Do you believe the more tests a doctor orders the better the Doc? Does ordering many tests mean insecurity? Perhaps ordering a test equals less time and questions ask that could make a diagnosis or arrive at the best treatment?
We are taught in medical school that 80% of the diagnosis is in the history and physical exam. Both require time! A detailed physical exam, hands on, using a stethoscope in at least 18 places – that is a careful thoughtful evaluation. Don’t forget the exam is clothes off and no noise nor interruptions.
Medical tests are not absolutely safe. Over ordering of imaging studies (scans) can result in exposure to radiation especially in the case of CTs. Never mind the many incidental findings – findings that do not explain your condition. Simply put an abnormal finding with no known medical significance. This reality occurs in more cases than you can imagine where upon a dilemma arises. Then a decision: order more tests, ignore or let the patient decide. Below are some results for specific conditions and tests.
Headache sufferers all too often have a brain imaging study ordered with less than 1% revealing the cause. In 20% of those brain CT scans (radiation exposure equal to 8 months of natural radiation) there are ‘incidental’ finding. If instead a brain MRI (no radiation) was ordered – 10 -12% have incidental findings.
If your work-up includes an abdominal CT scan (equivalent to 3 years of natural background radiation) while it may help with a diagnosis, 50% of these scans are read by radiologists to have ‘incidental findings’ which may leads to more tests and apprehension.
Remember medical radiation is cumulative in out bodies! Read my earlier Radiation blog on this.
If you read my blogs I try to impress on readers that medication even OTC are not totally safe. A recent study in children found those taking attention deficit-hyperactivity disorder (ADHD) medication had a double risk of cardiac problems versus those ADHD children not on meds. Overall this was a small number, but noted along with an inverse dose relationship. Implications that stopping medication or lowering may trigger a cardiac event. Prescribing info for methylphenidate (Ritalin) and similar drugs DO lists cardiovascular events under “Side Effects”.
Danish children diagnosis of ADHD were followed for 9 years: 8,300, 5,482 received stimulant drugs and the remainder did not. Two groups were compared to arrive at above finding, please note that other factors (family history, smoking during pregnancy, exposure) were not considered. These would be termed ‘confounders‘ in medical research.
My recent blog (7/27/14) on food dyes use and behavior problems in children hints to perhaps the increase in the US of diagnosis of ADHD. At best the diagnosis of ADHD is an educated guess, be sure before putting any ‘chemical’ into your body and especially allowing a child to be given one.
Why does the rest of the world eats safer than us? What quickly come to my mind is our abundance of GMO products. There must be a reason so much of the world bans GMO products? Read my earlier blog on this matter.
The latest ‘insult’, as I see it, is that in the EU a warning label (since July 2010) is placed on products that contain artificial dyes. A landmark UK study (University Southampton, 2007) found association between food dyes and behavioral problems in children. “We found mixtures of certain artificial colors together with sodium benzoate preservative in the diet increased the average level of hyperactivity in 3 and 8/9-year-old children in the general population,” Dr. Jim Stevenson, lead author of the study. More ADHD diagnosed children.
Why does Kraft®’s macaroni and cheese in the EU have no artificial dyes BUT do in the USA? US consumers get “Yellow No. 5 and Yellow No.6! Why not use paprika and other natural dyes as they use for UK children? In the UK, McDonald®’s strawberry sundae uses real strawberries while in US, Red dye No.40 is used!
You might wonder where is the FDA? Well they approved 9 petroleum-based color dyes! Horrible!
The way US FDA thinks is ‘innocent till proven guilty’ whilst in other countries ‘possible harm’ – even when evidence is ‘inconclusive’ – prevails in making the judgement.
The FDA uses the ‘precautionary’ principle for new drugs (years of testing) YET allows non-evaluated food dye chemicals. In 2011 the FDA determined that in ‘some children dyes’ do have ‘an effect’.
Dyes are only used for cosmetic purpose so why not focus on use of healthy foodstuff? Other than marketing there is no benefit from use of dye chemicals in foods.
‘Knowledge is power’ (attributed to Francis Bacon) however it can also be life saving. Often by personal desire or medical prescription we put chemicals into out system believing they are safe and that all will be better. Naive? Yes!
Your body, your job to find out all you can about a drug you are taking or will take. Where can you learn about the medication? Yes a doctor should explain about what chemical(s) you are given BUT they do not explain beyond you need “this should help”. Yes perhaps it will help but at what cost, what should you watch for, side effects, interactions contraindications to name a few.
Yes the pharmacist asks if this is the ‘first time’ you are taking this medication and hands you a few printed pages (very small font) info with your ‘order’. You do read these?
Resources beyond your doctor and pharmacist are definitely needed – greater insight is needed beyond what is written for the general population.
A few recommendations:
– Consumer Reports now has a dedicated section on ‘drugs’ that includes ‘off label’ uses and safety issues. Learn about splitting pills (some you can not), about generics and plenty more.
This week’s blog aims to show that chronic back pain (CBP) is quite complex. This phrase is thrown around so frequently one might think it is one thing in everyone. I want to help you ID the difference between the major types of ‘chronic back pain’: mechanical and inflammatory. There are many causes for each type but I am not diving into that here.
Knowing the type and specific cause allows tailored care. Nearly a third of adults with CBP have an inflammatory cause. This can be a sign of serious inflammation elsewhere in the body.
Characteristics of mechanical back pain (ex. disc disease, nerve pinched) include:
any age although usually older
sudden onset
AM stiffness <30 minutes
no night pain
worsens with activity
Characteristics of inflammatory back pain include:
age younger than 40
slow onset
AM stiffness >30 minutes
nighttime pain
improves with activity
When you talk to your medical care provider explain your symptoms (ex. stiffness, numbness, location) and offer specific from the list above. If your back pain has lasted more than 3 months, feels stiff when you wake up and hurts the most when you rest perhaps it is caused by an inflammatory condition (ex. ankylosing spondylitis).
Must Americans (June, 2014 – Consumer Reports) equate the use of the word ‘natural’ on processed food labeling as equivalent to ‘organic’. This short blog is just a rudimentary base so please read everything on products, research on-line and if not there, call the number on the product, I have had to do so to gain needed specific information.
Americans spend over $40 billion on food a year. It would be nice if there was truth in labeling.
There is no specific or official requirement/definition that needs to be met to use ‘natural‘ nor is that product subject to examination. There is a loose concept that labeling natural implies no added artificial color but this is not verified.
To label ‘organic’ a verification of specific criteria is necessary. The process requires renewal and re-verification – not a one-time deal.
ORGANIC means NO:
– genetically modified organism -(esp. GMO seeds)
– sewage
– synthetic fertilizers
– ionizing radiation
– antibiotic use
– growth hormone (ex. in bovine use of r-BST)
Other common buzz phrases:
– ‘free-range‘ only means animals had access to open space – the option – they need never have been outside!
– ‘no nitrates’ can mean natural nitrates were used. When we eat foods with preservative sodium nitrate our digestive tract converts it to sodium nitrite. Celery juice is used as a ‘natural’ sodium nitrate! While there is controversy over cancers’ relationship to nitrites, realize it is over the fact that no ‘direct’ proof exists for humans. Pretty hard to ever prove ‘behind a shadow of doubt’ a ‘direct’ cause and effect given the complex human body.
What is good for humans to eat is not a straightforward issue!
Read lots and keep current by using reputable websites and sources.
You, I hope, do not equate an over the counter (OTC) medication as being totally safe? Read this blog very carefully, especially if you take non steroidal anti-inflammatory – NSAID meds like aspirin, naproxen (Aleve), Ibuprofen (Advil, Motrin). The FDA has a ‘black box warning’ on this class of drugs. This severe warning is issued as the step before pulling the drug off the market.
Americans use over 30 billion NSAID pills each year; think everyone has a few tablets nearby, airports, Costco and even school nurse. No surprise that 16,500 die 100,000 end up in hospitals from the most common side effect bleeding. NSAIDs can erode the esophagus and stomach linings and cause bleeding. Many high-profile athletes have developed kidney disease from overuse of these OTC ‘pain killers’. Specific organ damage may or may not cause symptoms, may effect some and not others.
Another very serious side effect is the triggering of an autoimmune response in some individuals with a genetic predisposition. Let me explain ‘leaking gut syndrome’ that occurs as NSAIDs can prevent food from being fully broken down, the bowels then start to leak amino acids which the body does not recognize, hence thinking it is foreign it launches an immune response. Immune illness like Asthma, Lupus, Thyroiditis, Celiac disease, Scleroderma, or Rheumatoid Arthritis (RA) can result.
Do not forget the well-known heard effect these OTC can have – please re-read my previous blog an NSAIDs’ negative heart effects.
I recently an email from my favorite wine bar saying they now serve ‘gluten-free bruschetta’. I am confident you have noticed the increasing number of gluten-free products? Gluten-free breads, pastas, pizza dough, crackers, sounds good but remember they all still a powerful sources of carbohydrates. Do not think gluten-free means fewer calories via carbs.
Avoiding gluten is not just for the 1% of US population with Celiac disease (small intestine can not absorption gluten). Celiac disease is a genetic disease.
Eating too much gluten is bad for anyone! It is metabolized (broken down) in the human body creating loads of ‘free radicals’. Free radicals are well established as causes inflammation and especially bad for our nervous system including the brain.
Yes almost everything contributes to the daily max. of ‘Carbs’. My recommendation is to try to keep the total daily carbohydrates to 60-80 grams unless you are a diabetic or on a special diet.
FACT : Fruit = lots of carb – your AM OJ – 12-ounces freshly squeezed has 34-36 grams of pure carbohydrates (9 tsp of pure sugar). If you have 2 glasses of orange juice, you’ve already consumed 72 grams of pure carbohydrate.
Think a bit more before putting anything into your body.
Many of us have had bad breath (oral malodor) hopefully infrequently so here comes a quick blog with a few pearls.
Temporary relief toothpaste/mouthwash does not get to the root of the problem. Masking the result of hundreds of bacterial species metabolizing in all our mouths is impossible. These bacteria digest our diet esp. proteins, after several smelly substances arise, hence bad breath and even deposits on our tongues’ surface.
Have you heard of any of these ‘folk’ cures? I found that eggshells (China), parsley (Italy), guava peels (Thailand), and cloves (Iraq) are in the ‘lore’. Sulfur is the culprit, a by-product of bacteria breaking down protein.
It is not always your mouth that is cause postnasal drip from your sinuses can result in a malodor. Another possible cause is a belch from an esophagus that is not closed well, bringing up stomach odors.
So let’s get to prevention – naturally good dental hygiene – especially flossing as a deterrent, along with brushing or scraping your tongue surface or chewing gum. Stimulation of saliva, which contains lysozymes, inhibits of bacterial growth.
Check for postnasal drip and take steps to stop it. Should you suffer from frequent belching have your esophagus evaluated.
Recent Comments