Category Archives: Men’s Health

HEALTH: HOW SLEEP HAS CHANGED DURING COVID-19

From the Wall Street Journal (June 1, 2020):

The biggest problem has been staying asleep,” says Philip Muskin, a professor of psychiatry at Columbia University Medical Center in New York. “People aren’t exercising, their days have no structure at all.”

Preliminary results from a survey taken by around 1,600 people from 60 countries show that 46% reported poor sleep during the pandemic, while only 25% said they had slept poorly before it, according to Melinda Jackson, a senior lecturer at the Turner Institute for Brain and Mental Health at Monash University in Melbourne, who studies how stressful events affect people’s sleep. Forty percent also reported increased alcohol consumption.

The key is to prevent the sleep problem from becoming chronic, she says. It is important to avoid associating your bed or bedroom with a place where you are awake. Experts recommend that if you can’t fall asleep, or wake up in the middle of the night and are unable to go back to sleep after 20 minutes, get out of bed and do something relaxing.

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IN THE LAB: TESTS FOR AND DIAGNOSING “aNEMIA”

I should have known something was wrong.

I was getting short of breath with a third of a 45-minute exercise I had done for years, but I rationalized it away. I reasoned that I hadn’t been sleeping well, I am getting old. And my heart isn’t working as well because of the Atrial Fibrillation.

Physicians have a big armamentarium of excuses they can generate, and besides it is their Karma to GIVE Medical care rather than to RECEIVE it.

The AHA moment came when I bumped my leg, and peeled back some skin. My skin is old and fragile, and I’m always tearing it in small areas.

This time, I got to see the blood run all the way down my leg like a drop of grape juice, not the thick blood I’m used to. If anything, my blood should be thicker, more viscous, since my average Hemoglobin is 16 gm., on the high side of normal.

I got my blood drawn, and ordered a CBC and a ferritin. The CBC shows the Hemoglobin level, and a number of other measurements bearing on anemia, and the ferritin gives a measure of IRON STORES.

I can’t remember the first time my ferritin was ordered, or why, but it has for years been borderline, just barely in the normal range, dipping down as low as 18, and rising as high as 35.

Since a common cause of low iron stores with a good diet is colon cancer, I had about 3 colonoscopies to rule out cancer over a period of 6 years; lucky me.

At least they were all negative, and without polyps.

This time the ferritin was 12, well into the abnormal range, and the Hemoglobin was 8.6 gm. little more than half my usual.

I had been fibrillating for 5 months, and been on 5 mg. Eliquis ( an anticoagulant/blood thinner) for the same period. Having a recent normal colonoscopy, the most likely diagnosis was AVMs (arteriovenous malformations) of the small bowel, with bleeding accelerated by the Eliquis,

Since small bowel surgery contraindicated a diagnostic videocapsule, this diagnosis would have to remain an assumption.

I reduced the Eliquis by 25%, calculated my blood loss rate and started 2 capsules of feosol alternating with 3 capsules daily. Over a period of 4 months, my Hemoglobin came back up to 15 gm., and my ferritin came up to 50. I am due another test as soon as I get enough nerve to brave the Covid and go to the lab.

This story is a good illustration of treating one illness, and thereby creating another in this world awash with medication. How much better it is to stay as healthy as possible.

However, I am becoming increasingly aware of the fact that Health is not often the top priority in most peoples lives.

As an illustration, I refer to todays’ Sunday New York Times, which reviewed 2 books on walking, one written to praise its’ health benefits. To quote the reviewer, “

The issue with ‘ in praise of walking’ is Mr. O’Mara’s assumption that how good an activity may be for us is the most essential measure of its worth”. Praising health raises an issue?

Personally, my main exercise is walking, and I do it expressly for health. That doesn’t mean that I don”t enjoy walking and have other motivations. I would not be walking as FAST, however, it it were not so healthy.

–Dr.C.

COVID-19: CASE SEVERITY IS DEPENDENT ON VIRAL LOAD

From the New York Times

….in the case of the new coronavirus, people who have no symptoms seem to have viral loads — that is, the amount of virus in their bodies — just as high as those who are seriously ill, according to some studies.

Harry Henri, a research assistant, working with blood samples from coronavirus patients at SUNY Downstate’s BioBank in Brooklyn.Credit…Misha Friedman for The New York Times

When experts recommend wearing masks, staying at least six feet away from others, washing your hands frequently and avoiding crowded spaces, what they’re really saying is: Try to minimize the amount of virus you encounter.

A few viral particles cannot make you sick — the immune system would vanquish the intruders before they could. But how much virus is needed for an infection to take root? What is the minimum effective dose?

And coronavirus patients are most infectious two to three days before symptoms begin, less so after the illness really hits.

Some people are generous transmitters of the coronavirus; others are stingy. So-called super-spreaders seem to be particularly gifted in transmitting it, although it’s unclear whether that’s because of their biology or their behavior.

On the receiving end, the shape of a person’s nostrils and the amount of nose hair and mucus present — as well as the distribution of certain cellular receptors in the airway that the virus needs to latch on to — can all influence how much virus it takes to become infected.

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COMMENTARY

PRESCRIPTION DRUGS: “ON MEDICATIONS IN GENERAL”

Several ideas apply to ALL MEDICINES. Terminology should be clarified. Medicine, Pharmaceutical, and Drug, in my mind are equivalent.

The term “drug” is pejorative, and I try to use it so. The term “Pharmaceutical” is too long, leaving me with “medication”.

There are some Practical points. You should look at your prescription when you first get it, to make sure it is the right one. Yes, pharmacists rarely make some mistakes. They are human.

You should ask the Pharmacist if she knows WHERE the drug was manufactured. Foreign countries, especially China and India, are less reliable, and the USA is safer. The original Brand Name drugs are more often domestically produced, but even these are being “offshored”.

Next, check the prescription date and expiration date.You should get a ” SHELF LIFE” (the difference between the two) of about 2 years, otherwise, you might ask the pharmacist the next time to give you the “best dating” in his stock.

Store your medications in a cool, dark, dry place in order to prolong their life. Light, heat and moisture degrade most compounds. Remember the O.J. Simpson case? Part of the reason he was acquitted is that a critical DNA sample was stored in a plastic bag, which retained moisture, rather than a paper bag, which is recommended because paper is porous, and allows moisture to escape.

You should follow the suggested TIME to take the medication, because there is almost always an optimal time to take a given medication.

CHRONOPHARMACOLOGY is an emerging field, which is finding that more than 50% of medications are TIME SENSITIVE in their effect in the body. This is an unimportant, academic consideration for most Patients, given the high THERAPEUTIC WINDOW (dosage latitude) of most medications, the mild illness of most patients, and the disinclination of most Doctors to add one more detail onto their already heavy load.

In discussing the medicines in my cabinet and a few other important ones, I will be addressing TIMING.

What about OUTDATED MEDICATIONS? As discussed by the following article from Harvard, the dating is not critical except for liquids, and a few others, like Tetracycline.

This is fortunate, given the expense of medications today. What if I drop a pill on the floor, at home. I usually pick it up and take it. if i just dropped it, unless it is very inexpensive.

What if a pill sticks in your throat, like happens to me a lot? I drink water first, to moisten my throat to make it slipperier.

Next, I take a good sip of water, try to swish it back and go back with my head to accelerate the pill backward, and think confidence. Certain sizes of pills are my nemesis and i have to break them in two.

Please follow Dr. Cs Medicine Cabinet in future postings of DWWR.

–Dr.C.

Further reading

DR. C’S MEDICINE CABINET: “WHY PATIENTS TAKE ELIQUIS”

Eliquis nicely illustrates my contention in the Overview of Metabolism, that the body is a vast collection of pathways, or “supply chains”. Eliquis blocks a critical enzyme in the pathway leading to coagulation, or clotting” as the product.

Why in the world you want to block clotting? The staunching of blood flow, clotting, has saved countless hordes of early, Paleolithic humans, and continued useful through the bloody Roman and Medieval times, right through the violent 20th Century.

Recently, however, wars are becoming somewhat less popular, and eating excessively more popular, leading to a strange situation. Our evolutionarily-preserved CLOTTING mechanism is now leading to MORE problems than it is solving.

Obesity and type 2 Diabetes are leading to the production of so much fat, that it has to be stored in our arterial walls, clogging the blood flow to our Hearts and Brain, among other areas. This, and the somewhat surprising trend towards longer lives has led to an increase in a variety of age-related illnesses.

When I reached 80 years of age I developed Atrial Fibrillation, a condition leading to a tendency to form clots in my quivering atria, the upper chambers of my heart. To decrease the likelihood of clots getting into my blood stream, lodging in my brain and causing STROKE, my cardiologist started me on Eliquis, an anti-coagulant/blood thinner.

Drugs have three names. The proprietary name, Eliquis in this case, is given by the patenting company to be memorable; q,z,and x are popular letters. The second is the FDA drug name, Apixaban. The drug name often gives the doctor a clue as to its type: xaban refers to inhibiting (banning) of factor 10a (Xa). The third name is a chemical name of interest to biochemists and drug researchers.

When I started the Eliquis, at first unknown to me, I started to bleed internally, leading to a drop in my hemoglobin down to 8.6. I will go into this story when I start going through “how to read your laboratory report”.

I found that reducing my Eliquis from 5mg. to 3.75 mg. allowed me stabilize my hemoglobin by taking extra iron, which I will discuss later.

The doseage selected when the drug company markets a drug is fairly arbitrary, and usually involves round numbers. Interestingly, there is a 2.5mg. Eliquis, which is given if you meet 2 out of 3 criteria. I meet only one and am only 5 pounds shy of the second, in case you think (like my cardiologist does) that I’m taking a risk.

I believe that, whenever you are given a medication, you should be educated about the medicine, and the problem it is intended to benefit. Today’s physician often does not have the time to do this. The internet, including this website, offers a corrective.

I am trying my best to be helpful to you as a Patient Advocate. You and I both must have a doctor to rely upon. But to get the most out of our care, WE MUST BE INFORMED.

–Dr. C

TELEHEALTH: “Smartphones Used to Monitor Heart Patients with Pacemakers”

In a first of its kind study, Cleveland Clinic researchers found Bluetooth-enabled pacemakers successfully transferred information to doctors 95% of the time through an app on the patient’s smartphone or tablet. In comparison, traditional bedside consoles were successful 77% of the time.

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HEALTH: ARE FACE SHIELDS THE BETTER PROTECTOR?

From a New York Times article (May 24, 2020):

Dr. Perencevich believes that face shields should be the preferred personal protective equipment of everyone for the same reason health care workers use them. They protect the entire face, including the eyes, and prevent people from touching their faces or inadvertently exposing themselves to the coronavirus.

The debate over whether Americans should wear face masks to control coronavirus transmission has been settled. Governments and businesses now require or at least recommend them in many public settings. But as parts of the country reopen, some doctors want you to consider another layer of personal protective equipment in your daily life: clear plastic face shields.

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COMMENTARY

When I take my walk, which currently is my only outing, I wear a face SHIELD for my personal protection against contracting Covid 19 from others.

I gave up on the face MASK because it is uncomfortable, especially when I am breathing heavily while walking rapidly up hills.

There isn’t much research supporting the self-protective use of face shields, but the video accompanying this article was enough for me; notice the aerosol-free area behind the face shield.

While walking, I breathe In deeply through my nose, and exhale through my mouth, using “pursed lips”, which aids in oxygen extraction by holding the alveolae open.

Exhaling through the mouth also clears the air behind the mask for subsequent nasal inhalation.

With nasal inspiration, any SARS CoV-2 aerosol particles would be deposited in the nasal passages, Which are that much farther away from your vulnerable lung.

It isn’t perfect. For one thing, it wouldn’t protect you much if someone coughed at you from the side or behind. I often hold my breath reflexes when I hear someone cough, or when I pass closely (even 6ft.) to someone.

The face shield holds promise for protecting you from viral infection, including the “flu”.

—Dr. C.

PREVENTION: THE HEALTH AND HEALING BENEFITS OF PROPER BREATHING

From a Wall Street Journal article (May 21, 2020):

Breathing properly can allow us to live longer and healthier lives. Breathing poorly, by contrast, can exacerbate and sometimes cause a laundry list of chronic diseases: asthma, anxiety, attention deficit hyperactivity disorder, hypertension and more. Poor breathing habits can even change the physical structure of our skeletons, depleting essential minerals and weakening our bones.

Most of us misunderstand breathing. We see it as passive, something that we just do. Breathe, live; stop breathing, die. But breathing is not that simple and binary. How we breathe matters, too.

Last year, I wanted to see just how dramatically breathing habits—good and bad ones—could affect my own brain and body. I’d learned that up to 50% of us are chronic mouth breathers, a problem well described by an ancient Tao text: “The breath inhaled through the mouth is called ‘Ni Ch’i, adverse breath,’ which is extremely harmful.”

Scientists have known for decades that inhaling through this pathway saps the body of moisture, irritates the lungs and loosens the soft tissues at the back of the mouth. Mouth breathing has also been linked with neurological disorders, periodontal disease and increased risk of respiratory infection. But nobody knew how quickly this damage came on.

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COMMENTARY

Breathing is something we don’t think about. It comfortably transcends the merely habitual, and there is a complex of controllers in the brain to Drive breathing should we be unable or forget to breathe voluntarily.
Breathing has it’s own poets and cults, one of which is MINDFULNESS MEDITATION, which uses our BREATHING as the focus of our consciousness, to get us outside ourselves.

With DEEP breathing,  I noticed an INCREASED pO2, as registered on my Pulse Oximeter.

In the 1960’s asthma was not so well controlled as now. The mechanics of breathing were more important, so we taught our Patients how to breathe properly.

There are 2 sets of muscles we use to EXPAND our lungs, the DIAPHRAGM at the bottom of the chest, and the chest muscles themselves, the INTERCOSTALS. We refer to diaphragmatic breathing as “stomach” breathing, because the stomach bulges out as the descending diaphragm compresses the abdominal contents.

We refer to intercostal breathing as “chest” breathing because the chest expands when the inspiratory intercostals contract.

Diaphragmatic breathing is more efficient, and we encourage our asthmatic patients to Use their more efficient diaphragm to prevent them from tiring as they struggle to get their air out through their narrated airways.

You can squeeze a little extra air out of your lungs by contracting your abdominal muscles.

So to take a DEEP BREATH, see that your stomach rises and your chest expands with the breath IN, and that you squeeze both your abdomen and your chest with the breath out.

Your AIR SACS expand, your lungs are flushed with fresh air, and you blood oxygen, and BRAIN OXYGEN INCREASES with a deep breath in. The “stale air” is cleared by a full breath out.

When you are quietly breathing, letting that vital process take place automatically, notice that a deep breath, or “sigh”, occurs about once every 2 minutes. This is nature’s way to help lung surfactant PREVENT LUNG COLLAPSE and PNEUMONIA.

It is HEALTHFUL to PAY ATTENTION to your BREATHING occasionally! If uninclined to breathe deeply yourself, take a brisk walk up a hill, and let Nature do it for you.

—Dr. C.

INFOGRAPHICS: “WHAT ARE, HOW WE GET AND WHY DO WE EAT FERMENTED FOODS”

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This article gave an interesting classification of fermented foods, pointing out that with some, like bread and wine, we eat the products of fermentation without the living organisms, while with others like kefir and yogurt, we eat the viable critters also.

Lactobacilli are called probiotics, and are supposed to have health benefits. It is not proven that they do, but at least the lactobacilli use up some of the sugar we would otherwise be eating, and taste good.

The problem with the claim that they diversify and benefit our microbiome, and crowd out the bad germs, is that they do not generally attach to our intestinal walls, and go right through with the rest of our food. They don’t stick around long enough to do any good.

My late wife had a bad infection with a bad actor called Clostridium difficile, which caused her to have a severe, bloody enterocolitis. After the second hospitalization with this affliction, an Infectious disease doctor suggested “culturelle”, which contained a patented Lactobacillus rhamnosus GG, which WAS supposedly proven to attach for a while. My wife took this, and never had another attack.

I still take this daily, “on faith”. Gullible me. Fecal transplants are now used effectively for C. Dif. enterocolitis. Avoiding unnecessary antibiotics, which wipe out your normal microbiome, your “good guy competition”, is An even better idea, but seems risky.

BOTTOM LINE:  Kefir and yogurt are calorie depleted, and taste good. What is not to like?

–Dr. C

TELEMEDICINE: A REVIEW OF 9 CONDITIONS THAT CAN BE TREATED ONLINE (VIDEO)

TELEMEDICINE is here to stay! With all its’ advantages Patients will demand It!

This video is one of the few to highlight WOMENS’ HEALTH as an appropriate field for Telehealth. A remote visit first may at least let the Doctor order some tests that will accelerate your care.

Urinary problems can also be appropriate for telemedicine; the MEDICAL HISTORY is such a VALUABLE DIAGNOSTIC TOOL!

Psychological and Psychiatric care could be completely remote, by telemedicine. The Doctor could save on expenses, and deliver care less expensively.

Distance disappears as a barrier to Consultations and second opinions. A University medical center or prestigious multi specialty Clinic are on your doorstep.

Of course, barriers remain in the form of regulations, litigation, bureaucracy, and Insurance, but these can be overcome, if the Will is there.

—Dr. C