Maggie's Farm

People have been asking me about Damar Hamlin. Cardiac arrest or, sometimes termed "Sudden Cardiac Arrest", occurs at all ages. It is only newsworthy when it occurs in young, otherwise healthy athletes. Still, it happens enough that many states have rules about medical check-ups for athletes. I suspect that it occurs more often than reported.

Sudden Cardiac Arrest is usually associated with a heart arrhythmia called ventricular fibrillation. The heart stops. These have a long list of possible underlying causes, but it seems possible, if rare, that even a blow to the chest can set it off. The risks are that you die, or survive with brain damage. First aid is CPR (all of our readers should know how to do that), then shock from a defibrillator. The brain begins to die after a handful of minutes without a functional heartbeat.

In youth, arrest is hardly ever related to a "heart attack," which refers to a Myocardial Infarction.

Probably not. In fact, the meaning of Vit D blood levels is unknown.

It has become a casual consensus that exercise, or at least daily vigorous movement, enhances one's immune response. 

Anecdotally, it looks likely. But the catch is that it's the most fit people who do an hour or so most days, so is it causality? Statistically, fitter people are best prepared to deal with the attacks of nature: better disease-resistance, better healing, etc.

People with physical jobs do not need to think about it, but most of us do. In a way, daily exercise is an attempt to recreate a bit of what humans were built to do.

I feel that exercise (The Maggie's Fitness for Life program, especially) has the main goal of maintaining functionality and vigor for as long as possible. Sure, looking good matters too, in life. Nutrition for weight, exercise for strength.

Re immunity:  Exercise could bolster immunity in a variety of ways.

We linked this post a few days ago, but I am re-linking it because it seems so important.

I understand that we live in an hyper-politicized world right now. It seems more so than in the past, but I can't say. It does seem to me that "the long march through the institutions" has been occuring. I especially hate to see it occur in my field of clinical medicine. 

I do not mind debate about the role of government in medical care, and will even listen to arguments in favor of Medicare for all citizens. That is a different topic. 

Jabra hearing aids get excellent reviews. And their hearing test is online.

One aspect of hearing loss is that others notice before the listener does. 

Why do people with any fat stores ever feel hungry, or eat anything at all, considering they may have 1-5 month's worth of energy stored as fat?  (We term the hunger experienced by overweight people "False Hunger," because it is.)  Except in the truly malnourished or extremely fit, low body-fat athletes, hunger is rarely a signal of an energy deficit or of any nutritional need.

Think about it. Even normal-weight (neither overweight nor underweight) people carry 8-10 weeks of energy stored in fat if they can only access it. 

You can consider appetite in the pudgy or overweight, not to mention the obese, to be a design flaw based on the hunting and gathering, and, earlier, just plain gathering condition of human existence, same as the other great apes who only become overweight in captivity. Agriculture and food abundance, along with sedentary life, exposed the design flaw for people who overnourish themselves.  Of course, physical inadequacy is another side effect.

Here are a few issues (below) - 

I have seen people treated for cancer until the day they died with the poisons still dripping into their veins. I disapprove, although I am not an oncologist. There is a time to be born, and a time to die. Hospice care is a blessing with opioid meds as needed.

 Oncology therapy at the end-of-life: Have we missed the mark?

Unless elderly ("Have a good BM today?"), people don't talk much about poop. However, most people do it.

 It Was Once Someone’s Job to Chat With the King of England While He Used the Toilet, “Groom of the Stool” could be a crappy role, but it came with great benefits.

 How Often Should You Poop? What’s Normal and What’s Not?

Statistics say that 73% of Americans are overweight. Everybody knows the health and functional consequences of being overweight, however defined. Most people do not care. It's a free country, so I don't care if you do not.

If you care about fitness and functionality, staying trim and strong is a good idea. Staying strong is easy: Go to the gym or something daily with weights and cardio and calisthenics. It is rewarding if not exactly fun. Exercise will not keep many people trim.

It's an American thing. I don't know why because many parts of the world are full of cheap, tasty fast foods.

Without wanting to seem obnoxious to any overweight readers,  I have to offer the best article I've seen about nutrition and weight. It's a bit of a long read, but entirely reasonable: Behavioral Nutrition.

The authors are correct. For many people, willpower doesn't work. Habits do. A quote:

 Modern weight-loss approaches thus constitute an incomplete approach to long-term weight-control and one that must be complimented by a much more comprehensive appreciation of dietary habits, thought patterns and behaviors, and individual differences in consumption, food preferences, and control, as outlined below in a new approach to weight-loss [21]. Indeed, the selection and consumption of food in the modern era of abundance may have little to with nutritional analysis, appropriate macronutrient levels, or sustenance, as educational programs over the past decades have ensured that most the population is aware of what constitutes a healthy diet. Instead it could be argued that food consumption (and thus long-term weight control) is driven by a host of forces including personality, cognitive processes, food history, personal habits, ingrained behaviors, genetics, responses to environmental cues, neurochemistry and biological drivers, and mood states. In such circumstances, the current model of weight loss, with its emphasis on education, caloric restriction, moderation (moderate food intake) and will power, is ill equipped to promote sustainable weight-control and instead may have resulted in high rates of failure. One must question where the scientific evidence for this longstanding and continued approach to weight management lies, or perhaps by focusing on the most obvious factor, calories, and the field has overlooked the most critical, the person consuming those calories... 

 Virtually every major medical organization—from the American Medical Association (AMA) and the American Association of Medical Colleges (AAMC) to the American Association of Pediatrics—has embraced the idea that medicine is an inequity-producing enterprise. The AMA’s 2021 Organizational Strategic Plan to Embed Racial Justice and Advance Health Equity is virtually indistinguishable from a black studies department’s mission statement. The plan’s anonymous authors seem aware of how radically its rhetoric differs from medicine’s traditional concerns. The preamble notes that “just as the general parlance of a business document varies from that of a physics document, so too is the case for an equity document.” (Such shaky command of usage and grammar characterizes the entire 86-page tome, making the preamble’s boast that “the field of equity has developed a parlance which conveys both [sic] authenticity, precision, and meaning” particularly ironic.)

While this link is an advertisement directed towards physicians, it makes clear what is going on in medical practices today: THE DEATH AND LIFE OF THE “PRIVATE PRACTICE PHYSICIAN”

While many physicians might like the idea of independence, for most specialties the need for a large back-office staff requires being part of a group practice. Then, sooner or later, somebody buys the group. The buyer could be a hospital, a giant medical business, or even a venture capital fund. 

Things have changed. In many ways, sharing some income and being a part of a larger business makes it easier than being an old-fashioned independent physician. It's not the same thing, though.

People have been talking about this article: If you can’t balance on one leg for at least 10 seconds, you may be in trouble.

I think it's a silly article. Obviously, if you are older and in bad shape, you are more likely to be sick and die. But go ahead and try it. For a better test, do it with eyes closed.

Tirzepatide.

As they say, ask your doctor whether this seems right to try. 

Second Booster for COVID-19 Vaccination: Early Results

Effects of Intermittent Fasting on Health, Aging, and Disease

The news these days are preoccupied with the topic. I have never had a single, clear view on it and still do not. Moral, religious, freedom, politics, etc.

As I have noted in the past, I refused to participate in an abortion in medical school and nobody cared. I was not alone. It was not on any clearly-defined moral or religious grounds really, just more like a disgust for the whole idea. Other people did them as comfortably as doing a tummy-tuck. OK for them. Maybe I was weak. It was an inner conflict. I would never have been willing to do a tranny surgery either, but they were not routine then. 

I confess that I came from a good, solid family which stayed together and produced a large litter of good, solid citizens. Protestant, not Roman Catholic.

Regardless of the above, it is all about sex. Sex is a strong drive in us animals. We do not always use our brains despite every form of birth control.

Do you supinate, pronate, or neither? Sometimes you can tell by the wear on your shoe soles, but when it is more pronounced you can feel it when you walk or run.

When these things are severe, they can affect your joints and lower back. This is why God made Podiatrists. 

It is well-known that vigorous exercise does not "work up an appetite." On the contrary, it tends to reduce hunger and appetite.

That might not apply to 8 hours on the Appalachian Trail or a day job as a lumberjack, but it is certainly true for me with my 1-hr daily exercises. The more consistently I exercise, the less interest I have in food and the smaller the portions I can handle. This effect is most pronounced with demanding cardio and calisthenic exercise, not much with strength exercise or with sports. There is a theory that the effect has something to do with Peptide YY.

Nobody wants to eat anything after a hour of tough cardio exercise and that suppressive effect tends to last 24 hrs. 

Maybe it makes some genetic sense. If you need to move yourself vigorously and frequently, the less fat you have on you the better you can avoid becoming part of a Tiger Dinner Party. Hunger is an interesting instinct and only recently has it been studied biochemically. One thing we know for certain is that subjective hunger or attraction to food is not a signal for a need for nourishment for most adults in a food-rich environment.

Overweight people seem to have the strongest subjective hunger, and sedentary people tend to have stronger appetites. Cause or effect? Chicken or egg?