Need more time with your doctor?

Need more time with your doctor? In today’s hurried world both the doctor and the patient can feel frustrated by the amount of time available to speak with each other. Did you know that the insurance company rarely pays for more than a 15 minute visit with a primary care physician (PCP) unless the patient has a diagnosis they think should take longer. Even then extra documentation is required to show why it would take so long. Its ironic that they pay specialists for more time (even when it is a pop in and “keep taking the same medicine” visit) than they do for PCP’s who are supposed to be on the frontline and have a deeper understanding of you and your family’s overall health. I recently admitted a critically ill patient who had just returned from overseas and the insurance company refused to pay for my hospital visits to take care of him. Even though they saved a bundle by not having to pay specialists. They said his care is covered by the $20 a month they pay me for capitation. Small wonder most doctors don’t bother to take care of their own patients in the hospital anymore. They simply turn them over to a hospitalist who doesn’t know anything about them, kind of like a mechanic who only handles exactly what is in front of him. I recently returned from a conference (way out in the Boonies!) on alternative medicine and once again learned fascinating information I would love to share with my patients. But where is the time? While I am at conferences I keep thinking “wow! So and so may really benefit from that”. “I wish I had known that before so and so had that surgery” “I have a zillion patients who complain of fatigue, fibroids etc…If only I could have more time with them” When I come back I always like to meet with my VIP patients to discuss how new information may help them and what changes we can make to their vitamin regimens. Unfortunately I cant do that with everyone, however, if you feel that you would like to schedule a private self pay consultation with me please call the office. I am bursting to share the great news of how to improve health with everyone. Believe me my own regimen changed last weekend! Here’s to real health and vitality.

Dont discount doing a pap smear

A patient said to me last week “I do believe you saved my life for the second time Dr. Tuakli” And I thought Wow! You know what, she is right. People thank me for saving their lives from time to time and not to sound cavalier but I often think that it is nice to hear but I was just doing my job. Any qualified physician could have been credited with doing the same thing. But this time was different and very stark. This 50 something year old lady has been in my practice for perhaps 3 or 4 years. She has a variety of medical issues that we have been working on and from time to time I would suggest she have a pap. She had told me previously that she had been told that she didn’t need one because she had had a hysterectomy. Interestingly enough whenever I probed further she never seemed sure about exactly what had been done. Was the uterus completely gone including the cervix? How about the ovaries? Why was the surgery done in the first place? It never ceases to amaze me how many times I ask those questions and the answer is “I don’t know”, particularly in over 40 year old women. I eventually convinced her that it would be a good idea to just do a routine check up even though she had no symptoms and so I did a pap. As soon as I started her pap I knew from the look of the lesion in her vagina that it was cancerous. Putting cells on a slide and sending it to the lab quite frankly was a formality and I had her schedule an appointment with a gynecology oncologist pending the results. She told me when she came in last week that the specialist walked into the room and the first thing he said to her was “What is a women your age doing still getting pap smears?!” (I wont be referring any more patients to him). The arrogance dissolved when he saw the cytology report and the patient has since had the appropriate surgery. So why do I tell this cautionary tale? Well, for one thing, the current guidelines imply that she did not need a pap smear, simply based on her age. Secondly, I think that many women are walking around thinking that because they have had a hysterectomy they are immune to genital cancers. Thirdly, standard recommendations are just that, written for the common good but not by someone who knows you. Do not take them as gospel. You could argue that this is the exception to the rule and that is probably true but it also means that someone’s mother and sister will still be alive 3 years from now and she also managed to avoid the trauma of cancer therapy that would have resulted had she found it later. In medicine it is not always easy to argue with “official recommendations” and specialists who don’t know the patients. I believe that I taught myself something with this case, not everything has to be rational, and care must be individualized regardless. I am a strong believer in learning from past experience even if its not written anywhere. I derive no satisfaction from my patient being diagnosed with cancer but I am sure glad I followed my gut. When in doubt get a pap, it sure beats the alternative!

New Look for the New Year, my Detox face!

Well here is my 2013 look, post detox! I got new photos done today and here is the big reveal! I thought it was time I got an update and the photographer agreed, he made me laugh talking about realtors who still use photographs from 30 years ago and how surprised people are when they actually meet the person. "No you don't understand" I told him, "my goal is to show people how well my face products and anti-aging program work! I'm really not trying to scare anyone when they meet the real me". After 30 plus years of practice I like to think I am doing something right. On a serious note, the more you read about detoxing the more you realize how critical it is to detox. The water, the food, the environment, chemicals. The EPA says that the indoor air is more polluted than the outdoor air! Toxins in today's world are unavoidable and there is absolutely no doubt in my mind that they are associated with the increase in certain diseases especially cancer. Since we can't live in a bubble let's do what is within our power to stay healthy. That's your goal and my goal, one of those goals that has to stay the same year after year. Please come back and read my blog often together we will make it work. I plan too keep sharing my 'secrets' until the whole world knows! Add life to your years and years to your life! Dr. Nadu Tuakli

New Year! New You! Detoxify!!! Out with the old :)

Happy New Year! Its been a long time since we chatted! Well 2012 was very eventful and 2013 promises to be even more so. The only New Year's Resolution I made was to write my blog more often. Resolutions are great to make but even greater when they are kept. One resolution I think we all should make is to detoxify regularly. This doesn't have to be a major command performance in fact you can start with baby steps but I believe that in today's toxic world it is crucial. For those of you who attended my last (fantastic) seminar in November, you would have heard my talk on detoxification and why it is necessary. For those who did not, let me summarize: Everything we do, eat, apply and breathe is contaminated and the health consequences of this are dire. For example, when I finished my residency the incidence of breast cancer in the US was 1 in 12: now it is reported as 1 in 8! 2100 chemicals including pesticides, medications and recreational drugs have been found in city water supplies. 80,000 metric tons of cancer causing chemicals are released into the air annually in North America ( Reference courtesy of Douglas Labs). The EPA estimates that the average US citizen has residues from over 400 toxic compounds in their body. The advantages of detoxing in January include it being easy to keep track of. Ideally do it twice a year. Start the year fresh and don't let all those other resolutions like weight loss and exercise go to waste! We currently have two detox programs available in the office and the Omnicleanse one is 20% thru the end of January (so hurry if you want the discount). Whichever one you choose you will still need to adjust your diet so here are the food guidelines: AVOID: Caffeine Sodas Alcohol Processed foods Red meat trans fats Sugar Starch Chemicals in home and work, Dry cleaning, Nail Polish INCLUDE: Plenty of fresh fruits and vegetables 8 to 10 servings a day Organic produce Almond or Rice milk Fish Whole unprocessed foods Water We will give you more specifics when you are starting the detox. Usually you will lose 3 to 5 pounds while detoxing but this is not supposed to be a weight loss method. Look at it as a system of renewal. I will blog at a later date about controlling and maintaining weight loss. We have no choice, we cannot not Detox in the year 2013! So get it over with :) Cheers!

Mammograms and Breast Cancer prevention

The nice thing about blogging is that I can have an opinion and express it as such. This may be in direct contrast to the official 'recommendations' of the medical establishment.
A case in point are the new mammogram recommendations. Last year someone who was writing an article for 'Good Housekeeping' called me and asked how the new recommendations would change my practice. I told her honestly, they wouldn't.
My response must have been either uninteresting or not politically correct as it wasnt published!

Now that Breast Health awareness month is back (October) I get asked this question again quite a bit.
As far as I'm concerned the new recommendations dont make sense and I believe if my patients see the facts they will agree.
Some of the most egregious recommendations include: discouraging women from doing their own self breast exam and not starting mammograms until the age of 50. Do these jokers know how many of my patients would have been dead by now if I followed these recommendations?

While glancing through a recent edition of Family Practice News I noticed a reference to a study done in Michigan, with more than 5000 women, which agrees with me. The study was reported at the symposium of the American Society of Clinical Oncology. It found that many breast cancer patients would have more advanced disease and face harsher treatment if the recently updated screening guidelines of the US Preventive Services Task Force were widely adopted.
In women under 50, 48.3% of breast cancers were detected by mammography, 46% by palpation.
The speaker concluded that " you are better off if you can have your cancer detected by mammography .....you will have more options and likely need less aggressive treatment......we would support the societies that continue to recommend annual screening mammography starting at age 40"

Do not misunderstand me, mammograms are not perfect and there is some radiation exposure but if you have breast cancer they definitely beat the alternative! I think if you are under 50 you can work it where you can get more thermograms and less mammograms but you still need to get that baseline mammogram to know where you stand. They dont hurt anymore and can be life saving.
Breast cancer treatment has come a long way but we still have a long way to go to eradicate the disease.

Prevention is ALWAYS better than cure.

Stay Well

Dr Tuakli

Vitamin D the under represented vitamin

I first got interested in Vitamin D a few years ago when a professor of Dermatology at a high profile institution in the North East got kicked out of his job for recommending that people get more sunlight. I was a little curious as to what sparked such controversy as clearly, an Ivy League dermatologist would be unlikely to put his job on the line over a vitamin!

After that I started receiving emails from the 'Vitamin D Research Council' an organization apparently funded by a doctor who believed so much in the importance of vitamin D that he put his career and a fair amount of his own money into proving the point.

Initially I was a little skeptical of the apparently far reaching consequences of Vitamin D deficiency: from possible association with Autism and ADHD to an increase in Cancer and infections. Then my skepticism turned to concern, the more I read and the more I checked my patients' vitamin D levels. Almost 90% of my patients were vitamin D deficient and at least 50% severely so. As a result, I have been checking Vitamin D levels routinely in all patients presenting for an annual physical exam for at least 2 years.

Most patients are not aware that they are deficient and have no symptoms but sometimes people are markedly symptomatic. Fairly often I find that Vitamin B12 deficiency and Vitamin D deficiency go hand in hand.
Such was the case with a patient of mine who came in to my office complaining that she thought she was developing Alzheimer's. She was very distressed and told me a story of constantly forgetting things and her anxiety about this. She became emotional when she explained how she did not want her children to find out. I suggested she see a neurologist and get some labwork done while she was waiting for that appointment.
Apparently she was so demotivated and forgetful she didn't get the labs done, continued with the neurologist who told her she didn't have Alzheimer's but she could try some medicine if she wanted, in case it helped. She declined.
She came back to see me 3 months later more tearful and agitated than before, she could hardly get out of bed in the morning because she was so tired. Her legs hurt and everything was a struggle. This time she got her labwork done and both her Vitamin B12 and Vitamin D level were extremely low.
With replacement she is fine, two weeks later she was back working the garden she loves and now she laughs when I remind her that she was convinced she had Alzheimer's.

Most cases are not as dramatic but is Vitamin D deficiency another one of those 'silent killers'?
Andrew Weil recently wrote an article stating that he is raising his recommendation for Vitamin D to 2000 daily (something most of my patients are already doing) because of a recent study out of the University of San Diego California which suggested that raising vitamin D levels could prevent one-half the cases of Breast cancer and two-thirds the cases of Colon cancer.
Hello this is HUGE!! As Dr Weil points out: a 50 percent reduction in Breast cancer would have saved the lives of more than 20,000 American women in 2009.

Vitamin D is thought to affect the immune system, it controls the utilization of calcium by the bones and so is important for bone strength, lack of it contributes to fatigue, it helps seniors retain their balance. It is important for cardiovascular health, in Diabetes, Psychosis and every month a new article comes out with different attributes.

In short, we need it! You can get it through fortified foods like milk and cereals but the main way is either supplementation or the sun. The latter recommendation being what cost my dermatology colleague his job because he suggested patients go out in the sun for half an hour a day without sunscreen.

Bottom line vitamin D is beginning to be recognized as a critical vitamin, if you have not had yours checked, do it now and take the necessary steps to keep it above a level of 32 (ideally closer to your age).

As always wishing you good health

Dr Tuakli