What Is A Complete Physical?

Hi everyone! I’m feeling a little prickly today because I have been fired. No really, I got fired recently by a husband and wife who were angry I didn’t do certain tests with the husband’s physical.

Turns out their last physician performed certain tests during their physicals that are not recommended, and this particular couple is of the opinion that doing a test is always better than NOT doing them.

So since I declined (with an explanation) to do these tests they felt I was not a good doctor.

It seems to me that these two are not the only patients who don’t know what a “complete physical” entails. Let’s talk about it!

A “complete physical” or “wellness exam” is an opportunity for your doctor to go over your entire medical history, update your chart with things that have happened since the last visit, and make sure your medication and allergy lists are correct.

Your primary care doctor is the one who keeps all these things up to date. This is why it’s important to have your physical every year. If you get sick or need to see a specialist, your primary care doctor is the one folks will ask for records.

Your physical should include an examination and a discussion of your screening needs. Your doctor should make sure your vaccines are up-to-date. And you should go home with guidance on eating healthy, vitamin and supplement use, exercise, and harm reduction measures like using condoms with sexual activity, moderation in alcohol use, wearing your seatbelt and bike helmet, and wearing sunscreen.

For women your visit should review whether your Pap test and mammogram are up to date. Yes, your primary care doctor does Pap tests. You may need a bone density test based on your age and risk factors.

For men, there should be a discussion of prostate cancer risk and current screening recommendations, which are a little controversial. The current recommendation is NOT to screen men unless they are Black or have a father or brother with prostate cancer.

Both men and women should have their colorectal cancer screening recommendations reviewed. There are several options including colonoscopy and Cologuard, depending on age, family history and previous screening results. And both men and women should have labs ordered periodically to check blood sugar and cholesterol.

That’s a lot! So what is NOT included in a complete physical?

Urinalysis – Except in pregnant women, screening urinalysis has little or no value. It is common for a perfectly healthy person to have a small amount of protein or blood in the urine. Screening will turn these findings up and result in anxiety and additional testing. However, if someone has a strong family history of kidney disease, or has high blood pressure or diabetes, testing may be valuable.

EKG – Again, EKGs are an imprecise tool. It is common for patients with perfectly healthy hearts to have minor abnormalities on their EKG. This again leads to anxiety and unnecessary additional testing. If one is concerned about their heart risk, you can ask for a coronary CT (coronary calcium score). This is a much better measure of heart risk as it measures the amount of plaque in the coronary arteries.

These two tests are the most common inappropriately-ordered tests done with a wellness visit. The complete physical is a very valuable tool in keeping you as healthy as possible. You should definitely get one every year. Just be aware of “extras” that may cost more and don’t add to your care.

Want more information about appropriate testing and treatment? Please see the American Board of Internal Medicine’s Choosing Wisely site and app. Yes, there’s an app for that!

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Dietary Anthocyanins And Inflammation

When you were a kid did your parents tell you to eat your fruits and veggies? Have you been told that red, purple and blue fruits are healthy to eat? They’re right – because of dietary anthocyanins.

Credit: ProHealth.com

The anthocyanins are a group of flavonoids, pigments in fruits, flowers, plant leaves and seeds that have powerful antioxidant and anti-inflammatory properties. There are a lot of studies that have looked into the effects of dietary anthocyanins on obesity, inflammation and other metabolic markers of health.

In 2016 it was estimated that nearly 40% of American adults were obese. In 2018, 30 million Americans were KNOWN to have heart disease. Almost 650,000 Americans are newly diagnosed with heart disease every year. Dietary change is key to addressing obesity and heart disease. Diabetes and heart disease are not skyrocketing because we’re deficient in metformin and Lipitor, for Pete’s sake. It’s because of what we put in our mouths. Every. Day.

What sorts of foods are we talking about? Red cabbage, blueberries, blackcurrants, mulberries, cherries, black elderberry, black soybean and chokeberry contain a variety of anthocyanins. Foods that have red, purple and blue colors are incredibly healthy to eat because of these powerful antioxidant and anti-inflammatory pigments.

A group out of Korea published a very good review of the literature on the effect of anthrocyanins in the diet. Turns out eating foods containing anthocyanins reduces a number of markers of inflammation and metabolic illness, such as C reactive protein, LDL cholesterol, leptin, glucose, tumor necrosis factor, insulin and triglycerides. Eating these foods also down-regulates genes involved in weight gain and obesity.

We can do a lot with diet to impact our risk of obesity, diabetes, heart disease and other illnesses. Decreasing animal foods and saturated fat, sodium and salt in the diet and increasing fruits and vegetables, dietary fiber and other plant based foods are good steps in the right direction.

When you’re picking fruits and vegetables, pick red, blue and purple ones so that you’re getting lots of dietary anthocyanins!

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Sudarshan Kriya Yoga For Health

So many of my patients suffer with anxiety and depression. What’s worse, it is estimated that 90% of visits to primary care doctors are related to stress. Stress makes pain and other physical symptoms worse and harder to control. It interferes with management of medical problems like diabetes, high blood pressure and heart disease.

I’ve known for a long time that yoga is helpful for stress management and for your physical health. But there is one specific yoga practice, taught and practiced right here in Cleveland (and around the world), that has proven health benefits. Sudarshan Kriya yoga.

Sudarshan Kriya yoga (SKY) was developed and is taught by Art Of Living International, a nonprofit group led by Sri Sri Ravi Shankar. I was privileged to participate in a training course recently and can tell you from personal experience that there are real benefits to this practice.

I wouldn’t necessarily recommend this practice to patients and readers based on my own experience. It turns out, though, that there have been over 30 scientific studies published on the health benefits of this practice. Let’s review some of the evidence.

Anxiety is one of the most common mental health problems I see. It is a chronic illness that colors a patient’s entire experience and significantly impacts their quality of life. Sudarshan Kriya yoga was shown to produce improvements in symptoms in over 70% of subjects and complete remissions in 41% of subjects in only 4 weeks of practice. That is comparable to the effectiveness of medication and psychotherapy.

An estimated 20% of American adults will suffer with depression, and it is one of the most common problems I see in the office. Most patients respond well to medication but some do not. SKY is as effective as imipramine (a third-line medication choice) for patients who don’t respond to more commonly used medications.

Post-traumatic stress disorder is a terrible consequence of traumatic life events seen in survivors of natural disasters, terrorist attacks and childhood trauma, and especially in combat veterans. It is very difficult to treat and leads sufferers, particularly veterans, to even contemplate suicide to escape their symptoms. Sudarshan Kriya yoga produced significant and sustained improvements in symptoms in veterans suffering from PTSD, suggesting it should be considered in all patients with this awful illness.

With the attention being paid to the opioid epidemic, it is encouraging to be able to offer an intervention that improves quality of life for opioid users in recovery. One study did demonstrate this effect. SKY also helps smokers quit using tobacco products.

Stress, anxiety, and depression all have physical effects on the body. Many adverse effects of stress have been documented and they contribute to many chronic illnesses. How does SKY impact these physical illnesses and improve health?

Stress causes changes in the lipid profile and in hematological parameters such as platelet count. Over time, these changes may contribute to the increase in heart risk known to be associated with high levels of chronic stress. Sudarshan Kriya yoga has been shown to improve these changes in as little as 3 weeks.

It is also known that stress causes changes in the cardiovascular system related to the autonomic “fight or flight” system. Over time, especially in patients with high blood pressure and diabetes, dysfunction in this system can contribute to increased risk of heart attack and stroke. SKY improves measures of cardiac autonomic function which may in the future be shown to decrease cardiovascular risk.

Diabetics in particular can benefit from the practice of Sudarshan Kriya yoga. Glucose tolerance (postprandial glucose) improved significantly in people practicing SKY and, as mentioned above, cardiac autonomic function improved as well.

Those who are living with chronic, life threatening diseases such as cancer know that stress and anxiety worsens all their physical symptoms. Yoga, including SKY, improves pain and stress even in those with advanced stage breast cancer.

We are not just physical beings. Our minds, emotions and spirits affect our bodies as much as the foods we eat and the exercise we perform. Sudarshan Kriya yoga is an effective way to improve our mental health and our physical wellbeing. If you suffer with anxiety, depression, PTSD, substance addiction, diabetes, heart disease or any other chronic illness please consider taking the Happiness Course with Art Of Living International. Click this link to find a course near you!

QUESTION: Do you practice yoga? Would you consider trying it?

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Setting Goals For The New Year

Happy New Year everyone! Now comes the time of full parking lots at the gym and having to wait for equipment. Diet products are everywhere. Planners are selling out at the bookstore.

By February it seems like things are back to “normal” at the gym and elsewhere. Why does setting goals and meeting them seem like such a hard thing?

Generally there are three reasons why people don’t meet the goals they have set for themselves:

  • The goal is too vague: “I’m going to get healthier.”
  • The goal is too big: “I’m going to lose 100 pounds this year.”
  • No accountability

In management circles there is talk of setting SMART goals. SMART is an acronym that helps with effective goal setting. Goals should be

  • Specific
  • Measurable
  • Achievable
  • Relevant and
  • Time-limited

There are lots of resources to dive deeper into each of these characteristics but let’s start with our vague “I’m going to get healthier” goal from earlier. What would that mean? What does “healthier” mean?

In this case let’s imagine a diabetic patient. For him, “healthier” may mean getting better control of his blood sugar. If he is starting with a hemoglobin A1C of 8, he may set a goal of 6.5 in 6 months. This goal is specific, measurable, definitely achievable, relevant and time-limited.

If this were my patient, I would push him to make more goals to flesh out the plan. What is his food goal? What about an activity goal? Hopefully he already has taking his medication daily under control, LOL! After all, a dream with a plan (and a deadline, per Napoleon Hill) is a goal. The plan is important. How are we going to achieve this goal?

Once you have a goal and have broken it down into smaller pieces, it’s important to share the goal with someone who can support you. A spouse, a friend, a sibling, we need to have an accountability partner to remind you why you set the goal in the first place and pick you up when your motivation fizzles.

It doesn’t matter what your specific goal is. You can rock it this year!

QUESTION: What goals do you have? How can we make 2020 your healthiest year ever?

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Artificial Sweeteners And Health

Bonnie is a patient of mine who struggles with her weight. When she was younger she was slender, active, enjoyed exercise and enjoyed cooking. She is a nurse and has always been drawn to high-stress fields where she feels she can make a real difference for her patients. She married late and had two children and since then her weight has gotten out of hand.

At a recent appointment I asked whether she was ready to make some changes and tackle her weight. She has tried a number of weight loss programs without lasting success. At her last visit she brought a bottle of what turned out to be her favorite beverage with her: Diet Coke.

I asked her about it and she admitted she drinks almost nothing but diet Coke. She doesn’t like coffee so she relies on the caffeine in her soda to get her going in the morning. She justifies it by saying “at least it’s DIET Coke, there’s no sugar, so it’s OK.”

But is it? New research has come out suggesting that artificial sweeteners are not the weight loss magic they were designed to be.

Researchers in San Antonio, Texas, published a very thorough review of both animal and human research studies looking at the effects of artificial sweeteners on a number of health parameters. They found that animals fed a whole range of artificial sweeteners – including saccharin, sucralose, acesulfame potassium, aspartame, or the combination of erythritol+aspartame – had a number of adverse impacts on their health.

They tended to eat more. They gained weight. They developed higher percent body fat. They had worse metabolic markers including those for diabetes and for inflammation.

These changes were more pronounced in male animals and in those with a genetic predisposition to obesity. They were especially striking in those eating high-fat, high-sugar diets and diets meant to mimic our “Western” diet.

In the human studies those participants who reported daily (or more frequent) use of artificial sweeteners had more weight gain. They gained more weight around the abdomen, which is the most dangerous place to gain it. They were more likely to be overweight and obese.

I’ve always said there’s a difference between being fat and being unhealthy. You can be a fit overweight person. But those study participants who used artificial sweeteners tended to NOT be fit or healthy. Those who reported daily or more frequent intake of diet drinks (the most common source of artificial sweeteners) were more likely to have hypertension, metabolic syndrome, diabetes, depression, kidney dysfunction, heart attack, stroke, and even cardiovascular and total mortality.

Obesity studies tend to have a heavy participation of female subjects. Because the animal studies showed the impact of artificial sweeteners is more pronounced in male animals, the dangers of these additives may actually be more than what we are seeing (which is bad enough).

If you are currently drinking diet soda thinking it will help you lose weight, please stop. The science is clear that diet beverages promote weight gain and increase the risk of diabetes and other health problems. If you like fizzy drinks there are plenty of unsweetened seltzer drinks available to choose from. Even unflavored seltzer with a dash of fruit juice is a better option.

The good news is that diet soda consumption is on the decline. But people looking to lose weight are still susceptible to the lure of something for nothing. Remember, if it sounds too good to be true, it probably is.

QUESTION: Do you drink diet soda? Will this information cause you to rethink that?

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When Misleading Ads Harm People

My patient Brian is a gay man who has been taking the medication Truvada to protect him from HIV infection. Recently I saw him in the office and he said he saw an ad on Facebook suggesting this medication causes bone and kidney problems, so he stopped it.

When advertisers mislead people to make a buck, that’s one thing. When misleading ads lead to people being hurt or killed, that’s another.

Brian is at increased risk of HIV infection due to his lifestyle. He is a lovely, gentle man who is a talented musician. Whether you agree with his choices or not, he does NOT deserve to contract a deadly disease if it can be prevented. And Truvada reduces the risk of HIV infection by 99%.

The ads in question are being run by legal firms who, it seems, are attempting to organize class-action lawsuits against the company that makes Truvada. These misleading ads claim the medication is dangerous and imply taking it isn’t worth the risk. When patients without medical knowledge, like Brian, see these ads online they become concerned and sometimes choose to stop their medication.

All medications have risks. Doctors talk with patients and weigh these risks against the proven benefits of the medications. Often doctors run periodic tests to monitor for problems stemming from use of medications. Other medications can cause kidney problems (like blood pressure medications and NSAIDs like Advil) or bone problems (like some contraceptives and steroids used for severe arthritis) but we still use them.

Stopping blood pressure medication because some lots of generic medication have been found contaminated is one thing. High blood pressure is rarely dangerous over the short term – once it’s confirmed your pills aren’t from one of the affected lots you can restart them. However, stopping medication to prevent infection from HIV can be deadly over a short period of time, if one is exposed during that unprotected window.

Almost 40,000 new cases of HIV infection happen every year. Over 1 million Americans are living with HIV, and approximately 15% of these people don’t know they are infected. Gay and bisexual men, sex workers and IV drug users are at highest risk and most likely to benefit from treatment with Truvada.

If you are taking a medication, ANY medication, and you see something reported on TV or radio that concerns you, talk to your doctor before stopping your medication. Your physician should be able to address your concerns and, if not, you can decide together on a course of treatment that makes you comfortable and continues to meet your health goals.

It’s been said before, but bears repeating. Don’t believe everything you see or hear online.

QUESTION: How do you judge when you see concerning information online? How do you know what to believe?

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Taking A Break To Cultivate Faith

Hello everyone! I’m sending a short update because I’m taking a break this week from blogging. My son and I are attending the National Catholic Youth Conference in Indianapolis this weekend.

If you are Catholic and have young people in your life, PLEASE encourage them to get involved with their youth ministry at church. Encourage them to come to the next NCYC in November 2021. They will not regret it. This hasn’t been an incredible experience for me and for the teens.

I’ll be back to writing about health topics next week. In the meantime please pray for me – I am praying for you! If you have a specific intention you’d like me to pray for, please drop me an email ❤️

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Low Carbohydrate Diets And Health

Confession time. I tried Atkins in the ’90s to try to lose that stubborn 10 pounds that clung to me like stink on a skunk. I dutifully checked my urine every day to see if the magical ketones were present. Unfortunately I found that unless I ate nothing but meat and cheese those ketones kept disappearing. Unable to exercise due to profound fatigue, I eventually gave it up. The few pounds that I did manage to lose came right back, and brought along friends. My experiment with low-carbohydrate diets was a miserable failure.

Many of my patients proudly tell me that they are eating “low carb” to lose weight. A research study was recently published that looks at the evidence regarding the health effects of low-carbohydrate diets.

Credit: GreatLakesLedger.com

It doesn’t matter if it is called “keto,” Atkins, South Beach, or Paleo. Proponents of low-carbohydrate diets all insist that carbohydrates are the cause of overweight and obesity and must be avoided. The original ketogenic diet was developed to treat intractable seizures in children and did have some success. However, low-carbohydrate diets today are almost exclusively used for weight loss. A survey of over 1000 adults conducted in 2018 found that 16% reported eating some sort of low-carb diet in the previous year.

Are low-carbohydrate diets better than diets (low-fat, calorie-controlled, DASH, Mediterranean, etc) that don’t restrict carbohydrate intake? It seems that, in the short term, they do promote more weight loss while suppressing appetite. They also do increase insulin sensitivity and decrease blood sugar levels in diabetics.

However, low-carb diets are notoriously difficult to maintain. It is just really hard to avoid fruits, root vegetables and whole grains for long periods of time. Once a person starts adding back carbohydrates, it is a slippery slope and the weight typically starts coming back, with interest.

Scientists have not done long-term studies on those who eat a low-carb diet. We don’t know if they are less likely to have a heart attack, cancer, diabetes or other lifestyle-related illness. Low-carb diets are associated with higher levels of LDL (“bad”) cholesterol. And after a year or more, those who eat low-carb haven’t lost more weight than those who use other diets.

A healthy diet is pretty simple, but it isn’t easy. Plenty of whole fresh fruits and veggies. Green leafy vegetables, nuts, seeds and beans. Small amounts of lean meats and lowfat dairy, if any. Fatty fish several times per week. Water, water, water. Avoid processed foods and artificial food ingredients when possible. Carbohydrates-good fat-protein macros in a 50-30-20 ratio for most people. If you’re not sure what your macro ratios are, you can track for a few days at MyFitnessPal.com (not an affiliate, just a happy user of the app).

Low carbohydrate diets sound like an attractive way to lose weight rapidly. But they are hard to maintain and result in yo-yo dieting. They are not more effective for long-term weight loss than other diets. And they haven’t been shown to create long-term health.

QUESTION: Have you tried a low-carbohydrate diet? What was your experience?

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Vape Lung And E-Cigarette Use

It always sucks to see a young, healthy person die. Car accidents, homicide, suicide, overdose. There are so many dangers out there! What we don’t expect a young healthy person to die from is a sudden, severe lung illness that strikes out of the blue.

Well, six people in the US have died of this sudden severe lung illness over the last few months. The CDC has received 380 reports of so-called “vape lung” over the last several months. All the patients had a history of using e-cigarettes, most had used e-cigarettes that deliver THC, many used products that deliver both THC and nicotine, and some had used only nicotine products.

There is no evidence of infection in these patients. Right now researchers believe it is a direct toxic effect of inhaling the vape liquid on the lung tissue. Many theories are being discussed about which chemicals might be responsible, but the answers aren’t clear yet.

vaping, e-cigarette
Credit: theverge.com

What symptoms should people watch out for? If you use e-cigarettes or other vape products and get sick, these symptoms mean you should see the doctor to make sure you don’t have Vape Lung:

  • Respiratory symptoms like cough, chest pain and shortness of breath
  • Systemic (whole-body) symptoms like fever, chills, fatigue and a high heart rate
  • Gastrointestinal symptoms like abdominal pain, nausea, vomiting and diarrhea
  • Abnormal findings on chest Xray and chest CT scan.

Please consider stopping using e-cigarettes if you already use them. Ask your doctor for help, the same treatments that help with cigarette smoking cessation help with giving up e-cigarettes. They have NOT been proven safer than cigarettes.

The most important measure, though, is not to start using e-cigarettes in the first place. It is scary to realize how many tweens and teens use e-cigarettes: over 5700 kids start vaping every day! You have to talk to your kids about this. If you need help starting the conversation, the American Lung Association has resources to help.

Vape lung is real. Vaping is not safe. It is not a good way to try to stop smoking cigarettes. Vape products are marketed to children, easy to get, and easy to hide. It is important to protect yourself and your family from these dangerous products.

QUESTION: Have you heard of vape lung? Have you tried vaping?

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Depression In Pregnancy

Childbirth and the newborn period is supposed to be a joyful time. It’s stressful and overwhelming and sleep is hard to come by, but new moms are increasingly struggling with one more hurdle to enjoying time with their newborn. Depression.

depression, sad pregnant woman
Credit: profmed.co.za

About 25% of women in the United States will have depression bad enough to require treatment at some time in their life. Sadness, feeling that life isn’t worth living, not enjoying things that used to bring you joy, lack of motivation, trouble sleeping, and unusual fatigue are all symptoms of depression. What happens when a woman suffers depression in pregnancy?

An article published recently in Obstetrics & Gynecology looked at rates of depression diagnoses in women hospitalized for childbirth. The authors found that rates of depression increased from 0.41% in 2000 to 2.87% in 2015. That’s a seven-fold increase.

This study wasn’t designed to discover why diagnosis rates went up. It’s possible awareness is increasing so more patients are getting diagnosed, when the rates of illness aren’t actually rising. We do know that depression in pregnancy has serious consequences for both mom and baby, so more accurate diagnosis is important.

There are many possible triggers for depression, in pregnancy and at other times. Family history, stress, complications with the pregnancy or previous pregnancy loss, history of abuse or trauma, and relationship problems can all lead to depression.

Depression in pregnancy can have health consequences for both mom and baby. Poor nutrition, lack of exercise, alcohol and other drug abuse, smoking, poor sleep and social isolation can all stem from depression. Not taking good care of oneself during pregnancy (which includes withdrawing from loved ones who can help provide support) can lead to less robust health once the baby arrives.

Poor nutrition, substance abuse (including smoking) and social isolation can increase the risk of premature birth, low birth weight, bonding problems, and abuse/neglect of the baby once born.

If a pregnant women is feeling sad from time to time, usually all that is needed is to talk about her feelings honestly with her mate or a close friend or other family member. Symptoms that are severe enough to keep her from enjoying life, that last longer than 2 weeks or so, should be discussed with her obstetrician or family doctor.

Treatment can start with some dietary and nutrition changes and talk therapy with a trained counselor. If symptoms are bad enough, medication can definitely be prescribed to help with the mood. Remember, although no medication is perfectly safe in pregnancy (or at any other time, really), the risks of depression in pregnancy can be significant.

Pregnancy, while confusing, overwhelming and sometimes uncomfortable, doesn’t have to be as big a struggle as it is with depression. If you or a woman you know is struggling with depression in pregnancy, please make sure to discuss your symptoms with your doctor.

QUESTION: Have you or someone you know suffered with depression while pregnant? What helped?

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