Bottle of opioid pills and needle

Doing Our Part to Solve the Opioid Crisis

Posted on 04/24/19 by Allied Anesthesia

It’s no secret that there’s a countrywide opioid crisis. According to the National Institute of Health, more than 130 Americans die each day from overdosing on some kind of opioid: prescription opioids, heroin, fentanyl, and others. This crisis didn’t come out of nowhere—it’s been brewing for nearly three decades and is a result of a number of different elements: over-prescription by healthcare providers, a lack of awareness about how addictive opioids can be, a disproportionate focus on subjective measures of pain control, and a skewed reimbursement system. With so many contributing factors, it comes as no surprise that there is no easy fix.

Restricting opioid prescriptions has been floated as one viable method for cutting down on opioid related overdoses, and there has been some success here; according to the FDA,  the number of opioid prescriptions dispensed by pharmacies is at a 15 year low. But cutting back on opioid prescription has its own unintended and severe consequences:

  • People are turning to unregulated, illegal substances (e.g., heroin) as a less expensive and more accessible alternative
  • Many people with acute or chronic pain are not getting the treatment they need to function

Recent legislation aimed to address the crisis by limiting opioid prescriptions for acute pain—like the pain that may occur after a surgery—to just seven days. Though this well-intentioned bill is careful to focus solely on acute pain, rather than chronic pain, the potential consequences are problematic across the board.

The National Institutes of Health reported recently that about 25.3 million adults experienced pain every day for 3 months while nearly 40 million adults experience severe levels of pain. For many of these people, opioids are critical to their ability to function on a daily basis.

So how do we solve a national health crisis that affects the lives of so many Americans? It’s going to take a significant amount of collaboration on the part of healthcare providers, insurers, drug companies and governmental regulatory bodies.

For our part, we are determined to help our patients manage chronic or acute pain effectively and responsibly. There are a couple of ways we do that.

While we do use opioids to help patients cope with acute post-operative pain, we often rely on other methods, like individual nerve blocks, epidurals and other types of steroid injections to reduce pain or “numb” a certain area. In fact, regional nerve blocks often mean that patients are completely pain-free for 24-72 hours after surgery. By the time the nerve block wears off, many patients no longer need or want opioids; they are able to find pain relief with over-the-counter medications like Tylenol or non-steroidal anti-inflammatory drugs (NSAIDs).

For patients suffering from severe chronic pain, we do sometimes prescribe (and carefully manage) opioids if other methods are not working and opioids dramatically improve a patient’s quality of life.

As more solutions arise for opioid crisis, we are committed to working with other players in the healthcare space to do our part. As always, patients come first—we’ll continue to explore multiple pain-relief alternatives while also being conscientious and mindful in our use of opioids for pain management.

Does Anesthesia Affect Childhood Development? New Research Says No.

Posted on 04/17/19 by Allied Anesthesia

Undergoing serious medical procedures can be stressful at any age, but when you’re a parent and the patient is your young child, it’s particularly worrying. Aside from concerns about the nature of the procedure itself, many parents are hesitant to expose children to general anesthesia for fear that the medicine might have a negative impact on their child’s developing brain. Good news: it won’t.

A new study published in JAMA Pediatrics found that exposure to anesthesia does not inhibit a child’s brain development. The study followed nearly 10,000 sibling pairs between the ages of 5 and 6 who had Early Development Instrument (EDI) data completed prior to the study. The EDI assesses a child’s readiness and ability to learn based on five different factors:

  1. Physical health and well-being
  2. Social knowledge and competence
  3. Emotional health and maturity
  4. Language and cognitive development
  5. Communication skills and general knowledge

In more than 2,000 pairs (of the original 10,000+), one but not both siblings had undergone a surgery requiring general anesthesia. Upon evaluating the pairs, it was determined that there were no developmental differences between siblings who had been exposed to general anesthesia and those who hadn’t.

While previous studies using rat models suggested that anesthesia could impact the developing brain, these new findings make it clear that those results are specific to the species and not applicable to human children.

Even with these encouraging results, surgery or medical procedures requiring general anesthesia in young children is stressful for parents. We get it—that’s why our award-winning team includes board-certified pediatric anesthesiologists. Many of our doctors are parents themselves, so they know how important it is to give our pediatric patients the best available care.

From pediatric cardiothoracic services to complex pediatric pain blocks to rare conditions, our pediatric anesthesiologists handle more than 15,000 cases per year—and in every one, our utmost concerns are ensuring our little patients’ safety and easing any discomfort or pain they might have. Learn more about our pediatric specialists.

Prescription bottles laying together

Take Back Your Drugs on April 27

Posted on 04/11/19 by Allied Anesthesia

In 2017, at least 6 million Americans misused controlled prescription drugs, according to the National Survey on Drug Use and Health. Many of these prescription drugs were taken from the medicine cabinets of friends and family members.

If you’ve ever had a pain medicine prescription following a procedure, you may not have ended up using all of the medication. Once you’re feeling better, it’s not uncommon to forget about the prescription medication completely or decide to save it in case the pain returns.

Unfortunately, unused or expired medication is very easily lost, stolen or misused. In an effort to reduce the impact of this misuse—which includes addiction, overdose and accidental poisoning—the Drug Enforcement Agency (DEA) established April 27 as National Prescription Drug Take Back Day.

There are Take Back days in both April and October, and with thousands of collection sites across the country, it’s easy to safely (and anonymously) drop off unused prescriptions and controlled substances. Last year, 949,046 pounds (or about 475 tons) of drugs were collected from 5,842 sites and disposed of safely by the DEA.

What about simply throwing unused medication out or flushing it down the toilet? There are a few reasons why these disposal methods are strongly discouraged:

  • Even when in the trash, drugs can easily be stolen and then illegally used or sold.
  • If drugs are thrown out, the active chemicals in the medications can pose a danger to sanitation workers. Once in a landfill, these chemicals can damage the surrounding environment or seep into water sources.
  • Medicines that are flushed down the toilet are frequently not removed by water treatment plants or septic systems. These chemicals can end up polluting water sources, poisoning animals and contaminating our food and water supplies.

Keep your family, friends, community and environment safe this spring and find a time this month to collect your unused and expired prescription medicines. Then find a nearby collection site and safely dispose of your medications on April 27. We’ll be doing it too!

 

Doctor showing patient a slideshow

The Future of Anesthesia

Posted on 04/05/19 by Allied Anesthesia

Could anesthesia be used in the treatment of PTSD, depression and related conditions? It’s certainly possible.

A new study from the Universidad Politécnica de Madrid  found that when administered under specific circumstances, the anesthetic propofol can help alter traumatic and debilitating memories. The study included 50 patients who were undergoing procedures (like endoscopies and colonoscopies) and would be treated with propofol. A week before surgery, patients were shown a slideshow of emotionally charged images and a slide show of neutral images. Immediately before the procedure, the researchers “reactivated” the memories of both slide shows by asking the patient to recall the images.

Twenty-four hours after the procedure, researchers found that the memory of the emotionally charged slide show had been impaired—but not the memory of the neutral slide show. It’s important to note that the propofol did not make the memory disappear, it just made the recall of that memory a less emotional, disturbing experience.

A Scientific American article reporting on the research notes that in this study, propofol “functioned exactly as a PTSD drug should—impairing the disturbing memories and leaving the others alone.”

This study’s small sample size certainly does not prove that propofol or any anesthesia can treat PTSD, depression or related conditions—much more research will need to be conducted before anesthetics are used in this capacity. But this small study is an excellent illustration of how the medical community at large is continuing to learn about the far-reaching benefits of anesthesia.

At Allied, we specialize in all aspects of anesthesia, but as doctors and scientists, we are always interested in developments that could ultimately help our patients. Our priority, first and foremost, is to responsibly use anesthesia and other measures to help our patients.

Dr. Armen Chalian

National Doctor’s Day – Meet Dr. Armen Chalian

Posted on 03/29/19 by Allied Anesthesia

Armen Chalian Allied AnesthesiaMarch 30 is National Doctor’s Day, and to celebrate, we decided to interview Dr. Armen Chalian, one of the many incredible physicians we have here at Allied Anesthesia, about what made him want to become a doctor (in particular, an anesthesiologist).

Dr. Chalian joined Allied in 1993; since then, he has handled more than 20,000 cases with us. Dr. Chalian currently specializes in anesthesiology for pediatric, obstetric, neurology and orthopedic patients, as well as chronic pain management. Previously, he specialized in anesthesia for pediatric and adult open-heart surgery.

Here’s what he had to say.

 

Did you always know you wanted to be a doctor?

In high school, I really enjoyed the humanities—English and history. I wasn’t particularly interested in the sciences. I went to college at UCLA, and my dad told me to take a biology class just to try it. There were 600 students in the class, and I ended up being in the top 3. And I just kept going!

A little backstory here: My grandparents survived the Armenian genocide and escaped to the Middle East. Then my father similarly escaped war-torn Beirut to come here to the States. It was important for my dad and his siblings that their children become doctors, in part because doctors provide a critical service to others. And we did. Every single one of my cousins is a doctor or dentist.

 

What made you decide to get into anesthesiology?

That was an easy decision. Anesthesiology is the best and most exciting field in medicine—by far.

As an anesthesiologist, you have to be an expert in all fields of medicine—not just anesthesia—because administering anesthesia affects all organ systems. Anesthesiologists are the only doctors who need to have this broad base of knowledge and expertise.

It’s also the only field of medicine where, as a doctor, you have a cart full of medications and you can grab and administer them in real-time, which often ends up saving patients’ lives. I always tell people that if you had to pick one doctor to have around if you’re going to be very ill, it’s an anesthesiologist. We’re trained to spring into action, and our work depends on expertise across the medical spectrum.

 

What do you think is the biggest misconception about anesthesiology?

I think the biggest misconception is that anyone can administer anesthetic. And it’s not just a misconception on the part of patients. There are even doctors who think that!

But in reality, anesthesiology is not just pushing medicine in an IV and watching someone fall asleep. Every patient has unique things about them—age, general health, specific medical conditions, medications—and all of these characteristics factor into how anesthetic will affect them.

Another misconception is that anesthesiologists just administer anesthesia at the beginning of a procedure and then go home. You’re there the whole time, monitoring the patient, ensuring that they’re responding well to both the anesthesia and the procedure itself, and will wake up at the end of the procedure feeling better.

It’s an art form more than a medical practice. Everyone in my family knows that if they undergo a procedure, they have to demand to have an anesthesiologist present. Not a nurse anesthetist or a physician’s assistant, but an MD specializing in anesthesiology.

 

What do you like about working at Allied Anesthesia?

It’s been incredible to get to work in so many fields of anesthesia alongside such talented people. There are leadership opportunities here at Allied, and I’m not just a cog in an enormous healthcare machine. I’m practicing the kind of medicine I want to practice and have the freedom and support to be a true advocate for my patients. It’s the best job I can imagine.

Doctor and cancer patient look at data on computer

Can Anesthesia Impact Cancer Surgery Outcomes?

Posted on 03/07/19 by Allied Anesthesia

Many people think of an anesthesiologist’s role as limited to providing comfort during surgery—that our role begins and ends in the operating room. As our patients and their families know, anesthesiologists do much more. At Allied, we specialize in pediatric anesthesia, cardiac anesthesia, and chronic pain management. Other examples of anesthesiologist specialties are neuroanesthesia or anesthesia as apart of obstetrics or emergency care.

One of the most exciting parts of being a doctor, regardless of the specialty, is how the science of medicine is constantly advancing—as we learn more and more about certain diseases and treatments, our ability to help our patients gets better and better. Anesthesiology is no exception.

For example, a recent article published in JAMA Surgery suggests that modifying anesthetic techniques when operating on cancer patients could actually reduce the postoperative incidence of cancer metastasis, and therefore improve long-term survival.

First, some background. In general, regardless of the health of the patient, the experience of surgery can have lasting effects on your physiology. Specifically, surgery can induce stress and inflammatory responses that have a measurable impact on cellular systems and can ultimately compromise a patient’s immune system. These changes don’t just occur during or immediately after the surgery—they can extend well beyond the actual event.

We know that reducing pain and inflammatory responses after surgery helps people heal faster and makes them less prone to infection. Is the same true for anesthesia?

In a recent Anesthesiology editorial, the authors note that clinical evidence suggests that there are three different anesthetic approaches that might reduce the risk of cancer recurrence:

  • Regional anesthesia, including nerve blocks
  • Anesthetic adjuvants to help prevent infection
  • Using propofol as a replacement for anesthesia

All three of these approaches are currently being evaluated, and we’re very much looking forward to the results.

At Allied, we’re committed to helping our patients before, during, and after surgery—so if there are anesthetic management changes we can make to help reduce the risk of recurrence in our patients living with cancer, we’ll be among the first to implement them.

Operating room team

The Year Ahead

Posted on 02/01/19 by Allied Anesthesia

2018 was a whirlwind at Allied Anesthesia and we’ve already hit the ground running in 2019. Our highlights for the year include:

  • Adding five surgery centers to our partners (we now provide anesthesia services at a total of 32 different locations)
  • Treating a record number of cases: about 111,000
  • Bringing on highly skilled new team members
  • Providing top-notch care to our patients across southern California (as always)

2018 also came with its challenges, in particular Assembly Bill 72. The bill, which the California legislature passed in September 2016, was designed to eliminate patients’ “surprise medical bills” for out-of-network care. For example, if a patient goes to an in-network facility for care but receives treatment from an out-of-network doctor, they could be billed later for that doctor’s fees.

Of course, we fully support the thinking behind this legislation. As a medical group that partners with many hospitals and ambulatory surgery centers, one of our highest priorities is ensuring that patients are not billed separately for our anesthesia services. We feel strongly that patients should not shoulder the burden for out-of-network services they receive as part of covered treatment.

Unfortunately, the implementation of this bill hasn’t been this straightforward—in fact, it’s been deeply flawed. It doesn’t just eliminate surprise bills for patients (which is undoubtedly a good thing)—it gives large insurance companies with lots of resources even more leeway to take advantage of small, specialty practices like Allied Anesthesia.

By allowing insurance companies to severely limit how much reimbursement they provide to specialized, out-of-network doctors, it’s no wonder that insurance companies fully supported AB 72—while our peers in the medical industry strongly opposed it.

One of our primary goals for 2019 is to work with the authors of AB 72 to make them aware of the unintended consequences of this legislation. Ultimately, we want to help them find a solution that protects patients from unexpected costs and enables us to continue bringing in exceptionally talented physicians to provide the highest quality care to our patients.

That’s just one of the many things we plan to accomplish in 2019:

  • Establish new partnerships. We currently work with many renowned hospitals and ambulatory surgery centers, including Hoag, CHOC Children’s, St. Jude’s, St. Joseph’s, and more. We’re look forward to collaborating with all of our existing partners and some new ones in the new year.
  • Continue to add to our team. We’re looking forward to another successful recruitment season where we can bring on 6-10 more talented doctors
  • Expand our role. We’re looking forward to expanding our role in the perioperative process as we use multimodal therapies to decrease cancellations and improve efficiency in the operating room.
  • Decrease opioid use. Opioids are extremely useful in treating severe pain, but they come with many complications. We’ll be limiting our use of opioids through intraoperative nerve blocks and administering other types of medications that affect pain pathways.
  • Continue to provide exceptional care to our adult and pediatric patients. It will come as no surprise to our patients that this is always our top priority.

 

Doctor talking to patient in hospital

Current Trends in Anesthesia

Posted on 01/24/19 by Allied Anesthesia

One of the most fascinating things about working in medicine, and anesthesiology in particular, are the near-constant advances in medical technology and their implications for our work. While there’s no telling exactly what medical breakthroughs will occur in the coming months and years, some of the developments we’ve encountered recently are excellent indicators about where we’re headed this year and beyond.

Improving Sleep in Post-Operative Patients

If you’ve ever had major surgery, you know how difficult it can be to sleep immediately afterwards—especially if you’re in the hospital. Discomfort is a primary factor, but age, medication, anesthesia type, surgery type/method and environmental stress can also be factors. Trouble sleeping isn’t just an inconvenience—We need sleep to maintain our physical and mental health, and sleep is an important part of the healing and recovery process. A recent article in Current Opinion in Anesthesiology notes that there are pharmacological and nonpharmacological measures (like dim lighting, ear plugs, and eye masks) that can be used to promote sleep during recovery.

Using Data to Predict Outcomes

Doctors are scientists, and like all scientists, data is one of the most important aspects of our work. While vast medical databases have existed for years, only recently have nationwide databases been established especially for anesthesiologists’ use. The data collected by these databases help doctors document patterns across wide patient groups, enabling them to better predict outcomes in future cases. This data can also help healthcare providers identify rare but significant reactions or complications and respond to them appropriately. In order to be of real, lasting value, these databases will need to be consistently monitored for security and methodology, and the data itself must be validated, but their existence looks to be a promising one for the future of anesthesia.

Anesthesia Without Opioids

In an effort to minimize opioid use and the resulting complications, a movement around opioid-free anesthesia (OFA) is gaining traction. While opioids are incredibly important for pain management during and after surgery, they also have well-known adverse effects, including slowing down recovery and leading to long-term use or addiction. While comprehensive, multi-center studies are needed to better understand the risks and benefits associated with OFA, it’s definitely an avenue worth exploring.

Managing Chronic Pain

Chronic pain isn’t new, but given that more than 100 million adults live with it, it’s an important and ongoing focus in medicine. Defined as pain that lasts three months or longer, chronic pain limits your ability to work, sleep, relax, or eat. It also plays a huge role in mental health; studies show it is a prevalent factor in deaths by suicide. Most people know that anesthesiologists help manage pain before and after surgery, but many don’t realize that anesthesiologists specialize in the management of chronic pain. For example, at Allied, we have an award-winning pain management team that helps patients dealing with chronic neck and back pain.

 

Are there any recent medical advances you’re personally (or professionally) excited about? Let us know in the comments.

 

 

Man and woman working out in park - healthy lifestyle resolutions

The Best Resolutions You Can Make

Posted on 01/17/19 by Allied Anesthesia

Making New Year’s resolutions is easy, but keeping them? That’s another story.

If you’re hoping to make a resolution this year you can actually keep, try focusing on quality rather than quantity. In other words, instead of picking multiple resolutions, focus instead on one or two resolutions—clear, strong ones that will have a significant impact on your life and health.

1. Quit smoking.

This one might seem obvious, but there’s a reason for it—approximately 37.8 million American adults are still regular smokers, and more than 16 million Americans are living with a smoking-related disease. As any smoker knows, nicotine is highly addictive, and quitting is easier said than done. But there are a number of options for quitters, and the Mayo Clinic has a solid overview of them.

2. Eat healthy.

It’s hard not to indulge a little over the holidays, so it’s no wonder many people start off the New Year with a diet. But diets, and crash diets especially, can be difficult to follow (and easy to drop), so we recommend focusing on eating healthy, high-quality foods rather than restricting yourself to a rigid diet or completely eliminating certain foods or ingredients. Try to incorporate fruits and vegetables into every meal, limit animal products, and avoid sugars, fats, and processed foods as much as possible.

3. Develop an exercise routine.

Exercise doesn’t just give you a sense of accomplishment and increase your endorphins—It can lengthen your life expectancy, repair heart disease, and decrease your risk of getting cancer.

Experts recommend three to five hours of moderate physical activity (something that gets your heart rate up and makes you sweat) each week, or about 30-45 minutes a day, as well as two or three strength training weekly sessions.

4. Keep track of your BMI.

Your body mass index is your weight-to-height ratio and can be a good indicator of whether or not you’re overweight. Calculate your BMI and try to get to (and maintain) the “normal” range of 18.5-24.9.

5. Drink in moderation.

Some studies suggest drinking any amount of alcohol increases your cancer risk, while others show some alcohol consumption can help prevent cardiovascular disease. Either way, if you enjoy drinking, try to do so in moderation, which the CDC defines as up to 1 drink per day for women and up to 2 drinks per day for men.

 

Referred to as “intensive lifestyle change” by researchers, these resolutions may collectively seem prohibitively difficult. Try focusing on just one or two at a time, and remember that overall, each on its own will make a positive impact on your life—for this year and many to come.

Surgeons washing their hands before surgery

Staying Healthy All Year

Posted on 01/07/19 by Allied Anesthesia

Winter isn’t all festive holiday cheer and new beginnings in the New Year—it’s also (unfortunately) synonymous with cold & flu season. But there are two things you can do during the winter months (and the rest of the year!) to stay as healthy as possible.

As anesthesiologists, handwashing is a critical part of our daily work. Whether it’s a complex surgery or a simple office visit, we always wash our hands before and after having direct contact with a patient. We also wash our hands after having any contact with blood, other body fluids, or medical equipment/objects in close proximity to our patients. We wash our hands after removing our gloves and, just like everyone else, after using the restroom or before eating.

For routine examinations and office visits, we follow the healthcare provider handwashing recommendations issued by the CDC, which are probably similar to the hand-washing you’re familiar with:

  1. Wet hands with water.
  2. Apply the amount of soap recommended by the manufacturer.
  3. Rub your hands together vigorously for at least 15 seconds, covering all surfaces of the hands and fingers.
  4. Rinse your hands with water and dry with disposable towels. Use the towel to turn off the faucet.

Surgery, however, is another story. Because surgery sites are prone to infection, there is a thorough surgical handwashing procedure that every doctor, nurse or technician in the surgery suite follows:

  1. Remove rings, watches, and bracelets—your fingers and wrists should be free of any jewelry.
  2. Wet hands.
  3. Apply antimicrobial soap.
  4. Choose one hand/arm to start on. Using a clean scrub brush, scrub each side of each finger, between the finger, and the back and front of the hand for two minutes.
  5. Next, move up the arm, keeping the hand upright so that water from the arm does not flow down to contaminate the clean hand.
  6. Wash each side of the arm, all the way up to three inches above the elbow, for one minute.
  7. Repeat on the other hand and arm. If the hand touches anything except the brush at any time, the scrub must be lengthened by one minute for every area that has been contaminated.
  8. Rinse hands and arms by passing them through the water in one direction only, from fingertips to elbow. Do not move the arm back and forth through the water.
  9. Proceed to the operating room suite holding hands above elbows.
  10. Once in the operating room suite, hands and arms should be dried using a sterile towel and aseptic technique before you don your gown and sterile gloves.

If that sounds a little overwhelming, don’t worry; the guidelines for handwashing for the general public are much less intensive—but just as important! Handwashing is one of the best methods people have to avoid getting sick or getting other people sick. In fact, handwashing can prevent 30% of diarrhea-related sicknesses and about 20% of respiratory infections.

When you wash your hands, follow these steps from the CDC:

  1. Wet hands with clean, running water, and then turn off the tap.
  2. Add soap to your hands and rub together, being sure not to overlook the backs of your hands, between your fingers and under your nails.
  3. Scrub your hands for at least 20 seconds—about as much time as it takes to sing the “Happy Birthday” song twice from beginning to end.
  4. Rinse your hands well under running water.
  5. Dry your hands with a clean towel or air dry them.

In terms of when to wash your hands, the CDC recommends washing them before, after, and during food preparation, before eating and before and after caring for someone who is sick or wounded (including yourself). It’s also important to wash your hands after using the bathroom, changing diapers, touching animals, handling animal food or waste or dealing with garbage.

One of the illnesses handwashing helps prevent is influenza (or the flu), a common virus that affected more than 48.8 million people in the 2017-2018 season. With symptoms that include fever, chills, body or muscle aches, headaches and fatigue, the flu is incredibly unpleasant—but for people with compromised immune systems, babies, and older adults, it can be deadly. That’s why it’s important to get a flu vaccination every year (in addition to washing your hands regularly).

While the effectiveness of the vaccine varies year to year, studies show that getting vaccinated can reduce the risk of getting the flu by 40% to 60%. For children, pregnant women, older adults and people with chronic conditions, the flu vaccine is especially important in staying healthy.

All of us here at Allied get vaccinated every year—and you should too.