Accessing Resources for Empowerment

Wednesday, 01 April 2009 09:51 - The First Small Steps

Wed, 01 Apr 2009 14:51:58 +0100

People frequently talk about steps in analogies and metaphors. "One small step for man -- one great leap for mankind”, said Neil Armstrong as he stepped off the Apollo space craft on to the moon surface. "A journey of a thousand miles begins with a single step" said Chinese philosopher Lao Tzu. And the truth of the matter is that we can't get anywhere without taking steps, even small ones. In fact, it's one of the first things that we learn, after we learn to stand on our own two feet -- taking that first step. And look at how many steps you have taken since then!

We take steps in order to get from one place to another -- we take steps in order to get from home to work, from one side of the room to the other, from one place to the next in our lives, -- we simply can't get along without taking steps. So what's the problem when we take a step towards our own health and well-being by taking time to treat ourselves well at a spa for example? Why stop there? Why not keep taking steps after that big step that we have taken for the day, overnight, or weekend visit?

Most of the time it seems people say -- "I just don't have time" to take those steps to look after myself out there in the ‘real world’. But when you think about it, how much time does it to really take to take a step? It might need more effort to take one big step, but in fact it takes very little time to make several small ones.

Here is one step that you can take to continue the good feelings that you had when you were last really relaxed. Remember when you were lying on that massage table, getting that treatment or on that vacation? Just let your mind go back there now and remember it – right now remember the smells, remember the sensations in your body, remember the feelings that you had, remember the touch. You may not know this, but your unconscious mind remembers every experience that you have ever had, and faithfully stores it away so that you can access that ‘file’ whenever you need to -- like right now for example. Visualize this in your mind, hear the words that were being said to you, feel the feelings that you felt. Take just a moment to re-experience that feeling, and while you are at it, just take a couple of deep breathes and let go of any tension you might have in your body. You felt good then and you can feel good now. Your body and mind will rejoice in the re-experiencing of that moment -- and it's a small step -- and you can take many of those during the day, because you know what? They only take 30 seconds or a minute, and everyone has time for that. All you have to do is just be aware that you can, and make the choice.

Wednesday, 01 April 2009 09:51 - The Impact of Medication

Wed, 01 Apr 2009 14:51:09 +0100

Using medication to supposedly cure disease or ameliorate uncomfortable symptoms has become a part of our lives in Western culture. It is a part of the "pill for every ill" mentality that came about in the 1950s subsequent to the development of antibiotics and then tranquilizers. The ability to kill bacteria using antibiotics, thus literally saving thousand lives from the ravages of simple infections, naturally led to the idea that other medications might do the same for other diseases. However, over half a century later the medical profession finds itself in a very awkward and embarrassing position. An editorial in the prestigious New England Journal of Medicine by Dr. Jerry Avorn in November 2006 opens with the following paragraph –

"September 30 is becoming a day of infamy for drug safety. On that date in 2004 Merck announced that rofecoxib (Vioxx) doubled the risk of myocardial infarction [heart attack] and stroke and the company withdrew the drug from the market after 5 years of use in more than 20 million patients."

If this was an isolated situation, then my concern might be less. The problem is that this is a class of drugs known as NSAIDS, or non-steroidal anti-inflammatories -- perhaps better known to you as aspirin, ibuprofen, Advil®, Tylenol®, etc.

Now make no mistake about it, these drugs are effective in relieving pain from acute illness, and indeed they were supposed to be used that way. These long-term side effects that are being discovered are only being brought to light because long-term testing of these drugs does not take place until after they come to market! It takes literally millions of dollars to bring a drug to market these days, and pharmaceutical companies simply do not do long-term testing on all new medications, in the race to have the latest blockbuster drug. So who becomes the guinea pig? The answer is that you become the guinea pig after the drug is initially approved; and it is only after long periods of time with use by many people that these side effects are coming to light. You may recall, particularly if you are woman, that early in the millennium conjugated estrogens, better known as Premarin®, were found to increase heart disease as opposed to decreasing it -- the latter was a claim the drug companies and doctors had made for over 15 years. There was also a slight increase in the incidence of breast cancer. Women had been the subject of a huge uncontrolled experiment. Since that time hundreds of thousands of women have stopped taking conjugated estrogens and guess what? A recent study in 2006 showed that the incidence of breast cancer had decreased significantly over the last 5 years since women have decreased their intake of conjugated estrogens. Coincidence? Perhaps. More likely that the impact of huge numbers of women decreasing conjugated estrogens may actually be decreasing the incidence of breast cancer.

More concerning is that this is becoming a trend. The latest drug to receive a seal of disapproval is the anti-diabetic medication rosiglitazone. All that glitters is not gold! A large analysis in a 2007 study, again in the New England Journal of Medicine, showed a significant increase in the number heart attacks and death from heart disease in patients taking this medication. It’s bad enough that diabetes itself causes increased heart problems; we do not need a drug that is supposed to help control diabetes actually increasing death from heart attack!

Do you want to think twice before taking any drugs on a long-term basis? Absolutely. Many of these drugs were developed for acute pain situations -- not always for long-term use in ongoing osteoarthritis or other chronic illness. All these medications are foreign to our bodies, and they not only target those areas of our bodies that are in pain, say for example in the case of Vioxx, but they also target other areas of the body such as our blood vessels and stomach lining causing them to be affected in adverse ways through increased heart disease, or gastric upset and potential bleeding.

Adverse drug reactions were found to be one of the six leading causes of hospital deaths, reported in the Journal American Medical Association in 1997. Why are we taking drugs that are supposed to help us when they are actually killing us? It’s a good question that cannot be answered in this short article.

These adverse effects are not limited to pain killers, hormone replacement therapy, and anti-diabetes drugs, but have also been found to be significant in antidepressants that are prescribed to hundreds of thousands of people every year. A small increase in the suicide rate amongst those taking certain antidepressants, when pointed out by the psychiatric expert Dr. David Healey, resulted in his deferral from his upcoming position with the Canadian Association of Mental Health at the University of Toronto. A few years ago certain drug companies funded multiple clinical trials of their anti-depressants known as SSRIs – but they only reported the results of the favourable trials, and suppressed the unfavourable results! The impact of the pharmaceutical industry on medical science is both enormous and dangerous.

If you have to take medication then stick with the older medications that have been tried and true. You are better off in most cases because they have had the research behind them for many years, but… Lifestyle intervention on the other hand -- taking care of ourselves, eating healthy foods, exercising, relaxation, and just taking time to chill out have no adverse effects. They also have significant impact upon disease -- recent studies in Type II diabetes have shown that compared to diabetic drugs, lifestyle intervention was much more efficacious in keeping diabetes under control.

Take care of yourself – you’re worth it. And if you want to read that editorial in the New England Journal of Medicine you can find it at http://content.nejm.org/cgi/reprint/355/21/2169.pdf

©Edward Leyton MD 2007 © Accessing Resources for Empowerment™ 2007

Wednesday, 01 April 2009 09:50 - Insurance against Illness?

Wed, 01 Apr 2009 14:50:05 +0100

In Michael Moore’s new movie “Sicko” about the health care industry in the USA, much is made of the fact that Health Maintenance Organizations (HMOs) often deny coverage to patients because they failed to declare ‘previously existing conditions’ in their application. In the movie "The Rainmaker" a rookie lawyer defends a poor family against a decision by the insurer to deny their claim to benefits for treatment of their son who has leukemia. He wins the case, but the insurance company files for bankruptcy, so ends up paying nothing. "Never in Canada" you might say -- but, alas, such is not the case.

Although in Canada we have government funded health insurance, there are a growing number of services for which OHIP does not pay. For example, OHIP does not pay for all drugs, only for those generic drugs listed in the Ontario Drug Benefit listing. It does not pay for any ‘experimental’ alternative treatments such as acupuncture, or usually for any treatments given outside Canada. It does not pay for any vitamins or minerals that may be required for those on limited budgets, not having access to quality foods. Of course, it does not, nor has it ever paid for any long term disability (LTD) benefits necessitated by a chronic illness, such as cancer, heart disease, or rheumatoid arthritis. For LTD, Ontarians must rely on the woefully inadequate provincial disability insurance (ODSP), CPP, or private insurance. This is why some people pay premiums for extra insurance, often through their employers, provided by large multi-national insurance companies. When people buy this kind of insurance, they do so with the belief that that the ‘extra medical costs’ listed above will be covered, and that Long Term Disability payments will be granted for any chronic illness.

In 30 years of medical practice I have been less than enamored by the attitude of insurance companies to claimants for illness -- my patients. All too often patients have had to fight tooth and nail, often unsuccessfully, for any benefits. How can it be that people with chronic illness, who have paid hard-earned premiums for many years, are denied coverage for LTD, or for treatments that might help them get better? In "The Rainmaker" the prosecution shows that ‘all claims are automatically denied by the insurance company for a year’, hoping that the claimant will give up and go away. Now I wouldn’t want to suggest that companies in Canada would do that, but here is what can happen.

The patient goes to their family doctor and a chronic illness is diagnosed, for which there is no cure, and which prevents them from working in their chosen occupation. The family doctor refers them to a specialist who confirms the diagnosis. A claim is submitted, and on the basis of the written reports provided by the physicians it certainly ought to be paid. However, the ‘fun’ is only just beginning.

First of all there are the ‘bureaucratic’ delay tactics: this is where the company plays the ‘lost file’ game, or just simply takes a long time to pay the claim. If you haven’t kept photocopies of all your correspondence with the company -- watch out -- they may deny receiving the claim in the first place! Next, your file may be referred to the company ‘medical advisor’-- a physician. The physician has never seen you, and may make a decision based on the reports from the Family Physician, your Specialist, and, of course, their own biased opinion. If the letters from your family doctor or specialist are not strong enough or do not provide ‘hard evidence’, the claim may be denied. In “Sicko” medical doctors actually received bonuses if they denied a certain number of claims!

If not denied at this stage it may be recommended that you have an ‘Independent Medical Examination’ (IME), by physicians who are selected by the insurance company itself. Sound suspicious? Well, it is. Insurance companies appear to have a bevy of specialists, working for them of course, that will assess your condition in one brief session, and who usually tell the company you are fit to work, if not now, then in the future. Although you can refuse such an examination, you will probably be told that your benefits‘…will be discontinued or not allowed’. Somewhere in your contract, it will state that the company has a right to ask for an opinion from its own doctors.

By this time, you are probably frustrated enough with the whole game that it is making your chronic condition worse. You will feel angry and cheated, and justly so. Short of a long legal battle, there is not much you can do at this point. You have complied, you are following treatment, you are ill, maybe weak and tired, and a legal battle is the last thing you need. You may have already been spied on by private investigators and photographed by hidden cameras aimed at showing you lifting something, moving too much, or not taking your doctor’s advice. All of this is more ammunition for denial of your claim. Another nasty trick is to try to prove you are mentally unstable, or have a history of depression or anxiety. This somehow makes your physical illness less ‘real’, or more likely that you are ‘faking’ it.

Why do insurance companies do this? On the surface, there appears to be nothing illegal going on; they have the final word on any claim. But there is an underlying assumption that companies seem to operate under -- that patients would really prefer not to work, and are out to take advantage of the company. In other words in medical jargon they are ‘malingering’, out for a fast buck, so they can sit at home in front of the TV. The fact is that most of the time this is not the case -- for the most part people would prefer to work and lead productive lives. Or perhaps the bottom line is profit. There are many more claims these days for less definable illnesses such as Fibromyalgia, Chronic Fatigue Syndrome, and environmental sensitivities. People with these diagnoses are even less likely to receive deserved benefits, because there is often less ‘hard’ data to ‘prove’ they are ill. Companies are being deluged with these claims, and this is likely to increase as more psychological and environmental stresses take their toll on our lives. As these claims increase, companies ‘tighten their belt’ to offset them. However this is no excuse for the unconscionable, immoral and unethical behaviour that insurance companies pursue. What can you do if you are disabled? In Canada, each company has an insurance ‘ombudsman’ whom you can call or write, once a decision has been made in writing by the insurance company. If you get nowhere with the insurance company ombudsman, you can appeal to the Provincial Ombudsman who oversees the whole system. For further information on these avenues of appeal you can call or write for information on the ombudsman for your insurance company.

Financial Services Commission of Ontario (FSCO)5160 Yonge StreetP.O. Box 85Toronto, Ontario, M2N 6L9
Internet: www.fsco.gov.on.ca Phone: (416) 250-7250 Toll free: 1-800-668-0128
©Edward Leyton MD 2007 © Accessing Resources for Empowerment™ 2007