The Growing Popularity of Internal Medicine Jobs

The path to becoming a licensed doctor in the Unites States takes at least 8 years to finish. After this time individuals undergo specialty training to focus on certain areas such as pediatrics, internal medicine, or surgery. Internal medicine deals with the diagnosis, treatment, and prevention of disease in adults. Throughout the years, it has gained popularity and more students of medicine are aiming to eventually be qualified for internal medicine jobs.

Scope of Internal Medicine

A doctor with this degree is called a general internist. He may be a general practitioner or he can opt to develop his expertise further by sub-specializing in specific diseases that affect certain organs of the body. Some of these are in the fields of cardiology (heart), nephrology (kidney), hematology (blood), and infectious diseases. Aside from becoming practicing physicians, internal medicine jobs can also include involvement in areas of research and academia.

Job Description

The job of an internist covers the following: diagnosis of disease through proper physical examinations and laboratory tests, treatment of the diseases and injuries, prevention of disease through regular preventative care, and maintenance of care to the road of recovery.

Since internal medicine jobs also include a role in teaching, you can see a number of doctors who hold a class or two in universities. This is especially true of those who are practicing in a university hospital. Their expertise will help hone the skills of a new generation of doctors.

There are also a growing number of internal medicine specialists focusing in the field of research. As new diseases are discovered, the drive to invent a cure for these is also rising with adequate sponsorship from the public and private sectors. You have seen new breeds of viruses that have created havoc in communities and caused deaths, and researches are pressured to come up with a cure in the least amount of time possible. This makes their role very vital, both in the discovery of new cures and prevention of an epidemic.

High Paying Job

Internal medicine jobs are sought after because of their high demand and the good salary that comes with the profession. As seen throughout the history of the United States, people from the previous decades had a different perspective and situations from today. It was either they were really healthy and did not need the care, or they had a skeptical attitude towards medicine and illnesses and thus stayed away from doctors. Today, more and more people are becoming conscious of their health and go to great measures to prevent acquiring any diseases. At the same time, a large part of the population is suffering from illnesses brought about by current lifestyles, vices, pollution, and eating habits. Both of these have caused the high demand for the care of general internists, which subsequently increased their pay. Comparing the median compensation of internists in 1999 and 2012, the figure rose from $145,397 to $188,343. Those that have a subspecialty are getting more than this.

The road to becoming a doctor and finally obtaining internal medicine jobs may be long and hard, but it is very rewarding. General internists are very valuable in the healthcare system and in the community.

Friday is World Rabies Day

On September 28, the State of Maine will celebrate the sixth annual World Rabies Day. Although Maine has not had a case of human rabies since 1937 due to reporting and effective control measures, the threat of rabies remains.

Last month, Maine CDC was notified of a domestic dog that tested positive for rabies. This is the first case of rabies in a domestic dog in Maine since 2003. This case reminds us of the importance of keeping pets up-to-date on rabies vaccine and avoiding contact with wild animals to prevent the spread of rabies. The dog was infected with a variant of the rabies virus that circulates most commonly in raccoons and is predominant in the eastern United States.

Rabies is a preventable viral disease of mammals. The virus is spread when infected animals bite or scratch a person or another animal. The virus can also be spread if saliva or tissue from the brain or spinal cord of a rabid animal touches broken skin or gets into the mouth, nose or eyes of a person or another animal.

All mammals are susceptible to rabies infection, but only a few wildlife species are important reservoirs for the disease, including raccoons, skunks, bats, and foxes. While wildlife are more likely to be rabid than are domestic animals in the United States, domestic animals can be infected when they are bitten by wild animals.

Rabies in humans is preventable through prompt appropriate medical care. If you or someone you know is bitten or scratched by an animal, wash the wound with soap and water right away, and contact your healthcare provider to find out if you need to be treated for a rabies exposure. Usually, medical care can be delayed if rabies can be ruled out in the biting animal either through a confinement period for domestic animals or rabies testing for wild animals.

All Mainers are encouraged to consider ways in which they can prevent the spread of rabies including:

• Vaccinate your pet cats and dogs against rabies; it is the law.
• Avoid contact with wild animals or other animals that you do not know.
• Bat proof your home. Wildlife biologists can provide tips on how to bat proof your home without harming bats but preventing them from entering your home.  

For more information, contact your local animal control officer or Maine CDC at 1-800-821-5821. Stop by at our World Rabies Day Table in the lobby of KeyBank Plaza on Water Street in Augusta from 8 a.m. to 2 p.m. Thursday, September 27.

From continuous to categorical

During data analysis, it is often super useful to turn continuous variables into categorical ones.  In Stata you would do something like this:

gen catvar=0
replace catvar=1 if contvar>0 & contvar<=3
replace catvar=2 if contvar>3 & contvar<=5 

etc.  And then you would label your values like so:

label define agelabel 0 "0" 1 "1-3" 2 "3-5"
label values catvar agelabel

How can we do this in R? There's a great function in R called cut() that does everything at once.  It takes in a continuous variable and returns a factor (which is an ordered or unordered categorical variable).  Factor variables are extremely useful for regression because they can be treated as dummy variables.  I'll have another post on the merits of factor variables soon.

But for now, let's focus on getting our categorical variable.  Here is our data:

And now we want to take that "Age" variable and turn in into a categorical variable.  The most basic statement is like so:


mydata$Agecat1<-cut(mydata$Age, c(0,5,10,15,20,25,30))

Here the function cut() takes in as the first argument the continuous variable mydata$Age and it cuts it into chunks that are described in the second argument.  So here I've indicated to make groups that go from 0-5, 6-10, 11-15, 16-20, etc.  By default, the right side of the interval is closed while the left is open.  You can change that, as we will see below.  First, the output with the new "Agecat" variable:

Now we can customize our intervals.  First, in Agecat2, I show how instead of spelling out every cutoff of the interval, I can just specify a sequence using seq(0, 30, 5) - this means we start at 0 and go to 30 by intervals of 5.

For Agecat3, I switch the default closed interval to be the left one by specifying "right=FALSE".

Finally, for Agecat4 I add in my own labels instead of the default "(0,5]" labels that are provided by R.  I want them to be numbers instead so I indicate "labels=c(1:6)".  The output of all of the options are shown below.

mydata$Agecat2<-cut(mydata$Age, seq(0,30,5))

mydata$Agecat3<-cut(mydata$Age, seq(0,30,5), right=FALSE)

mydata$Agecat4<-cut(mydata$Age, seq(0,30,5), right=FALSE, labels=c(1:6))

Now, if I want some summary statistics or a bivariate table, I get some nice output:



summary(mydata$Agecat1)

  (0,5]  (5,10] (10,15] (15,20] (20,25] (25,30] 
      0       1       2       0       0       1 




table(mydata$Agecat1, mydata$Sex)
       
          0 1
  (0,5]   0 0
  (5,10]  0 1
  (10,15] 1 1
  (15,20] 0 0
  (20,25] 0 0
  (25,30] 0 1

The infamous apply function

For R beginners, the apply() function seems like a secret doorway into programming bliss. It seems so powerful, and yet, beyond reach. For those just starting out, examples of how to use apply() can really help with the intuition of how to harness its power. Here are some great ways to use apply() that can really help make R programming enjoyable and useful.  

First, the general structure of apply() is like so:

apply(x, MARGIN, FUN)

1. The first argument, "x", is whatever dataset or columns of a dataset you want to do something to.
2. The second argument, "MARGIN", is how you want to apply function.  The choices are either over the rows (MARGIN=1) or the columns (MARGIN=2).
3. The third argument (FUN) is the function you apply.  

So for an easy example, if you want to just sum the entries of all the columns in your dataset called "mydata", you can do it this way:

apply(mydata, 2, sum)

But this is not always very useful.  We have other columns in our datasets, and we probably don't want to just sum all the time.  What else can we do? Here are two nice ways to use apply():


1. Counting how many columns meet a certain condition 

I have 13 child outcomes in a dataset named "births" and I want to count up how many live births there were. My "births" data looks like this: 

How can I add up the live births, especially with those pesky NA's in there? Here's a one line way to do it: 

 births$childcount<-apply(births[,1:5], MARGIN=1, function(x) {sum(x=="live birth", na.rm=TRUE)}) 

This code is saying, for the first 5 columns of my dataset births, for each row (MARGIN=1), apply the following function. The function takes x as the input (x is just the births[,1:5] dataset), and sums up for each column of this dataset the number of times it sees "live birth". The na.rm option removes any NA's from consideration.  If you had other conditions, you could say function(x) {sum(x>2010, na.rm=TRUE)}) for example, if you wanted to count up how many years were after 2010. 


 2. Changing coded missing values to NA for multiple columns at a time 

 Often datasets code their missing values as 99 or -99 instead of just leaving them blank. We might want to change these to actual missing so we can work with the data better.  For one variable at at time, I can do it with with ifelse() statement:

originaldata$variable1<-ifelse(originaldata$variable1==99 | originaldata$variable1==-99, NA, originalvariable1)

This is equivalent to the cond() command in stata, where the first argument evaluates the condition, the second argument is what is done if the condition is true, and the third argument is what is done if the condition is false.  

But what if I have 3 or 30 columns that I want to do this to? I don't have to write ifelse() statements for them all individually.  Instead, I use apply.

Here we have a dataset called "originaldata" and we have 4 variables that we want to change from the original missing values to NA values. These variables are in column numbers 2, 4, 5, and 6, as below:

I take the columns of original dataset, and for each of those columns, I use an ifelse statement to check the value of the entry: if it's 99 or -99 I change it to NA, and if it's not then I leave it the way it is. This creates a new dataset called "new data" with just those columns that I choose.

newdata<-apply(originaldata[,c(2,4:6)], MARGIN=2, function(x) {ifelse(x==99 | x==-99, NA,x)})

We print out newdata:

Now if we want the original dataset together with the changed variables, we can just cbind (column bind) them together like so:

alldata<-cbind(originaldata[, c(-2,-4:-6)], newdata)

If you want to be extra fancy, you can just combine the cbind() statement with the apply() in one statement, like this:


newdata<-cbind(originaldata[,c(-2,-4,-6)], apply(originaldata[,c(2,4:6)], MARGIN=2, function(x) {ifelse(x==99 | x==-99, NA,x)}))

Energy Drinks - A Threat to Public Health?

Are ALL energy drinks a "threat to public health" as a recent Journal of the American Medical Association (JAMA) commentary suggests? Or is it just the ones with excessively high levels of caffeine? From the point of view of one of the millions of people worldwide who enjoy energy beverages, I am concerned that the public and our government regulatory agencies may be tempted to incorrectly label ALL energy drinks as dangerous, just because some people abuse them.

Not All Energy Drinks Are Dangerous

I welcome an intelligent discussion of the absurd and potentially dangerous levels of anhydrous caffeine in some of these beverages. The general public, however, may get the impression that ALL energy drinks are unhealthy and dangerous, simply because some are purposely formulated to appeal to thrill-seeking youth

.

That would be a great loss for the many people who could find in some energy drinks a pleasant alternative to coffee, for example.

That would be a loss to the numerous diabetics and chronic fatigue sufferers who are finding real relief from some of the more carefully formulated, low-sugar drinks.

There are some real merits to well-formulated energy drinks, but the general public rarely hears anything positive about these.

This is a complex issue, but it is ripe for scientific demagogues to use as a vehicle for obtaining more grant funding for their research. That is what this JAMA commentary is really all about.

Let us separate the key points and go over them carefully:

Some energy drinks do contain very high levels of anhydrous caffeine, which may cause unpleasant side-effects if an unsuspecting person drinks too much.

Retort: The authors of this JAMA Commentary, which was not peer-reviewed, are making an issue of something that is generally already disclosed by the fact that the purchaser is paying considerably more for something clearly labeled an "energy drink", which carries the tacit message that it is stronger than an ordinary soft drink.

Many of these beverages already are clearly labeled with their caffeine content.

Most youths and young adults are drinking these high-potency energy drinks because they are seeking an extremely energized, caffeinated experience. They usually know by reputation and by labeling cues which brands contain exaggerated levels of caffeine -- and they seek them out.

Warning Labels Are Not Going to Stop Teenage Excesses

Intelligent adults may caution against such foolishness and the predictably unpleasant results that are likely, but are kids inclined to take our advice?

How effective are warning labels on cigarette packs?

How effective are speed limits and safety devices in limiting teen deaths from auto crashes?

One of the favorite sentences is articles like this is, "More research is needed." Of course it is, because that's what keeps researchers on the payroll of universities and foundations everywhere.

Gaining access to more public dollars for pointless research is what this report is all about.

More research was "needed" to measure how much cow flatulence contributes to global warming. Now we know, but it cost the American people untold millions of dollars to find out. Please tell me how this gee-whiz information has benefited taxpayers in preventing "global warming".

How many local and Congressional hearings will be held, how many millions of dollars will be spent to fund research reports on this question? How much will the freedom of the responsible public be affected by witch hunts such as this?

And, how many lives will potentially be saved for these many millions of dollars?

Parents might want to consider whether they might benefit more by keeping more of their tax dollars and simply spend more time with their children teaching them the dangers of all the risky behaviors that might cause them harm.

Does the public really need more research reports to drive more expensive legislation to try to prevent the young people of this country from harming themselves by their poor choices?

There is no doubt that there are many energy drink brands that are competing on the basis of which is "the strongest energy drink". Will warning labels, as suggested in this JAMA article, stop teenagers from imbibing ridiculous quantities of these highly caffeinated beverages?

I doubt it.

Before we give researchers carte blanche to go on a witch hunt that may lead to a New Prohibition costing all the public for the ignorance of the few, it might be useful to learn more about the Energy Drink Facts.

Universal childhood immunizations

Public Law 2009-595 went into effect on January 1. This law reinstated the universal status of childhood immunizations in Maine. As part of this legislation the Maine Vaccine Board (MVB) was formed to help the State of Maine reinstate its universal purchase of vaccines for children under age 19. The MVB assures the necessary flow of vaccine purchase funds by collecting payments from health plans, insurance companies, and other payers and remitting the funds to the state. Through the Maine CDC's Childhood Vaccine Program, the State purchases vaccines at favorable rates and distributes them to providers at no charge.

 

This means that all Advisory Committee on Immunization Practices (ACIP) recommended vaccines are now available to all Maine children under age 19 at no cost to the child’s family or to providers in the State of Maine.

This program has many benefits for Maine citizens:

• reduces out-of-pocket vaccine costs for parents
• improves vaccination rates in Maine children
• lowers costs of vaccines through a public-private partnerships
• lowers vaccine costs in provider offices
• improves vaccine access by creating a single-tier system in provider offices
• most importantly, will improve vaccine rates by offering combination vaccines to reduce missed opportunities.

For more information: http://www.mevaccine.org/

Protect Your Groundwater Day

Nearly 2/3 of Maine people get their drinking water from groundwater, so we have a large stake in protecting our groundwater quality and quantity in Maine. We can all use this day to begin doing our part for protecting one of our most important natural resources — our groundwater!

 

Some things you can do to help protect our groundwater:

• Properly maintain your septic system: make sure to have your septic tank pumped every 3 to 5 years and check for signs that your septic system is not working
• Handle gasoline, motor oil, fertilizers, pesticides and other hazardous chemicals with care, making sure not to dump them on the ground or pour them down the sink. When you’re done with them, dispose of them properly at a recycling center
• Inspect your heating oil tank and its piping to make sure it’s not leaking, starting to corrode or rust, or in danger of tipping over
• Don’t throw away or flush unused or unwanted medications down the drain. Instead, properly and safely dispose of them by using Maine’s Safe Medicine Disposal for ME free medication mailback program

Public drinking water systems regularly monitor and test the drinking water they provide, but if you have your own well, you should have your water tested every year for bacteria, nitrates and nitrites, and every 3-5 years for naturally occurring arsenic, radon, and uranium.

 

For more information on Protect Your Groundwater Day, or to learn more ways you can protect groundwater, visit http://www.ngwa.org/Events-Education/groundwater-day/Pages/default.aspx. For information on public water systems visit the Drinking Water Program website at www.medwp.com. For more information on private wells, visit http://wellwater.maine.gov.

Fighting the Stigma of Diabetes

A few days ago I came across something I hadn't experienced for a long time, the social stigma of diabetes.

I was having a conversation with someone and, as often happens because of what I do for a living, the subject of my diabetes came up. Upon hearing about my condition the person looked me up and down and proceeded to pass a silent judgement on me based on what their perception of diabetes was ie a disease that's caused by laziness and greed. It didn't matter that I have type 1 diabetes, an autoimmune condition whose cause has nothing to do with lifestyle or diet, or that this persons judgment had an air of hypocrisy about it, given that I know they are a smoker!

But it got me thinking about what the general perception of diabetes is and how horrible it is for someone with diabetes, particularly type 2, to have to deal with judgement and generalization about their condition and the idea that people simply believe: "you ate too much, it's all your own fault!" It's hard enough having to look after this condition on an everyday basis without also feeling compelled to explain the pathophysiology of diabetes to every person who gives you a dirty look when they find out about your secret. In fact it's bloody exhausting sometimes!

I've often seen other diabetics, of all types, hide their condition or segregate themselves into particular groups, "I have diabetes but its type 1" is something I've often heard, as though they have to make an excuse. The public perception of type 2 diabetes is not only wrong but the social stigma attached to it only serves to divide us all and create conflict where absolutely none should exist.

Nobody wants to get diabetes.

Yes there is a plethora of evidence that type 2 diabetes is closely related to bad dietary choices and sedentary lifestyles but I have personally met and worked with many people with type 2 who do not fall into either category. It often affects people of all ages, builds and lifestyles for no other reason than genetic bad luck. Even those who are overweight and get it never intended for that outcome. Odds are that they feel bad enough without some high and mighty fool judging them and rubbing salt in the wound. It's always seemed strange to me that a person can develop lung cancer from a lifetime of smoking cigarettes and they will receive nothing but support and love from everyone. Yet if you are overweight and develop type 2 diabetes then the reaction is often almost the exact opposite even though both are life-threatening illnesses.

So what can we do about it?

Let's try sticking together for a start. Whatever type of diabetes you have, be it type 1, type 2, gestational or L.A.D.A, the fact is that we are all in this thing together. Instead of wishing that type 1 and 2 were given different names and definitions why not support each other, encourage each other and help each other live better and healthier lives with it. An interesting fact is that if type 2 diabetes didn't exist then the level of funding for treatment of the disease as whole would be far smaller and it would attract a lot less research into the hope of finding a cure.

The fact of the matter is that we are a nation within nations and we have a common bond with each other. We all know the time, effort and emotional toll it takes to look after ourselves. We know the pain of the highs, the fear of the lows, the frustration of having to always consider blood sugars when we're making daily decisions and we also know this is a life-long battle, and it's one that should never be fought alone.

Instead of trying to constantly distance ourselves from one another because of a fear of how we'll be perceived lets stand up for one another and try to eradicate ignorance and educate those who don't know what diabetes really is and just how hard it often is for all of us. The woman who I was speaking to judged me without thinking but that's not her fault. There's a mountain of disinformation, mistaken assumptions, half-truths and basic stupidity when it comes to how diabetes is reported in the news or portrayed in the media (if you don't believe me, watch "Con Air" (an immense low-point, diabetes-wise!). People simply take what they hear about it at face value and in reality they don't know that much about it. So I called her out on it immediately and explained the nature of the condition, taught her a little about it and how it's not something I would wish on my worst enemy. She actually thanked me afterwards as she didn't realize just how wrong she had it. And all of us can do the same. When you're confronted by a similar situation, don't get annoyed, don't make excuses for it, make something good come out of it by informing and educating. Every small moment like that will benefit every diabetic in the end as it will help to change how people see this thing and allow us more time to get on with the far more important task of actually living and thriving with diabetes.

Newborn Screening Awareness Month

Newborn screening saves lives, prevents disabilities and saves money. In the last five decades, newborn screening has become a well-defined, nationwide early identification program. Every year, 4 million infants born in the United States are screened shortly after birth for hearing loss and certain genetic, endocrine, and metabolic disorders. Each year, approximately 12,000 infants will be identified with one of these disorders.


The goal of newborn screening is to identify infants who appear healthy at birth, but who may have one of these disorders which can cause severe illness or death. Through early identification and treatment, newborn screening provides an opportunity for significant reductions in morbidity and mortality while reducing health care costs associated with treatment of lifelong debilitating conditions.

For more information, visit www.cdc.gov/features/ScreeningNewborns or get information on newborn screening in Maine.

Suicide prevention

There are numerous efforts being to recognize and support World Suicide Prevention Day. In Maine, a number of events are planned:


The Maine Suicide Prevention Program, a statewide suicide prevention initiative led by Maine CDC, in collaboration with the Departments of Education, Labor, Corrections, and Public Safety, is hosting a free training, “The Assessment and Management of Suicidal Clients,” from 9 a.m. to noon Sept. 10 at the University of Southern Maine in Portland. The goal of this workshop is to provide participants with the essential tools needed to assess suicide risks accurately and manage challenging scenarios effectively. The presenter is Dr. David Rudd, PhD, Dean of the College of Social and Behavioral Sciences at the University of Utah and Scientific Director for the National Center for Veterans Studies. Dr. Rudd is widely published and was recently elected a Distinguished Practitioner and Scholar of the National Academies of Practice in Psychology. In addition to his clinical work, Dr. Rudd is an active researcher with more than 170 publications. Registration is required at http://www.ccsme.org/Events.htm

Visit www.ccsme.org/train/suicideprevention to view the complete schedule of Suicide Prevention trainings for 2012-2013 and to register for these trainings.

The Maine Suicide Prevention Program is also organizing its annual event to raise awareness of suicide prevention activities statewide and to recognize people and organizations that are making a difference through “Caring About Lives in Maine” awards. The event will be held from 1:30-3:30 p.m. Sept. 18 at the Blaine House in Augusta. Registration is required. To register, please email Vincent Bryant at vincent.bryant@maine.gov and include your email address and phone number.

Healthy eating

September is both National Childhood Obesity Awareness Month and National Fruit and Veggies - More Matters Month.

Childhood obesity is a major public health problem. There is no single or simple solution to childhood obesity. It is influenced by many different factors, including a lack of access to healthy food and drinks, as well as limited opportunities for physical activity in the places where children live, play, and learn. Working together, states, communities, and parents can help make the healthy choice the easy choice for children and adolescents.

Maine CDC is proud to highlight Maine’s annual Harvest Lunch Week and Farm to School efforts this month. These programs succeed in getting Maine youth to enjoy eating more fruits and veggies, which is important since only 1 in 4 Maine youth eat the recommended number of veggies and fruits each day. Studies show that fruit and vegetables are important to support growth, good health, and a healthy weight. Eating the recommended number of servings of fruits and vegetables can also help protect against high blood pressure, heart disease, type 2 diabetes, bone loss, and some cancers.

Maine Harvest Lunch is a Farm to School activity that introduces students to local Maine grown veggies and fruits in their natural form. US CDC supports Farm to School as an obesity prevention strategy because it engages youth in learning about, preparing, and eating more veggies and fruits. Eating fruits and veggies prepared without added fat in place of higher calorie foods can help maintain a healthy weight. About 26% of Maine youth are overweight or obese. Fortunately, Maine has nearly 200 Farm to School programs with Maine farmers, teachers, and school food service personnel working together to improve the wellbeing of Maine’s youth and communities.

Maine CDC’s Division of Population Health staff is part of the Maine Farm to School Workgroup that provides technical assistance, best practice guidelines, and support to local schools, farmers, and teachers working on Farm to School. The workgroup is made of partners from state agencies and nongovernment organizations. The Healthy Maine Partnerships have been working on Farm to School and Maine Harvest Lunch Week in their local service areas for years, which helps support Maine CDC’s efforts to reach the Healthy Maine 2020 goal of increasing Maine youth’s fruit and veggie consumption.

To find out how many servings of fruits and veggies you need, go to ChooseMyPlate.gov.

For more information about how to eat more fruits and veggies, check out this PDF

How Diabetes Changed My Husband's and My Life

My disability sticks out like a sore thumb. That's putting it mildly, isn't it? If I ask you to hold a door open for me, you'll know why before I even ask. I'm a Hemiplegic. (It's a fancy way to say I'm a stroke survivor.) Not all disabilities are so easy to see. Diabetes is virtually undetectable and yet it is a growing public concern. I'm lucky. I don't have Diabetes.

My husband has Type2 Diabetes. Neither one of us realized how serious this health condition is when he was first diagnosed. After all, the doctor didn't put him on any medication and he didn't have to check his blood sugar. The doctor said matter-of-factly, "Cut down on the sugar and lose some weight." Will do. No problem. Both of us needed to lose weight. We hated the roll around the middle. Here was our motivation.

Unfortunately, that doctor was excessively relaxed about Hubby's situation. It took a while for it to fester but a couple of years later another doctor was talking to Hubby about Diabetes. She wanted complete blood work done before she made any recommendations. That would take a couple of days so the doctor told Hubby to call her if he didn't hear from her in two days.

The doctor called the next evening. She told Hubby to get himself over to the emergency room NOW. His body was completely out of whack. She was surprised that he was still feeling all right. Hubby asked her why but she just repeated, "Get to the emergency room!"

I got him to the emergency room. He was still feeling fine. When he got in to see one of the doctors, they took a blood sugar reading on him. His count was almost up to 600! The doctor and nurse kept on asking Hubby if he was feeling all right -- headache, vision problems, dizziness. No, he felt fine.

Of course, they gave him a shot of insulin and then put him on an IV. They wanted to put my dear husband in ICU.

But he's feeling fine!

An hour later his blood sugar had dropped enough that, they were talking about him just spending the night. That's better but Hubby and I looked at each other with a sad smile.

I went home. I fed the kitties, took a shower, and got into my pajamas.

The phone rang. It was Hubby. "Come get me. I'll meet you in the parking lot."

Okay, get the coat on, grab the purse, and off I went.

The next day, Hubby and I went through the kitchen pulling out anything that was meant to be a dessert. Whatever had sugar in it went into a cardboard box. It would be given to Hubby's mom to be distributed as she saw fit.

Hubby started Diabetes classes the next Tuesday. Most of what he learned he would have to do for himself although our grocery list changed quite a bit. We now have a Diabetes-friendly kitchen. I still have some of the sugary foods but most sweets these days come from fruit and sometimes a sugar substitute. Hubby lost 30 pounds. He looks good. I lost a whole big 3 pounds (big deal!) but I'm feeling better.

It isn't that difficult to shop for groceries using the Diabetic diet. Most grocery stores have the whole grain pastas and breads. You'd be surprised at all the sugar-free desserts and cookies there are. No, we don't eat ice cream anymore. We don't have pizza anymore either. Most of the fast-food restaurants are passed by because of all the carbohydrates in their menus.

Now that the weather is starting to get warmer, we'll be more active too which is good even if you don't have Diabetes. We just happen to have a major entrance to one of the state parks five miles away from us. In the months of warmer weather, we don't have any excuses not to get a little exercise.

If Hubby hadn't gone to the emergency room that evening, chances are he would have slipped into a Diabetic coma. Type 2 Diabetes can be avoided in many cases just by paying attention to your diet and getting a little exercise. We're killing ourselves with fast food, ready-prepared food that has preservatives in it, and reaching for the sweets all the time. Sitting in front of the PC isn't helping either.

On a tight schedule? Buy a freezer. Believe me; it makes a giant-size difference. And use the contraption by packaging leftovers correctly for freezer life. Once even two weeks or so, have a potluck night if you don't use all that you've frozen.