In a nutshell, I was born in NYC, grew up and was educated in Toronto, Canada, completed my Ear, Nose and Throat (ENT) / Head and Neck Surgery training in Albany, NY in 1998 and have been in practice as an Otolaryngologist in Chester County, PA since then. I love helping people, adore my wife and kids, have great friends and want to make the world a better place. For more details about my life, click here to see my ENT practice site. I am more interested in discussing improving our health, fixing our broken medical system, and stopping the abuse of our planet, the environment and the animals that share it with us.
I have always been athletic, ate what I considered a healthy omnivorous diet and had a healthy weight. I also have great genetics on my side with both parents being healthy and active along with one remaining 96-year-old grandmother. All three other grandparents died in their mid-90’s. I thought I was a responsible citizen, decent parent, husband and friend and a good, conservative doctor and surgeon.A lot of that started to change in the summer of 2015 when routine blood-work revealed elevated blood sugars. After a little more testing, I was diagnosed with Latent Autoimmune Diabetes of Adulthood (LADA for short), now called type 1.5 Diabetes. This is an adult form of insulin-dependent diabetes thought to be caused by my body miss-identifying my own tissues (specifically my pancreas) as foreign and attacking it. I was shocked and dove headlong into learning about my condition as well as how to normalize my sugars, deal with the inflammation in my body and if possible, delay my certain and eventual need to take insulin without which type 1 diabetics die. I was started on Metformin, the most common oral diabetic medication, but I attribute my blood sugar normalization to further improvements in my lifestyle, in particular my diet. I stopped snacking (letting the pancreas and the rest of my body rest) and quickly adopted a healthy vegan diet (no animal products whatsoever). No meat, including chicken or fish, eggs or dairy. I started and continue to eat only fruits, vegetables, legumes, grains, seeds and nuts; as much whole and unprocessed food as possible. I am now off all diabetes medications and my blood sugar levels, inflammatory markers and cholesterol panel are all normal. I still have high auto antibody levels and have no delusions that eventually my pancreas will give out and I will need to take insulin injections but the longer I can delay that day, the better. I also feel that with this lifestyle, how much insulin I may have to take will be much lower and much more predictable. I have more information about diabetes and its management on my “Disease Topics” page.
More recently, I was diagnosed with a heart issue! I have a small blockage in the main artery supplying my heart muscle with blood. Just like the diabetes, this was identified by accident. I have read many times about the importance for anyone approaching their 50’s to have a Cardiac Calcium CT Scan. This simple, quick and inexpensive test measures the amount of calcification in your heart arteries which tells a lot about heart health. Calcium gets deposited when damage, such as plaque formation, has occurred. Despite daily exercise, running 3-4 days a week and doing resistance training also on the other days, having a great blood pressure, normal cholesterol numbers, no family history and no symptoms, I was expecting the test to be normal. Surprisingly it was not. Although only in the mild range of disease, the one artery that seemed to have some damage was the LAD (Left Anterior Descending) Artery which is the main blood supply to the largest portion of the heart. This artery is dubbed “The Widow Maker” since when it is blocked, most of the heart, and usually the patient, does not survive. This led to a few more tests including a CT Angiogram which confirmed that in fact I do have a mild blockage only in the LAD. Fortunately, it does not need a stent and should not impact on my day to day activity. How this occurred is anyone’s guess but it is what it is. I am cleared, in fact encouraged, to keep exercising and doing whatever I want but it was certainly a wake-up call to the fact that my heart is not perfect and that anyone, even very fit and healthy people, can have some heart disease. On the advice of numerous cardiologists, I am now on a preventative dose of baby aspirin daily (or almost daily) as well as Crestor, an anti-inflammatory statin drug since I also have a genetic marker for cholesterol issues which predispose me to plaque formation. I hate taking drugs but I hate dying more!
One recent clue to my heart disease may be the presence of a type of cholesterol molecule called Lipoprotein a (LPa). Present in almost 25% of people, this very inflammatory cholesterol molecule is thought to account for most heart attacks when no obvious previous heart disease is identified. Although some new drug trials are ongoing, very little seems to work at controlling it. Statins do not work because LPa is generated through a complex mechanism typical statins do not address. In fact, most statins can worsen LPa levels. For some, niacin helps. It does for me. I take one called Enduracin. Eating a plant based diet helps a little bit. One particular berry which has shown to be somewhat helpful is the Indian Gooseberry, also called Amla.
Unfortunately, it takes on average 17 years for new findings to go from publication to doctors being aware of them and implementing those findings into their clinical practice. As I continue to read articles and books, listen to blogs and podcasts, watch movies and you tube videos, my information base continues to expand. I have been able to get to this information faster than 17 years and try to distill whats important and practically usable by people. I try to stay objective and learn about various approaches to many topics. Health, environment, animal welfare, medical practice… I continue to go down many rabbit holes. These may appear to be separate issues but to me, they are all interconnected.
MEDICINE. My diagnoses have also had a significant impact on how I practice medicine and surgery. What we think of as modern medicine is not “Health Care”. It’s “Sick Care”. The most important word in both descriptions is the “care” part. We don’t have a “healthcare” industry, we have a “disease management”. Despite spending the most on healthcare worldwide, almost twice as much as the second-place country, we have the worst life expectancy (50th, 42nd only 5 years ago) and highest rate of chronic diseases (48th) of all developed countries. 73% of Americans are at least overweight and 40% are obese. 40% of adults are on statins and at least 1/3rd of us are diabetic or pre-diabetic. It’s insane! We are great at saving someone from a heart attack, fixing broken limbs and ruptured organs and managing chronic diseases with a slew of medicines but we do a terrible job of reversing disease and making people better by promoting a healthy diet as well as other healthful lifestyle behaviors. This is reflected in the fact that you can see a pediatrician or family doctor for an acute medical problem much sooner (usually within a few days or weeks) than for a well visit or routine physical (often booked out many months in advance). This has led to an explosion of “walk-in” clinics which are basically medication dispensaries. I am reminded daily of the importance of health promotion when I speak to patients and realize how few of them have ever been told that with better lifestyle choices, and some effort, they could lose weight, get off of their multitude of medications and get healthier and by doing this, they can help our environment simultaneously. Much to the chagrin of my office staff who have to listen to my diatribes about health and deal with my longer and longer office visits, I am committed to at least start these important conversations with most if not all my patients. This website is part of that plan. We need to shift the healthcare model back to one of health promotion, not disease management. When you consider that 80% of the chronic diseases people have are all lifestyle-related, the healthcare model ultimately is really “self-care”. Nothing changes if nothing changes and people need to be guided through the quagmire.
Here is a comparison of present-day US healthcare compared with how we practiced in 1970:
- Number of healthcare jobs: 4 million VS >16 million. It’s the #1 US economy today!
- Healthcare spending per person: $550/yr. VS >$11,000/yr.
- Time allotted for office visits: 60 minutes (new patient) and 30 minutes (established) VS 12 minutes and 7 minutes respectively
- % of GDP of healthcare: <8 VS 18
- Average hospital daily room charges: ~$100 VS ~$4,600
Our healthcare model is not great. About 90% of Americans have some kind of health insurance. Although this sound like a high number, all other developed countries have 99-100% coverage. In addition, insurance in the US is, for most people, barely affordable and with high deductible and co-pays, families still have to make a daily decision between going to the doctor or feeding their families. We often look to countries like Canada where they have universal healthcare for everyone as something better. I grew up there and have a lot of family still living there. The Canadian healthcare system is far from perfect also. For example, you have to wait a long time to see any doctor, let alone specialists, have necessary surgery or have tests. REALLY long. And Canadian taxes are much higher than ours since something has to pay for that universal care. But for the majority of the people, it works, most of the time. We can and must do better. In the US, we spend twice as much on healthcare as we do on social services which is double the ratio of most other developed countries. This is probably the biggest factor in their improved overall health and lifespan. In the US, there is a significant disparity in life expectancy based on things like income (10-15 years longer for the top 1% as compared with the bottom 1%) and ethnicity (infant mortality is much higher in Native Americans and Hispanics than Caucasians). We can do better.
With all of the challenges our present healthcare system presents us, we can’t solve healthcare without peoples participation. That does not mean that we need to fix some of the issues like drug costs, wait times and lack of access, but people need to also take responsibility for their own health which will put less strain on the system. Simply put, people need to eat better, exercise more, work on stress management and be aware of everyone and everything around us and how our actions impact on the the world and the people around us. Everything is interconnected.
ENVIRONMENT. We treat our world as a personal dumping ground. All you have to do is read about the floating plastic waste island twice the size of Texas in the Pacific to realize how wasteful we are. 50% of the food we produce goes bad and ends up in landfills. Global warming, crazy weather and vanishing glaciers. It is estimated that by 2040, the oceans will be empty. That’s just over 20 years!! What kind of planet are we leaving our kids and subsequent generations? We can’t just act as selfish individuals and must start thinking globally. Simple, everyday acts are still vitally important. Reuse bags, recycle, compost, carpool… all important behaviors. We can deny it all we want however what and how we eat has the biggest impact on the environment. From deforestation in the Amazon to facilitate more meat production to dead ocean zones downstream from agricultural lands and farms, we are killing our planet. There is no question that going more plant-based and cutting back on our obsession with animal products will have the biggest and fastest positive impact on our environment and on global warming rates. I have a lot more stats and information about these issues on my Environment page. This is a great summary article: Environment and animal farming.
ANIMAL WELFARE. 99% of the animals killed in the world today die to satisfy our obsession with eating animal products. The vast majority of these animals live horrible, sad and abusive lives and are slaughtered inhumanely. Baby chicks put alive into meat grinders if they are not the right sex, collateral by-kill fish trapped in fishing nets, farm animals crammed into cages so tightly that they can’t even turned around. It’s all pretty hard to read about but it’s the way it is and we tolerate it. Unfortunately, we have separated the food on the plate from the process of how it got there and most people don’t even want to know. We also have conveniently decided that some animals are pets, and some we eat. This phenomenon is called carnism. It’s cultural, habitual, cruel and hypocritical. Dogs are tortured and eaten in the Orient. Horse meat is a delicacy in France and even Canada. Dolphins are culled and slaughtered in Japan. It goes on and on. In The US, we prosecute and imprison people who abuse dogs and cats yet it is perfectly legal to take a piglet on a farm by the legs and kill it by smashing its head into the concrete. It’s common “agricultural practice” so it’s legal. Pretty sad. We need to open our eyes, our hearts and have more compassion in this world.
If we take better care of ourselves, the world and the animals we share it with, we would be so much healthier and happier. It’s so simple, yet so hard. Nothing happens however if nothing happens. Dr. Dean Ornish is a pioneer in the world of lifestyle medicine. He has been at it for over 40 years and has seen 1000’s of patients reverse various chronic diseases. His wellness program is so effective at reversing and curing various chronic diseases that Medicare now pays for it (no small feat). He has a very simple, yet powerful philosophy: “EAT WELL, MOVE MORE, LOVE MORE and STRESS LESS”. Applying these principles to our everyday lives is great advice.
Please enjoy the website. Read, connect with and download whatever you want and I hope you adopt some of the principles I know will make you healthier and happier. Feel free to contact me. In the meantime, I’ll keep learning and posting.
Wellness and Lifestyle Basics Handout PDF Handout