Del Meyer, MD - Health Care News & Discussion

Health Care News & Discussion

Euthanasia

We’ve all heard of physician assisted suicide occurring in free democratic countries in Europe, primarily in the Netherlands. In socialized countries such as Europe, life and death matters are a concern of the state. Live patients who are sick consume valuable resources – tax moneys. Dead patients no longer are costly—they no longer consume tax dollars or Euros. Sick patients were never a legal problem until socialized medicine came into vogue. This is when governments paid the cost of illness and all governments have a cash flow problem—not just Greece, Italy, and Spain—but also Oregon which implemented a Physician Assisted Suicide law. All governments just don’t seem to think taxes are high enough to pay for the public good. Many times what is considered the public good is really the public harm.

President Obama has been raising taxes since he became president. Every day the news is telling us of another tax gimmick that was found to raise taxes on a particular segment of society which is not large enough to create a resistance problem. We are near the point where President Reagan was when he became President and found the Marginal Tax rate was more than 90 percent. He reduced it to 35 percent and the federal income increased greatly as citizens no longer had to use tax shelters. The government had plenty of money again. And the citizens also had money again to live more comfortably.

Now as taxes are skyrocketing again, the government is looking for ways to save money. Not as a benefit to its citizens but for the benefit of the government bureaucracy. We are seeing limits on life saving procedures as are common in Europe; age limits on life saving procedures such as Coronary Bypass surgery, kidney dialysis, and others so that the discussion of Physician Assisted suicide is raising its head again. “Why should the elderly lie in nursing homes year after year on Medicaid expense? Can’t we let the doctors just slip then a little more morphine or phenobarbital or digoxin than the heart and brain can handle, maybe turn off the cardiac monitor so no one can get excited as the heart goes into agonal rhythm and then flat lines so that all medical costs stop along with the heart beat.” By having doctors, who always have had the highest ethical standards of any group anywhere, do this it won’t seem like mass executions—just a rational cost saving procedure.

A doctor in The Netherlands confided in me during a break in a medical meeting in Amsterdam that he once admitted an elderly lady to the hospital. She said she worried about being put to death while in the hospital. The doctor I was speaking with assured her that he would watch over her to make sure that didn’t happen. The next weekend, he signed her out to a colleague. When he came back on Monday, he looked for her and couldn’t find her. The nurse said she had “died.” He quickly summoned his colleague as to what happened. He was told, “We needed the bed and she looked pretty sick.” He said he now felt it was a horrible tragedy for physicians to be involved in assisted suicide. It is more often an execution.

Statistics in Oregon, the first state in which physicians are allowed to kill patients who request it, indicate that perhaps as many as half of these patients have not signed a valid request stating that they wanted to be executed. These hospital mistakes are completely permanent. They are not simple medication errors that the Institute of Medicine feels are so tragic. Many of those are inconsequential and can be reversed. Physician execution of patients can never be reversed.

Patients in our day have enough lethal medications in their possession that doctors never need to be involved. Many pharmaceuticals are now dispensed in 90-day lots. Essentially all patients have enough cardiac or hypertension medications or narcotics at home that they can do the deed on their own. Even a 30-day supply of such medications can do the dirty deed. Why should we involve and corrupt a profession with high moral values. We have been revered as having the highest ethical values after after ministers, priests and rabbis.

A patient with obstructive sleep apnea came in for his annual evaluation. He had been snoring for decades, but about six years ago, his wife noted that his snoring stopped abruptly in the middle of the night. She observed her husband and noted that his chest was still moving, as if he was breathing, but there was no snoring. She then put her hand over his mouth and nose and did not find any air movement. She woke her husband immediately and after a loud strider, he began breathing. She insisted he see his pulmonologist as soon as he could obtain an appointment. He was immediately placed on a Continuous Positive Airway Pressure (C-PAP) device to wear at night and was scheduled for a Polysomnogram (sleep study). This confirmed the diagnosis of sleep apnea (no breath) and determined the optimal pressure to set the device to assure continuous breathing while asleep.

As I was finishing my exam and writing his prescriptions, he casually mentioned that a friend of the family, who had sleep apnea, also had severe respiratory failure requiring oxygen. His C-PAP was powered by oxygen pressure rather than compressed air. The friend was getting increasingly depressed over his disability and told my patient that sometimes he thought that he would just turn the machine off and end it all. Although my patient tried to joke him out of this approach, he apparently decided one night that he’d had enough. He turned off the machine and the oxygen and quietly died during the night.

With all the emphasis on physician-assisted suicide, it is indeed unfortunate, if not absolutely heinous, that physicians should play the role of executioner. That such a proposition can be passed by public vote underscores the lack of basic medical knowledge we have been unable to provide to the public. Or perhaps not enough moral turpitude that it matters. They don’t need a physician acting as an executioner to write a lethal dose of barbiturates (or to turn off life support or just cut the oxygen line.) The patients have numerous ways or lethal doses already in their possession. Whether in The Netherlands, Oregon or Europe, we should never have to worry about whether our doctor is wearing the white coat of healing or the black cloak of an executioner.

Diets

Review by Del Meyer, MD

The other day at the nursing station, I observed the ward clerk reading “Weight Watchers” as she devoured a “Babe Ruth.” … I guess that keeps the scales balanced and the economy moving. It also contributes to the epidemic in America – 50-60% of the population is overweight with 25-33% affected with obesity. We consumed 15% more calories in 1994 than we did in 1970 and today we dine out twice as often. If obesity was an infectious disease, we would call it a national crisis.

Of all the books that cross my desk, there is at least one or two each month about dieting. The “diet industry” is flourishing. But is there really any new information? At one bookstore I counted 107 different diet books. At another there were over 200 titles. It is interesting that as this deluge of new books were filling up the shelves, some “dated” diet books that spoke of revolutionary new medical dietary evidence were now on sale at 10% of their initial listing.

There are number of diet books written by celebrities. These authors are obviously without credentials. However, some of these books are quite basic and meet a need because of a co-author with credentials, e.g., MS, PhD or MD, although the latter group may not always be as knowledgeable as the public assumes.

A brief review of some of these books will describe this self-perpetuating industry. The questions still remain. Are they of value to the overweight Americans? Are they helpful to those with other dietary problems such as hyperlipidemia, coronary artery disease, peripheral vascular disease, hypertension, or diabetes? Do they provide complete lifelong nutritional programs? Do they incorporate exercise and stress management? There are at least three that do.

The Pritikin Diet Programs of Nathan Pritikin have been continued by his son Robert, director of the Pritikin Longevity Center. The current volume, The New Pritikin Program by Robert Pritikin (Pocket Books, $7) is friendlier and more in tune with a lifetime commitment. The results of the first 893 people that participated in the 26-day Pritikin Longevity Center program was published in 1974 and provided a wealth of data which was evaluated by the Department of Biostatistics and Epidemiology at Loma Linda University. The results indicated that 83% of hypertensive people lowered their blood pressure to normal and left the program drug-free; 50% of adult-onset diabetics on insulin left the program free of insulin; 90% of diabetics on oral drugs left free of drugs; 62% of drug-taking angina patients left the center drug free; cholesterol and triglycerides were each lowered an average of 25%; overweight people lost an average of 13 pounds; of the 64 people who were recommended for bypass surgery, 80 % of them had not undergone surgery even five years later. I remember that when Nathan Pritikin presented his data to medical staffs in this community during the mid 1970s, he himself had severe coronary artery disease and was recommended for bypass surgery. He declined and developed this program instead, which reversed his own atherosclerosis. There now have been over 50,000 people treated at the Pritikin centers in the last 15 years. They feel that quick fixes simply don’t work in the long run and one may even worsen the problem. One must address all the factors of health. There is nothing magical. This is truly a proven formula for lifelong success and health.

A couple of years ago, my RN-NP introduced me to The Zone Diet by Barry Sears, PhD. Since then he has written additional volumes, including Mastering the Zone, which I received in the current package of audio tapes (Harper Audio, $25). Dr. Sears gives a very comprehensive nutritional program which is easily put into action. After a discussion of the ill effects of hyperinsulinism, he presents a system of balanced eating so one always remains “in the zone.” If you’re “in the zone” of normal insulin levels one should not have postprandial lethargy. The current presentation seems more complete than what I have encountered in the past. He also states that only in America can one go to a gym and find valet parking. He advises that one should park at the most remote regions of a parking lot and walk. He even suggests that we park our cars about 15 minutes from work to provide at least 15 minutes of exercise every morning and every evening. He sees no need to buy exercise equipment or join a gym or pay to exercise. As physicians we have people run in place for a two minute exercise pulse in an eight foot exam room. Americans have a hard time thinking that anything happens unless they spend money. Much of the world feels we have too much of that. I found his system very easy to follow and quite effective.

Eating Well for Optimum Health by Andrew Weil, MD, (Knopf, $25) is a very comprehensive guide to food, diet, and nutrition. As a clinical professor of medicine at the University of Arizona, and director of the Program in Integrative Medicine, he speaks with authority and writes in textbook fashion. However, it is very readable. He presents the basic facts about human nutrition which allows us to make informed decisions about weight reduction. He gives us the pros and cons about a number of diets. He’s seen fad diets come and go and then, sometimes, come again and go again. He gives pointers on how to read labels on food products. He provides menu plans, recipes, and guidance for eating at home or in restaurants. In accord with his previous volumes, he gives dietary advice for a host of common ailments.

Review by Del Meyer, MD

Schwartz says that he personally never had a weight problem, until he decided to experiment with his own weight and diets to understand his clientele. Thereafter, the weight problem developed.

He tried one of the popular diets of the day. Losing weight was easy initially. With his first diet, he felt as though his body told him it didn’t like what was happening. But after one week, he had lost eleven pounds. When he went off the diet, he regained the weight he had lost. So he had an excuse to try another of the 26,000 diets floating around.

Diets Don’t Work

But with every successive diet, it took longer to get the weight off. After every diet, the weight came back quicker and quicker. Thus, he surmised that people couldn’t wait to get off of their diets and resume normal eating. Consequently, they regained their weight. Schwartz tells how between the ages of thirty and forty, he personally lost over 2,000 pounds using successive diets. But he also regained 2,001 pounds. Keeping it off wasn’t easy. So he concluded that Diets Don’t Work.

Review by Del Meyer, MD

The Really Bad News

One day as he was looking through the monthly weight and measurement files in his health clubs, he ran across an old record of one of his members who had been dieting and exercising for 20 years. Comparing her present day records with those of 20 years earlier, he discovered that her present day weight and measurements were bigger than when she had first started dieting and exercising. An idea began to form in his head.

Some people go to a health club to gain weight. What would happen if he were to put underweight people on the same diet that overweight people were on to lose weight? Would they also gain weight?

The program was a hit. He found many volunteers and they all gained weight.

Back Pain

Back pain is a common complaint. Most people in the United States will experience low back pain at least once during their lives. Back pain is one of the most common reasons people go to the doctor or miss work.

On the bright side, you can take measures to prevent or lessen most back pain episodes. If prevention fails, simple home treatment and proper body mechanics will often heal your back within a few weeks and keep it functional for the long haul. Surgery is rarely needed to treat back pain.

Symptoms

Symptoms of back pain may include:

· Muscle ache

· Shooting or stabbing pain

· Pain that radiates down your leg

· Limited flexibility or range of motion of your back

· Inability to stand straight

Back pain that lasts from a few days to a few weeks is considered acute.
Pain that lasts for three months or longer is considered chronic.

When to see a doctor

Most back pain gradually improves with home treatment and self-care.
Although the pain may take several weeks to disappear completely, you should notice some improvement within the first 72 hours of self-care. If not, see your doctor.

In rare cases, back pain can signal a serious medical problem. Contact a doctor if your back pain:

· Is constant or intense, especially at night or when you lie down

· Spreads down one or both legs, especially if the pain extends below your knee

· Causes weakness, numbness or tingling in one or both legs

· Causes new bowel or bladder problems

· Is associated with pain or throbbing (pulsation) in your abdomen, or fever

· Follows a fall, blow to your back or other injury

· Is accompanied by unexplained weight loss

Also, see your doctor if you start having back pain for the first time after age 50, or if you have a history of cancer, osteoporosis, steroid use, or drug or alcohol abuse

Causes

Your back is an intricate structure composed of bones, muscles, ligaments, tendons and disks.
Disks are the cartilage-like pads that act as cushions between the segments of your spine.
Back pain can arise from problems with any of these component parts.
In some people, no specific cause for their back pain can be found.

Strains

Back pain most often occurs:

· From strained muscles and ligaments

· From improper or heavy lifting

· After a sudden awkward movement

Sometimes a muscle spasm can cause or be associated with back pain.

Structural problems

In some cases, back pain may be caused by structural problems, such as:

· Bulging or ruptured disks. Disks act as cushions between the vertebrae in your spine. Sometimes, the soft material inside a disk may bulge out of place or rupture and press on a nerve.
But even so, many people who have bulging or herniated disks experience no pain from the condition.

· Sciatica. If a bulging or herniated disk presses on the main nerve that travels down your leg, it can cause sciatica — sharp, shooting pain through the buttock and back of the leg. The sciatic nerve is the longest nerve in your body. It runs from your spinal cord to your buttock and hip area and down the back of each leg. Sciatica is a symptom, not a disorder. The radiating pain of sciatica signals another problem involving the nerve, such as a herniated disk. Depending on the cause, the pain of acute sciatica — which may be quite uncomfortable — usually goes away on its own within a couple of months.

· Arthritis. The joints most commonly affected by osteoarthritis are the hips, hands, knees and lower back. In some cases arthritis in the spine can lead to a narrowing of the space around the spinal cord, a condition called spinal stenosis.

· Skeletal irregularities. Back pain can occur if your spine curves in an abnormal way.
If the natural curves in your spine become exaggerated, your upper back may look abnormally rounded or your lower back may arch excessively.
Scoliosis, a condition in which your spine curves to the side, also may lead to back pain.

· Osteoporosis. Compression fractures of your spine’s vertebrae can occur if your bones become porous and brittle.

· Rare but serious conditions. In rare cases, back pain may be related to:

· Cauda equina syndrome. This is a serious neurological problem affecting a bundle of nerve roots that serve your lower back and legs. It can cause weakness in the legs, numbness in the “saddle” or groin area, and loss of bowel or bladder control.

· Cancer in the spine. A tumor on the spine can press on a nerve, causing back pain.

· Infection of the spine. If a fever and a tender, warm area accompany back pain, the cause could be an infection.

Risk factors

Factors that increase your risk of developing low back pain include:

· Smoking – general effects of early aging of muscles & joints

· Obesity – mechanical stress on all joints

· Older age

· Being female – Pregnancies, high heels,

· Physically strenuous work

· Sedentary work – which may cause stiffness and pain through lack of motion

· Stressful job

· Anxiety

· Depression