George A. Sprecace M.D., J.D., F.A.C.P. and Allergy Associates of New London, P.C.
www.asthma-drsprecace.com
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Health Alerts

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Rapid Response for FRIDAY and SATURDAY, December 7 and 8, 2018

NOW HEAR THIS!
If an established Asthmatic is not treated with an accurate and complete diagnosis, with effective environmental control - especially involving pets, with an effective (and not excessive) program of anti-allergic and anti-inflammatory medications, with prompt on-call and effective treatment of superimposed respiratory tract infections, and WITH ALLERGY IMMUNOTHERAPY FOR UNAVOIDABLE ALLERGENS, he or she, at whatever age, is BEING POORLY TREATED.
And that is also true - and possibly especially so - for the many patients, undiagnosed by their Pulmonologists, who continue to miss combined Bronchial Asthma and Chronic Bronchitis, mis-labled as "COPD",
Everybody so affected, whether, parent or patient or primary care physician or pulmonologist:
EITHER LEARN, OR GET TO A CERTIFIED ALLERGIST, OR
GET OUT OF THE BUSINESS
George A. Sprecace., M.D., F.A.C.P, J.D.
asthma.drsprecace.com


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Α-gal Syndrome vs Chronic Urticaria

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Rapid Response for SUNDAY, November 18, 2018

BRONCHIAL ASTHMA: THE MOST TREATABLE - AND OFTEN THE MOST POORLY TREATED -  SERIOUS MEDICAL CONDITION.
I have been writing about and treating Bronchial Asthma for many decades. That information is available in several sections of this web site, and is up-dated regularly.
Today, I present the latest caution, prompted by the very recent re-approval by the FDA of Primatene Mist as an OTC medication for the treatment of "mild asthma".
WRONG, AND POTENTIALLY DANGEROUS.
In this position, I am joined by a Joint Statement just released by the major medical organizations dealing with such subjects : "Several Asthma, Allergy Groups Express "Deep Concern" Over Primatene Mist Approval" (MPR, November 12, 2018).
Use and overuse can easily result in a rebound worsening of the asthmatic bronchospasm, resulting in crisis situations.

There may be usefulness for Primatene Mist, only by prescription and under a doctor's emergency advice, in case of acute laryngospasm...and then FOLLOWED IMMEDIATELY by transfer to an Emergency Room - in view of the medication's propensity to produce worse rebound.
BEWARE: The life you save may be your own.

GS


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Rapid Response for SUNDAY, October 21, 2018

AKA "RED MEAT ALLERGY", ALSO CAUSED BY BITE OF "LONE STAR TICK".

It's a wild world out there. Be aware.

GS

Meet the new 6-legged cause of infection, allergy, and life-threatening disease

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Rapid Response for FRIDAY, October 12, 2018

THIS IS AN IMPORTANT HEALTH ADVISORY.
A majority of people are deficient in Vitamin D.

In recent decades, Vitamin D has been found to be vital for many body functions besides bone health.

Now comes the reproduced article.

Please get your 25-OH Vitamin D blood level drawn. If the level is below 30, contact your physician to prescribe Vitamin D3, 1000 or 2000 units per day, with repeat blood levels every four months.
You're Welcome.

GS

MRSA Bacteremia Treatments Compared

Vit. D Deficiency and Sepsis Mortality

Statins May Decrease TB Risk

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Rapid Response for SUNDAY, October 7, 2018

FOR YOUR CONSIDERATION, AS YOU SIP YOUR MORNING COFFEE.

GS

The dangerous effects of caffeine

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This Allergist Is 106 Years Old, and He's Not Slowing down Anytime Soon

What the Newest Medical Show, New Amsterdam, Gets Wrong

Design Features of this Device May Be of Interest to Your Patients

Racial Differences Uncovered in Debilitating Itchy Skin Condition

Individuals with Atopic Dermatitis More Likely to Have Antibody Response to S Aureus Superantigens

Inaccurate Penicillin Allergies Worsens Antimicrobial Resistance

Anaphylaxis: Treating A Potential Killer

The Breastfeeding-Asthma Link

Now Hiring at Doximity: Director of Medical Content

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Rapid Response for SATURDAY, October 6, 2018

ANOTHER OF THE MANY WAYS IN WHICH "LIFE STYLE" ISSUES ACCOUNT FOR WELL OVER 50% OF ALL HEALTH CARE COSTS.
"STUPIDO. STUPIDO. STUPIDO".

GS

Study: E-Cigarette Injuries Drastically Underestimated

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Rapid Response for FRIDAY through SUNDAY, September 28 through 29, 2018

MMMM MMMM GOOD.

GS

Yes, chocolate is good for you—but there's more to unwrap 

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Rapid Response for THURSDAY through SATURDAY, September 20 through 22, 2018

"THE DECLINE OF THE DIAGNOSIS" = THE DECLINE OF MEDICINE.
Here is an article, written by Joel B. Levine, M.D. and appearing in the September 2018 edition of Connecticut Medicine, which crystallizes the decline of Clinical Medicine...that is, the medical care that directly impacts every patient.
Apart from the 50% of a clinician's time that must be spent "documenting" on an increasingly redundant "electronic health record".
Apart from the rapidly increasing loss of private practitioners to the role of hospital employees tied to the "15 minute office visit", no matter what.
Apart from the decades-long theft of services identified as "adjustments", wherein a physician's reasonable and customary fee is discounted by 40-50% by insurance payors on a "take it or leave it" basis.
Apart from the sometimes idiotic regulations under which physicians are forced to practice...if they want to get paid at all.
This article describes how some physicians allow themselves to make a snap "diagnosis" without time to develop a "differential diagnosis" list  upon which to explore and act. The National Quality Forum, formerly the Institute of Medicine "acknowledges that the EMR (electronic medical record) is inherently incapable of such a clinical synthesis. The EMR demand for a billable action at the end of every encounter creates an ongoing need for a conclusion when one may not, as yet, have emerged." Resulting wrong diagnoses produce many adverse events and deaths.
Master clinicians are master diagnosticians. "By being smart, a masterful physician was invariably quicker to the right answer and cheaper."
"Sadly, we are being persuaded that medicine is not nearly as difficult as we thought it to be. All you need to do is keep the electricity bill paid."

GS

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Rapid Response for SUNDAY, September 16, 2018

"LIFE AND DEATH IN THE GREAT 1918 INFLUENZA PANDEMIC"
At this, the 100th anniversary of the "SPANISH INFLUENZA", John Ruddy and The Day perform another very useful public service:

to remind their readers that things are not always as they seem...and that contact with one's physician early on in an illness is much better than playing catch-up - or not catching up at all.

The following is a brief over-view, including my opinion of the lessons to be drawn from the 1918 devastating experience - and applicable to a future similar experience.
  1. That Influenza was extremely lethal. A future episode may be no less lethal if we rely only on vaccines and antibiotics.
  2. In that pandemic, it was the young, healthy and immuno-competent who were mainly affected. WHY?
  3. One theory relates to the variable availability of immune resistance, among young and old, from exposure to prior epidemics of the 1890's and of 1909, and to genetic mutations. Possible, but not sufficient for explanation, in my opinion.
  4. The pathologic findings in the lungs (the main cause of death being an overwhelming pneumonia and suffocation): bacteria were very hard to culture, and the lung tissue resembled the effects of toxic / inflammatory destruction.
  5. It is well-known that the Inflammatory System, a basic part of our Immune System, is a Blunt Instrument - not a scalpel - easily capable of doing more harm to the host than the invader might do...even killing the host itself, as in "Septic Shock".
  6. Most of the Influenza victims had robust Immune Systems.
  7. It is highly likely that the inflammatory response to the initial viral invasion killed the patients, through Sepsis and the implementing "Cytokine Storm".
  8. WHAT TO DO?
a) Seek the advice of your physician early-on, certainly within hours of developing significant symptoms and/or signs.

b) Be aware of the increasing capability of viruses, even in non-asthmatic and non-bronchitic patients, of producing substantial bronchospasm requiring aggressive anti-asthmatic treatment.

c) Patient and physician should have a high index of suspicion for the early signs of Sepsis...and should intervene with hospitalization and aggressive treatment immediately.

d) In the event of the above developments, the use of high-dose Steroids should be added promptly - not just "considered" - to counter the otherwise devastating effects of an Inflammatory System run amok.

THIS IS NOT OVER-REACTION. This may well save your life.

And - in the increasingly inattentive, hurried and even impersonal domains of today's medical care areas - you must have an effective ADVOCATE to present and if necessary to argue your case.

A Google Search under "Spanish Influenza, 1918" and under

"Sepsis and Steroids" will produce many relevant references.

Just don't get bogged down in the favorite ploy of some academicians, as distinguished from clinicians :
"On the one hand; on the other hand".

GS

Life and death in the great 1918 influenza pandemic

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Rapid Response for SATURDAY, September 15, 2018

RR#1

PLUS, WHAT WE LEARNED IN MEDICAL SCHOOL:
from the patient's point of view, the THREE MOST IMPORTANT QUALITIES OF A PHYSICIAN;
Ability, Affability, and AVAILABILITY...IN REVERSE ORDER!

GS

Do you have the 10 qualities that make a good doctor?

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Rapid Response for SATURDAY, September 1, 2018

"NO BRAG. JUST FACT".

Patients under my care for Allergy and Chest Diseases receive all of these services...in addition to "coordination of care"...at no extra cost. That's the way I've been practicing for six decades - and counting.

GS

Concierge Medicine Is Changing the Physician Practice Landscape

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Rapid Response for FRIDAY, August 31, 2018

ENJOY "HOOKING UP" INDISCRIMINATELY AS PART OF THE SOCIAL SCENE?
YOU DUMMIES!
Read the Linked article: "STDs Reach Record Levels in CT, Early Data Show", by Jake Kara and MacKenzie Rigg, in ctmirror.org, August 30, 2018.
Then "Google" Gonorrhea, Chlamydia and Syphilis. Read about Herpes for "extra credit". Then see if you "enjoy".

GS

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Rapid Response for SUNDAY, August 5, 2018

BINGO!
This is THE TRUTH, THE WHOLE TRUTH, AND NOTHING BUT THE TRUTH...
about physicians, the Medical Profession and the patients they find it increasingly difficult to care for properly.
This could only have been written by a Good Doctor. THANK YOU.

GS

Physicians aren’t ‘burning out.’ They’re suffering from moral injury

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PS: MOST PEOPLE ARE DEFICIENT IN VITAMIN D (less than 30 of 25 OH Vitamin D).
All patients should be tested. If deficient, they should receive Vitamin D3, 1,000 or 2,000 units daily. They should be re-tested every few months to avoid toxic levels (ie. above 70).

GS

Vitamin D: Recent research uncovers new benefits

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Rapid Response for WEDNESDAY and THURSDAY, August 1 and 2, 2018

PAYING FOR HEALTH CARE DELIVERY: THE MACRO AND THE MICRO.
Let's start with the MACRO...and with the obvious.

"Yes, the government should help those in need; but there is no fundamental reason that your and my health care and insurance must be so screwed up to achieve that goal".
So ends a recent article by John H. Cochrane entitled: "The Tax-And-Spend Health-Care Solution (WSJ July 30, 2018, Opinion, pA17. The author compares the current Health Care payment experience nation-wide with our experience with national telephone service and with national air service before and after finally producing a rational solution. Of course, why these vital and massive services were "so screwed up" was because businesses with great political clout wanted great profit - without competition. And our fearless leaders obliged. The same is true now - and for decades - with the Health Care Industry.

And now onto the MICRO. See: "The GOP's Clean Bills Of Health Savings" (in the same edition of WSJ, Editorial, pA16). As I have been writing for decades on this web-site and in the lay press, Health Savings Accounts have been a logical solution for decades...and have been thwarted for decades by the same organizations with great clout and by their wholly-owned subsidiary, the Government. And we are all, providers as well as consumers of health care, getting screwed!

GS

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Link between diabetes and cancer risk firmly established

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Beef jerky, processed meats linked to maniac episodes

Do omega-3 supplements really benefit the heart?

Alzheimer's risk 10 times lower with herpes medication

Good news for heavy coffee drinkers

Fats or carbs: What causes obesity?

Evidence to support 'breakthrough' drugs often very limited

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Rapid Response for SUNDAY, June 24, 2018

RR#1

"SEVERAL NOTABLE MEDICAL SOCIETIES HAVE ISSUED ETHICAL STATEMENTS DISCOURAGING PHYSICIANS FROM TREATING FAMILY MEMBERS AND FRIENDS."
This statement is too sweeping and is generally wrong, especially in today's health care delivery climate...where every patient needs a diligent advocate.
Furthermore, all of my patients are my friends, as are my family members.
In the informative discussions presented in this article, Dr. Gold is more doctrinaire than informed; Dr. Prager is too anxious; and Dr. Abbate presents the best of the arguments.
In the final analysis, "it takes two to tango". Doctor and Patient should make the decision for themselves.

GS

Incidence of Extrapyramidal Symptoms Higher With Certain Antidepressants

RR#5

THE HEALTH INDUSTRY AND ITS PARTICIPANTS: PART II.

GS

I remember when the Health Care Industry represented 8% of GDP. So, they went along just doing the same old things, like employer and employee tax deductability for health care expenditures, like suppressing health savings accounts that would bring patients back to caring about what they seek in health care, like making no effort to address the 50% of health care costs (ie. sickening life styles), like letting insurance companies run amok, like treating health care providers (the only ones who can really affect health care demands and costs) like the enemy, like Legislating a Prohibition against the Government being able to negotiate drug costs, like treating potential patients (ie. all of us) just as votes ("a chicken in every pot, a car in every garage").

So now, Health Care costs represent 17+% of GDP. What was that that Einstein said?

GS

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Rapid Response for FRIDAY, June 22, 2018

THE HEALTH CARE INDUSTRY AND ITS PARTICIPANTS:
the patient- public, health care professionals, payors, government...
This industry is approaching 20% of the GNP, a vital part of us.
Three recent articles in the WSJ will provide a detailed primer to the facts. And they augment several decades of personal writings on the subject.
(See the relevant sections of asthma.drsprecace.com)
•    "A Health Fix For Mom And Pop Shops", by Alexander Acosta, June 19, 2018.
•    "Exit From ObamaCare", Editorial, June 20, 2018.
•    "Health Savings Accounts for Everyone", by Scott W. Atlas, June 20, 2018.
The physical, mental and financial health you save may be your own.

GS

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Rapid Response for FRIDAY, May 18, 2018

RETARDING ADVANCED PRACTICE REGISTERED NURSES.
and efforts by some in their professional organizations to allow unsupervised practice.
My interactions with APRN's has been uniformly favorable. They are humane, highly motivated, fairly well educated and trained...and effective in what they do.
BUT THEY DON'T KNOW WHAT THEY DON'T KNOW!
That is the worst and most dangerous kind of ignorance.
It's not their fault, not even their responsibility. Their career path just does not provide for the comprehensive education, training and experience vital for the ultimate responsibility of a physician for the care of a patient entrusted to his or her care.
That is the one reason to work against free-standing APRN practice. It's not about turf or professional insecurity.
Therefore, please support efforts to retain APRN medical practice within the supervision of a licensed and practicing physician.

GS

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Rapid Response for SUNDAY, May 13, 2018

REGARDING DRUG  PRICING:
See the article published in The Day (May 12, 2018) entitled:
"Few Teeth In Trump's Prescription To Reduce Drug Prices".
"But it does not include his campaign pledge to use the massive buying power of the government's Medicare program to directly negotiate lower prices for seniors."
"Drugmakers generally can charge as much as the market will bear because the U.S. government doesn't regulate medicine prices, unlike most other developed countries."

AND DO YOU KNOW WHY?
Because your Senators and House Representatives in Congress, in passing the Medicare Modernization and Prescription Drug Act of 2002, specifically prohibited the Government from negotiating prices with the drug cartel.
Why did they do this? Because they did not want to lose the many millions of dollars of contributions to themselves from the drug companies. And to hell with their constituents. That's why.

President Trump cannot unilaterally reverse that. Only Congress can repeal or pass Laws. Indeed, there is now a Bill in Congress which would address that issue: "The Medicare Drug Price Negotiation Act of 2017.

It is going nowhere. Why not? Reread the above. And don't swallow the cyinical and divisive blame game being constantly dumped on the President. THE SWAMP HAS PROVEN TO BE MUCH DEEPER THAN ANY OF US IMAGINED. But give him time. He has accomplished a great deal of good, despite all manner of obstruction, in a short time.

GS

Few teeth in Trump’s prescription to reduce drug prices

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Rapid Response for WEDNESDAY, May 9, 2018

ABOUT MARIJUANA, OTHER THAN STRICTLY SUPERVISED MEDICAL USE:
DON'T BE STUPID!

GS

SAMHSA Head Stands Firm on Marijuana's Dangers—Also says younger generation of providers is key to opioid fight

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Rapid Response for SATURDAY, May 5, 2018


THIS IS GOOD ADVICE ABOUT TICKS.
Also:
1) Take a shower right after any walk in a wooded area;
2) Remember that Lyme Disease is much more likely to occur in a person who has already had one or more bouts of Lyme Disease than in a person who by this time in this region has never had the disease;
3) A rash, or "the target rash" does not occur in all cases. Any "flu-like symptoms" especially between Spring and Fall are suspect and should be tested for Lyme Disease and the other diseases related to tick bites.
As always, a diagnosis is most likely made by thinking about it as a possibility.

GS

Check for ticks every day, health district advises

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Rapid Response for TUESDAY and WEDNESDAY, April 17 and 18, 2018

MORE ON THE COMING DEMISE OF MEDICAL CARE - AND OF THE MEDICAL PROFESSION ITSELF- IN AMERICA. THIS IS OBSCENE!
A personal note. I have been a practicing physician for  61 years...and counting. I have never closed my practice to new patients. I have always taken all patients, regardless of the accompanying payment schemes, some miserable and all subjecting me and my medical colleagues to theft of services of about 40% of my income for the last 30 years.
"No Brag. Just Fact".

But I have refused to get sucked into the vortex described below: electronic health records for clinical care; performing work 10 points below my pay grade; sitting on hold - or allowing my staff to sit on hold, etc. I and my staff work WITH patients, not FOR patients. we require that they do their part.
Meanwhile, many tens of thousands of good physicians have given up private practice - or medical practice entirely, even choosing suicide! Not Me.
But you, the patient, are right now at great and increasing risk. You are receiving less and less effective and timely care. And only you can unite to reverse this lethal trend - because the regulators and the legislators don't give a damn for the health care personnel that they are trampling with abandon. Rise and Fight; or Sit and Die a slow death.
I kid you not.

GS

ER Docs: Secretaries with Medical Degrees

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Drinking in Adolescence Derails Normal Brain Development

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LET'S TALK ABOUT MARIJUANA.
Executive Summary: Medical Marijuana, YES; Recreational Pot, NO.
SOME FACTS.

1) The brain has many endo- and exo- cannabinoid receptors, ready to engage as part of the brain's endorphin systems.
2) There are many type of cannabinoid chemicals, natural and synthetic, that can be manipulated by manufacturers for specific effects.
3) A person's response is dependent on dose, frequency, route, types and ratios of chemicals.
4) When smoked, peak effect is in 15-20 minutes; duration is about one hour, then promoting further desire.
5) "Spice" is a synthetic cannabinoid, easily subject to overdose...and can be sprayed on other related drugs. It is not detectable in urine, but requires more extensive and expensive tests for detection. Withdrawal symptoms begin within 2-4 hours of withdrawal.
6) Cognitive effects: acute for 1-6 hours; residual for 7 hours to 20 days; long-term effects for 3+weeks; chronic effects possibly persistent. These effects include academic performance, driving and psychiatric illnesses.
7) Addictive in 10% or more of users. Withdrawal effects, including gastrointestinal, sleep and irritability effects, can last 10-14 days.
8) Age at onset of use is critical. Much worse in children and adolescents, including permanent reduction of IQ. There is evidence that use is now extending down to Middle School children!

MEDICAL MARIJUANA HAS MUCH MORE TO RECOMMEND IT,
in a "risk-to-benefit" analysis, and evidence-based.

Therefore: MEDICAL MARIJUANA, YES. RECREATIONAL POT, NO.

GS


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Rapid Response for Friday, April 6, 2018

MORE ATTACKS ON THE DOCTOR-PATIENT RELATIONSHIP.

GS

Doctor-Patient Relationship Compromised By Oppressive 'Quality' Reporting Requirements

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PLEASE ALSO CHECK OUT OUR MEDIDIETRESOURCES.COM SITE, CURRENTLY UNDER RE-CONSTRUCTION.

GS

Pecans Fight Heart Disease and Diabetes

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Rapid Response for TUESDAY, March 20, 2018

NOW HEAR THIS.
Judicial Watch is an excellent source of Real News, issue by issue.
Here is an example.

GS

Docs in AMA Survey Really, REALLY Hate Prior Authorizations

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HERE'S A GOOD AND QUICK SUMMARY OF "AUTOIMMUNE DISEASES".

GS

What happens when your body attacks itself

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Rapid Response for FRIDAY, March 9, 2018

JUST SO YOU KNOW: TWO THINGS ABOUT VITAMIN D.
1) In the last couple of decades, Vitamin D has been found to be important in many body functions besides bone health. This article points to another likely connection.
2) Probably a majority of people have Vitamin D levels below the minimum considered adequate (30-100). Certainly that is true of my patients.

Therefore, all should have their blood 25-OH Vitamin D level drawn and reviewed with their physician with the above in mind. In addition, it is now recognized that replacement should be with Vitamin D3 rather than with Vitamin D2.

JUST SO YOU KNOW.

GS

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Rapid Response for SUNDAY, March 4, 2018

REGARDING YOUR DOCTOR: HANDLE WITH CARE!

GS

One-third of physicians at major US hospital are 'burned out'

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Rapid Response for SUNDAY, February 25, 2018

REGARDING ALCOHOL, DEMENTIA AND CHRONIC ALCOHOLISM.
"True,True, and Related".

How do you want to spend your increasingly likely decades of life after your 60's?

GS

Alcohol use disorder is a 'major risk factor' for dementia

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Rapid Response for SATURDAY, February 24, 2018

READ IT AND WEEP: ABOUT HEALTH CARE DELIVERY TODAY.
Completing my 60th year in private medical practice, I don't work for patients; I work with patients, who have their own responsibilities for their health.
And as far as "concierge medicine" is concerned, I offer that daily, 24-7, without extra cost.
"No brag. Just fact".

GS

Health care's fundamental problem: Your doctor doesn't work for you

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MIGRAINE HEADACHES...NOT JUST A BAD PAIN.
First, get a clear diagnosis, preferably with a Neurologist,  ruling out other possible causes.
Then get the best treatment you can find, both for the acute episodes and for maintenance treatment to reduce or avoid the episodes. And also consider acupuncture with a qualified practitioner for treatment.
Protect your blood vessels, all of your blood vessels.

GS

Migraine linked to risk of many cardiovascular diseases, especially in year 1 after diagnosis

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IS THIS CLEAR TO YOU? THAT MAKES ONE OF US.
The important message is to use the safest medication...but NOT TO TOLERATE GERD / HEARTBURN.

GS

PPIs Lower Risk of Peptic Ulcer Disease

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CONCUSSIONS FROM PARTICIPATION IN COLLISION SPORTS MAY TURN OUT TO BE ONE OF THE MOST PERVASIVE AND SERIOUS MEDICAL CONDITIONS OF THIS GENERATION, AFFECTING OUR CHILDREN MOST OF ALL.
"Is anybody there? Does anybody care?"

GS

FDA approves blood test that determines severity of concussions

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This is not an acute coronary syndrome

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Rapid Response for TUESDAY, February 13, 2018

AND YOU WONDER WHY "DEFENSIVE MEDICINE" IS ALIVE AND WELL...AND IS RESPONSIBLE FOR 25-30% OF ALL HEALTH CARE COSTS?
WHAT A WASTE!
The only "Medical Malpractice Reform" that will work is the establishment of Health Care Courts, analogous to Patent and Bankruptcy Courts. The only impediment to that is the Trial Bar.

GS

Study: Half of doctors sued by age 55

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Rapid Response for SUNDAY, February 4, 2018

REGARDING THE CURRENT FLU EPIDEMIC.
1) Immunizations of all kinds are the most effective and cheapest form of medical care. To refrain from or to neglect getting immunized is STUPID; and for any parents and their children is IRRESPONSIBLE. Regarding the annual Flu vaccines, "egg allergy" is no longer considered an impediment to getting the shot. And you can still get the 2017-2018 Flu shot now.

2) The characteristics of this year's Flu epidemic resemble those of the Pandemic of 1918: the young and healthy are more likely to get seriously ill and to die. That is probably because the Inflammatory part of our Immune System is a BLUNT INSTRUMENT, prone to over-reacting to an invader, thus at times being itself the cause of death rather than the infection. The obvious example is SEPSIS. Therefore, make sure your physician considers high-dose Steroids in case of serious or grave illness.

3) Any "cold" is not "just a cold". It is a viremia, involving the entire body and capable of causing serious illness besides the well-known problems. Thus, treat a "cold" aggressively from the outset. My patients are given a "Cold Regimen" and are urged to use it. If you wish a copy of that Regimen, without thereby establishing a physician-patient relationship, send me a stamped, self-addressed envelope with your request. Meanwhile, an important note: "Z-PAK" DOES NOT WORK FOR RESPIRATORY TRACT ILLNESSES.

GS

CDC: US Flu Outbreak Worsens; Hospitalizations Highest in Nearly a Decade

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Rapid Response for TUESDAY, January 30, 2018

"PHYSICIAN, HEAL THYSELF."
That is my intent, as I complete my 85th year today.
For that, I thank God, my parents and my great family.
My inspiration is my mother, who lived well to age 95.
Other inspirations are noted in this direct quote from the Mayo Clinic Health Letter for December, 2017:

"Astronaut John Glenn returned to space at age 77.
Frank Lloyd Wright was still working at age 91.
Ronald Reagan was elected to his second term at age 73.
Dr. William Worrall Mayo founded Mayo Clinic at age 70.
Recently, Robert Merchand set a new world record for his age group by bicycling nearly 17 miles in one hour. Mr. Merchand is 102 years old.
What makes the difference among such people? Why do some stay young and vibrant despite their 'true age'?
Most people who live long, healthy lives are just regular  folks who refuse to equate age with illness and inactivity."

As I approach my 61st year as a physician, continuing an active medical practice of 40 hours per week (half/time for me), I intend to continue with this privilege as long as I am competent. That's my plan.

HAPPY BIRTHDAY TO ME.

GS.
January 30, 2018.

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Rapid Response for MONDAY, January 29, 2018

THIS IS GOOD NEWS FOR PATIENTS WITH SLEEP ISSUES.
Sleep Specialists are swamped with evaluations, resulting delays in attention.
Attentive non-sleep specialists who take a little time can make the diagnosis as well, then leading to specific treatment.
I have diagnosed scores of patients with Obstructive Sleep Apnea, actually an epidemic in recent years, by using three tests: a careful History, a Sleep Questionaire, and an Overnight O2 Saturation Test performed in the home.

Remember: good quality and quantity of Sleep is vital to good health.
OSA untreated can result in refractory high blood pressure, gastro-esophageal reflux, obesity, diabetes, heart attack and stroke.

GS

Provider Types and Outcomes in Obstructive Sleep Apnea Case Finding and Treatment: A Systematic Review

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Laughing Is Key to Good Health
By Mehmet Oz, M.D., and Michael Roizen, M.D.

From 1995 to 2014, comedies took in $38.6 billion at the box office — more than action, adventure and horror movies.
And that's not even counting romantic comedies, which grossed $9.1 billion.
While you might think that comedies are simply a great way to start off an evening with your significant other or spend an afternoon with the kids, they offer even more to all of you (that's moviegoers everywhere): They bring laughter, a great medicine.

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Rapid Response for SUNDAY, January 28, 2018


REGARDING ADEQUATE SLEEP, IN QUANTITY AND QUALITY...
Now hear this:
adequate sleep is the single most important controllable factor for GOOD HEALTH.
It is also the most abused and overlooked, other than the other miserable "life style habits" - which are responsible for over 50% of all illnesses and health care costs.
Sleep disturbances are Diagnosable and Treatable.
TALK TO YOUR DOCTOR. And if he or she isn't thinking straight because of sleep deprivation also, Run, Don't Walk to the nearest Sleep Specialist!
The life and quality of life you save Will be your own, for decades to come.

GS

Middle Age Sleep Problems Tied to Cognitive Decline Down the Line


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Rapid Response for THURSDAY, January 25, 2018

WHAT? A VOICE OF REASON CRYING IN THE WILDERNESS?
And something is definitely wrong when there is an ICD - 10 code, among over 60,000 other codes, for
"Had argument with in -laws."    I kid you not.

GS

Electronic Health Records: Is It Time to Uncouple Billing and Documentation Requirements?

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Rapid Response for SATURDAY, January 20, 2018

REGARDING THE IMPORTANCE OF ACCESS IN HEALTH CARE...
We were taught in Medical School that the three most important attributes of a physician to a patient are Ability, Affability and Availability - IN REVERSE ORDER!
I took that message to heart. During almost all of my 60 years in the practice of Medicine...and counting...I have been available to all of my patients all of the time: 24/7, directly through my three phone numbers. I don't call it "Botique" or "Consierge" Medicine. I don't charge extra for it. I just do it as part of good Medicine, Specialty Care and with Coordination of Care among my patients' other physicians. For this, I require only one thing: that patients do their part in dealing with their own care. I don't do things For patients. I do them With patients...or I don't do them at all. And for that I have been called "a living and breathing anachronism". Well,
"No Brag. Just Fact".

GS

Access...A Critical Benefit Of Concierge Medicine

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Rapid Response for FRIDAY, January 19, 2018

"BEFORE YOU CAN BE OLD AND WISE, YOU MAY BE YOUNG AND STUPID.
But don't push your luck.

GS

This is what happens to you if you take the Tide Pod Challenge

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Rapid Response for MONDAY, January 15, 2018

NOW HEAR THIS, PATIENTS AND SOON-TO-BE PATIENTS:

"THE LIFE YOU SAVE MAY BE YOUR OWN".

GS

Health insurance headaches cause continual stress for most physicians, survey finds

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HERE IS ANOTHER REASON, A VERY IMPORTANT ONE, WHY I DO NOT USE LABA INHALERS.
The continuing original reason is that the 24 hour effect on the body of such medications tolerizes the body against their effectiveness when needed in a "rescue inhaler".

GS


Starting new COPD inhaler tied to heart attack risk

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Rapid Response for FRIDAY, January 12, 2018

ON IMMUNIZATIONS (VACCINATIONS):
Folks, immunizations are the cheapest and most effective form of health care available.
If you fail to take them, you are negligent. If you intentionally refuse, you are reckless, especially with regard to your children.

GS

Potentially deadly flu virus is widespread in 46 states

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Rapid Response for SUNDAY, January 7, 2018

EXERCISE AND THE ELDERLY:

"The Best Things In Life Are Free".

GS

Muscle Inactivity More Harmful for Older People

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THE ARTICLE PROVIDED HERE DISCUSSES GENDER IDENTITY.
This has become a complex, confused and politicized subject.

Indeed, numerous other scientific questions have also become polluted by the injection of social / political demands.

In this case, the author offers strong reasoning for one position.

Please search also questions like the following for a more comprehensive review: Gender Identity and Intrauterine environment: Nature and Nurture.
My personal position is to urge great caution and expert medical advice in dealing with children with sexual identification issues. As always: "Primum Non Nocere / First Do No Harm".

Please see also the several articles in National Geographic, January 2017, entitled: "Gender Revolution".

GS

I’m a Pediatrician. How Transgender Ideology Has Infiltrated My Field and Produced Large-Scale Child Abuse.

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Rapid Response for SUNDAY, December 31, 2017

WOW!   MAYBE "WE ARE WHAT WE EAT".
This information, about Depression, is important...and CHEAP!

GS

‘Compelling’ Evidence for Probiotics in Treatment of Depression

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"JUST SAY NO."  HELL NO!

GS

Should Physicians Facilitate Lethal Injection Executions?

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More evidence links high-potency marijuana use to first-episode psychosis

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Rapid Response for SUNDAY, December 17, 2017

THESE PSYCHIATRISTS SHOULD HAVE THEIR HEADS EXAMINED.
No personal professional examination? And then divulge a "professional" opinion?
That's medical malpractice.
What psychiatrists should be allowed - and required - to do in all cases where they have reason to believe that a third party is at imminent risk, is to divulge that information to the proper authorities in order to protect the third party.
That's what "the world needs now". Not schlock.

GS

Is the Goldwater Rule Outdated?

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Rapid Response for FRIDAY and SATURDAY, December 2 and 3, 2017

THESE DAYS, WITH ALL THE NEGATIVE VIBES AROUND US,
we can use all the help we can get. And these are even pleasant.

GS

Moderate coffee drinking more likely to benefit health than to harm it

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Rapid Response for SATURDAY and SUNDAY, November 25 and 26, 2017

FINALLY: SOMEBODY IS STARTING TO LISTEN, IF ONLY BECAUSE IT'S COSTING MONEY.
The government regulators and the ivory tower researchers, in their hell-bent quest for "data", are in the process of destroying Health Care and its "providers".
What's going on is obscene.
STOP!!

GS

Counting the costs: US hospitals feeling the pain of physician burnout

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Rapid Response for THURSDAY, November 23, 2017


Targeted strategies better for birth cohort HCV testing

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Rapid Response for WEDNESDAY, November 15, 2017

ABOUT ELECTRONIC HEALTH RECORDS IN CLINICAL MEDICINE:
"True, True, and Related", an excellent exposition.
And may I add: I Told You So, about 8 years ago.
I do not use EHR'S in my clinical practice. And I am penalized 2-4% of my Medicare payments per year for that decision. My patients are just fine.

GS

Morning Break: GOP Tax Bill to Repeal ACA Mandate; EHRs' Burdens on Docs; Indy Sues Opioid Makers

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Rapid Response for MONDAY, November 13, 2017

FINALLY, THE WORD FROM THE MEDICAL "ON HIGH" AGREES WITH THOSE OF US WHO HAVE BEEN TREATING HYPERTENSION AGGRESSIVELY FOR MANY DECADES.

And we even had to go through the period about three years ago when some cost-conscious "gurus" proposed 160 mm Hg. as a good BP for the elderly. Crazy.

Essential Hypertension is the most important, most prevalent and most easily treated of the many chronic diseases that beset us, most often at a relatively early age. This is especially true if there is a family history of hypertension. The alternatives to good BP control are stroke, heart disease, dementia and a shortened and uncomfortable life span.
"CAN YOU HEAR ME NOW?"

GS

Half of US adults have high blood pressure in new guidelines

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Rapid Response for FRIDAY, October 27, 2017

DO WE NEED ANOTHER 80 YEARS OF RAMPANT DEBILITY AND DEATH FROM SMOKING?

GS

Vaping Elicits Immune Response in Lungs

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Rapid Response for SUNDAY, October 8, 2017

MORE ON INFLAMMATION, A PART OF OUR PROTECTIVE IMMUME SYSTEM...
but too often at the core of many illnesses. A Blunt Instrument.

GS

Suicidal Thoughts Linked With Brain Inflammation

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Rapid Response for SUNDAY, September 30, 2017

INTERESTING AND IMPORTANT, ESPECIALLY THE PART ABOUT PROLONGED SEDENTARY BEHAVIOR DESPITE ADEQUATE EXERCISE.

Couch potatoes become mashed potatoes.

GS

Sedentary Behavior and Mortality in Older Adults

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MORE ON THE CENTRAL ROLE OF INFLAMMATION IN DISEASE PROCESSES, FOR GOOD AND FOR ILL.

GS

Can Anti-Inflammatory Agents Be Used to Treat Bipolar Depression?

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Rapid Response for SUNDAY, September 9, 2017

THIS IS WHAT I HAVE BEEN SAYING FOR DECADES ABOUT
INFLAMMATION.

The inflammatory process, part of our Immune System, is a very blunt instrument that can at times hurt or kill you. Learn about it, both the internal mechanisms and external agents.

GS

Researchers Find ONE Root Cause of 5 Chronic Diseases

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Former medical director focuses addiction responsibility on prescribers

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AS I HAVE BEEN SAYING FOR DECADES, THE INFLAMATION ARM OF THE IMMUNE SYSTEM - THAT VERY BLUNT INSTRUMENT - IS AT THE HEART OF MANY IF NOT MOST DISEASES.
It is often as likely to kill as to cure.

GS

VIDEO: Inflammation’s role in atherosclerosis confirmed in CANTOS

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Rapid Response for SUNDAY, July 16, 2017

Our families are products of the free market system. Nobody gave us anything. Nor did we expect it. In that system, there were always winners and losers. Then that was allowed, even expected - like the tides. Given the last two or three generations, losing is not allowed. Everyone must be a "winner", with "participation awards", with diluted grades at both levels of the spectrum, and above all with ENTITLEMENTS. The word itself indicates the mind - set: we don't have to earn or be responsible...we are Entitled. The concept has now altered the genetics of hundreds of millions of voters and potential voters and illegal voters. The Democratic and Republican and Republicrat politicians have done their job well.
Thus, whether we are dealing with what the author N.N.Taleb has coined "IYY" ("Intellectual yet idiot") or just with run of the mill hypocracy  / cynicism, THERE MUST BE NO LOSERS, as is inevitable in a free market system.
And there is another problem. The "Free Market System" (aka. Wall Street in many minds) is simply not to be trusted. Washington is considered not the only "swamp". I think you will agree that some of this has been earned.
So, what to do?
For that, you need to read or re-read my many commentaries regarding HEALTH CARE REFORM" which populate my web site. They are all designed to re-inject Personal Responsibility into the Health Care System. They are all doable, given the legislative will. And they will all be attacked: "YOU CAN'T TELL ME WHAT TO DO, JUST GIVE ME MY ENTITLEMENT".
The end-game of that unsustainable scenario: with or without "medical care", prepare to suffer and die.
"In a democracy, the people always get what they deserve".

GS

Although there are of course bad actors in the free market, they are held accountable for their actions. Bad actors in government are much more dangerous because they have the ability to use force over others (that is the essence of government) and the government just throws more money at problem programs and departments while private companies are decimated by the market, the SEC, and the DOJ when the do something fraudulent (as they should be).

The Failure to Repeal Obamacare Is an Intellectual Failure

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Rapid Response for SUNDAY, July 2, 2017

IMPORTANT:
HEALTH CARE COVERAGE, "PRE-EXISTING CONDITIONS", AND GENETIC TESTING.
A genetic pre-disposition is Not a "pre-existing condition". I argued that years ago, including on this web site. But I then cautioned patients and the public not to undertake genetic testing unless and until iron-clad safeguards for their equal insurability were in place. Those safe-guards eventually came in the form of a Federal Law: GINA.
See the article published in ctmirror.org July 2, 2017:
"Safe Under ACA, Patients With Pre-Existing Conditions Now Afraid", by Charlotte Huff / Kaiser Health News.
Of course, when dealing with lawyers and paid-off legislators, "it depends on what the meaning of the word 'is' is".
Any new Health Care legislation MUST safeguard the equal insurability of persons who might seek information about genetic pre-dispositions before any "manifest disease" is diagnosed. The alternate - no protection or weasel-word "protection" would effectively eliminate this important method of avoiding "manifest disease" in time.

GS

MORE, EVER MORE, ON HEALTH CARE. 
This report has it exactly right.

GS

Elizabeth Warren Came Up With An Insane Idea That Would Destroy America

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The Difference Between Crohn’s, UC, and IBD - HealthLine.Com

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Rapid Response for SATURDAY, May 6, 2017

IMPORTANT HEALTH INFORMATION FOR US OUTDOOR TYPES...
especially the part about possible transmission of this severe tick-borne disease within 30 minutes of a bite - and no treatment.
BEWARE.

GS

Powassan Virus: the Tick-Borne Disease That Can Be Worse Than Lyme - Yahoo.Com

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Rapid Response for WEDNESDAY through FRIDAY, March 1 through 3, 2017

"OBAMACARE LITE".
Is that the best that Republicans controlling the House of Representatives, the Senate and most Statehouses can do?

Conservatives Fight to Stop ‘Obamacare Lite’ - Lifezette.Com
See also the article entitled: "Leaked ObamaCare Bill Fires Up Debate", in doximity.com, Health Affairs, Feb. 25, 2017.

Between the politics involved for  House members already preparing for their 2018 elections, and the massive cost of Health Care in general, the answer may be yes. 

But there is another way if enough of them are true  patriots and heroes: REDUCE HEALTH CARE COSTS BY ADDRESSING THE FOLLOWING PROBLEMS:
  1. Half of all health care costs are due to unhealthy health habits, "life-style related". I recently heard one politician say that "personal responsibility cannot be legislated". The Hell It Can't! Has he ever heard of motivation, of legal coercion if necessary?
  2. Drug costs are much too high and are artificially propped up by Government action. Remember the specific provision placed in the Medicare Act of 2002 by recipients of Big Pharma graft (aka "donations")...the one that PROHIBITS THE GOVERNMENT FROM NEGOTIATING DRUG PRICES?
  3. Employer provided Health Care benefits to employees, tax deductible to both, have for decades shielded both from the results of their health choices and treatments. Marvelous. Health Savings Accounts, properly structured, can restore patient consideration and decision-making into those choices.
  4. Half of all Health Care costs are generated in the last 6 months of a person's life.  Given mechanisms for meaningful choice (ie. Advanced Directives actually completed by the patient and actually followed by physicians and families), a vast amount of these costs would disappear...without any reference to "assistance in dying:". 
  5. Now we go to the doctor and "take a chance on the National Lottery", ie, Medical Malpractice suits.  Wasteful, unjust to all and simply a money machine for the Trial Bar, this situation generates about 25% of Health Care costs that are called "Defensive Medicine" ordered by health care professionals to protect themselves.  Health Care Courts, akin to Bankruptcy and Patent Courts with their special expertise, would generate more Justice at much less cost than the current "system" provides - and would obviate the need for "Defensive Medicine".
Physicians and related health care workers, by virtue of their position at the entrance to Health Care, are responsible for ordering over 20% of all such costs.  Pay them adequately (not now the case) and remove the unnecessary encumbrances on their professional expertise, and they will do a better job of triage, care, coordination and education. This is not happening now. 

SO YOU SEE, YOU DO HAVE CHOICES.
ANY PATRIOTS, ANY HEROES OUT THERE?

GS

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Rapid Response for SATURDAY, January 28, 2017

ATTENZIONE!

In recent months, several useful clinical topics - apart from the ever-present "urban legends" - have been reliably reported and deserve inclusion in standard medical practice, in my opinion.

1) Regarding Proton Pump Inhibitors (eg. Nexium, Protonix, etc), the plethora of recent warnings have been found by GI specialists to be overblown.  The most important goal is controlling GERD totally. If medications like Ranitidine (H2 antihistamines with dual effect) and Sucralfate work, fine.  If they don't, continue the use of PPI's.

2) Low Vitamin D has been found to be both nearly epidemic in the general population and important in many more areas of Health than just regarding bone health.  Thus, Vitamin D levels should be obtained on all patients (25 Hydroxy Vitamin D), and levels below 30 should be treated aggressively with Vitamin D replacement.
3) Sleep Deprivation is clearly an epidemic in today's society. There are many causes, including addiction to phones and gizmos used to and through bedtime, and the inordinate and inhuman demands of some employers to have employees "on call" at all times.  But an easily diagnosable and treatable cause is Obstructive Sleep Apnea, also present in epidemic form if looked for.  I use a Sleep Questionnaire and a Nocturnal O2 Saturation Test (performed at home) as screening devices. If either or both of these and the patient's initial history are suggestive, I order an Overnight Sleep Study, preferably performed in a formal Sleep Lab.  If that test is positive for OSA, the patient is placed on CPAP and/or on O2 during all hours of sleep. Untreated OSA  contributes to or causes obesity, GERD, high blood pressure, diabetes...and sudden death during sleep!

4) The following is an "oldie but a goodie": THE PROPER EVALUATION AND TREATMENT OF BRONCHIAL ASTHMA.
Notwithstanding the resistance and temerity of too many Pulmonary physicians to acknowledge this decades-long established fact, Bronchial Asthma - and also Chronic Bronchitis (aka "COPD") cannot be properly evaluated or treated without an Allergy Evaluation. In fact, COPD is a waste-basket diagnosis without that, a point at long last acknowledged by the admission of combined COPD - Bronchial Asthma syndrome. The patient, at least, should recognize this...and should self-refer if necessary.

5) Mental Health in today's world is much more than the absence of established psychiatric disease...and much more  than taking handfuls of psychotropic medications. See the section on this web-site entitled "Physician - Patient Spirituality" for some valuable insights.

6) Most patients these days have 3,4,or 5 different physicians. And too often, they don't talk to each other about the patient's multiple and often intertwined conditions and needs.  Seek out a physician who adds "coordination of care" to his or her offerings in your behalf.

7) We learned in Medical School (for me having graduated 60 years ago) that "the three most important attributes of a physician from the viewpoint of a patient are: Ability, Affability, and Availability...
in REVERSE ORDER."  Make sure that your physician is AVAILABLE  to you when you need him.

GS

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Rapid Response for SUNDAY, January 15, 2017

"PEOPLE NEEDING PEOPLE"

GS

Most doctors ignore one of the most potent ways to improve health, Penn experts say - MDLinx.Com

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"Best of 2016" from MDLinx.Com
 <--- Visit to access each of the articles below.

The 20 best journal summaries in Internal Medicine in 2016.
  1. Dietary water intake and bladder cancer risk: An Italian case-control study
  2. Meta-analysis of potassium intake and the risk of stroke
  3. Association between vitamin D deficiency and antinuclear antibodies in middle-aged and older U.S. adults
  4. Coffee and caffeine intake and risk of urinary incontinence: A meta-analysis of observational studies
  5. Chocolate intake and incidence of heart failure: Findings from the cohort of Swedish men
  6. How statins aid the immune system
  7. The Centers for Disease Control and Prevention opioid guidelines: Potential for unintended consequences and will they be abused?
  8. Coffee and green tea consumption in relation to brain tumor risk in a Japanese population
  9. Coffee intake and the incident risk of cognitive disorders: A dose-response meta-analysis of nine prospective cohort studies
  10. Sugar addiction: The state of the science
  11. Egg consumption and cardiovascular disease according to diabetic status: The PREDIMED study
  12. Statin myopathy: Over-rated and under-treated
  13. Coffee consumption is positively associated with longer leukocyte telomere length in the Nurses’ Health Study
  14. Discontinuation of statins: What are the risks?
  15. Infusing pleasure: Mood effects of the consumption of a single cup of tea
  16. Effect of vitamin D3 supplementation on blood pressure in adults: an updated meta-analysis
  17. Multivitamin use and the risk of cardiovascular disease in men
  18. Coffee consumption and risk of cardiovascular events in hypertensive patients: Results from the HARVEST
  19. Association of breakfast intake with incident stroke and coronary heart disease
  20. Add-on effects of a low-dose aripiprazole in resolving hyperprolactinemia induced by risperidone or paliperidone
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Rapid Response for TUESDAY and WEDNESDAY, December 13 and 14, 2016

THE STATE OF OUR HEALTH CARE SYSTEM
By George A. Sprecace., M.D., J.D.
A Recent Interview with Adam Sprecace, PE,
On the Lee Elci Radio Show, December 13, 2016
Q&A


Note:  You can also hear the segment broadcast on December 30, 2015...


1) A BRIEF SUMMARY OF HEALTH CARE IN AMERICA?
Quality: excellent at the top; modest on average, and decreasing.
Access: sporadic.
Cost: excessive and wasteful.
IN GREAT NEED OF EFFECTIVE REFORM.

2) WHAT HAS LIFE BEEN LIKE, WORKING IN THE TIME OF OBAMACARE?
(eg. patient workload, reimbursement rates and dependability, electronic record-keeping, etc.)
Workload increasing; compensation decreasing; EMR’s poor for the private practicing physician and patient, necessary for hospitals but generating increasing cost and workload and decreasing quality as measured by productive provider – patient interaction.

3) HOW HAS OBAMACARE AFFECTED PHYSICIANS?
Much more stress and strain, with less physician and patient satisfaction.
Physician burn-out and declining physician health.
Pressure to practice UNETHICALLY: eg. ACO’s, BUNDLING, etc., which for first time would force the physician’s self-interest to work at variance with that of his or her patient, with whom he has a Fiduciary Responsibility.

4) IS OBAMACARE GETTING BETTER OR WORSE?
Increased premiums, reduced coverage….
Obamacare was and is a Christmas Tree of Wants, with no attention given to needed Health Care Reforms. The Goals are reduced costs at any cost, and increased Regulations by many who have no knowledge of what they are doing. Example: THE 30 DAY READMSSION RULE, which substantially  penalizes hospitals for readmitting an inpatient within 30 days of discharge…EVEN FOR AN UNRELATED READMISSION DIAGNOSIS! 

5) WHAT ABOUT THE PENALTIES FOR REFUSING TO BUY MEDICAL CARE COVERAGE UNDER OBAMACARE?
20 million subject to penalty. 8 million paid penalty. 12 million exempt. Thus, more subject to penalty than were covered.

6) WHAT’S BEEN HAPPENING WITH RELIGIOUS HOSPITALS THAT REFUSE  TO FOLLOW OBAMACARE MANDATES?
Endless Litigation, including the USSC. Coercion: loss of Freedom of Religion, reduced quality and availability due to intimidation and decisions in a System (ie. Catholic Hospitals) that is nearly the largest in the nation.

7) WHAT WOULD YOU CHANGE ABOUT OBAMACARE?
Repeal and Replace, with a two year transition period. a) increase insurance policy competition across State lines; b) reduce and rationalize Regulations; c) make all patients financially at stake at every encounter (HSA’a, co-pays, defined contribution instead of defined benefit plans, etc; d) retain coverage for pre-existing conditions while imposing penalties for continued bad life-styles, which account for about 50% of all health care costs; e) as “Defensive Medicine” accounts for 20-30% of health care orders – costs, REFORM MEDICAL MALPRACTICE LAW – eg. Health Law Courts; f) promote and enforce End Of Life Decisions – 50% of Medecare costs occur in the last 6 months of a recipients life!;g) make electronic medical records OPTIONAL for private physicians; h) re-think and revise EMTALA LAW – currently a poor and wasteful use of ER’s; i) prohibit UNETHICAL medical practice and payment programs; j) pay physicians fairly – they are now bearing the brunt of this Christmas Tree. ETC.

8) DO PHYSICIANS AND HOSPITALS GENERALLY AGREE WITH YOUR POSITIONS ON OBAMACARE?
Most physicians, yes.  Hospitals are ambivalent: gaming the system where they can; merging and selling out; trying to “go along” so as to “be at the table” when government decisions are made – not working; acting like trained businessmen when dealing with professionals: “win-lose” instead of “win-win”, treating professionals like widgets…. A bad plan.

WHAT IS YOUR PROGNOSIS?
Short-Term, GUARDED. Much damage has been done.  Long-Term, FAIR, now that competents have retaken the ASYLUM.

NB: GEORGE A. SPRECACE, M.D., J.D. has been writing and speaking on this subject since the late 1970’s, a practicing physician for 60 years…and counting. These Commentaries are found on www.asthma.drsprecace.com

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The retirement issue that no one is talking about - Yahoo!

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Rapid Response for SUNDAY, November 20, 2016

‘Medical’ Marijuana a Con - American Center for Democracy

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Rapid Response for MONDAY, August 29, 2016

MEANWHILE, BACK IN THE MEDICINE CABINET...

GS

JAMA study: Why are drug prices so high, and what can be done about it? - MDLinx.Com

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Rapid Response for FRIDAY, August 26, 2016

Chemicals banned decades ago linked to increased autism risk today - MDLinx.Com

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Rapid Response for FRIDAY, May 13, 2016

"VALUE-BASED MEDICAL CARE".
Sounds like a no-brainer, right?

Not when your Government defines and implements it!

In fact, although our Health Care Regulators are doing as much as possible to make it sound like "motherhood and apple pie", THE DRIVER FOR THIS PLAN IS REDUCTION IN HEALTH CARE COSTS, at any cost.

And the vehicle for this trip is inherently UNETHICAL: rewarding physicians for providing less health care, and punishing them for providing more health care...perverse incentives that for the first time place the interests of physicians in opposition to the interests and needs of their patients.
It is RATIONING ON STEROIDS, couched in such reasonable terms as "evidence-based medicine", "efficient health care delivery" and "patient satisfaction".

NOW HEAR THIS: That's exactly how I have always practiced Medicine in my 59 years as a physician. But that will not shield me from being crippled with yet more demands for "documentation" beginning in 2017; and it will not prevent me from being penalized 4% of my receivables beginning in 2019 unless I want a 4% increase by cheating my patients of the care they need. That's what we're talking about, without the sugar-coating.

THE ABOVE IS DIRECTED MAINLY TO THE PATIENT / PUBLIC.  For the Regulators don't give a damn about what physicians and other health care providers care or say. They do care about what the voters say. 

So: "DON'T JUST STAND THERE.  DO SOMETHING", for a change.

GS

Value-based care 101 - InternalMedicineNews.Com

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Frequent Ejaculation Linked to Decreased Prostate Cancer Risk - Consultant360.Com

AND WHILE WE'RE AT IT, MEDICALLY SPEAKING:
Look up "Can breast feeding and breast sucking reduce the incidence of later breast cancer?"

GS

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Rapid Response for SUNDAY, October 26, 2014

RR#1

AM I A MIND-READER...OR WHAT?

"Articulate, Arrogant, Asinine".

GS

White House Presses States to Reverse Mandatory Ebola Quarantine Orders  - NYTimes.Com

RR#2

EBOLA VIRUS INFECTION and protection of Americans

Now comes the latest victim of Political Correctness run amok.

The prime responsibility of our government is to protect its people from threats near and far.  It's responsibility is not to rehabilitate a continent ravaged by the excesses of former colonial powers and by the corruption of its own leaders.  But that is exactly what our reckless "leaders" are touting to justify their refusal to quarantine America from a potential pandemic...an action successfully taken by some of the African nations themselves.  This is not "panic".  It is common sense and basic protocol for the management of infectious diseases of all kinds.

Then you have a litany of negligent actions and inactions taken by our own politicized "professionals": on - the - job training and making it up as they go along, all the while looking over their shoulders for the approval of their political masters.
"WHERE IS IT WRITTEN..." that
Meanwhile, the Governors of several States are to be lauded for their initiatives in defense of their own citizens.  Or can we expect Attorney General Holder to initiate legal process prohibiting such action "in order to protect Liberia..."

We can't "...stop the world".  And we can't "get off".  But we can object.  We can demand. We can Vote! 

"Is anybody there? Does anybody care?"

GS

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Rapid Response for FRIDAY, September 18, 2014

FEE FOR SERVICE: GETTING A BAD RAP FROM THE BEAN COUNTERS.  BUT ONCE AGAIN THEY ARE WRONG.  READ THIS.

GS

I thought you would like to read the attached article: Friday Feedback: Docs Defend Fee-for-Service Click http://www.medpagetoday.com/PracticeManagement/Reimbursement/47748 for the full story: Sign up at http://www.medpagetoday.com/updateProfile.cfm?action=register for your FREE, once-daily, Medical News Daily Headlines Email. MedPage Today(R) provides physicians and &#39;expert patients&#39; real-time coverage of breaking medical news and the top stories in health and medicine. Physicians, PAs, Nurses, and Pharmacists may also receive CME/CE credit as part of our news coverage. Our content is reviewed and accredited by the University of Pennsylvania School of Medicine, Office of Continuing Medical Education (OCME). OCME is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide CME for physicians. There is no cost to use the service. Visit MedPage Today www.medpagetoday.com now. At MedPage Today, we are Putting Breaking Medical News into Practice(R).

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E-Cigarettes Just More Smoke and Mirrors, Doctors Say - Yahoo News

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2/11/2012

KEEPING DEMENTIA AND ALZHEIMER’S DISEASE AT BAY

The following is a summary of the most recent foray into achieving this goal.  It is based upon a TV interview on the Today Show (February 11, 2012) between Lester Holt and a Professor of Geriatrics from California.  And it says a lot. 
  1. To enhance short and long-term memory: Focus on the topic; Snap a mental picture of the subject matter; Connect it to something else of interest to you. 
  2. Add to your regular diet foods abundant in anti-oxidants (see lists readily available, mainly vegetables, fresh and dried fruits), omega 3 oils (fish, nuts), and whole grains (especially oat and corn).
  3. Obesity promotes dementia.  Regain and maintain a proper weight.
  4. Anxiety promotes dementia.  Don’t be “Outcome Oriented”…”What if…” this or that.  Be “Process Oriented”: control what you can control; and then observe how the issue plays out.  “A little sugar…” in the form of rest and relaxation will help this “medicine go down”.
  5. Exercise, both physical and mental, is vital.  A daily brisk walk is all it takes.  And studying a new language or a musical instrument are potent exercises. 
  6. Humor…and a good laugh…help everything.  See the section on my web-site (www.asthma-drsprecace.com) entitled “A Bit of Whimsey”. 
  7. Make and keep friends, in every sense of that word.  And if you are lucky enough to be married, work on making that person your Pal. 
  8. Heredity is not destiny.  More relevant to destiny is what you do with your body, your mind and your time. 
YOU CAN DO THIS.  If not, at least buy Long-Term Nursing Home Insurance…because you may well be headed there.

GS

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KEEPING DEMENTIA AND ALZHEIMER’S DISEASE AT BAY

The following is a summary of the most recent foray into achieving this goal.  It is based upon a TV interview on the Today Show (February 11, 2012) between Lester Holt and a Professor of Geriatrics from California.  And it says a lot. 

  1. To enhance short and long-term memory: Focus on the topic; Snap a mental picture of the subject matter; Connect it to something else of interest to you. 
  2. Add to your regular diet foods abundant in anti-oxidants (see lists readily available, mainly vegetables, fresh and dried fruits), omega 3 oils (fish, nuts), and whole grains (especially oat and corn).
  3. Obesity promotes dementia.  Regain and maintain a proper weight.
  4. Anxiety promotes dementia.  Don’t be “Outcome Oriented”…”What if…” this or that.  Be “Process Oriented”: control what you can control; and then observe how the issue plays out.  “A little sugar…” in the form of rest and relaxation will help this “medicine go down”.
  5. Exercise, both physical and mental, is vital.  A daily brisk walk is all it takes.  And studying a new language or a musical instrument are potent exercises. 
  6. Humor…and a good laugh…help everything.  See the section on my web-site (www.asthma-drsprecace.com) entitled “A Bit of Whimsey”. 
  7. Make and keep friends, in every sense of that word.  And if you are lucky enough to be married, work on making that person your Pal. 
  8. Heredity is not destiny.  More relevant to destiny is what you do with your body, your mind and your time. 
YOU CAN DO THIS.  If not, at least buy Long-Term Nursing Home Insurance…because you may well be headed there.

GS

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Experts Assess Health Risks of Airport Full-Body Scanners, Emily P. Walker

Offerings by George A. Sprecace M.D., J.D.:    (Scroll down or click here for More Relevant Offerings)

"TRUE, TRUE...AND RELATED".  Good advice, especially about the Obstructive Sleep Apnea, of which there is an epidemic, most often undiagnosed.  GS

Mayo Clinic - Aspirin not a joke!

Dr. Virend Somers, a cardiologist from the Mayo Clinic who is lead author of the report in the July 29, 2008 issue of the Journal of the American   College of Cardiology

Most heart attacks occur in the day, generally between 6 A.M. and noon, Somers said. Having one during the  night, when the heart
should  be most at rest, means that something unusual happened. Somers and his colleagues have been working for a decade to show that sleep apnea is to blame.

1.   If you take an aspirin or a baby aspirin once a day, take it at night. The reason: aspirin has a 24-hour "half-life" therefore, if most heart attacks happen in the wee hours of the morning, the aspirin would be strongest in your system.

2.  FYI, aspirin lasts a really long time in your medicine chest for years, (when it gets old, it smells like vinegar). Please read on.

Something that we can do to help ourselves - nice to know.
Bayer is making crystal aspirin to dissolve instantly on the tongue. They work much faster than the tablets.

Why keep aspirin by your bedside? It's about Heart Attacks: There are other symptoms of an heart attack besides the pain on the left arm. One must also be aware of an intense pain on the chin, as well  as nausea and lots of sweating, however these symptoms  may also occur less frequently. Note:  There may be NO pain in the chest during a heart attack.

The majority of people (about 60%) who had a heart attack during their sleep, did not wake up. However, if it occurs, the
chest pain may wake you up from your deep sleep.

If that happens, immediately dissolve two aspirins in your mouth and swallow them with a bit of water.

Afterwards:
- call  911
- phone a neighbor or a family  member who lives very close by
- say "heart attack!"
- say that you have taken 2 aspirins.
- take a  seat on a chair or sofa near the  front door, and wait for their arrival and...
- do NOT lie down.
Our Health Care Future, GS

June 28, 2009

Until this year, "the Flu" was a viral disease of Fall and Winter, with occasional extension into early Spring.  Thus, a "flu-like illness" occurring in late Spring or Summer produced a search for tick-borne diseases like Lyme Disease, Babesiosis, and /or Anaplasmosis (formerly known as Ehrlichiosis). 
 
This Summer season there is another bad actor out there: Swine Flu, otherwise known as H1N1 Influenza.  It can be tested for by ordering an Influenza A test which, if positive, is further tested for Swine Flu virus.  But now that is not enough.  Tick-borne diseases must also be sought (requiring specific testing) when the patient presents with a "flu-like illness".  Please do not dismiss such symptoms and "tough it out".  Consult your physician; and share this information with him or her.  All of these illnesses are more or less treatable.  And all of them can produce serious consequences if not diagnosed and specifically treated in timely fashion.

GS

Immunization Notice, November, 2006, GS

Bronchial Asthma, COPD, and Inflamation, GS

  • Here is a report with which I agree: "Doctors See Benefit From Net-searching Patients", by Tyler Chin (American Medical News - www.amednews.com - Aug. 15, 2005, p1).  "As more people go online for health information, physicians are finding that research can deepen levels of conversation during visits".  So, please surf the rest of this web site, in addition to the Mediterranean Diet site: This is a public service gift...that keeps on giving.
  • But there are risks to patients' direct access to frequently raw medical data, not yet peer reviewed, and to pharmaceutical information which is often "mere puffery", not filtered by a "learned intermediary".  The recent and continuing problem with COX-2 Inhibitors, and currently the Vioxx case, are examples...with serious risks affecting both producers and consumers.  SO, "ASK YOUR DOCTOR".
  • The Patient Safety and Quality Improvement Act of 2005, recently signed into law andalso discussed on the same page of the above reference, sounds good - but stay tuned.  It may be too good to be true...and still to risky for health care providers to buy into.  More to come on this.

  • And to finish this offering on another medical note, this year "just a cold" may not be the right attitude...considering the past and possibly continuing difficulties with getting the flu vaccine, and with the possible arrival here of Bird Flu - God forbid.  Everyone, and especially people with other illnesses, should check with their physician for anything but mild symptoms.  Don't try to "tough it out" this time around.

    GS
     

    One of the most common dangers encountered by all of us who, especially in the summertime, stray to the shore, or the hills, or just to the golf course is the possibility of being struck by lightning.  One can survive, but dying is often not the worst of it.  A very informative article on the subject appears in this month's issue of Field and Stream" entitled "Thunderstruck", by Keith McCafferty (p32).  Unless I'm wrong, you don't know all that you should know in order to protect yourself and your family from this threat from the skies, even from the blue skies.

    GS
     

    Physicians and their patients are in tough times partly because, in a mis-guided and paternalistic effort to shield their patients from the turmoil, physicians in the 1980's and early 1990's did not keep their patients informed and did not seek their political help.  They also had this quaint idea that politicians and legislators gave a damn about their points of view and input.  We all learned otherwise.  So, in addition to all the warnings I have been sharing since the late 1970's  (see other relevant categories on this web-site),  here are some more that may make a real difference to the most altruistic of your physicians.

    1. "Pay for Performance" is one of the latest brainstorms being tested.  If not structured properly, physicians' income, already discounted over 30% from what they legitimately earn,  will be based - not on proper procedures - but on successful outcomes.  So now your physician would be held responsible for your adherence to instructions, for your taking your medications, and for all the other stupid life-style things that you might do...in addition to having chosen the wrong genetic stream at conception.
    2. "Cultural Competency Training".  Physicians  may be required to handle not only the medical problems of that patient from Haiti, but also to discuss her problem in her mother tongue and with sensitivity to her beliefs in voodoo.
    3. There is planned a further decrease in the already borderline reimbursment for treatment of Medicare patients, stretching several years down the road.
    4. Some States are considering taxing physicians 1% of their gross income for the permission to take care of Medicaid patients.  Their care, in which most of us participate, is often the most time-consuming and always the very least reimbursed.
    Patients take note: even the most caring and committed physicians may decide that they have been insulted, denigrated and marginalized once too often.  These smart and energetic people have always had other options.   This is not a threat.  Rather, it is a call for help.

    GS

    Health Alerts...June, 2006 GS

    Flu Season, 2004, GS

    Rules to Live By, GS

    There's a Fungus Among Us, GS

    WAZZUP?! - New and Notable, GS

    Xolair and Bronchial Asthma, GS

    Advice for Living a Long, Healthy and Happy Life, GS

    How to "Winterize" Yourself, GS

    Smallpox Vaccine, GS

    Hygiene Theory, GS

    Peanut Allergy, GS

    Bio/Chemical Terrorism, GS

    September 11, 2001, GS

    Keeping Insects at Bay, GS

    Scrombroid Poisoning, GS

    Medical Abstracts, GS

    The Next Allergy Season, GS

    Emergency Room Treatment of Acute Bronchial Asthma, GS

    Flu 2000-2001, GS

    Biting Insects, GS

    Flu 2000, GS

    Regarding Medical Errors, GS

    Lyme Vaccine, GS

    More Relevant Offerings:
    Sleep is Food for the Brain, Paul J. Licata, D. O.
    "Might as Well Dance", Author Unknown

    Good Advice For All Of Us, All The Time, As Long As We Still Have Time..."Slow Dance"

    "Risks and Benefits of Gene Therapy",
            by Philip Noguchi, M.D., the New England Journal of Medicine, 348:3, Jan 16, 2003, p193

    "The Real Face Of Cloning",
            by Tim Friend, USA Today, Jan. 17-19, pA1

    "Sexual Healing"
            by Melissa Gotthardt, Modern Maturity (AARP), Jan-Feb. 2003, Self Care, p14.


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