Doc’s Blog

Much has been in the news lately about the escalating costs of prescription medications – in particular price hikes for medicines necessary to save lives.

Last week, Mylan CEO Heather Bresch, was chastised before a Congressional panel for hiking the price of the epinephrine delivery device from $97 per two dose pack in 2007 to over $600 in 2016.

Epinephrine is a vital, life saving drug when administered when someone is suffering the grips of anaphylactic shock.  It is not a new drug, in fact epinephrine has been around since 1901.

As you will see in the video below, I’ve developed a unique solution that costs pennies on the dollar:

• One 1cc vial of epinephrine ($5.00)
• Three syringes ($.60)

I encourage you to share this post with not just your friends on social media, but your doctor as well.  For someone with a need for epinephrine on hand, utilizing some simple pharmacology basics along with the direction of a competent physician there is no reason why anyone should be without this drug.

One thing that is often overlooked is the expiration of the EpiPen.  Clearly stamped on each device, EpiPen effectiveness decreases over time.  You certainly don’t want to be in a situation where an immediate epinephrine injection is needed, but the medicine you have is outdated and ineffective.

Many pharmacies do not stock pure epinephrine simply because doctors have been conditioned to write prescriptions for name brand solutions.  Although I had to special order the epinephrine used in the above video, it still cost me only $5 for the vial.

EpiSAVE Kits Available

For patients living in Ohio and Florida, I am willing to prescribe and provide my own unique kit that contains one vial of epinephrine along with three syringes.  You’ll need to book an eVisit with me so I can consult with you and provide you the proper direction on how to administer the shot when necessary.  The cost of an eVisit is $60, and you can turn the receipt into your insurance for possible reimbursement. Our eVisit platform is secure, HIPAA complaint, and is convenient.  If you have a smartphone, tablet, laptop, or webcam enabled device you can connect with me anywhere.

I only ask you pay a $5 shipping and handling fee and the cost of the supplies ($5.60).  For a total of $70.60, you can receive three doses of epinephrine.

With some teaching and common sense, we can help fight these big pharma monopolies on saving lives.

Hi all! I am back from my beautiful and restful travels; and want everyone to know that I am officially OPEN and READY to be your GO TO resource for acute healthcare questions and care! Whether old friend or new, past work associate or new travel contact, or of course even if we have never met before and you have found me otherwise; rest assured, I am eager to address, advise, and YES IN FACT TREAT most of your urgent health care needs.

Thanks to all of you who have preregistered through eVisit,  the easily accessed link to my virtual waiting room contained on this site. While certainly I have no desire for any of you to be ill or injured and need me (or of course your friends or family), at some point…WE ALL KNOW BETTER! ‘Tis the season after all for just about everything!! I am still offering the first eVisit telemedicine consult – whenever that may be needed -for $30 (1/2 the normal $60 fee) if you sign up before January 1, 2016.  So check out the link to eVisit, sign up before you need me, and save on the first time we may need to “meet” again!

Keep an eye on the site for my blog posts (lots of fun!!), and my frequent educational video posts on various healthcare topics. I will now also begin to answer questions on the site now that I am back from the agonizingly slow (one of the few complaints allowed!) cruise ship internet….Be well all, GREAT TO BE HOME! Clicking my red ruby slippers, There’s no place like home indeed!!

As I sail to the other side of the world, surrounded by fellow travelers from literally 34 countries, our similarities appear far more striking between us than the differences. The beating heart, coupled with the human spirit longing for adventure, is the most obvious similarities between us all. Further, our deference to both “Mother Nature” controlling the weather, the tides, and our daily rituals; as well as “Father Time” controlling our aging process has become quite obvious amidst the beauty of our passage around Cape Horn and through the Straits of Magellan. The courage of those explorers from the earliest of days astounds me, sailing into the complete unknown being beyond most of our capacities. How anyone could have survived not only the sailing to these destinations, but the settlement of these desolate locales, is beyond comprehension. I salute them for their sacrifice, and will remember these sights forever!

Most interesting has been my discussions with my fellow travelers in regards to their medical issues, mainly centered around past surgical procedures, some successful, some not;  as well as the acute daily health concerns faced on a 2 week cruise. From the sore throat, to the aching joints and feet, (head to toe), the similarities CONTINUE between us all! When we are 100%, the body is rolling along in a fluid and appropriate manner, all “ship shape”, as they say!! When we are not 100%, no matter WHERE we are not right, the bottom line is the same: something, somewhere, somehow has become inflamed!!!

Thus “-ITIS”, the Latin root for inflammation, is the ultimate enemy, both acute and chronic!! For example, tonsils and the back of the throat feel normal until one develops “tonsillitis” or “pharyngitis”. Your joints (arth being the root) don’t hurt until you develop “arthritis”. Similarly your stomach feels well until you develop “gastritis”, and your bladder works well until you develop “cystitis”.  Just find the Greek or Latin root for the body part, add that nasty 4 letter word,”- ITIS”, and it’s easy to define. Both acute and chronic (think tendonitis for the simple ankle sprain, rheumatoid arthritis for the chronic); the process is all about the inflammation!!! The treatment, on the other hand, can be much more challenging than the definition, certainly for the chronic conditions.

The hallmarks of acute inflammation are easy to recognize. Redness, warmth, swelling, and of course pain being the BIG 4! Think acute gouty arthritis, if you’ve ever seen a gouty toe or the back of your throat when you’ve had strep. Treatment always starts with rest, coupled with ice and elevation, compression with an ace wrap or splint of the body part if possible to reduce the swelling. Medications are used with various levels of success. ANTIBIOTICS, of course, are the solution if the cause is a bacterial infection; ineffective for viral infections although still often utilized. The strongest of the anti-inflammatory medications, the steroids (prednisone, cortisone), work great in general, but can’t be used every day without significant side effects. They still are used daily in certain severe inflammatory conditions (severe arthritic conditions, connective tissue diseases, etc.), when the benefit outweighs the risks. The NSAID’s (non-steroidal anti-inflammatory drugs), aspirin being the oldest (ibuprofen, naproxen, many others) are widely used with a great safety profile, but longer term, daily use should always be discussed with your primary care practitioner, as they too can have side effects over the long term. Interestingly, Tylenol (acetaminophen), while excellent for pain relief is not an anti-inflammatory drug, nor are the narcotics of course.

Chronic pain is tougher, a huge problem for many, especially as “Father Time” wins his battle as he always does, and a topic for another blog:  this one is long enough already! Remember, -ITIS  is the enemy, common sense with activities the best way to avoid it, but it’s just a part of our common human condition we all MUST face from time to time, no matter how healthy we are!! Remember R.I.C.E. as the treatment…rest, ice, compression/elevation for swelling, antibiotics for the appropriate infectious causes, and see your doctor if it persists or recurs!! Be well all!!

As I am privileged enough to be posting this blog entry from literally the other side of the world, many things are so strikingly obvious.

What a beautiful planet we reside on – the natural beauty of the sea and the vast nature of the water.  Both are hard to appreciate until you are fully surrounded and engulfed within it. The thought of what lies below is a metaphor for life itself, almost beyond one’s capability  to imagine the wonders. The land forms which arise from the sea are equally glorious, sometimes appearing without reason to expect their presence (the Falklands, Easter Island, etc) and of course the main 7 continents serving as the anchor for our existence on this Goldilocks zone we call Earth; under the sun’s radiant warmth.

On this level, every beating heart brings equality to who we are in this celestial dance. As I cruise onward towards the bottom of the earth, it’s important to realize how similar we all are, we have the heartbeat….that human spirit. Only we humans have the ability to appreciate this gift given to us from whoever or whatever you believe has granted it to us! It is not to be ignored or wasted away!!

Not all of us can be lucky enough to sail to the tip of the planet. I know how fortunate I am to experience it. I hope I can relate a few of my experiences to you thru my video posts, and I hope to carry this unique experience forward with a renewed spirit of teaching and caring.

On this cruise are people from all over the world, many of them world travelers with far more experience than I.  So willing to share their past travels, their stories incite both a desire to see more, and also a desire to share what I have seen with others.

Most striking to me has been the interest of others in my past 32 years as an Emergency Physician, a journey unto itself! My life stories and journey have not been to unique places in location, just to the unique circumstances of our American healthcare experience. What I felt to be routine and mundane after 32 years, absolutely fascinates and interests others far more than I could ever imagine.  So I have had something to share with these worldly travelers as well, much to my surprise!

So onward I will go, my stories will be told, other stories will be heard, stored and shared with others! Good to be alive!! I will be getting back to some more healthcare related topics as we go, but the message for today is simple enough! Look around, look closely, share what you see, listen to others. We all have the ability to create our own reality, PLUS the value in our stories to make other’s reality more colorful and real!! Never underestimate your value on this planet! We are all here for a reason!! We all only have one chance at greatness, however it becomes available to us every single day of our lives!!  Be well all, see you soon!!

Medicine has changed significantly in many ways in my 32 years in practice. One of the primary changes has been the advances of mid level practitioners throughout all fields of care. When I went to medical school at Ohio State, only we medical students were learning the appropriate way to do the proper physical exam, rectal exam included (there is a best way believe it or not!) Only doctors ordered your tests and prescribed your meds for you, we were special in that way…think Marcus Welby for my age group.

Today, however, with the advanced training available for nurses, which can result in full NP certification, as well as the full utilization of the capabilities and training of our Physicians Assistants, there are many who can be there to lead you through the health care system. As a career ER physician, I was proud to lead a great team which included fantastic PA’s and NP’s. No busy ER can function in today’s world without them. I applaud this advance in care, as in general they do a fantastic job, and can fill most roles within primary care! The well trained and caring NP or PA can be a fantastic augmentation to any health care team, and they can and do provide fantastic healthcare. However, there are still differences.

The physician continues to lead the way in didactic education, internship and residency training. Most physicians, as well, are Board Certified in a medical specialty, mine of course is Emergency Medicine; and we need to undergo re-certification every 10 years to maintain our certification! When you see a Board Certified doctor, there is a level of expertise that should not be ignored.

Training is one aspect, experience is just as important. Acute care, ER of course, is a head-to-toe, all body system practice. I like to call it the specialty of time. My training and experience will allow me to not only treat what needs to be treated, but further, to best discuss the timing of your problem!! If you have a 5 second issue (you are choking, your partner has passed out), c’mon man…you know better than that. However, the 5 minute (my left face numbness and slurred speech just started, I have chest pain, etc), to the 5 hour, 5 day, 5 week circumstances can be more subtle.

What I bring to the table for my patients that others don’t, is my combination of dedicated  ER/urgent care training, along with 32 years of caring for and teaching patients the what to do’s, and when to do’s when you are sick or hurt! This is crucial in today’s medical world, as the technology can sometimes be confusing, and answers not always clear. The role of teaching becomes crucial, and as a lifelong communicator, I take pride in my ability to breakdown the issues of treatment and timing tailored to the education levels of my patients! I am thrilled to have found a new and innovative way of doing this: “SEE ME” thru my eVisit site and experience the difference!! I am here for you when you need me…