Tuesday, December 4, 2012

AN ASPIE BY ANY OTHER NAME...

I am not sure how to react to the news that my children don’t have Asperger Syndrome any more.  Should I celebrate a cure?  Hmmmmm.  Maybe not yet.

I remember when we finally reached a diagnosis.  After years of knowing something was just not right, being told not to worry because my children were not CLEARLY autistic, I finally had a diagnosis, a WORD, a NAME that explained their behavior, and so much more. Thankfully, the diagnosis also lead us to OT, SPEECH, group and individual psychotherapy, medication, numerous books, websites, meetings, lectures, support groups and friends.  I learned to work with their gifts and to accommodate their deficits.  I learned to ameliorate the problems caused by the sensory issues.  We have come so far. 
About 5 years ago, we took the kids to Disneyworld.  It was a nerve-wracking adventure.  I knew a bit, had a “special needs” pass for the rides, and prepared the best I could.  We managed to have fun despite their issues. Sure, Meredith spent the entire character breakfast UNDER the table, but I got it.  I understood why and wasn’t surprised.  Neither kid would look at or talk to a “Princess”.  No problem.  Lily needed to spin a bunch and cry even more. I understood and we went about our business and had fun within the constraints of our abilities.
This Thanksgiving, we went to London and Paris.  My children dealt with prolonged air travel, navigating the Metro and the Tube, time change, different foods, different languages and people, different smells and tastes, carrying their own luggage up stairs, not having ready access to internet and electronics, fatigue, and so much more.  The amazing thing was that they dealt with it all with very minimal fighting and fussing, with only minor meltdowns.  I was struck at how far we have all come.  I know with certainty that without our diagnosis of Asperger Syndrome, this would not have been possible.  Without the WORD and the NAME that lead to the education that led to the blueprint of the amazing brain that my kids have, we would still be serving the occasional meal under the table.  Without that NAME and diagnosis, we wouldnt have the proud identity that is now recognized by so many.
Our teachers currently put up with behavior that is normally not allowed in public school, because they get it too.  They look at my tiny Einsteins, and they appreciate the cool kids they get to teach.
So how do I feel about the peeps in charge making Asperger Syndrome disappear with DSM-V?  I have to ask why?  Why, when we finally have a NAME and a WORD that is recognized by so many, would someone go and delete it? When that NAME that can help so many find and understand the instruction manual that didn’t come with their child, but that has been communally written by so many caring parents, why would you banish the NAME?  Why?
I have to assume the reason ultimately is money.  I won’t get into that discussion tonight.  I will only say that obfuscation is not in the best interest of children with Asperger Syndrome.  DSM-V is not a new Bible written by the infallible.  It is, like all medical guides, written by humans.  My fervent hope is that other parents will have the opportunity to help their children the way I did.  I hope that parents in 5 or 10 years will have access to the resources that helped me and my family.  My prayer is that DSM-V doesn't harm the undiagnosed tiny Aspies of tomorrow.

Wednesday, May 2, 2012

Frogs made us late to school

We were going to be on time.  We really were.  I even had time to cut up some strawberries for Lily and steam touch up my pants.
Soooo, I'm standing there with no pants on, and decide to bring the strawberry remainders to the compost pile.  On the way there I see this really awesome bird, a big heron.  He is standing next to my pool.
The pool is a little green.  The cleaner thing needs a part because my kids can't keep their damned hands off of it so, surprise, it is broken.  Inez, the awesome pool guy should fix it today.
Meanwhile, my pool looks like a pond, even fooling the bird.
Mr. Heron is pacing back and forth trying to get the frog in his mouth to go ahead and die.  It is not quite like that "NEVER GIVE UP" T-shirt, but close.  He dunks the frog in the water several times trying to drown it.  This gives us time to take pictures with the big camera and then to try to get more shots with my iPhone.

He is not giving up on this frog so we are able to get pretty close.  In the process we see two other frogs swimming in the pool.  Lily is able to scoop one up in the net.  I can't find the other one.  Dammit.  We are really going to be late now.  I run to the closest filter cover, open it, no frog.  There is lots of crap I need to dump out because, it is there.  I can't just leave it.
Shit  Definitely going to be late.  I run to the other side of the pool to the other filter cover.  Mr. Heron is still trying to swallow his frog and eying me suspiciously.  Maybe it's because I'm not wearing pants, I'm not sure. 
I yank off the cover and there on a pile of leaves are two adorable brown toads. (Emily will tell if they are frogs or toads).  They are tiny and surprised and staring at me like two amphibious Anne Franks.  Don't worry tiny toads.  I'm not with the bird.
I toss the toads in the high grass where they will be safe.  Now we are REALLY late.  I scream at Lily to get in the car.  Running inside, I frantically pull now warm and wrinkle-free pants out of dryer and jump into them, Fireman style.  Wash hands quickly, grab bag, phone, etc. Run to car and screech out of driveway, confirming to my neighbors that I am indeed insane.
The victory is, HA, we were not actually late.  1 minute to spare.  Allison 1, ADHD BRAIN 1,563.  ADHD BRAIN still winning but I'll take my victory.

Tuesday, April 3, 2012

TOP 10 THINGS I LIKE ABOUT RAISING MY GIRLS ON THE SPECTRUM

10. No pesky team sports taking up Saturday leisure time.
9. Serial monogamy in footwear saves me a bundle.
8. Ditto paucity of birthday party invites.
7. No need to worry about affording the latest fad. We are clueless.
6. A long swim fixes almost any problem.
5. Ready source of encyclopedic knowledge about sharks, astronomy, anime, Harry Potter, Legos and so much more.
4. Nice to have reality check that, yes, Mommy, your bottom is big and you aren't very smart.
3. Grocery list ridiculously short thanks to sensory issues.
2. Sometimes they make me laugh so hard I might actually pee myself.

And my favorite thing about raising my kids on the spectrum:
1. On site tech support, 24/7.






Sunday, March 11, 2012

I DON'T KNOW HIS NAME, BUT HIS FACE RINGS A BELL


You are at a party.  You are introduced to the wife of an acquaintance.  You have met her before over the last 10 years, at least 3 times.  She shakes your hand as if she has never seen you.  As she walks away, you are likely to think, “She is so rude!  She knows she has met me before.”  Maybe you say it out loud, and maybe your friends agree with you, having experienced the same thing with her as well.

But there is another explanation.  She really does not remember meeting you.  She has prosopagnosia, also known as facial blindness.  Once thought to be very rare, it appears to be more common than we thought.  When people with facial blindness figure out what they have it, they are often relieved.  They finally have an explanation for why they cannot remember people and faces.  It is not because they don’t care about people, don’t have the intelligence to remember or don’t really try to remember faces.  It is just not a tool in their toolshed.  Like most things, there is a spectrum.  Some people say they never forget a face all the way to those that cannot recognize the face of their mother and father.

How do I know about this?  I happen to have a touch of it.  I didn’t know that facial blindness existed until recently.  I used to wonder WHAT was wrong with me.  I felt guilty about it for years.  I felt like there must be something wrong with me as a person that kept me from remembering people.  I am able to remember my kids, my husband, my siblings, and a few really close friends.  Beyond that, it is hit or miss.  

My particular form of prosopagnosia includes inability to recognize faces AND names.  For example, every year I dreaded our family reunion and the inevitable awkwardness of seeing cousins and aunts and uncles and having NO idea what their names were.  I might manage to remember how some of them were related to each other, at least group them in families, but that took a few years.  Unfortunately, since I only see most of them once a year, if I see them anywhere other than the Blazek family reunion, again, it’s a crapshoot if I will be able to figure out that it is a relative, and it is very unlikely that I will be able to pull up the name.  I have started seeing my cousins more often and that has made a big difference.
So how has this affected my life?  Is it a disability?  In a way it is.  I remember being with a group of people who were discussing a girl that was SUCH a snob because she always acted like she didn’t know them.  Gulp.  That could totally be me.  Actually it was me.   I distinctly remember someone telling me in a very rude voice, “You know, we have met several times”.  Please let a hole open up in the Earth and swallow me.   After that, I was very careful to be neutral when meeting new (?)  people in case, um, they actually weren’t new.  I have gotten pretty good at this.  I will either say “Nice to see you”, “How are you?” or some other phrase that fits both new and old peeps.  It’s a skill, like any other.

After my children were diagnosed with Asperger’s Syndrome, I learned about facial blindness.  I was actually quite relieved.  I knew I wasn’t just a cad, I actually have a disability.  Knowledge=Power.  Now that I know this, I can without embarrassment, explain it to people.  I have a name for it.  I don’t have to say “I’m a complete jerk so I won’t remember your face or name if I see you again.”   Instead I say, “I have facial blindness, so if I see you again and act like I don’t know you, please come up to me and tell me your name and how we know each other”.  I know that sounds weird, but it has really worked for me.  I was just at a wedding and a very nice person whom I truly really like approached me.  I was thinking, crap, she looks like someone I might know.  She came up and introduced herself and reminded me that how we knew each other.  Once she did that, I knew EXACTLY who she was.  Even though I have met her kids many times, I would not recognize them and have no idea what their names are.  I did know their names during my conversation with her, because she reminded me.  But I’ve forgotten those names.   I can pull her name up at the moment, but it will be gone by next month, unless I see her before then.

Another example: I introduced myself to a doctor at the hospital where I work.  He told me we had met before a few times.  He said it in a really nice way.  I explained the facial blindness and that I might just do it again 6 months from now (which I did, dammit).  He was actually very amused by the whole concept.  So is it a disability?  It can be, and like most disabilities, it is possible to figure out coping mechanisms.

I have developed a surprisingly positive perspective on this “disability”.  In my case, now that I know what it is, facial blindness really suits my life and my career.  I am a primary care physician in a large town, but in a neighborhood that acts like a small town.  Many of my patients are neighbors, related to each other, friends with each other, whose kids go to school together.  Just going to the grocery store or the local cafĂ©, I may see a handful of patients.  

Most doctors would have a hard time truly separating out their life as a doctor from their life as a neighbor and friend.  This is not a problem for me.  I love my patients and spend more time with them than most doctors.  I am interested in what makes them tick, what makes them happy and sad.  When I see them out in the community, I really have no idea who they are unless they tell me.  Even if they tell me they are a patient, I have no idea what is going on with them medically.  Without opening their chart and reading what is in there, they are just Joe Patient.  Once I do see them back in the office, and open their chart, the whole story comes back together and I know exactly who they are, what problems affect their lives. 

I don’t know how to explain it except to say that my patients don’t have to worry about my gossiping about them.  If I am lucky enough to recognize them, I will likely not know if the person they are with is spouse or lover, even if the other person is my patient.  By being unable to recognize them in the community, I ensure full patient confidentiality without even having to make an effort. It’s an unexpected “benefit” of having a social communication disability, but it’s one that in this case works to my advantage…and my patients’ advantage.



Saturday, March 3, 2012

KILLER SNOWBALLS

You probably know there is an obesity epidemic in this country. You likely also know that obesity can lead to heart disease, stroke, diabetes and lots of other potentially preventable diseases. Do you know why our country is so overweight and out of shape?

There are several reason. For one, our foods have changed. Most of the food we consumed is highly processed and barren of the good nutrients we used to get. The meat we eat is higher in saturated fat. The convenience foods that allow us to work 50 hour weeks are hell on our bodies.

That brings up the next issue: work. I rarely see people who are able to balance work and life. Usually the WORK side of the see-saw sends poor LIFE flying off the other end into the sandbox. Long hours, no time for exercise, eating the convenience foods, and add high stress with no release, and you have yourself a recipe for poor health. The average person who started off healthy and happy ends up with a progressively larger waistline, higher insulin levels, less energy, decreased flexibility, and a worse quality of life. I see this as a snowball effect that happens quite insidiously.

It begins with a little weight gain from overeating and not exercising. Then add a little sleep apnea. There may be no symptoms other than daytime fatigue and maybe some snoring, but every night there are repeated bursts of epinephrine and cortisol. This causes a nice round middle and an increase in weight. Now the sleep apnea is worse and the fatigue is worse, the person is just fighting to make it through the day, never mind trying to eat a healthy diet (which takes planning and energy) or hitting the gym on the way home.

By the time I see this poor soul, who has been working so hard to get ahead in life, the snowball has gotten so big and gained so much momentum that it seems there is no way to turn it around. The patient asks me why they feel so bad, and why they can't lose weight. Even if you embark on a wonderful diet of whole foods and start working with a personal trainer, it still seems hopeless. At this point, the sleep apnea needs to be treated for the snowball to go back up the hill.

This is where the conversation becomes serious. "There is no way I can wear a mask to bed." "I am claustrophobic." At this point, like Lucy, I have some splainin' to do. I give the example of a close friend's husband who was full-on a Frosty the Snowman. He finally got his sleep apnea treated and now, a few years later, he has lost 100 pounds and just ran his first Marathon. He has lost so much weight that he no longer needs his CPAP to treat his sleep apnea. (This is why some people call it Fat Apnea- it tends to go away when you lose weight.)

So if you finally get off your hamster wheel, and wonder how to become the happy, healthy person you once were, please see your doctor and be open to evaluation for sleep apnea. It can cause uncontrolled hypertension, sudden cardiac death and diabetes, among other things. And it is relatively easy to treat. If you don't believe me, just ask Frosty.

Monday, February 20, 2012

GOLDILOCKS LOOKS FOR HEALTHCARE

Goldilocks went to Forest Medical Center to look for healthcare.
First she came upon Managed Care.  She said “This kind of care is too small.”
Managed Care means there is an advantage to providing only the care that must be provided and nothing more.  In the abstract, it makes sense.  Why would you want procedure and tests done that aren’t necessary.  The rub is who decides what is necessary care? Who decides?
Usually Managed Care means an HMO.  The physicians in the HMO are rewarded financially for NOT spending healthcare dollars.   They have a regularly scheduled meeting, get a pat on the back, and hopefully a check.
Another scenario where there is an incentive to do less is Academic Medicine.  Physicians who teach residents and are paid by a university usually do not make more money if they see more patients or do more procedures.  They are paid the same salary regardless of the workload.  Doing more procedures does not net them more money, it just creates more work.
The full extent of “less is more” is seen in residency.  What resident hasn’t stormed down to the Emergency Room to dispute an admission to the hospital?  Discharge planning starts on hospital admission as a matter of survival.  More patients on your service = less sleep for you.

Let’s take an example of a patient with Congestive Heart Failure (CHF).  Severe CHF causes frequent hospitalizations.  Let’s say our patient, Mr. Bear, gets admitted to the hospital for CHF.  He receives the usual care and is discharged 2 days later.  The hospital gets paid based on what is called a DRG (Diagnosis Related Group).  If he stays 2 days or 2 weeks, the hospital gets paid the same.  The hospital has an incentive to get Mr. Bear out of the hospital as quickly as possible.    If the hospital tries to create a financial incentive for the doctor to make this hospital stay shorter, it violates the Stark Law.  The Stark Law is there to protect the patient’s interest.  It is to keep financial interest from interfering with good patient care.  Unfortunately, it can have unintended consequences.

Second she came upon Fee-For-Service.  “This kind of care is too large”, said Goldilocks.
Fee-For-Service refers to getting paid for things you do.  This means the more patients you see, the more procedures you perform, the more you make.  In this scenario, “more is more”.  There is a financial incentive to do more, whether or not the patient needs it.  I’m not saying that doctors will always intentionally do unnecessary procedures just to make a buck.  I am saying that financial incentives can cloud decision-making.  The Stark Law is also intended to protect the patient in this example.  If Dr. BB Wolf orders a test to be done at the B.B.WOLF Diagnostic Center, and Dr. Wolf makes money from tests done at his center, he must inform his patient that he could also have the testing done at the L.R. RIDINGHOOD Diagnostic Center.  If he doesn’t inform him of his options in writing, he violates Stark Law.
Let’s get back to Mr. Bear.  Dr. B.B. Wolf discovers that Mr. Bear has iron-deficiency anemia and a small lung nodule.  The doctor does not have a financial incentive to get Mr. Bear out of the hospital as quickly as possible.  He does have an incentive to address his problems now.  He get consults for Mr. Bear’s iron deficiency and small lung nodule, both things which could happen as an out-patient.  This may give more work to Dr. Wolf and his specialist friends.  With the current system, there is no incentive NOT to do this.  Also, this insures the workup is done so that Dr. Wolf isn’t sued when Mr. Bear doesn’t follow up.

Finally Goldilocks came to Accountable Care.  “This kind of care is just right!”   
Accountable Care is hopefully the solution to the problems with the above care models.  The patients are considered not as a discrete visit to a hospital or office, but rather as a whole person with all medical costs taken into account.  With this model, everyone involved in the care of the patient has a reason to keep them healthy.  The more money spent on the patient, the less the doctor makes.  Does this mean deny care for the patient?  No.  It means care for the patient in a way that keeps them healthier and out of the hospital.  If they are in the hospital, get them out quickly.   More importantly, keep them from being readmitted to the hospital. 
In the example of Mr. Bear, he really doesn’t want to spend his days in the hospital.  He would rather take his grandchildren for a walk in the forest.  With an Accountable Care Organization (ACO), the hospital can create an incentive for the physician to efficiently and safely take care of his CHF and send him home.  Stark Law does not interfere in this case.  The ACO then makes sure that he understands how to manage his CHF so he doesn’t end up right back in the hospital.  A team approach and a Medical Home provide the basis for coordinated care for Mr. Bear.  His iron deficiency and lung nodule are evaluated in a reasonable way as an out-patient, at a lower cost for everyone.  He feels more in control of his health and appreciates less visits to the Emergency Room.
These issues are more complicated than Mr. Bear or Goldilocks will ever know.  There is not one easy solution.  What Accountable Care Organizations hope to achieve is better patient care with less money.  The financial incentives don’t encourage too much or not enough.  The incentive is for just the right amount of healthcare. 
I have just signed with an ACO.  It is a leap of faith, but I have always been an optimist.  I am sure there will be barriers and frustrations.  At least in theory, this type of care will be best for my patients and aligns most closely with the way I practice medicine anyway. 

Wednesday, February 15, 2012

FERRIS BUELLER HAD IT RIGHT

I rented Ferris Bueller's Day Off for my girls.  They had never seen it, though they have heard us quote it on occasion.  I thought they should see it for Pop Culture Literacy.
One kiddo refused to watch because she knew there was an anxiety-provoking scene with Cameron and the Ferrari.  The other kiddo watched the whole thing and thoroughly enjoyed it.
What amazed me most is how much I enjoyed it after all of these years.  Even though I am no longer in highschool, I think we can all relate to being trapped in a classroom.  I think highschool just prepares us for all of the crappy jobs we have to endure before we hopefully find one we like. 
I hear stories all day long about abusive bosses and companies.  Gone are the days when loyalty was rewarded.  Now you are expected to skip your vacation days, work 10-12 hours a day, and if you get sick or have family issues, we'll just replace you.
We create most of the obstacles to our own happy lives.  We make things too complicated and hold fast to assumptions that leave us chained to things that don't really enrich our lives.
So, unless you have the rare boss that gives you the respect you deserve, why don't you take a Mental Health Day?  Hit the bookstore, the library, the museum.  Buy a journal and write in it.  Think about what you REALLY want out of life.  Remember, there is no finish line in life.  You will not reach a point where someone tells you to take it easy and enjoy yourself. You have to do that now. 
If you don't believe me, ask Ferris.

Friday, February 10, 2012

Why I love my Electronic Medical Record

I love hearing the "controversy" about electronic medical records (EMRs).  There has been resistance from doctors for many reasons. Just last week I read a scathing blog from a doctor about why he dislikes EMRs.  I used to feel the same way, and then...

Let me tell you the tale of my quest for an EMR and the love story that follows.

In 2008 I left a great job at MD Anderson to start my practice.  With nothing but a new Vaio laptop, a stethoscope and a line of credit, I started my business and my medical practice. 

One of my first decisions:  Paper or Plastic?  I decided to get an EMR if I could in any way afford it.  I don't like killing trees, I like being able to access my records from anywhere I can access the internet, and since I had a tabula rasa, I didn't have to worry about converting charts to a new system.

My second decision: which EMR?  I had no cash flow since it takes months to get contracted with insurance companies.  I was doing hospice house calls to pay the bills.  I started a process of reviewing all of the major players.  I looked in vain for pricing on the internet.  I tried to get prices from the vendors.  All of them required an online/phone meeting first so they could show me all of the bells and whistles.  All of them would then drop the bomb about price.  I would try no to gasp or laugh.  They all wanted thousands if not tens of thousands of dollars for the system, PLUS I had to close my office for a week to train my staff, PLUS I had to pay their peeps several hundred dollars a day for the training (with no option for less days of training or no training), PLUS a monthly service fee.  My favorite was the vendor that wanted me to pay for their staff to fly to Houston, put them up in a hotel and feed them, on top of the several hundred dollars a day for training.  After a frustrating summer of these useless calls, I was starting to think, "Man, what have those trees every done for me?  Why not kill a few of them?"

That is when I read about Practice Fusion.  It was in the comments of an article in I believe the NYT, an article about poor adoption of EMRs by physicians.  It said it was FREE.  Well hallelujah!  Where had they been all summer? Apparently they had been there but didn't have millions to spend on advertising their product so I had not heard of them.  I got right online and was up and running by the next day.  I couldn't believe I was getting for free what so many others paid top dollar for.  Sure, it didn't have all the bells and whistles, but there were promises of future noise-making capabilities.

How do they do it?  Well, they have advertisements.  Just like most of the free stuff on the internet, they have ads.  They make their money off of advertising.  Do I have a problem with this?  Heck no!  Just like I don't have a problem with my county and state medical societies making money by selling ads to the very expensive EMR vendors.

In fact, my state medical association was hitting all of the big hospitals and county medical societies to talk about which EMR to choose.  They compared and contrasted the big 5, or what they considered to be the big 5.  I was at one of these meetings and asked why they weren't making physicians aware of the FREE EMR?  Why were they focusing on how to get financing to pay for expensive systems when you could just get a free one?  I received a vague response about only being able to review 5 EMRs.  Several doctors in the audience approached me after to ask about Practice Fusion.  I was a little disgusted with my state medical association.  Then I realized how much money they make in advertising from these big vendors.  Silly me.

We doctors are suspicious folk.  When you tell us something is free, we want to know why.  NOTHING is free.  This is true.  All of those pizza lunches during residency weren't really free.  The price was an in-person advertisement from a drug company.  When you are hungry and have been awake for 36 hours straight, well, give me that pizza!  I asked some fellow docs why they were buying an EMR when they could have one free.  More than one responded that they were worried Practice Fusion might start charging for its services.  Hmmmm.  So they might charge one day so best to go ahead and pay another vendor.  Got it.  Wait, no I don't.

I'll admit I was suspicious too.  I had nothing to lose so I gave it a shot.  Sure enough, over the years, they have added scanned documents, e-prescribing, and even met their promise of "Meaningful Use".  I received my 18k deposit from Medicare a couple of weeks ago.  The support has been awesome.  It only makes sense.  If they make their money off advertising, more users = more money.  Ergo, they are Johnny on the spot when I need them.  The other large EMR vendors really don't have a reason to be responsive.  They have your money and a contract for more of your money.

So am I forcing myself to use something I hate?  Nope.  I love my free EMR.  I see my patients and print out the plan and email the prescriptions to the pharmacy before we leave the room.  At that point, Karla, my lovely assistant, already has a lab slip or card for the specialist I want and the patient gets all of that plus the printed plan.  Talk about convenient and efficient and a great way to keep your day moving.  The majority of refill request come through electronically and click, click I respond.  The majority of labs fall directly into the chart for me to sign off, click.  The majority of other documents are uploaded without ever making paper, from the digital fax service.  I swear I see trees smiling at me some days.

In summary, yes, there can be difficulties with the transition to an EMR.  I have found one with an easy user interface, with wonderful support and it is free.  There is no question that all of our medical records will someday be electronic in some form.  I am just glad that I found the EMR of my dreams before it was too late.  I am glad that innocent trees were not killed in the process.

Lastly, I must tell you that I do have a financial relationship with Practice Fusion.  They give me a free electronic medical record and I just got 18k from Medicare!  Whoopee!  Other than that, they do not buy me pizza or any other meals.  I have 18k to buy them myself.



Monday, February 6, 2012

Testing, One, Two...

I am having a hard time deciding on a subject for my very first blog.  I feel so tech-savy.  First I get a Twitter account and Tweet a few times, now my own blog.  Yet how to really distinguish myself...

I know:  I'll give you a glimpse inside the ADHD brain.

First, when I think of the word "blog" I think "blahhhh-g".  I am not really feeling blah, just sounds like blog.  Then I think of the word "bog", just because it rhymes.  Then I think of "The Bog of Eternal Stench".  Then Labyrinth, then David Bowie, Muppets, back to David Bowie (because he's hot), The Hunger, Catherine Deneuve, Shubert (music played by David Bowie in movie)... and I reach the end of that rabbit hole.

Lastly, I think of the word "log", because it also rhymes.  Log makes me think of very juvenile things like Beavis and Butthead, heh heh heh, heh.  I said log.  Heh heh heh.  Okay, if you get all of that you will probably get me.

So why have I decided to write?  Because I have nothing better to do?  Eating bon-bons and watching Erica Kane got old?  Actually, I feel I have something to contribute.  I am stubborn and willing to try to figure out anything and everything.  I am willing to ask questions that garner funny looks.  I have learned all about Asperger Syndrome, sensory disorders, starting a business, being an employer, health care reform, renovation a historic house... oh my the list goes on.  I continue to learn from my patients.  I am very interested in how to make people healthier with better balance and a return to old ways of living and eating.

So this is the end of the beginning, my very first blog.  Heh, heh.  I said blog.  More to come soon....