Wednesday, March 4, 2015

3.4.15 The Importance of Being Your Own Health Caseworker



     There are many books regarding the increasing phenomena, the double edged sword of medical treatments. Somehow we either think that everything for sale is safe. 
     Or we are desperate and trusting. 
     There is NOT a good tradition of doctors being straightforward with us. 
     Often, they risk their own AMA standing if they step on any toes, anywhere. They get in trouble for not urging people to do txs that they themselves would not do.
      How many doctors have I leaned forward across the desk, asked if this is something they would urge their partner or offspring to do, and have them say "No." And then we both lean back, and they explain that this is the accepted protocol, and it's their responsibility, legally, to urge me to do it. When i was practicing, I used to tell my clients that the elephant in the room was liability.
     That they needed to understand what a doctor, a lawyer, or many other professions could and could not say right out loud to you. It's vital to learn, and we don't know what there is to know, until stuff happens and there is a mess. It really sucks, and it's really important to learn these things.
     It's our responsibility, to make this stuff known. Unless you give up your hospital privileges, as a doctor, you are unable to be straight about these things, without risking your practice. Weird, huh?
     How many nurses do I know who talk about, or some have written books, telling you what you don't know.
     LIke, that if you or a loved one are being transferred from the hospital to a facility, to never never let them be transferred without you or a loved one with them. Because the people in charge lose track..of how long its been since the person had meds or liquids or foods. 

      How many nurses talk about how WE need to be the ones to carefully review our meds, in or out of hospital, or request an appointment with our doctor for the sole purpose of reviewing the med interactions. The testing. Ensuring the continued appropriateness of the medications , dosages, and interactions. 
      Even in hospital, we somehow need to review our charts, and keep up with the meaning of things.
      I spent 27 years learning, working with local doctors, and both educating people and teaching them to educate themselves, as to naturopathic alternatives to medications. How to discern what natural supplements and herbs were pivotal, versus secondary, with a condition. How to tell what is going to fit just for you. How to judiciously and incrementally increase natural supports (calming inflammation, increasing biochemical or structural or digestive or hormonal, etc. supports) as you slowly decreased meds. Which local doctors were knowledgeable and willing to help in this area. How to carefully and responsibly transition from thyroid meds to natural thyroid meds to supplements, watching to see if the bases are responsibly covered. How to transition slowly and responsibly from Anti-Depressants to supplements that will cover you responsibly. 
     Medications are an amazing opportunity. 
      Every single medication is tough on the body. Increased the already stressed load primarily of the liver. Is additional work for the liver, every single day. For this reason, most conditions are significantly relieved if one finds a responsible way to transition to a less costly (for the body, and longevity) and more costly (for your income, as supplements cost money) natural tools.
       The other remarkable aspect is that homeopathics and herbs and supplements all, if you are taking what fits well and doesn't disregard a sensitive GI tract , etc., are usually very nourishing and build deep immune health. Increase the overall functioning of all organs and systems. And give the all important liver a big break.
        Of course, some conditions need to be addressed, and quickly, by Western Medical means. Unless you are in excellent hands, or knowledgable yourself.
        And often, the doctors who have moved their practices in the direction of a meaningful capacity to spend time with a patient and teach them protocols to address their conditions safely and well, with out medications, often don't take your insurance. Because often, your insurance is a big pain. So you need to find $165 in flex benefits or cash, to have that excellent half hour to learn a protocol.
      There is the possibility of education yourself, if you're up for it. Learning to do literature reviews of ways to create a protocol that covers the bases responsibly for a condition is possible. It requires repetition and a learning curve. As a practitioner, I can say that one gradually learns the best origins of information, the best nay-saying sites that both recognize the up and coming remedies for conditions, and judiciously bide by the available research so far. The balance between information and medical establishment illuminates what is of value, what is safe, what approach is responsible, and holds promise for effectiveness.
     Checking in with a holistic doctor, once you have evaluated what bases need to be covered to effectively address a condition, is helpful. It ensures your medical safety, and provides you with some reassurance as to how responsible your protocol is. 
     For example, when we acquire gastritis or H Pylori from inflamed vulnerability after a flu or virus, there are common symptoms to learn. And then there are the bases to cover. For this, a natural way to adequately address inflammation, something to heal the gut continually when the acid balance is off, something to kill the bacteria back into balance, something to re-colonize the gut with beneficial flora. A simplified diet to enable assimilation of nutrients and elimination of waste. Support for elimination of waste. Ways to support the Lower Esophageal Sphincter and the Upper Esophageal Sphincter, so that the inflamed, open sphincters calm down and close when food is not passing by. Guarding your energy usage while your body is healing, something  underestimated for post-illness or addressing cancer.
     There are practitioners out in the world who assert that they can address practically anything. It's important to ask them how many people they have seen with this condition, how long it usually takes patients who are what is called 'compliant', meaning that they follow a protocol devotedly, to improve. To heal completely. It's ok to ask things like that.
      Then there is the aspect of 'How much can you handle', meaning, some people can handle big protocols with so many things to take and do. They both really want to get better, can manage to find the money to invest in getting better, and can slowly ramp up to tackling a big protocol.
     If it's not realistic and manageable, it's worthless. So some people begin with a few good items to do or take, and when that improves things some, they have more ability to add to that. The improvement encourages them, and they say "Fine, I'm in."
     But there are many practitioners who do NOT have tools that are pivotal. This is something you can learn, if you wish, with web perusal. With avoiding sites that are selling things. With gathering up slowly  your favorite sources that seem to make sense or have good references. Then you can complare ideas, figure out what the 3, 4,5 bases are that need to be covered, and see what  you want to plug in there. You can do searches for 'exacerbation from Oil of Oregano gelcaps' so you can judge the benefits (refrigerate, kills things well, possibly best after food to avoid exacerbation), or probiotics (most helpful first thing in the morning , before the gi tract has awakened, and has the ability to eat up the probiotics, making them unable to flow down into the gut and colonize the tissues ).
     In terms of cancers, it's a tough call. I've seen so many clients who undershot their estimation of what would be a responsible way of  naturopathically covering the bases. Like taking cornsilk for a bladder infection, we get to do whatever we want, but seriously, the bases must be understood, and covered very very well, in  a manner that fits the individual. And then, once again, broken record, we want to decrease our energy and stress expenditure with conditions, moreso with more challenging conditions. So that our bodies have all the resources they need, to really address the condition we are facing.
     Back to the article? Things are more complex than the old 'go see what this one doctor says." As my old, Italian father-in-law said to me, "I just wish I could go to one doctor and they would just tell me what to do." The old days. It might have felt better. It might have been a good story. But it was not always the most effective thing, to do.

A Sample H Pylori/Gastritis Digestive Protocol- for educational purposes only










Probiotic
1






Slippery elm pdr eat ½   cup  5x
1

1
1
1

1
Anti-Biotic caps
1

1
1
1
1
1
Oil of Oregano gel 10
2

2
2
2
2

Allicillin gel   7
1
1
1
1
1
1
1
Glutamine 1 tsp
1

1

1

1
GI Microbial X 9
4




5

HCL
2

3

4

4
Mastic Acid (2,ooo mg day)
 1

 1

 1

 1
Lemongrass eo internally 1 dr 5x
1

1

1
1
1
Vit C Bioflav tsp 4x day
1

1

1

1
Demulcent 4 caps
1

1

1

1
Miso Kudzu tsp each Umaboshi
1

1



1
Cranberry juice
1/3 c

1/3 c


1/3 c

B12 2,000 mg
1






Manganese 5 mg
1






Topical EO 3x day
1

1



1
Myrrh/Peppermint gargle
1


1


1
Castor Oil Swish
1

1



1
Castor Oil Compress heat
1







If Patients Only Knew How Often Treatments Could Harm Them

If we knew more, would we opt for different kinds and amounts of health care? Despite the existence of metrics to help patients appreciatebenefits and harms, a new systematic reviewsuggests that our expectations are not consistent with the facts. Most patients overestimate the benefits of medical treatments, and underestimate the harms; because of that, they use more care.
The study, published in JAMA Internal Medicine and written by Tammy Hoffmann and Chris Del Mar, is the first to systematically review the literature on the accuracy of patients’ expectations of benefits and harms of treatment. They examined over 30 studies that assessed whether patients understood the upsides or downsides of certain treatments. To a great extent, patients didn’t.
In the 34 studies that assessed understanding of benefits, patients overestimated their potential gain in 22 of them, or 65 percent. For instance, a 2002 study published in the Journal of the National Cancer Institute asked women who had undergone prophylactic bilateral (double) mastectomy to estimate how much the procedure reduced their risk of breast cancer. On average, the women thought they had reduced that risk from 76 percent to 11 percent, an absolute risk reduction of 65 percentage points.


Continue reading the main story

Overestimating the Benefits of Bowel Cancer Screening

Patients were given a multiple-choice test asking how many bowel cancer deaths could be avoided per 5,000 people screened over 10 years. The correct answer was 5. Almost everyone overestimated the benefit, some by quite a lot. (Two percent said they didn’t know.)
How many bowel cancer deaths could be avoided?
15%
21%
25%
33%

5 (correct answer)
50
100
500
1,000
Don't know

For the more than 80 percent of the women in the study who did not have a BRCA genetic mutation — which drastically increases the risk of breast cancer — the real risk before surgery of developing breast cancer was 17 percent, meaning they greatly overestimated their risk reduction. Even the women with a BRCA mutation overestimated their risk reduction, but to a lesser extent.
Another 2012 study published in the Annals of Family Medicine asked patients to estimate the benefits of screening for bowel and breast cancer, and the use of medications to prevent hip fracture and cardiovascular disease. More than two-thirds of patients overestimated the benefits of medications to prevent cardiovascular disease, and more than 80 percent overestimated the benefits of medications to prevent hip fractures.
Further, 90 percent of patients overestimated the benefits of breast cancer screening, and 94 percent overestimated the benefits of bowel cancer screening. The researchers also asked the patients to estimate the minimum reduction in bad outcomes (like fractures or deaths) they would need to achieve to find the treatment worthwhile. For three of the four studied interventions, the minimum benefit patients would accept was higher than the actual benefit.
In the 15 studies examined in the systematic review for which harms were a focus, patients underestimated potential downsides in 10 of them (67 percent). For example, a study published in 2012 in the Journal of Medical Imaging and Radiation Oncology asked patients to estimate the risks associated with a CT scan. A single CT scan exposes a patient to the same amount of radiation as 300 chest X-rays, and carries with it a 1-in-2,000 chance of inducing a fatal cancer. More than 40 percent of patients underestimated a CT’s radiation dose, and more than 60 percent of patients underestimated the risk of cancer from a CT scan.
Why do patients err in assessments of risks and benefits? One reason could be that what they know is driven by the messages they hear. Doctors, direct-to-consumer ads and the media can skew our perceptions. They tend to focus on the benefits, but rarely quantify them. Health care centers, screening advocacy programs and pharmaceutical ads all push us to talk to our doctors about getting treatment without talking about actual gains.
Doctors also aren’t always good at communicating risks. A 2013 study published in JAMA Internal Medicine found that fewer than 10 percent of patients were told about overdiagnosis and overtreatment associated with cancer screening, even though 80 percent of patients wanted to know about harms.



It might also be the case that some patients would use more of certain types of care if they had more information. Many chronic conditions remain undermanaged and undertreated in the United States. It’s possible that people with these conditions who had more information would use more care, which could raise spending for these patients but make them better off.
There’s also an argument to be made that people who overestimate the benefits of medicine to treat some conditions are more likely to take it regularly, which might lead to better outcomes, in some cases, than would occur if these patients were better informed.
Regardless, even though some patients may benefit somewhat from being ill informed, it seems wrong to argue that we should keep them in the dark. Many of the studies in the systematic review show that people report that they would opt for less care if they better understood benefits and harms. Improved communication could better serve patients and might improve the efficiency of our health system if patients focus on getting the types of care for which the benefit outweighs risk of harm.
It’s also possible that unrealistic expectations of care help patients cope with disease or provide them with some sense of control. Feeling hopeful about one’s future is not to be dismissed. But those unrealistic expectations don’t come cheap. We should at least consider the price that we pay for being uninformed.


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