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What Will the Opioid Crisis Look Like in Five Years?

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What Will the Opioid Crisis Look Like in Five Years?

Posted on: November 20th, 2019 by Access Computer No Comments

As an Infectious Disease physician, Dr. Bruce E. Ruben is always learning more about how current issues affect his patients’ healthcare. This article by Jirka Taylor and Peter Reuter originally appeared in the Concord Monitor in New Hampshire last week. Dr. Ruben found this commentary on what the opioid crisis will look like in five years to be a fascinating look at this world-wide problem and thinks his patients should read it too.

Few people had ever heard of fentanyl five years ago. By 2018 this synthetic opioid was implicated in more than 30,000 fatal overdoses in the United States. The next stage of the fast-changing opioid crisis may well depend on how the illegal drug markets morph in the years to come.

In the corners of Europe that have been dealing with fentanyl as long or longer than the United States, each illegal market for opioids took distinct turns. In some, heroin disappeared. In others, opioid nasal sprays arrived. Online sales became the norm. Any of these things could happen here.

What Will the Opioid Crisis Look Like in Five Years?

It’s Estonia where heroin practically disappeared. In the early 2000s, the Taliban’s prohibition on growing poppies in Afghanistan had a ripple effect in Europe constricting the heroin supply. Fentanyl smuggled from or through Russia took its place. Today, tiny Estonia (population about 1.3 million) has the only “mature” fentanyl market in the world.

The replacement of heroin with fentanyl in its drug market was devastating: By 2012, Estonia had one of the highest per capita rates of fatal overdoses in the world. Two other observations, however, offer a bit more reassurance. First, fentanyl does not seem to attract new users: The number of opioid users in Estonia began declining in the 1990s and has continued on that trend. Second, although fentanyl is much cheaper than heroin to produce and ship, drug traffickers do not appear to have lowered street prices, also limiting its spread.

Nearby Latvia underwent a different shift, essentially skipping the fentanyl stage. Stronger variations of the fentanyl molecule, called analogs, started appearing in large quantities around 2014. Until very recently, the most common was carfentanil. One gram of pure carfentanil represents thousands of lethal doses for those without opioid tolerance.

Despite this dangerous potency, Latvian health statistics don’t show a substantial increase in overdose deaths. This suggests that Latvian users and dealers have found comparatively safer ways of consuming synthetic opioids and that overdose death levels don’t inevitably have to skyrocket like they did in Estonia. (Some certainly go unrecorded, but the undercount would have to be enormous for Latvia’s fatal overdose rate to approach Estonia’s.)

Sweden, unlike every other country, developed parallel opioid markets: one for heroin and another for fentanyl analogs. Around 2014, dealers started selling fentanyl analogs online, offering direct-mail delivery. After a period of experimentation, these online dealers settled on an analog nasal spray—a popular alternative for people who preferred not to inject drugs.

Some, though not all, of these facets—the disappearance of heroin, direct online sales, nasal sprays, potent analogs—have begun to pop up in distinct pockets of the United States. None have become widespread in North America yet—but there is no reason why they couldn’t.

Sweden, Latvia and Estonia are, to be sure, much smaller than the United States. But it is useful to think of them as equivalent to a city or small state with a comparatively concentrated supply chain. That also shows us regions just a few hundred miles apart might be affected by fentanyl in completely different ways. The areas of North America that have suffered the most in the opioid crisis—New England, the Midwest, Appalachia, British Columbia—are likely to confront fentanyl in localized ways as well. That will have ramifications for prevention, provision of treatment and other services, and law enforcement efforts.

Despite the variations, there is an overarching commonality to the European cases, too: Once a synthetic opioid like fentanyl becomes dominant, it stays that way. The United States should prepare for fentanyl and other synthetic opioids as a lasting phenomenon, and learning from other countries’ experiences is an important part of that effort.

Jirka Taylor is a policy analyst at the nonpartisan, nonprofit RAND Corporation. Peter Reuter is a professor in the School of Public Policy and Department of Criminology at the University of Maryland. Both are authors of “The Future of Fentanyl and Other Synthetic Opioids.”

 

The Mayo Clinic on the Effects of Hyperbaric Oxygen Treatment

Posted on: November 6th, 2019 by Access Computer No Comments

Overview

Hyperbaric oxygen therapy involves breathing pure oxygen in a pressurized room or tube. Hyperbaric oxygen therapy is a well-established treatment for decompression sickness, a hazard of scuba diving. Other conditions treated with hyperbaric oxygen therapy include serious infections, bubbles of air in your blood vessels, and wounds that won’t heal as a result of diabetes or radiation injury.

hyperbaric-oxygen-therapy-chamber-west bloomfield-michigan

In a hyperbaric oxygen therapy chamber, the air pressure is increased to three times higher than normal air pressure. Under these conditions, your lungs can gather more oxygen than would be possible breathing pure oxygen at normal air pressure.

Your blood carries this oxygen throughout your body. This helps fight bacteria and stimulate the release of substances called growth factors and stem cells, which promote healing.

Why it’s done

Your body’s tissues need an adequate supply of oxygen to function. When tissue is injured, it requires even more oxygen to survive. Hyperbaric oxygen therapy increases the amount of oxygen your blood can carry. An increase in blood oxygen temporarily restores normal levels of blood gases and tissue function to promote healing and fight infection.

Hyperbaric oxygen therapy is used to treat several medical conditions. And medical institutions use it in different ways. Your doctor may suggest hyperbaric oxygen therapy if you have one of the following conditions:

  • Anemia, severe
  • Brain abscess
  • Bubbles of air in your blood vessels (arterial gas embolism)
  • Burn
  • Decompression sickness
  • Carbon monoxide poisoning
  • Crushing injury
  • Deafness, sudden
  • Gangrene
  • Infection of skin or bone that causes tissue death
  • Nonhealing wounds, such as a diabetic foot ulcer
  • Radiation injury
  • Skin graft or skin flap at risk of tissue death
  • Vision loss, sudden and painless

The evidence is insufficient to support claims that hyperbaric oxygen therapy can effectively treat the following conditions:

  • AIDS/HIV
  • Allergies
  • Alzheimer’s disease
  • Arthritis
  • Asthma
  • Autism
  • Bell’s palsy
  • Brain injury
  • Cancer
  • Cerebral palsy
  • Chronic fatigue syndrome
  • Cirrhosis
  • Depression
  • Fibromyalgia
  • Gastrointestinal ulcers
  • Heart disease
  • Heatstroke
  • Hepatitis
  • Migraine
  • Multiple sclerosis
  • Parkinson’s disease
  • Spinal cord injury
  • Sports injury
  • Stroke

Risks

Hyperbaric oxygen therapy is generally a safe procedure. Complications are rare. But this treatment does carry some risk.

Potential risks include:

  • Temporary nearsightedness (myopia) caused by temporary eye lens changes
  • Middle ear injuries, including leaking fluid and eardrum rupture, due to increased air pressure
  • Lung collapse caused by air pressure changes (barotrauma)
  • Seizures as a result of too much oxygen (oxygen toxicity) in your central nervous system
  • In certain circumstances, fire — due to the oxygen-rich environment of the treatment chamber

How you prepare

Pure oxygen can cause fire if a spark or flame ignites a source of fuel. Because of this, you can’t take items such as lighters or battery-powered devices into the hyperbaric oxygen therapy chamber. In addition, to limit sources of excess fuel, you may need to remove hair and skincare products that are petroleum-based and potentially a fire hazard. Ask a member of your health care team for specific instructions before your first hyperbaric oxygen therapy session.

What you can expect

During hyperbaric oxygen therapy

Hyperbaric oxygen therapy typically is performed as an outpatient procedure and doesn’t require hospitalization. If you’re already hospitalized and require hyperbaric oxygen therapy, you’ll remain in the hospital for therapy. Or you’ll be transported to a hyperbaric oxygen facility that’s separate from the hospital.

Depending on the type of medical institution you go to and the reason for treatment, you may receive hyperbaric oxygen therapy in one of two settings:

  • A unit designed for 1 person. In an individual (monoplace) unit, you lie down on a table that slides into a clear plastic tube.
  • A room designed to accommodate several people. In a multiperson hyperbaric oxygen room — which usually looks like a large hospital room — you may sit or lie down. You may receive oxygen through a mask over your face or a lightweight, clear hood placed over your head.

During hyperbaric oxygen therapy, the air pressure in the room is about two to three times normal air pressure. The increased air pressure will create a temporary feeling of fullness in your ears — similar to what you might feel in an airplane or at a high elevation. You can relieve that feeling by yawning or swallowing.

For most conditions, therapy lasts approximately two hours. Members of your health care team will monitor you and the therapy unit throughout your treatment.

After hyperbaric oxygen therapy

You may feel somewhat tired or hungry following your treatment. This doesn’t limit normal activities.

Results

To benefit from hyperbaric oxygen therapy, you’ll likely need more than one session. The number of sessions depends on your medical condition. Some conditions, such as carbon monoxide poisoning, might be treated in three visits. Others, such as nonhealing wounds, may require 20 to 40 treatments.

Hyperbaric oxygen therapy alone can often effectively treat decompression sickness, arterial gas embolism and severe carbon monoxide poisoning.

To effectively treat other conditions, hyperbaric oxygen therapy is used as part of a comprehensive treatment plan and administered with other therapies and drugs that fit your individual needs.

 

Contact Encompass Healthcare today to schedule a consultation with Dr. Bruce Ruben

Why We’re the Alternative to Hospitals

Posted on: September 26th, 2019 by Access Computer No Comments

Hospitals have been in the news a lot lately. The University of Michigan is set to build a nearly billion-dollar new hospital on the University’s Ann Arbor campus. Beaumont Hospital is growing its health system. Other hospitals are merging with each other and raising millions of dollars to start new facilities and departments. All of this sounds like it should be good news, but the truth is that hospitals are not the only option to treat health issues and illness. Hospitals also have many faults, chief of which is their inability to offer personalized, holistic medicine.

Encompass HealthCare and Wound Medicine, founded and led by Dr. Bruce Ruben, prides itself on being a non-hospital option. Hospitals claim they practice “patient-centered care,” but it’s quite obvious they cannot do this because they are simply too massive in size. Hospitals treat too many patients and have thousands of providers who are overworked and underpaid. Encompass likes to focus on you — our patient.

 

Dr Bruce Ruben Encompass HealthCare and Wound Medicine

 

At Encompass HealthCare, we provide medical care that is respectful of individual patient preferences, needs, and values. While hospitals are impressive in size with massive campuses and annual revenues that could buy and sell small nations, they present many problems for health treatment, wound care, infectious disease and caregiving. They are busy at all times of the day and extremely noisy for people trying to get some relief and relaxation.

Encompass puts the patient first. We offer a small, intimate location that is quiet and calming. We focus on you and your needs. Now you understand why we are the alternative to hospitals. And we like it that way.

What’s Sleep Got To Do With Healing?

Posted on: January 29th, 2019 by Mindy Ruben No Comments

What does sleep have to do with infection healing and wound healing?

A lot!

In fact, according to a recent article, when you sleep, your brain can attend to other issues within your body. When there are areas that need healing, the brain triggers the release of hormones that encourage tissue growth to repair blood vessels. This helps wounds to heal faster AND also restores sore or damaged muscles. While you sleep, your body can make more white blood cells that can attack viruses and bacteria that may interfere with the healing process. So if you are being treated for an infectious disease or a serious infection, getting enough sleep will be a critical part of your healing plan!

In fact, when you don’t get enough sleep, your immune system is not able to properly protect the body from infection. So getting an infection in the first place becomes a greater risk. According to expert Infectious Disease and Wound Healing doctor Bruce E. Ruben, M.D. of West Bloomfield, Michigan, this is true for viral, bacterial, and fungal infections. Dr. Bruce Ruben treats patients from all over Oakland County, Michigan.

It is true that many of us struggle with the ability to get more sleep. We all have so much to do, we live busy lives and somehow sleep gets the short end of the stick. Afterall, that’s what coffee is for, right?! Well, putting all kidding aside, it’s important to consider sleep in infection healing and in wound healing.

So now you know that good, restful sleep is one way that your body recovers from damage and protects itself against illness. If getting those zzzz’s seems like an arduous task, think of it as a “prescription”–one that comes from your own body’s desire to get better, heal, and to remain healthy.

What’s sleep got to do with infection & wound healing?

Encompass Healthcare is Grateful For Our Patients and Caregivers

Posted on: December 12th, 2018 by Access Computer No Comments

It’s hard to believe that the year 2018 is almost over. It’s been a wonderful year for us at Encompass HealthCare and Wound Medicine and a time for reflection. While we have been helping men and women in pain for many years, we still think of our medical practice as a new endeavor — and as an alternative to big-business hospitals. Dr. Bruce Ruben and his health care team are constantly working to use innovative medicine for our patients. We see it as our mission to keep ourselves several steps ahead of the pace in the medical field.

 

 

Our treatments for pain care and wound management are constantly evolving to meet the needs of our patients. The recent Thanksgiving holiday gave us an opportunity to count our blessings. We are so very grateful for our many patients and caregivers, who put their trust in our medical team of professionals. We see ourselves as teammates and partners with you.

At Encompass, we take your health very seriously and take great pride in keeping apprised of the many recent changes in how to treat ailments such as diabetic neuropathy, skin infections, bone infections, wounds and different forms of infectious diseases. The gratitude we receive when a patient or caregiver is satisfied with the level of service, the quality of care and the hospitality at Encompass reminds us that what we do really makes a difference. It gives our patients and their caregivers peace of mind.

During the winter holiday season, we gave thanks for all the good that we have in our lives. All of us at Encompass are grateful for you — our partners. We wish you a joyous and blessed holiday season and a successful ending to 2018. Please do not hesitate to contact us with any questions regarding your health or the health of someone you love.

Learning from Our Patients

Posted on: November 19th, 2018 by Mindy Ruben No Comments

In the Digital Age, so many doctors and medical offices believe that patient testimonials are solely for the purpose of posting on a website so potential patients see how loved you are. At Encompass HealthCare and Wound Medicine, we appreciate when our patients write glowing testimonials and reviews about our medical facility, but we love them for other reasons as well. We learn from our patients’ words in their testimonials and reviews.

Unfortunately, many physicians have begun to fear online reviews by patients. Whether it’s HealthGrades, RateMDs or Vitals.com, doctors are scared that patients or their relatives will leave feedback that is anything less than a 5-star perfect review. Our goal at Encompass HealthCare is to learn from reviews. Dr. Bruce Ruben and his staff absolutely love helping our patients and that is our mission. We strive to make our patients feel comfortable, safe and cared for at Encompass. While Dr. Ruben and Encompass have won multiple awards and have been cited as one of Michigan’s top medical centers, we know that we can still improve. We are grateful for our patients who leave us feedback through online reviews and testimonials because it informs us of where we’re strong and where there is room to improve.

We pledge to take the time to listen to our patients’ feedback and to always have an open mind when it comes to new treatments we can offer you. Please visit our website, full of helpful information and health-related resources, to begin your path to better health with us.

Why is a disability-friendly medical office important?

Posted on: September 28th, 2018 by Access Computer No Comments

WHY IS A DISABILITY-FRIENDLY MEDICAL OFFICE IMPORTANT? 😕And does your patient’s doctor’s office have this? At Dr. Bruce Ruben’s Encompass HealthCare & Wound Medicine, we know how critical this can be for disabled patients.

Lift at Encompass HealthCare & Wound Medicine, Dr. Bruce Ruben, West Bloomfield, Michigan

Click HERE to read our latest newsletter about our barrier-free office.

 

 

Dr. Bruce Ruben Praises Caregivers – Our Teammates

Posted on: August 22nd, 2018 by Access Computer No Comments

At Encompass HealthCare and Wound Medicine, we are keenly aware that our “customers” are not only our patients. We know that along with each patient there is at least one caregiver who is devoted to the physical and mental health of the patient. In some cases, there is an entire team of caregivers. These can be the adult children of the patient, hired nurses, friends or other relatives. And our staff at Encompass knows that this is not an easy job.

Being a caregiver can often feel like a lonely, thankless job. Having a caregiver charged with advocating for the patient is an important asset in the health field. In fact, our doctors and other medical professionals at Encompass see each caregiver as part of our own team. We all have the health of our patients as our top priority and we are dependent on a good relationship with each caregiver.

Encompass HealthCare & Dr. Ruben Salute the Caregivers

Research shows that caregivers manage better if they feel confident about handling the daily hassles of caregiving. The relationship between caregiver, patient, healthcare professionals and family members is such an important relationship and one that must be respected at all times.

Our hearts go out to the many dedicated souls who are serving as caregivers for our patients. We pledge to continue working with you to help ensure the good health of our patients. Additionally, we commend you for all you do. We know that even if you don’t always feel the gratitude, the patient and the patient’s family members are grateful for you. At Encompass HealthCare, we know that we couldn’t do it without you. Thank you!

Why Self-Care is So Important

Posted on: May 22nd, 2018 by Access Computer No Comments
At Encompass HealthCare and Wound Medicine, we know how important both self-care and the role of caretaker is to our patients. On a daily basis, we salute those men and women who take care of our patients by driving them to doctor’s visits at Encompass, ensuring they are eating properly, doling out their medication and advocating for them. Whether the caregiver is a hired professional, a family member or a friend, we recognize the sacrifice these individuals are making on behalf of another soul.

What Defines Self-Care?

This month, however, we want to focus our blog post on another issue that is of utmost concern for our patients at Encompass. The role of self-care in your daily health regimen. After all, no one cares about you more than yourself. You might rely on a caregiver for some daily functions and tasks, but there are many ways that you can provide self-care management to ensure a healthy lifestyle for yourself that is free from disease, infections and wounds.
Some tips for self-care include living a healthy life by trying to only eat healthy foods, get enough sleep, exercise regularly and take only the doctor’s prescribed doses of your medicines. Regardless of your age, it’s important to manage stress and go for regular medical check-ups.
Additionally, one of the most important aspects of self-care that Dr. Bruce Ruben at Encompass HealthCare encourages is to practice good hygiene. Good hygiene is important for social, medical, and psychological reasons in that it not only reduces the risk of illness, but it also improves the way others view you and how you view yourself. Dealing with infectious disease, Dr. Ruben cannot stress enough the importance of good hygiene on a regular basis as a key principle in self-care for his patients.

Social Interaction is Self-Care

Believe it or not, another aspect of self-care is social interaction. Studies have shown that individuals who live sociable lives live longer. See friends and family members to build your sense of belonging. You can also join a variety of different support groups to make new friends. Encompass HealthCare can recommend some local support groups and social clubs to help keep you active and involved.Self-care is important value at Encompass HealthCare & Wound Medicine, West Bloomfield, Michigan
Finally, hobbies are an integral part of healthy self-care. Try to do something you enjoy every day, whether it be exercising, dancing, going to a movie, taking a walk, watching a favorite TV show, working in the garden, painting or reading. You should also find ways to relax, like meditation, yoga, getting a massage, taking a bath or walking on a local path.
It is our strong desire at Encompass HealthCare and Wound Medicine that our patients live long and healthy lives. We know you can’t do that on your own. It takes a village of caretakers, support team and physicians. However, self-care management is also a very critical component of your healthy life.

Congratulations to Dr. Bruce Ruben Who Received The 2018 Top Infectious Disease, Hyperbaric Medicine & Wound Care Specialist Award in Michigan!

Posted on: April 28th, 2018 by Access Computer No Comments

We are so proud of our Doctor Bruce Ruben who received the 2018 Top Infectious Disease, Hyperbaric Medicine & Wound Care Specialist award in Michigan! Dr. Bruce Ruben, internationally known as “The Wound Doc,” is the Founder and Medical Director of Encompass HealthCare and Wound Medicine. Board certified in Internal Medicine, Infectious Disease, and Undersea and Hyperbaric Medicine, Dr. Ruben pioneered outpatient IV therapy and outpatient wound care.  To read about Dr. Ruben and his award, click HERE.

Bruce E. Ruben, M.D., founder and Medical Director of Encompass HealthCare & Wound Medicine, West Bloomfield, Michigan receives 2018 Top Doctor Award

Bruce E. Ruben, M.D., founder and Medical Director of Encompass HealthCare & Wound Medicine, West Bloomfield, Michigan receives 2018 Top Doctor Award.

Bruce E. Ruben, M.D., founder and Medical Director of Encompass HealthCare & Wound Medicine, West Bloomfield, Michigan receives 2018 Top Doctor AwardRuben is also a member of the Medical and Scientific Advisory Committee and National Spinal Cord Injury Association (NSCIA) board, an advisory board member of WoundSource, and serves on the board of The Emily Stillman Foundation in the Detroit and West Bloomfield, Michigan area.

EXPERT INFECTION & WOUND HEALING DOCTOR

Dr. Bruce Ruben is an expert in healing stubborn, non-healing infections & wounds. Offering services such as  I.V. antibiotic therapy, hyperbaric oxygen therapy, venous ablation, manual lymphatic drainage, unna boots, skin substitutes & more, Doctor Ruben and his staff offer these services to heal stubborn bed sores, pressure ulcers, bacterial infections, viral infections, burns, & other medical problems. His medical contributions are unparalleled & remarkably, patients can refer themselves.

The office phone number is 248-624-9800 or Dr. Ruben can be reached through our contact form found HERE.

 

 

 

Leading Infectious Disease, Hyperbaric Medicine and Wound Care Specialist, Bruce E. Ruben, MD is to be Recognized as a 2018 Top Doctor in Michigan

 

 

 

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