Low Carbohydrate Diets Finding Great Success

Spent part of the morning reviewing 20 years of journal articles on the "Science of Dietary Carbohydrates, Glucose and Insulin."  Fascinating reading. It is interesting that prior to the advent of insulin as a treatment for diabetes, the most common treatment from 1915-1920 used by William Osler for diabetes was significant carbohydrate restriction.

In 1999 a study was published in Pediatrics looking at twelve obese teenage boys.  They were randomly fed low glycemic equal calorie meals followed by high glycemic index meals or vise-versa.  The fascinating result was that when fed following a low glycemic meal, the boys at 81% more if the meal was high in glycemic index.  The fascinating factor is that their insulin levels were much higher which would correlate with notable weight gain and cholesterol rise based on other research.
Another study completed in 2005 helps to quash safety concerns about low carbohydrate diets and shows them to be just as effective in weight loss and more effective in lowering triglycerides, raising HDL in patients with type II diabetes then low fat diets.

My patient's in the office have had tremendous success with low carbohydrate dietary changes over the last 12 months. Every patient in my practice following a very low carbohydrate diet has drastically improved their cardiovascular risk, lipid profile, and significantly reduced their weight. In those patient with type II diabetes, they have additionally had significant improvement in their blood sugar control, average blood sugars (HbA1c) and there triglycerides (on of the lipid measures placing these patients at risk for heart disease). This correlates closely with recent studies reflecting similar results in the medical literature.  It is essential, however, to be monitored regularly on these types of diets, as rapid and significant metabolic changes can and do occur. Medications, blood pressure, and blood sugar control need to be closely monitored when following a low carbohydrate diet. Close follow up with your physician is highly recommended.

Removal of Your Parental Rights in United Nations Convention on Rights of Child

I am worried.  I am really worried.  I see children and their parents in my office every day.  A small bit of legislation is trying to be slipped past us as parents, physicians, and leaders.  If it works, it will supersede state law.  It sounds harmless and "fluffy" but it has the teeth of a shark.


Please read the twenty things listed below that this Convention on the Rights of the Child (CRC) will do if ratified. This is bigger than Obama Care. If this at all frightens you, then to go www.parentalrights.org, sign up and share this with everyone you know.

Why am I worried?  If this legislation is passed, it will remove a number of basic rights you and I have as parents and place them in the hands of world government.  I realize that you have heard all the conspiracy theories and I am not sharing the most recent.  Real legislation has been written and our progressive, soon to be lame duck, congress is attempting to place this on the table within the next month as their last heave-ho!  A number of countries have adopted the CRC and the State of Washington had a mirrored set of CRC laws on their books (trying them as an "experiment") until they were repealed due to the significant "hand tying of parents" that occurred. 


If this passes, it will remove the parental right to choose where the child is educated or participate in home school.  It will remove religious freedom.  It will remove the right of parents to enforce standards and discipline in the home.

Ten things you need to know about the structure of the CRC:

• It is a treaty which creates binding rules of law.  It is no mere statement of altruism.^1.
• Its effect would be binding on American families, courts, and policy-makers.^2.
• Children of other nations would not be impacted or helped in any direct way by our ratification.^3.
• The CRC would automatically override almost all American laws on children and families because of the U.S. Constitution’s Supremacy Clause in Article VI.^4.
• The CRC has some elements that are self-executing, while others would require implementing legislation.  Federal courts would have the power to determine which provisions were self-executing.^5.
• The courts would have the power to directly enforce the provisions that are self-executing.^6.
• Congress would have the power to directly legislate on all subjects necessary to comply with the treaty.  This would constitute the most massive shift of power from the states to the federal government in American history.^7.
• A committee of 18 experts from other nations, sitting in Geneva, has the authority to issue official interpretations of the treaty which are entitled to binding weight in American courts and legislatures.  This effectively transfers ultimate authority for all policies in this area to this foreign committee.^8.
• Under international law, the treaty overrides even our Constitution.^9.
• Reservations, declarations, or understandings intended to modify our duty to comply with this treaty will be void if they are determined to be inconsistent with the object and purpose of the treaty.^10.

Ten things you need to know about the substance of the CRC:

• Children would have the ability to choose their own religion while parents would only have the authority to give their children advice about religion.^13.
• The best interest of the child principle would give the government the ability to override every decision made by every parent if a government worker disagreed with the parent’s decision.^14.
• A child’s “right to be heard” would allow him (or her) to seek governmental review of every parental decision with which the child disagreed.^15.
• According to existing interpretation, it would be illegal for a nation to spend more on national defense than it does on children’s welfare.^16.
• Children would acquire a legally enforceable right to leisure.^17.
• Christian schools that refuse to teach "alternative worldviews" and teach that Christianity is the only true religion "fly in the face of article 29" of the treaty.^18.
• Allowing parents to opt their children out of sex education has been held to be out of compliance with the CRC.^19.
• Children would have the right to reproductive health information and services, including abortions,  without parental knowledge or consent.^20. 
• Parents would no longer be able to administer reasonable spankings to their children.^11.
• A murderer aged 17 years and 11 months and 29 days at the time of his crime could no longer be sentenced to life in prison.^12.

---

NOTES:

1. -Vienna Convention on the Law of Treaties, Article 26 “Pacta sunt servanda”:
   “Every treaty in force is binding upon the parties to it and must be performed by them in good faith.”
   
   United States Constitution, Article VI: “This Constitution, and the Laws of the United States which shall be made in pursuance thereof; and all Treaties made, or which shall be made, under the Authority of the United States, shall be the supreme Law of the Land; and the Judges in every State shall be bound thereby, any Thing in the Constitution or Laws of any State to the Contrary notwithstanding.”
   
   UNICEF  “Convention on the Rights of the Child” says: “the Convention is a universally agreed set of non-negotiable standards and obligations.” Available at http://www.unicef.org/crc/ on 12/2/2008.
   
2. -Vienna Convention Article 26 (supra);
   
   United States Supreme Court, Whitney v. Robertson, 124 U.S. 190 (1888): “By the Constitution of the United States, a treaty and a statute are placed on the same footing, and if the two are inconsistent, the one last in date will control, provided the stipulation of the treaty on the subject is self-executing.”
   
3. -Vienna Convention (supra) and Article 2 (g):  “‘party’ means a State which has consented to be bound by the treaty and for which the treaty is in force”
   
4. -United States Constitution, Article VI (supra, Note 1)
   
5. -Arlene Bowers Andrews, Implementing the U.N. Convention on the Rights of the Child, 171 (Greenwood Publishing Group 1999): “The Convention is generally regarded as having two classes of rights for the purposes of self-execution, one class that is self-executing and one that is not self-executing."
   
6. -United States Supreme Court, Medellin v. Texas, 552 U.S. ___ (2008), at 170 L.Ed. 2d 190, 219, “And  whether the treaties underlying a judgment are self-executing so that the judgment is directly enforceable as domestic law in our courts is, of course, a matter for this Court to decide.”
   
7. -Inter-Agency Standing Committee Reference Group on Humanitarian Action and Human Rights,Frequently Asked Questions on International Humanitarian, Human Rights, and Refugee Law, (2002), available at http://www.icva.ch/doc00001023.html#24:
   “Human rights law also contains provisions obliging states to implement its rules, whether immediately or progressively. States must adopt a variety of legislative, administrative, judicial and other measures that may be necessary to give effect to the rights provided for in the various treaties. This includes providing for a remedy before domestic courts for violations of specific rights and ensuring that the remedy is effective. The fact that a state has a federal or devolved system of government does not affect a state's obligation to implement human rights law.”
   
   United States Supreme Court, Reid v. Covert, 354 U.S. 1 (1957): “To the extent that the United States can validly make treaties, the people and the States have delegated their power to the National Government and the Tenth Amendment is no barrier.”
   
8. -United Nations Convention on the Rights of the Child, Articles 43 (amended) and 44. Available athttp://www2.ohchr.org/english/law/crc.htm#art43.
   
9. -Vienna Convention, Article 27: “ A party may not invoke the provisions of its internal law as justification for its failure to perform a treaty.”
   
10. -Vienna Convention, Article 19, available at available athttp://www.jus.uio.no/lm/un.law.of.treaties.convention.1969/19.html; also
    
    Louis Henkin, U.S. Ratification of Human Rights Conventions: The Ghost of Senator Bricker, The American Journal of International Law, Vol 89 No 2, 343-344 (Apr. 1995):
     “Reservations designed to reject any obligation to rise above existing law and practice are of dubious propriety: if states generally entered such reservations, the convention would be futile.  The object and purpose of the human rights conventions, it would seem, are to promote respect for human rights by having countries—mutually—assume legal obligations to respect and ensure recognized rights in accordance with international standards. Even friends of the United States have objected that its reservations are incompatible with that object and purpose and are therefore invalid.
    …By adhering to human rights conventions subject to these reservations, the United States, it is charged, is pretending to assume international obligations but in fact is undertaking nothing.”
    
11. -United Nations Convention on the Rights of the Child, Article 37(a):
    “No child shall be subjected to torture or other cruel, inhuman or degrading treatment or punishment. Neither capital punishment nor life imprisonment without possibility of release shall be imposed for offences committed by persons below eighteen years of age”
    
    United Nations Committee on the Rights of the Child, General Comment No. 8 (2006): The right of the child to protection from corporal punishment and other cruel or degrading forms of punishment (arts. 19; 28, para. 2; and 37, inter alia), CRC/C/GC/8, (2006):
    “The Committee is issuing this general comment to highlight the obligation of all State parties to move quickly to prohibit and eliminate all corporal punishment…. Addressing the widespread acceptance or tolerance of corporal punishment of children and eliminating it, in the family, schools and other settings, is … an obligation of State parties under the Convention.”
    
12. -United Nations Convention on the Rights of the Child, Article 37(a), (supra)
    
13. -The UN Convention on the Rights of the Child: A Guide for Children and Young People (April 2008), available at http://www.scotland.gov.uk/Publications/2008/04/01081649/1: “You have the right to choose your own religion and beliefs.  Your parents should help you think about this.”
    
    Geraldine Van Bueren, International Rights of the Child, Section B, University of London, 29-30 (2006):
    “Unlike earlier treaties, the Convention on the Rights of the Child does not include a provision providing for parents to have their children educated in conformity with their parents’ beliefs. In addition, the child’s right to freedom of expression and the right of the parents to initially give direction and later only guidance, strengthens the argument that children are entitled to participate in decisions so that their education conforms to their own convictions....  The second question is whether a child has the right to choose a religion.
    Under the Convention on the Rights of the Child, parents do have the right to provide direction to the child. Such parental power, however, is subject to two restraints:
    • First, such direction should take into account the evolving capacities of the child, as expressly required by the Convention.
    • Second, the direction should not be so unyielding that it equals coercion.
    It can also be argued that the right to freedom of religion in the Convention on the Rights of the Child ought to be read together with article 12 which gives the child the right to express his own views in the matter of choice of religion."
    
14. -United Nations Convention on the Rights of the Child, Article 3(1): “In all actions concerning children, whether undertaken by public or private social welfare institutions, courts of law, administrative authorities or legislative bodies, the best interests of the child shall be a primary consideration.”
    
    Geraldine Van Bueren, International Rights of the Child, Section D, University of London, 46 (2006):
    “Best interests provides decision and policy makers with the authority to substitute their own decisions for either the child's or the parents', providing it is based on considerations of the best interests of the child.  Thus, the Convention challenges the concept that family life is always in the best interests of children and that parents are always capable of deciding what is best for children.”
    
15. -United Nations Convention on the Rights of the Child, Article 12(1): “State parties shall assure to the child who is capable of forming his or her own views the right to express those views freely in all matters affecting the child, the views of the child being given due weight in accordance with the age and maturity of the child.”
    
    Inter-Agency Standing Committee Reference Group: “Human rights law also contains provisions obliging states to implement its rules, whether immediately or progressively. States must adopt a variety of legislative, administrative, judicial and other measures that may be necessary to give effect to the rights provided for in the various treaties. This includes providing for a remedy before domestic courts for violations of specific rights and ensuring that the remedy is effective.”
    
    Geraldine Van Bueren, International Rights of the Child, Section D, 137: “State parties are obliged to ‘assure’ to children who are capable of forming views the rights to express those views ‘in all matter affecting the child’ and to give those views’ due weight in accordance with the age and maturity of the child’.  By incorporating a reference to ‘all matters affecting the child’ there is no longer a traditional area of exclusive parental or family decision making.”
    
16. -ibid., at 36: “[T]he United Nations Committee on the Rights of the Child, criticized Egypt and Indonesia on the proportion of their budget spent on defence, as compared to the proportion spent on children’s social expenditure."
    
    The Committee also criticized Austria, Australia, Denmark, the United Kingdom, and others failing to spend enough tax dollars on social welfare for children:
    
    Paragraph 46, Concluding Observations of the Committee on the Rights of the Child: Austria, Committee on the Rights of the Child, 38th sess., U.N. Doc. CRC/C/15/Add.251 (2005).
    
    Paragraph 17 and 18, Concluding Observations of the Committee on the Rights of the Child: Australia, Committee on the Rights of the Child, 40th sess., U.N. Doc. CRC/C/15/Add.268 (2005).
    
    Paragraphs 18 and 19, Concluding Observations of the Committee on the Rights of the Child: Denmark, Committee on the Rights of the Child, 40th sess., U.N. Doc. CRC/C/DNK/CO/3 (2005).
    
    Paragraph 10, Concluding Observations of the Committee on the Rights of the Child: United Kingdom of Great Britain and Northern Ireland, Committee on the Rights of the Child, 31st sess., U.N. Doc. CRC/C/15/Add.188(2002).
    
17. -United Nations Convention on the Rights of the Child, Article 31(1): “States Parties recognize the right of the child to rest and leisure, to engage in play and recreational activities appropriate to the age of the child and to participate freely in cultural life and the arts.”
    
18. -American Bar Association, Center on Children and the Law: Children's Rights in America: UN Convention on the Rights of the Child Compared with United States Law, p. 182.
    
19. -Paragraph 52, Concluding Observations of the Committee on the Rights of the Child: Ireland, Committee on the Rights of the Child, 43rd sess., U.N. Doc. CRC/C/IRL/CO/2 (2006):
    “While noting that social, personal and health education is incorporated into the curricula of secondary schools, the Committee is concerned that adolescents have insufficient access to necessary information on reproductive health.  The education is optional and parents can exempt their children.”
    
    Paragraph 14, Concluding Observations of the Committee on the Rights of the Child: United Kingdom of Great Britain and Northern Ireland, Committee on the Rights of the Child, 8th sess., U.N. Doc. CRC/C/15/Add.34 (1995).
    
20. -Katie Hatziavramidis, Parental Involvement Laws for Abortion in the United States and the United Nations Conventions on the Rights of the Child: Can International Law Secure the Right to Choose for Minors?, 16 Tex. J. Women & L. 185, 202-203 (Spring 2007):
    “The unmistakable trend in the United States is to consistently increase anti-choice legislation, particularly with respect to minors. Ratification of the U.N. Convention on the Rights of the Child by the United States holds a strong possibility of assisting minors who seek abortions without parental interference.  [*203]  The Convention may offer the best hope for securing adolescent reproductive freedoms on a global level. If enough diplomatic pressure were exerted on the United States to compel it to ratify the treaty, the CRC could provide significant improvements in the outlook for reproductive freedom for minors.”
    
    Paragraph 3, Concluding Observations of the Committee on the Rights of the Child: Columbia, Committee on the Rights of the Child, 42nd sess., U.N. Doc. CRC/C/COL/CO/3 (2006): “The Committee notes with appreciation…decisions of the Constitutional Court on…the partial decriminalization of abortion.”
    
    Paragraph 55, Concluding Observations of the Committee on the Rights of the Child: Chile, Committee on the Rights of the Child, 44th sess., U.N. Doc. CRC/C/CHL/CO/3 (2007): “The Committee…is concerned over the high rate of teenage pregnancies, the criminalization of the termination of pregnancies in all circumstances….”

(Taken from Parental Rights.org)

Weight Loss Drug Sibutramine (Meridia) Pulled From the Market

A popular weight loss drug, Sibutramine (Meridia) was pulled from the market today by Abbot Labs after recommendation of the FDA.  It appears that post-marketing analysis showed increased risk in nonfatal myocardial infarctions (heart attacks) and nonfatal strokes.  The study, called the Sibutramine Cardiovascular Outcomes Trial (SCOUT), demonstrated a 16% increase in the risk for serious cardiovascular events such as nonfatal heart attack, nonfatal stroke, the need for resuscitation after the heart stopped, and death in a cohort of patients given sibutramine compared with another given a placebo. 

The FDA advised physicians to discontinue prescribing the medication due to the increased cardiovascular risk noted above.  Reassuring news is that there are no permanent side effects to the medication and the study reveals that the increased risk returns to normal once the medication is discontinued. This study and previous studies do no show any long-term consequences in patient's taking the medication. There is, also, no withdrawal effect noted with this medication.
This comes as a challenge as there are only a few medications on the market now that are helpful with weight reduction including phentermine, diethylpropion, and the over the counter Orlistat (found in over-the-counter Ali and prescription Xenical. Use of Orlistat has been liked to liver injury in a few patients and needs to be monitored if considering use of this medication.
In light of the findings surrounding sibutramine, the FDA also warned consumers against the use of Slimming Beauty Bitter Orange Slimming Capsules, sold over the Internet, because they contain sibutramine. Interestingly, sibutramine is not listed on the product label.

Doc, Why Do I Have Leg Pain?

(Great article taken from WebMD about frequent causes of leg pain.  I've re-posted it here for all to read.)

Lower Leg Pain: Causes and Treatments

If you're suffering from lower leg pain, you may wonder if it's serious or something you can treat at home. What follows is an overview of several causes and types of treatment for lower leg pain. Be sure to see your doctor if you have any question about your leg pain or if symptoms get worse.

Lower Leg Pain: Bones, Joints, and Muscles

Muscle cramps . This sudden, tight, intense lower leg pain is sometimes called a "charley horse." Often caused by muscle fatigue, heat, or dehydration, muscle cramps are more common among older people, endurance athletes, or athletes who are not well conditioned. In most cases, you can ease muscle cramps by stopping whatever triggered them. If needed, gently stretch or massage your lower leg muscle. Applying heat to tight muscles or cold to tender muscles may ease some symptoms. Proper conditioning and stretching can help prevent problems in the future.

Shin splints . This type of lower leg pain occurs when connective tissues and muscles along the edge of the shin bone become inflamed. This often occurs afterrunning or jumping, especially on hard surfaces. The repetitive force overloads muscles and tendons. Flat feet and too much outward rotation of the foot and leg can also contribute to this problem. Pain usually goes away with rest. It also helps to apply ice, take anti-inflammatories, and avoid anything that causes pain. Once pain lessens, stretch and strengthen your lower leg. To prevent future problems, wear supportive shoes and avoid running on hard surfaces.

Inflamed or torn tendons or muscles. One of the first signs of tendonitis (an inflamed tendon) is pain in the lower calf or back of the heel. Apply ice, take anti-inflammatories, and avoid anything that causes pain. Supportive shoes that lessen tension on tendons may also help. Just as with shin splints, wait until pain lessons to stretch and strengthen your leg. If pain is severe, the Achilles tendon may be ruptured. This can result from intense activity and not warming up well enough. See your doctor.

Broken bone or a sprained knee or ankle. A fracture (broken bone) or sprain (injury to ligaments from overstretching) can also cause leg pain. For mild sprains, try rest, ice, compression, and elevation (RICE). For a more severe sprain or fracture, apply ice and see your doctor right away. You may need a cast or brace. You may also need physical therapy to improve movement and speed recovery. Over time, gradually increase strength to support your weakened leg.

Lower Leg Pain: Veins and Arteries

These are some of the more common sources of lower leg pain caused by problems in blood vessels:

Blood clot. A blood clot that develops in a vein deep in the body is called deep vein thrombosis (DVT). Most deep vein blood clots develop in the lower leg or thigh. They are more likely to occur if you are inactive for long periods, smoke, or take medication that increases risk for clots. If you suspect a blood clot, go to your doctor or emergency room right away. Pieces of blood clots can travel to lungs and other organs. Medications and support stockings are two types of treatment.

Varicose veins. Weak valves and vein walls can cause twisted dark blue or purple veins near the surface of the skin (varicose veins). Varicose veins may cause a dull ache, especially after prolonged standing. Support stockings can be helpful. Throughout the day, alternate between standing and sitting. If your varicose veins are very painful, see your doctor about other types of treatment.

Infection. A skin or soft tissue infection can appear as red, tender, swollen, and warm. Warm soaks can help soothe discomfort. Your doctor may also recommend the use of antibiotics. If symptoms worsen or you develop a fever, call your doctor.

Lower extremity peripheral arterial disease. Just as with the heart, the lining of arteries in your legs may become damaged and hardened (atherosclerosis). Arteries narrow or become blocked, which decreases blood flow circulation. This can cause lower leg pain or cramping when walking, climbing stairs, or other kinds of exercise (called claudication) because muscles aren't getting an adequate blood supply. Resting may bring relief. If arteries become severely narrowed or blocked, pain may persist, even when you're at rest. Also, wounds may not heal well. If not treated, this disease can cause tissue to die (gangrene). People at high risk for PAD include: people with diabetes, high blood pressure, and/or high cholesterol and people who smoke.

Treatment includes lifestyle changes such as:

• Quitting smoking
• Reducing intake of foods high in cholesterol or saturated fats
• Managing weight
• Exercising, gradually increasing walking distance over time

Other treatment includes medications to control cholesterol, diabetes, and/or hypertension, to help with walking distance, and to help prevent blood clots. Surgery may be needed to improve blood flow to the area.

Lower Leg Pain: Nerves

These are some of the more common sources of lower leg pain brought on by problems in nerves:

Narrowed spinal canal (stenosis) and sciatica. A common cause of a narrowed spinal canal is arthritis of the spine.  Sometimes a herniated disc puts pressure on nearby nerve roots, which can lead to symptoms of sciatica such as:

• Burning, cramping leg pain when standing or sitting
• Numbness
• Tingling
• Fatigue
• Weakness

Pain may begin in your back and hip, then later extend down into your leg. Sciatica often doesn't get better with brief periods of rest. Treatment may involve resting for a few days, along with taking anti-inflammatories and pain medications, as needed. Cold and heat can help with some symptoms. Physical therapy and stretching exercises are often useful. Gradually increase movement over time. Your doctor may also recommend other therapies or surgery if pain is not resolved.

Diabetic neuropathy . With diabetes, nerves can be damaged from high blood sugar levels. This is a common complication of diabetes. It can cause pain in both legs along with numbness and less sensation in lower legs. Treatment includes controlling pain with oral medications and managing blood glucose levels.

If You Have Diabetes, Metabolic Syndrome, or Insulin Resistance Take Your Folic Acid

Recent study published in Obesity ((23 September 2010) | doi:10.1038/oby.2010.210) reveals exciting information about protecting the blood vessels of patients with diabetes, metabolic syndrome and insulin resistance.

It is a well known fact that excessive small blood vessel damage in these patients leads quickly to renal failure, macular degeneration (damage to the retina of the eye), and painful numbness and neuropathy in the hands and feet.  Patients with metabolic syndrome and diabetes have been shown to have increased levels of nitric oxide in their small blood vessels. This is thought to be one of the major causes of the damage that occurs in these patients. Much attention and monitoring is given to these patient in attempts to protect their blood vessels from ongoing damage.
Recent data showed that in just four weeks folic acid decreased the amount of nitric oxide present in the blood vessels of  patients with metabolic syndrome thereby implying significant vascular protection and health.  Further study is needed to determine the degree of protection folic acid renders in these patients, but until then, I'm taking my folic acid!!

Social Rejection Really Does "Brake" Your Heart

A fascinating study reported in the Journal of Psychological Science was completed in the Netherlands on social experiences and their effect on the heart. Participant's vital signs and heart rate were closely monitored throughout a period of socially emotional experiences. Participants were asked to look at a number of pictures of people they did not know and asked to predict whether or not the participant thought that each individual in the picture liked them or did not like them. The participants were then given feedback about whether the person they viewed accepted or rejected them. Heart rate and responses were closely monitored.
What is fascinating is that the participant's heart rate notably slowed when unexpected social rejection was observed, and significant delay in return to normal heart rate was also observed.
What does this all mean?

It means that experiences of social rejection have significant physical effects upon the heart and other vital organs of the body. There is a strong chemical signal from the brain on the parasympatheic nervous system slowing the heart rate when emotional rejection is experienced. The study noted that repeated episodes of rejection further lowered the rate and suppressed the time of recovery from that lowered rate even longer. This explains repeated rejection's physical symptoms and many of the physical symptoms that I often see in patient's suffering from emotional abuse. This explains the physical changes associated with depression and anxiety.
This may also be why hobbies or experiences that lend positive influence on our emotions lend to our overall physical health.

Waist Size in Childhood Predicts Risk for Adult Metabolic Syndrome

A recent study published in the Journal of Obesity begun in 1985 shows that your waist size as a child is a very strong and independent risk factor in your forming metabolic syndrome later in life.  Metabolic syndrome is a precursor stage to type II diabetes mellitus that puts you at significant risk for heart disease and stroke. The study was conducted in 2188 boys and these boys were followed and evaluated at age seven, fifteen, and twenty-seven years old (twenty years later).
Results show that as your waist circumference increases as a child, your risk for metabolic syndrome notably increases and is unrelated to waist changes between childhood and adulthood.  This means that emphasis on childhood weight is significant and must be a factor in evaluation of the child's overall health and risk for disease later in life.

Shadows of the Gallows

(Post taken in entirety from Musings of a Distractible Mind by Dr. Rob.  It was just too good not to, as this is exactly how I feel.  Thanks Dr. Rob for putting in prose my feelings for the last year. . . )

“It will never happen.”
“They know better than to do it.”
“They realize the disaster it would be if they let it pass.”
That’s what I hear.  I hear that the upcoming SGR adjustment, the one that will cut Medicare reimbursement by 23%, won’t go through.  In case you missed it, the SGR is a formula coming from the Balanced Budget Act of 1997 that does automatic cuts to Medicare reimbursement.  This year we witnessed a legislative game of chicken in congress, with both sides agreeing that it was a bad idea to screw physicians in a time that they are trying to fix healthcare.  Here’s what happened:

On March 3, 2010, Congress delayed the enforcement of the conversion factor until April 1, 2010.^[5][6] On April 15, 2010, Congress voted to again delay the implementation and extended the 2009 rate to June 1, 2010.^[7] On June 25, 2010, President Obama signed legislation that not only delayed implementation of the conversion factor until December 1, 2010 but also increased reimbursements by 2.2%.^[4] The 2.2% increase is retroactive to June 1, 2010, and will expire on November 30, 2010. Barring any further congressional legislation, this will result in a 23.5% decrease in Medicare reimbursements on December 1, 2010. (Wikipedia)

So we are t minus 65 days until we face another congressional battle.  The thing that makes it scary: November 2.  On November 2, our current congress changes its members, making the current congress lame-ducks.  Lame duck, impotent, worthless.  They are the ones who are supposed to fix this once and for all?  They are the ones who aren’t going to play political sabotage on the other side?
I was talking with some of my colleagues last week, and the “it won’t happen” line didn’t work.  They were all depressed, and all making plans to deal with a systemic melt-down.  They talked like men living in the shadow of the gallows.  Plan for the future?  The only way to do that is to stop accepting Medicare, which will be hard to do when 40% of the practice is Medicare patients.  There were a lot of downcast eyes, a lot of frustration.  There was not much comfort to give when the dark clouds are gathering.
Things are about to get worse.
Oh wait!  I forgot!  It will never happen.
Now I feel happy.

NSAID Use Increase Future Risk of Stroke and MI

Recent large retrospective study of 500,000 Danish healthy adults found in the Danish national medical registries reveals that use of Non-Steroidal Anti-Inflammatories, NSAIDs, (medications like ibuprofen, Naproxen sodium, and diclofenac) increase risk of future stroke.  Populations were controlled for age, gender, socioeconomic status, and patients with chronic disease were excluded.  The risk of stroke was found to be dose dependent with increased risk with increasing frequency of the use of NSAIDs.

Until further information is available about why this risk occurs in healthy patients, be cautious with the amount and frequency of NSAID use.

C-Reactive Protein Levels Decrease with Weight Loss

Weight loss lowers risk in many ways. Most specifically, there is evidence that it significantly decreases your risk for heart disease.  A recent study published in the Journal of Obesity showed that lowering BMI (Body Mass Index) also lowers your CRP (C-Reactive Protein).  This is significant in that elevated CRP is a risk factor for heart disease and and heart attack.
If you are struggling with weight loss, see your doctor or a bariatrician (a specialty trained physician in weight management) to help with decreasing your BMI and lowering your risk for heart disease. A great source for finding a physician trained in medical weight management in your area can be found here.

Medical Education in Chicago

I arrived last night in Chicago. Came for a medical conference. Chicago is interesting. It is the only place I have ever been that is cloud covered with 25 mile a hour winds and 85 degrees at 5pm.

The skyline, however, is beautiful and this was the scene from my cabin window as I flew in.

As we are flying over, however, the captain of the plane pulls out of the normal approach pattern and we circled over the city for about five minutes.  He then comes onto the intercom and calmly relates to us that the front landing gear has a problem, an error light has gone off and the crew is not sure if the gear has come down.  

We continued circling . . .

So after circling in a tight turn for another 2-3 minutes, the captain's voice is heard again over the intercom stating that the front landing gear has come down, there has been a visual that the front landing gear is in position and the gear hydraulic warning light turned off. So we all relax.  . .

We begin our approach. . .

"Ladies and gentlemen, the warning light has come back on."   Big sigh is heard throughout the cabin.

A few moments later, we are reassured that the gear has, again, been visually verified to be down, but all air traffic has been diverted to a holding pattern and all the fire crews have been called out.  

"Don't be alarmed when you see fire crews lining the runway for us" we are instructed. 

Images of a 767 "belly sliding" down the runway pass through my mind.  The lady sitting next to me says, "Oh, how nice."  I look out the window and realize that I am sitting next to the turbine.  Multiple scenarios pass through my mind.  A silent prayer is offered. 

I don't think I have ever experienced what felt like such a long runway approach.  It is amazing how you start to wonder how strong your seat belt actually is, how soft the seat back in front of you is if you whack your face on it, and how strong the bolts on your seat actually are if the plane were to slide along the ground.  First aid training, compression on arterial bleeding, acute chemical burn treatment and CPR training flashes through my mind.  

Touch down of the rear landing gear on the tarmac occurs smoothly, then touch down of the front landing gear occurs at the same time a large gasp echoes through the cabin.  No loud noises, no smoke, no crunching metal sounds occur.  I see over 40 fire trucks and ambulances lining the runway, with lights and sirens blaring. 

Applause arises from the cabin as the plane rolls smoothly to a stop at the end of the runway.

Our plane is slowly pulled into the gate with our fire escort. 

"Welcome to Chicago" announces the captain. 

We exit the plane and I walk through the huge O'Hare International Airport.  I am welcome at baggage claim with the following sign:

My hotel bed is very soft.  I slept quite nicely.

Disconnect Between Private Medical Practice & Medical Education

It fascinates me that there is such a disconnect between the economic view of those in private medical practice and those in Medical Education or University Based Practices.  Recently read an interesting post by Bryan Vartabedian, MD, at 33 charts discussing the future and inevitable changes in medical practice.
It is my opinion that medicine is changing and the practice of medicine will probably be unrecognizable in the next 10-20 years.
Yes, technology is making the evidence of practice guidelines better and more effective, but that is part of the way medicine is changing.
Daily, I am barraged with "practice protocols and guidelines" from every specialty group and every expert committee (a full ream of paper is mailed to me daily from all these expert groups).  Insurance companies then accept these guidelines as the "gospel truth" and if I'm not following them to the letter, my paycheck is reduced.  The "art of medicine" is disappearing with the overlay of the flowchart and practice protocol or practice guideline.  But to earn my living, I have to either demonstrate I followed the protocol, or write an additional paragraph as to why the protocol is not appropriate for that patient.  It is impossible to do that 35 times per day even with the most efficient electronic medical record available (I know 'cause I have one).
But the educational system still appears to be teaching the students that the current evolution is the "best."  The student cry "foul" and question the experience of those who have been in the trenches and claim that the error is on the part of private industry.  This progressive view of medicine is killing the "art."  And it is in the "art of medicine" where the caring and compassion is found.
Medicine as we know it will change into an efficient, cold, assembly line of diagnosis and treatment dispensing, unless we collectively change it.  The enjoyment of medicine is found in its art.  Once that is gone, you will loose the great physicians.  You will have an industry of cookbook, cookie cutter practitioners dispensing the latest medial equivalent of the GM Volt. The government is driving this.  In my practice, 50% of my patients care is driven by Medicare in some capacity.  When you put the government in control of medicine your going to get more bureaucracy and less art.
What is the answer?  Time.  Only time will tell. Until then, we practice medicine the best we can with the tools we have and apply the art of that practice to each individual.

Resistance Training More Effective in Shrinking Your Middle!

Resistance training with dietary changes were found to reduce abdominal adiposity (apple type weight gain) better that dietary changes alone in a recent study published in The International Journal of Obesity.

High Protein Diet More Satiating and Effective for Weight Loss and Appetite Control

Recent study of 27 overweight or obese men found that diets higher in protein were more satiating in than diets with normal protein content. This plays a very important role in controlling appetite and helping with weight loss. These findings were published in Obesity, September 16, 2010.

Rules of Medicine

1. The art of medicine consists of amusing the patient while nature takes its course.
2. It is impossible to make an asymptomatic patient feel better.
3. The urgency of the test is inversely proportional to the IQ of the insurance company pre-authorization clerk.
4. There is no cure for stupid.
5. Bad things really do happen to good people.
6. The better the surgeon, the more reluctant s/he is to operate.
7. It has to be fun.
8. If it isn't fun, see Rule 7.
9. Half of what is taught in medical school is wrong, but no one knows which half.
10. Poor planning on your part does not constitute an emergency on my part.
11. A bad idea held by many people for a long time is still a bad idea.

Quote of the Day

The whole aim of practical politics is to keep the populace alarmed (and hence clamorous to be led to safety) by menacing it with an endless series of hobgoblins, all of them imaginary.
H L Mencken

ObamaCare At It's Finest

Quote of the Day

"An idealist is one who, on noticing that a rose smells better than a cabbage, concludes that it will also make better soup."  H L Mencken

Michelle Obama Tells Doctors How to Practice

Mrs. Obama is now telling us that they (through the insurance plans) will mandate measurement of Body Mass Index (BMI) and that doctors should start writing more prescriptions for your obese children. When did Michelle Obama start practicing medicine?