On a personal note...

Getting the garden ready for the Fall and Winter. Have you ever seen a Marigold this tall (or a doctor this short)?

Suboxone treatment for opioid dependence

Opioids are prescribed in the US mainly for pain control. This includes medications like Codeine, Percocet, Vicodin, Oxycodone, Dilaudid, and many other branded and generic drugs. Chronic use of these medications, even when used appropriately, can lead to opioid dependence.

Opioid dependence is characterized by "an individual's inability to stop using the opioid despite the fact that stopping its use would be in his/her best interest." Criteria for the actual  diagnosis of opioid dependence have been developed by the World Health Organization, and are widely used by physicians in office practice.

The complications of long term opioid use are numerous and, besides physical dependence and addiction, include liver dysfunction, constipation, nausea, respiratory depression, and many more.

Opioid dependence can lead to opioid abuse, a much more dangerous condition with many medical and legal adverse outcomes.   

    

What do you do when it's time to get off the opioid pain medication, and you can't do it because of drug dependence?

The newest trend is to use Suboxone. Suboxone is a two-component medication which contains buprenorphine (itself an opioid) and naloxone. It works primarily by preventing withdrawal symptoms and controlling the craving for the opioid medication. It allows you to remain active in daily life activities such as work and family functions. The medication is taken daily, and comes in a wafer form which dissolves rapidly under the tongue.

Physicians have to go through specific training to become certified in the administration of Suboxone.

I am now certified to prescribe Suboxone. The advantage of having an Internist manage Suboxone therapy is that general medical issues and opioid dependence issues can now be treated in the same office setting in an integrated manner.

Feel free to share this information with those who may need help. If you need more information, please give us a call.

Prostate cancer testing, my view

Also appeared in the Westport News, 10/12/2011 - Letter to the editor.

The several-day old report by he U.S. Preventive Services Task Force Healthy men don’t need PSA testing for prostate cancer, sparked enormous controversy in professional and lay circles. I will not go through the back and forth arguments, which are described in detail in major newspapers like the New York Times and the Washington Post, but just give additional food for thought.

There is no question that with PSA testing, many more prostate cancers are diagnosed now and the number will increase as time goes on, and as newer techniques for screening become available.

There is also no question that in many cases, men are treated for prostate cancer when, at least in retrospect, they shouldn’t have been treated. Maybe because they did, or would have, died of other causes, or because the complications were worse than the disease.

It may be true that, overall, PSA testing does not presently lead to increased survival. Some men treated for prostate cancer definitely increase their life span. Others may not, or may even have complications that will shorten their lives.

But, in my opinion, these are not good enough reasons to stop screening men for prostate cancer. Not testing only decreases the amount of information we have, which creates ignorance, not knowledge. And this type of ignorance is not a solution to the question of how to treat prostate cancer, or any other cancer. More than 28,000 men die each year of prostate cancer, and literally ignoring the problem will not solve it.

The issue is that men have the right, and perhaps the obligation, to know if they harbor the cancer. And it is the responsibility of the medical profession to refine its techniques so that Medicine can better identify which patient has a better change to benefit from prostate cancer treatment and who may be hurt by it. As these techniques are refined, prostate cancer survival will increase, just as survival from many other types of cancer is increasing.

I feel that the Task Force report was seriously flawed, and I suspect was motivated by reasons other that good medical decision-making.

On a personal note: my prostate cancer was diagnosed over 5 years ago on the basis of a rise in my PSA, which was still considered normal. On the basis of the post-op pathology report, I know that, had I not had the surgery done at that time, I would have been in big trouble today.

Do you have diabetes? Five thing you must do!

The five must do lifestyle changes that will help you stay out of trouble if you have diabetes, or if you are at risk for the development of diabetes, are:

·        Follow a healthy diet

·        Maintain an optimal body weight (Body Mass Index not higher than 25)

·        Engage in recommended amounts of physical activity

·        Don't smoke (don't even think about it)

·        Keep alcohol use to no more than 1 drink a day for women, and 2 drinks a day for men.

According to data released earlier this year by American Diabetes Association, diabetes was the seventh leading cause of death in the US in 2007. Last year it was the sixth. In reality, the number is much, much higher, because diabetes is a major contributor to heart disease and stroke.

The economic burden to individuals and the country as a whole is enormous. Costs attributable to diabetes in 2007 were $116 billion in direct medical costs and $58 billion in disability, work loss and premature mortality. Again, this does not account for the contribution of diabetes to the cost of heart disease and stroke.

Overall, the risk for death among people with diabetes is about twice that of people of similar age but without diabetes.

All of these numbers are undoubtedly underestimates. Many case of diabetes continue to be undiagnosed.

Need help? We're here

Chronic Pain

Pain is now the most common reason why patients seek medical care. Data compiled by the CDC shows that in 2007, analgesics, as a group, was the number one prescribed category of medications in the US, approximately 13% of all prescriptions. The number is most likely higher now.

Pain can be either acute or chronic. Acute pain is the one you get with injury, such as a motor vehicle accident, moving furniture, or playing sports. Chronic pain is sometimes harder to define. Some authorities define chronic pain as pain that persists, despite attempts to cure it, for six months. Others call the pain chronic after 3 months. It appears that the best definition for chronic pain is pain that persists for a period longer than is medically expected for it to resolve.


The economic cost of chronic pain is mind boggling. The American Academy of Pain Medicine reports that in 2011, at least 116 million people in the US have "common chronic pain." Low back pain, migraine (or other form of headache) and neck pain are the leading diagnoses. A significant percentage of chronic pain patients (at least 20%) have had to take medical leave from their jobs and 16% had to modify their jobs. You can only imagine what this does to a person caught with this problem when unemployment is so high.

The cost for direct medical care for chronic pain is estimated to be $261-$300 billion a year. The lost of productivity is $297-$336 billion. This is almost $200 a year for each man woman and child in the US, and it's most likely an underestimate.

Treatment of chronic pain depends on the cause, severity, and the overall health of the person affected. To be effective, treatment is frequently multidisciplinary. Depending on the situation, it may involve medications, physical therapy, surgical intervention, biofeedback, hypnosis, management of stress or depression, exercise and reconditioning, acupuncture, chiropractic, weight management…and the list goes on…

So, it's very important to identify the cause of pain and treat it early in the game, before it becomes chronic. When the pain does become chronic, it is most important to control it, so that the patient can return to the mainstream of life, and become functional despite the pain.

Need help? Don't hesitate to call.