Archive for Preventive Medicine

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.

The Dalai Lama goes to Mayo

Posted in Preventive Medicine, Rants and Raves with tags , , , , on April 16, 2008 by Dr. CJ

Here’s the type of news piece that gives me a good, long laugh – another worldly figure travels across the world to get an annual physical exam at the Mayo Clinic

No doubt, the Mayo Clinic is capable of doing great things – they have specialists so specialized that they have forgotten how to treat a common cold.  Who wouldn’t want an “expert” to manage an unusual condition?  Few people have unusual conditions, though.

I’ve seen patients in my clinic who go there for their annual exam.  For some reason, they feel that getting a clean bill of health from Mayo is some kind of blessing for eternal wellness.  Mayo is, in fact, good at coordinating a ridiculous number of labs, imaging, diagnostic tests, and doctor visits into a comprehensive day-long physical exam.  They are masters at communication and planning, apparently.  However, is there any benefit to this kind of overwhelmingly thorough evaluation?

This shotgun approach to an annual health exam is a dangerous venture for a few reasons. 

  1. It’s expensive.  I’d hate to be your insurance company staring at a list of charges you rack up on that one day.
  2. It cultivates a sense of urgency to “do everything” all the time.  People love to feel pampered – talk to your insurance company or whoever is actually paying for those charges.
  3. It leads to unnecessary follow-up testing.  Not all “abnormal” results are necessarily abnormal.  But, if you go fishing for everything when there’s no focus on a particular problem, you’re going to find a lot of junk, and you won’t know how to interpret it.
  4. It’s a poor use of resources.  Common things being common, most people don’t have “rare” diagnoses that require an expert on minutiae.  In an ideal world, we could find a way to maximize the efforts of the highly-specialized physicians who really don’t need to be dealing with routine conditions that could be managed by any other competent physician.  Do you need a world expert on obesity and metabolism to tell you that you need to eat better and exercise more? 

I don’t question their value in managing rare or difficult-to-treat conditions, but for the average individual it’s a complete waste of time and money.  It’s all about perspective – the things that are going to kill you are staring you in the face every day and are simple to manage.  There’s nothing glamorous about searching high and low to come up with weird explanations for common problems. 

Then again, I don’t know Buddha’s take on health.