Thursday, March 31, 2011

Tim Hawkins Makes Me Laugh Until I Cry With A Bible Verse: Check it out!

I cannot believe he manages to make a psalm funny, but he does. 

Tim Hawkins: Things You Don't Say To Your Wife.

For those of you who have no current partner, listen up!  But for the rest of us, this is just too true!  You'd think we'd have a course or something.  Maybe a class in high school?  Maybe a master's degree in how to talk to your partner without dying?    

Wednesday, March 30, 2011

A Diet Book I Like: The New ME Diet.

The Tetas have hit upon the metabolic effect, which allows you do exercise more intensely for shorter periods.  This is the focus of the book.  Dietary advice is basically South Beach/Atkins, and the exercises are not strenuous enough to get the kind of metabolic enhancement you really want. 

To get a sense of the actual workouts, here's one of the authors doing the workout. 
For those of you looking at weight loss:  have a look at the weight charts.  It's disturbing to see those numbers and realize they added five pounds for clothing (they also took away an inch for shoes). 

Tuesday, March 29, 2011

Career Advice and Talk About Her Sex Life, Meet Penelope Trunk.

I am one of the few people I know who own both Tim Ferriss' book and Penelope Trunk's first book.  Penelope is a writer on careers who also adds in frank information on her sex life without batting an eyelid.  She has a new book out, self-published, hand numbered, and signed until the 29th of March. 

I found her information on self-publishing very interesting.  Since she has 50,000 subscribers, it makes sense that she should self-publish.  

By the way, Penelope's first book was all about careers.  Nothing about her sex life.  I have a feeling that's why it didn't sell as well as it should.  She also doesn't rely on any pity for her diagnosed Aspergers, which is both admirable and an interesting choice. 

Monday, March 28, 2011

Ernst Reporting On Colic Alternatives.

Since I can link to Amazon easily from Blogger, I thought I would provide a link to Ernst's book.  He's not an objective observer of alternative medicine, he's one of the outspoken skeptics.  So his reporting on studies involving alternative medicine should not be taken as definitive.  Here's my other report on colic, and my webpage showing his review, a previous review by the same journal, and the evidence in support of alternative medicine. 

Sunday, March 27, 2011

Hypertension: White Coat Syndrome Medline Studies.

I realized that many of my readers may not wish to search for the literature on the previous post.  Here are the relevant medical studies with the pertinent information bolded.  Please print out and take with you to start a discussion with your prescribing doctor if you are not currently basing treatment on home pressure readings. 

To your health!

Clin Exp Hypertens. 2009 Jun;31(4):306-15.

White coat effect and its clinical implications in the elderly.

Yavuz BB, Yavuz B, Tayfur O, Cankurtaran M, Halil M, Ulger Z, Aytemir K, Kabakci G, Oto A, Ariogul S.

Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Geriatric Medicine, Ankara, Turkey.

The aim of this study was to investigate the frequency and correlated factors of white coat effect (WCE) in the elderly. Geriatric patients who were known as normotensive and office BP exceeding 140/90 mmHg underwent 24-hour ambulatory blood pressure monitoring (ABPM). Correlation of WCE with clinical parameters, geriatric assessment scales, co-existing diseases, and laboratory results were analyzed. Within 61 patients 72.1% were diagnosed as white coat hypertension (WCH). Independent correlates of systolic WCE were activities of daily living, instrumental activities of daily living scores, creatinine; independent correlate of diastolic WCE was Geriatric Depression Scale score. White coat hypertension constitutes a major part of office-detected hypertension in geriatric patients. Ambulatory blood pressure monitoring should be performed on geriatric patients with office-measured hypertension in order to avoid overtreatment.

PMID: 19811359

Rev Port Cardiol. 1999 Oct;18(10):897-906.

[Arterial hypertension difficult to control in the elderly patient. The significance of the "white coat effect"]

[Article in Portuguese]

Amado P, Vasconcelos N, Santos I, Almeida L, Nazaré J, Carmona J.

Serviço de Cardiologia, Hospital Egas Moniz, Lisboa.

OBJECTIVE: Previous studies have revealed a high prevalence of white coat effect among treated hypertensive patients. The difference between clinic and ambulatory blood pressure seems to be more pronounced in older patients. This abnormal rise in blood pressure BP in treated hypertensive patients can lead to a misdiagnosis of refractory hypertension. Clinicians may increase the dosage of antihypertensive drugs or add further medication, increasing costs and producing harmful secondary effects. Our aim was to evaluate the discrepancy between clinic and ambulatory blood pressure in hypertensive patients on adequate antihypertensive treatment and to analyse the magnitude of the white coat effect and its relationship with age, gender, clinic blood pressure and cardiovascular or cerebrovascular events. POPULATION AND METHODS: We included 50 consecutive moderate/severe hypertensive patients, 58% female, mean age 68 +/- 10 years (48-88), clinic blood pressure (3 visits) > 160/90 mm Hg, on antihypertensive adequate treatment > 2 months with good compliance and without pseudohypertension. The patients were submitted to clinical evaluation (risk score), clinic blood pressure and heart rate, electrocardiogram and ambulatory blood pressure monitoring (Spacelabs 90,207). Systolic and diastolic 24 hour, daytime, night-time blood pressure and heart rate were recorded. We considered elderly patients above 60 years of age (80%). We defined white coat effect as the difference between systolic clinic blood pressure and daytime systolic blood pressure BP > 20 mm Hg or the difference between diastolic clinic blood pressure and daytime diastolic blood pressure > 10 mm Hg and severe white coat effect as systolic clinic blood pressure--daytime systolic blood pressure > 40 mm Hg or diastolic clinic blood pressure--daytime diastolic blood pressure > 20 mm Hg. The patients were asked to take blood pressure measurements out of hospital (at home or by a nurse). The majority of them performed an echocardiogram examination. RESULTS: Clinic blood pressure was significantly different from daytime ambulatory blood pressure (189 +/- 19/96 +/- 13 vs 139 +/- 18/78 +/- 10 mm Hg, p < 0.005). The magnitude of white coat effect was 50 +/- 17 (8-84) mm Hg for systolic blood pressure and 18 +/- 11 (-9 +/- 41) mm Hg for diastolic blood pressure. A marked white coat effect (> 40 mm Hg) was observed in 78% of our hypertensive patients. In elderly people (> 60 years), this difference was greater (50 +/- 15 vs 45 +/- 21 mm Hg) though not significantly. We did not find significant differences between sexes (males 54 +/- 16 mm Hg vs 48 +/- 17 mm Hg). In 66% of these patients, ambulatory blood pressure monitoring showed daytime blood pressure values < 140/90 mm Hg, therefore refractory hypertension was excluded. In 8 patients (18%) there was a previous history of ischemic cardiovascular or cerebrovascular disease and all of them had a marked difference between systolic clinic and daytime blood pressure (> 40 mm Hg). Blood pressure measurements performed out of hospital did not help clinicians to identify this phenomena as only 16% were similar (+/- 5 mm Hg) to ambulatory daytime values. CONCLUSIONS: Some hypertensive patients, on adequate antihypertensive treatment, have a significant difference between clinic blood pressure and ambulatory blood pressure measurements. This difference (White Coat Effect) is greater in elderly patients and in men (NS). Although clinic blood pressure values were significantly increased, the majority of these patients have controlled blood pressure on ambulatory monitoring. In this population, ambulatory blood pressure monitoring was of great value to identify a misdiagnosis of refractory hypertension, which could lead to improper decisions in the therapeutic management of elderly patients (increasing treatment) and compromise cerebrovascular or coronary circulation.

PMID: 10590654

Hypertension: Only Home Readings Count! Do Not Start Meds Based on Office Readings.

One of the most determined focuses in medicine today is the need to control blood pressure.  If I preface my taking of the readings with a short discussion of stroke risk, I can be sure to provide my patient with transient hypertension.  Once one elevated pressure is recorded, the patient is likely to experience anxiety about future readings and I am likely to be able to "confirm" the patient has hypertension in the office. 

Internationally this situation is recognized as "white coat syndrome."  Andrew Weil has a nice piece on the current state of the literature:  At this point if you are not doing home blood pressure readings, then you aren't getting the care you need.  I say this because I have patients who's home blood pressure is dropping too low, and others whose blood pressure is controlled only sometimes. 

The aggressive treatment of hypertension is focused on preventing stroke, but we haven't been terribly effective.  I suspect part of the cause is that we aren't effectively controlling blood pressure for many individuals.  Home readings done over weeks often spike when home stresses increase despite all the medications.  The body accommodates to the medication, and overrides it. 

The underlying cause is the stress of life, and we need to focus more on helping individuals deal with those stresses.  Once the stress is past, we need to help patients "re-set" to lower blood pressure.

For the studies on hypertension, have a look at the literature at:

Saturday, March 26, 2011

Osteoporosis: Beyond The Drugs, What Can We Do to Retain Bones?

We need to move beyond the calcium supplementation to addressing the core issues of osteoporosis.  It should be possible to alter the bone loss without resorting to lifelong estrogen replacement.  Some day we will treat this illness with comprehensive lifestyle changes, supplements, drugs, and hormonal balancing.

I've put some ideas about conservative treatments at:

If patients were only encouraged to take specific exercise programs (extension, not contraction) we'd see less fracturing. 

Friday, March 25, 2011

Radiation Fallout In the U.S.

Chernobyl 20 Years on: Health Effects of the Chernobyl Accident
Here's the short answer: do whatever you are going to do for the long term.  We're still seeing issues around Chernobyl twenty five years later.  Don't think that stockpiling a few bottles of potassium iodide is going to take you through the radiation issues.  Focus your attention on improving your overall health and antioxidant (fruits and vegetables) intake.  I've got all the information on

Thursday, March 17, 2011

Depression: Hold On, Spring Is Coming.

I've been seeing a number of fatigued patients this week, who are close to giving into depression as they see no change happening in their crises.  Hold on, we'll get there.  Spring is coming and with it change on all levels.  Here's my information on depression and new youtube video. 

Saturday, March 12, 2011

Michael Hawkins' Spiritual Conversion: What Does It Teach Us?

I was looking for another Hawkins, Tim Hawkins who makes me laugh, when I came across Michael Hawkins’ blog and autobiography.  It doesn’t really matter if you agree with anything he says, what matters is:  How can I get all my patients this high on life?  Really.  Something like 70% of Americans are depressed.  That means basically our way of life is rotten.  We take a huge number of mind altering substances, legal and illegal, to get this high.  I think we need a bumper sticker that says:  Say no to drugs, say yes to kundalini!

Earthquake in Japan: Aftermath There, Effects in U.S. children?

I know that that earthquake in Japan will not affect the U.S. physically, the tsunami wave having already passed relatively harmlessly.  But I wonder if we will see individuals here suffering from PTSD, just as individuals there certainly will be.  Watching something like this over and over is how I'm still dealing with individuals who are still actively traumatized by 9/11.   One of our congresspeople is having hearing right now, partially in response to his inability to cope with that event. 

Having our children watch and rewatch the horrific footage is a poor way to help them cope.  I found a study on children recovering from China's 2008 earthquake.  Those in the 4-5 grades were more susceptible to PTSD long term.  So let's all turn off our televisions and sent help via the Red Cross.

I wonder if there is a Therapists Without Borders that could go and help out about six months months from now when the physical devastation has been dealt with but the children are still in shock.   

PLoS One. 2011 Feb 23;6(2):e14706.

Mental Health Problems among Children One-Year after Sichuan Earthquake in China: A Follow-up Study.

Liu M, Wang L, Shi Z, Zhang Z, Zhang K, Shen J.

Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.


BACKGROUND: On May 12, 2008, a destructive earthquake registering 8.0 on the Richter scale struck Sichuan Province, southwest China. Beichuan County was the epicenter which was one of the areas nearly completely destroyed by the earthquake. In Beichuan, about 15000 people died and 3000 people were missing. Specially, the earthquake took 1587 students' and 214 teachers' lives from the elementary and middle schools there. The main purpose of the study was to provide a better understanding of mental health problems and associated risk factors among children after earthquake.

METHOD: Three hundred and thirty grades 3-5 children completed the questionnaire of disaster -related experience and the Trauma Symptom Checklist for Children-Alternate Version (TSCC-A). The first survey was carried out six months after the earthquake, and the second one was carried out six months later. The measurements and methodology applied in the two sessions were identical.
RESULTS: The prevalence rates of the problems at two time-points were 23.3% and 22.7% for anxiety, 14.5% and 16.1% for depression, and 11.2% and 13.4% for PTSD, respectively. Among demographic variables, no significant age difference existed, while it was found that 6 months after the earthquake, symptoms of anxiety, depression and PTSD were significantly more common among students in grades 4 and 5 than those in grade 3, Initial exposure to death, bereavement and extreme fear were significant predictive factors for the occurrence of anxiety, depression and PTSD.

CONCLUSIONS: Findings of this study suggest that posttraumatic mental health problems after natural disaster in children may have reached epidemic proportions and remain high for a long period. Psychologist and social workers should pay more attention to children who experienced more traumatic stresses and provide appropriate mental health interventions. Implications and limitations of these findings were discussed.

PMID: 21373188

Wednesday, March 9, 2011

Nutrition By Natalie: Education Made Easy

Natalie initially seemed like one of those nice young people who want to be helpful.  Then I realized she was a nice, young registered dietitian.  She manages to make watching nutritional information mildly interesting.  I think it's the giant food she flashes up behind her.  As far as I can tell (I haven't watched all her videos) her information is reasonably accurate.   

Monday, March 7, 2011

Homeopathy: Science or Myth?

I was very excited to find this fine book by a Stanford Physician trained by five Nobel Laureates.  And I found it on Google books! Or you could get it via Amazon.  It's a fascinating story of a physician who put homeopathy to the test, not simply in a study, but in the emergency wards while he was a staff physician.  His stories are extraordinary, and his science is impeccable. 

Wednesday, March 2, 2011

Rachel Naomi Remen: My Kind of Doctor.

I love the idea of a doctor spending time with patients, and talking about their stories.  It's perhaps a nostalgic vision of a time like Little House on the Prairie, but I wish for it nonetheless.