Thanks, Readers for 100,000 Page Views

Bloggers enjoy writing, at least I do, and readers.  Thanks to the many Dr Synonymous readers for 100,000 page views.  It tells me that there are readers of the blog and reassures me that I should keep writing.

Family Medicine is my main message.  I love Family Medicine and doing what Family Doctors do.  I'm passionate about the importance of my specialty for the health of individuals, families and communities (and the nation).  I still believe we have a lot to offer during and after the transformation of health care.  I'll write more about it.

Patients are even more interesting, and more important, than Family Medicine.  Their stories are meaningful and compelling.  Their lives are sometimes misaligned with their values, goals and dreams.  I enjoy validating their worth and helping with the "realignment".  I try to write about our shared humanity and the process of care.

Thanks again to Mike Sevilla, MD aka, Dr Anonymous (The "King" of social media in Family Medicine) for leading the way.

More later.  Thanks, Readers.

Chicken Pox, Vioxx and Goldilocks: Avoiding Avoidable Health Care

Where is health care headed?  Where has it been?  What can we do about it?

Think about Chicken pox.  Everyone gets them.  No big deal.  But wait.  There's an immunization now, given to one year old and every ten years thereafter (a booster).  Barely anyone gets the chicken pox these days. If someone wants their child to get exposure to someone with the chicken pox so the child can get the infection and by pass the immunization and boosters, it's almost impossible.

Think about Vioxx.  Great pain killer.  But wait.  A large number of users had a heart attack or stroke when they took Vioxx.  Many died.  There was a huge settlement from the manufacturer to patients or their families for damages.

Goldilocks and the Three Bears is a well known fairy tale.                                                                          

What do chicken pox, Vioxx and Goldilocks have in common?

What do you think?

More later.

Holistic Strategies for Health 2014

Holistic Strategies for Health, Enhance Your Brain and Heart Through Wholeness

Facilitator:  A. Patrick Jonas, MD

Find holistic strategies from the four major NIH categories of Complementary Practices for yourself that enhance your health.  Improve your sense of wellbeing by better understanding how your brain and heart are involved in wholeness. Review:

Mind-Body Strategies

Neutriceutical Therapies

Body Therapies and

Energy Therapies.

Find four of these that fit your style and need.

We'll have fun as we discuss these strategies and help you personalize while sharing with other attendees. We'll use a very interactive learning style in this session.  You already know a lot. 

Introductions

Disclaimer

Review of our holistic journeys

            Wholeness promotes holistic thinking- and human/spiritual connection

            From 60 trillion cells, each w/100,000 chemical reactions per minute

            1 billion + new cells daily, 1 of which is a malignant mutation

            How is it held together? How do we help/ harm ourselves?

Overview of NIH National Center for Complementary and Alternative Medicine

            www.nccam.nih.gov  (Practices not “Medicine”)

            Complete Systems of care such as Traditional Chinese Medicine, Ayurveda, Homeopathy, etc

            Mind Body Therapies/ Practices

            Neutriceutical Therapies

            Body Therapies

            Energy Therapies

Aspects of Wholeness:   The Bible

    

Molecules of Emotion  by Candace B. Pert, PhD. Every thought/ feeling affects our white blood cells/ immune system immediately.  T Cells and Natural Killer Cells.

 Vibrational Medicine for the Twenty First Century by Richard Gerber, MD.

The Biology of Transcendence and The Death of Religion and the Rebirth of Spirit by Joseph Chilton Pearce, PhD.

Wheels of Light by Rosalyn Bruyere; Hands of Light by Barbara Ann Brennan

Changing with NLP by Lewis Walker;  Time Line Therapy by James & Woodsmall

The Body Electric Robert Becker, MD & Gary Selden; Healing is Voltage by Jerry Tennant, MD

www.Heartmath.com “Coherence” balancing the autonomic nervous system

www.lef.org Life Extension Foundation- Top Twelve Supplements Recommended

www.healingdrummer.com Sound Atunement Therapy

Examples and Exercises:

            Neurolinguistic Programming (NLP); Hypnosis

            The “5-5-5”.   The vegetable/ herb garden.  The health food store.

            Massage; Chiropractic; Rolfing

  Quick Coherence Technique; Breathing; Relaxation

            Singing Bowls; Drumming; Didgeridoo, Music Therapy, etc.

            Touch; Exercise Ball

            Reiki; Reflexology; Holistic Chair Massage; Dry Needling; Acupuncture

            Prayer; Meditation

General Health and Wholeness

High Tech, High Touch: Technology to Recharge Patients and Family Physicians

I wrote this for the Ohio Family Physician about four years ago.  It's still a message about one of my favorite mechanical health strategies.  I use it a few times each month to get more wholehearted (attempting to balance the autonomic nervous system.)

By A. Patrick Jonas, MD from my article in The Ohio Family Physician

Cardiovascular disease is still the leading cause of death in America. Strategies to decrease the incidence of premature heart deaths are improving. Stents, medications, exercise, diet, etc. are well known interventions.  Biofeedback strategies for controlling blood pressure and stress were popular in the 1970-1990’s, but lost out in the reimbursement wars and disappeared from common use.  With enhanced understanding, those methods are making a comeback, even with some support from the Professional Golfers Association (PGA).

Golfer Nick Doherty had a habit of “choking” on the last day of pro golf events when he was in contention.  A few years ago, he forgot how to choke and became a very effective golfer late in competition.  When other golfers pressed him for his secret, he let them know he was using a biofeedback technology from Heartmath.com, called emWave Personal Stress Reliever and emWave Desktop.  These tools, now used by golfers around the globe, enabled him to be calm and focused under pressure.

Family Physicians are professionals under mounting pressures from outside forces in the health care system as they notice extra pressures in and from their patients.  The focused office visit to manage the high blood pressure is often stretched by the patient into a four or five problem encounter, sometimes trivializing the importance of the blood pressure and its complexity.  The sudden addition of the need to “refill” prescriptions for allergic rhinitis, asthma, gastroesophageal reflux disease (GERD), and the shampoo originally prescribed by their dermatologist add to the stress of the family physician and increase the risk of burnout.  While there are many reasons for these daily events in family medicine practices nationwide, there is no denial of the increased stress in the lives of family physicians and their patients.  With the addition of healthcare transformation and the shift to the Patient Centered Medical Home (PCMH), the stresses havel increased.

Could family physicians and their patients benefit from technology that helps golfers? Could the same technology enable both patient and physician to lower their blood pressure?  Studies support the use of the emWave biofeedback technology to lower blood pressure, improve sleep quality and even help many with poor eating habits when under stress.  In fact, family physicians are all trained to have insights about, and have strategies to help patients with, stress induced symptoms and diseases.  The EM Wave builds on that knowledge with information from neurocardiology about the impact of stress on the heart and subsequent effects on the limbic system, especially the amygdala.

 

One measure of heart-brain connection is heart rate variability (HRV), commonly used to monitor the wellbeing of unborn babies during labor, but also used as a measure of autonomic nervous system function.  Heart rate variability changes from second to second as our thoughts change.  The amygdala is continuously scanning our emotional memory to compare our current situation to past situations.  If a current pattern matches a past stress inducer- boom- a stress response is turned on to protect us.  This immediately decreases the quality of our cognition (test anxiety, anyone?) and increases heart rate, blood pressure and respiratory rate, among other elements of the response.  If our patient is having increased stress reactions and we’re trying to help them with the resulting blood pressure and get to the bottom of a stress reduction strategy, we get our own stress response when they deflect our efforts with the request for the four unrelated prescriptions.  We both need help!

The HRV synchronizes with the amygdala, sending messages from heart to brain and brain to heart.  If the HRV is “coherent” indicating a balance between sympathetic and parasympathetic nervous system elements of the autonomic nervous system, the amygdala is content to allow contentment.  If the HRV is chaotic, the amygdale finds an emotional state in memory that matches that HRV, generating a negative emotional state with a stress reaction, affecting the entire brain and body.

The HeartMath people have a “quick coherence technique” to teach people how to decrease the stress and re-balance the autonomic nervous system.  It has three simple steps that also are used with their software for skill training:

“1.  Heart Focus:  Shift your attention to the area of the heart and breathe slowly and deeply

2.  Heart Breathing:  Keep your focus in the heart by gently breathing- five seconds in and five seconds out- through your heart. Do this two or three times.

3.  Heart Feeling:  Activate and sustain a genuine feeling of appreciation or care for someone or something in your life.  Focus on the good heart feeling as you continue to breathe through the area of your heart.” (Wilson and Childre, 2006)

The beauty of the quick coherence technique and having the ability to become coherent in even the most stressful situations is that the patient or physician employing the skill need not be in a trance-like state.  This is not relaxation therapy.  They can be totally present and contributing with their best brain and heart function in full support.

 

The desktop version of the EM Wave Desktop includes a breathing trainer and games such as flying a balloon or painting a meadow with your coherence.  Several screens in the software enable the user to see a lead II of ECG, coherence scores, autonomic nervous system moment to moment balance between sympathetic and parasympathetic elements, and previous sessions for the same user.  Multiple users can use the same software which is totally self instructional down to the basics of HRV and stress.

Booklets about using the system to approach specific conditions are available on the web site where the EM Wave is sold.  These include, The HeartMath Approach to Managing Hypertension, Transforming Anxiety, Transforming Stress, Transforming Depression, Managing Emotions:  Golf’s Next frontier Booklet.

There are many ways to relate to stress reduction and blood pressure reduction.  The use of electrophysiology and biofeedback may help many family physicians and their patients to avoid or manage stress related diseases.

Patient Response to Appointment Issues and Priorities

Here's a really insightful comment in response to my post Family Medicine: The Generalist

I'm not sure there's a solution to this problem. As a patient I usually come to the doctor with an assortment of complaints. Often it's hard to summarize everything that's going on in a few short statements on a form or when making an appointment. Issues come and go. New things may have come up since the appointment was made. Also, being an old guy, I think I was trained by the doctor I saw several decades ago to simply talk about everything that is bothering me during an appointment. And I sometimes wonder if some minor problem may contain information that would be helpful to the doctor in understanding the more serious problem...and could actually be connected to it. I come to the doctor not as a symptom, but as a person with a number of reasons to seek medical attention. I greatly appreciate the fact that I can come to a family doctor that way and not have to visit a bunch of specialists who may have conflicting ideas about what's wrong and what to do about it. All that's good...from Dave Levingston

This statement is really helpful to remind physicians of how life really is for our patients.  The era of the Electronic Medical Record adds to the tension of misaligned expectations between patients and physicians.  We don't use ours, yet, but may soon dive in.

My response which didn't show was this:

Thanks, Dave for your comments. We have the continuing creative tension between patients and physicians, trying to figure out the big and little picture at the same time as enjoying a continuing relationship of humans. We might have "little picture" visits and "big picture" visits, to balance focus needs with long range needs. The patient's story remains central to every visit. Both persons stories remain central to the relationship of patient and physician- which we could find a better way to emphasize. Your comments are very insightful and right on.

As we work together on saving the good parts of health care, these considerations are important in designing the electronic connections away from the billing focus of the early EMR's to human focus.  I believe it can be done in Family Medicine as we work with patients and doctors to refocus on what's important.

Onward.