...who I wrote about on August 31 is sitting 20 feet from me, dialyzing 'emergently' again. His blood pressures are in the 220s over 130s. Heart rate in the 120s. Potassium is 6.7. Creatinine of 10.1, and BUN of 28.
He left hospital Q on Saturday, against medical advice. Now, he came to this ER and I drew the short straw.
"Zack," I said, with large 15 gauge needle in my hand, "I'm not trying to piss you off or anything here, but seriously, why do you do this to yourself?"
"Do what?"
"Blow off your dialysis appointments, the dialysis that is keeping you alive, and drag your butt into ERs around town when it gets too bad?"
"I'm supposed to go tomorrow."
"Yes, but why didn't you go to the one you were supposed to go to in the beginning? The point is what brought you HERE...TODAY... And every other time we see you?"
"I don't know what you're talking about."
At this point, I jab the first needle into his skin. This is soothing. "I think you do, because I don't think you're an idiot though you are acting like one."
"No I don't!"
"Whatever. Sit back, relax, and I'm not taking you off this machine for four hours even if aliens land, so don't even think about it."
I jab the second needle into his fistula and hook him up. I let his admitting nurse know he's here, what's goin on, brief history, and to be mindful of where her Against Medical Advice paperwork is. She may need it.
Thank you, Colorado taxpayers, for paying for my services today. I'm a nurse and I save lives.
....
(Maybe I'll have some nice, responsible patients who want to get well later this week. One can hope. It does happen sometimes.)
Monday, October 5, 2009
Wednesday, September 30, 2009
Old school MDs are boring.
I had to deal with a doc today who is possibly my age, possibly younger.
He speaks to me. He may ask the occasional question and will allow an answer unless I pause first to consider my answer. He does not wish to be spoken to out of turn. I don't think at any point I've really met anyone who demands 'speak only when spoken to' before. He allows no interruptions, even if it is to answer a previous question. He feels "rushed" when I stand within three feet of him. He will not answer questions like, "How many hours do you want her to dialyze today?" until he has finished chart review, orders, and a social call to another doc from another group.
There's another RN, a professional, on my team who refuses to work with him. He's asked her, in the past, with joy and glee on his face, as to whether he has "made her mad."
He doesn't make me mad.
He bores me. I go back to my book. I can even sit 10 feet away from you to read it, in a comfier chair. If you want to slog through the chart to find pertinent information on your patient instead of having me summarize it for you in 10 seconds, be my guest. Feel very important while doing so.
It's a really good book.
He speaks to me. He may ask the occasional question and will allow an answer unless I pause first to consider my answer. He does not wish to be spoken to out of turn. I don't think at any point I've really met anyone who demands 'speak only when spoken to' before. He allows no interruptions, even if it is to answer a previous question. He feels "rushed" when I stand within three feet of him. He will not answer questions like, "How many hours do you want her to dialyze today?" until he has finished chart review, orders, and a social call to another doc from another group.
There's another RN, a professional, on my team who refuses to work with him. He's asked her, in the past, with joy and glee on his face, as to whether he has "made her mad."
He doesn't make me mad.
He bores me. I go back to my book. I can even sit 10 feet away from you to read it, in a comfier chair. If you want to slog through the chart to find pertinent information on your patient instead of having me summarize it for you in 10 seconds, be my guest. Feel very important while doing so.
It's a really good book.
Tuesday, September 22, 2009
Americans and their sliced cheese.
I stopped off at the grocery store after work Saturday, still, of course, in my scrubs that mark me as a Healthcare Person.
I was in the dairy section as a large man using a walker huffed and puffed and sweated past me. He burst out in frustation (to me): "WHERE is the sliced cheese?!?" (Since I'm a nurse, of course, I know everything and am trustworthier than other customers.)
I pointed to a location across the store, and said, "Oh, that's way back near the meat stuff on the other side of produce." He shook his head, agitated.
I said, not unkindly, "Or, save yourself a few cents and slice your own cheese. The blocks are right over there." (Pointing to a refrigerator around the corner from us.)
"I have arthritis! I can't cut cheese myself! I can barely walk!"
I bit my tongue out of habit, because I'm polite by habit. I let him stomp and huff his walker away toward the sliced cheese section. Infantile cheese-cutting jokes aside, what I should have said is:
Well, if you cut your own damn cheese and USED your muscles in your hand, you might not lose use of your hands completely.
Or:
Better yet, skip the damn cheese altogether, lose 125 pounds and watch your arthritis diminish to a tolerable level, you whiny, lazy bastard.
I should have. I really should have.
I wear scrubs, and I know what I'm talking about. I'm trustworthy, even doing my grocery shopping. Right?
I was in the dairy section as a large man using a walker huffed and puffed and sweated past me. He burst out in frustation (to me): "WHERE is the sliced cheese?!?" (Since I'm a nurse, of course, I know everything and am trustworthier than other customers.)
I pointed to a location across the store, and said, "Oh, that's way back near the meat stuff on the other side of produce." He shook his head, agitated.
I said, not unkindly, "Or, save yourself a few cents and slice your own cheese. The blocks are right over there." (Pointing to a refrigerator around the corner from us.)
"I have arthritis! I can't cut cheese myself! I can barely walk!"
I bit my tongue out of habit, because I'm polite by habit. I let him stomp and huff his walker away toward the sliced cheese section. Infantile cheese-cutting jokes aside, what I should have said is:
Well, if you cut your own damn cheese and USED your muscles in your hand, you might not lose use of your hands completely.
Or:
Better yet, skip the damn cheese altogether, lose 125 pounds and watch your arthritis diminish to a tolerable level, you whiny, lazy bastard.
I should have. I really should have.
I wear scrubs, and I know what I'm talking about. I'm trustworthy, even doing my grocery shopping. Right?
Saturday, August 29, 2009
How do we do this?
Steve commented on my last post, suggesting that there are two sides of reform needed to fix health care. The users and the payers. He's right.
Insurance has an important place in the picture. We could have a system that each individual pays out of pocket for all their health care needs. This works for the very healthy and the very lucky. I myself was minding my own business one day in January of many years ago, standing at a streetlight, waiting to cross...and a Pontiac hit a patch of ice, popped up the kerb and took me with it. I don't remember the car accident (which was a hit and run). The first thing I remember after the 'minding-my-own-business' part is waking up while being rolled into an MRI.
In 1994, that entire mess had cost upwards of $25,000. Which is cheap by standards I know now. But when I was 25 years old, I was living hand to mouth and that 25K might as well have been $25 million. I was glad of having insurance. I was lucky. Dumb, stupid luck.
Thousands of people are not lucky, and bad things happen to good people all the time. Insurance holds a very useful place in the economy. It's a gambling business....who to whom can we provide a safety net while keeping the most in our coffers? There is absolutely nothing wrong with this. Yay, capitalism.
Logically, though, this leads to abuses. It's expensive to treat human beings who've been unlucky. With cancer, tuberculosis, diabetes...you name it. Obama's discussion does focus on reform on the insurance end of things.
So what DO we do about the other side of the equation?
I am not a doctor, and therefore, do not know boo about medical malpractice. I believe the many docs who say there needs to be reform here. My guys say it all the time. Others can speak to that.
What do we do about the fact that among users of health care, some people abuse the system? Read any nurse blog out there, and you'll find stories of those patients we really don't enjoy taking care of. How do you make Americans responsible, accountable, fair users of the health care system?
What if every American was required to carry health insurance, the way that you must have car insurance to drive a car....irrespective of pre-existing conditions. Obama's plan could conceivably force this in a number of ways.
Would spending less money out of pocket motivate people to improve their health? Might there be incentives in discounts on monthly rates, or in deductibles or in percentage paid for services? Incentives for:
* Having a healthy BMI or weight range or body measurements range?
* For belonging to a health club? For fitness training? For working with a physical and/or occupational therapist for some post-op surgeries?
* For safe driving records (e.g. no DUIs)?
* For proof of appropriate annual checkups that make sense? Annual physicals, or well-baby, or gyne PAPs/breast exams for women over 18, eye exams for those who need it and for people over a certain age (40? 60? I don't know). Mammograms for women, prostate exams for men...etc.
* Among diabetics, incentives for having good quarterly HB1AC values? For going to cooking classes? Among ESRD patients, incentives for going to their dialysis appointments three times a week, having good monthly KT/V and/or albumin numbers.
I don't know. I'm not sure how to encourage Americans to take care of themselves. Saying 'this is good for you' is useless. Saying 'this is less painful and difficult for you' is useless.
I'm thinking out loud, and I don't think any of these are original ideas. How else could we curtail user abuse of the health care system. Quit giving Dilaudid to people not genuinely screaming in the ERs?
I beg my docs to not order 'stat dialysis' after hours for patients who blow their dialysis appointments the same day, come into the ER feeling crappy, but their potassium levels are not yet dangerously high. I ask if they can wait 12 hours until morning. Some of my guys do this, some do not. It's a cost difference of a couple thousand dollars to the hospital/Medicare/the taxpayer. Rarely has this 'stat dialysis' been for a patient who missed an appointment in good faith. It's usually people like Zack (see below). (Zack, by the way, has been back to Hospital B this week.)
What else can we do to prevent abuses by the users of health care?
Insurance has an important place in the picture. We could have a system that each individual pays out of pocket for all their health care needs. This works for the very healthy and the very lucky. I myself was minding my own business one day in January of many years ago, standing at a streetlight, waiting to cross...and a Pontiac hit a patch of ice, popped up the kerb and took me with it. I don't remember the car accident (which was a hit and run). The first thing I remember after the 'minding-my-own-business' part is waking up while being rolled into an MRI.
In 1994, that entire mess had cost upwards of $25,000. Which is cheap by standards I know now. But when I was 25 years old, I was living hand to mouth and that 25K might as well have been $25 million. I was glad of having insurance. I was lucky. Dumb, stupid luck.
Thousands of people are not lucky, and bad things happen to good people all the time. Insurance holds a very useful place in the economy. It's a gambling business....who to whom can we provide a safety net while keeping the most in our coffers? There is absolutely nothing wrong with this. Yay, capitalism.
Logically, though, this leads to abuses. It's expensive to treat human beings who've been unlucky. With cancer, tuberculosis, diabetes...you name it. Obama's discussion does focus on reform on the insurance end of things.
So what DO we do about the other side of the equation?
I am not a doctor, and therefore, do not know boo about medical malpractice. I believe the many docs who say there needs to be reform here. My guys say it all the time. Others can speak to that.
What do we do about the fact that among users of health care, some people abuse the system? Read any nurse blog out there, and you'll find stories of those patients we really don't enjoy taking care of. How do you make Americans responsible, accountable, fair users of the health care system?
What if every American was required to carry health insurance, the way that you must have car insurance to drive a car....irrespective of pre-existing conditions. Obama's plan could conceivably force this in a number of ways.
Would spending less money out of pocket motivate people to improve their health? Might there be incentives in discounts on monthly rates, or in deductibles or in percentage paid for services? Incentives for:
* Having a healthy BMI or weight range or body measurements range?
* For belonging to a health club? For fitness training? For working with a physical and/or occupational therapist for some post-op surgeries?
* For safe driving records (e.g. no DUIs)?
* For proof of appropriate annual checkups that make sense? Annual physicals, or well-baby, or gyne PAPs/breast exams for women over 18, eye exams for those who need it and for people over a certain age (40? 60? I don't know). Mammograms for women, prostate exams for men...etc.
* Among diabetics, incentives for having good quarterly HB1AC values? For going to cooking classes? Among ESRD patients, incentives for going to their dialysis appointments three times a week, having good monthly KT/V and/or albumin numbers.
I don't know. I'm not sure how to encourage Americans to take care of themselves. Saying 'this is good for you' is useless. Saying 'this is less painful and difficult for you' is useless.
I'm thinking out loud, and I don't think any of these are original ideas. How else could we curtail user abuse of the health care system. Quit giving Dilaudid to people not genuinely screaming in the ERs?
I beg my docs to not order 'stat dialysis' after hours for patients who blow their dialysis appointments the same day, come into the ER feeling crappy, but their potassium levels are not yet dangerously high. I ask if they can wait 12 hours until morning. Some of my guys do this, some do not. It's a cost difference of a couple thousand dollars to the hospital/Medicare/the taxpayer. Rarely has this 'stat dialysis' been for a patient who missed an appointment in good faith. It's usually people like Zack (see below). (Zack, by the way, has been back to Hospital B this week.)
What else can we do to prevent abuses by the users of health care?
Saturday, August 22, 2009
Do not pass go, do not collect $200
I loved Dan Roam's look at the health care debate. It boils what the debate is about very simply. It's a great starting point.
Go here.
Go here.
Friday, August 21, 2009
A tale of two patients.
Meet Zack. Zack is 26, and will be dead by age 30. He has severe hypertension (240s systolic tyically, because he will not take medications to control his blood pressure). His kidneys have been blown out for a few years due to that bustin pressure, and he has an appointment slot at a clinic.
He doesn't go.
Last month, he was in Hospital A's ER "because he felt like ****." We dialyzed him, and he left AMA (against medical advice). He did not go to his scheduled dialysis appointments. Four days later, he returned to Hospital A's ER "feeling like ****." I dialyzed him, we discharged.
Last week, I saw him being dialyzed at Hospital B by one of my colleagues. I didn't ask why or when or whether he ended up again, leaving AMA.
Today, he was being dialyzed by a different colleague at Hospital C. He walked unaided to the inpatient dialysis room. This delightful boy flopped on the chair and barked at my colleage, "I'm having some ******ing pain, I need some ****ing Dilaudid. Those pills never work. It's chest pain. Eight out of ten." By the time we did our end-of-day hospital charges, his name was greyed out as being 'discharged'.
Now....call me stupid, but if you're going to different hospitals and sleeping over at least twice a week, going to your thrice weekly outpatient appointments seems like less bother. So is it about the ******ing Dilaudid that makes you want to spend the night at different hotels around town? If it's really that great, why not stay in the hospital and keep getting more?
I don't know for a fact that Zack doesn't pay for hospital bills, which cannot be less than $10,000 each visit.
But I do know that it is being paid for somehow, by somebody. The hospitals may write it off, but they do not take a cut in profit for someone like Zack. Those costs shift to elevated costs on other patients.
The next time I see Zack, I may ask him if he pays his multiple hosptial bills. I will be standing out of arm's length (he's thrown a punch at one of my colleagues, who is 60something and a grandmother and sweet as pie).
But I'll bet you're wondering the same thing, and for you, gentle reader, it might be worth the string of expletives.
****************************
Meet Josephine. She is 82. She is trim and active. Her two sons and their families live close by, and she has a strong network of friends. She went to the ER yesterday "feeling strange and nauseous" and they found Josephine to be in a rapid AFib. She was cardioverted today, and popped (tentatively) into sinus rhythm. (Cardioversion = low-end electric shock to heart in controlled environment.) (This can hurt.)
We also found her creatinine and BUN to be elevated enough that acute dialysis was appropriate. The cause of the acute kidney failure isn't yet clear.
She was profoundly exhausted when I arrived to dialyze. The fentanyl and versed had knocked her tiny, drug naive body SO hard that she got Narcan'ed and Romazicon'ed (reversal drugs...unpleasant to even watch them being administered). Fortunately, she does not remember this. She just really, really wants to sleep.
So I set up my half-ton of equipment and did my chart review and lab review and normal routine. Got her blood spinnin. I had assured her that once it was going, she'd have a nice quiet nap. If she woke up, I'd be at her bedside, charting and reading if she needed anything. Easy. That's what we did.
A few minutes into her dozing off, her eyes suddenly snapped open, "Is this? (she points to me and to my machines) Is this paid for by my Medicare?"
...."I'm sorry??"
"Because I have Medicare and supplemental insurance through ABC Company." She was genuinely worried.
....
Here's a LOL (little old lady) who just had 50 or so Joules direct to her heart, a cocktail of narcotic and anxiolytic that tied up her brain's opioid and other happy receptors so completely, her respiratory drive started to crap out...and then they administered meds to rip all those happy molecules right off her brain (ouch!)...and then I come in, slurp her blood into a machine, whip it around, pul off more electrically charged molecules, dumpin protein into her body to keep the blood pressure stable...and...
And she couldn't drift off to sleep because she wants to make sure she can pay for my services.
...
....
He doesn't go.
Last month, he was in Hospital A's ER "because he felt like ****." We dialyzed him, and he left AMA (against medical advice). He did not go to his scheduled dialysis appointments. Four days later, he returned to Hospital A's ER "feeling like ****." I dialyzed him, we discharged.
Last week, I saw him being dialyzed at Hospital B by one of my colleagues. I didn't ask why or when or whether he ended up again, leaving AMA.
Today, he was being dialyzed by a different colleague at Hospital C. He walked unaided to the inpatient dialysis room. This delightful boy flopped on the chair and barked at my colleage, "I'm having some ******ing pain, I need some ****ing Dilaudid. Those pills never work. It's chest pain. Eight out of ten." By the time we did our end-of-day hospital charges, his name was greyed out as being 'discharged'.
Now....call me stupid, but if you're going to different hospitals and sleeping over at least twice a week, going to your thrice weekly outpatient appointments seems like less bother. So is it about the ******ing Dilaudid that makes you want to spend the night at different hotels around town? If it's really that great, why not stay in the hospital and keep getting more?
I don't know for a fact that Zack doesn't pay for hospital bills, which cannot be less than $10,000 each visit.
But I do know that it is being paid for somehow, by somebody. The hospitals may write it off, but they do not take a cut in profit for someone like Zack. Those costs shift to elevated costs on other patients.
The next time I see Zack, I may ask him if he pays his multiple hosptial bills. I will be standing out of arm's length (he's thrown a punch at one of my colleagues, who is 60something and a grandmother and sweet as pie).
But I'll bet you're wondering the same thing, and for you, gentle reader, it might be worth the string of expletives.
****************************
Meet Josephine. She is 82. She is trim and active. Her two sons and their families live close by, and she has a strong network of friends. She went to the ER yesterday "feeling strange and nauseous" and they found Josephine to be in a rapid AFib. She was cardioverted today, and popped (tentatively) into sinus rhythm. (Cardioversion = low-end electric shock to heart in controlled environment.) (This can hurt.)
We also found her creatinine and BUN to be elevated enough that acute dialysis was appropriate. The cause of the acute kidney failure isn't yet clear.
She was profoundly exhausted when I arrived to dialyze. The fentanyl and versed had knocked her tiny, drug naive body SO hard that she got Narcan'ed and Romazicon'ed (reversal drugs...unpleasant to even watch them being administered). Fortunately, she does not remember this. She just really, really wants to sleep.
So I set up my half-ton of equipment and did my chart review and lab review and normal routine. Got her blood spinnin. I had assured her that once it was going, she'd have a nice quiet nap. If she woke up, I'd be at her bedside, charting and reading if she needed anything. Easy. That's what we did.
A few minutes into her dozing off, her eyes suddenly snapped open, "Is this? (she points to me and to my machines) Is this paid for by my Medicare?"
...."I'm sorry??"
"Because I have Medicare and supplemental insurance through ABC Company." She was genuinely worried.
....
Here's a LOL (little old lady) who just had 50 or so Joules direct to her heart, a cocktail of narcotic and anxiolytic that tied up her brain's opioid and other happy receptors so completely, her respiratory drive started to crap out...and then they administered meds to rip all those happy molecules right off her brain (ouch!)...and then I come in, slurp her blood into a machine, whip it around, pul off more electrically charged molecules, dumpin protein into her body to keep the blood pressure stable...and...
And she couldn't drift off to sleep because she wants to make sure she can pay for my services.
...
....
Monday, August 3, 2009
The obesity 'epidemic' is making me cook.
Many of my patients are on dialysis because they have had acutely failing kidneys. The kidneys get shocked from something horrible: falling off a bridge while trying to help a good samaritan....or being 28 and getting chemotherapy....or being 21 and having some stupid autoimmune disorder that causes your body to attack itself.
The bulk of the rest of my patients are overweight. The *reason* for their chronically stressed kidneys is typically due to hypertension (often a result of a high-fat high-cholesterol diet) or to type II diabetes (result of a high fat, high sugar diet and poor weight control).
I've never been heavy, but there's 7lbs that needs to go away before I let Mark take pictures of me in Hawaii in a month. I'm working consistently on it, become a regular again in the health club and all.
But just as important is that over the past few months, I've been cooking at home. Scratch that.
I have this stupid idea that women should have ONE domestic skill, such as sewing OR cooking. I quilt, and that falls under sewing. So I do not 'cook'. I assemble food. Yes, this is semantics and idiotic, but it appeases some post-feminist Camille Paglia Naomi Wolff crap I internalized in college.
So, lately, I've taken to assembling food. I know how much sugar is in my food. Not a lot, actually. I substitute butter for olive oil in most things, and I like the taste better. Mark and I pulled the first two big zucchinis out of our starter garden (read: jungle) this year. That, and some local farmer produce and my house smells of jalapeno cornbread (I made chipotle butter for it), zucchini and pecan bread, and I will make zucchini torte with green salad for dinner. Sounds fancy, but really, if I can do it...ANYbody can do it.
It's all low fat. My mother always cooked low salt, and I cook with even less because it never occurs to me to add it. I like making food spiced and flavorful, so I use fresh herbs (from my herb garden, which has never been touched by anything but sun and water and dirt) and veggies liberally. Zucchini bread takes sugar and butter, yes, but I don't have hydrogenated oils or sugar substitutes in my shelf...so my bread has none.
My mom's got this killer raspberry vinagrette that I've learned to make from ...revelation: FRESH RASPBERRIES. When I've run out, I have found exactly ONE store-made vinagrette that doesn't have high fructose corn syrup and xanthan cum and propylene alginate and other things I do not have in my pantry.
So I'm starting to give up on finding a good dressing that tastes like Mom's and make my own. Because she gave me the recipe.
And you know what? I'm a pretty decent food-assembler. You should smell this bread, man, holy cow, it's awesome. Can't wait to taste it. Our very own zucchini. From dirt we turned up a few months ago, seeds I started in Dixie cups out on my patio and transplanted. Mark did all the watering cos the garden is at his house. And I made it into bread.
I know the Food Network is a really popular thing. I hope this whole food-assemblage thing catches on to more people. I'm at the end of the bell curve in catching on. Real food. With less junk. And less of it.
Like Michael Pollan said: Eat food. Not too much. Mostly vegetables.
I do have obese patients that love to cook. I know how heavy some cuisine culture is...but it doesn't have to be. Regardless, most of my obese patients aren't cooks. They eat at Mickey D's, because it's cheap and easy.
I bet nothing at Mickey D's tastes as good as my zucchini pecan bread.
I'm slow to learn about this food-assembling thing, but I do learn.
The bulk of the rest of my patients are overweight. The *reason* for their chronically stressed kidneys is typically due to hypertension (often a result of a high-fat high-cholesterol diet) or to type II diabetes (result of a high fat, high sugar diet and poor weight control).
I've never been heavy, but there's 7lbs that needs to go away before I let Mark take pictures of me in Hawaii in a month. I'm working consistently on it, become a regular again in the health club and all.
But just as important is that over the past few months, I've been cooking at home. Scratch that.
I have this stupid idea that women should have ONE domestic skill, such as sewing OR cooking. I quilt, and that falls under sewing. So I do not 'cook'. I assemble food. Yes, this is semantics and idiotic, but it appeases some post-feminist Camille Paglia Naomi Wolff crap I internalized in college.
So, lately, I've taken to assembling food. I know how much sugar is in my food. Not a lot, actually. I substitute butter for olive oil in most things, and I like the taste better. Mark and I pulled the first two big zucchinis out of our starter garden (read: jungle) this year. That, and some local farmer produce and my house smells of jalapeno cornbread (I made chipotle butter for it), zucchini and pecan bread, and I will make zucchini torte with green salad for dinner. Sounds fancy, but really, if I can do it...ANYbody can do it.
It's all low fat. My mother always cooked low salt, and I cook with even less because it never occurs to me to add it. I like making food spiced and flavorful, so I use fresh herbs (from my herb garden, which has never been touched by anything but sun and water and dirt) and veggies liberally. Zucchini bread takes sugar and butter, yes, but I don't have hydrogenated oils or sugar substitutes in my shelf...so my bread has none.
My mom's got this killer raspberry vinagrette that I've learned to make from ...revelation: FRESH RASPBERRIES. When I've run out, I have found exactly ONE store-made vinagrette that doesn't have high fructose corn syrup and xanthan cum and propylene alginate and other things I do not have in my pantry.
So I'm starting to give up on finding a good dressing that tastes like Mom's and make my own. Because she gave me the recipe.
And you know what? I'm a pretty decent food-assembler. You should smell this bread, man, holy cow, it's awesome. Can't wait to taste it. Our very own zucchini. From dirt we turned up a few months ago, seeds I started in Dixie cups out on my patio and transplanted. Mark did all the watering cos the garden is at his house. And I made it into bread.
I know the Food Network is a really popular thing. I hope this whole food-assemblage thing catches on to more people. I'm at the end of the bell curve in catching on. Real food. With less junk. And less of it.
Like Michael Pollan said: Eat food. Not too much. Mostly vegetables.
I do have obese patients that love to cook. I know how heavy some cuisine culture is...but it doesn't have to be. Regardless, most of my obese patients aren't cooks. They eat at Mickey D's, because it's cheap and easy.
I bet nothing at Mickey D's tastes as good as my zucchini pecan bread.
I'm slow to learn about this food-assembling thing, but I do learn.
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