Tuesday, January 15, 2013

Why do we sneeze?

Sneezing helps our body to get rid of potential irritants such as dust and pollen, and it
also helps to clear our breathing passages.
A sneeze happens when we feel a tickle behind the nostrils: then a nerve in the nose sends a message to the brain. The brain informs the muscles of the abdomen, chest, diaphragm, vocal cords, throat, and even eyelids to work together in just the right order to get rid of the irritants, through the amazing mechanism of the sneeze. Our chest muscles squeeze the chest with enough force to shoot air up from the lungs and out through the nose at speeds of up to 100 miles per hour.
Sometimes bright light can make us sneeze-about one out of every three people sneezes when exposed to bright light. These people are called “photic” sneezers (photic means light), and this trait is hereditary.
An excerpt from the book “Why you shouldn╩╝t eat your boogers” by Francesca Gould

Thursday, January 10, 2013


by Dr. Evan Ratner M.D.
The topic of concussions in athletes has really been in the spotlight recently. There have been multiple stories on the local and national news, newspapers, and the most recent cover of Sports Illustrated.
From the NFL to the NCAA  to the UIL recognition of this all to common injury has come to the forefront of our awareness.  We have successfully managed  athletes who have sustained concussions over the past several months.
Some athletes have been cleared to return to play earlier than expected, and some have required a longer recuperation period.  By recognizing and properly managing concussion syndromes we hope to prevent the long term effects of repetitive, cumulative head injuries.
Impact Urgent Care has become a leader in neurocognitive testing for concussion management in San Antonio.
Although football may be the most widely recognized high risk sport, there are other high risk sports including soccer, cheerleading, lacrosse, basketball, baseball and bicycling. The optimal management includes obtaining a baseline study on any athlete at risk for head injury. If an injury occurs than those baseline results can be compared to a post - injury test to optimize the management of that injury.        
 The baseline study takes about 30 minutes and costs  no more than 10 dollars. A small investment of time and money can really make a difference when it comes to caring for concussions.

Isn't it normal to be tired?

I didn’t know it, but for many years I was literally gasping for air while I was asleep. It took me ten years and twelve doctors to find one who could and would help me. The persistence paid off and now I feel SO MUCH better!

This device could save my life
What was going on? I had been having health problems for years. Though never skinny, it wasn’t until I was 18 and suddenly gained 65 pounds in three months that I was truly obese. And no matter, which diet I tried or which doctor I saw, I couldn’t seem to get rid of it. Even though I tried the best diet of all: being a poor student who couldn’t afford to eat. But it still stuck around.

All through my 20s, I went to see more than a dozen doctors to see what caused this and if they could help me. Their response was almost invariably that I was just fat and should lose weight...and that was it. But how could I do it? And what caused it? Nobody seemed interested in that part, which to me was the most important factor.

I always thought, “Oh, I’m just an insomniac. So’s my dad. It must run in the family.” I'd lie down for hours, doze off, get up and go pee five times (a symptom of the apnea I didn’t know I had), read my book for a while, get a little more sleep and finally pull myself out of bed feeling bleh when it was time to get up for the day. What I didn't know is that I was dragging around with severe undiagnosed sleep apnea for who knows how long. I'm sure I had it when I was a teenager and through my 20s; I always looked at the bright energetic faces of my peers and wondered what it was like to have so much energy!

So imagine what a surprise it was when I went to see a new doctor recommended by a family friend. Rather than dismissing me outright as another fatty, she actualy listened to me, felt my neck and lower jaw and within five minutes of meeting me had diagnosed me with sleep apnea. She sent me for a sleep study that week.

I didn’t really know what to expect, but the sleep study was not bad. The rooms were like a small, nice hotel and the tech was very nice. She literally pasted wires to my scalp, but the worst part was the pulse oximeter on one finger--imagine just one finger stuck in an old-fashioned finger trap all night! The tech assured me that they would only put a breathing machine, or CPAP, on me that night if they thought it was an emergency; this was just meant to be a baseline test to see how well I slept.

I was actually able to sleep fairly quickly that night. The bed was comfortable, the tech was very nice and I was very, very tired. Only an hour later the technician woke me up with a worried expression on her face, and proceeded to fit the CPAP mask over my face! I had suffered 121 hypopneas in that first hour...essentially, I was breathing so shallowly that my blood oxygen level was in the mid-70s (i.e., not good). I didn't learn that part until later, though.

At the point when she placed the mask on my face, my main feeling was relief. They had finally found what was wrong with me. When the tech work me up four hours later, apart from a couple sleepy adjustments to the mask, I hadn't moved! They wake you up at five AM to leave the clinic, so I'd only had about five hours of sleep, four of which were on the CPAP machine. Despite that, I had SO MUCH ENERGY that day! It was incredible!

Two years later, I use my CPAP every night. I’ve fallen asleep three times without it for a nap, and boy can I tell the difference! It’s like having horrible nightmares all night and not remembering a thing except that SOMETHING happened. And my husband is still happily sleeping away next to me, the roaring of my snoring just a vague memory.

In my case, persistence paid off. But it took more than ten years. Here at Impact Urgent Care, our goal is to give you the best possible medical care, and our staff are strong patient advocates. But even the best patient advocate can’t feel the pain you’re feeling. Our clinical staff is here because they love helping and being your partners in healing, and want you to be actively involved in your own care. Don’t be afraid to ask your medical provider questions. If you’re in a clinic setting and meeting a doctor for the first time, ask them about themselves. What’s their specialty? Why did they choose to work in urgent care? What does the diagnosis they’re giving you mean? Ask until you understand and are comfortable with your treatment. After all, it’s your body.

Taking a nap for the camera
Taking a nap for the camera
Want to know more about sleep apnea? Ask your doctor.

Tips and tricks for getting along with your CPAP.
Sleep is precious. Try it.
I love the way I feel after a night's sleep now rather than how I remember feeling before I started using my CPAP, and have a few little tips and tricks I've developed over time to help keep me motivated to use it.

  • -Support helps a lot. My favorite forum for sleep apnea is CPAP Talk. There are a lot of newbies here asking many questions you may be wondering, and a lot of experienced CPAP users who can help. I highly recommend it if you're struggling.
  • -If you have an animal or a small child, you may want to introduce them to your mask and machine so you don't scare them.
  • -If you have a pet prone to shedding, like my cat, keeping fur out of your mask, hose and machine is very important. I keep my mask covered with a washcloth when I'm not using it to help keep it clean. Remember, anything that gets into that hose or machine may potentially end up in your mouth or lungs, yuck!
  • -Some kitties love to chew on plastic. Mine sure does. I caught him making tons of little teeth marks on my hose one day while I was taking a nap. I didn't have a backup hose, and had to end up covering the holes in duct tape while I waited for my new hose. Once I covered the plastic, Franklin Cat wasn't interested any more. I also keep the hose looped over our headboard so he doesn't sit or lie on it while I'm sleeping.
  • -If you have a humidifier, try it out with different settings. I'm a mouth breather and found that I had to set the humidity pretty high to avoid getting a mouth so dry it was painful and would wake me up! Some people prefer their humidifier to be set very low or even off.
  • -Use distilled water in your humidifier. You can usually get this easily at the grocery store in one or five gallon jugs. The distilled water doesn't have any minerals in it, so as it evaporates in your humidifier it won't leave a mineral deposit behind.
  • -Clean your mask, hose, humidifier, headgear, etc. regularly. I wash the snap-off silicone mask cushion at least every other night and usually every night. Keeping everything clean helps cut down on any kind of weird smell, and a clean mask always feels better on my face.
  • -Wash any makeup, lotion or moisturizer off your face before going to bed.
  • Having anything on your face can interfere with your mask making the proper seal and can cause leaks.
  • -When you're getting fitted for your mask, don't be afraid to lie down and ask for a machine to test with it. Remember, your face and the mask will shift when you go from upright to lying down, and the mask that fit perfectly in the supplier's office won't necessarily be the one you ultimately end up with.

Tuesday, January 8, 2013

Fun fact: Does it really take seven years to digest chewing gum?

What is it with seven years?  You break a mirror, seven years bad luck. Each dog year is seven human years.  Seven years to digest swallowed gum?  What if a dog broke a mirror and then swallowed a pack of gum?  Sounds like an algebra problem. 
Chewing gum is not digestible but it definitely doesn’t sit in your stomach for years.  Gum actually might help things move through the bowels faster: Sorbitol is sometimes used as a sweetener in gum and this can act as a laxative.  What does this mean?  Yes, if you look carefully, you should see it floating next to all of those lovely yellow corn kernels.

Excerpt from Why Do Men Have Nipples? by Mark Leyner and Billy Goldberg, M.D.

Thursday, January 3, 2013


Gina is a fantastic LVN who works mainly at our Woodlake location. She’s smart, bubbly and a great nurse. When her three teenage children are grown and gone, her ambition is to become an RN and travel the world nursing.

How did you get started in medicine?
When I was little, we had family friends who my mom took me to when I needed to see a doctor. I remember being a little girl and being allowed to run around the office and see what everyone did. Later, I was working at the registration desk at University Hospital and I was intrigued by everything the doctors and nurses were doing.

What was your first impression of IUC?
It looked very high tech and very up to date. Everybody was very friendly and family oriented. There were lots of smiles and people welcoming me.

How is IUC different from other places you’re worked?
I came from working at the county urgent care clinic, where we saw a more diverse group of people. IUC is different because although we don’t turn people away, it’s a private practice and so there’s a less diverse patient base; it’s just the way private practice is. I’ve worked at private urgent care centers before and it’s like that at every one.

Has anything surprised you about working at IUC?
The family orientation that everyone has here. At the bigger places, you don’t really have the chance to get together. Here, it’s a small private practice, and everyone works together to get everything done.

What do you wish other people knew about being a nurse?
I think that sometimes people fail to see everything nurses do. A lot of people think the doctors are the most important because they diagnose, but what they don’t see is the nurse is the person behind the doctor who gathers the information and tells the doctor what’s going on. The nurse sees the patient first and gets the information for the doctor, then the doctor puts it all together and the nurse implements the doctor’s orders. People tend to miss everything the nurses do.

What are some of your strongest beliefs about being a nurse?
The patient always comes first, no matter what. A lot of nurses tend to judge even though we’re not supposed to. Regardless of your personal beliefs, you have to put them aside to help the patient. The patient is always right, even if you personally don’t agree with them.

What do people usually ask you when they find out you’re a nurse?
“Wow, I didn’t know that! Have you ever encountered....?” Then I start to get calls: “I feel like this; what do you think?”

What would you tell someone who’s thinking about becoming a nurse?
It’s tough. There are a lot of politics involved and you have to be a strong person and ready to encounter different situations. You have to be able to put your personal beliefs aside to treat the patient correctly regardless of who they are and what they believe. You’re not always going to agree with the patient’s beliefs but that’s not your call. You’re there to heal their body.

How do you think IUC will change over the next few years?
I think it’ll become bigger. Over time, as more and more people find out about us, more and more keep coming because they’re satisfied with their treatment. I’m actually anxious to see us get bigger. I think we’ll be able to keep our family orientation because Dr. and Mrs. Ratner are so family oriented they’ll work hard to keep it that way; to make sure we’re still a family and we all stick together.

How would your coworkers describe you?
I think they’d say I’m caring, hardworking and a little crazy!

Have you learned anything new working at IUC?
Working as close to each other as we do there will always be disagreements and bickering but in the end we all stick together and treat the patients. Whatever our issues are with each other we put that aside and focus on the patients.

What do you think of our core values of Honesty, Respect, Teamwork, Integrity and Service?
I think our core values are very important. I see them every day; all our employees embody our core values.

What might we be surprised to find out about you?
When I come to work I’m outgoing but I keep quieter than I am outside of work. It’s work; you can’t come here and be all crazy and wild. Outside of work I can get a little crazy. I love to have fun, laugh, have a good time. Other than that I pretty much keep everything on my sleeve.

Is there anything else you’d like to tell us about IUC?
I’m really glad I have the chance to work with Impact. I think Dr. and Mrs. Ratner and all the staff are wonderful; their work ethics are beautiful because they care about each other and all the patients.

Tuesday, January 1, 2013

Dashed Hopes: When Pregnancy Ends in Miscarriage

Linda Ratner RN, CMPE
I was healthy and relatively young by today’s standards (30).  The first trimester of my pregnancy went well and seemed very easy.  I adjusted to the minor aches and pains and life went on.  At my first appointment we saw the tiny little fetus and were instantly in love.  There, before our eyes was our beautiful little glob!
Although 1994 seems a world ago,  the pain that accompanied that year is still very present.  Not only did I lose my precious dad rather suddenly, but I also lost a pregnancy that I  carried till the second trimester.  Hopes and dreams of holding that warm cuddly baby soon were replaced by a terrible fear of the unknown.
Nearly 25% of first pregnancies end in miscarriage.  Why then, if miscarriage is so common, don’t women speak of it more often?  Why aren’t we told of the risk of miscarriage by our OBs before we get pregnant so that we are armed with knowledge?
I am surrounded by young women of childbearing age that work side-by-side with me.  Together, we have suffered the inevitable loss of their first pregnancy.  As a nurse, I comfort and reassure them that Mother Nature knows what she’s doing.  They have to trust their bodies.  I offer my personal story which culminated in the eventual birth of 3 beautiful and healthy babies (not all at once!).  It takes time,  but eventually most of us move on and go on to have healthy babies.
Today, there are so many varied advances in maternal care.  I even read about a new test that can predict an impending miscarriage by analyzing progesterone levels.  According to Ioannis Gallos, MD at the University of Oxford in England, the risk of a nonviable pregnancy was 99.2% when progesterone levels were below the cut-off (Medpage Today, Neale).  This test, combined with symptoms, can help prepare a woman and her partner for an impending miscarriage.  I say “prepare”, but how can one ever prepare for such a thing?  I don’t know about you, but for me, knowledge is empowering. Not knowing is very difficult and seems to prolong the agony.  I guess given the choice, I’d rather be able to brace myself.