Archive for May, 2007

SALT USE AND CARDIOVASCULAR DISEASE AND HYPERTENSION

Monday, May 28th, 2007

Stroke and other cardiovascular diseases are linked closely to high blood pressure.  In many studies, hypertension is a strong predictor of these severe problems, including stroke (brain attack), congestive heart failure, and even myocardial infarction (heart attack).

The importance of salt intake (sodium chloride) with regard to high blood pressure is well linked.  Most of these studies have been a type of case control showing high probable causal relationship.  Some other studies have shown that higher salt intake predicted the higher incidence of cardiovascular diseases over time.

But a recent published and peer reviewed study, with randomized NON-hypertensive persons, about 3000 of them, has put a strong lock on this issue.  In the study, persons were given about 2.6 gms or 2.0 gms of salt daily.   Another group of placebo was a control also.  The groups were followed out to 18 months or 36-48 months. Then all the groups (cohorts) were followed over the next 10-15 years!

There was a remarkable 30% (approximate) lower incidence of cardiovascular events during this period.  This finding was controlled for age, body mass, sex, ethnic origin, and initial blood pressure – when compared to the placebo group. 

We have long known this concern of salt and high blood pressure and other cardiovascular diseases.  Even back in about 1985, the World Health Organization recommended the salt intake to be reduced to about 5 grams per day. 

In "Westernized" countries, bread and processed foods account for the great majority of salts in the diet, with personal use being about 15-20 %.  In many developing countries however, the personal use is the burden of salt.  Some countries have tried to "legislate" salt reduction, however most of the time, this effort turns to "voluntary" agreement programs with good intent, rather than hard legislation.  More efforts of education and the reason for limiting salt intake should be forwarded by all the main agencies such as the American Heart Association (AHA), the American Diabetes Association (ADA), and others that take the lead to limit cardiovascular disease, morbidity, and mortality.

So think about it.  Should we legislate the prepared foods, soda and beer, snack, eat 'n run, cafe, restaurant, and bar industries to limit the salt in their products?  Dear ol' Mom probably had it right when she said, "Not so much salt!" 

So next time you pick up the product, do a salt survey.  Remember less that five grams a day is highly recommended, while 2 grams a day really makes a difference in your actual risk.  The debate appears to be over.  Salt can take a toll.  Be a wise shopper and a wiser eater. 

Salty popcorn with butter anyone?  Remember, more fiber, less salt, less trans-fats….Yuk!

DROWNING AND WATER SAFETY – DO IT RIGHT

Saturday, May 19th, 2007

JUNEAU, Alaska (May 14, 2007)–Passengers from the Cruise Ship Empress of the North being offloaded onto the Coast Guard Cutter Liberty and civilian vessels after running aground at aproximately 2:00 a.m. here today. The Liberty took on 130 of the 248 passengers before offloading them onto the Alaska State Ferry Columbia, which will transport them back to the city of Juneau. (Official Coast Guard photo by Petty Officer Chris Caskey)  (from Coast Guard website)

 

Did you know that most drownings happen just a few feet from safety!  Many data sets show that as high as 90 % of all drownings are close to safety, in one form or another. 

Often, the victims of drownings are not only close to safety, but have personal safety devices close or have personal flotation devices.  But…the victims are not using them or wearing them.

Each boating season, the personal flotation devices should be checked for leaks, tears, rips, cuts, and general wear and tear.  They should be replaced.

Each season, your kids also change…bigger, taller, heavier, the kids need to be sized for proper fit and make sure the PFD fits each child snuggly and properly.   Do this in shallow water to practice.  Have the child put the PFD on, tilt his head back, and see that the water stays below the chin level.  The mouth must be well above the water level if the device is used in turbulent waters or waves.  Therefore proper weight and age sizing is very important.

It is a fun family event to practice throwing a type 4 (IV) flotation device.  Important techniques typically come with the device.  This few minutes may save a life.

Local and national groups say alcohol is the biggest common thread of up to 75-80 % of boating accidents.   Always monitor the skipper of any craft if she or he has been drinking.  Best rule is do not drink and captain the boating craft.

 

 

The types of PFDs include:  

Type I – the offshore, rough water type

Type II – the near shore, calmer waters type 

Type III -  called a flotation aid, wearable, and quick rescue most likely

Type IV – is the throwable device

 

HAVE A SAFE BOATING SEASON.  KNOW YOUR PASSENGERS.  KNOW YOUR VESSEL.

Mature Older 55+ Crowd and the Internet

Monday, May 7th, 2007

Saw a recent article in a magazine on the over 55 crowd.  Besides still listening to crooners, rock n' roll, and elvis (sightings often), the crowd is internet savvy.  In the game category, over 55 in the slotsites are 2/3 of the internet seekers.  Surprisingly, obituaries at one site are logged onto by the over 55 about the same amount of time.  Puzzles, investments, genealogy all run about half of the logged on are in the over 55 crowd. 

This is opposed to the 25-35 crowd that find the parenting sites, over 55 %, while family issues, shopping are frequented in the mid forty percents.  News, sports, and other items run in the 30s percent on those type of websites.

So, if you are in the over 50 crowd, now you know where your colleagues are and your kids!   Wink

DVT – DEEP VEIN THROMBOSIS – POTENTIAL SILENT KILLER – planes, trains, and surgeries

Friday, May 4th, 2007

YEARS AGO, MY FATHER RETURNED AFTER SEEING MY GRANDFATHER,  FROM THE SMALL HOSPITAL IN THE LITTLE TOWN IN MIN-NEE-SOOO-TAH.

My grandfather had been in the hospital after a minor surgery.  Remember years ago, even small procedures were done in the hospital by the general practitioners or early surgeons and patients were held in the hospital for days.  Just shortly after my father returned from seeing his father, our telephone rang.  I remember seeing his face change and his voice quiver slightly.  But dad was a strong man.  He said to all of us, a big family, and my mother, that grandpa had "some trouble" and that he needed to go to the hospital right away.  Only, not just dad went, but mom went hurriedly along also.  Grandpa died that few moments between my dad seeing him, and returning home, about 5-10 minutes.  Grandpa died of a pulmonary embolism, a clot in the lungs that travelled from his leg, after that small procedure.  Certainly a sudden and quick death, a reality that still exists these days.

Deep vein clot (thrombosis) is a relatively common, and a very serious potential disease.  We see those patients in the emergency room, immediate care, and certainly worry about many more.  The mortality and further injury (morbidity) from clots in the legs is not in the leg!  The risk occurs from associated lung clots (pulmonary embolism) and a rare condition of post-clot syndrom (post-thrombotic syndrome). 

There is not one specific symptom or sign that clinches the diagnosis.  The elderly have rates of DVTs in the 200/100,000 range while younger people have rates of about 50 per 100K.  The clots occur in the higher deep veins of the legs, or from extension of clots in the lower legs – even though this risk is lesser.  When clots in the lower leg veins extend, the risk of lung clots goes up.  The problem with DVTs creating the lung clot (PE) is that symptoms can range from sudden death to minimal at all symptoms.

In a doctor I knew, his clot formed during a long airplane ride and he lived.  In my grandpa's case as told by my father, it was sudden death.

Risks for developing DVTs in the leg veins are:

conditions:  cancer, pregnancy, blood disorders, kidney disorders, estrogens, and smoking

stagnant movement:  surgery, immobility, paralysis, obesity, extended travel

other:  previous DVT or PE increases risk, and trauma increases risk.

If patients have any two or more of these, they really become at risk.  Symptoms that patients can feel or see are: swelling of the leg compared to the other side, calf swelling, localized tenderness of the calf or leg, new pain or numbness in the leg.  There are other causes of these same symptoms, therefore you should see a doctor without hesitation.

Your doctor will most likely go through the above lists with you.  But your doctor will be concerned.  Lab tests will be drawn most likely and an ultrasound of your leg will be ordered stat.  Usually if both of these are negative, the cause is not a clot.  If the ultrasound is positive, you will begin treatment.  If the blood test is positive and the ultrasound is negative, you will probably have a repeat ultrasound in about a week.

Treatment consists of starting the pill, warfarin, for "thinning the blood."  But this takes days for the body to change.  Therefore, almost all patients will need to use injections of a heparin substance that "thins" the blood quickly.  Usually, patients will need to be on heparin medicine for 5 days or so, or at least until the pill warfarin reaches a therapeutic level in your bloodstream. 

Patients will need to use compression stockings during this time and after the event to minimize risk of recurrence of DVT.  These stockings also help prevent the post-thrombotic syndrome of pain, swelling, inflammation that can become a chronic condition. 

Risk of recurrence never goes away.  That is why proper treatment and post-event planning is so important.  Expect to be on medicine for 3-12 months after a DVT or PE.  Risk reduction knowledge goes a long way. 

TALK WITH YOUR DOCTOR ABOUT CONCERNS AND PREVENTION.  Bye

ER – CRITICAL ENCOUNTER OR DEATH IN FRONT OF YOUR EYES

Wednesday, May 2nd, 2007

After yesterday, castMD must speak out again.

The Emergency Departments are at a break point. A year or so ago, almost 3/4 of all medical directors said their ER has inadequate specialist on-call backup! There are fewer specialists in general surgery being trained, and neurosurgeons are at a standstill in training numbers. Many of the ortho, neuro, and plastic surgeons are older and not being replaced in numbers.

Yet the numbers of ER patients is exploding in numbers. Many patients are uninsured, underinsured, and have serious illnesses and injuries. ERs must see, triage, treat, and plan for each one without asking for a dime upfront. Declining reimbursement with increasing costs is a martial arts contest in the ERs. EMTALA dictates ERs must see everyone! The on-call specialist to the emergency doctors have high liability with these patients. Some specialty groups have stated one third of their groups have been sued by patients that they have responded to in the ER patient's time of greatest need.

Many ERs have closed, and more will. Many hospitals cannot continue to absorb the see all and sue all patients under the mandated-free care system. It is broken, and yesterdays marches reminded me. No one should be turned away in a critical time of health-need, but the system is critical now.

Washington State did not pass tort reform. Why work there? Why be on call to an ER that will lead the doctor to critical patients with high malpractice risk? You wonder why doctors quit being "on-call" to trial attorneys. Oh, did the drycleaners mistake settle for the 60+ million yet?