Readers respond to a CE/CME activity on kidney stones, and two editorials.
KIDNEY STONES AND CLIMATE
I read with interest the CE/CME article “Kidney Stones: Current Diagnosis and Management,” by Catherine C. Wells, et al (Clinician Reviews. 2012;22:31-37). However, I was surprised by the statement “Romero et al predict nephrolithiasis incidence could rise from 40% to 56% by 2050 as a result of the effects of global warming.”
In Romero’s paper, the following statement precedes the quoted passage: “Changes in dietary practices may be a key driving force. In addition, global warming may influence these trends.”
Furthermore, on reviewing some of the references from the Romero article, I found the following information: Stamatelou et al found that it was regional differences (“region of residence”) that contributed to kidney stone formation. Soucie et al write that “differences in exposure to temperature and sunlight and beverages may contribute to geographic variability.”
Currently, global warming is a political issue, not a medical one.
Gerald Christich, CRNA, San Antonio, TX
THE NEW 60, AND BEYOND
Nice editorial by Marie-Eileen Onieal (The new 60. Clinician Reviews. 2012;22:cover, 29-30). After 53 years of service as a nurse and an FNP, at age 73 I am still working part time and keeping my head clear and my brain operating.
During 60-hour workweeks, I often found little time for exercise, and all the work lunches, etc, had me very overweight. The greatest gift that retirement from a community health center gave me was enough free time to now do what I have told others to do for many years: exercise frequently (I now do three-mile walks in 60 minutes), drop my already healthy diet to half-size portions, and do more of what pleases my soul.
There are many nurses and other workers who are still going strong, either part time or full time, in our 70s. I believe 70 is the new 60. I have lost more than 50 pounds and feel so much better—I can’t believe that I felt so bad before! The mind can focus on things other than self-care and zero in on what is “needed by others,” to personal detriment. It is no wonder that my younger former colleagues are wising up and taking part-time instead of full-time positions. Good luck to Dr. Unseal with her 60 minutes of self-care.
Susan B. Collins, APRN, FNP-BC, AHN-BC, Flagstaff, AZ
Since both my parents had/have Alzheimer’s, I am especially interested in staying in the best possible physical and mental state. In my 60s, I became a partner in a freestanding NP practice. But I also started composting, increased my gardening time, and began something I have always wanted to do: learn to play the piano. (So far, it is just self-teaching books with some pointers from my husband.)
When I retire from my practice at the end of this year, I hope to sign up for college classes in piano theory and take real music lessons. After being an RN for 44 years and an NP for 14 of them, I am apprehensive at these huge changes—all in my 60s.
I will dearly miss the relationships in the clinic, but I am reading that taking classes brings you in touch with new friends as well as teachers.
Joann Lister, FNP-C, Alpine, TX
TITLES AND CONNOTATIONS
In response to Habib Rashed’s letter (Your Turn. Clinician Reviews. 2012;22:3), I definitely see a problem with his idea of using “MDA” (medical doctor associate) as a clinical title. Doctors of osteopathy will undoubtedly be upset that they are not being “recognized.” Do we then become doctor of osteopathy associates, “DOAs”? I’m afraid that the MDA and DOA titles would certainly make us “dead on arrival.”
I do like the term clinician, as referenced by Bud Isbell in another letter. However, I think a combination of Mr. Rashed’s and Mr. Isbell’s suggestions may be the most accurate and politically correct: associate clinician.
CPT Richard Heinl, PA-C, Fort Campbell, KY