We are a commune of inquiring, skeptical, politically centrist, capitalist, anglophile, traditionalist New England Yankee humans, humanoids, and animals with many interests beyond and above politics. Each of us has had a high-school education (or GED), but all had ADD so didn't pay attention very well, especially the dogs. Each one of us does "try my best to be just like I am," and none of us enjoys working for others, including for Maggie, from whom we receive neither a nickel nor a dime. Freedom from nags, cranks, government, do-gooders, control-freaks and idiots is all that we ask for.
I don't know what practicing clinician has time to write guidelines for other docs, but guidelines are nothing but trouble. The best medical care is both art and science. Knowledge is always incomplete, patients are individuals with unique situations, and all docs have their own preferences and points of view. Guidelines end up being little more than fodder for tort lawyers and time-wasters.
Worst of all, young docs feel as if they have to follow them. Many things go wrong when practicing by the book. Medicine is an art and a science.
I view part of my duty as to debunk folk myths about health and medicine. Readers know that one of my bugaboos concerns the human diet and the First World preoccupation with what we eat as if it mattered all that much. Food faddism has always been part of American life since we became a wealthy country and had food choices.
Eating fats does not make you fat. Carbs make you fat. That is no longer in dispute.
Do saturated fats "cause" heart disease? There is no evidence for it. Bacon and eggs is the Great American Breakfast, with or without grits, or biscuits and gravy. In the WSJ,The Questionable Link Between Saturated Fat and Heart Disease -Are butter, cheese and steak really bad for you? The dubious science behind the anti-fat crusade.
I agree with some of this, disagree with some of it. For one thing, she ignores insulin physiology. For another, she ignores menopause. She is right that losing weight is difficult given all of the abundant and cheap carbs available to everybody, and she is surely correct that people without weight issues are those who hear an internal signal that says "That's enough."
In the end, though, carb "addiction" is the main challenge for anyone who is overweight.
A Cholagogue containing Iron, Quine, Strychnine, and who knows what else:
I found this somewhere:
ABOUT VERACOLATE
REPORT FROM THE 1916 TEXAS STATE JOURNAL OF MEDICINE
Veracolate ~ The Council on Pharmacy and Chemistry reports that "Veracolate manufactured by The Marcy Co. of Boston, Massachusetts, is semisecret in composition, unscientific in combination and exploited under unwarranted claims. It reports that the same criticisms apply to Veracolate with Pepsin and Pancrea and Veracolate with Iron, Quinine and Strychnine. For Veracolate, the following non-quantitative formula is given ~ A compound containing the bile acids, sodium glycocholate, sodium taurocholate with cascara sagrada and phenolphthalein. Vercolate with Pepsin and Pancreatin is said to contain, in addition to the indefinite plain Veracolate, the two mutually incompatible ferments, pepsin and pancreatin, and oil of peppermint. The complexity of Veracolate with Iron, Quinine and Strychnine has increased so that this unscientific mixture is claimed to contain seven constituents. These products are discreditable to the medical and pharmaceutical profession alike and their use is against the public good. (Jour. A. It. A., April 24, 1915.)
Still no links found. No links found for diet and heart disease, either.
Nutrition remains folklore, magic, superstition, and there is essentially no science in it except to avoid scurvy and Beriberi. Of course, being overweight predisposes to almost all medical ailments except starvation. If you do not want to be fat, quit those tasty carbs and try to satisfy yourself with something else like reading blogs, or sex, or doing unto others. If you want to be strong, exercise hard or do physical labor. Otherwise, quit with the magical thinking and accept that death will arrive (unbidden usually) no matter what you do.
People hate to accept that reality because it feels powerless. Well, people don't dine on sacred offerings to gods anymore, and food is no longer magic medicine.
Vegetables and fruit? I do not particularly enjoy them so I am always pleased that they supposedly don't matter. For me, vegetables are just an excuse to eat the olive oil or butter. About fruit, when I get the impulse, I will occasionally eat a whole lemon or a whole lime, skin and all. Oranges are too sweet for me. Otherwise, fruit is good only for cheese. Pears, especially.
Somebody recently told me that they refused to donate to the American Heart Assoc. because she preferred to go by heart attack rather than by cancer. Well, those are the two main choices on life's menu these days, with the eradication of many infectious diseases. Carpe diem, and pursue what your soul needs before it's too late.
I am grateful that my needs are simple other than Jimmy Choos, that my life is rich and complete, and that food is not very important to me other than Shad Roe and caviar.
For years, I have been explaining here that dietary fats are not a meaningful factor in heart disease (arterial disease). Your cholesterol level most likely doesn't matter either unless you have familial hyperlipidemia or diabetes. I believe those outliers skewed earlier studies.)
The smaller, more artery-clogging particles are increased not by saturated fat, but by sugary foods and an excess of carbohydrates, Dr. Chowdhury said. “It’s the high carbohydrate or sugary diet that should be the focus of dietary guidelines,” he said. “If anything is driving your low-density lipoproteins in a more adverse way, it’s carbohydrates.”
Once again, it's the carbs that are the problem. Best thing is to deal with that carb addiction.
It's fascinating how crowded Everest is becoming these days, with queues of mountain tourists for the rope lines. The highways are all mapped out, ladders installed, ropes installed, sherpas hired, etc., so it's almost like a rich man's chilly Disney World.
The medical part - and the risk of bad weather - seem to be the greatest challenges. First World Problems, if you will, because nobody needs to do this. However, if it is made too safe, where's the credit?
As with the Olympics, I think it's wonderful that some people want to try these sorts of adventures in life, but I do not admire the amateur tourists. Good film:
"Decisions, decisions, decisions!" This often is spoken in a mixture of ennui and smug irony for decisions such as "should I buy the Audi, the BMW or the Lexus?" But this piece is nothing like that, it is about the general confusion and questionable value of our medical establishment.
The three "decisions" are apt because the diagnosis and treatment of three major illnesses have been called into question in the past year and this is disconcerting if not alarming. If you are unfamiliar with the work of Dr. John Ioannidis I recommend you find him on the web. His view of the state of medical research is summarized as "Lies, damned lies and medical research."
The original quote actually was by the British prime minister, Gladstone: "There are three kinds of lies, lies, damned lies and statistics."
The recent study out of Canada declaring the value of mammograms in women under fifty without value is noted. One doctor at Sloane Kettering has already balked and we have yet to hear from the Susan Komen foundation. The other disqualifying report identified antidepressant medication as simply placebo with no valid clinical evidence to the contrary. As a clinician my experience does not support that position, but there are facts that are hidden from us. For example, the FDA requires two "positive" studies to approve a medication for the treatment of a condition. That there may be six negative studies is not required to be revealed to us, and, as Ioannidis points out, many of the "successful" studies measure the new product against drugs that are known to be less than effective, if effective at all.
But it is prostate cancer I want to focus on. To PSA or not to PSA, that is the question. (Excuse me Prince Hamlet.) I have learned a great deal about this question from a man whom I have known for many years and who has had prostate cancer diagnosed. There was a series of articles in the popular press questioning the need for and value of the PSA test around the time his PSA began to increase incrementally. "You will more likely die with the prostate cancer than from the prostate cancer." This is very reassuring, unless you have witnessed a patient or a relative die the excruciatingly painful death of metatstatic prostate cancer.
The concerns expressed, in our behalf, is that the PSA can lead to biopsies which can be painful and prone to serious complications. While I am not a urologist, I can say I have seen one man who complained of persistent pain following a biopsy. That is all. What most of the articles failed to make reference to is something called the Gleason Score, an assessment of the aggressiveness of the tumor's malignant cells. The numbers of the score range from low to high but what you need to know is that a score of Seven is at the dividing line of could be serious and is serious. Eight and up are without question serious. Without that information one cannot make sensible judgements about how to proceed and one can only have that with the prostate biopsy. You can see the circularity of this process. With that information in hand one is then given a menu of treatment choices to consider. Watch and wait, radiation, surgery - robotic and standard supra-pubic surgical removal of the prostate gland, proton beam treatment, cyberknife, aggressive sonic ablation - more than most doctors, let alone lay people, can assess when in a state of some anxiety. Every treatment brings its own list of complications and ill consequences. "5%" risk of whichever one sounds reassuring but, if it is you who experiences that ill consequence it is 100%.
And what is most important is, as my friend learned, there is no evidence that any treatment is superior to any one of the other treatments and there may never be a study to pit one against the other to determine which is best. He chose surgery and has done well now for a few years. His PSA is zero and hopes it will remain that way. So, we ponder these three conditions, each afflicting roughly 10% of the general population, and we are asked to act or not act on the basis of flawed and insufficient information. What else are we missing?
Of course, recommendations like this change all the time, just as do all dietary recommendations. I take it all with a grain of salt or, I should say, with plenty of salt. I love salt.
There apparently was too much swelling in his leg to do the needed surgery, so the current stabilization technique (photo yesterday) is temporary for a week or so, then I assume a tibial rod or other internal fixation.
Guys gotta do what guys gotta do, and sometimes they have to get banged up in the process. I applaud these male efforts - and female efforts - to remain in the game and not to quit despite the risks to bones, pride, etc.
A medical colleague emailed me a photo of his own left tibia this weekend, acquired when skiing at Jay Peak. Ouch. An MD degree is not required for this diagnosis. For a layperson, this is a version of a "broken leg." This will need pins or a plate or something. Some metal and some screws, and I think he'll miss a day or two of work.
An annual re-post, but re-posted again because we seemed to help a number of people with this:
Forget the "Obesity Crisis." That's a crock. Abundant, good food is a blessing and a rarity in human history so it is a great privilege and luxury to be overweight. It certainly is true that, when tasty food is cheap, people will eat a lot of it and their bodies will kindly store what they don't need to survive today, to the detriment of our knees, hips, appearance, comfort, and general vigor. Trouble is, we won't need that storage tomorrow - or ever. It's like hoarding.
We can all be as fat or fit as we wish to be. It's a free country, and being fat (but not obese) isn't terrible for your health unless you are diabetic or want to be able to get around energetically. But don't listen to the Dieticians and Nutritionists. They will want you to get in shape slowly and in a "sustainable" way. In your heart, you know that will never happen. If you are bothering to read this, you just want to get in shape as quickly as you can without liposuction or use of the vomitorium.
Eliminating carbs reduces or eliminates carb craving in most overweight people over several weeks.
This can be a one- to three-month program as desired. Maintenance is another topic.
OK class, take out a pen and piece of paper, I am going to tell you a bit about ICD 10.
First, don't be alarmed by the prophets of doom who say you docs will be required to use this carefully crafted taxonomy in order for the insurers to refuse to compensate you for your services. This is true. I had dinner with an oncologist friend who is in bankruptcy because even though his patient's insurance company gave prior approval for a $100,000 course of chemotherapy they maintained that did not obligate them to actually pay for the cost. He already had, and on multiple occasions.
Back to ICD 10. This document will allow you to kick back and have some laughs about the conditions you likely will not be called upon to treat. The Monty Python crew had a field day constructing this and they've arranged for the ICD 10 office to be right next door to the Department of Silly Walks. Viz:
V9733XA: Sucked into a jet engine, initial encounter V9733XD: Sucked into jet engine subsequent encounter (Should this person be allowed on runways?) V9733XS: Sucked into jet engine, sequelae ( this is for the litigators)
But, don't overlook, Index to External Causes of Injury Accident E919.1 Bore, earth drilling or mining
Land or seabed E919.7 Bulldozer E909.9 Cataclysmic: Earth surface movement or eruption
So, be grateful if you only have to deal with intangibles and won't get blood on your shoes.
I'll be back soon to discuss Scott Stossel's heroic battle with anxiety and transgressive therapists.
The US government recommends 9-11 servings of fruits and/or vegetables daily.
What are they smoking? Unless a stalk of raw celery or a leaf of spinach counts as one vegetable.
If you ate all that, you would be obese, especially with the fruit which, as I always say, is God's dessert. Unless you are at a starvation weight, you don't need fruit. Fruit is just sugar, and you might just as well have some ice cream.
The message is that magical thinking about health and food, etc., doesn't accomplish very much. Neither does magical thinking accomplish very much in any other area of life - except in fiction.
The best way to go, many feel, is to get pneumonia in old age and to die quietly, peacefully. Most are not so lucky and some darn doc will try to treat your pneumonia at age 92 to extend your life for a few weeks in the ICU on a respirator. However, for many, if you outlive heart disease cancer will get you: Why Everyone Seems to Have Cancer.
We don't call it "dying of old age" anymore because we have much better diagnostic tools. Everybody has to die from something or other.
The Heimlich Maneuver and CPR should be known by every responsible citizen. As I regularly remind readers, the CPR procedure has been revised and simplified.
The difficult thing about CPR is knowing who needs it. I have heard stories of people doing CPR on people who were choking, and on people who simply fainted.
Medical risks associated with being overweight include breast cancer and several other cancers, cardiovascular disease, arthritis (esp. knee), diabetes (obviously) along with other insulin-resistance-related metabolic syndromes and carbohydrate-craving, non-alcoholic liver disease, pancreatitis, stroke, hypertension, gall bladder disease, sleep apnea, and many more fun problems.
As a native Cape Codder and cranberry fan, it's a delight to report that they may have a powerful anti-atheroscletotic effect. Maybe this news might have a beneficial effect on a specialized family farming that has been bedeviled by low prices.
The big producers are Wisconsin, Massachusetts, New Jersey, Washington, Oregon and Michigan.
The sentence in Science Daily I don't understand is the following: "The researchers said that the next step is to determine which compounds in cranberries contribute to the benefits and then figure out how to incorporate them into the diet in a form palatable to humans." How about in cranberry juice, cranberry muffins, cranberry pancakes, 25 kinds of cranberry sauce, cranberry cobbler, and dried cranberry "raisins,"....for starters? You can buy unsweetened, undiluted cranberry juice now in most supermarkets.
We keep bags of them in the freezer, and they seem to last a year.
Cranberry sauce: it's not just for Thanksgiving turkey. It's good for chicken and almost any kind of game meat. Never use the junk from the can, though. Even if you think you like it, you will find you like the home-made better.
More on this native North American bog plant here.
I recall my first deaths in medical school, in the ER. Two ambulances, family of four after a parking lot accident. The cool efficiency of the ER senior resident doing five-second triage: the 7 year -old - "Dead." The ten year-old - "Dead." The Mom - "Dead." The dad, blue but not grey like the others - "Breathing. Get him in a room and let's work on him. Tube here now, chest tube, EKG, crash cart, IV. Get a surgeon down here. Let's go, team."
In just a couple of minutes the unconscious Dad was intubated, had an emergency chest tube, IV, monitor, etc., survived.
I view part of my duty as to debunk folk myths about health and medicine. Readers know that one of my bugaboos concerns the human diet and the First World preoccupation with what we eat as if it mattered all that much. Food faddism has always been part of American life since we became a wealthy country and had food choices.
Still 
For years, I have been explaining here that dietary fats are not a meaningful factor in heart disease (arterial disease). Your cholesterol level most likely doesn't matter either unless you have familial hyperlipidemia or diabetes. I believe those outliers skewed earlier studies.) 
