Power Loss, Inconvenient, But Not Life Changing

You don't know what you have until you lose it, right? Well, where we live the power went out for well over 60,000 households for about a week due to an ice storm. We lost our power for 5 days. Some people are still out after 8 days or more. We were fortunate enough to borrow a generator and wire a 220 volt line into our fuse box in the house, but many other people moved out of their homes for a week. The timing was bad, being the week of Christmas. Our Holiday party was relocated from our home to my parents down the road, who were, fortunately, not affected. Small inconveniences came up.  Alarm clocks didn't work. Cell phones were hard to keep charged. No home telephone or internet made it difficult to communicate with friends and family. Some friends and neighbors burst pipes due to the cold weather.
We've lost power for a day or two in the past, but rarely during the winter and rarely more than a day or two. It was a bit of a wake up call for us to have more candles, coolers, flashlights (with batteries) and firewood in the future. A back up generator of our own would have made the early going easier.
It's times like these that pull people together. Our neighbors around us were very generous as well as family offering a warm place to stay and extension cords and gasoline. It will be a Christmas we won't forget for quite a while.

Vitamins or Medicine?

Why so many people are willing to take supplements instead of their medication is hard for me to understand. Sometimes I have patients taking as many (or more) vitamins and supplements as they are medications. You get everything you need from a good and balanced diet. Vitamins can help plug a few holes, but do not replace good dietary habits. And vitamins don't fix Diabetes or Hypertension.  Diseases like Coronary Artery Disease (CAD) and Diabetes and Hypertension require medication, not vitamins and supplements. Medication plays a primary role in their management, while vitamins have a very limited/tertiary and unproven role in their management. I don't understand the general distrust of the pharmaceutical industry that the average consumer seems to have. Statins in particular have been villified by the media and lay people as causing more problems than solutions in the management of CAD, but several well designed and well controlled studies consistently show that lower Total Cholesterol, and LDL Cholesterol in particular, leads to less morbidity and mortality in adults. Controlling Hypertension with Betablockers, ACE Inhibitors and Diuretics leads to longevity, but people are still more willing to pop a vitamin C tablet in their mouths than take their Blood Pressure Medication. People are living longer than ever due to Vaccination programs, antibiotics and better medication for Diabetes and Heart Disease.  Vitamins are an unproven commodity, but we spend billions of dollars on then annually...buy more fruits and vegetables, Olive Oil, lean protein and drink more water.

Live well.
- Dr.Ronan

Your Are What You Eat

Who do you want to be this holiday season? The guy on top or the women below? Spend your calories wisely over the Holidays. Try adding some shredded vegitables to those recipes. Things like red onions, mushrooms and shredded zucchini add flavor without calories. Apple sauce and honey are good natural sweeteners for cakes and cookies. Wild Rice and Brown Rice go nicely with most meat dishes and don't forget about Qunioa and sweet potatoes!

Bon Appetite!

-Dr.Ronan

Read

I'm so proud of both of my daughters this summer for not letting their minds turn into mush. Both kids read several books over the summer, especially my 10 year old. Both kids also attended math and science camp too at our local university campus, Michigan State University. I know kids should play and swim and recreate, but reading is recreation in our family. Even my father and mother are both voracious readers in their 80's.

Who says people don't read books anymore?
Dr. Ronan

Paleo Breakfast

We were out in California and enjoyed the breakfast burrito at our hotel each morning. My wife came home and made up a Paleo Diet version of it that turned out pretty good. She cooks sweet potato fries in coconut oil until soft, then adds chorizo sausage and onions along with a couple of scrambled eggs cooked to completion. I added about 1/3 of an avocado to the top and just eat it out of a bowl, but you can wrap up in a low cal soft tortilla to go. This bowl is really breakfast for 2.
Beats a protein shake any day.

Eat well.
Dr.Ronan

Why do people stop their medication?

It's very frustrating to review lab work for someone and recommend treatment for either their cholesterol or sugars, start them down the correct path to health and find out months or even years later that they never did most, if not all, of what you told them they should do. I've read several studies stating that half of all prescriptions from a doctors office ever get filled and I thought that was ridiculous at the time, but now have come to the stark conclusion that is probably pretty accurate.
We took up a new initiative a couple of years ago to review a patient's medication list every time they come into the office. A lot of times people are annoyed that we don't know everything they are doing and state all their medications are the "same as the last time I was in." In reality, the list we have seldom reflects what the person is actually doing. They've stopped some medications because "they read somewhere that one was bad for them" or a well meaning friend or family member told them "not to take that one."
Sometimes, they "don't like to take so many pills" but one of my patients recently was discovered to have impacted his bowels with vitamins and supplements. He takes over 120 vitamins or supplements in addition to his medications each day.He felt this to be a more natural approach!!??!!
Most of these people don't thing twice to eating a hotdog or bratworst, soda pop or bag of potato/corn chips, whose ingredients I struggle to pronounce or comprehend... and I've taken Biochemistry and Chemistry in college and graduate school.

Most of my patients are simply eating and drinking themselves to death, not walking enough and not taking the 2-3 medications that would lower their risk of heart disease, strokes and kidney disease which are all know to be the leading causes of death in the United States. Don't worry, insurance companies know this and are already starting to cash in on your free will. They tell you that everyone will get insurance, but what they aren't telling you is that it's going to cost you A LOT MORE to be overweight, to smoke, to have high cholesterol, diabetes.  The more problems you fail to address, the more you pay and the older you get, the harder it will be to change.

I'm a doctor, but I'm a patient too, and I take my medication as directed, get my lab work done when ordered, try to eat healthy (chicken, green beans and some wild rice medley with skim milk after 45 mins at the gym). I know I'm not going to cheat death, but I'm hoping to put it off for a few more decades. My medication does not make me feel bad. I'll sleep better knowing my odds of a fatal MI are on my side tonight.

Live well.
Dr.Ronan

How to keep the pounds off on a vacation

This is my wife standing in front of our hotel's wine tasting parlor in Napa California. One of the things we struggle with during travel is keeping the pounds away when we are eating out and consuming wine or beer or whatever the locals provide. One way we battle the bulge is by taking a morning walk and then doing the same after dinner each night. We also try to split our portions and share. That way we get to try more things and not consume so much at each meal. Admittedly, I'm not very good at sharing my deserts. Most of our vacations are active, but you don't have to go over the top to enjoy yourself, stay safe and not put on 5 or 10 lbs that you'll regret next week.

Be healthy.
Dr.Ronan and family

Talk to your doctor online

Talking To Your Doctor’s Office Online...The Future Could Be Now

You can look up the balance of your checking or savings account online 24 hours per day 7 days per week. You can pay bills online. You can even order food and make reservations from a computer or smartphone. Why can’t you talk to your doctor’s office? Well, the answer is you can. Well, not all doctors offices. But, a growing number of physicians and physician offices are making themselves available to their patients online. This is done through what is called a Patient Portal. The portal is a password protected site designed to protect a patient’s health information from anyone seeing it other than authorized people. Usually a relationship with the doctors office must be established face to face before an online relationship can be connected as well. Patients still need to see their doctors periodically to maintain this relationship, but a lot of ordinary coordination of care and communication can take place between those visits.

I was intrigued by online medicine a  long time ago from several articles I had read in medical journals and finally committed to it after attending a conference where a 4 physician practice from South Carolina was using one successfully and really found it useful. I came back to my practice and did some research and contacted a pretty well established company to try.  We use a system from McKesson called RelayHealth.com and we’ve been using it for nearly 10 years. Not only do we message with our patients, but we also refill their medications so they don’t run out before their next appointment. We order  lab work prior to office visits so that the visit is more meaningful. We set up sleep studies or order x-rays and can refer people to specialists to expedite care. We even do webVisits, for patients who are unable to come in and have routine medical problems. This keeps our Emergency Department visit rate down and keeps me connected to our my own  patients.

I do lament that very few physicians choose to connect to each other via portals, or we could actually talk to each other about patient care as well. I’ve been asked, how do I have the time to message with patients and why would I want to do that. The answer is pretty simple, I don’t waste time, I save time. I’ve available to my patients even when I’m out of town on vacation, so I can take care of a lot of little things so that when I come home I’m not burried in messages. I can even do online webVisits when I’m not around for routine medical issues like poison ivy, sinus infections, diaper rash, influenza.  We manage well over 300 messages per month online. That means staff are not picking up a phone over 300 times per month! We schedule dozens of appointments that because people don’t wait on hold. If people do call the office, the wait time is quite a bit less. Best of all, our patient satisfaction surveys have been very positive about this system of care.

Your doctors office may already have this ability and you just have not been connected yet. Get connected.  Maybe they’ve thought about it but have not committed to it yet. Push them. Better health care starts with better communication. Let’s make a change.

Arthur J. Ronan, D.O. is a board certified family physician at Lake Lansing Family Practice in Lansing, MI

www.lakelansingfamilypractice.com

www.relayhealth.com

Get Out and Run!

My kids took part in a 1 mile Zoo Fun Run this past weekend. Many parents participated too. This was a great way to enjoy our local zoo here in Lansing, Potter Park Zoo www.potterparkzoo.com, and get some exercise in as well.
I was really impressed by the turn out. It was a great morning to go to the zoo, since the cool/crisp weather had the animals moving around and active.
The organizers did a great job entertaining the kids and lining them up. All were accounted for at the finish line.
I think it is a great idea to get kids into fitness at such a young age.

Garden Time

I finally got the garden in this weekend. We are trying to grow some of the foods we regularly eat from the grocery store and teach our kids how to take care of the plants. I've had great success growing rhubarb in the past at our old house but this yard has proven challenging for that one. It looks like I've finally found a plant that is producing and a good place for it in the yard.
We use a lot of Basil, parsley and rosemary, which are easy to grow. I've never had good luck with Cilantro, but I'm going to try again. Cucumber, tomatoes, zucchini and summer squash are all easy to grow and standard summer fair. You might be able to see all of the fending and netting around and over the garden area in the picture above. Just like no picnic is complete without ants, no garden is complete without critters. For a suburban area, our neighborhood is teeming with chipmunks, rabbits, berry eating robins and tomato worms. Trying to find an eco-friendly way to grow a few veggies in my back yard has given me new found respect for the farmers who grow hundreds of acres of this stuff.
Hopefully, the animals and bugs let me keep a little bit for myself and I'll talk about what I've done with it as the summer unfolds.
Eat Healthy!

Dr.Ronan

Going Paleo

Caveman Breakfast, I love it!!!

My wife recently undertook the Paleo Diet Cleanse and dragged me along for the ride. I've got to say, I'm not a diet person. I don't believe in fad diets, but one sniff of her breakfast one morning made put my vanilla protein shake to shame. This bowl of ham, sweet potato onions, avocado was fantastic.
The diet avoids dairy, gluten or bread, eggs, cocoa, caffeine and certain night shade veggies. The meals are planned out and pretty simple for most amateur chefs to pull off in about 10-20 mins. Many of the foods you can prepare for dinner and eat for lunch the next day. She lost 5lbs the first week and I lost 3lbs (but I did not give up my coffee or dairy). I'm actually excited for the next meal on the menu. If you want to shake things up, go Paleo and eat like a cave man for about 3-4 weeks to shake things up. I still think cavemen ate eggs. I wasn't there but it just seems to make sense.

I would not live on this, but my wife and I definitely want to incorporate some of this tasty food into our own daily habits.

Look it up.
www.paleodiet.com

Dr.Ronan

Patient Portals

For years I was asked if I would communicate with patients via email, but I was hesitant to open up that door for fear that what little personal time I have I would spend messaging patients. I read a few articles about it nearly 10 years ago and decided to give it a try. We enrolled to use a Patient Medical Record before we decided to use an Electronic Medical Record and the results have been mostly very positive. Just this morning I received a message from a patient of mine on vacation in Finland. He was having some eye problems and was worried he should come home.I advised him to be seen immediately over there and arranged for follow up when he comes home with a local ophthalmology group. In the past I've refilled medication for patients spending the winter out of state down south. I've managed some of my college students while off to school out of state. We've even been able to inform patients about their test results without having to bring them in. We manage about 300 messages per month via the portal and it's really cut down on office calls. Simple problems like sinus infections, poison ivy/rash, athletes foot, or urinary tract infections can be treated via Webvisits and then followed up in the office at a later time so the patient can get treated over the weekend instead of missing work or going to the Emergency Department for things that are not really emergencies. A simple experiment 10 years ago has improved care for over 1500 patients who are connected in our practice. Who would have thought I'd be giving medical advice in Finland today.
Take care.
Dr.Ronan

Avoid the White Plate

When I talk to patients/clients about eating healthy, I use an analogy called the White plate (Carbohydrates). This is NOT a White plate. This is a Green (Vegetables) and Brown (Protein) plate with a dab of White.  It has 2 servings of vegetables (broccoli and bok choy), about 8oz of flank steak and 1/4 cup of white rice. The drink is water.

This meal takes about 20 minutes to make and is under 700 calories. Even my kids like it. The more Green and Brown you put on a plate the longer it stays in system and the less you desire the White stuff.

The next time you go through a buffet line or are grabbing items for your lunch, just try to make it 3 parts Green and Brown and 1 part White and you'll be on the right path.

Facial Fillers

Though not as long lasting as a face-lift, dermal fillers have become popular among women seeking a younger look and offer yet another alternative to cosmetic surgery.  As we age skin loses its volume and elasticity and hence, wrinkles appear. This is due, in part, to skin losing its ability to produce enough of a naturally occurring substance called hyaluronic acid (HA). Doctors have been using HA for years in knees for advanced degenerative arthritis, where the knee joint just doesn’t have as much of that squishy fluid as it used to, which causes the joint to wear out.  Two of the most popular fillers used today are Juvederm and Restylane, although other products are available.

Dermal fillers are substances injected into the skin of the face to fill in deep folds and wrinkles. They are used mainly for "static" facial lines and folds, the ones that don't come and go as you change your expression. They work chiefly as a substitute for lost collagen and fat under the skin. Their results may vary in different areas of the face, as does the duration of their effect.

The dermal filler field is booming because the effects are immediate, the procedure doesn't involve real surgery,  Depending on the areas treated, the procedure can be done during lunch and the results immediate.  The voluming effects of fillers can last nine months to a year or more.  Fillers are highly effective when combined with Botox or Dysport. The Botox inhibits strong facial muscles from creasing the skin and the fillers add some volume under the skin to smooth out the wrinkles. When combined together it is called a “Liquid Facelift” and the cost is significantly less than a surgical facelift. There is no missed work or downtime recovery.

Fillers are used mainly in the lower two-thirds of the face. Vertical frown lines between the eyes and right below the eyes can also be treated, but complications are more common in these areas. Thin lips can be plumped up to reduce wrinkles above and below the mouth. The winkles that most people are unhappy with are the ones that run from your nose the the corners of your outer mouth called the Nasolabial creases.

No cutting or stitching is required to increase dermal volume. Except for a little bruising at the puncture sites, there is very little evidence a procedure was performed. I generally recommend 5 days of recovery just in case my patients are planning on attending a wedding or other special occasion, especially for lips, which have a tendency to bruise more.

One other nice feature of fillers is that you can always add a little more at a later date. I can’t tell you how many times people come into the office complaining about wrinkles around the mouth and eyes and when I suggest fillers they say, “please don’t make me look like Angelina Jolie.” I tell them that I’ll use my best judgment and that I have a tendency to be conservative so that we can add some more later, if necessary.

Fillers don’t keep you from surgical options down the road, but they are an affordable treat for the person who doesn’t like what they see in the mirror.

www.juvederm.com

www.restylane.com

Physician Assistants and Nurse Practitioners

Our office utilizes what are called Mid-Level Providers to help increase the access to Healthcare Services. We have 2 Family Physicians in our office, but let's face it, there are only so many appointments each day to meet with the doctor. Our practice got so busy a few years ago, that we hired a Penny Dabney, a Nurse Practitioner, to meet the need for same-day appointments and to do routine health screenings including PAP smears and well child examinations, wart treatments and other lesion removals. She works independently under the supervision of a physician in our office. It was such a tremendous success, that we later hired second type of Mid-Level Provider called a Physician Assistant to help Penny have openings as well. A PA degree is another mid-level provider that can work independently with physician supervision and has medication/lab order/imaging prescribing priveledges just like a NP. With the expansion of Healthcare benefits under the Affordable Healthcare Act, Mid-Level Providers like Penny will play a very important role in getting people into the healthcare system and keeping costs down. Some of my patients complained initially about not being able to see their physician, but most have been won over by our NP and PA in the office and have no problem being seen by one of them instead of me if I'm not available for a few days or out of the office.

www.aanp.org

Botox and Dysport for wrinkles

 Here's a little information about a procedure we offer at our practice.

    Botulinum Toxin, or Botox is one of the fastest growing procedures in Cosmetic Medicine. Derived from the bacteria, Clostridium botulinum, Botox is a highly refined neuromuscular paralyzing agent. There are seven distinct neurotoxins produced by this bacteria, types A,B,C,D,E,F, and G. Botox is purified Toxin Type A. Another product on the market consisting of the same neurotoxin Type A is called Dysport. These products are essentially the same, but are manufactured by different pharmaceutical companies. Dysport does tend to migrate a little more from the injection site, which can be good and bad, depending on which region of the face is being injected.  The forehead can be more diffuse, but you don't want to migrate too much around the eyes or you can have a drooping eyelid.  The effects of the purified neurotoxin is not permanent, but does last about 3 months.

    It is used as a cosmetic procedure to temporarily paralyze an injected muscle in order to provide wrinkle reduction and/or to sculp the face by preventing muscular contraction. It's medical applications include treatment of strabismus, blepharospasm, dystonias, and severe intractable tension headaches. The FDA has only approved botulinum toxin A for Glabella wrinkle reduction and axillary hyperhydrosis, due to an odd side effect of inhibiting normal function of apocrine sweat glands.  It's use is cosmetic medical practice has been extended to include other facial muscles similar to the procerus and corrugators of the glabellar region which include, but are not limited to the horizontal forehead lines, crow's feet, bunny lines, verticle lip lines, brow lifting, mental crease, dimply chin, horizontal neck lines, platysma bands, nasal flare, bummy smile, and nasolabial folds. Not all injectors will know these applications, but most injectors will know how to treat the brow, glabella, crows feet, and bunny nose areas, which seem to be most popular.

    Why choose a cosmetic procedure that only lasts 3 months? Why paint your nails? Facelifts are permanent and much more costly and involve more risk and involve more down time for healing than the average cosmetic patient would like to invest in. Botulinum toxin A treatment is relatively painless, numbing creams can be applied pre-treatment for patients who do not have contraindications. The patient can return to work immediately after having it done and there is no downtime. The effects of the toxin take several days to reach maximum effectiveness, so don't expect to look any different for a few days. The cost of Botox and Dysport are very similar to each other, usually about $8-$12 per unit per treatment depending on location. Usually a place that injects more regions of the face will discount the units as they go along or bundle the costs with other sales in the office. The actual procedure takes about 15-20 minutes. When combined with fillers, Botox/Dysport treatments can be subtle, but stunning. It's a nice treat before a wedding, class reunion or holiday occasion. The effects are more effective when combined with other aesthetics procedures like microdermabrasion or chemical peels and, of course good skin care. The wrinkles fade after 2-3 weeks as old skin exfoliates and new, unfolded skin, forms.

    

There are certain myths that come up repeatedly, so let me address one of them. "It results in a frozen look," or "I will lose all expression." This is only the case when a client chooses to have too many areas in their face done all at once or staggers the treatements with multiple clinics or when the physician/nurse injector uses way too much toxin in too many areas. Most of the time I try to talk patient-clients out of doing too much. I like to treat 1-2 areas and bring them back to see if they are happy with the results. I also like to maximize the effects of Botox inections by combining them with gel peels and/or microdermabration to give their skin a clean glow and tighten their pores and fine wrinkles. You can always add more, but you can't take it back too easily once you've injected it.

    Does a doctor have to do the injections? Not necessarily. Doctors, both MD and DO can perform the procedure as well as Dentists, Oral Surgeons, Nurse Injectors of all sorts. Most importantly, they should have received adequate training in the procedure and have a certificate of that training posted in the office. Every doctor, dentist and nurse is trained to give injections, but additional training in Botox/Dysport technique is important to avoid unnecessary bruising, discomfort, and maximize theraputic efficacy. We have a trained and licensed esthetist in our office, but I'm the only person who does the Botox injections. I'm kind of a control freak and enjoy the peace of mind knowing that I do my own injections.  How do you find a certified injector in your area? You should be able to go to Dysport or Botox product web site and see who is ordering their products and dyspensing in your area. Those offices should have a web site to look at what they offer and may or may not list pricing. Then, just call and make a consultative appointment to see the office, meet the people performing the procedures and get some pricing.

    Botulinum toxin is a fast, easy, safe and cost effective way to take the wrinkles and creases out of your skin and look years younger. I hope you found this article insightful and enjoyable, now go out there and get fit and beatiful!

Dr. Arthrur J. Ronan is a Board Certified, D.O. Family Physician who is also a certified physician injector of Botox and Dysport forms of botulinum toxin A.

www.lakelansingdoctors.com

Muffin in a Mug...Yum

I saw this on Pinterest last night and I just had to try it this morning. It is a blueberry muffin in a mug. My mug should have been a little bigger, but it worked.
It takes about 2 mins in the microwave and about 5 mins to prepare. I topped it off with a dob of vanilla Greek yogurt and set it in the refrigerator for a few minutes to cool off before eating. Doing that gave me time to make coffee to go with it.

www.pinterest.com



Try this out:
put 1/4 cup Quakers oats in coffee mug with
1 tsp brown sugar or Stevia
1 egg
1 tbs skim milk or almond milk
mix together and add a handful of blueberries and sliced almonds
put in microwave for about 90 seconds and add 30 seconds if not completely cooked.
tip upside down onto plate and add a dab of your favorite yogurt and another handful of berries, and you just made a gluten-free muffin for breakfast.
You could add a tablespoon of protein powder and some applesauce to add a little kick to it.
Enjoy.
Dr. Ronan

Spring is starting to pop

Signs of Spring are popping up near our doorstep. I'm pretty sure these are Tulips and Hyacinths. I hear more birds in the morning and now I'm seeing green leafy things coming out of the ground, so it must be we are on the verge of Spring. Time to fill the bicycle tires with air, re grip the golf clubs and clean up the dog bombs littering my yard. I did get out and walk the dog today, but it was deceptively cold out there in East Lansing, Michigan today. Sunny, but windy. This makes my soul feel good.
Enjoy.
Dr.Ronan

What is your path to fitnesss??

I'm learning about health coaching. A funny statement came up about losing weight. You know, you don't have to lose weight. Dr. Phil says you can be overweight until the day you die. But, do you really want to be overweight until the day you die?

My wife is training to be a Health Coach and her questions caught me a little off guard last night. She asked what I want to be as far as fitness goes. I thought about it today and I guess my answer is I'd like to be a healthier version of my parents. My dad had his first heart attack when he was 58 years old and I'd prefer not to have one or if I have to have one, then I'd like one 10 years later. Both my parents are active and social people and both are alive in their 80's and living independently. I can only hope to do as well. My fitness goal is to keep doing the things that I like to do physically, mentally and socially until I can't do them anymore. I don't really want to run marathons or climb mountains I just want to play golf, tennis, ride bikes, walk my dog, read and write. I think I would like to add mental fitness to physical fitness. I'd like to be a productive member of my family and society for as long as I can.

I think eating sensibly, staying physically active and learning new things regularly is my path for now...

Find your path.
Dr.Ronan

Baked French Toast - Diabetes Friendly

Recipes have been pretty popular, so here's another one for you from the patient resource site of Sanofi Company, makers of Lantus and Apidra insulin products. This is a low glycemic version for people with Diabetes and/or Heart Disease.

Baked French Toast with Raspberry Sauce

Serves 4

serving size: 2 slices

Ingredients

4 egg substitute equivalents
2/3 cup skim milk
1 tsp maple extract
1 tsp cinnamon
1/2 tsp nutmeg
8 slices whole-wheat bread
2 cups frozen or fresh raspberries
1 Tbsp orange juice
1 tsp vanilla extract
2 tsp cornstarch

Directions

Beat together eggs, milk, maple extract, cinnamon, and nutmeg in a medium bowl. In a casserole dish, lay bread slices side by side. Pour over the egg-milk mixture, cover, and place in refrigerator overnight. The next day, bake the French toast at 350 degrees for about 30 minutes until golden brown and slightly puffed. To make raspberry sauce, puree raspberries in a blender. Strain to remove seeds. In a small saucepan, combine pureed berries with orange juice, vanilla, and cornstarch. Bring to a boil and cook for 1 minute until mixture is thickened. Serve over French toast.

Nutrition Information

Exchange/Choices
2 1/2 Starch
Calories: 216
Calories from Fat: 25
Total Fat: 3g
Saturated Fat: 1g
Cholesterol: 1mg
Sodium: 400mg
Total Carbohydrate: 38g
Dietary Fiber: 8g
Sugars: 8g
Protein: 12g

for more information about Diabetes and other healthy meal ideas, go to www.apidra.com

Enjoy

Dr.Ronan

Spin Class

One of my favorite things I look forward to all week is doing my Monday night spin class at the health club. I didn't realize how much I liked it until my wife told me I had a meeting to go to tonight and had to miss it. Then I found out the meeting was next week and I could go, yee haw. The other thing I really like about doing the evening class is I always stop by the snack shop and power up with a Great Harvest snack bar. www.greatharvest.com The 500 calories in the bar are a bit excessive, but i burn over 500 calories in the 60min class, so, it's a push.
I enjoy the Monday night class so much that I've added a Thursday morning class to my routine and it really gets me off to a good start. I don't feel pressed to get an evening workout in that day. I find different instructors have differing styles and formats for the classes they teach, so each one is a little different.
I always tell my patients to find something you like and can make a habit...I like this habit.
Enjoy!
Dr. Ronan

Know Your Numbers

The tubes on the right represent two different patient's blood samples. The one one the right is a normal sample with spun down red blood cell products on the bottom and a relatively clear/yellow layer of serum. The sample one the left has a milky serum that is high in cholesterol and Triglycerides (fats). A normal Triglyceride level is about 150ng/dl or less, but this person's TG's were over 1000ng/dl or nearly 10 times over the normal limit.  Blood like this leads to pancreatitis, fatty liver disease, coronary artery disease and other atherosclerosis or fatty deposits within the walls of arteries. This patient is 38 years old and completely unaware that he is heading towards an early heart attack.
The take home message is go to a doctor at least once a year to get basic blood work done, check your weight and blood pressure and see if you are due for any vaccinations. Just 30 minutes once a year can make you aware of an impending health problem like this person.
What are your numbers? Find out.
www.atherotech.com
Dr.Ronan

You Are What You Eat

One of my patients got his blood drawn in the office today to check his cholesterol. The blood was spun down and my lab technician just about fell over when she looked at the tube. A normal tube of blood like the one on the right, should have red blood cells on the bottom, and a clear serum on the top.

The tube on the left looks like it has melted ice cream in it. That is because the person who donated that blood just ate 3 tacos for lunch today. It is what we call a Lipemic blood sample. I would have preferred a fasting sample of blood, but I've been trying to get a blood sample from  this person for 3 years now and this seemed like the best opportunity I would have for a while.

That creamy/milky triglyceride layer is what builds up in the walls of arteries. This patient is a relatively young person at age 38, but if he keeps eating like this, he'll start to have more health problems at an earlier age than expected. Your body just can't process that much fat, sugar and oil meal after meal. Eventually your liver and pancreas can't keep up and people start to develop a thing called Cardio-Metabolic Syndrome. Blood pressure goes up, sugars elevate in the blood serum leading to Diabetes, Lipid levels rise and your risk of Heart Disease or Stroke go up exponentially.

Be proactive, eat better!... you're worth it.
Dr.Ronan

Online Messaging

Technology definitely has a place in health care. Sometimes we adopt technologies in our practice and find new ways to adapt them to patient care over time. One case is our patient portal from Relay Health. www.relayhealth.com
Our practice adopted this system of patient to physician messaging about 10 years ago with the idea we could use it to start messaging with our patients from home or when we were out of town. It was a way to take some of the pressure off of the on-call provider and to introduce electronic prescription writing to the practice. We now have over 1400 patients online and growing. It has reduced our office call volume by about 270 phone calls per month, so our staff like it.

I used it today to take care of a nephew with special needs that lives in Detroit, but couldn't get into either of his doctors this week, since they are both out of town. My sister was able to attach a picture of a skin problem to a message and I could look at it from over an hour away and send a prescription and a care plan to the local pharmacy for him to start medication today. His treatment is documented in his chart and can be passed on to the local hospital or forwarded to his doctor when they are back in town. I did all of this from my desk at lunch.

Ask your doctor if they do web messaging or have a patient portal. Many Electronic Medical Records have them today.

Having a Little Fun

One of my staff had a great idea to get us out of the office and have a little fun. She set up an after hours office get together at a local franchise called Painting With A Twist www.paintingwithatwist.com . I haven't pained since about the 5th grade.
A real art instructor works with the group to paint a picture of their choice on canvas. We brought in snacks and beverages and pained away for 2 hours. It was a really fun way to take everyone out of their comfort zone and have a little play time. None of us are artists, but all of us can be creative and nobody could fail. One of my staff is even color blind and he still enjoyed it.
It was such a good time, and I promise, we'll be back.

www.lakelansingfamilypractice.com

Eggs in a Mug

 I was listening to National Public Radio +npr.com on the radio the other day and was fascinated by a program on microwave cooking.
The reporter wanted eggs for breakfast but only had a coffee pot and microwave at the office, so he came up with this and it's great:

2 eggs (beaten)
a splash of either milk or water
add a couple tablespoons of cheese

optional: ham/sausage/green peppers/mushroom

microwave on high for about 90 seconds and Viola...eggs in a mug!

This was my breakfast this morning and now I'm really wondering why I bother making omelets.

You can also bake cake in a mug or brownies... check out www.npr.com or google microwave recipes for more great ideas.
Enjoy.
Dr. Ronan

Nothing beats unconditional love. We have 2 dogs that provide just that. Our newest edition to the left here is a female 2 month old lab mix named Josie. She's helped my kids learn responsibility. She's also the thing that gets me out of bed in the early morning and on my way. You just can't turn down a wimpering puppy who wants to go outside. Our older dog, Max, a 12 year old Border Collie mix, has taught my kids to be more careful around old dogs and people too. No matter how bad your day is, how can you stay mad or sad when someone so soft and fuzzy wags their tails and gives you a nice wet dog kiss. Learning to care about others and having them care back is important for all of us. I'm on my way home from the office to enjoy a little pet-therapy.
Good night.
Dr.Ronan

Exercises for Back Pain...it all works.

I get asked all the time if I recommend special exercises for back/neck pain all the time and my answer is "Everything works with regularity and moderation."

Several years ago researchers at two large university settings looked at what exercises worked best for people with back pain hoping to publish some magic regimen and the answer was surprising. They looked at swimming, biking, walking, ballroom dancing, yoga, pilates, weight lifting, etc and came to the conclusion that 30-45 mins of exercise 4-5 days per week regularly led to fewer flares of back pain, less days of missed work, less medication use, fewer imaging studies, less surgery in people who had been seen for back pain in the previous 12 mos vs a group that either did not exercise or did so only intermittently.

Find something that is enjoyable and sustainable for you and you should enjoy better back health. Working out too hard can cause problems too, so just try to stay fit not necessarily super-fit.

I'm off to Spin Class. Have a great day!
Dr.Ronan

As a primary care physician we see everything. 

I started my day with diabetes  and ended the day with a thrombosed hemorrhoid. In the middle was a stressed and tearful mother of 2 going thru a divorce and dealing with recurrent kidney stones. I managed a case of Influenza while driving to work in a snowstorm and messaged several patients via email thru our patient portal throughout the day.

I had a student following me around the office today, trying to decide what he wants to do with the rest of his life. We talk a little bit about medicine and a lot about work/family/life.

One of my patients showed up 2 hours late for his appointment, so i treated him during lunch instead of turning him away and rescheduling...I wish I had a doctor that would do that for me. I showed up 15 mins late for my dental appointment and got rescheduled a month later.

I feel very fortunate to be able to take care of people, and I hope I'm more of the solution than the problem.

Good night.

Broken Arm Ski Trip

As physician-parent you would think I'd know better than to allow my 7 and 9 year old daughters ski down a hill  they just aren't ready for. Heck, I didn't even want to ski down a Black Diamond hill.  But, after 3 successful runs down the slopes on the first morning of a weekend of ski fun, I caved in and let the girls shoot down the side of a set of moguls (something I haven't done in over 20 years). Needless to say, the 9 year old fell on her elbow and broke her right arm we got to experience the Canadian Healthcare System, which, by the way isn't too bad.
Of course, being a cash paying non-resident, we moved along swiftly to check out with xrays in hand to follow up in the States.
Now she's trying to get out of wearing her sling some parts of the day or at night when she sleeps. I'm sticking to my guns on this one. Wear your sling for 6 weeks.
Lesson learned. If you don't have a really good feeling going into any situation, DON'T DO IT!
And, as mom would say, "Just because other people are dumb enough to do something, doesn't mean you have to be dumb too."

Moms are usually right.

Yogurt Pancakes for Breakfast

Hey, try this Pancake recipe out this weekend if your looking for a high protein low carbohydrate way to start your day. My kids love these.

Blueberry Yogurt Pancakes:

2 cups (16oz) plain Greek Yogurt
4 egg whites
1/4 cup coconut oil -softened (or Softened/melted margerin or Vegetable oil if you don't have)
2 tbsp Vanilla
1/4 cup Honey
1.5 tbsp Baking Powder
3/4 tbsp Baking Soda
2 cups of Spelt Flour (unbleached) or Quinoa flour if trying to avoid Gluten
2 tbsp Ground Flax Seeds
1 cup Blueberries

Mix batter together without the blueberries. Heat your skillet or pan up with a little cooking oil or nonstick cooking spray. Pour pancakes and add blueberries...if it seems too  thick, don't worry, they'll flatten out as they cook.

about 3-4 per serving.

I downloaded my Nike app +Nike on my phone and also signed up for a cool program called Earndit +Earndit that gives your points for exercising that you can use to buy things that fit a healthy and active lifestyle, like clothing, sports drinks, trail mix/protein bars...etc.

I get asked all the time if I'm a runner or a biker or a golfer, but in reality I'm just an active person. I don't really log many miles running or jogging. I do a couple of classes per week at the gym, but I don't go every day. We have a pretty nice home gym that I can watch a ballgame and use our treadmill or eliptical or ride my bike. I just try to do something for about 30-60 mins 5 days a week and I feel pretty fit and sleep pretty well.

Studies consistently show that if you do some regular exercise 30-40 mins 5 days per week you miss less work due to illness or injury, take less medication, get fewer x-rays, see fewer doctors less often.
There are no Magic Exercises, just some exercise.

Make it fun and you're more likely to keep it up. Enjoy!

Dr.Ronan

What do my cholesterol numbers mean?

I try to check the cholesterol levels of my patients annually, especially if they are over 40 years old and even earlier (age 30 years)  if they have a family history significant for Heart Disease. A good cholesterol panel is as follows:
Total Cholesterol less than 200 (even better if less than 170)
HDL (good cholesterol) over 50
LDL (bad cholesterol) less than 100
Triglycerides less than 100
Ratio less than 3.0

A couple of good rules is to look at your Total Cholesterol and subtract HDL from it. This is called your Non-HDL Cholesterol and if the number is below 150 then you're in pretty good shape.

Another good rule is to take the LDL + HDL + TG and divide by 3... if you average 70 or less, you're numbers are great.

Risk factors for early Coronary Heart Disease include, but are not limited to: Age over 50 years, Males, Diabetes, Hypertension, Smoking, High Cholesterol, Family History of CHD.

If you don't know what your numbers are, ask your healthcare provider to find out. Many insurances today are being much more proactive with patients and encourage finding out your numbers to prevent early disease and it's working.

Skin Care

We are got to experience a new procedure for skin rejuvenation in the office today combining Microdermabrasion and chemical peel infusion and hydration. Excellent results. We are looking forward to improving our clients skin in 2013.

Also, skin looks older faster with unprotected sun exposure, smoking, and poor diet.

Use a "Broad Spectrum" sun screen with both UVA and UVB protection and a rating of at least spf 15. There are some great new moisturizers and day creams out there with UV sun protection.

Dr.Ronan
www.Biopelle.com

Hello out there

Hello and welcome to Health Talk with Dr. A.J. Ronan. We have a practice website at +lake Lansing Family Practice and do HIPPA compliant messaging on +RelayHealth.com, but a blog is a new thing to me. My goal is to share my thoughts each day from a busy family practice office and let you see what healthcare is about. Hopefully I can pass on some simple yet effective health tips each week.

I look forward to a healthy 2013 for all of us.
Dr. Ronan