Anchor
Paradise Valley Medical Clinic PC
Spring Newsletter
Douglas M. Lakin, MD    Dancing SunFlowers  
9977 N. 90th Street, Suite 180
Scottsdale, AZ  85258
P: 480.614.5800
F: 480.614.6322 
In This Issue
FROM THE DOC
Caregivers: Care fro Others....
New Presentation At SHC Conference Center!
Dr Lakin Named 'Top Doc"
How Couples Stay in Step?
Be Sure You Have Our Correct Address!
Exercise May Be The Best Medicine! . .
Loneliness is Risky!
Why Do We Twitch as We're Falling Asleep?
Even People With Super Recall. . .
Question On Your Lab Results?
We Need Your Help!
What You Sneeze Says About You!
Fish May Help Maintain Brain Volume
Have You Scheduled Your Physical Yet?
Are You Registered For Dr Lakin's Secure Patient Portal Yet?
AT THE MOVIES WITH BARB A.
Recipe: Spring Risotto
A Spring Joke!
Quick Links
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FROM THE DOC
Dr Lakin Sitting carteen

SOMEONE PLEASE STOP DR. OZ! SOMEONE LIKE YOU?

 

Yes....I said it.  Dr. Oz is full of baloney....or something more fragrant.
   Someone had to say it...someone legitimate, like a practicing, Hopkins-trained internist who is carrying on the
Well, not everything he says is suspect, but I hear from patients all the time about the latest supplement or vitamin that Dr. Oz is touting for weight loss, or to improve health, and it's just exaggerated claims that have minimal legitimate foundation.

Dr. Oz has a new weight loss cure.   Seriously......nothing like that exists.    It is a dream.

Dr. Oz tells us which vitamins are critical to our health.  Well, all vitamins are critical to our health, but there is virtually no hard data to support vitamin use as a critical component of a healthy diet, other than in people who have specific illnesses and who are lacking in the ability to absorb or process that vitamin.

So, although it's not nearly as sexy, I have already given you

THE KEYS

to the kingdom of

 health.   

Read my little book 

 and take the recommendations to heart.  These simple, yet basic tenets are the true guide to general good health for us all.

 

 

Yours in good health, 
Dr. Lakin 
 

VOL 10 / Issue: #2Spring/ 2014

Caregivers: Care for others - but don't forget about you

 

It's a noble job - taking care of an aging parent, chronically ill spouse or disabled family member. And more than 65 million Americans are serving as caregivers for loved ones, preparing meals, taking over household duties, managing doctor appointments and medications, and in some cases providing full-time assistance.

As rewarding as the role can be, caregiving is also tough, in many ways relentless, and often physically and emotionally draining. Surveys have shown that more than half of caregivers feel overwhelmed; they also report higher levels of stress than the average person, according to the American Psychological Association. But to care for others effectively, you have to look after your own well-being too. Some strategies to help keep you happy and healthy:

 

Recognize the warning signs of stress.

If you're irritable or exhausted most of the time, have trouble sleeping, are more forgetful or lose interest in activities you used to like, it could indicate you're under too much stress, which over time can harm your health. If you have a history of depression, pay even closer attention to the red flags - a new, small study suggests that caregiving itself doesn't necessarily cause depression but may raise the risk for those who have a vulnerability toward it.

 

Change the things you can.

Identify your sources of stress. Maybe you're trying to do too much; perhaps there are family disagreements or financial worries. Focus on matters over which you have control and then take a small step toward a solution, the Family Caregiver Alliance suggests. Even meeting a friend for coffee once a week or calling a financial planner can help alleviate some anxiety and stress.

Accept help.

 

According to some estimates, nearly one in five caregivers provides more than 40 hours of care per week. A friend could pick up groceries or run an errand; someone else could freeze some extra meals for you or even take the person you care for on a short walk a few days a week.

Seek support.

 

Maintaining a strong support system is key to managing the stress of caregiving, experts at the Mayo Clinic say. Set aside time each week to connect with family or friends, and consider joining a support group, which can be a good source for encouragement and advice from others in similar situations.

See your doctor.

 

Studies have shown caregivers are more likely to have a chronic illness, and rate their health as fair or poor. As impossible as it may feel to find the time, it's important to see your physician for checkups and screenings. Tell him you're a caregiver, and mention any health concerns or symptoms you have.

 

                                                        - The Doctors, USA Weekend 

New Presentation!  April 22, 2014, Dr Lakin Interviewing Dr Savas Petrides, Nephrologist
A nephrologist is a doctor who treats patients with kidney problems and related hypertension or high blood pressure. Once you have been diagnosed with kidney disease, early referral to a nephrologist is important in preserving and protecting your kidney function. As a specialist in kidney disease, your nephrologist has the knowledge and skill to work with you in developing a plan of care specific to your needs.

Come join us for an interesting discuss, Tuesday, April 22nd, 7 - 8:30 pm at Scottsdale Healthcare Conference Center.

RSVP HERE!

 

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Dr Lakin Named "Top Doc" Again For 2014!


Every year the Phoenix Magazine publishes a guide featuring over 500 of the Valley's best physicians. The doctors are selected through a peer-review survey. The theory is that medical professionals are the best qualified to judge medical professionals.


The survey asks the doctors to nominate those doctors who, in their judgment, are the best in their fields.

 

Once again, Dr. Lakin has been chosen as a TOP DOC among his peers.
Please join us in congratulating Dr. Lakin again for the 12th year!

 

 

How couples stay in step? Men compromise

In romantic relationships, women set the pace - literally. That's the conclusion of researchers who studied walking speeds among a small group of heterosexual couples and their friends.

As expected, men ambling solo generally walked faster than women. But when men walked with their wives or girlfriends, they slowed down to match their partners' speeds. Women barely sped up at all.

 

"It's really men who do all the compromising," at least in this small aspect of romantic relationships, says Cara Wall-Scheffler, a biologist at Seattle Pacific University.

 

An interesting note: When guys walked with female friends, they did not slow down. When they walked with other guys, they actually sped up. And when women walked with female friends, both women slowed down.

 

- Kim Painter, USA WEEKEND
 

 

 

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Be Sure You Have Our Correct Address!
Paradise Valley Medical Clinic

Office Pic 9977
Ninety Mountain View
9977 N. 90th Street, Suite 180
Scottsdale, AZ 85258
480.614.5800 (Phone)
480.614.6322 (Fax)

**Additional Top Floor Ramp Parking:
The 2nd floor ramp parking is very close to our door, but the entrance is at the VERY NORTH END of the parking area of the two buildings.   You drive all the way North...enter at the NORTH END, then drive down to the SOUTH END of the 2nd FLoor Parking to get a space very near the entrance.



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Exercise may be the best medicine for chronic pain

Chronic pain is often hidden from the USA's front pages and TV screens, but it is Americans' biggest health problem. Typically defined as pain lasting more than three to six months, it affects 100 million U.S. adults, according to a 2011 report from the National Academy of Sciences' Institute of Medicine. It is the leading reason people go to doctors, and it costs the nation upwards of $635 billion a year - more than cancer, heart disease and diabetes combined.

But many people, including many physicians, are unaware of the growing number of non-narcotic treatments available; chief among these is exercise. Many sufferers are terrified that if they move, they will damage themselves, but nothing could be further from the truth.

"To date, there is no scientific evidence that activity and exercises are harmful," says James Rainville, a spine and rehabilitation specialist at New England Baptist Hospital in Boston.

Exercise also can help prevent chronic pain: For women 65 and older in one 2011 Norwegian study, the prevalence of chronic pain was 21% to 38% lower among exercisers.

 

                                                     - Judy Foreman, USA WEEKEND


                                                           
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Loneliness is risky: Friendships can protect your health

Loneliness does more than make you sad. People who feel consistently lonely have a 14% higher risk of premature death than those who don't, a recent study finds.

 

The impact of loneliness is almost as strong as the impact of being poor, which increased chances of dying early by 19%. To avoid loneliness: stay in touch with former colleagues, maintain meaningful relationships and participate in family activities, says psychologist John Cacioppo, director of the Center for Cognitive and Social Neuroscience at the University of Chicago. He and colleagues reviewed survey responses from more than 2,100 adults 55 and older, controlling for age, gender, socioeconomic status, social isolation and poor health behaviors.

 

Their research has found loneliness can lead to sleep problems, raise blood pressure, increase the stress hormone cortisol, increase depression and reduce feelings of living a meaningful life.

 

"Having high-quality relationships with a few people is one of the keys to happiness and longevity," Cacioppo says. "The stresses of life are more easily endured if we can share them with someone in whom we can confide and trust," he says.

 

 

                                                 - Nanci Hellmich, USA WEEKEND
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Why do we twitch as we're falling asleep?

You're drifting off to sleep, when suddenly you feel like you're plunging off a cliff -- and you jerk awake. The jolt is disorienting, and you must try again to fall asleep.

As many as 70 percent of people experience sleep starts or hypnic jerks while falling asleep, says Dr. William Kohler, medical director of the Florida Sleep Institute and director of the pediatric sleep services at Florida Hospital, Tampa.

"A hypnic jerk or sleep starts are a perfectly normal occurrence that is almost universal," explains James K. Walsh, executive director and senior scientist at St. Luke's Sleep Medicine and Research Center in St. Louis.

"It involves a total body experience where your muscle contracts therefore your limbs jerk or your body twitches. They generally occur during the transition between wakefulness and sleep. All of these things are very, very brief, lasting a half second or less."

Hypnic jerks are myoclonus twitches, or involuntary muscle spasms, but sleep starts occur during hypnagogia, the stage when the body is falling asleep.   

While most people have felt hypnic jerks, a small number of people experience the frightfully-named exploding head syndrome, the sensation that there is an explosion, crashing cymbals, or thunder near (or in) one's head. Exploding head syndrome is so rare that it is mostly reported by individual case studies. While exploding head syndrome distresses people with it, both Walsh and Kohler stress that this, too, is normal and not a sign of any problem, physical or mental.

"They're healthy people with a very unpleasant experience," explains Walsh.

Movement plays a role in sleep - involuntary twitches commonly take place during rapid eye movement (REM) sleep, but these jolts occur with dreams whereas hypnic jerks occur before the body can dream.

"Some people think [hypnic jerks] might be associated with anxiety and stress or with unusual or irregular sleep schedules. The exact nature of why it occurs is not really clear," says Kohler.

While the cause remains unknown and little research is done on hypnic jerks (they are considered harmless and normal and are often too fleeting for observation), sleep doctors and researchers theorize about why they occur.  

Walsh says that he, like others in the field, speculate that as the body falls asleep it goes through mini-REM-type periods where the muscles slacken and dreamlike feelings might start.

Brainwaves occurring during hypnagogia resemble brainwaves during REM sleep, which could explain the physiological changes that occur when falling asleep. During REM our heart rate, breathing, and nervous system act erratically and if the body experiences flashes of REM while entering sleep, these irregularities could contribute to twitches. Most assume the hypnic jerks occur because the body begins relaxing.

While the visceral sensation of tumbling out of bed or plummeting off a cliff feels scary as it occurs, most people do not experience sleep starts frequently enough to seek medical treatment. Kohler says if hypnic jerks inhibit sleep, a person should consult a sleep medicine doctor. He adds that a better sleep routine -- such as having a resting period prior to bed; avoiding food, smoking, and caffeine; and going to bed and waking at the same time -- improves overall sleep.  

 

                                                         - The Body Odd

 

Even people with super recall tripped up by false memories, study finds

working people Some people have an amazing ability to recall specific events, like exactly what happened on a particular day decades ago. For example, when one person with such so-called highly superior autobiographical memory (HSAM) was asked what happened on October 19, 1987, she quickly replied that it was a Monday, "the day of the big stock market crash and the cellist Jacqueline du Pré died that day."

Yet even people with exceptional recall are as susceptible to being manipulated by false memories as the rest of us, according to new research released today in the Proceedings of the National Academy of Sciences (PNAS). The results could have enormous implications for legal proceedings, and any other forum that relies upon the memory of witnesses.

When a University of California Irvine team led by a graduate student Lawrence Patihis tested 20 super-memory people and 38 age- and sex-matched people with normal memory powers on three different tests known to elicit false memories, the HSAM people performed no better than the others.

HSAM is different from using mnemonic tricks and extensive training to remember the order of playing cards or lists, like those described in writer Joshua Foer's popular book, "Moonwalking with Einstein." It's a natural, and seemingly foolproof, ability, although no one knows how many people have it.

In the test, all the people were asked to read about United Flight 93 of Sept, 11, 2001. Part of what they read stated that "video footage of the plane crashing" was taken by somebody on the ground. In fact, no such video exists. 

Yet after reading the material, 20 percent of HSAM people and 29 percent of the other group indicated they had indeed seen the video. In a later interview, 10 percent of HSAM people stuck to their stories. Of the total number of fake details about the crash planted in their minds, there was no significant difference in false memory between HSAM and normal memory participants.

"These people are especially good at remembering news reports," Patihis told NBCNews. "So we expected zero false memories in that task. But they were similar to controls."

Super-memory people and the normal memory group also scored about the same on tests using word lists. And when it came to slide shows depicting two crimes followed by a written narrative of the crimes seeded with false details, the HSAM subjects were slightly more susceptible to developing false memories.  

This is how eyewitnesses can be influenced by police suggestion or news reports.

"When you think about what we already know about memory in terms of distortions, most people are prone to suggestibility effects," explained Jason Hicks, professor of psychology at Louisiana State University who studies false memory and human learning.

Recall, Hicks explained, isn't like pulling a snapshot out of our heads. The brain constructs memories from individual bits of information, and then pieces those bits together to reassemble it when we remember something. But new information is constantly mixing with old and can become incorporated in the reassembled memory.

Charles Brainerd, chair of Cornell University's Department of Human Development, believes true and false memories reside in distinct memory systems: "verbatim" and "gist."

"Gist memory, which is our ability to understand and interpret the meaning of our experience, underlies our most advanced human thinking, reasoning, and judgment abilities," Brainerd said. It evolved to help us survive. "However, because gist memory does not contain the same level of detail about our experiences as verbatim memory, it can be tricked and tripped up."

People can swear in court, and truly believe, in the accuracy of their false memories. But, as Hicks said, "confidence does not equal accuracy."

 

                                                  - By Brian Alexander



Question On Your Lab Results?
Check out:
DoctorDoug's Academy  
 
doctordoug
Dr. Lakin's guide videos on how to better understand your lab work results.....

Check the first edition here:

DoctorDoug's Academy: Lesson #1 CBC
DoctorDoug's Academy: Lesson #1 CBC

Watch for more videos on
our WebsitePatient Portal!

 

 

We Need Your Help!
Dancing SunFlowers Keeping you on your correct medication is as important to us as it is to you.  With your help, we can be more efficient and be sure you are getting your refill requests on time and to your correct pharmacy.

Tips:
1. If you need a refill, be sure to call your pharmacy FIRST, not our office.  They will know if you have more refills, and if not, they will call/fax/electronically message us with your request.  Then we will contact you if there is a question or concern.

2. Remember to call your pharmacy in plenty of time so you do not run out of your medications.  Sometimes we need  up to 48 hours to complete a request and we do not want this to be a hardship for you.

3. Register and use our SECURE PATIENT PORTAL for refill requests.  We monitor this continually and again will contact you if there is a problem.

4. Remember we do not refill pain or routine medications on Fridays or weekends and all pain medications must be picked up at our office.  We cannot mail or any medications outside our office.  Please plan ahead and make arrangements!

We are always here to help you and appreciate the opportunity to care for your healthcare needs!

Yours in good health,
Dr. Lakin & Staff

What your sneeze says about your personality. . . .

   

Some sound like mortar fire, others like somebody just stepped on a mouse.

"I have world famous kitten sneezes," says Susan Frykholm, a 31-year-old multimedia sales specialist from Seattle. "I'm not trying to be cute but people usually start laughing at how 'precious' they are."

"Mine are like a revolutionary war cannon," says Dan Fine, a 54-year-old IT consultant who is also from Seattle.

We each have our own individual sneezing style. But what, exactly, determines whether those sneezes come out dainty and demure or whether they blow down the whole dang house?

"Sneezes are like laughter," says Dr. Alan Hirsch, a neurologist, psychiatrist and founder of the Smell & Taste Treatment and Research Foundation in Chicago. "Some [laughs] are loud, some are soft. And it's similar with sneezing. It will often be the same from youth onward in terms of what it sounds like."

Hirsch says he doesn't know of any studies that have been conducted on various sneezing styles and what they might mean, but says he does believe the way we sneeze reflects some component of the personality.

"It's more of a psychological thing and represents the underlying personality or character structure," he says.

A person who's demonstrative and outgoing, for instance, would most likely have a loud explosive sneeze, whereas someone who's shy might try to withhold their sneezes, resulting in more of a Minnie Mouse-type expulsion.

Tara Spicer, a 29-year-old copywriter from Mountlake Terrace, Wash., has her own theory about why she sneezes the way she does.

"I'm a sneeze stifler," she says. "I've always pinched my nose to mute the noise. I think it's a subconscious rebellion against my grandmother, who raised me much of my life, and took pride in her ear-shattering siren-sneeze."

Others describe their sneezes as screams or trills or "triple threats," sneezes that come in threes. Just as with other basic body functions (we're thinking of coughs or hiccups or burps here), everybody's got their own signature style.

Why do we sneeze in the first place?

"In general, sneezing is an involuntary phenomenon, part of the body's mechanism of defense, a way of clearing out bacteria or other agents that would be injurious," says Dr. Gordon Siegel, a Chicago-area otolaryngologist (ear, nose and throat doctor). "That being said, you can control to a degree the way it comes out."

Siegel, an assistant clinical professor at Northwestern Feinberg School of Medicine, points to an acquaintance whose sneezes always incorporate a particularly colorful expression.

"When he sneezes, he likes it to come out saying 'horsesh*t' and he's got it down," he says. "There is partial control of the final product."

The shape of our nose or the bone structure of our face might contribute a small degree to certain sneezing styles much in the same way the resonance of our voice is affected by our anatomy, says Siegel. But "what we perceive as the sneezing sound is not really affected significantly by the nose structure."

For the most part, people don't really think that much about sneezes, he says. They just happen.

Hirsch, however, has given the practice some thought and adds this final insight.

"When we think about sneezing, it's almost orgasmic in its quality," he says. "By giving in to it, you're experiencing the positive pleasures of a nasal orgasm. So if someone is more sexually repressed, they may withhold it. But if they're hedonistically-oriented and like pleasure, they may sneeze loudly and strongly."

 

                                                    - By Diane Mapes

 

Fish may help maintain brain volume, function, with age

 

 

While a diet rich in fish has been touted as a way to improve brain health, research has been mixed.

Now, a new study of older women finds those with higher blood levels of omega-3 fatty acids, found in fish oil, had less brain loss as they aged. That might mean they would maintain better brain function for an extra year or two.

Results suggest fish oil may help delay cognitive aging and dementia, says lead author, Jay Pottala of the University of South Dakota. The new study is in the journal Neurology.

Fish high in omega-3 fatty acids include salmon, herring, mackerel, tuna, sardines and swordfish.

Shrinking brain volume is part of aging, Pottala says, but MRI scans found that the brains of women with the highest levels of omega-3 fatty acids "didn't atrophy as much."

These benefits could be achieved with fish or fish oil supplements, he says; to get to enough, you would have to eat fish five times a week, or twice a week and take supplements.

Physical activity also has been shown to potentially reduce risk of Alzheimer's disease, adds Heather Snyder of the Alzheimer's Association.

 

                     - By Nanci Hellmich, USA WEEKEND

 



Have You Scheduled Your Physical Yet? 

stethascope As you all know, Dr Lakin is a strong supporter of annual physicals. This is a time we can visit and explore any unresolved medical problems and any new health issues that need to be addressed. Annual physicals are one of the best ways to safeguard your health.

 

The American Medical Association recommends that if you are between the ages of 40 - 49 years, physicals should be done every two years. If you are 50 years plus, it is recommend you have yearly exams, especially if you have any chronic medical conditions that need to be monitored.

 

Call to schedule your well care visit today!

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Are You registered For Dr. Lakin's Secure Patient Portal?

patient protal


Now is the time!
For help on how to register and FAQ, check our these videos:

It's as easy as that!  
**Please note that our Patient Portal is not 100% optimized for
Internet Explorer 11.  Some of the functions will not work as intended.
The software development team is working on it.  Until then, please use Internet Explorer 8, 9, 10, or Mozilla Firefox, a free browser.

Please contact Nan at nan@doctordoug.com if you have further questions or concerns
.

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AT THE MOVIES WITH BARB A. . . . .

Barb A.Movies
A MUST SEE!              + + + + +
GREAT                         + + + +
ENTERTAINING           + + +
RENT THE MOVIE        + +
FORGET IT!                  +
**EMAIL ME!                 ???
 

 

 

 

 
THE MONUMENTS MEN 
+ + +  
 

This film had bad reviews but I truly enjoyed it. I was a history major at Cal so when I get a true historical film I always see it.  Who were the Monuments Men?  They were a special group of men during World War II who joined the front lines to try to save the masterpiece art work that the Germans were hiding.  The Germans also promised to destroy the art work if the Americans were close to recovering them.  They were hidden in mines and blocked at the entrances.  One of the elusive works was Madonna and Child. The cast was superb. Who doesn't enjoy George Clooney and Matt Damon.  IT wasn't "HOLD YOUR BREATH" dramatic but exciting enough to hold my attention.

 

THE GRAND BUDAPEST HOTEL 

+ + + + + 

This film actually deserves 6 ******stars.  I do however recommend that you read about the movie before you go....there are is so very much going on, so many time changes, and so many new characters that you need to concentrate.  The movie is in my opinion the most magnificent silly, yes silly, work of art I have ever seen.  It takes place in an imaginary city at a famous European hotel between wars.  Filmmaker Wes Anderson's best movie yet.  Although the film centers on Ralph Fiennes as M. Gustave(concierge) and his "lobby boy" Zero, favorite stars such as Bill Murray (we can never get enough of him), Owen Wilson, and Ed Norton wander in and out.  There is the murder of a countess, stolen art work, chases of a sled and skis superbly animated that delighted me.  See it. If you go to stay at the Grand Budapest Hotel, I think you will never want to leave. 

 

**NOW A DEPARTURE FROM THE NORM.  THERE REALLY WAS NOTHING I WANTED TO SEE, SO WHAT THE HECK!!!!!!!

 

 

NUMPHOMANIAC
 - +  

.   A minus one* for this one.  Sex for art directed and produced by Lars van Trier, staring no one of interest..  I understand that Nicole Kidman was to star in the firm but had previous commitments.  I really doubt that.  A nymphomaniac is rescued from a beating by a man who takes her home.  She shares all her exploits with him and he shares his love of reading, fly fishing, and organ music with her.  What a plot!!!!  The film is not sexy, raunchy or pornographic. Rather it is just silly and boring. Lars should pay me for seeing it.

 

 

    

Barb A.  

 

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Recipe: Spring Risotto
 

 
What You Need

3
Tbsp.  butter
2Tbsp.  olive oil
1medium  onion, thinly sliced
2cloves  garlic, minced
2cups   uncooked instant white rice
1can   (14-1/2 oz.) chicken or vegetable broth, warmed
1/2cup  milk
1bunch  (1 lb.) asparagus, trimmed, chopped into 2-inch pieces
1/3cup  KRAFT Grated Parmesan Cheese, divided
1/8tsp.   each salt and pepper

Make It

 

MELT butter with olive oil in a deep skillet on medium heat. Add onion and garlic; cook 2 to 3 minutes. Do not brown.

TOSS in rice and stir to coat the rice. Add warm broth, milk and asparagus.

BRING to a boil over medium heat; simmer for 5 minutes over low heat. Mix in 1/4 cup of the Parmesan cheese, salt and pepper. Sprinkle with remaining Parmesan cheese just before serving.  

 

Enjoy! 

 
                                                      
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A Spring Joke. . . .
Medical Practices
Uncontrolled laughing

Best friends graduated from medical school at the same time and
decided, that in spite of two different specialties, they would open a
practice together to share office space and personnel.

Dr. Smith was the psychiatrist and Dr. Jones was the proctologist;
they put up a sign reading: Dr. Smith and Dr. Jones: Hysterias and Posteriors.

The town council was livid and insisted they change it. The docs changed it to read: Schizoids and Hemorrhoids.

This was also not acceptable so they again changed the sign to read
Catatonics and High Colonics - no go.

Next they tried Manic Depressives and Anal Retentives - thumbs down again.

Then came Minds and Behinds - still no good.

Another attempt resulted in Lost Souls and Butt Holes -
unacceptable again!

So they tried Nuts and Butts - no way.

Freaks and Cheeks - still no good.

Loons and Moons -forget it.

Almost at their wit's end, the docs finally came up with:
Dr. Smith and Dr. Jones -Specializing in Odds and Ends.

 

 

 

 

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Wonderful Spring
  
 


Dr. Douglas Lakin & Staff

Paradise Valley Medical Clinic PC