Thursday, March 28, 2013

Tell Your Doctor About Your Supplements

Anyone who regularly reads this blog knows that I am not a fan of willy nilly use of supplements. One of the primary functions I perform during a Medicare Annual Wellness Visit is to identify which supplements people use, understand their rationalization or reasons for using them, and then discuss the science, or lack of, supporting their use. Despite my best efforts, some people are so emotionally attached, perhaps one dare say addicted, to their supplements, that nothing I say affects their decision to keep taking pills in the absence of reasonable evidence.

A recent episode underlines how confusing the situation can become.

A patient recently came to see me who was taking multiple supplements prescribed by his child, a physician, who lives and works in the northeast. The patient was a slim man, who otherwise appeared in good health, other than having been diagnosed two years earlier with prostate cancer and having a history of hypothyroidism.  His only health concern was that both his legs had swollen up.  During his wellness visit, during which a physical exam is not routinely performed, we discussed his multiple supplement usage, and I tried to persuade him that the supplements were not expected to nor were they doing him any good.  I even went so far to phone his child during the appointment to discuss the rationale for the pills. The child explained that the father had hypothyroidism and that this was responsible for the leg swelling and that the supplements were the best treatment for the disease.

Nevertheless, I convinced the father and child that it would be prudent that the patient visit with an endocrinologist, the specialist that deals with thyroid disease to make sure of the diagnosis. They reluctantly agreed. At the same time, I began to research the connection between hypothyroidism and bilateral leg swelling, medically called pedal edema. At best, the connection seemed tenuous.

The patient scheduled to see me again to discuss the endocrinologist visit and it turns out to inform me that he could only take the advice from one doctor and would be following his child's advice. I expressed concern that the leg swelling might be due to a different cause since hypothyroidism would not cause swelling to the degree he exhibited. Even though he was prepared to leave, I pressed him further about other symptoms and factors that may be contributing to the swelling. At one point he asked if his prostate cancer might be a factor and mentioned some slight difficulty urinating. I immediately implored him to allow me to examine him and he consented.

As he lay on the exam table, and I lifted his shirt, my eyes could not believe what I beheld.  There in front of me was a huge mass protruding from his lower belly. It felt rock hard and was dull to percussion. Without hesitation, I walked him to over to the nearby diagnostic center and ordered an emergency ultrasound. The ultrasound revealed that this rock hard mass was actually his bladder that was hyper-extended and that he had urine backed up on both sides filling his kidneys with water, a condition known as hypernephrosis. I then ordered an emergency CT scan which revealed extensive metastasis, presumably from his prostate cancer, to surrounding lymph nodes and bone.  His cancer had aggressively spread and was presumably blocking the out-flow of urine resulting in distension of the bladder and early shutdown of the kidneys. The patient was then sent to the emergency room where they drained the bladder of 2,400 cc of urine.

The next day, I scheduled him to see a urologist who offered him hormonal therapy for the prostate cancer, but again based on the child's recommendation, the treatment was refused. No comment.

This entire scenario had unfolded because he had relied on a long-distance diagnosis from his child and on supplements that were meant to treat his problem. To me this is akin to self-diagnosing based on what you read off the internet or some health-related magazine, and then self-medicating based on the presumed diagnosis.  In this patient's case, such actions probably cost him a year or two of precious life.

One last comment. Fortunately, this patient had an Annual Wellness Visit and shared his supplement usage with a physician. Many patients do nether. In fact, in 2012, only nine percent of eligible Medicare beneficiaries took advantage of the service. Furthermore, in a recent survey of cardiology patients at one clinic in Scotland, more than half reported they used at least one complementary therapy, according to Jenny Jones, PhD, and colleagues at the University of Stirling in Stirling, Scotland. But records suggested that few patients had told doctors about their use of complementary treatments, Jones and colleagues reported at the EuroHeartCare 2013 meeting in Glasgow, Scotland.

In the study, co-author Stephen Leslie, MBChB, PhD, said that a review of patient notes found little evidence that doctors knew of the use of complementary and alternative medicines. "We found that very few people had volunteered this clinically important information in consultations," he said in a statement, "suggesting that they don't often disclose (complementary and alternative medicine) use to cardiology teams."

A recent study involving children, Canadian researchers found widespread use of complementary and alternative medicines (CAM) among children treated at two hospitals that were widely separated geographically. Again, their doctors were poorly informed of such use.

It's bad enough that people are self-medicating with unproven remedies they've learned of from the media, internet, or well-intentioned friends. But failing to tell their physician is adding insult to injury--to their bodies.

So if you insist on using supplements that may not only be useless, but may also be harmful, at least have the common sense to let your doctor know so he or she can incorporate such information in helping to provide the best care to you. This is not the type of information you may want to keep from your doctor.  It may cost you your health or even life. And if you have Medicare, go get an Annual Wellness Visit. It's covered 100% with no deductible or co-payment and make sure to tell your doctor about your supplement usage even if he or she fails to ask.

If you want to come to MDPrevent and see me, call (561) 807-2561 to schedule an appointment.

Friday, March 22, 2013

Plea for help

A close relative has been diagnosed with renal cell carcinoma with sarcomatoid features that is growing aggressively. If you know of anyone/anywhere that is succeeding in treating this cancer, please contact me at (617)319-6434 or email me at

Thank you.

Steven Charlap

Friday, March 15, 2013

Is Fish Healthy? Yes, But Don't Ask Dr. Neal Barnard For An Unbiased Answer

On Friday March 8, 2013, Dr. Neal Barnard, a physician, author and president of PCRM, an organization dedicated to perpetuating veganism among other things, appeared on the Dr. Oz show to promote his new book about preventing Alzheimer's. During the episode, he made a statement that no one should eat fish if they wanted to avoid Alzheimer's. Even Dr. Oz was surprised by Dr. Barnard's complete repudiation of fish in human diets. 

Personally, I was shocked. How could anyone make such a statement, given the preponderance of evidence supporting the health benefits of certain fish, let alone a medical professional?  So I contacted Dr. Barnard to seek further clarification of his controversial position.  He was kind enough to respond and I offer below his full response so that you can reach your own conclusions.

My initial query:

"I am writing for clarification regarding a statement that Dr. Barnard made on the Dr. Oz show this past Friday March 8, 2013. During the show, Dr. Barnard stated emphatically that in order to prevent Alzheimer’s, one should completely avoid fish consumption of any kind. I am hoping you could provide me with any citations of peer-reviewed studies that support his conclusion as my own review of the literature does not support such a statement, particularly in regards to wild Alaskan salmon and other such fish rich in omega-3s and low in saturated fat."

His response:
"Dear Dr. Charlap:

Thank you for being in touch about fish. The question is a good one and one that I’m sure many patients will raise, too. Let me share my perspective. It’s certainly true that, compared with beef fat or chicken fat, fish oils have less saturated fat and more omega-3 fatty acids. In some studies, people who favored vegetable oils and/or fish have had a reduced risk of dementia, compared with people who focused on meatier fare. So that is all to the good. However, as a group, people who eat fish have more weight problems and have a higher risk of diabetes, compared with people who skip animal products altogether. In this regard, let me attach diagrams from two large epidemiologic studies, one in the US and the other in Europe. As you’ll see, the greatest benefit comes from plant-based diets, rather than meat-based or fish-based diets. [Added by me: The studies showed very minimal differences between the vegans and those who ate the unspecified fish.] As you know, excess body weight and diabetes can both increase Alzheimer’s risk. So, for people following a healthful plant-based diet, fish is really a step in the wrong direction. [Added by me: None of the science he produced made this connection. This is just his own hypothesis.  The facts are that studies show, as he even quotes above, that fish consumption decreases cognitive decline, which is obviously the opposite of dementia.]

Here are the numbers: Atlantic salmon is about 40 percent fat, as a percentage of calories. Chinook salmon is around 50 percent. Most of that is not “good” fat. That is, only about 15 to 30 percent of the fat in fish is omega-3, depending on the species. The other 70 to 85 percent is a mixture of saturated and various unsaturated fats. Since every fat gram holds nine calories, fatty fish can easily add to your waistline. You may wish to informally survey your patients about their fish consumption and their weight. You’ll often find that fatty fish set them back.

Of course, fish consumption in general has been controversial for other reasons. Mobile shellfish (eg. lobster, crab, shrimp) are very high in cholesterol—higher than beef, ounce for ounce—and also contribute contaminants, including neurotoxic metals. [My note: For an excellent review of the risks versus benefits of consuming fish with contaminants (see article titled: Fish Intake, Contaminants and Human Health, Evaluating the risks and benefits at The conclusion of this paper was, and I quote directly from the study, "Potential risks of fish intake must be considered in the context of potential benefits. Based on strength of evidence and potential magnitudes of effect, the benefits of modest fish consumption (1-2 servings/wk) outweigh the risks among adults..."] I think you could argue that salmon is somewhat better than some other fish species on both fronts, but even so, it does contribute cholesterol and animal fat, along with a varying load of contaminants, none of which is necessary.

So, the bottom line is that a person following a healthy plant-based diet—which has proven so helpful for heart disease and diabetes, and now appears to also apply to Alzheimer’s prevention—would not be expected to derive any additional benefit by adding fish.  Not surprisingly, in the Blue Zones—areas where people live the longest—fish is not a large part of the diet. That applies to Okinawa and Sardinia, just like the other regions. The diet staples come from plant sources. 

Let me make one other observation. You’ll discover that some patients—and even some doctors—become quite emotional about food prescriptions and get bent out of shape if one questions the value of nuts, fish, olive oil, red wine, or some other product. It pays to step back and recognize that we all have the health of our patients in mind. Just as doctors seek second opinions and don’t expect complete concordance in every conclusion, the same is true in nutrition. So it’s good to take a deep breath, keep our lines of communication open, and see where emerging evidence leads us.

I hope this is helpful information. I wish you the very best in your work. 
Neal D. Barnard, MD"

My response:

Hi Dr. Barnard,

Thank you for your prompt response. I have had the pleasure to hear you speak at the American College of Preventive Medicine conference in 2012 and found your talk to be informative. My understanding is that you fully advocate on behalf of a vegan diet and so I can appreciate your position about fish in general. However, I was very concerned to hear you on the Dr. Oz show create a negative link between fish and Alzheimer’s disease. Since you did not differentiate between types of seafood, this was particularly alarming as my knowledge suggests that fish like wild Alaskan salmon may offer specific benefits in preventing or delaying the onset of dementia, including Alzheimer’s. See some of the studies listed at end of this email.

Accordingly, as I am always eager to increase my knowledge and that of my readers/patients, I sought you out for clarification. 

Therefore, please indulge me as I pull out certain quotes from your response for further clarification and comment.

You wrote, “However, as a group, people who eat fish have more weight problems and have a higher risk of diabetes, compared with people who skip animal products altogether.”

In response, I ask if you have any credible studies that support that those who eat wild fish like Alaskan salmon, halibut, lake trout, etc. have more weight problems and a higher risk of diabetes?  I reviewed the two studies you cited and they do not differentiate between types of seafood. As you know, farm raised salmon is a far less nutritional fish than wild salmon as it includes more saturated fat, less omega-3s, less Vitamin D, etc.  Therefore, if you have any specific fish studies that look at particular types of fish in comparison to non-fish eaters, I would appreciate it if you could forward them to me.  I contend that in the absence of such studies, it is a rush to judgment to state that consuming fish leads to Alzheimer’s when studies, as even you cited to me in your response, show an explicit decrease in cognitive loss due to fish consumption.

Furthermore, you wrote, “Here are the numbers: Atlantic salmon is about 40 percent fat, as a percentage of calories. Chinook salmon is around 50 percent. Most of that is not “good” fat. That is, only about 15 to 30 percent of the fat in fish is omega-3, depending on the species. The other 70 to 85 percent is a mixture of saturated and various unsaturated fats.”

As discussed above, it is important to differentiate between wild and farm raised salmon as farm-raised Atlantic salmon has far more than double the saturated fat of wild Atlantic salmon and nearly four times the saturated and total fat of wild Alaskan pink salmon. In addition fat in the pink variety represents far less than the 40% of the total calories of fish that you cite.

You wrote, ”Of course, fish consumption in general has been controversial for other reasons. Mobile shellfish (eg. lobster, crab, shrimp) are very high in cholesterol—higher than beef, ounce for ounce—and also contribute contaminants, including neurotoxic metals. I think you could argue that salmon is somewhat better than some other fish species on both fronts, but even so, it does contribute cholesterol and animal fat, along with a varying load of contaminants, none of which is necessary.”

Let me start with the point you make that “none of it is necessary.”  This is not an accurate statement, as omega-3s are not the only valuable fat in wild salmon. For example, nervonic acid, one of the monounsaturated fats in salmon, plays a valuable role in the biosynthesis of myelin, a key component as you know, of our nervous system.  Again, while certain predatory fish like tuna, and many of the crustaceans tend to absorb the ocean’s pollutants, wild salmon from Alaska and certain lake trout which are non-predatory fish tend to contain few contaminants.  Besides, as you are well aware, many plants are victims of pesticides and other pollutants equal in their potential devastation to human health as anything found in the ocean, and yet you didn’t declare on national television that people equally avoid them like you said about all fish. 

You also wrote, “So, the bottom line is that a person following a healthy plant-based diet—which has proven so helpful for heart disease and diabetes, and now appears to also apply to Alzheimer’s prevention—would not be expected to derive any additional benefit by adding fish.  Not surprisingly, in the Blue Zones—areas where people live the longest—fish is not a large part of the diet. That applies to Okinawa and Sardinia, just like the other regions. The diet staples come from plant sources.”

Again, I am not sure of the source of your information, but in Okinawa fish is a large part of the diet although the diet contains many plant based foods, By the way, not only do the Sardinians eat fish, but they also eat meat and drink goat’s milk all while tracing their men’s extraordinary longevity back to the Bronze Age.

In conclusion, I feel that you do not offer a compelling case due to the lack of scientific support against fish like wild Alaskan salmon as part of one’s diet. If you have further studies that you think would be relevant, I ask that you forward them to me as soon as possible. As a courtesy, I will not publish until Sunday to give you ample time to response.

As for my patients, I advocate eating such fish as wild salmon every other day and have witnessed reversal of hemoglobin A1cs from mid 7s to below 6, cholesterols from 300s to low 100s, and 50+ pound weight loss.  My personal transition to such a diet enabled me to drop 25 pounds to below a 25 BMI and keep it off, while also weaning myself off of statins. Therefore, as you wrote, I agree that “it’s good to see where emerging evidence leads us.” However, I hope you agree that it’s not prudent to suggest to people that emerging evidence supports a conclusion unfounded by the facts, some of which are cited below.
“Emerging evidence” to consider about the benefits of fish:

1.     J Nutr Health Aging. 2011 Aug;15(7):551-4552.
Consumption of fish and Alzheimer's disease.
Newton W, McManus A.
Centre of Excellence Science Seafood and Health, Curtin Health Innovation Research Institute, Curtin University.

2.     Nihon Rinsho. 2011 May;69(5):953-63.
[Dementia and lifestyle-related diseases in Japanese aging society].
[Article in Japanese]
Iwamoto T.
Toshihiko Iwamoto: Department of Geriatric Medicine, Tokyo Medical University.

3.     J Nutr Health Aging. 2011 Jan;15(1):25-31.
High dietary and plasma levels of the omega-3 fatty acid docosahexaenoic acid are associated with decreased dementia risk: the Rancho Bernardo study.
Lopez LB, Kritz-Silverstein D, Barrett Connor E.
Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, California 92093, USA.
4.     Arch Neurol. 2010 Jun;67(6):699-706. doi: 10.1001/archneurol.2010.84. Epub 2010 Apr 12.
Food combination and Alzheimer disease risk: a protective diet.
Gu Y, Nieves JW, Stern Y, Luchsinger JA, Scarmeas N.
The Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA.

I can produce many more studies if you are interested.  The bottom line is that certain fish, like those rich in omega-3s and low in other saturated fats, play a critical role in health promotion, including Alzheimer’s prevention, and to suggest otherwise, is to ignore the “emerging facts.”
I mean no disrespect in my response and I trust you will accept it in the spirit intended, which is for all of us to identify the best dietary answers for ourselves, our families, our patients, and the community at large.
I look forward to your response.

To your health,

His response:

"Hi, Steven,

You have the same access that I do to published studies. See what you find. If you can find a study that shows that people who habitually add fish to the diet are as slim and healthy as vegans, I’d love to see it. The epi studies mostly characterize fish-eaters as a group, and they don’t do as well.

All the best,


My final response:

"Hi Neal,

Please find seven studies below that clearly show major health benefits associated with fish consumption.

As you know, there are no head to head studies between vegans and vegans who eat fish. While we can agree to disagree on which is better, I ask you to use caution in the future in telling people that all fish is bad for them because I hope you agree, there are clear benefits in consuming certain non-predatory, wild fish rich in omega-3s, antioxidants such as astathanxin (although no conclusive studies), Vitamin D, Vitamin B12, lean protein, etc. Consuming such fish eliminates the need to supplement with Vitamin B12.  I trust you agree that it is always best to get vitamins from nature than from a pill produced in a factory

1. Kromhout D, Bosschieter EB, de Lezenne Coulander
C. The inverse relation between fish consumption and
20-year mortality from coronary heart disease.
N Engl J Med. 1985;312:1205-1209.

2. Burr ML, Fehily AM, Gilbert JF, et al. Effects of
changes in fat, fish, and fibre intakes on death and
myocardial reinfarction: diet and reinfarction trial
Lancet. 1989;2:757-761.

3. Daviglus ML, Stamler J, Orencia AJ, et al. Fish con-
sumption and the 30-year risk of fatal myocardial
N Engl J Med. 1997;336:1046-1053.

5.Albert CM, Hennekens CH, O’Donnell CJ, et al. Fish
consumption and risk of sudden cardiac death.

6. Morris MC, Evans DA, Tangney CC, Bienias JL,
Wilson RS. Fish consumption and cognitive decline with
age in a large community study.
Arch Neurol. 2005;62:1849-1853.

7. He K, Song Y, Daviglus ML, et al. Fish consump-
tion and incidence of stroke: a meta-analysis of co-
hort studies.
Stroke. 2004;35:1538-1542.

In conclusion:

Now you have a well reasoned perspective of pure veganism versus a vegan diet combined with certain fish. Personally, until proven otherwise, I continue to advocate for the inclusion of wild fish like salmon in one's diet on a regular basis (every couple of days) for optimal health. You now have the available facts and both sides of the debate; you be the judge.

Friday, March 8, 2013

The Main Reason You Can't Lose Weight is EXACTLY What You Think!

Most businesses hope for repeat customers; weight loss businesses bank on it. Following New Year's, every single year, thousands of resolutions to lose weight are made and broken. If you have dieted once, chances are you have done it many times. You've tried the programs, read the books, watched the shows, took the pills, had the injections, and maybe even spoke to your doctor about your desire to lose weight.

Perhaps, you've even enjoyed some success, only to find yourself slipping again. But despite your best efforts, every time you look in the mirror or get out of a chair, you know you are carrying around more weight than is good for you. You are probably ready to throw your hands up in disgust and give up. Or maybe you will keep watching Dr. Oz hoping that one of his far flung schemes or pill of the day may actually work for you. Don't! The problem of losing weight and keeping it off is clearly a challenging one and difficult predicaments need good solutions. So what's a person to do?

From the inception of MDPrevent, I have believed that psycho-social issues are at the forefront of most people's inability to lose weight and keep it off. Some eat too much or choose the wrong foods because of stress, poor sleep, anxiety, depression, comfort, loneliness, etc. There are many reasons, and sometimes they even combine. Either way, if you don't deal with them, they keep plaguing you.

That's why one of the first professionals I added to my team was a health psychologist. Patients who want to lose weight once and for all find seeing a psychologist trained in such matters to be a godsend. Why? The answer comes from the psychologists themselves.

A new survey of psychologists confirms that dieters should pay attention to the role emotions play in weight gain and loss if they hope to succeed.

According to the American Psychological Association, the survey, conducted by the Consumer Reports National Research Center, queried over 1,300 licensed psychologists about how they dealt with clients’ weight and the challenges of losing weight. The strategies psychologists cited as essential to losing weight and keeping it off, was "understanding and managing the behaviors and emotions related to weight management." The doctors believed this was essential to forty-four percent (44%) of their clients who wanted weight loss. "Survey respondents also cited “emotional eating” (43 percent) as a barrier to weight loss, and included "maintaining a regular exercise schedule" (43 percent) and "making proper food choices in general" (28 percent) as keys to shedding pounds.

In general, gaining self-control over behaviors and emotions related to eating were both key, indicating that the two go together."

Among the 306 respondents who provide weight loss treatment, 92% reported helping a client “address underlying emotional issues related to weight gain.” More than 70 percent identified cognitive therapy, problem-solving and mindfulness as "excellent" or "good" weight loss strategies. In addition, motivational strategies, keeping behavioral records and goal-setting were also important in helping clients to lose weight and keep it off, according to survey results. Cognitive therapy, one of the clinical approaches often used by psychologists, helps people identify and address negative thoughts and emotions that can lead to unhealthy behaviors. "Mindfulness allows thoughts and emotions to come and go without judging them, and instead concentrate on being aware of the moment."

The full survey results are reported in the February 2013 issue of Consumer Reports Magazine.®
Now clearly, psychologists telling the surveyors that their efforts to ensure their clients keep losing weight is somewhat self-serving, and I would be a ‘doubting Thomas’ myself if I didn't see the difference a psychologist can make. By the way, it’s not just the psychologists with whom I work that make a difference.  I recently sat with a friend from out of state who has enjoyed over a one-hundred pound weight loss. When we sat down to discuss his formula, the secret sauce is that he has been working with a psychologist.  My only concern in listening to him was that some of the foods he was eating to lose weight are not the healthiest.  Also, he would have been better off to consult with a nutritionist or registered dietitian to make sure that he was both losing weight and eating health promoting foods. Not all weight loss is healthy and ultimately what's the point of losing weight only to get sick?

Therefore, I recommend that if you can afford to see both a registered dietitian and a psychologist to lose weight, there is no better combination. If you have Medicare, nutritional consultations for weight loss are 100% covered under a program called Intensive Behavioral Therapy for Obesity if your body mass index (BMI) is above 30.

Last year, MDPrevent was the largest provider of such services in the State of Florida. If you can get to our office in Delray Beach, I welcome you do so (561-807-2561).  If not, consult with your local primary care physician or cardiologist to identify who is offering this service near your home.  Even if you don’t have Medicare, you can still give us a call so we can let you know what your insurance company will cover.
It turns out that the key to losing weight may really be in your head and we can help you use that knowledge to unlock a healthier, higher energy, and more enjoyable life.     

So stop wasting your time and money on programs whose results usually don't last and address once and for all the real problem: your emotional health.

Tuesday, March 5, 2013

What Was Once Black Is Now Bright

Fifty years ago, a TV show that ran from 1958 to 1963 came to an end. Some of you may remember its iconic closing narration: "There are eight million stories in the Naked City. This has been one of them." Every week, Naked City, a police crime drama, focused on unique stories about criminals and their victims. To me, barely past the toddler stage, the show demonstrated how even though there are so many different people, each has his or her own story. 

"You are the best psychologist I ever met with" said my patient to me yesterday. "You are the first one to tell me not to focus on what has gone wrong, but rather to recognize the good that it represents." Although I am not a psychologist, I know one thing for sure. Harboring negative thoughts and being stuck in the past, even the recent past, serves no purpose.  

The patient, a lady in her late 80s, conveyed in all sincerity that she felt like she had recently been tested by G-d just as he had tested Job in the Bible. Her tale included a string of failed refrigerators that had forsaken her--at least that's the way she saw it. There is little doubt that a refrigerator is a vital appliance in Florida. This lady's refrigerator broke, then the replacement broke, then the next replacement also broke, and finally the last one worked. It took great effort to resolve the problem. She had to make multiple calls to the store that sold her the refrigerators, to the manufacturer's of the refrigerators, and she had to live without refrigerated food for an extended period of time before the problem was resolved. She truly felt like she had been through an ordeal equal to a biblical epic.

I am sure she expected me to empathize with what she had endured. But I didn't. Instead I marveled at it.  "Do you realize," I asked her "how amazing it is that at your age you were able to handle this entire situation on your own without the help of others?" It was a testament to the fact that older people, particularly those that hope to live to their 90s and beyond, can handle difficult situations with wisdom and aplomb duly earned over many years. I applauded the patient's efforts and reminded her that seventy-five percent of people over the age of 90 live independently and she had earned her stripes and showed her mettle to count herself among them. Suddenly, instead of thinking woe unto me, she was beaming at her masterful response to her latest life challenge.

In classical psychology, patients and their doctors often focus on what is wrong. In 'positive psychology,' the up and coming field which some call "the science of happiness,' the emphasis shifts to what works. Having read my share of 'positive psychology' books, I applied one of its simple lessons to my 'oy vey' patient.  Together, we shifted her paradigm from the perspective of a personal travail to one of a sense of accomplishment. What was once black was now bright. 

I wish it was so easy to help all my patients. But to paraphrase the Naked City, "there are many stories and this has been one of them."  I hope in reading this anecdote, you recognize its fundamental lesson: perspective means everything. What's your perspective on life? Come see me and let's explore it together.
(561) 807-2561.