Archive for health

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.

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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.

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.

Another good reason to have pets – Pets can detect cancer

Posted in Pets, Uncategorized with tags , , , , on May 14, 2008 by Dr. CJ

My wife and I are big-time lovers of dogs.  We have a couple cats, too, but the dogs are our passion.  They are basically our kids for the time being, and they certainly demand that kind of treatment. 

I’ve often wondered what it would be like without them, but that image seems so boring to me.  As much as a handful they can be, there are innumerable moments of bliss as a dog-owner. 

I’m often reminded of a bumper sticker I once saw:

The more people I meet, the more I love my dog.

Here’s another bonus of being a pet-owner.  Just in the last several years, some anecdotes about dogs detecting cancers in their owners have surfaced and have actually prompted some research studies.  The article describes a study for bladder cancers, in which the dogs were trained to sniff the urine and were 3x more successful at detecting presence of cancer than chance alone (41% vs. 14%). 

My favorite part of that study is that one of the so-called “normals”, a healthy control subject was consistently identified by the dogs as having cancer.  Further investigation led to the discovery of a kidney cancer.

Another study demonstrated that dogs were 99 percent accurate in their identification of lung cancer  and 88 percent accurate in identifying breast cancer by breath samples.  Pretty amazing results.  They note, however, that the control subjects were all healthy, and thus it would be important to verify that the dogs could distinguish cancer from some other condition, e.g. infection.

This could be an interesting area of research, particularly if an abnormality can be identified and consistently measured in a laboratory setting. 

Don’t be a wimp – play golf the way it was meant to be played

Posted in Exercise with tags , , , on May 8, 2008 by Dr. CJ

Taking advantage of an absolutely gorgeous day (read 70 and sunny), I managed my first golf outing of the year this week. Even though I felt like auctioning off my clubs after the first hole (and almost each one thereafter), I had a pretty good time . . . and actually got a decent workout.

Huh? Did he say “workout” and “golf” in the same sentence??? Just like I make softball a workout for myself, I ensure that my golf outings aren’t lazy drunken debacles. Some of that is by design; some of that is by virtue of my amazing lack of skill.

We unskilled golfers who just love the game for the sake of the game know and fully understand one of golf’s unspoken truths: Bad golfers get more exercise. Between walking a zigzag pattern down the fairway, hunting for balls in other fairways or out of bounds, and taking more than a par’s worth of swings, a lousy golfer is certainly working harder on the course than a scratch or other low-handicap golfer. But, it’s that PGA-material shot that you can pull off only 10% of the time that makes the game all worthwhile.

The particular course I played is a beautiful, wooded course with a layout that creates a significant amount of distance between several of the holes. The actual yardage of the holes alone (from the second tee’s, not the lady’s tees) is 5463 yards, which amounts to roughly 3.1 miles (if you play straight down the fairway). By no means is that a long course, by golf course standards, but it’s the between-holes walking that make it a trip. I don’t even dare estimate how much further I walked, but it was a decent distance.

As you are probably guessing, I’m not a golf cart kind of guy. In fact, I am quite opposed to golf carts and actually snicker under my breath at those who can’t fathom golfing a round without one. I can count on one hand the number of times I’ve golfed with a cart, and that number doesn’t grow very quickly.

  • For the 70-year-old with a hip replacement who is addicted to golf . . . great, you, sir, deserve a cart.
  • For the typical American guy with no major medical crises . . . you may, in fact, need the exercise.

There are a few flavors of golf, depending on the level of fitness one is willing to incorporate into his (or her) game (in ascending order):

  • Golf cart – minimal walking, only as far as the cart won’t allow one to get to certain areas of the course. Don’t pat yourself on the back at the end of the day for getting your exercise – you just did the equivalent of a day at the driving range.
  • Remote cart – what in the world are these things? I could not believe my eyes when I first saw one of these. Only in America, I thought. I’ve gotta know – does the value of the satisfaction of owning one of those come anywhere close to what it costs to have one? These carts actually give the sport a lazy name.
  • Caddy – same as the remote cart. Must be nice. I wouldn’t want the poor thing cringing at my shots all day.
  • Push cart – decent, but still taking the easy way out. To me, any one who thinks they’re fit enough to swing a golf club at least 70 times should at least be able to push a cart for a few miles.
  • Carry your own clubs – the way golf was meant to be played. Here’s a calculator to help you estimate how many calories/hour you would burn while carrying your own clubs while golfing. My golf bag with clubs weighs 21 pounds, hardly a strain on any one.

Give it a whirl – make your next golf outing a bonus addition to your fitness plan. It still amazes me that people are willing to pay to exercise in a sweaty, unsanitary gym and then also pay to avoid exercise on a beautiful golf course. Think of how easy it would be to satisfy exercise requirements by putting in a couple rounds of golf weekly – on foot.

Back in the swing

Posted in Exercise, My training updates with tags , , , on May 5, 2008 by Dr. CJ

This is my favorite time of year, by far.  I love the in-between feeling of Spring and Summer, the emerging green grass and leaves, and, best yet, the start of softball

I had my first game last night and am geared up for more.  Many criticize baseball/softball as a lazy sport, where there’s not a consistent level of activity and thus is not good exercise.  Very true for some people . . . not me.

A little background, first – I’m on a co-ed team with a few people who have never played organized sports, let alone softball (makes for interesting moments).  On top of that, we were short two players last night.  In a situation like that, I become the ultimate utility player, trying to cover shortstop and most of left field, trying to snag any fly ball in the same zip code.  I was huffing and puffing nearly the whole game.  Amazingly, or maybe because the other team was lacking skill, we managed to win short-handed.

There are plenty of sprinting opportunities during a game, between batting/running bases and chasing balls in the field on defense – at times, it felt a little like one of my HIIT workouts. I’m also feeling some DOMS already, from tapping into those base-running muscles.

I’m not going to advocate for softball as a replacement for regular workouts, but it certainly has a place in my fitness regimen.  Every summer, I drop several pounds, which I largely attribute to the summer sports, primarily softball.  I also have the opportunity to play Monday nights as well, but I’ve decided to limit it to one night/week so I can maintain my weightlifting regimen ideally 3 days/week.