On Becoming a Cubmaster

I have the opportunity to assist the local Cub Scout Pack 725 as the new Cubmaster.  In the initial training, I am learning about not only how to be the Cubmaster, but also about the purposes of Cub Scouting.

In the first lessons, I learned the ten purposes of Cub Scouting, and I plan to publish a series of articles in the local newspaper on each of the purposes.  This is part of a year round recruitment plan to increase the number of boys in the Pack, and to increase the families' involvement to keep Cub Scouting simple and make it fun.

The ten purposes of Cub Scouting are:

1.  Character Development
2.  Respectful Relationship
3.  Spiritual Growth
4.  Personal Achievement
5.  Good Citizenship
6.  Friendly Service
7.  Sportsmanship and Fitness
8.  Fun and Adventure
9.  Family Understanding
10.  Preparation for Boy Scouts

For each purpose, I will write a small article and anecdote to be published in the local newspaper.  This allows those reading to know and understand what Cub Scouting is, and to learn the knowledge we teach boys, will set a great foundation for future adventures.

Hearts Afire

This is my first novel's title.  A historical fiction, the year is 1780, during the early rebellion period of the India Independence Movement, as two people come together, as different as night and day, yet link their souls for eternity.

Kuyili, the army commander of Queen Rani Velu Nachiyar, over a 3 day span, experiences all life has to give, and then gives all.  This legend is a proud inspiration for all people of India, and brings to life the earliest female freedom warriors of documented history.  The brave warrior is well known as the woman who doused herself with oil and set herself on fire inside a British ammo depot to enable Queen Rani to win the battle and thus independence.

Jusi, freedom fighter for Kerala Raja's guerilla group, lost his heart and soul when he set eyes on Kuyili, and the fight for both India's freedom from the British East India Company and for Kuyili's heart raged like fire in him.

Edumo from Morocco and Cresh from Tunisia antagonize our hero and heroine as both worlds collide into the emotional maelstrom provoked by the energizing nationalist pride of India and the Colonial Imperialism and oppression of Britain.

Being an insufferable romantic, I am motivated by many brilliant authors.  Bringing my love for history, music, poems, and romance together in one novel might just be the beginning of a new chapter in my life.

American Sense and Sensibility

"These are times that try men's souls."  When Thomas Paine wrote those words during the winter of 1776 describing the hopelessness felt during the American Revolution, he ended it with the statement, "the harder the conflict, the more glorious the triumph," cementing therefore the sense and sensibility of Americans.

When Americans suffer, we cope.  The ways we cope are multiple, and varied.  Some take medicine, some get counseling, some utilize their hobbies or skills, yet we all are Americans.  Conflict in America today is the same as conflict since our country began.  Yet, take pride knowing that we all are sensitive about our rights--the freedom to pursue life, liberty, and happiness, to peacefully assemble, bear arms, speak, or write. 

One citizen's pursuit of happiness is that one citizen's right.  It may interfere with another citizen's pursuit of happiness, and that doesn't minimize either ideal.  Conflict will always be.  Centuries of conflict have molded many countries, boundaries, and religions, yet in any one lifetime, change is slow.  Our young republic is a testament against the civilizations that have lasted millennia.

America exists because the individual citizen is sovereign, the human body is sovereign.  As I lay my hands to examine each patient I treat, I remember this person is the reason we are America.  This government exists for the People, it consists of the People, and it administrates by the People.  Political rifts will forever exist, and our young republic will grow, mature, and our citizens will cope, because We the People.  We are America.

Tethered

Tethered to your soul,
My heart will always be,
As journeyed birds go,
Over mountains and sea.


When music drifts around,
Blessing the air with kisses,
You whisper a sweet sound,
Then joyful my heart is.


Justus Turner Peters MD
5/6/16

Making a Bucket List

I am going to start knocking things off my bucket list.  Foreign travel is high on the list of desires, and going to Italy as Team USA physician at the Tricolore Games in Italy started it all. 

I do want to hunt grouse, get a tailored suit on Savile Row, climb the Matterhorn, like every other man in the world, but I really need to get moving.

I am taking life by the horns right now.  The divorce knocked some reality into me, a real sense of mortality tested my soul.  Death is just as natural as life, and having been around it in the emergency room knocks some proverbial wherewithal into my life.

Life is short and can end quickly anytime, anywhere.  Carpe Diem, seize the day.  Kiss the girl, make love in the rain.  Ride my horse on a beach.  Ride my motorcycle to Sturgis.

Act in a play, sing in a show, dance on a stage, and smile all the while.  When can you perform?  Doing the French Taunter during Spamalot was the funnest time for me.  Dance with my daughter in a talent show.

Dress yourself up, ignore fashion code, learn an instrument, read the Bible.  Be true to yourself.

Going to China and Spain this year makes me very happy, and it is about damn time.  I am 40 years old, and I want to see the world.  Now it is time.

Night Sweats for a Year

Having mystery medical cases prompted fascination with me as long as I can remember.  One of the more recent mysteries involves a symptom as baffling as it is vague.

A middle aged man with history of diabetes, hypercholesterolemia, and hypertension came to me with complaints of night sweats nearly every night that is bothering him.  He reports it is consistent and chronic, happening for past year.  He denied fevers, but had intermittent chills, but the main thing is that he would nearly soak his bed sheets every night.

Night sweats can point to a number of problems, but the number one major issue is that the immune system is "revved up" for some reason.  The immune system is like the police force of the human body.  It is constantly trying to keep the body calm, therefore it fights infections or inflammation, cancers, or foreign objects--much like keeping society from rioting.

On examination, he had a chronic back pain in the middle of his back, but not to palpation.  He did have a mild discomfort with deep palpation in his epigastric region.  His lab findings showed slight elevation in liver enzymes.  I ordered the Liver ultrasound, and we found that he had a thickened gallbladder wall, cholecystitis, or inflamed gallbladder.

After he had it removed, his night sweats ceased, and he felt much better. 

This is a good example of not assuming "it's just hormones," when you have night sweats. 

Sometimes Doctors Forget how to treat Pain.

Pain treatment has been utilized multiple millennia ago.  Some of the written records can be found in stories such as Homers' Odyssey.

Homer wrote, "presently she cast a drug into the wine which they drink to lower all pain and anger and bring forgetfulness of every sorrow."

Opium has been written about as far back as 1500 BC in the Ebers Papyrus.  Chinese and Indian trade historical notations show Opium used to treat excessive crying in children, used with Hemlock to have a painless death, and treats anxiety, depression and mood disorders.

Opioids have a long history in the United States and has been relegated by the medical industry and the FDA for years.  As with any abuse of a relegated substance, problems arisen with opioid abuse has created a stigma--a barrier between doctor and patient.  The culture of pain relief is associated with psychological pathology, which sometimes decreased otherwise harmonius relations between patient and physician.

Most physicians now want to "turf" their pain patients to Pain management physicians because of the clamp down from the FDA and DEA on prescription abuse. 

The anti-pain med culture has spread to patients who have not experienced acute pain before, and are fearful of the side effects.  To them I reassure that true pain treatment doesn't make someone addicted to pain meds.  It seems those who don't have pain and use pain meds for the high, get addicted more easily.

But I have seen the vast improvement in the quality of life in an individual who suffers from chronic pain who utilizes pain meds appropriately.  I have seen the relief in hundreds of pain patients.  I hope doctors learn about the history of what physicians are, and what we do.  What we did best was treat pain.  Even in the current technological advancements of medicine, lets not forget how to treat pain.

A Rash of Spring Rashes?

Recently a rash of weird allergies have been taking place in Somervell and Hood County. People with very hyper-immune systems, mine included, have suffered from allergic or atopic dermatitis.



People with very hyper-immune systems who suffer from asthma or autoimmune disorders, usually have weird rashes on their skin for many reasons, and thus have aptly named "sensitive skin." 


Typically the best things to do generally are to make sure that you skip laundry detergents unless they are hypoallergenic, and have no dyes or perfumes.


Bathing in hot water really upsets the skin.  Try Lukewarm or even cool water.  The skin loves it.  Wearing cotton clothing is best for sensitive skin.



Medical treatment depends on how severe the rash is, and can include a combination of creams as well as medications. Conservative therapy with over-the-counter medications such as Cetirizine, or Loratadine, both are 2nd generation anti-histamine agents and don't cause sedation, is the first line mainstay.


Prescription oral medications such as Atarax or Hydroxyzine 25 mg by mouth every evening is commonly used.  It is way stronger than Benadryl and can stop the itching, but has a major side effect of sedation. 


Itching damages the skin almost to the point of disrupting the epithelial barrier.  If scratching to the point of bleeding occurs, it is vitally important to apply an antibiotic ointment to the wound and keep open areas covered with bandages.


Keep your your skin moist and out of the sunlight makes it healthy and happy.  Use a light moisturizer such as Laroche which has an SPF 15 rating.  Enjoy the Spring!

Words of Love I Wrote to My Ex-Wife when we were Married.

A Journey

 

She fills my waking moments,

With sweet honey tasting cherish.

She finds my heart with love,

 As wide as the seas above.

She goes further for me,

 Than endless eternity.

She makes my world go round,

 Than any being ever found.

 She gives me whole heartedly,

Her blessings to infinity.

She heals my lasting heart,

That from her I could never part.

She loves me endlessly,

As if today was the end of me.

She touches ever so soft,

To send my heart aloft,

She brings me soul to feed,

My desires, wants, and needs.

She hopes, and laughs, and cries,

 In times of love by and by.

 She longs for me each day,

 And loves anew in her sweet way.

She learns unselfishly,

And teaches the pride in me.

She sees me dear and strong,

 For me she eternally longs.

 She loves me and loves me,

So much it hurts thee,

And all I need is her,

 To cherish and love forever,

 And happiness I found to be,

The love of Donnette for me.

 

Justus Peters MD

 



A European Lunch is Relaxation

After spending time being Ft. Worth Sister Cities' Team USA physician for the recent Tricolore Games at Regio Emelia in Italy, I learned a bit about Italian culture that really is therapeutic.

All the stores close for 2-3 hours for lunch.  No shopping, no stress.  Just sit in the sun, drink a wine, and feel the breeze.  That is what I call living.  Enjoying the minutae of experience.  Rewarding yourself with quiet time.

Savoring food with each bite, and memorizing each sip of wine, watching people go by--all brings the body down to earth.  Stress hormones decrease.  The heart is happy.  Inevitably, the stomach becomes happy.

A happy gut, and a happy heart make a happy mind.  A mind that is relaxed can then focus better.  A happy mind can change the body.  It is amazing what the mind can do for the body.  But right now, I am just going to sit on the porch at my house on top of the hill with a great view, and enjoy an Italian Cabernet.

Treating Anxiety without Drugs

Having grown up with a language disorder because of my hearing loss, I often developed some social anxiety during school.  My nail bitten fingers constantly yearned for manicures.

After graduating high school, and getting my first digital hearing aids, I quickly learned to deal with anxiety in other ways.  I started running in nursing school, and increased to marathon training, which gave me complete and total relaxation in all settings. 

As a medical doctor in the emergency room, I meet a lot of patients who suffer from PTSD, Stress Reaction, Anxiety disorder, and Major Depressive Disorder.  While it is easy to diagnose and treat these symptoms with medicine, I often overlook a more conservative approach to the treatment of these problems. 

A recent article in the American Family Physician noted a systemic review of 19 randomized controlled trials, (RCT [the best kind of research study]) showed that cognitive behavior therapy (CBT) or relaxation training, alone or in combination, can be used to treat anxiety in adults. 

The authors also found that music therapy reduced anxiety in older adults.  This is a very good thing.  It is wise to focus on some conservative therapy prior to initiating medical treatment for a wide variety of illnesses.  I am excited to add this regimen to my management of these patients. 

Greatest Thing Since Sliced Bread

I have been doing Emergency Medicine full time since August of last year.  This has enabled me to do two things. 

One is to be a better father to my kids.  Before in clinic, I didn't see my kids much, didn't eat lunch with them, took them on Daddy dates sparsely, and effectively helped ruin my marriage.  Now I have full days and multiple days off where I can learn to be someone else. 

If I want to learn a dance or song and play piano, I can do it.  If I want to read a book, I can finish it.  I am laid back now, and feel like I have some time to do things that make myself happy. 

I can belt out some scary lyrics on the Karaoke machine to the delight of my kids who somehow amazingly still think I am the greatest thing since sliced bread.  And this has enabled me to do another thing. 

Be comfortable in myself.  This is important for I have fallen victim to feeling persecuted all my life while trying to impress other people, to win favor with other people, or to "get ahead."  My personal journey has led me here, and now I think I can cruise into my more mature years with a light heart.

I wish this for everyone, that you have a light heart.  Be well, healthy and safe!

 

Single Daddisms

I could have made pasta without sauce as this is what my kids like. I don't know why I felt guilty thinking about making  some easy peanut butter and jelly sandwiches for them. Those peanut butter and jelly sandwiches were nearly my only source of protein during med school. 

But instead I took easy way out- picked up the phone and called Simple Simon's Pizza as they have never failed me.

The kids have spent all day hijacking the television and 99% of the house while I was in the office taking care of business, paying bills, researching, organizing, etc.  where did they get all the energy? And it's like their bodies absorb atmospheric adrenaline. 

I go check on them every 30 minutes to remind them to drink water because they can dehydrate so easily. 

And after dinner when it is my turn to be entertained and I go for history channel documentaries.  Safe, boring, and a natural sedative for these adrenaline soaked eyeballs of my children, These documentaries never fail me.

After a brief psychological battle with the kids regarding the remote control and ending with my victory I search Netflix channels for my favorite entertainment. 

Both kids crawl onto my lap and promptly fell asleep. It reminds me of reading Robbins Pathology textbook and easily falling asleep at midnight while in med school. 

Nevada Academy of Family Physicians Summer CME

I will be attending the Nevada Academy of Family Physicians Summer CME meeting in Las Vegas this week.  Looking forward to some school, after a long year and a half of no vacation.  Have to get my Board Certification requirements updated. 

Saying Goodbye

Ending of practice is complicated. I don't want to leave my patients without good care, yet I want to be with my patients. I want to have more time with my children, yet I feel like I have betrayed my patients.  In the seemingly never ending circle of guilt in my mind, I decided to write a letter to my CEO. 

June 5, 2015

To my beloved patients and staff of GRMC

One of my favorite authors, Ralph Waldo Emerson wrote, “Do not be too timid and squeamish about your actions.  All life is an experiment.  The more experiments you make the better.  What if they are a little coarse, and you may get your coat soiled or torn?  What if you do fail, and get fairly rolled in the dirt once or twice?  Up again; you shall never be afraid of a tumble.”

My divorce has taken a tremendous toll on my spirit.  Affecting my childrens’ little spirits, this toll is more than I can physically bear.  The torment in their eyes when Daddy leaves, has no discrimination against the multitude of tortures it forces onto my heart.  When at the end of every visit, thoughts of betraying my children plague my soul deeply, I plead for mercy from God, freedom from heartache, rest and peace. 

I feel as if the Lord has opened my eyes to the correct journey now.  Although I am in a wonderful place already, surrounded by the most wonderful people on God’s green earth, my patients and staff, and all those who are entrusted to care, I have a new journey.  I must fulfill the obligations of being a responsible father and man.  I have enjoyed intensely, every one of you who believed in me, and trusted me with your care.  Those of you who knew what I was going through gave me strength and support I will never forget.  You, who gave me shelter and food during the darkest times of my life, I am forever indebted to. 

I plan to focus my energies on being available to my babies, as they desire to be with me all the time.  Therefore, I have given Ray Reynolds, CEO of GRMC my 60 days- notice, and my last clinic day is 8/1/15.  This isn’t permanent, as I may very well return.  But only after a new office manager has been hired.  Please understand and keep me close to your hearts and prayers.  God bless you and keep you close.

Forever humbled,

Justus Turner Peters MD

 

Treating Pain

Sometimes physicians forget the power of medicine. I am happy that we have a variety of medications that can treat pain. And my patients are happy as well.   People have been treating their own pain since the beginning of mankind. They have been using all kinds of mixtures, poultices, herbs, and spells all for the sake of a quality of life. 

Fact tweeted, " @Fact: Marijuana is the oldest natural, purest, and healthiest pain relief medication in the world. It's use dates back to 10 B.C."

When it comes to side effects of some medications we would like to err on the side of safety. Pure natural plant products tend to have the least side effects. 

5 Ways to Prevent Meningitis

Meningitis sounds scary and bad, but if certain precautions are taken, it is very treatable and preventable. 

A recent outbreak of 7 students at Princeton, and 3 at University of California Santa Barbara by 2 different strains shows the importance of these steps.

1.  Practice good hygiene.  Wash your hands frequently.  Yeah, your hands might get dry, but put some lotion on them.  It beats an ER visit or even hospitalization.

2.  Get the Quadrivalent Meningoccal vaccine.  Although the strains of Meningitis in California were not covered by the vaccine, you get enough coverage with this vaccine.  It is indicated at ages 11-18 and recommended in all first year college students.

3.  Cough into your arm.  People are always coughing into their hands.  The human mouth is quite filthy, and putting the germs in your hands just allows them to proliferate on another person.

4.  Sneeze into your arm.  Again, rather than explosion of mouth germs into the air around you, it is much better to cover your mouth with the bend in your arm. 

5.  Rent an apartment away from a campus dormitory.  Totally neglects the full college experience.  It is ok, I did it and survived.

by Justus Peters MD

 

Is the Annual Physical Exam Really Important?

A study that compiled information from over 180,000 patients done in Denmark showed no improvement in longevity of life in those who went to annual exams versus those who only went when they had a problem.  On average, about 7% of people died in each group, suggesting there was no mortality benefit to getting annual exams.

This study is flawed on account that each group did end up seeing a physician at some time in their life.  One group just got diagnosed with high blood pressure and high cholesterol more. 

What the study should have been showing is what the difference is in those who do the annual exam, and those who NEVER see a physician.

I think there will be showing a benefit in mortality between the number of people who see a physician versus those who don't.

However, back to the study; the fact that both groups saw a physician suggests that healthy individuals who see a physician only when needed probably do not have higher co-morbidities, such as diabetes or high blood pressure.

So, the importance of the annual physical exam remains the standard of care for all individuals.  Finding that one melanoma on the skin could be the difference between life and death, just as seeing the one abnormal lead on an EKG, warns of pending heart troubles. 

Annual exams are important really for 3 main reasons:

1. Find cancer.  The annual Pap smear, mammogram, prostate exam and the colonoscopy are the best methods for preventive care in finding cancers.
2. Find Coronary Heart Disease.  Complaints of chest discomfort, tightness, decrease in exercise tolerance, shortness of breath all point to possible cardiac or pulmonary diseases which can be looked further into.
3. Find Chronic Diseases.  Finding Diabetes, Hypercholesterolemia, Autoimmune disorders, and Degenerative musculoskeletal disorders help physicians assist patients to improve their quality of life, and therefore their life expectancy.

I hope you all enjoy the articles.  Email me with any questions at runsinthewynd@gmail.com

What Causes a Thyroid Attack?

The thyroid, like all the organs in the body gets blood flow.  As an organ receives blood, it also receives hormones.  A thyroid attack is when the thyroid is delivered a substantial blow as to render it nonreactive, or even hyper-reactive.

Stressful events such as pregnancy and vaginal deliveries have been known to cause hypothyroid or acute thyroiditis.

Even stressful events such as motor vehicle accidents can render the thyroid hypo-reactive.

I like to tell my patients that the thyroid is a fragile reactive organ, thus environmentally challenged by what we do in our daily lives.

You may have a normal thyroid your entire life, until possibly even a heart attack.  That is enough stress to cause thyroiditis.

On annual exams, it is important to check the thyroid stimulating hormone (TSH), which is the hormone released from the brain to tell the thyroid to work.  It is also important to check the Free T3, and Free T4, which are the hormones released from the thyroid gland itself.

By feedback mechanism, the thyroid gland and the brain work in symbiosis, but when the thyroid gland is not working, the brain has to put out more TSH to fire up the thyroid gland.

This is called Hypothyroidism.  Even slight elevations in the TSH can be a sign of Subclinical hypothyroidism. 

Symptoms of hypothyroidism include fatigue, weight gain or loss, headaches, hair loss, abdominal bloating, palpitations, cold intolerance, among other symptoms.

Don’t hesitate to see a doctor if you believe you have symptoms of low thyroid. 

Until next time, be safe and healthy.

Why Can't I Sleep

Having been resident a few years ago, I can tell how poor sleep affects the body.  There are many reasons why you can't sleep.  But also many things can help as well with poor sleep.

Being unable to sleep, also known as “insomnia,” affects one in five individuals.   This is a very common  problem.  The risk factors include medical illnesses, mental  illnesses, stress,  night shiftwork or rotating shifts.

We don’t know why, but it affects women more often, and occurs more often in people over the age of 60.

There are different kinds of issues with sleep.  Issues most commonly experienced is simply falling or staying asleep.  Also if you have non-restorative sleep, where individuals wake up not feeling refreshed or having poor quality of sleep then you have daytime fatigue and sleepiness during the day. 

If you have difficulty concentrating and remembering changes, or moodiness, irritability,  anxiety, or depression, it can stem from poor sleep.  You might even experience reduced motivation and energy.

Doctors can help by ordering blood and urine test to evaluate for liver or  kidney issues,  even for chemical imbalances such as low magnesium. 

Keeping a sleep log to record your sleep habits and patterns over 1 to 2 weeks can help us detect which habits are bad. 

Finally, we can order a sleep study, called a polysomnography, which is overnight test that can diagnose problems such as sleep apnea.

We can treat insomnia with medications.  But it is important to use the bedroom for just sleep and intercourse.  Having a TV in the bedroom is the first thing that makes sleep poor.  Using relaxation techniques in bed helps as well. 

Lunesta and Ambien are two of the most commonly used sleep agents.  They are well tolerated.  I do not use Ambien in older age groups above 65, but Lunesta appears cleaner with less side effects. 

Until next time, stay healthy!