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

Latest Posts

Study Shows That Processed And Unprocessed Meats Pose A Diabetes Risk

Red Meat! by ThisParticularGreg via Flickr and a Creative Commons license

There’s a strong association between daily servings of red meat, especially processed meat, and a nearly 20% increased risk of type 2 diabetes, researchers found.

Replacing red meat with healthier proteins, such as low-fat dairy, nuts, or whole grains, can significantly lower the risk, according to a study was published online at the American Journal of Clinical Nutrition.

Researchers reviewed questionnaire responses from 37,083 men followed for 20 years in the Health Professionals Follow-Up Study, from 79,570 women followed for 28 years in the Nurses’ Health Study I, and from 87,504 women followed for 14 years in the Nurses’ Health Study II. Diet was assessed by validated food-frequency questionnaires, and data were updated every four years. Diabetes was confirmed Read more »

*This blog post was originally published at ACP Internist*

Tummy Tucks Aren’t Just For Lazy People

Recently at the gym (I workout three to five days a week mostly swimming laps in a pool,) I got into a conversation with a mom about tummy tuck surgery. This happens occasionally when you wear your CosmeticSurgeryTruth.com t shirt to the gym. :)

“I would never get a Tummy Tuck. I would just workout more.”

People do not see outside of their own experience very often. This pretty young mom would not benefit much by a Tummy Tuck as she had no “hanging apron” or much lose skin. Many gastric bypass patients or other women not as fortunate after pregnancy to have their bellies “snap back” have changes. And some of them workout several days a week too. Tummy Tuck surgery is not Read more »

*This blog post was originally published at Truth in Cosmetic Surgery*

Beware Of Potatoes: They May Cause You To Pack On Pounds

Chips

Without meaning to, you’ve gained a few pounds over the last few years. How did that happen? Certain foods, especially the humble potato, may be partly to blame.

In a fascinating study of 120,000 healthy, non-obese women and men taking part in long-term studies of diet and health, the participants gained an average of 3.3 pounds every four years over a 13-year period. When the researchers tallied up the foods that contributed most to this weight gain, potatoes topped the list—twice:

  • potato chips
  • potatoes
  • sugar-sweetened beverages
  • red meat
  • processed meats

Other contributors to weight gain included sleeping less than six hours a night or more than eight hours, drinking alcohol, and watching television. The results were just published in The New England Journal of Medicine.

The study offered some good news and tips for losing weight, too. Foods and lifestyle choices associated with losing weight included Read more »

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

Why Is Weight Gain Contagious? Monkey See, Monkey Do

Woman-on-scale-with-friends

One of the big health news stories of 2007 was a study showing that your friends influence the size of your waist (and the rest of your body). Like any study, it raised as many questions as it answered, including why this happens. A new study from Arizona State University looked into that question by testing three pathways by which friends might influence one another’s body size:

  1. Collaboration. Over time, you might start to share the ideas of the people close to you after talking with them about what the proper body size is. Then you might choose your food and exercise habits in order to reach that body size, whether that means eating more food to look like your plus-sized friends, or less food to look like your thin ones.
  2. Peer pressure. You feel bullied into trying to look like your friends and family members. They make you feel bad about your body, so you go about eating and exercising to look like them.
  3. Monkey see, monkey do. You change your habits to mirror those of your friends without necessarily thinking or talking about an ideal body weight. Alexandra Brewis Slade, PhD, one of the Arizona State researchers, gave an example of this pathway that most of us can relate to: You’re at a restaurant with friends and the waiter brings over the dessert menu. Everyone else decides not to order anything, so you pass, too, even though you were dying for a piece of chocolate mousse cake.

All three of these pathways are based on the idea that loved ones share social norms, the implicit cultural beliefs that make some things okay, others not. Read more »

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

Cyclist Asks: Is Sugar Abstinence Possible?

After spending an entire vacation reading stories, I would like to start tonight’s post with a tiny dose of fantasy. Can we try using a daydream to learn something about the challenge of making good nutrition choices?

The fantasy goes something like this…

You have just been sentenced to eternal life on a far-away sun-drenched island. This island has mountains, paved roads, wide bike lanes, and mountain bike trails. You get to take two bikes, a couple riding buddies and your family—if they’ll go. You also get to take one Apple product.

Sounds good so far.

The kicker is that you only get four food choices—and liquids count.

You are a cyclist, so after coffee and beer there are only two food choices remaining. Obviously, you will need a protein source. Smart choices here would include nuts, mercury-free fish or organically-fed animals. The protein isn’t the point, let’s keep moving.

Now we are down to the carbohydrate source.

Choose one of the following:

A.) Arugula
B.) Quinoa
C.) Cranberries
D.) Fruit Loops

Herein lies the primary hurdle that smart-nutrition advocates face: unhealthy simple sugars taste really good. Read more »

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

Latest Interviews

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 »

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…

Read more »

See all interviews »

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.

See all cartoons »

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…

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 »

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…

Read more »

See all book reviews »