Friday, March 27, 2015

More on lies my patients tell me

No doubt about it, the physician - patient relationship is a complex one, one that is built on a truthful exchange of information.  You expect your doctor to be straight with you, while your doctor understands that you are often less so with information you provide.  Here is a second article where I was interviewed, this one for WebMD, called:
You can understand, I hope, that there are only five listed because the article had only a limited amount of space.  If there is a lesson to be learned, it is to be as honest and open as possible with your doctor.  To use a line we all have heard before, tell him or her the #truth, the whole truth, and nothing but the truth,  When you #lie, you hurt only yourself.

Wednesday, March 25, 2015

Do you spring into a cold?


It's spring, and lots of things are in the air, like pollen, viruses, you can get the picture.  With this in mind, and the need to watch your habits and practices, here is an article I was interviewed for from Women's Health Magazine:

Another tragic story just lingers on

The story of Bobbi Kristina Brown, the daughter of the late Whitney Houston, continues as she is moved to a rehabilitation facility, still in a coma.  Is there hope?  Newsmax writer Charlotte Libov, who is following this story, discussed the situation with me, and shared the information in the article:

If there is a lesson that can be learned from this tragic sequence of events, it is that we all need to have Advance Directives, including the appointment of a Health Care Agent, also known as durable power of attorney for health care, and Health Care Instructions, also called a living will.  These documents do not deal with your money or property, like a regular will, but with decisions about your health care in the event you cannot direct the care yourself, as with Bobbi Kristina.  Here in Maryland, the Maryland Attorney General has forms that can be downloaded and completed on their website.  Likely other states and jurisdictions have similar information available.  I know that this is not a topic that we like thinking about, but it is important, and everyone should have those documents, call them a form of insurance, just as we have other insurance policies for unforeseen events.

Monday, March 23, 2015

Television spot about sleep

This topic of sleep is a hot one, with our local NBC affiliate, WBAL, featuring me on this Monday evening's Women's Doctor segment, sponsored by Mercy Hospital.  Here are some thoughts on sleep by one of my patients, along with my comments on various aspects of the issue:

Sunday, March 22, 2015

The best way to start your day?

coffeeSo, I will begin by disclosing that I drink about three cups of freshly brewed, filtered, coffee daily, brewed from whole beans that I grind just before brewing, and I drink it black, with nothing in it, and I enjoy it! 

Having said that, I had a request from WebMD for an interview about

How could I pass that one up?  So, along with the article above, here are some questions and answers that I engaged in about coffee.

1. What is it about coffee that makes it so good for us? Is it the caffeine? Is it the antioxidants?( Do scientists know?)

Although there certainly are studies which relate health benefits to coffee consumption, it is anything but clear as to from where those benefits come.  While coffee does, itself, contain antioxidants, some say that coffee is a major source of antioxidants, it is not clear if those antioxidants actually have an effect in the body, if they are absorbed and utilized intact.  One can also postulate that a preferance for coffee is present in people who have lower incidents of certain diseases.  We always want to look for that cause and effect, the issue is that such an effect is not always there.

 2) In some studies (in the heart and endometrial cancers one, I believe) you have to drink 3 to 5 cups a day to get that benefit. That’s a LOT of coffee and it seems to me that that might lead to other concerns. Would drinking 3 to 5 cups of coffee daily lead to other health concerns? How much is too much? Are there any documented risks from drinking coffee?

Although some of the studies, such as with diabetes, have suggested that decaffeinated coffee may be as effective as the regular stuff, other disease relationships have typically involved caffeinated coffee.  For blood pressure and heart disease, up to about 200 mg of caffeine a day, which would be the equivalent of 2 six-ounce standard cups of coffee, would appear to be acceptable for most people.  More that that, or using a stronger coffee to get more caffeine, may cause issues with the cardiovascular system. 
  
3) Does it make a difference what kind of coffee or how it’s brewed?

Coffee made with a French Press may have substances which influence serum lipids; filtered coffee removes those substances in the brewing.  Instant coffee is also lacking those chemicals, and likely is lower in caffeine (for regular instant) than brewed coffee.  Some studies have suggested there may be toxins in instant coffee, but these are likely at very low level, it at all, and may or may not be of clinical significance in typical coffee drinkers.

4) If you don’t drink coffee, should you start?  (In other words... I do not drink coffee. I drink tea. If I were your patient, what would you tell me?)

Since at least some of the studies have suggested that the relationship may be that the person who prefers coffee is more resistant to a particular disease process, I would not feel at this time that there would be justification for starting coffee drinking for its perceived health benefits.

5) Is there anyone who just shouldn't drink coffee? 

Again, blood pressure and heart disease would be relative contraindications to consuming more that a few cups daily.  Certain specific cardiovascular problems may be exacerbated by even less than that.  In addition, compound in coffee, even decaffeinated coffee, can cause GI upset in many, limiting consumption.  Pregnant women should limit coffee intake to under the 200 mg limit, and people on diuretics should be aware that both caffeinated and decaffeinated coffee can increase urine output.

6) What if you load your coffee down with cream and sugar - does that negate the benefit or cause other health worries?

While cream and sugar won't change the amount of caffeine in your drink, it can certainly affect the amount of calories.  Some creamer and sugar could increase the calorie content by 1000% - ten times the calories of black coffee.  Have a few of those a day, and the calories can add up; make it a frappe latte and a few a day could be a pound a week.  And that will certainly impact your health. 

As always, these words of wisdom are to be taken generally, without any specific advice expressed or implied, and you should always check with your physician or health care provider regarding this, or any other food, supplement, or health related regimen.

You tell your doctor ... what?

So you go to your doctor, get poked and prodded, blood sampled, x-rayed, studied, and tested.  And that is enough to tell what's wrong with you?  Not if you don't tell your doctor what's really going on.  It happens all the time.  Someone comes into the office and tells the physician just what the patient wants the physician to hear, no more and no less.  The result may be a bad outcome -- for lack of knowledge.

Here's a little piece that I contributed to that looked at:

In the process of working on this piece, here were my responses to some questions:

What would be on your most common list of lies patients say (maybe top 5) and how often do you hear them?
On a daily basis patient will tell me that they follow their diet, exercise regularly, stopped smoking, stopped drinking, and …. the big one … take their medications exactly as directed. 
Why is it important to tell your doctor the truth?
A physician comes to a diagnosis or prescribes a course of treatment based on assembling a set of facts and conditions that are believed to be true.  Lying, defrauding, hiding, misleading, fibbing, or otherwise failing to give your health care professional the complete and honest story may results in ineffective or even dangerous treatment.  Tests may be ordered, invasive or dangerous tests, that you do not need; ordered because of the scant facts provided to the doctor.  Medication may be prescribed that may not help, or may harm, based on a lack of full knowledge. 
Why do you think people are less than truthful when it comes to admitting health issues?
There are a whole host of reasons that will prompt a patient to lie.  Many behave as a child does, trying to satisfy a parent by saying just the right thing.  There is embarrassment, of course, the feeling of having done something wrong.  Smoking, drinking, even drug use are behaviors that everyone knows are bad, but must be "fessed up" to the doctor.  "So why tell him if I think it does not matter?"  Only maybe that brief fling with drugs in college really is the reason for the elevated liver enzymes that the physician does not even begin to suspect are from lingering hepatitis.  Fear of what might be found, or found out, also can come into play.  And some people just don't get it.  Medication compliance, a healthy diet, good habits, vigorous exercise -- those are things that others do, not me.  But why go into that when a nod of the head may satisfy the busy doctor.

Is too much sleep too much of a good thing?

joey_ross

Thanks to some recent journal articles, the topic of sleep has become a hot one in the medical world.  Here's a little piece that I contributed to along with several others, seeing to look into the question: