Total Recovery – by Dr. Gary Kaplan

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First, know: Dr. Kaplan is an osteopath, and as such, will be mostly approaching things from that angle. That said, he is also board certified in other things too, including family medicine, so he’s by no means a “one-trick pony”, nor are there “when your only tool is a hammer, everything starts to look like a nail” problems to be found here. Instead, the scope of the book is quite broad.

Dr. Kaplan talks us through the diagnostic process that a doctor goes through when presented with a patient, what questions need to be asked and answered—and by this we mean the deeper technical questions, e.g. “what do these symptoms have in common”, and “what mechanism was at work when the pain become chronic”, not the very basic questions asked in the initial debriefing with the patient.

He also asks such questions (and questions like these get chapters devoted to them) as “what if physical traumas build up”, and “what if physical and emotional pain influence each other”, and then examines how to interrupt the vicious cycles that lead to deterioration of one’s condition.

The style of the book is very pop-science and often narrative in its presentation, giving lots of anecdotes to illustrate the principles. It’s a “sit down and read it cover-to-cover” book—or a chapter a day, whatever your preferred pace; the point is, it’s not a “dip directly to the part that answers your immediate question” book; it’s not a textbook or manual.

Bottom line: a lot of this work is about prompting the reader to ask the right questions to get to where we need to be, but there are many illustrative possible conclusions and practical advices to be found and given too, making this a useful read if you and/or a loved one suffers from chronic pain.

Click here to check out Total Recovery, and solve your own mysteries!

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  • Quinoa vs Couscous – Which is Healthier?

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    Our Verdict

    When comparing quinoa to couscous, we picked the quinoa.

    Why?

    Firstly, quinoa is the least processed by far. Couscous, even if wholewheat, has by necessity been processed to make what is more or less the same general “stuff” as pasta. Now, the degree to which something has or has not been processed is a common indicator of healthiness, but not necessarily declarative. There are some processed foods that are healthy (e.g. many fermented products) and there are some unprocessed plant or animal products that can kill you (e.g. red meat’s health risks, or the wrong mushrooms). But in this case—quinoa vs couscous—it’s all borne out pretty much as expected.

    For the purposes of the following comparisons, we’ll be looking at uncooked/dry weights.

    In terms of macros, quinoa has a little more protein, slightly lower carbs, and several times the fiber. The amino acids making up quinoa’s protein are also much more varied.

    In the category of vitamins, quinoa has more of vitamins A, B1, B2, B6, and B9, while couscous boasts a little more of vitamins B3 and B5. Given the respective margins of difference, as well as the total vitamins contained, this category is an easy win for quinoa.

    When it comes to minerals, this one’s not even more clear. Quinoa has a lot more calcium, copper, iron, magnesium, manganese, phosphorus, potassium, selenium, and zinc. Couscous, meanwhile has more of just one mineral: sodium. So, maybe not one you want more of.

    All in all, today’s is an easy pick: quinoa!

    Want to learn more?

    You might like to read:

    Take care!

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  • Getting antivirals for COVID too often depends on where you live and how wealthy you are

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    Medical experts recommend antivirals for people aged 70 and older who get COVID, and for other groups at risk of severe illness and hospitalisation from COVID.

    But many older Australians have missed out on antivirals after getting sick with COVID. It is yet another way the health system is failing the most vulnerable.

    CGN089/Shutterstock

    Who missed out?

    We analysed COVID antiviral uptake between March 2022 and September 2023. We found some groups were more likely to miss out on antivirals including Indigenous people, people from disadvantaged areas, and people from culturally and linguistically diverse backgrounds.

    Some of the differences will be due to different rates of infection. But across this 18-month period, many older Australians were infected at least once, and rates of infection were higher in some disadvantaged communities.

    How stark are the differences?

    Compared to the national average, Indigenous Australians were nearly 25% less likely to get antivirals, older people living in disadvantaged areas were 20% less likely to get them, and people with a culturally or linguistically diverse background were 13% less likely to get a script.

    People in remote areas were 37% less likely to get antivirals than people living in major cities. People in outer regional areas were 25% less likely.

    Dispensing rates by group. Grattan Institute

    Even within the same city, the differences are stark. In Sydney, people older than 70 in the affluent eastern suburbs (including Vaucluse, Point Piper and Bondi) were nearly twice as likely to have had an antiviral as those in Fairfield, in Sydney’s south-west.

    Older people in leafy inner-eastern Melbourne (including Canterbury, Hawthorn and Kew) were 1.8 times more likely to have had an antiviral as those in Brimbank (which includes Sunshine) in the city’s west.

    Why are people missing out?

    COVID antivirals should be taken when symptoms first appear. While awareness of COVID antivirals is generally strong, people often don’t realise they would benefit from the medication. They wait until symptoms get worse and it is too late.

    Frequent GP visits make a big difference. Our analysis found people 70 and older who see a GP more frequently were much more likely to be dispensed a COVID antiviral.

    Regular visits give an opportunity for preventive care and patient education. For example, GPs can provide high-risk patients with “COVID treatment plans” as a reminder to get tested and seek treatment as soon as they are unwell.

    Difficulty seeing a GP could help explain low antiviral use in rural areas. Compared to people in major cities, people in small rural towns have about 35% fewer GPs, see their GP about half as often, and are 30% more likely to report waiting too long for an appointment.

    Just like for vaccination, a GP’s focus on antivirals probably matters, as does providing care that is accessible to people from different cultural backgrounds.

    Care should go those who need it

    Since the period we looked at, evidence has emerged that raises doubts about how effective antivirals are, particularly for people at lower risk of severe illness. That means getting vaccinated is more important than getting antivirals.

    But all Australians who are eligible for antivirals should have the same chance of getting them.

    These drugs have cost more than A$1.7 billion, with the vast majority of that money coming from the federal government. While dispensing rates have fallen, more than 30,000 packs of COVID antivirals were dispensed in August, costing about $35 million.

    Such a huge investment shouldn’t be leaving so many people behind. Getting treatment shouldn’t depend on your income, cultural background or where you live. Instead, care should go to those who need it the most.

    Doctor types on laptop
    Getting antivirals shouldn’t depend on who your GP is. National Cancer Institute/Unsplash

    People born overseas have been 40% more likely to die from COVID than those born here. Indigenous Australians have been 60% more likely to die from COVID than non-Indigenous people. And the most disadvantaged people have been 2.8 times more likely to die from COVID than those in the wealthiest areas.

    All those at-risk groups have been more likely to miss out on antivirals.

    It’s not just a problem with antivirals. The same groups are also disproportionately missing out on COVID vaccination, compounding their risk of severe illness. The pattern is repeated for other important preventive health care, such as cancer screening.

    A 3-step plan to meet patients’ needs

    The federal government should do three things to close these gaps in preventive care.

    First, the government should make Primary Health Networks (PHNs) responsible for reducing them. PHNs, the regional bodies responsible for improving primary care, should share data with GPs and step in to boost uptake in communities that are missing out.

    Second, the government should extend its MyMedicare reforms. MyMedicare gives general practices flexible funding to care for patients who live in residential aged care or who visit hospital frequently. That approach should be expanded to all patients, with more funding for poorer and sicker patients. That will give GP clinics time to advise patients about preventive health, including COVID vaccines and antivirals, before they get sick.

    Third, team-based pharmacist prescribing should be introduced. Then pharmacists could quickly dispense antivirals for patients if they have a prior agreement with the patient’s GP. It’s an approach that would also work for medications for chronic diseases, such as cardiovascular disease.

    COVID antivirals, unlike vaccines, have been keeping up with new variants without the need for updates. If a new and more harmful variant emerges, or when a new pandemic hits, governments should have these systems in place to make sure everyone who needs treatment can get it fast.

    In the meantime, fairer access to care will help close the big and persistent gaps in health between different groups of Australians.

    Peter Breadon, Program Director, Health and Aged Care, Grattan Institute

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • Mammography AI Can Cost Patients Extra. Is It Worth It?

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    As I checked in at a Manhattan radiology clinic for my annual mammogram in November, the front desk staffer reviewing my paperwork asked an unexpected question: Would I like to spend $40 for an artificial intelligence analysis of my mammogram? It’s not covered by insurance, she added.

    I had no idea how to evaluate that offer. Feeling upsold, I said no. But it got me thinking: Is this something I should add to my regular screening routine? Is my regular mammogram not accurate enough? If this AI analysis is so great, why doesn’t insurance cover it?

    I’m not the only person posing such questions. The mother of a colleague had a similar experience when she went for a mammogram recently at a suburban Baltimore clinic. She was given a pink pamphlet that said: “You Deserve More. More Accuracy. More Confidence. More power with artificial intelligence behind your mammogram.” The price tag was the same: $40. She also declined.

    In recent years, AI software that helps radiologists detect problems or diagnose cancer using mammography has been moving into clinical use. The software can store and evaluate large datasets of images and identify patterns and abnormalities that human radiologists might miss. It typically highlights potential problem areas in an image and assesses any likely malignancies. This extra review has enormous potential to improve the detection of suspicious breast masses and lead to earlier diagnoses of breast cancer.

    While studies showing better detection rates are extremely encouraging, some radiologists say, more research and evaluation are needed before drawing conclusions about the value of the routine use of these tools in regular clinical practice.

    “I see the promise and I hope it will help us,” said Etta Pisano, a radiologist who is chief research officer at the American College of Radiology, a professional group for radiologists. However, “it really is ambiguous at this point whether it will benefit an individual woman,” she said. “We do need more information.”

    The radiology clinics that my colleague’s mother and I visited are both part of RadNet, a company with a network of more than 350 imaging centers around the country. RadNet introduced its AI product for mammography in New York and New Jersey last February and has since rolled it out in several other states, according to Gregory Sorensen, the company’s chief science officer.

    Sorensen pointed to research the company conducted with 18 radiologists, some of whom were specialists in breast mammography and some of whom were generalists who spent less than 75% of their time reading mammograms. The doctors were asked to find the cancers in 240 images, with and without AI. Every doctor’s performance improved using AI, Sorensen said.

    Among all radiologists, “not every doctor is equally good,” Sorensen said. With RadNet’s AI tool, “it’s as if all patients get the benefit of our very top performer.”

    But is the tech analysis worth the extra cost to patients? There’s no easy answer.

    “Some people are always going to be more anxious about their mammograms, and using AI may give them more reassurance,” said Laura Heacock, a breast imaging specialist at NYU Langone Health’s Perlmutter Cancer Center in New York. The health system has developed AI models and is testing the technology with mammograms but doesn’t yet offer it to patients, she said.

    Still, Heacock said, women shouldn’t worry that they need to get an additional AI analysis if it’s offered.

    “At the end of the day, you still have an expert breast imager interpreting your mammogram, and that is the standard of care,” she said.

    About 1 in 8 women will be diagnosed with breast cancer during their lifetime, and regular screening mammograms are recommended to help identify cancerous tumors early. But mammograms are hardly foolproof: They miss about 20% of breast cancers, according to the National Cancer Institute.

    The FDA has authorized roughly two dozen AI products to help detect and diagnose cancer from mammograms. However, there are currently no billing codes radiologists can use to charge health plans for the use of AI to interpret mammograms. Typically, the federal Centers for Medicare & Medicaid Services would introduce new billing codes and private health plans would follow their lead for payment. But that hasn’t happened in this field yet and it’s unclear when or if it will.

    CMS didn’t respond to requests for comment.

    Thirty-five percent of women who visit a RadNet facility for mammograms pay for the additional AI review, Sorensen said.

    Radiology practices don’t handle payment for AI mammography all in the same way.

    The practices affiliated with Boston-based Massachusetts General Hospital don’t charge patients for the AI analysis, said Constance Lehman, a professor of radiology at Harvard Medical School who is co-director of the Breast Imaging Research Center at Mass General.

    Asking patients to pay “isn’t a model that will support equity,” Lehman said, since only patients who can afford the extra charge will get the enhanced analysis. She said she believes many radiologists would never agree to post a sign listing a charge for AI analysis because it would be off-putting to low-income patients.

    Sorensen said RadNet’s goal is to stop charging patients once health plans realize the value of the screening and start paying for it.

    Some large trials are underway in the United States, though much of the published research on AI and mammography to date has been done in Europe. There, the standard practice is for two radiologists to read a mammogram, whereas in the States only one radiologist typically evaluates a screening test.

    Interim results from the highly regarded MASAI randomized controlled trial of 80,000 women in Sweden found that cancer detection rates were 20% higher in women whose mammograms were read by a radiologist using AI compared with women whose mammograms were read by two radiologists without any AI intervention, which is the standard of care there.

    “The MASAI trial was great, but will that generalize to the U.S.? We can’t say,” Lehman said.

    In addition, there is a need for “more diverse training and testing sets for AI algorithm development and refinement” across different races and ethnicities, said Christoph Lee, director of the Northwest Screening and Cancer Outcomes Research Enterprise at the University of Washington School of Medicine. 

    The long shadow of an earlier and largely unsuccessful type of computer-assisted mammography hangs over the adoption of newer AI tools. In the late 1980s and early 1990s, “computer-assisted detection” software promised to improve breast cancer detection. Then the studies started coming in, and the results were often far from encouraging. Using CAD at best provided no benefit, and at worst reduced the accuracy of radiologists’ interpretations, resulting in higher rates of recalls and biopsies.

    “CAD was not that sophisticated,” said Robert Smith, senior vice president of early cancer detection science at the American Cancer Society. Artificial intelligence tools today are a whole different ballgame, he said. “You can train the algorithm to pick up things, or it learns on its own.”

    Smith said he found it “troubling” that radiologists would charge for the AI analysis.

    “There are too many women who can’t afford any out-of-pocket cost” for a mammogram, Smith said. “If we’re not going to increase the number of radiologists we use for mammograms, then these new AI tools are going to be very useful, and I don’t think we can defend charging women extra for them.”

    KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

    Subscribe to KFF Health News’ free Morning Briefing.

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Related Posts

  • SuperLife – by Darin Olien
  • Too Much Or Too Little Testosterone?

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    One Man’s Saw Palmetto Is Another Woman’s Serenoa Repens…

    Today we’re going to look at saw palmetto. So, first:

    What is it?

    Saw palmetto is a type of palm native to the southeastern United States. Its scientific name is “Serenoa repens”, so if that name appears in studies we cite, it’s the same thing. By whichever name, it’s widely enjoyed as a herbal supplement.

    Why do people take it?

    Here’s where it gets interesting, because people take it for some completely opposite reasons…

    Indeed, searching for it on the Internet will cause Google to suggest “…for men” and “…for women” as the top suggestions.

    That’s because it works on testosterone, and testosterone can be a bit of a double-edged sword, so some people want to increase or decrease certain testosterone-related effects on their body.

    And it works for both! Here be science:

    • Testosterone (henceforth, “T”) is produced in the human body.
      • Yes, all human bodies, to some extent.
    • An enzyme called 5-alpha-reductase converts T in to DHT (dihydrogen testosterone)
    • DHT is a much more potent androgen (masculinizing agent) than T alone, such that its effects are often unwanted, including:
      • Enlarged prostate (if you have one)
      • Hair loss (especially in men)
      • New facial hair growth (usually unwanted by women)
        • Women are more likely to get this due to PCOS and/or the menopause

    To avoid those effects, you really want less of your T to be converted into DHT.

    Saw palmetto is a 5α-reductase inhibitor, so if you take it, you’ll have less DHT, and you’ll consequently lose less hair, have fewer prostate problems, etc.

    Read: Determination of the potency of a novel saw palmetto supercritical CO2 extract (SPSE) for 5α-reductase isoform II inhibition using a cell-free in vitro test system

    ^The above study showed that saw palmetto extract performed comparably to finasteride. Finasteride is the world’s main go-to prescription drug for treating enlarged prostate and/or hair loss.

    See also: Natural Hair Supplement: Friend or Foe? Saw Palmetto, a Systematic Review in Alopecia

    Hair today… Growing tomorrow!

    So, what was that about increasing T levels?

    Men usually suffer declining T levels as they get older, with a marked drop around the age of 45. With lower T comes lower energy, lower mood, lower libido, erectile dysfunction, etc.

    Guess what… It’s T that’s needed for those things, not DHT. So if you block the conversion of T to DHT, you’ll have higher blood serum T levels, higher energy, higher mood, higher libido, and all that.

    Read: Standardized Saw Palmetto Extract Directly and Indirectly Affects Testosterone Biosynthesis and Spermatogenesis

    (the above assumes you have testicles, without which, your T levels will certainly not increase)

    Saw Palmetto Against Enlarged Prostate?

    With higher DHT levels in mid-late life, prostate enlargement (benign prostatic hyperlasia) can become a problem for many men. The size of that problem ranges from urinary inconvenience (common, when the prostate presses against the bladder) to prostate cancer (less common, much more serious). Saw palmetto, like other 5α-reductase inhibitors such as finasteride, may be used to prevent or treat this.

    Wondering how safe/reliable it is? We found a very high-quality fifteen-year longitudinal observational study of the use of saw palmetto, and it found:

    ❝The 15 years’ study results suggest that taking S. repens plant extract continuously at a daily dose of 320 mg is an effective and safe way to prevent the progression of benign prostatic hyperplasia.❞

    Read: 15 years’ survey of safety and efficacy of Serenoa repens extract in benign prostatic hyperplasia patients with risk of progression

    Want a second opinion? We also found a 10-year study (by different researchers with different people taking it), which reached the same conclusion:

    ❝The results of study showed the absence of progression, both on subjective criteria (IPSS, and QoL scores), and objective criteria (prostate volume, the rate of urination, residual urine volume). Furthermore, patients had no undesirable effects directly related to the use of this drug.❞

    • IPSS = International Prostate Symptom Score
    • QoL = Quality of Life

    Read: The results of the 10-year study of efficacy and safety of Serenoa repens extract in patients at risk of progression of benign prostatic hyperplasia

    But wait a minute; I, a man over the age of 45 with potentially declining T levels but a fabulous beard, remember that you said just a minute ago that saw palmetto is used by women to avoid having facial hair; I don’t want to lose mine!

    You won’t. Once your facial hair follicles were fully developed and activated during puberty, they’ll carry on doing what they do for life. That’s no longer regulated by hormones once they’re up and running.

    The use of saw palmetto can only be used to limit facial hair if caught early—so it’s more useful at the onset of menopause, for those who have (or will have) such, or else upon the arrival of PCOS symptoms or hirsuitism from some other cause.

    Take The Test!

    Do you have a prostate, and would like to know your IPSS score, and what that means for your prostate health?

    Take The Test Here!

    (takes 1 minute, no need to pee or go probing for anything)

    Bottom Line on Saw Palmetto

    • It blocks the conversion of T into DHT
    • It will increase blood serum T levels, thus boosting mood, energy, libido, etc in men (who typically have more T, but whose T levels decline with age)
    • It will decrease DHT levels, thus limiting hair loss (especially in men) and later-life new facial hair growth (especially in women).
    • It can be used to prevent or treat prostate enlargement
    • Bonus: it’s a potent antioxidant and thus reduces general inflammation (in everyone)

    Want To Try Saw Palmetto?

    We don’t sell it (or anything else), but for your convenience…

    Click here to check out saw palmetto on Amazon!

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    Learn to Age Gracefully

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  • When the Body Says No – by Dr. Gabor Maté

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    We know that chronic stress is bad for us because of what it does to our cortisol levels, so what is the rest of this book about?

    Dr. Gabor Maté is a medical doctor, heavily specialized in the impact of psychological trauma on long term physical health.

    Here, he examies—as the subtitle promises—the connection between stress and disease. As it turns out, it’s not that simple.

    We learn not just about the impact that stress has on our immune system (including increasing the risk of autoimmune disorders like rheumatoid arthritis), the cardiovascular system, and various other critical systems fo the body… But also:

    • how environmental factors and destructive coping styles contribute to the onset of disease, and
    • how traumatic events can warp people’s physical perception of pain
    • how certain illnesses are associated with particular personality types.

    This latter is not “astrology for doctors”, by the way. It has more to do with what coping strategies people are likely to employ, and thus what diseases become more likely to take hold.

    The book has practical advice too, and it’s not just “reduce your stress”. Ideally, of course, indeed reduce your stress. But that’s a) obvious b) not always possible. Rather, Dr. Maté explains which coping strategies result in the least prevalence of disease.

    In terms of writing style, the book is very much easy-reading, but be warned that (ironically) this isn’t exactly a feel-good book. There are lot of tragic stories in it. But, even those are very much well-worth reading.

    Bottom line: if you (and/or a loved one) are suffering from stress, this book will give you the knowledge and understanding to minimize the harm that it will otherwise do.

    Click here to check out When The Body Says No, and take good care of yourself; you’re important!

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  • Maximize Your Misery! (7 Great Methods)

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    Let’s imagine that instead of being healthily fulfilled in life, you wanted to spend your days as miserable as possible. What should you do?

    Here are a few pointers:

    Stay still

    Avoid physical activity and/or outdoor exposure, to avoid any mood-lifting neurochemicals. In fact, remain indoors as much as possible, preferably in the same room.

    If you want to absolutely maximize your misery, make your bedroom the sole space for all activities that it’s possible to do there.

    Disrupt your sleep

    Keep an irregular sleep schedule by varying your bedtime and wake-up times frequently. Sleep in as much as possible, and make up for it by staying up late to ensure ongoing exhaustion.

    Maximize screentime

    Use digital entertainment as much as possible to distract you from meaningful activities and rest—as a bonus, this will also help you to avoid self-reflection.

    Begin and end your day with a device in hand.

    Fuel negative emotions

    If you’re going to focus on something, focus on problems you cannot control, to stoke the fires of anger and angst.

    A good way of doing this is by staying informed about distressing events, while avoiding meaningful actions to address them. Contribute only in token gestures, and then lament the lack of change.

    Follow your impulses

    Act on short-term desires without considering long-term consequences, while avoiding behaviors that you know might improve your mood or wellbeing.

    Trust that doing the same things that have not previously resulted in happiness, will continue to reliably deliver unhappiness.

    Set goals to miss

    It’s important that your goals should be vague, and overly ambitious in their scope and/or deliverability. Ideally you should also disregard any preparatory work that a person would normally do before embarking on such a project.

    Bonus tip: you can further sabotage any chances of progress, by waiting for motivation to strike before you take any action.

    Pursue happiness

    Focus on chasing happiness itself, instead of improving your situation or skills. Treat happiness as an end goal, instead of a by-product of worthwhile activities.

    Want to learn more?

    If you’d like to know many more ways to be miserable, we featured these 7 from this book of 40, which we haven’t reviewed yet, but probably will one of these days:

    How to Be Miserable: 40 Strategies You Already Use – by Dr. Randy Paterson

    Alternatively…

    If for some strange reason you’d rather not do those things, you might consider a previous article of ours:

    How To Get Your Brain On A More Positive Track (Without Toxic Positivity)

    Enjoy!

    Don’t Forget…

    Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!

    Learn to Age Gracefully

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