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<title>askDrJim</title><link>http://www.askdrjim.com/foler/index.html</link><description>Medical Questions and answers</description><dc:language>en</dc:language><dc:creator>doc@askdrjim.com</dc:creator><dc:rights>Copyright 2007 James Schindler</dc:rights><dc:date>2008-11-28T20:18:13-05:00</dc:date><admin:generatorAgent rdf:resource="http://www.realmacsoftware.com/" />
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<lastBuildDate>Fri, 28 Nov 2008 20:31:35 -0500</lastBuildDate><item><title>No&#x2c; Not Everyone</title><dc:creator>doc@askdrjim.com</dc:creator><category>None</category><dc:date>2008-11-28T20:18:13-05:00</dc:date><link>http://www.askdrjim.com/foler/page3/index.html#unique-entry-id-85</link><guid isPermaLink="true">http://www.askdrjim.com/foler/page3/index.html#unique-entry-id-85</guid><content:encoded><![CDATA[Our church had a recent revival and I am still processing what was changed in me.      Revival assumes something was previously alive and then has been re-energized.     This primarily then, is a term for Christians as opposed to a crusade for evangelism.    


The first night's speaker gave me two kernels for thought and hopefully songs that I will attempt to flesh out here.    First was the idea that we have the DNA, the finger prints so to speak, of our Father IF we indeed are Christians.     He used the text where Christ says that not all who call Him "Lord" when standing at the brink of heaven or hell will be welcomed by Him into paradise.    This is a disturbing passage.     Those who rely on their own works (the texts says casting out demons, prophecy, healing and the like) are not the criteria upon which God's decision will rest.    Rather it will be the act of Christ's death only that will be used to credit righteousness for us.


Those who are His will be unmistakable to Him.     We have the DNA of the Holy Spirit residing within us.     Our way of talking, acting, living all should be identifiable as from His family.    Just as earthly children come to act like and resemble others in their families, we too should have a family resemblance.    It is too true that I often must appear to the world as not from the family by the choices I make and the way I act. 


The second thought was "No, not everyone".     Meaning that not all who think they are Christians will actually be saved.    This is the scary part as one starts to question "what about me?"     The passage paints a picture of humans pleading their case somewhat indignantly when told "I do not know you".     How then are we to be comforted?     By the Comforter who dwells within us.     The Holy Spirit will confirm to those in whom He resides that their salvation is sure and real.     He was sent to teach, to comfort and to make manifest in us the new DNA we possess when we are saved.


That's a lot to chew on for one sermon!]]></content:encoded></item><item><title>Grace</title><dc:creator>doc@askdrjim.com</dc:creator><category>None</category><dc:date>2008-09-14T22:02:00-04:00</dc:date><link>http://www.askdrjim.com/foler/page3/index.html#unique-entry-id-84</link><guid isPermaLink="true">http://www.askdrjim.com/foler/page3/index.html#unique-entry-id-84</guid><content:encoded><![CDATA[Today in Sunday School we were discussing the concept of grace.    Unmerited favor is the way I have always thought of grace.      In the Christian world view this would mean that nothing within me should have caused the God of the universe to carry out a plan to remove the blood-guilt that my sin demands.     God&rsquo;s act of grace starts and ends in the will and action of God alone.    I am the unworthy recipient.  


Ah, but I must both see my need, confess my inability to save myself and then accept the grace that is given me by the act of Christ dying in my place.    There&rsquo;s the rub.  


 Accepting grace and then understanding that it was all sufficient and freeing is not easy.      Grace frees us from the slavery to sin under which we lived and places us in a righteous (here I would say blameless or sinless) position free to live fully the way God intended.    The problem is the way we think about it as humans.


I tend to look back or regret my sin....to wallow in my guilt.     This is almost like a slave once freed who has no idea how to live free.     I have patients who have a complaint and after an exhaustive work-up are told, &ldquo;good news, there is nothing dangerously wrong with your body&rdquo;, who seem unhappy with the news!   Moreover many go from doctor to doctor trying to find something wrong rather than embracing their health and living.     Too often I see myself in that pattern.     Bound up by guilt of past sin or of future sin afraid to seize the joy that grace has given to me.


In the Screwtape Letters, C.S.   Lewis outlines how Satan desires to keep humans focused on the past (regrets) or the future (fear) rather than living fully free in the present.    He says that the present is the closest thing to the &ldquo;eternal now&rdquo; of heaven and if humans fully embraced the present as God intends our eternal nature would recognize its joy  and Satan would lose his grip on our lives.     Embracing grace would seem to be the first step.    If you are a Christian saved by the death and resurrection of Christ then you indeed have received a clean bill of health.  ]]></content:encoded></item><item><title>Vitamin D</title><dc:creator>doc@askdrjim.com</dc:creator><category>None</category><dc:date>2008-09-14T21:51:23-04:00</dc:date><link>http://www.askdrjim.com/foler/page3/index.html#unique-entry-id-83</link><guid isPermaLink="true">http://www.askdrjim.com/foler/page3/index.html#unique-entry-id-83</guid><content:encoded><![CDATA[I know that I have written about Vitamin D before but I have got to do so again, albeit briefly.     When the research on Vitamin D deficiency&rsquo;s link with depression was published a couple of years ago I became curious about what I had read.    Then consistent research linked low levels of vitamin D with not only depression but increased cancer risk and, certainly, poor bone deposition.     I started to test patients, especially those who were elderly or at risk of osteoporosis fractures or the ones that were depressed.    Gradually I began to test more patients in my practice.    The results have been astounding.     Like most silent epidemics, vitamin D deficiency is easy to find when you are first testing in a population.    The prevalence is high and the yield of testing is also high.    I was not prepared for 8 of 10 tests to return under the levels thought to be needed for good bone health.     That&rsquo;s correct...80%.     Both men and women are testing low and largely middle aged to elderly.    Those who get little sunlight and little supplemented dairy products are the largest group.   


With supplementation I have seen levels rise to acceptable and those patients will be able to use OTC supplementation thereafter....we hope.    The question will be &ldquo;Is there a clinically relevant benefit to raising these levels?    Given the associations with cancer and depression and osteoporosis one would hope so.    Time will tell.      More later.  ]]></content:encoded></item><item><title>Olympics</title><dc:creator>doc@askdrjim.com</dc:creator><category>None</category><dc:date>2008-08-17T23:55:23-04:00</dc:date><link>http://www.askdrjim.com/foler/page3/index.html#unique-entry-id-82</link><guid isPermaLink="true">http://www.askdrjim.com/foler/page3/index.html#unique-entry-id-82</guid><content:encoded><![CDATA[Of course I have been watching the Olympics this past week....who could not.    The drama of sport at high levels is reality TV cubed.     I enjoy the races of all types.    It seems a great way to test your competitor.    I&rsquo;ll race you to the tree.     Just the type of race we all had when we were little.     I like but get frustrated with the judged competitions as it seems there is way too much subjectivity.     I do like the stories and pictures of sportsman/womanship.     The Games seem to always bring some type of special stories out.     But I still don&rsquo;t get Greko-Roman Wrestling.      I will be back from the summer hiatus soon and hope to have some changes to put on the site.   ]]></content:encoded></item><item><title>Kids and Statins</title><dc:creator>doc@askdrjim.com</dc:creator><category>None</category><dc:date>2008-07-07T21:31:09-04:00</dc:date><link>http://www.askdrjim.com/foler/page3/index.html#unique-entry-id-81</link><guid isPermaLink="true">http://www.askdrjim.com/foler/page3/index.html#unique-entry-id-81</guid><content:encoded><![CDATA[OK, so those of you who know me already know where this is going.    Today the American Academy of Pediatrics released and expert panel statement recommending more aggressive screening of cholesterol in kids AND selective use of statin drugs in kids as young as 8 years old AND a move away from whole milk in children after the age of 12 months especially if they are overweight.     The first is in an effort to identify those with risk of heart disease who may benefit from intervention.     The second is based on some small studies that did not show harm if children used the meds for a short term (long term followup does not exist yet).    The last is a major deviation from long held belief that for younger kids a certain amount of fat in the diet is crucial for brain development.


My take is mixed:   Obesity in children is rampant in America.  ...  We eat too many calories, too many calories as rapidly absorbed sugars and too little good protein and fiber.   ...  We have used sweet sports drinks to satiate our kids growing sweet teeth and as a society we &ldquo;do exercise&rdquo; rather that &ldquo;live active&rdquo;.    Our schools and social institutions feed our kids poorly and cheaply and exercise them rarely.     Our kids sleep too little (which in the < 8 year old crowd has been linked with obesity.


...We reach for pills because we don&rsquo;t want/cannot spend time with patients trying to educate and change lifestyles.    We have not been out front in advocating for healthy local school food and against corporate takeover of the lunchroom.     We have reached for pills to correct ignorance or sloth from parents who seem not to understand that they are killing their kids and we have gone away from common sense approaches.


Medicine has not lead the way in nutrution even for the youngest amoung us (unless they have an illness).    Did you know that nearly 1/3 of our baby boys in some surveys are drinking SOY forumla.     At the same time we promote soy as a phytoestrogen to help with the sympotms of menopause.   ...  Although obesity < 2 years of age has not been as strongly linked to adult obesity as in kids 3-8 we now seem poised to recommend against fats that nearly all science says may be cruicial for brain development in a toddler.  

...If you think that the pharmaceutical industry is not licking its lips anticipating a new group of &ldquo;patients&rdquo; who will take meds FOR LIFE you are kidding yourselves.     Doctors will not want to be &ldquo;behind the times&rdquo; and will start screening (not a bad thing) and given meds.    My experience over the years especially when I was teaching was that given a choice between educating and prescribing a medication, the Rx always won.   ...  So do not be decieved, these recommendations will largely increase testing costs, prescriptions to younger kids and side effects from those meds.


...Obese parents who eat poorly and do not exercise may wish their children were fit and active but, in my experience, the children quickly adopt the parent&rsquo;s livestyle.  ...  Sugars must become public enemy number one with high fructose corn syrup becoming our number one bad guy.    We need to have health care integrate nutrition and exercise eduation for children.     We need to insist on good independent sources of research on nutrition rather than relying of data compiled by manufactuers of medications.     We need to see that consuming is not healthy when it comes to medications and that the hard road of personal discipline and long term view is far better for society than the short term gratification of our taste buds.    We need to put patients back on the hot seat as active in their own health.  ]]></content:encoded></item><item><title>BFF</title><dc:creator>doc@askdrjim.com</dc:creator><category>None</category><dc:date>2008-06-30T22:04:52-04:00</dc:date><link>http://www.askdrjim.com/foler/page3/index.html#unique-entry-id-80</link><guid isPermaLink="true">http://www.askdrjim.com/foler/page3/index.html#unique-entry-id-80</guid><content:encoded><![CDATA[The other great thing about cyberspace is the fact that folks can find you drifing out there.     Recently I had a dear friend from years ago contact me because they found my website.     This was amazing in and of itself as we have had < 5000 visits in the past year!     Anyway I was found and then contacted.     I am so greatful that they took the effort to connect.    The other thing I have learned is that certain things are eternal.    I am sure that the eternal part of each of us recognizes the eternal part in our close friends.     How else can it be that after decades you can pick up almost without a pause?     It seems that certain types of human interaction just trancend (or may suspend) time.     Thanks for reachiing out when you did.       I have not had much to blog about with a busy summer schedule and I try to avoid politics other than bashing the pharmaceutical/medical/industrial complex.    There have been some studies out recently that I am digesting and trying to put into words to get out here.    I am also going to look at a podcast (because those of you who know me know I can talk and talk and talk).   Catch the poem in the verses page look at some friendship lines.  ]]></content:encoded></item><item><title>Forum on Hold</title><dc:creator>doc@askdrjim.com</dc:creator><category>None</category><dc:date>2008-06-30T22:02:27-04:00</dc:date><link>http://www.askdrjim.com/foler/page3/index.html#unique-entry-id-79</link><guid isPermaLink="true">http://www.askdrjim.com/foler/page3/index.html#unique-entry-id-79</guid><content:encoded><![CDATA[OK so maybe it was not such a good idea.    I certainly don&rsquo;t LIVE to sit at the computer typing and trying to intice &ldquo;friends&rdquo; to cyberchat.    The forum will go into hybernation for now.     I still would like have ideas on how to develop a more interactive site.     I really would like to &ldquo;ask the doc&rdquo; for both patients and others visiting the site but the forum was not working and I don&rsquo;t want to look at the site with in on any more.     The king is dead.    Long live the king.]]></content:encoded></item><item><title>Flippin Out</title><dc:creator>doc@askdrjim.com</dc:creator><category>None</category><dc:date>2008-06-30T21:54:24-04:00</dc:date><link>http://www.askdrjim.com/foler/page3/index.html#unique-entry-id-78</link><guid isPermaLink="true">http://www.askdrjim.com/foler/page3/index.html#unique-entry-id-78</guid><content:encoded><![CDATA[If you check out the last page on the site you will find a video of a trip I recently took with some friends and family.     The amazing thing is the camera on which the video was shot.     The Flip Mino is a new small video camera that is about the size of my very small cell phon.    It looks a lot like a blak iPod with a lens on one side.    The back has a large red button around which are four directional toggles and above which are 2 selection buttons.     The form is much like and MP3 player and is very intuitive.    There is a built in microphone and electronic zoom and a 1.5 inch LED screen in the back to watch what is being shot and to review the video clips.     Much like a digital camera, you can trash the clip if you don&rsquo;t like them.    It can record up to 1 hour of video/audio.     Now here it the kicker, it has a built in USB male port that pops out at the push of a button alowing you to link and download to a Mac or PC without much fuss.     If you want to use Quicktime or other players it is pretty straight forward.     And you can dump into movie software.     Thus the first effort you see posted.    This will be great for web video work.      I&rsquo;m just learning the ropes and will let the kids take it on a trip to North Dakota in July to shoot more footage.     I love the fact that you can be creative with minimal investment. ]]></content:encoded></item><item><title>What are you doing here?</title><dc:creator>doc@askdrjim.com</dc:creator><category>None</category><dc:date>2008-06-21T23:07:16-04:00</dc:date><link>http://www.askdrjim.com/foler/page3/index.html#unique-entry-id-77</link><guid isPermaLink="true">http://www.askdrjim.com/foler/page3/index.html#unique-entry-id-77</guid><content:encoded><![CDATA[Last week we were looking at the Old Testament story about Elijah and the phophets of Baal.    In the story Elijah is led to prove once and for all that his God is living and supreme and that Baal is an idol.     He challenges 450 of the prophets of Baal to build an altar and have their god produce fire from heaven to come down onto their altar.   ...  He then produces a simple altar, soaks the wood and the sacrifice with more water than was needed to make his point and then prays simply that God would show who is &ldquo;the Lord&rdquo;.  ...  Elijah has the false prophets seized by people who had come to watch the contest and then he has them all killed.     He prays to God to end the long drought that had ravaged the land and a torrent occurs.  

...He has been filled by God&rsquo;s Spirit  and with that filling has done miraculous things and observed God&rsquo;s power and constant attention to His people.     Our discussion looked at the way he was locked in to being brave and faithful in the story.


What struck me was the next chapter (1 Kings 19) where Jezebel has been told of the outcome of the duel and the death of the prophets (whom she supported).   ...  And fresh from his mountaintop experience and aware of God&rsquo;s power, the prophet........  He eventually wanders into the mountains and ends up in a cave apparently depressed and hiding.


...God does not ridicule him, demand he have more faith or punish him.   ...  The man complains that all others have been unfaithful and he has tried to do God&rsquo;s bidding and now he is in danger of his life.      God again, does not punish or correct, He tells Elijah to go out of the cave and stand on the mountain so Elijah can be there when God passes by.    Elijah does so and observes a great wind that shakes the mountain and shatters rock (and the text says &ldquo;&rdquo;But the Lord was not in the wind&rdquo;.   )   Next came an earthquake and then a fire with the same response.     Finally, there is a quiet voice of God which says... 

...Elijah repeats his statements of before and again, God does not chide him.   ...  Then God reminds the prophet there are still 7,000 men fiathful to Him during this time of turmoil. 


...Right now I am in a place where I am complaining, feeling sorry for myself and being generally depressed.   

...God is always in the places where we are, waiting, full of action and hope.    He has plans for us that He desires to tell us.   ...  He does not rebuke us for these but he wants us to move outside of the place where we are so that we can see Him.     He can hear our complaints but desires to put us firmly into His plan.    He also comforts us with the knowledge that we are never as alone as our emotions would tell us we are.     Lastly, He certainly can show us His presence in big and powerful ways but He does not need to do so because the power He places inside us is sufficient as long as we look to Him and obey. 


I hope that I can learn this lesson and move out from the cave to hear what He has for me to do. ]]></content:encoded></item><item><title>Abba</title><dc:creator>doc@askdrjim.com</dc:creator><category>None</category><dc:date>2008-06-08T23:48:57-04:00</dc:date><link>http://www.askdrjim.com/foler/page3/index.html#unique-entry-id-76</link><guid isPermaLink="true">http://www.askdrjim.com/foler/page3/index.html#unique-entry-id-76</guid><content:encoded><![CDATA[Today at Sunday School we were discussing the issue of fear.    The question at hand was &ldquo;where is God when I fear?&rdquo;   and the myriad questions that sprout from that point.    It is a very relevant question.     Daily in my practice I see people whose lives are dominated by fears and anxiety.     Some have phobias, some reactions to past traumatic events, some seem to be unable to leave daily worries alone and many are ashamed of their fear.


My take on this may be a bit different.     I believe God has given us all our emotions.     I cannot tell you where fear would fit in before the fall of man but certainly the adrenaline rush and &ldquo;fight or flight&rdquo; reaction it can produce is not in and of itself an evil thing.    God does not tell us to be ashamed of our fear.    He asks us to understand we have reason to boldly face the things that make us anxious through his power.


The passage that caught my attention says that we have not been given a spirit of timidity but of power.    We are not slaves but adopted sons and daughters and can call &ldquo;Abba&rdquo; or &ldquo;daddy&rdquo;.    I bet I had read or heard that passage dozens of times but it struck me today that an orphan wandering in the world faced with a fearful situation will likely cry and dispair.     A son or daugher yells &ldquo;DADDY!&rdquo;   fully expecting the rescue, the comfort and the support of the father.    The Spirit we are given is His Holly Spirit within us.    This certainly is not a spirit of timidity and we can cry out for Abba to come and be with us in our time of deepest anxiety.  ]]></content:encoded></item><item><title>Are You Confused Yet?</title><dc:creator>doc@askdrjim.com</dc:creator><category>None</category><dc:date>2008-06-01T23:50:49-04:00</dc:date><link>http://www.askdrjim.com/foler/page3/files/jun-2008#unique-entry-id-75</link><guid isPermaLink="true">http://www.askdrjim.com/foler/page3/files/jun-2008#unique-entry-id-75</guid><content:encoded><![CDATA[This past week the British Medical Journal (BMJ) published three very interesting articles related to Type 2 diabetes.    This is the most common type of diabetes seen in the world and is the one linked with central obesity and diet.    You see, over the past decade there has been a wealth of new medications including new types of insulin that have come on the market enhancing our ability to bring sugars closer to normal in most patients.    Many folks are now on several drugs and may be on drugs and insulin.     They also are monitoring their sugars multiple times per day to be more aware of their control. 


Much of the reasoning behind the desire to tightly control Type 2 diabetics was extrapolated from research on the other type of diabetes, Type 1 diabetes.    In this form the body&rsquo;s insulin production is impaired, often after a viral or autoimmune or other insult to the pancreas.    The result is generally patients who absolutely need insulin to live.     What was discovered years ago was that the rate of development of renal failure, blindness and other complications was slowed dramatically by tightly controlling sugars.    Since these people needed insulin, you started to see testing with each meal and in between meals to help them decide how much insulin to use.    Because of the pain with testing, new meters emerged that required less blood and caused less pain.   


It was thought that diabetes was diabetes and if tight control was good for one type then it must be good for another.  ...  Certainly, it is a patient&rsquo;s best interest to not have remarkably high sugars or wild fluctuations.    It is also good for them not to have hypoglycemia and pass out.   ...  If so it would require a lot of testing and more medications.


Enter coroprate America who was only too happy to settle the question.....if it gets paid for it should be done.    We now have organizations that aggressively market to patients who have diabetes offering to supply their testing materials delivered to their door with no hassle.     As a doc I get the &ldquo;request&rdquo; from these companies to test.    They are only too happy to send out more supplies regularly (even if the old ones are not used up) and to provide reqular upgrades, batteries, reagents and even blood tests normally done at a doctor&rsquo;s office.     All of this is for the patient&rsquo;s convenience AND to help with their control.      And of course now patients are testing so much that they become afraid or ashamed of the results and request more medications to control them &ldquo;to normal&rdquo;.


...Three articles:  the first was looking at whether it was cost effective to detect diabetics or prediabetics so interventions including diet, exercise, education and medication could be initiated:  This one was simple....it was cost effective to find the prediabetics and diabetics so we could intervene mostly with non-drug methods.     The second and third articles looked at the cost effectiveness and other outcomes of having patients monitor aggressively their sugars at home rather than seeing a doctor episodically and having adjustments to medications made at that time.    (You seen in Great Britain they have BUDGETS for their health care and they want to know if they are spending the money wisely or not).   


What they found was that aggressive monitoring by the patient was NOT cost effective, DID NOT result in better control but DID result in a LOWER QUALITY OF LIFE ASSESSMENT SCORE and HIGHER scores for depression!


Their editors questioned the value of aggressive home testing for the majority of Type 2 Diabetic patients and rightfully so.    Makes you wonder why we are pushing so hard.]]></content:encoded></item><item><title>Gas Prices and Other Thoughts</title><dc:creator>doc@askdrjim.com</dc:creator><dc:subject>askdrjim blog</dc:subject><dc:date>2008-05-26T22:42:41-04:00</dc:date><link>http://www.askdrjim.com/foler/page3/files/may-2008#unique-entry-id-74</link><guid isPermaLink="true">http://www.askdrjim.com/foler/page3/files/may-2008#unique-entry-id-74</guid><content:encoded><![CDATA[Gas is approaching $4 per gallon here and filling my truck is over $70 a pop now.      One becomes a conservationist in a hurry when the wallet is hurt that badly each time you fill up.    I certainly don't recall the gas rationing of the 70's very vividly but I wonder how far away from that we may now be.     As a consuming nation we have always "lived large".     America more than any other definition is one of excess to the rest of the world.    Excess violence, excess consuming, excess waste, excess pop culture.      Maybe this looming economic change for us will force some type of maturity on those types of patterns.    Then again, maybe not.    I know that Satan certainly uses our consumerism to aid our tendency toward greed and idolatry.    Not that we need much encouragement.  


 I find that the more I have, the more I want and the more I want the less I seem to have.    That is far from the contented life that Christ advocated.    We were not to even worry about things of material nature both because God will supply what we need when it is needed and because looking to the future with worry or convoluted plans robs God of our attention now.    By diverting our attention to something that does not exist (the temporal future) to something that does (our eternal security through Christ's grace) Satan achieves a goal of weakening our perception of eternity.    We are "amphibious" as C.S.   Leis wrote....both temporal and eternal beings.     The more we concentrated on one part of our nature, the less we will concentrate on the other.    God desires that we look to the Eternal and Satan desires we think only on the temporal.     If we could see from God's view we would be able to be as Paul was "content" in all circumstances.


The other thoughts I have had recently are about milestones.     Certainly, with school ending we see our children and friends marking, often publicly, a transition in their lives.    Other milestones pass uncelebrated but not unknown.    These may be special days in the lives of those whom we care about or those who have left us for eternity.     Memorial Day is a time to not only remember those who have died in the line of duty to our country but also those who have served or are serving honorably.    My thanks for those of you who have done so and my prayers for those whose milestones happen this month.]]></content:encoded></item><item><title>Me and Pat</title><dc:creator>doc@askdrjim.com</dc:creator><dc:subject>askdrjim blog</dc:subject><dc:date>2008-05-18T17:09:01-04:00</dc:date><link>http://www.askdrjim.com/foler/page3/files/may-2008#unique-entry-id-73</link><guid isPermaLink="true">http://www.askdrjim.com/foler/page3/files/may-2008#unique-entry-id-73</guid><content:encoded><![CDATA[Just a short blurb on another event this week.    I was asked to speak to a women's luncheon about weight loss and exercise.     I was prepared for a group of a bout 50 or so.    When I got to the event there were around 400.     That's 400 women and 4 men (the pastor of the church, one husband, a guy who may have wandered in and myself).     That is kind of the definition of intimidating!


Luckily, one of my first slides said that "Talking to a group of women about diet and weight loss is like trying to tell Pat Summitt how to coach!!"    


The talk went well and I think I am learning as I go about this whole diet issue.     One interesting fact from my preparation:  the LUMEN of the intestine appears to monitor its contents and sends signals to the brain and other body parts depending on what is found.     Let me say that again....our gut tests not only what is being absorbed into its bloodstream during digestion but MONITORS WHAT IS PASSING THROUGH as it attempts to tell our brain how much and what to eat.


We are fearfully and wonderfully made. ]]></content:encoded></item><item><title>Water and Blood</title><dc:creator>doc@askdrjim.com</dc:creator><dc:subject>askdrjim blog</dc:subject><dc:date>2008-05-18T16:52:04-04:00</dc:date><link>http://www.askdrjim.com/foler/page3/files/may-2008#unique-entry-id-72</link><guid isPermaLink="true">http://www.askdrjim.com/foler/page3/files/may-2008#unique-entry-id-72</guid><content:encoded><![CDATA[My middle son was baptized today.     There were several others at the church that went through the ceremony.    I was very happy and proud of his decision to publicly show what was a spiritual commitment that he had made.    I has me thinking about the sign of baptism.    I do not believe that there is anything in the ordinance that makes or breaks someone's eternal security.    That being said I know that Christ was baptized in order to "do all right things". 


...We are nurtured in the womb in a bath from which we emerge to face the world as a new creature.    Everything is changed and yet we are prepared for it physically.    Much will be hard.     There will be times of sickness, pain and loneliness, yet the journey begins as we come out of the water.    Christ told Niccodemus that he would need to be "born again" in order to inherit eternal life in paradise.    By using water the ancients re-inacted the physical birth.    By using some words (Christ's suggestion to baptize "in the name of the Father and of the Son and of the Holy Spirit." the ceremony is raised to a different and more meaningful level.  


We are submerged and dead, lost and unformed.     We emerge with this new life in Christ sinless, alive and growing toward His likeness.     The old is passed and the new has started.     We also identify with Christ's own baptism and life and say to the world "I am a follower of the Christ."    These are deep spiritual truths that all lie behind the act of baptism.    We do this in front of witnesses (even if only the pastor) in order to make that proclamation public and real.


Here is east TN baptism can be a real social event.    Some churches wait for months and do mass baptisms.    Others baptize new believers immediately.     Many still will "go to the river".    I attended one such baptism about a year ago that brought the simplicity and beauty of the act fully into view.    With nature all around and the flowing water of the river as a background, it was hard not to imagine Christ standing there, smiling and nodding.


I am glad that God has chosen to ask us to do public things to align ourselves with His cause.     It is far too easy to do what the crowd wants these days and my son's decision to run counter to that makes me proud. ]]></content:encoded></item><item><title>Stories and Connections:  Ramblings</title><dc:creator>doc@askdrjim.com</dc:creator><dc:subject>askdrjim blog</dc:subject><dc:date>2008-05-04T23:47:34-04:00</dc:date><link>http://www.askdrjim.com/foler/page3/files/may-2008#unique-entry-id-71</link><guid isPermaLink="true">http://www.askdrjim.com/foler/page3/files/may-2008#unique-entry-id-71</guid><content:encoded><![CDATA[I guess one of the things that entices me about medicine in general and primary care specifically is the diversity of stories and the way they are told.     I try to use the "pattern recognition" that seems to aid all of us in primary care because common things are common.   


In this day and age we have medicalized everything that used to be the realm of others:  nutrition, exercise, aging, spiritual pain, emotional upheaval as well as routine birthing.     The small step from childhood immunization for polio and smallpox has become an lucrative industry of well child visits.    These paternalistic encounters presupposed that parents cannot think about safety and diet and development themselves....it is far too complex.    Sure, I have detected developmental delays, abuse and neglect and the occasional congenital condition but these largely were self-evident or brought to me by a parent.     And, yes, I have seen my share of unfit parents who were clueless about feeding a 2 month old solid food or other basic issues.    


Yet I feel this reflects familial and social failings that would best be addressed elsewhere.     When I was in Houston we had an early model of RN's doing well-child visits largely because the MD's were too busy in an overloaded public healthcare system to perform the evaluations well.     The nurses did the screening as well as most of the doctors would have done BUT we found that the questions they were asked and the confidences shared were quite different.    They began to function as the wise aunt or grand-dame of the family who knows child-rearing from years of experience and observation.     The nurses also had a more culturally appropriate point of view as they often lived or grew up in the communities our clinics served (not the case with our doctors).


Back to my point.    I feel that primary care is about stories, listening to those stories and then responding both with expertise and inquisitiveness while being a caring human.    What I find daily is that the stories are fascinating...even the ones that are "made up" for the doctor to hear.    These are the convoluted histories that hide abuse or addiction or loneliness.    The stories make the day fun.   


The connections make the day stressful.     The child who is not quite right but you are not sure why and the parent (a friend ) puts their trust in you when you have no clue what is wrong....just some vague hunch.     The treatment that does not seem to work that keeps you awake at night wondering if you missed something in the story or the lab.     The patient who is sent to a specialist who, also a human, misses the story's point and dismisses symptoms I feel are urgent.    These are the things that terrify me.


It is the same with other jobs, I am sure.    Other people worry about the construction of a home for a friend or working on a car that doesn't quite seem to be right.     They too feel the pressure that is more than just a craftsman's care.     It is the connection with another whom you are serving with your chosen profession.    I am glad of the feelings because I have seen and taught folks who did not have them....and I would not send patients to them. ]]></content:encoded></item><item><title>Forum</title><dc:creator>doc@askdrjim.com</dc:creator><dc:subject>askdrjim blog</dc:subject><dc:date>2008-05-04T23:44:05-04:00</dc:date><link>http://www.askdrjim.com/foler/page3/files/may-2008#unique-entry-id-70</link><guid isPermaLink="true">http://www.askdrjim.com/foler/page3/files/may-2008#unique-entry-id-70</guid><content:encoded><![CDATA[If you look at the menu you now see a "Forum" area.    This is a fledgling bulletin board of sorts.     Forum are places where folks can leave thoughts in more connected ways and develop community with other visitors.     I will moderate this area and pull off postings or people that prove offensive.     I have started a few discussion areas and can post more.    I would like to leave this up for a while and see how people respond to it.    The general category is for  questions and advice on what should be on the forum.    The other areas are self-explanatory.    I would like you to be creative and give some input.     If it works we will keep it up otherwise it will die.  ]]></content:encoded></item><item><title>Help With This Site</title><dc:creator>doc@askdrjim.com</dc:creator><dc:subject>askdrjim blog</dc:subject><dc:date>2008-04-27T23:18:01-04:00</dc:date><link>http://www.askdrjim.com/foler/page3/files/apr-2008#unique-entry-id-69</link><guid isPermaLink="true">http://www.askdrjim.com/foler/page3/files/apr-2008#unique-entry-id-69</guid><content:encoded><![CDATA[Now that I have a new iMac and can find time to work on this website more I am thinking about how to change it for the better.     I would like to have a separate blog for medical issues and one for other things.    I would like to look into some podcasts.    I would like to compile RSS's from other sites that have breaking medical news for folks.    Given an interest in diet and exercise I would like to push out some tips or foods to make or buy.     I would like to think of automated emails to people who would like to have a regular update of some type.     I would be interested in doing some chat times "ask the doc" like times.


Help me filter out the things that would not be good and those that might be interesting.      Thanks. ]]></content:encoded></item><item><title>KISS Principle</title><dc:creator>doc@askdrjim.com</dc:creator><dc:subject>askdrjim blog</dc:subject><dc:date>2008-04-27T23:02:32-04:00</dc:date><link>http://www.askdrjim.com/foler/page3/files/apr-2008#unique-entry-id-68</link><guid isPermaLink="true">http://www.askdrjim.com/foler/page3/files/apr-2008#unique-entry-id-68</guid><content:encoded><![CDATA[Yesterday I went to the Franklin Graham Festival in Knoxville.    It was youth day and that meant lots of energy and 2 bands before the message.   ...  I would say the music but, yes I am officially old, I heard mostly chaos.     I think that the fusion type of hip hop that is common right now is interesting.     Synthesized voices, samples for beats and background and then several folks giving lyrics in rhythms that accentuate the background.    Generally one singer singing a few repetitive phrases that are catchy or function as a counter-tune.    All of this is done with a general frenzy and energy that includes jumping, hand pumping and slamming bodies.     The "lead" singer generally acts like a DJ asking the crowd to respond and the energy increases.     Sometimes the words are good....mostly the singing is not.     Finally it all seemed very choreographed and thematic.    Both bands could have come out of the same blender....but the kids liked it and that was important.


Now to the real heart of this blog.     When it was time for Franklin Graham to come up and speak, he did so with very little of the polish and emotion that you see from TV preachers.    The message was plain and simple and very brief.     He didn't talk down to folks and didn't use a lot of theological language.    He got the basics of the gospel and the call to repentance and then he was done.     I had been praying during the sermon that God would move in a mighty way but as Franklin spoke, I began to waver.    I thought this might be the first time no one came forward with a decision to come to Christ.


Now I know that the crusade places counselors all over the hall and they also come down at the time of the invitation.    This helps those "on the fence" gain the courage to step out as they see others coming.    I don't know how many folks were there as counselors.    All I know is that hundreds of people, both adults and children, came forward to the floor.     I was humbled and marveled at the strength of the Spirit that could call people with such force when what I had seen did not seem compelling from a human standpoint.   


This brought home to me the fact that God does not call us to save others.    He does not require that we be polished or have all the answers.    He does not need us to be perfection.    He only asks that we go and witness to what we have seen and heard and to make disciples.   ]]></content:encoded></item><item><title>Turn off the Lights and Watch Them Glow&#x21;</title><dc:creator>doc@askdrjim.com</dc:creator><dc:subject>askdrjim blog</dc:subject><dc:date>2008-04-22T22:18:42-04:00</dc:date><link>http://www.askdrjim.com/foler/page3/files/apr-2008#unique-entry-id-67</link><guid isPermaLink="true">http://www.askdrjim.com/foler/page3/files/apr-2008#unique-entry-id-67</guid><content:encoded><![CDATA[Twice a year I do a New England Journal of Medicine education program that forces me to dig deeper in the journal to look at research and reviews that often help me in my practice.     The next few blogs will be seasoned with some of the gleanings.      Did you know that over 4 million CT scans are performed each year on children?    That in and of itself might not be bothersome but increasingly these CT's are repeatedly done on the same child as a condition is followed or symptoms persist.    Think of the child who complains of headaches.     Of course it could mean they need glasses, become hypoglycemic from their high sugar diet or have migraines brought on by lack of sleep or preservatives in their food but IT ALSO COULD BE A TUMOR or some other rare but dangerous condition.     Picture the desperate parent going from doctor to doctor and ER to ER without relief AND without communication between doctors.    Eventually several CT scans of the head may be performed.     A review in the November 29th journal commented that, compared to abdominal x-ray, a CT of the abdomen had more that 50 TIMES the organ dose of radiation that is absorbed.     There is reasonable evidence by looking at nuclear survivors and cancer development that having had several CT scans increases the risk for organ cancer development in adults and "The evidence is...very convincing for children."     This should be a cause for concern and restraint on the part of both doctors and patients.    One straw poll of radiologists cited in the article suggested that perhaps 1/3 of all pediatric CT scans could be avoided without significant clinical harm.


We all know the data about childhood obesity in America.     I have outlined before the link in my mind with high carb diet (especially corn based sugars), lack of exercise and action oriented video games.     These kids can and do lose weight if those things are changed.    End of story....right?     Well, not exactly.    A Study by Baker, Olsen and Sorensen in the December 6, 2007 Journal reviewed body mass index (kind of a weight by height ratio) in childhood and the risk of coronary heart disease in adulthood.    What they found was  increased risk stronger in boys than in girls.     We need to get our toddlers off sugar and exercising.    Doing so may help prevent not only coronary disease later but hypertension, diabetes, some types of cancer and degenerative arthritis.      We are spoiling our kids literally to death with our poor habits and parenting and our society will pay.  ]]></content:encoded></item><item><title>Hidden in My Tent</title><dc:creator>doc@askdrjim.com</dc:creator><dc:subject>askdrjim blog</dc:subject><dc:date>2008-04-13T23:00:30-04:00</dc:date><link>http://www.askdrjim.com/foler/page3/files/apr-2008#unique-entry-id-65</link><guid isPermaLink="true">http://www.askdrjim.com/foler/page3/files/apr-2008#unique-entry-id-65</guid><content:encoded><![CDATA[Today at church Brian, my pastor, drew a startling connection between a familiar Old Testament story and a New Testament truth.   ...  The open ones are the ones we have become so familiar with that we excuse ourselves before the Spirit can prick our conscience.  ...  At first it is painful but with time the triangle cuts a circle and I feel the pain no longer".     These are those open sins:  the angry look on the freeway, the impatience with the clerk while in line at the grocery store, the prideful words when comparing ourselves with our neighbors.   


...These too can become numb to us as they are so common to us that we excuse ourselves before reflecting upon them.    These are the ones not anyone but you and God see: the lustful look at a stranger,  the anger we will not release,  the delay in loving others until they love us.   


Hidden sins are the ones we do know are harmful but we collect them and store them away.    Maybe we are afraid to ask for God's forgiveness, maybe we know he will ask for repentance and restitution that we do not want to give, maybe we want to sin again and want to ignore the Spirit's warning.   


...Jericho has fallen but Isreal has not been able to succeed in another battle.     God reveals that this is because of a specific sin and the accused is revealed by God to Joshua.     When confronted the man admits to taking spoils from Jericho in direct disobedience to God's stated desire.     He tells the men that he has hidden the gold and other spoils in the dirt in his tent.   

...He reminded us that OUR BODIES ARE THE TENTS that now contain the Holy Spirit!   ...  We seen to be unable to find joy or God's blessing in our lives but we have hidden sins in our tents and seem unaware that He knows and HE CARES.   ...  Surely I have open sin that all the world can see.   ...  I can ask God and the others who see the sin to forgive and support me.     It's the ones buried deep in the dirt of my tent.  ...  The man in the story said he "coveted" the gold and silver and cloth he took.    He loved the created more than the creator and when he coveted he took and completed the sin.   


...I mean that I don't want to let them go.    I find something base in myself that likes the sin and won't let go.   ...  I think they are the same for to gossip generally means you put yourself up in a better light than those about whom you are speaking.     So pride seems to be the root of much of my "hidden" sin.


...We know that God has forgiven our sin.   ...  God has ongoing knowledge of our sin and HAS forgiven us.    We must work with the Spirit to see, dig up and throw out the sin for it creates a barrier to our effectiveness that will not go away by other means but God's love is a constant not some type of popularity poll.     Sanctification is painful and messy but we need to have a clean tent with which to house our Lord. ]]></content:encoded></item><item><title>Oops&#x2c; We Did It Again&#x21;</title><dc:creator>doc@askdrjim.com</dc:creator><dc:subject>askdrjim blog</dc:subject><dc:date>2008-04-09T22:15:22-04:00</dc:date><link>http://www.askdrjim.com/foler/page3/files/apr-2008#unique-entry-id-63</link><guid isPermaLink="true">http://www.askdrjim.com/foler/page3/files/apr-2008#unique-entry-id-63</guid><content:encoded><![CDATA[I know I'm a week late on the Vytorin, Zetia mess but I had no way to get to the site.      For those of you following the box score,  Zetia and Vytorin (Zetia mixed with generic Zocor) recently were "outed" in a study reviewed at a national cardiology conference in Chicago and then published in the New England Journal of Medicine last week.     The study looked at over 700 people who carry a gene for VERY HIGH cholesterol levels.    The company-sponsored research set out to prove that the 2 drugs were better than Zocor (a "statin drug") used by itself.     The results looked good for the company:   ALL THE INTENDED LAB VALUES MOVED IN THE RIGHT DIRECTION.     The cholesterol and sub-fractions of "bad" cholesterol all went down, the good cholesterol rose and the measure of inflammation (CRP) thought to contribute to heart disease/attack went down.


In other words it looked like the study had done what the companies wanted:  proved that we all need to take the new drug not the old drug (that a few years ago they convinced us we all needed).     One little problem, the cholesterol plaques they monitored in the patients DID NOT GET SMALLER.     And to make matters worse, there appeared to be no mortality benefit.     Too bad.     Guess we'll just stick to the older, cheaper drugs.   


BUT WAIT.     It appears that the company knew the results for a couple of years now.     By the way during those 2 years they marketed the Zetia/Vytorin like crazy and they became MULTIBILLION winners for the company and its stockholders.     So releasing the study now isn't quite so hard for them to swallow.      In the end patients AND doctors have to shake our heads and wonder "what it the truth anymore?"   when it comes to research.


More concerning (enough to prompt some comments in the editorial) is the thought:   "if everything we wanted to have happen went right then could our entire theory of the progression of heart disease be flawed somehow?"     The closest we saw was a suggestion that there must have been another mechanism at work that gummed up the outcome.    But I ask again:  Could we have this wrong?     We see folks with low cholesterol have heart attacks and we see smoking, cholesterol consuming Frenchmen living long and happy....what if we are wrong?     More importantly...what if we are being told what best sells stock?      Be careful out there. ]]></content:encoded></item><item><title>Get Going Again</title><dc:creator>doc@askdrjim.com</dc:creator><dc:subject>askdrjim blog</dc:subject><dc:date>2008-04-09T22:09:16-04:00</dc:date><link>http://www.askdrjim.com/foler/page3/files/apr-2008#unique-entry-id-62</link><guid isPermaLink="true">http://www.askdrjim.com/foler/page3/files/apr-2008#unique-entry-id-62</guid><content:encoded><![CDATA[Well, I have an new iMac for use and so I should be able to update this site more readily.     I am thinking about having a portion of the blog be questions from patients or site visitors who want some type of medical information.    This would give me food for thought.     I am also looking at trying to do an email list to send out updates and possibly a podcast.     Ambitious, I know, but it will keep me busy and away from the TV.     The new iMac is a joy as usual.    So easy to get going and so easy to back up.     The new keyboard is a small metal one and I really like the feel of the keys.    I don't have as many sticking keys as the other iMac.


I also have a iTouch iPod that really excels.     It can do wireless internet through my or other open networks it encounters and allows web browsing and Email!     I am looking at software that would allow me to update the Blog from email remotely which would allow me to do it sitting in McDonald's etc.     Next medical. ]]></content:encoded></item><item><title>Sleep Apnea</title><dc:creator>doc@askdrjim.com</dc:creator><dc:subject>askdrjim blog</dc:subject><dc:date>2008-03-16T13:37:47-04:00</dc:date><link>http://www.askdrjim.com/foler/page3/files/mar-2008#unique-entry-id-61</link><guid isPermaLink="true">http://www.askdrjim.com/foler/page3/files/mar-2008#unique-entry-id-61</guid><content:encoded><![CDATA[I'm doing another medical type entry today.     I was listening to a radio program and the diagnosis sleep apnea was being discussed.     Not to belittle the suffering folks have with other conditions which are bursting out all over (restless legs and the like) but sleep apnea does deserve attention.     There was a time when it was funny or quaint to talk about the snoring of a spouse or friend.    We would tease and talk but no one paid much attention.  


Emerging research has linked obstructive sleep apnea (stopping breathing in the night due to obstruction of the airway, generally by a relaxed tongue) to high  blood pressure, congestive heart failure, glucose intolerance, stroke and sudden death.     These are serious effects.     Generally I see a man or woman who has AM headaches, obesity, sugar issues and elevated blood pressure where many meds have been tried but no assessment for sleep apnea has occurred.     The overall workup is noninvasive and relatively inexpensive compared to the outcomes that may occur if left untreated.    The treatments are not perfect but newer treatments are emerging.     The main issue is our lack of detection.


If you or a loved one snores loudly, stops breathing while snoring or has other disruptive sleep I would strongly suggested talking with your doctor to have it evaluated before a stroke or heart attack occurs and it is too late.  ]]></content:encoded></item><item><title>Take your medicine.  Drink the water.</title><dc:creator>doc@askdrjim.com</dc:creator><dc:subject>askdrjim blog</dc:subject><dc:date>2008-03-15T15:09:11-04:00</dc:date><link>http://www.askdrjim.com/foler/page3/files/mar-2008#unique-entry-id-60</link><guid isPermaLink="true">http://www.askdrjim.com/foler/page3/files/mar-2008#unique-entry-id-60</guid><content:encoded><![CDATA[Don't know if you followed the story recently about major cities testing municipal water supplies and, surprise, traces of medication were found.     Several years ago I read a book about the complex interactions in nature especially things we feel are more static (like plants and water).     The author went through several reports about the high level of pharmaceutical products being found in our ground water.


Now you may think that a little penicillin in the water is no big deal.    But would you think the same about hormones, antidepressants, narcotics?     I know it sounds a bit bizarre but the major thing found at that time was estrogen!.     Remember that our food supply (animals) are being fed large amounts of hormones, hormone laced foods and antibiotics.     People also consume increasing amounts of drugs and .... well they end up somewhere if that are not degraded by our bodies.     In the old days penicillin was expensive and the urine of patients who received it was collected and the penicillin was removed and reused.  


The concern here is not just drug interactions or allergies that may develop.    I am worried about low levels of so many centrally acting drugs (drugs that work in the brain).     Could our epidemic of depression, ADHD and the like be made worse by our water supply?    It is indeed frightening.      And those of you who use bottled water are not off the hook.     As I understand it there are no requirements to remove or test for drugs in the process of bottling water so we just do not know.     It all comes back to an old rant of mine....be careful in the use of medications.]]></content:encoded></item><item><title>What a week&#x21;</title><dc:creator>doc@askdrjim.com</dc:creator><dc:subject>askdrjim blog</dc:subject><dc:date>2008-03-01T22:10:31-05:00</dc:date><link>http://www.askdrjim.com/foler/page3/files/mar-2008#unique-entry-id-59</link><guid isPermaLink="true">http://www.askdrjim.com/foler/page3/files/mar-2008#unique-entry-id-59</guid><content:encoded><![CDATA[Thanks for those of you that have called or written comments about this blog.    I am hoping to get a new PC for home that will allow me to be more creative with this site.    I really would like to develop a place for social networking about health and creativity.      Stay tuned.


This week was, in a word, disorienting.     With the new management came a flurry of activities.     By Monday afternoon curtains were ordered, lab reorganized and workflow adjusted.    Our new nurse and clinic "boss" both had to be trained on the electronic record, and phones, and Dr.   Schindler quirks...this was no small feat.     I must say they dealt with it all very well.     I became a bit irritable at times.     It is funny how we talk about wanting change in our lives but really desire constancy.     The change was unnerving to me during the week but we'll get through.   


By midweek we had a bit much estrogen in the building, which is already quite small, and the cleaning and straightening caused me to be chagrined realizing how stuck in a rut I could be.     I can promise you that the basic feel of the clinic (being small and personal) will not change but the decor and trimmings will reflect Lakeway's commitment to the White Pine community.    I have been impressed with their speed and professional approach.    I only hope I can keep up. 


Please keep me informed as to problem you encounter, things you would like to see changed or added AND good things you want kept or see happening.     We would not be here if not for the community of patients that we are building.    Use this site to email me your comments and keep in touch.  


Stay tuned!]]></content:encoded></item><item><title>Transitions</title><dc:creator>doc@askdrjim.com</dc:creator><dc:subject>askdrjim blog</dc:subject><dc:date>2008-02-24T14:36:24-05:00</dc:date><link>http://www.askdrjim.com/foler/page3/files/feb-2008#unique-entry-id-58</link><guid isPermaLink="true">http://www.askdrjim.com/foler/page3/files/feb-2008#unique-entry-id-58</guid><content:encoded><![CDATA[  NOTE:  THIS IS WRITTEN SUNDAY 2/24...the blog date seems to be stuck.  


My practice (as well as my life) has been going through some times of testing.    Without going into a lot of detail I will say that there have been some extreme financial pressures since early Fall of 2007.    After delaying for as long as possible I began to pray about whether I needed to close the practice to avoid more financial debt or look at other options.     My options were limited in White Pine.     There are always jobs for doctors so I knew I could move the practice elsewhere, join another group (which would make me move) or choose to be employed somewhere (also entailing a move).    I had set a 3/1/08 deadline for a decision.


In the first week of February a friend informed me of another option: talking with a local hospital that was considering expanding their clinic network into White Pine.     After some preliminary inquiries I found that, indeed, this might happen and that they may be interested in negotiating with me.    By February 12th I had a preliminary contract in hand and after much prayer I decided to sign at noon on February 15th.     By the 20th the practice's assets had been reviewed and the ball was rolling.   


Long story short, on 2/25/08 the clinic (which largely will look the same for now) will be operated by a subsidiary of Lakeway Regional Hospital in Morristown.     I will by employed by them and they will provide all the supplies and staff the clinic.     Whew!    This moved very fast but seemed to provide for the top goals I had:  1) to stabilize finances personally for my family and their future and 2) to keep the practice in White Pine.    A month ago this was not on the radar and I pray that I have heard and heeded God's providence.


The changes will not be without pain.    I will lose some control of operations and billing and collecting.    The hospital is committed to helping my existing patients remain.    They also take all the major insurance that I do (including TriCare and Medicare and all the TennCare).      The staff will be hired and managed by the company.    This means we will have more staff but the staff will change.    This likely will cause the most pain as our team in the past has been so important to what I do.    Believe me when I say I hope this change will keep our care improving daily.


Thank you for all the thoughts and prayers from those of you that know the stress I have been enduring the past year.    Your prayers and encouragement have helped me get through this time.    I hope and pray that by remaining in White Pine, although under different practice management, I will return to you and the community the commitment you have shown me.]]></content:encoded></item><item><title>Truth</title><dc:creator>doc@askdrjim.com</dc:creator><dc:subject>askdrjim blog</dc:subject><dc:date>2008-02-17T08:06:29-05:00</dc:date><link>http://www.askdrjim.com/foler/page3/files/feb-2008#unique-entry-id-57</link><guid isPermaLink="true">http://www.askdrjim.com/foler/page3/files/feb-2008#unique-entry-id-57</guid><content:encoded><![CDATA[Our men's group is studying a book on the need to hold to absolute truth in this world.     As we have moved into a world that has developed some understanding that science and logic is not going to answer all the questions of life (the Post-Modern world of thought), truth, especially absolute truth, has become a casualty.     We have moved more and more to the use of relative truth.    We feel this makes us tolerant and  encompasses the ambiguity and chaos that we see around us.    "Well, that's my opinion" is a commonly heard phrase that really means "I believe what I just said right now regardless of the facts and I may change my mind in the future.    This is America and I can have and express that opinion."


Indeed, the relative freedom we think we have in modern democracies allows all types of ideas to, in theory, be expressed boldly.    Ideally those ideas would be discussed, tested and discarded if they have no basis in some type of truth.    In reality our desire for tolerance often means the ideas stay out in the public consciousness as "relative truth" that is not tested or questioned.    Outside of hard science we feel uncomfortable with someone stating that there is an ABSOLUTE truth that can be known and understood.     A person holding to that view is seen as "rigid" or "narrow-minded" and, in our politically correct environment, "fundamentalist".


In Christianity this denial of absolute truth is harmful.     By allowing "fuzziness" to replace clarity we open the Church up to false doctrine.     By championing tolerance over truth (tough though it may be) we weaken our witness.     In the garden the original way Satan attacked human relationship to God was "God did not really say..." and that doubt allowed the sin to seem less obvious as it dangled there in front of them.


Christ said "I am the way and the TRUTH..."   this means that if we as Christians believe Christ was the Divine incarnated as a man that His Words ARE truth.    When He says we must love others as ourselves or that the hour of His return is not to be know by any but the Father or that God so loved the world that He was sent so that anyone who believes would have eternal life these are truth.     To make His life and words fuzzy is to dangerously flirt with changing (not enhancing) the truth.


Certainly we run the risk of being rigid like the Pharisees of old but their rigidity was exposed by the fundamental lack of truth in the way they lived their lives.    Christ opposed their form of religious practice and offered the Truth-based alternative for us to follow.     "You have heard it said.....but I say..." was a way of showing us that the absolute truth on which this universe is based comes from God....  IS GOD.     Ultimately God is the truth and as Christians we must look to Christ and his example and his words as the expression of that truth.


If we believe this then our we may be called rigid or intolerant.    However,  no one would say that showing people the door marked "EXIT" in a burning building is rigid or intolerant.     Not just any door will do and insisting that there is a door and that it is clearly marked is not a sign of narrow-mindedness!]]></content:encoded></item><item><title>Why Only Some?</title><dc:creator>doc@askdrjim.com</dc:creator><dc:subject>askdrjim blog</dc:subject><dc:date>2008-01-19T14:17:23-05:00</dc:date><link>http://www.askdrjim.com/foler/page3/files/jan-2008#unique-entry-id-56</link><guid isPermaLink="true">http://www.askdrjim.com/foler/page3/files/jan-2008#unique-entry-id-56</guid><content:encoded><![CDATA[I'm sorry about the delay in the blogging.    People are complaining and I just don't have access to my software enough each week to do updates.    The good in the delay has been stories from friends and patients.    Some are stories of joy and miraculous events, others of tragedy upon tragedy that seem too much to bear.  


 I had one new patient who with their new insurance was finally able to see a doctor.     They had an alarming physical finding and x-ray confirmed what appeared to be a life-threatening problem.     Many were praying and a few days later when seen by the specialist the finding had almost completely disappeared!    One explanation is that the first reading was wrong.    The problem with that is every other piece of data from the exam that was abnormal was confirmed on the followup.    One explanation is the wrong name was attached to the file....again with such a specific test and alarming answer at the same hospital on the same day on the same side of a body of the same age and sex....well you could do the math.     I'm left wondering about the power of prayer for this person and what really happened.   ...  What are they supposed to do with the years of healthy life that will result from this change in events?   

...Another family had a sudden unexpected death of a loved one, a child sick with a major illness and a cancer in another member all happen in the span of a few days.  ...  The outcomes, however, were not all good.  ...  Were they not just as worthy?  

...I remember in college first being questioned by non-believing friends about the "capricious" nature of God.    His apparent kindness to some and indifference to others.    They would say they just could not believe in a God that would send any to hell or allow any illness or calamity in the world.   ...  There in history in black and white were the apparent acts of an almighty God that appeared to pick favorites.   


It was only when I fully understood my sin and the utter evil it represented in the face of a Holy God that I could say "All (I) have sinned and fallen short of the glory of God".    ...  It was in understanding that fact that the grace of the cross became clear.    Far from capricious, God reaches to all with a lifeline of grace.    That grace is for our ETERNAL security and in no way promises security or happy times always in the staging area we call life.     Not all reach out for that lifeline to eternity but for each one who does the grace is indeed amazing.     It helps put the events here on earth in a different perspective.    Sure, some may have happy and even miraculous outcomes....praise God.    But the real miracle will occur when we stand before the throne of judgement and claim our eternal reward based solely on the the grace provided by our Savior's sacrificial death for us. ]]></content:encoded></item><item><title>Milestones</title><dc:creator>doc@askdrjim.com</dc:creator><dc:subject>askdrjim blog</dc:subject><dc:date>2008-01-06T13:14:51-05:00</dc:date><link>http://www.askdrjim.com/foler/page3/files/jan-2008#unique-entry-id-55</link><guid isPermaLink="true">http://www.askdrjim.com/foler/page3/files/jan-2008#unique-entry-id-55</guid><content:encoded><![CDATA[Sorry about the delay in postings.    I am still sharing a iMac and I love the software.     I have not been able to work on it for a couple of weeks now.     I hope to have one of my own soon so I can blog "when the spirit hits me".     Obviously we are into a new year and all the reflection that usually accompanies that milestone.     Humans have a real need to reflect on the past in order the place themselves within history and in order to see how far they have come.     We honor new years, anniversaries, birthdays, days of historical or religious significance.    In each we attempt to reflect on the past event, remembering the who, what, where and when.    We weep or laugh or merely reflect.     We might picture the loved one or event in our minds or we may play the video of the event.


But we cannot turn back the past.    We cannot know or even plan accurately the future.    In the old testament writings, the Jewish people and their prophets would reflect on the history they shared with their God and His mighty works.    They would renumber His attributes and that remembering would draw them back to a relationship that existed in the present moment.     I believe we are called to remember in order to realign in the present.


In this new year I am hoping to remain in White Pine learning about serving others with my gifts in my practice.    I desire to be convicted about my shortcomings as friend, father, doctor and to understand how I might change ingrained patterns that are harmful into those that reflect Christ in me.     I pledge to be more in the Word and on my knees.     I hope to be more generous with my time, money and friendship.     I intend to grow stronger in my own self so that I can be an example to my family.


I can do none of this without God's guidance and strength.    I know that He desires that I be more like Christ and that I be closer to Him so these goal of mine should mesh with His goals for me.     I pray that at the end of 2008 I will be able to look back and say that I was found faithful in these things.    I hope your New Year's thoughts will be achieved in 2008.]]></content:encoded></item><item><title>Songs of Worship</title><dc:creator>doc@askdrjim.com</dc:creator><dc:subject>askdrjim blog</dc:subject><dc:date>2007-12-23T12:07:10-05:00</dc:date><link>http://www.askdrjim.com/foler/page3/files/dec-2007#unique-entry-id-54</link><guid isPermaLink="true">http://www.askdrjim.com/foler/page3/files/dec-2007#unique-entry-id-54</guid><content:encoded><![CDATA[Today we had our choir program for the church.    It has been good to see the growth in the choir.    We have some very nice voices and the folks both singing and directing have Christ in their lives so it is a joy to sing with them.     Worshiping through song is one of the greatest gifts we have from our Creator.    I know that  other creatures in nature sing but humans have unlimited creative capacity to put tones and words and instruments together.  


 I am struck by how simple a song can be and yet no one has ever had exactly the same song....that is amazing.     God is the source of this.    Just look outside at the variety of plants, animals, insect life and humans.     He loves to create unique things.     Each has its place in the ecosystem and certainly for humans each has a design best suited to serve and praise Him.


This Christmas season just enjoy the diversity of music that we have been given.    Find one that means something special and make it your meditation.     Rejoice in the creative God that is the originator of music and song.     It is fitting that Christ's birth was heralded by angels SINGING His praise.      To Him be the glory and honor of the season. ]]></content:encoded></item><item><title>Is Christmas Special?</title><dc:creator>doc@askdrjim.com</dc:creator><dc:subject>askdrjim blog</dc:subject><dc:date>2007-12-22T19:36:54-05:00</dc:date><link>http://www.askdrjim.com/foler/page3/files/dec-2007#unique-entry-id-53</link><guid isPermaLink="true">http://www.askdrjim.com/foler/page3/files/dec-2007#unique-entry-id-53</guid><content:encoded><![CDATA[Christmas in America (starting now in mid-November) is the over-the-top celebration of.....consumerism.     All around us advertising and messages tell us of the things our loved ones need to feel our love.  ...  The more expensive the better and don't worry about the payments as we can delay them for months.    In our area robberies are up around this time with folks coveting or desiring money to buy something to fulfill themselves or others.   ...  Everything we do sees to scream "LOOK", "BUY" "WATCH" "WORSHIP WITH US".


...The only drama was played out in the hills near the town where a bunch of boys and men were waiting for ewes to lamb in the early morning (as they tend to do), sharing watches for predators who also awaited lambing season in the hills.     To those uneducated, poor, common folks a sudden presence of first one and then myriad of angelic beings announced the birth of the Messiah long awaited. 


  I don't know what the visitation was like.  ...  Did they all hear the same words in the same way or as at Pentecost were there multiple ways the song was heard?


I don't know but we have no record of others seeing or hearing the announcement.  ...  The link with David is obvious the town being Bethlehem and all.    And the great psalm of David about shepherds (I bet they all knew that  one!).   ...  We have no record they were notified, just tired working people at their job site.  

...One thought that I have is that as remarkable as the incarnation of God as a fully human/fully divine being was, God visiting earth and simple people was nothing new.    The entire history of the old testament is dotted with God reaching down to man tangibly and directly.    To think He would appear even as a flesh and blood person may not have been a major step beyond what He had done for centuries.


No, what was remarkable was the reason for his incarnation...to live fully human and fully sinless in order to repair the rift between the sinful souls of men and the sinless Creator.    Ignoring sin could not work...they payment was demanded (the soul that sins shall surely die).     Forgiving was not possible or He would be inconsistent with His law.    No, payment was demanded with no "work around"  UNLESS a sinless man died for all and that sacrifice proved acceptable.   ...  Christmas never brings up the result only the initial event leading to the sacrifice.


Other than Luke (who does it beautifully) there is little hype about the birth of Jesus in the gospels....  Paul and others discuss it only as the needed initial step.   ...  Without the empty tomb and the stamp of approval that Easter represents we would not know the sacrifice was acceptable and complete.  ...  The time was set to try to aid pagan cultures in their transition to state religion of Rome.  ...  Easter changed the world forever and without it Christmas would not even be in our culture as it is today.


So I think on Tuesday I will thank God for the gift that became acceptable sacrifice....the one that Easter proclaims. ]]></content:encoded></item><item><title>Joining to Others</title><dc:creator>doc@askdrjim.com</dc:creator><dc:subject>askdrjim blog</dc:subject><dc:date>2007-12-16T14:39:24-05:00</dc:date><link>http://www.askdrjim.com/foler/page3/files/dec-2007#unique-entry-id-52</link><guid isPermaLink="true">http://www.askdrjim.com/foler/page3/files/dec-2007#unique-entry-id-52</guid><content:encoded><![CDATA[Christmas is a time to reflect on gifts that God has given.    The greatest was the gift of life to us through the life and death of the God/man Jesus Christ.     This unexplainable act of grace and mercy was rooted in love and desire to have relationship.    I cannot understand why He humbled himself to come as a man, as a child, as a commoner.     I can believe and be grateful that His act was the only way that my soul could hope to live eternally in the presence of the Creator.    If I can embody that belief then daily all other issues of life become easier.    If the God of the universe loved me enough to come humbly and die for me then how can I doubt His love an protection and guidance every day I live here on earth?  


The desire to have relationship, to love and be loved, to know and be known is a fundamental need etched into our human nature.   ...  He desires that our relationships here on earth teach us about what His love and His relationship with us is at its most basic level.  ...  In heaven He will have version 9.0 and we will be able to fully feel His love and presence.    While here, however the closest we can get is in our church family and to a degree in our earthly family.     It is in these relationships that we will experience the love, disappointment, support, rejection, sadness and joy that help us understand more fully our relationship to  Him.   


...I feel that the men's group has helped me in miraculous ways to begin healing from a long season of hurt and sin.  ...  I met with Brian earlier in the month and then "walked the aisle" today.     I walked it alone knowing that I come broken with my family broken.    I came knowing that only in committed relationship with other believers can I hope to heal an begin to serve and find my mission for this time in my life.     The sadness of coming alone was overwhelmed by the joy of the welcome the church family gave.  

...Often deep inside where we keep our secret and true self I have a feeling that I am not worth the notice of others I meet.    My face daily of the "doctor" makes me act with confidence but that is hiding insecurity about my worth to others.   ...  Brian had spoken about times when we may give or receive God's touch through the touch of other humans.    Today was such a day for me and I am grateful to the church for that gift. 


Now the hard work of trying to use my gifts and time to give back to Christ.     It is exciting to have a new family who will be helping me find the path that is ready for me.    God has been so good through this desert time in affirming me and moving me closer to Him while causing me to search for my role.    In the end that is really the great gift we have been given.    By freeing our soul from the slavery of sin and the inevitable eternal damnation that awaited us, God has allowed us to use our life and gifts to serve and praise Him without regard to the world and its standards.    We are free not only in the next life but in this one to serve Him with an unfettered heart.
]]></content:encoded></item><item><title>Sports</title><dc:creator>doc@askdrjim.com</dc:creator><dc:subject>askdrjim blog</dc:subject><dc:date>2007-12-09T13:04:47-05:00</dc:date><link>http://www.askdrjim.com/foler/page3/files/dec-2007#unique-entry-id-51</link><guid isPermaLink="true">http://www.askdrjim.com/foler/page3/files/dec-2007#unique-entry-id-51</guid><content:encoded><![CDATA[Over the past week I have attended about 5 basketball games.     I am now a spectator.    I used to not pay much attention to the folks in the stands because the game was everything.    The joy of the competition is something many of you can understand.    Sure, winning was great but often just the joy of feeling your body move and act in ways you wanted was...well, a joy. 


 I have 2 sons now playing ball and I do get some nerves for them as I want them to enjoy and savor the time.    The pride I feel has been real when I watch them.    Several things recently made me proud.     One son showed great sportsmanship recently and great capacity to help the others on the team feel good and achieve.    This is a gift and is not often seen during competition.    I am glad that he has learned that not all the lessons of the game are the points you score or the accolades you receive.      It makes me proud to know that he has internalized some ideals of sport that I hold very dear.   


The other son is younger and right now is learning in practice and watching from the bench more than on the court.    What I have seen from him is the joy of being a good teammate.     He actually seems more glad when a friend of his excels than when he does himself.     He has praised kids less talented than him and is a loud cheerleader from the bench.    I am proud that he understands that everyone on the team is important.


In healthcare we so often focus on the flash and the achievement and the stars.     The surgeon who saves a life is praised but the scrub-nurse that caught the fact that he left a sponge in the patient just as they were ready to close the wound gets hardly a notice.    Sports can really help you as you think of healthcare.     Teams are needed and all the skills are essential to the health of the patient.     The team leader IS the patient and they must feel that they are part of the process of healing or they will not achieve the goals they desire in their personal health.   


Church is like this too.    Today my pastor was talking about evangelism and about the skills we all bring to the table.    All the members are important, all have gifts to bring to the team.    No one is the center of the church save Jesus.       I am glad that in my and now in my boys' lives that sports teaches us so much about how our lives should be lived. ]]></content:encoded></item><item><title>What&#x2c; How and Who</title><dc:creator>doc@askdrjim.com</dc:creator><dc:subject>askdrjim blog</dc:subject><dc:date>2007-12-08T16:50:08-05:00</dc:date><link>http://www.askdrjim.com/foler/page3/files/dec-2007#unique-entry-id-50</link><guid isPermaLink="true">http://www.askdrjim.com/foler/page3/files/dec-2007#unique-entry-id-50</guid><content:encoded><![CDATA[I am sinful and disobedient and stand in need of grace and mercy.  ...  In my personal life I am willful and selfish when I think I am being open and honest.     I sin and sin and find no good in me on a regular basis.   

...To learn the what of the Bible and to then trust that knowledge will deliver me.   ...  I will just read and learn and the answer would be there.    I can better myself and then I will do good and receive peace in my soul.     The problem is that knowledge may not change my heart.    Knowledge does not have the power in itself to change my character and to make me new in a moral sense.     Ultimately knowledge would also depend on what I read and where I seek my answers and that may lead me astray or imbed non-truth.


Another approach is to try to feel my way and worship my way to grace.    If I could just find the right song or worship experience or body of believers then I would feel close to God and ultimately would feel delivered.     I could look to dynamic leaders who structure the worship experience to focus on my needs and how I feel.    I could raise my hands or say "amen" or cry at the alter again and again.     The problem with this is shown by David's attempt to bring the ark back to Jerusalem.    He did so with what he felt was the right method but he was wrong.    In the end people died and he was forced into a period of introspection until he did God's will and worshiped as God desired.     Worship focused on the how actually worships the creature not the creator.  

...The final way to try to deal with my sin nature and need for grace is to look at the object of my worship, my knowledge and my faith.   ...  I must have faith in God and my faith does not make Him who He is.     My lack of knowledge does not change His will or character in the least.     My worship follies do not change His eternal might and power.    Certainly knowing God involves learning of Him but the demons know these things.    The essence of what I think He wants is me and a relationship with me.  ...  Only in relationship with Him can I come to do the first and find the second.     He is the object of the worship.    Knowing Him and His will should drive my study.     Since He is the source of my power and of my redemption, it is "Who" that I must focus upon each day. ]]></content:encoded></item><item><title>Joy and Hope</title><dc:creator>doc@askdrjim.com</dc:creator><dc:subject>askdrjim blog</dc:subject><dc:date>2007-12-01T17:54:06-05:00</dc:date><link>http://www.askdrjim.com/foler/page3/files/dec-2007#unique-entry-id-49</link><guid isPermaLink="true">http://www.askdrjim.com/foler/page3/files/dec-2007#unique-entry-id-49</guid><content:encoded><![CDATA[This is a long weekend.     I have been challenged to feel God's leadership and to focus on His loving control of my life.     There is nothing brought into my life without His consent: no tests, no temptations, nothing.    He considers, and scripture says, allows these things AND makes ways for me to both escape the temptation or conquer the test.     My head knows this but my heart, my emotions have quite another take on the subject.     Part of me wants to rebel and tell Him to leave me alone to my own choices.    Part of me wants to complain about the fact that his omniscience causes me to be more like a puppet than a person.  


 Both those parts reflect old patterns and areas of my life that are not yet sanctified.     The fact remains that He knows my limits, my skills and my fears.     He also loves me enough to allow me to be tested and tempted.    When it happens He knows I can overcome and that He is right there with me.    The psalmist says that He is "near to the brokenhearted" and I have had to rely on that one quite a bit lately.


I have such strong emotions at times that I don't know that I can understand or control them.    I have had to come to grips with the fact that He has made me this way.    That He has emotions somehow and that as the Christ on earth He felt and now fully understands the ones that I have.    I still cannot fathom why, after calling and saving me, He allows pain and sorrow in my life.    I can feel so small and so lonely here on earth yet He knows and intends for me to come through these emotional upheavals with stronger hope in His salvation.  


This then is the joy to which we are called.     To have a deep and abiding understanding of the God who is our Lord and the sure Hope of our eternal security.     The passions of this world and the sorrow, pain and loneliness that sometimes come into our lives should not shake joy.    This weekend I need to focus on this thought and to cling to Him.     He is near to my broken heart. ]]></content:encoded></item><item><title>Homesickness</title><dc:creator>doc@askdrjim.com</dc:creator><dc:subject>askdrjim blog</dc:subject><dc:date>2007-11-30T22:34:05-05:00</dc:date><link>http://www.askdrjim.com/foler/page3/files/nov-2007#unique-entry-id-48</link><guid isPermaLink="true">http://www.askdrjim.com/foler/page3/files/nov-2007#unique-entry-id-48</guid><content:encoded><![CDATA[Wednesday night wrapped up the Beth Moore tape study on the Patriarchs.    She is a very good leader and her fresh insights inspire me.  ...  The idea was that as humans God has placed within our beings a longing for heaven and an innate knowledge of eternity.      We KNOW that there is more.    Goodbye is then such a temporary and artificial thing rooted in us living in time now.    In eternity time will have no meaning and goodbye will have no meaning.    She then tied the concept of the wandering of Abraham, Isaac, Jacob and finally Joseph to this thought.     Throughout scripture we are pointed to the God of these men and as we reflect on their lives we realize they were aliens on earth and their home was in heaven.     Again and again she brought out scripture that reinforced this concept.  ...  God does not intend for this world to be final.     Since the fall ALL CREATION (including me and you) groan for the fulfillment of the promised  perfection of the new heaven and the new earth to come.     She challenged us to embrace the discomfort of our earth as an affirmation that God has promised us more.


In my walks around White Pine in the morning I always see geese flying about the same time and same place on my trek.     I have come to look for them and as I walk I thank God for them.    I have seen them as a reminder of my North Dakota home which I miss daily.    I thank Him for the little slice of home He sends my way to remind me of that place.     Well, after the last Beth Moore talk I mentioned above, I decided that the next morning I would also see those geese as a reminder or my final home in heaven.     Sure enough morning came and as I walked I heard the familiar honking (you always hear them before you see them if you are a hunter).     As they flew by I thanked God that He has promised me a place in the perfect home that my soul KNOWS is there.


...There were quite a few more geese  flying Thursday morning than usual.    As I was praying a friend (who knows of my meeting with the geese each morning) sent me a text message that read: "I bet God sent all those geese as a gift 4 u 2day."     I was speechless before God.     It was a moment of praise without words.     Not only did I agree with the message but I was humbled that He exceeded my request to see some geese each morning.     His abundant grace to us is open for all to see.    He does not hide many of life's blessings from us or other Christians.     We just need to be alert....you might hear it before you see it. ]]></content:encoded></item><item><title>Overwhelmed</title><dc:creator>doc@askdrjim.com</dc:creator><dc:subject>askdrjim blog</dc:subject><dc:date>2007-11-25T13:54:47-05:00</dc:date><link>http://www.askdrjim.com/foler/page3/files/nov-2007#unique-entry-id-47</link><guid isPermaLink="true">http://www.askdrjim.com/foler/page3/files/nov-2007#unique-entry-id-47</guid><content:encoded><![CDATA[Today in Sunday School our lesson was again on money and giving.    This can be a very difficult area for me and, I assume, for many Christians in America.     We are wealthy beyond belief to 90% of the world even if we are lower middle-class.    We are consumers and buyers and covetous and we live in a culture that encourages all those traits.  


Christ called us to be sacrificial givers yet we barely give and even then too often with reluctance.     In the end our things often control us.    It might not be money, it might be clothes or cars or our physical appearance that demand time and resources that should be spent serving Him.    We can give money from our excess but rarely give of time or other things sacrificially.    In the end my lack of generosity stems from a lack of faith and a desire to get rather than give.


In the lesson we looked at a passage in Malachi 3:  "Test Me in this," says he Lord Almighty, "and see if I will not throw open the flood gates of heaven and pour out so much blessing that you will not have room enough for it."    This was in response to the people not giving God an adequate share of their material goods.


Now I am not a proponent of the theology that uses God like an ATM.    " Pray  or give or serve or request and God is only to happy to give more material wealth to you."     Notice that the above passage says God will pour out blessing not particularly wealth.     We may get to see the results of our giving and be blessed.     One group member said that in giving we may receive more  the mind of Christ and in that way will be able to see our world in a different light and be blessed.     That is a fresh way to see how He desires to make us more like Him and may have the essence of the blessing captured in a way I never imagined.


The part I focus on is the excess He is planning.     It's not "double your money".     He plans to overwhelm us with His gracious blessing.    The picture I have is from childhood when Captain Kangaroo would ask about a ping pong ball and then he would be completely covered with a shower of hundreds falling from above.    The picture is clear.     God as the owner of all in the universe PLANS to shower us with blessing.    We need only to exercise the faith to believe His promise by giving of our lives and our material goods in a sacrificial way.     He wants us to learn about the impermanence of the world in the face of His eternal being and love.


I am being challenged to disregard more and more the world's ideas of success as they are tied to things that will burn up in the fire of God's presence.     I need to acknowledge His place by yielding all to Him without regret or fear, knowing that His blessing will overwhelm my expectations.]]></content:encoded></item><item><title>David again</title><dc:creator>doc@askdrjim.com</dc:creator><dc:subject>askdrjim blog</dc:subject><dc:date>2007-11-24T20:42:57-05:00</dc:date><link>http://www.askdrjim.com/foler/page3/files/nov-2007#unique-entry-id-46</link><guid isPermaLink="true">http://www.askdrjim.com/foler/page3/files/nov-2007#unique-entry-id-46</guid><content:encoded><![CDATA[The book I am currently reading is about the life of David.     Again and again I am reminded that he was "a man after God's own heart" and that he was was called a friend of God.     His story and his psalms are nuggets of gold as I try to understand what made him those things.    


I am struck by two things as I read his writings:  first, he is transparent with God.    He pleads, he argues, he complains, he rejoices, he praises and he worships.     He seems to have complete honesty in telling God what he is feeling.     Too often my prayers are formulas or types that I think are "holy" when in fact I am closing my mind off to God by being less than open with Him.      That does not foster intimacy and God craves intimacy with us.     My best friends are those with whom I can be more honest about thoughts and feelings....some bad and some good.    Without that honesty and I am just playacting at true intimacy.


 Second, he has a proper perspective of his position relative to God's.     He always understands God is in charge.    He knows that God has all power and that God's will is going to occur.    He never orders God but he lets God know his mind before bowing to God's will.      I can learn a lot from this.    Too often I beg God and then pout when I don't get what I want the way I want it.     David's approach is better.    He lets God know and then meditates on His word  and bows to the perfect result.     No wonder God lifted him up to us as an example of what a man after God's heart is like.     We are to be both intimate and bowing creature before our lover-God.   


David also used emotions and words and music in his relationship with God.    I believe God gave us language, music and other art to express more fully our human emotions in our praise to Him.     Jesus got to experience human emotions while here on earth and we never see him apologizing for feeling or expressing love, anger, loneliness, joy and the like.    He showed us that emotions can bring us closer to God in worship (the woman washing His feet with her tears) and in prayer (Jesus sweating drops of blood).    David was a man's man and a great warrior and yet he was very emotional, weeping often, dancing with abandon and laughing with joy.


David is just such a great example of how God desires that I live:  fully aware of my emotions, strong in my confidence of His power in my life, secure in my relationship to Him and knowledgeable of my dependence on His grace every moment of every day.    I hope to be more and more "David-like" in my life.
]]></content:encoded></item><item><title>Giving Thanks</title><dc:creator>doc@askdrjim.com</dc:creator><dc:subject>askdrjim blog</dc:subject><dc:date>2007-11-24T20:19:08-05:00</dc:date><link>http://www.askdrjim.com/foler/page3/files/nov-2007#unique-entry-id-45</link><guid isPermaLink="true">http://www.askdrjim.com/foler/page3/files/nov-2007#unique-entry-id-45</guid><content:encoded><![CDATA[Of course I will write a bit about the holiday that just passed.     The nation needed a time of healing and unification when Thanksgiving was birthed and it has always been linked with the traditional end of harvest festivals that generally occurred this time of year.     Although it is a family holiday (more so now than even Christmas given the fixed nature of the day giving a long weekend) I have not spent it with my North Dakota family for over 2 decades now.   


...Because of coursework I got home late Wednesday night and early the next morning went with a second cousin for a "short deer hunting" trip that was to end in time for the meal.      We got up early and went to a spotting hill at dawn.     Snow had started to fall as we noticed a buck and doe about 1/2 mile away walking slowing in  a pasture.     After the deer went over a hill we got out and began to walk to the last site we had viewed them. 


We found the trail in the snow and it was starting to snow quite heavily.     We were walking in about 1 foot of snow and the trail was easy to follow.    After quite some time we came over a rise and saw a large brush pile ahead.     About the time I said this might be where they had bedded down, both jumped up and we shot both cleanly.     We gutted and cooled the carcasses with snow and then realized we were 3/4 mile from the car.    This was too long to drag the deer so we walked back to the vehicle only to find it completely snowbound.


About 1/2 mile away was a farmer's home and we trudged there and found that everyone had gone into town for the holiday!  ...  Finally a farmer we knew drove by an we got our car pulled out of the snow so we could drive the 10 miles or so back to town.     We were a bit late but ate the meal with relish and then had to figure out how to get back into the middle of nowhere in the snow to get the deer.      Another farmer used a 4X4 truck to drive us almost right to the spot and we got the meat home before dark.      All in all it was a memorable time and one that my friend, his family and my family mention about every Thanksgiving since.


That gets me thinking about what we have to be thankful for this season.  ...  Recently, however, I heard a speaker who said that the only two things you really will carry to eternity will be your own soul and your relationship to God.  ...  Family, though important, is not what I will have as my responsibility as I enter eternity.    Since my place in eternity is linked to my relationship to God, my salvation is my most precious and permanent thing that I have.  


I do not understand free will in the presence of an all-knowng God who is apart from time.    I do not understand the love it took to send a part of the God-head to be my sacrifice.  ...  I don't even understand why I was important enough for all this to take place.    What I do know is that His plan is real, His grace is true and His forgiveness is total.


...I pray daily to I tell others of this grace and see them accept it for themselves.   ]]></content:encoded></item><item><title>Knowledge&#x2c; Power&#x2c; Suffering</title><dc:creator>doc@askdrjim.com</dc:creator><dc:subject>askdrjim blog</dc:subject><dc:date>2007-11-18T13:59:27-05:00</dc:date><link>http://www.askdrjim.com/foler/page3/files/nov-2007#unique-entry-id-44</link><guid isPermaLink="true">http://www.askdrjim.com/foler/page3/files/nov-2007#unique-entry-id-44</guid><content:encoded><![CDATA[Today at church my pastor was talking about the the many little things daily we should be thankful to God for in our lives.     Certainly this is the case and if we, like David, would put pen to paper the list would be long and it would drive us to praise Him continuously.    Our very life not to mention things like music, color, touch and smell.     God has thought of us and gives our senses a symphony every day that is beyond man's making.   


The part of the sermon that got me really thinking was his use of one of my favorite verses.     Philippians 3:10 says "I want to know Christ and the power of his resurrection and the fellowship of sharing in His sufferings, becoming like Him in His death, and somehow, to attain to the resurrection from the dead."    Paul's powerful expression of Christian desire should be every Christian's template for life.     We all want to know and be known by our maker.     What a privilege that He actually wants us, calls us to such knowledge.    This is rooted as in any relationship in wanting to deeply understand and communicate with another person so that the relationship can deepen to our mutual fulfillment.     We should seek God as we do a lover.    Wanting to know everything about them, their history, their dreams, the things they like and dislike and what we can do to please and love them.   


Understanding the power that is at our disposal as Christians is difficult because it is a spiritual not earthly power.    I cannot lift a car because I am a Christian.    But I can tell satan to get behind me in the name and power of Christ and he must do so.     The power that raised Christ from the dead is one that no human will ever posses on their own and it is the source of power into which our lives are "plugged".    We must live boldly and fearlessly with that knowledge securely in mind. 


The next one is the difficult one.    How many of us really desire to share the "fellowship" of suffering with another?    Two things here.    First the suffering we endure for being Christian is HIS suffering not ours.    We are merely the vessel on which that suffering may be placed.    This does give comfort.     Jesus not only knows that suffering but He also OWNS it and is there with us (the fellowship part) when we are suffering for our faith.    Stephen's death by stoning is a beautiful example of how Christ was with someone during such suffering.     Many Christians in this world suffer daily for their faith and our Lord is right there with them.


If we could daily aspire to know more, to understand and use the power at our disposal and calmly suffer WITH Him, our lives, like those of Paul could change the world!]]></content:encoded></item><item><title>Thinking about Job and Joseph</title><dc:creator>doc@askdrjim.com</dc:creator><dc:subject>askdrjim blog</dc:subject><dc:date>2007-11-17T22:31:58-05:00</dc:date><link>http://www.askdrjim.com/foler/page3/files/nov-2007#unique-entry-id-43</link><guid isPermaLink="true">http://www.askdrjim.com/foler/page3/files/nov-2007#unique-entry-id-43</guid><content:encoded><![CDATA[The women at our church are going through a Beth Moore study on Genesis on Wednesday nights and a few of us men sneak in to watch the videos.    Having read some of her books the videos are a revelation because I can see her teaching style and the way she pulls your emotions.    


The last lesson was looking at the scene where Joseph, now a ruler of all Egypt second only to the pharaoh tells his brothers who he is and why he is alive.      Now the natural thing would have been revenge, blame or retribution but Joseph says that God had intended the circumstances to be for the good of his family.    In other words God was in charge and knew the situation and used it for His glory.     She then talked about Job.     Now Job is interesting because in the initial "dialog" between God and satan it is God that first brings up Job and his righteous living.     God pushed Job to the top of satan's hit list and then allowed circumstances to develop as satan tried to break Job down.    God was still in charge though certainly not behind the evil done to Job.


The point of both stories is this:  God is the supreme ruler of the universe and is in charge.    He will not allow trials in our lives to break us.    Rather He sees in us the result those trials will have with the ultimate aim that His purpose is achieved and His praise is proclaimed.     Now, sometimes it may be hard to see why a trial that is so hard on us or our family can have any good.  ...  Moore described her childhood of abuse and later relationship disasters typical for women who were abused as children.    Her eventual deliverance came through her faith.     That evil background has now been used for overwhelming good to the praise of God every time she picks up a pen or stands in front of a microphone.


...Trials MUST come and are given to us in proportion with our ability to learn and bring praise to God.      God didn't say "consider my servant Fred" because Fred was not ready to be so harshly tested.   Rather he pointed to Job knowing full well what he could expect from that servant.    And, in the end, after remaining true (complaining but true!)...  I have been praying that I see my trials and even those events that appear downright evil as conduits to a more sanctified life that would bring praise and service to God.    I have a friend who seems to get more than a standard share of trials.    I used to question God about the unfairness of it.     Now I marvel how He has continuously said "Consider my servant..." and then watched as their spirit is tested and emerges stronger AND more able to serve and to praise.


Joseph had the right perspective through all His trials he KNEW God was on the throne and that he needed just to keep that in mind trusting that the blessing would eventually come.    His family was saved and God was praised.     What more could we ask of our trials?]]></content:encoded></item><item><title>Testing One&#x2c; Two&#x2c; Three</title><dc:creator>doc@askdrjim.com</dc:creator><dc:subject>askdrjim blog</dc:subject><dc:date>2007-11-16T21:51:42-05:00</dc:date><link>http://www.askdrjim.com/foler/page3/files/nov-2007#unique-entry-id-42</link><guid isPermaLink="true">http://www.askdrjim.com/foler/page3/files/nov-2007#unique-entry-id-42</guid><content:encoded><![CDATA[I am getting a bit tired of only being able to blog once or twice a week but then maybe I have too little to say!


 A few entries ago I wrote about being more and more open to tests that God brings every day in an attempt to develop fruits of the Spirit in me.     I have been so excited about what I am learning that I have told everyone who will listen about being more open to see the test then to fully pass.    It is a decided joy to work with fellow Christians when I am learning so much because sharing these lessons and praying for each other as the day progresses becomes a more and more natural thing. 


This week after having a discussion about this very thing ,  we cared for  a family that has been very tested by tragedy.    We knew little more.     After they left tears were shed for the father who was trying so hard to keep it together.    We wondered if that had been "one of our tests" for the day.     Before much time passed the father returned as if God was saying "next page on this test."    He saw the tears and instead of hiding them or excusing them Holly told him that she had been thinking (and weeping) about him since he had left.     I was in the next room and was struck by the frank honesty and compassion.    He responded as well and after opening the conversation to spiritual issues he let out a history of hurt from the Church during his time of pain....  How many people are wounded by the very Church that Christ intends to heal them.


Because of the openness to the test and responding so honestly the man was healing before our eyes.    I fully expect that he will seek out another Church and God will be at work.     What a moment to observe and all because of being open to the Spirit's leading.


Today I saw a young person who was quite interested in the inventory of feelings and behaviors we get on teens to screen for mental health issues.    I missed their interest at first but they (and the Spirit) persisted and I sat them down apart from their family and a heard about sadness and rejection.     I then asked "what brings you joy?"    Hardly a question that I would ask a teen.    After some thought "I love to sing" was the answer and their face shone with, well, joy!    I then learned that they had a gift but had left church where they sang and did not do choir in school.     We talked about music and singing and I encouraged them to try another church and use, not hide their gift.      I am praying that Sunday will find both these families back in Church.


We have such a privilege in our work to be able to ask intimate, personal questions boldly.....and I have found a hunger by people to be asked and to discuss spiritual things.     In doing so I have found how much God is at work in what I do each day.    I am convinced our role is to see these moments and respond with love and compassion and see what He works out.  ]]></content:encoded></item><item><title>Variety in Medicine and Life</title><dc:creator>doc@askdrjim.com</dc:creator><dc:subject>askdrjim blog</dc:subject><dc:date>2007-11-10T17:05:21-05:00</dc:date><link>http://www.askdrjim.com/foler/page3/files/nov-2007#unique-entry-id-41</link><guid isPermaLink="true">http://www.askdrjim.com/foler/page3/files/nov-2007#unique-entry-id-41</guid><content:encoded><![CDATA[We have had a cool snap finally ending the heat we lived under all summer.    Variety is such a refreshing thing.      I know it might be nice to live in southern California and have similar weather daily for months but I think it would get boring.      In family medicine each person walking through the door is a new problem, new family of origin and new communication challenge.     It is why I love primary care and don't think I could be a specialist.     Oh, it would be nice to corner the market on a more narrow area of medicine.    It would be fun at times to be expert at a body of knowledge.    Certainly within a a narrow specialty one could have variety from patient to patient (they are after all unique individuals).     I just think I would go crazy seeing similar problems day in and day out.   


My youngest patient in the office thus far has been 3 days old and my oldest is 99.     I see women, men, boys, girls, married or not, straight and gay, white, black, Asian, native American and Latin.    Each day presents challenges to me and every day I must read about things to know how to proceed.     I am stretched by interpersonal and family dynamics and I need to call on other specialists, counselors, physical and occupational rehab specialists, lawyers, law enforcement, nursing and social work professionals to do my job.     The variety is what keeps me going.   


Life also has such variety....think of the number of plants, animals, stars, humans that God gives us.    We have summer, fall, winter and then spring.   ...  He's certainly no specialist.    He gifts us all differently and then set up tests to mature those gifts.     He gave us song and words and mankind has yet to exhaust those sources of inspiration (hip hop lyrics excepted at times!).       I am glad our God is a God of diversity and creativity. 


 It is when I ponder this that I can begin to understand why my life takes such turns and has such richness of variety even though that very variety challenges me when I want to remain comfortably unchallenged.      My recent life changes have certainly blown my comfort and that of my family out of the water.    In the end this has been very good spiritually although hard interpersonally.     God is molding and shaping me through the tremendous change that has happened and the variety of challenges I have been facing have caused me to be much more open to looking at my character and my way of loving family and friends.    It has allowed me to be open to my darkness and then to hold those areas up to Him for cleansing and renewal.


I keep thinking that winter's cold and darkness are followed by the renewal of spring when all is wonderful, colorful and full of renewed life and hope.     I know that the winter of this time of trial will open to a spring of joy and hope. ]]></content:encoded></item><item><title>Doh&#x21;</title><dc:creator>doc@askdrjim.com</dc:creator><dc:subject>askdrjim blog</dc:subject><dc:date>2007-11-09T22:54:00-05:00</dc:date><link>http://www.askdrjim.com/foler/page3/files/nov-2007#unique-entry-id-40</link><guid isPermaLink="true">http://www.askdrjim.com/foler/page3/files/nov-2007#unique-entry-id-40</guid><content:encoded><![CDATA[I am glad that God has such a store of patience!     Without this mankind (meaning me) would be lost.     We would have no hope as He would just wipe us out rather than wait for us to "get it".     Recently I have been really focusing on the fruits of the Spirit and how mine can develop more fully.     I know this is always done through situations that test the very fruit He wishes to produce in us.      As I have said before patience and joy are hard for me.     This is rooted in my need to be in control.     The two fruit are so linked that until I can get a handle on the patience thing I will not have the deep joy He desires for me.


I have started praying during my walks around town for God to bring tests that day to help me learn patience.....then I wince.     The problem is, even though I ask for the test and should know it's coming, it is often at the end of the day that I slap myself and so "Doh!"     I can then see clearly when the test came AND can too often again see how my patience did not hold and I shook my fist and advised God of a better plan of action.     I mean, this scene is repeated daily.      I almost wish I could be Bill Murray in Groundhog day were he gets the chance again and again to live the same day finally understanding the lessons presented after hundreds of failures.


The thing is: God IS patient.     He has no problems saying "again Jim" when I slap my head in frustration.     He wants me to get this right and He is very creative and subtle in the tests.    This week alone there were 3 I counted with one test causing me to rant and rave and just know that His plan was messed up only to be completely and utterly amazed by the actual event and way He achieved His goals.     I felt like Habakkuk who was told after ranting at God to "look and be utterly amazed for I am going to do a thing in you days that you would not believe even if I told you."      I love that verse as it embodies the authority of God, His great creativity AND His desire for us to get the lesson.     With that picture in mind I will keep asking to be tested and will gradually be molded into the man of patience and joy He so desires. ]]></content:encoded></item><item><title>Superbugs</title><dc:creator>doc@askdrjim.com</dc:creator><dc:subject>askdrjim blog</dc:subject><dc:date>2007-11-03T22:02:12-04:00</dc:date><link>http://www.askdrjim.com/foler/page3/files/nov-2007#unique-entry-id-37</link><guid isPermaLink="true">http://www.askdrjim.com/foler/page3/files/nov-2007#unique-entry-id-37</guid><content:encoded><![CDATA[Over the past several weeks I have encountered more cases of staph skin infections.    As you have been reading this bug long a source of skin infections has become progressively resistant to antibiotics.      As we have used more and more broad-spectrum antibiotics, the bacterial genome has adjusted resulting in strains that are resistant to most antibiotics now use.    Early on these bacteria were seen and seemed to live and thrive within intensive-care units within large hospitals.    Gradually we have become aware that they have now migrated out into the general environment, carried within the noses of unsuspecting health-care workers and frequent visitors to hospitals.   


We are seeing these cause both skin infections (often in epidemic outbreaks on athletic teams or in schools) as well as more invasive diseases like lung and kidney infections.    To effectively treat we need to be using multiple antibiotics and often novel ones to see results.    Hospitals are restricting the use of some antibiotics to allow for "weapons" that can be used in the future if they would be needed for a multi-drug resistant staph.  


Other bacteria have also gotten into the act including M. tuberculosis which has recently been in the news on an international level.     All of this brings to mind how very fragile is our current medical approach to infectious disease.    We treat infections but we have very limited understanding why one person in a family will become ill with an infection while another member may be unaffected.    There must be an underlying reason why our bodies become sick from infection.    


Nutrition and the source of our food is a primary reason, I believe.    We eat nutritionally poor food laced with antibiotics processed in factories that use chemicals to remain clean.    Our food supply is making us ill but it has never been more scrutinized or regulated.     I don't know what the answer may be but I am concerned that infections will become more and more deadly in the future. ]]></content:encoded></item><item><title>True Healing</title><dc:creator>doc@askdrjim.com</dc:creator><dc:subject>askdrjim blog</dc:subject><dc:date>2007-11-02T22:52:33-04:00</dc:date><link>http://www.askdrjim.com/foler/page3/files/nov-2007#unique-entry-id-36</link><guid isPermaLink="true">http://www.askdrjim.com/foler/page3/files/nov-2007#unique-entry-id-36</guid><content:encoded><![CDATA[There is nothing more humbling than being a family practice doctor...if you pay attention!     Each day I am amazed at how little I do to move people toward true healing of their bodies, their minds or their spirits.     It is true that there are times when I throw some medications at someone who is sick and they get better.    BUT IF I PAY ATTENTION very few walk away healed by those medications.    I am convinced that true healing must include mind, body and soul.    Too often I spend most of my time with patients discussing their bodies or minds and too little on the health of their spirit or soul.     The reality is that the sickest people I encounter are heart sick...meaning their spirits are broken.    This brokenness may come from families of origin who have tormented them, from relationships that are not feeding them or from jobs or circumstances that have them weighed down.  


At the core, however, is their need to be delivered from the weight of sin and the lack of God in their lives.    In the past weeks I have been consistent about being open to the moment of spiritual need that almost always appears in a medical interview.    It might be a deep sigh or a pause after a statement that demands further questioning.    It  might be eyes that tear up or a joke about spiritual things.     As I have been open to this I have been amazed at how often people hunger to talk about spiritual things....and how empty they feel.     As a Christian the thing is that I believe I know a way out....a way to be set free.


Grace, amazing grace is the heart of the gospel.     Undeserved favor that results in a way out from our sin.    God choosing mercy and forgiveness as a path for us while providing through His Son the payment that justice demanded.     This is liberating.     This is the gospel of which Paul was "not ashamed".    No wonder.     How could one be ashamed of the power to change lives through the amazing mercy that God has offered.    


In my personal life I have had to face my sin squarely in the past months and the man in the mirror appear wretched indeed.     In the act of facing my sin, confessing it and asking for mercy I have felt the power of that amazing grace.     I have had friends that I have severely wronged choose the path of mercy rather than justice and have felt the power of the healing love that is behind their act of grace.     Apart from a living God there is no explanation for either the act itself or the healing that it brought.     I hope I can learn from their mercy and begin to show more mercy myself.   I hope that as I am open to the spiritual sickness of my patients I will be able to bring them to the throne of grace at which the real healing in their life can begin. ]]></content:encoded></item><item><title>I miss home</title><dc:creator>doc@askdrjim.com</dc:creator><dc:subject>askdrjim blog</dc:subject><dc:date>2007-10-30T00:02:59-04:00</dc:date><link>http://www.askdrjim.com/foler/page3/files/oct-2007#unique-entry-id-35</link><guid isPermaLink="true">http://www.askdrjim.com/foler/page3/files/oct-2007#unique-entry-id-35</guid><content:encoded><![CDATA[Growing up in North Dakota not a weekend went by in the fall (and very few evenings during October) when we were not hunting birds.    Today the air was really crisp for the first time in east TN and I missed pheasants.    Before you jump down my throat about the whole hunting bit let me describe the scene.  


The morning is clear, crisp with the huge bright blue Dakota sky pressing down all around on the browns and grays that are prairie and harvested fields.     There are more shades of brown on the fall prairie than you can imagine.    If you are lucky you will also be in "big country" which is the term we use for large tracts of land that are only broken by dry creek beds and car trails.    The land rolls and falls and the wind is a constant causing the grass to move like waves.   


It is still nearly dark as the car pulls up to the starting point for what will be a very vigorous walk.    As you get out you begin to take old and trusted shotguns from their cases.     Hunting weapons you have come to know through years of loving use.    My double is an old Browning whose wood checkering pattern has long since been worn smooth by my hands that have doubled in size since I first fired it.    It is a familiar friend that has waited another year to be carried into the field.     Vests and hats, boots and coats all familiar through the years are put on and the dogs are released to run nervously around jumping up to greet everyone.     Rooster pheasants have a particular early morning call and you start to hear them not so far from where you stand.   


...Partly this is so no one else can shoot the birds I raise and partly because I am proud to be able to move still in the thick brush where the dogs sometimes rush by.   ...  I always have a song on my lips as I begin to breath more deeply.    Then someone says something like "watch her" meaning a dog is working a bird.   


...They will run far before they will fly and they can outrun dogs in thick brush.     But sometimes they stop and wait and the dog echos them freezing and shivering at the same time.   ...  There is no way they can hide and yet they always do.    You walk up to the dog spacing with others without words due to years of hunting together and....nothing happens.  

...Nothing here" an bird larger than you remember thunders out of the bare ground.     The colors catch in the sun and you take a half step back in fear of the noise, the motion and the surprise.     After vaulting 8 feet into the air the bird levels and then flies away at amazing speed.     Somehow in the middle of all this the older hunters again instinctively wait a bit to let the kid recover from surprise and take the first shot.    If everything is perfect they take their first pheasant in front of their older colleagues who all grin and praise the shot, the dog and the day.    The dog even grins as she brings the bird back, proud of her role in this ritual.  ]]></content:encoded></item><item><title>What He Wills</title><dc:creator>doc@askdrjim.com</dc:creator><dc:subject>askdrjim blog</dc:subject><dc:date>2007-10-28T23:03:56-04:00</dc:date><link>http://www.askdrjim.com/foler/page3/files/oct-2007#unique-entry-id-34</link><guid isPermaLink="true">http://www.askdrjim.com/foler/page3/files/oct-2007#unique-entry-id-34</guid><content:encoded><![CDATA[Most of you have gathered from the last few months that my blogging has been a fairly unvarnished look at an emotional and spiritual journey on which I am embarked.   

... A friend told of a writer who pictured life like a ride down a river.    Sometimes there are calm pools and the shore just slips by peacefully.    Other times we are in rapids and are just holding on for dear life knowing that our efforts to change things are minute compared to the power that is moving us.     I would agree with one exception:  those of us who know Christ at least have someone else in the boat with us to help us stay calm if we trust.    This  past week has been so emotionally draining for me I am just holding on.   


It has been a good week of lessons.     I finally received a fairly large check form Medicare about 1 day before I was completely drained of resources.    It had been nearly 7 months without payment from our major payor and I was just hanging on.    I was trembling when I opened the envelope and could not speak as I showed it to my staff.     God had promised to supply what I need not what I want and He did so on the day I needed it.     I was speechless both from relief and from a sense of awe that my God was watching, and knew my needs exactly.  ...  He has drawn me firmly to White Pine over the past month and I am not sure why but given His track record, I am expectantly waiting for that answer.  


I am reading an excellent J I Packer book on the Lord's prayer.    One of the main theses is that God's ultimate end and the essence of His nature is relationship.    Prayer is about extending and affirming that relationship and tuning our hearts to His will.    I find that as I have been going through some personal and family stress that relationships are the thing that makes my life livable.   

...I often manipulate, become envious and controlling or revert to "fighting dirty" by withdrawing, deceiving and pouting.   ...  I want things the way I think I see them needing to be even in relationships with others.    A friend of mine recently highlighted these flaws and then, in a display of Christ-like character, honestly challenged me while not throwing our friendship away.     I glimpsed how Christ wants us to relate to our brothers and sisters:  honest confrontation, love of the person and then firm hope in their ability to rise above their flaws with Christ's help.    God has been so good to lead me to a church that embodies His spirit and to friends who embody Him in their daily lives.    I can only hope I can learn from both groups to be a better man.


...I am not sure what is happening in my life.    I do not know what or who the future holds.     I do know Him and upon that knowledge I will rest for there seems to be some reason to continue my practice in White Pine despite tremendous pressures financial, spiritual and emotional to just give up.  ...  I'm just not sure for whom or for what reason.   ]]></content:encoded></item><item><title>Homecoming</title><dc:creator>doc@askdrjim.com</dc:creator><dc:subject>askdrjim blog</dc:subject><dc:date>2007-10-21T13:46:08-04:00</dc:date><link>http://www.askdrjim.com/foler/page3/files/oct-2007#unique-entry-id-33</link><guid isPermaLink="true">http://www.askdrjim.com/foler/page3/files/oct-2007#unique-entry-id-33</guid><content:encoded><![CDATA[My new church had a homecoming service today.    I don't know all the details but they have been through a half-decade or so of hurt and turmoil that has caused the remaining members to be very open to change, open to the Spirit and open to the voice of their new pastor.    I have felt a healing environment as I have attended and a "nakedness".     By this I mean I feel they are welcoming all of me:  my hurts, my flaws and my gifts.    They seem to say "we almost died as a church so we now know EVERYTHING must be on the table for us to bear each others burdens and rejoice when you rejoice....join us."     This is an amazing feeling in a church when you come with the pain and hurts, the shame and introspection that I did a few weeks ago.    I am so grateful.


I have lived away from family and home since 1981.    My family that remains in ND is quite interrelated doing a lot of things including church together.    I have missed that opportunity and now feel a hunger to have a church family to love and from whom I can be loved.     I have had such people and such churches in my past but I was the one not loving so that's the change.  


The idea of homecoming is sweet.    On the days I feel I cannot go on God seems to say "I don't want this earth to be too nice or you would not groan for heaven."     Boy am I wanting heaven!     For some reason He wants me here now so I can wait.     Paul said to "live is Christ and to die is gain".     I hope I can understand the first phrase better.     I yearn to have that final homecoming when we get a new name and can finally meet the author of our salvation.     Until then the homes we make in church here will have to remind us of what heaven ill be like.    I hope all my patients can look forward to such a homecoming. ]]></content:encoded></item><item><title>My Nickname</title><dc:creator>doc@askdrjim.com</dc:creator><dc:subject>askdrjim blog</dc:subject><dc:date>2007-10-20T16:48:40-04:00</dc:date><link>http://www.askdrjim.com/foler/page3/files/oct-2007#unique-entry-id-32</link><guid isPermaLink="true">http://www.askdrjim.com/foler/page3/files/oct-2007#unique-entry-id-32</guid><content:encoded><![CDATA[Two entries today as I will not have the computer for a while.     I have been through a tremendous amount of stress recently and although my faith has not failed my emotions certainly have.    I have spent a lot of time in prayer beating myself up with my own failures and my character flaws.    These pop out when I think I am doing better and they almost always 