Archive for January, 2008

Getting started on a diet

Posted in Diet, Getting started with tags , on January 31, 2008 by Dr. CJ

For those struggling with how to go about creating a healthy diet, take a look at this other site I came across.  It gives detailed analysis of foods, including glycemic index, nutrient content, ability to track foods, etc.

http://www.nutritiondata.com/

I haven’t had a chance to navigate the site much, but it looks like a useful tool.

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The Vasculopath

Posted in Addictions, Heart Disease with tags , , , on January 30, 2008 by Dr. CJ

I had an incredibly frustrating patient encounter yesterday – a 60-something gentleman who was recently in the hospital for an ischemic stroke. When I admitted him (late at night – curse this job), I mustered enough good charm to suggestively congratulate him on his first day of having quit smoking (I knew he wouldn’t). Super pleasant guy, with a supportive family all huddled around him in the ICU, but I just knew he couldn’t be reached on the smoking thing, even though he’d just dodged a major bullet by reversing all of his stroke symptoms after receiving the “clot-buster” medication just hours before.

Problem was, this guy is the ultimate “Vasculopath”. What is a “vasculopath”? It’s a rather informal term I apply to an individual with significant vascular disease, of which there are many risk factors and many manifestations. This guy had them all: high cholesterol, smoker, high blood pressure, family history of heart disease, age (>55), male sex, obesity, Diabetes Mellitus, and worst of all – personal history of heart disease, having had an MI (myocardial infarction) in the past. His regular physician had done marvelous work on him: normal blood pressure, controlled diabetes, normal cholesterol, had him taking aspirin – all the right things, but he refused to give up his cigarettes. As the saying goes: You can lead a horse to water, but you can’t make him drink.

Anyway, he convinced everyone at his bedside (at my less-than-gentle prodding) that he would quit smoking as a result of his stroke. I saw him back in clinic today and inquired about his 9 days since being admitted for a stroke – of course he’s right back to smoking with no intention to quit. [Deep breaths . . . count to ten] As I mentioned before, you choose your own death, in a sense. He’s basically playing a form of Russian Roulette – one of these days he’ll have “the big one”. My suggestion to clean up his diet and learn how to incorporate some physical activity into his daily routine fell on deaf ears, but he reluctantly agreed to try Chantix (a wonderful new addition to our smoking cessation arsenal) for the sake of his wife. [Mr. Passive-Aggressive, himself]

I can only hope that he sees the folly of his ways before it’s too late. A patient like this reminds me that I can do only so much as a physician – it’s times like this I just feel like a glorified advice-giver. It feels like a waste of my time, but maybe one of these times I’ll get through to him.

How far did I just run?

Posted in Cardio exercise with tags , on January 29, 2008 by Dr. CJ

I came across a great web site that makes it easy to calculate the distance of unusual routes, such as one you might take on your bike or when running. [Not that any one’s running outside in my neck of the woods tonight with -16 F low for tonight and -35 F wind chill.]

Take a look at MapMyRun.com. Once you orient yourself to the buttons, it’s relatively simple to caluculate a distance. No more need to hop in the car and drive the route while following your vehicle’s odometer.

Take a day off from your workout once in a while

Posted in My training updates on January 29, 2008 by Dr. CJ

Last night, I decided to skip my regular HIIT workout on the elliptical this morning because my legs were wiped out after a good leg workout 2 nights ago, another good case of DOMS

I also had a bit of a cheat meal for lunch yesterday – how can I turn down fajitas?  With a few more carbs than I normally eat, my weight is predictably up 1 pound this morning, but as I’ve said before I care more about body composition than the number I dial up on the scale. 

Remember to give yourself a break once in a while.  At the minimum, I suggest easing back on the intense cardio/endurance workout at least one day a week.  I don’t have to worry so much about easing back on my weightlifting schedule, because it’s hard enough as it is to fit in my planned 3 days a week. 

Risk Factors for Heart Disease, Vascular Disease

Posted in Heart Disease, Routine ailments with tags , , , on January 28, 2008 by Dr. CJ

Heart disease remains the number one cause of death. Cardiovascular disease, as a whole, encompasses far more ailments as well, including stroke, peripheral arterial disease, and atherosclerosis of the aorta, all of which are a result of the same process of atherosclerosis. For example, a stroke (ischemic, not hemorrhagic) is sometimes referred to as a “brain attack” – the equivalent of a heart attack in the brain.

There are a number of identified risk factors for cardiovascular disease, some of which you can do something about and others that you can blame on your parents or other factors out of your control.

Unmodifiable

  1. Age – Older age, increased risk. Considered a risk factor when men > 55, women > 65.
  2. Sex – Generally, men are at higher risk of disease compared to women who receive protective benefits from estrogen. But, certain other risk factors have greater impact in women than in men (e.g. smoking).
  3. Family History – Father having heart attack before age 55 or mother having heart attack before age 65.
  4. Other genetic conditions/predisposing factors – e.g. homocysteine and other inherited disorders of clotting

Modifiable

  1. Tobacco use – need I expound?
  2. Hypertension – high blood pressure, known as the “silent killer” because it rarely causes symptoms until it is extraordinarily high. Roughly speaking, the goal BP is less than 140/90, but the lower, the better.
  3. Diabetes Mellitus – an emerging epidemic due to obesity and inactivity
  4. Overweight – any degree of being overweight increases risk
  5. Inactivity – not as strongly associated with heart disease as some of the others, but exercise definitely reduces one’s risk
  6. Hyperlipidemia – high cholesterol, high triglycerides, can be broken down into all kinds of scenarios that increase risk:
  • Elevated LDL-cholesterol
  • Low HDL-cholesterol
  • Increased total-to-HDL-cholesterol ratio
  • Hypertriglyceridemia
  • Increased Lipoprotein (a)
  • Increased non-HDL-cholesterol
  • Increased apolipoprotein B and decreased apolipoprotein A-I
  • Small, dense LDL particles
  • Granted, there is certainly some genetic/family history influence on blood pressure and cholesterol, but for the most part that can still be significantly altered with good lifestyle. It’s not okay to just blame your genetics and give up because it’s a losing battle. Study after study demonstrates improvement in all-cause morbidity and mortality by improving on the basics: diet and exercise.

    Not to sound morbid, but your lifestyle basically determines how you will die. Very few non-alcoholics die of cirrhosis; very few non-smokers die of emphysema; and very few fit individuals die of a premature heart attack. We’re all going to die. I just don’t want to die clutching my chest while shoveling snow or running the bases. So choose your habits wisely, because they will come back to haunt you. Some also say to choose your parents wisely, but I can’t help you with that one.

    A Taste of my own Medicine

    Posted in Routine ailments on January 27, 2008 by Dr. CJ

    I had to change the order of my weightlifting workouts last night, because my shoulder (deltoid muscle) still ached from 2 days prior when I had to get a Tetanus booster (TdaP, to be specific). Oh well, a couple days of soreness sure beats a case of tetanus, diphtheria, or pertussis. So, instead of legs and shoulders last night, I did chest and triceps. I’m back down to the lowest weight I’ve been at since at least early college. But, I’m trying to pack on some muscle, so I don’t care about the pounds necessarily. I have to get back into monitoring my body fat percentage again as a better measurement of my progress.

    My grocery shopping day

    Posted in Diet with tags , on January 26, 2008 by Dr. CJ

    Just got back from my Saturday routine, zipping through the supermarket and discount warehouse for our weekly grocery needs. Here’s a peek at what I bought:

    • Bananas
    • Pears
    • Sweet Potatoes
    • Oranges (for my wife to juice)
    • Grapefruit (“)
    • Tater tots (my wife had a rare urge to make tater tot hot dish tonight)
    • Skim Milk
    • Cod filets
    • Grapes
    • Eggs
    • Naked – Blue Machine juice (love it, easiest way to get my blueberries in January)
    • Fiber Choice (reduce risk of colon cancer, of course)
    • Cat food (not for me, I swear)

    Missing from this list, of course, is my ridiculous amount of chicken – I usually stock up on it when it’s on sale or hit the warehouse club when I’m desperate.

    Why do I bother to discuss this list? It goes back to my point that “If it’s not in your house, you’re not going to eat it.” Therefore, don’t even put garbage in your grocery cart, and you won’t have to feel guilty about munching on it when you’re vulnerable. Remember, lifestyle changes begin at the grocery store.

    When I get a craving, I’m reaching for either the Naked juice or the grapes to tide me over, and I’ll still feel good about that.