Friday, November 29, 2013

Should you say yes to robotic surgery?

It sounds so modern, so um...cutting edge. Robotic surgery. It's not like Rosie the Jetsons' robot is scrubbing in --it means that remotely controlled arms and instruments will be manipulated by your doctor from a computer.

Stewart Pinkerton, WSJ, Nov 28, 2103, says this was the rage in some hospitals, but reports of injuries are rising. Punctures, tears, burns.

The American College of Obstetricians and Gynecologists has said robotic surgery is not the only or the best minimally invasive approach to hysterectomy--nor is it the most cost-effective.

But each patient is different--this does not mean you should automatically say no.

In 2000, a thousand of these operations were done a year, now it's 450,000. There is usually less blood loss, a shorter hospital stay, the need for less pain medication. Also--scars may be smaller.

Surgeons don't get as tired--they can sit at a computer, not bend over a table. The images may show problems better.

But hospitals may be buying the equipment and spreading its use too fast. There are more and more patient complications.

This also may be in part because of different training requirements for surgeons. There is no magic number for procedures a doc must do--usually his or her work is critiqued by someone more experienced.

Go over all this with your doctor before agreeing.

Wednesday, November 27, 2013

Say thanks--and mean it

I don't mean this to sound like some sort of icky sap-fest, but so often we say "thank you" and don't even hear ourselves, much less mean it.

Scott Ebin wrote about this in Government Executive magazine, Nov 26, 2013.

It really is quite a miracle that even with our worries and aches and pains, we are able to traverse this planet, think, create, and love others. THANKS!

You need to find people in your community who really deserve thanks.

This means being mindful--making an effort.

We emailed two fast food places recently thanking a window person for good service. We get so much indifferent service at those places--items missing, mumbled replies. Both times, the managers emailed us immediately and thanked us profusely. Mindful thanking from both sides.

You need to be in the "now," see what is good about the present moment.

Slow down, banter with people, make eye contact, smile.

It's so easy it's ridiculous not to. I don't even have a positive attitude!

HAPPY THANKSGIVING, ALL.

Tuesday, November 26, 2013

Chomp, chomp, don't stop, chomp

I know--you think you know how to eat. Wrong.

Heidi Mitchell (WSJ, Nov 19, 2013) says we don't know how to chew.

Digestion starts in the mouth. Chewing breaks down the food and mixes it with saliva, a lubricant containing enzymes. Chewing also keeps you from swallowing the toothpick in say, a club sandwich.

The cereal guy Harvey Kellogg, something of a health nut, said to chew each bite 35 times. He sort of made this up. Modern-day docs say maybe 10 times.

Chewing limits the calories that will be absorbed. It also cuts bloating.

Also you will feel full sooner if you chew chew chew.

Just putting the food into the esophagus, on doc said, provides no joy. You don't taste as much--maybe just the first bite.

I wouldn't go that far.

I would advise appreciating swallowing--if you have swallowing problems, it's miserable. I know, I have had them. The minute you think you can't swallow, you can't.


Monday, November 25, 2013

Trying to generate more primary docs

Barbara Sadick, WSJ, Nov 18, 2013, quotes a Harvard med student as saying the trend in medicine will be keeping patients healthy, rather than treating them after they get sick--so more primaries will be needed.

This comes as fewer doctors and other professionals are going into the family doctor business and demand is rising due to the health care mess.

The Assn of American Medical Colleges says we will be short 45,000 primaries by 2020.

Yet only 20% of grads go into primary medicine. The big money, if there is big money anymore, is in specialties.

To help with this, some med schools are adding community-based primary care training programs.

Seventeen new medical schools have opened since 2005. Some of these train only primary care docs.

Some medical schools and even hospitals make primary care sound crummy--like paper pushing.

Primaries do earn less.

Another focus could be to train primaries in the community rather than the academic area--meaning with a public health emphasis.

At Central Michigan Univ, 80% of the students grew up in remote or rural areas and much of the training takes place in such communities.

Still, better use will have to be made of nurse practitioners and physician assistants as primaries. I also see more doctors coming from overseas.

My primary is a physician assistant and he is much more suitable to me than any medical doctor I have had.

e

Friday, November 22, 2013

Tests to question if you are a headache patient

Recently, a friend wrote me that her mother was in the hospital and she and her siblings were having a hard time deciding what procedures to approve.

Been there.

In our family, one rule we have is if a test would indicated a surgery or drug we would not have or take, why get the test?

But The Choosing Wisely campaign (I have written on this before, you are not losing it), a product of the ABIM Foundation, tries to get docs to identify tests that may not be needed for certain ailments.

This time, the American Headache Society has five recommendations that can at least be conversation starters between you and your headache doctor.

--First, patients with stable headaches that are clearly migraines do not need neuroimaging.

--MRI is preferable to CT, except in emergency settings. CT=radiation, MRI=spendy.

--Surgical deactivation of migraine trigger points is not advised unless it's a clinical trial.

--Opioid or butalbital meds are not first-line treatment for recurrent headaches.

--And--prolonged use of over-the-counter pain medications is not a good idea.

For more Choosing Wisely recommendations, go to www.choosingwisely.org. Many more lists are coming out.

Pretty soon, I fear, the feds will try to decide all this for us...

Thursday, November 21, 2013

Please, please do not do this to us

Just because something can be done does not mean it should be. Oh, if only inventors and innovators would remember this.

Doctors are divided on those yearly blood tests for healthy people--but now researchers at the Intermountain Center Heart Institute in Murray, Utah, and Harvard's Brigham & Women's Hosp in Boston have gone that test one better.

They are taking the CBC--complete blood count--and manipulating the data in it to tell when you will die.

Or at least, your risk for death.

This allows them, they say, to pay less attention to those at low risk.

And--in my opinion--terrorize those at high risk.

The info is mostly available, so the test is cheap. They are doing a study now where some docs will get the score for half their patients and researchers will see if it helps them treat the doomed half differently.

You know--some days I think: Just leave us alone!

Would you want your death score? Is it like learning the gender of your baby?

Wednesday, November 20, 2013

Now hear this, diabetics--Get your eyes checked

The National Eye Institute says diabetic retinopathy affects 28.5% of those over 40 with diabetes. That's 7 million people and climbing to 11 million by 2030.

All people with diabetes are at risk for vision loss--but African-Americans, American Indians, Alaska natives, and Hispanics are more at risk.

The longer you have diabetes, the greater the risk of eye problems--including cataracts (clouding of the lens of the eye), retrinopathy (damage to the retina), and glaucoma (optic nerve damage).

You should have a dilated eye exam once a year--without fail. That's the exam where they put in the drops and sunlight hurts after and you have to wear some funky sunglasses.

Yet, half of all people with diabetes do not get this exam. Ninety-five percent of the damage from retinopathy can be prevented if caught early. Prevented!

You know you need to control your diet, take off weight if possible, exercise, stop smoking, and control your sugar, blood pressure and cholesterol.

Compared to that, a yearly eye exam is cake.

PS I only have one functioning eye--believe me, you will miss vision if you lose it.

Tuesday, November 19, 2013

Hot stoves hurting more people

I was going to write: Duh, don't touch a hot stove.

But apparently, people do it. Everyday five Americans are treated for scalds and burns from hot or poorly installed stoves.

Children are twice as likely to get burned. Older adults are twice as likely as kids to trip over a pulled out drawer on the stove.

The American Journal of Emergency Medicine says we need more education on this.

More than half of stove injuries are from contact with a hot stovetop, followed by a hot stove door (oven--done it), and the interior of the stove.

People also go to the ER for stove-related muscle strains. Taking heavy casseroles out?

I used to have a flat stovetop that stayed hot. There was a little light meaning the top was hot--but I have bad vision. Soooo....

Now I have a stove with coil burners and stuff falls under them.

Come to think of it, these stoves are out to get us.

Monday, November 18, 2013

Is concierge medicine right for you?

I don't know how to answer that question. Insurance is so screwed up now, no one knows anything! And this isn't ending soon.

But the WSJ had a story on Nov 11, 2013, by Jan Wieczner, that explored the world of so-called concierge medicine, a sort of hybrid of pay-as-you-go and insurance that is also supposed to get you more personal attention.

There is a variety of it called VIP medicine, where for huge monthly payments, you get the red carpet treatment in treatments.

Now, this is being dialed back to be available to the so-called middle class. Think paying $50 to $100 for basic primary care.

Of the 5,500 concierge practices, two-thirds charge less than $135 a month. The number of such practices is soaring by 25% a year.

The higher end ones bill insurance in addition to the monthly fee. The lower end ones usually don't accept insurance. (How this will fit with our being FORCED to have insurance, you tell me. Obamacare does allow direct primary care to count as compliant if it's bundled with catastrophic care for emergencies, but I heard catastrophic care policies are frowned on.)

The people who get both health insurance and concierge figure the deductibles will make them pay for most if not everything out of pocket, anyhow, so might as well have an accessible doctor. Some employer policies are now being built around this model.

The lower end ones usually have a list of procedures with a price--like a menu. Discounts can be considerable.

So--basically--you are paying either way...You have to cost it out.

When you got up this morning, did you know you have to become an insurance agent?

Friday, November 15, 2013

Making hospitals less scary for kids

Is there anything more pathetic than a seriously ill child--they are having their turn to have a life, then disaster...It's so glaringly unfair you just can't stand it.

Laura Landro (WSJ, Nov 12, 2013) wrote about ways hospitals are trying to make a stay less awful for little kids.

Just think--the needles, IVs, clanking machines, anesthesia, bright lights--I am an adult and can't stand these things.

Three million kids are "medically complex" and 5% more are added each year.

Hospitals use dolls and puppets for "medical play." They have special painfree injection routines.

They also give the kids a tour before surgery--so they can see what's what.

They even have digital videos kids can watch inside MRIs.

At a hospital near here in Phoenix--Cardon Children's--they never perform painful procedures in the patient's room--that is a safety zone.

When something "bad" happens, the kids go to the Toy Closet after for a fun toy to play with. Even the Spanish-speaking kids know the phrase "Toy Closet."

Thursday, November 14, 2013

No, no--stupid--don't do this

Oh, here is a great idea--a bar where you are hooked up to a vitamin IV.

It's called The Drip Room, and regrettably, it's here in the Phoenix area. It's a membership based club where you go to get vitamins dripped into you. Also offered--oxygen and good smells.

Vitamin IV's, apparently, have been used for years by celebrities. (And Michael Jackson had some twit anesthetize him to death, what is your point?)

This IV thing is for the dehydrated, hungover, aging, jet lagged, or people with dry skin and the blahs.

Drink a glass of water or tea. Take a Flintstone. Cheaper, if not cooler.

I need all my readers--don't do dumb things, such as this, or letting fish nibble your feet, or weird cleanses made of ground up brillo pads or something.Some people even get industrial silicon injected in at-home parties. Yeah, what could go wrong there?

Think!


Wednesday, November 13, 2013

Wow--Something I never heard before

I was reading a review of a book by Robyne Chutkan titled Gutbliss: A 10-Day Plan to Ban Bloat, Flush Toxins, and Dump Your Digestive Baggage. (We have to talk about Star's rules for long subtitles, Robyne.)

Anyhow, as reviewed by Laura Landro (WSJ, Nov 5, 2013), the book says something I had never heard before. And that is that women's intestines are twistier and longer than men's.

Men's innards, she said, are like a horseshoe, women's like a roller coaster. Women's are also longer, Chutkan says.

This explains a lot. All my life, I have had what I call "bad guts," always something!

She goes on to recommend fiber like psyllium and lots of water. But also advocates eliminating six categories--that spell SAD GAS. These are soy, artificial sweeteners, dairy, gluten, alcohol and sugar.

Now that sort of thing I had heard before.

But the women's guts are different than men's--that was new.

Have you heard it?

Tuesday, November 12, 2013

Young women losing interest in ess-ee-x


We usually think of older women as having low libido at a certain stage, but according to Larisa Wainer, PsyD, a psychologist with the Morris Psychological Group, says low desire is more common in older women, but when younger women experience it, they get more upset.

But desire in women fluctuates--women should know this.

Some causes are medications, such as birth control and antidepressants. Sometimes changing the dose can help.

Many illnesses affect libido---thyroid, cholesterol, high BP.

Hormonal changes, of course--from childbirth and breastfeeding. Staying up all night with a baby can also cut into desire.

D'oh.

Then there is poor body image ("I am fat," "I am bloated"). Or moral messages--"It's a sin."

Or--relationship factors--"He may be cheating." Or: "He does not look at me like he used to." Or "He is gross, when did he last take a shower?"

The best way to fix this is to fix on a cause.

One cause? This makes it sound impossible to anyone to have fun!

Monday, November 11, 2013

Asthmatics--You may visit a cat soon

We can never just have fun, can we? Every move has to be a health obstacle course. Don't eat this, don't go there, don't breathe this...ack.

Anyhow, the good old American College of Allergy, Asthma, and Immunology (acaai.org) says the number of asthmatics allergic to cats has doubled in the last 18 years.

And, of course, those with asthma are also more likely to be allergic to ragweed, ryegrass, and altermaria fungus. I have no clue what altermaria fungus is, but it sounds nasty. Sixty to 85% of asthmatics also are allergic to something.

And what do we do at the holidays? Go to someone's house. And might they have a feline or two? Chances are.

This can be dangerous, the ACAAI sez. But what should we do? Put the cats in a kennel? Take a pill first. Start allergy shots? Pack an extra inhaler? Pray?

What do you think?

Friday, November 08, 2013

Trans fats to be outlawed--but you need to watch out

I know--trans fats sound sort of interesting, but also known as partially hydrogenated veggie oil on the list of chemicals in our food, they are really pretty bad for you.

I think of them as styrofoam cruising through our blood vessels--and maybe causing clots. Even the fast food joints have tried to eliminate them or cut them way down.

Now, the FDA has proposed prohibiting them--it's up for comment.

Trans fats are preservatives, they make food last longer on the shelf. Not everyone buys fresh food every day at the French Market or Whole Foods. Some people eat packaged stuff.

So until the FDA gets most of this out of the foods we love, think about reading labels.

Foods likely to contain trans fats:

Cookies, crackers, cakes, muffins, pie crusts, pizza dough and some breads like burger buns.

Hard margarine (stick) and vegetable shortening.

Premixed products suich as cake mix, pancake mix, and chocolate drink mix.

Fried foods such as doughnuts, fried chicken (yes, nuggets, too), hard taco shells.

Snack foods such as potato and corn chips, candy, or microwaved popcorn or packaged popcorn.

Well, that pretty much does it for our diet over here!


Thursday, November 07, 2013

Kids conceal concussions

You know kids--they are tricky. The cross their fingers behind their back and think it excuses lying.

And--despite all the lectures from docs, coaches, moms, dads, phone apps, etc.--if they take a bad shot to the head in a game, they minimize it. They don't lie there begging for their baseline reactions to be retested to see how bad they are. They get up and get back in the game.

Jan Hoffman, NYT, Nov 5, 2013, says it's the ones who know a concussion when they get one (also the people where a new concussion is more serious) that do this.

Nausea, double vision, headache, confusion--just play it out.

The writer talks about one youngster who took a hit, then avoided eye contact with his coach because he knew he looked dazed.

Sure enough, that player got a sixth concussion and it was so bad, he had to take Ritalin and get someone else to take notes for him in class. That was the end of football.

The Institute of Medicine and National Research Council recently released a report on concussion--and one aspect was the "culture of resistance" among HS and college athletes.

This is also described as the machismo of sports.

Or try stupidity of sports.

A broken finger looks horrible and may stop play. A concussion does not look horrible but SHOULD stop play.

I wrote a booklet on concussion for parents and kids. It's a brain injury--brain damage--sound serious?

Check out http://healthsasspresents.blogspot.com for more info.

Come on, kids--be smart if you are not too concussed to be smart.

Wednesday, November 06, 2013

Treadmills, roads too boring--try trails

Jen Murphy, WSJ, Sept 17, 2013, writes about Andy Wirth, president and CEO of Squaw Valley Ski Holdings, who has spent most of his life out-of-doors, running for hours until the battery on his iPod punks out.

This is a physical guy, former rower, triathlete.

Whew--tired writing this.

Trails, he says, engage your muscles more--work more of them and in different ways. He loves running downhill, leaping over rocks.

He runs five days a week for 45 to 90 minutes. He does an hour of strength training a day.

As for his diet, he tries to avoid white sugar and saturated fat. But pizza is a weakness. Steak and salad may be his dinner. (Er, steak, saturated fat...)

He listens to loud music while gamboling down mountains. It helps, he says, with "pain absorption."

Ah--I wondered when pain would come up.

We can't all be like this--but if you are a runner--maybe check out a trail or two.

Tuesday, November 05, 2013

Making it harder to get to food can slow eating

Of course, it you put a burger at the end of a mud run, people will eat fewer burgers--but some evidence suggests that even wrapping pieces of candy in paper can cut the number of pieces people eat.

In a study in the Dec issue of Appetite, scientists showed that even a small obstacle can cut consumption.

They did some studies in Switzerland. In one, 60 women were divided into three groups and invited to sample some candy. For one group, the candy was unwrapped, while the other two groups had dishes of wrapped candy.

The ones with the wrapped candy were asked to put the wrappers in a nearby dish and in the second wrapped group, in a distant bin.

The wrapped group ate 3.6 pieces each, while the unwrapped group ate 5.5 pieces. The distance to chuck the wrappers made no difference.

Another study looked at whether being required to use tongs was a consumption-cutting obstacle. Tongs cut the consumption even of the delish chocolates, much less the dried apricots.

Oh, good grief--these studies. Just give me the candy. This is how people make a living?

To me, leaving a pile of empty wrappers would be a deterrent. Embarrassing!

Monday, November 04, 2013

Look out for gout

I am so sick of this chronic pain deal. My own bod is my enemy--arthritis. But for me, it's the knees.

Arthritis affects 46 million Americans, half over 65. It comes in many forms, two of which affect the feet, esp the big toe joint.

One doctor says it's truly remarkable what suffering can come from toe joint pain. Many patients, though, try to blow it off and suffer in silence.

Gout and hallus rigidis (rigid big toe) affect the feet.

Gout is inflammatory--sharp acid crystals are deposited in the toe joint. Yow! The toe can be red and hot to the touch.

Risk factors for gout are drinking beer and liquor more than wine, eating s diet rich in meat and seafood, being obese, and having high blood pressure.

The rigid big toe thing comes from regular osteroarthritis--joint wear and tear.

Symptoms are pain when you push off your toes to walk, swelling, a bump on top of the foot (bone spurs), an inability to bend the toe downward, and a tendency to walk on the side of your foot.

The doctor will suggest anti-inflammatories such as ibuprofen. Maybe ice packs. Or ice baths alternating with hot soaks. You will also want to wear shoes with room in the toe box.

Don't thing--it's just a toe. It's torture! Or is that toe-ture?

Friday, November 01, 2013

Postpartum is more than losing baby weight

Can you stand those sunny stories of H'wood celebs returning to Size Zero a week after giving birth?

They always seem to get those basketball attached to a skeleton pregnancy figures, don't they? At least Kim K got cankles!

In the real world as I know it, first, the boobs get huge, then the whole body seems to pooch out four inches all around. Then comes the beer belly! Without the beer.

Sarah Nassauer, WSJ, Oct 15, 2013, now cheers us with the fun news that way more is at stake than getting back in your old clothes.

Stretched, weakened and misaligned muscles and bones can plague you the rest of your life.

We have older pregnancies, now, closer-together ones, more twins...Bad news for the old bod. C-sections cause internal scarring. One woman started running a year after her baby and her six-pack muscles...separated.

Ew.

She had to strengthen her "core."

During pregnancy, docs recommend no situps and getting out of bed by rolling on your side and using your arms.

And there is the incontinence. You should get the doctor to check your pelvic floor after birth. Forty percent of women 60 to 79 report pelvic floor problems (leaking).

So just getting back into those jeans is not the whole magilla. Fun to come.