Simple and Inexpensive Alternative Health Care For the Whole Family

Here is a story to illustrate how modern medicine often works. A man had some weeds in his lawn. A gardener was called to remove them. He came with a bazooka, some grenades and a machine gun and proceeded to annihilate the lawn. After the job was done, the owner was all upset. “What have you done with my lawn. All I wanted was a few weeds removed.” The reply was, “Well, I got rid of them didn’t I?” Our health care systems often do something like this – costly and difficult fixes instead of relatively non-intrusive, simple and inexpensive body aids.

Until “modern” medicine came about less than 150 years ago, people mostly looked after themselves from a health care point of view. They trusted natural products and approaches for ills and ailments. The idea was to help the body help itself instead of introducing chemicals and products that are highly invasive and in many cases weaken the body further. Ancient wisdom and remedies were passed on to next generations. We have lost much of that ancient wisdom and it is under constant attack by the “modern” medical world. We are told we need to use the gardener’s “kill at any cost” approach instead of something gentle, simpler and less expensive.

Our family members go to a modern-medicine doctor only if absolutely necessary and as a last resort. We learn about our problems and try to fix them ourselves first. This knowledge about how our bodies work can then be used in future situations. I think I know my body pretty well by now and I’m pretty sure I will keep fairly healthy in future years. To be honest, I wonder if modern medicine often causes greater harm than what it should and nobody says or does anything about it.

Our family relies on only a few simple things to maintain control of our health. I want to pass on what we have used for years. We have also saved much money and lost very little “down” time because of them.

I offer no medical claims or scientific proof for these easy and inexpensive self-care methods that work for us personally:

Colds
Instead of buying medicines and syrups containing questionable chemicals, we use a strong salt water or diluted food-grade hydrogen peroxide gargle to kill cold germs in the throat and it seems to prevent them from spreading. At the first signs of a cold, we also use a hot water bottle on the chest and throat while sleeping. Germs are killed easily in the body by the heat and you use less energy producing the fever because of the external heat source. Simple, natural and inexpensive.

Body Toxins
A white coating on the tongue can be a good indicator of toxins. Scraping and mouthwashes to cover the smell are not the solution! Tongues should be pink and uncoated. Check your diet. The color of urine also indicates the level of toxins-the lighter the better. Drink more water to dilute and flush toxins. As you detoxify, two things will be evidence of successful detoxification: clearer urine and a fresh, pink tongue.

Dehydration
Many people are dehydrated and don’t even know it. Headaches can often be warning signs of not enough water in the system. Frizzy skin below cuticles, dry and lifeless hair, and dry flaky body skin are also indicators. Don’t just drink a whole glass of water all at once several times a day, sip continuously throughout the day.

Iron Deficiency
I didn’t believe this one until I saw it with my own eyes when we tried it on our daughter. Rub a gold ring on a cheek. An obvious black streak indicates there is an iron deficiency. We tried the same thing on others in the family. It showed only on her.

Lack of Energy
Low energy is very often caused by poor diet. Many people think they need more sleep because they are always tired. Sleep is not the solution because it is repair time, not re-energize time. If the body doesn’t have the tools and raw materials to repair, it will still be tired when you wake up. Energy comes from nutritious food. Check your diet if you have low energy. Unprocessed foods are best. Cook at low heat to keep needed vitamins and minerals. Eat more raw fruits and vegetables. Learn relaxation techniques to improve depth of sleep.

Pro-active Disease Prevention
Dentists will tell you that many physical ailments start with germs and bacteria entering at the gum lines. Brush and floss your teeth regularly. Many diseases develop as a result of stress which compromises the immune system. Learn formal relaxation techniques. Also exercise regularly to aerate your body and keep the pipes clear of “sludge.”

Miscellaneous Inexpensive and Safe Self-Care
a) exercise, flex and tense face muscles each day to reduce sagging skin. Save money spent on facial creams.
b) eye exercises help keep stronger glasses away and eyes strong. Look them up on the internet
c) get rid of warts by rubbing crushed garlic juice on them
d) rub your hands on any stainless steel to get rid of garlic odor
e) for athletes’ foot, soak your feet in a hot, strong ordinary salt and water solution each day until eliminated

Looking after your own health care is not easy. It takes time, observation, analysis and talking with people that know. Over the long term, you will get to know yourself far better, appreciate yourself more and feel more in control of your life. As well, your body will be healthier and thank you by working properly because you have helped it help itself.

How to Study for and Pass the Internal Medicine Boards

As the ABIM internal medicine certification exam approached, we received a large number of emails from our subscribers asking for suggestions on the best way to study for the boards. The truth is there is no one path to success though there are certainly ways to increase your likelihood of passing. Regardless of whether you are preparing for board certification or trying to achieve maintenance of certification (MOC), the best tried and true overall method is to “study early and study often.” Below we lay out possible strategies and tactics (in no particular order) for passing the ABIM board exam:

1. Know the basics of the internal medicine board exam

This is obvious but a lot of people simply don’t review this prior to starting their exam preparation and instead rely on their ABIM study source of choice to provide the information.

  • Review the ABIM exam blueprint and understand the topics covered on the exam
  • A large percentage (33%) of the exam is comprised of Cardiovascular Disease, Gastroenterology, and Pulmonary Disease
  • Over 75 percent are based on patient presentations – most take place in an outpatient or emergency department; others are primarily in inpatient settings such as the intensive care unit or a nursing home.
  • While it’s not a big part of the exam, be prepared and expect to interpret some pictorial information such as electrocardiograms, radiographs, and photomicrographs (e.g., blood films, Gram stains, urine sediments).

2. Use the in-training exam as a starting gauge

If you are a resident, the Internal Medicine in-training exam is a good starting point to see where you stand. It’s simply that – a barometer of where you stand. It will give you an idea where you may be weak and where you may be pretty strong. It will also give you an idea of how you compare with your peers. Don’t alter your ABIM study plan simply based on it but it does give you an early metric of the areas you need to focus on.

3. Get a study guide to prepare for the ABIM exam

It’s important to have a good study guide that is tailored for the exam. Some of the more popular and effective guides we’ve come across are the MedStudy Internal Medicine Board Review books and Harrison’s Principles of Internal Medicine Board Review.

4. Join a study group

Study groups, if utilized properly, are particularly effective because they allow you to learn from your colleagues and other exam takers. Oftentimes, people will form study groups with their colleagues (ideally limited to 3-4 people) at their residency program. Tactics to use in ABIM study groups may include:

  • Focus on a new internal medicine category by week. For example, focus one week on cardiology and the next on pulmonary care. The exam can be broken into a dozen or so categories (see the ABIM exam blueprint). The majority of the subspecialty questions on the Internal Medicine board exam will focus on cardiology, gastroenterology, and pulmonary care. However, do not neglect the other areas as the ABIM wants to ensure that internists have a broad base of medical knowledge.
  • Test each other with internal medicine questions you have written yourself. We are firm believers in the philosophy that the best way to learn is to teach. If you help others learn, your knowledge of medical concepts will be greatly strengthened.

We recognize that joining a study group is often not feasible – especially for those no longer in residency programs where everyone is preparing the boards. Fortunately, we live in a digital age where being part of a study group is much easier. You can connect with colleagues through Skype, Google hangout or a number of other channels. One of our favorite approaches is to remain informed and learn through the power of social media – in particular Twitter. In a previous post, we highlighted excellent Twitter handles to follow for ABIM exam review as you prepare for certification. If Twitter is not your cup of tea, you can also connect with colleagues through the Knowmedge ABIM community on Google+. Regardless of what approach you decide, studying alongside others preparing for the same exam is a great motivational tool for success.

5. Get a question bank that fits your personal needs

What is the value of an Internal Medicine question bank? This is a discussion near and dear to our heart, of course. Question banks have become a popular tool because they bring together a lot of material in a question format and help create a test taking environment. There are a lot of question banks to choose from – so what should you look for in an ABIM qbank?

  • High quality ABIM-style questions in a format similar to the exam: The exam is mostly filled with clinical vignettes and has straightforward questions as well. At a minimum, your ABIM exam question bank should have both of these types of questions. Quantity is important – but the quality of the questions and explanations is much more important.
  • Detailed explanations that review why the incorrect choices were wrong: A question bank that does not provide you detailed explanations is probably not worth the money and time spent. As you review questions, you will inevitably get some wrong – your choice of ABIM question bank should detail why your choice is incorrect and the reasoning behind the correct choice.
  • Ability to track your personal performance: Your choice of ABIM qbank should be able to tell you your performance overall and by category. Most – not all – question banks provide you a dashboard broken down by category. The Knowmedge question bank has gone an additional step to break the categories into subcategories as seen on the ABIM exam blueprint. This allows you to review your strengths and weaknesses at a granular level. Knowing you are weak at cardiovascular disease is great – knowing you are weak at arrhythmia questions is more valuable.
  • Add-ons – Notes, Lab values, Highlighting: Depending on how you study, these may be valuable features.

ABIM exam questions straight talk:

  • No question bank – not MKSAP, not Knowmedge, not any – knows what will be on the actual ABIM exam. Based on the ABIM Blueprint, you can make assumptions on what are the most high-yield areas to study. The point of a question bank is not to give you the exact questions that will be on the exam – it is to hopefully teach you concepts you may see on the exam and how to reason through what you don’t know immediately.
  • High-quality ABIM exam review questions can be found in many places – question banks are not the only place. There are study guides, books, and even free sources. So don’t simply base your decision on question bank on the questions. In addition to the quality of the questions, what truly differentiates one ABIM exam question bank from another is whether it will truly help you build a broad base of knowledge and help you retain information for the exam. If you are not comfortable reading a bunch of text – it won’t matter how great the questions are. If you are not an audio-visual learner, the Medstudy or Knowmedge videos won’t do anything for you (As clarity, the Knowmedge qbank contains text and audio-visual explanations for this exact reason). If you are an “old-fashioned” learner that prefers printouts – USMLEWorld is definitely not for you – those who have used them are well aware their software will block you from taking print screens or copying of their content. In short… don’t follow the herd – each one of us learns differently and you need to pick the best method for you.

6. Consider whether a review course is right for you

There are pros and cons to taking a review course for your ABIM exam prep. The pros are that it gives you a serious dose of review in a short period of time. It gets you focused if you weren’t focused and some courses are absolutely excellent – we know some internists are ardent supporters of some of the professors that teach these courses. The three most popular independent courses we are aware of are:

  • Awesome Review by Dr. Habeeb Rahman – The best known and most popular independent course. Dr. Rahman has a very unique style of teaching and accompanies his lectures with his own videos. During this six day course (Sunday – Friday), Dr. Rahman provides students his own set of notes and questions to practice.
  • iMedicineReview by Dr. Shahid Babar – This three day course (Friday, Saturday, Sunday) course comes with a set of 1,500 review questions.
  • Unique Course by Dr. Satish Dhalla – A six day course (Monday – Friday) taught by one of the Top Internists in the Nation as selected by U.S. News

The cons of a review course are that they are expensive (Often over $1,000 plus hotel stay) and can be inconvenient to travel to and from. Regardless of whether you attend a review course or not, it cannot replace the pre and post-course study time that is needed. It is complementary to study time and does not replace it.

7. Review our suggested ABIM test taking strategies

The ABIM exam questions are not intended to trick you – they are intended to challenge your knowledge and ability to bring together your understanding of many different concepts and topics. Below are some of the tactics you can use as you are practicing questions and/or taking the actual ABIM exam:

  1. For clinical vignettes, read the question (last line) first and then go back and read the scenario. This way you’ll know what to look for as you are reading the scenario.
  2. Try to answer the question even before seeing the answer choices.
  3. Pay attention for keywords that can clue you in on an etiology or physical exam.
  4. Watch for key demographic information – Geography, ethnicity, gender, age, occupation.
  5. The ABIM test is not intended to be tricky but we are all human so we miss keywords sometimes – such as “least likely” – pay attention to these.
  6. If you are challenged by a longer clinical vignette, note the key items and develop your own scenario – this may trigger an answer.
  7. Most internists we’ve spoken with say time is generally not an issue – but be aware that it is a timed exam and that you have approximately two minutes per question.

We cannot stress enough the mantra “study early and study often.” The exam is challenging but it can be conquered with diligence and proper preparation.

8. Understand and be prepared for ABIM test day

  • Be prepared and confident. No matter how you have chosen to study, on test day – confidence is critical!
  • Get a good night’s rest – last minute cramming and staying up late is only going to stress you out more.
  • Get there early – don’t risk getting caught in traffic. It’s much better to be a little early than be aggravated in traffic.
  • Take an extra layer of clothing. The last thing you want to do is be uncomfortable and cold because someone decided to turn on the air conditioner too high.
  • Test day is long! Be mentally prepared for it. From registration to the optional survey at the end, the day will be 8-10 hours long (depending on whether you are certifying for the first time or taking the maintenance of certification exam).
  • Keep some power snacks with you to take during break time.
  • Review the ABIM exam day schedule so you know exactly what to expect.

That’s a basic overview of how to study for and pass the ABIM board exam. As mentioned, there is no secret sauce or method to this – you simply need to have a broad base of knowledge. There is no substitute for studying early and studying often! If you are preparing for the ABIM Boards, we wish you well – we’re here to help so let us know if you have any questions! Happy studying!

Building Your Family’s Health Care Team

We could learn a lesson from ancient Chinese physicians. They were only ever paid if the patient was healthy. When the patient became sick, they weren’t paid again until he was well. An interesting concept, don’t you think?

Our “health care system” really isn’t about health. It’s about sickness. We wait until we’re sick and then go to the doctor to fix whatever is wrong. It’s a “sick care system”. In fact, it’s been noted that if we were to take better care of ourselves on a regular basis, we would have less incidence of colds, flu, allergies, asthma, ADD/ADHD, heart disease, diabetes, cancer, arthritis, Alzheimer’s, multiple sclerosis, and many more illnesses and diseases. The challenge is that traditional western medicine doesn’t fulfill the need of parents to keep their families healthy – they are too overrun with the emergencies that clog their waiting rooms. As a result, many parents are turning to complimentary or alternative health care.

Parents have shown a much greater interest in integrative health care over the last decade. Creating a “health team” for their families is gaining popularity instead of relying on a single physician for all needs. The role of complimentary or holistic health care is not to focus on a symptom, illness, or disease. More importantly, the goal is to look at the overall health of an individual and assess how best to keep the person well instead of waiting for them to get sick and then treating the disease.

A July 2007 study out of “Pediatrics” followed 114 children in a pediatric out-patient clinic affiliated with a university general hospital in Quebec[1]. It was stated that 54% of these children received complimentary and alternative medicine (CAM), which included chiropractic, naturopathy, homeopathy, massage, acupuncture, Reiki/energy care, hypnosis, osteopathic manipulation, and other hands-on techniques to promote health care. The most popular forms were chiropractic, naturopathy, and homeopathy, with chiropractic used most frequently at 24%.

In 2003, a survey of 2000 parents was conducted by UCLA in association with the American Academy of Pediatrics to discover their views on preventative care for their children[2]. The study showed that while topics such as vaccinations, feeding issues, and sleep patterns were discussed, topics such as child care, reading, vocabulary development and social development were not met with satisfaction. Parents who reported that they did not receive sufficient information noted that would be willing to pay for extra care, a marker of how strongly they valued guidance on the issues.

Creating your family’s integrative health team takes work. Interviewing chiropractors, naturopaths, homeopaths, dentists, physicians, midwives, massage therapists, and other practitioners you would like to work with is a big job. Starting by choosing one and then asking for referrals to others is an easier way to build a team that you trust to take care of the health needs of your family.

[1] Jean D, Cyr C. Use of complementary and alternative medicine in a general pediatric clinic. Pediatrics. July 2007; 120 (1):e138-e141

[2] The National Survey of Early Childhood Health: Parents’ Views on Preventive Care for Infants and Toddlers, June 2004