Mayo Clinic Center for Social Media Residency Helps Me with Patient and Physician Engagment in Social Media

I am attending the Mayo Clinic Center for Social Media residency in Jacksonville, Florida. Like most physicians, I am passionate about engaging patients in a collaborative dialogue about health and wellness. I work in the Division of Hospital Internal Medicine at Mayo Clinic Florida. My goal is to help patients stay healthy enough to stay OUT of the hospital.

Mayo Clinic Social Media Revolution
Mayo Clinic Social Media Revolution

There is a dizzying array of health information on the web. It is overwhelming for both patients and physicians. How accurate is all that information? How should patients and physicians find accurate and user-friencly information relevant to their medical conditions? Which patient support group sites are valuable? How many have accurate health information?

I blog about health issues important to adult and children’s health. Unfortunately, I am “technology deficienct” so my goal for doing the social media residency is to learn in greater depth the “tools for social engagement.”

What I learned during the social media residency was best practices in using various social media platforms, including Facebook, Twitter, Pinterest, LinkedIn, YouTube and wordpress blogs. Social media has limitless potential to advance patient and physician knowledge alike, and help them work collaboratively on medical care.

And I want to be part of the #Revolution!

–Vandana Y. Bhide, MD

View of Mayo Clinic Florida
Mayo Clinic Florida
Last updated on November 30, 2012 by Dr. Vee

The Search for Google: A Commentary on Social Media in our Lives

The Search For Google (Mt. Rushmore Road Show)

Ever notice how pervasive the internet is in our daily lives? And how one can lose track of time for hours with a single web search? A recent example: Halloween Trick or Treating. An age old American childhood tradition. It started out innocently enough.  I simply asked my son, “What do you think about dressing up as Abraham Lincoln for Halloween?” He is studying American history in Social Studies class so I thought this would be a respectable Halloween character, avoiding commercialized blockbuster movie or pop culture idols. I thought I would dress up as George Washington, his friends could dress up as Thomas Jefferson and Teddy Roosevelt and we could have a Mount Rushmore Road Show. This did not go over big with my son.  He looked at me, rolled his eyes and said nothing. I was worried he might be on Facebook “blocking” me or placing an ad on Craig’s List, “For Sale, One Lame Mom. Rants against energy drinks.  Eats brown rice. Still uses whole sentences to text. Takes notes at Parent-Teacher conferences. No, It’s NOT OK to contact me with other services, products or commercial interests.” I checked Angie’s List and became concerned when I was not listed as a preferred vender (mother).

Later that day my son used the most common type of adolescent communication: he texted, “Mom Please don’t embarrass me in public.” (At least he said please.) I texted back “How about dressing up like Facebook?” “OMG LOL!” was his immediate reply.

I thought that maybe his mind, like the American advertising community, had already moved past Halloween onto the more important Christmas shopping season, which starts directly after Back to School shopping season (I am still trying to figure what to do with those ten protractors for $20* I bought in the Back to School Specials frenzy). But no, he then emailed, “I think I’d like to dress up as a Google toolbar.” And so started the search for Google. 

Of course, being internet savvy, he went directly to Wikipedia. When I moved to the United States from India at age five, one of my most prized possessions was a complete set of the Encyclopedia Britannica. It took my parents a long time to save up enough money to buy me a set. In fact, I have kept it until this day to peruse on those late nights when I don’t get 300 emails, 30 email newsletters from mailchimp or a notice urging me, “Read about Dr. Extraordinarily Smarter and More Accomplished than You and On the Verge of Winning a Nobel Prize’s updates on LinkedIn!” 

Today, it’s easier to search the internet than the Encyclopedia Britannica. So naturally we went to YouTube (My son on an I Pad, me on my IPhone) and searched, “How to dress up like Google toolbar. The search returned “Bert & Ernie try Gangsta-Rap.” We moved on to eBay. We put in a couple of bids for Einstein wigs after examining the complete 360 degree view of the hair.  Next we put up for sale 10 protractors, shipping included anywhere in the continental United States.

We even did an advanced search on Amazon (who was kind enough to offer me some suggestions of similar items that I might be interested in buying). I saved a couple of protractors (on sale for a mere 10 for $5 with $10 shipping!) on my Wish List and emailed the list to my relatives for Christmas present suggestions.  All courtesy of those helpful folks at Amazon.

We did a general search on “Healthy Halloween ideas” and were encouraged by advertisers to “Come on over to the dark side with dark chocolate mini candy bars.” The manufacturer told us that there was 1 gram of fiber per 5 mini chocolate bars. That means we only have to eat 150 mini candy bars to get the recommended daily intake of fiber.  After reading the label, my son thought the candy bars were practically a health food and plans on substituting them for broccoli! I find it annoying that manufacturers have jumped on the dark chocolate bandwagon (Fortunately they are interested in our health, not in their sales), trying to convince consumers that candy (of course when consumed “in moderation”) can be part of a sensible diet!

The manufacturer of this candy bar was even kind enough to provide a fascinating article on theobromine, “a compound closely related to caffeine that only has a mild stimulatory effect on the central nervous system.”  They told us, “Preliminary research indicates that even relatively high levels of theobromine does not interfere with attention or mood.”  For our further education, we find out that dogs metabolize theobromine very slowly and it “carries the same risk to dogs as coffee, tea, cola beverages and certain houseplants.”  I bet that piece of useful information was never included in the Encyclopedia Britannica! 

Of course I had to post that article on my Facebook wall so that everyone interested could “Like” theobromine! And I certainly could not leave Facebook (Keep me logged on, Check) without contacting the 5 friends with birthdays this month, see status updates on 22 friends, no lie, play a couple of games of word scramble,  learn how to make gazpacho from Bobby Flay (He might be traveling to my hometown for a Throwdown and I better be prepared!),  print out a couple of coupons for more protractors, start a new game of solitaire (advanced hand), say “maybe” to the 18 events I was invited to by people I’m not sure I know,  “Like” the 400th “Baby’s first steps” pictures of someone I don’t recognize (Baby’s Mom, who I don’t actually know, asked to “Friend” me on Facebook and I agreed, since one has to exceed 7 friends on Facebook in order to well, Save Face) and whew, I am exhausted!

I told my son we HAD to get off the internet because we had exceeded the two hour daily limit of screen time recommended by the American Academy of Pediatrics. But not before we found websites to buy skull and crossbones ice cube trays, sour flush toilet candy, toxic waste candy, tongue tattoos, zombie blood energy drink, and a ketchup packet baby costume.

I thought idly about “quickly” checking behind the scenes photographs of Lindsay Lohan’s  first day of community service as a morgue janitor (CNN Entertainment informed me that “Thursday was suppose to be Lohan’s first day of work as a morgue janitor, but she was sent away after showing up late for the morning’s orientation. Her publicist blamed her tardiness on a combination of not knowing what entrance to go through and confusion caused by the media waiting for her arrival.”) As an act of good citizenship, I recommended this on Facebook (along with 586 other people!) as well as shared it on Twitter. 

Next I had to check what those down to Earth Housewives of Beverly Hills are up to on their behind the scenes blog (shopping, shopping, nails, hair, shopping, Spa, shopping, restaurants, shopping).  Learn about the newest medical breakthroughs on “The Doctors” (Who needs Mayo Clinic Proceedings?), Check. Let’s see what Mayo Clinic Center for Social Media, Deepak Chopra, KevinMD and Dr. Oz are tweeting about (dark chocolate) and we’ll call it a night.

Fortunately, I am pleased to report that my son did not dress up like Tron, Harry Potter (Ok, I admit that’s who he was last year), Charlie Sheen, any vampire from Twilight, Jack Sparrow (SO last year) or an IPad 2. (Why dress up as an IPad 2 when one only has to enter 5 or 6 thousand internet advertising contests in order to have a “chance” to win one?)  He also nixed the Mt. Rushmore Road Show mother-son bonding idea (South Dakota or bust!) as well as, ultimately, the Google toolbar costume (If it’s not found on YouTube it can’t be worth making). I tweeted to the world @VeeMD “My son is dressing up as a Mad Scientist for Halloween and I am dressing up as a Petri dish.” (Less than140 characters.)

*when bought with qualifying $50 minimum purchase

Updated on October 30, 2011 by Dr. Vee

Statins and Beta Blockers Deplete CoQ10


Coenzyme Q10 is a natural substance found in abudance in cells of the body that provides energy to the body and helps the immune system.  CoQ10 also acts as an antioxidant in the body.  Antioxidants are substances that attack and remove free radicals, dangerous substances which cause damage to cells and can eventually result in cancer, aging or cell death.  CoQ10 protect cells from stress from environmental toxins (e.g. cigarette smoke) or aging.  It is in this way that Coenzyme Q10 is believed to help the body fight cancer, prevent heart disease, and combat aging. 

CoQ10 is found in mitochondria, the parts of cells that generate energy. CoQ10 is involved in the generation of energy called adenosine triphosphate (ATP) in cells.  ATP is the energy currency that allows cells to carry out all their myriad functions, including muscle contraction, protein synthesis and other vital cell functions.

Two forms of CoQ10 exist. The more common form is called ubiquinone. The active or oxidized form of CoQ10 is called ubiquinol.  Young people convert ubiquinone to the active component ubiquinol quite readily.  However, ubiquinone is less easily converted to ubiquinol as people get older.  Until recently, ubiquinol was unstable and could not be manufactured as a supplement.  Now ubiquinol is available, but is typically more expensive than the ubiquinone form.

CoQ10 are found in large numbers in the power centers of the body, the liver and heart.  In the liver, CoQ10 is made in a pathway similar to the way cholesterol is made.  So when a person is on a statin, which inhibits an important enzyme that makes cholesterol, the CoQ10 pathway is also impaired.  It is believed that two important classes of medications, the statins (simvastatin, atorvastatin, pravastatin, lovastatin) and beta blockers (atenolol, metoprolol) decrease (up to 40 %) the production of CoQ10 in the body.

Eating antioxidants in Super Foods such as pomegranate juice is a good way to replenish CoQ10 in the body. Some experts feel that older patients on statins or beta blockers should take CoQ10 supplements to replace the reduced levels of CoQ10 in cells.  Some experts feel that people who have high blood pressure should consider supplementation with CoQ10 as well as Vitamin D3.  Athletes (and wannabe athletes) may want to consider adding CoQ10 supplementation to optimized exercise endurance and muscle recovery.

Last updated March 19, 2010 by Dr. Vee

Treatment of Influenza A H1N1 “Swine Flu” with Anti-Viral Medicines in High Risk Groups

Blue Swine Influenza Molecules from CDC


Electron MicrographView of Influenza A H1N1 Virions 


Two classes of antiviral drugs are available for the prevention and treatment of influenza: neuraminidase inhibitors and adamantanes, which inhibit a viral protein called M2. Influenza A H1N1, formerly known as swine flu, has been found to be resistant to adamantanes (amantadine and rimantadine). Oseltamivir (Tamiflu) and zanamivir (Relenza) are the two neuraminidase inhibitors currently available by prescription. These drugs reduce the median duration of symptoms by approximately one day and reduce the chance of contracting influenza by 70 to 90 percent when used for known influenza exposure.


zanamivir moleculeWho Should be Treated with Neuraminidase Inhibitors if they Contract Swine Flu?

High risk groups for the development of H1N1 influenza A, formerly known as swine flu, include children and adolescents who are on longterm aspirin therapy (which puts them at risk for the brain abnormality Reye’s Syndrome if they contract influenza), children under the age of five and pregnant women. Adults and children with chronic lung disease, cancer, heart disease, kidney dysfunction, diabetes, sickle cell anemia, HIV infection and transplant recipients are also considered high risk for complications for influenza, and should be treated with antiviral agents.

Adults and children with brain abnormalities which result in decreased ability to clear respiratory secretions should also be treated with oseltamivir or zanamivir in the event they contract or are exposed to Influena A H1N1.  Patients with cerebral palsy, Lou Gehrig’s disease, seizure disorders and spinal cord injuries would be considered at higher risk for serious complications if they were to contract influenza. Elderly patients, especially those who live in Nursing Homes are also at high risk for developing complications of influenza.

Surprisingly, most patients to date who have contracted Influenza A H1N1, formerly known as swine flu, are younger, healthier patients. Use of Neuraminadase Inhibitors in Infants Under the Age of One Treatment should be considered for infants (down to one day of age) and children with moderate to severe influenza, and those at high risk of complications, including children younger than 5 years of age. While antiviral treatment earlier in the course of infection is likely to have a greater impact on decreasing clinical illness, treatment can be started even if the duration of illness is greater than 48 hours.




Who Should Receive Preventative Treatment with Neuraminidase Inhibitors?


The Centers for DIsease Control (CDC) recommends consideration of antiviral prophylactic (preventive) treatment with medications in patients who have had known or probable exposure to swine flu and are at high risk for developing complications if they were to contract influenza H1N1. Pregnant women, patients over the age of 65, and patients who have the above described chronic medical conditions and who are household contacts of a suspected or confirmed case of swine flu should receive treatment with antiviral medications. A patient is believed to be infectious from one day prior to seven days after symptoms of swine flu start.

Children in daycare and school children who are at high risk for complications of swine flu and who have had close contact with someone diagnosed with swine flu is eligible for prophylactic treatment with neuraminidase inhibitors.

Travelers to Mexico who are at high risk of influenza complications should also receive preventive treatment. Prophylactic treatment with antiviral agents is available to babies under the age of three months, but is only recommended if the infant is critically ill.

Ambulance personnel, emergency medical service providers, first responders, emergency room personnel and other health care workers who are working in areas of confirmed swine flu, and who are at risk of serious influenza related complications may receive antiviral medications to prevent influenza. People who are required to have contact with others in high risk situations such as hospitals or in areas with numerous documented cases of influenza A H1N1 cases should use N95 respirators  to prevent infection.



Virion Particle

Viral Strains Resistant to Anti-Viral Medications are on the Rise

Antiviral resistance can develop to adamantanes such as rimantadine and amantadine after just two to three days of therapy with the class of antiviral agents called adamantanes. Amantadine is an example of this class of drug.

Resistance to oseltamivir, a neuraminidase inhibitor, can also form in two to three days of therapy. Resistance to neuraminidase inhibitors is being seen in some countries. It is expected that strains resistant to oseltamivir and zanamavir will be resistant to peramivir, another medication in the same class, which is currently in development.

Treatment with oseltamivir in infants under the age of one is based on age, not weight. Dosing of children between age one and twelve is based on weight. Zanamavir, which is an inhaled medication, should not be used in patients with asthma or chronic obstructive pulmonary disease (COPD) because it may cause wheezing or shortness of breath.

There have been rare reports of self-harming behavior that may be associated with neuraminidase inhibitor treatment, primarily in Japanese children. Therefore the risks and benefits of treatment with these anti-viral agents should be taken into account before they are used. Treatment or prevention with anti-viral agents does not negate the need for simple infection control measures such as hand washing to prevent the spread influenza H1 N1 infection.



Legal Disclaimer: This article is for informational purposes only and should not substitute for medical advice from your health care provider. The author is not providing personal medical opinion, diagnosis or course of treatment. Do not delay or substitute this information for medical treatment.

Last updated August 28, 2009 by Dr. Vee

Novel Influenza A H1N1 Virus Has Bird, Pig and Human Components

Scientis Electron Microscopeflying pigs

Here is my article in Suite 101 on how the current novel Influenza A H1N1 viral strain developed with pig, bird and human genetic components. We are in Pandemic stage 6, meaning infections have been documented on all continents around the world. The infection is considered of moderate severity by the World Health Organization.

Bird, Human, Pig

Last updated July 27, 2009 by Dr. Vee

Probiotics, Prebiotics and Symbiotics

Probiotics playing Golf

In 2002, a joint statement published by the Food and Agriculture Organization (FAO) and the World Health Organization (WHO) defined probiotics as “live microorganisms which, when administered in adequate amounts, confer a health benefit on the host.” Most commercially available probiotic products are strains of Bifidobacterium or Lactobacillus bacteria or Saccharomyces yeast. Lactobacillus caseii rhamnous GG (Whew! Fortunately abbreviated as LGG) is the most extensively studied bacterial probiotic.

Prebiotics are substances (such as certain carbohydrate sugars) that are not digested, and when they reach the large intestine, they stimulate the growth of beneficial bacteria. Breast milk has a large supply of healthy prebiotic carbohydrates. Symbiotics are a combination of probiotics and prebiotics.

GI Tract


The Gut–Where Probiotics work

When a baby is born, there are no bacteria in the colon. However, shortly after birth, bacteria start living (colonizing) in the large intestine. Breastfed babies have different bacteria (flora) than formula fed babies, which experts hypothesize may contribute to the fewer diarrheal illnesses experienced by breastfed babies. Formula fed babies tend to colonize more harmful strains of bacteria as normal residents of the colon. In certain circumstances, the harmful bacteria can cause problems.

Probiotics show promising positive effects in certain gastrointestinal and allergic diseases. Probiotics and Diarrheal Illnesses Probiotics show benefit in people who have a mild to moderate case of a stomach virus. They also help prevent antibiotic-associated diarrhea (AAD). Various over the counter Saccharomyces and Lactobacilli supplements are available to treat these types of diarrhea. Evidence suggests that probiotics need to be taken early in the course of diarrhea in order to be effective.

Bifidobacterium has been shown to have some effect in preventing relapses of ulcerative colitis in adults.


Probiotics and Colic


Lactobacillus reuteri has been shown to be highly effective in treating colic in babies. In fact, Lactobacillus reuteri worked better than the anti-gas drops that are the most often used medication to treat infantile colic.

There has been a great deal of research on probiotics and allergic illnesses. Studies have shown that LGG given to pregnant women and infants (in breast milk or LGG supplemented formula) may reduce the development or severity of eczema related to cow’s milk allergy in children.

Fluorescent green probiotics

Every spring, hay fever suffers search for a new way to treat their runny noses, sinus congestion and itchy eyes. Unfortunately, the evidence to date suggests that probiotics do not help prevent or treat seasonal allergic rhinitis or environmental allergies such as to pet dander.

Probiotics Cautions

Remember, probiotics are live bacteria, and they should be taken with the same precautions as any medicine or supplement. The risks and benefits of ingesting live bacterial or yeast cultures should be weighed carefully. Caution must be exercised with the use of probiotics in immunocompromised patients (patients with cancer or immune system defects). Consult your physician before using any probiotic.

Probiotics are not regulated by FDA

So why are probiotics more effective than say, plain old yogurt? Probiotics contain much larger amount of bacteria (over 108 microorganisms per gram of supplement) than yogurt. Remember, though, probiotics are not regulated by the Food and Drug Administration (FDA), and studies have shown significant variability in the number of colony forming units available in various probiotic formulations.

Reference: Food and Agriculture Organization, World Health Organization. The Food and Agriculture Organization of the United Nations and the World Health Organization Joint FAO/WHO expert consultation on evaluation of health and nutritional properties of probiotics in food including powder milk with live lactic acid bacteria, FAO/WHO Report No. 10-1-2001.

This article is for informational purposes only and should not substitute for medical advice from your healthcare provider. The author is not providing personal medical opinion, diagnosis or course of treatment. Do not delay or substitute this information for medical treatment.

Bad Bacteria Cartoon

Last updated August 22, 2009 by Dr. Vee

Vitamin D Deficiency in Children and Adolescents


milk vitamin DRecent studies show an alarming lack of vitamin D, also called cholecalciferol, in American children and adolescents.

Vitamin D is important for the development of strong bones. Vitamin D deficiency can lead to rickets (weak, deformed bones) in infants and children. It also contributes to osteoporosis(thinning of the bones) in post-menopausal women. Vitamin D deficiency may also contribute to high blood pressure, diabetes and certain cancers, although no definite causal link has been proven.

Vitamin D Made in the Skin from Sunlight

Vitamin D is available to the body in two different ways. Sun exposure helps the skin make vitamin D.  Ultraviolet B (UVB) waves help formation of vitamin D in the skin, but UVB rays are also responsible for the burning effects of the sun.

Not surprisingly, vitamin D deficiency is more common in northern parts of the country, where there is less sunlight. Melanin, the pigment in the skin, as well as sunblock applied to skin, can decrease the absorption of vitamin D. The more melanin in the skin, the darker the pigment of the skin, and the less vitamin D that is absorbed.

Regular application of sunblock to the skin will also decrease absorption of sun.  The American Academy of Dermatology does not recommend stopping the use of sunblock to allow the absorption of vitamin D, since the ultraviolet B rays can increase the risk of skin cancers.

Vitamin D can be Absorbed in the Stomach

200 IU (international units) of vitamin D is the daily recommended intake of vitamin D in children and adolescents. Post-menopausal women should have at least 400 IU a day to prevent thinning of the bones. Many experts feel that this recommendation is too conservative, and that post-menopausal women need at least 1000 IU daily to prevent/treat osteoporosis.

vitamin D sources

Fish, vegetables, and milk and cereal fortified with vitamin D are all good sources of vitamin D. However, a child would have to drink the equivalent of half a liter of milk a day to get recommended amounts of vitamin D. Vitamin D is important because it helps the absorption of calcium by the gut.

Vitamin D is Converted into 25 Hydroxyvitamin D, 25 (OH) D (Calcidiol)

Once vitamin D is absorbed by the skin or in the stomach, it is converted to a molecule called 25 hydroxyvitamin D (shortened as 25 (OH) D or calcidiol), in the liver. Although it is not routinely checked, 25 (OH) D can be measured by a blood test. 25 (OH) D is then converted to another molecule in the kidney. So it is not surprising that children and adults with kidney failure are prone to severe thinning of the bone. Vitamin D is then stored in the fat in the body once it is converted by the liver and kidney.

Vitamin D Deficiency is Common in Children and Adolescents

Currently, a level of < 11 ng/ml is defined as vitamin D deficiency. Many experts feel that this threshold is too low, and that the negative effects of vitamin D deficiency on bones can occur at levels of 20 ng/l or higher. A number of studies have shown that vitamin D deficiency is more common than previously thought. Three main factors play a role in vitamin D deficiency in children and adolescents: race, gender and body-mass index (BMI, a measure of obesity). Girls are twice as likely as boys to have vitamin D deficiency. Darker pigmented children are more likely to have vitamin D deficiency. 25 (OH) D levels decrease as BMI (weight) increases.

The Highest Rate of 25 (OH) D Deficiency is Seen in Overweight African American Adolscents

In the United States, up to 2 % of all children have levels of 25 (OH) D less than 11 ng/ml, and 14 % have less than 20 ng/ml. Even more concerning, 11-50 % of African American teenagers in the United States may have 25 hydroxy D deficiency (depending on how deficiency is defined). This is a startling statistic. In one study, African American adolescents were found to be twenty times as likely as Caucasion adolescents to have vitamin D deficiency. The risk of vitamin D deficiency in Hispanic and Asian adolescents is also higher than in Caucasions. Being overweight increases the risk of vitamin D deficiency by 75 %. The highest rate of 25 (OH) deficiency is seen in overweight African American adolescent girls.

Letter D on Plate

Vitamin D Supplementation in the Diet

It is unclear how vitamin D deficiency in adolescents will affect health when they become adults. Interestingly, in post-menopausal women, thin Caucasians are at highest risk for osteoporosis and bone fractures. It seems prudent to maximize food intake of vitamin D or to consider taking a vitamin D supplement if not enough vitamin D is consumed in the diet. In the future, it may be useful to measure 25 (OH) D levels in high risk adolescents.


Saintonge, Sandy, Bang, Heejung, Gerber, Linda. Implications of a New Definition of Vitamin D Deficiency in a Multiracial US Adolescent Population: The National Health and Nutrition Examination Survey III. Pediatrics 2009; Vol. 123, Number 3: 797.

Legal Disclaimer: This article is for informational purposes only and should not substitute for medical advice from your healthcare provider. The author is not providing personal medical opinion, diagnosis or course of treatment. Do not delay or substitute this information for medical treatment if you have any medical concerns.

Updated January 6, 2011 by Dr. Vee

Hand Washing Reduces the Spread of Swine Flu H1N1

Handwashing is the single most important measure to prevent the spread of infections, including colds and flu.  Photograph Courtesy of Amaya1991.

20 seconds hand washing is recommended to remove germs. Should you use regular or antibacterial soap? Depends on what kinds of germs you are trying to remove.

Read more:

Sing Happy Birthday Twice Whlie Washing Hands

Hand Washing Prevents the Spread of Infection, Including Swine Flu
Hand Washing Prevents the Spread of Infection, Including Swine FluHand Washing is an Effective Anti-Infection Measure

Last edited May 4, 2010 by Dr. Vee