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Latest Posts

How Many Calories Do I Need? And Other Questions From The Boys & Girls Clubs Fit Family Challenge

This year’s finalists for the Boys & Girls Clubs’ Fit Family Challenge are about to be announced. I’ve had the privilege of acting as nutrition coach for the semi-finalist families, and have had fantastic interactions with them about common nutrition questions. In my continuing Q&A series, I thought I’d share some of our email conversations:

Q: How many calories do I need per day, and how many should I eat to lose weight?

I like to use this Mayo Clinic calculator to get a rough estimate of daily caloric needs.   If you enter your height, weight, age, and activity level it will tell you approximately how many calories/day you need to maintain your weight. To lose one pound a week, you need to subtract 500 calories/day from that number. So, for example if the calculator suggests that you need 2000 calories/day – you should follow a 1500 calorie/day diet to lose 1 pound a week. Studies have shown that people who drop more than 500 calories below their daily maintenance needs have a hard time sticking to their diet. You may feel weak, trembly, and irritable if you cut down too low too fast. You will have to play with the amount a little bit since the calculator is not exact – if you don’t see the scale moving when you cut out 500/day, then you have to wonder if you’re counting calories correctly or perhaps if you have to go a little bit lower still. Unfortunately, the “reward” for losing weight is that you have to permanently eat less when you are at your desired goal because there is less of you to feed!

Q: What do you think about sports drinks? Do my kids need them when running races?

As far as sports drinks are concerned, their benefits are often over-hyped and exaggerated. That being said, I believe they do have a role in hydration during endurance sports like long distance running. When you do strenuous exercise for long periods of time (over 1 hour of effort) you lose a lot of body salt and minerals (electrolytes) in your sweat. It’s important to replace certain key electrolytes so your body doesn’t become depleted and begin to cramp. This is more likely to happen to folks running very long distances, such as marathons and triathlons. However, if it’s hot during your race, you could be at risk for dehydration and electrolyte loss as well.

Regular Gatorade (made by Pepsi Co.) has water, sugar, sodium, and potassium in it. Powerade (made by Coca Cola) has water, sugar, sodium, potassium and B vitamins. Powerade has a little bit higher sugar concentration, which could be an advantage on a long run. Both are reasonable choices for hydration during a race.

The rough rule of thumb is to take in 6-12 oz of fluid for every 20 minutes of running. Water is sufficient for runs that last less than an hour. Sports drinks (or adding electrolyte gels/chomps to water) are helpful if your run will last longer than an hour. It’s better to sip the water slowly at regular intervals than to dry to gulp it all down at one time. You may feel nauseated or have a “sloshy stomach” feeling if you don’t spread out your hydration.

Sports drinks can be quite expensive – and you can easily create your own at home. The World Health Organization has a simple recipe for rehydration fluids, and I found this (probably slightly tastier) version on a blog site.

Outside of endurance sports, I don’t see a physiologic need for sports drinks (with the exception of extreme sweating in hot weather or during illness with vomiting and diarrhea) – they can add unnecessary calories to your diet.

Q: Should I cut down the amount of salt in my diet?

Not necessarily. Too little salt, as well as too much salt, have both been shown to be unhealthy. If you’re eating a lot of fast food, you’re probably getting too much salt. If you cook for yourself and focus on fruits and veggies, whole grains, and lean protein you may not need to cut back. Unless you have a kidney problem or very high blood pressure, salt is generally not dangerous for you. About 2.5g of salt/day (roughly a teaspoon full) is optimal, but for most people up to 4g/day probably won’t hurt (and at least one study suggests that heart disease risk doesn’t increase until the daily intake of salt exceeds 7g/day).

CDC Works To Eradicate Polio Around The World By The End Of 2012

Men painting billboard for polio vaccination campaign

Polio is a crippling and potentially fatal infectious disease that is completely preventable. Since 1988, members of the Global Polio Eradication Initiative (GPEI), including CDC, the World Health Organization (WHO), Bill and Melinda Gates Foundation, Rotary, and UNICEF, have teamed up to eradicate polio world-wide through large scale vaccination efforts. Global polio cases are down more than 99% since GPEI began. We were able to completely eradicate the disease in the Americas by 1994 and protect our children. By 2006, polio was endemic in only four countries: Read more »

*This blog post was originally published at Public Health Matters Blog*

Secretary-General On World Mental Health Day: We Must Invest In Mental Health

U N I T E D   N A T I O N S

THE SECRETARY-GENERALMESSAGE ON WORLD MENTAL HEALTH DAY: 10 October 2011
There is no health without mental health.  Mental disorders are major contributors to illness and premature death, and are responsible for 13 percent of the global disease burden.  With the global economic downturn – and associated austerity measures – the risks for mental ill-health are rising around the globe.

Poverty, unemployment, conflict and war all adversely affect mental health.  In addition, the chronic, disabling nature of mental disorders often places a debilitating financial burden on individuals and households.  Furthermore, individuals with mental health problems – and their families – endure stigma, discrimination and victimization, depriving them of their political and civil rights and constraining their ability to participate in the public life of their societies.

Resources allocated for mental health by governments and civil society are Read more »

*This blog post was originally published at Shrink Rap*

Initiatives In The Field Of Positive Health: Optimism And Stroke Risk

Way back in 1946, the chartering documents for a new agency of the UN—the World Health Organization—defined health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”

We have made astounding progress in medicine and public health since the WHO charter was crafted, yet we have actualized only part of its comprehensive vision for health. What we call health care today is really just illness care. Even our disease prevention and health promotion programs focus on reducing risk factors for disease. It is the rare initiative indeed that encourages good health for its own sake. Read more »

*This blog post was originally published at Pizaazz*

WHO Report Outlines Problem Of Hospital-Acquired Infections

The World Health Organization’s new patient safety envoy will take on health care acquired infections in his new role, he announced last week. Liam Donaldson, England’s former Chief Medical Officer, pointed out in his first report as envoy that patient safety incidents occur in 4% to 16% of all hospitalized patients, and that hospital-acquired infections affect hundreds of millions of patients globally.

A WHO report outlined the problem.

High-income countries had pooled health care acquired infection rates of 7.6%. The European Centre for Disease Prevention and Control estimated that 4.1 million Europeans incur 4.5 million health care acquired infections annually. In the U.S. the incidence rate was 4.5% in 2002, or 9.3 infections per 1,000 patient-days and 1.7 million affected patients.

In Europe, these infections cause Read more »

*This blog post was originally published at ACP Hospitalist*

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…

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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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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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