PLEASE DON’T

PLEASE DON’T

Hey you!  Yeah, you know who you are.  Your wife wants you to stop.  So do I.  You’re going to hurt yourself.  I know you’re bright.  I know you’ve mastered the internet.  

Let me share a secret with you.  Your internet searches don’t trump my 40 years practicing medicine and my M.D. degree.  It also doesn’t trump the pharmacist’s training and knowledge.

Adjusting your medications by yourself and adding in handfuls of nutraceuticals is downright dangerous, bordering on suicidal.  Let me give you some examples.

Patient number one came into the ER at our local hospital bleeding severely from multiple sites.  He was on coumadin for a cardiac problem and the ER doc followed protocol administering Vitamin K to reverse the effects of the coumadin.  It should have been a slam dunk, but it wasn’t.  Patient number one spent a week in the ICU.  Unbeknown to his doc (me), he had started himself on multiple herbals for an assortment of complaints.

While his internet searches promised him enhanced health, vitality and a never-ending erection, he failed to appreciate the interactions between his miracle herbs and coumadin. 

Patient number two has an assortment of medical problems and medications, some prescribed and some self-prescribed.   So far, he’s been lucky.  Yes, lucky!  He has yet to have any serious side effects, but 40 years of experience has taught me that just because you’ve never experienced a problem doesn’t mean you won’t.  Actually, the longer you screw around with your meds, the more likely you are to have a problem.  Like Patient number three.

Patient number three stopped taking a critical medication because Dr Google told him his medication was a poison.  Patient number three will never recover from his fooling with his meds.  So as not to break HIPAA, I will not share any details but, trust me, fooling with his meds ruined his life.

SO, PLEASE DON’T SELF MEDICATE, CHANGE YOUR MEDICATIONS OR ADD NEUTRECEUTICALS WITHOUT YOUR DOCTORS PERMISSION AND/OR KNOWLEDGE.  THE LIFE YOU SAVE WILL BE YOUR OWN.

Go to Zdogg Pharmacist for an excellent description of your local pharmacists’ job and why you should include them on your team.

COULD THIS ARTICLE HELP YOU?

“Could” is a word I would do without if I had my way!  Unfortunately, my patients love it! 

“Doc, could my headache be from stress?”

“Doc, could my husband be suffering from depression?”

“Doc, could my son have ADD?”

“Doc, could …?”  is a question I hear multiple times a day.  The funny thing is the answer is always the same.  Realistically, anything “could” be true.  So every time a patient asks the question, “could,” the answer is yes. 

“Yes, your headache could be from stress.”

“Yes, your husband could be suffering from depression.”

“Yes, your son could have ADD.”

Unfortunately, the “could” question often mislead my patients.  While the answer to a problem could be stress, depression, or ADD, often those are unlikely sources of the problem at hand.  Explaining why they could, but are unlikely, is time consuming and stressful for the patient and the doctor.  I particularly hate when a parent asks the “could” question in front of their child.  It is not uncommon to see fear immediately consume the patient’s face.

The question my patients should be asking is, “Doc, what is the probability that stress, depression, or ADD is the problem?”  Differential diagnoses are based on probabilities.  A differential diagnosis is a list of the probable causes for an illness ranked from most likely to least likely or most dangerous to least dangerous.

Knowing what my patients’ concerns are is critical.  Cyberchondria is real and the internet stirs up trouble on a regular basis.  Learning to avoid the word “could,” and using “probable” instead, helps allay a lot of fears!

Could this article help you find the answer to what’s bothering you?  I hope so!

I HAVE A MIGRAINE

“Doc, I’ve got a migraine.  Can you help me?”  

In February of 2011, I published “Migraine, Its Not Just a Migraine.”  In that article, I advised that patients “Don’t underestimate your headache. Don’t put off seeing your doctor. Please don’t learn to live with it or let it control your life. We have excellent treatments for all types of headaches. When you see your doctor, he will want to know the following things in order to help classify your headache and provide proper treatment options.

Today’s article covers all those other types of headaches.  Patients tend to refer to any bad headache as a “migraine.”  A migraine is one specific type of headache.  According to Wikipedia, the International Classification of Headaches delineates 13 headache groups divided into primary and secondary headaches.  Today’s article will focus on headaches in the primary group:  migraines, tension-type headaches, cluster headaches, and trigeminal automomic headaches. Headaches caused by cough, exertion and sexual activity, daily-persistent hypnic and thunderclap headaches also fall into this group.

“Doc, I’ve got a migraine” often leads to a wrong diagnosis.  The patient’s self- diagnosis is often quoted in the nurse’s intake note as the patient’s chief complaint.  When the busy doc enters the room, he is likely to review the nurse’s note and then begin taking his history.

“John, I see you’ve got a migraine.  How long have you had the headache?”

“It started yesterday!  My whole head hurts.”

At this point, an experienced doc who has time on his hands would take a full headache history and discover that the patient does not have a migraine.  A busy doc who has patients waiting to be seen, patients waiting to be called, rounds to make at the hospital, and a family he would like to have dinner with might make the mistake of accepting the patient’s diagnosis, coding the visit as a migraine, and then treating the patient’s “migraine.”

Fortunately, the patient’s headache is likely to get better.  Unfortunately, the patient now has a misdiagnosis of migraine which he will carry from doc to doc until someone finally diagnoses his headache appropriately.

Headaches are often complex.  Many patients have several types of headaches lumped into one complaint.  Proper diagnosis of a headache disorder requires a careful history, both taken by the doctor and given by the patient.  Prior to going to your doctor, ask yourself the following questions:

  1. How severe are your headaches on a 1 to 10 scale?
  • How frequent are your headaches?
  • Do you have visual changes?  Do lights or sounds bother you? 
  • Where in your head are your headaches? 
  • What is the quality of the pain? Piercing? Stabbing? Throbbing? 
  • Describe the onset. Does it build in intensity? Is it sudden and severe? 
  • What makes your headache worse? 
  • What makes it better? 
  • Are there associated changes in your ability to think, speak, feel or move parts of your body? 
  1. What have you taken for your headache? 

Share your answers, along with your thoughts, about your headaches with your doc but resist calling it a migraine headache.  It may not be a migraine even if you have a long history of migraine headaches.  In August of 2011, I published “Your Doctor, the CSI Tech.”  Like a good CSI (Crime Scene Investigator), keep an open mind and investigate your headache carefully.  

If you have headaches, keep a headache diary. Learn everything you can about your headache by collecting clues. Read about headaches on WebMD and other reliable sources. Once you have collected as much knowledge as you can, see your family doctor. Let your doctor verify the type of headache and discuss treatment options, both for rescue and control. Certain types of migraines may require consultation with a specialist and your family doc will help you find the right consultant.  

The resource page at www.lzftc.com has lots of helpful links to reliable medical information.  Be happy and live “Wellthy” by conquering your headaches.

THE SHARKS ARE CIRCLING

After spending an entire weekday at home, I am sure of one thing; daytime TV can rot your brain!  Not only can daytime TV destroy brain cells, it highlights the worst traits of the human race.  Jerry Springer, Judge Judy, and multiple other TV personalities parade some of the human race’s most embarrassing individuals in front of their viewing audiences.

If you don’t believe me, channel surf like I did!  It was enlightening and frightening.  This article is all about the frightening side of my day at home.  As I was perusing the channels, I was mesmerized by a commercial segment I happened upon.  During that segment, five different law offices were mining for gold.   

“If you have been injured by the use of surgical mesh, call 1-800-We-Just-Won- The-Lottery!”

“If you experienced a bleed on Pradaxa, call 1-800-You-Can-Get-Rich!”

“If your child was born with a birth defect, call 1-800-Make-A-Fast-Buck”

“If your loved one developed a bed sore or fell in a nursing home, call 1-800-Collect-Millions now!”  

“If you developed a blood clot on Yaz, call 1-800-Screw-Them-Safely-And-Get-Rich.”

Yes, we have a healthcare crisis in the US.  Providing healthcare becomes more difficult and expensive every year.  Doctors are criticized for doing unnecessary tests and practicing defensive medicine.  Defensive medicine and the defense of unfounded lawsuits adds to the cost of care in our country.

Is it any wonder that doctors practice defensive medicine?  Frightening is an understatement when describing these commercials.  To make matters worse, each smiling attorney makes one promise:

“We promise that we won’t charge you anything unless we collect on your claim.”  Yes, you can sue a healthcare doctor for free!  You can roll the dice without any financial risk!  You can play the odds.  Just call 1-800-Increase-Everyone’s-Healthcare-Costs and hope your doc’s insurance company settles rather than financing a winning defense.

Why would they settle?  It’s simple math.  Pay out $50,000 to settle an unfounded claim or spend $300,000 to win in court.  Luckily for me, my insurer does not settle cases.  Fortunately, they would rather spend $300,000 and win.  Unfortunately, the cost of malpractice insurance is shared by every patient seen in this country.

Frightening?  You bet!  The sharks are circling and all of us are the food they live on!

HEADACHE

“Doc, I’ve got a migraine.  Can you help me?”  

In February of 2011, I published “Migraine, Its Not Just a Migraine.”  In that article, I advised that patients “Don’t underestimate your headache. Don’t put off seeing your doctor. Please don’t learn to live with it or let it control your life. We have excellent treatments for all types of headaches. When you see your doctor, he will want to know the following things in order to help classify your headache and provide proper treatment options.

Today’s article covers all those other types of headaches.  Patients tend to refer to any bad headache as a “migraine.”  A migraine is one specific type of headache.  According to Wikipedia, the International Classification of Headaches delineates 13 headache groups divided into primary and secondary headaches.  Today’s article will focus on headaches in the primary group:  migraines, tension-type headaches, cluster headaches, and trigeminal automomic headaches. Headaches caused by cough, exertion and sexual activity, daily-persistent hypnic and thunderclap headaches also fall into this group.

“Doc, I’ve got a migraine” often leads to a wrong diagnosis.  The patient’s self- diagnosis is often quoted in the nurse’s intake note as the patient’s chief complaint.  When the busy doc enters the room, he is likely to review the nurse’s note and then begin taking his history.

“John, I see you’ve got a migraine.  How long have you had the headache?”

“It started yesterday!  My whole head hurts.”

At this point, an experienced doc who has time on his hands would take a full headache history and discover that the patient does not have a migraine.  A busy doc who has patients waiting to be seen, patients waiting to be called, rounds to make at the hospital, and a family he would like to have dinner with might make the mistake of accepting the patient’s diagnosis, coding the visit as a migraine, and then treating the patient’s “migraine.”

Fortunately, the patient’s headache is likely to get better.  Unfortunately, the patient now has a misdiagnosis of migraine which he will carry from doc to doc until someone finally diagnoses his headache appropriately.

Headaches are often complex.  Many patients have several types of headaches lumped into one complaint.  Proper diagnosis of a headache disorder requires a careful history, both taken by the doctor and given by the patient.  Prior to going to your doctor, ask yourself the following questions:

  1. How severe are your headaches on a 1 to 10 scale?
  • How frequent are your headaches?
  • Do you have visual changes?  Do lihts or sounds bother you? 
  • Where in your head are your headaches? 
  • What is the quality of the pain? Piercing? Stabbing? Throbbing? 
  • Describe the onset. Does it build in intensity? Is it sudden and severe? 
  • What makes your headache worse? 
  • What makes it better? 
  • Are there associated changes in your ability to think, speak, feel or move parts of your body? 
  1. What have you taken for your headache? 

Share your answers, along with your thoughts, about your headaches with your doc but resist calling it a migraine headache.  It may not be a migraine even if you have a long history of migraine headaches.  In August of 2011, I published “Your Doctor, the CSI Tech.”  Like a good CSI (Crime Scene Investigator), keep an open mind and investigate your headache carefully.  

If you have headaches, keep a headache diary. Learn everything you can about your headache by collecting clues. Read about headaches on WebMD and other reliable sources. Once you have collected as much knowledge as you can, see your family doctor. Let your doctor verify the type of headache and discuss treatment options, both for rescue and control. Certain types of migraines may require consultation with a specialist and your family doc will help you find the right consultant.  

The resource page at www.lzftc.com has lots of helpful links to reliable medical information.  Be happy and live “Wellthy” by conquering your headaches.

PLEASE DON’T DRIVE

Having chest pain?  Please don’t drive.  Short of breath?  Please don’t drive.  Feeling faint?  Please don’t drive.  Is the room spinning?  Please don’t drive.  I am amazed at how many people get behind the wheel of a car when they are physically or emotionally impaired!

Once a week, we call the paramedics.  I guess I should be pleased that patients think enough of my care that they drive themselves to my office rather than calling the paramedics.  I’m not pleased.  It scares the crap out of me.  It’s one thing to underestimate how sick you are and die as the result of your own misjudgment.  It’s quite something else to arrive at the pearly gates with a stranger’s family in tow!

Pass out behind the wheel and the car drives off the road or into oncoming traffic.  What might well have been a treatable illness turns into a disaster of major magnitude.  Having such severe pain that you have to pull off on the shoulder leaves you all alone in your time of need.  I’m afraid that one day one of my most faithful patients is going to literally drive into my lobby.  Don’t let innocents get hurt because you don’t want to bother a friend or call the paramedics!

The paramedics are well trained professionals.  Their ambulance is a mobile intensive care unit.  Breathing is a funny thing.  My patients are always breathing until they are not.  They never know when they are going to stop breathing; it just happens.  It usually happens when they have a severe respiratory tract infection with cough and shortness of breath.  It happens when they are having the crushing chest pain of a heart attack.  The paramedics can breathe for you.  They can successfully start a heart that is no longer beating.  They save lives, yet many people are hesitant to call them.

Don’t be macho about driving.  This is one case where both men and women are alike.  Men can drive when they are half dead just because they are men.  Women are embarrassed to make a fuss by having the paramedics show up.  Dying needlessly is something to be truly embarrassed about.  Driving into a ditch or through a school yard is something to be embarrassed about.  Think about your family, neighbors, and friends.  Call them for help if you don’t think you need the paramedics.  Just don’t drive them off the road when you lose control of your car.

Treat illness like alcohol.  Don’t drive impaired.  Help is just a phone call away.  The life you save may not just be your own; it may well be the lives of the innocent!  

HEALTHY KIDS

On April 20, 2012, KevinMd published an excellent article by Barbara Bronson Gray, RN entitled “How to create a health culture at home for your kids.”  Since it’s hard to improve on perfection, I have reprinted, below, some of her tips on raising a healthy family:

“Here are some more proven tips for creating a health culture within your family:

  • Don’t use food as a reward for anything. Food is about nutrition, food can be fun, food can be celebratory, but you don’t get a candy bar for exercising or a cookie for turning in your homework. People who have learned to use food as a reward tend to develop weight issues and sometimes even eating disorders.
  •  Be calm about visits to the doctor and don’t make a big thing about injections or simple procedures. Explain why the “shot” will help them, dry their tears if they cry, give them a hug and move on. Kids will benefit if they don’t learn to associate health care with drama. Don’t reward kids for getting a shot. Make health care a regular part of life.
  • Serve balanced meals and avoid fast food.
  • Kids aren’t cows; they don’t need to graze constantly. Snacks, if really necessary, should be fruits and vegetables, a small handful of nuts. They should sip water, not juice (because it’s high in calories and natural sugar and can cause cavities without brushing soon after drinking).
  • Make sure your kids brush their teeth thoroughly twice a day.
  • Set a bed time that ensures enough sleep and stick to it. (You’ll benefit from this, too!)
  • Make sure everybody gets 30 minutes of exercise every day, including you. If you can, do things together. Shoot baskets. Take the dog for a walk. Play ping-pong. Grab a bike. Run around the neighborhood. Take a walk. Swim. Rollerblade. (Helmets, please; my only addition)
  • Go outside together. It’s far more likely to get you moving than staying between four walls.
  • Refuse to start the car unless everyone has their seat belts fastened. Period.
  • For teenagers who drive, set an ironclad rule about the car: no talking on the phone, texting, or eating while driving. Period.
  • Together, read books and watch videos that teach kids about their bodies and how they work.

Model healthy living for your children: no smoking, responsible drinking, exercise, stress management and active engagement in health care.”

FATIGUE

One of the questions I dreaded the most was, “Doctor, why am I always tired?”  Tired, fatigued, exhausted and lacking energy are among the many dreaded symptoms I heard almost every day.  Why did I dread this complaint?  Fatigue is a symptom of almost every disease known to mankind! 

In the article titled “Differential Diagnosis,” I reviewed how doctors formulate a list of possible causes for an illness, arrange those possible causes by probability of occurrence and potential for doing harm and methodically work through the list until an appropriate diagnosis is made.  The differential diagnosis for fatigue starts with “A” and ends with “Z”.  There are common causes of fatigue:  anemia; thyroid disease; sleep disorders including sleep apnea; depression; stress reaction; physical exhaustion; diabetes; hypertension; chronic fatigue syndrome; and COPD are but a few.

A typical office visit is divided into three parts: the interview, the exam and the planning stage.  The interview for the complaint of fatigue is often exhaustive.  The interview can also be frustrating as fatigue influences every part of a person’s life.   Doctors work with an interview tool called the “review of systems” (ROS).  The ROS is comprised of 14 organ systems with specific questions relating to each of those systems.  When dealing with a patient who suffers from fatigue, all 14 systems must be explored, and most patients have complaints in the majority of systems.  The doctor is often left with the “Chicken vs. the Egg” conundrum.

Now, do you understand why I dread this question?  To make matters worse, the physical exam seldom provides an answer requiring laboratory and other diagnostic testing.  While I am a puzzle solver and very experienced at solving this puzzle, each patient’s puzzle is unique and requires a novel solution and treatment approach.

So, when you complain of fatigue, and most of us will during our lifetime, recognize that the “Why” may be difficult to find, requiring extensive searching through your history, your physical exam and extended testing.  Be prepared for some frustration.  Be opened-minded about the various possibilities.  Recognize that one of the differential diagnoses is psychological and do not get offended if your doctor suggests you see a psychologist for testing.  At least, the psychologist’s tests don’t involve needles and KY Jelly!

Before seeing your doctor, ask the why, what, how, when and where questions about your fatigue.  Go through your own ROS (http://en.wikipedia.org/wiki/Review_of_systems).  In doing so, you may solve your own puzzle.  The more you question yourself, the easier it will be for you to answer your doctor’s questions.  While I am trained to solve puzzles by myself, it is easier if I have help.  Bring your significant other; he or she often has insights that are helpful.

One last request, if you could have a run of the mill anemia or thyroid problem, it would make my life easier! 

FIVE THINGS TO KNOW

In 5 things that I want my patients to know, by Leana Wen, MDpublished today on KevinMD.com, Dr Wen states:

1. Antibiotics will not help the common cold.

2. A CT scan will not improve a headache.

3. Every test has potential side effects.

4. Lifestyle changes make a huge difference.

5. Aspirin is one of few medications that’s been definitively shown to help you.

Dr. Wen’s advice is indeed wise and in many instances, parallels the advice I have been expounding on in this blog for the last 2 years. Other things I want my patients to know include:

6. Immunizations work! Immunizations prevent disease and, while they have potential side effects, are very safe.

7. The Flu vaccine cannot cause you to get the flu, cannot give you a cold, and does not weaken your immune system.

8. Doctors want to help you get well and improve your health. We would not offer a treatment to you or your family if we thought that it would hurt you.

9. The only truly foolish question is the one you didn’t ask. Feel free to ask me anything without the fear of embarrassment, just not at 3 in the morning if it’s not an emergency.

10. Doctors have on-call services to assist you in an emergency/urgent situation when we are not in the office. Please do not call after hours to get a refill or dodge an office visit.

11. No two insurance policies are the same. Know what your policy covers and what it does not. 

12. Stress is a disease and is contagious. Learn to manage yours and don’t transmit it to others.

13. Donating blood is the gift that keeps giving! When you donate blood on a regular basis, not only do you help others but you help yourself build the ability to make new blood more efficiently.

14. ‘Chicken Steps” work. You can become the person you want to be by setting your course and taking one tiny step after another in the right direction.

15. Diets are truly unnatural acts.

16. Because you have never had something is no guarantee that you won’t get it. As you age, you are likely to have a lot of new experiences. Work hard to make them healthy experiences.

17. You can change for the better. Define who you are and then refine who you are.

18. Love more, hate less!

19. Thirty minutes a day of exercise is not too much to ask of your body. It will pay off in spades!

20. Enjoy today and every day. No one really knows what tomorrow holds. Count your blessings in the morning and at night.

My list could go on and on but I will stop here and spend some time with my family, Skype with my children, and count my blessings. 

RESTORATION

I just saw an amazing sight:  a 1951 Ford Crestliner.  It’s amazing, in pristine condition and must be worth a fortune.  Can you imagine owning a piece of history?  I bet every head turns when it goes cruising by, proud owner at the wheel.

This particular Crestliner was all original, having been meticulously cared for over the last 63 years.  I imagine that the owner took it into the shop for regular tune-ups and preventative servicing.  When a part broke, he would do his best to repair it, resorting to using all original replacements only when necessary.

Ford sold a lot of Crestliners in 1951.  Have you ever seen one?  I doubt it.  Unlike the owner of the above-mentioned antique, most owners of cars do minimal maintenance, junking them when they age.  Junk yards across this country are full of rusting heaps of vehicles that once gleamed brilliantly.  A few will be meticulously restored.  Most will be turned into scrap metal and parts.

So, what’s all of this have to do with medical care?  I’ll tell you.  I’m a 1951 model that is currently being restored.  Unfortunately, I had neglected to take proper care of my body, making lots of excuses about why there was no time for diet and exercise, no time to take my body out on the road and run it.  I’ve got to confess, restoring one’s health takes a lot more effort than just preserving.

What model year are you?  DO OTHERS ADMIRE YOUR BOD WHEN YOU TAKE IT OUT OF THE HOUSE OR DO THEY SNICKER?  Are you showroom ready or heading for the junk yard?  Whatever shape you are in, start working on restoring your vitality.  Stop making excuses for not eating right and not exercising.  Trim down and take pride in what you have.  I guarantee you, it will be worth the effort!

By the way, I’m down 6 pounds, walking daily and finally sleeping.