NewFNP, that's who.

NewFNP has long been fascinated by two behaviors she often notes as regular occurrences in her clinic.

The first is that patients feel absolutely empowered to walk into the patient care area and ask the medical providers any number of questions while the provider is in between patients. These are patients who may have just happened to drop by, or who received a letter stating their labs were abnormal or who wanted to show a provider a rash or insect bite or what have you.

NewFNP finds this frustrating and fascinating. She would be hard pressed to stop her doctor in the hallway to ask her a question or show her a derm lesion. For being disempowered in many ways, it is remarkable - albeit somewhat misguided - that her patients have found a voice in this way.

The second behavior is fighting and swearing and name calling in clinic.

It was full-on baby daddy drama in clinic today as prenatal patient A and prenatal patient B realized in the reasonably tranquil waiting area that they were both carrying fetuses fathered by the same man. Although it did not come to fisticuffs, clinic security was on heightened alert.

As newFNP's medical assistant was vitaling prenatal patient B, newFNP heard the word "bitch" resonate down the hall four times. At this point, newFNP said, "Uh-uh. Not on my watch." She entered the vital sign area, closed the door and told the patient that while she understood that she was frustrated, that language was not tolerable in clinic.

To which prenatal patient B replied, "Who the fuck are you?!!?"

Indeed.

Fortunately, the remainder of the appointment went much more smoothly and newFNP noted that, in addition to sharing a baby daddy, newFNP's prenatal patients shared the exact same tattoo in front of their right ears on their cheek.

The remaining lot of tattoos - neck, chest and hands included - were all different.

The Freshmaker

To many of newFNP's patients, the human body is a big mystery. Perhaps because her patients have had limited access to medical care, they have fashioned DIY treatments for various ailments. Rubbing alcohol, of course, is the big savior, dematologically speaking. It's got a "cure for what ails ya" mystique amongst newFNP's patients. Tincture of violet is another go-to topical.

But mere derm problems are not the only health concerns for which patients fashion their own treatments.

Throw menopause into the body mystery equation and it's like one big clusterfuck of a mystery to many of newFNP's patients. The uncomfortably itchy atrophic vag, the non-existent sex drive, the beard, the emotional upheaval. Honestly, newFNP isn't looking so forward to it. But she will have options when she gets there. Maybe she'll hook up with Suzanne Somers a la Samantha from SATC, maybe she'll do acupuncture -- who knows!

But what she most certainly will not do it dutifully apply Vicks Vapo-Rub to her atrophic downstairs in other to refresh herself, which is precisely what her patient told her she was doing. Granted, new FNP is nowhere near her menopause (knock wood), but there are a few places in which newFNP would not apply Vicks no matter what and her Lady Gaga is one of them. Talk about a bad romance!

NewFNP Film Festival

Just last week, newFNP was lamenting her Groundhog Day-like hum-drum clinical existence. A pap here, a diabetic med refill there. Nothing but the same old, same old. In fact, she thought that should an abscess walk in the door, she would not have the slightest recollection as to how to treat it.

Well, the universe listened. She had one of those Field of Dreams type of scenarios. All she had to do was imagine an abscess and voila!! Not one, not two, not three but high five abscesses walked into the clinic. On the same woman.

Now, newFNP loves her some Hot Tub Time Machine, but she is remarkably less enamored with Hot Tub Folliculitis. It is not a sequel one would recommend. Apparently, this woman and her paramour took a romantic getaway to a local hotel and enjoyed a soak in the hotel jacuzzi. A fun time was had by all until newFNP's patient began experiencing some angry booty blemishes. By the time newFNP saw her, two of the five abscesses were ready to go.

It was the first time newFNP had ever incised and drained two abscesses on the same patient on the same day and the first time she had ever seen so much necrotic detritus exit the newly opened wound.

As is generally the case with incision and drainage, newFNP's patient felt immediately improved and newFNP felt a renewed enthusiasm for her role in clinic.

And just like in the movies, newFNP (and her patient) experienced a happy ending.

Punxsutawney newFNP

It has been just like Groundhog Day for newFNP. Stepping in the same puddle, getting annoyed by the same people and generally reliving the same thing day after day after day.

And then there was today, when newFNP literally hit her head against the wall while discussing yet another undesired change in her schedule.

Work. WTF. As newFNP's mom used to say, too bad we weren't born rich instead of so good looking.

When it's good to be newFNP

NewFNP has had a wonderfully and oddly rewarding work week.

First, she received the most heartfelt thank you letter from a patient on Monday. She has truly never received anything like it in her life and she knows that such notes will be few and far between in her career.

Then, Dr. Dual-Ivy-League-Degrees told newFNP that "a friend" had stopped by to say hello. Not having many friends in her area of clinical practice, her face must have betrayed her puzzlement. As it turns out, an adolescent patient for whom newFNP cared a couple of years ago (see Healing) just stopped by to say hi and tell newFNP how he was doing. He gave newFNP an awkward fourteen-year old boy hug and updated her on his life. He looked happy and it made newFNP immensely happy to see him feeling good.

And finally, newFNP completed a well-child visit on a 9-month old for whom she has cared since birth. NewFNP also did her mom's prenatal care and cared for her for three years prior to her pregnancy. It is truly one of the joys of family practice to share patients' lives with them and as newFNP held this beautiful baby girl in her arms, she was reminded her of that.

And it's a holiday weekend. Time for a weekend getaway, SATC2 and maybe even a new tattoo!

Ninety-nine

If newFNP could stress one thing -- aside from the importance of clear skin and a cute wardrobe -- to students, it would be that one must learn to elicit and write down a decent medical history. It is very clinically challenging to have too little information and may go as far as to cause newFNP to call chronically poor documenters 'douchebags.'

Say for instance one orders a CEA on a patient for apparently no reason whatsoever, as the subjective area of the progress note is left blank, and then say for instance that CEA comes back mildly elevated (4.2 ng/mL in a non-smoker) with all fecal occult blood tests negative. This may cause newFNP to think to herself, "What the fuck, douchebag."

It's not because newFNP doesn't appreciate that this abnormal test result necessitates follow up. It is that newFNP does not have one iota of medical history from whence to begin.

NewFNP walked into the exam room and immediately made the very subjective assessment that this 70-year old gentleman looked bad. He complained of chronic cough and dyspnea on exertion. NewFNP inquired as to whether he had ever noted hemoptysis with cough. He had. NewFNP was thankful that his daughter attended the visit with him as she mentioned in an off-the-cuff fashion that he had had multiple positive PPDs, but not even one chest x-ray.

Balls.

NewFNP listened to his lungs. The left lung was peachy. The right, not so much. NewFNP started at the bottom: diminished. She moved to the middle: unimpressive. She progressed upward: rales. She moved her stethoscope back down and asked the man to say "ninety-nine." Again the sound was diminished at the bottom of the lower lobe. She moved it to the middle of his back and almost had her tympanic membranes ruptured by the volume with which the words "ninety-nine" resonated through her stethoscope.

Positive whispered pectoriloquy, hemoptysis, positive PPDs sans CXR evaluation and an elevated CEA equals a trip on into the county emergency department. Truth be told, the first three would have prompted newFNP to refer for an ED evaluation, but newFNP is certain that this man received his chest CT much more easily having shown documentation of the elevated CEA.

NewFNP called the patient today. He was hospitalized overnight and had a negative chest CT. The AFB is pending.

And newFNP's documentation is clear, written in neat penmanship and thorough for the next provider.

News Flash

NewFNP hasn't read the study herself, but as she was driving home today she heard a news story on NPR stating that use of Viagra may be associated with long-term hearing loss, as opposed to the sudden hearing loss that was previously known.

This news is revolutionary -- Pfizer can seek a whole new indication for Viagra's use. Gents can continue to bone up on their partners without having to listen to requests to take out the recycling or trim the bushes.

It's the perfect lifestyle medication for the AARP set.

Psych!

NewFNP sees a lot of mental illness in her practice, but it is mostly dysthymia and depression. There have been a couple of wildly positive Mood Disorder Questionnaires, of course, which are generally accompanied by such wild extremes of dress that conducting the MDQ seems almost superfluous.

But it is really rare for newFNP to see schizophrenia in her clinic and it is really, really rare for her to have two schizophrenic patients on the same day.

NewFNP's first schizophrenic patient of the day was a G15P9 three-hundred pound crack-smoking schizophrenic with no teeth who lived in a board and care. She needed a pap and an HIV test which, you gotta hand it to her, is pretty decent self care for someone who is really deeply troubled. She had been off of her Seroquel for a few months and her flat affect was remarkable. NewFNP has never had so many monosyllabic responses to questions, even on her worst of dates. But it wasn't her negative symptoms that had newFNP concerned. NewFNP asked her of she had been hearing things that others could not hear.

"No," she responded.

NewFNP then asked if she had been seeing things that others could not see.

In the flattest of voices, with no change in tone whatsoever, she replied, "Last week the shadows came back."

The way in which she replied was so freaky and the response itself so fucking creepy that newFNP just resumed her Seroquel rather than having her wait for her psychiatric appointment.

Later in the same day, everyone's favorite schizophrenic patient, Cocoa Brown, came back to clinic for a follow up appointment. She, too, was smoking crack, had horrible dentition and approaching three-hundred pounds. Her weight had increased 24 pounds over the past month. She felt uncomfortable and wanted pain medication.

"Can't you give me some Tylenol #3s?" she asked newFNP.

"No."

"Some #4s??" she tried.

"No."

Her lower extremities were edematous. She was experiencing orthopnea. NewFNP's heart sank as she told Cocoa Brown that she was concerned about heart failure. She wrote some prescriptions and, not wanting her to go AWOL as she is wont to do, exited the exam room with her to accompany her to the lab.

As she walked out the room, newFNP's colleague - a good-looking Cuban doctor - told her hello. She smiled, giggled and said in an unreasonably loud voice, "He's handsome!"

NewFNP dropped her off at the lab where she, of course, bolted without having her BNP drawn. Oh, Cocoa. Seroquel or no, newFNP just can't give you the help you need to make you well.

Booze Clues

About a month ago, newFNP was lamenting the effects of hitting the bottle a bit too much. She had sent a gentleman to the emergency room, only to have him return - angry - with absolutely nothing done about his ascites. NewFNP has won him back over, has increased his Lasix and has serially monitored his bilirubin, albumin and weight. She gave him prenatal vitamins as that is the only type of vitamin available in her clinic. She gave him protein and salt guidelines.

She hasn't seen much improvement.

The good news is that the bilirubin is approaching normal and he is abstaining from alcohol.

The bad news is that one might mistake the rotund abdomen under his t-shirt as a basketball but it is, in fact, ascites. It is no exaggeration to say that his panza is 40-week-gestation-sized large, taut and in need of a paracentesis. Now, in addition, the cirrhosis, portal hypertension and ascites are leading to hepatic hydrothorax -- his lungs are wet and he has orthopnea. He has decreased one lousy pound since starting high dose Lasix. He smells like an ammonia factory.

NewFNP is far from being a liver specialist, but she thinks that the situation is not good. He needs a new liver and, even more so than the perfect flattering trouser, they are not so easy to come by.

And he still doesn't have insurance.

Bad Mojo

NewFNP has had one hell of a week and, if she is not mistaken, it is merely Wednesday.

Not that newFNP is overly superstitious, but she finds that the first patient of the day can sometimes set the tone for the rest of the day. And are stars aligned - or misaligned or crossed or something - because newFNP's first patients have been outliers, each and every one of them.

Monday's first patient was a run of the mill IUD insertion and things were sailing along as smoothly as ever. The tenaculum was at 10-&-2 and the Mirena's arms were released when the speculum went AWOL. It settled on the still intact tenaculum while newFNP's MA nearly infarcted. NewFNP should damned well know better but this tends to happen with overweight ladies and this patient was only slightly overweight. NewFNP removed the IUD and blindly attempted to remove the engaged tenaculum. If you have never tried this before, it's a task not as easily completed as one might like. Fortunately, the repeat placement went much more smoothly than the initial in no small part thanks to newFNP's MA keeping the speculum in its desired location.

At least Monday's patient was in the clinic when the situation went down. It is important to have a little background on newFNP prior to hearing about Tuesday. NewFNP is chronically early and is therefore in clinic thirty minutes prior to any other provider. So when a patient who had been standing outside waiting to be seen began seizing in line, newFNP was the only provider on the scene. The ambulance and firetruck had come and gone before the clinic was actually even open for business. And thirty-one patients later, newFNP went home.

And finally, this morning our clinic nurse brought a slurring patient to newFNP's attention. According to the patient, her methadone dose was increased yesterday. It took longer than necessary to elicit this information as the patient was nodding off during the subjective component of the interaction. She denied all drug use which may be the case but people may overdose on methadone and a good place to OD is in the hospital where there are doses of Narcan and ER physicians and IVs. Furthermore, her asthma was uncontrolled. Further-furthermore, she was six months pregnant. NewFNP put her on oxygen and a nebulizer and again invited the paramedics to the clinic.

Please. Please. Tomorrow. Let tomorrow be easy. Super frigging easy.

Hells Bells

For the first time ever, newFNP was jealous of a patient's t-shirt today. This is not to say that she wasn't impressed by the "other bitches just front" t-shirt of some time ago, but newFNP -- ballsy as she is -- just does not have the sack to wear that t-shirt in public. Would they even let her in J. Crew?? Maybe in Barneys Co-op, but probably not J. Crew.

Today, however, newFNP was ready to trade her J. Crew bedazzled tee for her patient's tee. From under her patient's coat, newFNP could see, in metallic silver glory, a C, a lightning bolt and a D and she knew, oh how she knew, that her 50-something year old African American lady patient was wearing a mother-effing AC/DC t-shirt. For those about to rock an AC/DC t-shirt, newFNP salutes you.

NewFNP loves AC/DC.

Her patient's hemoglobin A1c of 10.6%, she loves somewhat less.

There's an app for that

NewFNP dodged a bullet today. Not literally, but technologically.

Outside the exam rooms, newFNP's clinic has lovely fold-down desks. In her fold down desk, newFNP has lab slips, routing slips, medication order forms and, frequently, her iPhone 3GS.

Today, newFNP looked in her desk and her beloved iPhone had disappeared. "Mother fuck," she thought, "Somebody stole my phone." She looked in the providers office and was denied. She looked again in her fold down desk and was again denied. It was at this point that she truly began to lose her shit.

She thought about why in the world she would return to a place where people are stealing phones. She realizes that poverty leads to desperate acts - such as her patient who presented to the emergency room with abdominal pain and cholelithiasis using a fake name in order to avoid receiving a bill she could not afford. NewFNP does understand that these acts are of desperation, of not seeing any other way.

Nonetheless, they are wrong.

NewFNP is not insensitive to the fact that many bankruptcies are results of medical debt. But she does not condone what is essentially stealing health care from the emergency room. The medical system is broken. But when one lies in order to receive services, then is that person a part of the problem? Or are they just making the best of a fucked up system?

Today in clinic, newFNP's colleague blew up her cell time and time again. Given that it was password protected and that the mute function is not immediately accessible if one is unfamiliar with the phone, the culprit had to ditch newFNP's phone in the baby scale. She then walked around the clinic and went to her mental health appointment.

NewFNP had started her on Paxil yesterday and made a referral to mental health -- today's appointment. She had stolen another employee's phone several days before. No one has confronted her. The current plan is to have her escorted to every aspect of her clinical appointments, but apparently to never acknowledge her sticky fingers. NewFNP's clinic manager specifically asked newFNP not to confront her.

Fine. NewFNP will keep her mouth shut. She does, after all, have her phone back. And she learned a valuable lesson: keep your shit with you, newFNP!!

But newFNP is pretty damned certain that she does not want to give her time, service and care to this woman in the future. This patient does not get to have the special newFNP touch. She spent a shitload of time (read: 20 minutes) supportively encouraging this patient yesterday. She does not want to give that of herself to someone who takes and takes and takes, then takes some more.

As an aside, this incident has caused newFNP to re-evaluate her aversion to the lab coat. Perhaps it's time to pick it up off the floor of the coat closet and bring it back to clinic.

Blame it on the a-a-a-a-a-alcohol

NewFNP is no teetotaler. Hells to the bells no. But she does generally drink in moderation. Sure, she might have tied one on at the Liberty Hotel one night and fallen asleep while sitting on BostonCNM's couch while holding a glass of water, only to awake some time later -- cold, confused, wet and holding an empty glass. But those occasions are few and far between.

But newFNP, thankfully, has no addictions. Two of her patients this week have been debilitated by their alcoholism. One man, newly sober, came to newFNP in follow up after having received furosemide for his bilateral pitting edema. Rather than having diuresed some of the fluid, he had gained three pounds in two days. His legs were swollen. His abdomen was taut and distended with ascites. His sclera were yellow. He felt itchy. His bilirubin was 9 point mother-effing 9. He was urinating once daily -- on Lasix! NewFNP sent him to the emergency room. But his liver is shot. And whatever happens in the emergency room won't fix the damage that decades of alcoholism has wrought.

Another patient, a man just a few years younger than newFNP, stated that he drinks at least 100 ounces of alcohol every day and has done so for the past two years. CAGE questionnaire positive 4/4. Replacing meals with alcohol. So depressed that he couldn't imagine going through life any other way. Uninsured.

A pretty decent resource in such a situation is the SAMHSA treatment locator. NewFNP printed out a list of medical detoxes for him, drew some labs, started Paxil and gave him vitamins. She called him today to see if he had had any luck getting a detox bed.

His number was disconnected.

She's ba-aaack!

NewFNP has four words for you people: Hot Tub Time Machine.

Even without memories of movie hilarity, newFNP is pretty stoked to be back in full-time practice. Sure, she cried at work out of frustration yesterday but, to be fair, her dog was under the weather and newFNP was worried about him. (He's fine today.) And yes, newFNP has been inundated with penile warts and emergencies and non-compliant prenatal patients.

But she is certain that she is where she is supposed to be. She is truly happy to just be back in the clinical mayhem, taking care of patients. And there is really something to be said for coming home when it's still light out, hanging out with your pals, walking the dog and watching DVR'd Daily Shows.

Back to square one

NewFNP just returned home from her going away party held at the home of the medical director of the research clinic. She doesn't regret her decision to leave at all, but it sure as hell isn't easy.

Her last day was yesterday. Two weeks ago, she told a 29-year old guy that he was HIV+. She laid the foundation for his continued care, but she would like to have been there to help him. These are the situations that make working in health care so rewarding (helping people in their time of need) and changing positions so sad (leaving people in their time of need).

But on her last day, one of her favorite research participants who finished the trial several weeks ago, returned to the clinic.

"It's your last day, isn't it?" he asked newFNP. He came by to say thank you and to say goodbye. It was really touching.

And so she goes, back to urban community health full-time. Her NHSC loan repayment application is pending and she is happy to have regular hours, busy days and patients to care for.

But tonight, leaving the party, newFNP's heart is heavy. NewFNP loves people easily and there are some people at the research clinic who have won her heart. And she will miss working with them very much.

First time here?

In the shadow of historic health care reform's bill signing, newFNP gently knocked on a patient's door prior to doing her physical exam.

NewFNP does not room her own patients, but she has instructed her MAs to have the patient completely undress, don the paper gown open in front for ease of breast examination and place the paper drape over the lap for maximum modesty protection.

Rarely does the patient take this instruction, passed along by newFNP's MA, to heart.

Most often, the gown is open in the back. No big whoop - newFNP just opens the gown in the front for the breast exam. Sometimes, the patient will undress from the waist down only. Gentlemen will often keep their underpants on while otherwise undressed.

But for the first time, newFNP opened the door to see a 38-year old woman stark naked sitting on the exam table, folded gown and drape sitting untouched beside her. NewFNP reminded her as to how to utilize the paper goods and exited the room.

In what universe do we just hang out nude in the exam room? NewFNP knows that this woman has been introduced to Western medical practice because it was not her first time at newFNP's clinic. So what gives? Are there places in which patients are examined in the buff?

It's also shockingly common for newFNP to enter the exam room for a well woman exam and see the patient supine on the exam table, as though newFNP wasn't going to talk to her at all prior to assessing for cervical motion tenderness or discharge. It's not a stretch for newFNP to imagine that in other countries, where paternalism is a more welcome value in medicine or where there is a large uneducated, illiterate population, providers really do just do the exam and move on.

But newFNP really would like to have some type of therapeutic partnership with her patients and would hope that she could give them some health tools to take home. Therefore, it's pretty helpful for newFNP to chat them up while A) clothed, albeit in paper and B) in a seated position rather than in the relatively powerless supine or lithotomy positions!

Honesty - the best policy?

NewFNP had a bullcrap day at clinic. Sometimes that happens - no big whoop.

But then sometimes a patient says something that just sends newFNP into a personal tailspin.

NewFNP has cared for this patient for years. She's anxious and depressed, but kind. She's very thin and forever trying to gain weight. NewFNP, on the other hand, has the metabolism of a stoned hypothyroid tree sloth. Thus, the only amount of exercise and diet that allows her to be truly thin is an amount unattainable when working full time, visiting her elderly grandma, walking her dog, shopping and doing all the other activities that make newFNP newFNP. And because newFNP is a thirty-something year old white girl who has been conscious of her weight since the days of Seventeen magazine and Forenza, her issue with her weight is both omnipresent and frustrating.

So when her well-meaning patient told newFNP that she was "mas gordita," newFNP wanted to cry in the room. She felt as though she had been punched in her doughy lady belly.

NewFNP supposes that perhaps it's good that her patients feel so comfy cozy with her as to comment on her habitus. But damn if it doesn't feel badly to have her major issue voiced in an exam room. It feels more than badly - it pretty much ruined her GD day. Maybe newFNP should go on Kirstie Alley's TV show with her, sans the Scientology of course.

For crap's sake, her own PMD didn't even call newFNP chubby.

Balls.

Stirrup fail

It is preferable that when new patients come to the clinic, newFNP is (A) on time, (B) fashionable and (C) attentive. Thanks to her super cute new not-even-on-the-website-yet JCrew top, she was quite fashionable. Thanks to her caring nature, she was attentive. On time, however, remains an elusive trait for newFNP in her professional life -- ironic in that newFNP is pathologically early in every other aspect of her life.

So, all in all, two outta three. NewFNP will take it.

The appointment was moving along as smoothly as a newly threaded brow when newFNP attempted to extract the stirrup from its in the table hiding place. The stirrup gave newFNP a little resistance. Not to be deterred, newFNP gave it a little tug. Nothing. Determined to get the best of the stirrup, newFNP pulled at it with a little force.

And that is when the entire fucking stirrup came out of the table and into newFNP's hand. Imagine her surprise! She felt somewhat like the Statue of Liberty carrying her torch as she walked around the clinic, folded stirrup in hand, attempting to find her MA both to share with her the craziness of our clinic environment and to have her help newFNP replace the errant stirrup. Give newFNP your tired, your poor, huddled masses yearning to breathe free -- and to have their pap tests with intact examination tables.

NewFNP not so gently maneuvered the stirrup back into place and with the snap of broken plastic, shifted the stirrup, and subsequently the patient, into position and continued on with the exam.

Bienvenidos a nuestra clinica de la comunidad!, newFNP told her patient, who was kind enough to laugh.

It's not you, it's newFNP

NewFNP needs her head examined.

She gave notice at her research position and is going back to full-time community health. It's not as crazy as it sounds, she supposes. NewFNP has been spending a lot of time lately thinking about what kind of FNP she wants to be. (This is certainly something that her name brand nursing school did not teach.) High atop that list is that newFNP wants to be a community health practitioner. There certainly is a pride one feels when working in and for an underserved community.

NewFNP also wants to be a good teacher, a supportive listener, a knowledgeable medical practitioner, the type of person who says yes more often than she has in the past. This may be far more than newFNP can realistically achieve, but it is important to articulate and strive towards one's goals.

As such, starting early April, newFNP will be back in the thick of it. She hopes that she won't burn out so quickly this time around and that she'll have a lot of interesting tales to share.

That being said, she will miss working for her brilliant and hilarious research physician and her talented and creative research assistant. It is so hard to let people down.

Soda - two thumbs down

NewFNP was at the gym yesterday, reading the NYT whilst stationery biking. It's not her favorite workout, but yesterday was a day during which newFNP had to kill two birds with one stone. Thus, NYT and exercise together -- it's like church for newFNP.

The Week in Review section had a below-the-fold article about taxing soda written by Mark Bittman, whose bread recipes tend to be quite good, but whose sugar cookie recipe leaves something to be desired. Clearly, no manufacturer of any product is supportive of a tax on their wares, especially to the tune of 1 cent per ounce and when your product is being blamed as a component (and not an insignificant one) of the obesity epidemic. The industry quotes against such a tax were so transparently douchey, especially the one from one Mr. Derek Yach of PepsiCo who wondered if a tax on sugary food might make things worse by leading to an increased consumption of fat.

It should come as no surprise that newFNP supports such a tax. (She supports taxes on cigarettes as well. If marijuana were to become legalized, she would support a weed tax.) Soda has no nutritional benefits. Okay, okay, it has sugar. But overall, while tasting good, it is a piece of dump nutritionally speaking. When newFNP counsels newly diagnosed diabetics - something she does with alarming frequency - one of the first points she makes is that soda is a no-go, a killer, absolutely a never on the diabetic food pyramid. She believes that using the public health model that targeted cigarette consumption is a reasonable approach. After all, cigarette consumption has decreased significantly over the past few decades.

The article got newFNP thinking that there are other ways to decrease soda consumption. In newFNP's clinic, many, many of her patients receive food stamps. A quick trip to the national food stamp program website states quite clearly that the goal of the program is to help low-income families buy food that supports good health. Clearly, soda should not be on that list. Food stamps are a government program and the government already dictates some exclusions from the food eligibility list. For instance, alcohol is excluded, yet non-alcoholic mixers are not. Cigarettes are excluded. Flaxseed oil is excluded, yet cooking wine is okay. Hell, you can get bows and arrows with food stamps if you are lucky enough to live in Alaska!

If newFNP were asked to update the eligibility list, she would exclude all non-dairy sugary beverages. Good-bye Sunny D! You're not fooling anyone! See you later Orange Crush, you asshole. No one needs you! And no one would be about to do the Dew with food stamps.

But newFNP wouldn't stop there. No Hot Cheetos or any kind of chips. Knowing that food stamps and health are political issues, she might compromise and let Sun Chips or Baked Lays sneak by. No candy. No sugary cereals. No Lunchables. No Hostess, not even the delicious chocolate doughnuts that are so yummy on roadtrips home from snowboarding.

Yes, nutritious foods are expensive. Fresh fruits and veggies go bad if not eaten in a timely fashion. But frozen veggies don't. And if one's cart isn't piled high with a bunch of shit, the food stamps might go a little farther and actually work toward the program's goal of supporting healthy nutrition options in poor families.

And then move on to the schools. No soda dispensers and quit cutting recess and P.E. time. Seriously people - don't just have kids run the mile. Throw a kid a bone and help them to find a physical activity that they like, that they'll do for their entire lives. How about mat pilates P.E.? Hip hop dance P.E. class? Weight training. Not square dancing. Repeat - not square dancing.

Michelle Obama, if you're reading this, newFNP is here to help.