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Pills

Live Wellthy — Fri, 24 May 2013 12:15:00 GMT

May 24, 2013

Why do we trust some pills and not others? The answer often eludes me. Patient “A” is quick to remind me that he does not want to take any medications. His chart reveals that he is taking a multivitamin, Echinacea, Benadryl, saw palmetto, and Sam-E. Aren’t they pills?

According to the dictionary, a medication is defined as, “a drug used to treat an illness.” My patient is treating his depression with Sam-E and his prostate with saw palmetto, despite the fact that he does not want to take “a medication.” He is treating his poor dietary habits with multivitamins. He is taking Echinacea on a daily basis to ward off colds and isn’t aware of the fact that Echinacea is a ragweed, something he is highly allergic to. He is taking Benadryl to treat the side effects of his Echinacea. For a man who does not want to take any medications, he is heavily medicated with over the counter garbage.

Why do we trust some pills and not others? The F.D.A. regulates prescription medications. The government requires strict adherence to F.D.A. standards requiring certification of a host of factors. First and foremost, a prescription medication must be proven to be effective and safe. Secondly, studies must be done to identify potential side effects, contraindications, and interactions with other medications. Third and foremost, all company literature or advertisements about a medication must show a fair balance of information: if you mention a positive, you must mention a negative.

Over the counter neutriceuticals are not regulated. As long as they make no claim of treating any disease, they can say anything they want about themselves. They are not required to show effectiveness, side effects, drug interactions nor contraindications because, officially, they don’t treat anything! According to one internet site, Sam-e “promotes a healthy mood” a “revitalized mood”. The site goes on to state, “These statements have not been evaluated by the Food and Drug Administration.” With regard to side effects, the site states, “Generally speaking, SAM-e supplements have been shown to be very safe, with no known side effects.” What does “generally speaking” mean? What are the possible side effects? The site dodges this question.

The unknowing public is caught in the middle. On the one hand, the doctor tells his patient to take a medication for his depression that comes with a three page list of possible side effects; and, on the other, the internet tells him that Sam-e will “promote a healthy mood” and “generally speaking” is very safe. It’s no wonder the public doesn’t want to take medication but is willing to take lots of unproven, under studied, non-regulated pills and potions.

Why do people claim that their over-the-counter pills work so well? Many neutriceuticals actually are medications with active ingredients. Many simply deliver a placebo effect. I like placebos; they are safe and, in some studies, show effects, both positive and negative, in a large percentage of people. I worry about neutriceuticals that have active ingredients. How will they react with my medications? What are the unknown possible side effects that I should be monitoring? How are they processed by the body? What do I do if my patient overdoses on neutriceuticals? Will my patient admit to taking them?

In the case of my patient on Echinacea, he is actually making himself sick. He is allergic to the product he is taking and doesn’t know it! In addition, Echinacea, when taken on a daily basis, may damage the immune system. Many studies have found that Echinacea is ineffective at preventing or treating the common cold, yet it is marketed heavily (http://nccam.nih.gov/health/echinacea/) for the treatment of a variety of symptoms.

Why do we trust some pills and not others? The answer is easy; it is all in the marketing! Snake oil salesmen have been successful throughout history. Be skeptical of products that make fantastic claims. Look for the following disclaimer, “These statements have not been evaluated by the Food and Drug Administration.” Essentially, the merchandiser is telling you that his product is unproven and not approved to prevent or treat any disease state. While I am not a fan of government intervention, someone has to independently assure the effectiveness, safety, and quality of anything you ingest. That assurance cannot come from the company that is selling it to you. The F.D.A. needs to step in and regulate the neutriceutical industry the same as pharmaceutical industry. Comparing apples to apples would certainly make deciding what is best for you a lot easier. Forcing the neutriceutical companies to perform under the same standards as the pharmaceutical companies would result in the elimination of false claims and the unmasking of the snake oil salesmen who prey on the unsuspecting.

Oops

Live Wellthy — Thu, 23 May 2013 12:25:00 GMT

May 23, 2013

Oops, I screwed up. I’ve been in a pretty great mood since returning from Italy. Coming back to the office after a 2 week absence reminded me how much I love what I do. Then I read an article entitled America is at war with its doctors, and patients are the losers, by Mona Kotecha, M.D. The article started to sour my mood. The author’s discussion about doctors “submitting to endless asinine regulatory hurdles that do not improve patient care” prompted me to look closer at how many hurdles I have to jump on a daily basis in order to care for you.

Focusing on the “endless asinine” hurdles I face daily was where I screwed up. It was an eye opener. Yesterday, I was busy at work checking off regulatory boxes at the end of a typical Medicare visit. My patient’s son interrupted me for the third time in an attempt to remind me about his father’s condition. Yes, it was the third time he reminded me; and, for the third time, I acknowledge his concern and advised him, again, of our game plan. He obviously thought I was ignoring him, not understanding the importance of PQRI!

There are several problems with the above interaction. Number one was that to address his needs during the current visit would have required me to spend more than an hour with him, obtain stat labs and x-rays that weren’t available, and jump through a whole series of new hurdles. That being said, the real problem was that I should have spent the additional time working with my patient’s son’s concerns, not sending Medicare useless data, sending “educational” material to the patient’s portal to meet “meaningful use” criteria and justifying my charges so that, if I’m ever audited, I will not be accused of Medicare fraud.

Further, because I was paying attention to the number of hurdles I had to complete before sending my patient home, I was frustrated and short with my patient’s son. I love the fact that my patient has a caring and engaged son and want to encourage, not discourage, his questions.

I really screwed up! So, as of now, I am going to ignore the “asinine regulatory hurdles” and concentrate on great patient care. I will do what I can to keep Uncle Sam off my back but will not let the endless crap heaped on me from Washington and the insurers sour my love for my profession. And, if I can’t keep my head above water and practice medicine the old fashioned way (caring for one individual at a time), I’ll have to drop out of Medicare and insurance contracts and see those patients who value my services and the freedom that comes with paying for your own care.

So, when you see me tomorrow, I’ll be smiling and caring and I will attend to your needs. Unfortunately, my staff won’t. They’ll be trying to jump hurdles and keep me out of regulatory purgatory!

Hurdles

Live Wellthy — Wed, 22 May 2013 12:12:00 GMT

May 22, 2013

Yesterday’s article mentioned “endless asinine regulatory hurdles.” Today I felt like I was going to drown in the morass of regulatory policies created by Obamacare and “meaningful use.” Today, my schedule was heavily populated by Medicare patients and Medicare requires an endless flow of data be sent to them following every visit.

Let me explain. Medicare requires that I chose a minimum of 8 quality measures from their list of many. I am to meet or exceed Medicare’s requirement or be penalized financially. Sounds good, doesn’t it. After all, everyone wants and deserves a “quality” physician, don’t they? Here’s the rub, the quality measures have nothing to do with the quality of care the physician delivers. Instead, they center on how good the physician and his/her computer are at capturing the data points required by Medicare.

The entire process is time consuming, expensive and frustrating! To make matters worse, I have never seen a study that showed any improvement in medical care as a result of the “endless asinine regulatory hurdles.” In fact, I have seen articles that purport to show that the new regulatory policies have increased the cost of care and, in my experience, steal valuable time with the doc away from his/her patients.

Unfortunately, Medicare does not pay me to teach you about the disease that is threatening you. Instead, it requires that I either print (so much for paperless) canned articles for you or send them to your portal for your later enjoyment. I am good at following rules so many of you will see a steady stream of articles popping up in your portal box.

Personally, I would rather spend the 5 minutes I waste every visit documenting my “quality” measures, spending quality time with you. Regrettably, I can’t. It’s the price you and I pay for accepting Medicare.

War

Live Wellthy — Tue, 21 May 2013 12:26:00 GMT

May 21, 2013

America is at war with its doctors, and patients are the losers, by Mona Kotecha, M.D., is a must read. For those of you who do not have time to read this depressing piece, I will summarize:

There was a time when “they (physicians) were respected, paid fairly, and able to practice medicine autonomously at the highest and most uncompromising level”

Doctors are defeated and fleeing the clinical care

Doctors lost three critical battles which are:

“The first was submitting to endless asinine regulatory hurdles that do not improve patient care. Insurance companies, administrators, licensing and accreditation bodies, and government agencies, to name a few, render them crippled and barely able to focus on the practice of medicine.”

“The second defeat was internalizing a cultural assault on their fundamental spirits of risk-taking, innovation, and professional autonomy. Physicians do dangerous, complex work that requires making tough judgement calls that don’t always follow simple rules and pathways. But they feel stifled from doing so now.”

“The third was accepting a gross devaluation of the economic value of their work. Minimal pay from insurers – particularly Medicare and Medicaid – for life-or-death work is the new norm.”

Yes, physicians have lost the three critical battles listed above and many others. So, why read the article. Knowing what’s going on in the medical world is crucial in navigating your way through future medical problems. Understanding the plight of your doctor is critical in helping him care for you.

As for me, I don’t dream of leaving the world of clinical medicine but do dream of shooting the bird at Medicare and the insurers of America and establishing a practice free from outside interference. I will continue to jump through the hoops and “asinine regulatory hurdles” as long as I can and will ask you, the patient, to understand when I can’t. The future of medicine will resemble a relay race and I will need my patients to learn when and how to take the baton and clear some of the hurdles themselves.

Years ago, I, like so many others, accepted a “gross devaluation of the economic value” of my work. That process is ongoing and, at some point, has to stop. Many physicians are selling their practices to large corporations in order to stay financially viable. I believe that working for my patient instead of an employer is a crucial tenet of medicine and will not sell out to corporate America. Novel approaches designed to keep my practice independent for the next 20 years are therefore essential. Concierge medicine allows for a resetting of my “valuation” by those who see the benefits of a new approach to their medical care and is one such approach.

I opened my doors 29 years ago with a “We’re here to serve you when you need us most approach,” shunning appointments as they got in the way of access to my care. I continue to serve at your command and will keep my “No appointment necessary” practice philosophy as long as I can. The next few years will certainly be interesting!

Do everything you can to preserve your health and Wellth!

Nag

Live Wellthy — Mon, 20 May 2013 12:22:00 GMT

May 20, 2013

Recently, I read an article on Dr Robbins’ blog entitled “How to be a Better-Health Nag”. I have written about the health benefits of nagging (harping) wives in the past and am not surprised to find that having loved ones nagging or just encouraging you to live a healthy lifestyle pays off.

According to Dr. Robbins’ blog, “Psychotherapist Tina Tessina of Long Beach, California suggests taking the weight loss issue off the table, and instead focus on health, longevity and fun. She says, “If you cook healthy food, invite your partner to take walks with you and generally live a healthier lifestyle, that’s the best way to influence your partner.”

I particularly like her use of the word “invite” and I invite each and every one of my readers to start eating healthier, exercising and enjoying life! If you are the healthiest member of the family, inviting your loved ones to take a walk with you creates a win/win situation. If you are the one who follows a healthy diet, then assume the responsibility for shopping and cooking and invite your family to the dinner table for a scrumptious, healthy meal. An open invitation to a healthier and happier life is a fantastic gift if you can get the recipient to accept it.

If it takes nagging to save a loved one’s life, then by all means nag him/her. However, Tina Tessina’s suggestion in a much more inviting approach probably will lead to greater success and a more enjoyable outcome.

Starting today, I will invite each and every one of the patients I see to join me in the quest for good health. Unfortunately, thirty years of practicing medicine leads me to believe that I will still have to be a nag!

David and Goliath

Live Wellthy — Sun, 19 May 2013 12:01:00 GMT

May 19, 2013

As many of you know, I read “In My Humble Opinion,” by Dr. Jordan Grumet. Dr. Grumet has started on a new journey in an attempt to rid himself of the oppressive rule of Medicare and the insurers of America. As expected, some will take issue with Dr. Grumet’s new approach and his article yesterday addressed one such individual’s objections.

In response to the writer’s objection, Dr. Grumet wrote, “But the problem is, I can't protect my patients from the ridiculous, pervasive stupidity of Medicare and our modern day insurance Goliath.

I can keep bending, and giving, and finding ways to work around the vicious beast. Or, I can choose to step out of the lion's den. I will not be an enabler of this broken system.

Change will only come when doctors and patients alike are willing to stand up and say enough is enough.”

I don’t know any physicians who are happy with the current restraints imposed on our practices by the government and the insurers. I, too, would love to rid myself of Medicare, the insurers and the electronic medical record and return to the days when I could sit, face to face, with my patients and care for their needs. I dream of following Dr. Grumet into a brave new world of real fee-for-service medical care where the patient and I could make healthcare decisions based on his/her needs rather than those of the third party payer who has enslaved us all.

Alas, I fear I am too old to make such a daring change as evidenced by my use of “alas” in this sentence. I applaud my younger colleague and wish him well and dream of the day when I can “choose to step out of the lion’s den.”

Imaging can be helpful

Live Wellthy — Sat, 18 May 2013 13:50:15 GMT

May 18, 2013

I just saw version 2.0 of one of my long term patients. She thanked me for introducing her to my “Chicken Step” approach and stated that over the past few years, she has made small changes in everything she eats and does that have made significant differences in her health.

I remarked that she looked great and should be very proud of herself. Small changes are easy to do and add up to permanent weight loss and Wellth. Version 2.0 shared one of the secrets to her remarkable success with me. I want to share that secret with you.

Version 2.0 told me that she used “imaging” in several ways. First, she asked herself what she wanted to look like next year and in the years to come. She was not happy with her current image and, as she aged, she became even more disenchanted. By imaging what she would look like in 1 or 2 years, she was able to imagine a trimmer healthier self and then had a goal to work for.

Her second “imaging” technique helped realize how important losing as little as 5 pounds could be. When she lost 5 pounds, she would go to the grocery store and put 5 pounds of butter in her cart. Five pounds of butter is a lot of fat and looking at it in her cart helped her understand just how important it was to continue to shed her weight. Putting the butter back in the cooler felt good.

Start getting healthier now by imagining what you would like to look like next year. Shed five pounds of fat and then go to the grocery and pick up five pounds of fat. Hold the fat in your hand, feeling its weight. Look at the glistening yellow color and imagine it building up in your blood vessels and surrounding your heart then put it back in the case. Be proud of yourself as you “Chicken Step” your way to health and Wellth!

The child within

Live Wellthy — Fri, 17 May 2013 12:32:00 GMT

May 17, 2013

I want to be your friend. I really do! I want to be liked, admired and appreciated. I want to be uplifting and optimistic. I want to smile and laugh with you. Unfortunately, there are times when I can’t. Yesterday’s article described how bad things can get.

There are times when my job gets really tough. Those times revolve around telling you things you don’t want to hear. There are those times when I can’t be uplifting nor optimistic. Being a pessimist and delivering bad news means I can’t smile and laugh with you. Today was one of those days.

Bear with me for a moment as I digress. One of my favorite things to see in an adult patient is a glimpse of the child in the man (almost always a masculine thing) sitting in front of me. Yes, in front of me is a full grown, successful man and on his face is a childish grin (the kind you see when someone is caught with his hand in the cookie jar). Adults who maintain some of their childishness in them are the most fun to be around. They are also the hardest to treat.

The adult man knows his diabetes is serious. The child within ignores it, passing it off as nothing. A childish grin and a promise not to put his hand back into the cookie jar is the child’s solution to all that ails the world. The promise to do better, served up with all the sincerity he can muster suffices to buy him 3 more months to “get his act together,” several times over. Unfortunately, his promise is not kept and his diabetes worsens.

Today is the day I have to be all doc, serious and pessimistic. Today is the day I have to dish out the facts about uncontrolled diabetes and face the fact that my patient’s inner child is hellbent on killing the adult he lives within. I am in a mortal fight to save my adult patient and to win; I have to eliminate the child. Success comes at a high cost.

My patient’s childish grin is extinguished and replaced by a frown. Today, I am no longer his friend and he is not happy with me. It’s like déjà vu! Unfortunately, every time I have to play the heavy, part of my inner child dies. I go home exhausted, not from the long hours but instead from the heaviness of heart that occurs when that childish grin is extinguished. Thus is the burden of being a family doc.

It's a pity

Live Wellthy — Thu, 16 May 2013 12:35:00 GMT

May 16, 2013

It’s a pity! I’ve known her for 20 years. She’s always been an independent soul and not the easiest to get along with but that comes with the territory. I’m her doc and she’s my patient and we’ve been together a long time.

She and I have gotten older. I’m in my early sixties, she in her mid eighties. As my patients get older, healthcare decisions get harder. She’s unhappy with me! I know it’s time for her to use a walker, she’s much to vane and “young” for such nonsense. She wouldn’t get caught dead using a walker. I explained that not using the walker means possibly falling in public places. She accused me of using scare tactics.

Unfortunately, she has also reached the age where living alone in her own home is dangerous. Her vision, hearing and ability to walk are being assaulted by her age. Now, she’s really upset with me. Of course she can live alone safely; she has for many years. “I don’t know why you tell me theses things. You know they upset me.”

I apologize for doing my job. I tell her I am “caring” for her and my thirty years of experience tells me she is at risk. I ask for permission to talk to her family and get an emphatic “NO! It’s my life and I have the right to do as I see fit.” Her refusal brings forth the last piece of the puzzle. I think her memory is going. She seems to forget things she never forgot before. Her speech pattern is unusual.

“My memory is just fine!” I explain that sometimes, when people’s memories start slipping, they aren’t aware of what they have forgotten. I ask to have a family conference. I’m informed that I’m not a very good doc and she is going to find a new doc. It’s a pity!

It’s a pity because I’m a good doc and know her well. It’s a pity because I care about her and for her. It’s truly a pity because she needs help and is refusing it. Yes, she has a right to refuse care. Yes, she has a right to privacy; and, yes, she will probably find a new doc who doesn’t know her and may not pick up on the things I see in her.

It’s a pity! If you see yourself in this article, it is because her behavior is the rule rather than the exception. The person noted above is a fabrication of many similar cases, all too true and sad.

If you see your parents in this article, get involved. Invite yourself to their doctor’s appointment. You have a better chance at breaking through their stubborn pride than I do. You also have a wealth of knowledge that can assist me in caring for them.

It’s a pity! I’m a family doc and often am denied access to the family! Help me gain access. Share this article with your friends, family and co-workers!

Prayer

Live Wellthy — Wed, 15 May 2013 12:19:00 GMT

May 14, 2013

One of my more sagely patients remarked today that whenever he is asked to donate to a “worthy” cause, he asks what percent of his donation goes to administrative costs. He followed that comment by stating that his favorite means of giving was to say a prayer for those in need. “Prayers have no administrative cost” and can do great good.

While today was obscenely busy, taking a few minutes to listen to my patient’s viewpoint on the healing power of prayer and prayer trees was well worthwhile. A few years ago, I received a subscription to an alternative care journal. In a scholarly way, the journal would print research articles designed to prove the power of prayer. I always thought that investing money in proving the obvious was foolhardy.

I was once blessed with two elder patients who ran a local prayer tree. I would have sworn that their prayer tree had a direct line to G-d’s ear as I witnessed miraculous changes in patients’ health once placed on prayer list. I know the skeptics in my audience will challenge this concept, but they sure made a believer out of me.

I actually discussed the formation of a prayer tree with my Rabbi only to find out that my own religion had its own prayer tree and I was simply ignorant, having daydreamed through Sunday school.

The moral of the story is that prayer is a powerful way of giving to those in need and that 100% of what you give goes to the person or group you are giving it to. So, whatever your religion, join a prayer tree and give prayers to those in need of good health.

Denial

Live Wellthy — Tue, 14 May 2013 12:30:00 GMT

May 13, 2013

Doc – “So Jack, how are you doing?”

Jack – “I’m fine, doc!”

Jack’s wife (JW) – “Doc, he’s not fine. He’s always complaining about his stomach.”

Doc – “Jack, tell me about your stomach problems.”

Jack – “I don’t have any stomach problems. She worries about every little thing.”

JW – “Every time he eats something fat, he gets stomach pain and almost throws up. He eats something fat every day.”

Unfortunately, the above conversation occurs daily in my practice. Men are dragged in by their well meaning wives and resist telling me anything about themselves. With patients and careful prying into Jack’s history, I was able to diagnose the gallbladder disease that was causing Jack’s recurrent pain.

As they say in the medical world, de-Nile is a river in Egypt and a very dangerous state of mind. Denial kills people every day! Denial is universal, affecting both men and women. I once saw a poster depicting a harpy (bird of prey) sitting on a man’s chest. The caption read “Harpening wives save lives.” I wish I had bought it. It was perfect.

Spouses who drag their loved ones into the office to be seen help me break through the “denial” that blinds them to the truth. If your loved one is in denial, do whatever is necessary to awaken him/her. Don’t let them die from denial!

My favorites:

“It’s just heartburn!” He had quadruple bypass hours later.

“I nicked myself with the saw.” Removing the bandage led to arterial blood bouncing off the ceiling.

“I’ve been tired for weeks.” Patient is ashen white. He is missing ¾ of his blood volume. He “just” had indigestion for the last 6 months.

And, the all time best, “I’m not pregnant,” proclaimed the young woman as I delivered her baby. Her parents had noticed that she was getting a little “chubby.”

A unique view of the new world

Live Wellthy — Mon, 13 May 2013 12:18:00 GMT

May 11, 2013

All I can say is “WOW!!” If you think I’m paranoid or cynical about the future of my beloved profession, wait until you read “Health delivery models that require a less costly skill mix,” by Margalit Gur-Arie.

While the article is a little on the long side, I believe it to be quite accurate and very scary. Welcome to the future of healthcare. Now, if I can survive in the new world of medicine for 20 more years then I can retire with a smile on my face.

Loss

Live Wellthy — Sun, 12 May 2013 12:39:00 GMT

May 12, 2013

Next month I will attend my 40^th college reunion at The University of Virginia. Most of the time, I feel too young to be attending a 40^th anything, but not today. Today, I received notice that one of my friends and frat brothers died from a heart attack at the age of 60.

I have often thought about calling Dave but never took the time to do so. Today, I can only wonder if contacting my old friend might have made a difference in his life as well as mine. If Dave knew about my blog, would reading Saturday’s article gotten him into his doc’s office before his heart failed him? I’ll never know.

Recently, I have been focusing my efforts on “priorities,” asking my patients and readers to set their health as their number one priority. Dave’s passing reminds me that there is no better time than today to call an old friend, a family member or loved one and renew the bonds that brought you together in the first place.

If tomorrow really doesn’t exist, then we need to make the most of today. We need to make memories that will last a lifetime. While it is too late to call Dave, I will always have my memories of road trips and Crazy Eights and Dave will live with me in those memories.

Today, I feel very old! Today, I’m going to pick up the phone and renew old friendships, remember times past and forge new memories. I suggest you do the same. Life is full of enough regrets. Don’t put off until tomorrow what you can do today.

By the way, how is your heart? Seen the doc lately? Prioritize your health and live Wellthy!

How healthy is your heart?

Live Wellthy — Sat, 11 May 2013 12:02:00 GMT

May 11, 2013

As Mother’s Day approaches, I can’ think of a better article to write than one about the heart. Since I’m focusing on heart health, I thought I would share a little info with you. In medical circles, it is a well known fact that, if you have diabetes, you have heart disease. What is not as well known is that pre-diabetes is also associated with heart disease.

In Prediabetes Signals CAD Risk, by Ed Susman, Contributing Writer, MedPage Today, the author states, “about 36% of patients with impaired fasting glucose had coronary artery disease compared with 42% of patients with diabetes and 21% of patients with normal blood glucose said Harith Al-Shuwaykh, MD, a resident in internal medicine at Crittenton Hospital Medical Center, Wayne State University, Detroit.”

The author also states, “Likewise 37% of patients with impaired fasting glucose had hyperlipidemia compared with 38% of patients with diabetes and 24% of patients with normal blood glucose.”

The author warns, “there were limitations to his study, particularly the retrospective design and the lack of a control group.” Regardless of the limitations, paying attention to your heart and your risk of pre-diabetes is wise!

So, why should you care? You don’t have pre-diabetes, do you? Some authorities estimate that one in three adults aged twenty years and older have pre-diabetes. That’s pretty scary, isn’t it? It should be. The prevalence of diabetes is at epidemic proportions and growing rapidly.

What can you do to protect yourself? First and foremost is adopting a healthy lifestyle based on a diabetic diet and exercise. In other words, get Wellthy! Next, see your doc for an exam and fasting laboratory testing. There are new tests soon to be available that will help delineate your risk of diabetes.

As always, read about health, diabetes, and the effects of diet. Knowledge is power when it comes to health; and, by the way, don’t diet. Diets are unnatural acts that lead to temporary weight loss and then weight gain. Instead, slowly improve your own diet. The life you save may be your own!

My kind of fun!

Live Wellthy — Fri, 10 May 2013 12:05:00 GMT

May 10, 2013

I just saw a truly Wellthy patient. It was fun! She came in for her yearly exam. She had no complaints, no problems. She was happy, exercising, eating healthy and volunteering her time and her blood (Life Source) in order to help others.

So, why did she come in for a physical? She came in because she cherishes her health and Wellth! People who get it are unfortunately few and far apart. Ah yes, I forgot to tell you what “it” is!

Without your health, everything else pales. No amount of money can make a truly sick person happy or Wellthy. Life offers many choices forcing us to prioritize one over another. Prioritize your health over all others. Work at being happy! Happiness is a choice. We’ve all heard it before. “When life gives you lemons, make lemonade.” When life gives you lemons, what do you do?

It’s fun working with a healthy and Wellthy individual. There’s no bad news to give. There are no lectures on changing your ways. There’s none of the usual doc stuff like stop eating ice cream, stop smoking or let’s increase your medication and hope it doesn’t make you sick!

Help me be happy by shouldering your half of the partnership. Work hard to maintain and improve your health. The life you save may be your own and the doc you make smile will be me!

A milestone

Live Wellthy — Thu, 09 May 2013 12:03:00 GMT

May 9, 2013

Since the inception of this blog, I have learned the power of social media firsthand. When I started writing articles for my patients several years ago, I never realized how many people would visit my site nor could I possibly imagine how many would stay and read my articles.

I have just published my 900^th article. My site has had 6,630,885 visitors and those visitors have read 3,120,986 articles. I couldn’t be happier. Livewellthy’s primary goal is to educate and empower my patients. It has exceeded my wildest dreams.

I look forward to many more years of serving your needs! Feel free to share my articles with your friends and family. At the bottom of every article is a share button that will allow you to repost my articles on many of social media’s most popular sites. Also, there is a comment section that will allow you to share your ideas with others.

Be healthy. Live Wellthy!

Vertically integrated machine

Live Wellthy — Wed, 08 May 2013 12:28:00 GMT

May 8, 2013

In The power of the pen?, Dr. Jordan Grumet states, “As Obamacare pushes more and more physicians out of decision making positions and herds them into large academic and nonacademic hospital systems, one would expect one thing and one thing only: spiraling costs. Business exists in order to make money. Businessman go to school to learn about profit. Physicians who leave clinical practice to become administrators aspire to similar ends.

Physicians are the only ones who have made a covenant. We are the only ones who have taken an oath. We are smart, well educated, and innovative. And we have to look each and every patient in the eye before making decisions.”

The immediate future of medicine has been ordained by Obamacare. Dr. Grumet is right. The vertically integrated machine that has been created by the President and approved by the legislature will certainly increase the cost of care and, not surprisingly, fail to improve that care.

Would it shock you if I told you that having high-end health insurance does not improve your overall health? There are studies that show that your health has no relationship to access to good health insurance. While the President sold the nation on the fact that providing health insurance to the uninsured would save tens of thousands of lives, research does not support his assertions.

What health insurance does is prevent medical bankruptcy. In What health insurance doesn’t do, Ross Douthat makes that point perfectly clear. So, why create a multiple large vertically integrated and costly machine in the name of healthcare?

I think the President’s motives are quite clear. The first step in controlling the 660,000 physicians in the US is to corral them into massive hospital-run ACOs (integrated machines) by making the private practice of medicine unfeasible. Obamacare will pay the ACO and the ACO will pay its employees. Ultimately, as payer, the government will then be able to coalesce the smaller machines into larger ones and the larger ones into even more grandiose structures. The end result, government controlled Universal Healthcare, will have been very costly and, I think, dangerous! Doctors will be public servants, hospitals will run like the Secretary of State’s offices and patients will get in line, take a number and fill out forms 6693625a and 6693625b to make an appointment to be examined by a technician next month.

Welcome to the future of medicine!

The famous Z-pak

Live Wellthy — Tue, 07 May 2013 12:30:00 GMT

May 7, 2013

In Azithromycin and long QT syndrome: Facts from a cardiologist, Dr. John Mandrola addresses the newest controversy over the safety of azithromycin (Z-pak). Dr. Mandrola does an excellent job of analyzing the controversial study that led to the recent FDA warning regarding the cardiac risk of azithromycin. While I found his analysis fascinating, I’m a medical geek and appreciate the ins and outs of research. For those of you who are not scientifically inclined, I want to share a few of the good doc’s most important statements.

First and foremost, Dr Mandola sums everything up with:

“I don’t want to sound too loud an alarm on azithromycin. It’s not a bad drug. Drugs are not bad or good. They all have benefits and risks and alternatives.”

This is a very important statement. Everything you do, everything you eat and even everything you think “have benefits and risks and alternatives.” Think about it! You drive your car to my office to be seen. You know that people die every day in auto accidents, yet you drive anyway, right? Of course, you do. Driving certainly beats the alternative of walking over an hour to get to the office when you are sick.

The other major points that Dr Madrola writes about are covered in the following paragraph:

“First of all, many of the illness for which azithromycin is used are caused by viruses—not bacteria—and thus antibiotics are useless. Second, many of these illnesses, even if bacterial, will resolve with no therapy. Third, Z-paks have reached legendary status and ‘empowered’ patients seek out the drug. Fourth, profit-driven walk-in clinics, where many of these infections are treated, are incented to make patients happy—and Z-paks please. Finally, in the US, it is much easier (and perhaps less risky) to treat people with a drug than it is to explain the disease and that it may resolve without a drug.”

Yes, it’s hard to tell a virus from bacteria. Patients do, in fact, push to get an antibiotic; and, yes, it takes 30 seconds to make a patient happy by giving him a script for a Z-pak where it takes 10 minutes to tell him why he doesn’t need an antibiotic leaving him dissatisfied. Most importantly, many bacterial infections are self-limited and go away on their own.

Before you push your doc for that magic bullet, the Z-pak, remember everything has risks, benefits and alternatives. Sometimes, doing nothing is the best choice!

Speak up!

Live Wellthy — Mon, 06 May 2013 12:19:00 GMT

May 6, 2013

Yesterday’s USA Weekend has a great article entitled, “Speak up to doctors, for dear life.” According to the article, “about 100,000 people die each year due to medical errors, largely from misdiagnosis.”

You don’t want to be one of those patients; and, as your physician, I do everything possible to avoid misdiagnosing your illness. Unfortunately, diagnosing an illness is a complicated and dynamic process. The article mentioned above has several excellent tips on how you, the patient, can increase your odds of a proper diagnosis.

Number 1 – Partner with your doc. The article states, “So many patients are used to a parent-child relationship, but you want to be an equal partner.” Actually, you are the managing partner. The physician should serve as wise counsel and recognize that the ultimate decision about your health is yours!

Number 2 – Practice – According to the article, physicians interrupt their patients within 10 seconds of starting their visit. The author recommends that you “practice telling your situation in that time. Tell a beginning, middle and end, and don’t jump around.” This is the best advice I have heard in years. Often patients will jump from their headache, to their sprained ankle and then to their lifelong constipation all in a matter of 30 seconds. Such behavior is the equivalent of vomiting their symptoms on the floor and is a mess to try to clean up!

Number 3 – Insist – “The most common form of diagnosis is no diagnosis at all.” Yep, the author is right! Many times, a diagnosis can’t be made at the first or second visit. The author suggests, “Challenge your doctors to come up with something.” She’s right; your doc should be able to give you at least the top three differential diagnoses and which he is leaning towards.

Number 4 – Trust your instincts- Again, the author is spot on when she writes, “you know your body better than anyone.” Some of my most brilliant diagnoses have been made by believing my patient even when what he/she is telling me seems impossible. However, remember that you are at least as open to misdiagnosing yourself as I am!

Diagnosing an illness is fraught with problems and risks. When you work with your doc as his/her partner, you markedly increase the odds of a good outcome. Diagnosing an illness is only the first step. Formulating a treatment plan is the next step and, even more important, is activating that plan. Remember, the life you save may be your own.

The future

Live Wellthy — Sun, 05 May 2013 12:22:00 GMT

May 5, 2013

Dr Wes Fisher’s article, The Affordable Care Act: Spinning reform without real reform , is well worth reading. I couldn’t have said it better myself!

I had a lot of fun today giving a lecture on “Living the Wellthy Lifestyle” in Palatine, Illinois, to 50 of my favorite patients. I have tried to include my slide presentation below:

Live Wellthy

I hope you can open it. If not, I'll have some handouts available in the office.