Monday, April 27, 2009

Institute For Medical Wellness Vision

April 27, 2009

I have often been asked how and why I developed The Institute For Medical Wellness.

So here goes.

It all came down to following my vision of what makes a true Family Physician and developing a practice with this mission. This vision has been shaped and reshaped over the past 18 years. Upon graduation from medical school in 1991, and completing an internship and residency in Family Practice in 1994, I felt very well trained to begin my career. My first four years were spent working for another family physician with two offices. One was based in Cherry Hill and the other in North Camden. During those years I matured alot as an individual and as a physician. I learned that being a physician is not just about diagnosis and treatments. It is about building relationships based on trust and mutual respect.

My goal since childhood has always been to have a private practice. So in 1998 I started my own solo private practice in Moorestown. At the time I was told by a majority of physicians that I would never succeed. The prevailing thought in 1998 was that independent medical practices were too risky. In 1998, hospitals were buying up independent practices and physicians became employees of large hospital orgaizations. Well, if you do not know me well yet, I have my own views, many of them contrarian. I do not believe that the majority opinion is always correct. I also do not always play well with others, so an independent practice was my best career decision and I have never looked back and never regretted it.

Now starting a practice from scratch was not easy, but it was the right thing for me. It was slow the first year, but by the second and third year, things were moving along nicely. I was busy enough to be happy, but not so busy that I couldn't take the time necessary for each patient, as well as have enough time for my own family. Health insurance companies were strong, but they were not yet planting themselves between me and my patient's. But year after year insurance companies started requiring more and more bureaucratic nonsense in order for the proper delivery of care. Back in 2004-5 I stopped participating with 2 health plans due to their nonsense. My practice grew nonetheless. But again, each year brought more bureaucratic and governmental regulations that hindered the proper delivery of care. Referalls, preauthorizations, precertifications, electronic billing, HIPPA, and many others were not part of running an efficient and effective medical office when I started medical school. But this is what happens when Big Business and Big Government takes control of your healthcare.

In 2007, I was at a crossroads. My career goal was not to be the richest or poorest physician, but to be the best physician I could be. I explored two opportunities. One would have meant joining a large group practice that would deal with all the bureaucratic nonsense for me. The other was to convert my practice to a Concierge model. Both had many advantages, but also came with one big disadvantage, that being loss of control of how my practice is run. And as I stated before, I do not play well with others. So I needed another direction. I needed a practice model that fit my views of proper patient care and yet still remain viable in the community. So I brainstormed and put together the vision of The Institute For Medical Wellness. Special thanks to my wife, my daughter Nori, and great friend Ivy for all your help with bringing a name to my vision.

So in January 2008, The Institute For Medical Wellness was born and has been growing and evolving every day. It has not been all smooth sailing, and I have hit some bumps along the way, but overall I am moving in the right direction. Being in practice for 18 years, I have become more realistic in my views on medical care. I have learned that traditional medical care does not have all the answers. So while I received a traditional medical school education, my views now also include holistic approaches. In the treatment or prevention of illness, we need first to do it safely and effectively. I do not like to order tests just to order tests. I do not prescribe medications just for the sake of medications or expediency. I do not like calling in a prescription over the phone without a proper evaluation. That is not the best care I can provide. When I do prescribe medications or order tests, it will be the least amount necessary to do the job right. More is not necessarily better when it comes to medical treatment. My views are also that most disease can be classified as mild, moderate or severe. A holistic approach may work very well for prevention of disease as well as for mild disease. But when we get to moderate to severe disease, a traditional approach may be necessary. That being said, nothing makes me happier than lowering medication use by way of a healthier and more holistic lifestyle. Treatment without medications is always the number one goal.

So it is now the Spring of 2009. The Institute For Medical Wellness is 16 months old and is still in its infancy. But like all infants learning to walk, our legs are getting stronger each day. We are learning what our patients want and expect and are doing our best to accomodate in the safest and most effective way possible. The most frequent question has been about offering a closer integration of holistic approaches to treatment. So in future newsletters I will be introducing some holistic integrations available to improve your overall health and wellness. Many of our affiliates listed on my wellness network page will become more visible and available for your care.

So please stay tuned and be certain that The Institute For Medical Wellness is focused not on Big Business or Big Government, but instead on each and every individual who steps through our door. Our focus has always and will always be focused on you!

Steven Horvitz, D.O.
Board Certified Family Medicine
Founder of The Institute for Medical Wellness
128 Borton Landing Road, Suite Two
Moorestown, NJ 08057
Phone: 856-231-0590
Fax: 856-294-0311

For more information about Dr. Horvitz and The Institute for Medical Wellness, please click here.

To view upcoming Wellness Network Events, please click here.

Wednesday, April 08, 2009

Your Metabolism and You- Part Two

April 8, 2009

Dr. Steven Horvitz- Reading between the Lines:
Bringing you healthcare information you can trust!

Your Metabolism and You- Part Two

As mentioned in my previous newsletter, You and Your Metabolism - Part One, your weight is a result of a balance between anabolism-the storing of energy, and catabolism- the burning of energy. If you are overweight you tend to store more energy than you burn. If you are underweight, you tend to burn more energy than you store. During your yearly wellness exam, I take the time to review your diet and food choices. It also tends to be the time when my patient's eye contact starts drifting away. But back to your metabolism. The most common discussion if you are overweight is about becoming more of a burner than a storer of energy. While we all know that exercise increases the burning of energy, all the exercise in the world will not make you lose a whole lot of weight if you still store too much energy as fat. So how can you tip the balance towards becoming a burner as opposed to a storer?

Let me explain by bringing insulin into the equation via carbohydrates and sugar.


When you eat carbohydrates, and that includes both simple and complex carbohydrates, they are digested and broken down into glucose which enters your bloodstream. Elevated concentrations of glucose in blood stimulate the release of insulin, and insulin acts on cells thoughout your body to stimulate uptake, utilization and storage of glucose. When glucose is overabundant, it gets converted into triglycerides and stored as fat.

See the diagram below:

Excess carbohydrates---> increased glucose (sugar) ---> increased insulin---> increased storage of fat ---> increase in bad cholesterol ---> increase in weight.

So if you want to lose weight, and have that weight loss come from loss of fat, then by decreasing your carbohydrates the following occurs:

Low carbohydrates---> normal glucose---> normal to low insulin---> decrease in storage of fat---> decrease in bad cholesterol --->burning of fat for energy--->decrease in weight.

Let us look at this another way. When we need energy to burn, our body first uses glycogen (liver glucose store), followed by glucose available from our bloodstream. When these are used up, the next most available energy source is from our fat cells. So if we keep our carbohydrates low, thereby lowering the amount of glucose available for use, our bodies become better at burning our fat cells for fuel. Our metabolism shifts to burning more fat than we store, and weight loss comes predominantly from our fat stores. In men this is usually a decrease of weight around the abdomen. In women the weight loss occurs from the hip, legs and buttocks.

Now, if we want to build muscle, insulin as an anabolic hormone helps. When we eat abundant protein, this is digested into amino acids. Insulin acts upon the amino acids to form proteins. Proteins are the building blocks of muscle. To increase your muscle tone, start a good exercise program, to stimulate insulin to build muscle. This is why body builders can eat a whole lot of calories, put on a lot of muscle, but keep their body fat low. This is opposite to sumo wrestlers. Sumo wrestlers eat a high carbohydrate diet, thereby increasing their fat storage, and thus increasing their weight.

So take your pick.

Low carbohydrate diet with moderate exercise:






Or,

High carbohydrate with minimal exercise:







Any questions???

If you have any suggestions about topics for future newsletters, or how to make the newsletter better, please send me an email at DrHorvitz@DrHorvitz.com.

To Good Health!!

Steven Horvitz, D.O.
Board Certified Family Medicine
Founder of The Institute for Medical Wellness
128 Borton Landing Road, Suite Two
Moorestown, NJ 08057
Phone: 856-231-0590
Fax: 856-294-0311

To view previous newsletters, please click here.

For more information about Dr. Horvitz and The Institute for Medical Wellness, please click here.

To view upcoming Wellness Network Events, please click here.

http://www.drhorvitz.com/

Saturday, April 04, 2009

Your Metabolism and You- Part One

April 4, 2009
Your Metabolism and You- Part One


The most common health complaint I hear in my practice deals with weight management. Upon visiting my office. my patient's often get grumpy when asked to step on the evil scale.

When the evil, vile scale is read, I often hear the phrase, "It must be that I have a slow metabolism". But we should all remember that evil spelled backwards is live, so a scale is not always such a bad thing, but a necessary part of my job, and helps to keep you a-live!


Overall, metabolism is not just about being overweight, but is also responsible for being underweight. How can this be? Let us take a look at metabolism, and its definition.

Metabolism is the set of chemical reactions that occur in living organisms in order to maintain life. These "metabolic" processes allow us to grow and reproduce, maintain our organs, and respond to our environments. Metabolism is actually a balance between anabolism-the storing of energy, and catabolism- the burning of energy.


If you store more energy than you burn, you gain weight and may look like the figure on the right in the above cartoon. If you burn more energy than you store, you lose weight, and may look like the figure on the left.

How we maintain balance to get to a healthy weight is where the fun, or pain begins, and has been the subject of numerous diet books, of which, I have read a great many. Some have made me laugh out loud, while others have changed the way I eat and the way I practice. The first book I read was Protein Power, by Dr Eades. This book went over the metabolic processes of how we store and burn energy. It advocated we lower carbohydrates in our diet along while increasing both proteins and fats. It went against most of the lessons I was taught in medical school, yet it made tremendous sense. But I was not yet convinced and was not about to change my views based on one book. So I continued to research. Dr Atkins diet revolution, The Schwarzbein Principle, and Life Without Bread were all books that had similar concepts to Protein Power, but with their own distinct flavor. These books all based their theories on real human physiology. But just like life and politics, theories are one thing and reality can be another.

Would the theory of eating a low carbohydrate diet help the overweight and obese to lose weight? The only true way to know would be to test it out. But try convincing anyone to go against what all the so called experts on television and radio say about a healthy diet.

Well, the stars must have all been aligned, as a patient came to my office who had recently read Protein Power and wanted to try out the diet. I agreed to help and to monitor their progress by watching their weight, blood pressure, cholesterol and sugar levels. The low carbohydrate diet was a huge success. Weight loss with normal sugars and a much improved cholesterol profile. Blood pressure dropped so much that we had to stop blood pressure medications, and energy levels rose. How did this happen while eating more protein and fat, and less carbohydrates? Could all I was taught in medical school, and all the "media pundits" be wrong? More on this later. But if you want a sneek peek, check out the books mentioned above. It may open your eyes, slim your waistline, improve energy levels and balance out your metabolism!

If you have any suggestions about topics for future newsletters, or how to make the newsletter better, please send me an email at DrHorvitz@DrHorvitz.com.

To Good Health!!

Steven Horvitz, D.O.
Board Certified Family Medicine
Founder of The Institute for Medical Wellness
128 Borton Landing Road, Suite Two
Moorestown, NJ 08057
Phone: 856-231-0590
Fax: 856-294-0311
Please visit http://www.drhorvitz.com/ for more information about Dr. Horvitz and The Institute for Medical Wellness.

To view upcoming Wellness Network Events, please click here.