askDrJim.com

High-tech Care with Old-Fashioned Values

BFF

The other great thing about cyberspace is the fact that folks can find you drifing out there. Recently I had a dear friend from years ago contact me because they found my website. This was amazing in and of itself as we have had < 5000 visits in the past year! Anyway I was found and then contacted. I am so greatful that they took the effort to connect. The other thing I have learned is that certain things are eternal. I am sure that the eternal part of each of us recognizes the eternal part in our close friends. How else can it be that after decades you can pick up almost without a pause? It seems that certain types of human interaction just trancend (or may suspend) time. Thanks for reachiing out when you did. I have not had much to blog about with a busy summer schedule and I try to avoid politics other than bashing the pharmaceutical/medical/industrial complex. There have been some studies out recently that I am digesting and trying to put into words to get out here. I am also going to look at a podcast (because those of you who know me know I can talk and talk and talk). Catch the poem in the verses page look at some friendship lines.
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Forum on Hold

OK so maybe it was not such a good idea. I certainly don’t LIVE to sit at the computer typing and trying to intice “friends” to cyberchat. The forum will go into hybernation for now. I still would like have ideas on how to develop a more interactive site. I really would like to “ask the doc” for both patients and others visiting the site but the forum was not working and I don’t want to look at the site with in on any more. The king is dead. Long live the king.
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Flippin Out

If you check out the last page on the site you will find a video of a trip I recently took with some friends and family. The amazing thing is the camera on which the video was shot. The Flip Mino is a new small video camera that is about the size of my very small cell phon. It looks a lot like a blak iPod with a lens on one side. The back has a large red button around which are four directional toggles and above which are 2 selection buttons. The form is much like and MP3 player and is very intuitive. There is a built in microphone and electronic zoom and a 1.5 inch LED screen in the back to watch what is being shot and to review the video clips. Much like a digital camera, you can trash the clip if you don’t like them. It can record up to 1 hour of video/audio. Now here it the kicker, it has a built in USB male port that pops out at the push of a button alowing you to link and download to a Mac or PC without much fuss. If you want to use Quicktime or other players it is pretty straight forward. And you can dump into movie software. Thus the first effort you see posted. This will be great for web video work. I’m just learning the ropes and will let the kids take it on a trip to North Dakota in July to shoot more footage. I love the fact that you can be creative with minimal investment.
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What are you doing here?

Last week we were looking at the Old Testament story about Elijah and the phophets of Baal. In the story Elijah is led to prove once and for all that his God is living and supreme and that Baal is an idol. He challenges 450 of the prophets of Baal to build an altar and have their god produce fire from heaven to come down onto their altar. Then he taunts them while they futilily do so and finally stop. He then produces a simple altar, soaks the wood and the sacrifice with more water than was needed to make his point and then prays simply that God would show who is “the Lord”. The fire comes and consumes the wood and sacrifice. Elijah has the false prophets seized by people who had come to watch the contest and then he has them all killed. He prays to God to end the long drought that had ravaged the land and a torrent occurs. Finally, he outruns the king’s chariot back down the mountain.

Heady stuff. He has been filled by God’s Spirit and with that filling has done miraculous things and observed God’s power and constant attention to His people. Our discussion looked at the way he was locked in to being brave and faithful in the story.

What struck me was the next chapter (1 Kings 19) where Jezebel has been told of the outcome of the duel and the death of the prophets (whom she supported). She vows to kill Elijah. And fresh from his mountaintop experience and aware of God’s power, the prophet.....HIDES after asking God to let him die. He eventually wanders into the mountains and ends up in a cave apparently depressed and hiding.

And here comes the part I liked. God does not ridicule him, demand he have more faith or punish him. God asks him “Elijah, why are you here?” The man complains that all others have been unfaithful and he has tried to do God’s bidding and now he is in danger of his life. God again, does not punish or correct, He tells Elijah to go out of the cave and stand on the mountain so Elijah can be there when God passes by. Elijah does so and observes a great wind that shakes the mountain and shatters rock (and the text says “”But the Lord was not in the wind”. ) Next came an earthquake and then a fire with the same response. Finally, there is a quiet voice of God which says... “Elijah, why are you here?”!

The same question. No other great announcement. Elijah repeats his statements of before and again, God does not chide him. God gives him tasks to do which includes appointing a chosen successor (Elisha). Then God reminds the prophet there are still 7,000 men fiathful to Him during this time of turmoil.

The lessons for me are strong. Right now I am in a place where I am complaining, feeling sorry for myself and being generally depressed. But I don’t feel God’s chiding or ridicule. I hear Him say “why are you here?”

The answer is complex but certainly involves my own decisions and choices through the years. The story teaches me that there is more. God is always in the places where we are, waiting, full of action and hope. He has plans for us that He desires to tell us. He also is aware of our disappointments, our fears, our depression and our...humanness. He does not rebuke us for these but he wants us to move outside of the place where we are so that we can see Him. He can hear our complaints but desires to put us firmly into His plan. He also comforts us with the knowledge that we are never as alone as our emotions would tell us we are. Lastly, He certainly can show us His presence in big and powerful ways but He does not need to do so because the power He places inside us is sufficient as long as we look to Him and obey.

I hope that I can learn this lesson and move out from the cave to hear what He has for me to do.
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Abba

Today at Sunday School we were discussing the issue of fear. The question at hand was “where is God when I fear?” and the myriad questions that sprout from that point. It is a very relevant question. Daily in my practice I see people whose lives are dominated by fears and anxiety. Some have phobias, some reactions to past traumatic events, some seem to be unable to leave daily worries alone and many are ashamed of their fear.

My take on this may be a bit different. I believe God has given us all our emotions. I cannot tell you where fear would fit in before the fall of man but certainly the adrenaline rush and “fight or flight” reaction it can produce is not in and of itself an evil thing. God does not tell us to be ashamed of our fear. He asks us to understand we have reason to boldly face the things that make us anxious through his power.

The passage that caught my attention says that we have not been given a spirit of timidity but of power. We are not slaves but adopted sons and daughters and can call “Abba” or “daddy”. I bet I had read or heard that passage dozens of times but it struck me today that an orphan wandering in the world faced with a fearful situation will likely cry and dispair. A son or daugher yells “DADDY!” fully expecting the rescue, the comfort and the support of the father. The Spirit we are given is His Holly Spirit within us. This certainly is not a spirit of timidity and we can cry out for Abba to come and be with us in our time of deepest anxiety.
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Are You Confused Yet?

This past week the British Medical Journal (BMJ) published three very interesting articles related to Type 2 diabetes. This is the most common type of diabetes seen in the world and is the one linked with central obesity and diet. You see, over the past decade there has been a wealth of new medications including new types of insulin that have come on the market enhancing our ability to bring sugars closer to normal in most patients. Many folks are now on several drugs and may be on drugs and insulin. They also are monitoring their sugars multiple times per day to be more aware of their control.

Much of the reasoning behind the desire to tightly control Type 2 diabetics was extrapolated from research on the other type of diabetes, Type 1 diabetes. In this form the body’s insulin production is impaired, often after a viral or autoimmune or other insult to the pancreas. The result is generally patients who absolutely need insulin to live. What was discovered years ago was that the rate of development of renal failure, blindness and other complications was slowed dramatically by tightly controlling sugars. Since these people needed insulin, you started to see testing with each meal and in between meals to help them decide how much insulin to use. Because of the pain with testing, new meters emerged that required less blood and caused less pain.

It was thought that diabetes was diabetes and if tight control was good for one type then it must be good for another. The results are not so clear cut. Certainly, it is a patient’s best interest to not have remarkably high sugars or wild fluctuations. It is also good for them not to have hypoglycemia and pass out. It’s the rest that is the trouble. Should we shoot for perfect sugars? If so it would require a lot of testing and more medications.

Enter coroprate America who was only too happy to settle the question.....if it gets paid for it should be done. We now have organizations that aggressively market to patients who have diabetes offering to supply their testing materials delivered to their door with no hassle. As a doc I get the “request” from these companies to test. They are only too happy to send out more supplies regularly (even if the old ones are not used up) and to provide reqular upgrades, batteries, reagents and even blood tests normally done at a doctor’s office. All of this is for the patient’s convenience AND to help with their control. And of course now patients are testing so much that they become afraid or ashamed of the results and request more medications to control them “to normal”.

Back to the BMJ. Three articles: the first was looking at whether it was cost effective to detect diabetics or prediabetics so interventions including diet, exercise, education and medication could be initiated: This one was simple....it was cost effective to find the prediabetics and diabetics so we could intervene mostly with non-drug methods. The second and third articles looked at the cost effectiveness and other outcomes of having patients monitor aggressively their sugars at home rather than seeing a doctor episodically and having adjustments to medications made at that time. (You seen in Great Britain they have BUDGETS for their health care and they want to know if they are spending the money wisely or not).
What they found was that aggressive monitoring by the patient was NOT cost effective, DID NOT result in better control but DID result in a LOWER QUALITY OF LIFE ASSESSMENT SCORE and HIGHER scores for depression!

Their editors questioned the value of aggressive home testing for the majority of Type 2 Diabetic patients and rightfully so. Makes you wonder why we are pushing so hard.
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