Reflections on New Life

Hello everybody.  I’m feeling contemplative this week.  I’ve seen a lot of patients in transition this week and thought I’d write down some thoughts about it.  All transitions have both good and bad elements, changes we welcome and changes we wish wouldn’t happen.

Some of our transitions have been truly joyous.  Our practice has a new baby!  Those of you who have been in the office recently will know which staff member was expecting.  Since the last practice baby was mine and he started kindergarten yesterday, we had a really long dry spell!  Makenzie is beautiful and perfect and we wish her mommy and daddy the EASIEST of transitions 🙂  They have some long nights and some stress ahead but they have lots of folks ready to help.  I think I saw Amy arranging a shift schedule…

Another transition I’ve been thinking about lately happened in my own family.  One year ago this weekend my husband underwent his stem cell transplant for multiple myeloma.  He became, in part, a new person because he has a new bone marrow and a new immune system.  It was a rough process but we came through it with support from our wonderful family and friends.  Russ has discovered along the way a much stronger faith in God and closer relationships with his family.

We’ve had a few deaths in our practice recently.  Those are always very sad but in these cases the deaths came at the end of a long and rich life.  Families are left to create a new and different family without the member they have lost, while ensuring their loved one isn’t forgotten.  The person who died moves on to whatever waits for us after death, what in one of my favorite movies was called “the great unknown mystery.”

Some versions of new life aren’t so dramatic.  One of my dear friends is struggling because her younger child just went away to college and she’s alone in the house for the first time in over 20 years.  A patient hurt his knee and has to be on crutches for awhile, so he has to adjust to lower mobility for a while and figure out how to do his job in a different way.  A person with obesity made a commitment to lose weight and now is struggling to recreate her relationship with food and with her own body.

My recommendations for dealing with transitions aren’t really very profound but hopefully they will help.  First, realize you’re not alone.  You’re not the first to deal with this change.  No matter what it is, someone else has dealt with it too.  Find a support group.  Lean on family and friends and ask for help when you need it.  Check Facebook for an interest-group page.  Explore your faith and rejoin your church or temple if you’ve fallen away.  (No, it doesn’t make you a hypocrite to turn to God in times of trial if you haven’t been faithful all along.  It just makes you human, and I guarantee your local congregation will leap at the chance to welcome you.)

Secondly, be honest with yourself about what you’re feeling.  Feel sad when you’re sad and cry when you need to.  Be angry, be happy, be whatever you are in the moment.  You don’t make the feelings go away when you refuse to acknowledge them.  Talk about them with a close friend or family member.  Get a counselor if you don’t feel able to share with friends or family or if uncomfortable feelings are getting worse.  Feelings are normal and natural and are necessary parts of interacting with the world.

Lastly, practice gratitude.  Find at least one thing every day for which to be thankful.  Even if it’s just that you woke up and the sun came up, that’s something.  “Practicing gratitude” is just that – practicing.  Just like practicing a musical instrument or practicing medicine, you get better at it the more you practice, and if you stop your skills deteriorate.  Our grieving families can be grateful their loved one is at peace.  My family is immensely thankful every day that Russ’s cancer is in remission and he is feeling good.

Transitions are tough.  Even when the cause is joyous there will be bumps in the road.  Take every day as a new adventure, share your thoughts and feelings with those that love you, be gentle with each other and look for the silver lining.  Pretty soon you will be settled into your “new life” and it will be hard to remember what the old one was like 🙂

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Generic or Brand?

Today I thought I’d talk about something that has come up a lot this past week.  I have been hearing a lot of questions about brand vs. generic drugs.  With the high (and rising) cost of prescription meds it’s natural that people are interested in switching to generic medications to save money.  So is it a good idea to switch whenever you can?  Off to the Internet I go…

The FDA has some interesting information.  As the gatekeeper to the world of prescription drugs, the FDA is charged with protecting the safety and quality of the American people’s medications.  On the FDA website there is a bunch of info about generic vs. brand medications.  They maintain that generic drug manufacturers have to prove their meds have the same active ingredient, the same purity/strength/potency/quality/etc as their branded precursor.

It took a little digging but I found an FDA document that showed the standard for generic bioequivalence is that the generic must have 80-125% the activity of the branded precursor.  To put it another way, suppose you have a prescription for brand Tenormin (a blood pressure med) at 100 mg.  If you choose to buy the generic med atenolol, which is substantially cheaper, it has to be the equivalent of 80-125 mg of Tenormin.

So…  Is this good enough?  Surprisingly enough, usually it is.  Tenormin, for instance, comes in 25, 50 and 100 mg.  So the generic doesn’t overlap at all, even though the dose ranges are broad (20-31.25, 40-62.5, 80-125).

However you need to be careful with medications with small steps from one dose to the next, like levothyroxine (generic Synthroid).  Synthroid comes in 75, 88, 100, 112 and 125 mcg, among others.  So if 100 mcg levothyroxine could actually behave like 80-125 mcg, that overlaps quite a few other doses.  The broad dose ranges kind of become a smear, right?  In fact, the American Academy of Endocrinologist issued a policy statement expressing disappointment about the FDA approving generic levothyroxine and recommended more frequent blood tests in patients taking generic thyroid medication for just that reason.

Another class of medications that you need to be careful with is meds that have what is called a “narrow therapeutic window,” which means the difference of blood concentrations between the minimum effective level and the toxic level is small.  Synthroid is one of them.  So are many seizure drugs, heart drugs (like digoxin) and theophylline.  A good question to ask is, does my doctor do blood tests to check blood levels of my medicine.  (Not tests to check the EFFECTIVENESS of the medicine, like cholesterol or gout meds, but to directly test the level of the drug in your blood.)  If so, you might want to ask your doctor if a generic is ok or if you’d be safer with the brand-name drug.

One last consideration with generic meds is that the fillers and binders (stuff the manufacturer puts in to make the pill stay a pill until you swallow it) are not the same from brand to generic and even from one generic to the next.  Since pharmacy companies sometimes change generic suppliers as often as every three months, if you’re sensitive to dyes and fillers you might notice a difference in how you feel from time to time.

In spite of all this stuff I’ve written, I usually encourage patients to go ahead and get the generic.  Generally they are safe and effective, and definitely less expensive.  Sometimes they’re not, though, and you will be asked to choose whether you want to save money by getting more frequent blood tests and office visits, or just to bite the bullet, open your wallet, and pay the brand copay.  There’s no right answer, it’s an individual choice between you and your doctor.  As long as you have the facts, you’ll make the right decision for YOU.

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Viva Las Vegas!

Well I’m on my way home Sunday from an amazing conference here in Las Vegas. It’s obvious how much time and effort the Shaklee home office leadership and staff have put into making it a wonderful experience for us attendees. So many amazing stories, so many emotional moments, such great training packed into four short days.

The challenge in the coming year is to maintain the excitement, energy and focus of the conference in the weeks and months ahead.  I want to continue concentrating on all the chances I have to help people with Shaklee’s products and business opportunity while still providing excellent quality medical care to my patients and leadership for my staff and NPs.  Not to mention continuing to be an awesome mom for two small boys and a loving supportive wife to a husband with cancer. I guess it’s a good thing I have Merry Maids 🙂

As I return home to my normal routine I’m going to try not to get bogged down in the little details of everyday life and keep the long view. Life is measured in the moments, and I treasure those moments when I can really make a difference to somebody. The humbling experience of having to tell someone they have leukemia but then seeing them realize they’re not facing it alone.  Making frequent check-ins with a mom whose baby may or may not have a serious illness.  Hearing my patient tell me Shaklee’s stres relief product made her feel like herself again.

Making lives better is what it’s all about, guys and gals. I promise I’m going to make it my priority to help you find what will make your life better and do what I can to make it happen. Then next year in Nashville I will have some awesome stories of my own to share!

 

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The Doctor Goes To Vegas

Hey there, this is Dr. Jen reporting live from Las Vegas, Nevada. I’m here for Shaklee’s annual global conference. Some glaringly obvious impressions are begging me to elaborate, so here goes.

Many of you know I was in China in June. I was impressed at that time with how fit and active the Chinese people are, as a general rule. Everyone walks or rides a bicycle to get from place to place.  There are stairs everywhere (with real estate at a premium everyone builds UP). Escalators and elevators are pretty much reserved for areas that are upscale and cater heavily to foreigners. I saw very few overweight Chinese, NO obese Chinese, and most of the Chinese I saw were downright skinny by Western standards.

Now I’m in Las Vegas. The contrast is very interesting, to say the least.  There are stairs, but I see lines of people waiting to board escalators for 1-2 flights up OR DOWN!  There are “people movers” which allow you to stand in one place and the sidewalk will slowly move for you.   There are little trains to take you up and down the strip so you don’t have to walk. Granted, it was 112 degrees today so I spent very little time outside, but still.

I don’t think it’s much of a mystery why Americans are fat and getting fatter. We don’t move enough. (We also eat too much, but that’s a topic for another day.)  I have vowed for the rest of my time in Vegas I will not use an escalator (if stairs are available) or people mover.  I can’t control what others do but I’m going to do a little extra for my own health while I’m here.

Russ says good for me. I suspect he and the boys will be cheering me on from the “magic sidewalk.”

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Does Black Cohosh Cause Breast Cancer?

Hi, everybody.  I’m posting about black cohosh because a patient was upset that I recommended she try that supplement for her menopausal hot flashes.  She was reluctant to try traditional hormone replacement (which I understand, since PRESCRIBING it makes me nervous because of the risks) so I figured a nonhormonal supplement would be a great place to start.  She was very upset because she was under the impression it increased the risk of breast cancer.

Off I went to the National Institutes of Health’s PubMed database, which is where I go for research data.  Here’s what I found:

1.  A German study published in 2009 followed over 10,000 women and looked at their use of herbal products containing black cohosh and phytoestrogens (red clover and soy isoflavones) among other products.  They found that use of these herbal products was associated with a modest reduction in the risk of breast cancer and that the longer these products were used the larger the reduction in risk.  Note:  this was not a study designed to determine a CAUSAL relationship.     http://www.ncbi.nlm.nih.gov/pubmed/19661079

2. A really big study (more than 35,000 women) from Washington State  published in Cancer found no increased risk of breast cancer in women taking a variety of supplements including black cohosh, dong quai, soy, and St. John’s wort.  Interestingly, breast cancer was lower in women taking fish oil supplements.  http://www.ncbi.nlm.nih.gov/pubmed/20615886

3. Here’s my nod to basic science.  A group at Columbia University found that an extract of black cohosh applied to human breast cancer cells was able to induce cell death in those cancer cells.  They theorize that black cohosh may actually have a role in the prevention and treatment of breast cancer.  http://www.ncbi.nlm.nih.gov/pubmed/17980565

There is a lot of confusing information out there about supplements and cancer risk.  My (not exhaustive by any means) search of the database didn’t turn up any evidence that black cohosh causes breast cancer, but new studies are being published every day and everyone should choose the medications and supplements they take with advice from their doctor.  As always, interactions and risks are present no matter what you do.

I included the links above to the studies I mentioned so that anyone who wants more information can follow up.  I picked studies that have full-text articles available for free, just follow the links.

Be careful out there!

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