Magnesium, Chances are that if you aren’t taking this daily you should be

Magnesium is another vital nutrient but is difficult to measure. It’s 99% inside the cells and tissues and only 1% in the bloodstream. Therefore, blood tests are very poor reflections of our true magnesium levels. In 2009, the World Health Organization published a report that stated that 75% of Americans were consuming less magnesium then recommended. The recommended daily intake is about 400 mg but may be more if you drink alcohol, take certain medications like diuretics or acid blocking medication, and which kind depends on your typical daily bowel movements.

If you tend toward constipation then take it in the form of Magnesium Citrate. If you tend toward diarrhea then take in the form of Magnesium Glycinate or L-Threonate. L-Threonate is preferred form for those with migraines, or wanting to avoid dementia or osteoporosis, as it’s the only type that crosses the blood brain barrier. Taken with osteoporosis medications results in dramatic improvements as well. If you want to take it and it constipates you then do 1000 mg of L-Threonate instead of 2000 mg (the usual daily dose of this form) and take 200 or 400 mg of Magnesium Citrate to balance it out.

Magnesium is also a co-factor in over 300 chemical reactions in our system. It’s a necessary co-factor for many steps in the Krebs Cycle, the reaction that takes place in our mitochondria to turn glucose into energy.

Gluten-free comment from Dr. Oz website I have to correct

I try to remain open-minded about Dr. Oz but wow sometimes I see things on his website that make me think “uh-oh”.

So today I saw this under the heading “The Gluten-Free Diet Plan”:

“It’s a surprising statistic, but a study found that 81% of people suffering from celiac disease (gluten intolerance) who followed a gluten-free diet gained weight. That’s because there is a common misconception that anything labeled “gluten-free” must be good for you.”

http://www.doctoroz.com/videos/gluten-free-diet-plan

That’s not the reason most Celiac patients gain weight. What they fail to tell you is the majority of patients that truly have diagnosable Celiac Disease suffer from malabsorption. So they can’t absorb nutrients such as vitamin D, iron and often suffer from chronic diarrhea. My mother is a fine example. She is lucky now to weigh over 100 lbs. She would never go gluten-free despite a positive test for antibodies to Gliadin because a gastroenterologist did a biopsy from one site of her small intestine that was read as normal. It’s recommended now to biopsy 9 sites but we didn’t know that then. My mother now is 4′ 10″. She used to be 5′ 4″ and weighed 135 -145 lbs.

If she had gone “gluten-free” before losing more than a couple inches of height and 30 lbs of weight she very well could have maintained or even gained weight. So the reason most Celiac disease sufferers gain weight when they go gluten-free is not due to lack of reserve when it comes to eating gluten-free food, it’s because now they absorb all they eat after their intestines heal.

I’m just saying.

The Engaged Patient

Monday in the Wall Street Journal Health section was an article titled “How Patients Really Can Help Heal Themselves.” That obviously grabbed my attention and the article surprised me by saying something my husband and I have discussed for a long time. The need for patient responsibility for their own health. Today one of my patients thanked me for explaining so much to her and said no one has ever explained this like you did. I love and hate to hear that. Yes it’s flattering that she appreciated my efforts but really isn’t that what all doctors should be doing? How will patient’s “buy-in” and follow your guidance if you don’t explain it?

Examples the article cited for being an “engaged patient” were fairly rudimentary but still worth repeating:

1. Bringing a list of questions to your doctor appointment.

2. Always mentioning your medication allergies to the doctor or staff even if not asked.

3. Comparing your medication received at the pharmacy to the order given by the doctor. (You’ll need to write down or copy your prescription before handing it in or ask for a copy of what was sent in electronically).

4. Maintaining a copy of your own medical record.

The article claimed that of the above 4 things that 50%, 40%, 70% and 29% were doing that currently.  So this inspired me to add some more suggestions to the list and I thought I’d put them in order from basic to more complex and less and less necessary but just my thoughts. First of all I think the first and most important thing a patient could do to be more engaged is to always carry a list of their medications and allergies on a pocket card in their wallet. Write it in pencil or do it on the computer and print a new copy every time there is a change.  In Peoria and many communities, you can get the “File of Life” that comes with a folding, pre-printed medical summary including people to contact in case of emergency and your medication list and allergies all folded up in a red file and a duplicate one that is slightly larger and magnetic to keep on your refrigerator for the emergency medical tech’s if they have to pick you up in an ambulance. They are often available from the Fire or Police department. I used to get them by the box but when I ran out and asked for more all they sent me was four of them in an envelope. Here’s a picture of the File of Life and their website is https://www.folife.org/.

FILE OF LIFE

Then I agree with a copy of your medical record and would also suggest keeping it in electronic format saved on multiple different media storage devices and/or computers. I also considered when we first went to electronic medical record purchasing wristbands with USB storage for all the patients. I thought that would be a great way to encourage their participation and make up for the delay in their care it caused for at least 6 or more months. However, I ordered a couple and none of them lasted very long before breaking. I still think it’s a great idea though and maybe the technology has improved.

http://www.my-medical-id.com/product/USB-Silver-Medical-Bracelet

One of the biggest changes in the past 5 years is that your primary care doctor is no longer always included in the loop when you see other doctors or go to the hospital. It doesn’t matter if they ask you for your doctor’s name and say they’ll send us reports. They no longer send us anything! What they mean by we’ll send it is if your doctor has access to the hospital electronic medical record and you tell them you were there we can go online and retrieve the information. But only one of the three hospitals in Peoria IL currently send us notification that you were in the emergency department and I suspect that has recently stopped when they merged with another one. So assume your primary care doctor doesn’t know anything about your visit to the emergency department until you inform them. This is even more true now for any specialists you see or the urgent care settings. Some of the specialists are now owned by the hospital and also send the letter they used to send via fax or mail to the office now is parked on the hospital electronic medical record also. So again if I don’t know about it ahead of time I won’t have it for your visit. I can go online in the room and get it but that takes time. So not only should you let us know but you should let us know when you call and make the appointment. That gives us more time to get the information for your upcoming appointment. Then when you check in at the front desk ask if they remembered to pull the information. When the assistant puts you in the room ask again. That way if you have a wait before seeing the doctor that time can be used to pull all of this other information and not cause the doctor to fall behind trying to navigate these other systems.

It can only hold so much!

Something that is overlooked and rarely talked about is that the doctor used to enter the room and use all of their critical thinking skills to solve your health problem. Now as pointed out so wisely by a Nurse friend of mine, your healthcare providers have to use a good part of the brain to figure out this computer program in front of them as well. If they also have to pull information from one or more hospital sites and find the labs and x-rays and specialist notes they are really going to have less brain left to figure you out. No one wants to say it out loud but the older we are the harder this is also. Yet the physician gains all of this practical knowledge as they age so to chase them out of the system isn’t doing anyone any favors either.

So it also means that the patient today who commented you remember last year when I broke my arm was really assuming a lot. I looked back through the last two years of notes and there was nothing about a broken arm. She mentioned it so casually and went on to other things so I didn’t even get a chance to say “Broken arm?” Plus I have a feeling from knowing this person that when she heard I didn’t remember she would be insulted and that’s assuming she told me. She may have even assumed I was copied by an ER or specialist. I was not. I looked for 30 minutes today after finishing with patients in the clinic and could find nothing regarding a fracture of any kind. I could log on to the 3 hospital sites and maybe find it but at this point I was exacerbated and decided to put a staff person on it. I don’t see 30 people a day like so many physicians. I see 12-15 on average. But I still can’t write down every single thing that is said in the room. I would love to see technology developed that actually records our conversation and allows me to edit it later quickly into a note. So my last point is that as a patient please remember you are one of 12 to 30 people that doctor will see today and one of 2000 to 5000 visits they conduct this year. That means if you just mention something briefly chances are it was missed. If you feel it’s important it bears repeating and even bring documentation with you. So consider bringing a list of everything that has happened medically or even important life events since your last visit on a piece of paper for the doctor to keep.  We scan it all in and it really helps to jog my memory.  But also remember that if you don’t want certain information to be a part of your permanent medical record that could be released with your permission to an insurance company or another physician then say so and write CONFIDENTIAL on the top of the paper. I have a folder in every chart for that information. But don’t tell me something of vital important and then ask me to not document it in the chart. I really can’t do that. I would suggest presenting it this way. “Doctor, I’m not saying I have this concern, but if I as a patient had an older brother and my father both had Parkinson’s Disease how would I monitor myself for development of that? Again I’m not talking about myself.” (wink wink) I would probably still put the family history in the chart if the patient affirmed this was really his family history but I would not write in the patient had concerns about this if worded this way. I would still give him the following advice “Well, if I had a patient like that I would watch for a tremor of the hands at rest and reduced arm swing with walking…” It’s sad but patients do really have to watch what they ask about if it’s not a current concern in this day and age if they’re planning on applying for life insurance in the near future.

So it’s important to remember that with technology racing ahead that medicine is still supposed to be about the physician-patient relationship and all great relationships take two people!

On hold

I’m on hold for our new webpage that is going to contain this blog. However, it is hopefully going to move over next week and I am ready to start reviewing and researching topics. So send me comments about your areas of concern or recent news.

Femdoc: My perspective on daily health news, common concerns, Dr. Oz’s latest and other sources of info out there!

A new blog about health issues for today’s woman. I’ll discuss men’s issues as well since women often are concerned for their whole family including their men. But it’ll always be from my perspective. Remember this is my perspective based on 13 years of practicing medicine as holistically as possible, current research, integrated with my view as an epidemiologist, massage therapist, medical researcher, mom, gardener and internist.  I can’t possibly keep up with Dr. Oz’s shows BUT I will make this disclaimer. Before you get excited about something use this process to evaluate the source of the information:

1. Is the source a daily media show that is trying to attrack viewers? Remember the media is all about hype and the trend over the past 10 years in my opinion is that they mostly present the negative to attract people through fear instead of education.
2. Is the source trying to sell you something? If so do they offer alternative ways to obtain the product or do they only present their source.
3. Is the source someone that has made transparent their interestes? In other words are there other affiliations that might bias there information.
4. In many ways WE ARE ALL BIASED so do they acknowledge that in their presentation.

I’m sure there are even more considerations but this should get you off to a good start. To better demonstrate consider the following examples:

1. You attend a presentation on weight loss. They present their program. Do they also offer real outcome data from their site? Do they offer suggestons if you can’t afford their program?

2. The evening news presents story on the assocation of hormones and breast cancer from the Women’s Health Initiative. (Real example from 2005) Did they explain that the risk was an increase from 1 to 3 in 1,000 women (not actual numbers but close)? Did they present  any of the benefits that were found? Did they later that year present the data showing decreased risk of breast cancer from Premarin alone? (No they did not or at least not nearly to the magnitude of the negative report).

3. You receive a newsletter in mail saying 30 drugs you should never take from Public Citizen. (Patient brought me this newsletter last week). What are they selling? They want you to subscribe to their newsletter that will tell you every possible negative side effect about a drug or supplement (and they include almost all of them) for $24.95 a year.  Did they list the known benefits? (no) Did they tell you what percentage had this problem? (no) This publication was clearly trying to capture an audience through fear tactics and hype.

So this is where I’m coming from and it’s only my opinion. I feel my opinion is as fair and balanced as I can be but remember where I will be coming from  and my bias will be that of an independent physician that is self-employed, not owned by any hospital or large insurance organization and is somewhat skeptical of large “systems” and “public” figures. I’m sure I would have hard time being on my own talk show because I would have to keep issuing disclaimers and it wouldn’t attract most viewers.