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Dear Ariel Castro

About four hours ago, you took the cowardly step of taking your own life around 9:20pm ET. Over the course of ten years, you kidnapped and tortured Amanda Berry, Gina DeJesus, and Michelle Knight in that Seymour Avenue neighborhood. Thanks to people like Charles Ramsey, your secret was revealed, and you were in the midst of a 1000 year sentence.  

In your last desperate move, you thought you were still in control by hanging yourself in your cell tonight. Everyone remembers that creepy speech you gave during your sentencing blaming everyone but yourself. Suffering the consequences of your crime does not stop with your suicide. Your final judgement is to come and justice will be served. Michelle is right when she said during your sentencing, "Now your hell is just beginning. I will overcome all that happened, but you're going to face hell for eternity."

History will quickly forget who you are and you will be a distant memory. The best end to this story will be following the lives of Amanda, Gina, and Michelle as they put time and distance away from these horrific events. As seen in the video above, we are already starting to see the beginning of their recovery. The best revenge will be seeing these young women help others avoid people like you, so tragedies like this will never happen again...

 

Weekend in NYC

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I'm usually working most holidays (imagine that). But, I'm spending this Labor Day holiday weekend in New York City with the family. It's always fun spending time with the family, but add the elements of New York City, Times Square, and the Theater District - well, things get a little more interesting.

My facebook and twitter friends have been following along, but here are some random impressions from the past few days from specific places. In addition, I'll post pics soon, but enjoy the commentary below!

Bus Trip: We took a bus instead of flying in. I'm glad that I didn't have to worry about things like parking or getting/to from airport if we had to fly, etc. Even though their website is under construction, 20th Century Tours in NE Ohio did a nice job. Their temporary website is here. 

Little Italy: In my previous trips to NYC, I never toured this part of town. Of course, this area of town is made for tourists, but it was fun to walk around. Had lunch at Cafe Napoli which is in the heart of Little Italy. Good food and good people watching from outdoor seating. Also went to Ferrara Bakery and had some great treats!

The Edison Hotel: This hotel is in the heart of the Theater District and just steps from Times Square. Thanks to my sister in law's expertise, we were able to obtain the recently renovated rooms. Kudos to the hotel staff for their great service, hospitality, and professionalism. Well done!

St Patrick Cathedral: I've seen this on television in the past, but was never there in person. The church building is currently under renovation, but what we saw was still beautiful. What's cool here is that they encourage you to follow the church on twitter and to check in on facebook. What other Catholic churches do that? Very few, I would guess.

Hard Rock Cafe NYC: I know people will yell at me for going to this tourist trap, but I enjoy going here. I've been to other locations including Cleveland (Duh), Orlando, and Key West. Always good atmosphere and I always have fun there.

Strawberry Fields Memorial: Part of our bus tour took us around the city. One of the stops was The Dakota Building where John Lennon lived and was assassinated. In addition, we went across the street to the section of Central Park called Strawberry Fields which is a memorial to Lennon. Was weird just walking around that part of the park. 

Brazilian Day NYC: September 1, 2013 was designated Brazilian Day in New York City. A big part of 6th Avenue (usually 6 lanes of traffic) was closed off and there was a street fair and festival there. The coolest thing I got to see was an all female drumming group called "Batala NYC." These women rock!

M&M World NYC: Of course, I could not be in Times Square without stopping at the M&M store. I have no idea what it is about my interest/obsession with M&Ms. It's always fun seeing all the different colors that exist only at the retail stores (see pic above).

Kinky Boots: This musical that was part of the travel package. And, I admit that I knew nothing about this show. When I arrived here, I did some research and found out that it had won a lot of awards, and some of my friends have told me that it's a great show. I'm not really into Broadway shows, but this was an entertaining 2 hours. Even for uncultured me, I would recommend this musical to anyone - really.

John's Pizzeria: There has to be hundreds of pizza places in the New York area. My sister-in-law recommended this one, and it didn't disappoint. We heard that the Times Square location we were at was formerly a church, and now it makes great pizza. 

Times Square: What else can you say other than it's tourists and people dressed up in everything from the Statue of Liberty to superheros to cartoon characters to everything in between. If you have never been there, going at night time is so much different than going in the daytime. I did my very first instagram post from there. NYC police were everywhere and I felt very safe walking around and making fun of people LOL

9/11 Memorial: This will be the last stop before going home today. Probably warrants an entire post itself. We'll see...

Primary Care Advocacy By Students

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The Future of Family Medicine and Primary Care is Bright! This weekend, in the Boston area, was the Gregg Stracks Leadership Summit organized by Primary Care Progress. Pictured above is Dr. Andrew Morris-Singer who is the Founder of Primary Care Progress.

Few people are born leaders. In this two day conference, participants are taught advocacy leadership and organizing skills that will be applied back home in their communities. Yesterday, featured speaker Marshall Ganz shared an organizing model using the phrases, "Story of Self," "Story of Us," and "Story of Now." Claudia Fegan was also a featured speaker yesterday and a participant tweeted out from her talk, "It is our responsibility, as primary care providers, to fight for our patients."

A Primary Care advocacy campaign is to be announced at the conference today. Last year, Primary Care Progress conducted a very effective photo social media campaign called "Voices For Primary Care." I think social media will play a major role in the upcoming Primary Care advocacy campaign.

I hear all the time that students are too overwhelmed and too busy to think about anything else other than getting through the curriculum. What I saw this weekend are many talented young people who arrived with passion for Primary Care and a Passion for taking care of patients in their communities. These students will leave here with Leadership skills to pass on to their friends and colleagues at home. This advocacy momentum will continue to build to bring out change at the local level, state level, and eventual national level. 

My thanks to Primary Care Progress for the invitation attend this year's Leadership Summit. I invite you to check out my previous posts that had Tweets from Day One and Pics from Day One. Also check out today's events using the twitter hashtag #PCPSummit2013. More excitement to be announced soon by the organization...

 

Pics from #PCPSummit2013

Photos from Day One of the Primary Care Progress Leadership Summit In Boston. Most of the participants are trainees including medical students, nursing students, NP/PA students and others. Apologizes if I left out some of the people from the group photos, and other mistakes I made. Also check out the previous post with tweets from Day One...

The End Of Community Hospitals?

Are the days numbered for Salem Community Hospital and other community hospitals around the country? Yesterday, a local story happened that made me think of this. The announcement was made that the Akron General Health System was being purchased by a joint venture of Cleveland Clinic and Community Health Systems (CHS). CHS is a Tennessee-based hospital operator who also owns three other hospitals in the Northeastern Ohio area where I live.

Six months ago, Akron City Hospital along with the rest of the Summa Health System announced that they were joining Catholic Health Partners (CHP), the largest hospital system in Ohio.  CHP owns a hospital in the Youngstown, Ohio market, close to where I live.

There are two hospitals in Columbiana County: Salem Community Hospital and East Liverpool City Hospital. As of this second, these two hospitals are still independently owned and operated, but for how long? 

I am by no means a hospital policy expert. But, it's not hard to see that across country, smaller hospitals are either being bought or joining larger hospital systems. This has already played out in Ohio's larger cities of Cleveland, Toledo, and Columbus. 

Salem Community Hospital (SCH) is in the midst of building a new patient tower with 87 private rooms. SCH also boasts the area's only 3T open MRI unit between Cleveland and Pittsburgh. On the negative side, SCH recently announced the resignation of their CEO, but states that current leadership is still committed to the future. Will all that be enough to sustain hospital independence, or is aligning with a larger hospital system (like Cleveland Clinic, CHS, CHP, or even University of Pittsburgh Medical Center) inevitable at some point?

"Why one-third of hospitals will close by 2020," is an essay from the KevinMD website. They close the piece by saying, "What hospitals are about to enter is the place Americans cherish: the open competitive market. We know what happens in this environment. There are winners and losers."

Not so fast says Becker's Hospital Review in an article entitled, "Hometown Healthcare Isn't Dead: Why (Most) Smart Community Hospitals Can Still Thrive." The hidden strengths of community hospitals, according to the article, include nimbleness to adapt to change and the ability to achieve higher quality, greater patient engagement, and lower cost - easier than the larger hospitals.

What will be the ultimate fate of Salem Community Hospital and others like it? Some say that the hospital industry will be like the airline industry where there will be a few large players nationally and the small companies will merge or fail.

I think the community hospital model will be similar to the banking industry. There will always be that locally owned community bank that the community gets behind and supports because it is neighbors helping neighbors. The only way small community hospitals will survive is if the community finds value in it and will continue to support the hospital, not only in its hospital services, but also with word of mouth and positive community reputation. Without that, you might as well pick who you're going to merge with, or close up the hospital altogether...

Six Physicians To Follow On Social Media

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Thanks to my friend Bunny Ellerin (pictured above) for including me on a blog post for the ZocDoc blog entitled, "Six Physicians To Follow On Social Media." Bunny is the Senior Vice President at a company called InTouch Solutions and she is also Co-founder of NYC Health Business Leaders. I was given the opportunity to speak to the NYC group last year in this you tube speech called, "Physicians Must Be On Social Media." Here is what she said about me in the article...

This early adopter has gone from being Doctor Anonymous to being... Dr. Mike Sevilla. In between, he used Family Medicine Rocks as his home base, where he tirelessly advocated for his specialty - and primary care in general. Recently, he took a break from social media to regroup (many of us were sad), but came back stronger than ever (which made us happy).
Dr. Sevilla uses every form of social media: blog, podcasts, YouTube, Facebook, Twitter, Vine, Instagram - name it, he'll try it. Wherever he is, he's one to follow for his honest, funny, human musings about family medicine and life in general. 

Thanks to Bunny for these very kind words. We met in person a few years ago at the Mayo Clinic Social Media Summit and have kept in touch (pun intended, hehe) ever since then. I've said this before, but the best things about social media, at least for me, are the people that I've met and the places that I have been. I'm a lucky guy, let me tell ya.

For people who like lists, here are more that I'm on... 

For those new to the site, welcome and I hope you take a look around. I also encourage you to check out the podcast as well as following me on twitter, Facebook, youtube, and linked-in. Enjoy! 

 

Lyme Disease: 300,000 Yearly

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Lyme Disease (photo credit) is something that a lot of people have heard about, but not really understood. The Centers of Disease Control and Prevention just released a new estimate of 300,000 cases a year - which is 10 times more common than previously reported (AP story).

Every day in my office, my patients ask me about the possible sign and symptoms of Lyme Disease (WebMD). The first symptom is typically an expanding red rash. This rash is accompanied by flu like symptoms including:

  • Fatigue (the most common symptom)
  • Headache and stiff neck
  • Fever (which may be high in children, but this is rare)
  • Muscle and joint pain

If not properly diagnosed and treated, there are many complications that can happen as outlined in the WebMD article. Even though not 100%, there is blood testing that can be done after a visit and an examination by your physician. 

This is a mysterious disease that sometimes goes undiagnosed. I encourage you to check out the links above and read about this illness more. And, of course, if any questions, I encourage you to schedule a visit with your physician.

FDA Defines "Gluten-Free"

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More and more of my patients are asking me and telling me that they are following a "gluten free" diet. What many people do not realize is that this is more than a fad diet of the moment. This is the recommended diet of people with the clinical diagnosis of Celiac Disease.

What I did not know is that the term "Gluten-Free" really has not been defined officially, and manufacturers can call about anything they want "gluten free" to take advantage of the popular health craze. 

Earlier this month the US FDA (Food and Drug Administration), defined "Gluten-Free" as the following:

  • Food that does not contain any ingredient that is any type of wheat, rye, barley, or crossbreeds of these grains
  • Food that does not contain an ingredient derived from these grains and that has not been processed to remove gluten
  • Food that does not contain any ingredient derived from these grains and that has been processed to remove, gluten, if it results in the food containing 20 or more parts per million gluten

I gotta be honest. I read that three times, and I still don't know what it means. This is what government double speak is like. How do I really know if the food is "gluten-free" or not? How would you instruct people and patients on this?

The fad diet thing for "gluten-free" will fade in a few months until the next popular diet comes along. I guess I'm kind of reassured that there is at least some definition to "gluten-free" and that my patients with a true diagnosis of celiac disease can have some faith that this label will be a proper one for them.

 

Hope Disqualifies Olympian

Apparently, hope is a performance enhancing drug that disqualifies athletes. Victoria Arlen (pictured above) is a US athlete who is the defending gold medal champion for the 100m freestyle at the 2012 Paralympic Games. 

This week, Victoria was disqualified because the International Paralymic Committee has questions whether her disability is "permanent." Seven years ago, she woke up from a coma and could not move her legs. She is paralyzed from the waist down and is also wheelchair bound.

After she won four medals and set a world record last year, there was a review of her medical records. It was deemed that there was still "hope" that her disability is not permanent - and this drew the ban from this year's competition. 

Doesn't every athlete (whether it be olympian or paralympian) have hope to recover from illness, injury, and disability? Plain and simple, she was unfairly penalized for being too good. Before he went nuts, Oscar Pistorius was questioned whether technology (meaning his bionic legs) was an unfair advantage during his paralympic dominance.

What kind of precedent does Victoria's disqualification send through the paralympic world? Don't disabled athletes have enough of a challenge? Will these athletes now be discouraged from participating at the highest levels when they have to compete against other athletes and the International Paralympic Committee? This ruling is definitely not in the spirit of The Olympic Games.