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Not Consensus

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August 17, 2014

Great scientific medicine comes from someone who broke with consensus because of their conscience. Such people will usually have scars on their persona, or finances to prove it. In 1847 Dr. Ignaz Semmelweis a Hungarian doctor teaching medicine in Vienna close friend, Jakob Kolletschka, cuts his finger while he’s doing an autopsy. Kolletschka soon dies of symptoms like those of puerperal fever, which is killing 13 percent of the women who give birth at his university hospital. Another obstetric unit there, run by midwives, loses only two percent of its patients to this fever. They washed both their hands and instruments between deliveries!

No one had connected germs with disease yet. The germ theory came from England 6 years later and but information on how to kill them wasn’t available for another 18 years.

Semmelweis notices that students move between the dissection room and the delivery room without washing their hands. After much thinking and a reminder of his late friend Jakob, he sorts it out and sets up a policy. Doctors must wash their hands in a chlorine solution when they leave the cadavers. Mortality from puerperal fever promptly drops to two percent. As outside interest grows, we begin to understand Semmelweis’s inability to publish his findings. The hospital director feels his leadership has been criticized. He’s furious. He blocks Semmelweis’s promotion.

The situation gets worse. Viennese doctors turn on this Hungarian immigrant. Finally, he goes back to Budapest. There he brings his methods to a far more primitive hospital. He cuts death by puerperal fever to less than one percent. He does more. He systematically isolates causes of death. He autopsies victims. He sets up control groups. He studies statistics. Finally, in 1861, he writes a book on his methods. Of course the medical establishment gives it poor reviews. Semmelweis grows angry and hurts his own cause with rage and frustration.

In 1865 he suffers a mental breakdown. Friends commit him to a mental institution. There “to close the circle of coincidence” he cuts his finger. Within two weeks, he dies of the very infection that killed his friend Kolletschka and from which he’s saved thousands of mothers. This is the same year Joseph Lister begins spraying a carbolic acid solution during surgery to kill germs. In the end, it’s Lister who gives our unhappy hero his due. He says, “Without Semmelweis, my achievements would be nothing.”

Academic medicine like in Semmelweis”s time teaches consensus. Several “experts” or others in high places get together and conclude this is right and the other is wrong. In the last two decades Evidence Based Medicine (EBM) has come on strong. Until recently I believed in this. But it is upside down road to medical progress. In the past clinicians who had unusual medical situations would by intuit like our unfortunate hero, were able to offer treatments that they felt to be effective. This was not only based on the literature, but their understanding of Basic Science, experience, and their best clinical judgment. The physician would act on this as long as we first do no harm. This was my introduction into medicine philosophy using Latin “primum non nocere,” a fundamental medical precept of Hippocrates (ca. 460-ca. 377 B.C).

EBM has it upside down. Decisions are made when many studies that were amalgamated together, a mega analysis, give enough subjects to reach statistical proof. This leaves out the novelty of the human brain and insight. It is Intuitive, a direct perception of truth from fact, independent of any reasoning process with immediate apprehension. But one must superimpose consciousness on their intuition to have the personal awareness of right and wrong that we use to guide our medical actions to do right! “Chance favors the prepared mind,” remarked Louis Pasteur, a founder of microbiology who had made several serendipitous discoveries himself. Fruitful ideas do not come in an intellectual vacuum. They may pop up at a bus stop or a mountain road, or an “AHAH” moment. A person who stumbles on an event, recognizes its novelty, and if able publishes a factual description of it, making a discovery. However, the rudimentary discovery has little impact if it is not connected to other phenomena, for only in connections are causality explained and significances fully revealed. We must connect the dots, which develops and exploits a discovery. This requires much more knowledge and effort to add to the insight. Serendipitous connection of the dots led more than one medical scientist or practicing physician to the ‘TRUTH’. Now 55 years later, I appreciate my basic sciences (physiology, anatomy, microbiology, pharmacology and physics) in preparing me to best help my next patient who may have something that has never been revealed to me. However, the treatment must be with good conscience or I will have failed as a physician!!

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Eye Exercise

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August 10, 2014

What has eyes and cannot see? -Potatoes!
The eyes believe themselves; the ears believe other people.—German Proverb
The only thing worse than being blind is having sight but no vision.—Helen Keller

Our eyes need regular exercise in order to keep them healthy, just like any other muscle in the body. The thing is, we take it for granted that our eyes will eventually give up on us and we will finally need glasses or lenses, extra or intraocular. This does not have to be the case if one regularly exercises the eye muscles like the rest of our muscles. Unfortunately when we are coerced to wear glasses or contact lenses our eyesight will more rapidly get worse over time. Our eyes will get used to a new lens and need even stronger ones to function properly. Everybody who wears glasses or contacts will tell you their eyes have gradually become worse over time, but it is putting the cart in front of the horse. It is the glasses that are making the eyesight worse!! If it were not for glasses, we would not need glasses in 90% of humans (and far less eye personnel to service them).

The eyes are designed for a healthy balance of looking both in the near and far fields of vision. This design served us well when hunting and scavenging and in the last 10,000 years farming, was our way of life. With the advent of, handicrafts, books, instruments, and working indoors, then computers and now computer games our internal eye muscles deteriorated at an even earlier age. The average person now spends the majority of their day looking in the near field of vision. When you look in the near field of vision, the ciliary muscles around the lens contract to make the lens convex. Conversely, when you look away at something far at a distance, the ciliary muscles rest, and there is a flattening of the lens which is effortless and exerts a relax milieu for our brain. It becomes a wonderful exercise for the visual system, because when you look far at a distance, the total eyeball itself becomes a bit fatter and shorter than when you are looking at the near field of vision. In this way, looking at a distance is the most natural and calming exercise that the eyes can have. In addition, there is actually no mental activity involved, so the mind can relax as well, and simply enjoy whatever the eye sees.

Another way to approach this is to simply exercise the range of motion of our ciliary muscles by alternating between focusing on close objects versus far away objects (such as the horizon). This helps us accommodate better. Our lens and eye can be likened to a camera with lens that zooms in and out to bring an object into focus. You zoom in or out to make an object sharp either close or far away. When we are young, our lenses are able to “zoom” or “Accommodate” without any help. This is done by tiny little “zonules” or spider web-like band that suspend the lens. The zonules stretch like rubber bands to change the shape of the natural lens (before cataracts develop-which means the lens is cloudy). By changing the shape of the lens (naturally), one is able to focus in on the object regardless of the distance. Once we become “presbyopic” (old eyes) when are 40 or so, the zonules become a bit flabby and don’t stretch as much- therefore, the lens is not as easy to change shapes, becomes harder and thicker. This means no zooming in and out / no accommodation. Then the owner of the eye buys readers, contact lenses, or has lens surgery and later with their cataracts removed, a lens implant.

Early on, before the eye muscle becomes weaken exercises are performed. This is easily accomplished from inside the home, near a window. Simply look at something on the table or desk, and then look at something outside your window that’s far, far away (ideally, at the horizon). Alternate this process several times, then rest your eyes, and then repeat. Do daily for a few minutes each day.

If older and cataract surgery is done, I advise the hinged multi-focal device such as the Crystalens AO Lens. After two weeks postop start to work the ciliary muscle back into shape. As noted above, this is the muscle in the eye that enables the either replaced or natural lens to move and focus on images at different distances. As part of the normal aging process and after surgery, it has not had to work as before since you have seen at near through reading or multifocal glasses. The natural lens has enlarged and hardened and thus is less flexible. The muscle surrounding that lens grew out of contour and must be exercised back into shape.
A Vision Restoration Card is usually provided by the eye specialist as a tool in re-training eye muscles after cataract surgery Start by interpretation/discernment of the smallest type that one can with a slight strain. Don’t wear any reading glasses after the first two weeks then READ, READ, READ without glasses. 
Keep practicing until you can read comfortably without glasses (may be approximately two months) but may take 6 months to improve.

Other ways include Tromboning which is another basic near/far eye movement exercise. Hold up a pen at arms length and focus on the tip and then move it slowly in towards yourself, then slowly back out. Do this for several times, keeping your eyes fixed on the pen tip. Tromboning is a good because, for most of us, our lifestyles do not allow us the kind of near/far eye work that was part of everyday life in past generations. We do spend too much more time indoors, and doing close up work.

Gazing is another method, which is to find a room with a window, and with a soft gaze, locate four points on the horizon—like clouds, colors or features of the landscape. If no window, pick four points that are the farthest from where you are sitting in your room or office. Let your eyes shift gently from one point to the next at a leisurely pace, remembering to keep your gaze soft. If you are nearsighted and cannot see details at a distance, you may find yourself automatically straining to see the detail, or squinting to adjust to the light. Resist this urge to squint. Blink gently and wave your hands at either side of your eyes to increase your peripheral vision, and massage gently around the eye orbits to increase circulation. Consciously relax the eyes and let them rest on whatever they see, whether the image is clear or blurry. When reading or sitting in front of the computer, try to do this exercise every ten minutes for fifteen to thirty seconds. It takes less than a minute, and is a wonderful rest for your eyes.

Blinking is a simple way to keep your eyes lubricated and fresh which helps them to focus longer. Computer users and television watchers tend to blink less, especially when they are intently focused on something. Whenever you blink, your eyes are going into a brief period of darkness that helps to keep the eyes fresh and discharges previous information to make them ready for new information. This tends to reduce eyestrain.

LOOK AT THE HOT DOG BETWEEN YOUR INDEX FINGERs

This exercise is done to improve the flexibility and strength of the inside muscles of your eyes the ciliary muscles (in the iris). Either stand or sit with your feet, shoulder width apart. If you are standing, make sure your knees are slightly bent. Aim your eyes on any target in the distance. While looking at your distant target, bring your index fingers, tips touching about eight inches in front of your eyes and into your line of sight. Still aiming your eyes at the distant target calmly notice a mini hot dog has appeared between the tips of your fingers. Remember to continue to breathe easily and deeply. Pull the tips of your fingers apart slightly and observe the hot dog floating in the air. Then look directly at your fingers and the hot dog will disappear. Switch back and forth for two minutes.

Sunlight Therapy is looking for two minutes without sunglasses at the sun as it initially rises over the horizon and again finally at sunset.

Smaller is better. Most of us can easily read 12-point type as noted below, but if you read gradually smaller, not only will you improve your vision, but the brain in a process termed neuroadaption. Do this exercise by looking at this screen or print it off and carry with you and do in your spare time.
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Wants Versus Needs

July 20, 2014

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All Things Medical: Breast Thermography

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New Vision “No More Cataracts”

June 3, 2014

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Muscle Brain

May 20, 2014

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Abolishing Mammography Screening Programs?

May 5, 2014

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Experts, Androgen Study Group petition JAMA to retract testosterone article

April 23, 2014

Source: EndocrineToday April 5, 2014 Three medical organizations and an international group of over 130 scientists and physicians have issued a letter to the Journal of the American Medical Association requesting the retraction of an article which associated testosterone therapy…

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Melatonin is for more than just sleep

April 21, 2014

Melatonin has been ignored or trivialized as simply a “sleep aid” ever since it was introduced to the world in 1992 as a non-prescription supplement. A burst of new studies now reveals that melatonin can protect our body from many…

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Music that Heals – Binaural Beats

April 16, 2014

“Binaural Beats,” the term used for music with slightly different frequencies in each ear. The difference in these frequencies, or beats, elicits beneficial brain waves by releasing healthy neurotransmitters. So, in addition to drugs (antidepressants, energizers, and sleep aids), binaural…

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