Category Archives for Uncategorized

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Vasectomy

Vasectomy-procedure to interrupt the vas deferens bilaterally to achieve permanent male sterility.

Valparaiso Vasectomy Clinic ,a division of Pithadia Medical Professional Services, performs the procedure in the office.  Dr. Pithadia has performed several thousand vasectomies.  Technique used primarily is the” no scalpel technique”.

Valparaiso vasectomy clinic offers a special-” get one side done- the other side is free”.

Advantages of doing the procedure in the office include significantly lower cost than having it done in the hospital setting,  no General anesthesia (helps reduce health risk and cost), no Pathology costs ,greater privacy                ( additionally,spousal presence in the room allows for future greater empathy from the Spouse), and greater convenience where the Patient’s and the Doctors times are the only times that matter.

For further information , please visit www.valparaisovasectomy.com    .

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Chronic joint pain, stiffness and depression

Chronic joint pain and stiffness.

One of the conditions that is frequently overlooked and under treated is “Rheumatism”.
It also goes by names of “autoimmune disease”, “mixed connective disorder” and somewhat by a mislabeled illness “fibromyalgia”.

Arthritis is a condition that implies inflammation of joint(s). In a general sense, soft tissue attached to joints may also be inflamed and maybe termed as tendinitis.

Looking at both the entities as one, there are two kinds of arthritis .First one is called osteoarthritis.This is basically arthritis of wear and tear- thus it tends to afflict mature patients more so than the younger patients. It can be due to trauma , infection of joints- but basically it is loss of lubricating cartilage and reactive bone formation to protect the joint.
Second kind of arthritis where there is premature destruction of the cartilage. One of the conditions that causes this is damage caused by autoimmune disease. As defined above premature destruction of cartilage generally implies that this disease process occurs in much younger people. Ultimately, this destruction results in osteoarthritis ,albeit ,premature osteoarthritis. Damage to soft tissue around the joint directly and indirectly makes the condition worse. We shall visit that complication later.

Arthritis or inflammation of the joint implies swelling and pain. With the swelling goes stiffness. With the pain goes insomnia.

Insomnia leads to generalized fatigue compounded by generalized fatigue due to insomnia. Chronic pain ,generalized fatigue and lack of mobility leads to depression. Chronic pain ,generalized fatigue and depression leads to social issues including employment and marital issues. Accusations of being lazy and being nonproductive compound the issue. Medical attention is sought.Medical institution may fail the patient.

Blood tests are done and fail to identify the underlying disease process. Further frustration sets in hopelessness begins to take over.

Insomnia leads to generalized fatigue compounded by generalized fatigue due to insomnia. Chronic pain ,generalized fatigue and lack of mobility leads to depression. Chronic pain ,generalized fatigue and depression leads to social issues including employment and marital issues. Accusations of being lazy and being nonproductive compound the issue. Medical attention is sought.Medical institution may fail the patient.

What is of paramount importance is that Rheumatological diseases be diagnosed on clinical basis,-that means from the history and physical findings. Blood tests ,x-rays are only supplementary items to assist in making the diagnosis. Blood test do not make or disprove diagnosis.

Chronic joint pain , multiple joint pain fleeting joint pain and most importantly stiffness lasting for more than a half an hour in the morning for more than 3 months should be investigated for rheumatism. Appropriate clinical examination should be carried out. Appropriate ancillary testing should be carried out.

There are 2 kinds of Rheumatological diseases-seronegative and seropositive. Seropositive -blood test positive, illnesses are easier to diagnose and therefore get treated quicker. These include rheumatoid arthritis and lupus. The seronegative arthritis are harder to diagnose and get overlooked-these include ankylosing spondylitis, psoriatic arthritis, enteric arthritides and other autoimmune diseases that are less frequently found in the population. Again the hallmark of rheumatological disease tends to be joint stiffness lasting for more than half an hour of morning for 3 months or more.

Generally speaking if the criteria of joint stiffness lasting for more than half an hour  in the morning for several months is met and the blood tests are negative including checking for items such as Lyme disease-rheumatological consultation should be sought.

There are 2 schools of thought on a condition called fibromyalgia. One school believes that it is  the illness or a disease process that can exist as a solitary item. This author believes that fibromyalgia is part of the symptom complex and not a disease in it’s own right. As an example, fibromyalgia may be considered to be having a fever as part of the complex for the disease would be considered to be pneumonia. In this context fibromyalgia should be considered as any condition that can disrupt sleep-most common being pain from any cause or source, causing worsening of aches and pains in a defined fashion .Cyclically  pain interferes with sleeping  and the following day insomnia makes pain worse… and so goes the cycle. As can be surmised from the above statement-chronic pain alone can lead to fibromyalgia and it becomes imperative  the cause of chronic pain be found and treated to treat the symptom of fibromyalgia.

There are other conditions associated with rheumatism. These include Sjögren syndrome where there is involvement of  mucous membranes, there is dryness of mucous membranes of the eyes mouth  and  the genitalia particularly in women . Raynaud’s syndrome where blood vessels particularly the arterial blood vessels in the periphery of the extremities  develop spasm and can cause pain and in extreme cases gangrene and  amputations. Rheumatological diseases are associated with autoimmune disease such as Ulcerative colitis and Crohn’s disease. Treatment of Ulcerative colitis and Crohn’s disease brings about generalized relief of inflammation of joints as well as of the alimentary canal. Similarly, the treatment of psoriasis leads to relief of symptoms of inflammation affecting the joints once psoriasis is treated adequately.
For more information visit website www.arthritis.org or Arthritis Foundation.

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Universal Healthcare

Universal Healthcare

United States of America is the only major “Western ” country whose citizens do not enjoy Universal Healthcare.
Majority of the countries have Government directed Healthcare system(s). Majority have coverage that is deemed minimal by their respective Governments and is designed to cover all their citizens. Minimum coverage does not discriminate on the basis of financial, geographical, racial, ethnicity, sex, age, or religious status(including birth control and abortion rights).

Many of these countries allow for secondary insurance-albeit ,private institutions such as insurance companies, to provide for other perceived luxuries such as private rooms, physical therapy, dental coverage etc.
Some of these Countries have a rule of no co-payments. Some of them do not allow for private funds- personal or through insurance to intermingle with the government programs. Some of these countries do not accommodate people to pay to get ahead of the line.
I was trained in Canada. I practiced in Ontario Canada for a while. Some of my family members still live in Canada. All residents of Canada are covered by the respective Provincial governments programs. In Ontario there is no co-pay and there is no accommodation to allow people to jump the line. Majority of the residents are happy with the system. The affluent  who wish to not wait in the line are the ones who come to the United States to go to places like ,the Mayo Clinic or the Cleveland clinic. It must be understood that waiting in the line does not mean that those with more urgent or serious illnesses are not treated on urgent or emergent basis should the need the recognized. People are not left on the streets to die of ruptured appendicitis nor left invalid from not receiving knee replacement joints nor dying of heart attacks because of perceived(lies stated by the anti -Universal Healthcare militia in the U.S.A.) prolonged waiting in Canada.

In all fairness ,I’m sure there are isolated cases where few,very few  of the items that they mention did occur. But if we are to involve those few and far between examples let us consider the following:
Misinformation regarding rationing of care in the Canadian system has been described. This is not entirely incorrect. All systems are constrained by budgets. Resources are limited. However ,It should be recognized that while the affluent people can fly into Cleveland and Minnesota on their private jets to receive the care from the finest facilities United States healthcare can offer- the same services are not that readily available to the citizens of United States, particularly, if they happen to be poor -particularly if they’re working poor and have no insurance of any kind(no Medicaid or Medicare). That too is rationing.
Universal healthcare needs to be a right of  a citizen – same right as Right to Vote and rights of the “Bill of Right”. For those who believe otherwise , and for whom this this tantamount s to Socialism and even Heavens forbid, Communism-let us consider the following:
The first dollar collected in terms of tax for the Universal good, even if it is to build that ballistic missile to protect America from the threat without is Socialism- and, in the same way we must protect us ourselves from the threat within(albeit ,under the umbrella of Socialism).
To illustrate, during the first part of the last Century death rate began to go down, peoples life expectancy began to increase,. This was before the advent off antibiotics. Primarily this was due to running water, sewage system and building institutions such as sanitariums to treat people with tuberculosis and psychosis. Corporate America and the affluent people paid taxes to cover for many of these projects. The affluent people recognized that spending for these institutions resulted in improvement of communal health and thereby reduced risk of their own family members , loved ones and presumably their workforce from becoming infected from illnesses such as polio and tuberculosis. Tax dollars spent for the good of all-an unwritten contract between the affluent people paying taxes and the poor people recognizing an improvement in the living standard resulted in dissipating the threat  uprising-revolutions. I now submit to you that in the year 2025-say a virus labeled H9N9-presents itself. If there are members in our Society who are unable to pay for the care, then it is not difficult to see that they may go on to infect the affluent population as well as the common working class. With this illustration I present to you an absolute need to have Universal healthcare that is paid for by taxes. Higher taxes on the affluent should not be a problem to the affluent members of the Society- for they too will certainly stand to benefit directly and indirectly.

Every member of our Society living legally in this country deserves essentially basic  and  the same kind of healthcare. No child needs to suffer more from asthma nor adult needs to suffer more from ravages of diabetes and so forth simply due to their socioeconomic standard.
Voluntary insurance payments by individuals do not work as a young do not see the value and the older people feel it is too expensive. The expense is viewed as being too expensive by many in the Society. The only way to mandate is to have it through some normal mechanism of tax based formula.A basic tenet of insurance of spreading of the risk is easy to see.

It is my contention that, corporate America-employers would love to not have to deal with  employee health insurance. I came across an article that one time at the Honda motor company out of Japan decided to put a plant in Ontario Canada-one  of their reasons was they would not have to deal with health insurance. Recognize that the money the Corporate America is already spending and specifically deducting from the pay check of an individual  as well as , relatively speaking, very small amount of contribution from increased taxes on the affluent can  make Universal healthcare  an easy and affordable reality for all.

Additionally,Health insurance industry does not bring anything to the table. One should look at the price of the shares  of the four major Health insurance companies over the last 5 years compared to S&P 500. Those profits could easily be included  in  reducing the total cost of healthcare(also known as reducing premiums). Combining the processing departments of these healthcare insurance industries under one roof should help reduce costs further. In this context ,the most important thing that can be allowed to happen is that the Government could find/develop a software application  that  every hospital, every healthcare provider, pharmacist ,every nurse physical therapist etc  would be mandated in using as a software and the maintenance of the data stored centrally. The software and the maintenance including security  be provided to those user s for free. This should help reduce cost directly. But far more importantly, the Government can begin to extract data without violating personal information to begin to answer questions of what works well does not work, who it is cheaper and was gaining the system, thereby “cut out the fat out of the system.Empower USPTF  of CDC to do this without commercial or legislative influence.
Big Pharma has benefited immensely from Medicare part D legislation. Basically Medicare part D took away the right of the State to be able to negotiate prices of drugs with the manufacturer’s for the benefit off the citizens of the state. If this was how the legislation was presented to the public the legislation naturally would never have passed. Very cleverly, big Pharma together with a New administration crafted the deal and sugar coated this particular legislation with so-called Medicare D to provide drugs to the senior’s at a “cheaper” cost. An unfunded mandate nonetheless. I recall reading at the time that lobbying money spent was around $110 million-the payoff was supposed to be $500 billion over the following 10 years. No wonder cost of medication has skyrocketed and when bundled within healthcare costs naturally it gets reflected in the healthcare costs as well. Non medicare population has subsidized this windfall as well.We should demand that the next Congress  split the two aspects up and allow the States to negotiate prices of drugs. Let us allow Capitalism to liberate Americans from clutches  of Corporate America.
Please recognize that the provider cost in healthcare spending amounts to approximately 8-9%. Majority of the costs are due to hospitalizations, for surgical care Nursing home  and pharmaceutical care. A few years ago, in TIME magazine with a front cover with the title “The Bitter Pill”, a paragraph stood out-to the effect stating that one of the only major organization that was able to bend the curve off the rate of rise of healthcare costs was Medicare(CMS)-and that it could do even a better job if it wasn’t for the lawmakers.

The only procedure in our Healthcare system where  costs have come down is the LASIK eye surgery program. This because insurance companies are not involved-being a cosmetic procedure-the patient’s do their own research and presumably negotiation of payments- market forces come in relatively unadulterated. In this context ,the system if it is to remain private, it must be forced to post prices of all procedures. The insurance companies should be forced to share in the savings patient may be able to negotiate with the healthcare system-and ultimately the insurance company should demand  commonly  negotiated  prices as described above for all procedures and stays in the hospital setting.
There are other ways to reduce healthcare costs.
For now, let us work towards Universal healthcare for all-make it a right of every legal US citizen and resident. Have a single Universal electronic medical record and payment system installed in every healthcare provider’s office and every healthcare institution.
It has been stated that individuals have an obligation to look after themselves to reduce risk of illnesses and disease. It is for this reason that those will argue this point, feel that they do not wish to pay insurance for people who may be obese as an example. Or cigarette smokers. To that argument I ask what needs to happen to a 26-year-old without an insurance coverage who suffers an injury while mountain biking? I think it is fairly easy to see that again all members of the Society need to be covered for the common good as well as spreading of the risk.
I welcome comments or suggestions. Above all I would like community members to encourage our lawmakers to move towards single payer Universal healthcare coverage preferably without involving Corporate health care insurance industry in the system.

Surgical clearance by Primarycare Doctors and the dangers

A Surgical clearance has been requested by a Surgeon who intends to operate on you.

Historically, it has been the operating Surgeon’s responsibility to assess the patient not only for the body part or organ the Surgeon would be operating on, but also patient as a whole. If  during such an examination, with the knowledge, expertise and the experience of the Surgeon the patient was found to have a medical issue that could complicate the surgery and perioperative care beyond the Surgeon’s expertise, then naturally the Surgeon was obligated to refer the patient to the appropriate specialist(in the field of the abnormality detected) and get an opinion from the said specialist. Upon receiving the opinion, together with the Surgeons own training and experience it would be the Surgeon who would  make the decision regarding  fitness for surgery. It would be the Surgeon who will determine the risks, potential risks and advise the patient. The ultimate decision from the medical personnel team  would be the Anesthesiologist.

Over the last several years what has happened is that many Surgeons have been asking primary care Doctor’s for the so-called surgical clearance. Most primary care physician’s are not specialists,they are not the ones who would be doing the surgery, they would not know all the risks that would entail with the surgery . They would not be familiar with potential perioperative risks necessarily. Yet, the operating Surgeons have outsourced the responsibility to the primary care Doctor’s. Indeed to make matters more complicated the primary care Doctor is being asked to stratify the risk without knowing the intricacies  of  the surgery and certainly not having the experience of knowing what all that may be involved in the operation. Indeed , recent training and practices have limited the exposure of the primary care Physicians  of such procedures in training and in practice by not allowing them in the operating rooms.

This blanket request by the operating Surgeon adds not only extra expense and expenditure of time on the part of the patient but also risk(s).
Medicare guidelines have not addressed this issue in a satisfactory detail. I’m assuming commercial insurance industry will not take a position.

I have struggled with this by initially by not participating in doing these clearances. But, I came to realize that patients perceived  my refusal to participate in these clearances as an obstructionist in the process of receiving better health including alleviation of pain.

After discussing with a general Surgeon who is now retired ,I have modified my position.. It was pointed out to me that while my position has strong merits, the practice of Medicine has long ago  moved to an arena where it has now become the norm where many Surgeons do not assess the patient.I feel that these Surgeons have become mere technicians.

It was pointed out that with the training of newer Surgeons and  those who do not assess their own patients, and their experience, or the lack of it , regarding assessment,more than likely I would be able to do a much better examination of the patient . My assessment would serve patients better.With this in mind ,I wish to let you know that I shall do the surgical clearance examination to the best of my ability. This is also to inform you that there are many surgeons out there who do not practice medicine in this fashion of outsourcing preoperative assessment. You may choose to seek care from such responsible Surgeons.A more robust  preoperative assessment by Anesthesia  may be complementary .

Please be informed also that Medicare may not cover this assessment and you may be responsible for paying out of pocket for the said  “clearance”. With commercial insurance you’re urged to contact your insurance company and request coverage information.

Welcome

Fellow Citizens of Greater Valparaiso

Welcome!

I would like to introduce myself. I am a practicing physician in Valparaiso. I have been practicing in Northwest Indiana since 1984.I am an Independent physician– I am not employed by any Hospitals or “Clinics”.I report only to the patients I treat- I do not have another “Boss”-Patients are my one and only “Boss”.

Recently ,after attending a conference, I feel that publishing such a website may be of benefit to the residents of Valparaiso.

Over the next few weeks I shall try to publish articles that may benefit residents/patients in terms of how it may impact your health directly or indirectly-indirectly in the manner involving financial aspects, social aspects and political aspects.

Comments and suggestions for topics from readers are most welcomed.

Bharat Pithadia M.D. mph