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Archive for the ‘Family Doctor’ Category

No Hope?

In Diet and Weight, Family Doctor, Self Image on December 13, 2013 at 2:23 pm

I was performing minor surgery on a pretty young lady’s upper arm recently.  As always, I warned her about her chances of having a scar from the procedure and offered to send her to a dermatologist who could probably make a prettier scar than I could.

She said without pausing to think about it,” Oh, don’t worry, I never wear short sleeves anyway.  I hate my arms.”

I said “Ok,” and finished the procedure.  I told her how to care for the wound and when to come back to have the stitches removed.  We parted ways and I went on to my next patient.  That brief conversation really stuck with me though.  I thought about it the rest of the day.

She is a pretty, healthy, 31-year-old mother and wife that has gotten so used to being overweight that she never shows her arms and never plans to.  That just kills me to hear, giving up on health at 31.  Throwing in the towel and surrendering to a weight which will ultimately rob her of health and seems to have already taken her self-respect — it’s a terrible thing.

I wish I knew how to give her some hope again.  I certainly want to help those who haven’t lost all hope push ahead and reclaim their health.

Any ideas out there on how to re-kindle hope for her?

You are What You Eat

In Excercise, Family Doctor, Food and Health, Junk Food, Mindful Eating, Mindless Eating on November 2, 2012 at 12:07 pm

I come back into the exam room, keeping my best poker face, sit down and turn to face her.  She’s on the edge of her seat, nervous and barely able to contain herself, maybe not even sure which answer she wants.

pregnanttest

“Congratulations,” I say. She lets out her breath and smiles, huge.

“Thanks!”

Once the adrenaline settles down and she can hear me again, we start talking through the changes she can expect and the ones she needs to make.  I give her a very short ‘safe’ list of over-the-counter medicine she can take if needed.  She gets a prescription for pre-natal vitamins.  I remind her to avoid all alcohol and really put the screws on for her to quit smoking.

“Yes.”  “Ok,doc.”  “Mmm-hmm.”

Then I hold my fingers up about half an inch apart.  “This is how big your baby is right now.  It’s brain, bones, muscles, everything have to grow and the only food your baby gets it what you eat. Do you want your baby to be made from McDonald’s and soda pop or from healthy food, organic vegetables and fruits?  Now is the time to decide.”

photo

The light that goes on, the Aha! moment I get to see is pretty cool, let me tell you.  This is often one of the conversations that feels like I’ve made a difference in someone’s life.

What I’ve realized over the years is this is true for all of us, all the time.  Every part of our bodies and brains is being constantly re-made, day by day.  The trillions of cells that make me are not the same ones that made me even a few years ago.  Some of our cells are not the same ones they were even yesterday!

Our bodies are constantly repairing and replacing cells by the billions and the only raw materials we have to work with is what we eat.  So, you are what you eat.  I am what I eat.  Everybody is the peculiar mix of Big Macs, broccoli, Guinness, apples, Twix, Doritos, salmon, and whatever else they eat – and nothing else!

Just take that in for a moment.  Think back to what you ate today or yesterday.  Cocoa Puffs?  It’s in there.  Chardonnay?  It’s there too.  Fast food, snacks, sodas?  Yes, yes, and yes.

One of the best ways I know to change your life is simply to become aware.  Mindless eating, mindless couch-sitting, and mindless sleep-skipping are pretty popular ways to feel like absolute crap.  Just being attentive to what I eat, what I drink, how active I am, and whether I get to bed early enough can help me actively choose to feel better.  If I go around on auto-pilot, I’m likely to grab chips for a snack, conveniently forget to run, sit at the computer way too late and feel like I deserve.

Be aware of your choices – you are making the you of tomorrow.  Choose Health!

A Quick Fix

In Diet and Weight, Family Doctor, Food and Health on October 12, 2012 at 11:55 am

pills on doctorfoodtruth

Recently, the arsenic-in-my-apple-juice brouhaha heated back up.  Not long after, the FDA put the hammer down on many of the companies selling hCG for weight loss.   For a guy with food and weight on the brain like me, the connection is obvious.

As a society, we are consuming factory-made food and drink, getting way too big by doing it, then running to chemicals (yes, hCG and other homeopathy or ‘all-natural’ products are chemicals) for a quick fix.  Look how well it’s working!

What I see every day are heavy, unhealthy, unhappy people desperate for an antidote.  What I see less often is a heavy, unhealthy, unhappy person desperate enough for a change.  Guess who ends up better off?

I tell patients over and over, day after day: “There is no quick fix.  There is no magic pill.  If anything really worked, would anybody still be fat?”

Overweight is about calories, folks.  There is no way to dodge this issue.  The FDA link above has a short, blunt video exposing the hCG diet plans for what they are.

Yes, people lose weight on them.  No, hCG has nothing to do with it.  Then why do they work?

500 calories a day!!  That’s the diet plan they recommend!  No surprise, when you eat like you live in a concentration camp, you lose weight.  The problem is, cutting your calories to this point can cause serious problems with your body including passing out or having an irregular heart beat.  Definitely not try-it-at-home stuff here.

Rather than looking for the quick easy fix that doesn’t exist, change is needed.  Changing our food and drink to match what our bodies need for health is the only way to be healthy.  My motto is absolutely true:  Eat Healthfully, Live Fully Healthy!

Try it, you’ll see…

Fighting the Good Fight

In Diet and Weight, Family Doctor, Food and Health, Food Truths, Food Lies on March 2, 2012 at 12:29 pm

I just saw Lois yesterday. I have to admit, I was surprised to find her smiling when I walked in the room – coming to see me doesn’t usually put a smile on her face.

The fact the scale showed 40 pounds off in the last 4 months may have something to do with her smile. Her diabetes had really gotten out of control, needing over 150 units of insulin a day to keep her sugars from being sky-high.

Now? She’s cut her own dose back to 30 units and I told her to cut it back even more. I think she’ll be able to stop the insulin altogether soon!

When I started her on the insulin shots a couple of years ago I promised her she could fix this and come off it if she changed her habits. I can’t say I really had much hope she would, but wow has she proved me wrong.

She finally joined Weight Watchers (the only diet program I ever recommend since it’s the only one that is a forever life change and not just a quick fix.) Her daughter is doing it with her and has lost even more weight, probably preventing diabetes completely for herself.

It turns out that reading and re-reading my book is what spurred her to make the change.

She said, “When I read that thing it’s just like you’re sitting there beside me, telling me how it needs to be, nagging me to do better!”

“Perfect!” was my response. That is exactly what I want my book to be, an extra-long, face-to-face conversation with me about food choices and health.

For Lois, it looks like that “long conversation” is working – way to go!!

Diet Arguments, Cheats and Shills

In Diet and Weight, Excercise, Family Doctor, Food and Health on February 16, 2012 at 12:07 pm

Snake Oil Liniment Advertisement on doctorfoodtruth

I recently read a debate between a Ph.D. nutritionist and a physician about whether a person can be fit and fat.  This is an old argument that has lots of heat and emotion involved and not much logic or reason.  These experts argue about whether an overweight athlete is healthy but never really agree on how athletic or active this imaginary person is or even what they mean by healthy.

In the end both agreed that being normal weight was a good idea and exercise is good for you.  Amazing!   The MD said what I’ve always said: show me this person and we’ll talk.  After 15 years of examining thousands of patients a year, I don’t think I’ve met anyone in this category.

Debates aside, the fun links were at the bottom of this story.  A stomach-filling diet drink, a rejected diet pill, and a petition by Public Citizen to ban two more.  A lot to chew on, eh? (insert my wife’s dramatic groan here.)

Stomach-filling Diet Drink

The drink has a chemical called alginate that is liquid in a drink but changes to a gel once it hits stomach acid.  Interesting idea though it doesn’t sound that safe, really. Intestines blocked with gel-sludge could keep surgeons way too busy.

Seriously, this may have a future, since much of the trouble with eating less is the hunger people dread.  The recommendation I give is to eat apples and drink water to relieve the hunger pangs.  The pectin in apples actually does this same thing, thickening in the stomach and providing a full feeling.  My guess is the drink will cost a bit more than an apple.

Rejected Diet Pill

The diet pill Qnexa was getting some positive attention after news of the 10% weight loss people had in experiments.  Now it’s getting more attention but of the bad kind.  There were people with psychological problems and heart problems while taking the experimental drug.  Not many doctors would be surprised by the news since those are the problems the ingredients can cause too!

There is an enormous market and demand for weight-loss drugs, which means the drug companies will keep working at it.  The company that owns Qnexa says they will keep trying to convince the government of the drug’s safety.  My hope is that the FDA will do their job and protect patients.  Combining the ingredient in Adipex with a seizure drug and hoping its safe sounds like wishful thinking to me.

I’ve written elsewhere that I don’t prescribe Adipex.  I get at least one request a week from someone desperate for some kind of help.  I try to refuse gently and reasonably, but I still see the frustration and disappointment.

“Adipex isn’t safe,” I say.  “It isn’t safe, it doesn’t work and I have to carry extra malpractice insurance just to prescribe it.”

“Really?” 

That’s the best answer I could hope for — it means someone just listened!  There is very little proof of phentermine (Adipex) working in the short-term and none at all that it works over the long-haul.  If it works, most people lose 10-15 pounds over 3-6 months.

Once it is stopped, my experience is that everyone goes right back to their old eating habits and gains all that weight right back.  Nothing really changed.  If a person won’t change their attitude and approach to food, if they keep eating like an American, they should expect every fad diet and diet pill to fail, Adipex too.

The safety part of phentermine is my biggest problem with it.  That whole “Do no harm” vow sure can slow a doctor down.  There may not be much proof that it works but I think there’s plenty of proof that phentermine can cause mental problems and permanent heart damage.  That’s why my first insurance company after graduation required me to pay for a policy rider if I prescribed medicine for diet and weight loss.  They were so sure I would be sued for prescribing these medicines they wanted me to pay more ahead of time!

That’s actually when I started looking in-depth at these drugs and came to my decision not to prescribe them.  The drugs in this family work by the same effect on the brain and all have the same risks to the brain and the heart.  Two of the drugs have already been taken off the market: Fen-phen and Meridia.  I think that phentermine should have been withdrawn too, but it is so old the FDA rules that apply to it are a little hazy about safety so it has stayed around.

Public Citizen wants them Banned

This ABC News article is about the other weight-loss drug type available, the fat-blockers Xenical and Alli.  There have been complaints about both drugs in the public since they came out.  Like the other diet pills, these don’t really work and don’t change the person, plus they offer the nifty side effect of “flatus with discharge” according to my epocrates app.  For those not in the know, this is also called “oily anal discharge” or “anal incontinence.”  However politely you say it, this is pretty gross.

The Public Citizen complaint to the FDA says they cause  worse problems too, like pre-cancer in the colon and vitamin deficiency.  Again, plenty of bad effects, underwhelming weight loss (10-15 pounds for all of them) and no permanent change in weight or health.  Not a very good deal, especially when you consider how much these pills cost and that insurance won’t pay for them.

There is one other diet pill on the near horizon.  Contrave is still working its way through the FDA, with a solid “Yes, maybe” from them in December 2010.  Whatever they decide about this medicine (other than high blood pressure and seizures it seems pretty ‘safe’) it’s still good for only about 10 pounds.  The company can sell it to us with a straight face, saying “If you take it for a year, you’ll probably lose 10 pounds.”  Seriously?

Expensive, bad side effects, crummy results — how about learning some new habits and finding joy in feeling well and eating healthy?  Come on, try it, you’ll like it!

Change Your Food, Change Your Life!

All We Need is Just a Little Patience…

In Diet and Weight, Family Doctor, Mindful Eating, Mindless Eating on February 2, 2012 at 12:38 pm

Izzy Stradlin from Guns N' Roses

Do I date myself with the Guns N’ Roses reference?

I’m having a recurring theme come up in my conversations this week.  Plenty of folks had lost weight last summer, maybe to quiet their nagging doctor?  I’m starting to see them back for routine or urgent problems and I often notice the scale creeping back up.

I try to help people find the line between shrugging it off and beating themselves up over it, but that can be hard.  What I want people to know are just a couple of simple things.  I think these 3 thoughts should be kept in mind by anyone trying to change their diet or lose weight.

1) Realize the time it takes.  We live in the fastest paced culture around.  Drive-thrus, microwaves and the MinuteClinic make patience and perspective hard to remember.  What I continually remind my patients is that the weight didn’t come on overnight so it can’t come off overnight either.  Whenever you read an ad for a quick solution to health or weight, RUN!  They’re either flat-out lying to you or peddling something harmful.  Nature doesn’t do anything rapidly and trying to force your body into rapid weight loss will backfire, I promise.

Instead, be patient with yourself and your body.  The little choices every day add up, so keep making good little choices and you’ll be amazed where you can end up!

2) Water first.  I go over this topic in detail in Food Truths, Food Lies, but in a nutshell: Your body can’t tell thirst from hunger.  So what does this mean?  Drink water before eating anything, ever.  A cold glass of water and 5 minutes may completely fix any craving you’re having.  Even if it doesn’t, the water will help decrease the amount of food it takes to be satisfied.  Drink up!

3) Think before you eat.  This ties right into #2.  Eating without thinking is probably America’s biggest “bigness” problem.   Snacks and convenience foods are way too convenient.  A recent study showed we eat an average of over 550 calories per day more than Americans did 40 years ago.  Do the math: this is plenty to explain our weight problem.  Think before it goes into your mouth and pare back those needless calories that won’t even be enjoyed.   After all, how can it taste good if I eat without even realizing it?

Most of all, be kind and patient with yourself while making health changes.  All you have to do is make healthy choices today.  Keep it up and it will become a habit.  Keep healthy habits and your body will thank you for it.  I promise!

Eat Healthfully, Live Fully Healthy!

Frustration

In Diet and Weight, Family Doctor, Food Diary, Food Truths, Food Lies, Junk Food, Mindful Eating, Self Image on January 5, 2012 at 12:02 pm

Scale on doctorfoodtruth

One was almost angry, the other almost completely resigned.  Two still-young women in my office in back-to-back appointments recently, both with one thought on their mind: “That scale can’t be right!”

Both are busy moms with teens at home, days filled with errands, work, worry and everyone’s needs but theirs. These ladies are why I (usually) love being a family doctor and get excited about helping people.  These ladies are why I (sometimes) loathe being a family doctor and feel exhausted at the end of the day.  See, frustration all around.

Both Sara and Tara (not their real names) are here to see me about their weight.  These women aren’t asking me for a way to lose ten pounds either.  Both are about 100 pounds away from being healthy and they know it… and they hate it.

Sara really just wants Adipex.  Tara tried reading Food Truths, Food Lies but got discouraged by the challenge and quit.  Sara tried an app to count calories and is sure she doesn’t eat more than 1,500 a day but still gains weight.  Tara struggles with her normal-sized husband bringing home chips, cookies and other bad snacks even when she asks him not to.

See? Frustration.  How do I help them?  I’m not sure.

Sara hasn’t read my book yet, hasn’t yet found out all the ways her food habits are making her feel sick and gain weight.  I don’t prescribe Adipex (ever!) for a whole bunch of reasons but I did agree to check her thyroid along with some other hormone and vitamin levels.  I asked her to read my book — she really has a lot to learn about diet and nutrition.  I’ll see her again in a few weeks, we’ll go over her lab tests and I’ll start trying to help her change 30+ years of eating habits that are making her sick.

Tara is easier to talk to but harder to help.  I’m afraid she has given up on herself and is just calmly waiting for me to tell her she’s got diabetes, bad cholesterol, or whatever else will eventually go wrong.  Which brings me to the real source of our frustration.  I can’t make anybody want to change.  I just can’t.

The good news is that Sara can absolutely lose weight and take control of her health without ever taking Adipex.  Tara can absolutely find new hope and energy in little changes like eating a high-protein breakfast and skipping the orange juice and soda pop.  All of us can always change, improve, and renovate our health with two little words: “I will.”

Change Your Food, Change Your Life!

Do Drink the Water

In Diet and Weight, Family Doctor, Junk Food on December 12, 2011 at 12:43 pm

reflections in water glass on doctorfoodtruth

Something made me pause yesterday.  I filled a glass of water at the sink, something I’ve done who knows how many times.  A rare glimpse of winter sun made the water look like it was something special.

I realized how fortunate I am to be able to just turn the handle and get water anytime I want.  Billions of people don’t have such good fortune and taking it for granted is easy.

Of course, as soon as the moment of gratitude had passed, my mind went straight to nutrition as usual.

Several times a day I need to remind a patient that what they drink matters.  Choosing water instead of their favorite soda or flavored tea or sports drink or juice can save hundreds of dollars and thousands of calories a year.

The carbonation in soda pulls calcium out of bones and can cause kidney stones.  The sugar in juice (yes even the natural sugar!) causes cavities, weight gain and diabetes.  The sodium and sugar in sports drinks can help a marathon runner finish the race but is way overboard for what most of us do in a day.

How much less obesity and unhealthiness would we have if this miracle liquid from the faucet was our main drink?

Change Your Drink, Change Your Life!

A Breakthrough!

In Diet and Weight, Family Doctor, Food and Health, Mindless Eating, Self Image on December 1, 2011 at 12:58 pm

Just a few days ago I sat down with a patient and then nearly jumped back up again in excitement.

“Ms. J!  You’re doing it!”

“I know,” she said with a shy smile.

You have to understand, Ms. J and I have sat down opposite each other for more than a few appointments where nothing has really changed.  She usually beats up on herself for it, I usually ask her not to pick on my patient.  Then we talk again about motivation, about her pre-diabetes, about her family’s health, the usual.

What I can’t remember ever talking about is success like this!  She has steadily dropped a pound a week for the last 3 months (the pace I usually recommend.)

Even better, her blood work has come back to normal just that quickly.  Seeing a genuine smile on her face and not hearing a single negative word about herself was great, let me tell you.  Seeing a new determination and understanding that she is in control was even better.

Best of all?  Knowing the long-term effect her better choices could have on her family.

According to Dr. Brian Wansink, Ms. J is a nutritional gatekeeper.  In our culture, Mom is often the one who plans, shops for and prepares meals and snacks.  This means that when Mom gets motivated to choose healthy foods and habits, everybody at home finds their eating habits moving the same way.  I love it!

Eat Healthfully, Live Fully Healthy!

I Can See the Future (recycled post)

In Diet and Weight, Excercise, Family Doctor, Food and Health on November 21, 2011 at 12:05 pm

A family Tree on doctorfoodtruth

One of the unique perspectives I get as a small-town family doctor comes from truly taking care of families.  My little town is a place people tend to stay to raise kids and their kids stay, too.  The stability of the community is one of its big attractions to new families as well.

For a Family Doc, this means I often know three or even four generations in a family.  What better way to know about someone’s medical family history than taking care of both their mother and son?  The great part for me is how quickly I start to feel like one of the family.  As I walk through illnesses, births, deaths, and other milestones with people, we learn a lot about each other and often become friends.

The hard part is watching health problems trickle down the generations.  Grandma’s diabetes is connected to mom’s insulin resistance (pre-diabetes) and her son’s obesity and acanthosis (a sign of coming insulin resistance.)  Sometimes it can feel like trying to move a mountain to get everyone to change.

What I know is that the eight-year-old is on the wrong path and heading straight for early health problems like the rest of the family.  What I also know is that it doesn’t have to be this way.

I have seen whole families choose differently and re-vamp their health together, I know it’s possible.  I also know it’s hard.

One day turns into the next, the TV is on, healthy food is harder to make and more expensive to buy — all these things and more can make change hard for families.

But I keep hoping, keep nudging, keep encouraging people to change.  Grandma can feel better and younger, mom can avoid diabetes altogether, and Junior can be a healthy kid without his weight and tiredness slowing him down.  I know it! Now if only I could show the future instead of just seeing it…

Change Your Family’s Food, Change Your Lives!