• 24Apr

  Five Issues That your Doctor Often Misses

  Medical Care, Symptoms No Comments

  Health risks that often go unseen

  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.
• 08Apr

  Patient-centered Medicine

  Medical Care, Treatment No Comments

  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.
• 01Apr

  Rationing in the American Medical System

  FDA Regulation, Insurance, Medical Care, Treatment No Comments

  How Obamacare effects physicians and patients

  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
• 25Mar

  What is a Compounding Pharmacy?

  Medical Care, Pellets, Treatment 1 Comment

  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.
• 23Jan

  Erectile Dysfunction from a Medical Perspective

  Andropause, Bioidentical Hormones, Hormone Replacement Therapy (HRT), Medical Care, Relationships, Research, Sexuality, Symptoms, Testosterone 1 Comment

  What causes Erectile Dysfunction in men? The first of a three part series.

  

  Today is the first of a three part series that Brett and I are doing on the topic of ED in men. Erectile Dysfunction is very common. Most men at some point in their lives experience problems with getting or maintaining a satisfactory erection. Generally it is thought that if this is happening at least 25% of the time, then you have a problem and need to seek treatment.

  Brett and I talk about what causes Ed, and the physical symptoms and manifestations of various problems that lead to the inability to have or maintain an erection strong enough for a fulfilling sexual encounter. Erections are made possible by blood flow to the penis. When there is restriction of blood flow in the pelvic girdle, it becomes difficult to impossible for men to get erections. This restriction can be caused by many things. The most immediate causes are inflammation and cholesterol. The problem does not really start there, it starts for most men when they begin to loose their testosterone. If they replace their lost testosterone with a bio identical replacement (shots or pellets) then it will help by not only improving the blood flow to the penis, but also by increasing the oxytocin. This helps with arousal and emotional focusing on sexual matters as well as by helping the mechanics of the erection work better.

  If the problem is not solved with testosterone then we have to look more at other interventions. The next issue we consider is plaque build up in the vessels of the pelvic area, and that comes from high blood pressure and cholesterol. When there is plaque in the vessels the blood cannot flow properly and there will not be enough volume to maintain an erection.

  Brett and I talk about things that men do that lead to these problems. The first of course, is that by aging they lose their testosterone. But beyond that, they smoke, gain weight, eat poorly (beef, saturated fats, animal fats, etc.) and they don’t exercise. All of these are contributors to the problem of ED.

  One of the interesting things that we hit on is that men often are told that they will have heart attacks and die sooner if they live this way, and they laugh it off. If they are told that they will loose their erectile function and not have sex, they get serious and promise to do anything to be better!

  Finally, we discuss the mechanics of erectile functioning and how procedures like a fem-pop surgery might help, or medicines like beta blockers such as Benicar rather than linisopril, or the use of drugs such as Viagra. We even discuss the issue of dehydration and its impact on erections and sex. Diabetes, which is becoming an epidemic among the aging population of the United States is also a major contributor to ED problems in men.

  If you are a male, and you are having concerns about ED, you will find this podcast of interest and importance. Please listen to it, and come back for the next two weeks as we discuss more about how to treat or deal with ED problems.
• 15Jan

  Diet Soda is Bad For You

  Anti-aging, Medical Care, Research No Comments

  Consider drinking less soda!

  

  Today Brett and I are talking about the shocking statistic that the average American drinks two diet sodas a day! Drinking diet soda increases your chance of being obese. It increases your chance of having kidney disease. It also contributes to being diagnosed with metabolic syndrome, and depending on their storage and delivery method, it may contribute to heavy metal poisoning.

  We were looking at an article that summarized medical research being done at Universities from Minnesota to Texas, from Massachusetts to England. These various Universities were publishing data that identified a 34% risk of kidney disease if you drink the average American consumption amount of diet soda (2 a day). There are other studies that say if you drink 2 or more diet sodas a day you have a 500% higher risk of being obese.

  Research shows that you should not drink alcohol and diet soda together. The sugar used in regular soda feeds the cells and lessens the absorption of alcohol by your body. If you drink diet soda, you will hot have the alcohol blocked by the absorption of the sugar because the artificial sweetener is not sugar and does not feed the cell. Therefore you will consume larger quantities of alcohol than you think and get drunker faster and with more risks.

  Sometimes physicians will recommend that someone drink a diet soda. We do this because in limited amounts a diet soda can reduce nausea and decrease the impact of an acidic stomach. Doctors will suggest diet sodas as a treatment and will expect that you keep consumption secluded as part of your treatment.

  Other risk factors in diet soda are the preservatives. There are preservatives used in diet sodas that are not used in sugared or regular sodas. These preservatives themselves can cause damage to your cells.

  Diet sodas increase your risk of developing what is called metabolic syndrome, a cluster of issues ranging from high blood pressure to obesity to insulin resistance and heart disease. I really do not find any redeeming qualities of diet sodas in volume and strongly encourage you not to drink them. Before you say “Doctor you don’t understand” please listen to today’s podcast. Then make up your own mind.
• 07Jan

  What a Woman Needs from Her Doctor

  Anti-aging, Medical Care, Treatment No Comments

  Tips for Choosing a Doctor

  

  Today’s conversation is an outgrowth of a paper I wrote for a Medical Journal. I was attempting to explain to my colleagues how women pick physicians and other providers of services in their lives. I wanted doctors to know that women talk to each other and pass the word around about whom to call among all their feminine networks. There are many ingredients that go into those female networks; they talk about how the office is decorated, how the staff is helpful, friendly, or receptive, they talk about the doctor and whether or not she listens to them and or talks down to them. Does the doctor take time with you to hear you and get to know you or do they just do clinical symptom management like a laboratory scientist?

  Doctors are not traditionally chosen because they have empathy and compassion and good people skills, they are chosen for medical school because they score well on tests and have good grades. We want our doctors to be smart, and educated, but we also want them to be people oriented and have the interest, the commitment and the skill for listening to the patient and seeing the whole picture.

  Of course, I also talk to my women friends and explain to them that they have some responsibility for making a visit with their doctor, to be productive and get well. I tell them to make a list in advance of the three things they particularly want their doctor to know about what concerns them on this visit. Prioritize that list and make sure that you don’t just wander around in a conversation that does not go anywhere and that you do not just answer the check list questions the doctor will ask. When the visit is finished, you should have a clear sense of what the doctor is going to do and what he/she wants you to do. You should have a clear picture of what will be the progression of your treatment and what outcomes or results the doctor expects if you do what they tell you.

  Many patients have trouble being treated. If they are not able to follow the doctor’s instructions then they are less likely to get better. The outcomes may not be a direct result of the doctor’s choices and behaviors. They may be a result of the patients.

  Brett and I also spend time today talking about the differences between men and women in how they approach medical situations. What do they know? How do they behave? What do they want? How are men and women different? I wanted to tell my doctor friends this information as well in my article. I wanted them to think about the differences in communicating with and treating men as opposed to women. It is worth the time and effort to understand and take advantage of these differences, but in order to do that you have to know what they are.

  In this podcast you will hear my friend Brett tell me:
  “Kathy I have known you for years and I know many of your patients and they have said to me over and over again that they love their visits with you because you give them a reason and an explanation for every symptom they have and every treatment you offer and a clear path to evaluate if they are getting better. There are specific markers and hooks that you identify and share with them that they feel so grounded by because they have that information. You are not just saying ‘I am the doctor, take two of these and call me in the morning or come back in two weeks and we will see.’

  He says this because he has heard from his female clients that this is how they have experienced their visits with me. It is validation for me because it is what I am preaching to other doctors about the way women work.
• 04Aug

  Doctor–Patient Relationships

  Anti-aging, Medical Care, Relationships, Symptoms, Treatment No Comments

  Insist on quality communication during your doctor visits.

  

  Have you ever wished that your physician would spend a little more quality time listening to you and getting to know your medical issues? This episode talks about how the regulations from insurance companies prevent doctors from taking the time to work on their doctor-patient relationships.
• 20Jul

  Truth About Nursing Homes and Aging

  Dementia and Alzheimer's, Depression, Insurance, Medical Care, Relationships, Treatment No Comments

  Truth About Nursing Homes and Aging

  

  There are ways to avoid the unfortunate circumstance of being a burden on your family in your old age due to your declining health. Find out more about how to prevent such a drastic need for dependency on others.
• 15Jul

  Obesity, Diabetes and the Harvard Food Pyramid

  Anti-aging, Bioidentical Hormones, Insulin Resistance, Medical Care, Menopause, Research, Symptoms, Testosterone, Thyroid, Treatment, Weight Loss and Fat Reduction No Comments

  Obesity, Diabetes and the Harvard Food Pyramid

  

  This podcast talks about the importance of leading a healthy life so that we can avoid conditions that are common in older people that are overweight and practice bad eating habits.

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