Saturday, July 31, 2010

Weight loss and pride in your employees

Few people know how important obesity is in the disease states that are regularly treated at Texas Dermatology.

Psoriasis is a big focus in our practice. And Alan Menter's landmark work on metabolic syndrome and this disease has really brought the concept of diet and exercise to the forefront of global treatment for our patients.

So enter Medifast.

Medifast is not a new diet having been around for years with thousands of patients and physicians utilizing it for weight control When we were deciding on an idea for weight management in our patients, Medifast was a logical consideration.

Medifast is a "meal replacement" type diet. Basically you are provided five small meal substitutes and you combine this with one "normal" meal per day. This is recommended to be a lean protein and several servings of green vegetables.

We hit on a plan to have several of us give the program a trial. We anticipated about five chubby guinea pigs would be in our first cohort. Since I was the instigator, of course I volunteered. Cynthia Trickett our beloved PA (who happens to be a Major in the Air Force Reserve - yes, we are proud of her!) was appointed to be our Medical Officer to supervise our weight loss.

Now this is where it gets interesting.

When we made our adventure public, there was tremendous interest from our employees asking if they could participate. So much interest, that we decided what a cool employee benefit this would be if Texas Dermatology would provide most of the cost of participation. And we did.

And now? To date 22 people will begin the Medifast program in the next week or so.

I am so proud of our employees for their enthusiastic interest in health and weight loss. We are not having a contest, but we are going to go through the process together to see how this program might benefit our patients.

I will keep you posted in future blogs.

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Location:Drane Place, Corsicana, United States

Monday, July 26, 2010

Bullets and Bull

These quotes and comments were shared to me by Russell Cravey, MD, and ophthalmologist from Kerrville, Texas. They are attributed to Clint Smith the director of Thunder Ranch, a weapons training facility in Oregon. I thought they were too humorous and entertaining to pass up.

Clint is part drill instructor and part stand up comic. Here are a few of his observations on tactics, firearms, self defense and life as we know it in the
civilized world:

"The handgun would not be my choice of weapon if I knew I was
going to a fight....I'd choose a rifle, a shotgun, an RPG or an atomic
bomb instead."

"The two most important rules in a gunfight are: always cheat
and always win."

"Every time I teach a class, I discover I don't know something."

"Don't forget, incoming fire has the right of way."

"Make your attacker advance through a wall of bullets. I may get killed with my own gun, but he's gonna have to beat me to death with it, cause it's going to be empty."

"If you're not shootin', you should be loadin'. If you're not loadin, you should be movin', if you're not movin', someone's gonna cut your head off and put it on a stick."

"When you reload in low light encounters, don't put your flashlight in your back pocket.. If you light yourself up, you'll look like an angel or the tooth fairy...and you're gonna be one of 'em pretty

"Do something. It may be wrong, but do something."

"Nothing adds a little class to a sniper course like a babe in a Ghilliesuit."

"Shoot what's available, as long as it's available, until something else becomes available."

"If you carry a gun, people will call you paranoid. That's ridiculous.. If I have a gun, what in the hell do I have to be paranoid for?"

"Don't shoot fast, shoot good."

"You can say 'stop' or 'alto' or use any other word you think will work but I've found that a large bore muzzle pointed at someone's head is pretty much the universal language."

"You have the rest of your life to solve your problems. How long you live depends on how well you do it."

"You cannot save the planet. You may be able to save yourself and your family."

"Thunder Ranch will be here as long as you'll have us or until someone makes us go away and either way it will be exciting."

More Excellent Gun Wisdom....... The purpose of fighting is to Win. There is no possible victory in defense. The sword is more important than the shield, and skill is more important than either. The
final weapon is the brain. All else is supplemental.

1. Don't pick a fight with an old man. If he is too old to fight, he'll just kill you.

2. If you find yourself in a fair fight, your tactics suck.

3. I carry a gun cause a cop is too heavy.

4. When seconds count, the cops are just minutes away.

5. A reporter did a human-interest piece on the Texas Rangers.
The reporter recognized the Colt Model 1911 the Ranger was carrying and asked him 'Why do you carry a 45?' The Ranger responded, 'Because they
don't make a 46.'

6. An armed man will kill an unarmed man with monotonous regularity.

7. The old sheriff was attending an awards dinner when a lady commented on his wearing his sidearm. 'Sheriff, I see you have your pistol. Are you expecting trouble?' 'No ma'am. If I were expecting trouble, I would have brought my rifle.'

8. Beware the man who only has one gun. He probably knows how to use it!

Thanks Russell for sending these to me.

Friday, July 16, 2010

Sauerkraut and Pig's Eyes

Last night Kristen and I had a great dinner with friends Caleb and MaRisha Gidcumb. Caleb as you remember from prior posts is my helicopter instructor.

MaRisha made a wonderful dinner, but one dish stood out: sauerkraut and meatballs. Ok, ok I know this sounds weird and different. Plus, there was no spaghetti involved.

The recipe went something like this:

2 pounds ground beef
1 egg
1 package of onion soup mix

1 can of sauerkraut
1 can of cranberry sauce
1/4 cup of water

Make the meatballs out of the first list, place in a dish, and cover with the second list. Bake at 300 degrees for 2 hours.

This was absolutely fantastic. Sweet and savory and the perfect evening meal. MaRisha complimented it with green beans, yams, smashed potatoes, and chicken and dumplings.

Caleb said that his dad referred to this as "pigs eyes". I've never had pigs eyes, but if it tasted something like this, I'm all in. Particularly if MaRisha is cooking!

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Location:W 15th St,Austin,United States

Wednesday, July 7, 2010

Life in Hawaii

Part of exploring new locations in the world is to experience life. Travel is certainly a entertaining way to pass the time. But ultimately it is the life experiences that happen when you see and touch new places that make that indelible imprint on your frontal lobe.

This week has been no exception.

Hawaii is a great example of how life and destruction coexist to form some type of harmony.

As I mentioned in an earlier blog, Monday night we made our trek to see the manta rays. Though not a normal event in nature, the mantas have adapted to participate in the human interaction by the coaxing of local tour guides.

Over the years, local operators have suspended large halogen lights either pointed from the surface or from the bottom to form a cone of light that attracts plankton. These microscopic life forms form a swarm in the light stream that the mantas enjoy by making one circle after another as they devour the small food particles.

We on the other hand get to watch the show. From our snorkel pose the 7 to 14 foot creatures fly by within inches -- even occasionally batting you with a smooth fin.

It's an amazing experience and the kids enjoyed the proximity and the beauty of these animals. One female was entangled in a fish hook and float which was removed by one of the guides with a pair of scissors.

Now compare this with the other side of the Big Island. Though only a couple hours drive away along Highway 19, it seems like its a different planet. The green landscape in contrast to the Mars-like lava flow of Kona is abruptly interrupted by the 13,000 foot Mauna Loa volcano.

Still active and belching smoke, though no lava this trip from the report of Kristen and Will's 2-mile hike to find it.

Sulfur infused air, the warm earth, the steam vents, the devastation placed on the roads and houses defines the enormous power of our earth. Processes that clearly we don't completely understand.

But in this black graveyard of molten rock and glass you still find life.

There are plants and animals that somehow manage to carve out an new existence in the wake of this volcano And even people rebuild their houses, albeit in a different environment from months before.

They first must carve a road to their final property line, rebuild the house or structure, and learn to live without running water or electricity. From hauling in water to large cisterns to windmills to harvest the constant southerly breeze, they manage to reform their lives.

So whether it's several miles below the surface of the water or several miles above, Hawaii and the Big Island define the coexistence of life and death. And somehow what is created is both magical and beautiful.

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Location:Big Island, Hawaii

Food on the Big Island -- From Miso to DQ

I have always been blessed with kids who enjoy one trait from their father-- the interest and joy in trying new foods.

Cathryn is clearly the one I can talk into the easiest, but Will too will join the rest of us as we take a culinary journey.

So what have we found this trip:

1) Japanese Breakfast -- Hawaii is a frequent vacation spot for the Japanese. Probably a combination of the American dollar and the convenience of air travel, there are abundant Asian cultures at the hotel. To cater to these guests, the food provides some comfort. This includes rice, fermented soy beans, fresh fish, and Miso soup for breakfast. Cat has taken aggressively to this offering and for the past week has not passed up the Miso and rice for her morning staple. I hope I can make this at home for her!

2) Organic produce and meat in Waimea -- Last night we had the privilege of dining in one of the island's best restaurants. In the small village of Waimea, a town of 10,000 situated in the shadow of Mauna Kei, we stopped with for an early meal at Merriman's.

We were dressed in upscale volcano gear, but they didn't seem to mind as we were seated in the dining room inches away from the herb garden. Many people think this is the most beautiful area of the Big Island and the most desirable to live.

Located on the area of the Parker Ranch, it is lush with green as you look over the mountains in one direction and the ocean in another. This is not a beach town by any sort. It is more of a mountain village and the cool breeze at 3500 feet elevation convinces you of that.

The food was mostly local ingredients. From fresh bread with strawberry jam and goat cheese, to a salad with all local produce (beets, radishes, lettuce, and much more but Kristen didn't offer a sample), to beef and lamb that were all delightful.

Will and I especially enjoyed the locally made and smoked bacon. Bacon as an appetizer -- my kind of place that will serve a pork product as an appetizer. Wow.

3) Sushi -- We were able to find a reservation at Norio's, one of the local sushi haunts. We were all amazed. Cathryn had Miso-marinated Butterfish (see a trend here?), Will a tempura of lobster and shrimp, and Kristen and I multiple courses of raw fish. The kids enjoyed their fair share of sushi and I'm proud of both of them for learning to eat this wonderful fresh cuisine.

4) Fresh Hawaiian Bread -- Sweet by nature, this bread is at every store. One of our most refreshing meals was pre-snorkel snack of an impromptu fold over with this bread, meat and cheese.

5) The Loco Moco -- We have been blessed this week by having breakfast at the hotel every morning. This was included in our hotel stay and is a big plus. The buffet changes daily so there's really no excuse for going away hungry.

Every day it seems Will and I find our way to the omelet station. Here a one-armed man cooks omelets and eggs to order for the hundreds of guests that pass through here every day. Friendly, excited about his job, conversational, and amazing in his ability to flip skillets and make eggs with one arm, we have developed a quick relationship as we both stand in line with him every morning.

Today he talked us both into having the Hawaiian Loco Moco -- a cup of rice topped with a hamburger patty, soft egg, and turkey gravy. Initially I thought it might be island version of Candid Camera, but the dish was quite good. The egg yolk mixing with the gravy and rice made the dish. And, I mean, is anything not good if it has gravy on it?

6) Dairy Queen -- After the manta snorkel trip, we were famished (all but Kristen) so we stopped at a familiar southern eatery. I think we were surprised when we didn't find a single Hungerbuster or BeltBuster on the menu -- only hot dogs! Hawaiians love their hot dogs. That is clearly the hamburger of this culture. So when in Rome, we enjoyed them too.

7) Kona coffee and ice cream -- Kona coffee just taste better. Its not as bitter as most coffee, and it has a warm soothing effect as it goes down in the morning. Its very easy to have too much of this black elixir and stay wired for hours.

I guess that's why they invented Kona coffee ice cream.

For a bedtime treat of course.

- Posted using BlogPress from my iPhone

Location:Kona and Waimea, Big Island, Hawaii

Monday, July 5, 2010

Children and Fish: first impressions

We had a remarkable day yesterday. Will and Cathryn, outfitted in snorkel gear, joined me for their first real exploration of an active reef.

Sure, they've snorkeled in Galveston, the lake, and even at Balmorrhea. But its that first experience of seeing ocean fish in a pristine environment that can be a little breathtaking. And it was. Including for me.

We finned out about 100 yards or so, Cat holding my hand at first, until we found our first reef. There we saw all the reef regulars from Sergeant Majors, Yellow Tailed Snapper, and multiple angel fish of all varieties.

We even stumbled upon an eel. It was challenging to tell who had the biggest eyes -- Cat or the eel. He (or she, I couldn't tell) was a menacing looking creature. Mouth open reaching out of his cave. When you first encounter a new sea animal for the first time there is a sense of nervous interest on both parties. We were able to engage this animal long enough that I think Cat won't be so surprised next time.

We were able to get close to several types of puffer fish and a giant Porcupine Fish that we followed for at least a 100 feet or so until he turned around and looked with those plate size eyes questioning our persistence.

We also were able to find the Hawaiian state fish: humuhumunukunukuaupa'a. From diving here before I new it would be easier to find than to pronounce. This beautiful fish is plentiful in coastal waters, is friendly, and typifies the beauty that is Hawaii. It is multicolored with a broad black throat and shimmering scales.

Just beyond the reef there is open water, and in this area it is somewhere around 10,000 feet deep, so we began our turn back. Immediately both Will and Cat developed the seizure stroke that divers usually take on when they see something exciting or unnerving.

Fleeting views at first, it then came into view: a giant sea turtle. We were able to find another one closer to the reef happily munching on sea grass. This area of Kona is know to divers as an area filled with "cleaning stations". These are bizarre and fascinating areas where turtles come to be "cleaned" of parasitic debris by reef fish.

Hovering over the turtle at about 4 feet or so, you enjoy the magnificence that is the ocean. The turtle I'm sure had encountered a human before, but both Cat and Will were wide eyed in awe at this beautiful green creature. It only takes one experience like this to understand the need to protect these animals.

Today was a preview and Kristen and I wanted to get our kid's feet wet with diving in the ocean and experiencing animals in their world.

Tonight we are taking them on a manta ray dive. One of the few places in the world where you can be close and see these animals is Kona. Kristen and I scuba dived this area on our last trip where I had the infamous head butt by a 20 foot Manta sitting on the bottom with a lamp on top of my mask.

We won't do that today, but I'm hoping that Will and Cat can get their first impression of these fine animals. They are large, beautiful, and truly magical as they circle the depths looking for plankton.

More to follow.

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Location:N Kaniku Dr,South Kohala,United States

Texnology? -- Technology at Texas Dermatology

Technology invades our lives and our medical practice at Texas Dermatology is no exception. Over the last two years we have been on an aggressive campaign to upgrade our practice to include replacing virtually all of our hardware to create a paperless clinical environment.

We use a "cloud based" web software environment to handle all aspects of the clinical encounter from scheduling, checking on insurance eligibility, recording information in an electronic health record, and billing. It surprises many patients to learn that we use data centers all over the world to help us sort and keep track of clinical information. This allows us to rapidly, securely, and accurately file the thousands of pieces of data that are received by our practice every day.

One of the things I'm most proud of is our electronic prescribing rate. We only hand write a handful of prescriptions every month. Instead we send prescriptions to pharmacies directly which allows for patient convenience (its usually ready when they drive to pick it up!) and safety because we can cross check medications against both allergies and potential drug interactions. Refills are also automated and usually have a turn around time of less than an hour after the patient calls the pharmacy during business hours.

We hope that by the end of the year we will have a patient portal active which will allow patients access to some of their account and clinical information, scheduling, and even to submit and receive answers to their health questions.

So what would be the logical next step? A television studio of course.

Yes, its hard to believe but we have just completed construction of a state of the art broadcast studio in our Dallas office. Located in the "green room", we have lights, cameras, and action! We wouldn't have been able to do this project without the great folks at Dallas-based VideoTech and video genius Daryl Newman. He outfitted us with microphones, two broadcast quality cameras, and multiple cool LED lights -- as well as a some instruction!

But the heart of the system is a device from the San Antonio company NewTech. Its called a Tricaster and is sold as a "studio in a box" and that probably describes it well. We are able to mix multiple video inputs, internet feeds from remote broadcasts like Skype, and even local DVD video to make really cool live or recorded productions.

But probably the most exciting thing the device can do is to create "virtual sets". This is where we can use computer generated graphics to change the look and feel of the studio from a news room type environment to an auditorium for a PowerPoint presentation.

Why did we do this? We think it will add to the mission of our practice in communicating information to our patients and to that of our educational program and residency program.

Stay tuned to our website -- -- for more details as the project unfolds.

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Location:Kona, HI