The Road to Balad and Back.: For the Love of Guam...

Tuesday, July 21, 2009

For the Love of Guam...

Good Evening Everyone,

Today, I would like to dedicate this blog to the beautiful people of Guam. In 1944, Guam was in the hands of the Japanese and on this date in 1944, the Allied Forces with the help of the courageous people of Guam were able to take back their homeland. So today, I would like to wish the people of Guam a very happy and peaceful anniversary of their independence.

I think it is very important for us in the military to thank all of the country's who fly the Flag of the United States side by side with their country's Flag. Nations like Guam, the Virgin Island, Puerto Rico, St. Croix etc... are all small countries who have been our partners in conflict and in peace. We are so very thankful for having Dr. Walter Perez bless our lives even if it were for a short period of time. Dr. Perez sent us providers each a shirt that he purchased in Guam and asked that we wear it in honor of Guam's Independence from the Japanese. So with honor and great privilege, Dr. Perez we honor your lovely homeland.

These shirt are awesome and they go well with our uniform.

This simple but beautiful flag makes me want to go and visit Guam.

Dr. Perez, we all want to know that we dearly love you and miss you very much. We will be home soon and we will be with our families. I would like to say that you helped to make our little group feel like a family and for that we thank you.

I will be planning a visit to Guam, hopefull within a year, when our vacation time allows. I am so excited to see you again and to meet your family.

God Bless You,

Jeff and your fellow Band of Brothers.

2 comments:

Anonymous said...: Si yuos maase, my brothers. This is "thank you" in Chamorro, the language of the Marianas Islands which include Guam, Saipan, and Tinian, rich in WW-II history. The literal meaning is "may God grant mercy". I have been blessed to have served with all of you, undoubtedly the best PA's and RN the Army has. I think of you fondly and pray for you and your families. Please extend my greetings and love to all of the 215th, especially to my medics. You look great in your island shirts. Blessings, Dr. Chris; August 6, 2009 at 2:07 PM
Jeff said...: Chris,

Thank you for commenting. We missed you dearly. We are finally home and have been adjusting. Thanks for the shirts, they are great and of high quality. Thank you for editing my book as well. I made the changes and it is looking great. Brother you are awesome. Please email me if you would as I am not sure where your email address is. Thanks,

Jeff; August 23, 2009 at 7:32 PM

Scripture of the Day: Hebrews 10:22-25

'...let us draw near to God with a sincere heart in full assurance of faith, having our hearts sprinkled to cleanse us from a guilty conscience and having our bodies washed with pure water. Let us hold unswervingly to the hope we profess for he who promised is faithful. And let us consider how we may spur one another on toward love and good deeds. Let us not give up meeting together as some are in the habit of doing, but let us encourage one another and all the more as you see the day approaching.

Scripture of the Day: Ecclesiastes 5:2-3

‘Do not be quick with your mouth, do not be hasty in your heart to utter anything before God. God is in heaven and you are on earth, so let your words be few. As a dream comes when there are many cares, so the speech of a fool when there are many words.’

Note:
The truth is that the Lord knows what your prayers are going to be before you start to pray. So, get to the point when you pray and share your concerns with the Lord. He wants to hear from you and He wants to converse with you so talk to the Lord as you would a loving Father. Also, be careful about making a vow to God or promising that you will do something if he answers your prayers. God cannot be bribed. You have nothing that He needs. If you make a vow to the Lord, He will hold you to it, so be prepared to uphold your end of the deal. I truly believe that the Lord wants to work in the lives of those who love Him and are working to advance His Kingdom. I have been guilty of pleading with the Lord and promising Him that I would do certain things if He would honor my request. I learned that the Lord doesn't desire a relationship of Quid Pro Quo or this for that. He desires to serve you as you serve Him and we need to trust that His direction for us will lead us to Salvation.
Finally, the Lord doesn't always say yes to our prayers. Believe me I have had a couple of things in my life that I have prayed for Godly intervention and yet the Lord has been silent. I have even tried taking matters in my own hands and try to bring about things in my own way, but I have not been successful. My failures are really triumphs of God's will. He knows what is best and his silence was really for my gain. I will admit, however, that my heart aches at times for Godly intervention but at the end of the Day the Lord knows when to move and when to have us stay put. Praise the Lord for His wisdom.

Scripture of the Day: Philippians 1:9-11

'And this is my prayer: That your love may abound more and more in knowledge and depthe of insight, so that you may be able to discern what is best and may be pure and blameless until the day of Christ, filled with the fruit of righteousness that comes through Jesus Christ--to the glory and praise of God.'

Note:
Bryan and I work out at the gym together almost everyday. Yesterday we were walking to the gym and we were talking about what it means to be a follower of Christ. We both agreed that it seems that there is a great deal of emphasis in our Churches today, about the importance of faith, but little on the responsibilities and accountablity that we as Christ followers have.
In Colossians 1:10, Paul writes, 'And we pray this in order that you may live a life worthy of the Lord and may please him in every way: bearing fruit in every good work, growing in the knowledge of God...'
When we were called to be followers of Christ, we were called for a purpose. The Lord has sent us out to work. He raised us up to be a vine that bears fruit. I have been concerned over the last few years that churches have become more concerned with how big they can grow their congregation; more concerned with how magnificent their church building has become; more concerned with raising the monies to pay the huge debts that they have incurred. Growth of a church is great, but when a church has lost the ability to hold it's members accountable, then the church has lost it's function. It is not enough to say that you belong to a big church. Being a follower of Christ requires a personal devotion, an individual accounting of your activities and an accounting of your heart to Christ. The problem is that church is a Sunday social outing for many and the leadership of the church often times has no idea of who is coming and going from their pews. That is a shame. Jesus knew his disciples and called them by name. I have to say that I am thankful to the small churches who have concerned themselves with the personal Spiritual growth and work of the individual member rather than the physical growth of their church. Individual members who work together for the growth of God's Kingdom is the body of Christ. Churches need to hold their members accountable and members need to hold eachother accountable to Christ so that the Church may grow in Him.
My assessment may sound like a stinging indictment on the megachurch movement and in a way it is. It is not enough to fill the pews. It is not enough to build a building. The true body of Christ ensures that every part of the body is fit and ready to serve. If requiring accountablity of the congregation causes some to go somewhere else, then so be it. I would ask that we stop watering down the Gospel for the sake of growth and uphold the righteousness of Christ. Hold firm to His teachings and the Lord will bring willing workers and what growth the church may have will be strong and uncompromising.
My prayer is that the Lord allows you the wisdom to discern what is right and what is Godly so that you may present yourself blameless and pure and filled with the fruit of righteousness that comes from Christ. If you want the church, the body of Christ, to experience true growth, then allow yourself to be accountable to Lord.

Scripture of the Day: Proverbs 15:13

'A happy heart makes the face cheerful, but heartache crushes the spirit.;

I just want to share a note with you concerning heartache.
I know that life is not fair sometimes. And I know that sometimes there will be an event that will break your heart and crush your spirit. Some of you may have lost a loved one, had a relationship go bad, had your trust violated by another person or had something else happen that just rocked your world.

I want to share with you that God understands a broken heart. In my life, I have been guilty of getting angry with God and accusing Him of abandoning me during those times when my spirit had been crushed. I would ask, in prayer, for God to reconcile events to my specific desires and to undo the heartache that hurt so deeply. But I have learned to come to God and ask for His wisdom in helping me cope, instead of asking Him to do things my way. You see, I am flawed and I have earthly wisdom which means that my solutions are bound to fail. Instead if we ask God to fill us with His wisdom and ask Him to help us cope with our pain by using His mercy, then I think we would have our spirits lifted again.

I am so sorry for your heartache and I pray for those of you who hade had your spirit crushed. I understand your pain and what is more important is that God understands your pain. Please, in your moment of grief, turn to God and ask Him for His guidance. He is faithful and will honor your desire for wisdom.

God Bless

Scripture of the Day: Matthew 22:34-40

Hearing that Jesus had silenced the Sadducee, the Pharisees got together. One of them, an expert in the law tested him with this question: "Teacher, which is the greatest commandment in the law?"

Jesus replied: "Love the Lord your God with all your heart and with all your soul and with all your mind. This is the first and greatest commandment. And the second is like it: Love your neighbor as yourself. All the Law and the Prophets hang on these two commndments.

Note:

The Jewish laws numbered around 613 seperate laws at the time the Pharisees asked Christ this question. Now, they were trying to trap Jesus in this question, but Jesus gave a very direct and definitive answer. He said to love your Lord. This answer in and of itself would not have shocked the Pharisees, but what he said next, I believe, did. Jesus said, the next is like the first and that is to love your neighbor as yourself.

My thoughts on this are that the Pharisees had spent their life living for laws, not for a relationship. They looked at their role as spiritual leaders to be enforces of laws. So, when Jesus said that the most important law was to love not only the Lord but their neighbors, I believe this set them back on their heels a bit. Christ was saying that 'All of the laws...hang on these two commandments.' which means that the Pharisees had about 616 laws that had just been marginalized; laws that they had devoted to enforcing. What Jesus was saying was that the Lord was not interested in what laws man followed, no matter how well intentioned that the laws were established, but what kind of relationship that each man had with the Lord.

What the spiritual leaders of the day failed to understand was that, if we love the Lord with all of our hearts and love our neighbor as ourselves, then our risk of violating all of these other laws goes away.

We should desire to please our God. To come into a communion with Him. So, often we get into a pattern of worrying about what we should or shouldn't do in order to be in good standing with the Lord. What movie should I watch, what kind of people should I hang out with, what type of entertainment is appropriate, how do I know what is good for my children, how do I handle these people at work, what should I do to repair broken relationships...on and on it goes. The truth is that if we are in a loving relationship with Christ and loving our fellow man, then we will already have the answers to these questions. The Lord will reveal himself to you, when you are serving Him out of love and he will provide you with the wisdom that you need.

Mother Theresa confessed once that the only time the Lord revealed Himself to her was when she was working with the poor. Any other time, she said she had trouble communicating with the Lord. Isn't that interesting? So, what did she do? She chose to do those things that would allow God to reveal Himself to her.

If you are having a hard time in your relationship with Christ. If you feel that God is just not listening to you. Ask yourself, 'are you loving your God with all of your heart and are you loving your neighbor as yourself?' If so, then God will direct you to a place where He will reveal Himself to you.

Scripture of the Day: Daniel 2:47

The king said to Daniel, "Surely your God is the GOd of gods and the Lord of kings and a revealer of mysteries for you were able to reveal this mystery."

Note: My wife and her bible study are going through the book of Daniel, so I thought I would read it again, just in case she decided to give me a quiz the next time we talk. ;0)
So, how is it that King Nebuchadnezzar could make such a rousing proclamation for the Lord and then in the next chapter sets up a golden idol and demands that Shadrach, Meshach and Abednego to bow to this idol? Well, we know the story, the King has them thrown into a furnace of fire and the rest is history.
I think that the king had an experience with the power of God. He saw what amazing things that the Lord could do and he was blown away. But despite the close encounter that the king had with God, he was only a mere observer of God's power.
You see the king never had a relationship with the Lord. He saw God's awesome power but like a man who looks in the mirror and walks away, he forgot what he saw. Let's contrast that with Shadrach, Meshach, and Abednego, they were not mere observers of God's power, they were in a relationship with the Lord. They knew without a doubt that God would rescue them from the fire and that no idol of gold would bring them to their knees.
I think about my relationship with Christ and I think about how many years that I was a mere observer of God's power. I would have moments when God would do things and I would be completely amazed, but then I would walk away and forget the power that I observed. Christ called us, not to be amazed and fascinated at His abilities, but to come into a relationship with Him. He wants us to invite us into a relationship. It is funny that through the kings disobedience, God's power was displayed even more when he rescued the boys from the fire. Let that be a lesson to us all...God's authority and power continues despite our disobedience. God has invited us into his presence. Why do we walk away?

Scripture of the Day: Mark 1: 16-18

As Jesus walked beside the Sea of Galilee, He saw Simon and his brother Andrew casting a net into the lake, for they were fishermen. "Come follow me," Jesus said, "and I will make you fishers of men" At once they left their nets and followed Him.

Note: One of the few pleasant memories of my dad was one time when he took me to go fishing. My father and I never did see eye to eye on anything, but that one time when he decided to take me fishing, I dropped everything and I hopped into the car and went fishing. We sat on a river bank and we fished and talked. It was one of the few times that I actually enjoyed time with my father.

Jesus, came to these men out of love and asked them to go fishing. They recognized that this was a man who was calling them not to go fishing but to go with their father on a mission of love. They knew immediately that Jesus was calling them to be something greater then themselves. He was calling them to find the lost and to bring them home.

Jesus has called us to be fishers of men. When was the last time that your father took you fishing? and when was the last time that you caught anything?

God loves you and he has called you to go fishing. Cast your line today and see what you catch.

Scripture of the Day: Hebrews 10:19-25

Therefore, brothers, since we have confidence to enter the Most Holy Place by the blood of Jesus, by a new and living way opened for us through the curtain, that is, his body, and since we have a great priest over the house of God, let us draw near to God with a sincere heart in full assurance of faith, having our hearts sprinkled to cleanse us from a guilty conscience and having our bodies washed with pure water. Let us hold unswervingly to the hope we profess, for he who promised is faithful. And let us consider how we may spur one another on toward love and good deeds. Let us not give up meeting together, as some are in the habit of doing, but let us encourage one another—and all the more as you see the Day approaching.

Scripture of the Day: Proverbs 12:14

From the fruit of his lips a man is filled with good things as surely as the work of his hands rewards him.

Commentary:
I was thinking today, about this scripture. It seems that Proverbs likens the fruit of a man's lips to the work of his hands. I was thinking about the fruit that comes out of my lips is really what represents what I do. When we were called to be a witness for the Lord, we were given a task to share the Gospel. Our calling is to share the Word with those around us. It is our job, it is the work that rewards. So, I started thinking about how many days the Lord has allowed me to live and then I thought about how many days that I failed to share the Gospel with others and I came to the conclusion that the Lord should have fired me long ago. I have been a bad employee. My lips have failed to bring forth the fruit and my hands have failed to work to bring others to Jesus. I would really ask all of you to think about how you can perform your Witness on a daily basis. We are working for the Lord and he has commissioned us to 'go forth and make disciples.' How many disciples did you make today?

I love you all.

God Bless

Scripture of the Day: 1 John 4:7-12

7Dear friends, let us love one another, for love comes from God. Everyone who loves has been born of God and knows God.
8Whoever does not love does not know God, because God is love.
9This is how God showed his love among us: He sent his one and only Son[a] into the world that we might live through him. 10This is love: not that we loved God, but that he loved us and sent his Son as an atoning sacrifice for our sins.
11Dear friends, since God so loved us, we also ought to love one another.
12No one has ever seen God; but if we love one another, God lives in us and his love is made complete in us.

QUICK NOTE:
I have been thinking about God's love lately and I have been wondering how many of us realize the love and mercy that He gives to us. Verse 9 says that 'He sent His Son so that we might live through Him.' I wonder how many of us are living through Christ. In Genesis 18, the Lord told Abraham that he was going to destroy Sodom. Abraham pleaded with God to spare the city. God told Abraham if he could find 50 holy men then he would spare Sodom. Abraham pleaded his case and the Lord said, "For the sake of ten (Righteous men) I will not destroy it." So all Abraham had to do was find ten truly righteous men, he was not successful. I wonder if the Lord asked any of us to find ten truly holy men or women, could we do it? Would any of us be one of the ten that could be presented to God as truly holy? I am so thankful that God's mercy is on us.

Fun Facts: China

China, the new emerging power has been the oldest continuous civilization on Earth, for the last 4000 years. Chinese flag is red which represents the blood spilled during the communist revolution. On the flag there is one large star, representing leadership, and four small stars which represent four social classes: capitalists, bourgeoisie, workers and peasants all united under one Communist Party. Some of the China’s inventions: gunpowder, paper, printing, compass, porcelain, first paper currency, animal zodiac, cast iron, chopsticks, crossbow, toilet paper, collapsible umbrella, fork and many other cool inventions. Interesting fact about China is that in last three years growth of China’s economy was around 10% per year making China the country with largest world economy. The funny fact is that China was in dispute with WTO (World Trade Organization) because of the extremely low taxes on their exports. However, United States was in the dispute with WTO because of the high taxes on U.S. imports. "We are committed to challenging China's WTO-inconsistent practices that harm American workers and businesses," said U.S. Trade Representative Susan Schwab.

Fun Facts

John Williams is an American musical composer but did you know that he wrote the musical scores for the following films:

1960s
Because They're Young (1960)
I Passed for White (1960)
The Secret Ways (1961)
Bachelor Flat (1962)
Diamond Head (1963)
Gidget Goes to Rome (1963)
The Killers (1964)
None but the Brave (1965)
The Rare Breed (1966)
John Goldfarb, Please Come Home! (1965)
Valley of the Dolls (1967) Oscar nomination (songs written by André and Dory Previn)
A Guide for the Married Man (1967)
Fitzwilly (1967)
The Reivers (1969) Oscar nomination
Goodbye, Mr. Chips (1969) Oscar nomination
1970s
Storia di una donna (1970) His only score written for a foreign movie
Jane Eyre (1970)
Fiddler on the Roof (1971) Oscar winner (score adaptation)
Images (1972) Oscar nomination
The Poseidon Adventure (1972) Oscar nomination
The Cowboys (1972)
Cinderella Liberty (1973) Oscar nomination
The Long Goodbye (1973), also title song.
The Paper Chase (1973)
Tom Sawyer (1973) Oscar nomination shared with Robert B. Sherman & Richard M. Sherman
The Towering Inferno (1974) Oscar nomination
The Sugarland Express (1974)
Jaws (1975) Golden Globe, BAFTA & Oscar winner
The Eiger Sanction (1975)
Family Plot (1976)
Midway (1976)
The Missouri Breaks (1976)
Black Sunday (1977)
Star Wars (1977) later retitled Star Wars Episode IV: A New Hope Oscar, Golden Globe & BAFTA winner
Close Encounters of the Third Kind (1977) Oscar nomination
Jaws 2 (1978)
The Fury (1978)
Superman (1978) Oscar nomination & double Grammy nominations
1941 (1979)
Dracula (1979)
1980s
Star Wars Episode V: The Empire Strikes Back (1980) Oscar & double Grammy nominations, BAFTA winner
Raiders of the Lost Ark (1981) Oscar & double Grammy nominations
Heartbeeps (1981)
Monsignor (1982)
E.T. the Extra-Terrestrial (1982) Golden Globe, Oscar & BAFTA winner
Star Wars Episode VI: Return of the Jedi (1983) Oscar nomination
Indiana Jones and the Temple of Doom (1984) Oscar nomination
The River (1984) Oscar nomination
SpaceCamp (1985)
Empire of the Sun (1987) Oscar nomination, BAFTA winner
The Witches of Eastwick (1987) Oscar nomination
The Accidental Tourist (1988) Oscar nomination
Born on the Fourth of July (1989) Oscar nomination
Indiana Jones and the Last Crusade (1989) Oscar nomination
Always (1989)
1990s
Stanley and Iris (1990)
Presumed Innocent (1990)
Home Alone (1990) double Oscar nominations
Hook (1991) Grammy & Oscar nominations
JFK (1991) Oscar nomination
Home Alone 2: Lost in New York (1992)
Far and Away (1992)
Jurassic Park (1993)
Schindler's List (1993) Oscar, Grammy and BAFTA winner
Nixon (1995) Oscar nomination
Sabrina (1995) double Oscar nominations
Sleepers (1996) Oscar nomination
Rosewood (1997)
The Lost World: Jurassic Park (1997)
Seven Years in Tibet (1997)
Amistad (1997) Grammy & Oscar nominations
Stepmom (1998)
Saving Private Ryan (1998) Golden Globe, Grammy & Oscar nominations
Star Wars Episode I: The Phantom Menace (1999) Grammy nomination
Angela's Ashes (1999) Grammy & Oscar nomination
2000s
The Patriot (2000) Oscar nomination
A.I.: Artificial Intelligence (2001) Grammy & Oscar nominations
Harry Potter and the Sorcerer's Stone (2001) Oscar nomination & double Grammy nominations
Catch Me if You Can (2002) Oscar nomination
Star Wars Episode II: Attack of the Clones (2002)
Minority Report (2002)
Harry Potter and the Chamber of Secrets (2002) Grammy nomination
Harry Potter and the Prisoner of Azkaban (2004) Grammy & Oscar nominations (soundtrack)
The Terminal (2004)
Star Wars Episode III: Revenge of the Sith (2005) double Grammy nominations
War of the Worlds (2005) Grammy nomination
Memoirs of a Geisha (2005) Golden Globe, BAFTA and Grammy winner, Oscar nomination
Munich (2005) Oscar nomination, Grammy for Best Instrumental Composition
Indiana Jones and the Kingdom of the Crystal Skull (2008)
Untitled Abraham Lincoln biopic (2008)

Wikipedia

Pretty impressive, isn't it?

Medical Minute: Gallbladder

Ahhh the Gallbladder. Our quiet little friend that we never think about until it goes bad.

The gallbladder is a small storage sack that is located just underneath the right lower portion of the liver. The purpose of the gallbladder is to store the bile that is produced in the liver. The gallbladder does not produce bile but simply stores bile.
The purpose of bile is to help digest fats. When fatty foods enter the intestines the bile sack squeezes out bile and pumps it to the intestines and helps the intestines to break down foods that are rich in fats.

Now as long as this system stays patent or open then the gallbladder generally will cause no problems. But complications can arise when the drainage system of the gallbladder becomes obstructed.

The gallbladder as mentioned, stores bile. In some individuals this bile can stagnate and become think like slush. Stones can form and lead to obstruction of the bile duct or the tube that drains the gallbladder. When this obstruction occurs pain is the result. The gallbladder tries to squeeze bile against an obstructed duct and as a result, biliary colic occurs. This pain is felt in the right upper quadrant of the abdomen and occurs most frequently after a meal rich in fatty or fried foods.
When stones form in the gallbladder it is called Cholelithiasis.

The gallstones are not the only problem that the gallbladder can experience. Sometimes the gallbladder can become inflammed or infected. Often times this inflammatory response can cause constriction of the bile duct and obstruction can occur. This inflammatory condition is called cholecystitis.

Both cholelithiasis and cholecystitis can be problematic and as a result, often times, requires the removal of the gallbladder.

The symptoms of a 'hot' gallbladder are right upper quadrant pain, especially after eating, bloating, nausea, vomitting, and on some occasions, diarrhea.

People who are at risk for a bad gallbladder are patients over the age of 40, obesity, and female gender. Men can have gallbladder problems but problems occur more frequently in females. Diabetics and women on estrogen are also at risk of having a 'bad' gallbladder.

Diagnostic studies include CT scan and ultrasound. Unfortunately both of these studies look for stones and normal studies does not necessarily rule out an obstructed gallbladder. So if symptoms persist despite a normal CT scan or ultrasound then a hepatobiliary iminodiacetic acid scan or HIDA scan can be ordered. A HIDA or even another name is cholescintigraphy, measures the amount of bile that is excreted when the gallbladder squeezes. If the ejection fraction or amount excreted is abnormally low, then your provider will have an indication that your gallbladder is not functioning properly.

Surgery to remove a gallbladder has become quite routine. Often times the procedure to remove the gallbladder can be performed by making three small incisions in the abdomen, then using a camera and long instruments the gallbladder can be removed. The incisions are closed with one stitch or on some occasions with just a steri-strip or two and the patient can go home after a short period of recovery.

The post-operative complications can include infection, pain at the incision sites, and painful bloating. The bloating is often the result of the CO2 that is used to inflate the abdomen during the procedure. The surgeon makes every effort to remove the CO2 but invariably some gas is left behind and the patient may experience the sensation of wanting to pass gas but being unable to flatulate. This is because the gas is not in the bowel it is in the abdominal cavity and will reabsorb in a couple of days.

The gallbladder is a small organ but can cause some big problems. So, if you are having right upper quadrant pain especially after eating, experiencing bloating, persistent nausea and/or vomitting, or diarrhea, talk to your doctor.

Medical Minute: Hypertension

Hypertension is another word for high blood pressure. What blood pressure measures is the amount of force placed on the walls of our blood vessels. Now, all of the organs of our body to include the liver, kidneys, lungs, and the brain receive blood from blood vessels. Blood comes into the heart and is sent to the lungs to receive oxygen. Blood then goes back to the heart and then is pumped to the Aorta and then out to the blood vessels of the body. The amount of pressure on the walls of the blood vessel is important because if the pressure is too high, then damage to the vessel walls and the organs can occur.
High blood pressure or hypertension can lead to stroke, heart attack, and organ damage.

Blood pressure can occur for several reasons. One cause of hypertension is family history. It is important to have a thorough family history accessible, if you can, when you present to your doctor, so that future health planning can begin.

Another cause is dietary intake. High sodium diets can increase blood volume through an osmotic pressure gradient, thus putting extra pressure on vessel walls. Caffiene can cause vasoconstriction or a shrinking of the blood vessels which can also cause increase pressure on the vessel walls. Other foods can have an adverse effect on your blood pressure so be sure to talk to your provider about heart safe diets.

And yet another cause of high blood pressure is medications. Medications that contain sudafed, caffeine, or epinepherine can elevate blood pressure without you ever knowing. Epinepherine is used in local anesthesia like the kind your dentist use to numb a tooth. Other medications like oral birth control, steroids, appetite suppressants, thyroid medications, and certain anti-depressants can also raise blood pressure.

So, what to do? If you have high blood pressure diet and exercise may not always be enough. Sometimes your doctor may have to prescribe medications. The pharmacological approach to hypertension is varied. Blood pressure is controlled by a mechanism between the kidneys and the heart called the renin-angiotensin-aldosterone system. So, drugs that target this system called ACE inhibitors are used. Zestril, Accupril, Altace, and Lotensin are just a few of the drugs in this category. Sometimes a simple water pill is used to reduce the blood volume. HCTZ or Hydorchlorothiazide is a favorite in this category. Other category of drugs include beta-blockers like Atenolol and Propranolol and ARB's (Angiotension Receptor Blockers which work on the above cycle) like Diovan and Benicar are frequently used to control blood pressure.

The normal blood pressure should be 120/80. High blood pressure is considered 140/90 or higher. Now, the guidelines for what is considered normal is being tightened up by the AMA and so these numbers are probably going to be lowered as a standard of normal.

What are the symptoms for high blood pressure? Often times...none. Hypertension is a silent killer as the symptoms of this disease are often absent. But if symptoms do occur they are usually non-specific. Headache, ringing of the ears, flushing, and in severe cases nausea, visual disturbances, confusion and seizures.

High blood pressure or hypertension is a deadly disease that can persist, silently, for many years. It is a disease that can be easily managed however, if left untreated, it will cause death. So, if you have high blood pressure or think you might have the risk factors of obesity, family history, or are on medications that may cause high blood pressure, see your doctor immediately.

Medical Minute: Ear Infections

So your child has a problem with ear infections…well join the club. Ear infections in children are one of the most common presenting complaints in children who present to their doctors office. In fact, there are between 30-35 million cases per year of middle ear infections that are diagnosed. Ear infections account for 3% of all patient visits and are the number one reason for an antibiotic prescription.
But what is an ear infection? Before we answer this question, let’s look at the anatomy of the ear. The system of hearing that the good Lord has made for us is divided into three parts, the outer ear, the middle ear, and the inner ear.
The outer ear includes the ear and the external auditory canal.
The middle ear includes the bones of the ear, the Malleus, Incus, and Stapes, as well as the opening of the Eustachian tube. The Eustachian tube drains to the throat and helps the ear to equalize pressure. This is why your ears pop when you go up into the mountains or are flying.
The outer and middle ear is separated by the tympanic membrane or the ear drum.
The inner ear includes the Cochlea where sound is received via vibrations, converted to a neurological signal, and then sent to the brain for interpretation and is also the organ that contains the semi-circular canals which help us to maintain balance. The Cochlea is innervated by the Vestibular Nerve which is the nerve that transmits sound to the brain.
There are two types of ear infections, Otitis Externa and Otitis Media. The first type of ear infection that we will discuss is otitis media or middle ear infection. A middle ear infection is a condition where the area between the ear drum (tympanic membrane) and the cochlea (the organ of hearing) becomes inflamed and fills with fluid. The middle ear does not have a connection with the outer ear because the tympanic membrane is a non-permeable barrier. So when fluid builds up in the middle ear it will either drain down the Eustachian tube or it will continue to collect until so much pressure is put on the eardrum that is ruptures and spills content into the outer ear. There are three likely causes of ear infections, virus, fungus, or bacteria. Many patients assume that if there child has an ear infection, then the cause must be from a bacterium and that an antibiotic will resolve the problem. The truth is, however, that viruses and fungi can cause ear infections and in these cases an antibiotic will not be the most appropriate intervening treatment. I will be honest with you, though; it is very difficult for even your doctor, to know if your child’s ear infection is from a virus, fungus, or bacteria. Because of this, we providers will often times error on the side of caution and place the child on an antibiotic. Weather this is good practice or not; it is what happens.
A patient with a middle ear infection will present with pain in the affected ear and possibly fever. The outer ear canal may or may not have drainage and at times a child might complain of a unilateral or one sided hearing loss. A child may, very will have some swollen lymph nodes on the side of the neck and that is to be expected.
Treatment for a middle ear infection includes a decongestant to help reduce the fluid production and to facilitate the opening of the Eustachian tube so that drainage of the middle ear fluid can occur. Also, an antibiotic like Ceclor, Azythromicin (Z-Pack), Septra or the old stand by, amoxicillin, maybe prescribed. Sometimes a short-term, low dose, oral, steroid maybe helpful to reducing the inflammatory symptoms.
If a child has persistent or chronic middle ear infections then your provider may recommend ear tubes. Ear tubes or PE tubes are just little drainage tubes that are placed into the eardrum so that fluid can drain from the middle ear to the outer ear canal and out of the body. Tubes are a very effective tool to use in patients who are having 6 or more infections a year.
The second type of ear infection is called otitis externa or outer ear infection. Otitis media in an infection of the outer ear canal and is sometimes referred to as ‘Swimmer’s Ear.’ This type of infection may also be viral, fugal, or bacterial; however, again, often time’s antibiotics are used to treat this condition. The patient with otitis media will present with pain in the affected ear and this includes positional pain. A child may say that his/her ear hurts when he/she puts the affected side down on a pillow. Drainage may or may not be present and a fever is much less likely to occur with this infection than with a middle ear infection. Hearing is usually spared unless the canal is completely occluded from the swelling.Treatment for swimmer’s ear is usually as simple as using ear drops. A solution called cortisporin or a similar medication is used 2-3 times a day for 7-10 days. Cortisporin is a medication that contains an antibiotic as well as a topical steroid. A cotton ball placed in the outer ear canal is recommended after the medicine is placed so that the medication can stay in place longer giving it a better chance to work. PE tubes or ear tubes will not help with this condition.Some helpful hints to preventing otitis externa are to ensure that the ears are dried after swimming. Over the counter ear drops are available at your local pharmacy that can be used after your child swims. These drops generally contain isopropyl alcohol to facilitate drying. Additionally, be sure that your child does not put anything in his/her ears, to include Q-tips. The out ear is very sensitive to abrasions and the smallest damage to the skin of the outer ear can lead to an infection. Ear infections of both types are painful. In the event that your child obtains a middle or outer ear infection, seek immediate medial care. If your child has an allergy to medication such as sulfa, or penicillin, let your provider know so that an appropriate antibiotic can be administered if needed.If you have any questions concerning otitis media or otitis externa contact your physician office and ask for assistance.

Medical Minute: Ringworm

Ringworm is a skin infection that is caused by dermatophytoses: Trichophyton, Microsporum, and Epidermophyton. These dermatophytes can infect the epidermis or skin of various areas of the body. If it is on the trunk of the body or arms and legs it is called Tinea Corporis. This area of infection is what we typically identify as ring worm. However the infecting fungus can be located on the head (Tinea Capitus), groin area (Tinea Cruris), or the feet (Tinea Pedis).
Ringworm is a very common and found in children more than adults. The fungus is communicable and can be spread via direct contact. This makes populated social areas such as schools, daycares, and fitness facilities prime areas to contract these dermatophytes.
The trichophytan fungus thrives in warm and moist areas, so the feet and groin are extremely susceptible to an overgrowth of this organism.
The area of concern for today is the trunk of the body, the arms and legs as these are areas that are commonly infected in children.
The typical ringworm infection will appear as a small reddish, brown patch. The lesion maybe raised and palpated or felt with a light touch of the finger. As the infection progresses the inflammatory aspect of the lesion will start to spread outward in an annular or circular pattern and leave an area of clear skin behind. That is called central clearing. The infected area will have the appearance of an irregularly bordered red halo. The edges of the infected area will have a reddish, brown border and some diffuse flaking will begin to present.
As the ringworm patch continues to spread itching and irritation will increase which causes the child to scratch the infected area. This scratching can cause a break in the skin and a secondary bacterial infection can occur. Hair loss and breaks in the skin are common in more serious infections.
The diagnosis of ringworm is mostly a visual diagnosis; however, your provider may view the lesion under an ultraviolet light, called a Wood’s Lamp. The edges of the lesion where the fungi congregate will let off a characteristic appearance. A skin scraping maybe obtained and examined under a microscope for a definitive diagnosis. The skin scraping does not hurt to obtain and the diagnosis can be made right there in the office while you wait.
The treatment for typical ring worm is pretty straight forward. Topical antifungal over the counter medications like miconazole, clotrimazole, and tolnaftate can be effective in treating ringworm. The usual regiment is to apply a light coat of medications twice a day to the infected area. Continue this treatment for up to four weeks. Other topical medications like Lamisil can be used for a shorter duration with similar effectiveness, but the cost of the medications maybe prohibitive to some.
If topical treatments fail or if the infection is so severe that the child is having hair loss, has large areas of infection, greater than 10cm, or is having symptoms so severe that it is affecting your child’s ability to perform activities of daily living comfortably, then see your doctor immediately. Oral anti-fungal medications may be prescribed, however, liver functions tests will need to be monitored as the side effects of some of these medications can cause a rise in liver enzymes.
Once again, as mentioned in previous columns, the best way to tackle ringworm is to avoid the infection all together. Be sure that your child keeps his/her skin dry. Avoid sharing of towels or other toiletry items with other children. Be sure they wear shower shoes in public showering facilities and finally be sure to perform regular skin inspections on your preteen children.
As a foot note, it is important to note that ringworm can be transmitted from animals to people. Cats are the most likely culprit, so be sure that your child washes his/her hands after petting any animal.
As always if you have any questions about yours or your child’s health, be sure to consult your physician.

Medical Minute: Retainers

Kids, wear your retainers. For Pete sake, your parents paid thousands of dollars to straighten out your smile, so make sure you make their investment pay off.

I had my braces taken off about two months ago and even though you may not be able to tell, in every picture that I have posted on this blog, I am wearing my retainers.

Also, keep them clean and be sure to store them in their proper container. A wadded up napkin is not a proper container.

And finally, brush your teeth prior to putting in your retainers. This is especially true if you have the invisible retainers that cover the entire teeth. Food can get trapped in between the teeth and the transparent covering and accelerate the formation of dental caries or cavities.

Medical Minute: Pink Eye/Conjunctivitis

Conjunctivitis, commonly known as pinkeye, is an inflammation of the conjunctiva, the clear membrane that covers the white part of the eye and the inner surface of the eyelids.

Conjunctivitis occurs when the eye becomes infected with a virus, bacteria, or an allergen. Sometimes a substance in the environment such as chemicals and pollutants can irritate the eyes and give conjunctivitis symptoms.

Red eye usually presents with reddness and irritation of one or both eyes. In children, pink eye is often times viral and can present with the above symptoms as well as a green discharge that will sometimes cause the eyelids to stick together. Many people believe that having a green discharge is exclusive to a bacterial infection but this is not always the case. Viral infections can also cause a green discharge and so care must be taken to obtain an appropriate diagnosis. Viral and bacterial conjunctivitis can be contagious and will spread easily in the shared environment of the classroom.

Treatment for pink eye is dependant on the etiology or cause of the inflammation. If the infection is caused by a bacteria, then your medical provider may place the patient on liquid drops of antibiotics like Erythromicin, Gentamicin, or Trimethoprim sulfate and Polymixin B sulfate drops. Antibiotic ointments maybe issued as well and will be just as effective as the drops.

If a virus is suspected then cool compresses 3-4 times a day and supportive care is recommended. Sometimes the herpes virus can cause conjunctivitis. If this is the case then your provider may prescribe Acyclovir, Famvir, or Valtrex

If the cause of the inflammation is an allergen, then oral anti-histamines, or topical antihistamines like Patenol can be used. Avoidance of the allergen is always the first step in this treatment regime.

Finally, the best treatment for pink eye is to avoid the infection in the first place. Parents should encourage their children to wash their hands frequently and to avoid rubbing their eyes. If an outbreak does occur it is important not to panic. As metioned previously, pink eye, especially in children, is usually due to a virus. So, no medication is needed to treat and the infection will run it's course in 7-10 days. With this in mind, please do not be surprised or upset if your provider does not give you a prescription.

In general, most conjunctivitis, will turn out to be nothing more than an irritation and will resolve on it's own. However, if you notice redness or swelling that starts to extend beyond the eyelid or if a sudden loss of vision occurs or if the patient starts to run a fever, then seek medical care immediately.

Conjunctivitis is a common medical condition, especially in social setting. So, remember to wash your hands frequently, know the signs and symptoms of the infection, and seek medical care when needed.

Medical Minute: Weight Loss

It seems that everyone wants to lose weight. Millions of dollars are spent each year by people who want to cut the fat. Well, let's look at a few simple steps that you can take to reduce that bulge that is sitting around your waist (or other anatomical areas.)

-Put the food on your plate in the kitchen and carry it to the dinner table. This will ensure that the table doesn't have second helpings available.
-Pick one place in the house where you eat. Make it your dinner table and make it a point to not eat anything unless you are at your dinner table. This will help to cut down on snacking. If you are not at your table you shouldn't be eating. Generally, we gain weight, not only from our meals but from our snacks which are usually high in calories and low in nutritional value.

-Don't underestimate the amount of calories that are in drinks. Non-diet soft drinks are loaded with sugar, (carbohydrates) and calories. Additionally, many of you love those Starbuck types of coffee's. Weather they are hot or cold, the fat content in these drinks are sometime equivelant to a meal.

-Try keeping a food diary. A recent study showed that people who write down everything they eat during the day will actually cut down their nutritional intake by as much as 20%.

-Get off the couch and exercise. Even if it is walking around the block, you would do well to get your body moving. In inclement weather, you could walk in place as you watch television. The goal is to get your muscles moving and your heart pumping.

-Finally, make sure you visit your doctor once a year for a complete physical. Cholesterol levels as well as other labs are obtained at these visits and the information about your health can be used to obtain and maintain your body at an optimal level.

-And I want you to remember one thing. Do not diet and exercise to lose weight. Diet and exercise to get fit. A little extra weight is preferable if your cardiovascular health is good. There are plenty of thin people each year who have heart attacks.

Eat well, eat smart, and get off the couch.

The Road to Balad and Back.

Tuesday, July 21, 2009

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Medical Minute: Ulcers

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Medical Minute: Health Care Cost

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Medical Minute: Ear Infections

Medical Minute: Ringworm

Medical Minute: Retainers

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