Elizabeth Peña’s Death Due To Alcohol, Expert Commentary on Life Saving Abuse Treatment


Video still of Ms. Pena

Sadly on October 14, 2014, actress Elizabeth Peña died far too young at age 55 from a preventable disease, addiction to alcohol.

Her death was directly related to drinking.  The Los Angeles County Coroner has ruled that the “Modern Family” and “Matador” actress, was due to severe alcohol abuse reported People.

The El Rey network, home to the hit series “Matador” that featured Ms. Peña as the matriarch of the family, released a statement on her passing:

We are deeply saddened by the passing of our friend and colleague, Elizabeth Peña. She was a role model, a truly extraordinary performer and an inspiration in every sense of the word. Our thoughts are with Elizabeth’s family and friends during this difficult time. She ‎will be deeply missed.

The Los Angeles County Coroner cited cirrhosis of the liver due to alcohol, as well as cardiopulmonary arrest, cardiogenic shock and acute gastrointestinal bleeding on the actress’s death certificate. She died in a Los Angeles hospital.

Last week, Peña’s manager, Gina Rugolo, said the New Jersey-born actress died of natural causes after a brief illness.

Addiction specialist Dr. Akikur Mohammad, M.D. founder and medical director of Inspire Malibu treatment center is a guest editor for Monsters and Critics on matters of addiction to both alcohol and drugs, and he offers commentary about the fact that Ms. Pena didn’t receive proper treatment for her disease:

“Elizabeth Pena’s tragic death was unnecessary. Her prognosis could have been different had she received evidence-based treatment for her alcohol addiction, that lead to her cirrhosis. Today in the 21st century we have medications, provided under the supervision of trained medical professionals, that successfully treat substance abuse. Her death, like Glee’s Cory Monteith and Philip Seymour Hoffman’s, underscores how alcoholism and drug addiction are a chronic disease that must be managed over a lifetime. There should be no stigma in having this disease, which has a strong genetic component, anymore than we should stigmatize someone with diabetes or asthma. For most people with the disease of addiction, treatment based solely on abstinence does not work.”

Dr. Mohammad, based in Los Angeles, is a board-certified psychiatrist and associate professor at USC’s Keck School of Medicine where he teaches addiction medicine.

Original Article

Dr. A R Mohammad



Let’s face the only fact we know: Renee Zellweger’s appearance Monday night at the Elle magazine’s Women in Hollywood sparked an intense international frenzy as to how far is too far to go in the quest for the fountain of youth.

The Oscar-winning actress Wednesday addressed the rampant speculation that she has undergone plastic surgery, calling the conversation about her appearance “silly,” she says she is choosing to speak out about it because “it seems the folks who come digging around for some nefarious truth which doesn’t exist won’t get off my porch until I answer the door.”

“I’m glad folks think I look different,” Zellweger told People magazine. “I’m living a different, happy, more fulfilling life and I’m thrilled that perhaps it shows.” She added: “My friends say I look peaceful. I am healthy.”

She also attributed her striking new appearance to “finally growing into” herself.

Others didn’t see it that way, with headlines screaming that the “actress is virtually unrecognizable.”

“This is not Botox or even surgery,” quipped writer Viv Groskop on Twitter. “It’s a MISSING PERSON ENQUIRY.”

So has she hasn’t she had extensive work done?

We posed the question to two experts who do believe the 45-year-old’s new look isn’t entirely down to nature.

“Renee is the internet’s obsession of the day and she is the present conduit of our long-term ambivalence with plastic surgery, ” says Dr. Alexander Rivkin, a Yale-trained facial cosmetic surgeon and UCLA member who focuses exclusively on providing his patients with the latest in non-invasive cosmetic treatments. ”She is a beautiful woman who, like all of us, gets bothered when she sees signs of aging on her face.”

As to what procedures she has done, Dr. Alexander Rivkin tells Celebzter: “I think that she had surgery to reduce the heaviness of her upper eyelids and puffiness of her lower eyelids (blepharoplasty), which has made her eyes look more open and has changed her trademark narrow eyed look. I also think that she may have had botox injections that changed how she looks when she smiles, especially around the chin.”

He also thinks the media has been spectacularly unfair.

“She’s also changed her hair, so when the before and after pictures are shown she looks radically different and this isn’t quite fair, ” he says. “I would want to see a before and after of her where the before is a recent shot, not what she looked like 10 years ago.

Rivkin adds: “There’s this fantasy we all have that famous people are going to forever look like we remember them from the movies, but time takes its toll on them as well.

And his verdict?

“Yes she looks different, but I wonder how much of that is the natural aging process changing her cherubic trademark looks. I think she looks perfectly natural and nice, not weird or fake like some are screaming.”

Dr. Andrew Cohen, Clinical Chief (2010-2013), Division of Plastic Surgery Cedars Sinai Medical Center, also believes Zellweger has had work done to her eyes, adding: “She may have had a facial procedure and or cheek enhancements with fat grafting.”

And he has a note of caution for those wanting to alter their appearance.

“Obviously she wanted to change her appearance,” he says. ”Unfortunately she has a much different appearing face now and has lost that unique look that has made her who she is.

“I don’t know why some patients who are celebrities want to change their whole look. Plastic surgery is an art form. Part of that art form is recognizing that the face is not a photograph… It is a dynamic moving structure. The best plastic surgery respects that and turns back the clock a bit while maintaining ones personality of facial expression.”

Melissa Myers has worked as an entertainment journalist for ten years, both in London and New York. She now focuses much of her time helping bring inspiring stories to light and, additionally, her project “Makeover with Meaning,” which seeks to add a sprinkle of happiness into the lives of those who need it most.

Fat Or Fit? Feast Or Famine? Diet Expert Shows How To Overcome The Holiday Food Dilemma

You asked about savory, sane and satisfying ways to cook and eat this holiday season, and registered dietitian Misti Gueron MS, RD of the prestigious Khalili Center answered!


A California native, Misti shares with us her insights about how to eat and drink well while still enjoying your favorite festive foods with simple swaps, strategies and sound advice.

fall foods

Check back throughout the month of December for healthier holiday recipes from the Khalili Center and eating tips from Misti. Please feel free to ask her more questions in the comments below. She’s here to help!

A Santa Cruz and California State (Masters) graduate, Misti joined the Khalili Center – one of the nation’s leading bariatric centers — after being in private practice for 10 years. Previously, she was employed at two of Los Angeles’ more prestigious hospitals, Cedars Sinai Medical Center and Saint John’s Medical Center.


Inside the Khalili Center

In conjunction with the physicians and surgeons at Khalili Center, Misti is involved in community outreach and educational nutritional programs. She is also a member of the American Dietetic Association Academy of Nutrition and Dietetics and the Weight Management and Behavioral Health Specialty Groups. Her specialities are weight management, bariatrics, and eating disorders but also has extensive experience in diabetes, sports nutrition and cardiovascular wellness.

Monsters and Critics spoke with Misti about recipes and meal planning this time of year when many people overeat and then have to deal with holiday weight gain in January.

center 2

Inside the Khalili Center

Monsters and Critics: What’s the food darling of dieticians right now, what’s a great snack or trend to try?

Misti Gueron: Kale was the vegetable of the year last year; kale chips popped up at parties everywhere. Cauliflower is this year’s vegetable for its versatility and ability to be made into “breadsticks” and pizza crusts, whipped like potatoes, made into rice, turned into “dough” and caramelized for all sorts of recipes.

cauli shell

We made a cauliflower pizza “crust” – which is baked before adding toppings – Photo by M&C 2014

Maybe next year’s big vegetable “discovery” will be Brussels sprouts or zucchini? Invest in a vegetable spiralizer and discover one of my favorite recipes “Zoodles” where you can make pasta noodles from a spiralized zucchini!


Water metabolizes fat and aids with energy and weight control. So, instead of diet sodas — which are as bad as regular full-sugared soda — I like to see people explore eye-catching alternatives like sparkling “spa” waters decorated with sliced cucumber, or hollowed out tropical fruits filled with flavored waters and fresh herbs like basil and mint.

spa water

“Spa Waters” are glorious and there is a reason that they are found in health spas where those who seek weight loss go. Adding berries, sliced cucumbers, mint, oranges provide a surprisingly tantalizing change to regular water or sparkling water. Doing this with sliced veggies at the bottom might be a new hit this year. So when you’ve finished with your water you can munch on the veggies and fruit. It works with Bloody Marys and some martinis!

Prepared fresh Thai coconut prepped and ready to serve with a straw is another colorful and healthful alternative to sugary sodas. Many people have never tried it, and having a bunch of coconuts on ice is a fun non-alcoholic idea for a holiday party.

Monsters and Critics: I spent the weekend making several of the Khalili dishes you offer for your patients. Tell me your favorite ingredient swaps for recipes, and how you can even adapt cooking to the point where bread and flour products are minimized with higher protein flours and even Cauliflower please!

Misti Gueron: Here are some great swaps and recommendations:


  • 0% Greek yogurt in place of milk or creams
  • Applesauce or avocado in place of oil in baked goods
  • Mushrooms used to bulk up meat sauce, turkey burgers, eggs or sautéed and placed under or a top chicken
  • Stevia or banana in place of sugar
  • Egg whites in place of whole eggs
  • Quinoa in place of bread crumbs
  • Ground turkey or firm tofu crumbled in place of red meat
  • Vegetables for pasta or rice (zucchini, spaghetti squash or cabbage in place of noodles, zucchini ribbons in place of pasta or lasagna noodles
  • Fruits and jams to sweeten in place of sugar
  • Pureed potato in place of cream to thicken soups

Most importantly, you will lose weight and maintain weight if you hydrate your diet. When you add cauliflower in place of dough for pizza crust, for example, you are adding more water and indigestible fibers. Vegetables naturally have more water and indigestible fibers, thereby reducing overall caloric density for weight control and adding the extra cardiovascular benefit.

Food wants to be hydrated and so does your body. This minimizes the load of calories at any given meal and helps your body to process it faster without a compromise to flavor.


Strategies for adding more water to your foods especially for this time of year include:

  • When making whipped potatoes or whipped sweet potatoes, include nature’s first fluid, water! This adds moisture and offers a fluffy texture, perfect for the mouth feel. Then, to bring out the natural flavors in the food, add a touch of butter, seasoning and sour cream or regular cream to taste. These tips provide flavor without the heavy brick in your belly that adding pounds of butter and cream can do in the original recipes.
  • Heavy sauces and dressings can be made with lighter, yet still flavorful with greater water content to the base. This minimizes fats, sugars and sodium, taking care of your heart and your waistline.
  • Sauces like cranberry sauce and other holiday favorites can be sweetened with pears and other natural fruits as opposed to the cups of refined sugars commonly utilized.
  • Instead of rice, pasta or breads as the base of the meal, try a vegetable alternative like spiralized zucchini, spaghetti squash, mixed vegetables, shredded cabbage or Brussels sprouts and top with a delicious meaty sauce and a sprinkle of cheese for flavoring

Monsters and Critics: Many dieticians and nutritionists love to see people remove as much wheat product (regardless of gluten issues) and increase with vegetable and lean proteins for people who are in the process of losing weight and maintaining. What is your take, and what makes the most sense for a lifetime strategy?

Misti Gueron: It makes a lot of sense to minimize starchy foods by replacing wheat products with vegetables and lean proteins. Starchy foods like breads, rice and pasta are for those individuals that expend a lot of physical energy daily and burn it off. For the majority of us who live relatively sedentary lifestyles, consuming carbohydrates from fruits and vegetables is better. Vegetables and fruits have more water and indigestible fibers than starchy foods, and thus cause the body to work harder to extract the digestible carbohydrate and nutrients during the digestive process. This makes your metabolism work harder for weight control, helps keep your organs healthier, and gives you more energy.

Additionally when we reduce the wheat products, we tend to consume less processed snack foods and rely on more whole foods like fruit, which benefits your health and weight.

cauli pizza

Finished Cauliflower Pizza Crust with fresh tomato, mushroom, basil and fresh mozzarella topping- no wheat carbs! Photo by M&C 2014

Monsters and Critic: Eye appeal is crucial for an appealing party spread. How do you teach people to take the time to properly present and plate foods for parties (and even the average dinner table), so deprivation and “diet” mindset is removed?

Misti Gueron: Presentation is essential when it comes to feeling satisfied. Long term research supports that people tend to feel more satisfied when they are able to consume what is perceived as a “normal” portion. Utilizing smaller plates and utensils provides the illusion of abundance; it sets the mind up for a given expectation as opposed to consuming “less” than what others are consuming.

Further, those that consume smaller portions tend to chew and eat slower throughout their meal, which further promotes satisfaction with less food volume. Studies show that those who purchase larger containers of peanut butter or boxes of cereal consume them as fast as smaller sized packaging. Our eyes determine more than we think.

food appea;

When tantalizing the palate with foods arranged at a party table, mix colors and textures in neat but varied displays. Research demonstrates that to excite someone’s palate, you must first excite their mind! Displaying several food choices and types of foods together can be very tantalizing as the eye finds new things to explore selectively scanning the display. Our physical bodies usually respond with increased hunger feelings.

Monsters and Critics: How do you cut the cord between emotions and eating? What are the steps to get someone to stop associating food with holidays, loved ones, sad memories? How can you ” reboot” to look at food as body fuel that will get you to the place physically you want to be, instead of being trapped into a unhealthy lifestyle that can lead to the co-morbidity issues of diabetes, metabolic diseases and heart disease?

Misti Gueron: It is my belief that we should learn to listen more to our bodies and less with our minds. We need to learn to be friends with our bodies instead of at war with them through the self-sabotage of dieting. If we can stay more focused on the body’s experience of ingesting the food choices, tastes and textures, then the mind can explore the process rather than judge it. When we can accomplish a stronger, healthier and more trusting relationship with our food and our body, we begin to feel more in control of our eating behaviors and bodies.

Monsters and Critics: What are clever ways for people to “trick” themselves into eating slower and managing portions? Smaller plates? Tell us all your best secrets for getting people to be mindful when eating.

Misti Gueron: Often, when we eat mindlessly we go on “autopilot” and forget about our bodies, until we either run out of food or feel uncomfortably full. Some techniques to slow the eating process down are to utilize smaller plates for food, to sit down without distractions like television, practice deep breathing, to cut foods into tiny pieces, to pause by placing the utensil down between bites, and to utilize very hot, very cold or very spicy foods, which often force a break in the process of eating and chewing.

Food logs are also a useful tool to bring awareness to the eating process. Often the process of logging your intake can inspire more mindful eating habits. This might be why those that log their food typically make the most progress changing their food habits to healthy ones.


Monsters and Critics: What are the biggest misconceptions about bariatric surgery and subsequently, the keeping the weight off =? Is it a relearning process of all of the above? Give us the nitty-gritty, the details on what people go through afterward, and how they must adjust. Is it a process that takes a certain amount of time before the patient “gets” how to eat properly?

Misti Gueron: Weight loss surgery (WLS) is a modern-day medical miracle for those whose weight places their health at risk and who are also unable to lose weight successfully on their own. Depending on the procedure chosen, the patient may experience varying degrees of change in their hunger and satiety hormones. They may also experience earlier satiety and feeling full from the surgical change in the stomach’s anatomy. These changes alone often influence food and meal choices.

Although there are numerous changes that occur with the eating experience after WLS, some of these initial changes inspire greater incentive to make healthier food choices.

Healthier food choices combined with increased energy, a lighter body, improved sleep, decreased blood pressure, normalized blood sugar are health changes commonly experienced post operatively. They make it easier to live a healthier lifestyle, which includes exercise and great mobility. Often, positive feelings and emotions become associated with improved habits and food choices, and this also can make living a healthier lifestyle a lifelong habit.

Learning and maintaining long-term changes in eating habits and lifestyle practices can be facilitated by support groups and education by a dietitian about nutrition specific to bariatrics. There are also online options for patients to tap into and learn from fellow patients and health care professionals in the field when attending groups is not otherwise possible.

Monsters and Critics: What are the best foods to have on hand for fast healthy snacks and nibbles?

Misti Gueron: Fruit or a vegetables make the perfect between-meal snack.However, I commonly find that people need a small snack of protein to sustain their energy and maintain their blood sugar for stable concentration and mood. This can play in favor of maintaining a healthy body weight also by minimizing feelings of out of control hunger before the next meal time.

Satisfying snacks options that include protein:

  • Healthy lower sodium turkey jerky
  • Edamame
  • High protein yogurt topped with slivered nuts
  • Fresh fruit and a light string cheese
  • Vegetable slices, cucumber or bell pepper “chips” dipped into a protein filled dip like salsa or guacamole mixed with 0%Greek yogurt
  • Hard cooked egg with cherry tomatoes and some pepper
  • 2 extra lean meatballs on a skewer with cucumber slices
  • Sardines a top one-two whole grain crackers
  • Smoked salmon wrapped with 0%Greek yogurt and sliced into “pin-wheels”
  • Smoked turkey and light provolone wrapped and sliced into pin-wheels
  • 1 slice of extra lean ham wrapped around a light string cheese
  • Shrimp diced into gazpacho soup


Monsters and Critics: For those who drink alcohol, what are the best choices to make (and offer guests) at parties, so you are not drinking all the calories allotted for the day?

Misti Gueron: Best drinks are “minimal drinks” …so make sure to have 16 ounces of water between each alcoholic beverage. This strategy will help minimize your alcohol intake and also lessen any potential hangover that results from dehydration the next morning.

To watch calories when choosing an alcoholic beverage select wine, wine spritzers or liquors that are on ice or mixed with club sodas. Steer clear of the calorically dense and sugar-laden alcoholic mixes.

Misti Gueron and the Khalili Center’s Approved Recipes that are perfect to consider for the holiday parties:

Baked Chicken Milanese with Arugula and Tomatoes


For the Salad:

1 tbsp olive oil
2 tbsp balsamic vinegar
5 medium ripe tomatoes, diced
1/4 small red onion, sliced thin
1 tbsp chopped fresh basil
kosher salt and pepper to taste
6 cups baby arugula

For the chicken:

24 oz (3) boneless skinless chicken breasts, sliced in half lengthwise
3/4 cup Italian seasoned breadcrumbs
1/3 cup grated Romano cheese (or parmesan)
1 lemon, juice of
1 tbsp olive oil
kosher salt
fresh cracked black pepper
olive oil spray

*In a medium bowl, whisk olive oil and balsamic. Add tomatoes, basil and onions; season with salt and pepper. and toss. Set aside at least 10 minutes so the juices combine.
*Preheat oven to 450°. Place a large baking pan in the oven to get hot.
*Combine breadcrumbs and grated cheese in one bowl. In another bowl combine olive oil, lemon juice, and pepper.
*Lightly pound chicken breasts into cutlets, you should have 6. Wash and dry cutlets well with paper towels; season with salt and pepper.
*Dip cutlets into lemon/oil mixture, then into breadcrumbs, pressing firmly to adhere.
Remove the baking pan from the oven and spray with cooking spray. Place the chicken on the baking sheets and spray with olive oil spray on top.
*Bake chicken, turning once halfway through for about 15 minutes total, or until chicken is golden. Remove from the oven and top with arugula and tomato salad on top.

Servings: 6, Size: 3 oz chicken with salad
Calories: 250
Protein: 24.3 grams
Carb: 17.4 grams
Fat: 8.5 grams

Recipe courtesy of SkinnyTaste

Spaghetti Squash with Tomatoes and Basil


1 spaghetti squash
1 tablespoon olive oil
4 cloves garlic, minced
2 tomatoes, chopped
few basil leaves, chopped
salt and pepper
1 teaspoon balsamic vinegar
1/4 cup grated pecorino or parmesan cheese

*Using a sharp paring knife, carefully pierce (I really mean stab) the spaghetti squash in a few places (about 6 slashes is good). Microwave on high for 10-12 minutes, turning/rotating the squash halfway during cooking. A fork should very easily pierce through the squash, if there is resistance – microwave for an additional 1-2 minutes.
*Let squash cool for a few minutes before handling. Carefully (the squash will be steaming hot!), use a chef’s knife to cut the squash in half, lengthwise. The squash should be soft and easy to cut. Remove and discard the seeds. Use two forks to scrape apart the strands of the squash. Compost or discard the skin.
*Heat a large sauté pan over medium heat with the olive oil. Add in the garlic and cook for 1 minute. Add in the tomatoes and basil and cook for 2 minutes. Turn heat to medium-high and add in the spaghetti squash and toss. Season with salt and pepper and drizzle in the balsamic vinegar.
*Taste the squash – adjust seasoning and if the squash still needs a bit more time to cook through, cover and cook for 2 minutes. If the squash texture is perfect, toss in the grated cheese and serve immediately.

Servings: 8-10
Calories 70
Protein 2 grams
Carbs 11 grams
Fat 3.5 grams

Mini-Smoked Salmon Frittatas


1 tablespoon extra-virgin olive oil
1/4 cup diced onion
1/2 teaspoon salt
1/8 teaspoon pepper
4 ounces smoked salmon, cut into 1/4-inch pieces
6 large eggs
8 large egg whites
1 tablespoon half-and-half
3 tablespoons 1% milk
3 ounces 1/3-less-fat cream cheese, cubed
2 tablespoons scallions, thinly sliced, for garnish

*Preheat oven to 325°. Heat oil in a nonstick skillet. Sauté onion 2-3 minutes or until soft; add salt, pepper, and salmon. Remove from stovetop; let cool.
*Combine the next 4 ingredients (through milk) in a bowl. Stir in the cream cheese. *Lightly coat 6 (8-ounce) ramekins with cooking spray. Add 2 tablespoons of salmon mixture to each ramekin. Pour 3/4 cup egg mixture into each ramekin. (Do not overfill.)
*Place ramekins on baking sheet; bake 25 minutes or until a wooden pick inserted in center comes out clean. Garnish, if desired.


Makes 6 servings, serving size: 1 frittata
Calories 179
Protein 17 grams
Carbs 3 grams
Fat 11 grams

Kung Pao Chicken Zoodles for Two



2 medium zucchini, about 8 oz each, ends trimmed
1 teaspoon grapeseed or canola oil
6 oz skinless chicken breasts, cut into 1/2-inch pieces or shredded
Kosher salt and freshly ground black pepper, to taste
1/2 red bell pepper, cut into 1/2-inch pieces
1 teaspoon sesame oil
2 cloves garlic, minced
1 tsp fresh ground ginger
2 tbsp crushed dry roasted peanuts
2 tbsp thinly sliced scallions along diagonal

For the sauce:

1 1/2 tbsp reduced soy sauce (tamari for gluten free)
1 tbsp balsamic vinegar
1 tsp hoisin sauce
2 1/2 tbsp water
1/2 tbsp Sambal Oelek Red Chili Paste (or more to taste)
2 tsp sugar
2 tsp cornstarch

*Using a spiralizer fitted with a shredder blade (this makes a thicker noodle), or a mandolin fitted with a julienne blade, cut the zucchini into long spaghetti-like strips. If using a spiralizer, use kitchen scissors to cut the strands into pieces that are about 8 inches long so they’re easier to eat.
*In a small bowl, whisk together soy sauce, balsamic, hoisin, water, red chili paste, sugar and cornstarch; set aside.
*Season chicken with salt and pepper, to taste. Heat oil in a large, deep nonstick pan or wok over medium-high heat. Add the chicken and cook until browned and cooked through, about 4 to 5 minutes. Set aside.
*Reduce heat to medium, add sesame oil, garlic and ginger to the skillet and cook until fragrant, about 30 seconds. Add the bell pepper, stir in soy sauce mixture and bring to a boil; reduce heat and simmer until thickened and bubbling, about 1-2 minutes.
*Stir in zucchini noodles and cook, mixing for about two minutes until just tender and mixed with the sauce. If it seems dry, don’t worry the zucchini will release moisture which helps create a sauce.
*Once cooked, mix in chicken and divide between 2 bowls (about 2 cups each) and top with peanuts and scallions.

Servings: 2, Size: scant 2 cups
Calories: 277
Protein: 24 grams
Carb: 21 grams
Fat: 12 grams

Zucchini Noodles (Zoodles) with Lemon-Garlic Spicy Shrimp



1 1/2 teaspoons olive oil
Pinch crushed red pepper flakes
4 oz peeled and deveined shrimp
2 cloves garlic, sliced thin and devided
1 medium zucchini, spiralized
Pinch salt and fresh black pepper
1/4 lemon
1/4 cup halved grape tomatoes


*Heat a medium nonstick skillet over medium-high heat. Add 1 teaspoon of the oil and crush red pepper flakes, add the shrimp and season with pinch salt and pepper; cook 2 to 3 minutes.
*Add half of the garlic and continue cooking 1 more minute, or until the shrimp is cooked through and opaque. Set aside on a dish.
*Add the remaining 1/2 teaspoon oil and garlic to the pan, cook 30 seconds then add the zucchini noodles and cook 1 1/2 minutes. Add the shrimp and tomatoes to the pan and squeeze the lemon over the dish.
*Remove from heat and serve. Makes 1 serving.

Servings: 1, Size: 1 zucchini + shrimp
Calories: 235.5
Protein: 25 grams
Carb: 14.5 grams
Fat: 9 grams

*Misti’s Tip:
Paderno Spiral Vegetable Slicer is an all time FAVORITE cooking gadget. It’s the easiest way to make zucchini noodles, sweet potato spirals, carrot ribbons and more!

This recipe was originally published on

Original Article

Learn More about the Khalili Center for Bariatric Care

Perfectly Addicted? Michael Phelps’ Bad Behavior Maybe More Than A ‘Drinking Problem’


US Olympian Michael Phelps’ second DUI may be raising a lot of eyebrows, but it is also raising a number of questions: Does the Olympic champion have more than just a “drinking problem”?

Are we driving our athletes to addiction with a combination of at-the-ready access to prescription drugs and an unceasing demand for perfection?

From my perspective as an addiction medicine physician, Phelps has all the classic signs of an alcoholic in need of medical treatment. His internal perfectionist, coupled with an external pressure to meet those unreasonable standards, can be a lethal combination for anyone but especially for the superstar athlete who is paid to win.

When a person is thrown into the world of a professional sport, if he or she is genetically wired with an addictive personality, it doesn’t take much to start spiraling. Michael Phelps’ most recent DUI confirmed for me that that there is a deeper issue at play than just drinking too much, “occasionally.” Although the media enjoys playing out another episode of Olympians-gone-wild, sadly, this is Phelps’ reality, not reality TV. We are dealing with addiction, a serious disease, and as such, it requires immediate attention and treatment.

Lance Armstrong is the poster child of athletic prowess gone wrong. Live Strong? Remember the bracelets? The sentiment may prevail, but the tragedian behind the message no longer triumphs. Phelps’ boy-next-door looks and super-hero status convinced the public that he was above reproach, but twenty-two medals and two DIUs later, we have been forced to reevaluate our calculations.

Alcoholism is a complex condition comprised of biological, social, and psychological components. While there is a role for 12-step, AA program is useful for some patients, it should never be the exclusive treatment, since we are dealing with a chronic disease that involves a strong genetic component. Consequently, substance use disorder is a multifaceted illness, requiring both pharmaceutical and behavioral treatments.

I can’t help but wonder if Phelps will be getting the right kind of treatment–evidenced-based medicine. Unfortunately, all rehab treatment centers are not created equal. 90% of all addiction treatment centers in the U.S.– including some of the poshest — scandalously do not offer any treatment under medical supervision. Mr. Phelps should not assume he’s getting medically and scientifically sound treatment just because he’ll be paying a lot for it.

The dedication demonstrated by an Olympic athlete or a professional athlete is at once admirable and at once concerning. . In fact, Curtin University of Technology in Australia has a number of psychologists researched this very topic, [highlight only one word, e.g., "topic] and discovered that the level of “all or nothing” thinking was an indicator of how well perfectionists were able to manage their lives. The researchers had 252 participants fill out questionnaires and then rated their level of agreement with 16 statements. Needs one more sentence here about the conclusions reached by the study, e.g., “Those the highest on the perfectionist scale had the least ability to manage their daily lives successfully.”

Any way you slice it, obsessive dedication to a sport could itself be a tell-tale sign of an addictive personality. When an addict is also a perfectionist in a business like the Olympics, where the path to gold is paved with perfect scores, the underbelly of the perfectionist personality can be treacherous. That same drive to be perfect, which works so well to propel them towards the basket, the goal, and the end zone, can wreak havoc on their lives when they turn to alcohol or drugs, and end up losing at a losing battle.

Another study conducted by researchers Petra K. Staiger, Nicolas Kambouropoulos, and Sharon Dawe from Deakin University and Griffith University in Australia, investigated the question “Should personality traits be considered when refining substance misuse treatment programs?” According to their findings, “the data suggest that personality influences treatment outcomes.” identification of certain personality traits, including, for example, perfectionism, can make addiction treatment more effective.

The trickle-down effect happens even before professional sports begin, out on the playing fields at high schools across the country, and perhaps even earlier. If you know an athlete who is clearly a perfectionist, who exerts unrealistic pressure on him or herself, and tends to drink in order to alleviate pressure, don’t be afraid to recommend proper treatment facilities to those who are suffering. We must all take heed, as happy hour can become a slippery slope towards seriously unhappy consequences.

About our guest editor: Psychiatrist and Prescription Detox Expert Dr. Akikur Mohammad, founder of Inspire Malibu,  is Board Certified in Addictionology, Psychiatry & Neurology. He is an Associate Clinical Professor at USC Medical Center.  Inspire Malibu is directed by Dr. A.R. Mohammad who is America’s leading Detox Expert and award-winning Addictionologist. Dr. Mohammad is Board Certified in Psychiatry, Neurology and Addiction Medicine. He has been practicing Addiction, Psychiatry, and detox protocols for 15 years. Dr. Mohammad is on the cutting edge of addiction medicine and is a pioneer in addiction treatment.

Original Article

Dr. A R Mohammad

Bass Bottoms Up for Meghan Trainor, Tour Dates and More!


Are you all about that bass?

Thank board certified plastic surgeon in Miami, Dr. Constantino Mendieta, the author of The Art of Gluteal Sculpting for the fashionable craze on ass that is currently chewing up the airwaves and pop music, notably with Meghan Trainor who continues her breakout year with the release of brand new single “Lips Are Movin.”

Add to that, Iggy Azalea and J-Lo who have their Booty video out there too, smoking up the charts.

Dr. Mendieta counts some of the most famous rump shakers in the entertainment world as his patients. He’s been sculpting perfect rear ends for over 15 years in body conscious South Florida.

As for “bass-alicious” Trainor, Shazam offered a First Listen and MTV premiered the song last week plus “Lips Are Movin” impacts Top 40 radio today and will be available commercially at midnight tonight along with the pre-order of Meghan’s debut album Title.

Title will be released on January 13th as an 11-track standard version and 15-track deluxe version (track listing below). Fans that pre-order Title will receive “Lips Are Movin” as an instant grat track along with previously released tracks “All About That Bass,” “Title,” “Dear Future Husband” and “Close Your Eyes.”

“Lips Are Movin” follows Meghan’s multi-platinum debut “All About That Bass” which is currently #1 on Billboard’s Hot 100 chart for a 6th straight week.

Last week Meghan was announced as a 2014 American Music Award nominee for New Artist of the Year. She will compete against 5 Seconds of Summer, Iggy Azalea, Bastille and Sam Smith.

Fans can start voting on Nov. 1st at through the first hour of the ABC live broadcast on Nov. 23rd. Meghan was also named an MTV Artist to Watch.

Meghan will perform “All About That Bass” and “Lips Are Movin” on NBC’s Today on Nov. 3rd and it was just announced that she will perform “All About That Bass” with Miranda Lambert on the CMA Awards on Nov. 5th. She will also appear on Nickelodeon’s HALO Awards on Nov. 30th.

Meghan will join Clear Channel’s Jingle Ball concerts starting Nov. 30th in Grand Prairie, TX through Dec. 22nd in Tampa, FL (full schedule below) and is expected to announce her own headline tour soon.

Title iTunes pre-order

Title Amazon pre-order



  • 1. The Best Part (Interlude)
  • 2. All About That Bass
  • 3. Dear Future Husband
  • 4. Close Your Eyes
  • 5. 3am
  • 6. Like I’m Gonna Lose You
  • 7. Dem Sticks
  • 8. Walkashame
  • 9. Title
  • 10. What If I
  • 11. Lips Are Movin


  • 1. The Best Part (Interlude)
  • 2. All About That Bass
  • 3. Dear Future Husband
  • 4. Close Your Eyes
  • 5. 3am
  • 6. Like I’m Gonna Lose You
  • 7. Bang Dem Sticks
  • 8. Walkashame
  • 9. Title
  • 10. What If I
  • 11. Lips Are Movin
  • 12. No Good For You
  • 13. Mr. Almost
  • 14. My Selfish Heart
  • 15. Credit

Meghan Trainor – Clear Channel Jingle Ball Dates

  • 11/30 Grand Prairie, TX Clear Channel Jingle Ball
  • 12/5 Los Angeles, CA KIIS Clear Channel Jingle Ball [Jingle Ball Village]
  • 12/8 Minneapolis, MN Clear Channel Jingle Ball
  • 12/10 Philidelphia, PA Clear Channel Jingle Ball
  • 12/12 New York, NY Z100 Clear Channel Jingle Ball [Jingle Ball Village]
  • 12/14 Boston, MA Clear Channel Jingle Ball
  • 12/15 Washington, DC Clear Channel Jingle Ball
  • 12/18 Chicago, IL Clear Channel Jingle Ball
  • 12/21 Ft. Lauderdale, FL Clear Channel Jingle Ball [Jingle Ball Village]
  • 12/22 Tampa, FL Clear Channel Jingle Ball [Jingle Ball Village]

Original Article

Dr. Constantino Mendieta

Michael Phelps Arrested On DUI Charge, What’s Next For The Olympian?


Olympian Michael Phelps has been suspended for six months from USA Swimming-sanctioned competition after his arrest for driving under the influence in Baltimore last week.

In announcing the decision Monday, USA Swimming also said Phelps will be withdrawn from the 2015 FINA World Championships team and that he will forfeit his funding from the national governing board for six months.

“Membership in USA Swimming, and particularly at the National Team level, includes a clear obligation to adhere to our Code of Conduct,” USA Swimming executive director Chuck Wielgus said in a statement. “Should an infraction occur, it is our responsibility to take appropriate action based on the individual case. Michael’s conduct was serious and required significant consequences.”


Mentally tough and physically well trained, strong and accomplished, Michael Phelps is dealing with the repercussions of a second DUI within a 10 year period, and he has publicly apologized via Twitter and vowed to deal with his issues.

Phelps is the most decorated Olympian of all time with 22 Olympic medals, including 18 gold.  Olympic swimming champion Michael Phelps said Sunday he is “taking some time away” from swimming and will “attend a program that will provide the help I need to better understand myself” after his DUI arrest in Baltimore last week.

phelps tweets

Phelps, 29, registered a .14 percent on a Breathalyzer test after he was stopped on a speeding violation last week, the second time he has been charged with a DUI in Maryland.  Phelps also was charged with DUI in 2004 on the Eastern Shore of Maryland, and he received 18 months’ probation and a $250 fine. Phelps also was required to deliver a presentation on alcohol awareness to students at three high schools.

His second DUI trial is scheduled for Nov. 19.  Previously the USA Swimming governing body suspended Phelps for three months in 2009 after a photo emerged showing Phelps using a marijuana pipe, even though he was never charged.  USA Swimming has not taken any disciplinary action for his second DUI arrest. If he is convicted of the latest charges, he faces up to one year in jail, a $1,000 fine and the loss of his driver’s license for six months.

ESPN reported that his representatives at Octagon say he entered an in-patient program that will keep him from competing at least through mid-November.

A statement from Octagon said Phelps was entering “a comprehensive program that will help him focus on all of his life experiences and identify areas of need for long-term personal growth and development.”

“Michael takes this matter seriously and intends to share his learning experiences with others in the future,” the statement said.

Phelps retired after the 2012 London Olympics, but made a comeback to competition in April and won three gold medals while representing the United States’ team in last month’s Pan Pacific championships.

Phelps, according to ESPN, has already qualified for the worlds, and was not planning to compete in the short course world championships, which will be held in early December in Qatar. The U.S. team for that meet, which includes Phelps rival Ryan Lochte, was announced last week.

Michael Phelps second DUI raises the question if the Olympic champion has more than just a “drinking problem.” Dr. Akikur Mohammad, MD, a board-certified psychiatrist and professor of addiction medicine at University of Southern California’s Keck School of Medicine, suggests that Phelps has all the classic signs of an alcoholic in need of medical treatment.

Dr. Akikur Mohammad is a leading authority on drug addiction and treatment. He is board-certified in psychiatry and addiction medicine, and teaches addiction medicine at USC Keck School of Medicine and is the medical director of the prestigious rehabilitation center Inspire Malibu. He tells Monsters and Critics:

“Being in the public eye is especially hard when you are an Olympian like Michael Phelps. This is a man who has spent his entire life striving for perfection and being better than anyone else in his field. He has also been under a microscope since breaking records at the 2008 Olympics when he was still basically a teenager. Until recently, he was planning on retiring from the sport that gave him so much but decided to come back and compete against much younger and possibly quicker athletes.

“I imagine that trying to be the same Michael Phelps that won so many fans from his early wins and the grueling training with an older body, plus the pressure to succeed has got to be overwhelming. These are the ingredients that can create a very disastrous situation if you already have an alcohol problem, which apparently Phelps does.

“While I don’t know Michael Phelps’ medical history, his pattern of criminalized behavior strongly suggests that he is more than just a heavy drinker. Most likely it’s not that he doesn’t want to stop drinking but rather that he can’t. The self-destructive, physiological cravings that an alcoholic experiences can only be managed through medical intervention.

“Alcoholism is a complex chronic disease with a strong genetic component that requires both behavioral and pharmaceutical therapies. While there is a role for 12-step, AA program for some patients, it should never be the exclusive or the focus of treatment. Let’s hope that Michael gets the kind of evidence-based therapy that he needs.”

Original Article

Dr. A R Mohammad


Michael Phelps, the most decorated Olympian of all time, was arrested last week with his second DUI and had decided to enter a six-week rehab treatment program.

But does this mean the swimming champ has a problem?

DrAkikur Mohammad, medical director and founder of Inspire Malibu Treatment Center and the leading authority on drug addiction and treatment, shares with CelebZter his opinion on the situation.

DrAkikur Mohammad says: “Being in the public eye is especially hard when you are an Olympian like Michael Phelps.  This is a man who has spent his entire life striving for perfection and being better than anyone else in his field.  He has also been under a microscope since breaking records at the 2008 Olympics when he was still so very young.  Until recently, he was planning on retiring from the sport that gave him so much but decided to come back and compete against much younger and possibly quicker athletes.

“I imagine that trying to be the same Michael Phelps that won so many fans from his early wins and the grueling training with an older body, plus the pressure to succeed has got to be overwhelming.  These are the ingredients that can create a very disastrous situation if you already have an alcohol problem, which apparently Phelps does.

“While I don’t know Michael Phelps’ medical history, his pattern of criminalized behavior strongly suggests that he is more than just a heavy drinker. Most likely it’s not that he doesn’t want to stop drinking but rather that he can’t. The self-destructive, physiological cravings that an alcoholic experiences can only be managed through medical intervention.

“Alcoholism is a complex chronic disease with a strong genetic component that requires both behavioral and pharmaceutical therapies. While there is a role for 12-step, AA program  for some patients, it should never be the exclusive or the focus of treatment.  Let’s hope that Michael gets the kind of evidence-based therapy that he needs.”

Dr. Akikur Mohammad is a leading authority on drug addiction and treatment. He is board-certified in psychiatry and addiction medicine, and teaches addiction medicine at USC Keck School of Medicine and medical director of Inspire Malibu Treatment Center.

Original Article

Dr. A R Mohammad

Primary Care Doctor Explains Real-Life Challenges In New Study’s Recommendations For Men’s Cardiac Health


new study on cardiac health, whose results were published this week in the Journal of the American College of Cardiology, makes it all seem so simple: Five changes in lifestyle can reduce your chance of heart attacks by 80%.

Sign us up! But with most things in life, the devil is in the details.

The landmark study is considered a serious contribution to understanding how lifestyle affects health because of its size and scope.

More than 20,000 Swedish men who were 45 to 79 years old in 1997 were tracked until 2009 to see how life treated them, given their choices about diet, exercise and smoking. At the time, they had no history of cancer, heart disease, diabetes, high blood pressure or high cholesterol.

The good news is that those who were considered “ultra healthy” by not smoking, drinking moderately, eating a whole food diet, maintaining a proper weight, and exercising daily had a whopping 86% reduced risk of heart attacks. The bad news is only 1% of men qualified as living this ultra-healthy lifestyle.

Why the disconnect between knowing what’s good for you and actually doing it?


We decided to take the question out of the rarefied world of medical research and into the real world of patients by asking Dr. Doug Pitman, M.D., a seasoned family practice doctor, to interpret the findings for us.

Monsters and Critics: From your perspective as primary care physician, what are the most important “take-aways” from this study?

Dr. Doug Pitman, M.D.: Lifestyle choices are just as important as genetics in determining those at risk for heart disease. Identical twin studies confirm the fact that those twins who make preventative lifestyle changes have less heart disease then their identical twins who do not make those changes. These studies apply to both men and women. As the study stated these changes include attaining healthy BMIs with respect to weight, having an active lifestyle exercising 5 days per week, moderate alcohol consumption, no smoking, and a proper diet that lowers saturated fat intakes and avoid simple sugars.

Monsters and Critics: Of the “Big Three” problems identified with middle-aged men in the study — bad diet, lack of exercise and smoking — which is the most serious?

Dr. Doug Pitman, M.D.:I would say that smoking creates the greatest risk for heart disease. I suspect this is especially true in women who have a natural hormonal protection against heart disease based on cholesterol profiles.

Monsters and Critics: As a medical doctor, are you at all surprised that in 2014, medical researchers are telling American middle-aged men that drinking a cocktail each night is good for their health? (Will they next find that buying a fast car is good for your health?!?)

Dr. Doug Pitman, M.D.: It is been known for a long time that red wine with all of its antioxidants has a protective effect on blood vessels. In addition alcohol itself raises the good cholesterol HDL and in moderation — which is the key to consuming alcohol beverages — can play a small role in preventing heart disease along with the other behaviors mentioned in the study. Excessive alcohol plays havoc with virtually every system in the body creating fluctuations in insulin levels, which can lead to elevated triglycerides well known as significant risk for heart disease. In addition, the pure caloric intake from alcohol can lead to weight gain especially if drinking alcohol leads to uncontrolled eating.

Monsters and Critics: What is the challenge of the typical family practice doctor in encouraging their male (and female) patients to adopt a healthier lifestyle?

Dr. Doug Pitman, M.D.: The challenge for doctors is pursuing a healthy lifestyle themselves so patients can learn by example. One study that I can recall indicated that the most important factor in a primary care physician’s influence on patients’ risk for heart disease is not what he says but how he looks. If the physician is fit and practices cardiac prevention himself, patients or more likely to emulate his lifestyle. Overweight physicians who smoke cigarettes – which, by the way, wasn’t uncommon when my father was a physician in the 1950s and 1960s – can preach cardiac wellness until he or she is blue in the face, and they will not inspire their patients or promote compliance to their good advice..

Monsters and Critics:  The study suggests 5 lifestyle changes to dramatically improve men’s cardiac health. If you had to add a 6th, what would it be/?

Dr. Doug Pitman, M.D.: My 6th recommendation is one that I have lived by my entire life. Simply put, it’s stress reduction. Find time during the day to relax your mind away from your work and allow your body to exercise in a comfortable way. Get into a relaxed zone of exercise and your brain will rest. I have always stretched my lunch hours into 90 minute exercise sessions involving jogging, cross-country skiing, biking and more recently walking. What better way to prepare yourself for an afternoon of work? Also, try to take a half-day off per during the work week for some quality relax time. And don’t forget to spend quality time with family and friends.

Doug Pitman, M.D. is a concierge medicine doctor with SignatureMD and the founder ofWhitefish Primary Care in Montana, specializing in premier sports and family medical care.

Original Article

Signature MD

Direct pay: A promising care model with challenges

Physicians say direct pay models offer a viable alternative to health insurance, but require careful planning and outreach

 Fed up with the “hamster wheel” of traditional fee-for-service medicine, many primary care physicians are exploring direct pay models as a way to provide better care for patients and derive more satisfaction from practicing medicine.

READ: How to survive in independent practice

While there is no standard definition for what constitutes a direct pay practice, for the most part they fall into one of three categories. The first is a straight cash model, in which patients simply pay out-of-pocket for a procedure or consultation. Sometimes the practice will give the patient a superbill that the patient can submit to his or her insurance company for reimbursement.

Under the second, more common form of direct pay, patients pay a monthly fee to be included in a physician’s panel. The fee covers unlimited office visits and 24/7 access to the physician, including via text or e-mail. In most cases it also includes whatever in-office procedures and tests the physician offers, although some practices charge extra for these.

The third form, often referred to as concierge or personalized medicine, also includes a monthly fee, but one that is generally higher than in direct pay practices. In return, the patient receives services such as a comprehensive annual physical exam, and guaranteed no-waiting appointments. Unlike the other two forms of direct pay, many practices that call themselves concierge maintain contracts with insurance companies.

Direct pay practices

Managing the transition

While the vast majority of physicians using direct pay say they are satisfied with it, ensuring a smooth transition to direct pay (or start-up if it’s a new practice) can be challenging.

READ: Why cost gives independent physicians an edge

To start with, not every practice is well-situated for making a successful conversion. It requires a loyal patient base and solid reputation in the community, says Rob Lewis, vice president of physician marketing and operations for SpecialDocs, a consulting firm that helps practices transition to concierge-style medicine. How long a practice has been operating, and how long it’s patients have been with it, are among the first features SpecialDocs looks at when deciding whether to take on a conversion client, he adds.

Primary care physicians

For a typical primary care practice with a patient panel of about 2,000, Lewis says, between 300 and 600 will elect to stay with the practice after it converts to a concierge model.

As with virtually any issue involving the practice of medicine, finances are a significant consideration in the direct pay equation. Cash flow generally is not a problem at first, either because the practice still has contracts with third-party payers or patients have paid fees in advance of the conversion, or both. But getting the fee structure right is another matter.

“You have to do your due diligence and look at how appealing your practice is likely to be in your particular community,” says Harry Izbicki, DO, co-owner of Izbicki Family Medicine, a direct-pay practice in Erie, Pennsylvania. “If you charge too much, you won’t get enough patients to support your business. But if you charge too little, you’re leaving money on the table and maybe working harder than you have to.”

After deciding to transition to some form of direct pay, informing patients–and persuading them to sign up–becomes the next key challenge. The reason is simple: if patients don’t understand direct pay/concierge medicine, or why your practice is going to use it, or the benefits they will derive from it, they won’t stay with you.

The time required to switch to a direct-pay model varies depending on the size of the practice and patient demographics, but generally requires three to six months. Izbicki says it took his practice about four months to complete the transition, “and was really mostly dependent on contractual obligations of notifying each insurer that we were opting out of our contracts,” he says.

Success stories

The number of practices using direct pay is difficult to pin down, in part because some physicians are reluctant to say they do so, says Michael Tetrault, editor-in-chief of the online publications “Concierge Medicine Today” and “The Primary Care Journal.” “There are slightly less than 4,000 physicians who are verifiably, actively practicing concierge medicine or direct primary care across the United States, with probably another 8,000 practicing under the radar,” Tetrault says. That compares to an estimated 500 who were doing so in 2000, he adds. The Direct Primary Care Journal believes that the growth in direct-pay, non-retainer style primary care practices will grow at a rate of roughly 10-15% in the next few years.

Whatever form they take, such practices almost always have smaller patient panels than under the traditional fee-for-service model, allowing physicians to spend more time with each patient and get to know them better. Equally important, it frees practices from the expense and frustrations of dealing with third-party payers.

The experience of Izbicki Family Medicine is typical. After nearly three years of practicing independently, co-owners Jon and Harry Izbicki realized that the traditional fee-for-service reimbursement model wasn’t working for them, either financially or personally.

“We were in the cattle drive of medicine that the insurance companies have most doctors running nowadays,” recalls Jon who, like his brother, is a D.O. “We realized how it was affecting us adversely from a business standpoint and knowing that to keep our doors open we had to see more and more patients, which started cutting into the amount of time we could spend with them.”

In response, the brothers decided to convert to a direct-pay model. They set monthly fees ranging from $135 for a family to $65 for an individual, which covers all office visits and includes same-day appointments and 24/7 access to the providers. The practice negotiated a direct-purchase agreement with a local provider of lab services, enabling them to provide services such as lipid panels and blood workups for a fraction of the usual cost, often $10 or less.

In addition, because Pennsylvania allows physicians to dispense medications, the practice operates a pharmacy at which patients can get prescription medications for up to 90% less than at commercial pharmacies.

So far, says Harry, direct pay is succeeding. “We have the time to more effectively manage the medical concerns of our patients, without worrying about the number of patients we need to see each day to break even, or whether they have insurance,” he says.

He adds that the practice retained about 15% of its patient panel following the conversion, but “we still have upwards of a thousand patients who have yet to either sign up or tell us they’ve transitioned to a new physician.”

Like most practices converting to direct pay, Izbicki continued to treat all its patients up to the day of conversion, regardless of whether they planned to continue with the practice. Patients who wanted to transfer to another practice were directed to a local hospital and the county medical society for help in finding a new provider.

The ability to spend more time with each patient is often the deciding factor for practices that choose a direct pay model, says Matt Jacobson, founder and chief executive officer of SignatureMD, which helps practices transition from fee-for-service to a concierge-style practice. “The only correlation we can see between any sort of medical practice and better patient outcomes is time. Simply spending more time with patients inherently leads to better results,” he says.

Most of the physicians SignatureMD works with end up with between 350 and 400 patients in their panels, each of whom pays an “amenity fee” averaging  $1,720 annually, Jacobson says. For that they receive guaranteed same- or next business-day appointments and appointments for non-emergency medical issues are guaranteed to start on time.

Jacobson says nearly all his client practices use what he terms a “market segmented” model, under which patients who choose not to use the concierge service remain with the practice and continue to use third-party payers, but are treated by a midlevel rather than the physician. “Those patients often matriculate up to the concierge practice over time as they tend to have a change in health or economic circumstance,” he says.

For Brian Forrest, MD, a major benefit of direct pay has been the ability to provide more access to primary care. Forrest heads Access Healthcare, a family practice in Apex, North Carolina, about 10 miles from the state capital of Raleigh. When he opened his doors in 2002, he says, the county had about 85,000 people without health insurance, and probably ha more today.

To help address that need, he decided he would keep Access’s overhead expenses as low as possible, which also meant not going through insurance companies for payment. As a result, he was able to set a monthly fee of $25 per patient, plus $5 per office visit. For patients who preferred not to join the practice, there was an a la carte pricing schedule with no service costing more than $40.

direct pay chartToday the practice has three providers, with a patient panel of 6,300, of whom 3,300 are active, says Forrest. Membership fees have risen to $40 month. The practice also charges $20 for each office visit. “That covers the variable cost of seeing patients in the office [rather than through telemedicine or e-mail,] says Forrest. It’s the right amount to keep patients from coming more than they should, while not causing them to delay any necessary care.”

Forrest schedules one patient visit per hour, but spends an average of 45 minutes per patient. The remaining quarter-hour is for dealing with walk-ins. “It’s a luxurious pace, and I love it,” he says. His patient panel includes everyone from homeless people to millionaires.

“The homeless people say there’s nothing else they can afford. And we have millionaires who drive two hours away who tell me ‘I can’t pay anyone to get the kind of care I get here.’”

Because Access has used direct pay from the outset, it didn’t have to go through the process of explaining the model to existing patients.  Even so, Forrest says that when patients calling for appointments learned how the practice operated, “initially 80% of the people would just hang up the phone. But now that people have gotten to know us, I’d say 90% of the people who walk in the door understand that we don’t do insurance.”

Among his fastest-growing subset of patients, he adds, are patients covered by Medicare who want to be “off the grid.” “They don’t want to go to a doctor participating in meaningful use who will make their data available to Medicare,” he says.

Prior authorizations

Since most patients at direct-pay practices still have some form of health insurance, physicians are not free of the burden of obtaining prior authorizations for some procedures and medications.

READ: The prior authorization predicament

At the same time, having fewer patients reduces the number and the time spent on them. Apex in North Carolina “has to deal with the same [prior authorization] bureaucracy as everyone else,” says Forrest. When faced with a rejection from an insurance company he will sometimes threaten to tell his local newspaper that the insurer is denying needed coverage to a patient. “Most doctors can’t do that because their contracts with insurance companies prevent them from talking about it [authorization denials],” he says. “I can, and I get everything approved.”

Doug Nunamaker, MD, a physician with Atlas Family Practice in Wichita, Kansas, says many of his patients have high-deductible insurance plans that don’t cover many of the procedures typically requiring prior authorizations, so he does them no more than two or three times a year.

Atlas has about 1600 patients in its panel, which allows its providers to spend at least 30 minutes–and sometimes up to 90 minutes–on each appointment. Nunamaker averages about six patient visits per day. “There’s either quality or quantity, and traditional medicine now is all about the quantity,” he says. “If I can only spend six or seven minutes with a patient, they’re not getting good care.”

Staffing changes

Practices switching to a direct-pay model often find they undergo staffing changes. That’s due in part to the need for higher standards of patient service, particularly among practices using concierge medicine, says Signature MD’s Jacobson “You can’t charge a premium fee without having premium service across the board,” he says.

Jacobson advises clients to identify the staff member who best relates to patients and making him or her the primary point of contact with patients who have signed up for concierge services. “You want the person who treats patients like they’re at the Ritz Carlton focusing on the membership patients,” he says.

Lewis says physicians sometimes will use the conversion process as an opportunity to  dismiss staffers who haven’t been performing well, although those people often wind up leaving of their own accord. On the other hand, “some physicians, if they have a particularly tight-knit staff, will decide to keep everyone initially, and wait for attrition to pare down the staff.”

Original Article

Signature MD

Is Robert Downey Jr. Right that Drug Addiction is Genetic?

Getty Images

A child of an addict or alcoholic is more likely to get hooked.

“Pick a dysfunction and and it’s a family problem,” the Iron Man star told Vanity Fair. It’s not a far-fetched statement. ”Sons of alcoholic fathers are up to nine times as likely to develop drinking problems as the general population,” Dr. Mohammad notes. “Babies of alcoholics adopted into non-drinking homes have almost the same odds of alcoholism as they would if they’d stayed with their birth parents.”

Partying as a teen can set you up for future drug problems.

Robert Downey Jr. has spoken openly about his father (director Robert Downey) introducing him to drugs at an early age, once telling People“When my dad and I would do drugs together, it was like him trying to express his love for me in the only way he knew how.”  Bad idea, say the experts. “Young people (from birth to their college years) have a much higher chance of incurring permanent brain damage from using alcohol or drugs, because their brains are still developing,” Dr. Mohammad explains. Not to mention, partying with the kids sends a powerful message that getting drunk or high is a smart idea.

Nurture also matters–in a surprising way.

Nature and nurture play a role in drug abuse: ”Your environment can trigger the genetic component,” explains Dr. Mohammad. For an alcoholic, simply passing a bar is enough to stimulate the brain receptors that turn on a craving for alcohol. And it can be a lifelong vulnerability. ”Look at Philip Seymour Hoffman,” Dr. Mohammad points out.  ”After 20-plus years of being clean and sober, he reportedly snorted heroin several months before his death, and his addiction returned full-blown.”

These two steps help prevent the problem.

“The vast majority of people who take a drink or even shoot heroin will not become addicts,” says Dr. Mohammad. (Only 10% of the population have a true addiction.) But if you have a family history, it’s key to make lifestyle tweaks. Two smart moves: Avoid friends who party hard and get counseling for any mental health issue that could cause you to ”self medicate” with booze and pills. The encouraging news for the Downeys of the world: the cycle of addition can be broken, stresses Dr. Mohammad says: ”Their fate isn’t sealed.”

Original Article

Dr. A R Mohammad

Inspire Malibu