Tuesday, November 20, 2012

Patient Protection and Affordable Care Act & Chiropractic


Guest Opinion Commentary by Dr. J.C. Smith, M.A., D.C.
from Citizens for Health

Just as the 1964 Civil Rights legislation guaranteed that Rosa Parks would no longer have to sit in the back of the bus, the controversial Patient Protection and Affordable Care Act, euphemistically known as Obamacare, will guarantee your right as a patient to have a freedom of choice where you sit in the medical bus.
Chiropractic care has been welcomed by both patients and insurers in this era of evidence-based healthcare that has repeatedly shown the safety, popularity, as well as the clinical-effectiveness of this brand of “hands-on” spine care.
It will also save a lot of money. Musculoskeletal disorders alone currently affect 44.6 million Americans and cost our society an estimated $267.2 billion every year.
Since the early 1990s, research showed that the medical treatments for low back pain were expensive and inappropriate for the majority of cases. In fact, the Dartmouth Institute of Health Policy suggested 30-40% of spinal fusion surgeries were unnecessary.
Moreover, a prominent orthopedist admitted that back surgery “has been accused of leaving more tragic human wreckage in its wake than any other operation in history.”  A notable medical journalist minced no words when he recently stated, “Spinal medicine [drugs, shots, surgery] in the US is a poster child for inefficient spine care.”
Today research studies cannot be clearer that chiropractic care stands at the top of spinal treatments as Anthony Rosner, PhD, testified before The Institute of Medicine: “Today, we can argue that chiropractic care, at least for back pain, appears to have vaulted from last to first place as a treatment option.”
After decades of unwarranted medical defamation, this change in attitude highlights decades of controversial medical spine treatments consisting of narcotic drugs, epidural steroid injections, and spine fusion surgery that have all come under increasing criticism.
Despite this evidence-based research that shows chiropractic’s superiority for the majority of back pain cases, long-established medical associations that have dominated this market still resist the inclusion of chiropractic care.
However, this impediment may prove to be inconsequential considering Section 2706 of Obamacare, the so-called provider “Non-Discrimination in Health Care” clause that will apply to all insurance programs.
Section 2706 is healthcare reform’s most significant inclusiveness measure for chiropractors, naturopaths, acupuncturists, massage therapists, and licensed midwives, potentially opening consumer choice to millions of Americans.
Fundamentally, Section 2706 prevents plans from arbitrarily excluding the participation and coverage of categories of non-MD providers in their health plans when this participation is within their scope of practice and licensure.
What can we conclude now about the role of chiropractic in Obamacare? Certainly the evidence-based cost-effectiveness trend will continue to support the inclusion of chiropractic care and Section 2706 will protect chiropractors and their patients from unwieldy restrictions as we’ve seen in the past.
Dr. JC Smith, MA, DC, is the author of The Medical War Against ChiropractorsDr. Jarvis can be reached via e-mail at: jcsmith@smithspinalcare.com.
REFERENCES
1. Bigos et al. US Dept. of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, Clinical Practice Guideline, Number 14: Acute Low Back Problems in Adults AHCPR Publication No. 95-0642, (December 1994)
2. “New Study Demonstrates A Three-Fold Increase N Life-Threatening Complications With Complex Surgery,” The BACKLETTER, 25/6 (June 2010):66
3. Elliott Fisher, MD, on the CBS Evening News, “Attacking Rising Health Costs,” June 9, 2006.
4.  G Waddell and OB Allan, “A Historical Perspective On Low Back Pain And Disability, “Acta Orthop Scand 60 (suppl 234), (1989)
5. The BACKPage editorial vol. 27, No. 11, November 2012.
6. Testimony before The Institute of Medicine: Committee on Use of CAM by the American Public on Feb. 27, 2003.
7.  Michael Kranish, “Senators Seek Coverage For Alternative Therapies,” Boston Globe, July 24, 2009
8. Letter to the Honorable Kathleen Sebelius from Keith Overland, DC, President of the American Chiropractic Association, October 19, 2012

Wednesday, October 17, 2012

Legalizing Medical Marijuana

A recent Letter to the Editor to The Berkshire Eagle


Your recent article about “Pot on Statewide Ballot” states; “the Massachusetts Medical Society (MMS), representing 24,000 doctors, also opposes legalizing medicinal marijuana without scientific proof that if would be safe and effective on patients.”

Really? Perhaps they never heard of Google. Or, they have some other motives

According to the government: the FDA’s Adverse Event Reporting System (2009) Annual Causes of Death in the US: Cannabis/Marijuana ranks dead last, at ZERO deaths.

“Indeed, epidemiological data indicate that in the general population marijuana use is not associated with increased mortality.” Source:  Janet E. Joy: “Marijuana and Medicine: Assessing the Science Base,” Division of Neuroscience and Behavioral Research, Institute of Medicine (Washington, DC: National Academy Press, 1999), p. 109.

On the other hand:
1.      According to the CDC: “in the United States, tobacco use is responsible for about one in five deaths annually, about 443,000 deaths per year.
2.      Lack of health insurance and access to basic care kills 44,789/year.
3.      Preventable medical errors in hospitals kill 12,000/week = 624,000/year, a conservative estimate, responsible for 26% of deaths, making it the 3rd leading cause of death.
4.      An article by Dr. Barbara Starfield, MD, MPH, in JAMA: Vol.284, No.4, 07/26/2000: revealed that prescription drugs kill around 106,000 people in the US every year making it the fourth leading cause of death. “The data did not include fatal reactions caused by accidental overdoses or errors in administration of the drugs. If these had been included, it is estimated that another 100,000 deaths would be added to the total every year.” Furthermore, every year there are 2,216,000 serious adverse drug reactions (ADR’S). HMO’s spend more money treating ADR’s than they do on drugs.

When you understand that the MMS, like the AMA, are trade associations whose primary purpose is to protect doctors’ incomes, and have virtually nothing to do with improving patient safety and care outcomes, then the above starts to make some sense.

Why would they deny suffering and dying patients access to a benign, very helpful, inexpensive medicinal herb? As always, follow the money.

Clearly, the MMS and the AMA should be more concerned about the scientific proof, safety and efficacy of their doctors’ routine medical practices and prescribing habits.

The functioning of our democracy depends on an informed public given, as best possible, verifiable facts, not self-serving myths.

Peter May
North Adams, MA 01247
10-12-2012



Tuesday, September 25, 2012

Attack on All Things Natural: Undermining Health

It has been a rough few weeks for all things natural with back to back scientific studies and lay articles undermining the value of eating organic foods, taking omega 3 supplements, and questioning the benefits of the Paleo-diet.

NYTimes: Sanford Scientists Cast Doubt on Advantages of Organic Meat and Produce
Huffington Post: Organic Food is Not Healthier Than Conventional Produce: Study

"After an extensive examination of four decades of research comparing organic and conventional food...they concluded that fruits and vegetables labeled organic were, on average, no more nutritious than their conventional counterparts, which tend to be far less expensive. Nor were they any less likely to be contaminated by dangerous bacteria like E. coli. The researcher also found no obvious health advantages to organic meats."

NYTimes: Weighing the Evidence on Fish Oils for Heart Health

"People who put their faith in fish oils supplements may want to reconsider. A new analysis of the evidence casts doubt on the widely touted notion that the pills can prevent heart attacks in people at risk of cardiovascular disease.

Huffington Post: Paleo Diet: Healthy or a Hoax


"Does the Paleo Diet really lower cholesterol and help with many of the conditions that lead to metabolic syndrome? On insofar as they cut out sugary, fatty, and processed foods. But you can do that without eliminating whole food groups or imitating the eating patterns--most likely dictated by food scarcity--of pre-agrarian ancestors.''

 

Really?

As for eating organic verses non-organic conventional foods: 

The argument for eating organic foods has NOT centered so much around what nutrients are in the foods, but rather on:
     1. What is NOT in the food: as much pesticide residue and antibiotics which are harmful to all of us,        especially pregnant women and developing fetuses.
     2. Growing food organically is better for the environment. It is sustainable agriculture that enhances the soil rather than poisons it with toxic pesticides, fertilizers, and antibiotics; all of which ultimately enter into, and contaminate, the ground and drinking water becoming a secondary source of chronic toxic exposure.

 

In addition, organic farming does not use genetically modified seeds which:

     1. are creating crop mono-cultures more prone to plague
     2. make it illegal for farmers to harvest seed, making them dependent on Monsanto to buy seeds every year.                 (NOTE: make sure to click on and read the Monsanto link--an eye opener!)
     3. along with the pesticides, fertilizers, antibiotics, are creating adaptation strains of super antibiotic-resistant bacteria and crop super pests.

 


As for taking Omega3 (DHA) supplements for health:


The biggest flaw with this article is that it addresses the Omega3 fish oils from the allopathic perspective; like a medication--a specific treatment for a specific problem. 

"They found insufficient evidence of a protective effect against future cardiovascular events in the large number of heart patients who were studied."

...a typical blanket conclusion for research from a paradigm of care centered on fighting disease, rather than adding and nurturing health.

This completely misses the point of Omega3 supplementation.

 

DHA plays many important roles in the human body, that we know of. Its presence in the brain, nerves, synapses, and eyes are vital to their very structure and healthy functioning. In the mitochondria it serves as a source of fuel. The body also uses fatty acids as the starting material for special chemicals called prostaglandins, which are important in a whole array of body functions...among other things.

Omega3's are essential fatty acids; meaning that the body does not synthesize them, and that they have to come from dietary sources. As recently as 50 years ago, we would eat land and sea-based animals that grew in their natural habitats and green things (grasses and algae), from which they would get their Omega3's and, in turn, would pass them onto us when we ate them. It turns out that all animals are what they eat. Today, almost all livestock and fish are fed corn. So, they are deficient in Omega3's, and we are no longer getting what we need from them in our diets. Therefore, supplementation is essential to support good health.

 

As for the Paleo diet:

This unfortunate article also takes the allopathic approach, insanely obsesses with lowering cholesterol, as if that was a cure-all. And, it implies that the primary purpose of the Paleo diet is weight loss. 

As the  article correctly states: "the Paleo diet (also known as the (Paleolithic) "caveman diet") prescribes a pattern of eating that mirrors the way your ancestors ate way-back in the day...a hunter-gatherer diet of meat, fish, fruits and vegetables (and nuts, seeds and water)."

The reason to follow this hunterer-gatherer diet is that our genes have not changed (evolved) in 43,000 and are still consistent with those of our Paleolithic ancestors. As such, our genetic requirements for a healthy life match theirs, both in terms of what we eat (diet) and how much exercise we need.

The reason to minimize, or eliminate, dairy and grains--wheat, corn, and rice--are because these were not added to our diets until about 10,000 years ago, with the beginning of agriculture. Our genes have not yet caught up to eating and digesting these foods, making them the most highly allergic foods that we eat. These food allergies cause all kinds of misdiagnosed and un-diagnosed problems, often leading to cascades of unnecessary, invasive, and dangerous medical tests, procedures and medications. 

The reasons to eliminate processed chemical foods (masquerading as food) and sugars, are obvious.

Articles such as these are dangerous to our health. Their dismissive and patronizing tone belies their bias against all things natural and their reverence for medical/corporate science. They contribute to the confusion about health that only serves to undermine our belief in our true innate capacity for health, and our ability and will to nurture it with all things natural.

Wednesday, September 19, 2012



NOTE:  The image above and the following following text have been lifted directly from: 


..and posted at the request of someone connected to them.

Students young and old frequently complain about the quality of the desks and chairs provided on campus, yet it remains one of the more overlooked issues. A pity, because poor ergonomics and comfort can actually lead to poor health, and poor health leads to missed classes and heightened medical expenditures once career time rolls around. Maybe it’s about time educators, schools, and districts reconsidered their approach towards how they set up classrooms. The positive outcomes might very well prove surprising.
  1. Sitting increases the risk of a heart attack:

    Small children probably don’t suffer from the same risk of heart attacks as their parents, but healthy habits stick better when introduced early. A 13-year study by the Pennington Biomedical Research Center discovered that, of the 17,000 adults researched, 54% spent the majority of the day sitting. And wound up with an increased chance of suffering a heart attack as a result. Standing desks currently experience a surge of popularity these days as a means of keeping employees healthy. Nothing says this health trend must remain bound to the office.
  2. Standing burns more calories:

    Another major reason standing desks accrue so much love is the fact that it requires more calories than the more passive sitting. This means not only a reduced risk of heart disease, but diabetes, certain cancers, and other lifestyle-related medical conditions as well. Converting schools into bastions of standing desk action might not prove the most effective idea (especially since it does promote varicose veins), but encouraging something other than sitting for at least part of the day could easily promote overall health and wellness in the classroom and beyond.
  3. Sitting slows metabolism:

    Even regular exercise might not prove an adequate counterbalance to 23 or more hours of sedentary activity a week, as long periods of sitting lower the body’s metabolic rate. It also leads to muscular atrophy, a roadblock to proper workouts. If standing desks in schools isn’t a feasible option, consider incorporating more time for stretching, exercising, and walking around to offset some of the negative effects. This small habit could very well resonate in some big ways later on in life.
  4. Sitting increases the risk of obesity:

    From an aesthetic perspective, there is absolutely no shame with being overweight or obese. But one’s health stands as another matter entirely. With sitting lowering metabolism and heightening the chances of suffering from diabetes and heart disease, it makes sense that weight gain might play a role. A sedentary lifestyle combined with America’s less-than-ideal diet only adds to the issue and might mean a public health crisis down the road if left unaddressed.
  5. Standing encourages better posture:

    The desks so often utilized in classrooms and offices likely won’t garner much praise over how kindly they treat the spinal column. In fact, sitting adds between 40% to 90% stress to the back. Add another tick in the “pros” list for standing desks: they definitely guard against slouching and fidgeting. Alternately, more ergonomic sitting desks providing enough comfort and support to the lumbar system could work to help students stay focused and healthy.
  6. Decreasing the risk of carpal tunnel syndrome:

    Teach students some simple hand and wrist exercises to keep them from falling victim to the dreaded carpal tunnel syndrome. With computers factoring more and more into classroom settings, keyboards placed at improper angles raise the risk of the condition. This can be rectified by purchasing more ergonomic devices and setting them up in a manner reducing the chances of physical strain and sprain. And, of course, making sure the kids (and adults) know the proper workouts that go along with prolonged typing.
  7. Yoga balls in lieu of chairs build muscle:

    Fully replacing desk chairs with yoga balls might prove kinda sorta disastrous, especially for clumsier students, but bringing a few into the classroom and encouraging their usage might hold a few benefits. Allowing them to switch out for brief periods of time means offsetting some of the negative effects bundled with sitting for extended stretches. For one thing, it promotes healthier posture, builds muscle, and heightens balance, unlike the usual sitting habits.
  8. Greater adjustability to account for height differences:

    Investing a little more in adjustable desks and chairs could be all it takes to foster greater health in the student body. The current “one-size-fits-all” (ha!) option compromises the comfort and lumbar support of the particularly short and the particularly tall, meaning slouching and other pains prove the norm on campuses everywhere. In fact, evidence exists regarding an increase in overall academic performance correlating with heightened comfort. So that little switch may even mean raising grades in the long term!
  9. The traditional setup isn’t conducive to a tech-enabled classroom:

    An easy fix! Traditional classroom arrangements obviously don’t account for the rampant influx of technology, increasing the risk of eye strain and carpal tunnel syndrome. Different setups mean greater connectivity and better communication between students, which should hopefully bolster overall academic performance. Try exploring the various strategies other teachers have utilized to see which one works best for your particular environment.
  10. Standing increases energy:

    Nope, the standing desk contingency doesn’t plan on stopping with the benefits of not sitting all day, every day. Even though such an arrangement burns more calories, users claim to feel far more energetic once their work sessions conclude. It makes sense, though. Sitting for extended stretches of time might prove restful, but in excess (like during the typical school or work day) actually nurses sluggishness and poor health.
  11. Allow for desk exercises:

    Understandably, budgets might not allow for the most health-and-safety-friendly desks and chairs around. Should they find themselves in an environment not terribly conducive to student comfort, a few exercises throughout the day can provide some modicum of assistance. Teaching these and offering up a few minutes to adjust (maybe even re-adjust) is the least the education system can do if inadequate desks must stand as the reality for a while longer.
  12. Sitting too much means you die sooner:

    Up to 40% faster within the span of 15 years, in fact. On average, Americans sit 9.3 hours daily, with the risk jumping up around the six hour point. The healthiest lifestyles involve less than three hours of sitting a day, combined with regular exercise — which, sadly, ceases to prove effective after the aforementioned six hours.



Thursday, August 30, 2012

MUST SEE TV

The Tea Party = The American Taliban

Try as I do not to go political (other than as related to health and health policy) here on my health blog, sometimes I just can't help myself.

Each election cycle the Republicans are offering up more and more frightening candidates, many of whom are winning elections at the local, state, and national levels. People such as the current Missouri Representative Todd Aiken, also the Republican nominee for Senate, who recently expressed his warped views on rape and complete and mind-boggling ignorance of female physiology. His views are shared by a least 40 other members currently serving in Congress.

The GOP presidential ticket of Romney/Ryan is scary. Both have demonstrated a willingness to pander and blatantly lie, while concealing their real agenda and deflecting questions of substance. They are, in no uncertain terms, dangerous.

This video clip from the TV series The Newsroom says it best. Take heed. Make it go viral.



and...the only thing that beats that...is current events and the truth as told by Jon Stewart

http://www.hulu.com/watch/403025#i0,p7,s17,d0

Sunday, July 29, 2012

We're #1! Not Even Close.


We're # 1 ! Not even close.

Would you, or any other American, say no to a health care system that:

  1. Provided universal coverage; cradle to grave medical and preventive care and prescription drugs for every citizen; coverage that couldn't be denied --regardless of pre-existing conditions or prior health history, or terminated for any reason—loss of job, development of significant medical problems, etc.
  2. Allowed any patient to see any doctor, any specialist, any surgeon, and any hospital in the country, and the insurance must pay the bill.
  3. Has insurance that has no deductible—bills are paid from the first dollar billed
  4. Has insurance that pays doctor and hospital bills within a week, and patients are reimbursed for their costs at the end of each month.
  5. Has insurance premiums that are dirt cheap (ie: in 2007: a single person making $20,000/year paid $12.25/month, and the employers share of the monthly premium was $208.00)
  6. Has waiting times to see physicians about the same as in the US, for patients with insurance.
  7. Does a better job of curing people whose diseases are curable and doesn't allow more than 22,000 of its citizens die every year of curable diseases, as does the US, for lack of access to basic medical care.
  8. Has insurance administrative costs below 5% (vs 20% in the US), meaning more money is spent on direct care
  9. That spends less than half the per capita costs in the US ($3165.00: 10% GNP vs $7000.00: 17% GNP).. with everyone covered vs 50 million uninsured in US
  10. Has zero personal bankruptcies due to medical bills vs >700,000/year in the US.
  11. Is NOT socialized medicine, but is a system of private doctors treating patients who buy health insurance to cover most of the cost; and allows those who want to, to buy supplemental insurances, at low cost, to cover what the basic insurance doesn't cover: face-lifts, tummy tucks, erectile dysfunction, etc.
  12. Has a national card for each patient with digitized medical records of every doctor visit, referral, injection, operation, x-ray, diagnostic test, prescription, etc to improve doctor to doctor communication and decrease medical errors and deaths; and, has all of the billing information down to the dollar amount per visit/treatment, and how much the insurance will pay the doctor and reimburse the patient as well.
  13. Has the highest rated quality of care, most cost-efficient and highest customer satisfaction in the world.

What is described above is the health care system of France. France, like all of the other developed countries, except the United States, made the moral decision of solidarity that health care is a right guaranteed to all of its citizens; that the moral imperative to provide basic medical care, prevention and prescription drugs is fairer, works best for their society and the health of the nation, and is most cost-efficient.

The US, on the other hand, does not have a health care system. It is a fragmented for-profit market, driven by the imperatives and principles of profit and growth; where health care is a commodity, bought and sold, like cars and televisions and discriminates on the basis of wealth; where profit and growth—as in all other corporate enterprises—supersede the interests of the society, the individual, and even life.

Compared to other developed nations, our market approach to disease care has failed the customer in terms of quality, access and costs. Specifically, it is 37th in quality, while at the same time being the most discriminating, unfair and most expensive non-system in the world, with the highest rates of medical errors and death, all yielding one of the most unhealthy populations of any developed country. But, it does continue to provide massive profits to the corporations that run it.

The next time you hear a politician or talking head scream socialized medicine, death panels, rationing, the end of free markets, etc. recognize them for who they are, and their fear-mongering for exactly what is. They are the standard bearers for the status quo and the mouthpieces of the vested interests to protect corporate profits, and nothing more. You see, we already have socialized medicine in the form of Medicare and the VA; the two most cost-efficient, highest quality and most highly rated systems in the country. We already have rationing and death panels—insurance administrators who deny claims, coverage, and cancel policies, and craft insurance premiums that make health care unaffordable to tens of millions.

Our market driven system is bankrupting our country, businesses, and individuals. The most obvious question no-one asks is: Who benefits from it? Answer that, and you will see why the status quo is so important and why we, as Americans, are so sick. Here's a clue: follow the money.

We're # 1! We ain't even close, in health care and so many other ways.


Note: #'s 1- 13 above sourced from: The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care: by, T.R. Reid

Thursday, July 12, 2012

"Let Your Food Be Your Medicine"

"Let Your Food Be Your Medicine"



Hippocrates (460BC – 370BC), widely considered the “Father of Medicine,” said “Let your food be your medicine, and let your medicine be your food.”

Over 2000 years later, this is still the single best prescription for optimum health. Our abject rejection of, and failure to heed, this advice is the single largest cause and unifying explanation of the lifestyle diseases that plague Western cultures. These Western diseaseses including obesity, diabetes, heart disease, cancers, strokes, osteoporosis, and Alzheimer's disease are responsible for most deaths. They have become invisible diseases to the extent that we consider them part of normal aging. They are not.

As recently as 1900 cancer and heart disease combined accounted for only 13% of all deaths. By 2005, cancer and heart disease accounted for 50% of all US deaths. This meteoric rise occurred at the same time the intervening decades heralded significant advances in medical care and the explosion of pharmaceutical drug use.

The most dramatic change in the past 60 years that negatively impacted American health was the epic shift in the American diet and nutrition, compounded by an equal shift to a sedentary lifestyle.
  
Over the past 60 years the concept of “better living through chemistry” has dominated American life. Big Agra, chemical pesticide and processed food corporations, the restaurant and fast food industries, Big Pharma, and the medical care industry, as aided and abetted by the US government, have all redefined what and how we eat.

How and why this perversion of food occurred is expertly detailed in Marion Nestle’s: Food Politics. In short, it was the result of economic driving forces and special interests pressure on a government focused on driving down the cost of food; combined with bad, fraudulent, and corporate-friendly medical science, incessant marketing based on that science, a media functioning as a corporate mouthpiece, a medical system that feeds on disease, and a public in search of convenience in a fast-paced world with both parents working.

We humans foolishly believe that we can function outside of the laws of nature and the driving forces of millions of years of evolution that shaped our dietary requirements (like those of every other species) without consequences.

Our DNA is 43,000 years old, the same as our Paleolithic hunter-gather ancestors. As such, our food and exercise requirements are consistent with those of Paleolithic man, as dictated by that DNA. Nothing more, nothing less; except that we eat more (especially more simple carbohydrates and sugar, and chemical and processed foods) and exercise less, if at all.

The basics of health are simple:

1.      Eat natural/whole foods: fruits, vegetables, nuts seeds, meats, and fish. Basically, if it lives, grows, dies, and rots out-of-doors (and is within our species specific diet), you can eat it. Cut out, or minimize, all dairy, wheat, corn, pasta, breads, grains/cereals.
2.   Stop eating chemically processed foods, fast foods and snacks, sugars, artificial sweeteners, and high-fructose corn syrup.
3.  Take Omega 3 fish oils and Probiotics.  
4.   Drink a lot of water.
5.   Stop drinking all sodas, carbonated beverages, power drinks, and so-called vitamin waters.
6.   Stop smoking, completely.
7.   Exercise at least 30 to 60 minutes, or more, every day: a mix of cardiovascular (running/walking/biking/elliptical, dancing, etc) and weight training.
8.  Get plenty of sunshine without sunscreen. Do not allow yourself to burn.
9.  Commit and connect: have meaningful commitments and connections to other people and/or groups.
10.  Cultivate hobbies, goals, etc. to give purpose and meaning to your life.
11. Stop using toxic body, hair, and bath products and sunscreens.
12.Commit to health and get off as many, or all, of your medications as possible. “Let your food be your medicine, and let your medicine be your food.”

Health largely boils down to your choices, priorities, and personal responsibility. Do you want to be healthy or do you want to be sick. The choice is up to you. But it is not a matter of what you want. It is all about what you are willing to change and do.