Sunday, April 29, 2018

More Reasons for the Eroding Trust between Patients and Physicians

I’ve just been reading an article by James F. Sweeney, “The Eroding Trust Between Patients and Physicians”, that appeared in the 4/10/2018 issue of Medical Economics. First, I appreciate the fact that Mr. (Dr.?) Sweeney is addressing this issue, which is a serious detriment to effective medical care. Lack of time and of any substantial relationship with the patient are the causes emphasized by Sweeney, but there are a number of others that deserve attention.

Standard of Care imposes constraints that encourage doctors to play it safe and avoid creative thinking. Especially in the field of oncology, the threat of liability intimidates many doctors and may cause them to see each new patient as a potential lawsuit. The treatments endorsed by Standard of Care sometimes reflect out-of-date science rather than the latest and best thinking in the field.

Reliance on randomized controlled trials (in addition to lack of time) means that patients tend to be treated by category. RCTs are useful as an overall indicator, but they don’t tell the physician anything at all about a particular patient.

Medical offices frequently don’t have accurate, long-term medical records for patients. With the advent of electronic records, decades of precious data on individual patients were discarded and lost. Unless the patient herself has kept hard copies, the doctor must make recommendations based on a couple of years of test results. Adding to this problem is the lack of compatibility among EMR systems.

The connection between medical practice and science is becoming more tenuous. Protocols for some tests are not followed correctly. (My favorite example is the taking of blood pressure, when medical offices don’t have you sit quietly for a few minutes beforehand, the correct protocol. Then they tell you that you have high blood pressure.) We hear confident statements that calcium supplements promote heart disease, when the evidence for this is shaky at best. Medical practice tends to cherry pick scientific studies and highlight those that support what it is already doing.

In spite of substantial scientific evidence supporting the role of diet and exercise to good health, many medical practitioners discount their importance. Ads for medical practices and hospitals featuring photos of overweight doctors and nurses are clear evidence of this attitude.

Current medical practice tends to reject, even scorn, any therapy that isn’t part of the conventional canon. After developing painful scar tissue in my shoulder and arms, I was successfully treated by a chiropractor with myofascial therapy (MRT) and active release technique (ART). Conventional medicine’s recommendation? Pain meds or surgery.

These are all features of medical practice today that are causing physicians to lose credibility in the eyes of their patients.

Friday, February 9, 2018

Foot Surgery the Easy Way

I was born with curly little toes on both feet. That never bothered me until the past year, when the left one decided to curl out a bit more and started rubbing against the insides of formerly comfortable shoes and boots. For a while, I babied it along with band aids and pads but finally it was time for a visit to my wonderful podiatrist Dr. Hoffman (introduced in Respect the Feet).

“What have you done this time?” he asked. I explained that I thought I was getting a bunion. Instead, he identified it as a type of hammer toe, a condition that is often treated by breaking the toe and inserting a wire; big incision, lots of pain, weeks of recovery time. Instead, Dr. H proposed a minimally invasive 10 minute procedure in which a tiny incision is made, the tendon is nicked, and the patient goes back to normal life immediately.

So I did that. The worst part of it was the shots to numb the foot. After that, I really felt no pain at all, either during the procedure or later. Dr. H offered an antibiotic and suggested an over the counter pain med, but I said “No, thanks” to both of those. The only real hassle was keeping the dressing dry for a few days, which meant showering with a towel and a plastic bag around my foot. Now I’m back to wearing my regular shoes and boots. Dr. Hoffman scores again!

Sunday, January 21, 2018

Got IBS D? This Probiotic Yeast Could Be Your NBF.

In 2014 my doctor at the time ordered tests in an attempt to find the cause of my longtime gut problems (discussed in Trouble Down Below). The tests came back negative except for the observation that a few Blastocystis hominis (BH) organisms were seen. At some point later on, I mentioned this to a GI specialist and he said, “Oh, that’s nothing!”

In general, this seems to be true. In 2000, approximately 23% of the US population was infected with this protozoan, most with no symptoms at all. (In less developed countries, the percentage is much higher.) BH tends to run with IBS and with colorectal cancer but the relationship is not clear. For a few unlucky people, it can cause major digestive upsets lasting weeks or months.

During a trip last month I started to have diarrhea, acid reflux, and intermittent queasiness. Since I do sometimes have digestive upsets when I travel, I didn’t think much about it. When I got home, the other symptoms went away; the diarrhea got worse­­—many, many trips to the bathroom, often in the middle of the night. Before calling my nurse practitioner to see about ordering tests, I did some online research to see what treatments were likely to be. One word: antibiotics.

I’m not totally against these medications; if I have a life-threatening bacterial infection, an antibiotic is certainly what I want to be taking. In my present situation, though, I had reservations. Antibiotics don’t always work for bowel problems. They can also do long-term damage to the immune system by killing off good bacteria in the gut and they may have unpleasant side effects, like diarrhea and yeast infections.

I started looking around for other options and came upon a yeast called Saccharomyces boulardii (SB). This probiotic is a veritable Swiss Army knife of beneficial functions and has been studied for decades. It has repeatedly been shown to work well against diarrhea, sometimes as well as or better than antibiotics. SB is believed to be a strain of baker’s yeast (S. cerevisiae) and is completely safe and without side effects, except for people who are allergic to yeasts. SB can be combined with antibiotic treatment to help support bowel function; since it’s not a bacterium, antibiotics won’t kill it. SB has been shown in some studies to be effective against Candida albicans, ironic because they are both yeasts. There are also researchers who are looking at various uses of SB for cancer patients.

I started taking SB 250 mg. three times a day. The tests came back showing—you guessed it—Blatocysitis hominis! After a few days with not much change, I went online again and discovered a French study from 1996 about diarrhea in 30 people with AIDS (under Clinical Studies in PWAs). The subjects took 3000 mg of SB per day, six times the normal daily dose. After two days, they saw significant improvement, at eight days their bowel function was normal.

I started taking 3000 mg per day of SB and also saw significant improvement after two days. For me, it took about three weeks to get back to normal. I plan to continue at the same dose for another couple of weeks, then gradually reduce it. Given the possibility of an allergic reaction, I think it was just as well that I tried the lower dose first.

SB is sold under the brand name Florastor, $20 for 20 250 mg capsules, cheaper on Amazon and Ebay. CVS has a generic version that is sometimes on sale. Swanson, the online supplement store, sells its own version, $5.99 for a bottle of 30. Are they as good as the brand name, or better? I don’t know but I plan to experiment later on. Given my gut situation, I expect to be taking SB indefinitely, and happily too!

Friday, November 3, 2017

Layers of Pain

I picture them as cobwebs­ — layer upon layer of cobwebs — binding my muscles, tying them to my bones, pinching sensitive nerves, but unlike cobwebs they are not diaphanous and fragile. These are bands of scar tissue, solid and persistent flesh, and I have them all over my body, palpable reminders of all the times I have misused my muscles over the years: the too-heavy load of books or groceries I just had to carry, the meetings that caused my neck and shoulders to tense up for an hour or more, the overly ambitious stretch in yoga class. 

Up until last year I wasn’t particularly aware of scar tissue as a problem. About a year ago, I started getting pains in my upper arms while doing weight-lifting routines. For a while, I backed off on intensity, thinking that these were injuries that would heal by themselves. I tried heat and ice. Finally, after about six months of no improvement, my personal trainer suggested that I go to a chiropractor, a new experience for me.

The chiropractor turned out to be a man in his early thirties, a serious athlete, who has had more than his share of serious injuries. When he asked me to raise my straight arms from my sides to the highest point possible over my head, he was horrified at the condition of my shoulders. I couldn’t get to the top position and I couldn’t straighten my arms. (Years ago I had had a bad injury to my left shoulder, described in this post, and later to my right, the most overworked side because I am right-handed.) Over a number sessions, this movement improved until he was fairly satisfied with it. But I still had the pain in my arms and rotating my arms forward in a circular motion hurt my shoulders. By now the pain was bad enough that it was waking me up at night.

To treat the scar tissue in my shoulders, arms and legs, the chiropractor used two approaches: myofascial release therapy (MFR), where he presses firmly into tight areas, and active release technique (ART), where he presses into a tight area while I move my arm across a prescribed path. This process ranges from mildly uncomfortable to quite painful, but the benefits have been substantial. I can now sleep at night without pain, though my shoulders and arms are sometimes stiff when I first get up. I am starting to lift weights again. My range of motion is much better but still needs work, especially the right shoulder and arm.

All complex human relationships, especially marriages and doctor-patient interactions, require a constant readjusting of expectations. The chiropractor and I had both anticipated that my situation would be resolved in a matter of weeks, months at the most. It has now been over a year. During that time, symptoms have come and gone. For a while, I had trigger thumb in my right thumb; it lasted for a couple of months, then went away. At one point I mysteriously injured a nerve in my left leg and was hobbling around for a while. We worked on the left leg and that got better too.

Why is all of this happening to me right now? Age is probably a factor; I am 71 now. Another possibility is that in 2016 I stopped taking Premarin, an estrogen supplement I had been happily using for 36 years. Changes in hormones can affect muscles and nerves so this transition may have turned a tolerable situation into one requiring treatment. In any case, I am grateful that these therapies are available to me. Ironically, insurance won’t pay for interventions that are actually restoring me but it would pay for pain medication, which I certainly want to avoid!

Wednesday, May 17, 2017

How To Keep The Weight Off As You Get Older

One of the sad truths about aging is that you inevitably burn fewer calories than you did as a young person, even if you’re physically active, even if you eat a healthy diet. When you retire you may eat out more often and take more trips to foreign countries with delicious food, making the situation even worse.

At our house we have instituted a system of alternating big meals and small meals. A big meal is protein (often chicken or fish), vegetables, and maybe a starch plus a little fruit for dessert. A small meal is soup with a small piece of bread or a quarter of a frittata or a tuna melt, always accompanied by vegetable juice (bottled or homemade). We do three big and three small each week. On the remaining night we eat at a restaurant.

Lately we’ve been wanting to lose a few pounds so we’ve started a low food day every week or so, somewhat like the part-fasting diets that are popular now. Instead of fasting, we have the Mango Lassi with Anti-Cancer Spices for breakfast (plus coffee), the Pretty Good Almond BerryGreen Smoothie for lunch, and the usual kind of small meal for supper. After a few weeks we’ve lost a couple of pounds without too much pain.

The advantage of our system is that it is sustainable. With diets, you eventually go off the diet and the weight often comes right back. Our program incorporates enough foods we enjoy, including an occasional sweet dessert at a restaurant, so that we don’t feel deprived.

Tuesday, March 21, 2017

The New Cats

When our old cat Sadie Pearl died last year at almost 18 years of age, our 10-year-old, Rowan, was lonely and bored. My husband wanted to get another lady cat so we asked our handyman to be on the lookout for likely candidates at his farm, where most of our cats were born. Sometime in May, he started describing a litter of three kittens that were living there with their mother. Even though they were very young, he urged us to take one right away because he was afraid they might be killed by a predator. (Our cat Rowan was orphaned when his family disappeared under mysterious circumstances and he was adopted by the kind people at the farm – and later by us.)

We arrived at the vet with a beautiful little tiger and white kitten and the vet’s assistant, a cat expert, said, “It’s a boy.” However, she just happened to have a female kitten, a feral cat one week older than ours, that might be a suitable friend for him. So we ended up with Max and Bella. The picture of the cats when they were small illustrates their personalities: Max looks straight at you, ready to take on any challenge; Bella tilts her chin up dreamily, like a medieval saint awaiting guidance from Heaven.

During the first few days, I wasn’t sure that we should keep Bella. She seemed slow, almost lethargic, and her hygiene left something to be desired; her little face was often smudged with food. The vet’s assistant then explained that she was a litter of one (very rare) and had been living alone with her mother in a garage, essentially a sensory deprivation capsule. Max was born into the rich environment of a farm with other cats, horses, and cows, along with plants and farm buildings to explore. 

Max is not only masculine but a super-male: full of muscle and bravado. Smart and athletic, he is constantly seeking out new challenges for himself. All of our kittens have had to learn about gravity the hard way, by venturing under the railing around the second floor stairwell and falling to the landing about 10 feet below. For the others, once was enough, but Max has repeated the experience because he wanted to learn how to walk along the railing, a skill that none of our other cats ever mastered. 

For the first months of her life, Bella remained a kind of slow, dreamy moonchild of a cat but sometime after she was spayed she seemed to become more energetic and more focused. She and Max have always play-wrestled but now she sometimes chased him. Sometimes she tries to get Rowan to play with her, by rolling on her back in front of him and making little chirping noises. Usually, he considers this beneath him and walks away, though he sometimes play-wrestles with Max.

When the kittens first came, Rowan was horrified. He seemed to feel that these were not cats but alien beings introduced into his home. Over the next weeks, though, he came to enjoy watching their antics and gradually to interact with them directly. Sadie Pearl, his previous companion, had not been much of a role model in this respect. Like many lady cats, she was rather a diva. The new cats, though, are both friendly, playful, and easy-going, a welcome diversion for an older gentleman cat.

Sunday, February 12, 2017

How I’ve Saved the Health Care System Thousands of Dollars

  • Orthotics for problem feet, starting in my 40s, allowed me to do strenuous workouts and possibly to avoid later ankle, hip, and lower back surgery.
  • Opted for acupuncture instead of surgery for rotator cuff injuries.
  • In my 50s, used diet and exercise to lose weight instead of taking statins to lower cholesterol.
  • Started taking protein supplements and proteolytic enzymes to retain and build strong muscles. Enzymes also help to heal injuries.
  • Discovered that probiotics could alleviate long-term digestive problems, improve overall health. Drinking homemade vegetable and fruit juices may have helped too.
  • Treated my psoriasis with biotin (Vitamin B7), not prescription drugs.
  • In my 70s, began impact exercise (jumping) instead of bisphosphonates to improve bone strength.
  • Currently receiving chiropractic treatment (myofascial release therapy and active release technique) for scar tissue in my shoulders and arms instead of taking pain meds or trying surgery.
Of these, only the orthotics are covered by insurance and even those have been said to be ineffective in some studies.Yet athletes use them all the time.