Dr. Iliff’s 2017 Practice Newsletter/Rant
For the Second Year in a Row, I Delivered the First Baby in Topeka. Now I'm going for the Trifecta. All of you fertile females, give me a call toward the end of March for detailed instructions. By the way, 60 of my last 64 deliveries have been vaginal, the way God intended. How does that happen? Read the answer on my website: http://doctoriliff.com/maternity.htm
What's New in 2017: Hard to avoid the subject of President Trump and the Affordable Care Act. When Congress first passed the ACA without reading it, many of you would ask me what I thought. My answer was that nobody really knew, but my best guess was that it was going to be good for my practice and my patients, because it guaranteed that new insurance contracts would pay for an annual preventive exam and all preventive diagnostic tests approved by the United States Preventive Services Task Force. I also said that the benefits were front-loaded, and the costs were back-loaded. That is, lots of uninsured people would end up with insurance immediately (good), and then the expenses would pile up later. That's what happened. Now the Republican dog has caught the Democrat car, and as I write, nobody can guess what will happen. Stay tuned.
No Insurance? High Deductible? At the end of the 2017 Newsletter/Rant link at doctoriliff.com, you’ll get an idea for addressing your situation.
Muscle Building for Morons: Last April the FDA issued a warning that a supplement named Tri-Methyl Xtreme causes severe liver damage. It supposedly contained anabolic steroids. “Supposedly” is the operative word. Whenever you buy something at a health food store, whatever claim it makes on the label is a marketing tool, not a scientific fact. Furthermore, the office of New York Attorney General Eric Schneiderman found that only 21% of herbal supplements sold at certain major retailers actually had DNA from the plants advertised on the labels. Biggest suckers are body builders and high school boys. Protein supplements are largely a waste of money unless you’re a vegetarian. Here’s a thought: you know how male athletes are always spitting? Then buying protein drinks? Mucus is a good source of protein, and they’re wasting a free, natural supplement. Just swallow it, unless you‘re expectorating tobacco juice.
Pediatric Dry-eye Disease: Your kids having trouble with dry eyes? It's the smartphones.
The Case Against Sugar: The only diet book I've ever recommended is Gary Taubes' Why We Get Fat. Taubes is a journalist, not a scientist, but he's done his research, and he's right. Now he's got a new book out, The Case Against Sugar, which will convince you that the problem with obesity and diabetes in this country is pretty simple: it's the carbs, baby, about 700 calories a day more than the 1950s, when I grew up. Yeah, I know, a K-State professor lost weight eating nothing but Twinkies as a lesson for his students. Yeah, I know, I'm a bad example, as anyone who knows me will testify. Hypocrisy notwithstanding, I exercise a lot, so as long as you're in great shape, you can do what I do. Otherwise, sugar is poison. There, I just saved you $26.95.
23 1/2 Hours: Go to doctoriliff.com, and at the bottom of the page you'll see PLEASE WATCH NOW!!! in red letters. Follow those instructions carefully. Once you've mastered the secret instructions included in that decoded message, Google The Simple 7. Then take the assessment. You've already mastered one of the 7-- the most important-- after putting 23 1/2 hours into practice. Only 6 more to go!
Glucosamine/Chondroitin and Colon Cancer: A large study (over 90,000) found a 23% reduction in colon cancer. Practically, that's not a big deal if you get your colonoscopy every 10 years starting at age 50. Still, as you know, I've recommended this supplement for many years as a preventive measure against cartilage degeneration or injury in the knees and hips-- but the medical evidence is pretty soft. This might give some of you an added boost.
Muscle Cramps are not just the bane of athletes. Lots of older folks are tortured by cramps too, especially at night. Cramps are primarily the result of dehydration following muscle use, and we seniors already hold less total body water, so we're set up for problems. Electrolytes like sodium and potassium have nothing to do with it, so spare yourselves the bananas and salt tablets. Years ago I prescribed quinine sulfate pills for nighttime cramps, but those were taken off the market. There is an over-the-counter way to get quinine, though: tonic water, which is sold in cans and bottles by Canada Dry and Schweppes. Try 12 ounces an hour before bedtime if this is a problem. Gin is optional. Recently a Nobel winner has demonstrated that distracting the nerves with pungent or spicy foods will do the same thing, and this may be more useful for athletes. Personally, cramps were only a problem during marathons, where I just couldn't keep up with fluid needs-- but if this is an issue for you during competitions, you can buy the drink sold by the scientists: Hotshot. It's available on the Internet at teamhotshot.com for about $6 per dose. Or you can stick with cinnamon, wasabi, and pickle juice.
Caffeine, One More Time: Many of you have heard me preach the virtues of caffeine, the perfectly natural and enjoyable performance-enhancing drug which also reduces the incidence of asthma and diabetes. So I'll just say it again: enjoy, guilt-free. I have 3 or 4 mugs (6-8 cups) of home-brewed Starbucks every morning with breakfast, a habit for decades. If you've got money to burn, you can buy 2 oz. 5-Hour Energy bottles . Want to be really dumb? 5-Hour Energy Decaf. Whole lotta nuthin’.
The Mile-Walk Test, One More Time: If you want your all-cause mortality risk to approach the baseline for humans, the goal is 14 minutes for men, and 15 minutes for women. You can walk 4 times around a high school track, or go to doctoriliff.com and download the directions for the one-mile walk at Iliff Commons. It's more fun in the prairies and woods.
Parental Crazy-making, One More Time: I feel sorry for modern parents; I really do. You get so many wacky ideas from the Internet and your peers, and I don't have time to tackle them all in the office, unless you ask. No surprise to me, but the biggest pediatric practice in New York City advocates training your baby to sleep through the night at two months of age. They even invented a term for it: "extinction." It's pretty simple-- you put them down, and if they cry, you ignore them. Advantage for the infant is better self-monitoring and impulse control in the future. Advantage for the parent is some time for yourself. That's a win-win. School age kids don't need to carry water bottles to class, either. Compared to seniors citizens, they're like camels. I could go on, but <sigh> I won't.
Low T: I rarely watch television ads, having learned the joys of digital video recording, but every now and then I catch a glimpse of what audiences are subjected to. Here’s a general rule: anything you see advertised on TV is overpriced, and “treatments” for low testosterone are a good example. Are you fatigued? Then start an exercise program. Low libido? If you’re addicted to pornography and have depleted your brain dopamine by over-stimulation, it takes six weeks of abstinence to get normal. Otherwise, we’ll draw two morning testosterone levels, and if you’re really low, I’m not going to give you Androgel for $3000 per year. You’ll get clomiphene for $150 per year, which will fool your brain into sending out a hormone to kick your testicles back into action. But you won’t see that advertised.
Thanks Again to the Capital-Journal for selecting a competent group of young physicians to write the daily medical advice column replacing Dr. Komaroff, who retired. He was a gem, and a real help to me, especially as he followed a complete goofball, Dr. Gott. Gott wasted a lot of office time undoing his disinformation. Now if someone would just indict Dr. Oz-- I don't care for what. Do you have a medical question in need of authoritative advice? Go to the websites of the Mayo Clinic, the Cleveland Clinic, the National Institutes of Health, and the Centers for Disease Control. I don't recommend WebMD, unless you just want to know that your symptoms are probably cancer.
Two Easy Ways to Help Us Provide Better Care to YOU: 1. Bring your medicine bottles to your appointment. 2. CALL for an appointment when your medicine has NO REFILLS, and BEFORE YOU ARE DOWN TO TWO PILLS! That keeps phone lines free and avoids the chance of inadvertent mistakes.
Those Two Are Easy; NOW READ THIS: My nurses, who know you well, spend an extraordinary time on the phone for an unnecessary administrative task that is really nobody’s fault. It is caused by the automation of the pharmacy system, which often triggers requests for refills because you accidentally call in the OLD prescription number. If you know that it isn’t time for a visit with me, and the pharmacy says you’re out of refills, ASK TO TALK TO A PHARMACIST. That’s right-- a real, live person can straighten this out. I know that it’s easier to talk to my nurse, because we’re one of the few old-school offices in modern life that doesn’t stick you in one of those damned phone trees. SO-- try not to abuse us for providing good service. And thanks.
Help From Apps: Serious about diet and exercise? MyFitnessPal. Trouble remembering to take your pills? MedicineCabinet. Shopping with cash for the cheapest drugs at local pharmacies? GoodRx (brochures are in every exam room). Help with training plans? RunKeeper.
Special Note About GoodRx: Your prescription might cost less than your insurance copay with GoodRx, but you will have to ask for the cash price from the pharmacy clerk. They won’t give away money voluntarily.
Heartburn: I have information sheets with more information in the exam rooms, but here are the basics: 1. Don’t eat after dinner, or within 2 hours of bedtime. 2. If that doesn’t solve the problem, take an antacid at bedtime. 3. If you still suffer, buy a pair of GI bed blocks and put them under the head of the bed. 4. Next, try Zantac at bedtime. 5. Finally, Nexium.
Plantar Fasciitis: Review of essentials: 1. Never go shoeless at home; I recommend Crocs. 2. Stretch your calves daily. 3. Buy gel heel cups for your work shoes. 4. Ice your heels for 20 minutes before you sit down after work or exercise. 5. Custom orthotics
Pain Relief Without Narcotics: Start with extended-release acetaminophen 650 mg (Tylenol Arthritis), 2 pills every 8 hours. Then, as long as you aren't diabetic or suffering kidney disease, add ibuprofen 200 mg (Advil), 3 pills every 8 hours. You can take both drugs at the same time. That will handle almost all acute and chronic pain. Next stop: tramadol 50 mg (prescription) every 8 hours.
High Deductibles Are Here to Stay, and more of you all the time are going to be experiencing the bracing winds of the free market as it finally comes again to health care. Let me walk you through this Brave New World as I wrote in the Capital Journal many years ago. I just replaced my dishwasher after 17 years of faithful service. Did I have insurance? Of course not. So I shopped around for the best value, had a new one delivered from Nebraska Furniture Mart, and hired its installation locally. I also don't insure my televisions, my oven, my cooktop, my microwave, my septic tank... (continued online at doctoriliff.com)
Health Savings Accounts Are a Great Idea, because we should save money for routine household expenses, and HSAs allow you to do that and let the money accumulate year by year, tax-free. That's even better than my Dishwasher Saving Account! If you have a Flexible Savings Account (FSA), on the other hand, you're getting screwed. With an FSA, you have to "use it or lose it," like when I was in the Army: every year, in October, we'd have to suddenly come up with ways to waste money-- or those line-items would be cut in the next fiscal year. So my patients with an FSA come to the office wanting to know how they can blow out the balance on their FSA, which they put in their account from their salary, before their employer steals it on January 1. That doesn't happen with an HSA. At the advent of ObamaCare, I bought a cheap $10,000 deductible policy for my family and put the money I saved on insurance premiums into an HSA. It now has about $60,000 waiting for my skiing accident or stroke, and I still have a High Deductible Health Plan (HDHP) for my wife. (I'm now on Medicare, and our youngest son turned 26 in April). So...If Your Employer is Smart Enough to Offer a HDHP, take it! Who knows, it might even motivate you to lose weight and exercise, which is the sure-fire way to save money on medical care. I've been preaching that for forty-two years.Direct Primary Care: For the last couple of years I've been toying with the idea of opening DPC to patients for whom it would be a good fit. DPC bypasses insurance altogether, and so it is ideal for the uninsured, but it is also a good fit for people with a HDHP. The basis for DPC is that good primary care is very cheap; it's the hospitals and specialists that run up the bill. For instance, for $60 a month per patient ($30 that for those with Medicare, and $45 for ages 2-40), I could provide everything I do in my office, including after-hours visits to Minor Med, at no additional charge. That's right-- annual physicals, med checks, X-rays, EKGs, treadmills, biopsies, steroid injections, and all the common labs I order, free. Then all you have to worry about is-- you guessed it-- diet and exercise. You win if you avoid the hospital, and you lose your high deductible if you don't. Most people, most years, would win enough to come out way ahead over time, because you are now shopping for health care like for dishwashers, and cutting out the middleman. If you have a heart attack, or your house burns down, or you wreck your new Lexus, insurance does what insurance should do-- it saves you from a financial crisis. But you won't be going to the emergency room for hemorrhoids. Whether I offer DPC contracts depends in part on what the Republicans do. Stay tuned.