Dr. Barry’s Articles
Dr. Barry writes a monthly article featured on TableHopping.com. Read his current article below or check out some of his articles…
YOUR DOCTOR SAYS YOU CAN’T PREVENT OR TREAT DEMENTIA ARE THEY WRONG ON BOTH COUNTS??
I have been reviewing Dr Chris Knobe’s excellent work on the dangers of the seed oils, the omega 6 oils as inflammatory and related to most modern diseases. The oils, canola, corn oil, sunflower oil etc are polyunsaturated and therefore highly likely to oxidize which is a chemical change in their makeup that makes them antinutritious. Or you could equally call it slow food poisoning because this stuff is ineverything processed. Excess Omega 6 , and by that I mean the Standard American DIet, is dementogenic, atherogenic, obesogenic, carcinogenic , carcinogenic….I mean come on people how many “genics” do you have to hear before you get the idea these are man made chemicals that don’t belong in your body and are sabotaging your health.
Then I was listening to the Rhonda Patrick Found my Fitness Podcast with Dr William Harris who has worked his entire career investigating Omega 3 oils which are thought to be anti-inflammatory. The higher your Omega 3 index is the better your overall health and the lower your mortality. This is something you can easily measure at your doctor’s office and treat at your grocery store.
Then, to really hammer it home comes the recent Youtube videos of Dr Paul Mason who has posted lectures again linking dementia to your diet. Once you whet your appetite with the short video linked here you can refer to his other work.
In this video posted in September he reviews the literature and confirms that dementia is a dietary issue…not a genetic one. Sure there are genetic risk factors that can affect your risk but they seem to do so only in the presence of an inflammatory diet. Dr Mason reviewed the famous Nigerian study where people who have the highest possible genetic risk still have very low rates of dementia unless and until they adopt the Western diet. …watch the great dr paul; mason reversing .look at the nigerian study…proves its not genetic…didn’t have dementia 100 years ago and our genes have not changed in that short a time…seed oils and fructose….table sugar is 50% fructose….causes insulin resistance…after nine days you can reserve the liver.
There were only rare cases of dementia diagnosed 100 years ago and dementia is rampant now and our genes have not changed over 100 years…genetics takes hundreds of generations. What I liked about this video was the inclusion of the damage done by fructose and how this makes oxidation worse. So you have the one – two punch of insulin resistance / diabetes (which affects most of us if you do the right test) and the damaged and damaging seed oils which acts as a double whammy. I had not previously seen evidence that diabetics actually absorb more of the oxidized oils than non diabetics…makes sense when you think of the damaged gut lining. Also his finding that the highest risk allele the apoe4 ( the gene variants that affect your risk factor for dementia) is the highest risk because it’s the most susceptible to oxidation (from the seed oils) and glycation (damage from the high insulin/ fructose) was new to me and makes sense and might even be true.
What’s that Mr. It won’t happen to me!? Well , currently the risk of dementia doubles every 5 years starting after age 65. 43% of people over 85 carry the diagnosis and we haven’t really come up with an effective treatment since it was first diagnosed in 1906 despite spendin billions and billions of dollars and over 200 failed trials.
What’s that Mr So there’s nothing to be done about it? Well there is if you look at things from a metabolic angle. The brain has 2 percent of total body volume but uses 20% of metabolic energy. The brain is a stove ! And by using sugar as a fuel you are gunking up the pipes . By using ketones as fuel you clean out the pipes and burn more evenly. Ketones can allow the brain of demented patients to use a new stable healthy reliable food soursce as glucose is no longer able lto be used as fuel djue to insulin resistnace. High sugar levels are not good for the brain long term.
Diabetics are two to five times more likely to get demented..the bigger the belly the bigger the risk of dementia..triple the risk compared to slim people.There have been 31 trials comparing low-carbohydrate and low-fat diets that reached statistical significant results every single one of them showed better weight loss with a low carb diet.
Certain cells of the brain can take up sugar without any help but other cells which are spread throughout the brain but interestingly are concentrated in the hippocampus. This is a major memory area. These cells need insulin in order to get the sugar in the brain and if you have insulin resistance you’re not getting adequate sugar to these cells. These cells can however use ketones without any difficulty whatsoever.
People talk about amyloid plaques in the brain being associated with dementia . Actually the amyloid monomer is at very protective of the brain it’s when they are clumped together that it becomes pathologic but the amyloid itself is normally produced by the brain and has protective effect Studies have shown that HDL, that’s right the components of the lipid panel that your doctor has ordered for you many times, actually has protective effect on the brain trying to clear it of these amyloid products . That gets back to the Apoe4 allele…these genetic variants affect the hdl ..damaged hdl can’t clear plaque as well hence their increased risk of dementia. And oxidation ( damage from seed or plant oils) and glycation (damage from higher fructose and high fructose corn syrup/diabetes etc ) are what affects the HDL particles.One study showed that HDL levels over 55 offers a 50% protection of Alzheimer’s. It’s possible that the higher your HDL the less likely you are to have Alzheimer’s Looking at this from the angle of reducing dementia risk we have to mention sleep as well. Sleep deprivation increases beta-amyloid deposition so deprivation equals deposition equals dementia. And this has been shown to happen after only one night of poor sleep based on the Dr Mason data. Sleep deprivation worsens insulin resistance and that’s a consistent if not unifying theme. Check your continuous glucose monitor, your normal morning insulin spike will be higher in the mornings after poor sleep.
Interestingly the dietary supplement carnosine has been shown to both to lower insulin resistance and to prevent glycosylation . Carnosine comes only from flesh that is meat ,it’s not found in plants and Doctor Paul Mason points out that this lack of carnosine might increase the risk of dementia in vegetarians. I am not suggesting you start popping carnosine…do your own research . I haven’t taken it …yet….but it’s intriguing.
Bottom line is an ancestral diet of unprocessed food is your best bet to optimum health. Check out the Weston Price Foundation. https://www.westonaprice.org/ .Of course the most comprehensive approach to dementia I think is the Dr Dale Breseden approach which you can look up as well and a local resource for real evaluation and treatment is right here in town at Clarity Clinical Research . I have not become an official Dale Breseden but I am looking into it bacause I dont see other people locally doing it.
J T BARRY MD
I have two interesting things for you this month..both can be very helpful regarding your health and both are widely available and both are free ! How often does a doctor say that ! I am always on the outlook for tools and techniques that can improve your health and you need look no further than your smartphone.
First up is an app for those of you who want to try intermittent fasting and need a little motivation or advice. The app is called Zero…..its produced by Dr Peter Atia who has made healthgevity his lifelong mission. This guy has done every conceivable experiment on himself in regards to exercise, diet, supplements etc and has produced this app to help with what he ( and most people in the health improvement arena) thinks in an effective and important strategy to improve your health. He is a big Insulin guy as well. As I have written previously, keeping your insulin low is important to keep your inflammation low and Intermittent Fasting is one way to do that. Most of us eat from the time we get up until we tuck ourselves in at night and that’s a lot of work for your pancreas. If you can limit the time frame in which you eat to 8 hours or less that can help lower your overall insulin and improve your health. Of course, the most restrictive time frame besides completely fasting is a 2 hour window. This is the one meal a day model which studies have shown is very healthy and results in very low insulin and inflammatory markers but most of us don’t have the fortitude for that. My suggestion is to skip breakfast…(dont break fast) and eat between noon and 8 pm. Work your way towards that and use the Zero app to keep yourself honest and answer questions like taking supplements when you are fasting etc. There is a premium version of the app but you can get plenty of milage with the free version. Peter Atia is all over podcast and Youtube so you can see for yourself the guy behind the app. Also for more on intermittent fasting and insulin etc I refer you to the great Dr Jason Fung who you can youtube (Did I just use a noun as a verb? ) While you are at it, ask your doctor to check your fasting insulin level. It’s very simple…the lower your fasting insulin the overall healthier you are. And visa versa. It’s a cheap, simple , independent test of your health and you should ask for it. Your doctor has been trained to check your glucose but your insulin level will reveal your metabolic status years and years before you would otherwise be considered a diabetic. Don’t take my word for it, ask Drs Gundry, Mercola, Attia, Saladino, Knobbe, Gregor, etc…these doctors may have very different opinions on the best diet to improve your health but they universally believe that a low insulin level is desirable.
Now the second app is really a series of apps and again it’s oriented towards trying to help you with your resolve and motivation. You don’t lose weight because you should , or could you lose weight when you must. As Tony Robbins says you meet your musts. I could, I should, I think …those are not change words…I must, I will, …those are change words. But the apps are not about changing words, they are about changing your focus and attention. These apps, which are also free at the app stores, work via hypnosis. You can get hypnosis apps for weight loss , for drinking issues, to improve sleep etc. Before you start fumfering around that you can’t be hypnotized, let’s look at how well you are doing with your bad habits on your own. Most of us need help changing habits…You can join a group, zoom, or journal , but what’s really important is changing your motivation and outlook and that’s where hypnosis comes in.
Hypnosis is a state of relaxation with heightened and focused attention. It was first made popular by a German physician named Franz Mesmer who invoked the concept of animal magnetism. Later, a British physician named James Braid coined the term hypnosis from the Greek god of sleep hypnos. None less than Sigmund Frued took it up but later abandoned its use in favor of free association techniques he later championed. I am not talking about stage hypnosis. I am talking about one on one sessions with a trained practitioner to see if you can work on a particular problem. That’s what I have always recommended to my patients having trouble with making progress on a particular health problem. We have several well established hypnosis practices in the Central New York area.
Now, however, as apparently everything will be, it’s available on the smartphone. Why not give one of the many apps a try and see what happens. I have personally seen the effects of hypnosis and the literature is full of support for this modality. If the app helps but not enough , then perhaps, seek out an in person experience with a qualified professional.
Take control of your health. Take control of your behavior. Change your health destiny.
Until next month….get well …stay well
J T BARRY MD
One thing I notice as people are out and about more but honestly I see every day in my office is that people slouch. Yes you…you slouch a lot. Your posture sucks and it’s possibly affecting your health. Your mother was right again. Posture affects more than just how tall you appear. Poor posture can create a host of symptoms from back pain, headache, fatigue, breathing problems, jaw pain and even knee hip and foot pain at least according to the Cleveland Clinic. According to the American Posture Institute bad posture is a major risk factor for falls in the elderly and since falls in the elderly are a major risk factor for death ….poor posture = increased mortality. So it’s not just about how you look ..it’s about your whole body health. Most of the articles about posture on the internet are oriented around gaining height but my concern with your slouching is that it contributes to your poor health. I am a primary care physician not a chiropractor but both professions can agree that posture is important and working on your posture can have real benefits. So, your posture is bad but your grandkids posture is even worse since they are always looking down at their cellphones and there’s little chance of that changing.
Here’s a simple test from the Mayo Clinic to check your posture…it’s called the wall test.
Stand so that the back of your head, your shoulder blades and your buttoc ks touch the wall, and your heels are 2 to 4 inches from the wall. Put a flat hand behind the small of your back. You should be able to just barely slide your hand between your lower back and the wall for a correct lower back curve. If there’s too much space behind your lower back, draw your belly button toward your spine. This flattens the curve in your back and gently brings your lower back closer to the wall. If there’s too little space behind your lower back, arch your back just enough so that your hand can slide behind you. Walk away from the wall while holding a proper posture. Then return to the wall to check whether you kept a correct posture.
There are lots of options to help you work on your posture including some devices which buzz like the Upright Go and the Uposture which signal you if there is a change in posture ….I have no experience with them and just ordered the Uposture to check it out. I often recommend to my patients that they consider a garment to help their posture….they are called posture guards. I can’t recommend any of them in particular but they are not expensive and you can get a good sense of what they look like on the internet. You can also go to physical therapy and work on your posture and sometimes they use flexible tape that acts like the garments and helps maintain posture. There is a school of posture called the Alexander Technique and we have a local expert in this technique..Kathryn M Miranda….who has taught this program for decades. She can be reached at 315-412-4829.
I don’t think any of us are usually aware of our posture unless someone points it out …that’s why I like the garment idea …it’s a constant reminder to straighten up and fly right. I too am working on my posture…my wife and I are taking dance lessons in preparation for my daughter’s upcoming wedding and posture is the first thing the dance instructor focused on. Well, that’s what the second dance instructor focused on anyway…the first dance instructor fired us….That must tell you something right there…..I have discovered I like taking dance lessons. My wife and I have been married over 30 years and I worry that things could get a little stale and dancing once a week together really gives us something to do that focuses on both of us. Thankfully she seems to enjoy it as much as I do. If you are in a relationship that in any way could benefit from something new in your life I highly recommend giving dance lessons a try. Our instructor is suffering enough…go find your own and …work on your dance steps and your posture at the same time.
JT BARRY MD
THE ENERGY PARADOX
I will get to Magnesium in my next article but I just read Dr Gundry’s The Energy Paradox and wanted to bring it to your attention. His earlier works including the Plant Paradox radically changed my approach to illness and wellness and since so many people suffer from a lack of energy I thought you should know about it. I also highly recommend Walking with Peetey the dog who saved my life but that’s another article entirely.That book too brings together many of the concepts I bring up in the office everyday but again …another day.
The Energy Paradox addresses the issue around fatigue….When your get up and go has gotten up and gone. Many people erroneously believe that you run out of energy as you age but Dr Gundry points out that you are just running out of the right fuel ..that you are not recharging your body’s power and battery pack …your mitochondria. Mitochondria are tiny organelles that are found in almost every cell in your body and produce the vast percentage of all the energy your body manufactures in a day. If your mitochondria are happy …you are healthy. If they are not…you are not. Furthermore the mitochondria are heavily influenced by the bugs in your gut …there’s that microbiome connection again ! The mitochondria need full spectrum light ( which controls energy production via quantum mechanics..read the book for details ), properly constructed cell membranes (which brings us back to the omega 3 / 6 ratio I preach about and which your doctor can easily test for) and interestingly enough melatonin. Yes , it turns out the sleep inducing chemical produced by your pineal gland is a major protector of mitochondrial function. You don’t have to depend on just your own production of melatonin…it’s found in abundance in certain foods like olives, olive oil,pistachios and mushrooms. Dr Gundry posits that it’s not the resveratrol in red wine that makes it so healthy, it’s the melatonin !
The standard american diet overwhelms your mitochondria, damages your gut lining, changes the character of the microbiome in your gut and the processed foods damage energy production so it’s no wonder you lack the energy of youth. Furthermore , as Dr Gundry points out, our eating habits overwhelm the gut and the mitochondria by presenting too many nutrients too often that the mitochondria shut down to protect themselves. When the mitochondria are damaged it TAKES energy to destroy them and activates the immune system. The restorative medicine field has long held that all disease is inflammation and all disease is mitochondrial dysfunction and all disease begins in the gut and now you begin to see the interconnectivity of these theories. Dr Gundry’s research takes a whole different approach to the benefits of the keto diet. I thought the keto diet produced ketones which are a clean fuel for your cells and mitochondria. He postulates that these ketones and butyrates are actually communicating to your cells that times are hard and the mitochondria have to be more efficient and more plentiful in response to this stress.
How to improve your mitochondrial function and thereby improve your energy production? Get exposed to light…get outdoors. Dramatically cut down on the linoleic acid in your diet ( canola oil and the other seed oils) while adding Omega 3’s like fish, fish oil etc. He has long recommended Olive oil but now adds sesame oil as an oil that is a powerful antioxidant, a blocker of inflammation at the gut wall level and even has a protective effect against electromagnetic fields! Do some strength training or resistance work which increases the number of mitochondria in your cells. Change the composition of the bugs in your gut and the signals they send your cells and mitochondria by eating more fiber ( the term he uses to describe these substances that are made by the bacteria which then communicate with our bodies is post biotics).
Finally he again promotes the concept of time limited eating. Not grazing from sunup to sundown and beyond as most Americans do but limiting the time you consume food so the mitochondria are not overworked and have some down time to rest and repair. I am not going to get into the details about his dietary recommendations , his suggested supplements and his list of medications and chemicals to avoid. That’s too much for one or two columns to give justice to. This book is packed with details, loaded with references and pretty easy to read. If you want to change your energy level, lower your inflammation, and raise your overall health you want to read this book. Do yourself and your mitochondria a favor and read this book. You don’t have to get any special lab tests done to see results. You don’t have to read any testimonials. You will feel the results for yourself. This is called a N of 1 trial. You be the judge. Until next month…get well…stay well….
JT BARRY MD
Covid 19 might be calming down finally but the world is still going crazy. I was going to write an article about Magnesium or maybe review Dr Gundry’s latest book The Energy Paradox. I was thinking I would review the vaccination rates in various states and show their correlation or lack thereof with infection rates. But then I came across an article about my profession that I couldn’t believe. Last week the biggest medical organization …the American Medical Association .. issued statements to the effect that it supports critical race theory and no longer supports equal treatment to all people. The article I read states that “ The AMA also makes clear that it now rejects the concepts of “equality” and “meritocracy,” which have been goals in the fields of medical science and medical care. “ Furthermore, and I am quoting again..“Equality as a process means providing the same amounts and types of resources across populations,” the association said. “Seeking to treat everyone the ‘same,’ ignores the historical legacy of disinvestment and deprivation through historical policy and practice of marginalizing and minoritizing communities.”
I am of course not suggesting that minorities have not been screwed over in the past and may be still today but isn’t it the essence of America and shouldn’t it be the essence of medicine to treat everyone equally? How can this major organization reject equal treatment of all people? Needless to say I am no longer a member of the AMA and it’s interesting that I got an offer via the internet to renew my membership at 50% off. I wouldn’t renew my membership if they paid me. In my office its our explicit policy to treat everyone….no matter where you come from, no matter where you are going, no matter how you identify your gender or sexual preferences (as long as it doesn’t involve minors) no matter how much you are worth, no matter your age , no matter what…everyone deserves to be treated equally with fairness and kindness and hopefully understanding of your medical issues. As the well known business expert Mr Rogers has so aptly stated there are three rules of success….Rule #1 Be Kind. Rule #2 Be Kind…Rule #3 Be Kind.
Of course I have felt for some time now that my profession has lost its way. I have seen how we, instead of looking for the cause of disease, now only look to treat the symptoms with medications and procedures. Interestingly it all started when I read Dr Gundry’s second book the Plant Paradox. I realized then I was only focusing on the symptoms and not the cause. The obvious fact that every physician knows but few acknowledge is that we should be focusing on the basics of your health…your diet , your exercise, your sleep and your stress. Don’t cover up the indigestion..find out the cause. Don’t just treat the high blood pressure…it’s a sign that the patient is doing something wrong…find out what is wrong and fix it and the high blood pressure goes away. Healthy people do not have heart disease, cancer and diabetes…it’s when we deviate from healthy habits that we get ill. Returning to healthy habits will resolve the illness. My profession has been trained to study pathophysiology in medical school then completely ignore it in practice.
The current practice of medicine is superb at managing your illness but if you want to really improve your health…to regain your wellness you are not likely to find a champion in your primary care office. We pay the most by far of any nation for health care and we rank low on real health measures. And now I find that the most prestigious medical association is more focused on social considerations than real equality of health care. Sorry , but I am going to stay firmly in the camp that believes all people should be cared for equally and if that somehow gets me in trouble with the “powers that be” so be it. Opposing the AMA shouldn’t get me in trouble with the Medical Society or the Health Department should it? Free speech may not be so free in America anymore. Maybe it’s a little hubristic but I close with the words of Martin Luther at the Imperial Diet of Worms in 1521..”I cannot and I will not recant anything for to go against conscience is neither right nor safe. God help me. Amen.
Until next month…get well and stay well
JT BARRY MD
Vitamin C is not just about treating your cold.
I just finished reading Dr Thomas Levy’s book entitled Stop America’s #1 Killerwhich is about vitamin C deficiency. Perhaps you know it better as scurvy. Almost allanimals can make their own vitamin C but we humans, bats and guinea pigs cannot. We must get it from the environment. It’s said that scurvy killed more British sailors than warfare did but this is not a story about historical malnutrition. It’s about you and your risk of Vitamin C deficiency. 40% of patients with septic shock had Vitamin C deficiency. The Nutrition Journal reported that up to 87% of critically ill patients with Covid 19 had Vitamin C deficiency. Of course Vitamin C deficiency is not limited to seriously ill individuals. As reported in the American Journal of Public Health in May 2004 “vitamin C deficiency and depletion were common (occurring among 5%–17% and 13%–23% of respondents, respectively)” Based on my experience it’s actually more common than that. Doctors don’t routinely assay for Vitamin C deficiency but we probably should give your SAD diet. That’ s standard american diet …full of food depleted of nutrients, loaded with trans fats, extra sugars , exotic chemicals and seed oils.
Vitamin C is a potent natural antioxidant and is concentrated in white blood cells 80 times more than in the serum. Vitamin C deficiency at the cellular level has been shown to be a cause if not the cause for the changes at the arterial level that cause hardening of the arteries…ie heart disease. The literature supporting Vitamin C deficiency as a cause of heart disease is much stronger than the literature that high cholesterol causes heart disease. Dr Levy sites studies that show people with higher levels of Vitamin C have lower incidence of heart disease. Vitamin C facilitates lecithin’s ability to add esters to the cholesterol in your arteries thereby making it more soluble and allowing HDL to bind it and remove it from the artery wall and transport it to the liver. Lower levels of VItamin C are associated with higher levels of fibrinogen. High Fibrinogen levels are associated with increased risk for heart disease and blood clots. Dr Levy also reports that patients with the highest levels of Vitamin C have lower risks for cancer.
So, Vitamin C deficiency has been linked to both heart disease and cancer. Do you need more impetus to supplement than that? No article about Vitamin C would be complete without a mention of its prior champion ( preceding Dr Levy) Linus Pauling. His belief that Vitamin C would treat the common cold has been much debated and he further postulated that it would prevent cancer. It’s true he died of prostate cancer but not until the age of 93 ! Dr Levy’s book is very heavily and meticulously referenced but it’s an easy and informative read. I highly recommend his prior book entitled Death by Calcium and have just ordered his book on Magnesium so expect more to come.
Until then …get well and stay well
JT BARRY MD
Well , the vaccines have arrived and with it the push to vaccinate everyone. Never had covid? Better get vaccinated. Had a bad covid infection ? Better get vaccinated. Tested positive but didn’t get sick? Better get vaccinated. Immunocompromised? Pregnant? Able to get pregnant? Better get vaccinated. New strains are coming…get ready for more vaccinations.
All three currently available vaccines have been thoroughly tested and reviewed. They all appear very safe and effective. Of course, there are people who have a strong reaction to the vaccines but that’s true of many previous vaccines. There does not appear to be a relationship between having a reaction and having protection from Covid-19. Whether the shot bothers you or not doesn’t seem to make a difference in terms of protection. It’s all good in the hood.
So why shouldn’t absolutely everyone get the vaccine and we can get this whole ugly pandemic behind us? The supposition is we must get a high vaccination rate to achieve herd immunity. The WHO website says you must vaccinate 95% of people to have herd immunity to protect against measles. You must vaccinate 80% of people to have herd immunity to polio. We currently don’t know how many people you have to vaccinate to achieve herd immunity to Covid-19 but it will probably be in that range of 80% or above.
Again, the vaccines appear very safe and very effective so why am I proposing that it would be nothing less than scientifically disastrous if everyone is vaccinated. That’s right…there is a very very strong rationale to NOT vaccinate everyone. To vaccinate everyone violates very basic tenets of science and scientific experimentation.
Absolutely no one familiar with science will deny that any real experiment MUST have a control group. Without a control group you have no basis to understand interventions. This has been true since the beginning of experimentation. Without control groups you have no way of knowing whether any intervention, be it a drug, a procedure or a vaccine is really effective and safe. Even the WHO, the CDC, and the federal government completely agree with this. That’s why every single study of the vaccine safety and efficacy had these control groups.
Say what you want about President Trump but he did indeed facilitate the fastest development of a vaccine in the history of science. A term from the great Star Trek series..”warp speed” was used to describe the process. I personally have faith and confidence that the process was thoroughly vetted and all safety concerns were addressed. There were, as mentioned, controls on all the vaccines trials so what’s my beef? Absolutely none of the vaccine trials have LONG TERM controls. And we absolutely have to have long term controls. It remains vital to the scientific process. WIthout long term controls we have no way whatsoever to assess long term or distant effects of the vaccine. Like it or not, politically correct or not, but the need for long term controls is a scientific necessity.
It’s an unfortunate fact that prior coronavirus vaccine research was halted not because the viruses didn’t provide a good immune response in the animals tested but because those animals when later exposed to the virus got worse instead of better. so the vaccine instead of protecting the animals actually made their immune systems react overly aggressive when they were next exposed to that virus. It wasn’t for lack of money. It wasn’t for lack of trying. It was because of this viral potentiation that prior coronavirus vaccine research was giving up. None of the current available vaccines had trials that extended beyond a year. So we really have no way whatsoever of knowing about long-term side effects of the vaccine. I’m not saying in any way shape or form that the vaccine causes infertility but we have absolutely no information on this and therefore we have to have controls that are people that aren’t vaccinated. It does not appear right now that the vaccine causes viral potentiation in humans but again we’ve only been at this a few months. Without controls there is no way whatsoever to know whether some side effect or condition down the road is due to prior vaccination or some new virus or Chinese intervention or global warming or some new toxic agent. We have to have short-term controls and we have to have long-term controls and that means that it is, in fact , absolutely vital that we have people that do not receive the vaccine. If the government said we’re going to withhold the vaccine from 10 to 15% of the population in order to achieve this scientific goal, people would be outraged .But when people volunteer not to get the vaccine they’re considered anti-scientific . Not so.
Many of my friends think the vaccine will be mandatory for travel or to gain admission to concerts and events. I think they are probably right but who really knows? We will find out together pretty soon. Until then…Get Well and Stay Well.
JT BARRY MD
DETOX COCKTAIL….MAKE MINE A DOUBLE
This is going to be a longish article and there is too much to cover in one issue but it’s another very important topic for you to get a handle on. When I first heard of people doing detox’s I thought it was some hippy dippy West Coast wheat grass dealio but when I started to look into it I realized there is a lot to this and its important , as a healthcare provider, that I get a handle on what this entailed. Detoxifying regimens basically try to eliminate the build up of the various toxins both fat soluble and water soluble in the body you have built up over time.
Do I really need to convince you of how toxic you are? I have previously written that the US Government has been sampling human tissues for years this is taken directly from the EPA website. “The National Human Monitoring Program (NHMP), established by the U.S. Public Health Service in 1967, used an exposure-based approach to assess human exposure to toxic substances. Its primary component was the National Human Adipose Tissue Survey (NHATS), an annual survey conducted from 1970 to 1989 to collect and chemically analyze human adipose tissue specimens for the presence of toxic chemicals.”
According to their research 100% of fat samples contain styrene which is a breakdown product of styrofoam. Most samples tested contained dioxins, organophosphates etc. As reported in his book Toxic Solutions, Dr Joseph Pizzorno reflects on Dr Sanjay Gupta noted that there are up to 200 chemicals in the blood of babies even before they are born. Does that get your attention ? Over 90% of people in America have measurable levels of phthalates ( which is a breakdown product of plastic) and glyphosate ( the main ingredient in roundup ) Puget sound , the waterways off the coast of the State of Washington…have had the fish in the estuaries tested and they were found to have measurable levels of these drugs in the fish… Flonase Aleve Tylenol Paxil Valium Zoloft Tagamet Oxycontin and Cipro and other antibiotics.
Dr Pizzorno’s book mentions a study from Harvard which determined that Americans have lost 41 million collective IQ points as a result of exposure to lead , mercury and organophosphate pesticides. This doesn’t even include the question of fluoride exposure and mental retardation. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5285601/
What about these many products we use daily that makes them dangerous? The average woman uses 12 health and beauty aids a day and the average man uses 6. These chemicals are not well regulated. Think this is all just conspiracy theory? Watch the documentary Dark Waters which is about the Dow Chemical company and teflon type coatings. The government is coming late to the game and is heavily influenced by the very companies it’s supposed to be regulating.
We call these chemicals toxins because they affect your body’s insulin sensitivity, they affect the cell membranes, they affect the microbiome in your guy, they directly affect your DNA and its expression. Toxins disrupt hormone function , mitochondrial activity, nervous activity and displace needed minerals in your body. Furthermore the toxicities are synergistic…each one making the next more damaging.
As reported by the President’s Cancer Panel of 2010 there were 80,000 chemicals in the market in the US the vast majority of them understudied and unregulated. There is no point in listing the long string of chemical names and abbreviations that we are exposed to and consume, breath in, coat our skin with etc..it’s just too long and most of the names are unpronounceable.
Do you recall the article I wrote about children’s sunscreen and how recent evidence showed that the kids had much higher levels of these chemicals in the circulation than had previously been reported? Is there anyone who thinks this is harmless or unimportant?
The issue of toxins affecting Insulin sensitivity is a particularly interesting one. Dr Pizzorno’s book makes a compelling argument that it’s very likely that simply increased sugars are not the sole cause for the diabetic crisis we are experiencing. It makes sense that diabetes has increased as our consumption of sugar has increased. We went from consuming 5 pounds of processed sugar in a year to over 152 pounds a year as reported in 2014. But if you look at the graph of sugar consumption versus diabetes it is not a tight correlation. On the other hand when you graph diabetes against chemicals on the market there is a much tighter correlation. Now correlation doesn’t prove causation but it certainly raises the intellectual eyebrow.
So this month’s article laid out for you the basic facts that you are loaded with chemicals that disrupt your health at a cellular level. Next month I will lay out what to do about it…Until then Get well and Stay well.
JT BARRY MD
I have written previously to sing the praises of magnesium and now I carry thetorch for potassium. Potassium should be the third most common element in your bodybut often, for several reasons. it is not. Many people are on diuretics for their bloodpressure, heart failure, or edema and, unless they are careful with their electrolytes,their potassium can go dangerously low. You have to be careful because certain bloodpressure pills like ACE inhibitors and ARBs can cause your potassium to go too high.Even certain diuretics can be associated with high potassium . Both high and lowpotassium are dangerous. Luckily your doctor can and should be checking this on aregular basis with your bloodwork.
Potassium is crucial for the normal function of your heart, your nervous systemand muscle function. It is also important in blood pressure management. If yourPotassium or Magnesium are too low that can cause your blood pressure to go up.That’s right…a shortage of either element can be a cause of your hypertension. Theseminerals should be checked in every patient with a blood pressure problem and berepleated before your doctor reaches for the blood pressure pills. The reason thatpotassium is important in blood pressure control is because it has a significant effecton muscle contraction and arterial wall relaxation, but most Americans reportedly gethalf of the recommended daily allowance. A banana a day is not enough potassium tomake a real difference in your health. The average reported intake of potassium fromfood is about half of the 4,700 milligrams (mg) recommended. Research demonstratesthat these low levels of potassium may have a significant impact on blood pressure,especially as it relates to the amount of salt normally found in a Western diet accordingto Dr. Paul Welton, professor of epidemiology at Tulane School of Public Health andTropical Medicine, who did an analysis in 1997 of over 29 trials that demonstrated lowlevels of potassium resulted in higher systolic blood pressure readings. According toDr Welton studies performed since then have found similar results.
“The evidence is very strong and very consistent. A higher potassium intakemay blunt the effects of excess salt on blood pressure. Potassium’s effect isbigger in people who have higher blood pressure, bigger in older people,bigger in people who are consuming a lot of salt and bigger in black people.”
Other recent research found that “women without hypertension who consumed themost potassium (nearly 3,200 mg/day) had a 21 percent reduced risk of stroke. Further, women who consumed the most potassium were 12 percent less likely to die during thestudy period than those who consumed the least”
According to a recent review article by Dr Mercola “Potassium should be thethird most abundant mineral in the human body. Adequate amounts of potassium arealso associated with quicker recovery from exercise and improved muscle strength. Asan electrolyte, potassium helps to regulate the fluid balance in your cells and throughoutyour body. Fluid balance is essential to maintaining life, preventing dehydration at thecellular level and maintaining brain function. Potassium is important in the transmissionof nerve impulses in your brain, spinal cord and peripheral nervous system.”
There is evidence that low levels of potassium have been linked with high levelsof insulin and glucose, associated with metabolic syndrome and type 2 diabetes. So ,clearly, keeping your potassium at the right level is important. As I said earlier, if youhave any doubts about your potassium level you can easily have your blood checked butyou have to ask for the more sensitive Red Blood Cell Potassium if you want realaccuracy. As Dr Mercola points out “Getting nutrients from your food instead ofsupplements is preferable as your food contains more than a single nutrient and indifferent forms. For instance, potassium found in fruits and vegetables is potassiumcitrate or potassium malate, while supplements are often potassium chloride. Thecitrate and malate forms help produce alkali, which may promote bone health andpreserve lean muscle mass as you age.
So when you are told your blood pressure is too high, rather than reach for yetanother medication, why not look at your magnesium and potassium intake and theirlevels in your blood and work on the basis of your illness than on just trying to medicateit away. The pills will lower your blood pressure but they don’t address the underlyingcause of your high blood pressure and they have many many side effects. Work withyour doctor to focus on the basics…improving your diet, replacing electrolytes, gettingsome exercise etc. If you don’t manage your wellness the medical profession willmanage your illness but we don’t have a great track record of restoring your health.Remember what Thomas Edison said way back in 1903.
“The doctor of the future will give no medicine, but will interest his patient in the care ofthe human frame, in diet and in the cause and prevention of disease.” Until then…getwell….stay well.
Great Barrington Declaration https://gbdeclaration.org/
Sounds like a somber and weighty peace treaty but the Great Barrington Declaration is nothing of the sort. Rather, the Declaration is an open letter published on October 4th 2020 to world leaders beseeching them to avoid another COVID 19 lockdown. Named after a place in Massachusetts the Declaration is the work of three scientists ….each of whom are experts in this field.
Recurrent lockdowns seem to be sweeping the globe as I write this in early December. Lockdown fatigue is also quite prominent but we are told to appeal to reason and follow the science and listen to the experts. Which science and which experts are you hearing from? Since the mainstream media and our governmental authorities are doing a good job presenting the pro- lockdown side let me present a different point of view. Of course, it’s not just my opinion, it’s the opinion of three very different but very accomplished scientists from some of the absolute top education institutions in America. That’s what makes this so important and so credible. I am not quoting some obscure academician from a nowhere junior college.
The “experts”touted by the media say millions of lives have been saved by the lockdowns. These scientists argue just the opposite. Here are the bios taken directly from the website.
Dr. Martin Kulldorff, professor of medicine at Harvard University, a biostatistician, and epidemiologist with expertise in detecting and monitoring infectious disease outbreaks and vaccine safety evaluations.
Dr. Sunetra Gupta , professor at Oxford University, an epidemiologist with expertise in immunology, vaccine development, and mathematical modeling of infectious diseases.
Dr. Jay Bhattacharya , professor at Stanford University Medical School, a physician, epidemiologist, health economist, and public health policy expert focusing on infectious diseases and vulnerable populations.
A little more about Dr Bhattacharya who recently elaborated on the Declaration in an article written in Imprimis..a publication of Hillsdale college.
Dr Bhattacharya is a Professor of Medicine at Stanford University, where he received both an M.D. and a Ph.D. in economics. He is also a research associate at the National Bureau of Economics Research, a senior fellow at the Stanford Institute for Economic Policy Research and at the Freeman Spogli Institute for International Studies, and director of the Stanford Center on the Demography and Economics of Health and Aging. A co-author of the Great Barrington Declaration, his research has been published in economics, statistics, legal, medical, public health, and health policy journals.
So Oxford, Stanford and Harvard. Pretty impressive lineup of scientists with special expertise in this area who have reviewed the data and have concluded that the lockdown has been a global disaster with terrible consequences especially among the poor. Here I quote directly from his remarks “ Those who dare to talk about the tremendous economic harms that have followed from the lockdowns are accused of heartlessness. Economic considerations are nothing compared to saving lives, they are told. So I’m not going to talk about the economic effects—I’m going to talk about the deadly effects on health, beginning with the fact that the U.N. has estimated that 130 million additional people will starve this year as a result of the economic damage resulting from the lockdowns In the last 20 years we’ve lifted one billion people worldwide out of poverty. This year we are reversing that progress to the extent—it bears repeating—that an estimated 130 million more people will starve.”
Here is a copy of the Great Barrington Declaration for your own perusal. I am one of the 36,000 thousand physicians who have signed the Declaration along with 600,000 private citizens and over 12,000 medical and public health scientists. If we have to trust the experts …why not these experts…?
The Great Barrington Declaration – As infectious disease epidemiologists and public health scientists we have grave concerns about the damaging physical and mental health impacts of the prevailing COVID-19 policies, and recommend an approach we call Focused Protection.
Coming from both the left and right, and around the world, we have devoted our careers to protecting people. Current lockdown policies are producing devastating effects on short and long-term public health. The results (to name a few) include lower childhood vaccination rates, worsening cardiovascular disease outcomes, fewer cancer screenings and deteriorating mental health – leading to greater excess mortality in years to come, with the working class and younger members of society carrying the heaviest burden. Keeping students out of school is a grave injustice.
Keeping these measures in place until a vaccine is available will cause irreparable damage, with the underprivileged disproportionately harmed.
Fortunately, our understanding of the virus is growing. We know that vulnerability to death from COVID-19 is more than a thousand-fold higher in the old and infirm than the young. Indeed, for children, COVID-19 is less dangerous than many other harms, including influenza.
As immunity builds in the population, the risk of infection to all – including the vulnerable – falls. We know that all populations will eventually reach herd immunity – i.e. the point at which the rate of new infections is stable – and that this can be assisted by (but is not dependent upon) a vaccine. Our goal should therefore be to minimize mortality and social harm until we reach herd immunity.
The most compassionate approach that balances the risks and benefits of reaching herd immunity, is to allow those who are at minimal risk of death to live their lives normally to build up immunity to the virus through natural infection, while better protecting those who are at highest risk. We call this Focused Protection.
Adopting measures to protect the vulnerable should be the central aim of public health responses to COVID-19. By way of example, nursing homes should use staff with acquired immunity and perform frequent PCR testing of other staff and all visitors. Staff rotation should be minimized. Retired people living at home should have groceries and other essentials delivered to their home. When possible, they should meet family members outside rather than inside. A comprehensive and detailed list of measures, including approaches to multi-generational households, can be implemented, and is well within the scope and capability of public health professionals.
Those who are not vulnerable should immediately be allowed to resume life as normal. Simple hygiene measures, such as hand washing and staying home when sick should be practiced by everyone to reduce the herd immunity threshold. Schools and universities should be open for in-person teaching. Extracurricular activities, such as sports, should be resumed. Young low-risk adults should work normally, rather than from home. Restaurants and other businesses should open. Arts, music, sport and other cultural activities should resume. People who are more at risk may participate if they wish, while society as a whole enjoys the protection conferred upon the vulnerable by those who have built up herd immunity.
On October 4, 2020, this declaration was authored and signed in Great Barrington, United States.
TIS THE SEASON
Well, the coronavirus continues its wrecking ball ways with our lives both personally and professionally and it’s certainly had a big effect on our holidays. With that in mind I am not going to nag you this season about too much eggnog…too much Netflix bingeing…or too little exercise. I am not going to spend this column on advice for getting through the holidays which are always a stressful period for some people even in the best of times. Maybe having so many events cancelled or prohibited will give those people more time to focus on what’s important or at least to de-stress. What I am going to write about is some Christmas gift suggestions that you might not have thought about. Don’t expect ugly sweaters, exercise videos or a tin of muffins on this list. Obviously, gym memberships and season tickets are off the table right now as well.
First , why not give the gift of information and have it be the gift that keeps on giving. I am talking about getting your friends and loved ones a health newsletter. For years I have given a subscription to my friends and family to Reason the libertainian magazine just to give them a different perspective but at this point in our lives I worry more about their health than their political leanings. Sure, you can go to Cleveland Clinic or Harvard Health Letter but may I suggest you take a little walk on the wild side and try Dr Sherry Rogers newsletter and get a completely different perspective on your health and healthcare from the regular medical establishment. And you can order it digitally so no worries about the mail, etc. It’s available from Prestige Publishing on the net. Dr Rogers looks at your health from a molecular level instead of a body organ level to get to the real heart of illness. If your mitochondria aren’t happy you aren’t happy and your corner doctor really doesn’t know how to evaluate that. Of course , you know that you need to measure insulin resistance and your essential fatty acid Omega 3:6 ratio and your triglyceride/ HDL ratio etc and Dr Rogers covers all this each month.
Next, if you really love someone get them a heart scan. Heart disease is the number one killer in America and often strikes without warning. Most people just don’t think about their health until something goes wrong. Your family member or friend’s heart and health are too important for that. Get them a Calcium Score. Not a stress test…that type of heart test will only be abnormal when it’s the end of the line. Get them a Cardiac Calcium Score. This is a 120 dollar scan done right here in town and measures the calcium in a patient’s heart arteries. Many studies have shown a very good correlation between the amount of calcium in your arteries with the likelihood of having a heart attack or sudden death in the future. NASA uses it but the vast majority of local cardiologists prefer the old fashioned but high tech stress test even though the calcium score can show you about possible heart trouble building up years and years before things get to stenting or bypass. I say make this a gift because typically insurance will not cover this test yet even though it’s been around for 20 years. Watch the documentary “Widowmaker” for free on YouTube and decide for yourself.
If you want to keep your gift giving local, why not give the gift of Optimism by setting your friend or loved one up with Tim Smith’s Smile Therapy. This is an internet service that starts each day with an uplifting quote, sentiment or story. How you start your day determines your day and who doesn’t need a little positivity first thing in the morning. It’s another gift that keeps on giving. Mr Smith is a local guy and a positive force in the Universe so check out his website for yourself or someone you care about. .
Let’s finish off high tech and personal. Why not get something for yourself. Why not treat yourself to the possibility you can change something in yourself. I have had multiple patients tell me that they changed something about themselves..some habit or activity ..using the Noom app on their phone. There are a variety of apps to help you change yourself whether it’s to stop smoking or to lose weight. You use that phone for many questionable or unimportant things..why not harness its potential to really make a positive impact on your health. You never know until you try so what’s stopping you from trying ? Until next column and next year….Get Well and Stay Well..
TO SUPPLEMENT OR NOT TO SUPPLEMENT THAT IS THE QUESTION
Let’s talk collagen it’s the major structural protein in numerous tissues of the body including your tendons or ligaments, the blood vessels, the muscles, the gut tissues and your skin and cartilage. According to Rhonda Patrick found my fitness. They are the most abundant proteins in the body compromising about 30% of the total protein Mass unfortunately aging reduces protein synthesis and one protein synthesis that’s reduced in aging is collagen so as you get older you don’t make collagen as frequently or as copiously as when you’re younger.
Now you’re familiar with the double helix that’s DNA but collagen has a triple helix that is composed of about 1400 amino acids. There have been 28 distinct collagen proteins identified and they differ in their interactions with other proteins and location within the body. For instance , collagen type 1 and type 3 in the connective tissues, the tendons, the corneas, the bones, the skin and blood vessels Collagen type 2 is found primarily in cartilage cells. Collagen types 1, 2, and 3 are the most abundant collagen types in the body and are made up primarily of glycine, proline and hydroxyproline; these are individual amino acids that are linked together to form these collagen complexes. The sequence of the amino acids and the relative amounts determine whether it’s type 1 2 or 3 etc.
Why am I taking you down this little science highway? Because college is important and there’s something you can do about the fact that it slows down as you age.Collagen type 1 2 and 3 are typically hydrolyzed and used as oral supplements which have shown promise in improving skin health ,decreasing joint pain and improving hypertension no less. When you take natural collagen and heat it up you denature it and you get shorter peptide chains and it forms gelatin Again, it’s the same amino acids; glycine Proline and hydroxyproline. The one amino acid that seems to be absent is the essential amino acid tryptophan so you can’t use collagen as a general protein supplement even though it contains amino acids. You can get this hydrolyzed collagen from chickens, marine animals, pigs and cows. The one concern regarding sourcing your collagen is that if you get it from non bovine sources you do not have to worry about the possibility of mad cow disease People think that bone broth is a good source of collagen but the key components of amino acids, that are, glycine , proline and hydroxyproline were found in lower concentrations in bone broth compared to typical collagen supplements. So , I don’t think bone broth is necessarily a great collagen source but I do think it’s nutritious. Now, once you are taking your collagen how is it absorbed ? Well, hydrolyzed collagen, the kind you get when you buy it in the store probably is even better absorbed because it’s shorter chains then undenatured collagen straight from the source be it marine or mammal.
I had read previously that the collagen that you ingest doesn’t necessarily go into the joints but the ingestion of the collagen prompts the body to produce its own cartilage which is deposited in the joints. However , according to Rhonda Patrick (foundmy fitness.com) at least in rats the oral consumption of hydrolyzed collagen is deposited directly into the skin and joints. Rhonda Patrick points out that by the time a person reaches 80 years old collagen production in the skin has decreased by 70% compared to young adults. Of the skins total collagen, type 1 collagen comprises about 80% with type 2 comprising 15%. Topical collagen as used in cosmetics really doesn’t have a direct effect on collagen stimulation or production in the skin it does hydrate the skin and makes wrinkles less prominent. The topical preparation is not being incorporated into the actual skin but the ingestion of oral hydrolyzed collagen has shown positive effects on improving skin aging and is incorporated into the dermis itself.
As outlined again in foundmyfitness.com, oral intake of hydrolyzed collagen elicited the reversal in the natural decline of skin’s elasticity in aging women There are other critical components as well including Chondroitin sulfate which is an important structural component of cartilage while hyaluronic acid is a structural component of cartilage, connective, epithelial, and neural tissue.
What about collagen supplements in osteoarthritis? Several studies have shown that both placebo and commercial supplements report significant decrease in pain compared to baseline but there is a big difference between the collagen product 35% reduction and 15% reduction with placebo. So placebo helped but clearly collagen supplements worked twice as well as placebo with no serious adverse events reported in this trial.
Furthermore, hydrolyzed collagen may be helpful to bone health. Randomized controlled studies found that hydrolyzed collagen increase bone mineral density in postmenopausal women. Interestingly enough, hydrolyzed collagen has been shown to have a beneficial effect even in rheumatoid arthritis and I’m not talkin 1% or 2% Improvement I’m talking 30% – 50% Improvement in either morning stiffness, swollen joint count , 50 foot walking time etc.
Hydrolyzed collagen has also been studied in athletic joint pain and again both placebo and collagen diminish pain but as before collagen diminishes it by 40% and placebo by 28% so it’s not overwhelming but there’s a positive benefit with no obvious side effects.
Now for the most interesting part, hydrolyzed collagen may be effective at reducing blood pressure and improving metabolic function of people with type 2 diabetes. Multiple studies have found that hydrolyzed collagen primarily from marine sources (bones and skin if you must know ) exhibits antihypertensive activity. There are no big human studies proving that collagen lowers blood pressure yet.. Marine hydrolyzed collagen has also been shown to improve glucose sensitivity and insulin resistance in rodent studies. Most of us aren’t rats but still it’s supportive evidence and in humans hydrolyzed collagen powder induced a notable decrease in hemoglobin A1c including the fact that those receiving hydrolyzed collagen had a 20% decrease in fasting blood glucose after 3 months.
What’s the right dose? Well that’s a good question. Different studies have used 50 mL of liquid supplement containing 1000 mg. Some studies use 300mg twice a day or a gram twice a day to studies that used 5 grams twice-a-day etcetera so draw your own conclusions as to the appropriate and righteous dose for you. If you suffer from hypertension, diabetes, arthritis, athletic pain, changes in your skin etcetera why not take a month or two of this supplement and see for yourself if you feel better. Many people do and the dangers seem quite limited. For references go to found my fitness.com… type in collagen and you’ll see that everything I’ve written here is well-documented and footnoted etcetera.
I write today to once again save your life or at least try to. You can’t see or feel or taste the Coronavirus which will directly affect a few people tremendously and most of us not at all. However, there is something else you are constantly exposed to that you can’t see, feel, or taste that is ruinous to your health and that is glyphosate.
What I’m talking about is the active ingredient in Roundup which started out as a pipe cleaner and then graduated to herbicide but if I understand it correctly is also patented as an antibiotic. None of these things can be good for the bugs in your gut. Not only is glyphosate toxic to the bugs in your gut but it’s also toxic to the lining of your gut itself. This drug blows holes in the gut lining and therefore creates inflammation. Inflammation equals immune system overactivation equals chronic illness.
Most of us have less than 2 square meters of skin surface but the lining of our guts, if stretched out, would equal the surface area of two tennis courts. The lining of our gut is very thin, one or two cells only, and chemicals like glyphosate directly attack the tight junctions which maintain gut integrity. If that weren’t enough this drug, separate from what it does to the microbiome and to the gut lining itself, is also directly toxic to the mitochondria in almost every cell of your body. Glyphosate also affects your health on a cellular basis since it, in part, resembles the amino acid glycine and gets incorporated into proteins, cell membranes, Etc. Glycosade has been implicated in Non-Hodgkin’s lymphoma.
Glyphosate has been found, according to the European Working Groups website and many others, to be in breakfast cereals, pasta, flour-based products, oat based products, oat-based products, and even in most of the red wines that have been tested. Every American has almost certainly measurable levels of glyphosate in our bodies. A study published in Ecowatch in 2016 showed that 93% of Americans tested had glyphosate in their urine. If it’s measured in the urine that means you’ve ingested it and it’s gone through your body to reach your kidneys so it’s affected both the bugs in your gut and your own cells.
Let me put it to you a little more bluntly; this is food poisoning. You are being poisoned slowly but surely. Of course the Bayer Corporation is going to say these are microscopic levels and is considered safe by the government but it’s having its adverse effects on microscopic bacteria so it’s all relative. The more processed food you eat the more glycosade you’re being exposed to. Remember, I’m talking about the stuff you’re already eating pizza and Cheerios all of which is almost certainly contaminated with this chemical which is sprayed on crops all around the globe to the tune of 6 billion pounds a year. Roundup is commonly used in conjunction with genetically modified food stock to maximize food production. You maximize food production by poisoning all the other plants / weeds. More recently and very widespread is also aggressively used to ripen the crop for harvest.
Map out, as I have, a picture of the United States of America with cancer rates per state. Now superimpose a map showing the greatest amount of glycosade contamination and you will see when you superimpose these two maps that they line up in the scary fashion. This does not prove cause Amity obviously but I don’t think you could ignore this obvious data.
Okay, so we can agree that the biome in your stomach is important. You’re nothing more than a fellow traveler to them. Of the DNA and RNA we could recover from your body, human DNA is only 4% of that so there’s a lot of genetic material inside you that can affect your health. What happens to the bugs in your gut is important. You want a tropical rainforest not a desert. You want all kinds of creatures great and small living in perfect harmony not intestinal armageddon.The international Agency for research on cancer part of the World Health Organization announced on March 20, 2015 that glyphosate is “probably carcinogenic to humans”.
The most recent issue of Consumer Reports also addressed the question of pesticides and concluded that many fruits and vegetables have dangerous amounts of pesticides. They did not specifically address glyphosate because that is found more in the grains, the wheats, the Oats etc.
So, if this dangerous chemical whose long-term effects have only begun to be appreciated is found in almost everything we’re eating, what’s the course of action? How do you preserve your health against this singular act of food poisoning? You have to buy local. You have to know the people who are growing your food and you have to ask them directly what they’re spraying on it. You can’t wash these chemicals off. They are not inactivated by pressure cooking . You have to minimize the processed foods and you’ve got to read the labels. Change your diet like your life depends on it because in point of fact it does. Until next month, get well and stay well.
Until recently I thought the biggest risk to your health was insulin resistance. Now I know better. I can fix your insulin resistance in a day or two .. What is much harder to correct is your vegetable fat poisoning. That’s right …the seed oils like canola, corn oil , sunflower oil etc that line your kitchen cabinets are slowly poisoning you. What’s even more maddening is that these oils are recommended by both the American Heart Association and the American College of Cardiology.
Their reasoning is that these are healthy oils because they lower cholesterol. What they completely ignore is that these man-made oils are unnatural and do devastating damage to every cell in your body. This is not idle speculation, this is an obvious proven fact. Check out the references below and you will never be the same. Run, do not walk ,to your kitchen and toss these oils in the hazardous waste bin where they belong.
In 1890 5% of our fat calories came from animal fat ; butter, tallow and lard. By 198686% of added fat came from vegetable oils This is a complete and Incredibly dramatic reversal of our fat sources. This created a dietary change never-before-seen in the history of man because these oils had never existed in the past and WE won’t exist in the future if we keep using them. These seed oils are made in big refineries and look identical to motor oil. They don’t belong in your body. It’s been calculated that the average american consumes 80 g of these oils a day, over 700 calories.
The great Weston Price foundation looked at diets of people all over the world. Some diets had very very high carbs. Some diets had very very high fats. Neither of these diets produced significant amounts of heart disease, cancer, dementia, blindness etc. The introduction of excess sugars, refined flour ,and the seed oils has been ruinous to every country where they have been introduced. These oils are pro atherogenic, inflammatory, pro-oxidative, and demonstrably toxic. The danger of these oils is they contain excessive amounts of Omega 6 oils.. linoleic acid chief among them. You need tiny amounts of Linoleic acid in your diet in order to make Cardiolipin which is an essential component of the inner matrix of the mitochondria. Excessive linoleic acid completely distorts these membranes making the cells leaky therefore inefficient therefore you have mitochondrial dysfunction which is at the heart of most diseases. These oils are also nutrient deficient and rats fed these oils suffer from the consequences of no vitamin A and vitamin K. Additionally animals fed the exact same amount of calories gained dramatically more weight when the canola oil/linoleic acid was used instead of other fats. So even eating the exact same amount of calories these animals became dramatically obese and there is a direct correlation between obesity and American and increasing consumption of these vegetable oils. It’s only data in rats but the evidence is conclusive that high levels of linoleic acid are directly related to heart failure and diabetes and, as previously mentioned, obesity. If you want to lose weight get off all of these oils . It will take quite some time to flush them out of your system. It may take up to two years so you have to start immediately.
Of course once you heat these oils up as they do in every commercial application like every fast food place and every restaurant in America you produce breakdown products which are also toxic and carcinogenic. That’s right, the repeated use of these oils creates chemicals that are known carcinogens and are found in every fast food restaurant and for that matter every restaurant in America.
If you take nothing else from this article you must immediately go to your cupboards and get rid of all of those vegetable oils. Get rid of all those commercially prepared salad dressings. Much healthier are olive oil, avocado oil and coconut oil. Any other oil is a poison to you. Understand that every time you go out to eat you are being poisoned by these oils. I have recently taken to just getting my salads with a bunch of lemon slices which I squeeze over them. It’s not a bad dressing and I know that I’m getting healthy vegetables and not sabotaging the meal with the salad dressing. I am not sabotaging the meal I am sabotaging my health by using these other oils.This is an easy fix; read the label , if it says any canola oil sunflower oil safflower oil etc. it is poison to you.
Don’t be afraid of butter. Butter is your best friend. Butter is natural, the seed oils are not. We are nowhere near as healthy as prior generations and the only explanation I can understand is that our lifestyles are worse and that means our diets are worse. Of course we get much last activities than prior generations and that doesnt help but we consume the most seed oils of all time, these unnatural omega-6’s and we have the greatest disease burden of all time in terms of Alzheimer’s and heart disease and cancer. Like it or not these oils all fundamentally create underperforming cells at the molecular and cellular level. If you don’t give your body the correct building blocks and force it to choose inferior materials for the very essence of your cellular being you’re going to get what we have today. You’re a hot mess and it starts with these oils. Get the sugar under control. Do the oil change; that is, increase your consumption of fish, fish oils, nuts etc. and end your consumption of the processed oils. You must get your omega 3 level up and your omega-6 level down. To save your life get rid of all of the vegetable oils you’ve got in that cupboard today. Watch any of the superb lectures by Dr. Chris Knobbe ….. it’s only data in rats but the evidence is conclusive that high levels of linoleic acid/ Omega 6 are directly related to heart failure and diabetes and as, previously mentioned, obesity. if you want to lose weight ,if you want to lose the fatigue, if you want to improve your health overall…get off all of these oils It will take quite some time to flush them out of your system. It may take up to two years so the sooner you start the better.
This information is not new. Again, I urge you to challenge your doctor about this. This is an essential part of your health; knowing your Omega 3 6 ratio. It should be a 1:4 ratio and most of you are way past that! The higher the ratio the worse your cellular health.
So, I have given you immediate action to take. I have given you suggestions to bring to your health care provider. I have given you references to pursue further research. What’s stopping you now.?!
I am always on the lookout for new and better ways to assess the health of patients. Your doctor is measuring your cholesterol, your weight, your blood sugar and your blood pressure and checking for anemia etc…Important measures to be sure but available for decades and not at all inclusive. What your doctor should be measuring is your insulin resistance, your triglyceride / Hdl ratio and your Omega 3 : Omega 6 ratio because these are all markers of your metabolic health and are as important or more important than the traditional labs and they are usually covered by your insurance. As I have written about in the past your blood sugar will be normal for years even if you have metabolic syndrome (which more than half of the American population has) and only by measuring insulin and insulin resistance can you properly assess your metabolic flexibility and status of your pancreas. The triglyceride / Hdl ratio is another independent marker of your nutritional health and I think it’s a far more important measure than your total cholesterol or your ldl cholesterol which is often erroneously referred to as your “bad” cholesterol. The higher your ratio the worse your diet is. This is being measured already by your healthcare provider but they are focused on the cholesterol which is nowhere near as important as this ratio. This ratio is a marker for insulin resistance and metabolic syndrome while cholesterol is not. Finally the Omega 3 : 6 ratio is a marker for brain, heart and cellular health. Again, the lower the ratio the better. If you are 1 : 4 that’s very good and suggests you are getting enough anti-inflammatory Omega 3’s and are avoiding the deadly excess of Omega 6 found in processed food and the seed oils.
There is a new way to measure overall health, biological and cellular health and it’s called the phase angle. Ok, it’s been around for years but it’s new to me. Your gym is using some form of the same technology. The principle revolves around straight physics and how your different body tissues..bone, fat, muscle etc react to gentle electrical currents. The science is called bioelectrical impedance and the same set of measurements will check your visceral body fat, your lean muscle mass, the intracellular and extracellular water content etc. I think measuring these is an excellent idea for anyone to do to get some objective measures of their health. The phase angle measurement is even more important because it reflects your overall cellular heath and therefore your overall health. Multiple papers have been published that link your phase angle to frailty, and nutritional status and aging. Phase angles are different for men and women and are generally higher early in life, and in people who are healthier overall. You can get your phase angle measured and then make changes to your diet and exercise and get remeasured to assess your success. We know your chronological age..the phase angle can give us a sense of your biological age. So you could be 50 years of age but have a phase angle that suggests your body is testing more like 40 or more like 60. You cant just compare numbers between people like you can with all the other measures above because it is affected by age and sex but your number can be used as a reference for your overall health. I just bought a machine and will start testing my patients so we can see how they are doing on an ongoing basis…I expect based on the literature that improvements in their weight, their insulin resistance, their Omega oil ratio etc that they will get a higher ( better ) score. I will use this info to reinforce their progress. Knowledge is power after all. Speaking of which, as always, I would not have you trust whatever you read here…do your own research and I suggest starting with the following references. Just enter them on the search bar and the study should pop up.
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● PMID: 23822677
● PMID: 27504280
This is not expensive technology. Ask your doctor about it or have you already caused a commotion by asking for the other tests listed above? Heaven forbid you should ask about the Cardiac Calcium Score and find out about your degree of heart disease years before standard stress testing would reveal it. I’m going to have my phase angle measured next week and if it doesn’t say I have the body of a 30 year old I am going to throw it out !
Depending on the process, costs of testing etc I am thinking about offering to do this test to any one who makes a contribution to one of my favorite charities….Hope for the Bereaved, Helping Hounds, Father Chaplains Guardian Angel Society and Clearpath for Vets. I don’t need the business but you need the testing so stay tuned.
Until next month….get well and stay well. J T BARRY MD
I bring you something different altogether for you this month from my usual dietary diatribes and Covid 19 speculations. I have been seeing more and more articles come up about the use of molecular hydrogen to improve your health and thought I would give you an early heads up. Hydrogen is the most common element in the universe. It makes up ⅔ of the oceans . For that matter 55% of the atoms in your body are hydrogen.
New interest in hydrogen came out of Japan in 2007 where a mitochondrial researcher was looking for ways to minimize the build up of the toxic compounds generated by energy production. This researcher found that by using molecular hydrogen he got SELECTIVE reduction in the free radicals. From there an explosion of interest has occurred and of course is readily available on the internet.
Mitochondria are the power generators for almost all of the cells in your body. They produce energy but also produce as a by product reactive hydrogen species. These are oxidants and you can look anywhere and see the interest in antioxidants has grown exponentially. Hydrogen can directly work with the ROS (reactive hydrogen species) as well as independently activate autophagy, the body’s clean- house mechanism. Hydrogen chemically acts to diminish inflammation as well. If you do the research there is an alphabet soup of pathways that are activated by hydrogen.
Hydrogen, the most abundant element in the universe, is so small that it can penetrate into every cell in your body. It can penetrate through glass, plastic and many substances so it has no difficulty going through even your bulk. It’s inert and it’s safe.
Interestingly enough you produce your own hydrogen or at least the bugs in your gut do….daily. A diet high in fiber feeds the bugs that produce the hydrogen but you can ingest extra hydrogen for extra benefit.
After drinking a glass of hydrogen water it can circulate through the body in about 10 minutes. It is excreted through the lungs in about an hour but its effects on DNA repair and downstream benefits last a day. Various studies have been done and continue to be done to be regarding hydrogen benefits. It’s available in a gas form as an inhaled agent and hydrogen baths and hydrogen water. You can dissolve about 1.5 parts per million into water. Practically speaking there are three commercially available ways to make hydrogen water. You can buy a water alkalizing machine that also hydrogenates, you can buy a hydrogen generating “stick” you put into a container of water or you can buy elemental magnesium tabs that generate hydrogen when you put them in water. Until recently you really had no way of knowing if there was actual hydrogen in the water but test strips and solutions have become available.
Hydrogen water therapy is being used and explored to treat Parkinson’s disease as well as brain ischemia, that is , stroke and heart ischemia ,that is, .heart attacks. Most of this research is being conducted outside of the confines of the United States but that doesn’t necessarily mean it’s inferior.
I am going to try the tablets and see if I feel differently or if any of my labs improve. If you see me, ask about my experience and I will gladly update you. Below are some references for you from a wide variety of sources. Migraines? Chronic Fatigue? Since there are no real dangers of molecular hydrogen at these concentrations you really have little to lose. Until next month …get well and stay well.
Hopefully, things will be approaching some semblance of normalcy soon. Many of you have skipped doctors visits of all sorts or tried the telemedicine visit. Oh , don’t go feeling sorry for us healthcare professionals. I’m not writing this column to drum up business. As long as you insist on eating at McDonald’s and Kentucky Fried Chicken and Burger King etc etc etc healthcare is never going to be wanting for business. As long as you continue to follow the current published dietary guidelines I will be busy for the foreseeable future. So will all the surgeons and other doctors. So when you do, in fact, go back and have an in-person visit let me walk you through what you should really be focused on.
Of course you should talk about your overall health and that has to involve some conversation about your national status. You can look at this in three broad categories of intake ; proteins, fats and carbohydrates. Protein is very easy to measure both total protein and albumin in a simple and inexpensive blood test . But to measure the individual amino acids is much more expensive and complex so it’s the cheapest component to test for but it’s almost always normal so unless it’s out of range it doesn’t tell you much.
Moving now to measuring how you’re doing in terms of your carbohydrate intake is the test for insulin and sugar. A simple mathematical calculation provides your level of insulin resistance. Insulin resistance equals metabolic syndrome. Metabolic syndrome equals increased risk of heart attack, cancer, stroke, early death, obesity, dementia, arthritis etc have I left anyone out? By measuring your insulin resistance you will get a sense of how your body is handling sugar / carbohydrates. This blood sample needs to be drawn fasting. But, it can be done over and over again to assess your response to changes in your diet. This gives you yet another independent, reliable, and validated tool to tell us, like, Hemoglobin A1c etc of how you are doing in your management of sugar. The insulin level is going to be abnormal long before the hemoglobin A1c and blood sugar tests are abnormal. Your doctor or healthcare provider hasn’t ordered it because they have focused on the sugar but your sugar’s will be in a normal range for years while your insulin is elevated. It’s not an expensive test. It’s very very simple to interpret ….the lower the number the better.
Finally it comes to measuring the fats in your diet and your fat management. It’s easy for your doctor to measure your cholesterol and of course the minute they do they focus on the number and if the number’s over 200 you’re on a statin. Unfortunately, the cholesterol hypothesis has been demonstrated to be false. The article referenced below is just one of many …. an up-to-date review of 19 different studies which, when examined ,showed an inverse relationship between your bad cholesterol (the LDL) and all-cause mortality meaning the higher your bad cholesterol the longer you lived. It’s painful for me as a 30-year healthcare provider to have to admit that what I’ve been promoting for years is just, in fact ,not true. So when I order your cholesterol panel I’m not concerned at all about your cholesterol unless it’s too low but I am worried about your triglyceride to HDL relationship because this, I think, really reflects your metabolic state. The higher the triglyceride to HDL ratio the worst your metabolic state. you are probably not focusing on this when you review your labs with your provider. This concept is really not new and it is part of the very definition for metabolic syndrome. Here’s the link to the article regarding the relationship between LDL cholesterol and mortality.
But wait, there’s more to explore in the world of fats and your diet. You must work with your doctor to measure your omega-6 and Omega-3 ratio. The omega-6 is the anti-inflammatory essential fatty acid and the omega-6 is the inflammatory essential fatty acid. Examples of the major Omega-3s include EPA and DHA. These are found in fish oil, fish etc, Examples of the Omega-6 fatty acid would be arachidonic acid which along with cholesterol EPA and DHA makeup vital fats for your brain. It’s important though that they’re balanced and for most of us we are way out of balance due of course to the diet. The optimum Omega 6 and 3 ratio is 1:1 but most people have a 5 : 1 or 10 : 1 ratio which means that every cell in their body is affected by this distortion. This ratio is easy to measure and is actionable. Cut down the corn oil, the canola oil, the vegetable oils and cut down the fried foods. That will lower your omega-6 as you raise Omega-3s by either having more fish nuts Etc in your diet or by supplementing and, of course, I recommend cod liver oil just like Grandma used to do.
So now I’ve given you the information and the rationale to go to your doctors and have a proactive visit about what’s really important; these basic elemental markers of your nutritional status. If you’re not measuring your insulin resistance and you’re not measuring the Omega 6:3 ratio and you’re not measuring the triglyceride HDL ratio you’re flying in the dark with your health. Better fasten your seatbelt. Better yet… fast ! Luckily, all of those measures are completely controlled by you and your diet. These are simple inexpensive tests you can have repeated over time to measure your success in other than just the inches on your waist. These tests are reliable , usually covered by insurance , and give you a way to keep yourself honest. Now go get what you need! Until next month, get well and stay well.
JT BARRY MD
I was hoping to be able to write about something other than coronavirus this month hoping that the situation would be substantially behind us but as I prepare this column that’s clearly not the case. Of course I have recommended vitamin d and vitamin C and zinc and those are pretty obvious, generally available, extraordinarily safe supplements you can take to try and minimize your likelihood of infection and or minimize the degree of infection if you get it.
Hopefully, by the time this article is published we will have the antibody testing available for everyone who wants it. We will finally start to get a handle on who had a trivial infection and have a better sense of the real death rate etc. I sent a reference to a video in an email to all of my private patients but I feel it’s important enough to share with you as well. This video was one done by dr. Paul Masson and it’s entitled “How to Survive The Coronavirus The Effect Of Diet Part 1”. The link is here https://www.youtube.com/watch?v=4lJPjsuftmQ . I have on my way radio show talked about the possible role of high dose intravenous vitamin C the role of ultraviolet light and the role of ozone in the treatment of viral infections but this is something that requires medical intervention you can’t do any of these on your own. Doctor Mason’s video is about what you can do to improve your health and immune system. Of course he focuses on the diet and that’s music to my ears. As he elaborates diabetes, obesity , hypertension and heart disease all increase your risk of ending up in the ICU. Age is a risk factor but seems to be really related to the underlying illness not just the age. Healthy old people have less risk than sick young people or so the data shows so far. Dr Mason reviews the issues of metabolic syndrome…high waist circumference, hypertension, high triglycerides, low hdl cholesterol and fasting glucose over 100. Statistically speaking only 12% of adults in America have none of the risk factors for metabolic syndrome. Insulin resistance , a hallmark of metabolic syndrome, clearly impairs the immune system in multiple ways. Even the cytokine storm is related to insulin resistance. Of course you can be insulin resistant for years before your blood glucose goes up so your doctor must check your insulin not your blood glucose to find out if you are insulin resistant. Most doctors just dont run this test. It’s cheap, easy to order and it’s easy to interpret.
Luckily you can change your insulin resistance very rapidly by changing your diet and removing the bulk of carbohydrates in your diet. Lose the sugar and regain your health. Yes, I know you are addicted to sugar…we all are. But study after study shows low carb diets improve health…resolve insulin resistance…promote weight loss etc.
Dr Mason also reviews cholesterol and how high cholesterol is protective against infection. That’s right high hdl cholesterol makes you less likely to get infection and less likely to become septic if you do get infected. In his video he reviews major papers that completely disprove the cholesterol hypothesis that your cardiologist clings to… Cholesterol bad…must lower the number. Dr Mason uses important published research to completely shred the idea that it’s good to lower your cholesterol and saturated fats are bad for you. Bring this article to your doctor, your cardiologist and ask them to watch it and refute anything he is saying and they will be unable to. Of course most of them will not even watch it because they have been trained to believe cholesterol is evil and that’s that. Again , high cholesterol is protective against infection, sepsis and all cause mortality and the evidence is real , convincing and overwhelming if you just look at the research. Need another reference? Try Dr Malcolm Kendricks great book The Cholesterol Con.
So we are giving seniors the flu shot which demonstrably does not work to prevent death and hospitalization and according to published research this year increases the risk of getting ill with the coronavirus. On top of that we are giving statins to every senior we can convince to take them so it’s not surprising that this group has the highest rate of mortality with infections. My profession has much to answer for and it disturbs me that so many of my colleagues see this research and just shrug it off and can’t open their minds to the idea we have been making the wrong recommendations regarding your health.
Dr Masons video is a must see. He talks about treating patients on the ventilator. Often , because we were taught it was important, if patients are on the vent for any length of time , we feed them with tube feeds. This is a bad idea. The typical tube feeds are not healthy for you…I know ,I know they have been approved by the nutritionists / dieticians / intensivists etc but they contain unhealthy oils and sugars that do not , in any way, promote health and recovery. It has been demonstrated decades ago that starvation and fasting stimulate the immune system. High fat low carb feedings have been shown to cut down time on the ventilator. So what are the local hospitals using?
Next , Dr Mason takes on hypertension as the last component of the metabolic syndrome. Hypertension is associated with increased mortality in coronavirus infection. He shows that hypertension is not a problem of eating too much salt..it’s due to too much insulin and its effects on the kidney. Lower your insulin and lower your blood pressure. Table salt is not the problem. Stop looking for low sodium foods and get off the high carb diet. Dr Mason recommends you get a continuous glucose monitor even if you are not an obvious diabetic and once you keep your sugars down your pressure should follow. Now Dr Mason eschews all oils, including my beloved olive oil , and he might be right but I don’t see lard making a comeback in the near future. Finally , Dr Mason goes over the extensive data that reviewed saturated fat and diet and how saturated fat is good for you …the opposite of what you are being told today but the evidence is overwhelming.
Unfortunately, health professionals today are way too organ focused..This doctor takes care of your bones, this one takes care of your heart, this one your kidney etc..What every doctor has learned in medical school but quickly forgot because we focus on pills and procedures is that we are all bags of electrochemical activity and if the individual cells of any organ are happy the organ will be happy. What you fuel your body with will determine your health. Stop the cereal, stop the soda, ask your doctor to measure your insulin and you can begin today to improve your health and your immune system. Until next month….spread the love not the virus.
JT BARRY MD
No one wants to really talk about it but the biggest healthcare issue in America today is dementia. Sure cancer is a terrible thing but many people are cured of cancer. Dementia, at least today, is relentlessly progressive and besides profoundly affecting the patient it has a massive effect on the caregivers as well. Just as everyone knows someone with cancer likewise everyone know someone with dementia. Unfortunately, the currently available treatments for dementia are very limited. The toll on caregivers is massive. Dr. Dale Breseden proposes a treatment plan that includes addressing your diet, your exercise,your sleep and your stress as well as removing toxins and some supplements. In his book the End of Alzheimer’s, he documents multiple cases of people that were dramatically improved in memory and whose brain scans actually show regrowth of brain. A 2 year study in Finland called the Finger study demonstrated a significant beneficial intervention effect on overall cognitive performance was seen in a group of people who receive dietary guidance for physical activity cognitive training and intensive monitoring and management of metabolic and vascular risk factors.
So dementia is not inevitable and you can have a significant impact on your risk of dementia and your degree of dementia based on your lifestyle. As you know from my prior writings many people consider dementia a type of diabetes, so called diabetes type 3. This is one more reason to go to your doctor and ask for a fasting insulin level and a measurement of insulin resistance. Ask your doctor for a fasting insulin test and a HOMA score which is a way of measuring insulin resistance.. Your doctor is likely to say that your sugars have been fine so there is no need to measure insulin but you must remind them that sugars will be normal for years as insulin rises and the only way to know this is to measure insulin and if they are going to measure your insulin you might as well do a thorough test by checking the sugar at the same time and learn about your insulin resistance. I believe, after 33 years in medicine, that Dr Breseden is right in that diet plays a crucial role in preventing dementia. Minimizing sugar in all of its forms and maximizing basic simple whole foods I think is your best defense against this mental scourge.
Do you remember where you your car keys? Did you forget where the car is in the parking lot? Do you ever go down into the basement and wonder what you went down looking for? Is at the beginning of dementia or is it just benign forgetfulness of being older? Do you cover up for your loved one in the doctor’s office when they started asking memory questions? Is your doctor or even testing your memory? If you’re in Medicare you are supposed to have a memory test at your annual wellness visit. This is happening?
Well, if you worry about memory loss you do not have to rely in your doctor. Everyone and anyone who has an interest in dementia, who worries about dementia, who has a loved one with memory loss now has access to testing and treatment regardless of the ability to pay. There is a company called Clarity Clinical Research which is located at 6700 Kirkville Rd., Suite 107 East Syracuse New York. The phone number is 315-706-5905. You do not need a referral from your doctor. You do not need a referral from your neurologist. All you need to do is call this number to have yourself tested or your loved one tested. They will establish a baseline and if it is appropriate, offer you the option of being enrolled in a clinical trial. Given that the currently available medicines for dementia do not have a real impact on the disease, having a trial available is possibly a game changer for you and your loved one. . I understand from my conversations with the experts at this facility that it does not matter whether you have a little memory loss or whether you have advanced dementia they will evaluate you and try and find a trial for you. Clinical trials are the way medicine advances. Clinical trials are not new to Central New York . Many people that get chemotherapy are involved in clinical trials.. The testing and treatment available at Clarity Clinical Research are simply not available anywhere else in the area. They have access to scans that are not available outside of research settings. Again, all testing and treatment including the scans etc are free. No charge whatsoever whether you have insurance or not. Furthermore you don’t need approval from your insurance company or medical provider to get tested and treated. So if you really worry about your memory or your loved ones memory you are a phone call away from the most thorough and aggressive testing available anywhere. Of course,I urge you to improve your lifestyle as the primary approach to prevent memory loss and that’s outlined in books like Dr Breseden or Dr Perlmutter’s book Grain Brain. Naturally , I suggest you do both…investigate the lifestyle changes and avail yourself of the most advanced testing and treatment available by calling Clarity Clinical Research. Call today before you forget about it !
Here I go again, taking on another major important national healthcare guideline. … Both the United States Preventive Task Force and the American Academy of Family Practitioners recommend AGAINST using the PSA as a screening test. The American Cancer Society recommends that men only be offered PSA testing after a discussion of the risks and harms. Who is spending that much time with their doctor?
Directly from the American Society of Clinical Oncology comes the following information: “Prostate cancer is the most common cancer among men, except for skin cancer. This year, an estimated 174,650 men in the United States will be diagnosed with prostate cancer. Around 60% of cases are diagnosed in men over 65. The average age of diagnosis is 66 years. The disease rarely occurs before age 40. Most prostate cancers (90%) are found when the disease is in only the prostate and nearby organs. This is referred to as the local or regional stage.
The 5-year survival rate tells you what percent of men live at least 5 years after the cancer is found. Percent means how many out of 100. The 5-year survival rate for most men with local or regional prostate cancer is nearly 100%. For men diagnosed with prostate cancer that has spread to other parts of the body, the 5-year survival rate is 30%. Prostate cancer is the second leading cause of cancer death in men in the United States. It is estimated that 31,620 deaths from this disease will occur this year.”
Interestingly enough, Prostate Specific Antigen (PSA) —which means a protein that is specific to prostate tissue— was first used by the police starting in 1966 when it was identified in semen and came to be used in cases of sexual assault. Then in 1979 it was discovered that this protein could be found in low amounts in the blood stream of men. PSA was first used in diagnosing prostate cancer in 1987 and was approved by the FDA for this purpose 7 years later.
For years the PSA was done at your annual physical and if it was elevated you were sent for a biopsy to see if you have cancer. If you did test positive you are offered a choice between watching, radiation, surgery or hormonal treatment. Not everyone with an elevated PSA will have a positive biopsy. PSA levels rise as you age and bike riding, rectal probing, prostate irritation or infection can also raise the PSA. We have established a cutoff of 4.0 as the upper limit of normal but some people age normalize the number so as you get older up to 6.0 is considered normal. I have personally had patients with a PSA of 3 who had cancer (their prior PSA was less than 1 so the level of 3 was quite a jump) and patients with a level of 30 who did not have cancer. (They had a biopsy and it was just due to a very enlarged prostate.) So, your doctor CAN do a PSA test at your annual physical but some doctors, blindly following the guidelines, have abandoned this practice. Why? Because some researchers believe that the PSA does more harm than good because:
- Some prostate cancers are slow growing and should be left alone.
- There will be many people who have an elevated PSA who have biopsies that come back normal and they have been put through psychological stress needlessly. There are dangers of biopsy as well including infection, etc.
- Some people will be overly aggressive about treating slow growing cancers and have operations or treatments that leave them with incontinence and sexual dysfunction.
None of these are, to me, important enough to stop checking PSA. As noted above, prostate cancer is the most common serious cancer men get. … About 1 in 6 men will be diagnosed with cancer and it’s still obviously a common cause of death. ANY test that can help diagnose cancer is worth considering. Once you have the diagnosis it’s up to the individual patient as to how aggressive to be. That’s a completely different problem than diagnosing the cancer in the first place. Once you know, you are in the driver’s seat and can get all the consultations and opinions you want. But until you know, and the PSA test is the first stage of discovery, you have no idea what fate awaits your prostate and you. The blood test is cheap, reproducible and reliable and still covered by most insurances. I know I would have a hard time explaining to some widow that her husband’s prostate cancer death could have been prevented or at least delayed by a simple readily available blood test that I did not do because some guidelines said it was no longer appropriate.
There have been 2 large scale studies looking at the benefits of PSA testing. Roughly 75,000 men were tested with PSA starting in 1993 and there was no benefit in overall mortality between the group who got tested with PSA and the group that did not, although there were 22% more cancers found in the PSA testing group.
A second, larger study, was done in Europe … the European Randomized Study of Screening for Prostate Cancer began in the early 1990s. A total of 162,000 men between the ages of 55 and 69 were recruited. Quoting directly from the Harvard Medical School article: “After about nine years of observation, 214 men in the PSA screening group had died from prostate cancer, while 326 men in the comparison group had died from the disease. That means screening reduced the risk of dying from prostate cancer by 20%.”
The PSA is a screening test just like colonoscopy and mammogram and when you look at these tests from a population-based standpoint none of these tests —I repeat none of these tests— have been shown to cut down more mortality at the population level. That said, every physician I know has seen people whose lives were saved by a colonoscopy a mammogram or a PSA test. The PSA test is far cheaper than a colonoscopy or mammogram and for a disease that is going to affect one in 6 men I think that ongoing screening is appropriate and I will continue to do it. Yes, it is true that many more men will die WITH prostate cancer than FROM prostate cancer but on my watch I want to find any cancer as early as possible. The PSA is a test that does just that. I urge you to have this discussion with your own personal physician.
Until next month … Get well … Stay well.
(ed. Readers can listen to Dr. Joe Barry’s radio show “Your Health Matters” airing Sunday afternoons at 12:00pm on WSYR 570)
I am not going to start the year with an exhortation for exercise and changing your diet. Been there…done that. Rather, we start the new year together with an education regarding how to detoxify yourself from all of the foul chemicals you insist on slathering on yourself and ingesting. There is actually a national data bank that maintains fat tissue samples from patient’s all across the United States and based on an analysis of these fat tissue samples ( because that is where a lot of the poisons are stored… in your fat ) shows that 100% of Americans… that is every single sample that they tested , from all across America , tested positive for multiple contaminants/poisons.That is correct, 100% of the samples tested positive for stylene (a breakdown product of Styrofoam) 100% tested positive for xylene , 100% tested positive for ethyl phenol. Chloroform was found in 76% and benzene was found in 96% of samples.. That is not sick people, that is the average joe and jane, that is you and me. If the fish that lived for 4 or 5 years in the fairly clean waters here in Upstate NY have so many chemicals in them that the DEC warns you not to eat more than one a month, how likely is is that you, having lived much longer, would be free of contaminants? The answer is, based on the science available to us today, zero. We all have multiple toxins in us no matter what you want to think about how to clean your air and water are. The air in your house..yes, your house, is significantly more toxic than the air outside your house and most of you leave your house as little as possible. So it is fairly straightforward that we all have contaminants/pollutants in our fat stores. Thousands of chemicals are used in and found in all the processed foods we ingest daily as well as exposure to chemicals in your house, water etc. Don’t think because you are a vegetarian or eat organic that you are safe…most assuredly you are not.
Having all these strange chemicals in your body simply cannot be a good thing for you no matter how much you store them in your fat or otherwise. These chemicals; the heavy metals, the plastic derivatives etc affect the cell membranes, they affect energy transport, they increase cancer risk etc . All these risks are well documented in the scientific literature. Now what can we do about them?
Well, there are natural detoxification pathways in the body and detoxification is broken up into three phases. Phase one is where the chemicals are converted from fat soluble to water soluble thereby allowing them to be processed and transported easier for removal from the body. This involves oxidation, reduction, hydrolysis and epoxidation. This usually involves the cytochrome P450 system in your liver . This can be dangerous because you’re taking these compounds out of the fat and actually making them more available to the body and to possibly have more of a toxic effect so you have to move on to phase two. Phase two is where the compounds and molecules are made even more hydrophilic that is water-loving to again facilitate transport out of the body. This is done by glysine, glutamine and glutathione, acetylation sulfation and thiosulfation. Lastly , phase three is the process of transporting these chemicals to the sites of excretion primarily the bile tract and urine. Another way to look at it is to say that phase one is transformation phase two is conjugation and phase three is transportation.
This isn’t the time or place for a deep dive into the chemical details but it’s simple chemistry. And like all chemical reactions detoxification is very dependent on having the right chemicals and enzymes , vitamins and minerals like zinc, selenium, copper, etc. If you have a deficiency in these chemicals you are not going to be able to clean these poisons out of your body. How are you going to maintain the proper nutrient balance and minerals and vitamins with your McDonalds and Pizza Hut addiction, your donut and pancake habit, your soda and juice dependence? If you want the best chemical reactions to occur in that vast electrochemical bath that is your body you must provide the best chemicals and reagents. These pathways are very well known and so are the chemicals that compose them including glycine, certain B vitamins, glutathione, vitamin C , methionine, and cysteine to name just a few. You can get them from food and / or supplements. It’s still a wild wild world in the supplement market. Since everyone has toxins in them why shouldn’t we all be working on some detoxification on a regular basis.
Now, I am not talking about coffee enemas or the more aggressive detoxification using chemicals like EDTA and captomere…thats way above your pay grade but I am talking about eating health foods like garlic, artichoke, black and green tea, coffee, milk thistle and the whole broccoli family. If you want to maintain the most important pathways of detoxification I have been recommending a daily dose of Vitamin C, R Lipoic acid and Glutathione but many people also recommend N Acetyl Cysteine and Acetyl L Carnitine as well. Of course I am not going to give you doses etc…you have to do your own research or ask your own health care provider what they know about the toxics ever present in your body and how to detoxify yourself. Of course an excellent primer on this subject is Dr Sherry Rogers book Detoxify or DIe ! Maybe it’s too late for Christmas but it still makes a great birthday present. Of course I didn’t invent the term but “the solution to pollution is dilution” so keep the water intake up. Another great detox program is any multi-day fast. I know multi day fasting and cold water immersion are supposed to be very very healthy and I have seen study after study that supports both practices but I find the sauna and skipping breakfast so much more palatable.
I will be talking about other unfamiliar topics in the columns to come. My research into the very basic molecular nature of cellular function has me investigating the effects of light , electriciy and vibration and will be bringing you some interesting insights that modern medicine is ignoring because there is no big pharma behind it. Until then , eat your brocoli.
I was going to write this month about detoxing and I think it is a very important topic. However, I think there is something that is probably just as important and easier for you to discuss with your doctor. That is – measuring your sugar. Not just pricking your finger but checking your glucose level whenever you want … especially after meals so you can see for yourself immediately the effect of the food you have just eaten on your glucose level. I am talking about CGM (continuous glucose monitoring). If you think you have a good diet, if you think you are taking care of yourself, why not prove it to yourself and your health care provider by applying a monitor that can, for 2 weeks: check your blood sugar whenever you want; as often as you want; without having to prick your finger. I don’t think this is just for diabetics either although obviously this is very important for them to really understand the relationship between what they eat and their bodies response. This isn’t the same as checking your insulin level but it is very readily available and easy to understand. If you are diabetic or have metabolic syndrome or are overweight or just wonder about the interaction between the food you eat and your sugar it is finally easy to have this monitored. I am currently recommending this monitoring to every one of my diabetic patients. I also recommend the monitoring to anyone who is curious about their diet and its effects on their health. Do you really think that peanut butter and jelly sandwiches are healthy? Check your sugar afterwards and see for yourself. Do you really think that ice cream is an innocent treat? See for yourself. If you really think those sodas are not harmful check your sugars after a can and actually measure your own bodies response.
There is a continuous glucose monitor called the Freestyle Libre which is inexpensive and often covered by insurance. You apply the sensor to your upper arm and use a monitor to be able to measure your glucose level anytime. The tiny needle in the sensor really is not painful and its much better than pricking your finger. The sensor is pretty durable and can handle showering, etc.
Now we have been talking for some time about the so-called closed-loop system where diabetics could have their sugar monitored by this device and then have insulin administered to keep their sugar levels normal. I think this is going to be a disaster. People will eat whatever they want knowing that this system will handle their sugars but it will result in them getting much more insulin and, as you know, I believe that excess insulin leads to heart disease, dementia, generalized inflammation, arthritis, increasing cancer risk, etc. So I do not think treating your elevated sugar with insulin is the best option. Of course here I am talking about type II diabetics type. Type I diabetics are dependent on insulin. They are much less common and this is not the article for them although obviously monitoring their sugars are very very important for them and this sensor will apply to them as well.
I have just ordered the system for myself because I am curious as to what really happens when I have my pork fried rice for lunch and whether my late night pretzel snacking is raising my sugars or not. Also I am curious as to how low my sugar will go during the long periods when I do not eat. What effect will sauna use have on my sugars? What effect will strenuous exercise have on my levels? All of these questions I will soon have an answer to … once I get past my insurance company. For me this is just intellectual curiosity but for you, if you are diabetic or prediabetic, it may affect how you eat, what you eat, the dosing of your medications, etc. If you are overweight and you wonder whether your current diet is really the best for you you can measure your sugar levels. You can have instantaneous reliable and reproducible answers. This is not magic. This is nothing particularly new. This device has been around for months now and every primary care doctor should be familiar with it and be recommending it. I never understand why more patients do not ask me for this device. It’s your health … you should be and can be in the driver’s seat in terms of monitoring your health and this is one more device to assist you. Go – partner with your health care provider to improve your health one measurement at a time!
Until next month … Get well … Stay well.
P.S. Don’t forget about the Desantis Orchestra at the Palace theater on Sunday December 8th and the Solstice at the Cathedral December 5th, 6th, and 7th at St. Paul’s downtown. If you like seasonal live local music in great settings both of these shows are for you. -See you there!
(ed. Readers can listen to Dr. Joe Barry’s radio show “Your Health Matters” airing Sunday afternoons at 12:00pm on WSYR 570)
HIGH BLOOD PRESSURE HOAX BY DR SHERRY ROGERS
Ok, so you have been diagnosed with hypertension, high blood pressure, the pressure ..it goes by several names but it’s deadly serious by any name. Hypertension is more common as you get older…at least here in America. It affects about half of all adults in the USA. Hypertension is a significant risk factor for strokes, heart attack, heart failure, and kidney failure and loss of vision. It’s serious and should be taken seriously. I just finished reading The High Blood Pressure Hoax by Dr Sherry Rogers so I can offer you a new perspective on this critical health topic.
People can rightly argue about taking statins for cholesterol. (statins are just not that effective and have significant side effects). People can go back and forth about how tightly we should be controlling your sugar (it’s the insulin level that’s important not your blood sugar) but no-body argues that hypertension should be treated. Dr Rogers thinks anything over 120/80 is hypertensive which is a pretty strict definition. I usually use 140/80 in most adults and 160/80 in frail elderly since HYPOTENSION this group is especially dangerous due to inc risk of falls and underperfusion of the brain leading to an INCREASED risk of dementia.
Don’t let your doctor diagnose you with hypertension on the basis of a few office blood pressure measurements. This is serious enough that you should get multiple readings either at the drugstore or, better yet, buy your own BP machine and take your own readings. Best of all is getting your doctor to check a 24 hr bp monitor. That’s considerably more accurate as a cardiovascular risk evaluator that the readings your doctor gets in the office. This was just evaluated in several months ago in the JAMA.
Ok, so we agree that you should get multiple blood pressure readings before getting labeled as hypertensive. So what about treatment? Well, first we have to talk about the cause of hypertension. Is your doctor telling you it’s just caused by aging? Then why is hypertension so very uncommon in the third world? Same reason that cancer and heart disease are low…their diets are healthy, ours are not . We are killing ourselves with our diet, plain and simple. . We health care providers repeated the mantra that came down from on high….high fat diet is bad and you should get most of your calories from carbohydrates. How embarrassing to admit that we had that completely wrong ?! So why would you put any trust in what I am going to recommend here? Because the things I am going to recommend are cheap, readily available , nontoxic, natural , gluten free, blood diamond free , gender indiscriminant, and hopefully you get my point. I am not endorsing any product or getting any benefit from these recommendations. As we say in the business I have nothing to disclose.
Your doctor will say that your getting older and your pipes are getting stiffer and you exercise less, and we all take in too much salt so it’s only natural that you get hypertension as you age. Well , how do you explain those that age but don’t get hypertension…My short answer is they lived healthier…less processed foods , less processed oils and much less carbs ! In the 1950’s only 5% of dietary intake was carbohydrate based. By the 1990’s 60% of the standard american diet were carbohydrates. Thats a ginormous shift. The government experts said saturated fats were bad and carbohydrates were not only harmless but better for you. That advice , so readily taken up by nutritionists and doctors alike, continues to be ruinous to America both as a country and one citizen at a time.
No ..as Dr Rogers points out in her book and as also attributed to Linus Pauling…all disease is a result of some deficiency or the presence of some toxin. Translation… hypertension is caused by the combination of wrong lifestyle and environment with the ratio changing from person to person but it’s mostly lifestyle people. Unless your diet is righteous you could have a nutritional deficiency that, once corrected,could resolve the high blood pressure which is just your bodies way of showing stress on the system. Why not try some simple supplements before taking some prescription medicine ? Well, taking a pill is easy for you and it’s easy for your doctor. But, think of it this way, you don’t have a beta blocker deficiency, you don’t have a calcium blocker deficiency, you do not have a diuretic deficiency. You weren’t born with these deficiencies and you didn’t develop these deficiencies. You could ,however , easily have a magnesium deficiency or a potassium deficiency or both and when you correct the deficiency the blood pressure may return to normal. Unfortunately the usual magnesium and potassium that your doctor does is not accurate in reflecting total body magnesium needs. Sodium you can measure from simple blood test because most of it is extracellular. Magnesium and potassium are primarily intracellular so you have to measure the RBC magnesium and potassium. The big local lab LACNY can do this test for you and your doctor and it’s usually covered by your insurance.
Of course you must eat less processed foods eliminate corn oil, high fructose corn syrup, soda and canola oil. These all inflame your system and raise your blood pressure. This is the way to improve your heart disease, your diabetes, your pressure, etc. Unless your blood pressure is sky high why not try different things for a month before resorting to BP meds. Blood pressure takes years and decades to exert its effects. Ample time to deal with the underlying problem rather than turn immediately to some pharmacologic There are other supplements to consider including L Arginine; an amino acid.
Your doctor will tell you that hypertension is just you getting older and your artery stiffening up but really it’s endothelial dysfunction which is the inner lining of the blood vessels and we know that nitric oxide relaxes the muscles surrounding the endothelium, lowering the blood pressure. It also keeps platelets from sticking to the blood vessel forming plaques. It regulates many other enzymes. .Nitric oxide is made from L-Arginine which is a simple amino acid that you can supplement. Why not try that first before taking a pill.? In her book Dr. Rogers referenced several articles published in major medical journals that criticized the use of diuretics. Dr. Rogers claimed that people taking diuretics had WORSE cardiovascular outcomes.. Because it’s important I get this right I actually found those references and reviewed them and they were both published in major medical journals and do substantiate her claim that diuretic therapy, especially for diabetics, was associated with increased mortality not decreased. Unfortunately when you bring this up to your doctor he or she is going to say “That’s crazy, I don’t know anything about it “. That’s when you hand him copies of the article. Here are the references for those who are interested. Just type the following in the web browser PMID: 1823530 and And N Engl J Med 1994; 330:1852-1857
Besides L-Arginine another amino acid has been shown to cause vessel dilatation and promote diuresis and stop abnormal platelet aggregation is taurine , another simple amino acid. Why not give taurine a try before subjecting yourself to prescription medicines . Of course you have to get rid of the corn oil and canola oil and all the processed oils in order to stabilize your membranes and although this will take awhile it will slowly help you return your natural ratio of Omega-3 to omega-6 back to 1 to 1 instead of the 1 to 20 it is now in the developed world. This drastic change in the ratio from the norm cannot be a good thing for your health. I have not yet found a commercial salad dressing sold in Wegmans or Walmart that is free of these processed oils , except Braggs which I dont think tastes that great at least not compared to my wife’s home made dressing. Olive oil on the other hand is not a processed oil. How about trying some celery which has also been shown to lower blood pressure. There is no such thing as too much Brassica vegetables: cabbage, broccoli ,cauliflower, Brussels sprouts ,kale, collard greens, turnips, radishes, horseradish and watercress. They are natural and aggressive detoxifiers and the toxins you build up in your body certainly contribute to hypertension. Bottom line is that if you are interested there are multiple natural ways to try to treat your blood pressure before resorting to prescriptions. Dr Rogers lays all this out for you in her book which is readily available on the internet. There is a ton of referenced literature in all her books They are not too technical and I recommend them to all my patients who want to try natural products before resorting to big pharma. I used to think Dr Rogers was on the fringes of medicine but now I know she was at the forefront and I have learned much from her books and you can too ! Until next month …Get well, stay well.
JT BARRY MD
It’s been a while since I’ve covered it but I have to deal with it practically every day so let’s make sure we get through it as painlessly as possible. What I am talking about is your dying … the last chapter of your life and what control you have over it. I have been known to say to people ”I like you. -I hope you drop dead.” People are taken aback until they actually think about it, then they get it. You can drop dead in your sleep after years of good or you can succumb to one of your many illnesses probably during some nursing home stay. You know what a great place they are. They must be great because they are full all the time. Yet everyone I know says ”You’ll never get ME in one of those places!” This column is for you to plan ahead so you actually have some say in what happens to you when you are no longer independent. Don’t leave it up to your kids, most don’t have what it takes to do the right thing and honor your wishes, it gives many of them a guilt trip making life or death decisions that were not thought out ahead of time. You know me – I think you should have it all planned out, the burial business, even what you want in your obit and the music you want played. But we are not talking about what happens after you die, we are talking about filling out a few forms that will guide your care at possible end of life situations.
Either you are going to go out easy or hard —that’s your call— either surrounded by friends and family in your own home or die in some sterile Intensive Care Unit being tortured by emotionally repressed staff that are treating your body, doing whatever they can to eke out a few more hours or days of your badly dwindled self. I don’t know about you but that’s an easy choice for me. So that means I am a DNR. -Do Not Resuscitate. No CPR for me. I am well read on the success statistics of CPR and except for defibrillator use, there is only a tiny chance of meaningful recovery.
So the first decision you have to make is who will be your health care proxy. You should list an alternate because people die, etc. This person should have a good idea of your end of life wishes. My wife is my proxy and she knows my wishes well. There are free forms on the internet so you have no excuse.
Then you decide on DNR for yourself or not. If you really want everything done, (which I translate to mean that you have no idea what’s in store for you), but if you do indeed want every possible means taken to keep you alive all you need is the Health Care Proxy.
If you want to be DNR which, to me, translates to mean dignified death then you have to get an out of hospital DNR form from your doctor. They have blank ones on file. This only works if people see the paper so keep it in that folder on the fridge next to your med list.
Now it’s New York State so you know there is some terrible paperwork yet to be faced. A completely unnecessarily complex form that tortures patients families and doctors alike. It’s called the MOLST form. This form addresses reasonable questions about your care but in a needlessly complicated way. The form proceeds to ask about full code versus DNR, then whether you just want respiratory support, then to ask about IV fluids, antibiotics, at what point to hospitalize you etc. -Good questions … bad form.
I know a lady who had two children who were both doctors. -The daughter came to her mother one day and said, “You know, mom, your son is your health care proxy. Did you know that if you were in a nursing home and had pneumonia he would withhold antibiotics and let you die?!” The mother responded ”That’s exactly why HE is my proxy and you are not. If I ever end up in a nursing home that means I’m in a bad way. Don’t keep me around.”
It’s hard to pull the plug … it’s hard to see your loved one slowly endure the dwindles. Each one of us has to decide for themselves the right thing to do but it sure helps the family a lot if your wishes are obvious and oft repeated. My guiding principles are to try and treat everyone at this time like they were my own father and also to go along with whatever they want to do for as long as we can (even if its not in their best health interests) because that’s what I would want done for me. I hope I drop dead … just not today.
Now let’s get serious. Your loved one is in the adult home or nursing home. They wouldn’t be there if they could avoid it. They wouldn’t be there if they were healthy. They are indeed writing the last chapter of their lives. Why are you still insisting on giving them so many pills. Of course they are depressed. -Do you really think a little white pill is going to make it all better? You are deluding yourself and subjecting your loved one to unnecessary meds. Dr. Richard Kennedy published in the Journal of the American Medical Association November 2018 that the most commonly used drugs Aricept and Namenda actually worsened dementia and cause patients to be worse off than without the medicine. I know people that have started their mother or father etc., on one of these pills and they did well and I’m not discounting that but the published literature in a very prestigious medical journal says not only do they not work but they make people worse. Also, I see many people in the nursing home setting still taking cholesterol drugs. Dying quickly of a heart attack or stroke would be a blessing in these patients. The evidence that statin drugs work well in this population is very very limited and I don’t think justifies their use. For that matter I wouldn’t treat blood pressure because I think the side effects of many of the blood pressure pills outweigh the possible benefits. No, may I suggest to you that when you are putting your loved ones in the nursing home it’s time to stop almost every single medicine and focus on what’s important … their comfort. If they want ice cream and whiskey for breakfast and dinner great. If they want to eat M & M ‘s instead of peas, what color do they prefer? Multiple studies have shown that when you stop the polypharmacy some patients actually improve off the medications!
Some people look at me when we have these discussions like I am trying to finish off their relatives. On the contrary, I am devoted to doing everything I can to improve the quality of their life. Unfortunately patients and doctors alike put way too much faith in the pills which is not justified by the published medical literature but the urge to do something is very strong. It’s taken me over 30 years as a physician to realize that sometimes, often really, less is more.
Until next month … get well … stay well.
(ed. Readers can listen to Dr. Joe Barry’s radio show “Your Health Matters” airing Sunday afternoons at 12:00pm on WSYR 570)
It’s no wonder that you’re confused and your health suffers accordingly. You keep getting conflicting advice from health professionals. Being one of them, a health care provider, it’s a little embarrassing. Coffee bad … coffee good. Milk bad … dairy great. Eggs bad … eggs redeemed like the Christ child. Your government and professional guidelines recommended that you get 60% of your calories from carbohydrates. My people believe that insulin controls the burning of fat in you body and we tell you to limit dramatically your carbs to keep your insulin low. Who do you believe? How do you decide?
Sometimes the advice or guidelines change based on improvements in science and, of course, that is appropriate. But, too often the guidelines are either not based on the highest levels of science or the industries involved had some less-than-appropriate involvement in guiding the guidelines. There is plenty of literature on this. So I try to rely on the evidence, the science and not the guidelines. A case in point is the aspirin controversy.
On one hand we have the United States Preventive Services Task Force that currently recommends that adults 50 to 59 years of age start taking a daily low-dose aspirin if they have a 10% or greater 10-year cardiovascular risk, do not have bleeding risks and are willing to do so for 10 years. In patients older than 59 the risks outweigh the benefits and there’s insufficient evidence to assess the benefits of people younger than 50. This recommendation, which was issued in 2016, was based on 11 randomized control trials between 1988 and 2014.
On the other hand, we have the U.S. Food and Drug Administration in 2014 that cited that there is insufficient evidence for using low-dose aspirin therapy for primary prevention of heart attack or stroke and three recent studies support this position. In the “aspirin to reduce the risk of initial vascular events” or the ARRIVE trial, 12,000 European and U.S. adults 55 years of age or older without diabetes were given a hundred milligrams of aspirin daily for 5 years. They were at moderate risk of cardiovascular disease … meaning heart attack or stroke. No difference occurred between composite outcomes of cardiovascular death, myocardial infarction, unstable angina, stroke, or TIA. However, 1% of the aspirin group had bleeding versus only 0.5% of the placebo group.
Another trial, the Study of Cardiovascular Events and Diabetes Trial, enrolled 15,000 adults 40 years of age or older in the United Kingdom. After a follow-up of 7.4 years the aspirin group had a lower percentage of people having a serious vascular event than the placebo group but this benefit was offset by an increased risk of major bleeding. The numbers needed to treat would be 91 and 112 respectively from which they concluded that aspirin had no net benefit.
Finally, the Aspirin And Reducing Events In The Elderly Trial, examined the effects of 5 years of daily low-dose aspirin on community-dwelling adults 70 years or older in the U.S. and Australia. There were no differences in the primary endpoint of disability free survival, dementia, cardiovascular deaths, or hospitalization. However, the aspirin group had a higher rate of major hemorrhage and higher all-cause mortality.
So there are three recent good sized trials that question the use of aspirin in primary prevention. If you have already had a heart attack or stroke that’s a different story … stay on your aspirin. But the rest of you —schooled to take your aspirin and your multivitamin every day like trained seals, believing, somehow, that this would protect you despite your many and manifold dietary indiscretions— may want to think twice about the daily aspirin ritual. Your doctor should be having this conversation with you on a regular basis. -What are your risks and how can you best modify them? Lifestyle changes have always trumped medications but how much time does your doctor spend talking about this and making a plan to improve your health. For that matter, has your doctor assessed your 10 year Cardiovascular risk using the American Heart Association / American College of Cardiology risk calculator? How else are you deciding whether or not to take aspirin or take a statin? Personally, I think the calculator grossly overestimates your risks and therefore favors statin use in most people —and practically everyone over the age of 70 regardless of other risk factors— but at least it’s a place to start your cholesterol and aspirin conversation. Did I emphasize that dietary and exercise changes are far more effective than any medication in changing your risks of dying from the most common causes of death? It’s easy to recommend some medication, it’s harder, takes longer, and is more involved, to talk to patients about changing their behavior but that’s where the real benefits are. Stop depending on your doctor to manage your illness and enlist them in your efforts to improve your wellness. Your office visits should be a review of your diet and exercise, a conversation about improving your lifestyle, serial evaluations of your efforts long before you and your doctor turn to pills.
Getting back to the question of aspirin … When I am asked about aspirin I suggest people take it religiously … one tablet of any dose once a week on Sunday.
Until next month … get well and stay well.
There is an additive that was recently approved by the FDA that you should know about. Its industrial name is E951. The plan is to include it in over 6,000 products. It will be consumed by millions of people daily. It will likely be added to soft drinks, chewing gum, candy, desserts, yogurt as well as pharmaceuticals, in particular, syrups and antibiotics for children.
I first became interested in this additive because it has known adverse effects on the biome and you know how seriously I have been researching the importance of the bugs in your gut. Unfortunately E951 directly kills many of the bugs in your gut and adversely affects the ratio of Bacteroides and Firmicutes. You want more Bacteroides and less Firmicutes and E951 does just the opposite and that’s not good for you and your health. This is well-documented in the scientific literature.
When this additive was approved in Europe, there were immediate reports to their version of the FDA, which included: migraines, change in vision, nausea and vomiting, trouble sleeping, change in heart rate, abdominal pain, joint pain, depression, memory loss, seizures and brain tumors. That’s right brain tumors. Adverse reactions to E951 accounted for more than 75% of that agencies complaints involving a food additive!
E951 is made up of two main ingredients combined with a methyl ester. This methyl ester breaks down to methanol in the body. Methanol is grain alcohol. That’s the stuff that makes you go blind if you drink too much of it. This methanol, in turn, is converted to formaldehyde in the body. That’s right … formaldehyde. According to the American Cancer Society various agencies including National Toxicology Project, The International Agency for Research on Cancer, The EPA and The National Cancer Institute all list formaldehyde as a known or likely carcinogen. Furthermore one of the main ingredients is well-known to be neurotoxic. So, there are plenty of reported side effects: breakdown products that are known to cause cancer, ingredients known to be neurotoxic, adverse effects on the gut biome, etc. Who needs this product in the USA?
The pharmaceutical company reported 60 studies to evaluate the safety of E951. All 60 studies found no problem with the drug whatsoever. However, 93 independent studies were done and a problem was found 80% of the time. The drug company tried for years to get E951 approved. The science was so sloppy that the FDA took the rare step of asking the US attorney in Chicago to investigate the pharmaceutical company for its potentially illegal actions. The long list of very shoddy and very suspicious activity of the drug company can be found on the arizonaadvancedmedicine.com website.
Senator Edward Kennedy at the April 8, 1976 hearings before the Senate Subcommittee on Labor and Public Welfare stated: “The extensive nature of the almost unbelievable range of abuses discovered by the FDA on several major products is profoundly disturbing.”
So how does a drug whose research contained an unbelievable range of abuses get approval? Well, the FDA unanimously rejected the application for approval of E951 but when the President was elected, he appointed a new FDA commissioner who overruled the objections of his scientists. The head of the drug company went to work for the president on his transition team. How’s that for political skulduggery? Furthermore, this same commissioner went to work for the same drug company at the end of his tenure at the FDA.
So a drug, E951, with very poor scientific background, with reported toxicity, with known carcinogens as a by product of its breakdown in the body is unleashed on an unsuspecting and trusting public and will be incorporated into thousands of products used by almost every American.
Now for the reveal … E951 was actually approved in 1981! The President was Ronald Reagan. The head of the drug company was Donald Rumsfeld and the drug company was G.D.Searle. The FDA commissioner was Arthur H. Hayes who joined Searle’s public relations agency (Burson-Marsteller) as a senior medical advisor immediately after leaving the FDA (in 1983). You know E951 by its commercial name: Aspartame or Nutrasweet. Now you know the rest of the story.
If you really check out the details of the science you will never touch diet soda or a product containing Nutrasweet / Aspartame again. It does break down to methanol which turns into formaldehyde. It does trash your microbiome. It has indeed been the most reported food additive to the FDA. Research does suggest it causes brain damage and brain tumors. AVOID IT IN ALL ITS FORMS. Soda is the low hanging fruit of improving your health. Whether it’s the truly awful high fructose corn syrup found in regular soda or Nutrasweet in diet soda … you don’t need either one. Both are clearly bad for you and have nothing nutritionally redeeming about them. Just say no to soda and diet soda.
Until next month … get well … stay well.
Finally something new and exciting to talk about. Well it’s not actually new but its new to New York State. There is a company in Georgia that has been in business for over 20 years doing nutritional analysis and finally they have gotten clearance to do business in New York and that’s big news because this analysis could be fundamental to figuring out what’s wrong with you.
I do a lot of blood work … its one of the most important ways to access what’s wrong with you. We doctors check your thyroid, your Vitamin D, your liver and kidney function, your cholesterol etc. … but we have never before had the option to check your health at the cellular level. Never before could we check your amino acid levels, your toxins like aluminum, cadmium, mercury, lead, your omega 3’s, omega 6’s, oxidative stress, cell membrane components etc. all in one test.
Think of it this way. Your cells, the cells that make up your body —wherein all the chemical processes that keep you alive take place— are swimming in a pool of nutrients and chemicals. The question is … are your cells swimming in Skaneateles lake or are they swimming in Onondaga lake? Now for the first time we can actually measure these chemicals.
Your doctor knows about essential amino acids. Your doctor certainly knows about vitamins. Your doctor knows about chemical processes like the Krebs cycle. We all studied these pathways and processes. What we have not done is actually measure these nutrients in your body. We can now. We know the chemical components of these pathways. We know the composition of the cell walls and the mitochondria … but we have never before been able to see if your components are the right ones and the right amount. We can now. We can compare your own unique “recipe” with the gold standard “recipe” and the great thing is that we can adjust your recipe with changes of diet and use of selected supplements tailored to your specific deficiencies to approach the gold standard and when your recipe approaches the gold standard your health improves.
It’s really like a chemistry class. There are millions of chemical reactions taking place in your body continuously. Every chemist knows it is critical to have the right amount of the right ingredients to get a good product. Just ask Mr. White in Breaking Bad. Finally your doctor can order a test that tells us if you have the right amount of the right substrates for building health in your body.
How many people with chronic fatigue, malaise, or other chronic illness have been to doctor after doctor and found nothing actionable. “It’s your genes” or “it’s depression” or “its all in your head” are common rationale for not finding the cause of your illness. What if the real cause for your illness is some deficiency? Why not measure the measurable things and find out?
There are two issues with this testing which is called Cardio-Ion test and its offered by Genova Diagnostics in California. The first issue is that it’s not a cheap test. -But neither is an MRI or a Cat Scan. The cost varies depending on your insurance and deductible etc. With no insurance the cost is around $500 dollars. As of 3/19/2019 there were only 5 doctors ordering this test in New York. As I said it’s been around for over 20 years but only available in NYS since 2018. As one of the five current doctors ordering the test in New York I am still trying to get a firm price for my patients but you don’t have to come to me or one of the other doctors. Your own doctor can sign up to order the test. There is no charge to open an account or onerous paperwork to do so it’s not that hard for your health care provider to get set up to do this test.
The second issue is that the test is so specific, so detailed, that it will take your doctor some real effort to learn how to interpret it. The 11 page report measures the standard items like total cholesterol triglycerides etc. but also measures ferritin fibrinogen, C-reactive protein, insulin, testosterone, magnesium, homocysteine coenzyme Q10, 2 different measures of your vitamin E, limiting amino acids, branched-chain amino acids, essential amino acids, neurotransmitters and precursors, urea cycle and ammonia detoxification, aluminum, arsenic, cadmium, lead, mercury, zinc, copper, selenium, lipid peroxidase, DNA oxidative stress markers, polyunsaturated omega-3, omega-6, monounsaturated fats, saturated fats, and nutrient markers. It also measures cell-regulation markers, toxicants and detoxification and compounds related to bacterial or yeast/fungal origin. How’s that for a list!!?! So your doctor understands all these components but has never had to review them in this way so be patient with them. I was introduced to this test by Dr. Sheri Rogers and I actually pay her to help me interpret the results. Once I have done enough tests I will be qualified on my own but I have been impressed with how much information you can extract from this test. Dr. Rogers —like Dr. Gundry— believes that food, the right food, is critical to your health and they both believe that supplements are necessary to achieve the right “recipe” -(in part because we live in such a processed, inorganic world). These two experts from vastly different experiences and very different geographical locations both believe that only through lab tests can we really know the correctness of your “recipe” so to speak.
Do your own research. It’s your health and wellness after all. I think this testing will become standard practice as more and more doctors become familiar with it. The more exact science we can bring to bear on your health the better.
Until next month … get well and stay well.
Everybody and their brother is talking about the benefits of marijuana. According to cbdatwork.com recreational marijuana will be legalized in 2019 in New York State. Canada to the North of us and Massachusetts to the East have both fully legalized marijuana so it appears just a matter of time before its legal and available in New York State. Here’s an interesting bit of trivia … What was the first country in the world to legalize marijuana? The answer is a country in South America called Uruguay.
Let’s start with the very popular CBD oil. CBD oil is a legal derivative of the hemp plant that has some of the benefits of marijuana without the high. You can get CBD oil from well established outlets like Charlotte’s Web in Colorado … they even have dosing for your pets. Or you can get CBD oil from the local gas station and many places in between. The people selling CBD oil claim that it can help or cure many ailments … from insomnia, chronic pain, dyspepsia, arthritis, and chronic fatigue to name a few. I think CBD oil can help some people some of the time so I am all for trying it instead of more toxic drugs that your doctor or healthcare provider might prescribe. Benefits may be exaggerated but the likelihood of serious adverse reaction is low so the risk benefit ratio favors giving it a try.
Now medical marijuana has been legal for over a year now in New York State and it looks like recreational marijuana is on the horizon. I believe that marijuana is much safer than cigarette smoking and I believe marijuana is far safer than alcohol but that doesn’t mean is completely safe. All of the above, cigarettes, marijuana and alcohol and much more should be restricted from children. Most adults won’t be seriously harmed by pot. They might have issues with lack of motivation and concentration but there doesn’t appear to be a significant risk of lung disease, cancer, etc. with recreational use. Marijuana is touted as a treatment for chronic pain and insomnia, and the supposition is that people taking marijuana can and will take less sleeping pills and narcotics. Unfortunately, the literature and my personal experience as a Medical Marijuana Prescriber have not found that to be the case. Hey, even if it doesn’t cut down other med use, if it improves the quality of your life it’s a reasonable option to try. It’s no panacea but it’s also not opening up Pandora’s box.
However, one type of patient should probably avoid marijuana —medical or otherwise— those with a pre-existing mental illness … like depression, paranoia and schizophrenia. Research done by Alex Berenson has looked into the use of marijuana by people that are mentally ill. As you may be aware the THC content of marijuana has jumped from the historical norm of 2-3 % to over 20% from the modern cultivars. This increased potency can take a toll on patients with underlying serious mental illnesses. A January 2018 paper in the American Journal of Psychiatry found that people using cannabis in 2001 were almost 3 times as likely to use opioids 3 years later even after adjusting for other potential risks. Furthermore, studies have shown that people with schizophrenia are more likely to be violent under the influence of marijuana. Quoting Alex Berenson directly “Teenagers who smoke marijuana regularly are about three times as likely to develop schizophrenia, the most devastating psychotic disorder.” And, after an exhaustive review, the National Academy of Medicine found in 2017 that “cannabis use is likely to increase the risk of developing schizophrenia and other psychoses; the higher the use, the greater the risk.” There’s a lot more info about the connection between pot and mental illness elaborated in Berenson’s new book Tell Your Children: The Truth About Marijuana, Mental Illness, and Violence.
Now I am not into fear mongering but I am also not into the overhyping that accompanies any new drug or treatment. I guess that makes me a goldilocks guy … the middle road seems safest to me. Again, I don’t think marijuana is a cure all but it’s also not the work of the antichrist. -Caution should be used in patients with psychiatric issues.
Until next month … get well and stay well.
Protein shakes and paleo diets are all the rage right now but I’ve got to ring a cautionary note (if I may) regarding the excess protein in most Americans diets. My argument against excessive protein will be made both epidemiologically and scientifically. Don’t get me wrong there’s nothing wrong with protein but when it’s mostly animal-based protein vs. plant-based protein it’s more inflammatory and when I say more inflammatory I’m referring primarily but not exclusively to Insulin-like growth factor-1. IGF-1, like insulin itself, is designed to inflame you and induce growth. Unfortunately for most of us the growth is in belly fat and cancer and diabetes and this is not the right direction for your health.
You need protein. Protein is an essential building block of nutrition. Unfortunately when you eat more protein than your body needs it gets converted into sugar and then into fat. There is no significant way to store protein as energy. Your body stores energy as glycogen … a quick storage form and fat … the long term storage form of energy. This is simple biochemistry. You need fat in your diet. -Your brain is 60% composed of fat. How can cholesterol be evil and the cause of death dismemberment and destruction if we make cholesterol every day and people with a genetic deficiency where they can’t make cholesterol don’t live long. So you need protein and you need fat in your diet but too much of either is not a good thing.
Many people are starting to understand that the high carb diet recommended by the American Heart Association is dead wrong and in their effort to decrease the carbs they turn to protein (i.e. the paleo diet) which is low carb and high protein. You can lose weight on this diet, no problem, because you have eliminated sugar and thereby lowered Insulin which is the key to weight loss. So you can lose weight on a high protein diet but it may not be healthy for you in the long run. Too much protein can lead to weight gain, diabetes, cancer and heart disease.
Science wise, we have discovered mTOR … which is mammalian target of Rapamycin. This protein kinase is the ultimate controller of growth and destruction at the cellular level. High mTOR is important when you are a child and promotes growth but when mTOR is high in adults it promotes cancer etc. Excessive protein in the diet can stimulate mTOR. This excess protein is typically animal based which is high in methionine, an amino acid which directly stimulates mTOR. There is speculation that caloric restriction which has been shown to prolong longevity probably does so because of the restriction in methionine.
Let’s look at an epidemiologic study on protein in the diet. In 2016, researchers reviewed protein intakes of more than 131,000 women and men from the Nurses’ Health Study and Health Professionals Follow-up Study. After tracking their diets for up to 32 years, the authors found that a higher intake of red meat, especially processed versions (sausage, bacon, hot dogs, salami), was linked to a modestly higher risk of death, while a higher protein intake from plant foods carried a lower risk. This is a large study done for a long time in a population we are familiar with so it has to be taken seriously.
Broadly there are multiple reasons that more than a little red meat is bad for you.
#1 There is an increased cancer risk … primarily of colon and rectal cancer but also in premenopausal breast cancer. I am not a vegetarian but that group has a 40% reduction in cancer compared with us omnivores. Processing or cooking meat produces compounds known to be carcinogenic including heterocyclic amines (HCA) and polycyclic aromatic hydrocarbons (PAH).
#2 Meat consumption increases risk of heart disease and diabetes. As third world countries adopt a western diet … meaning more processed food and more meat… their risk of heart disease and diabetes increases.
#3 Eating meat increases risk of obesity. Cultures around the world with the greatest meat intake also have higher rates of obesity and this gets back to the fact that excess protein is turned into sugar and then into fat in the body.
#4 Meat represents the highest risk for foodborne illness. Sure romaine lettuce has taken a beating recently but it pales in risk compared to salmonella etc.
#5 Meat eaters have more atherosclerosis and this has an effect on their sexual performance and vegetarians have been shown to have better sperm quantity and quality. Maybe the hormones in the meat affect your sex life as well.
#6 It is estimated that 60 percent of all antibiotics sold in America make it into our livestock and this poses risks to all of us in terms of antibiotic resistant organisms etc.
We probably need half the protein we have been told we need. The old rule is 1 gram of protein for every kilogram of ideal body weight. So a 170 pound man weighs 77 kilogram and that means 70 grams of protein in the diet. The new understanding of protein metabolism says we need only one half that amount. If you are going to eat meat your daily portion should be smaller than a deck of cards.
Whey protein is made from dairy source and still as IGF-1 in it and is therefore not the best protein source. Pea proteins are better but still may be inflammatory for lectin reasons. Horses, the Great Apes and Elephants never touch animal protein and look how well muscled they are. I recommend if you really want to have a protein shake that you try hemp seed, flaxseed and spirulina as good sources of non inflammatory protein.
Until next month … get well … stay well.
Instead of harping on your usual holiday behavior of stuffing your face with whatever you want and using the excuse … ”its the holidays!,” I have decided to give you some gift suggestions that will improve the health of anyone you get the gifts for.
Let’s start with some reading material for those few of you and your friends that still read books. Of course there are YouTube versions of all these authors for those of you who have given up on reading. For me there is nothing like the print version that I can dog ear, markup and review again but I know the idea of a buying a physical book is fading like the memory of most 90 year olds.
First is a magnificent book on vaccines by Dr. Suzanne Humphries entitled Dissolving Illusions. I too thought that vaccines had saved more lives than any medication but after reading this book, and others, I now have a different view and so will you! Dr. Humphries was a practicing nephrologist (kidney specialist) when she started to investigate why her very sick patients were being given flu shots routinely when hospitalized and that changed her life forever. The book is not about her … the book is about the science and history of vaccination.
Second is another book by a nephrologist but this one focuses on diet. Dr. Jason Fung wrote Intermittent Fasting after watching one too many diabetic patients end up on dialysis after pill after pill did nothing to affect their disease progression. Other longevity specialists call it time limited eating but the basic idea is there is nothing easier or more straightforward than fasting to improve your health. Gluten issues? Try fasting. Money issues? Try fasting. Food allergies? Try fasting. Limited food choices? Try fasting. Fasting has been used for thousands of years to lose weight and improve your health. Dr. Fung lays out the when, where and whys in a very straightforward and simple manner. This book is not just for diabetics either. Anyone who has an interest in improving their health, their immune system, their mitochondria, etc. will benefit from this book.
Two other books I highly recommend are Dr. Thomas Levy’s Death by Calcium where he lays out the real cause of osteoporosis and details how dangerous calcium supplementation (other than through diet) may actually be. This book is not about his opinions … it is a scientific exploration of the actual effects of calcium in your body. If calcium supplements are as good for you as your health professional urges … why are drugs that block their effect so beneficial in dealing with hypertension and heart disease? The final book I recommend is by the great Dr. Robert Lustig who wrote The Hacking of the American Mind which lays out exactly why so many of us are addicted and depressed. It’s a fabulous read which will leave you very worried about the current health situation and future generations as well. We are doomed if we keep going down our current path but he lays out simple easy steps to reverse course.
For those of you less erudite let me recommend that instead of another sweater you consider a gift certificate this year … not to Dicks or Destiny … not that there’s anything wrong with that but what about a gift certificate for a massage for someone who works out all the time. A certificate for an hypnosis or acupuncture session for the person you love that still smokes or is in chronic pain. -That may be the gift that keeps on giving!
Finally, give the gift of time and yourself … spend some time volunteering … spend some time in the nursing home … spend some time with your wife … your kids … your aunt Em. Take someone you care about but don’t see that often to a show. Check out the great Desantis at the Palace show Sunday December 9th. Fabulous orchestra, great venue, local singing talent, holiday tunes and fresh popcorn. -How can you go wrong with that?!
Until next month … get well … stay well. Merry Christmas and God bless us every one!
I am not controversial by nature or training but I can’t run from a fight either. It pains me greatly when I read that the American Heart Association still, to this day, in spite of all the published and well researched information is still telling people to avoid saturated fats. Despite a mountain of evidence their recommendations about diet have not changed and they still recommend corn oil and canola oil. Forget “I cant believe its not butter.” I cant believe an organization entrusted with your health would continue to give out terrible advice … advice not based on science or research.
If I am going to take on the AHA I have to come correct as we say in the hood. First I would tell you to check out YouTube videos by Nina Teicholz who has written extensively about this and her book The Big Fat Surprise is quite the read. I am not going to talk about my 30 years experience as a primary care doctor. I am not going to give my my opinion, I am not going to bring you my personal research. -I am going to share with you the obvious research that your own doctor should know … research that has been widely published and widely reported but ignored because it departs from the party line. Fat bad … clogs the arteries … carbs good … get most of your calories from that source. -Saturated fats very bad avoid at all cost. All of this is wrong. Let’s start with the basic fact that saturated fat is found aplenty in breast milk and we know how toxic that substance is!
The largest and latest study to look at high carb versus high fat diet called the PURE study demonstrated that high carb diets were bad for your health and high fat diets were good for your health. Another study PREVIMED also showed that high fat diets like the Mediterranean diet were much healthier than the standard high carb American diet. But those two individual studies are not enough to convince you so lets tally a little more evidence with 5 separate studies.
Let’s start with Hooper L, et al. Reduction in saturated fat intake for cardiovascular disease – Cochrane Database Systematic Review, 2015. The Cochrane Database is considered one of the finest independent panels to review medical issues. This study involved 15 randomized controlled trials with over 59,000 participants. The conclusion was that “People who reduced their saturated fat intake were just as likely to die, or get heart attacks or strokes, compared to those who ate more saturated fat”.
Next up is a study by De Souza RJ, et al. entitled Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality, cardiovascular disease, and type 2 diabetes systematic review and meta-analysis of observational studies – BMJ, 2015. The British Medical Journal is not some obscure publication. The data included 73 studies, with 90,500–339,000 participants for each endpoint. Their conclusion: People who consumed more saturated fat were not more likely to experience heart disease, stroke, type 2 diabetes or death from any cause, compared to those who ate less saturated fat.
Next up is a study by Siri-Tarino PW, et al. Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease – American Journal of Clinical Nutrition, 2010. The studies included a total of 347,747 participants, who were followed for 5–23 years. Conclusion: This study did not find any association between saturated fat intake and cardiovascular disease.
Then we have the much published Dr Chowdhury R, et al. Association of dietary, circulating, and supplement fatty acids with coronary risk: a systematic review and meta-analysis – Annals of Internal Medicine Journal, 2014. The Annals is also another mainstream medical publication. The study included 49 observational studies with more than 550,000 participants, as well as 27 randomized controlled trials with more than 100,000 participants. Conclusion: People with higher saturated fat intake were not at an increased risk of heart disease or sudden death.
Finally, we have Schwab U, et al. Effect of the amount and type of dietary fat on risk factors for cardiovascular diseases, and risk of developing type 2 diabetes, cardiovascular diseases, and cancer: a systematic review – Food and Nutrition Research, 2014. Participants included both people who were healthy and those with risk factors. This review included 607 studies; randomized controlled trials, prospective cohort studies and nested case-control studies. Results: Consuming saturated fat was not linked with an increased risk of heart disease or an increased risk of type 2 diabetes.
What does this all mean to you? The very simple take away message is that butter and olive oil, avocado and coconut oil are very good for you and corn oil, canola oil, safflower oil, sunflower oil and all the other processed oils etc. are bad for you. Since they are not saturated they are MORE liable to be oxidized than the saturated fats … and oxidation is bad for you. It’s not about your cholesterol level it’s about how oxidized your cholesterol is and that is controlled by your diet. The second take home message is that any oil in any frier in any restaurant is bad for you because the chemicals that are created when you heat these oils are super bad for you but that’s another article right there. Google it in the meantime.
It’s time again to challenge your health care provider … what are their recommendations about saturated fats? … are they following the party line? That’s easy but it’s wrong. What evidence do they have besides the unsupportable recommendations of the AHA? Look into who funds the AHA if you want to see why they haven’t updated their recommendations. Do your own research. … Its your health after all and what’s more important than your health? Sure there is some crazy stuff on the internet but its a powerful tool and available to everyone. It’s way past time to just trust your doctor. Partner with your health care provider to focus on your wellness. … Look past your illness and regain your wellness … more on this topic next month.
Until then … get well … stay well.
Failure…biggest loser… double failure if you want to be technically accurate. I don’t think I brag about my successes ( maybe I just haven’t had that many ) but I am not afraid to share my failures. If you are looking for some hard core medical advice …skip this column..this is an article about my recent experiences. I share them for one reason , if you get to know me better you may actually start to trust my advice . I take some alternative views to dairy, vaccines, statins, and in general our medication oriented practice of medicine. . Of course I don’t really want you to trust me…I want to serve as an instigation into your own research. Its your health, it’s your life…don’t you want to make informed choices? Well here’s two recent examples of my personal failure . Know me better and perhaps believe me more when I write about something medical I have researched.
I practice brazilian jiu jitsu and of course recommend it as great exercise, great mental discipline and fun. I work out at Inner circle BJJ in solvay with a great group. I did karate for years but when this style became available there was nothing else for me. I have taken classes for years but being a beginner in this sport is really not easy and it takes a while to really start to get good at it…at least for me. Once the dojo moved closer to me my attendance and therefore my understanding improved. BJJ has been described as wrestling and chess mixed together. I have no illusions , I am a 60 year old blue belt ….most other people would have long ago quit or have gotten better and received their black belt. Well, I was buoyed by a recent win at a tournament in New Jersey and signed up for the Worlds Masters BJJ tournament in Las Vegas . A weekend in Vegas is never a bad deal but i was way too nervous to enjoy anything at all until after my competition. The long and short of it is I lost in my first bout. Specifically I started a standing guillotine choke ..we transitioned to the ground with my opponent in a better position. It took me a while to slowly reverse and come out on top but I got caught in a triangle choke. I had to tap out. Now you could say, I spent a lot of time and money and energy doing this sport for years and years and we come all the way out to Vegas for me to lose so quickly. Thats not me. Sure I was pissed about losing especially in front of my wife but how long can you pick at that sore before moving on. I went back to the dojo where Professor Walt had already seen my video and we started working on my deficiencies..and there remain plenty but I am just starting now as a blue belt to conceptualize the positions and then of course to use the right move and the right timing . I guess I didn’t take that loss too personally because I get beat all the time by my teammates …It’s just that most of them are half my age and I hoped going up against some other 60 year old guy would be easier.
Not so , it turns out. My sweet Debbie tried to console me…..”Look honey, how many men are there out there that are doing this kind of stuff…and how many are doing it at your age..you should be proud.” I couldn’t hear her because I was muttering loser city, loserooni, loser , failure, loser. But after all it’s Vegas and we were soon distracted.
That’s failure number one. Much time and effort went into this endeavor only to result in failure. Doesn’t faze me. I will learn from my failure.
Failure #2 is another insight into where I am coming from. Again, if you know me a little you might be that much more motivated to instead of just reading my recommendations.. to actually take action…. look into the sources I reference repeatedly. Drs Gundry, Attia, McDougal, Patrick, Mercola, Sinatra etc. Will my sharing my failures translate into you taking me more seriously or less?
Well, failure #2 involves a recent climbing trip in the North Cascade range in the state of Washington. It was climbing with the Haswell boys again. Another long weekend…another peak attempt. We have a great history of what were for me in many senses of the words breathtaking escapades…You have to be in very good shape to take on a Haswell hike and you can be guaranteed to be brought to your physical limit and don’t get me going about facing my fear of heights. We attempted Prophets peak…not a 14,000 or 13,000 foot peak like we have focused on in the past…so the lower elevation should have made the climb easier but the complication was the greater than 5000 foot elevation gain to do in one day. This is one day after the 10 mile hike up 1600 foot elevation with full packs on to base camp. This area isn’t like your local parks with well marked trails …the guidebook says …go uphill after the stream…there is no path just find your own path of least resistance. Ok ..sounds kind of zen like but in actuality it’s going straight up a 30 degree slope covered in huge fallen trees and scrubby brush….3000 feet of this to get to a class 4 pitch ( my translation..no technical equipment needed but if you miss a foot or hand hold you could get badly hurt or die. ) After this , a talus field of stone for a thousand more feet..again…straight up. I made it 4000 feet up this 5000 footer and just couldn’t keep going. . ..I gassed. I bonked. I could go no further . Five hours of continuous climbing in the Haswell manner (non-stop) and I was done. I had been soaked in sweat for hours and had probably done more elevation than on any other trip but I was still over 1000 feet from the summit. The Haswell boys pressed on to the greater glory and summiteed a peak reportedly rarely done . I waited on the mountain side below and we retraced our steps back to camp. We started at 730 am and got back to camp at 730 pm…They summited. I did not. They succeeded I failed. Failure again. For the second time in a month. I thought my conditioning was pretty good but it obviously wasn’t Haswell quality. If I cant talk myself out of another grueling trip next year I am going to really work on my conditioning. I am not usually the limiting factor in our climbs but I sure was this time.
As I sat there in the meadow , waiting for them to climb down to me after peaking I was cursing Pete for leaving me the smoked cheese instead of the cheddar..who does that ! As I waited shivering a little from dehydration, I looked out across the valley at a vista of peak after peak with glaciers …old growth forests and clouds just above..wildflowers and wild little blueberry bushes with berries all around me Yes, this is failure but look where I am.! Agian how many other people are even doing this. I guess the sporting slogan is “you’re still in the game” .
So you know I preach about you addressing your diet and exercise,sleep and stress in my medical pulpit in my office, on the radio show and in these articles. Hopefully this article gave you a glimpse that I practice what I preach. Its your health, it’s your healthcare dont sit back and be passive. Take control of your health by focusing on diet and exercise, sleep and stress…make a plan with your doctor / life coach /trainer and meet frequently enough to monitor your progress and achieve your goals. You have to be proactive. Your doctor is adept at managing illness ..that’s how we were trained…you must manage your wellness….and this you know begins with your diet. Your health is tremendously affected by your diet. You all know that but you ignore it until the illness sets in and you focus on that. Focus on more salad and less processed food and turn your health around. Don’t look for improved health from any pill…look to your dinner plate.
Until next month…. get well stay well
My friend Stan wanted me to write more about collagen but I need to get back to even more basic science. The science of DNA ? the strands of life. Most of us have 23 pairs of chromosomes which contain all the details about the care and building of the human body. If your DNA gets screwed up ? you are screwed up. Mutations in DNA are one way that cancer forms in the body. On way to assess the health of your DNA is to assess the health of the system that maintains the DNA integrity. At the end of each strand of DNA is an endcap called the Telomere. telo = end ? meros = part ? telomere = end part of DNA.
These short nucleotide sequences (TTAGG for you purists) maintain DNA health. Think of it like the aglet, that little wrapper at the end of the shoestring that keeps it from unraveling.
This is no idle speculation. A nobel prize has been won by Professor Elizabeth Blackburn PhD. Her work has conclusively shown that there is a relationship between telomere length and health ? telomeres shortness is associate with just about all major disease of aging. The shorter your telomere the more disease. Of course this Nobel prize winner runs a commercial lab that will measure your telomeres ? hence your ?DNA age? not your apparent/ chronological age. You may be 50 years old but have the ?DNA age? of a 40 year old or a 60 year old. Wouldn?t you like to know your DNA age? Well there are multiple companies that offer this testing but you can?t get the tests done in New York State ? that would sound fishy but there are a large number of well quantified tests that New York State does not allow including biome testing etc. Forgive me, nitpickers ? of course New York State will allow it ONCE you fulfill all the regulatory hurdles. Do they appear to have more regulatory hurdles than any other state in the union? Lets just say that there are multiple companies that can offer this testing but not currently in this state.
So besides the Nobel Prize winner, who has a financial interest in this field so may not be impartial. Who else is confirming this science? Well, Professor Richard Cathorn writing in the Lancet in 2003 involving a small study of 143 people age greater than 60 years followed for 15 years. Shorter telomeres equal shorter survival. Also Dr. Rodrigo Calderon M.D. PhD wrote in the New England Journal of Medicine 2009 that Telomere dysfunction seems to underlie the development of a range of human genetic degenerative aging diseases and cancer In a study sponsored by the American Heart Association and published in 2008 they had 780 patients followed up for 4.4 years. Patients with shorter telomeres had twice a risk of death as patients with longer telomeres.
Another study done in Sweden on 175 swedish twins showed that the twin with the shorter telomeres had a 2.8 times greater risk of death. So short telomeres bad and long telomeres good. Telomeres shorten with age naturally in a slow predictable pattern. What else can shorten and lengthen telomeres?
I know you Americans, you don?t want the details ? you just want to know if there is a pill you can take to lengthen your telomeres and thereby lengthen your life. Well there just might be ? but follow me through the risk factors first.
Shorter telomeres are associated with earlier death and stressors including PTSD, stress employment and work schedule childhood institution or trauma depression pessimism phobic anxiety and hostility, poor sleep quality and sleep apnea, low physical activity, smoking cigarettes, migraines, all types of heart disease, including hypertension, MI, atherosclerosis, aneurysm, carotid artery disease and stroke.
What is associated with longer telomeres? Younger age female gender, increased paternal age of birth, increased physical activity, smaller waist circumference, normal BMI, Mediterranean diet, dietary fiber calorie restriction, vitamin D, vitamin E, vitamin C, glutathione, and hormones. Dr. Dean Ornish has a diet based program to reverse heart disease. Studies show that his program could increase telomerase, as well as meditation, and TA 65 activation supplement.
So exercise and supplements and a righteous diet have been associated repeatedly with longer telomeres and longer telomeres are associated with better health. Sounds like from the above list you could work on multiple risk factors that impact your telomere health.
If you have been reading carefully you should be asking ? what?s this about TA 65 activation supplement? Well there is a well known enzyme that works to promote telomere health/length. Telomerase is a natural enzyme that helps to extend telomeres, it was discovered in 1985. When telomerase is activated it adds DNA bases at the end of the chromosomes and allow cells to live longer and revert to a more useful phenotype. Super bonus round ? it preferentially extends short telomeres which are the most dangerous. It is active throughout embryogenesis but then stops of birth.
Turns out there is a Chinese herb ( isn?t there always?) that has been shown repeatedly to increase telomerase activity and has been shown in both mice and humans reliably to lengthen telomeres while you take the supplement. What we don?t know ? and it?s a big what ? is if this ? natural? lengthener really translates into important clinical results like living longer or less cancer or better overall health etc. It?s very intriguing but way too early to take action with some supplement until you have done everything else you can do ? Mediterranean diet, exercise, better sleep, stress reduction, quit smoking, normalize body weight, etc. I will get a lot more excited about this when I can actually order the test ? make some changes ? or have my patients make changes and repeat the test to assess whether the intervention made a difference. .
Soon hopefully you can get a Four pack of tests that will assess your health better than the many tests your current doctor is doing.
1. Gut biome
2. Telomere length
4. Antioxidant scan
The first two are held hostage to bureaucracy for now. The third any doctor can do and the fourth test is available if you ask around.
Unfortunately if you take this list to your current doctor they will look at you like you are a mental patient (and I think we are all mental patients) and mock you for falling for some internet chat site pseudo science. However if you had the time to sit and talk about any one of these issues they would eventually COMPLETELY agree that each one is important. Even a doctor who hasn?t opened a medical journal in 5 years must have heard something about the important work being done on understanding the bugs in our guts and how they may control our weight, our mood, our immune system etc.
Your doctor may know nothing of telomeres but a two minute search of the internet will bring them up to speed. Every doctor alive knows about Insulin but most don?t look at it as a marker for inflammation but that is also something they can relate to once they start to look closer at the inflammatory processes in the body ? and finally everybody talks about antioxidants. Turns out there is a machine that can reliably measure one of them (and they travel in packs like wolves). There is a cheap machine your doctor can lease / buy that will allow him to scan you and give you insight into this one antioxidant but suggests your overall antioxidant status. The problem is the scan is not covered by insurance and most doctors stop right there thank you very much.
I am not looking for business ? certainly not your business, but it pains me that this scan is not more readily available. The science is very solid and the tech is simple and reliable. So, If you are interested I will scan you for a $10 donation to Wanderers Rest Pet Rescue, Hope for the Bereaved, Helping Hounds, Clearpath for Vets, or Father Champlin?s Guardian Angels. Call 410-0651 and we can make it happen. It?s no additional charge. Its not an office call ? its a quick scan, say hello and comment on the scan and off you go.
I think it?s an interesting and exciting time to be a healthcare provider. The focus on longevity is interesting and once we can measure your telomeres we will have one more tool to assist you in your efforts to maintain and improve your health.
Until next month ? get well ? stay well.
JOINT JUICE ANYONE?
For once I am writing about something non controversial…or at least less controversial than arguing about statin drugs, proton pump inhibitors, calcium supplements, dairy and vaccines. This months article is about a supplement that could help you look and feel younger but presents no danger of overdose ..that product is collagen.
Collagen comes from the greek word for glue…kolia…There are twenty eight different types of collagen and this protein is found throughout the body in the bones, skin, teeth , joints and blood vessels… most of this is type one collagen, type two is in the cartilage…type three is the mesh around your intestines etc….type four is found in your respiratory tract….and type five collagen is found in hair and cell surfaces.
Now the problem with collagen is that we lose it over time. Starting as young as 20 you start to lose collagen as you age. You can supplement with collagen and maybe offset some of this natural loss. We get collagen from chicken, bone marrow, fish skin,the hides of animals, etc..Remember you need the vitamin c to use collagen properly so if you are going to supplement with collagen you should be taking vitamin c as well. Also you need acid in your stomach so if you are taking a ppi…like nexium or prilosec …which you know i think you should not be taking chronically …if you are taking this class of drug the collagen will not be absorbed. Collagen needs to be taken on an empty stomach for best absorption.
Collagen is rebuilt on a constant basis in your body .Collagen is broken down into fragments which contact collagen production cells and stimulates production of more collagen. Starting in your twenties the stimulation of production slows down. This low collagen production may affect skin and joints…the collagen supplements serve not to replace the collagen in your body but to stimulate collagen production. Collagen has a typical amino acid protein configuration which is hydrolyzed in processing which makes the protein fragments shorter and easier to digest.
What is collagen supplementation good for? Well it’s clearly good for your skin…biopsy proven research has shown that collagen supplementation improves markers of aging in the skin. There have been lots of independent studies looking at this and the results show consistent improvement in skin parameters.
But that’s not all…multiple studies show that collagen …specifically type 2 collagen that’s found in cartilage tissues has been shown to decrease the pain of arthritis especially in the knees and in one recent study appearing in the international journal of medical sciences, “f our out of five osteoarthritis sufferers who took a daily 40 mg oral dose of undenatured type-ii collagen (“uc-ii”) experienced less pain, and their pain dropped by an averag e of 26%.”
Even as far back as 2006 a study done in athletes came to this conclusion. “ This was the first clinical trial of 24-weeks duration to show improvement of joint pain in athletes who were treated with the dietary supplement collagen hydrolysate. The results of this study have implications for the use of collagen hydrolysate to support joint health and possibly reduce the risk of joint deterioration in a high-risk group. Despite the study’s size and limitations, the results suggest that athletes consuming collagen hydrolysate can reduce parameters (such as pain) that have a negative impact on athletic performance.”
Collagen is also important for your gut health…It contains lots of glycine and glutamine ..similar to levels find in bone broth. Both of these proteins support the good bugs in your gut.
The only downside to collagen supplementation is that depending on the source the supplement may contain too much calcium but this is something a routine blood test can check out for you.
So, if you want to improve your skin try collagen types 1 and 3 which are usually found together. If you want to ease your joints you want collagen type 2. The nice thing about this supplement is you should notice the benefit within a month. Why not give it a try and see for yourself.
Until next month…get well …stay well
J T Barry MD
Flu For You?
Its February and thats VaIentines day and I should be writing about your love life but I have done that plenty of times in the past and it’s time for another issue altogether. It’s a little late in the season but knowledge comes to me when it comes and when it comes to me it comes to you… after I have done my due diligence. I’m hoping to do an article that’s not controversial someday but every time I read a new book or review a medical issue I feel compelled to write about it . This time I take on the flu shot. Everyone should get a flu shot is what we are told. Children from six months and older should get the shot. Pregnant women should get the shot. Grampa especially needs the shot. The flu shot is safe and effective.
Well, that’s the party line but I am crashing the party. Yes I know many of you think I am off my meds. Just some crazy fringe doctor who has lost his way. I have said we take way too many pills including statins. I have written that milk is really not good for you at all. I have recommended a crazy diet that eliminates sugar and wheat and dairy to lower your inflammation. Now I tell you that the flu shot should be avoided. Thats right… The flu shot is neither effective nor safe and the data comes right from the Supreme Court, the Centers for Disease Control and major publications including the prestigious Cochrane Review. Thats right not the musings of this crackpot physician who is oppositional , straight facts, facts from the major literature that you can easily snopes or fact check on the Internet.
Let’s start with the safety issue first.. The Supreme Court has ruled in 2011 that vaccines are “unavoidably unsafe.” Ask your doctor as he is draws up the solution from the vial… is this safe? If it is why does the Supreme Court say its unavoidably unsafe.. That should start an interesting conversation and you will probably be labeled a kook just for asking that question. Depending on the manufacturer and the specific vaccine the vaccine can contain mercury, formaldehyde, aluminum, polysorbate 80, cell lines from aborted fetuses, tissue from hamsters, dog kidneys, monkeys, peanut oil adjuvants and much more. I will have more to say on mercury and aluminum in other writings but everyone in power says thimerosal is safe and does not cause autism etc. Why then does the FDA say there is no safe dose of mercury exposure?. Why then have the manufacturer’s made such efforts to get the thimerosal out of the vaccines?
Adverse reaction to the flu is one of the leading causes for payout from the Vaccine Injury compensation Program. This program was established when the Supreme Court said vaccines are unavoidably unsafe and you can’t sue the pharmaceutical companies but you can appeal to this court if you feel you have been injured. Over 3.5 billion dollars has been awarded by this court.. and flu vaccine awards are among the top listed. So how are they safe. We know that one particular flu shot lead to cases of narco lepsy. Who would have predicted or expected that ! Flu shots are given to pregnant women even though they are labeled pregnancy category B or C. (meaning no real testing has been done on pregnant women) The CDC itself reported that there has been an increased risk of miscarriage with certain flu shots. One uncommon but well known risk of the flu shot is Guillain Barre which is an ascending paralysis ! Hows that for safe !
Let’s turn now to the efficacy side of safe and efficacious. The Flu shot is indicated per the CDC for all kids 6 months of age or older , all adults, pregnant women and seniors. There has never been an efficacy study in pregnant women. The Cochrane Review is an independent board tasked with independently reviewing published research on medical issues. They concluded that there was no evidence that flu vaccine protected any children between 6 months and 23 months. CDC says do it but this independent panel , looking at published studies, says its not effective. The CDC says the elderly are most in need of the flu vaccine due to their underlying chronic illnesses etc. The Cochrane Review says there a review of 75 research studies over 40 years said due to the poor quality of the available evidence any conclusions regarding the effectiveness of influenza vaccine for people over 65 years of age are suspect. Furthermore influenza vaccines have a modest effect in reducing influenza symptoms and working days lost. There is no evidence that they affect complications, such as pneumonia, or transmission.
Furthermore from the Lancet volume 7 issue 10 october 2007 “Recent excess mortality studies were unable to confirm a decline in influenza-related mortality since 1980, even as vaccination coverage increased from 15% to 65%. The remaining evidence base is currently insufficient to indicate the magnitude of the mortality benefit, if any, that elderly people derive from the vaccination programme.” We went from vaccination very few people to vaccinating most people and there was no evidence of less deaths !
Finally again referencing the Cochrane Review …”Vaccination of healthy adults only reduce risk of influenza by 6% and only reduce the number of missed work days by less than one day. Universal immunization of healthy adults was not supported by the results of this review”.
So…. maybe not so safe… maybe not so efficacious.. why the big push to immunize everyone ? Well the lady doctor who took over the CDC’s vaccine Julie L. Gerberding, MD, MPH. went to work for Merck ( one of the largest vaccine manufacturers in the world) when she left government service. Immediately after working for the CDC. Since then she has cashed in Merck stock valued at approximately 2 million dollars and still has more stock with a cash value of almost 2 million dollars.
Well, I will still give you a flu shot if you ask but I won’t offer it up as safe and effective anymore and I probably should apologize for the glib way I gave out shots in the past. What can I say except I have kept an open mind and am continuing the process of self improvement and there is obviously more progress needed.
Until next month… get well ….stay well
Dr Joe Barry
START THE YEAR MILK FREE
As I have been studying diet and nutrition over these last months I have encountered multiple controversies….How much protein should you eat?…How many carbs are good for you? How many and what types of supplements should you take? What constitutes the right amount of protein versus carbs or fats for your diet? The one thing that unfortunately has become clear..the one thing that the disparate experts can agree on is that we are taking in too much dairy. I say unfortunately because dairy is big business in central new york and I really don’t want to spearhead this message. I am not by nature a controversy guy. I am not by nature a guy that needs attention except from my wife. But the message about dairy is so clear and compelling I must bring this to your attention. To not bring this to your attention would be wrong.
Remember now that I am a regular primary care doctor…I am not a chiropractor. I am not a naturopath. I am not a complimentary doctor. I don’t operate at the fringes of medicine. But I do have time to do basic nutritional research and as your doctor will admit we got precious little exposure to nutrition in medical school. Unfortunately this is still true today. I know I am not going to make any friends with this information but you have to know what I know.
Milk can be a lifesaving source of nutrition if you are malnourished. Milk is packed with minerals and proteins and good fats . That doesn’t change the fact that cows milk is for baby cows. Let me quote Dr Frank Oski former Director of Pediatrics of Johns Hopkins University..”There is no reason to drink cows milk at anytime in your life. It is designed for calves not humans and we should all stop drinking it today”. Dr T Colin Campbell from Cornell University…Dr Gundry, Dr John Mcdougall, Dr Breseden, Dr Klepper, Dr Gregor….these are all big names in the nutrition field…they disagree on many nutritional points …but all of them believe we should stop dairy.
First….cow’s milk is not human breast milk…it contains lots of proteins…too many proteins designed to make a baby cow grow…these same proteins cause inflammatory responses in the body that contribute to type one diabetes, arthritis, a host of bowel problems etc. That’s right…giving babies cow milk can cause an inflammatory response that causes type one diabetes. Why believe me? What do the “real ‘ experts say? “Early exposure of infants to cow’s milk protein may be an important factor in the initiation of the beta cell destructive process in some individuals.” and “The avoidance of cow’s milk protein for the first several months of life may reduce the later development of IDDM or delay its onset in susceptible people.” (The American Academy of Pediatrics Work Group on Cow’s Milk Protein and Diabetes Mellitus – 1994).
Second is that there is a lot in cow’s milk besides water ,minerals, protein and fat. Milk contains a lot of pus ( that’s white cells )…hundreds of thousands o f pus cells per milliliter of milk. Also in milk are bacterial cells, traces of pesticides, contaminants like blood and feces, antibiotics, and hormones..lots of hormones. These are not removed by pasteurization.
Third it’s the presence of these hormones that accelerate growth ..they are designed to accelerate growth in calves….they are not designed for humans…and may accelerate the growth of cancer. There has been a strong link between milk consumption and prostate cancer And this could be related to either all the estrogen in the milk ( which may account for the feminization of America) or the presence of Insulin LIke Growth Factor. Some people feel ILGF is a major promoter of cancer growth. You know I believe insulin is an anti longevity agent. The more insulin in your blood the less healthy you are. The more insulin in your body the fatter you are. The more insulin in your body the more likely that cancer is promoted. So why would you drink milk if it contains some insulin like protein?
Fourth is that milk absolutely does not make strong bones. When the dairy industry started advertising that “milk makes strong bones” the Federal Trade Commission asked the USDA to review the facts and they found that milk does NOT make strong bones…furthermore the independent panel found that milk might contribute to heart disease, no improvement in sports performance, possible prostate cancer link, multiple gastric issues etc. The countries in the world with the highest milk production have the highest fracture rates.
Fifth is the issue of Bovine Leukemia Virus and Bovine Immunodeficiency Virus…that’s right cow AIDS …Remember mad cow disease? The USDA found in 2007 that 80% of herds had the BLV infection and antibodies to the infection were routinely found in the milk. Some cows had both infections at the same time. How can drinking milk from a sick cow be good for you.
So there are a host of reasons to avoid milk and there are plenty of alternatives. Almond milk, and coconut milk to name two…avoid soy milk..it’s too proceeded and contains too much estrogen. My advice is to avoid all milks altogether. “What do I put on my cereal ? “ I am often asked….my answer is simple…avoid cereal as well…It’s all processed sugar….all of it. You have heard me say many times if you really want to get healthy skip breakfast altogether. It is absolutely NOT the most important meal of the day.
Taking soda machines out of the schools was a good idea…the next step is removing milk as well. It’s not good for kids either. Water, precious clean water that you take for granted should be your fluid of choice.
Well, I want to discourage Americans from drinking milk but I don’t want to hurt the dairy industry. Of course I have an answer to this problem…export the milk to other countries. Milk might be completely unnecessary in America where we have a cornucopia of nutritional choices but would be a lifesaver in developing countries where diarrhea and malnourishment are very serious health concerns. Exporting the milk would help the Dairy Industry, would help the trade deficit, and would benefit the health of the malnourished worldwide. Maybe we start with North Korea….wouldn’t that be great if we could break the North Korean crisis with humanitarian aid in the form of milk? Someone tweet President Trump ! That’s how I roll ..win win..win.. Until next month….get well …stay well – Joseph Barry MD.
Osteoporosis is big business in America and rightfully so. Falls with fractures are a leading cause of disability and death. Osteoporosis means Òporous bone. Ó Viewed under a microscope, healthy bone looks like a honeycomb. When osteoporosis occurs, the holes and spaces in the honeycomb are much larger than in healthy bone. Osteoporosis is responsible for two million broken bones and $19 billion in related costs every year. By 2025, experts predict that osteoporosis will be responsible for approximately three million fractures and $25.3 billion in costs annually. Many different underlying conditions cause osteoporosis but the biggest risk factor is advancing age. There are obvious differences in the prevalence of osteoporosis between men and women and different ethnic groups. Asians appear more susceptible than white people who appear more susceptible than black people. Obviously women have a lot more trouble with osteoporosis than men. Osteoporosis is an issue in some very old men but most very old women.
Along the unfortunate causes of osteoporosis are prescription and nonprescription drugs including things like heparin, lithium, methotrexate, anti seizure medicines like Dilantin and phenobarbital, selective serotonin reuptake inhibitors such as Lexapro, Prozac, and Zoloft Proton, pump inhibitors such as Nexium and Prevacid and Prilosec. Also, thyroid hormones in excess and aluminum containing antacids to name a few. Also autoimmune disorders, rheumatoid arthritis, lupus, ankylosing spondylitis and multiple sclerosis of all been associated with osteoporosis. Likewise celiac disease and weight loss surgery have been associated with osteoporosis as well as leukemia, lymphoma, multiple myeloma and sickle cell disease.
Rounding off the list of diseases that can cause osteoporosis include diabetes, hyperparathyroidism, hyperthyroidism, and cushingÕs syndrome. Also to blame are menopause and low level of testosterone and estrogen. Strokes, ParkinsonÕs disease, spinal cord injury and multiple sclerosis as well as depression and eating disorders are also associated with osteoporosis. Finally, chronic obstructive lung disease, chronic kidney disease, organ transplants, post polio syndrome, poor diet and weight loss have also been associated with osteoporosis. Smoking probably is a risk factor for osteoporosis as well.
Now you go to the doctor and have an x-ray done that shows osteoporosis. This is the classic way of evaluating people. You could have an x-ray of your ankle but the best scan to do is the scan the places where the important fractures occur. Dexa scans (the low dose x-ray test to evaluate for osteoporosis) are the ones that I prefer to do because this is where the action is. No one suffers long from a fractured ankle, not the same way people do with a fractured back or broken hip. Since the dangerous fractures occur in the back and in the hip thatÕs where the testing should be done. ItÕs an easy, fast and painless test usually covered by insurance.
Now once the doctor establishes a diagnosis of osteoporosis you have options and most of the time that includes taking a bisphosphonate like Fosamax, Actonel, Boniva, or Reclast. You can also use different classes of drugs like Evista or Prolia to treat osteoporosis. Weight bearing exercises can increase bone density and should always be recommended.
So there are some high tech drugs that are available to treat thinning bones. Most gynecologists and primary care doctors recommend calcium and vitamin D supplements but the evidence behind this recommendation is very poor and calcium supplementation in particular has not been shown to affect bone health. Go ahead and google it. I wrote to the gynecologist down the street about why he was still recommending calcium supplements and I sent them several articles that addressed the issue but I am still waiting for a response. I regret that doctors today donÕt have the time and inclination to educate each other É Its what we used to do before we were so busy filling out those insurance forms or trying to work with the electronic medical records.
I think before you take any prescription meds you would do well to look to the supplements that affect bone health É namely vitamin D and vitamin K2. You have heard of vitamin K but youÕre usually thinking of vitamin K1 (phylloquinone), which is found in plants with leafy greens etc. whereas vitamin K2 ( menaquinone ) is found in animal fats and fermented foods but also found in eggs and cheese. I donÕt think many people know about vitamin K2. The main function of vitamin K2 is to modify proteins to give them the ability to bind calcium. Multiple studies in vitamin K2 have shown improvements in bone related mineral density. Several of these trials also reported fractures and found that vitamin K2 reduce spinal fractures and hip fractures and all non spinal fractures by a greater amount than any of the other drugs listed above. Vitamin K2 is also produced by bacteria in the large intestine and there is some evidence that repeated antibiotic use can contribute to Vitamin K2 deficiency. Luckily you can buy Vitamin K2 at the drugstore. The U.S. Food and Drug Administration (FDA) has not approved any form of vitamin K for the prevention or treatment of osteoporosis. There simply havenÕt been enough trials to inform our recommendations.
I would If I had osteoporosis or osteopenia ( a milder form of osteoporosis É call it osteo lite! or pre – osteo ) Regarding vitamin D deficiency; it is rampant. It is very hard to take too much vitamin D despite it being fat-soluble. We see literally hundreds and hundreds of patients with vitamin D deficiency and I have seen no-one with vitamin D toxicity in many years and we check Vitamin D on everyone! I usually recommend at least 5000 international units of vitamin D3. From the Medical Dictionary ÒVitamin D3 is synthesised in the skin after exposure to ultraviolet light; ( sunlight) in contrast, vitamin D2 is obtained only from the diet. Both vitamins D2 and D3 are metabolised to 25-hydroxyvitamin D in the liver, and then to the active 1.25 dihydroxy form in the kidney. Vitamin D has a major role in the intestinal absorption of calcium, bone calcium balance and renal excretion of calcium. Ó So just being exposed to a lot of sunshine is not sufficient alone to get a therapeutic vitamin D level. Treating vitamin D deficiency should be your first response if you have been told you are osteopenic or osteoporotic. Finally a word on calcium supplements. Calcium is important for bone health but taking calcium supplements has not been proven to be beneficial. I know I get a lot of flak from the gynecologists when I bring this up but trial after trial has failed to demonstrate that calcium supplementation in the form of calcium carbonate etc. has been significantly beneficial to bones. I tell my patients get your calcium from food É broccoli, canned salmon, oranges, almonds etc. not from tablets/pills.
Finally this is holiday time after all É This is the season to get out and enjoy events with friends and family. Why not try the sleigh ride at Highland Forest or try ice skating downtown? I want you to consider two other events. The first is the Solstice at the Cathedral. This event is December 7th-9th at St PaulÕs Cathedral downtown. As taken from their website É ÒSolstice at the CathedralÓ is a musical experience celebrating the Winter Solstice Ð the return of light after the longest night of the year. This special concert features secular music from some of Central New YorkÕs most critically acclaimed performing artists. Collaborations include a mix of pop, jazz, blues, Celtic, and original compositions combined with creative lighting and a state-of-the art sound system to enhance the overall experience. Ó Also that same weekend is the Desantis orchestra doing Christmas at the Palace Theatre on Sunday Dec 10th. This is a great show of traditional Christmas music done by local talent young and old alike. You will hear prominent singers and musicians and be introduced to some rising starÕs at a traditional Christmas setting and what a great way to start the month of December. Next year we will continue to challenge you about your health. Until then É get well and stay well. Happy Holidays. Joe Barry MD
I’m guilty. Guilty as charged. I’ve been guilty for almost 30 years. Guilty of prescribing what I thought was an innocuous medication that now I think is so dangerous I never prescribe it anymore. It’s a whole class of drugs really …called proton pump inhibitors. Drugs like Nexium, Aciphex, Protonix, Prilosec, Omeprazole, Dexilant and others. These drugs are used to treat ulcers, acid indigestion, reflux, heartburn, gerd….its stomach pain with many different names. Now if you have a serious esophageal problem called Barrett’s Esophagus you should stay on these meds. You would only know if you had Barrett’s if you had an endoscopy …thats a procedure where they put a flexible periscope down your throat to look around. I highly recommend this test for anyone with longstanding persistent stomach troubles. What I don’t recommend is giving everyone with heartburn these medications. I used to prescribe these meds because they are very effective at eliminating symptoms and I thought they had no serious side effects, drug interactions etc. I now know better. Prescribing these drugs was easy…easy for me and easy for the patient but its just wrong.
It has been an error in my thought processes which I think reflects my training in med school and beyond. I looked at the problem…indigestion and said what do we have to treat this with…I should have been asking what causes the problem. Its that same thought process that had me look at inflammation in the body and ask what antiinflammatory drugs do I have for this instead of asking what’s causing the inflammation.
Now I look at indigestion and ask what is the cause of the indigestion. And the cause is 99% percent of the time what you are ingesting. You see those advertisements where people are going out to eat and intend to overindulge and they make it right by taking a pill. Thats, of course, the entirely wrong way to approach the problem. For almost 30 years I covered up the problem instead of working on the root cause. …your dietary mistakes. Some foods that can cause indigestion are obvious…tomatoes,peppermint, carbonated beverages etc. Some may take some investigation to determine what is not right for you but that’s the right approach. If you have indigestion it’s your body trying to tell you that you have eaten something bad for you ! It’s just that simple. Don’t try to cover it up…get to the bottom of it by making dietary changes until the problem goes away.
Now, again, for any persistent stomach issues see your doctor and get a scope done because you have to check for cancer, precancer (Barretts), and or an infection called H Pylori which can cause ulcers. Once you know it’s nothing serious you can do the detective work to find out what is bothering your stomach and eliminate it from your diet. How many ways can you body try and communicate with you? You aren’t getting text messages or following your stomach on twitter. When you have pain there is a reason and instead of treating the pain find out the cause and let your body heal itself.
Ok but what’s wrong with the PPI’s ?..the Proton Pump inhibitors I listed earlier? Well it’s very very clear that those drugs affect your absorption of VItamin D and Vitamin B12. They clearly have been implicated in osteoporosis which is thinning of the bones leading to increased fracture risk. There are also reports from the European literature that these drugs may be implicated in increased risk of stroke and dementia. ! Hows that for a side effect. ! Also there was a recent study reported in the British Medical Journal of 350,000 men followed for approximately 5 years. In this large study men taking PPI’s regularly had a 50% percent, that’s right 50% increase rate of death ! How many of you out there have been blithely taking these meds for years !
Finally …these drugs work by impairing the proton pumps in the cells. Not just the cells we thought they worked on in the stomach but also in the cells in the rest of the body. These drugs affect the powerhouses in your cells called the mitochondria. So when you inhibit the acid secretion in your stomach you also inhibit activity in all your cells and that doesn’t sound like a healthy thing to me.
Of course, work with your health care provider ..but work with them to get off these meds and get to the bottom of your indigestion which I remind you is almost certainly that you are eating something wrong ! Look at you…it’s probably not just one thing but multiple things that you should avoid and avoid them because they are not good for you.
One easy way to check your stomach symptoms is to do a three day rice diet. Nothing but white rice for three days….Billions of people live on essentially this diet all the time. I am asking you to go on rice only for three days…you could alternatively fast instead of the rice but I know you and fasting is something you don’t think you can do. If you eat rice and nothing but rice for three days all your stomach problems should go away. If they don’t , it’s not your diet , and you should have further investigation. If all your symptoms go away, and I suggest that they will indeed all go away for the vast majority of you…you know it’s your diet and you can start cleaning it up. Not as easy as popping a pill but in the long run much healthier for you. That’s what’s important …getting healthy and staying healthy for the long run.
Why haven’t you had this conversation with your healthcare provider ? You and they should be focused not on covering up the problem with medication but solving the problem with your diet. I can, and do, make the exact same argument for diabetes…we can keep throwing more medications into you or we can finally correct your diet and improve your diabetes naturally. !
Last month I scared you with all the tick borne illness that we have right here in the good old USA. Of course you have enough to worry about with global warming, the Korean crisis, West Nile virus, and of course the difficult work of tearing down civil war statues. I thought the Taliban was the only group that tore down historic sites / statues.
I have blacked out all the faces of George Washington on my dollar bills because after all he was a slave owner and I want to express my solidarity. Don’t expect me to sit down during the national anthem however.
So, it’s great to bring up an encouraging scientific development that made the news recently. It didn’t make the medical news. Much to my chagrin there is almost nothing in the current ongoing medical literature about nutrition. Articles about management of end-stage HIV disease sure. Articles about the management of advanced non-small cell lung cancer are plentiful but articles about the benefit of nutrition are unfortunately absent from the Journal of the American Medical Association, the Lancet, the Green Journal, and New England Journal of Medicine. My sister sent me an article by Dr. Steven Gundry and this has revolutionized my way of thinking about nutrition. It’s informed my understanding of inflammation as well. Everyone is talking about inflammation and anti-inflammatory supplements etc. But the real question we should’ve been asking all along is what’s causing the inflammation and it turns out it is probably being caused by the foods we are eating. This not only includes junk food which we all know is bad for you but also certain foods like corn, potatoes, tomatoes and eggplant that we all thought were healthy foods. The book by Dr. Steven Gundry is entitled the Plant Paradox and that lead me to his earlier work and also to the work of Dr. Dale Bredesen who wrote the book the End of Alzheimer’s. Both works review the interaction between your diet and inflammation and your diet and your gut bacteria which plays and unexpectedly important role in your health. This is an area in medicine we have only just started to understand. These 2 books are must reads for anyone who is concerned about their health and especially anyone who doesn’t have good health. If you have inflammation, migraines, gut issues, arthritis issues, fibromyalgia, or depression you should really look into these books. You know how I feel about people that recommend a particular program. -What is in it for them What’s the catch? Who do you have to pay? What group do you have to join? What special secret program do you have to pay for?
As we say in the Latin, who benefits? In this case I think the person who benefits will be you. The diet I’m talking about in general is referred to as a low lectin diet. You probably haven’t heard this before. Lectins are a protein found in many foods but more so in North American food than in our ancestral diet from Europe. If you ingest too many lectins they cause leaky gut and this causes generalized inflammation in the body. Depending in part on genetics this may result in different manifestations of inflammation like thyroid disorder, depression, hardening of the arteries and even memory loss. That’s right, all of these varied and seemingly disparate disorders may have the underlying unifying cause which is inflammation. The inflammation may be due to you ingesting unknowingly these foods that have high lectin and causing inflammation. Not indigestion, inflammation.
Dr. Gundry was a very well known cardiac surgeon who performed over 10,000 operations and was a past president of the American Heart Association so he is no obscure weirdo preaching some crazy idea that no one else is heard of. Dr. Gundry had a patient that actually reversed his hardening of the arteries with a certain diet and certain supplements and he forever changed his practice to prevent heart disease rather than simply repair damage at the end of the disease process. 10 or 12 years ago when he embarked on this journey there was not a single medicine available to cause reduction in blocked arteries. Now in 2017 the list of medicines that causes of reduction in blocked arteries remains at 0.0. The statins and drugs like it can slow the progression of blocked arteries but they have not been able to show reduction in blockages. Yet this patient showed Dr. Gundry that it was possible with diet and supplements alone. His life was changed when he started that patient and my practice has changed because I studied his books. Dr. Dean Ornish M.D. and Dr. Kim Williams M.D. have completely independently reported that diet in the can substantially reverse heart disease whereas no medicine has been shown to have that effect.
When was the last time your doctor spent any time with you discussing your diet? Before this if people I asked I was recommending a low carbohydrate diet with intermittent fasting and modest protein intake but now I can make a more informed and intelligent recommendation. A recommendation based on real science and one that can BE MEASURED. That’s right, of course the only way to know if the diet works for you is to try the diet but your doctor can independently test you for inflammatory markers and then, when you change your diet, can retest for inflammatory markers and see if in fact the markers of inflammation have changed. There is nothing placebo about it. This is science.
Dr. Gundry’s contention is that most of us are from Northern European ancestry and we have come to North America and our eating proteins found in the foods that create an immune response. This immune response causes inflammation which manifests as heart disease making your cholesterol sticky, dementia making your brain inflamed, arthritis because of inflammation in the joints etc. If your healthcare provider still believes that statins work by lowering cholesterol they haven’t been doing enough research because statins work by the action of lowering inflammation not lowering cholesterol. The new listed drugs to treat cholesterol these PCSK9 inhibitors lower your cholesterol by 70% which is a very dramatic and yet they lower heart attack rate in people that are at the highest risk but only 1.5%. Very very unimpressive and inconsistent with cholesterol being the primary cause of heart disease. As I have said many times it’s not your cholesterol level but how sticky your cholesterol is. Smoking makes cholesterol sticky. Diabetes makes cholesterol sticky. Being a couch potato makes cholesterol sticky. As important, if not more important, may be the foods you are eating.
That’s right. You can have a dramatic and profound effect on your health without spending a lot of money at the doctor’s office. You don’t have to join a secret club. You don’t have to take special rare supplements. You don?t have to use a special tool or have a special procedure. You can learn a lot about the diet from YouTube or you can buy the Dr Gundry’s book but that’s about the extent of the expenses. The hardest part of the diet is giving up the stuff that you know and love like wheat, simple sugars, sodas of all types, eggplant, corn, tomatoes, potatoes etc. You give up foods that are not good for you and you get better health, less cancer, less heart disease, less dementia etc., I think that’s a great trade off. So , if you know anyone who is suffering from poor health or you want to try to improve your health give the low lectin diet a try and see for yourself. Next month we talk about the bugs in your gut, Your biome and how vital they also are to your health and well being. Until then get well, Stay well.
The Crimean Congo hemorrhagic fever was recently diagnosed in Spain. Yes, this is a relatively newly diagnosed viral tick-borne disease and it can be a mild flu-like illness or you can bleed out from your mouth, eyes and nose and die and of course there’s no treatment for it. So along with Lyme Disease and Babisiosis and Dengue and West Nile Virus and Swine Flu and Chikungunya you now have the Crimean Congo Hemorrhagic Fever to worry about. It’s not an issue in Central New York yet but with the rate of world traveling look for it to be in a theater near you soon.
This report comes from the New England Journal of Medicine July 13th 2017 and talked about an AUTOCHTHONOUS infection. I didn’t even know what that word meant so I had to look it up and it means that the infection didn’t come from a traveler it came from someone living in Spain who contracted the illness without traveling to the endemic area. You can rest easy, for now, regarding the Crimean Congo Hemorrhagic Fever but let’s not let your guard down because we have a whole lot of home grown tick borne diseases to contend with.
As reviewed in the Cleveland Clinic Journal Of Medicine Volume 84 July 2017 there are a host of tick borne diseases right in our own backyard to worry about. All that’s tricky is not Lyme. Depending on where you live you have to contend not only with Lyme Disease but also Anaplasmosis, Babesiosis, Ehrlichiosis, Rocky Mountain Spotted Fever and Tularemia. Looking at the maps that show where these tick borne diseases are found it doesn’t look like there is one state in the union that doesn’t have a problem with at least one of these vectors.
The names of the bugs alone are daunting … Rickettsia rickettsii is the bug that causes Rocky Mountain Spotted Fever and it’s carried by the tick Dermacentor variabilis … now there is a Rickettsia Parkeri infection as well but this virus is borne by the tick Amblyomma maculatum.
There is an illness called Human granulocytic anaplasmosis that is borne by the common tick Ixodes scapularis. Don’t forget about Human Monocytic Ehrlichiosis with the tick vector Amblyomma americanum … this same tick carries the pathogen Ehrlichia ewingii. So far the infection called Ehrlichia muris like agent is limited to Wisconsin and Minnesota but for how long?
Lets not forget Babesiosis which is also borne by Ixodes scapularis and this illness presents, as do all the others with fatigue, fever or malaise headache, myalgia or arthralgia, nausea, anorexia, and cough. In the laboratory all of these infections can cause leukopenia and thrombocytopenia, that is low white count and low platelets. You would think that an infection would cause an elevated white count but not in these cases. Let’s round out the list by mentioning tick borne relapsing fever which is caused by Borrelia hermsii which is born by ticks which so far now only involve the Pacific Coast in Northwest and Southwest regions. It causes (as the name applies) relapsing fever or headaches gastrointestinal symptoms arthralgias and myalgias. Almost all of these pathogens can be treated with doxycycline just like Lyme disease except for tickborne relapsing fever and this bug is treated with tetracycline this isn’t a virus this is a spirochete. There is something called Southern Tick Associated Rash illness but we don’t even know the pathogen although we think the vector is Amblyomma Americanum.
Okay, let’s round out the list with Tularemia, Heartland virus infection and Powassan virus infection. The Powassan virus Is apparently an uncommon Flavivirus but it’s becoming more common right here in New York State. Tularemia at least you can treat with an antibiotic. The Heartland virus which is borne by the tick Amblyomma Americanum (most likely) is also for now only diagnosed in Missouri and Tennessee.
Bottom line is that “Tickborne illnesses should be considered in patients with known or potential tick exposure presenting with fever or vague constitutional symptoms in tick endemic regions. Given that tick bite history is commonly unknown, absence of a known tick bite does not exclude the diagnosis of the tick borne illness. Starting empiric antibiotic is usually wanted before the diagnosis of tick borne illnesses confirmed. Tick avoidance is the most common effective measure preventing tick borne infections.”
Hopefully all of this talk of ticks doesn’t make you afraid to go outdoors. Just wear long pants and long sleeves and/or use a lot of DEET and check yourself when you come back inside. If you do experience any illness that doesn’t have a good explanation … work with your doctor to check for other possibilities and don’t rest until you have an answer or get better. Until next month … get well … stay well.
I have been floating around an idea which I think has a lot of merit and the time has come electronically. Grandma should be chipped! In this day and age when you buy something you can pay with Paypal, you can use a check, or you can use a credit card. Yes, cash is an option for you monetary Luddites. At one point the Green Hills Grocery store in the Valley had a way of paying for your groceries just by using your thumbprint and I loved that but they got rid of it. If you lose your wallet or your car keys there are now ways you can use electronic devices to recovery your items. There are a variety of these available including the tile system and tracker. You can use them to find your wallet. You can use them to find your phone or laptop. There is already technology that uses implanted chips … in your pet! You can get your dog or cat chipped so if they run off they can be identified when someone brings the animal to the vets office. If you would put a chip in your pet why won’t you chip grandma!?
For that matter I would also suggest chipping kids until the age of 18 when they can decide for themselves whether to stay chipped or not. Why wouldn’t you want to be able to find out where your kids are just by using an app on your phone? No more Amber alerts!! No worries about where your kids are after midnight. There is a phone finder app that you could potentially use to find where your kids are but what if they turn it off or it gets turned off by someone or they simply leave their phone at home etc. No way to turn off the chip. You could get the kids a chipped bracelet or necklace but what’s wrong with putting it under the skin somewhere so they can never screw it up.
Let’s get back to Grandma … She’s living alone now and she is getting older and slower but wants to stay in her house. Maybe you have taken over paying the bills. Maybe you do the driving now. Who doesn’t worry about momma? Well, get her chipped and half your worries go away. You can be notified when she leaves the house. You can monitor her driving. You can check on her from across the country. Maybe you worry she will wander off. Maybe you got her the upgraded version that can alert you if she falls. There is a great system in CNY called Project Lifesaver International that can find a demented patient who wanders but you have to have the person wear a special device and you have to use a helicopter (or now perhaps a drone) to find the signal put out by the device. This is expensive but effective. Central New York has Ruth Hurd Boshart to thank for this service. She essentially single handedly spearheaded this program and is a testament to what one motivated individual can accomplish! Technology has advanced and I think we can do better. I don’t think there really is a chip to put in people yet but there should be and someone is going to make a big pile of money when they finally come to market.
How about an timely and local example? The great New York State Fair is this month and you know how crowded it can get … how easy it is to get separated from your loved ones. Maybe you have taken the Boy Scout troop or you brought a few of the neighbors kids with you. You turn your back for one minute and someone’s gone … Are they in the bathroom or in the trunk of some car? Are they at the petting zoo or are they scoring drugs off the carny? Pull out your phone … activate the app and there they are! It’s just a matter of time before someone puts this together and I predict it’s going to become universal! I know you worry about your “privacy” but you really don’t have any privacy anymore and I think the safety issue will win out and eventually you too will want to get chipped. If you just think about it for a while you will eventually agree with me that this is a good idea … and it’s ready for prime time … all it will take is one of you millennials to get this going … Don’t make me do ALL the work. Until next month … Get well and stay well.
I gave a lecture recently regarding the top 5 health issues for seniors and I thought I would translate that into an article. (By the way if you have a group interested in hearing about medical issues contact my office and we’re happy to oblige if we can. I have a lot of information stored in the data banks and I’m happy to give it all at once to a group of people rather than one of the time in office calls. I don’t know if I will entertain you but I know I will educate you.)
The top 5 health dangers to seniors are pills/polypharmacy, falls, heart disease, cancer and dementia. Luckily, with each of these issues there are interventions. -Interventions that are patient based. Interventions that will save you money and make you healthier and that don’t require prescription medication.
Starting with polypharmacy … That’s defined as an increase in the number of medications or use of more medications than is medically necessary. Polypharmacy is common in ambulatory care, hospitals and in nursing homes. Polypharmacy increases the risk of practically everything. According to the NIH polypharmacy increases healthcare costs, increases side effects, increases medication noncompliance, worsens functional impairment, affects cognitive status, increases the risk of falls and incontinence. You can take action here. Carry a list of all your pills including supplements to all your doctor visits. Involve your doctor and your pharmacist in reviewing your list. Don’t to be afraid to challenge your doctor and ask questions. Know what pills you’re taking and why. The more meds you take more dangerous it is. Having practiced for almost 30 years I can tell you there are not a lot of doctors in Syracuse that are stopping pills and in fact only geriatric doctors are really trained to cut down the pills as age-appropriate. Just as an example if you are over the age of 76 and you have no history of heart disease the US Preventive Services Task Force in November 2016 concluded that “the current evidence is insufficient to assess the balance of benefits and harms of initiating statin used for the primary prevention cardiovascular events.” I have seen literally 100’s of people in their 80s with no inkling of heart disease or stroke who are taking a statin drug.
Next up is Falls. Falls are the leading cause of death by accidental injury among people who are older than 65. The average healthcare cost of a fall injury involving a person 72 years or older was 19,448 dollars in 1998 according to the NIH. Please don’t think it won’t happen to you. One fourth of Americans age 65 or older fall each year. Every 11 seconds an older adult dies from a fall. Falls are the leading cause of fatal injury and the most common cause of nonfatal trauma related hospital admissions among older adults. Again here as a place for you can take actions. You can clean up the clutter, repair or remove tripping hazards like rugs, install grab bars and handrails, appropriate lighting, shoes not socks, live on one level, wear an emergency alert type device. Be aware that your diabetic and blood pressure meds can increase falls. No matter how careful you are you will eventually fall and that’s why exercise is best protection against fall related injury. If you work on your balance actively and you work on keeping your muscles in tone then you’ll recover better faster etc. after the fall. The bottom line is that you’re going to fall, but the better you take care of yourself the better you will recover.
Of course we can’t forget about heart disease. It remains the #1 cause of death in America. Genetics, exercise, diabetes, blood pressure, smoking, diet, stress, age and cholesterol all play a role. Luckily except for genetics and age you can work on all those modifiable risk factors. Focusing on the basics of diet and exercise is available to everyone and anyone.
Likewise cancer remains a common killer. Cancer does not become less common as you get older. Treating cancer comes with a staggeringly high price tag. Preventing cancer does not. Again this is an area where very simple changes in your lifestyle can have a profound effect on your risk for cancer. Not smoking. Moderating alcohol. Increasing fruits and vegetables … the antioxidants. None of this is controversial. None of this requires a prescription from the doctor. Again you’re in the driver’s seat when it comes to your health heart wise and Cancer wise. The problem is most of you are unwilling or unable to turn the keys in the ignition and get started on your drive to healthy longevity land … and of course that’s the key. You don’t want to just grow old you want to grow old and remain healthy as possible. This does not come from a random act of kindness this comes from you putting in consistent sustained attention to your health.
Finally we come to dementia. Dementia, to me, seems much worse than cancer or heart disease because of how long it lasts and the effects it has not only on the patient but the caregiver. No one wants a heart attack but at least if you drop-dead your suffering is over quickly. Likewise no one wants a cancer but after whatever harrowing therapeutics are necessary you can hope to enjoy a quality of life again but with dementia it’s a never ending nightmare. The staggering financial costs related to dementia, which are certain to increase dramatically as the Silver Tsunami peaks, Pale in my mind in comparison to the psychological damage done by this process. As depressing as this subject is, and I find it profoundly depressing, there is action again you can take to attempt to prevent dementia. Keep your weight down because obesity is associated with dementia. Keep your sugars under control because diabetes is related to dementia. Get regular exercise because regular exercise is strongly inversely correlated with getting dementia. Don’t smoke and be moderate with alcohol. Control your blood pressure but don’t let it go so low that you get dizzy. Most important is exercise. Whether you can help yourself prevent dementia by engaging in new activities and mental challenges remains debatable but physical exercise has been studied in multiple trials and has a protective effect on the brain.
So there are multiple dangers ahead for seniors but luckily you can take action that improves your odds. Simple basic action like eating better and exercising etc. Even though I’m the doctor I find it heartening that you don’t have to come to me to make a big impact on your health. Take charge, take action and work on your health every day.
Last month I wrote about the manifest benefits of exercise. Right after I wrote the article there was yet another paper in the medical journals that further supported the evidence that regular exercise decreases cancer risk as well. Imagine that… a treatment that doesn’t involve tremendous expense, a treatment that doesn’t require special medicines… a treatment that doesn’t require a doctor’s supervision. We have no pill that lowers dementia risk, lowers cardiovascular risk and lowers risk of cancer all at the same time. Plus, you will actually feel better!!!
This month I want to focus again on something really new, at least for Syracuse. There is a new treatment for Fibromyalgia. Fibromyalgia as defined by the Mayo Clinic is “a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues.” We still don’t have a good handle on what causes fibromyalgia. Some doctors think it’s all just depression. Some doctors believe it is an infectious disease and we just haven’t found the causative organism yet. So far the treatments for fibromyalgia involve pain meds, antidepressants and seizure meds like lyrica and neurontin used for their pain relieving properties. Of course we advise all patients to try exercise but it’s tough to get people in pain at rest to really exert themselves. Genetics may play some role but it’s not a certainty. Women are affected more than men but we don’t really have a handle on why.
Other than prescription meds we have advocated meditation, tai chi, yoga, massage and acupuncture all of which have shown some improvement in symptoms over time. The prescription drugs don’t fix or cure anything they just help deal with the symptoms. Of course, the meds can cause their own symptoms and the patient is left trying to decide what’s worse, the disease or the treatment.
Now, however, there is something new. There is a company called Fibrocentix which offers a new patented treatment which is safe and effective for most patients and is also all natural. The company approached me about working with Fibro patients and since we don’t have any really good effective treatments I was all for trying it out. Any patient interested in the treatment gets seen by a trained specialist (not a nurse or doctor but someone with lots and lots of experience treating Fibro patients) for an educational and informational visit. At this visit the patient’s trigger points will be tested. Trigger point tenderness is one of the hallmarks of Fibro. Each patient after being evaluated is given a dose of the solution (it’s a liquid preparation) and can judge for themselves if it’s working. The visit and the trial of the medication is FREE. Thats right I used the F word. One of the reasons I was impressed with this company and its solution is that patients will know from the one free visit if the supplement works for them. YOU will be the judge of whether it works for you or not. If you get benefits from the supplement you take it for a few months and gradually wean off. If it doesn’t help… you do not proceed and keep looking for other solutions… it’s as straightforward as that! The solution is not guaranteed to work. I don’t think you can guarantee anything in the medical arena. I wouldn’t trust anyone that guarantees anything in medicine.
If you ask your doctor about this I expect that they will say… ”never heard of it.” If it’s not covered by insurance—and this treatment is not—doctors are not reading about it or being exposed to it. Insurance companies have to be dragged kicking and screaming to cover new meds, new FDA approved treatments, etc. -They sure are not going to warm up to the idea of covering an all natural patented supplement treatment. The insurance companies are not in charge of your health… you are. If you are in Fibro pain or know someone who is suffering from Fibromyalgia why wouldn’t you check this out. Since this doesn’t involve your insurance you don’t need a referral or anything like that. You can go to the web site and you will find a list of doctors who offer this treatment option and of course you can call us directly at 315-487-8109315-487-8109. You really have nothing to lose but possibly your pain !
Until next month… get well… stay well. JT BARRY MD
I have written in the last year about interesting or exciting innovations like the Cognivue test which is the first and only FDA approved machine to test for dementia. I have written about the Pharmanex scanner to assess your nutritional / antioxidant status. I have written about the chronic care program sponsored by Medicare. These are all up-to-date, next generation/new wave issues but today I want to write about one of the bedrock issues of medicine which is the benefit of exercise. Everyone knows that exercise and eating right are good for you, in fact, it’s so well known that you spend very little time with your doctor discussing it. That’s a shame because the benefits are dramatic and sustainable and I think that the proof of this should be brought up on a regular basis.
We doctors have recommended a lot of things that in the end didn’t turn out to be true or meaningful. We told her to avoid eggs and that isn’t right. We told you to cut down the meat and the fats in your diet and that’s wrong as well. Years ago and still recently we said increase the carbohydrates in your diet and we know how wrong that is. We used to use leeches, we still do but in medically appropriate setting now. So If I’m going to recommend something I’d better back it up with up to date science.
Let’s start with exercise and dementia in the February 2017 Mayo Clinics proceedings they did a test of 6000 veterans to assess for exercise capacity and the association with dementia and cognitive impairment. The researchers found that “exercise capacity is strongly associated with cognitive function.“ The more you exercise the better your brain testing was. Since dementia is considered in some circles to be the #3 cause of death In America, this alone should be strong impetus to get on a good exercise program and to stay on it.
Another article from the Mayo Clinic from January 2017 assessed cardiovascular fitness and the likelihood of having an adverse cardiovascular event that is stroke or heart attack or sudden death. This test involved 20,000 US veterans more than half of whom are African-American. This study followed these men for 11 years. The research found that there was a very direct correlation between exercise capacity and adverse cardiovascular events. -The more fit you were the less likely a heart attack or stroke etc. The difference in mortality between the least fit and the most fit was quite dramatic.
Finally, the American Journal of medicine in 2016 published study that evaluated the impact of cardiorespiratory fitness levels on the risk of developing atherosclerosis -(hardening of the arteries). As you know the conventional wisdom is that the higher your cholesterol the more hardening of the arteries you’ll have. Hardening of the arteries leads to strokes and heart attack.
They basically followed people like myself with very high cholesterol levels who were also vigorous exercisers to see if the vigorous exercise could counteract the effects of the high cholesterol levels. They found, in fact, that if you had regular vigorous exercise it was amazingly protective of the heart despite the high cholesterol levels.
So, three articles published within the last year all confirm the various benefits of exercise. It protects the brain. It protects the heart. You don’t have to belong to a gym to get good exercise. Of course in this part of the country the other important thing to remember is that you have to weatherproof your exercise. So many people tell me that they don’t get out of the house much in the winter. Imagine leaving your car in the garage over the winter and trying to start it reliably come spring. There are many places like Destiny, Wal-Mart and Wegmans that have been enclosed areas you can walk in. Soon with Uber coming you won’t have any excuses left.
The great thing about exercise is it doesn’t really require prescription from the doctor. It doesn’t require special outfits. It doesn’t require special training places. It doesn’t require hours and hours of your time every day. You can do it alone or you can do it with other people. You can do it indoor or out. You can do it daytime or nighttime. There is no real reason that you can’t get started today to improve itself a little bit every day physically and for that matter mentally.
Next month we will again bring you something cutting edge, at least for Syracuse. Until then get well and stay well.
Last month I got a little personal. This month I am taking you to the very cutting edge of scientific thought. There seems to be a real connection between diabetes and dementia. Someone coined the term that Diabetes Type 3. Until recently I had never heard this term. The contention is that Alzheimer’s Disease is really a brain form of diabetes. This is not really new info in the scientific community but it sure didn’t make it to the front line caregivers. The real culprit, as I understand it, is once again INSULIN. Simplistically Type 1 diabetics have no insulin and need to take shots of insulin to control their blood sugar. Insulin is a growth hormone that pushes the sugar in your bloodstream into the individual cells where they can be used. Type 2 diabetics don’t respond as well or strongly to the high sugar in your blood so it takes more insulin than normal to get the sugars into cells. This is called insulin resistance. Type 3 diabetes appears to be abnormal insulin effects in the brain resulting in histochemical and pathological changes identical to those found in Alzheimer’s brains. This is big big news which appears to be based on pretty good scientific underpinnings. The idea that Alzheimer’s is a form of diabetes has been around since 2005. Roughly one third of Americans have diabetes. Diabetes and dementia are both epidemic in this country and increasing over time. It has been known for some time that diabetic patients are 2-4 times as likely to become demented as those who are not diabetic. Besides telling the bodies cells to take in sugar, Insulin also tells fat cells to grow. If you are Insulin resistant, which the vast majority of Type 2 diabetics are , you have higher amounts of insulin in your bloodstream to keep your sugars under control. This same higher insulin level makes losing weight very difficult because insulin puts your body in growth mode not weight loss mode. You need insulin to live but you want to get away with as little as possible.
Suzanne de la Monte a neuropathologist at Brown University did rat research that showed when she blocked insulin to the rats brains they acted demented and their brains showed “all the signs of Alzheimer’s”.
Shall we get more technical? In the Journal of Diabetes Science and Technology published November 2008 experts reviewed the evidence regarding this possible connection and found “extensive disturbances in brain insulin and insulin like growth factor (IGF) signaling mechanisms represent early and progressive abnormalities and could account for the majority of molecular, biochemical, and histopathological lesions found in Alzheimer’s Disease. “ Furthermore , when they experimentally induced brain diabetes these rats brains shared many features with Alzheimer’s and when they treated these rats with currently used insulin sensitizers the changes were reversible. Now we are not rats and many times what’s true in rats and mice does not translate to humans but it’s a pretty strong chain of evidence nonetheless.
Shall we talk numbers? According to an article in the NY Times…Diabetes and Dementia have nearly tripled in the US in the last 40 years. Both Diabetes and Dementia are separately listed among the top ten causes of death in America today. Currently 2 % of Americans have dementia…that’s over 5 million people and dementia costs our healthcare system 200 billion dollars. Add the cost of Dementia care and the cost of Diabetic care and you are talking some real money and a real impact on the health care system.
For further reading check out the well known Dr. David Perlmutter’s book Grain Brain.
The most important finding in all this is that Alzheimer’s is no longer just a “condition that befalls us by chance.” You might be able to dramatically decrease your risk of dementia with your diet and exercise program. No fancy medications, no special treatments. The same diet that can improve your brain is the very same diet that improves your heart, your waistline, and your liver….so now what’s stopping you ! Next month we finally take on the supplement industry with hard science and new technology. Stay tuned…until next month…get well and stay well. Jtb
Rather than belabor the whole New Year’s Resolution thing I wanted to start out the new year with a top 5 stories list. You know I don’t think people should wait for a certain date before they begin the process of changing themselves. The day to start changing is today. I have a friend who says … ”I will start my diet on XX date.” He then uses this as an excuse to overeat until that date … ”Well, soon I will be on a drastic diet … overeating now can’t make a difference.” Then, of course, the date comes around and he has another excuse as to why he is putting it off. My friend is very well intentioned and I think he really means it but this pattern has occurred so often you would think an intelligent person would recognize this but that just goes to show that it is hard to really know yourself. Change your life and habits or don’t but the day to do that is today … not tomorrow or Jan 1st.
My top 5 medical stories are probably not the 5 your own doctor would list. I would urge you to bring up any of these articles to ask your doctor if they are in fact true but I think you’re just going to upset your doctor because it’s extra work for them or challenges their long held beliefs.
Story #1 is the United States Preventive Task Force statement regarding treating cholesterol and primary prevention. They state “There is insufficient evidence to recommend for or against statin use for people older than age 75.” I know many many people older than 75 that are taking a statin drug just because their numbers are high. I have seen multiple patients in their 90s never having had a heart attack or stroke that are given a statin drug which is designed to prevent premature death but I don’t think there is anything premature about death In your 90s. This recommendation from this independent panel is likely to go ignored because it doesn’t agree with current practices for most doctors. One of the scariest things to me is that when we have new evidence —unless it agrees with our current thinking— we have a tendency to ignore it.
Story #2 is the recent article in the New England Journal of Medicine that suggested that most supplemental oxygen is a waste. Essentially if you can walk around with your oxygen bottle you probably don’t need it! Medicare, who makes most of the rules, has long stipulated that oxygen therapy is appropriate for people if their oxygen saturation when tested in the office is less than 89%. If oxygen is low you should prescribe oxygen and the patient should benefit and live longer and require less hospitalizations and feel better. It certainly made sense but unfortunately this most recent study shows that for the vast majority of people getting submental oxygen there is no difference of hospitalizations, life expectancy or patient’s satisfaction. Again, what we have been doing for many people for many years seems to be not appropriate or not cost-effective or simply not impactful to the patient’s health. Despite this report which was well done and published in a major journal I believe most doctors again will not change their practice. Don’t get me wrong … people with very severe lung disease who require oxygen should not have it yanked away from them but many people who had episodes of low oxygen saturation when they’re walking or moving around do not benefit from supplemental oxygen based on this most recent and thorough report.
Story #3 is more speculative and claims that there is a link between Alzheimer’s and insulin resistance. There has long been evidence that diabetes increases your risk of dementia and it may actually double your risk although the numbers are debatable. Newer understanding suggests It’s not the sugar itself but the insulin resistance that may cause these proteins to build up in the brain. For every patient out there with known diabetes there is at least one other with insulin resistance so it’s understandable how dementia could be a major problem in the years to come. Of course I liked this finding because it confirms the validity of my suggestion of skipping breakfast to help you lose weight and lower your insulin level. Google intermittent fasting.
Story #4 is about hot peppers. Hot peppers can apparently kill you. I am a big fan of a moderate use of spices, onion, ginger, and garlic. I think they’re all healthy for you and when I was younger I used to hit the hot peppers a bit more than I do now and even now I can get a good sweat going from eating a hot pepper. There is however a danger from hot peppers and that is if you have a pepper that so irritating that it causes you to vomit violently. This can cause a spontaneous esophageal rupture which is also called Boerhaave’s syndrome. There was an article recently about a patient who was in hot pepper eating competition and vomited so vigorously that he ruptured his esophagus and this is usually 100% fatal unless treated surgically. I’m told he recovered fully but he did spend over 3 weeks in the hospital and I’d hate to see his hospital bill! Although this is a cautionary tale I think most of us are safe and I continue to recommend peppers, onion, horseradish, etc. because I think these vegetables and preparations are very healthy for you.
Story #5 is that we finally have proof of the benefits of breathing. Not your day to day breathing although it’s obviously beneficial to keep breathing. I’m talking about conscious breathing likely doing yoga … being aware of your breath and focusing on your breath. There was an article in the December 6th Journal of Neuroscience that mentioned that scientists at Northwestern Medical Center have discovered the rhythm of breathing creates a “activity in the brain that enhances emotional judgments and memory recall. Northwestern Medicine scientists have discovered for the first time that the rhythm of breathing creates electrical activity in the human brain that enhances emotional judgments and memory recall. “When you breathe in, we discovered you are stimulating neurons in the olfactory cortex, amygdala and hippocampus, all across the limbic system.” You know I love yoga and recommend yoga to almost everyone … I really don’t need any more studies to make me a believer. Anyone who has practiced deep breathing exercises knows how powerful these techniques can be but it’s nice to see scientific evidence of their benefits.
Listen, it’s the beginning of the year. You don’t have to make a resolution but you can make a plan so that this time next year you are healthier and in better shape than you are now. Maybe it’s the time to finally quit drinking soda. Maybe skipping breakfast will find you 5-10 pounds lighter next year. What separates the dreamers from the successful people is making a plan and following up on the plan. Start today! Until next month … get well … stay well.
As I write this in mid November sitting by the fireplace by the pool it’s such a nice almost summer like day that it’s hard to imagine that Thanksgiving is around the corner and then it’s time for Xmas plans. There is as yet no holding back the hands of time so might as well get ready for it. Not too ready … I still shudder at all the Xmas decorations even before Thanksgiving but that’s just the traditionalist in me.
There’s a lot of health issues around the holidays and we might as well deal with the most common and get our Xmas cards on the table … so to speak.
This can be a rough time of year both physically and mentally. Physically because this is when you go a little cra-cra with the diet … The typical adult puts on 1-3 pounds of weight each year and this is the time of year when that happens. You did fine the rest of the year but now look at you!?! Are you really cutting into that cakey thing made of nutella and dried prunes? You can’t possible reel it in after that first piece of pumpkin pie? You can at least go for a walk before or after dinner … it won’t give you any real weight loss but at least when you are walking you are probably not eating. I know there are those proud few of you that can eat and exercise at the same time but you are not reading any articles about health or medicine so I can safely exclude you from the conversation. I love how people act like the holidays sneak up on them every year … I had no idea we would be sitting down to a full turkey dinner with all the trimmings? Who knew there would be treats on the table for the holidays? Who could have guessed?
You could actually plan for these occasions … intentionally bringing a healthy choice to the communal dinner, you could get some extra walks in and or trim down your usual portions for the week or two before the get together to keep the weight gain down. I am not saying you should not enjoy the holiday … life is way too short and I have no objection to the eat dessert first crowd. I am saying throw some cranberry on that plate … even the kind that still has the ring imprints from the can it came from. (That’s my personal favorite). Take a couple spoonfuls of that green bean casserole … it’s good and it’s good for you. Well, as I write this I realize when you read this you will already have debauched yourself at Thanksgiving but you can still get yourself together for the rest of the year end festivities.
This is also a tough time of year physically because people “turtle up” for the winter. They have no problem being outdoors and active during the three months of the summer but wintertime comes and they go into exercise hibernation waiting out the long cold months for the sun and warm weather to return. That’s too much down time for a person of your age. You have to keep moving it in the winter. You don’t have to go to the gym but you should move around more than you are. Don’t kid yourself … if going down the stairs with the laundry is really exercise for you … you are not the fittest amongst us. Of course I’m a big fan of walking but I understand the dangers of the slippery sidewalk, etc but you can always walk at the Mall. It’s absolutely nothing like being outside in the elements but it is safer!
Turning to the psychological side of the holidays this can be a stressful time. A lot of people let the whole family gathering and or gift giving get them anxious and depressed. Also people who have lost a loved one during the year are experiencing their first holiday without them and I just don’t know how to lessen that pain except to urge them to find comfort in the company of others. Of course I would be remiss if I didn’t recommend the great local charity Hope for Bereaved because this is completely their bailiwick.
Now on the issue of gift giving … Last year I gave someone who I thought I knew a gift of Bacon of the Month … and I mean this was high end, thick cut, special rubs and salts specialty bacon not a package from the Gas and Go … in return I got a disco ball from Spencer’s gifts with the promise that if I gave more bacon further disturbing gifts would follow. Needless to say all subsequent bacon was diverted … to my house … I still don’t know what to make of this incident because I thought a love of bacon was shared by all guys my age. My point being you can torture yourself trying to think of gifts and be oh so wrong so why not try something new? Is it too trite to suggest you give the gift of time together? Instead of that sweater you know they will exchange … why not movie tickets to a show you can all go to together. Why not a dinner gift certificate that includes you? Tickets to a baseball game are dirt cheap so you can’t throw down the $$$ excuse. Speaking of getting together as a gift, which it surely is, this is the perfect time of year for that because there are Christmas shows aplenty. To bring just two to your attention why not check out The Desantis Xmas show at the Palace Theatre Sunday Dec 11th … This is a great venue for great Xmas music provided by local talents both new and legendary fronted by Maria Desantis. For something a little different check out the Solstice at the Cathedral Celebration on December 8th, 9th and twice on the 10th. This series of concerts features other local powerhouse performers like Joe Whiting, Donna Coulton, Loren Barringer, Matt Vacanti to name just a few. There is something for everyone at both of these events. There are memories to be made. Isn’t that the best gift of all?
Until next month … get well and stay well.
Today I take on aspirin. Why not? I have already talked about the overuse of statin drugs, the crazy dietary recommendations including salt restriction, the beneficial role of fat in your diet, and supplements so why not take on aspirin. Seems like everyone in America is taking an aspirin or knows someone taking aspirin. It’s almost expected on people’s records that if they are adults you just mark multivitamin and aspirin as presupposed medicines. I think most doctors just assume adults are taking a multivitamin and an aspirin … on general principle. But what’s the science behind it? I was going to write that there is no evidence that aspirin is beneficial for most people. That would be wrong. There is evidence that aspirin is beneficial … but there is also evidence that most people don’t need it and actual can be hardened by it. You shouldn’t just drink the aspirin-aide … you should decide for yourself and should base it on the evidence.
If you ask your doctor if you should take an aspirin he or she will probably say … ”sure why not?” This is the conventional wisdom. The current thought is to take a low dose aspirin product because you get all the benefit with the least risk. Sounds great. Sounds prudent. But what does the evidence say? What are the guidelines? That’s what I will focus on here. If you mention to your provider that Dr. Barry questioned the universal use of recommending aspirin they will respond … ”Dr. Barry is off his meds !” So instead clip out this article and bring it with you and ask them to refute the expert testimony herein!
Let’s start with the recommendations from one of the most prestigious organizations: the United States Preventive Services Task Force. “The USPSTF recommends initiating low-dose aspirin use for the primary prevention of cardiovascular disease (CVD) and colorectal cancer (CRC) in adults aged 50 to 59 years who have a 10% or greater 10-year CVD risk, are not at increased risk for bleeding, have a life expectancy of at least 10 years, and are willing to take low-dose aspirin daily for at least 10 years.”
Furthermore “The current evidence is insufficient to assess the balance of benefits and harms of initiating aspirin use for the primary prevention of CVD and CRC in adults younger than 50 year or older than 70 years.“ So yes I am saying that one of most prominent organizations say that aspirin only has really good evidence in people between 50 and 60! There are bleeding risks associated with aspirin. I am not worried about the increased risk of GI bleeding with the drug … I figure that is offset by the possible benefit of decreasing colon cancer. The bleeding risk I worry about is in the brain. If you take aspirin and have a fall with head injury aspirin can increase the amount of bleeding around the brain. If you have a bleeding type of stroke, which thankfully accounts for only a small percentage of strokes, having been on aspirin increases the bleeding in the stroke area. This is not good. I can transfuse blood but I can’t transfuse brain. At least not yet.
OK so this is just one panel … what do the other experts say … surely the American Heart Association and the American Diabetes Association weigh in on the use of aspirin. In the September 2015 edition of the American College of Cardiology commenting on the American Heart Association and the American Diabetes Association joint statement which state that “low-dose aspirin (75-162 mg/d) is reasonable for those at 10-year CVD risk of at least 10% without increased risk of bleeding (ACC/AHA Class IIa, LOE B, ADA LOE C) and in those with diabetes at intermediate risk defined as 5-10% 10-year CVD risk (ACC/AHA Class IIb, LOE C, ADA LOE Expert Opinion).”
A careful reading of the above will show that only in the sub population of people that have a 10 year risk of heart event of 10% does aspirin show any proven benefit. Translation = most people don’t need aspirin! Even the American Heart Association website specifically states “You should not start aspirin therapy on your own.” How often have you and your doctor calculated your particular 10 year heart and stroke risk score? After all, heart disease is the number one killer of adults in America … isn’t it worth 5 minutes of your time and your doctors time to calculate your risk or at least have a conversation about your risk factors? The calculators are available on the web and if you have access to your labs you can do your own calculation. These calculators have their detractors but they at least set the stage for the important conversation about your heart health and therefore your overall health. Don’t be a passive observer of your health care experience … bring questions … expect at least conversation and education if not definitive answers about your health. Your doctor can only guide you … only you can improve your health and that’s a great thing. You don’t need a good insurance company. Its nice to have but it doesn’t ensure your health. You don’t need a gym membership. Its nice to have but it doesnt mean you can’t take care of your exercise business anywhere. You are the one who has to put down the cigarette and say “I’m done.” You are the one that has to look at your dinner plate and say “My new lifestyle starts today.” Does that empower you or scare you. Just because its up to you doesnt mean that you cant get help in lots of different ways to improve your health. Build your team. Work your team. Hopefully your medical provider is part of that team.
Until next month … get well and stay well.
Maybe it’s just me but I think you should practice what you preach. Can you really take advice on weight loss from a doctor who could lose 50? Has the professional that is recommending a colonoscopy had one themselves? pv-1Hey, I know I’m no stud muffin but I make an effort to keep my weight in check and work out regularly and aggressively. The aches and pains you take Tylenol or Aleve for are my regular companions and a reminder of the workout. I feel guilty if I don’t have an ache or pain because it means I haven’t pushed myself in a while. Although I have my regular exercise routines I think it’s also important to mix it up a little and one nice way is to do some event. There are 101 charity events with some run / walk seemingly and probably literally every weekend. You get out of the house, you test yourself a little whether you run or walk, you have new experiences, meet people you know and make new acquaintances. What’s not to like? Plus it’s usually for a good cause and not usually expensive. Winner Winner chicken dinner.
Earlier this year I did a charity run for Hope for Bereaved … you know I love that organization. I hadn’t run again until an event came up last weekend to which I made a donation and promised to do the run … I don’t run much anymore but these folks do my compounding when I want to use topical meds and I think they are nice people and it was in support of 9/11 with Todd’s Fund. Etc …
So there I was cruising down a country road en route to a 5k run at Vernak Farms Store somewhere nears Skaneateles … I don’t know how long the run is or what the course is like but it’s a beautiful day and by using the Chi-Running technique I can usually power through most races. Not winning any awards but plugging away … never stopping … getting ‘er done. No matter how long or short the race I will look near death at the end. I see a sign on the side of the road —presumably a country church— as the sign says … “Whenever 2 or 3 may gather in my name there I am.” Mathew 18:20.
Now what goes through my mind first is that this is a nice affirmation that even a little group has the attention of God. Then, on pondering a little further it occurs to me that this implies that you need at least 2 people to get things going. So does that mean if I were to pray alone at night, which many people do, that I don’t have God’s ear? It doesn’t say “Whenever one person” no … it says “Whenever 2 or 3.” Seems like a minimum to me but I know that can’t be right. Now I have this conundrum in my head while I am getting my race game face on. You’ve seen my regular face … race face is no prettier. I am trying to think of some Biblical passages that might provide more insight at the same time I am double knotting my sneakers before the race. I got my mind right before the race by listening to some Bob Marley … the question of the utility of singular prayer put away for now.
The whole event was nice … They have a yearly wellness fair and expo with an impressive layout of vendors and informational booths. The race was tougher than your usual 5K. It starts out uphill … short flat section then what seemed like a mile and a half slow steady up hill. It was an out and back course so there is a turnaround but I didn’t know that because the pain of going uphill for so long would have been mitigated by my knowing I have a long downhill on the last part of the race … At the top of the long slow … for me … uphill part there was a steep downhill with the turn around at the bottom … So you know you are going to have to go back up the steep uphill once you turn around but beyond that is the blessed long gentle downhill part … I can shamble like a corpse from the Walking Dead indefinitely on the downhill and I am not alone. Everyone who beat me looked much younger than me so I wasn’t disturbed by my performance.
I hope you see more and more health professionals at these events. It’s good to show people we are doing the things we recommend. It might be one more way to make a difference.
Until next month … get well … stay well.
Having written about cholesterol and saturated fats I now turn the Eye of Sauron towards another perennial topic which is sodium restriction. Excessive salt intake can raise your blood pressure and increase your risk for heart attack and stroke. So if salt (sodium chloride) is bad for you it should be restricted.
Lower salt intake should result in less heart disease and stroke. Unfortunately this just isn’t the case. As you will read below, cutting down on your salt intake too much can be dangerous. You shouldn’t sprinkle salt on your food even before you taste it. Even today the American Heart Association states that dietary sodium should be restricted to less than 1,500 mg a day. This guideline is exceeded by 95% of Americans! Even if you accept this premise the experts say this will only reduce your blood pressure by a few points. Going from 180/100 to 176/96 just isn’t enough to change any clinical outcomes. Don’t get me wrong: Hypertension is a killer. -It’s the main cause of stroke and a leading cause of heart disease and should be treated. Exactly how low to go is still under debate (See the recent Sprint trial). Lowering blood pressure is important. Dramatically restricting salt is just not the way to achieve meaningful results and restricting salt too much can actually have adverse effects as well. I am going to quote from several articles instead of paraphrasing as I usually do because I can’t improve on what’s on the page. Melinda Wenner Moyer wrote in the New York Times reporting on a 2006 American Journal of Medicine study: they “compared the reported daily sodium intakes of 78 million Americans to their risk of dying from heart disease over the course of 14 years. It found that the MORE sodium people ate, the less likely they were to die from heart disease.“
Don’t like that study? Too old to be relevant? How about a July 2011 meta-analysis of seven studies involving over six thousand people — published in the American Journal of Hypertension — this study “found no strong evidence that cutting salt intake reduces the risk for heart attacks, strokes or death in people with normal or high blood pressure. In Many European researchers publishing in the Journal of the American Medical Association reported that the less sodium that study subjects excreted in their urine — an excellent measure of prior consumption — the greater their risk was of dying from heart disease. These findings call into question the common wisdom that excess salt is bad for you, but the evidence linking salt to heart disease has always been tenuous.” Still not convinced? Want something more recent? The American Journal of Medicine November 2013 had this to say: “The American Heart Association recently strongly recommended a dietary sodium intake of <1500 mg/d for all Americans to achieve “Ideal Cardiovascular Health” by 2020. However, low sodium diets have not been shown to reduce cardiovascular events in normotensive individuals or in individuals with pre-hypertension or hypertension. Moreover, there is evidence that a low sodium diet may lead to a worse cardiovascular prognosis in patients with cardiometabolic risk and established cardiovascular disease. Low sodium diets may adversely affect insulin resistance, serum lipids, and neurohormonal pathways, leading to increases in the incidence of new cardiometabolic disease, the severity of existing cardiometabolic disease, and greater cardiovascular and all-cause mortality. Although a high sodium intake also may be deleterious, there is good reason to believe that sodium intake is regulated within such a tight physiologic range that there is little risk to leaving sodium intake to inherent biology as opposed to likely futile attempts at conscious control.” You have to wonder how the Heart Association can make such a drastic recommendation when it comes to sodium restriction in the face of these findings? I don’t get it but I don’t get the dietary fat recommendations either.
Until there is real science behind the guidelines I think you are best off following a moderate path. Don’t be afraid of salt but don’t go crazy either. Most importantly check your blood pressure periodically and if it is elevated get it down with diet, exercise and medications as needed. Don’t make the pills your first choice! Talk with your doctor about potassium chloride instead of sodium chloride because there IS evidence that a higher potassium diet may actually lower blood pressure! And you don’t have to take potassium pills; you can find plenty of potassium in mushrooms, bananas, green veggies etc. That’s right, healthy eating can lower your blood pressure! Why not give it a try … Utica Greens are still in season.
P.S. Remember … what happens at the Fair stays at the Fair!
Sometimes that’s how I feel. I am by no means a lone voice crying out in the woods in talking about the exaggerated benefits of statin therapy, the limited data to support dietary sodium restriction, the modest and controversial benefits of aspirin therapy for primary prevention but it sure seems like it.
I write today about birth and death. The birth of dietary guidelines and the death of common sense. I know you think the government is careful and thorough in all things…I mean look at how well Obamacare is doing, our war against terrorism, our carefully balanced budgets etc. Well, the dietary guidelines were crafted years ago…perhaps the government was somehow better, more honest then. Sorry to disappoint but read on.
I will write more about the cholesterol con in further posts but today I focus on dietary guidelines. In 1977 the United States Select Committee on Nutrition and Human Needs convened a consensus panel… (one of the participants quipped that if there was real consensus they wouldn’t need a panel) That panel concluded… despite the lack of any real evidence that dietary fat caused heart disease and obesity. Interestingly enough for you history buffs the chair of the committee was Senator George McGovern. The panel’s guidelines became the Dietary Goals for the United States and the instructions were to eat more carbohydrates and less fat. Specifically the guidelines said you should consume 55-60% of your calories from carbohydrates! As the great Dr. Jason Fung points out in his book “the Obesity Code” the American Heart Association’s guidelines in 1995 “Americans should eat six or more servings of breads, cereals, pasta and starchy vegetables and to choose fruit juices and carbonated beverages as your liquids of choice.” Six servings of bread? Carbonated beverages as the liquids of choice? This seems laughable ! How can this be a real recommendation? The results of these recommendations? Heart disease did not decrease significantly as was predicted but obesity has increased to “epidemic” proportions. Current recommendations are still based on misguided interpretations of research done years ago. There is almost no scientific basis for the current guidelines. For a an absolutely superb video on this subject… check out Dr. Peter Attia on youtube or his website “the eatingacademy.com”. His common sense, easy to follow review of massive amounts of historic and current data…the same data some of the guidelines use to make their recommendations and so much of the conflicting data that has been ignored will completely convince you of the errors of our current thinking.
Just from a common sense standpoint… who could believe that such completely natural things like eggs and butter could be deadly and you should instead use this alien yellow substance in a slightly different yellow colored plastic container. We were told the fat in milk is bad for us… not a shred of evidence to support that and instead we became a nation of soda drinkers or just as bad… juice drinkers… if, as is typical, the juice contains high fructose corn syrup. We all learned to cut off the fat from our steak while at the same time consuming more nitrate containing bologna and hot dogs. We were told that breakfast was the most important meal of the day which is worse than nonsense since the typical american breakfast consists of some cereal product. News alert… there is no healthy cereal period. It’s all processed carbohydrates. It’s the worse thing you could put in your mouth in the morning. The worse thing. I recoiled in horror the other day when I learned that a relative of mine was so proud of the fact that they had the same thing for breakfast every day… Cheerios. First, wouldn’t a little variety be nice? Who really wants to eat the very same thing every morning ? Well I could understand if the results were impressive but let’s just say the Cheerios have left an impression on my relative. A BIG impression.
So yes I am saying that eggs and butter and steak and milk are very healthy foods. The idea that you should substitute one fat for another is flawed. The one exception is trans fats… completely manufactured fats for the most part. You avoid trans fat and processed sugars when you avoid processed foods. Anything out of a box is processed. Many current dietary guidelines say to limit saturated fats and substitute fats like linoleic acid will cut down the risk of stroke and heart attack.
Now it gets interesting because recently data from the Minnesota Coronary Experiment which looked at just this question has been reexamined. As published in Cardiology Today July 2016 (hows that for current data!). The data are very damning for the guidelines. This was a double blind study involving almost 10,000 people They wanted to see if substituting linoleic acid for typical fats would cut down on cholesterol levels and heart attacks and death. Those are some easy to understand endpoints. Dr Zaomora and colleagues found that the change in diet did indeed lower cholesterol but it had no mortality benefit whatsoever. The change in diet did not decrease deaths. In fact the researchers found that as the cholesterol level lowered the risk of death actually increased! At autopsy the group on the linoleic acid died were found to have twice as many heart attacks as the regular diet group… twice the number of heart attacks!
Now I don’t trust metaanalysis data (where multiple trials are lumped together to try to find significant findings) as much as I trust the double blind trials like the one above but the same investigators included the above trial and 5 other trials and found there was no association between serum cholesterol and BMI. They found no association between cholesterol lowering interventions and heart disease mortality or all cause mortality. This is pretty damning stuff! This analysis is saying that cholesterol lowering drugs have not shown any benefit in terms of how long you will live!! This is not the only trial that has shown this. A recent paper looked at trials in high risk patients… the elderly, people with diabetes, people with kidney disease, and people who have had bypass surgery and the vast majority of these trials showed no benefit in terms of all cause mortality. Even in high risk patients… taking a statin will lower your cholesterol nicely but just doesn’t have an impact in terms of how long you will live. We will talk about relative risk and absolute risk and the number needed to treat in subsequent articles but even the most “convincing” data from a recent trial showed that a thousand people have to take the pill for years and only one person might actually live longer…that’s not very convincing or encouraging to me.
Unfortunately when you show data that disputes the current “Cholesterol is bad…if your cholesterol is high you must take a pill” dogma usually the establishment just rejects it. For example when Dr Willett …chair of nutrition at Harvard… was confronted with the evidence that changing the fats in your diet was either unhelpful or actually harmful..evidence from a large trial done using what we think are the best research methods available… his response was “this report adds no useful new information and is irrelevant to current dietary recommendations…” How do you argue with a person who won’t even acknowledge the basic data?
Well you and I have had 40 years or so of dietary brainwashing and it’s going to take more than one column to help you come into the light. For some great summer reading on this from much better and more knowledgeable doctors than myself look to Dr. Malcolm Kendrick , Dr. Peter Attia and Dr. Jason Fung.
Lest you think me a lone nut job… well I may be a nut job but I am not alone in my distrust of much of what we have been told…let me end with a quote from someone more prominent and public than myself…”It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgement of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of the The New England Journal of Medicine” Dr. Marcia Angell. Until next time…yours in gentle scepticism.
Original Published in Table Hopping Night Life Magazine, August 2016.
Sure I used to scan the obits every day when we had a newspaper that was delivered daily. I guess that dates me…I remember when we got the newspaper delivered twice a day, a time when we only had 3 channels on TV, when you had to go to the library if you wanted to research something. If my arms were a little shorter I would be reminiscent of a T Rex.
So, in this modern age you can get the obits on your smartphone but there seems to me to be something unseemly about the ability to “swipe right” to leave the obit almost like you do with a dating site. It’s just not the same on line.
If you do peruse the obituaries..a practice I know is common… one of the things you notice is that there seems to be times of year with more deaths than others. Especially around the holidays. I guess that speaks for itself but I still don’t understand it. Are some people holding on to having one more Easter with the family? I understand holding on for a grandson’s graduation or a niece’s wedding but when someone you love passes away on a major holiday it sets up immediate conflict in the cortex cerebral. You want to celebrate or at least observe the holiday for its sake and you want to give the departed their due as well…celebrate / mourn…celebrate / mourn…this is what I mean about the conflict. What I am saying here is that all other things being equal you should try to avoid keeling over on any major holiday or at any major family gathering. I’m not saying go quietly ….quite the opposite let’s go out celebrating but lets not share the memory of your passing with Passover. I think you, of all people deserve your own day. So yes I am saying that you should avoid dying during the Holidays. All of them. Still leaves plenty of other days. Obviously , most people don’t have any choice about when they die but a surprising number of people do. You know who you are.
When you read the obits in print form you can often see some people have lengthy columns and others have just a few lines. Does a longer column mean a more important life? How many inches will your column be? T.S. Elliot wrote in his poem, The Love Song of J Alfred Prufrock that we have measured out our lives in coffee spoons.Do we measure out our deaths in inches of newspaper column? The obits reflect what a person accomplished in their life…what they did and when. What they don’t reflect are the emotions surrounding their life…for that you have to read past the obits to the memoriams. These are the remembrances posted by those who remain and remember the loved one usually at the anniversary of their birth or death. These can be positively gut wrenching. A good gut wrenching can be a positive and therapeutic thing. To experience strong emotion without having some direct involvement is the stuff of Greek Tragedies. Reading these memoriams can really help you remember what’s important in life. It seems disrespectful to use any actual quotes from the memoriams but suffice it to say these are heart and gut wrenching postings. And that’s precisely why I read them. I don’t read the obituaries and say to myself…I would like a long column about my accomplishments and achievements. I can be dispassionate about the deaths of strangers. I read the memoriams and say to myself I hope my life impacts others as deeply as these people have done! You can’t possibly read these postings…some of which use standard phrasing and many are very personalized…and not stop and think and feel. I find it a very powerful exercise. Thats right…I read the memoriams to help me stay mindful about the life I am living now .
Steven Covey the author of the bestseller “The seven habits of highly effective people” wrote that one habit of success was to begin with the end in mind. It’s difficult to accomplish anything if you don’t know what you want to achieve in the end. He recommended extending this idea not to a project but to your life as a whole. He recommends that one day a year you go to the cemetery and just sit and ponder. You will be in the grave eventually…what do you want to accomplish between now and then. Who do you want to have an impact on. What will you be remembered for and by whom? Instead of just going through the motions…stop and think about your life and where it’s heading…be mindful of your words and actions.
As a physician I write about this because I think an awareness of our mortality is a healthy thing and the memoriams are a daily poignant reminder of how our lives can impact others. I dare you to read a few memoriams and not feel something. Until next month…get well stay well.
Original Published in Table Hopping Night Life Magazine, July 2016.
I have written separately about the way that Medicare and other insurance companies are going to change the way they reimburse doctors. The government wants to move away from paying a doctor or physician extender a fee for each visit and moving towards paying for measures of performance. These include the percentage of patients that have had a mammogram, the doctors immunization rate, their hospital readmission rate..their management of heart failure etc…These seem like good ideas but ,as always, the devil is in the details. One of the ways that Medicare intends to reimburse doctors is based on the management of the patients chronic medical conditions and this part is called the CCM program. Although I am no fan of a lot of things about Medicare I am a big fan of this program and once you hear about it you will be as well.
Listen, I don’t have to try to sell you anything here. This is not my program. I have a program..SignatureMD …this has nothing to do with that. This is a first ever available extra level of coordination of your care, This is a program crafted by Medicare which finally acknowledges the tremendous amount of work it takes to really coordinate care properly for patients with multiple chronic illnesses. This is not for the young , or the healthy…They don’t need their care co¬ordinated. When you start seeing more than 2 doctors regularly you qualify. When you have multiple caregivers changing medications or ordering tests you qualify. When you have two or more significant health issues on an ongoing basis you qualify. You get the idea.
Chronic Care Management means your primary caregiver is taking extra steps to have someone check up on you regularly and actively so that we know you are not missing medications, appointments etc,. You have a dedicated person overseeing all your visits. This involves making sure all the providers and whatever family members the patient has designated have all the same information. This involves more transparent but HIPPA etc compliant access to the patient’s medical history. This involves following up on all the appointments and reviewing independently all the records. This is a person reaching out to the patient on an ongoing basis to minimize the screw ups that could have serious consequences. Do I have to go there? Last month’s British Medical Journal suggested that medical mistakes could be the third leading cause of death in America. Really?! This program could significantly impact that likelihood and its covered by insurance. !!
If this is now available and you are eligible why wouldn’t you give this a try? For the doctor this is extra work and there is an extra charge. . Most, if not all, of the cost is covered by Medicare, Medicare Advantage and Blue Cross / Blue Shield. This is an available, covered, upgrade to your medical care that could save your life or your mother’s life… if you are a child living out of town or across town worried about your momma! Accurate information , easily accessed, can make an immense difference in your care and in your ultimate health care spending and that’s why Medicare and some of the big insurance companies are so interested in it. They see the financial advantage and that’s their job… I see the advantage to your health and health care!
Your primary care physician is supposed to be the conductor of the orchestra . He’s the one that refers patients to other doctors and then follows up with the other appointments and tests that were ordered etc. This sounds simple and appropriate but in the real world this is very fragmented. Some patients know the medicine changes that their last specialist made and many don’t. Some patients remember all their appointments and some patients don’t. If You have multiple medical problems or see multiple specialists… good luck at keeping the communication open and up to date. This is extremely difficult in practice. One patient could have a cardiologist, a kidney doctor, an eye doctor, a vascular surgeon, etc. and each of them is trying to keep in communication with the others and is a very fragmented system. Currently the electronic medical records do not communicate well with each other. This will not be fixed anytime in the near future. It infuriates me when patients tell me… ”the doctor didn’t have the report”… perhaps you have had a similar experience?
Once a doctor recommends that the patient see a specialist he may have no way of knowing what day the visit was, what the findings were etc. until the doctor sends his report. Some offices are quick with their reports and some are not so quick. What if I don’t get a report. How can I review a report I didn’t get? What if the patient misses the appointment or a test or labs? What if another health care provider changes the patient’s medications? Sometimes important details are lost in a 3¬10 ¬page consultation note and it is a nightmare trying to keep the medical record true and correct let alone attend to the myriad details of the outside consultations, tests and appointments. This is very difficult and important work and finally the importance of this work has been recognized and codified.
So Medicare has offered physicians a monthly extra monthly incentive to really step up and stay on top of patient’s care. To actually “coordinate the care”. This means hiring someone in particular who will monitor the appointments, the results, coordinate communication between the medical offices etc. on an ongoing basis. I can either hire one person to manage between 200¬/250 patients or I can outsource it to professionals. Luckily, here in America, companies have risen to the occasion to offer this service to physicians and their patients. The internet, the fax machine and the phone enables the co¬ordinator to work from anywhere. Anywhere for me at least means anywhere in America. The person co¬ordinating your care will be calling you from somewhere in the USA. I understand the reasons to outsource to China but this is way too important to handle offshore.
This is a new program. These are new opportunities to improve patient care. This is actually the most proactive thing for patients I have ever seen Medicare do. EVER . I think this can really make a difference by decreasing errors and increasing communication. In terms of medical dollars this is dirt cheap and can have a big impact. It’s encouraged and covered by many insurance companies and each patient can sign up or drop out anytime for any reason. I always find that type of arrangement very reassuring. No special contracts. This is an opportunity for patients to get better co¬ordination of their care by a incentivized caregiver. This sounds like a win¬win to me.
Again, this is not some crazy program I have cooked up. This is a program that has been encouraged by the government and is part of current and future Medicare programming.
Usually the other major insurance companies follow suit. For people with complicated medical situations or any combination of serious chronic medical conditions this level of oversight can make a real difference in your health. Best of all is that this is not some limited time offer, this is not something available only to the first 100 callers… this is something your primary care practice can be doing. This, as I have said, is a new program and many practices just don’t know how to approach this program but it’s something that every office can do in one form or another. This program, like the cognition test Cognivue, passes my test. For me the test.. ”Is it in the best interest of the patient?” This could be a great thing for patients if it works out. It may turn out to be too good to be true but you must know by now that I am an Optimist. Check out this new program and how it can make a difference in your life or the life of someone you love! This is the shizzle my nizzle!
Original Published in Table Hopping Night Life Magazine, June 2016.
Some pundits opine that with advances in medicine the average life span can be extended to 120 . After all ,wasn’t the average lifespan just 30 or 40 years of age something back in the 1800’s?….we are so far advanced from that time period it should be easy to extend life from 80 to 110 or 120?
Well, It turns out that the real life expectancy has not changed much in 2000 years. After all Socrates died at the age of 70…and it wasn’t from natural causes at that. It turns out that the claim that average life expectancy was 35-40 was very much skewed by infant mortality and that the usual span of life hasn’t really changed over time. Sure, we have made strides with public sanitation and infection control but that just means that the average person is living longer not that we have extended maximum life expectancy over time.
Sure there is evidence from manipulating the environment in nematodes , yeast, mice, etc you can increase longevity in these lower species but really..?? Really? Are you serious about comparing human beings to worms and yeast?? I would trust more the research from the primate world….that at least might have some real relevance to our species. Nature magazine published in 2012 a study of 25 years of primate research that involved caloric restriction as a means of living longer. Caloric restriction is one of THE leading concepts in life extension. Eat less and live longer has been shown to extend life in much lower life forms. The Nature article showed no benefit to caloric restriction in extending life duration.
Before we go organ by organ in our search for long life let’s quickly dispense with all the cloning and gene splicing come on’s. We are just as likely to unleash some alpha helix armageddon as we are to cure any real disease or extend life and neither is likely in the lifespan of anyone reading this article despite all the recent headlines so let’s move on to what’s currently plausible.
Alright ….let’s take this one organ at a time…..We can keep your heart going or use a replacement or artificial pump..we have this technology already. We can keep your lung function going indefinitely with the respirator. We already have the tech to replace your kidney function. We can’t replace your liver function yet but we will have artificial pancreas soon and we can control your gastric system very well. Sure your joints will suffer over time but we can design exoskeletons to support us in our dotage. We can replace your blood and most of your joints and there will be artificial skin aplenty. BUT the one thing we can’t seem to make any headway in life extension is mentation. The body functions we can maintain perhaps indefinitely but the brain seems to wear out at a certain point regardless of what we do.
Before I unload the truth as I know it on you let me share the thoughts of some of the leading experts in longevity. Thomas Perls is the Director of the New England Centenarian Study at the New England Medical Center. He believes that Iron is a cellular toxin and that we can extend life by decreasing our iron load. He therefore donates blood every 8 weeks to keep his iron level on the low side. Lower iron levels might be one reason women typically seem to live longer than men.
Perhaps you prefer the advice of Dr. Mark Mattson ,Chief , Laboratory of Neurosciences, National Institute of Aging,National Institute of Health…He advocates intermittent fasting and keeping daily calories to below 2000 calories a day.
Personally I rather like the advice of Felipe Sierra, Molecular Biologist, Director of Aging Biology, National Institute on Aging…”I laught a lot” …Reflecting his scepticism about the current state of life prolongation.
So the experts have weighed in but I would like to add my three cents as to why living longer is not really such a great thing for individuals or for society.
Think what this would do to the divorce rate?….People have a hard time in this day and age to stay married for 10-20 years….If you get married at age 20 and are likely to live to120 what is the likelihood that you will still be with the same person? Living longer doesn’t necessarily mean living longer happily together.
Who is paying? You know most people don’t plan for retirement already…if they live twice as long someone is going to have to pay to take care of them …how can this be sustained? Where will these resources come from? The social security lockbox is already busted open…who can afford for you to live longer and almost certainly need more care as you get over the 100 year mark.
What’s the point of sustaining the body when the mind has faded. What do we do if the limiting factor is your mental function. Even those geriatric patients that have been able to avoid dementia at an earlier age eventually have more trouble with memory and cognition. There are a very few people living into their 90’s and beyond with remarkably preserved mental function. Most people hit the memory wall at or before the age of 85 plus or minus 5 years and it’s all downhill from there. Is there a point to living until 120 years of age if the last 10 years are in diapers?
On a more philosophical note I would suggest that most people have a much more limited existence after a certain age….Depending on the person this could be at age 50 or age 75 but sooner or later most people start to really “ turtle up”. They do less and less…don’t go out as much, don’t interact with family as much, don’t travel as much,, do less and less in their social groups, the church, etc ..in short….don’t live as much.. Is it too offensive to say they are slowly shutting down and I think their quality of life dwindles incrementally ?. My sister Marijo, tells me that I am too judgemental….If they are happy to go from bedroom to couch to kitchen with slippers and doing the tea and toast thing and slowly slip away who am I to judge? I just don’t think that’s the best way to spend your golden years. I’m just saying that most people don’t do more, try more, press onward as they reach the last chapters of their life and I am afraid that living to 120 is only going to prolong the most difficult chapters not the most desirable chapters.
I close by exhorting you to carpe diem! Living long is, I am sure, a desirable thing but Living well I think might be a better goal. Until next month….get well …stay well!
Original Published in Table Hopping Night Life Magazine, May 2016
One of the things I hear patients talk about when they mention Obamacare is the “death panels”..as they sneer these words they look to me for some knowing and indignant nod of agreement at this latest oppressive government outrage.
Unfortunately, they are again disappointed in me because I stop them in their tracks when I intone…”We need the death panels…the death panels are a very good idea…I’m all about the death panels !”
The term “death panel” conjure up some white coated tribunal of indifferent doctors ..hired guns as it were …strangers who will chose who lives and who dies. Which grandma still has a little life in her yet. Whom to refuse fourth line chemotherapy. Which sick little baby will be tossed off the side of the mountain as the ancient Spartans used to do with children who did not seem whole and well. Cruel, Arbitrary and Indifferent ! Who could be comfortable with those decisions?!
Swap out the word “independent” for “ indifferent “ and I am actually down with the plan. You will be as well once I have explained things from my standpoint. When you really think about it, and I don’t blame you if you haven’t been preoccupied with this subject… who better than to decide on your medical fate than a professional medical team of independent experts. This isn’t about the death panel randomly picking out people at Destiny USA for harvesting like some grim reaper Halloween pageant. This whole issue is about what to do at the end of meaningful productive life. This is about not torturing Grandma during her final days despite the well meant desires of their family.This is not just about what makes economic sense. Frankly I think economics should not factor into the equation in any way shape or form at all but you can’t be ignorant of the financial issues. WNET news reports that “Medicare, the health insurance program for the elderly, spends nearly 30 percent of its budget on beneficiaries in their final year of life. Slightly more than half of Medicare dollars are spent on patients who die within two months.” That’s a staggering amount of money and sadly it’s usually poorly spent. Way too many grandmas spend their last few days on Earth in some oddly lit room full of strangers and stranger equipment…often tied up to the bed or some equipment , sedated lest they pull on their life support. One tube going in here and another tube coming out there Never well enough to have meaningful communication with their family. Dragging out the inevitable process from hours to days if you allow nature to take its course to weeks or even longer if “all measures are taken” to keep grammie going . I’m sorry but that’s just not right!
Although I am sure Obamacare’s underlying concerns are financial I view the Death Panels from a more moralistic standpoint. Sometimes enough is enough. Just because you can artificially prolong someone’s life doesn’t mean you should. My sister who is a doctor in Florida once approached my mother with consternation and although I wasn’t there I imagine a little indignation as well…”Mom” she decried .” Do you know that your health care proxy…your first born son ….Bud..(meaning me) ….has told us that if you were demented and in a nursing home and had pneumonia ….he would withhold antibiotics ..he would just let you die ! “ My mother responded ….”That’s precisely why HE is my proxy and YOU are not ! “ I know Momma wouldn’t want to be kept alive under those circumstances…and I have the conviction to honor HER wishes. Not impose my own.
That’s always one of my founding principles…do what the patient would want…not what I would do or what the family wants….What would the patient want had they still had the capacity to tell us? WWMW..What would Momma want ? That actually makes it easier for me. I feel better when I am honoring the known wishes of the patient. Having said that I also feel there is a place for an independent evaluation of the end of life situation.
There comes a time…and it’s almost always involving the hospital…when the question has to be raised ….Are we doing too much? Have we gone too far?.. I think there is a place for an independent panel to weigh in on this issue. If it’s obvious that we are dealing with a possible end of life issue I think we should call a “Code White” Although we can work out the details later it would be, I think, relatively easy to convene a panel of independent doctors who can evaluate the situation and the patient and weigh in on the appropriate use of advanced life support. Mind you these people would never have the last say in what happens to the patient but they would determine whether insurance of any kind should pay for the care.
So I could envision this scenario…..Your mother has advanced dementia and hasn’t been able to say the names of her kids in years or live independently. She gets pneumonia and is hospitalized. She does poorly despite usual hydration and antibiotics…and the questions become….should she go to the ICU for closer monitoring?…should she be fed by a tube since she is not eating well? ….How many tests and procedures to put her through ? CODE WHITE …is called an within a day a panel of doctors would have reviewed the chart and examined the patient and would be able to weigh in as to what’s the most appropriate thing to do. At that point they would not say what could or could not be done but would say what would be covered by insurance. It’s OK to say “Keep Momma alive at all costs !” But it’s also OK for a panel of experts to say …”We feel that aggressive care is not appropriate but It’s fine if you want to proceed but it’s not going to be covered by insurance and its 5,000 dollars a day for the ICU and can we have 3 days stay in advance.?!” . Of course there is the risk that these oversight doctors will be incentivized to cut short care to reign in finances but what we have now is just as bad….No cost control whatsoever and even worse …no routine evaluation of the appropriateness of care. You rightly fear a government that will devalue lives but I see every day where we , from an understandable combination of love and regret and fear , put our loved ones through procedures that rob them of their dignity and deny them a comfortable reflective peaceful passing. We can do better…we must do better and the Death Panel conversation is a good place to start.If this article does nothing else but get you to make sure Momma has a Health Care Proxy and someone both knows what Momma wants but has the strength to carry out HER wishes then I have been of service…
Until next month…get well …stay well….
I am wincing as I type this….no, not from my painful turn of prose…I took a beating in the dojo where I attempt to learn jujitsu. Well, the truth is I take a regular beating there but this one taught me a lesson. Hopefully only a temporary pain but a long remembered lesson. I love jiu jitsu… it’s like adult wrestling and chess mixed together.
…and the workouts where you spar / grapple / roll even for 3 minutes can leave me feeling exhausted. I love that feeling. If I am going to work out I want to feel beat afterwards. Jiu-Jitsu_Brasileño Now let me admit that I am terrible at jujitsu as my attendance has been less than stellar this last year. When you don’t practice often enough it’s hard to remember the right moves and counters. I know that if I go more often that has to help. Since in my profession I exhort my patients to work out more regularly I thought it would be wise to practice what I preach and make jujitsu attendance a bigger and more regular part of my routine. So,I set my schedule for twice a week. Between twice a week at the dojo and my biweekly sax lessons I am bound to improve myself somehow and someway. So there I was at class last friday. rolling with a guy less than half my age, twice my strength, and much higher belt level. I knew this guy doesn’t roll lightly. But I’m there for the challenge and besides when you are as old as I am, relative to the rest of the class…and as inexperienced as I am ..pretty much everyone is better than me and I am bound to get whooped each and every time. My ego can take it and it’s always great exercise and hopefully I am slowly getting better. I like it when my opponent has a serene look…this one guy wouldn’t recognize serene if he saw it in a magazine. Maybe it’s my innate paranoia but I get a subtle “ I’m not going to get much out of rolling with this guy..it’s a waste of my time “. That’s absolutely true…!! .I have watched him roll, he is very good and goes hard so I understand where he is coming from. During our roll he actually took it easy on me and I think that might have pissed him off even more because even when he went easy it was hard for me to sustain an attack or defend myself. During just one of the many times he was choking me or using an arm bar I might have resisted a bit too much for too long and got myself in a position where my opponent was locking my arm up to make me quit. Whenever you feel you have been bested and are ready to admit defeat and start again all you have to do is tap the other guy and they will let up. When people don’t tap they are telling you to use more pressure, better technique etc before they will admit defeat. So when I didn’t tap immediately the higher belt took it to a higher level and we could both feel when I hyperextended my elbow. It didn’t get dislocated just stretched a wee bit more than usual. It felt funny for a second then everything was back to normal and we continued the three minute session. I rolled with two more guys before I staggered off the mat. It was only later while driving home that it started to hurt. I knew nothing was broken …just painful. It was very tender today but there is still fullish range of motion and terrible swelling or bruising so let’s see how it goes before I go running off to the doctor. As long as it gets a little better each day I will just follow it. I had already learned long ago that active people will get injured. You can’t stop because of injury …you have to modify. This elbow thing will not allow me to use the rowing machine so I will spend more time on the bike and ski machine. No the lesson I learned this time was to TAP EARLY! Don’t be all macho on the mat…When you know you have been beaten… accept defeat and move on. Leave the dislocations to someone else…anyone else. I am not normally a guy that says “Know your limits.” How can you know your limits without testing them? Don’t sell yourself short. I try to remember this is a marathon not a sprint. If I resist too much and get hurt that affects my overall ability to train. Recurrent injuries have made many a person finally give up their sport. If I take it a little easier I can stay in the game longer. Let’s see if the other guy is still rolling when he is my age.! Jujitsu is one of the few sports you can do at any age…you don’t see a lot of guys playing baseball, basketball, soccer or football as they get past 40 years of age…but you can “roll” on the mats until an advanced age if you have the desire. I hope you have some physical activity you can keep interested in through all phases of your life. Until next month…get well …stay well…and when you get injured regroup and get back in the game !
Well, It’s February and that means Valentine’s Day is around the corner. Hopefully you are not expecting “that column” The one where I say how important sex is to men and how easy it is to make us happy. Before the cat calls of chauvinism start I am only echoing the sentiment of Dr. Ruth, Dr. Laura, and the girl from friends.
RFH_WordCloud2No, love is an easy subject which you will be saturated with on the radio, TV, newspapers etc. Writing about love and sex ..two different but important topics …that’s the low hanging fruit…too easy for me. Been there done that. Well perhaps just one suggestion…use oil…use lube ..it works on the feet, it works on the neck and it works on the tender bits. It can really make a difference.
Speaking of making a difference I am writing this week to bring to your attention the idea of a WORD CLOUD for someone who is sick and or dying. OK, pay attention, this is important for a change. Most of you will turn from this. I don’t blame you… it’s a tough and touchy subject .Perhaps just one amongst you will follow the advice in this column and that would be worth it .That would make a difference. I know it’s not an easy subject but it’s an important one. elderly-hospital-patient-1437289
I write today about word clouds. Specifically, word clouds for people who are very ill. Let me explain…this is not an original idea on my part. This comes from an article printed in the Annals of Internal Medicine last year. Listen, serious illness, death and dying are tough to write, read and talk about but it’s important and can make a big difference. The full article involved transitioning the patient from the medication and procedure centric focus to focusing more on the wishes of the ill patient. Basically you have a frank conversation with the patient…The last chapter of your life is being written…you can tell us what’s important to you and what you want to accomplish before the last page is turned. “I want to see my nieces again” “I want to reconcile with my ex sister in law” “I want to get in the garden again and surround myself with the sights and smells of the flowers” “I want to have this music play at my funeral etc”. This is difficult stuff and many people shy from it…both health care professionals and patients and family alike.
words-639306A word cloud is basically a message board. It’s a framed collage of words as a keepsake for the patient AND family and friends. You bring a board you can write on…Put the patient’s name prominently in the middle and have staff, friends and family mark it up as they see fit. People can add special expressions or pet sayings or phrases…something that connected them to the patient. The word cloud prompts recollection and reflection. Family sees and contributes …Friends see and contribute. This connects everyone to everyone else. This gives people a focus point for conversation when they come in the room. It gives you something else to focus on other than the hospitalization and illness itself. Visiting patients in the hospital …especially seriously ill patients can be very uncomfortable for people. This is a way to focus the conversation away from illness and towards the patient and their shared memories. It doesn’t have to be just “how’s the food” and long awkward silences. Instead you can focus on the Cloud Board ..“I wonder who wrote that !” “I wonder what this means?” When the hospital staff see such a visual expression it acts to remind them that it’s not just another body in the bed…it’s a “touchstone to appreciate the footprint of the patient’s life and to learn what mattered most to the patient.”Doctor_consults_with_patient_(4)
Let’s say the patient improves and goes home…they have a great memento of the experience with real comments from real people about themselves. Not just an inexplicable hospital bill. Let’s say the patient succumbs from their illness…the family has a one of a kind memento of the patient which can be brought to any service they might have …and can serve as a visual remembrance for years to come. Flowers fade. Notes get put in some drawer. This word cloud will long serve as a reminder of the patient and who they touched in their lives. I sent an example along with this article that hopefully they can reproduce to give you a better idea of what I am talking about…a picture is worth a thousand words they say .
As a doctor I struggle with the idea of making a difference in someone’s life. I struggle too with making a difference in someone’s death or serious illness. With this word cloud idea I think I can make a real impact in how people deal with the process. You can too. This doesn’t have to come from the doctor. In fact I don’t ever see this coming from the doctor or staff so it’s up to you! You CAN make a contribution during this difficult time…a contribution that will stand the test of time. Go, make a real difference. I’ll be here when you get back.
GET OUT! Is it Christmas time already? It’s a wonderful time of the year but it’s very stressful for a lot of people. The traveling. The shopping. The scheduling. What to get for who. It is a very busy time for most people. Busy busy busy but it’s important to stop and take stock for a moment.
Dare I say be mindful? When people are “busy” they are getting stuff done but they are usually not thinking much. Not thinking about their lifestyle. Not thinking about what’s really important during this Holiday season. I love the line from Dickens’ A Christmas Carol where Scrooge is confronted by the ghost of his long dead partner Jacob Marley … Scrooge complimented him on his business acumen when alive and the ghost remonstrates, “Mankind was my business. The common welfare was my business; charity, mercy, forbearance, benevolence, were all my business. The dealings of my trade were but a drop of water in the comprehensive ocean of my business!” His trade was not his business! Let me help. Let me give you a couple of ideas for the holidays. First…the gift of massage…Get someone you love a gift certificate to massage therapy.
It’s the antidote to busyness. There are a few people out there who don’t like massage and we are rounding them up for analysis but they can always re-gift the certificate. The nice thing about the gift certificate is that the person you give it to can arrange when they want the massage…It doesn’t add to the scheduling stress of the holiday. Also, consider the gift of a yoga class…nothing is more relaxing and revitalizing as a yoga class…you might not have thought of this as a gift idea but it’s a good one…for an interesting variation that even my wife liked…try Aerial Yoga! Even your friends that have everything or have tried everything will have been unlikely to have tried this yet. Lest I leave the wrong impression…my wife is super easy to please…she just doesn’t find regular yoga strenuous enough…not enough sweating for her hour of exercise…She was, however, very impressed by the aerial yoga.
Second…the gift of your company. Take your aunt out to one of the seasonal events…Maybe you have done Lights on the Lake one time too many…still plenty of other venues for you. Take them outdoor skating downtown. Not very expensive but it will be a memorable experience for everyone. Take them for a horse driven carriage or sleigh ride at Highland Forest…being on the sleigh covered with a blanket as you glide along the pathway with the twinkling of the stars competing with the jingling of the bells on the horses…memory magic! Let me recommend the Desantis Xmas at the Palace show. Hearing seasonal music done by live local talent in this great venue never gets old to me.
Often, they have talented kids from the local schools perform and that’s bonus time! This is a great show for the young and old and everyone in between. The popcorn made fresh in the lobby is another draw for me. My office is one of the sponsors for this show and we never miss it!
Also, the Winter Solstice Celebration is coming back to Syracuse. This show will be at St Paul’s Cathedral downtown and run for 34 nights. When the Solstice Celebration was last in town it was an eclectic mix of solemn, seasonal, and joyful music. You will leave the Cathedral uplifted and how many events can you say that about!! There is so much more to recommend…Spend an afternoon snowshoeing or X country skiing with family or a friend. Being outdoors in this weather is very very good for you…it increases your metabolism and helps you burn off some of those Christmas goodies. Bottom line is that this holiday should be about you growing your personal relationships not your relationship with Amazon Prime. Merry Christmas and Happy Holidays to one and all.
I have studied diabetes for years…all primary care doctors have…but only recently have I been exposed to a concept that can really make a difference in the care of diabetics. One of my Signature MD patients sent me a link to Dr Jason Fung …a doctor with a “new” approach to treating type 2 diabetes. Immediately, I saw the rightness of the idea. There have been multiple new drugs in the past several years but they just increase our medication choices…they don’t have a meaningful impact on changing the lives of diabetics. When you become a diabetic you go on one med…after a bit you go on a second med…eventually many people go on an injectable agent…all the while monitoring their sugars, blood pressure and cholesterol levels routinely. We are treating the sugar number but not the underlying problem which is that your insulin levels are too high.
am talking now about the very common type 2 diabetes not the uncommon type 1 diabetes where they don’t make enough insulin. So, most diabetics have insulin resistance and high insulin levels. High insulin levels prevent you from burning fat, High insulin levels cause weight gain. High insulin levels keep your belly fat growing. High insulin causes salt retention and therefore raises blood pressure. So, high insulin levels bad. Now the current diabetic teaching is low carb, frequent small meals etc… Not bad advice but nowhere near the best advice for treating high insulin levels. To treat diabetes and prediabetes effectively you must get the insulin level lower. Turns out that this is possible and doesn’t require any strange new meds, treatments or therapies.
Ok, how much extra time in your day do you need for this new treatment? How much money will it cost? How many choices will you have to make each day? Special equipment? Extra doctor or professional visits? The short answers are that it frees you from too many choices. It will save you time. It will save you money. No special meetings or equipment needed. Do I have your interest piqued yet? Well, I am talking about intermittent fasting. Fasting lowers your insulin level back to normal. This allows you to start mobilizing the fat in your body. Fasting reverses all the metabolic processes that insulin resistance causes.
There are many many types of fasts…I have gently recommended the 5:2 diet for years….5 days a week you eat healthy…2 days a week you take in only 500 calories or less. This is simple, basic and reasonable. I recommend doing the two days in a row for best results but you can vary the schedule to suit you. The intermittent fast recommended by Dr Jason Fung involves skipping breakfast and lunch every day and only taking in calories from 610 pm at night. Yes, this flies in the face of all the recommendations that you should eat a big breakfast and or have 5 small meals a day. If you follow that advice, you will keep spiking your insulin and weight loss will be much harder. This advice certainly has not made a dent in our diabetic problem or obesity problem. With intermittent fasting you don’t have to make a decision as to what to eat for breakfast or how to manage eating lunch on the road etc.… You don’t have to spend extra time in the gym, buy special scales or tubs, or learn anything new about calories, fats, protein etc. The first few times are psychologically daunting but almost UNIVERSALLY people that do the intermittent fasting FEEL BETTER. More energy. More mental focus. Less stomach issues. As the doctor said on one of the many videos I reviewed for this issue, you can do the test of 1. That is , try it for yourself ..you be the judge. You don’t have to ask anyone else what happened to them or how they feel. You can try fasting for yourself and see for yourself and feel for yourself the benefits. “Oh I could never fast…it’s just too hard !” Really? A billion people fast for Ramadan, Hindus, Buddhists, and old fashioned Catholics all have experience with fasting.
I am not going to give you the play by play because it really is just that simple…black coffee and water only until 6 pm. Eat healthy or not for 4 hours then no food after 10 pm. There are many variations on the Internet. Start with Dr Fung on youtube and off you will go. By the way…this is not really some new fad or trend. Fasting has been around as long as we have. When people tell me that it’s impossible to do I refer them to the TV show…Naked and Afraid ..where strangers are put together in the wilderness for 21 days to survive. The vast majority of them never find anything to really eat and that has not prevented anyone from completing the challenge. They might get sick from drinking contaminated water but no one quit due to lack of calories.
You don’t have to need to lose weight, you don’t have to be a diabetic, you just have to want to feel better. If you are a diabetic on lots of meds it would be prudent to check with your doctor about which meds to cut back etc. Your doctor should be sympathetic to your efforts even if he is not familiar with fasting. If he can’t be bothered perhaps it’s time to upgrade your medical care. When I mentioned fasting to one of my colleagues he opined that he thought the idea made sense but that we couldn’t get people to go along with it. I have more faith in you than that.! Did I mention that people who do fast say they feel physically and mentally better!
Let me close with a few quotes about fasting so you know it’s not just me! “Humans live on one quarter of what they eat; on the other three quarters lives their doctor.” Egyptian pyramid inscription, 3800 B.C. “Fasting is the greatest remedy the physician within.” Philippus Paracelsus, one of the three fathers of Western medicine “Instead of using medicine, better fast today.” Plutarch, a Greek biographer and moralist “The best of all medicines is resting and fasting.” Benjamin Franklin Until next month…get well stay well…
I am trying to practice what I preach…I have always believed that good living will trump most medications. I am not saying you can treat all medical problems with diet and exercise but I am saying that lifestyle is more important than medications.
Look up the treatment recommendations for hypertension, heart disease, diabetes, arthritis, etc and the first line will say either diet and exercise or lifestyle modification which is really the same thing. Your doctor glosses over this because he or she has no control over what you eat or whether you work out…What we in the medical profession can control are the meds and you know we love our pills! We give out pills to help you sleep at night and then another pill to keep you awake during the day. One pill for your blood pressure and another to counteract the side effects. When you add in the supplements and the vitamins and aspirin many people find they are taking 10 pills a day or more. We can’t control you but we can control the pills we give you.
So, my mantra has been diet and exercise…exercise and diet…I read somewhere that to get the same benefit a person gets from statin drugs (the popular cholesterol lowering drugs like crestor, lipitor, zocor etc ) …the radical alternative that has the same benefit as the statins….eat more veggies ! Now I am talking about primary prevention here… If you have already had a heart attack, blocked arteries, stents, stroke, diabetes etc that’s secondary prevention and the statins are very important for those people.
The debate has raged however as to how important it is for the average Joe to take a statin. Some doctors think they are overprescribed while other doctors think practically everyone should be on a statin. The studies are reviewed all the time with different conclusions depending on who is doing the interpretation. The most recent recommendation regarding statin use involves using a risk calculation like http://cvdrisk.nhlbi.nih.gov/..If your 10-year risk is higher than 7.5% you should consider a statin. This number is calculated by putting in your sex, your age, your cholesterol number, smoking status , and blood pressure information.
So, I try to plug in my numbers and when I punch the calculation button I get an error message. It seems my cholesterol level is so high that the computer assumes that I mistyped the number. My cholesterol is so high that when I tried to get life insurance years ago the agent said…don’t bother to even apply. My response at the time was to show them my recent cardiac cath results which did not show any blockage. So even though my cholesterol was high…it was not sticking to my arteries. They didn’t care that I didn’t have blocked arteries …they only cared about the number on the paper…So I went on meds…got my number to where they wanted it and got my insurance. Of course I stopped the pills afterwards…I am not a pill guy if I can help it.
Fast forward to this month…From time to time I get chest symptoms. Could be anything…probably nothing but that’s not how I treat my patients. If you worry about some symptom and some test can give us information why not get the test? At least twice a year I will push myself past the limits of my endurance physically…usually hiking and skiing with the Clan Haswell. I would rather not keel over in the near future because life is great right now. My wife still seems interested in me and my professional work has never been more satisfying with Signature MD so I would like to stick around long enough to at least see how Iran, Greece and China all play out.
I told you that I took meds to get my cholesterol down…I didn’t stay on the meds…I don’t like meds and what I read says you can accomplish the same thing with the right diet and exercise program so that’s what I concentrate on. But am I being stupid not treating my high cholesterol? Are my arteries slowly and silently clogging up? In my favor is the fact that I am not a smoker or a diabetic ..that makes whatever cholesterol you have stickier. Also, my family history is good…neither parent having had an mi or stroke. So , do you go with a good family history and lifestyle or go with the population based scientific calculation. Well, you don’t have to be abstract about it…you can just measure the amount of blockage and act accordingly. So, last month, I went to St Joseph’s Hospital and had a heart catheterization. They snake a wire from your wrist or groin to your heart and inject dye to check the arteries. It’s an interesting sensation. Not pleasant but tolerable. Dr Simon and his team were very professional …not even giving me grief about my not wanting to take any sedating meds. I don’t like to alarm my wife and I figured if I skipped the sedating meds I could drive myself home. My wife is a working girl after all and no need to keep her from her job. Bottom line is that there were no real blockages. Maybe a little plaque here and there but no blockages that needed stents, balloon angioplasty etc. If that’s all the blockage I have after 57 years of genetically high cholesterol I am doing the right things!! Maybe the tequila has some role in keeping the arteries open but that’s another column altogether. Until we know for sure I am going to credit the exercise and diet. I feel a little vindicated with my diet and exercise mantra. I also think having a persistently optimistic attitude is also important but that may be more for my head than my heart. There is data to suggest that being happy…having a positive attitude ..is as important for your heart as it is for your head and I want to believe that as well.
The deal I made with the heart doctor was that if there was any plaque at all …any narrowing…I would go on the statins. I don’t like statins but a deals a deal. If they will only come up with a pill I could take Sundays only…that way I could be possibly compliant with doctors’ orders. Just because I think I am a good doctor doesn’t make me necessarily a good patient!
So, just like I preach and practice…if you worry about a possible problem and there is a test for it…why not find out for sure. You know I don’t like surprises or guessing. When it comes to your health you shouldn’t either. Never be afraid to be proactive with your health…It’s not wrong to say to your doctor… ”This is my symptom…this is what I read about it…this test seems to provide clarity…is there a reason I should not get the test?” Until next month… Get well… Stay well.
I had an article ready to go but I was then reminded that the New York State Fair opens up soon. As a dedicated health professional I would be remiss if I didn’t have some diatribe against the artery clogging junk to eat at the fair. In fact, I know I wrote about this exact same issue previously…I could just go back and cut and paste and who would know or care. Sorry, that’s not the way I roll. This is fresh off the cerebral cortex stuff but it will be very familiar. If I am going to preach about the same lifestyle issues over and over again I better have that patter down pat…so to speak.
The important principles of how profound an effect that diet and exercise can have in your life and health don’t change but the ways to approach and illustrate them sure can. What can I say to those that don’t go to the fair? It boils down to this…anyone who doesn’t go to the fair is hiding something. That’s right, hiding something. Maybe they say, “It never changes,” but they are hiding the fact that they are too weak to make it around the fair on their own. Oh, maybe they are hiding the real fact from you but I think they are often hiding the reason from themselves as well…Not wanting to acknowledge their debilitated status. Maybe they say, “All the food there is unhealthy,” but again they are really hiding the fact that they have a hard time making food choices. If you call them on this they will say…no…I just don’t like the fair…to which I have always countered with, “What’s not to like?” but now I see I will have to ask, “What are you hiding?” All those people who say I went for 30 years in a row…What made you stop? Did you start doing something else instead?
The exaltation of the Fair is easy. First, is its proximity people! The damn fair is in our backyard and for that reason alone deserves a visit. As do the Zoo, the Everson, the MOST, Symphoria, Syracuse Stage, etc., but they are here year round. The State Fair is more ephemeral…here but a few days at the end of summer. Gone before you have even gone through your full list of reasons not to go. The Fair IS exercise! Walking, walking, walking…it’s exactly what I preach. You can walk miles at the State Fair and not see everything. There is indeed always something new at the Fair …maybe not something monumental but always something new. There is always a lot of educational stuff at the Fair and you know I preach about feeding your brain. Free music…and you know how I preach music therapy. The midway, the crazy deep fried “what-the-hell?”, the animal barns, the Native American area, all have their own allure.
The Fair IS diet! Rather it’s a chance to test and challenge your diet. If you plan ahead, you can easily modify your diet and exercise enough before and after the Fair that you can overindulge on your favorite fair food. Are you on some “diet” you have to adhere to rigidly to get results or do you have a “lifestyle” that allows you to go buck wild on the deep fry but then rein it in the next day. Why would you go to the fair and look for a salad?
That’s not just silly its insulting! I couldn’t find a green salad so I had to settle for the Blooming Onion!? People Please! Now, there is one caution about the Fair. If you are over 50 you are crazy to go on any of those vomitorium rides. You have had your brain jostled and giggled around enough already…don’t add insult to injury. Go ahead and do the Ferris Wheel and try your luck at one of the squirt gun games but avoid all the upside down, back and forth stuff if you want to stay out of the nursing home. So, overall the New York State Fair is good for your health. I will pit the walking against the fair food any day…the secret of course is to make it any day…any one day…not every day! Get out of your rut. Try something new. Try something that you “used to do.” Keep up those traditions whatever they may be….well ok…drunk and disorderly is not a good tradition but you know what I mean. Get yourself to the fair and challenge yourself!
The experts claim that one in three Americans will suffer from Alzheimer’s disease. Suffering is a relative word because honestly most of the suffering done with Alzheimer’s is the suffering of the caregivers as the patient themselves is usually unaware of their condition. You suffer through cancer…you suffer through depression…your family members are the ones that suffer when you have severe memory loss. Alzheimer’s is listed as one of the top 6 causes of death in America but before it kills you it takes a toll on you, your dignity, your family, your bank account, etc. Dementia is probably the #1 diagnosis in the nursing home and therefore at $8,000 a month, per patient, it’s probably one of the most expensive diagnosis to treat on a national level. Maybe one of those wildly expensive chemotherapy agents are more expensive but usually they’re used for 6 weeks or 3 months whereas dementia can persist for decades.
I don’t actually use the term Alzheimer’s much…It’s really a diagnosis that can be made with brain evaluation at autopsy and it’s just a name…I prefer to call it by the more practical and less charged name…memory loss.
That’s what I see and that’s what I try to treat. You could call it Alzheimer’s, you could call it Binswanger’s disease, you could call it Lewy body dementia, you could call it senile dementia, you could call it multi-infarct dementia but the bottom line is the person has a functional problem with their memory, usually short-term more than long-term. They might remember the name of their second grade teacher but they sure don’t remember where they left the car keys or that they wrote two checks to the cable company and one to the gas company. There are some new and up-and-coming brain scans that might help decide whether you have in particular the typical Alzheimer’s changes, but it doesn’t matter much since the treatments are all the same. There is no good reliable blood work to aid in diagnosis. Diagnosing dementia is like diagnosing Parkinson’s. It’s best done by the same observer evaluating the patient over time and seeing what changes occur. Unfortunately, in the modern doctor’s office the typical patient can get in and get out and be quite demented but not picked up by the doctor if he doesn’t ask the right questions. In an office visit with the doctor checking the blood pressure, checking the meds, checking the cholesterol and attending to any issues with the insurance company it’s hard to step back and ask “by the way can you tell me the name of the last 3 presidents? By the way can you remember these 3 words and draw me o’clock etc?” It is not particularly hard to do. You just have to have the time and interest… I have seen many people that were really having a lot of trouble with their memory before it was picked up by their healthcare professional because they didn’t think to ask the right questions. You don’t require a psychologist, or a neurologist, or any specialist to diagnose dementia.
So dementia is diagnosed by asking patients questions. You can use formal testing like the Mini-cog, or the MMSE, or the SAGE questionnaire, or you can diagnose it informally. Once you look for it, it’s not hard to diagnose. On the other hand many people have mild cognitive impairment and never go on to dementia and it is hard to determine who will progress and who will not, and that’s why it is best managed over time by the same professional doing serial observations.
Now, the treatment for dementia is unfortunately quite limited. None of the current prescription medications cause significant and sustained improvement in cognition. The best we can say is that these medicines keep the patient as they are, and delays deterioration, but even the most ardent user of these medicines, if they look at the literature, realize they lose their efficacy within a year or year and a half. I wanted to be known as a very aggressive dementia doctor and so when the NIH recommended that we use Aricept and then add Namenda that’s what I did. I happily told patient’s I was following the NIH recommendations proving to them that I was an up-to-date well-informed physician. The only problem was this combination didn’t really work well for the vast majority of patients I treated. There might have been a patient here and there that the family said they noticed some improvement temporarily, but it wasn’t common. Additional experience with these medicines over time has continued to disappoint. Not only did these drugs not make a big difference…they also had side effects. My experience has shown me that in point of fact the benefits are quite minimal and the side effects are real, not dangerous but real. I have had many patients stop these pills and either did not deteriorate further or improved off the medicines, so my view of prescription treatment for dementia has been leavened by experience over time. There are also 2 medical foods/nutritional supplements to treat dementia as well and they include Axona and Cerefolin NAC. I like the idea that there would be some vitamin you could use that might actually have a clinical effect because I think there are less side effects with these prescriptions then there are with the other drugs mentioned previously. Unfortunately, these nutritional supplements are not usually covered by insurance because they are considered vitamins but they are not available in GNC or Natur-Tyme as they require a prescription from the doctor. Once again although individual families will say this medicine helped or that medicine helped they have not been overwhelmingly successful. Worth a try: yes. Guaranteed to work: absolutely not. I have absolutely no confidence in any nonprescription supplements that are available in the nutrition stores and vitamin stores. Completely unproven and potentially dangerous! Show me a single study done in America using human beings that show some improvement in a double blinded study and I will happily change my tune. So unfortunately, our current armamentarium is quite limited when it comes to treating Alzheimer’s/memory loss and therefore we are left with trying to prevent it, which I think in the long run is much more important…
There are obvious risk factors for dementia and they include smoking, diabetes, hypertension, and being inactive. There are genetic risk factors as well but there is nothing you can do about your genes so we focus on the modifiable factors. So yes, you can directly diminish your risk of dementia by not smoking, not drinking excessive alcohol, controlling your blood pressure and controlling your sugar. I prefer to focus on the couch potato aspect because the studies show that this is one of the most important modifiable risk factors. Besides exercise helping your cholesterol, your blood pressure, your joints, your mood, your fall risk, etc. physical exercise cuts your risk of dementia. Mental exercises are also touted to prevent dementia but the evidence that supports that is very slim. Physically pumping more blood to the brain works…mentally challenging your brain hasn’t been shown to work. It just makes sense to me that if you can open up the arteries to your brain with exercise you can get a little better blood flow and therefore a little better function from the brain. Studies have not shown that mental exercises have a basic and lasting impact but studies have shown that physical exercise seems to be associated with a lower risk for dementia. The mature patients that I see on a regular basis would benefit from exercise for many reasons not just the dementia component. People may be afraid of a heart attack or stroke in some vague way but the fear of dementia seems to strike a stronger chord. They take it a little more personally because they know someone who’s had the problem. Still, knowing about it and actually doing something about it are two different things. Get up off the couch and take a walk regularly…walk over to the local Nursing Home and that will provide you much better motivation than I can with this article. If walking through the halls of the nursing home doesn’t motivate you to get moving while you still can nothing will!
So memory loss can be a terrible problem with life changing consequences for the entire family…meds so far have little effect…but you are not helpless against this scourge…In fact you don’t need special tools, expensive tests, or exotic supplements to ward off memory loss. You just have to move it or lose it. Move your body to prevent losing your mind. So what or who are you waiting for? Until next month…get well…stay well.
I often use this line…“I like you…I hope you drop dead!!” Immediately, most people are, of course, taken aback until they think about it for a bit. I didn’t say drop dead right here and now. I said drop dead…eventually. Think about it for a minute and you will find yourself…reluctantly as always, agreeing with me. What are your eventual options? You could just keel over shopping or at dinner OR end up dying after a long and difficult fight with cancer. You could just die quietly in your sleep OR spend your last days drooling over yourself demented in the nursing home. Now, with this perspective I think you’ll agree that a short painless expiration is preferable to a long lingering finish. In essence…dropping dead, when you consider the other options, is quite desirable.
What brings this issue to mind this month are two separate articles in the medical literature recently as well as my wife having to take a CPR class for her new job. I have been feeling pretty good about my medical pronouncements recently because things that I have been saying for years are finally making front page news in the Journal of the American Medical Association and in the New England Journal of Medicine and in the Cleveland Clinic etc…From Charles Krauthammer writing in the Washington Post about the dissatisfaction of doctors, to articles in JAMA about how diabetic care has to be personalized to the patient, to articles in the NEJM about the difficult issue of pain management with chronic opioids, and including two articles regarding CPR.
The first article was about improvements in CPR but when you drilled down to the actual numbers what you find is that even in the best of hands out of hospital resuscitation gives you less than 1 in 10 chance of surviving to the hospital. Note this is not intact survival. It’s having a heart beat when you reach the emergency room. “Survival” often means living with major brain damage. The 1 in 10 chance is of course very optimistic…the more realistic number is that less than one person in 20 will survive long enough to reach the emergency room doors. They never talk about the part wherein most people who have been successfully resuscitated are never the same again. This is not the way I want to go!
Let me take a moment here because I know a lot of people are going to respond angrily to this article. They’re going to say they saw someone or know someone who was successfully resuscitated. Well, it’s got to work right sometime but I think when someone collapses in the store people rush to pound on their chest… they could have just had a faint or a seizure…but in the stress and urgency of the moment they get CPR even if they don’t really need it…then they wake up and it’s a “save from CPR.” Don’t take my word for it…ask any ambulance attendant or an emergency room nurse about the effectiveness of CPR. How often do people with no heartbeat get successfully brought back to life with no significant deficits?
Also, don’t get me wrong I am a big believer in defibrillation but not CPR. If someone collapses due to very irregular heartbeat called ventricular tachycardia or ventricular fibrillation…hooking them up to the defibrillator can restore a regular rhythm quickly and easily and the person will usually not have significant brain injury. This is a whole different kettle of fish from pounding on someone’s chest so hard which, if done properly, causes rib fractures and other injuries even as you try to save the person’s life.
The second article on CPR was an editorial commenting that even in the hospital with the plethora of trained personnel the survival to get to the ICU was only 20% and again these are people who survived just to be transferred to the ICU. They don’t give out the figures for the extent of brain damage. This article said we should be doing less CPR in part due to financial considerations because the last 90 days of people’s lives can be frighteningly expensive but my rejection of CPR is not based on finances. I am a doctor not an accountant. My point is that there is a time and a place for everyone to be born and for everyone to die. For us to attempt to intervene usually does not end well for the patient nor for the family for that matter.
I call for a respect of death. If you are religious, the line I would use is to say “If the Lord calls you home which He will do eventually, and He gives you an express pass by having you collapse suddenly and painlessly in your sleep let’s say…Why would you or anyone else want to delay it?” If you’re not religious, I point out the basic facts that when your heart gives out your brain and kidneys usually follow and instead of a dignified moment of silence for you as you pass you get instead days or weeks of slowly worsening in the intensive care unit until some doctor’s sad duty is to suggest to the family it’s time to turn the machines off and let the patient meet their end peacefully. It doesn’t have to be that way. We should have a better respect for the quality of healthy living and not try to deny aging or death. Of course this is a hard sell in a country obsessed with youth and looks. We have all kinds of celebrations when people give birth and I’m not saying we should celebrate death but we certainly should acknowledge it in a less desperate manner than we do today.
Again there are always exceptions and cold water drowning etc. may justify CPR but for the run-of-the-mill patient who collapses in the parking lot I personally don’t feel that I am doing them any favors when I perform CPR. I know it’s very unlikely to result in any quality time for the patient. For a doctor trained to help people, not taking action is difficult but I’ve learned through a fairly long career so far that sometimes the best action is no action.
As you know CPR, until recently, has involved pounding on the chest and attempting to breathe for the person but the American Red Cross is abandoning the concept of breathing for the patients stating that pounding on the chest alone produces the same results as pounding and breathing. I propose to you that the reason they abandoned the breathing part of CPR is because it doesn’t work well, but then again I don’t believe that the pounding on the chest works well either. If a procedure works only one time out of 20 that to me is not successful.
You know I love my mama but I hope she passes quickly and painlessly when her time finally comes. Making someone a Do Not Resuscitate or having a MOLST form or Health Care Proxy gives patients the chance to have some say in what’s done when they get sicker. Making someone a DNR doesn’t mean put them in a corner and ignore them. It means that when it’s obvious to health professionals and family alike that the end is near we treat the patient with dignity and not as a piece of meat. That people are given the option to die at home or in a comfortable setting surrounded by their family and friends, not being subjected to what I think is cruel and unusual punishment in a frantic environment during their final moments.
Many times my job as a geriatric specialist is to tell people that less may be more. Maybe you need less medicines. Maybe you need less testing at a certain age. Maybe we should look ahead and make plans for that final day whenever that might come. That’s something that each patient and doctor should decide together. You didn’t have any choice about how you came into this world but at least here in America you have plenty of choices about how you’re going to go out. A little planning done ahead of time can make a huge difference.
I received a lot of responses to my Bitch Bitch Bitch column from last month. One person asked me if was ever going to write about real medical issues as the column is labeled Preventive Medicine. So here you go Stan!
There’s a new player in town…cancer town that is. That player is a test called Cologuard. Colon cancer is the second leading cause of cancer death in men and women so it’s obviously important. This is not some obscure disease we are talking about like the Pustular Psoriasis of Von Zumbusch or the Spreading Depression of Laeo. This is a disease that is killing someone in your family or your neighborhood. And colon cancer is not a quick easy death. There is much we can do to you and for you before the end. The NIH spends roughly 270 million dollars a year just funding studies of colon cancer. This figure does not include the detection of cancer, the treatment of cancer, etc. How do you put a number on the emotional toll of cancer? So, it’s a big deal when we have a new approach to detecting colon cancer.
First, some facts and figures regarding colon cancer. The average American has a 5% risk of colon cancer in their lifetime. Another way of stating the same thing is that one person in 20 will get colon cancer. Men get cancer more than women but we don’t know why.The last year for which we have firm statistics is 2012 and approximately 25,0000 women and 25,000 men died of colon cancer that year. Cancer deaths are going down because of improved detection primarily from colonoscopy as far as we can tell. 90% of colon cancer incidents occur in people aged 50 and over. That’s why most people started having a screening colonoscopy at age 50. The important thing is to find the cancer while it can be excised simply without needing chemo or radiation, etc. Currently the #1 way to do this is with colonoscopy.
A colonoscopy is the insertion of a flexible lighted periscope into your rectum and looking into your colon for any kind of cancerous or precancerous lesions. It’s not cheap. It’s uncomfortable enough that for most people it requires a sedating injection. The prep which is required for the test is often considered the worse part of the whole procedure. You need to get cleaned out so the doctor can see enough to be sure he didn’t miss anything. Many people dislike the prep more than they dislike the procedure. If the preparation isn’t good enough the colonoscopy might have to be repeated and / or they might resort to using an older technique like a barium enema. There is a new technique called the virtual colonoscopy which is basically a barium enema and a CAT scan but I never recommend this because #1 it is a lot of x-ray exposure, #2 the doctor could miss something and therefore you suffer because of a misdiagnosis, or #3 the radiologist could and often does say he thinks it could be a polyp and therefore you have to have a colonoscopy anyway. With virtual colonoscopy you still have to do a similar prep so virtual colonoscopy doesn’t work for me. There have been, up to now, a couple of other options including testing the stool for blood in the doctor’s office or in a take home preparation. I have given out well over 1000 of those packets and only got about 10 back, so that scenario has not played out well either. Testing for blood is not the same as testing for cancer.
Now for the new guy in town, and that’s Cologuard. Don’t get me wrong …colonoscopy is still the “gold standard.” That’s the test I get. But for people that are unwilling or unable to have a colonoscopy there is a new technique that’s called Cologuard. It involves simply sending a sample of your stool to the company where it is tested 11 different ways for any evidence of cancer. The test is 92% sensitive in the detection of cancers and that’s a very good number in medicine. The test is not perfect but neither is colonoscopy. The test report comes back simply negative or positive.. if it’s positive you need a colonoscopy…if it’s negative you are probably ok and can discuss what to do next, and when, with your physician. So if you have been neglecting getting your bowels checked for cancer it’s time to bring this article to your doctor and ask him what they think of this test and if it is for you. The test is for average risk people…it’s not meant for people who are known to be at increased risk for cancer, like people with a family cancer syndrome or patients with a history of colitis. Hopefully your doctor is familiar with the test and maybe a life will be saved. What a great way to start the summer. Until next time …get well and stay well.
Can I bitch and whine for a column? Join me in my world this month and you might have some insight into why there are fewer and fewer doctors going into primary care. I’m not talking about the vast difference in reimbursement between primary care and specialists. I’m talking about the hassle factors and frustrations of being a primary caregiver.
Forget about the fact that the insurance companies are charging 10-15 % more each year but I haven’t had a single raise in years and have absolutely no negotiating power. I am board certified in two specialties with over two decades of experience but that’s not worth a penny extra to the insurance company. Recently one major insurance company in the area came to the office to review our mammography screening rates. Our results were at the top of the scale, well above the average and far above the worse performing physicians. What do we get for our superior care.? Nada…Zip…Zero. Why not at least publish this to the paper or to the patients with your insurance so they can see the individual doctors performance and judge for themselves who they want to see? What a shocking concept…giving patients real informed choices. Instead the high quality and low quality is all mixed together and patients really have no idea about quality measures.
First it’s the insurance hassles. There are many different health plans and I have to hire a whole billing dept to sort through the different plans and deal with their individual convoluted coverage. These plans will cover shingles shots…these plans won’t . These plans cover this test…those plans don’t. Impossible to keep straight in your head. I have to hire another staffer to fight with the insurance companies to get authorizations for MRI’s, stress tests, etc. Now some high school graduate with a checklist is saying the stress test is not covered because we used the term “chest pressure” not “chest pain”. So now I have to get on the phone personally to speak doctor to doctor to get this straightened out. Imagine doing this multiple times every day of the workweek.
Likewise the insurance companies have their own strange and arcane rules regarding drug coverage…This company will cover these meds…that company will cover completely different meds for the same medical problem. They send us multiple faxes daily alerting us to possible drug interactions with our patients even if the possible reactions are rare or trivial . We have our own computer system that warns us of serious interactions. They send us notices when our patients don’t fill their refills as if I have any real control over that. Each year the plans can change what drugs they cover so the same patient with the same medicines may have the insurance company change their coverage yearly. I can assure you this is not based on the quality of the meds or the benefits of the meds…it’s made on a $$$$ basis only.
Test results are another area of tremendous stress for the primary care doctor. Forget about the patient that gets sent for a test but doesn’t show up. You decide to skip a mammogram this year and if you get a breast cancer somehow it’s my fault . I can send you reminder after reminder to get your colonoscopy or mammogram.but if you still don’t get the test it’s still my fault. Trust me that’s how the courts look at it. Telling you to get a mammogram is not enough. Scheduling the mammogram for you is not enough. I have to stay on your case until it gets done or I am liable . At some point the patient has to take some responsibility but thats not how the courts see it. But the real hassle with test results is that the radiologists refuse to read any test as yes or no anymore. When I started in medicine…the radiologists would issue a simple report..”Chest X Ray showed pneumonia”. “Chest X Ray normal” Now almost universally the reports hedge their bets …”Could be pneumonia…could be cancer…could be a variant of normal” Almost all reports we get now suggest further more expensive testing which may or may not require further testing or more testing down the road. This is very frustrating for the doctor and even more frustrating for the patients. “How many tests am I going to have to do to get an answer?!” The test report may give me an answer about a specific issue but raise another one. “The spot seen on the x ray is shown to be nothing serious but on this scan I see a possible cyst on the liver”. The radiologist will suggest more expensive testing now and or in 3-6 months which may or may not give a real answer and further testing could reveal new incidentalomas that have to be addressed. Patients get mad at me for all this testing but if we don’t check every possible problem out it could be you that suffers and me that gets sued. Not good for either one of us.
Noncompliant patients are another source of frustration to the doctor. Patients just don’t understand how seriously we take the doctor patient relationship. If we see patients regularly ..if we are in regular contact , then any potential problems can be followed and there are less complications down the road. When you let patients go for years without being seen any little problem from the last visit could grow into something serious or catastrophic. So when we send you three separate written requests to schedule an office call and also call you at least twice and get absolutely no response we have to discharge you from the practice. One of the negative reviews we have on the internet addresses this. The patient complained that she was fired just because she never responded to our calls and letters. I’m not the publishers clearinghouse…I am contacting you for a reason and all you have to do is call us to stay in communication. Yes, it’s my business and I do think I know what’s right for you healthwise including how often you should be seen. We can discuss this and work out a mutually agreeable program but not if you never respond. No response = discharge letter. Another complaint about our office on the internet involves the no show fee. If you give me any notice at all…any kind of notice..even the same day ..there is no charge. But if you blow off a scheduled and confirmed appointment there are consequences. Lawyers charge by the minute when you call them. I just want you to keep your appointment and if you don’t you have to pay a no show fee. If I miss an appointment with my massage therapist or my Saxophone instructor I pay the full price for their time. That’s the right thing to do but not according to the guy who bitched about our no show policy on the internet.
I just took my annual recertification for malpractice. It’s always a depressing experience. Basically they remind you that each and every office call could lead to a major lawsuit. It’s also not the obvious problems like chest pain that the doctor is sued over…What you and the patient think is just a sore throat or arthritis of the back could turn into something potentially life threatening so there is no real “easy “ office call. Patients bitch if they think you are not taking their complaint seriously. Patients also bitch if you take their complaint seriously and suggest referrals to specialist. Look what position that puts me in…It’s crystal clear that the main reason doctors get sued is “failure to diagnose”. The main defense against failure to diagnose is referral of the patient to a second opinion. I would think patients would be appreciative of a medical office that was willing to be thorough and get a second opinion but judging by the mostly anonymous complaints I get they really don’t appreciate it. I tell my Nurse Practitioners to not hesitate to get a second opinion or do a referral if they feel it’s necessary. I would rather have a patient bitch about too many referrals than a widow complaining that we were not thorough enough!
Thanks for letting me give you a little glimpse of what the modern doctor has to deal with. Is it any wonder that more and more doctors just want to be hospital employees or work in a large group setting where they might be insulated from some of the hassles? Of course I’m sure they have their own unique hassles as well.
So, these are all the reasons primary care medicine is not the same anymore. The hassle factor is driving more and more doctors to chose other specialties and to retire early. Yes, even with all the hassles and decreased reimbursement and rising expenses doctors still make a good living but that’s not a primary reason why I went into medicine. My interest in people and their medical problems hasn’t diminished. I still think I can make a difference. Of course, changing part of my practice to a personalized care service certainly has helped to ward off any doldrums. Despite all the hassles I still love going to work everyday. I hope you do as well! Until next month, get well….stay well.
We use an electronic medical record in our office. It’s managed by a national company and it has helped in some ways with record keeping but it has as many drawbacks as it has advantages.
We can use the EMR to keep better track of your medicines and when and how often you have been seen in the office. Its nice to be able to bring up a patients labs or results from another physician with a touch of a few buttons. Its very helpful when I am on call and have to access the record from off site. It eliminates the issues of poor penmanship. On the other hand, the EMR generates so much useless information that really important stuff gets lost in the midst of the records. Just look at the records we get from the local emergency rooms…The sheets we get documents that the patient was educated about seatbelts and flu shots but its very hard to find out what really happened during the visit. What did the patient complain of ? What tests were done ? What diagnosis did the doctor come up with? This important information is getting harder and harder to find in the record. I think this is dangerous. When we get a transfer from the Hospital to the Nursing Home the record can have pages and pages of nursing notes and vital signs but often doesn’t have a complete problem list and a coherent narrative of what transpired in the hospital. This is dangerously obfuscatory. Things are going to get missed and thats never good for patient care.
Likewise we get records from prior doctors when we see a new patient. Often we receive 60-80 pages of records to review. Most of these pages are incomplete or blank or have info regarding a sore throat visit from a decade ago. We have to wade through all these pages to find out basic but vital information like …When was the last mammogram? When was the last tetanus shot? This is sabotage !! It would only take three minutes for a person to really pull out the important information and just send that part. I don’t know if its laziness , I don’t know if its because the office can charge 75 cents per page. I don’t know if its because the doctor just can’t be bothered as the patient has transferred care. But I do know its dangerous.
The other problem with the EMR is that it takes away face to face time with the doctor. Unless the doctor documents after the visit or uses an assistant called a scribe the modern encounter with a health care provider has them spending some time looking at you and some time looking at and dealing with the computer. Have you had that experience in the doctors office where the doctor or nurse practitioner barely looked up from the computer screen ? Doctors spend time “populating” the record to make sure they don’t get in trouble with reimbursement from the insurance companies. If the doctor checks off the boxes saying they reviewed the family history and / or reviewed outside records they get paid better even if those sections are not relevant to the visit. For example …it doesn’t really matter that your grandmother had breast cancer in order to treat your sore throat.
Also, the EMR presents me with a damned if you do and damned if you don’t situation. If you just pick and choose from the preselected lists in the EMR it can make the record look very vanilla, very programmed, machine generated. Can you tell if the doctor really examined the patient? Is the person missing a few fingers on his hand but the record doesn’t mention this?
I try to get around this problem by always adding something personal to the record. I type something in that clearly shows details of the encounter and personalizes the record. This too gets me in trouble from patients that prefer the record to have nothing personal in it. People will get mad at me for putting in information about their lives that I think are important but they don’t want “someone” to see it. If you have stress in your life that is effecting you so much that you have come to me for pills or other treatment I think it’s better if the record has details of this and it helps on the next visit when I refer to the actual cause of the stress not just the symptoms. I still prefer the “personalized” record over the “vanilla” record because I think the more you know about people the better you can care for them. We are not cattle…people are very different one from another and I think that should be reflected for better or worse in your record. I had a lady who said she was the victim of “Demonic Abuse” Now I don’t know what that means but if it’s somehow important to the patient then I think there should be a place for that in the medical record. You know me…I did ask what that meant but the patient declined to elaborate. She eventually called me and asked me to take that out of the record because whenever she went to a specialist she got some weird looks. I told her I can’t change the old record but would take it out of future visits. So you can indeed get in trouble by trying to personalize the record. Of course the government which insisted that doctors pay for and use EMR’s also is threatening to punish doctors if the records look too “cut and pasted” .
We have, and I think most primary care offices have, many patients who travel South for the winter. I tell all my patients to come by and pick up a travel package. This includes their last full physical, the last office call or two, the last ECG and labs. This is really all the emergency room or clinic needs. This usually comes to less than 10 pages and really has all sorts of important info including your meds, allergies, surgeries, etc.This is precious information and can save you time , money and possibly avoid unnecessary tests and surgeries. You can’t be expected to remember all this info on your own even when you are healthy. Imagine trying to recall details of your family history whilst you pass a kidney stone. I have been told by multiple patients that the travel package proved very helpful to the patient and their snowbird caregivers. Your doctor should give you this for free but even if they charge 75 cents a page its worth it. Beware the cd/disk. Its great for the radiologist to give you a copy of the images from a test you had. This may be very useful for the Orthopod across town who wants to see the actual images not just the report about the images. On the other hand , If I run a HIPAA compliant office , I must be very careful of any cd /disks that may contain some hidden virus so I really shouldn’t use my regular computer to try to view your images. I have extensive experience in reading Xrays of your chest and CT scans and MRI’s of your brain and can read a skeletal x ray for obvious fractures but I am very unlikely to find more than the radiologist or to disagree with him based on my reading of the images. Some physicians provide their patients with a disc with all their records on it. This is even worse for me than paper records since at least with 100 pages of paper I can go over each page and mark it off as reviewed etc but with a disc you don’t know how its organized, I don’t know if I have a program that will access the files. Again , precious information is obscured by a lot of unimportant data. Sabotage again !
So, the EMR is here to stay…unfortunately the many systems out there do not communicate well with each other so its not anywhere as useful as it could and should be. I know we will get there eventually but tomorrow would be nice. Some day all your information will be available on your phone, your watch, or the implanted chip you will someday have. The implanted chip and universal health care are still not ready for prime time. Until then , if your doctors office uses an EMR , get access to the patient portal so you can review your own records and at least make sure the basic information is correct. Take charge of your health. Take care of your body. Take even better care of your mind. Get well. Stay well. Be an active participant in your care!
I honestly don’t know much about basketball. My son considers me a failure, in part, because I don’t really pay attention to most organized sports like basketball and football. I would rather be doing the activity than watching someone else do it.
If I was younger I would be applying for American Ninja or Wipeout but those are really individual events not team events. So, when people talk about March Madness I really have very little to contribute to the conversation. I do know madness when I see it. Madness to me is doing the same thing over and over again and hoping for a different result. Albert Einstein said the same thing. Madness to me is someone saying every day “ I really ought to blank”, “I know I should blank.” “It would be better for my health if I blanked.” Fill in the blank with lose weight, quit smoking etc. Saying the same thing over and over again but never actually taking action… that’s madness to me… That’s why I find the Upstate Medical Center advert so amusing. Their catchphrase is “knowing changes everything.” You and I know that knowing changes nothing. Doing changes. Doing makes a difference. We have to figure out a way to get you from knowing to doing. That’s not easy stuff. That happens also to be the most important thing you can work on with your health. You can work on your blood pressure alone. You can work on your cholesterol alone. You can work on your diabetes without the help of anyone else. But it’s very difficult for people to change themselves/ their behavior on their own. As I often relate to patients, most people don’t have enough tools in the toolbox to achieve the results they want on their own. If they had those tools they would probably already have used them. There has been work done on how to motivate people but mostly by the marketing divisions of big companies like FORD and Proctor & Gamble. To get you to change toothpaste, fabric softener, etc.
Work has been done by the medical profession as well but it’s really limited because it involves real conversation between patient and Doctor and thats not happening much anymore. You come in for a blood pressure check visit and also have questions about a rash, etc., and it’s all the provider can do to check your meds, review your blood pressure and evaluate your rash in the allotted 15 minutes. How is the provider to really engage you about changing aspects of your life and your health in this environment? Unfortunately this is just not happening. Changing behavior requires work. Changing behavior takes effort. It’s very hard to get rid of a habit or form a new one. Hard, but not impossible and there are some guiding principles to work with. Number One principle is that if you want to eliminate a habit you will have much more success if you substitute a behavior not just try to eliminate a behavior. Instead of having that cigarette or that extra plate of cookies after dinner, you might take a walk or write a letter. Substitution helps change habits. Number Two principle is to make yourself accountable. Accountable to a group like weight watchers or AA. Making yourself accountable to friends, family, health team has been shown to work on your psyche in a way that reinforces your motivation to change. My experience with the technique called motivational interviewing has shown me that we really can’t change other people, we can only help them change themselves. This comes from having conversations where people’s prior successes are supported and their rationale for change is explored in a non-confrontational environment… The doctor telling the patient “You really should lose weight and get more exercise” patently doesn’t work, hasn’t worked, and is unlikely to work in the future.
However, talking with people so that they can themselves express their concerns and desires sometimes tips the scale in the balance favoring change. It often takes more than one conversation. It certainly takes more than 1 visit every 3-6 months. So yes, change is possible and change is difficult but change it is possible and can be supported by a variety of tools. People roll their eyes when I ask them about what tools they have in their toolbox change-wise but I think having a varied toolbox is critical. Not every tool works for every patient. Not every tool is right for every problem. Many people have preconceived notions about what tool works for them and what will not. I tell people let’s open up the full toolbox and look around and see what might work for you. Let’s not have preconceived notions about what works and what doesn’t. If we want to achieve some change that is losing weight, quitting smoking, etc., we have to be open to doing something new, trying something new, doing something different. Hypnosis, acupuncture, motivational CDs, all might help you change your thought process and therefore your action process. Cognitive behavioral therapy, personal trainers, visualization techniques all can help facilitate change. Since none of these tools involve shots, pills, x-rays, needles, or dyes why wouldn’t a person explore/consider these tools? I learned a great expression in yoga class one day. The instructor reminded us to guard your thoughts because thoughts become feelings. Guard your feelings because feelings become words. Guard your words because words become actions. Guard your actions because actions become habits. Guard your habits because habits determine character. Guard your character since character determines destiny. Maybe it’s a little wordy but I do like the sentiment. Essentially it relates back to the fact that it all begins with your mind and you have control over that in the way no one else does. Link your desire to change with one of the tools of change and let’s see what happens. Until next month get well and stay well.
My last few columns have been rather personal…I thought you might enjoy the more scientific side of Dr Barry for a column or two. Since I make my living trying to talk people into taking better care of themselves I thought I should review with you the real enemy…its not the insurance companies, the government etc…its what will kill you prematurely and what you can do to make a difference. The cdc says that 30% of cancers, heart attacks, strokes etc are preventable. Other sources say that you can make an even bigger difference than 30% but thats still a huge number compared to what you can get from pills etc.
What’s killing americans? If we don’t know what is killing us we don’t know what to focus on in your health. We are looking for opportunities to cut down your risks of the top killers through lifestyle modification / behavioral intervention. There is something we can impact on for all of these. Below is the very latest data from the CDC as to the top causes of death in America each year (Cause/Number of People).
Heart disease: 596,577
Chronic lower respiratory diseases: 142,943
Stroke (cerebrovascular diseases): 128,932
Accidents (unintentional injuries): 126,438
Alzheimer’s disease: 84,974
Influenza and Pneumonia: 53,826
Nephritis, nephrotic syndrome, and nephrosis: 45,591
Intentional self-harm (suicide): 39,518
So, lets look at these issues one by one and see which ones we can have an impact on.
Heart DIsease…the number 1 killer!!! We can intervene with changes in blood pressure, cholesterol levels, smoking status, diabetes control, diet and exercise and meds… heart disease is of course also in part genetic but we cant do anything about this component…yet!
Cancer… There are a lot of different recommendations from different organizations but the most common cancers.breast, lung, colon, skin, prostate, bladder, have screening tests which can be done at the appropriate intervals. Yes we can survey for cancer but we can also try to impact your cancer risk with diet and exercise and stopping smoking.
Chronic lower respiratory disease is basically smoking and pulmonary fibrosis. Between Chest X Rays and Spirometry ( breathing tests ) we can get a good measure of your lung status. Since this category really is COPD / Emphysema / Chronic Lung DIsease… this is another modifiable lifestyle issue since most of this is smoking related. It doesn’t matter how many times you have failed to quit smoking in the past there is more we can do here if you want it !!
Stroke… the modifiable risk factors here are smoking, hypertension, diabetes, and cholesterol. All of these we can work on and modify.
Accidents…Driving assessment…fall risk /evaluation…Alert bracelet… Need for physical therapy…carbon monoxide detector…staying off the roof after the age of 70 etc.
Dementia…You can have your memory assessed using nationally validated tools, but this is just checking for the problem. The most important intervention you can take to prevent memory loss seems to be exercise. Physical exercise is most important and mental exercise may be helpful as well. Medications have heretofore been widely used but have had only marginal results overall. So the name of the game remains prevention!
Diabetes…The single most important issue in managing your diabetes is your commitment…to diet…to exercise…to taking your meds… so much of this is under your control and therefore modifiable.
Flu and Pneumonia…You should have a list from your doctor regarding your shot status. I believe in routine immunizations. When an injection can cut down your risk of dying from one of the top causes of death for as long as 10 years…I want that shot. Luckily those shots are the flu shot and the pneumonia shot.
Nephritis…basically kidney failure… still affects lots of people and there are well recognized modifiable risk factors…Once again being: smoking, cholesterol, hypertension, diabetes…easy to measure…easy to work on…easy for you to make a difference in your outcome.
Suicide… What a terrible thing that 40,000 people decide to kill themselves every year. Did you know that each year there are more suicides than homicides. Unfortunately we don’t have a strong mental health care system in this country…Depressed or anxious? Here…take a pill. See a counselor and come back in 3-6 months. Hard to make a change in your mental health with this system. Again, I think people need more time to work out their problems with a professional than we are giving them now under our current system. Change is hard and changing your feelings is hard and it comes from inside…not outside. Yes, once again I think the right diet and a good exercise plan will make a difference in how you feel and what you think.
So, we have reviewed the top killers. You can take action regarding all of them. You can make a difference in your health. It makes me laugh when I hear Upstate’s commercial…“knowing changes everything”, because knowing doesn’t change a damn thing. You KNOW you should quit smoking…you KNOW you should lose weight…doing something…taking action…that changes things. How to help people make those changes…take that action, etc. That should be a very high priority for every health care professional you see. Nothing wrong with hunting deer or rabbits but what about hunting down and killing your bad habits!! Now there’s a challenge!!
I have just made the biggest change in my medical practice ever. I feel like I am waking from a long slumber where doctors are struggling to work harder and harder for less, and professional morale is at an all time low. A company called Signature MD helped to rouse me from my professional lethargy, and once again I am excited at the prospect of being able to deliver even higher quality health care than I am now. I will have a chance to really practice at the top of my game. Once again I think I will be able to really make a change in people’s lives. I am excited about finally being able to make a difference.
I’m also nervous because this is a fundamental change in my practice. I am adopting a Personalized Care Program in which a limited number of my patients will receive enhanced services, more detailed management of their health and wellness, and a focus on Preventive medicine.
At the core of this new program is time. I’ll have more time to devote to each patient. In effect, I’ll be acting as their Life Coach.
I really don’t have a better term for it yet, but I think Life Coach conveys my intent. Any good healthcare provider, and we have many in Syracuse, can handle your blood pressure, your diabetes and your sore throat. This is midlevel provider stuff, which is important but doesn’t need my skill level. I want to actively follow a smaller number of patients and really provide them more oversight and attention.
Frankly, we all should have this kind of relationship with our doctor, but we will never have it without a program like the kind offered by Signature MD. The healthcare system has been changed into an assembly line with a different healthcare provider for each visit, not enough time allowed for meaningful consultations, and where the standard of care has devolved to some pills, some tests, and then it’s on to the next patient in line.
Walmart says they want a healthcare clinic in every store and want to be the number one provider of medicine in a few years. You don’t have to scour the national news for changes in health care. Look at what has happened to North Medical Center. Clinics aren’t bad…but I don’t want to practice assembly line medicine. Signature MD’s Personalized Care Program will give me the opportunity to spend quality time with patients, including the time to follow the patients when they are hospitalized at any of the local hospitals.
When we doctors turned over your hospital care to Hospitalists (in-house staff healthcare providers), it was a good for the doctors but really not so good for the patients. As a patient, you want the medical professional that knows you best to see you when you are sick, whether that’s in the office or in the hospital. But it’s most important in the hospital when you are most vulnerable to mistakes and miscommunication. Signature MD will give me the time to manage all that and actually be there to assess you in person, and to communicate directly doctor-to-doctor with the physician charged with your care in the hospital.
Yes, there is a fee for all this extra service, but however, because I believe that the health of every single person that enrolls in the program will be improved, I think it will be worth the fee. I think your health is worth it. I think you are worth it. I realize that this program will not appeal to everyone. Some people won’t see the value in a sustained and engaged relationship with their doctor. Some people are young enough, healthy enough and or self-directed enough that they don’t really need the program. Some people simply won’t want to pay an extra fee. I don’t fault them for not taking advantage of this program, but I am hearing from a few people that are faulting me for working on being a traditional doctor again.
By “traditional” I mean having the time to really listen and establish a relationship with each individual patient. I have heard from and respect those who are opposed to this new program. However, I have been given an opportunity to fundamentally change my practice in such a way as to make me feel that I am actually making a difference again. What an opportunity. What a risk. But I just had to take it because the price – better health care for my patients and better job satisfaction for me – was worth it.
This will not be a one-size-fits all, cookie-cutter program. What’s important in healthcare differs from patient to patient. What’s obvious is that this isn’t being addressed in the world of 10-minute office calls. We are just bandaging the problem with these visits and not really focusing on what’s causing the underlying problem in the first place. I cannot get a person to quit smoking or lose weight with a couple of office visits. Complaints of anxiety, depression, insomnia or chronic pain are not treated with a pill and a referral to a specialist. We can do better than this…but we need more time.
The new Signature MD Personalized Care Program gives us the time we need to make a difference. This doesn’t mean that I will be making patients get more tests done. If anything, I could actually end up recommending less testing. Whatever testing that I do recommend will be accompanied by written explanations of all my suggestions as well as comparisons to the national guidelines.
Now, for those people who choose not to sign up for this Personalized Healthcare Program, there are still plenty of options in our office available to you. Starting next year all of my patients that choose not to sign up will be directed to my Nurse Practitioner Zoryana Bozak, who will handle all the routine office calls and physicals. She will be working directly with me and whenever your medical problem needs my direct attention, I will be there for you. If it is a routine visit, if it is a routine visit, you will see Zoryana. If it’s not routine, you still see Zoryana first, or another one of our excellent providers, who then will get me directly involved whenever the situation warrants it. If you feel you need or want to see a physician, we still have Drs. Knudsen and Manfredi taking new patients.
I didn’t get into medicine to see as many office calls as possible. I got into medicine because I enjoyed the intermixing of the sciences and dealing with people’s problems and personalities. I have lifted my head up from the din of visit-after-visit where I don’t know if I am making a difference to say, “Wait a minute. This isn’t how it’s really supposed to be. This way is not really allowing me time to change peoples lives.” There must be a better way. The new Personalized Care Program that I’m offering is the wake-up call to a better way. At last, time will be on our side.
One of the most delicate parts of my job as a doctor is the conversation about whether the mature patient should still be driving. You know the folks…they brag that they never had a ticket or an accident but can’t walk steadily and reliably across the parking lot.
How can you claim you are “safe?” Look at you…your vision is not great. Your hearing…well the less said about that the better…you can’t turn your neck more than a few degrees due to arthritis…you can’t really feel your feet can you? Your strength, focus, coordination, endurance, etc. are all far from peak and you still say it’s fine for you to get behind the wheel of two thousand pounds of steel and plastic and gasoline. All WE can think about is you hitting some kid or plowing into the school bus and the whole thing being quickly engulfed in flames. And it will be our fault because we should have somehow forced you to stop driving.
The scope of the problem? The CDC says that of 2009 there were over 33 million senior drivers on the roads. Fatal crash rates start to rise at age 75 and rise up sharply after age 80. This doesn’t always mean they have more accidents but they get more injured from the accident. 500 senior drivers nationally are injured every day in America. According to the Insurance Institute for Highway Safety drivers over 75 years of age have higher per mile accident rates than middle aged people but still LESS than younger drivers.
First, this whole sticky wicket of senior driving safety becomes mute once the self-driving cars finally arrive. “Car, take me to church, hairdresser, my kids’ house,” etc. How great will that be?! Just say where you want to go and sit back and read, relax, take a nap, make a phone call without worrying about driving distractions. That’s something I will pay extra for when it’s available. I am not saying everyone has to let the car drive them…the tread heads, as my sister Marijo refers to them, will say it takes the joy out of driving, etc. so let them stay behind the wheel but make them pay extra for it because in the end it will not be as safe as letting the computer do it for them.
Until that happy day we must wrestle with the personal and public issue of who should be driving and for how long. Should women be tested more often than men? When do you start testing…only after an accident? Retest everyone at age 80? Of course someone will say testing is racist or sexist. None the less…if you ask me about your ability to drive a car I am going to give you my stock response and no one likes it! If you wonder about your ability to drive, go see the specialist…go take a driving test. You can use the DMV but you can also call one of the driving schools and they will evaluate your driving. Taking the refresher classroom course absolutely doesn’t count. Under my benevolent Caesar-like leadership the rule will be established that everyone will be tested every five years. You can do the DMV or you can do it privately. This puts to rest the issue of who to test and when. We test everyone…regularly. Commercial drivers will be tested yearly. If you are 95 years old and pass the test the car keys are yours! And of course did you notice my solution also provides jobs in both the private and public sectors! I wonder what will happen to all those couples where the husband is demented but the wife lets him drive because she hasn’t in years and he is indeed a better driver. That makes me mention that all you older ladies that let your husbands drive all the time…it’s likely you will outlive your husband and it’s a mistake to stop driving just because right now things are easier. Keep your skills up!
So you don’t think your mom should drive anymore…you do know that taking away her driving is like stabbing her in the heart with a dagger. Maybe that nice carving knife she got your husband for Christmas…that’s it…the very one, and remember to come up under the ribs. You want to set off indoor fireworks? Just try working in “you should probably give up driving” into casual conversation. The fact is that you are robbing her of her independence. It might be what you think is the right thing to do but it is not likely to be appreciated. This doesn’t usually go over well. It’s a sure trigger for depression…akin really to the loss of a spouse. And I am supposed to make that better with a little white pill?
Sometimes one of my roles as a physician is to be the bad guy…to take the blame. Much better to be mad at me regarding getting some help in the home or mad at me for telling you not to drive…rather be mad at your family member. I routinely refer patients for driving testing but they never go…I am pretty sure they are afraid of taking the test and not passing. I can’t force them to stop driving. I can’t force them to take the test. I can only offer my advice and insight. What I cannot do is notify the DMV if I think you are unsafe behind the wheel. It is a violation of your confidentiality. So you are safe in bringing up your driving concerns but I am always going to be on the side of personal freedom. Now, while I can’t report you to the DMV your family or for that matter anyone who wants to can. Although the NY DMV says on their website that a physician can report a patient my lawyers tell me this isn’t true. There is a form you can fill out that will prompt an evaluation of the person’s driving skills.
Although my periodic retesting scheme makes sense to me as long as the current system allows seniors the right to drive I don’t think we should infringe on this right unless and until something happens…the fender bender in the mall…the garage door frame…and yes, even some of the worst sort of accidents…your freedom and independence are important enough for this risk. In the end, it comes down to common sense like not driving at night…not driving long distances to new places…extra care when backing up…keeping your cell phone available but not in use, etc.
So let’s keep giving our seniors the benefit of the doubt when it comes to staying independent when driving. When trouble finally happens, an independent reevaluation of driving skills takes the emotion and guilt out of the decision.
Don’t forget the fair. You owe it to yourself and the grandkids to go. Stop with the negatives and enjoying the sun, the sites, the wild food, the music, the exhibits, the petting zoo, the Iroquois Indian Village…how can you have this great attraction in your backyard and not support it and enjoy it!
It’s the December issue and I usually spend it exhorting you to spend a little extra time on the friend and family part of your health equation. To get out and do stuff…whether it’s Lights on the Lake…going out to just one of the seasonal shows at the Palace Theater…going Cross Country Skiing at Highland Forest…we have covered this ground and you should be picking up your phone to make arrangements. You’re going to say…let me at least read through the rest of the article and then I will make the calls. Here’s the problem…I know you…you have good intentions but at the end of the article you are just going to forget about it. So, it’s much more important to stop now and at least make one new plan than to read through this article…you can always come back to the article…you probably won’t make a new plan unless you start right now.
Well, we are all deeply flawed individuals as my colleague, Dr. Manfredi, likes to remind me. So let’s get on with the article. Did you think I misspelled whining at the top of the article? No, I really do mean it’s time to stop wining. For more than 5 years our office has been quietly giving out a bottle of wine to our patients who had appointments around Xmas time. We appreciate our patients and thought it was a nice touch…giving a gift of health. It’s well known in the medical community that a modest amount of wine is good for your health…of course there are the exceptions and therein lays the problem. With exceptions come problems. With problems come headaches. Headache cause us to say it’s time to stop the gifting, at least for now.
Let me elaborate…we want to do something nice for the holidays but not if it’s going to make people mad at you, give you new legal issues and potential liabilities, take up too much time and money. Frankly the money part of the equation was not the main reason we are stopping the giving of the wine. We had people complaining that they did not like our choice of wine. We had people complaining that they were good patients but did not come by around Xmas but surely they deserved a bottle. We don’t want to give a bottle to a person with a history of alcohol trouble but what if the person says “I have been proudly sober for 10 years but I see other people leaving with wine and I wouldn’t mind bringing the bottle over to my sister’s house for the holidays.” People would come in for a problem…have a recheck for the problem three days later and want another bottle of wine! Frankly when we had so many people expecting a bottle like we were some assembly line it isn’t a nice healthy surprise anymore. It’s lost the magic. It’s lost the meaning of the gesture. So, no more wine from Preventive Medicine Associates. Please don’t take it personally.
Instead of giving individual gifts of wine, we will spend the money on several local projects including supporting the Maria Desantis Xmas show at the Palace Theater. It’s a great show for the young and old alike. The reason for the season is all about the Birth of Jesus…but anyone of any religion can understand this is a time of year to enjoy with friends and family. You should absolutely watch some version of Scrooge each year. If you can’t take something important away from this story you are beyond help…and I know you and there is still some hope for you. Well, I for one have not given up on you.
Another way we at Preventive Medicine Associates will show our gratitude to our patients is in support of some local family that needs help during the season. We have done this for years already but this year we can bump it up a few notches. We will put some smiles on some family faces this year.
So please understand that we thought that the wine gifting idea had run its course. I wanted to give out little jars of horseradish because along with garlic and ginger it is one pf the best things you can put in your mouth but there was surprisingly little support for the idea around the planning table. So we are doing more for the community in general by sponsoring the Desantis show and by being Secret Santa to some families. Hopefully you will understand and agree with our decisions and motivations. Wishing you a healthy and happy Christmas.
Now is the time to make those family Christmas plans and don’t forget Maria Desantis at the Palace Theater Sunday Dec 14th. Next month…why and how I hope to fundamentally change my practice of medicine. Stay tuned.
Do you mow your lawn? I cringe when I drive around and see people mowing their lawns and weed whacking without hearing protection. Don’t they know what they are doing to their hearing? How can they get used to that clamor? I am all for full employment for their audiology (hearing aid) colleagues but I would rather get my hearing aids at age 80 than age 60. Hopefully they will be cheaper, better, and/or covered by insurance by then so as so many baby boomers will be deaf that they will insist on coverage. Riding the lawn mower has saved my life. Well, maybe not saved my life, but certainly has changed my life. I dare say that only the beatudinous (WHAT????) vision that is my wife has had a more positive influence in my life than sitting on my lawn mower.
When we moved to Lafayette in 1999 I bought a new riding mower and I have a fairly big yard and it can take me just under 2 hours once or twice a week, depending on the temperature and the rain, to get the job done but at that time is spent more inside my mind than on top of that tractor. So, it’s not the actual task of mowing the grass that has helped me so much as the time spent listening to lectures on my MP3 player. I have listened to lectures from the Teaching Company about Ancient Greece and Rome, about the history of medicine and about music appreciation, etc. the lecturer makes or breaks the course and there is none better than Professor J Rufus Fears but he limits himself to historic stuff. Too bad because he could read the phonebook and make it interesting. The history of medicine lecturer was okay but of course the subject matter was important to me so that was pleasant listening. The lectures on music appreciation and sentence writing are so much denser and the speakers seem to drone on and I haven’t gotten through those series yet. Right now I am working on less history and more introspective stuff from the Mind Valley Academy. Stuff about meditation, quantum jumping, positive visualization and and positive vibrations.
Sure I will just listen to music from time to time but I can listen to music anytime and with the lawn mower I know I have a solid block of time to try to mentally absorb something. It’s like reserving a block of time to devote to a book you’re reading…I don’t want to read it in 10 minutes dribs and drabs. I want to have time to really get a few pages into the story…get up in there…immerse myself in the story…and you can’t just dp that in a few minutes here and there. Same thing with the audio lectures…I want to listen to the whole block…not just five minutes at a time.
So I think I have learned something about the world around me and hopefully about the world inside my head and who amongst you can say they are doing that on a regular basis. Hold a second…you can…anyone can. MP3 players like iPods are pretty cheap and if you can’t figure out how to get files on someone in your family surely can or you can YouTube it!
Having your mind engaged while your body is doing some repetitive task can only make the time go by faster and perhaps you will feel better at the end. Surely there is some subject you have an interest in…besides fantasy football and fishing…expand your mental horizons, not your waistline.
So far no one has asked the question about what I am doing the rest of the year when the grass is not growing. Well, I am listening to less lectures I can tell you that. On the other hand it gives me a chance to relax and enjoy when I am skiing or snowmobiling. You can’t have your mind on “go” all the time but you should try to get it in go some of the time.
Continuous Quality Improvement as they call it in the Industry. Taking Care of Business as Elvis Presely used to say.
My colleagues at the University Hospital have a slogan that says “Knowing changes everything.” With all due respect, that’s not true at all! Everyone knows you should quit smoking. Everyone knows you should get more diet and exercise. Knowing doesn’t change everything. Action changes everything. “Change gonna come” said the great Sam Cooke. Are you going to bring change to your life? You know it starts and ends with you. Maybe you will give thanks this season for your good health and spend a little energy making sure you stay healthy. Change a little something…in your diet, in your habits, in your thought process and see how you feel.
Please check back soon.
Sure I read the big journals to keep up…JAMA, New England Journal of Medicine, Table Hopping, etc…I want to be reasonably up to date with the “scientific” literature but I also try to keep an open mind (albeit attached to a somewhat skeptical eye) about the out of box subjects like energy fields, coherent rhythms, intuitive information systems, field versus particle psychics…as Einstein is said to have put it the particle is wholly responsive to the field. Are we really “particles” dependent on the energy fields around us? What about the energy fields each of our bodies generate. Can you have an effect on these fields…does it make a difference to your health?
There is a lot of talk…scientific and otherwise on this subject right now. University level talk. This isn’t about psychic fairs and palm readings anymore. This is using the concept of physics and metamorphosis to try and explain the universe around us we can’t see but know exists. I have been reading a lot about this recently…from a variety of sources. Maybe it’s just because I want to believe that with the power of your mind you can change things. Maybe you can’t bend a spoon but can you break a habit? I have always said attitude is everything…will it turn out the Power of Positive Thinking can affect your health? Well, I sure believe the opposite. That you can will yourself into poor health. That you can let stress really affect your health. That depressed people are generally sicker people than those who aren’t depressed. There are a lot of people who think that you can affect your health positively with just your mind. Either these people are the paradigm shift ahead of the rest of us or they are kooks…however well intentioned…but kooks nonetheless. I am hoping for and betting on the paradigm shift but that doesn’t mean I won’t “hedge my bets” by looking for the real science behind this stuff as it becomes available. There are people out there who think they can affect your energy fields with their energy fields as well…giving you a psychic energy manipulation to fix your fields. In this area we have some “real” science to guide us…referring to the practice of reiki now…there have been two reviews published in the International Journal of Clinical Practice and the Journal of Alternative and Complementary Medicine that conclude that reiki “is not an effective treatment to any illness.” Astonishing as it may seem a nine-year-old student named Emily Rosi published in the Journal of the American Medical Association study where she showed that “Therapeutic Touch”, which is reiki by another name, could not be shown to exist. The practitioners specifically trained to feel and manipulate energy fields could not do so when under controlled circumstances. Don’t get me wrong…I know the body puts out electrical fields…what I don’t know is whether you can externally manipulate these fields – especially not with the power of your mind. But I certainly do feel you can manipulate your own energy fields! I do think the power of your mind cannot be underestimated. Obviously a lot of coaches, trainers, etc. would agree with me.
I found out about Quantum Jumping when I responded to an email from Mind Valley Academy. There were many courses on self-growth, personal improvement physically, mentally and spiritually. Obviously I haven’t taken all the courses but I am in the midst of several series including the one on Quantum Jumping…Burt Goldman formulated the technique he labeled Quantum Jumping using a meditative and visualization technique to “jump” within your mind to an alternative universe where you meet a better you…you know the better you if I just went to the gym more, I just kept my weight down more, if I only reached out to my friends more…THAT better you…in your mind you now hang out in that alternative universe with your best self….you spend some time with him or her…if follow what they do…how they act…it’s you after all so the stuff they are doing is what you could be doing yourself…now jump back to this world and try to follow the same techniques and habits here. Bring the habits and patterns of your perfect self into this world. This is obviously only my poor paraphrasing of only one aspect of his technique but it could be really positive stuff if you let it and are open to it. Aren’t all the great athletes supposed to use visualization techniques to improve performance? Absolutely no reason you can’t either. And the great thing is that all it takes is your mind. No expensive equipment. No special uniform. No special time or schedule you have to keep. No need for a partner or group.
It’s about Mindfulness…living your life examined not going through the motions. I know the term Mindfulness is a little “soft”…a little psychobabble sounding but regardless of the baggage I do think it refers to a life examined….living 50 years not one year 50 times. I like that concept and it’s no better represented than in the movie Groundhog Day…this poor guy lives the same day over and over until he “gets it right” and can move forward. It’s one of my favorite movies because it’s both funny and thought provoking (at least to me) without being preachy.
In the same vein I also enjoyed the movie About Time. It’s about a guy with the ability to go back in time and fix mistakes. He doesn’t kiss the girl at midnight on New Year’s Eve the first time around so, if he wants to he can go back and relive it and kiss her this time. His father from whom he inherited the ability tells him his personal little secret is to relive each and every day. Didn’t make the right move on the date? Didn’t stand up to the bully? Mindfully he would monitor what he did/what he said/how he acted each day so he could improve it on the “repeat” day. In a great twist the son improves on his father’s technique by living so alertly and mindfully that when he encounters whatever situation he would want to possible do-over, he was alert and mindful enough to do it “right” the first time.
You want to feel better? Try going on YouTube and watching one of the over 100,000 motivational videos…they are usually pretty short and super positive. Best to do this early in the day so you can use the positive energy that same day. Better than any pill from a bottle.
Let me finish with a little humor. Adam is in the Garden of Eden but he is a little lonely. He petitions the Lord for a mate…the Lord tells him he can make a perfect mate in every way…a great partner in bed, in life, perfect match in every way…Adam says, “Sounds great! What will this cost me?” The Lord responds, “The perfect mate will cost you an arm and a leg.” Adam then responds, “Well, what can I get for a rib?!”
Obamacare…surely you know I have thoughts on this. It directly impacts my business in both ways…getting insurance for my employees and figuring out how it affects my patients. There is much I know. There is much I do not know. I do know it’s a mess. A big mess and it’s going to get messier from the sounds of it.
Okay, let’s start with the obvious. Before I go criticizing the President and his plan what’s my alternative? I used to think the problem was too big to solve…that unless I devoted hours and hours to the plan I would never get it right or understand the nuances. I thought I would have to spend countless hours listening to the economists and the “thought leaders.” Luckily, as it turns out, it came to me out of the clear blue…of course I think that’s really the fulfillment of the subconscious ramblings and ruminations of my mind until it surfaces in my conscious but call it clear blue if you will. I’ll take it from wherever it may come.
So, my plan is simple…just extend Medicare or Medicade to whomever wants to buy it…don’t make it mandatory. If you have low income you can buy into Medicade. If you have more money, have a job etc., you can buy into Medicare. You have to pay something. You can’t get coverage for free. I don’t have the exact number but roughly 20 cents of every dollar you pay to Blue Cross Blue Shield goes to the paperwork and the processing and the advertising, etc. All those $200,000+ salaries which seem quite nice for a not for profit organization have to come from somewhere (I’m only bitching because I don’t have one of those aforementioned jobs!). Medicare on the other hand charges more like 5 cents per dollar. That’s a huge difference when you are talking about the number of dollars in the system. You don’t need a new tax code or more IRS agents. You don’t need a super expensive website that still doesn’t work more than a month after it’s supposed to be working. You need only expand systems that are already working but need significant reform…not replacement or reinvention.
Libertarians should love my plan because it preserves choice. Republicans should love my plan because it doesn’t set up a new huge government bureaucracy. Democrats should love it because it offers an option for everyone to get insurance. Insurance companies would love it because it still leaves them in the game because part of Medicare…most of Medicare for that matter…involves people choosing between Medicare plans that that are supplemented by the private insurance companies, like Excellus, Atena, AARP, etc. So it’s winner winner chicken dinner but that ship has probably sailed already.
So, even though we don’t really know all the details on Obamacare, we do know a few things:
1. The plan is supposed to provide insurance to everyone
2. The plan is dependent on getting young, healthy people to sign up in order to cover the cost of older people
3. There is no penalty or surcharge for “pre-existing” conditions
4. Part of the plan calls for doctors and hospitals to form groups to “manage patients.” Translation = manage costs
It’s this manage patients part that interests me and should interest you. It’s basically the return of a previously tried and abandoned form of reimbursement called captivation…this was a plan put forth by insurance companies years ago that gives the doctor and/or hospital a set amount of money to care for a set amount of patients. So let’s say that I am given $100,000 to take care of a set of patients for a year…if, because I have a lot of young people who don’t need much doctoring, there is money left at the end of the year I would get some of that as a reward for giving frugal care. If, because I have more patients go to the hospital, or have more difficult to treat diabetics or do more tests, and there is no money left at the end of the year I would be penalized. The name of my practice is PREVENTIVE medicine associates…so I do think it makes sense to order lots of mammograms and colonoscopies and check your labs frequently when you are on blood pressure meds or hypertension meds or diabetic meds. I would rather be safe than sorry.
Also, the part where preexisting illness isn’t penalized is crazy! You don’t pay the same for insurance for a Ford as a Ferrari. Why should a diabetic smoker pay the same rate as a healthy person? Now things like Multiple Sclerosis…that you don’t have much control over contracting would be treated differently. Actions have consequences…so do inactions and I would have an appropriate sliding scale. So Obamacare is going to give medical access to the chronically ill who couldn’t previously afford it…how is this going to cut costs?
Sure, there is lots wrong with the current system. Prices are crazy. More of these expensive tests keep suggesting other even more expensive tests without even giving you a firm diagnosis. Deductibles are out of sight. Non-generic meds cost an arm and a leg. There can be long waits to see the specialist and communication between doctors is still last century. I don’t see how Obamacare can fix these issues. They say they want to focus on primary care and encourage more doctors to go into primary care but for the last decade we have faced a potential 30% cut in Medicare pay each January 1st unless the President signs each year a bill overruling this law. Hard to recruit people to go into a profession that has faced this potential 30% cut in pay annually for the last decade or so. A big distinctive to go into primary care is that specialists make twice the income the primary care doctors make…would even a 10% increase make a difference? Don’t you see a lot of young doctors going into primary care? Not in Upstate New York you don’t.
My profession is under siege. Between lower reimbursements and much more paperwork and pre-authorizations and rising expenses and dealing with the electronic medical records and the daily dreaded risk of malpractice…morale has never been lower. Doctors have been de-selected by insurance companies without warning or obvious cause and with no real recourse. Luckily I am an optimist (of the Lafayette branch) so I have promised myself to always look on the bright side. Just because most can’t see a bright side doesn’t mean there isn’t one. This will be a challenging next few years for doctors and patients alike. Don’t have a thrombo over things you can’t affect. Try and find the humor.
In the meantime, don’t rely on insurance companies or the government or your momma or supplements…take care of yourselves with the old tried and true…diet and exercise. Exercise and diet. Excelsior!
A few months ago I urged you to take a hike…my advice this month is to join a club. This article is not for you folks with small kids. You are plenty busy with homework, housework, the soccer league, bunko night, etc. Your world is probably busy and varied. You focus on the kid and that’s god and important…but at the risk of your current scorn (you know who you are) I again urge the ladies to not forget about the big baby. Oh I can almost see you sneer as I write this. There goes mister misogynist, mister sexist, mister me me me. Compare and contrast that sneer against your expression as you sign the divorce papers. Is that too harsh?
Plan some time with your spouse that doesn’t involve the kinder if you value that relationship. It was just the two of you in the beginning; hopefully it will still be the two of you together when and increasingly if the kids move out. That doesn’t happen on autopilot. Maybe it did for your parents’ generation but not anymore. This is the family we are talking about, your family…isn’t a little investment in energy and time appropriate? I’m talking about date night. You can go with other couples or a group or other people just not with the kids. You know it’s different when the kids are around. So, you young professionals with kids YPWK’s (follow them on Twitter…hashtag WTF). You people should skip the rest of this column and maybe read the exercise ladies column or the guy who writes about the corruption of our government both locally and nationally. There’s nothing more for you to read here…move along. Thank you very much.
Now, I guess I am writing this column for you widows and retirees. Most of you have one thing in common. Your world is shrinking people! You are hurtling up! Are you making new friends or losing friends? People keel over…interests change…all kinds of shenanigans…but most of us I think could use a bigger support group. It’s really very easy to get socially isolated. It’s also very easy to fix….Join a club. Wine tasting…club for that. Giving toasts? Club for that. Book club? Plenty of those. Poker club? Sure thing. Royal Order of Whateverthehell. The Ladies That Knit on Their Knees. Shriners. Optimists. Odd fellows. Church groups. Sewing groups. Canning clubs. They all share the commonalty of getting you out of the house for new experiences, and a chance to meet new people and to do new things, and to possibly make a difference in the world. The retired population has such a huge amount of collective experience and wisdom and it’s going to waste when you just sit at home watching NCIS for the 50th time. Social isolation is a real problem with real medical implications. I’m not going to quote any medical journal here because I don’t have to. Real life examples abound. Look at your Momma (not my momma, mind you!). Or your mother in law. Are they doing the same things now they did 10 years ago? Is their social circle getting bigger or smaller? I think most people don’t stop to realize just how limited their activities have become…most of us are up for a challenge, ie. invited to dinner or a movie but most of us are not great at challenging ourselves ie. spontaneously deciding to take a class or join a club.
As I write this I got the Cazenovia College extended learning catalog in the mail. OCC I’m sure has equally diverse offerings. You can take all sorts of classes…Hypertufa Garden Sculpture for you artists…Understanding the Mind of a Dog for you animal lovers…Photography, Soup Making, Whittling, Jewelry Making…quite the smorgasbord of offerings. Why, you could probably teach a class but I am happy to get you back in the classroom on the either side of that little desk. Most of these classes are one to three sessions long so we are not talking about a major commitment here. But we are talking about a commitment to yourself. Frankly, I’m not sure you are up for it. I mean look at you…when was the last time you really and truly tried something different. You don’t even try different restaurants anymore…you go to the same place and order the same thing all the time. It’s not sad but it’s not joyful either. You don’t have to turtle up…you don’t have to close window after window in the house that is your life. The view can’t be all that good once you close that last window…perhaps its similar to the view from inside the casket! You don’t have to rehearse for it…the hearse will come in on its own good time.
“I don’t fly anymore.” “I won’t drive downtown.” “I have stopped visiting the family that lives out of the area.” All these statements tell me you have a problem. Sometimes it’s a medical issue…many times it’s not. I view that as an integral part in my role as Doctor/Life Coach. It’s not all about sore throats and rectal exams…maybe I can help you with the social issues as well. It doesn’t cost extra and I have had a lot of people that are going through the same thing you are. I see what the successful ones do and I see what the failures don’t do…any chance you want to really explore the issue? Or, just continue to live in a smaller and smaller universe. You can expand that universe immensely with a club, group, organization, etc. You will find people who are different from you and people who are not. You will really enjoy some people’s company and will grow to dislike that one or two people in any group that tweaks you.
It’s good for you physically, it’s good for you mentally, I think it can be good for you spiritually, tell me again what’s stopping you? Yes I know about inertia. I don’t live in inertia, I live in Lafayette…I am a member of the Optimist Club there so you know I’m walking the walk…repeat after me: “Every day I wake up and I can improve something in some way…maybe improve myself in some way, maybe improve my surroundings…any little thing but going forward in some way, or I can get older, weaker, poorer of spirit, etc.” It’s a choice you make every morning you get up. Choose to get involved! Join a club!
This article will hopefully be short…short, sweet and to the point. How’s that for a change? I know how well you listen when I lecture about diet and exercise…so if you don’t follow my simple recommendations about the basics of your health, how likely are you to try something new? Well, hope springs eternal so I thought I would write about something that I know can benefit anyone. Yoga. That’s right…yoga.
You should do yoga. Not try yoga…do yoga. You should do it if you are injured or sick. You should do it if you are well. You really have no good excuse…oh you have plenty of excuses but each and every one can be overcome if you really want to. Instead, when I mention yoga you draw back like I was swinging a rattlesnake in your direction. I really can’t understand why you are reluctant. Yoga can be done very cheaply. No special uniform is necessary. You can practice it at all skill levels in the same setting. Young or old. Male or female. You don’t need a partner. You can do it alone to a tape or take a weekend retreat. You know my mantra…diet and exercise…exercise and diet. But if I were to amend my mantra it would be diet, exercise and yoga.
I often get a funny look when I recommend yoga. People are willing to risk getting hooked on pain pills or having ulcers with the nonsteroidal drugs rather than consider yoga. People seem willing to have surgery or have needles stuck in their backs, risk infections or go for rounds of and rounds of physical therapy but are not willing to try some prolonged gentle stretching program. I’m not saying you shouldn’t do physical therapy…I’m saying you should do both. It’s a good fit with both cardio programs and strength building programs. So what’s stopping you. There are yoga classes all over the place…the fitness center…the church recreational center…the firebarn…but you can look for a dedicated studio if you want to class it up a little. I take my classes at a dojo in Liverpool. If you are reluctant to do yoga with others or are somehow worried about embarrassing yourself in front of others you can get a DVD from the store, the Internet, the library, and try it at home. Taking a class with others works better for me for some reason but I do tend to keep my eyes closed most of the time or maybe it’s that I’m so focused on me I don’t notice much else. Please hold the cracks about me focusing on me all the time, anyways.
So yes, I recommend yoga. This isn’t about religion. This isn’t Jesus versus the Buddha…this is a set of exercises that stretch and realign your spine and body and seek at the same time to relax you and get you in touch with the basics…like breathing and physical self-awareness. By that I mean listening to what your body is trying to tell you. What hurts and why and how you can possibly make it better with stretching and better balance and posture. How is that not a good thing? What keeps you from trying? No, you may not break a sweat during yoga…you might but it’s not guaranteed. You put as much into it as you like and of course I think the results reflect how much you put into it. Yoga tests not specifically a cardiovascular exercise…it’s not aerobic and it is not weight training but that doesn’t mean it shouldn’t be in your exercise program. If you really have an exercise PROGRAM hopefully that doesn’t mean just doing the same exercise every day. Of course consistency is important but more in terms of frequency…there should be some variety in your exercise and yoga should be just one part of your pattern…
Of course there are multiple types of yoga but I’m referring to the slow set of repetitive stretches that challenge your range of motion and balance. Opens up your spine and lifts your spirit. Sure it’s uncomfortable at times but that’s what the slow stretch is all about…you get all up in that discomfort…you own that discomfort…you map that territory…you’re not paying taxes on that discomfort but it’s just a matter of time…that’s your personal discomfort…then…as you learn to let go of the tension…the position becomes comfortable and you decide if you want to challenge yourself further.
I have never left a yoga class not feeling relaxed and somehow more centered and peaceful. I know that sounds a little “soft” but you can’t understand the feeling if you haven’t done the class.
I’m not the only one recommending yoga. The PX90 program has a yoga component. All the high-end spas and workout places have yoga available. I have never left a yoga class not feeling relaxed and somehow more centered and peaceful. I know that sounds a little “soft” but you can’t understand the feeling if you haven’t done the class. How long that peaceful sense lasts depends mostly on me…sometimes it’s hours afterwards before my innate pessimism returns…sometimes it’s minutes…why oh why are you pulling out coupons in the seven items lane at my beloved Weggies. I overlook your having 20 items in the 7 items lane because I’m feeling good after yoga but when you pull out the coupons suddenly the old Joey is back. Still, my point is that yoga makes me feel better both physically and mentally and I know it will help you too if you would only give it a try. It’s May 2013 and it’s just the right time of year that you tried something new…or you could keep coming to my office for the drugs that give partial relief, see the chiropractor, go through physical therapy again, another round of MRIs, injections or surgeries. If that’s working for you, great. But I see many people who are not getting better or feeling well despite the above. Yoga is an essential tool you should have in your personal health tool box. The instructor where I take my class usually ends with an expression that goes something like “thank you for taking this opportunity to quiet our chattering monkey minds.” You know how that resonates with my prior writings about how the day to day grind dulls us and obscures what’s important…we focus on the minutiae and forget about the big picture. Yoga will help you stretch thoroughly and relax for at least a time. It’s up to you to and me to make that time last longer. It’s up to you to make the time to give yoga a try. Until then…get well…stay well.
I write this month about apps for the smartphone. If you don’t own one now the experts say you will soon, the next time you upgrade your phone for instance. In roughly two years’ time therefore, the only person on the planet without a smartphone will be me. Now I had a smartphone but gave it to my daughter and got a militarized flip phone so I can get it wet and not hurt it. I didn’t use the barcode reader and the night sky reader or the Angry Birds game whatever that is. I didn’t need all the fancy bells and whistles. I couldn’t read my email without glasses so it’s back to the primitive phone that only makes and receives phone calls. Can you imagine my primitive state? Smart phones do so much these days, from GPS to capturing photos of what you ate last night. How did I ever get by not getting a photo of your sushi plate emailed to me while I’m trying to read. The ugly downside to the smartphone is so obvious to everyone over 20. They intrude on real life. How many times do you see someone at the dinner table checking their email while a conversation with real live people occurs around them? I was in the Caribbean recently with my wife and I marveled at the obviously American family sitting next to me in the outdoor dining spot…the gentle warm breeze…the sights, the sounds and smells. The family of four was all sitting there each one immersed in their own device. It looked like two iPads and two iPhones from the dim glow but really…you travel thousands of miles to “get away” and still can’t bear to really separate yourselves from your tech? don’t you know how ridiculous it looks for you to be frantically thumbing these little pads constantly?! Listening for the furtive tweet honk or other personalized sound that notifies you that someone or something has something for you? Just as you laugh at me for being a tech dinosaur, future generations will laugh at you for this frantic fingering. How panicked you get when you can’t get a signal and check your Facebook constantly. You look like a heroin addict who can’t get his fix. Heaven forbid you have to endure a little silence or perhaps get involved in the conversation.
There is no way to turn back the techno clock nor would I want to. We live in a world of constant change and miniaturization and I foresee that we will all be wearing glasses in the future that projects a data street or multiple streams based on what we are looking at or doing. Don’t have to look down at your watch or hold anything at all to make a phone call. For that matter the data streams will project onto your contact lenses. We probably already have the little watches that can work as a phone as well. We will do more with our voices and less with the keyboard; at least not a physical keyboard. No, peripheral brains are here to stay and as we seem to be getting dumber all the time it’s a good thing. Don’t think we are getting any dumber? Look to Washington…any sign of intelligent life there?
So let me help you put something in that peripheral brain that can make a difference with your health. And by doing so make a difference in your life. Maybe some free app from the internet can motivate and educate you in some way that has escaped us during your office call. How many of those little icons on your phones are links to something actually useful?
Of course these apps will only work if you actually use them. You must put them front and center in your phone like a photo of your fat self front and center on the fridge. Get in the habit of using them daily…anything less won’t work. There are literally thousands of apps available, some free, some not, and I’m not saying the list below is best but it’s a start. These are from the list I give my patients and I will add it to any apps that people suggest (after I’ve checked them out of course).
So the big areas that a little peripheral brain can help you include quitting smoking, diet and exercise as well as hypertension and diabetes management. You can take great care of yourself without these apps but if they are available why wouldn’t you at least give them a try. One of the hallmarks of people that are improving themselves, one of the reoccurring suggestions from the gurus of self-improvement, one of the recommendations from all the experts in the health industry is to track the data. Using these little phones you can follow your blood pressure, your blood sugar, your exercise frequency, etc. the more you know the better decisions you can make. The very act of keeping track and reflecting on the activity can reinforce good behavior, patterns and lifestyles. More of my patients are keeping their copies of their medical records on their phone but I still don’t know the best app for this.
Most importantly is quitting smoking and there are multiple free apps, but the one with the most umph is My Quit Coach (available at the Apple Store or Droid download sites as are all others). This one has a livestrong association which I don’t know how I feel about but the app is good and the issue of quitting smoking so important. You can chose to quit it at once or slowly and the app tracks differently.
For diabetics I recommend WellDoc or Glucose buddy. Both not only track data but interact with you to attempt to change behavior, results.
To remind you to take your meds, try RemindMe. Most experts think the average patient screws up their meds all the time and the more the meds the more the screw ups. What’s wrong with having that little device that’s next to you remind you to take a pill? Might just be the thing to keep your college age daughter on her birth control pills, or grandma might need help remembering the third batch of pills each day which your old hand me down phone could help her with.
When was your last tetanus shot? No questions about what shot or when with the VaxTrak app. Do you know how many pages of old records I have to comb through to try to figure out when your last pneumonia shot was? Keep track of your own vaccine info.
If you want to stay healthy you have to take care of your blood pressure. If it’s high you have to treat it. If you treat it you should track it and besides knowing more about your own health it proves to your doctor that you are an involved participant in your care. The app for you is IBP blood pressure.
Although I have more to say on this in a future column, if you have trouble sleeping try Pzizz, it’s $10 at press time but worth a try.
For those working on diet…and you should all be, I offer you four choices: LoseIt, MyNetDiary, Mindful Eating and Mindful Bite. I like the first two apps more than the second two, but it’s a style thing, not a content thing.
For those working on fitness and that’s you: MyFitnessPal, C25k, iFit and Daily Cardio Workout. Many also have calorie counters and diet information. C25k stands for couch to 5k, meaning they will go from being a couch potato to fit enough to run a 5k. Pretty neat.
Finally for relaxation…for those of you too stubborn to follow my advice and try yoga, try Breath2Relax or Buddhify. I really like the latter program as you can customize it for commute, exercise, etc.
Lastly for brain training, consider Luminosity Brain Trainer or Memory Trainer Pro. The former is a more thorough program and the latter is something you do while you are waiting for your lunch to arrive. I don’t know if either program will help you remember your girlfriend’s favorite song. These apps can’t help your marriage or help you figure out what’s really wrong with that kid or grandkid of yours, at least not yet. Give them time. I’m working on an article about an exciting new Internet-based treatment program for insomnia. No gimmicks, no fancy machines, no medications of any kind. Nothing to lose or break or have to send back. You can get to the bottom of the problem or you can just cover it up. This new program offers a real, long-term solution that does not require input from you or some kind of work on your part. And of course that means 90% of you can’t be bothered and will ask for a sleeping pill. I know, believe me, how important a good night’s sleep is but I can’t believe taking some medication that powerfully affects your brain night after night is good for you either. What do you know…neither do the experts as recent news stories detail. “Use less, use lower doses” was the recent update from the FDA. Of course, they also recommend not using drugs for more than two weeks at a time, but try to tell that to someone asking to stay on this medicine for all time.
I am so going to surprise you by actually writing about something I have some experience with. I want to talk about something that’s going to depress you. No, not the economy, it’s not about the future of health care, although both subjects have left me morose. It’s March so it’s a dark, wet, cold time anyway…perfect weather to let a bad mood fester. Of course that’s why I always take and recommend a vacation down south this time of year for some much needed warmth and sunshine on the old pineal gland. No, the depressing issue I want to write about is Nursing Homes. Not the care in nursing homes…but your unrealistic expectation of life therein. I have worked in two nursing homes and was a medical director of a third. I still have a floor at a local home that I have worked at for over 20 years so that’s my bone fides. Last year my mother died in a nursing home so I also have the perspective of a family member.
I don’t write these columns to make friends…sometimes I write to get stuff off my chest or to show a different side to a story, but today I write to because sometimes there’s stuff you really need to hear and you are not going to hear it from anyone else…not in writing, anyways. Everyone who works in any aspect of the nursing home environment…the nurses, the diet staff, the therapists…they all will nod in agreement with what you are going to hear. I’m not going to sugar coat this topic…it’s too important.
Let’s start with the basics. No matter how nice you try to make it…paint the walls in cheerful colors and dress up the dining service and have memory hour during activities…it doesn’t change the basic facts. For the vast majority of residents, the nursing home is the place to go to die. It may be in 3 days or 33 years but most people don’t get out alive. It’s the last train to Clarksville, people. It’s the end of the end of the line. No body but nobody says “I am looking forward to spending my last days in the nursing home. Get me there on the double.” Not everyone wants to spend their waning days in their own home…however unrealistic that may be without a buttload of help. Not everyone has the resources for this help and so we shuttle you off to the nursing home.
So the nursing home is unfortunately all too often the last chapter of your life. It’s usually not a very pleasant chapter. Can you see the comparison with a book? If the last chapter of your life is going to be unpleasant…why would you prolong it? Is it better to die within a month of entering the nursing home or would you rather linger usually in great diminished capacity until some illness finally claims you? You go into the nursing home because of a broken hip or because you are too old or weak or had a stroke…most nowadays go in with dementia. Even the demented patients…maybe especially the demented patients, know they are in the “wrong place” and can literally beg anyone that comes by to take them home or ask over and over again “Why am I here?”
These poor retches are taken care of by people who can never get paid enough for the care they give. Their families have completely unrealistic expectations of how much time and effort can be put into any one patient’s care. The costs of care…or at least the charges seem outrageous. You could live abroad a cruise ship and get more care, better service and better food for a cheaper price. It’s the next most regulated industry short of nuclear plants. Probably has surpassed nuclear plants by now. Whole staffs have been hired…countless hours of completely ridiculous paperwork to try to explain away and justify the events that inevitably have to happen in the nursing home. Here’s a partial list of what inevitably happens.
Your loved one WILL FALL. Unless we strap them down they will want to get up for any number of reasons no matter how confused and weak they are…and they will fall. Honestly you know, I blame many of these falls on too many medications. Staff and families alike want a medicine for each problem…there must be a pill for the agitation…sure there is but it comes with a black box warning that says its use results in more deaths than in patients who don’t take the meds. But meds or no meds your loved one will fall…the last fall will result in some serious injury and they will pass away…will you make them struggle in some ICU or will you let them pass quietly away with family nearby?
Your loved one WILL get dehydrated, have a urinary tract infection and get pneumonia. You can’t easily or reliably prevent any of these things from happening. If you give them food they can’t recognize they will choke. Personally I would rather choke on a nice sausage sandwich and die rather than have all my food pureed so it’s just globs of different colored mud on the plate…the pale yellow puree…the brown glop and the green glop…I know the therapists that made that suggestion and the dietary staff that is arranging it are doing their best but that doesn’t mean you have to go along with it. A knowing and eminent doctor long ago said that “Pneumonia is a friend of the elderly and in firmed alike”. He said that over 100 years ago and that means that a quick death from pneumonia is preferable to a slow lingering death.
So let’s get down to serious suggestions. Maybe you won’t understand my suggestions until you have someone you love go through this. Just because it’s the last chapter of your life and just because you don’t want to prolong this certainly difficult tome doesn’t mean you don’t have a helluva lot of control over it still.
Make you loved on a DNR. Of course you don’t want your mother to die. Sorry, gonna happen anyway but you can help her with a DNR. When the end comes they can die peacefully with meds to keep them comfortable or they can die surrounded by tubes and wires and some poor nurse or doctor crushes their chest in an order to keep them alive a few days longer…and those won’t be good days.
Let them eat whatever they want. If Uncle Johnny wants ice cream for breakfast, lunch and dinner…why the heck now. Who cares if they were on a low-salt diet on the outside. Who really cares about their diabetes now. It’s about quality of life now…not quantity. Unless the resident can sign the papers themselves don’t put a feeding tube in. this isn’t saving their lives…it is prolonging their suffering. When you can’t reliably swallow any more it’s game over…
Stop most of the pills. Why are you letting them give your loved one a pill for cholesterol? Don’t you realize a stroke or quick heart attack would be a blessing for most of them. Likewise it’s long past time to worry about high blood pressure…the side effects from the pills are likely worse than any possible benefit from the meds. Your own doctor will likely admit it if you press him. If the pill directly makes them feel better…Tylenol, pain pills, etc., use it. Otherwise, you are just not thinking about the end game, a painless gently passing into the next life.
Aggressively treat pain. I hate codeine for chronic pain on the outside but in the nursing home because again it’s the last stop on the train to endsville I open up the cabinet and will try to help keep your pain to a minimum. No one ever said to me “My mother was too comfortable when she passed”, but they have said the opposite. Don’t be frightened of morphine at the end. We are not committing euthanasia, we are making the patient pain free as far as we can tell. It’s one of the few things we do have control of.
I try to treat all my nursing home patients with three guiding principles. Would I do this to or for my momma? Would the patient themselves want this treatment if they could wake up and speak to us for just a moment? How do we help the families realize there is only one eventual outcome and to focus on that understanding rather than the day to day stuff that drives them crazy? I am not saying in any way that the families’ concerns aren’t real or valid. It’s just not focusing on the big picture. This makes decisions easier for me. I hope my suggestions make things a little easier for you.
It’s February and one’s thoughts should turn to love…Valentine’s Day and all that. My thoughts turn to sandy beaches and bikinis but I have been married a long time…a very long time…at least it seems like a very long time. Hey, whose idea was it to suggest people should be in monogamous relationships that last until someone dies. Is that a reward or a punishment. Let me get back to you on that one. I will ask my wife. She knows the answer to everything or so I am told over and over. Do I sound testy? My wife says I get testy at times. If she really knew me, she would know why and how to prevent it, namely, more sex, more sex, while I’m still young enough to enjoy it! I don’t know how you 70 year old people do it. Between the wrinkles and the arthritis and worrying about the grandchildren, it’s hard to imagine what that must be like. Frankly, I don’t want to imagine it. The very thought makes the back of my eyeballs ache. I love my wife and she keeps herself in great shape and you can bounce a quarter off many parts of her body. Not that she’s given me the change but I have a good imagination. At 70 however, I’m going to need beer giggles, several tongue depressors and no doubt drugs still in development. Of course, it’s highly unlikely I will survive to 70 once someone reads this article to her. Don’t you be that one. I know you are dying to get me in trouble but it’s bad karma for you. Everyone who knows my wife knows that is the center of my universe but I wouldn’t mind orbiting around her a little more often. If you get my drift and I think you do sir!
In years past I have written at this time of year about how most women seem to lose their sex drive a decade after the wedding cake and men are forced to deal with their sex drives until the testosterone wears off, usually decades later. I would gladly give men advice on how to keep pleasing their women but I got nothing. Flowers, candies, doing the dishes… all old bromides for a bygone age. I’ve tried them all…the cards and candy left for her to find on her steering wheel, the romantic text messages, the spontaneous flowers. Good the first 10 times but them it’s ho-hum. I would stand naked in the doorway covered only in peanut butter and a few well-placed bits of dark chocolate but I wouldn’t be able to keep the dogs from licking me and that’s gross even for me and, with my luck, the door would be opened by one of my kids. So, clearly, I am drawing a complete blank in the pleasing the modern woman department. Go read Cosmo or something for that advice. On the other hand it’s easy to give women advice on men. On that subject I can speak with some degree of certainty. It’s easy. It’s simple. It’s inexpensive. It’s much more important than you know.
Keep the loving coming and maybe mix it up a little. That’s it. That’s all. Notice I said loving to try to fru fru it up for you but you know I mean sex. If you put as much effort into trying a little something new or different in the bedroom as you do in worrying about your next haircut, we men would be ecstatic, if you could put a little effort into your bedroom wardrobe like you do your work wardrobe, you would have my gratitude and the gratitude of the nation. It’s fine to fuss over a new casserole recipe but I have a little bedroom recipe I would like to work on with you. When I heard about these 50 shades of gray books, I thought that might light a little fire in the right places for my wife but all I got was a green shade of disgust when I brought it up. But then again can you blame her? Look at what she has to work with. Still this little ring on my finger means I am cut off from all other avenues of intimate pleasure. I am happy to be faithful but how about a little wow once in a while. Still, it’s not just me. Most of the women’s magazines in the checkout line have an article about how to spice up the love life… locations, outfits, time of day, toys, etc. Cary it up a little bit. Is that too much to ask for a man facing a life sentence? But may I suggest skip the sexting? I don’t see how that can be anything but trouble.
By mentioning adding a little variety, frequency and intensity to your intimacy I am covering ground covered previously and by others but good advice bears repeating. I know the women are all thinking what a sexist pig and the men are all thinking how do I leave this article around so she will read it, commend on what a chauvinist I am, and he can make her feel good by agreeing with her but then segue into “say whatever did happen to that fuzzy outfit I bought you last year?”
Leaving covered ground let’s switch it up with a little Valentines trivia to provoke conversation at the restaurant, the bar, the kitchen table.
Who was cupid? Who was Valentine?
Who is credited with selling the first mass produced Valentine’s day card?
Approximately how many marriages are performed each day in the USA?
Name two states that have towns/cities with the name Valentine?
Son of Venus goddess of love and beauty.
Roman clergyman executed for performing marriages in defiance of Emperor Claudius II who thought that marriage was bad for his soldiers… weakening their righting resolve.
Ester Howard of Massachusetts.
Texas and Nebraska
I understand laughter is the best medicine so let me close with a few bon motes.
Did you hear that having sex burns as much calories as running 8 miles? What I want to know is who can run 8 miles in 45 seconds!!
I liked these two from Playboy.
A woman and her boyfriend were having an argument. The woman shouted at him, “Leave! Get out of his house.” Resigned, the boyfriend headed for the door. But the woman continued. “I hope you die a slow and painful death!” she yelled. He turned around and asked “So, now you want me to stay?”
And, finally, a man was unhappy with his wife’s emotional swings, so he bought her a mood ring to gauge her temperament. He found that when she was in a good mood, the ring glowed green and when she was in a bad mood it left a big red mark in the middle of his forehead!
I would close by saying next month we will deal with some real and serious medical topics but wait a minute, not just myself but experts have opined that sexual health is part of physical health and can be one gauge of a relationship. I’m sure Dr. Oz and Dr. Phil are both on record saying the exact same thing, perhaps not in the same way I do, but I’m sure they are doing their best.
PSA = Prostate Specific Antigen. This is a protein that is made in the prostate that normally circulates in minute amounts in the blood stream. Women don’t have a prostate and, therefore, they will not have any measurable amount of this protein that is specific for the prostate, hence, the term “Prostate SPECIFIC Antigen”. Young people have small prostates and low levels of this protein circulating. Old people have bigger prostates and higher levels of PSA. We don’t really know why but the prostate is one of the few glands/organs that grows as we get older. Your height shrinks, your kidneys shrink, etc. etc.
The PSA test is just a measurement of this protein in your circulation.
It slowly goes up as you age. The normal range is 0-4. Some experts say you should age normalize the results and use a bigger range as you get older. So, up to 4.0 is okay if you are younger than 60 but over that age maybe a top score of 6 is still normal. The actual number is less important than how it changes over time and it’s easy to measure. When the level is elevated or jumps a lot from the last test, there is a reason. There is always a reason but only sometimes is it cancer. Sometimes the level is elevated and it’s just the prostate getting bigger over time. Sometimes it’s an infection and more of this protein leaks out due to the inflammation/infection. But, sometimes, elevation of the PSA is associated with cancer.
There is no perfect test. I have had patients with PSAs under 4 who had cancer and patients with PSAs over 30 who did not have cancer. Cancer can only be determined by a biopsy. Prostate cancer is treated differently depending on the stage, your age, the aggressiveness of the cancer itself. But if you don’t find it when it’s still small, it greatly limits your choices and the PSA offers the only hope of finding the cancer before it has spread from the gland.
So an elevated PSA doesn’t necessarily mean you have cancer BUT a big jump in the PSA (over 1.5 increase) and every number over the current cutoff of 4 should get checked out. This means either having the test repeated within 6 months or talking about a trial of antibiotics or possible prostate biopsy. What do I do with my results. Your results will be sent to me by the method you selected at the time of the blood draw. This will be done by Dr. Barry directly for each and every sample. It will be Dr. Barry who sends you the email, mails the result or calls you…your preference. You should be notified whether the results are normal or abnormal. You should be notified within 10 days or you should call 559-9936 and let me know. You should share your results with your doctor. Tell him you had a free screening done and the results are xyz. It should be a number hopefully less than 4. If it’s over 4, it doesn’t mean you have cancer, but it does mean you should get it checked out.
There is some controversy over the PSA test. Although I don’t know a doctor seeing men who doesn’t order the test, there is one specific government panel that suggests that people shouldn’t be tested. This makes no sense to me. Little the government does lately makes any sense to me including but not limited to the health care field. Just drop dead already will you. Dropping dead is cheap, chemotherapy is not. The PSA is just like the mammogram…not every abnormal mammo is cancer…not every high PSA is cancer. But, the PSA has still revolutionized prostate cancer because before this test was available prostate cancer was usually diagnosed after it had widely spread to the bones. You could do things to slow the cancer down but this was usually a death sentence and prostate cancer was a top 5 cancer for men. Now with the PSA the cancer is found when it’s still inside the prostate and you have options…watchful waiting if you’re 85 but robot surgery or radiation therapy etc. if you are younger. The technical meaning of younger being having a 10 year life expectancy.
I set up this screening because I am an optimist. I’m not looking for new business. Like Scrooge learned… “Mankind is my business.”
That’s right…I’m talking about the State Fair…..A chance to get up close and personal with livestock of all shapes and sizes and breeds. By the time you are reading this the Fair has been open for at least a week already. Hopefully you have checked it out. If not, there’s still time to get out there and I will give you plenty of reasons why you should. I love the Fair! The sights. The sounds. The smells! I have a strange soft spot in my heart for the multicolored chicks in the bird house. Who thought that up? Why? Having personally raised pigs and sheep (don’t ask!) I do like to check out the squeaking and squealing piglets and watch the sheep shearing. To watch the cascading waves of wool come off the lamb at the hands of a good clipper is almost magical. In the end you a pretty big pile of wool and a lamb ready to enlist. How’s that for sustainable energy!
Speaking of sustainable energy, you have to have one of those lemonades made from fresh squeezed in front of you lemons and a quarter bucket of puro cane sugar. (I have watched a few too many crime shows, I can’t say pure, it has to be “puro”, the Mexican way, like you are talking about blue crystal meth), at least it’s not the dreaded high fructose corn syrup. The pucker factor mixed in with the ice cold sweet jolt is a real pick me up. I, of course, always bring my cup from last year because you get a discount, I keep it in my day pack on my back, having taken kids to the fair for years you a have to have something to hold all the small junk and you should have a stroller/wagon for all the really small kids, say under 15. Most kids these days are weaklings. Yes that’s right, I have a day pack, at least it’s not my fanny pack, but that’s another article. Yes, you can pick up some type of freebie bag from Nimo or Keybank to carry your junk, but I prefer the small backpack because I like to keep my hands free. I must be unencumbered if I am to save that baby falling off the tilt o whirl. I only hope it’s a toddler or smaller or I’ll get crushed! Oh what’s that? Not this time? Ok, just saying I am ready is all. Should a horse get away from its handlers I am prepared to wave it away from the twins in the stroller, that right, because my hands are free. And you know there are plenty of opportunities for the Heimlich maneuver to come up, there are too any sausage selling places to have an EMT crew stand by at all of them , but that’s where the action is. I don’t think anyone is choking on the walk away Sunday, and I do like to end my fair visit with one, where they start with the brick ice cream on a cone and then dip it in chocolate and then thrust it, still dripping of excess chocolate into the nuts and end with a cherry on top! Here my health related suggestion, enjoy the ice cream etc., but ditch the cone, you have had carbs aplenty already. I go to the one near the taffy store where you see the taffy get pulled and pulled in the machine, so, of course, I recommend getting a box of that salt water taffy to go. Sure it’s a stress test for your fillings, and you can enjoy them for weeks after the Fair. An edible memento. A Fairmento.
The Fair is expansive enough (that’s right, expansive, not expensive; you can do the Fair on the cheap if you have to). It’s expansive enough to wear out the kinder, the teens and the elders alike, it’s an agricultural, entertainment, and gustatorial triathlon. Between the rides and the exhibits and the stands selling almost everything, but bath salts, the fair can be a draining and exhausting day. That’s why I love it and encourage all my patients to go. Precisely because it is a challenge, it is absolutely a different experience each time you go, if you do it right. Can we be honest here? I think most of you don’t have the strength for a full day at the fair. Admit it. It’s too much walking. Too much exposure to the outside at one time. There are bathroom issues. The crowds. The parking. I hear it every day. Along with all the excuses about why you can’t exercise. That’s a defeatist, I hear. That’s a negative attitude and I can’t tell you how bad that is for your health. No! Rally, I say! Do not go gently into that dark night!
Ok, you can’t take a full day. So what, do a couple of hours. Take one of those buses from the nearest mall, etc. Are you worried about eating unhealthy? I worry about your unhealthy eating the rest of the year. If you are eating right a few indulgences at the fair are meaningless. That’s ok. You know you are going to overindulge in something. Blooming onion? Mystery meat on a stick? Don’t delude yourself, own that pizza fritz, but own the work it’s going to take to get that junk out of your system. Maybe now that I think of it, you shouldn’t own the fritz, rent it, or nibble one fritz between the bunch of you. You do go to the fair as a group, don’t you? That’s a part of the fun. Who will break down first? Will it be Grannie’s knees or Dad’s temper? I like to go with a group of 8 people and play those water games where you squirt the target. If you have 8 people you can own the whole row of seats and someone from your group is guaranteed to win. It’s a blast to go with a little kid this way because all the other adults and older kids can blast away all around the target, but not hit it and the little kid thinks he beat everyone. It’s good to build up the spirits of the little kids before life’s brutal realities grind them down. Of course one of the other kids will be jealous, how come he gets to win because he is the smallest, you never let me win like that, then they have to reveal the secret to the now quivering tot and all the others have to nay say it and there’s the part with Dad’s temper.
So why go to the Fair?
Point 1. It’s Exercise. That’s right, capital E Exercise. Plain and simple, even if you skip the Indian village you have to walk a ton to take in the whole Fair. Don’t skip the Indian village. It’s probably the lone space at the Fair that is quiet and peaceful and less crowded. You go from the hustle and bustle of the midway to this tree trimmed area that seems both cooler and slower, you know how often I say that to feel good, o get your mind and body right you should spend time outdoors in nature, this is a natural oasis amidst the ice cream of the future and the carnie that will guess your weight or zodiac sign. Sure I pick on the carnies, they are easy targets and they probably can’t or don’t read so I don’t fear reprisals. Now listen, just because they are illiterate doesn’t mean they can’t safely and responsibly put those vomitoriums together, never mind that reference to babies flying off rides earlier.
Why do you let me go off on tangents? Let’s get back to the Indian Village…You have a moment away from the din. Enjoy the natural oasis and then once more into the breach as you thread your way back into the midway in search of a candied apple and a henna tattoo. So just coming to the Fair can be a bit of a physical challenge, the heat, the humidity, the crowds, etc. This is a good thing. You know I think you should challenge yourself. Grow or grow old, my father has said many a time. Or did I read that in a fortune cookie.
Point 2. Try something new. You know that’s also one of my mantras, not motto, I am sensitive because I have been accused by my closest friends and allies of exceeding my motto allowance, who know!! So my mantra has been to challenge yourself, try a new ride or new game, some new food, actually sit and watch a show being put on by talent from all over the state. Ok, every act may not be worthy of America’s Got Talent, but just the experience of seeing someone perform live? That does something good for you.
Point 3. Support the local businesses. Ok, the guy selling the Sham Wow isn’t local, but many local merchants make their presence known at the Fair. Jobs going overseas. Local plants closing or downsizing. Here is a chance to make a difference. How often can you say that? How often can you actually do that? You go, you meet up with someone. You spend a little money, you keep people working, and that’s got to be a good thing in the long run.
Point 4. Sheer entertainment and education. I’m not talking about just the sheep, with so many venues and activities the only way you can be bored at the Fair is if you are a teenager with a dead smart phone, Ewuh, what’s that smell? Where are we? Why is the Center of Progress building selling sham wows? I know you wouldn’t willingly and knowingly do to it, but if you actually give it a chance there are many interesting shows each and every day. How can you not enjoy watching the Frisbee catching dogs, the high divers, the guy that uses a chain saw to sculpt logs, the livestock judging, the exhibits, the shows from the grandstand to all the little venues? I am not much for the grandstand shows or the free court shows, but they also have multiple smaller venues and I have seen great talent there for free and in the shade. I’m talking about local greats, Nancy Kelly and Joe Whitting, to name just a few.
Point 5. People watching. I don’t care what a wreck you have made of your life or your physique there is bound to be someone at the fair that makes you feel better about yourself. You could be a 400 pound, bath salts loving, no underwear wearing, bad tattooed, unemployed drunk and still find someone to look down on at the Fair. I’m not saying that looking down on others is a good thing, but we all compare ourselves to our surroundings don’t we? Is it only me? Ok, so I have hair only in places I don’t want it and my mug would fit right in on a most wanted poster and I could lose a few pounds and dress nicer, etc., at least I have more teeth that that guy! Is that shirt two or three sizes too small. Ok, I admit it; I can’t tell if that person is a man or a woman. (Those people frighten me) I’m just saying!
People trot out that old shibboleth, I have been to the Fair ten times, nothing changes, and it’s always the same. I used to go when the kids were in the house, but why go now? I can’t get around that well, that should set off a red flag, unless you are 80 years old and beyond, and speaking of Seniors, did you catch my Mother’s dance group performance? How many of you can say your parents are still alive in their 80’s? How many are dancing at the Fair? Way to go Momma! Or would you rather stay home and watch reruns of Little House on the Prairie and wonder about the butter sculpture.
So, nothing changes at the Fair? Well obviously some things are the same, we call those traditions, like Christmas and Easter, and no one says, I did Christmas for 10 years, nothing’s different. I would say there is always something different to a person that really takes a look, to a person that is still growing, to a person that still has some life left in them. So, get to the Fair and have your own experience.
Miss me last month? Did you think the outrage was over? Had I finial been kicked out / shut down? Not yet anyway! Apparently my article was too long and I have revised it accordingly.
It’s August already and therefore I should be writing about staying hydrated and about how dangerous fireworks can be. But I know you…you will interpret this to mean have another beer and to let Junior set off the bigger fireworks because he’s already missing half his thumb. Not from last year’s party…that happened over the winter with the snow blower.
Besides, people only usually die from heat exhaustion in France where the pensioners go off on vacation in August and leave gramper in the attic for the month. Google it if you don’t believe me. Hydration it turns out is a timely topic as they recently changed the running of the Corporate Challenge Race into a fun run. Really ?!? I understand the rationale being peoples safety but really…isn’t that part of the endeavor to be able to exercise, to know your limits, to test your limits both in terms of speed but also in your ability to perform in the rain, the heath, the cold etc.?
In the Lafayette High school they have posted for the parents attending sporting events in the gym, “Let the coaches coach, let the referees referee, let the players play.” I like this and would add for this occasion “Let the runners run”.
I say let them run. It is after all the Corporate CHALLENGE. All the runners have signed the gobbledygook waiver that no one reads but everyone knows will be used to hold no one accountable. What are the criterion for halting a race? Who will decide? A race official? One of our many trusted government officials? Will it be Wayne Mahar? Will it be the biggest sponsor? Is it based on heat? Is it based on humidity? Will more races be prevented by heat or humidity or cold or rain? Will this become a standard for other sports? Will high school football, lacrosse, baseball games be stopped if it gets too hot? Speaking of high school sports, when are they going to start letting girls really play lacrosse and at the same time outfitting them for proper safety. Concussions from football problem? Check out the concussions in girls lacrosse. It’s not getting hit with the sticks that’s causing the concussions it’s getting hit by the ball. These girls should be wearing helmets like the boys…perhaps with a bit a sporty plumage to close the deal.
Let’s get back to me…I tell you I somehow look forward to someone collapsing at the event. When I do some event, the Boilermaker for instance, if no one collapses, it devalues the event for me. Okay, my time wasn’t that great but at least I beat those people who collapsed from heat exhaustion. Ok you beat me to the finish line but I see you over in the tent getting hydrated with an IV. When I finish I’m ready to form up columns like the ancient Spartans and prepare for the chariot charge. See? That’s me third from the left.
Notice my shield is lined up perfectly?! Yes my spear is wobbling a little but give me some wine and a minute and does anyone know if I beat Crixus. I know I didn’t beat Annette.
Also, think if you will, about the ambulance and first aid people. No race means no emergencies. When people go down, the EMS teams jump into action. They love it! They are bored otherwise! Starting the IVs and maybe getting the paddles ready…it’s what they live for. When you don’t allow people to collapse (dare I say their inalienable right to test themselves to the point of collapse) you deprive these dedicated EMS workers a change to do their thing… maybe they won’t involve/hire as many services next year since the number of calls was down this year due to changing to a walk. So collapses means jobs just that simple. That’s right…the occasional collapse means jobs for the ambulance, the dispatcher, the fire dept., the emergency rooms, etc. Please understand I am talking about the dehydrated person, the twisted ankle, the low blood sugar. Heart attacks and strokes are serious medical emergencies and I am not making light of them but they didn’t curtail the Corporate Challenge because of worries about heart attacks but rather dehydration. It’s these low grade oft times self-inflicted injuries that I’m talking about. They are part of the engine of the health care economy. Yes, in their own morbid way heart attacks and strokes both also do their part to stimulate the economy as well. Unfortunately, it’s the funeral homes and nursing home part of the economy in these cases.
To die suddenly is a terrible thing until you think about the alternatives with the chemo and the nursing home and the chronic pain and loneliness. I don’t use the line often because many people just get freaked out but I like to say “you, I like…I hope you drop dead”. Meaning that I hope they are spared much suffering. Some get taken aback by the expression until you explain it, but a quick death is a blessing that fewer people experience in our modern world.
Next month, publisher willing I will return with more summer advice.
The experts claim that one in three Americans will suffer from Alzheimer’s disease. Suffering is a relative word because honestly most of the suffering done with Alzheimer’s is the suffering of the caregivers as the patient themselves is usually unaware of their condition. You suffer through cancer…you suffer through depression…your family members are the ones that suffer when you have severe memory loss. Alzheimer’s is listed as one of the top 6 causes of death in America but before it kills you it takes a toll on you, your dignity, your family, your bank account, etc. Dementia is probably the #1 diagnosis in the nursing home and therefore at $8,000 a month, per patient, it’s probably one of the most expensive diagnosis to treat on a national level. Maybe one of those wildly expensive chemotherapy agents are more expensive but usually they’re used for 6 weeks or 3 months whereas dementia can persist for decades.
I don’t actually use the term Alzheimer’s much…It’s really a diagnosis that can be made with brain evaluation at autopsy and it’s just a name…I prefer to call it by the more practical and less charged name…memory loss.
That’s what I see and that’s what I try to treat. You could call it Alzheimer’s, you could call it Binswanger’s disease, you could call it Lewy body dementia, you could call it senile dementia, you could call it multi-infarct dementia but the bottom line is the person has a functional problem with their memory, usually short-term more than long-term. They might remember the name of their second grade teacher but they sure don’t remember where they left the car keys or that they wrote two checks to the cable company and one to the gas company. There are some new and up-and-coming brain scans that might help decide whether you have in particular the typical Alzheimer’s changes, but it doesn’t matter much since the treatments are all the same. There is no good reliable blood work to aid in diagnosis. Diagnosing dementia is like diagnosing Parkinson’s. It is best done by the same observer evaluating the patient over time and seeing what changes occur. Unfortunately in the modern doctor’s office the typical patient can get in and get out and be quite demented but not picked up by the doctor if he doesn’t ask the right questions. In an office visit with the doctor checking the blood pressure, checking the meds, checking the cholesterol and attending to any issues with the insurance company it’s hard to step back and ask “by the way can you tell me the name of the last 3 presidents? By the way can you remember these 3 words and draw me o’clock etc.?” It is not particularly hard to do. You just have to have the time and interest… I have seen many people that were really having a lot of trouble with their memory before it was picked up by their healthcare professional because they didn’t think to ask the right questions. You don’t require a psychologist, or a neurologist, or any specialist to diagnose dementia.
So dementia is diagnosed by asking patients questions. You can use formal testing like the Mini-cog, or the MMSE, or the SAGE questionnaire, or you can diagnose it informally. Once you look for it, it’s not hard to diagnose. On the other hand many people have mild cognitive impairment and never go on to dementia and it is hard to determine who will progress and who will not, and that’s why it is best managed over time by the same professional doing serial observations.
Now, the treatment for dementia is unfortunately quite limited. None of the current prescription medications cause significant and sustained improvement in cognition. The best we can say is that these medicines keep the patient as they are, and delays deterioration, but even the most ardent user of these medicines, if they look at the literature, realize they lose their efficacy within a year or year and a half. I wanted to be known as a very aggressive dementia doctor and so when the NIH recommended that we use Aricept and then add Namenda that’s what I did. I happily told patient’s I was following the NIH recommendations proving to them that I was an up-to-date well-informed physician. The only problem was this combination didn’t really work well for the vast majority of patients I treated. There might have been a patient here and there that the family said they noticed some improvement temporarily, but it wasn’t common. Additional experience with these medicines over time has continued to disappoint. Not only did these drugs not make a big difference…they also had side effects. My experience has shown me that in point of fact the benefits are quite minimal and the side effects are real, not dangerous but real. I have had many patients stop these pills and either did not deteriorate further or improved off the medicines, so my view of prescription treatment for dementia has been leavened by experience over time. There are also 2 medical foods/nutritional supplements to treat dementia as well and they include Axona and Cerefolin NAC. I like the idea that there would be some vitamin you could use that might actually have a clinical effect because I think there are less side effects with these prescriptions then there are with the other drugs mentioned previously. Unfortunately these nutritional supplements are not usually covered by insurance because they are considered vitamins but they are not available in GNC or Natur-Tyme as they require a prescription from the doctor. Once again although individual families will say this medicine helped or that medicine helped they have not been overwhelmingly successful. Worth a try: yes. Guaranteed to work: absolutely not. I have absolutely no confidence in any nonprescription supplements that are available in the nutrition stores and vitamin stores. Completely unproven and potentially dangerous! Show me a single study done in America using human beings that show some improvement in a double blinded study and I will happily change my tune. So unfortunately, our current armamentarium is quite limited when it comes to treating Alzheimer’s/memory loss and therefore we are left with trying to prevent it, which I think in the long run is much more important…
There are obvious risk factors for dementia and they include smoking, diabetes, hypertension, and being inactive. There are genetic risk factors as well but there is nothing you can do about your genes so we focus on the modifiable factors. So yes, you can directly diminish your risk of dementia by not smoking, not drinking excessive alcohol, controlling your blood pressure and controlling your sugar. I prefer to focus on the couch potato aspect because the studies show that this is one of the most important modifiable risk factors. Besides exercise helping your cholesterol, your blood pressure, your joints, your mood, your fall risk, etc. physical exercise cuts your risk of dementia. Mental exercises are also touted to prevent dementia but the evidence that supports that is very slim. Physically pumping more blood to the brain works…mentally challenging your brain hasn’t been shown to work. It just makes sense to me that if you can open up the arteries to your brain with exercise you can get a little better blood flow and therefore a little better function from the brain. Studies have not shown that mental exercises have a basic and lasting impact but studies have shown that physical exercise seems to be associated with a lower risk for dementia. The mature patients that I see on a regular basis would benefit from exercise for many reasons not just the dementia component. People may be afraid of a heart attack or stroke in some vague way but the fear of dementia seems to strike a stronger chord. They take it a little more personally because they know someone who’s had the problem. Still, knowing about it and actually doing something about it are two different things. Get up off the couch and take a walk regularly…walk over to the local Nursing Home and that will provide you much better motivation than I can with this article. If walking through the halls of the nursing home doesn’t motivate you to get moving while you still can nothing will!
So memory loss can be a terrible problem with life changing consequences for the entire family…meds so far have little effect…but you are not helpless against this scourge…In fact you don’t need special tools, expensive tests, or exotic supplements to ward off memory loss. You just have to move it or lose it. Move your body to prevent losing your mind. So what or who are you waiting for? Until next month…get well…stay well.