NSAID Use Increase Future Risk of Stroke and MI

Recent large retrospective study of 500,000 Danish healthy adults found in the Danish national medical registries reveals that use of Non-Steroidal Anti-Inflammatories, NSAIDs, (medications like ibuprofen, Naproxen sodium, and diclofenac) increase risk of future stroke.  Populations were controlled for age, gender, socioeconomic status, and patients with chronic disease were excluded.  The risk of stroke was found to be dose dependent with increased risk with increasing frequency of the use of NSAIDs.

Until further information is available about why this risk occurs in healthy patients, be cautious with the amount and frequency of NSAID use.

C-Reactive Protein Levels Decrease with Weight Loss

Weight loss lowers risk in many ways. Most specifically, there is evidence that it significantly decreases your risk for heart disease.  A recent study published in the Journal of Obesity showed that lowering BMI (Body Mass Index) also lowers your CRP (C-Reactive Protein).  This is significant in that elevated CRP is a risk factor for heart disease and and heart attack.
If you are struggling with weight loss, see your doctor or a bariatrician (a specialty trained physician in weight management) to help with decreasing your BMI and lowering your risk for heart disease. A great source for finding a physician trained in medical weight management in your area can be found here.

Medical Education in Chicago

I arrived last night in Chicago. Came for a medical conference. Chicago is interesting. It is the only place I have ever been that is cloud covered with 25 mile a hour winds and 85 degrees at 5pm.

The skyline, however, is beautiful and this was the scene from my cabin window as I flew in.

As we are flying over, however, the captain of the plane pulls out of the normal approach pattern and we circled over the city for about five minutes.  He then comes onto the intercom and calmly relates to us that the front landing gear has a problem, an error light has gone off and the crew is not sure if the gear has come down.  

We continued circling . . .

So after circling in a tight turn for another 2-3 minutes, the captain's voice is heard again over the intercom stating that the front landing gear has come down, there has been a visual that the front landing gear is in position and the gear hydraulic warning light turned off. So we all relax.  . .

We begin our approach. . .

"Ladies and gentlemen, the warning light has come back on."   Big sigh is heard throughout the cabin.

A few moments later, we are reassured that the gear has, again, been visually verified to be down, but all air traffic has been diverted to a holding pattern and all the fire crews have been called out.  

"Don't be alarmed when you see fire crews lining the runway for us" we are instructed. 

Images of a 767 "belly sliding" down the runway pass through my mind.  The lady sitting next to me says, "Oh, how nice."  I look out the window and realize that I am sitting next to the turbine.  Multiple scenarios pass through my mind.  A silent prayer is offered. 

I don't think I have ever experienced what felt like such a long runway approach.  It is amazing how you start to wonder how strong your seat belt actually is, how soft the seat back in front of you is if you whack your face on it, and how strong the bolts on your seat actually are if the plane were to slide along the ground.  First aid training, compression on arterial bleeding, acute chemical burn treatment and CPR training flashes through my mind.  

Touch down of the rear landing gear on the tarmac occurs smoothly, then touch down of the front landing gear occurs at the same time a large gasp echoes through the cabin.  No loud noises, no smoke, no crunching metal sounds occur.  I see over 40 fire trucks and ambulances lining the runway, with lights and sirens blaring. 

Applause arises from the cabin as the plane rolls smoothly to a stop at the end of the runway.

Our plane is slowly pulled into the gate with our fire escort. 

"Welcome to Chicago" announces the captain. 

We exit the plane and I walk through the huge O'Hare International Airport.  I am welcome at baggage claim with the following sign:

My hotel bed is very soft.  I slept quite nicely.

Disconnect Between Private Medical Practice & Medical Education

It fascinates me that there is such a disconnect between the economic view of those in private medical practice and those in Medical Education or University Based Practices.  Recently read an interesting post by Bryan Vartabedian, MD, at 33 charts discussing the future and inevitable changes in medical practice.
It is my opinion that medicine is changing and the practice of medicine will probably be unrecognizable in the next 10-20 years.
Yes, technology is making the evidence of practice guidelines better and more effective, but that is part of the way medicine is changing.
Daily, I am barraged with "practice protocols and guidelines" from every specialty group and every expert committee (a full ream of paper is mailed to me daily from all these expert groups).  Insurance companies then accept these guidelines as the "gospel truth" and if I'm not following them to the letter, my paycheck is reduced.  The "art of medicine" is disappearing with the overlay of the flowchart and practice protocol or practice guideline.  But to earn my living, I have to either demonstrate I followed the protocol, or write an additional paragraph as to why the protocol is not appropriate for that patient.  It is impossible to do that 35 times per day even with the most efficient electronic medical record available (I know 'cause I have one).
But the educational system still appears to be teaching the students that the current evolution is the "best."  The student cry "foul" and question the experience of those who have been in the trenches and claim that the error is on the part of private industry.  This progressive view of medicine is killing the "art."  And it is in the "art of medicine" where the caring and compassion is found.
Medicine as we know it will change into an efficient, cold, assembly line of diagnosis and treatment dispensing, unless we collectively change it.  The enjoyment of medicine is found in its art.  Once that is gone, you will loose the great physicians.  You will have an industry of cookbook, cookie cutter practitioners dispensing the latest medial equivalent of the GM Volt. The government is driving this.  In my practice, 50% of my patients care is driven by Medicare in some capacity.  When you put the government in control of medicine your going to get more bureaucracy and less art.
What is the answer?  Time.  Only time will tell. Until then, we practice medicine the best we can with the tools we have and apply the art of that practice to each individual.

Resistance Training More Effective in Shrinking Your Middle!

Resistance training with dietary changes were found to reduce abdominal adiposity (apple type weight gain) better that dietary changes alone in a recent study published in The International Journal of Obesity.

High Protein Diet More Satiating and Effective for Weight Loss and Appetite Control

Recent study of 27 overweight or obese men found that diets higher in protein were more satiating in than diets with normal protein content. This plays a very important role in controlling appetite and helping with weight loss. These findings were published in Obesity, September 16, 2010.

Rules of Medicine

1. The art of medicine consists of amusing the patient while nature takes its course.
2. It is impossible to make an asymptomatic patient feel better.
3. The urgency of the test is inversely proportional to the IQ of the insurance company pre-authorization clerk.
4. There is no cure for stupid.
5. Bad things really do happen to good people.
6. The better the surgeon, the more reluctant s/he is to operate.
7. It has to be fun.
8. If it isn't fun, see Rule 7.
9. Half of what is taught in medical school is wrong, but no one knows which half.
10. Poor planning on your part does not constitute an emergency on my part.
11. A bad idea held by many people for a long time is still a bad idea.

Quote of the Day

The whole aim of practical politics is to keep the populace alarmed (and hence clamorous to be led to safety) by menacing it with an endless series of hobgoblins, all of them imaginary.
H L Mencken

ObamaCare At It's Finest

Quote of the Day

"An idealist is one who, on noticing that a rose smells better than a cabbage, concludes that it will also make better soup."  H L Mencken

Michelle Obama Tells Doctors How to Practice

Mrs. Obama is now telling us that they (through the insurance plans) will mandate measurement of Body Mass Index (BMI) and that doctors should start writing more prescriptions for your obese children. When did Michelle Obama start practicing medicine?

It's Time to Re-Educate Us On ObamaCare

Despite their best efforts in the past to convince the American public that ObamaCare is the kind of “change” we all need, the White House is quickly realizing their talking points aren’t sticking. Public opinion polls are reporting sustained opposition to the Democrats’ health care reform plan more than five months after the president signed it into law.

But they’re not giving up–Health and Human Service Secretary Kathleen Sebelius says the administration will use “reeducation” to try and convince voters heading into the midterm elections. According to the Obama administration, the sweeping health care overhaul remains unpopular due to lingering “confusion.”

“Unfortunately, there still is a great deal of confusion about what is in [the reform law] and what isn’t,” Sebelius told ABC News Radio in an interview Monday.
With several vulnerable House Democrats touting their votes against the bill, and Republicans running on repeal, Sebelius said “misinformation given on a 24/7 basis” has led to the enduring opposition nearly six months after the lengthy debate ended in Congress.
“So, we have a lot of reeducation to do,” Sebelius said.
Sebelius also told ABC that she “strongly” disagrees with what her predecessor, former Health and Human Services secretary Mike Leavitt, wrote in a Washington Post op-ed last week, suggesting that ObamaCare’s changes to Medicare merely create the “illusion” of reform.

Meanwhile, Mary Katharine Ham of the Weekly Standard and Guy Benson of Townhall.com offer a breakdown of ObamaCare’s promises and realities–a thorough assessment that will not likely to make it into the administration’s “reeducation” curriculum. Read it here.

Dear Valued Patient,

Medicare is the program that provides health insurance for most older Americans. Whether you, a family member or a friend has Medicare coverage, what happens with Medicare affects all of us ultimately and directly. In addition, you may know someone who gets insurance through TRICARE, the program that covers members of the military and their families. There is a serious and fundamental problem with Medicare that impacts TRICARE patients as well, and I’d like to ask your help in getting it fixed. This will mean your writing your U.S. Representative and your U.S. Senators in Congress.

Here’s the problem. Right now, the federal government pays physicians like me for health care services provided to my Medicare patients using a complicated formula that is out of date. This formula, called the “Sustainable Growth Rate” (SGR), is based on U.S. economic factors that are not related to the cost of patient care. The formula was put into place many years ago to save on health care costs, but it no longer works or makes sense. It isn’t based on older people’s health care needs, or on how much it costs to keep my practice up and running. When the government uses this formula, I effectively get paid less and less every year because the formula does not keep pace with the cost of providing services. And since the payment rate for TRICARE health insurance program for military members and their families also is based on these rates, this issue affects the health care of military families as well.

For example, right now, I pay my staff 2010 wages. I pay for electricity, heating and water at 2010 rates. I buy medical supplies and equipment at 2010 prices. However, the government is paying me to care for Medicare patients at rates equivalent to those of 2001. I will not be able to keep this up for long. If changes do not occur this November, I will be forced to drop all Medicare and TRICARE insurance.

The U.S. Congress has to change federal law to fix this formula. The federal Medicare Payment Advisory Commission has recommended that Congress replace the old formula with a new one based on realistic and relevant information. Unfortunately, each year, rather than fixing this complicated formula, Congress has voted to postpone real reform to the system. This has happened many times over the past few months, so I knew what payment I would receive for caring for my Medicare patients for only a few weeks at a time.

In fact, I received no payments for Medicare visits for the entire month of June, 2010, until mid-July. I know of no other business that can function without getting pain for services until 1-2 months after the services are rendered.

Here’s what Congress needs to do to solve the problem:
• Permanently fix the SGR formula.
• Provide better payment in that formula for primary care physicians, who are the doctors who coordinate health care for the whole person at every age, not just for a certain body part or particular age group.

Here are a few closing thoughts for you, as my patient:
• Yearly or monthly Medicare payment cuts — nearly 30 percent next year due to this formula — create an unstable program for everybody: patients and doctors.
• Because of the financial strains that these cuts impose on many physicians’ practices, they may be forced to stop seeing Medicare patients. This will make it more difficult for new Medicare patients and even some current ones to find a primary care doctor who can provide them needed care. Elderly people should not have to worry about their health care.
• Many of America’s family physicians are small businesses. We are very committed to our patients but, like you, we need to make enough money to stay afloat.

I would deeply appreciate it if you could send a letter to your U.S. Representative and your U.S. Senators on this issue.

There are two easy ways you can do this:
• Go to http://capwiz.com/aafp/go/patients, enter your zip code and email a letter from you to your U.S. Senators and U.S. Representative.
• If you’d like, my office can fax the letter for you while you are at the office.

Thank you very much for your help in keeping me in business.

Voices That DON'T Speak For Us!!

Government Attacks Parental Rights

Through activist courts and the threat of ratifying the UN’s Convention on the Rights of the Child (CRC), big government intrudes on families more and more. Already, the liberty of parents to direct the upbringing of their children has greatly eroded in federal courts and in such settings as public schools, local libraries, and your doctor’s office.

The traditional right of parents to make decisions for their children (absent abuse or neglect) is now "substantially diminished" at the federal level, and its demise is trickling down to the states. Only an amendment to add this liberty to the text of the U.S. Constitution can give back to our families the legal protections they deserve.

Please take action. Click here to stop big government’s takeover of the family by supporting Senate Resolution 519 (which opposes ratifying the CRC) and the Parental Rights Amendment to the U.S. Constitution.

Pass It On!

Once you have signed on, please forward this link to as many friends and family as you can. Add this message to your Facebook account. Or click here to visit this page online and use the "share" button to add it to virtually any other social network.

Please take just a moment to spread the word. America’s freedoms must be protected before it is too late!

Why Obamacare is Actually a Form of Slavery!

Congressman Pete Stark thinks that the government has free reign to "do anything" it wants.

Low-Carb Diet Compared to Low-Fat Diet - Arizona Republic Article

Low-carb outshines low-fat diet

BP Oil Spill Timeline

Oil Spill Timeline from RightChange on Vimeo.

Weight Loss Quackery

Ok.  I couldn't resist.  Here is some recent weight loss quackery, much of which is still being propagated on the internet.

Magic Tights Weight Loss -

Embedding into the fabric of the "Slim fit 20 Caffeine Tights" are tiny capsules of caffeine.  When the caffeine comes into contact with the skin it is supposed to be absorbed and stimulates metabolism, burn fat, and tighten leg muscles.  The manufacturer, a British company called Palmer's, promises that if the tights (which cost about $50 for a three pack) are worn for a month, about an inch in diameter can be lost from each leg.  If this catches on (apparently over 50,000 units have already been sold - mainly to men) it may replace the phrase "Hey, you smell like pizza" with, "Hey, how come you smell like Starbucks?"

Spray-On Weight Loss -

CLAmor is sprayed onto food.  It contains a chemical called "clarinol" that's thought to shrink fat cells.  When clarinol-sprayed food is eaten, it reduces fat on the food and fat that's already inside the body.  It comes in four flavors: butter, olive oil, garlic and plain.  So what is clarinol?  CLAmor, the name of the product and the company , says it is a naturally occurring bacteria found in the stomach of cows.  It's "harvested" from fried ground beef. Clarinol is now sold as CLA and is essentially worthless as as weight loss medication, however, it has been show to have a minimal additive effects to muscle building. (And there's nothing like the taste of ground beef cultured bacteria!)

Alchemy Weight Loss -

A magic pill called Phena-Frene/MD sold in the mid-1990s claiming to turn fat into water, which was then flushed from the body forever by simply urinating it out.  Packaging claimed users could loose up to 10 inches off their waist in just two weeks.  Only one small problem: It is chemically impossible to turn fat into water!  The product bombed despite "medical school proof" from non-existent institutions such as the California Medical School and the U.S. Obesity Research Center.

Magic Pants -

Sold via the late night TV infomercial in the 1980's, "Slim Jeans" weren't actually jeans, and they probably didn't make anybody slim.  Slim Jeans were silver, futuristic-looking sweat pants made of "an amazing polymer material" that turned out to be a cheap rayon knockoff.  They were supposed to cause weight loss by trapping in body heat, making the wearer lose water weight by sweating. The makers of Slim Jeans said weight loss could occur if the pants were worn exercising, sleeping or even watching TV.  For a while, Slim Jeans were sold with a matching shiny sweatshirt to allow for even more good-looking weight loss.

Clip-On Weight Loss -

According to Ninzu, the manufacturers of a 1990s device called the B-Trim, weight loss could be attained by clamping this little object onto the ear.  Here's how it was supposed to have worked:  The clip put pressure on a nerve ending, which supposedly stopped stomach muscles from moving, signalling the brain that the stomach was full.  This was apparently supposed to control appetite leading to weight loss.  Ads for the B-Trim said these claims were proven by "scientific evidence."  The only problem: they didn't actually list any of that evidence.  The result was that the Federal Trade Commission made Ninzu stop selling the B-Trim in 1995. (Don't they call these "ear rings" now?)

Phrase of the Day: "The only thing I like better than a low fat diet are my Magic Pants!"

Our New Medicare Czar

Donald Berwick, our new Medicare Czar, was appointed by President Obama during Senate recess to avoid partisan voting.  Again, we see Obama's abuse of the "recess appointment" to push his agenda and install a Center for Medicare and Medicaid leader in place that firmly believes in "redistribution of wealth."



Donald Berwick will use Medicare to "redistribute wealth."