Friday, November 28, 2014

Treating Irregular Heartbeat with Digoxin May Come with Risks

The widely used heart drug digoxin is associated with increased risk of death and hospitalization among patients who have the heart rhythm disorder atrial fibrillation but no evidence of heart failure, a new study shows.

Atrial fibrillation is a common form of irregular heartbeat that has been linked to a rise in risk for stroke among older Americans. Digoxin has been widely used for more than a century to help treat irregular heartbeat, the authors of the new study said, and many guidelines recommend the drug for the treatment of atrial fibrillation.

However, the new findings “suggest that the use of digoxin should be re-evaluated for the treatment of atrial fibrillation in contemporary clinical practice,” study co-author Dr. Anthony Steimle, chief of cardiology at Kaiser Permanente Santa Clara Medical Center, said.

“In my experience as an electrophysiologist, specializing in heart rhythm, I’ve seen time and again that digoxin can be toxic to atrial fibrillation patients, proving useful in only a tiny subset who are bedridden,” said Dr. Soad Bekheit, director of electrophysiology services at Staten Island University Hospital in Staten Island, N.Y.

The new study involved nearly 15,000 adults who were recently diagnosed with atrial fibrillation and had no prior history of heart failure or digoxin use. During the three-year study, more than 4,800 of the patients began taking digoxin.

Those who took digoxin had a 71% higher risk of death and a 63% higher risk of hospitalization that those who did not take the heart drug, according to the study published November 21 in the journal Circulation: Arrhythmia and Electrophysiology.

“Given the other options available for heart-rate control, digoxin should be used with caution in the management of atrial fibrillation, especially in the absence of symptomatic systolic heart failure,” Steimle believes.

“Digoxin remains commonly used for rate control in atrial fibrillation, but very limited data exist to support this practice – mostly small, older clinical studies with very limited follow-up that did not assess the long-term effects of digoxin on mortality or hospitalization,” added study senior author Dr. Alan Go, a research scientist at the Kaiser Permanente Division of Research in Oakland, California.

Digoxin is one of the derivative drugs produced from the herb Foxglove. The discovery of Foxglove is attributed to Dr. William Withering who published a paper on its’ use in 1785. However, the use of Foxglove goes back hundreds of years in Europe where it was commonly used to treat “dropsy” (congestive heart failure). All parts of the plant are poisonous and it is not considered to be a “safe herb”.

Apparently, the drugs derived from Foxglove are not very safe either.

Atrial fibrillation is a common issue. In fact, I have developed atrial fibrillation over the course of the past year. I also manage several cases in the office. In the early stages, eliminating caffeine and chocolate often eliminates the symptoms. Over time however, dietary restrictions are not enough. Most cases will resolve when we increase the riboflavin (vitamin B2) and niacinamide (vitamin B3) while limiting the thiamine (vitamin B1). I believe that the large amounts of thiamine added to grains and other processed foods are responsible for most cases of atrial fibrillation.

Personally, I have not had an incident since adding vitamin B2 and B3 to my supplements several months ago.

If shifting the B-complex is not successful, increasing the magnesium to calcium ratio often is effective. Most calcium supplements contain a 2:1 ratio of calcium to magnesium. If your supplement has 250mg of calcium, it generally will contain 125mg of magnesium. Switching to a 1:1 ratio, or even a 1:2 ratio often will eliminate the symptoms of atrial fibrillation.

If you suffer from atrial fibrillation, consult your physician about the use of digoxin. Refer them to this study (there are others with similar findings) and convince them to help you get off this medication.

Eliminate caffeine and chocolate from your diet. Consider working with a nutritionist to alleviate your symptoms with simple vitamin and/or mineral supplementation.

Source: National Institutes of Health –Friday, November 21, 2014

Wednesday, November 26, 2014

Wisdom Wednesday: Constipation

Constipation is the most common digestive complaint in the United States. It is a symptom, not a disease.

However, diagnostic workup generally does not occur until medical management of the symptoms fail. Even with a diagnosis, treatment is aimed at alleviating symptoms with a bulk laxative, a stool softener, and/or drug that increases peristaltic action of the bowel.

The medical definition is a having at least two of the following symptoms over the course of the past three months:
  • Fewer than 3 bowel movements per week
  • Straining
  • Lumpy or hard stools
  • Sensation of anorectal obstruction
  • Sensation of incomplete defecation
  • Manual maneuvering required to defecate

If you are not having a bowel movement every day, preferably twice per day, you are constipated.
The most common cause of constipation is a sluggish gallbladder. The gallbladder stores bile manufactured in the liver. When the food bolus moves from the stomach to the small intestine, the presence of HCl lowers the pH of the small intestine and stimulate the gallbladder to contract. The released bile travels down the common bile duct, stimulating the release of all the pancreatic digestive enzymes. The bile emulsifies the fat while the pancreatic enzymes breakdown our food for absorption.

If the fat is not broken down, the ileocecal valve will close, trying to prevent the fat from entering the large intestine resulting in constipation. Fat does not belong in the large intestine as it feeds the harmful bacteria in the bowel.

Enter the protein pump inhibitors (PPIs). Nexium is the third most commonly prescribed drug in the US, behind Synthroid and Creastor. Twenty million people in America take Nexium to prevent acid reflux, effectively stopping the normal digestive process. In addition to constipation, PPIs cause anemia, osteoporosis and a host of malabsoption syndromes.

Of course eating excessive fat will also cause a sluggish gallbladder. Americans eat too much fat. They just eat too much – too much protein and refined carbohydrates as well. The only thing well don’t eat too much of are fruits and vegetables.

Monday, November 24, 2014

Nearly 3 in 10 Americans with Diabetes Don’t Know It

Almost 8 million Americans have diabetes but don’t know it, a new study shows.

That’s despite the fact that about two-thirds of those with undiagnosed diabetes have seen a doctor two or more times in the past year, according to the researchers.

The study also found that among those who were diagnosed with diabetes, only about one –quarter met three important goals for people with diabetes: managing blood sugar, blood pressure and cholesterol levels.

“Out of 28.4 million people with diabetes, more than a quarter don’t know [it],” said study author Dr. Mohammed Ali, an assistant professor of public health at Emory University School of Medicine in Atlanta.

“About 80% of those people are linked to a health care provider, and two-thirds are seeing them twice a year or more. So, through whatever means, they aren’t being identified with diabetes,” Ali explained.

Symptoms of type 2 diabetes, which may be subtle and come on slowly, include fatigue, blurred vision, slow-healing cuts and scrapes, and the need to urinate more often, according to Dr. Robert Ratner, chief scientific and medical officer for the ADA.

Despite greater awareness in recent years, diabetes remains a major cause of death and disability in the United States. It’s a leading cause of adult-onset blindness, kidney failure and limb amputations, according to the researchers.

This is a prime example of a failing heath care system – over 5 million undiagnosed diabetics are seen by a physician a least twice a year, but not properly diagnosed.

As a clinician, you are responsible for the total health of your patient, regardless of their chief complaint on entry. If a patient seeks my help for acute low back pain and they also happen to be an undiagnosed diabetic, I am responsible to diagnose, properly treat, and/or refer that patient for their diabetes.

Diabetes is an easy diagnosis. Occult cancers like breast, lung, and prostate are much more challenging. This is why a good history is so important. I recently had a new patient who was being treated for anemia with iron supplementation by her MD. She had a microcytic anemia, so iron probably would be effective. However, her history included breast cancer. As a clinician, you must assume this patient has metastatic carcinoma until you prove otherwise. You can not just treat the anemia and ignore the potentially fatal diagnosis. My new patient was referred to her oncologist for further evaluation and treatment.

Every patient in my office is evaluated for signs of metabolic syndrome, the precursor to diabetes and heart disease. The signs are central obesity (weight gain around the belly), high blood pressure, high serum lipids, low thyroid function, and insulin resistance. I see these signs all day long. Look around you or maybe look at yourself and you will see them too.

The fasting glucose only shows how well your body handles sugar without the stress of food for the past 8 hours. You are diabetic long before the fasting glucose is elevated on your lab test.

I recommend all my patients have laboratory testing each year as a preventative tool. Included in that panel of tests is a glycohemoglobin A1c. This test measures the percent of RBCs (red blood cells) that are saturated with glucose. That number should be below 5.7%. Please ask your physician to run an A1c. Don’t wait for your MD to diagnose you as a diabetic.

Source: National Institutes of Health -Tuesday, November 18, 2014

Friday, November 21, 2014

B Vitamins May Not Boost Memory or Thinking

Taking vitamin B12 or folic acid supplements may not reduce seniors’ risk of memory loss, according to a new study.

Past research hinted that taking vitamin B12 and folic acid might help protect memory and thinking skills, according to background information from the study. But follow-up trials have yielded less convincing findings.

The current study included nearly 3,000 people with an average age of 74. Half took a tablet daily with 500mcg of vitamin B12 and 400mcg of folic acid daily for two years. The rest took a placebo. All participants had high levels of homocysteine, which has been linked to memory loss and Alzheimer’s disease.

Memory and thinking skills tests were given at the start and end of the study. Results of the study were published in the November 12 issue of Neurology.

“Since homocysteine levels can be lowered with folic acid and vitamin B12 supplements, the hope has been that taking these vitamins could also reduce the risk of memory loss and Alzheimer’s disease,” Rosalie Dhonukshe-Rutten, of Wageningen University in the Netherlands, said in a journal news release.

Dhonukshe-Rutten and her colleagues found that people taking the vitamin B12-folic acid supplements had larger decreases in homocysteine levels than those taking the placebo. Despite the decrease, there was no difference between the two groups on the thinking and memory tests.

Wednesday, November 19, 2014

SmartRide 11

Last Friday morning at sunrise, my wife and I joined over 400 cyclists on a journey from Miami to Key West. This is the fifth year we have made the 165 mile trek and by far it was the hardest.

SmartRide is a charity event that raises money for those suffering with HIV/Aids. This year we raised 1.1 million dollars and that will be distributed to seven organizations, all in Florida. One hundred percent of the money raised goes to the charities. In fact, as a rider, I will decide where 50% of the money I raised goes.
It is a great event and the need is even greater. However, for the purpose of this blog, I would like to focus on the health aspects of the ride.

Typically, we train for 3-4 months prior to the ride. That involves a long ride each weekend and a couple of spinning classes during the week. We start with a 26 mile ride as a base and build from there. By the time the ride is over, we’ve ridden over 1500 miles in preparation for the event.

This past year, I tried to ride offseason as well and was able to log an additional 1000 miles on the bike. Our base began with a 40 mile ride, rather than 26, and we fared better than most riders during the event.

For the past four years, the ride was difficult for the first 50 miles as we work our way south and east to Key Largo against a strong head wind. However, once we made the turn west on Card Sound Road, that head wind became a tail wind and carried us all the way to Key West.

Monday, November 17, 2014

Can Video Game Play Help Young Minds Learn?

New research suggests that action video games like ‘Call of Duty’ can teach young adults new skills while also improving the way the skills are learned.

It’s not clear how the improved learning abilities may translate to life outside of the screen and joystick. There’s also no evidence that endless playing of video games is a good idea.

“Our studies are no excuse for binging on video games,” said study co-author Daphne Bavelier, a research professor with the department of brain & congnitive sciences at the University of Rochester in New York. Still, she noted, the research reveals the “beneficial effects of playing action video games on vision, attention, and now learning.”

At issue is a phenomenon known as “perceptual learning.” In particular, the small study examined the kind of perceptual learning that’s involved in detecting the subtle differences between things – “the process whereby one person might be able to taste the difference between wines because he has had perceptual practice, but to another person they taste the same,” said Felice Bedford, an associate professor emeritus of psychology at the University of Arizona who’s familiar with the study.

The study involved several different experiments with young adults, average age of 22, both skilled and unskilled, playing various video games.

In one experiment, they trained 26 players for 50 hours on the action video games ‘Call of Duty 2’ and ‘Unreal Tournament 2004’ and then compared them to players of non-action video games like ‘The Sims.’ Those who played the action games showed improvement in not just their skills but also their abilities to learn in certain areas, the test showed.

“I think they are learning how to better apply themselves to certain types of tasks,” said Aaron Seitz, a psychology professor at the University of California, Riverside. The brain, he said may be adjusting to using certain skills.

This kind of learning is important in real life, he added. “Many tasks that we do involve understanding what to look for. This ranges from finding the cereal that we are looking for at the grocery store to the skills of radiologists and even athletes,” Seitz said.

Friday, November 14, 2014

Spinal Surgery Varies by Region in U.S.

“Nearly 80% of Americans will experience low back pain at some point in their lives, and about 30 million people a year receive professional medical care for a spine problem,” co-author Brook Martin, of the Dartmouth Institute of Health Policy & Clinical Practice, said in a college news release.

In spinal stenosis, thickening of tissue surrounding the spine affects the spinal nerves, resulting in pain, according to background information in the study. Treatments include surgery, medication, physical therapy and steroid injections, the study said.

The two types of surgery of surgery for spinal stenosis are spinal decompression and spinal fusion. In spinal decompression, doctors remove the tissue compressing the spinal nerves. In spinal fusion, surgeons join two or more vertebrae to stabilize the spine.

Spinal fusion has a higher risk of infection and readmission to the hospital, and there is no evidence that it provides greater benefit to patients, according to the news release. Even so, its use increased 67% among Medicare patients from 2001 to 2011 and it’s now more common than spinal decompression, the researchers said.

The study’s analysis of Medicare data revealed that rates of spinal decompression varied eightfold across the United States, from about 25 procedures per 100,000 patients in Bronx, N.Y., to nearly 217 procedures per 100,000 patients in Mason City, Iowa. In general, rates of spinal decompression were higher in the Pacific Northwest and northern Mountain states.

Wednesday, November 12, 2014

Wisdom Wednesday: Glandular Therapy

A basic concept of glandular therapy is that the oral ingestion of glandular material of a specific animal gland will strengthen the corresponding human gland. The early Egyptians are credited with this concept of “like cures like”. People with liver ailments were encouraged to eat liver. Those with kidney disease were fed animal kidneys.

The concept really dates back many thousands of years and is still practiced in its original format in primitive cultures throughout the world. If you killed your enemy in battle and especially if he was brave, you ate his heart to absorb his courage. This might be the heart of a lion, other ferocious animal or maybe the leader of a rival tribe.

Glandular extracts were in wide use all over the world until the early 1940s. With the discovery of antibiotics, modern medicine turned from the use of glandular extracts to research in developing antibiotics and other pharmaceutical drugs.

Purified extracts from the endocrine glands of animals are used today in alternative medicine to treat a host of illnesses. The most common extracts are thyroid, thymus and adrenal. However, pituitary pancreas, heart, liver, kidney, prostate, ovary, and other glandular extracts are readily available.

Protomophogens are specific extracts from the nucleus of the cells of specific glands. The process for extraction was developed in the 1940s by Dr. Royal Lee, using sea salt to concentrate the nuclear material. He stated that protomorphogens are tissue specific, not species specific. That is adrenal protomorphogen will support any adrenal gland, human or otherwise. Dr. Lee had two theories to explain the benefits of protomorphogens.

Monday, November 10, 2014

High-Fat, Low-Carb Diet May Help Treat Epilepsy

A review of five studies found that a ketogenic, or modified Atkins, diet, that focuses on foods like bacon, eggs, heavy cream, butter, fish and green vegetables, could help reduce seizures in adults whose condition doesn’t improve with medication.

“We need new treatments for the 35% of people with epilepsy whose seizures are not stopped by medications,” study co-author Dr. Pavel Klein explained in an American Academy of Neurology news release. “The ketogenic diet is often used in children, but little research has been done on how effective it is in adults.”

In conducting the review, the researchers analyzed five studies on the ketogenic diet with a ratio of fat to protein/carbohydrate of 3 or 4 to 1. They also reviewed five more studies on the modified Atkins diet, which has a 1 to 1 fat to protein/carbohydrate ratio by weight.

The researchers found that 32% of the patients on the ketogenic diet and 29% of those following the modified Atkins diet had reduction in their seizures of 50% or more. Meanwhile, 9% of those in the ketogenic diet group and 5% of the modified Atkins group had drops in their seizures by 90% or more, according to the study published October 29 in Neurology.

The benefits of these high-fat diets happened quickly – just days or weeks after the patients began following them. The results persisted, but only if the adults continued to follow the diets. Once the patients stopped following the diets, the benefits also stopped, the researchers noted. None of the side effects of the diets were serious, and most often the patients experienced weight loss, not weight gain, the researchers said.

Friday, November 7, 2014

Almost 1 in 5 Americans Plagued by Constant Pain

The poll of roughly 35,000 American households reveals almost one-fifth of Americans experience daily crippling, chronic pain according to a new report published in the October issue of the Journal of Pain.

“I wasn’t particularly surprised by our findings,” said study author Jae Kennedy, a professor of health policy and administration at Washington State University in Spokane. “But I found it sobering that so many American adults are grappling with persistent pain.”

The study authors analyzed responses to a 2010 National Center for Health Statistics survey. Those who said they had experienced serious continual pain during the prior three months were the focus of the poll, rather than participants who said they had experienced short-term pain or pain that was intermittent or moderate in nature. Overall, 19 percent of the adults polled were deemed to have experienced “chronic” and severe daily pain.

That grouping did not, for the most part, include adults who said they struggled with arthritis or back and joint pain, as those people tended to say their pain was not constant and persistent, the study authors noted.

The chronic pain figure exceeded 18% among specific groups of respondents, including those between the ages of 60 and 60, women, those who said their health was fair or poor, those who were obese or overweight, and those who had been hospitalized in the prior year.

Kennedy suggested that for those experiencing chronic, crippling pain there are a variety of potential interventions including physical and occupational therapy, exercise, dietary changes, weight loss, massage and psychotherapy, alongside alternative interventions such as acupuncture, yoga and chiropractic services.
Medicines, including narcotic painkillers like hydrocodone, oxycodone and morphine, can also be helpful, but only if long-term use is avoided, Kennedy said.

“We are clearly overusing opioids [narcotics],” he noted. “The US consumes about 60% of the world’s opioid supply, and 99% of the hydrocodone supply. These medications are effective in the short term for managing postoperative pain, but long-term use often leads to dependency or addiction.”

Wednesday, November 5, 2014

Wisdom Wednesday: The Shoulder

Pain and limited motion in the shoulder is a very common musculoskeletal complaint. Its frequency is second only to low back pain. The onset is usually insidious but there is usually some history of a past injury. Most of us tear the rotator cuff of the shoulder at some point in our youth and most of us have forgotten the injury. As we age, this old injury often comes back to haunt us.

The rotator cuff is a group of muscles that support the shoulder and create movement. They are, in order of importance, the supraspinatous, infraspinatous, serratus anticus, teres minor, and subscapularis.

The shoulder is an unusual joint in that there are no ligaments to hold the humeral head to the glenoid fossa of the shoulder. So it is the rotator cuff muscles that hold the arm into the socket. To facilitate this process, the supraspinatous contracts constantly, even in your sleep. It is the only skeletal muscle in the body that does so. If the supraspinatous is weak, the arm actually dislocates from the shoulder. This commonly occurs during sleep and is often the cause of chronic shoulder pain. Strengthening the supraspinatous is the key to resolving most shoulder problems.

Constant contraction of the supraspinatous requires ongoing input from the nervous system, so weakness of the supraspinatous can be an indicator of brain imbalance. The supraspinatous is used in Applied Kinesiology (AK) to evaluate the limbic portion of the brain, specifically its relationship with the endocrine system.

In similar fashion, the teres minor is related to the thyroid gland. So weakness of the teres minor may indicate thyroid imbalance. Monitoring teres minor weakness is also used in AK to evaluate the endocrine system.

The shoulder is also a common site for referred pain. In cardiac insufficiency, pain is often referred from the heart to the left shoulder and down the left arm. Gallbladder inflammation will refer pain to the right shoulder in a similar fashion. When evaluating shoulder pain these referred pain pathways must always be considered, even when there is a strong history of injury.

Monday, November 3, 2014

Exercise as the Best Medicine

Sports cardiology researchers from Texas Presbyterian Hospital recently published their new study in the journal Circulation.

They wanted to demonstrate that cardiac adaptation to regular exercise is based on the training load, not just genetics. They enrolled 12 sedentary human volunteers in a 1-year training program. All participants underwent supervised training, frequent MRI scans, and even cardiac catheterization at the beginning and end of the study.

The endurance training began with exercising 30 to 45 minutes three to four times per week by brisk walking, jogging, swimming, or cycling. Then, after a couple of months of base training, exercise intensity and duration was gradually increased. After 9 months, a long run was added to a steady dose of interval training. At the end of the study, average exercise time per week was 7 to 9 hours.

The results were striking. The right and left ventricles of all participants underwent structural changes seen in elite-level athletes. RV mass and volume increased significantly and immediately. Months later, when more intense intervals were introduced, the researchers observed the same eccentric hypertrophy in the LV. VO2max surged by an average of 20%. Cardiac compliance, diastolic volume at a given pressure, increased significantly – but nowhere near as much as elite athletes.

At the end of the study, all the previously sedentary subjects completed their endurance goals: a marathon for 10 of them, an Olympic-distance triathlon for one and a cycling “century” (100 miles) for one.