All posts by David Moseman

Vitamins are they Vital?

Do you feel like the person you would like to be? Do you eat like you know you should? Does your diet lack some important nutrient? Of course you feel the answer might be yes. So take vitamins and you will correct this flaw in your life.

That is why vitamin and mineral supplements are such a big business in the US. The average American spends over $100 a year on such products. In fact I took my vitamin this morning. But then, is that really necessary?

As I have aged my metabolism has slowed. If I eat like I did at twenty, I would really be obese.В  In fact I doubt I could avoid obesity if I eat as the dieticians recommend.В  I am probably missing some vitamins or minerals.

Yet, much of the vitamin and mineral supplement I take shows up in my very yellow urine. Yes urine is yellow, but not that yellow. If you doubt this stop your vitamins for a week, and then restart them. Your urine will go from pale yellow to a bright yellow.

Is the American diet deficient in some vitamins and minerals?

Yes, the American diet is deficient. That is why milk is fortified with Vitamin D and salt with Iodine.В  We debate about adding Calcium to orange juice.В  The limited usual dietary supply of these three elements cause health problems in many Americans.

The average person suspects they are suffering from some other vitamin or mineral related ills and takes supplements “just in case.”  These illnesses are not as dramatic as scurvy or rickets. Neither are the vitamins or minerals toxic.

There are many problems with this debate. The science lacks the rigor of most medical studies. The products fail the quality standards of prescription medications. The motivation to correct these flaws is lacking.

Faced with all the marketing and uncertainty what are we to do?

What is causing you trouble? Is it the worry or the lack of vitamins? That is hard to tell. Worry and stress are part of our lives. Worry leads to many illnesses. Those illnesses are common and have many causes. They also have many potential ways of prevention. One can’t do all that  might be done, without spending so much time worrying as to have the worry become the problem. So, relax. Listen to a trusted source.  Try to follow that source’s advice.  Being relaxed will often help you better than more or less vitamins or minerals would.

When you get a cold you will want to do something. If you think Vitamin C will help take some. Just be sure to drink plenty of water. The first problem with high dose vitamin C is the possibility of kidney stones. Lots of water will reduce that risk. It is really hard to get too much water, and with a cold mild dehydration is common.В  The second is possible rebound Scurvy when you stop. The Scurvy is transient and will be in the form of cracking at the corner of your lips. Now that your worry about whether or not to take Vitamin C is over, you will relax. Relaxing will help your body heal quicker.

As All Ways, Seek Joy,

Coach Dr. Dave

Ps. I welcome sharing and commenting.

The Hospice Cure?

People in hospice are living longer than expected, according to a recent Washington Post article.  Why is that?  It’s because for-profit hospice companies are recruiting less ill patients, or patients not really dying. In my experience as a geriatrician, many chronically ill people have lost most incentives to keep them alive.

Why might Hospice Cure a dying person?

In my experience as a geriatrician, I saw that seriously ill patients often became isolated. As we become ill we cut back on our social contacts. With a cold or flu that is certainly wise. However, after heart attack or stroke there is no reason to avoid social contact. Yes it might take more effort, but can yield benefits that make it worth it. Have you ever gone to a party feeling bad only to enjoy yourself and forget your ills?

As we get older our bodies stiffen up. We are aware of more aches and pains. Most people past 60 have some osteoarthritis but for some people it doesn’t cause problems.  Doctors can’t explain this. I have seen very deformed knees that did not ache and seemingly normal knees that were crippling.  It seems that some people with osteoarthritis have adapted very well and others not as well. Those who adapted live full lives, the others are shut up in their illnesses.

What are the benefits or remaining active?

The main benefit of an active life is the self-image of health. When I can shop and do other things by using a bus I don’t feel the loss of driving. When I get to the gym I am among others who are enjoying strengthening their bodies.

There is a large social benefit from getting out. I go to a book group regularly. The others bring their printed books. I recall what I heard while listening to the book and my thoughts about the book. In the time I have attended this group I have made several friends. If I had let the difficulty of transportation and low vision stop me, I would have missed out on the friendships.

Those who are shut in by illness are cut off from friends and family.В  When people recognize that they are dying, they enter hospice, which brings renewed support. The hospice teams are available in person and by phone. They have a network of supporters who will sit with a person and do chores.

Hospice changes the focus from Cure to Care. This was the biggest change I noted when I became a Geriatrician. No longer could I expect to cure an illness. In fact I often had to decide which symptom to address, recognizing that other illnesses would be left to run their courses.

Our society is very isolating. We no longer live in multigenerational groups. Families are separated by distance. Many divorced or widowed people live alone with personal contacts limited to what they can organize.В  If someone misses a group gathering, soon they will be forgotten.В  The news of their entry into hospice may bring renewed contacts.

Humans are social animals. Infants who don’t get physical contact with care givers soon die. Kids are always in contact with each other. They wrestle and roll together on the floor. Adults too need physical contact. Hugs are usually welcomed and enjoyed. Even a hand shake can enhance the experience of meeting a stranger. We can take stock of someone we meet by the strength of the handshake. Physical labor makes one’s hand strong and well-muscled. Confidence is communicated by willingness and taking the lead.

Thus the social supports and contacts Hospice Care provides might be just the Cure a person needs.

As All Ways, Seek Joy,

Coach Dr. Dave,

Author of the forthcoming book: “Recipes for Lemonade (thriving through disability): Dr. Dave

S Personal Recipe”

www.www.bsmk-med.com

Stop don’t make New Year’s Resolutions!

That’s right don’t make New Year’s Resolutions that you know you will break before the month is over. We all have things we want to change, but resolutions are not the way. We all know that a lot of resolutions are made, few of which have any chance of happening. If you really want to make a change then you will have to plot a revolution. So, if you want to make change plot a revolution.

Revolutions take a lot of work. They start simply enough with people realizing that a change needs to occur. We know there are changes we should make in our lives. How many of them are worth the effort to do the work to actually create a change in your life?  What would your life be like if that change happened?

We all want to control our weight. What would it take to control your weight? For me it is to change my compulsion to eat when food is around. Since New Years we have had a lot of extra food left over from a party New Year’s Eve. Every time I walk past the dining room table I grab something to nibble on. Tonight to slake my thirst I finished the egg nog; water would have been better. Thus to lose weight I must change the way I respond to the sight of food.

Changing the way I respond to food requires a lot of work. The simplest would be to create ways to avoid seeing the foods. I put the box of triscuits in the cabinet.  I could try reprograming my brain with affirmations. If that fails I could go to some exploration of the history of food in my life. Why does food, or at least certain foods, have such an attraction for me?

Which of the New Year’s Resolutions you made are you’re ready to make happen? Are you ready to make a Revolution in your life?  Do you need help plotting your New Year’s Revolution? A coach might be the person to help you plot and implement your revolution.

As All Ways, Seek Joy,

Coach Dr. Dave

The Old Gray Mare

Sometimes I feel like that, “Old Gray Mare”, not what I used to be.  I know I have done lots in my life, but I often think of myself as being about 30, never mind that my sons are both over that age.  Then I realize that there are many things I did not know when I was 30.

While some might try to put a positive spin on getting older by saying things like, “Older, but Wiser,” I am not always sure of the latter part. I just pitched an idea for disability coaching product, at a conference and it bombed. Only one or two people out of a room of about 250 liked it.  However, they were really enthusiastic.

Over these holidays we see many people we have not seen for some time. They too are not what they used to be. Children are bigger and more mature. Their parents too have changed. They seem more capable of doing their adult tasks. Some adults may be stepping aside and letting others do the work. Is the family gathering still hosted by the parents of the clan?  Then there are those who should have stepped aside and don’t. The cook that forgets to turn on the oven. The dropped food or forgotten name. These we try to overlook but can’t.

As we change is it for the better or worse? Perhaps, it just is.

As we pause to reflect in this hectic time of year may we find what really matters, our love for each other.

What are your thoughts on how people grow and change?

As Al Ways, Seek Joy,

Coach Dr. Dave

Heal Thanksgiving, family stress

Large Family gatherings like Thanksgiving are often very stressful times.  Can we make this a Thanksgiving where we don’t leave thankful that we don’t have to see them again for another year?

Yes, there are ways to make this Thanksgiving a time we will give thanks for. It will take some effort, but it can be worth it. There are three phases to Healing Thanksgiving family stress. Preparation, action, and recovery.

Prepare yourselves.  We gather together because these people have meant so much to us in the past. The stress arises as we relive and re-enact old ways that caused pain. Focusing upon the joy and love we shared will help. As we prepare for the gathering several things can be done.

First, get yourself in a positive frame of mind by playing music you enjoy.   Don’t listen to the news or talk radio. Play music that you want to dance to or sing along with. In the family car can you all join in?

Next recall what you have enjoyed about those you will see. Are there funny stories or tender moments you shared?  Was there a favorite bedtime’s story you used to share? What games did you play together? Were there vacations that you enjoyed together? Yes, there was some pain in these events but focus upon the fun and joy you shared.

What do you want to accomplish at the event. Thanksgiving is the start of a season where we exchange gifts. Can you make it a goal to listen to each person you meet and find the perfect gift that will bring that person joy? It may be a note or other personal act that will mean the most to many people. What will make each person you meet happy?

At the event there are things you can do.  While you wait for the organized meals and other activities you will have time to talk and catch up. What did they enjoy since you last met?  What joys do they look forward to? These enquiries will help you discover that perfect gift.

As people gather to eat, pause to share. Taking a moment for each person to express a reason they are thankful for each person there will help. Then also share a brief story of a good time you shared with each other. Smaller gatherings can be done one at a time. Larger groups may have to do musical chairs with several people talking and listening at the same time.

Between the meal and desert there is often a pause to let the food settle. Use this time to join in a pastime that you enjoyed in the past. Try to include that entire are there. Card games, puzzles, and charades are just a few examples of ways to gather and enjoy.

Others will have expectations that are not met. Don’t criticize others. If you feel offended, let them know you felt pain at their action. Ask that they act differently next time. If they criticize you, realize that they cared about what you did. They are risking the relationship to express their pain. Why did they care so much?  How else could their need been met? Is there a gift idea here?

Ass you part company find a way to express your joy at seeing each person again. And wish them well.

As you head home you are usually exhausted. Hopefully you are happy and content. Often we are frustrated by all the social correctness we had to perform.  Give yourself and others a time to relax and rest. Put soothing music on the radio (or CD player).  When you feel calmed let the conversation flow. Seek out the joys and frustrations. Why did certain things people did or said frustrate you? What did you need when you got frustrated?  Once people feel heard then you can try to end the ride exchanging what you look forward to with each person that will bring you BOTH Joy.

Thanksgiving is a time for giving Thanks; can we make this gathering an event to be Thankful for?

As All Ways, Seek Joy,

Coach, Dr. Dave

Author of the forthcoming book, “Recipes for Lemonade (Thrive thru Disability): Dr. Dave’s personal story”

www.InJOHealthandLIfeCoaching.com

PS. Share the Joy by sharing this blog with friends and family. Your ideas and comments are welcome on this blog site or the associated Facebook page.

Disability Monster, Are you like a tit on a Boar Hog?

Sometimes we all feel as useful as Tits on a Boar Hog. Boars are males of the pig family. Thus they have no need for tits, but they still have them. Nature put them there as part of the package of being a pig. Then, did nothing with them.  They are sort of unused potential.

I am sure there was a time when my wife would have wished I could breast feed our son.  When he woke up in the middle of the night, I could check on him. I could change a dirty diaper or adjust his blankets and cuddle him, but often he just wanted to breast feed.  My wife was specially equipped for that task.

There are other times I am sure my wife feels I am no more useful than those Tits on a Boar Hog.  After I stopped driving, that chore fell to her.  We inherited a cabin that is several hours drive from our home. It used to be one long day’s drive. We used to escape on Friday evening and spend the night a few hours into the drive.  The next day we would spell each other at the wheel. Now she gets it all.  I try to find ways to amuse her and make it less boring. She has at times invited a friend to share the driving.

Today’s near miss

Today we almost had to eat my disaster.  I like to cook. We like to eat pancakes together.  Usually she will mix that batter while I set the table, make the coffee and fry the bacon. A few weeks ago I found a recipe for Pumpkin Pancakes in the Christian Science Monitor.

I also like pumpkin pies. I have learned how to bake them from fresh pumpkin. I take the left over Jack o’ Lantern and cook it down. Then I scoop it out and blenderize it. We have pumpkin puree in the freezer and fridge.

Today, my wife slept in. I got impatient and after my third cup of coffee decided to make those pumpkin pancakes. Most of the ingredients I could easily identify. Sugar and Flour are obvious. When my wife awoke she found me rummaging through the spice cabinet.  Straining to read labels and sniffing likely candidates can get you only so far. My wife’s eyes to the rescue! Pepper pancakes anyone?

The pancakes turned out to be good and filling.

I have not always been so willing to let others help me. In fact I might have said, “Let me do it myself!” That attitude would drive a wedge between us. It might have given her ammunition to throw back at me.

Disability Monster what are you trying to do, heal a marriage that has at times been near the breaking point? I thought you were my enemy, stealing what I had. Now you are giving me something I had longed for but not realized.

Disability Monster, are your trying to be my friend?

 

Do you have a Disability Monster in your life? Do you know someone who has one? Feel free to comment below or share this with friends.

As All Ways, Seek Joy

Coach …Dr. Dave

Author of the forthcoming book, “Recipes for Lemonade (thriving through disability): Dr. Dave’s Personal Story”

www.www.bsmk-med.com

Learn more about how to Dance with a Disability Monster at Dancing with Monsters

PS. It you don’t want to miss any of these blogs, sign up to the right of this post. You will also get additional content in my newsletter announcing each blog.

Disability Monsters can steal our Paddles, leaving us “UP the Creek without a Paddle

When our disability Monster appears we can often find ourselves, “Up the Creek without a Paddle: We are still in the stream and canoe, but the Disability Monster has stolen our Paddle.  This is fine while the stream of our life is calm, but the stream is flowing. Where is it taking us?

Disability Monsters can be sneaky slowly robbing us of our abilities. For me this was my initial experience. Over the many years between when my glaucoma was diagnosed and when I finally had to make changes, it slowly stole my peripheral vision.  For this reason it made me legally blind before I knew it.

Then my Disability Monster got serious. I took a medication for another illness. An Illness that if I had not been cured might be now threatening my life. As I started the medication a cloud descended over my world. I found myself looking into a foggy world. It was my choice to risk it being permanent. I already had to learn to live as a blind man. Fortunately, I am “high functioning” and my disability Monster has left me able to do much as before.

Disability Monsters do not always choose times when we can focus only on them.  We need to do other things in life. Often the Disability Monster strikes by making it impossible to work. Yet, we have to find a way to pay our bills.  Families may need us to be there for them. They may not be able to meet our new needs. . Marriages end when one partner is forced to seek what a new mate can provide.  That leaves us “High and Dry, without that Paddle” or person.

We all know that the stream of life has rapids as well as calm stretches.  In those calm times we can dip our hands in the water and maneuver the canoe. When the rapids come we need a good paddle. Many such rapids lie in our stream of life. New bosses and coworkers, illness in the family, our kids moving out and many other events serve as rapids in our stream of life.  We know the stream’s course. We do not know how rough they will be. We do know we will need that paddle. How will we get safely through those rapids?

Realizing that Rapids lie ahead we panic

The rapids in our life’s stream have upset others. We see others try to negotiate these rapids and some have to swim for their lives! Without our trusted paddle how can we stay afloat?

When we have a “Life Partner” we are not alone in that canoe. Let’s hope their paddle is good. We will need to be sure that we are ready for the next rapid. We need to adjust so the stronger paddler and best paddle is in the stern. Changing positions in a canoe is tricky. Most do the over –under method. Literally one person passes under the other as they move from front to back and back to front. It is easy to tip the canoe and swamp it.  Can the former “bread winner” stay home and the homemaker find our bread? I took up the challenge of washing dishes and doing the laundry. However, my relationship with the kids had suffered over the years. Teenagers need to be able to rely upon their parents.  They are learning to paddle their canoes and negotiate the rapids of adolescence.

How else might we prepare for our next rapid?  Few people have experiences with persons with disabilities.  As a physician I had cared for a few blind persons. I had seen some people with white canes. However, I had not really KNOWN them. They have struggles unique to their disability.

At least those with physical disabilities are obviously challenged. . My white cane tells people why I can’t read signs. What about a person who is depressed, or has heart disease, or dementia?  How can we see the whole person?

What has been your experience when a Disability Monster steals your paddle, or the paddle of others?

In future blogs I will explore this more and then explore ways to keep our canoes afloat and moving with new paddles. If you know anyone who might like to share their journey or just join us, tell them about this blog.

As All Ways, Seek Joy,

Coach Dr. Dave

Author of the forthcoming book, “Recipes for Lemonade (thriving through Disability): Dr. Dave’s Personal Recipe”

www.www.bsmk-med.com

Disability Interventions: the workplace

The workplace is very stressful. I never realized how stressful my job had been until recently. There is always the fear of not performing as well as others expect. When you become aware that you might not continue to perform well, it is very stressful. It is also stressful when a friend or coworker is not performing as well as you had come to expect. This can be a very delicate topic whether the disability monster is yours or somebody else’s.

Office politics is always a difficult subject. You have friends. You have coworkers, and you have people who seem hostile. They all have demands upon them. These demands may be formal, as are those of your supervisor. Or they may be informal such as trying to meet the expectations of someone else. When you discover a disability monster lurking, Whom do you turn to? Who do you trust??

Close friends and confidants may have no experience with a disability. Many people are uneasy around people with obvious disabilities. I have several friends who use guide dogs to replace their eyesight. People often try to pet the dogs. If the dogs weren’t working this would be appropriate. However, it distracts the dog while it is working. It makes it difficult for the dog user to know what is going on. They prefer you ask before trying to pet their dog. If you are uncertain how a friend or other coworker would respond in similar situations, what would you do?

A disability intervention: with your disability monster

Most of us with a disability find that both the boss and coworkers are less supportive than we would like. When we finally choose to seek assistance we will need to approach somebody. One way to do this would be as follows:

First, connect with the person in a comfortable place. This might be over some coffee or lunch, where you are not likely to be distracted for a while. Then you’d be sure that person is not upset with something else by making some sort of small talk. Then with both of you being comfortable you can bring up the general issue of what you are struggling with. If you’re having trouble reading presentations that are projected on a screen, you might ask your friend, “is that difficult to see? “ If you’re having trouble hearing, you might ask, “Did you understand what was said? “

In other situations it might be reading reports, concentrating or being easily distracted. In these situations the assistance you would be seeking is more complicated. In my office I was the boss so I could be open with my staff and encouraged them to correct me when I misread something. I had also asked them to write with felt tip pens. These were adaptations that help me perform the job we all depended upon. Many people are not that fortunate. They work with people who don’t care or maybe are openly hostile.

When you’re working in a small organization it often become sort of a family. However many people work in large and impersonal organizations. Large corporations will have people in the human resources department whose job it is to help you perform your own job. I will talk more about how to work with the disability system in future blogs.

A disability intervention in someone else’s disability monster

If a friend or coworker seems to be having trouble this is also a problem. You might approach it much like I suggested when the disability monster was yours. Find a time and place where you are both comfortable. Let both of you settle in, and then bring up the general topic, before talking about a specific incident. You may want to make it clear that this was not the only time you saw the person struggling, and that you want to help. You want to keep that attitude of helpfulness front and center. Most people will try to deny a single incident. They may not be ready to admit it to themselves. There is the potential that they will leave angry. This will hurt. Remember denial and anger are the first steps in the process of dealing with any loss.

As your friend struggles to admit having a problem, you may become the focus of their anger. By reminding yourself that this person is struggling, and trying to care for that person while not taking it personally you can weather the storm. The storm can last for days or longer. You need to be comfortable and feel safe while it blows over. Having chosen to bring up such a difficult subject took courage; continue to have the courage to care.        You are being a real friend.

Please, have the courage to comment and share with those who might benefit from this.

As Always, Seek Joy,

Coach Dr. Dave,

Author of the forthcoming book, “recipes for lemonade (thriving through disability): Dr. Dave’s personal recipe”

www.www.bsmk-med.com

Disability interventions: coping with family and friends

Disability interventions are always difficult. Family and friends are well meaning, but our relationships with them are complex. We don’t want to scare them, but we need their help. How can we negotiate the changes in our abilities brought by the Disability Monster?

I recently took a friend to the hospital. He had all the signs and symptoms of an impending heart attack. He kept saying over and over again, “I don’t want to be a burden to anyone. “

As his friend and a physician I could not live with myself if anything happen to him. His not wanting to be a burden troubles me. I too had not wanted to ask for help as my Disability Monster reared up. As a man and a professional I was to be the leader, the strong one. Yet, there are times we must ask for help.

Friendships are easier to deal with than family relationships, especially with family members with whom we live. They depend on us and us upon them. We have many roles in the family. Others depend upon us to perform those roles. We expect them to perform their roles too. When a spouse cannot pick up the kids after school, it puts that burden on the one who can. Occasional inabilities to perform are roles are expected. We all get ill or have unexpected interruptions and demands.

When one member of a family cannot be depended upon things get complicated. Much has been written about the family dynamics around an alcoholic. Other behaviors can also create similar situations. A physical or mental disability that requires others to provide some sort of special care certainly causes changes in the family.

We often experience this when a family member gets ill. If an elderly family member has a stroke others will come to assist. Then pain has to be dealt with. In the United States our healthcare system can provide some support. When intensive personal care is needed nursing homes are often used. They are impersonal and most people prefer to be at home. Then greater demands are made on the family. Old squabbles come back.

At some time many of us have cared for an ill family member; we know what those demands are. We don’t want to place long-term demands on anyone. When someone had a cold or flu we trusted that they would get better. We could look forward to a return to normal. With a long-term illness we can’t expect the old normal. We don’t like the current situation, and want the burdens to lessen quickly.

When we are the ones making those demands we have many feelings. Like my friend we might feel ashamed and a burden. We can no longer feel proud of whom we are. We often fear abandonment. We know of families who could not cope with someone’s sudden illness. Will this happen to us?

Since we are now the ones who are dependent, we must depend upon the reactions of others. If they cannot meet our new needs how will we get them met? Our self-confidence is being tested. Do we really want to go back and create a totally new life? We know some changes are now necessary.

Do you share your struggles? Do you share your fears? If you do so what will happen? These and other questions swirl in our minds.

In coming blogs I will share some of my experiences and insights. I would love to hear other stories as you or others confronted their disability monster in the context of their family and friends.

As All Ways, Seek Joy,

Coach Dr. Dave

Author of the forthcoming book, “recipes for lemonade (thriving through disability): Dr. Dave’s personal recipe”

WWw.www.bsmk-med.com

Disability interventions, how can you confront a disabled person?

When we intervene in the lives of others, we do so because we care. We love. How can we communicate that care and love?  We intervene in the lives of others daily, but these are in usual social situations like holding a door. When we note that someone is becoming disabled it is harder.

The idea of a formal intervention became popular several years ago with people who had addictions. Since then, the popular media has applied the idea to other situations. With disabilities interventions often occur when parents intervene to get assistance for a child. I would like to talk about intervening in the affairs of another adult whose abilities are failing.

It is normal to lose some abilities as we age. Most of us realize that we can’t play sports like we used to. That is not a problem unless our identity exists around that. Most adults see decreased abilities as a problem of old age. However, life and diseases often make that a reality before we think we are old. 

When someone we care about struggles to do things, we are tempted to intervene. When someone struggles to carry something, it is natural to offer to help. However, other situations arise that aren’t so simple. How can we intervene in the poor driving of another?

Driving is just one of many situations where we might feel obliged to intervene. Other situations can arise at work or in usual activities.  In such situations we expect the person to make major changes in the way they do things. Intervene in Things such as stopping driving. These changes will not be popular.

How might we intervene without becoming unpopular?

The problem of confronting someone with bad news is hard. We fear becoming the focus of any anger associated with the message. We easily get trapped by such anger. Communication experts suggest that one start such conversations by saying such things as, “When I see you do such and such, I get scared that something bad will happen,” and then making a request for the change we would like to see.

By starting this way we first express our need. That means we have opened ourselves and expressed our pain. That usually elicits a desire in others to help.  Such desire can easily get lost when we start with the request. We have not exposed our personal pain. Most people don’t want to hurt others, so they hesitate to get angry at a hurting person.  The conversation now revolves around the problem and not feelings.

Such approaches can be used in the workplace as well.  When dealing with a friend or family member it is easier. In the workplace legal and economic consequences exist. In either situation resources exist. I will talk about options when dealing with a disability in future blogs.  Today, how have you confronted someone else’s disability? Do you have experiences or other ideas?

I appreciate comments and your sharing this blog with others.

As All Ways, Seek Joy,

Coach Dr. Dave,

Author of the forthcoming book, “Recipes for Lemonade (Thriving through Disability): Dr. Dave’s Personal Recipe”

www.www.bsmk-med.com