DR. C REVIEWS MAJOR HEALTH AND TELEMEDICAL NEWS FOR THE WEEK ENDING JULY 26, 2020.
Category Archives: Men’s Health
FALLS AMONG THE ELDERLY: CONDITIONS & PREVENTION
Falling down is common on both ends of the Human lifespan. Little kids are always falling down, but there isn’t much energy to dissipate, since their mass is small and they don’t have far to fall. Moreover, their bones are pliable.
The Elderly also fall, increasingly, as they age. They have a lot further to fall, and their bones are often brittle and osteoporotic. Injury is quite common, they often break a hip, and may slide into a peogressive deterioration leading to their demise..
Ordinary walking, a “normal gait”, is a very complex activity and requires a lot of information and coordination by the nervous system.
VISION is critical, as you are often navigating through a minefield of stairs, rug edges, slippery objects, lamp cords, tubes and pets. Cataracts may be a problem to be corrected. Multifocal glasses can be a factor.
HEARING can warn of certain hazards or warnings and is important. A FINE SENSE OF TOUCH is required to give you cues as you are walking. Peripheral neuropathy can make walking difficult.
PROPRIOCEPTION, the positional sense of where your extremities are located in space, is a sense we take for granted, but which may deteriorate in time. Proprioception is very important for a normal Gait. The inner ear, with it’s semicircular canals and vestibular apparatus is necessary for proper BALANCE.
Balance can be PRACTICED in a number of ways, like standing on one leg, or merely WALKING a lot. These MULTIPLE SENSES must be COORDINATED by the Thalamus, Corpus Striatum, medulla, Cerebellum, and Cerebral Cortex and instructions sent to the muscles of your Legs, Arms, back and abdomen.
It is mandatory to keep these muscles, your Heart and your body, STRONG and FIT. Factors that make you more likely to have a fall are mostly the reverse of the above, and are called RISK FACTORS.
- –Previous Falls are the best predictor. More than 2 or 3 in a year is worrisome.
- –Balance Impairment is best treated by practice.
- –Decreased Muscle strength. –Visual impairment.
- –Polypharmacy (more than 4 prescription Meds), or a Psychoactive drug (look up)
- –Gait impairment, Walking difficulty.
- –Depression, which is often treated by antidepressants or sleeping pills- Psychoactive drugs.
- –Dizziness or orthostatic hypotension, which causes a drop in blood pressure on standing. and a number of other problems, often a function of age.
PREVENTION of falls is of course better than treatment of the resulting INJURY. Working on your HEALTH will help the INTRINSIC causes of falls, and that is what we have been discussing.
Preventing the EXTRINSIC causes of falls means working on: –Improving the household safety by putting in railings, getting rid of throw rugs, clutter, and maybe pets( a good friend went into a downward spiral after tripping over his Dog.
Adjusting or eliminating psychoactive drugs and antihypertensive drugs (which often include the beta blockers which worsen orthostatic hypotension.
Interestingly, VITAMIN D supplements were mentioned in 2 references I saw. Apparently Vitamin D reduces falls by increasing MUSCLE STRENGTH.
Please refer to the following Canadian article for a more complete discussion.
–Dr. C.
CORONAVIRUS: “HOW WE CAN REACH HERD IMMUNITY”
Scientists are working at breakneck speed to develop an effective vaccine for the coronavirus. Their ultimate goal: to immunize enough of the world’s population to reach herd immunity. WSJ explains.
Illustration: Jacob Reynolds
HEALTH: “MECHANICAL VENTILATION AND ACUTE RESPIRATORY DISTRESS SYNDROME” (INFOGRAPHIC)
BLOOD CIRCULATION: THE “LYMPHATIC SYSTEM”
The pulmonary circuit oxygenates and the systemic arterial circuit circulates several Liters of blood per minute. As this blood trickles through the capillaries, some of it oozes out through the thin endothelial lining, becoming interstitial fluid.
Most of this flud gets back into the capillaries and returns to the heart in the venous return. About 20% of the fluid drains into the LYMPHATIC SYSTEM, through the Lymph nodes, and back into the thoracic duct, into the vena cava, and eventually back into the general blood supply, which recirculates.
The Return of the residual interstitial fluid by the Lymphatic vessels back to the general circulation is important, and if BLOCKED by such things as surgery and parasites, produces a swelling known as LYMPHEDEMA.
But the major importance of the lymphatic vessels is their characteristic cells, LYMPHOCYTES, and their accessory structures, The THYMUS, SPLEEN, LYMPH NODES, AND LYMPHATIC TISSUES is in the development and training of the IMMUNE SYSTEM. The THYMUS can be regarded as an organ to TRAIN Lymphocytes to be functional members of the immune system.
SomeT-cells operate to Help B-cells to produce antibody. These are called Th-4 cells. Others, called Th-8 cells. function to delete cells,
The thymus POSITIVELY selects cells that are prepared to recognize pathogens, and gets rid of cells (NEGATIVELY selects) cells that recognize the body’s own cells.
Failure to do so would result in “horror autotoxicus”, or AUTOIMMUNITY. The Thymus performs most of its functions when we are young.
The LYMPH NODES act as a type of filter for the Lymphatic channels, and intercept most bacteria and other pathogens coming through the lymphatic channes to keep them out of the blood stream. Lymph nodes are present at predictable locations throughout the body.
The Spleen acts as a big lymph node to filter the blood directly, and can intercept organisms that have escaped the lymph nodes. The Spleen can enlarge with certain infections, as with the EB Virus that causes mononucleosis.
Rupture of the spleen is not uncommon with direct blunt trauma to the abdomen. Removal of the spleen can increase susceptibility to blood stream infection. Lymph tissue is scattered throughout the body, like in the Tonsils, adenoids and Intestinal tract.
This Lymphocyte-containing tissue can expand with exposure to infection, and can become cancerous with Lymphomas. It can also enlarge enough to produce local Blockage, as with Adenoids. Lymph tissue should not be removed wantonly, since it may provide protection. There are 2 arms of our immune system.
I have been discussing the ADAPTIVE immune system which recognizes the pathogen, and stores memory of this interaction in “memory T-cells”. The helper T-cells( Th-4) start to multiply and stimulate the B-cells to “clonally” proliferate and differentiate into Antibody-producing Plasma Cells. The Cytotoxic T-cells, which can directly kill Pathogens, also multiply.
The first time this happens with a new Pathogen, Like SARS CoV-2, this adaptive process takes a week or so. But if the same Pathogen comes later, The adaptive immune system is ready, via the Memory T-cells, and springs rapidly into action. The 2nd arm of our immune system, shared with all of our vertebrate relatives, is the INNATE immune system.
The innate system is prepared IMMEDIATELY to recognize certain foreign molecules common to many invaders, and foreign our own bodies. It usually does not have the Power of the innate immune system, but in healthy people does an amazingly good job.
Some people just don’t get sick very often. Do the best you can to be one of these healthy people by getting proper SLEEP, DIET. AND EXERCISE!
INFOGRAPHICS: “HOW TO ACHIEVE YOUR WEEKLY RECOMMENDED EXERCISE”
COMMENTARY
The idea of “METS” as a unit of energy expenditure is interesting and practical. I agree that EXERCISE IS IMPORTANT.
Frank Wilczek, in an article on Dyson Freeman, talked about another unit that I find even more interesting . He proposed that 100 Watts be the unit of energy expenditure. This is (approximately) the energy used in an old 100 Watt incandescent light bulb. It is also the amount of energy used by the “average” human on a 2000 Calorie diet.
Using this unit, the average U.S. Citizen uses 95 units, compared to a 25 unit world average. The suns output is 5 X ten to the fourteenth power, of which 1X ten to the fourth power units lands on earth. Good cocktail information.
I also read that a professional cyclist has an output of only 400 watts, vs. the 14 Mets mentioned in the article.but when I read that the human body is only 20-25% efficient in converting Calories to Watts of Output, 14 Mets made more sense.
—Dr. C.
INNOVATION: PHILIPS “VIRTUAL CARE STATION”
Philips Virtual Care Station, inspired by the VA’s ATLAS program, is a community-based telehealth solution designed to expand access to high-quality care by connecting patients and providers remotely through a secure, clinical-grade environment.
STUDIES: 4- AND 6-HOUR TIME-RESTRICTED EATING (TRE) DIETS, NO FOOD LIMITS RESULT IN WEIGHT LOSS
“The findings of this study are promising and reinforce what we’ve seen in other studies — fasting diets are a viable option for people who want to lose weight, especially for people who do not want to count calories or find other diets to be fatiguing,” Varady said.
…participants in both daily fasting groups reduced calorie intake by about 550 calories each day simply by adhering to the schedule and lost about 3% of their body weight. The researchers also found that insulin resistance and oxidative stress levels were reduced among participants in the study groups when compared with the control group.
Two daily fasting diets, also known as time-restricted feeding diets, are effective for weight loss, according to a new study published by researchers from the University of Illinois at Chicago.
The study reported results from a clinical trial that compared a 4-hour time-restricted feeding diet and a 6-hour time-restricted feeding diet to a control group.
“This is the first human clinical trial to compare the effects of two popular forms of time-restricted feeding on body weight and cardiometabolic risk factors,” said Krista Varady, professor of nutrition at the UIC College of Applied Health Sciences and corresponding author of the story.
COMMENTARY
Time-restricted eating brought my weight down from 142 pounds to 136, which is close to what was found on the study; not much, but every pound counts. The improved insulin resistance was reassuring but I am surprised they didn’t find any effects on the HDL, LDL and triglycerides.
The most detailed study on time restricted eating and fasting in general was in the New England Journal of Medicine in December 26, 2019. That excellent article went into all kinds of metabolic pathways that are benefited by fasting.
Good sleep, diet and exercise can be very helpful.
–DR. C
DR. C’S PODCAST: WEEKLY MEDICAL NEWS (JULY 19)
DR. C REVIEWS MAJOR HEALTH AND TELEMEDICAL NEWS FOR THE WEEK ENDING JULY 19, 2020.
LIGHTHEADEDNESS: ITS SYMPTOMS & CONDITIONS
Dizziness, Fainting, Falls, Orthostatic Hypotension, Heart rate and rhythm, Cardiac output and Perfusion, The Autonomic Nervous system,
Falls and Injury are all very interconnected. They all tend to accumulate as we age, but the young are not immune to these conditions. In all of these discussions,
I make the ASUMPTION that you have these conditions in an undramatic, infrequent, moderate way, and are not burdened by Risk factors such as diabetes and hypertension. Stroke is always a worry lingering in the background, and will be discussed at the end of the series.
I will begin with DIZZINESS AND FAINTING. The amazing thing is that we are able to walk upright all day without falling. We can surprisingly lie on our backs, suddenly get up and run away seamlessly, or at least we were able to do these things, most of the time. Our bodies almost magically supply our brains and balance mechanisms with the right amount of blood and nourishment ALMOST all of the time.
Everybody gets dizzy if they spin around enough, and even young people can faint if they stand long enough in one place. Dizziness and fainting is usually considered normal if there is a good explanation. It is when they are too sudden, too severe, last too long, or happen too frequently that we seek medical Help.
Dizziness can mean “lightheadedness” without the room spinning. This is often more concerning than Vertigo, since it more often is due to a lessening of blood flow to the brain. When we get up suddenly from a sitting or lying position, the blood may pool in our abdomen and legs, with consequent insufficient pumping of blood to the brain.
This happens at 1G to civilians, but it takes about 5Gs for young jet pilots to need their “blackout” suits. Instead of blackout suits, we can use support-hose, or even a constricting pants-suit which includes our lower abdomen.
I have also been using a buzzer-timer which reminds me to walk every 10 minutes, to keep me from staying in my comfortable lazy-boy too long. I try to walk rapidly and breathe deeply, and believe this helps keep my body “toned up” and responsive for when I stand up rapidly.
The other way to adapt would be to “baby” my body, and stand up more slowly. There are always the opposite ways to respond: go easy, or push the body and expect it to adapt. If you are worried, your Family Doctor can help you and suggest a path forward .
Perhaps you are overmedicated, need medication, or some tests would help clarify the situation. Vertigo is where the room seems to be spinning. You might be able to tell whether it is spinning clockwise or counterclockwise.
The most common cause is BPPV, or benign periodic positional vertigo, and you can wait it out. Look it up on the internet for parameters. Persistent Vertigo can also be due to inner ear (labyrinth) problems. which an ENT Doctor can address.
For more details, I have included a couple of good articles. A discussion of Falls is next in this series.
–Dr. C.
Reference #2
Doctors Without Waiting Rooms 