Posted by & filed under General.

Medical RecordGovernment 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.
Read more »

Posted by & filed under Cancer.

MammogramA New England Journal of Medicine article casts doubt on the value of screening mammography in preventing death from breast cancer. (Effect of Three Decades of Screening Mammography on Breast-Cancer Incidence, November 22, 2012, pp 1998-2005).

Screening mammography, or mammography performed in the absence of symptoms, has doubled the frequency of detection of early-stage breast cancer, from 112 to 234 cases per 100,000 women each year. However, the rate at which women have presented with advanced breast cancer has only slightly declined, by 8 cases per 100,000 women. This suggests that many of the cancers detected by mammography are not aggressive, and would never lead to symptomatic disease. Detection of these inactive cancers represent overdiagnosis, the discovery of cancers that would not cause illness. The authors estimate that in 2008, breast cancer was overdiagnosed in over 70,000 women, representing 31% of all diagnosed breast cancers. In the last three decades, breast cancer overdiagnosis has affected over one million women.

Read more »

Posted by & filed under IPM News.

Happy and eventful New Year to everyone.
Wonderful times await you.

At the Institute for Progressive Medicine we were involved in a number of new protocols this last year.

We began using ozone therapy, with excellent results in several areas.

Ozone is a gas, produced in a generator through the activation of oxygen. It is highly effective at killing bacteria, fungi and viruses. It can be applied to the skin in olive or neem oil to heal skin infections including herpes and shingles, to improve acne, and to suppress onychomycosis, or toenail fungus. It can help to heal mouthsores and skin ulcers. Ozone may be infused intravenously in saline to treat infections such as bronchitis or pneumonia, or to improve chronic fatigue syndrome, fibromyalgia, and immune disorders such as rheumatoid arthritis by enhancing immune function. Research performed in Cuba documents improvements in macular degeneration and other eye disorders with intravenous therapy.

Ozone can also be given by enema to heal intestinal inflammatory disorders, such as Crohn’s disease and ulcerative colitis.

InjectionThis last year we have been using ozone as a component of injections for treating joint, ligament and muscle injuries and degeneration, including osteoarthritis. It can be given in the same injection with prolotherapy, which is a combination of glucose and procaine, use for many years as an alternative treatment for joint, muscle and tendon problems . This combination, called prolozone, can be injected into shoulders, hips, knees, lower backs, necks and forearms, and almost all other affected jonts. Injections may be given every two weeks. Prolozone works to strengthen tissue while reducing pain, sometimes avoiding the need for surgery. We also have a new technique for injecting platelet rich plasma, or PRP, along with prolozone, to provide even more effective healing. Platelet rich plasma is extracted from a patient’s blood and injected into affected areas. Platelets contain powerful growth factors that stimulate the healing process.

These injections can be applied as part of a comprehensive treatment program along with physical therapy, chiropractic, massage and acupuncture, and therapeutic exercises like Pilates, yoga or tai chi, to promote healing without the need for surgery.
Read more »

Posted by & filed under Viruses.

VaccineAs a result of vigorous drug company advertising and recommendations made by several health organizations, many patients have come to me asking if I advise getting  the shingles vaccine.

Shingles, also called herpes zoster, is a painful rash occurring on one side of the body only. It usually involves the chest or abdomen, but may affect any area, including the face. Direct involvement of the eye, though uncommon, is a medical emergency, since vision may be permanently impaired.

Shingles is due only to reactivation of the chickenpox virus that has been dormant in the body, usually for years.  It does not occur by transmission from other individuals. Factors that impair immune function, such as physical or emotional stress, nutritional deficiency or steroid use, may activate the virus from its location within nerve cells, where it resides.

Read more »

Posted by & filed under News.

Source: New York Times Health

A new study of acupuncture — the most rigorous and detailed analysis of the treatment to date — found that it can ease migraines and arthritis and other forms of chronic pain.

The findings provide strong scientific support for an age-old therapy used by an estimated three million Americans each year. Though acupuncture has been studied for decades, the body of medical research on it has been mixed and mired to some extent by small and poor-quality studies. Financed by the National Institutes of Health and carried out over about half a decade, the new research was a detailed analysis of earlier research that involved data on nearly 18,000 patients.

The researchers, who published their results in Archives of Internal Medicine, found that acupuncture outperformed sham treatments and standard care when used by people suffering from osteoarthritis, migraines and chronic back, neck and shoulder pain.

“This has been a controversial subject for a long time,” said Dr. Andrew J. Vickers, attending research methodologist at Memorial Sloan-Kettering Cancer Center in New York and the lead author of the study. “But when you try to answer the question the right way, as we did, you get very clear answers.

“We think there’s firm evidence supporting acupuncture for the treatment of chronic pain.”

Acupuncture, which involves inserting needles at various places on the body to stimulate so-called acupoints, is among the most widely practiced forms of alternative medicine in the country and is offered by many hospitals. Most commonly the treatment is sought by adults looking for relief from chronic pain, though it is also used with growing frequency in children. According to government estimates, about 150,000 children in the United States underwent acupuncture in 2007.

But for all its popularity, questions about its efficacy have long been commonplace. Are those who swear by it experiencing true relief or the psychological balm of the placebo effect? Read more »

Posted by & filed under IPM News.

Urgency Incontinence TreatmentUrinary urgency incontinence is leakage of urine due to inability to control the urge to urinate. Patients simply cannot get to the bathroom soon enough. It differs from stress incontinence, which is the spontaneous loss of urine occurring with activities that increase abdominal pressure, such as coughing or laughing. Urgency incontinence increases with age, is more common in women than in men, and often reflects a weakness in abdominal musculature.

Involuntary loss of urine is a very unpleasant problem, causing embarrassment, avoidance of social activities and therefore isolation, impaired sexual pleasure, anxiety and depression. Kegel exercises to strengthen abdominal muscles are helpful if correctly employed, but most people require instruction in performing these properly.

Medications that reduce bladder contractions are often beneficial, but have significant side effects, including dry mouth, constipation, blurred vision and confusion. They may also cause urinary retention with increased risk of infection, especially in men.

A new, non-drug therapy is available, providing at least a 50% improvement of symptoms in 60-80% of patients. It is simple and virtually painless.

Read more »

Posted by & filed under General.

Doctor and PatientA 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.

Read more »

Posted by & filed under Hormones, Weight Loss.

Healthy ManTestosterone deficiency is commonplace, and closely related to age. Levels decline 1% yearly after the age of 40. We also see declines in men under stress, either emotional or physical, and in men taking psychoactive agents such as antidepressants, sedatives, as well as alcohol and other drugs, particularly narcotics.

Testosterone is easily measured with a simple blood test. Deficiency is variously defined, but levels under 300 ng/dl are considered low. Treatment with testosterone by transdermal gel, injection or subcutaneous pellet will raise blood levels, and restore energy, libido, muscle mass, bone density, and sense of well-being.

A recent study reveals a further benefit with weight reduction and lower waist circumference. These improvements were progressive over 5 years, not limited to a few months after starting therapy.

The study, reported at the annual Endocrine Society meeting, involved 255 men averaging 61 years of age. All were obese or overweight. Testosterone levels normalized with long-acting intramuscular injections. Mean body weight dropped 16 kg (35 lbs) over 5 years. Waist circumference dropped an average of 8.8 cm (3 ½ inches).

Read more »

Posted by & filed under Cancer.

The US Preventive Services Task Force has recommended against routine PSA screening in men for prostate cancer. The recommendation was based on the conclusion that “there is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.” Large studies had revealed either no or very small increases in survival from screening in patients followed for over ten years. In a European study, results showed that in men aged 55-69, screening prevented only 7 deaths per 10,000 men followed over 9 years. In older men, screening is even less useful. Moreover, screening often leads to prostate biopsy with negative results, with complications of pain, infection and bleeding. Subsequent elevated PSA readings lead to additional biopsies with further complications. I have seen patients who had three prostate biopsies performed, all negative for cancer.

The incidence of cancer within the prostate is high, and increases with age. A 50 year-old man has about a 50% chance of having cancer in the prostate, while an 80 year-old man has an 80% chance. Many of these cancers, however, are indolent, do not metastasize, and will not cause death if untreated. Unfortunately, we have no easy way of determining early which individuals have aggressive cancer.

How will this recommendation translate into action in the real world? Will patients not want to have a PSA test? Will doctors recommend against it? Will insurance companies refuse to pay for it? Will lawsuits occur when patients who were not screened develop invasive cancer and die? I think it is unlikely that PSA screening will drop into obscurity, especially when it is compared to the ritualistic frequency of mammography screening, which the Task Force has recommended not be initiated until the age of 50, then performed every two years until the age of 75, and discontinued.

Read more »