Welcome!

Dr. Lakin and his Crew

Autumn is here, and we look forward to seeing our winter visitors again. This is our second newsletter, and our goal remains to update, inform, and hopefully brighten your day.

If you are not already familiar with our website, please take a moment to check it out at www.doctordoug.com. We are always adding new information and updating material on the site to help you with your medical needs.

Again, we hope you enjoy our newsletter as much as we enjoy making it!

Paradise Valley Medical Clinic, PC
10250 N. 92 nd Street #216
Scottsdale, AZ 85258
P: 480.614.5800
F: 480.614.6322

Doctor's Corner

The Skeptical Scientist:

I am a scientist, and applying the principles of science to everyday events, is much of what goes on in my medical office. People come in to be seen and either have either a specific new healthy symptom that needs to be addressed, or they want to make sure “all is well.” Either way, they are looking for answers, and if needed, treatments.

Of course, what a person notices and reports, and much of what is observed on examination, is not “just like the textbook.” It is not an exact match for what is related in medical teachings, but is somehow similar or connected. Enough to make valid judgments and recommendations about what is going on and what to do.

Sure sometimes, when I’m lucky, a patient presents with an exact description of a known condition, such as a “classic appendicitis. They’ve had 24 hours of right lower abdominal pain, associated with loss of appetite, and fever, and it’s progressively worsening. Examination, if it’s a perfect fit, demonstrates tenderness over “Mcburney’s point” confirms the diagnosis, and off they go to the hospital for (nowadays) a CAT scan and then surgery.

But mostly, what patients report are symptoms that are similar to things I’ve heard about, but nothing that exactly matches a medical text. It is then, that my medical judgment is required. There is no book to go to, to find the exact story my patient is describing, so I need to listen carefully, disregard what is superfluous, and focus in on the specific symptoms that clarify, rather than that confuse the diagnosis.

Even though I’m trying to be scientific, erroneous assumptions can be made. Not only does information need to be obtained and synthesized, other information needs to be discarded. You often end up seeing what you look for in this world, and the same holds true for diagnosing patients’ conditions. You see what you’ve seen before and what you know.

An example of this principle from our general world of experience is something I’ve noticed when traveling. Often, I’ll think I notice someone I know, traveling in that same place as I am. Generally, I’m delighted with such a thought and intrigued by such a happy accident. But, the closer the person comes, the more I can see. Eventually, with enough visual information, I realize this is not the person I was thinking of. Of course not, how unlikely would that be. How unlikely is this that a person I know would be traveling to the same exact location, coincident with me, particularly when I’m in a large city like Chicago or New York.

The same can hold true for a making a diagnosis in someone. At first, I tend to see what I’ve seen many times before. But the more information I get, and the more detail I have, the clearer the picture becomes that this is not exactly what I thought it was. A healthy skepticism is needed to prevent me from falling into the exact same patterns of thought. I have to be able to recognize that I don’t recognize something. As one of my professors famously reminded me, “Lakin, your mind is like a parachute. It only works when it’s open.”

Sincerely,

Dr. Lakin

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News You Can Use

Front Office:

WIFI Access in Dr. Lakin’s Lobby

We now have WIFI in our lobby for those patients that would like to work while they wait for their appointment with Dr. Lakin. Please ask the front desk for our log-on and you will be on-line with “LAKINlobby”!

Back Office:

Ultrasounds in Our Office

We are very pleased to announce the addition of 2-D echos cardiac ultrasound examinations, carotid ultrasounds, and arterial and venous studies in our office.

Please meet Sapna. She is a cardiovascular sonographer. Sapna works for Ultrasound of Arizona, and comes to our office every Thursday morning to do our patient’s echos.

Ultrasound of Arizona utilizes cutting edge digital technology combined with professional and caring service to deliver clear, crisp imaging and the safest, most effective noninvasive diagnostic imaging available.

Please join us in welcoming Sapna to our office!

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Medicare Drug Plan, “ Beware the Doughnut HOLE”

Medicare members are paying all costs for drugs much sooner than expected.

It’s called the “doughnut hole,” but there is nothing sweet about it. Arizona seniors and people with disabilities are learning the hard way about a feature in the new Medicare drug plan that can cause them to pay, at times unexpectedly, three to four times more for their medications.

What is the ‘doughnut hole’?
Medicare beneficiaries are in the “doughnut hole” from the time they accumulate $2,250 in total prescription drug expenses until they surpass $5,100 in total drug expenses in a year. During that period, they must pay 100% of their drug costs. After they pass through the “doughnut hole”, the government picks up 95% of their costs.

Many Medicare beneficiaries have been caught off guard by the “doughnut hole.” They believe that the first level of coverage (the $2,250 tier) was reached only when they had spent $2,250 out of their own pockets, but it’s actually when their total costs (what they and the insurers pay) reaches $2,250.

Where to go for help?

For general information call Medicare: 1-800-633-4227. If you are deaf or hard of hearing, call the TTY number: 1-877-486-2048. Or you can visit their website at www.medicare.gov.

For one-on-one counseling, call Medicare or the State Health Insurance Assistance Program at 602-542-6595.

For one-on-one counseling, call the Area Agency on Aging: 602-264-2255.

If you believe you have been a victim of fraud, contact the Attorney General’s Office in Phoenix at 602-542-5743 or visit their website at www.azag.gov.

The new Medicare prescription plan can be a real “Catch-22”, but being well informed is the best way to understand the plan and how it affects you.

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In-Office Flu Vaccine:

The flu season is just around the corner, and this year we will be offering influenza and pneumonia vaccinations through our Flu Clinic.

Late October or November is the best time to get vaccinated, but getting vaccinated in December or even later can still be beneficial. Flu season can begin as early as October and last as late as May.

The CDC has said this year there will be a flu shot available for all that request the vaccination.

We would like to offer our patients this very important vaccine or information where you can be vaccinated for this flu season.

Please contact the front desk to schedule and for more information.

"Don't be a sick M&M this year!"

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New Shingles Vaccine Available In Our Office
Zostavax

The first vaccine to prevent shingles, Zostavax, has been approved in both the USA and Europe for adults, age 60 and older.

Shingles develops when the virus that causes chicken pox, varicella-zoster, is reactivated. After a childhood bout of chicken pox, the virus lays dormant for many years, ready to come into action when the carrier’s immune system weakens, either through age or illness.

Anyone who has ever had chicken pox is susceptible to developing shingles later on in life. Of the approximately one million people in the USA who get shingles each year, nearly half are over 60.

The new vaccine, according to the data so far, offers protection for at least four years. Zostavax is a preventative vaccine, not a treatment for shingles once you have it.

Zostavax should not be given to people with a weakened immune system, or anyone taking doses of steroids by injection or by mouth.

Call our office today, and ask Dr. Lakin if this new vaccine to prevent shingles is right for you!

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Get A Flu Shot To Protect Others As Well As Yourself!

We have all heard every reason for skipping out on flu shots;
“I don’t need it because I never get the flu”
“The last time I got a flu shot I got the flu”
“I don’t have the time.”

But a primary reason we all should get a flu shot is to protect those around us. Most healthy adults who acquire influenza will get sick, but not die from the illness. Unfortunately, that’s not true for elderly people, children, and anyone with chronic illness. Hospitalization rates for flu-infected children are high, particularly if they also have conditions like asthma.

The problem: Flu symptoms can take up to four days to develop after exposure, so people often don’t know where they got the bug. Because this family of virus is highly contagious, it spreads quickly among clusters of people. That’s why the influenza virus often is associated with an epidemic.

Flu shots thwart the virus’ attempt to spread. They significantly decrease the risk of acquiring the infection and tend to minimize symptoms in those who get it.

The shot itself is an inactivated virus, so it’s a myth that you can “catch” the flu from the shot.

As the season rolls around, we must all do our part to protect our communities.

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Put A Song In Your Heart……

Our favorite music man, Frank and Dr. Lakin!

A recent study found that people can lower their heart rate, blood pressure, and respiration by listening to slow or meditative music, even if they don’t especially like the song. Intriguingly, pausing the music occasionally for two minutes enhances the effect. By contrast, faster music literally gets the blood pumping.

Researchers say doctors may be able to improve treatment for heart attack and stroke patients by playing them a selection of songs that alternately relax and stimulate their heart. Could a home cardio workout soundtrack be next?

- Journal of the British Cardiac Society

Frank entertaining Dr. Lakin's lobby

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Tests That Keep Disease In Check As We Age

As we get older, a variety of medical tests can warn of impending problems, with hearts, bones, and other chronic disorders. As long as you are in good health and have no unusual symptoms, here is a list of tests recommended to do periodically. Of course, you should always follow your doctor’s advice.

Cholesterol:

This simple blood test can give you an idea of your heart disease risk. You should have your cholesterol tested every year beginning at age 20 and have your HDL (“good”) cholesterol and LDL (“bad”) cholesterol checked on a regular basis if your total cholesterol is over 200.

Bone Density:

Any women at high risk of osteoporosis (because her mother had it or because she is light-boned and fair skin) should have a DEXA scan to determine her bone mineral density and keep track of how it is declining over time. All women age 65 and older should have at least one DEXA scan to gauge the condition of their bones.

PSA:

This test for prostate specific antigen, a protein produced by prostate cells, can warn men of prostate cancer.

Mammogram:

Every one to two years all women over 40 should have a mammogram to detect early (and curable) breast cancer. Women with a positive family history of breast cancer may want to start screening earlier.

Colonoscopy:

This is a test for early signs of colon cancer. It should be done every 10 years starting at age 50, earlier if there is a positive family history.

Blood Pressure:

This should be checked every year after the age of 18 as long as your blood pressure is normal. If abnormal, blood pressure should be monitored according to your Doctor’s recommendations.

Eye Exams:

Every two to four years between ages 40 and 65 you should have an eye exam. Then an exam should be done every one to two years after age 65. If you wear glasses or contacts, you should have your eyes checked annually, regardless of age.

Dental Exams:

Everyone should have a dental check-up once or twice a year.

Full-Body Skin Exam:

Check yourself monthly for moles, and have an annual skin exam by a physician regardless of age. You should follow your doctor’s recommendations for more frequent exams if you have had any type of skin cancer.

Thyroid Tests:

All adults, particularly women should be screened for thyroid disorders at the age of 35 and every five years after that.

Pap Smears:

Women need a Pap smear every one to three years to detect abnormalities that may precede cervical cancer.

Diabetes Screening:

Fasting blood sugar and insulin levels should be checked if you are overweight or have a positive family history for diabetes.

- Integrative Medicine, University of Arizona 2006

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October: Breast Cancer Awareness Month

SUSAN G. KOMEN HISTORY AND MISSION

The Susan G. Komen Foundation began in 1982 as a result of a promise between two sisters. Today the Foundation has 119 Affiliates in the United States and three internationally. There are 117 Race for the Cure® events during the year in 47 states in the U.S. as well as in Germany, Italy and Puerto Rico.

All Komen events are made possible by more than 100,000 volunteers who give of their time, talents, energy and more. The Komen Foundation is known for being driven by its volunteers to raise money in the fight against breast cancer.

The Phoenix Affiliate

The Phoenix Affiliate was created in October 1999. In 1992, after losing one of their friends to breast cancer, three members of the Junior League of Phoenix determined that something needed to be done to raise awareness about the disease in the Phoenix area. They joined forces with Banner Health to bring the Race for the Cure® to Phoenix for the first time in 1993.

From that first Race with 1,500 participants and earnings of $65,000, the Komen presence in Arizona has grown. The 2005 Komen Race for the Cure® attracted more than 41,000 participants and more than 1,000 volunteers on Race Day. The Phoenix Affiliate was able to grant over $1.6 million dollars in 2006 to research, education, screening and treatment programs. Up to 75% of the money remains in Central and

Northern Arizona to help the medically uninsured and underserved. The remaining 25% goes directly to breast cancer research through the Komen Foundation Award and Research Grant Program. In 2004 and 2005, the Komen Foundation Award and Research Grant Program granted back to researchers at ASU and T-Gen, $1.2 million dollars to continue the fight against breast cancer locally.

Since the establishment of the Phoenix Affiliate, Komen has had a presence all year long in various events such as BMW Ultimate Drive®, and Rally fora Cure® which occur throughout the year. A Speaker's Bureau is available to provide free information to any group that requests an educational program and literature.

For more information about the Komen Foundation or breast health, please visit www.komen.org or call 1-800-I'M AWARE (800-462-9273). Se habla español. TDD is available.

Mission Statement

The mission of the Susan G. Komen Breast Cancer Foundation is to eradicate breast cancer as a life-threatening disease by advancing research, education, screening and treatment.

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Cut Breast Cancer Risks

October is breast Cancer Awareness Month, so this is a great time to take stock of your life style and make healthy changes. A recent study shows that eating the right number of calories and getting enough exercise are the best defenses against breast cancer---not just one or the other.

Women with high body indexes who do not exercise at least three hours per week were five times more likely to develop breast cancer. Even women who adopt these healthy behaviors later in life are more protected.

Three key factors to learn:

Body Mass Index (BMI)
Check out www.cdc.gov/nccdphp/dnpa/bmi/index.htm. If you fall out of the “normal” range, then beginning to make changes to your diet and exercise habits can decrease your chances of developing breast cancer.

Activity Level:
Keep a journal of all your activity. That includes housework, walking, gardening, and taking the stairs, anything that gets you moving. Total your time for the week. If it is less than three hours, find ways to add activity to your day.

Caloric Intake:
Check out www.mayoclinic.com/health/calorie-calculate/NU00598. Keep a daily food journal listing all calories you consume to see how you are doing.
Research indicates that lowering caloric intake alone is not enough to prevent cancer. It’s the combination of exercise and weight control that is crucial.

“Let’s Win This Battle Together!”

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Food for Thought

Foods to avoid when you are taking medications

Did you know that milk, grapefruit juice, and some other foods can interfere with your medications? Basically, there are three ways foods interact with medication.

1. Interfere with how medicine is digested and absorbed by the body:
   
   For example, milk blocks iron absorption in the stomach. Calcium found in dairy products can bind some medications, such as iron supplements and some antibiotics.
   
   
2. Block how the medicine is broken down, or metabolized, in either the intestines or liver:
   
   The body breaks down drugs and eliminates them in urine, which is why we take medication daily or several times a day. Grapefruit juice blocks enzymes in the intestines that break down certain drugs, such as cholesterol-lowering ones, heart medicines, and immunological drugs. Grapefruit juice has also been shown to reduce activity of allergy medicines so its effects are not consistent. Since the body metabolizes less medicine, more circulates in the bloodstream, as much as two to three times as much; this greatly increases the likelihood of side effects.
   

3. Mimicking the drug’s action:
   
   Some foods, or drinks, exaggerate the drug’s effect, so it’s as if you were taking a higher dose. Alcohol, for instance, acts on the brain circuits as sedatives. Caffeine can boost the effects of asthma medication.

Good advice?

Make sure to read the label on your medication.

Be sure to ask Dr. Lakin if you need to avoid certain foods while on new medications.

If you do not start feeling better, or feel worse, after starting your medication, call. It may be related to a particular food or the way you are taking the medicine.

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Just For Joints

Make life easier on your joints:

1. Avoid placing stress on smaller, more fragile joints by using larger or stronger joints.
   
2. Write with a thick pen.
3. When getting up from a chair, slide forward to the edge, keeping your feet flat on the floor. Lean forward and push down on the arms or seat of the chair with the palms of your hands.
4. Avoid squatting or kneeling.
5. When exercising, don’t do movements that require you to jerk or bounce.

- American Medical Association

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A Healthy Recipe for Fall

Roasted Salmon with Salsa

If you are looking to add fish to your diet, try this recipe!

Fish:

• 1 tsp. canola, grape seed or olive oil
• Salt and freshly ground black pepper
• 1 ½ lb. salmon fillets with skin, cut into 4 pieces

Preheat oven to 425 degrees F. Season each piece of fish with a pinch of salt and a dash of black pepper.

Heat the oil in an oven-proof medium skillet. When a drop of water dances on the surface of the pan, add the fish, skin-side up. Cook until they are seared and have a golden crust, about 3 minutes. Using tongs, turn the fish skin side down. Slip the skillet into the oven and roast until the fish is pearlescent in the center, 8 minutes for a 10 inch-thick fillet. Transfer the salmon to a serving platter or individual plates Add ½ cup of the salsa to each plate and serve.

Salsa:

• 1 small zucchini squash
• 1 small yellow squash
• 4 medium plum tomatoes, seeded and chopped
• 1 small roasted red bell pepper, seeded and finely chopped
• 1 roasted poblano chili pepper, seeded and chopped
• 1 small red onion, finely chopped
• 1 tbsp. chopped fresh lime, or 1 tsp. limejuice
• Salt and freshly ground black pepper

Dice the zucchini and squash into uniform pieces by cutting off the bottom and standing each up on a cutting board. Vertically slice off a strip about 3/8 inch wide. Rotate the vegetable and cut off 3 more strips. Stack these strips crosswise into 3/8 inch cubes. Transfer them to a bowl and combine with the tomatoes, bell and poblano peppers, and onion.

Mix in the oregano and lime. Season to taste with salt and black pepper. Let the salsa sit 15 minutes before serving to allow the flavor to meld.

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Your Top 10 Moments of Zen

1. Always remember you’re unique. Just like everyone else.
2. Never test the depth of the water with both feet.
3. It is far more impressive when others discover your good qualities without your help.
4. If at first you don’t succeed, skydiving is not for you.
5. If you tell the truth, you don’t have to remember anything!
6. Experience is something you don’t get until just after you need it.
7. Some days you are the bug, some days you are the windshield.
8. Good judgment comes from bad experience, and a lot of that comes of bad judgment.
9. A closed mouth gathers no foot.

And last, but not least…

10. Before you criticize someone, you should walk a mile in their shoes. That way, when you criticize them, you are a mile away and you have their shoes!

"Never at Dr. Lakin's office!"

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We have your healthcare needs in focus

Dr. Lakin & Staff

"Happy Halloween!"