tag:blogger.com,1999:blog-30147559245096312392024-03-13T13:29:05.104-07:00CAREGIVER SURVIVAL: I HATE ALZHEIMER'S ........................................ Joseph J. Sivak MDJoseph J. Sivak MDhttp://www.blogger.com/profile/04997532868387955895noreply@blogger.comBlogger149125tag:blogger.com,1999:blog-3014755924509631239.post-54962206163423481892016-07-18T09:00:00.002-07:002016-07-18T09:00:53.237-07:00Where is Dr. Sivak?Many of you who have followed my blog for some time, also read I Hate Alzheimer's by Dr. Joseph Sivack. Doc has not posted is some time and we are still close friends. He and his have been traveling and moving to find the right spot to get away from Minnesota winters. Well, I am happy to tell you that Doc is still alive and thriving and Living in the Land of Oranges. Yes, Florida. Exactly where is up to him to let you know. He still has access to post on my blog.<br />
Many of you know he wrote; When Can I Go Home. His story of caregiving to his mother who had Alzheimer's. He now has problems with his eyes, I guess that is because he is a psychiatrist and has seen too many things in people's brains that have taken their toll.<br />
Well back to my world to figure out where I am.<br />
<br />
God Bless & Keep You & This Country of Ours!<br />
joeAnonymousnoreply@blogger.com0tag:blogger.com,1999:blog-3014755924509631239.post-24240933211624138832012-11-05T10:41:00.000-08:002012-11-05T10:41:00.271-08:00Long time for Alzheimer's blog.Hello blog readers especially all of you in the UK that seem to be faithful readers! I realize I have not blogged since March I believe, much too long, I would like to say I have been busy, and I have, but that is not an excuse. I expect you will hear from my dear friend Joe Potocny shortly after I post this also. He loves to jump on after I post and it is always good to see him. <br />
I know everybody just wants to know, "Is Alzheimer's a mental illness?" (see prevous entries over the years)<br />
As far as Alzheimer's, not a whole hell of a lot to report in the trenches. You are all aware or should be of the concept of biomarkers which is the rage in the Alzheimer's world. Basically blood tests, spinal tap cerebrospinal fluid tests, neuroimaging MRI's PET scans etc, looking at ways to identify Alzheimer's months and years before it ever clincally shows up on a day to day basis. The idea is if we identify it really early before it is even there, we can develop better treatments, and even preventative treatments. The giant Alzheimer's Assosciation continues to clip along, non-profit that it is. One noble thing they are doing is trying to get the "experts" to come together, to work on this stuff. I give them much credit. Remember I tought you I think, that the first order of bussiness for any non-profit is to stay in bussiness. Second, secretly every expert it seems want to be the first to win the "space race' that is discover the cure for Alzheimer's. So the mission to make this not competitive and make it truly more collaborative is a noble thing. I know I am cynical and I know every expert and every Alzheimer's associaiton person has been "touched" by Alzhiemer's be it a grandmother, in-law, aging parent, or spouse. Everyone has been touched it seems, that's how prevalent it is. <br />
We tend to gauge people on how close a relation that relative was, are they still living, etc.<br />
Example I know when I show up at the local Alzheimer's walk, I feel more removed and left out, my pain is not as poignant objectively as some family member currently living throught it. <br />
Nobody seems to give a crap. I mean my mother has been dead for 25 years now from Alzheimer's, so get over it right? I seem to have less creidbility as a survivor as the years go on. Perhaps I have gotten over it, the fact that I am not on the inner circle anymore, put some daylight between it and me. Perhaps when you are over it, you still feel bad. <br />
So anyways the biomarker stuff is not cmoing to you corner primary care any time soon. If this ObamaCare stuff continues you can and will see a lot less attention to more meds and treatments being developed. My opinion, and prediction. Many in the know would vainly and sarcastically refute that, but I am sure it is true. God help us tommorrow at the election. <br />
I am seriously considering changing up the focus of this blog. There are so many places you can go to find out the latest fads and Alzheimer's news. I know you get things here that others don't know or say or are afraid to say. You have heard all the stories, you know the course, you will survive. If you are going through it, someday you will be like me 25 years later, still feeling bad but wondering why you don't fit in at an Alzheimer's walk, or if you are like me, and lost somone to AD a kong time ago, you know EXACTLY what I am talking about. <br />
Good luck voting, don't be ashamed or embarrassed anymore to vote for the right guy espeically if you live in a geographic region or demogrphic that exepcts you to vote a certain way.<br />
Lets wage a war on political correctness and be proud of who we are again! Vote from your heart not from hate.Joseph J. Sivak MDhttp://www.blogger.com/profile/04997532868387955895noreply@blogger.com0tag:blogger.com,1999:blog-3014755924509631239.post-67538184855049796552012-03-10T12:31:00.001-08:002012-03-10T12:31:19.777-08:00Cell Energy Dysfunction Is Present Early In Alzheimer's, Before Memory Loss<a href="http://www.ahaf.org/alzheimers/newsupdates/cell-energy-dysfunction-is.html?utm_source=eAlert&utm_medium=email&utm_campaign=ADR_eAlert">Cell Energy Dysfunction Is Present Early In Alzheimer's, Before Memory Loss</a>: <br />
<br />
<a href="https://chrome.google.com/webstore/detail/pengoopmcjnbflcjbmoeodbmoflcgjlk" style="font-size: 13px;">'via Blog this'</a><br />
<br />
and the quest continues.<br />
<br />
God Bless,<br />
JoeAnonymousnoreply@blogger.com0tag:blogger.com,1999:blog-3014755924509631239.post-10665565925195450092012-03-09T20:36:00.000-08:002012-03-09T20:36:05.311-08:0025 years ago my mother died from Alzheimer's disease.<span style="background-color: #edeff4; color: #333333; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; line-height: 14px; text-align: left;"><span style="font-size: x-small;">From my sister Madeline the other day on facebook_</span></span><br />
<span class="caption" style="background-color: white; color: grey; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; line-height: 14px; text-align: left;"></span><br />
<div class="text_exposed_root text_exposed" id="id_4f5ad90f479c89093020796" style="display: inline;"><span style="font-size: x-small;">"Today is March 6th. 25 years ago today, my mother left this earth and moved into<span class="text_exposed_show" style="display: inline;"> heaven. She was 69 (5 days short of her 70th birthday) and I was 29. For almost the last 10 years of her life-she did not know who her children were. She lived in a very good nursing home with wonderful care. When she was diagnosed with Alzheimers Disease in 1980-no one had heard of it except my physician brothers and sister in law who was a medical geneticist. You learn how cruel life really can be when your parent asks you who you are. I tried to do everything I could to fight against Alzheimers-(became the youngest board member of the Alzehimer's Association, gave trainings and talks- everything physically possible to annihilate this killer disease. Now those words are a part of the American fabric.<br />
I only found out something so special about her last year. When I was a teenager, I spent a total of two years on the adolescent medical floor at St Vincent Hospital in Erie. (My parents had met there when my father was an intern and my mother worked there and volunteered for decades there.) Last year, while perusing through her scrapbooks-I found that she had been the president of the Hospital Guild when they raised funds to open an adolescent unit. She never once mentioned that to me. Nor was it she that told me that she used to play the organ at the Warner theater in Erie to go along with the films in the 1930’s. So many things I can never ask her about.<br />
Everyone felt her kindness and caring and how loved her life so much-as a wife,mother, daughter,musician, community volunteer and so many other roles. My greatest sadness in life was not to have parents around as an adult-how lucky people are that could have this kind of relationship-truly a gift. My luckiest gift was to have had the parents I did even though it was for a short time. Luckily, my parents named me after my sweet mother-We were the two Madges. God bless Madeline Mary Mentz Sivak-March 11, 1917-March 6, 1987.</span></span></div><div class="mts uiAttachmentDesc translationEligibleUserAttachmentMessage" style="background-color: white; color: grey; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; line-height: 14px; margin-top: 5px; text-align: left; word-break: break-word; word-wrap: break-word;"><div><div class="fsm fwn fcg"><span style="font-size: x-small;">By: <span class="uiAttachmentDetails" data-ft="{"type":12}" style="color: #333333;"><a data-hovercard="/ajax/hovercard/user.php?id=1215219013" href="http://www.facebook.com/profile.php?id=1215219013" id="js_1" style="color: #3b5998; cursor: pointer; text-decoration: none;">Madeline Sivak</a></span></span></div></div><div class="fsm fwn fcg"><span style="font-size: x-small;"><br />
</span></div><div class="fsm fwn fcg"><span style="font-size: x-small;"><a class="actorName" data-ft="{"type":35}" data-hovercard="/ajax/hovercard/user.php?id=1215219013" href="http://www.facebook.com/profile.php?id=1215219013" id="js_6" style="background-color: #edeff4; color: #3b5998; cursor: pointer; font-weight: bold; text-decoration: none;">Madeline Sivak</a><span style="background-color: #edeff4; color: #333333;"> "</span><span class="commentBody" data-jsid="text" style="background-color: #edeff4; color: #333333;">It was so heartwrenching painful to try to explain to people what was wrong with my mother-as if dealing with it at 20 wasnt hard enough-the insensitivty of most people was what now I consider amzaing seeing how AD is now-"TRENDY DISEASE". obviously we might have what you call bitter feelings-I just don't think we can ever get rid of them it was such a heartwrenching decade."</span></span></div><div class="fsm fwn fcg"><span style="font-size: x-small;"><br />
</span></div><div class="fsm fwn fcg"><span style="font-size: x-small;"><br />
</span></div></div><br />
<span style="background-color: #edeff4; color: #333333; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; line-height: 14px; text-align: left;"><span style="font-size: x-small;">How I'm feeling about it all lately.....</span></span><br />
<span style="background-color: #edeff4; color: #333333; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; line-height: 14px; text-align: left;"><span style="font-size: x-small;"><br />
</span></span><br />
<span style="font-size: x-small;"><span style="background-color: #edeff4; color: #333333; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; line-height: 14px; text-align: left;">"</span><span style="background-color: #edeff4; color: #333333; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; line-height: 14px; text-align: left;">a quarter of a century of broken heartedness now and a piece of yourself and your very fabric, identity and self-worth ripped from you slowly and sadistically unrelenting-thats what AD in a parent does to you as a kid, (despite all the hope</span><span class="text_exposed_show" style="background-color: #edeff4; color: #333333; display: inline; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; line-height: 14px; text-align: left;"> and positve spin BS on the disease), and then you cover the wound that never really heals and limp through life- Thats Alzheimers disease, and nobody really cares becouse it is too icky to talk about, until it happens to them. Then they want to know how you got through it, so you say "I tried to tell you, don't you see? This is why I am like I am" I so wish I had something to offer them. I promise Alzheimer's in a family member does not make you stronger- it weakens and chronically wounds you. Sorry"</span></span>Joseph J. Sivak MDhttp://www.blogger.com/profile/04997532868387955895noreply@blogger.com0tag:blogger.com,1999:blog-3014755924509631239.post-89318809152274601482012-02-27T12:40:00.000-08:002012-02-27T12:40:21.677-08:00Lewy Body Dementia Treated by Donepezil | Dementia & Alzheimer's Weekly<a href="http://alzheimersweekly.com/content/lewy-body-dementia-treated-donepezil">Lewy Body Dementia Treated by Donepezil | Dementia & Alzheimer's Weekly</a>:<br /><br /><a style="font-size:13px" href="https://chrome.google.com/webstore/detail/pengoopmcjnbflcjbmoeodbmoflcgjlk">'via Blog this'</a><div><br /></div><div>this is for our family members that are dealing with Lewy Body Dementia.</div><div><br /></div><div>God Bless,</div><div>joe</div>Anonymousnoreply@blogger.com0tag:blogger.com,1999:blog-3014755924509631239.post-31477675791985155462012-02-20T08:15:00.000-08:002012-02-20T08:15:07.548-08:00Glenn Campbell and Alzheimer's Disease -Music as a Gift for ADWas watching Fox News the other night (because I watch Fox News, and I am not ashamed) anyway they had an AD special on and were talking about Glenn Campbell. He of course has AD and is still touring. It was wonderful to see. Music is fantastic, it permeates the temporal lobe and the memory long term and the personality. It soothes the soul. It seems to be preserved as a memory longer than almost any other entity or medium.<br />
Leeza Gibbons was also interviewed along with Maria Schriver. Leeza is an incredible spokesperson, and presented wonderful metaphor about the primary caregiver being the first rsponder iin an emergency. I really wish she was more of a National Spokesperson for AD. She does not seem too political and very kind, (not sure if that precludes someone from a position like that, but she is a wonderful advocate. You could feel the emotion and pain in both her and Maria, just below the camera interview surface. I have always maintained that if it is 1 year or 100 years that the pain of AD in a loved one the heartbreak never really goes away, but you do go on.<br />
Anyways I love Glenn Campbell, this is a wonderful action to tour and raise awareness that people with AD are just that- PEOPLE.<br />
My son will be going to several nursing homes in the Duluth area and playing guitar and Piano for the residents. Again nothing better than music. He is 16 years old and I am not able to emphasize to him how lonely many residents are and how powerful music is and what a gift he has in music to be able to do this.<br />
His grandmother my mother died from AD five years before he was born.Joseph J. Sivak MDhttp://www.blogger.com/profile/04997532868387955895noreply@blogger.com1tag:blogger.com,1999:blog-3014755924509631239.post-22298169481708717642012-01-31T13:57:00.000-08:002012-01-31T13:57:28.938-08:00Sign The National Alzheimer’s Plan Petition<a href="http://www.alz.org/DM/Advocacy/013012.htm">Sign The National Alzheimer’s Plan Petition</a>:<br /><br /><a style="font-size:13px" href="https://chrome.google.com/webstore/detail/pengoopmcjnbflcjbmoeodbmoflcgjlk">'via Blog this'</a><div><br /></div><div>important.</div><div>God Bless,</div><div>joe</div>Anonymousnoreply@blogger.com0tag:blogger.com,1999:blog-3014755924509631239.post-66810988181399524972012-01-28T10:43:00.000-08:002012-01-28T10:43:23.862-08:00Your Father is Dead. Grieving Children-Fathers and Sons.It was 34 years ago today January 28, 1978, The residents of Cleveland and Buffalo and Erie PA (where I was), remember it as the "blizzard of the century". It was a Saturday Morning and the wind was howling and the mountains of snow were piling up. In Cleveland. it was and still remains the lowest recorded barometer reading in history.<br />
I had just turned 16 a month before. On that morning, I stood in the driveway trying to jump start our car, as somehow my father in the hospital at Cleveland Clinic 100 miles away from Erie, had taken a turn for the worse. We had to somehow get the car started and make it 100 miles in the blizzard to see him. No one including myself, believed in his mortality. It wasn't magical thinking, it was just that my father the strongest, smartest person, whom could provide all forms of safety and security, like no one else in the world ever would or could.<br />
As I stood in the driveway, that phone call came- the one that in an instant changes the course of your life- 'we didn't need to come to Cleveland now'. My Mother in a panic shouted to my sister and brother, "Dad just died."<br />
My first thought was, "Oh no. Now what am I supposed to do?" 34 years later I am still trying to figure out the answer. It is a timeless question for the ages maybe only asked and answered in a way between fathers and sons. I do wish I would have asked him when he was on earth, but I am not sure I would have been ready for the answer then. It might be something that is demonstrated through life, a question we go back to and revisit over the life span.<br />
In that blizzard. I knew then that life would never be the same. I wondered what it would be like for my father to be dead. Would he be all right? How could he leave us? What would the world be like now? What was I supposed to do right then and what was I supposed to do for the rest of my life?<br />
I had a lot of questions and there was now a fundamental problem that has plagued me forever. If the most secure thing in the world -my Father , could die, then there really was nothing secure at all in the world.<br />
I had lost part of myself and part of my identity. When you lose part of your heritage, you roots and your essence, it might figures that one would not know where they were supposed to go or what they were supposed to do from then on in the future.<br />
My life has never been the same, The world has always been a bit more uncertain, and maybe a little cruel, without that safety and security. His loss has colored every aspect of my life. All the success and all the failures, all my roles as a man have been touched by this loss. From father to husband, brother, uncle, friend. personally and professionally. All of the good and all of the hardships, since he died, oh so many hardships, the pain, the sorrow and agony, which I mostly as a man have kept to myself- all these have been colored by his loss, and they have been experienced and endured without him.<br />
On earth I was nobody's son anymore. My mother soon took sick with Alzheimer's. It is a foul, lost feeling not being anyone's son, not belonging to anyone. We create relationships through out life, some are fostered and nurtured, some are lost and decay, but there is no bond like a father and son. There is only one. Joseph J. Sivak MDhttp://www.blogger.com/profile/04997532868387955895noreply@blogger.com1tag:blogger.com,1999:blog-3014755924509631239.post-11139764812860663742012-01-03T08:25:00.000-08:002012-01-03T08:32:42.978-08:00Forget the Politics...Sorry....Doctor vs Provider what is difference between a psychiatrist and a psychologist??"Uhm same thing?" psychiatrist or psychologist? Nope. "Uhm ( from the sophisticated smarty pants of society) a psychiatrist can prescribe meds and a psychologist can't. True but is that the only difference, is that the defining divergence?"<br />
As you probably know I am now from what I can see the most politically incorrect PRO-PHYSICIAN Blog I can find on the world wide web in the English Language. As you know I don't side step stuff by providing the same constant SAFE-helpful information on common medical problems that you can find in a thousand places on the Internet. Granted my blog is true honest and candid, it is highly opinionated, and I like to think I speak for a lot of doctors whom are simply terrified to say some of the things I say about the adversity a physician is up against in this day and age in the practice of medicine. Of course I don't provide SAFE blog posts on all the latest medical technology ipod and ipad apps and all that BS. Another good clean and SAFE fun topic for doctors to blog about.<br />
So I have an opinion on this question and some facts. I even discuss it somewhat in <a href="http://www.niagarapress.net/">When Can I Go Home?</a><br />
Yes psychiatrists are physicians and they can prescribe medication,<br />
But so can Clinical Nurse Specialists and Nurse Practitioners, and Physician Assistants, all have varying degrees of prescribing authority and autonomy and this varies by state. In a couple states psychologists can ever prescribe psychiatric meds.<br />
The honest to God truth is that this physician extender, or mid-level practitioner model had its origins and motivations in necessity. No one wants to go into the Field of Psychiatry. There is a shortage of psychiatrists.<br />
<br />
(I did a recent interview for the Minnesota Medical Associations monthly journal talking about the recession and the effect on depression. The sophisticated and educated Free-Lance Writer hired by the Association to conduct interviews had no idea that psychiatrists were just about the lowest paid specialty in Medicine.)<br />
<br />
Okay so we know people don't go into psychiatry to make money and if they think they are , then they are misguided and ignorant, no big issue there. <br />
<br />
I won't get into all the reasons why there is a shortage of psychiatrists, it isn't about the money, it is a host of reasons. <br />
<br />
Now when you take the shortage issue and you couple it with that fact that politically and perceptually doctors are arrogant SOB's whom only care about making money and therefore just not good people, than you have the legitimization and flourishing of mid level prescribers in psychiatry.<br />
<br />
Let me illustrate my point further by example.: I had a student nurse once, whom was getting a masters degree and essentially then getting her license to prescribe psychotropics, I was supposed to teach and train her. She was a good person and quite bright and caring toward patients. I asked her, "What is the difference between a physician and a nurse prescriber?" She advised spontaneously, " nurses are different than doctors. Nurses talk to their patients" <br />
I will never forget that. To this day it irks me and hurts my feelings to no end. She truly believed that and was indoctrinated into believing that, She was not stupid just politically brainwashed. <br />
All I do all day is talk to patients and give and give and give my energy all day. It has nothing to do with the biological mechanism of the meds. It is what a doctor- a good psychiatrist does, Nurses and psychologists do not have a monopoly on talking to patients.<br />
<br />
So once I was at a music shop and buying my son some guitar strings the quintessential music story pony-tail guy saw my credit card signature and he said "Ahhh... MD making decisions" he actually had it right. No one has ever signed anything since the day I graduated form medical school below my signature, An MD always gets to sign at the most bottom line, I swear to God. The signature underneath everyone Else's assures that individual is the master of all liability and assumes all responsibility when the rubber hits the road,<br />
<br />
Now the reason I talk about liability and responsibility goes to making decisions. By the nature of training the physician is really not allowed to have a comfort zone for making decisions, Decisions imply ultimate responsibility and liability. Sure you can have colleagues to consult get second opinions, but in the end the physician really has no where else to go. By the nature of the training doctors make life and death decisions in the middle of the night after no sleep for forty hours. That is pressure. Psychologists don't have that kind of training,<br />
I may have blogged about this in the past but the point got driven home to me a couple weeks ago. Talking to some psychologists and one in training, this therapist trainee was overwhelmed and intimidated by a patient. She wanted to pass the patient off to someone more experienced, she did. no problem right? So how does that work. Will there always be someone more experienced and how did they get that way?<br />
Training more Training and supervision.<br />
Okay here's the bottom line as a psychologist in your training it is ethical and appropriate to give the patient away to someone Else if you are scared and over your head. No problem sounds like the right thing and it probably is, especially for the patient (psychologists call em' clients like lawyers and accountants and advertising executives have 'clients') I don't want someone who does not know what they are doing.<br />
<br />
Now jump back 20 years, I'm in my residency I am overwhelmed and intimidated by a patient, I don't even want to see the patient behind a closed door. "Please someone more experienced take this patient off my hands. PLEASE! I'm just a resident,.... a doctor in residency training.<br />
So an old supervisor long dead now says to me, you will have lots of patients over the years who are overwhelming, frightening, you have to learn to work through it, accept it deal with it, get good at treating them. There may be no one in the end more competent to fall back on. Get supervision guidance. Learn. I did, the patient lived and got through the year and things went okay, I did all right, and actually helped the patient. I did not have the luxury to dump the patient on someone more experienced.<br />
Therein lies one of the most fundamental difference between psychiatrists and psychologists and nurses.<br />
If a doctor does not know what they are doing, they damn well better get some supervision and figure it out, they don't get to send the patient somewhere else because "ohh it's too hard"<br />
<br />
Anyway I hope and pray for all of you blog readers caregivers around the world that you had a Blessed Christmas or Happy Hanukkah and have a wonderful and prosperous New Year. And thanks for Reading my blog in 2011. I know most people are looking for the difference between delirium and dementia and depression, or questions about Alzheimer's being a mental illness. I will keep blogging in 2012. <br />
I do not forget all of you caregivers world-wide, and we will hope and pray for some SIGNIFICANT Alzheimer's progress in 2012.Joseph J. Sivak MDhttp://www.blogger.com/profile/04997532868387955895noreply@blogger.com1tag:blogger.com,1999:blog-3014755924509631239.post-12806510332356362862011-12-24T10:06:00.000-08:002011-12-24T10:06:41.059-08:00Hello Old FriendSince you are a world renowned author and authoring another book, I thikn. I ike to take this time and say it was nice to know you when you were just a lowly shrink. Best of Luck my old frined in all you do.<br />
<br />
God Bless,<br />
JoeAnonymousnoreply@blogger.com1tag:blogger.com,1999:blog-3014755924509631239.post-4453456689496145512011-12-07T10:49:00.000-08:002011-12-07T10:49:40.762-08:00Physician Coders, Pearl Harbor Annniversary and other issueWell I passed my Billing and Coding Exam for the<a href="http://www.aapc.com/"> AAPC</a>, the American Association of Professional Coders. That is sort of the world that gets physicians and facilities sometimes paid. Every bill to a third party provider that is Medicare of a Private Insurance Company has to have a Diagnostic Code and a Procedural Code. There are thousands and thousands of codes, with several digits. For example the diagnostic code for PTSD is 309.81. In the billing and coding world if you don't bill the right and correct code and have the proper documentation it is a reason and an excuse for an insurance company to not pay the doctor or a facility, or at least delay payment. It is not like medicare or insurance companies have money sitting around and just can't wait to pay doctors. When you can delay payment or simply not pay a doctor and hope that no one notices, that money sits somewhere, typically it is gaining a bit of interest. So to delay payment or not pay is cost effective for the insurance company no matter whom it is. Most people that work in billing and coding do not understand this part. Moreover most people think doctors get paid lots of money anyway, way too much and this makes people angry, this attitude actually provides support to a system designed not to pay doctors if they don't have to. Most people are oblivious too it.<br />
Now there are tens of thousands of people that work in billing and coding. Keep in mind they have families they have to support and feed. The money to pay them comes from somewhere. It is considered a health care cost. <br />
I took the certification exam because I wanted to understand this world. Most doctors coming out of residency and medical school don't even know a thing about billing or coding. We rely on others to do it for us. Of course without physicians there would be no billing or coding jobs. There are only a handful of physicians in the country that are certified coders. I suspect some or most of them are good business people. I know nothing about business.<br />
Billing and Procedural Codes have nothing to do with the practice of Medicine, most coders don't believe that. The exam was 5.5 hours long. I had to go to the bathroom during the test, but could not allow myself the time, since the clock does not stop. To pass the test and become certified you need a 70%. I was sure I flunked. Lots of people flunk. I got a 90%. I was happily surprised. I am turning fifty in one day and I worry that I am not as cognitively sharp as when I was 20 years old. However this test that lots of people flunk reassured me a bit- that I still got it. <br />
The test is hard and chaotic like the world of billing and coding. You actually sort of have to think more like an attorney than a doctor. Find those hairline splits of the black and white dogma and make an interpretation. Remember lots of lawyers wanted to be doctors, but very few lawyers "settled" for medical school. Medical School is harder. The coding certification test was really hard. Maybe as hard as a test in medical school.<br />
I take care of patients all day, every day. regardless of how I feel or how I am doing. I get to give 110% every day to patient care. Call it a responsibility, a burden or a privilege, it is what it is and I probably won't quit my day job anytime soon to be a coder. If many people and entities have their way, we can maybe drive most doctors out of the practice of medicine and make it so arduous to practice medicine that no one wants to go to medical school. Then nurses, technicians and computers can practice medicine, the masses of people will be so dumbed-down by society, that they maybe won't know the difference. Some think this will save money. It won't. I dont' know if this will happen in my lifetime, but I am happy to be a bit more versatile with a certification in coding, should physicians practicing medicine become obsolete. I may have a marketable skill.+++<br />
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Now take a moment to remember in your hearts and in your prayers those Veterans of Pearl Harbor and WWII. It happened seventy years ago today. The last great generation, the last War the United States flat out won. I've visited Pearl Harbor and I've been to Hiroshima. Both are incredibly moving places. There are not so many WWII veterans living anymore, they would be in their 90's, many of them. Thank God for them, because there is a good chance that I would not be writing this blog and you would not be reading it, if it was not for them. Joseph J. Sivak MDhttp://www.blogger.com/profile/04997532868387955895noreply@blogger.com0tag:blogger.com,1999:blog-3014755924509631239.post-28298302936456149412011-11-18T13:53:00.000-08:002011-11-18T13:54:51.746-08:00PTSD, and Alzheimer's Treatments- FDA-on-label or off label, formularies, studiesSo what is new with the treatment of Post Traumatic Stress Disorder? Well we still have two government approved meds, one is Paxil (paroxitine) and one is Zoloft (sertraline). It has been over ten years since these were approved and have been indicated by the FDA for the treatment of PTSD. Sometimes they help and sometimes they make things worse. Basically most psychiatric meds out there have been used for somebody somewhere to treat PTSD.<br />
A few basic facts:<br />
Most people associate PTSD with veterans of combat wars. The truth of the matter is in shear numbers there are more civilians with PTSD than veterans. However for those military veterans whom have served in combat there is a much higher percentage of that sub population with PTSD than in the general population. Combat increases the possibility of developing PTSD. Not everyone whom has serves in combat gets PTSD. The reason there are a larger number of civilians with PTSD is that there are simply more civilians than those whom have served in the Military, by shear numbers.<br />
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The percentage of women with PTSD is higher than men 10% versus 5%. Most traumas being physical and sexual abuse and violence and the same for men as well as combat. Motor vehicle and work accidents are also not unusual sources for the trauma.<br />
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Most people that have experienced a psychological trauma (an event involving death or serious injury witnessed and involving certain responses like helplessness and terror) do not develop chronic long term PTSD. However about 30% of people do develop it. (Millions of people).<br />
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As far as treatments, remember the FDA does not do drug testing, they simply review what comes across their transom, IE mostly studies submitted by the industry (pharmaceutical). PTSD like Alzheimer's disease, is really hard to treat and no one med emerges as the gold standard. Therefore drug companies don't want to touch it. It is more lucrative to simply refine and develop another med in say an illness that does already respond well to medications, like good old major depression. <br />
It is hard to get a med that sort of works for some people, some of the time and spend billions on it only to have the FDA say "no-go drug company, it does not work well enough consistently". . The drug companies like to stick with things that they know will work, and the studies will show really good results so that the government will approve it. The FDA does not say "Hey get more meds for PTSD and Alzheimer's", that is not in their cubicle or jurisdiction to do so, even though we all know we need to develop more and better meds to treat these two catastrophic illnesses.<br />
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We have lots of meds used "off-label". Example a patient with PTSD has tried paxil and zoloft and they get worse of they get side effects and can't tolerate the med, you can't really send that patient away for years, till we have a new FDA approved med we can offer. In other words there are lots of studies and data indicating efficacy and positive results on a certain med for say PTSD.<br />
Researchers like to get published, they like to refute each other, They like to get a name and get famous. Sometimes the drug company funds a study and shows great results and then others say it does not count because the drug company did the study and therefore the way the study was set up was not good science-- since the study was designed to show the med worked. <br />
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Sometimes studies are set up with the hopes of showing a med does not work:<br />
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Why would that be? Well if a med is really expensive and a doctor knows it works for certain patients but say he or she works within a health system that has its own pharmacy formulary that only covers certain meds, then it may be too expensive to tpay for that med. So it is not listed on the formulary. Therefore that doctor won't be able to get that med within that health system for that patient.<br />
Now if you can get a big name, big time, researcher to set up a scientific study to show maybe that type of med is not effective, even though the doctor may have been using that med or combination of meds for years to help patients. Now the doctor can't get it because he wont' be going with the most recent studies and evidence. <br />
It would make the doc look bad if he went against that most recent, vogue, trendy scientific study.<br />
End result is doctor is not allowed to prescribe the med they know is best for their patient. <br />
Remember formularies are negotiated between health care systems and insurance companies and have nothing to do with if a medicine being helpful or not. It is basically economical and not clinical. But if you can get a good study from a big name researcher behind it -to dispute a meds clinical efficacy, it just happens to be 'cooincidently' economically desirable and sweet for the health care system. The slug doctor and the poor patient are caught in their middle and not heard.<br />
Remember also if a doctor is prescribing something "off label" that is for something not indicated by the government, even if they are trying to help their patient and there is a bad outcome, in some jurisdicitons, that doctor is liable and a bad doctor.Yet if the doctor knows there is an 'off-label" treatment that works well in may patients and they withhold it from the patient because the drug company did not push it through the government to get an indication, then it may be unethical for the doctor to withhold that "off-label" treatment if they know it has the potential to provide benefit.<br />
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Conversely when a med comes out on the market, that has gotten approval from the FDA for some indication or another, and even been advertised on TV, the doctor may know in certain patients or most patients that it does not work as well as the studies and the TV commericals show based on real life clinical experience then what does the doctor do? Direct to consumer advertising makes patient ask for meds by name. It builds instant credibility. If the governement approved it, and the doctor does not pracitce exactly what the govenremnt says, and what the TV commercials say, should you get a new doctor?Joseph J. Sivak MDhttp://www.blogger.com/profile/04997532868387955895noreply@blogger.com1tag:blogger.com,1999:blog-3014755924509631239.post-74773911762891368952011-10-23T16:40:00.000-07:002011-10-23T16:42:31.631-07:00Does the Pain of Alzheimer's Ever go Away?It has been over thirty years since my mother was diagnosed with Alzheimer's. It has been 24 years since she died of the disease. I was seventeen when she was diagnosed, my book talks all about that struggle. But something is happening now around me now and it is very strange and very sad. It stirs a myriad of emotions for me. I was a junior in high school when my mother was diagnosed. There was no Internet, no Alzheimer's Association, no blogs, no Aricept, generally no awareness and no hoopla. We had "hardening of the arteries" and old people were "senile". That was about it. For awhile I had to sort of cover up to my friends, my mother acted weird, sort of crazy. It was most embarrassing and humiliating. It made me really enraged. Now some thirty years later I am getting phone calls from many old friend whom are now going through what I went through when I was 17. All the signs and symptoms of dementia. Nursing homes, sibling power plays. Meds, Aricept, Excelon, somehow now I am the expert having lived through all this so many years ago. <br />
They turn to me for advice. Sadly I don't have the answers in the end. I can tell them all about the meds, all about my experience, but in the end for most of the dilemmas, there is no right answer. Should my mother go into a nursing home? She she keep living at home? Is it safe. What is the difference between dementia and Alzheimer's? For some questions I have very clear and informed answers. <br />
With other dilemmas like the nursing home question I advise there is no correct or perfect answer, you have to try to do the best you can, of course you want to stay in the home as long as you can, but when is it not safe, who decides? Basically you do the best you can and no matter what it is going to hurt and it is going to hurt am lot. <br />
Two old friend from high school and college had parents die this year, once again in a perverse way I am the expert. Having gone through it when I was a kid, all I can do is listen. It was impossible for many friends to conceive how bad it felt for my father to die in high school or my mother to get Alzheimer's disease. <br />
I wish people could have related to me then, they couldn't.<br />
Now so many years later,, I am hit with a wave of sadness and anguish for them, I know it hurts for them at 50 years old as much as it did for me at 17 years old. I am filled with sorrow and a deep compassion for them, I want to fix it but I can't. I listen and tell them that is how I was feeling back in high school, so long ago, it is a strange and surreal experience. <br />
Do I feel indignant because none of these friends could really understand me back then like I understand them now? Not really, just a real deep sadness for them. They will go on, but it is never the same, loosing a parent to AD is as bad at 15 as it is at 50 or 70, it is always bad. <br />
Then we can talk about the resilience of the human spirit. Makes us feel better. I like to refer to it as a survival instinct and that's about it. I am convinced that had my father not died when I was sixteen or my mother gotten Alzheimer's disease, I would have been a hell of a lot stronger as an adult and would have had a much easier time of it. And no I am not talking about getting through medical school and all the hateful stereotypical prejudices people have against doctors, I am talking about life. So call it resilience or survival instinct,. Nietzsche was wrong when he said "what does not kill me makes me stronger", that is total BS. It greats on you and tears at your psychological and spiritual core, we are human beings not robots. <br />
Alzheimer's is isolating and it always hurts, regardless of how long you have lived or how strong you think you are. I tell My Friends I know how they fell, I am so sorry, and I know they will get through it. I relate to their every scenario, every painful situation, and regardless of all the hoopla around Alzheimer's in 2011, the pain of what it is like for my old friends to now live with an Alzheimer's parent has not changed at all in thirty years, it is the same stuff, the same pain, I went through as a kid. It hurts them now as it hurt me then.I am sorry I had to go through it and I am so sorry people still have to go through it., but you will make it..Joseph J. Sivak MDhttp://www.blogger.com/profile/04997532868387955895noreply@blogger.com1tag:blogger.com,1999:blog-3014755924509631239.post-61282316008830931142011-10-11T15:17:00.000-07:002011-10-11T15:17:00.705-07:00Would you recognize the early signs of Alzheimer's? - Healthy Living on Shine<a href="http://shine.yahoo.com/channel/health/would-you-recognize-the-early-signs-of-alzheimers-2572892/;_ylt=ApmScCgJoC1uKbr9YDTgLRJrbqU5?pg=40#comments">Would you recognize the early signs of Alzheimer's? - Healthy Living on Shine</a>:<br /><br /><a style="font-size:13px" href="https://chrome.google.com/webstore/detail/pengoopmcjnbflcjbmoeodbmoflcgjlk">'via Blog this'</a><div><br /></div><div>am only posting this so you read the comments. I want you to see what folks really think about us. remember you heard alot of this from me, i think.</div><div><br /></div><div>God Bless,</div><div>joe</div>Anonymousnoreply@blogger.com0tag:blogger.com,1999:blog-3014755924509631239.post-49001364351558578542011-10-10T21:31:00.000-07:002011-10-10T21:31:05.784-07:00Duluth, Minnesota Alzheimer's WalkIts that time of year again. Annual Alzheimer's Walks to raise money to benefit the Alzheimer's Association, and happening all over the country. Here are a few pictures from the one in Duluth, Minnesota at Spirit Mountain. As you can see it was a beautiful fall day, last Saturday Morning. Lots of people, including myself turned out. Congratulations to the Local Alzheimer's Association in Northern Minnesota Region for a successful and well attended event.<br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEge_cwCJthhSqIUeMjQEtTxwGWaD40wr0aVJgIIuXDQRzTrfKEJ8us5fKF9qUU65x6di_CrFP59xJW-Sp7wUnRnHqZ_FIX5Lx18lz8sX4gyG9aIBbpxicEsXkKOnbEDqM9_Uunt_O7AyBw0/s1600/Walk+Alz+1.bmp" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" kca="true" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEge_cwCJthhSqIUeMjQEtTxwGWaD40wr0aVJgIIuXDQRzTrfKEJ8us5fKF9qUU65x6di_CrFP59xJW-Sp7wUnRnHqZ_FIX5Lx18lz8sX4gyG9aIBbpxicEsXkKOnbEDqM9_Uunt_O7AyBw0/s320/Walk+Alz+1.bmp" width="320" /></a></div><br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiojIh0vPLISAJTQKb8s-R42b-r9qCMWp7KMMTCuP5ke0BZ1SbWJjqz9cO0CC94aEwn5BqR_h8QIIHht99vj1dfhla5MDzwMLUHwdP6ZIz9V_QqQCZO4hUkF-r_T5k675usJ8BnH6ArAsFl/s1600/Walk+Alz+2.bmp" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" kca="true" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiojIh0vPLISAJTQKb8s-R42b-r9qCMWp7KMMTCuP5ke0BZ1SbWJjqz9cO0CC94aEwn5BqR_h8QIIHht99vj1dfhla5MDzwMLUHwdP6ZIz9V_QqQCZO4hUkF-r_T5k675usJ8BnH6ArAsFl/s320/Walk+Alz+2.bmp" width="320" /></a></div><br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjjOwwuzppxZLDotlmXDxqJvV-AYRaR-6xM-ejIplPPeDLlFgSWfZFT3-QpzEw6vDrwU9MEvD6VlGWn0NjvLMvFmxuRSXIykEDuSicbjgjWVk9uYmlRoMgRIizwWaxxkhG2nwqydmPO2j76/s1600/Walk+alz+3.bmp" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" kca="true" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjjOwwuzppxZLDotlmXDxqJvV-AYRaR-6xM-ejIplPPeDLlFgSWfZFT3-QpzEw6vDrwU9MEvD6VlGWn0NjvLMvFmxuRSXIykEDuSicbjgjWVk9uYmlRoMgRIizwWaxxkhG2nwqydmPO2j76/s320/Walk+alz+3.bmp" width="320" /></a></div>Joseph J. Sivak MDhttp://www.blogger.com/profile/04997532868387955895noreply@blogger.com0tag:blogger.com,1999:blog-3014755924509631239.post-91389408211341630642011-09-24T23:57:00.000-07:002011-09-25T00:01:18.609-07:00Really: What is New In Alzheimer's Research?? Diagnosing ADWell here we are in late 2011. One of the things that is astounding to me is the disconnect between the research experts and those in the daily grind. If you are the caretaker of a loved one or live with someone with AD you are the real expert in my opinion.<br />
So we have no cure, we have no definitive way to treat it and we have no definitive way to diagnose it with 100% certainty except brain biopsy or autopsy of brain. I need to re notify and present those grave and awful facts to give an understanding and perspective of where things are at and break it down for the general public, so we can understand exactly where the current efforts to combat the disease are at. I suppose a lot of websites and organizations try to do that, but it is not always easy to follow what the heck is going on with AD.<br />
The hottest research, at least what is put out to the media outlets, and available to you and me is in diagnosis. In terms of treatment or cure, one of the things you have to understand is that a lot of the medicines and treatments and funding for studies comes from the private sector IE. big old pharmaceutical companies. I think you know as well as I do that drug companies are considered sinister, evil and only concerned about the bottom line. Everyone likes there funding though. But with the Obamacare crisis- the acceptance and positive regard for drug companies is probably at an all time low. That actually hurts research efforts for things like Alzheimer's disease. -(swear to God)<br />
In Duluth, MN- a city and state that arguably, collectively loves to hate physicians as much as any place: I can barely even talk to drug reps anymore. I almost don't let them in my office. If a doctor around these parts does interact with a drug company representative, then his or her name may be smeared all over the local fish wrapper newspaper for being bad as a doctor and moreover as a human being and everyone believes it. <br />
Who is going to pay for the research. Just dont' hear much about the plight of AD with the health care antics, do you?<br />
So take it up with the publicly funded agencies like the NIMH and the NIH. Very politically correct since they are "PUBLIC". Publicly funded research is up there with the perceived unconditional altruism of the "non-profit" tax status entity. Whatever way you look at it, they are all politically correct right? <br />
I am not going to even get into the funding for AD research relative to many other diseases, but lets just say by looking at the numbers, we can draw an easy conclusion that AD research may be underfunded in the public sector. <br />
So the thought leaders: those in the Research trenches while liasoning up with the Alzheimer's Association, want to figure out a better way to diagnose AD other than a brain autopsy. We want to diagnose it early. Really really EARLY. <strong><em>Early diagnosis without question is good-clinically and humanely it is ALWAYS good</em></strong>. I will not consider the economic, bio-ethical and therefore political implications- the liberal weasels will talk care of that, and it won't be pretty for those whom care about the sanctity of human life- like myself and perhaps most readers of this blog.<br />
Now let's think about the AD process. It is a two-fold process: internal and external.<br />
There is something internally going on at the brain cellular level and also something externally going on with the victim- the behavior, the memory, the personality changes-you caregivers are the experts on the external manifestations of the disease. You live it everyday. <br />
Now consider this-A person does not wake up one day and have Alzheimer's. We all know this and it is established that there are changes at the brain cellular level and gross physical biological changes to the brain. Amyloid and such- the battle cries and buzzwords we have all heard before. plaques and tangles amyloid and tau<br />
It should not be a leap of faith to say that the internal changes to the brain start before the external changes. That's just how the brain and the disease works. Remember we have millions and millions of brain cells, and if you kill one cell nobody is going to notice too much. The disease has to destroy a lot of brain cells to notice externally, that can take years.<br />
Researchers want to make the diagnosis early in the process, really early. Once again, what is happening internally to the brain and the cellular level in an AD victim may start years and years MAYBE even decades before the external change start when victim starts showing the signs of Alzheimer's all of you are so familiar with. If you get it early there might be something more we can do about it. Maybe some day at least stop it before it advances.This is a good thing. It is why we want to find it early, before the external manifestations start.<br />
Now how do you do that. Basically we can look at pictures of the brain, through neuroimaging, CT MRI, PET SPECT all kinds of elaborate scans. We can tag certain cells to go to certain parts of the brain that might be showing changes in Amyloid composition per say. not new to medicine but in terms of radioactively tagging cells to look at the brain, it is not as common and established as say a scan of the heart using tagged cells. <br />
So there is a big area-Advancing Neuroimaging, sophisticated picture of the live human brain and its real time functioning. in PET scans, one of the really expensive but promising radio tracers is called (PiB) which is short for:<br />
Pittsburgh Compound B This can help trace and assess Neocortical amyloid Burden or how much amyloid is accumulating in the brain, with pretty good accuracy. <br />
The second diagnostic tool we have is laboratory tests either blood or cerebrospinal fluid. Biomakers Biomakers and Biomarkers. BIOMARKERS.<br />
So that's it. We have blood (and spinal fluid) and neuroimaigng to work with, and that's about it. Not too much else these days. Those are the main things we have to work with in terms of diagnosing that disease when it is still internal and otherwise invisible, years before it externally manifests itself. Yes of course we have genes to look at and work with, but we have been barking up that tree for a few decades now, and it really isn't totally panning out for everybody across the board as a gold standard to definitively make the diagnosis or rule it out in anyone and everyone. So take some of those better studied genetic markers like ApoE, (well discussed everywhere now) and lets clump them into blood work studies.<br />
Now is there a way we can combine all the bloodwork and biomarkers and Amyloid Burden in the Brain by imaging? Is there???<br />
Well it just so happens that the AIBL (Australian Imaging, Biomarkers and Lifestyle Study) is working on doing just that.<br />
Basically they took 273 people , performed the expensive PiB-PET scans and then also took bloodwork from them. Studying the blood they used 9 different biomarkers in a panel, thing like cortisol and ApoE were tested in the blood panel. They figured out the biomarkers that would correlate with the different amounts of amyloid burden in the brain that would predict and be consistent with developing AD. Basically not an easy thing to do.<br />
Then they took another 817 people or so and didn't do a scan. They clumped these people into clinical diagnosis: AD (external Alzheimer's); MCI (mild cognitive impairment); healthy individuals.<br />
!00% of the Alzheimer's victims had a high neocortical burden based on the blood panel with the 9 biomarkers, (remember the panel correlated with the neuroimaging originally that showed the brain amyloid.<br />
Okay so what does it all mean?<br />
Basically it is moving us a little closed to developing a blood test to allow us to diagnose AD much earlier before it externally manifests. No we are not there yet.<br />
The idea is neuroimaigng is too expensive, getting a spinal tap is too invasive , and we need a good blood test that will work for everyone to make the diagnosis before the disease outwardly manifests.<br />
Remember all the research is happening around the world not only America. As I said in previous posts, it is collaborative and competitive. Everyone wants to be the first to make that discovery. No one openly admits it. That just would not be altruistic. '<br />
So that's where the efforts are. If we can get it diagnosed early, have a mainstream blood test that you can get at the primary care clinic, then perhaps we can find more effective treatments earlier on inn the disease process. . If we don't have meaningful treatments, but we can diagnosis it really years earlier... well the way American society it acting, We will be in really big trouble.Joseph J. Sivak MDhttp://www.blogger.com/profile/04997532868387955895noreply@blogger.com3tag:blogger.com,1999:blog-3014755924509631239.post-56852025240978250752011-09-19T10:46:00.000-07:002011-09-21T20:17:59.565-07:00PHYSICIAN BURNOUT!Wow, what is it? Last I checked physicians were not allowed to "burnout". Burnout is even somewhat poorly defined, since it is not a clinical concept. Everybody knows what it is but it looks different in different people. Consider it a chronic state of emotional, physician, intellectual and spiritual exhaustion-In this case induced by ones job, or occupation or in this sense I still use the term profession. It can manifest with more cynicism, physical health problems, addictions, calling into work sick-(doctors don't get to), anger, irritability, slowed cognition, anxiety, marital and relationship problems and of course the catch all term "depression". Sometimes the depression is a clinical depression. <br />
People end up hating their work, retiring early (if they can) switching careers( if they can) and a whole host of other consequences.<br />
The fact of the matter is just a few years ago, almost all physicians wanted their son(s) or daughter(s) to become doctors. Now only some 30% encourage their children to go into medicine. Most docs over fifty years of age want out ASAP. <br />
There are lots of little initiatives to help physician burnout, often run by para-professionals, psychologists, nurses, you know people that didn't go to medical school, didn't give up all of their adolescence and most of their adult lives to serve. Interestingly enough many of the physicians who lecture about physician burnout have gotten out of the game, they have gotten out of direct patient care.<br />
Now I will tell you the rest of the story, that no one seems to comprehend, even most physicians, the anti-physician New York Times media type outlets, and the general anti-physician mainstream society.<br />
Most.....no make that ALL doctors who make it (WHO MAKE IT) IE gotten through school, residency etc. want to serve others, they want to help patients. They are also as a whole very self-punitive, very even shame based, we are our own harshest critics. Most take it very very hard and suffer in silence when things do not go well with a patient. Moreover we are not allowed to whiners, it is politically incorrect, and just plain wrong if you are a physician, this blog is just plain wrong- because it talks about the things the smiley faces whom have gotten out of the clinical world and make a decent living, as well as all the physician despisers annoyed- it is uncomfortable to think about.<br />
Most docs are perfectionist by nature, everyone whom isn't this is WEEDED OUT in the 12 year process. The integrity and commitment is phenomenal, and yet their is something profoundly masochistic and self-punitive about the culture and very nature of the indoctrination of becoming a physician. In other words you pretty much give up yourself, it is selfless. That is in the backbone of any good physicians, and most are good. The not so good one 'wannabes', did not have the intellectual or spiritual or emotional commitment.<br />
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So here is a secret, maybe not a secret but a taboo statement within society.- a lot of physicians want out of direct patient care, this is where the stress and burnout comes from. Why? There is more pressure than ever, to see patients- as many as possible, that pressure comes from payers, administrators etc. <br />
There is literally a bulls eye on physicians backs in regard to litigation, when we don't get the outcome we want we immediately want to sue the doctor. We want retribution, accountability. We want our doctor to be perfect, to know everything and have a wonderful bedside manner. <br />
But nowadays we live in such a physician-hostile climate, we are ready to sue if something does not go our way. It is another pressure. Also we really place no actual value on the doctor. We know how much it costs to get our oil changed in our car or to get a crown on our tooth at the dentist, but we never really know how much a doctor's appointment costs. Moreover we get huge uncovered bills from institutions and the general assumption is that all that money is going into the doctors pocket. I will never be able to convince anyone outside of medicine that the doctor does not see that money. It helps us devalue and hate the physician even more.<br />
And here is another concept- there is generally a breakdown of the family more social media, less human contact and intimacy and perhaps as a society we treat each other with less respect than ever. Call it a post-war pervasive narcissism except know we are about 5 generations post war, and have been busy indulging ourselves for decades, feeling good putting ourselves first, convincing ourselves that the destruction of the nuclear family is cool and politically correct. what does this have to do with physician burnout???<br />
NO ONE WANTS TO PAY TO BE CARED ABOUT. The physicians office is one of the few institutional bastions left in our ever-advancing society where a person is supposed to and can feel cared about. <br />
With that said a person can never feel cared about from the nurture they didn't get from their fragmented family of origin. Now couple that with a doctor whom you don't pay- (insurance does or does it?) and that doctor is working hard to be good enough and help you as much as they can, but it will never quite be enough given the combination of factors conscious and unconscious between patient and doctor. It is a perfect storm for an -anti-physician society to advance their distaste towards doctors and an even more perfect storm for physicians whom actually take care of patients all day, to become really really burned out.<br />
But since we are so shame-based, it is completely taboo to say we dont' like treating patients anymore. That is a sign of being bad, and that is the LAST thing a doc wants. So we burnout or quietly switch careers, except most docs have no marketable skills outside of medicine.<br />
Physician burnout is more complex than eating right, balancing work and play, getting enough sleep, prioritizing family, exercising. Yes all that stuff is crucial to avoid burnout but it really needs to be understood, from a developmental and personality-character perspective to be able to do something more about it. One must also consider what has happened to society in the last four generations, to understand why there is more physician burnout.<br />
I would love to see a doctor that still takes care of tons of patients all day speaking on burnout, except they don't have the luxury. Sorry I'm just whining, I must stop. I know like all good docs all over this great nation of ours, I will just keep trying harder every time.Joseph J. Sivak MDhttp://www.blogger.com/profile/04997532868387955895noreply@blogger.com0tag:blogger.com,1999:blog-3014755924509631239.post-54119052185518557862011-09-06T17:09:00.000-07:002011-09-06T17:09:45.437-07:00WAM Match Appeal #1: Advocates 9-2-11<a href="http://www.alz.org/dm/wam/090211-Advocacy.htm?tr=y&auid=9435083">WAM Match Appeal #1: Advocates 9-2-11</a>:<br /><br /><a style="font-size:13px" href="https://chrome.google.com/webstore/detail/pengoopmcjnbflcjbmoeodbmoflcgjlk">'via Blog this'</a><div><br /></div><div>caring for those with Dementia.</div><div><br /></div><div>God Bless,</div><div>joe</div>Anonymousnoreply@blogger.com0tag:blogger.com,1999:blog-3014755924509631239.post-10178461613865713302011-09-06T12:47:00.000-07:002011-09-06T12:47:44.532-07:00Eternal Peace or endorphin release, or God, religion, afterlife, the divineWell it has been a really long time since I blogged. The summer is officially gone by us as we just finished labor day. It is coming up on two years sincee I fell off a scooter and broke my face in 4-5 places. I have ringing in my ear and a tumor called an acoustic neuroma, which Mayo clinic can do nothing about except watch it and charge me lots of money that my insurance won't totally cover to pay for staging it once a year. It is on my cochlea which is sort of the end of the eight cranial nerve the other end connects up to your brain.<br />
Also loosing my hearing in that ear. Because of location that won't operate. More later on this.<br />
Not too much new on the AD front. Australian study and Mayo looking at a bunch of blood markers, a whole panel of tests to try and identify Alzheimer's in people before it becomes clinically apparent and obvious. So earlier recognition is where it is at. Testing and findingg it before it becomes apparent, maybe years before. No clear treatments emerging. <br />
So this summer I went to a Benedictine Monastery for a few days in St. Leo Florida mostly to pray for healing for my ear. I ended up praying for my enemies and people I can't stand. My ear did not get cured but me stress level went down considerably. <br />
I also ran my first 5k marathon this summer, ironically with the exception of the cancer in my ear, I am in probably the best shape of my life at nearly 50 years old.<br />
I had a bit of a spiritual moment. I was with my son and a climbing friend. We climbed the South Sister in the Cascades in Central Oregon. The summit is about 10,500 feet or so. We started at 5AM and completed the summit about 12 noon. Note that this is a climb I never completed in 1994 when I was 33 years old. I started out to late in the day on that one. Now at almost 50 I completed the climb. <br />
On the way down we rested a few times. At one point, I sat down then layed back. The sun shined on my face and warmed me on the side of the mountain. I said aloud, "this is what it must feel like to be dead." I didn't mean it in a bad way, but it upset the friend my son and I were climbing with. He said, "don't talk like that." What I meant what I felt so incredibly at peace, I wished for nothing, felt no stress or worry, just the beautiful sunshine warming me. It was so incredibly comfortable. I corrected my self and said, "No I mean this is what heaven must be like." I felt really peaceful and loved and even connected to God. Nothing hurt, I can't remember my ear ringing or throbbing, just peace.<br />
This happened a couplee weeks before I went to the monastery. <br />
It is unusual to have an experience like this. One could say I was exhausted from climbing for 8 hours and it was cold and brutal winds at the top of the mountain but on the way down it was sunny and nice. Perhaps it was endogenous opioid release, a similar feeling a person may get from taking opiates.<br />
On the other hand it simply could have been God and a peaceful loving content and fulfilled feeling.<br />
You see how I struggle between the science and the spiritual. <br />
At any rate I was lucky to have this moment, this time where I felt close to God. <br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh6uQD-ocMtPvis4yuWycNMmcsx8cTfl3gLhkh8P448HwOhMfypy7NLxxsxPYD01GJ6Fo63E5CXORCfysXQYvfQriHW8CuFs104I_hxTKw9xcLBJyQj2afIGc5aKFWc08UvJq6CKEYXJWtd/s1600/south+sister+one.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="290" nba="true" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh6uQD-ocMtPvis4yuWycNMmcsx8cTfl3gLhkh8P448HwOhMfypy7NLxxsxPYD01GJ6Fo63E5CXORCfysXQYvfQriHW8CuFs104I_hxTKw9xcLBJyQj2afIGc5aKFWc08UvJq6CKEYXJWtd/s400/south+sister+one.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">SOUTH SISTER in OREGON</td></tr>
</tbody></table>After loosing my parents at an early age, a lot of life has been filled with a certain stress, sometimes an anguish, (read the book) like everyone I have my struggles. As a doctor and a psychiatrist, a lot of my life is surrounded by the worst pain and evilness known to mankind and the terrible things that human do to one another and how it affects them. So if I get a moment on the side of a volcano and it is complete with human fulfillment I have to take it as a sign from God. I wish I had more of those signs, but we take what we are given. It was a good thing, perhaps a divine thing.Joseph J. Sivak MDhttp://www.blogger.com/profile/04997532868387955895noreply@blogger.com0tag:blogger.com,1999:blog-3014755924509631239.post-37400024237982987322011-06-29T16:12:00.000-07:002011-06-29T16:12:51.963-07:00Thanks to Normal, Illinois for Book Signing<div class="separator" style="clear: both; text-align: center;"><br />
</div><div class="separator" style="clear: both; text-align: center;">Lots of thanks to the very kind people of Normal, Illinois for coming out to the book signing at the Library last week. Here are a couple of pics from that signing. </div><div class="separator" style="clear: both; text-align: center;"><br />
</div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjjpeaVocACgGH0vkMs4oUdMvsmABpJyK76Jgn5afodDVOKcfCLlxwETn3-Ty1YwciRJJrMt92phR_iGkO7-za5vtrRktSa05H5b0Ce0Zt6fFc1CPsoU5CNEgdkZzHWOhAumCik3ikKg13m/s1600/DSC08769.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" i$="true" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjjpeaVocACgGH0vkMs4oUdMvsmABpJyK76Jgn5afodDVOKcfCLlxwETn3-Ty1YwciRJJrMt92phR_iGkO7-za5vtrRktSa05H5b0Ce0Zt6fFc1CPsoU5CNEgdkZzHWOhAumCik3ikKg13m/s320/DSC08769.JPG" width="320" /></a></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi7IFCxhj6rFtsti30PDKCv8ET9VuT_02VJmexOsiJ9G-fJzo_0p4oAn5vq692ABPCNSIJc7w4kyA8rIk-5HtfRCzo7ytwCsXwP-HLLaT1IykAJIfL9eFZccee9au5-5jWH2vCbnfwQjXwu/s1600/DSC08768.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" i$="true" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi7IFCxhj6rFtsti30PDKCv8ET9VuT_02VJmexOsiJ9G-fJzo_0p4oAn5vq692ABPCNSIJc7w4kyA8rIk-5HtfRCzo7ytwCsXwP-HLLaT1IykAJIfL9eFZccee9au5-5jWH2vCbnfwQjXwu/s320/DSC08768.JPG" width="320" /></a></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgmynp-rdCe_TKjgKF16Sap9gLVzK6FUK1ZmUCigZmwYyrfzj6lOR6uvGzJbBKhKE9fgX4Z5jnkNmiq13FoFGuV9rjj6jxqcTo49dIOCYHpD2WrpOVN0_4FUVKw8VNulbQVfAlQhIMDFFvL/s1600/DSC08766.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" i$="true" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgmynp-rdCe_TKjgKF16Sap9gLVzK6FUK1ZmUCigZmwYyrfzj6lOR6uvGzJbBKhKE9fgX4Z5jnkNmiq13FoFGuV9rjj6jxqcTo49dIOCYHpD2WrpOVN0_4FUVKw8VNulbQVfAlQhIMDFFvL/s320/DSC08766.JPG" width="320" /></a></div>Joseph J. Sivak MDhttp://www.blogger.com/profile/04997532868387955895noreply@blogger.com0tag:blogger.com,1999:blog-3014755924509631239.post-39554427344915752022011-06-14T20:22:00.000-07:002011-06-14T20:27:24.242-07:00New Blog: Medical Fiction Writer and other updatesGood Day. Long time no blog. I have been busy with some Health Care Issues lately. In fact I have been down to Mayo Clinic twice since I last blogged. (Great Venipuncturists at Mayo, also fairly decent restaurants in Rochester, MN) I won't bore you with the details right now, needless to say it sucks, but then you go on as best you can, as time keeps marching on.<br />
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Also I have been busy trying to survive as a Private Practice Physician in the State of Minnesota, despite the best efforts of many bureaucracies and agencies to annihilate entities like myself: all done of course shouting the Battle Cry and in the name of health care "REFORM". When it is all said and done, we will still need doctors to take care of patients and patients who need to be cared for and cared about by their doctors. <br />
It is absolutely astounding how many people are now employed (with really good employee health benefits I might add) to hinder, hamper, occlude and basically prevent physicians from simply spending their time taking care of their patients. ASTOUNDING<br />
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On the lighter and more fun side of things, I started a new blog.<br />
It is called <a href="http://medicalfictionwriter.blogspot.com/"><em><strong>MEDICAL FICTION WRITER</strong></em></a> CHECK IT OUT. Not too much there yet, but it will get there. Over the last couple if years I wrote another book. very different than When Can I Go Home?. This one is a work of - you guessed it-medical fiction. It is sort of a drama, action, crime, romance, with chaos, violence, doctors, lawyers, courtrooms, lots of things. Stay tuned. I'm in the process, a very grueling process of doing the first edit.<br />
The blog will be for writers and readers and about writers and readers of medical fiction. and of course Medical Fiction Books.<br />
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For all you Alzheimer's caregivers, it is Summer at least in the Northern Hemisphere, if that's where you are. Try to get outside for some warmth, even for a little while. Keep the faith, do your best, I know you didn't sign on for this, but I am sending you my positive thoughts, hopes and wishes and energy right now. What I still have of that positive energy, it is there just below the surface of my cynicism! I promise though, that positive energy and hope is real in me, just as it is in you, whether you know it or not. So don't get too lost in losing the daily battles, overall by caring for your loved one, with your devotion and dedication, you are winning the war on this thing.<br />
God Bless.<br />
Joseph J. Sivak MDhttp://www.blogger.com/profile/04997532868387955895noreply@blogger.com0tag:blogger.com,1999:blog-3014755924509631239.post-25447324110857910142011-05-15T12:09:00.000-07:002011-05-15T12:38:37.677-07:00Brand NEW BOOK SIGNING and Alzheimer's Q & A suburban Chicago and the HeartlandMonday June 20, 2011 - 7 PM Evanston Public Library, Evanston, Illinois <br />
<div style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none;">Thursday June 23, 2011- 5:30 PM Normal Public Library, Normal, Illinois</div><div style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none;"><div style="text-align: center;"><strong><em><u><span style="color: orange; font-size: large;"><a href="http://www.niagarapress.net/contactus.html">CLICK HERE FOR MORE INFORMATION</a></span></u></em></strong></div><br />
<div style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhQjJVxkLpGmd31N90bYJ2f5-1AIEJFYX8aFFIaFqPs3onslHURJqe5FZjqQZFSrkP8UhPnfCHFGeVCKMboVPEVjhH14cda91ZghWFEIrLiAEv0Bv5kIItD7m5LKzGf7NI2qKGN678Yu2js/s1600/EVSNSTON+PUblic+library.jpg" imageanchor="1" style="clear: left; cssfloat: left; float: left; height: 132px; margin-bottom: 1em; margin-right: 1em; width: 206px;"><img border="0" height="150" j8="true" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhQjJVxkLpGmd31N90bYJ2f5-1AIEJFYX8aFFIaFqPs3onslHURJqe5FZjqQZFSrkP8UhPnfCHFGeVCKMboVPEVjhH14cda91ZghWFEIrLiAEv0Bv5kIItD7m5LKzGf7NI2qKGN678Yu2js/s200/EVSNSTON+PUblic+library.jpg" width="200" /></a></div></div><div class="separator" style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none; clear: both; text-align: center;"></div><div class="separator" style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none; clear: both; text-align: center;"><br />
</div><div class="separator" style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none; clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh0UZP8jwWw_I-sAN7cpbWDxWUAsqagmoMvUNjFXX0q0wC74Qkt-ePTS4RYlWNYIH_vcwQ1Zd5QZWbnJmIA1uCqwezW03E7QCgn4F3SiivLqW-yuWmJSApfaHeOEVhoN33KAMPYFBnHncNH/s1600/Illinois_wheat_field_near_Odell__IL.jpg" imageanchor="1" style="height: 118px; margin-left: 1em; margin-right: 1em; width: 200px;"><img border="0" height="150" j8="true" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh0UZP8jwWw_I-sAN7cpbWDxWUAsqagmoMvUNjFXX0q0wC74Qkt-ePTS4RYlWNYIH_vcwQ1Zd5QZWbnJmIA1uCqwezW03E7QCgn4F3SiivLqW-yuWmJSApfaHeOEVhoN33KAMPYFBnHncNH/s200/Illinois_wheat_field_near_Odell__IL.jpg" width="200" /></a></div><div class="separator" style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none; clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEijm3XFLMZiFO72onQC55creBgg7gijdIMs2sNZMrAZuIzIqvh1WQDSjboB22Bkk5uHnGiTRb970mXVf6_k0nI8UjuQN1rBhq-XEu0r06nZOBWLKGSZdVf6DWe8eaYSKx8hw9_4HMFD93fo/s1600/chicago5.jpg" imageanchor="1" style="clear: right; cssfloat: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="150" j8="true" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEijm3XFLMZiFO72onQC55creBgg7gijdIMs2sNZMrAZuIzIqvh1WQDSjboB22Bkk5uHnGiTRb970mXVf6_k0nI8UjuQN1rBhq-XEu0r06nZOBWLKGSZdVf6DWe8eaYSKx8hw9_4HMFD93fo/s200/chicago5.jpg" width="200" /></a></div>Joseph J. Sivak MDhttp://www.blogger.com/profile/04997532868387955895noreply@blogger.com0tag:blogger.com,1999:blog-3014755924509631239.post-13646599971741866412011-05-07T08:55:00.000-07:002011-05-07T08:55:59.862-07:00Happy Mother's Day<span class="messageBody">Happy Mothers day, and for all of those with dead mothers, those who have lived though so many of these mother's days without the support, the basic self-esteem and innate confidence that come from having a mother on this earth, you are not alone. God Bless and carry her strength and love with you.</span><br />
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<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh8VxpDcuDFpsTl5F4rQzIdRmDgSDJixxldEI-yIhfTPXzH50tm5eXq0lo5aQ35aHra0vpInly6ig_Nlv1TSIJaudJLOc_ie8qcDNMZYBgkrb96p1nr89QJixECVp7clQK0IReo7nd1DFX2/s1600/mother.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" j8="true" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh8VxpDcuDFpsTl5F4rQzIdRmDgSDJixxldEI-yIhfTPXzH50tm5eXq0lo5aQ35aHra0vpInly6ig_Nlv1TSIJaudJLOc_ie8qcDNMZYBgkrb96p1nr89QJixECVp7clQK0IReo7nd1DFX2/s1600/mother.jpg" /></a></div><span class="messageBody"><span class="messageBody">Oh and if you are fortunate enough to have a Mother on this Earth, don't forget to honor her the rest of the year, not just Mother's Day with brunch and flowers,</span></span>Joseph J. Sivak MDhttp://www.blogger.com/profile/04997532868387955895noreply@blogger.com0tag:blogger.com,1999:blog-3014755924509631239.post-29125454976961445712011-05-06T08:25:00.000-07:002011-05-06T08:25:18.845-07:00Nocebo Effect-Blog Post From FreeLance MDHere is a post I did for <a href="http://freelancemd.com/blog/2011/4/12/the-nocebo-effect.html">Freelance md</a> it is on the Nocebo effect. Another Website Called <a href="http://physiciannexus.com/forum/topics/the-nocebo-effect">Physician Nexus</a> added it to their site. I was invited to post and told I could post on anything I wanted, related to medicine or doctorhood. Well that covers about a billion potential topics. I wanted to cover something out of the mainstream, that you won't see many people write or talk about, for a whole host of reasons. If you have any questions, please feel free to ask or comment.Joseph J. Sivak MDhttp://www.blogger.com/profile/04997532868387955895noreply@blogger.com1tag:blogger.com,1999:blog-3014755924509631239.post-64642401114220772162011-04-23T15:19:00.000-07:002011-04-23T15:19:18.529-07:00NEW PODCAST- Delirium vs Dementia vs Delusion Some Considerations<span style="color: red; font-size: large;"><strong>Click below on play bar to listen</strong></span><br />
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<strong><em><span style="font-size: large;">Here is a new podcast on Delirium, Dementia and Delusion. Some of the major differences and considerations. If you have quesitons please email me or comment below. The podcast is in lecture format, and there is too much to cover for one podcast, but some major features and genreal informaiton are discussed. These issues seem to come up frequently on the blog in search engine queries, so I hope this podcast is helpful.</span></em></strong>Joseph J. Sivak MDhttp://www.blogger.com/profile/04997532868387955895noreply@blogger.com0