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Click the book cover image above to watch our radio interview with Dr. Judy Melinek!

Photo Credit: Dr. Judy Melinek Facebook page – https://www.facebook.com/DrJudyMelinekMD/

Dr. Judy Melinek is the author of “Working Stiff: Two Years, 262 Bodies, And The Making Of A Medical Examiner.” The book about forensic pathology explores homicides, suicides and the many other ways the human life can end. Melinek says that approximately 10% of what forensic pathologists work on are homicides or suspicious deaths. The remaining are accidents, suicides, and unexpected natural deaths. She also discusses her time studying at the NYC Medical Examiner’s Office during 9-11.
About her career path, Melinek says “helping people understand death, helps them appreciate life so much better.”
Learn more about Dr. Melinek and her book at this link: http://www.pathologyexpert.com/drjudy…

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American Medicine Today went behind the scenes of Limbitless Solutions, a non-profit organization that uses additive manufacturing to advance personalized bionics and solutions for disabilities. A team of approximately 50 student volunteers from the University of Central Florida work at Limbitless Solutions, which gained notoriety for creating and donating 3-D printed bionic arms for children. The arms, explains Executive Director Albert Manero, cost approximately $350-500 in materials, and are a combination of engineering and art.

Learn more about Limbitless Solutions: http://limbitless-solutions.org/index.php/en/

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The VA healthcare system has been called “a corrosive culture resistant to reforms and change by Obama’s Deputy Chief of Staff, Ron Nabors.” (Read the publicly released summary of the Rob Nabors report from June 2014 at this link). American Medicine Today Radio spoke to Darin Selnick, Senior VA Adviser of the Concerned Veterans for America (CVA) about the CVA’s Fixing Veterans Health Care Task-force.

 

Ethan Youker/American Medicine Today host: From 2001-2009, you were an appointee at the Department of Veterans Affairs. You’re also a veteran of the Air Force. You’ve been entrenched with this issue for a long time. What has changed over the years, from when you served under President Bush to now under the current administration?

Darin Selnick, Senior VA Adviser, Concerned Veterans for America
Darin Selnick, Senior VA Adviser, Concerned Veterans for America

Darin Selnick/Concerned Veterans for America: What’s changed is the leadership and management. Ultimately, it’s a failing system. We had a lot of the problems, and recognized a lot of the problems, and we passed those continuity binders to the Obama folks and they disregarded them. So, we’ve known we needed fixes for a while. When you have really good leadership, you’re able to put a lid on the problems, and deal with a lot of it. New leadership came in, they didn’t listen to anybody, they did untenable things like changing performance measures to stuff that people couldn’t do, and it just caused a collapse to the system, quicker than it would have happened. It would have eventually happened.

Kimberly Bermel/American Medicine Today host: Congressman David Jolly was a guest on our program recently. He mentioned the Choice Card program, which was supposed to alleviate problems, some of which lead to deaths. (Learn about Choice Card .) A Veterans of Foreign Wars report found that only 1 in 5 veterans eligible for the Choice Card were offered the option to get private care outside of the Veterans Affairs Department.

Darin Selnick: 27,000 of the hundreds of thousands of veterans that have tried to do use Choice Card were able to do it. The VFW surveyed its members and only 20% of those that tried could get any access whatsoever. Basically, the Choice Card was considered a Band Aid. — $10 Billion or 2-3 years, whichever ran out first. It was always a “stop the bleeding” approach. But there’s no real choice when you have to ask permission. I knew in the very beginning – and I warned them – that if you give the VA an opportunity to play around with the parameters of getting that choice (such as waiting more than 30 days for VA medical care, or living more than 40 miles away from a VA medical facility), you’re in real trouble.

Ethan Youker: The Veterans Choice card program was supposed to alleviate some of these horrendous wait times. Where did this program go wrong?

Selnick: First, they were very late in issuing the (Choice) Cards. Second, they did rules changes. Congress said “hey do 40 miles and then there are exceptions,” but the VA interpreted it as ‘40 miles from any facility’, not the intent. which was 40 miles from where you needed the healthcare. Then Congress’s recommendation of 30 days from your desired date for an appointment was changed to 30 days from when the VA decided it was medically necessary. For example, when is a colonoscopy medically necessary? You could push it back a year and say you’re still not late.  Intent is everything and the VA really didn’t want to let veterans go outside, so it started doing whatever it could.  Also, Congress said, “pay Medicare rates, but there’s an exception if you need to.” It (the VA) started paying 30% less. What doctor or health plan is going to be able to accept patients’ 30% less than Medicare rates, which are already lower?

Youker: The Concerned Veterans for America have come up with something called the Veterans Independence Act and it’s supposed to right all of these wrongs that were supposed to be righted in the first place with this program.

Selnick: You need to fix the VA healthcare, and you’ve got to provide choice. If you make it an independent, government-chartered non-profit, accountable, healthcare organization, and not be a monopoly, it will be able to reform itself and make business decisions. Right now it doesn’t control its IT, doesn’t control its personnel, how much money it pays its doctors. It’s got government rates, so it’s got lots of problems. The other thing is offering enrolled choice. Our plan (www.CV4A.org) says if you like your veterans healthcare, you’re close to a facility, and you’re getting good healthcare, you can keep that. But if you don’t like your healthcare for any reason, it’s your choice to leave it. No 40 miles, no 30 day rule. You can be in one or the other. You can pick any healthcare plan in your state.

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Ativan05mgAlthough opioids are frequently prescribed to treat chronic lower back pain, new research suggests these powerful medications may be less effective in some patients.

A study published in the Online First edition of Anesthesiology, the official medical journal of the American Society of Anesthesiologists® (ASA®), found patients who were prescribed opioids to treat chronic lower back pain experienced significantly less pain relief and were more likely to abuse their medication when they had psychiatric disorders such as depression or anxiety.

“High levels of depression and anxiety are common in patients with chronic lower back pain,” said Ajay Wasan, M.D., study author and professor of anesthesiology and psychiatry at the University of Pittsburgh School of Medicine. “Learning that we are able to better predict treatment success or failure by identifying patients with these conditions is significant. This is particularly important for controlled substances such as opioids, where if not prescribed judiciously, patients are exposed to unnecessary risks and a real chance of harm, including addiction or serious side effects.”

Chronic lower back pain affects 50 million adults in the United States. Patients with lower back pain may experience depression or anxiety in response to their chronic pain.In the prospective cohort study, researchers examined 55 chronic lower back pain patients with low- to-high levels of depression or anxiety symptoms. Patients were given morphine, oxycodone or a placebo to take orally for the pain as needed over a six-month period. Patients recorded their pain levels and the doses taken daily.Patients with high levels of depression or anxiety experienced 50 percent less improvement in back pain (21 percent vs. 39 percent pain improvement), 75 percent more opioid abuse (39 percent vs. eight percent), and increased side effects when compared to patients with low levels of depression or anxiety symptoms.

“It’s important for physicians to identify psychiatric disorders prior to deciding whether to prescribe opioids for chronic back pain as well as treat these conditions as part of a multimodal treatment plan,” said Dr. Wasan. “Rather than refusing to prescribe opioids, we suggest that these conditions be treated early and preferably before lower back pain becomes chronic. For those prescribed opioids, successful treatment of underlying psychiatric disorders may improve pain relief and reduce the chance of opioid abuse in these patients.”

The authors note that further testing is needed to confirm whether treating psychiatric disorders early in the course of lower back pain can solely improve pain and function without the use of opioids or other treatments.

REPOST FROM AMERICAN SOCIETY OF ANESTHESIOLOGISTS (ASA) July 6, 2015: Opioids May Not Spell Relief for Chronic Back Pain Sufferers with Depression, Anxiety

THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS

Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 52,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. ASA is committed to ensuring that physician anesthesiologists evaluate and supervise the medical care of patients before, during, and after surgery to provide the highest quality and safest care that every patient deserves. For more information on the field of anesthesiology, visit the American Society of Anesthesiologists onlineatasahq.org. To learn more about the role physician anesthesiologists play in ensuring patient safety, visit asahq.org/WhenSecondsCount

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A study published in the August issue of the Journal of Pediatrics found that the spines of boys and girls are different at birth. This difference aids in childbearing, but likely imparts a greater susceptibility for scoliosis and osteoporosis in females.

SOURCE: Childrens Hospital Los Angeles

Released: July 24, 2015

Looking at measurements of the vertebrae – the series of small bones that make up the spinal column – in newborn children, investigators at Children’s Hospital Los Angeles found that differences between the sexes are present at birth. Results of the study, now online in advance of publication in the August issue of the Journal of Pediatrics, suggest that this difference is evolutionary, allowing the female spine to adapt to the fetal load during pregnancy.

Baby Spine

Using magnetic resonance imagining (MRI), the researchers found that vertebral cross-sectional dimensions, a key structural determinant of the vertebra’s strength, were 10.6 percent smaller on average in newborn females than in males.

“Human beings are the only mammals in which this difference is seen, and it is one of the few key physiological differences between the sexes,” said Vicente Gilsanz, MD, PhD, director of the Research Imaging program at The Saban Research Institute of Children’s Hospital Los Angeles and senior author on the study.

“The reason could be that the spine has to move forward during pregnancy, so that the female can walk and maintain her center of gravity. Unfortunately, it also imparts a disadvantage in that it increases stress within the vertebrae for all physical activities, resulting in a great susceptibility for fractures later in life.”

“Although we’ve known that girls had smaller vertebrae than boys, we did not know how early this difference first occurred,” added Gilsanz, who is also professor of radiology at Keck School of Medicine of the University of Southern California. “Our study indicates that the distinction between sexes is already present at birth, and provides new evidence that this difference begins during prenatal development of the axial skeleton.” While the mechanisms responsible for the smaller female vertebral body during the fetal stages of skeletal development remain unknown, it likely results from complex interactions involving sex steroids, growth hormone and insulin-like growth factor.

In the study, 70 healthy, full-term newborns (35 boys and 35 girls) were measured. Weight, body length, and head and waist circumference did not significantly differ between sexes. Compared to newborn boys, girls had significantly smaller vertebral cross-sectional dimensions – a difference independent of gestational age, birth weight and body length. The study notes that, over their lifetimes, women also accumulate less bone mass than men, resulting in a two- to four-fold increase in spinal fracture. A deficiency in vertebral growth in girls is associated with greater spinal flexibility and lower peak bone mass in young women, eventually resulting in an increased likelihood of scoliosis as well as osteoporosis in later life.

“While girls are born with a predisposition to developing osteoporosis as older adults, we know that bone development can be optimized with exercise and nutrition,” said Gilsanz. “This is an example of how traits that might predispose an individual to disease can be mitigated through personalized medicine and customized health care, beginning early in life.”

Additional contributors to the study include first author Skorn Ponrartana, MD, PhD, Patricia C. Aggabao, BA, Naga L. Dharmavaram, BS, Carissa L. Fisher, BS, and Philippe Friedlich, MD, MS, EPI, MBA, of Children’s Hospital Los Angeles; and Sherin U. Devaskar, MD, of Mattel Children’s Hospital, David Geffen School of Medicine, UCLA. Funding was provided by the National Institute of Diabetes and Digestive and Kidney Disease grant R21DK090778.

About Children’s Hospital Los Angeles
Children’s Hospital Los Angeles has been named the best children’s hospital in California and among the top 10 in the nation for clinical excellence with its selection to the prestigious U.S. News & World Report Honor Roll. Children’s Hospital is home to The Saban Research Institute, one of the largest and most productive pediatric research facilities in the United States. Children’s Hospital is also one of America’s premier teaching hospitals through its affiliation since 1932 with the Keck School of Medicine of the University of Southern California. For more information, visit CHLA.org. Follow us on Twitter, Facebook, YouTube and LinkedIn, or visit our blog at http://researchlablog.org/.

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The Catalyst Refuge is a unique program that teaches relaxation techniques utilizing wild animals to facilitate healing. The program is based at The C.A.R.E. Foundation, a non-profit exotic animal rescue and sanctuary located in Apopka, FL. Catalyst founder Kevin Rose offers the program free to combat veterans, many of whom suffer from PTSD.

 

Kimberly Bermel/American Medicine Today: Give us some background about why you started this facility?

CatalystTiger2Kevin Rose/The Catalyst: The Catalyst is a human/animal interaction program that helps people move from feeling totally stressed out to absolutely calm in just seconds. As a massage therapist, I’ve worked with people for more than 20 years, all who have different kinds of stress. I found that there was one variable that brought everyone back to calm within seconds: using the five sense. I developed this program to promote the simplicity of learning to get calm. But the teachers that have been chosen, and have chosen me, perhaps, are the animals. They always live in their senses. They’re always responding to the environment with their senses. They taught me a valuable lesson about how to teach others how to use those inherent tools to calm in seconds.

Dr. Bonati/American Medicine Today: How did you put together the relationship between a person under stress, and an animal?

CatalystPantherKevin Rose: My whole career I’ve been fortunate and privileged to work with animals, as well as people. My first encounter was with dolphins, as a teaching assistant. During class, we were working in the water and swimming with a couple of dolphins. As I was swimming, the dolphins sandwiched me and began following my movements. It was if they were following my thoughts! I was amazed by it. Later, I had the opportunity to work hands-on with wolves. I recognized as I was in the middle of this wolf pack, and my energy raised and lowered, the animals would respond. They would growl and bump me.

Ethan Youker/American Medicine Today: If you’re anxious and upset and feeling aggressive inside, the animals reflect that?

CATalystTiger

Kevin Rose: That’s right. When I’d calm myself, they would reflect that as well. And that was my introduction to be able to work with the predatory animals specifically. There’s no real filter with them; they respond to the environment and what’s coming towards them. I started working more with them with the intention of bringing other people face-to-face with them to see how they would react. Like clockwork, the animals would react to the stress of that person. I teach this very simple technique that allows you to ground and the animal calms as well.

Ethan Youker: You’ve had a good success rate with soldiers who are diagnosed with PTSD?

Kevin Rose: Yes. It’s been a great time working with them and seeing how they respond to that sensory training. Think about how the universe is based on polarity: I know what hard is, because I know what soft is. When these men and women are trained in this heightened state, they can also know peace at that same degree.

CatalystPTSD
Chris is a Navy Veteran, diagnosed with PTSD, who uses techniques he’s learned through The Catalyst program to center and calm himself.

Chris/Navy Veteran who has trained with Kevin at Catalyst:  When I first came to Catalyst, I didn’t have any expectations; I didn’t come thinking these animals are going to react in a certain way. All I knew was to listen to Kevin and go with it. The first time that I stepped up to a cage I felt my shoulders tensing,  my stomach began to hurt, I was breathing heavy, my chest was getting tight and my pulse rate was going up. It was all of the things I was familiar with from having a panic attack. The animal started to growl and feed off of my negative energy. I used Kevin’s techniques to calm down and center myself. I immediately saw a reaction in the animals – I could see it in their eyes and in the way they were breathing. I no longer have tunnel vision. When I first came to Catalyst, I didn’t listen to anything. Kevin told me to listen to the birds. Before, I wouldn’t have heard them. It used to be that if I was driving my car, I didn’t hear anything. There was no outside world I was living in, it was just ‘what is right here.’ No, I have the ability to start hearing noises I naturally tuned out for many years. It’s opened my eyes.

Click here to learn more about The Catalyst Refuge.

Click here to learn more about the C.A.R.E. Foundation.

 

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The National Hyperbaric Oxygen Therapy Center, located in Palm Harbor, FL, uses pressurized, concentrated oxygen to treat children with autism, as well as people with severe brain injuries.

Dr. Allan Spiegel says hyperbaric oxygen therapy increases the amount of oxygen that saturates every part of the body, 8-10 times more than is currently present. That turns oxygen into a drug, which can do several things:
Causes new blood vessels to grow
Increases white cell function
Enhances immune system

Johnathan Pineda was diagnosed with autism at age two, and has been non-verbal or limited in speaking most of his life. He began hyperbaric therapy as a teenager, and after 20 treatments, his mother notices amazing results. Johnathan admits he is more social, and says he feels more comfortable talking with people.

Alexandra Thomas went in to cardiac arrest and wasn’t expected to survive. However, she pulled through but is undergoing intense physical and speech therapy. Hyperbaric treatment has been added as a part of her treatment plan. Her mother says that four treatments, Alex is able to carry on longer conversations than she has since she became sick.

Learn more about The National Hyperbaric Oxygen Therapy Center: http://www.florida-oxygen.com/

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BioLucid, located in Sarasota, FL, is a technology company specializing in digital health. BioLucid’s advanced visual platform is designed to personalize and improve the overall health experience for both healthcare providers and consumers. Learn more about the creators, and designers, behind BioLucid in this one-on-one interview.

Learn more about BioLucid: http://www.biolucid.com/about-us/