Ten Signs You Are Seeing the Wrong Doctor

December 8th, 2018

By Natan Schleider M.D.

If dustballs in the corner of the doctor’s exam room and bullet proof glass separating your from the receptionist aren’t good enough, here are ten signs that you probably are not seeing the best doctor:

  1. An old expression states if the ink on the diploma is to wet or too dry, seek treatment elsewhere. If the diploma is a pile of dust behind a dingy glass frame, run.
  2. The doctor’s lab coat is dirty. This simple observation reflects the doctor’s hygiene and their respect for medicine. Dirty lab coat, dirty doctor.
  3. Magazines in the waiting room are over 10 year old. This shows the office is not up on the times, that is, if they can’t even update their magazines, what kind of archaic medicine is being practiced.
  4. The doctor spends less than a minute with you and can never remember your name. While I grant many doctors are overworked, they can spare a few minutes and knowing their patient’s names.
  5. The doctor is a social media star who does nothing but tweet, post, take selfies, and promote his brand. While I’m sure these doctors are attractive and interesting, they probably are not practicing as much medicine as the good old fashioned doctor–oh, excuse me for a second, someone just liked my latest post on instagram, just joking.
  6. The appointment is spent talking about the doctor and not about the patient (for example, ‘So you just had a little heart attack, big deal, I get my coronaries rota-rootered every year and since my 8th heart attack and some Lipitor, I eat at the buffet daily).
  7. The doctor cannot make a decision and refers you to a specialist for every problem (IE that splinter in your finger is tiny but just to be safe, let’s have a dermatologist look at it to make sure nothing is being missed).
  8. The doctor’s office frequently cancels your appointment or is late for your appointment.
  9. You arrive on time for your appointment and realize yo have read Was and Peace before being called in to see the doctor.
  10. You are asked to disrobe in the exam room for a talk therapy visit.

I’ve seen variants of all of the above so keep the above in mind before choosing your next doctor.

Natan Schleider MD

Which ADHD Medicine is Right for Me?

by Natan Schleider M.D.

December 7th, 2018

So you think you have attention deficit hyperactiviy disorder (ADHD formerly ADD) and you are considering medicine options. If you are like most patients I see, you’ve already queried friends, family, and the internet so you can tell the doctor what you think is best. I have no issues with educated patients so I’ve put together a list of medicines I use and why.

Note the family of stimulants (IE methylphenidate, Adderall, Vyvanse, and others) are the first recommended treatment in general for patients but that varies by patient and whether they have other medical or mental health issues.

Stimulants can be habit forming so considering a non-controlled medicine (bupropion aka Wellbutrin, Strattera) for ADHD may be a nice option as they are not habit forming although tend to be milder and less strong.

The first question to ask when it comes to stimulants are whether your want a short acting medicine that can be used a few times a day or a long acting medicine taken once a day. This is patient preference as some like flexible dose options with a short acting medicine while others just like to take one pill a day.

So here are your stimulantmedicine options for ADHD:

  1. methylphenidate (best known as Ritalin) which is the oldest and comes as short acting (last 2-4 hours) and long acting (last 6-12 hours for Concerta or Focalin or Vyvanse–I find they last closer to 6 hours in most patients). Note Daytrana is a patch that lasts up to 10 hours
  2. Dextroamphetamine/amphetaime (Adderall) which comes as short acting or long acting (Adderall XR) and super long acting (Mydayis) at up to 12 hours.

 
And here are your non-stimulant medicine options for ADHD:

  1. Atomoxetine (Strattera) which takes about 3 days to kick in and dose can be adjusted from 40 mg to 80 mg (the standard dose) in 3 days.
  2. bupropion (Wellbutrin) is a very activating antidepressant approved for ADHD, tobacco cessation, and depression.

My patients tend to prefer Vyvanse which is the least speedy of the stimulants but every patient breaks the medicines down differently so it may take some trial and error to find the right choice.

When reviewing medicine options with patients I go over the above in detail. While talk therapy helps for most other mental health illneses, it is less effective for ADHD (but no harm in trying it).

If you have any questions or comments please reach out to me on Twiter or Instagram or facebook.

Thanks for reading,

Natan Schleider, M.D.

Herbal Supplements: Helpful, Harmful, or Harmless when using Prescribed Medicines?

Herbal Supplements: Helpful, Harmful, or Harmless when using Prescribed Medicines?

By Natan Schleider M.D.

December 6th, 2018

One of the first things a good doctor does when discussing medical management of an illness is figuring out what treatments the patient is interested in.  Chances are they have already tried cranberry for their urinary tract infections, St.John’s Wort for mood, and a host of other over the counter herbs or supplements which their mother, butcher, or favorite celebrity has recommended.

When these patients come to see me, the melatonin is not really working for sleep and the horny goat weed has not helped libido. These patients may consider trialing a standard medicine when indicated as they feel so bad. Concurrently, they have a strong aversion to taking chemicals bundled into pills that the evil pharmaceutical companies are marketing. After all, if it is natural, it must be better?

When I prescribe a medicine, I need to make sure it will not interact with the herbs that millions of American take so I am writing this blog to weed out (pun intended) the supplements that you can take with other drugs and those that should be avoided or used carefully.

HERBAL DIETARY SUPPLEMENTS WITH LOW RISK OF DRUG INTERACTIONS:  Black cohosh, Cranberry, Gingko, Ginseng (American), Milk thistle, Saw Palmetto, Valerian

HERBAL DIETARY SUPPLEMENTS WITH HIGH RISK OF DRUG INTERACTIONS: Goldenseal, Green Tea Extract, St. John’s Wort

I have not discussed vitamins much and this may lead to a further blog. For example, iron supplements (along with calcium, antacids, and cholesterol drugs) impair absorption of thyroid supplements so take your thyroid medicine 1-2 hours before or after you’ve taken your other medicines and supplements.

I’ve scratched the surface of a major issue but most importantly, tell you doctor and pharmacist what supplements you take so they can tell you how they may or may not interact with your mediation.

Thanks for reading!

Natan Schleider, M.D.

SOURCE: AMERICAN FAMILY PHYSICIAN V.96 No.2 July 15th, 2017