Posted in Employment, Health, news

Stand-Up Desks Help You Poop

Image from Officesupply.com

Most of us who work standing up or use a stand-up desk can attest to the fact that we seem to get a thumbs up from our colon.  In fact some of us will even admit we suffer from less constipation than our 90 degree angle sitt’n brethren.

Why?

Sitting may impede flow, flow that occurs hours before one needs to empty his bowels.  And not only do angles play a part in this but when one sits, their abdominal cavity shrinks, as opposed to stretching when standing up.  An individual who is standing allows more volume of abdominal room for the colon to work.

Additionally, pressure from sitting and the chair may cause undue pressure on the lower colon.  If you think back to high school physics, pressure has to be less at the destination of flow.  True, mass and density can vary based on poop amount but even NASA gets it (see below).

 

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….where “choke” is the act of sitting.

Even in basic terms, our caveman forefathers and mothers realized that standing made an easier bowel evacuation, (standing and squatting even easier).  So 2019 humans may need to go old school, doing less sitting and more standing.

 

Stools Help You Stool

 

A study from Ohio State University reinforces the theory that putting your feet up when you poop helps passage.

Studies have long suggested that standing or squatting when we poop is more natural and easier on our bowels.  When we sit angled with our legs at a 90 degree angle to our torso, we may worsen constipation.  (you see why we needed to learn geometry in school…)

 

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Dr. Peter Stanich and colleagues used a sample size of 52 people and of those who used a stool when they pottied, 71% reported faster bowel movements and 90% reported less straining.

They cite these “defecation posture modification devices” are a natural way to help one evacuate their bowels without relying always on medication.

 

So how do we define constipation?

Constipation is a decrease in frequency of bowel movements or difficulty passing stool that persists longer than one’s normal bowel movement cycle.  In general, less than three bowel movements a week could be considered constipation.20-30% of the US population suffers from constipation and this percentage increases in those who are elderly or confined to medical facilities. Some people have hard stools that are difficult to pass with normal motility, whereas others have soft stool but poor motility.

 

What causes constipation?

A variety of factors could be the culprit. These include:

  • Lack of water
  • Lack of fiber in one’s diet
  • Certain foods in one’s diet such as cheese, diary, fat, gluten, those high in meat
  • Caffeine
  • Hypothyroid
  • Stress
  • Lack of exercise
  • Pregnancy
  • Hormone fluctuations
  • Irritable Bowel Syndrome
  • Inflammatory Bowel Disease
  • Cancer
  • Laxative abuse
  • Eating disorders
  • Medications such as narcotics, antidepressants, iron supplements
  • Constipation should never be ignored………

 

What should our stool look like?

When someone is constipated, the stool is not moving through the colon as quickly as it should.  The more hours and days it sits in the colon, the more water is absorbed. So the stool churns and churns becoming dryer, smaller and harder.  So pebbles or rock-like stool is a sign of constipation.  Conversely, as in diarrhea, stool has not been processed by the colon properly, water has not been absorbed and thus it appears very soft or liquid-like. This puts one at risk of dehydration. Therefore healthy stool is a happy medium.

Using the Bristol Stool Chart, the ideal stool would be in the shapes of Type 4 and 5.

 

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What should I do if I’m constipated?

First drink more water. Secondly look at your diet and see if you have any offending agents such as dairy or fried foods.  Thirdly visit your medical provider for an evaluation.  Finally, try and relax.  Many of us have difficulty pooping because we are stressed or on a time crunch.  Your body doesn’t care if you have a meeting in 5 minutes.  The body likes to relax when it relieves itself so grab a magazine, or my blog, and take some time out of your day to poop.  Sometimes we need to stop and smell the roses……

 

 

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Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, iHeart Radio and Board Certified Family Physician

Posted in Education, Employment, Health, Millennials, news

Personal Statement For Residency: Tips on Making a Great Impression

The trials and tribulations incurred during medical school culminate during one’s 4th year when they need to go on their biggest interview of their life: their residency interview.  But as with most interviews, one needs an excellent resume (CV) and cover letter to walk in the door.

Hence a student’s “Personal Statement” is what completes the package that is presented to residency directors who choose your fate.

An advantage to this is that it provides an opportunity to personalize your application, which unfortunately can look very itemized during the application process.

In communication we are successful when we use the “Three E’s.”  These stand for Engage, Educate and Enlist.  You engage a person by garnering their attention, then once you have their attention you educate them, and once they are educated you can enlist them (such as rank me for your residency).

So what makes a good personal statement?

Length

The length of your personal statement should be approximately one page.  This gives you 5-8 paragraphs to tell your story without boring one to death.  You don’t want to be too short and sweet but rather to the point and hammer your message home without getting into trouble saying too much later.

Open with a grab, but don’t choke them…

The average person puts down an article, book, essay within the first sentence if it doesn’t catch them.  So avoid opening your personal statement with “I’ve always wanted to be a doctor…”  Putting your future residency director to sleep seven words in prevents him from remembering your application and choosing you for his program.

So instead you should focus on a personal story that led to your resolve to dedicate your life to others.  Examples of this include:

My decision to pursue medicine began when I came to the United States with my family to start a new life……

The art of medicine compels one to study the canvas before haphazardly wielding a paintbrush.  I learned this when……

But don’t be too flowery. Get to the point early on in your first paragraph on how life experiences affected your decision to pursue medicine and the specific specialty for which you’re applying.

Which brings us to….

Know your specialty

If you are planning to pursue a career in Family Medicine, don’t discuss how you want to become a “Jack of all Trades.”  This isn’t what family medicine is about.  Just as the specialty of surgery isn’t all about “cutting.”  Let them know in your statement that you get it by saying something like…..

Understanding the wide range of pathologies that may affect a patient of any age is paramount to becoming an excellent family physician.

Being an advocate for my female patients and enabling them to bring life into this world attracted me to the field of obstetrics and gynecology.

Show you’re a team player

The residency director, who’s interviewing you, needs to know you play well with others.  The team with which you will work includes senior residents, attendings, nurses, ancillary staff and administrators to name a few.  So incorporate in your letter how you are cognizant of how a patient’s success is dependent on a hospital’s “team approach.”

Avoid negativity

Avoid insulting other specialties or specialists…which may occur inadvertently when describing why you chose your specialty.  For example, in one personal statement I edited, the student wrote, “I didn’t want to be a doctor who just cuts, so I chose primary care instead.”  

A better approach would be, “I found being a front-line provider, making the initial decisions in a patient’s care, to be exciting.”

Do your research

Most students begin their personal statement at the end of their third year, when actually it’s during your third year when you can gain much insight into how to write it. So questions you may want to ask your preceptor are:

How do you define family medicine (or the specific specialty)?

How did you come to decide to pursue medicine?

What do you look for in a personal statement?

If you could give me any advice on what to include in my personal statement what would that be?

Additionally, ask your clinical education department for resources or examples of good personal statements.  Prior graduates who secured their top five choices may have offered their personal statements to the medical school for others to use as a guide.

Have a format

Even though personal statements vary in length, creativity, subject matter and prose,  there is a general format most appear to follow.

Part 1 – your eye-catching opener that gives the program director a glimpse into your passion, personality, and plan (entering the field of ……).

Part 2 – a patient case or moment in your past that led you to forming this educated decision to pursue a specific specialty.  Don’t go into too many specifics regarding the patient due to HIPPA, and make sure your decision to pursue a particular field was not done on a whim or at the last minute before fourth year.

Part 3 – explain why you would be a good candidate for their residency program.  What makes you a good student, doctor, leader, team player, educator (you will be teaching medical students) and person.  Don’t itemize every accomplishment on your CV, but highlight some of your finest accomplishments and strengths.

Part 4 – after you’ve engaged and educated the reader, you are ready to enlist them.  The final portion of your personal statement reinforces why you are an excellent candidate for their program and how your goals are aligned with theirs in terms of providing good patient care, educating others, and giving back to your community.  This is also where you can suggest what you are looking for in a residency program, such as one that offers research opportunities.

Remember to end the personal statement with a note of gratitude, such as, “Thank you for considering my application to your residency program.”  A piece of humble pie goes along way.

Have it edited

When you have completed your personal statement, make sure you have someone else read it and find any grammatical and spelling errors.  Although most residency directors do not expect you to be a professional linguist, errors in one’s statement may suggest that you are haphazard, inattentive, have a lack of care for details, or lazy.

So in summary, being given the opportunity to market yourself is a gift.  So don’t put it off until the last minute and pray one draft does the trick.  Write this as it’s the most important 500 – 800 words of your life….

 

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Great Gift!!!

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Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

 

Posted in Education, Employment, Health, news

Woman Arrested After Passing Gas and Then Pulling Knife on Offended Bystander

Embarrassment many time leads to violence.

This week a woman who was embarrassed by a remark after she passed gas pulled a knife, threatening to “gut” him.

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37-year-old Shanetta Wilson was standing in line at the Dollar General Store in Broward County, Florida, when she let loose some loud gas.  When a man confronted her on how loud it was, she allegedly pulled a knife out of her purse, threatened she would “gut” him and appeared to lunge.  She was arrested with a charge of aggravated assault with a deadly weapon (the knife, not the fart).

 

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Does embarrassment lead to violence?

One of the most undercited reasons for violence is embarrassment.  Violence that ensues after one is fired, rejected, ousted or expelled appears to occur fairly often.

Last year in the same county, 17 people were killed at Marjory Stoneman Douglas High School by Nicholas Cruz, who was previously expelled by the school.

Last month a man rejected by his fiancée killed her and two others at a Chicago hospital.

In August a 14 year-old Oklahoma teen stabbed a 16 year-old 11 times after she rejected his request for a relationship.

Now, most likely many of these soon-to-be-violent individuals are rejected due to their odd behaviors.  However, the time surrounding the “embarrassment” may be the most dangerous.

Hence society’s approach to stopping domestic and workplace violence may need to tap in on key times that surround one’s expulsion.

 

 

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Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

She is also a Board Certified Family Physician and Assistant Professor at Touro University Nevada

Posted in Employment, Health, news

Ambien Side Effects: Erratic Behavior but NOT Racism

Roseanne Barr in, an apology for a tweet in which she alluded to ex-Obama aide, Valerie Jarret, as “muslim brotherhood & planet of the apes had a baby=vj” cited Ambien as the cause.

ABC News cancelled her hit show Roseanne on Tuesday.

In an apology, the actress tweeted, “I apologize to Valerie Jarrett and to all Americans. I am truly sorry for making a bad joke about her politics and her looks. I should have known better. Forgive me-my joke was in bad taste.”

She later tweeted, “I did something unforgiveable so do not defend me. It was 2 in the morning and I was ambien tweeting — it was memorial day too — i went 2 far & do not want it defended — it was egregious Indefensible. I made a mistake I wish I hadn’t but…don’t defend it please.”  CNN reports she also tweeted the following, “Not giving excuses for what I did(tweeted) but I’ve done weird stuff while on ambien — cracked eggs on the wall at 2am, etc.”

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The makers of Ambien, Sanofi, tweeted the following response, “While all pharmaceutical treatments have side effects, racism is not a known side effect of any Sanofi medication.”

Millions of people use Ambien (zolipdem tartrate), a sedative hypnotic, in a 5 mg or 10 mg tablet form, that is used for fast-acting sleep initiation and is famous for not inducing a drowsy feeling the next morning.

Unfortunately multiple users have cited odd side effects such as driving to work in the middle of the night, or cooking breakfast.

According to rxlist.com, side effects of Ambien may include:

  • Daytime drowsiness
  • Dizziness
  • Weakness
  • Lightheadedness
  • “Drugged” feeling
  • Tiredness
  • Loss of coordination
  • Stuffy nose
  • Nasal irritation
  • Dry mouth
  • Sore throat
  • Nausea
  • Constipation
  • Diarrhea
  • Stomach upset
  • Headache
  • Muscle pain
  • Confusion
  • Insomnia
  • Euphoria
  • Ataxia (balance problems)
  • Visual changes
  • memory loss
  • mental/mood/behavior changes (such as new or worsening depression, abnormal thoughts, thoughts of suicide, hallucinations, confusion, agitation, aggressive behavior, or anxiety).

The medication is a gamma-aminobutyric acid (GABA) A agonist, inciting a neurotransmitter cascade that can inhibit activity between neurons, nerve cells.  Lower levels of GABA are linked to sleep disorders, so inciting the GABA receptor as Ambien (zolpidem tartrate) does, can induce sleep.  But once we’re affecting nerve signals other side effects may ensue since the GABA inhibitory neurotransmitter affects the central nervous system.

So odd behavior could be a side effect. However, as with alcohol-induced behavior, exacerbations of feelings or tendencies may occur.  Forming new opinions, which may be racist, would not be a side effect of this medication.

Medical providers warn users to hide car keys, lock of refrigerators and put child locks on stoves and ovens as “sleep walking” behavior could put them and their families at risk.  This also includes posting on social media… so keep phones away from the bed and computers off.

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Radio personality Mark DiCiero shares his personal experience here.

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, iHeart Radio, KDWN and Board Certified Family Physician

 

 

 

Posted in Employment, Health, news

How Doctors Can Prevent Burnout

A new study from the American Medical Association (AMA), the Mayo Clinic and Stanford University finds 1 in 5 physicians plan to cut back their hours next year and 1 in 50 will leave the profession completely within the next 2 years.

Burnout is cited to be the main cause and is one of the biggest threats to healthcare today.

According to AMA President Dr. David Barbe, “An energized, engaged, and resilient  workforce is essential to achieving national health goals.”

And burnout affects all fields of medicine, surpassing 50%, in those including primary care and specialties such as gynecology, neurology, urology, emergency medicine, anesthesiology, cardiology and critical care to name a few.

Patients are at risk because if doctors aren’t at the top of their game, things get missed.  Moreover the keen instinct of a clinician is imperative to diagnosing correctly, and this gets blunted when one is emotionally fatigued, or burned out.

Why are Doctors Burning Out?

A variety of factors can lead to physician burnout but the following appear to be the most cited:

  1. Electronic medical records – these are time-consuming to learn and implement, take time away from patients and may be financially burdensome due to their cost and lack of revenue for those who struggle to type and work with computers.
  2. High patient insurance deductibles – with insurance companies not paying until patients reach their deductible, it forces doctor’s offices to work harder to collect the income needed to run a practice.  Physicians do not want to get into the financial aspect of patient collections and it adds undue stress on an already stressful field.
  3. Red tape – ICD 10 code changes, insurance authorizations, referral forms turn the average day of a physician to less patient care and more bureaucracy.
  4. Less respect – in the old days, doctors were considered heroes and revered greatly.  Today they are frequently blamed for issues such as rising healthcare costs and the opioid epidemic.
  5. Malpractice suit fears – doctors are human and can only combat nature so much.  When one is diagnosed with cancer a physician has to fear that one will accuse him of not diagnosing it “quickly enough”.  When a lab gets ordered, the clinician has to hope that his staff is ensuring that every lab value comes across his desk.  When a prescription gets written, he has to hope that the correct medicine gets dispensed, works effectively and does not cause an adverse reaction.  And when a referral is made to a specialist, he has to hope all the above issues go well with the second physician or he can be sued for the referral.  And since a doctor sees thousands of patients a year, the odds that he will be sued for something is higher than any other profession.  Moreover, one lawsuit is a enough to bankrupt him.  Pretty darn stressful.

 

What are the signs of burnout?

In any profession, the following may be signs of burnout:

  • Apathy
  • Exhaustion
  • Poor sleep
  • Negative attitude at work
  • Absence from work
  • Being irritated
  • Feeling empty
  • Dreading going to work
  • Feeling underappreciated
  • Feeling you don’t matter
  • Blame others for mistakes
  • Low energy
  • Thinking about quitting

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How to prevent burnout?

  1. Find the humor – As Milton Berle once said, “Laughter is an instant vacation”.  Watching a comedy or taking a 10 minute break to watch some funny You Tube clips offers immediate relief and energizes you.  A day without laughter is a day wasted. Charlie Chaplin
  2. Take care of yourself – how can one heal others when he himself needs healing?  So what can you do?  Try Massage, Meditation, Yoga, Exercise, Stress diary, Sleep, Mini vacations, Staycations but most of all…..Take breaks!!
  3. Learn to say “No” – Its OK to take a day off. Why not take off early on Friday’s?  Or better yet, work a half day on Wednesday to break up the week?  Learn the 4 D’s…..Deflect, Defer, Deter, Delegate…..
  4. Make small goals – too many times we burnout because we failed to meet a goal that was unattainable in the first place.  So we toil for years to become “promoted”, or “wealthy”, or “slim”, or “married”, or “see the world”.  Instead, make smaller attainable goals (find a partner, open auxiliary office, lose 10 lbs, take a trip).
  5.  Quit comparing yourself to others – we watch Shark Tank and then wonder what we are doing wrong, not being millionaires.  It’s unrealistic to think you should be “rich by now”.  We will always be inferior to someone else.  So get over it and love who you are and what you’ve accomplished.
  6. Have fun at work – contests, pot luck lunches, lunch room decorating, accent days, dress up days, and end of the week happy hour can spice things up at work.  Plus it increases morale among coworkers and staff.
  7. Be charitable – Doing community service is so rewarding and energizing that having a pet project helping out a local charity may be just what this doctor orders.  You can choose a cause, fundraise, attend charity events or walks, or even create a campaign.
  8. Get a hobby – tap into your artistic side by writing a book, song, article; paint; cook; build; teach; sing; dance; or even ride.
  9. Work on your bucket list- whether its going to a foreign country, learning to speak a new language, buying a vacation property, or even starting a second business, don’t let job burnout deter you.  This may give you the energy and perspective you need.

Finally, be around others and have a Bitch and Moan session – it feels so good to complain and gripe. Find others in similar situations as you and you’ll realize that you may have it better than you think.

Remember you have to come first and doing so will make you more of a help to others.  Feel great and you’ll make others feel great!

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, iHeart Radio and Board Certified Family Physician

Posted in Employment, food, Health

Employers: How to Help Improve Your Employees’ Health

Image above from MedicalDaily.com

 

While the future of employer based health insurance remains uncertain, one certainty that remains is employers need healthy employees.

Your staff is the backbone of the organization, hence nurturing and facilitating good health practices not only ensures their stability and health but also that of your company/business.

Here are a few ways to accomplish this:

Offer the Flu Shot

According to the CDC, 20% of Americans get the flu each year, costing businesses $87 billion dollars a year.  The cost of supplying the flu shot pales in comparison to 1/5 of your workforce calling out sick during your busy season.  Supplying a one day flu shot clinic is not only economical but life saving as the flu can be deadly.

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Provide Adequate Sick Leave

Sick leave varies per company and critics of extended sick leave are concerned with abuse of the paid days given.  Some employees may use up their sick leave for personal time and then when cough and cold season comes around, they are forced to go to work sick or face unpaid leave.  This exposes other workers to illness leaving more posts vacant when those employees need to take leave.  Understandably, it’s a controversial subject as a small employer would have to staff double to ensure adequate coverage of a position if one calls out sick. The more sick leave, the potentially higher the cost.

However a few modifications may help both employer and employee.

a.  Begin the Sick-Leave Cycle during Flu Season.  Rather than Leave Periods renewing every July 1, start the new Leave Cycle November 1.  This helps increase the chance that the employee would have their sick days untouched during a very common time of year when it needs to be used.

b.  Make sure adequate hours are offered for both sick leave and personal leave.  A cold, respiratory infection, stomach ailment, etc. can easily burn through 5 sick days.  An employee taking off one or two days could still be contagious days 3-5 or more.  Adequate sick leave prevents one from returning to work too soon.

c.  Offer a means to earn extra days of leave.  If an employee wants to re-earn sick leave/personal hours for later in the year, offer incentives or work projects that allow employees to gain extra days.

d.  Institute an “hours bank”.  If an employee has used all of his/her personal, vacation and sick leave, they can borrow from an “hours bank”.  The “hours bank” could include hours donated by other employees, hours won during office contests, or simply a bank that exists that will award an employee additional time with the understanding that they will have to replenish the hours in the bank at a later date.  This will allow an immediate need for sick time to be gratified but prevent abuse as it is understood to be a “loan” of hours.

Promote Prevention/Offer Screening Services

Encouraging employees to get preventative screens may help prevent serious illness. These screens can be done at their primary care provider’s office or the employer can bring the screening in-house.

 

Encourage Getting Up and Moving Around

Before the end of each hour, a “stand up and move around” alarm should go off and allow 5-10 minutes of physical activity. Not only is this beneficial for health but helps prevent burnout in the work place.

Offer Healthy Snacks

Swap the sugary carbs in the snack machine with healthy juices, snacks, and bottled water.  Encourage potlucks or contests where employees bring in their most creative healthy snacks.

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Image above from HealthyFamily

 

Have Plenty of Sinks and Hand Sanitizing Stations

An individual’s workplace can get very dirty as studies have shown computer keyboards to hold more pathogens than a toilet seat.  Offering cleansing wipes, wall sinks and sanitizing stations will improve employee hygiene.

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Offer Workstation Modifications

Many employees may suffer from low back pain, arthritis, hemorrhoids, and a variety of conditions that may worsen when one sits all day at a computer.  Offering chair modifications, for example, could decrease their need to call out and help improve their comfort and therefore efficiency.

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A well implemented program for workplace and employee health is a necessity for all organizations, and as you will come to see, cost saving in the long run.

 

 

                                                                                                         

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, iHeart Radio and Board Certified Family Physician