Orange Juice, Hba1c, And The Management Of Diabetes

Every doctor has a few cases that become memorable. In my fourth year of medical school, I was working in a Brooklyn hospital as part of an endocrinology team. During that month I treated many people with diabetes – but one case stood out. The patient taught me valuable lessons in nutrition, orange juice consumption, calories in an orange, and the use of the HbA1c test for the management and treatment of diabetes.

My team was called up to the ICU one morning to consult on a patient that had been admitted to the hospital through the Emergency Room the night before. He came in in pretty bad shape, but the doctors in the ER were able to stabilize him and get him comfortable until the long-term care doctors could take over.

The patient was in his mid-40’s. He had a long history of pretty severe type II diabetes, mild hypertension, and more than his share of nutritional challenges. In short, he didn’t eat well, and it showed. One day, his delicate health balance snapped and he found himself in the ER. It was the job of my team to find out what went wrong and make a plan to fix it.

One of the many tests that were run on this patient is called the HbA1c. It is a test that allows a doctor to tell what the average blood sugar has been over the last 90 days. The scientific basis of the test involves glucose “sticking” to the red blood cells. The more glucose you have in your system, the more red blood cells that become “glycosylated”. Using this test, a doctor can determine what a person’s average blood sugar has been. You can’t lie about your sugar consumption.

Normal HbA1c is less than 6%. This patient was 17.9%. For those that aren’t trained in medicine, this is an absolutely insane number. By all rights, the patient should have been dead. He was only alive (barely) because that level rose slowly, allowing his system to at least partially acclimate to the insanely high amounts of sugar in his blood.

In order to help the patient, we desperately needed to find out what he was eating to cause this high level of sugar in his blood. We spend a long time talking to him about his diet. He claims to have been working with a diabetic nutritionist – making a great effort to improve his old “pizza and beer” diet that he lived on for many years.

After about an hour, we hit the jackpot. One of the things his nutritionist had told him he needed to eat more of was fruit. She’d even given him a list – things like oranges, mangos, strawberries, and such. It turns out he likes oranges. Great!, said his nutritionist.

So he began to consume oranges in a way that he liked, and seemed to him to be healthy – he drank them. He reported drinking about two gallons of orange juice every day. He thought he was doing the right thing. But he didn’t know that orange juice is very high in sugar. Very high. It almost killed him.

In the end, my team managed to stabilize him. We got him back to the nutritionist, with specific instructions to get a more detailed menu of acceptable foods. There is a lesson in this case – you can’t assume a person is going to understand all the nuances of instructions that are given to them. Even the best of intentions can go horribly wrong if the details are left out. It’s a testament to the resiliency of the human body that this patient was able to survive a dangerously high HbA1c.

How to Care for Your Dog or Cat After a Bee Sting

Many of us don’t think about our pets ever getting stung by a bee, but it is something that does happen. There are several things that you will want to look for in order to determine if your dog has been bitten by a bee. The first thing is your dog licking or biting a certain area of their skin. In my experience, I have found that many dogs do this because the skin is irritated after a bee sting. This will cause them to start biting or licking the area. If you notice a small pimple, it could simply be that they have been stung by a bee. You will also notice that the skin is red and irritated. They may even begin to wine and whimper in pain.

 The first thing that you will want to do is put some ice on the bee sting. This will help to ease the pain of your dog . Some veterinarians will recommend that you put some ointment on the bee sting as well. IF your dog still seems irritate you may want to put some skin ointment on the dog. If your dog is known to lick than you may not want to put any cream on the dog. If the dog still seems like he is in pain or irritated you may want to call the veterinarian and ask them what to do next. They may want you to bring the dog in to check the area. In most cases a trip to the veterinarian is not really necessary.

It is always good if things can be worked out at home itself because the vets always charge high and complicate the problem much more than it truly is whenever you visit them for getting your pet checked up.

You will want to watch and make sure that your dog does not have any type of reaction to the bee sting. This does not happen often, but it can happen once in a while. You may notice that your dog is having a hard time breathing or just in extreme pain after the ice has been applied. If you notice this, a visit the veterinarian may definitely be in order.

When it comes to cats you will notice right away that something has irritated them. Cats will usually start to lick the area where they were stung. In my experience with cats they will continue to lick the area until the pain goes away. It can be a challenge to put the ice onto eh cat since they will clearly not like it. I would recommend you trying to put the ice on if you can. If the cat still seems to be irritated by the bit the next day you will need to take them to the veterinarian for them to treat the bee sting. These are just a few ideas and suggestions on how to care for your dog and cat.

Tips for Buying a Puppy at a Pet Store

There are plenty of arguments against buying a puppy from a pet store that include: you don’t know what breed you’re really buying; purchasing a puppy at a pet store keeps puppy mills in operation; and you’ll end up with a puppy that has health problems. We’ve seen these arguments on the TV news, newspapers, and magazines. But these are the bad stories. You never hear the success stories. Bad news simply and always travels faster. With that in mind, if that little doggie in the window catches your eye, what should you do?

The first thing is to see if the staff is knowledgeable and trained well. Many of these pet shops are franchises and although franchises have rules to abide by in order to keep using the franchise name, some franchisees only stick to the basic minimum. To see where along these lines the pet store you’re looking to buy a puppy at falls, ask the staff a few questions. Some questions to ask: 1. How often does the owner come by? 2. What are the store’s regulations? 3. Does the store train its employees in the care and handling of dogs and small animals? 4. What happens to the puppies that don’t sell right away? 5. What do you do about sick puppies? If the staff can answer these questions freely and with confidence then you can feel better about the store because it’s trying to educate its staff. If the staff hesitates, doesn’t want to answer questions, or doesn’t seem knowledgeable, then think twice about buying a puppy from there. If a person will read this article, then there will be offering of the tips for the purchase. The guidelines of the purchase should be fulfilled for the purchase of the pets. The rates of the pets will be under the funds available with the person. The reading of the article will deliver effective results to the owner of the pets. 

Watch how the staff handles the puppies. When a customer asks to see a puppy, is the staff friendly and courteous? Do they gently take a puppy out of the puppy’s cage, or do they do it roughly? Watch how the staff responds to both customers and puppies. If the staff treats the customers and the puppies well then you’ll have less to worry about in regards to problems with your puppy and how the store will handle it.

Look at the cages to check for cleanliness and available water. If the pet store is truly concerned about the welfare of its puppies, then the cages will be clean and there will be water available for the puppies to drink. When a pet store takes the time to train its staff and hires diligent people, then you can feel more secure that they will stand by the puppies they sell.

Ask to see the registration papers. The puppies that pet stores sell as purebreeds should have papers indicating the breed’s lineage and breeder information. Chances are you won’t find many AKC dogs at pet stores, although some do make their way there. The other registration associations may not be ones you’ve heard of but you can check them out online. If you’re buying a puppy from a pet store then you’re probably buying it as a pet and not as show dog potential. As a pet, how much the registration papers matter is a personal choice. If you’re looking for a show dog prospect, then buy a puppy through a breeder with referrals.

Ask about the return policy and health guarantee. A good pet store will have a clearly stated return policy and a clause that allows you to have your own vet look over the puppy. Read the fine print and ask the staff about it. Again, if they are confident in their answers, you can feel more confident in purchasing a puppy from them.

And last but not least, make sure the breed matches your lifestyle. While this seems a no-brainer, many people skip this step because they fall in love quickly with a cute button-nosed fuzzy puppy. Ask the staff how large the breed gets, how active it is and how vocal it is. The staff should have the answers ready or be able to get the answers for you.

Buying a puppy from a pet store is similar to making any purchase of value. Make sure you do your homework and make an educated decision and not an impulse buy.

Keep Your Dog Safe when You Have Puppy Play Time in the Summer

Dogs have summer vacations too and like humans they can also get overheated. When you set aside time to play with your dog during the hot summer months make sure you take steps to take care of your pooch as well as you. Here are some practical tips for having doggy activities this summer.

Keep Your Cool

Dogs pant to shed excess heat instead of sweating. Veterinarians have also determined that dogs pant to release stress as blood circulates from their mouths to their brain to keep them cool. Exercising and play time with your dog not only gets them physical exercise but also is a tension reliever for your pooch. Much in the same way play time is relaxing for humans the same can be said of your canine companion.

Two things are important for keeping your dog cool in general but especially as they’ve had lots of physical activity when it’s hot outside. Shade and cool water are the two best ways to cool off after vigorous exercise. Provide a doghouse if you have an outdoor dog or bring your pet inside if they live in the house with you. Your dog will already be thirsty so simply putting cool water in their dish will let them gravitate to the water on instinct.

It will keep his mood in check as dogs are known to create tantrums if they aren’t given food and drink on time because cool climate equates to a cool mind and what better place than his own doghouse to calm his nerves as that becomes his new house address. 

Cooler temperatures are important so the time of day in which you play with your dog may be a good idea. Instead of the afternoon, consider taking your dog for an early morning jog around six or seven in the morning when the temperature is still relatively cool. Where you live may also be important for summer activities. Northern latitudes are generally cooler and less humid so conditions may be more favorable for afternoon play in the outdoors than in places like Florida or Texas. Indoor dogs won’t nearly have these difficulties.


Never leave a pet unattended in a car if you take your pet out for the day. Even when it’s not summertime a car can heat up quickly if the sun is out. Watching for heat exhaustion and heat stroke is also important if you feel like your dog is getting overheated.

Excessive panting and a dry mouth can both be important signs that your dog needs to cool off quickly. If simply drinking cool water isn’t enough consider drenching your dog with water as a means to regulate their body temperature more quickly. Whether it’s in the bathtub, kitchen sink, or under a hose outside sometimes a cool bath is a fast remedy to being excessively hot.

This article is for informational purposes only. Consult with your veterinarian about what steps you can take to keep your dog cool in the summer time when you have an active lifestyle with your dog.

Stashing Your Dogs Stuff In The Family Mudroom

Even man’s best friend needs a place to rest and call his own. But, you’re probably tired of tripping over dog dishes and don’t want to stare at your pup’s bed in your bedroom or living room any longer. If this sounds like you, then it is time to relocate your dog’s stash. From food to toys and everything in between, you can have a place for everything and everything in its place for your dog in the family mudroom. Let me show you how.

Why the Mudroom?

Of all the places in the house, why stash your dog’s stuff in the family mudroom? The mudroom is perfect because it is out of the way and out of sight when you are entertaining company. For the same reasons people are building mudrooms with locker space and cubbies for their kids’ stuff – it makes sense to build in places to keep your canine’s essentials, too.


And when you’re designing that built-in open locker arrangement for the kids, don’t forget a space for Fido. Imagine a space in the middle of your kid’s lockers – with a hook for a leash or collar above and a built-in dog bed below. Make it just the right height and your pup will be able to climb right in for a snooze. Just imagine your dog curled up, comfy and out of the way in his own private sleeping quarters.

Feeding Dishes and Dog Food

Take your built-in to the next level by installing a floor-hugging toe kick slide out drawer for water and food bowls. Pull out the drawer when it’s time to feed the dog; push it in and out of the way after your pup is done eating. Then conceal a slide out dog food bin as part of the cabinetry in the room and you’ve got feeding time completely covered.


When you are planning out your mudroom, remember to dedicate at least one drawer for your dog’s toys and other paraphernalia. Bones, chew toys, nail clippers and medications can all go in one tidy place where you’ll always be able to find them.

Check out great examples for these ideas in the Dogs in Your Mudroom ideabook post on Houzz. With a little bit of inspiration, you can create a mudroom that accommodates your furry family member’s stash – right along side of the kids’ coats and backpacks. You don’t have to spend a lot of money in stashing your dog’s stuff. You just have to know the basics and some essential tips like the mentioned above, so you can do it easily, cost effective and efficiently.