Taking control of your health

Listened to a fascinating TedTalk that looks at how physicians can work together to better diagnose and treat patients, but also, how patients can take a more active role in their care.

Eric Dishman has endured more than a fair share of health issues, but when faced with a dire diagnosis, he decided to take some control. He sees the foundations of our current healthcare system as faulty, dependent on too much guesswork and patient passivity, but he also poses a potential solution. Eric believes that if the fundamentals of care are developed in three main ways: caregiver networking, the personal customization of care, and what he calls “care anywhere,” which translates to the constant availability and accessibility of health advice regarding basic care, that people can more fully understand and direct their healthcare.

Dishman’s idea isn’t that far from what my colleagues and I have been aiming for with the Hospice and Palliative Care Advisory Group. The more informed we are, the better our decisions, and if we need more information, if we want an educated but unbiased opinion, it ought to be available. In this digital age, it should never be that difficult to get.

Eric closed by introducing the crowd to the woman who donated a kidney and saved his life. For many, it won’t be one person or one surgery, but it will be about making decisions and understanding that we can have a hand in the outcome. To watch the TedTalk, click here. To read about the Hospice and Palliative Care Advisory Group, click here.

Thanks for reading.

-Dr. Joe


I recently watched a funny TedTalk that looked at how value is subjective, and perception is often more important than reality. The giver of the talk is “advertising guru,” Rory Sutherland, recorded in 2009, and may not be appropriate for all listeners, but his humorous delivery questions how we change human behaviors and perception, and how these things work together.

There are so many ways that our perception can be influenced, but often rather than rational, scientific reasoning, it’s by emotional response. This begs the question, how do we address important issues? Questions about health, about wellness, about our lives?

Rory’s final statement was a poignant answer, “When you place a value on things like health, love, sex and other things, and learn to place a material value on what you've previously discounted for being merely intangible, a thing not seen, you realize you're much, much wealthier than you ever imagined.” Really, isn’t that the bottom line? Watch the TedTalk Here.

Thanks for reading.

~Dr. Joe

A Helping Hand

You may have seen an AED, but not been sure what it is, or how it works. An AED is an "automated external defibrillator." It's the device used when someones heart goes into cardiac arrest which shocks it back into a normal rhythm. I recently ran across this funny video of first aid instructor Todd Scott, that explains it's safe use, and the humorous aspect will likely help people to remember...as long as your a Star Wars fan! Watch the video here. The transcript of the video is written out below. For help with Star Wars terms, go here.


"Last year, I got a chance to watch the new "Star Wars" movie, which was fantastic, but one thing kept bugging me. I don't know if you noticed this or not. In this entirely technically advanced world, I did not see a single AED anywhere, which was totally shocking -- almost as shocking as not knowing what an AED is, which you guys do know. But for those at home, an AED is an automated external defibrillator. It's the device you use when your heart goes into cardiac arrest to shock it back into a normal rhythm, or, as one of the guys I was teaching a class to referred to it as: "The shocky-hearty-box thing."

But I really can't blame the Empire, since health and safety regulations aren't really their first order of business. Though, even if we -- I think worse than not having an AED would be if there was one there, but just, no one knew where to find it. These devices can drastically increase your chance of survival -- almost like a tauntaun on Hoth.

But I'm pretty sure that stormtrooper is going to be toast, regardless if we have an AED or not, since what happens is the chest plate is going to be quite hard to get off, and like that tauntaun, the AED has a very short window of time at which it's highly effective. In this case -- basically, we've got to use it within the first 10 minutes.

The Jedi, on the other hand, have no problems with their outfits. Those robes open straight up, you can place the pads right onto the chest -- so upper-right-hand side of the chest, lower left, wait for the unit to determine if it's a shockable rhythm and get ready to shock. But, the Jedi do have a problem. They have a head appendage issue. And so I can be totally clear, thinking I'm ready to go, but I'm accidentally touching a tentacle and inadvertently shocking myself.

So before you hit that button, make sure you are clear and everyone else is clear.

Going back to that stormtrooper: If I did get that chest plate off in time, what would you do if you suddenly found there was a Wookiee under there, or possibly two Ewoks?

Well, lucky for us, in the kit there's actually a razor, and we can use that to shave the chest on the upper right-hand side and the lower left.

Wookiees also have another problem. They have an accessory issue. What we want to do is remove these -- anything between the two pads we want to remove, since it can cause something called "arcing." For those who don't know what arcing is, do you remember the Emperor, when he shoots electricity out the ends of his fingers --

that would be kind of like arcing. Another thing that -- Oh! By the way, he creates that by wearing wool socks under his robes.

We can also get arcing if we have an extremely wet chest. The electricity travels across the surface instead of through the heart. We can correct this with the immortal words of Douglas Adams: "Don't panic," which most of us have done today -- and also always having a towel. So, good words to go by.

The metal bikini -- unfortunately, this is where panic sets in -- like the modern bra, we have to make sure we remove, because this can cause severe arcing along with burns. But unfortunately this opens up an issue that's almost as controversial as talking about the prequels.

The mere mention of the word "nipples," and people get into a little bit of a tizzy. By the way, that is not a nipple, that's a cupcake.

Chances are, if you do have to use this, this is going to be on someone you know. And remember, everyone has nipples, except for Jabba.

But he does love cupcakes. Speaking about Jabba, if we do have to use an AED on him, remember pad placement is the same, even though he doesn't have nipples. So it's going to be upper right-hand side, lower left. If we were going through, we're shocking, getting ready to go -- after we've done the shock, one of the things we need to do is remember to do compression. The preferred method is 30 compressions and two breaths in the center of the chest, between the nipples, pressing down at least two inches, no more than two and a half, at a rate of at least 100 beats a minute, no more than 120. Unfortunately, due to the size of Jabba's mouth and also what he puts in said mouth, we may not want to actually do the mouth-to-mouth part. So instead, we can do compression-only CPR. The way of remembering the compression-only part is we can actually use the Imperial March.

I would sing it for you --

Unfortunately, that would be more something an interrogation droid would do.

Yoda. Small little guy, like a baby. What we do is basically treat him like a baby, in the sense that we're going to place one pad in the center of the chest and one in the back. If we place them both in the front, they can be too close and cause severe arcing, so we want to avoid that.

Hopefully, this helped to clarify and put some light on some of the darker issues of using an AED in the Star Wars universe, or any universe in total.

I'll leave you with one point. Remember, if you do find yourself dealing with a Wookiee, do not shave the entire Wookiee. This takes way too much time, and it only pisses them off."

Thanks for reading.

~Dr. Joe

Now What?

After recent events, many of us are left considering what to do, or how to deal with these tragic situations. An article in TIME said, " One wonders if it's possible for us to expand our hearts and minds to embrace this level of hurt and destruction--a trail of stricken families and communities that stretches from the Gulf to the Atlantic and parts in between. It must be said that the trail of kindness and courage reaches just as far. But I worry that our capacity for empathy has been worn thin and that our attention spans are now so tweet-size that we won't be able to focus long enough on any one of these tragedies to provide long-term help."

I think there is much we can and should do, both for others and ourselves. To get an idea of where to start, I recommend this article in The New York Times, which details how you can go about choosing where to donate. I also found this article in Vox interesting. It addresses how different faith leaders address tragedy. The TIME article offered this in the end, " Maybe the answer is for each of us to choose one thing to fix and not let go. Take a tiny piece of a larger disaster and make it your responsibility, whether it means agitating for funding in Washington or sending a holiday package to a child who lost their home or a parent who lost their child. And not just this year, but next year too and the year after. Because that's what it's going to take to heal a nation." I'd say that's a good place to start. To read that piece in full, click here.

Thanks for reading.
-Dr. Joe

Coping with tragedy

Dr. Joe is actually in Las Vegas today. He is safe,  but we thought it would be a good time to share this information from the University of Wisconsin. You can download the PDF version here.

What You May Experience & How to Cope

Immediate Reactions: There are a wide variety of positive and negative reactions that survivors can experience during and immediately after a crisis, disaster, trauma or loss. These include:

Positive Responses  

Determination and resolve, sharper perception, courage, optimism, faith

Feeling involved, challenged, mobilized

Social connectedness, altruistic helping behaviors

Alertness, readiness to respond, increased energy

Increased desire for spiritual community, greater feelings of connection to and trust of God/religion/higher power

Negative Responses  

Confusion, disorientation, worry, intrusive thoughts and images, flashbacks, self-blame, difficulty concentrating, difficulty making decisions or problem solving, slowed thinking, nightmares

Shock, sorrow, grief, sadness, fear, anger, numb, irritability, guilt and shame, anxiety, feeling abandoned, feeling overwhelmed, emotional outbursts

Extreme withdrawal, interpersonal conflict, dissociation, inability to rest/relax

Fatigue, headache, muscle tension, stomachache, increased heart rate, exaggerated startle response, difficulties sleeping, loss of appetite

Anger at God/religion/higher power, desire to disassociate from God/religion/higher power, excessive focus on religious blaming or justifying

Common negative reactions that may continue include:  

 Intrusive reactions  

•       Distressing thoughts or images of the event while awake or dreaming 

•       Upsetting emotional or physical reactions to reminders of the experience

•       Feeling like the experience is happening all over again (“flashback”) 

 Avoidance and withdrawal reactions  

•       Avoid talking, thinking, and having feelings about the traumatic event 

•       Avoid reminders of the event (places and people connected to what happened) 

•       Restricted emotions; feeling numb 

•       Feelings of detachment and estrangement from others; social withdrawal 

•       Loss of interest in usually pleasurable activities 

 Physical arousal reactions  

•       Constantly being "on the lookout" for danger, startling easily, or being jumpy 

•       Irritability or outbursts of anger, feeling "on edge" 

•       Difficulty falling or staying asleep, problems concentrating or paying attention 

 Reactions to trauma and loss reminders  

•       Reactions to places, people, sights, sounds, smells, and feelings that are reminders of the traumatic event

•       Reminders can bring on distressing mental images, thoughts, and emotional/physical reactions 

•       Common examples include: sudden loud noises, sirens, locations where the incident occurred, seeing people with disabilities, funerals, anniversaries of the traumatic event, and television/radio news about the event

Positive changes in priorities, worldview, and expectations

•       Enhanced appreciation that family and friends are precious and important 

•       Meeting the challenge of addressing difficulties (by taking positive action steps, changing the focus of thoughts, using humor, acceptance) 

•       Shifting expectations about what to expect from day to day and about what is considered a “good day” 

•       Shifting priorities to focus more on quality time with family or friends 

•       Increased commitment to self, family, friends, and spiritual/religious faith

When a Loved One Dies, Common Reactions Include:  

•       Feeling confused, numb, disbelief, bewildered, or lost

•       Feeling angry at the person who died or at people considered responsible for the death 

•       Strong physical reactions such as nausea, fatigue, shakiness, and muscle weakness 

•       Feeling guilty for still being alive 

•       Intense emotions such as extreme sadness, anger, or fear 

•       Increased risk for physical illness and injury 

•       Decreased productivity or difficulties making decisions 

•       Having thoughts about the person who died, even when you don’t want to 

•       Longing, missing, and wanting to search for the person who died 

•       Children and adolescents are particularly likely to worry that they or a parent might die 

•       Children and adolescents may become anxious when separated from caregivers or other loved ones


Focusing on something practical that you can do right now to manage the situation better 

Using relaxation methods (breathing exercises, meditation, calming self-talk, soothing music) 

Accept some negative feelings as normal

Exercising in moderation 

Participating in a support group 

Keeping a journal 

Seeking counseling 

Praying and tending to spiritual/religious faith

Talking to another person for support or spending time with others 

Engaging in positive distracting activities (sports, hobbies, reading) 

Getting adequate rest and eating healthy meals 

Trying to maintain a normal schedule 

Scheduling pleasant activities 

Taking breaks 

Reminiscing about a loved one who has died 

Attending religious services


Working too much 

Violence or conflict 

Doing risky things (driving recklessly, substance abuse, not taking adequate precautions)

Blaming others

Excessive TV or computer games

Not taking care of yourself 

Using alcohol or drugs to cope

Extreme withdrawal from family or friends 

Withdrawing from pleasant activities

Overeating or failing to eat


Extreme avoidance of thinking or talking about the event or a death of a loved one


Take care of yourself. And each other.

-From all of us at HAPCAG