Medicine has segregated the sexes in its research focus. Typically things are researched by categories, i.e. women and rheumatoid arthritis, men and diabetes, breast cancer and women, etc. . But more and more medical research is becoming androgenous. We are now looking at rheumatoid arthritis, or RA as it impacts both men and women. We are looking at common ingredients, triggers, and treatments for both sexes. What we are finding in particular about RA is that it is impacted by the amount of testosterone in the body. This is true for both men and women. As you age (either sex) you lose testosterone. Once this happens you also become more at risk for RA. If you replace your lost testosterone, you can reduce the risk or intensity of RA.
This week, Brett Newcomb and I are talking about testosterone and arthritis. From this beginning, we segue into other topics of aging and testosterone. We point out the connection between loss of testosterone and other autoimmune disorders such as MS, and fibromyalgia.
Brett mentions his theory that most men do not realize that they produce estrogen naturally, and that women produce testosterone. We discuss the interplay of these two hormones and the effect on the body of losing these as we age. One of the points made in the podcast is about how doctors measure your loss of estrogen, testosterone and other hormones through blood tests. Lab results will compare your present blood count with those of “normal” young men or women. I carefully explain how to use this information in more useful ways to determine what your levels today should be rather than compare you to others your own age. I look at not what you “should have” at your current age, but what you should have to be healthy, vivacious and lively!
Please listen to this podcast to get a refresher course on talking to your doctor about your hormone levels and the blood tests that measure them.
This week, Brett and I are talking about skin care and summer weather exposure. It is spring, and people are beginning to think about being out and about in the weather. We live in a culture where most of us are insulated from the impact of weather most of our days. We drive air conditioned cars, and live in air conditioned homes, and work in air conditioned buildings. We can protect ourselves from the adverse elements more than any other generation. However, all that protection from the real weather elements does not necessarily mean that we are protected. There are always humidity and dryness issues in air conditioned environments. These impact your skin as much as the outside weather does. The additional concerns of outside weather beyond humidity, are wind, sun, and exposure.
Men generally do not want to pay attention to skin care. But they should. Especially the effects of the sun’s rays and the impact of pre cancerous burns on the skin. The skin is our largest organ, it makes up about seven percent of our body weight. It is our first line of defense against injury, disease and contamination. Our concerns in this podcast are not just about “beauty” related issues. They are about health and longevity and vibrancy! But beauty or attractiveness does matter and we want to talk about that as well.
We talk about the reality that healthy skin holds to your muscles and connective tissues and bones. It does not wrinkle and pull away or sag. We want to avoid brown spots and texture problems. As you age, and lose your hormones, particularly estrogen, your skin becomes thinner. That is a concern. Also as you age, you lose testosterone and that allows your skin to pull away from your bones and sag and wrinkle more rapidly. Estrogen loss also decreases the amount of moisture your skin will hold.
As we move into the outdoor and the tanning seasons, all of us, men and women alike, will benefit from taking a look at our basic skin care regimine and our plan for taking care of ourselves. This will impact the way we look and the way we feel as we get older.
Living longer means that we are sexual beings longer. Recent studies in the United States and England, provide data that says both sexes are maintaining interest and activity about things sexual well into their eighties or nineties. One study says 26% of people between 76-85 years of age are still sexually active. As you drop to younger generations that number increases.
Why does this matter? There are many reasons, and Brett Newcomb and I are talking about them this week. Socially where are we when we think about our seventy five year old widowed grandparent living in the retirement home having sex? Where are our grandparents that age with the idea of having sex? What about being married? If your grandfather and some lady he meets at the retirement home want to get married what concerns about that need to be resolved? If they don’t want to get married, but just want to touch each other and have sex, what then?
There are moral, social, physical, and psychological ingredients facing us about this as we and our parents increase in age. The concern, however, is not just about what we call the elderly. What about those among us who are 45 and over who are single. As we age our patterns for finding sexual partners and for establishing our sexual relationship are different than they have ever been.
Some numbers to consider: Only 12% of dating men and 32% of single women who are over 45 and dating report that they use condoms for safety. STD illness in this population has increased over 50% in the last decade. Why? One reason is that these generations tend to think about safe sex as meaning how do I prevent a pregnancy? It is about procreative control not about disease. Once we reach an age such as 50 where we are not concerned about having babies (women) then we don’t think about condoms for other reasons. The divorce rate among 60 and up is skyrocketing. It is now over 50% in some areas of the country. Once divorced, those people are not going to give up being sexual. How do we convince them it is possible to be the victim of an STD and that practicing safe sex is still as important as it was in high school?
There are lots of fascinating and disturbing elements to this story. Listen to our podcast for a stimulating survey of problems more and more of us will be facing as we and our parents get older.
This week Brett Newcomb and I are continuing our discussion of five sneaky things that your doctor probably won’t ask you about, but that you should watch out for. We are focusing on autoimmune disorders , fibromyalgia in particular. We are discussing the nature of fibromyalgia and the fact that it hurts people all over their muscles. It moves around, it is not located in the elbow, or the knee, or the joints. It hurts when you sit and when you sleep and when you work. It is hard to pinpoint and many doctors do not ask about it because they are focused on the symptoms that brought you in the office and they only have a six minute window to find out what you need and try to make a helpful intervention.
People who suffer from fibromyalgia usually begin to suffer from it around 38 years of age. Often they are mistakenly thought to have chronic fatigue. Fibromyalgia is an autoimmune disorder, the body attacks itself and the muscles become inflamed and swollen. They hurt. Chronic fatigue is a virus like the mono virus, Epstein- Barr. The initial symptom of both of them is extreme tiredness. Doctors often treat for the viral infection and the patient does not get better because that is not really the problem.
The pain from fibromyalgia moves around. It may be in your arm one day and in your thigh another, it could be in your chest or some other part of the body. It is not localized to just a joint. Chronic pain is a viral infection and there are drugs which help with fighting the viral infection. Fibromyalgia is different. Basically you are attacking your own muscles. They become inflamed and you are never without pain. Anti-inflammatories sometimes work a little but usually not a lot. Sometimes you can be given drugs to suppress your immune system and those will help reduce the pain, but if you suppress your immune system you become vulnerable to other illnesses.
We are spending time talking about these issues because the nature of office visits with your physician is changing. Due to insurance companies and Obamacare, it is becoming necessary for doctors to spend less and less time with individual patients. The average primary care visit is now just six minutes! Your doctor is interested and fully qualified, but may not have time to cover all the possibilities. The more you can help by being informed and prepared the better your care will be. If you know about things like the difference between chronic pain and fibromyalgia the more you can help your physician help you.
Listen to our podcast and become better prepared to help your doctor provide you with the best care.
Women over 40 are statistically at increased risk of developing, strokes, and heart attacks. This is directly correlated to deficiency of testosterone. After the age of 40 women fight weight gain, increasing triglycerides, cholesterol, and inflammation. This is triggered by falling testosterone levels. The result of these changes is that plaque builds up in blood vessels and increases your chance of developing hypertension and heart disease.
This week Brett Newcomb and I are talking about the health challenges that doctors often miss. The discussion of replacement of hormones is frequently overlooked. We identify the ten year window for each of these hormones to be replaced with optimum impact on a woman’s health. If women are treated by replacement of the lost hormones during these ten year windows they dramatically lower their risks of stroke, heart disease, and dementia.
The third medical problem that doctors overlook is the nature and treatment of autoimmune disorders. Auto-immune diseases are common in women after 40, and research shows that testosterone and estrogen replacement, but particularly testosterone can reverse the deterioration from autoimmune disorders.
I have an opportunity this week to share the stories of several of my patients who suffer from auto immune disorders such as RA, MS, and Lupus. What we have found is that when these women had testosterone replaced with pellets, they noticed that they did not get worse. Their regular doctors often are surprised by the dramatic effects of testosterone and do not understand what is causing them to stop progressing, but they acknowledge that “something”amazing is happening. We do not see evidence that the replacement of testosterone will “cure” them or make the problem go away, but it does seem to slow it down.
Listen to the stories of these women and learn more about the important positive steps you can take to manage your quality of life in general and your health in particular by replacing your lost testosterone.
I really want to focus on the importance of getting a good night’s sleep. If you don’t sleep well, you will suffer from fatigue, you will have trouble losing weight, you expose yourself to multiple medical diseases over the long term such as dementia, and Alzheimer’s. If your insomnia is from sleep apnea you really need to get it treated because it decreases oxygen to your brain. There are multiple treatments for apnea issues, ranging from C-PAP machines to surgeries.
One treatment that is not often recommended for sleep related issues, is the replacement of testosterone. Many of my patients report that once they have replaced their testosterone their sleep issues resolve!
This week on our podcast, Brett Newcomb and I are talking about health issues that doctors often miss, but that you should be aware of. Sleep related problems is the first on the list of concerns that we address. In our podcast we discuss both the viscous cycle of fatigue and sleeplessness and how they contribute to other medical and psychological complications. If you want to be healthy and alert and fully able to function, you need to find a way to get a good night’s sleep.
Part of our conversation emphasizes the importance of a dual approach to good health, the approach of being physically evaluated and treated for the mechanical or physiologic issues that are quantifiable, and being psychologically prepared for being healthy through the development of adequate coping skills, stress management skills, and proper conditioning of habits, particularly in the area of getting a good nights sleep.
We recommend developing good bedtime habits; try to go to bed and to sleep at a set time every day. Women in particular need to set a time to just turn themselves off and go to bed. You really should not eat or watch TV in bed, you should teach yourself to go to bed to rest and to sleep and regenerate. You condition your body for that by managing your schedule, your attitude, and your physical surround. Keep your room dark, be consistent and habituated in your approach to rest.
Listen to our podcast to learn more about the importance of good rest and sleep patterns with regard to your overall health.
Who should decide and who should pay for your medical care?
One of the most fundamental teaching concepts that physicians are exposed to the Hippocratic Oath. In taking the Oath, we swear to first do no harm as we work with our patients and attempt to help them. The second is that we will not consider cost or profit in determining what the patient needs. As doctors our oath requires us to treat someone in the best manner possible to get them better. Other elements of our medical system do not operate under this same premise. For instance, insurance companies do not really operate to provide care for you, they operate to make a profit and to keep as much money in their own pockets as they can. Doctors are often at cross -purposes with insurance companies in attempting to treat their patients under the guidance of their training and the Hippocratic Oath they have taken.
This week, Brett and I are discussing the critical need for people to become informed and understand the role the insurance companies now make in the medical decisions of your doctor, and in the future the role of government in your personal relationship with your doctor. There is a tremendously important conversation going on today within the medical, economic, and political communities that revolves around the questions of rationing of services, lowering the minimal medical care that is required to treat each patient, and making the personal medical decisions of your doctor more like an assembly line. The question is, is a global decision made at the level of government, without your individual needs considered, the way healthcare should take care of people? How do we solve the conflicts between what we spend and do as a society to provide the best medical care to our large community, and what to do in our personal contacts with individual patients? As consumers, as citizens, and as patients, we hope you will become involved in an informed way as participants in this conversation. As someone once said, if you do not become a part of the solution, you most certainly will become part of the problem.
Government regulations that limit or require behaviors from licensed medical providers, insurance companies that limit or require behaviors from contracted providers, or insurance companies that sell medical insurance contracts to individuals and groups that limit or require behaviors are all attempting to define what constitutes provided medical care to individuals. Doctors are a minor part of that conversation, but they are impacted in important ways by the conversations. I believe my relationship is with my individual patient and that the government and the insurance companies should not be intimately involved in making medical decisions. Yet I acknowledge the reality that there is a government function in the area of licensure and regulation and that there are financial concerns between or among all of us as a society. Our system is not perfect and should be changed, but more lay decisions and fewer doctor-patient decisions is not the correct decision. Because it is America, in every part of our life we are able to choose where we want to spend our money. If it is on four-wheelers, a big house, or anything else, we are able to decide what we pay for. Some of us want to be able to pay for excellent healthcare and give up other luxuries, and some would rather buy a New Lawn mower or an SUV. In terms of paying for the care that a patient receives or does not receive, should always be available, and we as a society should pay for citizens who are extremely ill and unable to pay, but the rest of us should be able to choose our healthcare without the help of insurance or government.. I do not believe in being a passive recipient of the decisions of others. I hope you do not either, and that you will become involved in contributing to these conversations.
Please listen to our podcast to hear our reflections on these topics and join our conversation.
This week Brett and I are discussing rationing and medicine. As our population ages, and Obamacare has brought more people into the group receiving healthcare under the universal healthcare plan, we must have a conversation about how to stretch the system to deliver the medical treatments promised, and that means decreasing medical services to some to provide services to the increasing number of patients. Rationing is a term used in government but one that has only recently been used in regard to medicine. The act of rationing means denying care to some, which is not provided for in the Hippocratic Oath doctors take when they commit their lives to healing. The contradiction between what physicians have agreed to and what rationing requires is the subject of this podcast and the important task everyone should consider when agreeing to this governmental dictum.
Rationing of healthcare is driven by several factors: the current economic reality of fewer Americans available to financially support a growing number of retired Americans (the Baby Boomers);the increasing cost of every element of healthcare; and trend in this country to more obese and sicker population; and the fact that the patients who are being added to the group of “insured” are people who generally have medical illnesses that have kept them from being insured. It is the moral conflict that occurs between the oath of medical doctors to keep each and every patient healthy, and the limitations of money, doctors and medications that has been voted by politicians into law that will cause the future malfunction of this system. We hope our listeners will become involved in this discussion before it is enacted, as citizens and as consumers.
Rationing in medicine can be discussed in so many different circumstances. Some are already in place in terms of big picture situations. This happens currently when accrediting agencies help determine whether or not a community hospital can open a new heart center or cancer center. This rationing is based on need of the community. Rationing can refer to very personal medical care when discussing the triage of emergent medical care, which many people have experienced in the ER when patients are seen in order of the severity of their illness and not in order of when they come in to the ER. In this program everyone is seen, but the order in which they are seen is a judgment of the triage nurse or doctor. Rationing is done differently in war, which makes the decisions of care based on whether a patient can survive until transport comes, which actually leaves some patients to die. This is not a system that is used currently unless there is a war or a huge disaster. It is an exception to the way doctors are trained based on an unusual circumstance. Future rationing is sure to become necessary in the new universal healthcare system called Obamacare. In the doctors office when care is decided based on how expensive it is and how much care and money the last patient required. We must have conversations about how the new system will handle a doubled patient load in the same number of hours. That inevitably means each patient will get less time. how much time they should spend with that patient. That, too, is a form of rationing.
As a physician I am concerned because I was trained thirty plus years ago to see the patient in front of me as an individual who is presenting with symptoms and a history and individual needs for treatment. It is my job to take the time to make a good diagnosis and then consider the optimal
Why are compounding pharmacies important in the market?
This week, Brett and I are discussing the way drugs are made and marketed in the United States. We talk about the production and the distribution systems and how they work. One of the interesting things about this conversation is that there are often shortages of medicines. When you have a prescription for a med, you expect to go to a drug store and just get it filled. Sometimes you encounter the frustration of not being able to get it when you want it or need it at your local pharmacy. Sometimes though, it is more than mere frustration. Sometimes you desperately need the drug. It might even be a life threatening situation if you don’t get it. Then your are way more than frustrated, you are frightened and at risk.
“How can this happen in the United States? What can we do about it? Large industrial pharmaceutical companies plan production and distribution runs. There are many factors that go into that planning process. Sometimes there are emergent situations like an epidemic that throw everything off balance, once in awhile there are shortages because of the limits of the manufacturing process, and finally shortages happen because administrative decisions are made to manufacture high profit high demand drugs and others fall off the radar and don’t get made.
When there is a need and the drug stores don’t have them, where is a person to go? They go to a compound pharmacy. These pharmacies, using their own raw ingredients, make the drugs to order on demand and provide them to the individual or the hospital or the vet who need them.
This is much more common than you would think. Fully 40% of all IV drugs used in American Hospitals are manufactured by compound pharmacies. At least compounding pharmacies makes 20% of the veterinary medicines used in the United States, particularly in veterinary hospitals.
Today there is a great deal of lobbying and maneuvering going on in Washington as our government endeavors to make changes in the laws regarding Compounding Pharmacies. We want you, as informed consumers, to monitor these efforts and make your voices heard to your Congressman about the importance to us all of Compounding Pharmacies and the jobs they do.
Nurse Practitioner Sandi talks about hair loss and hormones.
This week one of my nurse practitioner’s Sandi Redhage, who has been with BioBalance Health for almost 15 years, sat down to talk with Brett about hair loss and hormones.
Sandi is a very skilled Nurse Practitioner who has chosen to work with BioBalance Health. She spends time talking with Brett about what an NP is and how that is different from a registered nurse. Sandi explains how this difference enables her to do the things she does at BioBalance Health.
One of Sandi’s passions is her interest in healthy hair and women. Sandi describes how may women who begin to lose their hair come in for a consultation to see if hormone therapy would be helpful to them in fighting this condition. In discussing this idea with her patients, Sandi is able to help them distinguish the type of hair loss they are having, and to look at many of the potential causes.
Potential causes can be due to varying kinds of alopecia (hair loss), like thyroid imbalances, diet related issues, malnutrition, too much di-hydrotesterone, and loss of estrogen.
There are tests that we can run to help identify the specific problem causing the hair loss, and often we find that replacing hormones can solve these problems.
Throughout the conversation with Brett, Sandi makes the point that while hair is a passionate concern for her and she has great compassion for women who are losing their hair, her main goal, as is true for all of BioBalance Health, is to find the correct treatment for women who are having health issues. We look carefully at patient history, we do an intensive patient interview and discussion about quality of life issues and lifestyle choices, and we work with an extensive network of other specialists and physicians to help us diagnose and treat correctly and appropriately.
I hope you enjoy getting to know Sandi and hearing the energy and enthusiasm she brings to her work.