Wednesday, December 27, 2006

My new AIM buddy icon based on status of my brain cells. Per my brother:

"Greek tragedy meets acid indigestion."
Tired, grumpy, facing another blizzard in the forecast and the end of my daughter's visit, I dressed without care for the drive to the airport this a.m. Gray fleece, black pants, red and green striped socks, blue suede shoes. Never thought how that would appear to Subaru service department which was stop number two after dropping off the kid at DIA.

Worse yet, problem with rear window defroster was merely this...I was pushing the wrong button. Dressed like a middle-aged frump AND pushing the wrong button! Am I losing my buttons here?

Turns out what I always told my children as they slinked self-consciously through adolescence is true: No one cares how you look. The service rep never even looked up from his computer screen as I sheepishly retrieved my car.

Thursday, December 21, 2006

It may take a village to make you overweight. New evidence suggests that those bacterial hangers-on living in your gastrointestinal tract may be partly to blame for the state of your waist.

Microbiologists at Washington University in St. Louis checked out the gut bugs in mice of various sizes. The docs found that the resident GI fauna differed predictably based on the size of the host.

Furthermore, when the researchers analyzed the intestinal microbes of obese people, they found the population skewed heavily towards Firmicutes and short on Bacteroidetes compared with normal weight controls. After weight loss, the little Firmicutes lost ground to a growing group of Bacteroidetes, assuming a pattern more consistent with that of their leaner colleagues.

If mousy microbes are at all indicative of those that we carry through life, here's what your little gut friends may be doing to you:

Microbes from the obese mice had more genes for processing starches and complex sugars and produced more simple sugars and fatty acids--that is, calories--for the gut to absorb.

Things to do in Denver when you're snowed in

Wednesday, December 20, 2006

If we go back on our four legs and get down on the ground, we may be able do things we had no idea we could do.
--Neuroscientist Gordon Shepherd, Yale University

Dr. Shepherd was commenting on a recent informal study out of California that tested a group of undergrads with respect to their ability to track prey using their sense of smell. The Berkeley researchers conducting the experiment dipped 10 meters of twine in a distinctive scent and outfitted the 32 volunteers in earmuffs, gloves and kneepads so they couldn't use sensory cues other than smell.

Two-thirds of these game subjects successfully followed the 'game' trail, scooting on hands and knees across the grassy knoll like dogs in pursuit of a squirrel (There's actually a brief film clip of the merry chase on the ScienceNOW web-site!).

And the scent? Chocolate, of course. So if you ever need to track a chocolate bunny in the night, chances are good you'll not go hungry.

Monday, December 18, 2006

Happy Hanukkah from Femail Doc and her brother Bob
Attention can act as a beam of spotlight. A good mood broadens that beam.
--Psychologist Adam Anderson of the University of Toronto

So if you don't want a broad beam? Narrow it, says Dr. Anderson, by working yourself into a nasty snit, then go balance your checkbook. Or help your son study for his anatomy test. Or do the day's charting. Bring 'em on, I'm in the mood.

Saturday, December 16, 2006


My friend Anita says this should be an inner mantra for aging ladies. Yesterday, I forgot to be mindful of toe positioning at the Cherry Creek Mall, and got caught up instead with the shopper's mantra: IwannagohomeIwannagohomeIwannagohome

Worse yet, was carrying a shopping bag with six champagne flutes when I hit the unforgiving floor in front of six thousand other people (many of whom were kind enough to inquire about my well-being post-kneeplant). Now, IgottagobackIgottagobackIgottagoback.
This from Dr. Peter Ravdin of the M.D. Anderson Cancer Center on newly released data that showed a decreased incidence of breast cancer within one year of the termination of the Women's Health Initiative hormone therapy study:

What we think is going on is that about half of the cancers that were just below the detection range in 2002 in women who were taking hormone replacement therapy actually stopped growing or regressed when they stopped [HRT].

Friday, December 15, 2006

Big news about hormones and breast cancer today. For more information, see Not forever, not for everybody.

Tuesday, December 12, 2006

Good genes, bad circumstances

I had the pleasure of eating lunch out today with a friend. We sat on an enclosed patio, roasting pleasantly under a heat lamp, chatting over a delicious lunch of pasta and bread. This is not your ancestors' dining experience.

The human genome was perfected during the Ice Age, and the humanoids that survived to pass their perfected genes on to future generations assembled genetic material perfectly suited to cold, famine, and obligatory exercise.

So toasty, overfed, and happily seated is not what brings out the best in our bodies. Good for the soul, however.

Monday, December 11, 2006

Screening wars

And forty-something breasts caught in the crossfire. A large study of nearly 17,000 UK women in their 40's again highlights the risk/benefit considerations of regularly screening youngish women--with smaller cancer risks--for breast cancer.

The benefit, of course, is the chance to catch a cancer before it catches on. The risks include the significant possibility of 'false positives,' cancerish sorts of changes on the mammogram that turn out, after much anxiety, expense, and biopsy procedures, to not be cancer. But here's a comment from the commenters (editorialists in the Lancet journal about another dilemma:

Every woman, with her physician's guidance, should decide whether regret will be greater if she develops breast cancer that could have been detected earlier by screening mammography, or if she develops breast cancer later in life as a result of screening mammography itself.

Saturday, December 09, 2006

Greens against cancer

Gotta love those greens. Per the women of the Iowa Women's Health Study, those in the highest quartile of greens consumption had less than half the ovarian cancer risk of those eschewing greens.

But there's the problem, how to cook the greens so you can chew them? A patient of mine says boil them for 2 and 1/2 hours. She favors turnip greens, or green turnip green pudding after cooking that long. After all that cook cook cooking, is there any goodness left for the fight against cancer?

Thursday, December 07, 2006

Blink-proof holiday photos

Just in time for group shots of the fam' at Christmas dinner, this from the June issue of Velocity magazine. Physicist Dr. Piers Barnes explains the chances that all the folks will have their eyes open when the shutter snaps:

Piers says the probability of one person spoiling a photo by blinking equals their expected number of blinks (x), multiplied by the time during which the photo could be spoilt (t) - if the expected time between blinks is longer than the time in which a photo can be spoilt, which it is....

Piers then figured out how many shots I'd need to be 99% certain of getting a good one. He found that photographing thirty people in bad light would need about thirty shots. Once there's around fifty people, even in good light, you can kiss your hopes of an unspoilt photo goodbye.

Tuesday, December 05, 2006

Holding on to your teeth

I'm always gathering data on how to make it to the finish line with all parts intact. Information from the Leisure World Study--can you imagine living in a community with that name?--suggests that estrogen therapy helps women hang on to their teeth.

This study of nearly 9,000 old ladies in the Laguna Hills of southern California found that those women who reported long term use of estrogen were more likely to have their own teeth a decade or more after the study began. They were also one-third less likely to lose their minds to Alzheimer's Disease.

Monday, December 04, 2006

Remember your dreams

I recently found a blog that recommended a three step approach to remembering more dreams: 1) Make a conscious decision to remember your dreams, 2) Write them down as soon as you awaken, even if it's the middle of the night, 3) Become more aware of the details of your environment during the day.

I've done tips 1) and 3). And while I'm aware that I am dreaming more, I can't remember a thing about them. Guess tip 2) is critical, but I think writing in a dream log would wake me up completely.

Meanwhile, a word or two on drugs and dreams. Nexium gives me vivid, dreadful nightmares. I've heard that from one other person. Melatonin gives me a weird night's sleep and weird dreams--too bad, the sleep aid is supposed to be crazy good for your brain. Progesterone also enhances dreams.
We've got LDL-cholesterol lowering down, easily and safely accomplished through the use of statins. HDL-cholesterol--that's the good stuff as in the more the merrier--is a different matter. At the same time that HDL levels are hard as hell to budge, this worthy high density lipoprotein (responsible for toting cholesterol from the peripheral cells back to the liver for elimination) is increasingly in the spotlight as equally if not important than LDL levels in determining cardiac risk.

I was hopeful that a new drug would soon be available to hoist up HDL effectively; early clinical trials indicated that torcetrapib could boost HDL by nearly 50%. Not going to happen; recently halted clinical trials also indicated that significantly more persons in the active treatment group died compared to those on placebos. Back to the drawing board on HDL-raising drugs. Meanwhile: exercise, wine, and weight loss are the best approach currently available to do the job.

Saturday, December 02, 2006

Spotty physician counseling

Ouch, that hurts. The authors of this particular article published in the Archives of Internal Medicine do, however, have a point. They found that we physicians fail to communicate important points about medication use to our patients. This includes duration of use, possible side effects, and potential interactions with other drugs.

Shoot, guilty as charged. More than once I have discovered that a patient quit her new meds after the first prescription's worth, thinking a single month of therapy would take care of a chronic problem such as elevated cholesterol or hypertension.

Thank heavens for pharmacists who pay attention to the drugs you're on and possible conflicts between all those that you take. We are often called to clarify dose or drug name, or given a heads up that a drug we've prescribed may interact with therapy already underway (just last week because I added the antibiotic Zithramax for a patient already on Zocor).

I know my part: pay attention to the entire picture and take the extra time to explain. Your part as drug-using patient according to the authors of this article?

Ask questions about the medication name, dose, and purpose; how, when, and how long to take the medication; possible adverse effects and what to do if they arise; what food, drinks, other medicines, or activities should be avoided while taking the medication; and what should be done if a dose is missed.

And I would add that you should use one pharmacy for all your prescriptions. These well-trained pharmacists do pay attention to all your meds and do notify me when I've made a choice that may not fit with your health history.

Friday, December 01, 2006

It's a wonder I get anything done. I did shovel the walk, do two loads of wash, and register a car at Denver Motor Vehicle today. But this evening, all I've accomplished is to follow a meandering line through the web that led from an article about tamoxifen and wound healing to an interesting new product for wrinkles.

My journey started with an article from the Archives of Facial Plastic Surgery about tamoxifen. Apparently, physicians have noted that women on tamoxifen have delayed wound healing but better scars. Tamoxifen delays cellular division in skin cells called fibroblasts by decreasing the production of various growth factors (GFs). These GFs are a good thing if you happen to slice your thumb open with the cat food can. But if you are an exuberant GF producer, even piercing your ears can result in an unsightly pile-up of skin known as a keloid or exuberant scar.

Now plastic surgeons hate exuberant scars, and the authors of this article proposed that tamoxifen may some day prove clinically useful in their profession to minimize scar formation. But I'm thinking a dense layer of fibroblasts below aging skin might be the very anti-wrinkle solution. So off to PubMed to check out whether anyone but me had the bright idea of putting transforming growth factor (TGF) into a topical cream.

And yes indeed, Topix pharmaceuticals had that very notion, and they combined TGF with vitamin C and black cohosh extract into Cell Rejuvenation Serum (aka CRS which also stands for Can't Remember S*** amongst women of a certain age). Preliminary studies suggest this dandy CRS significantly increases collagen production and decreases the appearance of wrinkles.

Shall I order some for sale through the office?

Thursday, November 30, 2006

You snooze, you lose?

I've always wondered at my patients who get up early--really early--to go exercise. Losing sleep to lose weight may be a losing proposition. Multiple studies suggest that short sleep duration is associated with obesity. So sleep in and skip the pumpkin latte--that's a better strategy for health.

Tuesday, November 28, 2006

I tell people to think of this like a marble in a
bowl of Jello-- you can compress the Jello, but the
marble won't compress or change size.
Richard G. Barr, MD

Elasticity breast imaging. Doesn't sound like a test at which aging women would excel.

Elasticty ultrasound, however, may be an up and coming way to evaluate suspicious breast lesions. If the results of a study of 80 women are confirmed in larger samples, this test may some day significantly reduce the number of unnecessary biopsies.

The new technology measures the movement of tissue, and malignant tissue just doesn't wiggle like a bra-ful of jelly. In the small series of 80 women with suspect breast lesions, the elasticity ultrasound correctly identified 100% of the cancerous tumors and was 99% specific in identifying only cancers and not benign growths.

Monday, November 27, 2006

Slouch not

But neither should you sit at the computer in a bolt upright postion. Scientists have confirmed that book-on-head perfect posture is as hard on the backbone as schlumping in our chairs like vultures feeding on prey.

The Scottish radiologists used MRI imaging to watch the effects of various seated postures on the back dynamics of young adult volunteers. The first scans were done while the subjects were lying on their backs, a position which stresses the discs between vertebrae not at all. Subsequently, the group was positioned for follow-up imaging while sitting upright in a "90% position" with the spine at a right angle to the thighs, again while slouching forward as if hunkered over a keyboard, and finally while reclining slightly with knees below the level of the hips "much the way a Formula One race car driver sits in the cockpit of the car."

Turns out that race car drivers have the formula one should use while seated through the workday. When the angle of the trunk to the thighs is 135 degrees, the MRI's demonstrated the least amount of squash to the intervertebral disc and the central nucleus pulposus (the part of the disc that gooshes out with ruptures) remained well-centered.

For those of us who do not work out of racing cockpits, the doctors recommended sitting on a well-inflated exercise ball high enough to allow our knees to drop below the level of our hips. Try scooting forward in your chair right now so your knees drop down and your feet hook back behind the front legs of your chair. My lower back feels better already!

Sunday, November 26, 2006

Brush and dab bests scoop and smear

Those of you of a 'certain age' are trying to come to grips with colon cancer screening. If you are like me (she says smugly), you've signed up for your colonoscopy or already have had it. If you're like me in 2005, you're fretting endlessly over whether or not to have a colonoscopy at all.

In the a-little-is-better-than-none-at-all world of colon cancer screening, perhaps you have agreed to have your stool analyzed for occult blood. The rationale behind stool testing is that precancerous polyps or early colon cancers tend to bleed in a microscopic sort of way. So even though you can't see it, special tests can detect even small amounts of blood in your solid waste.

A recent study out of Australia suggests that scraping at your stool and smearing it on a card is yesterday's news, and thank heavens for that. Instead, a tidy little test called InSure which allows you to swish a brush over your production as it sits in the toilet and then dab the results onto a mailing card is not only more agreeable to perform but more accurate.

The InSure test was half again more likely to detect a cancer and nearly twice as likely to detect a complex polyp called an adenoma--a colonic goomba with cancerous potential. So until you get up the nerve to go for the scope, request the InSure test for your annual close encounter of the turd kind.

Friday, November 24, 2006

Falling often, and falling fatally

People are living longer as frailer adults, more prone to falling. As a result, the rate of falls resulting in disability or death is significantly higher than it was a decade ago.

My frail old mom just started using a Soloflex Whole Body Vibration system ( in the last few weeks. This device--a sleek black bench low to the floor--is supposed to enhance muscle and blood vessel tone, balance, and bone strength in just 10 minutes per day.

Unfortunately, one small step up on a shaking platform is one small step too much for a shakey old lady. So she sits on the side of her bed with only her feet on the bench for her daily 'work-out.'

Interestingly, just this little shake-up has resulted in increased feeling in her numbish feet. I am hopeful that more sensitive feet means surer footing as she navigates around her apartment.

Sunday, November 19, 2006

The British Medical Journal studied smokers and their deteriorating lung function over a lifetime of inhaling.

By the time the study subjects first became symptomatically short of breath around age 58, they had lost 50% of their lung function. They were severely disabled by age 65 when their lung function was 75% gone, and by age 70 they were dead of COPD (chronic obstructive lung disease).

Those smokers, however, who quit at age 45 added 10 additional years on to the point at which they were first symptomatic, and did not experience severely disabling symptoms until age 75. And finally, those smokers who quit at last with the onset of severe disability at age 65 added 5 addtional years to their life.

Saturday, November 18, 2006

If it's not one cancer...

Then it's another. As if getting successfully through one cancer diagnosis is not triumph enough, Danish investigators sorting through a half million records found that women who survived breast cancer had a 25% increased risk of contracting a new primary nonbreast cancer in 57 years of follow-up compared with women cancer-free from the outset.

The scientists suggested several reasons why this might be so including: a genetic susceptability to cancer, shared environmental risk factors, the result of previous cancer treatment, and increased surveillance.

Friday, November 17, 2006

Flu shots

We will finally have flu shots available next week. If you have not yet gotten one, consider making an appointment to get vaccinated soon. While most people survive the flu, it can certainly take a week or two out of your life.
Coughing it up in the waiting room

My waiting room, not necessarily a pleasant place to sit through the cold and flu season. Two things to consider before you join the hackers and wheezers out front:

1. This from the latest issue of the NEJM:

Cough after acute bronchitis typically persists for 10 to 20 days but occasionally may last for 4 or more weeks.

If you're no longer feeling ill but still coughing, join the crowd. Especially in Denver's dry, dusty, cold winter air, coughs go on and on and on.

2. If you need a prompt appointment, consider Thursdays. For some reason, this is a quieter day at the office, and you may be less likely to share air space with someone who's got an illness that you don't want.
Wrinkled old knees

Or rather, a new wrinkle in treating old knees.

Maren Mahowald, a Minneapolis MD, found that botox injections into the aching knees of patients with severe pain from osteoarthritis caused a significant drop in discomfort. These patients were not candidates for knee replacements. Interestingly, the worse the pain, the better the response.

Here's strong praise for the possibilities:

One of the most provocative things that have come down the pike for the treatment of osteoarthritis in a long time.
--Robert Wortmann, MD, University of Oklahoma College of Medicine

Wednesday, November 15, 2006

Depression is bad for your heart

Well, no kidding. But now investigators are uncovering the specifics as to why depression increases the risk of cardiovascular disease.

In a study published in the Archives of Internal Medicine, Maryland researchers checked out C-reactive protein (CRP) levels in nearly 7,000 people. They found a significant association between depression and CRP which is a measure of inflammation in the body and known to predict cardiovascular risk.

Treatment with antidepressants has been linked to a decreased risk of heart attack in depressed persons, in part scientists theorize because some of these medications have anti-platelet effects. This study suggests, however, a direct link between depression and low level inflammation in the body which in turn is detrimental to blood vessel health.

Monday, November 13, 2006

Bye bye B's

Women who are taking them solely for that purpose [to slow the development of cardiovascular disease] may want to discontinue.
--Christine Albert, Brigham and Women’s Hospital, Boston, Massachusetts

5,000+ women participating in the Women’s Antioxidant and Folic Acid Cardiovascular Study were randomized to folic acid/B12/B6 supplements or not to see if lowering their homocysteine levels with the B vitamins would lower their risk of cardiovascular disease.

Over 7 years of being B-less or B-ful, no differences were noted in the rates of heart attacks or strokes. Dr. Albert noted that these findings "provide support for homocysteine as a marker of pre-existing CVD rather than a risk factor."

Sunday, November 12, 2006

Brains vs. Breast

This is not a commentary on the merits of beauty pageants, but rather additional information for those of us who dither endlessly about the best therapeutic course through menopause and beyond.

Finnish researchers took samples of normal breast tissue obtained at the time of tumor surgery from otherwise healthy women. When these breasts cells were nurtured in the laboratory along with estradiol and/or medroxyprogesterone (aka Provera), all hormonally-exposed cells demonstrated increased growth, decreased apoptosis (the normal death of breast cells that occurs on a regular basis throughout our reproductive lives), and a loss of differentiation. In other words, the cells increased in number causing them to become more susceptible to potential carcinogenic mutations while losing characteristics of normal breast tissue. Arggh! Time to flush the estrogen down the toilet?

Up the road a ways at the brain, however, the news was better. Noted neuroscientist Roberta Diaz Brinton and colleagues cultured cells in the lab as well, checking for the effects of estradiol on neurons. Hippocampal cells (the little darlings in charge of memory function) ducked destruction from beta-amyloid protein--the Alzheimer's villain--when they were pretreated with estradiol prior to amyloid exposure.

While we wait for Dr. Brinton and others to identify an estrogen-like molecule that neurons love but breast cells ignore, which will it be, brains or breasts?

Saturday, November 11, 2006

No more delicious, crispy, french fries for me

Trans fats, can live without them. These manufactured fats start life as a perfectly worthy vegetable-derived fatty acid molecule that's bent in at least one position on its long carbon chain--called a cis unsaturated fat. As a result of a partial hydrogenation process, the newly straightened out trans fat molecules are: 1) solid at room temperature, 2) resistant to aging in a rancid sort of way, and 3) full of that great fatty mouth feel found in foods we love to eat but should avoid.

Trans fats are known to elevate levels of cholesterol and triglycerides which, in turn, is known to increase risk of coronary heart disease (CHD). The elevated incidence of gummed up arteries, however, attributable to trans fat intake exceeds that which would be predicted by cholesterol levels alone. Trans fats actually upset endothelial cells--the worthy little cells that line blood vessels--causing them to produce cellular alarm signals as if they were under attack by bacteria or traumatized from a bagel knife.

Food manufacturers are now required to post trans fat content on food labels. Be aware that manufacturers of foods that contain less than 500 mg of trans fatty acids per serving are allowed to list their trans fat content as zero.

Friday, November 10, 2006

For those of you who take comfort in the fact--and I hear this a lot--that "there is no breast cancer in my family:

We don't know why most women get breast cancer. Only one out of 10 or one out of 20 has inherited a germline mutation from her parents, so that means that 19 out of 20 women who get breast cancer get it because of something that happened after they were born.

--Devra Davis, PhD, MPH, University of Pittsburgh

Tuesday, November 07, 2006

Signs of sinusitis

So what's it take to get an antibiotic prescription these days? It's not just the arbitrary whim of a doctor too harried to argue nor a pharmocological sympathy vote for the best hard luck story of the day. I'd like to banish your bug before your long-planned trip to Ireland too, but there is a bit of science to discerning that which responds to antibiotics and a lot to lose if these medications are too freely prescribed.

Researchers at the University of Oslo set out to answer that age-old riddle, how do you tell a Norwegian with bacterial sinusitis from one with just a cold? They identified four clinical factors that separated CT scan proven sinusitis (as in responds to antibiotics) from the great viral pretenders: 1) A history of purulent--as in nasty, colored--drainage from the nose, 2) tooth pain, 3) seeing that yucko stuff in the nose on exam, and 4) an elevation of a blood test called the erythrocyte sedimentation rate which is an indication of inflammation and infection. Sickly Norwegians with three out of four of these miserable signs had an 86% chance of having sinusitis, and the diagnosis could be made quickly and without costly imaging studies.

An additonal important clue noted by Dr. Morten Lindbaek was a history of a two-phase illness that's lasted at least 7 days. In other words, a patient begins with a common cold that abruptly gets worse and lasts longer than average, presumably due to a secondary bacterial sinus infection. Dr. Lindbaek found that the majority of patients with CT-confirmed sinusitis had symptoms for a week or more while those with shorter illnesses generally had clear-headed scans.

Saturday, November 04, 2006


Chemotherapy, especially in women undergoing treatment for breast cancer, can be associated with confusion and memory problems. For several of my patients, the mental fall-out from treatment has been far more distressing than the cancer diagnosis.

Several studies of note have appeared recently in the medical literature regarding chemobrain--including its causes, longterm outlook, and treatment:

1. An imaging study done at UCLA utilized PET scan technology to measure changes in blood flow and brain cell metabolism after chemotherapy. They found that key regions in the frontal cortex in charge of memory and 'executive functioning' demonstrated functional changes as much as 10 years after treatment. Lead investigator, Dr. Daniel Silverman, noted: "We found that the lower the patient's resting brain metabolism rate was, the more difficulty she had performing the memory test."

2. Ohio researchers improved focus and memory function in a group of 'chemobrainers,' 94% of whom were women post-therapy for breast or ovarian cancer, with the use of a purified form of methylphenidate (Ritalin) called Focalin. This medication is used for treatment of ADD. Focalin is known to improve function in brain pathways utilizing the neurotransmitter norepinephrine which enhances attention and focus, and chemotherapy is believed to alter neurotransmitter levels.

3. A large study of cancer survivors age 65 and older did not show an increase in dementia diagnoses within the first 2 years after chemotherapy treatment. The authors theorized that chemobrain may cause more short-term changes in memory rather than the permanent and profound disruptions that lead to Alzheimer-like diseases.

Saturday, October 28, 2006

I hate lung cancer. It's usually caught too late so it's too often fatal. My mom survived lung cancer 15 years ago because a totally unrelated problem brought her to medical attention long before the cancer would have reared its nasty head.

Good news then in a recent New England Journal of Medicine that screening CT scans in high risk persons can markedly improved the outlook in lung cancer survival. More soon.

Thursday, October 26, 2006

5,976 minutes...

To a sneeze-free you. Seattle investigators set out to see if regular exercise reduced not only the waistline, but also the risk of upper respiratory infections.

They invited 115 overweight old gals down to the gym to participate in a year's worth of supervised fitness activities. Half of this postmenopausal bunch were assigned to regular aerobic classes while the other half stretched and chatted.

At the end of nine months, the aerobic group had not met their goal of 45 minutes of hot sweaty work-outs at least five days per week. They had, however, managed to dance to the oldies for an average of 166 minutes throughout the time period.

So, 36 weeks X 166 minutes = 5,976 minutes of activity (I did NOT do that in my head, but neither did I use a calculator). In the final 3 months, some 6,000 minutes into this exercise adventure, the fitter group got 1/3 as many colds compared to the stretchy group.

I am here to tell you, the sniffly parade I saw today in the office apparently had not yet read this study.

Tuesday, October 24, 2006

High old rats...

completed their maze tests better than the ones who didn't inhale. Does this bode well for boomers who indulged? Check out the next issue of Femailhealthnews.

Saturday, October 21, 2006

Chemo Brain Study in Denver

No news to those who've been through cancer treatments that chemotherapy is a mixed bag. Unexpected perhaps, and devastating, are the residual effects on brain function, leaving susceptible patients muddle-headed and forgetful.

An interesting new study confirms that chemo can cause long-lasting changes in brain metabolism and blood flow. More on that in the upcoming edition of femailhealthnews.

Meanwhile, University of Colorado Health Science Center investigators are seeking women 45 years of age and older, newly diagnosed with breast cancer, to participate in a study of chemo brain. Subjects will be enrolled prior to the start of their chemo treatments.

If you'd like more information on the study, contact, or call 303-724-2536.

Thursday, October 19, 2006

Dr. Martin Blaser, an infectious disease specialist at New York University, notes that C. difficile infections* require "changes in the intestinal micro-ecology." The most common culprit in such changes is a course of antibiotics, even a brief course.

"Even a few doses have been shown to have effects on intestinal flora that can last for years," according to Dr. Blaser. He adds:

Most physicians think that prescribing antibiotics is relatively low-cost. But cost always depends on context and in the context of an epidemic (of C. difficile), the costs are going up.
*See previous post

Monday, October 16, 2006

Another reason to avoid antibiotics

Cold season is here, another season of inconvenient illnesses interfering with trips, holidays, presentations, and birthday parties. Before you wish you could take antibiotics 'just in case' it might cut the illness short, be careful what you wish for.

A small series of patients from Philadelphia, including six young and previously healthy women, contracted serious intestinal infections caused by Clostridia dificile,. These bad boys are bacteria that overgrow after good bacteria are bumped off during antibiotic therapy. Three of these women received just one or two doses of antibiotics, three were pregnant, one had just had a caesarean delivery, and one of them died.

Check out sobering words from an infectious disease specialist tomorrow.
A word on coenzyme Q-10

This is the perfect supplement to a statin prescription.

Statins such as Lipitor and Zocor (now generic simvastatin) are known to decrease the risk of heart attack and stroke in at risk persons such as diabetics or those with elevated cholesterol. They interfere, however, with energy production in muscle cells because they decrease the production of ubiquinone, aka coenzyme Q-10. CoQ10 is a key player in the process through which our cells make ATP, the high energy molecule that powers all our body machinery.

Statin takers can develop muscle pain similar to that which develops after vigorous exercise or with the flu. NYU investigators found that achey patients had a significant decrease in discomfort when they downed 100 mg of CoQ10 each day along with their statin pill compared to a group who took vitamin E instead.

Saturday, October 14, 2006

Baked Brie with Nut Crust*


1/3 cup pecans
1/3 cup almonds
1/3 cup walnuts
1 egg
1 tablespoon heavy cream
1 wheel (8 ounces) Brie cheese
2 tablespoons raspberry jam

1. Preheat oven to 350°F. Place nuts in food processor fitted with steel blade; pulse to finely chop. Do not overprocess. Transfer chopped nuts to shallow dish or pie plate.
2. Combine egg and cream in another shallow dish; whisk until well blended.
3. Dip Brie (rind on) into egg mixture; then into nut mixture, turning to coat. Press nuts to adhere.
4. Transfer Brie to baking sheet; spread jam over top. Bake 15 minutes or until cheese is warm and soft.

Fat city!

Scientifically-sanctioned heaven here since the Spanish study (sponsored by the California Walnut Board) came out with evidence that walnuts can specifically counteract the adverse effects of high fat meals on blood vessels.

These Barcelona researchers are hot on walnuts. Their first study (see Nuts to blood vessels showed that a month of daily walnut consumption can improve blood vessel function.

This newest study found that a single walnutty but fatty meal can bring as much joy to your endothelial cells as it does to your soul. Sounds like Baked Brie with Nut Crust to me!

Friday, October 13, 2006

Dr. Ivan Schwab as a Dryocopus pileatus

Ever wonder why woodpeckers don't get headaches?

The pileated woodpecker, aka Dryocopus pileatus, strikes its feathered noggin against trees at a rate up to 20 times per second as many as 12,000 times per day. Dr. Schwab, who's studied such stuff, estimates this rap star generates forces equivalent to banging human heads face first against a wall at 16 mph!

So how does the noble woodpecker avoid brain damage and subdural hematomas with all this head-banging behavior? Dr. Schwab wrote a scholarly article on that very subject for the British Journal of Ophthalmology, citing among other protective mechanisms the woodpecker's spongy skull which cushions the blows. And its brain, which is tightly packed into the space, has little room to slosh around against the bony walls.

Contrast that with the shrinking brains of aging humans. These little old control centers float unsteadily in thinned-out skulls, swaying dangerously as frail feet stumble. If head meets bathroom wall after toe catches in bathroom rug, untethered blood vessels around the brain easily break and spill blood into the space between gray matter and bone.

Dr. Schwab concludes "So, when you complain about your headache, think of the industrious woodpecker." He received an IgNobel prize in biology for his work and attended the awards ceremony dressed as his feathered subject.

Wednesday, October 11, 2006

Cure for a Headache

Sometimes it seems that you are simply banging your head against a brick wall, as the frustrations of contemporary life seem to conspire against you. For us, life’s headaches are common enough, but what if you spent your life battering your head against a wall—intentionally? How would you avoid headaches, concussions, "shaken baby" syndrome, or even retinal detachments?

Intriguing words from Ivan Schwab of the University of California, Davis, Department of Ophthalmology. More tomorrow.

Sunday, October 08, 2006

Bulking up at home

This is not an exercise tip but rather a remedy for constipation.

Doctors often recommend psyllium, a non-absorbable plant fiber that adds a gelatinous sort of backbone to your stools to keep them moving towards the exit sign. Psyllium, however, can be expensive and a little creepy to use. So researchers at the University of Texas SouthwestenMedical Center in Dallas have found an easier solution.

Their urogynecology clinic schedule was backed up with constipated patients, so they invited 82 of them to participate in this little trial. Half were randomized to take 1 teaspoon of psyllium in 8 oz. of liquid each day for 6 weeks while the other half lucked out and received the tasty concoction noted below. All subjects kept bowel diaries.

[Dear Diary,
I hate to dump on you again, but I can't take any more of this gritty crap they are serving us each day in juice.

Both groups enjoyed a decrease in constipation scores, and the researchers declared the recipe "an effective and economical stool-bulking agent for the treatment of constipation.

Pantry Remedy for Constipation

1 cup applesauce
1 cup coarse, unprocessed wheat bran
1/4 cup prune juice

Cost over 6 weeks: $8.65
Cost for psyllium over 6 weeks: $16.72

Saturday, October 07, 2006

Anti-Hiccup Kit

As noted in a previous post, the long-anticipated IgNobel awards were announced last week. The prize for medicine went to an emergency room physician for a technique he pioneered 18 years ago to stop intractable hiccups.

Hiccups are generated by spasms of the diaphragm, and various techniques that stimulate the vagus nerve--such as breath-holding--may quiet its twitches. Apparently, Dr. Frances Fesmire discovered that digital rectal massage was an ultra-effective method for hiccups that just wouldn't quit.

He distributed the above kits to attendees at the awards ceremony.
The Mosquito ultrasonic teenage deterrent

I kid you not; this device is billed as "the solution to the eternal problem of unwanted gatherings of youths and teenagers in shopping malls, around shops and anywhere else they are causing problems."

The owner of the Spar shop in Barry, South Wales commented "Either someone has come along and wiped them off the face of the earth, or it's working" aftter the Mosquito drove away the anti social youths that congregated near his store, repelling the legitimate customers.

The device was awarded the Peace Prize at the annual IgNobel Prize award ceremony this past week.

Do you want one? Of course you do. Check out: Teenage control products.

Friday, October 06, 2006

Best of Denver 'There when you need 'em' Awards

I spent the entire afternoon on the phone today, calling patients or making calls on a patient's behalf. Gad it's hard to get service out of a specialist on a Friday afternoon; I sometimes think that Adele and I are the only ones holding office hours by week's end.

A special thanks then to Jody at Dr. Tom Reed's office who offered a prompt appointment to 'run both ends' (down the esophagus and up the opposite side) for my patient whose food was hanging up on the way down and on the way out. Also to Dr. Alan Synn who got a patient in without delay yesterday late p.m. for evaluation of a blood clot in her leg, then called me today with an update and an apology for not calling sooner! And to Dr. Friednash, the new lady dermatologist in with Dr. Meg Lemon who gave me phone advice on treating another patient's neck infection to get him comfortably through the weekend ("Just have him call me this weekend if he's having trouble."). And to Dr. Claudia Panzer, a delightful endocrinologist, who will actually see a patient within two weeks of their call.

Tuesday, October 03, 2006

Mercury mangles S mutans

I've spent the morning chauffeuring my aging mother to her dentist for two root canals. If we, as my hygienist told me, tend to outlive our teeth, here's a bit of good news about those supposedly toxic mercury fillings that abound in aging mouths such as mine.

German researchers counted the cavity-causing Streptococcus mutans clinging to various surfaces artificially inserted in mouths. There are far fewer bacteria carrying on their daily lives on the old black fillings then on the attractive teeth-colored composite ones. As metallic ions in such stuff as mercury amalgam or gold are toxic to these bacterial bad boys, old fillings are a less congenial climate for creeping decay.

The German dentists did note that:

1. This does not "dilute the controversy" over mercury toxicity.
2. Frequently brushing one's teeth still remains the most important preventive measure in dental health.
3. Mercury-laden amalgam remains a viable option for restorative work.
Hotels host viruses too

I've just returned from an eating tour of Philadelphia. Well nominally it was billed as a visit with my daughter, but we ate our way through the best of Philly, including too-die-for cupcakes from a hole in the wall cafe.

The only meal that fell far short of satisfactory was the room service breakfast at the Hilton. Rubbery omelettes arriving way late with a side of soggy toast. And now late breaking news from the Interscience Conference on Antimicrobial Agents and Chemotherapy suggests that these unappetizing memories may not be all I take from this hotel.

Researchers from Virginia checked out residual rhinoviruses left by volunteers with colds after they sniffled their way through a free night in a hotel. The investigators found that telephones, TV remotes, light switches, and other objects tested positive for cold viruses as much as a day after the infectious subjects left the room.

Dr. Owen Hendley remarked "They left a very interesting room for whoever came after them." Remember, however, contaminated fingertips are only the first step to getting a cold. The next step, fingers to nose or to eyes, is your choice. Keep your hands off your face in hotel rooms, even if the food makes you weep.

Wednesday, September 27, 2006

A good cure for insomnia is to get plenty of sleep.
~ W.C. Fields


Scientists in Singapore noted that persons with irritable bowel syndrome (IBS) often experience sleep disturbances. As melatonin is known to regulate sleep patterns in some, they wondered if it might also have favorable effects on bowel function as well.

Forty patients with IBS were invited down to the sleep lab for an investigation of the effects of melatonin on bowels and bedtime. While this gaseous group did not experience any favorable effects on sleep, within 2 weeks of consuming 3 mg. of melatonin each evening, their average abdominal pain scores decreased significantly compared to the placebo group, while their mean rectal pain threshold increased seven-fold.

Don't even ask how they measured that last parameter, just know that these subjects either didn't know what they were getting into, or they were handsomely paid.

I've tried 3 mg. of melatonin, more for its neuroprotective effects (experts believe that this supplement can decrease risk of Alzheimer's disease and Parkinson's) than any bowel benefits. While I noted a great night's sleep and increased dreaming, I felt foggy and hungover most of the following day.

Tuesday, September 26, 2006

Did you let your subscription to Gut magazine run out? Then you missed the news about melatonin and irritable bowel. I'll fill you in later.
Here's a woman after my own heart. I don't know why I never thought of this myself, and now I've given away all my old towels!

I am okay with donating the good stuff that we no longer need, it is
the tattered things with holes in them I have trouble letting go. I
feel if they can´t be fixed, I should at least cut them up and use
them to make rugs.

Sunday, September 24, 2006

Got six minutes?

Got no time to exercise? No bucks for a gym membership? Dr. Martin Gibala, pictured above practicing what he preaches, suggests that a series of 30 second sprints -- four to seven per exercise session for a total of three sessions per week -- can turn your muscles into lean, mean, metabolizing machines.

So here's the catch. Between each sprint, you should sit on your exercise bike and just suck air. So we're talking about a 20 minute commitment three times weekly, each workout made up of six intense bursts of activity separated by a few minutes of recovery. Then poof! sweet, guilt-free release, on to the rest of your day.

At the end of two weeks or 2 1/2 hours total of this on-again off-again stuff, your muscles will show the same increase in citrate synthase --an enzyme that reflects the ability to utilize oxygen-- as a bunch of hooples who actually wasted 10.5 hours in that same time period cycling nowhere. Furthermore, adds Gibala, you'll get the weight loss benefits as well:

People forget that if you do a 30-second hard spurt your body continues to burn calories during recovery; just because you have physically stopped racing doesn't mean the effects of the workout are over.

So now what's your excuse?

Saturday, September 23, 2006

Of linen and proteins...

And stressful situations in closets and cells.

I've mentioned before that I suffer a weense from disposophobia or the inability to part ways with stuff. Old towels are no exception. My linen closet bulged (past tense due to recent reform efforts) with tattered towels and sheets too short for current mattresses. As I dug deeper in search of bath accessories with the most residual fluff, the rifled remaining towels took up more and more space, threatening the hinges on the closet doors. I desperately needed an unfolded towel response (UTR).

Enter the towel-like equivalent of body clutter, namely unfolded proteins. Not only do your cells need to string the appropriate sequence of amino acids together to form proteins, but they also must pull a little proteinaceous origami trick to get them into the right spatial configuration for proper functioning. Unfolded proteins are the bane of an aging cell's existence--witness all that rumpled beta-amyloid protein that gums up old neurons in Alzheimer's disease.

Hurrah for evolution! Enter the unfolded protein response (UPR), nature's way of sensing a haphazard pile of proteins on the cellular floor. And if the UPR can't straighten up the protein closet--wadded proteins stacking ever higher--then the UPR just makes some sort of nasty enzyme that explodes that cell and its proteiny mess right then and there.

Alas, as Dr. Dale Bredesen of the Buck Institute for Age Research points out, the UPR is no different than a lot of other body responses to dysequilibrium: "The initial response is protective, but the late response is destructive." He and other neurobiologists are hoping to unlock the secrets of UPR in order to keep this organizing principle on our side.

Tuesday, September 19, 2006

I am particularly interested in states of mind--anxiety, depression, dementia, face blindness, etc. So I assumed I was just in a fretful aging lady sort of state each morning as I went to work, barely able to contain my visions of disaster when I'd get stuck in traffic directly under the large construction cranes on Colfax or 17th Avenue.

Just now, however, a news spot on the radio announced that a 60 foot section of crane had indeed collapsed at Fitzsimmons! So not anxiety, but reality! That does it; I'm taking 23rd to work.
No time to exercise

Yeah, yeah, yeah, I hear that one all the time. Well, exercise physiologists at McMaster University just blew that one out of the water. Stay tuned for more details.

Monday, September 18, 2006

Bowels don't like to be touched

And believe me, abdominal surgery is a very 'hands-on' sort of experience. As a result, as well you know if you've ever undergone any such procedure, bowel action stops short. In fact, the reawakening of the bowels puts a whole new meaning on the term 'gas pains.'

Research from Japan and California supports a new concept in post-op recovery: "Three sticks a day makes the gas go away." Surgeons on both sides of the Pacific proved in separate studies that gum chewing at regular intervals after bowel surgery can much improve a patient's flatus status.

Working over a piece of gum shaved as much as a day off the time to the first post-surgical passage of gas or any other moving productions. The first feelings of hunger were also accelerated in the gum chewing group, and, best of all, two days were eliminated from the total length of the hospital stay.

The librarian at my elementary school used to recite (as she dispatched us to the principal's office): A gum-chewing girl and a cud-chewing cow, what is the difference? I see it now. It's the intelligent look on the face of the cow. Well take that Miss Marye; gum-chewing is indeed a moo-ving experience!

Sunday, September 17, 2006

Health Inspection As Applied to the Individual*

Every individual should be thoroughly inspected from time to time by a physician applying the resources of a complete physical examination, with chemical and microscopic observation of all obtainable secretions, in order to ascertain the standard of health of the individual.

No one would think of running a complicated machine without an annual inspection and overhauling of those slight defects which, if neglected, lead to a serious breakdown.

*A 100 year old case for the annual physical exam from JAMA, September 1, 1906
More D-tales

A new study of thousands and thousands and health professionals showed a 41% decrease in the risk of pancreatic cancer with the consumption of 400 units of D per day. That's the amount found in one multivitamin pill.

If you're not taking daily D, why on earth not?

Saturday, September 16, 2006

Vagal triggers*

My son is worried about anatomy lab. As soon as the dead rat shipment arrives, his class will be dissecting these departed rodents. And Mike is NOT looking forward to the opportunity. When he brought it up at dinner the other night, I was all set to regale him with stories of all the critters I've disassembled through the years. My husband, however, asked in a strained little voice if we could change the subject.

Is there anything that makes a doctor weak in the knees? Absolutely yes, and highly likely to happen early on in training. One of my vivid memories from medical school is watching my good friend (who was also a fairly new mother of a baby boy) hit the linoleum as we observed a circumcision.

I'll tell you what gives me a sinking sensation in the pit of my stomach--finger injuries! Did those of you who've come to the office having crushed a finger or ripped off a nail--you know who you are!-- suspect that I would be more comfortable cutting up a dead rat than checking out your injured digit under those yards of gauze?


*Any intense experience--emotional, visual, visceral, etc.--that stimulates the vagus nerve, causing a slowing of the heart rate and a drop in blood pressure that may result in fainting.

Wednesday, September 13, 2006

Two interesting items in this morning's news:

  1. An analysis from the October 4th issue of JAMA confirms that there's always a price to pay for squashing some undesirable body function like inflammation. While the cardiovascular side effects of the so-called COX inhibitors have been in the news for some time since Vioxx was yanked off the market, older NSAIDs such as Volataren (diclofenac) and Indocin (indomethacin) are also proving risky business for cardiac health.

    Interested in analgesia of the COX-inhibiting variety? The study authors found that naproxen--sold over the counter as Aleve--is your safest bet. For more information on the association between these drugs and trouble, see The dangers of knocking your COX off.

  2. Michigan's state legistlature took a bold step this week introducing a bill that would require sixth grade girls to be vaccinated with Gardasil, the newly approved vaccine against cervical cancer. Critics are not happy with this infringement on parental rights and the implied endorsement of sexual activity.

Tuesday, September 12, 2006

Yuck, nasty air over Denver today. As I drove to a health screening in Boulder, I wondered what I was thinking to raise my children under such a blanket of doom. No wonder I've been seeing more of my asthmatic patients in the office lately.

Fortunately, despite years in the Mile High City and a history of smoking in my younger, foolish days, I scored just fine on the single breath screening test for lung disease.

Did you inhale anything in your youth? We now have spirometry screening available in our office. For more information, see Spirometry screening, and ask for the test on your next visit.

Sunday, September 10, 2006

I'm sitting here dithering over whether or not to go to step aerobics. On the one hand, I could motor on in my robe, drinking coffee and reading the paper. On the other, I could get dressed and drive over to the gym to spend an hour dancing on and off a step to driving hip hop music.

A medical journal by my computer here is helping me make this Sunday decision. A study presented at the recent meeting of the American Society of Clinical Oncology found that over 36,000 Iowa women lowered their risk of postmenopausal breast cancer by 10% through exercise. And when the investigators considered a breast cancer subtype positive for estrogen receptors and negative for progesterone receptors (a more aggressive tumor), a high level of physical activity slashed the risk 34%!

That does it, I'm stepping out of the robe and stepping up to the music.

Friday, September 08, 2006

Cough season resumes

Sometimes I think it never really stops here in Denver where we all cough, clear our throats, and paw through our purses for Kleenex on a regular basis due to the dry air and dust. Now, of course, we're also hacking from colds brought home by school-aged children aggravated by all the residue in the air from raging forest fires nearby and a big-time ragweed crop.

Short of moving to Portland, is there any relief from all this upper respiratory aggravation? Some hackers of the pulmonary variety may benefit from inhaled steroids if their coughs are due to airway irritation from undiagnosed asthma. Doctors from the Mayo Clinic just reported that a simple breath test may easily identify which sleep-deprived coughers are likely candiates for this therapy.

They measured exhaled nitric oxide (NO) in patients, noting that increased NO in exhaled air is a good marker for bronchial inflammation. Of 41 patients with elevations in exhaled NO, 36 reported improvement in cough after use of inhaled steroids such as Flovent. On the other hand, only 2 of 23 patients with normal NO levels responded favorably to the treatment.

As always, the researchers called for more research prior to implementing this test as a routine screen in chronic coughers.

Tuesday, September 05, 2006

'Cancer without disease'

Chances are, if you're over 50, you've got it. Consider these statistics from autopsy studies:

--More than a third of women between 40 and 50 have small in situ breast cancers. Only 1 percent of women this age are diagnosed with clinical breast cancer.

--Virtually all persons between 50 and 70 have small in situ thyroid cancers. Far less than 1 percent are diagnosed with clinical thyroid cancer.

Check out the upcoming edition of Vintagefemail for more information.

Sunday, September 03, 2006

A comforting thought from Dr. William Woodhouse of Pocatello, Idaho:

...loss is made whole not by joy, but by life, ordinary life.
Ketamine: Out of the clubs and into mainstream medicine

Are you a fan of the TV show House? If so, we're both eagerly awaiting the first show of the new season this coming Tuesday. House requested a shot of Ketamine on his way into surgery during last season's finale, seeking relief from his chronic pain and narcotic addiction. So what's the scoop on Ketamine?

This drug was originally developed as a veterinary anesthetic and subsequently gained favor as a 'club drug' similar to PCP or phencyclidine. Its use for chronic pain-- including cancer-related pain unresponsive to standard narcotic analgesics --is under investigation. Participants in one study experienced pain relief lasting up to 8 weeks after a 3-5 day infusion of the drug.

A study in the August issue of Archives of General Psychiatry found that a single injection of Ketamine in a group of depressed volunteers improved mood in 12 out of 17 of them. Whereas antidepressants such as Prozac can take up to 2 months to kick in, Ketamine's effects were noted in just 2 hours! This finding, therefore, has generated excitement in the possibility of a fast-acting therapy to alleviate depression and suicide risk during the crucial first days of standard therapy.

Ketamine targets receptors in the brain that respond to an excitatory neurotransmitter called glutamine. This represents a new approach to alleviating depression prompting one psychopharmacologist to declare "The glutamate stoary as it has emerged is very promising."

Saturday, September 02, 2006

Your acne will go away after you get your first period."
--Dr. R, my pediatrician, 1962

Hah! Dr. R, perhaps my memory is shot ( perhaps about that) because maybe you actually told me that my acne would finally go away when my periods stopped. Which it did.

You also told me to stop drinking milk. To heck with the state of my skeleton in the decades to come, stop drinking milk you said. So I did. At least in that respect, you were correct, and over 48,000 female nurses have proven you so.

The Nurses Health Study II did a retrospective study correlating severe acne with consumption of dairy products during the high school years. Investigators found that total milk intake, specifically skim, was associated with an increased incidence of zits. They theorize that this may be the result of hormones and other 'bioactive' molecules in milk.

Bioactive. Great.

Friday, September 01, 2006


At a purely chemical level, every experience humans find enjoyable - whether listening to music, embracing a lover, or savoring chocolate - amounts to little more than an explosion of dopamine in the nucleus accumbens as exhilarating and ephemeral as a firecracker.

--J Madelaine Nash

While music, love, and chocolate are more or less harmless, nicotine is another pleasure of sorts that results in a burst of dopamine from the nucleus accumbens (NA) deep in the brain. The new anti-smoking drug Chantix is designed to occupy nicotinic receptors in the NA, stimulating the release of a little dopamine but not a big surge. As a result, ex-smokers get a smooth dopamine lift but no cigarette-charged rush, thus allowing them to kick the habit without seeking out other big-time dopamine dischargers such as chocolate and ice cream.

Wednesday, August 30, 2006

Can you 'C' yourself after a festive meal?

Sure you can see yourself--a little too full and a quite a bit sleepy. But oy, can you picture your arteries?

We're talking major arterial dysfunction here after a high-fat meal. The endothelial cells that line the blood vessels supplying oxygen-rich blood to the body ideally have the capacity to dilate these passages and increase blood flow as needed. When stunned by a load of saturated or trans- fats, these cells lose this ability, and those arteries already affected by atherosclerosis are most vulnerable to high-fat assaults.

Chinese cardiologists invited 124 patients down to the lab to chow mainly on high fat foods. Arterial function was measured before and after the meal, and half the group was pre-medicated with 2 gm of vitamin C before they dug in. Both participants with coronary artery disease and normal controls showed no change in vessel elasticity with vitamin C on board, but those who were C-less in Hunan showed a critical sproing in their springiness after the feast.

Experts estimate that most American women have cholesterol deposits in arteries by age 65. If you must eat high-fat food--and most of us indulge on occasion--chase your fat with a C!

Tuesday, August 29, 2006

Are things piling up on you?

If so, be aware that you're at risk for depression. This study from the Archives of General Psychiatry used mathematical modeling to identify underlying mechanisms of depression
"Depression is found to result more often from pileup of negative stimuli than from single life events."

Monday, August 28, 2006

Justice at work

No fairness in the workplace? No's bad for your health. Investigators from Finland and England suggested employers ponder this:

An indicator of justice at work is whether people believe that their supervisor considers their viewpoints, shares information concerning decision-making, and treats individuals fairly and in a truth manner.

Previous studies have confirmed that undervalued is way worse than overworked when the longterm effects on health and wellbeing are considered. This particular study reported last year in the Archives of Internal Medicine followed 6500 British civil servants over nearly 9 years, correlating incidence of coronary heart disease with perceived justice in the workplace. They found that the level of justice was a significant predictor of future heart disease even when numbers were adjusted for conventional risk factors such as hypertension and smoking.

I mentioned in an earlier post that I've seen a lot of unhappy workers in my office recently. Certain local government offices here in Denver are not only endangering the daily satisfaction but also the future health of their employees.

Sunday, August 27, 2006

Bookmark and you will get a glimpse behind closed doors. It's a remarkable web-site; thanks Leigh for sharing it with me.

Saturday, August 26, 2006

Is Lemon Zinger your nightcap of choice?

Aromatherapy uses essential oils from flowers or herbs to promote health. And if you happen to be a rat and prefer working out on your exercise wheel instead of sleeping, than lemon oil is your odor of choice.

Japanese neuroscientists worked with a group of good-smelling rats (rodents with a working sense of smell--we can only guess how they smelled). As the rats prepared for bed, the researchers presented them with a number of oils to sniff.

Whiffs of valerian and roses sent the animals into a prolonged snooze shortly after they settled down. But did lemon aid their sleep? Insomnia city for the citrus snorters; they scuttered about until the wee hours of the morning.

The researchers concluded: "The present results may suggest the possibility that lemon inhalation may cause a worsening of insomnia symptoms." So pass up the lemon meringue pie at bed.

For more information on valerian, check out the latest issue of femailhealthnews which will be e-mailed to subscribers in the next few days.

Thursday, August 24, 2006

Weeping in the exam room

Don't feel bad if you do. Lots of other people weep as well, as often as not over their jobs. What makes employers think that employees will do their best if the job makes them cry?

Tuesday, August 22, 2006

GAD, how I hate being anxious. It's one thing to fret a bit as you watch the teen head off for an evening with friends, but quite another to dither endlessly over replacing the gutters, or finding a parking place, or, worst of all, to pace the floors over no troubles at all.

A patient I saw yesterday could hardly bear his ride to work on the light rail; he'd plot his escape at each stop, then grit his teeth and travel on, promising himself he'd surely bail at the next opportunity. Then another patient in the early afternoon related that she'd finally gotten up the nerve to come in to discuss her unending fear, then nearly made herself sick with worry that her employer would be angry that she was taking time off to visit my office.

Generalized anxiety disorder or GAD is associated with an unpleasant free-floating sense of danger, exaggerated worry over the trials of everyday life, and an inability to relax. Social scientists have recently released a 7 item screening test to easily identify GAD, appropriately named GAD-7.

Worried that you suffer from GAD? Check out:Are you overanxious?

Sunday, August 20, 2006

Docosahexaenoic acid

DHA is an appealing PUFA (poly-unsaturated fatty acid) delivered by fish oil. French investigators theorize that this PUFA or omega-3 fatty acid becomes incorporated into the cell membranes of neurons. Once embedded in the cellular surface, DHA may protect against the injurious effects of amyloid-beta, the protein fragment that gums up the brainworks in Alzheimer's disease.

And in clinical news, a decade long study of Boston oldsters showed a 48% decrease in the incidence of AD among those who had the highest levels of DHA due to regular intake of fatty fish.

Saturday, August 19, 2006

Tylenol troubles for liver

The recommended daily limit of 4 gm may be too high.

University of North Carolina researchers found that a significant number of participants in a recent trial had notable abnormalities in a liver enzyme test called ALT. These elevations occured after two weeks daily dosing of a combination analgesic that provided 4,000 mg of Tylenol (acetaminophen) in a day. While such elevations do indicate liver damage, all the participants normalized their levels after they discontinued the drug.

Twelve Tylenol tablets in a day may sound like a lot, but many persons with chronic pain easily ingest the equivalent amount of acetaminophen through products such as Vicodin or Lortab. Eight tablets of Vicodin ES or 5-6 tablets of Lortab-Plus contain 4 gm of acetaminophen.

Friday, August 18, 2006

One of the most frustrating things about undertaking a weight loss program is the initial lack of success, particularly in people who have become seriously overweight. The inability to see even a little progress leads to that 'to-heck-with-it-today-maybe-tomorrow' mentality that dashes diets in the late afternoon.

Part of the problem is that prolonged obesity with its resultant insulin resistance causes changes in the way that muscle cells use fat for energy. As a result, these cells fill up with fat droplets. Chronic, persistent exercise is needed to pull the fat out of the muscle cells before a more normal metabolism finally initiates weight loss.

One drug designed to return proper fatty acid metabolism to muscles actually made it to phase 3 clinical testing with initial bright results. Unfortunately, many patients became resistant to the favorable effects of Axokine. Australian investigators are, however, hot on the trail of other pharmaceutical methods to induce weight loss by directly targeting skeletal muscle cells.

Saturday, August 12, 2006

Don't let this swell your head, but skulls these days are significantly larger than the head bones of centuries past.

UK orthodontists measured 30 skulls from victims of a 14th century Black Death epidemic and 54 skulls of unfortunate sailors who went down with the ship off Portsmouth in 1545 and compared them with x-rays of modern young adults. In particular, scientists found that the size of that part of the skull which houses the frontal lobes--the portion of the brain which sits behind our foreheads and is associated with intelligence--has gained in size while our faces are now less prominent.*

While the researchers acknowledge that humans have increased in overall size in the intervening centuries due in part to better diets, they theorize that our bony brain cases may be swelling disproportionately to changes in the attached body.

*Think Kanamites, the flesh-eating aliens of The Twilight Zone who arrived on earth "To Serve Man."

Friday, August 11, 2006

"....Vitamins are potent, essential nutrients which have effects that can precipitate harm as well as provide benefit.
---Margo Denke, MD, Center for Human Nutrition

Dr. Denke's remarks were in reference to a study on vitamin A intake and hip fractures in postmenopausal women. Osteoporosis and hip fracture are associated with chronic over-consumption of this essential nutrient at levels just twice the current recommended RDA.

There is growing concern among experts about this 'subtoxicity' of too much vitamin A, particularly in developed countries where food is fortified with A and there is a high level of use of vitamin supplements.

Tuesday, August 08, 2006

Can this neuron be saved? Check out:

Doc of Ages

or, a new blog for women of age.

Saturday, August 05, 2006

Diarrhea forever vs. The Techno-Goat

You may recognize the phrase 'diarrhea forever?!?' from the movie Mrs. Doubtfire. For two million people each year, diarrhea forever means the end of the line. That's the number of persons, mostly children, who die annually due to dehydration from intestinal infections.

Nursing infants are protected by enzymes in breast milk from the bacterial dysentery. Specifically, the protein lysozyme rips open the walls of E coli causing their germy little guts to leak out. While human milk is rich in lysozyme, animal milk is not. Once children are weaned, therefore, they are much more vulnerable to toxic bacterium and the terminal runs.

Scientists at the University of California have discovered a way to inject human lysozyme-producing genes into the milk-producing instructional DNA packet located in goat mammary glands. As a result, the transgenic goats' milk has much higher levels of the enzyme and has been proven to decrease the bacterial load in the guts of baby pigs.

Lead investigator Dr. Jim Murray hopes that the milk will someday boost the immune systems of children at-risk.
Up your nose with a video camera!

Now how fun is this? Visit with Dr. Edward Hepworth of the Colorado Sinus Institute and watch the pus pour from your sinuses!

Ellen of Denver reports that Dr. Hepworth invited her to share the view from her maxillary sinus as he scoped out her nasal situation. While it wasn't pretty, it explained her misery. Better yet, the specialist at CSI offered her a new and careful approach to her sinus situation.

Considering the toll that Denver's dry and dusty air takes on our upper airways, Dr. Hepworth's skills are a wonderful addition to our therapeutic solutions. You can reach him at 303-744-1961.

Monday, July 31, 2006

On occasion, I find myself trapped in a tiny exam room with a mom and her small, loud children. As long as it's not my kids carrying on, neither of whom are small and only one of whom continues loud, I really don't mind the fuss.

And breathing. I hear a wind tunnel's worth of that through the work day, some of it wheezy and a lot of it congested. As long as it's not issuing from the other side of my bed, I'm okay with that as well.

Scientists are interested in what makes a bad vibration, as in which noises make whose hair stand on end. Would you like to participate in some annoying research? Check out
Bad vibes.

Sunday, July 30, 2006

Luxuriant Flowing Hair Club for Scientists

As many of you are aware, I spend not a small amount of time bemoaning the state of my aging mane. Moreso now that I've discovered a club to which I aspire but alas may never join.

I kid you not; there really is a LFHCfS. And if this guy can be a member, maybe I can too!

Check out these honorary historical members:

Dmitri Mendeleyev

Albert Einstein, "A bold experimentalist with hair"

Sir Isaac Newton, "arguably history's greatest physicist, the inventor of the calculus, and hair like a rock star."

Saturday, July 29, 2006

[We] behave nicely when we're being watched.
--Melissa Bateson, behavioral biologist

This was no news to my junior high algebra teacher. Mr. Duran donned a pair of reflecting sunglasses during exams. Never sure just who was under surveillance, we all kept our eyes glued to our test papers.

Ms. Bateson tried a little observation test of her own in the University of Newcastle upon Tyne psychology department. She alternately posted pictures of flowers or eyes near the donation box by the office coffee pot.

During the weeks where eyes gazed down on the scene, donations to the office kitty nearly tripled. She also found that judgmental male eyes elicited a more generous donation compared with flirty female eyes. And the departmental drinkers went back to their ungenerous ways altogether when pretty posies were posted.

I'm going to post eyes by the kitchen sink!

Thursday, July 27, 2006

The volume is shocking: equivalent to 33 double-decker buses.
--Gavin Harper*, University of East London

Mind-boggling news from Cadbury. The chocolate manufacturer was forced to dump 250 tons of their chocolate due to possible bacterial contamination.

Mr. Harper, however, was intrigued by the potential power of such an enormous chunk of chocolate. He presented a paper this month at a 'sustainable science' symposium proposing that if the candy had been burned instead for energy, it could have provided enough to run a town of 90,000 people for a week.

Gaynor Hartnell of the Renewable Energy Association in London notes, "Chocolate is biomass. It is also very calorific."

No kidding, Gaynor!

*Author of 50 Awesome Auto Projects for the Evil Genius.

Wednesday, July 26, 2006

Gad, was it something I ate?

Have you ever wondered on a down day with the kid whether you did something wrong during pregnancy that is now coming back to haunt you? Here's reassuring news out of Johns Hopkins University. Now, however, you can fret that maybe you just weren't stressed out enough while the teen was under construction.

Maryland researchers theorized that pregnancies complicated by psychological distress resulted in dysfunctional offspring. They analyzed the development of children whose mothers reported anxiety, depression, and non-specific stress during otherwise low-risk type pregnancies. Rather than finding signs of bad behavior and ill temperaments in the kids, the investigators found the children were more advanced in both motor and mental skills.

It's not your fault. Take the teen's advice and chill.

Friday, July 21, 2006

No more thermoneutrality for me!

Read this and rejoice in the heat:

Experts gathered round for a little discussion on the causes underlying the obesity epidemic at a workshop held in Washington, DC this past March. While the main focus of the meeting was the association between weight and sleep ("Sleep loss and obesity may be interacting epidemics"!), Dr. David Allison of the University of Alabama's clinical nutrition center had a few thoughts on temperature and obesity.

He noted that the availability of home heating and air conditioning in the past few decades has reduced human energy expenditure. Prolonged exposure to cold is known to improve insulin sensitivity, and both humans and animals eat less when too hot or too cold. Conversely, we all eat more in thermoneutral zones.

Please don't hate me because I don't have air-conditioning.
I reallly want to see if we can get out of mice and into humans for some of these interesting herbs for cancer, and I think we will.
---Dr. Mary Hardy, Center for Dietary Supplement Research, UCLA

All right you mousies, back away from the tea. While animal studies suggest that tea is useful chemoprevention against cancer, now it's our turn to tea off the tumors.

Indian researchers are conducting an ongoing study of 82 patients with oral leukoplakia (a pre-cancerous conditon of the mouth characterized by white patches, often associated with cigarette use). Oral cancer is the number one malignancy in East Indian men.

The investigators checked out the sturdiness of the DNA from these leukoplakic hotbeds of chromosomal chaos. The subjects then were treated for a year with 4-5 daily cups of black tea.

Of the first 15 patients who completed the study (that's at least 21,600 cups quaffed for you tea-totallers), all showed a significant decrease in the chromosomal equivalent of split ends.

Dr. Hardy points out that "This is not a toxic or difficult intervention." Why wait then for the final report from this study to make tea your caffeinated beverage of choice?

Thursday, July 20, 2006

'D'-fend against breast cancer

I hate to belabor the point, but the evidence in favor of an increased intake of D keeps growing.

Statistics were flying at the annual conference of the American Association for Cancer Research. Keep in mind as you read on that the recommended daily allowance of vitamin D is 400 international units (IU)--the amount in a basic multivitamin pill.

In one meta-analysis (a study of studies) on vitamin D concentrations in the blood and subsequent breast cancer development, researchers found that an extra 1,000 IU a day over the normal background intake lowered a woman's risk of breast cancer by 10%.

Investigators at the University of California San Diego found a strong correlation between rising vitamin D levels and decreased breast cancer risk. Those whose serum vitamin D concentrations exceeded 52 ng/ml, a level that would require an intake of more than 2,700 IU per day, had a 50% lower breast cancer rate compared with the 'D'-less individuals whose puny little levels fell below 12.

Tuesday, July 18, 2006

Hack your way home

Dr. Leonard Roberts suggests the cough over coffee approach to late-night driving.

When returning home from hospital work in the wee hours of the night, Dr. Roberts has discovered that coughing buys a "lucid moment and a little time to avoid a disaster." Per Dr. Roberts, here's how you might hack your alertness back:

The increased intrathoracic pressure is transiently transmitted to the superior vena cava and cerebral venules and capillaries, perhaps leading to a brief increase in oxygen availability."

In other words, the sleepy driver coughs up the blood pressure in the large veins of the head and neck which may increase blood supply to the fading brain.

Sunday, July 16, 2006

Vertical Strip Breast Exam

No more running circles around your breasts. The three-finger, three-pressure, 'Vertical Strip' method is now the exploration of choice according to both the CDC and the American Cancer Society.

This is definitely not your palpate-and-run technique, requiring 3-5 minutes per breast whether it's you or your clinician checking you out. Using the pads of your first 3 fingers, apply light touch in overlapping vertical strips from your collarbone to the ridge below your breasts, from your breastbone to the lymph nodes under your arm. Then do it again with medium pressure, and yet again with firm pressure.

Does that seem like a heap of a lot of palpating? Be reassured, Dr. Elizabeth Steiner of the North American Primary Care Research Group tells us, "In our study, for every 15 seconds you took, it made you 29% more likely to find a 3-mm. mass."

Saturday, July 15, 2006

Fruit information loops

You've probably heard that the shape of your inner fruit influences your risk for heart disease. The pears with heavy hips have it all over the apples with expanding waistlines.

Doctors at Columbia University checked out waistline measurements on nearly 7,000 women from 18 to 93, adding further credence to conventional wisdom. Those women whose waistlines topped 35 inches were significantly more likely to have associated hypertension, elevated cholesterol, and blood sugar troubles.

Get out the tape measure. If you measure up in an unfortunate way (check at the level of your midsection that is first to enter a room), ask your doctor to measure your blood pressure, fasting cholesterol, and pre-breakfast blood sugar.

Many of you may know that I am a bit of a wimp in my enthusiasm for medical procedures. I finally got my colonoscopy, but it's been 25 years since my last tetanus shot. After all, in my many years of medical practice, I've never seen a case of tetanus or diphtheria, and frankly shots creep me out.

Time to reconsider the strategy, however, now that Adacel is available. This vaccine not only protects against the theoretical case of tetanus and diphtheria, it also is "arming more people against pertussis."

I do see a hack of illnesses each year involving a show-stopping mega-cough. Many of these seasonal upper respiratory infections have been proven in population studies to be whooping cough (pertussis). Furthermore, studies indicate that the series of shots that we received against this illness--which can cause months of coughing--does not confer lifelong immunity.

The shot is recommended for teens and adults 11 through 64 years of age, particularly health care personnel and parents of small children. Thankfully no small children here, but I share a small exam room each winter with a grip of grippe.

Catchy slogan, nice ad campaign (smiling folks baring arms with bandaids on them), good shot. I'm getting mine this week!

Friday, July 14, 2006

Menopause Management, one of many magazines sitting in stacks in my office, periodically poses 'interesting clinical questions and dilemmas' to their Editorial Advisory Board. Last month, they asked "How have you changed your clinical practice since publication of data from the Women's Health Initiative?"

The WHI was the landmark study of older women and hormone therapy (HT) that rocked the world of menopausal medicine after its publication in 2002. Here' what two gynecologists answered:

Post-WHI, I no longer consider it mandatory to discuss HT with all menopausal women.
--Margery Gass, MD

Since publication of the first data from the WHI, I have spent more time carefully evaluating the literature in order to be prepared to provide a balanced view on the benefits and risks of HT to women and their family physicians--many of whom have benn confused by scary media stories.
--Robert Reid, MD

Which doctor would you choose to go to?

Wednesday, July 12, 2006

Exercise is associated with mortality benefits but simply expending energy through any activity in an individual's free-living environment may confer survival advantages.
--Todd Manini, PhD et al, JAMA, July 12, 2006

Why am I glad my son dribbled lemonade across the kitchen floor? Three words--free-living energy, as in my energy spent cleaning up his sticky mess (he was long gone for the evening). While some energy expenditures are more fun than others--say dancing compared to mopping--expending energy at any activity improves survival, and now we've got the scientific proof.

Researchers at the National Institute of Aging studied a grip of high-functioning old folks over six years to see who made it to the end of the study in the upright position as a function of how generally active they were through the years. They did not, however, depend on those unreliable old memories to determine who moved and who didn't. They fed the seniors 'heavy water' where extra neutrons are somehow added to the hydrogen and oxygen atoms. The heavy oxygen goes in as water and comes out as CO2 at a rate dependent on the amount of heavy breathing the oldsters do while house-cleaning etc.

The group of participants in the lowest one-third of energy spent per day were twice as likely to be carried out of the study feet first compared to those in the highest one-third.

So perhaps I will not only survive Mike's adolescence, I will thrive as a result of it. Pacing the floor and wringing the hands counts as activity, right?

Tuesday, July 11, 2006

For those of you who fuss about your liver, and we should always be mindful of and grateful for our liver, here's some good news.

Surgeons know that the liver has remarkable regenerative properties. They can remove more than two-thirds of this powerhouse organ, and within weeks, it's back to its previous size.

Here's what George Michalopolous of the University of Pittsburgh Medical Center has to say about the overlapping systems that the liver uses to reassemble itself in response to the various slings and arrows of liver fortune: [It's] like a car with 20 cylinders. You crank up the engine, all 20 cylinders fire. These are cylinders 21 and 22.

Sunday, July 09, 2006

Here's scientific proof that sunshine on your shoulders makes you healthy. This map correlates ovarian cancer rates by region, showing a strong association between available sunshine and cancer protection. For more reassurance that a little sun is good for the body as well as the soul, check out other such maps on the home page of

Of rain and pain and aging knees

What is with this weather? It's more like springtime in the Northeast than July in Denver out there. Whether or not it's appropriate to Colorado, it's cold and damp here, and hell on old joints. I've just checked; researchers have looked for a correlation between osteoarthritis and weather-related pain, and the results are mixed. They did not, however, ask me. I tossed and turned most of the stormy night with knees and back complaining.

I thought about getting up and taking a glucosamine plus chondroitin tablet. I chose to stay in bed instead, and a recent issue of The New England Journal of Medicine suggests I made the right choice.

Investigators in Utah and elsewhere studied a large group of arthritis victims to see if glucosamine hydrochloride (note most supplements are glucosamine sulfate) and/or chondroitin sulfate improved pain compared with Celebrex or nothing at all. The answer was 'no,' the supplements did not decrease pain scores.

Other research suggests, on the other hand, that getting up and taking an Actonel might've been a better choice. Postmenopausal women on this drug or Fosamax for osteoporosis not only had a good response to the medications with respect to less bone breakdown, they also reduced their levels of cartilage breakdown products, suggesting that these agents save cartilage as well as bone.

Friday, July 07, 2006

It's a wonder I get anything done. My task du jour was to prepare a brief, amusing talk about aging skin. Along the way, I got lost on the dermatological information highway and found the following important bits of information on rashes:

On the anti-inflammatory properties of milk:
Make a compress soaked in half milk and half water and apply it to the rash. Just rinse off afterward, so that the milk doesn't turn bad. You don't want to smell like sour cream.
--Amy Newburger, MD

On ginkgo, an herb that is good for your brain and bad for your behind
The rash related to ginkgo particularly appears in the perianal region, so be sure to query your patients about their use of this agent if they present with such an eruption.
--Mary Ruth Buchness, MD

Wednesday, July 05, 2006

The affable professor is a generously large man. Over his tall-and-big-store tummy this day stretch a bright yellow shirt and a red, yellow, blue, purple, white, and green tie, all bustling stripes and darts. Flashy rings sparkle on his fingers, and his Mercedes-Benz carries a vanity plate: "Wiseguy."
---Peter Monaghan on Bernardo Carducci of the Shyness Research Institute

Doesn't Mr. Carducci sound like the very sort to school us all on shyness? In fact, he wrote the book! Several of them, including Shyness: A Bold New Approach and The Pocket Guide to Small Talk which is truly pocket-sized so you can consult it on the sly the next time that you attend a party at which you know no one but the host.

A couple of days ago I mentioned a web-site faceblind where you could see if you suffered from an inability to distinguish your partner from the milkman (unless of course your partner is the milkman!). If you check out shyness, you can find out both your ShyQ and how your uneasiness in social situations compares to the world at large. Check out Dr. Carducci's web-site at The Shyness Research Institute to read his sensible five step approach to small talk.