Through rain or snow or even more snow! (or...the Post Office has nothing on us!)

I have to say, when I woke up yesterday, the thought of a snow day took me back to those mornings when you can't wait to hear that you have the whole day to either look out the window at the snow or go out to play in it!


But...instead...I picked up Maja, Ashley, and Mallory (the M-3's rotating this month) and we set out for home visits in the snow.


Our first stop was to lend support to a woman with schizophrenia caring for her elderly mother who has lung cancer. She was outside shoveling when we pulled up and when we went in the house, her mother yelled at her because the path wasn't straight!!! That gave us a window into her stress level:) I think we managed to bring her stress level down a notch or two...she did have a good laugh seeing the 4 of us bail out of my vehicle clad in jeans, boots and winter gear instead of our traditional "white stuff."


Next, we checked on a gentleman who is trying to get his driver's license back after a bad head trauma several years ago (he was knocked off the back of a snow plow). He proudly took us into his basement to see the amazing model ships he has built over the years...one of which floated in a pond at the Mitchell park Domes for years! We did see how very frustrating it is for a previously capable man to be patient while regaining his skills to drive again (which may or may not happen...) I think he enjoyed having 4 pairs of listening ears!


Our last stop was a group home where we evaluated another patient who has had trouble settling into her new environment. We found her in good spirits and she had even gotten outside to make a snowball! (a big accomplishment if you know her...)


Overall, we were left feeling like we had accomplished quite a bit on our snowy day....never underestimate the power of a home visit to make someone feel worthwhile and cared about...

OB skills clinic a big hit!!!!

A few weeks ago, we held the second of our 4 planned skills clinics offered for MCW students featuring the fabulous teaching skills of our faculty and residents.

...I do have to mention that our dedication was most highlighted by the energy and muscle power needed to load the ultrasound machine in Dr. Izard's van while bystanders gawked and never offered a hand...needless to say, we never give up or back down from a challenge!!!!

The clinics have been well received and this one was focused on OB skills which included perineal laceration suturing, ultrasound, and measuring beautiful pregnant bellies and listening to heart tones. We have some wonderful patients that offered themselves to help the med students have this great and exciting experience (and our new professional friend Kathy, who lent her expertise teaching the ultrasounds).

The next topic in the New Year will be Domestic Violence and we have creative ideas to make this important topic another successful skills clinic.

Thanksgiving

As Dorothy said to Toto, "My, how things change so quickly around here!" Thanksgiving holiday is already upon us, and the Christmas blitz is already in the making. This weekend LaTonya and I went to a program for the Safe Schools Initiative at New Testament Central City Church. I got the chance to update the parents on immunization requirements, and to we spend quite a bit of time discussing and dispelling myths about H1N1 influenza. It is a "Healthy People 2010" goal that at least 90% of American children will have their primary immunizations completed by age 3. The state of Wisconsin has come close to reaching this goal, but it is hampered by the City of Milwaukee, where only 64% of kids have done so. It never ceases to amaze me the level of disparity we still see in Milwaukee. But it also reminds me of how much for which we have to be thankful. With all the problems we have, things are MUCH better here than they are in most of the world.



This morning my Community Medicine student I spend 0ver an hour with a patient discussing her social situation, the choices she has made, and how it affects her present health predicament. And without make excuses for bad choices, I have to acknowledge that there are SOOO many obsticles in her way. Her parents died when she was young, and so she and her siblings were raised by her older sister. She and her extended family are living off of 2 disabilty checks. She is addicted to her pain medications. Their environment is unsafe (she was raped in her home by her sister's drug-dealing boyfriend several months ago). They presently have NO electricty (her outstanding electric bill is $4000, and her sister's is $10000). They have no car, and usually do not have a telephone. Today I had to explain to her how her pulmonary hypertension is so bad that she probably has only several months to live. Maybe this time can be extended if she quits smoking. Even more importanly, maybe she can make her world better if she takes control of her life. Of course her problems are so insurmountable that she needs a whole different outlook on the world, that only comes by a complete psycho-spiritual regeneration. But I can only hope...



Anyway, make sure that you thank God as you engorge yourself with food this Thursday, and map out your plan for Black Friday deals. Thank God tonight its them instead of you.

Dr. Izard

GOOD SOLID ADVICE!!!!

Was just laughing to myself.... We were out at Clara Barton for our food tasting which is a part of the "FAN" club (Fitness and Nutrition). After sharing and tasting different things like pomegranate, papaya, spinach, organic cookies, and vegetable chips, I told the kids that Dr. Mike was kind of nervous because he had a BIG test (Step 3) on Wednesday. I wanted to know if any of the third graders had some words of advice for him...

A little boy very earnestly waved his hand and said, "Dr. Mike, be sure to read all of the questions carefully." The next young man, equally as eager to share his wisdom said, "Do your best." Last to speak up, another young boy added, "Just think positive!"

The genuine looks on their faces when they gifted these precious pieces of advice to Dr. Mike helped us understand that they were sharing these ideas as if they were some new found secrets to impart on their Dr. friend....

Truly priceless:)

What...it's November?????

October was SO full of "happenings" it literally flew right by!!! Much time was spent out in partner schools teaching topics including sickle cell anemia, safe boundaries (good touch, bad touch), nutrition, substance abuse, and sexual health.

I was so fortunate to have 2 excellent M-3s from MCW to teach with me for the month. We demonstrated a "pharm" party at Vincent HS passing out Dixie cups of colored candy from a large bowl which represents all the prescription drugs kids might collect from their homes to bring to a party. The students got to see the different combinations that each one had, but Chip and Mark also addressed the different effects medications can have on different people. Then, they didn't know we had mixed in 3 odd colored candies and when we asked who had those particular ones, we announced that sadly, they would have died....

That was pretty heavy but made an important point...on a lighter note (for an equally important topic) we took turns letting the students try to walk a straight line with the drunk driving goggles. We even had the real set of pig lungs from the American Lung Association to set up our discussion of smoking.

We fit home visits in with the health education and visited a patient struggling to take care of her mother who has lung cancer while managing her own schizophrenia. We also visited one of my favorite patients, an elderly woman with the weight of the world (and all her dysfunctional relatives) on her shoulders. The next day she called to tell me our visit had made her day and lifted her spirits commenting that she had bragged to her friends at her senior citizen group that "nurse Jenny brought 2 cute young med students over and they listened to all her troubles."

October also brought the first time that Dr. Izard and I got to visit a school together. We did a session of "Ask the Doctor" for a room full of teen girls at the Silver Spring school. They asked great questions about everything ranging from swine flu to the old favorite...sex...

The month ended with a new experience at the Hmong center for women where I was asked to speak about nutrition. They were part of a group of women who have experienced domestic violence and their bravery, resilience and strength was truly inspiring.

...wonder what November holds??? I will meet 2 new mcw students tomorrow AM and we will venture out on 3 home visits. I have so lucky to have LaTonya (an M4) doing a Community Medicine elective this month and her enthusiasm has already pumped me up for another month of new experiences!

"Ask the Doctor" goes back to school...

This week took us back to one of our partner schools:Clara Barton Elementary. One of the residents and 3 MCW students assisted me in the kick-off of the ever popular "Ask the Doctor" program. We visited 8 classrooms of grades 3-5 and answered any question on the minds of the kids ranging from "Why did you want to be a doctor?" to "What is sickle cell trait?"

The first of our bi-monthly visits is "open topic" and starting next time. we have pre-determined topics like asthma, cancer, nutrition, or bullying....just to name a few. The doctors like the chance to transfer their information to appropriate levels for different age groups. The students shriek with delight when they see me with my "doctor friends" and we are usually greeted with tackles, hugs, and stories....stories that teach us what important things are on the minds of the average kid.

I can't help but think that all the contact with different residents from our clinic over the past 8 years has made a positive impact on how these students value their health...I do know it has made quite an impact on all of us!

All conditions are not created equal

Today, our visits took us to the home of a morbidly obese patient who has many mobility issues. When asked, she admitted the effects these difficulties have on her self esteem have led to daily anxiety and depression, often resulting in problems sleeping. After assessment of the home, we constructed an initial list of aids to improve the safety and usability of her surroundings (ie..walker, shower seat, raised toilet).

She also was very interested in seeking help from a therapist to regularly discuss the unique struggles she faces when out in public due to her obesity. This is a woman who wants to socialize like most everyone, but often ends up humiliated and isolated instead.

On our way back to the clinic we discussed the different perceptions that accompany various diagnoses in our society. Conditions like mental illness or morbid obesity often carry very negative stereotypes that can impair access to care unless we continually remind ourselves that most of our patients want the same thing: to feel better...

I thank this woman for reminding me to look at the person underneath the diagnosis.

The adventures of Nurse Jenny:)

Another busy community day "out and about." I'm fortunate to have another MCW M4 student doing a Community Medicine elective in September.

Shawn and I agreed that our home visit with a diabetic patient was the highlight of the day. Diabetic teaching is so much easier when the patient's food choices are within reach in their own kitchen. We were able to teach basic label reading skills using her own foods and having quite a few laughs in the process. "What, juice has sugar? I have apple jc, orange jc, cranberry jc and grape jc!!!"

Our rule about that: Pick the fruit and NOT the juice!"

We left with garden tomatoes, hugs and a lady that knows to look for "Total Carbohydrates" on her food labels!!

This week has brought many new and interesting experiences...

Bonnie (doing M4 elective MCW) and I did 1:1 childbirth educ with a 16 yr old "mom-to-be," visited St. Francis several times to stay involved in finding group home placement for one of our pts with complicated mental illness, and took our new nutrition "toys" to teach 4/5 year olds the importance of eating healthy at a local school.

Tomorrow...more home visits ending with a delightful 80-something woman who says she feels like she's "falling apart" and needs some advice from us:)

Oh...one of the week's highlights was teaching a Somali breastfeeding class with the help of our interpreter on site at a day care center where the women are employed.

Had great time talking with teen girls Friday at AJA group home. Dr. Bonnie and I are going back tomorrow...wonder what questions they will have for us???? Made them "puppy chow" since they never get anything homeade:)

Sex and guys are the hottest topics!!! Who could have guessed?

July , 2009. St. Joseph Family Medicine Residency welcomes its new intern residents.

MOST RECENT H1N1 FLU UPDATE

Click here to see the most recent information on the flu epidemic.

Swine Flu Update

It appears that Swine Flu has hit Milwaukee. There are now at least 2 likely cases in the Milwaukee area, and many more suspected. As a result, the Milwaukee Health Commissioner has recommending closing 4 schools (Riverside University High School, Mitchell Street School, Clement Avenue School, and Rogers Street Academy).

Nationwide, there has now been one death associated with Swine Flu-- an infant. The World health organization has raised the Threat level to 5 out of 6-- indicating that a pandemic is immanent.

Your best advice for getting through this period of concern is

• Wash your hands frequently-- either with soap and water, or with antibacterial gel.
  
• Avoid contact with sick individuals.
  
• Begin to Make plans for what you will do if your child's school or daycare closes.
• If you do develop symptoms (see previous blog for description), STAY HOME. Call your health care provider EARLY. There is medication which can lessen the severity and duration of your illness, but you have to get it as early to the onset of symptoms as possible.

Stay tuned for updates.

Pandemic Flu: A cause for concern?

Why all the concern about Pandemic Flu? Well, few of us are old enough to remember the Influenza epidemic from September 1917 through June 1918, which killed 675,000 Americans (a number far greater than the total number of Americans who died in World War I, World War II, Korean War, and Vietnam Wars COMBINED). With few exceptions, "the Flu" has become an inconvenience for most people, causing us to miss work or school for a few days. Even so, the CDC estimates that about 36,000 Americans die of flu related illness every year.

Fortunately, one of the things which helps to defend people against a dangerous, germ infested world is the fact that animal infections, generally, tend keep to their specific species, and human specific viruses stick to humans. This means pig viruses infect only other pigs, and human viruses infect only humans. Furthermore, we are protected from developing life-threatening Flu infections every year because our immune system is already partial immunized against Influenza, from previous exposure. However, every now and then, a rogue virus, such as influenza, mutates, and acquires the ability to infect human beings as well as their natural host (e.g. pigs [swine] or birds [avia]). And when this happens NO ONE has immunity to this new virus.

What appears to have happened with this new Mexican Swine Flu is that an Influenza virus that previously infected only pigs, mutated, and now has the ability to infect human beings. Influenza is generally highly contagious. Typically flu viruses spread from one person to another via respiratory droplets (a sneeze or cough), or more likely, though touching an infected object such as a hand or doorknob, and then your own nose, mouth, or eyes. That being the case, people get infected from other infected people, not from touching or eating infected pork.

One difference with this type of Flu from the ones we normally see from year to year, is that this Flu seems to attack young healthy people, not just the very young, very old, and the sick. It is also striking that this infection is appearing later than the normal Flu season. At the time of writing, about 149 flu-related deaths have be limited to Mexico, with about 2000 people being hospitalized. Thus far, the few suspected US cases have not been deadly. There have been no confirmed cases in Milwaukee. As you can imagine, with an illness as common as the flu, it is difficult to get accurate numbers. This infection is often referred to a "pandemic" because it has the potential to spread across the whole world, but it is important to note that at this time the numbers of deaths are small; FAR smaller that those seen in a normal flu season, so there is no need for panic.

What are the symptoms of influenza? A sudden onset respiratory infection, with a fever (greater than 100.5 degrees F), and severe body aches and/or headache. You might also have a cough, sore throat, or diarrhea/vomiting. If you develop theses symptoms, contact your health care provider by telephone. Sometimes it is better for someone to screen your symptoms over the phone rather than come in and infect an entire waiting room. Your provider will probably want to get a viral culture at this early stage to confirm the presence of Swine Flu. Your provider might also want to prescibe a medication called Tamiflu, or Relenza. If you are sick, stay home from work or school.

How do you protect yourself from getting infected? First, and most importantly, wash your hands frequently. You might want to invest in a portable hand gel sanitizer. Avoid rubbing your eyes or nose. Also, keep away from sick individuals. Wearing face masks is probably over-kill unless you are in close contact with someone infected. It has also been suggested that masks potentially trap and collect the virus, causing you to inadvertantly carry it around with you.

For further information about this Swine Flu outbreak, follow this link to the City of Milwaukee Health Department.
Also see the community resources links below to contact the Centers for Disease Control (CDC).

Welcome Wisconsin BadgerCare Plus Core

As of January 1, 2009, the Milwaukee County General Assistance Medical Program (GAMP) ceased to exist. Its directive, to provide medical care to the indigent in Milwaukee County, was taken over the State of Wisconsin, as its patients were folded into the BadgerCare Plus Core program (also known as the "BadgerCare Plus Core Plan for Childless Adults", or more accurately, the "BadgerCare Core Plan for Adults without Dependent Children". In fact, these former GAMP recipients became the pilots for this new program.

BadgerCare came about in 1999, in the midst of the dismantling of the Wisconsin welfare system. When Governor Tommy Thompson moved to eliminate welfare in deference to the W2 (Wisconsin to Work) program, critics bemoaned that low income residents would be forced to work low end jobs lacking health care benefits, a position worse that that already provided by the state's medicaid program (Aid to Families with Dependent Children). In response, the BadgerCare program was to developed to cover low income residents WITH DEPENDENT CHILDREN whose jobs did not offer affordable health insurance. Those without dependent children were out of luck.

The BadgerCare Core program expands upon that program by extending limited to low income families WITHOUT DEPENDENT CHILDREN, the largest demographic of people previously covered by GAMP in Milwaukee county. In essence, this provides a GAMP-type safetynet program for the rest of the state, at or below 200% of the Federal Poverty Level. It is expected that the program will open to the rest of the sate July 1, 2009. (Follow link for enrollment requirements: badgercareplus.org/fpl.htm)

One noteworthy feature of the new program is that it covers both preventive and sick care. In fact, patients will be required to have an annual preventive care exam. The program will also cover prescription medictions, BUT ONLY GENERICS, with rare exception, for up to $5 per prescription, or total of $20 for all prescrions from a single provider. Furthermore, participates will be required to enroll in a state contracted HMO to manage services.

Follow the link to enroll in the BadgerCare Core Program online: access.wi.gov; or by phone at 1-800-291-2002.