Ask the Doctor

Common law

2015-05-16T08:17:00.001-07:00

1- What is common law and how is it created?

Common law is a type of law established by a collection of judges after reviewing the assessments of courts and other similar judicial bodies that have decided on individual cases. Common law is different from statutes which are adopted via a legislative process or principles issued by an executive branch

Before common law can be established, there are several phases of research and examination required of “what the law is” is a similar scenario. Initially the facts must be established. The next step is to find any relevant cases and statutes. This is followed by extracting the analogies, similarities, principles and statements by the many courts on what they considered was important to conclude how the next court is likely to rule on the facts of the present case. Decisions made later and in higher courts generally carry more weight than lower courts and earlier cases. Finally, one has to combine and integrate the information and understand “what the law is.” When all done, the law can be applied to the facts of the present case.

2- What are statutes?

A formal written representation or publication of a judicial body that governs a country, city or state is known as a statute. In general, a statute either prohibits or commands something or states a policy. Statutes are laws made by the judicial body and often referred to as the “black letter law.” As a basis of law, statutes are a well thought out primary authority. In most cases, statutes are in agreement with the fundamental law of the land.

Guarantee after bariatric surgery

2014-02-11T06:10:00.000-08:00

Is there a guarantee that I will lose weight after bariatric surgery?

There is no guarantee. There is a considerable variability in how people respond to surgery. This cannot be predicted beforehand. Just because one obese person lost 100 pounds after surgery does not mean the same will happen to you. Depending on whom you believe and what you read, the numbers of people who fail to respond to bariatric surgery vary from 10%-40%. There are no refunds if you do not respond.My best advice-eat less and walk more. it is cheaper, safer and does work as long as you remain dedicated.

Surgery for dumping syndrome

2014-02-11T06:08:00.002-08:00

Do you recommend surgery for dumping syndrome?

Absolutely not. This is not some Mickey Mouse removal of the appendix or repair of a hernia. This is a major undertaking and very few people in the USA are accomplished at it. While all surgeons claim that they can treat dumping syndrome with surgery, the results suck.

The first thing you need is an experienced intestinal surgeon not some mediocre bariatric surgeon. There are various procedure devised to treat dumping syndrome, but there are no long term studies that have shown their effectiveness.

I would avoid surgery and try a drug like octreotide or acarbose. The surgery is also prohibitively expensive and you can rest assured, there will be some type of complication afterwards.

Bariatric surgery and dumping syndrome

2014-02-11T06:07:00.002-08:00

I had a gastric bypass done for weight loss and have now developed the dumping syndrome. Is there a medication that will work for this?

To begin with, you are in tough KAKA (that means big S..T). Dumping syndrome is a known complication of gastric bypass surgery. The symptoms can vary in severity but in all cases, make life very unpleasant.

In the past, surgical revision was the only option, but now there are a few drugs that can be tried. Mind you, there is little proof that these drugs work as there are no large clinical trials.

One common diabetic drug that is often prescribed is acarbose. This mild antidiabetic drug is known to interfere with absorption of carbohydrates in the gut, which results in lowering of blood sugars. Acarbose has been shown to decrease symptoms of dumping syndrome.

Now to the negative aspects. The drug prevents absorption of carbohydrates and this leads to fermentation of sugars in the intestine which can cause diarrhea. In addition, the accumulation of carbohydrates leads to excess gas, bad breath and bloating. The majority of people are not able to tolerate the drug because of these adverse effects.

Since now you have very few options, I would try a low dose of this drug-perhaps 25-50 mg and take it from there. Most people see a response at 100-200 mg. Good luck

Heat Therapy for Rheumatoid Arthritis

2014-02-11T06:05:00.002-08:00

Is heat therapy effective in patients with rheumatoid joints?

Heat therapy is widely used as complimentary treatment in patients with rheumatoid arthritis. It is claimed to decrease the pain and increase joint mobility. Heat is often administered by a topical heat pack, electric mittens, ultrasound, paraffin wax or going to a spa. There is no difference between any of them when it comes to effectiveness.

You can use a hot water bottle at home and that is as good as a trip to the physical therapist. Most heat therapies at the spa and exercise parlors are nothing more than scams. Physical therapists often recommend exotic devices for heat application but this is primarily designed to swindle the insurance companies or you for more money.

If you want to obtain benefit from heat, it needs to be applied regularly. When combined with some type of exercise, the results are gratifying. Do not expect miracles because there are at least 30% of rheumatoid patients who see no benefit from heat.

Lefunomide for rheumatoid arthritis

2014-02-11T06:02:00.001-08:00

Do you think lefunomide is a safe drug for rheumatoid arthritis?

Lefunomide has been around for 15 years and is sometimes used to treat rheumatoid arthritis; while the drug does work it does have many serious adverse reactions. This has to be discussed between you and the doctor.

Any patient who is on lefunomide must be closely monitored. The drug can seriously damage the liver, cause allergic reactions, suppress the bone marrow and can even cause shortness of breath.

If you can tolerate methotrexate, I would avoid this drug. It is also very expensive and the extra monitoring will mean more visits to the doctor and more costs.

Sulfasalazine is a better option but it is not as potent as lefunomide. Sometimes patients have no choice other than to be prescribed lefunomide.

Rheumatoid arthritis and carpal tunnel

2014-02-11T06:01:00.002-08:00

I have rheumatoid arthritis and have developed carpal tunnel syndrome. My surgeon says surgery is the only way to make the symptoms go away. Any suggestions?

Carpal tunnel syndrome is a known complication of rheumatoid arthritis. The symptoms do vary and so do the treatments. There are several treatments for the disorder including rest, splints, acupuncture, ultrasound, pain control and surgery.

Since you have rheumatoid arthritis, I would not recommend surgery. Plus, the surgery does not cure the problem and recurrence of symptoms is common.

The best therapy I can suggest is to wear a splint at night and exercise the wrist and hand during the day. The longer you stay away from orthopedic surgeons, the better the quality of your life will be.

Baker's cyst and surgery

2014-02-11T06:00:00.001-08:00

I have a baker’s cyst and my doctor wants to perform surgery. Any suggestions?

Yes, dump your doctor. A Baker’s cyst is a small lesion usually behind the knee, in most cases it is identified coincidentally. In rare cases, it may cause discomfort. The majority of baker’s cysts resolve on their own and no treatment is required.

Surgery is almost never done to remove the cyst and the surgeon is more likely to damage some critical nerves in the area. The cyst can be aspirated with a needle if it is large- even this is rarely done.

Best advice, change your doctor, rest and take the occasional Tylenol. This is not a life threatening condition. There is no harm from leaving it alone. The doctor just wants to cut you up so he/she can make money.

Probiotics and Bariatric Surgery

2014-02-11T05:58:00.003-08:00

Is it true that probiotics can help weight loss after bariatric surgery?

First, the probiotic supplement industry is a billion dollar business which often makes unsubstantiated claims. And there are a lot of gullible and foolish people who believe in probiotics as the ultimate panacea for all health problems. As to whether probiotics help lose weight is debatable. Normal people who eat kilograms of probiotics everyday have not been shown to lose weight, without the aid of exercise.

Now there are reports suggesting that people who undergo bariatric surgery procedures may be able to lose more weight if they consume probiotics. The recent study has many limitations in interpretation and it is hard to say much about the results.

The only suggestion I have is that you are free to try probiotics. If they work- good for you. If they do not, join the list of suckers.

Rheumatoid arthritis and drugs

2014-02-11T05:56:00.002-08:00

I have moderate rheumatoid arthritis and was on methotrexate in the past. I could not tolerate the drug. Is there something else I can take?

Yes, you can ask your doctor for either lefunomide or sulfasalazine. They both work but lefunomide is slightly more potent than sulfasalazine. Lefunomide is also associated with more adverse effects and is also more expensive. Before you are prescribed lefunomide, make sure you are told every detail about this medication.

What exactly is MSM?

2014-02-09T04:38:00.003-08:00

Methylsulfonylmethane (MSM) is also known as methyl sulfone. This inert chemical compound is a break down product of dimethlylsulfoxide. MSM has been widely touted to cure arthritis and relieve back pain. The people who advocate this substance for its use in various arthritic conditions claim that it is a miracle product. It is claimed that MSM can cure many medical disorders including snoring, diarrhea, peptic ulcer, allergies, respiratory ailments and arthritis.

All over the internet, almost every seller of MSM makes claims that it can cure almost everything, including your pockets. In fact there is not a disorder that can not be cured with MSM. Some sellers on cyberspace claim that MSM can reverse hair loss, make gonads bigger, increase libido, heal varicose veins, increase breast size, prolong orgasms, diminish allergies, keep skin young, remove acne, diabetes, carpal tunnel syndrome, lupus, fibromyalgia, chronic fatigue syndrome, parasites, muscle cramps, migraine, make the penis bigger and keep you looking young- and this is only a partial list of what MSM can do.

Based on this information, any person with a tiny bit of common sense should be able to see that MSM is nothing but CRAP. For those who like crap, the recommended dose of MSM is 0.5-1 mg/kg per day.

Echinacea sucks for the common cold

2014-02-09T04:36:00.000-08:00

Many people swear that Echinacea is the best treatment to fight a common cold. To fight the cold one must take 10 grs of Echinacea on the first day and then 5 gr the day after for 7-10 days. However, the latest study shows that Echinacea sucks.

In the latest study, more than 700 people who took the Echinacea pills did not do better than who took the sugar pill when it came to fighting the cold. This is not the first time Echinacea has flunked the test. Many other high quality studies in the past have revealed the same thing. The plant did not improve the symptoms nor did it decrease the duration of the cold. It did ZILCH.

Echinacea is an American plant and widely used by the native Indians to treat a variety of ailments. The plant is sold in many health food stores as a liquid, pill, powder and even a tincture.The cost of Echinacea is not trivial either. The pills depending on where one buys them from can cost anywhere from $10-$22 for a 2 weeks supply.

While Echinacea is a harmless herb, it is useless when it comes to fighting the common cold. With today’s difficult economy, that money is better put towards gas in your car or food on the table.

Pink patch for weight loss

2014-02-09T04:34:00.000-08:00

Do you recommend the pink patch for weight loss?

The bottom line is that the pink patch is just another swindle. There is no scientific data that indicate effectiveness of the pink patch as a weight loss aid. Moreover, any weight loss product that does not recommend exercise or mentions what you can/cannot eat is always CRAP.

Therefore, all you young women who want to lose weight, save your hard earn money and stop falling for such B.S. weight loss gimmicks. The only think you will ever get from the pink patch are the “blues.” If you really want to lose weight, start by walking more and eating less. Walking is safe, free and of course, you also get to enjoy nature.

Pink Patch For Weight Loss

2014-02-09T04:32:00.003-08:00

So does the Pink Patch work for weight loss?

Of course, it does not.

Consumers should know several things about the pink patch. First, the FDA has not approved it 2) there is not a single study on the pink patch and its efficacy, 3) there are no guidelines and no exercises recommended and 4) the ingredients in the formula have never been shown to induce weight loss in any living creature. By the way, the pink patch costs nearly $50 a month. Even though the pink patch site mentions of a refund, many people online complain that they have never received their money back. Almost every review on cyberspace indicates that pink patch is an ineffective method for weight loss.

Pink patch ingredients

2014-02-09T04:31:00.001-08:00

What are the magical ingredients in the pink patch?

The pink patch contains some exotic seaweed, focus vesiculosis, which has been touted to decrease fat by increasing your metabolism. There is also yerba mate, 5-HTP, zinc, flaxseed oil, lecithin and carnitine (PS-None of these ingredients have ever been shown to help anyone lose weight). The manufacturers do not even recommend exercise with this patch, nor is there a limit on your calorie intake.

Pomegranate Juice Sucks

2014-02-09T04:29:00.002-08:00

Almost on a weekly basis, exotic juices are hyped up to cure every medical disease underneath the sun. For the past few years, people have been drinking gallons of pomegranate juice in the hope of curing arthritis, getting rid of the wrinkles and or preventing the common cold. In fact, most health food stores have been selling pomegranate juices with labels that it can cure heart disease, prevent prostate cancer and even potentiate erections.

So is pomegranate juice the magic bullet for all of our health problems?

The federal trade commission says pomegranate juice is tasty but it is not buying all the B.S. medical claims made by the manufacturers of this exotic colorful juice.

The FTC has filed a complaint against POM Wonderful alleging that the juice maker has been making "false and unsubstantiated claims" about their pomegranate-based products, which also includes other pomegranate products like iced teas, POMx pills and nutrition/energy bars. Pomegranate products are heavily marketed and can be purchased online and in retail stores.

In its complaint, the FTC has mentioned that there is no scientific study that backs the claims made by POM. In fact, one of the studies presented by POM even showed that the health benefits of pomegranate were no better than a sugar pill.

So for all you juice fanatics, there is nothing wrong in drinking pomegranate juice. However, if you are consuming this juice for prevention or cure of any medical disease, think again. You may just as well drink urine- because the medical benefits from both “juices” are the same-but the urine is free.

TENS for back pain

2014-02-09T04:26:00.003-08:00

I have had back pain for some years and my doctor suggests I should buy a TENS device. Do these machines really work?

Transcutaneous Electrical Nerve Stimulation (TENS) is a non-pharmacological method of treating back pain. The device delivers low voltage electrical currents to the skin. TENS has been used by millions of people to treat a variety of pain disorders. Almost every healthy food store and pharmacy sells these devices. So do these devices actually work?

Review of the literature indicates that that the majority of people who used TENS found no pain relief. In fact, the pain relief by the sugar pill was much greater than the TENS device. The few people who did find relief noticed that the pain relief was very short in duration. After several months, most people found that TENS devices were more suitable as a paper weight.

So what does all this mean for the consumer? TENS mania has led to billion dollar industry which has thrived chiefly because of desperate people spending their hard earned money on bullshit devices. For the consumer with pain, do not spend your hard earned money on crap. Be knowledgeable, read about the devices before you buy them and avoid pain clinics- this is the one place where you are most likely to meet charlatans who will suck you dry.

Capsaicin for pain

2014-02-09T04:25:00.000-08:00

I am a diabetic with severe neuropathic pain. Do you think capsaicin may help relieve this pain?

Capsaicin has been heavily marketed for a variety of pain syndromes. Today people buy this product and use it for the treatment of neuropathic and herpetic pain. When capsaicin is first applied, it actually worsens the pain, but then the pain sensitivity is reduced after repeated applications. While many people claim that it works, there are very few clinical studies that have actually looked at its efficacy. Based on some studies, capsaicin may work for mild neuropathic pain but complete relief is not possible. The product must be combined with other medications.

One can buy a low dose cream containing 0.075% capsaicin which can be used for repeat applications or use the 8% formula for single application. One of the most common side effects of capsaicin is the skin irritation which often leads to discontinuation of therapy. Capsaicin also does not come cheap. If you have the money, you may want to try the small dose of capsaicin. Pain relief is not instant and often takes many days. If you do not have money to waste on a product that may not work, you may want to try lyrica.

Brazilian Tea for Pain Relief

2014-02-09T04:23:00.003-08:00

Does Brazilian mint tea provide pain relief?

For centuries, the herb hyptis crenata has been ingested by people of South America to treat a variety of medical problems including pain relief. Anecdotal reports have circulated for many years that individuals who drink Brazilian mint tea feel relaxed and have a higher tolerance to pain. The leaves and bark of the willow tree contain a substance called salicin, a naturally occurring compound similar to acetylsalicylic acid, the chemical name for aspirin.

The Brazilian mint tea is very different to the taste and in fact tastes more like sage rather than mint.

As far as it ability to relieve pain goes, there is still ongoing debate.

Before you stock up on Brazilian mint tea, just a final note. Anecdotal reports claim that the beverage tastes horrible (sucks) and the pain relief is mild and not seen in all individuals. The tea is also outrageously expensive- in simple words- Another Rip off .

TENS for pain relief

2014-02-09T04:17:00.003-08:00

Is there evidence that TENS is useful for pain relief?

As of today, there is no evidence that TENS does anything for people with chronic pain. There is not a single randomized blind study which has categorically shown that TENS works to decrease pain.

So for the time being TENS cannot be recommended for pain control. Some health care professionals who recommend these devices often have shares in these companies or are paid to give out positive reviews. The next time you get prescription for a TENS machine from a physician, go get a second opinion. Of course there will always be some who argue otherwise; for these non believers go read Cochrane reviews on this topic. Consumers should save their hard earned money for things that work and not on scam devices.

For those who hate medical jargon- in plain English- TENS is junk therapy.

Tea and health

2014-02-08T08:05:00.003-08:00

Can Tea Reduce Heart Disease

Heart disease now affects millions of people all over the globe. For decades, patients have been advised to change their lifestyle to reduce the risk of heart disease, but compliance has been low. Heart disease carries an enormous burden both medically and financially. Despite introduction of new medications, heart disease still ranks as a common cause of death.
Over the years, many types of preventive treatments for heart disease have come and gone. One such therapy is the consumption of tea. It is widely believed by many that green and black tea can lead to a decrease in heart disease. There are many anecdotal reports detailing the benefits of drinking tea.

Unfortunately, most studies show that drinking tea has no medical benefits. The few positive results have been published by the manufacturers, who have a vested interest in the beverage.

For consumers, it is important to understand that tea is an excellent social beverage but whether it possess any healing powers still needs to be proven in long term studies. In the mean time, there is no harm in drinking tea but one should also eat healthy, exercise and refrain from smoking.

Urinary incontinence

2014-02-08T08:01:00.002-08:00

Can acupuncture help my urinary incontinence?

Urinary incontinence has many causes and in all cases, is quite difficult to treat. Some therapists recommend acupuncture for this disorder. Unfortunately, studies show that acupuncture sucks as a treatment of urinary incontinence. Worse, acupuncture is not a one shot deal- you have to enroll for many sessions over many months. Each session can cost anywhere from $100-$300. Best advice, keep away from this BS therapy. It is a complete waste of money and time. The only people who benefit from this therapy are the people who offer it. For most patients, acupuncture offers minimal benefit.

Hyponosis & Schizophrenia

2014-02-08T07:53:00.002-08:00

Does hypnosis help people with schizophrenia?

The majority of individuals with schizophrenia are treated with antipsychotic medications. These drugs are quite effective but they also possess many adverse effects such as weight gain and metabolic changes like elevated lipids and glucose.

Some professionals in alternative healthcare recommend hypnosis for these patients. This is nonsense -most patients with schizophrenia are paranoid, afraid, have labile mood, are often hallucinating, have poor interpersonal skills and often keep to themselves.

It is hardly likely that a schizophrenic is going to sit down with a therapist and undergo bullshit hypnosis for 15-30 minutes. Schizophrenics just do not have the concentration or attention span to chit chat and undergo some bogus mantra.

Hypnosis is not a realistic treatment for these patients. In any case, analysis of studies indicate that hypnosis does not work for schizophrenia. A complete waste of money and time. Hypnosis is still looking for something it can treat. Only stupid and gullible people go for hypnosis.

MSM for back pain

2014-02-07T18:07:00.000-08:00

Are there any clinical studies on MSM and back pain?

As far as clinical studies are concerned, there is very little scientific data on MSM. Except for a few animal studies there is little known about it. The only anecdotal data on MSM are made by the manufacturers and dealers. There is not a single individual who has come forward and revealed that his/her back pain, diabetes or arthritis has been cured with MSM.

With regard to MSM and back pain, there is zero evidence that it does anything. In fact the FDA has already warned dealers against making false claims about MSM. No one questions the fact that sulfur is needed by the body but the amounts needed are miniscule.

So for individuals seeking a miracle in MSM, you are going to be disappointed. For the moment, it is nothing more than a scam. And MSM does not come cheap. Ninety capsules cost anywhere from $15-$20 and you can add up the yearly cost. If you have back pain, go to a bona fide healthcare professional and seek a therapy which works. Unfortunately, if you have low back pain, you are going to be scammed by most healthcare professionals.

Botox for migraines

2014-02-07T18:05:00.004-08:00

Botox sucks for migraine

All over the country, physicians have been injecting Botox for migraines. The only people who claim that Botox works for migraines are the doctors who inject it. The chief reason for this is most likely money. Botox injections for migraine are not reimbursed by Medicare or any health insurance- so it is a cash business.

Now finally there is evidence which shows that Botox sucks for migraine. A recent study from England revealed that Botox was no better than a sugar pill. So far, only anecdotal reports exist that Botox works for migraine, but how it works remains a mystery. Experts say the most likely reason Botox worked for a few people is because these individuals never had migraine in the first place. After proper selection of migraine patients, no one benefited from the injections. In some cases, Botox injections even made the migraine worse.

Botox injections do not come cheap and can cost anywhere from $500-$800 per session and have to be repeated many times. Botox is great for wrinkles but there is little evidence that it can cure your migraine. Therefore, anyone who suggests Botox for migraines is simply trying to rip you off. Go tell them to P..S off.