Medial Monday: A joke of a research study

I think we can all agree that the following three things are good : 1. Chocolate 2. Humor, and 3. Getting the bad guys in a sting operation. This story I am going to feature for you today has all three. 

Science Journalist John Bohannon and his well educated friends created a bogus study on the health benefits of chocolate. To do so, he created a bogus health institute, and a bogus study wherein he enrolled 18 unsuspecting individuals. They followed through with the study protocol and a statistician ran the results. Lo and behold, those in the chocolate group lost weight faster. He then goes on to explain how this is obviously a falsely significant result, otherwise known as a " false positive". A study designed this way is bound to have numerous false positives. This is related to the very low number of people in the study and the high number of effects tested for. Any person educated in the basics of research could see this. 

He and his colleagues "wrote up" their paper on their "research", generated a catchy press release, then began submitting the paper to a variety of journals for publication. He included journals of borderline credibility, and those which are "pay to play" meaning you have to PAY THEM to get your article published! (I didn't even know these existed!) He had alarming rate of acceptance of this ludicrously flawed paper. Once it was published and picked up by all kinds of news services and magazines, he fessed up to the prank. I am sorry to say it was picked up by the likes of Huffington Post, and Shape magazine. Have a look at their glossy reporting of the bogus story in his article linked below. 

All this goes to illustrate what I have cautioned readers about all along: The need to critically evaluate what you read on the internet and elsewhere on the subject of health and medicine. So much misinformation is out there. Much of it is done by groups who know better, but who are in it for the profit. 

And yet, at the same time, so many promising things are happening in medical research. Please take a few minutes to review our section on Information and Learning. It will give you some basic tools with which to safely navigate the internet. 

And then for some real entertainment and information, check out John Bohannon's article exposing himself HERE. His interview on NPR about his elaborate ruse is featured HERE. Finally, here is a fun and scientifically solid site about health reporting in the media: HEALTH NEWS REVIEW, where they look at the the good, the bad, and the ugly. 

Have fun and be careful about there. 

Wellness Wednesday: Quantify Yourself

I have always said that knowledge is power. This is especially true in this digital age since we have access to so much searchable knowledge. I have also always said that one of our primary goals in our medical practice is to empower women to take charge of their own health.  It is therefore natural that I am very interested in helping women to empower themselves through the use of technology.

It turns out that one of the most powerful things we can do to take control of and change our own behaviors is to observe, record and track them. This habit is called quantification. People who do this regularly as a part of their self improvement are participating in the "quantified self’ movement. Livescience.com defines the quantified self movement as a “movement which aims to measure all aspects of our daily lives with the help with technology.” 

Quantifying ones habits such as hours of sleep, minutes of exercise, or calories eaten, does not necessarily need to be done with a high tech device. It can be done with paper and pencil. However, since smart phones are nearly ubiquitous, these records are most often kept on these small powerful personal devices.  Of course there is a proliferation of different apps for this, one for every topic and several for many parameters. Not only is there a proliferation of different software apps to help with quantification, there is a proliferation of different hardware such the Apple watch and the FitBit. 

If the patient and I decide to follow some detail of her health such as her blood sugar, we begin some sort of record keeping. The patient makes the measurements, records them and naturally evaluates them herself as she goes through the week. This alone often results in substantial improvement in her numbers, since she can begin to discern patterns and the reasons behind them. Taking measures to push the data toward better performance is gratifying day by day. It becomes like a game that the patient is determined to win. This is called ”gamification" and it too, it is powerful in behavior change.

When the patient comes in to review her data, she can get even more benefit when we analyze her data together. If we add another layer such as her diet, and superimpose it graphically on the blood sugars in her records, we can see a cause and effect relationship between what she eats and her blood sugars over time. Sometimes a third layer of data such as activity can be added into her records and we can use this variable to improve her blood sugar control even more. 

This kind of record keeping puts the facts and the control in the hands of the patient. It is much more effective than a doctor simply telling her to eat better and exercise more. It has been my consistent observation that all sorts of patients have success with this type of approach. Moreover, in reading about this "quantified self movement" it seems apparent that this technique can be used for many types of conditions, like weight, exercise, autoimmune activity, sleep problems and even mood disorders. It can also be used for broader issues of life performance, in relationships and on the job. 

I hope this introduction into the quantified self movement has inspired you to learn more. Here are some fun references which makes for very interesting reading.

The Quantified Self, a TED talk by Gary Wolf

The Quantified Self at Livescience.com

The Beginners Guide to Quantified Self, at Technori

Why You Should be tracking Your Habits ( and how to do it well) at Lifehacker.com

The Quantified Self: How Cold Hard Data Improves Lives, at Bloomberg.com

The Data Driven Life, at the New York Times 

How Self-Tracking Apps Exclude Women, at The Atlantic

Medical Monday: Skin Deep

What does it take to be beautiful ? I mean physical beauty. It it feels so awkward to even ask this since, in general, beauty is mostly a matter of the heart.

 You might be surprised to hear about my idea of physical beauty. Basically, to me, physical beauty equates with health. Every face, every age, every body type, hair type or skin color is beautiful when it is healthy. 

Skin is especially telling. It is the first thing we see. The skin of the face is vulnerable and worthy of our protection. It is sun season again, and I would love to see everyone take pride in and care of their skin. 

What are the main steps to beautiful skin ? 

• Optimize your fitness, nutrition and hydration. 
• Cleanse and moisturize twice per day. 
• Exfoliate once per week.
• Sun (UV) protect ardently. 
• Never tan. Never. 
• Be assured sunscreen is safe.
• Chose a broad spectrum sunscreen with SPF 30 or greater. 
• Chose a water resistant brand. 
• Apply 15 minutes before going out so it will soak in. 
• Reapply every 2 hours. 
• Consider a hat or SPF clothing. 
• Get a partner to "watch your back" for any suspicious moles. 
• See your dermalogist for any concerns. 
• Enjoy summer. 
• Be beautiful. 

Medical Monday: You asked for it… Endometriosis

Women are curious about endometriosis because it is a curiosity. The causes of endometriosis are not precisely understood but we have a good working knowledge.

We do know that it involves endometrial tissue being extruded out of fallopian tubes and into the pelvis. There, in a subset of women, the tissue implants and becomes active. Then, in a subset of these patients, this tissue secretes inflammatory mediators. Finally, some of these women develop autoantibodies. Pain and infertility can result from all of the inflammation and the damage that it causes. Cysts full of liquid can form; scarring can block tubes and distort anatomy. 

Treatments are of two types: medical and surgical. Medical therapy makes good sense because we know that endometriosis is hormonally responsive. Conservative surgical therapy is helpful to drain cysts, cauterize lesions, and release adhesions such as the ones in the photo. Definitive surgical therapy includes removal of the tubes, uterus and ovaries. 

Recently I was asked to review a blog post posted on my Facebook page. (See blog post HERE)  It was by a naturopathic doctor who was proposing a different approach to endometriosis. She was postulating endometriosis as an autoimmune disease. Apparently she had read a speculative literature review article, (Reference HERE) which noted an increased prevalence of inflammatory mediators and auto antibodies in those with endometriosis. Despite anything like a high level of evidence, (See levels of evidence HERE) she drew a causal relationship between these findings in the occurrence of endometriosis.

I think the authors of the study would consider these findings noteworthy associations, but would not feel entitled to draw any further conclusions such as causality.  I myself would say her blog post thesis is a case of confusing eggs with chickens. In other words, endometriosis probably causes inflammatory mediators to arise and fosters the development of autoantibodies, not the other way around as she proposes. Some people are more immunologically reactive than others, and those that are will likely develop more autoimmunity of whatever type. 

It is important to note that the author of the blog post draws a conclusion from this paper from which no conclusion can legitimately be drawn. She goes on to propose therapy, including modifications in diet, i.e. going off dairy and gluten. She then suggests her book which further discusses endometriosis and the "natural immune-modulating treatments" which she offers. 

I see two main differences between legitimate medical websites and others. First, legitimate medical websites are evidence based. This  means that not only must they cite medical research, but that they must cite it correctly, and not draw unfounded or speculative premature conclusions for associations which may be suggested. Secondly, legitimate medical websites are realistic. Others are boundlessly optimistic, offering readers and customers results that invariably surpass conventional treatments. 

I say, follow the money. Also, if it seems too good to be true, then it probably is. Finally, the proof is in the pudding. 

Click HERE for your internet learning toolbox. 

To learn more about endometriosis, check out our straightforward page on this common disease HERE. 

Medical Monday: Gardasil Gets an Upgrade

Most of you are familiar with Human Papilloma Virus, aka HPV. This is the very prevalent virus which causes precancer and cancer of the human anogenital area. When I first started training in gynecology, fighting HPV seems like such an uphill battle, since it spreads so easily and is so prevalent. And then came the idea of a vaccine. It seemed too good to be true. 

Gardasil was developed and released. I am proud to say one of my friends was involved. It protects against two strains of HPV known to cause cancer, and two which cause condyloma or warts. Physicians all over the world rejoiced, but adoption rates weren't what we had hoped. 

Gardasil was initially studied in girls and women since the disease caused in women is more common and more severe. And so it was initially approved only for women. I got all my children vaccinated, and even the boys before it was approved for boys. One of my sons did some research after he got his shot, and approached me later, asking, " Mom isn't this just for girls ? " I reassured him that nothing bad would happen. It works just as well in boys and men, who distribute the virus, usually without having any disease themselves.  It eventually was approved for boys. 

Now Gardasil has been expanded to cover NINE viruses ! It is worth noting who is eligible to receive it: 

Boys ages 9-15.

Girls and women ages 9-26. 

 I expect that the age differential in eligibility between boys and girls is simple a case of what groups have had validating studies done, and I anticipate that the boys group will be expanded to the same age group as girls eventually. 

Chilling statistics anyone? 

" In 2013, coverage of at least one dose of HPV vaccine was 57.3% among adolescent girls and 34.6% among adolescent boys2. According to the CDC, for every year that coverage does not increase, an additional 4,400 women will develop cervical cancer3. Furthermore, if health care providers increase HPV vaccination coverage to 80%, it is estimated that an additional 53,000 cases of cervical cancer could be prevented during the lifetime of those younger than 12 years." 

reference: ACOG Clinical Practice: The 9-Valent HPV Vaccine 

Gardasil has had a very good side effect profile, with just some arm soreness at the site. We believe its benefits far outweigh the risks. 

To learn more about HPV, please see Pap Smears, HPV and Cervical Health. 

Medical Monday: Participatory Medicine

Are you an empowered patient? Do you participate in Medicine 2.0 and Health 2.0? Learn more about these terms and the interesting and beneficial changes that they describe.

Click HERE to learn more. 

P.S.  We would be very pleased if you would consider subscribing. I have placed a Subscribe and Comment page in the navigation menu for your convenience. When you subscribe, you will receive a White Paper (see definition HERE) entitled "How to Become an Empowered Patient " with our compliments. 

Structure Sunday: The Structure of a Website and ….YOU

Just last week Google lowered the boom and decreed that sites that are not mobile friendly will suffer in search rankings. At first I felt a little threatened, but after a little research, I have discovered that it is all about….YOU! Yes you. As they say in TRON, “I fight for the users.”. 

I love nothing better than to come into a patient’s room and see her on a smartphone. Do you realize any garden variety smart phone of the present day is literally powerful enough to have run the entire Apollo space program that landed a man on the moon? A smartphone is a very powerful computer and almost every girl and woman I know has one, even the ones of modest means. It is fantastic. Not only do I remember the Apollo missions, but I remember the days when women did not touch technology, not even stereo components. 

Technology is empowering. Information is empowering and the whole world of information is at your fingertips. Patients read about diagnoses, medications, and communicate with others who share their experience. So it is with great satisfaction as I watch my patients as they not only use technology, but make it. I have in my practice graphic designers, filmmakers, website designers, software engineers and IT administrators. I do believe it is technology combined with the goodwill of people, that will solve many of the world’s problems and inequities. As a force in neutralizing gender inequalities, technology is formidable. 

In blogging, and in making this website, I have wanted to provide easy access to what I would like my patients to know. My education has made me  familiar with the best sources of medical knowledge, i.e. institutions like the National Institute of Health (NIH), and the Center for Disease Control (CDC). It has enabled me to tell the legitimate from the bogus. So I feel obliged and enthusiastic to give you all key to all the doors that lead to the best paths to all this valuable information. I want to make it easy, and I want to make it fun. Additionally, I want to make it beautiful. Perhaps this last goal is a universal desire for website designers of all genders, but I think a beautiful website is more welcoming to women. 

And that user experience, in short, is what Google’s directives have been all about. I see from my website analytics that over 50% of you view the site on mobile devices. Had I looked to author my site looked on mobile? Not enough! The main page was cluttered, the font was too small, links were too small to push and you had to scroll way too much. All this gave me a very bad mobile rating on Google. Plus, page loading times were a bit long, and I admit, that is because of the higher definition photos that I chose to upload. This was all a very unpleasant but useful revelation. I felt bad but grateful for all of you devoted readers on mobile who slogged through all of that. 

I read a great deal in Google’s website design and mobile responsive design guidelines. At their heart, the recommendations are meant to enable you, the user, to see the site clearly, and to get the information you want as conveniently as possible. It is all about enhancing the user experience. I spent this weekend changing things around, using fewer main pages, and tucking more within them, so now you will do more clicking and less scrolling. And I promise, if you have a little wait for a photo, it will be a good one. More mobile friendly changes are coming next week. I fight for the users! Those of you who really want to get your geek on can learn the origin of the phrase in this clip from the movie TRON Legacy. 

Medical Monday: C Section Delivery

Do you know about VBAC, TOLAC and RCS? Obstetricians love acronyms. The website section about C sections has been updated and expanded to include a comprehensive section on VBAC (vaginal birth after C section), TOLAC (trial of labor after C section) and RCS (repeat C section). Go to the general C section page, then scroll down to the part on Repeat C sections and VBAC.  

Click HERE to learn more about this hot alphabet soup. 

Wellness Wednesday: Knowledge is Power. Get some.

I recently finished and published the website's pages on Infections in Pregnancy. At the bottom of those pages, I have added that much again in a new section called "Other infections of Perinatal Significance". Now this may sound way too scientific and unrelated to daily life, but nothing could be further from the truth. These are the big time everyday infections we hear of each week: Pertussis (whooping cough), Bacterial Vaginosis, Toxoplasmosis, Influenza, Herpes, Chicken Pox, and more. Learn more about these common infections and how they pose special risks to pregnant women. Learn what you can do to protect yourself and those around you. 

And, also coming tomorrow, will be a special section on Preterm Labor. Learn the facts and figures as we know them, and how we handle Preterm Labor today. Hint: It is not how we handled it even 5 years ago. 

Medical Monday: Pelvic Floor Relaxation and Prolapse

Baby shower cake: champagne cake with raspberry filling, courtesy of MISS PATTY CAKES of Kalispell, Montana 

Here's a problem that besets 1/3 to 1/4 of all US women, and that is rarely discussed. The risk factors are common and it greatly affects quality of life. This blog post will lead you to a newly completed page on this very important topic.

To learn more on this fascinating and important condition that affects so many, click HERE. 

And just so you know, this post is serving both as your Structure Sunday and Medical Monday posts for two reasons:

1. It required quite a bit of time and research

 2. On Saturday I threw a baby shower for our daughter Echo, who will have our first grandchild in May : ) 

Many thanks for your patience, 

Dr. Gina 

Medical Monday: Hysterectomy

Hysterectomy is a topic that is highly politicized in our media and in our culture. It is the most common operation that women have except for Cesarean section. The reasons or indications for hysterectomy are fairly well defined. And yet there is debate about when to do them and how to do them. The good news is that the quality of our research and the quality of our surgery is improving by the day. Our decision making processes regarding treatments, our ways of discussing options with patients, and our methods of surgery are far better than they used to be. 

Click HERE to learn more. 

Structure Sunday: The Structure of Laparoscopy

In the " olden days" all surgery was done through open incisions, meaning an incision large enough to see and get at whatever you were operating on. During my Ob/Gyn specialty residency training in the years 1990-1994, our profession made a big transition to laparoscopy. Instead of large 14 cm incisions for a hysterectomy for example, we made a 1-2 cm incision tucked discreetly under the belly button and two others out to either side of the same size. We would use instruments on sticks in the side ports to do the surgery. Most recently we have a adopted the use of the multi-armed Da Vinci Robot for laparoscopy which confers numerous advantages to surgeon and patient alike.

One a warm evening in 1992 in a synagogue in Boulder Colorado, I had the pleasure of meeting an elderly Russian man and his family. His wife was a cardiologist and his adult children a variety of scientific professionals. They were recent refugees to the States. Despite their education and experience, they could only find work at McDonalds.

 The old gentleman himself had been Chief of Surgery in a large Russian hospital. Since his children spoke English, I decided to chat with him though a translator about what surgery we were doing at the University Hospital. I described the new laparoscopic technique, from the small incisions, to the use of CO2 gas to elevate the abdominal wall, and the positioning of the patient with her head down, to get the bowel out of the way of the pelvic organs. I described the long straight tools which we inserted in the two side ports, one cautery, and one grasper, and how we could switch out for a scissors which rotated at the end. There we sat at a festive dinner table after services, with good food, and these amazing people, discussing the latest advances in surgery. I had to suppress my eyes from getting misty when I contemplated all they had been through. I thought he would be so proud and pleased. 

He listened thoughtfully but his face was very grave. I feared he had not understood me. He seemed restless. I finally had to ask his daughter what was the matter, and she measured her words in a thick Russian accent. He did not believe me. He said it was impossible. He thought I was mocking him. Despite my best efforts, he gathered up his family and left. 

I wish I could have a chance to show him all that I have presented for you in the latest section of my website: Laparoscopic and Robotic Surgery. Click HERE to see it. 

Structure Sunday: The Structure of Surgery

Surgery is a major intervention. It can be a wonderful help and a positive experience, but only if patient and surgeon work together closely. 

Learn more HERE. 

Medical Monday: Another Obstacle to Health Care: Anti-science

What does vagina steaming and the recent measles outbreak having common ? Need a hint ? OK. What can make people on both sides of the political spectrum mad ? You guessed it ! The anti - science movement. 

According to that venerable site rationalwiki.org, anti science 

" refers to persons or organizations that promote their ideology over scientifically-verified evidence,[3] usually either by denying said evidence and/or creating their own." 

Recall that science is advanced through the scientific method, which involves testing hypotheses with experiments, then revising said hypotheses. Experiments should be on done on that which is measurable, done blinded, controlled, and should be reproducible and peer reviewed by the appropriate scientific institution. Science is always undergoing a process of refinement based on observable facts. 

This should be clear. Yet the media and advertising to which we are daily exposed has become a brew of fake science and real science. How is a person to know the difference ? Well you can use your gut feeling of course. ( And I have a bad feeling about vagina steaming.)  Or, you can have a look at my section of this site where I try to give some help on this issue. It is called Information and Learning. I try to give you some tools with which to navigate the information stream coming at you every day. 

Let's look at some hot news topics where anti-science is in play: climate change, genetic engineering, vaccines, juice cleanses, GMO food, stem cell research, and yes vagina steaming. These topics are especially hot in election years, and when money is involved. 

Here is a great article in Scientific American about a science quiz given to presidential candidates 2012. 

Click here to either laugh or cry. 

Here too, is a fair handed look at anti-vaccine sentiment on both sides of the aisle from Slate. 

Here is fantastic compendium of articles from various writers on the anti-science movement from Huffington Post. 

I would like everyone to take a charitable look at the nature of our national dialog. Feelings are running high, especially in the wake of the recent measles outbreak. In this climate, where there are many voices clamoring to be heard, let us keep the dialog civil and ahem, scientific, whenever possible. 

In that spirit, I will share with you an article about one of my favorite most well intentioned celebrity health gurus, Gwyneth Paltrow. Don't get me wrong, I love Gwyneth. Her site, Goop.com is full of lovely recipes and pretty unaffordable clothes. She has a holistic approach and a lovely positive attitude which really does count for a lot. HOWEVER, I cite this article below to show that sweet well intentioned people can get it wrong. Enjoy, and remember that laughter and affection are the best medicines. 

Three Reasons You Definitely Shouldn't Get Your Vagina Steamed , from Women's Health 

Food Friday: I'll drink to that

Drinks 

Modern drinks are the most deranged dietary items on the modern menu. Consider "Rock Star"  and the like. They are the deliberate and crass result of corporate engineering for maximal addictiveness at the least cost. Cheap artificial colors, caffeine, sugar and flavorings combined with carbonated water are all put into a flashy package, and marketed aggressively to young and old alike. 

Little did we know that rapidly digesting frequently consumed sugary drinks like these would have more to do with the obesity epidemic than consumption of actual dietary fat. But we should have known. 

Now we have in sharp focus the fact that simple carbohydrates of all kinds, sugar and flour included,  jet into our bloodstream faster than we can metabolize them. That spike in blood sugars triggers the body to store fat and very shortly thereafter, one is left devoid of energy in the so called sugar crash. 

Not only has this contributed to obesity, it has also contributed to heart disease, diabetes and the like. Moreover, these phenomena wreck havoc on mood and attention span, conceivably influencing behavior in both children and adults. Finally there is increasing evidence that foods like this contribute to irrtation in the gastrointestinal tract, possibly making us vulnerable to more inflammation and even autoimmune disease. 

Rant over. My newly minted section on Nutrition is just a beginning, but I would like to show the Drinks section to you. In it, I discuss more about carbohydrate metabolism and even go into the Glycemic index. Don't worry, we will do a lot more than talk about what not to eat. The most fun is yet to come when we get to the great things that we should be eating and drinking. This blog post will highlight drinks from a nutritional point of view. Click on the beverage below to read more. 

Medical Monday: Evaluating Medical Reports in the Media

Everyone is interested in medical news. It is inherently sensational. But, it is challenging to report, and even journalists with the best of intentions have a hard time getting it right. 

When an intelligent patient comes to the office and spends 15 minutes with her doctor, and the doctor goes through a detailed explanation, under the best of circumstances, only part of that will be correctly remembered. Here are some links if you are interested in reading more about that : 

How Much Can Patients Learn in a 15-Minute Doctor Visit?

New Prescriptions: How Well Do Patients Remember Important Information?

Long term clinical trials: how much information do participants retain from the informed consent process?

The difficulties are on both sides. Doctors have crammed schedules. They aren't always the best of communicators. Sometimes the doctor and the patient have differing agendas for the visit. And the patients are often distressed about what they hear, which impairs understanding and memory. 

Consider classroom learning. I need to hear things and be thinking about them, take notes, see diagrams about the topic, get handouts, look it over,  and repeat it all before it is really ingrained. This type of thing is also what patients need to understand a topic. They know this and so they head for the internet. That's where it gets exciting. 

Since I am in the process of building a website for patients, I have been researching other doctors' websites. They range from the sublime to the ridiculous. Most of the sites have some useful information. However too many of them contain unfounded claims and conflicts of interest by way of selling unproven remedies. In many cases the remedies involve foods or supplements which in limited lower quality studies, showed promise, but were never followed up or proven. 

I will highlight perhaps the most prominent of these internet doctors, Dr. Mehmet Oz. With the most impeccable of academic credentials, and a media empire to boot, he is under serious fire for making unsubstantiated claims and hawking unproven products. The best documentation of this to date is through Vox Media, what I would call the thinking person's news network. Until I read the series of articles at Vox, I had no idea, since I do not have a TV. Check out this entertaining and informative debate here. 

Meanwhile, if you would like to read more about how to safely navigate the internet, check a  series of pages on my site, starting HERE.  There are lots of internal links so be prepared to click. I really put my heart into these pages since I believe strongly in freedom of information and the patient empowerment movement. I hope they are beneficial for you. 

Medical Monday: Increasing concern over narcotic pain medications

The Flathead Valley has a problem with narcotics. I am told this is not unique to our Valley. I never thought I would have this much first hand experience with narcotics, even heroin. 

Problems with narcotics affect our women of childbearing age. Narcotic use in pregnancy is associated with low birth weight, preterm labor, SIDS and several major birth defects, as well as a lengthy neonatal withdrawal. 

Narcotics are a class of drug which acts in our body though our body's own neurotransmitter and receptor system. We have many neurotransmitters, tiny molecular messengers that allow us to feel sensations and even emotions. Neurotransmitters like dopamine bind, lock and key style, to specific receptors in nerve cells and set off a reaction which make perception possible. 

Narcotics also fit these nerve cell receptors. While bound at the receptor, narcotics can block pain and simulate pleasure. That is why they work, and that is why they are abused. 

If only that were the whole story. You see, when a narcotic binds at the receptor, it stimulates an electrical potential, or pulse, down to the end of the nerve cell, and there another neurotransmitter is secreted, further conveying the signal. If there is constantly narcotic at the receptor, the molecules at the other end get depleted and the system no longer works. 

The patient initially experiences relief with use of the narcotic. If too much is used for too long, it begins to no longer work. Worse still, more drug barely produces the feeling of being at baseline. No drug comes to feel worse than bad; hideous, in fact.  More and more needs to be used to even feel baseline. This is the basis of addiction. 

Patients, caregivers, and bad luck are responsible when things get out of hand. It is always easier to give or take a pill than to treat, cure, or work on things. Physical methods like exercises and therapy take time and are not always perfect. Surgery is expensive, and not always the answer to pain. Other nonnarcotic medications may be partial solutions. 

Life can be hard and confusing. Well meaning people can slip unknowingly from using pain meds to treat real pain, to using them to treat other things like withdrawal, anxiety, or their ability to deal with life. Those of us who care about these people need to start from a place of knowledge and compassion. No one really signs up to be miserable. 

Medical Monday: Infections by the numbers

Ebola is on everyone's mind. Worldwide the death toll is approximately 2000 people most of whom were in West Africa. People are not aware that it is not easily spread. The odds of getting it in United States are vanishingly small. Sadly there is not yet any vaccine for Ebola. 

To put the death toll from Ebola into perspective consider these numbers: 

9,700,000 children under five per year die from  preventable disease.

250,000 per year,  probably more from flu or flu related complications. 

100,000 per year die of measles of cholera 

1,500,000 per year die of diarrheal disease

Now let's consider our little corner of the world, Montana. Flu season officially started at the end of September. This year Montana has had 5 confirmed cases so far. However, in the previous reporting year we had a total of 3192 cases, 313 hospitalizations and eight deaths that attributed to influenza, with the bulk of cases being in December and January. 

What about Montana's other common preventable infectious disease ? It's Pertussis of course. It is also known as whooping cough. However in the previous reporting year we had a total of 661 conference cases. There were 361 hospitalizations and 15 deaths, mostly of people over 65.

Our scourges, flu and pertussis,  are vaccine preventable diseases. What about theGuillain-Barr syndrome (GBS) , or temporary paralysis ? It too has been studied and it's incidence in the US is around 3000-6000 cases per year whether or not a vaccine was or was not received. It has been determined that one is much more likely to get GBS after flu than after a flu vaccine.

 As I look at the disease rate time charts for prior seasons of each of these vaccine- preventable diseases, I see that we are right ahead of the big bumps in numbers of cases. I hope we get ahead of the curves this year. Pertussis and flu vaccines are available everywhere now. 

Big Soda versus Milk

I love a cold carbonated drink. Who doesn't ? But I am on a mission to get my patients off of soda. Why pick on one particular junk food and not them all ? Soda pop is a special concern to me since I care for girls and women. 

I have tried to educate my patients, young and old, about carbohydrate metabolism. Carbohydrates are the starches and sugars in our diet. We need them for energy, but we can only absorb them at a certain rate. The modern food industry has altered natural food materials in such as ways to make them taste good and not spoil. In short, they have processed the food, and that basically means the food is already partially broken down and relieved of its perishable nutrients. It is also filled with strategic additives to recolor, reflavor, or stabilize. When we eat processed carbohydrate, it jets right into our bloodstream since there is little breakdown left to do. The gratification is quick and the effect is almost addictive. Of course this is by design on the part of the food industry. 

Soda pop is the epitome of this phenomenon. I think of it as a sugar water IV. Even a young non diabetic person will raise their blood sugar beyond what it should be. What does the body do with excess sugar that it can't burn ? It stores it as fat. 

So many of us work hard to keep the waistline trim, and it turns out that is worthy goal. Truncal or waistline obesity is associated with cardiovascular disease. I have seen patients who drink large amounts of soda reduce their waistline and weight by just quitting that one thing. 

There's a special concern about girls, women and soda pop, and that is that it displaces milk as a common go-to beverage. It is consummately uncool to drink milk. I want that to change. You see, women are living longer than ever and in their older years, bone thinning is becoming a bigger and bigger problem. We women only have until the mid thirties to build are bone density. After that it's all downhill. It's just a question of how fast downhill, and from what height. 

So it is very important for girls and women to drink milk to build bone. Milk is rich in protein, Calcium, vitamin D and water. They need not be concerned about taking in too much fat, since skim or nonfat options are available everywhere. Furthermore, those with lactose intolerance can now find lactose free varieties on every street corner. 

It is worth mentioning that claims that soy, coconut, rice, almond, or hemp milk are superior are unfounded. None of them contain complete protein. They are essentially a complex carbohydrate and their role in a diet should factor that in. If as a lactose intolerant person I order a latte where there is no lactose free milk, I am happy to get one of these substitutes as the mood suits, but they are not a dietary substitute for milk from mammals such as cows or goats. 

So how am I going to get my fix for an ice cold carbonated drink ? Easy. I am going to buy one the newer elegant low sugar natural fruit based sodas. Or, even better, I am going to go home and mix plain club soda with crushed ice, a small splash of real fruit juice and a twist of lime. 

For more information about Big Soda, go to The Center for Science in the Public Interest.