Introduction Post

To my Kaiser patients - for those of you who are new to my blog - I started this blog as a class project back in October of 2010.  In 2011, I am going to be more serious about really using this blog as a communication tool for my patients.  I will make a much bigger effort to talk about my blog in clinic in the hopes of getting more patients to subscribe to it.  As such, I thought a brief intro to this blog is in order.

My plan is for this blog to have two kinds of posts:
#1) Once a month, I will post something longer.  My plan is that for even numbered months - I will post something clinical - maybe something on nutrition, or cancer prevention, diabetes, heart disease - stuff like that.  Every odd month, I will post something more techie related - usually I will try to highlight some website (like webMD) that I think can help patients out with their health issues.
#2) Once a week, usually on Sunday - I will post my schedule for the week.  Here is my usual schedule template:


Monday - appointments from 9:10AM to 3:10PM with lunch from 12:30 to 1:30
Tuesday - appointments from 2:30PM to 4:30PM
Wednesday - appointments from 9:50AM to 4:30PM, with lunch from 12:30 to 1:30
Thursday - no appointments
Friday - appointments from 1:30PM to 4:30PM


However, I often have to "shuffle around" my appointments to accommodate the many meetings that I have to attend.  This is what I will be highlighting once a week on my "schedule blog posts".

Second Life and Health Care

                For those of you that do not know, Second Life is an online virtual reality environment.  People go to www.secondlife.com, sign up to create an “avatar” and then enter an online virtual environment.  Some people call Second Life a game, but that is really a misnomer.  It is a game-like environment, but there is no game-like objective in Second Life.   The objective, if you can call it that, is to simply interact with other people in this environment.

                Many healthcare systems are experimenting with this relatively new environment (created in 2003) to see if it can help improve a patient’s ability to interact with their healthcare provider or healthcare system.  The Palomar Medical Center recently created a copy of their planned hospital in Second Life before the real hospital was built.  This gave prospective patients a chance to see what the hospital would look like before the doors actually opened up.

                Do I see doctors and patients interacting in Second Life in the future?  It is certainly a possibility.  However, I do not envision doctors and patients simply interacting thru their avatars – I think that that is a bit too impersonal for the doctor-patient relationship.  But I could see Second Life as a means of conducting video phone calls with one another.  Before that can happen, however, video phone calls between doctors and patients have to become more common place in general.  That particular change will likely take many years, but I am confident that it will happen at some point.

                Where I see the most benefit is in education – both in educating medical professionals and patients.  Second Life is a very powerful educational medium.  The virtual reality environment allows for simulations that are simply impractical (or even impossible) to do in real life.  Physical distance between participants is also rendered moot by this technology.   This is probably the most common current use of Second Life in the healthcare field, and it is a trend that I think will continue for many years to come.

                Do I see Kaiser using this technology in the future?  Because Kaiser is so large, I am doubtful that Kaiser will use Second Life specifically.  Kaiser tends to want to have greater control over the technology that it uses.  However, there are some people in the Kaiser IT department that are looking at the possibility of having Kaiser create its own closed system virtual reality environment – perhaps something like “Kaiser Life”.  Kaiser has always been a big proponent of using classes to teach patients how to manage their various conditions.  Using a virtual reality environment will help Kaiser reach those patients who are either unwilling to simply too busy to attend a class in the real world.

My take on the vitamin D issue

One of the hottest topics in healthcare right now is vitamin D.  By some estimates, as many as 60% of all Americans are deficient in vitamin D.  We know that vitamin D plays an important role in helping people absorb calcium from foods, and therefore is important in bone health.  However, vitamin D may also be a key player in our immune systems as well.

The main way that our bodies produce vitamin D is thru exposure to sunlight.  Therefore, most scientists suspect that Americans are so low because we spend too much time indoors, and not enough time outdoors.  Many dermatologists are beginning to recommend that when people go out, they wait 10 to 15 minutes before putting on sunscreen, to make sure that they get enough UV exposure to create enough vitamin D for themselves.

However, one other culprit that is more controversial is the role that animal protein may play.  In his book, The China Study, Dr. T. Collin Campbell talks about several studies that show that cultures that eat a larger amount of animal protein (such as most Americans), have a significantly higher risk of getting cancer and heart disease.  In the book, he suggests this possible link between animal proteins and cancer:

Animal proteins have a higher amount of sulfur containing amino acids than plant proteins do.  These sulfur containing amino acids tend to acidify the blood – to counteract that, the body leaches calcium from bones to maintain the proper pH.  This, in turn causes the blood calcium levels to be higher, which in turns inhibits the body’s ability to activate vitamin D.  This, in turn, depresses the immune system, which plays an important role in preventing cancers from taking hold inside our body.

At this point in time, much of what Dr. Campbell proposes is still theoretical – the basic science behind his claims are in the very early stages.  It is possible that the current epidemic of vitamin D deficiency and the emphasize on animal products in the American diet are purely coincidental, but I for one do believe that there is indeed a connection.

So, what should you do?

#1) Feel free to ask me to check your vitamin D levels next time that you do routine lab work.  To be honest, I have not been very good at remembering this on my own, so remind me – I will not mind.

#2) As above, if you use sunscreen when you go out (and you should), wait 10 to 15 minutes first.  15 minutes of sunlight twice a week should be enough to keep your vitamin D levels up.

#3) If you don’t get out twice a week, then consider a vitamin D supplement.  For men with normal levels – 400 units once a day should be enough.  If your levels are low, you may consider 1000 or even 2000 units a day.  For women, I would recommend a calcium and vitamin D combo – the most common combo is 600mg of calcium and 400 units of vitamin D.  You should take such a combo at least twice a day.  If you are worried about maybe getting too much, ask me to get your levels checked – it’s a simple enough test to order.

#4) Finally – give serious consideration to cutting out, or at least cutting down on animal products in your diet – that includes all forms of meat, eggs, milk, and cheese.  To learn more, I would recommend reading The China Study, as well as Dr. Neal Barnard’s Program for Reversing Diabetes.

Tips for doing video visits

Technical requirements: in order to participate, a patient must have the following:

-High speed internet connection, at least DSL.  Dial up is not sufficient.

-A good Web Cam – I recommend the Logitech 9000, available for about $75 on Amazon.com.  This is an excellent camera for video conversations.  Even with a very fast internet connection, having a good camera makes a big difference.

-Unfortunately, at this time, Kaiser cannot provide technical support.

Some tips for doing a Web Cam conversation:

-Here is a link to a website that has some great tips on how to effectively do video conversations: http://strobist.blogspot.com/2007/05/how-to-improve-your-cheapo-webcams.html

In summary - Be aware of your background, and make sure the room is quiet.

-You need a light source shining towards your face, light coming from behind you is bad.

-Try it with your friends 1st, it’s best if your very first Skype conversation is not with me.

-Center your face in the camera.

This is a “proof of concept” project – your participation will help Kaiser figure out how to better use this technology all across California.  However, this is the first time that we are trying this, so we ask for your patience while we all try get a better handle on how to do this.

-Dr. Eric Wang

Current status of my Skype/home video visits project..

For now, Kaiser has asked me to put a hold on my Skype project.  However, I am hopeful that I can start sometime in early 2011.  In the meantime, if you think that you might ever be interested in using this technology to communicate with me, there are 2 things that you can do.

#1) Get setup at home - that means getting a webcam, setting it up, downloading Skype, and giving Skype a try. Try it with your family members, it's a great way to stay in touch.

#2) Download the consent form, fill it out, and fax it back to me at 916-480-6424.  You can download the form by clicking here: https://docs.google.com/fileview?id=1L_ELj-b8ZXtaQ0H7MA1ps6Ytww5a77fs5gNbQF7EMRtfxlyILWvVDdXrgkbR&hl=en&authkey=CNTy_OQF

As always, I will let my patients know when I will be starting this service up.  In the meantime, you can see how posting about how to get the most out of your webcam by checking out this post: http://drericwang.blogspot.com/2010/10/tips-for-doing-video-visits.html

-Dr. Eric Wang