High-tech Care with Old-Fashioned Values

New Beginnings

Well, this has certainly been a very hectic/chaotic few weeks! As most of you know we have ended our financial relationship with East TN Health Centers and the sponsoring hospital Lakeway Regional Hospital in Morristown. It was a good time for me to take a bit more control over the practice again. Healthcare is in great flux and for those of us that are not "business first" many of the changes can be distasteful. I still hold out the hope that I am a health advisor, coach, cheerleader and partner with patients and their families. Most doctors feel the same way but financial pressures mold the way we practice.

During this transition it has not always been smooth and I am sorry for that. Under my contract I could not solicit patients away from the practice and I tried to honor that arrangement. I also contractually was not able to give more warning to patients about the changes and that has caused hardship and confusion for which I am sorry. Let's just say we are starting again and I hope to win your trust. With new paint, furnishings and phone numbers we all have a bit of adjusting to do. I told one friend that a cliff can hold a thrilling ride or a devastating fall on the other side so it will not be boring. Until things are settled I hope you will continue to use this site, my cell phone and the Facebook site
AskDrJim to follow and ask questions. Let us know how we are doing and HANG ON FOR THE RIDE!

iPad therefore I am

Yes, I am an early adopter of technology. Not to the degree I would like to be. I pour over tech sites to look for the latest gadgets. Recently I purchased an iPad. I must explain I never was entirely a PC guy. I always toyed with other models (Commodore Amiga's in the past and Mac's in the present). I was nearly in the Amazon store purchasing a Kindle when the rumors started flying about some type of Apple product. So I waited. Late winter came and the announcement of the iPad was streaming online while I watched Steve Jobs put it through the paces and the announcment. Then April came but I waited to see one in the Apple Store in Knoxville. Finally, I got a 3G version about a month ago. All I can say is I think tablets will change the way we seen computers. They always were intended to be more that tethered keyboards (remember Star Trek anyone?). This thing is amazing with one very large caution.....there is very little medical content of worth.....YET. I see the possibilities here of holding in my hand most of my books I reference weekly, my CME courses, my applications for educating patients and my conduit to the electronic medical record in my office. It is a way to communicate with patient's and specialists, a way to market and research, a way to think about problems and a way to interact with an ever changing world of medical information. I am excited.

When all is crumbling around

It is hard not to see all the chaos out in the world and wonder if there is any sense to it all. The gulf oil disaster may harm the coastal marshes for generations. The North Korean chest thumping threatens to break into a major conflict. The ongoing violence in the name of religion or country seems never to slow. It is difficult to see a quiet end. And that's the point. I believe the world is spinning closer and closer to the type of violent climax we all fear. I have friends who say "I've read the ending of the book and know how it turns out" and I would have to nod to that thought. But what if you were a character in the book. Would you know how it was going? It is a sad thing to see so much evil and hate in the world. Then I think of the movie that has my last name and the scene the director shot following a single little girl walking through the chaos. She was the only one that was shot in color with black and white all around. The idea the a remnant of good of purity of righteousness exists in spite of the chaos around is a metaphor of the hope people of faith hold to so tightly. God is there in the pain. Evil can only be understood if good exists as the marker unchanging. Hold tight to hope.

Flu, Flu and Flu

Well,the H1N1 is upon us in East TN. I thought I would put down some information that might give my take on the ever changing CDC recommendations. First, this is a "novel" H1N1 Influenza A virus. It's genetic makeup resembles viruses from the 1950's and after that they presumably jumped in the hog population living there for 50 years before re-emerging in this past year. Generally flu viruses change over time and occassionally they will have a major genetic shift. Whenever that happens any potential immunity developed from previous years is non-existant and larger numbers of people are prone to getting infected. When a very different strain emerges this is especially true. This virus and variations of it have not been seen by folks less than 50 years old and therefore more young people will be getting ill.

We have known that influenza is especially spread by school children and efforts to immunize them in this country have been increased in the past several years. Generally seasonal influenza is riskier for people who are infirmed, elderly or immun-compromised with healthy kids not being particularly at risk for severe disease and death. The pandemic H1N1 seems to be affecting children group more seriously. Children under 3 years (especially unter 18 months), pregnant women (who's immune system is downregulated to prevent damage to the "parasite" in the womb) and the usual high risk groups are the most likely to get severe disease and even death.

Remember that death from influenza generally is a result of overwhelming pneumonias that developed during or shortly after people contract the flu. Aggressive use of antibiotics may help but people need to understand that the fever and cough of flu are not the fever and deeper cough of pneumonia. Sometimes this is hard to distiguish. See or call your doctor for help.

Early on we thought we would be using a lot of Tamiflu as we faced this deadly strain. However, with experience the CDC has urged more prudent use of the drug. As most people in low risk catagories are not getting very ill they have suggested using the drug for those who are hospitalized, caregivers of high risk persons or housemates of high risk persons. The drug will decrease the illness by about 1/2 day and contagiousness by about 1 day. It is not a wonderdrug.

Finally what to do with immunization. First, the vaccine is safe. It is produced just like seasonal flu. If you are over 50 without high risk designation it is not recommeneded although will be used if someone insists. If you are in a high risk group it is recommended with some younger children needing a booster dose after the initial dose. In east TN where seasonal flu comes in late December through March I have suggested to my patients to try to get the H1N1 first and then get their seasonal flu shot. There is some theoretical benefit to getting the shots in that order and not the other way around. The nasal spray is live virus and you cannot take 2 nasal sprays at the same time. I would space nasal sprays by 1 month for maximum effect. The shots can theoretically be given without spacing but as I said above I would urge people to consider spacing the shots if they can. As usually call us for questions. AND WASH YOUR HANDS!

Faith and courage

I have not had the time or creative energy to do much writing of any sort lately. Winter does that for a doctor. There is lots of illness and work to be done but the days are short and by the time the day is over you have darkness. It's natural to start to feel down or deflated. My ability to be self-centered is boundless but at times God pulls me back to reality by showing me a glimpse of what he intends for us to experience as we walk in relationship with Him.

Last fall one of my brother's daughters was found to have a rare cancer in her abdomen. After a time of rapid evaluation and second opinions half way across the country, she was started on chemotherapy prior to what was possibly going to be a horrific surgery to try to save her life. The chemo and complications of it meant that her senior year in high school was to be very different that what she had thought it would be. A great athlete, she would have her basketball season cut short and her soccer season ended before one game.

Through it all she had a peace and faith that God was in charge and would use this event, awful as it seemed, to bring about great things. An outsider might say this was just innocence of youth or delusions of an old religion. That outsider would be wrong. Through her fight and her testimony she has touched literally thousands of people in her state and the love poured back on her and her family has been nothing short of astounding.

The day came last week for surgery and we all knew that this story was no longer one of cancer but of courage and great faith. When the surgeon opened her abdomen no new sites were found and those that had been there had been killed by the chemo. Now just a week after surgery she is eating some, walking and has been told she is cancer-free. Now this is all good stuff and worthy of great praise to God for His kindness and healing but my view was seeing a young woman, her family and her faith community coming together with love and support. As a result all who came into contact with them were blessed. To me that was the purpose and that was the miracle.

As a doctor I see the ravages of cancer but I also have seen how disease, especially cancer, can transform patients, families and communities. I have been blessed to witness such a transformation through my niece. Thank you Katie. Praise to our Great Father.