Tuesday, February 27, 2007

Did You Know? Mindful Trivia

I see that Fox TV has a new way of dumbing down America with its new quiz show "Are You Smarter Than a 5th Grader". Hopefully, anyone who is smarter than a 5th grader will not be tuning in. Speaking of dumbing down, it is rather frightening that only 24% of Americans can name two Supreme Court Justices but 77% can name two of the seven dwarfs. (Time, 2006)

Here are some more trivia facts that you can use to dazzle your friends or make small talk at that next party. Most of these facts are even EverythingHealth.

32% - Percentage reduction in heart attack risk in men who take one aspirin a day. (Jama, 2006)

17% - Percentage reduction in stroke risk in women who take one aspirin a day. (Jama, 2006)

34% - Percentage of patients who request drugs that they read about on the Internet. (BusinessWeek, 2006)

20% - Percentage of American adults who smoke. (BusinessWeek, 2006)

90% - Estimated percentage of DVDs sold in China that are illegal copies. (BusinessWeek, 2006)

9.9% - Percentage of teens 12 to 17 who abused drugs during a one-month period in 2005 (Health & Human Services)

11.6% - Percentage of teens abusing drugs during one month in 2002 (HHS)

$1.9 Trillion - Amount Americans spent on health care in 2004 (National Coalition on Health Care, 2006)

1 for 390 - number of physicians for every person in the United States. (World Health Report, 2006)

1 for 33,000 - number of physicians for every person in Mozambique. (World Health Report, 2006)

5,000 - Number of species of mushrooms.

100 - Number of mushroom species that are poisonous to humans.

Isn't it amazing how much trivia there is in the world and how interesting it can be?

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Wednesday, February 21, 2007

Stroke - What You Need to Know

While talking with some girlfriends about, what else...Health...I made the comment that the one condition I most feared for myself was a stroke. Just the idea of having a stroke and the disability that goes with it is something I think about often. My friends said, "You should write about it on your blog because there is a lot of confusion about what a stroke is". Always aiming to please, here is what you need to know about strokes (aka cerebral vascular accidents, aka "brain attack")

Stroke is the third leading cause of death in the US and it is the leading cause of severe, long-term disability. Despite this, the public awareness of stroke symptoms and the need for immediate treatment evaluation is poor. Strokes occur two ways. The most common is an embolic stroke where one of the arteries leading to the brain is blocked by a small piece of plaque that has broken off. A second type of stroke is a hemorrhagic stroke where the vessel leading to the brain bleeds.
The five most common warning signs of stroke are:

(a) sudden numbness or weakness of the face, arm or leg, especially on one side of the body;
(b) sudden confusion, trouble speaking, or understanding speech;
(c) sudden difficulty seeing in one or both eyes;
(d) sudden difficulty walking, dizziness, or loss of balance or coordination;
(e) sudden severe headache with no known cause.

Notice the word "sudden". Strokes occur suddenly. That headache that you get every monday morning is not a warning sign of a stroke, nor is that numbness in your fingers when you wake up or the twitch in your eye.

When I started medical training there wasn't much you could do for a patient who was having a stroke. We admitted them to the hospital and did frequent neuro checks but if a stroke was going to happen, it just happened. Times have changed. We now have intravenous thrombolytic therapy called tPA (tissue plasminogen activator) that can reduce the resulting disability, yet few patients arrive in time to be eligible for tPA. The window for treatment is just 3 hours from the first sign until drug infusion so early recognition and getting to a hospital fast is critical. A number of hospitals are becoming Stroke Centers of Excellence, which means they have special protocols in place for rapid evaluation and treatment.

Now that you know the warning signs of a stroke, what can you do to prevent it from occurring at all? The risk factors for ischemic (not enough blood getting through the vessel) vascular strokes are the same as the risk factors for heart attack. That is why some neurologists are using the term "Brain attack", so people will make the connection. The risk factors are:

1. Hypertension (even slightly elevated blood pressure increases risk)
2. Diabetes
3. High Cholesterol (hyperlipidemia)
4. Obesity
5. Smoking

Every single one of these risk factors is treatable and within our control. Virtually all stroke victims have hypertension.

Since I have a morbid fear of a stroke, I am going to re-commit to eating 5-6 fruits and vegetables a day. If any of you want to join me with this intent, email me and I will check back with you in a week to see how you are doing.

For more information about stroke click here, American Stroke Association

Saturday, February 17, 2007

What Are the Medical Journals Saying?

This weeks brief synopsis from the medical journals

Poverty and Heart Disease

It has been said that the best diagnostic predictor of a persons health status is their income. Unfortunately this concept was upheld by The Center for Disease Control (CDC). They found up to a 2 fold difference in heart disease (the #1 killer in America) between States. The highest incidence of heart disease was found where States clustered the lower Mississippi and Ohio River Valleys where there is more poverty and social isolation. If you live in West Virginia, you are twice as likely to have a heart attack than a resident of Colorado.
MMWR Weekly

Treat Lice With a Hair Dryer

Applying hot air for 30 minutes can eliminate head lice infestation. Investigators tested 6 different methods for delivering hot hair to the scalp in 169 persons with head lice (pediculosis). The most successful was the LouseBuster, a custom-built machine that delivered air that was slightly cooler than that of a standard blow dryer. Hot air for 30 minutes killed nearly all lice eggs and 80% of lice. All patients treated were louse free one week later and no adverse effects of treatment were observed.

Still No Fountain of Youth

Although it had been speculated that supplemental dehydroepiandrosterone (DHEA) and testosterone may hold the key to a fountain of youth, a study has largely debunked this idea. In a 2 year, placebo-controlled, randomized double blind study in elderly men and women, (the very best form of scientific study) researchers found that physical performance, body composition, bone mineral density, glucose tolerance and quality of life were not improved with DHEA or testosterone supplements. Since humans have been searching for the fountain of youth for centuries, it is unlikely this study will impact the huge anti-aging industry, but the readers of EverythingHealth will be informed.
The New England Journal of Medicine

Calcium and Health

The most recent published medical literature reiterates the health benefits of eating 1200 mg a day of calcium. Average calcium consumption is far below the amount recommended for optimal bone health. Dietary sources are the preferred means of obtaining adequate calcium. Here are some food sources for Calcium:

Almonds, dry roasted - 1/4 cup.... 100mg
Beans, refried, canned- 1 cup.... 190mg
Broccoli, fresh,cooked - 1 cup.... 180mg
Cheese, American - 1 oz.... 175mg
Cheese, Cheddar - 1 oz.... 200mg
Figs, dried - 10figs.... 270mg
Fruit juice w/calcium - 1 cup.... 225-300mg
Ice Cream - 1/2 cup.... 285mg
Milk, whole/skim - 1 cup.... 300mg
Sardines in oil - 3oz.... 370mg
Soybeans, cooked - 1 cup.... 175mg
Turnip greens - 1 cup.... 200mg
Yogurt,low fat - l cup.... 340-450mg

North American Menopause Society

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Monday, February 12, 2007

Many Questions - Limited Time

I received a call yesterday from a friend who wondered if I knew of any physicians who are offering "concierge" medical services. This is the new trend where a physician limits his/her practice to a few hundred patients and charges a membership fee ($1000 to $5000 per year)to those patients. The fee is in exchange for perks like same day visits, prompt return phone calls and more time with the physician at each visit. It doesn't cover the costs of the office visits or tests, but is a retainer for better service. Reports show that patients in these relationships are satisfied and the physicians enjoy having the "financially protected" time to spend with the patient.

A recent study reported in Health Services Research and referenced in The New York Times, studied videotapes of almost 400 primary care visits. They found the median time for visits was just under 16 minutes and patients tended to bring up 6 subjects. About five minutes was devoted to one major topic, with the other issues receiving as little as one minute. When a patient presented a complex problem, the doctor had two basic choices: limit the time or make another patient wait while he extends the visit. If the doctor extends the visit of several patients a day, he will soon be so far behind that every patient will feel rushed and no one will feel well cared for. This treadmill pace is not good for the patient or the physician and is one reason so few young doctors are choosing the primary care field as a practice choice.

Is concierge medicine the answer? For my friend, who says "I've had three doctors and it just isn't working for me anymore" it probably will solve his problem. He can afford the fee and will enjoy the relaxed pace of his new doctor's office.
But this model is the solution for only a few patients and a few doctors and will only make the primary care doctor shortage worse.

Unrushed quality time is something Physicians want to give and something patients want. With our current insurance and Medicare reimbursement structure, the solution seems a long way off.

Friday, February 9, 2007

Global Warming

I'm not tired of hearing about Global Warming and other threats to Mother Earth and I am glad it is finally getting mainstream attention. If you haven't seen Al Gores's Oscar nominated, amazing film "An Inconvenient Truth", rent it today. We are blessed to live in a Country where we can educate ourselves and it is up to each of us to be informed and accountable in our own way. Check out this website for ongoing information about our environment, Franklygreen and learn more about protecting the land and what you can do, as an individual to help. I photographed this beautiful iceberg in Alaska. There is nothing more "everythinghealth" than protecting our earth, air and natural resources.

Thursday, February 8, 2007

What Are the Medical Journals Saying?

Medical Update - This Weeks Brief Synopsis From the Medical Journals:


Watch out for a slew of new marketing to appear on TV and in magazines this summer, advertising GlaxoSmithKline's weight loss product Xenical as it hits the shelf for over-the-counter use in the U.S. This drug, at twice the strength, was previously by prescription only. It will now be called alli (pronounced al-eye). Taken at meal time, alli works by blocking about 25% of the fat in the food a person eats. Unfortunately, it only works in conjunction with a reduced-calorie, low-fat diet containing about 15 grams of fat per meal. If more fat is eaten, the nasty side effect can be an urgent need to use the bathroom with diarrhea and fatty bowel movements. It is also important to take a multivitamin once a day at bedtime because alli can reduce the absorption of some vitamins. I wouldn't be surprised if it appears to be a miracle fat blocker. The real weight loss comes from the low fat,reduced calorie part of the deal but it is safe and may act as a type of "biofeedback" if the user is eating too much fat.

Religion and Doctors Decisions

A U.S. study finds religion and conscience often affect decisions physicians make in telling patients about morally controversial medical treatment. The study suggests many physicians feel no obligation to inform their patients of such treatments or even to refer them to doctors who do not object to such procedures. The medical profession appears to be divided in its attitude about terminal sedation, abortion, birth control for teens and other procedures. The study found although 86% of doctors surveyed felt obliged to present all options in such cases, only 71% said they would feel obligated to refer the patient to a doctor who did not object to the requested procedure. Sixty three percent of physicians believed it is ethically permissible for a doctor to describe his or her objection to the patient.
New England Journal of Medicine


Breast feeding has long term benefits for visual development in babies. The British team studied 78 previously breast-fed and 184 previously formula fed children ages 4-6 years who were followed prospectively from birth. Based on random dot E tests, the breast-fed children had greater visual acuity than did the formula-fed kids. Even adding DHA (certain omega 3 fatty acids) to the formula did not alter the benefits of breast feeding. The mechanisms involved are unknown.
Am Journal Clinical Nutrition

Sunday, February 4, 2007

Medication Errors

This Century is beginning with a new focus on patient safety within the medical community. One of the aspects that is receiving a lot of attention is "prescribing errors". While medications are lifesaving for millions of individuals, taking certain combinations of drugs can be a recipe for disaster. Over half of all older patients take 3 drugs a day and millions of patients take 8-10 drugs daily. Add that there may be several doctors prescribing pills for various conditions and it is no surprise there can be mistakes. Recent studies have shown that physicians need to pay close attention to potentially dangerous drug combinations when writing prescriptions and also provide patients with necessary information about the drugs. The 5 elements that you need to know whenever you receive a new prescription are:
  • medication name
  • purpose of the medication
  • how to take it and what to do if you miss a dose
  • how long it should be taken (duration)
  • possible side effects

The one that gets left off most often is duration and many people with chronic conditions may not realize that they need to take their medications indefinitely. Before I made it a habit to cover every one of these elements, I often had patients return for a visit and they had stopped their medication because "It ran out and I thought I was finished". That was my fault, not theirs.

Excellent and safe health care needs to be a partnership between a physician and a patient. The Physician has the expertise about medications and it is his/her job to educate and explain why a drug is being prescribed. It is the patient's job to know the medications they are taking. Until we get an electronic medical record that provides real time information for all prescribing doctors and hospitals, it is critical that a patient carry the names and doses of their medications on a card in their wallet. If the Orthopedic doctor prescribes a new pain pill....pull out that list and show her your medication list. Ask the question "Are there any interactions with these meds that are a problem?"

Don't be shy about asking questions. Your health safety is worth it.

When to Use Urgent Care

We all know that Emergency Departments are over-crowded with long waits and exorbitant fees.  Free standing Urgent Care is a great solu...