Monday, February 02, 2015
You make me nervous
When you're in your seat
-----Jerry Jeff Walker
What on earth would our Ice Age ancestors think? Genetically identical to our 21st century selves, they were perfectly suited to a life of obligatory physical exercise, periodic famine, and unrelenting cold. We, on the other hand, no longer running from predators or chasing our dinner, pass our days on the job and at leisure slouched in our chairs, inert, well-fed, and warm.
My Fitbit, a pedometer-plus, tallies steps, stairs, and calories. Gizmos within know when I am active and know when I am not. After a day at home or at work, add housework or laundry plus a walk and a trip to the store, I might manage to reach the 10,000 step goal. Syncing with Fitbit on-line turns daily data into a pie chart of motion, gray for sedentary with blue, yellow, and pink for light, moderate and heavy action. Alas, my so-called busy day is awash in inert--big yawning gray, a thin slice of sky, a sliver of sun, and one slash of pink.
Perhaps it's time for on beyond Fitbit. A smart--and very pricey!--desk might be the next best thing to a personal trainer. For several thousand dollars, you can buy a work station at stirworks.com that greets you by name, gently nags you to move, keeps a log of your day, week, and month, and advises you how long until you're next scheduled to fidget. When you've been too still for too long, the thing takes a 'whisperbreath', heaving beneath your laptop like an impatient dog past due for a walk.
Sit-stand workstations are today’s medical news; studies prove they decrease on-the-job sedentary behavior (SB), may or may not affect productivity, and mostly don’t cause workplace injuries. Ingenius, creepy, or just a sign of our times?
Saturday, November 29, 2014
Monday, September 29, 2014
I’ll admit that I got my bag of KissMe Organics Matcha for free with a request for a review. I’ve been a one cup of green tea per day is plenty kind of believer, good for the health but, honestly, I prefer coffee. Green tea’s not fun, green tea tastes odd. But I had no idea just how odd green tea could taste until I tried a half teaspoon of this green Matcha powder which doesn’t even really dissolve when mixed in hot water. Odd is not necessarily unpleasant, the flavor is like a slightly gritty, mild infusion of grass clippings. But what a great way to get one’s green tea intake out of the way in one earthy serving (yeah, I fact-checked; it really does have 137X the anti-oxidants of the brewed China Green Tips variety), and. oh my, check out the health benefits.
There’s a host of worthy molecules in green tea called polyphenols, the best and most plentiful of which is epigallocatechin gallate or EGCG. A pubmed.gov search for EGCG and cancer returns 1,299 articles on research studies wherein EGCG messes with the dastardly growth, reproduction, and metastasis of prostate, breast (including the triple negative scary kind), glioma, and colon cancers and T-cell leukemia. And that’s just from the first page of results! Clinical evidence suggests it has chemopreventive properties as well with respect to preventing or reversing the cellular changes that lead to malignancy. Diabetic animals—both rats and humans—display improved cholesterol levels and glucose control when green tea is added to their diets, and some even lose weight in amounts that may or may not be significant depending on which study results you consult. HDL-cholesterol (the good kind) rises while total cholesterol and LDL levels fall.
Well I’m sold on Matcha, and I’m ordering some for a friend recently diagnosed with breast cancer. I probably won’t try green tea cupcakes because, honestly, I prefer the good old brown-from-chocolate variety.
Monday, June 09, 2014
I took another pass through the medical literature on oil pulling recently, and discovered new information on how this pulling business works. Given a busy life and hectic mornings, it's hard to carve out 15-20 minutes for an oral work-out around a mouthful of oil. As a result, I did the multi-tasking thing that we all do, making coffee and breakfast, packing lunch, reading a book or the paper, often holding that mouthful of oil with just an occasional swish. Turns out, however, the magic is in the agitation.
Scientists conducted trials wherein they sampled the oil from the mouths of willing subjects at various intervals during the pulling process. Heaven only knows how they did this without sending sesame oil and spit down the volunteers' chins. Early samples revealed big globules of oil in saliva while later specimens showed that the washing machine action of hard-working jaws had broken the oil into tiny droplets upon which bacteria and old dead mouth cells clung. This did not occur until 15 minutes or more into the activity. Thus, indifferent, distracted oil pulling while dashing around the kitchen for 10 minutes just doesn't get your mouth that soap-like cleansing effect. Give it your all for 15 minutes, spit the thin, milky stuff out, rinse, and SMILE!
For more on oil-pulling, see Bacteria, bad breath, and oil pulling and Oil pulling testimonial
Friday, October 25, 2013
This morning I completed an online continuing medical education course on medical handoffs. I wasn't even sure of what this meant when I registered and embarked on the course. Turns out that it's just what it says, namely the handoff of a patient's medical care from one professional to another, say, for example, from me as primary care provider to a specialist consultant, or from a hospitalist to me as one of my patients is discharged from an inpatient admission back into my care. These handoffs are risky business (and so this course is sponsored by my medical malpractice company) if information is incompletely or inaccurately transferred.
I can't tell you how many times I've been in this situation--a patient comes to my office for follow-up to hospital care, and the discharge summary is not available. Sometimes, I've heard the history via phone from the doc in charge at the hospital. Too often, I did not even know that the admission occurred. More than once, the patient does not know the names of the physicians that were in charge of their inpatient care, and, worse yet, may not even know their final diagnosis! You may be nodding in recognition because this has happened to you or a family member.
This course gave a nice summary of that which a patient should know on leaving the hospital. With just slight adjustments, many of these items could apply to any handoff situation where more than one professional is in charge of any aspect of your medical care.
- What are warning signs of a relapse? (I would add that any change that alarms you is worrisome enough to inquire about).
- What are side effects to look out for from new medications?
- Whom should I contact in case of difficulty? (I feel like your primary care doctor should be available to advocate for you in this matter even if they are not fully apprised on the matters at hand)
- Does my primary care doc know that I was in the hospital and that I am leaving?
- Do I understand why I was hospitalized, what was the diagnosis, and what is the treatment plan?
- What results are pending? Whom do I contact to find out these results? (this is extremely important, and applies as well to outpatient tests ordered by a specialist; find out if the specialist or your PCP will be the one to get the results, and call them if you don't hear from them within a reasonable amount of time).
- Have any new medications been reconciled with my usual medications? How long must I be on these meds, and who will order refills?
- Where, when, and with whom do I follow-up?
Be your own best advocate on behalf of yourself or a loved one; ask these questions and make sure you get answers!
Friday, August 09, 2013
Saturday, March 09, 2013
But what of these purported health benefits? A visit to the NIH library at PubMed Central only strengthened the love; many Chinese researchers in multiple scholarly articles provided a slew scientific reasons to make mine Pu-erh in the a.m.
The evidence was a regular alphabet soup of enzymes and genes and proteins favorably enhanced or suppressed by this brew and its metabolic byproducts of fermentation. I’ll leave the anti-obesity praise to Dr. Oz who, incidentally, is looking downright anorectic to me. Rather, consider some of the anti-tumor aspects of Pu-erh enumerated in an article(1) supported by grants from the“Scientific Puer Action” program.
Well make mine Pu-erh! Great flavor, way more nuanced and full-bodied than green, and stops tumor cell cycles dead in their tracks!
Saturday, February 02, 2013
“[Mark] Lauren broke, and still holds, the Department of Defense’s long standing “underwater record” by swimming 133 meters, on one breath, subsurface, for 2 minutes and 23 seconds, until losing consciousness.”
You can’t beat those creds for an exercise guru. Seriously though, not only can Mr. Lauren successfully train Special Ops forces, he’s developed a home-based, no equipment purchase required, fitness program first outlined in “You Are Your Own Gym” now tailored to meet the time constraints and physical requirements of women. Based on “bodyweight” exercises, this program requires only that you pit your own weight against readily available surfaces such as doors and their handles, floors, tables, counters, stools, and chairs.
While I admit that I have issues with doors as props, picturing my husband saying “Now tell me again how this door ripped off its hinges,” I found this little program quite the heart-pounding challenge all accomplished within eighteen minutes in the privacy of my own kitchen. Basically, you pull, squat, push, and bend your way through a routine that is clearly explained in prose and in pictures. So four categories with 25 graded exercises within each one for a total of 125 bodyweight maneuvers, many of which I will never perform in this lifetime (e.g. one-arm push-ups with hand elevated hip height and 2-second pauses).
That said, Mr. Lauren expects that you will progress only as far as you are able and at your own pace, and he fully explains how to advance without injury. His patter through the book is encouraging, complete with enthusiastic sidebars titled “Hooya” which must be military talk for “you can do this” and “don’t give up soldier-girl.” As with all habit changes—weight loss, diet change, smoking cessation, or exercise plans—this program will only work when you’re really ready to do it. But if the expenditure of time or money is your stumbling block, this could be the plan that changes your life and your body.
Thursday, January 10, 2013
So how many of us are normal in a BMI sort of way? According to recent US data, roughly one-third of adults have bypassed normal into overweight (BMI 25-30) and an additional one- third weigh in at obese (BMI 30 and above). Epidemiologists warn that the obesity epidemic is increasing the incidence of chronic disease.
Statisticians from the CDC conducted a meta-analysis (combining data from many studies) of nearly 3 million subjects from 97 separate studies that looked at all-cause mortality over time as related to BMI(1). Relative to normal BMI, the researchers compared the risk of dying in those overweight (BMI 25 to 30) and obese (BMI 30 and above). The researchers used hazard ratios (HR) to express their findings, a measure of how often a particular event happens in one group compared to how often it happens in another group during the course of a study. They found that the overweight and the grade 1 obese were slightly less likely to die than those in the normal BMI range (HR=.95). On the other hand, those with BMIs at or above 35 had a calculated HR of 1.29, nearly a third again more likely to check out early than those weighing less.
Sunday, March 20, 2011
If you've not had a panic attack, you can scarcely imagine what they are like. When I diagnose patients with this condition, they all nod when I describe panic as not so much a feeling of "I'm so anxious" but a frightening conviction that "I will pass out" or “I will die.” As opposed to anxiety, panic attacks are intense and episodic, occurring abruptly with or without a particular trigger. They cannot be banished with rational override. If they are not recognized as panic, they often result in expensive overuse of medical services through visits to ERs, cardiologists, or pulmonologists. Theories abound on the biological underpinnings of these show-stopping events.
Panic attacks often include a subjective feeling of not being able to get a deep breath accompanied by the need to yawn or sigh in order to improve the situation. Conscious attention to breathing overrides the automatic regularity of inhalation and exhalation, a state I've dubbed "too much minding the matter.".As a result of disordered breathing, panic victims suffer disturbances in body levels of carbon dioxide, either hypercapnia (too high) from shallow breathing or hypocapnia (too low) as a result of hyperventiliation.
Oddly, variances in either direction have been linked to the onset of panic attacks. Shallow breathing or hypoventilation produces hypercapnia which in turn induces a fear of suffocation--think buried alive or stuck in a mineshaft rebreathing air increasingly devoid of oxygen. Some researchers believe that panic patients have an overly sensitive internal suffocation alarm--any rise in carbon dioxide levels sets off a frantic 'gotta’ get outta here now' reaction. Conversely, hyperventilation produces hypocapnia which causes a constriction of airways and an unpleasant awareness that each inhaled breath is insufficient. Either way spells panic for susceptible souls. Many people with panic complaints often lose that frantic focus on breathing while exercising as aerobic activity drives a deep and regular breathing pattern.
Newer research suggests that a hormone that plays a role in wakefulness may contribute to panic attacks. Before considering how high levels of orexin (orx) turn ordinary citizens into panicky wrecks, here’s some interesting background on this hormone also known as hypocretin. Brain cells that release orexin are found in the hypothalamus and are active during waking hours and inactive during sleep. Orx receptors exist throughout the brain and are activated by orx release. A lack of orx-producing neurons causes narcolepsy—a condition associated with unpredictable and sudden attacks of sleep. Researchers have used orx-antagonists which block the effects of orx to induce sleep in lab animals and humans.
Pharmacologists at Wake Forest University administered orx as a nasal spray to a slew of sleepy monkeys to see if they could rouse sufficiently to perform complex mental tasks(1). The monkeys, like your average teenager, were kept awake with videos, music, treats, and interacting with humans ‘til all hours of the night. As you can see from the PET scans above, snorting orx changed great scads of sleepy blue brain material into red, glucose-metabolizing neurons hard at work on image-matching tasks, and the orx-treated group performed circles around their sleepy colleagues. Imagine squirting your comatose teen with orx on a school morning!
So what’s orx got to do with panic? Psychiatrists at Indiana University found that panic-prone rats were over orx-ed(2). Not hard to imagine if a little orx is good for alertness, too much orx would result in a tightly wound rat—or human—jumpy, easily startled, and prone to freak out. And the more active the orx neurons in the rats, the more their paniclike behavior increased.
Not satisfied with rat data alone, the investigators somehow persuaded humans with panic disorder to undergo spinal taps, checking for levels of orexin bathing their beleaguered brains compared to others free from fear. Sure enough, orx levels were much higher in the panic-prone. Someday, orx-antagonists that block orx receptors may be a non-sedating, non-addictive approach to panic control.
1. Deadwyler, SA et al. Systemic and nasal Delivery of Orexin-A Reduces the Effects of Sleep Deprivation on Cognitive Performance in Nonhuman Primates. Journal of Neuroscience. 26 December, 2007, 27(52): 14239-14247.
2. Johnson, PL et al. A Key Role for Orexin in Panic Anxiety. Nat Med. 2009;16:111-115.
Tuesday, March 08, 2011
But Jack came back the following week, yet again shouldering grave doubts. A second opinion from another orthopedist confirmed the original diagnosis of a torn rotator cuff. So what was on Jack's mind? He was agonizing over the fact that Dr. Two took a repeat set of shoulder films. Not the unwarranted expense that now worried Jack, however, he was near tears over the possibility that this extra radiation would significantly increase his future risk of cancer.
So what's the scoop on medical imaging and cancer risk? Radiation from any source is not only a cancer inducer, turning healthy cells into pre-malignant ones, but also a cancer promoter which can push these compromised cells into a more abnormal state. Radiation danger is compounded through a lifetime of ionizing destruction; years of exposure compounding today's CT with yesterday's tan. If you'd like an estimate on your annual irradiation, check out the interactive quiz at American Nuclear Society's website.
If you're not an internet quiz type, let me inform you that a single CT scan can deliver a radiation dose equal to dozens of shoulder films. And there's no particular standardization here; radiologists can adjust their sets to enhance detail, and the higher the dose, the crisper the image. As a result, concerned specialists have banded together in various self-policing initiatives to rein in the rads, among them Image Gently setting guidelines for testing children and Image Wisely for adults. Nevertheless, the estimated annual number of CT scans in the US rose from 3 million in 1980 to 67 million in 2006 and the numbers continue to climb. Scarcely an ER visit goes by for one of my patients without an accompanying CT procedure. And one CT begets another when "incidentalomas" are found (unexpected abnormal findings of unclear significance) that require future scans to clarify their nature.
Based on data from survivors of the atomic bombings in war-time Japan, biophysicist David Brenner estimated the lifetime risk of cancer for a child undergoing a single abdominal CT as one in 1000. While other experts take issue with both his calculations and his conclusions, all agree that rads must be reduced.
One of the most innovative approaches comes from Mass General Hospital. Docs there created a rather complex program that scores the appropriateness of the choice of a diagnostic CT as compared to other imaging techniques for any particular clinical situation. The software shares this info with the ordering physician who is then offered the opportunity to change their minds and their orders. This software replaces the aggravating insurance pre-authorization procedures that Dr. James Thrall has dubbed "1- 800- may- I- do- a scan." Once this process was in place, CT use at MGH dropped considerably.
There is no doubt that CT technology has been critical to the accuracy of diagnosis since its inception. Pre-CT scanning (back when I was a doc-lette in training), diagnosing brain tumors involved a horrendous procedure wherein air was introduced into the spaces around the brain (as demoed graphically in "The Exorcist"). CT scans are perfectly appropriate even while over-ordered. Ask your doctor, however, what your other choices might be when offered such tests.
Saturday, March 05, 2011
I stay in touch with the world in the course of a night as things that go bump in the night make me jump. Ringing phones send me into a hot flash of anxiety and insomnia even if it's just the gentle whir of a cellphone on vibrate! Last night, my husband's cell went off at 3:30 a.m. one floor and half the house away. He snoozed on while I tossed and turned.
No doubt that many--e.g. mothers, doctors, and plumbers--all need a heightened nighttime awareness of the world, but this sleep-searing sensitivity can get out of hand. "Resistance to acoustic disturbance" is a measure of sleep soundness and is known to vary during the course of a night's sleep and also from sleeper to sleeper. Scientists are hot on the trail of why.
Nocturnal observations of 13 sleepers sleeping in a Massachusetts General sleep study lab revealed certain brain wave characteristics that predicted whether or not an individual would rouse to the noise of traffic or phones(1). As we transition from wakefulness to sleep, certain patterns emerge in our brain wave patterns signaling a shutting down of external awareness and a growing hubbub of internal brain activity. Alpha waves that flow from the back of our brain decline in amplitude as we drift into sleep. However, this wakeful wave does not disappear entirely, and, in fact, the more powerful these alpha signals, the more fragile our sleep.
The scientists confirmed that increased alpha activity as seen on EEG prior to the delivery of an external sound increased the likelihood that the subject would rouse unto wakefulness in response to the noise. Thus, alpha activity in the brain not only correlates with mental alertness by day but easily disturbed snoozing by night. The researchers concluded that this information may someday allow for the over-alpha'd amongst us to be variably medicated based on read outs from sleep monitoring devices rather than bluntly sedated for hours by currently available meds.
Sounds kind of "Brave New World"ish to me. And who then will lie awake waiting for teens?
(1) McKinney SM, Dang-Vu TT, Buxton OM, Solet JM, Ellenbogen JM (2011) Covert Waking Brain Activity Reveals Instantaneous Sleep Depth. PLoS ONE 6(3): e17351. doi:10.1371/journal.pone.0017351.
Saturday, February 19, 2011
Good news here is that this year's shot, for those of you who got it, is a good match for the strains currently flying through the air in projectile spittle. The CDC's latest update confirms my observations that true influenza is here, and the predominate strain is A/H3N2 which is not that scary H1N1 "swine" flu that showed up last year (although that one's going around as well). The H3N2 virus hits hardest amongst young children and older adults. And I'm here to tell you that the in-betweeners are pretty darn miserable too.
If you have an underlying illness such as asthma or COPD, beat feet to your doc's at the first sign of true flu. This year's strains are still sensitive to Tamiflu, but official recommendations are that this drug only be given to those who either are at risk for or suffering from progressive disease.
Sunday, November 21, 2010
The perfect personalized gift this holiday season--a work of art based on the recipient's unique genetic sequence. If you can only figure out some sneaky way to swab their inner cheek without raising suspicions, you then mail off the sample to Yonder Biology who will turn it into a "beautiful genetic image" on photographic paper, stretched canvas, or acrylic face mount at prices ranging from $99-$1,199. Add a "Me" t-shirt for an extra $34!
Whether or not you choose this route to self-expression, it's a fun web-site. Check-out:
Sunday, August 01, 2010
Gracious, hilarious, and soothing, she told me that she viewed death as "just showing up for my next assignment. An angel in life, she has ample experience for her upcoming gig.