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Caring Bridge: Using The Internet To Monitor Your Loved One’s Health/Hospital Status

When Beth found out that her husband had cancer, a friend suggested that she look into creating a page on CaringBridge.org.  As she puts it, “CaringBridge became a tool to help us communicate with others.”

I spoke with Sona Mehring last week, who is the owner of CaringBridge.  The site started as a simple webpage for a friend of Sona’s who was going through a difficult pregnancy.  Sona and her friends used the site to keep friends and family informed of updates, keeping everyone in the loop without having to make several phone calls each day. Read more »

*This blog post was originally published at code blog - tales of a nurse*

Are Plastic Products Safe? An Overview Of The Science

bisphenol-a-cp-4695571There has been a lot of media attention surrounding the safety of polycarbonate plastic products containing bisphenol A (BPA). BPA is found in polycarbonate, hard clear plastic products like eye glasses, bicycle helmets, and food containers, and also in epoxy resins that act as protective coatings on everything from food and beverage cans to steel pipes and car engines.

In the next week or so, the FDA is expected to provide a new analysis of the science behind BPA safety. To gain some insight into what the fuss is all about, Dr. Steve Novella and I interviewed Dr. Steven Hentges (Executive Director of the Polycarbonate/BPA Global Group of the American Chemistry Council) on a blogger briefing call.

You may listen to the entire conversation here (and please read on for my summary of the issues):

[audio:https://getbetterhealth.com/wp-content/uploads/2009/12/bpacall.mp3]

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What Can Weekend Warriors Learn From Elite Athletes?

For this week’s CBS Doc Dot Com segment, I thought I’d cover something completely non-controversial: what can weekend warriors learn from elite athletes? But I’m starting to believe that in this era of evidence-based medicine, nothing may be truly knowable. I went to the studios of the world famous Ballet Hispanico in New York City and spoke to athletic trainer Megan Richardson. She took me through the motions, emphasizing the importance of warming up and stretching in preventing injury. It sounded good and it felt good. But proving in the medical literature that it’s effective is another thing. An online search quickly produced multiple conflicting reports and advice: stretching definitely works, stretching definitely doesn’t work; stretching only works if you do it my way. Click here for a sampling:

PubMed:Warm-up And Stretching PubMed: Stretching Perspectives BioMed Central: The Effects Of Stretching

My friend and CBS colleague, Richard Schlesinger, offered his solution. ”I get around it by neither stretching nor exercising.” Had I listened to Richard, my blog post would have ended right here. But I figured I needed at least one more paragraph so I contacted a true expert on the subject, Ian Shrier MD, PhD, a specialist in sports medicine and Associate Professor at McGill University. He has a PhD in physiology and is Past-President, Canadian Academy of Sport Medicine. He’s not a huge fan of stretching right before exercise.

“First, the stretching, whether with or without warmup, does not improve performance. It makes you run slower, jump not as high, and makes you weaker.” And “stretching definitely can hurt people if you overstretch; people do it all the time if they force the stretch.”

He added, “I don’t think it hurts you in general if you do it properly but it doesn’t prevent injury.” He’s more supportive of stretching at other times, including after exercise, saying, “Regular stretching at other times is beneficial. It makes you stronger, jump higher, etc, and there are three studies suggesting it reduces injuries as well, although the results were only significant in one.” He adds that “stretching is analgesic; it allows you to put your muscle through a wider range of motion without feeling tension. And that may be why ballerinas say that stretching helps them.” Dr. Shrier spells out his take on the subject in detail in a chapter called
Does stretching help prevent injuries?

For me, Dr. Shrier’s most interesting advice, especially for weekend warriors, was about the importance of warming up. He explained that muscles need energy to function properly. Energy is mainly produced inside of cells in structures called mitochondria. When you are resting, your mitochondria power down. During exercise, it takes awhile for the cell to rev up the enzymes needed for breaking down fat and carbohydrates for fuel and for using oxygen to make energy from that fuel. If you start running at full speed without warming up, your body will produce lactic acid. Lactic acid can impair muscle function for awhile, preventing you from sprinting efficiently at the end of the race.

So Dr. Shrier suggests gradually warming up. He estimated it takes about 3 to 5 minutes to efficiently go from one level of exercise to the next – for example, going from rest to a ten minute mile or going from a ten minute mile to a seven minute mile. If you go for a jog, “you walk, then jog slowly, and then pick it up. Elite marathoners might go for a fifteen to twenty minute jog before they run a marathon. That allows them to run faster at the beginning of the race. They run the second half of the marathon faster than the first.”

In summary – and I suspect that I am the first person today to tell you this – don’t outpace your mitochondria.


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What If Other Parts Of Life Were Like Healthcare?

robert-lambertsHealthcare is bizarre.  Anyone who spends significant time in its ranks will attest to the many quirky and downright ludicrous things that go on all the time.  But I am not sure people realize just how strange our system is.  Perhaps it would be interesting to see what it would be like if other parts of our lives were like healthcare.

1.  Get up in the Morning

The first thing that happens in your day is that your alarm fails to go off.  Although you have major things happening, nobody ever has explained to you exactly what you are supposed to do and when.  You watch the morning TV show and it seems that some experts say you should go to school while others say you should avoid school at all cost.  You call a friend who says that she knows someone who went to school and it destroyed their liver.  Another friend goes to school every day and is just fine.

Confused, you turn to the Internet and go to a website that explains that you should base your schedule on the pattern of tea leaves in a cup.  This site claims that your normal schedule is actually fraught with secret appointments that will, unbeknown to you, make you have cancer.  It states that those people in power are making you go through this dangerous schedule so they can make money off of you.  They don’t care for you like the people who made this webpage (and for $400 you can have 6-months of magic tea leaves).

Finally, you decide that you are going to go with the majority opinion and go to school.

2.  School

You go to your bus stop and wait.  You keep waiting.  You know that the bus was supposed to come at 8 AM, but after an hour you begin to wonder if you missed it.  Calling the bus service, you find out that the bus got caught up doing some extra routes.  There is a shortage of buses, and so the ones that remain have to do twice as many routes as is feasible.  After a two hour wait, the bus finally arrives to take you to school.

The first teacher comes into the classroom and looks very distracted.  She teaches general studies and is staring at a curriculum that contains a huge amount of subjects.  As she is doing her lessons, she furiously takes notes on her own teaching so that she can submit documentation to the school board and prove that she taught you.  This is the only way she gets paid.

In total, she teaches for about 15 minutes and documents her teaching for 45 minutes.  You want to ask questions, but the bell rings and you have to move on to your next class before any can be answered.

The next teacher only teaches a small specialized subject.  This teacher is paid four times more than the first teacher.  Instead of teaching and answering questions, however, he is constantly making you take tests.  Apparently, the school system pays a huge amount for making you take tests, but very little for teaching lessons that would make you do well on those tests in the first place.

School is finally over, but you don’t feel like you got much out of it (except for taking a lot of tests and getting more confused).  You decide that a trip to the store would perhaps make you feel better.

3.  The Grocery Store

Upon entering the grocery store, you notice something odd.  There are very few different brands of items stocked on the shelves.  Your choice is limited to only the brands that have struck the best deal with the grocery chain.  These brands have to send the grocery store a large “rebate” check because they are carried exclusively in this store.

When you go to the meat counter and ask for some steak, the butcher asks you if you have first tried the ground beef.  You may not purchase steak unless you have first tried and disliked the ground beef.  The ground beef, of course, is actually ground turkey, but the butcher says that these two are basically interchangeable and so the substitution is permitted.

The grocer can’t post prices because all customers have different negotiated prices.  Posting prices, in fact, would be considered collusion since other grocers could find out exactly what this grocer is charging.  Some congressman in California decided that grocers are all crooks and should not be allowed to share what they charge for things.

You go to the cash register to pay.  The total is $380, but the cashier informs you that your negotiated price is only $150.  A poor person behind you has not had the chance to negotiate a price and so must pay full price for everything.

There are a few people in the store who don’t have to pay anything.  They have had the price negotiated for them by the government, and so will come to the store very often.  They sometimes come for real food, but are often coming for candy and cigarettes – all paid for by the government.

This experience leaves you more tired and confused, and so you decide to go home.

4.  Home

Coming home, you notice that your house is under construction.  There is a new wing being built that contains all sorts of the newest and fanciest gadgets, such as flat-screen TV’s, the fastest computers, and wonderful new kitchen appliances.  Going into the house, you notice that there is no running water or heat.  Apparently, there are all sorts of grants and low-interest loans to pay for the fancy gadgets, and so contractors find it much more profitable to do that instead of fixing water or heating.

Your mother is in the kitchen trying to make dinner, but instead of cooking she is staring into a cookbook and at the ingredients you brought from the grocery store.  You assume she can make due with what you brought, but she just sighs helplessly.  Despite the fact that your mother is incredible at improvising meals, she is required to follow a cookbook that doesn’t fit the ingredients that are available.  This makes dinner taste pretty bad.  Your mother, obviously angry about this, gives you a weak smile and tells you to finish what is on your plate.

After dinner, you settle down to watch some television.  As you are finally starting to relax, a knock on the front door breaks your peace.  At the front door stands a police officer.  ”You are only authorized to be in the house for two hours today, so I am going to have to ask you to leave.”

You try to explain that two hours is not enough to get the rest you need, but the officer threatens a stiff fine and forces you to leave.  Before you can get your necessary things, you are forced to leave – without an explanation of how you are supposed to survive on the streets.

(to be continued)

**This blog post originally appeared at Dr. Rob Lamberts’ blog, Musings of a Distractible Mind.**

Plastics and Bisphenol A: Mounting Evidence For A Health Hazard

I first became aware of the potential link between a chemical found in some plastics (bisphenol A) and health effects in humans a little more than a year ago. I was concerned enough by the preliminary data collected by the NIH to blog about it, and it seems that many others are voicing concerns as well.

In fact, Canada has decided that the evidence is sufficient to label the chemical “dangerous” and will be announcing this shortly:

In Canada, the Globe and Mail newspaper said the Canadian health ministry was ready to declare BPA a dangerous substance, making it the first regulatory body in the world to reach such a determination. The newspaper said the ministry could announce the decision as soon as Wednesday.

Environmental activists long have warned about health concerns regarding the chemical. They praised the draft findings of the National Toxicology Program, which cited more potential worries about the chemical than did a panel of experts that advised the program last year.

At this point we don’t have enough information about how the chemical impacts humans to be sure of its level of risk. But what we do know is that:

1. The chemical is ubiquitous (most Americans have trace amounts detectable in their urine).

2. Animal studies appear to have demonstrated a causal relationship between bisphenol A and fertility, behavioral, and immunologic disorders in rats.

3. Human breast cells exposed to bisphenol A in a Petri dish developed a more aggressive form of cancer.

4. There is a plausible biologic mechanism by which the chemical could exert clinical, endocrine-mediated effects.

For these reasons, I think we should certainly view bisphenol A with suspicion. I will continue to follow the research with interest and concern.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

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…

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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…

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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…

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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…

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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…

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