In Memory..

As hard as I work, as hard as I study and learn, as much as I want to do what is best for my patients I know that every last one of them will die.  Does that make my efforts futile?  Of course not. Promoting good health enhances life now, each and every day.  It helps us function well in our older years.  It is not my goal as a physician to make some live as long as absolutely possible but it is for them to live as well as possible.  There comes a time when added minutes and days do not add to added quality of life.  Even when we understand that a love one is suffering and lingering, it is still hard to say goodbye.  It is in these heart gripping moments when we achingly say goodbye to the ones we love that we grieve the most.  These goodbyes are especially hard when life is cut short unexpectedly.  Grief may turn to despair and even depression.  While we must go on with our own lives, I am grateful to have a day set aside to reflect on those who have passed before us, a time to celebrate the memory of their lives and the impact they have had on our souls.


As a physician in training, I always figured that as I became more experienced, handling the death of my patients would get easier.  Having now been in practice nearly fifteen years, I can testify that the opposite is true, it is exceedingly more difficult.  To sit at the bedside of a patient that is now a dear friend, look them in the eye and say good bye for the last time is heart wrenching.  To be someone's physician is an honor and a privilege.  I always hope to say goodbye with no regrets, having done the very best that I could.  


As difficult as it is to say goodbye as a physician, I recognize that it is immeasurably more so as a family member.  Even when the loved one is clearly suffering, their departure leaves a void in our lives.  My own personal belief in a God and of the resurrection takes the sting out of death to some degree.  I am not sure how I would feel without such beliefs and am grateful for them.  Dr. Russel M. Nelson, a notable cardiothoracic surgeon, now a leader in my church recently said the following, "If the body’s capacity for normal function, defense, repair, regulation, and regeneration were to prevail without limit, life here would continue in perpetuity. Yes, we would be stranded here on earth! Mercifully for us, our Creator provided for aging and other processes that would ultimately result in our physical death. Death, like birth, is part of life" (April 2012).  Granted, it would be easier if God would just take us up in a twinkling of an eye, but that is not the way of life.  There are lessons to be learned at the end of life, both for those who leave as well as those left behind.


I would, therefore, like to pay tribute to my dear friend, patients, who I have grown to love and are no longer with us.  Each in his or her own way has taught me life lessons.  I am grateful to have been their physician and hope that the happy memories of their lives will sustain their loved ones who still miss them dearly.  Happy Memorial Day!


Editor's Note: I would like to acknowledge Daniel Pearlmutter, a patient friend and professional illustrator who graciously offered to provide the art for this post.  I am thrilled that he has taken an interest in my blog and know that you will enjoy his work.

Family Heroes

As a teenager, it was common for me to come home to having a grandparent in the house.  Both my father's father and my mother's mother spent time with us toward the end of their lives.  When I was nineteen years old, I lived for a year as a missionary for my church in Guatemala. A severe knee injury cut short my time with the wonderful people I grew to love there.  I returned home to have my anterior cruciate ligament repaired.  My mother talked Grandma into coming to stay with us by saying that I needed her there to nurse me back to health.  On my first day out of the hospital she told me of being a young woman and working as a nurse's aide at the local hospital.  Sponge in hand, she scrubbed me, telling me how she had been taught to "wash down as far as possible, then wash up as far as possible, and then washing possible."  I grabbed her hand and said, "Grandma, I'll take care of possible."  As Alzheimer's Dementia would later rob her mind of memories, I cherished the times we spent together.  Later, coming home from college, she loving looked at me and declared, "I used to know you!"  Her overall concern was that she did not want to be a burden to her family.  She spent time with all four of her children.  The bond and memories with Grandma was more than worth any burden caused by her care.

My grandfather also spent time with us.  Towards the end of his life, heart failure sapped his strength.  Ultimately he was done in by a fall which resulted in a subdural hematoma-bleeding around the brain.  He became too much to handle for my parents alone and ultimately spent his final days in a nursing home.  It was a difficult decision to make. The care received at the end of life is a decision that affects generations.  I have an elderly couple in their mid 90's.  The wife has Alzheimer's and the husband has been weakened by aspiration pneumonia and a blood clot to his leg.  They became too frail to live on their own.  An attempt to live with a daughter in a far away western state resulted in agitation and delirium.  The decision was made to bring them back to their home and their granddaughter now oversees their care.  She works full time during the day and spends every night with them.  The family has hired care givers during the day.  This loving granddaughter is spelled by her husband on the weekend.  I am amazed by her dedication.  I have no doubt that they have received better care than they would in any institution.

Family heroes come in many shapes and sizes.  Another patient of mine is a widow with no children of her own.  Her mind has slowly slipped, though she is loathe to admit to any problem.  She saw her husband decline from Alzheimer's and is terrified of having the same happen to her.  Her nephew has taken it upon himself to direct and guide her care.  He persists patiently despite my patient's unwillingness to admit to needing any help.

I feel strongly that our society is blessed by generations living together and spending time together.  Benefits are seen not only to the elderly in need of assistance and care but also to the youth who are able to get to know their grandparents better.  Nursing homes will always be needed to provide care that can not otherwise be given.  I want to salute those who stand up and take on the challenge of caring for loved ones.  They are healthcare heroes  Who are your family heroes?  Share with me your stories.

Fact or Fiction: High Cholesterol-Part 2

"I was in for my annual physical two weeks ago and the letter you sent me said that my cholesterol reading had increased from 210 to 216 over the last year.  You said you wanted me to come back in 6 months to get retested.  My questions are:

1.       I take one 900 mg fish oil tablet a day - would it be beneficial to double that?

2.       Some of the "natural" remedy information indicates that cinnamon tablets are helpful - any thoughts on that?

3.       My wife wants me to take "Cholest-Off" which is advertised as an all-natural means of reducing LDL numbers - would that be worth trying?

4.       Any thoughts on the Juice Plus program and if that might help?

5.       I eat a fair amount of peanut butter at lunch and drink 2% milk most nights for dinner - is that a problem?

I am eliminating or reducing my favorite vices - brats and ice cream sandwiches - probably  a good thing no matter what my cholesterol number is."  Name Withheld


The last post described what cholesterol is and how it can be damaging.  I want to go back to this email and discuss some of the issues that were brought up.

Let's start with fish oil.  It has been observed that a diet high in fish consumption is protective for heart disease. Now to be clear, seafood itself is not healthy, it is fish.  Crab, lobster, clams and other shell fish are actually bad for us.  It is the fish that swim that are healthy.  For many of us it is tough to eat fish 3-5 times a week.  For that reason it was thought that purifying the oils contained in fish could be used as a supplement.  Sure enough, fish oil has been shown to lower cholesterol, specifically the triglyceride fraction.  Within the last few months a study has come out that looked at whether or not this would lead to a decrease in the rate of heart attacks.  Those in the study had the expected improvement in their triglyceride levels but unfortunately there was no benefit in the heart attack rate.  It is only one study but it is the best information we have so far.  My feeling is that if you sit down to a big steak dinner and pop a fish oil tablet, you are not going to do yourself any good.  One of the good things about eating fish is not just the oil but it is also the fact you will not be eating something else that is not healthy.

What about cinnamon tablets?  Quite simply, I have seen no data in regards to cholesterol lowering effects of cinnamon.  I have seen modest data in regards to lowering blood sugar.  The effect is quite small.  Avoiding sweets will have a much greater effect on lowering blood sugar than ingesting a little bit of cinnamon.

  

Moving on, let's discuss "Cholest-Off."  This is a plant based sterol put in margarine that has been shown to lower cholesterol levels.  It has actually been around for several decades.  The effect is not huge but it has been demonstrated.  If an oil spread is going to be used, it is best to pick one that works for you, not against you.  It has also been put into capsules aswell.  I have no problems with "Cholest-Off."

The next item is "Juice Plus."  The idea behind this product is to get the benefits of multiple servings of fruits and vegetables in a few capsules.  I know of no data showing that it helps cholesterol levels.  It is high in vitamins.  My biggest concern is that people will take these capsules and fail to eat fruits and vegetables.  If so, the food they do eat is more likely to be of a lesser quality.  Eating fruit and vegetables is more than getting vitamins.  It is filling up with good fiber and an excellent source of water.  The more whole food and fruit that we eat, the better off we will be.  I do not endorse this product though it is safe.  Let's make sure and get our 4-5 servings of fruits and veggies in a day.

What about peanut butter and milk?  Peanuts are a decent source of protein but peanut butter is usually about 70% fat by calories.  It is not the worse thing that can be eaten but if one has high cholesterol, there are better alternatives.  In regards to milk, it is all about the fat.  Two percent is better than whole milk but not as good as skim milk.  I drink nothing but skim.  I think it tastes great.  Your taste buds will adjust, you don't need the extra fat.

The last paragraph on this email is my favorite.  Nothing we have discussed so far will make a difference at all if the brats and ice cream sandwhiches are still being eaten.  I can think of nothing worse for cholesterol than brats.  It is like a wrapper for fat.  Ice cream has the distinction of being the deadly double.  It has both fat and sugar in it.  No amount of cinnamon, fish oil, Cholest-Off, red yeast or even Lipitor will negate eating poorly.  It is not rocket science, it is quite straight forward.  If we use our common sense over our taste buds we will be "simply healthy."