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Article Questions The Effectiveness Of Antioxidant Supplements During Training

I have skeptical confession to make. I was once a panacea-seeking antioxidant-taker. As background, I’m a marathon runner and occasional triathlete. Several years ago, I was training for an Ironman triathlon, and banking 20+ hours of intense exercise per week. That may sound absurd to many (it does to me, now that I have kids) but that kind of training is necessary for the long races. So what did this pharmacist-wannabe-triathlete with access to discount vitamins do? He stocked up on the fancy bottles of multivitamins, the “endurance” version, of course — with extra antioxidants. Why did I supplement? I wanted to maximize my workouts, speed recovery, and minimize downtime and the risk of injury. Oxidation sounds bad — like a rusting car. Anti-oxidants sounded like the ultimate in preventative medicine. My workouts may have been more extreme, but the practice of supplementing if you exercise is common among athletes.

As it turns out, not only were the antioxidants likely ineffective, they may have compromised some of the gains I was seeking with all that training. That I didn’t evaluate the evidence at the time was my critical-thinking blind spot. Over the the past several years, more data on antioxidants and exercise have emerged. A recent review article, Read more »

*This blog post was originally published at Skeptic North*

Understanding Hospital Delirium And Some Tips To Prevent It

No matter how sick my grandmother got or what her doctors said, she refused to go to the hospital because she thought it was a dangerous place. To some degree, she was right. Although hospitals can be places of healing, hospital stays can have serious downsides, too.

One that has been getting a lot of attention lately is the development of delirium in people who are hospitalized. Delirium is a sudden change in mental status characterized by confusion, disorientation, altered states of consciousness (from hyperalert to unrousable), an inability to focus, and sometimes hallucinations. It’s the most common complication of hospitalization among older people.

We wrote about treating and preventing hospital delirium earlier this year in the Harvard Women’s Health Watch. In the New York Times “The New Old Age” blog, author Susan Seliger vividly describes her 85-year-old mother’s rapid descent into hospital delirium, and tips for preventing it.

Although delirium often recedes, it may have long-lasting aftereffects. Read more »

*This blog post was originally published at Harvard Health Blog*

Harvard Medical School Provides Tips For Improving Bladder Control

I was hiking in the woods recently with a group of women friends when something caught my attention. It wasn’t an interesting bird or plant, but the surprising number of “pit stops” my friends needed to make.

Their frequent detours into the bushes struck me because I had just finished working on Better Bladder and Bowel Control, the latest Special Health Report from Harvard Medical School. According to the report, incontinence is the unintended loss of urine or feces that is significant enough to make it difficult to do ordinary activities without frequent trips to the restroom. In the United States, about 32 million men and women have some degree of incontinence. For women, incontinence is a common but rarely discussed result of childbirth and aging—that could explain the pit stops of my hiking friends, who were all mid-life mothers. For men, incontinence is most often a side effect of treatment for prostate disorders.

Many things can go wrong with the complex system that allows us to control urination. Read more »

*This blog post was originally published at Harvard Health Blog*

Study Shows That Deployed Veterans Have Worse Health Than Their Non-Deployed Counterparts

Remember the 1991 Gulf War between the United States and Iraq (aka: “Operation Desert Storm”)?  A new study has been published in the American Journal of Epidemiology that assessed the health status of 5,469 deployed Gulf War veterans compared to 3,353 non deployed veterans.  At 10 year follow up, the deployed veterans were more likely to report persistent poor health.  The measures were functional impairment, limitation of activities, repeated clinic visits, recurrent hospitalization, perception of health as fair or poor, chronic fatigue syndrome illness and post-traumatic stress disorder.

From 1995 to 2005, the health of these veterans worsened in comparison to the veterans who did not deploy to the Persian Gulf.  A study done in the United Kingdom that compared Gulf War veterans to UN peacekeepers who served in Bosnia and other non-deployed Gulf War soldiers found Read more »

*This blog post was originally published at EverythingHealth*

Would You Trust An Unhealthy And Unfit Cardiologist?

There was a very controversial presentation made at a recent meeting of heart doctors in Canada. I’ve been stewing about what to say about it for a week.

The title speaks to its inflammation:

Fat, unfit, unmotivated: Cardiologist, heal thyself

The presenter that made the stir, pediatric cardiologist, and IronPerson, Dr. Brian McCrindle (Toronto) argued that overweight, unfit doctors are doing their patients a disservice. His bottom line: cardiologists are acting like the rest of Western society. They are not living a healthy lifestyle.

He made three major points. (in-depth coverage can be viewed here, on TheHeart.org)

*This blog post was originally published at Dr John M*

Latest Interviews

How To Make Inpatient Medical Practice Fun Again: Try Locum Tenens Work

It s no secret that most physicians are unhappy with the way things are going in healthcare. Surveys report high levels of job dissatisfaction burn out and even suicide. In fact some believe that up to a third of the US physician work force is planning to leave the profession…

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Caring For Winter Olympians In Sochi: An Interview With Team USA’s Chief Medical Officer Dr. Gloria Beim

I am a huge fan of the winter Olympics partly because I grew up in Canada where most kids can ski and skate before they can run and partly because I used to participate in Downhill ski racing. Now that I m a rehab physician with a reconstructed knee I…

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Latest Cartoon

Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.

***

Click here for a musical take on over-testing.

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Latest Book Reviews

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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Unaccountable: A Book About The Underbelly Of Hospital Care

I met Dr. Marty Makary over lunch at Founding Farmers restaurant in DC about three years ago. We had an animated conversation about hospital safety the potential contribution of checklists to reducing medical errors and his upcoming book about the need for more transparency in the healthcare system. Marty was…

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