Wednesday, March 30, 2011

Pine Nut Bitter Taste

After practicing medicine for 25 years, I didn't think there was much I hadn't seen or diagnosed.  Was I surprised to learn about a condition called Pine Mouth from a friend who experienced it!  Of course that sent me to the internet where I learned that there truly is a weird food syndrome known as Pine Mouth.  And from the google search, it seems everyone but me knows about it!  In case you don't, here is what I found:

For reasons that are not understood, some people experience a persistent bitter-metallic taste after eating pine nuts (aka: pignoli if you live in Italy).  This taste can last a few days or up to two weeks.  Nothing tastes good because the bitter taste permeates the mouth.  It isn't a "disease", nor does it cause any illness...just an annoying taste.

The medical term for this metallogeusia, "a perceived metallic or bitter taste" and it was reported on in the Journal of Medical Toxicology.  One theory is that some Chinese Red Pine imports are inedible and have made it into the market.  Pine Mouth seems to be a relatively new phenomenon so this theory makes sense.

There isn't much a consumer can do to prevent Pine Mouth.   All pine nuts look alike and there are no tell-tell signs.  The good news is that the condition is self limited and normal taste finally resumes.

Have any of you readers had Pine Mouth?

Tuesday, March 29, 2011

Doctors Don't Discuss Weight Loss With Patients

Patients are more likely to lose weight when physicians tell them they are overweight and advise weight loss.  Despite this, fewer than half of overweight patients and fewer than 2/3 of obese patients say they have been told by their physicians that they are overweight.  The current obesity epidemic has made higher weights and larger sizes seem more normal.  Patients who don't perceive their weight accurately also don't recognize the health risks, so physician intervention is a key component to encouraging weight loss and lower risk of disease.

Data from the 2005-2008 National Health and Nutrition Examination survey (which looked at 7,790 patients)  found that overweight and obese patients who were not told by their physicians to lose weight, continued to consider themselves to be of normal weight.  Of the overweight subjects (BMI>25), only 45% reported their physicians told them.  Those that were told by their doctors were much more likely to identify themselves as overweight than those were not informed.  They also reported they wanted to lose weight and attempted to do so.

So we have an opportunity here to influence patient behavior, but physicians are letting it pass.  Why is this?   The study did not assess why physicians fail to identify patients as overweight and obese (BMI>30).   Here are some guesses:
  • Physicians think patients already know it and it won't make a difference
  • Physicians think the patient lacks motivation to change
  • It takes a long time to address lifestyle changes, weight and diet
  • Physicians think the patient might be insulted
  • The doctor might be fat and feel personally embarrased to bring it up
  • Physicians have no training in weight management and how to lose weight
  • The doctor has no advice to give
The fattening of our population is one of the biggest health risks we face.  Our health system will surely collapse if we don't get a grip on the potential increase in diabetes, heart disease and joint disease from the collective weight gain of Americans.  When you look at groups of kids and teens, you can see that this is a problem than we can no longer ignore.    And except for shows like "The Biggest Loser", not much is being done about it.

The blame cannot be placed only on physician's shoulders.  It is a societal problem that requires solutions to come from many areas. But doctors can play a vital role in letting patients know their health is at risk and their weight is not normal.  It is not an insult to point out concern about health risks.

Monday, March 28, 2011

Direct To Consumer Advertising

Important Women's Health Issue:

* Do you have feelings of inadequacy?
* Do you suffer from shyness?
* Do you sometimes wish you were more assertive?
* Do you suffer exhaustion from the day-to-day grind?

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Margaritas are the safe, natural way to feel better and more confident 
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Shyness and awkwardness will be a thing of the past and you will 
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Margaritas may not be right for everyone. Women who are pregnant or 
nursing should not use Margaritas. However, women who wouldn't mind 
nursing or becoming pregnant are encouraged to try it.

Side effects may include:
- Dizziness
- Nausea
- Vomiting
- Incarceration
- Erotic lustfulness
- Loss of motor control
- Loss of clothing
- Loss of money
- Loss of virginity
- Table dancing
- Headache
- Dehydration
- Dry mouth
- A desire to sing Karaoke

* The consumption of Margaritas may make you think you are whispering when you are not.
*  The consumption of Margaritas may cause you to think you can sing.
* The consumption of Margaritas may make you think you can logically  converse without spitting.

Please share this with other women who may need Margaritas.

(hat tip to Raymond)

Sunday, March 27, 2011

Lifesaving Antibiotics Losing Power Due to Resistant Germs

 The single most important medicine ever discovered is the antibiotic.  Prior to 1930, humans died at early ages of simple infections and even childbirth was a major killer of women because of infection.   The mortality rate from simple staph aureus was as high as 80%,  but between 1944 and 1972 the human life expectancy jumped by 8 years because of antibiotics.   By 1950 the golden age of antibiotics was already looking tarnished as organisms became resistant to the drugs.  Now many medical advances that we take for granted, including cancer treatment, surgery, transplantation and neonatal care are endangered by increasing antibiotic resistance and a decline in new medications to combat the super germs.

Drug resistance is both a public health and global security threat. Resistance has emerged for all known antibiotics in use.  For most antibiotics, resistant genes have created super bugs that require more combinations of antibiotics  to treat and there are certain infections that we cannot effectively treat. 

Why are bacteria becoming resistant to antibiotics?  Every time a person takes antibiotics, sensitive bacteria are killed but resistant germs may be left to grow and multiply.  Exposure to antibiotics therefore provides selective pressure which makes the surviving bacteria more likely to be resistant as well as develop mutations of genetic material that code for resistant properties from other bacteria.

It is estimated that as much as 50% of antibiotic use in humans is either unnecessary or inappropriate.  Doctors call this "antibiotic stewardship" and it is important not to use "super" antibiotics when simple ones (or none at all) will work.  Also many food animals - poultry, chickens, pigs and cattle - are routinely treated with antibiotics in order to grow faster and compensate for unsanitary conditions on industrial farms.  It is estimated that between 30-70% of all antibiotics sold in the U.S. are used on farm animals.  The genetics of resistant bacteria in farm animals is exactly the same as humans.  The resistant bacteria can be spread to soil, well water, contaminated waste and even farm workers or food processors.

The development of new antibiotics has almost come to a standstill.  From 1983 to 1987, 16 new antibiotics were approved by the FDA.  From 2003 - 2007 just 5 were approved and since 2008 only 2 were approved.  Most pharmaceutical companies have withdrawn from market research and development because these drugs are not as profitable as those used to treat chronic conditions or lifestyle issues.

(Top $$ selling brands in 2009 were Lipitor, Plavix, Remicade, Advair, Enbrel, Avastin, Abilify, Rituxan, Humira, Diovan, Crestor, Lovenox - none are antibiotics and  all are used for chronic conditions.)

So what can we do?  First, understanding that antibiotics are precious medications that need to be preserved for serious infections is important.  Insisting on legislation that cleans up industrial farms and uses antibiotics on animals only to treat disease, not for growth or prevention is also critical.  Being aware that this is a problem is first and insisting on regulations follows.

And third, promoting financial incentives for drug research and development and funding increases for research on resistance and drugs to treat infections is a needed step.   The FDA should have priority regulatory review for applications for these types of products.

(JAMA, March 9, 2001, Vol 305, No 10)

Wednesday, March 23, 2011

Japanese Hospital Provides Disaster Care

Senen General Hospital was hit hard by the Tsunami in Japan, but it continues to provide care for patients even though there is no electricity or running water.  The hospital is located between a river and the coast and it was flooded on the first floor when the giant tsunami hit the neighborhood. The basement held the boiler, electrical room and other machinery.  The kitchen was ruined and there is no heat in the hospital.

Most of the staff lost their homes and now live in shelters, yet they are working round the clock to keep patients alive.  To combat subfreezing temperatures, the staff pours hot water into plastic juice bottles and tucks them around patients.  The nurses hand feed patients cold meals by the light from windows. The six story hospital lost one wing and the ground floor in the earthquake and flooding.  Patients have been clustered together, buried under mounds of blankets against the cold.

The hospital had about 200 patients when the earthquake hit and many of the patients have been transferred out.  On Sunday there were 52 patients left who had no relatives and were to sick to be moved.

Overall, Japan has responded amazingly well to this enormous natural disaster. The area most affected was rural and was already suffering from a shortage of doctors and nurses.  Japan is a wealthy, industrialized nation that prepares for emergencies like this, but the magnitude of the earthquake makes it almost impossible to be fully prepared.

The resilience of the Japanese medical teams is quite amazing and we are seeing some of the same selfless acts we saw in Haiti after the earthquake.  Japanese doctors and nurses, like the Haitians,  are putting their own needs aside and show their dedication to their patients.  It is inspiring to watch.

Monday, March 21, 2011

Exercise Helps Knee Osteoarthritis

When we think of osteoarthritis (OA), we think of chronic "wear and tear" on a joint that has just plain worn out.  Many patients with arthritis become less and less active and that is actually the worst thing for an arthritic joint.  A new study published in Arthritis Rheum. looked at the functional performance in 2589 adults with knee OA and found that there was a consistent relationship between physical activity level and better performance in these patients.

Patients with high self reported physical activity and a timed 20 meter walk test had better performance than patients who were not active.  Even a small increase in activity was related to better walking function.  Other studies have shown that active patients who engage in vigorous forms of exercise did not increase the risk of developing osteoarthritis of the knee.

We don't know what causes OA.  It is the number one chronic disease and the most common form of arthritis.   OA is characterized by a progressive loss of cartilage that is often accompanied by the development of bone cysts.  Swelling and stiffness occur and this causes pain when the joint is used.  It is undoubtedly genetic and is also related to obesity.  One wonders, however, if the weight gain came first or after,  since people with pain in their lower extremities (hips and knees) stop being as active.  Even small degrees of weight loss can help the symptoms, but it is hard to lose weight if one is sedentary so it is a vicious cycle.

What is important to preserve the joint and maintain good function is to continue to exercise.  A physical therapist can be invaluable in teaching exercises that do not load the joint but keep it mobile.  Building the muscle strength around the knee is critical, as is working on balance and  getting the extra weight off.  Even a 5-10 lb weight loss can make a huge difference on the joint load and help with pain and mobility.

If you have had pain, swelling and stiffness in your knees for 6 weeks or longer it may be Osteoarthritis.  Don't ignore it.  Get it diagnosed and get with a good exercise program to keep your joints as healthy as possible.

Sunday, March 20, 2011

Radiation From Japan

The week after the Japan Earthquake and Tsunami have had Americans watching the events unfold in horror.  The explosion at the nuclear power plant in Fukushima and the threatened melt down of the reactors created a near panic in some Americans thousands of miles away.  I am not downplaying this event and the potential damage to the reactor core with release of large quantities of radiation is certainly a disaster.  But we need to understand that the risks vary depending upon proximity and exposure and people in the United States are at the very low end of the risk pole.

I was dismayed when U.S. Surgeon General Regina Benjamin endorsed the idea that the public should stock up on potassium iodide as a "precaution".  What was she thinking? 

First of all, the only think that iodine helps prevent is thyroid cancer.  Radiation poisoning affects the entire body's DNA and iodine does nothing to protect us.

Second, the risk of any clouds of radiation reaching the U.S. in amounts large enough to cause problems is almost zero.  OK, I didn't say "Zero" because scientists never use the "Z" word.  Nothing in life is absolute, but even the Chernobyl disaster in 1986 did not cause any uptick in cancer in the rest of the world or Europe.

The risk of nuclear radiation on the human body depends upon the amount of exposure and the length of time you are exposed.  The workers who are bravely working in the reactor have still not reached levels that are unsafe.   People outside of the evacuation radius of 12 miles are considered safe and Americans have been advised to stay 50 miles away.  That is good advice.

The panic and stockpiling of iodide tablets is just like the Cipro stockpiling during the Anthrax scare or the Tamiflu shortage during the H1N1 scare.  Neither of them materialized and the nuclear scare will not either.  Instead of being afraid, we should get educated and empower our legislature to make environmental decisions that will benefit mankind in the future.

At this time officials have confirmed 7,197 deaths in the earthquake and tsunami aftermath.  The Japanese people have shown their resilience and strength during this awful disaster as written about here.

Thursday, March 10, 2011

Blogging Vacation

I'll be away for a few days...taking some of my own advice to heart and exercising and relaxing.  Here is what I'll be doing.  But not quite this well....

Here is who I hope I will see:

For great blog reading, please look to the links on the right.  Lots of interesting blogs and information for you.  See you next week back at EverythingHealth.

Eat More Fiber

Fiber is great for us because it helps with weight control and high fiber diets reduce colorectal cancer.  The American Cancer Association recommends 25 grams of fiber a day for women and 38 grams a day for men.  That is about 3 1/2 to 5 cups of vegetables and fruit a day.  So if you are eating your recommended 5 cups a day you are in good shape.  Keep it up.

If you struggle with getting enough fiber,  here are some suggestions for healthy quick snacks that will increase your fiber intake.  Put these on your shopping list and keep them handy in your pantry for a quick grab:

  • 1 and 1/8 cup edamame in the pods: 9 grams of fiber
  • One medium-sized pear, apple, orange or banana: 3 grams of fiber
  • 1/2 cup of cooked black beans: 8 grams of fiber
  • 1/4 cup of hummus: 4 grams of fiber
  • 1 cup bran flakes: 7 grams of fiber
  • 1 oz. slice whole wheat bread: 2 grams of fiber
  • Medium baked potato with skin: 4 grams of fiber
  • 1/2 cup of oatmeal: 2 grams of fiber
  • 6 whole wheat crackers: 3 grams of fiber

 Compliments of MD Anderson Center

Tuesday, March 8, 2011

Blogosphere Grand Rounds

Head on over to Dr. Pullen's blog for the best of Grand Rounds on the Blogosphere.  There are so many good medical writers.  My current favorite is the wonderful Grady Doc.  Read her every day and be uplifted with wonderful writing and stories.  We should all be so talented!

Higher Risk of Death For Women With Heart Attack

Several studies have shown that women have a higher mortality rate than men if they have a heart attack.  A study published in the American Heart Journal  helps to explain why.  The researchers looked at data from 2,542 women who had a heart attack.  Compared to men, the women were older, less likely to be white and less likely to smoke.  They also had more serious health conditions than the men.  They had diabetes, hypertension, congestive heart failure and COPD.

We have known for a long time that women are about 10 years older than men at the time of their first heart attack.  The authors believe that the reason women are more likely to die is because of these other conditions that are present. Women in the study were also more likely to receive a transfusion and experience gastrointestinal bleeding, strokes and vascular complications which lead to death.

They did not find any gender difference when they controlled for these other conditions.  The number of diseased vessels were the same as was the severity of stenosis.

So what does this tell women? The guidelines for longevity and good health have not changed.  Don't smoke (stop right now PLEASE!), control high blood pressure, make sure your weight is low to prevent diabetes and other vascular problems.  Stay active.
Heart attacks can be prevented by lifestyle changes.

Sunday, March 6, 2011

Charlie Sheen is Sick

Charlie Sheen is sick and not in a good way.  After a media blitz over the past few weeks, I finally saw one of his many interviews on ABC  and it was immediately obvious that he is in the throws of a major psychiatric condition.  He talks at length about his drug use and super-human ability to control drugs, which is a common denial we see in drug addicted people.  But beyond that, he is showing classic symptoms of the manic phase of a bi-polar illness.

Mania in a bipolar disorder is a hallmark cluster of symptoms and it can quickly spiral out of control as shown by Mr. Sheen.  In this disease patients experience increased energy, restlessness and constant activities that keep them going from place to place. (Notice how he has suddenly appeared on talk shows, events, even showing up at UCLA to give a pep talk to the baseball team).

Other symptoms are rapid, pressured speech that is peppered with grouping words based on their sounds and rhyming without much logic in pairing the words. (known as Clang associations).

He shows impaired judgment caused by mania;  impulsiveness, grandiose thinking , hyper sexuality and inappropriate humor and a total lack of insight into how others are perceiving him.  His interviews also show classic signs of excitability, hostility and feelings of exhilaration. (He believes his life is now magic. "I'm now on a drug and it's called Charlie Sheen. If you try it once you will die, your face will fall off.")

When patients are in a manic phase, they are unable to see how extreme their behavior is.  They do not want to take medication or be treated because they are out of touch with reality.  Many patients with bi-polar disease self medicate with drugs and become drug addicted.  It is often hard to separate the drug affect from the mental disorder, but in Charlie Sheen's case he is currently testing negative for drugs so this is truly psychiatric.

It is sad that Americans seem to love a watching these true "reality shows" and he is getting media attention rather than help.  Charlie Sheen has become the Anna Nicole Smith of 2011.  I wish my blog today would signal a news blackout and we would hear no more about Charlie Sheen until he gets needed treatment.

There may be two good things that come out of this.
1.  Hopefully there will be a greater awareness of serious mental disorders and the need for identification and treatment.
2.  My 15 year old son has no idea who Charlie Sheen is.  To the kids he is just some old guy.

Friday, March 4, 2011

Guys React to Vasectomy

Essure has an effective way to market their new permanent birth control device.  Make a humorous video that shows how some men view vasectomy and leave it to the women. 

Previously there were only two methods for voluntary permanent sterilization...a male vasectomy or female tubal ligation.  Of the two, vasectomy is the cheapest and safest.
(Fatalities per 100,000 tubal ligation - 3.51  cost $2,500     Fatalities vasectomy - 0    cost $750-850)

Essure is a newer technique of inserting coils in the fallopian tubes without surgery to block them and create permanent, non-reversible birth control.

This creative marketing campaign is aimed at women.  Not much has changed when it comes to who takes the ultimate responsibility for contraception.  It has always been the woman.   Essure is one more tool for us to consider.

Serena Williams Has Serious Lung Blood Clot

Serena Williams is one of my tennis heroes and is also one of the strongest women athletes in the world.  At age 29 she has won 13 Grand Slam tennis titles.  It was a surprise to the tennis world to learn that she was hospitalized in Los Angeles with a pulmonary embolism (PE); a serious blood clot in the lungs.  These blood clots do not form in the lung. They start in veins elsewhere in the body, usually the legs or pelvis and break off and travel to the lung vessels where they obstruct blood flow.  A pulmonary embolism is often a life-threatening event and is always very serious.  Thirty percent of people with a PE die immediately without treatment.

Although it is speculation, I can try to piece the scenario together of how Serena Williams was afflicted with a PE.  She cut her foot on glass last July after winning Wimbledon and has not been in a tournament since then.  She underwent an operation in October and possibly a 2nd surgery since then.  She had a protective boot removed and then flew 6 hours to LA for the Academy Awards.  Immobilization (wearing a cast) coupled with a long flight can cause a blood clot to form in the large leg veins, a condition called deep vein thrombosis (DVT).  It is the clot from a DVT that travels to the lung and causes the PE.

It can happen to anyone. Some people have a genetic predisposition for a DVT.  Estrogen, birth control pills, smoking, prolonged immobilization, pregnancy, broken bones or trauma, underlying cancer can all be risk factors for forming a DVT.

In the hospital, we are very careful to prevent DVT by using leg supports and treatments, getting patients up and moving and even anticoagulants to prevent clots.  Patients who undergo orthopedic surgery (joint replacement or trauma repair) are at particularly high risk as is anyone who is lying in bed or immobilized for a long period of time

Serena is home recovering now and she will be on blood thinner medication for many months.

Wednesday, March 2, 2011

Potassium Increase Cuts Stroke by 20%

There are few medical conditions that people fear more than a stroke.  We know that blood pressure control and lowering cholesterol levels reduces stroke risk.  Now, thanks to a huge analysis from Italy, published in the Journal of the American College of Cardiology, we know that higher dietary consumption of potassium is associated with lower rates of stroke and could also reduce the risk of coronary heart disease and total cardiovascular disease too.  What is even more remarkable is that the results apply to all parts of society and not just to specific "at-risk" subgroups.

Most doctors are not even aware of how important it is to eat potassium rich foods.  And what are these foods that have potassium? is fruits and vegetables like bananas, tomatoes, oranges, apricots, most legumes, spinach, winter squash, avocado kiwi and cantaloupe.  Actually almost all fruits and vegies have moderate to high potassium content.

The researchers looked a number of well done studies that included 247, 510 participants over 30 years and found that those patients with the higher potassium intake reduced their stroke risk by 21%.  The Italian doctors say the protective effect of potassium against stroke is in part due to its blood pressure lowering effects and also due to other properties of the potassium mineral, such as the inhibition of free radical formation.

I have written before about the DASH diet which also found that reduction of sodium and addition of fruits and vegetables to the diet is an effective way to control blood pressure.  The Dash diet is high in potassium.

Think about it.  Did you have 5 fruits and vegetables today?  Numerous studies have shown the life-prolonging benefits.  This new study just adds to what we already know.  I challenge all readers to keep a diet count and make sure you are eating 5 fruits and vegetable servings a day, every day to help reduce your risk of stroke, cancer and heart attack.

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...