This week’s feature examines First Choice Healthcare, celebrating its 40th year of helping underserved areas throughout the state stay in tip-top shape. But while First Choice is accepting new patients, Michelle Melendez says that appointments and routine visits are difficult to schedule right away. Most folks wait several weeks. Here’s a checklist of things to do during that time to ensure your visit runs smoothly.
• If you have insurance, check with them to see if First Choice is in your network. Double-check your policy’s co-pay and deductible. Call and ask how much it’ll cost you if you need lab work or X-rays. That way you have an idea of how much you’ll be paying out of pocket.
• If you don’t have insurance, gather any documents you might need for financial assistance. This might include tax returns, W2 and 1099 forms, pay stubs, bank statements, proof of residence (utility bills), identification documents (social security card, birth certificates, etc.), picture ID (driver’s license), daycare documents, and documents from any other financial assistance or insurance programs you’re enrolled in. Make a file for you, your spouse and your kids.
• Gather a family medical history. Your provider wants to know about the health status of first-degree relatives (parents, siblings and children) as well as any conditions that affect multiple extended family members (for example, if you have three cousins and an aunt affected by lupus).
• Gather your own health history. This includes past diagnoses, current diagnoses, previous surgeries or injuries, immunization status, current medications (including herbs and supplements), and allergy history.
• Be prepared to discuss some personal social issues. Your provider may want to know who you sleep with, if you smoke or drink or use drugs, if you exercise, what your diet is like, where you work, how things are going at home, and if you feel safe and happy. These questions can be uncomfortable but they are not meant to judge. They’re to help your provider select the labs, treatments or referrals you need.
• If a particular symptom is bothering you, keep a diary of that symptom until your appointment. For example, if you have bothersome headaches, write down when they happen, how bad they are, if you have other symptoms, how long they last, what you do to make them go away and what you were doing prior to the headache.
• Make a list of your medications (name of drug, dose, how often you take it), or just toss all your medication bottles in a brown paper bag and bring them with you to your appointment.
• Make a list of every single question or issue you’d like to address during the visit. Now number the first, second and third most important things to you on that list. You need to know your priorities going into that visit. Given time constraints, lesser priorities may have to be addressed at follow-up visits.
• Plan on wearing loose-fitting clothing that’s easily removed. I can’t tell you how many tripled-layer wool turtlenecks, high-waisted skintight pleather pants, and knee-high lace up boots I’ve wasted valuable time wrestling with during the physical exam.
• You may need to authorize your previous health care providers to release your medical records.
• If you have copies of any previous lab or test results, heck, bring ’em with you.
• Try to arrive about 15 minutes early for your visit. I always bring a girlie magazine to flip through or a novel to read in case the clinic is running behind.
• Answering calls or texting during your visit will slow things down. Let your peeps know you’ve got an important meeting beforehand so they don’t start blowing up your cell phone once you’re in the room with the doctor.
I have a recurring nightmare. In this nightmare, I am running around my former high school stark naked. I dash into the bathroom and frantically MacGyver an outfit out of toilet paper. But my makeshift frock falls apart. It’s then that I notice the urinal, and realize I’m not in the girls’ bathroom. I’ve accidentally ducked into the wrong bathroom, and numerous pubescent males are gawking at me.
Now, I’m not some closet Freudian who believes the mind buries its urges in obtuse dream riddles. But there is one minor detail of my recurring nightmare that always leaves me shaking my head when I finally wake up. In the dream, I never attempt to cover my breasts or groin with my toilet paper garment. Instead, I fashion a little backflap to conceal what my dreaming self is so urgently desperate to hide: cellulite.
My cellulite and I have a … complicated relationship. I’ve been trying to break up with my cellulite for years now, but the stubborn bastard just won’t take a hint. It doesn’t matter how many hours I spend at the gym. Cutting back on calories doesn’t do the trick. For seven years now, I’ve been telling myself that if I just work a little harder, I’ll finally achieve the smooth lifted backside I want so badly.
One night in the not-so-distant past, I found myself in tears over the dismal rear view in the mirror, despite my years of hard work and persistence. After wallowing in my self-pity for awhile, I became angry. I wiped away my tears defiantly, and marched to the medical library. “Screw you, cellulite!” I hissed. “I’m going to blast you away once and for all, with science!!!”
I pored over textbooks and journal articles, attempting to understand the evil dimples colonizing my backside. I searched, high and low, for the best weapons to demolish my enemy. Liposuction! Cryosurgery! Laser beams! Take that!!! I expected to find a smorgasbord of fat-blasting options. But much to my horror, the scientific literature on the topic was strangely sparse.
Despite the fact that humans possess the technological sophistication to land a robot on Mars, we still don’t really know exactly what cellulite really or how it differs from “normal” fat. What we do know is that cellulite occurs almost exclusively in women and usually on the lower body. Though the exact mechanism behind cellulite has yet to be discovered, it probably results from the complex interplay of numerous factors like hormones and circulation. This condition, defined by doctors as “a localized metabolic disorder of subcutaneous tissue that provokes an alteration in female body shape,” affects up to 98% of women.
The media often portrays cellulite as a shameful side effect of weight gain, but in reality, there is little correlation between body mass index (or ratio of weight to height) and cellulite. Although extra weight can exaggerate cellulite, not all heavy women have cellulite. In some cases, weight loss improves the appearance of cellulite. But weight loss can also worsen the appearance of cellulite, when previously plump skin hangs loose. The vast majority of lean women have cellulite, and this condition is not associated with any health problems at all.
If cellulite affects up to 98% and women is a completely benign condition, should we really be defining it is a metabolic disorder? Metabolic disorders, like diabetes and hypothyroidism, are pathological conditions that cause significant illness. Cellulite is a complete wimp compared to these health wreckers. Even defining cellulite as a cosmetic disorder is a bit of a stretch. Some cosmetic problems, like balding and varicose veins, can come with risks such as increased chance of skin cancer or blood clots. Not so with cellulite. Physically speaking, cellulite is a total pacifist.
Since the jury is still out on what cellulite is and why it happens, I feel at liberty to offer up my own interpretation. Starvation was a very real problem for our ancestors. Now imagine trying to breastfeed throughout those lean winter months, when you’re already low on fuel. The thighs, hips, and buttocks are known fat storage sites in the female body (FYI, women who store fat in these areas rather than on the abdomen have a lower risk of heart disease). In fact, research shows that the fat stored on the lower female body is much more resistant to lipolysis (or the process of breaking fat down for fuel) than other areas on the body. This means that the body only burns those stylish saddlebags in times of significant calorie deprivation. I think that cellulite is probably some sort of vestigial skin/fat configuration that makes it easy to pack fat on to that area of the body and tough to break it down. Is this good for breastfeeding hunter-gatherers living off of berries and squirrel? Yes. Is it good for spring break on Padre Island? No!
Just because cellulite is normal and harmless doesn’t mean we all need to commune beneath the moonlight to embrace the organic beauty of our cellulite. Personally, I believe that whoever invents a completely safe, cheap, effective cure for cellulite deserves every damn penny of the billions of dollars she’ll make. Yet, by the same token, whining and crying over one’s less-than-perfect backside as I’ve done in the past is a lame waste of energy that our ancestors probably didn’t have the time for. This self-hatred is a form of self-obsession, which is the real modern plague with consequences far more dire than a little smattering of cellulite.
When it comes to modern women, the world is too full of perils and wonders to get caught up in the cellulite shame spiral. This is not something that will ruin your eyesight or land you in a wheelchair (unless you experience some adverse reaction to an anti-cellulite treatment). It won’t even ruin a romantic date, unless low self-esteem robs you of your enjoyment. A leg with cellulite can still dip a toe into a summer lake, or enjoy the warm sunshine, or run a marathon every bit as well as a leg without cellulite. So I guess what I’m trying to say is, if you’re a woman with cellulite, it’s your birthright to bypass the stages of grieving that I’ve subjected myself to… denial, anger, bargaining, and depression… and skip right to the acceptance part. Yup. There it is. Cellulite. Now tear yourself away from the mirror and go enjoy your life.
Don’t Let the Bedbugs Bite : As Albuquerque joined countless U.S. cities in the battle against bedbugs, exterminators in the city need all the hep they can get. The Alibi talks with exterminator David Erik Swanson about how he found an extra edge in his combats with Captain Dale, his bedbug-detecting black Labrador retriever.
Creepy Crawlies: Author Amy Stewart talks with the Alibi about her horror book Wicked Bugs, and how it is more than a typical shudder-inducing collection of tales or a field guide.
Dr. Robert Stevens of Albuquerque's New Mexico School of Natural Therapeutics
Home to landmark institutions like the Ayurvedic Institute and the New Mexico School of Natural Therapeutics, Albuquerque is a mecca for alternative medicine. Scores of students from all over the world make a pilgrimmage to the Duke City, often becoming temporary or permanent residents during their studies.
Albuquerque's Ayurvedic Institute is one of the pre-eminent voices in Ayurveda, a form of traditional medicine in India. Through his many books, clinics, and impecable reputation Dr. Vasant Lad, the institute's founder, is well-respected throughout India and the world as one of the Ayurveda's foremost experts.
The New Mexico School of Natural Therapeutics gives their students a firm foundation in a variety of therapuetic styles. Although the school draws heavily from many indigenous medicinal traditions, its teachings focus primarily on the western cannon of natural medicine which includes luminaries like Paracelsus, John Harvey Kellog (inventor of corn flakes), Dr. Henry Lindlahr (founder of American Naturopathy), Dr. Randolph Stone (founder of Polarity Therapy), and Dr. Samuel Hahnemann (father of Homeopathic medicine). Many of these great minds became largely disenfranchized by the politics surrounding the development of the American Medical Association. Their practices, however, continued outside the mainstream. Today alternative medicine is experiencing an explosive resurgence in popularity.
This week is a good week to learn more about natural healing.
• The New Mexico School of Natural Therapeutics is offering a free class this Thursday morning (at the school or via webcast) an introduction to the Philosophy to Natural Therapeutics. • And the Ayurveda Institute will be having a free lecture by Dr. Robert E Svoboda, the first westerner to receive a doctorate in Ayurveda in India. In addition to penning many popular books on Ayurvedic medicine, Dr. Sovoboda is known for his Aghori books detailing his many adventures with his mentor.
Deconstructing our federal government is pretty similar to dissecting one of the waxen cadavers from my college anatomy lab. Peel back the layers and you’ll find judicial brains, and military muscle, and convoluted channels funneling money, the lifeblood of government, to all its various parts.
If government were an organism, however, it might look like some freakish homunculus with an oversized mouth and a huge anus. The vitals parts, like the heart and the hands, would appear atrophied, leaving us with a system that’s incapable of doing much besides talking, eating, and squeezing out feces. What are we supposed to do with such an obnoxious patient? Is our government, like a cadaver on the table, already dead, or is there some kind of life support that would help reanimate the precious organs and return our system to dynamic, efficient functionality?
Perhaps we should take a cue from Mother Nature and invest in a beefy pair of kidneys for our dying system. In the human body, the kidneys have about a zillion hobbies, but their day job is filtering waste products from the blood and preventing a toxic overload of metabolic byproducts like urea. They also excrete or reabsorb water and electrolytes as needed in order to keep blood pressure normal. For instance, if a person is dehydrated, the kidneys sense the drop in blood pressure and begin reclaiming every spare water molecule in sight. As such, they play a major role in maintaining homeostasis, or the stable internal equilibrium of a living system.
The kidneys know that fiscal responsibility has more to do with sustainability and recycling than tightfisted, miserly budgeting. The kidneys never hesitate to spend, but they spend wisely, always keeping an eye on the wellbeing of the whole organism. They secrete the hormone calcitriol when they sense the body is low on calcium. They regulate the body’s red blood cell production via the hormone erythropoietin, and they manufacture a hormone called renin in response to dropping blood pressure. They reclaim important molecules, like sugar and protein, and return them to the body for reuse. They’re like waste management, recycling, manufacturing, and the EPA all rolled into one, or rather two, sweet little bean-shaped organs. They’re located towards your back, flanking your spine on either side just underneath your two lowest ribs.
The kidneys have always been my favorite organ. Like a good Sophia Coppola film, the kidneys have a kind of quiet, indie appeal to me. The heart thumps predictably, the guts squish and squirt without regard to decorum, and the lungs wheeze and rattle and cough. The music of the kidneys, however, is an ambient, internal whirr. And the pieces of the kidney have the best names, like nephron and glomerular tuft and distal convoluted tubule and minor calyx. Yesssss. Plus there are two of them, and who doesn’t like twins?
I think that our country’s founders tried to build a solid set of kidneys into the infrastructure of our government with a series of checks and balances. But, like human kidneys, disease and aging take their toll. Human kidneys are vulnerable to infection, injury, and the devastating consequences of systemic illnesses like diabetes or high blood pressure over time.
A diabetic patient in kidney failure must go to dialysis three times a week, sit in a chair for half the day while their blood is pulled from the body, filtered through the dialysis machine, and returned to the body via the largest, scariest needle you’ve ever seen. People often die on dialysis, awaiting a kidney transplant that never materializes. I think, in much the same way, cultural and social illnesses have disabled the homeostatic apparatus of our government, and we must wait on dialysis until the dead parts are removed and replaced with shiny new organs. What will the government’s new kidneys look like? Congressional overhaul? Economic restructuring? Massive investments in education and the environment? I don’t know. But I know we can’t sit here for the rest of time, with a damn needle in our arm and a body full of waste. Let’s clean this mess up before the grip of death turns our society into a cadaver, useful only for future generations to cut open and identify the diseased parts.
Telling people condoms don't work is irresponsible, says Alibi columnist Whitny Doyle, R.N. But APS board member David Robbins spread that misinformation like an STI a few weeks ago. Read Miss Diagnosis' op-ed, which is rooted in her nursly experience.
Be afraid. Be very afraid. At least, that’s what your amygdalae are telling you to do. These two almond-shaped neural hotspots are groups of nuclei (or clustered neurons) deep in the middle of your brain, one on each side.
One of the best ways to learn about what a specific brain region does is to study a person in which that region has been destroyed. People with a damaged prefrontal cortex lose judgment and personality, while people who’ve knocked out Wernicke’s area can’t understand language. The hippocampus is often obliterated in Alzheimer’s patients, which is why they suffer memory dysfunction. And the amygdalae? These little puppies play a role in learning and emotion, particularly fear. Injure your amygdalae and conquer your fear!
JK. Seriously. Don’t do that.
Today, my amygdalae began tweeting to me as I pondered the onslaught of the upcoming flu season. It’s supposed to be a bad one, and there I’ll be in clinic, being coughed upon, sneezed upon, barfed upon, yelled at by cranky patients, and scolded by overworked colleagues. Flu season really activates my fear response, as it should yours.
Actually, I take that back. I don’t want to steal the politicians’ strategy of the manipulating you with fear. Flu season shouldn’t activate your fear response as it does mine. After all, you won’t be facing the waiting rooms crammed with unhappy people (unless, of course, you fail to get your flu shot and wind up in a waiting room yourself). Instead, flu season should activate the above-mentioned prefrontal cortex. This is the executive center of your brain, the planner and decision-maker, the smart librarian-looking lady with the black-rimmed glasses who, like a calculator, can look at a situation and weigh the pros and cons, the risks and benefits, the good and bad, without messing up even one little hair in her perfect French twist. Yes, the prefrontal cortex, your brain’s inner librarian lady. She can tell you the cold hard facts about how the benefits of the flu shot outweigh the risks. She can do so coolly, objectively, without emotion or fear. Here are the facts, my child. At the very least, even if you were never destined to get sick, a flu shot can prevent you from being a carrier that spreads the virus to others. The flu shot can save you a miserable weekend spent in bed, or an ER bill, or a hospital bill. It can even save your life. And the risks are nanoscopic. Now go in peace, my child.
One more thing. When you go get your flu shot, don’t forget to take granny and the kids with you. A new study found that kids who contracted H1N1 last year were more likely to suffer neurologic problems than kids who just got seasonal flu. A second round of H1N1 is predicted to make a comeback this year, and the new batch of flu shots contain protection against H1N1. Another study found that flu shots actually decrease risk of heart attack in older adults. So maybe crazy Great Aunt Agnes can avoid that third triple-bypass she’s been working on.
For those of you who develop an overly stimulated amygdala at the thought of shelling out money for a vaccine, relax. The University of New Mexico is offering free flu shot clinics to the public. Here’s a list of time, dates, and locations you can swing by to get your annual free poke.
The University of New Mexico Health Sciences Center 2010 schedule for free flu shots for the public:
Think of your favorite bar. It might be an unpretentious dive bar, a kitschy sports bar, or maybe it’s a faux-swank establishment crawling with coked-out LA types. Perhaps it’s one of those pervasive Meccas of cultural rot where popped collars abound, or some cooler-than-thou hipster hangout. I care not. The point is that you’re sitting there at your favorite bar, deciding what you’re going to drink. There’s a special on well liquor, but you find yourself eyeballing the shelf selections appreciatively. A bloody Mary? Scotch on the rocks? Some nauseating lametini concoction? If liquor isn’t your thing, you night turn your attention to the wall of beers on tap. Or perhaps your closeted wine-enthusiast wants to come out and play. Even if you’re a twelve stepper or teetotaler, you’ve got plenty of options. Hey, there’s no shame in ordering a champagne flute of maraschino cherry juice. Wait, yes there is.
Chances are, you’re no idiot. You see that this article is about saliva, so you maybe you think I’m going to describe the medical implications of drunkenly French kissing the herpetic bar patron sitting next to you.
The human body is analogous to a bar in that many of its most vital components are liquid. With water comprising up to 75 percent of the human body, it’s no wonder that the story of life is written in aqueous characters. There are some old familiars, such as urine, sweat, and tears. Other bodily fluids remain mysteriously aloof. What’s in blood plasma, anyways? And where the hell does bile come from? Still others fall into that category of the beautifully exotic. Ghostly lymph circulates silently through the lymphatic system, while cerebrospinal fluid courses through the ventricles of your brain and your spinal canal. And there’s about a billion more, from stomach acid to the thin layer of fluid between the membranes lining your lungs (pleural fluid) to semen to pancreatic juice to snot. Each and every one of these fluids has a at least one job. Pleural fluid allows the lungs to expand smoothly when you breathe. Vaginal secretions protect the vagina against pathogens and provide lubrication during sex. Pancreatic fluid contains enzymes that help digest food. And urine, well, urine exists so that we can continue making jokes about R. Kelly.
Of all the bodily fluids, though, saliva might be the hardest working. This multitasking oral tenant contains digestive enzymes, antibacterial compounds and antibodies, lubricants, sex hormones, and even a pain-killing substance. Its various jobs include softening food for digestion, facilitating taste, and protecting the teeth. Saliva allows us to talk, kiss, and play musical instruments. In this sense, it not only plays a role in survival but also in the experience of being human.
Medically, saliva can tell us a lot about someone’s health. We can measure someone’s drug or alcohol level using saliva. Saliva production requires adequate hydration, and so health care providers should always look inside the mouth of a sick person to make sure they’re not dehydrated . Certain autoimmune disorders destroy the salivary glands, producing chronic dry mouth. There’s even a whole segment of the dental market dedicated to artificial saliva for people with dry mouth.
What does this all mean? It means, mon frère, that you should go out to your favorite bar tonight. Order a margarita and lick the salt off your lips. Chew on the mint leaves in your mojito. Laugh and talk with your friends. Spit on that one rude guy. Drool over your nachos. Make out with someone cute. Summer is almost over, so there’s never been a better time to enjoy all your fluids while you can, before you dry up and flutter to the ground like the last leaf of autumn.
When my older sister and I were around 1 and 2 years old, my parents snapped a photo of us sleeping next to one another. In the quarter century that has passed since then, the deep symbolism that was accidentally captured in that photo has slowly emerged. The photo is now the stuff of family legend, an important historical document that is used to explain why things are the way they are.
You see, my sister Emily is the tidy, polished, pretty, immaculately dressed and expertly coifed fiancé of a famous opera star. And I … well, I like cats. And books. And books about cats. My hair automatically assumes the shape of the ponytail I wear everyday, and every single article of clothing that crosses my path bears some kind of oil or mustard or ink or baby vomit stain.
The aforementioned photo has become a famous family document because it perfectly captures, in one elegant little 4X6 time capsule, Emily’s and my future personalities. Two-year-old little Emily sleeps prettily on her side in a sweet little white nightgown, her blond hair gracefully and neatly spread around her relaxed, angelic face. And there I am next to her, fitfully sleeping with my mouth open, my hair hopelessly deranged and my body awkwardly tangled in a bizarre mountain of blankets and partially removed pajamas.
From this photo and other various scraps of anecdote, I’ve come to believe that a person’s sleeping habits can tell us a lot about that person’s personality, which itself is influenced by brain chemistry. My own brain has always been a tortured little theater of cognitive dissonance.
As the photo of Emily and me exemplifies, my sleep habits reflect this. In the miraculous event that I actually fall asleep, I toss and turn and toil away at unsolvable homework problems and an endless series of nonsensical tasks in my dreams. I wake up numerous times throughout the night, and by morning I’m usually more exhausted than I was the night before. Emily, on the other hand, presses energetically and cheerfully through her day and falls into bed sleepy, satisfied and generally unburdened by the useless emotional heft of global death and destruction. Twenty-five years after that photo was snapped, she still sleeps like an angel, and I like a Tasmanian devil.
I’ve always just kinda dealt with my insomnia. I’ve never sought therapy or anything like that for it. But a few years back, a rogue Ambien crossed my path and I, chronically tired and sick of not sleeping, decided to try it. Around 10 pm, I made a cup of decaf tea and drew a bath. Before entering the bath, I took about a quarter of the Ambien pill, thinking it would take effect just as I was ready to emerge from the bathtub and hit the hay. I washed the pill down with tea and stepped into the tub, closing my eyes.
I don’t remember anything between when I closed my eyes and when I opened them again, startled and shivering in a tub of cold water. I attempted to crawl out of the bathtub but couldn’t. My body was trying to go back to sleep, and I couldn’t find the strength or mental focus to remove my freezing naked flesh from the cold tub. I splashed my face with water and tried again, this time managing to drag myself out of the bathtub. After stumbling to my bed, I fell onto my mattress without drying off and pulled a blanket over me, falling asleep again almost immediately.
Ambien, which is a trade name for the generic drug zolpidem, works by enhancing the action of a neurotransmitter (or a chemical used to transmit signals from brain cell to brain cell) called gamma-aminobutyric acid (GABA). While most neurotransmitters stimulate brain activity, GABA actually inhibits brain activity. The ability to inhibit neural activity is absolutely crucial for brain function. Without it, each thought or sensation or active neuron would trigger a full-blown seizure. The brain must have some mechanism of terminating nerve impulses so they don’t just keep firing over and over again.
Neurons talk to one another via chemicals. If a neuron’s job is to activate other neurons, it’ll usually send out a neurotransmitter called glutamate. Glutamate is like a party invitation, and other neurons get all excited when they receive their glutamate invitation. However, if a neuron’s job is to shut the party down, it releases GABA. GABA is like a cease-and-desist notice. It’s like the cops knocking on your door at 3 a.m., busting up the party. So glutamate and GABA (along with a host of other neurotransmitters) work together to regulate brain activity. When you take an Ambien, the inhibitory effects of GABA take over, allowing the brain to slow down. This helps you fall asleep.
However, the “sleep” you get on Ambien is not the same as natural sleep. This is because natural sleep is a very active process requiring all sorts of highly organized brain activity. Inhibiting brain activity may allow you to fall asleep, but it can also stunt your brain’s ability to progresses through the normal sleep cycles. So, like any drug, Ambien has a bunch of risks along with the benefits. It works great for short-term use, to help quiet a noisy brain so that sleep is possible. It’s not so great to use every night, or to help someone stay asleep. And, as my bathtub experience demonstrates, it’s mighty powerful. Tinkering with the brain’s excitatory/inhibitory balance can lead to all sorts of bizarre things, from blacking out in bathtubs to memory loss to sleep eating and sleep driving. Yikes. Use with caution, and never without a prescription. Do as I say, not as I do, dammit!
So there you have it. GABA. Now you can rest easy.