Scoliosis, as many of you know, means lateral curvature of the spine. It is a structural alteration that can progress as the person grows, leading to significant deformity. Adolescent idiopathic scoliosis (AIS) is typically defined as curvature greater than 10 degrees. Curvatures that are less than 10 degrees have no long term clinical significance. 

The 3 subcategories include:
- Infantile (0-3 years)
- Juvenile (4-9 years)
- Adolescent (>10 years)

So how common is AIS?
The prevalence of AIS is approximately 3% and only 10% of those adolescents require treatment. Males and females are affected equally. However, the risk for curve progression is 10 times higher in females than males. The degree of curvature is measured by Cobb angle. When considering prevalence, think about this:

• Cobb Angle > 10 = 2-3% 
• Cobb Angle >20 = 0.3-0.5%
• Cobb Angle >30 = 0.1-0.3%
• Cobb Angle > 40 = <0.1%

So if a family member or friend has scoliosis, first appreciate their strength and uniqueness, and then ask about their angle if they wish to share. Knowing that piece, one can greatly appreciate the prevalence of their condition. 

It may surprise you, but your primary care doctor can screen for scoliosis, diagnose, order the X-ray, and even start brace treatment if needed. If surgery is indicated, your primary care doctor can coordinate efficiently with an orthopedist. Point is, don't run to an orthopedist the minute you hear about scoliosis. This diagnosis, like any other diagnosis, requires a conversation.

What does having scoliosis mean? Do I have to have surgery? What are the post surgical challenges I may encounter as I am recovering? Even after treatment, what should I worry about? What about pregnancy? What about sports or even contact sports? Is this genetically linked that I need to have my kids screened? What about working out - any precautions I should take?  

So, what does all this mean in adulthood?
Regardless of getting treatment or not, there definitely are clinically significant concerns one may face as they enter adulthood. Even when the spine is corrected to midline with surgery, individuals must be cautious when weight training, aerobic activity, and may have chronic back pain. The muscles that support the spine have to adjust and may be prone to strain. Rotation is largely limited in the surgically treated spine, so one may not be able to participate in some activities. 

Mental health studies have yielded conflicting results based on surveys. My opinion is that this only reminds us that diagnoses are perceived differently by each one of us. I argue that your perception of your diagnosis, whatever it may be, is facilitated by your team of doctors. As physicians, we have a duty to treat illness, but also to be a coach, a friend, and most importantly a partner in any journey that requires chronic management. Positive thinking and supportive behavior has shown study after study to improve outcomes - that is the job of the physician. Be a true advocate and partner. 

After surgical correction, pulmonary function improves, but skeletal alignment may still have long lasting joint pains. 

In those patients where surgical correction is not done, the curvature can progress and cause more pain with pulmonary issues. As our bones get weaker with age, the spine may slump even more leading to alteration of your gait. 

Surgical correction at times requires repeat operations, scar healing, and hospitalizations can be prolonged. Thus, the sooner we can screen and treat, the better outcomes we get. Self-image might be an issue in adolescents. Wearing a brace or having visible scars after surgery may leave keloids that challenge an adolescents self image. 

Scoliosis is a condition that must be identified early, have a management plan, and must be included in long term management. This is not, like any other diagnosis, something that is "repaired" and forgotten. 

Build a relationship with your primary care physician to be at your side as you enjoy the many blessings life has given you. Nothing is impossible. We just have to make some adjustments with the challenges that are thrown our way. 

Please help me raise awareness about scoliosis and I hope I taught you something new about this condition that you may not have known before. 

To your health and our community, 
Dr Ahmed 

Memorial Day was originally established to celebrate Civil War heroes in a single unified day, instead of separate days celebrated by the Union and Confederate states. Around the 19th century, Memorial Day expanded to celebrate all veterans who fought as American forces. 

As physicians, we learn from one another and are united in our thirst for knowledge to better serve humanity . War, in all its ugliness and chaos, demands innovation in science and technology. Thus, it is not surprising that modern medicine seems to have strong roots during times of war. The ancient philosophers and scientists created a foundation for physicians during the Civil War to innovate to meet the demands of its wounded soldiers, but also to create standards of care that we practice even today. Here are 5 innovations that were developed during the Civil War:

1. LIFE SAVING AMPUTATION 
- The old practice of saving limbs with wound cleaning using rats and maggots was replaced with cutting off infected limbs to prevent the spread of infection. In fact, Union soldiers were known for amputations, had less mortality from their procedures, and took no more than 6 minutes to perform. The technique not to cut through joints and to cut far away from the heart as possible became the standard of care. 

2. THE ANESTHESIA INHALER 
- Stonewall Jackson's surgeon recommended the removal of his left arm after it was injured during friendly fire. When a chloroform-soaked cloth was placed over his nose, General Jackson muttered, "What an infinite blessing," before going limp.  The cloth was inefficient as the liquid evaporated quickly, so Dr. Julian John Chisolm invented a 2.5 inch inhaler. Chloroform was dripped through a perforated circle on the side onto a sponge in the interior - the patient inhaled through tubes and the vapors mixed with air. This new method required less liquid; thus, allowing the physicians to treat more soldiers and using less supplies. 

3. CLOSING CHEST WOUNDS
- Benjamin Howard, an assistant surgeon, was told to do busy work while his superiors performed the surgeries. He started to experiment and realized that if he closed the chest with staples and linen, the lungs did not collapse as they did when the chest cavity is opened from negative pressure; thus, there was no suffocation. Survival rates quadrupled with this new technique. This technique became the standard treatment. 

4. FASCIAL RECONSTRUCTION 

Dr. Gurdon Buck, father of modern plastic surgery, looked onto a young 20 year old private named Carleton Burgan of Maryland. This private had battled pneumonia and now the mercury pills had led to gangrene that was moving from his mouth to his eyes. His right cheekbone had to be removed and the young man was willing to try anything  to stop the infection. Dr. Buck was the first to photograph his progress of his repairs and use tiny sutures to minimize scarring. 

5. THE AMBULANCE-TO-ER SYSTEM
- The Union went into the First Battle of Bull Run on July 21, 1861 not expecting a true battle. As approximately 1,011 Union soldiers lay wounded, the ambulances remained empty, leading to high numbers of mortality. The civilian drivers at the time were, according to some, described as "cowards" or "drunkards." 

Jonathon Letterman, the medical director of the Army of the Potomac, created a model of triage that we all know today. He established caravans of 50 ambulances, each with a driver and 2 stretcher bearers. He hired private wagons to carry medical supplies. The ambulances had spring suspensions and a lock box to prevent soldiers from stealing protein, bedsacks, and morphine that was reserved for the injured. 

Every war brings innovation and the medical community must not forget the sacrifices made by soldiers, scientists, physicians, and several other professionals who made modern day medicine what it is today. 

In this reflection, we must ask the question, have we been effective in preserving that fundamental drive that our predecessors had to innovate to help a large number of people without regard to creating any complex systems that may interfere in allowing the injured to access the innovation?

Memorial Day should make all of us pause and reflect on the many lessons learned across  all professions during our times of war.  What is even more fascinating is that those lessons continue to teach us today; regardless of how advanced we think we are as a society.

In loving memory of all fallen soldiers, 
Dr. Ahmed   

Many of you might have read the book Toyota Kata, or heard of lean management. Furthermore, many may have heard about lean health care. As the principles of lean management take over organizations across many industries, we find that the most successful organizations are those who achieve integration and implementation of these principles. But, it is not these principles alone that make an organization successful. It is the organizational culture of commitment, leadership development, empowerment, and employee investment that makes the difference. 

Health care has become an industry that is one giant green monster that is zapped from many stakeholders, like the government, private corporations, pharmaceutical companies, and insurance companies, all trying to get this monster under their control. But who is really out there protecting the people? 

As I mature as a physician in this circus, also known as United States health care system, I am starting to realize a few things. When I was a medical director at a large health system, I saw how decisions in health care are largely led by thinking of margins before patient care. My department was not a revenue generator compared to others, but a cost savings one. But, as I continued to grow my team and expand our services, I realized that no matter how hard I tried the decisions I would make were always under the scrutiny of corporate leadership. How is this different than the practice of medicine?

The decisions that physicians make "out in the field" - in clinics, hospitals, etc - are largely guided by insurance companies, government insurance, hospital policies, and pharmaceutical companies. We often hear, "that costs too much" or "my insurance does not cover that" or "they are not in my network" or when a hospital finds out a patient is not in network, the move to a different hospital happens at lightening speed! 

Kata, in Japanese, means a way of doing something, a pattern, or a standard form of movement. So as leaders, the challenge is to get team members implementing a routine without requiring constant input from administration. The idea is to have a routine that nurtures continuous improvement and adaptation. More importantly, decisions are pushed to those who are closest to the issue. So, when Toyota stops the line when a part is not put in correctly, the lights go off, the line stops, managers come over to help repair the part, others assist as needed, and the line resumes once corrections are made. This process is more efficient, has a team approach, allows everyone to adapt and improve the process immediately by correcting a routine to make it more efficient. 

Health care today, uses cost benefit analysis (CBA) to the max! The problem is that the budget is a dependent variable, not independent. 

Instead of CBA, health care providers and leaders must think in terms of target conditions to move towards their vision. More importantly, not only do organizational leaders must think this way, but physicians must practice this with their patients; thus, developing their patients as leaders of their health care! 

Here is an example of how this works, especially in primary care. If I have a overweight type 2 diabetic, my first visit might be discussing the importance of blood sugar control, diet, and how their current medications will help them prevent further organ damage. 

1st step: Understand the current situation. What is their current blood sugar control and where do they want to be in terms of their diabetes control? What does the future look like? What is their overall prognosis today if their current situation does not change? 

This visit is truly about goal setting. As Charles Duhigg says in Smarter, Faster, Better, goals should be SMART (Specific, Measurable, Achievable, Realistic, Timeline). 

2nd Step: Set SMART goals or target conditions to achieve the vision of - coming off insulin, achieving BMI less than 25, having an A1c< 6.5%, etc. Put a timeline together. Discuss potential barriers with possible solutions the patient can use when they might come across these barriers. 

3rd Step: Meet frequently. I recommend every 1-2 weeks the first month. Reflect on barriers, solutions, and give feedback of how to improve to stay on tract to achieve the goal set for that month. This is the  value of direct primary care, instead of the insurance model. 

4th Step: Provide ongoing support and always keep focus of the patients vision. When the vision is realized, celebrate! Get feedback from the patient and provide them with your feedback so that they can lead others. 

In my young career, I have held a few leadership positions and have been mentored by great leaders. My Master's program was fantastic and had created a good foundation to build my experiences. All my experiences and positions in health care form my current vision for my fellow Americans: Patient leaders who then lead others in achieving their quality of life. 

Imagine a United States health care system that truly implemented Kata principles and SMART goals. Naturally, in this type of system, primary care becomes the most crucial aspect. It is the place where patient empowerment begins and grows. Patients as leaders of their health care must be the mindset of future health care entrepreneurs.

In my company, this is how we achieve success - develop everyone around us as leaders. Whether it be patients, partners, or staff, our focus is to develop leaders. Empowered health care consumers should not be just a term we throw around. It is time we implement this belief  and it is the missing ingredient our health care needs. Otherwise, we remain broken. 

To better health for all, 

​Dr. Ahmed

Climate change, according to the EPA, means that the Earth is warming. In fact, the average temperature has risen 1.5 degrees Fahrenheit over the past century. It is expected to rise another 0.5 to 8.6 degrees Fahrenheit over the next hundred years. Why should we care and as a physician, what does this mean to our health?

This is an important topic. So important, in fact, that the American College of Physicians (ACP) has written a position paper on this matter. The rising temperatures have led to changes in weather and climate. This means more floods, droughts, intense rain, and more frequent and severe heat waves. 

Oceans are heating up and becoming more acidic and with glaciers melting, sea levels are rising. Many bacteria, insects, and other disease causing organisms thrive in these environments. You see, insects are effective carriers and vehicles for spreading disease to large populations. The Zika virus, Lyme disease, West Nile Virus, Ehrlichiosis, and the list goes on. 

In addition, water is at risk of becoming contaminated and the air is becoming more polluted and full of allergens, which lead to significant health hazards from infectious disease to cardiovascular and respiratory illnesses. 

The health effects are already being felt by all of us, especially physicians. The number of emphysema exacerbations, sinusitis, allergies, asthma flares, and respiratory failure from these pathologies is increasing in frequency and severity. The number of strokes and heart attacks in young and healthy individuals are increasing - in fact, I tweeted a NY Times article a few months ago that raised this concern. 

I was in the doctors lounge last weekend and talking with a critical care friend of mine. As we sat there talking about our day, I asked him "how has the flu season been?" To this he responded, "we had worse years, but still lost a few." To us, the stories of healthy 18 year olds going on ECMO - life saving bypass machines- are not extraordinary. Unfortunately, it is all too common. In our experience, we have seen and heard of many young healthy folks pass away from things like the flu or an asthma flare triggered by allergies. Cases of infectious disease from contaminated water or food poisoning are also common. Ultimately, cases that come from contaminated food and water that should have been "ancient" are present and claim many lives today. 

It is hard to convince the general public about the importance of climate change and it's effect on all of us. Thus, we write position papers, use TV, radio, and journals to get the word out. But like any other health issue, as much as physicians long for conversations like this to take place before any crisis happens, it almost always ends up being at the bedside surrounded by concerned family members. 

The issue of climate change transcends countries, race, nationalities, or gender. This is a human issue. It's a international issue that must be taken seriously by each of us. Like many health challenges and pathologies, there are solutions and steps we can take today to prevent the development of global disease and fatalities.  Please read the ACP position paper published yesterday and also visit www.epa.gov to learn more about how you can help. 

We are currently 9 months into the practice since my clinic opened and more than 12 months since I started doing house calls to spread the word about a new way of providing primary care. 

In the last 5 years, we have seen a shift in healthcare policy. Expanding coverage we all know does not immediately mean accessible and affordable care. In addition, we see people waving their Medicaid/Medicare or private insurance cards in the air saying, "we are insured so come see us" but there are less physicians to take care of them. More and more physicians as well as large health systems are not participating with Medicaid/Medicare or some private insurance carriers. 

So, before you start to feel comfortable having that plastic card in your pocket, you should spend the time to figure out exactly what you actually bought and which physicians participate with your plastic card. 

                                          WARNING: This blog is very geeked out, so it is NOT for the casual reader.

The health and fitness industry has grown to become a multi-billion dollar industry. A large part of this growth has been through selling supplements to the “busy” consumer who just does not have time to eat healthy. Or, these products target the average American who has the aspirations to have the body like their favorite athlete. This has led to an explosion of various products confusing the consumer as to what is really necessary to take. 

The goals of this post are:
1. Understand basic human physiology of muscle contraction and all the micronutrients that are involved
2. Educate regarding these micronutrients and how supplements aim to help, assist, or replace them
3. Learn about various supplements, including pre-workout drinks, branched chain amino acids (BCAAs), creatine, B vitamins, and much more!
4. Touch on the topic of probiotics and fiber. What's my colon got to do with all this? 
5. Touch on "detox" programs, juicing, and fasting. Which is better and do I really need to do this?

Throughout this discussion, there is one proven fact that cannot be dismissed: all the nutrients your body needs already exist in your environment. To eat and live healthy, all we have to do is be willing to learn, make healthy eating a priority, and surround ourselves with people who will support eating healthy. Easy as that. To learn more, check out Dr. Sommer White, a board certified physician who is a great resource for you to learn about how food can heal and facilitate healthy living. http://www.sommerwhitemd.com

Also consider reviewing my previous blog about the 7 essentials to live healthy.

Basic physiology of energy
We all need energy to do anything. This is a law of physics where energy that is kinetic (motion) is dependent on the weight of the object and its speed. So the faster it moves and heavier it is, the more kinetic energy it develops. 

                                                                     Energy = weight (kg) x velocity (m/s2)
​
In food, we measure energy in calories. Our sources of energy come from proteins and carbohydrates. 
1 calorie = 4.1868 Joules (measurement of energy in an object) 

There is international debate as to how much calories we should consume. But here is a general recommendation: 

Men = 2500 daily calories 
Women = 2000 daily calories

​Those who are sedentary, certainly these requirements will suffice. But, what about those who are active. Meaning, those who are working out 150 minutes per week or more? Active individuals have a higher demand for micronutrients and calories, especially if they want to maintain their weight and/or muscle mass. 

This means, that the more you exercise, the more you expend energy, then the more you need to invest in the recovery phase. 

The recovery phase means:

1. getting 7-8 hours of restful sleep per night
2. optimizing nutrition 
3. balancing workout with stressful and non stressful routines
4. stretching, yoga, and meditation to allow muscle fibers to heal

It is the recovery phase where you build muscle, not when you are working out in the gym. 
Remember, before a single muscle fiber moves, it needs to get a signal from the nervous system. This is called an action potential. This process involves sodium and potassium channels. This is why micronutrients are so important!

Basic muscle physiology

​Our muscles are important structures as they not only give us strength, make us look “buff”, but also strengthen joints and improve our balance as we age. To learn what an action potential is watch this video. I love this guy because this is what I probably would be doing if I didn't become a doctor.

Now that you understand the basic muscle physiology and realize all the micronutrients that are involved in the contraction, the following sections will make more sense. 
​
What about these pre-workout drinks? 
There are various drinks on the market. At the gym, I see few people still use Monster energy drinks and the like. More commonly, I see 5-Hour energy. The main component in many of these drinks is caffeine. 

*Depending on the brew, an 8oz serving of coffee contains anywhere from 60-120mg of caffeine. Tea averages about 20-90mg per 8oz cup. Soft drinks average 20-40mg per can. 

How much caffeine is too much?
According to the Mayo Clinic, up to 400mg of caffeine a day is safe in healthy adults. However, in adolescents and children, they should limit to no more than 100mg of caffeine per day. 

So, taking a pre-workout drink will get an adult close to or meet that maximum daily requirement. Remember, these recommendations are for healthy adults. If you have heart disease, high blood pressure, anxiety, high cholesterol, arrythmias, and many other health conditions, then these recommendations DO NOT apply to you. 
Here is where having a good primary care doctor can help. Have a good conversation about your workout goals and work together to reach those goals in a healthy way. If your current primary care doctor is not comfortable with this conversation or doesn't even workout…well, then give Dr. Ahmed a call! 

​Many energy drinks and pre-workout drinks are packed with B vitamins. Ever wonder why? 
​Check this out:

What about whey protein and branched chain amino acids (BCAAs)? Or, creatine and glutamine so I can look like those fitness models? Because clearly, if I take all those, I will look like them right? 
Um, no you will not look like those fitness models just by taking these supplements. It takes a good balanced diet and exercise. More specifically, 80% - 90% is diet and the rest is exercise. You read that right: diet is more important than your exercise regimen. 

​How about juicing, fasting, and all these “detox” programs?
Majority of these programs are sketchy and very dangerous. Regardless of which program you are following, you need to be followed by a physician. This idea of “detox” should be an ongoing program where you eat foods that help clear any toxins by allowing normal bowel movements, increasing the efficiency of our cellular enzymes and reactions to digest all the toxins we are exposed to in our foods, water, air, etc. 
Check out www.sommerwhitemd.com. Watch her videos and her explanation of detoxification approach through food. We had her at our clinic and support what she offers. 
​
Short intervals of fasting are healthy, but must be monitored by a physician. Juicing has similar advantages for detoxification with elimination of inflammatory markers and provide antioxidants. Again, this should not be a one time thing and must be monitored by a physician. The bottom line is, get a doctor to monitor and assure that whatever you choose to do, follow it up with eating a healthy balanced diet and exercising daily. At the end of the day, diet and exercise is what is going to give you the benefits. If a fast or a juice helps you transition or get you to diet and exercise, then do it I guess. 
​
Here is a breakdown of the most popular ingredients the average athlete is curious about?

How much protein do I really need?
The average person needs about 1g/kg of protein per day. Those who are not as active can probably be ok eating a little less than that. However, if you are trying to add muscle mass, then the usual recommendation is 1.5g/kg. Remember, muscle building happens at night when you are sleeping or when you are resting, not at the gym. Balance this with about 30g of fiber to prevent constipation and certainly anyone with kidney disease, high blood pressure, or the medical conditions must be monitored by a physician. 

To give you some idea of how much protein some common foods have:

• 3 oz meat = 21g protein
• 1 cup milk = 8g protein 
• 8 oz yogurt = 11g protein 
• 1 cup dry beans = 16g protein 

So, the point is, before you run to the store to get containers of whey protein and bottles of BCAAs, think about how much protein you already consume and if there is a deficit, THEN consider possibly supplement. Remember, many if not all supplement products are NOT FDA approved. This means, these supplements are not benign or harm free. We just do not know the long term effects of some of these supplements. That is why I recommend use supplements to help you fill in gaps and hopefully you can replace those supplements with actual food. Long term supplements are not a good idea since we do not have the data to support their absolute need for the average human being. Professionals athletes are a different category in this discussion. 

Probiotics and colon health
There has been more enthusiasm about probiotics recently without the support of much scientific evidence. All the trials that are done on probiotics are inconsistent with methodology or are small studies. The intestinal tract is a host to any bacteria and any change in these colonies can affect your health. In a sense our intestine has its own ecosystem with bacteria regulating certain toxin elimination and protecting the intestine from inflammation and other processes that can damage its lining. 

By definition, probiotics are microorganisms that have beneficial properties for the human being. Many of the bacteria in these tablets are available in foods, such as non-pasteurized yogurt and milk. Some of the benefits include suppression of growth or epithelial binding/invasion by pathogenic bacteria, improvement of intestinal barrier function, modulation of the immune system, and modulation of pain perception.  Reports for benefit have been seen in the following conditions:

1. infectious diarrhea
2. Clostridium deficile infection 
3. preventing antibiotic associated diarrhea
4. Possible benefit with IBS 
*Again, the data is limited here. As you can see, there are only a few things have shown moderate evidence of benefit

Fiber is a stool bulking agent that helps people stay regular. It is important to have one bowel movement per day. The bulking agent facilitates peristalsis, which is contraction of the intestinal tract to help move stool along to facilitate a bowel movement. You need to take in about 20-25g of Fiber daily. I usually recommend 30g given the poor American diet. You can get fiber in a balanced diet or supplement with any affordable over the counter powders. 

Colon health is important to eliminate toxins from our body. If you think about it, our body eliminates waste by sweating through our skin, urination, and stool elimination. The average American does not stay hydrated and nor do they stay regular with their fiber intake. So the body is left with only sweat as a mechanism to eliminate waste. There is something to be said as these toxins accumulate and are not released, this can lead to poor health outcomes. More evidence is needed for this statement to be completely accurate, but the basic physiology suggests this possibility. 

                                                                       What is the bottom line on supplements?
I take supplements to help with muscle development and recovery. However, supplements are there to do just that - supplement your diet! A majority of supplements I think are unnecessary long term. If you are working out for a competition or a sport, then short intervals are reasonable. The more I learn about various vegetables that I had no idea about: daikon, miso, wakame, dried shiitake, and the benefits of brown rice, I am starting to realize how silly supplements seem. 

​Every supplement, whether they claim to be “all natural” or not, need to be monitored by a physician who is comfortable with these products. 

I have tried many supplements and do so with the intent to taste what my patients or future patients are likely trying. I also read about these products, because for me, it is important to have a knowledgable discussion about these products in the right medical setting. Consumers who take these products are likely very in tune with their bodies and would appreciate a physiologic lesson as to why they should continue, adjust their dose, or maybe even stop what they are taking. 

So, bottom line, focus on your diet. Get a team together that will help you not only understand but hold you accountable to a good balanced diet. Food should be entertaining, enjoyed with company, and diverse to facilitate curiosity and enjoyment. The supplement industry makes billions off the human behavior of not sticking to a plan or climbing on and off the wagon. Save yourself money and put together a good team for yourself to help you take what you need and stick to a program for life. Finally, combine your healthy diet and supplements with the right exercise program. You do not need to work out 6 days a week and spend hours at the gym. 

After 1 hour in the gym of active working out, any more time is just increasing your risk for injury. Athletes are different in that they know how to recover in between training sessions during the day with the right nutrition to allow healing of those injured muscles. 

Don’t be swayed by these new years resolution gimmicks. Stick to what you know - great diet with 150 minutes of activity per week is all you need to see results. Finally, be patient and positive. Feed your soul with a good book, meditate, do yoga, and laugh. 

Please do no hesitate to ask any questions you may have. Better yet, if you don't have a primary care doctor, please consider joining my practice. 
​
To a great year full of happiness, health, and blessings,

​Dr. Ahmed 

The air was crisp this Sunday afternoon. The snow had already melted and the cold air brushed my face softly. My body was shaking from the cold, but my mind was too busy to really take notice. My shoes had managed to gather a layer of mud that was an inch thick. To my right and left, I was surrounded by sad faces. Many were people I have known from the community, my friends, and others I hope to know one day. 

As I looked around the muddy cemetery, I noticed the clean gray speckled tombstone blocks that were neatly organized in rows to identify where the deceased rested. However messy the grounds seemed, the tombstone blocks were clean as if it was a dry summer day. The trees were bare and the sun shined bright through a clear blue sky.

At the distance I noticed the large fresh dirt mound that had been created to cover the deceased body whom we laid to rest this afternoon. All the sons surrounded the mound for their last prayers for their father. I could not help the tears that started to fill up. Why am I crying? I did not know the man. This was a very captivating moment for me. Here I am, extremely emotional for a man I never met, whom I never said a single word to, never shook his hand, never saw a picture of him till the announcement of his passing. What is the deal? 

Who I did know were his sons. You see, his children have impeccable personalities. When you meet them, your soul is fed with calmness, a certain ease, your heart slows a bit, and you can feel genuine compassion when they speak to you. I have watched, listened, and simply enjoyed being part of his son's community charity events. Their message is always simple and food for the soul: Live with compassion and use your talents to better your community. At least that is what they have taught me. You see, that is the mark of compassionate leaders - their actions touch us all in different ways. 

During the funeral, one of his sons educated us about his father. Most importantly, he said and I am paraphrasing "all the things we as sons do in the community and good deeds you see us doing, has been taught to us by our father." It was at that moment, I grasped what kind of man their father was. He was amazing. After listening to those words, I knew he was a great man. A humble man. A man who probably never made himself known in a room with a loud bolstering voice declaring all his accomplishments. Instead, I sensed he was a man who promoted a sense of community, provide a lending hand to those in need, emphasized the importance of charity - which comes in many forms, even a smile. 

It is these thoughts that came flooding in my mind with tremendous force.  I could not handle the emotions that followed. It was a tsunami of thoughts and pictures of what I imagined him doing or saying to his adult children when they were young kids.  I must say, I did well in fighting back the tears. But, as I lay down to sleep that Sunday night, the tears flooded my pillow. I could not fight it anymore. Silence of the night made the thoughts not only return, but were uninterrupted by any other concerns. 

​The Abdullah brothers are an inspiration to me and to all of us.  I am honored to know them and our Kansas City community is privileged to benefit from their extreme compassion. As a physician, they have taught me and motivated me to take my talents and skills to the next level to help those who are uninsured and insured to receive accessible and affordable primary care. 

I hope to be an asset to the community as the Abdullah brothers are to our community. When I pass, if my good deeds come even close to what their father has accomplished in raising his kids alone, then maybe, just maybe, I will get a chance to meet him...and thank him for his gift to my community. 

Dr. Ahmed 

Employer wellness programs have become more popular in the last several years. Its popularity for implementation has its roots in the ever increasing concerns of rising prevalence of obesity, diabetes, heart disease, and many other chronic illnesses. In fact, based on recent surveys, almost 80% of companies offer some type of a wellness program. 

Vendors for these wellness programs have enjoyed their growth in the last several years to a point where it has become a $6 billion industry. 

So, it is only fair to ask the question: Are employers getting a significant rate of return on their investment?

The rationale for having a wellness program in the workplace is to create a organizational culture of wellness, improve the health of its employees, decrease turnover, increase productivity, reduce health care costs, and on a larger scale - improve the health of our nation. Nearly half of Americans get their health benefits from their employer and we all spend a majority of our time in the workplace. Thus, these goals and rationale make sense. 

But, has this $6 billion industry delivered on its promise? 

On average, employers spend about $693 per worker and larger companies who have 20,000 workers or more spend nearly $878 per worker. A large survey found that although some biometric markers like BMI, smoking cessation, and exercise had improved, these changes were not large enough to reduce health care costs nor provide the employer with a substantial ROI. 

In addition, one of the major challenges in offering a wellness program is employee engagement (industry talk for employee participation). Surveys have shown that even after a wellness program is implemented, employee engagement is low. Studies have shown that the lost productivity from employee disengagement costs between $450 billion and $550 billion annually in the United States. For each employee, disengagement can cost the employer $5,000 to $7,000 per year in lost productivity. 

What if a physician led an employee health benefit plan where it included resources like fitness trainers, physical therapists, nutritionist, chiropractor, acupuncture, supplements for healthy eating and weight loss, financial advisors, lawyers for estate planning, massage therapists, counselors, medical specialists, and educators?

What if the physician also had partners in imaging, laboratory, pathology, had wholesale medications in their office, did not charge for any office visits or in clinic procedures like EKG, joint injections, suturing, skin biopsies, wound care, breathing treatments, or spirometry?

What if each employee as part of this physician led wellness plan had 24/7 access to their physician, even during holidays? Certainly a relationship between the employee and the physician is inevitable.  So is there value in this relationship where the physician understands the stresses, aspirations, goals, as well as medical condition of the employee?

Finally, what if the cost is only $600 per employee that is fixed annually with no other out of pocket expenses for the employer? While the employee enjoys significantly discounted medications, imaging, laboratory, and other services. 

The answer to all these questions is not an ideal nor is it impossible to implement. I do it already with companies right here in Kansas City. Many physicians across the country who share my vision and mission have also aligned their practice with other companies of various sizes. 

In a study that reviewed insurance claims data from 2013 to 2014 showed that the employees who belonged to the Direct Primary Care model compared to those who did not saved $679,000 per 1000 employees. In addition, there were close to 20% less claims  from the DPC group. 

Isn't it time to be innovative and offer a more comprehensive program to your employees? My practice is NOT insurance. So to qualify for the ACA mandate, employers must have a high deductible plan or a self insured plan that can be paired with our practice to give the most value to your employees. 

Healthcare is changing. Costs are rising and the physician supply is decreasing. Employers can play an important role in changing this landscape with one decision: partner with a direct primary care practice. 

Our mission is to recruit more primary care physicians, retain more physicians in private practice to facilitate patient focused care, and bring back continuity and relationship medicine. We do this simply because the health of our nation depends upon it. 

Please contact us today if you would like to learn more about our primary care practice and how we can partner together to truly establish wellness in the workplace. 

To your health
​- Dr. Ahmed 

Recently, there has been much discussion regarding concussion and sudden cardiac death (SCD) in young athletes. Although this is rare in children and adolescents, they are so devastating when it happens. There has been a growing effort in finding evidence-based strategies that will prevent this in a cost-effective manner. 

How common is this?
The incidence for SCD ranges 0.5 to 20 per 100,000 persons-years. Interestingly, when we compare studies from 1980s to 2009 show a rise in survival, which is attributed to improvements in community-based EMS and changes in resuscitation protocols. 

What is the cause?

• Coronary artery disease (29%)
• Primary arrhythmia like Wolff-parkinson-White syndrome (WPW) and conduction defects (22%)
• Cardiomyopathy like dilated, hypertrophic, and myocarditis (20%)
• Congenital cardiac disease like tetralogy of ballot, hypo plastic left heart syndrome and transposition of the great arteries (15%)
• Other cardiac disorders like coronary arteritis, anomalous origin of coronary arteries, aortic dissection, and mitral valve prolapse (8%)
• Unspecified disease (7%)

Interestingly:
2 years old and younger - cause of death congenital heart disease (84%)
3-13 years old - No dominant cause - congenital (21%), hypertrophic cardiomyopathy (18%), long QT 
                                    Syndrome (14%)
14-24 years old - No dominant cause - Primary arrhythmia (23%), congenital (23%), and dilated 
                                       hypertrophic cardiomyopathy (14%)
25-35 years old - Coronary artery disease 

When should I be concerned?

• chest pain
• fatigue
• passing out or lightheadedness 

What is the role for screening?
The American Heart Association (AHA) and the American Academy of Pediatrics (AAP) recommend that the most cost-effective initial screening for children and adolescents for cardiac disease is a detailed history and physical examination - ALONE. That is right, no need for unnecessary expensive testing no matter how some of these organizations market their services. 

There NO evidence that a ECG or any other cardiovascular screening program would reduce the incidence of SCD in the United States. 

Even for young athletes, there is NO evidence for routine use of ECG, echocardiography, or exercise stress testing. However, athletes older than 35 years old, some experts recommend ECG. If the athlete who is 35 years and older has moderate-to-high risk of coronary heart disease, then some experts would recommend exercise stress testing. 

Bottom line: Be careful out there as consumers are inundated with advertisements for services that can prevent cardiac disease. The truth is that unnecessary testing not only is costly, but also leads to false-positives that lead to further unnecessary testing. As with every health care topic - have a GOOD PRIMARY CARE DOCTOR to discuss issues like this and build a relationship with them so that you protect yourself from unnecessary testing that can be costly or lead to further unnecessary procedures that might expose you to harmful agents like radiation. 

To your health my friends, 
- Dr. Ahmed