Wednesday, March 30, 2011
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.
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?
Posted by Toni Brayer, MD at 8:34 PM
Tuesday, March 29, 2011
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
Posted by Toni Brayer, MD at 9:59 PM
Monday, March 28, 2011
* 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?
If you answered yes to any of these questions, ask your doctor or
pharmacist about Margaritas.
Margaritas are the safe, natural way to feel better and more confident
about yourself and your actions. Margaritas can help ease you out of
your shyness and let you tell the world that you're ready and willing
to do just about anything. You will notice the benefits of Margaritas
almost immediately and with a regimen of regular doses you can
overcome any obstacles that prevent you from living the life you want
Shyness and awkwardness will be a thing of the past and you will
discover many talents you never knew you had. Stop hiding and start
living, with Margaritas.
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:
- Erotic lustfulness
- Loss of motor control
- Loss of clothing
- Loss of money
- Loss of virginity
- Table dancing
- 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)
Posted by Toni Brayer, MD at 9:18 PM
Sunday, March 27, 2011
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)
Posted by Toni Brayer, MD at 3:38 PM
Wednesday, March 23, 2011
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.
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.
Posted by Toni Brayer, MD at 10:45 PM
Monday, March 21, 2011
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.
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.
Posted by Toni Brayer, MD at 10:39 PM
Sunday, March 20, 2011
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.
Posted by Toni Brayer, MD at 12:12 PM
Thursday, March 10, 2011
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.
Posted by Toni Brayer, MD at 9:55 PM
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
Posted by Toni Brayer, MD at 8:06 AM
Tuesday, March 8, 2011
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!
Posted by Toni Brayer, MD at 5:51 PM
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.
Posted by Toni Brayer, MD at 9:04 AM
Sunday, March 6, 2011
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.
Posted by Toni Brayer, MD at 8:56 AM
Friday, March 4, 2011
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.
Posted by Toni Brayer, MD at 11:50 PM
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.
Posted by Toni Brayer, MD at 9:52 AM
Wednesday, March 2, 2011
Most doctors are not even aware of how important it is to eat potassium rich foods. And what are these foods that have potassium? Surprise...it 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.
Posted by Toni Brayer, MD at 9:35 PM