Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Latest Posts

The Power of Medical Blogging

Less than a year ago, I didn’t even know what a blog was.  Many physicians still don’t know about them, and yet (according to Wikipedia’s September ’07 figures) there are over 106 million blogs currently online.  A recent article about medical blogs suggests that the number of health professionals blogging may be in the order of 100′s. Therefore, medical blogs are only a tiny drop in the blogosphere bucket.

As with IT initiatives in general, the medical world is sorely lagging behind.  However, there is a small group of pioneers who are already making a difference in the lives of patients and colleagues around the world.  I have witnessed with my own eyes how cancer patients are being directed towards optimal care through blogs like those of Dr. Heinz Josef Lenz. Although he practices in southern California, his blog has been discovered by colon cancer patients across the country – and he has a loyal following who learn about cutting edge research and clinical trial information three times a week. These patients would never have access to this kind of information without his blog – they would have to wait for research to be published in a peer-reviewed journal, and then hope that the media would faithfully translate the findings into consumer language. (Good luck with that.)

Some blogs are being used to educate peers about surgical techniques.  Dr. Bates has a wonderful, detailed blog about how to correct cosmetic defects, and a group blog called Inside Surgery has information for surgeons about difficult or unusual cases.

Dr. Rob, our Grand Rounds host this week, does a wonderful job of educating others about primary care, physical exam basics, and the broken healthcare system. He does it with flair – and a whimsical approach that is very entertaining. Where else can you learn about the healthcare system AND the lifestyle habits of llamas, goats, and accordion players?

If you want to keep up with healthcare news – KevinMD is a one-man news feed of all the most interesting goings on.  If you need to keep up with advances in the medical device industry, MedGadget is your one stop shop.

Of course there are many other great medical blogs out there as well (and so many nursing blogs, like Emergiblog are outstanding)- but what excites me the most is when I see patients benefiting from the information they receive directly from healthcare professionals. Blogs can truly improve access to the minds of medicine, and even save lives – Medical blogs have the power to:

1. Educate patients about their health

2. Debunk medical myths

3. Cut through the media spin associated with research and health news

4. Influence health policy

5. Instruct other healthcare professionals

6. Expose dishonest medical schemes

7. Increase awareness of clinical trials and important research

8. Provide emotional support

9. Create a networking opportunity for professionals, advocates, and patients

10. Help people navigate the broken healthcare system

If you haven’t already, I hope you’ll add your voice to the medical blogosphere, and be part of a movement to change healthcare – one blog post at a time.This post originally appeared on Dr. Val’s blog at

Conversations At The Spa

As some of you faithful readers of Dr. Val may know – I’m a huge fan of massage.  Consider it my
addiction, I suppose – it could be worse! And so it may come as no surprise that I had a massage every day of my vacation (7 days in Southern California – sorry I haven’t been blogging as much lately).  Yes I’m well and truly tenderized from head to toe.  But I have to say that some of the therapists’ chatter was quite amusing to me.  I was unsuccessful at completely removing my doctor hat during the experience, and tried not to look quizzically at them as they explained what they were up to and what I needed.

Those of you with healthcare backgrounds may especially appreciate this dialog:

Therapist (scrutinizing my back as I’m face down on a
table): have you seen a chiropractor recently?

Dr. Val: Um, no.  Why?

Therapist: Well, two of your ribs are out.

Dr. Val: They’re ‘out?’
Where did they go?

Therapist: A chiropractor can put them back for you so your
muscles won’t pull in the wrong direction.

Dr. Val: Will a chiropractor be able to fix this

Therapist: No, you’ll have to keep going.  (Adds some eucalyptus lotion).  This will bring your red blood cells to the
surface, and the cooling brings white blood cells to the area.

Dr. Val: (considering what a collection of white blood cells
actually do – yuck).  Hrmph.  That’s a nice massage technique.  What are you doing?

Therapist: I’m using my elbows to stimulate repair cells.

Dr. Val: Ahum…

Therapist: You have lactic acid build up in your shoulders
so we have to flush the toxins out with special oils.  You should also drink a lot of water.

Dr. Val: What sort of toxins?

Therapist: Like, dirt and metals and stuff that you’ve been
exposed to.  You might have eaten fruit
with pesticides on it.  Do you eat
organic food?

Dr. Val: Sometimes.

Therapist: Oh, you should only eat organic food.  Then you won’t have as many toxins built up.

Dr. Val: How do I know how many toxins I have in my body?

Therapist: Well, your shoulders are really tight and your
ribs are out so I think you probably have a lot.  You’ll need a lot of massage and you need to
see a chiropractor.  The oils I used on
you will have a calming effect, though.
You’ll probably sleep really well tonight.

Dr. Val: I see (inhaling, exhaling).  I hope I do.

** 15 minutes post massage – back at the hotel room **

Husband: You smell funny – like an almond.

Dr. Val: That’s “the calming oil that flushed the toxins out
of my body” today.  I have to drink

Husband: Well we’re driving 2 hours up to L.A. so don’t drink too much or we’ll have to
stop along the way.

Dr. Val: The therapist said 2 of my ribs were out and that I
need to see a chiropractor.

Husband: There’s nothing wrong with your ribs.  Don’t be silly.  Why do you keep getting these massages?

Dr. Val: They feel good.

Husband: I could give you a back rub for free.

Dr. Val: It’s not the same, though.

Husband: Why, because I don’t tell you your ribs are out of

Dr. Val: Well, they have a proper table…

Husband: I don’t understand you.

Dr. Val: But you like almonds (hugs him).This post originally appeared on Dr. Val’s blog at

Good Cholesterol (HDL) Is More Important Than You Think

Heart disease is the number one killer of Americans, and high cholesterol levels are a primary contributor to heart disease. But the cholesterol story is a bit complicated – some of it is damaging to blood vessels (Low Density Lipoproteins or LDL is considered “bad” cholesterol) and some of it is restorative (High Density Lipoproteins or HDL is “good” cholesterol). Most medications are aimed at lowering the “bad” cholesterol, and this strategy has been very helpful in reducing heart disease and atherosclerosis. But what about raising the good cholesterol as part of a heart healthy strategy?

A new study in the New England Journal of Medicine suggests that having low levels of HDL can put people at risk for heart disease and heart attacks, even if the LDL is well controlled.  This is the first study to show that low LDL does not erase heart disease risk if the individual’s HDL is also low.  In fact, each increase of 1 mg in HDL cholesterol is associated with a decrease of 2 to 3% in the risk of future coronary heart disease.  So lowering LDL with statins (if lifestyle measures fail) is only half the battle for those who also have low HDL.So how do you increase your HDL levels?The most effective medicine for raising HDL is a type of Vitamin B called niacin.  Taken in the quantities required to have an effect on HDL, though, there are usually unpleasant side effects: flushing (redness or warmth of the face), itching, stomach upset, mild dizziness, and headache.

Perhaps the best way to increase HDL is to lose weight and exercise regularly.? In fact, the list of HDL-raising “to do’s” reads like a healthy living manual:

1.  Avoid trans fats

2. Drink alcohol in moderation

3.  Add fiber to your diet

4.  Use monounsaturated fats like olive oil where possible

5. Stop smoking

6. Lose weight

7. Engage in regular aerobic exercise

So next time you see your doctor, make sure you review your cholesterol levels, and discuss some strategies to get your levels of HDL and LDL in the optimal zones for a healthy heart.This post originally appeared on Dr. Val’s blog at

Marty Abeloff: Farewell To A Great Physician

The oncology community bid farewell to one of its greatest leaders last week, Dr. Marty Abeloff.  Marty was a dear colleague of Dr. Avrum Bluming (a guest blogger and friend of Dr. Val & The Voice of Reason) and Av was kind enough to write this obituary to honor him:

On September 14, 2007, Marty Abeloff died.

An intelligent, gracious, caring and supportive human being, he brought all those qualities to his roles as physician, mentor, educator, administrator, and friend.

He was a Phi Beta Kappa graduate of Johns Hopkins and an Alpha Omega Alpha graduate of Johns Hopkins Medical School. He did his house staff/fellowship training at the University of Chicago, the National Cancer Institute, Harvard, the New England Medical Center, and Johns Hopkins. At the time of his death, he was Professor of Medicine and Director of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University. He was a past President of the American Society of Clinical Oncology, past Chairman of the Oncology Drugs Advisory Committee of the Food and Drug Administration, past Chairman of the Board of Scientific Counselors to the National Cancer Institute’s intramural division of clinical sciences, and past Chairman of the Breast Cancer Committee of the Eastern Cooperative Oncology Group. He was the lead Editor of Clinical Oncology, a comprehensive textbook, now in its third printing, Editor of Current Opinion in Oncology, former Associate Editor of the Journal of Clinical Oncology, and founding Editor in Chief of Oncology News International, a wonderfully informative periodical, a position he established and occupied since 1992.

He was held in high esteem by his peers, and beloved by his colleagues, co-workers, patients, students, family members and friends. Patients held on to his phone number long after they finished treatment, and those of us seeking advise in the management of our own patients never hesitated to call upon his help. He was always available and always helpful.

Any individual looking to fashion a life and career distinguished by accomplishment and filled with love could find no finer role model.

Avrum Z. Bluming, MD, MACP

Clinical Professor of Medicine

University of Southern California

This post originally appeared on Dr. Val’s blog at

Motion Sickness: What Can You Do About It?

If you’re one of those unlucky souls who is easily nauseated by riding in planes, trains, and automobiles – and forget about boats, they’ll keep you hanging over the rail for hours – then welcome to the motion sickness club.  You’ve probably already read about your treatment options, but you may not find any of them completely satisfying.

Motion sickness (like car sickness, sea sickness, etc.) is caused by an uncoupling of input from the eyes, ears, and joint position-sensing nerves throughout your body.  In other words, your brain becomes confused by conflicting messages about where your body is in space.  If you’re sitting in a chair, your brain expects it to be fixed and not to move – but then if that chair is in a car or on a boat, the movement doesn’t make sense to it, and you become dizzy and nauseated.  The details of the science behind motion sickness is quite complex – and there are many different approaches to treating and preventing it.

In terms of medications – antihistamines such as Benadryl (diphenhydramine), Dramamine, Antivert (meclizine), and Phenergan and anticholinergics like Scopolamine may be the most commonly used.  They have varying sedative side effects which can be very inconvenient for those who need to be alert and active immediately after they get out of the car, train, boat, etc.

Some people have used Zofran (ondansetron) for motion sickness prevention – and although this drug is only approved for the treatment of nausea side effects caused by cancer chemo and radiation therapy, it has a unique mechanism of action for preventing nausea.  It works by blocking serotonin receptors in the brain (and perhaps in the gut) to head off motion sickness.   It does not produce drowsiness as a side effect, and is generally well tolerated.  Unfortunately, it is very expensive (about $50 per pill – without insurance).

Personally, I try to stay away from medications as much as I can (they always have the potential for unwanted side effects) – but if you’re really struggling with motion sickness and have exhausted all your options, you might want to ask your doctor about Zofran.  I must admit that for me (someone who gets ill just looking at amusement park rides), a little bit of Zofran has radically improved my traveling difficulties.  In fact, I’m writing this blog post from a seaside vacation spot in sunny California… and I have no worries about the flight home, choppy air or not.  Bring on the deep sea fishing, parasailing, and jet skiing – I have no fear, Zofran is here!This post originally appeared on Dr. Val’s blog at

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

Read more »

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

Read more »

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

See all book reviews »