Speech . . .

There are many things I believe . . . that I shall never say; however, I shall never say the things that I do not believe.

What Do You Want To Do . . . ?

You can master anything you love doing  . . .

Camouflage . . .

The plumbing under my sink exploded just before we had some company coming over.  I raced over to the Home Depot and found the parts and found myself under my sink. Memories of my father fixing my mother's sink crossed my mind as I removed the old corroded seals and replaced the piping.
This was not something I wanted to do in front of my visitors, however, we could not finish cooking dinner.  You never realize how much the kitchen sink is used until the pipes explode.
Anyway, the pipes are flowing again, my wife is happy, and dinner went well.  No Plumber's Camouflage was needed.

Arizona Entitlements...To Expand or Not to Expand?

I had the wonderful pleasure of visiting the Arizona State Capital yesterday and meeting with a number of our state senators and representatives.  The big "hula-ballou" was that Governor Jan Brewer was also holding a press conference about her proposal for Medicaid, Arizona Health Care Cost Containment System (AHCCCS), expansion for our state. This has had a significant amount of media coverage, as Gov. Brewer a fiscal conservative, has decided to expand Arizona's entitlements by leveraging federal funds. Her press conference was held on the same morning the Arizona Osteopathic Medical Association (AOMA) was meeting with our state legislative representatives.  I was interviewed by News Channel 3's Dennis Welch, but only three seconds of my three minute interview was aired and it was taken completely out of context.
Here is what I tried to explain and my position on the issue. At first appearance, it seems that Gov. Brewer sprouted "progressive" tendencies and has given in to the Affordable Care Act ("ObamaCare") to which she has been historically and strongly opposed.  However, this is a very sticky problem, and it is important to understand the back ground on this issue to understand why this proposal has arisen.
It started in1982 when Arizona voted to enter the Medicaid program.  Arizona was the last state in the union to enter into Medicaid.  This brought on a number of budgetary challenges, and to solve this problem, the state "privatized" Medicaid, allowing a number of insurance companies to compete for and oversee the distribution of the care and funding in 1987 called the Arizona Health Care Cost Containment System (AHCCCS) and lovingly termed "access."  This allowed for tighter control and efficient use of the Medicaid funds.

Bigger challenges arose with the voter passage of Proposition 204 in 1995 and then re-voted upon in 2000, amending the Arizona constitution to mandate state health coverage of those residents up to 100% of the federal poverty level.  This means that no matter what, Arizona is constitutionally required to pay for and participate in Medicaid.  Part of the health care dollars have been paid for by an Arizona Sales Tax which was set to expire on December 31, 2013.  The renew of the sales tax was voted down at the end of 2012 and these funds will no longer be available.
Currently, the federal government matches Arizona's contribution to Medicaid at a 2:1 ratio. Because of budgetary AHCCCS enrollment freezes, childless adults that will not be covered, mandated changes to the plan required by the ACA, and the loss of revenue from the sales tax, AHCCCS will cost Arizona an additional $450 million dollars per year that will be required to come from the State's general fund.  This makes it impossible to balance the state's budget in 2014.
Because Medicaid coverage at a minimum of 100% of the federal poverty level is required by the state constitution, Governor Brewer is stuck with a difficult problem.  Services have already been notably reduced and reimbursement to providers has already been cut by 10% over the last few years.  Further cuts would cause providers and hospitals to drop the program like a rock.
The proposal, therefore, is to accept the Federal 9:1 match of funds by expanding Medicaid to 133% of the federal poverty level. This would actually allow coverage of an additional 60,000 Arizonians and would save the state $325 million dollars per year.
From the perspective of Health Care Policy, it is important to look at any policy in regards to cost, quality and access.  Governor Brewers proposal will allow her to balance the budget much easier, however, this proposal will not improved quality and only partially improves access.  The liberal side of the community is excited about the expansion of entitlements; however, the strong conservative side of the community is concerned that we are adding to the federal debt to balance the state's budget and strapping our children with today's burdens.  Because of increased access to services (modest as they may be), most physician and health care organizations have thrown their support behind Governor Brewer.
Will federal income tax increase in the future because of this?  Will the federal government actually have the funds to move the ACA forward? If the federal government fails with it's commitment, will that leave Arizona in a financial bind?  Does this affect our states sovereignty? These are questions that have not been answered.
I agree that something must be done, but is there another way to balance Arizona's budget without increasing  our state's dependence upon federal funds?

Just Return To The Basics

My son I recently completed our open water SCUBA dive training.  We signed up and took the course through a wonderful near-by diving shop with some trustworthy diving instructors, George & Pete, and a group of master divers that we quickly came to admire. I have always want to SCUBA dive, however, living in landlocked Arizona makes this hard, and when the opportunity presented itself for my son and I to get trained, we jumped at the chance.

It was a wonderful experience. I came away with a sense of awe and the realization that there is an entirely new world below the surface yet unseen by most.  My son and I made a pact to begin discovering this new world. I look forward to some time with my son in this adventure.

I learned something else. Just like most things in life, safe SCUBA diving requires that you master and frequently return to the basics.  We spend about 30-45 minutes in the water with each dive and most of the time was spent reviewing and refreshing simple techniques of breathing, regulator recovery, mask clearing, following the buddy system, preparing for emergencies.

On our last dive, we descended to 45 feet and demonstrated that if we lost our mask, or our air regulator, we could recover or assist our buddy in these emergencies. You don't realize how easy panic can set in when you loose your air supply 45 feet under water. 

While demonstrating that I could safely remove my regulator by dropping it to my side,  I had to lean over and reach behind myself to find it.  It the process, my mask filled with water and I ended up getting water up my nose.  This caused me to cough and empty my lungs.  I was still searching for my regulator during this experience and panic set in.  My first instinct was to dart to the surface, however, I recognized this is a bad idea as we were below 33 feet and I was now at 2 atmospheres of pressure. A shot to the surface could easily rupture a lung or cause decompression sickness.  I've treated those problems in other patients before, and it isn't pretty. 

So, with a little concentration, back to the basics.  I located my regulator, cleared it with the purge button, took a deeply desired breath, and cleared my nose.  I then followed the techniques I was taught to clear my masks and within a few seconds, life was good again.  I gave my instructor the "OK" sign and we moved on to our last few skills checks.  

This little experience drove home the message about how important it is to just return to the basics. Life is like that.  Weather in SCUBA diving, medicine, relationships, marriage, weight loss, driving, sports or any other life experiences, when all goes south, just fall back on the basics and get yourself grounded.

Action . . . The Measuring Stick

I came across an interesting quotation by Francis Bacon.  In thinking about the message here, I thought of myself, as well as those that currently lead our state and our country.  It is advise that acts as a good measuring stick.

"He that gives good advice builds with one hand; 

he that gives good counsel and example builds with both; 

but he that gives good admonition and bad example 

builds with one hand and pulls down with the other."

Either way, anyone named after one of the most delicious breakfast foods on the planet, should be paid some attention.

Thanks, Francis!

Had Enough Yet?!

Just so you know, I Second the First!

We The People . . .

I seem to recall that the Declaration of Independence starts with the phrase "We the people . . ." not "We the elites . . .," "We your leaders...," or "We your congress..."  The Declaration of Independence asserts, as a matter of Natural Law, the ability of a people to assume and maintain political independence and that the grounds for such independence must be reasonable and therefore explicable. 
We the people came together and established a body of government to protect OUR God given rights of Life, Liberty and the Pursuit of Happiness by the consent of the governed.  I don't recall consenting to have the freedoms and rights to protect my family, home and community removed.  The arrogance of superiority of many of our leaders demonstrates that they do not understand or account for the principle that we have granted them power, we pay daily to protect them, and our politicians are only as powerful as we the people allow them to be . . .


May each of us have the courage to stand for and defend the life and liberty for which our fathers spilled their innocent blood.

How Does Stress Cause Weight Gain?

Had you been under a great deal of stress lately?  Have U. been struggling with her finances?  Job?  Relationships?  School?

Many of my patients working on their weight management have found that there weight increases or plateaus due to stress.  Patient's frequently ask how this occurs.  A simple answer is this: our bodies are designed with a "fight or flight" response.  If you're in the woods and you stumble across a bear, you will immediately experience a rush of adrenaline which includes cortisol, hormone that stimulates increased glycogen in your bloodstream from the liver.  Glycogen is a form of sugar, and the glycogen response raises her insulin level.  The adrenalin and cortisol, among other hormones, are released so that blood can be shunted from your stomach and intestines to your muscles and brain to more effectively enable you to either fight the bear, or run from the bear.

Most of us will never "stumble across a bear," however, your boss may drop an extra pile of work on your desk, you may run short on your finances this month, you may have a serious disagreement with your significant other, or someone may cut you off in traffic causing a near accident.  Any or all of these stimulate the identical "fight or flight" response. Whether the bear or traffic, the same adrenalin and cortisol response occurs.
The elevated cortisol causes a cascade effect raising your insulin levels.  Insulin will remain effectively elevated in the blood stream for 4-12 hours.  Insulin is the primary hormone driving and stimulating weight gain.  If you've had 2 or 3 stressful events throughout the day, and you have not had the opportunity to burn off these stress response hormones, your body will store and/or continue to gain weight throughout the entire day.
How do you prevent this from happening?  A simple 15-20 minute walk is enough to decrease the stress hormone surge that occurs from a "fight or flight" response.  Any regular exercise program will decrease these stress hormones.  Adequate sleep also decreases these hormones.
So, if your job is stressful, incorporating an exercise program as simple as a daily walk for 15-20 minutes will  notably improve your waistline.

Common Sense Is Not Common . . .

I have come to the conclusion that common sense is no longer common.  

Why should we need to legislate food or soda size?  What good does legislating one less round in a magazine do other than cost us each individually on April 15th?

I am of the opinion that if you teach a man sound principles he will govern himself.  If we teach people that it is the carbohydrate intake in each meal that causes our weight and diabetes problems, those people will govern themselves.  This is what I see in my medical practice daily.  When a person understands why the body actually gains or looses weight, that person will naturally govern their actions.

Legislating one less round in a magazine is like taking a spark plug out of a corvette because people die in auto accidents. 

Restricting soda size will never effectively shrink our waist size.

Give a man a fish and he will eat today, teach a man to fish and he will eat for the rest of his life. 

Immune System Passport to the Body

Researchers at the University of Pennsylvania have figured out how to create a "passport" for the human immune system.  They identified and have created a series of proteins called CD47 that act as a passport when the body's immune system attacks.

Macrophages, the body's big immune cell "eaters," literally eat foreign objects and then dissolve them.  If a cell or a nanno-particle contains the CD47 protein particle, the macrophage recognizes it as friendly and doesn't eat it.

This is really amazing medical science at it's best. This is the kind of thing that gives doctors a "warm fuzzy" thinking about the potential uses.

You can read more about this remarkable discovery here.

Wise Thoughts . . .

Johann Wolfgang von Goethe once said that all truly wise thoughts have already been thought thousands of times; but to make them ours we must honestly ponder them and apply them till they take root in our personal experiences.
My first question is who thought them? Second, how do we honestly ponder a wise thought?
King Solomon implied that the Lord gives wisdom (1) and the mouth of the just brings forth wisdom (2). Wisdom and knowledge will bring stability in times of turmoil (3).
Let no day, therefore, pass you by without some intellectual gain . . . Let the hope of new discovery, as well as the satisfaction and pleasure of known truths, animate your daily industry.

The Dalai Lama, when asked what surprised him most about humanity answered, "Man. He sacrifices his health to make money. Then he sacrifices money to recuperate his health. Then he is so very anxious about the future that he does not enjoy the present; the result being that he neither lives in the present nor the future. He lives as if he is never going to die, then dies having never really lived."
The wise thought then comes as inspiration and will be applied bringing value. The application of these thoughts brings you and I the greatest happiness.

1. Proverbs 2:6
2. Proverbs 10:31
3. Isaiah 33:6

Phoenix Blizzard . . .

Green Eggs & Ham . . . I like them, Sam I Am!

You know, Dr. Seuss was right, the whole egg is actually good for you.
A recent study from the University of Connecticut demonstrated that eating the whole egg actually decreases LDL (the bad cholesterol) sub-particles and insulin resistance in Metabolic Syndrome better than the egg white or the egg substitute. 

I like green eggs and ham!
I do!! I like them, Sam-I-am!
And I would eat them in a boat!
And I would eat them with a goat...
And I will eat them in the rain.
And in the dark. And on a train.
And in a car. And in a tree.
They are so good so good you see!

Buy A Double Barrel Shotgun . . . ?

I just listened to our esteemed Vice President, Joe Biden, advise a woman to buy a double barrel shot gun if she wants to protect herself, and if she feels threatened, to take that shotgun outside and fire off two rounds. "You don’t need an AR-15. It’s harder to aim. It’s harder to use, and in fact, you don’t need 30 rounds to protect yourself. Buy a shotgun, buy a shotgun, " he said (1).  

I was shocked. 
But, what more should I expect to hear from a Vice President that apparently knows nothing about owning or using a gun. 

As a physician, who is also a certified rifle instructor, this is the last piece of advise I would expect to hear from our national leadership. 

The first rule of gun ownership is that you never fire the gun unless you intend to destroy or kill your target.  Encouraging someone to walk outside and "fire off two shots" as a warning is the most irresponsible comment I have ever heard from this man. 

Second, if the intruder continues to enters your home, which he probably will, you have now emptied your shotgun and it will take you at least 15-20 seconds to reload if you're not nervous.  

Third, firing your gun outside into the air within the city or town limits is illegal in most parts of the country and you will be charged and fined for that action alone. 

Most women I know prefer shooting an AR-15 to a shotgun, as most of them can't stabilize the shot gun when it is fired due to the large amount of recoil. It is apparent that Mr. Biden has never witnessed his wife or any other woman shoot either of them.

Why is he saying this?  It is the step-wise process of this administration trying to remove our second amendment rights. 

If you walk into or near the den of a bear to check out the den or to pet the cuddly little bear cub you find there, the nearby mother bear will attack and probably kill you. Everyone knows that this is not the bear's fault, it is your own carelessness or stupidity that is at fault. 

We accept this action as Natural Law, defined as "law or a specific principle held to be derived from nature and binding upon human society in the absence of or in addition to positive law" (2). Every animal in the world has an innate, instinctive, God given right to protect it's home and children. Every animal species will, at the risk of its own life, defend its home and children to the death.  

This administration, and many members of congress, are trying to legislate away Natural Law.  This comment from our Vice President is another demonstration of the State assuming that they are greater than Natural Law.  From the perspective of science, Natural Law applies to all species within the Animal Kingdom and you, I and all human beings (homosapiens) are part of the Animal Kingdom. 

If you or I walk into the bear den, it will rip you from limb to limb protecting its home and children. No one will fault the bear, because each of us knows that each animal has the right to defend its home and family.  The right to bear arms and the right to use those arms in defense of your home and children are not just constitutional.  Those rights were given by God or Nature's God, and cannot be taken away, they are instinctive. You try to tell a mother to do something against her instinctive values and see what happens. She has the right to protect her home, family and possessions in any way she needs.  If that means she feels the need to do that with a 30 round magazine, the State has no authority to remove that right. Hell hath no wrath like a woman scorned.  
Socialism is not my religion, government is not my church, and Barack Obama is not my god.

I recommend that if you feel the need to protect your home with a gun, then you should. However, you absolutely need to be trained to use it and store it properly and safely. 

Mr. Biden, I think you need to educate yourself and rethink your position. 

Fat Thoughts on Cholesterol . . .

As a medical bariatrician and family practitioner specializing in low-carbohydrate diets, I often see the panic stricken look on people's faces when they look at their cholesterol profiles just after starting a carbohydrate restriction life-style.  

First, it is very important to understand that if you check your cholesterol within the first 4-6 weeks of dietary changes, there will be a transient rise in the cholesterol profile as your adipose tissues (fat cells) release your new fuel source into the blood stream and the mitochondria in the one trillion cells in your body convert from the use of glucose to the use of ketones (derived from triglycerides) as the primary fuel source.  This is not a problem as the body is designed to handle this increase in triglyceride and cholesterol. I explain to patient's that we are essentially making the figurative change from "un-leaded fuel to diesel fuel."

Second, the standard cholesterol profile does not give you a true picture of what is occurring at a cellular level.  The standard cholesterol panel checks Total cholesterol (all the forms of cholesterol), HDL (the good stuff), LDL-C (the bad stuff) and triglycerides.  It is important to recognize that the "-C" stands for a calculation usually completed by the lab. 
Total cholesterol, HDL and triglycerides are usually measured and LDL-C is measured using the Friedewald equation [LDL = total cholesterol – HDL – (triglycerides/5)].
Third, it is also important to realize that HDL and LDL are actually transport molecules (the buses for the triglycerides (the passengers). HDL is taking triglycerides to the fat cells and LDL is taking triglycerides from the fat cells to the muscles and other organs for use as fuel. 
When you being a low carbohydrate diet, your blood glucose availability as the primary fuel source drops and triglycerides become the primary source.  It takes your body 4-6 weeks to increase the number of mitochondria necessary to effectively use triglycerides as the primary fuel.  (This is why many athletes and patients who are active will feel slightly sluggish during their exercise for the first few weeks). 
Once your body accommodation to the new fuel, there will be a notable drop in LDL-C and a rise in the HDL.
But this still doesn't answer the question and relieve the panic seen above. A deep sigh and the look of relief occurs when I explain that LDL-C doesn't give us the real story. 
To make it simple and understandable, LDL is made up of three main sub-types  big fluffy ones, medium sized ones, and small dense ones. It's the small dense ones that contain lipoprotien A [Lp(a)] found in increased vascular risk. Recent studies reveal that heart disease and atherosclerosis is caused by the small dense LDL molecules. 
A low carbohydrate diet causes the small dense cholesterol to drop and there is a rise in the two other sub-types   This shift in sub-types can actually elevate the Total Cholesterol number and occasionally the LDL-C. 
If you are following a low carbohydrate diet, get your cholesterol levels checked.  It is more ideal to get an NMR Lipoprofile or VAP Cholesterol test that will give you an LDL particle number and this can be explained more fully by your doctor. 
Now, off to the fridge . . . where did I put that package of bacon . . . ?

Hope . . .

Over the last year, I have found myself worrying about the tumult of wars and rumors of wars, the decay of morality, the changing of our nation and the onslaught of challenges that beset our youth and the rising generation. A very good friend of mine pointed out the declaration of F. M. Bareham in 1909. It stands true today:
"A century ago men were following with bated breath the march of Napoleon and waiting with feverish impatience for news of the wars. And all the while in their homes babies were being born. But who could think about babies? Everybody was thinking about battles. In one year between Trafalgar and Waterloo there stole into the world a host of heroes: Gladstone was born in Liverpool; Tennyson at the Somersby Rectory, and Oliver Wendell Holmes in Massachusetts. Abraham Lincoln was born in Kentucky, and music was enriched by the advent of Felix Mendelssohn in Hamburg. But nobody thought of babies, everybody was thinking of battles. Yet which of the battles of 1809 mattered more than the babies of 1809? We fancy God can manage his world only with great battalions, when all the time he is doing it with beautiful babies. When a wrong wants righting, or a truth wants preaching, or a continent wants discovering, God sends a baby into the world to do it."

Bacon is the Answer . . .

Needle-less Vaccines on the Horizon

Scientists at King’s have demonstrated
the ability to deliver a dried live
vaccine to the skin without
a traditional needle
(credit: King’s College London)

Researchers at King's College in London have demonstrated the ability to deliver dried live vaccine without a traditional needle.  The vaccine is delivered via a silicone mold with micro-needles made of sugar. They have also demonstrated which cells the body uses to trigger the immune response in the skin.  See the fascinating article here.