Smart Doc Resource Network

Food For Healthy Eating!

2012-01-25T11:02:00.000-08:00

Eggs: Average 6 gms of protein in egg and only 4 gms of fat and 30 calories. It is known to control your cravings all day! Hint: Protein does that!

Salad: Make and eat a good salad before your meal. Cut the pieces into small bite size morsals and look for a low fat dressing that you like. I like to dip my salad into my dressing. That way I get what I like on the bite!

Apples: An apple a day keeps the doctor away...Great Preventive Medicine Food. It has 3 gms of fiber and also pectin (which is know to stabilize blood sugar). So this is the perfect snack for the midafternoon cravings.

Green Tea: Did you ever see a fat Japanese person? They drink green tea daily. This speeds up metabolism and helps burn fat. Have a hot cup of green tea for breakfast instead of coffee. You'll get the hang of it soon and eventually wont miss the Joe!

Grapefruit: Remember the grapefruit (diet)? A study showed that if you ate even 1/2 of a grapefruit before meals (or drink the juice) - it increases metabolism and weight loss (and appetite). See Florida is good for something!

Lean Beef: We are back to the importance of protein. Remember the high protein diet (I loved that one! Steak all the time!) amino acids(aa) are necessary for body building (and muscles) so this goes go with the exercise routine that you just started - right? It has Leucine (an aa) that helps you lose weight without losing muscles.

Hey are you hungry? Lets go eat lunch!

Who wants to DIEt?

2012-01-25T10:28:00.000-08:00

The word diet always makes me SAD. (and depressed!) Its that time of the year that we punish ourselves for being overweight, out of shape, and not what we think we are supposed to be. Our self esteem has taken one last lick after Xmas (and the guilt of holiday meals) and now its time to suffer! How come we find ourselves in this situation every Jan.?

One reason is the media (and advertizing) but that is a soap box to mount some other time.

Perhaps we went in for our annual physical and were told to lose weight and exercise. Preventive Medicine - that is a good- and another conversation for another time.

So you have to ask yourself when we DIEt-
1. What are you doing?
2. What is the purpose?
3. Does this make you feel good ? (come on kids - be for real - diets feel good?)
4. Does this plan have sustainability and accountability for long term results?

Wikipedia defines dieting as the deliberate selection of food to control body weight or nutrient intake. How depressing can that be...socially we are taught food is good, we are rewarded for good behavior with a 'treat', we celebrate with food, we socialize with food. So therefore, to be without food, we are lonely, mis-bahaving bad creatures.

Is it easier to take DIET out of our vocabular than go for extensive psycho-couseling for the rest of your life! Besides we all know that diets do not work. There is no magic pill or potion, no instant machine or exercise and no 'one of a kind, start of the year diet product' that is going to work!
Do you ever see the ads on TV where someone lost 100lbs or even 20lbs in a month...it says in small writing 'this is not typical for this product.' Where do they get these people? Are they for real? Maybe some of them...but what I would like to see is that same person off that magic pill, or product - a year later, six months later, even three months after the thrill has gone and the hubby wants more twinkies.

The basic concept in healthy living is just that....healthy living. You are not going to lose 20 lbs in a month and perhaps will have to not plan going to the buffett bar after Church on Sunday, but in the long run...we all know the way to go...sensibly.

This just aint right...who do we blame for meth addiction?

2012-01-24T12:45:00.000-08:00

When a 23-year-old Fresno woman fatally shot her two toddlers and a cousin, critically wounded her husband, then turned the gun on herself last Sunday, investigators immediately suspected methamphetamine abuse in what otherwise was inexplicable carnage. It turned out the mother had videotaped herself smoking meth hours before the shooting.

In family photos, the children are adorable, the mother pretty. They lived in a large apartment complex near a freeway with neatly clipped lawns and mature trees. The father was recently laid off from a packing-house job.

"When you get this type of tragedy, it's not a surprise that drugs were involved," said Lt. Mark Salazar, the Fresno Police Department's homicide commander. "Meth has been a factor in other violent crimes."

A Bakersfield, Calif., mother was sentenced Tuesday for stabbing her newborn while in a meth rage. An Oklahoma woman drowned her baby in a washing machine in November. A New Mexico woman claiming to be God stabbed her son with a screwdriver last month, saying, "God wants him dead."

"Once people who are on meth become psychotic, they are very dangerous," said Dr. Alex Stalcup, who treated Haight Ashbury heroin users in the 1960s but now researches meth and works with addicts in the San Francisco Bay Area suburbs. "They're completely bonkers; they're nuts. We're talking about very extreme alterations of normal brain function. Once someone becomes triggered to violence, there aren't any limits or boundaries."

The Central Valley of California is a hub of the nation's methamphetamine distribution network, making extremely pure forms of the drug easily available locally. And law enforcement officials say widespread meth abuse is thought to be driving much of the crime in the vast farming region.

Chronic use of the harsh chemical compound known as speed or crank can lead to psychosis, which includes hearing voices and experiencing hallucinations.

The stimulant effect of meth is up to 50 times longer than cocaine, experts say, so users stay awake for days on end, impairing cognitive function and contributing to extreme paranoia.

"Your children and your spouse become your worst enemy, and you truly believe they are after you," said Bob Pennal, a recently retired meth investigator from the California Bureau of Narcotic Enforcement.

Meth's availability and its potential for abuse combine to create the biggest drug threat in the Central Valley, according to a new report from the U.S. Department of Justice's Drug Intelligence Center. From 2009 to 2010, methamphetamine busts in the Central Valley more than tripled to 1,094 kilograms, or more than 2,400 pounds, the report says.

Most law enforcement agencies don't keep statistics on how many homicides, burglaries and thefts are meth-related, but those responding to the National Drug Intelligence Center's 2011 survey said the drug is the top contributor to violent crimes and thefts.

Tips for Seniors with Diabetes

2012-01-24T04:52:00.000-08:00

Tips for Managing Diabetes

Diabetes is a lifelong, total-body problem. Manage your condition, and your overall health, effectively with these smart tips.

Monitor your blood-glucose levels every day
Some people resist checking their blood-sugar levels, but daily monitoring really is the only way to know if they are under control. Foods, activity level, medications, illness, and even stress can affect blood glucose. Unless you check, you might not know whether your levels are holding steady or spiraling out of control.

Take Medication as Directed
Diabetes symptoms are silent, so you may not notice an immediate repercussion when you neglect to take your medicine, and that means far too many people decide against taking prescribed medications (or forget to take them). Don't be one of them! Untreated diabetes carries the grave risks of heart disease, nerve damage, and other complications. Take medications or insulin as directed by your physician.

Patient Accountablity : This is the only thing that will rescue Health Care~

2012-01-20T09:38:00.001-08:00

While payers and providers are usually in the spotlight when it comes to accountable care, the most successful models will be the ones that place a strong focus on patient accountability. More and more frequently patients are selecting doctors with the best outcomes, asking proactive questions, and taking an active role in their lifestyle and behaviors. Empowering patients with the support and tools to be responsible for and more involved in their own health is critical to improving outcomes and reducing costs as part of any accountable care environment.

Currently, patients navigate the medical system to achieve the best outcome in the shortest amount of time, but physicians are incentivized to provide more services. If the decision-making process of the physician and patient are not fully aligned, then it is not reasonable to deploy a strategy focused solely on stimulating greater accountability in the patient. An alignment of goals for the highest quality and most financially efficient care can help to ensure patients are never in a position to make a health decision against the advice of their physician. The burden of responsibility has to be directed equally at all stakeholders. Once alignment is established, strategies to stimulate greater patient accountability can be deployed.

Establishing a primary care relationship is key for patients because it provides them with the opportunity to view care more holistically, gain a better understanding of medical alternatives, and feel supported by an advocate for better personal health. Group visits can also encourage patient accountability by allowing patients to connect with others who have similar conditions, and providing physicians with an opportunity to educate and promote better overall patient health. In addition these strategies, tools to enable patient engagement are paramount. I’ve bucketed these accountability enablers into three categories:
•Demand management: Stakeholders too often demand a greater intensity or frequency of service than necessary to achieve clinical success—experiencing more readmissions, ER visits, and MRI or CT scans than needed for example. It may sound simple, but asking discharged patients questions such as “Where will you go post discharge?”, “Are you certain any equipment or physical therapy has been arranged?” and “How can we reach you?” counters some of the system inefficiencies and better moderates unnecessary demand in the medical system. In fact, such efforts can cut in half the readmit rates.
•Population management: According to a commercial insured 2010 population analysis, half of high cost claimants had minimal to no engagement with the delivery system in the prior year, indicating that providers need to better engage with individuals who are not active in the system, not just at the point of care. This is a significant challenge that can be overcome by partnering with organizations that specialize in identifying and engaging individuals who will become future sources of medical costs. It is particularly important for providers to reach out to individuals with a low intensity of need that don’t consider themselves patients and individuals with immobility or lack of access to care.
•Network management: Oftentimes, individuals choose to access care at the wrong place. Transparency of information on physicians and specialists ensures that patients are receiving the best care at the lowest cost. By facilitating transparency providers can influence patients’ decisions, increase patient involvement and open the door for better communication across the care continuum.

All patients across the care continuum need to be participants in their own care, and providers should be implementing strategies to encourage this accountability both at the point of care and, more importantly, once the patient goes home. The focus should not be directly on changing a physician’s practice or reducing a hospital’s patient load, but instead on implementing an accountability model that aligns both physician and patient expectations to improve the health care system as a whole.

Miles Snowden is Chief Medical Officer of OptumHealth.

Article about Hospice Care: Important to think about today!

2012-01-20T09:29:00.001-08:00

Dear Doctors:

I am writing no less than 45 days after my mother died from a GI bleed from ovarian cancer. Not once did my mother’s team of doctors mention palliative care. It was not until days and even hours before her death that hospice was discussed and implemented. Our family was blind sighted by this.

While no one likes to talk about the topic of death, it is important to remember that this is a natural cycle of life. Doctors are always on the cutting edge of medicine and talking about the possibility of death seems like failure. In reality not talking about the services available to family is the ultimate failure.

Here are the top 5 reasons why:

1. Pain. Patients may get to a point where pain is not manageable with the regular visits to the office. To know that there are potential solutions from a team that understands the full situation and can target medicine toward avoiding suffering is key. It can make a huge difference in quality of life and the person’s overall attitude toward the options available. It puts the patient in the driver’s seat.

2. Quality of life. Running from doctor to doctor, balancing prescriptions at the pharmacy and not tending to one’s overall quality of life can be draining. If more attention were paid by doctors to palliative care during serious illness the patient would feel a sense of relief that there is a friend on the sidelines ready to work with the entire team to manage symptoms and if need be start discussing hospice.

3. Hospice gives the patient comfort at a time of great stress. Hospice should not be a last-minute option. It should be done with great thought and care with the patient’s needs in mind at all times. To be able to stop all treatments and procedures and focus on the remaining days ahead without pain and suffering is often a relief.

4. Families are grateful for palliative care and for hospice. The patient’s families are often in the dark about these services. Their stress on trying to do the best for their family member is truly overwhelming because they worry about what they can do to help. Knowing that these services are there is half of the battle. Even if they are not going to be needed in all likelihood, families deserve the right to know about them.

5. Dignity. While we are so busy “fixing” the patient we should also look to giving that person a sense of dignity. No one wants to suffer in death. Patients want the ability to have time with their family members and to peacefully convey last words and more.

Consider creating a simple sheet describing palliative care and hospice and handing it out to patients as they start treatment for a life-threatening illness. Make it clear that you plan to do all that you can to help them but in that same vein you also want them to be completely informed of their rights to extra services should the illness become complicated. More often than not, you will find patients and their families grateful for the “road map” for their full treatment, successful or not. It is the ultimate gift.

Deb Discenza is co-author of The Preemie Parent’s Survival Guide to the NICU and the founder and former publisher of Preemie Magazine.

Little Plates, Smaller Portions - Save health and your wallet!

2012-01-16T08:35:00.001-08:00

Little Plates, Smaller portions

When I was traveling Europe, one man asked me if all of the people in the US were obese. (I guess I was one of them!) Another man in Germany commented on the amount of food that was served at American Restaurants. (We are the home of the buffets!)
I remember growing up when the whopper came out. We all thought that was shameful and evilly delightful – a hamburger that big (and I think back then the whopper was bigger). But then again is bigger better?
Not when it comes to eating. We are now in the habit of eating large, expecting a plate full (or more than one plate full) and with the goal of getting our money’s worth when eating out. Is it really our money’s worth when we think of the expenses that come with obesity?
Habit – yes we just have to put it in our mind to break the habit. One way to do that is to set a goal for 21 days (or longer) to eat less at each meal. For those who love to eat out like we do, order a smaller portion. I applaud the restaurants that are now offering the “smaller plates”. It used to be that all you could order was the kiddie meal if you were lucky or perhaps just an appetizer plate. However, now eateries are offering the “senior” “kiddie” or even the just the smaller plate for those who don’t want to eat like little piggys. They usually come with a smaller price tag too- so there we are, saving our budget as well as our health.
At home try cutting your recipes into smaller portions. I know at our house – dinner for two, was usually dinner for four. Now I cook for two and try to fill up the meal with more salads or other veggies. This also saves on the budgets and leaves less left overs to throw away.
Also try to serve on smaller plates. I love a pretty table – try flowers and music, colorful mini-plates, cups, colorful napkins and no TV! Try to plate your meals with mindful enjoyment. Garnishes and decorative plating also make eating fun. Put the emphasis on the food not the quantity. Eat slowly and enjoy!

LIFE

2012-01-13T05:33:00.001-08:00

Last night was clear with full moonshine and the owls were busy hunting on our farm, calling back and forth to each other, comparing notes on where to find prey.

Thankfully they were not calling my name. At least I don’t think so, nevertheless their hoots haunted me.

A coastal tribal legend has it that if you hear an owl call your name, your death is imminent. I’ve had no recent brushes with death, thank goodness, but as a doctor turned patient over the last two weeks, I’ve had cause to consider the preciousness of life and preservation of health.

The first was dutifully going in for my annual screening mammogram which became a two hour marathon of the radiologist asking for various wedge and coned down views, finally resorting to an ultrasound to determine that a small simple cyst had developed under a nipple and did not, from its appearance, need further investigation. Whew. My worry meter, working overtime through all the imaging, slid back to zero.

Then a subtle vision change in one eye resulted in an appointment with my optometrist who confirmed new vitreous floaters and opacities, but also noted an abnormal retinal artery in that eye. The next stop was the retinal specialist who documented a small retinal “wrinkle” and tear, but was more concerned about the artery which appeared to show some previous injury, whether from a clot or atherosclerosis was not clear. Initial screening lab work for diabetes, lipids, sed rate and metabolic functioning looked okay so more specific testing was ordered (D-dimer, C reactive protein) with elevated levels suggesting I am at risk for clotting, cardiovascular disease, and stroke, not to mention possible hidden malignancies causing a hypercoagulable state. As a 57-year old with hypertension whose family history contains plenty of cancers, wayward clots, unfortunate strokes and one sudden death heart attack, this certainly got my attention. The worry meter has gone into overdrive. Now I’m going through testing of my legs (no clots but lousy incompetent deep veins), carotids (no plaque) and next week my heart (to look for valve issues and emboli). Whether more testing is warranted beyond that has yet to be determined, so I’m sitting in the uncomfortable position of feeling just fine, thank you very much, but that is my denial kicking in.

There are no good reasons for retinal artery problems. They are all bad reasons. As someone on blood pressure medications for a decade and having gained weight I don’t need over the years (just in case of an unexpected serious food shortage, right?), I consider myself sufficiently warned. Besides aspirin, fish oil capsules and lipid lowering agents, I must change how I take care of myself or things will change for me without asking permission first. The doctor turned patient has been given a chance to make a difference in at least one patient’s future, or I’ll be no use to any patient.

The owls may not be calling my name but their hoots haunt for good reason. I’m listening.

Emily Gibson is a family physician who blogs at Barnstorming.

Healthy Snacks for the Holidays

2011-11-11T05:12:00.001-08:00

Great snacks with less than 200 calories

Craving salty?
•5 olives (any kind) (45 calories)
•1 small Martin's pretzel (50 calories)
•2 oz Applegate Honey and Maple Turkey Breast wrapped around 2 bread-and- butter pickles (80 calories)
•1/4 cup hummus, 3 carrot sticks (80 calories)
•1 Laughing Cow Light Swiss Original wedge, 3 pieces Kavli Crispy Thin (85 calories)
•One 1-oz package tuna jerky (90 calories)
•1 oz buffalo mozzarella, 1/2 cup cherry or grape tomatoes (94 calories)
•1 bag Baked! Cheetos 100 Calorie Mini Bites (100 calories)
•15 Eden's Nori Maki Crackers rice crackers (110 calories)
•1 cup unshelled edamame (120 calories)
•50 Eden's Vegetable Chips (130 calories)
•One 1-oz package of Planters NUT-trition almonds (130 calories)
•1/4 cup Trader Joe's Chili con Queso, 18 baked tortilla chips (140 calories)
•1/2 cup pumpkin seeds in shell (143 calories)
•2 pieces (30 grams) prosciutto, 4 dried figs (154 calories)
•1 Subway Turkey Breast Wrap (190 calories)

Craving sweet?
•1 package Original Apple Nature Valley Fruit Crisps (50 calories)
•1 packet O'Coco's Mocha cookies (90 calories)
•1 Jelly Belly 100-calorie pack (100 calories)
•One 100-calorie pack Trader Joe's Chocolate Graham Toucan Cookies (100 calories)
•One 100-calorie Balance Bar (100 calories)
•1 Starbucks Mocha Frappuccino bar (120 calories)
•1 package Back to Nature Honey Graham Sticks (120 calories)
•1/2 banana rolled in 1 tbsp frozen semisweet chocolate chips (123 calories)
•2 tbsp Better 'n Peanut Butter, 4 stalks celery (124 calories)
•1 bag Orville Redenbacher's Smart Pop Butter Mini Bags topped with a spritz of butter spray and 1 tsp sugar (126 calories)
•24 Annie's Chocolate Chip Bunny Graham cookies (140 calories)
•Half of a 1.08-oz container of M&M's Minis mixed with 1/3 cup lowfat granola (145 calories)
•1 McDonald's Fruit 'n Yogurt Parfait (160 calories)
•1 container Fage Greek Total 2% fat yogurt, 2 tsp honey (173 calories)

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My son Kent

2011-11-04T14:58:00.000-07:00

My son is 38 years old and has lived as a homeless person on the streets of LA for at least 6 years. How did he get out there and why did he decide on this life is a mystery to me.

It all started after high school when he met someone online and wouldnt stop until I gave him a round trip ticket to San Diego for Xmas. The relationship didnt workout but he fell in love with California. Several times he traveled to LA and lived on the streets. Once he called and wanted to go to rehab and came home, only to return 4 months later.

He is 38 and has never had a job and I am sure has not had a sober day in twenty years. I cannot save him. All I can do is pray for him almost constantly.

I have an 800#. SOme people think it is a business thing, but it is for Kent. So he can call me anytime to let me know that he is still alive. I dont know what is worse to hear his drunk voice mumbojumbo or not to hear anything.

When he first went out to LA, I was frantic. I called the LA police everyday until they assigned a detective to my "missing" persons case. I finally heard from Kent. He was OK and had melted into the homeless community - he was one of them, his new friends, his new home, his new life style.

Well it probably wasnt a new life style. He was probably on drugs and drinking at an early age. Now that I look back I see that there was HUGH red flags...why didnt I see them then. I probably didnt want to see them. I too was in my own little world hurting.

motherhood

2011-11-04T14:50:00.000-07:00

Its always sad when your kids dont turn out like you would have liked. Sometimes we blame other people, situations, and sometimes we blame ourselves. I still blame myself but then again I have learned to forgive myself and move on...we can never go backwards...only foward.

Check out the new website

2011-10-31T15:32:00.001-07:00

http://www.amway.com/smartdocresources

Fruit and Veggies to Go

2011-10-31T15:23:00.000-07:00

Where's the veggies?

If you don't believe this, bite into a regular supermarket tomato and taste it. Bland, tasteless, huh? That's because it was probably picked before it was fully mature, or ripened in a "hot-house." Nutrient and flavor deficient vegetables are mainly due to the wide use of commercial fertilizers and over-worked soil. Sure, the crops grow like "wildfire," but they are nutritionally inferior. Long gone are the days of using compost and natural fertilizers. This has also resulted in weak crops that require regular spraying for destructive insects.
.

They tell us that we need to the recommended amount of fresh fruits and vegetables every day to stay healthy. Unfortunately, that's easier said than done. You see, most of the commercially grown vegetables we buy at the supermarket or produce market are devoid of flavor and nutrients, plus many are heavily sprayed with pesticides. The exception to this are organically grown fruits and vegetables.

Then its the 'Too busy' to eat right excuse. Fast food and instant 'food' is now on the menu . Most of us don't get the vegetables and fruit requirements that we need.

NUTRILITE® has Fruits & Vegetables 2GO Twist Tubes This product gives you the antioxidant equivalent of two of the 9–13 servings of fruits and vegetables your body needs in a convenient, squeezable tube. Simply twist into a cold, 16-oz. bottle of water and enjoy a refreshing Mango-Citrus treat anytime, anywhere. The good part - it doesnt taste like brocolli and the kids will love it.

Smart Doc Resource Network: The Editors Checklist - borrowed from my friend an...

2011-10-28T07:09:00.000-07:00

Smart Doc Resource Network: The Editors Checklist - borrowed from my friend an...: Editor’s Checklist (26 ways to increase your chances of selling a manuscript) Assuming you have a great story with lots of trouble and con...

The Editors Checklist - borrowed from my friend and author - John May

2011-10-28T07:07:00.000-07:00

Editor’s Checklist (26 ways to increase your chances of selling a manuscript)

Assuming you have a great story with lots of trouble and conflict, and strong characters with a great deal at stake (prerequisites), here are some key ways to make sure these wonderful things actually come across to the reader (or agent, or editor):

1. Show it, don’t tell it.

a. In the television age, more than a very few paragraphs of exposition, introspection, or scene setting at a time can lead to Snoozeville—make me experience a story, don’t just report it. Start your story as soon as possible; don’t rev your engines very much at the beginning with the aforementioned stuff.

b. The most successful novels invoke emotions in the reader. Exposition is the writing form least capable of stirring emotions. Action and dialogue are tied at number one, followed by introspection, scene setting (an often overlooked way to set tone and stir emotion), and finally, at a very distant fifth, exposition. Never use exposition to reveal anything that has the potential to wring emotion out of the reader. Exposition is useful to prevent bloat but only use it to convey non-emotional, relatively less important information; and only in small doses.

c. Don’t introduce each character with a bio, (that is so 1940’s and earlier) or describe them with adjectives (lazy, mean, kind, careless, etc.) let me get to know them gradually by what they do and say—it’s more fun for me that way.

d. Don’t tell me what non-Point Of View characters are thinking or feeling, show me with descriptions of their actions and/or expressions.

e. It’s okay to tell me what the POV character is thinking or feeling but it’s often better to show it instead (especially when highly emotional).

2. To everything (turn, turn, turn) there is a Reason.

a. Unlike the real world, random results are not allowed in novels (not good novels at any rate). In your scenes, follow the rules of cause-effect, stimulus-response.

b. If you have your protagonist win (or lose) because of random chance or an Act of God, your readers will hate you.

3. Passive voice is a buzz kill (except in this sentence, of course).
Eliminate as many passive verbs (was, were, had) as possible. This is absolutely critical whenever action or dialogue occurs. But, because there’s no immediate action to interrupt, eliminating passive voice in exposition, introspection, or scene setting is not critical but it’s often better to remove it here too.

4. A view from the top.

a. Third person omniscient can work and work well (although it can make it harder to invoke emotions and thus requires a very highly-skilled writer).

b. In third person personal, once inside a scene, don’t wander around from head to head. If you must go into another person’s head, start another scene.

c. In first person scenes, I must inhabit one head and one head only.

d. Very early in the scene, make sure I know who the POV character is.

5. Well, I do declare.

Vary sentence structure. Too many simple declarative sentences, (He verb… She verb… It verb…) and you’ll sound like the evening news.

6. 1 + 1 = 1/2.

Eliminate redundant phrases, explanations, and attempts to explain dialogue via attacks of supporting exposition or ly adverbs. If you feel you must explain something or repeat it, then you probably said it poorly the first time. Fix it; don’t try to use a crutch. If you did say it right the first time, repeating it or explaining it weakens it.

7. Mysteries aren’t just for “Mysteries.”
Even if you’re not writing in the mystery genre, don’t just report events like you’re writing for a newspaper. Hold a few things back. Hint at bad things and/or tantalizing information to come. Readers love to worry and wonder. Do make sure to solve some of the little mysteries during the course of the book (and hopefully replace some with new ones) and solve all by the end of the book or, once again, your readers will hate you.

8. Breaking up is easy to do.
Avoid long paragraphs except for times when you deliberately want to slow things down, lull the readers almost to sleep, and then quickly hit them over the head with something exciting. Using passive verbs in a long paragraph is a great way to help your readers go to sleep at night, but you’re not supposed to be competing with Tylenol PM.

9. Dialogue is talking; it’s not elegant prose nor even necessarily grammatical.

a. Human beings often speak in sentence fragments—they interrupt, they ignore, they misdirect, they use contractions and sometimes slang. If you’re not writing science fiction or fantasy, have your characters talk like humans.

b. With rare exceptions, don’t have your characters give little (or even worse, big) speeches to each other.

c. Avoid the “as you know” syndrome (exposition poorly disguised as dialogue where characters tell each other what they already know, or they don’t have a natural reason to say it). If the only way to replace exposition is to use forced, unnatural dialogue, go with exposition.

10. Who’s on first?

Make sure I know who is speaking. Don’t use a speaker attribution every time someone talks, but do make sure you don’t go more than a few lines without reminding me who’s turn it is. When there are more than two people in the scene, you’ll probably have to use more speaker attributions.

11. The beat goes on.

a. Beats (little snippets of action during dialogue) are a good way to vary speaker attribution and add action and sense of place to dialogue.

b. During highly emotional or dramatic parts of dialogue, be careful to use beats very sparingly or not at all as they can reduce the tension. However, beats that show emotion (He slammed the book down!) can be used to heighten dramatic effect, and are usually far superior to ly adverbs.

12. Up the lazy dialogue river.

When you have to tell me that your characters interject, muse, tell, ask, demand, plead, counter, repeat, remind, offer, exclaim, intone, inform, etc., it usually means the dialogue itself is weak and you’re forced to explain it to me. The best dialogue needs only the “said” attribution, or a beat, or no attribution at all. Very occasional use of a select few “special” attributions can be effective in the right spots, but frequent use leads one down the road to Hacker Town.

13. Don’t think too long.

When writing in third person, literal thoughts that shift to first person (Oh, my God!) should be reserved for very short and highly emotional phrases. For lingering looks into your POV character’s mind, use third person.

14. K.I.S.S. – Keep It Simple, Stupid.
Your goal is to entertain, not to impress everyone with how many complex clauses and flowery words and phrases you can juggle in a single sentence. When the reader has to pause in order to understand, you’ve failed him or her.

15. Speaking of entertaining.
Educating the reader about a cause or an important social issue is okay so long as it doesn’t interrupt the entertainment for more than a second or so.
16. Speaking of flowery words and phrases.
Phrases like, “the purple tendrils of dawn” belong in poetry, not prose. Agents and editors love to compare passages they’ve received of what they call purple prose. This is not a good thing.

17. Where the hell am I anyway?

a. If the action could just as easily be taking place in the reader’s living room or backyard, credibility suffers. Establish sense of place for enhanced realism and a vivid experience.

b. However, beware of purple prose or verbosity. One paragraph of scene setting is usually okay, two may be okay, three or more (except in science fiction or fantasy) and you’re probably writing for an audience that lived in the prior century.

18. Often, a little bit goes a long way.
Understated emotion can often be more effective than histrionics. Occasional fireworks (or waterworks) can heighten drama and tension, but, if your characters are constantly going off the deep end, it becomes ineffective and boring.

19. It’s like déjà vu all over again.

a. Eliminate unintentional word repetition, even if removed from each other by a few pages. Repetition should only be intentional and for effect.
b. When using repetition for effect, using three or more instances is usually better than just using two which can be mistaken for laziness.

20. Built-ins are better than add-ons.
Taking care to retain message and/or imagery, eliminate as many adjectives and adverbs as possible. Use vivid nouns and verbs (where adjectives and adverbs are built-in) wherever possible.

21. Watch your as’s and ings.

a. Sentences that begin with as or ing clauses should be used sparingly and only for sentence structure variety and avoidance of more complex constructs. More than one or two a page is a hacker alert.

b. When used, these clauses should refer to the less important action in the sentence.

22. And you’re referring to?

Make sure it’s absolutely clear what each clause refers to. Misplaced modifiers are more than just confusing, they’re annoying.

23. A proportional response is best.If you spend a long time talking about something, I’m going to assume it’s important. If it turns out it’s not, I’m going to assume your book isn’t very important either.

24. Be consistently consistent.

a. Be on the lookout for instances where the facts in one part of the book or scene don’t jive with the others.

b. Also be consistent with the real world (assuming your piece is set in the real world). Do your research.

25. Hut two three four.

a. Read your story out loud or, even better; have someone else read it to you. If the words don’t flow, the reader may go. Cadence is very important.

b. What’s that all about? Often, the word that is an annoying, unnecessary appendage and it can ruin cadence. If your grammar checker doesn’t barf on the sentence with that removed, and it’s not absolutely necessary to understand the sentence, remove it (unless it actually improves cadence which is not likely).

26. Clichés are just so…well…cliché.

a. Characters may use clichés in dialogue occasionally (don’t overdo it), especially when it’s consistent with their personality. The narrative voice of the POV character should avoid clichés; however, an original, cleverly reworded alteration of a cliché can be fun and effective.

b. Cliché can also strike in the form of overused plot elements or actions. If you’ve heard it before, your reader probably has too.

The Destiny of Books

2011-10-28T06:21:00.000-07:00

I remember reading Ray Bradybury and was shocked when during the story, they burned books. Well now a days, worse things are happening; we are throwing them into the garbage. At one library I plundered the outcasts and found books from the 1800s! I was told that no one wanted old books! Many of the original classics were trashed. Is this what we want to teach the kids - an ebook is better!?

check out smartdocresources new website!

2011-10-26T14:34:00.001-07:00

Madame Boomer's Halloween

2011-10-26T13:56:00.000-07:00

Madame boomer likes to dress up for halloween. The walker comes in handy and she can scrape down the street without being laughed at. Then again Madame Boomer likes chocolate - lots of it, so MB Lovers hang out your chocolate sign so I wont waste my time

Part II - Haloween Goodies

2011-10-26T13:47:00.000-07:00

Alternative snacks are a good idea to give those trick or treaters. Although they may be a little more expensive (I usually give the cheap candy - not the expensive chocolate!) - the snacks may include small boxes of cereal, animal crackers, graham grackers in little boxes, cheese n crackers packages, pop tarts, 100 calorie snacks (great variety) little bag of pretzles, trail mix, peanuts (although watch out for allergies) and fruit rolls ups. Some people still like to give fruit, even raisins, but I have found that they sometimes land up in the garbage. (and fruit is expensive). So what do you do when you run out of candy - go through the cabinets - indivdual packets of

Smart Holiday Choices - Halloween!

2011-10-26T13:40:00.000-07:00

Halloween to most children means candy, a lot of candy. With childhood obesity on the rise in the United States, what can families do to stay healthy amongst the candy corn, chocolate nougat bars and gummy bears? Healthy and Halloween aren’t usually two words that are normally seen together, but there are good and easy alternatives that will make Halloween not so scary for your family’s health.

Some people suggest Halloween-themed pencils and note pads, boxed raisins, and fruit. How many kids are going to empty their halloween buckets and go for the good stuff. Many of the not so interesting things go in the garbage...so I say don't waste your money.

Money - now that's an interesting drop in the basket. Figure out how much each handful of candy is going to cost you and give kids the cash. Just be careful of the babies!(they like to put shiny things into their mouth- unless you want to give out the big money!).

I figured out that my goodies cost between 5-50 cents each. Hmmm - the money concept - a kid might become rich on halloween!

Sales Kids!

2011-10-24T13:25:00.000-07:00

Do you get a bunch of munchkins coming to your door trying to sell you stuff for the school fundraiser, or band, or football or whatever?
It used to be that you ordered on paper and paid when delivered. Now you pay in advance and what do the kids get...a plastic toy if they sell $250 worth or maybe a freindship braclet or something you could pick up at the dollar store. But the kids want that PRIZE! so the parents take them all over, sell wrapping paper to co workers and grandma's take order forms to church picnics. (all for a $1 friendship braclet?) and then the products come in and we do it all over again - deliver the products.

now its money up front and I understand. I was once that parent who was stuck with all the items that people no longer wanted or didnt have money to pay for !

But my situation was a little odd - we moved into a kid infested neighborhood...was bombarded with little sales kiddies and I bought from two kids...had to turn away dozens! the first one returned my check as someone forgot to turn it in....kid or teacher..? the second one only brought 1/2 of our order and say -oh well think I gave away you order to someone else. I'll bring back your money later. Never saw the kid again and didnt know him (being new in the hood).

What is this all about - making the kids sell for what? overpriced items to support their school? pressure from school and peers to outsell for what - a friendship bracelet? cheat your neighbors - is there no customer service (ah - they are just kids!) no moral, ethical or responsibility training? isnt that what schooll is for?

Halloween and Candy - Now a great idea from San Diego!

2011-10-24T11:23:00.001-07:00

The Candy Buy Back Program is a collaborative effort among local health agencies and other community members to address the issue of childhood obesity and dental health among our local children. During the Candy Buy Back Program, children will bring in their surplus unopened candy into participating dental and pediatric offices. The offices will give the kids $1 for each pound of candy brought in during the days following Halloween/Harvest Celebrations. Participating shipping stores will ship the candy "at cost" to Operation Gratitude who ships the candy to our US troops. http://www.opgratitude.com/

Risk management for Health Care professionals - lecture coming soon.

2011-10-21T10:17:00.001-07:00

This is a huge topic today...in all business, especially health care. Between HIPAA and other privacy laws and the way we are trained to sue someone or some entity at the drop of a hat, it is necessary to CYA.

More info on the lecture and Risk Management in-house manual coming soon.

Cold Laser Therapy

2011-10-21T10:06:00.000-07:00

I was the first Chiropractor to legal purchase a cold laser back in 2006. It was very popular in my practice. Now I see more than ever, the need for modalities such as the laser.

A friend of mine called me a few weeks ago from Mississippi. She has been having a terrible time with her bilateral knee pain. She has tried everything...medication (which is restricted due to her underlying comorbidities), creams, lotions and even drove 2 hrs each way to see an accupuncturist. Desperate she called me and asked if I had ever heard of Cold laser therapy...she had seen it on a medical show.
I reminded her that we had discussed this modality and I had even used it on her several times and it worked. She had forgotten because she got well.
I shipped my laser to her since there are no physicians that use laser who are close by for her. Lets keep our fingers crossed.

Today I met a young lady at the nail shop. She too was in pain from a knee problem. She had already had a procedure - surgery - that lead to several other surgeries and the problem is still getting worse. She was not a candidate for knee replacement because o f her age. Now she has problems with her hips, low back and other knee probably due to compensation for all of the years (yes years!) of trying to stay off the knee. She also subsequently had foot surgery! She has been out of work for 5 years and still waiting to get back her life. I suggested cold laser, at least until something better comes along I also told her to check out a chiropractor for her misalignments.

Well - there I go running my mouth! I hope I dont get hit with a malpractice suite or something. I found with just trying to help someone you can also put yourself in the line of fire of a lawsuite. Ridculous!

Madame Boomer - who is she?

2011-10-20T14:40:00.001-07:00

My new passion or I should say our new passion (Peter is my partner in this new love) has been history - specifically English - Tudor History. A subject that I really wasnt familar with, but still there was something romantic, interesting and curious about that time period. Therefore my inner Madame emerged.

Boomer: That part is easy. We are now the largest population in the U.S. - the baby boomers. Now a young senior citizen (although my husband refuses to admit and gets very embarrased when I ask for the senior discounts) we have issues that sometimes are not addressed. One of them being, health care for women. Although this subject material is much improved and also not as skewed as it used to be, there is much information that may not be clear or as individualized as it should be.

The thing that I have found is that our modern medicine and diagnostic tools compartmentalizes symptoms and diseases so much that we treat each symptom and not very much the disease. And then again we are so much more knowledgeable than we were even 20 years ago, we have discovered new defects, gene disorders, chemical malfuctions, illnesses, virus, syndromes and diseases. And because we are so specialized in our treatment (your G.P. sends yo to the dermatologists who refers you to the orthopedic who may send you to a shrink), sometimes the whole is lost in the parts.

There are many ways to look at the whole. Oriental Medicine focuses on the whole body, the energy of the body and the function of the body as one. The treatment of the body as a whole is certainly an option. However, if in western medicine we look at the body as a whole, we see overlapping functions, disfunctions, side effects, and comorbidities. How can that be dissected? Western Medicine certainly tries - so we can be compartmentalized and treated.

So where do we go from here? I can speak Chinese!

Fibromyalgia - My story

2011-10-20T14:33:00.000-07:00

I think back when I put together a very poorly written booklet about Fibromyalgia called Fibro Facts. It still did what it was suppose to do - give people information and let people know that there were others out there. I started a support group in Columbia (really my first support group for FIbromyalgia was 10 years earlier in Newton- Rockdale County , Georgia).

Now I am back to writing about Fibromyalgia - I never quit doing research and studying the syndrome, it just kind of wore me out. I got so caught up in the syndrome - I was exhausted. Maybe it was the syndrome itself, maybe it was working 3 jobs and maybe it was the fact that Fibro was my life. My friends and patients had fibro, we talked about fibro, our group meetings - you guessed - fibro. In any case I needed the break from alot of things - we moved away from Columbia and I did things differently and things got better, then worse, then better and then we moved back to Columbia.

Now I feel better about fibro - stronger in mind and in health - its time to do the Fibro Book (which my agent has been asking me to do for 10 years).

You all ready to help?

restless leg syndrome and hypertension

2011-10-20T14:30:00.000-07:00

A study done at Harvard Medical school found that woman that had restless leg syndrome were 41% more likely to have hypertension than their counterparts. How scary. I thought I was just running through the tulips in my dreams and got all worked up....now I find out that I really have RSL and hypertension!

Restelss Legs and Essential Tremors- fiibromyalgia or something else?

2011-10-20T11:37:00.000-07:00

Restless leg syndrome

Nocturnal myoclonus; RLS; Akathisia

Last reviewed: August 28, 2009.

Restless leg syndrome is a disorder in which there is an urge or need to move the legs to stop unpleasant sensations.

Causes, incidence, and risk factors

Restless leg syndrome (RLS) occurs most often in middle-aged and older adults. Stress makes it worse. The cause is not known in most patients.

RLS may occur more often in patients with:
•
Peripheral neuropathy

•
Chronic kidney disease

•
Parkinson's disease

•
Pregnancy

•
Iron deficiency

•
Use of certain medications

A form of RLS may be passed down in families. This may be a factor when symptoms start at a younger age. The abnormal gene has not yet been identified.

Restless leg syndrome can result in a decreased quality of sleep (insomnia). This lack of sleep can lead to daytime sleepiness, anxiety or depression, and confusion or slowed thought processes.

Symptoms

RLS leads to sensations in the lower legs that make you uncomfortable unless you move your legs. These sensations:
•
Usually occur at night when you lie down, or sometimes during the day when you sit for long periods of time

•
May be described as creeping, crawling, aching, pulling, searing, tingling, bubbling, or crawling

•
May last for 1 hour or longer

•
Sometimes also occur in the upper leg, feet, or arms

You will feel an irresistible urge to walk or move your legs, which almost always relieves the discomfort.

Most patients have rhythmic leg movements during sleep hours, called periodic limb movement disorder (PLMD).

All of these symptoms often disturb sleep. Symptoms can make it difficult to sit during air or car travel, or through classes or meetings.

Note: Symptoms may be worse during stress or emotional upset.

Signs and tests

There is no specific examination for restless leg syndrome. The health care provider will not usually find any abnormalities, unless you also have peripheral nerve disease. Blood tests (CBC and serum ferritin) may be done to rule out iron deficiency anemia, which in rare cases can occur with restless leg syndrome.

Examination and testing may be used to rule out other disorders with similar symptoms.

Treatment

There is no known cure for restless leg syndrome.

Treatment is aimed at reducing stress and helping the muscles relax. The following techniques may help:
•
Warm baths

•
Gentle stretching exercises

•
Massage

Low doses of pramipexole or ropinirole (Requip) can be very effective at controlling symptoms in some people.

If your sleep is severely disrupted, your health care provider may prescribe medications such as Sinemet (an anti-Parkinson's medication), gabapentin and pregabalin, or tranquilizers such as clonazepam. However, these medications may cause daytime sleepiness.

Patients with iron deficiency will receive iron supplements.

Low doses of narcotics may sometimes relieve symptoms of restless leg syndrome.

Expectations (prognosis)

Restless leg syndrome is not dangerous or life-threatening, and it is not a sign of a serious disorder. However, it can be uncomfortable and disrupt your sleep.

Complications

Insomnia may occur.

Calling your health care provider

Call for an appointment with your health care provider if:
•
You have symptoms of restless leg syndrome

•
Your sleep is disrupted

Prevention

Techniques to promote muscle relaxation and stress reduction may reduce the incidence of restless leg syndrome in people prone to the condition.

Madame Boomer drinks Beer

2011-10-17T11:31:00.000-07:00

Beer is good for you (and so is prunes) but not necessarily together! A new study found that women who sipped on one to two glasses a day were less likely to gain weight than the abstainers. Turns out those women consumed less calories from other beverages as well said researcher Dr Lu Wang. So Drink up ladies.

Madame boomer is always close to pottie

2011-10-17T11:28:00.000-07:00

More than 38% of women in the US suffer from incontinence; these woman pay more than $20 billion dollars a year to manage their condition. One way to reduce the risk, is to cut out caffeine. Caffeine stimulates production and acts as a bladder irritant.

Madame Boomer: Menopause

2011-10-17T11:18:00.000-07:00

Menopause oh Menopause - where for art thou? Menopause hits women between the ages o 44-56 and is usually determined by your genes. Smoking and certain medications can trigger early menopause but the fact is not much can trigger or slow down menopause. IT was throught that stress, having children or diet may be facts but it was ruled out by a study done by the Reproductive Studies Research Department in San Diego. You got what you got when you got it.

Madame Boomer doesn't wear skinny jeans

2011-10-17T11:13:00.000-07:00

Skinny jeans are thought to be blamed for a new syndrome called Tingling Thigh Syndrome. Sounds kind if kinky - well its not cause if your thighs are compressed it can cause compression on nerves and circulation in your legs, thus leading to more than tingling. Your legs can go numb and your skinny jeans may make you walk like a mummy~

Madame Boomer Facts - don't loose sleep over lost sleep

2011-10-17T11:11:00.000-07:00

Women only need between 5-6 hours of sleep a night for a long and healthy life. Researchers at the University of California in San Diego did a 14 year study that came up with this data.

Madame Boomer Facts - after menopause go to the dentist

2011-10-17T11:09:00.001-07:00

A new study from the Case Western Reserve University Research team found that post menopausal women are at a greater risk for periodontal disease and need frequent professional cleanings - perhaps up to four a year to remove the hard plaque that triggers gum disease thus weakening the jaw bone.

Madame Boomer Facts -eat halloween candy

2011-10-17T11:07:00.001-07:00

A study from the Harvard School of Public Health found that those who eat sweet treats a few times a month live longer than those who say no to sugar. Researchers believe that people who indulge every once in awhile are less likely to binge.

Madame Boomer Facts

2011-10-17T11:04:00.002-07:00

Yes including the obvious, prunes are also good for osteoperosis. Florida State university researchers found that women who ate 6-10 prunes a day had significantly higher bone density that women that ate other fruit. "Prunes are rich is potassium and boron, which are known to increase bone mass." said author Barhram Arjmandi

Madame Boomer Facts

2011-10-17T11:04:00.001-07:00

Prunes are good for you!

Madame Boomer Facts

2011-10-17T10:54:00.000-07:00

ck out website for more resources

2011-01-28T14:38:00.000-08:00

http://www.smartdocresources.com