August 2015

Time For A Second Opinion? By Robin Miller, MD MHS

As in life, in medicine there are rarely black and white answers to questions and treatments for medical conditions. Many of us have experienced different doctors with different personalities who either fit with us or did not.  When situations arise and you need treatment or diagnostic evaluation, and you feel things are not going in the right direction; it might be time for a second opinion.

This is especially important for those diagnosed with cancer. There are now a variety of approaches for acute and maintenance therapies.  Some doctors may prefer radiation to chemotherapy and others may have other types of treatments in mind.  This is especially apparent for those with prostate cancer. Some doctors may recommend conventional surgery vs. robotic surgery vs. cryosurgery.  For therapy there may be ultrasound vs. radiation pellets vs. hormone therapy vs. a variety of experimental therapies.

As you can see, it is important to find the approach that fits with what you may want and what will work best for you.  It is your body and you need to make an informed decision. It may take a couple of opinions for you to figure it out.  Patients are often afraid they will offend their doctors. However, most doctors welcome a second opinion.  If you have one that does not, perhaps it is time to find another doctor.

Who should you see for that second opinion? I will usually encourage patients to go to a university medical center such as Oregon Health Sciences University or Stanford.  However, there are often specialists that are highly regarded in our own communities. Speaking to people with similar diagnoses and your own physician can help you to find them. As a physician, I welcome another pair of eyes looking at my patients and possibly seeing something I may have missed or finding a treatment I might not have thought of or realized that was available.

Providers are always talking about how important it is for patients to take responsibility for their own health as regards to diet and exercise. Part of being accountable for your own health includes being an informed patient.  Seeking a second opinion is very often essential in order to do just that.






Useful Tips For Weight Loss By Robin Miller, MD MHS

Nutritionists and scientists have long tried to unlock the secrets of overeating. But some of the best information is coming from an unexpected source: marketing experts! It turns out that even the most self-aware individuals are subject to mindless eating.

Most of the research comes from a marketing professor, Dr Brian Wansink, from Stanford University. He wrote a book called Mindless Eating: Why We Eat More Than We Think.

Interesting things to know

* Package size counts
In one study, two groups of people were given free, but stale (five-days old) popcorn while watching a movie. Half of the group got a medium-sized tub; the other got a large tub. The people with the larger tubs ate 53 percent more than those with the medium tubs. They ate the popcorn regardless of taste (five-day-old movie popcorn? YUK!) because it was there and they were distracted by the movie.

* People use visual clues to stop eating
In another study, Dr. Wansink rigged a soup bowl to continuously fill with tomato soup essentially making it bottomless. The eaters with the rigged soup bowls ate on average six ounces more soup than those with a regular bowl. This means that most people ignore how full they feel and eat until they clean their plates.

• Our eating is influenced by color
People will eat more M&M’s when they are multicolored than when they are all one color. People also eat more in a yellow or red room (think about the colors at McDonald’s), and eat less in a blue room.

• We are influenced by those who eat around us
People are more likely to eat faster (and larger amounts) if those around them are shoveling food into their mouths.

• Sound and distraction matters
Playing fast music while eating will cause you to eat more. And every parent knows that kids (and adults) eat more when in front of a TV.

Some tips to help you avoid overeating:

* Eat slowly (or pick a slow eater to sit next to at the next dinner party). It takes ten to 20 minutes for your brain to register that your gut is full.

* Use smaller bowls and plates. Since we all have a tendency to clean our plates and bowls, start small and use smaller utensils as well.

* Never eat directly from the box or bag (think cookies and chips). You can’t see how much you’re eating, which means you won’t remember how many calories you’re consuming.

* Beware of buffets. Use a small plate and only put two items on the plate at a time.

* Be aware of your surroundings. Always sit down to eat and try not to eat in front of the TV. When you choose restaurants, gravitate toward the quiet ones that are painted blue!

Mindless eating contributes to the gradual weight gain that many of us experience as we age. By being aware of some of the cues that trigger overeating, you can turn gradual weight gain into weight loss!

Natural Remedies: To Use Or Not To Use? By Robin H. Miller, MD MHS

As a practitioner of Integrative medicine, the majority of my patients prefer herbal remedies to modern medications. When my patients come to see me initially, I always ask them to bring their supplements. I do that so I can see which ones they are taking and which brands.   Most patients bring their supplements in huge shopping bags.  One of my colleagues had a patient who brought in a shoebox overflowing with bottles of vitamins and all kinds of things.  He told her that she was either going to have to eliminate some of the bottles or buy bigger shoes.

Needless to say, the majority of those who prefer herbal remedies are probably overdoing it on many levels.  It makes me very uncomfortable, because we do not have any way to tell if the supplements contain what they say they do and if they are free of contaminants.  This is especially true for those that come from China.

It is my experience that most patients take supplements to get more energy and to ease their aches and pains. The majority of those I see would prefer to take the supplements rather than get what they need from food.  I always try to emphasize that it is far better to get vitamins and herbs in their natural state such as food or tea, than it is from a pill. Pills do not often digest for starters, and they usually cost a lot. So, you might end up with expensive toilet water and sewage.

Finally, natural does not mean safe. It is possible to become toxic from supplementing too much of a vitamin such as those stored in the liver (Vitamins A, D, E and K).  Herbs can be dangerous as well and can interact with each other and modern medicines causing serious problems.  As an example, St. Johns Wort, commonly used to treat depression can decrease the effectiveness of birth control pills.

Fortunately for you, dear reader, I have an amazing resource on my website at If you go to the homepage, you will find three icons that you can click on from Natural Standard-Therapeutic Research Center.  This is an excellent organization that reviews herbs and supplements and gives them grades as to how well they work for different ailments. It also discusses interactions and dosages. I highly recommend checking it out before you try anything.

Review everything you are taking with your doctor.  Know that there are certain brands that are better than others. The ones I prefer are Integrative Therapeutics and Standard Process.  Take a hard look at which supplements you are taking and why.  Usually, once I get people eating a healthy diet and exercising, the need for their supplements goes way down and their wellness quotient goes way up.

Remember the wise words of Hippocrates: “Let food be thy medicine and medicine be thy food”



Don’t Worry Be Happy:) By Robin Miller, MD MHS

Women want to be happy, but this can be elusive. Focusing on health and wellness is important. In addition, I have observed several things that happy women have in common. Knowing what these are can help to make it obtainable.

Financial security

Most people think that if they had a ton of money they would be happy. Studies have found that the difference in happiness between those who make $5000 a year and $50,000 a year is huge. However there is no major difference in the level of happiness between those who make $50,000 a year and those who make $50 million dollars a year.

I have watched many women struggle over the last several years and those who have been able to use their creativity, ingenuity and imagination to find a way to improve their income have been the happiest and most successful. Having a sense of control over their destiny by finding a way out of their financial difficulties and designing their own jobs in some cases helped them to be happy.


Feeling connected is another common feature of happiness. It is interesting that when parents are asked what gives them the greatest joy in their lives they usually say it is their children. However, when you ask them about day-to-day issues, their kids actually cause them a fair amount of grief (especially during adolescence). It is that close relationship, that special bond with our children and significant others that is important with all of the ups and downs. Being able to see that connection (even on tough days) helps to promote happiness.


Having a sense of community is key. Women who have a group of friends and/or are involved with their community are generally happier than those who do not. Getting involved is easy even if you are not an extrovert. Volunteer at a food bank; join a house of worship or consider working for a political campaign group.

Give Back

When people give to others they are able to improve their health and wellbeing. They live longer too. When they are busy helping others they tend to forget their aches and pains AND it makes them happy. If you have not done it, try it in just small ways. Smile at a stranger, see where help is needed in your community, or donate money to your favorite charity. It is amazing what can happen.

Abolish Resentment and Anger

I heard a great quote from St. Augustine, “ Harboring anger and resentment is like taking poison and expecting the other person to die.” Anger can be productive in that it causes discomfort and helps us to change our circumstances. However when we hold on to it and it builds into resentment it only hurts us further. Happy people find a way to resolve situations when they find themselves getting upset and angry. If you find yourself holding on to anger it is time to get help. Exercise, learn to meditate, or consider seeing a therapist.

The Bottom Line

Happiness is something that we all want. We can have it by harnessing our creativity, nurturing relationships, and finding ways to give back to our community. To quote Aristotle, “ Happiness depends upon ourselves.”


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