F2CMy thanks to Janet Parshall and Talking it Over for a great conversation today about protecting the rights of conscience for health care workers.  The best source of information that I have found on this issue is Freedom2Care.  Visit this website to learn more about this important issue and to find out what you can do to ensure that our health care system preserves your right to receive care from a physician or health care worker who is freely able to practice according to their deeply held beliefs, whatever those may be.

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On Saturday Jan 16th I will appear on Talking It Over with Janet Parshall a nationally syndicated radio program on the Moody Radio Network.  We will discuss the earthquake in Haiti and also talk about health care reform.  Tune in at 12:30pm Central Time on 90.1FM in Chicago and on stations across the country.  Visit the link above to find a station near you.

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dennis miller

I had the chance to attend a live broadcast of The Dennis Miller Show at Navy Pier.  I took it upon myself to grant him an honorary MD for the health benefits of his humor.  Listen here.

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uesday morning on WMBI a caller asked if there was something safe that her daughter could take in her 7th month of pregnancy to help her sleep. In the midst of a busy morning of calls, I gave her a kneejerk response by recommending the antihistamine diphenhydramine, the active ingredient in Benadryl. This approach is safe, as diphenhydramine is a pregnancy category B medication (meaning that studies in humans have proven it to be generally safe for the unborn child). However, I did not take the opportunity to discuss other natural remedies, as well as behavioral strategies for sleep in the later stages of pregnancy.

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"House Calls" airs Sunday night at 10pm on AM 560 WIND and streams live at 560wind.com. In addition to the latest health headlines, I will address the topic of H1N1 flu. My guest is Donald Thompson, MD, Senior Medical and Public Health Program Director in the Center for Infrastructure Protection at the George Mason University School of Law in Arlington, Virginia.

Episode Two Action Steps:
1) Prepare to utilize hand sanitizer liberally this flu season. Purchase some bottles for you and your family to have with you at all times.
2) Do not touch your eyes, nose, or mouth until your hands are clean.
3) Get the regular influenza vaccine, available now at your doctor's office or other locations (unless you have a contraindication like egg allergy or previous adverse reaction to the vaccine).
4) Get the H1N1 vaccine when available (likely late October-early November) if you are in one of the recommended groups:
a) Pregnant women
b) Household contacts and caregivers for children younger than 6 months of age
c) Healthcare and emergency medical services personnel
d) All people from 6 months through 24 years of age
e) Persons aged 25 through 64 years who have health conditions associated with higher risk of medical complications from influenza (these would include asthma and other lung disorders, and conditions causing immunosuppression such as HIV or certain cancers).
5) If you get sick with fever, aches, cough, and congestion ("flu-like" symptoms) stay home and limit your exposure to people until 48 hours after your fever is gone.
6) If your fever is over 103, you are unable to eat or drink, or you are having severe vomiting or diarrhea, seek medical attention. These are risk factors for dehydration, a major cause of morbidity and mortality from the flu. You should also seek medical attention, of course, if you are having difficulty breathing.
7) Don't panic. Common sense will get us through this!
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House Calls Radio debuts this Sunday evening Sept 6th at 10pm on AM 560 WIND. In addition to the latest health headlines, we will discuss the topic of advance care planning. My guest is Dr. Martha Twaddle, director of the Midwest Hospice and Palliative Care Center.

Show #1 Action Steps
1) Choose the person you would trust to make health care decisions on your behalf if you become unable to express your health care wishes.
2) Ask that person if they would be willing to act as your health care power of attorney.
3) Download the Durable Power of Attorney for Health Care form. (Here's the Illinois form if you live in my home state)
4) Complete the form and have a witness sign it. You may also have your chosen agent sign the form but it is not required. No notary or attorney is required. You may choose successor agents in the event your primary agent is unable to fulfill their responsibility.
5) Make copies of the form.
6) Keep two for yourself, give one to your power of attorney, one to your physician, one to your successor agents (if applicable), and one to your lawyer (if applicable).
7) Have a conversation with your power of attorney about the things that are important to you when it comes to your health care. If you need help with this, make an appointment with your physician specifically to discuss advance care planning and ask for at least a 30 minute appointment. Bring your power of attorney with you. In Chicago, you can find a trained facilitator to help you with this process at Someone To Trust.

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Here's  a list of all Doctor Fisher previous shows:

November 22, 2009
Listen here!
(right-click to download to your computer or mp3 player)
Tips for eating healthy during the holidays!
Dr. Fisher welcomes David and Susan Lindgren of Comfort Keepers as we discuss options for in-home caregiving.

November 15, 2009
Listen here!
(right-click to download to your computer or mp3 player)
House Calls salutes our veterans!
Doctor Fisher welcomes Attorney Rick Law of Law Elder Law to discuss some little-known and often underutilized health care benefits available to veterans.
Also sponsored by: your extensor digiti minimi

Tuesday, November 10th

 

Click above to hear Dr. Fisher on The Dennis Miller Show
November 8, 2009
Listen here!
(right-click to download to your computer or mp3 player)
Topic: Home Safety
Doctor Fisher welcomes Mary Tinetti, MD of the Yale School of Medicine, and nationally recognized expert in the prevention of falls among older adults.
He also welcomes David and Susan Lindgren of Comfort Keepers, who discuss some innovative technologies being used to improve the safety of loved ones at home.  Click here for more information about SafetyChoice.
November 1, 2009
Listen here!
(right-click to download to your computer or mp3 player)
Topic: Brain Health
Guests:
Dan Buettner, National Geographic explorer and author of The Blue Zones: Lessons on Living Longer from Those Who Live the Longest.  Dan talks about the secrets to long life.  He will speak at the Museum of Science and Industry on Saturday November 7th at 1pm.
Dan Michel, CEO Dakim Brain Fitness
Susan Schaefer, Administrator Heritage Woods of Huntley
Also brought to you by: your medulla oblangata
October 25, 2009
Listen here!
(right-click to download to your computer or mp3 player)
Topic: Children's Health
Doctor Fisher takes questions from kids!

Also brought to you by: your epiphyseal plate

 

October 18, 2009
Listen here!
(right-click to download to your computer or mp3 player)
Topic: Women's Health
Guest: Julie Goldstein, MD
Director, Division of Clinical Ethics
October 11, 2009
Listen here!
(right-click to download to your computer or mp3 player)
Topic: In-Home Care
Guest: Katie Fielmann and Melissa Watters of Comfort Keepers
October 4, 2009
Listen here!
(right-click to download to your computer or mp3 player)
Topic: Your phone calls!
Also brought to you by your medial longitudinal fasciculus (MLF)
September 27, 2009
Listen here!
(right-click to download to your computer or mp3 player)
Topic: Heart Health
Chairman, Department of Medicine, Advocate Christ Medical Center
Director, Heart Failure Institute at Advocate Christ Medical Center
Also brought to you by:  Your Purkinje fibers
September 20, 2009
Listen here!
(right-click to download to your computer or mp3 player)
Topic: Senior living options
Guests:
Wayne Smallwood
Also brought to you by: Your Sartorius Muscle
September 13, 2009
Listen here!(Right-click to download to your computer or mp3 player)
Topic: H1N1 'Swine' Flu
Guest: Donald Thompson, MD
Also brought to you by: Your Thymus Gland
September 6, 2009Listen here!
(Right-click to download to your computer or mp3 player)
Topic: Advance Care Planning
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A caller to my Tuesday morning appearance on WMBI asked a question about chia seeds, and I had to admit that I did not know much about what they had to offer. If you're like me, the word "chia" conjures up images of pet-shaped terra cotta pottery with green sprouts. It turns out that eating chia seeds can have some positive health benefits.

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This morning on WMBI I talked about a recent study on the popular Proton Pump Inhibitor (PPI) medications and their potential to cause "rebound" acid reflux. This could lead to a dependence on these medicines. Many callers and e-mailers have questions about this. If you are on these medicines, should you stop them? If so, what is the best way to stop? Is there any risk to staying on the medicine?

The PPI medications are commonly known as Prilosec, Prevacid, Nexium, Aciphex, and Protonix. The generic names have the common ending "-prazole". These medicines block the stomach's production of acid. They are useful for people with acid reflux disease, or gastroesophageal reflux disease (GERD). This class of medicines is one of the most commonly prescribed group of drugs in the world. Many doctors prescribe them the first time their patient reports symptoms of heartburn. Some of these drugs are now available over-the-counter without a prescription.

The problem that is now coming to light is this: it turns out that while these medicines are in the system, the stomach responds by attempting to crank up acid production. When the medications are stopped, the floodgates open and heartburn symptoms return, possibly in a more severe form than previous. This study actually placed people with no heartburn symptoms on a PPI medication for two months, and when the medicines were stopped, the patients with no history of GERD developed symptoms of heartburn within a few weeks.

So what are the implications? First, if you are on a PPI, there is no documented long-term risk of staying on the medicine. That being said, it is best to use these medications for the shortest time possible in order to avoid the "rebound" effect. The recommended time frame is 2-3 weeks, in order to treat a severe flare-up of GERD. During that trial, there are lifestyle modifications that should be tried. These include limiting the intake of alcohol, tobacco, caffeine, and spicy foods. Stress can also contribute significantly to GERD.

If you are already on these medicines, and you have been taking them for some time, talk to your doctor about stopping. One way to do this is to wean yourself off by cutting your dose in half, then going to every other day, then every third day, etc. Do this over the course of 4-6 weeks. What may happen, as suggested by this study, is that your symptoms may return when the dose is reduced. I would encourage you to try to ride this out over 1-2 weeks, because the stomach may re-calibrate its acid production on the new lower dose. This may need to occur over several weeks and multiple, step-down dose reductions.

For those who cannot manage their GERD through lifestyle modifications (mentioned above), another medication option is ranitidine (brand name Zantac). This medicine is available over the counter in a 75mg tablet. The maximum dose is 150mg (two tablets) twice a day. Start by taking one tablet at night, go to two if needed, and then add a morning dose if necessary. It is safe to start on the ranitidine while you are weaning yourself off the PPI's, and this may help with any "rebound" heartburn you may experience.

There is a group of patients that should be on PPI medications for life. These are people with something called "Barrett's esophagus". This occurs when the acid reflux is so severe that it causes tissue damage to the esophagus. This damage can progress to esophageal cancer and can be deadly. Barrett's esophagus is diagnosed by esophagealgastroduodenoscopy (EGD), a test in which a GI specialist passes a small camera down the esophagus and can look at or biopsy the tissue. Anyone with a positive test should stay on PPI's. For the rest of us, it seems best to limit the use of these medications.

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The following are recommended products that I would recommend you consider.

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Housecalls

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