Friday, March 28, 2008

Wellness Weekly

Scanning for Lung Cancer: There is concern, even offense, over the disclosure that tobacco money has been used in research on lung cancer. A study (or studies) that are meant to determine if screening for lung cancer with a CT scanner is effective in preventing lung cancer death is the trigger for this concern. I wrote about the results of the study before, as there was unease that there are many false positives, invasive follow up procedures, and uncertainty to whether or not the expensive test can save lives. Further, there is the risk of radiation. Having a CT on a regular basis is hardly without risk. The concern that tobacco companies funded the research or some of it, is less disconcerting to me than the disclosure of a CT Scanning company contributing to the funds. NOW that is bias. It is interesting to hear the health groups weigh in as supporters of CT scans. The point they make is how having smokers regularly screened for lung tumors may save their lives. I will tell you what will prevent smokers from dying of lung cancer. Stopping Smoking.

Zyprexia: This medication is a psychotropic often used to treat bipolar disorder or schizophrenia. It has a warning that it may increase weight, raise blood sugar levels and lead to diabetes. I have seen the weight gain. The interesting thing is this. First of all, people gain weight when they eat more calories than they need. Sometimes medications do change the way we metabolize food and or medicine can make us hungrier so we need to eat differently. I believe that persons who are prescribed these drugs should be given nutrition counseling. This week however, the state of Alaska won law suit against the makers of zyprexia. They claimed that the use of the medication had raised the rates of obesity and diabetes in their Medicaid patients. They have been compensated. Other states may also sue. I think that this is a good thing. Here is why. These medications come with warning labels and I have known at least three doctors in my personal experience who knew the risks and chose to use the drugs anyway. A lot of the time the doctors said, well, they just have to list that as a side effect it won’t really happen.

Kraft is Insane: Well no they are not, we are. Mind you I think Kraft is awesome and I appreciate the many products that they offer which are low in fat, sugar and calories. I am frustrated by their so called functional food lines. This LiveActive business where they add pre and pro biotics to foods like cereal because they feel that we would rather pay extra money for that product than eat a healthful diet baffles me. The company did research to learn that we do not have good digestive health. Well, this is because we eat highly processed foods and not enough fruits, veggies and fiber. You do not need to eat those chemical altered foods and chances are, they do not work the way unprocessed foods work. So, well, you just have a lot of expensive waste and little improvement to your health.

Anorexia: Switching gears for a minute here. Italy is beginning a campaign across their country to prevent further rises in the cases of anorexia. They have two or three million cases, pretty average for developed countries, though their 10 percent of males may be higher. They have laws in place regarding rules for modeling that are noble. Health organizations in that country note that families are more in tune with what their children eat as there may be more of a focus on eating together. I was raised by an Italian and have been to Italy. Eat Eat Eat, is a phrase I am used to hearing in both
English and Italian. I was surprised to see that there was this problem and that the government seemed so vested in addressing it. One thing I really liked was a statement that the children were not “sick” but overly concerned about appearance. Yes.. Labeling people as sick, in my experience, only makes them so.

: Since there are quite a few more people in this category, let me get back to it. Research from Canada was discussed at a meeting this week. Comprehensive approaches to battling this problem are needed. In fact, some of the findings may have me, in time, rethink my simple tagline “energy in and energy out”. But not just yet. It is true that one’s weight or in aggregate, the weight of our countrymen, is affected by personal genetics, environment, social standing, behavior and more. What we eat absolutely matters but being able to get the food also matters. Waist circumference is being touted more and more often as an important measurement for heart disease and diabetes risk. Persons who carry their weight in the abdomen are at higher risk. So where your fat goes is genetic, but what you eat is behavioral. Do you know you hip to waist ratio?

Schools and Farmers: In addressing the nutrition of our children, some states are using local produce from local farmers to get fruit and vegetables to the cafeteria. This is a time consuming and sometimes expensive process. Farmers sacrifice some expediency in payment and schools may pay more, however if it reduces obesity rates and improves overall health it seems worth it to me. Most schools continue to cut costs with foods that are processed and easy to prepare. Hopefully, more money will be available to buy and use the more natural foods. This type of intervention would fit in perfectly with nutrition course work, physical activity and the Go Slow Whoa program.

Bipolar Diagnosis: A scientist has created a test based on his research into the genetic make up of bipolar disorder. It is very disconcerting to some and to me. First of all, he has identified some genes, but admits that not everyone who has them gets the disease. The test only applies to white people of particular ethnic descent. The test can be wrong. The test involved spitting in a cup and sending the sample by mail. The results of your spit test go to a physician who may or may not have experience in diagnosing or treating the illness. The result of the test may lead to medication and those medications will have side effects. Diagnosing this illness with a genetic test has too great a risk in my opinion. Marketing the test to consumers is dangerous. I also feel that just as marketing the drugs to us directly results in unnecessary pharmacotherapy and labeling so will this. Of course, this could also lead to more cases of disability or claims of disability because of mental illness.

Risk, Cost, Benefit: Lastly, an article that brings us back to blurb one. Insurance companies are requiring precertification for diagnostic exams such as a CT, PET or nuclear cardiology tests. All of these do put the patient at risk from radiation exposure and also cost a lot of money because the equipment was expensive to purchase. There has been some concern that hospitals and doctors buy these machines and then order the scans to increase revenue or to pay for the machine. In other words the scans may be unnecessary. Then again, there are some who order less expensive or risky tests which are also less effective only to later ask the patient and his or her insurer to also have the more advanced test. The cost of scans like this doubled in just five years and when I say doubled, I mean from costs in the billions. I still, when appropriate, like to ask the doctor, okay, what would you do if these machines didn’t exist and what will you advise me to do if it says what you think it is going to say? In other words, how will the scan impact the course of treatment. I consider health care to be a resource and do not want to be a part of the exploitation. I also do not want to expose myself to danger or discomfort without just cause.

wishing you wellness

Thursday, March 20, 2008

Wellness Weekly

Breast Cancer and Weight: Research related to a specific type of breast cancer shows an increase in death rate associated with that cancer and obesity. In fact, overweight and obese women with inflammatory breast cancer have lower survival rates than normal weight women. The researchers are now trying to determine why that might be and are looking into fat tissue which relates to inflammation and thus the aggressive nature of this disease. It is also noted that fat cells are associated with hormone production, or increased production. This study comes on the heels of another which linked obesity to several cancers, in fact, doubling ones risk for leukemia, colon and kidney cancers. It is also worth noting a quote from the Reuters story that I read, “Obesity goes far beyond just how a person looks or any physical strain from carrying around extra weight.” This was said by the principal investigator of the study, Dr. Massimo Cristofanilli. He makes that statement, I believe, to emphasize that obesity causes disease and is in and of itself of risk factor for fatal illness.

Overeating and Obesity and Choices: The article I read regarding obesity and genetics took me a little by surprise, more in its ending than beginning. The article, again from Reuters, discussed a study that showed a change in “entire networks of genes” linked to the way one eats. The researchers stated that eating a high fat diet changed ones system and particularly the immune response which may then lead to diabetes and heart disease. The story told how the changes that occur do not lead to the same disease in separate people. THUS, the MERCK employee said, they are trying to find a test that will determine which type of disease YOU will get from your obesity and what subsequent cellular damage may ensue. That way they can make a PILL for you. The guy did say that good diet and exercise would be the better step to take. He might actually be suggesting that you strive not to become obese. Still, he offered that if you did not want to alter your lifestyle, MERCK hopes to bring your impaired network back into balance with this yet to be created chemical. They are also developing a test to see which particular dysfunction a person has. Are these people for real?

Pain: Chronic pain affects a high percentage of our population. This includes the person with the pain and those around them. It affects job performance, relationships and life satisfaction. As many people seek treatment for pain related issues, and continue to seek relief year after year, insurance companies and medical societies are taking note. It is interesting that chronic pain is almost a malfunction of a purposeful system. When we have an injury and the alarms go off with sharp pains, we know to stop what we are doing and get help. Chronic pain, some will say, is like the car alarm that keeps going off for no reason. The injury causing event is over. No one is trying to break into the car. And yet, the pain is real. It is disabling and defeating. Some have turned to a certain boot camp style treatment where they spend weeks with others and learn to do things in spite of the pain. This includes EXERCISE. My own philosophy on pain, which only developed in the last two years, is that giving into it exacerbates it. The more I say, my back hurts, the more that pain owns me. (I do find myself saying it though and have to make a concerted effort to stop). Instead I go for my walks, my runs, my swims, etc and on the days that it doesn’t hurt, I note THAT!

Lettuce and those leafy greens: It is true that there have been more cases of foodborne illnesses related to produce in the last ten years. One question the researchers from the CDC addressed was consumption. Were there more cases because more people are eating lettuce and such or are there really more cases? Yup, more disease. Though we eat about 10 percent more, good for us, the disease rate is up almost 40%. [we don’t have 40 percent more disease, the reports of contamination are up 40%] Hygiene and general processing issues could be the cause and I expect there will be more inspections done in order to reverse this trend. What really caught my eye was the headline though. It referred to our eating our leafy greens as the ‘salad fad.” I truly hope healthy eating is not a fad.

Wishing you Wellness and Renewal this Spring

Friday, March 14, 2008

Wellness Weekly

The Physical Exam: Last week I made a comment about preferring an old fashioned clinical exam to an MRI. This week a WSJ article discussed the reliance on scanners and diagnostic tools over medical history and physical exams. The article was written by a practicing MD. He stated that doctors often feel less confident about their abilities to diagnose and have great fear of missing something important. He also noted that fewer people are becoming internal medicine or family practice physicians and the void is being filled by other professions such as nurses and physician assistants who rely even more on the tools as they have had less medical training. The current trend is to use technology over skill and I do hope that it reverses.

Fat $$: A thorough article on the search for a weight loss pill was printed in Business Week on March 6th. The common theme for the weight loss drugs in studies or development is the side effect issue. Most companies are struggling with the number of suicides and also depression in persons who take the study drugs. To date, there has been no safe AND effective weight loss pill. This does not mean that weight loss is impossible; it means that diet and exercise are the preferred method to achieve it. Eating less and moving more when one has done the opposite for most of their life is incredibly challenging. It is hard. It is worth it. The outcome of obesity is an obesity related illness and that illness can lead to disability, years of healthy life lost and premature death.

Mom’s Fault: Some research is under way to determine if a heavy or obese woman who is obese during her pregnancy predisposes her child to obesity. An obese gene or an obese prenatal environment are suspected culprits. This hasn’t yet been proven or even suggested by the research. That being said, preventing obesity does begin in childhood and children who are overweight or obese by age nine are more likely to continue to be obese throughout their shortened life.

Pregnancy and Smoking: A study of 18,000 British babies found that those whose mothers quit smoking during pregnancy were happier than those whose mothers had continued smoking. We all know that a happy baby is a happy family. Of course, quitting smoking will also cut the risk of the baby’s dying from SIDS and being born prematurely by as much as 50 percent.

Water Woes: A story out this week noted that some water supplies have been found to contain at miniscule levels, prescription drugs or metabolites of the drugs. Whether you A) believe the report or B) worry about a consequence from the water, remember this, disposal of medications should be done in a safe manner. The only safe way that I am aware of is to bring unused meds to your pharmacist or any pharmacist and ask him or her to dispose of them. Industrial dumping or industrial waste is an entirely different matter and may be under the auspices of the EPA. I hope that the story, whether you believe it or think as my brother in law (the bottled water industry is behind the story), gets the issue out in the open. Every drug has some side effect and though we may or may not be adversely affected by these trace amounts, our plant and animal life may be. This environmental thing, well it affects ALL species in the end.

Wishing you wellness and clean water

Friday, March 7, 2008

Wellness Weekly

Pollution and IQ: A study relates air pollution, specifically a compound called black carbon, to reduction in IQ points, memory, and other cognitive factors. The researchers equated some of this with the effects of cigarette smoking on children whose mothers smoked while pregnant. Unfortunately, the US Surgeon General has not found a causal association with cigarette smoking and IQ. The researchers note oxidative damage and inflammation as possible causes of brain problems. I wonder myself about oxygen flow as pollution, specifically gases such as carbon monoxide, can effect it.

Hormones and Cancer: When the Women’s Health Initiative study was amended in 2002 women stopped receiving HRT but continued to be followed by the researchers. Those scientists are able to track the women over time to test for continued adverse or protective effects of past hormone use. The most recent analysis continues to say that the risks are greater than the benefits of HRT. The higher risk of heart attack does diminish over time. The risk of cancer, any cancer, remains inflated. A good piece of advice offered in the article was that one should take the least effective dose of a hormone supplement for the least amount of time. I feel that is across the board a sound bit of advice.

Snow: In an article that shares a not so startling bit of news (snow has germs) a comment was redundant enough to repeat here. “It’s a very ubiquitous bacteria that’s everywhere.” Says, Dr. P Dennehy. Too funny. Anyway, no one thinks that snow should not be eaten, but that moderation is wise. Well, as we all can attest if Americans know anything, it’s moderation!

XRays: Last year I wrote about CT scans being radioactive and cautioned against consenting to them too often. I am actually the kind of patient that asks the doctor to try to diagnose me with a clinical exam, you know, the old fashioned way. The study I saw this week regarding x-rays in the ER was actually from Wake Forest University, the University of my former employer, WFU Baptist Medical Center. The researchers were interested in the amount of scans that trauma victims received. Though this kind of diagnostic evaluation is necessary in saving lives, not all scans or complete body scans, are warranted. The researchers and those interviewed about the study do repeat what we learned in the past, this is exposure to radiation and that radiation puts one at risk for developing cancer. It is especially concerning to use CTs and to use the machines on young persons. Tumors do take time to develop so when the scans start early, the dose and time both increase. Safer options may include MRI, though I question that one, and ultrasound.

Fatigue: So nice to see my advice supported in the research. People who do not engage in regular exercise generally feel that they have less energy than those who exercise. Physical activity, movement, increases energy levels, focus, positive mood and health. The most recent proof of these things involves such a small sample size that the results are not considered statistically significant. However, the participants who did begin to exercise with just a 20 minute walk a day had more energy and felt more alert than the non exercising group. It is easy to test actually. Commit to a daily walk, do it for three weeks and then “re eval”. Let me know how you feel.

Rx drugs and Risks: Just a note on how to wrap your mind around reports you hear regarding side effects of medicine. A good example is Chantix, the stop smoking drug. It has a high efficacy rate. This drug is said to be more effective in getting people off cigarettes than the older Zyban(wellbutrin) or the nicotine replacement products. It has also been linked to nightmares, psychosis, and suicidal thoughts. Five million people took the drug and X number had an adverse event. To determine if that is a drug related phenomena, look at five million similar people who have not taken the drug and count the number of similar adverse events. Most people are advising that the general population would have at least as many sleep disturbances, first psychotic episodes and suicidal thoughts.

Wishing you Wellness as you Spring Forward to Good Heal