Humans and Animals: Closer Than Ever?

By Karin Krisher

humans and animalsDid you know about the completion of the canine genome map? It happened in 2005. We hope you were paying attention, because the rest of the world wasn’t—or at least, we didn’t seem to understand the implications of the breakthrough. Luckily for average Josephines like myself, the American Medical Association and the American Veterinary Medical Association were paying attention and came together in 2006 to adopt a new mindset about medical care for humans and animals.

The organizations recognized that “about 60 percent of all diseases move across species and that environmental pollution, animal diseases and human diseases constitute a single interlocking problem.” The mindset, called “one health” or “one medicine,” is changing the way physicians and veterinarians think about working together.

And that’s changing medicine. Where advancements in the two (animal and human medicine) have manifested 10 to 20 years apart in the past, today they happen around the same time.

DaVinci understands the commonalities between the two areas of health. To that end, we’ve worked closely with Research and Development to create products in our line that support companion animal wellness. Our line includes supplements like Joint Support and Serenity Now for Cats and for Dogs.

If you haven’t thought about your options for supporting companion animal health, perhaps there’s no better time than in this emerging era of cross-discipline information sharing.

Learn more about the changing face of medicine with this article—reading until the end helped us grasp the full power of these changes.

Have you ever worked side-by-side with a veterinarian? How did the experience match up to your expectations? Tell us in a comment!

Mindfulness Meditation Benefits

By Karin Krisher

mindfulness meditationLast week, we broached the topic of doctor burnout. This week, we want to talk about how to actually handle it with a little something called mindfulness meditation. Mindfulness meditation benefits are far reaching, but perhaps the most obvious and relevant to you and your patients is a better ability to provide quality care.

Mindfulness is all about being present. It’s not about being comfortable when you are all alone in a room. (Though that is still important.) It is about being able to be fully in the moment and aware of the moment. It is about drowning out distractions that might remove you from the moment, and being open to both having and reflecting on the experience, rather than simply regarding it as one average event in a string of many.

Because your patients (and anyone, for that matter, including yourself) can easily sense if you’re running on autopilot, that tendency can be detrimental to your care and the doctor/patient relationship. If you, like many physicians, have noticed yourself slipping away into a sea of electronic distractions and paperwork, rather than focusing on every interaction’s quality, learning mindfulness will benefit both your mental state and your patients’ experiences.

Mindfulness Meditation 101

So, how is serene awareness learned? It isn’t easy to both let go and hang on at the same time. Letting go of distractions and grabbing tightly to the very fact of a moment with your patient seem like they would be mutually exclusive endeavors. But that’s not true: being present means you don’t zone out to ignore distractions—instead, you zone in.

There are meditation groups that can help. Some even specifically address physician burnout. In 2009, The Journal of the American Medical Association published results of a study that examined such a course, wherein physicians learned about “that ability to be in the zone and present in the moment purposefully and without judgment.” (The New York Times)

The results were incredible; “Several of the improvements persisted even after the yearlong course ended. And, those changes correlated with a significant increase in attributes that contribute to patient-centered care, such as empathy and valuing the psychosocial factors that might affect a patient’s illness experience.” (The New York Times)

The study’s author, Dr. Michael Krasner, later stated to a New York Times writer that “One of the most wonderful things about practicing medicine is that you have the opportunity to be in the middle of challenging events. Reflecting on those events while also holding them in your thoughts has to do with not only physician well-being but also patient healing.”

With that in mind, go forth. Seek out your own course, or begin one. Find a personal way to reflect and engage on a daily basis. And most importantly, work on remaining in the moment not only when you’re trying those techniques, but by default, so that every day–every experience—is as wonderful as it has the potential to be.

Got Physician Burnout? You Aren’t Alone.

By Karin Krisher

physician burnoutEvidence that an American productivity schedule (8 to 5) isn’t ideal for maintaining productivity or motivation has been piling up for years. Now, the results of a survey of 7,288 physicians from June 2011 proves that doctors have it the worst: Physician burnout is reported at a much higher rate than the general  population, with nearly 1 in 2 physicians reporting symptoms.

I use the word symptom loosely. We’re not saying that every one of us who gets burned out has a malady that manifests in daily life. We are saying that doctors are being taxed—emotionally and physically.

The physicians surveyed were asked to fill out a questionnaire about burnout symptoms, such as emotional exhaustion, cynicism and loss of enthusiasm in work. The burned out are at risk for personal problems like addiction and depression, as well as professional problems, such as compromised care quality.

Writes Alexandra Sifferlin for, “The data showed that rates of burnout were high: 45.8% of doctors experienced at least one symptom of work-related burnout. When each symptom was considered separately, 37.9% of the physicians had high emotional exhaustion, 29.4% had high depersonalization and 12.4% had a low sense of personal accomplishment. U.S. doctors are burning out ‘at an alarming level,’ the authors write.”

Front-line care practitioners, such as emergency physicians, internal medicine and family medicine, had the highest burnout rates, while doctors of pathology, dermatology, pediatrics and preventative medicine had the lowest rates.

There’s more: Physicians work an average of 10 hours more per week than other people. While only 10.6 percent of the general population admits to working 60-hour (or more) weeks, 37.9 percent of physicians (the same percentage that reported emotional exhaustion) said the same.

The authors of the study published in the Archives of Internal Medicine proposed no real solutions for the issue of burnout. But we’re wondering if you have any tips.

Are you personally experiencing physician burnout, or burnout from another profession? What have you found to help you deal with these feelings? Share your story in a comment.

Chiropractic Care for Children

By Karin Krisher

chiropractic care for childrenChiropractic care can be scary the first time. But the fear wouldn’t exist if people were experiencing its benefits throughout life. Chiropractic care for children is on the up and up, and there are few good reasons why.

Many parents have their child see a chiropractor right after birth, as the trauma of the birthing process can cause both misalignment and nerve issues. While the child grows and learns to hold up its head and sit up, then crawl and walk, he or she could use chiropractic care to develop proper alignment from the get-go.

Further, chiropractic care isn’t quite the same for children as it is for adults. As parents, your clients might be wary of introducing their children to the procedures involved; a cracking neck wouldn’t sound or feel as good if it were your child’s and not your own. Assure your clients that adjustments are not the same. Pediatric chiropractors mostly work on cartilage and directed alignment, helping children learn.

Regular activities like biking, swimming and running can cause subluxations. If neglected, health can suffer over time. The rapid growth of the body during childhood is a perfect reason why your clients should know about the option of pediatric adjustment.

Parents often seek out pediatric chiropractic care because of concern about another condition (aside from misalignment). Colic, asthma, behavioral issues, headaches and ear infections are common reasons to introduce children to chiropractic care. Of course, it’s important for all parents to have a clear understanding that chiropractors aren’t treating disease; they’re checking the child for misalignments that can have an impact on total wellness through impacting the nervous and immune systems.

Talk to your patients about chiropractic care, and mention pediatrics. This area of healthcare is often under utilized, and you can be the doc to make a difference.

Have you introduced one of your patients to chiropractic care for children?  What was the result? Share your story on our Facebook page!

Talk to Your Patients Like you Mean it: How Doctors Lead by Example

By Karin Krisher

doctors lead by exampleA recent John Hopkins University study of physicians’ health behaviors led this writer to take a nice little walk down medical memory lane, pausing at each pivotal doorstep to recall the true nature of the encounter. Reading the study brought me to a lingering question: were my doctors telling me to do as they say, or as they did? Do doctors lead by example?

Because I didn’t delve into a reciprocal questioning process with any one of my many physicians, the answer escapes me. But there is a more important series of questions whose answers seem more clear: is consistency in personal health and recommendation a must? Is it even important? Why?

First, some background: The study was comparative, and noted some positives, like the fact that physicians are less likely to smoke, drink, or engage in other risky behaviors than the average American. However, when it comes to the hidden stuff, like cholesterol, BMI, frequency of exercise or quantity of vegetable consumption, physicians, as a group, seem to fall slightly short. Perhaps most disturbing is the fact that suicide and depression rates among physicians and medical students are higher than average.

So, is that important? When my doctor tells me how to deal with depression, or that my cholesterol should be lower, does she or he have to be healthier than I in order for me to understand and comply? It’s likely that most patients never question their doctor’s health. But for those few that do, of course it’s important. Of course one is less likely to comply with a hypocritical instruction. Though I hesitate to directly compare the authority or motive of doctors to mothers, my hyper, yellow-toothed doc telling me I shouldn’t drink coffee can be likened to a mother who smokes a pack a day telling her child never to pick up the habit: Somehow, the advice seems less poignant.

To maximize a patient’s chance of compliance, you don’t have to lie. You also don’t have to necessarily ignore the health issues that concern them simply because you aren’t compliant. Instead, to lead by example, simply start taking your own advice. While many patients won’t be acutely aware you’ve made this change, those that pay attention to your general demeanor, and not just what you say, will appreciate the level of sincerity that’s unveiled in the process. Plus, if you believe what you say, and you say what you believe, chances are your health is going to improve right along with your patients.

We’re all in this together. Tell us about your experience confronting a patient’s health issue with which you personally struggle. Did you reveal the truth or try to give advice without including your experience? Why did you choose that path? Share in a comment!

Talk to Your Patients About Donating Blood

By Karin Krisher

donating bloodToday, we want to talk about something that everyone seems to know, but few people seem to talk about: the number of people donating blood is fluctuating, leaving America’s blood supply is at its lowest level in 15 years.

The Red Cross has noted a lack of summer donors as a few bouts of severe weather have caused cancellation of drives around the nation. Even extreme temperatures are to blame, as donors don’t want to stray far from home or the air conditioner. Summer always sees a lull in drives and donations, but this year the turnout is especially sparse. The fact that the 4th of July fell on a weekday even had an effect.

All doctors know the importance of sufficient blood stores. Without them, surgeries and transplants can be called off altogether, putting lives at risk. In June, fewer than 50,000 donations came in. Today, after a total 10 percent drop in donations this year, there are 50 percent fewer blood products readily available than at this time in 2011.

Talk to your patients and family about donating blood. It takes just minutes and can provide a lifetime more. Visit to find a donation time and center near you.

Robots in Medicine? On the Rise

By Karin Krisher

robots in medicineThis post isn’t necessarily meant to offer advice, or too much insight. We just think advances in medical technology are really cool, and that these are ones you should definitely know about.

Robots in medicine are on the up and up. Just yesterday, news broke that RP-VITA (Remote Presence Virtual + Independent Telemedicine Assistant) will begin making bedside visits. And today, the FDA approved a robotic system to perform remotely controlled angioplasty.

If there’s fear these two robots will replace human docs, let’s dispel it now. Today’s tech is designed to make the doctors’ and patients’ experiences more successful and simple. It’s for us, not against us. In fact, both advents still involve patient/doctor interaction:

The former is designed to make rounds simpler. The robot’s head is a video screen that features the visiting doctor, who could be home sick in bed himself. High-definition camera eyes allow the clinician magnification and angular perspective so she or he doesn’t miss a beat or slight pupil dilation. RP-VITA also features a microphone that relays the doctor’s voice. Overall, it’s an incredible opportunity to allow more staff to attend to emergency or critical situations.

Clinical trials showed that the latter robot, named the CorPath 200, is 97.6 percent successful in its endeavor: holding open an artery and placing a stent. On top of that, it reduces lead exposure (to the surgeon) by 95 percent and gives doctors better precision and visualization. Patients should be more comfortable having a doctor who isn’t exhausted from standing on his or her feet draped in a lead cape for an hour or two, and doctors should feel good about added precision and mental acuity.

It’s no question that medical technology no longer refers solely to an EKG. Times are changing, and RP-VITA and CorPath 200 are just the newest reminders of how innovation will continue to shape the landscape of medicine as far as the eye can see.

What do you see for the future of robots in medicine? Are you excited, nervous, or even enthralled? Tell us in a comment!

Talk to Your Patients About Chronic Pain

By Karin Krisher

Chronic PainThe phrase “It’s all in your head,” really might bear some credence. Researchers at the Northwestern University Feinberg School of Medicine have shown for the first time that cross chatter in two regions of the brain is related to the persistence of pain. In other words, chronic pain is related to the brain’s original response to the pain.

Ten years of research led the team to conclude that in relation to chronic back pain, the injury itself was not enough to explain the pain, but the injury combined with brain state might very well be. The pain’s persistent nature could be related to an emotional response.

The study relied on fMRI scans to detect brain changes that happen early. The two parts of the brain involved, the insula and the nucleus accumbens, exhibited a much higher level of cross talk between them in study participants whose pain continued than in the participants whose pain faded. While the insula is active when people have an emotional response to an event or environment, the nucleus accumbens region is involved in teaching the brain how to respond to environmental changes.

The amazing part? The scientists found that their initial scans could predict the chronic nature of pain with 85 percent accuracy, suggesting that the more emotional the initial reaction to the injury was, the longer the pain will last. Further, the study found that participants with chronic pain lost gray matter density over time.

What does this mean for the future of pain? The researchers hope to develop new therapies for chronic pain based on the findings. Many medical endeavors are now leaning sharply toward the neurological, and pain is no exception. Pain is the main reason for medication, a driving factor behind disability, and some estimates note that in the United States, its chronic form could cost up to $635 billion per year.

Perhaps approaching pain from a neurological standpoint can help your patients who don’t even have chronic pain. Addressing this concept now could give patients the information they need to make rational decisions at the time of an injury, thereby avoiding the emotional burden and response chronicled in the study participants.

What kinds of chronic pain do you treat most often? What is your main course of treatment? Is there something you would suggest to other practitioners?


Talk to Your Patients About Allergies: The Follow-up

By Karin Krisher

After detailing the big concepts of allergy conversations, we were sure we had painted a reasonably complete picture.

But then this article about children’s allergies arrived in our inboxes, and we thought we had better take a moment to share that there are even more obvious allergy dangers to discuss with your patients.

One warning is so important, it earned itself an entire blog post.

Remember reading this?  “Begin with the idea that allergies are malleable. They change. That doesn’t mean your patients should ignore signs of allergic reaction—only that they should understand that allergies can develop and conversely disappear through changes in time and environment.” I wrote it, I meant it, and I still do.

However, information that came to light in the highlighted study tells me that there needs to be a caveat to this conversation: The fact that allergies can fade and develop does not give your patients the green light to experiment at will—especially with children. The study found that a significant percentage of children’s allergies are caused by intentional ingestion of the known allergen. Whether these are provided to the children in the name of experimentation or harm in each case is not clear, but researchers suspect the former.

Tell your patients not to allergy test at home. If a child has a known allergy and hasn’t been introduced to the allergen since the previous reaction, despite any length of time passed, to reintroduce the allergen is to ignore medical advice at your patients’ peril.

Tell your patients to just see an allergist, or to come to you (if allergy testing is available at your office) and avoid taking unnecessary risks. No peanut should be tempting enough to put a child in a potentially harmful situation.

That said, your patients shouldn’t be forever terrified of the allergen. The best advice, again, is simple. Get professionally tested. Have the children tested. Don’t spend life on either end of the allergy spectrum—hypochondriatic or thrill seeking. Share this information with your patients, so that their next reaction can be their last, and so that children in this position may remain both safe and informed.

Have you ever cared for a patient who had intentionally induced his or her own or children’s allergies? What advice did you give them for the future? Tell us in a comment!

Talk to Your Patients About Sun Damage

By Karin Krisher

sun damageWe’ve all heard (and given) plenty of tips about avoiding sun damage.

Cover up if you can, slather on the sunscreen, don’t go tanning. The conversation about skin cancer might seem worn out, but given the constantly emerging tidbits of information about melanoma risk factors, newly approved drugs, and other harmful forms of tanning, I think it’s still fresh. And it might be time to talk to your patients about skin cancer—again.

What’s New?

A starkly asymmetrical photograph of a lifetime truck-driver’s wrinkled/smooth visage drew my attention back to the issue of sun damage, reminding me that melanoma is the most common form of cancer. Because there is a plethora of new information, we’ll simply list quick references here instead of going too in-depth—like we said, the conversation is a bit tired, but the new information makes it a necessary repeat.

That man’s sun-ravaged skin doesn’t seem so far fetched (no, it wasn’t Photoshop) when recent research confirms that older men are at higher risk for skin cancer. In fact, The American Academy of Dermatology’s data tell us that in men over 65, the number of melanomas has increased approximately nine percent since 2002.

Further, emerging research indicates that:

-Tanning just four times can present an increase of 15 percent likelihood of
developing skin cancer

-Smoking cigarettes might raise your odds

-Spray tanning chemicals have been linked to lung cancer (See? The sun isn’t always the bad guy, after all!)

-Childhood abuse, maltreatment or divorce experience exhibits some correlation with the development of skin cancer

The Good News About Sun Damage?

For every new fear about skin cancer-causing agents, there’s a way to assuage that fear. In the May 29 publication of “Cancer,” researchers revealed the possible benefits of ibuprofen and aspirin use in supporting skin cell health. The anti-inflammatory properties of these drugs may have some effect.

Yet another bone has been thrown my Irish/German way—caffeine consumption and exercise may lower my risk of skin cancer.

And finally, patents and licenses on skin cancer preventative drugs are on the rise. sun damageResearchers at the Society of Nuclear Medicine’s 2012 Annual Meeting  noted earlier this week that “a customized patch treatment for basal cell carcinoma completely destroys facial tumors without surgery or major radiation therapy in 80 percent of patients studied.” (ScienceDaily)


What You Can Do

All of your patients should be familiar with what to look for in a mole, and what to hope not to find. If you don’t have even a poster or a brochure on the topic, get some. Dispelling myths about sun protection is also part of the conversation: it’s not true that you can apply once and call it quits. It’s also not true that you can apply sunscreen and then jump right in the water, or that a light shirt will offer full protection.

Help your patients figure out a plan for their outings to ensure they are appropriately guarded, and most importantly, that they are able to enjoy the sunshine without once experiencing its lack of restraint.

Have you had to have a serious conversation about sun damage? Tell us about your approach in a comment!