An Old Cherokee Tale of Two Wolves

One evening a Cherokee Indian told his grandson about a struggle inside all people. He said, ‘My son, there is a battle is between two ‘wolves’ inside each of us.

One is Evil. It is anger, envy, jealousy, sorrow, regret, greed, arrogance, self-pity, guilt, resentment, inferiority, lies, false pride, superiority, and ego.

The other is Good. It is joy, peace, love, hope, serenity, humility, kindness, benevolence, empathy, generosity, truth, compassion and faith.’

The grandson thought about it for a minute and then asked his grandfather: ‘Which wolf wins?’

The old Cherokee simply replied, ‘The one you feed.’

 

Nurture your compassion. Starve your anger and self-pity. Keep the Good Wolf strong. —Dr T

Online Scheduling

Dear patients,

My website now has an online scheduling page! Try it, and let me know if you like it. For those of you who prefer a live connection, you can still reach me on my phone: (520) 400-8223.

—Dr T

What I offer: Primary care that people say they can’t get anymore

“I can never get through to my doctor on the phone.”  

“They never return my calls.”

  • You can reach me easily by phone. 24/7.
  • My office phone number, 400-8223, is my cell phone.  How many family physicians give you their cell phone number?
  • If I don’t answer, I am with a patient or on the phone with a patient (or in the shower) (or driving). Leave a voicemail. I will call you back.

“If I’m sick, I need to be seen today, not three weeks from Thursday.”  

“For a new patient, their first available appointment is in three months.”

  • Whether you are a new patient or have been seeing me for a long time, I will try to get you in today if you are sick.
  • Affordable urgent care with no waiting.

“The doctor spent the entire appointment typing on the computer.  Never even looked at me.”

  • I don’t have computerized medical records.

“The doctor spends 5 minutes with me, then he’s out the door.”

  • How much time would you like to spend with me? It’s up to you.

“My previous doctor didn’t really listen to me.”

  • Most of the art of medicine is in the art of listening.  
  • Doctors who take insurance have to keep their appointments short and see a lot of people every day. No wonder they don’t listen. They don’t have time.

“I had a cat scan last year, but I never heard the results.  It must be OK, because I would’ve heard by now if there was a problem. Right?”

  • This is the scariest thing I hear from patients. Always call for test results.
  • Keep calling until you get them.
  • Never assume a test was normal just because you haven’t heard anything.
  • If you don’t get results in a reasonable amount of time, assume they are lost.   Yes, it can happen. Sometimes bad news gets lost.

“My insurance changed, and my doctor is not on my new plan. I have to find a new doctor.”

“The doctor I’ve had for years stopped taking my insurance.”

  • Since I don’t deal with insurance, these will never be problems for my patients.

Think about what you are looking for in a doctor. My goal is to deliver modern medicine with old fashioned care.

Help for nighttime leg cramps

Nighttime leg cramps cause pain and sudden muscle tightness in the legs, feet, or both. The cramps can wake you up from sleep. They can last for many minutes or just a few seconds.

Nighttime leg cramps are common in both adults and children. But as people get older, they are more likely to get them. About half of people older than 50 get nighttime leg cramps.

What causes nighttime leg cramps? — Most nighttime leg cramps do not have a cause that doctors can find. When doctors do find causes, the causes can include:

  • Having a leg or foot structure that is different from normal – For example, having flat feet or a knee that bends in the wrong direction
  • Sitting in an awkward position or sitting too long in one position
  • Standing or walking a lot on concrete floors
  • Changes in your body’s fluid balance – This can happen if you:
  • Take medicines called diuretics (also called “water pills”)
  • Are on dialysis (a kind of treatment for kidney disease)
  • Sweat too much
  • Exercising
  • Having certain conditions – For example, Parkinson disease, diabetes, or low thyroid
  • Being pregnant – Some pregnant women do not have enough of the mineral magnesium in their blood. This can cause leg cramps.
  • Taking certain medicines

Is there anything I can do on my own to feel better? — Yes. Things you can try include:

  • Riding a stationary bike for a few minutes before bed – If you normally get little exercise, this might help.
  • Doing stretching exercises (picture 1)
  • Wearing shoes with firm support, especially at the back of your foot around your heel
  • Keeping bed covers loose at the foot of your bed and NOT tucked in
  • Drinking plenty of water, especially if you take diuretics. (Do this only if your doctor or nurse has not told you to limit the amount of water you drink.)
  • Limiting the amount of alcohol and caffeine you drink
  • Staying cool when you exercise, and NOT exercising in very hot weather or hot rooms

If you get a cramp, slowly stretch the cramped muscle. To prevent more cramps, you can try:

  • Walking around or jiggling your leg or foot
  • Lying down with your legs and feet up
  • Taking a hot shower with water spraying on the cramp for 5 minutes, or taking a warm bath
  • Rubbing the cramp with ice wrapped in a towel

Should I see a doctor or nurse? — See a doctor or nurse if:

  • You wake up several times a night with leg cramps
  • Your cramps keep you from getting enough sleep
  • Your cramps are very painful
  • You have cramps in other parts of your body, such as your upper back or belly

Are there tests I should have? — Probably not. Your doctor or nurse will talk with you about your symptoms and do an exam to find out what could be causing your nighttime leg cramps. Depending on your symptoms and exam, you might also need some blood tests.

How are nighttime leg cramps treated? — Treatment is different for everyone. Most people have to try a few different things before they find a treatment that helps them.

Treatment options include:

  • Mineral and vitamin supplementation, including vitamin B complex (three times daily, containing 30 mg of vitamin B6) or vitamin E (800 international units before bed), before using prescription medications. Vitamin B complex (containing fursultiamine 50 mg, hydroxocobalamin 250 micrograms, pyridoxal phosphate 30 mg, and riboflavin 5 mg) showed benefit in one randomized trial [40]; and vitamin E was beneficial in some small studies but not others [35,41].

Iron may be helpful in patients who have iron-deficient anemia; and magnesium supplementation may be of benefit in patients with pregnancy-related cramps [19,42]. However, a systematic review of randomized trials comparing magnesium supplementation with placebo identified four trials involving 322 patients with idiopathic (primarily nocturnal) leg cramps; meta-analysis of the trials found no evidence of significant benefit in the frequency or severity of cramping with magnesium therapy [42]. Three trials involving a total of 202 women with pregnancy-associated leg cramps were identified in the systematic review; only one found benefit.

  • If vitamin and mineral supplements are ineffective, you can try diphenhydramine (Benadryl), 12.5 to 50 mg nightly, at bedtime.

How to stretch the backs of your legs

Stand facing the wall, feet together, about 2 feet from the wall. With your heels firmly on the floor and your shoulders, hips, and knees lined up straight, lean forward into the wall. This should stretch the backs of your legs. Hold this position for 10 to 30 seconds. Repeat 5 times each session, at least twice a day.

Leg stretch

Gentle Oral Rehydration

If you are vomiting or have diarrhea, the greatest danger to your health is dehydration. This means your body doesn’t have enough water to function normally. Some symptoms of dehydration are thirst, weakness, and dizziness, especially when you stand up quickly. The best way to treat dehydration is with frequent, small amounts of liquids. Drinking too much or too fast can trigger more vomiting.

To rehydrate after vomiting:

1. Don’t eat or drink anything for two hours.

2. Once you have gone two hours without vomiting, take a sip of clear liquids every 5 minutes for two hours.Clear liquids include: water; chicken broth; apple, grape, or cranberry juice; Jell-O; popsicles; and caffeine-free soda. If you vomit, go back to Step 1.

3. If you can handle sips of clear liquids without vomiting, you may take two swallows of clear liquids every 5 minutes for two hours. If you vomit, go back to Step 1.

4. If you can handle swallows of clear liquids without vomiting, you may add soft foods such as mashed potatoes, cream of wheat, white bread, and rice. Avoid dairy products and caffeine. Remember—eating too much or too fast can trigger the vomiting all over again. If you vomit, go back to Step 1.

5. If you’ve come this far, you may resume a normal diet. Glad you’re feeling better!

If you haven’t been able to keep anything down for 24 hours, seek medical attention.

To rehydrate if you have diarrhea:

Drink lots of clear liquids. Clear liquids include: water; chicken broth; apple, grape, or cranberry juice; Jell-O; popsicles; and caffeine-free soda. Avoid caffeine, dairy products, and greasy foods.

If you are drinking 8 ounces every hour, and you still feel dehydrated, seek medical attention.

Follow the “BRAT” diet/ These foods tend to be a little constipating, which may help slow down the loss of fluid:

        Bananas
        Rice
        Applesauce (or apples without the peels)
        Toast

Food for Thought

Iron-Rich Foods

People with anemia have fewer red blood cells than they need. Iron-deficiency anemia, the most common form of anemia, is caused by too little iron in the diet. Without sufficient iron, your body can’t produce enough hemoglobin, a substance in red blood cells that makes it possible for them to carry oxygen to the body’s tissues. As a result, you may feel weak, tired, and irritable.
About 20% of women, 50% of pregnant women, and 3% of men do not have enough iron in their body. The solution, in many cases, is to consume more foods high in iron.
Iron from meat is heme iron.

Very good sources of heme iron, with 3.5 milligrams or more per serving, include:

  • 3 ounces of beef or chicken liver
  • 3 ounces of clams, mollusks, or mussels
  • 3 ounces of oysters

Good sources of heme iron, with 2.1 milligrams or more per serving, include:

  • 3 ounces of cooked beef
  • 3 ounces of canned sardines, canned in oil
  • 3 ounces of cooked turkey

Other sources of heme iron, with 0.7 milligrams or more per serving, include:

  • 3 ounces of chicken
  • 3 ounces of halibut, haddock, perch, salmon, or tuna
  • 3 ounces of ham
  • 3 ounces of veal

Iron in plant foods such as lentils, beans, and spinach is nonheme iron. This is the form of iron added to iron-enriched and iron-fortified foods. Our bodies are less efficient at absorbing nonheme iron, but most dietary iron is nonheme iron.

Very good sources of nonheme iron, with 3.5 milligrams or more per serving, include:

  • Breakfast cereals enriched with iron (Cream of Wheat has a lot of iron)
  • One cup of cooked beans
  • One-half cup of tofu
  • 1 ounce of pumpkin, sesame, or squash seeds

Good sources of nonheme iron, with 2.1 milligrams or more per serving, include:

  • One-half cup of canned lima beans, red kidney beans, chickpeas, or split peas
  • One cup of dried apricots
  • One medium baked potato
  • One medium stalk of broccoli
  • One cup of cooked enriched egg noodles
  • One-fourth cup of wheat germ

How to Get More Iron From Your Food

To improve your absorption of iron, eat it along with a good source of vitamin C — such as orange juice, broccoli, or strawberries — or eat nonheme iron foods with a food from the meat, fish, and poultry group.

If you have trouble getting enough iron from food sources, you may need an iron supplement. But speak to your health care provider about the proper dosage first and follow his or her instructions carefully. Because very little iron is excreted from the body, iron can accumulate in body tissues and organs when the normal storage sites — the liver, spleen, and bone marrow — are full. Although iron toxicity from food sources is rare, deadly overdoses are possible with supplements.

The Popeye Myth

If you don’t like spinach, don’t worry! It doesn’t really have much iron in it, compared with the foods listed above.