Why it is important to ask your Doctor WHY??

"Trust me I'm a Doctor"
“Trust me, I’m a Doctor”

We all want to believe our Doctor’s know best. But if our knowledge is doubling almost every year, how can a busy and dedicated Doctor keep up on all the medical knowledge needed to treat their patients???

In reality, Doctors and hospitals use guidelines established by well know associations and groups such the American Heart Association (AHA) and the American College of Cardiology (ACC) to treat patients.

But what if these medical associations and groups are using data that is as scientific as you would think. Especially, if a loved ones health is being based on it. Well, that is what a study in the Journal of American Medical Association (JAMA) has reported when it looked at cardiovascular treatments.

Currently, there is a rating system that the ACC/AHA use to evaluate the evidence behind a recommended guideline (available at http://www.acc.org and http://www.aha.org). One is based on the level of evidence behind the study (Level A, B, C) and another based on a grading of the types of studies supporting the recommendation and expert consensus/opinion (Class I, Class II, IIa, IIb IIc and Class III)

The evidence or Level A, B and C based grading is as follows:

  • Level A: including multiple randomized trials or meta-analyses.
  • Level B: single randomized trial or non-randomized studies.
  • Level C: recommendations based on expert opinion, case studies, or standards of care.

Level A is viewed as the best because it encompasses more information and testing before the recommendations are made to Doctors.

The class of recommendations  (Class I, II, IIa, IIb IIc and Class III) are as follows:

  • Class I: conditions for which there is evidence and/or general agreement that a given procedure or treatment is useful and effective.
  • Class II: conditions for which there is conflicting evidence and/or a divergence of opinion about the usefulness/efficacy of a procedure or treatment.
  • Class IIa: weight of evidence/opinion is in favor of usefulness/efficacy.
  • Class IIb: usefulness/efficacy is less well established by evidence/opinion.
  • Class III: conditions for which there is evidence and/or general agreement that the procedure/treatment is not useful/effective and in some cases may be harmful.

The Class of recommendations requires the guideline writers to make a judgment about the relative strengths and weaknesses of the study data AND to make a value judgment about the relative importance of the risks and benefits and based on the the evidence they have and to “synthesize conflicting findings among multiple studies“.

WHAT THEY FOUND . . .

"Um are you sure?"
“Uuuummmm are you sure?”

That with 16 guidelines for reporting levels of evidence, only 314 of 2711 recommendations were are classified as Level A with the higher evidence to back them.  But that the Level A recommendations were mostly concentrated in Class I where there is evidence and/or general agreement that a given procedure or treatment is useful and effective.

However, only 245 of 1305 Class I which indicate a general agreement about a treatment or procedure by the guideline writers had a Level A evidence to back them.

They found that the BIGGEST increase in recommendations has been in Class II, where there is “conflicting evidence and the usefulness/efficacy of the guideline is less well established by evidence/opinion.”

Simply put, a lower standard overall.

The article concluded that the medical research community needs to streamline clinical trials, focus on areas of deficient evidence while expanding the funding for clinical research.

More telling is the last line in their conclusions “Finally, clinicians need to exercise caution when considering recommendations not supported by solid evidence.”

Not good, right?? It doesn’t help when you look at who funds the American Heart Association.

  • AstraZeneca LP
  • Sanofi-Aventis
  • Bayer Corporation
  • Bristol-Myers Squibb Company
  • Centocor Inc.
  • ConAgra Foods
  • CV Therapeutics
  • GlaxoSmithKline to name JUST a portion.

    Who did you say you worked for again?
    Who did you say you worked for again?

While I could not find who funds the American College of Cardiology, on their web page the reoccurring ad was for AMGEN the world’s largest independent biotechnology firm.

I am not saying we should ignore our Doctor’s advice but we should definitely be our own and our family’s BEST advocates. Sometimes being a better advocate means simply asking WHY?

Or even go a step further and ask to read the studies or do some research on your own about a particular drug or treatment.

Here are some other similar articles you might find helpful:

Clinical Practice Guidelines: Still Miles to Go…

Systematic Analysis Underlying the Quality of the Scientific Evidence and Conflicts of Interest in Interventional Medicine Subspecialty Guidelines. 

Sometimes a crappy situation …

You choose! Both the ability to Frown Or Smile.
You choose! Both have the ability to Frown OR to Smile.

This year has been great.

Some of things have turned out even better then I could ever have imagined. After almost 9 years together, I still look at Chris and think WOW. He’s the most wonderful person I have ever know.

Turns out, I would work  . . .  just so I could do Crossfit.

More impressively in spite of getting 21 stitches at the AT & T Spartan Sprint Race I learned I love obstacle races. Not only that, but I plan on doing a longer and harder one next year.

I really Leaned In to my career. I read Sheryl Sandberg’s Lean In book . . . twice. I joined not one but 2 Lean In groups. I went to a Women’s Leadership Conferences. I worked late, went in on the weekends, I volunteered for projects. I tried to be the best team player possible. Then I got my annual review and let just say it’s pretty clear we were not on the same wave length, at all.

I went home so mad that day I could barely hold (I actually didn’t) my temper. I had been so convinced that if I tried harder, went at it longer or something else, I would just BE successful and happy at my job. But I realized that no amounting of leaning was going to make this job a calling.

BUT and this is the best part of the story. I started to look at other options and outta the blue IT came to my husband and me on the same day! Why don’t I look into Physical Therapy?

So I found out what pre-requisites I needed to take to get into a DPT program.  I talked to my Boss about leaving early (at 5, so not really early but at a “normal” time), only to be told he highly doubted it, but he would ask. I even approached out HR “department” and discussed my plan. Low and behold about a week before my class was supposed to start and they called me in and propose that I go down to 30 hours, take over all the case management along with a FANCY new title and a raise!!

Ladies and Gentlemen count me IN !!!

This may not be quite was Sheryl Sandberg was talking about. But the next time I get discouraged by some of the things I see as negative, I need to remember what at first seems like a negative like a trip to the ER or a craptastic review can actually be major INCENTIVE for some pretty cool and necessary changes.

In the end sometimes it’s all in how I approach things.

The Positives Rule!!
The Positives Rule!!

 

 

 

 

 

 

P.S. Some days I just have to focus on the big picture and not what my next review might be.

Meet my healthy friend Lilly Liver.

Your not afraid of some Liver, are you?
Your not afraid of some liver, are you?

Wow, A lot has happened in the last 6+ months!

We got married.

I finally took the leap and joined Crossfit.

I decided on a long term career path that is a great juxtaposition of many of my interests.

I did a Spartan Race.

All while working a very stressful job that if it wasn’t for some SUPER DUPER positive and fun co-workers would be a bit more then I could handle.

To be honest that is why I have found it so hard to blog any thing any more. It takes a lot to deal with stuff sometimes . . . but I am hoping I might be able to get back to some recipes and other stuffs.

On THAT note here is how after YEARS of a complete hatred of liver I have been able to find a way to eat it almost daily.

Liver
Liver is my new Friend!

Are you ready . . . I add other good stuff until I cannot taste it.  Brilliant RIGHT?? OK, here is how I do it.

  • 1 lb of liver (you decide on the kind, this is beef)
  • 1 lb of some other grass fed meat.
  • 2 Eggs
  • 1 to 2 Cups of a sauce you like. I buy a Green Harissa Sauce Or a Chili Pepper Garlic sauce from a local Mediterranean market. Personally for me, the spicier then better.

First, I pan fry the liver. Yes, it will smell like liver. I tried and could not find a way to totally knock out the smell.

Do you smell that??

Then I stick it in a food processor and mix until it is paste like. If you don’t have a food processor, dice it into small (as small as you can) bits. I then add the other uncooked meat, the sauce and mix well ( I used the green sauce here). Be sure to scrap the bowl so everything gets evenly mixed.

Now spoon the mixture out in whatever quantity and shape you like. Fry this mixture until it’s at the level of cooked you like. I like the outside to be crispy. You just want to make sure the other meat gets cooked also. In the picture above, I made little patties and dressed it with some basil from my garden. Some fat in the pan will help it to not stick. Because it has a paste like consistency it can be very hard to do meatballs. Trust me, I tried it, it was just way to sticky and that is why they look like smashed meatballs ;o).

But why eat Liver? How about all these nutrients versus regular red meat??

RED MEAT (3.5 oz) BEEF LIVER (3.5 oz)
Calcium 11.0 mg 11.0 mg
Phosphorus 140.0 mg 476.0 mg
Magnesium 15.0 mg 18.0 mg
Potassium 370.0 mg 380.0 mg
Iron 3.3 mg 8.8 mg
Zinc 4.4 mg 4.0 mg
Copper .18 mg 12.0 mg
Vitamin A 40 IU 53,400 IU
Vitamin D Trace 19 IU
Vitamin E 1.7 mg .63 mg
Vitamin C None 27.0 mg
Thiamin .05 mg .26 mg
Riboflavin .20 mg 4.19 mg
Niacin 4.0 mg 16.5 mg
Pantothenic Acid .42 mg 8.8 mg
Vitamin B6 .07 mg .73 mg
Folic Acid 4.0 mcg 145.0 mcg
Biotin 2.08 mcg 96.0 mcg
Vitamin B12 1.84 mcg 111.3 mcg

OK, I hope this helps!! Feel free to offer suggestions or comments.

Rona

How I know this year is going to be exceptional !

I will MAKE this happen!
I will MAKE this happen!

You know how I know this year is going to be exceptional? Because I am going to make this year everything I was originally HOPING it would be! That’s right, I am taking the hope out of my wish for a Fabulous 2014 and I am going to make it happen.

Do you know it took me 2 colds, one sinus infection, one bout of flu and a nasty case of hives due to antibiotics during the month of January to realize that I was simply hoping for a great year not concentrating on actively making it a great year.

While I may not have a magic wand. I have something better  . . . I have faith in myself and my abilities to push myself. Even more It means that for the first time in a long time I am not sick AND I am enjoying the journey again! A journey I intend on taking a very active role in!

~ Look at my easy peasey lunch for the week.

Grass fed beef with Double Roasted Salsa from Trader Joe’s and Spaghetti Squash this week’s lunch.

This week's lunch.
This week’s lunch.

I rang in the New Year by being . . . SICK!

All the best plans laid to waste!

Are you kidding ME???
Are you kidding ME???

That is what comes to mind when I think about all the great plans I had for New Years 2014. Because sure enough 2 days before the ball dropped I woke up sick and just got sicker as the days rolled by.

Turns out I had a sinus infection guess that why my head felt like a beehive. Unfortunately, because I have gotten sick more in the last couple of months then in the last several years I decided to go ahead and take the antibiotics my Doctor prescribed. I hate that I felt I had to go this route.

Trust me, I know the side effects of antibiotic how it kills ALL the good stuff along with the bad. But tomorrow will be the first time I have been able worked out in 2014.

I am not going to let this setback derail me, in fact my nutrition was pretty on point the whole time. I honestly made myself proud with how nutritious and healthy I ate. Not to mention almost no panic about the lack of workout OK  maybe a little but no self sabotaging inner voice telling me I am failing.

SO now I am ready to run tomorrow with my goal written on my board, my meals all laid out and my clothes ready to go. My meals are dominated by items that will help me get back the good bacteria my stomach lining needs and I am ready to make good on some of these promises I made to myself!

I guess the reason I am writing this small post is to say that set backs even one like this short one can really just be opportunities for having a stronger plan and a firmer commitment. After all I did commit to running 650 miles this year not to mention wearing a bikini on my honeymoon.

AND if I don’t remember this in the coming months . .  feel free to remind me!

Rona                                                                                                                            Life is 10% What Happens To Us and 90% How We React To It.

P.S. My best probiotic meal so far has been homemade sauerkraut ( I used this one http://thenourishingcook.com/sauerkraut-winters-miracle-vegetable-salad/) and avocado yummy!

 
Life is 10% What Happens To Us and 90% How We React To It.

Ringing in more then just some resolutions!

Why wait until after New Year’s to have a game plan for the next year??

I got this year covered!
I got this year covered!

In the back of my mind I have some things I know I want to accomplish this year.  If you have read my Facebook page I am sure you know it’s to get in the best shape of my life for my wedding, not to mention the rest of my life.

The other is to learn to deal with stress better. Not just because I want to have the most stress free, fun and loving wedding possible. But to learn to deal with the stress around me better. Of course, this means I need to listen to my own advice and not stress over a bunch of stuff I cannot control. No matter how hard I try.

It also means not surrendering to that nagging and gnawing feeling that seems to “poop” on my entire day. That feeling in the pit of my stomach as I realize I am going (or to often have gone) from the sane and balanced person I walked in the door as, to the stress bundle who has totally forgotten that ultimately she’s got this. Of course sometimes this is compounded by the people around me and how I react to whatever form of crazy or passive aggressive they decide to share with me.

But seriously who wants to get wrapped up in ALL that drama. Let alone know you have become part of the problem and none of the solution by lunch time. Don’t you wish people would asked themselves that question more often “am I part of the problem or the solution?”.  Because we all know that it’s easier to think someone else is the problem. I certainly need to ask it of myself that MUCH more often.

So the main things I am going to accomplish this next year are some smoking hot arms and killer abs and the ability to deal with stress like Mike Tyson and bite it’s ear off.

Of course I have added to my list just in writing this post because we all know self improvement is a process and there are no shortcuts.

So here GOES . . .

1) Be comfortable and strong in my own 40+ skin.

2) Control the stress in my life.

3) Avoid people who bring me down.

4) Push my home workouts.

5) Enjoy life MORE.

See Yourself Six Months From Now. Don't stop it will be worth it.
See Yourself Six Months From Now. Don’t stop it will be worth it.

What are you going to put out there in the universe for 2014??

Success Does Not Come To You . . .

Success Does Not Come to You . . . You go to it!
Success Does Not Come to You . . . You go to it!

Sometimes, something that makes you uncomfortable and even feel bad is the best medicine for pushing you closer to success.

For me to move closer, I had to face my failure. For me, that was the inability to get into the physical shape I have always wanted to be in.

So to make a long story short, someone posted a couple of REALLY bad pictures of me, not out of spite but from a great family event. The pictures looked horrible and made me feel worse and to boot I had the worst meltdown over my weight I have had in years!

But it made me reassess my weight, my fitness level and how I am approaching how I want to look for my wedding and the rest of my life.

I love Paleo/Primal but I have said it before while it has really helped me be healthy and maintain my weight , my weight loss stalled a long time ago. I know the Paleo/Primal community could argue that I have to be doing something wrong. Maybe I am, but for me Paleo/Primal  just has not made me look the way I want.

So in my pursuit of balance, health, an outlet from my “dream” job and a photo ready wedding I went back to running, added a Trainer and shed some of my internal excuses.

I feel better and more optimistic then I have in a long time and I have been able fit into cloths that have not seen the light of day in about 3 years. In truth, I never would have been able to push myself closer to success if I had not had to face my failure in living color on Facebook.

So the one lesson I have learn about success besides hiring a Trainer really speeds things up, is to face my failures so I can go toward success. While this does not mean I am ready to look at those pictures again or post them here YET!  I am moving toward success instead of expecting it to come to me.

Just cause I want it to REALLY bad!

Life is 10% What Happens To Us and 90% How We React To It.

Life is 10% What Happens To Us and 90% How We React To It.

 
Life is 10% What Happens To Us and 90% How We React To It.
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