My name is Mark and I am 36 years old. I have always relied heavily on my communication and people skills to get me ahead of everybody else. I never would have thought that I would struggle with something everybody takes for granted.

I can’t pinpoint the exact moment where my life changed but I know for a fact that it happened in early 2006 while I was working for the San Antonio Express News in their call center as a Customer Service Representative. I was struggling to speak and was hesitating with certain words and phrases. It was extremely embarrassing!

I kept asking myself: Why is this happening? Will it ever go away? Will I lose my voice? Could it be stress related? Is it psychological?

There were certain words and letters that I really struggled with. The letter “h” was the hardest for me and to this day still is. The opening phrase at the San Antonio Express News was: “Thank you for calling the San Antonio Express News, this is Mark, how can I help you?” Two “h” words! So, I changed this to: “Thank you for calling the San Antonio Express News, this is Mark, what can I do for you?” A simple change but this really helped me on the phones.

Despite my speech issues, I never got any complaints or questions from customers or co-workers who couldn’t understand me. I thought it would eventually go away, but it never did. It was getting more difficult every day for me to speak clearly and be understood and I was embarrassed.

On May 1, 2006, I saw Dr. Yvonne Page, a Speech Language Pathologist.

As I soon started talking, Dr. Page knew exactly what I had. She asked me a lot of questions trying to pinpoint my problems and took a lot of notes. She eventually had me read these phrases: “Early one morning, a man and a woman were ambling along a 1-mile lane, running near Rainy Island Avenue” and “He saw half a shape mystically cross a simple path, at least 50 or 60 steps in front of his sister Kathy’s house.”

I read the first with ease but really struggled with the second sentence.

Dr. Page referred me to Dr. Blake Simpson, an Otolaryngologist, who works at the University of Texas Health Science Center. He would be able to get a better look at my vocal cords and verify my speech problems.

Dr. Simpson also wanted me to read those phrases. With the second phrase, it felt as if I forgot how to read. I couldn’t even say the word “house.” My mouth opened but nothing came out. It took a few seconds for the word “house” to finally come out and it didn’t sound good at all. By using a fiber optic Laryngoscopy, Dr. Simpson showed me what was happening with my vocal cords.

In May of 2006, I was officially diagnosed with a rare voice disorder called Abductor Spasmodic Dysphonia. According to the Dysphonia website:

Spasmodic dysphonia (SD), a focal form of Dystonia, is a neurological voice disorder that involves involuntary “spasms” of the vocal cords causing interruptions of speech and affecting the voice quality. SD can cause the voice to break up or to have a tight, strained, or strangled quality. There is no cure. It is treatable by speech therapy and Botox injections in the vocal cords.

I started speech therapy with Dr. Page immediately after I was diagnosed. Our sessions were weekly for 12 weeks. For the first four weeks, we met twice a week. I was very lucky that my work schedule allowed me to have two consecutive days off during the week. Otherwise, I would have had to use all of my sick and vacation time.

We did a lot of breathing and relaxation exercises. We worked on the voiceless sounds. Every few weeks we would try words that began with the letter “h.” Dr. Page wanted me to have a soft voice; no yelling or talking loud on the phones. She had software that measured how loud my voice was and how much roughness I had. It was really interesting to see these changes before, during, and after a session. I was also able to hear my voice; it was good sometimes, bad sometimes, and sometimes just plain laughable!

I was relieved that the Speech Language Pathologist knew what I had as soon as I started talking.  Unlike other people I have met with Spasmodic Dysphonia, I didn’t have to wait months or years and see several other doctors to get the correct diagnosis.  After lots of research, talking with Dr. Page and Dr. Simpson, and consulting with my parents, I decided to try the Botox injections. I was aware there could be side effects. But I was ready to take the plunge.

On August 14, 2006, I was in the waiting room at University Hospital in San Antonio, Texas. I was extremely nervous.  My mother came with me and her support really helped me get thru the anticipation of getting my first Botox injection.

Dr. Simpson sprayed my nose to numb it.  It didn’t taste like anything, but it really made my nose runny!!  He then inserted a needle into my neck to numb it.  The numbing medication tasted really gross and made me cough a lot; but that means the numbing was working.  A Neurologist, Dr. Carlayne Jackson, put some sensors on my stomach; this helps locate the proper spot for injection.  A resident from the hospital was also in the room and he was the one who inserted the fiber optic Laryngoscope from my nose to my vocal cords.

I coughed a few times and said the letter “E” for a few seconds.  I even read these phrases again “Early one morning, a man and a woman were ambling along a 1-mile lane, running near Rainy Island Avenue” and “He saw half a shape mystically cross a simple path, at least 50 or 60 steps in front of his sister Kathy’s house.”  

Dr’s. Simpson and Jackson located the correct spot for a unilateral injection and I didn’t even feel the Botox. Wow!  Afterwards, I was coughing a lot, had some discomfort in swallowing, and my voice was very strained.  But, those side effects wore off quickly and I was very glad.

I went back for my 2nd Botox injection on October 23, 2006. I was more eager this time and was looking forward to how my voice would fare. It was the same procedure for the treatment. I had the same side effects but again they vanished quickly.

Since my diagnosis, I have had 17 Botox injections and I am getting fantastic results and do notice a HUGE difference in my voice.   I always have the discomfort in swallowing, a strained voice, and lots of coughing.  But, they go away quicker each time.  My last 3 Botox injections have lasted about 6 months. I will probably schedule another Botox injection toward the end of the year.  Each injection I get lasts longer than the previous.

If you heard me talk, you probably wouldn’t even know I have any issues.  I do struggle at work occasionally but nobody notices it. I am kinda curious to see how my voice would do without Botox?

I made my first podcast to share recently.  I gotta admit, I was extremely nervous when I recorded this last night in my car on the way home from work.  Yes, my recording studio was my car; hey, it was quiet and nobody bothered me.

At least I thought it was quiet…when I replayed it afterwards, I heard my keys jiggling and my turn signal clicking.  Next time, I will unhook the car key from the miscellaneous keys and find a straight path to nowhere in particular.  Other than that, I am very excited  to debut my voice and hope you enjoy it.

This post was reproduced with permission from Mark at mdlblog.com. 

Today is Children’s Mental Health Awareness Day.  The National Federation of Families has declared this year’s theme to be: “Out of the Shadows: Exposing Stigma.”

As healthcare providers at Impact Urgent Care, we frequently have the privilege of providing care for children with mental health issues who present with acute illness.  While addressing the child’s acute illness is paramount, an equally important issue (as with all children we treat) is addressing any associated family or parental concerns.  Without a doubt, one of the greatest challenges parents face when caring for their child with any mental health diagnosis is dealing with the stigma of mental illness.

Whether your child is struggling with Depression or Situational Anxiety, or more chronic conditions such as ADHD or Autism Spectrum Disorder/Aspergers, you are already well-aware of the overt and sometimes subtle ways that the stigma of mental health illness can impact a child and his or her ability to navigate the waters that other children breeze through at school or athletics, or even just going out to eat and going to the movie theater.  Reversing the stigma of childhood mental health illness will not happen overnight, but efforts are definitely underway to begin the process, and events such as Children’s Mental Health Awareness Day are critical in raising public awareness and educating all of us on how we can make a difference.

The Hogg Foundation for Mental Health (www.hogg.utexas.edu) has produced a brochure titled Language Matters in Mental Health that gives excellent guidelines for HOW WE TALK about persons with a mental health condition.  Saying, “He has a mental health condition” instead of, “He’s mentally ill” — or “She has Anorexia Nervosa” instead of, “She’s an Anorexic” may seem like potato — po-tah-toe to folks who don’t have (or live with a family member who has) a mental health condition but for those of us who do, it’s a night-and-day difference that expresses volumes about a person’s attitude toward mental health and/or the stigma of being labeled.  Educating your child’s siblings, friends and teachers on the impact of the word choices we make when talking about a child with a mental health diagnosis is crucial to helping shape a healthy and encouraging environment for them to thrive.  This approach is called “people-first language” and can open up communication lines with others that take a concern for your child’s well-being.

Caring for a child with mental health issues can be an enormous challenge for their parents, and we hope you will consider us a resource you can depend on at Impact Urgent Care.  We count it as a privilege.

Dr. Dan Powell

Dan Powell, M.D.

Staff Physician, Impact Urgent Care

Photo credit: alles-schlumpf / Foter.com / CC BY-NC-SA

Today, Dr. Ratner tells us how important it is to have good air. 

An average adult breaths over 3,000 gallons of air daily, and children breathe a larger amount of air relative to their body weight. A 3,000 gallon tank would be roughly a tube 6 feet in diameter and 18 feet tall. Throw in a little exercise and that number gets much bigger.

That’s a lot of air. Our lungs have a huge surface area to extract what we need and exhale our carbon dioxide. So the combination of the lung efficiency and the huge amount of air in contact with the tissue means that even tiny amounts of pollution and irritants will come in contact with our lungs.

Those irritants include ozone, smoke, dust, suspended particles, noxious gasses, and allergens. There is a set of health issues with long term exposures and there are immediate concerns as well.

Poor air quality can contribute to asthma. Asthma is also referred to as “reactive airway disease.” That term describes what happens: the lungs and tubes that bring air into the lungs become inflamed and aggravated. That leads to shortness of breath, coughing and wheezing. Unlike an infection (such as pneumonia) which is usually a bacterial or viral infection. Since we use antibiotics for infection, not inflammation, there’s no need for antibiotics when you have a reactive airway disease. Medications such as steroids, anti-inflammatories and inhaled beta agonists (rescue inhalers) are part of the typical treatment.

Symptoms from asthma can be triggered from poor air quality, so people with reactive airway need to be especially cautious when the air quality is reduced.

If you’re having trouble and need a breathing treatment, that’s a service we offer every day 8–8 at both locations. If it’s an ongoing problem, be sure to tell your primary care doctor. 

Photo credit: gurana / Foter.com / CC BY-NC-SA

It is common for people to come into an emergency room because they can’t find their contact lens.  Sometimes it is found folded and tucked beneath the eyelid, but other times it is nowhere to be found.  So where is it???

Probably on the bathroom floor at home.  A little anatomy lesson:  there is nowhere else for it to go.

Other commonly “misplaced” items that lead people to the ER: tampons, condoms, and car keys.

Excerpt from Why Do Men Have Nipples? by Mark Leyner and Dr. Billy Goldberg.

Photo credit: איתן טל / Foter.com / CC BY

What will my insurance cover at Impact today?

Everyone’s insurance is different and pays for different things.  your coverage is most often called “benefits”.  Your benefits can be best explained in the package you received from either your employer or your insurance company when you purchased your insurance.

We are considered “urgent care” by insurance companies, so you would need to look under the section for “Urgent Care Benefits” to find out what is covered for your visit to Impact Urgent Care.  Your benefits listed in this area may include your co-pay, your deductible, and your coinsurance.

What is my co-pay?

Your “co-pay” is the amount your insurance company wants you to pay just for your office visit to Impact Urgent Care.  This is usually a set amount and covers your medical exam only.  It does not cover additional labs, tests, x-rays or medications given. Depending on your benefits, your co-pay may be higher at  Urgent care centers than it is when you visit your primary care physician (PCP).  This is because an urgent care center is considered by many insurances to be mid-level care that falls between the level of PCP and the emergency room.  For this same reason, your co-pay would be even higher should you visit an emergency room.

What is my deductible?

A deductible is the amount of money your insurance company requires you to pay yearly before your insurance will begin paying for any services you use.  If your deductible is $500 a year, you will be required to pay all of your medical care up to $500 before your insurance begins paying for anything else associated with your visit, also called “coinsurance”.

What is coinsurance?

Coinsurance is the percentage your insurance company has said you are required to pay for your healthcare.  For example, your insurance company may pay for 80 percent of your healthcare and you are responsible for the other 20 percent.  Some insurances do pay 100 percent of the coinsurance.  However, most of our patients have a percentage of their visit they are responsible for paying.  You will be asked to pay your percentage of the coinsurance at checkout.  At times, this amount may be billed to you following your visit should your insurance company notify us you owed more than we billed you at check out.  This will be noted in your Explanation of Benefits (EOB) from your insurance company.

Why did I get a bill?  Why do I have a balance?

Following your visit to Impact Urgent Care, we will submit a claim to your insurance company for processing.  While we try to bill you at check-out based on your EOB and coinsurance amount, the amount we bill you is only estimated.  Any additional balance remaining after your insurance claim is finalized and paid by your insurance company is your responsibility to pay.  If you have not paid your bill prior to your next visit at Impact Urgent Care, you will be required to pay the bill in full before you can be seen again.

Questions? Comments? Please ask! We’re always happy to help.

You have a chronic condition that causes pain, occasional embarrassment and lifestyle restriction. Nobody really knows why or how you got it, though there are theories. There’s no cure, though the symptoms are treatable. Sometimes you can eat whatever you want, others even looking at something as innocent as white rice causes spasms.

It sounds dreadful, doesn’t it? Well, if you are one of these people, you may have IBS, or Irritable Bowel Syndrome.

For those who don’t have IBS, have you ever had food poisoning? Imagine that happening to you every day or even several times a month. The problem is that it’s not well understood. IBS can effect you either with diarrhea or constipation, and it’s estimated to effect 3–20% of the population. It’s a wide estimation because not everyone will seek medical help or even think they have a medical condition.

IBS can be treated in a variety of ways, including dietary, hypnosis, lifestyle changes, yoga, medications, therapy, etc. Some doctors will perform gastrointestinal scans to rule out other medical problems, while others will just write a prescription for an anti-spasmodic and allow you to go on your way.

Do you have IBS? How do you deal with your symptoms?

There are lots of resources out there to learn more about IBS and how to treat your symptoms. The US Department of Health and Human Services has a good overview. Thehelpforibs.com site has a lot of information and message boards (fair warning–they also sell supplements and books about IBS). There’s even a site directed at women with IBS.

In the end, you’ll need to have a conversation with your primary care doctor if you’re not sure you’ve got IBS and to make sure it’s not something more serious.

And if you have any unexpected emergencies remember we’re always here to help!

Photo credit: Dranik / Foter.com / CC BY-NC-SA and http://help-health.com/stomach-pain-after-eating/

It is difficult to say how many poppy seeds you need to eat to fail your drug test, but some reports have stated that three poppy seed bagels, for example, could generate a positive test result.  Pastries and cookies that contain heavy amounts of poppy seeds, like hamantaschen, could also lead to a positive test.  There is an additional test that looks for certain chemicals present in heroin that are not present in poppy seeds.  So, your athletic future really will depend on the exact test you are taking.

What is the poppy seed-heroin connection?  Cultivated poppies are the source of opium, from which morphine and heroin are produced.

Excerpt from Why Do Men Have Nipples? by Mark Leyner and Billy Goldberg, M.D.

Today is the perfect day to forgive them: Reconciliation Day. Started as a suggestion by Ann Landers in 1989, it’s now known to many as a day to forgive and forget. Who will you forgive?

Photo credit: The U.S. Army / Foter.com / CC BY

Pop Rocks were accidentally invented in 1975 by William Mitchell, a scientist at General Foods.  Mitchell was trying to design an instant soft drink when he mixed sugar flavoring and carbon dioxide in his mouth.  His startling discovery may or may not have led to the demise of Mikey, the boy for the Life cereal commercials, who as the urban legend goes, liked mixing Coke and Pop Rocks.  Supposedly, this deadly mix caused his stomach to rupture.

In 1983, Pop Rocks were taken off the market but recently have come back into the fashion like Razzles, Sugar Babies, Charleston Chews, and other retro candy.  You should have no problem finding Pop Rocks for your home science experiments.  You will surely find that there is no danger in the delicious combination of soda and Pop Rocks.

As for Mikey, he is alive and well and living in post-child star obscurity.  As for other child stars, we offer these dramatic gastrointestinal induced death rumors:

1. Gary Coleman (Diff’rent Strokes) from snorting Lik-M-Aid and drinking fizzies.
2. Danny Bonaduce (The Partridge Family) from ingesting the marshmallows from thirty boxes of Lucky Charms.
3. Erin Moran (Happy Days) from choking on Razzles while intoxicated from drinking excessive amounts of Clamato.

Excerpt from Why Do Men Have Nipples? by Mark Leyner and Billy Goldberg, M.D.

This week, Dr. Ratner tells us about preparing for the unexpected. What’s in your emergency kit?

Dr. Ratner

Most of us here in San Antonio do not know that this week is Tsunami Preparedness week. Just because San Antonio is only a little more likely than Salt Lake City to suffer the direct effects of a tsunami there are lots of lessons we can learn from this week.

1. Really bad things happen, even if they’re not very likely to happen. So, do you need life vests? Probably not, but you should think of some basic items and procedures for any unplanned catastrophe. Events that happen far away can have ripple effects. Are you prepared if your plant closes down because you can’t get parts or your customers are unavailable?
2. We may not be at risk for a tsunami, but what about a flash flood?
3. How hard would it be to store 5 gallons of water and a few days of canned or dehydrated foods, or some macaroni and cheese for each member of your household? You could fit a few days’ worth under each person’s bed.
4. Can you put together a small plastic type toolbox with a few screwdrivers, a pair of pliers, some duct tape, a utility knife, some zip ties, a hacksaw and a flashlight?
5. Take a few minutes and discuss with your family and your extended family where and when you will meet in the event of fire, blackouts or other disasters.
6. Once a month buy a few extra AA, AAA,C, D and 9 volt batteries, and switch out your used batteries with your current stock. This will prove very useful if there’s a power outage.

This is not an all-encompassing list, but it is easy, inexpensive and really useful when the expected happens.

It’s not something we want to think about every day, but if we’re prepared it can turn a disastrous situation into something that’s just difficult. The American Red Cross has some great resources and advice for all kinds of situations here. And a tool to help you estimate how much you’ll need of everything here based on your household. Always remember we’re here to help at IUC, but we hope you have a happy and safe weekend!

The unexpected strikes…unexpectedly.

Photo credit: United Nations Development Programme / Foter.com / CC BY