Monthly Archives: November 2010

Hardening of the Arteries and Other Blood Vessel Mischief

There is a point when discussing blood pressure, cholesterol or weight control that patients are genuinely perplexed about what causes what.

There is a very common notion that hard arteries or obesity both cause high blood pressure. It makes a certain amount of sense, when you think about it, but it’s unfortunately not true.

That’s why it’s well worth understanding this stuff as atherosclerosis is the leading cause of death and poor health in this country. As luck would have it, many cases of arteriosclerosis are fixable.

Heart coronary arteriesphoto © 2007 Patrick J. Lynch | more info (via: Wylio)

Atherosclerosis is commonly called “hardening of the arteries,” but the real problem is blockage of the arteries. Two hundred years ago, which in medicine might just as well be a million years, people dissecting dead bodies discovered arteries that were hard as pipe. These thick, hard walls were the result of calcified cholesterol plaques in the wall in arteries, thus the idea of “hardening of the arteries.”

We care a lot less about hardness than lousy blood flow. What happens when blood doesn’t flow? The body part turns black and dies – that’s bad.

So atherosclerosis means not enough blood to whatever the artery supplies – in the heart, no blood means a heart attack; in the brain, a stroke; in the kidneys, kidney failure. The list goes on, so we want to avoid atherosclerosis.

Many modifiable risk factors work through atherosclerosis to do their damage. High blood pressure (hypertension) beats up on the arteries by over pressuring them. That causes microscopic tears in the lining of the arteries. The body responds by causing an inflammatory reaction in the blood vessel. Over time this causes cholesterol to reinforce the walls of the vessel. In this case, the reinforcement causes trouble, namely atherosclerosis.

Cholesterol is another modifiable risk factor. By modifiable I mean something can be done about it. In general, the higher the cholesterol, the faster you develop atherosclerosis.

These days we understand that not all cholesterol is bad. There is bad cholesterol that plugs up your plumbing, like saturated fat. To make life more complicated, there are also several types of cholesterol particles. The good guys are called HDLs (high density lipoproteins), which are thought to bring cholesterol back from the plugged blood vessels, improving blood flow. LDLs are the bad guys. They are in the business of plugging blood vessels.

Good news – drinking wine increases your HDLs.

Smoking is another way to accumulate blood vessel damage as quickly as possible. There are chemicals and carbon monoxide in tobacco smoke that injure blood vessels. Once the vessels are injured, they are well on their way to becoming atherosclerotic.

Diabetes is a disease of uncontrolled or poorly controlled blood sugar. Blood sugar that is out of balance damages – you guessed it – the blood vessels. This results in high rates of inflamed and blocked arteries. This is a treatable condition, and careful control of blood sugar measurably reduces the rate of atherosclerosis.

Blood Vessel Model 3photo © 2005 Eina Jane | more info (via: Wylio)

No discussion of “hardening of the arteries” would be complete without mentioning obesity. It is readily apparent after a brief glance around any city in the country that obesity is at nearly epidemic levels. Obesity gets involved with hastening atherosclerosis in a variety of ways. Just being very overweight puts an additional load on the cardiovascular system. This alone can cause damage.

Obesity is also associated with type 2 diabetes. Often, people don’t get extra large eating only low-fat foods, so cholesterol-rich diets are also a factor.

These risk factors work together – smoking, high blood pressure, cholesterol and obesity cause a much greater risk when together in the same patient at the same time. The fancy name for this is metabolic syndrome. For those people, lifestyle changes are essential.

The good news is most of what plugs your plumbing is under your control. A doctor can help you with high cholesterol or blood sugar. You can help yourself by making good dietary choices and getting a little exercise. It might also be a good idea to throw the cigarettes away.

Take care,

Dr. B

Broken Bones: Cast, Surgery or Nothing At All

To cast or not to cast, that is the question.

It seems there are a lot of very different treatments for broken bones. What gives?

Foot Right x-ray 002 - no infophoto © 2006 Eric Schmuttenmaer | more info (via: Wylio)

In broad strokes, broken bones like to be lined up and held still for a month or two to heal. Joints, in general, like to be kept moving. The joint capsule is made of collagen, much like scar tissue. This tissue tends to shorten if not stretched out regularly. This means the joint will be stiff and lose range of motion when immobilized.

Most broken bones involve some joint injury, so there is always a trade off between the joints wanting to move and the bones needing to stay still.

Some fractures stay still enough to heal without a cast or surgical plate. Ribs run parallel to each other, so a fractured rib is supported by the ribs on each side. We also don’t put a bunch of pressure on our ribs, so they heal easily. Breaking a long bone in the foot (metatarsal) also heals with just the support of the bones on both sides.

Many joints will tolerate six weeks of immobility from casting. Ankle fractures and wrist fractures commonly immobilize the broken bone with a cast, and these joints get moving pretty quickly when out of plaster. This only becomes a problem if the joint has a lot of arthritis. Then even the ankle or wrist gets pretty stuck after casting.

There is another reason that ankles and wrist fractures are more often casted than surgically plated. These areas have little tissue surrounding the bone. The cast can be molded easily to keep the bones immobile and straight. Contrast this with a fracture of the thigh (femur). Because the thigh bone is surrounded by very bulky muscle, the bone can’t be held straight with a cast around the thigh. That is why broken femurs are always surgically fixed (with a rod down the middle of the bone).

My boss castphoto © 2008 Joe Hall | more info (via: Wylio)

There are other joints that don’t do well with immobilization. The two most common examples of this are the elbow and the shoulder. Immobilize a bent elbow for 6-8 weeks and you may never get it straight again. For that reason, some elbow fractures are simply put in a sling to keep the elbow moving. Shoulders also tend to develop adhesive capsulitis if not raised for four weeks. Even a healthy shoulder will scar if not raised for four weeks. The lesson: if your shoulder hurts, make sure you raise your elbow to your ear every day.

There are considerations to make in every fracture as to the best treatment. The key is to make sure the broken bone is held straight with little motion, while not making a bad joint from the prolonged lack of movement.

Take care,

Dr. B

Protecting Your Business’ Most Valuable Assets

Every businessperson does what they can to protect their company. Strategic planning is a part of every move to ensure the likelihood of success. Insurance provides all sorts of protection. But even so, we sometimes forget to protect our most valuable resources – our people. People are the backbone of any organization. In today’s economy each person can be mission critical in carrying out the effective operations of any business, large or small.

Earlier this year, the California Department of Public Health (CDPH) declared an epidemic of whooping cough (Pertussis), a highly contagious bacterial illness spread by coughs and sneezes. Transmission can also occur indirectly through touching contaminated shared surfaces in common areas. The work environment is a potential place for Pertussis to spread quickly.

Although Pertussis most significantly impacts the health of infants and children; adults who get infected with the bacteria can potentially be off work for months due to severe coughing attacks. Employees may also spread infection to their children, who can become severely ill. The employee may require time to care for their family and need to take time away from work.

In response to the high levels of Pertussis in the community, the CDPH is recommending that all Californians make sure that they are immunized against this disease, especially if they are in contact with infants and children. Many adults may require “booster” vaccinations to achieve immunity.

The Tdap vaccine which became available in 2005 offers the best protection against whooping cough. The threat of Pertussis affecting employees and the potential effect on businesses is clear. Vaccination is the best defense against whooping cough.

– Dr. Minh Q. Nguyen, Area Medical Director

HCG and Weight Loss (Or Lack Thereof)

Where I work in Scottsdale, Arizona, is probably second only to Hollywood in the med-spa business. 

It’s reassuring to know that day or night, weekend or even holiday, in an emergency I can get a walk-in Botox shot or an HCG supplemented diet. I sleep better knowing these things.

Hypodermic Needle Stomach Injection 3-1-08 8278photo © 2008 Steven Depolo | more info (via: Wylio)

The HCG diet ads are so plentiful, I don’t even hear them anymore. It was with mild surprise one day when I realized they were actually talking about injecting people with HCG as part of a diet. HGH seemed plausible, but HCG?

For those that think acronyms are a silly, HCG is Human Corionic Gonadotrophin and HGH is human growth hormone. HCG is a pregnancy hormone, and it is secreted by the placenta and helps keep progesterone levels high to maintain the pregnancy. It’s the hormone that is tested to confirm pregnancy. HCG doesn’t seem a likely candidate for injecting non-pregnant people, even males, to assist in weight loss.

This is the second or third cycle for this particular medical diet fad. It tends to re-emerge roughly every 25 years, which perhaps not coincidentally, is about once every generation. If you remember HCG not working in the 70s, you are not likely to pay for it today. How in the world did this pregnancy hormone get hooked up with weight loss?

For that we have to travel back in time to the early 1950s and to India. India was a brand new country at that time, having just emerged from British rule. There were still some British medical types hanging around acting like they owned the place. One such British endocrinologist was Dr. Simeons. He did studies on pregnant Indian women on starvation diets (pleasant thought – not! There is no mention on why Dr. Simeons didn’t do this research on pregnant British women in London. Medicine was a lot more wild and wooly in those days, which are thankfully passed. But I digress…)

Anyway, he injected these starving pregnant women with HCG and they seemed to lose more fat than protein. He also studied overweight males with Froelich’s Syndrome (pituitary failure). They were also put on a 500 calorie diet and given HCG shots. They also managed to lose considerable weight. He theorized that giving supplemental HCG in extreme diets hastens weight loss and spares protein-producing for a more healthful weight loss. This doesn’t even make medical sense, but this became quite the fad in Italy where Dr. Simeons had a clinic. Pretty soon everyone was injecting all manner of HCG preparations in the pursuit of lean living.

Rapid weight loss that spares protein and preserves vigor is the holy grail of the dieting world. Many attempts to prove Dr. Simeons’ theories about HCG-assisted weight loss have failed to reproduce any measurable benefit from the HCG. It seems the severe 500 calories restriction diet was the actual cause of the weight loss, and it had nothing to do with HCG. That is not too surprising since HCG is a pregnancy hormone.

Lose weight nowphoto © 2009 Alan Cleaver | more info (via: Wylio)

Injecting HCG as part of a diet was popular in the 50s, in the 70s, and now in the first decade of the new millennium. HCG is still little more than an expensive placebo. Its popularity seems to be related to the income it produces rather that any measurable medical benefit, other than to fetuses. It’s really hard to sell an unusually harsh diet, but combine it with a magic weight loss shot with a medical name, and you have an industry.

Take care,

Dr. B

U.S. HealthWorks’ Dr. Thomas Miller recently spoke with KXLY-TV in Spokane about the HCG diet. His interview can be found here.

U.S. HealthWorks Doctor Talks Touchscreens and Flu

U.S. HealthWorks’ Dr. Clyde Wilson spoke with KING-TV in Seattle about the dangers of catching the flu from touch screen devices such as the iPhone, Droid and iPad.

His interview can be found here.

Rusty Nails, Dirty Wounds and Tetanus

This morning I heard a newscaster lament, “I was cut with rusty metal, and there is a national shortage of tetanus vaccine.”

Despite his concerns, this is not exactly certain death. Growing up in Southern California, I spent most of my youth barefoot, tangled with more than a few rusty nails and was on the tetanus-shot-a-year plan. This experience prompted an interest in the whole rusty nail tetanus connection.

What about rusty nails and tetanus? Tetanus is actually caused by a germ, not by rust. This germ is in spore form and lives in the dirt. The technical name is clostridia tetani. Clostridia is a bad family of bugs; its relatives cause botulism and gas gangrene. Pretty unpleasant stuff.

Nailedphoto © 2005 Scott Robinson | more info (via: Wylio)
Rust is the oxidation product of iron. Oxidation is a form of chemical burning. You are familiar with this – this is what chlorine does to your swimming pool. It oxidizes germs, meaning it kills them. Rust is not infectious for anything, including tetanus. Yes, I said rust does not cause tetanus, and reading in the dark won’t ruin your eyes. So much for medical myths.

The concern is getting dirt in the wound, which may contain clostridia tetani spores. If these spores find a friendly environment in your wound, you can get tetanus. These spores don’t like a lot of oxygen, so wounds that have a lot of dead tissue, like road rash, are perfect for growing clostridia tetani. These spores also like wounds in the foot because the foot is a long way from the heart, so it doesn’t have the best blood flow.

There is the rusty nail connection. The nail was lying in the dirt, thus the rust. When you stepped on it, some dirt may have been pushed into the hole in your foot. Dirt in a foot wound is a good set up for tetanus. You could get tetanus from a plastic nail as long as dirt got into the wound.

If you get a few clostridia tetani spores in your wound and the conditions are just right, they will try to grow. If they succeed in growing, they will release a toxin that paralyzes your muscles. The lock-jaw will be the least of your problems; the lock-diaphragm stops your breathing. If you have had a tetanus shot recently, you have high levels of immunity that can kill these germs before they cause trouble. If you haven’t had a tetanus shot in 5 or 10 years, we give you a tetanus shot (usually TDap) and remind your immune system to get going. Once you have had a couple of tetanus shots, you can mount an immune response in a hurry when given a tetanus booster. Your body can actually make this protection faster than the clostridia spores can grow, so you’re safe.

syringephoto © 2006 connyx / crucify | more info (via: Wylio)

A tetanus shot (TDap) gives you great immunity for 5 years. Even in the presence of a dirty wound containing clostridia tetani, you are safe from tetanus.

For five to 10 years after a tetanus shot, you have partial immunity to tetanus, but it would be a race between the clostridia growing and your immune system fighting it. If the wound is clean, you don’t need a tetanus shot, as there is little or no risk of tetanus. If it is dirty (literally containing dirt), we will give you a tetanus shot, just to be safe.

The most common wound that is the source of tetanus in the U.S. is rose thorn wounds. You are gardening, so you have dirty hands, a rose thorn pokes you, and what self-respecting gardener worries about a rose thorn prick? You don’t even wash your hands. You just keep gardening. Perhaps not too surprising this can be the source of tetanus.

So get a tetanus shot (TDap) every decade or sooner for dirty wounds. Remember to promptly use soap and water to get any visible dirt out of a wound, even minor wounds. Gardeners especially – stay up on your tetanus immunizations.

Stay well,

Dr. B

Can Your iPhone, Droid or Touchscreen Device Transmit the Flu?

According to British researchers, mobile phones harbor 18 times more bacteria than a flush handle in a typical men’s restroom.

And Stanford University research suggests that the risks of transmitting pathogens from glass surfaces to a person’s skin are relatively high. Especially considering that 30 percent of the virus or germ will get on your fingertip when you touch the infected screen.

Since we were little, our mothers admonished us to wash our hands and cover our mouths when we sneezed – pretty good advice in this germy world; however, we received that guidance before anyone had ever heard of a touchscreen device.

But just how are infectious diseases passed from person to person?

People with upper respiratory infections sneeze and cough, blow and snort – spreading germs all over the place. These germs can live on surfaces, sometimes for hours or even days, just waiting for someone to touch them and rub their nose. The fancy word for this is autoinoculation, meaning you gave yourself the disease.

Washing your hands before eating is a good start, but I would take it a step further and wash your hands before you touch your face – always.

What about that smartphone on your hip – the one with the touchscreen?

If you are like me, you pick it up whenever it rings and put it to your mouth. I can almost hear my mom saying, “You don’t know where that cell phone has been!” You also pass it around freely to share the latest music, video or photo.

But when is the last time you disinfected your phone? Do you even think of it as an object capable of transmitting respiratory germs? How would we even go about doing germ warfare with your smartphone?

Clearly, boiling your phone is a really bad idea. I have personally tried the immersion technique – in a lake and in a toilet (two different phones … I’m not stupid), with identical results. In the medical world, we autoclave instruments to make them sterile, a kind of a steam pressure cooking. I haven’t yet tested that method, but I expect it would be a variation on the drowned phone phenomena.

Operating rooms use ethylene chloride gas sterilization to kill germs on sensitive electronic equipment. This would probably work well on the average smartphone, but it is a rather expensive and cumbersome technology for personal cell phone cleaning. Maybe this is a business opportunity for someone: set up ethylene chloride sterilizing equipment in a truck and sterilize cell phones for five bucks a piece. Franchise anyone?

But let’s be practical.

We can be a little bit low tech here and still get most of the bad germs off the touchscreen. There are a number of germicidal wipes available at drug or grocery stores. You can even grab one when you get your grocery cart. Take one that is moist, not dripping wet, and wipe off the screen of your touchscreen device periodically. It’s as easy as that.

Most wintertime respiratory infections are the result of us touching germy surfaces and then touching our face. The germy surface can be the counter, the grocery store cart or even your cell phone. Get in the habit of washing your hands before you touch your face, and give your cell phone the occasional swipe.

Stay well,

Dr B.


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