September 2007

I have to share this experience with you, the patients, so I can paint a more clear picture of what it means to be a medical practitioner in today’s America. Every day when we open the mail at our clinic, it is an opportunity to confront a number of the latest tactics insurance companies will employ in order to delay payment for the care we delivered to you the patients. Today it all moved to the next level. Here’s what happened. I opened the mail, only to be confronted with a few payment denials from United Healthcare in the cases of a few patients for which there was no reason to deny payment. It has become so commonplace that I recognize immediately when payment has been denied on purpose and a phone call will fix it (the phone call lasts half an hour). But it buys the insurance company a couple of months and all they have to do is apologize for the error. The error, by the way, looks like this: “Since you have submitted this claim outside of the allowed time we have to deny your claim at this time.” On the same piece of paper it states that you have 90 days to file the claim and it is apparent from the date of service that we submitted it within 30 days and yet………..there is a mistake. 

 But I digress. Here is the surprise of the year…………..

Wait for it…………….

Calls are being tranferred to India!!!!!!!! Now this is not computer technical support which has become mainstream in India. Noooooooooo! This is help with your medical claim. The questions are being answered by “Ricky” or “Penny” with all the other”Brians” and “Beckys” helping other customers in the background. I would imagine the insurance companies had to make this move seeing how all these intentional mistakes they make create a high call volume. Of course there aren’t enough people in America to answer all these questions! We need to enlist the help of 1 billion Indians to solve the crisis at United Healthcare.

Give me a break!

The picture was taken on July 21, 2007 on Mount Rainier, WA. Together with Dr. McKinley, a family physician at Valley View Wellness Center we joined a group of friends and set off to watch the world from the top. It is worth mentioning that even though we were first time mountaineers we were tackling the most expansive glacier range in the continental United States. Just a good place to start! :).

There are a lot of things to be said about the beauty that surrounds us, the challenges that such an expedition presents, and the reasons why one would even consider doing this. However, this being a blog focused on health, fitness and…..pain, I will focus on these issues. Let me start by saying that both myself and Dr. McKinley were worried about the physical shape we were in and whether it would be enough to allow us to climb such a mountain and have some amount of fun while doing it. We tried to stay informed by asking people that had already summited this mountain, reading online posts and recommendations of such people but we never had the feeling that we had gotten a clear picture of exactly how fit a mountaineer had to be. With this in mind, I think both of us decided that it would be better to overtrain that to be “rejected” by the mountain. How is this concept important for you, the patient? I think that in life we should always strive to be better than average…….better than what the consensus says we should be. If you have an injury that has been plaguing you for a long time and the mainstream tells you you should do this or that to get better… should do more. As I always tell my patients: If you want to maintain the status quo, you have to always put up a battle. It is an uphill struggle for constancy.

What turned out to be important for me was the aerobic exercise done over extended periods of time. It was very clear to me leaving on this trip that we will be climbing for many hours at a time, therefore rendering any short length exercise virtually useless. We had to get used to sustained amounts of effort over many hours. This not turns your heart and lungs into pumping machines but quite frankly makes you tough mentally. The mental aspect is very important when putting your body to the test. Paying attention to pain and discomfort is a sure way to get discouraged and turn around on a trip like this. One should also keep in mind that both myself and Dr. McKinley trained at sea level, while our trip took place at between 5,000 and 14,000 feet. The other important factor was the weight of the backpacks which exceeded 60 pounds. None of us exercised while carrying that amount of weight on our back.

To our delight, even though we did not reach the summit on this trip due to severe weather, we both became quite confident that our individual training had paid off and fitness was not the limiting factor in reaching that summit.

Here is an interesting article I found today. Good to read it if you’ve been smoking a lot and have knee pain.

Knee Pain May Signal Lung Cancer

It could give an early warning and improve treatment success, researchers say

— Madeline Vann

WEDNESDAY, Sept. 5 (HealthDay News) — Heavy smokers with knee arthritis may be experiencing an early sign of a difficult-to-treat lung cancer, research shows. Researchers at Prato Hospital in Italy reviewed the case files of 296 patients with inflammation in one knee between 2000 and 2005.

In just under 2 percent of these patients, the mild knee arthritis was accompanied by non-small cell lung cancer. All patients were middle-aged men who had been heavy smokers for most of their lives. Once the cancer tissue was surgically removed, the knee pain cleared up as well.

About 85 percent of all lung cancers are non-small cell lung cancer, according to the American Cancer Society. Unless it is caught early, non-small cell lung cancer is difficult to treat. It spreads to the bones in one in five cases and is well advanced by the time it is diagnosed in half of all cases.

Writing in the September issue of The Annals of Rheumatic Diseases, the researchers noted that early warning signs such as knee pain could lead to earlier diagnosis and more successful treatments.

To learn more about non-small cell lung cancer, visit the American Cancer Society.

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SOURCE: The Annals of Rheumatic Diseases, news release, Sept. 3, 2007

Back pain. Knee pain. Fibromyalgia. Car accidents. So many times I have wondered if my pain will ever go away. It is hard to be objective when it is you that’s hurting. You figure the pain will never go away because it is so real… touchable……. It might get better for others….but this pain will not go away. Just as I have been wrong most of the time with the occasional pain in my body you too are probably wrong. I will attempt to bring to light issues and solutions that are going to help you deal with the questions you have about your pain. And if I can’t do it in writing contact me and I will do it in my clinic in Garden Grove, CA. I am Dr. Daniel Buda, an orthopedic physical therapist in practice for ten years. I am an avid cyclist and soccer player so I have had the occasional pain and (before becoming a physical therapist) the occasional question that most of the time remained unanswered. Well, times have changed and technology allows you to tap into a whole new resource. Use it!

A patient asked me today: What’s the difference between a physical therapist and a chiropractor? What do you think? Is that a fair question? Have you asked yourself the same question before? I will give you definitions for both professions but first let me ask you some questions which will help you answer the question by yourself. If your mother had a stroke would you take her to the chiropractor? How about if your child had cerebral palsy? Chiropractor or physical therapist? If you were dizzy and fell a lot would you call a physical therapist or a chiropractor? Here is a harder question: what would you do if you had back pain?

 Let me begin by giving you the definitions provided by the professional associations of these two professions.

The American Physical Therapy Association states that a physical therapist should be:

-Examining individuals with impairment, functional limitation, and disability or other health related conditions in order to determine a diagnosis, prognosis, and intervention.

-Alleviating impairment and functional limitation by designing, implementing, and modifying therapeutic interventions.

-Preventing injury, impairment, functional limitation, and disability, including the promotion and maintenance of fitness, health, and quality of life in people of all ages.

-Engaging in consultation, education, and research.

Here is how the American Chiropractic Association defines chiropractic:  

– A drug-free, hands-on approach to health care that includes patient examination, diagnosis and treatment. Chiropractors have broad diagnostic skills and are also trained to recommend therapeutic and rehabilitative exercises, as well as to provide nutritional, dietary and lifestyle counseling. The most common therapeutic procedure performed by doctors of chiropractic is known as “spinal manipulation,” also called “chiropractic adjustment.” 

I would say that the biggest difference is that physical therapy addresses functional impairment as related to pathology. In other words if there is something wrong with your body (trauma or strain or stroke….etc) you will have certain functional limitations. A physical therapist will assess these limitations and help you regain the function lost.

More on chiropractic in a later post.

For now, have a healthy, beautiful day. We’ll see you at OCDPT!

Welcome to OCDPT’s blog! We are opening new lines of communication between you, the patient, and OCDPT (Orange County Doctors of Physical Therapy). I will answer your questions at anytime. If I don’t know the answer I will get it or tell you where to find it. Please feel free to use this blog to express your concerns. You will find an interesting array of commentaries on contemporary health, fitness, nutrition, and recreational issues. And much more…..feel free to call us and schedule a time so we can see you and become familiar with your musculoskeletal problems.