they recommended, but I thought this was plenty. Feel free to add a bit more in.

• 2(15oz.) cans chick-peas, drained (or 3c. cooked)
• ¼ cup vegan mayonnaise
• 2/3 cup minced celery
• 1/3 cup minced dill pickle (you can also use sweet relish)
  
• ¼ cup nutritional yeast flakes
• 2 green onions, chopped
• 2 teaspoon soy sauce
• 1 teaspoon kelp powder (optional -- I didn't use this in my version)
• 1 tablespoon miso (optional)
  
• salt & pepper, to taste

To mash the chickpeas, you can either use a potato masher and do it by hand, or you can use a food processor or blender and blend for a couple of seconds. The consistency should be well mashed, but not creamy. Mix in the remaining ingredients, using ¼ cup mayonnaise at first, and then adding more as needed. Cover and refrigerate. Use on sandwiches or on a bed of salad greens.

Medical blog content and relationship with blogger credentials and blog host

A quantitative content analysis was performed on 398 blog posts from a constructed 1-week sample of posts in WebMD, Yahoo!Health Expert Blogs, and independently hosted blogs.

Most health and medical blog posts highlighted and provided commentary pertaining to medical issues found in external media such as books, television, Web sites, magazines, and newspapers

Only 16% contained actual health or medical information.

Distinct differences in patterns of content were evident between credentialed and noncredentialed bloggers, as well as different blog hosts.

References:
Health and medical blog content and its relationships with blogger credentials and blog host. Buis LR, Carpenter S. Health Commun. 2009 Dec;24(8):703-10.

Comments from Google Buzz:

Shabber Hussain - Now if I can some how know about those 16% medical blogs that "contain actual health or medical information", it should make my day. Feb 26

Arin Basu - I think (I just read the abstract perhaps a closer reading of the full text of the article might be more useful, @Ves, did you have a chance to read the full text?)

* The findings are not unexpected, at least that's what you expect based on "credentialing the blogger who has written the posts"

* There seems on first reading at leas the abstract that there may be quite a bit of bias in that study (just one week snapshot (too few blogs sampled), few selected sites (selection bias right there), and interpretation)

* Not surprised that most blogs contained commentaries published in popular press and journals.

I think that's what blogs should ideally do. Raise awareness, enable and alert people to read & interpret meanings. I'd not expect blogs to replace "actual" texts (well, that's my perspective)

* Which makes @Shabber's point very pertinent, what are those 16% saying, on a one week selective sampling?

All in all, a very interesting article. I think it needs to be closely read and discussed in medical blogosphere. Feb 26

Image source: public domain.

Book Review: Motherhood and Feminism by Amber E. Kinser

I doubt any role is more judged than mother. Add in sexuality, class and race into the equation and for some of us, we will never be a good mother. But what are we really comparing ourselves/each other to?

We are trying to live up to a myth. A myth of Biblical proportions that has been around for less than sixty years. Stephanie Koontz’s The Way We Never Were does an excellent job at debunking the myth of a “Leave it to Beaver” family and letting Donna Reed be our benchmark. Amber E. Kinser picks up that conversation and runs with it.

In Motherhood and Feminism Kinser outlines the evolution, both natural and government imposed, of the role of motherhood in American society. At the same time she is tracking the evolution of the feminist movement in the USA. Sometimes both areas collide, others they complement each other. And that is what is fascinating about this book – How easily motherhood and the role of the women in families can be shifted by outside economic pressures and government propaganda as well as how the feminist movement often takes its cue from how motherhood is framed.

During the first wave of feminism, it was obvious that many of the women who were engaged in the fight for suffrage took a look at themselves and s,aid, “Hey, women need the vote so we can be better citizens for our children and because women are just better people than men.” The theory that infusing women into politics would clean it up remains with us today. The fact that women could not ask for their own rights for their own sake, but rather used their children as the reason why they shouldn’t be left penniless after her husband dies, also remains with us. Consider how many mothers organizations fight for rights on behalf of children rather than for women themselves.

In many ways the fight for women’s rights has and continues to be fought in the home. The so-called Mommy Wars are a proxy for where a woman should be in society and not about the well-being of children. It is also a proxy for who is worthy of support. “How dare that woman take government money to stay home with her children when my husband works hard and I budget so I can be home?” The backlash against mom bloggers earning money, directly or indirectly through free samples, is yet another battle over where a woman’s priorities should be: her career or her children?

Kinser makes the point over and over again that not all mothers movements are feminist, nor do they want to be. It is honestly easier to get a thousand women to rally for children’s health care than to rally for their own health care that includes access to full reproductive health services. And that’s where the gruff lives.

I've talked with feminists who wished that mothers organizations would just claim the damn label, but I get it. And yes, it usually falls to the abortion question. Kinser has one of the BEST rationales on why feminism must include a pro-choice stance, no ifs ands or buts. I won't quote it, as you really should get the book. I think she does a good job at tackling moms of color, queer moms and low-income moms. This is not a history of white middle class feminist motherhood...Althou she correctly states that much of "mainstream" feminism and motherhood expectations are white middle class and then she rips it apart.

Kinser's book is well written and documents a shared history that many moms and feminists often forget or aren't even aware of. Without moms, we wouldn't have won the right to vote. Without feminism, moms wouldn't have the rights they have today. We're like peanut butter and chocolate...And some us are peanut butter cups.

Lastly, a lot of people have asked me if I teach, I don't. Some of those people then follow up with why not? Or you should. If I were to teach a class, I'd start by using this book. And I just might inquire about starting off with a seminar class. But I have a few other things to wrangle at the moment.

I've already said to go and get this book and regular readers know that I'm gonna ask you to please purchase from an indie bookstore or Powells.com. Now, what are you waiting for?

Disclaimer: The only payment I received was the copy of the book. Amber and I are also both in The Encyclopedia of Motherhood, but we have never met...at least that I recall. :)
 

This month is Latino Book Month. To celebrate, I'm giving away three books to one reader. To enter, just comment on any May 2010 post by May 31, 2010. I'm too busy to make you jump thru hoops. Comment!

Oral Tolvaptan (Samsca) Is Safe and Effective Treatment for Chronic Hyponatremia

Vasopressin antagonists increase the serum sodium concentration in patients who have euvolemia and hypervolemia with hyponatremia in the short term (30 days), but their safety and efficacy with longer term administration is unknown.

In a study, 111 patients with hyponatremia received oral tolvaptan (Samsca) for 700 days.

The most common adverse effects attributed to tolvaptan were pollakiuria, thirst, fatigue, dry mouth, polydipsia, and polyuria.

Mean serum sodium increased from 130.8 mmol/L at baseline to greater than 135 mmol/L throughout the observation period.

Responses were comparable between patients with euvolemia and those with heart failure but more modest in patients with cirrhosis.

In conclusion, prolonged administration of tolvaptan maintains an increased serum sodium with an acceptable margin of safety.

Samsca (tolvaptan) Black Box Warnings

Appropriate Use

Initiate and re-initiate tx only in hospital with serum Na monitoring.

Monitor Serum Sodium

Osmotic demyelination may occur w/ rapid correction of hyponatremia (faster than 12 mEq/L/24h), resulting in dysarthria, mutism, dysphagia, lethargy, affective changes, spastic quadriparesis, seizures, coma, and death; slower rates of correction advised in pts w/ severe malnutrition, alcoholism or advanced liver disease.

Cost comparison of conivaptan (Vaprisol) versus tolvaptan (Samsca)

Conivaptan is administered IV only, the average cost per day is $573.

Tolvaptan is administered PO only, the average cost per day is $300.

References:

Oral Tolvaptan Is Safe and Effective in Chronic Hyponatremia. Journal of the American Society of Nephrology, 2010.

Samsca (tolvaptan) Black Box Warnings. Epocrates.

Cost comparison of conivaptan (Vaprisol) versus tolvaptan (Samsca) (PDF).

Lowest sodium I have ever seen http://goo.gl/QgJmf

Image source: Tolvaptan, Wikipedia, public domain.

Comments from Twitter and Facebook:

@kidney_boy: tolvaptan is safe for the patient but not their wallet at $250 per pill!

Neil Mehta: "It costs a king's ransom to keep the sodium level up! Maybe we should just say "Let them eat Salt"!"

Updated: 10/28/2010

TED Talks: A new strategy in the war on cancer

From TED Talks/TED Med: Traditionally, David Agus explains, cancer treatments have had a short-sighted focus on the offending individual cells. He suggests a new, cross-disciplinary approach, using atypical drugs and computer modeling.

Doctors use Facebook Pages to connect with patients

With a 500-million large audience, many practices find that creating a Facebook presence can be an easy -- and free -- way to stay in touch with patients or attract new ones.

Businesses, including physician practices, can create something similar: pages (previously "fan pages"). Anyone on Facebook who elects to "become a fan" or like your page receives, on his or her own home page, any updates, photos, videos or Web links that you post.

Rather than having patients "friend" you on Facebook, you can direct them to this page. Having a moderator is important, because having someone dedicated to responding to people makes them feel more connected and encourages respectful and on topic discussions.

References:
Amednews: How Facebook fan pages can connect with patients.

Facebook Pages Manual.pdf - File Shared from Box.net via @sandnsurf.

10 Easy Ways to Enhance Your Facebook Page. Web Worrker Daily, 2010.

Image source: Wikipedia.

Updated: 07/15/2010

Sometimes you have to judge other parents

A friend of mine who is also a new mom wrote on Facebook about seeing a baby in a stroller with a million toys in its face. Then she said, "Oh, I shouldn't judge." I replied, "Sometimes it's ok to judge." And I mean it. I don't mean petty little things, I mean big picture things. Yes, like the "Single Ladies" parents.

I've seen one set of parents on two different networks explaining away why they would let their pre-teen daughter dance around in a lingerie-looking costume. On ABC they have a lot of excuses, er, reasons for being ok with the dance routine:

• It's a dance competition: I'm not familiar with the circuit and the dancers I knew in high school didn't dress like this and I went to high school in the 1990s. We were all about the Fly Girl attire and dance moves, believe me. So I did a web search for some dance competition videos and found none that look like a 7-year-old burlesque show. Even the teen dances that were "sexy" weren't gyrating the same way as the "Single Ladies" girls.
• When you go swimming, you wear a swimsuit: In other words, the costumes are standard fare for dance competition. Again to the Bat Computer! One catalog's children's wear was fairly tame. Most were cheesy enough to be age-appropriate. Another [flash catalog, page 92] pushed the limits, but was just one this side of burlesque.
• These are the type of routines you see at competitions: One competition site I found has a letter [PDF] for coaches and parents on appropriateness of routines and music. "The [Federation of Dance Competitions] appreciates the art form, creativity and desire to heighten world awareness of these themes through dance but deem it inappropriate to present them to audiences that include children of every age." Honestly, when I read the letter, I felt that they were more concerned with WHO was in the audience (and I don't mean 6yos) watching than anything else. 

But here's what disturbs me about this routine...Dance (including cheer leading, color guard, poms, etc) is about exhibition, competition and obtaining approval (in the form of a score and applause) from an outside source. That's all fine and dandy EXCEPT when it involves 7-9-year-old girls dancing like they belong to a burlesque troupe (FTR: I don't think there's anything wrong with burlesque when it involves adults). Those girls were learning that if they dress in a skimpy way, thrust their bodies like so, SMILE and shimmy, that they will be loved and adored. I admit there's a line and it's called age-appropriateness.

Our media is sexualizing girls at younger and younger ages. Why are parents adding to this problem?

As I said, I'm not familiar with the dance circuit, all I can do is analyze what I see, filter it thru what I know and make a judgment.

This month is Latino Book Month. To celebrate, I'm giving away three books to one reader. To enter, just comment on any May 2010 post by May 31, 2010. I'm too busy to make you jump thru hoops. Comment!

New Treatment Effective in Killing Head Lice - benzyl alcohol lotion 5% (Ulesfia)

From WebMD:

A new prescription lotion (Ulesfia) with benzyl alcohol treats head lice and is effective and safe for children as young as 6 months. The study shows it works by suffocating lice, a method that has long been tried with limited success using messy substances like petroleum jelly, olive oil, and even mayonnaise.

Overnight "home remedies" such as mayonnaise merely appear to kill lice, but don't because the bugs are able to close their spiracles long enough to survive. This is called the "resurrection effect" because, after rinsing, the lice thought to be dead are able to open their breathing spiracles and start biting again.

Existing over-the-counter head lice treatments contain neurotoxic pesticides as active ingredients, resulting in potential toxicity and other problems, including lengthy applications, odor and ineffectiveness.

References:

New Treatment Effective in Killing Lice. WebMD.

Losing the Lice Without Losing Your Wallet. NYTimes, 2010.

Image source: Benzyl alcohol, Wikipedia, public domain.

Updated: 05/28/2010

Room-temperature plasma gases may replace hand disinfectants

From the NYTimes:

Instead of scrubbing, the workers would put their hands into a small box that bathes them with plasma — the same sort of luminous gas found in neon signs, fluorescent tubes and TV displays.

This plasma, though, is at room temperature and pressure, and is engineered to kills bacteria, including the drug-resistant supergerm MRSA.

References:
Hospital-Clean Hands, Without All the Scrubbing

Image source: Neon sign. Wikipedia, Rolf Süssbrich, Creative Commons Attribution ShareAlike 3.0 License.

Stir-Fried Bok Choy

I believe that the most delicious and enjoyable recipes are often the simplest. I love making food that's quick enough to create after a long day and easy enough that you don't have to worry about hunting down the recipe. In my kitchen, garlic, ginger, and onions are my allies. I've found these to be key ingredients for adding quick flavor without a lot of effort. It also helps to keep a few fresh herbs and spices on hand. And then voila! Before you know it, you're eating delicious food and spending more time on what matters -- eating it with those you care about. To me, that's the best part of any meal!


If you're a soy sauce person, you can also add a little to suite your tastes. I left it out of this batch. This goes perfect with some tofu or a grain dish like quinoa or brown rice.

Serves 1 hungry person (or 2 as a side dish)

1 tbsp sesame oil (olive oil also works well)
1 garlic clove, minced
2 cups chopped baby bok choy
1/2 tsp fresh ginger, minced
salt & pepper to taste

Heat oil in a large skillet over medium heat. Add garlic and ginger and cook 1 minute. Add bok choy and cook 3 to 5 minutes, until greens are wilted and stalks are crisp-tender. Season, to taste, with salt and black pepper.

Book Review: Beyond the Echo Chamber by Jessica Clark & Tracy Van Slyke

How did the internet go from the dancing hamster to being a pivotal tool in the 2008 Presidential election? Well, it wasn't easy.

In January of 1995, sophomore year of college, I found myself on a listserv run by Antonia Stolper and her husband Bob Fertik, among others. It was a feminist response to the 1994 GOP take over of Congress. It was mad, it was informative and it was fucking awesome. To this day, I still have no idea how I got on, but it changed my life. 

Women Leaders Online's newsletters gave me more information about what the hell was going on than the newspapers and CNN combined. Plus it came right to my inbox so that was nice. Then a discussion listserv popped up and my world imploded. I was instantly connected to veteran feminist activists in Westchester (NY), New York City, Wichita, DC, Louisiana and everywhere in between. Holy crap! We were debating the issues of the day and strategizing on how to rally for the next election cycle. WLO was the first online feminist organization and soon gave birth to the first pro-choice online voters guide. Sadly WLO folded a few years ago, but many of us are still in touch and are definitely connected to the organizations that are discussed in Beyond the Echo Chamber: How a Networked Progressive Media Can Reshape American Politics by Jessica Clark and Tracy Van Slyke.

 I tell you my story as a mere example of how long this evolution has been brewing. Many models have been attempted to get to where we are today and progressives/feminists are still tinkering. Beyond the Echo Chamber is a great look at where we were, are and going.

And that's just the thing...We need to know how we got here, where we are in order to take the next step forward...together.

Clark & Van Slyke do a most excellent job at addressing the need for old school media to change, specially those who cling to the title and status of journalist. "Professional journalists will need to switch from an ethic of neutrality to an ethic of transparency and disclosure in order to work successfully with pro-am reporters (pg 121-122)." A simple web search turns up articles from 2005 about how the tension between journalists and bloggers is over...yet it's still debated & discussed.

They are outlined a cautionary tale about going for power. A lot of feminists have been tossed to the side in the political realm in order to get to a Democratic Congress and White House. The tune we kept hearing was, "Once we're in power, Roe and all that will be safe." I still hear that echoed today as Illinois Dems appear to be bracing themselves for losing the Senate seat once held by President Obama. I can't get one of my Dem friends to tell me why I should vote for Giannoulias based on his record, not scare tactics about Kirk or the Supreme Court. This harkens back to the emergence of the Blue Dog Democrat. The Dem who could win a Red state/district and save the liberal way. Cause that really happened, right? On page 137, Kos is quoted as referring to this strategy as getting "more and better Democrats" and admits that at first, they want more and now they will focus on the better. Um, that's so gonna work.

My political commentary aside, Beyond the Echo Chamber is an excellent read for those of us swimming in all this Politics 2.0 stuff or those watching us from the sidelines.

This review is seriously late as the book came out in February, but if you still don't have a copy, GET ONE! And as always, I highly recommend getting a copy from an indie bookstore or Powells.com.


Disclaimer: The only payment I received was the copy of the book. 

This month is Latino Book Month. To celebrate, I'm giving away three books to one reader. To enter, just comment on any May 2010 post by May 31, 2010. I'm too busy to make you jump thru hoops. Comment!

Physically fit students score higher on tests than their less fit peers

Test scores dropped more than one point for each extra minute it took middle and high school students to complete a 1-mile run/walk fitness test.

65% of the students were below the state fitness standard. Compared with these students, students who met or exceeded fitness standards had higher average test scores. Overweight and obese students also scored significantly lower on tests.

Schools may have to reverse their recent disinvestment in physical education ostensibly for the purposes of boosting student achievement.

Exercise slows telomere shortening (and aging). Telomeres are the chromosome tips which shorten each time a cell divides, making them a possible marker of aging. A study of 2400 twins showed that physically active people had longer telomeres than sedentary people.


Human chromosomes (grey) capped by telomeres (white). Image source: Wikipedia, public

domain.

If you need any more convincing, please see this "health promotion" video that clearly shows the benefits of exercise:

"Health Promotion" video: Benefits of exercise.

Participation in sport is associated with a with a 20—40% reduction in all-cause mortality compared with non-participation. Exercise might also be considered as a fifth vital sign, according to the Lancet: http://goo.gl/gyxYf

References:
Physical, academic fitness tied at the hip: study. Reuters, 2010.

The Journal of Pediatrics, published online January 25, 2010.

A mother's love finally reaps its reward

After nine long years, Melanie's bill is now law. Carol Blocker is a goddess.


 

This month is Latino Book Month. To celebrate, I'm giving away three books to one reader. To enter, just comment on any May 2010 post by May 31, 2010. I'm too busy to make you jump thru hoops. Comment!

Metabolic pathway plays a role in susceptibility to stuttering

Stuttering is a disorder of unknown cause characterized by repetitions, prolongations, and interruptions in the flow of speech. Genetic factors have been implicated in this disorder, and previous studies of stuttering have identified linkage to markers on chromosome 12.

This study shows that variants of proteins that guide hydrolases to the lysosome are associated with stuttering. This unexpected finding implies a metabolic pathway in susceptibility to stuttering.


Video: Biology Homework about Lysosomes.

References:

Mutations in the Lysosomal Enzyme–Targeting Pathway and Persistent Stuttering. NEJM, 2010.

Health benefits of chocolate

The health benefits of chocolate may include:

- Reduction of blood pressure by eating 6 grams of dark chocolate per day. Probably due to the flavonol epicatechin
- Reduction of platelet and endothelial cell activation
- Reduction of inflammatory mediators
- It can also inhibit oral caries
- It can cross the blood brain barrier and increase cerebral blood flow in humans

From Writer's Almanac:

Ode to Chocolate by Barbara Crooker (excerpt)

I hate milk chocolate, don't want clouds
of cream diluting the dark night sky,
don't want pralines or raisins, rubble
in this smooth plateau. I like my coffee
black, my beer from Germany, wine
from Burgundy, the darker, the better.

References:
The Essence of Chocolate. Dr Shock MD PhD, 2010.
Chocolate could lower blood pressure but the required dose may be too much - BMJ http://goo.gl/uoBN
Chocolate linked to substantial reduction in risk of cardiometabolic disorders but evidence not of best quality. BMJ, 2011.

Photo Essay: Making Chocolate in Belize http://goo.gl/2DPi

Image source: Wikipedia, public domain.

I am a person, not a brand

December 2010 will mark my tenth anniversary as an official blogger. Before I set up shop at Blogger.com*, I was doing fairly regular updates of my Geocities website about news of the day, how the Chicago Cubs were doing or just how I was feeling. But marking that day when I first “blogged” ten years ago is important and causing me to reflect on how things have changed. Yes, we have evolved from ranty blogs (that’s where I started) to topic-focused blogs and mega-blogs like Feministing. But I also scoff at the professionalization of blogging.

Just about every "blogging 101" session I've ever attended has someone tell the audience to find a niche, create a brand and feminism just never seems small enough for those "experts." Narrow...narrow they say. Unfortunately for them, my mind doesn't work that way. If you ask me for advice on blogging, I will always tell you that I usually break all the rules. Write from your passion points, write what you know.

I will always be grateful for being asked to contribute to the AWEARNESS blog. While I was asked what my angle would be on that blog as we can’t all cover the same issue like green living. I wasn’t asked what my niche was and told to stay there. I was also given the opportunity to show how feminism is my niche. In other words, while I am not an expert in everything, I do have the ability to look at issues, topics and policies and reflect on how they may impact women and girls in a different way. Thus, I can write about pay equity, health care, sports and travel all from a feminist perspective.

I haven't had time to properly reflect on the closure of the AWEARNESS blog until now. I will miss the AWEARNESS blog and the flexibility we were all given to write about what moves us, why it should move you and what we can do about it together. But most importantly, it made me write for an audience. While I know others are reading this, my stats are lower than most people assume. But I knew that the AWEARNESS blog was getting some good hits. It made me stretch my writing, my skills and my abilities. The gig was tough at the beginning because we were supposed to be more fact and less opinion. The last nine months we had editors who were more hands on about how posts flowed. The entire time it made me stop and think, "How do I write for a not-so-feminist audience about an issue I want them to know about?"

So while I spent a few years writing for a brand, it helped me cement my feeling that I am not a brand. I am simply a woman with a blog and a lot of opinions.

*This blog was begun in 2007, but from 2000-2008 I wrote at a different blog that is no longer accessible. I occasionally repost pieces from that blog here. 

This month is Latino Book Month. To celebrate, I'm giving away three books to one reader. To enter, just comment on any May 2010 post by May 31, 2010. I'm too busy to make you jump thru hoops. Comment!

"Blogging fame does not pay the bills"

From Social Media Examiner:

Wendy Piersall provides some insights into the "dark side" of being popular online:

- Fame does not pay the bills
- Being on the front page of Digg does not bring you success
- It takes lots of work to get internet fame and even more work to maintain the internet fame

See the video interview at Social Media Examiner.

References:
The Dark Side of Blogging Fame (a Wendy Piersall Interview). Social Media Examiner.

Image source: public domain.

Antibiotic use for respiratory infections could be reduced by 40% by procalcitonin (PCT) test

Procalcitonin (PCT) is a precursor of the hormone calcitonin, which is involved with calcium homeostasis, and is produced by the C-cells of the thyroid gland.

In healthy people, procalcitonin (PCT) concentrations are low, but in those with bacterial infection it occurs at high concentrations in the blood as early as 3 hours after infection. In people with viral infections, procalcitonin (PCT) levels rise only marginally, if at all.

A PCT-guided strategy applied in primary care in unselected patients presenting with symptoms of acute respiratory infection reduces antibiotic use by 41.6 percent without compromising patient outcome.


The FDA Approved an Automated Procalcitonin (PCT) Test in 2008.

References:
Simple test could cut excessive antibiotic use. Reuters, 2010.

Where you can find me this summer

After a quiet period in terms of public engagements (private engagements are a whole other enchilada!), I have three big gigs coming up.

The first is at work. For many years, our Office of Women's Affairs has been holding a leadership conference for women who work and study on campus. Each year we get a good number of women from the community, which we love, as well. The one day event has two sessions of workshops where women chose to learn more about financial management, relaxation, stress management, how to go back to school, etc. The last 2-3 years I've been in New York City and haven't been able to attend or finally provide content. This year I'm doing a blogging workshop!

THEN I'll hop in my car and head on over to Columbia and sit on a panel for the Making Media Connections conference. And finally I'll be on a panel with THE Andrew Huff. My life is complete. *wink*

Lastly, Deanna Zandt organized a panel for Netroots Nation and it was accepted. WOO! I guess when I hang with rock stars...Althou, I gotta say that after watching Baratunde, who is also on the panel, I'm super nervous. I guess when I hang with rock stars...ACK!

Not bad for summer. Especially considering that the kid & I are going to Lilith Fair, we're still planning a family vacation, all the sporting events we want to attend and we need to take plenty of time to just hang out in Chicago. Gawd, now I already feel like summer is over.

This month is Latino Book Month. To celebrate, I'm giving away three books to one reader. To enter, just comment on any May 2010 post by May 31, 2010. I'm too busy to make you jump thru hoops. Comment!

Book Review: Put on Your Crown By Queen Latifah

Normally I don't do self-help books. I also have a hard time with motivational books as well. But when I was offered the chance to review a motivational book for young women by Queen Latifah, I said, "Oh, hell yes!" Put on Your Crown: Life-Changing Moments on the Path to Queendom by Queen Latifah, Samantha Marshall is an age-appropriate, perhaps too much, book of advice for the young women in our lives.

First, being that Queen Latifah, or Dana as she refers to herself in the book by her given name, grew up in an urban setting and a lot of the things she references are urban in nature, I'm not sure how well a teen from a small rural town might identify with the book. Then again, a lot of the advice is quite universal. But I can imagine that a jaded teen might think, "Well, oh yeah, you weren't stuck in a one-horse town!"

That said I thought that Queen Latifah was quite forthright in the challenges she faced growing up, the missteps she took, how she let her early money be misspent and yes, a lot of body love.

About that body love...I understand that Queen Latifah decided to lose some weight to get healthy. That's cool. But the company that helped her lose the weight is mentioned a lot. As are a lot of big companies.

One of the things that I believe is hurting our kids from growing up with a true sense of self is this competition to have things. To hear a celebrity mention a brand and the instant need to get it. So if there is one thing I wish Queen Latifah had done differently in this book would had been to tone down the brand names.

Overall, I think this would be a good book to gift to a young woman in your life. I suggest that you read it first or get yourself a copy, so you can start a conversation about the book. As always, please buy yourself a copy at an indie bookstore or Powells.com.


Disclaimer: The only payment I received was the copy of the book.

This month is Latino Book Month. To celebrate, I'm giving away three books to one reader. To enter, just comment on any May 2010 post by May 31, 2010. I'm too busy to make you jump thru hoops. Comment!

Sign of the times

One more sign of the increasing geriatric population - in 2009 the adult size diapers outnumbered the baby diapers at the U.S. waste sites for the first time.



From Twitter:

@drwalker_rph Who counted the diapers???

Osteoporosis Drug Lasofoxifene May "Fight" Several Diseases But Increases Risk of Blood Clots

Lasofoxifene is a part of a class of drugs known as nonsteroidal selective estrogen-receptor modulators (SERMs). It has already been shown to decrease the bone loss associated with osteoporosis, like other SERMs, including tamoxifen and raloxifene. But until now its effect on other health conditions commonly experienced by postmenopausal women was unknown.

The women who took lasofoxifene had an 81% lower risk of estrogen-receptor (ER) positive breast cancer, a 32% lower risk of heart-related events like heart attack, and a 36% lower risk of stroke. "This is the first SERM that reduces the risk of all of these conditions at once."

However, not all the results were positive. As with other SERMs, women taking lasofoxifene had double to nearly three times the risk of experiencing a serious blot clot of the deep veins.

References:
Osteoporosis Drug May Fight Several Diseases. WebMD, 2010.

NEJM -- Lasofoxifene in Postmenopausal Women with Osteoporosis.

Image source: Flickr, Creative Commons license.

Ramen For Change

"Fear change only when you stop changing. Without change we cannot go forward."
~ Sam Byron

There's a lot of change coming and going in my life right now. I've been learning in these past few weeks how I deal with knowing that change is coming. I know that life changes so quickly in a moment, but for some reason, I tend to become really anxious when I know that a dramatic shift is coming my way.

If you've been going through the Center for Creative Change program at Antioch with me, my apologies. The last thing that you probably want to do right now is hear about change, sitting with ambiguity, or trusting the process. Feel free to skip over this and get to the broth. :)

However, I've been thinking a lot about change lately. About how I deal with change, how those around me deal with change, and what change really means. What I'm thinking is that change is a reminder for me to be present. You cannot hold onto the past, and when the future has not yet arrived, all you have is the present moment. I know that I am going to miss my Antioch community so much. But, instead of being afraid and wanting to cling on, maybe it's time I sat still and appreciated everything that is happening right now.

So that is exactly what I am doing. I'm trying to spend time with the people that I love and care about. I'm giving myself the time and space I need to process. And I'm letting the natural fear and anxiety run its course.

In the meantime, I'm also enjoying some broth. While all this change is going on in our lives, sometimes food is a nice constant and reminder to be present. Are you a broth person? I'm learning this week that I am a big broth person. When facing stress, anxiety, or uncertainty, I gravitate to broth. The noodles are just a bonus.

I really love ramen. Ever since I had that instant stuff in the package as a kid, I've always been drawn to warm noodles and broth. This is my version - it goes great with some broccoli or tofu. Nori is a more traditional addition for ramen, but I absolutely love cilantro so that is how I garnished mine! Here's to the foods we love that never change and all of the great things in our life that always do!


Ramen for one:

1 vegetable bouillon cube (or use about 2 cups of fresh vegetable broth)
2 cups water (or sub broth)
1 garlic clove, minced
1 tsp sesame oil
salt & pepper to taste
1 tsp ginger, minced
noodles - about 2 cups cooked (I used gluten-free, brown rice noodles. You can use whatever noodles you like!)
2 tsp soy sauce (optional)
nori (optional)
handful of broccoli florets (optional)
cilantro (optional)

Cook the noodles according to the package directions. Rinse in cold water, drain, and set aside.

Next, heat the sesame oil in a pot over medium heat. Add the ginger and garlic and saute for about 3 minutes. Then add the water and bouillon (or broth). If you are using broccoli and/or soy sauce add that next. Cook for about 3-5 minutes. Finish with salt and pepper and nori or cilantro (if using). Add the noodles and serve.

Review: Flirty Cupcakes

After a week of lobbying, the Flirty Cupcakes powder blue van finally hit my work neighborhood!


I have to admit that it's too much fun trying to track down a van full of cupcakes over Twitter. I stood at one corner for a few minutes hitting "refresh" awaiting word on which direction to go. I went west to the end of a block, then assessed the parking situation and went back east...They parked 2 blocks west. I can say that I don't think I walked anywhere faster than I did on Tuesday.

I fully intended to buy one cupcake and savor it on my walk to a staff potluck and grant strategy meeting. But once I realized I could get 4 mini cupcakes, I was sold. See, I like to have an even ratio of frosting to cake. I kinda hate eating mega cupcakes where I'm eating half of the cake without frosting. Cause really, what's the point? But mini cupcakes are usually perfect in ratio.

Then I thought, hmmm...do I eat these all or wait until tonight and SHARE? I waited to share.

In the left photo, you see No Plain Jane and I think the McDreamy in the front row. In the right photo, you see Devil in Disguise and I think CBFF in the front row.

The results?

CBFF: Tasted more like a brownie than a cupcake.
No Plain Jane: This made both the kid & I say, "OMG!" I rarely like vanilla cupcakes, but I'd get a full size one of these babies.
Devil in Disguise: Thumbs up all around. The frosting is always key to red velvet cupcakes/cake and they got it perfect.
McDreamy: Good. It didn't wow me or anyone else the way that others did.

Bottom line? Add Flirty Cupcakes to your Twitter feed and/or Facebook and remember to check them every morning cause they might be flitting over near you. They are worth the effort of seeking them out and tracking them down. And start thinking of where exactly they can park near you because they seek out legal parking spots as to keep the guys and gals in blue smiling.

This month is Latino Book Month. To celebrate, I'm giving away three books to one reader. To enter, just comment on any May 2010 post by May 31, 2010. I'm too busy to make you jump thru hoops. Comment!

What is the oldest medical blog?

Medical Blog Anniversaries

Dr. Rob explained why he had been blogging for 4 years http://goo.gl/seKp. He went on a hiatus in 2010 but then he came back in 2012. Dr. Bates has been blogging for 3 years, leading to over 1,000 posts and many new friends http://goo.gl/eB1e

I have maintained medical blogs since 2004 but never thought about blog anniversaries - blogging seems such a mundane task of daily life.

What is the "life expectancy" of a medical blog?

The studies are ongoing but the current record is around 8-10 years... http://goo.gl/5LRx

In the medical blogging world, the physician bloggers who produce high volume of original content often quit after 1-2 years. There is too much to handle. Medical blogging is a difficult task that requires a lot of time and mental energy (scientific accuracy, HIPAA compliance, ethics, etc.), and the financial rewards are nonexistent or negligible.

What is the oldest medical blog?

As pointed out in the comments, the "oldest" medical blog probably is Family Medicine Notes, followed by GruntDoc.

Related reading:

As A Busy Physician, Why Do I Even Bother Blogging? http://goo.gl/fSF3 - Excellent summary.

Twitter comments:

@gruntdoc (GruntDoc): That's why I'm pacing myself - @DrVes: You know it best - you were there at the beginning and the only one still blogging... :)

@Doctor_V (Bryan Vartabedian): Would love to see post from @gruntdoc (one of the oldest medblogs) on longevity. He's seen lots. Seen patterns.

@giustini (Dean Giustini): Moving to microplatforms Twitter & Facebook (from blogs) in medicine is trendy but they tend to cut off discussion & cause an exodus - @DrVes: Agree, but this is different. High-volume medbloggers used to quit after 1-2 years even before FB/Twitter... :)

@DrOttematic (Jessica Otte, MD): I only do a few posts a month unless spectacularly inspired. It's natural and not too demanding that way. I can't imagine how the high-outputters even last a year at it - @DrVes: Doctors are dedicated people. If you want to know "How Doctors Think", don't read books - read their blogs.

@giustini (Dean Giustini): Physicians are good at 'pattern recognition' after observing - daily blogposts are onerous / intellectually unsatisfying. I find that time & effort in blogging does not equal reward/recognition systems in medicine; partly true in my field too - @DrVes: True. Only printed publications count in academic promotion as of 2010... :) -

@giustini (Dean Giustini): This is why I think your blog is a standout. Has your publishing output decreased since starting your blog? what about presentations? - @DrVes: I publish more blogs than ever before (medicine, allergy, peds, etc.). Fewer presentations and conferences.

@giustini (Dean Giustini): Have you considered writing a book like "Medical pioneers in the web 2.0 era"? A review of blogging/ experiences; quotes from others? -- @DrVes: I have considered some book ideas (not this one in particular) but unfortunately have little time to do it. May be later, in 2012 - @giustini (Dean Giustini): We should write it sooner. The end of 2010 marks a natural demarcation line between web 2.0 and web 3.0.

@erinrbreedlove (Erin Breedlove): I'm an undergrad student and "baby" med blogger but hope to make your list someday. So rewarding. :) - @DrVes: I don't have a list. If you have a reflection of your blogging anniversary, I will reference it in the blog post... :) - @erinrbreedlove (Erin Breedlove): I knew that...no anniversary yet! May! Have a neat series I think you'd like, though. Working on it now. http://bit.ly/dFNkP2

@geeners (Gina Rybolt): I think I am the oldest nursing blog :) Just turned 8 in December 2010 - @rlbates: Impressive! Glad you're still active.

@DrVes: Why blogs are "better" than Twitter - it's difficult to have a discussion on Twitter but it works as a commenting system. Check the comments above, for example.

@gruntdoc: Your comments here prove the value of blogs. Twitter immediate & ephemeral.

Dr John Weiner @AllergyNet: Hi Ves. Until proved otherwise, AllergyNet Australia claims the title of oldest medical blog in Australia. Nov 1997

Related reading

Diagnostic Accuracy in Pharyngitis http://goo.gl/OFnyP - Do you know who devised Centor score? Medical blogger Robert Centor at medrants.com.

12 years of blogging about medicine, technology and their intersection. DocNotes, 2011. Including a 6-year break.

7.2% Decrease in Work Hours of U.S. Physicians Between 1996 and 2008

After remaining stable through the early 1990s, mean hours worked per week decreased by 7.2% between 1996 and 2008 among all physicians (from 55 hours per week in 1996-1998 to 51 hours per week in 2006-2008.

Excluding resident physicians, whose hours decreased by 9.8% due to duty hour limits imposed in 2003, nonresident physician hours decreased by 5.7%.

Physician fees decreased nationwide by 25% between 1995 and 2006, coincident with the decrease in physician hours.

A steady decrease in hours worked per week during the last decade was observed for all physicians, which was temporally and geographically associated with lower physician fees.

References:
Trends in the Work Hours of Physicians in the United States, February 24, 2010, Staiger et al. JAMA 303 (8): 747.

From Happy Hospitalist:

"That means your doctor earns 25% less today than they did just a decade ago. If you went to college and joined a company that said up front you would be paid 25% less in a decade than you were paid on the day you were hired, would you join them?

Why are physicians working fewer hours, a trend unique to doctors? The conclusion was reduced pay. Physicians just don't seem inclined to spend long hours in the office and hospitals to sacrifice their family life for the life of their patients when the the economic reward of doing so just isn't there.

I've talked with many subspecialists at Happy's hospital about the declining payment for their efforts. They all tell me exactly the same thing. They are going to work less and limit their hours as payment reductions come down the pipeline."

Image source: sxc.hu

Feminist Parenting: Explaining old vocabulary

I am proud to say that I was a tomboy when I was growing up. I ran around, rode my bike, climbed trees, played in the mud, played sports...all the things one might think about when you think of a tomboy. The problem is that the term tomboy is outdated.

Back in the early 1980s the distinction between girly girls and tomboys was fairly rigid. At least it was to me. I played with the boys during recess and in trying to hang with them, I spent a lot of energy trying to prove that I wasn't like the other girls. Thus, I know what it means to be "one of the boys" and the games one plays to get there...including fooling yourself. When I was forced to wear dresses, I couldn't play the way I wanted. This drove home the distinction to me: Wear a dress, act like a girl; Wear jeans, act like a boy.

But today...I see not just my daughter, but many girls running, jumping, climbing and being active and sporty one minute, then they are like Wonder Woman (in reverse), magically turning into girly girls in dresses and primping their ponytails. I have told my daughter many times that she lives in an amazing time where this can happen. I tell her, she doesn't have to choose.

She has chosen to be girly, but not uber-girly. She loves her dresses, skirts, etc., but she also loves playing soccer, gymnastics and climbing.

But last week she came home from school saying that a friend called her a tomboy. "What's a tomboy?" she asked at dinner. BIG SIGH...Her dad looked at me.

I explained that it was something, back when mommy was a little girl, people use to call girls who liked to play sports, climb trees and just run around. I also explained that for me, I liked the word, that it wasn't a bad word. I could see she was hurt to be called a boy for her athletic prowess. I then tried to explain that we don't need to use that term anymore since all girls can play sports and still wear dresses. Then she rolled her eyes...that's when I know I'm covering something again.

I think she got it.

She then reported that her friend then said, "Oh, you're not a tomboy, you're a tomGIRL!"

Perhaps her friend was merely trying to find a term to tell the kid that she's an athlete and admires her abilities. I hope so. Even thou I remember being gender-policed at that age, it still amazes me when it happens to the kid. She's not going to stop being a total girly athlete, but neither is the gender police. Hopefully I can build her up so high that when people try to knock her down, she still stands tall.

This month is Latino Book Month. To celebrate, I'm giving away three books to one reader. To enter, just comment on any May 2010 post by May 31, 2010. I'm too busy to make you jump thru hoops. Comment!

Seven Years

I can't believe it's been seven years since we last talked. I can't believe that our girl is almost seven. The little girl that you always dreamed about, the one you nagged me to have is just as we pictured.

People tell me that you would be proud and I know it's true. Thanks for starting me on this road. Thanks for all our fights too. I know they were primers for the ones I'll have with the kid.

Seven years ago friends and others in my life who had also lost parents said that time would heal. I can honestly say that they were right. Seven years later my heart still aches, but I'm at a peace that is hard to explain. Perhaps it's that today was not a regularly scheduled day, we were a bit rushed out the door, I even forgot the beer bread that I had baked for an office potluck, but it wasn't until 11 am that I remembered what today was. At first I felt terrible for forgetting, but then I thought, ahh...I think this is where I should be. At least I hope this is where I should be.

Yes, that's me at about age three with my mom and my puppy. 

Video: Cleveland Clinic Model of Medicine

ClevelandClinic — May 12, 2010 — "Innovation has made Cleveland Clinic a world leader in medicine, and is the only true long term solution to high quality affordable healthcare. The founders of Cleveland Clinic launched a revolutionary model of medicine, collaborative, patient centered, dedicated to innovation."