The Veterans Administration is the largest federal employer, with more employees even then the Army. The horrific and deadly scandal involving this huge bureaucracy is disturbing on a number of fronts. It has direct effect on the veterans, our heroes who have kept us safe. It has frightening implications for the civilian population because it is likely a window to our future.
A Freedom of Information Act request by a watchdog group found that the Edward Hines VA hospital in Cook County, Illinois paid its staff millions of dollars in bonuses over the last three years. General Shinseki, the former head of the VA, attempted to solve this problem by firing an undersecretary of the Veterans Administration who was already planning to retire. His choice for a replacement was the very administrator who oversaw the Edward Hines VA that paid the bonuses in the first place. It is hard to imagine a tighter circle of incompetence.
Even worse, the Edward Hines VA in 2013 had 4230 employees, including 309 physicians and about 800 nurses. Only 25% of these employees were involved in taking care of the patients. Administration and support staff outnumber caretakers 3 to 1. This brings a whole new meaning to the question, "Is there a doctor in the house?"
When the door to our clinic opened one day about two years ago, I was happy to see a patient I had not seen in quite a while. He dropped over to say goodbye. He had a pharyngeal tumor and a history of smoking up to four packs per day, so he assumed an ugly end was coming. He was excited, though, to tell us that he had kicked a 50 year addiction to tobacco. How? He pulled an electronic cigarette from his pocket and demonstrated it for us. I was intrigued. I researched this product before adding it in the clinic to help others put down their cigarettes. So far, it has helped many to break this habit and turn toward health and self control.
Since the earliest colonial years of this country, tobacco and its products have been part of our culture. People smoked cigars and cigarettes for hundreds of years without realizing what they were doing to their health or innocent bystanders.
The last two decades have shown such a tremendous growth in the rate of spinal surgeries that even spinal surgeons have called for a reevaluation of the criteria for these ultimate interventions. You may have also heard in the news that the number of people on disability in America is unreasonably high at nearly 50,000,000.
I referred to surgery as an “ultimate” because surgery should always be a last resort, never a first resort. You might be shocked at the number of times I find out that patients were referred to surgeons without first being referred to in a conservative option to see if the problem can be resolved nonsurgically. The “surgery first” approach is a violation of the standard of care, if not a violation of the patients themselves.
Question: There is a new study about marijuana in the news. What is all of that about? Is there anything dangerous about marijuana, really? I only use it occasionally – may be three or four times a month at parties.
When we look at research, we should consider the preponderance of evidence that it offers and temper that with common sense. Sadly, common sense is sometimes trumped by political considerations when it comes to this particular drug. I cannot imagine, for example, protracted political fights over personal use of Zantac or Amoxicillin.
I have just returned from my annual trip to Washington, DC to talk with legislators about healthcare issues. Specifically, we petitioned Congress about our veterans and their need for care in the Veterans Administration medical centers. Most of the injuries in our veterans returning from Iraq or Afghanistan are musculoskeletal, related to carrying 60 pounds of gear. Congress mandated chiropractic care in the veterans administration 12 years ago, but the VA has been an unresponsive bureaucracy thwarting the will of Congress.
The other major issue that we addressed is called the “sustainable growth rate” for Medicare. Essentially, unless Congress takes action, Medicare reimbursement will drop 27%. Congress likes to kick cans down the road instead of enacting permanent repairs for situations like this. If these drastic cuts happen, if you are on Medicare and do not already have a physician, chances are you will not get one because physicians will not be able to afford to take Medicare at all and stay in business.
As you might imagine, we see a lot of athletes in the practice. They play baseball, football, basketball, tennis, cross-country, and other team sports. We have many who are engaged in personal fitness, such as jogging, weight training, and CrossFit. There is always a chance for injury, and my task is to assess each situation individually for the cause of the problem and treated appropriately. Often my charge is to also treat quickly because a team has an upcoming need for a particular athlete. No pressure, right?
"Finding your game" is what happens when you achieve optimum function at any level of fitness. I take particular pleasure in helping senior athletes maintain optimum function so that they can enjoy life as they should in the golden years, whether that means playing golf or tossing grandchildren into the air to hear them laugh.
When athletes and weekend warriors are injured, they may try to play through pain, hoping a painful elbow or low back will get better by itself. As a rule of thumb, the earlier a musculoskeletal injury is assessed and treated, the sooner healing can begin. An untreated injury can easily slide from "acute" into "sub-acute," and even into "chronic." Each phase has its own characteristics and challenges.
The acute phase lasts from 48 to 72 hours after injury. This phase is characterized by pain, inflammation, loss of range of motion, increased temperature around the injury and swelling. It is very helpful if I can get to a patient at this point of an injury. Early intervention may translate into shorter duration of loss of function. By the way, we typically use ice to reduce swelling at this phase of the injury, not heat, which could increase swelling.