Health Education

The GAO Gets Genetic

I didn't want my title to be so clever as to prevent you from reading, but my post is about the genetic tests that are marketed to YOU in magazines, Internet ads and on the TV. I have already told you that they are not ready for prime time and that the biggest concern from some experts and certainly from me, is that people will rely on the test results over common sense and family history. This view is vindicated in a very recent General Accounting Office report. I really think that you should read the whole thing. It is a 33 page pdf document that can be accessed <a href="http://http//www.gao.gov/new.items/d10847t.pdf">here.</a> The GAO investigated several genetic tests and the companies that make them in 2006. They found them to be unreliable. They also found that the companies made disease predictions that were not medically valid. Since then, new tests have been developed and placed on the market. Some companies suggest that they have the support of experts. Very recently big chain drug stores agreed NOT to sell these new tests. The field of human genetics is a remarkable and valid science. Please do not take my strong distaste for the direct to consumer marketing of retail tests to be a judgment against the science. It is not. Genetic testing and counseling has been in place for many years and for a number of diseases it is VERY accurate. The tests that are currently available for YOU to buy and use at home with a saliva DNA test are NOT scientifically valid, useful., accurate, legitimate or endorsed by the leading genetic experts. In fact, the GAO report has some charming quotes from some of them. Let us see, one person described them as "complete garbage." Another expert used the word "horrifying" and still others noted my most pressing concern which is that people might get a test result that demotivates them to make healthy lifestyle decisions. Some of the companies try to sell supplements as well. They say the pills will prevent certain diseases. This is an illegal statement. The claims are fraudulent. The advertising tactics explained in the report are despicable. I would NEVER purchase these 300 to 1000 dollar kits. It just gets crazier. Some of the people in the "sting" operation actually had the diseases that they were tested for and told that their risk for getting that particular disease was low. The GAO sent the same DNA sample to different companies and got completely different results on the same diseases for the same person. Companies offered consultation but rarely did more than regurgitate the results. People were told to talk to their doctors, but I gotta tell ya, the average doctor doesn't know what to do with these results either. That is NOT a reflection on the doctor but on the tests. I write this blog in order to help people make decisions on things to do and not to do in order to increase their chances of a long, quality, active, limited diseased life. The best that any of us can do is know what has happened to people both with similar genes as ours (our family) and with similar lifestyles (people who smoke for example, or don't exercise or do exercise, etc). If you want a valid prediction of what will happen to YOU - that is where to look for answers and place your bets. This sentiment is stated quite directly in the report. One expert suggested that people send in the DNA sample, the 500 dollars, complete the family history profile and then through out the DNA results and go from there! Please read the<a href="http://www.gao.gov/new.items/d10847t.pdf"> report </a>- a government agency doing something to protect the consumer from fraud. It is a good thing. (btw, the GAO report is not a clinical study or rigorous research, but it is informative)

The GAO Gets Genetic

I didn't want my title to be so clever as to prevent you from reading, but my post is about the genetic tests that are marketed to YOU i...

4:00 PM

and the doctor said

Every now and again, I veer off the public health track and tell you a little personal story. That usually resonates well with readers and today I add to that. With my impending - looming- move to NC on my mind, I scheduled a visit with my dentist, optometrist, and my primary care physician. I let them each know that I was leaving town for a while and after my visit I asked for a copy of my medical record to take with me. I will be so happy when that is an electronic record that I can access by password through some Internet portal. Anyway, they have all obliged and been very cool about it. Only one office wanted to charge me, but the doctor took care of that :) Today I want to talk about the check out I had with my primary doc. I remember very well the first meeting I had with him. It seems that both my first and last visit was more talking than anything else. As the three years passed, I may have had one sick visit and one or two sports injury visits. I met with him in October of 2007 after I did some research (it was almost an interview, to see if we fit with each other.) I found a listing of clinicians that were accepting my insurance and then, as I have done for my last two or three docs, I found one that was a doctor of osteopathy who had also completed a fellowship (extra education/internship) in sports medicine. NOw if I had a chronic condition of some sort, like a heart problem, I might search for a DO with a cardiac speciality. In other words, this was about ME! It has been a great relationship and many times we had dialogue that led to diagnosis and treatment suggestions. He knows, as have all my doctors, that I prefer clinical exams to Xrays and rehab or ice to medications. I was prescribed two medications during this time frame. One was for migraines, but after taking ONE of the sample, and finding relief, I have never taken any of the prescription. I do keep them in my purse because the day that I did take that pill I thought I was going to die. The migraines last summer were triggered by dehydration and I have been able to prevent a recurrence. My doctor also advised me to take one of the bisphosphonates for low bone density and I did, for about six months. So when I saw him this past week, we touched base. He was very glad that I had added two serious weight training days to my routine. He feels that the muscle mass is important and running doesn't build it. He supports my running very much, and tells me to run as many miles as my body will let me, but ONLY running isn't necessary going to make me the fittest. He is also very pleased with my swimming. I too see the benefit of that in that it gets me off my feet and works my upper body really well. He thought that my taking 1000 IU of Vitamin D was exactly the right thing to do. He was not upset that I stopped the Fosomax because some people who take it don't have fractures and some people who take it do. (he said that the low bone mass and the risk for osteoporosis was pronounced in small framed whites and some Asians and there wasn't any way to prevent those risk factors) He supported the eye doctor's direction to protect my eyes from the sun and to use eye drops. My doctor said that with my running I needed wrap around sunglasses. I do not have those just yet. $$$$$$$$$$$ Oh and he told me to protect my eyes from the glare that I might get in NC from the SNOW! I told him that I wanted to have one of those head to toe skin checks for precancerous spots etc. He thought that was a good idea and that I might get it done at one of the medical schools in NC - probably my former employer WFUBMC. And I was happy to hear him collaborate what I have said here, in regards to sunscreen. I should wear it of course, but there was evidence to suggest that anything over 30-50 SPF did not raise the protection level and wasn't necessary. I think that is about it. He referred to me as fit and healthy and didn't examine me at all. The nurse had taken my vitals. I will be getting health insurance through the University in Greensboro and will definitely take advantage of student services. I have my records should they be needed and I have my knowledge about health (which grows every day) and I know my own limits and strengths and am ready for this new journey.

and the doctor said

Every now and again, I veer off the public health track and tell you a little personal story. That usually resonates well with readers and t...

4:44 PM

whoop whoop

Whooping Cough: (as it so often happens, while investigating this disease, I learned something about vaccines too) Firstly, I heard on the news and confirmed with the CDC and WHO that the respiratory infection pertussis also known as Whooping Cough is increasing in frequency in the USA and other parts of the world. The disease at one time effected over 100,000 persons a year but with the DTaP vaccine, that incidence came down as low as 3000 a year. The CDC has the rate back into five digits. One reason could be lack of vaccination. The illness, which affects the lungs and begins much like a cold, is very contagious. Pertussis is a bacterial infection and it has a three stage progression. I wanted to look into it when I heard it referred to as a serious and sometimes fatal respiratory infection. I had just not thought it so serious, perhaps because of the common name. It is also true that I received all my vaccines in the late 60s before we were all afraid to get them. My cohort, in other words, didn’t get this disease. The second phase of the disease is the worst and can last for weeks if not months. The person, usually a child, has uncontrolled, frequent, explosive coughing events. Antibiotics can be used. When I read that the illness was a bacterial infection, thus treated with antibiotics, I got confused. I have only recently truly absorbed that viruses or viral infections are NOT treated with antibiotics. I took that further to mean that vaccines were for viral diseases and not bacterial ones. The herpes VIRUS, the Flu, human pappillomaVIRUS, but alas, it is not true. Vaccines are created for both types, it is just that the medicines to treat the actual infections are different. Pertussis is a serious and contagious disease that is better prevented than treated. The whoop sound comes between coughing spasms as the patient gasps for breath. Recovery is long and has its own phase. A person does not suffer the coughing spells in the first or last phase, but during the last phase a person is lethargic and weak.

whoop whoop

Whooping Cough: (as it so often happens, while investigating this disease, I learned something about vaccines too) Firstly, I heard on the n...

4:49 PM

Respect Your Feet

Not only do I now have more respect for my feet, I also have it for a certain organization. Actually, I have always taken care of my feet as I am a runner and though I can get through many aches, pains and strains, I cannot run on a hurt foot. When I heard about cosmetic foot surgery however, I was a bit aghast. I sought the opinion of the American Orthopedic Ankle and Foot Society also known as AOFAS. They issued a press release on this topic in June and you can read it <a href="http://www.aofas.org/Scripts/4Disapi.dll/4DCGI/cms/review.html?Action=CMS_Document&DocID=313">here</a>. It definitely cautions against having these surgeries, which include toe shortening and fat injections. Yes, because wearing high heels is often uncomfortable at the balls of the feet, some podiatrists will take fat from another part of the body and put it into that tender area. Comfort is only one of the reasons women, mostly, have this elective surgery. Another reason is to beautify the feet for the super exposure they get in what we women call strappy shoes. I am the last person that will have this surgery because for five or more years, I have eschewed heels in general. I do buy gel pads to put inside my shoes though and so I get that, and SURE it is nice to have something to do with the fat we don’t need, but the AOFAS is very clear to point out that the risks are significant with these procedures. I want to add that I am now impressed with the folks at AOFAS for more than their stance against the surgeries. I clicked around on their website and found a link regarding healthy eating. SEE – there is nothing that being overweight doesn’t effect. Along with encouraging us to maintain a health promoting weight, the clinicians suggest that we engage in regular physical activity to avoid arthritis. Additionally, they address osteoporosis and encourage adequate consumption of vitamin D and calcium. I also learned that one of the first indications that a person has osteoporosis is a stress fracture in the foot!

Respect Your Feet

Not only do I now have more respect for my feet, I also have it for a certain organization. Actually, I have always taken care of my feet as...

5:43 PM

Obesity as a Risk Factor for Early Sexual Debut in Young Adolescent Girls?

<div class="MsoNormal" style="margin-bottom: 0in; text-indent: 0.5in;"><shapetype coordsize="21600,21600" filled="f" id="_x0000_t75" o:preferrelative="t" o:spt="75" path="m@4@5l@4@11@9@11@9@5xe" stroked="f"><stroke joinstyle="miter"></stroke><formulas><f eqn="if lineDrawn pixelLineWidth 0"></f><f eqn="sum @0 1 0"></f><f eqn="sum 0 0 @1"></f><f eqn="prod @2 1 2"></f><f eqn="prod @3 21600 pixelWidth"></f><f eqn="prod @3 21600 pixelHeight"></f><f eqn="sum @0 0 1"></f><f eqn="prod @6 1 2"></f><f eqn="prod @7 21600 pixelWidth"></f><f eqn="sum @8 21600 0"></f><f eqn="prod @7 21600 pixelHeight"></f><f eqn="sum @10 21600 0"></f></formulas><path gradientshapeok="t" o:connecttype="rect" o:extrusionok="f"></path><lock aspectratio="t" v:ext="edit"></lock></shapetype><shape id="Picture_x0020_2" o:spid="_x0000_s1026" style="height: 148.3pt; left: 0px; margin-left: 18pt; margin-top: 4.2pt; mso-position-horizontal-relative: text; mso-position-horizontal: absolute; mso-position-vertical-relative: text; mso-position-vertical: absolute; mso-wrap-distance-bottom: 0; mso-wrap-distance-left: 9pt; mso-wrap-distance-right: 9pt; mso-wrap-distance-top: 0; mso-wrap-style: square; position: absolute; text-align: left; visibility: visible; width: 198pt; z-index: 1;" type="#_x0000_t75" wrapcoords="-218 0 -218 21556 21600 21556 21600 0 -218 0"><imagedata o:title="" src="file://localhost/Users/Anunez1/Library/Caches/TemporaryItems/msoclip/0clip_image001.png"></imagedata><textbox style="mso-rotate-with-shape: t;"></textbox><wrap type="tight"></wrap></shape><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEge8akxnrhbYW5jthkMd1VLgWh9Nw9cScgYEeOXyZDWRoFLIJSRrxlbmsk5KnC5S1qKdL9FgVGEwBgE_LE4HYiqOfwfNX5_0of8B0UJBybFV9jV_NlpRh0NeeV8HNRixaXNqGRCZf1tIgEj/s1600/colorfulcondoms.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEge8akxnrhbYW5jthkMd1VLgWh9Nw9cScgYEeOXyZDWRoFLIJSRrxlbmsk5KnC5S1qKdL9FgVGEwBgE_LE4HYiqOfwfNX5_0of8B0UJBybFV9jV_NlpRh0NeeV8HNRixaXNqGRCZf1tIgEj/s320/colorfulcondoms.jpg" /></a>The topic of obesity in relation to adolescent girls and sexual activity first arose during a patient encounter of an obese 13-year-old girl, who was asking for birth control pills.  The family physician I was following, mentioned that recently, in the past few years, she has noticed that her overweight and obese adolescent female patients are having sex much more than her normal weight patients.  She prompted me to read an interesting article on the topic on Medscape Medical News, which is summarized below:</div><div class="MsoNormal" style="margin-bottom: 0in; text-indent: 0.5in;">“In a recent study presented at the 58th Annual Clinical Meeting of the American Congress of Obstetricians and Gynecologists by Villers, et al, showed that overweight and obese adolescent girls are more likely to engage in risky sexual behavior than their normal-weight peers.  The researchers evaluated data from the CDC’s Youth and Behavior Survey from 2003-2007 of 21,773 girls in grades 9-12.  The BMI was calculated using self-reported height and weight.  The study analyzed 6 different risky sexual behaviors such as whether or not the teens had sexual intercourse age at first sexual intercourse, number of sexual partners, condom use, and alcohol/drug use during their last sexual intercourse.  The results revealed that obese and overweight girls were more likely to have an earlier age of sexual debut, more sex partners, and were less likely to use condoms than their normal weight counterparts.”</div><div class="MsoNormal" style="margin-bottom: 0in; text-indent: 0.5in;">During the women health discussion of the topic at DUCOM, it was noted that the study did not account for history of abuse, socioeconomic factors, and other factors such as self-esteem and depression.  Another interesting point is that obese and overweight girls reach puberty earlier than their normal weight counterparts.  More research needs to be done on why overweight and obese adolescent girls are more likely to engage in sexually risky behaviors than those are normal weight.  Childhood and adolescent obesity is a risk factor for many things from health related ailments to psychosocial limitations, and this recent survey adds to the list of the harmful effects of obesity.</div><div class="MsoNormal" style="margin-bottom: 0in; text-indent: 0.5in;"> </div><div class="MsoNormal" style="margin-bottom: 0in;">-- Mimi Mak MS IV, adapted from <a href="http://www.medscape.com/viewarticle/722673?src=emailthis">Obesity a Factor in High-Risk Sexual Behavior in Adolescent Girls</a>  Medscape Medical News , 2010-05-28</div><div class="MsoNormal" style="margin-bottom: 0in;"> </div><div class="MsoNormal" style="margin-bottom: 0in;">Additional Resources <a href="http://www.nature.com/ijo/journal/v23/n2s/abs/0800852a.html">Role and Consequences of childhood obesity</a></div><div class="MsoNormal" style="margin-bottom: 0in;"><a href="http://aappolicy.aappublications.org/cgi/content/full/pediatrics;112/2/424">AAP Consensus report Prevention of Pediatric Overweight and Obesity Committee on Nutrition</a></div><div class="MsoNormal" style="margin-bottom: 0in;"><a href="http://www.cdc.gov/HealthyYouth/obesity/">CDC Resources</a></div><h2 style="font-family: Arial, sans-serif; font-size: 1.4em; font-weight: bold; letter-spacing: normal; line-height: normal; margin: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"> </h2>

Obesity as a Risk Factor for Early Sexual Debut in Young Adolescent Girls?

The topic of obesity in relation to adolescent girls and sexual activity first arose during a patient encounter of an obese 13-year-old girl...

6:41 PM

The Grocery Aisle

I have done my best to educate my friends, family, coworkers and YOU on the importance of reading food labels and making choices that are best for your health and if you shop for others, theirs too. I may have mentioned that I had at one time created a proposal to teach people about labels right in the places where they need to know - the store. Well, that isn't exactly what is underway now, but at least we are moving in the right direction. Some store chains are highlighting if not, ranking, certain food items at the point of purchase. The shelf tags encourage a person to buy a product because it is considered healthier than a similar product. If you think food manufacturers are miffed about this, you would be right. My concern is over the criteria that is being used to judge the food. It is expected that salt, fat and sugar content will be taken into consideration, as will fiber content. I read that one of the large grocers was thinking of hiring a dietitian to walk the aisles and assist shoppers for a FEE. That got my dander up. I have advocated and will continue to advocate for making healthy choices possible for all people. These foods have to have an accessible price, and the knowledge about them has to be just as easy to get. The store that probably needs a program like this the most is Wal-Mart and that is exactly where I had proposed to do my little label reading point of purchase "in service." I may change my intervention ideas a bit while in graduate school but I will not leave Wal-Mart and the community out of my sights. These shelf tags are a good start and at the same time, people need to be empowered with nutritional truths. I propose to arm people with knowledge so that they understand WHY that food got a better score, not just that it did. For example, we don't all need the same amount of nutrients. In addition, all nutrients are not created equal and just adding good foods without addressing calories will NOT end our obesity epidemic. I would like to see a national standard if we are going to start an onsite information program. Perhaps this is something that the DHHS would fund! I do not at all like heterogeneity in this area. What I find most inspiring is that people are starting to deal with this problem. We have some school lunchrooms providing whole foods and lower calorie options. If manufacturers, grocers and restaurants continue to modify their foods, shelves and menus - we just might create an environment that is conducive to healthful eating. BTW, Wal-Mart is expected to make an announcement about their nutritional planning before the end of the year. I look forward to hearing about their approach as the poorest of us frequent THOSE aisles and the poorest of us have the most obesity related diseases.

The Grocery Aisle

I have done my best to educate my friends, family, coworkers and YOU on the importance of reading food labels and making choices that are be...

12:59 PM

The Laser

Not long ago I mentioned the laser when I was discussing another topic and said that I would get back to that. I wanted to learn about and explain the FDA approved uses of the laser in regards to medical procedures. I am torn now about writing this post even though I spent an hour or more searching for the answers, because my intent is to enlighten the reader not confuse them more! The laser, which is used in surgery, hair removal and even physical therapy, is a device that emits a very intense light, a single wave length, with non ionizing radiation. We don't generally think of this radiation as harmful or cancer causing. It could however, cause skin reddening and in the case of surgery, side effects are possible. The light is so intense that it can "burn" away tissue, hair, wrinkles even. In the case of wrinkles, the laser is essentially removing skin and is abrasive. The laser is used to remove tattoos as well. IN fact, I have had that done myself. What I understand, and I could be mistaken, is that the device itself is approved by the FDA per manufacturer. The manufacturer has to abide by certain safety standards, including monitoring the radiation emissions. Each company has to label their devices specifically, and report any adverse events to the FDA. If a manufacturer wants to market the device, it has to submit an application and data to show that the device does what it says and does so without serious adverse consequences. This is the same criteria put on medication applications. My quest was to find the FDA approved uses for the laser itself, but it seems that there isn't a clear list. It is not as simple as say, looking up Wellbutrin and seeing that it is indicated for depression. It is true that once the device or medicine is approved clinicians can use it as they see fit. I wanted to see what they could advertise for- which I still do not understand. One source of information on the FDA website implied that with safety approval (and not clinical study) a company could market but not advertise. These leads me to believe that the two words are not interchangeable in the medical world. Instead, market just appears to mean sell. With regard to hair, I did learn that the laser can only be advertised as a means to reduce hair not to remove it! With regard to wrinkles, some laser devices are treatment "approved" while others are not. The consumer can look up the particular device to see what the FDA did give the ok on. Consumers are also encouraged to talk to the clinician and ask to see the labeling for that particular device. I feel that is it safe to say that the laser, but not ANY (they have separate approvals) laser, is thought to be effective in these areas: surgery, eye surgery, hair reduction, wrinkle treatment, dental care, and maybe even pain reduction. Please read more <a href="http://http//www.fda.gov/Radiation-EmittingProducts/ResourcesforYouRadiationEmittingProducts/Consumers/ucm142607.htm#2">here.</a> I DID finally email the FDA to see if I could get a list of approved laser uses - re promotable uses. Will let you know if I get a response. Not just anyone can use a laser. There are also certifications and licensing issues for the practitioner. I can say and WILL say, the FDA did not at any time note the laser as an effective method for quitting smoking.

The Laser

Not long ago I mentioned the laser when I was discussing another topic and said that I would get back to that. I wanted to learn about and ...

4:57 PM

Odds and Ends

Hedonistic or Homeostatic? Interesting words and you have probably heard them before - however, I recently saw them used to describe differences in the way that people eat. Or as I like to say, fuel themselves. A hedonistic eater would be a person that eats for pleasure, obviously, but without any connection to the body's messages about whether or not food is really needed at the moment. A homeostatic eater is more in tuned with the needs of his or her body. A person who continuously overrides the system and eats anyway, will make that system malfunction. You're Lucky - Someone that knows me pretty well, made an unusual comment the other day. She asked how much I weigh I think and said that I was lucky. NO NO I am NOT lucky. IF I were lucky, wouldn't I be a hedonistic eater without consequences?? I am a controlled and disciplined eater and a frequent exerciser. I choose this, and I thrive in it, but it is work to be sure. ( and if any of you out there read the Sookie Stackhouse novels - that would make me bitten not born - in other words, it isn't a natural or genetic trait of mine) Tanning - OK, sorry - this is hard truth time. The problem with obesity is that it adversely affects ones joints and mobility. It also can lead to chronic and life changing diseases. I know what I am about to say is true, because I used to believe it and do it. Tanning fat seems to make it look less well, fat - voluminous. But tanned fat is still fat and not only does the person still have the health risks from obesity, now the skin cancer risk is added to the mix. Reputable Web - In the Boston Globe recently, a column listed the names of websites frequently visited for health information. Only two were said to be good sources of information and I was glad to see that they were two that I use. They were WebMD and Emedicine. Conbiotics- Food should just be food. Adding extras seldom accomplishes anything and misleading claims abound. This time Nestle got a hit from the FTC for saying that its probiotic yogurt or shake or whatever it was, helped children's immune systems. Not proven - What has been said to be helpful - a well balanced diet - food on a plate, and exercise! Me and the CEO - I was reading a fluff piece (not really fluff, but not research so for me it is fluff!) about the CEO of Cigna. He is a triathlete and in the WSJ article about him, he said that he will often get ideas for something while riding his bike at 5 a.m and by 9 a.m. he is explaining his new plan in the conference room. The exact same things happen with me, but maybe not at 5 a.m. Exercise absolutely generates brain power! "You" Don't Pay a Thing - Oh that damn sassy chair. I think that the motorized chair that is pitched directly to the elderly is a scam to be reckoned with and when the announcer discusses the billing of Medicare by the company, he adds, "You don't pay a thing!" So of course, I shout back to the TV, "No Everybody else pays for it!" Eco Index - What is it? You may be hearing the term more these days. It is used to gauge how much a product does or does not adversely impact the environment. This can include the materials involved, the places they are put together, exporting, and disposal. To learn more, click on this<a href="http://www.eco-index.org/about/index.cfm"> link.</a>

Odds and Ends

Hedonistic or Homeostatic? Interesting words and you have probably heard them before - however, I recently saw them used to describe differe...

4:00 PM

Mind Body Connection

I cannot locate the information to match the story that I heard on NPR one evening this past week, but it involved a discussion on the mind body connection and that relaxation techniques have been used to effectively reduce pain in many people. I was especially intrigued by some of the examples given and the explanation over all. It makes sense when you think about it. We have blood running through our entire bodies and in our blood we have oxygen of course, and toxins and waste. Our neurotransmitters fire in our brains, but also on nerve cells throughout the body - messages are sent, received, perceived, etc. It made me realize that unless my head was no longer attached to my body, it would ALWAYS influence the rest of it. This specific show was regarding stress as it impacts our physical bodies and that stress could trigger back pain. Well! When I have a flare up in my low back, I tell my friends, that I can never pinpoint the trigger. I have an old injury that could be sensitive. I might have lifted something wrong or just heavy. I did some back work while strength training. I ran. I sat too long. ETC - Sometimes I have NO idea what tweaked my back and now I realize it could be unrelated to any of those things. In the story I heard, a few people had such back pain that they were prescribed strong drugs and surgery was suggested. There is a clinic however, that provides guidance on how to relax and how to ease this pain with nonmedicine and non surgical interventions. Oh YES, I remember now, there was a guest on the show who is an editor for the Wall St Journal and he declared himself pretty skeptical but also, NOT in favor of surgery. He went to the clinic, probably had some physical therapy also,and learned relaxation techniques. Some of this includes thinking of a word or phrase and repeating it to yourself. I thought that I should try, "sunshine on my skin" as I take deep, slow breaths. I do not think that I would ever take drugs or have surgery for back pain - I am afraid of the knife and do not like pills. People I know who have had surgery for back pain seem to still have back pain. You know, I can say the same about knee surgery - all of it.

Mind Body Connection

I cannot locate the information to match the story that I heard on NPR one evening this past week, but it involved a discussion on the mind ...

5:20 PM

Prevent or Reduce Cancer Recurrence

Exercise and maintaining a health promoting weight have been recommended as ways to prevent many cancers. A growing body of evidence is available to support that exercise can reduce some symptoms associated with cancer treatment - first and second line - and that continuing to exercise and eat moderately after treatment is suspended, can reduce the recurrence of cancer. I have blogged on this in the past, I say it again today because it was the topic of an article in the ACSM Certified News this month. Dr. Jonathan Ehrman explored the existing research which was mostly focused on breast, colon and prostate cancer. One study regarding physical activity in women with breast cancer found a link between positive treatment outcomes and moderate physical activity. The study followed the women for two years. In that study, the positive benefit was found whether the women had begun exercising before diagnosis or after. Though not all cancer patients receive radiation or chemotherapy, most are prescribed an oral medication after or instead. We are not used to hearing about weight gain with regard to cancer, but that is exactly what happens to many persons. The weight gain that occurs with treatment or after, is especially harmful if it leads to obesity and related diseases. Exercise can reduce the chances of weight gain, muscle wasting, diabetes and hypertension. Physical Activity and Healthful Eating are elements that we should include in our lives at all times.

Prevent or Reduce Cancer Recurrence

Exercise and maintaining a health promoting weight have been recommended as ways to prevent many cancers. A growing body of evidence is avai...

3:57 PM

Supplements

Never a fan of supplements or the supplement industry, I have previously and frequently noted that suggestions on pain reduction and cartilage repair are very overstated for both chondtroitin and glucosamine, either separately or together. In July, a JAMA article highlighted yet another study - a randomized, double-blind, placebo controlled study - [what?? it means pretty tight and therefore, valid!] The research found no difference in pain reports between the two large groups. One group was given glucosamine and the other was not. The research design I noted above blinds the researchers and the subjects. In other words, no one knows who is really taking the supplement until the end of the study. This particular project involved persons with back pain related to osteoarthritis. I have been told that I have OA in my SI joint. That would be my sacroiliac or very low back and an uncommon place to have OA, so I am told. I would love to have less pain - though it is only occasional at this time. For now, I treat my flare ups with ice and the very infrequent 200 mg of ibuprofen. This I know, works.

Supplements

Never a fan of supplements or the supplement industry, I have previously and frequently noted that suggestions on pain reduction and cartila...

3:50 PM

Strength Training

I feel like I might be poaching from another health professional but I want to share the information as it supports my own workout philosophy. So I will first give credit where it is due. An exercise science professor from Quincy College wrote an article in the American College of Sports Medicine's Certified News regarding recent research on the frequency of weight training and the benefits there of. In fact, he shared results on more than one study. People who are doing no weight training whatsoever are going to benefit from adding just one day a week. This will last you six months or so, in my informed opinion. I want to consider optimistically, that all who are reading this post already lift weights or pump iron at least twice a week. Dr. Westcott discussed the research on whether or not a person benefited most from two or three days a week in a focused full body circuit workout. In fact, the two days were better and especially better if they were spaced apart, for example, a Wednesday and a Saturday. The reason that this is suggested as best is the time of recovery between workouts. We do break down the microfibers of our muscles and then with proper nutrition (not OVER supplementation, just basic fueling) and rest, the muscles repair themselves and become stronger and in some cases larger. Workouts that are less that 48 hours apart, actually detract from this process and progress. People who do want to work out with weights more frequently should change up on the muscle groups to allow sufficient recovery. Because I like to do every muscle every time - I am the two a day candidate. I have been working out twice a week consistently since January. I had been doing once a week for a while. Years past, I did work out with weights more frequently. I do need to concentrate on spacing my workouts however, and with the added challenge of not having a hard weight day before a long run day - OR, two days before the run, because when will I be sorer - see, always things to consider - but the longer, healthier life that it could lead me to, well, it's worth it! Oh the upshot - which is an upside - two days of weight training is enough!!

Strength Training

I feel like I might be poaching from another health professional but I want to share the information as it supports my own workout philosoph...

4:50 PM

AIDS progress and insight

This is not the post I had planned for today, but as this issue has been staying in the news I could not resist. What I have been hearing and reading is that the funding for treating AIDS is really taking a hit as countries around the world are having financial difficulties. Though a good deal of funding for AIDS treatment and research does come from independent sources, specifically Bill and Melinda Gates, many AIDS activists (for lack of a better term) are sounding alarms. IN the last two days I have become more aware of a push for prevention. This was pronounced again in a WSJ article describing a promising research study. In that smallish, but well controlled study, women using a medicinal, vaginal gel, significantly reduced their risk for contracting HIV through intercourse. The particular study involved South African women. Many countries in Africa also have high rates of HIV and AIDS, including in pregnant women and children. This study, which must be replicated and was not a clinical trial with regard to drug approval, is still important. However, in the WSJ article an AIDS researcher was quoted as saying something to the effect of how costly the treatment of AIDS has become and that the real effort should be in preventing it in the first place. YOU THINK? Do you think maybe we should spend time, talent and dollars on PREVENTION - oh my gosh, the guy is a genius! Maybe I should go back to school to see if I can help with this prevention idea, maybe even, I know this will sound CRAZY, but maybe we could save money also if we worked to prevent OBESITY. (after note: You might wonder about the human subject disclaimer and consent waiver in the AIDS/HIV research. I do too. I did not read the study protocol for the research I referenced though I have read others. IN some instances, the researchers educate the participants on how to prevent sexually transmitted diseases by abstinence and condom use. They might then ask them to use their "medicine/gel" if they choose to have unprotected sex and to keep a record of the times that they do. In other words, the research outcomes will have to be considered in this context.)

AIDS progress and insight

This is not the post I had planned for today, but as this issue has been staying in the news I could not resist. What I have been hearing an...

6:35 AM

First, Second, Third - Smoke and Chemicals

Probably a year ago, a MassGeneral pediatrician coined the term third hand smoke or THS. He was quoted on this in several national publications at the time and I continue to be asked about this during my presentations. I tell my audiences and classes that I absolutely concur with him on the concept and the harm from THS, but not the name. Third Hand Smoke, as he refers, is the chemical residue left behind in buildings and cars, on upholstery and skin. It is not smoke at all, but a dirty noxious film. Dr. Winickoff has spoken again. He was interviewed and quoted by the Boston Globe on July 12, 2010 after a joint letter from he and colleagues was published in the New England Journal of Medicine. The letter was a call to ban smoking in Public Housing complexes. Super YAY for that. We are working on such an initiative in Manatee County Florida. Dr. Winickoff explains how the smoke seeps through doors, cracks, air and heat systems and can harm the most vulnerable citizens (youngest and oldest). Massachusetts bans smoking in cars with kids, so he may "get er done." On a personal note, I just agreed to pay an additional 20 dollars in rent for my new place in North Carolina - for a totally tobacco free building!

First, Second, Third - Smoke and Chemicals

Probably a year ago, a MassGeneral pediatrician coined the term third hand smoke or THS. He was quoted on this in several national publicati...

4:10 PM

Odds and Ends

Lollipops - I presented a tobacco prevention program to a summer camp class recently. In the kit of goodies I brought along were a bag of lollipops that had no-smoking symbols on them. I had not realized they were in the box or I would have left them behind. I said to the teacher, HOPING she'd decline, "Do you mind if I hand these out?" She didn't mind at all and after my presentation I gave the children a new pencil AND a chance at a Lollipop. I walked to each of the four tables with my open ziplock bag and said, "Would you like a Lollipop? It is okay if you don't." No one turned them down - dang it! Leaving the Gym one morning a man slightly older than I walked out behind me. He said, "Now if I can just stay out of the refrigerator." Of course, if any of you had been along you would have thought - oh boy - great person to mention that to! So indeed, I said, "Well, best not to put things in there that you don't want to eat." He said, "My problem is sleep walking. I get up at 3 am and go for the fridge." I said, "That's a hard habit to break." Then he said, "Some people just have such fast metabolisms." WHAT?!?!??! Of course the "person" me - as opposed to the health educator me, was thinking, "DUDE stop eating so much." But I said, "Really few people have that issue. I certainly don't." Standing Tickets- Some people were shocked when an airline, I believe out of Ireland, proposed to offer less expensive tickets for standing room only - i.e. no seats. I thought it was a marvelous idea. One thing we are advised to do while traveling is to get up and walk. One thing that too much sitting can lead to is deep vein thrombosis - or clotting. So this to me was a grand idea and I would be the first to get a standing ticket if a US airline offered one. Chlorine Indeed - In a recent post I mentioned showering before and or after the pool. Just the next day on NPR's Science Friday the issue came up. There really is an interaction between chlorine and other chemicals that people bring into the pool as well as micro organisms and bacteria. So, it is paramount to shower both before and after entering. I now do both whether anyone is watching or not! Lung Cancer Still kills the most. Recent CDC data highlighted incidence of breast cancer and colon cancer but the leading killer of both men and women - with regard to cancer is cancer of the lung. The main cause of lung cancer is cigarette smoking. At this time, we have more tools for prevention and treatment for colon and breast cancer and the CDC urges everyone to have mammograms and colon cancer screening when age or gender appropriate. Speaking of Cancer. In a recent post I iterated on the pharmaceutical industry's quest to have drugs created for one condition approved to treat another. One such drug, Avastin, is approved for lung and colon cancer. The company that makes it was able to get it fast tracked for breast cancer also, but with continuing studies and final approval pending. The studies of Avastin in combination with chemotherapy are not showing a survival benefit. Without much change in the outcomes, but a slew of unwelcome side effects, the drug may lose its breast cancer indication and a billion dollars in sales. Get sick already - don't you know that drug stores need you to buy flu and cold medicine. Yup, one of them, Walgreens I think, recently stated that they did not have as much revenue as expected because less people got the flu. HATS OFF to the HATS ON. In this past week's season opener for The Closer on TNT, the detectives had to visit a sunny roof top to examine a crime scene. Lead character Brenda had on a lovely straw hat and one of the guys made a show of putting on a white hat, sailor type hat. NO visors, hats! AWESOME.

Odds and Ends

Lollipops - I presented a tobacco prevention program to a summer camp class recently. In the kit of goodies I brought along were a bag of lo...

4:30 PM

Understanding Triggers

I am 100% against tobacco in its current disease causing form. This includes cigarettes and much smokeless tobacco. There may be nicotine containing nontraditional tobacco products do not cause harm and I will keep a lookout for them. As it stands now, I am against smoking. I find the act and the emissions from it to be quite rebarbative. Smoking harms everyone who is exposed to it. It is bad for the environment and the individual. I support all smoking bans and I want to tell you why. Other peoples' smoke is a significant trigger to light up or relapse to a nicotine addict. Even seeing tobacco products acts as a trigger to smoke. This trigger is something that manifests itself physically – it is NOT a controllable factor or an absence of willpower. It is a physiological response to access or availability. Let me provide a non-tobacco example so those of you who have never used tobacco can understand – really understand. Imagine that you have to use the bathroom – to urinate. You have a subtle urge to go, maybe this feels like a 3 on a scale of 1-10. You say, “Well, I can wait a bit.” “I may even be able to wait an hour. Yes, I can wait an hour.” The first half hour the “urge” is steady at 3 or 4. The second hour, the “urge” is beginning to feel like pressure. Now you are at a 5 maybe a 6. (You should absolutely think about this the next time you have to go to the bathroom, so you really get what I am explaining). Okay time to find that bathroom – or that rest stop. You are getting physically closer to the bathroom and then you are there – you SEE the toilet – the “urge” is now an acute, pain in your bladder, at least an 8. You did not do anything, you did not THINK, you saw the toilet and your body, your mind, your neurotransmitters, reacted to it. That is what happens when someone is trying not to smoke and he or she sees cigarettes or people smoking. The smoker or quitter goes from not really thinking about a cigarette to “I must have one.” Anything that we can do to make smoking harder, WILL make quitting easier.

Understanding Triggers

I am 100% against tobacco in its current disease causing form. This includes cigarettes and much smokeless tobacco. There may be nicotine co...

4:57 PM

airlines, fats, and tobacco

Not going to be the post you are imagining! After several unusual and harrowing tarmac flight delays, regulation was proposed and then passed, which limits the amount of time a plane loaded with passengers can sit idle. In other words, people no longer have to worry about being essential prisoners of the airline. As the rules neared enactment, the airline industry warned of dire consequences for THEM and an increase in cancelled flights for us. It turns out, um, that it is not so bad really. The industry has adapted and consumers are relieved. I mention this in the health blog because the exact same thing could be said with regard to the legislation to rid foods of TFAs, to lower salt in products, to ban smoking in restaurants and so forth. Industry groups panic. Examples I recall for the TFA initiative include frying capacity, shelf life, and taste. As it turned out – the technology was there and NO ONE misses the TFAs. The sodium content in foods has been lowered once already and I doubt a second round is going to devastate the processed food industry. We will adapt. Moreover, those restaurants forced to ban smoking have had a BOOST in sales, not a reduction. We can be a healthier society and companies can maintain financial health. People balk at change, but change is not always bad. A current instance, for example, is health care reform. The new law includes a provision for free preventative care in all new health insurance plans. The insurance companies might cringe at the new upfront costs, but the benefit is going to be the money they save by reducing the incidence of chronic disease in their plan participants. Oh and two more I just thought of – oldies but goodies; lead paint and asbestos.

airlines, fats, and tobacco

Not going to be the post you are imagining! After several unusual and harrowing tarmac flight delays, regulation was proposed and then passe...

5:18 PM

Children and Cholesterol

An interesting project has been underway in West Virginia for ten years. The purpose of the study, among other things, is to determine the amount of children who would not be screened for abnormal cholesterol levels under current best practice guidelines for this population (who should have been). This is more of a pilot program than an intervention and some might suggest doing the evaluation in other states. I prefer using this data to do one or both of the following: 1) Begin standard screening of all children, in school and at no cost 2) Create systematic and intensive school and community based programs to address what West Virginia has already found The findings include that a significant portion (more than 30%) of children have high enough levels of low density lipoprotein to warrant lifestyle interventions on nutrition and physical activity. I have to say that in reading about the WVA work I was initially very skeptical regarding the end that they were heading to – which is medicating the kids and that did come up. However, the lead investigator Dr. Neal denies any industry ties or funding. The study is published in a journal titled, Pediatrics.

Children and Cholesterol

An interesting project has been underway in West Virginia for ten years. The purpose of the study, among other things, is to determine the a...

5:08 PM

Healthy nutrition - need to ask about access

<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiFViSaCX2UD6yeopGjxTkf7OgejK2BokIA16x9b1G5clQxucOqzgyz2o5rDbbLyahnJxbK7F24gSMGEIHusbKDQI3RPMDjpm7NQwJ8zlgLssTS2D04nFZ10ob96Jqe6CFLBoDRl0erUnEY/s1600/Untitled-1.jpg" imageanchor="1" style="clear: left; cssfloat: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200px" rw="true" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiFViSaCX2UD6yeopGjxTkf7OgejK2BokIA16x9b1G5clQxucOqzgyz2o5rDbbLyahnJxbK7F24gSMGEIHusbKDQI3RPMDjpm7NQwJ8zlgLssTS2D04nFZ10ob96Jqe6CFLBoDRl0erUnEY/s200/Untitled-1.jpg" width="150px" /></a></div>When you ask about nutrition - you need to ask about access to food. During your third year as a medical student,  caring for people in the Philadelphia area, you quickly realize that obesity, hypertension and diabetes are the norm. Diet has a big impact on these health problems. As clinicians we instruct our patients to eat a healthy diet and maintain a healthy weight. When we advise patients in this way we assume that they have access to healthy food. The fact is that many Philadelphians do not have access to fresh healthy food. <div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhRilgBW5AApoivQtQwQVvQ9FJ5aTNuWqvgw-rPxrN5D6iP4oVjyaTDWJb35z7qoCnhN69nDjJLKLKa_iT5Pn1rD6yh17UsmpbWZ8ZQi0i9eRG5JaH5og_uYmL64MA1wxwpKqSwhRiX11WC/s1600/beetlesandmorocco.jpg" imageanchor="1" style="clear: right; cssfloat: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="141px" rw="true" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhRilgBW5AApoivQtQwQVvQ9FJ5aTNuWqvgw-rPxrN5D6iP4oVjyaTDWJb35z7qoCnhN69nDjJLKLKa_iT5Pn1rD6yh17UsmpbWZ8ZQi0i9eRG5JaH5og_uYmL64MA1wxwpKqSwhRiX11WC/s200/beetlesandmorocco.jpg" width="200px" /></a></div>In fact the recently proposed <a href="http://www.govtrack.us/congress/bill.xpd?bill=h111-3100">Food Desert Oasis Act of 2009</a> named Philadelphia as one of 20 “Food Deserts” in the US. This means that many of the people who we care for do not have access to fresh food, they many not live within a walkable mile of a grocery store, and may not have transportation to grocery stores in other neighborhoods. This problem disproportionally affects lower income and minority neighborhoods. So ask! Before you advise someone to eat more fruits and vegetables ask, <ol><li>Where do you get your food? </li> <li>Do they sell fresh food where you shop? </li> <li>Is it quality and affordable fresh food? </li> <li>Do you have affordable transportation to a grocery store? </li> </ol>Want to learn more about fresh food access in your neighborhood? Check out the <a href="http://www.ers.usda.gov/FoodAtlas/index.htm">USDA interactive food atlas</a>. Blog submission Alethia Donahue MS4 WH Pathway class of 2011 Photo credits: Homegrown tomatoes Alethia Donahue 2009; Saharan Beetle Juice A. Núñez 2009

Healthy nutrition - need to ask about access

When you ask about nutrition - you need to ask about access to food. During your third year as a medical student, caring for people in the ...

12:53 PM

Off Label Complications

It has been mentioned here that many drugs are created for one condition and used for another. Drugs CAN usually be used for an indication beyond their original market approval, but not advertised as such. This is one way for drug companies to earn more revenue off their existing formulary and it is also sometimes a legitimate next step. For many years, one such quinine drug, sold as Qualaquin, has been used off label for muscle cramps. The drug is intended for use in acute malaria - only. Though the drug has been effective for the cramps, the adverse events related to its use have concerned the FDA and public health experts for several years. The FDA has warned physicians NOT to prescribe it off label and this July came out with a more serious and concentrated effort to stop this off label prescribing and use. This directive would include any medicine/supplement containing quinine. The FDA has issued a risk management plan which will include a medicine insert that strongly advises anyone against taking this drug outside of its original intent. From the FDA website : Additional Information for Patients Qualaquin is only approved for the treatment of a certain type of malaria (uncomplicated) caused by the parasite Plasmodium falciparum—a rare infection in the United States (approximately 1500 cases per year) primarily resulting from travel abroad. Qualaquin is not approved for the treatment or prevention of night time leg cramps. Patients using Qualaquin for this condition are at risk for serious side effects. If you are taking Qualaquin for night time leg cramps, you should discuss other treatment options with your healthcare professional. If you experience easy bruising, severe nose bleeding, blood in your urine or stool, bleeding gum, or the appearance of unusual purple, brown, or red spots on your skin, contact your healthcare professional immediately. As you can see above, the drug itself is not a blockbuster by any means. It would do the drug company well if people could take it for other indications, but I must say in this case, they will just have to let it go.

Off Label Complications

It has been mentioned here that many drugs are created for one condition and used for another. Drugs CAN usually be used for an indication b...

4:30 PM

Retro Post!

This is a copy of a news story I wrote in March of 2007 when I was still an employee of Wake Forest University Baptist Medical Center. I tried NOT to edit it too much :) You can see that some of the issues have remained in the press and that maybe, my writing skills have improved since this was written! News Notes Special Edition The information in today’s newsletter is derived directly from a conference I attended earlier this week. This was part of the research series brought to us by the Women’s Health Center of Excellence. I did attend sessions on weight loss surgery, diabetes, fad diets and most importantly life style factors and disease. In fact, the reason I took the day off from work was to hear the man, the physician and doctor of public health whom I esteem above all others, speak on the prevention of the chronic diseases that are affected by life style and diet. He is Walter Willett, Harvard professor and researcher. This is my best representation of what I heard during his lecture. He also has a new book for the public titled Eat, Drink and Weigh Less. I highly recommend any and all of his publications. There were pearls here and there in his lecture. But I will begin with the bottom line. Based on careful analysis of two large, rigorous and scientifically valid prospective cohort studies,[ one the Nurses Health Study, the other the Physician’s Health Study] ….it is believed that the following life style choices are protective against heart disease and diabetes… Moreover, as much as 80 to 90 % of the cases of these diseases could have been prevented…. [ NOTE: Dr. Willett did not provide a presentation out line and I am fallible. There could be error here, by misunderstanding or even a typo… check the facts ok!] Okay, the LIST of things to DO!!!!! To prevent heart disease 1) be a nonsmoker 2) keep the BMI (body mass index) below 25 and lower is better (to 20) but he is choosing a number that more persons might be able to attain. [realism…] 3) exercise more than ½ hour a day every day. He suggested brisk walking though he said running is better. Again he said he is being realistic for the majority. 4) choose what you eat! Low to no trans fats, high ratio of polyunsaturated/saturated fats, low glycemic load foods, high CEREAL fibers, high fish intake (3x/week), consume the recommended daily allowance of folate 5) alcohol (any kind not just wine, it’s the ethanol stupid – little joke there, but yes, it is the ethanol that appears protective as long as the folate intake is not lacking. Very important that you hear that part, FOLATE + ½ glass per day of alcohol o prevent heart disease For diabetes Dr. Willett said it was the same but not the fish and folate recommendations. He said that prevention for colon cancer also adds that one should not have more than two servings of red meat a week (serving is 3 oz which is NEVER the size a restaurant provides!). Alcohol and Folate rule does apply and I think the alcohol recommendation was slightly higher. Screening for this cancer is strongly recommended in the literature. Dr. Willett does not recommend dairy products or calcium overmuch. He noted some bad outcomes with too much calcium, regardless of fat content in the dairy products. He notes that we are the only country that consumes so much dairy. Some use none. He noted research that does NOT show that calcium protects against fracture. A new to me "factoid". Height is a risk factor for fractures… long bones.. Also the hormones in milk accelerate growth in our kids leading not only to early puberty, but breast cancer and fracture risks because of the growth… He promotes Vitamin D… I hinted at that a few weeks ago and now I am going to make changes because of it……. All he recommended in regards to supplements is Vit D 1000 IU a day and the RDA for Folate…. He suggested a multivitamin with 1000 D, but I haven’t seen one (yet) [actually I went shopping between the above and the below, I did not see any multivitamins with more than 400 IU of D but the D tablets came themselves in 400 and a 1000. Be careful you don’t over do it if you are taking multiples, i.e. your calcium might have D and your Multivitamin, so don’t add 1000 of D if they both already have some] Dr. Willett reviewed research that helped us track down why some countries had more rates of certain disease than others. He spoke about the mistakes made with fat free diets and the error of the original food guide pyramid. He addressed the butter v margarine and Trans Fat issue. He believes that the biggest issue and the one that has had the most impact on this increase in obesity, heart disease, diabetes and some cancers is the failure to differentiate between the types of fats and the types of carbohydrates in our diets. He supports the positive aspect of fats in olive, canola, and soy bean oils. He encourages consumption of food with poly unsaturated fatty acids or PUFA and of foods with Omega 3 and 6. These fats are correlated in the rigorous research with decrease in heart disease where as trans fats those in processed, and until recently, fried foods as well as saturated fats in red meats, etc are related to increase in heart disease. Though both are health promoting Omega 3 is better than 6 in this regard: A real pearl for me: Omega 3 fatty acids, often found in fish are the only ones that in research have been shown to control or prevent heart arrhythmia, ( irregular heart beat ) and though they do not stop heart attacks from occurring, they decrease DEATH from the heart attack.. My father’s death certificate states arrhythmia and acute MI… so hmmmm. Food for thought isn’t it. Oh yes, on that same note. He said that dietary changes such as he proposes are good at ANY age and with any heart disease history. He states that the Mediterranean type diet, low in sat fat, higher in fish and veggies and monounsaturated oils will increase life expectancy. His best quote I thought, “the hydrogenation of oils that leads to the TFAs is done to increase the shelf life of products, but it decreases OUR shelf lives!” Do you all remember a couple years back I brought up a type of inflammation in the blood that might indicate heart attack risk. The CRP or c reactive protein? WELL he mentioned it and said that trans fat could double it! Oh dear, I notice I am on page three. Better wrap this up. Gosh it’s hard to not repeat everything he said. I suppose the most important thing would be the pyramid that I mentioned earlier. It was a lovely slide. Shoot. I didn’t get to the carbohydrate issue. Basically it’s the same as I’ve already written. He said that white potatoes should not be in the vegetable category.. He said that white flours, rice, pasta, bread etc are high glycemic foods and he did give credence to the issue that these foods should be avoided or limited. This is especially so if one has an increased BMI. In other words, lean all day active people, like the Chinese of a generation ago, they can eat white rice and not get diabetes! In July of 2009 I did include Dr. Willett's food pyramid in a post. You can see it <a href="http://yourhealtheducator.blogspot.com/2009/06/recommended-daily-intake.html">here</a>.

Retro Post!

This is a copy of a news story I wrote in March of 2007 when I was still an employee of Wake Forest University Baptist Medical Center. I tri...

3:30 PM

UV Awareness

July has been recognized for national UV Awareness. For this reason I encourage you to revisit the following two posts. <a href="http://yourhealtheducator.blogspot.com/2010/04/vitamin-d-sun-good-bad-extra.html">http://yourhealtheducator.blogspot.com/2010/04/vitamin-d-sun-good-bad-extra.html</a> <a href="http://yourhealtheducator.blogspot.com/2009/06/suncsreen-vitamin-d-and-skin-cancer.html">http://yourhealtheducator.blogspot.com/2009/06/suncsreen-vitamin-d-and-skin-cancer.html</a> I also bring this to your attention with renewed interest as one of my friends, and a loyal reader, recently saw a dermatologist who emphasized much of what was said in the above posts. Ultraviolet radiation from the sun reaches us in both UVA and UVB rays. Though they do not penetrate the skin at the same intensity, they are both cancer causing and both can lead to premature or accelerated aging and they damage our eyes. When choosing a product for protection, whether its a lotion, lip balm, window or tee shirt, there are certain terms, numbers and chemicals that are considered necessary for adequate coverage. For example: The Skin Cancer Foundation suggests that we look for a "sunscreen with an SPF of 15 or higher, plus some combination of the following UVA-screening ingredients: stabilized a avobenzone, ecamsule (a.k.a. Mexoryl™), oxybenzone, titanium dioxide, and zinc oxide." SPF is the term used to let you know how long the product will keep the skin protected from reddening. When your skin begins to redden you are putting yourself at risk for DNA damage which can effect aging acceleration and cancer incidence. My friend Melanie shared that her physician encouraged the use of sunblock over sunscreen. The Skin Cancer Foundation has recommendations for both. The SCF website can provide the information you need to choose a product and they have a good sized list of products that have their <a href="http://www.skincancer.org/seal/">seal of approval</a>. I expect to spend some time with the lists and the many categories for choosing my skin protection and my glasses. I may even consider upgrading my hat. I want you to go to their website because they are they experts, not me. OK - get on that - protect your skin now- you will be glad that you did!

UV Awareness

July has been recognized for national UV Awareness. For this reason I encourage you to revisit the following two posts. http://yourhealthedu...

4:54 PM

Guest Blog: Odds and Ends

Okay, my friend sent me an odds and ends post on June 12th. It was very funny and referred to my posts from the week before - so you have to look back to those if you are wondering what she is referring to. The reason I did not post it then was because I had called her just the day or so before to give her some very important news - and she notes it in her text. BTW, she actually cried when I told her my news and I have rarely felt so loved and appreciated as I did at that moment. So here is her post - feel free to laugh out loud and then, I will explain. Hello, All. This is the "blog" from "YourHealthEducator's" non-healthy friend, with a few of my own end-of-week observations: 1) My mother informed me this afternoon that I had already told her "TWICE already" that my friend Dee was moving back to the area and that perhaps I had ingested too much sugar today. (no joke). 2) I did the "healthy100" questionnaire, with the following results: Conservative life: 79 Expected life: 89 Potential life: 97 FYI: 2 great-grandmothers lived into their 90s; maternal grandmother was 91 when she died of a heart attack as result of being thrown from a car in an accident (which was NOT her fault); paternal grandmother will be 93 later this month; of maternal great aunts, one lived into 90s; one died at 101) Additional FYI: On maternal side, women tend to lose their hair in their 80s. Great! I'll live to be 90 or 100, but I'll live the last 20 years of my life with no hair!!! 3) I took at least 4 years off my life today b/c I took everything out of my clothes closets, vacuumed them, then re-organized them. It was a traumatic afternoon. (What else can you do when it's 96 degrees, 80% humidity, and a big afternoon thunderstorm?) So I then made myself feel better by having half a bottle of sauvignon blanc and one summer squash, sliced and baked on a pizza stone with pepper, salt, and Parmesan cheese. Yep, that was my dinner. Oh, and I also had 2 of those little mini dark-choc, mint 3 Musketeer bite size bars. I keep them in the freezer. They are SO yummy when frozen, and you have to chew them really slowly. 4) I made myself run 3+ miles this a.m., b/c my friend Dee is moving back to NC, and I have to be ready to run 6 miles by mid-August. 5) The not funny news: Yesterday in WS, there was a fatal house fire. Sadly, the woman who died, a veteran, had COPD, was using an oxygen tank. The report said the fire was caused by the cigarette she was smoking. And to end on a lighter note: 6) I am now less than 50 pages into Sookie's story, and I am addicted. Thank you very much! 7) As I sit at my desk, the wind is blowing this direction from Bowman Gray Stadium (remember that place?), and I can hear all the race cars going 'round and 'round and 'round. Saturday night sounds! Have a good evening! (Um, sorry, I did NOT video myself: a) baking the squash from my garden, or b) cleaning out my closets. Your Non-HealthEducator Ah so - here it is everyone, the news I have been alluding to for several weeks. In truth, the information has been in my hands since April, but kept close to my chest as I kept creating new standards as to what constituted official. My family and three close friends only heard this within the last month. I must tell you, because almost down to a person the GUESS about my news was "pregnant or adopting a child." No, no not at all. The truth is that my passion is preventing disease, especially as related to obesity. I want to prevent the chronic disease epidemic in YOUR children and their children. I want to impact society so that your great grandchildren are not going to have hypertension and diabetes type two when they are 30 and 40. So my dear friend who just gave us a laugh or two and is more healthy than she is letting on- is my running buddy, was my running buddy. She ran many miles with me while I studied for my MPH and joked to the professors at my graduation that she should get an honorary degree as she heard every single word of all my papers and projects. She is now going to get even more education, whether she wants it or not, because in August I will begin my studies as a full time student at the University of North Carolina in Greensboro. I will be working on my doctorate in public health, and YES, I am going to make a difference....

Guest Blog: Odds and Ends

Okay, my friend sent me an odds and ends post on June 12th. It was very funny and referred to my posts from the week before - so you have to...

4:50 PM

Smoothie Uproar

Is a McDonald’s smoothie in your future? The fast food giant is testing Smoothies. In fact, some of the franchises have tested them so well the main company has asked them to back off. The company is afraid that they will run out of the mix before the start of their national ad campaign according to the WSJ. When reading about this, my thoughts quickly went to the nutrition side. I am NOT a fan of smoothies, even the ones you might make yourself. The reason is that they condense a lot of calories and sugar and thus are more caloric than one might realize. If for some reason, a person cannot eat food on a plate, then sure, this is a good meal replacement every now and again. I have a feeling that people who get a smoothie at McDonalds are probably also going to grab a burger. The smallest Smoothie they make is 12 ounces and for some reason, the with and without yogurt versions are both said to have 210 calories. Both also have well over 40 grams of sugar.

Smoothie Uproar

Is a McDonald’s smoothie in your future? The fast food giant is testing Smoothies. In fact, some of the franchises have tested them so well ...

1:04 PM

Ping WHAT?

Pinguecula – Another reason to wear those sunglasses! This noncancerous growth or film like fatty deposit may impair vision (unlikely) and is a discoloration on the white part of the eye, usually to the inside of the cornea. I learned about this from my eye doctor as I noticed a slight discoloring in this area on both of my eyes. I was taken aback thinking it could be the start of cataracts. He said that it was really nothing, just like a callous. Of course, he said, “just a fatty deposit” and I heard FAT??!! Ha ha. But the condition can progress in rare circumstances and is then called pterygium. Removal of the pinguecula is usually only considered when the callous moves across the colored part of the eye. It is a little tricky to remove, according to the doctor that I see. I was concerned about my vision but at the same time I am quite distressed over the cosmetic effect. He did say that it is sometimes associated with natural aging and more often with sun and wind damage. It is seen more often in states with much sun. I LOVE the sun and have not been consistent with eye protection over my life. I do always wear my sunglasses now – running, cycling, walking, driving, shopping etc. My optometrist also told me to use eye drops each evening. Cool thing was that I DID start the eye drops when I noticed the discoloration. I thought, what the hell, worth a shot. It is nice to be intuitive from time to time. So please, protect your eyes from damage by wearing sunglasses and such. If you do a Google search for these terms you will find that there is not a clear cause and effect for the condition, but sun damage is strongly suspect.

Ping WHAT?

Pinguecula – Another reason to wear those sunglasses! This noncancerous growth or film like fatty deposit may impair vision (unlikely) and i...

4:00 PM

Who's Watching

There are many things that we might do to keep ourselves and our environment safe. The reasons that we do them are not always them same and in reviewing our own motivations and observing the behavior of others, much can be learned. These are fascinating concepts to me as I am, by education, someone who works to impact the behavior of others, and by others I mean groups - communities-populations. The great child development expert, Piaget, began his research by observing his own child. Observation is not a clinical study but it certainly gives research minded people a place to form their hypothesis. The behavioral theories that I appreciate the most are not so differentiated in my mind anymore as the constructs that I believe in now run together into one planning theme. You may remember my key concepts from past posts. They are relevancy, threat, self- and behavior(tool/new skill)-efficacy, social norming, obstacles and more recently I have been considering intrinsic and extrinsic motivation. Besides belief in ones ability to do something and the strength of that something to have a positive (or remove a negative) impact, why is a person doing something? Does the incentive come from inside or outside or both. Here are some things people may or may not do or use: seat belts bicycle helmets motorcycle helmets sunscreen and the like goggles (eye protection) condoms recycling vaccines pool showers Pool showers! Yes that is the behavior that inspired this deeper blog discussion. We are told to shower before we enter a public pool or hot tub and less often, to shower after we leave them. I believe that the reason we are supposed to shower first is to remove our perfumes and lotions as they are bad for the pool and or can cause a reaction on our own skin if they mix with the water chemicals. I know from personal experience and have been told by - well I cannot remember - I want to say my doctor told me but I really think it was a massage therapist- that the chemicals from the pool or hot tub - are absorbed into our skin. Makes sense, isn't that why we soak in Epsom salt? So I ALWAYS shower after but I only shower before if other people are at the pool area. What does that say about me? Apparently, I believe in the second concept but not the first. Or I do not think that the first really is RELEVANT to me as I don't usually lotion up and put on perfume before going to the pool. I do want to set a good example though and/or am afraid I will appear thoughtless if I don't shower first, so I do if people are around. The before is apparently extrinsically motivated and the after is intrinsic. I believe that the chemicals will harm me and I believe that a shower immediately after will get them off of me. What are some things that you do regardless of being watched compared to when you are watched? Do you always recycle? Do you only where a helmet if kids are around? ETC -

Who's Watching

There are many things that we might do to keep ourselves and our environment safe. The reasons that we do them are not always them same and ...

4:10 PM

It IS Outrageous

With regard to drugs and pharmaceutical companies I have gone from skepticism to cynicism and now I think I am approaching outrage. I feel this might be repetitive but to err on the side of caution I will reiterate a point. For the most part, drug companies are focused on making money. They do spend a lot of money on research and development and a great many times that money is lost with no cure or treatment actualized. When they do have a breakthrough however, it seems to go something like this. The company gains approval to use the drug for a certain condition in a certain population – say adults – or adults who have had one heart attack. They can market their drug to the doctors who prescribe them, to the nurses who might suggest them and to You – who might request them. When a drug for heart disease seems to help with something else, that is a bonus for a drug company, but unless they complete another, albeit abbreviated drug study, they cannot market it for the new condition. Usually a drug gets patent protection for many years and generic forms are not available during that time. Drug companies do many things to maximize revenue for their products. Researchers are often funded to explore after market options for drugs. I feel the effects of this when I see drugs like those used to treat osteoporosis being suggested to prevent it and then panels of scientists or health experts calling for more bone scans in younger and younger people. My skepticism is that it is not because those women or even men are going to have fractures but that the company making the drug is seeking additional money. Pharmaceutical conglomerates, as they seem to be becoming, have other strategies or tactics in this regard. Even years before a drug is to come off patent they work to change the formula from say short acting to long acting and they may do a little research into other disease conditions and other populations, as well. So often we hear about drugs to treat one cancer site that are being tested for other cancers. My post today is triggered by a new indication for Pfizer’s Lipitor. Unfortunately, the same thing happened in the US several years ago, I happened to miss it. The European Union, which I consider stricter on drug applications and acceptance than the US FDA, is allowing Lipitor prescriptions for children aged 10 and older. This is wrong on so many levels – in my educated opinion. The reason the children would be placed on a statin medication is because they have dangerously high cholesterol levels. The answer is not to place them on a medication that could cause muscle wasting, liver problems and possibly diabetes. The answer is to get the kids healthy with nutrition and exercise. It is an outrage to me that we would think it best to medicate our children.

It IS Outrageous

With regard to drugs and pharmaceutical companies I have gone from skepticism to cynicism and now I think I am approaching outrage. I feel t...

5:51 PM

The Anti Exercise "voice"

I am tired, I am busy, it hurts, I don't like it, it's raining, it's hot, I don't want to be a hard body, I don't have the right shoes, I walk all day at work, my weight is fine, I have to help the kids with homework, someone has to make supper... etc etc etc I have absolutely no trouble making time for my daily exercise. I have time or stress challenges on occasion but exercise is no longer something I waffle or bargain. I have been at this regularly for ten years, after fits and starts in my teens and 20s. I now have the benefit of a learned behavior that is embedded in my psyche. There is no struggle with regard to convincing myself of the benefits – I know them, my learning curve has long since been mastered. I no longer need to approach a workout with blind faith that it will make me feel better. I don’t have to take any one’s word for it, now. So what happened? How did I get here? How do you get here? You may start by faking it – Fake It til You Make It. Trust all the evidence around you – scientific and anecdotal. You can also remind yourself of these things – If you do not exercise you will feel just like you did before – lethargic and unhealthy. People seldom regret the exercise they DID (only that which they didn’t) –thanks JB It must be a priority. Set clothes and any equipment you need or want (IPOD) out the night before – try mornings to beat things like weather, work, kids etc OR put all stuff in the car and exercise BEFORE you go home if you prefer evenings. (include your pre workout snack and your water in the things to get together) It does take some time to get used to this, but the health benefits are just unparalleled and include physical as well as mental improvement. This is up to you and under your control. Good health does not happen by accident. Sure, some people have incredible resilience to lifestyle missteps, but you probably don’t. You must own this – your body – your health. All the incentives and motivational prompts will be wasted if you do not act…

The Anti Exercise "voice"

I am tired, I am busy, it hurts, I don't like it, it's raining, it's hot, I don't want to be a hard body, I don't have ...

5:11 PM

Cookies and Milk

Yes - I said cookies and milk - such a shock you had to read the post eh? It is hard to believe that the Got Milk campaign has been in place for about 17 years now. It is certainly one of the most recognized promotions. Sometimes we forget that it is really a commercial intended to get people to spend money. That is right. It is not really a health campaign. Dairy products have a place in our diet and calcium is a nutrient that we need in order to keep our bones strong, however, milk is not the only source of calcium. Milk can be high in fat and calories, so fat free is the best choice. I am not anti milk and do have a cup of skim a day, along with cheese and yogurt on many days – but again, the fat free versions. Now I have something to tell you about the next move by the National Milk Processors and I don’t want you to get upset with me. The group is teaming up with Nabisco to have a little contest. This is going to be a Got Milk and Cookies contest. I do think it is cute and I think you could be on TV or something if you win – but you have to sign up on Facebook. However… because I am Deirdre and I write this blog with all of my opinions unfiltered, radical as they may be – I have to say this. With a national obesity crisis that has our health and nutrition experts, the First Lady, a former US president AND a former US governor calling for moderation of sweets and an increase in fruits and vegetables – isn’t this kind of um…. reckless?

Cookies and Milk

Yes - I said cookies and milk - such a shock you had to read the post eh? It is hard to believe that the Got Milk campaign has been in place...

4:45 PM

Odds and Ends

Next week a guest will share her odds and ends in an entertaining tongue and cheek about yours truly - do come back for that one... until then, it's me again with notes from the week past... Holistic Pet Food: I saw a sign directing consumers to a store which sold holistic pet food. This made me wonder what they might be selling at this store. Holistic? As in natural? So live or dead mice for cats and what, squirrels and road kill for dogs? I can’t imagine any food in a can or bag being holistic for an animal. Hey wait, WE are animals, hmmm... that's something to ponder. Cialis: Recently I viewed a full page color ad in the Wall St Journal for this medication that for men who have medically related impotence or erectile dysfunction. I thought to myself WOW, I wonder how much that cost… the ad. I found the answer in this <a href="http://wsjmediakit.com/pdf/newspaper/2010_Global_rate_card_122109.pdf">brochure,</a> so you can fact check me – but it cost over 300,000 dollars! Food Company Strategy: This was a little disconcerting. Certain food companies are marketing to developing and even underdeveloped countries with products that are sold cheaply – in very small packages. In other words, people who make just dollars a day cannot afford the same snack items that say Western countries enjoy – but can buy a ten cent (monetary equivalent) tube of yogurt. The product I read about came in 50 gram pouches and is called Dolima. I also read that in some markets the people did not like a similar product and so the makers of it added SUGAR. Oh yeah, lets make sure that even before the country obtains a middle class it is primed for an increase in diabetes cases so that we can then sell them blood glucose medications. The Dolima product is made by Danone – maker of Activia. I searched for it so I could look up the nutrition info, but could not find it. I do have my suspicions. Colon Health: Ah, I do not remember what the product was now, but a commercial for a supplement was touting the item for Colon Health and maybe that was the name of it. A pill that had some probiotic properties and included fiber. I will tell you this because I studied it. Colon cancer is related to lifestyle and to prevent it, one is best advised to eat a plant based diet, high in fruits, vegetables and fiber and to reduce the consumption of red and processed meat. No where in the research does it say that one should take this supplement or any probiotic or fiber supplement. Also, a fecal blood test is recommended. Shakle or Is it Shakee- I thought that the Saturday Night Live skit that had dumb bells that vibrated was a JOKE. My friends said that the product was real but I did not believe it until I saw it for myself on TV. I just , I just do not have WORDs. Lift weights okay. Slow, steady and controlled. If you buy those weights I will know and make fun of you. (when you want results and hear the words EASY – you will not get results. The ad for this stupid product of the day says that it is an Easy Six Minute Workout. Guess what you will get for that? The results of a six minute workout.) Wasteful: I wish I could say that I am surprised that millions of dollars worth of the swine flu vaccine are going to be destroyed. They were not used. They were not needed. They are expired. I am not surprised.

Odds and Ends

Next week a guest will share her odds and ends in an entertaining tongue and cheek about yours truly - do come back for that one... until th...

4:43 PM

July 4th 2010

<div>Though I have posts ready - I feel like I will be wasting them. For that reason - I will just wish you a Happy Fourth of July in America and return with health related content tomorrow - but wait - should I tell you about the chemicals that can be created during grilling, the ones that have been associated with colon cancer - or how terrible hot dogs really are for us - Nah- that would just be mean...</div> <div></div> <div></div> <div></div><img alt="" border="0" id="BLOGGER_PHOTO_ID_5489829834935239362" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiIrk79GfnOrxLwsJEaxd-nDXqjQUWt-IvG_6Gjn5XISw6zwWCWIVl1qyCNSKnhQ3GFXTMXKazlflCq6Xz82Hv6vkFpIBZwFGspbv9aQMYDfq9xA1KLHUd-FjuzIMZT1xI-3BK2LRdjShTD/s200/fourth.JPG" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 143px; CURSOR: hand; HEIGHT: 200px; TEXT-ALIGN: center" /> <div></div> <div></div> <div></div> <div></div>

July 4th 2010

Though I have posts ready - I feel like I will be wasting them. For that reason - I will just wish you a Happy Fourth of July in America and...

4:39 PM

What to Wear

Hats V Visors Deciding which is best to wear has a lot to do with your sport or the purpose for wearing the covering. Here are my thoughts on the issue. If you are engaging in an indoor sport and want to keep hair and sweat out of your eyes, a visor should do the trick. If you are outside and it is raining, visors are great to keep the water out of your eyes. For any other sport or activity, including beach and mountain escapades, a hat is best. The hat will protect your hair and scalp from the burning and radiating rays of the sun AND can protect you from ticks. I understand that some people think that hats are not cool. Maybe you can reframe this and make it one of long term vanity by considering the hat as a way of keeping your hair healthy looking and preserving your natural or costly color. All of this applies to young and old, male and female. What about people without hair? All the more reason to cover that scalp – skin cancer risk should trump style when deciding whether or not to cover up. Ah yes, I just remembered one of the skin cancer prevention slogans I heard some years ago – slip, slap, slop – I think it was. Slip on a shirt, slop on sunscreen and SLAP on a hat.

What to Wear

Hats V Visors Deciding which is best to wear has a lot to do with your sport or the purpose for wearing the covering. Here are my thoughts o...

5:06 PM

Health Education

The GAO Gets Genetic

and the doctor said

whoop whoop

Respect Your Feet

Obesity as a Risk Factor for Early Sexual Debut in Young Adolescent Girls?

The Grocery Aisle

The Laser

Odds and Ends

Mind Body Connection

Prevent or Reduce Cancer Recurrence

Supplements

Strength Training

AIDS progress and insight

First, Second, Third - Smoke and Chemicals

Odds and Ends

Understanding Triggers

airlines, fats, and tobacco

Children and Cholesterol

Healthy nutrition - need to ask about access

Off Label Complications

Retro Post!

UV Awareness

Guest Blog: Odds and Ends

Smoothie Uproar

Ping WHAT?

Who's Watching

It IS Outrageous

The Anti Exercise "voice"

Cookies and Milk

Odds and Ends

July 4th 2010

What to Wear

Popular Posts

Blog Archive