Can I Eat Fish When I’m Pregnant?

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I get asked almost every day if fish is safe to eat in pregnancy. Fish is not only safe to eat but we should eat more whether we are pregnant or not!

Why is fish healthy and why should we eat more? Fish provides something called omega-3 fatty acids. Our body cannot make omega-3 fatty acid on its own so we must get it from our food. This type of fatty acid is extremely important in developing the brain and eyes in your unborn baby. Fish is the best and most abundant source, it is low in saturated fats, and is high in protein.

There are, however, a few types of fish that we should limit to one serving per week particularly in pregnancy. This is because some fish have a higher mercury content than others. High levels of mercury in our bodies can lead to a build-up of harmful toxins that can increase the risk of neurological damage to your unborn baby. These types of fish include Shark, Swordfish, Albacore tuna, King Mackerel, and Tilefish.

What kind of fish can I eat when I’m pregnant? Any white fish is safe in pregnancy as well as canned light Tuna, Salmon, Halibut, or Tilapia.

Whether we are pregnant or not we should understand that by eating raw or undercooked meat, fish or eggs we are at risk for food poisoning. In order to decrease this risk meats should be cooked thoroughly. Sushi lovers can still partake but make sure your restaurant is reputable.

Which fish are highest in omega-3 fatty acids? Try Anchovies, Sardines, Trout, Salmon and Atlantic Herring. If fish is not your favorite item on the menu, try walnuts, grape seed oil and food items fortified with omega-3 fatty acids such as eggs.

Try this basting sauce on some salmon next time you warm up the grill. Add some steamed asparagus or your favorite green vegetable and some orzo for a complete meal.

Honey-Balsamic Grilled Salmon

1 ½ tablespoons honey
1 ½ tablespoons Dijon mustard
1 tablespoon balsamic vinegar
¼ teaspoon pepper
Salt to taste
2 6-ounce salmon fillets

Combine the first 5 ingredients in a bowl. Brush fish with mixture. Grill 2-3 minutes on each side or until fish flakes easily with a fork. Serves 2.

Nutritional Information:

Calories 256
Fat 10.7 grams
Protein 24.2 grams
Carbohydrates 14.1 gram

Technology Brings Dad into Delivery Room via Skype

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Baylor Irving’s labor and delivery unit recently hosted a high-tech delivery when patient Christina Robertson used Skype, a software application that allows users to make voice and video calls over the Internet, to share the birth of her daughter with her husband overseas.

Christina is so shy she wasn’t even sure she wanted the doctor in the delivery room, much less extended family. But, as her labor progressed she became more comfortable with the experience. Besides, she had something really important to focus on. Her baby girl was on the way, but her husband, Army Specialist Justin Robertson, was stationed half-way around the world in South Korea and would have to miss the birth of his first child.

“We had been Skyping once or twice a week and I promised him I would Skype after she was born so he could see her,” Christina says, “Then one of the nurses said another patient had Skyped her baby’s delivery.”

Phone calls were made, e-mails were sent, permissions were granted and procedures were followed. Christina’s mom was instructed to stand at the head of the bed, iPad ready. Though it was after 9:57 p.m. in Irving, it was 11:57 a.m. in Seoul, South Korea, as Justin sat at his computer, listening and watching as MacArthur OB/GYN Jeff Livingston, M.D., lifted the soldier’s precious baby girl over the draped sheet and laid her on her mother’s chest.

[blockquote3]“What an amazing experience,” says Dr. Livingston. “I love how technology can be used in health care to bring people together and make the world a little smaller. Using Skype to make it possible for one of our soldiers fighting for our country to be able to witness the birth of his child is just awesome. I love that Baylor Irving continues to be supportive and a leader in innovative uses of technology in health care.”[/blockquote3]

Taylor Robertson was 9-pounds, 3-ounces at birth with a full head of dark hair like her mom. Dad received permission to come home two days after Taylor’s birth so he could spend the first 10 days of his daughter’s life with his family. Once he returns to South Korea, he will be far away in miles, but the sound of daddy’s voice and the look of love on his face will only be a mouse click away.

HealthTap’s Social Network of 5,000 Doctors is Ready to Give Free Advice

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It’s fair to raise an eyebrow when a social network for healthcare comes along, but this network just might make you raise both eyebrows in surprise: HealthTap has created a healthcare social network with more than 5,000 real-live doctors to answer patient questions. Not peers, not “experts” and not brands. Health questions aren’t posted for the world to see or comment on. This is a private network between a patient and thousands of doctors. Read more »

Life-Saving Potential of EHRs Already a Realization

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With all of the hoopla regarding how electronic heath records enable providers to earn incentive payments, it’s heartening to read Health Affairs’ new study that indicates meeting the computerized physician order entry (CPOE) standards for meaningful use may reduce the number of inpatient deaths due to heart attack or failure. Read more »

What Exactly is a Nurse Practitioner?

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By now most of us have heard of a nurse practitioner. But what exactly is a nurse practitioner? What can they do? How can they be incorporated into a medical practice?

A Nurse Practitioner is a Registered Nurse who has completed graduate-level education and advanced-practice training. Nurse practitioners can see a wide range of patients, both well and sick, and perform many in-office procedures. Prescribing medications, ordering and interpreting tests, hospital admitting and discharge privileges, and hospital rounding are just a few of the privileges falling within the scope of a nurse practitioner.

The next question is what is so special about a nurse practitioner? The answer, for the most part, lies in the approach nurse practitioners take in their patient care. The physician typically uses a disease-based or problem-based approach meaning that the focus is more on diagnosing a problem and treating that problem. Nurse practitioners use an approach that is nursing-based, focusing on the patient and his/her environment as a whole. Nurse practitioners not only diagnosis problems and treat those problems, but we incorporate that treatment and that response into their family, their culture, their daily lives and their community. We focus on teaching people ways to stay healthy and have the capability to treat people for their acute and chronic illnesses. Both approaches to care are important and together give the patient a more complete resolution and stabilization of their condition.

In our practice we do a lot of collaboration; not only from nurse practitioner to physician but also physician to nurse practitioner. Many times either I have gone to a physician or a physician has come to me to work with a patient. The benefit of this collaboration is that the patient’s immediate need is met and she does not have come back for another visit, ultimately resulting in a quicker resolution of the problem. Since the nurse practitioner can practice independently, when our doctors leave the office to go to the hospital for a delivery, the nurse practitioner can see the patients. Again, the patient is seen avoiding an appointment that needs to be rescheduled. Thus, patient satisfaction is increased, problems are immediately addressed and patient outcomes are improved.

For instance, in our practice, most of our OB patients with diabetes get seen twice a week. One day the patient sees her physician who manages her pregnancy. The other day she sees the nurse practitioner. Although her pregnancy is monitored when she sees the nurse practitioner, the focus of this visit is on her diabetes and how to maintain good glycemic control and still check blood sugars four times a day, eat six times a day, take care of three children and work full-time. This type of visit can be very time consuming. Using the nurse practitioner in this manner allows the physician to continue to focus on those patients that need physician-specific attention. It also gives the patient more education, individual attention, encouragement and incorporation of her disease into her individual lifestyle. The benefit to the patient is she gets the best of both worlds, which ultimately optimizes the outcome for her and her pregnancy.

With the current and future changes in health care, nurse practitioners will become an even more important part of a medical practice. By using nurse practitioners to see well-checks and to monitor established therapies, the physician is freed up to focus on surgical cases and those conditions that fall outside the scope of a nurse practitioner.

But how do patients view nurse practitioners? My experience is that most patients love nurse practitioners. All for the above reasons plus more. There are many patients in our practice that will see their physician for certain problems and the nurse practitioner for other problems. Some patients are not comfortable talking to a physician about certain issues. Although the care that the patient receives from both the physician and the nurse practitioner is the exact same, the title “doctor” can still intimidate some. The nurse practitioner is a little more on their level on the totem pole and can be less intimidating. After talking to many patients regarding nurse practitioners once they see one, they are be hooked. This keeps your patient in your practice, helps to grow your practice, and gives your patient complete and “holistic” management of their condition, and other options for care.

Meaningful Use Readiness Center

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Dr. Jeff Livingston of MacArthur OB/GYN has been in private practice for 8 years. In June 2011, the clinic of seven doctors underwent the successful attestation for Stage 1 of Meaningful Use in which the practice secured $148,000 in federal incentive payments. Read more »

Wikipedia Goes Dark but the Doctor is In

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Today Wikipedia and other websites have gone dark in protest of the online privacy bill. This got me thinking about the issues of copying the online work of physicians across the country. There is a growing group of physicians like me who are involved in social media, blogging and online patient outreach. Most of us do this based on a passionate belief that patient engagement matters. We believe that providing high quality information online is important. We believe that these efforts will lead to more engaged patients and ultimately better patient outcomes. We believe that by using technology we can expand the doctor-patient relationship beyond the four walls of the office.

I have given dozens of lectures across the country teaching physicians how to develop a social media strategy. I am well aware that as a result of these presentations many physicians will go check out the work MacArthur OB/GYN is doing and seek to replicate it. I have seen some physician’s Facebook pages that bear a striking resemblance to the MacArthur OB/GYN Facebook page. To that I say “Great! Go for it.” Imitation is the best form of flattery. Those of us leading the way, like my Twitter friends in #HCSM and fellow Healthtap docs, are trying to create a movement. We hope to develop more E-patients and more “E-doctors.” In fact, most of what I am doing online I learned from following smart, progressive people on Twitter. I love reading blog posts by @dr_v on 33charts.com. I enjoy reading the thoughts of other physicians and patients on KevinMD.com. @hjluks is now my friend. #HCSM moderator @danamlewis is one of my internet idols. Following smart people and adapting their ideas into our lives is the way we make progress.

If using my words and thoughts help move this movement along then, by all means, copy me. Share our Facebook posts, retweet me, share my Healthtap answers and follow me on Google Plus. I am all for it. By doing this together we can show patients and physicians the value of integrating social media into their practice. More and more physicians will develop a strong web presence and patients everywhere will benefit.

The Gathering Place

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I am again preparing for the holidays running at full speed ahead. The house has been decorated inside and out. Gifts have been purchased and wrapped and ready to place under the tree on Christmas Eve. Baking is finally finished and not without its own set of mishaps. This past Saturday I pulled my pumpkin bread out of the oven…it looked so beautiful…set the aromatic loaves on racks to cool…turned them out a few minutes later only to discover that the bottom half of the loaves were not cooked! Total panic set in as I realized that it is 8 days before Christmas, I still have baking to complete and the bottom heating element in my oven has gone out! Fortunately it was a relatively easy fix and by dinner time that evening my oven was working better than ever.

For as long as I can remember, my house has been a beehive of activity. It is the heart of all family activity. Being Italian, good food has always been the center of my life. As a child, I learned baking skills from my mother and grandmother. Many times Sundays were spent making bread and pasta. Each creation would be served to my dad and, with baited breath, await his seal of approval. As an adult, I have continued to find joy in the kitchen creating new dishes and passing learned skills on to my children and family. I never know who will show up for a meal nor how many will be served. “Strays” just tend to migrate here, whether it is dogs that follow kids home, the 2-legged human type, wondering what is for dinner or my sister calling to inform me there will be 2 more for the upcoming holiday meal. When my kids were younger, their friends would take a poll checking to see what was on the menu for dinner, trying to decide which house to eat dinner at that evening…mine won the majority of the time! I can’t count how many times kids, friends and family would just show up to eat dinner. It is a good thing I don’t know how to cook for two!

My house has always had a revolving door. This is where we gather for family and extended family meetings, in times of joy and in times of sorrow. There is where we celebrate birthdays, holidays, and the simple fact that it is Sunday. Impromptu meetings for various booster club activities occur here. Family vacations are planned here while the kids discuss who is going to ride in which car. This is where 25 TCU saxophonists gathered for a Christmas party and enjoyed a gourmet meal of ribs and grilled vegetables. This is where my youngest daughters’ best friend runs for a hug and meal, where my nephew learns how to cook, and where my son and daughter bake gingerbread men together. This is also where my kids’ friends magically appear at the kitchen table for a Thanksgiving meal. I never really thought of all this as anything unusual…it has just always been this way. It wasn’t until my sisters’ husband said one day as we discussed another impromptu family Sunday dinner and I didn’t know what I would prepare yet…“It doesn’t matter” he said.” The food is always good and this is just the place to gather.”

I am very blessed to have such a wonderful family. I’m glad we not only live close by but are also very close and have a strong bond with each other. We have shared a very busy year together; struggles and achievements. I look forward to another very busy year and a new revolving door to replace the one that is worn out.

From my Gathering Place to yours, may everyone have a safe and happy holiday!

Try this tasty twist to turkey. I made this on Thanksgiving and the flavor of the meat was fantastic!

  • 3 tablespoons light butter
  • 2-3 tablespoons chopped fresh parsley
  • 2-3 tablespoons minced onion

Make a paste with the butter, parsley and onion. Loosen the skin from the breast, drumsticks and thighs. Rub the past under the skin. Cover turkey with foil and bake at 350 degrees according to package directions. Uncover turkey the last 45 minutes of baking so turkey will brown.

Corn Salsa with Black Beans

15 ounce can black beans drained and rinsed
1 cup frozen whole kernel corn, thawed
1 large tomato chopped
2 green onions, thinly sliced
1 fresh jalapeno pepper, seeded and finely chopped
2 tablespoons fresh cilantro, chopped
2 tablespoons lime juice
¼ teaspoon ground cumin
Salt to taste

Combine all ingredients into bowl. Makes about 4 cups. Serves 16. Serving size ½ cup.

Nutritional information

Calories 32
Total fat 0 grams
Carbohydrates 7 grams

My family loves this corn salsa. Use pita chips or fresh vegetables to dip.

Taken from Diabetic Living Online.

Surprise. It’s a…

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Are you having a boy or girl? This is one of the standard questions people ask a pregnant lady. Everyone asks. It has become a kind of conversation starter. It’s not that the stranger in the grocery store really cares, but it just seems like natural thing to say. It’s part of the standard questions we ask pregnant women. How far along are you? Is there just one? When are you due? People get excited about pregnancy and want to share the experience. Read more from Texas Health Moms »

Doctor, Google Thyself

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Have you ever Googled yourself or your practice? Did you know that you have an ever growing online reputation? Whether you know it or not, doctors have an online presence. When you type your name in a search engine you may be surprised by what you find. Everything you do professionally creates a digital footprint. If you are involved in social media then you are contributing to your online reputation. If not, your online reputation is being written for you. There is a conversation taking place about you online, but unfortunately you may not be included in it.

A simple Google search of your name will likely show your practice website. Your name will also appear in numerous third party review sites. Take the time to read a few. You may be surprised. You will find your name and your practice appearing on people’s Facebook and Twitter pages too. While at first this may be disturbing, I view it as an opportunity.

The Internet has revolutionized healthcare. Health information is now available to everyone with the touch of a button. Pew Internet shows that 80% of people look up information online. A patient experience goes like this. Before a patient sees you they research their symptoms to try and decide what is wrong. Next, they search online for doctors and read online reviews to decide who to see. Then, they schedule an appointment to see you. After the appointment they go back online to see if you knew what you were talking about.

Patients have moved beyond simply reading about health information. They now want an interactive experience. One of my favorite people on Twitter, Phil Baumann, likes to say “Health is social.” By interacting in social networks patients become e-patients: equipped, enabled, empowered, engaged, equals, emancipated and even experts. As doctors we can be frustrated by this and passively complain in the background or we can choose to embrace it. Like it or not, social media is here to stay in healthcare.

Embrace this excitement. Own your online reputation by providing the online information your patients are asking for. Your patients should not have to rely on Wikipedia to know what to do. They should be able to get high quality information directly from you. By getting involved in social media you can promote your area of expertise and define your image. You can create your own digital footprint. You can improve patient education, increase referrals, promote practice loyalty and increase utilization of services leading to practice growth.

This has worked well for Macarthur OB/GYN. By providing high quality health information on our website, podcasts, social media channels and innovative use of technology in the office we are helping our patients make better informed decisions. A perfect example is during the six week postpartum exam when I ask a simple question like, “What would you like to do for birth control?” In years past the answer would be “what are my options?” A brief discussion of the 32 flavors of contraception would follow. Nowadays, our patients say definitively what method they want to use. They tell me what they want. Throughout their pregnancy they have been exposed to birth control options in our waiting room power point presentation as well as through social media channels. They know the options, have thought about it and clearly communicate an educated decision. Our visits become more efficient and higher quality discussions take place. A win-win for doctors and patients.

Our journey to social media began years ago when my teenage daughter suggested I start a Myspace page as a way to reach my teenage patients and address issues such as unplanned pregnancy and sexually transmitted disease. I learned how social media serves to humanize doctors in the eyes of patients – making us more accessible and improving communication. We then evolved into Facebook, Twitter, blogging and YouTube. All of this has worked well but these sites have limitations. Content created has a short half-life as postings get pushed down the wall and older content gets lost and forgotten. All are great platforms to push out information but none are great for pulling out the needs of specific patients. None overcome the problem of direct one-on-one communication. To solve this, we established a practice portal through our EHR software. This provided a secure messaging system which is a great tool to allow HIPAA compliant one-on-one online communication from doctor to patients. You can read about this here: How secure messaging helps this doctor connect with patients.

New networks are popping up to help overcome the limitations of the existing networks. Doximity is an excellent network designed to facilitate HIPAA compliant doctor to doctor communication. Another new platform called HealthTap brings doctors back into the online conversation. Users ask medical questions. Doctors answer these questions through the creation of their own virtual practice. While engaging patients, HealthTap aggregates the content created so it will stay available forever for the benefit of others. Internet users can find concise health information that they know has been written by qualified medical professionals.

I am not sitting on the sidelines and allowing my online reputation to be created for me. I am actively engaging. I choose to create my own digital footprint and encourage my patients to engage in their own health.