Dr. Wittenberg received her B.A. in Biology from Lehigh University in Pennsylvania and attended Drexel University in Philadelphia for her Master’s Degree in Public Health and her Medical Degree. She and her husband, an Emergency Medicine doctor, then migrated to the warmth of Southern California for residency training. She is a graduate of the Long Beach Memorial Family Medicine Program, and is Board-certified in Family Medicine. (more…)
Articles on General
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Around half of Americans suffer from acid reflux and many take regular medication for the symptoms. However, by treating the symptoms, you are not getting to the root of the problem. Millions of dollars are spent on medication for acid reflux but what if there was a way to prevent it without resorting to conventional treatments? Here are some of the common triggers of acid reflux to help you start treating the cause. (more…)
Patients sometimes are dissatisfied with the communication offered by physicians. “He won’t answer my questions.” “He gets angry with me.” “He cuts me off.” “He won’t answer my calls.” “I can’t understand him.” “He scares me.” Sometimes they say, “You’re the only one who spends time with me.”
Our office schedule allots sufficient time for thorough explanations. In the current medical paradigm, insurance companies, including Medicare, pay physicians less and less for the work they do. Office overhead, however, only goes up. Doctors spend less time with patients because their income depends on seeing more patients. If physicians are employed by an HMO, only a limited amount of time is permitted for each office visit.
New requirements for electronic medical records (EMR) have aggravated the problem. According to reports, doctors now spend more time on the computer than they do with patients. In many offices there is a computer in the exam room, and the doctor focuses his attention on the screen, occasionally looking up to face the patient. The bureaucratic demand for endless documentation has made the situation much worse.
Yet underneath all of this is a more elemental problem. Many physicians have not learned the technology of communication. They should face the patient throughout the time of the visit. They should offer easy to comprehend explanations, then appeal to the patient’s intelligence and understanding, and not try to enforce obedience through fear. Fundamental to effective care is the nurturing of affinity between doctor and patient. The physician should be aware of the patient’s concerns, current stressors, and the family situation.
The physician should use words the patient will understand, and not be too technical. He should provide illustrations of relevant anatomy and procedures. He should define complex terms. Recommendations should be provided in writing, since patients otherwise may not remember what is said to them. Individuals who cannot understand instructions are unlikely to follow them. We should simplify our language.
It is also important to understand the patient’s point of view. A patient may have an intense fear of surgery or anesthesia, whether justified or not. Some individuals prefer to risk the consequences of their disease rather than the side effects of medications or the complications of surgery.
My purpose is to offer knowledge, experience, and judgment. It is up to the patient to decide what course he will choose. If I disagree I will say so. Throughout all discussions it is crucial to maintain affinity. Otherwise the communication line will wither.
Medicine in my lifetime has made astounding advances in knowledge and therapy. It has lost some ground in the practice of communication.
We need to rediscover the virtues of the old-time doctor-patient relationship. Have a doctor you can trust and who listens to you and talks to you.
Dr. Allan Sosin
Stem cell therapy is revolutionizing medicine. Stem cells are multipotential cells residing in various body tissues, especially adipose tissue and bone marrow, but also circulating in the blood stream. When activated and placed in different areas of the body, they are able to differentiate into functional cells to replace damaged tissues. Stem cells are being employed to heal the heart, repair the retina, and reverse various neurological disorders including multiple sclerosis and ALS. In all of these conditions technology is being developed.
Stem cell therapy is well established in the treatment of orthopedic disorders. Many studies have documented regrowth of cartilage and reduction of pain in damaged joints, especially knees and hips. Any joint can be treated, including the back, neck, wrists, elbows, shoulders, feet, fingers and toes. Injections can rebuild torn and degenerated tendons including the Achilles tendon. Partial tears can be reversed and individuals can return to prior activities without the prolonged healing time required after surgery.
And if yes, why and what should we eat for breakfast?
After a whole night of fasting, breakfast serves as a means to supply “fuel” to the brain. Research show that daily breakfast eaters tended to gain less weight and have lower body mass index levels (an indicator of obesity risk) compared with those who had skipped breakfast. On the other hand people that skip breakfast are missing out on key nutrients, such as Vitamin D, Vitamin B12, and Vitamin A. Breakfast-skippers consume 40 percent more sweets, 55 percent more soft drinks, 45 percent fewer vegetables and 30 percent less fruit than people who eat breakfast.Children and teens who regularly have breakfast on a near-daily basis had 25% higher score in math, science and reading, meaning breakfast helps keep a clear and sharp brain at any age. (more…)
The CDC completed a cross sectional study looking at the nutrient density of powerhouse fruits and vegetables. Let’s look at the top 10 nutrient dense foods that we should be emphasizing on a daily basis.
- Watercress – This may surprise many as it is not always the first food selected in the produce aisle. However, it is now the unrivaled superfood champion. Gram for gram, this mild tasting green contains 4 times more beta-carotene than an apple and 238% of the recommended daily dose of vitamin K. It is also very rich in anticancer phytonutrients. If you are less familiar with watercress, start adding it to salads, wraps and vegetable juices.
- Chinese cabbage – CABG which is also called Knoff or celery cabbage. This is very rich in calcium and iron and as a member of the cruciferous vegetable family also is anti-inflammatory, reduces heart disease and cancer.
- Swiss Chard – This is another favorite leafy green that contains at least 13 different antioxidants and has been used to prevent type 2 diabetes
- Beet greens – This is another compelling reason to buy organic beets. The beet itself is high in bioflavonoids, antioxidants and an excellent food for detoxification and liver support. Now we are reminded of the nutritional content of the leafy green that is attached to the beet, that sometimes gets overlooked. This is a wonderful green to add to a stir fry or your vegetable juice. (more…)
A meta-analysis of treatments for osteoarthritis of the knee reached a surprising conclusion: intra-articular injections were more effective in relieving pain than any oral medication. (Annals of Internal Medicine, January 6, 2015, pages 46-54)
The knee is the joint most commonly affected by osteoarthritis. Forty percent of people older than 45 years have some degree of knee osteoarthritis. Four hundred thousand knee replacements occur every year in the US. Millions have pain and stiffness that limits their ability to exercise, leading to obesity and all the complications associated with it, including worsening arthritis.
Government agencies have become obsessed with requirements for universally accessible medical records. They will enforce this requirement by law within the next two years. I shudder to think what this will do to individual privacy. Already I have seen the shadow of the computer come between the individual and the physician, interfering with communication as the physician fiddles with screens while ostensibly listening to the patient. Eye to eye contact is becoming a thing of the past. I deplore this, since it detracts immensely from the physician-patient relationship.
Recently I requested a patient’s records, and was sent an E-mail containing 300 pages of notes, largely illegible and mostly irrelevant. It took me half an hour to obtain a few bits of useful information that could have been expressed in one paragraph.
A patient goes to a doctor’s office with the belief that the doctor knows something, or has the ability to do something, that will help the patient. It is the doctor’s obligation to have knowledge, or have access to knowledge, relevant to the patient’s situation, or the training to perform a procedure to evaluate or treat the patient.
It is therefore important for the doctor to be educated in what he purports to know, to offer recommendations based on a satisfactory knowledge base. It is also important that the basis of a physician’s recommendation is the well-being of the patient, not the physician’s self-interest.
These conditions are by no means straightforward. Many types of approaches are available for most conditions, while other conditions have few proven therapies. Still, patients will always look for answers, for some kind of help, because it is not in man’s make-up to sit and do nothing in the face of adversity.
The doctor must keep in mind that a given treatment may not help the patient, or may cause complications and make the patient worse, or that the real diagnosis lies elsewhere. The age, physical and mental status of the patient must also be considered in choosing a therapy. Cardiac bypass surgery may be a proper choice for a 50 year-old, hard-driving businessman, but excessively dangerous for an 85 year-old woman with severe arthritis and emphysema. Determining the best therapy may more involve the art than the science of medicine.