"Doc Martin"-Life is our Greatest Possession and Love its Greatest Affirmation: Dr. Leo Buscaglia

Medicine Needs More Individuals like Doc Martin

Look Beyond His Brash Exterior and Find the Heart of Medicine

DH DeForge, VMD

"Life is our Greatest Possession and Love Its Greatest Affirmation"

Dr. Leo Buscaglia

Extracted from Wickipedia: 30March2014

Dr. Martin Ellingham (Martin Clunes), a brilliant and successful vascular surgeon at Imperial College London, develops haemophobia (a fear of blood), forcing him to stop practising surgery. He obtains a post as the general practitioner (GP) in the sleepy Cornish village of Portwenn, where he spent childhood holidays with his Aunt Joan (Stephanie Cole). Upon arriving in Portwenn, Ellingham - whom, to his frustration, the locals address as "Doc Martin" - finds the surgery in disarray. He inherits an incompetent receptionist, Elaine Denham (Lucy Punch). In series 2-4, Pauline Lamb (Katherine Parkinson), a new receptionist and later phlebotomist, replaces Elaine. In 2011, Morwenna Newcross (Jessica Ransom) takes up the post.

The show revolves around Ellingham's interactions with the local Cornish villagers. Despite his medical brilliance, Ellingham is gruff, ill-mannered, and lacks social skills. His cold, abrasive manner offends many of the villagers. They perceive him to be short-tempered and lacking in a bedside manner, whereas he feels he is performing his duties in a professional and no-nonsense manner, not wasting time chatting with the villagers. The villagers eventually discover his fear of blood and the frequent and debilitating bouts of nausea and vomiting it causes. Ellingham's aunt, Joan Norton, provides emotional support in the face of the disquiet his abrupt manner causes among the villagers. Ellingham also finds it difficult to express his romantic feelings to primary school teacher Louisa Glasson (Caroline Catz), often spoiling a rare tender moment with, for example, a comment about an unpleasant medical condition or requesting a stool sample.

Doc Martin hides behind a gruff manner and cold abrasive words.  Inside he is gentle, kind, and a brilliant doctor.

He has a child with Louisa Glasson and marries her in this year's series.  Louisa can see through this very tough "Doc" and loves him dearly even though at times she is hurt by his defense system of pushing people away.

More doctors should be like "Doc Martin".....not in the concept of poor bedside manner or lack of social skills but in their love of their work and their compassion for the sick, the lonely, and those without hope.  Many cannot sit and watch the show Doc Martin because of its slow movement, British tones, and slow pace of action.  We must learn from the British.... member we were once British......and enjoy the quality of this special programming with the doctor who needs help from his patients to help those patients.  

I grew up in a home of great love with a strong nuclear family.  Caring, sharing, and helping others were the qualities that I was taught by my parents.  As a veterinarian, I want to be more like "Doc Martin" as part of  his inner self without the exterior facade of coldness.

Medicine has lost the "Doc Martins", the country doctors, who were always there to listen and to help.  It has been replaced by medical economics, bottom lines, and profit margins.  I am not saying that the human physicians and veterinarians who really care have disappeared but I do think the decline which started a quarter of a century ago continues to decline.  I applaud the sophistication of medicine in 2014 and the saving of lives.  I applaud the knowledge of specialists in human and veterinary medicine.  That is all terrific.  What I do not applaud is the separation of the patient from the doctor and the patient becoming just "another case"!  That is wrong!

Martin Clunes is a special actor.  His facial expressions which always are made to show gruffness cannot hide his inner self of true compassion and love.  [See photos of Martin with his baby on the program].  If you scratch the surface of this program you see a country doctor alienating his patients and acting like a royal pain.  Take a moment and look for the doctor that I see in this show.   He is a special man who cares.

Even better find "Doc Martin" within yourself.  Maybe you, too, are hiding in an abrasive outer core and cannot get close to people.  We all live as imperfect creatures seeking to be better people.  My mentor Leo Buscaglia taught me this: "We need not be afraid to touch, to feel, and to show emotion.  The easiest thing in the world is to be what you are; what you feel.  The hardest thing to be is what other people want you to be.  Don't let them put you in that position."

Dr. DeForge welcomes comments to his Blogs at:

DoctorDeForge@yahoo.com

30March2014

Obesity in Pets and Kids

Obesity in Pets and Kids

DH DeForge, VMD  08March2014

“Challenges are what make life interesting and overcoming them is what makes life meaningful.” - Joshua J. Marine

It is amazing when reviewing the Center for Disease Control and Prevention-- Fact Sheet on Childhood Obesity-- to see a mirror reflection of Obesity in Pets.  Take a moment to read the CDC's comments on what is happening to our children's overweight problem and what long term effects it can have as these young children become adolescents and then adults.

Childhood Obesity Facts-CDC

• Childhood obesity has more than doubled in children and quadrupled in adolescents in the past 30 years.1, 2
• The percentage of children aged 6–11 years in the United States who were obese increased from 7% in 1980 to nearly 18% in 2012. Similarly, the percentage of adolescents aged 12–19 years who were obese increased from 5% to nearly 21% over the same period.1, 2
• In 2012, more than one third of children and adolescents were overweight or obese.1
• Overweight is defined as having excess body weight for a particular height from fat, muscle, bone, water, or a combination of these factors.3 Obesity is defined as having excess body fat.4
• Overweight and obesity are the result of “caloric imbalance”—too few calories expended for the amount of calories consumed—and are affected by various genetic, behavioral, and environmental factors.5,6

Health Effects of Childhood Obesity

Immediate health effects:Childhood obesity has both immediate and long-term effects on health and well-being.

• Obese youth are more likely to have risk factors for cardiovascular disease, such as high cholesterol or high blood pressure. In a population-based sample of 5- to 17-year-olds, 70% of obese youth had at least one risk factor for cardiovascular disease.7
• Obese adolescents are more likely to have prediabetes, a condition in which blood glucose levels indicate a high risk for development of diabetes.8,9
• Children and adolescents who are obese are at greater risk for bone and joint problems, sleep apnea, and social and psychological problems such as stigmatization and poor self-esteem.5,6,10

Long-term health effects:

• Children and adolescents who are obese are likely to be obese as adults11-14 and are therefore more at risk for adult health problems such as heart disease, type 2 diabetes, stroke, several types of cancer, and osteoarthritis.6  One study showed that children who became obese as early as age 2 were more likely to be obese as adults.12
• Overweight and obesity are associated with increased risk for many types of cancer, including cancer of the breast, colon, endometrium, esophagus, kidney, pancreas, gall bladder, thyroid, ovary, cervix, and prostate, as well as multiple myeloma and Hodgkin’s lymphoma.15

Prevention

• Healthy lifestyle habits, including healthy eating and physical activity, can lower the risk of becoming obese and developing related diseases.6
• The dietary and physical activity behaviors of children and adolescents are influenced by many sectors of society, including families, communities, schools, child care settings, medical care providers, faith-based institutions, government agencies, the media, and the food and beverage industries and entertainment industries.
• Schools play a particularly critical role by establishing a safe and supportive environment with policies and practices that support healthy behaviors. Schools also provide opportunities for students to learn about and practice healthy eating and physical activity behaviors.

References

1. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011-2012. Journal of the American Medical Association 2014;311(8):806-814.
2. National Center for Health Statistics. Health, United States, 2011: With Special Features on Socioeconomic Status and Health. Hyattsville, MD; U.S. Department of Health and Human Services; 2012.
3. National Institutes of Health, National Heart, Lung, and Blood Institute. Disease and Conditions Index: What Are Overweight and Obesity? Bethesda, MD: National Institutes of Health; 2010.
4. Krebs NF, Himes JH, Jacobson D, Nicklas TA, Guilday P, Styne D. Assessment of child and adolescent overweight and obesity. Pediatrics 2007;120:S193–S228.
5. Daniels SR, Arnett DK, Eckel RH, et al. Overweight in children and adolescents: pathophysiology, consequences, prevention, and treatment. Circulation 2005;111;1999–2002.
6. Office of the Surgeon General. The Surgeon General's Vision for a Healthy and Fit Nation.  [pdf 840K]. Rockville, MD, U.S. Department of Health and Human Services; 2010.
7. Freedman DS, Zuguo M, Srinivasan SR, Berenson GS, Dietz WH. Cardiovascular risk factors and excess adiposity among overweight children and adolescents: the Bogalusa Heart Study. Journal of Pediatrics 2007;150(1):12–17.
8. Li C, Ford ES, Zhao G, Mokdad AH. Prevalence of pre-diabetes and its association with clustering of cardiometabolic risk factors and hyperinsulinemia among US adolescents: NHANES 2005–2006.Diabetes Care 2009;32:342–347.
9. CDC. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011  [pdf 2.7M].  Atlanta, GA: U.S. Department of Health and Human Services.
10. Dietz WH. Overweight in childhood and adolescence. New England Journal of Medicine2004;350:855-857.
11. Guo SS, Chumlea WC. Tracking of body mass index in children in relation to overweight in adulthood. American Journal of Clinical Nutrition 1999;70:S145–148.
12. Freedman DS, Kettel L, Serdula MK, Dietz WH, Srinivasan SR, Berenson GS. The relation of childhood BMI to adult adiposity: the Bogalusa Heart Study. Pediatrics2005;115:22–27.
13. Freedman D, Wang J, Thornton JC, et al. Classification of body fatness by body mass index-for-age categories among children. Archives of Pediatric and Adolescent Medicine 2009;163:801–811.
14. Freedman DS, Khan LK, Dietz WH, Srinivasan SA, Berenson GS. Relationship of childhood obesity to coronary heart disease risk factors in adulthood: the Bogalusa Heart Study. Pediatrics2001;108:712–718.
15. Kushi LH, Byers T, Doyle C, Bandera EV, McCullough M, Gansler T, et al. American Cancer Society guidelines on nutrition and physical activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity. CA: A Cancer Journal for Clinicians 2006;56:254–281.

Data from many sources indicate that the minimum percentage of overweight and obese pets in today's society is approximately 30%.  

Dr. Deborah Linder, DVM, DACVN from Tufts University reflects that a more recent study-see resource in NAVC Clinician's Brief Feb 2014..reported that up to 63% of cats are overweight or obese.

In this same publication, Dr. Linder lists the Top Five Health Effects of Obesity [i.e. Clinical Consequences] in our overweight companions.

For Dogs:

1. Poor Quality & Quantity of Life
2. Osteoarthritis
3. Intervertebral Disk Disease
4. Subclinical Conditions
5. Cardio-Respiratory Effects

For Cats:

1. Diabetes
2. Urinary Disease
3. Osteoarthritis
4. Subclinical Conditions
5. Poor Quality & Quantity of Life

If one compares the childhood obesity data to the pet obesity data, the clinical consequences are very similar.  

The development of cardiopulmonary disease and hypertension occurs in both groups and so does Diabetes.  Dr. Linder comments: "In cats, diabetes is the clinical consequence with the strongest correlation to obesity.  Not only is obesity a risk factor for diabetes, but weight loss is a mainstay of treatment for diabetic cats and increases the likelihood of remission."  The correlation between bone and joint problems in both overweight/obese humans and pets is also parallel.  

I feel that the overweight problems in pets starts when they are very young. Pets who became obese as teenage puppies and kittens are more likely to be obese as adults.  There is no data available that I can quote about this reflection but it is a reflection based on my forty years of clinical companion animal practice experience.

The CDC states the following about the Prevention of Obesity in Kids: "Healthy lifestyle habits, including healthy eating and physical activity, can lower the risk of becoming obese and developing related diseases."

There is a parallel to our pets but also an exclusion.  We can readily exercise our dogs and cats and we certainly can correctly monitor calorie intake in consultation with your Local Doctor of Veterinary Medicine.

The exclusion concerns exercise in the cat.  If a cat does not want to exercise it will not exercise.  If a cat wants to sleep it will sleep twenty hours per day and eat the other four.  Mark Twain writes:  

“Of all God's creatures, there is only one that cannot be made slave of the leash. That one is the cat. If man could be crossed with the cat it would improve the man, but it would deteriorate the cat.” 
― Mark Twain

Dr. Linder concludes: The veterinarian "discussing the potentially severe consequences of obesity and the benefits of weight loss for improving quality of life and alleviating pain and suffering may help lessen owner concerns about implementing weight management."

Post-Script from Dr. DeForge:

The important post-script is to never try to manage weight loss in any pet's seriously overweight condition by yourself.  If weight reduction is done quickly or without the guidance of a Doctor of Veterinary Medicine, it can lead to grave consequences for your pet. Clinical Lab Exams must be completed to find out if the weight gain is a consequence of calories or some other medical problem. Let your veterinarian be your guide.  Cases as seen in the cat and dog picture in this blog should be referred to a Diplomate of the American College of Veterinary Nutrition to manage with the pet owner.

Supplement Reading:
CHOW HOUNDS-Why Our Dogs are Getting Fatter-A Vet's Plan to Save their Lives-Dr. Ernie Ward-[DVM] available on Amazon.com

Please address comments concerning this blog to Dr. Don DeForge at:
DoctorDeForge@yahoo.com
08March2014