Monday, November 20, 2017

What's up with the new BP guidelines?

Every time you walk into a doctor's or even a dentist's office, they take your blood pressure. I see a lot of those automatic machines that squeeze your arm until tears pop out of your eyes.

According to H. Gilbert Welch, NYT, for years, doctors were told a systolic (top number) of less than 140 (changed to 150 for older people) was ideal. Now, that 140 has been lowered to 130.

This makes half of all adults in the US hypertensive.

Welch is a physician. He points out that the new numbers come from a large, federally funded study called Sprint (New England J of Medicine, 2015). Welch says this is a high quality, well-done study. It randomly assigned high blood pressure patients over 50 to a top number target or a bottom number target.

The lower targets results in a 25% reduction in cardiovascular events.  In the top number category (below 140), 8% had a cardio event in 4 yrs. For the low number target, (less than 120), 6% did.

This is the 25% reduction.

Also--to be qualified for the Sprint study, participants had to be at risk for cardio events.

Also how blood pressure is "taken" makes a huge difference. It can be high just from being at the doctor (white coat syndrome).

Ideally, the patient sits quietly for 5 mins before it's taken. It's taken on both arms. Three times.

And the medications can increase dizziness and falling--another mole pops up when one mole is whacked.

My advice is to discuss this with your doctor. If you are on medication, see how controlled you are and if it isn't good enough. This upshot here is not that hypertension should never be treated, but that it has to be treated wisely.

We can't be a slave to our numbers. There is more to life.

Friday, November 17, 2017

10 things you need to do

Or think about doing. Or do more. This is from the website Black Health

DRINK WATER. Eight glasses...? They say drink your weight in ounces--if you weigh 125, drink 125 ounces. That's a lot.

GO FOR A WALK.  De-stresses, increases oxygen. A 150-lb woman burns 130 cals in 30 mins of walking.

TAKE DEEP BREATHS. Inhale. Exhale. Push your stomach out on the inhale, not in. This also decreases blood pressure.

SLEEP. Most people need 7-9 hours a night. Less than that and memory and heart health can be affected.

OPEN A WINDOW. The air in your home may be worse than the air outside. You decide.

EAT WHOLE FOODS. Fruit, vegetables grains, lean meat. Make the produce half your plate.

READ SOMETHING. A book...even a long magazine article..not endless tweets.

PUT DOWN YOU PHONE, iPAD,m even KINDLE. Studies show being tethered to your blue lights can make you a jerk.

STRETCH. This relieves muscle tension, keeps you flexible. Do it before getting up, do it during TV time. Make it a habit.

GIVE THANKS. Maybe just list the items you are grateful for at the end of the day.

Recently I found myself praying, saying, "Please don't let anything bad happen today." Kinda negative?

And by the way, I do almost none of these 10 things. I don't drink much water, I can't walk because of arthritis, I sleep badly, I can't open a window in AZ (too hot), you get the idea.

But I can still type--so listen up!

Thursday, November 16, 2017

Do not take kratom!

With the focus on opioids and people with chronic pain worried about being able to function if the control efforts come to their door, a supplement called kratom is gaining popularity for pain, anxiety, and drug dependence.

Made from a plant grown in Southeast Asia, sometimes this stuff is even mixed with oxy--and it's dangerous enough on its own.

But the FDA is throwing red flags and working to block shipments. Kratom also carries risk of addiction and death.

Hundreds of calls to poison control centers have been logged--and 36 people have died.

Kratom is currently legal  under federal law, but Alabama, Indiana, Tennessee, and Wisconsin have outlawed it.

The FDA tried to ban the plant, but last October public complaints and 62 members of Congress blocked the ban.

Who organized that action? The Kratom Association!

They said banning it would inhibit research on therapeutic benefits. Yeah, sure.

Wednesday, November 15, 2017

Hospitalists and older people

I remember the moment when I learned the word "hospitalist." Time was, when you were hospitalized, your doctor made rounds--came by usually in the morning to check on his or her patients currently in the hospital. (My dad was a physician and did that every day--back in the day.)

Apparently, for convenience and cost reasons, about 15 yrs ago, private practice doctors began turning over their hospitalized patients to doctors paid by the hospital. These people were called hospitalists. You will hear a lot about how they "know" the hospital and procedures better than the private doctors, they are in the hospital most of the time and handy (not true), and provide sort of a second opinion (or a conflict maybe?).

I was struck with agonizing stomach pains, went to the ER, was admitted to the hospital because of a paralyzed intestine and a young woman said she was my doctor. I was confused. My doctor? I had a doctor--he had visited me in the hospital less than a year before. Did she know him? She did not. I called his office, gritting my teeth against the pain--"Oh," the nurse said casually, "they will take good care of you. Call us when you get out." This doctor had been my doctor for seven years.

I survived--the paralysis released after five days on a stomach tube (you do not want one of those!!).

After this, I encountered hospitalists many times both for me and for my mother, whom I took care of for 18 years. Her primary doctor was even a hospitalist as a sideline (so much for working just in the hospital). I had a hospitalist who would not enter my room because his English was not good...he preferred to stare at test results at the nurses' desk. We had one who informed us that old people (presumably Mom) smelled bad. I had one just last Easter with my hernia surgery who took four hours to let me out of the hospital because he was out of the hospital.

Now, there is a Harvard study (JAMA) that shows elderly patients with common conditions such as pneumonia, heart failure, and urinary infections treated by their primaries in the hospital were slightly more like to survive than those taken care of by hospitalists.

Eleven percent of those taken care of by hospitalists died within 30 days of leaving the hospital--with 9% of those taken care of by their own doctor dying within 30 days.

The theory is that even with the changing landscape of who one's doctor is, the primary knows better whether the patient needs to go to a nursing home after the hospital or has an OK situation at home. The primary will pay better attention to how many followup visits are needed and can be tolerated and what medicines are best.

The researchers did not recommend replacing hospitalists but did say their use might be limited with the elderly.

Personally, the hospitalists I have met are usually foreign-trained, their communication skills are limited, they may be squeamish about patient contact, and some are arrogant. One time, we saw Mom's hospitalist duck around a corner to avoid talking to us.

I will tell you a funny story. The hospitalist who said old people smelled bad? I responded asking him if he had seen the movie THE GODFATHER...He said sharply, "Of course!" I said, "Do you remember the line, 'This is the business we have chosen.'" He paused. He got it. But he also wrote me up in the chart saying I had been rude to HIM!

Tuesday, November 14, 2017

Are you cool? What is cool?

I bet you use the word "cool" a few times a day, or at least a few times a week. It is an elusive, changing quality most people seem to admire.

In an article, Lalin Anik, Johnny Miles, and Ryan Hauser (Newswise) break down "cool" into three and sometimes four parts. (1) autonomy, (2) authenticity, (3) attitude, and sometimes, (4) association.

Autonomy is the number one factor in coolness-nonconformity., rebellion. Examples are artists who reject the minimalism of the day and substitute complicated graffiti instead. Or people who wear casual clothes to formal affairs. But--rebellion is not always a cool trait--some things need to be predictable.

Authenticity means being true to your own character. People can spot a phony (usually). When a product tries to be cool, though, people can also spot misrepresentation. Musicians are often the coolest element of society--we match the music to the person.

Attitude means the person pursues authenticity and autonomy with the right attitude--maning not looking like they are trying.

Coolness is an act against the mundane. This takes underlying confidence.

The fourth quality--association--is not always needed to confer coolness. Cool people often deal with other cool people, though.

I once had a coffee mug that said POST COOL. Someone said maybe I wasn't quite over cool yet. What a compliment.

Overall, I would say if you have to ask what cool is, maybe you need more of it.