DRLUGO BLOG

I am sure we all have heard how much money is spent in our country. we would think that we would be the healthiest country in the world. where is the money going? why are we not getting what we pay for? I am a doctor and I am also disappointed to see how the money is wasted. IT is not only one problem. IT is many problems together and not a simple solution.

I believe that a large part of the problem is that many companies and insurance companies, other third parties and many politicians make money at the expense of health care. the doctors make money, but the truth is hat every day we make less and we get more and more restricted on what we can do. the first mistake that we made was to loose control of patient care and the way we practice medicine. We have to follow insurance company guidelines and these companies only goal is to make money. It is outrageous how these companies want to run the medical decisions from an office in a distant city without even seeing the pt and in that way control the cost. I can not believe how many times pt care is denied and obstacles are set in place to save money and prevent pt care t take place. That is one problem. IT is more complex than what I stated here, but this is a large part of it. Another problem is the lawyers. there is so many lawyers out there that make their living looking for medical errors. The interesting part is that most of the lawsuits are not even malpractice. A lot of times they make their money because the doctor has no time and settles. why is this allowed. Well the clearest evidence of this abuse is that we have seen a reduction in frivolous suits in TX. The reason for that is the changes in legislation limiting the amounts awarded. All of the sudden, it is not profitable so they really pick and chose the cases. So was this in the best interest of the pt or in the interest of the lawyers pockets? Don’t get me wrong, malpractice should be monitored and quality medical care should be advocated, but this should not be a business where people get rich and in the process destroy other professionals lives. I am glad that there is a balance being reached finally. Even though the medicine we practice now a days is defensive in nature and that increases the cost. Doctors are expected to be perfect and never make a mistake. We are not allowed to use our medical instinct or knowledge. We have to prove over an over that we are right. So many unnecessary tests to just please the hungry lawyers.

Another part of this equation is the government intervention. I believe that it is important for doctors to be involved in the decisions made by our politicians. Many times I see that decisions on healthcare are made by politicians without real doctor input. This leads to mistakes and miscalculations. They think that by talking to doctor representatives they get the whole picture. Well, I find that many of the doctor group representatives are politicians first and then doctors. they do not always represent the best interest of the medical community, or truly understand what is like to practice i the community. to be a business owner and have to deal with the ever increasing bureaucracy. the amount of paperwork is incredible and continues to increase. Even with the electronic medical record implementation, we have to document so much, it is time consuming and increases the cost of medicine, since we have to increase the number of employees in order to comply and continue to take care of patients.

It is harder and harder to just practice medicine and focus on pt care alone. I am deeply concerned with the direction healthcare is taking. we see less and less people wanting to put the years it takes to get to be a doctor (in my case 13) and the debt that one has to also take. In many ways a single payor system seems like the best option to eliminate all the private insurance companies. IT is not a choice that doctors are making, it is a choice that is the best of two evils.

I wish doctors were ask for input on how to run the medical care of this country, after all we are the ones that provide it. We will see where this ends.

This is commonly known as reflux.  As the word suggests, there is reflux or regurgitation (comes up the throat) of stomach contents.  These stomach content is mostly acid, but at times, in severe cases can be food.  The symptoms can be as vague as bloating, but can involve burning in the upper abdominal area, pain, difficulty swallowing or a chronic cough.  Most people that have it treat it with over the counter remedies.  Although the symptoms usually respond to simple antiacid medication, we should not ignore these symptoms.  The mere fact that a person has reflux symptoms is an indication that something is not working well.  It may be caused by eating late late eating,  being overweight or a problem with the sphincter (circular muscle) that separates the eophagus from the stomach.  Reflux can also be the result of other diseases like scleroderma or even viral conditions.  Although common and easily treated many times, we should not ignore the symptoms and seek help.  A patient should not just treat the symptom and forget looking for the cause.  Just treating the symptoms can be dangerous and bad for the person.  Chronic reflux, if uncontrolled, could lead to cancer of the esophagus and or ulceration.  This is a big problem now a days since many of the reflux medications are available over the counter for the patient to treat themselves.  This allows for a person to treat a symptoms for a long time and not treat the cause.  IT is my opinion that this can lead to more serious problems.

 Although there are no real medical standards defined, on the frequency of endosopy to follow patients with reflux, I think it is appropriate to get this test done at some time to determine if there has been any damage made to the linning of the esophagus and then treat it accordingly.  

From the surgical stand point there is an operation called Nissen fundoplication.  This consists of wrapping the stomach around the lower part of the esophagus t try to restore the some of the physiology that is lost when the lower esophageal sphincter is not working.  Now a days it is done laparoscopically and has very good results when done well.  We reserve this for patients that get no relief with the medications known as PPI (proton pump inhibitors).  these are medications that we have been using for years now and usually are enough to stop the symptoms caused by GERD.  sometimes the pt has a large associated hiatal hernia. In these cases surgery is probably going to be necessary to improve the symptoms.  Not all hiatal hernias need to be operated on and this is a decision that the doctor can make with the patient.  Please visit my website for questions www. DRLUGO.com

Thi is a common ailment and many times misunderstood symptom.  People have the idea that when they have apin in the anus, it means hemorrhoids.  The truth  is that most of the time it is not.  I can not say the same about bleeding, bleeding alone can be a hemorrhoid, but if bleeding is present with pain, it is most likely an anal fissure.  an anal fissure is a small cut in the anal area.  Thi is usully the result of a hard bowel movement or straining.  the pt sometimes recalls the event that precipitated the symptoms, but most of the time they don’t.  The treatment for anal fissure initially is not surgical.  Most of these heal spntaneously or with minimal therapy that consists of warm bath and stool softeners.  The ones that do not resolve then should be operated on.  The operation for that is a sphincterotomy.  this means cutting of the sphincter(internal sphincter).  this will take the tension off the cut and allow it to heal.  

The most important part of fissure treatment is prevention.  If the pt goes back to bad habits of constipation, this can recur.  This is true for almost all anal problems (hemorrhoids and fissures).  

IT is important to note that blood in the anus and pain ca also be a serious problem, so by no means a person should read the above and then stay home.  It is important that someone identifies the so called fissure.  Like I have said i the past, any blood coming out of any orifice should be investigated, with or without pain associated.  Please call yur doctor or email me if you have any questions.  HAve a great day

RLUGO MD

Many people ask me what are the things that a person should do when they know that they are having surgery. How to prepare for such an event. My answer can be very technical or complex, but I try to simplify it. Just imagine that you are about to compete in the Olimpics. You have to prepare your body for a very demanding event. You should try to be in the best conditions possible from the nutrition stand point, rest and psychologically. The individual should start by placing positive thoughts in their mind. It is important that the person visualizes the surgey going well and a positive outcome. There should be minimal or no negative thoughts in the mind. Not to say that there will be no fear. It is expected certain degree of fear of the unknown, but we need to counteract this with positive thoughts and visualization. this is very powerful and very important. The pt should also try to rest the days before surgery and try to have good nights of sleep. this will normalize the cortisol levels. this is a very important hormone in the healing process and for the utilization of sugars and nutrients during moments of stress The pt should try to eat healthy and balanced food. This stimulates also the growth and replication of healthy cells. IT is never too late to start a healthy diet and then maintain it during the healing process. Excercise also helps tone the muscles and build some muscle mass to weather the tough times. Everytime we even think of exercise the body releases hormones that help us deal with pain and stress. these are called endorphins. IF the pt starts an exercise program and sticks to it, they can stimulate the release of endorphins and help with pain control and coping with the surgical stress. By this I do not mean a strenuous exercise for someone that has never done exercise. IT could be as simple as starting a walking program and build on it. Each person needs to start at a comfortable level and slowly build on it. Smoking and alcohol should be avoided as many days before surgery as possible. Both of these toxic substances can weaken the immune system and the power of the body to heal and recover. Finally make sure that there is a good support and planning for the recovery time. We should have a plan for the first few days after surgery and then the weeks following. Do not wait for after surgery to plan the recovery. It helps to have a realistic image and mental plan of the series of events and the duration. IT helps to communicate with your doctor who can give you realistic expectations on the timing and what to expect. He/She probably has done this many times and has a pretty good idea of the expected time for full recovery. These are simplified steps, but I think that are essential and very easy to follow. If you have any questions do not hesitate to ask me or visit my website drlugo.com.

HELLO

Gallbladder disease can be tricky and go unnoticed for a log time before the pt ends up in the ER with severe abdominal pain.  Now a days with the internet and all of the over the counter remedies the patients tend to wait sometimes too long to get help.  

I have found that many patients tend to wai until it is obvious, that they are having a gallbladder attack or a complication of gallstones to seek help.  Gallbladder disease can present itself as a sudden upper abdominal pain with other gastrointestinal symptoms of nausea and vomiting or simply pain.  The classic symptoms are R upper abdominal pain that sometimes moves along the R rib cage and into the back.  On occasions the pain is sever and moves into the L chest making the pt think he/she is having a heart attack.  This is the classic presentation.  As the reader can imagine, this is not always the way it presents and there is a broad range of ways that the disease can present.  Most of the time is a repeated bouts of what people call indigestion.  This is usually noticed after eating rich or fatty food.  

Because we have so many over the counter anti acid medications, people tend to self prescribe and treat their symptoms.  The problem with this is that the gallbladder disease progresses and can even be deadly.  IF the pt ignores the symptoms and the gallstones move out of the gallbladder, then the pt is up for a tough time.  The complications of this can be, gallbladder infection(cholecystitis), pancreatic inflammation(pancreatitis), and or jaundice.  These are serious problems and can be prevented by removing the gallbladder early on.

As of today the only know solution for gallstones is removal of the gallbladder.  This is done laparoscopically most of the time and the pt is home the same day.  This changes if we wait until one of the above complications sets in.  IF you have any questions, please contact me or come to my office and we can discuss further.  For more information go to my website, www.drlugo.com