When Breath Becomes Air – Healthy Matters Book Club

when breath becomes air“I began to realize that coming in such close contact with my own mortality had changed both nothing and everything.”

Paul Kalanithi, from When Life Becomes Air

Welcome to Healthy Matters Book Club!  This is the first of what I hope will be many posts in which I will explore a health & medicine book that I have read and found interesting .  I’m not a book critic and this is not a thorough book review – just a couple of my thoughts.  I hope you will read it and join the conversation by leaving a comment below or perhaps joining me on Twitter @DrDavidHilden.  Plus, I’m hoping you will leave me book discussion suggestions in the comments – I’m always looking for a good read!

Today’s Book:  When Breath Becomes Air

Re-read the quote at the top of this post.  It is a pretty good summary of When Breath Becomes Air, the recent book from Dr. Paul Kalanithi.  I strongly recommend the book to you – it is a quick read – just a few hours – but it is gripping.

Dr. Kalanithi died in March 2015 and the book is a memoir of his last months of life.  An accomplished neurosurgeon and a rising star in the medical community, Paul Kalanithi learned of a terminal diagnosis when he was just 35 years old.   Also a talented writer who was initially torn between a career in medicine or as a writer, he set out to chronicle his life knowing that he would not live a great deal longer.  He is a terrific writer and his prose is quite lyrical – almost poetic to the degree that some may find a bit much –  and I found it brilliant.

Paul writes with an intimacy rarely seen in books by doctors.   Neurosurgeons, fairly or not, are not known for their sensitive sides.   But in this case, the surgeon becomes the patient and is faced with what he knows in his mind and in his gut – that he has a disease from which he will certainly die.  He knew it the instant he looked at his own CT scan.   This unnerved me a bit as I can imagine any of my colleagues facing the same situation in which we look at our own medical results and know a bit too much what it means for us.

When I was reading the book, I couldn’t escape the knowledge that the writer has already died and is really speaking from the grave.  Made me pause more than once or twice.

But it is a great read even if you are not a doctor.  Maybe even more so, as it gives you an unfiltered glimpse into the mind of a brain surgeon with a soft spot for poetry.  You really feel like you get to know him.  And just as great is that you get to meet Lucy, his wife, who seems to me an incredible person.

Throughout the reading I couldn’t escape the knowledge that Lucy and their infant daughter are still here – real people, alive and carrying on their lives.  To me Lucy is as fascinating as her husband and her epilogue is as poignant as her husband’s writing.  Now about one year after his death, she has found herself doing something she probably didn’t imagine just 2-3 years ago – she’s on a book tour for her late husband.

Here’s an interview she did on National Public Radio that I encourage you to listen to:

 “Live as if you were to die tomorrow. Learn as if you were to live forever.”

This oft-quoted bit of wisdom by Gandhi was realized by Dr. Kalanithi during his lifetime.  After his awful diagnosis, he continued to practice surgery, continued to read, continued to write, continued to love, continued to learn, and continued to reflect on what is important in life.  He indeed was acting as if he may well live forever.

But he also acted as if he may die tomorrow which for him was not an abstract concept but a real possibility.  One aspect of their lives that gets my thoughts all tied up in knots is their decision to have a baby, knowing that he would not live to see their child grow up.  Here is an exchange from the book:

“Will having a newborn distract from the time we have together?” she asked. “Don’t you think saying goodbye to your child will make your death more painful?”

“Wouldn’t it be great if it did?” I said. Lucy and I both felt that life wasn’t about avoiding suffering.”

Can you imagine having such a conversation when thinking about having a child? Holy cow.  Listen to the audio clip above to hear Lucy say more about this.

Join the discussion!

What would you do if you knew you had a very limited amount of time to live?  Would you continue to work at whatever you do?  Would you drop everything and try something new? What would you do if you were Lucy – his spouse?  Are you a “live-for-the-moment” type or a “planner for the future” type?  Maybe a little of both?

So now it’s your turn.  Read the book and leave a comment below with your reactions.  I’d love to hear your thoughts!

Also, if you have read a health/wellness/medical book that you’d like to recommend – leave me a comment right here on the blog (in the comments section below).   Can be fiction or non-fiction.  Maybe we can discuss it on a future post on the Healthy Matters Book Club!

 

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No more ipecac! National Poison Prevention Week 2016

I have the great fortune to work side by side with the smart folks at the Minnesota Poison Control Center, which is housed right here in my hospital.  Each year we try to do a service to the community by higJon Cole studiohlighting National Poison Prevention week, which is going on right now.   Dr. Jon Cole is the Medical Director of the Poison Center, and Kirk Hughes is the Education Director.  You won’t find two more dedicated experts than these two guys – and I was happy to have them on the Healthy Matters broadcast this week.  That’s Dr. Cole’s smiling face on the left and Kirk below – bright and early on a Sunday morning.   Now wouldn’t you want this guy to be the one helping you?

Listen to the podcast of the show here by clicking the logo here –> .logo_healthy-matters

I encourage you to click the link to the Minnesota Poison Center.  It is a site loaded with information, including tip sheets that you can download for your own use.

My own daughter and the iron tablets

First my personal tale of woe.  I mentioned on the radio show about a brush with poisoning with our own daughter.  The story is a scary one for any parent . . . our little one was just 1 or 2 years old when we found her on the floor with an open bottle of iron tablets, some of them spilled out.  We had no idea if she had swallowed any of them.  Yikes.   Iron tablets don’t sound all that bad, right?  But these common supplements are really dangerous in overdose for the wee ones.  So we took her to a doctor and she had to have a x-ray (to look for the pills in her digestive system).  Thankfully she was all right, but today we would have called 1-800-222-1222 and talked to the poison experts.

What I learned about poison prevention

Here are just a few of the things our listeners learned from Dr. Cole and Kirk (that’s Kirk in the picture below – he’s a guy with a head-full of knowledge from his career as a nurse, a basic EMT, and a poison prevention educator).  And down below, look for a neat video of Kirk in action with a grateful parent.  It’s worth a few minutes.

  • The most important thing of all – know this number.  1-800-222-1222.  This is the number for the Poison Center, and the beauty of it is that it is valid nationwide.  The system will direct your call to the Poison Center nearest you, based on thKirk Hughes studioe area code you are calling from (or the area code of your cell phone).
  • Calling the Poison Center number is the first thing you should do if you have a question about poisoning – unless you or a child is experiencing chest pain, difficulty breathing, or seizures.  In that case, call 911.
  • It doesn’t have to be an emergency – call if you simply have a question.
  • In the vast majority of cases (>90% of the time), the experts at the Poison Center can safely get you advice and treatment recommendations while you stay at home.  It is highly likely that you can avoid a trip to the Emergency Department or clinic by calling them first.
  • Program the number into your cell phone under Poison Center!

A word about keeping kids safe

More than half the calls to Poison Centers involve children under the age of six, and the problems are usually right in their own homes.  Kirk and Dr. Cole told us that there are several reasons why kids are at risk in the home.  Could these happen at your house?

  • Poisons are not stored properly.  Keep them up high, in original containers, well out of reach of curious minds.  Grandparents, your home may have your pills out on the counter or bathroom sink where you won’t forget them.  But if little ones come to visit, it takes just a second for them to grab them and swallow them.  Keep your grandchildren safe by keeping the medications out of sight!
  • Children are naturally curious.  Pills look like candy.  Spray bottles look interesting.  Brightly colored liquids look pretty.  But all can be deadly.
  • Many poisonous liquids look and smell like something safe to drink.  Fuels, cough syrups, even shampoo are like this.  Keep them out of sight and not accessible to kids.
  • Children imitate adults.  They see you taking medications or drinking liquids, they are certain to try to do the same.

This all sounds like common sense but in reality, many if not most of our homes are not particularly safe for children.  So if you have kids coming to visit, think of how to keep them safe.  It just takes a second when you are not paying attention for a kid to get into something that is really dangerous to them.  In my little story of my daughter’s scare with iron tablets, we failed to do these simple things.  Now I know better!

What about good ‘ol syrup of ipecac?

Lots of us probably still have an old crusty bottle of syrup of ipecac in our cabinets, especially if you are a bit older.  Well get rid of it!  It is no longer recommended to use ipecac to get kids or adults to vomit.  If fact, you should not even keep it in your home.  Ipecac is yesterday’s news.  Today, call 1-800-222-1222 instead.

Final thoughts

Poison prevention is a huge topic that I could never cover in a blog post such as this.  Rather, I hope to have provoked you to think a little bit more about keeping ourselves and our kids safe.

A listener to our Poison Prevention show on Healthy Matters posed the simple but really good question – just what is considered a poison?   I learned that a poison can be darn near anything – medications, cleaning supplies, fumes in the air, plants in your garden.  I also learned that poisoning is the leading cause of injury death in the United States.

Here’s that video of Kirk Hughes in action, about a family far away from a hospital but who did the right thing and called the Poison Center:

A final word on the Poison Control system in the United States.   Poison Centers are available to you:

  • Anytime.  24/7, including holidays
  • Anywhere.  Call from home, school, business.  Anywhere in the country.
  • Anyone.  Whether you are a concerned parent, a caregiver, a senior, a teenager, a teacher, a clinician – experts are there to help you.

And it comes free of charge to you.  

1-800-222-1222.  It’s a number you should know.

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The stethoscope of the 21st century?

V0003303 René Théophile Hyacinthe Laënnec auscultating a tuberculous Credit: Wellcome Library, London. Wellcome Images images@wellcome.ac.uk http://wellcomeimages.org René Théophile Hyacinthe Laënnec auscultating a tuberculous patient at the Necker Hospital, Paris. Gouache after T. Chartran. By: Théobald ChartranPublished: - Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 http://creativecommons.org/licenses/by/4.0/
Credit: Wellcome Library, London. Wellcome Images
http://wellcomeimages.org
René Théophile Hyacinthe Laënnec auscultating a tuberculous patient at the Necker Hospital, Paris. Gouache after T. Chartran.

“That it will ever come into general use, notwithstanding its value, is extremely doubtful; because its beneficial application requires much time and gives a good bit of trouble both to the patient and the practitioner; because its hue and character are foreign and opposed to all our habits and associations.”

Such was the opinion of the stethoscope by an English doctor in 1821 named John Forbes.   The stethoscope had recently been invented by French physician René-Théophile-Hyacinthe Laënnec in an effort to protect the modesty of his female patients by removing the necessity of placing his ears directly against their chests.  The skepticism of Dr. Forbes notwithstanding, the stethoscope is now considered one of the greatest inventions in history.  Check out the patient of Dr. Laënnec at the left – head firmly pasted to the chest of this guy with tuberculosis.  Oh my!   (Since this patient was male, the good doctor did not need to use his new stethoscope invention).

Whether the doctor actually contracted tuberculosis I know not.

But in the year 2016, the stethoscope is so familiar to patients that we probably would wonder what was wrong if the doctor did not have one hanging around his or her shoulders.  An old doctor sitting with his arms crossed

So what is the technology that doctors will be using in the future?

Enter the ultrasound

The stethoscope is nearly 200 years old.  Although I doubt I’ll ever hang my stethoscope up for good, today we do have some newer tools to help with diagnosis.  The ultrasound, though a tool we have had for many years, has now hit the bedside.   Today I spent some time with my colleagues (inpatient doctors, or hospitalists) learning how to use portable ultrasound machines in our practice.  As a patient, you will likely encounter a doctor with an ultrasound in his or her pocket and you may wonder what the heck this is all about.

So this post is a sort of “mini-Medical School” into the use of ultrasound in clinical diagnosis – a brief look at how clinicians of today can use this tool in medical practice.

Most medical students are repeatedly taught that 80% of the diagnoses they make on their patients will be from the history and physical exam.  In other words, fancy blood tests, high-tech imaging (x-rays, CT, MRI . . . ) and other extensive tests are needed much less often than we all may think – perhaps just 20% of the time.  So we teach doctors-in-training to learn the skills of talking to patients and laying on of hands by doing a physical exam.  Most of us can recall some of our mentors and teachers, patiently and skillfully showing us the tried-and-true physical exam skills.

An anecdote from my training about one of the great ones . . .  I rememasingerber Dr. Richard Asinger, here at HCMC, putting his stethoscope on the top of a patient’s head.  I thought he was messing with me, but he said he could actually hear a heart murmur up there.  I was in awe of this pure genius.  On the other hand, maybe he really was just messing with me!  He’s still at HCMC; I should go ask him.  On a side note, he’s also a killer dancer on the dance floor.

But even listening with our stethoscopes to hear abnormalities of the heart (murmurs, for instance, which could mean valve disease) , or of the lungs (like rales, which could mean pneumonia) it is still a bit primitive.  Sometimes we want to know how much extra fluid a person has in their body due to heart failure (called hypervolemia).  Or we need to know if they have a partially collapsed lung with air around it (called a pneumothorax).  Or if they have a blood clot in their legs (called a deep venous thrombosis, or DVT).

So that is where ultrasound comes in.

iStock_000063540139_Large

This is an ultrasound image of a heart.

  • See the four chambers?  Clockwise from upper left: right ventricle, left ventricle, left atrium, right atrium.
  • See the valves?  There are four valves in your heart – you can really see the mitral valve leaflets in this picture – the two white lines that look like a tent at about the 3:00 position.

If the chambers and vessels look big – maybe you have too much fluid in your body.  If the valves are not opening and closing correctly, maybe that is what is causing that murmur we hear with our stethoscope.  If the heart is not beating strongly, you may have heart failure.  So much information can be learned from these pictures!

Ultrasound training with the HCMC Hospitalists

I thought Healthy Matters listeners and blog readers may like to see how we stay competent in the medical profession – so here’s a sneak peek of our group at HCMC  learning to use ultrasound in our daily practice.  The technology is really neat.  The machine is just a bit bigger than your smartphone, so now we can carry them around in our white coat pockets.  I think you will see more and more of this when you are a patient – doctors pulling out teeny little ultrasound machines.  I have even heard that we will be able to use our smartphones for this purpose at some point.

Here’s my colleague, Dr. Mike Lawson – an HCMC graduate, all-around good guy, and Minnesota Vikings fan – recently returned to Minneapolis after a spell as a doctor in the Seattle VA Medical Center.  He’s really good at using ultrasound and one of the best teachers around so he was helping the rest of us become proficient at it.

Mike

These pictures are of two of our outstanding clinicians working with the ultrasound machines (Chief Resident Dr. Marissa Durman on the left and Physician Assistant Erica Monroe at right).  Look at how tiny the machines are!  The doctors and PAs in our group were worried that they were going to have to do ultrasounds on pregnant women.  No worries – we have specialists for that!  Relief all around.

Ultrasound training at HCMC

From putting an ear to a patient’s chest to listening through the tubes of a stethoscope to using sound waves on a portable ultrasound.

The centuries-long attempt to probe the human body continues.

 

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When weight loss surgery makes sense

“Ohartley in studionly 1-2% of people who could benefit from weight loss surgery are actually getting it done”

So says Dr. Gil Hartley, my radio guest this week on Healthy Matters.  Dr. Hartley is an internal medicine physician, like me, who specializes in the care of people who are very overweight.  We focused our conversation on bariatric surgery – which is the medical term for weight loss surgery.

Here is the Healthy Matters podcast page to listen to this show or any of our recent shows.

BMI checkerThe first step to knowing if weight loss surgery may be right for you is to calculate your own Body Mass Index, or BMI.  You just have to know your height and weight, and it takes less than a minute to do.  Find out your BMI by clicking the button —>

What does the BMI mean

Here are the categories of BMI:

  • <18.5       = Underweight
  • 18.5 – 25 = Healthy weight
  • 25 – 30    = Overweight
  • 30 – 40    = Obese
  • >40          = Severely obese

It may be emotionally hard to find out which category you fall into – and you’d be right to note that it is just a number.  But think of it as a starting place, and if your BMI is high, perhaps now is the time to take action.  Especially if your BMI is greater than 40 in which case  I really encourage you to see a weight loss surgery expert.  For people with diabetes, the BMI at which to consider surgery drops to 35.

Is weight loss surgery right for me?

As Dr. Hartley mentioned, weight loss surgery is the best option for many people who are excessively overweight – the people who are at risk for complications due to their weight – diabetes being the most prominent example but also including high blood pressure and obstructive sleep apnea.  I won’t get into all the details, as there are lots of good resources for people who are overweight or obese (for instance, check here for good info from the National Institutes of Health – a source you can trust).   But what struck me about my conversation with Dr. Hartley was when he said the resistance of people to getting weight loss surgery is still a real problem.  And he isn’t trying to peddle unnecessary surgeries on anyone.  He simply knows firsthand that surgery is the best solution for many people.

And don’t be too hard on yourself.  Being overweight is not a character flaw.  For most people, it is also not just a problem with overeating (although that is the problem for some).  Rather, obesity is a complex chronic condition with lots of causes and contributing factors.

I’ll close with a few more things I learned from Dr. Hartley today about weight loss surgery:

  • Weight loss surgery may be the most effective treatment for diabetic patients who are obese.  Some patients actually leave the hospital after the surgery without needing their diabetes medications anymore!
  • We used to think it did not matter when you did your surgery.  We told people to just think about it and do it whenever you are ready.  Doctors are reconsidering this due to more recent evidence that suggests that getting it done earlier leads to better longer-term health in patients with diabetes.  So waiting for years and years to do the surgery may not be the best idea after all.
  • The laparoscopic banding surgery, which showed great promise 10 years ago, is used much less today.  The two more common surgeries are gastric bypass (Roux-en-Y), and vertical sleeve gastrectomy.
  • You can drink liquids without problem after weight loss surgery.  One caller to the show was worried about being thirsty after surgery.  Not to worry, you can still drink liquids normally as they just pass through your system just like they always did before surgery.
  • Loose skin can be a problem for some after weight loss surgery (to the degree that cosmetic surgery is considered), but for many people the skin does remodel back to a less bothersome condition over time.

If you are in Minnesota and want to take action on your weight . . . here is information on Dr. Hartley and his team at the Hennepin Bariatric Center.

Thanks for joining me on the air, streaming online, and on MyHealthyMatters.org!

 

 

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Every 8 seconds: the science of brain injury with Dr. Uzma Samadani

There’s big news from HCMC this week.  Many know that HCMC is the largest provider of TBI care in the state of Minnesota.  But many don’t know that we are also a major research institution and in no area is this more true than TBI.

The big news is that our researchers are launching the largest single-center study of brain injury in the United States.  It’s been all over the news – check out the buzz this is getting in the national media.


But I don’t have to go to the national media, I just have to walk down the hall to talk with people who are quite literally the country’s leading researchers.  So I dropped by the laboratory of Dr. Uzma Samadani (<–click for her bio) here at HCMC.  She’s super cool even when I gave her only 10 minutes notice before showing up in her office!  Check out the short video clip above – and be sure to listen to the end to hear Dr. Samadani’s important advice about protecting kids from concussion/TBI.  For a more in-depth perspective from Dr. Samadani, click on the TedMed video below (it’s only 6 minutes long).

Eye tracking

Every 8 seconds someone has a traumatic brain injury.  But you may be surprised to learn that doctors really don’t have great answers to the most basic questions like:

Do I have a brain injury?  How bad is it?  Where is it in my brain?

That is what the researchers hope to answer.

Shakira’s hips

Shakira’s hips?  Huh?  Rather than have me try to explain it – watch this brief talk by Dr. Samadani herself.  It is fascinating.

So Dr. Samadani and her team are doing research based on the knowledge that you can actually track the movements of a patient’s eyes to help answer these questions.  As it is now, doctors wave their finger in front of a patient like we have been doing for centuries.  The researchers are hoping to change that by studying all sorts of ways to diagnose brain injury – using blood tests, eye tracking, and imaging (x-rays and pictures and the like) . The eye tracking technology in particular could be game-changing in the way we diagnose and treat brain injury.  For more on eye tracking, click here.

I am convinced that some day the research being done right here at Hennepin County Medical Center and the University of Minnesota will change the lives of millions of people.

That excites me!

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Quick tips: ABCs of cholesterol and other meaty topics

Hi from the mailbox!DRH Letterbox

Another great Healthy Matters show this week -thanks to the listeners who are up on a Sunday morning – getting dressed, eating breakfast, going to church, drinking their coffee – and tuning in to listen to me talk about fungus and pus.   So a heartfelt THANK YOU to Healthy Matters listeners and for your terrific questions by text and phone.  

If you have not heard the show yet, you can do so a few ways:

  • Live radio broadcast:  WCCO 8-3-0 AM dial  – Sundays 7:30 a.m. Central
  • Live streaming on your computer/mobile: WCCO.COM  – Sunday 7:30 a.m. Central
  • Podcasts for listening at your convenience – podcasts available here.

The whole shebang is sponsored by my organization, Hennepin County Medical Center (HCMC) in be-yoo-tee-ful downtown Minneapolis.

This week’s post features quick answers to questions I received on the show.  These are quick and incomplete, so make sure to talk to your own doctor to learn more.

I’ll also be doing some video posts where I can answer questions by talking rather than typing . . .  look for those soon.

From the Healthy Matters mailbag

iStock_000022745765_Large

Several questions this week about cholesterol numbers, like this one . . . 

“My doctor recommended coming back in 6 months for repeat of cholesterol numbers and tweaking my lifestyle.  Is there an alternative to statins?”

Short answer:    Dyslipidemia, which basically means your cholesterol is out of whack, is a risk factor for developing cardiovascular problems in the future.  Statins remain the medications with the most scientific evidence to prove that they work.  There are alternatives, but none with such strong proof to back them up.

Longer answer:

  • LDL = low-density lipoprotein.  LDL = bad.  You want this one low.
  • HDL = high-density lipoprotein.  HDL = good.  You want this one high.
  • Triglycerides = fats floating around your blood stream.  You want this low.
  • Total cholesterol = a combination of the above (but you can’t simply add up the 3 of them to get your total cholesterol – it is a more complicated formula).

Your body actually requires cholesterol for life since it is part of cell membranes and an important part of the normal steroid hormones that your body makes.  Most cholesterol is manufactured in your liver, with only a modest amount coming from your diet.

The trouble for many of us is that our cholesterol factories (aka your liver) don’toff switch have an “off” switch.  It simply makes too much.  Think of statin medications as the “off” switch.  Yes, they have side effects (the most common one is muscle problems) and as science progresses, we will undoubtedly learn more about these medications.  But for now, for the right people, if you have cholesterol problems statins are the best way to reduce your risk of heart disease.

Who are the right people for statins?  Here are the latest guidelines (new in 2015):

  • People who do not have known cardiovascular disease and are between 40 and 75 years old and have a 7.5 percent or higher risk for heart attack or stroke within 10 years.

      This is cool and you should do this –> to find out your 10-year risk of heart disease, click here.

  • People with a history of heart attack, stroke, stable or unstable angina, peripheral artery disease, transient ischemic attack, or coronary or other arterial revascularization.  (Basically if you have known cardiovascular disease).
  • People 21 and older who have a very high level of bad cholesterol (190 or higher).
  • People with Type 1 or Type 2 diabetes who are 40 to 75 years old.

There are a LOT of people who could be taking these medications and receiving the benefit of reduced risk of heart disease.  Click here for a nice discussion of the guidelines.

 


Read on for another related question . . . 

“I thought the higher the HDL cholesterol the better.  My HDL was 100, LDL was 128, triglycerides 27.   Doctor expressed concern that sometimes an HDL at either extreme can be a problem . . and ordered a VAP test.”

Here is an analogy that works for me.  Bear with me, I made this up . . . 

Cropped shot of rubbish that's been put out for garbage collection day

Think of LDL and triglycerides as “garbage” floating around your bloodstream and attaching itself to your blood vessel walls, like garbage accumulating on the curb.

 Too much garbage = a mess of badness.

Now think of HDL as the “garbage trucks” driving around, picking up the garbage from the curb (vessel walls), and delivering it back to your liver where it can be processed and removed.  

You want lots of garbage trucks.

So in general, you want an HDL that is high (preferably 50-60 or more).  But can it be too high, as this questions asks?  Well, yes, it is true that HDL that is not working properly is not only ineffective in its garbage truck duties, but may actually be harmful.  However, we really don’t know what to do with that information.

The VAP test is a series of advanced tests that can more accurately pinpoint your cholesterol situation.  As I mentioned on the radio, however, we still don’t know what to do with the information since  getting the test will usually not lead to any change in treatments.  After all, we don’t really have any additional proven treatments.  So you can get the VAP test if your doctor recommends it, but be prepared to hear the same advice when it is back:  eat healthy, exercise, don’t smoke, take a statin if indicated.

And choose your parents carefully.


On to a new topic from the mailbox . . .

iStock_000021022726_Large“Do acid control medications cause Alzheimer’s Disease?”

Short answer.  We don’t know.

Longer answer:  This one has been in the news as of late since a group of German researchers published the results of their study which showed an association between proton-pump inhibitor use (PPI) and the development of dementia.  The study was in people over 75 who did not have dementia at the outset, but who were taking one of the common acid-suppressing agents called PPIs.  Examples (among many others) of these drugs are omeprazole (Prilosec) and lansoprazole (Prevacid).

 The study showed that more people on these medications developed dementia than those not taking them.  Why this may be the case is not known.  But it is really important to note that the association between these medications and dementia is not proof of causation.  In other words, these medical studies do not prove that doing one thing (taking the acid-suppressing medications) actually causes the other thing (getting dementia).   Here’s a link to the actual study if you are super into medical journal articles with subtitles like “A Pharmacoepidemiological Claims Data Analysis” – I’m not joking, that is the actual subtitle of this real page-turner.

Bottom line:  this is not a reason to stop taking your acid-suppressing medications if you have a strong indication to do so (you have proven acid-reflux disease, for instance).   I should add that many people take acid-suppressing medications for shakier reasons and probably don’t need them in the first place.

 


One more for the good measure . . . 

“Paryonychia on thumb. Causes?”

OLYMPUS DIGITAL CAMERA

Paronychia is an inflammation around the finger- or toenails.  It is sometimes chronic (long-lasting) but often acute (comes on quickly and resolves).  It is usually due to a bacteria or fungus getting in the grooves around your nails.  It shows up as a sore, red, and swollen area around the nail.  The acute kind may be due to minor daily-living types of activities (dishwashing, trimming nails, minor trauma . . . ) and may not need any specific treatment other that putting warmth or topical anti-inflammatories on it.

If there is pus oozing out of it, you may need antibiotics or drainage by your doctor.  Chronic paronychia may be due to a fungal or allergic type of dermatitis, and may require topical treatments with anti-inflammatories or anti-fungals.


The rest of the mailbox

To give you a sense of the range of topics on a typical Healthy Matters Open Lines show – I’ll show you a partial and condensed list of the topics listeners raised this week but that I did not get to cover.  I’m struck by the range of questions – and also just how legitimate they all are!  Doing the radio show really makes me aware of the shared human condition – I bet most of us can relate to something on this list . . . !

  1. Febrile seizures in infants.
  2. What is neuropathy?
  3. Clostridium difficile infections.
  4. Atrial fibrillation.
  5. Cold sores in a young adult.
  6. Epilepsy in children.
  7. Ear infections.
  8. Testing for Diabetes type 2.
  9. What is pre-diabetes?
  10. Causes of dry tongue?
  11. Carpal tunnel syndrome.
  12. High calcium in blood tests.

Keep listening, keep checking out the blog . . . and if you have a preference for what I should cover in the future please leave me a comment and I’ll do my best!

 

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