Pistachio Power

Pistachio Power!

A new study highlighted in the Tufts University Health and Nutrition Letter suggests that eating tree nuts such as Pistachios may help fight Type II  Diabetes.  Tree nuts include walnuts, hazelnuts,almonds,brazil nuts,cashews, pecans, pine nuts,macadamia nuts  and of course pistachios.

How Tree Nuts Help?

Tree nuts according to the report help the body better control blood sugar and help to reduce inflammation  Prediabetic patients in a study done in Spain ate two ounces or 57 grams of Pistachios daily.  After 4 months this group had significant reductions in blood sugar and insulin levels and showed a reduction of inflammation in their bodies.   It was pointed out that Pistachios are a concentrated energy source so you would need to eat them instead of something else you might eat to keep your calorie consumption under control.

A Powerful Pistachio Punch!

Two Ounces of Pistachios contain:

  • 321 Calories
  • 11.9 grams of protein
  • 5.6 grams of fiber
  • 16.7 grams of carbohydrates
  • 571 milligrams of potassium
  • 21 grams of unsaturated fat
  • 3 grams of saturated fat
  • no cholesterol

In conclusion studies showed adding more tree nuts into your diet may help to lower your levels of fasting glucose and your HbAic over time. A possible explanation offered is that tree nuts are high in healthy fats and fiber are low in carbohydrates and by substituting this for foods you should not be consuming you lower the glycemic load on your body.

Invokana Has Reported Serious Side Effects

Invokana linked to serious side effects - Legal Examiner

 

 

 

Invokana is linked to serious side effects. Medical experts state Invokana medication is linked to severe and life-threatening side effects including kidney failure, leg amputations, heart attacks and diabetic ketoacidosis., a build up of acid in the body known as diabetic ketoacidosis

Invokana  was the first member of a new generation diabetes drug to hit the market, known as sodium glucose cotransporter 2 (SGLT-2) inhibitors.  Others in this class of drugs include Farxiga, Jardiance, and Invokamet

Increased Risk of Diabetic Ketoacidosis

SGLT-2 inhibitors alter normal kidney functions to increase the amount of sugar excreted in the urine.

As a result of this, the body loses the carbohydrates that it needs to function, and the kidneys become stressed and damaged by sugar molecules.

Because of a reduced amount of circulating sugar, the body goes into “starvation” mode where it begins to break down muscle tissue and stored fat to generate ketones as fuel. This condition is called “diabetic ketoacidosis” and can be deadly if left untreated.

In June 2016, the U.S. Food and Drug Administration (FDA) required the drug makers to add a new Invokana safety warning, highlighting that the diabetic medication may increase the risk of acute kidney injury and kidney failure.

The FDA has also required new Invokana warnings about a risk of diabetic ketoacidosis, a serious medical condition associated with elevated levels of acid in the blood.

Increased Risk of Amputations

Based on new data from two large clinical trials, the FDA in May 2017 concluded that the type 2 diabetes medicine canagliflozin (Invokana, Invokamet, Invokamet XR) causes an increased risk of leg and foot amputations.

Final results from two clinical trials – the CANVAS (Canagliflozin Cardiovascular Assessment Study) and CANVAS-R (A Study of the Effects of Canagliflozin on Renal Endpoints in Adult Participants With Type 2 Diabetes Mellitus) – showed that leg and foot amputations occurred about twice as often in patients treated with canagliflozin compared to patients treated with placebo, which is an inactive treatment.

As a result one has to question the use of these type of drugs and maybe consider the difficult choice for some to control their diabetes by diet and exercise if it is an option.  At minimum one should question their doctor about diabetes medications prescribed and do your own research,  Your Dr. should closely monitor your health when taking this or other similar medications.  If your Doctor knows less than you do about Diabetes you might want to find another who at minmum is willing to let you take an active role in your own care.

My opinion is that the American Diabetes Association is too chummy with the diabetes drug industry and their  guidelines are not stringent enough to protect your health and your doctor may lack the necessaary education or is just overwhelmed with patients.

 Sitting in a Dr’s Office where my Dad goes you are exposed to one long diabetes commercial interspersed with drug ads .  It tells me that the diabetes epidemic is real and YOU have to be responsible for your own health!  A recent article I posted pointed out the huge number of drugmakers at the ADA conference and the huge money being made by drug companies selling diabetic drugs. Read this post also on this blog, http://suddenlydiabetic.com/diabetes-drugs-cost-soar/

You can bet that your Dr is getting hit up by attractive drug representatives pushing these various companies drugs with incentives to prescribe them.

Knowledge is Power so visit here often for the latest news!

 

Diabetes Drugs Cost Soar

The cost for drugs for diabetes has doubled since 2009 in the United States. That is great for drug companies, but also reflects the increasing numbers of people requiring prescription medications to manage their diabetes.

The pharma exhibits at the American Diabetes Association conference here last month stretched across the San Diego Convention Center floor like a mile of drugs.

Displays for Tresiba, Invokana and Victoza, to name just a few, conveyed the largesse of an industry that is skyrocketing by all measures: dollar cost per unit, the number of people purchasing them and the number of prescriptions sold.

With $51.5 billion in U.S. sales in 2016 alone, diabetes drugs had the highest amount of revenue in the nation, above drugs to treat cancer and autoimmune disease, according to QuintilesIMS, which analyzes information from drug companies and suppliers.

Some 29 million people with diabetes across the country take drugs to control glucose. Costs among the 136 brand name drugs soared* from $15.9 billion in sales in 2009 to $32.2 billion in 2014.

Among the 136 top brands analyzed, the drug with the largest revenue increase in 2014 is a pen that delivers doses of insulin by injection, sold as Lantus Solostar. Wholesale sales were up 525 percent from $714.8 million in 2009 to $4.46 billion in 2014.

According to the American Diabetes Association, insulin drug prices overall rose three-fold between 2002 and 2013.

“Insulin prices have skyrocketed,” said Pat VandenHeuvel of San Diego, whose 22-year-old son, William, needs those drugs for his Type 1 diabetes, a genetic form of the disease. For example, their insurance plan now charges $410 as a co-pay for a 20-day supply of one brand of insulin pens, up from about $350 a year ago.

Januvia, another top selling diabetes drug called a DPP-inhibitor, which is taken by oral tablets, increased from $1.53 billion in 2009 to $3.46 billion in 2014, or 126 percent.

Another Lantus insulin pen product was the third largest selling diabetes drug, with $1.9 billion in 2009 sales, growing to $3.4 billion in 2014, a 78 percent increase.

Medicare, which pays for care for some 55 million people, most of them 65 or older, is especially concerned about the cost of treating diabetes and its complications.

Medicare spent $42 billion more in 2016 for services for Medicare beneficiaries with diabetes than for those that did not have diabetes. That included $5 billion for pharmaceuticals to treat diabetes. Per beneficiary, that is $1,500 more on Part D prescription drugs, $3,100 more for hospital and other services, and $2,700 more on physician and other clinical services the agency said.

It is not just the cost of drugs that has been increasing, but also the number of prescriptions. Between 2012 and 2016, the number of prescriptions for diabetes drugs rose from 186 million to 224 million in the U.S., a 20 percent increase. (That 2016 number may actually be higher, because an increasing number of prescriptions are being filled for a 90 day-supply instead of for 30 days.)

According to Quintiles, the “largest drivers” of growth in prescription sales were the increasing number of seniors who are more likely to have health problems requiring drug treatment.

These massive increases are a major reason Medicare officials want to prevent people from getting diabetes in the first place. Starting Jan. 1, it plans to roll out a program, described in an inewsource story June 29, that pays qualifying organizations up to $450 if participants stick to attendance in a year-long lifestyle program with 22 classes and lose 9 percent of their body weight within the year, and $425 if they lose 5 percent.

*The amount does not include reductions in prices due to coupons, discounts, rebates or promotions.

 

 

George Bush hated this but your A1C won’t!

George H.W. Bush famously noted his dislike for Broccoli in 1990.

 

 

Broccoli contains an ingredient that can help those with type 2 diabetes control their blood sugar level, according to a new study – potentially providing a much-needed treatment option for millions.

A chemical in cruciferous vegetables like broccoli and brussel sprouts called sulforaphane is thought to be responsible, having been shown to lower glucose levels in earlier lab experiments on diabetic rats.

To identify suitable compounds to examine, researchers used computer models to identify gene expression changes linked with type 2 diabetes, and then sifted through thousands of chemicals that might reverse these changes.

“We’re very excited about the effects we’ve seen and are eager to bring the extract to patients,” one of the researchers, Anders Rosengren of the University of Gothenburg in Sweden, told Andy Coghlan at New Scientist.

“We saw a reduction of glucose of about 10 per cent, which is sufficient to reduce complications in the eyes, kidneys and blood.”

That 10 percent average reduction was across a sample of 97 human volunteers taking part in a 12-week randomised, placebo-controlled trial. The participants who were obese and who had higher baseline glucose levels to begin with benefitted the most.

The dose was the equivalent of around 5 kilograms (11 pounds) of broccoli daily – a fair few platefuls – but the researchers say it could be adapted into a powder to add to food or drinks.

It’s important to note that all but three of those taking part in the trial continued to take metformin, a drug already used to improve blood sugar regulation in people with diabetes.

However, the researchers think sulforaphane could eventually replace metformin for some patients – up to 15 percent of those with diabetes can’t take metformin because of the associated risks of kidney damage.

With more than 29 million people having type 2 diabetes in the US alone, and that number on the rise, any kind of help is going to be very welcome.

Before the human trial, the researchers also found sulforaphane was able to reduce glucose production in liver cells grown in a lab, and shift liver gene expression away from an abnormal, diseased state in diabetic rats.

Larger and more detailed studies are required before the drug can get approved for regular treatments though, and until then it’s probably wise to keep your vegetable intake to a normal, healthy level.

“More research is needed to see if this repurposed drug can be used to treat Type 2 diabetes, as it was only tested in a small number of people and only helped a subset of those who are taking it,” Elizabeth Robertson from Diabetes UK, who wasn’t involved in the research, told New Scientist.

“For now, we recommend that people continue with the treatment prescribed by their healthcare team.”

Reduce your weight, Change your fate!

Prediabetes can progress to Type II Diabetes but it is not a given particularly if you can lose a small amount of weight. A Harvard Medical Assistant Professor, Rhonda Bentley-Lewis recently said, “. “I stress to my patients that we’re not talking about a huge amount of weight,” she said, “just 5 to 7 percent of one’s body weight” — or 10 to 14 pounds for someone who weighs 200 pounds.

Doctors often treat prediabetes with medication. Many patients choose to try weight loss and exercise first. Among thousands of people with prediabetes who participated in a national study called the Diabetes Prevention Program, those who received counseling about lifestyle changes, like losing a modest amount of weight, stepping up physical activity and reducing the amount of fat and calories in their diets, were able to reduce their risk of developing diabetes by 58 percent.

woman exercising photo
Photo by kennethkonica

My advice:
1) Eliminate sugar. If you must use something use Stevia.
2) Increase water intake.
3) Increase your physical activity
4) Reduce your portion sizes or limit yourself to one bowl, plate, No refills.
5) Reduce the size of your plate.
6) Monitor your blood sugar levels, 2 hours after each meal. Make adjustments to keep your blood sugar at 100 or below.

Apple Watch Diabetic Tracker?

 It is rumored Apple is gearing up to release a special blood sugar tracker for the Apple Watch.

 CEO Tim Cook has been spotted wearing what appeared to be an Apple Watch-connected glucose tracker in the vicinity of the company campus, according to CNBC

Details are few with the exception that the new wearable module is directly connected to the Watch.

This technology could become a must-have for millions of people suffering from – or at risk of getting – diabetes.

Speaking at the University of Glasgow earlier in February, Cook said he had “been wearing a continuous glucose monitor for a few weeks” but stopped short of making any significant revelation about the gadget.

Cook said itwould also make it easier for people to responsibly monitor their blood sugar levels and avoid health complications.

“It’s mentally anguishing to stick yourself many times a day to check your blood sugar,” he commented. “There is lots of hope out there that if someone has constant knowledge of what they’re eating, they can instantly know what causes the response… and that they can adjust well before they become diabetic.”

DANGEROUS FOODS FOR DIABETIC PATIENTS || Health Tips

Hi Friends, Watch More Top Five Health Care Videos Click here: https://goo.gl/UnZvu8 Today I am Going To Show You , DANGEROUS FOODS FOR DIABETIC …

 

Yoga and Diabetes

File:Yoga (9704344717).jpg

Diabetes affects up to 5% of the world’s population. Diabetes type II is the most prevalent form of diabetes.
Yoga , which many people just associate with being flexible is actually defined as being in union or connection to where you are at at that moment. This includes accepting and working within the restrictions you may have in your physical body including your diabetes. If you have never practiced Yoga then you will be surprised that it is a complete exercise and the yoga postures can be adapted to your level of fitness.

Yoga won’t make your diabetes disappear but it can be helpful in controlling your diabetes. As in any exercise program it is best to get your Doctor’s OK. Yoga postures can aid you in improving your body function.
Daily Yoga practice including breathing techniques, meditation and poses enhances digestion and helps the liver and pancreas function better helping to better regulate your blood sugar levels. Cobra (Bhujang Asana) Locust (Shalabh Asana) Bow (Dhanur Asana) are few asanas that help diabetics.

Pranayama teaches you to use the other 90% of your lungs and to neutralize the stress that contributes to high blood sugars associated with diabetes. It creates a deep cleaning of the body tissues and helps treat high blood pressure , irritability and improves sleep. Pranayama breathing activates the parasympathetic nervous system. The Parasympathetic response calms you down and helps you to neutralize stress and anxiety.

Asanas like Sasangasana (Rabbit Pose) and Janushirasana with Pashimotthanasana (Head-to-Knee with Stretching Pose) provide stimulation and rejuvenation to the cells of the pancreas and other endocrine glands by way of compression. Compressing these glands and then relaxing increases the flow of oxygenated blood to your cells and rejuvenates them.

Here is an exercise for you to try:

Sit on a padded surface on the floor like a mat or a folded blanket. Extend your legs and then fold your legs so the soles of your feet face one another.. Now keeping your feet together raise both knees and then bring them back down to the ground. Repeat 40 times. This will reduce the stiffness in your knee and hip joints.

 

For more resources you migh want to check out this popular diabetic video yoga program.

Or if reading and looking at photos works better here is another alternative.

 

Are Diabetes Drugs The Answer?

If you are diabetic and fail to control your blood glucose levels, you will most likely end up with several debilitating health problems such as heart disease, stroke, kidney disease, nerve damage, diabetic neuropathy, digestive problems, blindness, or a variety of infections.

 

Many of these conditions could kill you.

So taking diabetic drugs to manage your  Type II diabetes might seem like the right thing to do.

Well maybe not… for several good reasons.

Survival rates using diabetes medications are not so promising.

According to a research paper Benefits of Diabetes Drugs Dubious, published in the Milwaukee Journal Sentinel in December 2014, no doctor-prescribed diabetes drug has been shown to save the life of a diabetic. They didn’t prevent heart attacks, strokes, kidney disease, nerve damage, blindness or other diabetes complications such as the need for amputations.

High blood sugar levels are not the same as diabetes. They are only signs or symptoms of diabetes but they are not the disease itself. The problem is: diabetes drugs target blood sugar levels only… they do not treat diabetes. But very few people die of high blood sugar in their blood.

However they do die of the damage caused by diabetes: heart disease, strokes, kidney disease and raging infections… and diabetes drugs do nothing for them.

A peer-reviewed meta-study; Comparison of Clinical Outcomes and Adverse Events Associated with Glucose-lowering Drugs in Patients with Type 2 Diabetes, published in the Journal of the American Medical Association in 2016, showed that there was no increase in survival rates among type 2 diabetics who took diabetes medications.

The study examined nine classes of diabetes drugs, including insulin, comparing the drugs to a placebo. The researchers reviewed more than 300 randomized clinical trials covering nearly 120,000 patients before reaching their conclusions.

Dangers of Diabetes Drugs

Drugs for diabetes are have serious side effects.

These include cardiovascular reactions, flu-like symptoms and dizziness. They have been linked to muscle and stomach pain, diarrhea and anemia. In addition, if diabetics are not careful, these drugs can cause dangerously low blood glucose levels.

The bad thing is that many patients take two or even three of these drugs at the same time, all prescribed by their doctor .

But, instead of reducing deaths, this multi-drug regime increases your chances of dying.

A research paper Effects of Intensive Glucose Lowering in Type 2 Diabetes, published in the New England Journal of Medicine in 2008, concluded that intense efforts to lower blood glucose with drugs resulted in a 22% higher rate of death from all causes. The same study showed that deaths from heart disease increased by a whopping 35%.

So what should you do?

Can you Reverse Your Diabetes Without Diabetic Drugs?

The fact is that some  people believe there is no need, unless your diabetes is far advanced, to use these drugs at all. They believe can reverse your diabetes using diet alone, perhaps with a little extra exercise thrown in.

There is no cure for diabetes, IE once you have it well you have it. But when I say you can reverse your diabetes, What I mean is you can beat the awful consequences the disease brings such as the cardiovascular problems, strokes, kidney disease and so on.

The beating-diabetes diet is simple. It requires a small amount of discipline.

You can reverse type 2 diabetes by eating foods that are :

(1) low in sugar
(2) low in fat
(3) low in salt,
(4) high in fiber and that
(5) are digested slowly.

The easiest way to do this is by concentrating on natural, unprocessed foods that are mostly plants. You also need to avoid all dairy products and eggs, and to drink plenty of water.

The fundamental cause of type 2 diabetes is fat blocking the receptors in your muscle cells, leaving glucose (produced by the digestive process) and insulin (produced by the pancreas) swirling around in your bloodstream. This condition is called insulin resistance.

The diet works because it minimizes your intake of fat so that, after a month or so, the fat blocking the receptors in your muscle cells will have disappeared.  This fat is normally in your midsection.

Unblocking the receptors ensures that the insulin can do its job of opening those receptors to get the glucose out of your bloodstream and into cells, thus ‘reversing’ your diabetes.

As well you should also take up some mild exercise, such as walking, gardening, swimming, dancing , etc. This will help stimulate your muscle cells to use the energy (glucose) floating around in your blood stream.

Also, you can give the reversing-diabetes diet a boost in several ways using various supplements:

Vitamin D

Low levels of vitamin D3 New Price: (as of 10/19/2017 14:14 America/New_York) have been linked to both pre-diabetes and full-blown diabetes. A lot of people have a vitamin D deficiency.

A research paper entitled Lipoprotein lipase links vitamin D, insulin resistance, and type 2 diabetes: a cross-sectional epidemiological study, undertaken by Chinese researchers and published in January 2013 in Cardiovascular Diabetology, showed that even a minor defecit in vitamin D3 can increase the risk of diabetes by more than 90%.

So how do you increase your intake of vitamin D3?

You can get sufficient vitamin D3 by getting outside for just 10 minutes or so a day in the midday sun… with a lot of skin showing which might be a little rough in the winter but thank god there are supplements

You could also get plenty of vitamin D by eating oily fish (tuna, sardines, mackerel and salmon), free-range eggs, grass-fed beef, liver and dairy products. But these foods contain copious amounts of fats which you need to minimize if you are to reverse your diabetes.

For diabetics, therefore, the best way to get sufficient vitamin D3 New Price: (as of 10/19/2017 14:14 America/New_York) is to take a supplement. The recommended dosage is 8,000 IU’s (international units) a day.

Guava

The leaves, stems and flesh (but not the skins) of the tropical guava fruit block the digestion of carbohydrates which reduces spikes in blood glucose. Consuming pealed guava also makes the development of insulin resistance less likely and helps improve the blood sugar levels of diabetics.

If fresh guava is available in your locality you should eat it daily. If not, you can get guava tea Guava Leaf Tea 120 Individually Wrapped Teabags New Price: $59.99 Old Price: $59.99You Save: $40.78 (as of 10/19/2017 14:14 America/New_York) made from dried leaves at your local health food store or online. A cup a day (or more) is highly recommended.

Vanadium

Vanadium Source Naturals Vanadium with Chromium, 180 Tablets New Price: $13.43 Old Price: $11.43 (as of 10/19/2017 14:14 America/New_York) is a trace mineral that acts like insulin.

Vanadium reduces spikes in blood glucose and insulin levels by helping to move blood glucose into muscle cells and by inhibiting the absorption of glucose from the gut.

In a study described in Rare Earths: Forbidden Cures, Rare Earths: Forbidden Cures New Price: $18.10 Old Price: $21.95You Save: $3.85 (as of 10/19/2017 14:14 America/New_York) a book published in 1994, diabetics took daily supplements of vanadium… their average blood glucose levels dropped by 10% in only three weeks.

You can use vanadium by taking it as a supplement… 500 mcg three times a day… but:

Caution:Do not exceed 10 mg a day.

Berberine

Berberine New Price: (as of 10/19/2017 14:14 America/New_York) is a plant nutrient found in the roots, rhizomes, stems and bark of medicinal herbs such as barberry, tree turmeric, Oregon grape, goldenseal, yellowroot, Chinese goldthread, prickly poppy, and Californian poppy.

In the 1980s, Chinese doctors discovered that berberine can normalize blood glucose levels. It does this by decreasing insulin resistance, by decreasing the production of sugar in the liver, and by increasing the ability to breakdown glucose inside cells.

To lower the levels of sugar in your blood, you should take a supplement… one 500 mg capsule with meals two or three times a day.

Caution: I am not a medical doctor and my strong advice is that you consult your doctor before you stop taking your prescribed diabetes medications.

I do believe though that you are your best advocate and doing your own research and trying to stay off diabetes medications by improving your diet and by exercise is worth a shot. In my case my doctor agreed with this approach and I have thus far avoided taking diabetic medications to control my insulin levels

This article is based on an article by Paul D Kennedy

Paul D Kennedy is a type 2 diabetic. He used his skills as an international consultant and researcher to find a way to control his diabetes using diet alone and, about seven years ago, he stopped taking medications to control his blood glucose levels.   His book, Beating Diabetes, How to Defeat type II Diabetes is available  from Amazon.

 

Telemedicine Could Be The Answer for Proper Diabetic Care

If you have diabetes or believe you are prediabetic and financial resources avoid you from looking for a Dr’s care and suggestions a brand-new pattern in telemedicine may be the answer for you.

 By phone or on your computer system you now can have live contact with a doctor to discuss your medical scenario and in many cases the Dr. can even recommend required medication without an office visit at a lower expense for you.

Over the last 10 years, out-of-pocket healthcare expenses for Americans have more than doubled, with medical costs now representing 8 percent of yearly family costs, according to the Consumer Expenditure Figures.

Simply think about a few of the heart-wrenching numbers. Almost one in 4 non-elderly American adults had past-due medical financial obligation in 2015. That’s really an enhancement from 2012, when the figure was closer to 30% (insurance protection gains under the Affordable Care Act are one most likely factor for the decrease). In Mississippi, more than 37% of the population owed loan to care companies in 2015. Medical costs are the leading cause of individual bankruptcies. And in 2015 the federal government predicted that the country’s healthcare expense would top $10,000 per individual for the very first time in history.

So exactly what do we get for these huge personal and public expenses? A system where it takes weeks to see a physician in person, where more than 6,500 places are formally considered to have too few doctor to fulfill clients’ requirements, and where U.S. health results are regularly average compared to those of a lot of our developed-nation peers (as well as a few of the less industrialized ones).

This status quo is ripe for disturbance. And while real reform will need everyone– federal government, market, and healthcare customers themselves– to make significant changes, an insurgent group of digital health business is doing its finest to drag American medication into the 21st century kicking and shouting.

That implies superseding physical restrictions like having a real health center by utilizing the power of mobile innovation, making the act of taking your medication less of an inconvenience, and peering into our really biological foundation to wage war on the most intractable conditions.

At the turn of the 20th century, getting an examination in America regularly indicated your physician equipped with a modest black bag of tools and old-fashioned medical knowledge, paying a home visit

As charming as that image might appear today, it’s in some methods a vision of the future. New innovations are restoring your home call– or a digital variation of it, anyhow.

One apparent benefit of telemedicine is that the physician can be anywhere– which is not the case for our standard healthcare system. At health centers throughout the nation, in truth, there is an established physician scarcity, which has actually grown just more severe as countless Americans have actually gotten health protection in the last few years.

 The growth of telemedicine is making regular and preventive care offered online and through mobile phones, with the expense of a video-based virtual see (generally less than $50) offerings cost savings when compared with expenses for comparable small medical requirements dealt with at a medical professional’s workplace (roughly $80), immediate care center (around $160) or emergency clinic (around $650).

Current advances in audio and video innovation are allowing individuals to get a medical diagnosis and essential prescriptions for small medical requirements consisting of allergic reactions, sinus and bladder infections, bronchitis and other conditions.

Telemedicine is now being used to diagnose diabetic retinopathy remotely and with computerized insulin pumps and remote medical monitoring becoming more of a reality it might not be long when you will be able to get better quality care at a lower cost than doing the standard office visit.