I am sorry... I misspoke...

OK... I thought I was going to be able to write in feelings about National Health care on my facebook account. Wrong! Facebook only allows limited text...
Anyway... I wanted to share with you feedback on England's National Health care from one of my patients.
I saw an established patient of mine (she is 91 years old) in my clinic yesterday and the topic of health care (which is heavily debated right now) came up in our conversation. This woman is 'literally' scared of what is happening to our country.
She also told me that she has a neighbor who's husband was transferred to England last year. Shortly after their arrival, the woman developed an eye condition and wanted to see an Opthalmologist. The doctor's office told her that she had to be enrolled in England's National Health Care to be seen even though the lady was willing to pay cash. It took "6" weeks for her to get enrolled and another "6" weeks for her to be seen. (BTW the 'government' told her which doctor she had to go to which was not the original one she contacted.)
The after the lady was seen, she was told she needed to have surgery which took another "12" weeks. So from the day she initiated contact with a physician, it took "24" weeks, almost half a year to get treated.
After the surgery, she developed double vision and yes, it only took "2" weeks for her to get a follow-up. Frustrated, she came back to America, having to abandon her family and was able to see an Opthomologist within 72 HOURS after making an appointment. The patient had to undergo additional surgery to correct what was done by the surgeon in England, but she was able to go to surgery within 5 days.
This woman also relayed to my patient of a 70 year old man, a national of England, who was diagnosed with 'severe' degenerative joint disease of his knee. You know what he was told. "Let's take a couple of years and see if it gets better." What...???
So 'you' want a public health care plan???

"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM

Getting back to basics...

I have started a Facebook account where I will be posting my political views. This blog started as a means to post medical information. I am going to return to the roots. If you are interested in my thoughts about health care... go to Facebook. My account name is barclaydpm@hotmail.com

G.M. Barclay, DPM

Animal House comes true...

I can't believe what I just saw on the news yesterday. The DNC has posted that if you are aware of anyone who is against health care reform... you can report this activity to the 'Obama Administration' at (flag@whitehouse.gov). "ARE YOU KIDDING ME!" What happen to our 1st ammendment rights??? You know a little something called the freedom of speech?!?!?
I remember in high school reading George Orwell's 1984. You know, that 'fictional' book that made fun of socialism using a bunch of farm animals with pigs controlling the farm. I loved that book. Fun read. Little did I know how accurate that book would become in 2009.
When are we going to wake up America and realize that this administration is set out in creating a socialistic society where the citizens are dependent upon 'big brother' for our food, clothing, housing, etc. This is scarying me... more about health care reform tomorrow.

G.M. Barclay, DPM

Who are Obama's friends?

Yes... I am a Christian. Not a fanatic, but a Christian none-the-less.
My favorite bible passage is from Proverbs. "A mirror reflects a man's face, but what he is 'really' like is shown by the kind of friends he chooses." Proverbs 27:19 TLB
Wasn't it really evident of who Obama really was prior to the election based on the friend's he chose? How in the heck did America close their eyes and vote this guy in office. We can't go back to the past but let's look at the present.
44 appointed Czars!!!!! The term invokes a vision of the Czar's of Russia. And we know what they were like.
I decided to look up the term Czar online. Czar: "An appointed official having special powers to regulate or supervise an activity." This was the 3rd definition. The 1st definition related to the Czar's of Russia. What scared the hell out of me was the 2nd definition, THE 2nd DEFINITION.
Czar: "a person having 'great' power; an autocrat." What? So I looked up autocrat.
Autocrat: "a person with 'unlimited' power or authority." Holy crap Batman.
So let's see about these Obama appointed Czar's who have unlimited power that answers to no one.
Brian Deese - Treasure Auto Advisor: has NO experience in the automobile industry. This idiot, who came up with the 'cash for clunkers' (which is destruction of assets and redistribution of wealth) which will cost us, the taxpayers 3 billion dollars, has written books wanting to 'remove' and distinction between gender and wants to redefine relationship between parents and children essentially, separating a relationship or 'The rights of a child act.' He also wants 'equality of opportunity which in effect increases affirmative action and promotes redistribution of wealth.
Van Jones - Greens Project Czar: FIRST a felon who is an admitted communist. Founder of the Apollo project started by TIDES foundation who wrote the stimulus package and cap and trade. He is into social justice which is a code word for taking money from someone else and giving it to another.
Phil Angeledes: President of Apollo Alliance. Former treasurer of California 1999-2007 (we know how they can manage a budget) owns a company that refits buildings that our Greens project Czar will promote and orchestrated Cap and Trade.
Obama and his 'friends' are hijacking America.
I will write more...

G.M. Barclay, DPM

You gotta love this...

During the Clinton administration... Fannie Mae and Freddie Mac... were 'instructed' to make loans available for people who normally did not qualify for a home loan. So private lenders followed suit and came up with... adjustable rate mortgages... lower down payments or no down payments... qualifying people for homes based on 40 - 50% of gross income. What happened? A housing debacle with foreclosures at all time highs. So, I our government's infinite wisdom... they bailed these failing banks out with 'our tax payer dollars. So the banks began tightening lending guidelines and guess what has happened? That's right... the government is creating a 'watch' list for those lenders who fall below a standard, established by our government, to start lending again to who... people who defaulted on the home mortgages to begin with. Why do we keep rewarding people who fail? Failure doesn't mean the person is a failure... only made failed decisions. But we insist on 'bailing them out' which in essence is saying, "that's OK... go ahead a make failed decisions again." You gotta love it.

G.M. Barclay

I have joined Twitter...

Yep! Finally did it. I joined Twitter tonight. I joined because I am a concerned citizen worried about the state of our country. I have been so distraught since the election of Barrack Obama and his policies his first 6 months of office, I have lacked the desire to write about general health information. Instead, I am writing about the general health of our society. If I can inform one person about what is really going on with this administration, what they are attempting to do to our society and specifically how it is impacting health care, then I feel I have done my job to make health care better. Oh yeah, I will still try to occasionally slip in some general health information as well, but for now, however long it takes... I want to take back America from bureaucrats who want to destroy our constitution and create a one country and eventually one world order.

G.M. Barclay, DPM A concerned citizen.

"Boomeritis"... the new catch phrase for Baby-boomers.

"Boomeritis." The new catch phrase coined recently to describe those people between the ages of 45 and 64 regarding exercise related injuries. There were a reported 166,000 emergency room visits in 2008 in this age group complaining of exercise related injuries. These injuries are caused from overuse of tendons, muscles and bones resulting in tears, chronic inflammation and stress fractures.
The main problem? Boomers don't give themselves enough 'rest' time between repetitive activities. Performing the same activity or exercising the same mucleskeletal groups everyday leads to these overuse injuries. Here are some things to consider to reduce your risk of "Boomeritis":
1: Always get a check-up from your primary care physician: If you haven't exercised in awhile (over 2 years) your health is probably not the same. Make sure your physician knows the type of activities you are planing to participate in and listen to his suggestions. (Note: I see runners in my office frequently with foot and ankle complaint regarding training for a Marathon. The minimum time frame to adequately prepare is at least six months and most recommend a year.)
2: Mix it up: Don't do the same thing everyday. You work on cardio 3 - 4 times per week and throw in some strength or resistence training 2 - 3 times per week. But, don't do the same exercise everyday.
3: Work on flexibility: Remember when you played sports in High School or College? What was the first thing you did? You stretched... Most people are recommending that the first activity a Boomer should participate in is Yoga. Trust me... I have been to a Yoga class and it was worse than lifting weights. Gotta work on the f-l-e-x-i-b-i-l-i-t-y.
4: Watch what you eat: The normal diet should consist of 20 - 30 protein, 25 - 30 fat, and 40 -50 percent carbohydrates. Of course you should eat lean proteins, mono or poly unsaturated fats and stay away from simple carbohydrates.
5: Take lessions: Even if you played a sport competitively, but haven't participated in awhile and especially if your are trying a sport you have never played before... get some lessions. Remember the old saying, "Practice makes perfect!" Well is should be, "Perfect practice makes perfect... and can prevent injuries."
6: Stay balanced: This goes back to principle 1. Mix your workouts with cardio, strength, and flexibility.
7: Rest: This can not be stressed enough. If you participate in a very rigorous workout, take a couple of days off. If you work muscles one day, do some flexibility the next or cardio. By all means, take 1 or 2 days off PERIOD.

"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM

Some memory theives.

Do you feel like you are having a harder time remembering things as you get older? Well, it is quite frequent. There are some things that makes it harder for us to remember. Fortunately, there is something we can do about it. Here are nine signs to recognize.
1: Your blood sugar is to high. Memory lapse me be in your blood - specifically your blood sugar. MRI's suggest that high blood sugar might damage parts of the brain that deal with memory. Solution: if there is a history of high blood sugar in the family, have your blood sugar tested. Eat well and stay active with brisk walks that are proven effective in controlling and even preventing diabetes.
2: Pushing to hard. Our brain need sleep. You needn't pull all-nighters trying to get something done. Subjects who got a 6 hours of sleep didn't feel sleep-deprived but performed poorly on tests of short-term memory. Solution: Make adequate rest a priority. Try Micro-naps of six minutes to boost memory.
3: Snoring. You may have sleep apnea where your airway gets blocked during sleep shutting off oxygen to the brain. Men or more likely than women (24% to 9%) to develop apnea. Risks factors are being overweight or over 40. Solution: Get tested for sleep apnea if you constantly feel tired or are a loud snorer. You may need a C-PAP device.
4: You feel manic or sluggish. If you feel out of control or extremely sluggish, it may be your thyroid. Under performing thyroid causes fatigue while a hype-up thyroid will make your heart race and you may feel manic or anxious. Solution: have your hormones checked for hormone therapy.
5: Over 65. You may have a B12 deficiency. It can look a lot like Alzheimer's. Up to 20% of the people over 65 are low in B12. Solution: Get your B12 level checked if you are feeling fuzzy. Also consider getting tested if you are over 65 and a strict vegetarian.
6: Depression. People with depression lose brain cells. Solution: See your doctor. The longer you are depressed, the less likely you are to recover.
7: Allergy or sleeping pills. Many drugs prescribed for insomnia, incontinence, allergies, and gastrointestinal cramps can interfere with crucial brain chemicals. Solution: older patients are susceptible to diphenhydramine and anticholinergic drugs. If you begin these and feel fuzzy, contact your prescribing doctor.
8: You shuffle when you walk. It's called a magnetic gait. Your feet seem to stick to the ground. This could be a sign of normal pressure hydrocephalus which is to much brain fluid. Solution: Again call your doctor for prompt treatment.
9: Taking a lot of medications. If you are on five or more medications, you are at high risk for problematic interactions. You must also consider any over the counter medications as well. Solution: Make sure you medical doctor is aware of all the medications you are taking. Take a list of your medications to appointments with specialists.

"The journey of life is taken on step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS

Your feet may indicate other health issues.

Your feet me be an early indicator of other health issues.
* Numbness in your feet and toes may be an early indication of diabetes or lower back osteoarthritis.
* Stiff joints, e.g. toes and ankles may be an early indication of osteoarthritis.
* Unexplained swelling may be an early indication of kidney disease, heart disease, hypertension or circulatory disease.
* Discolored or clubbing nails may be an indication of respiratory disease.
Visit your local Podiatrist if you notice any changes in your feet.

"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS

I'm scared. Very scared.

*Deep breath*

I'm scared. Very scared the direction our country is taking. My goal with this blog was to provide my patients, my beloved state of Texas, even the world with accurate and current information regarding everyones health specifically of the foot and ankle.
After seeing the National news the last two evenings, I realize that we, as Americans are allowing our government to not just socialize, but to allow our country to become communistic in principle and practice.
First, I can not believe that our government is now going to control 50% of General Motors with the Unions controlling the other 40%. What happened to free enterprise? I blame everyone associated with this company from the top executives to the line workers. They did it to themselves. Let them go bankrupt. Will it cost people their jobs? Of course. But we at least don't have a federal government, which knows nothing about free enterprise, which creates no income, dictating how to build a car. The government only gets their money from those of use who think freely, work hard, put our heart and souls on the line to better ourselves, our families, our community and our country.
Secondly, I just saw this evening that Arlin Spector, the turncoat conservative has switched to the Democratic Party. How scary is this. He could not win re-election in his own state so instead of standing on his political convictions, he allowed his self-interests dictate that 'his' party was no longer representing him. What does this mean? It means that with two independent seats that generally vote with liberals, the Democrats now control 59 Senate seats. If Dan Frankin wins his seat, the Democrats will control 60 seats preventing a filabuster by the conservatives or Republicans. This means that the Democrats... Obama, Congress, the Senate can push through any legislation they choose, and we can't stop them.
I pray, yes... I pray, to God every night that America will come to their senses. That there is not to much damage to our free enterprise system. That there is not to much damage to our personal freedom. That America can remain strong and return to our principles as outlined by our founding fathers and return control to the individual, to our states, as it was intended and hopefully can vote these (explicative) out of office.
Until then... I am very, very scared.

"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS

If you are going to wear heels...

WOW. It has already been a month since I posted last! Well, here is a little information for you women who 'just have to wear heels'.
It is well known that I believe from a physics and biomechanical standpoint, the research data concludes that the musculoskeletal system is placed under abnormal stress when someone wears a heel that is 1-and-a-half inches higher than the ball of the foot. However, I do tell my patients that occasional high heel use is OK when done in moderation.
I just saw a report from a physician in New York who has designed strength training classes to increase the strength and tone in the gluts (butt muscles), thighs, calves and feet. However, she does stress the following which I agree with:
1: Never wear the same shoes 2 days in a row.
2: Never wear heels over 4 inches.
3: Alternate heel height on a daily basis.
4: Do daily stretches to increase tone to the areas previously mentioned.
By doing this, you can reduce the risk of muscle and joint injury. I should note however, that continued use of heels over 1-and-a-half inches over a few years can create structural abnormalities that can only be changed by surgery.

"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS

Are your feet ready for vacation?

The weather is getting warmer... and you're thinking about your vacation. While you are planning, you need to plan on how your feet will do during this much deserved and most of the time, expensive venture. Here are some tips on getting your feet ready for your vacation:
*Get your feet in walking shape. If you have a sedentary job or life style, you need to exercise your feet. Start walking about 3 to 4 weeks before your trip. It is especially important to wear the shoes during this exercise period that you will be wearing on your trip. NOTE: as I have mentioned in the past... flip flops, sandals, and high heels are 'specialty' shoes and still should be worn for limited amounts of time.
*Take care of any pre-existing conditions. If you have any soft tissue problems like cysts, neuromas, warts, painful callouses... you need to get these examined at least 4 weeks before your trip. If you have painful bunions, hammertoes or any other painful joint or boney problem... these need to be evaluated a minimum of 8 weeks and preferably 12 weeks before you go on vacation.

"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS

Magic Mushrooms

I am not talking about the kind back from the '60's. I'm talking about the kind you buy in the grocery store.
You don't have to have a lot of knowledge about cooking to know the benefit's of mushrooms in addition to their lush, earthy flavor. But whether you go for the exotic like smoky morels to the familiar like buttons, you'll get some newly discovered health benefits.
* They safeguard against cancer. Mushrooms are rich in disease-fighting phytochemicals, and eating them regularly has been linked to a lower risk of breast cancer in studies of Chinese and Korean women. Mushrooms also prevent prostate cancer cells from multiplying in mice - and might do the same in men.
*They supply hard-to-get nutrients. One medium portobello mushroom supplies 21 percent of the recommended daily intake of selenium and one third your need of copper; it also has as much potassium as a medium-sized banana. Other varieties are just as rich in minerals, recent analysis has found. What's more, mushrooms retain their nutrients when stir-fried, grilled, or microwaved.
* They help you cut calories. When ground beef was swapped out for mushrooms in lasagna, sloppy joes, and chili, adults consumed 400 fewer calories per day, according to a Johns Hopkins Bloomberg School of Public Health study. Researchers estimate that if you sub mushrooms for ground meat in one meal every week, you can lose five pounds in a year. Just don't sabotage this fringe benefit by preparing mushrooms with loads of butter. Instead, toss them into a nonstick pan that's been lightly sprayed with oil, then saute' on low heat until they soften.

"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS

Laser treatment for fungal nails...

I have been asked by three of my patients over the last month what I thought about a new laser treatment for fungal nails. I had not heard of it... so I decided to do some research. Here is what I have come up with:
From MedicalNewsToday.com (March 8, 2009): A company called Nomir Medical Technologies (nomirmedical.com) has developed a "near-infrared" device for the treatment of onychomycotic nails. Nomir Medical Technologies is an optical energy technologies company developing products for medical application. The system called Noveon is a light based system that photobiologically targets bacterial and fungal infections. A study conducted by one of the co-founders of Nomir Medical, Dr. Eric Bornstein, D.M.D. has conducted a trial of 32 patients with confirmed onychomycosis of nails by culture. This was a prospective, randomized, controlled study at multiple U.S. sites. 120 day evidence indicates that 76.3 percent of those in the trial showed clinical improvement with 74 percent showing a significant drop in positive cultures. The patients received 4 treatments over a 4 month period. The company is trying to get FDA approval for use in Podiatry for the treatment of onychomycotic nails.
OK... here is my opinion:
#1: I am leery about any study conducted by someone who has a financial interest in the company. I have concerns about how controlled this study actually is and how the data may be skewed.
#2: The results state, "76.3 percent clinical improvement with 74 percent significant drop in positive cultures." Notice it does not say... CURED.
#3: There is no indication that this treatment will be reimbursed by insurance companies. Most insurance companies are not paying for oral or topical medications currently due to the low success rate of treating onychomycotic nails.
#4: What will be the cost to the patient? New technology, not very many people using it... I anticipate quite a hefty per cost treatment for this technology.
I will maintain an open mind about any new scientific breakthrough in medicine. But until I see randomized, double-blinded studies conducted by others than the people who develop the technology... I will take a wait-and-see viewpoint and not endorse it.
Until then, I feel I get 75 - 85% improvement in my patients using current topical or oral antifungal products and will continue recommending and using them.

"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS

Make walking a healthy habit.

Everyone knows walking can help with your health, controlling weight, and even effect your mood, but sometimes taking that 'first' step can be a problem. Try walking to your computer. Starting April 8, you will be able to create a personalized walking program on the American Heart Association's Start! site (heart.org/start).
You take a ten-question quiz; the site selects one of seven walking plans matched to your fitness level, goals, and lifestyle. You can even plug in your zip code to find a walking buddy and beginner-friendly local route maps.

"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS

Log on to cheer up

When economic security leaves you feeling anxious, depressed, or sleepless, you may feel unable to spend money on therapy. New research however points to an inexpensive and effective way of relief - do it online.
Programs based on cognitive behavioral therapy (CBT) can rapidly deliver some impressive results. One Web-based program for depression and anxiety gave as much relief as typically gained with face-to-face therapy (people with serious depression may need face-to-face help). Studies also suggest that CBT works as well as pills for most sleep problems, with no side effects. Here are some research backed programs that may help:
* MoodGYM: blends CBT and problem-solving therapy for depression but may work for other conditions as well. Free at moodgym.anu.edu.au.
* MySelfHelp: has Web-based CBT programs for insomnia, depression, eating disorders, and more. Fee of $20 per month at myselfhelp.com.
* The Good Days Ahead DVD-ROM: written by a team of doctors, addresses depression and anxiety. $99 at mindstreet.com.
* Blues BeGone: uses cartoon talking heads to deliver CBT for depression. $185 at bluesbegone.com.

"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS

How much more do we have to take?

I know... with the recession and people losing their jobs everyday... you are going to say I don't have a right to complain. But as an American... I do have right to complain.
CMS (Medicare) is proposing a whopping 21% pay cut in physician reimbursement for this year. TWENTY-ONE PERCENT. Physician reimbursement is already lower than reimbursement levels in 1991. Even by cutting reimbursements to physicians, health care spending by the government is expected to double between 2009 and 2018.
The problem is not what physician's are reimbursed, it is people wanting Medicare or Private Insurance to pay for everything. I will repeat... insurance was never, ever designed to pay for everything. It was designed to keep people from facing economic financial devastation.
I am having to spend $20,000 on my wife's teeth. Do you think this is a financial burden on me? You better believe it is. It is putting a major dent in my lifestyle. But I have choices. To be responsible for my health care which is part of my everyday living, or have our government, which can't run anything efficiently, to provide it for us.
If reimbursements keep diminishing as they are, you are going to be left with inadequate physicians treating major diseases and trauma as those with intelligence and abilities will find other endeavors to pursue.
It should be noted that with the physician cutbacks that health care costs would increase 4.6% in 2009 - 2010. But if Congress averts this paycut proposal, health care costs would only increase 0.8% to 5.4%. Isn't your physician worth 0.8%. I certainly hope so.

"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS

New way to keep bones strong.

Generally, you can see bone density changes on x-ray even if it is not a conclusive study for osteopenia or osteoporosis. When I see evidence of bone density changes, I refer my patients back to their PCP (Primary Care Physician) for consideration of a bone density study.
Bone loss is a natural process that comes with aging. All of us lose bone at varying rates. Daily doses of calcium and Vitamin D are good in keeping bones strong. But new research suggests that another dietary move may be as important as the aforementioned.
You see, it is a matter of chemistry. When you digest carbohydrates, the process causes your digestive track to become acidic. Here lies the problem because high-level acid environment leaches calcium from bone. In contrast, fruits and vegetables create a skeletal friendly alkaline environment. The American diet tends to be acid-producing which is hard on older people whose kidneys can't clear acid compounds quickly. So by tweaking your diet, you may be able to prevent bone loss. Here are some suggestions:
1: Include two vegetable or fruit servings at every meal and eat no more than two daily servings or carbs like bread, cereal, and pasta. Also, here are some substitutions that will help as well.
Eat the first item instead of the second item:

Potatoes instead of pasta.
Fruit juice instead of soda.
Tofu instead of meat and poultry.
Wine instead of beer.
Raisins instead of Peanuts.

Happy eating everyone.

"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS

Glucosamine and Chondroitin update for Osteoarthritis

I see a lot of patients with Osteoarthritis (OA) of multiple joints in the foot and ankle. I have read data over the last 7 years of seeing patients to support both as dietary supplementation to help with the pain and stiffness associated with OA. Many of my patients reported some level of reduction of stiffness and/or pain in taking both.
A few years ago, a large arthritis study group known GAIT had delivered some disappointing news: Glucosamine and chondroitin sulfate didn't ease the pain in people with mild arthritis, though the combo did seem to help people with severe discomfort. New GAIT results further erode the hopes for the supplements, which don't appear to slow cartilage damage. Knees showed similar wear over two years, whether the patients took a placebo, a prescription painkiller, or supplements.
Still, these researchers are reserving final judgment, partly because volunteers' knees stayed healthier than expected. Looking at small differences (not big enough to be statistically reliable), the researchers say that patients on glucosamine alone fared the best. It seems that a combination of glucosamine and chondroitin, where study patients did worse, may interfer with the other's absorption.

"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS

Springing forward may be bad for your heart.

According to 20 years of research by scientist in Sweden, turning the clock forward seems to be bad for your heart. Their research found that heart attacks rose by 6 to 10 percent for the three days after the clocks were set forward; declining by 5 percent for the three days after the clocks were set back. A lack of sleep may be to blame for the danger. This coincides with other studies that show a lack of sleep or chronic sleep deprivation is hard on the heart. It is recommended that you hit the sack early the first few days after setting to clocks forward. The researchers noted that if you are over 65 you are less apt to be harmed by the time change - perhaps because retired people are less tied to the clock.

"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS

Do's and Dont's in your Physician and Patient Relationship

As mentioned a couple of posts ago, I didn't realize that medicine was going to present itself with so many challenges. From decreased reimbursements, uncooperative patients, to people thinking that doctor's are loaded with money, a good relationship between a physician and patient can go along way for both parties being satisfied with the association. Here are a few suggestions with no particular order of importance except #1:
1: Expect office charges and have payments ready during your doctor visit: Nothing is more frustrating than to provide medical treatment to someone only to walk up at the end of the visit and hear them say, "I don't have the money, or, I can't pay you today." The physician is running a business and has people relying on him from staff to his own family. How would you feel if you completed your work and you heard from your employer, "I'm sorry. I don't have the money, or, I can't afford to pay you today." You don't put gas in your car without paying. You don't walk out with free groceries. You can't stay in your home or apartment if you don't pay. Why would you think a visit to the doctor is any different.
2: Missing appointments: Perhaps this is the second most frustrating part of practice. You schedule a time for a patient only for them not to show up and worse yet, not have the courtesy to call and cancel the appointment. This time allocated for you could have been used to see another person who had a medical need. In addition, physician's get paid when they see people. When you don't keep your appointment, you are taking money out of the doctor's pocket.
3: Pay your co-pays: your contractual agreement requires you to pay a co-pay at your doctor visits. If you insurance company has a contract with a physician paying them $100 for the service and you have a $20 co-pay, the insurance company is only going to reimburse the physician $80. Again, the doctor is entitled to the full reimbursement with your responsibility of paying the co-pay.
4: When scheduling an appointment with a doctor, have your current insurance information to give to the person scheduling the appointment: Offices have to verify insurance coverages especially at specialist's offices. You may not have the coverage needed and have an out-of-pocket expense. You don't want to be surprised when you show up for the appointment.
5: Inform your physician when your insurance changes: If you have been with a physician for awhile, there is a likelihood that your will change insurance, especially if employer provided. When you call to schedule an appointment, provided the scheduler with your new insurance information.
6: Show up early to your appointment: My daddy always said, "Son, never be on time for an appointment, but never be late." I have always held this close to heart. Especially if you are a new patient, show up at least fifteen minutes early as every office has paper work to be filled out. If you are an established patient, also show up early. If the doctor has a cancellation, he can get you in early and will help with his day as well.
7: Provide a written list of illnesses, surgeries, and current medications: This just takes a couple of minutes to start and only a few seconds to update. This is invaluable to you the patient and the doctor. I always have patients who tell me at subsequent visits, "Oh! I forgot about that medication, that surgery, etc." If your like me, you need a list to help you remember.
8: Don't be the doctor: Being informed is one thing. Telling a doctor on how you want to be treated is another. The Internet is a wonderful tool, but it can be filled with misinformation and some terms can be difficult to understand. Allow your medically trained physician to treat you. It is important to ask questions so you can understand what is going on and why the doctor is making the choices they are. But please, don't direct your medical care.
9: Have realistic expectations: I treat abnormalities of the foot and ankle either medically, biomechanically, and even surgically. But, I am not God. I can not take a foot or ankle that is not functioning properly and get it back perfectly. Even with 'elective' surgeries, the outcomes are not going to be perfect. They will be much or significantly improved. It is important that you have realistic expectations of any medical or surgical outcome.
10: Things happen: All doctors and surgeons are required by law to have continued medical education to practice their craft. We go through residencies to learn from some of the best. But it is important to understand, that with all this training and education, things can just go wrong. Any physician is going to feel sorry for any medical or surgical outcome that is not what is expected. But going back to realistic expectations, you have to understand and be accepting of the fact that things can just plain go wrong.
I hope this helps with your physician relationships in the future.

"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS

Facts and Fiction regarding Fibromyalgia Syndrome

I have patients who come into my office complaining of generalized foot pain. It is frustrating to me as the practitioner and the patient when the patient can only say, "my feet hurt!", with no definitive reason. During the history phase of the visit, I find out that the patient has been diagnosed with fibromyalgia. There are still some social stigmas regarding this syndrome and here are a few facts regarding this debilitating disease.
1: FMS is caused only by stressors, such as infections or injuries. False: There may be multiple causes, though recently it was proven that FMS is primarily a disorder of pain signaling in the central nervous system. This is probably a genetic component. This precise nature of the cause is still unclear.
2: The presence of tender points provides a definitive diagnosis of FMS. False: The American College of Rheumatology (ACR) classification criteria involve indentification of 11 tender points, but pain and tenderness are often more widespread without the presence of true tender points. There is no simple approach to diagnosis, and that can be a barrier to effective treatment.
3: The prognosis for patients with FMS is hopeless. False: There is no cure, but early appropriate treatment can prevent deconditioning and dysfunction. A variety of pharmaceutical and nonpharmaceutical therapies are available, and a multidisciplinary approach that combines therapies is recommended. Drug use focuses mainly on pain reduction, and physical therapy is geared to disease consequences, such as pain, fatigue, and sleep disturbances. Several alternative therapies have been shown to be effective.
4: FMS is a "phantom" illness that's "all in the patients head." False: Many in the medical profession have held the view that FMS does not exist or is a manifestation of depression or anxiety disorders. FMS often is associated with depression - depression can cause FMS, and the symptoms of FMS may lead to depression - but FMS is a real illness in its own right. Again, better understanding can lead to earlier and more effective management.
5: Because FMS is such a complex disorder, treatment provided by a rheumatologist or other specialist is required. False: No specialized care is necessary, and the condition usually is managed by generalist physicians. Some rheumatologic practices are no longer accepting FMS patients - they find FMS patients difficult and they also know they might not provide any better treatment than the generalists.
FMS is a complicated disease that is still misunderstood and very little understood regarding the cause. With knowledge on your part and finding an understanding generalist, your disease can become manageable.

"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS

How you can help physicians.

Yes, I will soon be 55. But, I have only been practicing privately for 5 years. The practice of medicine certainly is not what I expected to be. Dealing with unrealistic patients, fighting insurance companies for every penny you make, people not wanting to pay their bills, and yes, the fear of a patient wanting to sue you.
Physician reimbursements have been declining steadily since '91. Since I started private practice in '04, I have seen my physician reimbursement decline by 4.6%. You are probably thinking, "that isn't much?" But given the fact that the average cost of living goes up by 3.5% a year, I have effectively lost 22.1% in income.
I hear my patients say, "But Dr Barclay, my insurance premiums go up every year!" I know, I pay premiums myself. Do you realize that the CEO of United Health Care made a $440 MILLION dollar bonus last year!!! That money could make a bit of a dent in some of our health care costs.
Because of the potential for law suits, physicians are ordering more and more tests to protect themselves. Yes, some tests are necessary, but some or done because of this fact.
With HMO's, people seek medical treatment for conditions that really don't require a person to see a doctor. I remember as a child growing up (before the HMO era) my parents told me, "Son, we will always take you to the doctor if you are sick. But you better be sick because if you aren't, you WILL need to see the doctor." My parent's actually weren't that mean, they were just saying we didn't have the money to throw away on unnecessary expenses.
I am thankful when people come to see me in my office. But I would say about 1 - 3% of the people who visit me REALLY shouldn't have seen a physician of any kind.
During this period of economic downturn in the U.S., I ask that all of us evaluate what we utilize on any level of our daily expenses and needs. Using common sense will go along way to solving our current economic crisis including our health care system.
Tomorrow, I will discuss some do's and don'ts in your relationship with your physicians.

"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS

A change of direction with my blog.

The economy is hurting. I am sure it has affected you. I know it has affected me.
My intentions when starting this blog was to share health care information specifically regarding the foot and ankle. I will continue to do this. But I feel that it is important that information be shared regarding health care as it impacts us as end users (patients/insureds (remember I am an end user as well)) and providers (hospitals and physicians).
Our health care system is still very good, but in many respects, is no longer the best in the world. Our health care system is broken. Badly broken. But, it can be fixed. It will require an effort on all of our parts. But remember it starts with you (I am also pointing a finger at myself).
Insurance was never designed to be "all inclusive." Insurance started back in the middle ages originally insuring ships as they went to sea. But it is important to remember, the insured shared a good bit of the risk. Insurance then started covering homes, lives, cars, boats and yes... our health. But we have gone from a "fee for service" environment to a complicated Health Maintenance Organization (HMO) environment where people feel that everything should be paid for.
Another term that bothers me is entitlement. "I am entitled to health care." The dictionary defines entitle as "to furnish with a right or claim to something." I agree... we are entitled to access health care, but not to have health care provided for us. If that is the case, then I should be entitled to... a free home, free meals, free car and gasoline, free clothes, free... you get the point. Somewhere during my soon to be 55 years of existence, America has become a nation of "I am entitled to..." We no longer want to assume responsibility for most anything.
I know that this is not everyone, but it is a lot of people. I am in hopes that with this blog/forum I can continue to inform you about various health issues regarding our bodies as well as issues regarding our American health care system.

Numbers to watch for Heart Disease

I can't believe I haven't written anything since last October. No excuses except laziness.
I see a lot of people in my office that have some form of heart disease. Even heart disease can have devistating effects on the feet and ankles. If you have a family history of heart disease, overweight, smoke, or have diabetes; here are some tests you should have done:
Total cholesterol: should be under 200 milligrams per deciliter (mg/dL).
LDL: should be under 100 mg/dL.
HDL: should be above 50 mg/dL for women, and above 40 for men.
Triglycerides: should be under 150 mg/dL.
Fasting blood suger: should be under 100 mg/dL.
Blood pressure: should be no higher than 120/80 mmHg.
BMI: shouldn't be higher than 25. If your body mass index (your weight-to-height ratio) tops that figure, your heart risk increases 32%. Over 29 and it spikes to 81%.
Waist circumference: should be 35 inches or less for women and no more than 40 inches for men.

"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS