When I was in my sportsmedicine fellowship, I used to see a small collection of patients come into the office as a referal complaning about shoulder and neck pain. Many times it would have been fully worked up by the primary care doc and with minimal signs (if anything) on xray and mri. The usual diagnosis would be that of an issue or problem with the joint involved most. Many times it would be shoulder bursitis or pinched nerve of the neck. We would again get them into therapy, thinking the therapist used by primary care was doing something wrong. Sometimes an attempt at different medicines, often stronger, and maybe a steroid injection would be attempted. After another exhausting work up to look for neck or shoulder pathology (without finding anything) and yet a patient that is still suffering, a diagnosis of a mental disorder or a malingering patient just trying to get money from the car accident or the government was made. The average age of onset is usually 20's but patients are into 30-40 with chronic pain.
Symptoms were usually the same: poor sleep, fatigue, multiple trigger points to muscles (mostly back), depression and headache. There is usually a trigger event like an accident, infection or stressful time of life. I found a diagnosis of fibromyocytis, also known as fibromyalgia being kicked around that lumped all these patients together. So actually other doctors were getting the same kind of patients and wondering if there was a syndrome that was being missed. Somehow though, it was thought of as a waste basket diagnosis since it wasn't "real" and was just coined so doctors could identify that a patient was suffering from something. Western medicine couldnt do anything with it short of sending the patient to a psychiatrist for psych meds. Being in sportsmedicine, I would utilize very gifted physical therapists that would have an eye for finding movement disorders and they would usually be able to help a patient get mobility back and work on flexibility. This alone would make many people feel better than they every had thus less medicines and eventually less side effects from medicines. Usually when a patient began to believe in themselves again, outlook would be better and they would be more involved with what works and get healthier. At one point, I had alot of patients with this diagnosis coming to me. I have to admit, I did get burned out since the diagnosis comes with many complicated issues and sorting things out took alot of emotion out of me. It was always rewarding to get the patient pointed in the right direction and see them get off medicines but if this took 45-60 minutes to evaluate and a family practice doctor that works for a hospital is expected to see a patient every 10-15 minutes.....I would get very backed up for the day. "Dr Saguil is running behind" was a common statement in my office (but patients were willing to wait! and I wasnt sure why they waited so long! I guess it was because I was listening and giving them some useful guidance.)
In a few years the American College of Rhuematology backed up the fibromyalgia diagnosis by saying that if someone came in with no other medical problems (like hidden hepatitis or arthritis) if they had sleep disorder, depression and 11 of 18 painful areas of muscle to specific areas on the body, the diagnosis was true. This was a "touchdown" for people with FibroMyalgiaSyndrome since a big authority said it is true and can be treated. Guess how it was treated, medicine for sleep, medicine for depression and physical therapy! So now the rhuematologists were getting all the referals instead of the orthopedic surgeons and they were doing the same thing.
Fast forward to the millenium, big difference now is the sprouting up of pain clinics! FMS is still being diagnosed but since its a very well documented disease, any average doc is treating it with a medicine for sleep, a medicine for depression and immediate prescription writing to see a therapist.....oh and a muscle relaxer and narcotic. Note....narcotic! Patients are being treated more readily by the unexperienced doc, usually adequate at first but with the next flare up, (and it is a lifetime diagnosis so a flare up is going to happen 1-3 times a year- especially in chicago), the frustrated doc is going to give potent medicine to quiet things down, but depending on the intensity of the flare, and other issues at the time, a narcotic will be relied on probably a little to much. Then comes the fast food mentality. Patient not educated on how important it is to get the fire put out immediately before resuming work and/or child care so reliance on meds like muscle relaxers and vicodin becomes more of the daily medicine than the "only for emergency" medicine. Then when the patient calls for a refill....referal to the pain clinic for narcotic management.
Don't get me wrong, the pain clinics are good, they did have a great headstart but they are now being dumped on by every doc that doesn't have the time to care for the 20-40 year old women (and rarely- men) with FMS. There are waiting times of up to 2 months before a patient can be seen. If you have ever suffered from a trapezius that is numb, tingling and a trigger for headaches and nausea, you would understand that just taking a muscle relaxer and popping a narcotic to get to that Jimmy Hendrix level of being high doesnt cut the pain and dysfunction. I have experienced this and it came after the emotional separation of me from my practice in 2005 when my previous hospital said they wanted to cut my pay since I wasnt producing like the docs in the rest of the country.
Suffice it to say, while in florida, I was finding the same suffering from FMS and because there werent as many "creative" docs there, I had no competition for patients but there was also great acceptance by patients for alternative medicine docs. The patients were getting smart and going to other forms of healing and getting better. Acupuncture works (no matter what a standard questionnaire says), mind body strengthening helps, movement like tai chi or the more popular yoga is a must and nutrition education is mandatory. You can always go the the pain clinic, get hard medicines for a few months, maybe a steroid triggerpoint injection her and there while you are on your way to flexiblity and healthy living.....or....just start with the movement, nutrition, time off and skip the narcotics.
Lets see where patients get dumped in the next decade.....with the government approving some alternative medicine therapies, may not have to get dumped anywhere since education is being given by those who dont have as many time constraints on visit time and those same....only can rely on movement since aggressive medicines are only given by doctors. I do believe there is a place for everything but not in excess and again I maintain it always starts with a good history and physical.
Wednesday, March 5, 2008
Wednesday, February 20, 2008
Breakin up is hard to do
6 fractures yesterday! Thats aside from the usual sickness, pains injuries patient list to the ER/Expresscare. Funny thing was they were all the same bone. Histories were all the same, older lady was out doing the usual activity. Just so happens the snow fall day before wasn't bad but the temperature and wind chill was very low. All of the women fell onto their butts or forward. Outstretched hand to catch and stop the fall and wrist pop with extreme pain. All came in and had terribly deformed and shortend wrist and hand. Xrays all showed distal radial fracture. 3 were right and 2 were left, (the last fracture of the day was a right hip). Luckily enough for the first fracture, an orthopedic surgeon from M & M orthopedic was outside in the parking lot and came back in to reduce (straighten) and cast. The other 4 women had to be splinted and sent to the ortho office. One of the ladies with HMO had to go the the primary care doc first then get a piece of paper then call to get an appointment to the ortho (an extra few steps that probably took 6 more hours!-is it worth it the extra hassel?)
The final lady with the hip had to stay until surgery (from Castle Orthopedics) to correct the hip.
I had a discussion with one of the nurses, funny about the onslaught of fractures, is there a correlation to time of year? Well, most obvious is the ice condition but my point is would the ladies have tolerated the fall without a fracture if they had better calcium and vitamin D? Much of the new literature states in the states above the imaginary line from virginia to san fran, people in the winter suffer more cardiovascular problems due to decreased sunlight and less vitamin D being made by the skin. It has also been studied with a coorelation ot fractures. More evaluation has to be made but now that the ladies are fractured, they will be on vitamin D and calcium for the next 2-3 months, (none had calcium stone issues). They will probably be in a cast, on pain killers and in physical therapy.
The Saguil Approach would be: prepare for a fall with good traction shoes, snowsalt and shovel access, balance exercise (tai chi is excellent) and increase the vitamin D and calcium supplements from halloween to easter. A blood test for levels before starting and after about 2 months of starting is good. A DEXA scan for a baseline bone density level is always helpful if there is question on bone being thin. The US Preventive Services Task Force suggests:
-all postmenopausal women under age 65 who have one or more additional risk factors for osteoporosis (in addition to being postmenopausal and female)
-all women age 65 and older regardless of additional risk factors
postmenopausal women who sustain a fracture
-women who are considering therapy for osteoporosis if bone density testing would facilitate the decision
-women who have been on hormone replacement therapy (HRT/ERT) for prolonged periods
Once it is found, those medicines that force bone to absorb calcium have to be used for 2-3 years! Takes that long to show effects. Better to be ready and stop smoking, decrease caffeine, weight bearing exercises, Vitamin D and Calcium supplements (if no calcium stones).
(Please see my discussion = Vitamin D in my herbal411review
The final lady with the hip had to stay until surgery (from Castle Orthopedics) to correct the hip.
I had a discussion with one of the nurses, funny about the onslaught of fractures, is there a correlation to time of year? Well, most obvious is the ice condition but my point is would the ladies have tolerated the fall without a fracture if they had better calcium and vitamin D? Much of the new literature states in the states above the imaginary line from virginia to san fran, people in the winter suffer more cardiovascular problems due to decreased sunlight and less vitamin D being made by the skin. It has also been studied with a coorelation ot fractures. More evaluation has to be made but now that the ladies are fractured, they will be on vitamin D and calcium for the next 2-3 months, (none had calcium stone issues). They will probably be in a cast, on pain killers and in physical therapy.
The Saguil Approach would be: prepare for a fall with good traction shoes, snowsalt and shovel access, balance exercise (tai chi is excellent) and increase the vitamin D and calcium supplements from halloween to easter. A blood test for levels before starting and after about 2 months of starting is good. A DEXA scan for a baseline bone density level is always helpful if there is question on bone being thin. The US Preventive Services Task Force suggests:
-all postmenopausal women under age 65 who have one or more additional risk factors for osteoporosis (in addition to being postmenopausal and female)
-all women age 65 and older regardless of additional risk factors
postmenopausal women who sustain a fracture
-women who are considering therapy for osteoporosis if bone density testing would facilitate the decision
-women who have been on hormone replacement therapy (HRT/ERT) for prolonged periods
Once it is found, those medicines that force bone to absorb calcium have to be used for 2-3 years! Takes that long to show effects. Better to be ready and stop smoking, decrease caffeine, weight bearing exercises, Vitamin D and Calcium supplements (if no calcium stones).
(Please see my discussion = Vitamin D in my herbal411review
Tuesday, February 12, 2008
Slow ride, take it easy!
-by Foghat
This one sling shots off my previous discussion on sept on "hitting the Wall". Nice couple came in and a guy in his mid to late 30's had a bad headache. Claims it was tolerable but he started with left eye twitching and became worried. Looked alittle overweight, dressed ok, not disheveled but could use a makeover. Wife pretty, good weight, possible smoker. He wasnt in distress andjust wanted to make sure it wasnt cancer. No history of it but he didn't want to be the first and has no time to get sick. I cleared him with an extensive physical exam and in history apparently had a history of headache like this before and worse. Doesnt complain too much and has a high tolerance for pain. Turns out he also has recently worsened his already poor sleep, drinking about 1 and 1/2 pots of coffee a day, no time to eat right. Has been heavier but is overweight and has no time for exercise with 50-60 hours a week of work. Cant take time off since someone will be pissed off with himat work. Wife says he has been stopping breathing at night with sleep.
So everyone reading can see where I am going with my diagnosis. I reassured him of the high possibility for headache due to sleep disorder, sleep apnea, caffeine dependance and SAD. Certainly cant rule out a brain tumor but with everything else occurring, I told him likelyhood of morbidity from the other previous problems mentioned is high. If he keeps up the pace over the next few years, he will be on several medicines by 40y/o. Told him if he cant afford the switch in careers now, better start saving up money over the next 8-12months and go back to school. (he already told me with the increase in weight, he has been told there is a blood pressure issue).
The Saguil Approach is to put bandaids on most of the symptoms with the understanding that he shouldn't be on the medicines for more than a month. (I fear with alleviation of some basic symptoms he will continue on his lifestyle direction and just rely on meds) Medicines are always a short cut but only to allow an avenue for the body to heal and get stronger with nutrition, sleep and exercise. How does he do this with all the obligations? I dont know that answer. I can only jump to the future and one road he may end up on is diabetes, high cholesterol, high blood pressure and sleep apnea. At a minimum, 2-3 medicines and a sleep mask-(not to mention viagra). Many docs and patients for that matter, get the bandaid meds but are given refills for a long duration since they have no other alternative than to continue with the meds for symptom suppression since they keep on returning. It does take alot of sit down time to get the point accross that the road they are taking is going to a bad place. Most docs and patients dont have this time.
We-(the docs) usually give this "face to face" time when the diagnosis we find is terminal and time is short. When noone is going to die soon, most find it hard to schedule a family intervention and it is also very demanding on the office staff to coordinate. This is ashame but when the patient cant make a job switch and the doc cant afford staff to make extra phone calls, the short cut is taken. I have spoken about the truncated interactions with the doctor and how its easier to prescribe meds than do 60 minutes of counseling in the past and it seems this is where medicine in now. There are places you can get more attention but it typically comes at a premium and is cash up front. I think its worth it especially if eventually the visits are only 2 times a year when health is improved. (Compared to insurance premiums for a family approaching 800-1000 dollars a month even without having to see a doctor!...thats just the premium to maintain the insurance policy!) I should stop now before I get on my soap box about industrialization of the bond between doctor and patient. Placing a value on and "interaction" is impossible no matter what statistics say. Every high level medical officer will always refer to statistics when explaining how the average patient and doctor visit should be in the US. Then that same high level person will make a phone call to a personal doctor as soon as he or his family gets sick all the while bypassing all the hurdles his administration has set to care for people in a timely manner since the numbers speak for themselves. I remember one of the board members in a previous hospital, pushed to save money and close the express cares during times that were nonproductive, then the rumor was when his kid was sick and he couldnt avail of the expresscare in his neighborhood, he complained and magically of the all the expresscares with the hospital, his local expresscare stayed open later than the others!
The Saguil Approach:
1. see a doc to make sure you are not going to die
2. take some bandaid meds for a designated time period
3. get deeper sleep with meds or herbs or a vacation or medical leave
4. get off red meat and eat more veggies....depending on the season, I like dominics, target and of course whole foods. Trader joes and the local farmers are also popular.
5. save money now for a possible layoff for 3 months(this would be the amount of time to find another life style or the same job but a different place.
6. stress reduction, exercise, sleep and family spirituality have to be learned, can't get it in a prescription....try working in a homeless shelter, the va, or a cancer center and it will ground you that life isn't that bad that you don't have a choice.
This one sling shots off my previous discussion on sept on "hitting the Wall". Nice couple came in and a guy in his mid to late 30's had a bad headache. Claims it was tolerable but he started with left eye twitching and became worried. Looked alittle overweight, dressed ok, not disheveled but could use a makeover. Wife pretty, good weight, possible smoker. He wasnt in distress andjust wanted to make sure it wasnt cancer. No history of it but he didn't want to be the first and has no time to get sick. I cleared him with an extensive physical exam and in history apparently had a history of headache like this before and worse. Doesnt complain too much and has a high tolerance for pain. Turns out he also has recently worsened his already poor sleep, drinking about 1 and 1/2 pots of coffee a day, no time to eat right. Has been heavier but is overweight and has no time for exercise with 50-60 hours a week of work. Cant take time off since someone will be pissed off with himat work. Wife says he has been stopping breathing at night with sleep.
So everyone reading can see where I am going with my diagnosis. I reassured him of the high possibility for headache due to sleep disorder, sleep apnea, caffeine dependance and SAD. Certainly cant rule out a brain tumor but with everything else occurring, I told him likelyhood of morbidity from the other previous problems mentioned is high. If he keeps up the pace over the next few years, he will be on several medicines by 40y/o. Told him if he cant afford the switch in careers now, better start saving up money over the next 8-12months and go back to school. (he already told me with the increase in weight, he has been told there is a blood pressure issue).
The Saguil Approach is to put bandaids on most of the symptoms with the understanding that he shouldn't be on the medicines for more than a month. (I fear with alleviation of some basic symptoms he will continue on his lifestyle direction and just rely on meds) Medicines are always a short cut but only to allow an avenue for the body to heal and get stronger with nutrition, sleep and exercise. How does he do this with all the obligations? I dont know that answer. I can only jump to the future and one road he may end up on is diabetes, high cholesterol, high blood pressure and sleep apnea. At a minimum, 2-3 medicines and a sleep mask-(not to mention viagra). Many docs and patients for that matter, get the bandaid meds but are given refills for a long duration since they have no other alternative than to continue with the meds for symptom suppression since they keep on returning. It does take alot of sit down time to get the point accross that the road they are taking is going to a bad place. Most docs and patients dont have this time.
We-(the docs) usually give this "face to face" time when the diagnosis we find is terminal and time is short. When noone is going to die soon, most find it hard to schedule a family intervention and it is also very demanding on the office staff to coordinate. This is ashame but when the patient cant make a job switch and the doc cant afford staff to make extra phone calls, the short cut is taken. I have spoken about the truncated interactions with the doctor and how its easier to prescribe meds than do 60 minutes of counseling in the past and it seems this is where medicine in now. There are places you can get more attention but it typically comes at a premium and is cash up front. I think its worth it especially if eventually the visits are only 2 times a year when health is improved. (Compared to insurance premiums for a family approaching 800-1000 dollars a month even without having to see a doctor!...thats just the premium to maintain the insurance policy!) I should stop now before I get on my soap box about industrialization of the bond between doctor and patient. Placing a value on and "interaction" is impossible no matter what statistics say. Every high level medical officer will always refer to statistics when explaining how the average patient and doctor visit should be in the US. Then that same high level person will make a phone call to a personal doctor as soon as he or his family gets sick all the while bypassing all the hurdles his administration has set to care for people in a timely manner since the numbers speak for themselves. I remember one of the board members in a previous hospital, pushed to save money and close the express cares during times that were nonproductive, then the rumor was when his kid was sick and he couldnt avail of the expresscare in his neighborhood, he complained and magically of the all the expresscares with the hospital, his local expresscare stayed open later than the others!
The Saguil Approach:
1. see a doc to make sure you are not going to die
2. take some bandaid meds for a designated time period
3. get deeper sleep with meds or herbs or a vacation or medical leave
4. get off red meat and eat more veggies....depending on the season, I like dominics, target and of course whole foods. Trader joes and the local farmers are also popular.
5. save money now for a possible layoff for 3 months(this would be the amount of time to find another life style or the same job but a different place.
6. stress reduction, exercise, sleep and family spirituality have to be learned, can't get it in a prescription....try working in a homeless shelter, the va, or a cancer center and it will ground you that life isn't that bad that you don't have a choice.
Sunday, February 3, 2008
Just like ole times.....
Got a call from old friends/patients in Wheaton. As I was at the ER/Expresscare working, came accross a note from one of the old families I used to take care of in Wheaton. First I thought, oh no...it's bad news. (I can't imagine what it's like to have a loved one in Iraq and getting a call from the government!) When I got some time, I called to get the news from the frustrated wife. My old friend; retired airborne armed forces patient, had gone to see a good neurosurgeon collegue of mine. (This was a doctor I rotated with when I was at Cook County Hospital visiting from the philippines trying to experience Traumasurgery and Neurosurgery. He was chief resident then and very meticulous; when I came back to Illinois to practice medicine in '95, he was at the same hospital! Excellent surgeon, great bedside manor, all around nice guy....and here he is again back in my life somehow.....for those who read the "Secret"...this is the law of positive attraction!) Anyway, my old patient had back pain and went to see Matt. The MRI showed 2 discs, so with intractable pain failing conservative treatment, the next step was to fix. Unfortunately, he still had pain and now muscle atrophy psot surgery. After getting all the info on what had been ordered and attempted in the last 3-4 months, everything was correct and my only reply was (in my cup half full reasoning)....at least it wasn't cancer! In the midst of all his pain, after having gone through corrective surgery, physical therapy with the best and to be unchanged with his pain, the last thing he wanted to hear was "it's not that bad".
But it is true, he isn't going to die..... but he isn't getting sleep and has 24 hours of pain. All I am thinking is that..."great, if Matt has worked his magic and found no surgically corrective issues, my turn!!! I started rattling off everthing I wanted to do in order, just because I have been down this road before. Even when I didn't do as much integrative medicine, I was still using all my non surgical possibilities to help patients and guess what, it was about the same thing. Listen to what the patient was complaining about, interpret what the true issue is, fix the sleep, give hope, insure proper nutrition and start rehab(movement/flexibility).
Here's the message boys and girls, no matter what the medical issue is, always need to support the basics: nutrition, sleep, movement, spirit. Even if the skilled surgeon is involved, still need those basics satisfied or else surgical outcome will be poor. Sometimes in preparing for an ACL reconstruction like in football, the therapists will do what we call "prehabilitation". This is getting the muscles and joints tone and strong enough to go straight into therapy after surgery. We can take this same concept and use it even for smaller issues. Prehab for surgery, chemo, travel, new medicine trials, starting stressful times in life or even before starting antibiotics for a cough. Outcomes will always fare better when the body is prepared.
So I am sending Bob to an acupuncture friend of mine = http://www.eastwesthealingcenter.net/, (I still don't have a physical space set up yet), the therapist will hopefully be able to get a TENS unit for the patient to use hourly, I will add a gentle muscle relaxer and then suggest and herbal antiinflammatory (he is on a blood thinner and regular nsaids can't be used). The most help I probably gave him was a chance for improvement. When western medicine stops, eastern medicine continues on! It's amazing how this gets me energized also!...I'll keep you informed on how "Bob" does.
But it is true, he isn't going to die..... but he isn't getting sleep and has 24 hours of pain. All I am thinking is that..."great, if Matt has worked his magic and found no surgically corrective issues, my turn!!! I started rattling off everthing I wanted to do in order, just because I have been down this road before. Even when I didn't do as much integrative medicine, I was still using all my non surgical possibilities to help patients and guess what, it was about the same thing. Listen to what the patient was complaining about, interpret what the true issue is, fix the sleep, give hope, insure proper nutrition and start rehab(movement/flexibility).
Here's the message boys and girls, no matter what the medical issue is, always need to support the basics: nutrition, sleep, movement, spirit. Even if the skilled surgeon is involved, still need those basics satisfied or else surgical outcome will be poor. Sometimes in preparing for an ACL reconstruction like in football, the therapists will do what we call "prehabilitation". This is getting the muscles and joints tone and strong enough to go straight into therapy after surgery. We can take this same concept and use it even for smaller issues. Prehab for surgery, chemo, travel, new medicine trials, starting stressful times in life or even before starting antibiotics for a cough. Outcomes will always fare better when the body is prepared.
So I am sending Bob to an acupuncture friend of mine = http://www.eastwesthealingcenter.net/, (I still don't have a physical space set up yet), the therapist will hopefully be able to get a TENS unit for the patient to use hourly, I will add a gentle muscle relaxer and then suggest and herbal antiinflammatory (he is on a blood thinner and regular nsaids can't be used). The most help I probably gave him was a chance for improvement. When western medicine stops, eastern medicine continues on! It's amazing how this gets me energized also!...I'll keep you informed on how "Bob" does.
Tuesday, November 27, 2007
I can't breath!
Tonight, took care of a 15 y/o who was running in the school hallway and fell backward. I thought he was screwing around but turns out another team had the gym so the indoor track team had to run in the hallways! I used to do this in the 70's during winter track and this was before technology was developed for sneaker soles. I remember seeing the "waffle" sole for the first time and wondering how in the world can anyone get good traction with these soft rubber nipples sticking out from under the shoes. Well, now in this high tech time of protein supplements, 200-300 dollar running shoes, internet running clubs, high tech water......there are still schools that have their runners train in the hallway! I shared this memory with the student and his parents and of course gave some free advise about running and performance enhancement with his running and football training.
What is more online for tonight's problem is about an asthmatic that came in after being seen 2-3 days ago for asthma. Given an albuterol inhaler to help breath temporarily (4hours) and a steroid called prednisone to speed up the lungs fixing the inflammation that was causing the wheezing. She worked for a nursing home as an assistant and made a little money. Unfortunately, this was enough of a paycheck to not qualify for a medical card. She was now responsible for paying for an emergency room visit last time that came out to 400-500 dollars. And now again since she was slowing getting better but still having problems breathing, has to come in again to get reevaluated to make sure nothing was wrong. I was wondering why the previous doctor didn't maximize on her medicines and give her everything possible to "cool" down the asthma so she would turn around fast. Well, I did what the other doc did and after evaluation, gave her a nebulizer treatment with medicine steamed through a small hand held machine with a liquid medicine going straight to the deepest portions of her lung tissues. This makes a faster difference than the 10 dollar inhaler she is using every 4 hours. Inhaled steroids would be good...yeah so I wrote a script for something but called the pharmacy and found out one little inhaler costs 200 bucks! Asked about a few different older ones and all were 100-200 each! Tried to get her a long acting albuterol inhaler so she wouldnt have to hit the rescue inhaler so often but that also was 100-200 dollars! I couldn't find anyone even walmart or kmart discount drugs to cover anything. I felt so bad for this lady but exhausted all I knew to help her get better medicines. I even tried to give her a nebulizer which I did find medicines for that walmart had for 4$ only but the nebulizer machine itself was 100-200$.
How do people trying to make a living support not only their health but the lives of their kids? In Illinois we have an All Kids Program. Even before that, how can a medicine that lasts a month and saves lives cost 100-200dollars? Really I know the answer but it sounds powerful to throw a rhetorical question out in anger. In business weekly I read of how hospitals are joining with finance companies to collect from people who visit and get care without health insurance. Not that hospitals shouldn't charge for services rendered but when will the escalating prices ever plateau? Drug companies arent helping either. Listening to Suze Orman in the background she is touting not to discount yourself to others. When you undervalue yourself to the world, the world with undervalue you! So I also should not give out care at a discount and learn to charge top dollar since not too many doctors do what I do.
Bull! I always tell my daughter hatred is infectious, mob mentality is infectious, the less you know, the more you can be influenced. This countrywide problem of healthcare is too big to stop. But you know what, I will not play the same game, that lady will be spending alot to turn off her asthma in the next 1-2 weeks but I will get her to make some changes with diet and exercise so next winter she hopefully wont get sick and if she does, she will have the knowledge to calm down the lungs before they flare up to the point of having to come to the ER which is probably the most expensive way to see a doctor quickly. I also tell my daughter smiling is infectious so is a good deed. I see she always goes out of her way to protect her friends and as long has she doesn't make naive choices, I will continue to support her for being giving. Hopefully my teaching has already paid off and she can make a bigger difference in society than me.
The Saguil Approach to asthma-
avoid smoke
improve on omega 3 fishoil intake
decrease alleric response with stinging nettles
improve bowel function the entrance point to many of the triggers for asthma (probiotics)
the antiinflammatory diet....whole grain, decrease animal protein, decrease dairy
increaseing lung volume, deep breathing exercises breath holding (swimming, yoga, meditation)
biofeedback, emotional freedom technique for psychotherapy
change the environment; pets, flowers, molds, cold, dirt, dust, food.
What is more online for tonight's problem is about an asthmatic that came in after being seen 2-3 days ago for asthma. Given an albuterol inhaler to help breath temporarily (4hours) and a steroid called prednisone to speed up the lungs fixing the inflammation that was causing the wheezing. She worked for a nursing home as an assistant and made a little money. Unfortunately, this was enough of a paycheck to not qualify for a medical card. She was now responsible for paying for an emergency room visit last time that came out to 400-500 dollars. And now again since she was slowing getting better but still having problems breathing, has to come in again to get reevaluated to make sure nothing was wrong. I was wondering why the previous doctor didn't maximize on her medicines and give her everything possible to "cool" down the asthma so she would turn around fast. Well, I did what the other doc did and after evaluation, gave her a nebulizer treatment with medicine steamed through a small hand held machine with a liquid medicine going straight to the deepest portions of her lung tissues. This makes a faster difference than the 10 dollar inhaler she is using every 4 hours. Inhaled steroids would be good...yeah so I wrote a script for something but called the pharmacy and found out one little inhaler costs 200 bucks! Asked about a few different older ones and all were 100-200 each! Tried to get her a long acting albuterol inhaler so she wouldnt have to hit the rescue inhaler so often but that also was 100-200 dollars! I couldn't find anyone even walmart or kmart discount drugs to cover anything. I felt so bad for this lady but exhausted all I knew to help her get better medicines. I even tried to give her a nebulizer which I did find medicines for that walmart had for 4$ only but the nebulizer machine itself was 100-200$.
How do people trying to make a living support not only their health but the lives of their kids? In Illinois we have an All Kids Program. Even before that, how can a medicine that lasts a month and saves lives cost 100-200dollars? Really I know the answer but it sounds powerful to throw a rhetorical question out in anger. In business weekly I read of how hospitals are joining with finance companies to collect from people who visit and get care without health insurance. Not that hospitals shouldn't charge for services rendered but when will the escalating prices ever plateau? Drug companies arent helping either. Listening to Suze Orman in the background she is touting not to discount yourself to others. When you undervalue yourself to the world, the world with undervalue you! So I also should not give out care at a discount and learn to charge top dollar since not too many doctors do what I do.
Bull! I always tell my daughter hatred is infectious, mob mentality is infectious, the less you know, the more you can be influenced. This countrywide problem of healthcare is too big to stop. But you know what, I will not play the same game, that lady will be spending alot to turn off her asthma in the next 1-2 weeks but I will get her to make some changes with diet and exercise so next winter she hopefully wont get sick and if she does, she will have the knowledge to calm down the lungs before they flare up to the point of having to come to the ER which is probably the most expensive way to see a doctor quickly. I also tell my daughter smiling is infectious so is a good deed. I see she always goes out of her way to protect her friends and as long has she doesn't make naive choices, I will continue to support her for being giving. Hopefully my teaching has already paid off and she can make a bigger difference in society than me.
The Saguil Approach to asthma-
avoid smoke
improve on omega 3 fishoil intake
decrease alleric response with stinging nettles
improve bowel function the entrance point to many of the triggers for asthma (probiotics)
the antiinflammatory diet....whole grain, decrease animal protein, decrease dairy
increaseing lung volume, deep breathing exercises breath holding (swimming, yoga, meditation)
biofeedback, emotional freedom technique for psychotherapy
change the environment; pets, flowers, molds, cold, dirt, dust, food.
Monday, November 26, 2007
Head in the clouds
It was a chilly day in Chicago and my family was in post turkey slumbering. We had a birthday to attend and it was a pool party! (Indoor of course) I haven't swam since august and the anticipation of doing "laps" got me excited but at the same time, I didn't want to injure myself with overusing muscles I haven't used in a while. I had done the usual work out the 2-3 days prior of aggressive weight training (heart rates into the 160-170 range) for 30 min followed by 40 min of cardio (bike and run with heart rates in the 130 range). I pride myself on being able to mix up the weight training with a little crew team type station to station exercise with the "300" type work out. This is where muscle hurts with lactic acid build up but the dry bronchial tube pain reminds me of the feeling from school track practice with repetitive sprints of 100, 200 yard for what seemed to be hours. Gives you a kind of razor in the trachea type feel while breathing in cold air. I feel a 45 if I can do this without injury and still notice muscle bulk increases, a 20-30 something should be able to kick my butt. Watching my wrestlers at UCF go through a workout just puts me to shame and collegiate athletes are not only muscular but ripped to shreds. (low body fat for you non-athletes) If they can do it then there's no reason I have to see guys talking and joking around waiting between sets and staring at themselves in the mirror. One of my pet peeves is when I see guys walking from machine to machine in between sets... staring at themselves as if something is going to change! After watching the extras part from the movie "300" and seeing how the personal trainers got the actors in shape for the movie.....the principal character stated many times he would work out to the point of barfing. That's the good old days measurement of exhaustion....not pulse rate taking but vomiting. You know you had a good work out if you threw up.....and only the best athletes vomited after a lift or a sprint! As a warning, there is the theory of overuse when it comes to exercise but come on....in this day of ultramarathoners, triathletes, iron men and olympians....is there is a new standard by which we can push ourselves in a gym or at home. I just think we get too delicate once we hit 30 for fear that a heart attack may emerge from nowhere so we take it easy. I plan on encouraging my older patients that have been cleared by me to push the envelope with heart rate and exercise and set a new standard.
As I was saying, I was looking forward to doing some laps and after my boy swam a little and my wife had time to socialize, got my goggles and swim fins and hit the 25 meter pool. Did some slow laps and had my cousin join me for a few....by the time I was done, 30 minutes went by and I covered about a half to 3/4 of a mile. The adrenaline wasn't spectacular but just being able to tackle the distance after being out of water so long put me on a high.....then I went on to the dinner table and saw a few pork dishes and ended up going with a little roasted pork (no skin) with a plate full of peanuts and grapes.....no guilt! The rest of the night was all the same, I actually was amazed I didn't feel sore at all. This is the kind of feeling with yoga, not the adrenaline rush of weight training but a more euphoric feeling with a feeling of being impervious to outside insult or trauma.
I am a big proponent of tai chi and yoga with stress reduction, hypertension, arthritis and depression. It is always a difficult sale to someone from a society built around getting self reward for breaking a sweat in front of a mirror over 60-90 minutes and feeling a "pump". With most of the baby boomers hitting 50-60, they will probably have a basic knowledge of the 2 forms of exercise with a picture of an short old chinese guy or a man in a turbin exercising. Truth of the matter is is you look in any local YMCA or health club, they will usually have a female instructor in yoga and a male instructor in tai chi. (Yoga seems to be the big craze now). When done properly and continued for 30 days or more, one will usually see the benefits of the gentle movement sports over the hard hitting exercises for heart health. Just takes a little encouragement to make it to the point of gaining the benefits.
As I was saying, I was looking forward to doing some laps and after my boy swam a little and my wife had time to socialize, got my goggles and swim fins and hit the 25 meter pool. Did some slow laps and had my cousin join me for a few....by the time I was done, 30 minutes went by and I covered about a half to 3/4 of a mile. The adrenaline wasn't spectacular but just being able to tackle the distance after being out of water so long put me on a high.....then I went on to the dinner table and saw a few pork dishes and ended up going with a little roasted pork (no skin) with a plate full of peanuts and grapes.....no guilt! The rest of the night was all the same, I actually was amazed I didn't feel sore at all. This is the kind of feeling with yoga, not the adrenaline rush of weight training but a more euphoric feeling with a feeling of being impervious to outside insult or trauma.
I am a big proponent of tai chi and yoga with stress reduction, hypertension, arthritis and depression. It is always a difficult sale to someone from a society built around getting self reward for breaking a sweat in front of a mirror over 60-90 minutes and feeling a "pump". With most of the baby boomers hitting 50-60, they will probably have a basic knowledge of the 2 forms of exercise with a picture of an short old chinese guy or a man in a turbin exercising. Truth of the matter is is you look in any local YMCA or health club, they will usually have a female instructor in yoga and a male instructor in tai chi. (Yoga seems to be the big craze now). When done properly and continued for 30 days or more, one will usually see the benefits of the gentle movement sports over the hard hitting exercises for heart health. Just takes a little encouragement to make it to the point of gaining the benefits.
Sunday, November 11, 2007
Fear of Flying
I was flying back from a lecture in Clermont today and sat next to a wonderful young lady. She had been trying to flag down the steward before take off and the urgency in her voice made me think she was a little worried. It was headphones she was looking for to relax. I know the feeling. Several years ago about the time of the 911 tragedy, I used to have a fear of flying. I would take a xanax (fast acting valium) to relax. I think it came from years of flying back and forth to the Philippines during winter when the storms over Japan were harsh. Imagine, 2 hours after take off from a tropical island and then snow storm in Narita Japan....then only 16 more hours to fly before getting home! Needless to say it was either alcohol or drugs and drugs were cheaper. When I learned acupuncture, my instructor said he would take needles with him to France to start treating jet lag before he would even step off the plane. (The needles are so small they don't even set off security alarms) I tried this once and placed in 3 needles to relaxation points and landing didnt even phase me. From that point I was encouraged by my daughter to not stick needles in my self on a plane cause it looked "weird". I went onto acupressure techniques and breathing with meditation. (More recently I added aromatherapy-lavender- and piece of cake.
I quickly offered my seat mate a whiff of my lavender bottle and explained how it is used. Before I knew it we were up at 30 thousand feet and talking about all kinds of things. She had so much energy and life, it was inspiring to me. Usually the sick I see are worn down with a medical issue and chronic stress. Here is the perfect picture of someone with gobs of energy and life with some medical issues from not controlling or harnessing the power she wields. Stressed, on a medicine from the OB for anxiety/depression, never suggested to see a therapist, no experience of biofeedback. I forgot to ask if she ever was tested for thyroid disease of vitamin imbalance. Got a little diet hisorty from her but not enough. She also leads the typical life of a twenty something living single in "wrigley-ville". Alot of freinds and going to bars and parties. (ahhhh the good old days) What was a red flag for me was she had indicated a doctor placed her on Wellbutrin which she states helped her tremendously without gaining weight. But the doc never sent her to behavioral health. Here she is far from her initial stressor but still on the same dose.
I stressed to her that although she is feeling great with the low dose of the medicine and she uses it every day, more stressors are coming. Theres's always going to be stressors during christmas holiday, tax day, birthday and new years. God forbid she develops a sickness from Chicago winters in addition to late night partying on weekends. If she is being maintained on a level dose and a larger stressor comes up..doc is going to increase the dose or add another med. May I add that a rather large stressor for single women in the US is coming up.....30th birthday! So I gave her my advice for breathing exercises, yoga (although she sounds like an adrenaline junkie) aromatherapy and possibly acupuncture/tui na. Luckily Dr Leon Chen of East West Healing Center in Lombard also goes to Chicago and may be able to help her. Turns out there is also couple other problems typical for a person of her level and she would benefit from kidney clensing with probiotic.
I am a walking example of what I preach, The Saguil Approach-
-plan to wean off meds 2-3 weeks, have a substitute in place to help control the original issue, add a few more interventions with alternative medicine that will help control the flare up that always happens when stopping potent perscription medicines.
( although I dont think the alcohol is one thing she will give up)
Moral of this story is not to just accept a medicine as a cure. Always work to get off what you are on...whether it is a script or an herbal medicine. Nutrition and exercise are always the basis to treatment even if the doctors dont remember. I will keep an update as to how she tolerates acupuncture, anxiety sufferers dont do well and usually go to alcohol for its depresant properties. No coffee, caffeine, guarana, tobacco. She should also try carb rich diets. I usually suggest protein for breakfast and lunch then carb for dinner. In the anxious case, carbs for dinner with an evenly distributed prot/carb breakfst and lunch is good to go. Suggested breathing technique and reading into drweil.com for some pointers.
Alway insist the doc treats the mind, body and soul. In eastern medicine its all in the same package. Only in america does the body get treated without consideration of the mind. (and visa versa) serotonin that acts on the mind also is big in the colon so docs have no choice but to make it work with a multi faceted aproach.
valerian
respir-eze
kava kava
lavender aromatherapy
emotional freedom technique with psychology
diet and multivit changes.
I quickly offered my seat mate a whiff of my lavender bottle and explained how it is used. Before I knew it we were up at 30 thousand feet and talking about all kinds of things. She had so much energy and life, it was inspiring to me. Usually the sick I see are worn down with a medical issue and chronic stress. Here is the perfect picture of someone with gobs of energy and life with some medical issues from not controlling or harnessing the power she wields. Stressed, on a medicine from the OB for anxiety/depression, never suggested to see a therapist, no experience of biofeedback. I forgot to ask if she ever was tested for thyroid disease of vitamin imbalance. Got a little diet hisorty from her but not enough. She also leads the typical life of a twenty something living single in "wrigley-ville". Alot of freinds and going to bars and parties. (ahhhh the good old days) What was a red flag for me was she had indicated a doctor placed her on Wellbutrin which she states helped her tremendously without gaining weight. But the doc never sent her to behavioral health. Here she is far from her initial stressor but still on the same dose.
I stressed to her that although she is feeling great with the low dose of the medicine and she uses it every day, more stressors are coming. Theres's always going to be stressors during christmas holiday, tax day, birthday and new years. God forbid she develops a sickness from Chicago winters in addition to late night partying on weekends. If she is being maintained on a level dose and a larger stressor comes up..doc is going to increase the dose or add another med. May I add that a rather large stressor for single women in the US is coming up.....30th birthday! So I gave her my advice for breathing exercises, yoga (although she sounds like an adrenaline junkie) aromatherapy and possibly acupuncture/tui na. Luckily Dr Leon Chen of East West Healing Center in Lombard also goes to Chicago and may be able to help her. Turns out there is also couple other problems typical for a person of her level and she would benefit from kidney clensing with probiotic.
I am a walking example of what I preach, The Saguil Approach-
-plan to wean off meds 2-3 weeks, have a substitute in place to help control the original issue, add a few more interventions with alternative medicine that will help control the flare up that always happens when stopping potent perscription medicines.
( although I dont think the alcohol is one thing she will give up)
Moral of this story is not to just accept a medicine as a cure. Always work to get off what you are on...whether it is a script or an herbal medicine. Nutrition and exercise are always the basis to treatment even if the doctors dont remember. I will keep an update as to how she tolerates acupuncture, anxiety sufferers dont do well and usually go to alcohol for its depresant properties. No coffee, caffeine, guarana, tobacco. She should also try carb rich diets. I usually suggest protein for breakfast and lunch then carb for dinner. In the anxious case, carbs for dinner with an evenly distributed prot/carb breakfst and lunch is good to go. Suggested breathing technique and reading into drweil.com for some pointers.
Alway insist the doc treats the mind, body and soul. In eastern medicine its all in the same package. Only in america does the body get treated without consideration of the mind. (and visa versa) serotonin that acts on the mind also is big in the colon so docs have no choice but to make it work with a multi faceted aproach.
valerian
respir-eze
kava kava
lavender aromatherapy
emotional freedom technique with psychology
diet and multivit changes.
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