Douwe Rienstra, MD

Educational Activities

2006 | 2005 | 2004 | 2003 | 2002 | 2000 - 2001 | 1988 - 1999

December 13th, 2002- Jefferson County Health Department update on smallpox vaccination and complications. The risk of death from smallpox is twenty to thirty percent. The risk of death from smallpox vaccine is about one in a million vaccinations. The speaker showed slides of many complications so we would know what to look for. Many people will suffer flu-like symptoms for a few days after vaccination. The Health Department will be vaccinating physicians and nurses so that they will be able to administer the vaccine in case smallpox becomes a threat.

You can read the latest information at the Center for Disease Control website.

December 6th, 2002- Chris Johnson, MD discussed Autism Spectrum Disorders, a spectrum of developmental disorders in childhood. Contrary to popular conception, these disorders are not rare, nor are they easy to diagnose. There are no set signs and symptoms, nor any laboratory test. These disorders are becoming more prevalent for reasons unknown. Treatment can help many of these children, and the earlier begun, the better.

November 22nd, 2002- James Schumacher, MD of Virginia-Mason clinic reviewed surgical methods used to treat Parkinson's disease. There are two major techinques being researched. Most reported on in the news is fetal cell transplantation. This involves using certain brain tissues from 10 to 20 aborted fetuses, and results seem to fade after a year. The difficulty of obtaining the tissue in this way will prevent this method from becoming popular. They are working on using stem cells instead; these cells could then be transplanted into the proper area of the brain to correct the deficiency that occurs in Parkinson's disease, but there will be many problems associated with such transplants.

The more common procedure is to place a stimulator deep into the brain, connected by a wire to electronics under the skin. Success varies, and there are still significant risks of this procedure.

November 13th, 2002- Dr Michael Gluck of Virginia Mason gave an excellent overview of inflammatory bowel disease. This includes ulcerative colitis and Crohn's disease. Newer treatment methods include immune system modulating agents and antibiotics. The latter are much less expensive and we have had success with them.

October 18th, 2002- Timothy Jacobs MD of Virginia Mason does not live up to his name. He is a giant gentleman from South Africa who spends his days peering through a microscope at tiny cells in biopsy tissue. He showed slides of common breast conditions, up to and including cancer, with details of how the diagnosis is reached and the best treatment chosen. This is an ever-evolving field as new research changes old practice.

September 27th, 2002- Swedish Medical Center. This all day conference was titled "Mind, Body, and Pain." Several speakers made these important points...

A "functional MRI" senses the increased oxygenation of regions of the brain when the part of the brain becomes active. Pain causes increased activity in the somatosensory cortex which tells us where the pain appears to be. Pain also causes activity in the more primitive areas of the brain. We call these emotional centers the limbic system. Distraction reduces pain-responsive activity in the limbic system, visualizing someone else's pain or anticipating your own pain increases it. Chronic anxiety or depression increases activation of the limbic system.
Compared with normal people, those with fibromyalgia have increased limbic system activity in response to pain in both the somatosensory cortex and the limbic system. Both paroxetine (Paxil is one brand) and psychotherapy decrease pain-stimulated activity in the limbic system.

Pain affects the immune system and vice-versa. Dr Veerinda Goli of Duke University points out that methods of improving immune response include visualization, Biofeedback (Psychology), hypnotherapy, Meditation, exercise and placebo effect. He concludes with the idea that the human body is a five million year old system with an innate pharmacopaea able to bring about healing in many ways.

Gordon Irving, MD, Swedish Medical Center pain specialist noted that although most patients with chronic pain suffer from depression, they usually have a different form of depressive disorder. They are more likely to gain weight than to lose. Compared to other forms of depression, they tend to be more anxious, agitated and angry, and to suffer less guilt. They are less likely to respond to antidepressants.

To treat anxiety in people with chronic pain, he uses tricyclic antidepressants, paroxetine, venlafaxine, bupropion and/or doxepin. Many of these will also reduce pain.  Patients may have to try several of these agents in varying dosing schedules to obtain optimal benefit.

A number of traumatic life events can make us more susceptible to developing a chronic pain syndrome. For example, post-traumatic stress disorder can result in chronic pain. Therefore an honest self-appraisal of "how is my life going, don't blame all my problems on this pain" is a must. The specialists in this conference agreed that though they were working to improve their approach, that those patients who were able to participate as part of the treatment team were most successful in regaining a more normal life. For some people, narcotic pain relievers were effective in helping them to return to normal activity. Unfortunately for many people, complete pain relief is not possible at this point in time. However, return to a more normal life is a very realistic goal.

September 13th, 2002- Stuart Cohen, MD, from the University of California at Davis Medical Center spoke at the Virginia-Mason Clinic about the treatment of pneumonia. A specialist in infectious disease, he outlined the kinds of bacteria to be expected in different situations, and which antibiotics are likely to kill them. Most people with pneumonia are infected with a bacteria called Streptococcus pneumonia. (This is different from the Streptococcus pyogenes that causes a "Strep throat.") In much of the world, Streptococcus pneumonia drops dead when faced with penicillin. However, in the western United States about 30% of people with Streptococcus pneumonia do not improve when treated with penicillin.

We know, of course, that this is due to overuse of penicillin and other antibiotics. You know that when we throw an antibiotic at the million or so bacteria in any particular infected person, what is left are the mutant bacteria that aren't killed by that antibiotic. These multiply and can spread through the community. They replace some of the bacteria the antibiotic used to kill, and the antibiotic is much less effective. This is due to evolution of the bacteria, and not to any "resistance" to the antibiotic on the part of us humans.

Although new antibiotics have proven effective, Dr Cohen noted that there are few truly new antibiotics in the development pipeline, and we need to be careful to preserve the effectiveness of those we have.

Too many of our patients come to the office having consulted out-of-town practitioners and having been unnecessarily prescribed the latest generation of antibiotics. Our patients have been very understanding when we explain to them that we are giving an appropriate antibiotic for their infection, and saving the "big guns" for when they really need them.

June 19th, 2002- Jacqueline Vuky, MD of Virginia-Mason Clinic reviewed the treatment of cancers of the kidney. In summary, these tumors are aggressive and treatment is difficult. Oncologists are making progress, but slowly.

She discussed treatment of advanced prostate cancer and bladder cancer. They are investigating many new anticancer drugs. Treatment protocols are changing constantly though improvement in survival is difficult to achieve.

She pointed out that Virginia-Mason is studying the use of vitamin E and selenium to prevent prostate cancer. She did not mention this, but there have been studies showing that fruits, vegetables (especially tomatoes), soy products, selenium, zinc, and vitamins A, B6, C, D, and E reduce the risk of prostate cancer.  Excessive calcium and animal fat in the diet seem to promote prostate cancer.

May 31st, 2002- David Robinson, MD of Virginia-Mason Clinic reviewed some fascinating history. He began his story in the 1930s with the tale of a young physician who thought it might be possible to put a tube into the heart by inserting the tube into a vein in the arm. He sought permission from his superiors to try it on himself and was turned down. Undaunted, he returned after hours and tried it anyway. He took xrays and photos to document what he had done. As a result, he was fired. (Several decades later, he was awarded a Nobel prize.)

Dr Robinson brought us forward in time. Further techniques were developed. Today surgery can be performed through such tubes (called catheters), and advances are occuring very rapidly. Just a year or two ago, people with aneurysms (swelling of an artery due to weakness of the arterial wall) had to undergo surgery. Sometimes, even then the problem could not be corrected, and surgery of course had certain risks. Today, they can put a catheter into an artery in the arm or leg and repair that problem with much less risk. Similarly, people who have an arterial blockage used to require surgery- surgery of the heart, the neck, or the legs. Today, these arteries can be opened using catheters. The advantage is that problems within the skull (previously untreatable) can be treated. Sometimes (but still not often), a stroke can be reversed. Blocked arteries in many parts of the body can be opened and patients often can go home the same day.

Not only can disease be treated by opening previously closed blood vessels, but diseases can be treated by stopping the flow of blood through a vessel. For example, varicose veins can be treated by inserting a laser into the vein and burning the vein from the inside, causing the vein to scar closed. Fibroid tumors of the uterus can be treated by causing the blood vessels that feed them to become blocked. With this, the tumor will shrink, and hysterectory is not required.

The rate of innovation in this area of medicine and surgery is accelerating. Stay tuned!

May 17th, 2002- Paul Kozlowski, MD, practices urology at the Virginia-Mason clinic. He showed us techniques of laparoscopic treatment of kidney problems. He (and similarly capable urologists) can remove a diseased kidney using special instruments and tiny incisions in the abdomen. Recovery time is much more rapid than the older techniques which used very large incisions. In certain situations they treat cancer of the kidney by freezing or heating tumors through these instruments.

The ureter is the tube connecting the kidney to the bladder. He illustrated surgical methods of using tiny instruments to enter through the bladder and operate inside the ureter and thereby avoid major surgery. He went on to show slides of operations performed with instruments passed through the bladder up into the kidney to correct problems in the kidney.

A couple of decades ago, the movie "Fantastic Voyage" gave viewers an intimate view of the human body. The voyagers were shrunken to microscopic size, injected into a human, and saw all the nooks and crannies of the body. Dr Kozlowski compares what he can see during these surgeries to the images you might remember from that movie.

The instruments used in these surgeries cost hundreds of dollars each, and many are not reusable. More time is required in the operating suite, which is also expensive, so the procedures themselves are more costly than the older techniques. Patients go home much more quickly, however, which reduces hospital costs dramatically. They suffer less pain, and return to work more quickly, which reduces their personal costs. This is one instance where spending more on a surgical procedure can save a person money when all their expenses and costs are evaluated.

May 15th, 2002- Richard Thirlby, MD, specializes in gastroenterologic surgery at the Virginia-Mason clinic. He discussed the treatment of diverticulitis, a condition in which the colon develops pockets that become infected. In the past, doctors advised people to avoid seeds and fruit and vegetable skins to help prevent future occurances. Dr Thirlby does not believe this necessary (nor do I.) He outlined medical and surgical treatment of the various ways in which this illness can occur.

May 3rd, 2002- Dwayne Bever is a cardiopulmonary resuscitation trainer. My medical assistant, our RN, and I watched a video refresher of techniques, took a written test, spent an hour practicing on manniquins, and reviewed our office emergency procedures..

April 26th, 2002- Andrew Weil, MD, the well-known author and pioneer of medicine that integrates western and other kinds of medicine, spoke at Virginia-Mason hospital. I have heard him speak on previous occasions. In this videotape of his presentation, he discussed the great interest of some academic centers in developing programs to train physicians in integrative medicine and some of the successes and difficulties in that endeavor.

April 19th, 2002- Otto Lin, MD discussed screening for colon cancer. This is the second most common cause of cancer in the United States. Each year, about 134,000 new cases occur and 55,000 men and women die. Eighty percent of those cancers occur in people with no identifiable risk factors.

Most colon cancer is very similar to skin cancer. Skin cancer starts as something you can see, and can be removed at that point for a complete and permanent cure. Colon cancer starts as a kind of mushroom shaped growth called a polyp. This can persist for years before turning into an invasive cancer. The favored method of preventing colon cancer is to perform a colonoscopy. Colonoscopy is the procedure of inspecting the colon through a flexible tube. If a polyp is found, it can easily be removed at the time of colonoscopy. Like skin cancer, whatever cancer was in that polyp is gone, never to return.

For people over the age of 50 with no special risk factors, Dr Lin believes that colonoscopy should be done every ten years.

April 17th, 2002- William DiPasso, MD, directs the sleep center at Virginia-Mason Clinic. See more information about sleep disorders further down this list. Here are some additional points raised by Dr DiPasso. Not all sleep disturbances are due to sleep apnea. Other causes include asthma, esophageal reflux, spasm of the larynx, and heart disorders.

Symptoms of obstructive sleep apnea can be daytime sleepiness, poor work performance, poor memory, poor driving, fatigue, erectile dysfunction, morning headaches, dry mouth or sore throat in the morning, swelling of the ankles.

People with severe obstructive sleep apnea have about a 66% chance of surviving 8 years, compared with 96% in a control group without severe sleep apnea.

April 12th, 2002- A radiologist is a physician who specializes in producing and reading Xrays, CT scans, ultrasound images, and other kinds of diagnostic images. Several radiologists from the Virginia Mason Clinic discussed the developing practice of using CT scans to screen for colon cancer, heart disease, and lung disease. Usually these tests are offered on a cash basis by entrepreneurial radiologists. These tests are not paid for insurance companies because they are not ordered by the patient's personal physician as part of caring for an illness. They are usually obtained by the patient on the basis of advertising by the CT scanning company.

People like these tests because they don't need to remove their clothing and they can obtain the test on their own without going through a physician. What people need to know is that a "whole body" CT scan covers the chest and abdomen (as of this date) and will show some sort of abnormality 15% of the time. This can result in expense and worry to find the 1% that have an actual cancer.

Screening for colon cancer with these tests is best done by injecting air and contrast media into the colon, which most scanning entrepreneurs will not do; failure to use contrast media reduces the accuracy of that part of the scan.

Abnormalities found on the screening lung scans can result in consultations, tests, and surgery to determine the cause. Most are not cancer but some are. There is as yet no evidence that this results in a longer life for those so diagnosed.

My summary opinion- a promising technology, not ready for prime time.

March 29th, 2002- Doug Paauw, MD from the University of Washington discussed doctor-patient communication. I don't need to tell you that doctors often speak unintelligibly. One of the most common reasons people give for transferring their care to our practice is that their previous physician did not appear to take the patient's beliefs and concerns seriously. One term that has been coined to describe the habit of seeing everything from the doctors' point of view is medicocentrism. This results in a physician thinking and speaking a language the patient doesn't understand. I believe this is one the the key faults with our current medical system and one that adds greatly and unnecessarily to cost. Dr Paauw's talk was meant to help physicians communicate better with patients.

March 16th, 2002- Thorne Research sponsored an all-day conference on nutritional medicine. David Perlmutter, MD spoke for two hours about the causes and treatment of Parkinson disease, Alzheimer disease, and other so-called neurodegenerative diseases. These are called neurodegenerative because the illness is brought about by a physical destruction of the brain tissue. You can read an excellent description of this at Dr Perlmutter's website. Dr Perlmutter's point in a nutshell is that toxins in the environment (including the excessive sugar and fat in the American diet), stress, certain infectious agents, and free radical damage lead to this destruction of the brain tissue.

Brain tissue is protected by a number of nutrients. CoEnzymeQ10 is just one of those. CoEnzyme Q10 is depleted by many drugs that we physicians commonly prescribe, including medications for sleep (amitriptylene and desipramine), for high cholesterol (all the statin drugs), for high blood pressure (clonidine, hydrochlorothiazide or HCTZ, beta-blockers, hydralazine), for psychiatric problems (nortriptylene, haloperidol, imipramine, chlorpromazine, doxipin, protriptylene, and trimipramine), diabetes (glyburide and glipizide), and others. This may be why one study showed that people who take the cholesterol-lowering agent lovastatin failed to improve on a test-taking exercise compared to patients who didn't take the statin drug.

Dr Perlmutter showed videotapes of the effect of intravenous glutathione on patients with severe Parkinson disease. The benefit of a single infusion lasts just three days, but the improvement is so dramatic that patients are very happy with it.

These illnesses are better prevented than treated. We would love to help.

When I first heard the term "naturopath," I pictured someone pounding herbs in a mortar and pestle, then recommending an enema. I know now that there are some naturopaths who spend more time in the medical library than most physicians. Davis Lamson, ND and Matt Brignall, ND are two such naturopaths. They spoke about how cancers start, and how we can use our knowledge of nutrition to prevent that. They discussed many nutrients in detail and how they can be used to help people with specific malignancies.

Parris Kidd, PhD works as a nutritional and biochemical consultant. He has helped develop and promote many ideas that are current and valuable in the field of nutritional medicine. He spoke about atherosclerosis. What causes it? What can help? Many of the ideas he elucidated are already in use in our clinic, such as EDTA chelation therapy. He pointed out that a trial of chelation by van Rij published in the journal Circulation concluded that EDTA chelation was of no value. This conclusion was reached only by failing to follow standard statistical procedure, thereby masking the fact that the chelation group as a whole improved much more than the placebo group as a whole. (One other fault with almost all academic studies of EDTA chelation is that they do not use an inactive placebo. They use a multivitamin, magnesium-rich infusion that by itself is very helpful to the circulation.)

Walter Crinnion, ND discussed naturopathic support for people with addictions. Alan Miller, ND, reviewed some of the medical studies that state that certain nutrients are harmful or of no value. He believes that these studies should not be ignored, but that often they indulge in "dirty tricks."

March 15th, 2002- Doug Backous, MD from the Virginia Mason Clinic discussed diagnosis and treatment of infections of the ear canal. These can be tricky problems and he added good information to what I already knew. One important point is that an antibiotic we commonly use in the ear, topical gentamycin, can occasionally result in permanent deafness. Another point is that diluted vinegar by itself can rid the ear canal of many mild to moderate infections. He dilutes it 1:1 with water; in the past we have used it diluted 1:1 with alcohol. Our favorite treatment for chronic infections was described in a recent newsletter.

March 1st, 2002- David Aboulafia, MD from the Virginia Mason Clinic pointed out that people with AIDS are more prone to cancer. We think that in all people, cancer develops more readily with an an impaired immune system. Dr Aboulafia discussed a man with AIDS who had the cancer Kaposi's sarcoma in his lung. This is usually rapidly fatal. The man refused chemotherapy but did undergo anti-viral therapy. His HIV count fell dramatically and his cancer melted away. Years later, he remained free of cancer. This is a common scenario.

Kaposi's sarcoma probably occurs as a result of a type of herpes simplex (HHV8), a sexually transmitted virus that occurs frequently in the gay population. In a man who also has HIV to reduce his immune response, Kaposi's sarcoma can occur.

February 22nd, 2002- Thomas Littman, PhD from the Virginia Mason Clinic gave an in-depth presentation on hearing loss, hearing testing, and hearing aids. Here are some points you may find useful to know.

The Audiology Department at Virginia-Mason can give you a free Hearing Aid Evaluation (HAE) that includes a five minute hearing test, consultation, and explanation of the type of hearing aid that might be most appropriate for you.

There are a number of reasons for hearing loss, not all of which are treated with hearing aids.
If you are losing hearing, you will retain your hearing capacity better if you use a hearing aid sooner rather than later. Hearing involves not just the ear, but the brain, which can lose some hearing ability if the sound isn't getting through.

"Behind the ear" hearing aids give the most bang for the buck. New digital hearing aids are much better at filtering out background noise than the older models. Hearing aids can now provide directional "aiming" to pick voices out of the crowd.

When you need hearing aids, you need them in both ears. Otherwise the ear without the hearing aid will lose function.

Nation-wide, over 17% of people who purchase a hearing aid will return it for a refund. (Return rights are guaranteed by law; do not sign this privilege away!) At the Virginia-Mason Clinic, return rates are about half that.

February 20th, 2002- Robert Barnes, MD from the Virginia Mason Clinic spoke on life-threatening infections of the soft tissues. These infections can progress and kill rapidly. The newspapers refer to these as "flesh-eating bacteria." In treatment, immediate surgery is used to determine the extent of the infection and to reduce pressure. Actually, various bacteria can cause these infections, and there are several ways in which they can occur. Sometimes they occur in people with depressed immunity due to diabetes, circulatory disturbance or other illnesses. They can occur in areas of tissue damage as from surgery or trauma.

This kind of infection is one good reason to avoid unnecessary surgery, eat heathy food, maintain a healthy lifestyle, and seek medical care promptly when advisable.

February 15th, 2002- Kris Kowdley, MD from the University of Washington gave a talk at the Virginia Mason Clinic about an iron storage disease called hemochromatosis. This is a genetic variant by which about 1 in a four hundred people absorb iron much better than average. This was a benefit some 4000 years ago when the gene appeared, as early agrarian peoples were prone to iron deficiency. Dr Kowdley thinks that the mutation first appeared in northern Europe as today the condition is more common in that area.

Today, with more iron in our diets, about half of people with this mutation will retain too much iron. This will result in one or more of the following: arthritis, fatigue, heart disease, liver disease, skin discoloration, diabetes. If treated before liver scarring begins, there is no change in life span. Removal of blood removes the excess iron, and prevents the condition from causing harm.

Our standard blood panel screens for this condition.

February 8th, 2002- John Hsiang, MD from the Virginia Mason Clinic discussed treatment of vertebral bodies that collapse due to osteoporosis. Everyone is aware that such fractures cause the spine to curve forward and a woman to lose height, which no one wants to have happen. What you may not know is that such fractures cause a significant decrease in lung function, appetite, and therefore general health. The result is that such fractures shorten a woman's life span more than do fractures of the hip.

The lastest surgical technique to ameliorate this situation is kyphoplasty. A balloon is placed inside the collapsed vertebral body, inflated to restore much of the lost height, and cement injected to maintain the restored height.

The procedure is quite costly, of course. Far better to prevent such a fracture in the first place. We can help.

February 1st, 2002- Christopher Fellows, MD from the Virginia Mason Clinic discussed sudden cardiac death. The most dramatic advance has been the use of permanently implanted defibrillators, which monitor the heartbeat and provide a shock to restart it if it should suddenly stop. The device costs about $40,000 plus installation costs. In people who have suffered a cardiac arrest, it definitely improves their survival.
Those of us who attended this presentation are all in primary care. Discussion after the talk centered around the opinion that if that same amount of money were made available for prevention, peoples health and wallets would be much the better.

January 18th, 2002- Elaine Peskind, MD from the Virginia Mason Clinic discussed treatment of dementia.

January 16th, 2002- A cancer specialist from the Virginia Mason Clinic discussed treatment of cancer of the cervix. The talk in a nutshell? The disease is aggressive, treatment difficult. This is the illness the Pap smear detects in time for easy treatment. (Editorial note- we use the more

accurate "thin-prep" technique for Pap smears. Because infection with human papilloma virus (HPV) predisposes a woman to cervical cancer, we identify that as well. Several nutrients have been shown to return abnormal Pap smears to normal and to reduce the risk of cervical

cancer. )

January 11th, 2002- Len Rosoff, MD of Virginia Mason discussed non-infectious liver disease. This includes Wilson's disease, in which abnormal amounts of copper are stored in the liver and damage it. (He did not mention it, but zinc supplementation under medical supervision has been shown to be helpful in this situation.) Other conditions he discussed were autoimmune hepatitis, cholestatic hepatitis, and primary biliary cirrhosis.

3/29/05 ms L

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