Posts Tagged ‘medication’

A Pill Or Pounding the Pavement To Produce Good Health And Lower Healthcare Costs

January 5, 2014

Many times I am consulted by patients for a solution for their medical problem. Most often it comes with a pill, an injection, or a surgical treatment. But I enjoy having conversations with middle-age men who visit my office to find a solution to their problem with erectile dysfunction (ED) or impotence. Many of these men are 50-70 years of age and are over-weight; take multiple medications for arthritis, diabetes, high blood pressure, and heart disease. I then have the following conversation with them:

Mr. Smith if I could offer you a pill that would lower your blood pressure, lower your cholesterol, decrease your pain in your back, knees and hips, decrease your obesity, decrease your glucose level and improve your diabetes, improve your mood, decreases your risk of prostate and colon cancer, has absolutely no side effects and is very affordable and would be covered by your insurance company, and best of all it will make your penis appear 1-2 inches longer, would you take the pill?

One hundred percent of the men say, “Why yes. Will you write me a prescription?”

I respond by gently tapping the man on his shoulder and say, “Mr. Smith, I’m so very sorry, it’s not a pill; it’s exercise!”

That’s exactly what exercise will do for you. It will improve your overall health and will make it possible to throw away so many of the multiple medications that middle age men AND women take. We are a polymedicated society and look for a pill to solve our healthcare needs. Except for genetics, which we can’t change, there are lifestyle changes that ALL of us can make that will improve our health and allow us to live longer and healthy lives.

Let’s look at the facts about obesity in America.
Obesity rates are soaring in the U.S.
Between 1980 and 2000, obesity rates doubled among adults. About 60 million adults, or 30% of the adult population, are now obese.

Similarly since 1980, overweight rates have doubled among children and tripled among adolescents – increasing the number of years they are exposed to the health risks of obesity.

Fact: Most people still do not practice healthy behaviors that can prevent obesity
The primary behaviors causing the obesity epidemic are well known and preventable: physical inactivity and unhealthy diet.

Despite this knowledge: Only about 25% of U.S. adults eat the recommended five or more servings of fruits and vegetables each day.

More than 50% of American adults do not get the recommended amount of physical activity to provide health benefits.

No one knows with any degree of certainty what the Affordable Healthcare Act (ObamaCare) will bring to modern medicine. One thing we do know for sure that one of the best ways to control healthcare costs is to control obesity. Obesity-related costs place a huge burden on the U.S. economy Direct health costs attributable to obesity have been estimated at $52 billion in 1995 and $75 billion in 2003 and by now is over $100 billion of the more than a trillion dollar healthcare budget.

Bottom Line: As Everett Dirkson, the late Senator from Illinois, once said, “A billion here, a billion there, pretty soon, you’re talking real money.” This holds true today as it was uttered by the senator nearly 50 years ago. Americans must take responsibility for their health. We need to quit looking for the quick fix or a pill to solve our healthcare problems. We need to start exercising. You will be happier, your doctor will be pleased with your weight reduction, and the percent that Americans spend on healthcare related to obesity will come down. Advice from Doctor Baum…..get moving!

P.S. How does the penis get longer from weight loss? When you lose that belly fat and reduce your abdominal girth, you will see your toes and the end of your penis for the first time in many years!

Dr. Neil Baum is a physician at Touro Infirmary and can be reached at 504 891-8454 or through his website, http://www.neilbaum.com

How Often Do You Need To See Me?

September 1, 2012

You may wonder how the decision is made to making the next appointment for a patient. Is there a book, or now a website with guidelines, that guide physicians on when to make the patients’ next appointments? No, there is not. It is not something we learn in medical school but is something that is part of the art of medicine. Some patients really need to be seen in a few days or a few weeks such as the patient with a urinary tract infection where the urine has to be checked to be sure the infection has cleared even after the symptoms have subsided. Then there is the asymptomatic patient who is on no medications and probably needs to be seen only for a screening annual or even a biannual exam. Then there is the majority that fall somewhere in the middle of those two extremes.

What if you had diabetes, coronary disease, hypertension, high cholesterol, and sleep apnea, but no symptoms to indicate any acute problems? You’d probably see your primary doctor fairly routinely (mostly for management of diabetes) and maybe your cardiologist every six months or so.

Here’s the big question: When you’re coasting along pretty well with no actively changing symptoms but with chronic medical problems, how often do you need to see your doctors? Let’s take the example above: with those particular problems, should you see your cardiologist yearly, biannually, quarterly, monthly, or what? In the non-hypothetical world a patient’s follow-up is likely to be dictated by the doctor and set at the end of each appointment. “Okay, Mrs. X, it looks like you’re doing well. Let’s plan to see you again in 6 months.”

How does the doctor know when to see you next? There are a few ground rules to take into consideration. The pharmaceutical industry doesn’t allow us to write prescriptions with refills that extend past 12 months, and many clinics have a policy of not providing new prescriptions after the 12-month mark unless they’ve at least laid eyes on the patient (apparently to make sure the patient is indeed alive), and so most people with chronic problems will likely have to be seen at least once a year. It is amazing how many men using erectile dysfunction drugs will keep that annual appointment in order to obtain a refill of their medications! The other ground rule is common sense.

So, routine follow-up will most likely fall somewhere between “less often than weekly” and “at least once yearly or more frequently.” But within those limits, as a doctor I’m pretty much free to choose whatever I like.

I don’t know how other doctors do it, but I like to burden healthy patients with as few doctor visits as possible, so I mostly try to set my return appointments for a year. This works well for most people, but there are clearly exceptions. I see a lot of men with prostate cancer. Many of them are on medications to decrease the testosterone level and receive injections every 3-6 months. If it is possible, I try to convert these men to injections that can be given once a year. Most of the men with prostate cancer like the idea of getting a yearly injection and coming in every six months for a blood test, a PSA level. However, there are some men that want that more often and I allow them to make appointments to be seen more frequently. This, again, is where the art of medicine is used to guide how often a patient returns for an appointment.

There are patients with certain conditions like bladder cancer that should have a cystoscopy or look into their bladder with a lighted tube every 3 months. This guideline is written in all urologic textbooks and is good medicine to see these patients on a frequent basis.

I commonly ask certain patients to see me more frequently. Any patient who is on medications that is having side effects is asked to come back more frequently until I can get the dosage or the medication straightened out that provides them with the beneficial effect and with manageable side effects.

Bottom Line: How often should you be seeing your doctor? I have no clue. Between you and your doctor you’ll come up with some type of balance that works. Just understand that none of this is written in stone….i.e., a kidney stone!

This blog was inspired and modified from a blog by Dr. Eric Van de Graaf, which appeared in Patient on January 17, 2011.