Alesse .75mg Pills $200.00

Alesse .75mg pills $200.00 Background

Alesse .75mg pills $200.00 In 2011 I took a vacation from to go work at Naval Hospital Camp Pendleton (NHCP) with Marines returning from Afghanistan. Alesse .75mg pills $200.00 Camp Pendleton is the Marines main base an hour’s drive up I-5 from San Diego. Alesse .75mg pills $200.00 NHCP is where the Navy implements its duty to provide the care Marines need as a result of their combat responsibilities. Alesse .75mg pills $200.00 I took the job for 3 reasons: 1) to add to my knowledge about pain, alesse .75mg pills $200.00 to see what the Navy had learned from a heavy concentration of pain cases about how to restore optimal functioning; 2) to treat Marines with chronic pain the “Navy way” and learn how to implement their rehab approach for chronic pain; and, alesse .75mg pills $200.00 3) to give wounded Marines my personal “thanks” for their bravery in Afghanistan by extending to each one in pain a credentialed pain specialist’s best efforts to help restore function.

Alesse .75mg pills $200.00 What follows are my observations extracted specifically from my experience with Marines who had diagnosable chronic pain disorders – often in combination with other combat-related disorders – and which I personally treated during 2011.

Alesse .75mg pills $200.00 Functioning As An HMO, alesse .75mg pills $200.00 Is NHCP Structured to Treat Chronic Pain? 

Alesse .75mg pills $200.00 The quick answer is “No” because only if the structures are in place for a hospital to be enabled to effectively treat, alesse .75mg pills $200.00 manage and rehabilitate chronic pain and restore function is it possible to rehabilitate chronic pain. Alesse .75mg pills $200.00 Simply put, alesse .75mg pills $200.00 the extent to which you ski is determined by the investment you make in developing the skill-knowledge needed to ski. Alesse .75mg pills $200.00 Since NHCP made no investment in developing chronic pain rehab capabilities, alesse .75mg pills $200.00 it has none to offer.

Alesse .75mg pills $200.00 Problems of All Non-Pain Specialty Approaches to Treating Chronic Pain

Alesse .75mg pills $200.00 The problem for those with chronic pain is that NHCP operates like any other HMO in the country and so it concentrates on offering only a narrow range of primary care services in general, alesse .75mg pills $200.00 family and internal medicine. Alesse .75mg pills $200.00 A few additional services in specialty medicine, alesse .75mg pills $200.00 like Ob/Gyn and Pediatrics, alesse .75mg pills $200.00 exist which, alesse .75mg pills $200.00 in combination with the primary care services, alesse .75mg pills $200.00 are available to anyone who is a beneficiary of Tricare, alesse .75mg pills $200.00 the military’s health insurance. Alesse .75mg pills $200.00 Medical needs that fall outside the hospital’s primary care area of practice ar simply not acknowledged and that is why they are never treated. Alesse .75mg pills $200.00 Therefore, alesse .75mg pills $200.00 those chronic complex disorders that do not “fit” the primary care acute care model, alesse .75mg pills $200.00 referrals to “out-of-network” providers who are qualified to treat these disorders are rarely made. Alesse .75mg pills $200.00 If as far as primary care providers a disorder is not acknowledged then no need exists to make a referral to someone who specializes in that disorder. Alesse .75mg pills $200.00 Again, alesse .75mg pills $200.00 the services needed to treat the chronic complex pain disorders that many Marines develop were never adequately treated for 18-24 months, alesse .75mg pills $200.00 do not exist at NHCP.  The fact a Marine could be exposed to primary care or specialty care treatment at NHCP for 18-24 with no objective change in the Marine’s chronic pain condition provides evidence of the absence of qualified pain treatment at NHCP. Alesse .75mg pills $200.00 Clearly engaging a pain patient in 18-24 months of inept, alesse .75mg pills $200.00 failed treatment does nothing to provide stable enough pain relief, alesse .75mg pills $200.00 restored function, alesse .75mg pills $200.00 and a return to full-duty status, alesse .75mg pills $200.00 all of which are the explicit duty of Navy doctors to provide wounded Marines. Alesse .75mg pills $200.00 That the Naval Hospital at Camp Pendleton has chosen to administratively limit itself to functioning as a primary care hospital that does not offer a qualified chronic pain rehab program does not exculpate it and its doctors from its duty to treat wounded Marines according to the needs of their symptoms.

Alesse .75mg pills $200.00 How Navy medicine manages a Marine with chronic complex pain reveals the same negligence seen in how civilian providers manage chronic complex pain – by either under treating or not treating it at all, alesse .75mg pills $200.00 which leads to worsening of condition and a complex chain of further costly healthcare services in all pain patients. Alesse .75mg pills $200.00 Marines are harmed further by terminating their careers without a solidly grounded differential diagnosis or proof of the failure of a demonstrably competent chronic pain rehab program. Alesse .75mg pills $200.00 My experience in running a chronic pain rehab program is that ~70 percent of musculoskeletal pain cases could be restored to optimal functioning with that 12 months, alesse .75mg pills $200.00 or about half the time that Marines in chronic pain are exposed to failed or inept acute approaches to chronic pain.

Alesse .75mg pills $200.00 The Steps NHCP Uses to Evaluate Chronic Pain Complaints

Alesse .75mg pills $200.00 The steps that Marines went through who I treated for chronic pain were as follows:

Alesse .75mg pills $200.00 - All Marines are first evaluated by their BAS MOs (Battalion Aid Station Medical Officers), alesse .75mg pills $200.00 family medicine residents not yet licensed to practice as independent physicians. Alesse .75mg pills $200.00 Since BAS MOs work and live with and are deployed with the battalion, alesse .75mg pills $200.00 they know individual Marines best and the likely conditions of their symptoms occurrence. Alesse .75mg pills $200.00 Most complaints at the BAS level are acute and are resolved by usual care from a family medicine approach. Alesse .75mg pills $200.00 However, alesse .75mg pills $200.00 many Marine complaints surface once Marines are no long “in theater” where most believe they have “no time or stomach” for severe pain.  So once some Marines return to base, alesse .75mg pills $200.00 chronic pain issues will emerge. Alesse .75mg pills $200.00 When issues develop that require repeated visits over a period of 6-9 months to their BAS MOs for treatment to which the Marine fails to respond, alesse .75mg pills $200.00 referral is then made further up the ladder;

Alesse .75mg pills $200.00 - Primary care (physicians licensed in general medicine, alesse .75mg pills $200.00 family practice or internal medicine) now evaluates the complaints  and starts a medication regimen that fits the acute care model of the primary care doctor and has nothing to do with the end objective of restoring function and a return to full-duty status.  This treatment usually shows no response within 4 weeks, alesse .75mg pills $200.00 but it may be extended, alesse .75mg pills $200.00 or literally forgotten, alesse .75mg pills $200.00 for another 6-9 months. Alesse .75mg pills $200.00 As with the BAS MO, alesse .75mg pills $200.00 this is a similar treatment to which a Marine with an under or untreated pain disorder will fail to respond. Alesse .75mg pills $200.00 Referral is now made to specialty medicine;

Alesse .75mg pills $200.00 - Specialty medicine now evaluates the Marine’s complaints, alesse .75mg pills $200.00 usually orthopedics, alesse .75mg pills $200.00 neurology or psychiatry, alesse .75mg pills $200.00 to rule out objective causes from the perspective of the particular specialty. Alesse .75mg pills $200.00 More modifications to treatment are made over a period of another 9-15 months, alesse .75mg pills $200.00 often with multiple prescription drugs to which the Marine with an inappropriately treated pain disorder will again fail to respond, alesse .75mg pills $200.00 often with side effects that further exacerbate the pain condition and decrease his/her ability to function as a Marine.

Alesse .75mg pills $200.00 - In several cases, alesse .75mg pills $200.00 specialty medicine referred the Marine for evaluation by pain anesthesiologists at the Naval Medical Center at Balboa in San Diego where a competent differential diagnosis was obtained and medications to which the Marine finally began to respond well and to get some pain relief. Alesse .75mg pills $200.00 However, alesse .75mg pills $200.00 a solid diagnosis and some initial pain relief are not chronic pain rehabilitation by a qualified integrated interdisciplinary team where the primary responsibility of each of its members is chronic pain rehab alone. Alesse .75mg pills $200.00 The problem was that there was no continuity of care by the pain anesthesiologists who knew how to best manage the pain; that responsibility fell back onto the BAS MO who, alesse .75mg pills $200.00 once the prescription ended, alesse .75mg pills $200.00 s/he might or might not renew, alesse .75mg pills $200.00 completely change the treatment, alesse .75mg pills $200.00 or be deployed and the Marine require transfer to a temporary BAS MO who would start this entire process all over again.

Alesse .75mg pills $200.00 - By this time, alesse .75mg pills $200.00 specialty medicine would usually begin to discuss preparation of the Marine’s Medical Board, alesse .75mg pills $200.00 terminating his/her career in the Marine Corps. Alesse .75mg pills $200.00 This without the chronic complex and disabling pain disorder ever being competently diagnosed, alesse .75mg pills $200.00 effectively treated (and confirming the diagnosis) and having this entered in the Marine’s AHLTA medical chart to document, alesse .75mg pills $200.00 once s/he went to request treatment from a civilian provider that the Marine was a legitimate chronic pain patient as evidenced in a credible military document by a qualified physician who treated the Marine’s pain and could attest to it if the civilian physician felt the need to do so.

Alesse .75mg pills $200.00 With the Marine’s career ended thanks to a chronic pain disorder that the Marine has no awareness of what its causes are, alesse .75mg pills $200.00 how to relieve the pain, alesse .75mg pills $200.00 manage the conditions of its occurrence, alesse .75mg pills $200.00 what to do to return to optimal functioning (allowing for regular employment), alesse .75mg pills $200.00 and to enjoy increased quantity of life within his/her unique life situation.

Alesse .75mg pills $200.00 The Result of “Business As Usual” At NHCP

Alesse .75mg pills $200.00 In other words, alesse .75mg pills $200.00 the outcome of a military medicine approach to chronic complex pain is no different from that seen in the private sector when chronic pain patients are seen by independent practitioners and left with the same disabling conditions that will lead to unending high frequency use of medical visits, alesse .75mg pills $200.00 prescription medications, alesse .75mg pills $200.00 diagnostic and laboratory studies, alesse .75mg pills $200.00 the ER, alesse .75mg pills $200.00 hospitalization and unnecessary surgery. Alesse .75mg pills $200.00 To this must be added becoming totally disabled, alesse .75mg pills $200.00 unemployed, alesse .75mg pills $200.00 divorced, alesse .75mg pills $200.00 with loss of children, alesse .75mg pills $200.00 in medical bankruptcy, alesse .75mg pills $200.00 living alone, alesse .75mg pills $200.00 being highly prone to developing multiple chronic diseases, alesse .75mg pills $200.00 intractable pain (see, alesse .75mg pills $200.00 along with a likely addiction to alcohol and prescription or street drugs.

Alesse .75mg pills $200.00 Finally, alesse .75mg pills $200.00 my experience included a clear case of no leadership on the part of the psychiatrist who was in charge of the Wounded Warrior Battalion who knew I was credentialed in pain management and was bound to practice based on the ethical standards of my diplomate with the American Academy of Pain Management (AAPM) and who told me to “do less pain management and something more psychological.”  Ultimately he demanded I become credentialed in health psychology – which is not an evidence-based procedure for rehabilitating chronic complex pain – or not have my contract renewed. Alesse .75mg pills $200.00 I chose to stick by the ethical standards of the AAPM and did leave.

Alesse .75mg pills $200.00 Marine Myths about NHCP

Alesse .75mg pills $200.00 NHCP knows and treats everything. Alesse .75mg pills $200.00 No it doesn’t. Alesse .75mg pills $200.00 NHCP only has the evidence-based skill-knowledge set for primary care – or the perspective of general, alesse .75mg pills $200.00 family or internal medicine plus a few specialty medical services. Alesse .75mg pills $200.00 That’s it. Alesse .75mg pills $200.00 Marines should not expect more. Alesse .75mg pills $200.00 For Marines with pain that has lasted more than 3 months and for whom the usual medical care offered at NHCP has done nothing to restore their ability to function, alesse .75mg pills $200.00 NHCP lacks the MOS to treat, alesse .75mg pills $200.00 manage or rehab a Marine’s chronic pain disorders. Alesse .75mg pills $200.00 The likelihood is that a Med Board will be the outcome for those with chronic pain.

Alesse .75mg pills $200.00 Specialized rehab programs for chronic pain exist at NHCP.  They do not. Alesse .75mg pills $200.00 There are many rehab programs in hospitals around the country. Alesse .75mg pills $200.00 The classic ones are Cardiac Rehab, alesse .75mg pills $200.00 and Diabetes Rehab, alesse .75mg pills $200.00 and they all have the same characteristics: an integrated interdisciplinary team who are all knowledgeable about chronic pain with the single minded objective being to: (a) restore optimal behavioral and molecular to the patient as evidenced by objective behavioral and molecular markers, alesse .75mg pills $200.00 and (b) turning over to the patient the responsibility of self-managing the conditions of their pain’s occurrence.

Alesse .75mg pills $200.00 If one has chronic pain, alesse .75mg pills $200.00 one can quickly get to see a pain specialist at NHCP. Alesse .75mg pills $200.00 Not possible. Alesse .75mg pills $200.00 A chronic pain specialty requires special education, alesse .75mg pills $200.00 training, alesse .75mg pills $200.00 experience and credentialing. Alesse .75mg pills $200.00 There are no such providers at NHCP. Alesse .75mg pills $200.00 Pain specialists are available at Balboa but it takes a long time to go through the steps to get a referral to Balboa. Alesse .75mg pills $200.00 And then it’s just for a “differential diagnosis” that will probably be the basis for your Med Board rather than for ongoing treatment, alesse .75mg pills $200.00 relief of pain and restored ability to function (especially in “full-duty status”).

Alesse .75mg pills $200.00 The Med Board process is no big deal. Alesse .75mg pills $200.00 Not really. Alesse .75mg pills $200.00 Most wounded Marines who I saw at Camp Pendleton ended up being “med boarded” out of the Marines – at great harm to the Marine – not because the Marine had a specific, alesse .75mg pills $200.00 diagnosable condition that made him/her “unfitting” for duty. Alesse .75mg pills $200.00 That their disorder rendered them “unfitting” never could be confirmed because they were never exposed to the appropriate treatment for chronic pain, alesse .75mg pills $200.00 which when done right, alesse .75mg pills $200.00 could have confirmed if their pain disorder really rendered them “unfit” by disappearing. Alesse .75mg pills $200.00 Instead, alesse .75mg pills $200.00 Marines with chronic pain were summarily “med boarded” out of the Marines because the Marine’s pain disorder did not respond to general medicine’s acute perceptions, alesse .75mg pills $200.00 treatment and management approach to pain and your chronic pain failed to respond to their mistaken expectations.

Alesse .75mg pills $200.00 If a provider at NHCP says I don’t have chronic pain it’s so.  Not so, alesse .75mg pills $200.00 not today when evidence-based pain management is what we practice, alesse .75mg pills $200.00 rather than philosophy and the unsupported use of words. Alesse .75mg pills $200.00 Scientific pain management exposes the patient to the evidence-based treatment for the specific pain condition that is implemented by an integrated interdisciplinary team qualified in providing chronic pain rehab. Alesse .75mg pills $200.00 If the Marine’s chronic pain responds to the qualified version of chronic pain treatment within the expected period of time, alesse .75mg pills $200.00 there is confirmation of the pain condition and the primary care doctor’s diagnosis is therefore false. Alesse .75mg pills $200.00 If there is no response to the chronic pain treatment, alesse .75mg pills $200.00 there is no confirmation of the pain condition and the chronic pain specialist’s diagnosis is therefore false.

Alesse .75mg pills $200.00 It’s easy for a neurologist to see the real causes of pain. Alesse .75mg pills $200.00 No so. Alesse .75mg pills $200.00 Take the case of a 20 y/o Lance Corporal “mortar man” who was on patrol in enemy territory carrying a heavy mortar barrel by wrapping both his arms around the mortar barrel and resting it over his traps as one might hold a heavy barbell prior to doing squats. Alesse .75mg pills $200.00 As the patrol came over a rise, alesse .75mg pills $200.00 enemy rocket fire started coming in over the Marines, alesse .75mg pills $200.00 and the Lance Corporal started running down a hill that was inclined to the right. Alesse .75mg pills $200.00 As he ran he stumbled on a rock and as gravity took him towards the right, alesse .75mg pills $200.00 still with the mortar barrel over his shoulders, alesse .75mg pills $200.00 he fell hard with all his weight. Alesse .75mg pills $200.00 As he fell he put out his right elbow to break the fall and, alesse .75mg pills $200.00 in so doing, alesse .75mg pills $200.00 the barrel was forced towards the right front and tightly against his right trap which he fell against with all his weight. Alesse .75mg pills $200.00 When he was able to get up the pain was sharp and throbbing over his right shoulder and neck. Alesse .75mg pills $200.00 He reported to the BAS MO, alesse .75mg pills $200.00 was given rest and mild analgesics. Alesse .75mg pills $200.00 The pain subsided slightly but within a week he reported having “bad migraines.” He was returned to base but was unable to perform his duties due to the “bad migraines” so he was air-evac’d back to Camp Pendleton for evaluation and treatment. Alesse .75mg pills $200.00 After a period of unsuccessful treatment by his BAS MO he was referred him for primary care evaluation and more treatment with analgesics which again did nothing to relieve his headaches. Alesse .75mg pills $200.00 At 12 weeks post-injury the Marine was referred to a neurologist for evaluation who prescribed the standard medication for migraines to which the Marine faithfully adhered for a further 4 months; however the migraines persisted while his marriage, alesse .75mg pills $200.00 work, alesse .75mg pills $200.00 and social life got worse. Alesse .75mg pills $200.00 Another 8 months went by with relief in his migraines; he also was treated with psych meds because he couldn’t stand the side effects. Alesse .75mg pills $200.00 He couldn’t do any exercise, alesse .75mg pills $200.00 he had no appetite and he lost 15 pounds. Alesse .75mg pills $200.00 The neurologist told him he was going to be “med boarded” since his symptoms didn’t improve, alesse .75mg pills $200.00 he couldn’t qualify for any of his Marine required activities, alesse .75mg pills $200.00 and his Command was ready to support his being med boarded.

Alesse .75mg pills $200.00 Since NHCP can provide no qualified treatments for chronic pain, alesse .75mg pills $200.00 all his Navy doctors could say concretely was that this young Marine did not have the neurological, alesse .75mg pills $200.00 psychiatric, alesse .75mg pills $200.00 or orthopedic conditions they hypothesized he might have. Alesse .75mg pills $200.00 There is no way of confirming with hard evidence of either Navy physicians’ impression of the condition or provide no qualified treatment, alesse .75mg pills $200.00 only assertions that the condition is something that it is not – and for which there is no confirming response to treatment – rather than what it is – and for which the confirming response to treatment does exist.

Alesse .75mg pills $200.00 CONCLUSION – THE EMPEROR HAS NO CLOTHES 

Alesse .75mg pills $200.00 My original impression before I came to work with wounded Marines at NHCP was that Navy medicine at NHCP was at the same level of expertise that military medicine was at in their work amputees. Alesse .75mg pills $200.00 This was not the case at NHCP on closer inspection:

Alesse .75mg pills $200.00 - There is no qualified pain treatment at NHCP;

Alesse .75mg pills $200.00 - There are no qualified full-time pain specialists available to Marines at NHCP;

Alesse .75mg pills $200.00 - There are no continuing education courses on chronic pain for providers at NHCP;

Alesse .75mg pills $200.00 - There is no integrated interdisciplinary chronic pain program at NHCP;

Alesse .75mg pills $200.00 - Med Board diagnoses for those with chronic pain are probably in error

Alesse .75mg pills $200.00 - Med Board diagnoses for those with chronic pain are often trivial (“neuritis” was given as a diagnosis rather than the disabling Complex Regional Pain Syndrome that it was based on a second round work-up by pain anesthesiologists at Balboa);

Alesse .75mg pills $200.00 - There is no credentialed chronic pain specialty leadership for the Wounded Warrior Battalion.

Alesse .75mg pills $200.00 The Marines I worked with were a wonderful group of men I got to know and appreciated enormously. Alesse .75mg pills $200.00 They deserve a more than the “business-as-usual” primary care effort they have been given. Alesse .75mg pills $200.00 All Marines should be returned to the high level of behavioral and molecular functioning they had shortly after finishing boot camp at their physical best. Alesse .75mg pills $200.00 Hopefully, alesse .75mg pills $200.00 legislators in Washington will implement the urgently needed chronic pain rehab programs these brave young Americans deserve.

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Alesse .75mg pills $200.00 Dr. Alesse .75mg pills $200.00 Henry Adams

Alesse .75mg pills $200.00 AAPM Diplomate in Pain Management

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Alesse .75mg pills $200.00 COMPLEX PAIN – DEFINITION

Alesse .75mg pills $200.00 This is a very special type of pain. Alesse .75mg pills $200.00 It’s pain that …

Alesse .75mg pills $200.00 - is not caused by cancer, alesse .75mg pills $200.00 diagnosable tissue or structural damage and it responds poorly to all sorts of medical treatment;

Alesse .75mg pills $200.00 - has lasted for more than a year;

Alesse .75mg pills $200.00 - is not mild or intermittent but rather it occurs daily and the pain is moderate to severe (5+ on a 10-point scale);

Alesse .75mg pills $200.00 - is pain that physicians you’ve seen haven’t been able to get you back to work or functioning normally again;

Alesse .75mg pills $200.00 - all of your diagnostic tests produce “negative” findings and your physicians tell you that “you have nothing, alesse .75mg pills $200.00” yet you continue to have moderate to severe pain and you can’t work and you can’t lead a normal life;

Alesse .75mg pills $200.00 - is pain that the medications that have been prescribed for you for pain have not only not helped but more often than not they’ve made your pain more severe, alesse .75mg pills $200.00 more frequent, alesse .75mg pills $200.00 and more long-lasting;

Alesse .75mg pills $200.00 - it’s very likely you’ve never been evaluated and treated by a doctor who was Board Certified or credentialed in pain management;

Alesse .75mg pills $200.00 - it’s pain not caused by nerve damage as determined by a Nerve Conduction Study (NCS) and examination by a qualified neurologist;

Alesse .75mg pills $200.00 - it’s complex pain that has led your doctors to tell you, alesse .75mg pills $200.00 “That’s all we can do for you. Alesse .75mg pills $200.00 Learn to live with it;”

Alesse .75mg pills $200.00 - it’s complex pain that is becoming increasingly difficult to have carriers pay for the integrated, alesse .75mg pills $200.00 interdisciplinary treatment that works best; and, alesse .75mg pills $200.00

Alesse .75mg pills $200.00 - it’s pain you had better learn to self manage because: (a) the teams of qualified doctors needed to treat it are extremely difficult to find; (b) the carriers aren’t paying for either the drugs or the effective treatment; and, alesse .75mg pills $200.00 (c) pain patients who follow a qualified program do learn how to self-manage pretty well without physicians and much fewer of the wrong drugs.

Alesse .75mg pills $200.00 HOW DID WE GET HERE?

Alesse .75mg pills $200.00 We’re at this state of chaos because this is pain that fell between the cracks of conventional, alesse .75mg pills $200.00 acute-minded, alesse .75mg pills $200.00 acute-treated solo practice medicine. Alesse .75mg pills $200.00 That means, alesse .75mg pills $200.00 urgent care type medicine provided by a single doctor for as little time as possible. Alesse .75mg pills $200.00 Why? Because that’s all that healthcare will provide. Alesse .75mg pills $200.00 Healthcare is broke. Alesse .75mg pills $200.00 It can’t be afforded any more. Alesse .75mg pills $200.00 Where before it used to cost $200 a month for all medical services and medications, alesse .75mg pills $200.00 today it’s the equivalent of a salary, alesse .75mg pills $200.00 or a quarter or more of your take-home pay.


Alesse .75mg pills $200.00 Today’s chronic pain doesn’t fit the acute (urgent care) treatment model that worked well from about 1850-1950 when the average age was 25 and the major concern was communicable diseases (like TB, alesse .75mg pills $200.00 influenza, alesse .75mg pills $200.00 cholera, alesse .75mg pills $200.00 smallpox, alesse .75mg pills $200.00 sexually transmitted diseases, alesse .75mg pills $200.00 measles, alesse .75mg pills $200.00 malaria and everything we could pick up from viruses, alesse .75mg pills $200.00 bacteria and little animals that get under our skin and into our body). Alesse .75mg pills $200.00 It’s great that experimental medicine met the challenge and developed, alesse .75mg pills $200.00 through experiment and skills learned by doing, alesse .75mg pills $200.00 a consistent way of identifying a single cause of an illness, alesse .75mg pills $200.00 isolating the presumed cause in the laboratory, alesse .75mg pills $200.00 then finding a specific agent that would kill it, alesse .75mg pills $200.00 then giving the agent to the patient in certain doses over a specific time frame and then watching the patient’s symptoms disappear and the patient’s ability to function return. Alesse .75mg pills $200.00 That’s what happened when the average age of the population was 25, alesse .75mg pills $200.00 communicable disease was the problem, alesse .75mg pills $200.00 and acute-minded treatment “fit” the need.

Alesse .75mg pills $200.00 THE CURRENT SITUATION

Alesse .75mg pills $200.00 Conditions drive the type of medicine needed. Alesse .75mg pills $200.00 The problem is that an average age of 25 no longer exists. Alesse .75mg pills $200.00 And communicable diseases are no longer a problem. Alesse .75mg pills $200.00 And urgent care is no longer what is needed. Alesse .75mg pills $200.00 The current condition is that the average age everywhere is increasing, alesse .75mg pills $200.00 right around 45 when people develop chronic (non-communicable) diseases with multiple causes affecting multiple systems that no solo practitioner with one view of the world – the acute one – can treat effectively. Alesse .75mg pills $200.00 What are we doing treating diseases that have multiple causes with methods that assume that diseases have single causes? What are we doing treating anything chronic, alesse .75mg pills $200.00 like chronic pain, alesse .75mg pills $200.00 as if it had a single cause when research around the world indicates chronic pain has multiple causes? Worse. Alesse .75mg pills $200.00 By what magic do primary care physicians develop the skills needed to treat chronic pain effectively when virtually none have ever taken a single course, alesse .75mg pills $200.00 continuing education credit or completed a pain residency, alesse .75mg pills $200.00 nor much less ever completed the supervised proctorships that produce the “demonstrable competence” that ethical principles require? By what sense of illogic can someone who is not qualified in chronic pain prescribe “off license” medications for a disorder they are not qualified to treat? In what other sub-specialty besides chronic pain can a physician accept to treat a patient and then say “I don’t feel comfortable prescribing opioids for you” and prescribe a medication that winds up under-treating and/or inappropriately treating  the disorder and then makes the condition worse? Since when does when does the Hippocratic Oath require that a doctor – rather than the patient – “feel comfortable?” Since when does “I will never do harm to anyone” in the Hippocratic Oath now come last, alesse .75mg pills $200.00 and personally “feeling comfortable” come first? When you’re not qualified to treat, alesse .75mg pills $200.00 do what the Hippocratic Oath tells you to do:”I will leave this operation to be performed by practitioners, alesse .75mg pills $200.00 specialists in this art.” Evidence-based medicine is increasingly showing that the outcomes physicians get who are not qualified to treat chronic pain are essentially random, alesse .75mg pills $200.00 meaning that general physicians efforts at treating chronic pain are worse than a roll of the dice. Alesse .75mg pills $200.00 In a controlled study that we did for 6 years on the Scripps Memorial Hospital campus pain program, alesse .75mg pills $200.00 pain patients who were left to the “usual care” provided by their primary care physicians got 25% worse in 90 days compared to their counterparts who got the right medications from a Board Certified pain management anesthesiologist, alesse .75mg pills $200.00 or who got the integrated interdisciplinary reference standard for complex chronic pain. Alesse .75mg pills $200.00 It’s too bad that health care left to its own devices hasn’t worked. Alesse .75mg pills $200.00 It would have been nice to let doctors practice at their convenience, alesse .75mg pills $200.00 and that they could “feel comfortable” rather than having started addressing 25 years ago the predictable need to deal with the shift of the population towards chronic disease that we knew would cost 8 times what treating acute disease costs. Alesse .75mg pills $200.00 But we didn’t and here we are, alesse .75mg pills $200.00 pretending that it’s ok fir physicians with no demonstrable competence to treat chronic pain “because it’s expedient.” It’s not so and there is no way that a bunch of overworked general practitioners are going to learn the skills fast enough to meet the need. Alesse .75mg pills $200.00 The further fact is that  there simply aren’t enough qualified pain specialists to treat the 100+ million plus Americans afflicted with complex pain. Alesse .75mg pills $200.00 Do you doubt that number? Don’t, alesse .75mg pills $200.00 because when 70% of the population has the risk factors for insulin resistance and diabetes, alesse .75mg pills $200.00 that means that 70% of the population has the risk factors for chronic pain. Alesse .75mg pills $200.00 So what do pain patients do?

Alesse .75mg pills $200.00 RIGHT! PATIENT, alesse .75mg pills $200.00 HEAL THYSELF

Alesse .75mg pills $200.00 Pain today is the most frequent reason that patients give for going to doctors. Alesse .75mg pills $200.00 Yet, alesse .75mg pills $200.00 acute-minded medicine that was designed to identify the single causes of symptoms doesn’t work. Alesse .75mg pills $200.00 It’s been proven over and over again in every chronic disease. Alesse .75mg pills $200.00 Acute-minded medicine is out of sync with the times and the chronic diseases afflicting us at this point in time. Alesse .75mg pills $200.00 Acute thinking doesn’t meet the need. Alesse .75mg pills $200.00 So why are we still insisting on using an outdated decision process, alesse .75mg pills $200.00 because there is no evidence that supports its use for any chronic disease. Alesse .75mg pills $200.00 Acute-minded medicine, alesse .75mg pills $200.00 unless some readers have missed the point, alesse .75mg pills $200.00 does not address the lifestyle factors that all chronic diseases are caused by, alesse .75mg pills $200.00 and there’s no demonstrable evidence that the “usual care” general physicians give chronic pain patients helps patients get back to work or back to functioning optimally the way they used to. Alesse .75mg pills $200.00 Single cause medicine, alesse .75mg pills $200.00 and treatment by solo practitioners, alesse .75mg pills $200.00 has proven useless with chronic pain because chronic pain requires a different decision process because chronic pain is a product of a combination of things that, alesse .75mg pills $200.00 over time produce diseases of wear and tear the symptoms of which acute treatment, alesse .75mg pills $200.00 does it need repeating, alesse .75mg pills $200.00 is useless at reversing.

Alesse .75mg pills $200.00 The problem is that the world has changed significantly from the time acute-minded medicine met the challenges of communicable disease 100 years ago. Alesse .75mg pills $200.00 The challenge now is chronic, alesse .75mg pills $200.00 multi-factor diseases that acute-minded, alesse .75mg pills $200.00 acute-trained physicians who try to force a round peg in a square hole, alesse .75mg pills $200.00 despite their persistence at trying, alesse .75mg pills $200.00 will fail to achieve.  And that’s not a debating point. Alesse .75mg pills $200.00 It’s evidence-based, alesse .75mg pills $200.00 and the numbers demonstrate it around the world. Alesse .75mg pills $200.00 Urgent care thinking is not working, alesse .75mg pills $200.00 people are suffering, alesse .75mg pills $200.00 and our current acute-minded physicians are unable to say, alesse .75mg pills $200.00 “I don’t know.” And, alesse .75mg pills $200.00 either primary care docs should do the ethical thing and refer out to a qualified person, alesse .75mg pills $200.00 or consider trying simple solutions, alesse .75mg pills $200.00 rather than make the life of patients miserable with shots in the dark that have no evidence base for being used by doctors unqualified in the field in which they are using them.  What we’re going through right now in the treatment of chronic pain is no different from what was happening shortly after the internal combustion engine was invented. Alesse .75mg pills $200.00 Lots of folks were still trying to repair Model Ts using horse-and-buggy methods. Alesse .75mg pills $200.00 We have medicine and physicians that are acute-minded and that are convinced that all health problems are caused by single agents, alesse .75mg pills $200.00 and they go ahead and treat our chronic diseases as if acute-minded medicine had an evidence base to stand on when the evidence shows their efforts to be wrong. Alesse .75mg pills $200.00 The environment, alesse .75mg pills $200.00 the times, alesse .75mg pills $200.00 the lifestyle and the out-of-date medicine for the chronic need is the mix that has created the conditions that people with chronic pain will have to line up their priorities and decide whether they’re “sick and tired and I’m not going to let it happen anymore.” In the current situation, alesse .75mg pills $200.00 pain patients have to keep one thing in mind: Abuse is what I permit. Alesse .75mg pills $200.00 And, alesse .75mg pills $200.00 then, alesse .75mg pills $200.00 don’t permit it. Alesse .75mg pills $200.00 Don’t yell and scream – mainly because it’s useless – just walk. Alesse .75mg pills $200.00 Walk away from the unqualified and do what you can to get into the right hands, alesse .75mg pills $200.00 as quickly as possible. Alesse .75mg pills $200.00 Otherwise, alesse .75mg pills $200.00 you’re the only one responsible for the abuse.

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Alesse .75mg pills $200.00 The pain implications of an older average age in a wealthier more indulgent times is simple, alesse .75mg pills $200.00 our bodies will predictably be exposed to more wear and tear and develop more “systemic” diseases that disrupt multiple systems. Alesse .75mg pills $200.00 Just on the physical side, alesse .75mg pills $200.00 over time we are exposed to more bangs and whacks from vehicles made of plastic that we drive at speeds at which our unprotected bodies were not meant to travel. Alesse .75mg pills $200.00 We use sports equipment designed for professional athletes, alesse .75mg pills $200.00 and therefore we can predict before they even put on the equipment that non-professionals will get injured and will likely wind up suffering persistent pain for many years, alesse .75mg pills $200.00 possibly until they die because they couldn’t not respond to the aspirational advertising. Alesse .75mg pills $200.00 Our industrial environment has also changed. Alesse .75mg pills $200.00 We now sit or stand or use specific body parts in unnatural ways for periods of time that the human body was also not designed to do. Alesse .75mg pills $200.00 We were designed to be mobile, alesse .75mg pills $200.00 not immobile, alesse .75mg pills $200.00 and to use certain body parts up to a certain point and then to stop. Alesse .75mg pills $200.00 But we don’t now because making a salary forces us to push the body beyond the tolerances of human physiology. Alesse .75mg pills $200.00 Or we go to wars where every day brave men go beyond the tolerance limits of the human body. Alesse .75mg pills $200.00 So disuse and overuse pain syndromes, alesse .75mg pills $200.00 especially of the low-back now dominate the headlines. Alesse .75mg pills $200.00 Finally, alesse .75mg pills $200.00 even when we try to entertain ourselves, alesse .75mg pills $200.00 we engage in single activities like jogging or weight-lifting thousands and thousands of times, alesse .75mg pills $200.00 most of the time with above-average levels of resistance, alesse .75mg pills $200.00 that lead to repetitive strain disorders. Alesse .75mg pills $200.00 In sum, alesse .75mg pills $200.00 we live in an era when we are reinforced for exceeding the tolerances of human physiology. Alesse .75mg pills $200.00 And then we wonder why we have persistent pain that has been produced by a combination of conditions affecting multiple systems in the body and we fail to ask Why can’t my acute-minded doctor not “fix’ this problem right now? Of course, alesse .75mg pills $200.00 we too are acute-minded so that explains the demand for “right now.”

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Alesse .75mg pills $200.00 Go back to the bullet points at the top. Alesse .75mg pills $200.00 If you meet the criteria, alesse .75mg pills $200.00 you probably have pain that is out of sync with acute-minded, alesse .75mg pills $200.00 urgent care medicine that may have worked for communicable diseases but that medicine has not yet redone itself, alesse .75mg pills $200.00 from top to bottom as it did last century, alesse .75mg pills $200.00 to deal with a new challenge, alesse .75mg pills $200.00 the noncommunicable diseases or what the World Health Organization now calls NCDs. Alesse .75mg pills $200.00 And that means that you are going to have to become responsible, alesse .75mg pills $200.00 accountable and liable for your the conditions of your own pain’s occurrence. Alesse .75mg pills $200.00 You will have to decide whether you allow yourself to continue going to a physician who is not qualified to treat chronic pain, alesse .75mg pills $200.00 and you continue to think that s/he is “my pain doctor, alesse .75mg pills $200.00” just because s/he prescribes some pain medications that have never worked for you, alesse .75mg pills $200.00 but have made your doctor “comfortable.” You will have to decide after letting your doctor treat a treatment for 3 months and it fails to get you functioning again how vigorous an action you will take, alesse .75mg pills $200.00 either with their medical board or with your State’s Intractable Pain Laws. Alesse .75mg pills $200.00 Or, alesse .75mg pills $200.00 you will learn how to treat the part of your pain that you are more qualified than your physician: the lifestyle, alesse .75mg pills $200.00 habits and attitudes that are totally beyond your doctor’s area of practice and expertise. Alesse .75mg pills $200.00 They know nothing about effective functional changes where you, alesse .75mg pills $200.00 with some guidance, alesse .75mg pills $200.00 can make changes that will modulate your pain. Alesse .75mg pills $200.00 You will also have to decide how to think the way the Body does, alesse .75mg pills $200.00 with the KISS formula (Keep It Simple Silly). Alesse .75mg pills $200.00 That’s learnable, alesse .75mg pills $200.00 and actionable, alesse .75mg pills $200.00 and it modulates pain.


Alesse .75mg pills $200.00 This website deals with pain that meets criteria as a non-communicable disease. Alesse .75mg pills $200.00 That is, alesse .75mg pills $200.00 chronic pain that is a product of a combination of factors, alesse .75mg pills $200.00 not the single causes of acute-minded medicine and acute-minded diagnostic techniques. Alesse .75mg pills $200.00 This website also deals with the reality that – international surveys tell us – 98% of chronic pain patients will never see, alesse .75mg pills $200.00 nor will they ever be treated by a qualified pain specialist. Alesse .75mg pills $200.00 The economics of healthcare make that a predictable impossibility for anybody but the richest chronic pain patients. Alesse .75mg pills $200.00 Qualified, alesse .75mg pills $200.00 credentialed, alesse .75mg pills $200.00 board certified continuing care for chronic pain patients is dead. Alesse .75mg pills $200.00 You’re on your own. Alesse .75mg pills $200.00 You have to learn the skills for effectively self-managing the conditions of your pain’s occurrence and extracting whatever helps your particular type of pain from existing healthcare and that is likely the best that you will be able to get for your pain until you die. Alesse .75mg pills $200.00 Moaning and groaning about “the healthcare system” hasn’t changed a thing in half a century. Alesse .75mg pills $200.00 The money isn’t there to deal with any disease that is chronic because the numbers indicate that treating chronic diseases costs 8 times what it costs to deal with acute disease. Alesse .75mg pills $200.00 They’re trying to force a round chronic peg in an acute square hole. Alesse .75mg pills $200.00 And, alesse .75mg pills $200.00 from your own experience, alesse .75mg pills $200.00 you know it’s not working.

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