By Karin Krisher

Maybe virtual care isn’t a topic you approach often. Maybe that’s because of your own thoughts on the doctor-patient relationship, or maybe it’s because you feel your patients won’t be receptive. Whatever the reason, virtual diagnoses and treatments are an up-and-coming phenomena of which you, and your patients, should be aware.

Many insurance companies, including Aetna and Cigna, have made the leap to cover telemedicine. Many patients are searching for an economically sound solution for their health care issues. Many doctors are responding by taking their practices to the web. What can you do?

Simply discussing this possibility with your patients will give you a better gauge for telemedicine’s potential. It may seem counterintuitive at first—after all, isn’t the point of working in a practice that it allows you to develop a relationship with your patients that gives you better, personal knowledge to respond to their medical needs?

But in a changing global communication environment, that relationship can be developed over a vast space. Proximity shouldn’t dictate our ability to give and receive information. Further, doctors enjoy the ability to open up their schedules for appointments that require face-to-face examinations, and patients get the same freedom. The cost is also less for both parties.

Writes Phil Galewitz of Kaiser Health News, “One major obstacle has remained, however: Many state medical boards make it difficult for doctors to practice telemedicine, especially interstate care, by requiring a prior doctor-patient relationship, sometimes involving a prior medical exam.”

This stipulation could be reassuring to your patients, though, and isn’t necessarily a negative concept to hold onto for a moment as we ease our way into this new era of medicine. After we become comfortable with the idea, and telemedicine is a more widespread practice, this stipulation will likely fall to the wayside, giving way to a world in which your patients can choose their care from a wider range of practitioners, and you can expand your clientele to include more patients concerned with your specialty.

Whatever your feeling on the changing medical communication landscape, your patients should know that the option exists. Ask them for their opinion and their concerns to further your understanding of patient desires, and share your opinion and concerns with us– in a comment!

By Karin Krisher

We know—the conversation about understanding depression is overdone—now. But 20 years ago, depression was still relatively under the radar, and it took humble admissions from several prominent figures (most notably, Tipper Gore) for American society to recognize and generally accept that depression concerns a chemical imbalance, rather than a lifestyle choice.

Today, there persists a strong dichotomy in the treatment process: Depressed people can either A) attempt to correct their chemical imbalance with prescription drugs, or B) change their lifestyle and wait for mood changes to come about naturally, depending on chosen environment.

But what if neither of these proposed solutions are actually solutions at all? What if depression is a fact about someone’s physical makeup, like blue eyes or big hands, and an attempt to “correct” it is doomed from the start? A newly published study suggested that might be the case.

Understanding Depression in Chemical Terms

The study showed that those with higher releases of dopamine in the striatum and ventromedial prefrontal cortex are more willing to work hard for rewards. In other words, a dopamine flood to the areas of the brain that play roles in motivation and reward will motivate those people, regardless of the reward.

“On the other hand, those who were less willing to work hard for a reward had high dopamine levels in another area of the brain that plays a role in emotion and risk perception, the anterior insula.” (Janice Wood, PsychCentral) That lack of motivation persisted even when the participants had knowledge that the resulting reward would be less.

Though the study explicitly refers to motivation as it relates to effort, its implications for mental health are staggering. For so many years, we’ve been “treating” depression, anxiety, schizophrenia and ADD/ADHD as if dopamine was a transmitter whose powers could be harnessed and regulated. Now, the truth is becoming clear: Location, location, location.

If one’s brain were hardwired to release dopamine to certain areas, redirecting it would be a massive task that employed the powers of geneticists, neurologists and psychologists alike—perhaps so massive that we should reconsider the very fact of any effort to “correct” chemical imbalances, and change the way we talk about depression.

Motivation is a huge factor in depression. If a person truly desires a reward, they’ll take the necessary initiative. In a world chock full of over-achievers, if a person isn’t willing to work hard because he or she doesn’t actually want the reward that badly, s/he is often faulted in a way, and relegated to a diagnosis of depression.

Or, taking it one step further, the reward the person wants might be different, as the release is in the area of the brain associated with emotion and risk. Perhaps (and this is speculative, but seems intuitive) s/he would be more motivated to take a large emotional risk for an emotional, rather than monetary, reward. But does that make that person, who the rest of society might label “unmotivated,” clinically depressed?

Talk About It

Talking to your patients about depression can be tough. Certainly, you don’t want to negate the reality of its existence. Certainly, what they feel is very real, and in this fast paced, whole-lot-of-work-for-little-reward world, stifling. Certainly, support is needed for that person to function happily amongst those who are in the striatum camp.

But what kind of support is the issue. Maybe we should focus on making the things we can’t change work for us, instead of trying, often without result, to change them. With that thought in mind, talk to your patients about depression and anxiety. It’s a reality that negatively impacts one in ten American adults—and now, we are learning, one that might never change.

That doesn’t mean there is no hope for overall happiness—only that hope needs a new direction.

Tell us about your experiences with discussing depression. Will this new information change how you view that conversation? In what ways?

By Karin Krisher

The hot topics among parents today include Autism, diet, technology dependence and of course, inoculation. Most states require vaccinations for children entering public school—currently, Vermont does not.

The debate is, as should be expected, based on the balance between utilitarian arguments and personal freedoms. When so many people do take the steps to proper vaccination, and those individuals’ choices are affected by those that do not take the steps, we have a difficult legislative battle on our hands.

One of the fuels for the battle is the misperception that vaccines and vaccines alone directly cause diseases, disorders or behavioral issues. Parents who choose not to vaccinate are, in their minds, choosing health, making it difficult for anyone to fault them.

But the problem arises when people making that decision would also like to be part of a massive public educational infrastructure, which is a product of the needs of the many. As a majority of people do have their children vaccinated, putting that decision in jeopardy due to the decisions of the few is likely unethical.

At the same time, choices about health are a personal freedom in many senses, and to take that away makes a statement. Our feeling is that representatives are elected to speak for a majority, and so will generally attempt to promote the needs of the majority. The majority of people do vaccinate, and health has become a public effort in many ways, meaning we think Vermont will be making some changes.

How do you feel about vaccinations? Do you recommend them to your patients?

By Karin Krisher

What does it mean when retractions of scientific papers are on a noticeably steep upward trajectory? Does it mean individuals are less credible overall? Does it mean that publications have abandoned their commitment to truth seeking? Or does it simply reflect a changing scientific environment that facilitates competition between many little fish in an ocean rather than encouraging collaboration between the big fish in a smaller pond?

We’re inclined to blame the environment, a negative result of a generally positive change -–growth. We of course recognize that online publication of papers allows them to reach a wider audience, meaning errors are likely spotted more often. But the argument here is not really about statistical method—it’s about the attitude shift that seems to have occurred with a boom in numbers of college (more specifically PhD) students and subsequently, scientists.

Because government spending on medical research has increased over time, and because media publication is a business, money is often a factor in a researcher’s success. Writes Carl Zimmer of the New York Times, “The National Institutes of Health accepts a much lower percentage of grant applications today than in earlier decades. At the same time, many universities expect scientists to draw an increasing part of their salaries from grants, and these pressures have influenced how scientists are promoted.”

These pressures can also lead science down a terrible path: A promotion (and more flawed research efforts) might depend on research that isn’t viable if the researcher/writer has published many articles in journals of high import, an ability also determined by grant allocation.

By definition, the scientific method recognizes ignorance and incorrectness on the part of the scientist. But it has always been about dispelling, rather than encouraging, those traits. Talk to your colleagues about the sharp increase in retractions and discuss what it means to your practice and your way of understanding information.

With the advent of online publication comes the civilian’s ability to rapidly discover and absorb. While access to information is a beautiful thing, access to misinformation can be harmful—and retractions don’t always make headlines. That’s why it’s important to know your stuff and be capable of dispelling those beliefs that may have been generated from since-retracted studies, either for your patients’ sake or for the value of your own information-seeking lifestyle.

How have you dealt with misinformation in the past, either with your patients or yourself? How do you feel science can get back to the basics in ensuring the publication of only verifiable material? Tell us in a comment!

We thought it would be a small change of pace and a fun glimpse into personal taste to ask our DaVinci Account Representatives to choose their favorite onscreen doctor. The marketing team contributed, as well. Here are our picks and justifications of the choice:

Elizabeth, DaVinci’s Team Lead:
Dr. Sheldon Cooper from The Big Bang Theory “because he has a way of saying things that make no sense very matter-of-factly, and it cracks me up!”

Aryel:
Doogie Howser, “because who doesn’t love a young doc played by Neil Patrick Harris? Plus, he’s into nutrition and nutritional supplements!”

Noah:
“The esteemed Dr. Hannibal Lecter, because he envisions the dark thoughts that… (can) come from working with the exposed human body for years.”

Cathy:
Dr. House, “for his outrageous and unconventional WISDOM!”

Deb:
Also House!

Connie:
Dr. Noah Drake because “I liked his whole personality and he was damn cute!”

Sean:

Dr. Zoidberg, from Futurama “because of his eating habits and the hilarious noises he makes.”

Christy:
Dr. Spaceman from 30 Rock “because he’s an excellent doctor and a pretty good dentist.”

Jordan:
Dr. Spaceman, for the same reason.

Karin:
Jack Shephard from Lost. “Even though his character makes bad decisions, it’s only due to his classic hero complex.”

Alek:
House ”because I think it’s a really interesting character.”

Eric:
Dr. Hibbert; he’s funny.

Darcie:
George Clooney. Enough said.

Who are your favorite on screen doctors? Tell us why you love them!

By Karin Krisher

Dr. Leila Denmark began her career as the first resident of Henrietta Egleston Hospital for Children in Atlanta, admitting the first patient. That was in 1928.

She retired at 103 as the world’s oldest practicing physician, and died Sunday in Athens, GA at 114, the world’s fourth oldest person.

Dr. Denmark began her personal pediatrics practice in her home in 1931 and saw patients all hours of the day for 70 years, including those children in desperate need of care during the Great Depression.

Family members cited Dr. Denmark’s love of her work and her diet as the reasons for her longevity. Her commitment to the craft of healing was unparalleled.

By Karin Krisher

Let’s begin with a fair warning. This post has nothing to do with supplements or Complementary and Alternative Medicine, except that it relates to something with which 100 percent of your patients are familiar: Aspirin.

We’re bringing it up now because it’s in the news, and so often, that’s where patient concerns are generated. Advocating for or against aspirin might be a little touchy, so instead, let’s just examine the facts. Familiarizing yourself with these ideas, theories and data will equip you to better answer patients’ questions when they arise, or to start the conversation yourself.

First, the most recent news: Two studies published last Thursday indicate that taking daily doses of aspirin can lead to reduced risk of cancer. The results of the studies are no less than staggering.

Writes Rony Carin Rabin for The New York Times, “One of the new studies examined patient data from dozens of large, long-term randomized controlled trials involving tens of thousands of men and women. Researchers at the University of Oxford found that after three years of daily aspirin use, the risk of developing cancer was reduced by almost 25 percent when compared with a control group not taking aspirin. After five years, the risk of dying of cancer was reduced by 37 percent among those taking aspirin.”

 The second study found that over an average of 6.5 years, daily use of aspirin reduced the risk of adenocarcinomas by 46 percent. As the findings are hailed as promising and doctors the world over make points of recommending daily aspirin intake in preventative regimens, some are still taking pause. It is widely known that aspirin increases the risk of hemorrhagic strokes and gastrointestinal bleeding, so recommending it, as we mentioned, can be touchy.

Writes Rabin, “An analysis in Archives of Internal Medicine in January found that for every 162 people who took aspirin, the drug prevented one nonfatal heart attack but caused about two serious bleeding episodes.” It’s a matter, then, of weighing the risks and benefits for each patient. If a patient has a long history of colonic cancers in his or her family, perhaps aspirin would be overall beneficial rather than harmful.

If a patient is otherwise healthy with no family history of cancers, recommending daily doses of aspirin could be more detrimental than preventative. Generally, those that take daily aspirin now do so because their perceived cardio risk is greater than the risks of popping that daily pill.

When studies like this come around, many consumers get popping right away, without understanding the study itself or the risks associated with making those types of quick decisions. The Oxford studies, for example, were designed to determine aspirin’s effects on vascular disease, not cancer, though the summarized results don’t generally reveal that information.

Talking to your patients to assess the risks and potential benefits of an individualized aspirin regimen will allow them to make informed decisions. We still don’t know what the “right” amount of aspirin is, or how frequently that amount should be ingested to hit the Goldilocks zone of prevention—studies use anywhere from 75 mgs to 1200 mgs daily as control levels.

While some consumers might take negative comments on aspirin to heart and stop their daily doses suddenly, some might take the positive comments as fact and begin an unnecessary regimen on their own. Neither of these acts will be beneficial—guidance should be individualized. Keep that in mind with every patient, and approach the conversation from an educational, but still exploratory, standpoint.

By Karin Krisher

Let’s talk about something that’s on everybody’s minds. And skin. And noses and eyes. Let’s talk about allergies. Talking to your patients about allergies is crucial to their everyday health and peace of mind.

While most patients don’t need to know the details of IgE activation to feel like they’re safe from hives and anaphylaxis, they probably do need some counsel on what allergies they don’t have, and on those symptoms to which they should actually pay attention.

Because mild allergies are so common in the human population, it’s important to take the conversation about determining atopy slowly. First, consider the fact that allergies are somewhat psychosomatic. Despite their obvious realness, allergic reactions can be influenced by both behavior and emotion (especially because emotion is the manifestation of a chemical cascade.)

It’s important to keep this in mind because your patients may be easily influenced by your diagnosis, or conversely, may be averse to the idea that their perception of their own allergies may be incorrect. With this idea as the undercurrent for your conversation, take it slowly.

Begin with the idea that allergies are malleable. They change. That doesn’t mean your patients should ignore signs of allergic reaction—only that they should understand that allergies can develop and conversely disappear through changes in time and environment. Beginning with this fun fact will set the stage for your patients’ open-mindedness.

Next, talk about allergic history, including parental predisposition to allergies, but again, be wary. Despite your information about malleability, many people still may assume that a one-time reaction denotes a severe and lasting allergy and be resistant to the idea that their dad’s foot rash in eighth grade wasn’t indicative of anything except poor hygiene.

With an established allergic history in mind, approach the concept of an allergy test.

Testing for allergies is a relatively recent advent that now encompasses a variety of methods for a variety of allergens. You can either move forward with skin or blood tests with determined precautions or recommend an allergist for the job. These specialists are especially important to the skin-testing process, as it bears some risk.

During this time, it would be appropriate to also address the many Complementary and Alternative Medicine options available for allergy support, such as dietary analysis and subsequent supplementation.

However the conversation flows, be sure that you are sensitive to the very real misconceptions surrounding allergies and self-diagnosis. It will be easier for your patients to accept their own allergy situation (whether it exists or not) if they have some good, credible information from a credible source—you.

By Karin Krisher

“To me, if life boils down to one thing, it’s movement. To live is to keep moving.”

 -Jerry Seinfeld

You’ve talked to your patients about joint health before. But how many of them have brought the issue to you? Addressing it out of the blue can catch some patients, specifically younger patients, off guard—especially because joints, if not in pain, can fly very much under the radar.

We move constantly. From a small finger twitch to the knees’ bends as we climb out of bed, joints are involved. That’s why they’re so easy to forget. Like all biological processes– blinking, muscle metabolism, immune system function– the movement of the joint doesn’t generally demand our brain’s full attention.

And so we forget that it needs nourishment and attention, often until it is too late.

According to Dr. Greg Fors, author of “Why We Hurt” and clinical director of the Minnesota-based Pain and Brain Healing Center, “Even in today’s ‘modern medicine,’ early diagnosis of degenerative joint disease” (one of the top ten most common diseases in the world) “is still based on keen clinical observation and radiographic changes. However, when you make the diagnosis at this point, your patient has already fully developed the disease.”

Bring up joint health with your patients long before they expect it: it will be better for them to experience a surprise today than to continue down a path that can lead to a bigger (and much more disappointing) surprise later.

The Truth About Joint Health

Inflammation and break down of joint cartilage is caused by various factors, especially genetics and nutrition. Right now, we can’t do much in the way of the genetic factors (aside from monitor those patients closely), but we do have an option to make a difference in patients’ dietary and supplementation choices.

First, ask the patient if s/he has ever spoken with anyone about joint health and function. Often, patients aren’t aware of the factors that influence joint health—many are even unaware of the definition of synovial fluid and its place in and impact on the body. If your patient is unfamiliar with the lingo, a slow introduction will be appropriate.

List the factors that can contribute to joint health, so he or she can tell you if any of these factors might be cropping up in his/her lifestyle.

Over-acidification of tissue and blood is one major underlying cause of degenerative joint disease. Here, your patient may not know much about the alkaline nature of his or her food. Inform them that paying attention to acidity is important—including foods that are more alkaline in nature should be emphasized.  Similarly, avoiding foods like white potatoes, tomatoes, eggplants, and other deadly nightshades comes highly recommended for those that are susceptible to joint degeneration, as arthritis sufferers often share an allergy to these types of foods.

Candidiasis has also been linked to joint issues. Too much sugar (intake of which most patients are unaware) can cause this infection that can proliferate degenerative joint disease through producing fungal poisons.  Similarly, patients concerned about potential gluten intolerance issues deserve a joint discussion.

Finally, address heavy metal toxicity. If your patient has never attempted detoxification processes, ask them about their diet to find out if they are eating plenty of foods that contribute to liver health and detoxification processes. If not, find out why– perhaps they need a more convenient source of nutrients to support detoxification processes, like Spectra Greens.*

Other important factors for joint health do exist outside of the diet. Of course, exercise should be mentioned (see our post on this conversation). Over exertion or minimal activity can contribute directly to joint issues.

For example, as we age, we lose muscle mass, which can lead to the joint taking the impact of activities that otherwise impact muscle. Maintaining muscle mass as we age is important to maintaining joint health. Excess weight can cause joints to do the same—take unnecessary impact and degrade over time. A moderate, healthy amount of varied exercise should be emphasized.

Action

When it’s time for your patient to make figurative and literal moves, guide them with further discussions similar to the one highlighted above. Compliance is nine tenths of the law in Complementary and Alternative Medicine, and as time goes by, your patients might fall off their own joint health bandwagon.  Keep them on it by asking periodic questions about their diet or joint health regimen, and by suggesting comprehensive literature on the subject.

What may surprise your patients today could have them thanking you tomorrow for your clear understanding of the importance of early action and prevention and your commitment to overall health.

*These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.

By Karin Krisher

Veterinarians and doctors have a few things in common.  The most obvious, of course, is that both are helpers. One group focuses on pet health, one focuses on human health. Both vaccinate, (generally) know how to check vitals, carry stethoscopes, and don’t get the heebie-jeebies when blood shows up unexpectedly (or expectedly).

But for all the things they have in common, veterinarians and doctors remain fundamentally separate in one aspect: their patients. Your human patients seem worlds away from their animal counterparts, especially because your office might be a pet-free environment where your patients can remain comfortably compartmentalized into a separate medicinal realm. They might stay there, too,  until they have a health issue directly associated with an animal, like an allergy to their new puppy or a serious kitten scratch.

But the truth is, the health of the human species is unquestionably related to the animal species with whom we choose to spend our time. That’s why DaVinci carries a line of pet health support supplements designed to support total health in cats and dogs. We know that the relationship between two species is incredibly important, and that discussing healthy options for supplementation for pets can go a long way, for several reasons.

Discussing pet health with one of your patients shouldn’t be difficult, and you definitely won’t be barking up the wrong tree. (People love their pets!) Begin humbly, conceding that their veterinarian might have already discussed with them the subject of animal/human relationships and health. Then share with them some of the reasons for your concern.

Not only can certain illnesses be transmitted from pet to owner, but attitudes can be transmitted from owner to pet, and similarly, when one of the two is stressed (or unhealthy), the other will most likely be under the weather as well.

First, we can catch illnesses from our pets, either through an infected scratch, a fungal spread from mere petting, or through getting some nasty litter box dirt underneath our nails. But the less obvious health benefits of having a pet should be your true focus throughout the conversation. From improving human cognition to lowering human stroke risk, pets have proven their far-reaching beneficial effects again and again. In fact, National Public Radio recently reported that recently, “studies have been focusing on the fact that interacting with animals can increase people’s level of the hormone oxytocin.”

The conversation about these benefits doesn’t arise because you want your patient to run out and buy a dog, but because if he or she already owns one, s/he may not realize just how much pet health affects his or her own health, either positively or negatively. And s/he probably also doesn’t realize that there are tools to support the positive effects.

For example, when a cat is stressed out, he might get aggressive or participate in excessive urine marking, consequently causing his owner stress, which we all know can be detrimental to health. Cats get stressed out for a variety of reasons, from sickness to minor environmental irritations. Supporting their total health with multivitamins or a calming complex is a great way for patients to come to understand feline health needs while meeting their own.

Final thoughts on pet health

Bringing the topic of pet health to light for your patients will show them that you’re truly paying attention to all aspects of their health and what affects it on a day-to- day basis. Offering them healthy alternatives, like DaVinci pet supplements, will not only show that you care, but it will also make their lives more simple, as your office will have become a one stop shop, so to speak, for health.

Check out our line of supplements to support pet health at davincilabs.com. And remember, a healthy, happy pet means a healthy, happy patient.