4 Mistakes Patients Make

Have you had any problems with your doctor lately?  Are you dissatisfied with his or her care?  Have you had any misunderstandings, or do you feel like he or she doesn’t understand you?

Before you put all the blame on your doctor’s care, take a good honest look at your own behavior and see if you’ve made any of these 4 mistakes in your interaction with your physician.  You and your doctor are both responsible for making the relationship work.

1.  Not being completely honest

Let’s face it, sometimes doctors ask uncomfortable questions.  Sexual history, substance abuse, mental health, there are lots of topics we don’t like discussing with (near) perfect strangers.

We know that sometimes it takes time to build a comfortable relationship.  Often it’s much easier to let a stranger see our naked bodies than to let them know about less-than-perfect choices we’ve made in the past (and sometimes are continuing to make).

As a rule, doctors ask these questions only because we are concerned about the health consequences of the choices you make.  If we ask a teenager if she’s sexually active, it’s because we want her to be safe and healthy, not because we’re nosy busybodies or planning to tell her mom.

Sometimes there’s a very real risk we could hurt someone if we don’t know about their past.  For instance, if I were prescribing medication for a recovering alcoholic, I would want to stay far away from meds with abuse potential, or make a management plan if dangerous drugs (like narcotics) are necessary.  Believe me, I will celebrate and protect your recovery, not judge you for it.

If a doctor asks a question that makes you uncomfortable, or seems unnecessarily personal, it’s OK to ask why they need to know that information.  You won’t offend the doctor and it will give you a chance to increase your comfort level before sharing.

2.  Expecting to get everything done at one visit

Boy is this a big source of conflict.  With the rise of high-deductible plans and the free wellness visit, patients have a financial incentive to get as much done at the annual physical as possible.

Unfortunately that’s not always possible.  We can’t do a physical (which takes time), refill all your medications (which takes MORE time) and assess a new problem (you can guess) all in the time allotted for an annual physical.

We are constantly hearing complaints from patients that doctors run behind.  I see friends complaining on Facebook that they’ve been waiting an hour to see their doctor.  Unfortunately expectations from patients to get more done in each visit contribute to long wait-times. If I give one patient extra time, that means I have to take time away from another patient or I run late.  You wouldn’t like it if I did that to you, would you?  Sometimes it can’t be helped, and a patient turns out to have an emergency (that’s the fun of primary care!) but that doesn’t happen too often.

If you’re my patient, here’s my recommendation.  If you’re coming in to see me for your annual physical and something comes up (like one of your meds isn’t working, or you sprained your ankle) PLEASE tell me before we start.  Better yet, tell Shari as soon as she gets you in the room!  If we need to address an acute problem, we’ll do that instead.  A physical can be done anytime, there’s no pressure to get one done today.

If your meds need refilled, please make an appointment for that.  If you have multiple concerns it’s OK to make an appointment and say there are a couple of things you need to discuss.  You don’t need to ask for a physical just so there will be extra time.

I try to make every patient feel like they’re my only patient.  Sometimes it’s like parenting, LOL!  I have to do my best to treat everyone fairly and respect everyone’s time, and managing MY time is part of that.  As a patient it’s important to be aware that sometimes other patients are waiting.

3.  Not asking enough questions

Communication is a two-way street.  As physicians it’s our responsibility to make sure our patients understand what we’re doing and why.  Explaining a patient’s illness, the cause (if we know it) and the treatment plan are important parts of what we do.

The patient has an important responsibility to reflect back the information to the doctor so that everybody knows the communication is effective.  For instance, if I tell the patient that they have an infection in their prostate gland, and the patient doesn’t know what a prostate gland is, and doesn’t ask, I’ll get the impression that the patient understands everything I said.

If your doctor tells you something that you don’t understand, you must ask questions until you DO understand.  PLEASE don’t feel like you’re asking stupid questions.  There is no such thing!  We KNOW you don’t know what we know.  That’s why we’re the doctor!  We have to explain things to you in a way that you understand.

If you’re my patient and I say something you don’t understand, call me on it!  Be persistent, be a bulldog, be a pain in the butt!  Keep asking.  I’ll keep breaking it down until we find a place to start that’s familiar to you.  If we have to start at “Your nose is this thing in the middle of your face that you breathe through and put your glasses on,” that’s where we’ll start.

It’s your body.  It’s your illness or injury or concern.  It’s my job to make sure you get what’s going on, but it’s your job to help me do it right.

4.  Assuming the doctor knows everything or is always right

Let’s just lay that assumption to rest right now.  NOT.  TRUE.  Nobody knows everything.  Even so-called experts have limits to their knowledge.

I have less trouble with this than some doctors do.  I’m a family doctor and in general we have less problems admitting the limits of our expertise.  In the office I’m pretty ready to admit when I don’t know something and call one of my specialty colleagues.  Many people who have been in to see me in the last few months have seen me haul out my textbooks to look things up, or consult an Internet resource (NOT GOOGLE!!).

My older patients tend to have a “Doctor knows best” mindset that frustrates me sometimes.  I want my patients to participate in creating the treatment plan.  There are usually several good ways to go about achieving any given goal (like getting blood sugar under control).  It’s important to respect the patient’s lifestyle and values in making treatment decisions.

My younger patients, I’m happy to say, are usually right up-front if I ask them to do something that makes them uncomfortable.  That’s good!  I want my patients to be active participants in forming the treatment plan.

If something isn’t adding up, it’s perfectly OK to ask for a second opinion.  No doctor worth seeing will be insulted by asking for another opinion.

Many patients unfortunately are unhappy with their doctor but it’s important to remember that communication with your physician is a two-way street.  By being honest and forthright, keeping expectations realistic, insisting on having things explained in a way you  understand, and making sure you have an active role in forming your treatment plan, you can go a long way towards making a strong partnership with your doctor.


Candida Overgrowth

Last week I had a request to discuss Candida overgrowth.  I love audience participation!  And it’s a great topic because the symptoms of yeast overgrowth are very common and can be difficult to diagnose.

So what is Candida?  Candida is a species of yeast that grows in humans.  It often causes thrush in the mouth and vaginal yeast infections.  It can also be found in the intestine.

The large intestine has a number of different species of bacteria.  Some can be harmful and some are helpful.  Yeast is also present in the intestine in small amounts.  Under some circumstances, such as after antibiotic treatment or with certain dietary problems, the yeast can overgrow and outcompete the beneficial bacteria.  If that happens the person can develop symptoms of illness.

What happens if there is yeast overgrowth in the intestine?  There is evidence linking high amounts of yeast in the stool to chronic fatigue, fibromyalgia, irritable bowel syndrome, among other problems.  Since 2/3 of the immune system is located in the intestine, Candida overgrowth can cause immune dysfunction.  It is linked to autoimmune disease and can also lead to frequent infections.

So how do we know if you have yeast overgrowth?  If you have chronic fatigue, irritable bowel syndrome, fibromyalgia, autoimmune disease or other medical problems, the diagnosis of Candida overgrowth is made with a comprehensive stool analysis.  The comprehensive stool analysis is ordered by a doctor who has a relationship with a specialty lab;  regular labs don’t perform this test.  I work with Doctor’s Data, one of the leading labs providing these special tests.

Treatment of Candida overgrowth generally involves both antifungal medication and careful adjustment of the diet.  It’s important to avoid simple sugars because yeast lives on sugar.  Eating sugar stimulates the overgrowth of the yeast organisms.  Probiotic supplements (I recommend Shaklee’s OptiFlora) will replace the yeast and other problem organisms with good, healthy bacteria to support the immune system and digestive health.  Caprylic acid, a supplement made from coconut oil, kills yeast without harming the good bacteria.

Candida overgrowth is a common problem with symptoms that are very nonspecific.  These symptoms range from fatigue to chronic pain to digestive upset (diarrhea, bloating, constipation, and gas) to mood disorders.  The problem is difficult to diagnose and requires real commitment on the patient’s part to treat effectively.  It’s not just a matter of taking pills;  you must be ready to change your diet too.

If you think you might have yeast overgrowth and would like to be tested, please let me know.  I’d be happy to see you and discuss it.  If you’re not in the Cleveland area you can check the Academy of Integrative Health and Medicine to find a doctor close to you.


Fatty Liver Disease

A very wise man told me once that if you find yourself explaining the same thing to three different people, you need to write it down to have a handout.  Well there’s a topic that’s been following me around this week like somebody stuck one of those funny signs on my back.  This week I need to talk about fatty liver disease.

What is fatty liver disease?  This is a condition where the cells in the liver get little droplets of fat in them.  You can see the fat on liver biopsy (although that’s not always done) and it changes the way the liver looks on ultrasound.  The most common way we pick it up, however, is that the liver enzyme blood tests go up.

Before we talk about what causes fatty liver disease, I want you to think about something.  Everything you eat, drink, breathe, and put on your skin must be processed and got rid of.  What goes in must come out, right?  Carbon dioxide from burning sugar and fat for fuel gets breathed out through the lungs.  Extra water, salt, urea from protein metabolism and other substances are eliminated in urine.  Undigested plant fibers in our food are a big component of our stool.  Heavy metals and some toxins are eliminated in sweat.

The workhorse organ in your body for neutralizing toxic stuff you eat, drink, breathe and wear is your liver.  It is an amazing powerhouse, chock full of enzymes to detoxify chemicals and get rid of them.  Unfortunately in today’s toxic world often the poor liver is overworked.  Although medical science hasn’t given us a definitive answer, my belief is that fatty liver disease is what happens when we overwork our livers.

Fatty liver disease was first described in alcoholics.  In fact the fatty liver disease that I see most often is sometimes called “nonalcoholic steatohepatitis” or NASH.  It was felt that the liver damage in alcoholics was a form of chronic alcohol poisoning.  I think they were right on the money and that the nonalcoholic fatty liver disease we’re seeing as an epidemic now is from chronic “life” poisoning.

Where are the poisons coming from?  In the last 20 years we have seen an explosion of fast food, convenience food, and food additives.  I truly believe the poisons are in our food and water supply.  Artificial food ingredients like artificial colors, sweeteners, flavors and preservatives are everywhere!  Partially-hydrogenated vegetable oils are artificial fats created to extend the shelf life of processed foods.  Pesticide use in agriculture continues to climb (and the runoff winds up in our drinking water). Nobody knows what effect genetic modification of food crops has on the human body.  About 80% of the antibiotics used in the USA are used in livestock, not people, to help the animals survive the conditions in which they are raised and to make them grow faster.  Those antibiotics are detectable in the food products made from those animals.

If you have been told you have fatty liver disease, there are a number of things you can do.  Read labels and avoid partially-hydrogenated vegetable oils like the plague.  Avoid artificial sweeteners (they are NOT better for you than sugar, even if you are diabetic), colors and chemical preservatives.  Buy organic produce.  If your budget won’t allow you to buy ALL your produce organic, then get the list from the Environmental Working Group and buy at least the Dirty Dozen Plus organic.  Buy your dairy products organic or switch away from dairy altogether.  I discussed some other recommendations recently in this post.

What about beverages?  Obviously, be careful with your alcohol intake.  Also PLEASE give up soft drinks, and don’t let your kids drink them either.  They have NO nutritional value and often contain caramel color, artificial sweeteners and other harmful chemicals. Organic fruit juice is good for an occasional treat.  Coffee, hot and iced tea, homemade lemonade are all good options.

Most of what you drink should be good old water.  Fresh, clean water tastes SO good!  Filtered tap water is the most economical solution (no plastic bottles to wind up in the landfill).  Choose one with a good rating by the Water Quality Association to remove the contaminants found in your tap water.  Northern Ohio residents can find our water quality report here.  Did you know our drinking water contains detectable amounts of chloroform?  Yikes!  My family uses Shaklee’s Get Clean Water pitcher, which removes all the nasty stuff and filters twice as much water per filter block than the “other” brands.

OK, I can hear some of you saying, “But my husband and I eat the same foods and drink the same water.  He drinks beer and I never drink alcohol.  Why do I have fatty liver and he doesn’t?”  Great question!  Turns out that there is about a thousand-fold variation in individual people’s livers’ ability to detoxify stuff.  And men’s livers do this better, on average, than women’s.  The development of fatty liver disease depends both on how much toxic stuff you’re asking your liver to process AND how good your liver is at doing the job.  It’s like asking a Great Dane and a Dachshund to both run a mile.  They’ll both get there, but the Dachshund might be worn out at the end, and the Great Dane will still be ready to play.

So how do you know if you’re at risk for fatty liver disease?  The next time you get your annual physical, ask your doctor to check liver bloodwork (better yet, ask for a Complete Metabolic Panel) along with your routine cholesterol.  It’s covered by insurance in general.  The best test to check how well your liver is handling the job you’re asking it to do, as far as processing toxins, is a GGT (gamma glutamyl transferase).  This one you will probably have to pay for unless your doctor finds your routine liver tests (called AST, ALT and Total Bilirubin) are elevated.  GGT goes up in response to a strain on the toxin-processing system.  Normal range is up to 85 but I start getting concerned at about 40-50.  I consider those levels as a warning that the liver is starting to complain.

Fatty liver disease is a big deal.  According to the American Liver Foundation, it’s estimated that 25% of adults in the USA may have fatty liver disease.  It can progress to cirrhosis and liver failure, and ultimately need a liver transplant.

Be nice to your liver!  It works very hard to protect you, and it has to last!


Weight Loss For A Healthy Family

Happy New Year!  This week I’m here to talk a bit about weight loss, one of my absolute favorite topics.  Before you roll your eyes, hear me out!  This isn’t just another New Year’s Resolution email that will be forgotten in a month.

I talk about weight loss a lot.  The majority of my patients need to lose weight.  They may have high blood pressure, high cholesterol, diabetes, heart disease.  They may have sleep apnea and arthritis.

Many of my patients also have another really good reason to lose weight and get healthy.

© Lisa James | Dreamstime Stock Photos

© Lisa James | Dreamstime Stock Photos

They have kids.

Think about it.  If you are overweight or obese, what are you missing out with your kids?  How much easier could things be with your kids?  When was the last time you climbed a jungle gym with your kids?  Went for a walk or run in the park with them?  Chased them in a game of tag?  Swam in a pool without being self-conscious about your body?

Another critical reason to consider weight loss if you have children is the fact that if a child has obese or overweight parents, he or she is more likely to be overweight themselves.  This makes intuitive sense:  children learn their dietary and other health habits from their parents.

One of my biggest goals in my medical practice and with this blog is to help parents create a healthy family.  The number-one biggest health risk in the USA is overweight and obesity.  We are seeing more and more overweight and obese kids, more children with type-2 diabetes and high cholesterol.  Mood issues, self-esteem and body-image problems, and bullying are much more likely in kids who struggle with their weight.

If you’re a parent and you’re overweight or obese, you have a great opportunity to show your kids that it’s never too late to choose different habits.

I’ve explored many weight loss programs.  In the past I’ve used very-low-calorie diets, protein-sparing modified fasts, referred to community programs, and occasionally will prescribe amphetamine appetite-suppressants for those who meet the criteria. (Ohio’s regulations are pretty strict but if you’d like to discuss medications you’re welcome to call 440-743-4740 and make an appointment.)

The best weight loss program I’ve found is called Shaklee 180.  It is a simple meal replacement program, but unlike many other meal-replacement programs it contains only natural ingredients and provides lots of support.  It also has been scientifically proven effective (unlike most other weight loss programs).

If you need to lose weight, please check out Shaklee 180.  It will fit into your busy lifestyle.  The products taste good.  The products are good for you, without artificial sweeteners, colors, flavors or other ingredients harmful to your body.

The products are even good for your kids! The meal bars, snack bars and smoothees are great for busy families on the go.  No more drive-through or questionable snacks.  We used them on our 10-hour drive from Myrtle Beach to Columbus over Christmas, for example (see last week’s blog post).

As a bonus, Shaklee has decided to set the record for most weight lost by a company or group.  We have set our goal for 40,000 lbs lost in the first 3 months of 2015.  Want to help?

If you need to lose weight and are interested in learning more about Shaklee 180, please email me at drjen@jenniferwurstmd.com and let me know.  I will make sure you get the information you need to decide if the program is right for you.

PS – If you are currently losing weight with Shaklee 180, please contact me with your current weight.  I will add you to my Shaklee Family list!  When we reach the end of March I will need your weight at that time so I can let Shaklee know how much we lost as a group.  Keep up the good work!


Where’s Dr. Jen? (Part 2)

Well, as those of you who saw me yesterday (all 18 of you!  Wow!) can verify, I am safely at home and back to work.  So many people responded to last week’s post that I wanted to finish telling you about our travels over Christmas.

When I wrote last week I was sitting in our condo in Myrtle Beach.  We spent 5 days in Charleston with my sister and her family then moseyed up the road to Myrtle Beach for 3 days.  Myrtle Beach in the winter, you say?  Heck yeah!

First of all, the weather was VERY unseasonable, temps in the 60s and 70s while we were there.  We were loving it!  My boys even swam in the heated outdoor lazy-river pool at our condo resort.  We walked around in shirt sleeves and hoodies the whole time we were there.

Some of the Myrtle Beach attractions are seasonal.  For instance, the amusement park and waterpark are closed in the winter.  However, there was plenty of shopping to be done at Broadway at the Beach.  We had a blast at MagiQuest (yes, we are geeks) and spent a few hours at WonderWorks.

Have I mentioned that my family and I LOVE to eat?  Myrtle Beach has awesome food.  Our new find was Art Burger, a nice little hole-in-the-wall with local art for sale and yummy food.  I had the mango summer roll sushi appetizer for my entree.  Yum!

Do you remember me using the word “mosey” to describe our wanderings both in last week’s post and today’s as well?  Tuesday we did the exact opposite of moseying.  We blasted all the way from Myrtle Beach to Columbus, Ohio in a 10-hour marathon sprint.  We ate meal bars and other snacks and drank bottled water in the car and made only the most necessary of stops along the way.  Boy were we tired!

New Year’s Eve saw us heading to one of our favorite spots, COSI!  We have a membership, we go so often!  Chris loves the Gadget Cafe but often it’s booked by the time we make it there.  This time we were able to get a reservation and decided to take apart a computer.  Chris’s Dad is an engineer and has built computers in the past, so it was fun to take all the pieces apart and see what goes where, what hooks up to what else, and how the “guts” of a computer work.

COSI has a new planetarium so of course we had to see the planetarium show.  We also walked through the LIFE exhibit (Nicky is fascinated by the see-through talking woman and how she describes all the body’s organs) and OCEAN, where we did our best to keep the boys from getting soaked.

We stayed at the Embassy Suites in Dublin because they have a great family-friendly New Year’s Eve party every year.  We watched “Frozen” and “Penguins of Madagascar,” played pool, and danced!  Russ asked Nick if he was shaking his booty on the dance floor and he said “No, Mommy was doing that.  I was dancing.”  LOL!  Upstaged by my baby 🙂

At 10 PM the staff unrolled a massive roll of bubble wrap on the dance floor and we had a countdown, then the little ones got to stomp all over the bubble wrap.  So much fun!  Then at midnight of course we watched the ball drop, exchanged kisses and toasted the beginning of a wonderful New Year!

We slept in on Thursday and I bet you did too, LOL!  After checkout and lunch we headed home to find our kitties had missed us but the house was unscathed.  Unpacking and laundry and catching up on house stuff kept us busy until bedtime.

We had a wonderful trip filled with fun and family.  Nobody got sick beyond cold symptoms, nobody got on anybody’s nerves too much and everyone arrived home safely.

I hope your holidays were as much fun as mine were.  Now we’re settled at home and happy to get back to normal.  The boys go back to school Monday.

Where’s Dr. Jen now?  At home, counting her blessings and grateful for all of you!  Happy New Year!  Make 2015 the best year ever!