My Journey Into the Future

I am currently in the process of completing one of the greatest experiences of my life.  I am completing my educational experience to become a family nurse practitioner.  I Just got done with pediatrics and have already done family medicine, Ob/Gyn and will soon start the residency portion which has some optional rotations alongside more family medicine.  To set the stage of this post I will drop just a little info about me here real quick.  I love to study human nature.  I enjoy interacting with my patients and getting to know them.  I also love to study the politics and the structure of health care.  I love it so much that I intentionally did all of my rotations in facilities that offer medicaid and or medicare, basically government funded care.  I felt that this had the greatest parallel to the stuff coming down the pike for ALL of us.  That is all of us unless you are a senator or representative.  You know - the guys that are actually making the laws that the rest of us live by except them.  Anyway, I wanted to taste the reality of what the future holds for me when I'm old and broke down, or placed in a socialized model against my will.  I also want to include that this post is really not about following a party line, or reacting out of emotion, it is simply a brief recall of my experiences.  So here it is. 

I'm totally frightened at this point.  I noticed several things.  The first thing I noticed is that people, regardless of income, nationality or gender do not and will not completely appreciate or embrace their health and well being if they are not personally investing anything into it, especially money.  I noted time and time again that those who got everything for free saw no need to do anything to prevent the breakdown of their bodies.  They avoided educational information, they did not take their drugs, they do not show up for appointments and getting a large percentage of them to do anything that equaled disease prevention was impossible.  For instance, a lot of the patients I observed simply would not take their insulin.  As a result, they got tissue ischemia, renal failure, retinal damage and profound peripheral and central nervous system changes.  This triggered incredibly expensive diagnostics, surgical procedures and often the need for long term care and ultimate disability.  That patient who had the 75 dollar office visit and the 20 dollar bottle of insulin turned into a patient that cost close to 250 thousand dollars very quickly.  I noticed this time and time again during my rotation.  I finally asked one of the patients, "hey, how would you treat yourself if you had to pay for some of the care that you get." The patient replied, "I would do more to prevent this in the first place, because I would not be able to pay for all of this otherwise."  It hit me at that time, when people do not have an invested interest in something, they just don't seem to care as much.  In conclusion to this observation, people should invest in their health. In particular, they should invest in wellness and prevention before the you know what really hits the fan and things get expensive.  Those that do all they can with what they have should have premium reductions and offered assistance.  Those that elect to not take care of themselves and decide to smoke, drink, never exercise and not take the advice they are given should clearly have higher premiums.  The problem is, it seems to be the other way around, that hit me as very strange.  Doctors who also elect not to educate their patients so they know more about what is wrong with them should not be paid as well. 

Next, the patients never got what the needed other than some generic meds and very basic labs.  Here is a good example.  I had a patient that I diagnosed with a severe ulnar nerve lesion.  The patient was getting hand weakness, a claw deformity and profound sensory loss.  I told the attending doctor that the patient needed an immediate surgical referral and he laughed at me.  I was a bit surprised.  He told me that it will take months.  He was right, it did take months.  It took six months to be exact.  This was a medicaid patient.  The office worked diligently to get the referral.  By the time it was made, the patient had permanent loss in hand function.  This equals disability which equals more cost to the total amount that this patient is going to accumulate.  In addition, they now cannot work which is a whole other deal all together.  I saw this time and time again.  There were limited specialists taking these patients also and those that did were slammed with patients and the red tape to get the patient to the specialist took tons of man hours and is an added over head to a system that is reimbursing up to 25% less than major med. 

This leads me to my final point, time to cost ratio.  If reimbursement is cut up to 25%, that means that I as a family doctor has to see more patients in a shorter time frame to pay the bills.  So, now I have a patient taking ten medications and has four different conditions and I realistically get five minutes with them.  This is insane.  It is so insane that it starts to prematurely burn out the providers that practice in this environment and it simply is not as safe as having an environment where the provider can slow down, think, take some time and do better work.  I foresee this as being an enormous problem.  Practitioners are going to be pushed into seeing more patients then they can safely and realistically see in a given day or period of time.    

In the end, I spent time with some great doctors, I met some amazing people and I realized a few things.  Nothing, absolutely nothing is better than a doctor that holds their patients accountable, makes them invest into their health, educates them on everything and pushes them to strive for disease prevention verses luring them down a path of chronic illness and debilitation by just throwing a lot of drugs at them.  Some patients need that, but not all of them.  I love being an educator and wellness doctor and teaching people to prevent the illnesses that is epigentically hiding out in their systems for as long as they can.  I encourage all of you that treat patients to do these things.  I encourage all of you that are patients yourself to practice prevention.  I encourage the government to also hold patients accountable as well as offer adequate access to diagnostics and necessary procedures when medically necessary.  In the end, I do not think socialized medicine will accomplish any of these things, so get ready to invest into yourselves when you can.  Also, do not be surprised when this system falls totally into place to see America become much more unhealthy and do not be surprised when the cost of healtcare sky rockets, despite everyone getting a cheaper more watered down version.  Don't be surprised when your doctor spends less time with you, is less thorough and you get more generic meds.                   

Drugs Got You Chasing Your Tail?

I was hanging out in the kitchen the other day with my super wife and amazing kids and I noticed that Choochie, my killer 4 pound chihuahua, was endlessly chasing her unusually long tail again.  She runs until exhaustion and then stops and looks at me with a face of total disbelief.  Before you think I'm crazy, realize that this story translates into the world of patients and health care.  I have a lot of stories about patients and even doctors chasing their tails and then looking up and wondering why things are the way they are.  Patients take their drugs, do their exercises and everything else that they have read about, were told to do and so forth.  The problem is, they still feel terrible.  They are feverishly chasing their tails with every treatment trick they can gather and in the end they stop, exhausted, look up and wonder. 

One of the greatest examples of this is using prescription or over the counter drugs that contain gluten.  Before we even get going here I want everyone to clearly understand that I have no problems with giving a patient medication when they need it, so this is not a blog that is meant to hammer the drug industry.  Next, if you are a skeptic regarding gluten contributing to or causing a multitude of diseases, then you just need to go to pub med or google search and read the literature available.  You could not read all of it if you spent your entire life trying to do so, and most of it has been around for years.  It is no longer a question that those who are gluten intolerant in one form or another will ultimately suffer from gluten exposure, especially with daily, chronic exposure.  It is also a fact that gluten intolerance is one of the greatest health problems in the entire world.  This is because it most often goes undiagnosed, it contributes to hundreds of other expensive and costly medical conditions and the awareness of the situation is still in it's infancy when you look at the big picture that surrounds gluten related scenarios.  As a result, many people suffer endlessly not knowing what is going on while their doctor continues to poison them with a medication that contains the one ingredient that is slowly killing them - gluten. 

Picture this.  You have an underlying inflammatory condition.  Maybe you have any arthritic condition.  Maybe you have an inflammatory bowel condition, a thyroid pathology, diabetes, a degenerative brain disorder, anxiety, depression or an autoimmune disease.  The list literally goes on and on and on.  Picture having one of these conditions and you are taking medication to control that condition and you find out that the one thing that can agitate, perpetuate or even cause your condition is an underlying intolerance, reaction, sensitivity or autoimmunity related to dietary gluten.  Then you find out that the medication that you are taking daily is giving you a nice heaping, helping of gluten.  Do you understand the chihuahua tail chasing analogy now???? 

Here are some of my favorite tail chasing stories.  A patient that has anxiety and is taking generic Xanax (Alprazolam).  Alprazolam is suspect for containing gluten.  There is literature that demonstrates that patients who have issues of gluten intolerance can have a 500 percent increase in episodes of anxiety.  Another one is spastic colon and Levbid.  Levbid is often a drug that is used to actually treat GI symptoms caused by gluten exposure.  Amazing!!!!!  The drug actually has gluten in it.  That's like taking a drug that treats arsenic toxicity and it has arsenic in it.  The good news is that the generic drug for Levbid, Hyomax SR, does not have gluten in it and this drug actually does help GI symptoms with no additional exposure.  Another great one is Lovastatin for elevated blood lipids and cholesterol.  How about this one - Novolin 70/30, a form of insulin.  There are reams of information correlating a connection between diabetes and issues related to gluten.  Last but not least are supplements.  I'm not going to go into the laundry list of supplement companies that put gluten into their products, but you would be totally astonished at the number.  Research your supplements, and don't let them give you the run around when you ask them.  Stick it to these people!! 

So what is the take away educational point of this post.  Here it is.  If you have a chronic illness or suspect that gluten might be a key to your health related issue, then get it checked.  You can do it yourself, https://www.enterolab.com/.  I HIGHLY recommend that you find a doctor that can help you with this journey however.  The next educational point is that you should check ALL your medications for gluten as an ingredient.  You Can check some of these at http://www.glutenfreedrugs.com/.  I ALWAYS recommend that you call your pharmacist or call the manufacturer of the drug that is in question.  Again, don't let them give you the run around, stick it to them and make them send you the information about the drug you requested.  This is especially important if you are having to take a drug that is going to be long term, like Insulin, or blood pressure medications. 

The conclusions are clear.  Stop chasing your tail.  Find out if you are gluten sensitive, reactive, intolerant or if you have full blown Celiac Disease.  If you do, check ALL of your prescription drugs, over the counter drugs and supplements for gluten.  Remember, over the counter drugs typically have gluten present more commonly than prescription medications.  Doing this just might be the one thing you need to do to stop the decline you have noticed in your health (stop the tail chasing).  I wish you the best.  I can tell you from experience, doing this has helped A LOT of my patients.