Yearly Archives: 2020

Dr. C "Comments", PODCASTS, TELEMEDICINE

PODCASTS: TELEMEDICINE TECHNOLOGY CAN LEAVE MANY PATIENTS BEHIND

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Amid the Covid-19 pandemic, more doctors are turning to telemedicine. That’s a problem for tens of millions on the wrong side of the digital divide.

SPEAKING ON A landline, the patient complained of an itchy eye. On the call’s other end, physician Carla Harwell considered the possibilities, from seasonal allergies to vision-damaging herpes. Luckily, the elderly patient’s daughter was visiting during the phone consultation, so Harwell asked her to text a picture of her mom’s eye. The photo shocked Harwell. It was the worst case of bacterial conjunctivitis the doctor had ever seen.

Without the picture, Harwell would have told the octogenarian patient to call back in a few days or come to her office, risking an in-patient visit during the Covid-19 pandemic. She certainly wouldn’t have prescribed the antibacterial eye drops needed to treat the infection. “I probably would not have prescribed anything,” Harwell says. “That’s a scary thought.”

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COMMENTARY

Telehealth is here, will remain after the pandemic, and is useful in many situations.

Being older, poorer, minority, Linguistically challenged, rural, less informed and less Tech-savvy reinforce each other in comprising Barriers to proper Medical care of ANY kind, especially Telemedicine. These handicaps will hopefully improve with time, and should be A societal priority.

Special internet-connected roving Aid-mobiles in afflicted areas is one feasible idea that would help. Responding to a lesser “911” number, the health-van could go to the calling persons location,  help the person to the van, take pictures and other data for a Telehealth Doctor to evaluate, and facilitate treatment.

A neighborhood Telehealth site is also workable, and was a precondition to Rural Telehealth access, pre-pandemic.
If you are reading this message, congratulations! You are increasing your information, technical facility and your access to better Healthcare.

—Dr. C.

Dr. C "Comments", Men's Health, PODCASTS, Prevention, Women's Health

PODCAST: “MEDDIET” ALTERS GUT MICRIOBIOME IN OLDER PEOPLE, IMPROVES FRAILTY, COGNITION, INFLAMMATION

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We observed that increased adherence to the MedDiet modulates specific components of the gut microbiota that were associated with a reduction in risk of frailty, improved cognitive function and reduced inflammatory status. 

Dr Philip Smith, Digital and Education Editor of Gut and Consultant Gastroenterologist at the Royal Liverpool Hospital interviews Professor Paul O’Toole; who is Professor of Microbial Genomics, Head of School of Microbiology and Principal Investigator in APC Microbiome Ireland, an SFI funded centre at University College Cork, Ireland, on “Mediterranean diet intervention alters the gut microbiome in older people reducing frailty and improving health status: the NU-AGE 1-year dietary intervention across 5 European countries” published in paper copy in Gut in July 2020.

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COMMENTARY

Diet is one of the 3 pillars ( or 4, if you don’t consider intellectual stimulation a form of exercise) of health. And there are 3 prime dimensions to diet: Quality, Quantity, and Timing. This excellent study addresses the Quality of the diet. Vegetables, fruits and whole grains are the foundation.

Dietary Fiber is the main difference between the healthful Mediterranean diet and the highly processed diet so common in America.

How can you be sure you are eating enough fiber? Read on.
On almost all cans and boxes, you will find a nutritional statement, by law. Assuming that the contents are “real food”, and preferably “organic”, look for the “fiber” in grams, and the “calories” in 100’s, and mentally divide the grams of fiber by 100s  of calories, and you get a number. Let’s say that your fiber for the day totals “25” gms. and your calories for the day Totals 2500; that is “25” hundred calories. Divide the 25 grams by the 25 hundred calories, and you get “1”. Anything less than 1 is low in fiber.

25 grams of fiber is about the daily recommendation for fiber. 25 hundred calories is a ballpark figure for an average diet.
PORTION SIZE DOESN’T MATTER, since your dividend is a ratio.
The bacteria in your MICROBIOME feed on the fiber, and the higher and more diverse the fiber ( within reason. Hay is high in fiber) the healthier the food.

Blueberries are good for a fruit at 4-5 gms. of fiber per hundred calories. Broccoli is a good vegetable at 10 gms fiber per hundred calories, carrots about 3, and so on.

Sugar is the perfect “bad” food, at no fiber for as many calories as you can pack in. It makes you Want more, and “desensitizes” your taste buds to the natural sweetness of fruit, or even vegetables.

HIGH FIBER foods are MORE FILLING, leading you to eat less.
Civilization and Capitalism pushes too much food and too many calories at us. Overeating , obesity, and many of the modern illnesses is the result.
Generally, fresh fruits and vegetables are preferred, though cooking doesn’t do much harm, other than some vitamin loss that can be replaced.

Whole grain cereals have fiber in addition to other nutrients. Also, the complex carbohydrates in whole grains  are released more slowly than wIth refined cereals. This floods your blood less rapidly with glucose, and elicits a Less precipitous insulin response. This results in a lower, healthier  “glycemic Index”.

Vegetables, fruits Legumes, seeds, nuts and their oils are the mainstay of the Vegan diet, which is healthful If enough protein and essential fats are ingested.

Fish, eggs, milk and cheeses are other components of the Mediterranean diet.

I take many of my daily Vegetable and fruits and  liquefy them in a food blender. Drinking my daily vegetables and fruits is a tasty and convenient way to improve my diet. I Savor individually those items I find most tasty, like nuts, apples, avocado, And fruit in season. This exercises my jaws, which is probably healthy.

YOUR MICROBIOME helps you in many ways that science is just beginning to understand. A healthy Microbiome is a DIVERSE Microbiome. FIBER is the food of the Microbiome, and a diversity in dietary fiber leads to a diverse Microbiome. A diverse, happy Microbiome produces many biological substances, like neurotransmitters, and probably communicates with the brain directly through the gut-brain Axis.

The Podcast on the 1 year Meddiet showed how directly a diet can BENEFIT HEALTH STATUS.

-Dr. C.

Men's Health, TELEMEDICINE, Women's Health

TELEHEALTH: OLDER ADULTS INCREASINGLY FIND VIRTUAL VISITS SAME AS IN-PERSON

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From the John A. Hartford Foundation:

While the benefits of telehealth are myriad and more apparent than ever, our survey revealed that 41% of older adults did not see telehealth as living up to the in-person experience. Providers must optimize the technology so that it caters to the less tech-savvy patient and caregivers—especially, if it is their only means of accessing health care—so that it replicates the in-person visit as close as possible. 

A survey we recently conducted shows that more than half of US adults age 70 and older (55%) experienced a disruption in their medical care during the first month of social distancing due to COVID-19. These older adults were most likely to delay primary or preventive care, and that’s alarming. Even more worrying, 15% of older adults put off essential medical treatment because of the pandemic. We don’t need medical degrees to know that delaying necessary care does not make the outcomes better.

As older adults continue to delay getting needed care, the problem will compound—increasing pent-up demand for services will ultimately vex health systems as patients’ conditions worsen. We think about the 4Ms of age-friendly care – what Matters, Medication, Mentation and Mobility – and how the pandemic may be delaying the assessments and interventions needed to prevent medication errors or to preserve cognitive and functional status.

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Men's Health, Prevention, Videos, Women's Health

STUDIES: CHRONIC SLEEP DEPRIVATION CAUSES TOXIC CHANGES IN GUT HEALTH, INCREASED EARLY MORTALITY

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From Harvard Medical School (June 4, 2020):

“We took an unbiased approach and searched throughout the body for indicators of damage from sleep deprivation. We were surprised to find it was the gut that plays a key role in causing death,” said senior study author Dragana Rogulja, assistant professor of neurobiology in the Blavatnik Institute at HMS.

The first signs of insufficient sleep are universally familiar. There’s tiredness and fatigue, difficulty concentrating, perhaps irritability or even tired giggles. Far fewer people have experienced the effects of prolonged sleep deprivation, including disorientation, paranoia, and hallucinations.

Total, prolonged sleep deprivation, however, can be fatal. While it has been reported in humans only anecdotally, a widely cited study in rats conducted by Chicago-based researchers in 1989 showed that a total lack of sleep inevitably leads to death. Yet, despite decades of study, a central question has remained unsolved: Why do animals die when they don’t sleep?

Now, Harvard Medical School (HMS) neuroscientists have identified an unexpected, causal link between sleep deprivation and premature death.

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Men's Health, Prevention, Women's Health

STUDY: “INTENSIVE DIET AND EXERCISE” REVERSES TYPE 2 DIABETES IN 61% OF PATIENTS

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From The Lancet Diabetes & Endocrinology (June 2020):

Our findings show that the intensive lifestyle intervention led to significant weight loss at 12 months, and was associated with diabetes remission in over 60% of participants and normoglycaemia in over 30% of participants. The provision of this lifestyle intervention could allow a large proportion of young individuals with early diabetes to achieve improvements in key cardiometabolic outcomes, with potential long-term benefits for health and wellbeing.

The Lancet Diabetes & Endocrinology

Type 2 diabetes is affecting people at an increasingly younger age, particularly in the Middle East and in north Africa. We aimed to assess whether an intensive lifestyle intervention would lead to significant weight loss and improved glycaemia in young individuals with early diabetes..Between July 16, 2017, and Sept 30, 2018, we enrolled and randomly assigned 158 participants (n=79 in each group) to the study. 147 participants (70 in the intervention group and 77 in the control group) were included in the final intention-to-treat analysis population. Between baseline and 12 months, the mean bodyweight of participants in the intervention group reduced by 11·98 kg (95% CI 9·72 to 14·23) compared with 3·98 kg (2·78 to 5·18) in the control group (adjusted mean difference −6·08 kg [95% CI −8·37 to −3·79], p<0·0001). In the intervention group, 21% of participants achieved more than 15% weight loss between baseline and 12 months compared with 1% of participants in the control group (p<0·0001). Diabetes remission occurred in 61% of participants in the intervention group compared with 12% of those in the control group (odds ratio [OR] 12·03 [95% CI 5·17 to 28·03], p<0·0001). 33% of participants in the intervention group had normoglycaemia compared with 4% of participants in the control group (OR 12·07 [3·43 to 42·45], p<0·0001)

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