Want some breast milk in that ice cream?

Posted in humor, Preventive Medicine with tags , , on September 24, 2008 by Dr. CJ

In a typical throw-all-rational-thinking-out-the-window approach, PETA sent a letter to the founders of Ben & Jerry’s Ice Cream requesting that they use human breast milk rather than cow’s milk in their products.

Read letter here.

Wow.  [said with complete lack of emotion, or is it utter (no pun intended) disbelief]

That is so over-the-top ridiculous – that all I can say.

OK, maybe one more comment because it irked me:  You want to prevent obesity and diabetes?  Quit coddling your child – force them to do something other than play video games and surf the internet.

Extreme Lipids II

Posted in Diabetes, Heart Disease with tags , , , , , on September 23, 2008 by Dr. CJ

There aren’t many lipid panels that stun me, which is probably a bad sign – that we are becoming more tolerant of slothen behavior and excessive hyperlipidemia, knowing that there are medications to rescue one from years of lousy self-care.

This gentleman had a most impressive lipid panel, perhaps forcing you to ask how he is even alive.

Total Cholesterol    1248  (normal < 200)

LDL                         n/a  (normal < 130)

- invalid when Triglycerides > 300

HDL                        n/a  (normal >39)

- invalid when Triglycerides > 1200

Triglycerides          8062  (normal <150)

This very nice 40-something gentleman presented to me in clinic in DKA (Diabetes KetoAcidosis) – his first doctor visit in 10+ years.  He was continually thirsty (polydipsia), continually urinating large amounts (polyuria), and had lost 40 pounds over the past 3 months . . . unintentionally.

He knew that he had Diabetes Mellitus, for he had witnessed the disease in nearly all of his family members and recognized these classic symptoms.  Unfortunately, he waited to the point that he developed DKA. 

DKA is a complicated process – briefly, the body is so overwhelmed with high glucose in the bloodstream that it is no longer able to utilize glucose in the tissues (muscle, brain, etc.) and the pancreas is exhausted from pumping out so much insulin that it stops doing so.  The result is that the body cannot utilize glucose as a fuel source and must resort to breaking down fat (hence the weight loss) to provide fuel for the tissues.  This process creates a toxic acidic environment in the bloodstream, potentially deadly.

I admitted him to the hospital, and we achieved control over his diabetes.  It appears that he does, in fact, have Type 2 Diabetes Mellitus (DM) – formerly known as Adult-Onset Diabetes Mellitus.  DKA is far more common in Type 1 DM, but occasionally does occur in Type 2 DM.

But, about those lipids . . . there a couple notable findings:

  • the person who drew his blood immediately noticed how fatty the blood appeared
  • he had Xanthomas (cholesterol deposits) on his elbows
  • the in-house glucose machine misread his glucose as normal (the true serum test drawn at the same time was markedly elevated)
  • he had no problems with his pancreas – he dodged a bullet.  When the triglycerides are above 500, one is at risk for pancreatitis.  At 8000, it’s a miracle he didn’t kill off his pancreas (or maybe he did, and that’s why he’s not making insulin – regardless he didn’t have any lab evidence of pancreatitis)

  The quickest and easiest treatment for such severe hyperlipidemia and hypertriglyceridemia in a person with diabetes is correction of the diabetes.  I’m anxiously looking forward to rechecking those numbers, now that he is on a treatment regimen.  I’ll post an update.

Extreme Lipids I

Posted in Heart Disease, Preventive Medicine with tags , , , , , on September 22, 2008 by Dr. CJ

I saw a woman a few months ago who had concerns about a strange sensation in her chest.  She had had her cholesterol panel checked a few months prior by her gynecologist at her yearly female exam.  The gynecologist communicated to her that her total cholesterol was too high at 240 and that she should follow-up with my clinic.

Sure, 240 is high for a total cholesterol is high, but the details of the individual lipid measurements are far more telling than a “total”.  This woman’s lipid panel is a perfect case in point.

  Here’s the panel – refer to this post for details on the significance of each value.

Total Cholesterol    240  (normal < 200)

LDL                         111  (normal < 130)

HDL                        117  (normal >39)

Triglycerides            61  (normal <150)

So what?  This panel achieves one of my fantasy goals for cholesterol numbers – an HDL greater than the LDL [without cholesterol medication].  There was one other patient who came close.

Her total cholesterol is high in part due to the very high HDL cholesterol, but if you’re going to have a high total cholesterol, this is the way to do it.

Why is a high HDL a good thing?  HDL protects the heart and brain by it’s “scavenger” effects on plaque in blood vessels.

That’s no easy task, although favorable genetics certainly help.  The hightest HDL’s I’ve seen are generally in alcoholics – unfortunately, the HDL-raising benefits of alcohol are outweighted by its deleterious effects.

The best way to raise the HDL is through regular, intense exercise.  There was a study from years ago that analyzed HDL’s in runners: the more miles they ran in a week, the higher their HDL.

My return

Posted in My training updates on September 19, 2008 by Dr. CJ

I had a bit of a hiatus over the past few months away from posting on this site.  With the variable demands of my job, I just wasn’t able to maintain the kind of constant presence that I would like to maintain with posting.  I have realized, however, that my goal of making daily posts is probably a bit ambitious for me right now.  Maybe someday when I change up my schedule (read: change jobs) I’ll be able to do so. 

My goal is to provide quality posts, rather than pump out flaky posts just to be able to publish something on a particular day.  Unfortunately, those quality posts require a fair amount of time and effort, both of which are often in limited supply.  I would like to aim to make at least 3, maybe 4, quality posts each week as a starting goal. 

This new goal coincides with my renewed dedication to my fitness regimen in the Fall.  Summer is nearing its end, which signals to me another chance to make significant progress on my health.  I hear a lot that people have more trouble focusing on their health in the winter than summer, but I’ve found the opposite for me.  It’s time to discipline myself again, getting back into my diet and exercise regimens that have worked well for me in the past. 

Thank you to those who have followed my posts in the past and also to those who are newly discovering this site.  Feel free to drop me feedback at any time.

Extended absence

Posted in Uncategorized on July 20, 2008 by Dr. CJ

For those who come to my page and expect to see new posts, thank you!  And, I’m sorry for not creating anything new lately.  I have been overwhelmed (to put it lightly) with other obligations, and I just can’t justify spending spare time on this blog, even though I do enjoy it.
I intend to return to frequent posting in the near future, once I settle into a more normal routine again.  Thanks for being patient, and thanks for those who continue to have an interest in this site.  I certainly have respect for those who maintain blogs with quality postings on a daily basis.  I’ve decided not to pass off poor quality posts simply to post daily.

Why are so many people on chronic medications?

Posted in Medicine, Uncategorized with tags , , , , on May 16, 2008 by Dr. CJ

A recent report revealed that over half of all Americans are on at least one medication on a chronic basis.  This analysis includes children and adults.

The article cites that medications for blood pressure and cholesterol are the most common.  Note that these problems are core features of the Metabolic Syndrome which is already at epidemic levels and steadily worsening.

Best line of the article:

"Honestly, a lot of it is related to obesity," he said. "We've 
become a couch potato culture (and) it's a lot easier to pop a 
pill" than to exercise regularly or diet. 

Another epidemic problem is the overdiagnosis of and over-prescribing of medications for so-called ADHD.  That calls for a separate post, if I dare, but no one can argue that so many children need medication to get through a school day.  That’s flat-out ridiculous and more an indicator of a parent’s ability to teach discipline and maturity than a “disorder” of the child. 

Certainly, there is also an influence from public education.  For example, I frequently see people who have either learned about their risk for certain medical conditions or about medications that are being advertised for these conditions, and this bit of awareness prompts them to initiate a discussion about it. 

There’s room for a long, complicated discussion about the necessity and ethics of pharmaceutical products being used on this scale.  As mentioned previously, I encourage patients to minimize their use of medications by addressing the important health factors

People want quick fixes, and especially easy fixes.  It still amazes me, yes, but people are far more willing to pay $30-100 / month and subject themselves to risk of liver disease, muscle injury, electrolyte depletion, and other side effects than to devote themselves to a regimen of healthy eating and regular physical activity to achieve the same results.

This report also begs the question: why are the doctors prescribing so much medication?  Aside from the obvious increase in chronic medical conditions like hypertension, hyperlipidemia, and diabetes; the philosophy of the physician is put to the test when confronted with these patients, as in drug vs. fitness.

Witzelsucht

Posted in Unusual medical terms with tags , , on May 15, 2008 by Dr. CJ

I came across this term when doing a trivia “game” on medical terms.  I got a kick out of it.  It’s obviously of German origin, and I enjoy a lot of the original meaning contained in foreign words, though they unfortunately lose a lot in translation.  I’m not up on my German any more to offer any insight on this one, but it literally translates to “joke seeking”.

Definition (from the trivia game):  A mental condition characterized by the making of poor jokes and puns. 

Definition (from Dictionary.com): excessive facetiousness and inappropriate or pointless humor especially when considered as part of an abnormal condition.

There’s also a decent little entry on Wikipedia, which confirms what I found in my quick review of the medical literature when I did a search for that term.

That was a fun, mindless diversion, even though it was still medically related.

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