Opening up the schools safely after the Covid lockdown

New interview "Talk with Toun"

Hello everyone.

Here is a interview that came out today:
https://www.youtube.com/watch?v=xHheuzgD68Y&feature=youtu.be

It is pretty general but explains a lot of what I do and my views on Anti-aging, its a little long so watch it at your leisure.

I would very much appreciate any feedback you would like to give.

Cheers,

Enjoy the fall!

Dr. Tuakli

Roses don't put weight on you :)

Happy Valentines! Its so hard that Valentine's day comes right after all those New Year's resolutions to lose weight :(
The good news is that receiving roses doesn't put weight on you so the whole day doesn't have to be a bust.
Still, its nice to be able to navigate the other traditions of the day without gaining 5 pounds.

When did 'love' get so caught up in 'sweets'? So long as it is heart shaped you can feel loved and cared for by consuming it. ....But then there's tomorrow.

A lot of people ask me how I maintain my weight and I tell them honestly, my first rule of thumb is not to gain weight in the first place. That sounds a little trite but it is so much harder to lose weight than to gain it. Therefore, we have to take that into consideration in the first place.

I may not do all the things I preach but once I see the scale go up by 5 pounds I don't make any excuses, I adjust my activities to make sure it comes off and I can return to baseline.

I think it is easy to allow your weight to keep creeping up with a variety of excuses "it's the holidays", "It's cold outside", "when I retire/start my new job/join the gym, I will start working on my weight " and then you look around and your weight has crept up 15 pounds.

Sometimes when your weight reaches a certain level you get discouraged and think "what's the point I'm always going to be overweight!" Now, you have an excuse for not even trying. But remember rule number one is NOT to put the weight on in the first place.

 A patient of mine the other day who was 199 pounds said she just didn't know what to do, so she would just do nothing. I told her that if she continued to gain when she hit 220, all of a sudden 199 would look mighty good to her!

Whatever your weight is, it is worth starting where you are.  Even if you don't lose weight but have not gained you are still ahead of where you would have been if you didn't try. So its always worth it to make the effort even when it doesn't seem like it.
Keep rule number one rolling around in your head as you take a pinch of those Valentine candies or better yet just smell the roses!
have a happy and healthy Valentines Day!

Doctors commit suicide too!

Doctors have the highest suicide rate.

Patients may be surprised to realize that doctors get depressed and commit suicide. But what may be even more surprising is the fact that doctors have the highest rate of suicide in the country. Physicians in America have the highest rate of any profession: twice the number of suicides as the general population. 

According to Medscape: physicians have at least one completed suicide daily despite the fact that they are surrounded by other medical professions. 

A doctor at the CDC recently killed himself by drowning. This illuminates the fact  that if you don’t  seek out the signs or ask, depression can be masked.  

If you suspect someone maybe suicidal you must act.

 54% of people who commit suicide have no known prior mental health condition. 

The commonest method is with firearms, followed by hanging or strangulation. Montana has the highest incidence of suicide and Washington DC the lowest, in the United States.

I had planned to write this blog a couple of months ago when I read about a doctor and a  final year medical student, at the same hospital in New York, committing suicide in the same week. 

I didn’t get around to it because I was extremely busy and getting ready for my safari to South Africa.

But, in less than the 2 weeks that I was gone: two well known celebrities hung themselves. It is becoming an urgent issue: according to the CDC the rates are definitely increasing, having risen 25% since 1999.

Whenever someone kills themselves I always think about what a waste of a life it is, and I often wonder if they are aware of the pain and suffering they bring to their loved ones and friends. 

The people left behind feel like failures, they feel helpless and empty, soul searching for what they could have done differently.

Doctors, clearly, must do a better job of suicide prevention both for our patients and ourselves. Doctors are taught the symptoms of depression which should give them an advantage yet they too succumb to suicide. How much more people who don't understand what they maybe going through. It is up to us to assure them that the cloud will lift, even if it doesn't feel like it.

Please look at the suicide prevention website or call the national suicide prevention lifeline for more information and educate yourself.

In a nutshell: if you are depressed seek assistance from your doctor immediately. If you are on anti-depressant medication follow up with your doctor regularly even if you think nothing has changed. 

Learn the signs of depression and if your friends, family or co-workers exhibit them, encourage them to get help. Do not be afraid to ask people you care about, you will not give them an idea too commit suicide if they haven't already considered it.

Depression is like any other medical condition and there should not be a stigma attached to it. By understanding the condition and removing the stigma, people will be more willing to share how they are feeling with others.

Dr. Anne Schuchat, principal deputy director of the CDC said there are simple steps anyone can take to help someone at risk. "Beginning a conversation, helping keep them safe, helping them connect and then follow up with them," she said. "We don't think every single suicide can be prevented, but many are preventable."

How to get help: In the US, call the National Suicide Prevention Lifeline at 1-800-273-8255. The International Association for Suicide Prevention and Befrienders Worldwide also provide contact information for crisis centers around the world.

Together we can all save lives!

Pap smears

A patient said to me last week “I do believe you saved my life for the second time Dr. Tuakli” And I thought Wow! You know what, she is right. People thank me for saving their lives from time to time and not to sound cavalier but I often think that it is nice to hear but I was just doing my job. Any qualified physician could have been credited with doing the same thing. But this time was different and very stark. This 50 something year old lady has been in my practice for perhaps 3 or 4 years. She has a variety of medical issues that we have been working on and from time to time I would suggest she have a pap. She had told me previously that she had been told that she didn’t need one because she had had a hysterectomy. Interestingly enough whenever I probed further she never seemed sure about exactly what had been done. Was the uterus completely gone including the cervix? How about the ovaries? Why was the surgery done in the first place? It never ceases to amaze me how many times I ask those questions and the answer is “I don’t know”, particularly in over 40 year old women. I eventually convinced her that it would be a good idea to just do a routine check up even though she had no symptoms and so I did a pap. As soon as I started her pap I knew from the look of the lesion in her vagina that it was cancerous. Putting cells on a slide and sending it to the lab quite frankly was a formality and I had her schedule an appointment with a gynecology oncologist pending the results. She told me when she came in last week that the specialist walked into the room and the first thing he said to her was “What is a women your age doing still getting pap smears?!” (I wont be referring any more patients to him). The arrogance dissolved when he saw the cytology report and the patient has since had the appropriate surgery. So why do I tell this cautionary tale? Well, for one thing, the current guidelines imply that she did not need a pap smear, simply based on her age. Secondly, I think that many women are walking around thinking that because they have had a hysterectomy they are immune to genital cancers. Thirdly, standard recommendations are just that, written for the common good but not by someone who knows you. Do not take them as gospel. You could argue that this is the exception to the rule and that is probably true but it also means that someone’s mother and sister will still be alive 3 years from now and she also managed to avoid the trauma of cancer therapy that would have resulted had she found it later. In medicine it is not always easy to argue with “official recommendations” and specialists who don’t know the patients. I believe that I taught myself something with this case, not everything has to be rational, and care must be individualized regardless. I am a strong believer in learning from past experience even if its not written anywhere. I derive no satisfaction from my patient being diagnosed with cancer but I am sure glad I followed my gut. When in doubt get a pap, it sure beats the alternative!

Originally published in 2013 by Dr. Tuakli

Babies, babies, babies!

Babies, babies, babies! People often comment that there are so many baby pictures in my office. That’s because I love babies and they are pictures of children I have taken care of over the years, many of whom have graduated from college already. Over the years we have less and less babies in our practice. This may be because of all the anti-aging signs in the office, perhaps mothers think you have to be walking and talking to be a patient of mine! The average age of my adult patients is also increasing so not as many are getting pregnant. Be that as it may, we love our littlest patients as much as the older ones. I am still certified by Johns Hopkins with privileges in the newborn nursery and I take care of many small people. Many people do not realize that Family physicians do 3 years post graduate training in pediatrics just like pediatricians. Their focus tends to be more on out patient healthy children than sick hospitalized ones. A common question asked is why someone would choose a family physician (board certified of course) over a pediatrician to take care of their children. Here are some of the reasons: A family physician knows the whole family and what history may be relevant to the baby. The child doesn’t have to find a new doctor at 16 and has someone who has followed them and their family all their lives. With female children family physicians can answer questions about periods and gyn issues. Girls are developing much earlier these days. Family physicians generally have less children in their practice so they know and care about the intricacies of each individual child. We know all our babies by their first name. In our practice we have a dedicated room for babies so they don’t have to wait in the waiting room. And they don’t have to compete for space. In many cultures it is assumed that the person who takes care of the mother is able to take care of her whole family, it is more the norm than the exception, family practice is a holistic specialty that encompasses everyone. It is the one specialty that specializes in you whatever your age. In this country there is a push to use specialists for everything, for example I know my patients are often surprised when I treat their rash and it goes away yet they thought they would have to go to a dermatologist because they have something on their skin. Everyone should really think through their options, as always knowledge is power, and then do what makes sense for them, their family and their personal aspirations. ‘My’ last baby was born the week before Xmas rounding out a family of five and 2015 for us. Looking forward to 2016 and more babies to love and care for!

Originally published by Dr. Tuakli in 2015