Leadership Thoughts

A ship, to run a straight course, can have but one pilot and one steering wheel.  The same applies to the successful operation of a business.  There cannot be a steering wheel at every seat in the organization.

Carol of the Bells . . .

Amazing!! I'm now in the mood for the Holidays again. Thanks Pentatonix!

Little Drummer Boy . . . Pentatonix

One of my favorite renditions:

John Wayne on "Optimism"

Excerpts from a 1975 interview where he gives his perspective of liberal politics and political tactics sound like they could have been stated just yesterday. This is the reason John Wayne is still a true American hero. 

"The Duke's" take on liberalism is “they never listen to your point of view, and they make a decision as to what you think, and they’re articulate enough and in control of enough of the press to force that image out for the average person.”

 "Ok, Pilgrim," you just have to be a little more optimistic . . .  (I feel like I'm sitting at my grandfather's knee while listening to this bigger than life hero give a little advise.)  Thank you.
You just have to listen:

Open Letter to Legislators on Obesity

Dear Senators McCain, Senator Flake and Congressman Franks,
I am a Family Physician, Obesity Specialist and Health Policy Fellow.  I had the opportunity to meet with your staff a few months ago and would like you to consider co-sponsoring S-1184 and/or HR-2415 the "Treat and Reduce Obesity Act." Obesity affects 34% of the population and 33% of the population in the US is overweight. Obesity is affecting military readiness and our economy using 21% of all healthcare costs.
One of the challenges I find as a physician who treats obesity daily, is that medications and therapy that is effective in treatment is not covered by Medicare services.  S-1184 will allow me as a physician to use effective medications for obesity that patient's current cannot afford.
I would love to talk with you or your staff about this bill and its effect on our treatment ability.
Please consider co-sponsorship of this bill and feel free to contact me regarding this issue at any time.
Sincerely,
Adam S. Nally, D.O.
Board Certified Family Physician & Bariatrician
Health Policy Fellow

Open Letter to my Senators . . .

Dear Senators John McCain and Jeff Flake,

I am a family physician and health policy fellow, as well as a constituent in Arizona. I have a busy practice serving 5500+ patients in the Surprise, Sun City West area. I would strongly encourage you to vote to De-Fund the Affordable Care Act (Obamacare) as this bill has already increased the price of premiums 2-3 times the cost from last year and has made it nearly impossible for my Medicare patients (50%) of my practice to afford a supplemental health insurance plan. Allowing this bill to be funded will force me to lay off a minimum of 2 members of my office staff within the next year and may make it impossible to continue practicing medicine in the near future. 

I have personally heard you make the promise to stop this bill, on multiple occasions, and that reversing this bill was one of your priorities. Please keep your promise and vote to de-fund this atrocity.

Please stand with Senator Ted Cruz, Senator Mike Lee, and Senator Rand Paul in de-funding Obamacare!

Sincerely, Adam S. Nally, D.O.

ObamaCare & Medicaid . . . On the Road to the Great Depression

Robert Lewis Stevenson said, "Don't judge each day by the harvest you reap but by the seeds that you plant." So . . . I'm going to plant a seed.
The Arizona Osteopathic Medical Association has been asked to contribute Political Action Funds (PAC) to those congressional members supporting Arizona’s Medicaid expansion.  I seem to find myself in the physician minority as to my point of view on this subject. Do others not see the economic damage that the Affordable Care Act has caused and will cause in the future?  Does no-one see the sadness and depression on the faces of patient’s in the exam rooms? Does no-one put two and two together to see the effect that federal and state regulations imposed upon the small businesses of America have upon the average American family?  

I respect their points of view, however, I am very discouraged by the progressive position and mindset of many physicians around me.  Maybe I'm missing something? Maybe they see the world with a different set of spectacles? This kept me awake last night as I pondered the reasons. 

I recognize that the practice of medicine is, to say the least, life encompassing.  Often, it is all you can do just to keep up with the many demands upon the physician each day.  Understanding how the economy effects your practice is the last thing that many physicians want to do.  But I see it as one of the most important, especially as a physician who owns his own practice. 

Maybe this lack of interest is due to the declining physician ownership of practices. According to Becker’s Hospital Review, only 37% of physicians in 2013 have any ownership interest in their practice, down by almost 8% this year from last year.  This statistic, just over a third of physicians, seems in line with the number of physician that are opposed to expansion of Medicaid in Arizona and the Affordable Care Act or “Obamacare” in general.  

“Obamacare” and the employer mandate has made it nearly impossible to expand my practice, and the Medicaid expansion may make it worse.

How is Medicaid expansion bad?  Wayne Allen Root explains it better than I can: “Forget the 7.3 percent unemployment rate that is reported by the government. That’s pure fraud and propaganda. That figure goes down only because hundreds of thousands of Americans drop out of the workforce. In other words, if you stop looking for work, and go on food stamps and welfare, [our White House Administration] says the unemployment number just got better!

 “The only truth about unemployment is found in the Labor Force Participation Rate of 63 percent. That’s the lowest in four decades. For men it’s the lowest since record-keeping began in the 1940’s. What this means is 37 percent of the able-bodied, working age adults in America are not only not working, they’ve given up looking for work.

“Even worse, an unimaginable percentage of those who are employed have only part-time jobs. Seventy-seven percent of the new jobs created since January 1st are part-time jobs. That’s not good folks. Studies show 1-in-4 part-time workers live in poverty, while only 1-in-20 full-time workers live in poverty. So millions of Americans under Obama who show up as “employed” are merely working their way towards poverty. And millions of others who have full-time jobs are working at McDonalds, or working as waiters, or bartenders, or janitors.”  The American middle class is being moved to the intensive care unit.

“Here are the two most ironic points about this slow-motion train wreck called the Obama economy: “Obamacare” is the number one culprit destroying real jobs. Business owners are done. No smart business owner in all of America will lift a finger to create a full-time, high-paying job with benefits. It just makes no economic sense anymore. So Obama’s signature achievement has not only created a part-time economy, but all those people in part-time jobs don’t have health insurance. This should be a Saturday Night Live skit. The man has created nationalized health care so that everyone loses their jobs and no one has health care.” 

This is pure insanity . . . unless your goal is to create an entire nation dependent on government welfare.

Mr. Root continues, “Secondly, here’s the really sad, tragic, and ironic fact of the Obama economy . . .Obama’s policies are destroying the very people who elected and believed in him. It’s almost as if Obama is out to destroy his own voters. Let’s take a look at who is suffering the most from this Obama Great Depression.

“Obama won the 2012 election with a razor thin 51 percent of the vote. His biggest supporters were blacks (93 percent voted for Obama), Hispanics (71 percent), single women (67 percent), young people (60 percent), and those without a high school diploma (64 percent). This is the loyal foundation of Barack Hussein Obama. This is who made him President, without a single qualification, except being a community organizer.

“Now let’s look at how Obama repays his loyal fans. New research out just last week proves that since 2009 income for black heads of households dropped by 10.9 percent. For Hispanic heads of households it dropped by 4.5 percent. For single women head of households it dropped by 7 percent. For young people (under age 25) it dropped by 9.6 percent. For those with a high school diploma or less, income dropped by 8 percent.

“In dollar terms the numbers are even worse. Female incomes are down by $2,300 per year under Obama; black incomes are down over $4,000 per year; Hispanic incomes are down by $2,000 per year.

“How about actual unemployment figures for Obama’s fans? We see the same results. Reported unemployment (a bogus figure) is 7.3 percent. But among blacks (who voted 93 percent for Obama) it is an unimaginable 13.3 percent. Among Hispanics it’s 9.4 percent. Among black youth it’s 20.9 percent. Among teens it’s 23.7 percent.

“The black middle class is being destroyed. Black home ownership has slipped to the lowest level in decades.

“But perhaps the worst statistic of all is the unemployment plus under-employment rate for college graduates under age 25: 18.3 percent. That means new college graduates (also big supporters of Obama) not only can’t find a decent full-time job in the Obama economy, at the same time they are saddled with the highest student debt in history. That could be why we have the highest student loan default rates in history.”

The Medicaid Expansion in Arizona will just speed up the process already occurring across the country.  Our “lemming-like” acceptance of this expansion as physicians is leading to the further destruction of Arizona’s and America’s economy. Contributing PAC funds is like putting the proverbial nail in my businesses coffin. For the reasons above, I cannot in good conscience support the expansion of Medicaid in Arizona.  

First Fruits

Today was a lesson of "first fruits."  The preservation of life lies within the basic family unit.  Preservation of the family unit requires knowledge in the application of seeds. The "first fruits" are the harvest of knowledge applied as the nutrients and fertilizer of those seeds. 

Prior to the hybridization of seeds, our grandparents survived by taking a portion of their crops and using the seeds from them to plant crops the following year. Most of our grandparents understood this concept, however, unfortunately, most of us know nothing about it. Our grandparents used open-pollination seeds (seeds that are not genetically engineered not to reproduce).

Hybridization has been a boon to mass production in crops, but has it's down sides.  These seeds can no longer reproduce themselves and they also have changes to their colors, size and nutrient concentrations. 

This lesson was made clear to me today as I looked out over the expanse of a farmer's field while riding horseback with my family.  The basic unit of development in life is the family. It is where the lessons of life are taught and where knowledge is applied and becomes wisdom. Is it the only place this can occur? No. However, it is the most effective. My wife and I have been striving for more self sufficiency in our lives. We have been looking to improve the self sufficiency of our family and children. 

This morning we got a chance to talk about those seeds figuratively with the family.  Our children our our "first fruits" and helping them to become self sufficient is a liberating feeling. 

It was a majestic Arizona morning, the temperatures were wonderful and the horses were calm 

The great danger for most of us is not that our aim is too high and we miss it, but that our aim is too low and we reach it.

My Best Friend . . .

Social Medial Bacon Style . . .

Honesty is the Best Policy . . .

Andreas Eenfeldt, MD, a trusted low-carb colleague posted this today. Couldn't help but repost it here. Thanks Andreas!

Tears . . .

Give a Man a Fish . . .

The Skinny On Sweeteners

I am frequently asked about the sweeteners that can be used with a low carbohydrate diet. There are a number of sweeteners available that can be used with cooking; however, many of them are not appropriate for use with a low carbohydrate diet.

First, and foremost, we must understand how these carbohydrates or sugars are labeled or named so that we can identify them in the food products we eat. Most sugars are labeled with the ending “ose".

With an understanding that weight gain or weight loss is controlled by the hormone insulin, our overall goal is to lower the insulin levels in the blood stream. Glucose (a carbohydrate in its most simple form) stimulates insulin to rise. A Low carbohydrate diet works because insulin levels are significantly lowered throughout the day. Elevation in cholesterol, elevation in triglycerides and stimulus for production of uric acid also occur because of surges in the hormone insulin. The most common stimulus for insulin to rise is the body’s recognition of the presence of carbohydrates or sugars.

Sucrose, fructose, glucose, dextrose, lactose, and maltose are very common sugars you’ll see in the ingredient list of many products containing carbohydrates. All of these types of sugars will stimulate a significant insulin rise and lead to weight gain, elevation in cholesterol and triglycerides.

Other very commonly used names that you will find containing the sugars above are: white and brown sugar, succanat, corn syrup, high fructose corn syrup, honey, malt syrup, cane juice, cane syrup, rice syrup, barley syrup, maple syrup, molasses, turbinado, and fruit juice concentrate. Beware of products that contain "no added sugar" because they will often contain sugar concentrates in the form of concentrated grape or apple juice.

Fructose is sometimes promoted as a suitable sweetener for patients with diabetes or people who are wanting to follow a low-carb diet; however even though it does not cause a significant insulin rise, it is rapidly absorbed by the liver and converted into glycerol which leads to increased triglyceride and cholesterol levels. Even though fructose occurs naturally in regular fruits and some vegetables, it is usually only present in small amounts. The fiber in these fruits or vegetables balances out the fructose content. Today, fructose is added commercially to many foods in a highly refined purified form as high fructose corn syrup. Be careful because this form of fructose is found in soft drinks, ice teas, fruit drinks, jams, jellies, desserts, baked goods and even in many baby foods. This form stimulates an extremely powerful stimulus in the liver to form triglycerides and leads to fatty liver disease, a form of non-alcoholic cirrhosis (J Am Diet Assoc, Lustig RH, 2010 Sep; 110 (9):1307-21).

Artificial Sweeteners
Most artificial sweeteners fall into a class that is referred to as “non-nutritive” meaning that they have no nutrient value to the human body. They provide a sweet taste to the senses without raising the blood sugar. These sweeteners can be useful in cooking and in maintaining blood sugars; however, it is important to realize that many of them still stimulate an insulin response.

Aspartame
The most popular artificial sweetener in use today is aspartame (NutraSweet™, Equal™). Aspartame is calorie and carbohydrate free; however, it is not the ideal sweetener. Because of its chemical instability, it breaks down under heat into its chemical constituents - namely phenylalanine and aspartic acid. This makes it notably unsuitable for cooking or for storage for more than a few days.

Second, in light of its safety profile maintained by the manufacturer, a number of people of experience side effects including headache, stomach upset, migraine and exacerbation of depression (Neurology October 1, 1994, vol. 44: 1787). Most people enjoy without problem, however.

Acesulfame Potassium
A second popular sweetener has been identified by the food and beverage companies called acesulfame potassium (Ace-K™, Sunette™). This sweetener is not fully absorbed by the gut, and yields no calories, nor does it raise blood sugar. It also contains no carbohydrates. To many palates, it has a slightly bitter savor, so it is often combined with aspartame to eliminate the bitter aftertaste. The problem with acesulfame potassium is that there are a number of studies revealing it significantly increases insulin response without raising blood sugar. Studies show that the insulin response is as remarkable as if a person ingested an equivalent amount of glucose (Horm Metab Res. 1987 Jun; 19(6):233-8.). It appears thatacesulfame potassium works directly on the pancreas to stimulate insulin release (Horm Metab Res. 1987 Jul; 19(7):285-9).

This product appears to be one of the most popular artificial sweeteners currently used in a number of low-carb products. It can be found in many of the protein bars and protein shakes on the market. It is also found in Coke Zero™, Pepsi One™ and a number of other diet sodas. I have found in my private medical practice that this sweetener significantly limits weight loss.

Sucralose
Sucralose (Splenda™) is actually derived from regular sugar in such a way that the body doesn't recognize it, and it is not absorbed. It contributes no calories or carbohydrates to the body in its pure form. Amazingly, it remains stable in heat and has become ideal for cooking and baking. It is available as a bulk sweetener and actually measures equivalently to table sugar. Be aware, however, Splenda™ is not carbohydrate free. Because of the maltodextrin used to make it bulk in nature, it contains about 0.5 g of carbohydrate per teaspoon, or about 1/8 of the carbohydrate of sugar. It does cause some insulin release and may lead to weight gain or difficulty with weight loss when used in excess (J Clin Oncol [Meeting Abstracts] June 2007 vol. 25no. 18_suppl 15127). 1 cup of Splenda™ is equivalent to 2 tablespoons of sugar, or 12-15 grams of carbohydrate in 1 cup of Splenda™.

Saccharine
Saccharine (Sweet’N Low™, SugarTwin™) is another unstable chemical when heated, however, it does not react chemically with other food ingredients and thereby stores well. It was used for quite some time as one of the original sweeteners. It does not increase glucose or blood sugar, but it does stimulate an insulin response and can be problematic in weight loss (Am Jour Physiol - Endo April 1980 vol. 238 no. 4 E336-E340). It is often combined with other sweeteners to preserve their shelf life.

Cyclamate
Cyclamate (SugarTwin™, Sucaryl™) is a sweetener available in Canada that is often combined with saccharine and is similar to sucralose. However, there is some controversy over this substance as it is known to cause bladder cancer in rats. There has been no human occurrence in its 30 years of study (Ann Oncol, October 2004, 15(10): 1460-1465.doi: 10.1093/annonc/mdh256). This product is currently banned in the US because of the notable potential for cancer. Cyclamate is stable in heat and therefore is an alternative for cooking and baking.

Stevia
Stevia is a non-caloric natural sweetener which contains no carbohydrate. He is to rise from a South American plant and has been widely available for use in Asia for many years. It comes from a shrub called Stevia rebaudiana that has very sweet leaves. Stevia is in extract, a white powder that is derived from these leaves. It can be found today commercially in extract, powder, or in a powdered green herbal leaf. It has an intense sweet taste which actually does have the potential to be slightly bitter. Stevia has two faults. First, it is so very sweet that it is hard to know just how much to use when cooking. Second, he often has a slight bitter taste as well as a sweet one. Therefore, stevia is often combined with fructooligosaccharide (FOS). FOS is a sugar, but it is such a large molecule that humans cannot absorb it. It does not raise blood sugar and it does not stimulate insulin release. Stevia does not increase blood sugar and appears to improve insulin sensitivity in the pancreas (Metabolism, 2003 Mar;52(3):372-8.). FOS is only half as sweet in table sugar; therefore, it makes it a perfect partner for stevia.

Sugar Alcohols
Sugar alcohols are also called polyols. These are a class of long-chain carbohydrates that are neither sugar nor alcohol. Included in this group are maltitol, sorbitol, mannitol, xylitol, erythritol, lactitol, and hydrolyzed starch hydrolysates (HSH). These sweeteners give the texture and sweetness of sugar to corn syrup and can be used to make crunchy toffee, chewy jelly beans, and slick hard candies, moist brownies and creamy chocolate. However, they are incompletely absorbed by the human intestine. This causes problems, as side-effects of these long-chain carbohydrates include gas, bloating and diarrhea for a significant portion of people. The other issue is that there seems to be notable variability in people's ability to absorb these long-chain carbohydrates. In other words, these sweeteners affect people differently and may actually increase the blood sugar and insulin release in varying degrees among individuals.

Maltitol, sorbitol and xylitol seemed to be worse offending culprits in this class of artificial sweeteners. They cause an insulin response of about half that of normal sugar (American Journal of Clinical Nutrition, Vol 65, 947-950). Maltitol and sorbitolhave also been shown to increase cholesterol (International Journal for Vitamin and Nutrition Research, 1990 Vol. 60 No. 3 pp. 296-297). Erythritol is absorbed and excreted unchanged and appears to have no insulin response (Food and Chemical Toxicology Volume 36, Issue 12, December 1998, Pages 1139-1174). Erythritol also seems to inhibit fructose absorption (http://rave.ohiolink.edu/etdc/view?acc_num=osu1180462637).

So, in summary, which sweeteners will not cause weight gain or cholesterol changes? From the research that is presently available, aspartame, Stevia, anderythritol have no weight gain or cholesterol changes associated with them. Splendais a great sweetener, but excessive quantities will limit your ability to loose weight. All of the other sweeteners listed above have significant insulin response when ingested and will make it more difficult to lose weight. I have found that combinations of Stevia, Splenda and erythritol seem to provide adequate texture and remove any aftertaste that may be found when using them individually.

Three MOST Difficult Activities in the World

The top three MOST difficult things to do in the world:

1. Counting the hair on your head
2. Washing your eyes with soap
3. Breathing while your tongue is sticking out



Please, put your tongue back in your mouth . . .

Trey Gowdey Eplains Why IRS Shouldn't Have Your Medical Records

Clicking Will Change Your Life . . .

Hepatitis A Linked to Frozen Berry Mix

Hepatitis A has been linked to a contaminated batch of berries sold at Costco's in five different states. See the news video below . .  .

If you have eaten these berries and have symptoms of stomach pain, fatigue, nausea, diarrhea, or yellowing discoloration of the skin or white parts of the eye, see your doctor.

US News | Weird News | More ABC News Videos

New ICD-10 Code Requirements

Senator Rand Paul, an opthamologist, explains how much our government just wants to take care of us.

Analysis of the Obvious

When familiar things happen, mankind doesn't get bothered much about them.  It requires a very unusual mind to undertake the analysis of the obvious . . .

One of those is the planetary trio that will occur this evening in the night sky.  Look to the west just after the setting of the sun and you will see Jupiter, Mercury and Venus just above the horizon.  A planetary trio like this will not reoccur until 2021.

May 25th, 2013
Oklahoma Skyline - Mike O'Neal

We see the stars  in the evening sky all the time.  So why is the obvious  . . . interesting?  The first chapter of Genesis, 14th verse, states "And God said, Let there be lights in the firmament of the heaven to divide the day from the night; and let them be for signs, and for seasons, and for days, and years."

Both Mercury and Venus will appear as a "morning star" or "evening star" throughout the year, however, Jupiter will only appear with Mercury and Venus as an evening star once every 12 years.   Because of their orbits, they will always appear on the same side of the horizon as the sun when they are seen.

The Native American legends and the correlating 260-day Sacred Round (also called the tzolkin) Mayan and Aztec calendars state that Venus (the brightest of the stars), or the "Dawn Star," follows the life and death of a white and bearded god named Quetzalcoatl who visited them in the first century AD (which sounds a lot like the resurrected Christ).

Their calendar closely followed Venus or the "Dawn Star" in marking important religious or spiritual events throughout history.  It may well be that long ago these principles were understood by them. Jesus Christ referred to himself as the "bright and morning star" in Revelations 22:16.

Venus Cycle as observed on Earth
(JohnPratt.com) 

To understand why Venus (the brighter star) and Mercury are called "Morning" and "Evening" stars, see the Venus Cycle pictured to the right. Points 1, 2, and 3 correlate with "man's conception" according to the Mayan Priests and their Sacred Round calendar. Numbers 4 & 5 correlate with Christ's adult life and mortal ministry on the Earth.

According to the Venus and Hebrew calendars, the three wise men appeared on May 27th, 1 B.C., correlating with the three stars coming together at their closest positions this evening.

All three planets can be seen within a simple binocular view with Mercury being the most difficult to see without the aid of binoculars.

Either way, pull out your binoculars this evening at dusk and show your family something they won't see for another 12 years. That's what I'll be doing . . .

Memorial Day . . .

Be safe out there this weekend. . .

The Essence of Experience in Leadership

The great illusion of leadership is to think that man can be lead out of the desert by someone who has never been there. . .

Electronic Health Record challenges . . .

One of the challenges of using an electronic health record (EHR) is that of communication and order generation with ancillary services.  Medicare has mandated conversion to the use of electronic prescribing and commercial insurance has followed suit. The challenge is that as we are all becoming more paperless, ancillary services are no longer accepting prescriptions that don't have an "actual signature".  Medicare as also mandated that every order be "physically signed" which is becoming impossible with use of EHR.

This hasn't posed a problem with Medicare or with the commercial insurances, but it has begun to drive a wedge between the patient and his or her physician. We send a prescription electronically and the ancillary service kicks it back because it isn't "actually signed on paper."  Patient's feel our office is not doing its job correctly because the ancillary services told him that he "orders were signed correctly."  We are doing our job and having to duplicate services.  Everyone gets irritated all the way around the process.
Because we as a society are used to getting "our burger our our way" within a two-and-a-half minute window, my staff frequently gets an ear-full. Screaming and cursing at the doctor's office staff is not the way to get things done or aid your cause.
The burden that is created by the mandate for EHR use causes a significant change in the office flow.  It takes a good 6-12 months for a physician's to improve efficiency when the whole office flow changes.  My office is not alone in this problem.  We just recently changed our electronic health care record and significant process changes were made which has caused us delay and efficiency drops while we accommodate the new flows and attempt to write orders that were signed with electronic signatures with "actual wet signatures."
I have been using electronic health records for over 11 years.  The process isn't getting any easier, unfortunately. If you are a patient, or an ancillary service, please be patient with your doctor's office.  We are becoming as regulated as the airlines . . . who knows  . . . you may soon need to pass through a TSA scanner before you can enter my office.  Wouldn't that be exciting?!

Meet Brutus

Meet my friend Brutus . . . !

It's coming . . . mark my words. 15,000 IRS agents looking at your healthcare information as it flows through CMS. 

Change

The challenge in life is to adjust to changing times while still holding true to unchanging principles . . .

Journaling Thoughts . . .

A man would do well  to carry a pencil in his pocket, and write down the thoughts of the moment. Those that come unsought for are commonly the most valuable, and should be secured, because they seldom return.
Francis Bacon

(Anyone who's name ends in bacon ought to be listened to!)

Another reason: those who don't keep journals, will be defined by those who do. Think about it.

The Middle-Aged Mormon Man gives a great synopsis here.

Mother's Day

Life does not come with an instruction manual . . .

It comes instead with a mother.

Characteristics of Great Leaders . . .

1. JUST DO IT.

• A leader's most powerful ally is his or her own example.  
• Leaders don't just talk about doing something; they do it.

Influence

Money motivates neither the best people nor the best in people.  It can move the body and influence the mind, but it cannot touch the heart or move the spirit; that is reserved for belief, principle, and morality.

The Microbiome of the Gut: Medicine's Final Frontier?

I have been fascinated by a new school of technology that has revealed itself to us in the last few years presented by Suzanne Devkota, PhD, at the recent ASBP Conference. There are 100 trillion bacterial cells in our bodies (more than the number of cells that make up our body). Recently bacterial 16s ribosomal genes have been identified that give us a very fast, specific and quantitative identification of the bacteria in the stomach and gut.  It gives us a new gene map of the gastrointestinal system. This identification process not only allows us to look at the current bacteria in the gut, but lets us look at bacteria present in the guts of our ancestors.  It also gives us insight into how we metabolize food and how these bacteria can be helpful in the treatment of disease.

There are thousands of bacteria in our bodies that live symbiotically with us of which we were never aware. Landmark papers have been released about these bacteria and their effects begining in 2001.  Most of these papers have focused on how these bacteria affect obesity. There are three very interesting benefits I found important.

1. The spectrum of bacteria in our gut affects how we metabolize and break down different foods in our diet. It also influences our health. 

2. Mothers transfer the microbiomes early on through the method of birth.  There are very specific bacteria that confer specific beneficial or harmful immunity to a person's body.

3. These bacteria have the ability to perform Lateral Gene Transfer. Bacteria have the ability to share genes "laterally," to their neighbor, that confer antibiotic resistance, immunity or action. 

What is also important is that these microbes can process dietary fibers more effectively leading to increased formation of glucose and free fatty acids and triglycerides.  This can be the reasons that some people gain weight from the same fiber intake that others don't. These bacteria can also increases Lipoprotien Lipase, the enzyme in the body that stimulates increased fat storage. 

Another fascinating piece of information relating to this field of study reveals that certain bacteria found in patient's with type II diabetes causes a "gut leakiness  that arises predisposing many to various forms of bowel inflammation. 

The types of fat we eat actually have an effect on the bacteria colonies and upon the degree of "leakiness" in the GI system.  This may be why so many patient feel like they have "gluten" intolerance or gastrointestinal inflammation.

Omega 3 fatty acids have been found to help protect the bacteria and the "leakiness" in the GI system.  

We still have much to learn in this area and much to gain as we apply what we are learning. 

Stay tuned . . .

The Real ....

More Bacon Please . . .

Imperfect People

Great Thatcherisms . . .

An amazing lady passed away yesterday, the former research chemist turned barrister and then later, British Prime Minister serving from 1979 to 1990. She was nick-named the "Iron Lady" because of her uncompromising political views and leadership style.  In honor of the passing of the great Iron Lady, Margaret Thatcher, here are 16 of the best Thatcherisms:

"ON GETTING THINGS DONE:


“If you want something said, ask a man. If you want something done, ask a woman.”

“If you just set out to be liked, you would be prepared to compromise on anything at any time, and yu would achieve nothing.”

“I’m extraordinarily patient provided I get my own way in the end.”

"AN IRON PRIME MINISTER:


“Where there is discord, may we bring harmony. Where there is error, may we bring truth. Where there is doubt, may we bring faith. And where there is despair, may we bring hope.”

“I am in politics because of the conflict between good and evil, and I believe that in the end good will triumph.”

“Do you think you would ever have heard of Christianity if the Apostles had gone out and said, ‘I believe in consensus?’”

“Standing in the middle of the road is very dangerous; you get knocked down by the traffic from both sides.”

"ON HER CRITICS:


“If my critics saw me walking over the Thames they would say it was because I couldn’t swim.”

"ON THE START OF THE FALKLAND WARS:


“Defeat? I do not recognize the meaning of the word.”

"ON GOVERNMENT:


“We want a society where people are free to make choices, to make mistakes, to be generous and compassionate. This is what we mean by a moral society; not a society where the state is responsible for everything, and no one is responsible for the state.”

"ON HUMANITY, SOCIETY, & FEMINISM:


“The woman’s mission is not to enhance the masculine spirit, but to express the feminine; hers is not to preserve a man-made world, but to create a human world by the infusion of the feminine element into all of its activities.”

“I owe nothing to Women’s Lib.”

“Being powerful is like being a lady. If you have to tell people you are, you aren’t.”

"ON AMERICA:


“Europe will never be like America. Europe is a product of history. America is a product of philosophy.”

"ON SOCIALISM:


“Socialist governments traditionally do make a financial mess. They always run out of other people’s money. It’s quite characteristic of them.”

“And what a prize we have to fight for: no less than the chance to banish from our land the dark divisive clouds of Marxist socialism."

(taken from the article by Becket Adams on TheBlaze.com)

Family Physician Burnout . . .

A national survey published in the Archives of Family Medicine in 2012 reported that US physicians suffer more burnout than other American workers.[1] Some 45.8% of physicians were experiencing at least 1 symptom of burnout: loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment.
Medscape conducted a survey and family physicians were given the same criteria. The response was discouraging: 43% responded that they were burned out. The 2 specialties with the highest percentage of burnout were those that dealt with severely ill patients: emergency medicine and critical care. Family physicians were in third place.



What is causing the burnout? Following table lists the causes found in the study.



In the Archives article,[1] the authors sum up the very challenging problem of physician burnout: "Collectively, the findings...indicate that (1) the prevalence of burnout among US physicians is at an alarming level, (2) physicians in specialties at the front line of care access (emergency medicine, general Family Medicine, and family medicine) are at greatest risk, (3) physicians work longer hours and have greater struggles with work-life integration than other US workers, and (4) after adjusting for hours worked per week, higher levels of education and professional degrees seem to reduce the risk for burnout in fields outside of medicine, whereas a degree in medicine (MD or DO) increases the risk. These results suggest that the experience of burnout among physicians does not simply mirror larger societal trends."

What to do? The finding suggest that physicians should participate in and advocate for changes in work that give them more control over there ability to help and interact with patients. They should become involved in advocating for health reforms that will return a greater level of control to physicians and their patients. These would include payment for value and greater patient participation in decision-making about care. Reorganizing primary care practices to allow more time for complex patients and recognition by insurers that excessive hassle is bad for patients and physician are also vital. These changes should lead to more satisfied patients and physicians and less burnout,[3] .

References:
1. Shanafelt TD, Boone S, Tan L, et al. Burnout and satisfaction with work-life balance among US physician relative to the general US population. Arch Intern Med. 2012;172:1377-1385. http://archinte.jamanetwork.com/article.aspx?articleid=1351351 Accessed February 7, 2013.
2.http://www.medscape.com/features/slideshow/lifestyle/2013/family-medicine?src=wnl_edit_specol#2
3. Centor RM, Morrow RW, Poses RM, et al. Doc burnout -- worse than other workers'. Medscape Roundtable in Primary Care. November 13, 2012. http://www.medscape.com/viewarticle/774013 Accessed February 20, 2013.

Where Do You Get Your Advice?

I DO ALL MY OWN STUNTS!

I've determined that life is not a journey to the grave with the intention of arriving safely in a dainty and well-preserved condition. But, my life's journey is, rather, to be fully enjoyed, thoroughly used up, totally worn out and I intend to be found skidding broadsided into heaven and when landing I will proclaim, "WOW, WHAT A RIDE!"

My orthopedic surgeon, just grinned and recommended I avoid bungee jumping or hang gliding . . .

Confidence

One of the greatest success in life is the confidence that comes from understanding shared in sincere conversation between two people.

My Friend The Doctor . . .

My sister (an up and coming author), Robyn Oler, recently published a wonderful children's book entitled "My Friend the Doctor", published by Tate Publishing.  She admits the book is based on my medical office and the experiences of her daughter in the doctor's office.  She has done another fabulous job!

The new book is a wonderful addition to any children's book library and, in my biased opinion, I highly recommend you buy your copy today.  You can order it online here.

Keep up the good work, Robyn!

Today's Thoughts . . .

Patriotism is easy to understand in America: it means looking out for yourself when looking out for your country. - Calvin Coolidge

He who floats with the current, who does not guide himself according to higher principles, who has no ideal, no convictions-such a man is a mere article of the world's furniture - a thing moved, instead of a living and moving being - an echo, not a voice.