Skin Wellness- How to Maintain Your Beautiful Exterior

Posted on May 6, 2013 by mcminnclinic

True story: Her hands were cracked, dried, bleeding and painfully burning. She had tried all of the usual over-the-counter remedies, and had been to 4 different dermatologists. She had been placed on numerous prescription salves, and she had taken oral steroids and other medications. Still she suffered for months on end with no relief. Nothing was working. She came to see me as the doctor of last resort. I started with a history and then proceeded with an examination. She was dry all over, but her hands were in particularly bad shape as described above. After contemplating the issue, I started her on a targeted nutritional program to build her skin health from the inside out. When I saw her back in the office a few months later, I could hardly believe my eyes! Her hands were as smooth as a baby’s bottom. The thick, dry skin was gone. There was no sign of the cracking and bleeding. The patient was relieved that she didn’t have to live a life of suffering with this painful condition, and she was delighted with the outcome. I shared her joy in seeing such an amazing recovery. All of this was accomplished with no drugs, but only by fixing her gut and giving her body the nutrients it needed to heal itself.

I use this story to illustrate the importance of skin health, and to point out that we need to build skin health from the inside out. We tend to take our skin for granted until something goes wrong. Also, we focus on the cosmetic topical aspect of skin care while ignoring the underlying functional and structural integrity of the skin. Certainly topicals may be helpful, but attention to the fundamentals of nutrition, hydration, hormone optimization, detoxification, and stress management plays a crucial role in optimal skin health.

Skin is the largest of all of our bodily organs. It is what interacts with and protects us from our environment; heat, cold, chemicals, UV radiation, and infection. It has many important bodily functions such as: detoxification, regulating hydration, and controlling body temperature. It carries blood vessels, and is home to many of our nerve endings. It houses the fifth sense, which is the sense of touch. Finally, it is the first thing that we and others see, so understandably it is important for our appearance to others and our own sense of self.

It is also important to understand that many underlying medical conditions, including nutrient deficiencies and toxins, may manifest themselves as skin conditions. Drug reactions, cancer, infections, gut dysfunction, rheumatologic conditions, allergies, and more may present as skin conditions. Stress, both acute and chronic, may affect the appearance and health of the skin. All sorts of skin conditions, including eczema, psoriasis, and hives may experience an exacerbation during a time of intense stress.

As you can see, skin is not just something to hold our innards in. It deserves its rightful place, right up there with heart and brains, in the list of complex and important organs. Now here are some tips to help you maintain beautiful, glowing, youthful, healthy skin at all stages of life.

*Attend to the foundations of wellness: Nutrition, optimal hydration, exercise and restorative sleep. All of these affect your skin health.

*Diet: It all starts with what you eat. Start with a whole food (not processed food), mainly plant food diet, with added lean protein, and some “good fats.” Your body needs the fiber to keep the gut healthy which affects the skin. Your skin needs the bioflavenoids for healthy vessels and blood supply for the skin. It needs the protein to help build the skin. It needs the good fats to build healthy cell walls and lubricate the skin.

*Foods rich in the “good fats” include: salmon (and other cold water fish), walnuts, canola oil, olive oil, flax seed, flax oil, and fish oils.

*Maintain good gut health. Good digestion, absorption, and metabolism are important for these nutrients to get to the source.

*Add a good multi-vitamin and multi-mineral

*Also add extra beta-carotene, biotin, and B complex

*Add extra anti-oxidants: Vitamin A, C, E, D, and selenium.

*Antioxidant rich foods such as blackberries, blueberries, strawberries, plums, and green tea may also be helpful.

*Avoid frequent prolonged hot baths and hot tubs.

*Avoid harsh detergents.

*Avoid over exposure to household cleaners and chemicals.

*Avoid lotions, oils, sprays, sunscreens, etc. with toxins and harsh chemicals.

*Acupuncture and Chinese herbals may also be helpful.

*Avoid sugar, simple carbs, and processed food.

*Get your hormones tested, optimized, and balanced. Hormones play a critical role in maintaining skin health.

*Healthy levels of testosterone for men and women are important for skin moisture thickness.

*As women lose their estrogen, everything dries out, creating a significant increase in facial wrinkles. Supplementation with bio-identical estrogen can help tremendously. Also, topical estriol face cream may also be very effective for wrinkles, and skin moisture

*Don’t smoke- this is disastrous for your skin.

*Avoid overexposure to the sun or tanning beds.

*Use natural skin care products without toxins.

*Dry brush exfoliation in the AM before your shower may also be helpful.

*Topical Vit C and Vit E, and regular skin care may also be helpful.

Bottom line: Take care of your skin, so that it can take care of you.

Yeast Overgrowth Syndrome

Posted on January 2, 2013 by mcminnclinic

“I never got better until they treated the yeast.” I have heard this statement many times from patients suffering from various maladies such as headaches, brain fog, depression, irritable bowel, chronic sinusitis, weight gain, and fatigue. Due to the modern day world that we live in I am seeing more and more people suffering with yeast overgrowth. Old fashioned doctors used to say that “good health starts in the gut.” I think that they were right.

Poor gut health can manifest itself in many ways. Ideally we have a perfect balance in our guts with good bacteria, bad bacteria, and yeast. It is a symbiotic relationship. We can not live without our friends the “good bacteria.” Yet the modern American lifestyle tends to promote poor gut health. The standard American diet (or SAD diet) is full of sugar, simple carbs, and processed food, which is not good for the body, but which is ideal for the overgrowth of yeast. Yeast loves to feed off of sugar. When you combine this with the overuse of antibiotics in our society, it makes for a toxic environment in our guts, and that is often the beginning of a slippery slope to worsening health.

Chronic sinusitis is a classic example. We go to the doctor with a stuffy nose, and the standard response is to start antibiotics. However, according to the Mayo Clinic “fungus (yeast) is the likely cause of nearly all of these problems.” So in the long run, if we don’t treat the yeast, the antibiotics kill the bacteria, promote more yeast overgrowth and they can actually make the problem worse.

At McMinn Clinic we have Yeast Overgrowth Syndrome on our radar screen, and when appropriate we treat yeast overgrowth with a comprehensive and robust anti-fungal protocol. We have been blessed with many testimonials from our patients with stories of recovery, often after suffering with symptoms of yeast overgrowth for many years.

Call McMinn Clinic at 868-1313 and set up your appointment for a thorough evaluation for yeast overgrowth syndrome.

Grumpy Ol’ Man Syndrome

Posted on December 12, 2012 by mcminnclinic

On a given day if you asked my wife, she might claim that they named the above medical syndrome after her own beloved husband. I must admit that I have my good days and bad days on the home front. However, I take some comfort in knowing that I’m in good company. In fact, if my women patients are right, “grumpy ol’ man syndrome” has reached epidemic proportions.

The usual scenario is that the wives drag their husbands in, kicking and screaming the whole way. Of course, the men are in complete denial and are busily hoping that Scotty will beam them up at any moment and rescue them from any event in which “feelings” are discussed. Guys need to have just the right pretense for talking about such things. It’s OK to ask “how’s the marriage” when you’re riding around in a golf cart with a good ol’ buddy, or out in the middle of a lake on a fishing boat. It’s like foreplay; the only acceptable ways to engage in such conversation is if the foreplay is centered around football, golf, beer, fishing, hunting, or NASCAR. Just to cold turkey and purposely sit down and have a talk about sensitive issues such as feelings can seem extremely unmanly and may be down right uncomfortable, even with the doctor.

Fortunately the wives are on the case big time, and they usually have the common sense to come with their strong silent types to the initial doctor’s appointment. Although I know going into it, who is going to be the communicator, I at least show the guy enough respect to address the question directly to him. “How’s it going” I say. “Fine,” or some other one worder is usually about all I get. Then the truth spews forth like an Icelandic volcano from the fairer half. “He’s grumpy, sullen, irritable, moody, depressed, and he has no sex drive. He comes home after work and just crashes into his Lazyboy. He doesn’t have any energy, and he doesn’t want to do anything. He has no interests, no get up and go, no joy in life. He’s totally disconnected. And he’s getting fat and lazy.”

On the face of it such phrases may sound like fighting words. Instead, more often than not, he agrees with her, or through his silence and lack of argument one can assume that she is not too far from the truth. Now we’re starting to get somewhere. Just like when you look up at the summer night sky and see the big dipper, it all comes into focus. He has “Grumpy ol’ Man Syndrome.” Another name for this dreaded and all too common condition is “Andropause.” At that moment, I know that I can help him.

Just like women go through menopause, men go through a similar process wherein their levels of hormones (in this case testosterone) fall to well below the acceptable range. Also just as a woman’s menopause may have dramatic affects on her health, her mood, and her behavior, so too andropause may insidiously choke the life out of even the most macho of men. They often become a shell of their former selves. The men, their wives, family, friends, and co-workers all suffer the dreaded consequences of the decline in testosterone and its accompanying symptoms.

At the risk of seeming to be biased toward men, after all I personally fall into that category, I have to stand up for the guys just a bit and let them off the hook. In many instances they can’t help it. The behavior, as I described above, is not of their choosing, but instead it is often hormonally driven. If only they had a robust and balanced hormone profile they most likely would be their usual lovable and manly selves.

True story: I had a patient in the office just recently who fit this description to a tee. His wife drug him in back about 6 months ago with the classic symptoms of “grumpy ol’ man syndrome.” He was clinically depressed, grumpy, frail, had no libido and was starting to suffer from ED (erectile dysfunction). We did all the appropriate lab testing and found that his testosterone was quite low. I put him on a program of hormone repletion, nutritional supplementation, and life style changes. WOW! He came back in for his follow-up visit and announced that he was feeling fantastic. As he put it, his energy was “through the roof.” He could hardly believe what a difference the program had made for him. The depression was gone. Energy was better. He was exercising again. He was interested once again in sex, and interested in life in general. His ED had magically disappeared, and he was thinking much more clearly. He and his wife were both ecstatic. She had her beloved husband back. He had his life back, and they had their marriage back. There is no antidepressant or any other “drug” in this world which could have achieved this outcome for this patient.

Furthermore, low testosterone and andropause can have even more dire consequences. A study published in the Archives of Internal Medicine describes an 88% increase in mortality in male veterans with low testosterone. Other published studies form reputable medical journals have linked low testosterone with poor cognitive function, Parkinson’s disease, Alzheimer’s disease, osteoporosis, hardening of the arteries, heart failure, insulin resistance, diabetes, and metabolic syndrome. Testosterone decline may also contribute to abdominal obesity, decreasing muscle mass, joint pains, loss of self confidence, fatigue, disturbed sleep, anxiety, and excessive worry. Low testosterone is not just about muscles and libido. It is about optimal health, and even mortality.

Testosterone must be respected. Like all medications it must be used properly and must not be abused or used in excess. Testosterone replacement should never be done if it is not medically indicated. Furthermore, the replacement program must be conducted properly with adequate monitoring to attain optimal levels, while paying attention to possible side effects. If done properly, it is safe and may be profoundly effective. Testosterone replacement therapy is not for everybody. However, in the presence of “grumpy ol’ man syndrome” like with my patient described above, it can make a remarkable difference in the life of the patient and his partner.

Bottom line, if you suffer from “grumpy ol’ man syndrome,” get your T checked, and get it optimized. If your loved one shows signs of this dreaded disease, drag him in and get him checked for “low T.” You’ll be glad you did.

Feeling Fat, Fatigued, and Depressed; Think Low Thyroid

Posted on November 26, 2012 by mcminnclinic

Many experts now agree that millions of Americans are falling through the cracks when it comes to the diagnosis and management of low-thyroid conditions (hypothyroidism). Unfortunately, the lack of proper attention to this issue often results in the patient living a life of fatigue, low mood, struggles with obesity, and many other problems.

Although the thyroid gland is small, it has powerful effects on the body. Thyroid hormone regulates the metabolic rate of every single cell. If thyroid function is underactive (hypothyroid) a person can have a multitude of symptoms, sometimes subtle and sometimes profound. These symptoms may include, but are not limited to: fatigue, weight gain, cold extremities, low libido, dry skin, aches and pains, fibromyalgia, constipation, hair loss, brittle nails, poor memory, low stamina, headaches, puffy face, and low body temperature. Perhaps the most common and important of the symptom being varying degrees of fatigue.

Diagnosis of low thyroid conditions, like most medical conditions, starts with listening to and examining the patient. Symptoms, as mentioned above, family history, and physical signs often point to the diagnosis of hypothyroidism. If thyroid disease is suspected, a thorough lab evaluation should also be performed to assist in the diagnosis. However, the goal is to treat the whole patient, and not just to treat the labs.

If hypothyroid disease is confirmed, then proper treatment may include thyroid medications. There are several medications on the market, which may be quite helpful in relieving low thyroid symptoms. These include Synthroid, Armour thyroid, Cytomel, compounded thyroid, and others. One patient may respond well to a particular medicine, while another patient may find that a different medication works best to alleviate his or her thyroid related symptoms. Although Synthroid is often the drug of choice for many physicians, I have found Armour thyroid to be particularly effective in many of my low-thyroid patients. For others, Cytomel may be the key to alleviating their symptoms.

In summary, thyroid dysfunction is a condition that may have a profoundly negative impact on many patients. Yet according to various experts, millions of Americans suffer from inadequate diagnosis and treatment of hypothyroidism. Proper evaluation and treatment of these patients may help tremendously in improving their symptoms, and their quality of life.

“Good Health Starts in the Gut.”

Posted on August 20, 2012 by mcminnclinic

As I reviewed the long list of initial symptoms, I was happy to hear the patient say that everything was “better, better, gone.”

Dr. McMinn: “How is the fatigue?”

Patient: “It’s much better doctor.”

Dr. McMinn: “How is the brain fog and anxiety?”

Patient: “They’re also much better.”

Dr. McMinn: “How is the diarrhea?”

Patient: “It’s gone.”

This patient had been to doctor after doctor for her various symptoms, but it wasn’t until we addressed her gut issues that she got better.

Old fashioned country doctors used to say that “good health starts in the gut,” and as I have become an older and perhaps wiser physician, I have become abundantly convinced that they were right all along.

Other organs may be “sexier” but the gut is where wellness begins. We marvel at the processing ability of the incredible human brain, and the heart amazes us with it heroic pumping marathon. We manicure our nails, and fuss over our hair. However, we take the lowly gut for granted, as if we’d rather not acknowledge, much less to glorify, a mere poop factory. Yet the oft-ignored gut frequently holds the key to good health, and likewise poor gut heath may manifest in all sorts of bodily havoc. I have seen miracle cures for many different maladies by attending to gut issues. Seemingly unrelated diseases and symptoms such as fatigue, brain fog, headaches, rashes, asthma, arthritis, autoimmune disease, fibromyalgia, ADD, autism, sinusitis and many more health problems may be linked back to poor gut health.

Let’s take a look at some of the issues affecting gut health:

*Diet: Let’s begin with what we put in our mouths. Certainly the MAD diet (Modern American Diet) has not helped the situation. It’s amazing to me that our bodies can survive the daily onslaught of junk food, processed food, transfats, sugar, and toxins as well as it does. The term “garbage in garbage out” frequently applies to computers. However, the same principle is applicable to the human body. We feed our bodies garbage, and yet we expect this to miraculously turn into healthy cells. Instead, our junk diets wreak a heavy toll on gut health, which then dominoes onto other bodily parts and functions.

*Stress: This is one of the main fundamental causes of disease. Stress can take its toll on just about any body part and the gut is no exception. Stress is often associated with issues such as Crohn’s disease, irritable bowel disease, and chronic diarrhea. Ulcers, leaky gut, cramps, poor digestion, and stomach upset.

Food Allergies and Sensitivities: The gut has the daunting challenge sifting through every single molecule we eat and of deciding what to let in, and what keep out. That’s one reason that we call the gut “the second brain.” To meet this challenge, approximately 70% of our immune system lies in the gut.

For millions of years our ancestors ate a “natural” diet of berries, fruits, vegetables, roots, and leaves. They killed critters and ate fish for lean protein. Now let’s fast forward to the modern American grocery store. Most of the food we might find in the center isles may rightfully be considered by our bodies to be like a foreign body, and thus generate an immune response. This untoward immune response may express itself in all sorts of clinical symptoms. Our food has changed drastically in a relatively short period of time, but our immune system is genetically the same as our hunter-gatherer ancestors.

Poor Digestion: Next time you find yourself at the drug store, take a moment to walk down the isles and look at the over-the- counter medications. You’ll find that by far, the number one item is the digestive and gastrointestinal aids. Year after year, Nexium and its acid blocking cousins are at the top of the charts in terms of prescriptions sold. These powerful acid blockers, as well as the seemingly benign antacids like Tums, interfere with our natural digestive ability. As such, we may not get the nutrients form our food that we need to maintain healthy cells.

Bacterial Imbalance (Dysbiosis): The human body exists in an amazing state of synergistic balance with our gut flora. Perhaps an oversimplification, but this mainly consists of “good bacteria,” “bad bacteria,” and yeast. We cannot survive without our “good bacteria.” Unfortunately, we frequently kill off the good bacteria with the antibiotics that we take. Also, with the sugar ladened diets we frequently find our guts in a miserable state of yeast overgrowth. This can result in bowel wall inflammation, and eventually “leaky gut syndrome.” A cascade of inflammatory and immune reactions then take place which can affect the far reaches of the body, including brain, bones, skin, auto-immune disease, etc.

Similarly, parasites may add another twist to the complex milieu of bacterial flora.

A simple plan for gut health recovery involves the 4R program: Remove, Repair, Restore, and Replace. This program is available in the integrative medical literature, and I have had great success by adopting it in my practice.

Step One: Remove the stressors on the gut such as the drugs, alcohol, sugar, caffeine, tobacco, and other poor food choices that we find in the modern American diet. A gut detoxification program may be helpful in this regard.

Step Two: Repair the damage with optimal nutrition, stress reduction, etc. Targeted nutritionals may help such as aloe vera juice, quercitin, licorice root, garlic, tumeric, digestive enzymes, and fish oils.

Step Three: Restore a healthy bacterial balance with high quality probiotics. Cutting out unnecessary antibiotics, treating yeast, and reducing the sugar in the diet may also help.

Step Four: Replace the deficient elements such as digestive enzymes, which can have a major impact on digestion and utilization of nutrients.

In summary, continue to ignore and abuse the gut and you will reap the unhealthy consequences. Give the gut the respect it’s due, and you will enjoy the many benefits in the years to come. Start today with the 4R program; remove, repair, restore, and replace gut health program in order to achieve optimal overall wellness.

Fatigue: A Treatable Disease

Posted on July 23, 2012 by mcminnclinic

Out west the ol’ cowboys might say, “my get up and go has done got up and went”. In the east they may complain of “demininsed Qi”. Whereever you go, east or west, fatigue is one ot fhe most common complaints voiced in the doctor’s office. Fatigue can be mild and nagging or it can be severe and debilitating. It affects not only the patient, but also his or her family, and loved ones. Unfortuantely, getting to the root cause of fatigue can be difficult. Rarely is work-up simple, and more often than not there may actually be multiple problems contributing the symptoms of fatigue.

Fatigue has many friends, It is often accompanied by aches and pains, headache, tension, deprdession, muscle spasms, mental fogginess, insomnia, and sometimes even a low grade fever. Some of my patients have morning fatigue. It is a major struggle for these patients just to get out of bed in the morning. Others may notice that they crash in the afternoon or early evening. Fatigue can come on suddenly, or it may present insideously. Many of my fatigue patients don’t recall ever having energy, as far back as they can remember.

Since the cause may be varied and multiple, the work-up may be complicated and prolonged. Even then, after an exhaustive work-up the root cause may be difficult to flush out. The process often starts with a history and physical exam. Hopefully that will stear us in the right direction. Lab work is often helpful. Occaisionally imaging studies may be in order. Ultimately, causes may include stress, poor nutrition, toxins, anemia, allergies, yeast, parasited, infection, hypoglycemia, leaky gut syndromes, insuin resistance, depression, smoking, alchlol, insomnia, side effects to medications, work place issues, relationship issues, digestive problems, heart problems, chronic pain, lack of exercise, HIV, cancer, medications, alcohol, shift work, grief, adrenal burnout, and hormone problems.

The key to success in treating fatigue is to leave no stone unturned. All of these issues must be addressed. The good news is that with a thorough, customized program over 90% of patients will experience significant relief from their fatigue program.

Bottom line- fatigue should be considered a treatable disease! At McMinn Clinic we specialize in fatigue. Come see Dr. McMinn, “the energy doctor,” to going on the path to optimal wellness and abundant energy.

Women’s Health

Posted on July 27, 2011 by mcminnclinic

Throughout my career in medicine, when studying the care of children, I have often heard the phrase “Children are not just small versions of adults”. They have their own unique characteristics that make them different than adults, and which require a different approach when providing medical care. I have found the same is true when it comes to women’s health care, i.e. women are not just different versions of men. Certainly, men and women have their similarities. At the root of our existence, bodies of both men and women have the fundamental missions of surviving and reproducing, albeit the way men and women go about both of these is very different. Fundamentally women are biologically, chemically, hormonally, genetically, mentally, and spiritually, and sexually different than men. As a result, there are a whole host of conditions and diseases that disproportionately affect women, such as depression, anxiety, obesity, thyroid problems, and many autoimmune diseases including lupus, rheumatoid arthritis and multiple sclerosis. Now let’s begin to take a look as some of the differences which contribute to these discrepancies.

The most profound difference between women and men is the fact that women have babies and men don’t. This basic fact propels us into a whole host of other characteristics that distinguish women from men. In addition to the obvious anatomical differences there are many other unique characteristics of women. Women go through puberty earlier, mature quicker, but have fewer fertile years than men. In order to produce healthy offspring, women must have a higher percent of body fat, and a higher waist to hip ratio. They have different mating, sexual, and orgasmic tendencies than males. Men are taller, with more body hair and have thicker skin. Women tend to tolerate pain better and live longer. Sugar metabolism in the brain is different in women and men. This may help to explain why women are more likely to suffer depression and act impulsively, while men are more likely to be aggressive and hyperactive.

Women generally have smaller organs, including liver and bladder. I can personally vouch for the bladder issue after taking many long road trips with my daughters and having to stop every thirty minutes for the potty. The smaller liver is associated with an increase in sensitivity to toxins. This fact may help to explain why women are much more likely to suffer from multiple chemical sensitivity disease than men. Also associated with the liver is the fact that alcohol is metabolized more quickly by women, therefore the effects of alcohol come on quicker and are more pronounced. Compounding this fact is the tendency of women to be more likely to be binge drinkers. Women also have a higher fat to water ratio which makes it more difficult for them to dilute toxins.

Men and women both have breast tissue, but breast cancer is much more common in women than in men, and it has reached epidemic proportions. This contributes to breast cancer being the most feared disease of women. However, it is vitally important to understand that heart disease kills about six times more women than breast cancer. Hearts are smaller in women. They beat faster and are less prone to atherosclerotic disease while being more prone to spasm of the heart arteries.

Differences in men and women are seen even at the genetic level. In many situations, men and women may have many of the same genes, but the expression of the genes often has a significant gender based component.

Hormonally men and women are quite different. Women have the cyclic production of estrogen and progesterone associated with ovulation, while men have about 10 times as much testosterone as women. This has a profound effect on women at every level.

The implications of these differences are profound for women. In my many years as an ER doctor, we applied a male model of heart disease to women for many years. In order for a women to be considered for a cardiac diagnosis we thought that she had to have the same symptoms that men had, i.e. chest pain, nausea, left arm pain, and shortness of breath. Recently we have begun to realize that almost half of women with a heart attack have no chest pain. The symptoms of a woman’s heart attack may be very subtle. As a result women often don’t get the help they need until it is too late. Women are less likely than men to survive their initial heart attack, less likely to get out of the hospital alive, and more likely to die within a year of their heart attack.

As evidenced by the above differences, women and men are each unique unto their own. Yet most of the medical literature is based on studies of men. Historically we have just assumed that what is good for men must be also good for women. The American medical community was so negligent in this arena that the federal government finally had to step in and in 1993 they passed a law that required that women be included in medical studies. Medicine still has some catching up to do as far as appreciating the uniqueness of women. We need to develop a more gender specific approach to diagnosis, treatment and prevention in order to improve women’s outcomes. If men had to deal with many of the issues that women experience, there would have been solutions long ago, but instead the medical community often turns a blind eye to women’s concerns. Indeed, women are not just different versions of men. There are fundamental differences at every level, which have a profound effect on wellness.

Listening……….The Most Powerful Tool in Medicine

Posted on July 11, 2011 by mcminnclinic

A wise and experienced medical school professor once said “listen to the patient, they will tell you what is wrong with them.” As profound as his words were, it took me many years to really “get it.” We in the medical profession tend to drink from the cool-aid of high-tech tests, gadgets, and procedures. They’re hot. They’re sexy, and most importantly they pay big bucks. Listening is old school, passé’ and it’s not codable, billable, or re-imbursable. Unfortunately, the system does not respect the art of listening. It does not adequately pay for a listening physician, and in fact it punishes them. I’ve known bright, kind, caring, compassionate physicians, dearly loved by their patients, who were fired from their jobs basically for being good listeners. They took too much time with patients. They weren’t productive enough. They didn’t churn patients as fast as their colleagues, so they didn’t bring in as much revenue for the practice, and as a result they were let go. Both they and their patients paid the price for a system that devalues listening. Unfortunately this penalty for listening falls disproportionately on female providers, but that’s a story for another day.

Ninety-nine percent of doctors I have known in my twenty something years in health care have been hard working, conscientious, kind, caring, compassionate, smart, well trained, and well-meaning providers who have gone to work every day with the goal of helping and healing their patients. I have the ultimate respect for their talents, and dedication to their noble cause. However, in this day and age of industrial, big business medicine, driven by government, insurance companies, and drug companies, the average primary care physician has about seven to ten minutes per patient. What is a physician to do when a patient comes into the office and gets out their internet printout and a list of symptoms that includes weakness, fatigue, brain fog, abdominal pain, hot flashes, night sweats, low libido, and insomnia? Most likely they’ll get a few perfunctory laboratory tests and the then the doctor will get out the prescription pad. In this case it’ll probably be an antidepressant a sleeping pill, and maybe a pain pill. It’s the well-worn symptom-pill, symptom- pill revolving door, which inevitably leads to more pills to treat the side effects of the first pills.

Stop the madness! The system is broken. It’s a set-up for failure for the physician and the patient. The physician does not have the necessary time to listen to the patient. Therefore they will rarely get to and treat the root cause of the problem. They’ll only put Band-Aids on the symptoms with more pills, which is a prescription for side effects and often a lifetime of unnecessary suffering.

The power of listening is that it can be such a compelling tool in finding and treating what is at the root cause of the patient’s problems. The power of the prescription pad is that it’s the accepted tool of modern western medicine. Unfortunately, after a lifetime of conditioning, it also meets many patient’s expectations (especially with direct to consumer advertising by the drug companies). Practice managers also love it because it helps meet the ten minute deadline to get the patient out and shore up the financial bottom line.

Just yesterday I had a patient in my office who was in tears because she had been suffering for ten years with profound fatigue. She had been to many physicians. She did not feel as though her doctors had ever taken her seriously. The tests were all “within normal limits”, so it must be all in her head. After ten years of searching for an answer to her symptoms she never felt “listened to.”

In fairness to doctors, the issue of non-listening goes well beyond the medical sphere. As parents, friends, brothers, sisters, husbands, wives, politicians, teachers, and world leaders, we would all benefit from being better listeners. It seems to me to be one of the most important skills that a human being can learn. We teach reading, writing, and arithmetic to our kids but we hardly ever teach them about the art of listening.
Such a class should be a part of the curriculum at every stage of ones education. Especially in medical school, there should be an emphasis on the art of listening. It is so fundamental to what we do as healers. It is diagnostic as well as therapeutic. One might say the classes are not needed. “Listening is easy. Anyone can do it” they might claim. But then again, if good listening is so easy why is it such a rarity for a patient to find a medical provider who is a good listener?

In summary, the most powerful tool in medicine is neither a scalpel, a drug, nor an MRI scanner. It is an engaged, caring, compassionate provide, patiently and earnestly listening to the wants, needs, joys, and suffering of the patient in front of him or her, who has honored the healer by entrusting them with their heart, their soul, their mind, and their body. Let’ all strive to be better listeners.

Your Weakest Link

Posted on July 4, 2011 by mcminnclinic

Your Weakest Link by James E. McMinn, M.D.

We’ve all heard the adage before: a chain is only as strong as your weakest link. So what’s your weakest link? At the end of the day, what’s going to get you? And just as importantly, what can you do to improve your odds?

Cardiovascular disease: Heart disease is by far the number one cause of death in America. Almost one million Americans die of cardiovascular disease each year. This amounts to about 40%, or 1 out of 2.7 deaths in our country. Your first important decision in avoiding this, the weakest of all links, is to pick your parents well. There is definitely a genetic component for cardiovascular disease. However, much of the risk for cardiovascular disease is also attributable to lifestyle choices, and most of these risk factors are well within your control. Smoking is perhaps the biggest single risk factor. If you smoke, you automatically increase your risk of dying from heart disease by approximately 3 fold. If you smoke, the single most important thing that you can do for your health is to put away the pack. It’s not easy, but the benefits are enormous. Obesity and being overweight are the next major risk factors. In fact, obesity has overtaken smoking as the number one overall cause of preventable death in America. I believe that a few extra pounds is often the beginning the slippery slope of disease leading to a premature death. Many of the other risk factors for cardiac disease are often directly linked to the weight issue, such as hypertension, diabetes, high cholesterol and triglycerides. Obesity is also very pro-inflammatory, and inflammation is evermore being appreciated as a major contributor to many disease processes, including heart disease, as well as Alzheimer’s and cancer.

Cancer: Although cardiovascular disease is by far the most common cause of death, cancer is the most feared. Although we declared a “war on cancer” many years ago, this terrible disease has gone unabated. Two out of every five people in America will develop cancer, and one in five will die from it. Approximately one in every eight women will develop breast cancer in her lifetime. Even worse almost all men will get prostate cancer if they live long enough. To my way of thinking, the key is prevention. Certainly, diagnostic tests are becoming more and more advanced, but they can’t prevent cancer, they can only find it, and by that time you’ve already got the disease.

The number one rule of cancer prevention is “don’t smoke”. Sound familiar? As it turns out, the same preventive measures pertinent to cardiovascular disease, also apply to cancer. It’s all about diet and lifestyle. Studies suggest that if you take people from a country with a low rate of cancer and put them in a country with a high rate of cancer, once they adopt the diet and lifestyle of the new country, their cancer rate goes way up, to equal that of their new home country. In fact a majority of cancers in our country could be prevented with smoking cessation, exercise, diet, and lifestyle changes. Some specific strategies for cancer prevention include the following: stay slim, get regular exercise, avid saturated fats, eat more fiber, avoid excess alcohol, avoid unnecessary radiation, avoid toxins, This is more powerful than any expensive, high tech treatment on earth. Your mother was right, eat your fruits and vegetables!

Diabetes: It is fair and accurate to say that we are currently in the midst of a very frightening epidemic of type 2 diabetes. Between 1980 and 2002 the prevalence of diabetes has doubled. If this trend continues, we may soon start to see shorter lifespan in America starting with the next generation. Unfortunately, these shorter lifespans will be fraught with complications such as: heart disease, hypertension, stroke, impotence, kidney failure, amputations, blindness, and nerve damage. Diabetes has even been linked with cancer.

I know I’m beginning to sound like a broken record, but here we go again. For diabetes prevention, it’s back to basics. You really are what you eat. Diet and exercise are the keys to diabetes prevention. The basic diet principe is called glycemic index. Avoid sugar and anything that acts like sugar, such as white flour. Sugar hides and goes by many names, so learn to read labels. Often “health foods” are really sugar Trojan horses and heart attacks in disguise.

Dementia: So far we’ve had the most common disease, the most feared disease, and the scariest disease. I’ll wrap things up with what I consider the saddest of diseases; dementia. This tragic disease may take many forms including Alzheimer’s disease, vascular dementia, and stroke dementia. Your lifetime risk of dementia now stands at about 10-15 percent. Once again, prevention lies in the foundations of wellness: exercise, diet with plenty of antioxidants. Staying socially involved, and keeping your mind active are also helpful.

The list of weak links goes on to include infectious disease, kidney failure, and liver disease. However, by now it is quite clear that the prevention prescription remains largely the same. Most importantly, it all starts with the conscious decision to live a wellness lifestyle. It sounds simple enough, but in our modern day stressed out society full of junk food and toxins, the wellness path is the exception rather than the norm. In addition, it is not enough to make a decision. One must then set goals and devise an action plan for getting there. In America, we seem to be caught up in a “victim mentality” when it comes to our health. Even the phrase “heart attack” implies that this disease lashes out at innocent victims, like a “shark attack.” When in fact, most of us have been knowingly sewing the seeds of that heart attack for many years. It says on the package of cigarettes in bold letters, yet many of us knowingly keep smoking. We know that most processed food is full of junk, and fast food makes us fat, and causes heart diseases, diabetes, and stroke and yet many of us keep eating it.

My plea is that we wake up out of our victim slumber and realize that we, the patients, have much more control than ever before to make changes for the better. Changes that will shore up our weak link, and allow us to live a life of wellness.

Sleep: The Magic Elixir of Wellness

Posted on June 29, 2011 by mcminnclinic

The first domino to tumble in the insidious fall from the graces of good health is often the consistent lack of deep restorative sleep. Insomnia is one of the most common complaints I hear in my practice. If left unchecked, sleep difficulties inevitably begin a negative spiral down a path of increasingly severe health problems. Insomnia begets fatigue, weight gain, irritability, ADD, depression, brain fog, fibromyalgia, cognitive impairment, memory loss, impaired judgment, hallucinations, impaired immune function, increased type 2 diabetes, increased risk of heart disease, tremors, and many more serious health problems. Likewise, it is unusual to find a patient suffering from conditions such as fatigue or fibromyalgia who also don’t also experience a chronic lack of quality sleep.

As an ER doctor for 20 years I worked more than my share of night shifts, and I have paid my insomnia dues first-hand ever since. Bless the men and women who staff our hospitals, nursing homes, factories, and other shift work enterprises, who are going to work for their long night’s work just as we are climbing into our cozy beds for a good night’s sleep. Back during my night shift days, I must have heard it a thousand times, “Jim you look tired today.” Duh! I had a right to be tired; I had been up all night. Day shift people just don’t understand night shift people, and visa versa. Finally, after many years in denial, I realized that I was slowly taking years off my life by cheating my body of mother nature’s most potent medicine: a good night’s sleep. Shortly thereafter, I weaned my self out of the ER, into a “wellness medicine” practice, and into a wellness lifestyle. More and more, I try to practice what I preach, and now I sleep in my own bed every night. Just like an ex-smoker who becomes overly indignant about those around him who light up, I have since become a crusader for a night of deep restorative sleep.

When a patient comes in with fatigue, brain fog, or many of the other conditions of chronic disease, one of the first questions I ask them is “how are you sleeping?” More often than not the patient’s response will reflect problems with chronic insomnia. The patterns can vary. Sometimes it is difficulty getting to sleep. Many others get to sleep just fine, only to awaken at 2:00 in the morning. Often they can’t get back to sleep, which makes for a long and fatigued day at work the next day. Occasionally, I’ll find that a patient may get to sleep and sleep through the night, but may never wake up feeling rested and refreshed. Each of these patterns represents their own diagnostic challenges and therapeutic approaches.

Why do we sleep? In our busy lives, it seems like a total waste of time. We spend about a third of our lives sleeping! That adds up to about 25 years in the sack conked out. How the need for sleep evolved over time remains a hot topic of research. However, we do know this much: sleep is absolutely necessary for physical, mental, and emotional health, and even for life itself.

In the old days, sleep patterns were matched with the circadian rhythms of the earth. The sun went down, and it got dark. This triggered our melatonin to go up and our cortisol levels to go down, and thus we became sleepy. However, the electric light bulb changed the paradigm. With artificial electric light, we control our day and night light. Our eyes, brains, and bodies can’t distinguish between daylight and electric night light. Many people have totally lost touch with the rhythms of nature. Studies show that these people have more depression, more ADD, more heart attacks, more illness in general, and they die younger.

Sleep labs to the rescue! Sleep medicine has mushroomed in the past decade. Everybody’s trying to get in the game. Sleep labs are popping up all over the country. However, in my humble experience, many sleep labs have become a laundering service for the sellers of C-pap machines. Certainly sleep apnea is an important part of the equation. Without a doubt, it is under-diagnosed and undertreated. Many patients do get excellent relief from C-pap therapy. I’ve known some who claim that it has saved their life. However, it represents only a small part of the overall insomnia problem. The sleep labs often leave many important questions unanswered.

The beginning of the road back to restorative sleep begins with the understanding and practice of “sleep hygiene.” Contrary to implications from the word “hygiene” this has nothing to do with cleaning up anything. Instead it involves the consistent practice of setting the conditions optimally for a good night’s sleep. I like to tell my patients to take a “mini-vacation” before bed. Turn off the TV, and the computer. Turn on some “white noise” like a fan. Turn the lights down a bit. Do things that you find relaxing, such as reading a book. Better yet, read one of my old articles. That’s bound to put you right to sleep!

As I consider therapy, when possible I like to figure out the cause of the problem. That way I can treat the root cause. With proper testing, I often find that imbalances in estrogen, progesterone, cortisol, thyroid, and neurotransmitters are the culprit. Similarly, low melatonin, or elevated cortisol levels at night may contribute to the problem. Correcting the root cause can bring about dramatic relief in some patients.

Sometimes we must resort to empirical treatments. Finding the right sleep medication is like trying on shoes. The shoes that fit Cinderella did not fit her sisters at all. Similarly, the very supplement that helps one patient “sleep like a baby” may cause the next patient to stay up all night. I prefer to try natural supplements, such as melatonin, valerian, 5HTP, GABA, and other herbal remedies first. I find that about 75% of my patients respond well to these remedies. If these supplements are not working, then I may resort to sleep medications. In this case however, patients and providers must be careful not to choose a medication that promotes sleep, but never allows the patient to get into a Stage 4 REM deep restorative sleep.

A final category of potentially helpful therapeutic measures includes such modalities as acupuncture, hypnosis, neurofeedback, biofeedback, and CES (cranial electrical stimulation). I have found these therapies to be quite helpful for some patients.

In summary, sleep is a vital aspect of your foundation of wellness. If you are not getting a deep restorative sleep, it will eventually take its toll on your health. Work with your health care provider, and at the end of the day, adopt a “whatever it takes” policy toward getting a good night’s sleep. You cannot achieve true wellness, without getting a consistently good restorative sleep.