Monday, February 27, 2017

Rude, Disrespectful Surgeons May Also Be More Error-Prone

Researchers compared surgical outcomes with patient reports of unprofessional behavior by their doctors at several health systems in the United States.

The investigators found that people treated by surgeons who had the most complaints had nearly 14% more complications in the month after surgery than patients treated by surgeons viewed as more respectful.

Complications included surgical-site infections, pneumonia, kidney conditions, stroke, heart problems, blood clots, sepsis and urinary tract infections, according to the study lead by Vanderbilt University Medical Center (VUMC) researchers.

Lead author Dr. William Cooper said surgeons who are rude and disrespectful to patients might also treat other medical professionals poorly, which could affect the quality of care. Cooper is a professor of pediatrics and director of the Vanderbilt Center for Patient and professional Advocacy.

“For example, if a nurse’s reminder to perform a safety procedure such as a surgical time-out is repeatedly ignored, the nurse may be less likely to continue to share his or her concerns with the surgeon,” Cooper noted.

Study co-author Dr. Gerald Hickson is senior vice president for quality, safety and risk prevention at VUMC. He said that “we need to reflect on the impact patients and families experience from there avoidable outcomes. From conservative economic estimates, the cost of addressing the excess surgical complications could amount to more than $3 billion annually.”

The findings also suggest that analyzing patient and family reports about unprofessional behavior could help spot surgeons with higher complication rates.

Hospitals could then take steps to improve the doctors’ behavior and, possibly, also patient care, the researchers said.

Friday, February 24, 2017

Possible Drawback to Gluten-Free: Toxic Metals

America’s love affair with gluten-free foods may come at a cost: greater intake of the toxic metals arsenic and mercury, a new study contends.

“These results indicate that there could be unintended consequences of eating a gluten-free diet,” said study author Maria Argos of the University of Illinois at Chicago(UIC).

Gluten-free products often contain rice flour as a substitute for wheat, rye and barley. And rice is known to accumulate arsenic and mercury from fertilizers, soil and water, said Argos, an assistant professor epidemiology in the School of Public Health.

For the study, the researchers analyzed the U.S. National Health and Nutrition Examination Survey data from thousands of Americans, aged 6 to 80. The investigators identified 73 people who said they ate a gluten-free diet.

Compared to other survey participants, those who ate gluten-free diets and nearly twice the levels of arsenic in their urine, and 70% higher levels of mercury in their blood, according to the study.

However, “more research is needed before we can determine whether this diet poses a significant health risk,” Argos said in a university news release.

Gluten-free diets are recommended for people with celiac disease – an out-of-control immune response to gluten, a protein in wheat, rye and barley.

Just 1% of Americans have been diagnosed with the disorder, but nearly one-quarter of Americans reported eating a gluten-free diet in 2015, the researchers noted.

Many consumers believe gluten-free eating reduces harmful inflammation, but there is no scientific evidence supporting that, the study authors said.

Wednesday, February 22, 2017

Wisdom Wednesday: When is a Diet Treatment?

This was the title of a recent interview by a couple of physicians published in the New England Medical Journal. The online version generally includes a video interview on timely topics in health care.

I thought about the question for a couple of days before I actually watched the video. Honestly, I had not come up with a good answer. Dietary recommendations are a mainstay of my practice. I frequently tell my patients that no amount of supplementation will replace a good diet. So I decided that diet is always treatment, and maybe the most important aspect of treatment. At least, in the long run.

Obviously, that is not the opinion of the physicians in the interview. They decided that a protein-sparring fast qualified as medical treatment. This short-term diet is rather radical by medical standards. But the results are pretty amazing.

The diet limits the patient to eating just fruits and vegetables with a 20 gram supplement of powdered protein daily. Typically, this diet is used to treat type II diabetics that are no longer responding to insulin.
They report that dramatically high glucose levels drop rapidly over the course of several days. The patients have to reduce or stop their insulin injections and often can return to metformin and/or glyburide to control blood glucose levels.

Their “medical treatment” is nothing more than a strict vegetarian diet (no refined carbohydrates) with a protein shake once a day.

Use of the protein-sparring fast is not widespread. Patients returning to their normal diets invariably end up back on insulin. But in the short term their diabetes is reversed and their medication is reduced.

What would happen if all type II diabetics were placed on a protein-sparring fast, then converted to the Mediterranean Diet or Paleo? What about the pre-diabetics that make up half of our U.S. population?

Monday, February 20, 2017

U.S Heart Failure Rates on the Rise

The number of American adults with heart failure – in which the heart is too weak to pump blood throughout the body – rose by 800,000 over five years, the American Heart Association (AHA) said in a new report released last week.

The same report also said that heart disease remains the leading cause of death in the United States, even as the death rate from heart disease is heading down.

The number of people with heart failure is expected to rise by 46% by 2030. That means 8 million people will have heart failure by then. Reasons for the rising number of Americans with heart failure include an aging population and a growing number of heart attack survivors, who are at increased risk for heart failure.

Cardiovascular disease includes all types of heart disease, high blood pressure and stroke, the heart association noted in an AHA news release.

Heart disease and stroke are the two top causes of death worldwide. In the United States, heart disease if first and stroke is fifth, according to the AHA’s 2017 Heart Disease and Stroke Statistics Update.

In the United States, more than one-third of adults (92) million) have cardiovascular disease. In 2014, nearly 808,000 Americans died from cardiovascular disease.

However, one bright spot in the update is that deaths from cardiovascular diseases fell more than 25% from 2004 to 2014.

Heart attacks strike about 790,000 people in the United States each year, and kill about 114,000. The update found similar numbers for stroke. In 2014, about 795,000 Americans had a new or repeat stroke, and 133,000 of them died.

Friday, February 17, 2017

The ABCs of Good Zzzzzs

A new report from the National Sleep Foundation lists these key indicators of healthy sleep habits: sleeping at least 85% of the total time spent in bed; falling asleep within 30 minutes or less; waking up no more than once a night and being awake for 20 minutes or less after initially falling asleep.

Foundation researchers said that 27% of people take longer than 30 minutes, on average, to fall asleep.
Corresponding author Dr. Maurice Ohayon said, “In the past, we defined sleep by its negative outcomes, including sleep dissatisfaction, which were useful for identifying underlying pathology. Clearly, this is not the whole story. With this initiative, we are now on a better course toward defining sleep health.”

Ohayon is director of the Stanford Sleep Epidemiology Research Center in Palo Alto, Calif.

My Take:
I like this approach – let’s define the parameters of health rather than just look for pathology. However, to say this report is oversimplified is an understatement.

Sleep occurs in a rhythmic pattern with four phases. When we first fall asleep (Phase 1) we begin to dream. You may experience some body movement during this phase as your brain stimulates various muscles in response to the dream scenario. This phase lasts just a few minutes followed by Phase 2. In Phase 2 we sleep a little deeper and continue to dream, again just for a few minutes. In Phase 3 dreaming stops and true restorative sleep begins. During the first sleep cycle of the night, this phase is also short and we quickly move into Phase 4. Like Phase 3, Phase 4 is deep, deep sleep and very restorative for the body. About 90 minutes into the first cycle, we move quickly back through Phases 3, then 2, then 1 and briefly awaken.

Wednesday, February 15, 2017

Wisdom Wednesday: Alternative Facts

Kelly Ann Conway may have coined the phrase, but “alternative facts” are nothing new to health care. Here are several that come to mind:

  • High cholesterol causes heart disease – More than half of all patients suffering their first heart attack have normal or even low cholesterol.
  • Stain drugs reduce the risk of heart attack by lowering cholesterol – No, however they due reduce the risk slightly by reducing vascular inflammation. Lowering cholesterol (and LDL) is a side effect of statin drugs.
  • Red Yeast Rice works as well as a statin drug – No, red yeast rice is an uncontrolled statin drug with potentially fatal side effects.
  • “Hysterectomy”, the removal of hysteria from a woman. You may laugh, but that was the original reason for the surgery and is still the accepted medical term.
  • Preventive health care – Really? Less than half of PCPs run the A1c to look for diabetes in their obese population over the age of 45. I routinely see lab work from other doctors showing moderate kidney failure, anemia, or hypothyroidism without comment. The average physician knows less about nutrition then their patients.
  • Managing polypharmacy – That’s a class for physician on how to manage a patient taking 5 or more prescription drugs daily. You cannot manage polypharmacy.
  • Junk DNA – Ninety-eight percent of our DNA has unknown functions, therefore it is “junk” DNA.
  • Vestigial organ – An organ in the human body that no longer serves a purpose, like the appendix. The thymus was considered vestigial at one point, but we now know it’s the hub of our immune system.
  • The yearly flu shot – Given for ever changing viral infections that mutate so quickly that the shot is obsolete before it is distributed.
  • Round-Up Ready seed – wheat seeds that have been genetically modified (by Monsanto) to survive direct application of the herbicide Round-Up. That way the herbicide can be sprayed directly on our food to kill the surrounding weeds. Which leads to the next one….
  • Biodegradable – A chemical compound (like Round-Up) that is supposedly safe because it supposedly breaks down into safe compounds. Although the WHO (World Health Organization) classifies Round-Up as a carcinogen.
  • The Food Pyramid – The official U.S. recommended diet consisting of a base of refined carbohydrates. A middle layer of dairy, meat and eggs, topped by a very small (think top of a pyramid) peak of fruits and vegetables.
  • Sleep Aid – a drug that forces you to sleep, but disrupts the normal rhythmic patterns of sleep taking away most of the benefits of sleep.
  • Efficacious Antidepressant – The best antidepressants work about in about one-third of patients. In order to be considered efficacious, a drug must work at least 50% of the time. The new twist, adding additional antidepressants when the first one (or two) fail to work.
  • Better Living Through Chemistry – the concept that we are somehow healthier by taking prescription drugs.
  • Longevity – Statistically we are living longer, but only because infant mortality has been markedly reduced in the past century skewing the statistics and because we can extend life without quality using drugs and machines.

The Bottom Line:
I bet you can add to this list.

Monday, February 13, 2017

‘Red Yeast Rice’ Statin Alternative Not Harmless Either

A natural cholesterol-lowering supplement called red yeast rice could pose the same health risks to users as statin drugs, a new study contends.

Red yeast rice could increase risk of muscle injury or liver damage, Italian researchers reported after reviewing 13 years of patient data.

“These findings raise the hypothesis that the safety profile of red yeast rice is highly similar to that of synthetic statins and warrants further investigations to finally characterize the safety profile of red yeast rice,” the researchers concluded.

American heart experts said it’s not surprising that the researchers discovered adverse reactions to red yeast rice that are similar to those produce by statins. That’s because one of the compounds in red yeast rice – monacolin K – has the same chemical structure as the statin drug lovastatin, said Dr. Paul Thompson.

“Statins actually exist in nature, in fungi and molds and stuff like that,” said Thompson, an American College of Cardiology fellow. “Patients need to know there is lovastatin in this product.”

Red yeast rice is concocted from yeast grown on rice. U.S. sales of red yeast rice dietary supplements totaled about $20 million a year in both 2008 and 2009, the most recent years for which data are available.

The FDA views red yeast rice products containing more than trace amounts of monacolin K as unapproved new drugs, since they are chemically identical to lovastatin, and cannot be sold legally as dietary supplements. But dozens of red yeast rice products remain on the market. And products tested as recently as 2011 have been found to contain monacolin K in substantial amounts.

Patients with high cholesterol often buy red yeast rice over the counter when they’re concerned about the side effects of prescription statins, said Dr. Robert Eckel, a spokesman for the American Heart Association.

Friday, February 10, 2017

Special Diet May Be Boon for Kid’s With Crohn’s Colitis

Children with Crohn’s disease and ulcerative colitis may be able to achieve relief without medications by eating a special diet, a small study suggests.

The diet includes non-processed foods, such as fruits, vegetables, meats and nuts. Over 12 weeks, the diet appeared to ease all signs of these inflammatory bowel diseases in eight of the 10 affected children, researchers report.

“The study shows that without other intervention, other changes, we can improve individuals’ clinical as well as laboratory markers,” said study author Dr. David Suskind. He’s a professor of pediatrics and director of clinical gastroenterology at Seattle Children’s Hospital.

Inflammatory bowel disease (IBD) affects about 1.6 million Americans, according to the Crohn’s and Colitis Foundation of America. Both Crohn’s and colitis are believed to be autoimmune illnesses. The two conditions share symptoms such as abdominal cramps, diarrhea, rectal bleeding and/or constipation.

Standard treatments for Crohn’s and ulcerative colitis may include steroids and other immune-suppressing drugs. Sometimes surgery is needed to remove damaged portions of the intestine.

The children in the study were between 10 and 17 years old. The diet removes grains, most dairy products, and processed foods and sugars, except for honey.

“One of the likely reasons why dietary therapy works is it shifts the microbiome from being pro-inflammatory to non-inflammatory,” Suskind said. “Another potential [reason] is there are a lot of additives in the foods we eat that can have an effect of the lining of the intestines. This diet takes out things deleterious to the mucus lining in the intestinal tract,” he said.

Wednesday, February 8, 2017

Wisdom Wednesday: Urine Hormone Testing

I have written several blogs about HRT (hormone replacement therapy) including bio-identical hormone therapy. Sometimes, HRT is prescribed based on the age of the patient and/or their symptoms. However, most of the time some sort of laboratory panel is run to evaluate hormone status prior to treatment. These tests are often repeated over time to measure the effect of the therapy.

Clinically, I use hormone testing to verify my QA (Quintessential Applications) findings and assess the patient response to nutritional therapy.

Some hormones can be tested from blood and many more from saliva. More recently, the dried urine test has become the most comprehensive, cost effective method for hormone analysis.

Serum testing from blood was the industry standard for many years and is still performed by many gynecologists. The drawbacks are cost, convenience (requires a blood draw) and limitations. In order to adequately test cortisol, you need to perform four blood draws over the course of 24 hours. Although you can measure the major sex hormones, you cannot measure the metabolites from phase 1 liver detoxification.

Salivary hormone testing is much more convenient. It can be done from the home and although the preparation is a little tedious (time restrictions on food, brushing the teeth, etc.), you can easily spit in a test tube four times over 24 hours to measure the daily fluctuations in cortisol. However, like blood, you cannot measure hormone metabolites and it is relatively expensive.

DUTCH (dried urine test for comprehensive hormones) has the convenience of salivary testing, it very cost effective, and is much more comprehensive than either blood or saliva.

Monday, February 6, 2017

Medical Groups Raise Blood Pressure Rx Threshold for Healthy Adults Over 60

Two leading medical organizations are recommending a less aggressive target for the treatment of high blood pressure in adults 60 and older who are otherwise healthy.

Traditionally, the threshold for high blood pressure has been set at 140 mmHg systolic blood pressure (the top number in a reading). But the new guideline says doctors should now begin treatment when adults 60 and older have persistent systolic blood pressure that’s at or above 150 mmHg, to reduce their risk of heart problems, stoke and death.

A less aggressive target like this offers a suitable balance of benefits and potential harms for these patients, according to the new guideline from the American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP).

Any additional benefit from more aggressive treatment is small, the group say. Doctors specializing in the cardiac care of older patients said the new guidelines may be warranted.

“Several recent studies have suggested that tighter control of blood pressure in healthy older adults may produce more harm than good,” resulting in events such as too-low blood pressure or fainting, said Dr. Gisele Wolf-Klein. She directs geriatric education at Northwell Health in Great Neck, N.Y.

Dr. Kevin Marzo is chief of cardiology at Winthrop University Hospital in Mineola, N.Y. He noted that “more than half of the population over the age of 60 have hypertension. When under-treated, the risk of serious cardiovascular problems such as stroke, heart attack and heart failure increases. A lower goal of under 140mmHg may be preferred for adults with known cardiovascular disease.”

Friday, February 3, 2017

Study Casts More Doubt on Value of Mammograms

Mammograms frequently detect small breast tumors that might never become life-threatening, causing women to receive treatment they likely don’t need, a new Danish study finds.

About one in every three women between the ages of 50 and 69 who was diagnosed with breast cancer wound up have a tumor that posed no immediate threat to her health, the researchers reported.

At the same time, mammography did not reduce the number of advanced breast cancers found in women in the study.

“This means that breast cancer screening is unlikely to improve breast cancer survival or reduce the use of invasive surgery,” said study author Dr. Karsten Juhl Jorgensen, deputy director of research for the Nordic Cochrane Center at the Rigshospitalet in Copenhagen. “It also means that breast screening leads to unnecessary detection and treatment of many breast cancers.”

Doctors refer to the detection of non-life-threating cancers as “overdiagnosis.” Women overdiagnosed with breast cancer are frightened needlessly and undergo potentially harmful, but ultimately useless, medical treatments like surgery, chemotherapy and radiation therapy, Jorgensen said.

These results call into question the value of regular mammograms, Jorgensen said. Current U.S. guidelines recommend mammograms every other year for women aged 50 or older, although some medical societies recommend annual screening.

“Breast screening has not lived up to its promises,” Jorgensen said. “All women must seriously consider whether participation in breast screening is right for them, after having sought balanced information about what it can and cannot do.”

But Dr. Otis Brawley, chief medical officer for the American Cancer Society, said the current regimen still saves lives, and women should continue to get mammograms while doctors hone genetic tests that will provide more accurate appraisal of each tumor.

For the study, Jorgensen and his colleagues used data from two comprehensive Danish cancer registries to check the effectiveness of breast cancer screening. They reviewed the medical records of all Danish women diagnosed with invasive breast cancer between 1980 and 2010.

The researchers concluded that between almost 15% to nearly 39% of breast cancers were overdiagnosed.

Wednesday, February 1, 2017

Wisdom Wednesday: Salt Therapy

The first modern references to salt therapy or halotherapy come from the mid-1800s when Felix Brochkovsky, a health official in Poland made the observation that salt mine workers rarely suffered from any colds, respiratory ailments or lung diseases. He attributed this to the salt aerosol being inhaled on a daily basis. People with asthma, allergies, emphysema and other respiratory problems began heading to the salt mines, and speleotherapy (salt cave therapy) was born.

However, people from all over the world have been traveling to the Dead Sea for the renowned health benefits of salt since the time of the ancient Egyptians.

Today salt spas are springing up all over the country. They utilize a halo generator that produces a dry salt aerosol of microscopic salt particles.

In addition to treating respiratory ailments, halotherapy is very effective for a variety of skin conditions including dermatitis, acne, eczema, and psoriasis.

My lungs are admittedly my weak point. I think it stems from working in a cold storage facility during Chiropractic College in Davenport, Iowa. I developed “walking pneumonia” (interstitial pneumonia) and suffered for several months. Only after a 10 day vacation on the beaches of sunny Florida did I slowly recover from the infection.

Since that time virtually any infection leaves me with a residual cough that typically lasts for months. In reality, I develop asthma secondary to the infection. Although I know a short course of steroids would probably break the cycle, to date, I have refused to take them.

After a recent infection and reappearance of the asthmatic cough, I decided to give the Salt Suite in Delray Beach a try.

The facility is very clean and the staff is friendly, informative and helpful. After checking in, you enter a lowly lit room in which the walls and floor are covered in salt. Several recliners are spaced around the room and each pod has an IPod Shuffle and headphones provided with Spa music and various meditations. The sessions begin on the half-hour and last for 45 minutes.