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Frustration

So today I was listening to Pema Chodron and doing a great job of calming my anxieties and stress. That was until I went online to do the meaningful use submission for the Medicare insurance for 2013. At that time, I just lost it completely.

No matter how hard you try to calm your thinking and your breathing and not attach to frustrating situations, occasionally we all lose it.

Receiving reimbursement based on not ordering an x-ray or MRI for studies for someone who comes in complaining of back pain. Therefore, reinforcing the physician to not order any studies, even if something sinister might be ongoing.   However, the same person with minimal anatomic findings could have surgery without having trailed any conservative treatment modalities such as physical and massage therapy. The fact that your insurance companies pay minimal for massage therapy; which should be the first treatment of choice for many of these situations. 

Using our reductionistic approach: 

We continue to spend exorbitant amounts of money on surgical interventions that are not necessary. 

If you are not fixed the interventional or operative procedure, then you are considered to be a failure or a “bad patient”. 

The moral of the story is that medicine is becoming so big brotherish. Medical practitioners are now forced into very restricted guidelines that focus on policies like prescribing pharmaceuticals for your cholesterol and lipids instead of recommending lifestyle changes or allowing allowing the individual to rely on their own intuition. We continue to train you, the patient, to believe that we can fix all of your problems, as opposed to having you focus on their own body’s ability to heal itself. 

 

Sorry for the rant, but had to vent the frustration of the day!!!!!

 

Dr J

From Consumerlab: Low vitamin D levels associated with increased risk of being hospitalized with pneumonia. The levels studied were > 20ng/mL versus <20ng/mL and then as low as 13.5ng/mL. Clearly the lower the vitamin D level the greater the risk of being admitted to the hospital for it. Low vitamin D is as great a risk as smoking by these results.

A recent study completed at multiple centers, randomly assigned 351 patients with mild to moderate osteoarthritis on imaging to have either surgery with post operative physical therapy or just standardized physical therapy. They were evaluated over 6 to 12 months. The surgery was a partial meniscectomy. Findings were not statistically significant for outcome in either group. However, the 30% of the surgical group decided to have surgery by 6 months and only 9% of the surgical group decided not to have surgery. There were no more complications in the surgical group than in the non surgical group. At 12 months, the findings were the same. 

Limitations of the study noted as selection bias as many of the patients that refused the study were committed to one treatment or the other. Selective enrollment as referring surgeons may not have referred being uncomfortable with randomizing their patients. 

From the NEJM, Published 03, 19, 2013, from Multicenter, Katz, Jeffrey N, et al.

Try some of these herbs to decrease the amount of NSAIDS that you are taking.  As with any medication or treatment:  Start low and go slow. It can take two to three weeks to see results.

Boswellia:  It is effective as an inhibitor of 5-lipoxygenase which is one of the enzymes that converts essential fatty acids to leukotrienes in production of arachidonic acid; therefore, pro inflammatory.  Because Boswellia inhibits this part of the inflammatory cascade, it can be an effective anti-inflammatory agent. Average dose is 400 -1200 mg up to three times a day.  

Ginger: Usually known for the treatment of nausea and dyspepsia, it can also be beneficial in arthritis. It is frequently combined with other herbs. It can be used as a dry herb (2-4gms/day) or as an extract (1/4 to 1 ml up to three times a day.

Turmeric:  The primary active ingredient is cir cumin which has been developed as an extract. Turmeric and cir cumin is a powerful antioxidant and has been shown to be quite beneficial in osteoarthritis. Also irritable bowel syndrome. It should be taken with a meal that contains pepper to assist with absorption of the active ingredients.  The average dose is about 400-600mg three times a day.

Ashwaganda: It is an adaptogen. It is helpful in combination with other agents to treat pain from inflammation. It also has good anti anxiety effects. Doses of 3-6 gms per day of the dried root or 5 ml’s three times a day.

 

Love-Fear-Life

This is a quote from Marianne Williamson, sent to me by Dr Frederick Craigie, one of the attendings in my Integrative Medicine fellowship. I think that it is quite appropriate, and something I could learn to work on!!!!


Love is what we were born with.  Fear is what we learned here.  The spiritual journey is the relinquishment, or unlearning, of fear and the acceptance of love back into our hearts.  Love is the essential existential fact.  It is our ultimate reality and our purpose on earth.  To be consciously aware of it, to experience love in ourselves and others, is the meaning of life.

 

Marianne Williamson, A Return to Love


Hope you enjoy it as you progress to your new year!!!

Love and happiness to all. Happy New Year

Marian Johnston MD

I have always had problems with United healthcare and have found many of the other providers complaining as much as I do. However, I ran upon this information this morning.

I got this from the Medscape site. 

For the fourth year in a row, Medicare Part B has received the highest overall satisfaction score from group practice professionals.

UnitedHealthcare has received the lowest score, according to the latest survey on third-party payers conducted by the Medical Group Management Association (MGMA).

Medicare Part B and UnitedHealthcare also took the top and bottom spots, respectively, with regard to other key indicators of a happy business relationship, such as timely and accurate responses to questions, the claims appeals process, and full disclosure of payment policies.

Phytonutrients

These are organic plant compounds that promote human health. These are consumed in fruits and vegetables, whole grains, legumes and soy. Increased consumption of these phytochemicals has been shown to decrease the incidence of chronic disease. 

Some of these include indoles, flavonoids,  isoflavones, carotenoids, lycopene, resveratrol, lignans. 

Lignans more specifically are found in flaxseeds in much larger amounts than many other plant based foods. These are a major class of phytoestrogens. The lignans are from the outer coat of the seeds and woody parts of the plant walls. The breakdown products of the lignans have been shown to decrease the risk of breast cancer and have a protective effect against cardiovascular disease. They are also protective against prostate and colorectal cancer. 

It is appropriate for men to eat fresh ground flax seed for protection of the prostate; however, they should not ingest flax seed oil. As the oil has no or minimal lignans and can increase the risk of benign prostatic hypertrophy and prostate cancer. 

The flax seed should be ground freshly, about every week. You can do this in a coffee grinder. Place the fresh ground seed in the fridge or freezer in a container and you can eat about 1 or 2 tablespoons per day. 

Once you grind the flax seed, it will immediately start to oxidize from the omega 3 fatty acids to omega 6 fatty acids. So buy in smaller amounts. 

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