Ever since I knew exactly what I wanted to do with my life, I have worked passionately to make it a reality and I have always believed that if I am to be successful in my pursuits, I will find that success through balance. It is because of this I want to introduce to you a television program called Balance. Balance is a nationally-televised cable TV show that explores connections that people have made between health and wealth. The essential idea behind the show is that everyone is entitled to realize their full potential yet often what stands in the way is poor health or poor finance. However, with a balanced lifestyle that emphasizes wellness as well as taking care of yourself and your community, success can become a reality. The program offers the personal stories of guests who have achieved success in their careers and personal lives and can reflect on the — sometimes arduous — journey.

I was asked to speak about my own journey and I am excited to announce that the episode will air on the Discovery Fit & Health channel on Thursday, November 15, 2012 at 5:00 AM. You will also get to meet Gavin Keilly, founder of GBK Productions, and hear how he came to be a successful entrepreneur and charity contributor as well as hosts Steven E. Schmitt and Trissa Tismal.

You can find Balance TV on the web at BalanceTV123.com and Gavin Keilly can be found at GBKProductions.com.

We will all miss Junior Seau whose life after the NFL seemed so full and productive. He had just completed a celebrity golf tournament for his foundation last month with other ex-NFL players. He had a successful restaurant and he was beloved by the city of San Diego years after starting off as an overly aggressive, if not immature player.

There is tremendous controversy in the way that Seau chose to end his life. Formally labeled as a suicide by the coroner, the question is: was Seau suffering from untreated depression, or experiencing the effects of years of chronic head concussions? Another player, Dave Duerson, also committed suicide this year and shot himself in the chest so that his brain could be studied. It showed moderately advanced evidence of chronic traumatic encephalopathy (CTE) — a progressive degenerative disease related to repeated concussive blows. The disease has been linked to at least 18 deceased NFL players, researchers have reported, but no definitive cause-effect relationship has been established. Seau’s family has just released his brain so that it can be studied by scientists to see if CTE played a role in his death. Untreated depression can certainly lead to suicide and even if Junior did fall asleep in 2010 when he drove off a cliff, that was a troubling warning sign of his potential for suicide and the demons lurking within. If he was deeply troubled this year, Seau concealed his private misery to most, even to family members who are also seeking answers for their untimely loss. However, it is understood that it is very difficult for many players once they leave the NFL to adjust to civilian life as they no longer have the same level of fame and their self esteem is challenged.

The NFL is under a lot of pressure to make changes to the way the game is played and Seau’s death will ratchet up those efforts considerably. Remarkably, eight Chargers from the 1994 Super Bowl team have died from a variety of causes, all before age 45. There is a lot of homework still to be done and long term, mental health support should be provided for players on and off the field. Finally, we as fans must do our part to support the NFL as the sport becomes less violent. Otherwise, our grief will not seem sincere.

Junior, whatever the circumstances may be, know that you have a virtual stadium full of fans who appreciate the passion that you brought to your game. Rest easy knowing that your death will not be in vain as we will seriously explore CTE and untreated depression to try and help other players in the future.

Peyton Manning sustained a disc herniation in his neck which pinched a nerve that interfered with his throwing ability. He has undergone 3 surgeries to repair this in the past 2 years, one, just last September called a neck fusion. In this surgery, which is successful in the majority of patients, the spine is stabilized, in this case, with a piece of bone from Manning’s hip which was placed between two collapsed vertebrae so that the nerve could be unpinched. When nerves are pinched they can limit muscles in a quarterback’s throwing arm from functioning at their fullest. Over the next few months, Peyton Manning will continue the process of rehabilitating his arm and maximizing his throwing potential in order to lead the Broncos to the playoffs and hopefully to win another Super Bowl title.

History of the Injury

It is widely believed that Manning first injured his neck against the Redskins in 2006, when the quarterback was twisted between two defenders. He wiggled his arm after he stood, as if it had gone numb. Reportedly neither Manning or the Colts realized it until after the season, but Manning had pinched a nerve in his neck. On March 3, 2010, Manning had surgery at Northwestern Memorial Hospital in Chicago to repair it. This helped to alleviate Manning’s chronic pain for a while but then in the spring of 2011, the pain returned. On May 23, 2011 Manning went to Northwestern for a second surgery where doctors shaved part of the bulging disk that had pinched the nerve. Due to the persistence of his problem Manning reportedly went to Europe last summer to attempt stem cell therapy which did not work. He finally underwent a definitive anterior cervical discectomy and fusion surgery September 8, 2011 in Marina Del Rey by Dr. Watkins.

“The technical term is lupus nephritis. It’s a rare form of Lupus that’s just attacking my kidneys,”Nick Cannon explained to Robin Roberts on Good Morning America earlier this month. At the end of 2011, the entertainer cut short his family vacation so that he could be hospitalized for mild kidney failure. Doctors discovered later that the problems were more widespread than they’d thought. 

“They thought it was just kidney disease, and then they were trying to figure out why my immune system was attacking my kidneys, and that was sort of the root of it all”, the star adds. It took a related spate of unexplained blood clots in Nick’s lungs for doctors to realize that Nick’s immune system was the culprit.

Nick Cannon, along his wife, singer and actress Mariah Carey and their infant twins have become the public face of a family afflicted with Lupus. Systemic Lupus Erythematosus (SLE), or Lupus, is a chronic, inflammatory, autoimmune disease that mainly affects women of childbearing age. Its symptoms range from unexplained fever, swollen joints, and skin rashes to severe organ damage of the kidneys, lungs, or central nervous system. Though Nick Cannon’s Lupus nephritis is currently the most visible case of a Lupus-related disorder, they are actually rare amongst men. The most vulnerable group in our population is African American women, who are three times as likely as Caucasian women to get lupus. African American women also tend to develop lupus at a younger age, and have more severe symptoms than Caucasian women. 

Young people all over the world who look forward to Rihanna and Chris Brown’s next album, teasingly released last week, will be getting the wrong message about the thin line between love and hate.  Consider the sexually charged lyrics in Rihanna’s 2011 hit song “S&M”: “[S]ticks and stones might break my bones but chains and whips excite me”.  When you juxtapose these fantasy lyrics with Rihanna’s very real abuse at the hands of her former lover, the images of fear, submission, and pain become undeniably disturbing. Indeed, I certainly agree with Rihanna that “nothing could measure” to the physical pain of being hurt by a loved one, but it is extremely dangerous to rationalize a violent relationship by recasting it as sadomasochistic “pleasure.” Many people who associate pain and danger with pleasure and love have died when they put themselves in the way of danger again and again.

You know it and I know it—Rihanna should not be reuniting with Chris Brown.  Their reignited flame and its promotion through controversial song releases like “Birthday Cake” and “Turn Up the Music”, are an uncomfortable intersection of art and life. Though we generally pride ourselves at drawing a distinction between what an artist says and what an artist does, it’s hard to forget that today’s overtly sexual Rihanna was being badly and conspicuously battered not so long ago. Though her lyrics may blur the line between violent sex and domestic abuse, she can’t completely repackage her victimization as a show of sexual liberation.

Nor should she. It is not appropriate for any partner to endure physical, emotional or sexual abuse in relationships, whether they are female or male, famous or otherwise. Underneath the celebrity façade is still an innocent person, who in this case is a victim of severe domestic violence.

To be clear, many partners have a dysfunctional “love-hate” relationship without any undertones of masochism; any sort of unhealthy relationship volatility can escalate dangerously when the cycle of domestic abuse is left unchecked.  Short courses in anger management are hardly enough to maintain this fragile balance when passions reignite.

Rihanna reported to Rolling Stone: “I love to be submissive… being submissive in the bedroom is really fun. You get to be a little lady, to have somebody be macho and in charge.” Like all adults, Rihanna should be able to choose to explore the sensations of power and powerlessness alike with a sexual partner she knows and trusts. But Rihanna knows that Chris is violent, and she shouldn’t trust him. Being submissive with someone who has physically battered her is not what Rihanna needs, nor is it the narrative she should be pitching to her fans.

Yet this is the narrative that is being presented by the PR storm that surrounds Rihanna and Chris Brown. Rihanna and Chris are both young and reportedly in love, but they are also caught up in a social media and marketing frenzy to move as many albums as possible.  The commercial aspect of their very public private drama is one of the most harrowing aspects of it; the financial structure of Rihanna’s career would welcome Chris Brown, even as the emotional structure of Rihanna should refuse to see him again.

Let’s stand up and send a clear message to entertainers that not everything that makes money while compromising safety is “just art.” Every public failure to recognize and reject abuse helps countless more to justify their own tragedies in private.  Yet the story of the personal and emotional triumph of a high-profile victim like Rihanna can help many other victims on their own paths to reclaim their strength. For this reason, I urge you, as a physician who is a parent, to screen the content of what your children listen to on the radio and through their iPods to ensure that if your children’s music pushes the envelope that it doesn’t cross the line into their young ears and formative minds.

Source:   Rihanna’s Rolling Stone’s Interview Lee, Joyce (2011-03-31). “Rihanna talks Chris Brown, S&M tendencies in Rolling Stone”

“I will always love you” icon Whitney Houston died Saturday, her body reportedly submerged in the bathtub of a Beverly Hills hotel.  Whether substance abuse issues played a role in her death remains to be seen pending autopsy and toxicology results.  The death of Whitney Houston comes as the latest in a growing and alarming trend of celebrity deaths—from King of Pop Michael Jackson to singer Amy Winehouse. “All too painfully we are seeing an increasing trend of untimely celebrity deaths following a long history of substance abuse issues,” says San Francisco pain management specialist Moshe Lewis, MD.  A fan of Whitney Houston’s since the age of 16, Dr. Lewis is devastated by her passing adding that he “grew up with her music on a daily basis.” Unfortunately, as a physician with sub-specialty training in public health he is identifying drastically diminished life spans amongst celebrities whose “lives seem to be cut short almost exponentially with fame” notes Dr. Lewis.

To Dr. Lewis it seems like just yesterday he was giving interviews on King of Pop Michael Jackson’s death from the anesthetic propofol. Sadly less than three years later following Michael Jackson’s death in the midst of a massive comeback tour we are overwhelmed by the loss of the Queen of Pop in the midst of promoting a new movie as part of her comeback campaign.

Whitney, “we will always love you” and can only hope that your life provides a valuable lesson for the public at large to hear. When we address the demons of low self esteem, depression, and anxiety with therapy instead of substances, we can live long enough to appreciate that we are not perfect, but a work in progress. We do not need to be the richest, the prettiest, the smartest, the most athletic or the most famous person all the time.

The Los Angeles County Coroner has concluded that the cause of rapper Heavy D’s November 2011 death was a pulmonary embolism related to deep vein thrombosis, known simply as DVT. Prior to his death, Heavy D, whose birth name is Dwight Arrington Myers, had recently returned home to California on a trans-Atlantic flight from England.

This means that a clot dislodged from a leg vein and traveled up to Heavy D’s lung and resulted in his death. DVT usually occurs among people who have to sit for long periods of time such as on a long-haul flight, which placed Heavy D at a dangerously high risk. And while long airline flights account for many DVT cases, there remain other external causes of DVT. With the advent of marathon video gaming, these clots can also form and prove deadly. In fact, only last year I consulted on a report for ABC affiliate KGO 7 to discuss twenty-year-old Chris Staniforth, who reportedly played the game “Halo” on his Xbox for up to 12 hours at a time. In Chris’ case, he had sat so long that a blood clot formed in the leg and moved up to his lung to cause a fatal pulmonary embolism.

With more people and celebrities traveling around the world without layovers, public awareness of DVT and prevention becomes key. The most important thing I can do as a doctor is to go on the news and stress the importance that everyone, including celebrities, get up and walk around during long flights and when they are traveling for several hours non-stop, especially those that are obese or have heart disease. Once a blood clot detaches from the leg and travels to the lung there is little I or any physician can do to save your life.

Apple founder and CEO Steve Jobs embraced alternative and holistic treatments, even going so far as to opt for Eastern medicine over conventional Western medicine after he was initially diagnosed with pancreatic cancer.  In October 2003, Steve Jobs underwent a routine abdominal scan—something not uncommon for top executives and CEO’s—which revealed a tumor in his pancreas.  A subsequent biopsy revealed that he was one of the fortunate ones with a treatable form of what is commonly a deadly cancer.  With proper treatment, in this case a radical and invasive surgical procedure known as a Whipple procedure, most patients such as Jobs would still be alive in a decade.

Tragically, less than eight years following his initial diagnosis, Steve Jobs, a man worth at least $6.5 billion who could afford the best that money could buy access to in the medical world, has died. Despite his fame and vast wealth as the world's 105th richest person, Steve Jobs under-lived the projected survival rate for his pancreatic cancer. While we will never know the answer for his untimely demise, one glaring oddity stands out in Jobs medical treatment.

In the initial nine months following his cancer diagnosis, Steve Jobs bucked conventional medical treatment, in this case surgery, in favor of Eastern medicine approaches.  Specifically Steve Jobs opted to treat his cancer with a special diet, much to the horror of people in his tiny inner circle to whom he had confided. Ultimately, Mr. Jobs underwent a Whipple procedure in 2004 at Stanord and a liver transplant in 2009, both of which were significant in extending his life expectancy.

Cancer is a scary word and the diagnosis plunges patients into a search for the most effective treatments. Some gravitate toward modern medical treatments, some to alternative treatments, and some, like Mr. Jobs, blended the best of both. Recent studies point toward complementary treatments as having a very positive impact on the overall health and well-being of cancer patients. Clearly, there is a need and a place for complementary and alternative treatments (CAM) where cancer is concerned, whether aimed at a cure, temporary relief, or overall quality of life.

California’s Dr. Moshe Lewis  specializes in the treatment of pain and is an expert in complementary treatments. When asked if he thought cancer patients should ever forgo modern treatments like chemotherapy, surgery, or radiation in favor of alternative treatments, Dr. Lewis stated, “No, I believe patients should combine the best of traditional methods with alternative treatments to compliment the best of both and achieve the best care outcome for the patient. It is important to appreciate that testimonials are just that: another person’s experience.” It is not unreasonable that Mr. Jobs and any person with pancreatic cancer would want to maintain a healthy diet and be very particular about what they are putting into their bodies. However, no diet has currently been proven to effectively eradicate pancreatic cancer.

Dr Lewis adds, “I always recommend that patients check with their regular medical doctor and keep them informed of alternative treatments, vitamins and supplements they may be taking. Many supplements help to alleviate symptoms of cancer and side effects from mainstream treatments, such as anti-oxidants and natural anti-inflammatory agents. Diet-wise I like a vegan approach. A healthy dose of humor is always an excellent medication.” Scientific proof of the health benefits of humor can be found as early as 1989 when the Journal of the American Medical Association published a study that showed that laughter therapy has an immediate symptom-relieving effect.

Earlier this year, the NIH’s National Center for Complementary and Alternative Medicine (NCCAM) unveiled a new online resource designed to give health care providers easy access to evidence-based information on complementary and alternative medicine. Providers will now have the tools they need to learn about CAM practices and products so they can discuss them with patients. With Americans spending almost $35 billion in out-of-pocket CAM products and practices annually, and studies showing that many patients do not discuss CAM with their physicians, this is good news indeed. As we break down the barriers between modern medicine and CAM, we will all have better control over our health and well-being.

InsuranceQuotes.com recently interviewed me about the medications Michael Jackson was taking:

When Michael Jackson died in June 2009, he practically had a medicine cabinet full of drugs in his system. On top of that, thousands of dollars worth of drugs were found in his house. His personal physician, Dr. Conrad Murray, is standing trial for involuntary manslaughter in Jackson’s death, and a cornerstone of the criminal case is Jackson’s enormous appetite for prescription and over-the-counter drugs.

The King of Pop reportedly took several daily doses of various prescription and over-the-counter drugs. Feeding that kind of habit would be extraordinarily expensive for the typical American. In most cases, the drugs Jackson took would have been covered by health insurance, but only if there was a valid medical reason and the drugs were properly prescribed.

Michael Jackson’s buffet of drugs cost more than $7,000 a month, according to one expert. “Based on the medications found in his body, and figuring a conservative four times a day dosing, this smorgasbord of prescriptions could have cost as much as $7,000 a month,” says Dr. Moshe Lewis, a pain management specialist and professor at the University of California, San Francisco.

Based on Lewis’ estimate, the annual tab amounted to more than $80,000.

Of course, Jackson’s over-the-top drug use is far from the norm, and his pill bill was much higher than what regular folks would pay. The monthly cost if you took the regular dosages of each of Jackson’s drugs: an estimated $3,100.

Here’s a look at what just one dose of each of the medicines found at Jackson’s home would cost the average American, and whether the average health insurance plan would cover the expense, as long as the medicines are appropriately prescribed. The dollar figures take into account what a consumer would pay without insurance, or what a consumer and an insurer would pay in combination.

Read the cost breakdown of the drugs Michael Jackson had in his home at InsuranceQuote.com.

Doctors are frequently given complicated medication requests from their patients who have chronic pain and insomnia.  It can often be challenging to help the patient understand when safety is being compromised and risk is being accelerated.  Treating celebrities is even more challenging for several reasons.  Most celebrities are quite charming and charismatic and at the same time live on the edge.  They push the limits between safe use of medication and the risk of death by often having multiple doctors prescribing overlapping medications.  Sometimes they have medications all mixed together and frequently are not clear about exactly what they are taking in terms of quantity and frequency.

Any doctor interacting with Michael Jackson would be challenged to assert the proper balance of risk and benefit for several reasons.  Many people feel like they knew Michael because he grew up in the public eye and because his lyrics were so personal.  Given his chronic history of pain and his pursuit of excellence, insomnia was an insurmountable challenge.  By entering into a game of Russian roulette with Michael it was only a matter of time before the combination of deadly agents proved fatal. 

Doctors have a professional obligation to maintain a healthy relationship with their patient that does not compromise the standards of medical practice such that every encounter becomes another spin of the roulette wheel.  Careful documentation of the amount of medication that celebrities are taking, and a clear understanding of other doctors that may be prescribing, is critical to undertake a treatment plan with honesty.  Today even testing urine, blood, or saliva is not unreasonable to provide a better understanding of what a patient, or even a celebrity, may be taking.  A patient should not see this type of testing or monitoring as insulting as they can lower the risk of death. These tools are becoming standardized in pain management and are supported by all doctors being trained today.  In my practice, celebrity patients are drug tested with the same frequency as ordinary patients.  Despite all of these measures, some patients are willing to put their lives on the line, even if they are a celebrity, because they are not happy living in pain.  Even though they can bring happiness to others, they want out at all costs.  When a physician becomes embroiled in this type of situation, whether it be Heath Ledger, Anna Nicole, or Michael Jackson, they are kidding themselves to think that they are doing anything else besides assisting in suicide.

According to the Drug Enforcement Administration (DEA), “doctor shopping” and frequent early refill request are one of the primary ways that addicts obtain prescription drugs for non-medical use. “Doctor shopping” refers to when an individual visits several different doctors to obtain prescriptions for the same medications, and then has the prescriptions filled at different pharmacies. This allows the individual to obtain more of the prescribed substance than any one physician or pharmacist would allow. Legally, doctor shopping is not a minor matter; it is prosecuted as a felony and is punishable by up to five years in prison.

At a 2006 hearing, a high-ranking official from the DEA testified before the House Government Reform Committee Subcommittee on Criminal Justice, Drug Policy, and Human Resources regarding current efforts to address prescription drug abuse in the United States. According to Mr. Rannazzisi’s testimony, doctor shopping is a growing problem in this country and is a primary means for addicts to obtain prescription medication for illicit use. Mr. Rannazzisi referred to prescription drug abuse as an “epidemic.”

Other illegal activities associated with doctor shopping may include the forgery of prescriptions or the sale or transfer of the drug to others. To address this situation, PDMPs (prescription drug monitoring programs) are being introduced in many states. These programs are designed to allow physicians and pharmacists to cross-check prescriptions with each other and identify individuals who may be doctor shopping.

Abuse of prescribed medicines often begins with legitimate use. Because of this, individuals who otherwise would not abuse substances find themselves addicted when it is already too late. They begin doctor shopping to feed their addiction, but rationalize this behavior as being necessary to manage the pain and maintain the façade of being in control. Pain medication, prescribed for a variety of common reasons, including back pain or surgery, caesarian sections, or even dental procedures, carries the highest risk for dependence.

One Ohio mom recently posted her story on a public message board. She related having had three back surgeries and a herniated disk in her neck. She started on pain medication after her daughter was born by C-section. Soon, the medication from her pain management physician wasn’t enough. She went to see another physician, and then another.

She was finally caught when a doctor’s office, where she had called to schedule an appointment, asked for her social security number. Apparently, the office participated in a PDMP and had access to a list of all the physicians and pharmacies she had used. The office contacted her husband and provided him with a copy of the list. Now she is enrolled in a treatment program.

This story is typical of many pain medication abusers - middle- and upper-class individuals who lead otherwise respectable lives.

In 2006, one of the most famous doctor shopping and prescription drug abuse stories came to light. Conservative talk show host Rush Limbaugh turned himself in to Palm Beach authorities for doctor shopping. From 1998 to 2006, Limbaugh obtained massive amounts of the painkiller OxyContin, both through multiple prescriptions from different health care providers and through illegal channels. Limbaugh began taking painkillers in the late 1990s after an unsuccessful back surgery. By the time he turned himself in to police, he was rumored to be taking up to 30 pills per day. His drug abuse was severe enough to damage his hearing. According to a 2004 statement from the White House’s Drug Czar John Walter, “The non-medical use of prescription drugs has become an increasingly widespread and serious problem in this country; one that calls for immediate action. The Federal government is embarking on a comprehensive effort to ensure that potentially addictive medications are dispensed and used safely and effectively.”

A study completed by the Boston University School of Medicine in 2006 reported that more than 10 million Americans are taking opioid medications to treat pain, and more than 40% of those use potent painkillers on a regular basis. The study consisted of random telephone surveys of 19,000 adults from 1998 through 2006. With such a jump in use and abuse of pain medication by Americans, it’s no surprise that associated behaviors such as doctor shopping and prescription fraud are also on the rise.

One of my good friends and fellow pain management specialists was recently featuring in an inspirational article about how she dealt with pain when weight lifting:

Liza Reichenberger knows about pain.   Suffering from chronic and severe pain secondary to familial osteoarthritis and degenerative disc disease, she has “a horrid neck” with a large herniated disc and multiple bone spurs causing her daily pain – especially in the morning as she struggles to move upon awakening.  Three different spine surgeons have recommended cervical decompression and fusion.  Their advice?  Stop exercising.  Yea, sure.

You don’t tell “Herculiza,” the greatest natural female bodybuilder of all time, to stop working out.  But, like most people, Reichenberger did what she was told and followed her doctor’s advice.  She stopped all upper body weight training for 6 months. Big mistake.

Read the full article on Examiner.com — Local bodybuilding legend helps patients conquer pain

(Image courtesy Associated Press/Yahoo!)

The recent decision vindicating Howard Stern is a mixed victory of sorts. In the court of public opinion and in the eyes of the law when people doctor shop for opioid prescriptions and secure them under false pretenses patients lives are put at risk. I have seen this approach result in fatal and near death consequences in celebrities and non celebrities. Anna is not the first or the last. However I do respect the judges decision that chronic pain patients do suffer severely and as adults they alone have to accept responsibility for the risks they are taking with controlled substances.

After losing Anna Nicole Smith and then a court battle over her estate, Howard K. Stern says a judge's dismissal of convictions in a prescription drug case vindicates both him and the late Playboy model.

"I loved Anna and I cared for her so much. I have no regrets," Stern told The Associated Press in an interview Thursday, hours after the court reversed his two conspiracy convictions for using his name on prescriptions for Smith.

"The regrets I have are for what people caused afterward," he said, referring to multiple legal complications which arose after Smith died of a drug overdose in Florida in February, 2007.

The most agonizing postscript, he said, was the prescription drug abuse charges filed in Los Angeles against Stern, Smith's psychiatrist Dr. Khristine Eroshevich and Dr. Sandeep Kapoor, Smith's general physician. He called the months of trial a nightmare.

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