One of the great fears we all have is to lose our mental ability as we grow old. No one wants to end their life with dementia (such as Alzheimer's Disease). We all should be highly motivated to do things to avoid this tragic outcome. We already know that regular exercise is good for the mind and may reduce the risk of dementia. Recent evidence shows that the use of statin medications to lower cholesterol may help reduce dementia risk. Now we have evidence that the roll of fat around your waist may be a marker for increased dementia risk.
The University of California, Berkeley Wellness Letter (February, 2010) reports on a study published in the journal Neurology that followed 1500 Swedish women for 30 years. Those with more fat around the waist were twice as likely to have dementia by age 70 compared with thinner women. A 2008 study from Kaiser Permanente that included men and women showed similar results.
The fat around the waist is a better marker for internal fat than the fat around the hips. If a woman has a waist of 35 inches or greater, and a man a waist of 40 inches or greater, that is evidence of increased cardiovascular risk and dementia risk. The leaner the better as we get older.
Losing this fat is hard work. It requires an excellent diet and regular physical activity. Medications should be used if needed. A healthy body and mind in the senior years cannot be taken for granted. We may be lucky with good genes, but we all must live a healthy lifestyle in order to earn our good health later in life.
Tuesday, March 2, 2010
Wednesday, February 3, 2010
Fibromyalgia--Is it Real?
Every Tuesday, I conduct a diagnostic clinic at the University of Arkansas. This clinic sees patients referred throughout the state with complex or hard to manage medical problems, or patients that the referring physician is not sure who to turn to for advice or answers.
One of the most common problems I see is a patient with diffuse, hard to categorize soft tissue pain. Most of the patients have a diagnosis of "fibromyalgia". The patient that I saw this week told me her physician sent her to our clinic because "he doesn't believe fibromyalgia is real". Physicians often become frustrated with these patients because the pathophysiology of this condition is not well understood, and because effective treatment takes time and patience. The physician cannot rely on brief office visits and prescription refills to adequately address the issues of most fibromyalgia patients.
Fibromyalgia is very real and is a common problem in practice. Any busy primary care physician will attest to the fact that a significant number of patients with this condition visit our office every week. Fibromyalgia is a rheumatic condition whose characteristics include widespread muscle and joint pain and fatigue as well as other symptoms. Fibromyalgia can, and often does, lead to depression and social isolation because patients are so uncomfortable and fatigued. Patients with chronic fibromyalgia are often really miserable and need the help of a competant, sympathetic physician. Patients with fibromyalgia often complain of "total body pain". They almost universally have great difficulty sleeping. Most have tenderness when you press on the muscles of the upper back and shoulders. Females are 10 times more likely to complain of these symptoms than men.
How well do patients respond to treatment? I have yet to find a single patient who responds quickly or dramatically to any treatment. Rather, they tend to gradually improve with effective treatment of sleep and depression and tend to improve with stretching and exercise and, occasionally, with certain medications.
There are no blood tests, biopsy findings or imaging studies that confirm the diagnosis of fibromyalgia. This lack of clarity and specificity has led many to assert that this diagnosis is "not real". But many patients, mostly middle aged women, have chronic, diffuse, muscle and soft tissue pain and they all need help managing this condition.
The best treatment approach for those who suffer from this problem includes drugs, as well as alternative remedies and lifestyle habits that may help decrease pain and improve sleep. Medications include antidepressants to help alleviate the pain, fatigue, depression, and anxiety that comes with the disease. In addition, your doctor may recommend physical therapy, moist heat, regular aerobic exercise, relaxation, and stress reduction to help you self-manage your symptoms. There is no one "pill" that treats or cures fibromyalgia. A multidisciplinary approach that uses both medication and alternative or lifestyle strategies seems to work best. Medications that help in certain patients include Cymbalta, Savella, and Lyrica.
Patients with fibromyalgia badly need a compassionate, patient primary care provider who can see the patient at regular intervals and who will take a multidisciplinary, long-term approach to managing this condition.
One of the most common problems I see is a patient with diffuse, hard to categorize soft tissue pain. Most of the patients have a diagnosis of "fibromyalgia". The patient that I saw this week told me her physician sent her to our clinic because "he doesn't believe fibromyalgia is real". Physicians often become frustrated with these patients because the pathophysiology of this condition is not well understood, and because effective treatment takes time and patience. The physician cannot rely on brief office visits and prescription refills to adequately address the issues of most fibromyalgia patients.
Fibromyalgia is very real and is a common problem in practice. Any busy primary care physician will attest to the fact that a significant number of patients with this condition visit our office every week. Fibromyalgia is a rheumatic condition whose characteristics include widespread muscle and joint pain and fatigue as well as other symptoms. Fibromyalgia can, and often does, lead to depression and social isolation because patients are so uncomfortable and fatigued. Patients with chronic fibromyalgia are often really miserable and need the help of a competant, sympathetic physician. Patients with fibromyalgia often complain of "total body pain". They almost universally have great difficulty sleeping. Most have tenderness when you press on the muscles of the upper back and shoulders. Females are 10 times more likely to complain of these symptoms than men.
How well do patients respond to treatment? I have yet to find a single patient who responds quickly or dramatically to any treatment. Rather, they tend to gradually improve with effective treatment of sleep and depression and tend to improve with stretching and exercise and, occasionally, with certain medications.
There are no blood tests, biopsy findings or imaging studies that confirm the diagnosis of fibromyalgia. This lack of clarity and specificity has led many to assert that this diagnosis is "not real". But many patients, mostly middle aged women, have chronic, diffuse, muscle and soft tissue pain and they all need help managing this condition.
The best treatment approach for those who suffer from this problem includes drugs, as well as alternative remedies and lifestyle habits that may help decrease pain and improve sleep. Medications include antidepressants to help alleviate the pain, fatigue, depression, and anxiety that comes with the disease. In addition, your doctor may recommend physical therapy, moist heat, regular aerobic exercise, relaxation, and stress reduction to help you self-manage your symptoms. There is no one "pill" that treats or cures fibromyalgia. A multidisciplinary approach that uses both medication and alternative or lifestyle strategies seems to work best. Medications that help in certain patients include Cymbalta, Savella, and Lyrica.
Patients with fibromyalgia badly need a compassionate, patient primary care provider who can see the patient at regular intervals and who will take a multidisciplinary, long-term approach to managing this condition.
Sunday, January 24, 2010
Ideal Cardiovascular Health
You too can have ideal cardiovascular health. What is that you may ask? The American Heart Association has come out with a new report that defines it.
Ideal cardiovascular health means you do all of the following:
1. You do not smoke
2. You are not overweight (normal body mass index, or BME less than 25)
3. You get regular physical activity, about 5 hours a week
4. You eat a healthy diet low in saturated fats and simple sugars
You also have the following:
1. Your total cholesterol is normal (generally below 200 or a healthy ratio of total cholesterol and HDL (good) cholesterol)
2. Your blood pressure is aroung 120/80
3. Your fasting blood sugar is less than 100 (better yet 90 or less)
All of these are within reach of most everyone, with or without treatment. Ideal health is a choice and requires a commitment to action. Go for it. There are no justifiable excuses.
Reference: Circulation: January 20, 2010
Ideal cardiovascular health means you do all of the following:
1. You do not smoke
2. You are not overweight (normal body mass index, or BME less than 25)
3. You get regular physical activity, about 5 hours a week
4. You eat a healthy diet low in saturated fats and simple sugars
You also have the following:
1. Your total cholesterol is normal (generally below 200 or a healthy ratio of total cholesterol and HDL (good) cholesterol)
2. Your blood pressure is aroung 120/80
3. Your fasting blood sugar is less than 100 (better yet 90 or less)
All of these are within reach of most everyone, with or without treatment. Ideal health is a choice and requires a commitment to action. Go for it. There are no justifiable excuses.
Reference: Circulation: January 20, 2010
Wednesday, December 23, 2009
Reflections on the State of Online Health
As 2009 draws to a close, the US health care system is ailing and quasi-reform proposals are frantically being debated and voted on. Although some type of reform is likely in 2010, we will have only scratched the surface of what still needs to be changed. One particular aspect relates to the ease with which patients can use the internet to improve their health care. At eDoc, we've been using the internet to improve the health of our users for over a decade. Ten years ago, I predicted that patients would routinely use internet messaging to interact with the health care industry by now, but I was wrong. Although, increasingly, web 2.0 approaches are providing innovative communication and health management tools for patients, the growth of interaction between patients and doctors has been much slower than I predicted it would be. And the future still remains cloudy. The issues are nothing new and include:
1. Many patients still lack ready, reliable internet access. This is especially true for those who need it most: sick, elderly, and financially disabled persons.
2. Most insurance companies do not recognize e visits as reimbursible under health insurance plans. This provides a powerful disincentive for physicians to spend significant amounts of time answering e mail questions from their patients, since they are reluctant to bill patients directly for this type of service.
3. Professional liability issues have not been well worked out, leaving physicians and malpractice insurers feeling squeamish about supporting this approach.
4. Licensure issues remain the domain of individual states, are not consistent from state to state, and maintain unachievable standards in their definition of "doctor patient relationships". This requires a physician who wants to provide "on line care" to have a license in every state for which they provide this care (edoc provides medical information, not on line practice). Moreover, they define the minimum requirements for establishing a doctor patient relationship as an "in office" history and physical examination performed by that individual.
5. Physicians and health care providers who are interested in providing online care are dissuaded from getting involved lest they be tarred by the brush of thousands of online health care supplement companies, bogus care recommendations from quacks, and illegal drug distributions sites.
So, how will we deal with this, and in what direction will we go in the future? Hopefully, my predictions for the next few years will be more accurate than my last ones:
1. Online care will continue to grow, in spite of the obstacles mentioned above, because the internet an incredibly powerful and efficient resource for patients. The growing demand will eventually overwhelm the remaining barriers.
2. Patient and peer groups will become increasingly sophisticated, with or without the cooperation of health care providers, and will increasingly rely on each other, rather than sole reliance on trained professionals.
3. Grudgingly, more payers will begin to support online care as the patients/employee groups realize the benefit and demand it of their employers and insurers.
4. Access to online services will continue to grow, including adaptation on cell phone applications, which will lower the bar for patient groups that are currently left out of the action.
The ability to communicate with a physician via secure e mail has tremendous benefits, including saving unnecessary office visits, allowing patients to optimize the timing of their visits to physicians, and increasing patients' confidence to act on issues and questions. Moreover, it allows physicians and patients to emphasize and more efficiently monitor preventive practices such as healthy diet, exercise programs, weight loss programs, smoking cessation and others.
Health care reform may increase the number of patients who have some type of insurance, but thus far, has not included proposals to reform the online environment to encourage or stimulate more communication between doctors and patients.
As always, your comments or dissenting opinions are welcome.
Merry Christmas and Happy New Year to all, and thanks for being a part of eDocAmerica!
1. Many patients still lack ready, reliable internet access. This is especially true for those who need it most: sick, elderly, and financially disabled persons.
2. Most insurance companies do not recognize e visits as reimbursible under health insurance plans. This provides a powerful disincentive for physicians to spend significant amounts of time answering e mail questions from their patients, since they are reluctant to bill patients directly for this type of service.
3. Professional liability issues have not been well worked out, leaving physicians and malpractice insurers feeling squeamish about supporting this approach.
4. Licensure issues remain the domain of individual states, are not consistent from state to state, and maintain unachievable standards in their definition of "doctor patient relationships". This requires a physician who wants to provide "on line care" to have a license in every state for which they provide this care (edoc provides medical information, not on line practice). Moreover, they define the minimum requirements for establishing a doctor patient relationship as an "in office" history and physical examination performed by that individual.
5. Physicians and health care providers who are interested in providing online care are dissuaded from getting involved lest they be tarred by the brush of thousands of online health care supplement companies, bogus care recommendations from quacks, and illegal drug distributions sites.
So, how will we deal with this, and in what direction will we go in the future? Hopefully, my predictions for the next few years will be more accurate than my last ones:
1. Online care will continue to grow, in spite of the obstacles mentioned above, because the internet an incredibly powerful and efficient resource for patients. The growing demand will eventually overwhelm the remaining barriers.
2. Patient and peer groups will become increasingly sophisticated, with or without the cooperation of health care providers, and will increasingly rely on each other, rather than sole reliance on trained professionals.
3. Grudgingly, more payers will begin to support online care as the patients/employee groups realize the benefit and demand it of their employers and insurers.
4. Access to online services will continue to grow, including adaptation on cell phone applications, which will lower the bar for patient groups that are currently left out of the action.
The ability to communicate with a physician via secure e mail has tremendous benefits, including saving unnecessary office visits, allowing patients to optimize the timing of their visits to physicians, and increasing patients' confidence to act on issues and questions. Moreover, it allows physicians and patients to emphasize and more efficiently monitor preventive practices such as healthy diet, exercise programs, weight loss programs, smoking cessation and others.
Health care reform may increase the number of patients who have some type of insurance, but thus far, has not included proposals to reform the online environment to encourage or stimulate more communication between doctors and patients.
As always, your comments or dissenting opinions are welcome.
Merry Christmas and Happy New Year to all, and thanks for being a part of eDocAmerica!
Thursday, December 17, 2009
Do Diet Sodas Make You Fat?
You would expect that diet sodas would help you lose weight since they have no or minimal calories. Drinking a diet soda rather than a regular soda saves you all that sugar, right? Many people develop diet soda drinking habits due to several factors, the caffeine, the sweetness or just wanting to drink something without the calories.
The link between diet sodas and weight is not what you might expect. Reviewed recently in the medical journal JAMA (Dec. 9, 2009), a major heart study showed that people who drank more than 21 diet sodas per week had twice the risk of becoming overweight or obese compared with people who don't drink diet soda. In another major study, daily consumption of diet soda was associated with a 67% increased risk of developing type 2 diabetes (cause by excess weight). Drinking diet sodas gives you the same "sweet tooth" behavior as other sweets and actually results in people eating more calories than if they stayed away from sweets in general.
Other research is even more disturbing about the addictive nature of diet sodas. When rodents are fed artificial sweeteners, not only do they consume more calories and become obese, but they become very addicted to the sweeteners. When given the option of repeated use of cocaine or diet soda, they preferred the diet sodas!
There are so many options for healthy drinking than diet sodas. Water is the healthiest beverage to complement natural foods. If you want some caffeine, coffee or tea would be healthier than diet sodas. Be mindful of what you put in your body and I'm sure most of you have thought that diet sodas are not very good for you.
The link between diet sodas and weight is not what you might expect. Reviewed recently in the medical journal JAMA (Dec. 9, 2009), a major heart study showed that people who drank more than 21 diet sodas per week had twice the risk of becoming overweight or obese compared with people who don't drink diet soda. In another major study, daily consumption of diet soda was associated with a 67% increased risk of developing type 2 diabetes (cause by excess weight). Drinking diet sodas gives you the same "sweet tooth" behavior as other sweets and actually results in people eating more calories than if they stayed away from sweets in general.
Other research is even more disturbing about the addictive nature of diet sodas. When rodents are fed artificial sweeteners, not only do they consume more calories and become obese, but they become very addicted to the sweeteners. When given the option of repeated use of cocaine or diet soda, they preferred the diet sodas!
There are so many options for healthy drinking than diet sodas. Water is the healthiest beverage to complement natural foods. If you want some caffeine, coffee or tea would be healthier than diet sodas. Be mindful of what you put in your body and I'm sure most of you have thought that diet sodas are not very good for you.
Wednesday, November 18, 2009
Is a Low Carb Diet a Bad Mood Diet?
An interesting study out of Australia suggests that long term use of a low carbohydrate diet may result in more common bad moods and hostility. 106 overweight and obese people were followed over a year with either a low carb diet without fat restriction (the Atkin's Diet) or a low fat diet. Both resulted in the same amount of weight loss, but those on very low carb diets were cranky more often. This makes sense since carbohydrates increase serotonin in the brain, an important neurotransmitter that affects mood. Common anti-depressant medications such as Prozac work by increasing serotonin. Fats and proteins reduce serotonin.
How you put these findings in perspective? It all leads back to a balanced diet. Whole grains, a natural source of carbohydrates, are good for you! The bottom line is that we all should eat a healthy diet and avoid excess calories that put on excess weight. Simple carbohydrates, such as sugars, cause more hunger and induce us to eat more. Complex carbohydrates, especially when mixed with protein, do not do this. Saturated fats also are not optimal foods in any large amounts.
Eating right means eating healthy foods most of the time, and not too much food. Grains, vegetables and fruits are the foundation of any healthy diet. Protein sources should be healthy, such as nuts, vegetables, fish, dairy and lean meats. Healthy fats such as vegetable oils should be eaten regularly and in moderation. Beware of any diet that seriously restricts any natural food type. You might lose weight, but having frequent bad moods is certainly not worth it!
How you put these findings in perspective? It all leads back to a balanced diet. Whole grains, a natural source of carbohydrates, are good for you! The bottom line is that we all should eat a healthy diet and avoid excess calories that put on excess weight. Simple carbohydrates, such as sugars, cause more hunger and induce us to eat more. Complex carbohydrates, especially when mixed with protein, do not do this. Saturated fats also are not optimal foods in any large amounts.
Eating right means eating healthy foods most of the time, and not too much food. Grains, vegetables and fruits are the foundation of any healthy diet. Protein sources should be healthy, such as nuts, vegetables, fish, dairy and lean meats. Healthy fats such as vegetable oils should be eaten regularly and in moderation. Beware of any diet that seriously restricts any natural food type. You might lose weight, but having frequent bad moods is certainly not worth it!
Monday, October 26, 2009
New Journal for Health Professionals and Patients Launches with Ambitious Ideas
Last week at the Connected Health Symposium in Boston, a new journal was launched, The Journal of Participatory Medicine (http://www.jopm.org/). This journal's mission is to transform the culture of medicine to be more participatory. This special introductory issue is a collection of essays that will serve as the 'launch pad' from which the journal will grow. I would like to ask you to log on and read these essays and help us as we connect patients, caregivers, and health professionals.
I am one of the Journal's Co Editors. The other is Jessie Gruman, PhD, founder and president of the Center for Advancing Health, a Washington-based nonprofit organization funded by the Annenberg, Macarthur, Kellogg Foundations and others. The Center works to increase patient engagement. She holds BA from Vassar College and a PhD from Columbia University teaches at The George Washington University. Jessie authored The Experience of the American Patient: Risk, Trust and Choice (2009); Behavior Matters (2008) and AfterShock: What to Do When the Doctor Gives You -- or Someone You Love -- a Devastating Diagnosis (2007).
Please take a look and send us your ideas.
I am one of the Journal's Co Editors. The other is Jessie Gruman, PhD, founder and president of the Center for Advancing Health, a Washington-based nonprofit organization funded by the Annenberg, Macarthur, Kellogg Foundations and others. The Center works to increase patient engagement. She holds BA from Vassar College and a PhD from Columbia University teaches at The George Washington University. Jessie authored The Experience of the American Patient: Risk, Trust and Choice (2009); Behavior Matters (2008) and AfterShock: What to Do When the Doctor Gives You -- or Someone You Love -- a Devastating Diagnosis (2007).
Please take a look and send us your ideas.
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