Sunday, March 31, 2013

LASIK: Before, During, and After Treatment

Imagine being able to see clearly without the use of glasses or contact lenses.  For millions of men and women who have chosen laser vision correction, the dream has become a daily reality.   Now, while you may have heard the term LASIK before, many patients aren’t sure what this cutting-edge procedure is really all about.  To help you make an informed decision, we wanted to give you a general sense of what to expect before, during and after treatment.  Ready to find out more?

What to Expect with LASIK

  • Before: If you are tired of dealing with poor vision and are considering LASIK, the first step to take is making an appointment with your ophthalmologist.  He or she will help you determine if you’re a good of candidate for this procedure.  There are a number of factors that determine if LASIK is right for you, one being eye health.   Candidacy can also hinge on corneal thickness as well as a patient’s individual prescription.  You should be over a certain age — generally 21 years of age — and your vision should be stable.  You and your doctor will discuss other factors that make a good LASIK candidate.  Your ophthalmologist will also outline pre-surgery procedures, such as not wearing contact lenses for 1-3 weeks before you undergo LASIK.
  • During: When it comes time for your procedure, you will first be given numbing eye drops to keep you comfortable throughout. As our practice offers cutting-edge iLASIK™, the procedure is fully customized using cutting-edge 3D eye mapping.  Based on this unique “road map,” we then use a special laser to cut a thin flap in your cornea.  This flap will be peeled back, and a second laser will be used to reshape the cornea, allowing light to be correctly focused on the retina.  The flap made in your cornea will then be set back in place, and your LASIK procedure is complete — the entire procedure usually takes no more than a matter of minutes.
  • After: While someone will have to drive you home following your LASIK procedure, many patients are able to resume normal activities in just a day or two.   You will be given prescription eye drops following your procedure, to minimize any mild discomfort you may experience.  Be sure to follow all post-surgical instructions and attend all your follow-up appointments.  In terms of improved vision, many patients see an apparent improvement in vision as quickly as the next day.

LASIK in Winchester

To learn more about laser vision correction or any of the procedures we offer, contact us today and schedule a consultation.  Our offices are located in Winchester, serving Virginia, West Virginia and Maryland, and you can reach us directly at (540) 722-6200.  We look forward to serving you.

Source: http://www.seeclear.com/blog/lasik/lasik-before-during-and-after-treatment

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Mindful Meditation vs. Chronic Pain

Are you a chronic pain sufferer who is looking for an alternative to pain meds? Grab a candle, find a quiet room, and try meditating your way to less pain. A recent study confirms that spending a total of one hour practicing mindful meditation can help your mind become less sensitive to your chronic pain. Skeptical? Give it a try and let us know if it worked for you.

Source: http://www.spine-health.com/blog/mindful-meditation-vs-chronic-pain

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Reducing our Environmental Impact to Create Healthy Communities

Note: Today we have a guest blog post from Bernard Tyson, president and chief operating officer of Kaiser Foundation Hospitals, Inc., and Kaiser Foundation Health Plan. He recently wrote about Kaiser Permanente’s work to reduce its environmental footprint – not just as an business imperative, but as a core strategy for improving the health of its members and the communities it serves. Read more about Bernard Tyson through his bio in the Kaiser Permanente News Center.


There is little disagreement that greenhouse gas emissions, which are known contributors to climate change, have led to a rise in pollution and adverse health impacts. In fact, the World Health Organization estimates that urban air pollution causes about 1.2 million deaths per year and exacerbates cardiovascular and respiratory illnesses, particularly in sensitive populations like the elderly and young and in minority communities that are disproportionately impacted by urban and industrial activities.

Ironically, the health care industry – responsible for preventing and treating these types of illnesses – also contributes to the problem. According to a study by the University of Chicago, 8 percent of the total carbon emissions in the United States are attributable to health care activities. Not surprisingly, hospitals are by far the largest carbon emitters due in large part to strict requirements for temperature control, ventilation and lighting, and, of course, 24/7 operations.

Compounding the problem is the fact that many hospitals and health care facilities were built decades ago and have not been remodeled to use energy more efficiently. This is a similar situation to many government-owned buildings across the country. Late last year President Obama announced a multi-billion dollar government and private sector commitment to finance building renovations to make government-owned properties more energy efficient, and to create jobs in the process. The energy performance contracts proposed by the federal government, with improvements paid for by energy savings, are similar to those being used by schools, colleges and municipalities.

Given that the health care industry in America has nearly 600,000 facilities – and many of their workforces are equal in size to large government agencies (Kaiser Permanente’s workforce, for example, is of similar size as the U.S. Department of Homeland Security), health care organizations have a real opportunity to adopt sustainable business practices that reduce emissions, increase energy efficiency and the use of clean energy. This in turn will better protect public health and create jobs, achieving results that are in line with our focus on wellness and prevention, and helping grow the economy.

In January, Kaiser Permanente set an aggressive business strategy of reducing our greenhouse gas emissions by 30 percent by 2020, as compared to 2008 levels. To achieve this goal, we are adopting sustainable energy measures, both related to the construction of new facilities and the upgrading of existing facilities, such as installing new lights and window-film installations. These measures will not only reduce the impact of our operations on the environment, but are expected to save roughly $1 million per year in energy costs as well, which is good news for our members.

We are also investing in clean energy sources, such as deploying solar energy and fuel cell generation capacity at facilities throughout California.  In Maryland and the District of Columbia, we are purchasing renewable energy credits to offset 100 percent of our carbon intensive activities in those markets.

And Kaiser Permanente is not alone. Last year for Earth Day, Digital Health committed to reducing greenhouse gas emissions and energy use, and increasing sourcing of power to green energy. The University of California at San Francisco has also established a robust sustainability strategy to reduce carbon emissions with an ultimate goal of becoming climate neutral.

I hope these climate change commitments are just the beginning for our industry. Together, we have an opportunity – and a responsibility – to help prevent climate related illnesses and improve the health of our communities.

Source: http://centerfortotalhealth.org/2012/tyson-healthy-communities/

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Causes of Leg Pain Video

There are a number of different ways structures in the spine can cause pain going down into the leg. The two main types of leg pain coming from the spine are referred pain and radiculopathy.

Video presented by Grant Cooper, MD

[TOC]

Video Transcript

There are two basic ways that the spine can cause leg pain. The first is referral pain from structures within the spine itself, such as the disc, facet joint, sacroiliac joint. Structures that can become painful can also refer pain down into the leg. That pain tends to be more dull, deep, vague, achy. The way that we usually think about pain coming from the spine into the leg is more radiating, electric, burning pain. This comes from irritation of the nerve root within the spine.

There are a number of variables within the spine that can cause that irritation of the nerve root - herniated discs, spondylolisthesis where the bones slip on each other, facet joint arthropathy with the little joints in the back of the spine become arthritic and hypertrophy, ligamentum flavum buckeling and hypertrophy with the ligament in the back of the spine. Basically, a number of different arthritic types or processes or acute processes like a herniated disc, all of which have a common denominator which is that the hole where the nerve exits becomes smaller and, as a result of that, there is more of a propensity towards an inflammatory response along that nerve and that can send pain shooting down into the leg, often there is associated numbness, sometimes there is some weakness.

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Source: http://www.spine-health.com/video/causes-leg-pain-video

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Cholera in Zambia, Dominican Republic and Cuba

There are current outbreaks of Cholera in Zambia, the Dominican Republic and Cuba.

Zambia – the outbreak is in northern Zambia, more than 400 miles from Lusaka.

Dominican Republic – at present the outbreak is confined to a correction facility in the far eastern end of the island.

Cuba – there have been several outbreaks following Hurricane Sandy, including one in the area of Old Havana, a popular area with tourists. Travellers should take extra care with food and water, and should consider vaccination.

Sources: ProMed Newsgroup and Agence France-Presse

For advice about Cholera and other travel related illnesses and vaccinations, contact the Globe Travel Health Centre in Norwich on 01603 667323

Source: http://www.globetravelhealthcentre.com/travel-advice/cholera-in-zambia-dominican-republic-and-cuba.html?utm_source=rss&utm_medium=rss&utm_campaign=cholera-in-zambia-dominican-republic-and-cuba

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Causes of Foot Drop Video

Foot drop can be caused by stroke, tumor, or Parkinson's disease, but it can also develop from an issue in the spine. There are many conditions which can affect the peroneal nerve that controls the foot's ability to flex properly.

Video presented by Grant Cooper, MD

[TOC]

Video Transcript

Foot drop is the inability to dorsiflex the foot - so, to pull the foot up. Foot drop often presents as people saying that they are tripping over themselves. Essentially, it is hard to clear the foot, so people after they go for a long walk might find that they start to trip over themselves. As the foot drop gets worse, then that can become more pronounced and more profound and often people will develop a steppage gait - which is basically you have to heighten the leg up in order to clear the foot as you're walking.

Now, foot drop itself is not a disease, it's a sign of an underlying pathologic process. There are two general categories that we think of for foot drop. The first is people are plantarflex, so the calf is in spasm or it is spastic and it is not letting the dorsiflexors to overpower it, so the dorsiflexor muscles can't bring the foot up. The other reason is a lack of communication between the nerve and the muscles that are supposed to be bringing the foot up. Now, this lack of communication is what we're going to focus on at the moment and that lack of communication can happen anywhere along the path from the brain down into the foot. So, people could have central problems such as a stroke or a tumor or Parkinson's in the brain, then as the impulse comes down the spinal cord you can have spinal cord lesions. As the nerve exits the spine people can have what is called a "radiculopathy," or more colloquially a pinched nerve in the back that can certainly cause foot drop. Then as those nerves come out of the spine - the ones that go into the dorsiflexors - they branch out, they come together to form the sciatic nerve and people can have irritation to the sciatic nerve. The sciatic nerve then goes down the leg and branches again to the peroneal nerve, which the peroneal nerve can also have a lesion in it that could be causing a foot drop. And then you could have a problem at the neuromuscular junction as well and in the muscle itself. All of those things can lead to a foot drop.

When the problem is coming from the spine, typically will be an L5 radiculopathy - an irritation around the L5 nerve. And that irritation comes, in general, from the same kinds of things that can also cause pain going into the leg, which are things like herniated discs, like spondylolisthesis, facet joint arthropathy, spinal stenosis - essentially narrowing of the space where the nerves exit the spine, which can then put pressure or irritation around that nerve and then leads to the lack of communication between that nerve and the muscles that are supposed to do the job of lifting up the foot.

Often, but not always, there will be an accompaniment of pain, of numbness, tingling, but sometimes it can just present as foot drop in the absence of other symptoms.

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Source: http://www.spine-health.com/video/causes-foot-drop-video

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Saturday, March 30, 2013

Radio Interview

Source: http://adventuredoc.net/2013/01/03/radio-interview/

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Dry Eyes in the Winter Months

The cold dry air that is common in the winter months can have adverse effects on the moisture in your eyes.  But what many people may not realize is that your eyes can become just as dry while trying to keep warm inside.  The heat produced in our homes is a very common cause of not only dry skin, but dry eyes as well.  By taking a few simple precautions — both inside and outside — you can ensure that dry and itchy eyes are avoided.  In most cases, dry eyes are caused by the quick evaporation of moisture from our tear ducts.  In dry weather, hot or cold, this can occur quickly and cause itching and dryness that is very uncomfortable.

Take Steps to Keep your Eyes Moist

Artificial Tears – Using artificial tears as directed can help keep your eyes moist when your tear ducts may not be able to keep up with the dryness of the air.
Sunglasses – Wearing sunglasses when out in the cold weather can shield them from direct contact with the cold dry air particularly when it is windy.
Humidifiers – When indoors, use a humidifier to make the environment less dry.  Indoor heat can dry the air, making your natural moisture dry up faster than usual.
Cut down on coffee – Qe already drink more warm liquids during the winter months in order to warm up, but coffee is a mild diuretic that can cause dryness in your eyes and skin.  Monitoring your coffee consumption may aid in keeping your eyes more moist.

By making sure that your eyes are moist at all times, you can experience less discomfort while both inside and outside during the winter.

Do you have more questions?

If you feel you’re experiencing Chronic Dry Eye, and would like more information on treatment, we encourage you to contact us today.  Dry eye is a common condition especially in the colder seasons, and we can work together to find the best treatment options for you.  Our offices are located in Winchester, serving Virginia, West Virginia and Maryland.  We can be reached at (540) 722-6200.  Call today to make an appointment.

Source: http://www.seeclear.com/blog/dry-eye-carerestasis/dry-eyes-in-the-winter-months

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Baltimore Eye Surgeon Now Performing Cosmetic Eyelid Surgery

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Baltimore, MD – According to the Administration on Aging (AOA), persons 65 and older represented nearly 13% of the U.S. population in 2009, and are expected to represent 19% by 2030. The Bureau of Labor Statistics finds that the number of older Americans in the workforce is growing as well. As the population and workforce ages, Baltimore eye surgeon Jay C. Grochmal, MD says his patients that are late stage baby-boomers are under extreme pressure to maintain a high level of performance in the workplace, and portraying a vivacious and youthful appearance is essential to continued success.

While helping patients improve their vision with procedures such as LASIK and cataract surgery is important to success in the workplace, Dr. Grochmal says the desire to help his patients enhance their aesthetic appearance has become an important part of his practice as well. He says this growing demand for increased confidence and a natural-looking enhancement is what led him to the decision to add cosmetic eyelid surgery to his list of procedures: “Our society places such a high value on appearance and equates a youthful look with the likelihood of business and social success. Baby boomers are still very active and productive and a refreshed look can eliminate unwarranted bias in career choices.”

As the number of cosmetic procedures performed in the U.S. continues to increase, Dr. Grochmal says the desire to look younger longer is obvious, adding that a tough economy and high unemployment rate further contribute to the stress his older patients must endure. Because he constantly strives to improve patient care while providing the latest and safest procedures, Dr. Grochmal says providing cosmetic treatments for his patients is a result of his original commitment to provide the most effective treatments available to meet any and all needs of his patients: “As the cliche goes now, 50 is the new 40 and 60 is the new 50, and so on. My patients want to look as young as they feel and be able to see well too. Ultimately, we believe providing cosmetic eyelid surgery will improve their chances of success in the workplace.”

About Jay C. Grochmal, MD

After earning his medical degree from the University of Maryland, Dr. Jay C. Grochmal completed his residency while achieving the rank of Chief Resident at the Greater Baltimore Medical Center’s Department of Ophthalmology. In addition to being on staff at some of the leading hospitals in the Baltimore area, Dr. Grochmal has traveled on a number of missions dedicated to improving eye care around the world.

Grochmal Eye Center is located in the Catonsville Professional Center at 405 Frederick Rd., Ste. 102, Baltimore, MD 21228, and can be reached at (410) 697-4090. Dr. Grochmal and his team can also be reached at grochmaleye.com or their Baltimore Eye Care Facebook page.

Source: http://www.grochmaleye.com/oculoplastic/baltimore-eye-surgeon-now-performing-cosmetic-eyelid-surgery/

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Baltimore LASIK Surgery Practice Hosts Valentine’s Day Special Offer for BOTOX ® Cosmetic

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LASIK Surgeon in Baltimore Announces BOTOX Cosmetic Special Offer for Valentine's Day

Dr. Jay C. Grochmal, a LASIK surgeon in Baltimore, has announced his practice will be hosting a special offer on BOTOX ® Cosmetic to provide patients with a rejuvenated appearance and improved self-confidence at a discounted rate. The offer will run until Valentine’s Day and will give patients the chance to take advantage of reduced pricing on BOTOX in Baltimore in preparation for celebrating the iconic holiday with their loved ones.

At his Baltimore cataract and LASIK surgery practice in Baltimore, Dr. Jay C. Grochmal has announced the beginning of a special offer on BOTOX ® Cosmetic for patients looking to boost their appearance before Valentine’s Day. From now until the upcoming holiday on February 14, the Grochmal Eye Center will be offering BOTOX ® Cosmetic at $9.75 per unit. Dr. Grochmal and his practice provide laser vision correction procedures such as LASIK in Maryland, as well as cosmetic enhancements including BOTOX ® injections, Juvederm®, and eyelid surgery.

Dr. Grochmal says cosmetic procedures such as the non-invasive BOTOX ® Cosmetic and surgical procedures like eyelid surgery can offer patients an aesthetic addition to their LASIK or laser vision correction surgery in order to provide a more comprehensive and noticeable enhancement to their new, clearer vision. Dermal injections like Juvederm® and BOTOX ® Cosmetic are designed to tighten loose skin and treat wrinkles and facial lines. He says with reduced pricing on BOTOX ® Cosmetic and his variety of aesthetic procedures, patients now have the opportunity to improve self confidence and tighten the skin under their eyes for a completely refreshed outlook on life.

For patients interested in taking advantage of the Grochmal Eye Center’s BOTOX ® Cosmetic special for Valentine’s Day, Dr. Grochmal says to contact his practice for more information. He also adds that consulting with an experienced and qualified practice is essential for achieving safe and effective treatment.

About Jay C. Grochmal, MD

Dr. Jay Grochmal received his medical degree from the University of Maryland, after which he completed a rotating internship at the U.S. Public Health Hospital in Baltimore. During his residency, he achieved the rank of Chief Resident at the Greater Baltimore Medical Center’s Department of Ophthalmology. Dr. Grochmal is on staff with the Greater Baltimore Medical Center and St. Agnes Hospital. He has participated in several medical mission trips to third world countries to provide his expertise in eye care, including Pakistan, Jamaica, and the Bahamas. Dr. Grochmal is also a member of the American Academy of Ophthalmology.

Located at 405 Frederick Road, Suite 102 in Baltimore, MD, the Grochmal Eye Center can be reached at (410) 697-4090. It can also be contacted online via the website grochmaleye.com or facebook.com/grochmaleye.

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Source: http://www.grochmaleye.com/blog/baltimore-lasik-surgery-practice-hosts-valentines-day-special-offer-for-botox-cosmetic/

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Improvised chest seal

Source: http://adventuredoc.net/2013/01/05/improvised-chest-seal/

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Glaucoma Worsens in Winter, Reports National Post

Sad as it is, Summer is almost at its end.  Soon, we’ll be trading in our swimsuits and sandals for scarves and sweaters.  And, while we typically associate the season with shorter days, changing leaves and cooler weather, researchers are now explaining that the cold months of winter may also have a profound impact on something far more important – your eye health.

“A study done at the Devers Eye Institute in Portland, Ore., found [Glaucoma] worsens in cold weather, especially among people in early stages of the disease,” reports Canada’s National Post.  “The more extreme the weather patterns, the greater the impact on a person’s intraocular pressure and sensitivity.”  Glaucoma, which is the leading cause of blindness and visual impairment in the US, is commonly associated with an increased pressure in the eye.  The condition can affect patients of all ages, many of whom do not experience any symptoms and may not be aware that they have the disease.

And, while still a new study, these findings serve as an important reminder: although winter is still a few months out, take the time to come in for a glaucoma screening.  If you think you may already be suffering from the condition, explore glaucoma treatment today!

Treatments for Glaucoma

Glaucoma is a progressive condition, and once it has been diagnosed, treatment should begin as soon as possible to help minimize the risk of permanent vision loss. While there is no cure for glaucoma, there are treatments available.  These tend to focus on relieving symptoms and preventing further damage from occurring.

Common glaucoma treatments include:

  • Eye Drops: Glaucoma eye drops are typically used to reduce fluid production in the front of the eye or to help drain excess fluid.
  • Laser Surgery: Laser surgery for glaucoma works to increase the outflow of fluid from the eye or eliminate fluid blockages.
  • Microsurgery: Microsurgery works to reduce pressure in the eye by creating a new drainage channel, allowing fluid to drain from the eye.

Glaucoma Treatment in Winchester

To schedule an eye exam or to learn more about Glaucoma Treatment, contact us today.  Our Ophthalmology Offices are located in Winchester, serving Virginia, West Virginia and Maryland. Book your appointment at (540) 722-6200.  We look forward to hearing from you.

Source: http://www.seeclear.com/blog/glaucoma/glaucoma-worsens-in-winter-reports-national-post

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Friday, March 29, 2013

Adventure Medicine Magazine

Source: http://adventuredoc.net/2012/09/15/adventure-medicine-magazine/

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Dr. Labor Publishes New Technology Article In National Publication

Cataract & Refractive Surgery Today, a major industry publication, recently asked Phillips Kirk Labor, MD to share his expertise about a revolutionary cataract surgery technology he introduced to Dallas/Fort Worth in 2011. The result was an article Dr. Labor authored, Updating Your Practice With Advanced Technology, with the subtitle, Intraoperative aberrometry is a worthwhile investment for the practice and provides added security for cataract patients. The article appeared nationwide in the October 2012 issue.

A prime example of intraopertive aberrometry he discusses is the ORA System. This is a “wavefront aberrometry device,” the first of its kind to measure cataract surgery results in real time – during the procedure. Previously called ORange, Dr. Labor was the first metro Dallas/Fort Worth eye surgeon to use this technology when it was introduced in 2011. When ORange changed to the further enhanced ORA System, Dr. Labor remained at the forefront as an early adopter of this newer, better technology. Today, he is one of the top ORA surgeons in the world.

Cataract & Refractive Surgery Today is a trusted, highly regarded publication among leading surgeons all over the world. I was grateful when they contacted me, and didn’t hesitate to do it,” Dr. Labor said. “Although written for our industry, my main goal, however, was to share my experiences and successes related to how this benefits the patient first.”

To learn more about the ORA System, or any our comprehensive eye care services, please call us in Grapevine at 877-516-4364. We’re conveniently located to all of Fort Worth and Dallas.

Source: http://www.eyectexas.com/blog/dr-labor-publishes/

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Cholera in Zambia, Dominican Republic and Cuba

There are current outbreaks of Cholera in Zambia, the Dominican Republic and Cuba.

Zambia – the outbreak is in northern Zambia, more than 400 miles from Lusaka.

Dominican Republic – at present the outbreak is confined to a correction facility in the far eastern end of the island.

Cuba – there have been several outbreaks following Hurricane Sandy, including one in the area of Old Havana, a popular area with tourists. Travellers should take extra care with food and water, and should consider vaccination.

Sources: ProMed Newsgroup and Agence France-Presse

For advice about Cholera and other travel related illnesses and vaccinations, contact the Globe Travel Health Centre in Norwich on 01603 667323

Source: http://www.globetravelhealthcentre.com/travel-advice/cholera-in-zambia-dominican-republic-and-cuba.html?utm_source=rss&utm_medium=rss&utm_campaign=cholera-in-zambia-dominican-republic-and-cuba

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It’s World Diabetes Day

In honor of World Diabetes Day, Kaiser Permanente’s Care Stories blog is highlighting stories of patients dealing with the disease. You can view all the stories here. The video below is about a physician who was surprised to find out she was diabetic, herself. Now she says her diagnosis is helping her be a better doctor for her patients.

Learn more about diabetes—including risk factors, warning signs, prevention and treatment—at the International Diabetes Federation website.

Source: http://centerfortotalhealth.org/2012/its-world-diabetes-day/

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The flu season has now started!!

Winter flu outbreak has now started – and it looks as though it may be a much worse season than last year.

Just as a couple of winters ago, children seem to be catching flu as well.

Globe Travel Health Centre has stocks of flu vaccine, and will also vaccinate the under 16s…

For further advice, contact the Globe Travel Health Centre on 01603 667323

Source: http://www.globetravelhealthcentre.com/travel-advice/the-flu-season-has-now-started.html?utm_source=rss&utm_medium=rss&utm_campaign=the-flu-season-has-now-started

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Careers As Advanced Health Care Practitioner In Demand

According to data collected by the American Medical Group Association’s and Cejka Search 2011 Physician Retention Survey, careers in the advanced health care field are growing rapidly.  As such, employment in medical groups for nurse practitioners (“NPs”) and physician assistants (“PAs”) has increased significantly in the past five years.  According to the data, 75% of the responses to the survey indicated more NPs and PAs will be hired in the next five years.

Growth in these advanced health care professions is due largely to economics, according to an article in U.S. News and World Report.  NPs, for example, can provide patients with many primary health care services at a fraction of the cost of an internist.  In addition, FiercePracticeManagement reports that due to physician shortages and the demand to create a medical “team” to care for patients (accountable care organizations, “ACO”), medical groups are employing the NP and PA at increasingly high rates.  This gives NPs and PAs the advantage of choosing where to work, thus creating a high turnover rate for these positions.  In addition, recruiting and retaining these professionals are challenges to medical groups.

Meiselman, Denlea, Packman, Carton & Eberz P.C. offers legal advice to physicians on medical issues.  If you need legal assistance or guidance on a matter regarding your practice, please call our office.

Source: http://www.pagingdrblog.com/2012/04/17/careers-as-advanced-health-care-practitioner-in-demand/

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Thursday, March 28, 2013

One thousand patients with primary myelofibrosis: The Mayo Clinic experience

Ayalew Tefferi, M.D., with the Department of Hematology at Mayo Clinic in Rochester, Minn., discusses the results of a study of 1,000 patients who have primary myelofibrosis.

Key findings
Researchers found that when patients with myelofibrosis present, their clinical features are not at a steady state and usually progress within the first few months of the diagnosis. It is best to wait a several months before providing a prognostic score.

Many patients with primary myelofibrosis can live a long life (exceeding 15 years) and patients who won’t live that long can be identified.

The most recent version of DIPSS-plus scoring system performed much better than prior versions, helping researchers to determine what proportion of patients with myelofibrosis are suitable for therapies. More than 50 percent of patients require observation alone.

A description of the study is included in the January 2012 issue of Mayo Clinic Proceedings.

ABSTRACT
Objective
To share our decades of experience with primary myelofibrosis and underscore the importance of outcomes research studies in designing clinical trials and interpreting their results.

Patients and methods
One thousand consecutive patients with primary myelofibrosis seen at Mayo Clinic between Nov. 4, 1977, and Sept. 1, 2011, were considered.

The International Prognostic Scoring System (IPSS), dynamic IPSS (DIPSS), and DIPSS-plus were applied for risk stratification. Separate analyses were included for patients seen at time of referral (N=1000), at initial diagnosis (N=340), and within or after 1 year of diagnosis (N=660).

Results

To date, 592 deaths and 68 leukemic transformations have been documented. Parameters at initial diagnosis vs time of referral included: 

  • Median age (66 vs 65 years)
  • Male sex (61% vs 62%)
  • Red cell transfusion need (24% vs 38%)
  • Hemoglobin level less than 10 g/dL (38% vs 54%)
  • Platelet count less than 100 × 109/L (18% vs 26%)
  • Leukocyte count more than 25 × 109/L (13% vs 16%)
  • Marked splenomegaly (21% vs 31%)
  • Constitutional symptoms (29% vs 34%)
  • Abnormal karyotype (31% vs 41%)

Mutational frequencies were 61% for JAK2V617F, 8% for MPLW515, and 4% for IDH1/2.

DIPSS-plus risk distributions at time of referral were 10% low, 15% intermediate-1, 37% intermediate-2, and 37% high. The corresponding median survivals were 17.5, 7.8, 3.6, and 1.8 years vs 20.0, 14.3, 5.3, and 1.7 years for patients younger than 60 years of age.

Compared with both DIPSS and IPSS, DIPSS-plus showed better discrimination among risk groups. Five-year leukemic transformation rates were 6% and 21% in low- and high-risk patients, respectively.

Conclusion
The current document should serve as a valuable resource for patients and physicians and provides context for the design and interpretation of clinical trials.

AUTHORS
Ayalew Tefferi, M.D.,  Terra L. Lasho, M.T., Thitina Jimma, M.D., Christy M. Finke, B.S., Naseema Gangat, MBBS, Rakhee Vaidya, MBBS , Kebede Hussein Begna, M.D., Aref Al-Kali, M.D., Rhett P. Ketterling, M.D., Curtis A. Hanson, M.D., Animesh Pardanani, MBBS, Ph.D.

Source: http://physicianupdate.mayoclinic.org/2012/03/15/one-thousand-patients-with-primary-myelofibrosis-the-mayo-clinic-experience/

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HIV Vaccines and the future

Source: http://adventuredoc.net/2012/10/24/hiv-vaccines-and-the-future/

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Shopping for LASIK? Want a chance to win the NEW iPad Mini?

Attend our How To Shop For LASIK event November 13, 6:30-7:30 PM.

It’s almost gift-giving season. If you have to depend on glasses or contacts every day, LASIK could be one of the best gifts you can give yourself. Whether you’ve been shopping for LASIK or not, our How To Shop event can help you shop smarter. In just 60 minutes, one of our expert doctors will give you the honest scoop in a simple way you can understand – what the procedure’s like, costs, financing, generally what to expect, and if you’re a candidate for LASIK.

But it gets even better.

Just for attending, you could win a cool new iPad Mini* we’ll give away that night! That’s right, this is a brand new iPad just announced, and sure to be the hottest ticket this holiday season. In fact, the new iPad Mini is so new, it may still be on order as of the date of this event. If you win, we’ll notify you immediately upon it’s arrival.

Remember that LASIK is an elective procedure, so it’s important to shop with your eyes open. Our How To Shop For LASIK event, November 13, is a good place to start. It’s Free, and we’re hosting it at our beautiful Grapevine offices. We’re located just off Hwy 114, convenient to Fort Worth and Dallas Metro.

To reserve your space, call us in Grapevine at 877-516-4364 today.

*Single winner will be determined by random drawing. There’s no purchase necessary, but you must be 18 years or older to attend, and be present to win.

Source: http://www.eyectexas.com/blog/shopping-for-lasik/

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Federal Government Questions Legality Of Certain ASC-Service Provider Arrangements

Recently, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services issued an advisory opinion regarding two types of Proposed Arrangements between an anesthesia provider (AP) and physician-owned ambulatory surgery centers (ASCs). This came as a result of a request for an opinion from an AP who, because of competitive market pressures, was considering one of two new business relationship models. Under the AP’s current professional arrangement, the ap offers exclusive anesthesia services to ASCs, employs personnel to meet the anesthesia needs of the ASCs, and independently bills patients and third party payors, including Medicare, for professional fees. The ASCs bill the same parties for professional services plus a facility fee for materials and ancillary staff.

  • Under Proposed Arrangement A, the AP would continue to provide exclusive anesthesia services to the ASC and to bill independently. Additionally, the AP would pay a market value “management services” fee to the ASC for each non-Federally funded patient. The ASC would both collect this fee and continue to charge a facility fee to Federal and third party payors.
  • Under Proposed Arrangement B, the ASC physician-owners would set up a separate subsidiary to exclusively provide anesthesia services to their patients. The subsidiary then would hire the AP as the exclusive independent anesthesia services contractor, handle all billing with the assistance of the AP and its staff, pay the AP out of fees collected, and retain any profits.

In analyzing the legality of the two arrangements, the OIG considered two questions: 1. Does either arrangement violate the Federal anti-kickback statute, and, 2. Would any safe harbor protection apply?

Under the anti-kickback statute, it is a criminal offense to offer, pay, solicit, or receive any remuneration for referrals reimbursable by a Federal health care program. This statute seeks to ensure that referrals are based on sound medical judgment and not financial or other incentives. Regarding Proposed Arrangement A, although the AP would pay a management services fee only for non-Federal health care program patients, this does not reduce the risk that the fee might be paid by the AP to induce referrals from the ASC of all types of patients. Additionally, the arrangement allows the ASC to be paid twice for the same services, and this could unduly influence the ASC to select the AP as the exclusive provider. The OIG concluded that Proposed Arrangement A could violate the anti-kickback statute. No safe harbor protections apply.

Safe harbor protections for ASCs, employment, and personal services and management contracts were determined to not apply to Proposed Arrangement B. The Subsidiary does not qualify as a Medicare-certified ASC because it would not provide surgical services, only anesthesia services. As such, its income and the profits distributed to the ASC physician-owners would not be protected by any safe harbor provisions. Additionally, the OIG is concerned about exclusive arrangements between those who refer business (the ASC physician-owners), and those who furnish goods or services reimbursed by a Federal health care program (the AP). The AP and the ASC physician-owners both would benefit financially in Proposed Arrangement B, with the AP receiving its negotiated rate and the physician-owners receiving residual profits from the subsidiary after expenses and payment to the AP. The OIG concluded that Proposed Arrangement B would permit the physician-owners to receive compensation in the form of profits from the subsidiary from referring patients to the AP; this payment would be for services that they themselves could not provide. The more than minimal risk of fraud and abuse and the prohibited remuneration both would be in violation of the Federal anti-kickback statute.

Physicians should be aware of this development, as it may affect current and future professional relationships. A health care attorney can offer assistance in interpreting the potential impact of the OIG decision and evaluating the need to restructure business arrangements.

Source: http://www.pagingdrblog.com/2012/07/18/federal-government-questions-legality-of-certain-asc-service-provider-arrangements/

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Healthcare provider interaction

Source: http://adventuredoc.net/2013/01/03/healthcare-provider-interaction/

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Baltimore Laser Eye Surgeon Discusses the Future of Advanced Cataract Surgery

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Cataract Surgeon in Baltimore Discusses the Future of Advanced Procedures

Baltimore, MD — According to the latest statistics from the American Academy of Ophthalmology (AAO), cataracts affect nearly 22 million Americans age 40 and older. However, Dr. Jay C. Grochmal, a LASIK and cataract surgeon in Baltimore, says with the recent advancements in cataract surgery, patients do not have to let blurring vision hinder their daily life. Dr. Grochmal discusses the latest innovations in refractive-cataract surgery and how they can benefit patients looking to improve their vision.

At his Baltimore cataract surgery practice, Dr. Grochmal says the aging baby boomer population has brought an influx of patients needing vision correction for cataracts and other age-related conditions. Cataracts develop as people get older and are exhibited in a clouding and opaqueness of the natural lens inside one’s eye, causing vision to blur. The AAO report also shows that by age 80, more than half of all Americans will have visually significant cataracts. Dr. Grochmal says while cataracts can be a bothersome medical issue, the good news is that advancements in ophthalmology and surgical techniques have made clear vision an affordable and effective option through cataract surgery.

With procedures such as laser refractive cataract surgery on the horizon, Dr. Grochmal says treatment is now ultimately safer than ever before and more successful in helping patients achieve improved vision with less dependence on glasses. He says other innovations have helped create smaller incisions for lens extraction and replacement during cataract surgery, and through technology such as the Zeiss IOL Master, doctors can better measure the power of the intraocular lenses and offer more accurate visual results. “With the safety of cataract surgery improving, patients no longer have to wait for their vision to drastically deteriorate before undergoing cataract surgery. Also, the quality of newer IOL’s are allowing excellent vision after surgery,” says Dr. Grochmal.

Thanks to a diverse arsenal of lenses such as toric and multifocal IOL’s, Dr. Grochmal says patients can now enjoy the benefits of custom treatment for their individual eye condition and lifestyle needs. Whether patients wish to enhance their vision up close or far away or find a balance of clarity in both distance and near vision, he says there is a solution for every patient’s desires. Dr. Grochmal says cataract surgery recovery is now also much quicker and requires less trauma to the function of one’s eye. “With such small incisions now possible and the availability of toric IOL’s, post operative astigmatism can be minimized if not completely corrected,” he says.

Regardless of whether patients are looking for cataract surgery or another vision correction procedure such as LASIK in Baltimore, Dr. Grochmal says the advancements in ophthalmology are making significant strides towards helping people attain perfect, lasting eyesight. He adds that he is excited to see the further development of patient comfort and care and hopes patients continue to take advantage of the benefits that procedures like cataract surgery can offer.

About Jay C. Grochmal, MD

Dr. Jay C. Grochmal received his medical degree from the University of Maryland, after which he completed a rotating internship at the U.S. Public Health Hospital in Baltimore. He also completed a residency in the Department of Ophthalmology at the Greater Baltimore Medical Center, where he was Chief Resident. A member of the American Academy of Ophthalmology and the American Society of Cataract and Refractive Surgery, Dr. Grochmal has participated in several medical mission trips to offer his experience and skills in vision correction to patients in Pakistan, Jamaica, and the Bahamas. He is currently on staff with the Greater Baltimore Medical Center and St. Agnes Hospital. He is the medical director at the Snowden River Surgery Center.

Located at 405 Frederick Rd, Suite 102 in Baltimore, MD, Dr. Grochmal’s practice can be reached at (410) 697-4090. He can also be contacted online via the website grochmaleye.com or facebook.com/grochmaleye.

Contact:
Rosemont Media
Aaron Hurst
aaron@rosemontmedia.com
(858) 200-0044
www.rosemontmedia.com

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Source: http://www.grochmaleye.com/blog/baltimore-laser-eye-surgeon-discusses-the-future-of-advanced-cataract-surgery/

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Wednesday, March 27, 2013

New Tuberculosis drug and a TB refresher

Source: http://adventuredoc.net/2013/01/02/new-tuberculosis-drug-and-a-tb-refresher/

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Supreme Court Health Care Law Hearings

In November of 2011, the Supreme Court announced that it would hear challenges to President Obama’s health care reform law (Patient Protection and Affordable Care Act of 2010).  Those hearings are scheduled for March 26-28 and will address the following issues:

  • Are opponents of the new health care law challenging the law too soon?  According to the new law, everyone is required to purchase health insurance, with or without government assistance, or be fined (individual mandate).   However, it is unclear as to whether the fine to be imposed is considered a tax.  If it is a tax, then the Anti-Injunction Act, a federal law, prohibits anyone challenging the health care law until 2014, when violators will be required to pay the “fine” or “tax”.
  • Assuming the individual mandate can be challenged now, is the individual mandate constitutional?   There is a Commerce Clause in the Constitution, which allows Congress to regulate interstate commerce, but does this clause also allow Congress to require people to purchase health care insurance?
  • If the individual mandate is found to be unconstitutional, will the rest of the health care law remain in effect?   Sometimes a portion of the law can be struck down, if it is found to be unconstitutional, while the rest of the law continues in force.  If the Court finds that the unconstitutional part of the law is so intertwined with the rest of the law, then it comes to an all or nothing at all proposition.
  • Is the health care law’s expansion of the Medicaid program constitutional?   The argument is state versus federal rights.  The new law requires states to change their Medicaid programs, so that all people will be eligible for coverage.  If states do not change their laws, they will lose all of their federal funding for the program. 

The Supreme Court plans to release recordings of the arguments on its website (http://www.supremecourt.gov/) around 2 p.m. each day for arguments held that morning and around 4 p.m. for arguments held in the afternoon of March 28.   After hearing the challenges to the new health care law, the Court is expected to reach its decision in June 2012.

Source: http://www.pagingdrblog.com/2012/03/19/supreme-court-health-care-law-hearings/

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Safety Of Medical Implants Questionable

Millions of Americans receive medical implants yearly and those who do presume that the implants are safe and will alleviate, or at least help to ease, their specific medical problem.  However, according to a May 2012 article in Consumer Reports, “Dangerous Devices”, most implants (artificial joints, defibrillators, surgical mesh) have not been tested for safety and effectiveness.  The “testing” is done on the patient who has the medical device implanted.  In other words, patients are living with implants that often times give them more pain and suffering than not having had the implant at all.  According to the article, the FDA is not testing medical devices and most times all that is needed for the device to be placed on the market is for the manufacturers to “. . . file some paperwork and pay the Food and Drug Administration a user fee of roughly $4,000 to start selling a product that can rack up millions of dollars in revenue. . . .”   Frequently, it takes years before the FDA even tests a product or reclassifies it to a high-risk category.

It is crucial for doctors, as well as their patients, to research a medical implant thoroughly before implantation, as the consequences can be debilitating.  An orthopedic surgeon, for example, who had an all-metal hip replacement (the same type of device he implanted in his patients) experienced medical issues of increased chromium and cobalt levels in blood, sleep disturbance, constant pain, mood swings and anxiety, hearing loss, tinnitus, and visual problems.    

Meiselman, Denlea, Packman, Carton & Eberz P.C. offers legal advice to physicians on medical issues.  If you need legal assistance or guidance on a matter regarding your practice, please call our office.

Source: http://www.pagingdrblog.com/2012/05/08/safety-of-medical-implants-questionable/

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Dry Eyes in the Winter Months

The cold dry air that is common in the winter months can have adverse effects on the moisture in your eyes.  But what many people may not realize is that your eyes can become just as dry while trying to keep warm inside.  The heat produced in our homes is a very common cause of not only dry skin, but dry eyes as well.  By taking a few simple precautions — both inside and outside — you can ensure that dry and itchy eyes are avoided.  In most cases, dry eyes are caused by the quick evaporation of moisture from our tear ducts.  In dry weather, hot or cold, this can occur quickly and cause itching and dryness that is very uncomfortable.

Take Steps to Keep your Eyes Moist

Artificial Tears – Using artificial tears as directed can help keep your eyes moist when your tear ducts may not be able to keep up with the dryness of the air.
Sunglasses – Wearing sunglasses when out in the cold weather can shield them from direct contact with the cold dry air particularly when it is windy.
Humidifiers – When indoors, use a humidifier to make the environment less dry.  Indoor heat can dry the air, making your natural moisture dry up faster than usual.
Cut down on coffee – Qe already drink more warm liquids during the winter months in order to warm up, but coffee is a mild diuretic that can cause dryness in your eyes and skin.  Monitoring your coffee consumption may aid in keeping your eyes more moist.

By making sure that your eyes are moist at all times, you can experience less discomfort while both inside and outside during the winter.

Do you have more questions?

If you feel you’re experiencing Chronic Dry Eye, and would like more information on treatment, we encourage you to contact us today.  Dry eye is a common condition especially in the colder seasons, and we can work together to find the best treatment options for you.  Our offices are located in Winchester, serving Virginia, West Virginia and Maryland.  We can be reached at (540) 722-6200.  Call today to make an appointment.

Source: http://www.seeclear.com/blog/dry-eye-carerestasis/dry-eyes-in-the-winter-months

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Interview With Law Of Attraction Expert Bob Doyle From Wealth Beyond Reason

Bob Doyle is The Founder & CEO of Boundless Living, Inc. You may know
Bob from his appearances in the popular movie and best-selling book,
“The Secret”. Bob was one of the featured “teachers” in both. Before
“The Secret” was featured on, “The Ellen DeGeneres Show”, “Larry King
Live, and “Oprah” – Bob had written his own book called, “Wealth Beyond
Reason”
.

Bob Doyle - Author & CEO of Boundless Living, Inc.

For years Bob had jumped around from career to career, trying
desperately to find something that provided a solid income for him and
his family, but also tapped into his sense of passion and creativity.
After 4 years at his last corporate job, he literally felt like he was
dying and made the decision to quit his job, give up his salary and
benefits, and create a business of his own.

This proved to be quite a challenging endeavor. Bob was $70,000 in debt
and had started to receive phone calls from creditors. Further, his
various attempts at creating a business that was both fun and profitable
were simply not working. Ironically, the businesses he was trying to
create were focused on helping people to live their lives by design, and
although he could “teach” these concepts, there was clearly simply a
component he was missing, as his own life clearly showed.

It was at this point, he set a new intention for himself. Instead of
putting his attention on “solving his money problems”, he instead
focused on what he truly wanted his life to look like. He created a new
inspiring vision for himself and let go of trying to “figure everything
out”, and instead decided to follow his intution into inspired action.

The dramatic change of approach eventually led him down a path to the
answers he was seeking. As a result of what he learned, he was able to
finally create a business that he loved, and was very lucrative.

Soon, he wrote his first book, “Wealth Beyond Reason“, based on his
Internet program of the same name and built up his Internet presence of
www.BoundLessLiving.com to a 6 figure, and eventually a 7-figure income
and now he is helping others live the life of their dreams and own their
own terms, utilizing the same principles that facilitated the change in
his own life.

Here is our interview with Bob Doyle.

Abundant Health Center: Bob, hello. Thank you for taking your time to
speak with us today. A lot of people (I think) get confused by the
title of your book, and of course now it is an entire course, “Wealth
Beyond Reason” – but it’s really more than “material” or “physical”
wealth isn’t it? Would you mind explaining what it means to you and how
you came up with the idea to write this wonderful book?

Bob Doyle: Well, the book of course was based on our Internet curriculum
in the Law of Attraction, also called Wealth Beyond Reason. And
honestly, I wrote the book based on the material in the program because
I needed something physical to give to people at an upcoming speaking
event! I never really ever planned to write the book. It just showed up
as an inspired action to take, and I’ve definitely learned to follow
through when I get a “nudge” to do something like this.

One of the first things we do in the program and the book is help people
to define what “wealth” really means to them. Obviously, our natural
inclination is to associate wealth with the amount of money that we have
- but for the purposes of the work we do, we distill a different
definition of wealth which is, in essence, the ability to do what we
truly want to do, whenever we want to do it.

That may mean you have a lot of money and that financial abundance
facilitates your ability to live the life you want. But many people have
passions or callings that bring them great happiness and fulfillment,
but don’t necessarily require huge bank accounts.

In any case, it’s important for people to get clear on what they truly
do want – what really inspires them in a powerful way – so that they can
understand what “wealth” really means to them.

A.H.C: Was it during the time of writing the book that you started the
Bill Phillips “Body For Life Challenge”?

B.D.: Actually, the Body For Life Challenge came 2 years BEFORE I was
doing any of this work, but it was an key part of my journey, because it
was during this time that I learned a tremendous amount about what drove
people to successful results in ANY area of their lives.

A.H.C.: Isn’t this when you really started helping people achieve their
goals? Because at this time you created a website / forum for people to
come to and participate in their own “body revolution” at
www.BodyChangers.com correct?

B.D.: Bodychangers was the result of following my newly discovered
passion for fitness – and moreover, what were the keys to success in
taking on a physique transformation. After all many more people TRY to
change their bodies dramatically than actually succeed. Bodychangers was
a study in what the successful people did. After a while I began to see
patterns among the most successful that transcended simply the diet and
exercise program they chose.

The most successful and inspiring stories on the Bodychangers web site
came from people who had an extremely powerful “WHY” with regards to
their reasons for taking on the transformation. I saw that when people
got clear that being more physically fit was going to to help them live
the lives they truly wanted – to allow them to truly be the best and
most powerful version of themselves possible – their results far
outweighed those who took on an exercise program to simply have their
jeans fit better or something similar.

A.H.C.: So, not only were you working on your body with the Bill
Phillips Challenge, but you were also learning more about personal
development in general. How did your work with BodyChangers eventually
evolve into the work you do now with Boundless Living?

B.D.: After about 2 years of interviewing around 150 people about their
physique transformation stories, I was starting to feel myself burn out
a little. I was feeling that there were common themes among the
interviews and that even if I never did another interview, the site
would still be able to help people the way I intended it to.

At the same time, I felt called to expand what I was teaching outside of
simply the fitness area – because what I learned from all those
interviews was the importance of getting clear on what inspires you -
what you’re passionate about – and who you truly want to be. It was
during that time that the name “Boundless Living” popped into my mind,
and I knew then that I wanted to start making a difference for their
lives as a whole.

When I finally had the “ah-ha” moments in my own life as to why things
weren’t working, and as a result created the Wealth Beyond Reason
program, I knew it was time to bring my work with BodyChangers to a
close and focus my attention on my work with the Law of Attraction and
following ones passion.

A.H.C.: What are some of the books that were the biggest influencers on
you?

B.D.: The book that turned it all around for me was David Cameron
Gikandi’s “A Happy Pocketful of Money“. It’s an amazing study of how our
lives in this Universe work, and discusses the principle of “wealth
consciousness” (something I was definitely struggling with prior to
reading the book.)

I was able to gain an understanding of the power of our thoughts and
beliefs on a quantum level and that made all the difference for me.

Another book which I read YEARS prior that opened my mind to all kinds
of possibilities was Richard Bach’s “Illusions“.  In my mind that’s
must-reading for every human.

A.H.C.: Bob, you work with people from all types of different
socioeconomic backgrounds, in fact, you work with clients from different
parts of the world…what are some of the common denominators that you
find are holding people back from what they want to have (and what they
can have) in life?

B.D.: For the most part, it all boils down to the limiting beliefs we
have. These beliefs come from all sources: parents, friends, society,
television…the list goes on and on. Different cultures have their own
sets of beliefs of course, but wherever there is a belief in limitation
that is passed down to us, it creates something called “resistance” in
us as humans. This resistance is real energy that has an impact on what
we can experience in our lives. The scientific aspect of this
conversation gets a little deep, but suffice it to say that if we want
to attract anything in our lives – be it money, a healthy body, or a
great relationship – our belief system has to be in alignment with
having that or we will always run into problems realizing our goals in
these areas. This is actually what most of my work is about.

A.H.C.: What are three key things that people should know if they want
to transition out of the daily grind of a corporate job and start a
business of their own?

B.D.: First, they have to get super clear on what they want to do and
WHY they want to do it…and that reason should go beyond just “making
money.” They need to identify how, through this business, they are going
to creatively express themselves and their passions…as this is the
best way to assure they bring their most powerful and focused energy
into their work.

Secondly, they need to start recognizing what limiting beliefs they
might have lurking under the surface as it pertains to success in
whatever business they take on. Some of these beliefs may be very
obvious such as “I don’t know anything about running a business”, but
other beliefs run a lot deeper and may take a different kind of “work”
to deal with. Again, that’s what I help people do every day. It’s
absolutely essential.

Finally, they’ve got to be committed to taking constant inspired action.
This doesn’t necessarily mean they have to “work hard” (though it may
look from the outside that they ARE working hard.) It means that they
learn to follow their own intuitive nudges in terms of what action to
take when. If you’ve never done this before, it can take some practice,
but learning to trust and follow your intuition is what makes any
endeavor fun and seemingly effortless.

A.H.C.: Where can our readers find out more about you, the work that
you do, and the coaching that you offer?

B.D.:  Virtually everything I know I put into the Wealth Beyond Reason
program, which can be found at http://www.WealthBeyondReason.com, but we
also have smaller programs that address certain aspects of “living your
life by design” that can be found at http://www.BoundLessLiving.com – I
also post regular updates on Twitter, FaceBook, and YouTube.
 

A.H.C.: Is there anything else that you would like to add?

B.D.: Human beings have enormous creative potential. However, we’ve
learned far more limitation that possibility. However the limitation
we’ve learned to a great degree is an illusion that seems real because
of the impact those limiting beliefs on our ability to “attract” the
experiences in our lives that would make us feel more powerful. You can
do yourself no greater service that to take the time to decide what you
truly want your life to be, learn a bit about the energetic nature of
the Universe and your role in it, and commit to taking consistent
inspired action in the direction of your most inspired dreams.

A.H.C.: Bob, thank you for taking the time to speak with us today.

B.D.: Totally my pleasure.

Source: http://www.abundanthealthcenter.com/blog/interviewwithlawofattractionexpertbobdoylefromwealthbeyondreason

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