Turf Wars; Cash Practices; Choosing a Professional to Do a Procedure; Pain in Tailbone Area; Inflamation & Chronic Diseases

Once again I begin with an apology for the lateness of this post.  No excuses... I've just been very busy this past week!  We began Let's Talk Medical with Doctor Gigi on Friday February 17, 2012 with conversation regarding a bit of a turf war.  Two different professionals had previously spoken about how each of them would treat a patient with plantar fasciitis, which is a painful inflamation at the heel where the tissue at the bottom of the foot attachs.  The Chiropractor had one approach, whereas the Neuromuscular Massage Therapist had another.  There were apparently some judgements regarding whose treatment is "right."  Well, I proposed that the treatment will vary according to the professional's training.  For plantar fasciitis, I generally recommend treatment which differs from either of their approaches:  a soft-soled shoe, an arch support, ice stretches, & an anti-inflammatory (such as Ibuprofen).  If the patient does not improve, I often recommend Physical Therapy, or perhaps a referral to a Podiatrist (who often gives a steroid injection & possibly fits the patient with an orthotic).  As you can see, the treatment depends upon which type of doctor or therapist you see... and no one treatment is right or wrong!  It is good to know that there are multiple options, so you can choose the best one for you.  Of course, you might have to try several options before you find your best regiment.  Though most medical professionals believe that their specialty provides the best treatment, realize that we are limited by our training & often do not even know what other professionals know or do!  So, we should all remember that we are complimentary, not competitive, as we should provide the care we know & understand, but welcome other therapies in which we lack training & knowledge... as long as all the treatments help the patient!

Skip stated that it seems that multiple physicians are changing their practices & seeing fewer patients.  He expressed a hope that they are getting away from the rat-race of medicine & perhaps doing as I am... abandoning insurance & taking "cash only" so I can actually work for the patient.  Reality is that most of the physicians who are changing their practices are not doing this, but instead are incorporating cosmetic procedures for which patients pay cash.  Unfortunately, this helps the physician make a better living, but takes a well-trained professional out of the true practice of medicine.  Also, since these cosmetic procedures do not involve insurance & thus provide an excellent source of revenue, many professionals are trying to get into the act.  As a consumer, you should realize there are many people who will profess to have the appropriate training to do a cosmetic procedure, & in fact they are likely telling you the truth.  To be certain however, don't hesitate to ask to see a person's credentials, as that will let you know if they in fact have the proper credentials & exactly what training they have had.  And did you know that payment is usually based on the procedure itself, not on the training or expertise of the professional doing the procedure.  So... if you want Botox injections, a Plastic Surgeon will likely do it for the same price as a Family Practice doctor or a Nurse Practitioner.  But... the Plastic Surgeon has years of training dedicated to cosmetic procedures, whereas the other 2 likely have had only limited training in that or a few cosmetic procedures.  When you pay cash, realize that people compete for your dollars, so shop around & ask questions.  As they say, "buyer beware," as licensure does not always translate to expertise!

On a different note, Gene sent an e-mail indicating that he occasionally has sharp pain beneath his tailbone when he is in bed.  First, I would look for a pilonidal cyst as these are painful cysts which occur at the bottom of the tailbone (at the top of the buttocks crease).  However, Gene would likely have redness & swelling in this area, with perhaps some discharge, & the pain would probably occur at any time... not just in bed.  It is more likely that the discomfort is due to some musculoskeletal problem as it is positional (occurs when the body is in a particular position).  He might consider whether or not he needs a new bed, & he might investigate this by sleeping in a different bed for a while to see if he feels better.  If he is a side-sleeper, he might try a small flat pillow to support the tissue between his ribs & his hips, as most of us have an hour-glass shape which allows us to torque at the waist when we lay on our sides.  If these simple things do not help, Gene likely needs to see his doctor for an evaluation, which should include a physical examination to look for a pilonidal cyst, as well as for a boney or soft-tissue abnormality.  X-rays might be ordered, as they might show arthritis or masses, & if there is no big problem found, perhaps a physical therapy evaluation or chiropractic evaluation might be helpful.  I did point out that since Gene said the pain sometimes feels like a gas bubble, it might in fact simply be gas.  If that is the case, I would expect that he would be aware that he has pain, then he passes gas, & then he feels better!  Lastly, I believe that if Gene continues to have this pain, he should have a rectal exam to evaluate his prostate & rectum, and perhaps even a colonoscopy, as problems in the prostate or rectum might cause pain of this nature.

Colleen posed a question about chronic inflamation & chronic diseases.  Certainly "inflamation" is the buzz-word lately, & science is apparently showing that many chronic diseases such as diabetes & heart disease are associated with chronic inflamation.  This does not mean however that inflamation is the cause of these disease processes.  I propose that the disease process itself leads to inflamation, not vice versa.  Thus inflamation does not likely cause diabetes, high cholesterol, or high blood pressure, but rather poor control of diabetes, cholesterol, & blood pressure likely cause an inflamatory reaction in the body which in turn causes damage to blood vessels & other organs in the body.  So treatment of inflamation actually requires treatment of the disease process itself, not just an anti-inflamatory medication.  So if you are worried about inflamation be sure to control your blood pressure, blood sugar, & cholesterol, and stop smoking.  Also, there is a belief that statin medications (such as Zocor, Lipitor, Mevacor, & Pravachol) not only lower cholesterol, but also lower inflamation in blood vessels.  Similarly, Ace-inhibitors (such as Lisinopril, Vasotec, & Univasc) or ARB's (such as Cozaar & Benicar) not only lower blood pressure, but also decrease intravascular (=inside the blood vessel) inflamation.  Some people with high risk for strokes & heart attacks opt to take a statin & perhaps even a low-dose Ace-inhibitor even if they have normal cholesterol & normal blood pressure... simply to try to decrease inflamation & perhaps keep their blood vessels healthy!  Most of us know that Cardiologists recommend aspirin to decrease one's risk of heart attack & stroke.  Most strokes and heart attacks are caused by clumps of platelets which lodge in & block blood vessels, leading to a lack of blood flow to the brain (a stroke) or heart (a heart attack).  Aspirin is known to stop platelets from clumping, thus aspirin decreases the likelihood of strokes & heart attacks, but perhaps they also help prevent these things simply by virtue of their anti-inflamatory effects, as aspirin is a great inflamation reducer.  Lastly, a little known source of chronic inflamation is the mouth.  Teeth with "cavities", & gums with "gingivitis" result in chronic inflamation, & there are reports that people with these problems are less healthy & more likely to suffer from cardiovascular disease.  So if you want to be healthy, be sure to brush daily, floss often, & see your dentist regularly!

Here's to our health!


PS  Don't forget to listen to me on Let's Talk Medical with Doctor Gigi at 1:00PM Eastern time on WTAN 1340-AM in the Tampa/St. Pete/Clearwater area, or via www.SkipShow.com where you can listen live or to the recorded podcasts.  And please don't hesitate to call or e-mail if you have a medical question or comment:  (727)-441-3000 or toll-free at (866)-TAN-1340 or DoctorGigi@SkipShow.com.  New blog to follow soon...