Questions & Answers
What makes your integrative practice unique?
Succinctly put, what differentiates me is the depth and breadth of my expertise as both a physician and an alternative practitioner. During my 17 years in primary emergency care at several top New York City hospitals I consulted with 6,000 to 7,000 patients per year. I treated them for trauma as well as medical, surgical, psychological, and gynecological illnesses. The wide variety of conditions in an emergency setting requires the practitioner to develop an extremely good eye, skilled hands, and the ability to make rapid and accurate diagnosis.Later, I accepted an opportunity to work and train at the Center for Alternative Health at Beth Israel and discovered the power of blending alternative therapies with traditional medicine for the overall benefit of the patient.
As an “Integrative Medical Doctor,” I combine the best of both worlds treating the body holistically and individually. This may include medical nutrition, herbal remedies, Mesotherapy, prolotherapy, trigger point injections and acupuncture, along with conventional medicine when appropriate.
What makes you different from an internist?
Physicians who are board certified in internal medicine offer basic, conventional treatment. The course of treatment is prescribed and often based upon methodology and statistics. In addition, most internists are under strict time constraints as to the amount of time they spend with each patient.To make the best diagnosis, a doctor must fully understand the patient’s lifestyle: how diet, time management, stress, family and business relationships relate to his or her health. In short, you need to know the patient, and you need a broad range of experience and diagnostic skills. Given my ER experience, when I hear a patient describe, for example, lower stomach pain, I am trained to consider all the possibilities — medical, surgical and gynecological.
By putting the emphasis on developing a close working relationship with the patient, I am in a better position to become their partner. Gathering a detailed history leads to a superior understanding of the patient and a more effective diagnosis and treatment plan. Once the problems are identified, the course of treatment is dictated by the comfort level of the individual patient.
Our ability to offer an array of alternative treatments, as part of a well grounded internal medicine practice adds a great value.
How do you view the state of conventional vs complementary medicine and the United States?
Presently, these two approaches are perceived as diametrically opposed camps. Complementary and alternative medical practitioners and those in conventional medicine each assert that only theirs is the correct worldview.Think of the Sufi tale of the four blind men asked to describe an elephant. Each feels a different part of the animal, each insists that the elephant can be described as tree trunk or sinuous like a snake, one is describing the tail, the other the legs, each missing the entirety of the animal, each grasps only one element of the truth. Integrative medicine can, by definition, draw these two camps together — through education and understanding.
Already there are several schools offering courses, including the University of Arizona Program in Integrative Medicine, founded by Dr. Andrew Weil, the University of Maryland, School of Medicine, Program in Complementary Medicine. A GME Fellowship in Integrative Medicine has been developed by Dr. Woodson C. Merrell at the Continuum Center of Health and Healing in New York City, in conjunction with Albert Einstein College of Medicine and Beth Israel Medical Center.
In addition, U.S. medical schools have begun offering courses on alternative and complementary therapies, recognizing that more and more Americans have tried at least one application. With so many vitamins, supplements and herbs available today, it also makes sense to teach medical students to become more aware of this realm regardless of how conservative they might be, if only to become aware of conflicts and reactions that occur when popular supplements are improperly combined.
However, there may never be a place for certain alternative practices in certain areas such as high-pressure departments of hospitals like Emergency Rooms. Using this example, regardless of a doctor’s knowledge of alternative treatments, an ER patient suffering back pain will receive treatment that is very specific and confined. That is because it is simply too difficult for a hospital administration to oversee the use of alternative treatments in this setting.
Complementary alternative therapies are best suited to treating and managing chronic long-term illnesses and pain-related injuries. I firmly believe certain techniques will eventually be embraced, with a slow, gradual acceptance into the private practices of conventional medicine.
How would you characterize your patients?
They are well-educated, aware of, and curious about alternative treatments that are combined with or replace traditional conventional treatment. They appreciate that alternative treatment can go hand-in-hand with internal medicine.My patients ideally are not concerned simply with acute conditions, but look further. They desire maximum health and well-being. Everything at our practice is individualized to the patient, based on overall lifestyle and the big picture.
How do you stay current on the latest in medical and health innovations?
It is crucial to keep abreast of developments and treatments in both the conventional and alternative worlds of medicine. It builds a better doctor. My curiosity has always been a driving force and for me innovation is what keeps practicing medicine interesting, as well as fun.A doctor should always be learning both for himself and his patients, then incorporating that into his practice so that treatment is constantly evolving and improving. There is a plethora of information on health, alternative and traditional, out there in the form of the Internet, magazines, books, new diets and fads.
How does the patient wade through all that? How do they know what is real and what is not real? What works?
My role is to help the patient make sense of the information, and to guide them through the maze and in the best direction of what is safe and effective.
Do you have any general recommendations for those seeking optimal health?
If a person is adequately motivated through diet, exercise and supplements, they can control the majority of chronic health conditions and ease symptoms substantially. Assuming the average person will live into their late 70’s to 80’s — here is what I ask…how do you want to live?The health templates we have developed are centered on a healthy lifestyle. From our perspective, this translates to elements as diet, exercise, medical nutrition and selected supplements. By following our templates, patients are given the tools to minimize their exposure to illness or sub-par health and maximize their health and quality of life.
What specific sports injuries have you had success treating non invasively?
Sports injuries such as partially torn tendons, ligament and cartilage damage, and a wide variety of musculoskeletal conditions (tendonitis, back and neck pain, arthritis, degenerated discs and sciatica) can all be alleviated.
What types of pain have you had success alleviating?
I have been able to successfully treat acute pain, sports injuries and chronic pain using acupuncture, Mesotherapy and/or Trigger point injections and Prolotherapy. These modalities present no side effects in well trained hands, are relatively painless, affordable and local—they do not have systemic effects.
Explain the difference between acute and chronic pain.
When discussing sports related injuries for example, tendonosis would be considered chronic, whereas a torn ligament would be acute.
If I am in pain how long should I wait to see you? What should I try at home first?
Don’t wait. If you have for example an injured ligament, it won’t repair itself and may need more than one session to help you recover. If you are experiencing spasms, the longer you wait the more other muscles will be “recruited” as the body fights to support the back and they will begin spasms as well. Bottom line is if you hurt, come in. Treatment is more likely to be successful with immediate intervention.
Describe a typical consultation for injuries/pain. Can I be treated the same day I see you?
The first step in evaluating a patient is taking a medical history and discussing the problem or condition the patient is seeking to relieve. It’s important for me to know what precipitated the injury.
What has the patient noticed exacerbates or alleviates it?
The physical exam includes various movement tests to evaluate muscles and ligaments until we can measure the patient’s response to my maneuvering the area. Once area is located or isolated then we determine the treatment plan according to duration and severity.
What diagnostic tools do you have at your disposal?
A comprehensive physical exam always comes first. We have a musculoskeletal ultrasound device to further identify certain conditions. If necessary I will order standard tests such as x-rays, MRI, or a CAT scan. We are fortunate to have a radiology office next door to our practice which makes it ultra convenient for our patients.
What methods do you most commonly employ to treat both symptom and cause?
Mesotherapy, Trigger Point therapy and Prolotherapy are important parts of my practice, among others. Many have found significant relief through Mesotherapy. This treatment addresses a host of conditions from rheumatology to sports trauma, and a wide variety of diseases. Migraines, gastric problems, sinusitis all respond well to Mesotherapy. Originally intended to heal, Mesotherapy is also successfully used for aesthetic concerns including hair loss. In Mesotherapy a very low dose medicine is injected with an ultra fine needle into the superficial dermis where it slowly releases its power through smaller capillaries for an extended period, perfectly targeting the intended problem area.Prolotherapy goes straight to the heart of the cause by repairing ligaments nonsurgically. The integrity of all our joints — knee, wrist, shoulder, ankle — are maintained by ligaments and tendons. If a ligament/tendon is loose, the muscles will overreact to fill the void and pull tightly on the tendons. As a result, muscles become rigid and often spasm and lock. In time, the muscles will take over completely and you will have chronic pain. You can try to relax the muscles, but this will not affect the core of the problem, which is the weak or frayed ligaments.
I also use trigger point therapy frequently to eliminate the acute pain of a muscle spasm, whether in the neck, shoulders or low back, while using prolotherapy to address the cause of the pain. Trigger point injections gives almost immediate relief, but needs to be combined with prolotherapy to prevent reoccurrence.
Aside from common sports injuries resulting in partially torn tendons and ligament and cartilage damage, a wide variety of musculoskeletal conditions can be improved using prolotherapy. These include tendonitis, back and neck pain, arthritis, degenerated discs, sciatica, whiplash and even TMJ and Migraines. The beauty of prolotherapy is that gets the patient functional almost immediately, generally replacing physical therapy. The injection is painless. Patients are sore for 3-4 days during the inflammation response and then back on the field, so to speak.
When can I expect relief using alternative therapy?
Trigger point is instantaneous. Prolotherapy results are evident within the first 1-2 treatments. You will be sore but within one week significant improvement is usually realized. Severity and duration play a role and may indicate up to 4 to 8 treatments.
Do you ever prescribe traditional medication?
Yes. It depends upon patient history and current medical conditions. There are many benefits to alternative herbal remedies but they do take time and are not reasonable if an acute condition is present.
Do you do any work with hormone therapy?
Yes. When working with women on Bioidentical Hormone Replacement Therapy (BHRT) I begin with a complete panel of hormone tests to determine your level of hormonal decline. These can be done by blood, urine or saliva. We will be studying how your hormones fluctuate during the day—giving us a video vs. a snapshot so to speak. Once the results are in, I can prescribe just the right cocktail for your individual hormone needs at a registered compounding pharmacy. We will then repeat the hormone panel every three months and make any necessary adjustments.In most cases patients report dramatic changes in their symptoms. They begin to sleep as they normally did, depression and fatigue lifts, sex drive normalizes (or improves), in both men and women.
In women so does the vaginal dryness, hot flashes abate, menstrual cycles regulate, bone loss improves, and the mood swings stop.
Does insurance cover visits and procedures?
My practice is considered “out of network.” The consultation and basic blood work is usually covered. Insurance also covers at least one (up to three) injection(s.) Trigger point is typically accepted and occasionally prolotherapy is accepted. My staff can help determine and estimate what out of pocket expenses you might anticipate so there are no surprises.
Is there any set of conditions you cannot treat?
Should a ligament be completely ruptured or badly torn or if a patient presents with a complete full thickness muscle tear, surgery is the obvious option. A herniated disc accompanied by nerve and severe neurological findings is also a clear indication for surgical intervention.
When is surgery the only option? Do you refer?
In some cases surgery is the only option and my background as a physician gives me credibility to make that determination. My network is extensive comprised of highly qualified practitioners. Knowing a myriad of surgeons in the various specialties allows me to match not only their expertise, but suit their personalities to the individual patient.