Tuesday, June 30, 2009
So again... 85% percent of lung cancer (NSCLC and SCLC) is directly related to cigarette smoking. The people who are diagnosed with lung cancer years after they quit smoking did NOT get it because they quit, but HAD IT when they quit.
Lung cancer most often begins in the bronchi or tubes of the lungs when cells change into precancerous lesions after coming into repeated contact with carcinogens in the tobacco smoke. (If you ever had a white patch in your mouth, which is referred to as leukoplakia, you can use that as a visual.
Lung tissue changes because of the assault or injury from tobacco smoke and if the cells become cancerous they will multiply incredibly fast. Cancer cells secrete or emit a chemical that creates new blood vessels that actually feed the cancer cells. NONE of this can be seen on an XRAY but it is happening just the same. When a tumor forms from these cancerous cells THEN it can be seen. Symptoms may come at that stage, but not usually before so.
The time it takes for the cells to change into cancerous cells is YEARS and because we have gone from a national smoking rate of 42% to a near 19% we have a LOT of former smokers. These people had lung damage when they stopped smoking they did not get lung damage because they quit.
In NSCLC the tumor is usually isolated and can be removed. In SCLC, the one that does not have many nonsmokers as victims, the spread is so fast and symptomless that treatment must involve drug therapy and the five year survival rate is less than 10 percent.
Many times a smoker will tell me that they had a lung scan and the doctor said that everything was just fine. Here is what I want these people to understand:
The xray or scan will show when you HAVE cancer not that your GETTING cancer.
A person who quits smoking will have at least 1/2 the risk of getting lung cancer after ten years as one who continues to smoke. I have been quit since 1997 and well, I just have to keep my fingers crossed and do everything else healthy that I possibly can.
I understand also that disease sometimes JUST happens but that means that I need to prepare my body for such a challenge by living as healthy a lifestyle that is in my power to live.
Monday, June 29, 2009
I feel much more comfortable with our American Cancer Society, the National Cancer Institute and others. To the side of the headline LUNG CANCER were the words Media Planet which in fact is a company that assists in placement of advertisements. Shame on the Journal this time as there is NO mention that this is an advertisement as is usually the case in papers and magazines.
Besides the placement of ads for special surgical knives and state of the art imaging machines, the part that got my research blood pumping and later boiling was this statement, "60% of new lung cancer cases are from never smokers or former smokers."
Also the article was misleading in the way it presented that small cell lung cancer which is almost always related to smoking was not the most prevalent cancer. The article/ad does correctly states that 80% of lung cancers are non small cell lung cancer which is abbreviated as NSCLC. The first time I read the article I was left with the impression that only 20% of lung cancer was related to smoking. This conclusion went against everything I know as a tobacco treatment specialist and led to an hour or so of investigation.
Most certainly I found the number one risk factor for lung cancer of all types is tobacco. In an article published by the Massachusetts's DOH in 2005, 80% of lung cancer was associated with smoking. The National Cancer Institute puts it even higher at 87%.
The main types of lung cancer are non small cell and small cell. The non small cell lung cancer has three types, with subtypes also identified. The three types are adenocarcinoma, squamous carcinoma and large cell carcinoma. (carcinoma is a malignancy in the tissue of an organ) The most common of the non small cell is adenocarinoma according to the 2005 DOH article and the American Cancer Society. The Lung Cancer Organization states that adenocarcinoma is only the most common in women and non smokers. All sources put large cell carcinoma at the bottom of the NSCLC cases.
It is clear from all sources that 80% is NSCLC and the other 20% is SCLC, small cell lung cancer. This is NOT the only lung cancer that smoker's get but the type that non smokers do NOT get. That was not at all clear in the WSJ article and I think I know why.
Again the most common cause of lung cancer of any type is smoking but in NSCLC there are other risk factors as well. In NSCLC cases one also finds the most non smokers. Other causes are of course, genetics, but more importantly, radon, asbestos and occupational chemical exposure, and second hand smoke.
The treatment is very different between NSCLC and SCLC. The odds of surviving are also different. In NSCLC the cancer is often isolated to one section or place on the lung and can be surgically removed. There is a risk of new tumors however. SCLC, the kind that is almost always the result of smoking is not isolated and is often already progressing through the body when found. It is more likely to kill a person than NSCLC and quickly.
It appears that the Media Planet article placement in the WSJ was an attempt to remove the stigma from smoking related lung cancer and encourage aggressive testing and treatment. This is not wrong, however, the best thing one can do is to NEVER smoke or to stop immediately.
Now to the final point that got my blood from pumping to boiling. I tracked down the printed statement that 60% of new lung cancer cases were never smokers or former smokers. The amount of new cases of lung cancer that are NOT current or former smokers is 15%. Which means of course that 85% of lung cancer IS related to smoking.
Lastly, lung cancer cases are most often seen in people over age 50 and that is because the cell changes in the lungs are taking place slowly over time. These changes cannot be seen on CT and other scans... because a doctor did not find a spot on a smokers lung in NO WAY indicates that the lungs are fine.
Here are some noteworthy websites:
Deirdre Dingman, MPH, CHES, CTTS
Sunday, June 28, 2009
A perfect example is dinner out last night. There were about eight or nine of us and I ordered grilled fish and steamed veggies, i.e. no added fat, butter, oil or sauce and a side salad. I had as much if not more volume of food as anyone at the table, but the least calories. The waitress asked why I was ordering this way when I was so "skinny". This was not the first time something like that has been said to me, and I always use it as a teaching point. Perhaps you already have an idea of how I respond to comments like these. I say, "oh, you have it backwards." "I look like this because of how I eat and exercise, it isn't natural or genetic, it is purposeful." People often want to think that a little person can eat whatever they want and which can excuse them from having to eat less and move more which can be hard seeming. Thin persons can of course have horrible blood work if they eat crap and do not exercise, but I in fact, have great blood work.
To say that all more simply, being of low weight is not necessarily an invitation to gluttony but a consequence of forgoing it.
Another thing that I do that sometimes gets a reaction is adding salt to my food. I have long known and said to people that not everyone has to avoid salt and that some people have worse outcomes than others because of salt intake. Knowing it and reporting it in my blog are a little different so I researched the issue somewhat today.
I feel and the research supports that hypertension in this country is very much a response to environmental change. This change is in food preparation. We have mass production of highly processed foods which have far more sodium than a body needs. As a population, we have consumed these foods in excess and have in aggregate, the consequence of a blood pressure problem so huge that policy was created to lower sodium content in foods and label clearly the amount of sodium in them.
Our Institute of Medicine has determined that 1500mg of sodium a day is the Adequate Intake (AI) for most people. People who are very active and or work in extreme heat would need more than that. There IS a need for sodium, it isn't like sugar which has no nutritive benefit.
Research has also determined that an Upper Limit (UL) of sodium should be 2400mg a day. This is a recommendation based on the overwhelming percent of Americans who get too much salt. There is no benefit to getting more than 1500 mg a day, so there is no harm in limiting everyone to 2400mg.
Interestingly, study after study has shown that the excess salt, over 1500 mg, is from foods in the control of manufacturers, not from our use of table salt. Of course, adding table salt to say, your McDonald's french fries, canned vegetables or TV dinner would be problematic and some people do indeed do that.
There are also groups of people who more so than others, respond adversely to salt intake over the 1500 mg. This includes people already hypertensive, especially those that do not respond to blood pressure lowering medications as well as black persons, people who were low birth weight babies, middle aged persons and persons with a genetic predisposition to renal problems.
Here is a startling little piece of research info. There is a multi year clinical research study in place now that is referred to as NHANES and in review of the data collected prior to 2004, 100 % of us, regardless of sex or race, exceed the AI of 1500mg a day.
Back to me. Well, for the most part I do not eat processed foods and I happen to be very active with out door sports and I live in Florida. I add table salt to my popcorn and some of my food. So ingrained and so good a message has been delivered that people will look at me with raised eye brows, and relatives may even say, "salt?! oh but salt is so bad." This is their way of finding holes in my (obsessive) healthy lifestyle.
I wonder what we have to do to get the general public to avoid saturated and trans fats and all that sugar and maybe to exercise more?!
Still to be clear, I am not saying that we do not have a problem with too much salt nor am I saying that salt doesn't impact blood pressure, only that a minority of us do not have to watch our salt intake as closely as others.
In my research I also read that potassium intake can offset some of the adverse consequences of too much salt.
One last misconception - water. There is no "8x8 glasses a day" as an official recommendation. Think about it, how could a 95 pound athlete a 120 pound couch potato and a 200 pound construction work all need the same amount of water every day?
I leave you with your pondering... and hey, "hold the salt!"
Saturday, June 27, 2009
Mr. McMahon died in old age, though not a very active old age. Mr. Jackson died of a heart attack at way too young an age and apparently in correlation to being over medicated, not unlike much of this country. Ms. Fawcet, again, too young to die of natural causes, her illness is one that can often be prevented and if not prevented then treated. Screening for disease may have helped all three. Not knowing any of their life styles, that is all I can really say.
Now: If you have been getting into any of the You Tube cooking videos you may be ready to indeed "try this at home". Here are (quite) a few things that I would suggest you add to your shopping list. Remember, for the most part I chose foods that have more nutrients than calories per gram. I try to stay away from processed foods, but am a one a day diet soda drinker, so obviously I sneak some things in.
Red, green, yellow and orange bell peppers
Lettuce (any kind really, I like the leaf lettuce with red edges)
Butter Nut Squash
Shredded cabbage (use it in simmer fries)
Canned baby corn
Greens, frozen or fresh
Peaches and Plums
Lean Meats (?) you are on your own here
Fish such as salmon, tilapia, grouper, mahi mahi
Clams, mussels, oysters
Canned light tuna (not tuna steak and not albacore tuna) in water
Smucker's all natural peanut butter
Eggs or Egg beaters
Vegetarian lunch meat and veggie strips
Morning Star or Boca Crumbles, sausage, bacon, etc
Hummus (2 tbsp should have 50 cals or less - read your labels!)
Sugar and fat free yogurts (80 - 110 cals)
Skim Milk (I like lactose free, others like Over the Moon)
Sugar and fat free ice cream (watch the label 1/2 cup yes, but what is the serving size weight? compare your brands by weights)
Sugar and fat free jello and puddings (use skim milk and water if you make your own)
Sargento 2% cheese slices
Laughing Cow (skinnies) 35 calorie cheese wedges
Whole wheat flour and bread
Soy and Quinoa flour
Mini Stoned Wheat Thins
Jacobsens Snack Toast (cinnamon, raspberry, etc.)
Marinela Suavicremas (my favorite sugar wafer cookies!)
Kedem tea biscuits (chocolate or vanilla)
100 calorie pre made snacks (for emergencies)
All bran original and Kashi Go Lean Cereals
Cream of Wheat
Loose Oat bran and wheat flakes
syrups, dips, salad dressings
Polaner Sugar Free jelly
Olive Oil (for topping)
Vitamin D and Fish Oil Supplements, based on research from Drs. Willett and Cooper.
Well, this is not all inclusive.. I am sure I left off a ton of things, but you get the idea!
Friday, June 26, 2009
that I viewed courtesy of a face book friend. He sent me the clip as he correctly assumed it would get my attention. The clip is of a TV show host responding to something that Rush Limbaugh said on his radio show. To paraphrase, Mr. Limbaugh said that people who exercise so much, exercise nuts I believe he called them, were likely to blame for the rising costs of health care in this country. The reason? He suggested that all of their physical activity, of which he mostly named group sports, resulted in a significant amount of injuries and emergency room visits.
First of all, I have only once gone to the emergency room with an injury fitting that distinction and it was from a ballet class mishap and I only went because my sister insisted. I believe it was a torn tendon and it was not emergent but painful.
We have spoken a lot lately about calorie reduction for weight loss and physical activity for disease prevention. There is a causal link between lack of physical activity and disease and vice versa (meaning exercise and weight control also prevent disease). People who are physically fit and of a normal weight are much less likely to require prescription medications and the frequent physician visits to monitor the progress and side effects so there associated.
Yes, I do have pulled muscles from time to time for which I might see my primary care doctor, massage therapist and or physical therapist; however, I do NOT take medicines. I do not have any chronic disease for which I need disease management.
Though we already know that Mr. Limbaugh is in err, we can back it up with some fact checking of our own. In fact, he should have looked at the CDC’s Advance Data documents himself where he could easily deduct the cause of emergency room visits.
Here are some results from the National Hospital Ambulatory Medical Care Survey (NHAMCS). The survey was conducted from December 29, 2003, through December 26, 2004. I appreciate that this data is five years old (though the report is only three years old) but it includes a review of over 110 million emergency department or ED visits and will certainly show if Mr. Limbaugh’s assertion holds any weight. You can review this very detailed report and conduct your own data queries at http://www.cdc.gov/nchs/data/ad/ad372.pdf.
Though the entire report is fascinating, the bottom line is this, Rush Limbaugh is ignorant. I enjoyed writing that sentence. The truth is that the plurality of ED visits is related to abdominal pain, chest pain, and fever. The report does note musculoskeletal complaints but later breaks down injuries and we can make a cleaner assumption from that data.
For example and by category:
Injury and Poisoning make up 26% of the ED visits and 20 % of that 26% is for fractures, sprains and strains, open wounds, superficial injury, contusions with intact skin. To be extra extra safe, we can add 1.4 % for “other” injuries. So 21.4 percent of 26 percent is 5.5%.
When the report breaks it down to the top twenty diagnosis, however, bruising is on the top, I am referring to the contusions with intact skin. In very close range, only .1 % apart follow abdominal pain, open wounds (non head), chest pain and then respiratory infection. That makes the report a little confusing however, if it were broken down by cost of care, I feel fairly certain that evaluating and treating some bruises is a lot less expensive then working up chest and abdominal pain.
The report goes even further however and categorizes injuries by intent and mechanism. In review of that table it appears that I significantly over estimated which injuries were related to exercise because only 4.3% of unintentional injuries were said to be caused by overexertion and strenuous movements with an additional 1.1 % due to non traffic “pedal cycle” accidents. This would take us down to 5 percent of 26 percent of ED visits related to sports and or exercise. APPROXIMATELY! So 1.3% of ED visits are the cause of the health care crisis.. yes.. that makes sense. (!)
In conclusion, with an ever increasing overweight, diabetic, hypertensive population, we would do well to not only encourage physical activity but to legislate the promotion of it.
The report that I referenced today is cited below:
McCaig LF, Nawar EN. National Hospital Ambulatory Medical Care Survey: 2004 emergency department summary. Advance data from vital and health statistics; no 372. Hyattsville, MD: National Center for Health Statistics 2006.
Well, don't just sit there! Move IT
Wednesday, June 24, 2009
BTW, I always travel with healthy meals too and made it through the Tampa Airport without any lunchbox loss. That was a first!
Meals of Deirdre
Each morning I have a small serving of fruit and one of my cereal bars, recipe on FB and You Tube, along with one of the following:
· 1/3 c egg beater, rice cake with smart beat cheese on top
· 1/3 c (dry) loose oat bran from Richards, cooked in h20, served w/ splenda & cinnamon
· 3 TBSP cream of wheat, cooked in water, and served with splenda
· My home made pancakes, recipe on video somewhere
· One 6-8 ounce SF/FF yogurt with 1/8 c all bran or kasha added (warmed in microwave)
I have 65-120 calorie snacks ~ 3 x a day, including:
· 90 calorie Special K bar (or bargain brand)
· 90-100 calorie granola bars (watch those labels!)
· Home made wraps, video available
· ½ egg sandwich
· ½ PBJ sandwich
· Publix cookie toast with non fat cream cheese 2 = 90 cals
· Mexican sugar cookies, staw, van, choc – 30 cal per cookie
· Tea biscuit cookies 65 cals for 4
· Vegetarian lunch meat with sargento 2% cheese (95 – 100 c)
· Pizza slice that I baked and cut into 100-120 cal slices
· And more, with my late afternoon snack I also have a diet soda (12 oz)
For Lunch, I have a small serving of fruit and a cereal bar along with a meal of protein that I made on the weekend. Lunch usually has 150-200 cals
For Dinner, I eat the Volumetrics way with either a salad or stir fry
For Dessert, either SF/FF ice cream with pudding sauce and extras or my dessert cakes with pudding sauce (150 cals either choice)
For a snack, my PB cookies and skim milk cappuccino
Before Bed, air popped and salted pop corn with 1 tsp olive oil on top!
Yesterday’s post mentioned the need to lower energy intake to lose weight and suggested eating low calorie foods to do so.
In the paper today there were side by side articles referencing a physical activity routine and a calorie expenditure gadget. The routine was interesting and note worthy as it was that of New York Police Commissioner Ray Kelly. He notes that since his time as a marine many years ago he has made weight training a significant part of his life. In fact, it has been said that his commitment to his routine borders on addiction. It is something that he has to do to feel right. Amen to that. He does work out for about an hour a day four days a week. He spends about 30 minutes of that time in cardio activity. He walks and runs, on a treadmill. He certainly dedicates a lot of time to his weight lifting and does many more sets than I would ever do, but he does vary the number of repetitions based on the pounds he is lifting. He made a good point, an iteration of one made here, that there is a difference between lifting to build and lifting to maintain. It is his current goal to maintain and to also to do functional exercises. Functional exercises help you do the activities of daily living, or ADLS. Working your legs to maintain your ability to take the stairs, doing core work so that your back and abs are strong and perhaps most importantly, adding balancing exercises to prevent falls.
He also eats a low fat high produce diet.
I have never watched the TV show the Biggest Loser but a certain device was used on the show that is supposed to help people track their calorie expenditure. These devices are somewhat less accurate than ones used in research studies and could cost you up to 200 dollars, but are certainly more on target than ones embedded in say, a treadmill or elliptical machine. Laura Johannes mentioned a few of these accelerometers in the paper today. The one used on the TV show has been involved in several studies. The studies were small and that certainly dilutes their validity but interestingly the gadget underestimated calorie burn, only slightly, which is far better than over estimating it. We do that without the help of an accelerometer! Anyways, it would be consistent in it’s under estimation and could still be a helpful tool for a person.
My Garmin Forerunner GPS tells me time, distance, pace and calories too and I can see when I run further I burn more, but it does not take into account when I sweat or shiver more, so I don’t think it is high in accuracy for calories. I do not wear it for that, so it is okay.
Lastly, there was a small note that got my attention. A large research study is to begin soon which will track users of vitamin D and fish oil capsules over time, to see if the purported health benefits, Drs. Willett and Cooper, will prove true and also to see if these benefits hold with blacks who will make up 25% of the study population. As you know I take Vitamin D and recently began the fish oil, so this is very exciting stuff!
Okay, that is enough I think. I am freezing to death on this plane.. and I am not alone, many people are digging out their jackets. That is just dumb.
Monday, June 22, 2009
It is my belief, educated opinion, that when a person has health complications, mild or moderate related to obesity or overweight, then the first goal is to get some weight off. The second goal is to keep the core strong and supple and the third is to increase muscle strength. Pretty much in that order.
A person who is ten pounds from their goal weight and working towards it would do fine with a weight training routine. If a person has 20 or more pounds to lose or an unhealthy weight measure http://yourhealtheducator.blogspot.com/2009_05_01_archive.html the first priority is to get the weight off.
The phrase eat less move more is helpful if you take it personally. It means that to lose weight you need to eat less than YOU are eating today and to move more than YOU moved yesterday. Of course, you can't eat less calories if you do not know what you were eating and what calories are in foods. Websites and registered nutritionists can help. Soon menus may help. The same is true of expenditure. Even the link below this post, Stand Up and Eat, can get you on the right track.
(check this out before beginning a new exercise program http://www.americanheart.org/downloadable/heart/1176844249407Phys%20Activity%20Questionnaire.pdf )
Once you lose your weight, a personal trainer can design a routine just for you. While losing weight, concentrate on exercises that stabilize and strengthen your core. You can find these on line as well.
My You Tube videos can give you some ideas on making meals without adding non nutritious calories. I want to be clear however: the term restriction and moderation are very different. Restriction can cause a rebound effect, is not healthy, and is never recommended by this health educator
Below is a sample video, many more can be found here:
Today I took the American Red Cross Basic First Aid certification class. I chose this because I could do it entirely on line and it was only forty dollars. To make the most of my money, I will use some of what I learned for the blog entry, which of course will improve my chances of remembering the information. I have taken the CPR and AED courses in the past.
The course was good in that it covered a broad ranges of emergencies. I learned that the most common cause of death for the adult is Sudden Cardiac Death and that the most important thing to do in that and many situations is call 9-1-1. It is also clear that a lay person such as you or I, should be prepared to provide immediate but temporary care for a sudden illness or injury.
When responding then, it is crucial to check the scene for safety, i.e. an explosion, fire, domestic violence... call 9-1-1 and then provide care that you feel secure to dispense because you have been trained to do so.
The standard, many of you may recall (ABC) remains your first response. Check the scene, check the person, (tap shoulder, ask if ok), call 9-1-1- if appropriate and provide CARE.
By the way, it is necessary to get consent "to assist" from an awake adult and from a child's parent. The A, of the ABC's, is for airway, tilt chin back to open it, the B is for breathing, watch chest, feel for breath and the C is for circulation... and one checks for injury at that time. The rescue position and how to roll people over was also taught. Interesting carrying techniques were taught along with when and when NOT to move a person.
I learned that in some cases you do not elevate a persons legs or feet and it isn't just when you expect head or back injury but also when the person is nauseated. That seems important. I also learned that when a person exhibits the signs of shock, one of which being excessive thirst, the responder is NOT to give food or drink. The definition of shock is when the circulatory system cannot get oxygenated blood to vital organs. It is a critical condition.
Different types of wounds and how to "treat" them was another section of the class and included video learning. I absorbed a few things there as well, beginning with types of wounds.
Abrasion - this scrape should be cleaned with soap and water for FIVE minutes
Laceration- this cut may or may not be severe
Avulsion- tearing away of some skin, or possibly an amputation
Puncture wound- something sharp has penetrated the skin, usually less bloody, but more risk of infection
Only minor wounds should be washed, do not wash if there is excessive bleeding, but apply pressure with some barrier between wound and your skin. If it is not serious, the bleeding should abate in ten minutes. When treating bleeding, hold pressure for the ten minutes and then wrap in a sterile bandage, if the blood leaks through, wrap over that wrap, always over the existing wrap. Continue with the pressure until EMS arrives.
Oh and interestingly, when treating a head wound that is bleeding, apply the bandage over the wound, but the pressure along the sides of the wound.
Except for the cheek, do NOT remove an object from the skin or body (puncture wounds). This can lead to serious blood loss.
We should all have a tetanus shot and or booster between 5 and 10 years.
Internal bleeding, even a small bruise, generally responds to the pressure, ice and elevation protocol. If a person has a nose bleed, they should put chin towards chest and pinch nostrils, EXCEPTION- do not try to stop a nose bleed if there is also a head injury.
If a person looses a tooth, say violently, pick it up by the biting end AND put the tooth in milk. Get person and tooth to the DDS right away.
If a person has lost a limb or appendage, wrap it in a sterile bandage and put in a plastic bag and THEN put in or on ice, but not directly in or on ice. Keep body part with the person.
Burns came next and they too have particular responses as we try to do no further harm (as the course stated).
The severity of a burn; first, second, third and critical degree is related to these factors:
Temperature of the burn source
Duration of contact with source
Body part burned
Age and health status of victim
All burns should be cooled with water, but only the most minor should be iced. There are heat, chemical and electrical burns. Chemicals should be brushed off, not with a bare hand, before flushing with water begins. Shock must be considered in almost all circumstances. (not our minor cooking burns, a minor burn is dry and red, the more serious ones blister, are moist and in third degree, the tissue is charred)
Electrical and chemical burns are always considered critical and so are burns that are located on more than one body part OR hands, feet, the head or genitalia.
The musculotskeletal portion of the course was somewhat a review and did go over brief treatment for sprains, strains, dislocation and fracture. I did learn that one does not elevate an open fracture but the RICE acronym would otherwise apply. This is again, treating during emergencies, not diagnosing or treating people in the general sense.
A special note for head, back and neck injuries, in that they would be expected if the symptoms included any blood or fluid from nose or ears, bruising behind ears or under eyes, loss of feeling in and/or inability to move hands and feet. In this case, it is the best to keep the person still, watch for shock, immobilize the head, control extremity bleeding, but do not try to stop the fluid from nose or ears. 911 would have been called immediately.
Finally I got to the part of the course that was my motivation for signing up. Fainting and such! This part was titled sudden illness and many types were covered:
Fainting, which usually self corrects
Seizure, place something under the head, a pad, do NOT touch or immobilize person
Stroke, check face (smile), arms (raise both), speech, time of event... call 9-1-1
Diabetic emergencies, could be too low or too high glucose, the response was give sugar (according to the training, which is the only part I question)
Poisoning, four ways of happening with distinct signs of each.
BTW, an injected poison includes bites and stings
Anaphylaxis, is a severe and life threatening allergic reaction. Care needs to be given within minutes. A person with a history of this may have their own epinephrine to inject.
Spiders and scorpion bites, apply ice, get help
Snake bites, do not do the stuff you have seen on TV. Clean and immobilize,get help.
AND, Heat and Cold Emergencies
The heat related info is a review from yesterday's blog, but did not mention syncope. Noting that heat exhaustion and heat stroke require EMS or 9-1-1- if the person vomits or refuses water and/or has a change in level of consciousness. Heat stroke includes rapid breathing and pulse, but a weak pulse and red, hot skin. Remove wet clothes and offer small sips of water here.
Interestingly, with frost bite when you warm the body part in water, do not let the part touch the sides of the basin. It is also important that you do not RUB the frost bitten body part. With hypothermia which is life threatening, the heart rate is also abnormal, but slow and irregular. Warm the person slowly, remove wet clothing and use warm dry blankets. Offer warm drink, if fully conscious. Avoid alcohol and caffeine.. no hot toddy!
So that is about all that I learned in the course which was followed by a test for a three year Basic First Aid certification. I passed. Interested in the test yourself?
Saturday, June 20, 2009
A little back story then.
Today I tried a new activity. I have a running friend who lives the hottest time of the year in Maine, but has been in Florida the last several months. She is due to leave June 30th so we planned this last minute "learn to kayak" adverture for this morning, having heard about it from another running pal.
We began relatively early, but not early by Florida standards. We usually start running no later than 7 a.m. this time of year, and our kayak "class" didn't get under way until after 8:30 a.m.
We began as a group, perhaps ten of us. We spread out in the grass and the instructor led us through some movements, standing up, with our paddle. The sun blazed upon us as we stood with our backs to it. All ten of us. All but one of us had on a hat. My friend had a hat, but it was a visor, that may have mattered.
Most of us were dutiful with our sunscreen and sun glasses as well.
I believe the standing in the sun part may have lasted an hour. The sweat dripped off the back of my neck and down my shirt. I felt uncomfortable.
(I had some significant over heating with my runs lately, it was not that bad.)
I worried about my friend because she will often have to take breaks during our runs when it is over 80 degrees. She was in the back and I was in the front.
We, the group, returned to our starting place near the instructors van and back into the shade. We then all had to put on life jackets. It was time to get in the water when my friend told me, very casually, "I feel nauseous." Maybe a bit later, "I am sort of dizzy."
The class was moving towards the waters edge (lake) but we stayed back. I asked if she wanted to sit, and she said, "Where would I sit?" I said, "I guess right here in the grass, so you are still in the shade." We had our paddles still. Maybe I had put mine down.
No one was near us anymore. My friend seemed to be leaning into her upright paddle with all of her weight. She doesn't remember this part. She was definitely pitching forward. I dropped my paddle, if I had it still, and lunged for her, but her legs went out and under mine as I yelled, "Help." We both fell in a rather tangled mess, and she hit her head.
People came then, but no one was medically inclined. I got her life jacket undone very first thing, sort of the "loosen the collar" of TV first aid. We got water on her, I checked her pulse. In fact it was strong, not thready as they say and not irregular. I knew that was at least not a bad sign.
We cooled her off etc. She went in the lake in a kayak after the class was over and rather got a private lesson. The Economy Tackle people were extremely accomodating to my friend and she does get to take the class again, no charge.
My biggest thought was why did she faint and I didn't and what do you call it when someone faints in the sun, but it isn't heat stroke?
First my investigation of the scene and the person>
My friend and I are about ten pounds different in size, we are both small people. She is about 20 years older then I am, but can at times out run me. She is physically active and eats nutritiously. She ate this morning at 6:30a and I ate at 8a. We both have low normal blood pressure. I do not think she is on medicine, I can't believe I forgot to ask!!
Our hats were different. Remember I felt bad, she actually fainted. She drank less water before and during than I and we think that the lack of hydration and the fact that about three hours had passed since her last meal.. may have pushed her over. She withheld water because... are you ready... there were no bathrooms nearby. A park with no bathrooms.
I was conscious of that too, however, I never "pee" when I run and I hydrate often. As I told my friend, you won't need to use the bathroom because you will be sweating! And we were.
So she is all good, had a nice lunch afterwards and stayed in the cool inside. Though she bumped her head, she has no sore spot.
What I learned since then is that a milder form of heat exhaustion is called heat syncope. At least some sources say it is a milder form of a more serious condition. I will stick with what I learned from the American Academy of Family Physicians. There are several types of heat related illnesses and some are life threatening and require medical stabilization, while others are mild and require hydration, a cool down, a lie down perhaps, and getting out of the heat. The best preventative measure is acclimatization. If you are going to be doing out door activity, get used to the heat gradually. It is clear that one needs to hydrate before, during and after activity in intense heat.
There absolutely is a way to over hydrate and a medical consequence to that as well. We are not discussing that today.
My friend did not hydrate prior to or during the activity.. that is likely the biggest contributing factor to her syncope. We did lie her down and cool her down, so good for us we responded as we should have.
So the heat related illness, in order of severity are:
Heat Edema - swelling in the limbs because one is not used to the hot temperatures (mildest)
Heat Cramps - not used to the heat yet, lack of sodium, perhaps medicine related (hydrate)
Heat Syncope - blood pressure drops and dizziness occurs, often from standing too long or from standing too quickly from sitting, (that is what orthostatic hypotension is) the heat can induce it. Heat syncope also comes from dehydration and lack of acclimatization. I should have gotten my friend on the ground as soon as she said she was dizzy. (recovery is quick)
Heat Exhaustion - may need IV rehydration, usually better in a few hours. No neuro deficits
Heat Stroke - very serious, may lead to death, does involve mental status changes (serious)
All right, try new things but be careful out there!
This was a nutshell synopsis, a syncope synopsis if you will... more technical stuff is yours to be had at :
[after note, June 21st. My friend said that she did NOT feel sick to her stomach and remembers saying instead, "I don't feel right." Now that she mentioned it, I believe she is quite right about that. Otherwise, it pretty much happened as I said. ]
OH my and here is a little extra thing I learned. Funny how we learn things. I wanted to make sure I was spelling nauseous right so I googled it of course, (though Bing is cool too). And I learned that my friend meant to say, I feel nauseated, as saying you feel nauseous means that you make other people sick... Huh....That is weird though isn't it, because if someone bothers us, don't we say "he/she is nauseating?"
Firstly, cigarette smoke can affect every part of the reproductive process. Meaning that nicotine and other constituents of tobacco smoke and tobacco can affect men and women's reproductive capacity and well as the health of the unborn and born child exposed to it.
This post is not intended to cast blame or to lead you to cast blame. Most people are aware of the adverse effects of tobacco products and continue to smoke or minimize risks as a defense mechanism. They have an addiction. Other posts have dealt with tobacco addiction.
Because the US Surgeon General and many others have identified adverse outcomes from this exposure, one of the goals of Healthy People 2010 was to decrease the percent of smoking during pregnancy to a very low 2-3 % but it now stands at about 11%.
The adverse outcomes are due to both the nicotine and carbon monoxide in cigarettes as well as some other chemicals. It is not crystal clear, and therein lies the problem. The evidence is sufficient to state a causal relationship to premature birth, low birth weight, premature rupture of membrane, placenta previa and placenta abruptia as well as SIDS. The SIDS, or sudden infant death risk lasts through the first year of life and is related to second hand smoke as well. There is also a substantial amount of evidence to support that the smoke can lead to cleft palate.
We also know that nicotine replacement therapy or NRT can double the chances that someone will quit using tobacco. The debate or dilemma comes in weighing the risk of NRT which provides nicotine vs continued smoking which sends several thousand other chemicals through the placenta into the amniotic sac and the umbilical cord . These chemicals run all through the mothers blood, to the baby. Nicotine is a neurotoxin, it can effect brain development. What does one do? Most of the medical experts I have spoken to would first suggest quitting without medicine and then say that NRT is better than continued smoking but ONLY if the NRT is the ONLY source of nicotine for that mother.
Most of the discussion is based on animal studies and older ones at that. One of the first involved pregnant rats which received far more nicotine than a woman would receive smoking OR with a patch. A more recent study used comparable nicotine doses and did not find an increase risk of low birth weight with those pups, as they're called. The studies that do exist come with a lot of weaknesses. I was especially concerned about one I read this week as I had been of the mind that NRT has to be better than continued smoking. In the new study, information was rather pieced together over what the mother's themselves reported and adverse birth outcomes were noted from birth certificates. In this study the researchers asked if the pregnant woman was a smoker or non smoker and if the mother was prescribed NRT or recommended it by the MD. This study found increased low birth weight and premature birth in the NRT group. The lowest rate was in the non smokers, but the NRT babies were worse than the babies of smokers. Here is what we do not know... did the mom's indeed use the NRT and if so, what dose and for how long? What if the Mom's who were told about it were the one's smoking the most, but they never used the NRt and or quit?
Isn't that messy?
Well, I didn't think anyone would do a placebo controlled NRT study on pregnant women but indeed there is one under way in Britain. The British National Health Service began recruitment in 2007 and will follow the women for two years, to assess the health of the children post natally. The women, who are smokers, will be given either a nicotine patch or a placebo patch. The results should be available soon and because the women are in a study, their labs will be routinely analyzed and we should know with some confidence, the result of using NRT during pregnancy.
It is not advised that women use NRT without the consultation of their physician.
I will bust one myth for you however. There is No evidence to support that quitting smoking is worse on the fetus than continuing to smoke.
Potera, C. NRT in Pregnancy. Environmental Health Perspectives. May 2007 115(5)
Gather, K. et al. Does the use of nicotine replacement therapy during pregnancy affect pregnancy outcomes. Maternal and Child Health Journal. June 2009. Viewed in Medscape.
Friday, June 19, 2009
So why in the world would the FDA approve a medication for this. A medication which does not lower any heart disease death or disability over the statin therapy one takes for lowering their LDL-C. Even the TV ad tells us that the medicine will not do that.
The reason we lower any of the numbers, whether it is cholesterol, blood pressure, CReactive protein, triglycerides, etc is to lower the risk of disease and death. If this new medication lowers triglycerides while putting the patient at great risk for side effects for NO OTHER REASON than to have a lower number.... WHY would a person take it, a doctor prescribe it or an insurance company PAY for it. This is how our country spends so much money on health care without having the best healthy life expectancy.
So, I am blasting about a drug called Trilipix... cute huh. The scientific name is fenofibric acid. The drug company did complete severe phase III trials before gaining FDA approval and I was able to read a little about that. The company used the drug in conjunction with statins (i.e. Zocor and Lipitor) of different strengths compared to a group that just used the new drug. In the combo therapy all numbers changed to the better, lower LDL and TG and higher HDL but again, there are no improved health outcomes so why would you subject yourself to the risk factors and the cost of another medicine?
Better than that, the TV ads and the literature on the drug insist that it is to be used WITH a diet regimen. In fact, the print warnings and prescribing info for clinicians states that diet and other non medicine strategies should be exhausted before prescribing Trilipix. The consumer ads and website just say to talk to your doctor about this new drug. Heck they even give you a print out of talking points so that you, the patient, can educate the doctor and advocate for this treatment on your own behalf. This is certainly playing to our cultural leanings toward pill focused solutions.
But pills come with more than a financial cost. The physical risk can be great as well. For this drug, side effects include
And more seriously, muscle wasting and possibly kidney and liver problems. The serious side effect risks go up when the drug is used in combo with the statins, but it is with statins that it works. Again, why would one take this drug.
Eat Smart Move More... Live better, longer... Extend your life not your death...
Thursday, June 18, 2009
Heart disease and heart attacks are related to plaque build up within the arteries and hardening of those arteries. Arteries can get closed off or the plaque can break off and block an artery. Sometimes, as with an aneurysm, the artery walls weaken and leakage and rupture can occur.
Much of the risk for this problems comes from lifestyle. Of course genetics are involved, and if you have a family history of heart attack that means that lifestyle modification should be even MORE important to you, not less.
Eating foods high in saturated fat has long been known to raise one's "bad" blood cholesterol. While exercising helps increase one's HDL which helps the body process and eliminate the bad, or LDL low density lipoprotein.
In an article I read yesterday, the WSJ reported on the changing picture of treating heart disease and preventing fatalities. Over the last twenty years cholesterol lowering medications have become a billion dollar industry, but they have also saved lives. My father took a cholesterol lowering medicine, too. He had one of the original powders that he mixed up diligently every day, even when we went out of town. I forget the name, it came in a can.
What we didn't pay attention to those years ago but appears to be our next big challenge with regard to heart disease is triglycerides. It is high triglycerides that cardiologists consider the big risk factor for a heart attack. In the article I read, it was said that having triglycerides at 150 or above was a big indication that the person had a poor diet and limited physical activity.
The new focus is on raising HDL and lowering the other blood fat. Unfortunately, some say, blissfully I say, the best way to make the HDL go up and the tri's go down is.... drum roll please...
Become physically active, cut calories and eat more fruits and vegetables.
Triglycerides need to be monitored in much the same way total, LDL and HDL are monitored. It is said that even if the LDL stays at a decent 100, if the HDL drops below 50 and the triglycerides start trending up, something is happening and the chance for a heart attack will go up.
I am including another website for you today called CardioSmart. On this website you can complete some assessments of your risks and learn about reducing LDL and TG. TG is the abbreviation for triglycerides. I have learned from this website that it is important to eat a low saturated fat diet with lean protein and lots of fiber but NOT a low fat diet in general. So what you have heard here and what you see on my You Tube page, is correct. Include your mono and polyunsaturated fats in a calorie controlled lifestyle.
I do not think that TG were looked at much if at all in 2002 when my Dad died. I know that he had changed the way he ate after his first heart attack and tried to exercise regularly, but I also think he drank more than the recommended 2 or less alcoholic beverages a day. I know growing up that he was heavy into red meat and potatoes with lots of gravy and starchy vegetables. I am NOT faulting or blaming at all... we did not know what we know now. I am telling YOU so your kids don't sit around wondering about it.
My Dad was awesome... just had to end with that...
Tuesday, June 16, 2009
You might be interested to know also that sleep deprivation can lead to psychiatric problems. As you may remember, I once worked in a hospital setting and when taking history we always wanted to know about sleep, bladder and bowel.
We will talk about sleep today. I am going to share information from a June 8th Wall St Journal article before telling of my own observational sleep research study.
Melinda Beck shared information that she had received from the National Sleep Foundation's recent conference. Interestingly, a lack of sleep can lead to many of the same illnesses associated with being overweight and inactive. In fact, it can disrupt metabolism and cause hormonal imbalances. Sleep deprivation also affects memory and learning. It is important that a person experience both REM sleep and deep sleep. I will add the NSF website at the end of the post in case you would like to learn more.
Serious sleep disturbances should be evaluated through a sleep study and several centers exist for just this purpose. In her column, Ms. Beck spoke of a device that one could use at home to gather data to upload that could track the amount of different sleep levels a person was getting. The device is costly and is not a true diagnostic tool. She also spoke of having a laboratory sleep study that found problems and now she may take a medicine because of a condition called Periodic Limb Movements. Cynical me thinks they just made that up so they could have everyone take a pill for it. The pill is Requip. There is a condition call Obstructive Sleep Apnea which I do consider valid having seen people with it. A special breathing machine is available to treat that condition.
While writing this post I went to the NSF website and was browsing when I saw at the bottom of the page a little note about them working with Sanofi Aventis on a Sleeping Smart program. Well. Well. I don't like that so much.
I guess the foundation is still good, it says it is a non profit that promotes restorative sleep.
Most of us have heard some advice on sleep hygiene.
Watch the caffeine and alcohol intake
Consider when you exercise (perhaps not too close to bed time)
Use the bedroom only for sleep (though many of us read and watch tv there, among other things)
Watch that you don't eat too much too soon before bed
Keep a regular bed and wake time
My personal experience has been that the absolute most important piece, if it is in your control, is to wake up at the same time every day. If you must sleep in because you feel you deserve it, make it no more than a half hour difference. It is truly better to go to bed early if you are tired then to sleep in. Sleeping in can disrupt everything and returning the balance can be a challenge.
I changed my mind about the link. I am going to give you a different one. This is to the National Center on Sleep Disorders Research which does have a patient education section and is affiliated with our NIH.
Monday, June 15, 2009
My purpose today is not to tell you how many calories you need nor what percent of carbs, fat or protein... the gold standard for that kind of personal input is a licensed nutritionist. I do want you to be able to access credible Internet resources that can give you a general idea of how many calories you may need. Remember, the energy you need is based on the size you are now, the size you want to be and what you require of your body. I.e. , a football player versus an office receptionist who walks after work.
I also believe that if you limit saturated fat and sugar you will get the right amount of protein and carbs. (actually it is like the saying my Mom is fond of, "if you take care of the pennies the dollars will take care of themselves". If you watch the fat and sugar, and sodium as well, then chances are you will also cut the calories) To survive, to function, our body needs protein, fat (mono and poly unsaturated), carbohydrates (specifically complex ones), water, vitamins and minerals.
According to my study notes, which are several years old, a person needs about 60% complex carbs, zero refined sugar and about 25 grams of fiber a day. Protein, carbs and monounsaturated fats are key. I do not have my Cooper Institute notebook at home with me, but I recall one of the professors telling us not to get caught up in percent breakdowns.
Please consider this food guide pyramid by Walter Willett, MD and the Harvard School of Public Health.
Copyright © 2008. For more information about The Healthy Eating Pyramid, please see The Nutrition Source, Department of Nutrition, Harvard School of Public Health, http://www.thenutritionsource.org/, and Eat, Drink, and Be Healthy, by Walter C. Willett, M.D. and Patrick J. Skerrett (2005), Free Press/Simon & Schuster Inc.
I believe if you follow these recommendations within
your own caloric requirements you would get the right amount of carbs and protein, etc. If you are underweight, recovering from illness, have wounds or injuries, a special recommendation will be made for you by a medical professional and or nutritionist.
Also use this website to get an idea of how many calories a day you may need.
Go to the bottom left and there is a link called Calorie Needs, click there:
Continue to explore the above link and you will learn much to get yourself on the way to a healthy active life. Remember we want to extend healthy years not debilitating ones.
Sunday, June 14, 2009
Just briefly then.
I had said to my mother on Friday that I thought health insurance should be like car insurance or home owners insurance. When we get those types of insurances, we do everything we can to act in ways that will not lead to a price increase. People who do not speed or get into self caused accidents have better rates. People who live in hazardous zones pay higher premiums.
Why wouldn't we take care of our bodies? Oh, yes, likely because pharmaceutical companies tell us we do not have to as pills can fix everything. Well, they cannot. And when they can treat a condition it often comes with a real and physical price. We also spend a lot on tests, scans, procedures etc which do not change outcomes.
With my whole heart I believe that health insurance and health care is a resource to be preserved.
I found on Friday that my idea wasn't new at all as the CEO of Safeway had an article in the WSJ saying just about the same thing. I saw also that he had started a coalition.
I can not say this better so below are the links to the article and to his website.
Saturday, June 13, 2009
First the frustration and then the scientific input.
You may have noticed a commercial that talks about feeling lethargic and not yourself etc, with the voice over, "it may be LowT". It is a very cutesy, can it be cutesy and target men?, ad that is just another example of direct to consumer advertising for a medication. This is one of my top five pet peeves. I feel the same way about direct marketing anti-depressant medications, any medications really.
The pharmaceutical companies have a product to sell and they cannot sell it if people don't have the condition it is intended to treat. Well it can be used to treat other conditions, but that is another story. They are in it to make back the money they spent on development and then to turn a profit.
Now the drug company feels that it has to educate the public on the medical condition. Well, low testosterone is usually a matter of aging. It is also true that men who are overweight, sedentary, diabetic and who use tobacco are often in the group with low testosterone levels. It has not been said that lifestyle causes low testosterone levels, only that the condition is found to a higher degree in those situations.
BTW, the actual term for low testosterone is NOT low T, but hypogonadism. That has a nice singsong ring to it doesn't it?
Ok. The condition is real. I would hope that a well educated physician would know to evaluate a person for this if they had the symptoms. The condition does respond to treatment, of which there are several types. Mainly, injections, patches or gels. The oral treatment is not used in the this country due to risk of liver damage.
The Low T commercial directs you to a website to learn about the condition, I direct you instead to the Cleveland Clinic website...
The website the ad directs you to is copyrighted by Solvay Pharmaceuticals, Inc. This company sells a gel to treat low testosterone and it encourages you to ask your doctor about it. I was able to learn a little about the options and risks of all TRT (testosterone replacement therapy) by reading this article:
Medical Progress: Risks of Testosterone-Replacement Therapy and Recommendations for Monitoring. Rhoden, Ernani Luis; Morgentaler, Abraham.
Volume 350(5), 29 January 2004, pp 482-492
And in a Medscape article I was able to find a chart that compared blood levels of testosterone by treatment. I learned that the TRT patch and gels are similar and that the injections were able to get the level up higher but for shorter periods. The gel is the most expensive of the medications at about 300 dollars a prescription.
An additional concern with the gel, which is not applied to the penis, but the arms, shoulders or stomach, is that it will get on someone else.
Hormone therapy is not to be taken lightly. There is not a consensus on treating hypogonadism with hormone therapy as it was years after we treated women with estrogen therapy it became apparent that it caused cancer.
My message to you today is to let the medical experts educate and treat, not the pharmaceutical companies.
Friday, June 12, 2009
It is true that the majority of Americans are overweight or obese and because of that many have been advised to lose weight. According to premier health experts and programs, including the Cooper Institute which you can link to below this post, the best way to lose weight is to cut calories. The best way to maintain weight loss is to control calories and to exercise.
When your goal is to influence the behavior of others, as mine is, it is helpful to start where the "others" are and to use personal experience if you have it and evidenced based solutions if they exist. You are in luck as I can provide all of the above! I know what it is like to be overweight, I know what it is like to have dieted and dieted and dieted, better still, I know what it is like NOT to do that anymore. Science says we have to eat less energy then we expend to lose weight. The public health consensus is that almost to a person we overestimate the calories we expend and underestimate the calories we consume.
Reducing caloric intake scares the hell out of people. We just do not want to be deprived. I know. Dr. Barabara Rolls and others say that low energy dense foods can make cutting the calories different from cutting volume. One can lose weight without hunger pains and deprivation. Volumetrics is a safe, effective and pleasant way to improve health. Yes, I said pleasant.
As it turns out, Dr. Rolls has a study published in the journal Physiology and Behavior from March of this year. I haven't read the article yet, only the abstract. But here is your evidence.
The relationship between dietary energy density and energy intake
Barbara J. Rolls ⁎
The Department of Nutritional Sciences, 226 Henderson Building, The Pennsylvania State University, University Park, PA 16802-6501
I am doing my best to provide you with science and evidence based programs as I don't diet and do not endorse ANY diet program.
Also, I want you to listen to the commercials especially from Nutra System, w/ their special diets for men and for diabetes or people who don't want to get diabetes. And really listen, because what the announcer says is this... "clinically tested". Read that again. Tested is not Proven.
Anyways, I meant today to be a short blog with a video focus. It did not turn out that way. Still, the video is short - 5 minutes - and showcases a very filling 150 calorie meal.