Thursday, 25 February 2016
HEALTH BENEFITS OF CUCUMBER
Wednesday, 24 February 2016
Colonoscopy 101
Dr. Ginsberg |
In recognition of Colon Cancer Awareness Month, we spoke with Greg Ginsberg, MD, director of Endoscopic Services, about why colonoscopies are considered the gold standard for colon cancer screening.
What is a colonoscopy?
A colonoscopy uses a slender, flexible tube with a light and video camera on the end that allows the doctor to view the entire colon. Most colon cancers come from abnormal growths of tissue in the lining of the colon called polyps. A colonoscopy not only identifies potentially pre-cancerous polyps but also removes them. The entire procedure, during which the patient remains under sedation, takes about 30 minutes and is not painful.Are all polyps the same?
Most people think of polyps are mushroom shaped but now, thanks to high-definition endoscopes with electronic enhancing imaging, we’re finding flat lesions that may have been missed. These lesions have a more accelerated pathway to cancers.Who should get a colonoscopy?
Screening for the average-risk individuals – those without a family history or the presence of other medical conditions – starts at age 50. Some guidelines recommend that African-American men, who may be at increased risk at a younger age, start screenings at 45.If a person’s first colonoscopy is normal, the procedure should be repeated every 10 years, unless risk factors exist.
How should you prepare for a colonoscopy?
Prior to getting a colonoscopy, the entire bowel must be emptied. The prep is probably the most feared aspect of colonoscopy. Indeed, at one time, this required drinking a gallon of a prescribed preparation in a short period of time. But there’s been considerable progress in this arena. HUP uses a low-volume (half gallon) and split dose prep. The patient drinks one quart, waits six hours, and then the second.Providing a prep that people find more tolerable is essential: The quality of the exam is only as good as the quality of the prep.
Is colon cancer treatable?
In its early stage, colon cancer is often highly treatable but it’s a silent disease. There are no symptoms until the advanced stage, when survival rates plummet to less than 10 percent. Preventing the disease from starting remains the goal.Early detection and proper screening by colonoscopy can prevent 90 percent of colon cancers. I’m glad we’re demystifying colonoscopies. Knowing more saves lives.
To learn more about colonoscopies, download our free Prevention Guide or schedule a screening.
Tuesday, 23 February 2016
Health Benefits of Grapes
Either/or Thinking about Opiate Addiction
The story describes how Dr, Mark Willenbring, a psychiatrist specializing in addiction treatment, became frustrated at the limited uptake of medication-assisted treatment of opiate addiction, which, according a review of evidence in last year's Harvard Review of Psychiatry, doubles the likelihood of obtaining abstinence. Dr. Willenbring started his own treatment center, at which he makes extensive use of medications that reduce cravings and help many patients achieve stable abstinence.
The NYT article quotes a counselor who favors abstinence - treatment without medications - as follows:
"Substituting one drug for another is an external solution for an internal problem. [Dr. Willenbring’s approach] deprives his patients of the opportunity to have a full range of emotional experiences, a change of spiritual perspective and a return to an improved quality of life."Unless there's rigorous evidence for this view - and there isn't - it's an irresponsible symptom of either/or thinking. It should be a no-brainer that treatment for opiate addiction should combine medications, psychotherapy, 12 step programs like NA and AA, and more, in whatever combination seems best for a particular patient.
When I first entered psychiatric practice I was puzzled when people asked me what "camp" I followed. Was I a Freudian? A Jungian? A medication-oriented psychiatrist? Just what was I?
Sometimes I tried to explain why I thought the question itself was misguided. Sometimes I was provocative - I remember saying things like "if standing on my head and spitting wooden nickels helped my patients get better, that's what I'd do." But if I felt that the person I was talking with needed to put me in a "camp," I said I was a follower of Dr. Adolph Meyer, a distinguished early 20th century psychiatrist who embodied balanced thinking, and whose articles were published as The Commonsense Psychiatry of Dr. Adolph Meyer.
I assume that our earliest ancestors developed "us versus them" thinking as a way or consolidating their tribe. We still see all-too-much tribal thinking all across the globe. Medicine should set an example of thoughtful gathering of evidence, respectful discussion of alternatives, and steady improvement in what we have to offer. Either/or thinking and clumping ourselves into warring camps may give us a "high," but should not be part of our efforts to deal with as difficult a problem as opiate addiction!
Friday, 19 February 2016
All Physicians Should be Doing Palliative Care
My family member: The hospital recommended that X should have palliative care. What is palliative care?The question pointed to a real problem. Helping people suffer less and feel better is indeed what every doctor who cares for patients is supposed to be doing. So even though I'm a fan of palliative care, we have to ask: why does it exist?
Me: Palliative care is a specialty that focuses on symptoms - helping people suffer less and feel better. It's for people who have serious ailments. Its aim is to improve the quality of life for patients and families.
My family member: I'm confused. Isn't that what every doctor is supposed to be doing?
In my view, palliative care exists for three reasons - one good and two bad.
The good reason is that we've developed a lot of knowledge about controlling symptoms and improving quality of life, ranging from medicines and devices to psychological techniques to judicious use of community resources. Orchestrating all of these often requires a skill set beyond that of primary care physicians and subspecialists. Thus the emergence of a new specialty.
Bad reason #1 is the ethos of U.S. health care. It's displayed when we physicians, coming to the end of our potentially curative interventions, say "there's nothing more I can do for you." We should know better! 2,500 years ago Hippocrates taught us that our role was to:
One of my medical heroes is a clinician/basic scientist who cared for a dear friend of mine who had an incurable cancer. My friend came for an appointment after the last known treatment had failed. The physician said, "X, the best thing I can do for you now is to give you a hug." That's what he did. When I met the physician some years later and told him how much I admired him, he thanked me and immediately asked after my friend's spouse. Palliative care was part of what this physician expected of himself! I picture Hippocrates smiling and saying "you got it right."
Bad reason # 2 is time. When physicians ask each other about the most meaningful moments in our clinical careers, the stories are often about palliation - making contact, relieving suffering, bringing comfort. But the way we have structured medical roles makes it very difficult to spend the time required for giving good palliative attention. Rather than finding ways to make more humane practice possible, we've created the specialty of palliative care.
I have regular contact with primary care residents, and over the years a number have chosen further training in palliative care. It's not that they've turned against primary care - it's that they concluded that palliative care was the best way for them to practice medicine as they hoped to when they went to medical school. This is also why some physicians in practice choose the "concierge" format, in which they limit the size of their practice and make up for lost income by charging a fee for "belonging" to the practice.
But my belief that when we physicians care for patients we should all be doing palliative care isn't, alas, practical in 2016. I ended the dialogue by saying - "In principle you're right - every doctor should be doing that. But it isn't happening. Palliative care is a great idea for X. Go for it!"
Some Top 18 Healthy Living quotes to Remember
Wednesday, 17 February 2016
HEALTH BENEFITS OF FRUITS
Viagra and the Political Genius of Mary Lou Marzian
A health care practitioner shall:Representative Marzian, a retired nurse, wanted to expose the hypocrisy behind Kentucky's new law requiring a women to receive "counseling" 24 hours before having a legal abortion, in hope that Kentucky women would join her in saying "enough is enough." Not surprisingly, her proposal has gone viral. It's an act of political genius. Rather than offering another rant, she takes the precedent of legislative intrusion into medical care to its logical extreme - but focused on men.
(1) Require a man to have two (2) office visits on two (2) different calendar days before the health care practitioner prescribes a drug for erectile dysfunction to him;
(2) Prescribe a drug for erectile dysfunction only to a man who is currently married;
(3) Require a man to produce a signed and dated letter from the man's current spouse providing consent for a prescription for erectile dysfunction; and
(4) Require a man to make a sworn statement with his hand on a Bible that he will only use a prescription for a drug for erectile dysfunction when having sexual relations with his current spouse.
In addition to being hilariously funny, her bill represents a philosophical argument Socrates would have been proud of. His distinctive technique was to take an inadequately thought through position and show how it leads to conclusions his interlocutor cannot accept. If a picture is worth 1,000 words, a spoof like the bill Representative Marzian proposed is worth 10,000 or 100,000.
Hats off to a Kentucky legislator with the guts, wisdom, and delicious sense of humor to come up with the proposal she made!
(See here for an op ed by Representative Marzian in the Kentucky Courier Journal.)
Tuesday, 16 February 2016
Causes of Bad Breath – And How to Get Rid of It
The fear is real. You’re deep in conversation with a friend when, out of nowhere, you’re slammed with an alarming odor. Was it your breath? Your train of thought veers and all you can think about is a quick exit and searching for gum…mouthwash…any remedy for bad breath.
Bad breath, or halitosis, is an issue we’ve all encountered at one time or another. Whether we’re the culprits or the victims, it’s a problem most hope to avoid. Thankfully, rather than doling out embarrassing apologies for foul-smelling breath, there are several ways to prevent and treat halitosis. Tina McGroarty, CRNP, MSN, a nurse practitioner from Penn Family and Internal Medicine Lincoln shares three tips to keep your mouth smelling fresh and clean.
Limit Potent Foods
After eating a meal heavy with garlic, onion, or other flavorful—but stinky—ingredients, the food is digested and absorbed into your bloodstream, delivering nutrients throughout your body. Unfortunately, the stench of your tasty meal hitchhikes along for the ride, eventually arriving at your lungs, where it pollutes your breath. Since the odor lies in the lungs, the quick fixes for treating bad breath—brushing, flossing and rinsing with mouthwash—are only temporary solutions.
To save your breath, try to limit your intake of garlic, onions, some varieties of fish, and meaty meals. If you want to treat yourself but don’t want to deal with the repercussive stink, a glass of milk during or after a meal has been known to help deodorize breath.
Stay Hydrated
Saliva plays an important role in oral hygiene. One of its main jobs is flushing your mouth of the tiny food particles that stick to your teeth and gums. Without some spittle, those food particles become a tasty treat for bacteria. As the bacteria snacks on the teeny pieces of food left behind, they grow in number and in stench. Gross!
The absence of saliva in the mouth is also referred to as “dry mouth.” Dry mouth has hundreds of causes, such as:- Some prescription medications
- Dehydration
- Disease and chronic illness
- Consuming alcohol and caffeine
Lucky for us, dry mouth is easily prevented. Chewing on a piece of sugar-free gum may aid your saliva production and provide some minty freshness to your mouth. Another simple strategy is swapping that second cup of coffee or glass of wine with a refreshing glass of cold water. A simple glass of water can combat dry mouth by hydrating your body and flushing away pesky food particles and oral bacteria. If quick fixes aren’t enough, let your doctor know and he or she may be able to prescribe a more effective approach.
Your Overall Health (Schedule Annual Checkups)
Those of us with allergies or a cold, which can lead to post nasal drip, may notice our breath suffering along with our health. All that excess mucus is a feasting ground for bacteria, which creates an unpleasant scent.
In addition to acute ailments, chronic illness has been known to effect breath. Liver, gum, and kidney disease, along with many other conditions, may contribute to halitosis. Make sure you’re getting annual wellness check-ups to prevent and treat any underlying health issues. Once your general health improves, your breath will follow.
Tobacco products are also a sure way to infuse bad odor into a close conversation. Added to the natural stench cigarette smoke brings with it, smoking-related oral health problems can cause chronic and painful conditions such as gum disease and oral cancer.
With the various causes of halitosis, there remains the most crucial and well-known path to fresh breath: maintaining your oral hygiene. This means brushing at least twice a day and flossing regularly. For extra coverage, rinse with mouthwash and give a tongue scraper a try. Cleaning out any extra food debris and bacteria will do your hygiene and health a world of good. Here’s to clean, fresh and healthy breath!
Sunday, 14 February 2016
"Guilty mind" and the jailing of Professor Anna Stubblefield
If I erroneously take your suitcase from the airline carousel because it looks exactly like mine, I'm not guilty of theft. But if when I get home I decide to keep it because I like the content of yours better than mine, I've become a thief. The difference is in my knowingly and intentionally appropriating your property. That's guilty mind.
My critic was right. In initiating a sexual relationship with D.J., a disabled man, Professor Stubblefield (a) believed he had given enthusiastic consent via "facilitated communication," that she was (b) fulfilling his wishes (as well as hers), and that (c) bringing a disabled, previously uncommunicative 32 year old into the shared human world was an ethically admirable act. That doesn't look like a guilty mind. How could jailing her for rape possibly be ethically allowable?
That argument troubles me too. But here's my response. "Facilitated communication" (placing the uncommunicative person's hand on the facilitator's hand to guide writing at the keyboard) has been decisively and definitively shown to be a false theory. The writing comes from the "facilitator," not from what believers in the false theory call the "communication partner."
But given the widely known results of scientific evaluation of "facilitated communication," and the multiple condemnations of it by reputable professional societies, Professor Stubblefield should have known that D.J. could not give valid consent. She should not have accepted her experience at the keyboard as evidence for consent.
Another interlocutor invoked the history of science. Haven't there been examples of theories widely regarded as false that were later determined to be true?
Yes, there have.
Professor Stubblefield and her co-believers in "facilitated communication" are entitled to believe that mainstream science is wrong, and to make ethically allowable efforts to disprove the scientific consensus. But they're not entitled to invade the rights of others, as by "determining" that consent for sexual relations has been given. Similarly, the occupiers of the federal wildlife refuge in Oregon are entitled to argue that the federal government is acting wrongly, but they are and should be liable for trespass for acting on their beliefs.
Still, from the perspective of ethics, sentencing Professor Stubblefield to 12 years in prison makes no sense. She's not a danger to others as long as she neither commits nor incites actions like hers with D.J. That would be a condition of probation. She did not have a guilty mind. Although her case is not a slam dunk, I hold to my view that given 25 years of well publicized scientific findings, she was not entitled to act on her beliefs.
In my view, the jury was correct in defining her actions as rape. But guilt is one thing and sentencing another. The sentence may be consistent with state law, but the 12 year sentence does not fit the crime.