What's Your Number?

I participated in a sprint triathlon today at Innsbrook, here in MO.  It was a beautiful day, sunny and warm and not too hot. What a blessing!  I had some time to think during the race and came up with a few questions.  All of the participants in the race are marked with two numbers.  One is the race number we are registered under.  The other is our age, on the back of the left calf.

The first number doesn't say much to a general observer, other than how committed we were to the race.  The numbers are ordered by when we signed up.  I was number 595.  There were only about 610 participants, so that tells everyone that I committed to this race quite late in the process.  The other number seems to garner more attention.  It is our age.  The race is started in several heats or waves according to age and gender and which course is being competed in (there was a long and a short course).  The start is in the lake swimming.  No one is really paying any attention to the numbers of others in the water.  Most of us are trying to just not drown.  However, on the bike and on the run portion of the race most of us will glance at the person's age that we are passing or who is passing us.

I notice that if I am passed by a man with a 55 on his leg, I tend to push a little harder and try to stay up with him. I don't pretend that I am going to win the race, but I would like not to be passed by someone older than myself (though that did happen twice today!).  Here's my question: If we all walked around with our blood pressure and cholesterol numbers on our forehead, would it change our behavior?  I think it is worth a thought or two.

Many of us are rather competitive at heart, but not all.  Some tend to be more fatalistic and feel that it is all out of their control.  It doesn't really matter what someone else's numbers are, does it?  I guess if that other person were a loved one we might be more inclined to try and assist and support them if we saw that they weren't so good.  Would seeing other's numbers spur us to better habits?  It might.  The most obvious benefit to me is that it would ingrain in all of us what the normal ranges are.  I know what they are but I do this for a living.  I deal with these numbers every day.  These are numbers we should all know.  It is most important to know our own numbers but it doesn't do much good to know just one number without having a value attached to them.

Here are the ranges:

                          Optimal         Borderline               Bad
B/P:                   <130/80     130-140/80-90        >140/90

Cholsterol:
Total                  <200 (depends on the breakdown though)
HDL (good)      >45                35-45                     <35
LDL (bad)         <130              130-160                >160
LDL (for those with diabetes or heart disease:
                         <70                70-100                  >100
Triglycerides      <150              150-200                 >200

So look at these numbers closely.  What are your numbers?  If you are not in the optimal range, talk to your doctor about how to improve them.  In the race of life we win by being healthy.  We can all be winners.  It is easy to get discouraged.  One of the greatest things about participating in a triathlon is that there are many spectators who cheer loudly for all of the participants.  It really gives a boost.  Let's all cheer for each other. Don't give up if you are discouraged.  Keep running and keep trying.  Your health is worth it.

Super Size This!

We live in a day of convenience and ease.  Have you ever seen the process our pioneer fore bearers went through to just make soap?  It took about a week of stirring pot ash over a fire, separating impurities and repeating the process over and over.  Think about the work to eat a piece of bread.  The wheat was often grown by the family itself.  Fields had to be seeded, crops had to be cut.  The grain was taken into town to be milled into flour.  The rest of the ingredients had to be procured.  The dough needed to be kneaded and allowed to rise.  The oven had to be heated by a fire until the correct temperature was achieved.  We don't even think twice about such things now.  We walk down an isle, plop items in our cart, wave a piece of plastic and go on our merry way.

Not long ago, most professions in our country required physical labor.  This is not the case any more.  Even farmers are not as active as they once were.  Vast tracts of land can be plowed from an air conditioned cab on large equipment.  A farmer patient of mine recently told me that in ten years he suspects that most farms will be worked by unmanned equipment.  Many of us spend a large part of the day sitting in front of a computer screen.  Our cars take us right to the doorstep of almost any destination.  If we have to walk more than 100 feet after parking, we get cranky.  I know because I hear it from my patients all the time.

My point is this, most of us cannot live our lives and expect to be active enough to stay healthy.  Obesity is a huge problem world wide and especially in our country.  My patients ask for pills and hope beyond hope that the latest dietary supplement will truly help them lose weight.  I talk to them about diet and exercise and most people recognize that what I am saying is correct.  It is one thing to know it; it is another to do it.  Let me share with you, two ways to view your day to maximize your health.

First of all, you must move.  The reason why we eat is to provide fuel for our muscles.  If we don't use our muscles, there is no reason to eat.  Here's my offer: you only have to exercise on the days that you eat.  Now of course we all eat every day, but every time you open your mouth for a bite you should think about how much activity you have done for the day.  I have a daughter that was a swimmer up to and all four years of college.  While in training, I have seen her and her friends eat more calories than I can imagine eating myself. That is OK, they needed those calories.  Conversely, I have seen her bypass a dessert, saying "I didn't swim today, I can't eat that."  She has figured out that we must earn every bite that we take.

The last point I want to make is this:  eat all the fruits and vegetables you want.  Even if there was no exercise  in your day, you can sit down to an all-you-can-eat buffet with fruits and vegetables for all three of your meals.  No one ever died from super-sizing their fruits and veggies.  It is recommended that we get 4-5 servings a day.  Not a week, a day!  More is even better.  Use it for a snack.  A banana or other piece of fruit in the morning is a great way to start your day.  A salad will often be 2-3 servings of vegetables.  If you get the munchies before bed, eat a few grapes.  Sure it takes more effort to buy the fruit.  I know that it is more expensive, but it is worth it.  Go ahead, super size it!

The Hippocratic Oath for You

It is customary for medical school graduates to take an oath as they graduate from school and enter the profession of medicine. This practice stems from Hippocrates, widely consider the father of western medicine.  There are many facets of the oath ranging from answering to deity, providing free medical education, practicing confidentiality, not working beyond our expertise, proscribing abortion and avoiding personal relationships with patients.  The most widely known tenant is in regarding doing no harm.  The original version states:

I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice (www.pbs.org).


I recently saw a patient who told me she was trying to apply the Hippocratic oath to her own body, meaning she was trying to first, do no harm to her body.  As I thought about that concept, it sat rather well with me.  I spend much of my day as a physician preaching the admonition to first do no harm and second do your body right.  Harm comes in many forms.  The human body is an incredible organism capable of self repair and growth.  For most of us, if we give it the chance to work right, we will have the means to live a long, healthy life.  If the body is forced to deal with self inflicted damage, it's defenses will wear down and it won't have as much energy to spend on normal processes to keep the body going strong.  


The easiest form of harm to conceptualize comes from that which we ingest.  This ranges from that which we eat as food, the medicine that we take and the supplements that we consume.  I have discussed all of these previously in earlier posts (see categories: watch what goes in).  Illicit drug use, cigarette smoking and alcohol consumption are the most important toxins to get a handle on.  Each is truly a poison and will only lead to harm.  Other chemicals such as caffeine and artificial sweeteners are less dangerous and not as well understood but should be avoided or limited at least.  The more food we eat off of bushes, picked from trees or dug out of the ground, the better off we will be (God's food).  The less processed food (that which comes out of cans, boxes and wrappers) we consume, the less toxins we have to process (Man's food).  Keep it simple and keep it healthy.  


Harm also comes in the form of exposure to infectious diseases.  Those we do not follow safe sexual practices may harm themselves for the rest of their lives.  Good hand washing skills are important to limit exposure. Simple measures such as coughing into the crook of one's elbow instead of the hand may not keep us from being ill but it may for our close contacts.  Using helmets on bikes and motorcycles and seat belts in cars can be life saving.  Being smart about sun exposure and using sunscreen is another simple measure to avoid harm.  We can do harm to our bodies by getting too little sleep.  Stress, likewise, can adversely affect our health.  


Lastly, there is sometimes a need to experience short term harm for beneficial long term effects.  Avoiding a prescribed medication due to possible side effects, while ignoring a serious health condition can cause serious harm in the future.  Exercise also falls into this category.  Muscles and bones get stronger, only after first being broken down, thus the adage, "no pain, no gain."  Again, our physical body is a marvelous structure.  You are the steward of this great gift.  Will you take the oath?  Will you accept the challenge?  First, do no harm.

Using "E-Cigarettes" to quit smoking

As part of my duties as a volunteer teacher at Washington University, I periodically have medical residents (doctors in training) spend a month with me at the office.  I have been fortunate to have Dr. Seema Mahale with me this month.  She will be entering the practice of medicine in a few weeks and has been wonderful to work with.  I invited her to write a post for my blog.  She graciously accepted.  I hope you enjoy!

Dr. Mahale's post:

As I was walking by a kiosk at the mall, I was approached by a salesperson selling E-cigarettes.  While I didn’t buy into the man’s pitch that I will look very sophisticated and cool with an e-cigarette, I couldn’t help but wonder if and how this new device could be used to help people stop smoking. 

First I needed to find out how e-cigarettes work. It turns out there are several different styles available, but the main idea is there is a network of metal filament heated by a rechargeable power source that heats a liquid reservoir. A vapor then is created that the user can inhale. The liquid is made up of water, flavorings and nicotine.

Unfortunately, there have not been many studies done to see the potential beneficial use of E-cigarettes and there are differing opinions. The FDA looked at many different brands of E-cigarettes and studied the content. They found there were traces of tobacco specific impurities that are associated with adverse health effects. Their report also notes there is no way to predict the amount of nicotine actually delivered when inhaled. The FDA also feels E-Cigarettes may even promote younger generations to start smoking since it is a new device. Based on this, the FDA does not feel E-cigarettes can be used for smoking cessation.

However, a small study done by Boston University School of Public Health found that E-cigarettes are much safer than real cigarettes. While E-cigarettes do contain carcinogenic components, the amount is 1000 time less than real cigarettes. The study goes further to suggest that E-cigarettes can be used as an aid to stop smoking as it mimics motions that one does while smoking.

There is no doubt that smoking is bad for you. It increases the risks of several disease such as cancer most notably lung cancer, heart disease, emphysema and poor circulation. However, it is very difficult to stop smoking, as it is one of the most addictive substances available.  Therefore, I feel it is important for one to realize all the different modalities available to help kick the habit. Some combination of counseling, support from family and friends, medications (such as Chantix and Wellbutrin), and nicotine replacement (patches, gums, etc.) are needed for one to be successful to be become smoke free.

I feel E-cigarettes can help people stop smoking and most importantly by using E-cigarettes people are not exposed to such harsh chemicals. The bottom line is a person should pick the method that works for them the best. While it may take multiple attempts, quitting smoking is the most important things you can do for your health.