The question we need to ask ourselves is whether our officials are making the right decisions regarding this Ebola outbreak. I am sure you have heard the CDC say that there is no way an infectious outbreak of Ebola could occur in our country like it has in Liberia and Sierra Leone. This is because we have too sophisticated of a healthcare system and our population is able to exercise appropriate hygiene.
I beg to differ. In my opinion I am beginning to believe that Dr. Anthony Fauci of NIH and Dr. Frieden of the CDC are not only wrong but maybe it is time for them to step down as head of their respective departments. While I agree that we are unlikely to have a scenario such as that seen in those West African countries where the corpses are tossed into the river we have duplicated their problem of having a healthcare worker using appropriate precautions now contracting this dreadful disease. Now, the CDC is reconsidering whether every hospital in the country is able to handle this disease. This is no surprise to me as we have seen hundreds of healthcare workers in Africa sickened and dying from this disease due to exposure at work while doing their best to exercise appropriate precautions.
My concern as I stated in my last post is not that we will have a massive outbreak of uncontrolled Ebola but rather the financial devastation an outbreak would cause our country. We need to look at the amount of effort we are expending in Dallas for a single patient that brought this disease to our country. We are now monitoring 50 people, one of whom has developed the disease, we have hundreds of CDC professionals in the city of Dallas both monitoring the disease as well as reassuring the public.
Do we have the resources to respond to this degree if we have individuals in multiple locations being diagnosed and treated for this condition? At what point does the cost of fighting the disease as well as the lack of adequate professionals trained in caring for the disease become overwhelming? I think we each need to ask ourselves if we would modify our behavior if someone in our community developed Ebola. Would you take your child out of school? Stop going to parks and other recreational activities? Would you treat a coworker differently who comes to work coughing and sneezing? If you were a healthcare worker would you feel confident that the patient you were seeing in your office or the emergency room was not a dangerous carrier of this disease?
I suspect that many of you would answer yes to at least one of the questions above. Therefore if we this infection is not contained to the two people in Texas we might see dramatic changes in behavior as we act to protect ourselves and in the process our economy could come to a serious halt. We must remember that the act of 911 where 3000 people died resulted in the freezing of aviation for only two days. How many days would we be shutting down airports if we were worried about the disease spreading throughout our country?
I think it is time to state the obvious. The inherent dangers in this disease require a much more aggressive response than we have seen by our government. I am not reassured that checking body temperature on individuals traveling from the countries of Sierra Leone, Liberia and Guinea is adequate to prevent additional transmissions in our country. I believe that anyone who has traveled to those countries should not be allowed to enter the United States until they have passed the 21 day incubation period. While this may seem inconvenient to the 200 people a day who wish to enter our country it is a hazard we should not risk!
Finally, now that I have finished ranting I would like to announce I have completed 5 more chapters of "Virestorm" and I will begin sharing them on this blog. Check back soon to see them posted.
Tuesday, October 14, 2014
Tuesday, October 7, 2014
Are You Afraid of Ebola? You Should Be...
Why? Many of you have read the first few chapters of my story "Virestorm" about a nefarious plot to trigger an outbreak of Avian flu. If that seems frightening the possibilities with Ebola are truly staggering.
Let's start with a few statistics. As of 9/30 7400 people contracted the disease and 3439 have died. We have now had our first confirmed case on US soil and Spain has had their first. The disease has a 50% mortality and is transmitted in blood, urine, saliva, sweat, and feces. The dormant period is up to 3 weeks and you are contagious when you have initially mild symptoms of fever, sore throat and cough.
OK, big deal, the CDC says they will have no trouble containing the outbreak in Texas monitoring the 50 exposed people. Texas doesn't scare me, what scares me is what Texas tells me could happen.
Give me a moment to expand. I was talking to a biomedical expert 2 weeks ago and she confirmed the virus can live on soiled clothing for at least a few days. I can think of lots of ways trouble could happen. When I was talking to a friend about it on Saturday he thought I was describing a new Clancy novel.
So, let's imagine there is an evil person or group who wants to cause terror and disruption. How might they do it and could the plot already be in action? Maybe our person in Texas was just a test to see if the virus could make it into the country and to see how well we responded. If that's the case the hospital failed the initial test as Mr. Duncan was sent home contagious. During the next few days he was in contact with many people. But, the scary aspect of this is how easily he made it here and once ill was able to circulate among the population.
What would happen if someone was able to gain access to tissue and bring it here? I don't think the idea is too farfetched. I was just reading that in the poorer areas of Africa people are tossing infected bodies into the local rivers for disposal. How hard would it be for a Jihadi to grab one of these bodies and take a chunk of diseased tissue and put it on dry ice or liquid nitrogen and manage to bring it in to our country?
Once here he could walk through a crowded subway rubbing infected tissue onto unsuspecting hands. I'm sure someone would end up rubbing an eye or nose or mouth and perhaps this person would start their 21 day incubation period. What happens when the unsuspecting person becomes contagious with typical flu symptoms a few weeks later and is transmitting the virus to others on public transportation? Imagine a few people doing this in a few major cities. If Jihadists are willing to blow themselves up I believe they would be willing to die of a tragic disease to achieve their aims.
How disrupted would our economy be when hundreds if not thousands of people became either infected or placed in quarantine? We can't forget that taking down two office towers and killing 3,000 people resulted in a severe impact on our nation and economy.
You can even twist the plot a little. Our own president was riding an elevator a few weeks ago with an uncleared contractor with a bad history and was carrying a weapon. Maybe the sloppy secret service could allow someone with an Ebola tainted cloth come in contact with the President or a family member or member of the cabinet. Maybe aim low and just infect a US congressman.
I think that if 9/11 caused us trouble we have no idea how bad it could really be. Forget about grounding airplanes. If we had a well orchestrated attack we would be shutting down transportation, schools, sporting events. The list goes on.
You are reasonable if you ask if there is anything we can do. I don't think we can completely prevent something this evil but I think we better be prepared. Personally, I am beginning to think that anyone traveling from those areas of Africa should be placed in 21 days quarantine. And I'm not afraid of us forfeiting some civil liberties for the next few months particularly regarding monitoring of telephone and electronic communications. I also suggest being prepared to park yourself and your family at home for at least a few weeks if something does happen.
That reminds me, I better tell my wife to buy some more canned goods!
Thursday, September 25, 2014
Vindicated
On my first day of medical school one of the first lectures we attended we were told that even though we would be studying and memorizing facts we should expect that everything would change and that in 20 years we would probably find out everything we had learned was no longer correct. I took that bit of wisdom to heart and I maintained a healthy skepticism of everything we were taught.
About six months in to medical school we were studying renal, kidney, physiology and the associated pathologic diseases. One of the most important of these is hypertension or high blood pressure. The kidney in the process of filtering our blood is responsible for controlling how much water is excreted as well as maintenance of our electrolytes such as potassium and sodium.
According to our professor increased sodium intake in the form of table salt leads to water retention and therefore hypertension. According to our professor the main way to manage this was via sodium restriction. The study referenced basically showed that if a group of patients went on a severe restriction of sodium their blood pressure went down. Also if they took medication that depleted sodium it would have the same impact. The conclusion was that sodium intake caused high blood pressure.
To my critical mind the conclusion wasn't necessarily supported by the facts. Just because the blood pressure decreases in a person with hypertension when the sodium goes down didn't mean the sodium caused the problem in the first place. At the time in the mid 80's we didn't have a lot of medication and this was one of the primary treatment methods.
At the end of the lecture I approached the professor and stated my concern that the conclusion made wasn't necessarily supported. The professor looked at me like I was a complete idiot and said I was wrong and of course he was right. Unfortunately, the way I was spoken to discouraged me from confronting faculty in the future. I chose to keep my criticisms to myself. I can only assume other students of medicine or science must have experienced this as well and may have held back on their expresson of critical thinking which is vital to the advancement of science and medicine.
Over the years we have all learned of previous dogma that many years later was proven wrong. One recent major example had to do with cholesterol and heart disease. Decades ago when heart disease started increasing scientist looked at the blood vessels especially in the heart and saw atherosclerosis plaques blocking the blood flow. These plaques looked like cheese under the microscope and were indeed full of cholesterol. The conclusion was that cholesterol caused heart disease. The result was a complete change of the American diet to low fat, low protein, high carbohydrate diets. Ironically these changes have had no benefit in managing heart disease and has caused a huge jump in diabetes. We now know that the food pyramid was wrong and it is OK to eat meat, eggs, butter, and milk.
The pharmaceutical industry is still focused on lowering our cholesterol but there are no studies showing benefit in otherwise healthy people and very limited benefit in those with heart disease. In fact what does help is advice any mother could give. Eat a balanced diet, fresh vegetables, get plenty of rest, and exercise regularly.
Now back to the original reason why I wrote this story. Yesterday I was reading time magazine and they quoted a scientific study that showed that dietary sodium intake in otherwise healthy people had no impact on high blood pressure. While i was glad to see this l can only guess it took 30 years to reverse this dogma because inquisitive critical thinkers were discouraged from questioning these ideas. In fact, I think it takes a great deal of courage to be willing to go against accepted opinions. When a courageous person is shot down early in their career we as a society potentially lose a great deal.
Fortunately, those who know me will confirm that despite the occasional episode of discouragement I remain eager to express my critical reviews of dogmatic ideas that aren't well supported by the facts. We should all remember to be patient and supportive of those who are willing to swim against the current for they may be the next one to discover the real answer to that which plagues us.
Friday, September 19, 2014
7 Pounds in 7 Weeks! Thanks to my 12 Year Old Dietician
I really have lost 7 pounds in 7 weeks and it wasn't hard so I feel compelled to share this. This isn't the first time i lost weight and I wouldn't describe myself as someone who desperately needs to lose weight but like most of you I want to look and feel good.
I imagine many of you have noticed the same thing I have which is that as I get older my weight goes up. This has happened despite exercising 3 to 4 times a week. I also am afflicted with stratospheric cholesterol and lipids. That did improve with medication but I had severe side effects which could be the subject of a post in the future. So for 20 years I have played with my diet following the food pyramid avoiding red meat eating grains and fruits and vegetables. I even tried being a vegetarian several years ago.
Despite all those efforts my weight slowly went up. I weighed about 165 when I finished my residency at 32. By the time I was 39 I weighed 175 and just looked chubby. But, then over the next year I last 16 pounds. This was a result of two factors. I started surfing which was responsible for about 2 pounds. The other 14 were because I went through a divorce and was anxious and lost my appetite. I don't recommend that weight loss program and my current wife who is beautiful, wonderful and perfect has voted against the strategy.
Anyway, after the divorce over the next 11 years my weight slowly climbed to 177.5. This occurred despite watching my diet and exercising. I did notice over the years that my weight would drop a pound or two if I stopped consuming alcohol. Also I would have a drop a couple days after returning from a surfing vacation. But the weight would creep back up.
Now, I'm sure many of you are familiar with the recent diet trends such as the paleo diet or the Adkins diet. I have considered them too much of a fad and also not really the way I want to eat. I even had a friend try to convince me to do the fasting diet. In that one you basically starve yourself once a week for at least 24 hours. The idea is that fasting causes a systemic glucose depletion and so fat will be burned at a high rate to replace the necessary brain food. That one just seemed to hard for me.
So, I was in Michigan 8 weeks ago. Michigan is usually very bad on my waistline. I feared returning home with a new record weight. I was at dinner with my close friend, Ross Halpern and his son Ariel. Ariel is a bright high energy 12 year old. Ross and I are discussing our slow weight gain over the years and how frustrating it is. Ariel interrupted Ross and said "Dad you need to go back on your no carb diet! " Ross agreed and took his piece of bread he was ready to bite and put it down. Ironically, skinny Ariel immediately grabbed it and ate it.
Ross went on to tell me that whenever he did a strict low carb diet he would lose weight. Ariel was pleased to confirm his father's success. I told them it would be wayy too hard for me to give up carbs. I like them too much. But, I was going with my family in a couple of days to family camp in northern Michigan and I thought maybe I would work on it there.
So, I did do my best at camp. I wasn't going to skip all carbs but i gave up on breads and other starches. Sometimes I would break down in the evening but I stayed pretty true. When we got back to California my weight surprisingly was stable at 177. I decided to hold the course with some exceptions. I decided I wouldn't eat my morning oatmeal and instead would do a protein bar. For lunch I would give up bread but I was going to increase the meats and make big salads.
A strange thing happened. I noticed my appetite went down. I also found myself not as tired in the afternoon. I like to weigh myself everyday. This is against all the books but I know my weight fluctuates and I like to keep mental track of my highest high and my lowest low. So by the end of the first week at home my high was 177 and my low was 176.
The next week I peaked at 176.5 and bottomed at 175. At that point I thought it was intriguing but not a trend. In fact i was so skeptical I didn't say a word to my wife. But nonetheless I stayed true and despite my skepticism I wasn't hungry and things progressed.
About 2 weeks ago I asked Cynthia if she noticed anything and she said my face looked skinnier. I noticed pants that were tight 2 months ago were fitting nicely. I started to think a real tend was happening. I didn't want to share any of this until i crossed a significant milestone. For me that was a week where I consistently hit 172.5. That was my old standard weight where I could wear a 32 inch waist pants.
I crossed that last week. This week i peaked at 172.5 and my low shocked me at 170.5. I haven't been there in over 5 years. So now I'm beginning to think this is more than a trend. The interesting thing is that I'm not doing a no carb diet. I'm only avoiding breads and starchesee for breakfast and lunch. Dinner I do whatever I want including a cocktail if I desire. I have increased my protein and even the fats.
I've thought a lot about why this is working so well for me. Obviously, my metabolism is performing very well with this. I believe that since there are no simple carbs after dinner until dinner the next day my body is forced to burn fat for glucose. I'm not starved but my body has to adjust. When I do eat carbs at night it isn't enough to carry my body in to the next day.
The result is burning fat without much discomfort. I don't know how this will impact my cholesterol and lipids. I'm going to wait until I get down to 168, my ideal weight, and then get tested. At this point I'm very hopeful. You can be assured I will let you know.
Realistically we are all different and what works for me may not work for you but if you give it a try and it works, or even if it doesn't let me know. By the way, I still exercise 3 to 4 days a week and I think that is critical to success.
Finally, I would like to thank my 12 year old buddy Ariel for pushing me to do this.
I imagine many of you have noticed the same thing I have which is that as I get older my weight goes up. This has happened despite exercising 3 to 4 times a week. I also am afflicted with stratospheric cholesterol and lipids. That did improve with medication but I had severe side effects which could be the subject of a post in the future. So for 20 years I have played with my diet following the food pyramid avoiding red meat eating grains and fruits and vegetables. I even tried being a vegetarian several years ago.
Despite all those efforts my weight slowly went up. I weighed about 165 when I finished my residency at 32. By the time I was 39 I weighed 175 and just looked chubby. But, then over the next year I last 16 pounds. This was a result of two factors. I started surfing which was responsible for about 2 pounds. The other 14 were because I went through a divorce and was anxious and lost my appetite. I don't recommend that weight loss program and my current wife who is beautiful, wonderful and perfect has voted against the strategy.
Anyway, after the divorce over the next 11 years my weight slowly climbed to 177.5. This occurred despite watching my diet and exercising. I did notice over the years that my weight would drop a pound or two if I stopped consuming alcohol. Also I would have a drop a couple days after returning from a surfing vacation. But the weight would creep back up.
Now, I'm sure many of you are familiar with the recent diet trends such as the paleo diet or the Adkins diet. I have considered them too much of a fad and also not really the way I want to eat. I even had a friend try to convince me to do the fasting diet. In that one you basically starve yourself once a week for at least 24 hours. The idea is that fasting causes a systemic glucose depletion and so fat will be burned at a high rate to replace the necessary brain food. That one just seemed to hard for me.
So, I was in Michigan 8 weeks ago. Michigan is usually very bad on my waistline. I feared returning home with a new record weight. I was at dinner with my close friend, Ross Halpern and his son Ariel. Ariel is a bright high energy 12 year old. Ross and I are discussing our slow weight gain over the years and how frustrating it is. Ariel interrupted Ross and said "Dad you need to go back on your no carb diet! " Ross agreed and took his piece of bread he was ready to bite and put it down. Ironically, skinny Ariel immediately grabbed it and ate it.
Ross went on to tell me that whenever he did a strict low carb diet he would lose weight. Ariel was pleased to confirm his father's success. I told them it would be wayy too hard for me to give up carbs. I like them too much. But, I was going with my family in a couple of days to family camp in northern Michigan and I thought maybe I would work on it there.
So, I did do my best at camp. I wasn't going to skip all carbs but i gave up on breads and other starches. Sometimes I would break down in the evening but I stayed pretty true. When we got back to California my weight surprisingly was stable at 177. I decided to hold the course with some exceptions. I decided I wouldn't eat my morning oatmeal and instead would do a protein bar. For lunch I would give up bread but I was going to increase the meats and make big salads.
A strange thing happened. I noticed my appetite went down. I also found myself not as tired in the afternoon. I like to weigh myself everyday. This is against all the books but I know my weight fluctuates and I like to keep mental track of my highest high and my lowest low. So by the end of the first week at home my high was 177 and my low was 176.
The next week I peaked at 176.5 and bottomed at 175. At that point I thought it was intriguing but not a trend. In fact i was so skeptical I didn't say a word to my wife. But nonetheless I stayed true and despite my skepticism I wasn't hungry and things progressed.
About 2 weeks ago I asked Cynthia if she noticed anything and she said my face looked skinnier. I noticed pants that were tight 2 months ago were fitting nicely. I started to think a real tend was happening. I didn't want to share any of this until i crossed a significant milestone. For me that was a week where I consistently hit 172.5. That was my old standard weight where I could wear a 32 inch waist pants.
I crossed that last week. This week i peaked at 172.5 and my low shocked me at 170.5. I haven't been there in over 5 years. So now I'm beginning to think this is more than a trend. The interesting thing is that I'm not doing a no carb diet. I'm only avoiding breads and starchesee for breakfast and lunch. Dinner I do whatever I want including a cocktail if I desire. I have increased my protein and even the fats.
I've thought a lot about why this is working so well for me. Obviously, my metabolism is performing very well with this. I believe that since there are no simple carbs after dinner until dinner the next day my body is forced to burn fat for glucose. I'm not starved but my body has to adjust. When I do eat carbs at night it isn't enough to carry my body in to the next day.
The result is burning fat without much discomfort. I don't know how this will impact my cholesterol and lipids. I'm going to wait until I get down to 168, my ideal weight, and then get tested. At this point I'm very hopeful. You can be assured I will let you know.
Realistically we are all different and what works for me may not work for you but if you give it a try and it works, or even if it doesn't let me know. By the way, I still exercise 3 to 4 days a week and I think that is critical to success.
Finally, I would like to thank my 12 year old buddy Ariel for pushing me to do this.
Tuesday, August 19, 2014
The Day The Car Was Too Loud
Ok, I know I haven't written a post in ages but today I just had to post a funny incident. About a month ago I did a routine simple surgery of placing tubes in a child's ears. Usually, at the preoperative visit I counsel the parents that some of the children will be hearing well for the first time in a while and they might complain about loud noise. They should be careful the first few days especially to avoid shouting.
Anthony had a long history of attention deficit and autism symptoms and when he saw me he had complaints of poor attention and poor hearing. His symptoms were present for years but it was unclear whether his ears were part of the source of his troubles. We did an audiogram and found that he had about a 30% decrease in hearing as well as poor eardrum motion. We tried some medication to clear the ears without success and so a month ago I placed tubes in his ears.
Today he came in for his recheck and he told me he was hearing a lot better. I asked mom how he did after the surgery and she said it was very easy. She did remark "When we got in to my car he complained how loud it was." I nodded and smiled because this was not surprising until she said to me, "I thought that was pretty interesting because I drive a Prius!"
I have to admit that made me laugh pretty hard. After they took off I thought about when I decided to do Otolaryngology. When I was in medical school and trying to decide which area of medicine to specialize I knew I wanted to have the ability to make a significant impact on people's lives. When I was introduced to my specialty of Otolaryngology (ENT) I was excited by the opportunity to restore the sense of hearing.
When I did my residency we first learned the easier and more common surgeries such as placing tubes in children's ears and tonsillectomy but soon the training shifted to more exciting and dramatic procedures on all areas of the head and neck including removing tumors, reconstructing eardrums, and inserting tiny artificial bones to restore hearing and soon those original procedures seemed very mundane.
I recall talking to one of the Fellows in Pediatric ENT on a day we did surgery on about 20 children who needed tubes put in their ears or removal of tonsils. I asked him if he found it boring in comparison to the more involved surgeries. He looked at me surprised and said he loved it all and wouldn't give up any of it. After that conversation I made sure that regardless of how mundane or repetitive things were I was going to try to enjoy it.
My experience with Anthony and his hearing the Prius is one way of making sure my work doesn't become boring or mundane. I feel fortunate that I am able to experience this level of satisfaction as I know it is a rare occurrence for most people . I find that it is incredible that a relatively easy task can have such a large impact. Sometimes the easiest things have the most fantastic and dramatic results.
I hope I made you smile today and I'll try to bring the next story to you a little quicker.
Anthony had a long history of attention deficit and autism symptoms and when he saw me he had complaints of poor attention and poor hearing. His symptoms were present for years but it was unclear whether his ears were part of the source of his troubles. We did an audiogram and found that he had about a 30% decrease in hearing as well as poor eardrum motion. We tried some medication to clear the ears without success and so a month ago I placed tubes in his ears.
Today he came in for his recheck and he told me he was hearing a lot better. I asked mom how he did after the surgery and she said it was very easy. She did remark "When we got in to my car he complained how loud it was." I nodded and smiled because this was not surprising until she said to me, "I thought that was pretty interesting because I drive a Prius!"
I have to admit that made me laugh pretty hard. After they took off I thought about when I decided to do Otolaryngology. When I was in medical school and trying to decide which area of medicine to specialize I knew I wanted to have the ability to make a significant impact on people's lives. When I was introduced to my specialty of Otolaryngology (ENT) I was excited by the opportunity to restore the sense of hearing.
When I did my residency we first learned the easier and more common surgeries such as placing tubes in children's ears and tonsillectomy but soon the training shifted to more exciting and dramatic procedures on all areas of the head and neck including removing tumors, reconstructing eardrums, and inserting tiny artificial bones to restore hearing and soon those original procedures seemed very mundane.
I recall talking to one of the Fellows in Pediatric ENT on a day we did surgery on about 20 children who needed tubes put in their ears or removal of tonsils. I asked him if he found it boring in comparison to the more involved surgeries. He looked at me surprised and said he loved it all and wouldn't give up any of it. After that conversation I made sure that regardless of how mundane or repetitive things were I was going to try to enjoy it.
My experience with Anthony and his hearing the Prius is one way of making sure my work doesn't become boring or mundane. I feel fortunate that I am able to experience this level of satisfaction as I know it is a rare occurrence for most people . I find that it is incredible that a relatively easy task can have such a large impact. Sometimes the easiest things have the most fantastic and dramatic results.
I hope I made you smile today and I'll try to bring the next story to you a little quicker.
Tuesday, October 8, 2013
Ruminations on our healthcare and our government
I think it's pretty obvious from the posts here that I love what I do. So when I have a chance one of my favorite things is to just talk with my patients. Lately, the most common comments I receive are about Obamacare and the childlike behavior of our government.
A very satisfied patient came in today. For years he was suffering from fatigue, eye itching, and generally just miserable. He had gone to doctors with no help. Once here I diagnosed allergies. But since he didn't have classic symptoms it took a while to convince him to do treatment. A year in to allergy shots and he's doing great.
Today was his annual visit. Just so happens he was one of the government furlough victims but fortunately he was called back to work after just one week. We were talking about the government and we both were shaking our heads. After all, we have to maintain a budget, please our customers and we are subject to feedback regarding our performance. We aren't able to just disagree and shut down businesses. We have to work!
Somehow, the folks in congress, who are elected to create and execute a budget, refuse to do the primary job they are required to perform. And this weak performance is rewarded with lifetime healthcare and a retirement program even if they only serve a single two year term. Even better, they get to gerrymander their districts so they can maximize their chance of reelection. On top of this, once they finish their service they oftentimes are hired by lobbying companies for huge salaries. Quite a deal for a group that doesn't even execute their job.
So, what does this have to do with healthcare? The second thing we talked about is whether the Affordable Care Act, aka Obamacare, is going to affect me. For a long time I told people I just didn't know the answer. But now I do have some answers, and they are a bit unsettling.
My office has provided good quality health insurance to the doctors and the employees for over 15 years. This year we received notification that in reward of this long history of dedication due to Obamacare our premiums would INCREASE 30%. The only silver lining is that they were allowing us to renew our plan from last year with pre Obamacare mandates if we signed up this week.
Now, here is the kicker, we just received notification that due to Obamacare if we were going to be on panels to treat these newly insured patients were are to take a 30% REDUCTION in payments. Hmmm! I may not have won a Nobel prize in mathematics but something here does not add up.
So, I am now wondering if the impact on my medical practice is an increase in my insurance premiums as well as a reduction in reimbursements how will this impact other physicians in the country? Now, I know that someone out in the ether is going to tell me I should thank the Republicans in Congress who are trying to shut down Obamacare.
I have a different perspective. If the Republicans in Congress recognized they can do a great deal of positive change by not shutting down Obamacare but demanding some corrections they could make this much better for all of us. I highly doubt the President and the Democrats are going to allow this program to be shuttered but I do believe they are starting to see the warts and might be willing to make some change.
Therefore, I ask all of you to ring the bell out there and encourage some reasonable civic minded discussion on how we can get our Government to do its job. In exchange, I promise to tell some new stories about my wonderful patients. And yes, despite all the insanity I still love what I do.
A very satisfied patient came in today. For years he was suffering from fatigue, eye itching, and generally just miserable. He had gone to doctors with no help. Once here I diagnosed allergies. But since he didn't have classic symptoms it took a while to convince him to do treatment. A year in to allergy shots and he's doing great.
Today was his annual visit. Just so happens he was one of the government furlough victims but fortunately he was called back to work after just one week. We were talking about the government and we both were shaking our heads. After all, we have to maintain a budget, please our customers and we are subject to feedback regarding our performance. We aren't able to just disagree and shut down businesses. We have to work!
Somehow, the folks in congress, who are elected to create and execute a budget, refuse to do the primary job they are required to perform. And this weak performance is rewarded with lifetime healthcare and a retirement program even if they only serve a single two year term. Even better, they get to gerrymander their districts so they can maximize their chance of reelection. On top of this, once they finish their service they oftentimes are hired by lobbying companies for huge salaries. Quite a deal for a group that doesn't even execute their job.
So, what does this have to do with healthcare? The second thing we talked about is whether the Affordable Care Act, aka Obamacare, is going to affect me. For a long time I told people I just didn't know the answer. But now I do have some answers, and they are a bit unsettling.
My office has provided good quality health insurance to the doctors and the employees for over 15 years. This year we received notification that in reward of this long history of dedication due to Obamacare our premiums would INCREASE 30%. The only silver lining is that they were allowing us to renew our plan from last year with pre Obamacare mandates if we signed up this week.
Now, here is the kicker, we just received notification that due to Obamacare if we were going to be on panels to treat these newly insured patients were are to take a 30% REDUCTION in payments. Hmmm! I may not have won a Nobel prize in mathematics but something here does not add up.
So, I am now wondering if the impact on my medical practice is an increase in my insurance premiums as well as a reduction in reimbursements how will this impact other physicians in the country? Now, I know that someone out in the ether is going to tell me I should thank the Republicans in Congress who are trying to shut down Obamacare.
I have a different perspective. If the Republicans in Congress recognized they can do a great deal of positive change by not shutting down Obamacare but demanding some corrections they could make this much better for all of us. I highly doubt the President and the Democrats are going to allow this program to be shuttered but I do believe they are starting to see the warts and might be willing to make some change.
Therefore, I ask all of you to ring the bell out there and encourage some reasonable civic minded discussion on how we can get our Government to do its job. In exchange, I promise to tell some new stories about my wonderful patients. And yes, despite all the insanity I still love what I do.
Friday, July 5, 2013
Noises In My Head
I was sitting in the doctors lounge the other day and I overheard two physicians talking about a patient. One doctor was telling the other how his patient had ringing in his ears. He said it was causing a lot of discomfort but he didn't see anything wrong on the exam. He went on to say that there wasn't anything we could do for it and so he told the patient to live with the problem.
So is that true, do you have to live with noise in your ears?
I would like to talk about about this disorder of hearing sound in the head and share my thoughts about what can and should be done. First of all, we need to be using the proper terminology. The sensation of a sound in the head is called "Tinnitus". A diagnosis of tinnitus is just a medical way of acknowledging how to describe the problem.
There are many causes of tinnitus but most essentially relate to the same general problem. The inner ear communicates with the brain constantly by sending signals back and forth. When a problem occurs in that path such as when you have lost hearing the signal increases in intensity and frequency and you hear ringing. If hearing is restored or the path is repaired then hearing goes away.
We have all experienced this when we have been exposed to a loud noise and we have a sudden loss in hearing with the onset of ringing in our ears. A few of us may have experienced this at July 4th celebrations yesterday. Fortunately, healthy ears will often times recover over the next few hours.
We have a problem when the ringing never goes away. So, if someone develops ringing in the ears what should they do? First of all, don't panic. Second, be wary of what you read on the internet. Third, don't let your doctor dismiss your problem without an adequate evaluation. An adequate evaluation includes a complete look at the head and neck area.
I often times find the culprit of the ringing when I look in the ears. One very common cause is wax impacting the ear canal or touching the eardrum. Fortunately, this is easy to fix. I even had a patient this morning whose main cause of her tinnitus was wax. Another common cause is fluid trapped behind the eardrum from a recent upper respiratory infection. Once the fluid resolves most times so does the tinnitus.
Unfortunately, looking in the ears doesn't always identify the cause. Usually I will proceed with a detailed hearing test. Most patients who have tinnitus will have hearing loss and that hearing loss is usually in the frequencies that the sound is heard. If the hearing loss is due to injury to the eardrum, the middle ear or the tiny bones then surgery may be offered. More commonly the loss is to the sensory apparatus itself. This is called sensorineural hearing loss.
The next question I usually get asked is what can be done. This is where the frustration was expressed by that physician I was mentioning at the beginning of this article. Since we can't cure sensorineural hearing loss what is the benefit from going through this whole process? Most hearing loss can improve with hearing aids and up to 70% of people who use hearing aids who have tinnitus will have improvement in their tinnitus symptoms. There are even hearing aids that have the ability to place a sound in the ear that helps quiet the tinnitus.
Some of my patients don't have poor enough hearing to benefit from a hearing aid. I had a middle age woman present with that scenario today. We talked about the various ways to try to handle the tinnitus.
In addition there are several things that can exacerbate tinnitus or trigger it. Any medication that affects the nervous system can be trouble. Also aspirin in high doses and in some people even low doses. Stress, anxiety, tension and fatigue all will worsen symptoms. Jaw clenching and teeth grinding is another source of trigger.
Currently I recommend several things to try to help mitigate the symptoms:
1) Play masking sounds to quiet the tinnitus. This could be a water fountain or a music player. You can download masking sounds in the Apple and Google app stores.
2) Consider meditation and relaxation exercises when the tinnitus worsens.
3) Supplements known to improve symptoms include zinc 40-50mg/day, Gingko Biloba, and bioflavinoids often called "Tinnitus Relief Formula" in pharmacies. A well known version on the internet is Arche's Tinnitus Relief. With these supplements changes may not be felt for 30 to 60 days but if there is no relief by 90 days they probably aren't worth continuing. In addition, I have had some success having patients start melatonin about 1-2 hours before bedtime to help you fall asleep.
4) Tinnitus suppression-This is based upon the idea that if sound is presented in the ear at the frequency of tinnitus it can help with the feedback loop between the ear and the brain to calm the ear down. There are studies that show that if the sound is played up to 2 hours per day for several weeks, long lasting suppression can occur. I have recommended that patients try downloading an application from their smart phone. A number of these are free and are found by searching "Tone Generator". Once installed on your smartphone find the tone that matches the frequency of your tinnitus and play it at a low volume, just loud enough to be louder than your tinnitus. Start off at a few minutes per day and increase based upon your tolerance up to 2 hours per day. If you begin to observe the tinnitus improving then continue with the program as long as you wish. Most studies suggest 2 to 6 months of treatment.
5) Don't give up, new ideas are coming up every year and most people will have some spontaneous improvement in 3-6 months after symptoms start.
I strongly recommend my patients check out www.ATA.org The American Tinnitus Association puts out a quarterly journal that is understandable and relates the latest research and ideas for tinnitus management.
I hope those of you who have tinnitus or know someone who suffers will find some comfort in reading this article and you are welcome to print this and share it.
So is that true, do you have to live with noise in your ears?
I would like to talk about about this disorder of hearing sound in the head and share my thoughts about what can and should be done. First of all, we need to be using the proper terminology. The sensation of a sound in the head is called "Tinnitus". A diagnosis of tinnitus is just a medical way of acknowledging how to describe the problem.
There are many causes of tinnitus but most essentially relate to the same general problem. The inner ear communicates with the brain constantly by sending signals back and forth. When a problem occurs in that path such as when you have lost hearing the signal increases in intensity and frequency and you hear ringing. If hearing is restored or the path is repaired then hearing goes away.
We have all experienced this when we have been exposed to a loud noise and we have a sudden loss in hearing with the onset of ringing in our ears. A few of us may have experienced this at July 4th celebrations yesterday. Fortunately, healthy ears will often times recover over the next few hours.
We have a problem when the ringing never goes away. So, if someone develops ringing in the ears what should they do? First of all, don't panic. Second, be wary of what you read on the internet. Third, don't let your doctor dismiss your problem without an adequate evaluation. An adequate evaluation includes a complete look at the head and neck area.
I often times find the culprit of the ringing when I look in the ears. One very common cause is wax impacting the ear canal or touching the eardrum. Fortunately, this is easy to fix. I even had a patient this morning whose main cause of her tinnitus was wax. Another common cause is fluid trapped behind the eardrum from a recent upper respiratory infection. Once the fluid resolves most times so does the tinnitus.
Unfortunately, looking in the ears doesn't always identify the cause. Usually I will proceed with a detailed hearing test. Most patients who have tinnitus will have hearing loss and that hearing loss is usually in the frequencies that the sound is heard. If the hearing loss is due to injury to the eardrum, the middle ear or the tiny bones then surgery may be offered. More commonly the loss is to the sensory apparatus itself. This is called sensorineural hearing loss.
The next question I usually get asked is what can be done. This is where the frustration was expressed by that physician I was mentioning at the beginning of this article. Since we can't cure sensorineural hearing loss what is the benefit from going through this whole process? Most hearing loss can improve with hearing aids and up to 70% of people who use hearing aids who have tinnitus will have improvement in their tinnitus symptoms. There are even hearing aids that have the ability to place a sound in the ear that helps quiet the tinnitus.
Some of my patients don't have poor enough hearing to benefit from a hearing aid. I had a middle age woman present with that scenario today. We talked about the various ways to try to handle the tinnitus.
In addition there are several things that can exacerbate tinnitus or trigger it. Any medication that affects the nervous system can be trouble. Also aspirin in high doses and in some people even low doses. Stress, anxiety, tension and fatigue all will worsen symptoms. Jaw clenching and teeth grinding is another source of trigger.
Currently I recommend several things to try to help mitigate the symptoms:
1) Play masking sounds to quiet the tinnitus. This could be a water fountain or a music player. You can download masking sounds in the Apple and Google app stores.
2) Consider meditation and relaxation exercises when the tinnitus worsens.
3) Supplements known to improve symptoms include zinc 40-50mg/day, Gingko Biloba, and bioflavinoids often called "Tinnitus Relief Formula" in pharmacies. A well known version on the internet is Arche's Tinnitus Relief. With these supplements changes may not be felt for 30 to 60 days but if there is no relief by 90 days they probably aren't worth continuing. In addition, I have had some success having patients start melatonin about 1-2 hours before bedtime to help you fall asleep.
4) Tinnitus suppression-This is based upon the idea that if sound is presented in the ear at the frequency of tinnitus it can help with the feedback loop between the ear and the brain to calm the ear down. There are studies that show that if the sound is played up to 2 hours per day for several weeks, long lasting suppression can occur. I have recommended that patients try downloading an application from their smart phone. A number of these are free and are found by searching "Tone Generator". Once installed on your smartphone find the tone that matches the frequency of your tinnitus and play it at a low volume, just loud enough to be louder than your tinnitus. Start off at a few minutes per day and increase based upon your tolerance up to 2 hours per day. If you begin to observe the tinnitus improving then continue with the program as long as you wish. Most studies suggest 2 to 6 months of treatment.
5) Don't give up, new ideas are coming up every year and most people will have some spontaneous improvement in 3-6 months after symptoms start.
I strongly recommend my patients check out www.ATA.org The American Tinnitus Association puts out a quarterly journal that is understandable and relates the latest research and ideas for tinnitus management.
I hope those of you who have tinnitus or know someone who suffers will find some comfort in reading this article and you are welcome to print this and share it.
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