Thursday, September 30, 2010

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.

Tuesday, September 28, 2010

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.

Monday, September 27, 2010

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.

Saturday, September 25, 2010

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.

Friday, September 24, 2010

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.

Monday, September 20, 2010

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.

Friday, September 17, 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

Saturday, September 11, 2010

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

Monday, September 6, 2010

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?