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David Fisher, MD, MPH: June 2009

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Tuesday, June 30, 2009

I Bumped My Head- Now What?

The recent death of famed pitchman Billy Mays was tragic (he convinced me to spend $19.95 for not one, not two, but six tubes of "Mighty Putty"). He apparently died from heart disease, but initial speculation blamed his death on a head injury he suffered during a rough airplane landing the night before. While the head trauma seemingly did not cause Billy May's death, it raises the question: what worrisome signs should I be looking for if I bump my head?

Bleeding in the Brain

Head injuries can be lethal from something called a hematoma. A hematoma develops when there is bleeding in the brain. There are two main types: epidural and subdural. The brain is surrounded by a tough layer of tissue called the dura. When the skull suffers an impact blow, the brain shifts and collides with the skull, causing shock to the tissues. This is known as a concussion. Depending on the severity of the blow, concussions range from mild (with symptoms lasting only a few hours) to severe (confusion, nausea and headache lasting for days). Most concussions are not deadly, but bleeding in the brain can be.

An epidural hematoma is a collection blood that develops between the outer skull and the dura layer. This type tends to develop quickly and can be deadly within hours. Actress Natasha Richardson died of this type of hematoma, which she suffered during a skiing accident. Symptoms include severe headache, vomiting, a sudden change in vision, profound lethargy, and confusion. An epidural hematoma will show up on a CT scan of the head within minutes of the injury. Brain surgery must be performed within hours to removed the blood and stop the building pressure from killing brain tissue.

A subdural hematoma occurs beneath the dura, between the dura and the brain. It tends to develop more slowly. In fact, someone with a subdural hematoma may not show symptoms until days after the initial injury. A CT scan performed within minutes or hours of the injury may be normal. The symptoms are the same as with the epidural: severe headache, vomiting, a sudden change in vision, profound lethargy, and confusion.

What to Watch For
If you suffer a head injury, seek medical attention immediately if you have the following symptoms:
- Severe headache that does not get better with acetaminophen (Tylenol) or ibuprofen (Motrin/Advil)
- Vomiting (especially if it is what we call "projectile" vomiting- when it is very forceful)
- Blurry or double vision. Some concussions, which are not life-threatening, can produce mild blurriness for a few hours. If the blurriness is severe or does not resolve within a few hours, seek medical attention.
- Irregular pupils. If the pupils are different sizes, you need to be evaluated.
- Extreme drowsiness. Many concussions produce a "tired" feeling. However, if all you want to do is go to sleep, and people around you can get you to rouse or wake, they need to take you to the ER. It is also advisable during the first 24 hours following a head injury to have someone wake you every 2-3 hours, just enough to rouse you. If they can't wake you at all, it's time to visit the ER.
- Confusion. This is a major red flag. If you are saying oddball things (more than usual), confused about time or place, or just babbling nonsense, this likely indicates a serious problem.

Lastly, a word about prevention. Wear a helmet when biking, rollerblading, riding a motorcycle, or playing contact sports. It is well worth the trouble.
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Sunday, June 28, 2009

One Good Decision can Lead to Another

There are many foods that are healthier than cereal bars (like fresh fruits and vegetables), and I am not endorsing Nutri-Grain products, but I am a big fan of their new ad campaign. Watch their commercial here and be inspired to make a small change today.
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This Week's Health Headlines

Bone density tests not needed once osteoporosis meds are started
Diet high in red meats and dairy linked to pancreatic cancer
FDA approves generic morning-after pill for girls 17 and under
One in 25 deaths worldwide blamed on alcohol
Right ear is better for hearing
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Saturday, June 27, 2009

A Simple Cure for Vertigo

One of my favorite Alfred Hitchcock movies is Vertigo. Jimmy Stewart plays the detective who becomes an unwitting foil in a complex murder scheme, then goes too far in orchestrating a second chance to absolve his gnawing guilt for failing to save a woman's life. The twisting plot and gripping finale will make your head spin.

And speaking of spinning heads, your head was made to spin without causing you to lose your balance. This happens thanks to a delicately designed system contained in the inner ear. The semicircular canals are three looping arcs that sit behind the eardrum and are oriented in three separate planes. They contain fluid which moves as we move, triggering the movement of tiny hairs that line the inner surface. These hairs send messages to the brain, letting it know the direction our body is oriented in space. This allows our brain to coordinate our eye movements, blood pressure, and depth perception so we do not lose our balance. This video illustrates the role of the canals in maintaining our equilbrium (Notice: the audio is in German, but this was the best video I could find that accurately demonstrates the function of the inner ear).

This is a wonderful system until it malfunctions. Those who have experienced vertigo know how severely debilitating this condition can become. Even the smallest head movement or change in position can literally send the walls spinning. Vertigo is often accompanied by nausea, sweating, and feelings of wanting to faint. The fact that you can sit up, lie down, and turn around without launching into these symptoms is often taken for granted unless you have experienced a bout of vertigo.

The most common cause of vertigo is Benign Paroxysmal Positional Vertigo (BPPV). This temporary condition is caused by irritation of the interior canals and the tiny hairs that deliver information to the brain. The nerves are overstimulated and send faulty data to the balance center, causing our brains to think we are spinning when we are not. The Mayo clinic offers a succinct description of BPPV.

Often the irritation is the result of tiny stones or sediment that collect in the canal fluid. This sediment can be removed from the canals by a technique called the Epley maneuver. By manipulating the head through a series of positions, the force of gravity is used to draw the sediment out of the canals. Your doctor can perform this maneuver, but it is something you could do at home as well. Though you can do this yourself, I recommend recruiting as assistant, just to ensure you do not fall off the table or bed. The technique is demonstrated in this video. Each successive position will likely reproduce your symptoms if you truly have BPPV. The video instructs the patient to wait 30 seconds between positions; in reality, you should wait until the dizziness resolves and then quickly move into the next position.

If this technique does not solve your vertigo, see your doctor. There are medications that can help with the symptoms, and there are other causes of vertigo besides BPPV that your doctor can diagnose.
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Friday, June 26, 2009

Where President Obama is wrong about health care reform

I don't have all the answers to health care reform. American medicine is a complicated web of economic, political, and social factors. I believe that everyone engaged in this debate wants the best health care for the most people; we just disagree about how to accomplish that goal. President Obama's recent statements about Medicare tipped me off that he is about to damage our health care system in ways that may not be reversible.

Medicare Advantage- standard or scapegoat?
His comments were about the program called Medicare Advantage. This is a program that works like an HMO. Patients who are Medicare-eligible enroll and reassign their Medicare benefits to an insurance company. The government then pays the insurance company a set amount per month to manage that patient's health care. Patients pay lower premiums (regular Medicare still requires patients to pay 20% of most of their own health costs), and patients must navigate their medical care through their primary care physician, who oversees everything and generates referrals for procedures or visits to specialists.

The insurance company contracts with doctors and hospitals to provide the care. If they do a poor job of efficiently managing a patients' medical care, they lose money. Let's say Medicare pays $700 per month for a patient. If that patient ends up having a $3000 hospitalization that month, the insurance company loses $2300 (and often passes that loss along to the doctors and hospitals in the form of reduced reimbursements). If, however, the doctors keep their patients healthy and out of the hospital, or help them avoid invasive (and therefore expensive) procedures, they have money left over at the end of the month. The doctors and hospitals who figure out how to manage their patients' care at the lowest cost have an incentive to do so. For example, if I meet certain clinical goals with my Medicare Advantage patients (things like improved blood sugar readings for my patients with diabetes, improved blood pressure readings, timely immunizations, etc), then I will qualify for a year-end bonus from my employer, Advocate Health Care. If I don't help my patients meet these goals, then no bonus for me.

For those who are concerned that this arrangement motivates doctors to withhold care, one of the largest factors we measure is patient satisfaction. Our scores go down if our patients' satisfaction goes down. Also, because there are many insurance companies, doctors and hospitals who accept Medicare Advantage, patients who are unhappy with their treatment can always switch providers. Another potential concern about this program would be that insurance companies will only accept healthy patients under this arrangement, but Medicare adjusts payments based on diagnoses and severity of illness, in order to encourage providers to take all patients, both healthy and sick.

The bottom line: Medicare Advantage sets a goal for health care costs, and then encourages doctors, hospitals, and insurance companies to work together to stay within that cost. Those who do it the best will keep more patients and will see financial benefits at year's end.

Obama's flawed philosophy

Here's where President Obama comes in. He wants to eliminate Medicare Advantage. His reasons reveal what I believe to be a flawed philosophy towards our health care system. According to Obama, Medicare Advantage "overpays insurance companies" and leads to "wasteful spending." Here's what irks me about that. Let's say that Medicare pays a capitated rate of $500/month per patient to the insurance/doctor team. (This is an oversimplification, but works for the sake of example). And then let's say that I work hard to keep my patient's healthcare costs to $400/month. I do this by spending more time with my patients emphasizing prevention, making extra phone calls to make sure their treatment is working so they don't end up in the ER, and arranging for family meetings to discuss advance care planning so patients avoid unwanted treatments and procedures. The resulting $100/month cost savings is my financial incentive to control my patient's costs. In many ways, it makes it possible for me to spend the extra time, since Medicare does not directly reimburse for phone calls or family meetings. What bothers me is that President Obama looks at the cost per month for this patient and thinks the $100 is "wasteful". He naively assumes that the patient's costs could have been managed within $400/month under regular Medicare, that pays according to what doctors/insurance companies bill (the "fee-for-service" model). He sees Medicare paying $500/month when they could have just paid $400. He fails to realize that my patient's lower cost per month was the result of my hard work, which was motivated, in part, by the opportunity to earn some extra money for being efficient and effective. When Obama labels this financial incentive as "wasteful" and "overpayment" he suggests that doctors, hospitals and insurance companies should be expected to control their patient's costs with no additional incentive for doing so. In today's world of declining reimbursements and increasing malpractice insurance rates, this is an unreasonable expectation.

By President Obama's own admission, any financial profit gained by health care providers who manage their patients well and keep costs down is considered "wasteful." His comments reveal a philosophy that resists, and may even resent, any financial gain by those who succeed at providing health care efficiently. This philosophy demonstrates a gross misunderstanding of human nature. It is a philosophy that could damage, and perhaps destroy, America's excellence in health care.

One factor more than any other has made American innovation in health care the envy of the world. That single factor is competition. Here in the USA, the business entity that does anything better than its competitor will achieve success. Competition drives creative solutions in all fields, including health care. The hospital that provides the best care at the lowest cost will end up with patients lining up outside its doors. The pharmaceutical company that invents a drug easier to take, and with better results, will take over the market. The medical school that develops innovative training techniques will get the best and brightest applicants. There is nothing obscene about success in a health care market; indeed, it is the potential for success that drives new innovators to enter the field and achieve personal goals, financial or otherwise, while improving health care for patients.

President Obama must understand human nature enough to understand this. Very few enter the health care field (or any field) on purely altrustic motives. There is always an underlying desire for personal success in the field that one loves. Yet, Obama naively labels financial incentives in health care as "wasteful" and "excessive." These statements frighten me, as Obama pushes for health care reform. Introducing more government into health care will skew the competitive market away from free enterprise, away from opportunities to develop innovative solutions, and towards more paperwork, beauracracy, and waste. The nursing home environment, where I spend the majority of my time, is one of the most heavily regulated sectors of health care. I am not against regulations; some rules are necessary to protect the vulnerable. However, the efforts required of doctors, nursing home staff, and administrators, in order to keep up with the documentation for state and federal regulations, drains nearly all of the patient-focus out of daily care. Nursing home employees are often more concerned about keeping their charts and documents within regulations than they are about caring for their patients. This is not a knock against nursing home staff; they are some of the most caring people I know. This is simply an example of what a large beauracracy does to any industry.

Stop cursing profits
Any health care reform must preserve the opportunity for people and organizations to compete on a level playing field in the health care market. The introduction of a wide-reaching "public option" for health insurance will, by its nature, limit these opportunities. Government subsidized health care will not be under the same pressure as private health care providers. Private companies must generate a profit in order to survive. This forces people to work hard, innovate, and contain costs. Governments that can simply print or borrow money do not need to generate profits. There is no pressure to perform well. This leads to laziness and lack of care, and costs tend to expand. President Obama should stop cursing insurance companies and innovators who earn money by introducing solutions into the health care market. He should not naively assume that injecting more government into health care will somehow bring equality and order. I believe it will have the opposite effect. I believe more government involvement in medicine will reduce health care quality for most Americans, will ultimately limit access to care for most Americans, and will discourage our best and brightest from entering the field of medicine. I hope and pray that the administration and Congress take a measured approach before increasing federal involvement in health care, because once government expansion occurs, it is very difficult to retract.

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Thursday, June 25, 2009

Use Listerine to fight... mosquitoes?

Some of you have possibly seen the e-mails going around that tout Listerine as an effective mosquito repellent. I decided to try it myself and... it seems to work. Most mouthwash products contain eucalyptus oil, which is known for its insect repelling properties. The only caveat: because the concentration of eucalyptus in the mouthwash is much lower than in commercially available repellents, the Listerine must be sprayed more frequently to keep up the effect.

Make a solution of half mouthwash and half water in a spray bottle.
Avoid spraying eyes and nose (not toxic, but irritating).
Spray body or any area, like your deck, where you don't want mosquitoes.
Repeat roughly every hour.

Read a NY Times article on Listerine as repellent here.
One more disclaimer: mosquitoes are drawn to the heat of your body and the odors you give off through your skin. Some people just happen to give off more attractive odors to mosquitoes. In those people, this is less likely to work. I hope it works for you!
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Thursday, June 18, 2009

Lessons from a Broken Alternator

About 2 weeks ago, the "Check Engine" light began to appear each time I started my car. When this happens, my emotions go through several stages. First, denial. "There's probably nothing wrong, the light is just malfunctioning." Next, anger. "I don't have time to take my car in! Doesn't it know this is a crazy week for me?!" Then I move into bargaining. "OK, car, if you can hang on for one more week, I'll make sure to never again go over 3000 miles before changing your oil." And finally... well, back to denial. "Hey, the light went off- I knew nothing was wrong."

So I continued in my happy state of blissful ignorance until today. While crossing the mile-long bridge on I-294, the engine died. Uh-oh.

I shifted into neutral, and pulled to the shoulder. My first step was to justify myself for not taking my car in to the mechanic. How could I have foreseen this, right? Next, I called the motor club to arrange for a tow truck.

"What town are you in, sir?" came the voice at the other end. I looked around. I could explain where I was on the interstate, but I had no idea in which southwest Chicago suburb I currently sat. Even my high tech GPS and smartphone couldn't tell me. Then I remembered the old-fashioned Chicagoland map book my wife had given me, "just in case." I opened the book to my current location, and I wasn't sure whether to laugh or cry as I spoke the name of the town to the motor club assistant.

"I'm in Justice," I told her. Though I drive through it (or over it) nearly every day, I never knew there was a Justice, IL. I started to laugh. I happen to believe that God orchestrates all events in our lives, even the most mundane, and I was deeply amused at the thought of God allowing me to break down and land in Justice after ignoring my car's warning signs. Justice indeed. There are consequences to actions and inactions, whether we want them or not.

Waiting for the tow truck, I pondered the other warning signs that many of us ignore. They occur in relationships, in our occupations, and in our health. I'm not usually big on the "your body is like a car" analogies, but there are a number of "Check Engine" warnings that our bodies give us that should not be ignored. Sometimes these warnings will appear for a while and then disappear, like my dashboard light. Don't assume that means the problem has gone away. You should see your doctor if you experience any of these warning signs.

Excessive fatigue. I don't just mean getting tired after a long day or a particularly busy week. If you find yourself feeling unusually tired all the time, it is not normal. It could be caused by a thyroid problem, low blood counts, or other more serious health conditions.

Unexplained weight loss or gain. If you changed your diet or exercise habits and notice a change in your weight, don't worry. But if your lifestyle has not changed and you are suddenly lighter or heavier by more than 10% of your previous weight, you should see your physician.

Bleeding. Occasional nosebleeds are common, especially in the winter. Gums somtimes bleed with brushing, especially in the setting of gingivitis. Hemorrhoids can cause blood to show up on the toilet paper or occasionally on your stool. These types of bleeding are not concerning, but other types are. Blood in the urine, excessive bruising, dark, tarry or purplish stools, or coughing blood are all conditions that require immediate attention.

Sudden change in mental status. If you or a loved one starts behaving in ways that are uncharacteristic, such as forgetting something that was previously second nature, getting confused, or losing inhibitions and behaving completely out of character, it's important to be assessed by your doctor.

Chest pain. There are many causes for pain in the chest. Unfortunately, we cannot easily determine the cause without sophisticated medical tests. A person having some indigestion may feel exactly the same as a person having a heart attack. For that reason, everyone who seeks medical attention for chest pain will receive a battery of tests to rule out a cardiac cause. Chest pain caused by a heart attack, or heart disease, does not always fall into the typical pattern of crushing pressure in the center of the chest radiating to the jaw or the arm with accompanying nausea, sweating, and shortness of breath. Sometimes it can present as simple abdominal pain. This is especially true among women, older adults, and people with diabetes.

Changes in a skin lesion. Most skin abnormalities are benign. They may grow at a very slow rate, but otherwise, benign lesions remain mostly the same in their color, shape, and behavior. Skin lesions that are worrisome have irregular borders, diverse colors, and they will change more rapidly. They sometimes itch or bleed as well. If you notice a skin lesions that exhibits any of these characteristics, see your doctor quickly.

Sudden flashing lights. We all see "floaters" and other visual disturbances throughout our life. This is normal. Sudden, bright flashes of light, especially when moving the head around, could indicate a detached retina. This is an emergency that needs immediate attention.

Persistent fever or night sweats. Fever that lasts more than 3 weeks, as well as night sweats, could be an indication of a serious infection.
Thoughts of suicide. This is often a sign of severe depression. People who are depressed may sometimes wish they could just go to sleep and not wake up, or they may feel like they would not mind if they were in a car accident and died. That is different from suicidal intentions. If you spend time planning how you might kill yourself, seek the help of a doctor or therapist. The worst thing to do is not tell someone.

Worsening exercise tolerance. If you find that you are no longer able to endure the workout that you are used to doing, that could be a sign of a heart or lung problem. Seek attention if you are unable to exercise at your usual pace for no obvious reason.

This is by no means an exhaustive list, but it is a start. I hope this helps you determine when it is important to see your doctor. By the way, while waiting for the tow truck, a rainbow appeared over my head, reminding me that even God's reminders of justice are an act of mercy.
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Friday, June 12, 2009

Fight Empty Stairwells!

A few months ago, I decided to start taking the stairs at the hospital instead of the elevator.  I make rounds on the 4th floor of Advocate South Suburban Hospital at the inpatient unit for Advocate Hospice.  Climbing 4 flights of stairs may not seem like a big deal, but it has several benefits:

1) Burns more calories than taking the elevator
2) Exercises the quadriceps, a vitally important muscle group
3) Provides a snapshot of one's cardiovascular health (if you are winded after 3 or 4 flights, you are not getting enough aerobic exercise)

I finished my rounds the other day and I was on my way back downstairs when something dawned on me.  Since my decision to utilize the stairs 5 months ago, I had never met another person in the stairwell!  Now, I know people are traveling between floors, because when I was taking the elevator I almost always had company.  What are the reasons people don't typically use the stairs?

1)  Inconvenience.  It is hard to find a stairwell these days.  Many are not near the elevator bank, and most buildings are designed with the elevators front and center.  Tip: Look for the "Exit" signs and you will find the stairs.

2)  Time.  We are often under the impression that taking the elevator will save us crucial seconds, and since most of us (myself included) don't leave any margin in our schedules, we feel the pressure to get upstairs as quickly as possible.  By the way, I timed my average elevator trip, including waiting, and compared it to taking the stairs.  Result: no difference.

3)  Fear of setting off an alarm.  Many stairwells are now marked "emergency exit" and it gives the impression that they are only to be used in case of emergency.  There is a difference between "Emergency Exit" and "Emergency Exit Only: Alarm Will Sound."  If you go through a door like the one pictured here, you will give a lot of people some extra exercise, including some local firemen, but the embarrassment is probably not worth it.  If the door simply says "Emergency Exit" it is usually safe to use.

4)  Plain old laziness.  Elevators are just too easy.  It takes a conscious commitment to use the stairs.

Make your decision today to join me in populating stairwells once again!

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Thursday, June 11, 2009

Alzheimer's resources

This morning on WMBI-FM I spoke about Alzheimer's disease. Judging by the number of calls and follow up e-mails I received, this is a topic that affects many people. Below are more resources that I have found helpful:

Information from the National Institutes of Health (main site here)
Alzheimer's Disease Fact Sheet
Alzheimer's Disease Medications

Watch HBO's new documentary The Alzheimer's Project free online!

Caregiver resources from the Alzheimer's Association

For Illinois residents, a place to print advance care planning documents like Durable Power of Attorney for Health Care. Everyone should have one of these. All you need to do is choose the person who you would trust to make health care decisions in the event that you cannot express your wishes. Then put it in writing, and talk with your power of attorney about your wishes.
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Saturday, June 6, 2009

Who Was Albert Schweitzer?

This weekend, Chicago celebrates the 60 year anniversary of Albert Schweitzer's only visit to the United States. Most of us know just a little about him. Maybe you know that he was a doctor who opened a hospital in Africa in 1913, during a time when Africa's desperate medical needs were largely ignored by the world. Perhaps you knew that he was friends with Albert Einstein. You may know that he won a Nobel Peace Prize for his work in and Africa and for his efforts to abolish nuclear weapons. This remarkable man has inspired me throughout my career.

Dr. Schweitzer is known for his philosophy of "Reverence for Life." He recognized that we each carry within us the innate "will-to-live." We naturally treat our own life with great care and respect. Schweitzer argues that ethical living is to apply that same care and respect to all life. In his own words:

"that is what gives me the fundamental principle of morality, namely, that good consists in maintaining, promoting, and enhancing life, and that destroying, injuring, and limiting life are evil. Affirmation of the world, which means affirmation of the will-to-live that manifests itself around me, is only possible if I devote myself to other life."
- The Philosophy of Civilization, p.79

Schweitzer's philosophy echoes the famous commandment from the Book of Leviticus, often quoted by Jesus, "Love your neighbor as yourself." Leviticus 19:18. This quotation has been increasingly used to justify the cultivation of self-love as the pathway to caring for others. The argument goes, "If you fully love and respect yourself, that will free you to show that type of love to others." I think that argument misses the point. Schweitzer, Jesus, and the author of Leviticus seem to agree- we are born with an deep instinct toward self-preservation. Self-love does not need to be cultivated; it is innate. This is nothing to be ashamed of. Your desire to care for yourself and acquire what you need to survive is part of what makes you human and alive. This instinct is only selfish if it ends there. What Schweitzer, and Jesus, seem to be saying is that our deep desire for self-preservation, what Schweitzer would call the "will to live" and what Jesus would call your "love for yourself," this desire is a gift. It should be used as the standard by which you measure your care for others. We are called to care as much about the needs of others as we automatically care about our own needs. Consider how Albert Schweitzer applies this principle to the problem of pain and suffering:

"Those who have learned by experience what physical pain and bodily anguish mean, belong together all the world over; they are united by a secret bond. One and all they know the horrors of suffering to which man can be exposed, and one and all they know the longing to be free from pain. He who has been delivered from pain must not think he is now free again, and at liberty to take life up just as it was before, entirely forgetful of the past. He is now a 'man whose eyes are open' with regard to pain and anguish, and he must help to overcome those two enemies (so far as human power can control them) and to bring to others the deliverance which he has himself enjoyed. The man who, with a doctor’s help, has been pulled through a severe illness, must aid in providing a helper such as he had himself, for those who otherwise could not have one. He who has been saved by an operation from death or torturing pain, must do his part to make it possible for the kindly anesthetic and the helpful knife to begin their work, where death and torturing pain still rule unhindered. The mother who owes it to medical aid that her child still belongs to her, and not to the cold earth, must help, so that the poor mother who has never seen a doctor may be spared what she has been spared. Where a man’s death agony might have been terrible, but could fortunately be made tolerable by a doctor’s skill, those who stood around his deathbed must help, that others, too, may enjoy that same consolation when they lose their dear ones. Such is the Fellowship of those who bear the Mark of Pain."
- On the Edge of the Primeval Forest, pp. 173 f.

To love others is to seek to bless them with the same blessings you yourself have received. This is an active love. Schweitzer's most famous quote is perhaps this one:

"My life is my argument."

May this be true of all of us, starting with me.

Recommended reading:
Out of My Life and Thought
- Schweitzer's autobiography, an excellent overview of his life. Though I do not agree with everything he wrote, particularly his theological conclusions about the person of Jesus, his life story is incredible.
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Wednesday, June 3, 2009

Knee pain? Strengthen your Quadriceps

On yesterday's radio program, a woman called me to ask about the arthritis pain she was experiencing in her knees. She is not alone. Osteoarthritis of the knees is one of the most common joint disorders. It occurs when the cartilage padding between the bones wears down over time. Additional pressure on the knees, whether from being a Major League catcher or from being overweight, will cause that wearing-down process to progress more quickly.

Arthritis pain can be helped if you take some pressure off the knees by strengthening the quadriceps muscles.

This is a group of four muscles that rest on the front of the thigh. They extend the lower leg , allowing the knee to straighten, and they provide stability when standing. They are the most important muscle group for maintaining the ability to stand and to walk independently. They are a key to preventing falls in older adults.

In just five minutes a day, you can keep your quads strong. Several simple exercises can be done either throughout the day or in one sitting. They are:
1) Seated straight leg raise
2) Lying straight leg raise
3) Quad clench

A diagram of these exercises (and one stretching exercise) can be found here.

By taking care of your quads, you will help prevent arthritis, joint deterioration, falls, disability, and loss of independence. Take a few minutes each day to invest in your quads.
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