Some Doctors Miss the Mark

For the past few years I have seen pain management specialists for chronic pain. Seeking relief after many, many years has indeed been a challenge. Each time I was referred to a pain management specialist for the neck and back pain (from arthritis and herniated discs), treatments offered were medicine (especially samples of new stuff), and invasive procedures like epidural spinals and trigger point injections. Alternative treatment was rarely offered, and if so was limited to 20-30 minutes physical therapy sessions for about six weeks every few years, upon my request.

Fortunately, my neurosurgeons saw the light. In efforts to achieve pain control and maintain function without surgery, other treatments such as massage and acupuncture were recommended. Sadly enough, these choices are not covered by my insurance. I am still waiting for over a year now for approval and payment for long term treatment (which works) instead of six weeks.

Even though some doctors miss the mark, there are others who are on the mark. As a savvy patient you must always recognize this. You have choices even if you must pay for medical services you need out of your pocket. It is a tough choice, but the best for your health. If there is something you need that is not covered by your insurance, you have choices. Make the one best for you, especially if your doctor misses the mark.


by J. L. Richardson, MD, family medicine doctor, patient advocate and author of Patient Handbook to Medical Care: Your Personal Health Guide.

www.mypatienthandbook.com
www.twitter.com/MD4U

Read excerpts at Google Books http://books.google.com/books?id=kPmXiNrg1pYC&printsec=frontcover&dq=patient+handbook+to+medical+care

Routine Checkups Work, Ask Kareem

After disclosing his diagnosis with myeloid cancer, Kareem Abdul Jabbar, told journalists how routine checkups (for him every two years) help find his cancer early. His confidence in telling his medical story was utterly genuine. What a smart patient! He revealed that his symptoms were clues that something was awry with his health. His complete blood count (CBC) helped his doctor find the cancer. He further expressed his savvy by discussing his family history and that cancer was present. This is valuable knowledge for every patient.

Prevention and early detection in addition to education are key for great health. You must help your health care team with your health plan. Information like family history, your present medical and past medical history are the basic building blocks for your individual health maintenance plan. Take the time to put this down on paper and share with your present doctor and each new doctor you see. As you go along research your findings from medical records you have, and be sure they are accurate, correct and yours.

Routine checkups work. Ask Kareem.

by J.L. Richardson, MD, family medicine doctor and patient advocate, author of Patient Handbook to Medical Care: Your Personal Health Guide, recipient of Writer's Digest International Self Publishers award in reference books.

http://www.mypatienthandbook.com/
www.twitter.com/MD4U
www.blogtalkradio.com/drjfpmd - readings by author
http://short.to/vb5e - excerpts & bookstores on Google Books

Marijuana for Pain: Up Close & Personal

Such a timely question, medical cannabis. I live in a state that has all but decriminalized possession of small amounts of marijuana for personal use. Police may write tickets and confiscate, but even that minimal enforcement is rarely performed.

While I empathize with my cohorts with a variety of pain issues, I can only speak from my own experiences, so here's my first person perspective.

I was in the music business in Nashville when it became known as the "Third Coast" in the early-mid 1980s. Drugs were everywhere. The same people who smoked dope were into exotic highs like mushrooms, and then cocaine swept over us like a wave. Not wanting to raise my daughters in that environment, I left - the business, and the state.

Having been in the environment, I am one who unfailingly believes that marijuana is indeed often a "gateway drug" to more hard core substances - but for a different reason. The people I saw moving on to harder substances were a personality type - those who pushed the envelope. Perhaps for some it is the thrill of living dangerously, i.e. breaking a law, rather than the effect of the drug. I honestly
don't think I ever met anyone who suffered withdrawal symptoms from either being without a supply of pot, or from discontinuing it cold turkey.

Alcohol and tobacco are legal, controlled and taxed. There is an expectation that the ingredients (including the toxic ones) are of a consistent strength and character. Not so with illegal cannabis, which may be laced with angel dust or rat poison for that matter. No two highs are the same, or so I'm told.

The fact that there is no guarantee of safety or consistency, nor a legal way for me to try cannabis medicinally (and that I obey the speed limit when no one is watching) prevents me from experimenting. But some nights the painful systemic neuropathy drives me to the very brink of sanity.

With liver function tests consistently out of normal range, I'm in a terrible place for pain control: I have none. Neuroleptic drugs like gabapentin are notoriously hepatotoxic. Hydrocodone/apap or stronger narcotic/acetaminophen combinations are not only not effective for neuropathic pain, the acetaminophen is contraindicated in the presence of suspected or confirmed liver disease. So is alcohol.

I'm not aware of any research indicating cannabis in liver disease.

Medical cannabis can be delivered through smokeless methods, important to folks with respiratory disease. I've read that atomized cannabis is particularly effective and I'd love to try it, prescribed and monitored by my physician. Surely it would be safer pain control than the corticosteroid that only helps a little.

I've been a good Doo-Bee. I passed up the pipe, the rolled dollar bill, the magic mushrooms, and the Jack Daniels bottle under significant peer pressure. I'm so careful with my prescribed pain medications that I'm considered "narcotic naive". I've had surgical pain interventions, but there is no rhizotomy for systemic neuropathy.

Would it be too much to ask my government to permit me compassionate use of a natural substance to alleviate the pain that prevents me from being the person I can be?

Rachel Rosenfeld
http://www.twitter.com/NanaRCR

Thanks to guest blogger Rachel Rosenfeld for this great post on medical marijauna as it relates to her personal health issues. Medical research by doctors has shown it to be effective for safe treatment of pain and many other medical conditions that have been failed by traditional medication (including Marinol pills). Legalizing marijuana will have a great positive impact on patient comfort and quality of life.

Side Effects of Flu Vaccines

The flu vaccine may mimic symptoms of the flu. Check with your health care provider for any side effects from vaccination. Some side effects encountered are:

Allergy reaction with rash, shortness of breath/asthma, swelling

Fever, chills. malaise

Sore arm with redness, swelling, bruising at injection site

Muscle aches and headache

Nausea, vomiting

Guillain-Barré syndrome (GBS) muscle weakness and sometimes paralysis

There have been no reports of the more serious side effects in the small studies conducted. Which poses the greatest risk - the flu or the vaccine? It is up to you and your health care provider. Be informed so you can make the best decision for you.

Best health!

by J. L. Richardson, MD family physician, patient advocate, and author of Patient Handbook to Medical Care: Your Personal Health Guide, the book that tells you how to be your best advocate from medical records to medical exams to medical tests and more.

http://www.mypatienthandbook.com/
www.twitter.com/MD4U

Doctor-Patient Communication Suboptimal, Part 2

When you go to see the doctor you expect compassion, kindness and time! Doctors are walking out the door while you speak. There is little time for much more. Unprofessional hurried behavior is the norm amongst many physicians, while their health care extenders - nurses, physician assistants, nurse assistants - are reported as having much more bedside manner that shows true compassion. Is it really okay to be an unprofessional professional?

Is is okay for your doctor to come in and say, "How you doing dawg?" ? Meanwhile you look around to see if you are in the veterinarian's office by mistake...without your dog. All of a sudden this middle-aged man has finally joined the hip hop now generation. A "How u doin'?" a la Wendy Williams would have been really nice.

Is eight minutes really long enough for a doctor visit? This includes only the conversation without an exam. After repeatedly interrupting you and being interrupted this decreases to three to four minutes. The doctor has just enough time to meet the objective of writing that medical note about you that you may never get to see yet it determines your destiny.

Is it okay for your doctor to admit that she is a "bad doctor" because she admits that she is not keeping a list of all the medicine samples she has given you over the years? There is no documentation in your medical records of all the current medication you are taking. "Bad doctor" by self admission raises a red flag for sure. It seems "bad medicine" is more like it.

As has been said many times, many ways...YOU are your best advocate. It is up to you to be sure that you know all the medicines you are taking and to know your complete medical history. It is up to you to be informed and educated about all of this. Waiting for your doctor may be very hazardous to your health.

by J. L. Richardson, MD family physician, patient advocate, and author of Patient Handbook to Medical Care: Your Personal Health Guide, the book that tells you how to be your best advocate from medical records to medical exams to medical tests and more.

http://www.mypatienthandbook.com/
www.twitter.com/MD4U
www.blogtalkradio.com/drjfpmd

H1N1 Update

The US Center for Disease Control (CDC) has reported 593 deaths to date (compare to 170 at the end of June increasing from 17 at the end of May). All 50 states have been affected. Mass vaccination is planned starting some time in October. Over 2,800 have participated in vacccine clinical trials http://is.gd/3cVSf . Though reported to give immunity in over 90%, many are already reluctant to get the vaccine.

Thank God, H1N1 is not chicken little and the sky is not falling. Best health!

More references:

Preventing the Flu http://short.to/q651 wash hands, cover mouth when cough, consider vaccine
H1N1 map of cases around the world http://is.gd/1Kxtj


by J. L. Richardson, MD family medicine doctor, and author of Patient Handbook to Medical Care: Your Personal Health Guide.

http://www.mypatienthandbook.com/
www.twitter.com/MD4U
www.blogtalkradio.com/drjfpmd

Know Your Medication Names - Brand & Generic

Please welcome, guest blogger, Ellen Richter for this post. Know your medication!

If you take a brand-name drug, you should learn all the other names for the drug. I cared for a patient last month who had been taking Plavix for a mini-stroke since 2001. He knew that he should never stop taking the drug, so when he was hospitalized, he asked his nurse what medications his doctor ordered. She told him baby aspirin and clopidogrel. He never heard of clopidogrel so he called his wife & had her bring in his Plavix. He thought the hospital wasn't giving it to him! Every day, he silently took his own Plavix without telling the staff and then was given the daily dose, in generic form, by the nurses! If only he knew the different names for his drugs! He assumed the generic clopidogrel was a new pill the doctor had started him on!

Ellen Richter, RN, CLNC is a legal nurse consultant and founder of South Florida Legal Nurse Consultant Service, specializing in medical record review.
http://www.findlegalnurse.com/index.html