Thanks for checking out my website!
This is where you can get medical news and information, along with a touch of creativity along the way.
Remember to tune in to my internet radio show, "Good Medicine"
on
www.isgoodradio.com
every Monday evening 7-8:30 (Paciic Time) for medical news and your questions along with great music from www.isgoodmusic.com.
213-484-6639 (213-ITGOODY)
AOL IM: drgroovyster
Check out isgoodmusic.com for tons of local, independent Southern California bands and artists and schedules of events tailored just how you want them.
Find Dr. Groovy music from bands, Breach and Bluesquare on the myspacemusic link
and
Dr. Groovy vids on youtube link.
Health and Happiness
-Dr. G
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Newsletter Feb 2010 |
02.14.2010 |
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Hello friends of Dr. Katrina Miller- Happy February 2010- Hope you’ve been dry in all the snow and rain! I recently made an appearance on the online show "Healthline" with Gregory Zarian and Susanne Whatley- topics ranged from immunizations and autism to Family Medicine training. Here's the link: http://www.youtube.com/GAMChealthline Also, we finally uploaded a few news shorts to the youtube channel- check it out at: http://youtube.com/drgroovyster I had the pleasure of meeting Dr. Drew Pinsky of "Love Line", "Celeb Rehab", & "Sex Rehab" fame. He made an appearance at the USC class I teach on Mondays and gave an impressively detailed discussion of the neurobiology and genetics of addiction. An inspiration for me indeed! Great news - isgoodradio studio has now acquired new equipment for your listening pleasure....as always check out “Good Medicine” with me and DJ JSeltz on Monday nights 7pm - 8:30pm (pacific time) for good health advice and great isgoodmusic on www.isgoodradio.com. Here's the link for past podcasts. http://drgroovy.podomatic.com/ Check out my favorite new music artists Valerna on www.isgoodmusic.com/valerna. Hopefully, they’ll help me to celebrate my birthday, February 26th! Speaking of birthdays - special birthday wishes to my brother, Felix, in Feb and my birthmom, Mitzi in March. Don't forget your flu shots! Happy Valentine's Day! Health and happiness to ALL! -Dr. K |
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| Hi folks- Well, I see patient after patient, kids, adults, students who have skin so dry that is progressing to an eczematous state. Just to clarify, dry skin is dry, sometimes flakey but not necessarily eczema, or what is otherwise called atopy or atopic dermatitis. This situation is a longer term diagnosis, that involves a skin “reaction” complete with inflammatory factors and possibly a sort of allergic reaction to something in the environment.
But I am writing now for a simple idea that can help either and all of these situations. Hydration. If you have dry skin or eczema, start by drinking tots of water. And hey here’s an idea- tone it down on the caffeine. It makes me laugh sometimes when I ask patients, “Well, how much water do you drink a day?” and I get an answer like, “4-5 cups of coffee a day….and diet coke at lunch.” Well, I’m sure you already know this but caffeine is a diuretic, it makes you pee. And when you pee out all of your fluid, you don’t have any more unless you drink more (or eat foods with a high water content). And what does a leaf look like when it gets all dried up? Yep- crinkled and brown, and cracks really easily. So it makes sense that your skin could do the same type of thing if dried up, right? Well, just something to think about.
There is no statistical evidence to this, but I tell people to drink 2 cups of water for every cup of coffee to rehydrate enough. It could make you feel more energetic, cleaner, and well, more hydrated. And your pee won’t look brown- it’ll look pale yellow, and isn’t that a good thing too?
And hey- ever heard of lotion? You can get it over the counter and the best time to place it is right after a shower. I mean some of my patients act like they’ve never even heard of lotion! Well, once they’ve seen me they have…
So, some common sense to consider. Good luck with your dry skin and check in with your doctor if you can’t handle the dryness, the itch or the cracking. It could lead to secondary bacterial infections and that is not so good and very uncomfortable. And that definitely needs treatment.
So drink water, eat well, exercise and get sleep- in short-be healthy.
Peace, Dr. G
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Ovarian Cancer |
08.08.2009 |
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Hey folks. Long time no talk. I think I usually start these missives that way. Well, here it is. My friend (who is younger than me) (but I’m not going to tell you how old) was recently diagnosed with Ovarian Cancer. Based on my medical training, whenever I used to hear that, well, that was it. I was either counseling these patients to “get their affairs in order” or taking care of their intractable vomiting in the hospital. This is a terrible disease to have, with terrible chemotherapeutic treatments. Nowadays, more and more women are living through the diagnosis, I am happy to say. And even though I know that, I immediately started crying when I heard about my friend. Ah logic. So, luckily, the stage of my friend’s cancer was 2 (out of 4), so that was already a good sign. And by the time I talked to her about it, she had already had surgery to remove the diseased ovaries, her uterus and the omentum, the fatty covering over the guts. (Cancer loves to hide in there) So that was great. The bummer is, it took her a while to get to that point. Ovarian cancer has very vague early symptoms. Usually no symptoms until it is further along, but then such problems as abdominal gas, constipation, a “funny feeling in the abdomen”. And, unfortunately, it happens to women. So put together vague symptoms with women and some doctors just blow it off. Now I’m not saying every woman who has constipation or a funny feeling in her abdomen has cancer, but some may, and they need to be addressed as such. My rule is, if the patient keeps coming in with the same complaint, I, the doctor have to do something to prove that it is nothing, or else the patient will not be satisfied and worse, something may be missed. Well, my friend went back to this clinic as her belly was swelling with her vague symptoms and the doctor diagnosed reflux, or that she was stressed (which she was, and so was her body). Now, for the doctor, this is a very difficult situation. Vague complaints are the hardest to figure out. They could be nothing or a big something. And the doctor must try and tell the difference. I understand that, and that some doctors make mistakes, and miss something, and some just don’t care. (too busy, too stressed, too egoistic, whatever..) So, unfortunately, my friend’s belly had to swell up like a basketball before it was taken more seriously, and this was by a family member, not said doctor. I guess my point there is, if you are a doctor- listen to the patient, touch them where they hurt, or have problems. Do something to prove there is nothing there. If you are the patient, keep going in until your needs are satisfied. As the doctor, we may think everything is better and you are having no problems if you never come back. But if you come back repeatedly for the same issue- we do take notice (I hope). And then as to the vague symptoms of Ovarian Cancer- just recently the powers that be have come up with recommendations on how to diagnose Ovarian Cancer. A consensus statement from the Gynecologic Cancer Foundation reads: “Women experiencing bloating, pelvic/abdominal pain, difficulty eating or feeling full quickly, or frequent or urgent urination for more than a couple of weeks should see their doctor, as these may be early signs of disease” Wow, well that sounds specific, eh? So the point is, not every woman with these symptoms needs to worry, but if you’ve had these symptoms for more than a few weeks straight, get it checked. My friend agreed with these recommendations. More research happens every day to figure out the cause and treatments for all kinds of cancers. We are all lucky that many researchers devote their lives to searching for answers. And we can feel encouraged that more and more as we are diagnosed with terrible conditions, there may be more hope for better treatment and cure. Be vigilant and press your health care worker to be vigilant. It’s a harmony that takes input from both sides. Peace Dr. G |
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What is Primary Care? |
08.06.2009 |
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| Hi folks- sorry it’s been a while since I checked in here- but I just wanted to tell you about some things that are happening in Family Medicine.
Unfortunately, we in the US seem to have a medical system that does not value primary care very much. Primary care generally means Family or General Medicine. A Family medicine physician who has completed the boards has gone through 3 years of residency training and testing by the Board of US Medical Licensing Examiners and the American Board of Family Practice.
A general practitioner has gone through at least one year of training and is not “boarded” or verified through a Board such as that of Family Practice. (Other boards would be those of Surgery, Radiology, OB-GYN- any specialty or discipline in medicine)
I currently work at a Family Medicine Residency, which is a place where we train residents who are becoming full-fledged physicians. Working at a residency means that I see my own patients on certain days of the week, on other days of the week, I supervise the residents seeing patients- usually 3-5 at a time and that can mean anywhere from 10-50 patients in a half day. I also take “call” which means I am supervising the residents overnight with patients who are in the hospital. The attending doctors in the program all share in this call schedule. We also share in the everyday inpatient supervision, which at our program we do for one month at a time. Every morning, we supervise the residents with their work on patients who are in the hospital. Our patients in the clinic and the hospital sometimes have insurance, and it may good- PPO type insurance or less covering HMO insurance- or no insurance at all. Part of the deal with the residents working at the hospital and the government helping with their salary is that our Residency program takes care of the uninsured patients, when other doctors don’t want to. So the residency is helping out all types of people.
While all this is going on, I also help out the Physician Assistant education and training program as Medical Director, where 2 days a week I help with the curricular overview, course responsibilities like lectures, exams and projects, and anything that needs to be addressed.
I try to take part in a small bit of research regarding email communication with patients, and whatever else I can. We are also trying to transition our clinic to using an electronic medical record (EMR).
So there’s a fair amount going on.
Recently our residency, and Family Medicine program, like many others in the nation have come upon difficult times.
The government helps fund residencies by funneling money through hospitals so the residents can get paid. Well, as of last year, our hospital and medical school changed some things around and now our residency is not receiving those funds. We have another hospital we work through as well and the funds are not coming through that hospital either. Both of the hospitals are in the process of changing their ownership as well, so we don’t even know if the people we are talking to now will be the people we will be talking to in 2 months and if the deals will be the same.
Because this situation has left the Residency in such a negative financial state, the Chairman of the Department was demoted, and the residency will not be allowed to accept an incoming intern (first year) class. The Residents who are here have been offered the opportunity to find a new program, and we must now stop interviewing new residents and not allow some wonderful prospective residents to enter. Those Residents who stay will then have a completely different kind of experience where they will have fewer colleagues and may be on rotations and call alone, where before there were pairs or groups.
It is a very sad time while our program tries to figure out how to make sense and the best out of the situation.
Luckily we have an amazing set of faculty at this program.
But what could we have done about this deal with the Hospital no longer channeling the money to our program? What could we do about the Medical School arranging the new set-up?
As I hear, not much.
The funny thing is, I have experienced this kind of thing before. (Could it be me?) The residency from which I received my training closed its doors as soon as my class left the building. My former residency merged with another residency and that may not have been the best thing for the other residency, but it was what the administrators decided. As well, the chairman of our program was suddenly no longer in office and replaced by another, quite less scrupulous and knowledgeable but, deemed appropriate by the administrators from above. (As testament to his prowess, our former chair became the head of the American Board of Family Practitioners. Was he unfit to be chairman?)
I am well-removed from the definite details of these situations, but it leads me to my main discussion.
If this country values the Family Doctor, the one who you go see first whenever you have anything, the one who reminds you to take your medications and calls you in refills when you can’t get back to the office for a visit, then we need to secure the supply of more Family Doctors.
A great percentage of medical students enter into training for disciplines other than Primary care because the lifestyle, money and pain-in-the-ass factor are much improved in specialty medicine. Centers for Medicare and Medicaid Services (CMMS) is the body in the government that decides how much reimbursement physicians get for their services. They tend to reimburse better for surgery or procedures than they do for the office visits and discussion that are so important for prevention. The insurance companies follow along and reimburse similarly. Some family medicine clinics get so little money back that they may end up losing money on seeing patients with certain issues and certain insurance. So the surgical and subspecialties are far more lucrative and therefore less time may be spent in clinical care because they get paid more. They also tend to be much more respected in the media, the general public and the medical establishment. As a family doc, you know you are doing a good thing for a lot of people, but you kind of end up feeling like the ugly runt child.
With few medical students going into Primary Care, there will be few Residents in training and fewer and fewer primary care practitioners.
And then if the Residency programs are closing down, the few Residents will not be able to receive training.
A difficult situation.
What do we do?
I am not sure the answer to that question, but I do feel like the public is not completely aware of this situation. I am not even completely aware of this situation, I just know this much.
If we don’t value primary care medicine, medicine for all people at any time, any stage of life, any question- if we don’t value this, it will die out.
Perhaps that is appropriate. Perhaps we need a new system. It has been suggested that Physician’s assistants and Nurse Practitioners are the future of primary care. Doctors in primary care may become an anachronism. And that is why I value the education of these “mid-level” practitioners and I am working to try to maintain high standards for their training.
Perhaps that is what the system and the consumer, the patient wants. Easier access to mid-level practitioners, and only use the medical doctor when needed. . If so, we will simply see where we as Family Physicians then fit in the scheme of things, or where we can fit ourselves in.
And if family medicine remains and needs to have residency training programs, perhaps the government will become aware of the fact that the money that should be going to Residency training and underserved care, may not be making it there. Perhaps those funds should go directly to the program, not to the hospital that sponsors the program. (I still have not received a satisfactory answer as to where the money that was supposed to go to our program actually went. A large insurance company? A large hospital? A large medical school? Hmm….)
How do you fight Goliath? And who is Goliath? Is one entity or a system that is corrupt and replete with discrepancies?
Consumption patterns? Demanding more appropriate insurance company and governrmental financial responsibility? Voting? Legislation? Media? I wonder how much the American Medical Association or the Association for Family Practitioners or even Associations of Patient Care can do about this. Sometimes it seems like such a huge imbalance of power where the worker bees and the clients don’t really get to choose what is best, but only what is offered. “Take this and like it”
Is that enough? Does it matter? Who cares what we think anyway?
Just thoughts. I’m still trying to work it all out. I thought you, my reader, may want to know.
A few of my colleagues are already injecting Botox and Restylane to make ends meet. You get paid more for reducing wrinkles that than saving someone from certain death or morbidity due to Diabetes or Hypertension which remains out of control.
At least we had our education. Even if it is not completely paid off yet.
Dr.G
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Health in General |
07.15.2009 |
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Health Hey Folks. Just wanted to give a few words about my thoughts on health. I believe that health starts in the heart, in the soul and in the mind. Ancient health practices haven’t stayed around so long for no reason. I believe they have lasted so long because there is validity to their ideas. In the tenets of Ayurveda (ancient Indian health practices), disease starts with “impure thoughts”. Now impure here doesn’t necessarily mean pornography- it’s more of a thought imbalance. Stress could be such a thought imbalance, and usually is. Stress can come in a variety of shapes and forms, and the point is, if it’s there- whether from your job, your family, your significant other, whatever it may be- if it’s there, it might not be the best idea or the healthiest thing for your mental or physical body. This alone can be the beginning of disease. Similarly, Acupuncture and Asian medicine discusses energy flows that can be out of balance, and this alone can be enough to constitute problems. The problems can be insomnia or cancer. Balancing the energy flows may help with the physically manifested issues. I even believe there is biophysical basis to these ideas, as all cellular activity turns out to be electrical changes and balances. Perhaps Acupuncture is re-directing that electrical activity, which translates to nerve transmission, which translates to larger physical changes So without convincing anyone that they should use Acupuncture or Ayurvedic herbs, the idea here is- balance your heart, mind and soul first and foremost. It is very important to keep your physical body healthy as well, but without a calm and content mind, the body may suffer from unknown and very confusing ailments. And these ailments may be difficult to diagnose or detect with western medicine practices. Now, I am a western medical doctor. I was trained at a great medical school that had an open mind to many ideas, and perhaps that is part of why I feel confident enough to discuss these ideas. And I thank EVMS for that. But as I do what I was trained to do, and listen to the heart and lungs, and use pharmaceutical medications when needed, I will also try to find the imbalances of your thoughts, and of your soul. I believe that your disruptive homelife, the amount of water or caffeine you drink, or the fact that you don’t have a comfortable bed may be just as important as the glucocorticoid inhaler I prescribe for asthma. So please consider these thoughts. And keep in mind that the things that make you happy may be more balancing than any medical treatment you can get. What makes you happy? Is it art? Music? Running? Dancing? Laughing? This website is a collection of things that make me happy, and my attempt to make others happy through these efforts. It also makes me happy. And that is a beautiful thing. A yoga instructor, Gurmukh once said, “if you laugh and sweat everyday, you life will be healthy, happy and whole.” I love those words and live by those words. Perhaps you may consider it too. Peace, Dr. G |
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| [ Year 2010 ]
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