Medical Blog Posts

Holiday Buffet

turkey-570935_640In honor of our upcoming Thanksgiving holiday, this blog is a buffet of topics I’ve collected over the past few months.

And as we close this rancorous election season, let’s peacefully reach across the table and settle the debate of what pie to serve: the piecaken will satisfy members of every culinary denomination. Enjoy your meal!

 

Operations Improvement?

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A few months ago I stumbled across a website for a virtual physician assistant called Bright.md. Built around a structured questionnaire, this medical application allows a clinician to remotely collect routine aspects of the patient history. Bright.md figures that it’s time-saving tool can increase physician efficiency up to tenfold — meaning you could cut the typical 20 minute visit to 2 minutes.

And you thought a 15 minute appointment was short.

I can see the value of a product like Bright.md from the physician perspective, but I see little benefit for the consumer. After all, patients complain that their doctors spend too much time with them about as often as my daughters ask to turn off their iPads and go to bed.

There’s an overflow of fat to be skimmed from our health care system, no question. I’m just not sure Bright.md should be part of the cleanup crew.

Eat your Vegetables

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More support for lifestyle modifications that prevent cardiovascular disease appeared in this week’s New England Journal of Medicine. Building on two decades of research showing that healthy habits — defined as not smoking, avoiding obesity, regular physical activity and a diet rich in fruits and vegetables — prevent heart disease, investigators combined four studies totaling over 55,000 patients at highest risk for coronary events.

Their findings were unequivocal: adhering to just three of the four healthy lifestyle habits reduced the risk of heart disease by almost 50%, compared to individuals who maintained an unhealthy lifestyle (no or only one good habit).

To put this in context, cholesterol “statin” medications (think lipitor, crestor, zocor and the like) reduce risk by only 25%. There’s no question that it’s easier to take a pill than follow a healthy lifestyle. But the benefits of the latter extend well beyond reducing the risk of heart disease. Exercise alone, for example, improves your sex life, sleep, mood, and cognition.

Please the Knees

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Finland brought us Angry Birds, an amazingly functional and honest government, and more saunas per capita than you dreamed possible. Add to that list of gifts a growing body of evidence promoting conservative treatment of symptomatic degenerative knee cartilage tears.

Most knee cartilage tears are degenerative — in other words, not associated with a specific injury. For decades, symptomatic tears were treated with arthroscopic meniscectomy (surgical trimming of the torn cartilage), with all the attendant costs ($4 billion annually in U.S. alone) and risks associated with surgery.

In 2013, some U.S. researchers proposed that perhaps we were overtreating these joints. In a landmark study, they documented no difference between conservative (physical therapy) or invasive (arthroscopy plus physical therapy) approaches.

The Finns built on this research with another study in 2013 showing no difference between sham procedure (incisions without surgery) and traditional arthroscopy. Why the sham surgery? So patients did not know whether they were actually operated on or not.

Now they complete the hat trick with a paper involving patients with knee cartilage tears accompanied by locking or catching. Such symptoms have always been considered the gold standard for selection to surgery — the locking/catching is due to the tear, right? But here again, the Finns prove the fallibility of intuition. Patients were no worse off with sham surgery than actual removal of the torn cartilage.

Now it’s Personal

koli-bacteria-123081_640While you are digesting your Thanksgiving feast, remember to acknowledge the bacteria that are helping with the process. Trouble is, that thank-you list just got a lot longer.

Researchers at Aix Marseille Université in France have developed a new way of identifying bacteria via “a culturing approach that uses multiple culture conditions and matrix-assisted laser desorption/ionization–time of flight and 16S rRNA for identification.” Luckily some consumer-minded folks in the group rethought that description and decided “microbial culturomics” was more digestible for the layperson.

Regardless, this method allowed the French scientists to look inside the gut and identify over 1,000 different bacteria. The really impressive accomplishment: 531 of these bacteria have never before been identified in the human intestinal tract. Furthermore, 187 of these bacteria were newly-isolated in humans, and 197 strains are potentially new species. Of course, now they have to figure out what all those bugs are actually doing down there.

As we grow our knowledge of how our bacteria help (and harm) us, we’ll be in a much better position to address the wide range of diseases that we believe are influenced by those microbes, like diabetes, obesity, asthma and allergies.

Now that’s worth giving thanks for. Happy Thanksgiving!

 

 

Another Sleepless Night

Sleeping

As a mother of two young children, the quest for a good night’s sleep at times seems elusive.

Thankfully, for the majority of my life I’ve had little difficulty getting a good night’s rest. Aside from occasional times when I was worried about an exam, I would easily drift off once my head hit the pillow.

That carefree nocturnal landscape has been transformed into countless nights nursing, rocking and soothing my sons back to sleep. With mounting evidence on the detriments of not getting enough sleep and my desire to return to sleeping eight hours per night, I decided to review tips for healthy sleep to aid myself and my patients in getting those much needed “ZZZs.”

First off, I decided to take stock and see how my sleep hygiene compared to the recommendations. I scored pretty well:

  • going to bed and waking up at a similar time everyday
  • limiting caffeine to a morning cup of coffee
  • dimming the lights in the evening
  • exercising early in the day
  • using my bed solely for sleep

Areas with room for improvement:

  • avoiding late night meals
  • disconnecting from TV/computers/phones earlier in the evening
  • getting rid of my alarm clock

But I love my alarm clock! Unfortunately, clock watching can worsen insomnia, so a better way to wake up might be a dawn simulator. These clever devices have improved sleep in patients with depression and seasonal affective disorder, and benefits may extend to the general public as well. Or try the new alarm clocks that wake you up with scents of coffee or other delectables. Croissant, anyone? If you must stick with your old ticker, turn the clock away from you, or stick it in a drawer while you sleep.

Before reaching for over-the-counter or prescription sleep medications, let’s explore some other tricks that can help you drift off to dreamland. Set your thermostat to 65 F. Cooler temperatures help the body’s core temperature drop, which is needed to initiate sleep. Next, set aside 30 minutes before bed each night to engage in a relaxing activity. Read a book, drink tea, journal, take a bath, or do some gentle, restorative yoga poses. I like to do a simple meditation called the 4-7-8 breath. Learn how to do it here!

If you still are struggling with insomnia, discuss treatment options with your doctor and rule out underlying health conditions that could be contributing to your poor sleep. Hypnotic sleep medications like Ambien, Lunesta or Sonata were initially designed for short-term (7 – 14 days) use. They can be helpful when traveling, during a period of high stress, or to help break a bout of insomnia. Avoid nightly use as they can negatively affect your body’s ability to process new memories, trigger unusual sleep behaviors, and increase the risk of cancer and death.

Common adverse effects include fatigue, dizziness, headaches, nightmares, nausea, and impaired performance on tasks the morning after use. Over-the-counter sleep aids, which generally contain diphenhydramine (the active ingredient in Benadryl) don’t fare much better. Sedatives, such as benzodiazepines, should be avoided due to the risk of dependence.

Melatonin can help improve the time to onset of sleep by ~12 minutes, but the safety of long-term use is not known. If you have been using sleep medications for an extended period of time and wish to stop, or if you prefer to treat your insomnia without medications, try cognitive behavioral therapy for insomnia (CBT-I).

CBT-I examines how your beliefs, behaviors, and other external factors negatively impact the quality of your sleep. CBT-I has been well studied and is shown to be the most effective first-line treatment for chronic insomnia. CBT-I does require more work initially versus taking a sleep medication, but the benefit is long-term and completely without adverse side effects. Additionally, CBT-I has been shown to help treat associated conditions, including depression, PTSD, pain and fibromyalgia. You can work one-on-one with a sleep specialist who is trained in CBT-I or do an online course.

So if you are struggling with falling asleep or staying asleep, first optimize your sleep hygiene. If that still doesn’t get you sleeping soundly, rather than reaching for an easy, short-term fix, invest in doing CBT-I. Your mind and body will thank you.

We’re Not Always Right

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photo credit: NASA

I heard an uplifting story the other day on the radio. It was an interview with the current head of NASA, Charles Bolden, who shared his experience as a youth trying to gain entrance to the Naval Academy. Mr. Bolden dreamed of becoming an astronaut, which for a black man growing up in South Carolina in the 1960s was a lofty goal indeed.

Luckily, as part of the Great Society programs, President Lyndon Johnson had dispatched a retired federal judge around the nation, looking for “nontraditional” entrants to the military academies. Mr. Bolden was saved by a nomination from a congressman from Illinois, after the entire South Carolina delegation declined to consider his application.

But then a strange thing happened. For the next several decades, at every milestone in Bolden’s career — as he progressed through his schooling, pilot training, military service and eventual acceptance into the astronaut program — a letter of congratulations would arrive. The personal note was always hand-signed by Senator Strom Thurmond, the same man who had previously turned down his request for recommendation to the Naval Academy.

The interviewer pressed Bolden for an explanation. Why would Strom Thurmond — a historical supporter of segregation — take such an interest in a black man whose career he had personally tried to derail?

Bolden struggled for an answer. He never inquired as to why the Senator wrote him, nor did they ever have direct contact beyond those occasional, one-sided exchanges. But he thinks the reason lay in some change of the Senator’s moral compass, something that, sadly, he could not admit publicly.

Like the Grinch who had a change of heart, Senator Thurmond might have realized he was wrong. It’s a theory that has been debated for years — and one both Bolden and others have put forward.

In medicine, we’ve taken a long time to embrace the idea that the doctor is not always right. There was a time when questioning a senior physician or specialist consultant was considered insubordination, and risked retribution.

But once a more forgiving philosophy of care takes root, everyone on the healthcare team (including the patient) is empowered to identify — and rectify — potential errors. After all, most complex systems like health care delivery produce complex failures, where multiple people had the opportunity to correct the course but failed.

Our motto: Trust your doctors, but don’t be afraid to question them.

Knowing your fallibility, and being able to appreciate and admit when you have made a mistake, is an attribute that is harder and harder to find in America. Certainly a great deal of this behavior flows from the top leadership of our country. When was the last time you heard an elected official admit an error? When was the last time you heard it from a leader of industry?

I think the administrative folks in Flint, Michigan, have gotten close to an apology, but what got them there in the first place is more alarming than their lack of remorse. Those same state and local officials were so convinced that others had it wrong that they completely dismissed — in fact, aggressively tried to discredit — the clinician and scientists who were sounding alarm bells.

It’s hard to always be right. The amount of energy that is required to constantly defend your position in the face of competing facts or interpretations is enormous. That energy and effort could be much better directed toward understanding the position of your opponent — and in the process, enlightening your own arguments.

Out of an understanding of our own fallibility comes the ability to compromise, and we’ve clearly lost that skill, too.

I’m sorry. I was wrong. Let’s see if we can find some middle ground. We’ll be better parents, spouses, friends and citizens if we have the courage to share these thoughts with those around us. If you left these words off your Valentine’s Day card, it’s never too late to add an epilogue. And you don’t even have to buy another box of chocolates.

Year in Review

calendarIt’s time once again for Baskin Clinic’s annual Medical Year in Review, where we bring you developments in medicine and science that have either escaped the popular press, or deserve deeper scrutiny than most sound-bite shows offer.

You’ll notice a number of topics involve research that reexamines widely-accepted practices or beliefs.

At Baskin Clinic we welcome questions (both from our patients and our colleagues) that challenge the status quo. This constant re-evaluation of what we do, and why we do it, is a big part of our core principles: “Participate, Communicate, Educate.” Read on….

1. No more fasting for cholesterol tests. This longstanding practice was debunked in several excellent studies over the past three years, but only recently gained popularity in the clinic. Even the federal government — not known for its culture of change — has adopted the guideline of not requiring patients to fast. The end result is far more efficient (and just as accurate!). Now patients can combine their lab draw and physical exam at any time of day, without going hours without food.

2. Calcium and vitamin D have no value in the prevention or treatment of osteoporosis. This one was difficult even for us to absorb, especially since it goes against the guidance of several advisory groups.

First, some definitions. Osteoporosis is the medical term for fragile bones caused by structural thinning. Osteoporosis contributes to fractures, which are a major cause of death and disability in older patients.

That supplemental calcium and vitamin D could help reinforce weak bones seems highly plausible, and goes something like this. Bones are made of calcium compounds. Vitamin D helps the body absorb calcium. Taking supplemental amounts of these raw materials should help grow more bone, right?

But sometimes even perfectly reasonable theories turn out to be wrong, as was discovered with the failure of the homocysteine trials at the turn of the millennium. The few studies that have examined supplemental calcium and vitamin D have shown no reduction in fracture risk. And just because recommendations come from an official source, doesn’t always mean they have been well-researched.

Bottom line: supplementing your diet with additional calcium and vitamin D is probably doing little more than enriching the vitamin industry (and raising your risk for kidney stones and heart disease).

3. We disagree with the growing criticism of the annual physical exam. Even The New York Times joined the chorus, publishing an opinion piece by the former White House Special Advisor for Health Policy Ezekiel Emanuel. Dr. Emanuel writes that he’s skipping his annual physical, but will continue to get his evidence-based treatments like annual flu shots and periodic colonoscopy.

That’s easy for him to say, because as a medical professional, Dr. Emanuel knows which treatments are recommended at what ages — something the general public is not always aware of. (Do most lay people know that there now are two recommended vaccines for pneumonia?)

Emanuel argues that the annual exam encourages needless testing on asymptomatic persons — and is therefore a worthless exercise. We’ll concede this point. As a result, you won’t find any routine EKGs or stress tests at a Baskin Clinic annual exam. What you will find (and what Dr. Emanuel overlooks) is the real value of the annual visit: a thorough review of your health goals and health status (including a full review of systems, immunizations, blood pressure and weight).

4. Speaking of blood pressure, what is the ideal goal for patients? The SPRINT trial, a study of over 9,000 middle-aged patients with one or more risk factors for cardiovascular disease, has touched off a lively debate in the medical community about how low is too low in blood pressure control.

True, participants in the experimental arm (BP 120/80 or less) had fewer cardiovascular events — mainly in the categories of heart attack and heart failure — but had higher rates of serious adverse events (faints, low blood pressure, electrolyte abnormalities, or falls). In fact, only 45 people would have to be treated to a lower blood pressure to cause one serious adverse event.

Our take: for the right patient, it’s a reasonable approach, but with caveats. Additionally, there are contradictory data in the ACCORD trial, which studied similar blood pressure goals in diabetics (and found no benefit). Tough to reconcile all this in a tweet, but that didn’t stop thousands from trying. Thanks #SPRINT!

5. In addition to the existing pneumovax, or PPSV-23, there’s a new pneumonia shot recommended for those over age 65. Called the PCV-13, it protects against an additional (you guessed it) 13 strains of pneumonia-causing bacteria. It’s recommended to receive the PCV-13 first, followed eight months later by the PPSV-23. Already had the PPSV-23? Just wait a year before getting the PCV-13. Confused? Scroll down to the graphic at the bottom of this link.

6. Those intestinal bacteria continue to amaze. The gut microbiome is now implicated in the efficacy of certain cancer treatments utilizing the body’s own immune cells (so-called immunotherapy). In two separate papers published just last month in Science magazine, gut bacteria played essential roles in whether or not these treatments were successful. The next logical question: could probiotics someday become a routine therapy for cancer?

7. And we’d be remiss if we did not mention the most pressing health event for the future: global warming. While the topic has received plenty of press since the Paris Climate Change Accord was signed, we’re still amazed that critical issues like groundwater depletion and shrinking snowfalls are receiving only scant coverage. Let’s face it: many organisms can live without oxygen; none can live without water. We’re going to have to get a lot more creative with how we use the fresh water we have left.

8. Lest we leave you feeling depressed, here’s one to rejoice: we may be witnessing a new generation of healthier Americans. The latest tables from the aptly titled Health, United States, 2014 (just published in May, 2015) show that for U.S. children ages 2-5, obesity rates dropped from 12.5% to 10.2% of children measured. Nice work America!

Have a healthy and happy New Year from your friends at Baskin Clinic. Please let us know if we can be doing anything differently for you in 2016.

Scales Tipping Towards Body Composition Over Weight as a Measure of Health

Who doesn’t own a scale, or have access to one? While weight is a useful measure of overall health, it reveals nothing of our body composition. The most common body composition estimate is the body mass index, or BMI. However, BMI is simply a function of height and weight, ignoring body type (broad shoulders, for example, get missed because BMI doesn’t incorporate width or depth of the patient). As a result, the BMI misclassifies as either normal, overweight or obese some 25% of men and 48% of women, according to a recent study published in the journal PLoS One.

Tools for reliably measuring body composition are now more accurate and available than ever. For example, multi-frequency bioelectrical impedance analysis provides users with accurate measures of body fat mass, fat free mass, and total body water. Baskin Clinic now offers this analysis for patients, using the InBody 230 machine. Knowing your percentages in all these categories can provide a clearer picture of health and obesity-related risk factors than the BMI alone.

A study from Mayo Clinic found that more than half of people classified as ‘normal weight’ using BMI had excessive body fat, coining the new term normal weight obesity to describe the group.

Regardless of body type, excessive body fat has been shown to signal health risks, such as: cardiovascular risk factors, high cholesterol, pre-diabetes, and type 2 diabetes. Since BMI is such a rough estimate, body composition testing is more appropriate for assessing personal health.

Body composition testing is also a great tool to use for monitoring progress towards health goals, such as weight loss. Ever been frustrated by the bathroom scale, while your clothes seem to fit better and better? Losing weight “the healthy way” means not just cutting weight indiscriminately, but working to sustain lean tissues while dropping fat mass. Body composition testing supplies information on how your body is changing beneath the surface, and that can make a big difference in motivation when the number on the scale gets stuck.

InBody230 with Model

InBody230 with Model

The InBody 230 machine reliably estimates body composition using multi-frequency bioelectrical impedance analysis. For the engineers in our readership, here’s how it works: two frequencies of low-current electricity pass through the body between eight points of contact. The machine measures the speed at which the electricity moves from point-to-point. Water is a much better conductor of electricity than fat, and so the resulting measures can be used to calculate a very good estimate of body fat mass and fat free mass. We can even see a breakdown in distribution among various segments of the body.

Take our holiday challenge: test your body composition before and after all those events to see if you’ve held your ground! The test only takes about 30 seconds to complete. There are some simple preparations you must follow on the day of testing to ensure accurate results. For more information, contact shane@baskinclinic.com.

Mindfulness

ladybugPause for a moment. Sit up straight, put down your smartphone, close your eyes and take a few deep, cleansing breaths. Take an inventory of your muscles – is there tightness in your calves, tension in your neck, or pain in your feet? Do you sense a lot of mental chatter? Perhaps you are, like us, overrun with reminders, messages, judgments, or commentary.

Observing the flow of thoughts that pop up and go down, sometimes slowly and other times rapidly, can be eye-opening. It’s all part of the very normal activity of the brain doing what it’s designed to do – think.

But getting caught in a pattern of worry, future-thinking, regret, or rumination can trigger a physical response that is linked to our fight-or-flight system. This neurological system is perfect in an emergency but often gets activated in non-emergency situations – we call that the stress response. Chronic stress can impact us in a variety of ways such as poor sleep, increased blood pressure, difficulty concentrating, tension, headaches and anxiety.

The good news is that each of us already has the capacity to work with that mental chatter so it doesn’t end up causing mischief. This ability is mindfulness, and it can be cultivated, strengthened and developed as a reliable antidote to stress.

Talk of mindfulness seems to be everywhere: in the news, the workplace, in schools, and increasingly in medicine. Over the past 30 years the interest and research into mindfulness has blossomed, and for good reason. Learning to be more present, focused and less reactive is one of the most powerful ways of improving health and well-being.

The research is clear: Practicing mindfulness changes the brain in beneficial and measurable ways, strengthening the neural connections that help regulate difficult emotions, decrease stress, and appreciate the positives in life more fully.

Mindfulness isn’t about emptying the mind, meditating on a cushion, or achieving a state of constant bliss. Rather, it’s a practical method to develop resilience and to meet life’s challenges with more calm, balance and equanimity.

Stay tuned for more about mindfulness and our conversation with Baskin Clinic’s Dr. Rebecca Neborsky as she talks with us about her experiences with mindfulness.

Would you like us to keep you informed of upcoming mindfulness offerings at Baskin Clinic?   Let us know! Contact Michelle or Jillayne to find out more.

Guest contributors Michelle Bobowick Psy.D and Jillayne Sorenson Psy.D are clinical psychologists and mindfulness educators with a passion for sharing the healing benefits of mindfulness. Michelle is co-owner of Clearwater Associates LLC which shares office space with Baskin Clinic. Jillayne is the owner Centerpoint Network LLC where she teaches Mindfulness Based Stress Reduction (MBSR) and other mindfulness-based programs in community, education and research settings.

 

The Problem with Artificial Sweeteners

CoffeeAndSugarOn the way to Ikea the other day, I was consumed by an overwhelming sense of hunger. Big stores do this to me — something about the thought of walking all those aisles.

Unfortunately, my tasty lunch was tucked away back at clinic. And reports of horsemeat-laden Ikea Swedish meatballs were still fresh in my mind, ruling out a store-based snack. (News flash: Ikea just now offering vegetarian meatballs!)

So I reached into my purse and pulled out my daughter’s pack of sugar-free Bubble Yum. The blast of guilt-free sugary sweetness was surprising and, well… delicious.

Back at the office and halfway through the build-out of my desk, I began having some pains through my midsection. I assumed it was due to the contorting positions required of Ikea projects, so I changed into my more accommodating running pants — no improvement.

I complained to one of my office mates, who happens to be a psychologist. She suggested the pain was due to my age. (Now that’s therapy.)

By the time I picked my daughter up at the school bus, I was convinced I had a full-blown case of appendicitis or ruptured ovarian cyst. But then I remembered: the Bubble Yum! I was reacting to the artificial sweetener.

Abdominal pain is one of the more common medical issues we encounter here at Baskin Clinic. Our first step in evaluation is always a dietary history, which is usually quite revealing. Some of the many offending substances we all commonly consume include:

  • Sugar substitutes such as Splenda, Equal, Sweet & Low, and others
  • Caffeine
  • Beer and carbonated drinks
  • Foods containing short chain carbohydrates called FODMAPs (fermentable oligo-, di-, and monosaccharides and polyols). FODMAPs are poorly absorbed and can result in bloating and gas production. Examples of FODMAPS include broccoli, cauliflower, mushrooms, cabbage, and beans.
  • Anti-inflammatories, from the lowly aspirin to name-brand non-steroidals like Celebrex.

Still other possibilities include air swallowing and onset of lactose intolerance. As a girl from the dairy Midwest (Ohio), I thought I was immune from the latter. But yes, I am lactose intolerant since my thirties.

Examples of sugar substitutes are sorbitol, xylitol, and mannitol. These “fake sugars” are not easily digested (which is why they are noncaloric – we don’t absorb them). But as we have previously discussed, noncaloric sweeteners still have deleterious effects on metabolism. Additionally, as these compounds pass through the gut they start to ferment (translation: form gas) and draw water into the colon. For some people this heralds symptoms of bloating and diarrhea.

I often see patients for chronic gas and distention who have no idea that sugar substitutes may be contributing to their condition (and that with cessation, those symptoms can quickly improve). Recently one patient had complete resolution of her condition by switching from Equal to sugar in her morning coffee.

For some people use of simethicone (found in Gas-X, Mylanta Gas, Phazyme) can help break up gas bubbles, but our experience is that only about fifty percent of patients find these medications helpful. The best medicine, really, is avoidance.

My story ends well. I made a quick trip to the grocery store for a strawberry ice cream bar for my daughter and a box of Gas-X for me (we both opened our purchases before paying). In about an hour, I was good as new.

But should you desire to read more about the dark underbelly of artificial sweetener-induced gastric distress, check out the reviews for sugar-free gummy bears on Amazon. The stories are as humorous as they are distressing — it’s like reading the script for an entire episode of Curb Your Enthusiasm.

So please read the ingredient labels for those candies and drinks – sugarless sweeteners are hidden everywhere! Your stomach will thank you.

Year in Review

 

Calendar

Well it’s that time of year again… when we review the best medical stories of the past year. This year we broadened our aim to include more than just medical research. Take a look at the curated list of topics that have captured our attention.

1. Grow Your Own

I’m not talking about pot, though that came close to making this year’s list. I’m referring to the amazing work in regenerative medicine that has been quietly humming along for years.

Starting with bioscaffolds to create a “framework” for the final organ, researchers have coaxed pluripotent human stem cells to differentiate into simple organs like the main airway (trachea). More complex organs have been out of reach until now, when researchers managed to grow human intestinal tissue and successfully transplant it into a mouse model.

Regenerative medicine could revolutionize the field of transplant medicine — and bring some relief to the frustrating bottleneck for organs that leaves many patients on waiting lists for years.

2. Personalized Medicine

The concept of tailoring medical treatments to one’s unique genetics just may be the vitamin D of 2014, judging from the voluminous press coverage and expansive editorials that appeared recently. Genomic medicine (often referred to as personalized medicine), even had its own spot in the State of the Union Address.

Unlike all the fanfare for vitamin D, there’s good science behind this idea: that genetic differences are the reason a given treatment doesn’t work for everyone, whether we’re talking about high blood pressure pills or a particular form of cancer chemotherapy.

But while we’d love to see tumors vaporized with the same deadly accuracy as SEAL Team 6, genomic medicine is a lot more complicated than a double tap.

For starters, simply performing the research to elucidate treatments for specific disease subgroups will be expensive and time-consuming. Imagine running not one breast cancer trial for thousands of patients, but dozens of smaller sub-trials on various tumor types, each with its own protocols and drugs. Furthermore, such small numbers make it statistically more difficult to determine complications and adverse side effects of treatments.

3. Mobile Stroke Units

This is perhaps my favorite topic from 2014. Stroke kills nearly 130,000 people annually and is the leading cause of adult disability in the US. And unlike coronary heart disease (think heart attack) — another major killer with nearly 380,000 deaths annually — there are relatively few good treatments for stroke.

The best chance of recovery for someone with an embolic stroke (where an artery in the brain is blocked by clot or cholesterol debris) is to receive tPA, the “clot busting” drug that has become a widespread and successful treatment.

Trouble is, tPA must be initiated within four hours of the stroke. Wait any longer and adverse side effects of tPA (bleeding) present a greater risk than the stroke itself.  Deciding quickly whom to treat is tricky, too; it requires specialized imaging (MRI or CT scan) and evaluation by a neurologist.

To reduce the delay between diagnosis and treatment, some municipalities and hospitals are deploying mobile units with everything needed to assess a possible stroke. While these specialized ambulances are very expensive — upwards of $1M  to build, let alone staff — they hold the promise of making stroke a far less deadly disease. We should have data on how these units are performing within a year or two, so stay tuned.

4. Our Amazing Gut Microbiome

This year we discovered that maybe there was more to being fat than simply eating too much and exercising too little.

True, we all are consuming more calories than we used to, largely in the form of excess sugar calories. You can read more about the dangers of sugar here.

But the idea that people absorb and process calories differently based on the types of bacteria in their gut — and that those bacteria can be permanently altered by exposure to antibiotics early in life — well that’s a mind-blowing revelation.

5. Superbugs

The Feds are finally on the case with the PCAST (President’s Council of Advisors on Science and Technology) report detailing the dangers of antibiotic resistance (like an extra 23,000 deaths annually). That’s as many as die from flu each year.

It’s high enough on the White House agenda to have made it into the State of the Union Address of 2014 (but alas, not 2015). CDC then granted superbugs their own microscopic line item, with a piddling $30M allocation from the $3.9T (yes, that’s trillion) federal budget.

Based on the near-daily reports of new outbreaks, we think $30M was way, way too little. Case in point: the 2016 budget proposal from the White House now includes a $1.2B provision across all government agencies for fighting these frighteningly adaptable microorganisms.

6. The Future is Plastics

Forget those massive great white sharks. The greatest danger in the oceans these days is plastic trash — more than 250,000 tons of the stuff are floating around. From your basic water bottle down to the tiniest micro-shard, plastic is making its way up the food chain, bringing with it a host of endocrine disruptors, toxins and death to sea animals everywhere. Some even argue that plastic should be reclassified as a hazardous waste.

7. Obamacare

It’s a fact: Obamacare has been a tremendous success, judging from enrollment figures (10 million newly-insured Americans and counting). However, as more than one commentator has pointed out, the Affordable Care Act (ACA) does nothing to control costs in our rampantly inefficient, inflationary health care system.

And that just may make this landmark legislation a big liability for years to come. For an excellent summary of the economic shortcomings of ACA, take a look at this video from a recent episode of “60 Minutes.”

8. Food Chain Contamination

Superbugs don’t just hang out in the hospital, waiting to infect unsuspecting patients. Sometimes those bacteria are on our food.

Here’s how it works:

  • Farmers feed antibiotics to their livestock both to prevent disease and to enhance growth. (Hmm… didn’t we talk about antibiotics and weight already?) In fact, 80% of antibiotic use is on the farm, not in the pharmacy.
  • Those farm bacteria then become antibiotic-resistant.
  • During butchering, farm animal carcasses get contaminated with the resistant bacteria, sickening consumers who may improperly prepare or handle the contaminated meat.

This cycle has been in operation for dozens of years, right under the noses of FDA, USDA, and all those acronyms that are supposed to protect us. How bad is it? In 2014 Consumer Reports found that 97% of all chicken parts were contaminated with potentially harmful bacteria. It’s enough to make a meat-eater cry fowl… I mean foul.

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2015 should be an interesting year in the world of medicine and health policy. Stay tuned for updates on these topics!

 

The Bittersweet Truth About Our Sugar Consumption

ImageAs I sit here writing this blog entry, I am mindlessly eating a raspberry yogurt and drinking coffee sweetened with soy creamer. It’s only 7:30 in the morning and I’ve already consumed 32 grams (or 8 teaspoons) of sugar.

Not the healthiest way to start the day, especially since poor diet is a major contributor to the development of chronic diseases including heart disease, diabetes and cancer.

It’s no surprise that we have an obesity epidemic on our hands when sugar has made its way from scarce condiment to dietary staple. In the 1820s, annual U.S. sugar consumption was 20 pounds per adult. Today we gulp down 130 pounds of the stuff per person. That’s 22 teaspoons of added sugar every day! Children consume even more: 32 teaspoons of added sugar daily. And sugar is calorie-rich and nutrient poor.

How did our sugar consumption rise so rapidly?

In the 1970s, a number of studies appeared linking fat and cholesterol intake to heart disease and premature death. Ironically, the strength of this link has now been called into question. Back then, consumers were encouraged to replace fats and proteins with carbohydrates.

This was not a misguided recommendation. A low-fat, high complex carbohydrate diet is perfectly healthy, as reflected in the new USDA Choose My Plate recommendations. But complex carbohydrates — vegetables, fruits, and whole grains — are best consumed in their natural state, which produces much less profit for the food industry.

So food companies found a way to twist this new advice to their favor. They took less nutritious, cheap, processed carbohydrates like sugars, flours, and starches, turned them into more expensive things like SnackWells, and then pitched them as healthy, low-fat, low-cholesterol snacks.

Trouble is, these processed carbohydrates are a far cry from the complex carbohydrates originally recommended. Packaged foods are usually higher in sugar and salt, more easily digested (translation: don’t fill you up), and lack many of the micronutrients present in less processed food.

Then in the 1980s, high fructose corn syrup (HFCS) came onto the market. Now the food industry had a sweetener that was inexpensive, shelf-stable, and offered the advantage of making processed food moister. HFCS quickly became ubiquitous in our food supply.

Do a quick search of the Internet and you’ll find HFCS being blamed for everything from the obesity epidemic to autism to pancreatic cancer. Is high fructose corn syrup more harmful to the body than other sugars? There is simply no evidence in human studies that consumption of HFCS in normal amounts is any worse for you than other sugars.

What about the fructose in fruit? The amount of fructose consumed this way is such a small part of total sugar intake as to be negligible. So eat all the fruit you want. The real harm appears to come from the sheer quantity of sugar we are consuming.

Our natural craving for sweet foods worked well in an environment where sugar was rare and food was scarce. Sweets were caloric gold that could supply our bodies with energy when there was little else to eat.

But we live in a much different world now — with food outlets on every corner. Unfortunately, our biology has not changed much (evolution works slowly) and those same instincts now work against us. For example, eating sugar-sweetened foods still activates the reward centers in our brain, making sugar highly addictive. A recent study showed that when given a choice, rats preferred sugar-sweetened water over cocaine!

Armed with this knowledge, you can adjust your diet to avoid getting unneeded calories and curb your sugar intake.

Here are some tips for the next time you sit down to dine:

  1. Cut out sweetened drinks like sodas, iced teas, sports and energy drinks. Stick with water. Avoid fruit juice, too: even “100% juice” is still very high in sugar.
  2. What about alcohol? Wine and liquor are low in sugar, but high in calories. If weight loss is your goal, then cut out alcohol. And of course, drinking in moderation is best for your health (no more than one drink for women and two drinks for men per day).
  3. Avoid processed foods – eat foods as close to their natural forms as possible. (Example: whole nuts instead of nut butters.) The only exception to this would be frozen fruits and vegetables, which are equivalent or better than fresh in terms of nutritional value.
  4. Switch to whole grains. Eliminate white bread, white rice, and white pasta.
  5. Try making your own salad dressings and sauces. You’ll use less sugar and salt than packaged brands. And most sauces freeze well, so you can store them up. (We’ve been putting away basil pesto for the winter.) Image 1
  6. Switch to plain yogurt. Add fresh fruit, nuts and a small amount of sweetener if needed.
  7. Limit your intake of baked goods and sweets. These are treats to indulge in every so often, not every day.
  8. Skip the artificial sweeteners. Although these don’t contain sugar, you are still giving your body a sweet flavor (which triggers the reward center in your brain) and leads to more cravings.

Too long of a list? Pick just one to work on — it doesn’t matter much (though my personal recommendation would be the sweetened drinks). I’ll be joining you in your quest… just as soon as I finish my coffee.

Counseling at Baskin Clinic: Introducing Clearwater Associates

LucyDid you notice that the Baskin Clinic has two therapists working in their office? Are you concerned for the mental well-being of those docs and nurses?

Don’t worry…Clearwater Associates is here for all!

Over the years, we’ve heard a variety of unusual and stigmatizing descriptors for psychotherapy. Some of our favorites are emotional vortex, hocus pocus, mental control, and crazy house. Hocus pocus sounds kind of fun, perhaps because it reminds one of a magic trick.

To this day, unfortunately, the realm of counseling remains quite mysterious to most people.

What really happens in that room? What do they do? Will I still be myself when I leave? If I go to a therapist, does that mean I’m crazy, weak or a failure? What will others think? What if I’m seen coming out of that kind of office?

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Let’s clarify a few things. Most people who initiate counseling do not have a significant mental illness. They have serious life challenges or are going through difficult life-cycle transitions that may be taxing their ability to cope. Examples include:

  • Dealing with health issues or a recent health diagnosis
  • Life transitions or aging
  • Eating disorders
  • Work stressors
  • Family or parent/child conflict
  • Loss or grief
  • Addiction
  • Anxiety or depression

Ultimately, counseling is a valuable investment in your emotional, physical and mental health, an act of courage (not weakness), and a gift to those whose lives you touch.

Who are we? Don’t worry — we are not the silent types. In fact, our new rooms required extra sound proofing for the therapeutic laughter that is heard frequently. We don’t shy away from feelings and guarantee humor (even when it may seem impossible to find).

We love human narratives: the good, the bad, and the ugly. We remain curious and non-judgmental while helping you explore, understand and gain new skills to deal with the changes and challenges in your life. We strive to build healthy therapeutic relations, versus quietly assessing you squirming on the sofa.

CouchBoth of us came to the therapy profession through the back door.

Michelle arrived in the great Northwest as a job coach. She oversaw adolescents who cleaned campground outhouses and fire pits in the Mt. Baker/Snoqualmie National Forest.

Michael grew up on Orcas Island and worked in the family business, San Juan Sanitation. (Motto: “Satisfaction guaranteed or double your garbage back.”)

To no one’s surprise, both Michelle and Michael can roll up their sleeves and work with “messy” mind and body struggles.

But please don’t take our word for it. Read more about Clearwater Associates at our website, where you can read bios for Dr. Michelle Bobowick and Dr. Michael Leidecker, see photos, and learn more about the Clearwater philosophy.

We are excited to share our new home within the Baskin Clinic. We and the doctors of Baskin Clinic are convinced that combining primary care and mental health allows for a more efficient, comprehensive, and effective delivery of health care. Many think tanks and federal agencies are echoing this sentiment.

We look forward to meeting you. If our doors are open, please say hello.

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