ASHLEY MALTZ, MD
  • Home
  • About
  • Conditions Treated
  • Work with Me
  • Services and Fees
  • Blog
  • Contact Dr. Maltz
  • Store

Blog

RSS Feed

A whole lotta' Pap smears going on (too many!)

8/24/2011

0 Comments

 
It's hard for most of us to imagine that our physician(s) may be going against scientifically-drafted guidelines when it comes to screening for diseases and/or their treatment. But, this seems to be the case for cervical cancer screening. 

Researchers from the Centers for Disease Control and Prevention (the CDC) recently conducted a survey on whether or not docs would do a Pap smear on 3 different imaginary, yet low risk patients (defined as a woman in a monogamous relationship with one partner having a current negative HPV test or 2 consecutive normal Paps), and 2/3 of them recommended another smear in one year. This goes AGAINST the clinical guidelines that recommend spreading these screenings out for low risk patients. Not only do these extra tests cost us all more health care dollars, but they also increase frequency of pain and anxiety for the women undergoing them. And trust me, that discomfort and anxiety can be significant.

This doesn't mean that 2/3 of doctors are setting out to cause harm to their patients or order needless tests. For the most part, I do not believe that physicians are bad people looking to take vengeance out on their patients. I believe the confusion lies, well...in the confusion of clinical guidelines. Guidelines change constantly. One day, physicians are supposed to teach monthly breast exams to women for breast cancer detection and the next, they are supposed to recommend "breast awareness". One day, vitamin E is good for preventing heart disease and the next it's actually harmful! Etcetera, etcetera. The contradictions are endless.

But such is the nature of the beast. Medicine is dynamic, not static. It changes just as the seasons change, our moods change, our lives change. It is a process. 
With more and more technology and research, researchers are trying to figure out how to become more efficient and less costly with providing medical care to the aging masses. However, this is not an easy task nor is it simple. For one, it COSTS money to study cost-effectiveness...lots of it and secondly, it takes TIME to conduct a good study and obtain the results.  The average randomized clinical trial lasts over 5 years which is often not enough time to make long-term predictions.  Funders of studies want results asap, thus putting even more pressure on researchers.

Thirdly, doctors are constantly bombarded with information and often do not have the time or the patience to read the latest, most credible journals and research updates (which, in my opinion, is a product of the system). They then defer to 
practicing medicine the way the person(s) who trained them did. In doing so, non-evidence-based traditions (and there are MANY) are practiced and taught to future practitioners. As such, tradition has a great influence on the practice of medicine. Until this issue is addressed, costly medicine will persist and not without it's risks. 

Potential ways to address this issue are investments in electronic medical records that automatically schedule the next screening according to the most recent guidelines and physician audits during which random chart are extracted from a physicians' caseload and the physician is held accountable and liable for not adhering to current recommendations (although I would not be a fan of either of these options if I were in private practice as the former is very expensive and time-consuming to implement and the latter is very regulatory).

Changing the pay structure for docs would also help. Instead of the current fee-for-service structure in place now where payments are made for procedures, not necessarily for quality time spent with a patient, physicians are financially inclined to do more procedures (including Pap smears). This flies in the face of ethical medicine - no matter how ethical a person is, finances rule all and we, despite what some of our own think, are only human. 


So, my proposal to my readers is - be an astute patient and question your physician (in a nice way) as to whether or not you really need that cat scan or the annual Pap smear. After all, it most likely will not extend your life but it may make it less enjoyable (think anxiety, discomfort, etc). And if you question them and end up changing their practice, you can claim the cost-savings with pride! 

Happy Wednesday,
Dr. M
0 Comments

Irradiation vs Illumination - Dr. David Katz discusses the difference

8/22/2011

0 Comments

 
As many of my close friends and family know, I had the pleasure to work with Dr. David Katz of Griffin Hospital in Derby, CT this past year. The rotation was fabulous as I got to see true Integrative and Preventive Medicine in action. For those new to Dr. Katz, he is  rock star in the Integrative and Preventive Medicine world.

Here's a quick bio (skip this paragraph if you want to get to the meat of the article): "Dr. Katz is the director and founder of the Integrative Medicine Center at Griffin Hospital (2000) in Derby, CT; founder and president of the non-profit Turn the Tide Foundation. Know internationally for expertise in nutrition and chronic disease prevention, as well as integrative care models, Katz has secured roughly $30 million in research funding, and has published over 120 scientific papers, numerous textbook chapters, nearly a thousand newspaper columns, and 12 books to date. He is the principal inventor of the Overall Nutritional Quality Index utilized in the NuVal™ nutrition guidance program (www.nuval.com), currently offered in approximately 1,000 supermarkets throughout the United States. He has been recognized three times by the Consumers Research Council of America as one of the nation’s top physicians in Preventive Medicine; was a nominee for the position of US Surgeon General in 2009; and was the 2011 recipient of the Katharine Boucot Sturgis award from the American College of Preventive Medicine, the most prestigious award the College confers – awarded for illustrious career contributions to the field. Dr. Katz is a health editor for the Huffington Post, and Editor-in-Chief of the peer-reviewed journal, Childhood Obesity."

So needless to say, I was thrilled to work with him for 5 weeks. He publishes a weekly column in the Huffington Post and in his most recent column, he discusses the differences between irradiation (medical procedures that require radiation) and illumination (knowing whether or not the test is the best one for diagnosing and/or treating your medical conditions). Here's what he writes:

"My colleagues at the Huffington Post recently did a fine job characterizing the trade-offs that bedevil decisions about the use of modern medical imaging. On the one hand, sophisticated imaging with CT scanners can inform treatment choices, and save lives. On the other, rates of imaging have sky-rocketed over recent years, raising concerns about radiation exposure for patients and for doctors, that invention may be acting as the mother of necessity!

The challenge, of course, is finding the sweet spot between damned if you do, damned if you don't. Being overly cautious about medical testing -- imaging or otherwise -- could mean missing out on the very test you need to answer a critical question, or guide a crucial therapy. Being overly accepting of every application of modern medical technology might well mean it does you more harm than good -- making you glow in the dark, rather than illuminating the source of your troubles.

Up to a point, getting such decisions right requires trust in your doctor -- because they are decisions your doctor has been trained to make. Often that trust will be warranted -- and ideally it is in your case. Ideally, your doctor is not only highly educated, but equally intelligent and genuinely caring. With my many colleagues in mind, I can certainly say this is true much of the time. I can also say it isn't invariably true, and even the best of us have bad days. So I invoke my favorite Reaganism: Trust, but verify.

Verify you are getting the tests you need, and only the tests you need. Challenging such decisions is not an insult to your doctor. Simply, it is an affirmation of the fact that you, literally, have skin in the game: It's your body and your health on the line. Take nothing for granted.

In her
Huffington Post column about diagnostic imaging, Emma Gray makes the following, reasonable suggestions. Before getting any type of scan, ask: How will this improve my care? Are there any alternative imaging exams that don't use radiation?

I like these tips, but I would like to go further and generalize them. Radiation is not the only hazard of medical testing -- any test can do harm of some kind. That's acceptable if, and only if, potential harm is much outweighed by potential benefit. To ensure that, always ask these questions before any test:Wwill the results of this test directly affect your decisions, or my options? Will this test provide a definitive answer, or is it preliminary to more tests? Is this test the safest way to get the information we need? Would you have this test if you were me?

If you can bring yourself to ask these questions about medical testing as a matter of routine, they should serve as a fairly good filter, letting only genuinely useful testing through. But with a little help from your inner statistician (yes, s/he's really in there!) you can do even better.
The goal of medical testing is to figure out what is going on (and then, what to do about it). That, in turn, is really dependent on establishing two things: What does this patient have and what doesn't this patient have? Testing is about confirming a diagnosis (ruling it in) and excluding all the rest (ruling them out). Ideally, it leads to ruling out everything so you can get that proverbial clean bill of health.

There are two, simple statistical concepts you should (and can!) master so that you can help guide testing toward ruling in what it is and ruling out what it isn't. The concepts are sensitivity and specificity.

In life, sensitivity is noticing and reacting to every little thing. It's not much different in medicine: It's the capacity of a test to detect a condition when it is really there. In the two-by-two table below, it is [a/(a+c)]. (Imagine a 2x2 table described as below, it would not copy into this post)

The table summarizes the universe of diagnostic possibilities into four quadrants: disease is present and the test finds it (cell a); disease is absent, but the test says it's present (false positive, cell b); disease is present and the test fails to find it (false negative, cell c); disease is absent and the test says it is absent (cell d). Sensitivity is, in essence, the percentage of the time that disease is present (cell a plus cell c) that the test finds it (cell a); thus, [a/(a + c)].

Here's the surprise: Although sensitivity is the measure of how reliably a test finds a condition that's actually there, it's the property a test needs to rule disease out! Here's why:

If a test is highly sensitive, it will almost always be positive when disease is truly there. Therefore, if a test is highly sensitive, it will almost never be negative when disease is truly there. A highly sensitive test will almost never be negative unless disease truly isn't there. And thus, a negative result on a highly sensitive test reliably rules out disease. The corollary, of course, is that a negative result from a test that is not highly sensitive -- whether or not it is highly specific -- does not reliably rule out disease!

Imagine the stunned expression on your doctor's face when s/he says: Llet's get this test just to make sure you don't have X ..." And you reply: "I trust, then, that this is a highly sensitive test for X?" I would love to be there when it happens!

On the flip side, specificity is the capacity of a test to exclude what truly isn't there. In the two-by-two table, that's [d/(b+d)]. The explanation is much as before, so I won't belabor.

Again, it is somewhat counterintuitive, but it's a test that is good at ruling out what isn't there that is needed to make a diagnosis! The logic is much as before:

A highly specific test is almost always negative when disease is truly absent. A highly specific test will almost never be positive when disease is truly absent. A highly specific test will almost only be positive when disease is actually present. And thus, a positive result on a highly specific test reliably rules a diagnosis in. Again, we have the logical corollary: A positive result from a test that is not highly sensitive does not rule a diagnosis in -- it merely suggests it. So before being treated for a particular condition, particularly if the treatment is apt to be unpleasant or dangerous, you would be well within your rights to ask: Was the testing this diagnosis is based on highly specific?

You are, I am confident, more than capable of mastering and using these simple, statistical principles. But I also recognize that some of you break into a cold sweat at the mere sight of anything that recalls high school algebra! For those in that group, here's your shortcut: SPin/SNout. Specificity to rule in, sensitivity to rule out.

There are
more useful, simple statistical principles where these came from -- but they can wait for another day, and another column.

For now, we should recognize that medical testing used well should be illuminating. Used badly, it might simply be ... irradiating. Trust your doctor -- but on behalf of your skin, verify! Bring a few good questions -- and your inner statistician -- to your next doctor's visit to help ensure you stay in the sweet spot."

Hope this helps explain one of the ways doctors assess the risks and benefits of certain medical tests/procedures/exams. Remeber, an illuminated patient is the safest one.

Have a great week!

Dr. M
0 Comments

My Happiness Project :D

8/12/2011

0 Comments

 
Happy Friday to all!

We've all read the research showing that happier people live longer, have a better quality of life, are more successful, etc. So, why not improve our lives with a Happiness Project?? What is a Happiness Project , you may ask??
Thanks to Gretchen Rubin, a lawyer and best-selling author in NYC, I am finding out!  

As an aside to studying for my Internal Medicine Board exam, I just started reading Rubin's book, “The Happiness Project” and am feeling quite inspired! In the book, Rubin discusses the need to improve our lives by setting goals that help us achieve happiness. While thoroughly researching the topic, she discovered that happiness is a long sought-after, yet attainable value. She quotes Aristotle and Socrates during their pursuits of happiness and bases her project on Benjamin Franklin’s own version of the same during which he sought to improve his life in multiple areas, including servitude, temperance, solitude, etc. He even made a calendar with checkmarks and goals to help him achieve this! Pretty modern thinking Mr. Franklin!. The experts (including Mr. Franklin) argue that goals are more attainable when written down and posted in front of you. 

In Rubin’s project, she created a list of specific areas in which she would like to improve her life (ie, family, friends, mind, body, finances, etc) and set about creating goals that worked to improve them (ie, spend more time with husband, organize bills and financial papers, etc). Using her analytical skills from law school, Rubin systematically broke down the areas into concrete, attainable monthly goals. Each month she would work towards completing that month’s goals and ultimately end up a happier person by the end of the year.  (Disclaimer: I have no idea if the plan actually worked as I’ve just begun the book, but I can take an educated guess that she wouldn’t be writing about it if it didn’t...?)

So, here is an attempt at my own Happiness Project and I’d like for you all to join me.  I aim to meditate for 5-15 minutes every day, no matter the circumstances (unless I’m traveling). By meditation, I mean focusing on breathing in a quiet room without interruptions. I know that meditation makes me feel good; it decreases my stress and anxiety levels, issues I have struggled with my entire life, by relaxing my often pathologically tight muscles and allowing me to center my focus on my breathing. In taking these five minutes a day to “breathe”, I hope to achieve a better outlook on life and more energy to help others. We all know the world could use more happiness! 

Here's a link to Gretchen's website - http://www.happiness-project.com/

This is my first goal. What’s yours? 

Dr. M


‎"Happiness is neither a virtue nor pleasure nor this thing nor that, but simply growth. We are happy when we are growing." -- William Butler Yeats, poet, playwright and Nobel Laureate
0 Comments

A little mid-week stress relief

8/10/2011

1 Comment

 
It's Wednesday, aka "Hump Day". Your boss is breathing down your back, the stock market is a mess and all of your nerves are frazzeled. What to do?? MEDITATE! Not only will it decrease your stress relief, but it decreases your blood pressure, risk of heart attack, stroke and other catastrophic health conditions. And we could all use a little security these days. 

Here's a fantastic 4-minute** guided meditation (**we don't have the original link now but check out other meditations on SoundCloud) by James Gordon, MD, a Harvard-trained psychiatrist and founder of the Center for Mind-Body Medicine in Washington, D.C. Dr. Gordon is an expert in using mind-body techniques to treat anxiety, depression, addiction, post-traumatic stress disorders, etc. He's even bridging gaps between people in war-torn areas (Israelis and Palestinians to name one). To sum it up, he's INCREDIBLE! 

So take 5 minutes of your day, EVERY DAY, to smell the roses, be it with Dr. Gordon or on your own. Here's a link to his organization's website - http://www.cmbm.org/.  Enjoy!

Salud! 
Dr. M
1 Comment

Great tips for cutting out some calories

8/5/2011

0 Comments

 
Thanks to Yahoo Health for compiling these EXCELLENT calorie-saving tips! Try one today and another tomorrow and pretty soon you'll hopefully be cutting significant amounts of calories without even trying. : )  Remember, what goes in must come out (calories in = calories out). So, if you're not so in to slaving it out at the gym, aim for about 1200-1500 calories a day depending on your metabolism. If you're an exercise addict, you definitely need more calories  (usually 2000-2200, again, based on metabolism). The more muscle you have, the more calories you burn. It's all simple math. 

But today, Yahoo Health helps us all by illustrating 26 practical tips to cut unwanted calories out. Think: cook at home where you know what you're putting in your food. Salud and have a fabulous & safe weekend!!!!

http://health.yahoo.net/articles/weight-loss/photos/25-ways-cut-500-calories-day#25
0 Comments

Spice it up for disease prevention!

8/3/2011

0 Comments

 
Adding fresh herbs and dried spices can boost the flavor and antioxidant content of your summer meals. The ORAC value, or Oxygen Radical Absorbance Capacity, is a measurement of a food’s antioxidant power, which has been ranked by the USDA. It provides a measurement of a food’s ability to neutralize free radicals in the body that are linked to the development of many chronic diseases, such as cancer, heart disease, Alzheimer’s and Parkinson’s disease. According to the USDA, fruits, nuts, and vegetables are great food sources of antioxidants, in addition to herbs and spices.    

What are free radicals? When cells die, they release reactive oxygen molecules also known as free radicals, which can build up in our bodies and harm healthy cells (think of how an apple browns on the surface when exposed to oxygen). Exposure to certain environmental factors, such as tobacco smoke, can also lead to free radical formation. In addition to the color-producing compounds mentioned above, other examples of antioxidants include vitamins A, C, and E.

Herbs and spices are also a no-fuss way to ramp up the flavor of meals without adding a lot of salt or sugar. For a few seasonal starters, try tossing basil into a summer tomato salad, add chopped cilantro to salsa or guacamole, or top your iced coffee with ground cinnamon. 

ORAC Values of Seasonal Fresh Herbs
:
Herb Serving         ORAC Value (the higher, the better)                       

Sage 2 tsp                     500                          
Peppermint 2 Tbsp      400
Oregano 2 tsp               400
Cilantro ¼ cup              200
Thyme 1 tsp                  200
Parsley 1 Tbsp             100    
Dill 5 sprigs                   100                      
Basil 1 Tbsp                  100
   
  

Source: The O2 Diet by Keri Glassman, MS, RD

0 Comments

    Enter your email address for blog updates sent directly to your inbox:

    Delivered by FeedBurner

    RSS Feed

    Author

    Dr. Maltz earned a Medical Degree and Master in Public Health from the University of Texas Medical Branch (UTMB) in Galveston, TX. She completed a combined Internal and Preventive Medicine Residency at UTMB in June, 2011. She then completed a 2-year Integrative Medicine Fellowship at Stamford Hospital in Stamford, CT, during which she simultaneously underwent an intensive 1000-hour curriculum created by The University of Arizona Integrative Medicine Program founded by Dr. Andrew Weil.  

    Dr. Maltz's specific interests include helping her patients and populations improve their health through lifestyle interventions including, but not limited to, natural pain relief, nutrition, mind-body techniques and decreasing environmental exposures. She spent the last year of her four-year medical residency participating in health policy, cancer prevention and environmental health rotations and enjoys guiding people through the overwhelming amount of health information available on the web.

    Archives

    October 2020
    January 2019
    July 2018
    May 2018
    December 2017
    October 2017
    September 2017
    July 2017
    June 2017
    May 2017
    April 2017
    January 2017
    September 2016
    June 2016
    May 2016
    April 2016
    March 2016
    February 2016
    April 2013
    February 2013
    January 2013
    December 2012
    November 2012
    September 2012
    August 2012
    July 2012
    June 2012
    May 2012
    April 2012
    March 2012
    February 2012
    January 2012
    December 2011
    November 2011
    October 2011
    September 2011
    August 2011
    July 2011
    June 2011
    May 2011
    April 2011
    March 2011
    February 2011
    January 2011
    December 2010
    November 2010
    October 2010
    September 2010
    August 2010

    Categories

    All
    Abe For Fitness
    Abuse
    Achieving Happiness
    Acpm
    Acupuncture
    Added Sugar
    Addiction
    Adhd
    Adolescence
    Adolescent Medicine
    Air Pollution
    Airport Scanners
    Alcohol
    Alcohol Consumption
    Alzheimer\
    Alzheimer's
    America Lags
    American College Of Lifestyle Medicine
    Anti-depressants
    Anti-inflammatory Diet
    Anti-inflammatory Diet
    Artificial Sweeteners
    Aspirin
    Attention Span
    Autism
    Avatar Course
    Beauty
    Bicycling
    Body Image
    Bpa
    Brain Injury Awareness
    Bread
    Breast Cancer Rates
    Breast Cancer Risk
    Cancer
    Cancer And Environment
    Cancer Prevention
    Cancer Prevention Fellowhship
    Cancer Rates
    Cardiovascular Disease
    Cartoons
    Cdc
    Cell Phone Use
    Change Your Life
    Chemicals
    Childhood Obesity
    Children
    Chocolate
    Chronic Disease
    City Living
    Climate Change
    Cognition
    Cold
    Colon Cancer
    Colorectal Cancer Awareness
    Consciousness
    Contaminated Water
    Corn Sugar
    Cosmetics
    Cost-savings
    Cuts
    Dairy
    David Katz
    Death
    Decreasing Cancer Rates
    Deepak Chopra
    Depression
    Diabetes
    Dietary Supplements
    Diet For Adhd
    Diet For Cancer Prevention
    Diet Soda
    Digestion
    Disease Prevention
    Distance Learning
    Dna
    Dr. Andrew Weil
    Dr. David Katz
    Dr. James Gordon
    Dr. Katz
    Dr. Landrigan
    Dr. Weil
    Dvt
    Dying
    Easy Ways To Cut Calories
    Eating
    Emerson Ecologics
    Endocrine Disruptors
    Environmental Health
    Environmental Toxins
    Environmental Working Group
    Exercise
    Fast Food
    Fda
    Fish To Avoid
    Flame Retardants
    Flu
    Folic Acid
    Food
    Food Cravings
    Fox News
    Fragranced Cleaning Supplies
    Genetics
    Gluten
    Glyphosate
    Gradual Weight Gain
    Gratitude
    Guided Meditation
    Harm To Others
    Health
    Health Policy
    Healthy Child
    Healthy New Years Resolutions
    Healthy World
    Heart Attack Risk
    Heart Failure
    Heart Health
    High Fat Diets
    High Fructose Corn Syrup
    Hot Flashes
    Houston
    Huffington Post
    Incidence
    Inflammation
    Insulin
    Integrative Medicine Fellowship
    Internet Addiction
    Internship
    In Utero
    Iq
    Lately
    Lead
    Leukemia
    Life Span
    Lifestyle Changes
    Lifestyle Medicine
    Lifestyle Modification
    Light
    Low-carb Diets
    MB-EAT
    Medical Tests
    Meditation
    Melanoma
    Menopause
    Mental Health
    Meralgia Paresthetica
    Mercury
    Mindfulness
    Mindfulness-based Cognitive Therapy
    Mindfulness-based Meditation
    Mmwr
    Mold
    My Happiness Project
    National Nutrition Month
    Nature
    Nci
    New Yorkers
    Nitrates
    Noise
    Nutrient-gene Interaction
    Obesity
    Omega 3
    Omega-3\\
    Overeating
    Over-eating
    Oxybenzone
    Pain
    Palliative Care
    Pap Smears
    Parabens
    Pe
    People-pleasing
    Phthalates
    Physical Activity
    Pillcam
    Pku
    Plastics
    Poison Prevention
    Pollution
    Potato Chips
    Poverty And Diabetes
    Poverty And Obesity
    Prediabetes
    President
    Preventable Deaths
    Prevention
    Prevention Of Type 2 Diabetes
    Preventive Medicine
    Primary Prevention
    Processed Foods
    Public Health
    Public Health And Prevention Fund
    Radiation
    Retinyl Paminate
    Risk Reduction
    Safer Chemicals
    Safer Products
    Self-care
    Self Love
    Sensitivity
    Sleep Hygeine
    Small Bursts Of Activity
    Smart Patients
    Sodium
    South America
    Soy
    Specificity
    Spices
    Stamford Hospital
    Statistics
    Steer
    Stilettos
    Stroke
    Stroke Risk
    Sugar
    Sunscreen
    Sustainable Wellness
    Tainted Supplements
    Thanksgiving
    The Lancet
    Tight Jean Syndrome
    Toxin
    Toxins
    Toxins In Food
    Tradition
    Turkey
    Turn The Tide Foundation
    Type 2 Diabetes
    Unnecessary Tests
    Vegetables
    VOCs
    Vulnerability
    Wasteful Spending
    Weight Gain
    Weight Gain And The Brain
    Weight Loss
    Weight Reduction
    Women
    Workplace Wellness

    RSS Feed

  • Home
  • About Dr. Maltz
  • Contact

Disclaimer:

The content of this website does not serve as medical advice nor does it substitute for a thorough medical evaluation by a qualified health care practitioner. Consult a physician or local health care provider before adding any supplements, changing any medications or diet or starting an exercise regimen.
©️ 2019 - 2022 Dr. Ashley Maltz
  • Home
  • About
  • Conditions Treated
  • Work with Me
  • Services and Fees
  • Blog
  • Contact Dr. Maltz
  • Store