Category Archives: Women’s Health

Dr. C "Comments", Men's Health, Prevention, Technology, TELEMEDICINE, Videos, Women's Health

PREVENTION: “FORWARD CLINICS” ARE ALL-INCLUSIVE, FLAT-FEE PRIMARY CARE

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Forward care is evidence-based, focused on prevention and improvement. Set goals and collaborate for better health.

  1. Connect Your Biometrics Sensors
    • Receive your Sensor Kit
    • Record measurements in the app
    • Review insights together with your doctor
  2. Complete Your Labs at Home
    • Schedule your at-home blood draw with a lab specialist
    • Receive comprehensive results
  3. Create a Personalized Plan During Your Baseline Visit
    • Discuss your health goals and concerns
    • Review your biometrics and lab results
    • Develop a personalized, preventive plan
  4. Answer Questions In-App for Insights on Your Mental Health
    • Answer a short series of questions in-app
    • Receive a measure for anxiety and depression
    • Partner with your doctor on your results
  5. Customize Your Plan Based on Your Genetics
    • Receive your Genetics Kit
    • Review the results with your doctor
    • Update your plan to address your risks
  6. See Your Doctor In Person for a Custom Follow Up Visit
    • Request an in-person visit in the app
    • Review your progress with your doctor
    • Complete a physical exam and diagnostics
  7. Assess Your Skin Cancer Risk
    • Complete a physical exam of your skin
    • Capture high-definition images of any moles or blemishes
    • Discuss your skin health and cancer risks with your doctor
  8. Receive a Message From Your Doctor to Update Your Plan
    • Your doctor will check-in regularly 
    • Update your doctor on progress and goals 
    • Ask questions, anytime from anywhere
  9. Develop Nutrition Goals Based on Recurring Labs
    • Review your latest labs with your doctor
    • Develop a nutrition plan for targeted results
    • Measure progress with future labs

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COMMENTARY

Forward Healthcare differs from a conventional primary care clinic in several, generally good ways.

Most importantly, they stress PREVENTATIVE care. Blood tests that monitor diabetes, metabolic syndrome, and anemia are done regularly, since they have a laboratory on premises. They have their own EMR (electronic medical record) platform, and their own telemedicine platform, which are downloaded on the initial visit.

They give out a “sensor kit” consisting of temperature monitor, Pulse-oximetry, and a BP monitor, which wirelessly sends information to medical records.

Telemedicine is available through their own Downloaded platform. Although I get the impression that Telehealth isn’t as central as I would have expected in a technology oriented operation, it is increasingly important.

The monthly membership fee of $149 pays for the above and unlimited Doctor Availability 24/7 without copay.

Concierge Medicine has the monthly/yearly fee and unlimited access, but has a copay. Both will utilize your insurance, and neither treats patients in the hospital or provides referral care.

Government Health care is coming, and with it longer waiting times, shorter Doctor interaction times, and probably less time for Preventative Health Care.

Systems like Forward Health and Concierge Medicine will be the upper tier of a 2-tier system.

Proactive attention to Health in my opinion is essential in the future if we are to have a healthy nation, and not “bankrupt the system”. Telehealth is growing in importance, and offers help in making medical expertise more convenient, widely available and for less cost.

I am happy to see progressive Systems like Forward Health offer a preventative option to the present, broken, reverse-incentivized, fee-for-service System.

—Dr. C.

Dr. C "Comments", Medicine, Men's Health, Women's Health

INFOGRAPHIC: A LOOK AT “CANCERS ASSOCIATED WITH OVERWEIGHT & OBESITY

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There is consistent evidence that higher amounts of body fat are associated with increased risks of a number of cancers (6), including:

  • Endometrial cancer: Obese and overweight women are two to about four times as likely as normal-weight women to develop endometrial cancer (cancer of the lining of the uterus), and extremely obese women are about seven times as likely to develop the more common of the two main types of this cancer (7). The risk of endometrial cancer increases with increasing weight gain in adulthood, particularly among women who have never used menopausal hormone therapy (8).
  • Esophageal adenocarcinoma: People who are overweight or obese are about twice as likely as normal-weight people to develop a type of esophageal cancer called esophageal adenocarcinoma, and people who are extremely obese are more than four times as likely (9).
  • Gastric cardia cancer: People who are obese are nearly twice as likely as normal-weight people to develop cancer in the upper part of the stomach, that is, the part that is closest to the esophagus (10).
  • Liver cancer: People who are overweight or obese are up to twice as likely as normal-weight people to develop liver cancer. The association between overweight/obesity and liver cancer is stronger in men than women (11, 12).
  • Kidney cancer: People who are overweight or obese are nearly twice as likely as normal-weight people to develop renal cell cancer, the most common form of kidney cancer (13). The association of renal cell cancer with obesity is independent of its association with high blood pressure, a known risk factor for kidney cancer (14).
  • Multiple myeloma: Compared with normal-weight individuals, overweight and obese individuals have a slight (10% to 20%) increase in the risk of developing multiple myeloma (15).
  • Meningioma: The risk of this slow-growing brain tumor that arises in the membranes surrounding the brain and the spinal cord is increased by about 50% in people who are obese and about 20% in people who are overweight (16).
  • Pancreatic cancer: People who are overweight or obese are about 1.5 times as likely to develop pancreatic cancer as normal-weight people (17).
  • Colorectal cancer: People who are obese are slightly (about 30%) more likely to develop colorectal cancer than normal-weight people (18).A higher BMI is associated with increased risks of colon and rectal cancers in both men and in women, but the increases are higher in men than in women (18).
  • Gallbladder cancer: Compared with normal-weight people, people who are overweight have a slight (about 20%) increase in risk of gallbladder cancer, and people who are obese have a 60% increase in risk of gallbladder cancer (19, 20). The risk increase is greater in women than men.
  • Breast cancer: Many studies have shown that, in postmenopausal women, a higher BMI is associated with a modest increase in risk of breast cancer. For example, a 5-unit increase in BMI is associated with a 12% increase in risk (21). Among postmenopausal women, those who are obese have a 20% to 40% increase in risk of developing breast cancer compared with normal-weight women (22). The higher risks are seen mainly in women who have never used menopausal hormone therapy and for tumors that express hormone receptors. Obesity is also a risk factor for breast cancer in men (23).In premenopausal women, by contrast, overweight and obesity have been found to be associated with a 20% decreased risk of breast tumors that express hormone receptors (22).
  • Ovarian cancer: Higher BMI is associated with a slight increase in the risk of ovarian cancer, particularly in women who have never used menopausal hormone therapy (24). For example, a 5-unit increase in BMI is associated with a 10% increase in risk among women who have never used menopausal hormone therapy (24).
  • Thyroid cancer: Higher BMI (specifically, a 5-unit increase in BMI) is associated with a slight (10%) increase in the risk of thyroid cancer (25).

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COMMENTARY

Obesity increases the incidence of cancer, and complicates its treatment.
A healthy life style.,’including good sleep, diet and exercise, should prevent obesity in all but extreme genetic aberrations.

It is better to prevent problems than to grapple with them.
Stay healthy!

—Dr. C.

Dr. C "Comments", Medicine, Men's Health, Women's Health

INFOGRAPHIC: A LOOK INTO “CANCER’S COMPLEXITY”

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Technology Networks Cancer Drug Discovery-page-0

COMMENTARY

This infographic is a high-level discussion of cancer, with plenty of information to keep a Physicians’ interest.

The Human Body is a complex Community of individual cells that normally work together with admirable Harmony. Each individual cell is supplied with all its’ wants, and vigorously does its’ part for the Body.

Occasionally a ROGUE CELL escapes constraints and GOES ITS’ OWN WAY.

This has been happening from the beginning of multicellular life, and these MISCREANTS have EVOLVED to preserve themselves and have an amazing bag of TRICKS.

They are Very resourceful just like VIRUSES, which can also cause CANCER.

These twin threats give modern medical technology about all it can handle, and more.

PREVENTATIVE care offers a remedy.

Prevention is not at all complex, but of course requires thought, energy and planning. Prevention is difficult to square up with the easy, effortless, intuitive  life we yearn for.

Do you have the resolve to give SLEEP, DIET and EXERCISE a chance?

–DR. C

Men's Health, Prevention, TELEMEDICINE, Women's Health

TELEHEALTH CARE: PATIENTS CAN EXPECT EXPANDED “CONTACTLESS EXPERIENCES”

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From Healthcare IT News (June 12, 2020):

Technology-enabled workflows now enable patients to complete most of the registration formalities prior to the visit, be it a virtual consult or a clinic visit. Registration kiosks in hospital lobbies may soon be enabled with facial recognition software to eliminate the need for touching any surface.

Routine examinations are also going virtual, with many diagnostic procedures now possible through remotely controlled devices. Caregivers are beginning to do their patient rounds through virtual visits. This trend will only grow in the coming years.

A vast and growing array of automated communication tools allows caregivers to use rule-based messaging to push everything from health coaching, post-discharge care instructions, and appointment reminders through IVR, text, SMS, and mobile alerts.

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Men's Health, Opinion, Women's Health

MENTAL HEALTH: SOME THOUGHTS ON DIAGNOSING AND TREATING “DEPRESSION”

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I recently posted a discussion on osteoporosis that was based on a MNEMONIC, using the word itself as the basis of exploring the Risk factors Evidence that you have Osteoporosis is hidden, and are discovered by Dexascan, or when you suddenly have a major fracture.

DEPRESSION is common, but sneaks up on you. It may be a job to discover that you have it, to DIAGNOSE it, so that you can be treated. The diagnosis has about 10 markers that can be formulated into a mnemonic, so that you can remember what they are. My favorite is by Paul Blenkiron, writing in the BMJ:

These 10 symptoms are described in the 10th edition of “the international classification of Diseases. The problem with some mnemonics is to remember the mnemonic itself.

Not here. Interestingly, The 4 PILLARS OF HEALTH are each represented in this list. 3 of them are valid TREATMENTS for DEPRESSION, as you will see in the following articles. When I looked up intellectual stimulation as a treatment for Depression, all i found was electrical or magnetic deep brain stimulation.

I can’t help but believe that INTELLECTUAL STIMULATION itself would at least help ward off much Anxiety and Depression. SLEEP has an interesting relationship to depression. Lack of sleep can be a CAUSE of Depression.

Recently, deprivation of sleep has been used to TREAT episodes of severe depression. Obviously there is a lot we don’t know. Another puzzlement is the several week delay in the effect of SSRI medications. I acknowledge that throughout history many great intellects have manic-depression, which may be key to their productivity.

Depression itself is credited with deep understanding. The “black Dog” of depression is best avoided, however. A HEALTHY LIFE STYLE SHOULD HELP WARD OFF DEPRESSION.

–Dr. C.

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Dr. C "Comments", Men's Health, TELEMEDICINE, Women's Health

TELEMEDICINE: THE RISE OF TELEDERMATOLOGY (AMA)

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From AMA.org (June 12, 2020):

Teledermatology

“There’s an aging population, and there’s a lot of skin out there,” said Dr. Isaacs. “One in five people in the country develop skin cancer, but there is a plethora of benign skin conditions that also require the expertise of the dermatologist. So, you have increasing demand and a limited supply of dermatologists.”

A basic example of how the TPMG teledermatology program works involves a patient who is concerned about a suspicious lesion or mole on their body. The patient can take a picture of the location in question and send it to their primary care physician for review. The physician can request the patient come in for a more thorough evaluation, or if the physician determines that a dermatologist should be involved, they can send the photo to an on-call dermatologist to review.

If the patient does an in-person evaluation, the physician can also take a higher-quality image and forward that to a dermatologist. The dermatologist can then decide whether there is a problem, if a prescription is needed, or if there should be an in-person evaluation and potential biopsy.

A study in the Journal of the American Academy of Dermatology in 2019 found that when TPMG dermatologists had the chance to look at well-photographed skin lesions, they were able to identify nearly 10% more cancers with almost 40% fewer referrals to the dermatology department.

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COMMENTARY

A high quality I-phone picture of a skin lesion can provide the dermatologist with 90% of the information needed for a diagnosis.

Melanoma diagnosis depends even more on the visual. In fact, Artificial  Intelligence evaluation of Melanoma may be  overtaking dermatologist expertise.

Size can be indicated by including a dime in the photo.

It is true that the roughness, softness or hardness may be important in diagnosis, but perhaps these characteristics could be described by the Patient.

This week, I started worrying about an itchy, rapidly growing lesion on my back. I sent a picture of this to my dermatologist, hoping he would call it a wart and reassure me. It was very regular, soft, and had a rough surface like warts I have had in the past.

However, he saw some redness and had me come in for removal. We will see what the pathology shows.

Dermatologists are in short supply, and making more efficient use of their expertise attractive.

Calling the Doctor’s office, arranging for e-mail Photo transmission, and a talk with the Doctor on the phone could save a visit. The Primary Doctor could send you directly to the dermatologist, or might be comfortable with watching and waiting.

Dermatology is indeed a field ripe for Telemedicine.

—Dr. C.

Men's Health, TELEMEDICINE, Videos, Women's Health

TELEMEDICINE: “DOXY.ME” IS A FREE, LOW-TECHNOLOGY ENTRY FOR VIRTUAL VISITS

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  • Simple and convenient to use – See your doctor from anywhere, just click their personalized room link (like doxy.me/YourDrsName) to join them for a video call.
  • No downloads or accounts – No need to download software or create an account. Just use a browser on a computer or device with a camera and microphone.
  • Private and secure – All data is encrypted, your sessions are anonymous, and none of your information is stored. We adhere to HIPAA, PIPEDA, and GDPR data privacy requirements.

WEBSITE

Dr. C "Comments", Opinion, Prevention, Women's Health

WOMEN’S HEALTH: RISK FACTORS AND PREVENTION OF OSTEOPOROSIS

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I have heard the same story over and over. You get older, you trip over your dog or on the edge of a rug, you fall and break your hip, and in treatment or convalescence, you get a pneumonia and die, or at least you get weaker, setting you up for the next fall. Your course is downhill.

The culprit is often OSTEOPOROSIS. Osteoporosis is a disease characterized by loss of bone mass, as opposed to Osteomalacia, discussed in a recent podcast on this site, which is softening of bone The word itself is a MEMONIC for the RISK FACTORS; Then comes WHAT TO DO.

The RISK FACTORS and Prevention Strategies can be remembered in the following mnemonic:

Osteoporosis prevention begins when you are a child, with healthy diet rich in Calcium, and lots of exercise. Your bone mass peaks in the early 20s. While you are young, in your reproductive years, your reproductive hormones, Estrogen and Testosterone protect you.

Women should develop a Preventative strategy during menopause. Being THIN, like i am, is generally a marker of good health, much better than being Fat.

But especially as you get older and Lose muscle mass, Osteoporosis can become a problem, maybe because your bones don’t get the stress required to keep them strong.

BONE DENSITY DECLINES WITH AGE. I get a DEXASCAN as often as my insurance allows, about every 2 years, and am due this summer.

More and more treatments for Osteoporosis are emerging, if your bone loss becomes severe enough.

KEEP IN CONTACT WITH YOUR DOCTOR.

–Dr. C

Dr. C "Comments", Men's Health, Studies, Women's Health

DIET STUDIES: HIGH-SUGAR DIETS SUPPRESS DOPAMINE, LEADING TO OVEREATING

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From Phys.org/Univ. of Michigan (June 9, 2020):

High-Sugar Diet Dampens Release of Dopamine Causing Overeating - Univ of Michigan - Credit Christina May and Monica Dus

“On a high-sugar diet, we find that the fruit flies’ dopaminergic neurons are less active, because the high sugar intake decreases the intensity of the sweetness signal that comes from the mouth,” Dus said. “Animals use this feedback from dopamine to make predictions about how rewarding or filling a food will be. In the high-sugar diet flies, this process is broken—they get less dopamine neuron activation and so end up eating more than they need, which over time makes them gain weight.”

It is well known that consuming food and drink high in sugar is not great for us, but scientists are continuing to unravel the intricacies of how the sweet stuff drives negative health outcomes. The latest finding comes from researchers at the University of Michigan, who through studies in fruit flies have found that excess amounts of sugar can shut down crucial neural circuits linked to regulating satiety, possibly leading to overeating in humans.

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COMMENTARY

SUGAR IS A POISON.

A novel illustration of sugars’ lethality was the Georgia sugar refinery explosion in 2008, which killed 14 people. Finely ground sugar is flammable.

Sugar appeared early in civilization, but it was expensive, sparing all but the wealthy of its’ depredations, mainly tooth decay.  Only with the post WWII expansion of wealth was it consumed excessively to produce the diseases of overeating. The developed world now consumes over 70 pounds of sugar per person, amounting to over 250 CALORIES PER DAY!

This  article shows how SUGAR acts like a DRUG In its INTERFERENCE with the DOPAMINERGIC Reward system. The neurons send less signal, so you need MORE SUGAR to satisfy.

The metabolic systems through which overeating and sugar causes the OBESITY, DIABETES, VASCULAR DISEASE and Early DEMENTIA are convoluted.The best detailed explication is in the NEJM article in intermittent fasting, a healthful practice that is the polar opposite of overeating.

Two very important metabolic mechanisms are discussed, the mTOR system and the Sirtuin system. These systems are important for NUTRIENT SENSING and repair, and conserved in all animals. They worked just fine in our early ancestors.

It seems that primitive man was not blessed (or is it cursed) with easy overabundance or food, and actually spent hours or days in Hunger. When times were good, his body put on muscle, and stored fat against the hard times to come. This is called ANABOLISM. When times were bad, his body went into repair mode, and used the fat for energy. This is called CATABOLISM.

Anabolism has evolved expressly for Young Animals, where extra food is welcome for Growth. After the growing and Reproductive years, our Bodies’ evolutionary “warrant” expires, since the genes it carries have already been spread. Our older bodies are left to deal with machinery more suited to an earlier vibrancy. Our metabolism didn’t evolve to deal with the calories we shove into our aging Bodies. Many mechanisms beneficial in the young prove harmful later on. This divergence has been called “ antagonistic pleiotropy”.

Whatever the explanation, the observation remains: if adults eat more than they can use, they gain weight. With insufficient exercise, this weight is fat. With excessive fat, the joints, blood vessels, liver, heart and brain suffer,  and lifespan is shortened.

RETHINK YOUR LIFESTYLE AS SOON AS POSSIBLE. AVOIDING SUGAR, and ALL THINGS CONTAINING SUGAR is as good a place as any to start. You will be rewarded by being able to fully taste and enjoy the natural sweetness of many REAL FOODS, and afforded a longer life to partake in this pleasure.

—Dr. C.

Dr. C "Comments", Men's Health, SLEEP, Women's Health

STUDY: “FRAGMENTED SLEEP” INCREASES INFLAMMATION & HARDENING OF THE ARTERIES

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From UC Berkeley (June 4, 2020):

UC Berkeley Logo

“We’ve discovered that fragmented sleep is associated with a unique pathway — chronic circulating inflammation throughout the blood stream — which, in turn, is linked to higher amounts of plaques in coronary arteries,” said study senior author Matthew Walker, a UC Berkeley professor of psychology and neuroscience.

Disrupted nightly sleep and clogged arteries tend to sneak up on us as we age. And while both disorders may seem unrelated, a new UC Berkeley study helps explain why they are, in fact, pathologically intertwined.

Some tips to improve sleep quality

  • Maintain a regular sleep routine, going to bed and waking up at the same time each day.
  • As part of a nightly wind-down routine, avoid viewing computer, smartphone and TV screens in the last hour before bedtime, and keep phones and other digital devices out of the bedroom.
  • Engage in some form of physical exercise during the day.
  • Get exposure to natural daylight, especially in the first half of the day.
  • Avoid stimulants, like caffeine, and sedatives, like alcohol, later in the day.

UC Berkeley sleep scientists have begun to reveal what it is about fragmented nightly sleep that leads to the fatty arterial plaque buildup known as atherosclerosis that can result in fatal heart disease.

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COMMENTARY

“How much sleep do we need”, and “Sleep Hygine” were past topics on this site, and my own sleep fragmentation was mentioned. This study correlates sleep fragmentation in the elderly with increased blood vessel disease compared to elderly people who have no interruptions in their sleep.

The elderly have several obstacles to a good, full night’s sleep, although a fair number of my friends claim the blessings of sleeping soundly. As we get older, we lose the deepest sleep we enjoyed as children, and there is some loss of REM sleep as well. The elderly sleep more lightly.

Diseases begin to accumulate as we get older, and These DISORDERS and their TREATMENT can disrupt sleep. I mentioned My BPH with it’s blockage of flow, leading to incomplete emptying of my bladder. This led to FREQUENT URINATION and frequent arousal at night.

With aging, the tissues in the throat become more flabby, and if you SLEEP on your BACK, your inhalation may be blocked. This may result in OBSTRUCTIVE SLEEP APNEA, where your breathing  and sleep are interrupted repeatedly. The associated SNORING may interrupt the sleep of your partner, or even the sleep of those in the next room.

GERD, where you choke on regurgitated stomach contents, is more common in the elderly.

Chronic Heart, lung and Kidney disease can interfere with sleep.
SLEEP DEPRIVATION leads to a variety of problems, such as the inflammation and Arterial blockage highlighted in the above article.

Sleep is intimately connected with DIET and EXERCISE. As one of the PILLARS of HEALTH,  It s well worth discussing with your Doctor and following her instructions.

—Dr. C.