Diabetes care and research with Dr. Elizabeth Seaquist

If you missed the show this morning about diabetes with Dr. Elizabeth Seaquist from the University of Minnesota, you’re going to want to check out the podcast.  She is not only a terrific person to hang out with but she is also incredibly accompHesy-Ra_CG1426_clished in her career as a clinician and researcher.  And she is terrific at explaining diabetes, why it matters, and how she and others are doing research that promises to help us all in managing diabetes into the future.  No, that is not Dr. Seaquist in this picture (I think it is Hesy-ra, the Egyptian who first described diabetes in 1552 BC).  I was going to take a selfie of Dr. Seaquist at the microphone but alas and alack, I forgot.  Here’s her bio page at the University of Minnesota.  There is a short video from Dr. Seaquist later in the post as well.

For those of you checking for information about the GRADE study that we discussed on the air today, the number is 612-301-7040 or grade@umn.edu for the University of Minnesota location.  Read more about GRADE later in this post.

And I’ll do a couple quick tips from the phone and text line at the end of this post.  OK, on to the business of honey sweet urine.  Ew.

Sweet urine

First I can’t resist a quick aside about the origins of the name “diabetes mellitus”  (which is the full name of the disease).  Diabetes is from the Greek for “siphon” (or “passing through”) and mellitus from the Latin for “honey” or “sweet.”  Put ’em together and it loosely means “sweet urine” – sugar passing through the body and kidneys into the urine.  Ancient people were aware of what was probably diabetes in Egypt, China, India, Persia, and Greece, but it was an intrepid British doctor who really latched onto the sweetness of urine (and now for the “ew” factor – I guess that they used to actually taste the urine.  Makes one immensely thankful for modern lab equipment).

OK, enough history.

Diabetes basics

For Type 1 diabetes, the body lacks the normal function of creating insulin, which is necessary for life.  This is the less common form of diabetes and it always requires insulin for treatment.  I’m not going to talk about it here.

Type 2 diabetes is in some ways more complex and thus harder to summarize.  Basically, the body creates some insulin, but it is either in insufficient amounts or the body is resistant to the usual effects of insulin.  This is called insulin resistance.  It correlates with excess body weight, so being overweight does put one at higher risk for developing diabetes (and conversely, diabetics who can lose weight can improve their sugar control).  However, as Dr. Seaquist mentioned on the show today, there is more to the story than being overweight, something that should be evident when you consider that some lean people develop diabetes while many overweight people do not.  So there is a genetic component that we are still trying to understand.

Diabetes is such an important topic that people spend their whole careers diagnosing, treating, researching, and support patients with diabetes.  It is certainly too much for a blog post.  I would refer you to the American Diabetes Association for solid information.  Just a couple of points here.

If you have Type 2 diabetes, you should:

  • Know your A1c and your A1c goal (usually aim for <7%, but this can vary with your personal situation so ask your doctor).
  • See your doctor regularly (every 3 months, or more frequently if sugar control is not adequate).
  • Manage your glycemic control (aka sugars) with diet and exercise, and if that is not enough to reach your A1c goal, then with medication.
  • Pay attention to the parts of yourself that are vulnerable – get eye exams, protect your feet and wear good shoes, monitor your kidney function, and do what you can to lower your risk of heart disease (keep cholesterol down, consider taking an aspirin a day, do not smoke . .  ).  Of course, these are general guidelines only – you should do all of this in consultation with your doctor.
  • And finally, consider enrolling in the GRADE study if you meet the criteria

GRADE study

There are oodles of treatments that are FDA-approved to manage Type 2 diabetes.  A healthy diet and exercise are important for everybody  After that, the first choice for most people will be a medication called metformin.  Medical data has shown that this is the most effective at safely bringing blood sugars under some control.

The problem is that for many people, metformin alone does not control the high blood sugars adequately.  In other words, metformin alone does not bring their glycosylated hemoglobin, or A1c below ~7%.  (You may have a slightly different goal based on factors unique to you, but for most people getting below 7% is a good goal).  So a second agent is needed, and that’s where there is not rock-solid data to tell doctors and patients what to use next.  Is it insulin? One of the older classes of drugs called sulfonylureas?  Or perhaps one should use some of the newer drugs, of which there are many.  After all, they are all FDA-approved, but after metformin we still don’t know which ones are best.

So that is the big question that the GRADE study is going to help us answer.  Check out the short video about GRADE:

If you have diabetes type 2, ask yourself these 2 questions:

  1. Have I had diabetes less than 10 years?
  2. Is metformin my only diabetes medication?

If the answer is YES to both of these, then you may qualify for the GRADE study.  If you enroll, you can expect the following:

  1. Ongoing care at the University of Minnesota (in Minneapolis, or at another GRADE site near you) for medical visits 4 times per year.
  2. You will get your diabetes medications at no cost to you.
  3. You will get your physical exam and diabetes lab tests also at no cost to you.

Great care for your diabetes, free tests and medications, and you will be doing an important service to people living with diabetes everywhere by helping us all understand the best treatments.  I encourage you to give the GRADE researchers a call.  Their University of Minnesota number is 612-301-7040 or e-mail them at grade@umn.edu.  If you live elsewhere, go to the GRADE site at gradestudy.com to find a location in your part of the country.

I really want to thank Dr. Betsy Seaquist for joining me this morning.  HCMC and the University of Minnesota are partners in clinical care and research!

Quick tips from Healthy Matters text line

I received way more questions from listeners than I can answer on the air Sunday mornings.  Here are short responses to a few text questions from today (I paraphrase the questions a bit here).

Is macular degeneration the eye condition associated with diabetes?  Although macular degeneration is a common eye condition, it is not the one we most associate with diabetes.  Diabetes does lead to a higher risk of retinopathy (sometimes with excess blood vessel growth in the eye), macular edema (swelling in the back of the eye), cataract, and glaucoma.   These are treatable conditions, so people with diabetes should get regular eye exams.

Is it possible to stop taking diabetes medications if I lose weight?  For many people, yes, this is not a myth.  Sometimes losing just 10-20 pounds may be enough to control blood sugars.  Certainly there is strong evidence that people who are very overweight and then get a weight-reduction surgery often are able to stop their diabetes medications almost right away.

Can prednisone raise blood sugars?  You bet it can!  We touched on this on the radio today a bit.  Any corticosteroid (like prednisone pills that you swallow, or intravenous steroids that some people in the hospital need, or even injections into your knee or other joints) can and usually do raise your blood sugar levels.  Usually the blood sugar levels come down after these anti-inflammatories are stopped, but be prepared to adjust your diabetes medications if you are also on these corticosteroids.  As always, consult your doctor before changing any of your diabetes medications and be sure to let your doctor know if you need to take these steroid medications.

Healthy Matters – next week on the radio:  Open Lines!  Get your general health questions ready.

 

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Reflections on bias in health care

Do black people feel less pain than white people?  Are overweight people at fault for developing diabetes?  Do doctors evaluate symptoms differently if a white man reports them than if a black woman reports themrace bias nejm?

Most of us would emphatically answer these no, no, and no.  But there is evidence that the answers actually are much more complex than that.  For instance, there is scientific data that suggests that people hold unacknowledged attitudes that African-Americans feel pain less than white people.  Some people do feel that overweight people are personally to blame for their diabetes.  And there are studies that suggest that doctors evaluate and treat people differently based on race.  (The punch line of the study is that when the actors in this picture reported symptoms to doctors, they received different treatment recommendations despite identical symptoms – a fascinating study).

I think these are disturbing but important things to think about if we are going to address disparities in health care.

This post is prompted by a class that I facilitated at the University of Minnesota Medical School.  I was pinch-hitting for a colleague this week in a small-group discussion class that that aims to get these first-year medical students to think about something other than biochemistry and physiology.  Stuff like bioethics, humanistic care, doctor-patient relationship, and so forth.  There were ten of us seated around a table discussing the week’s topic – bias in medical care.  (As an aside – if these 10 thoughtful students are any indication – the future of health care is in good hands.)

I’d like to share some reflections from that session and offer some interactive resources for you to try – the exact same ones the students did.  And you don’t have to pay medical school tuition!  So read on, think about it, check out some of the links, examine your own biases, and leave a comment on this blog post. Let’s talk about it.

(At the bottom there is a link to a thought-provoking self-assessment that you may wish to consider doing yourself).

Being privileged

I think the first step toward addressing bias is to examine our own situation.  Here is my situation, in the proverbial nutshell:

  • White
  • Male
  • Straight
  • Financially secure
  • Naturally-born United States citizen
  • Protestant Christian
  • English-speaker
  • Not overweight

I don’t apologize for any of them – I am happy with who I am.  But it is crucial to realize that I didn’t do anything to accomplish any of those things – and yet, my personal characteristics put me in a place of privilege.  Nobody would doubt me if I showed up in an Emergency Department with chest pain.  I’d get the appropriate tests in an instant and probably be provided with pain medications without delay.

Would I get the same great medical care if I were a disheveled homeless man?  If I didn’t speak English?  If I were a Muslim woman wearing a hijab?  If I were a transgender person?  If I were a woman?  If I were overweight?  Maybe, maybe not.

So we talked about this with the medical students, starting with recognizing one’s own privilege and naming it out loud.  I told the students, especially the white guys, that it is totally OK and cool to be a white guy.  No apologies.  But it is important to recognize the privilege that comes with personal characteristics which you were simply born into.

Great quote:  “When you find yourself on 3rd base, don’t assume you hit a triple to get there.”

Unconscious bias vs. conscious bias

What is bias, anyway?   The medical students in our class watched the following video of a talk given by a physician who reflects on his own bias.  It is worth 15 minutes of your time:

This video raises several points to ponder, but two stick out for me.  First, Dr. Attia painfully recalls the contempt for which he held a diabetic patient – basically blaming her for needing a leg amputation because she was – as he recalls – “fat” and therefore somehow responsible for her decaying leg.  Years later he still feels the need for her forgiveness for this attitude that he wasn’t even aware of at the time (be sure to watch it to the end).  The second point is his recognition that medical science may, in fact, not always be accurate.  This second point is certainly true and something I hope to explore in future posts.  The first point is a perfect example of bias.

In our medical school discussion, we tried to acknowledge the possibility that we could be harboring bias even without knowing it – implicit or unconscious bias as opposed to  explicit or conscious bias.

Explicit bias

First the one that is easy to identify – explicit bias.  This is something we deliberately think about and often verbalize.  Consider the current United States presidential campaign, when serious candidates for the presidency are endlessly providing examples of explicit bias:  accusing whole groups of people of nefarious deeds (Mexican people as rapists), labeling hundreds of millions of people into stereotypical categories (lumping all Muslims together), openly advocating mass killing of innocent people for being not like us (“carpet-bombing” whole populations of civilians).

These are open, deliberate attitudes that should be easy to identify and weed out (although sadly we often fail at this).  I would call them explicit biases and we should reject them outright.

Now the harder one.  Contrast explicit bias to implicit (or unconscious) bias.  These are the attitudes that we are not conscious of and that we may well deny holding when confronted with them.  But they are real.  Like Peter Attia in the Ted talk (click picture above if you missed it), I would never openly accuse a person with diabetes of being personally responsible for her gangrenous leg.  But deep inside me, would a part of me wonder if she could have tried harder to lose weight?  If she had only cared for her leg a little better could she have avoided an amputation?  I think that it is not only possible that I could hold such unconscious biases, I think it likely that I do.  And most of my physician colleagues do as well.

This part is hard  . . . examining our own bias

The medical students were asked to take a self-assessment, called an IAT (Implicit Association Test).  My first reaction is that the IAT is just another bit of academic jargon, but having tried it I found it actually sort of cool.  The test involves words and images appearing on the screen, and the students are asked to rapidly react to the images by making a selection.  No thinking about it logically.  Just react.

I encourage you to try an IAT – take a test yourself.  This can be difficult emotionally, so prepare yourself.  Hearing your own results may not be easy but it is eye-opening.  Before you take a test, read the materials from the Implicit project (a consortium of researchers) on the website and then take the test yourself.  Note that the interpretation of your results may be troubling to you.  With that in mind – give it a try.

Did you discover any unconscious bias in yourself?  How did it make you feel to hear that you may harbor attitudes that you were not aware of?  Do you agree that such biases exist in you?  And if so, what ought we to do with that information?  How is our society affected, not only in healthcare, but in other aspects of our life, when such biases exist?  Does bias contribute to unequal health care outcomes? 

This is a conversation worth having.  Tell me what you think – leave me a comment!

 

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Quick tips: injecting goo into your knee

Time for a logo_healthy-matterstopic from the Healthy Matters mailbag.  Today’s “Open Lines” show was a busy one, and as is the case for these shows, I leave many questions from listeners unanswered, or not fully answered.  Mea culpa, Healthy Matters listeners!   Miss the show today?  You can always listen to the podcast at your leisure –  in your pajamas, in the car, while out exercising.   Anywhere you want.  You’re so connected like that.

I’ve picked just one of today’s queries to highlight here.

Injecting goo into your knee

Here’s a text from today’s show (paraphrased a bit):

“I recently had injections of hyaluronic acid over 3 weeks.  Now I’m having severe pains in knee and calf when walking. . . taking ibuprofen and resting and ice-packing . . . “

I can relate to this question since I’m no stranger to bone and knee pain.  Witness the body work I needed after a marathon a few years back.  I think I may actually be unconscious in this picture:

Napa Valley Marathon 064

Alas, injections of hyaluronic acid or steroids or fairy dust or salt water or anything else aren’t going to help me.  None of that is probably going to help the person who asked this question, either.

First, some definitions:

Osteoarthritis (OA) is the very common “wear-and-tear” type of joint disease (not to be confused with inflammatory joint problems, of which rheumatoid arthritis is the most familiar one).  In OA, the cushioning cartilage wears down over time, leading to pain with movement of the joint.

(Don’t get me wrong, my problem in the picture above is not osteoarthritis.  My problem is entirely self-inflicted but I’m going for the sympathy vote here).

Hyaluronic acid (HA) is the naturally occurring goo in your joints, which helps to lubricate the moving parts.  Viscosupplementation is the practice of injecting a manufactured version of hyaluronic acid into the painful joint.  By the rooster combway, viscosupplementation, although the proper medical term, doesn’t sound nearly as cool as injecting goo, so I’m going with the latter term.

Some brands of injectable hyaluronic acids are made from bacteria, I think.

Other brands are made from rooster comb.  Seriously.  I’m not making that up.  You are literally injecting chicken parts into your body with some of them.

 So does it work?

In a word, no.

It has long been proposed that injecting a manufactured form of HA will aid in the pain of osteoarthritis.  It does make some sense, I think.  After all, lubrication is good for the pistons in my Mini Cooper.  It worked for the Tin Man as well.  And people have been trying it for years.  A lot of years.  To be fair, many people do seem to report some relief from it.  If it is going to work at all, the relief should be expected to be delayed (a few weeks after the injection) but may last for many months.  And you can find some fairly respectable Internet sites that discuss it as a viable therapy.

The problem is that there is no convincing evidence that it has any significant clinical benefit.  This is where medical science comes in.  Research has been done (lots of studies), and it is to the science that we must turn.  Here’s the no-nonsense clinical guideline from the American Academy of Orthopaedic Surgeons:

“We cannot recommend using hyaluronic acid for patients with symptomatic osteoarthritis of the knee. Strength of Recommendation: Strong

You can read the whole guideline by clicking the link above – it is not exactly a page-turner but it is thorough and covers everything you want to know about knee arthritis.  You can believe these guys from AAOS.  The little teensy-weensy clinical benefit that may or may not be present from these injections just isn’t to be found.  May as well inject sugar water as best we can tell.

So what does work for osteoarthritis?

A whole lot of us, doctors and patients alike, wish we had a cure, or just better treatments, for the many people who have joint pain.  What we do have that has some scientific basis is what you might expect:

  • Strengthening and exercise program to build up the support structures of the joint.
  • Weight loss if overweight (BMI 25 or greater).
  • Use NSAIDS (non-steroidal anti-inflammatory drugs) like ibuprofen and naproxen.

So for our texter who raised the question, you raise a really good topic and I hope you get some relief!  Here’s my thoughts:

  • First, make sure you have tried a good course of physical exercise, including strengthening exercises.
  • Second, unless you have a contraindication to using them (and there are many – like heart failure, intestinal ulcers, kidney disease to name a few), then give the NSAIDS a try for a while.
  • Maybe not surprisingly, acetaminophen (trade name Tylenol) has not been shown to help much.
  • If your osteoarthritis is only mild to moderate (not severe), and you have received relief from the hyaluronic acid injections, then it may be something to consider for you (it does carry FDA-approval for what that is worth), but there is no evidence to support it and so I don’t recommend it for my patients.
  • If your pain is severe, see an Orthopaedic Surgeon.  Knee replacement does work for many people.
  • What about the symptoms the texter is experiencing – the calf and knee pain?  Well that could well be a side-effect of the injection itself.  Nothing is risk-free, including these injections.  Could be an infected knee (a serious problem which requires attention) or a fluid-collection or something else.  I recommend going in for evaluation to rule these things out.  I suggest an Orthopedic specialist or a Rheumatologist for that.

Thanks for listening to HealthyMatters and for checking out the blog!

Next week on the radio broadcast:  Diabetes – the latest research on controlling your blood sugars.

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Procreative success and Blue Zones: Dr. Meghan Walsh visits the studio

Procreative success and Blue Zones?  The whole thing sounds like it may not be suitable for discussion in mixed company.  But rest assured, it’s all good, nothing indelicate going on here.  This is a post about living long and living well.  Please read on . . .

On my HealthyMatters radio broadcast last Sunday, we talked a great deal about keeping your heart healthy – after all, it was Valentine’s Day and I’m not above doing a cheesy tie-in between chocolate hearts and actual cardiac health.  I’m sentimental like that.  But good thing I brought someone to keep me from milking the sappy heart analogies too much . . . Meghan studio

To help me out, I asked my super smart good friend Dr. Meghan Walsh to join me – you’ll want to click on the Listen to Podcasts link on the right to hear her advice about broken heart syndrome, aka stress cardiomyopathy, and other heart topics.  She’s a hospitalist (cares for people in the hospital) with a focus on cardiology – in other words she totally knows what is going on when you have a heart problem.  And she should know a thing or two about keeping it healthy.  Too bad she hails from “the wrong side of the tracks” (which to a Minnesotan like me means she’s from Wisconsin).

Lately, though, I’ve been thinking about living longer and living well.  I talked about “Living to 100” on TV last week , I wrote my last blog post on “Living to 100,” and I just worked a week in the hospital where I pronounced the deaths of two people and cared for several more in the last weeks of their lives.  Let’s just say longevity is on my mind.  So Meghan and I talked about not just heart health, but how to actually live longer in general.  And during the show, she brought up the concept of Blue Zones.

Say what?  Blue what?

Well it turns out some cool people have looked all around the world and located little pockets where people actually do live a good deal longer than the rest of us.  And they do so with vigor and purpose and vitality.  This intrigued me, and having looked into it more, I’d like to share it with you.  Read on for more . . .

So what the heck is a Blue Zone?

Turns out there is a guy from Minnesota named Dan Buettner who worked with National Geographic to identify areas in the world where people actually live longer than the rest of us – and then to try to figure out how they are doing it.  I haven’t met Dan but I’d sure like to.   He called these areas Blue Zones:blue zones

 

After studying these areas, where people routinely live longer than in most other communities (even living to 100 and beyond), the researchers learned some key factors – and none of them required fad diets or going to the gym!  He wrote a book by that name and he’s given some really engaging talks about it.  They will really get you thinking:

In his work on Blue Zones, Dan Buettner learned that these 5 communities shared 9 important characteristics, grouped into 4 categories.    Note that all of this is his work, not my own – I want to give appropriate credit –  but I’m going to paraphrase them here and include how some of it makes sense in my own life.  Maybe it will in yours as well.

And you’ll just have to read to the end to learn about procreative success.

Move naturally

  1.  Moderate, regular physical activity.

Communities in which people live the longest tend to be quite active, but it is not through intentional exercise – at the gym or anywhere else.  Rather, they structure their communities and routines so that movement is a routine part of daily life, not scheduled like we do.  Gardening.  Taking the stairs.  Regular hikes for leisure.  Mix the cake batter by hand rather than use the mixer.  Stuff like that.

Right outlook

2.  Life purpose

The Okinawans of Japan have a saying  – ikigai – which basically is the reason you get up every day.  The Blue Zone researchers found that having a sense of purpose is worth 7 years of extra vigorous life expectancy.  So many of us, however, retire from our jobs somewhere in our mid-60s, then try to figure out what to do that feels meaningful after that.  But Dan found that really old people in Japan still maintained a sense of life meaning – be it fishing, holding great-great-great grandchildren, or doing martial arts.

Here in Minneapolis, this week I admitted to the hospital a woman in her 80s who broke her hip while playing volleyball. Her goal was to get well enough to get back to her active life.   The take-home point is not that she broke her hip; that was an acceptable risk to her.  The take-home point is that she was out playing volleyball.  Awesome.   (Full disclosure – I changed a couple bits of her history to protect her privacy – but the message is the same).

3.  Stress reduction

People who live longer tend to know how to chill out.  They do this in ways that are meaningful to them, something we could all learn to do.

I’m about as Type A as they come and tend to talk too quickly, move too quickly, eat too quickly.   Guilty as charged.  When walking around Lake Harriet with Julie, my wife, she often grabs my hand.  I like to think it is for romantic reasons, but as she points out, it’s to keep me at a pace that doesn’t require her to jog to keep up.  So calming down is not a strength of mine.  But I do try.  Like live classical music concerts.  For me, a heavenly evening is spending an evening at Orchestra Hall listening to the Minnesota Orchestra.  I don’t talk to many – or any – people since I usually go alone.  For my wife, and many of my colleagues who are doctors, stress reduction means a ritualized practice of meditation.  For you it may be something else.  But we need to learn to sloooooooow down.

(Quick aside – we recently did a HealthyMatters show on meditation with a cardiologist colleague of mine, Steve Goldsmith, and a Buddhist master, Marc Anderson.  Listen to the podcast here).

Eat wisely

4.   Moderate calories intake

This is one I’ve been harping on for years when giving my own presentations on living long.  Portions sizes today = obscene!  Believe me, when you go to one of those big sports bar restuarants, you know the kind with 98 big screen TVs lining the walls, there is nothing OK about the size of that plate of food.  There just isn’t.  There are enough calories on that plate for two or even three meals.  Eating less is something we can and should do – and there are tips to help.  Like reminding yourself before every meal to stop eating when you are 80% full like the Okinawa folks.  Or putting the food on the plate in the kitchen, rather than serving family style at the table where you are tempted to take more helpings.  Or just use a smaller plate.  Simple as that.

5.  Plant-based diet

I’m sorry if you are in the meat-producing business, but I have to say it.  It is pretty clear that we need to eat, as I say, “lower on the food chain.”  Plants and legumes should be the mainstay of our diets – and the more colorful, the better!  The dark green, rich red, and bright orange ones are best.  This is pretty well established advice.  If you do eat meat, make it lean and in much smaller portions than we are used to.  The meat – if present at all – should be the size of a deck of playing cards.  The veggies, whole grains, and legumes should take up most of the real estate on your plate.

6.   Moderate alcohol intake, mostly wine

A glass or two of wine daily is probably reasonably good for you, at least if you look at the communities where people are living a long time.  Many of us doctors have been saying this for years, and there is some evidence to back it up.  After all, people in Provence seem to do OK with it.  I always qualify this recommendation, however, because it just isn’t for everybody.  For instance, if you have alcohol dependence or addiction to alcohol or other substances, certainly this is a really, really bad idea for you.  And as a doctor, I see people all the time who drink 7 drinks on a Saturday night, thus averaging out to one per day for that week.  Sorry, doesn’t work that way.

Right tribe

7.   Engagement in spirituality or religion

This is a common theme in the Blue Zone communities.  People who live to 100 typically are part of a spiritual community of some sort.  And they aren’t hit-or-miss about it – they show up several times per month for some sort of spiritual connection.

I was in Jerusalem on Yom Kippur last year.  Talk about honoring the holy days – the entire city shut down in what seemed to me a collective nod to the spiritual.  And my Muslim friends pray faithfully many times a day.  And Christians like the Adventists of Loma Linda reverently keep the Sabbath.  Just examples – your faith traditions may be vastly different and that is OK, but the idea of regular spiritual engagement as a factor in how long you live – well that intrigues me.

8.  Engagement in family life

Communities in which people live to 100 tend to be very family-centric.  They take care of both their children and their aging parents.  Old people are honored in the family.  It turns out that taking care of your family makes you live longer.  A good read about this is Atul Gawande’s Being Mortal.  I recommend it.

9.   Engagement in social life

Isolation isn’t good for you.  That seems to be clear.  This makes sense to me – particularly in our culture where our “friends” may well be people we barely know on our social media accounts.  Watch the TedTalk that I referenced earlier in this post and learn of the close-knit group of people in Okinawa who are life-long companions throughout the life journey of the group.  Through good and bad.  Wow.

When I was in medical residency we had a group of friends that hung out regularly to de-stress, commiserate, laugh.  We called ourselves the “Plexus” a name whose origin is a long and probably boring story.  Meghan Walsh was part of the Plexus.  But the group sort of scattered after our residency at Hennepin County Medical Center though some of us have stayed in touch.  Our friends come and go sometimes.  Not a good thing, perhaps.

Meghan and me studio

Here’s Meghan and me at the studio – the remnants of the Plexus.  (And now if I could just lose that gut . . . !)

OK, as promised . . .  what is procreative success?  Sounds like something good, eh?

According to Dan Buettner, this is the genetic goal, if you will.  It means that we are programmed to see our children and our children’s children and if we do, that’s considered success, at least evolution-wise.  So all this longevity talk – well, evolution and our genes have little to say about that.

So look to the Blue Zones for help.

 

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Live to 100 or die trying

You can always pick different parents.  Well, maybe not.

Recently I was on WCCO-TV, Channel 4 in Minnesota, to appear in the popular segment done by Heather Brown, called Good Question.  This week’s question was about “How to live to 100” and I gave some tips.  Click the picture below to see the piece and see the video – but really listen to Mr. Richard Mann, the gentleman who appears in the segment.  This 101 year old guy was seen shoveling snow the other day up here in Minnesota.  He starts out with “I love my life” – I want to be like this guy so much.

Here’s the video of the segment.  Click here or on the picture to see the video.

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But what can you do to live to 100 years old?  Or maybe the better question is, do you even want to live to 100?

Over the years I have given a talk/workshop to various groups of people called “How to live to 100 or die trying” in which we explore these questions.  There is lots to talk about, and so in future posts I’ll be exploring ways to live healthy, including living to 100.  After all, there are some things you can do (don’t smoke, eat right, exercise, get certain tests), but much of it is out of our control (picking your parents, for instance).

And almost more interesting to me – outside of eat this and don’t eat that, or exercise this much, or get this test but not that one – is about our mental state of mind as we age.  I close almost all my “Live to 100” talks with the advice to not worry so much about things we cannot control.  It goes something like this:

Continue reading “Live to 100 or die trying”

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Quick tips: angina, bronchitis, and acid reflux

Regular listeners to Healthy Matters know that I often can’t get to all the questions that come from listeners via phone or text message, or I can’t answer the questions as thoroughly as I’d like whlogo_healthy-mattersen doing live radio.  So every so often I’m going to use this blog to post a few “quick tips” in response to listener questions.  Nothing in-depth, just a few tips I think are interesting.

And you can always listen to old shows by clicking the “Listen to podcasts” link in upper right of this blog.

Remember, these are just quick tips and are not complete medical advice.  Be sure to click the link in each section for more information!

These are from the Sunday, February 7 show.

Angina pectoris

One texter this morning asked about angina – what is it, does it mean there is heart disease, and what to do about it.

Angina pectoris is a mix of Greek (“strangling”) and Latin (“chest”) and is the term we use to describe pain in your chest which is due to coronary heart disease.  This is the blockage of your coronary arteries by plaque that some of us know as “hardening” of the arteries.  Coronary ecg-long-hiheart disease also leads to heart attacks – an unstable, emergency situation, but angina is the stable condition that comes when your heart isn’t getting enough blood to meet the demands being asked of it.  In other words, the heart is doing fine when at rest, but doesn’t have the reserve required for exertion or stress.

  • Angina occurs with exertion, stress, and hot or cold temperatures and is relieved with rest or nitroglycerin.
  • It usually feels like a pressure or squeezing in the chest (hence the name which means “strangling”).
  • There are lots of variations in symptoms, particularly in women, and may also feel like nausea, indigestion, or include arm, neck, and jaw pain.
  • Angina usually lasts just a few minutes.
  • Symptoms are usually predictable – not coming out of the blue at unexpected times.  Onset with exertion/stress, relief with rest/medications.

If you think you may be having angina, then you should be seen by your doctor for tests.  There are good medications and other treatments for angina.  Importantly, if the symptoms are becoming more frequent or severe, or occur at rest, then you may have unstable angina which requires urgent attention.  Like right now attention, not tomorrow or next week.

For more, check out the reliable American Heart Association site.

Continue reading “Quick tips: angina, bronchitis, and acid reflux”

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Staying active on the frozen tundra

Downtown in winter HCMCAs most of my radio listeners know, I’m a runner.  Like many of you, I find a few miles on the paths of Minneapolis to be relaxing, rejuvenating and probably pretty good for me.  But here in Minnesota, the weather presents some challenges.

So how do you stay active in winter, whether running, walking, or just getting to your car?  Here’s what we’re up against – check out the view from my office on this balmy February day.  HCMC is on the left, the Star Wars sandcrawler behemoth invading downtown from the right is USBank Stadium, still under construction.  Not your ideal running conditions, eh?

As a doctor, I know there are risks to everything, including being active outside.  Your asthma may get worse or you may fall and break your wrist – there are real risks and of course, you should tailor your exercise regimen to your own situation – but in general being active beats the alternative!  So we soldier on – off for a run.

Here’s my route on the street by my house:

Mpls street winterPretty, don’t you think?

Of course you could exercise inside – there is always the gym and the dreaded treadmill.  To be sure, that’s better than sitting on the couch.  But to me, a mile on the treadmill feels like an eternity, and it’s a bit soul-sucking to be lined up with a bazillion other people, all plugged into their headphones, running like hamsters.  Much better to be outside, I think.

For those of you living in southern California, you can get all smug now.  For those of us in God’s country (aka Minnesota), let’s talk about surviving a winter run (or walk).  Basically there are 2 concerns, both of which sadly happen with some regularly:  a) falling on your tuckus, and b) freezing various body bits.

Continue reading “Staying active on the frozen tundra”

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