Smoking, lung cancer, and early detection

Smoking is the number one primary cause of premature death in the US (did you know that the obesity-sedentary lifestyle is number two?)

Many pulmonary physicians, including myself, argued for many years that periodic x-rays of the lungs in heavy smokers could save lives. Several years ago a study showed that doing chest CT scans in heavy smokers leads to early detection and possibly a better cure rate. All this was met with harsh criticism from many professional organizations (I wonder why).

But what the pulmonary specialists knew for quite a few years was finally shown to be true in the June 29 edition of the New England Journal of Medicine. The use of low radiation, periodic CT scans of the lungs in heavy smokers led to early cancer detection, and thereby saved many lives. This is not the total answer to lung cancer, but it certainly helps.

So, if you are a heavy smoker and have not discussed the cancer risk issue with your physician, do it now. If your insurance company doesn't cover this screening test, I know several radiology practices that will do it for $300, and it's well worth it.

Suboxone treatment resources

If, for whatever reason, you have developed an opiate dependency problem, this may be an excellent time for you to quit. Suboxone is gaining popularity as a medical, office-based opioid dependency treatment program.

Fewer than 3% of US physicians are certified to prescribe Suboxone. Most of those certified are psychiatrists. In our area, very few internists, like myself, are Suboxone-certified.

You can find Suboxone-certified physicians at http://www.suboxone.com/, and you can try to match up with one by email at http://www.treatmentmatch.org/local/.

For additional information you may want to watch my interview of the weekend of 11/5/2011, Cablevision channel 12.

On a personal note...

Getting the garden ready for the Fall and Winter. Have you ever seen a Marigold this tall (or a doctor this short)?

Suboxone treatment for opioid dependence

Opioids are prescribed in the US mainly for pain control. This includes medications like Codeine, Percocet, Vicodin, Oxycodone, Dilaudid, and many other branded and generic drugs. Chronic use of these medications, even when used appropriately, can lead to opioid dependence.

Opioid dependence is characterized by "an individual's inability to stop using the opioid despite the fact that stopping its use would be in his/her best interest." Criteria for the actual  diagnosis of opioid dependence have been developed by the World Health Organization, and are widely used by physicians in office practice.

The complications of long term opioid use are numerous and, besides physical dependence and addiction, include liver dysfunction, constipation, nausea, respiratory depression, and many more.

Opioid dependence can lead to opioid abuse, a much more dangerous condition with many medical and legal adverse outcomes.   

    

What do you do when it's time to get off the opioid pain medication, and you can't do it because of drug dependence?

The newest trend is to use Suboxone. Suboxone is a two-component medication which contains buprenorphine (itself an opioid) and naloxone. It works primarily by preventing withdrawal symptoms and controlling the craving for the opioid medication. It allows you to remain active in daily life activities such as work and family functions. The medication is taken daily, and comes in a wafer form which dissolves rapidly under the tongue.

Physicians have to go through specific training to become certified in the administration of Suboxone.

I am now certified to prescribe Suboxone. The advantage of having an Internist manage Suboxone therapy is that general medical issues and opioid dependence issues can now be treated in the same office setting in an integrated manner.

Feel free to share this information with those who may need help. If you need more information, please give us a call.

Prostate cancer testing, my view

Also appeared in the Westport News, 10/12/2011 - Letter to the editor.

The several-day old report by he U.S. Preventive Services Task Force Healthy men don’t need PSA testing for prostate cancer, sparked enormous controversy in professional and lay circles. I will not go through the back and forth arguments, which are described in detail in major newspapers like the New York Times and the Washington Post, but just give additional food for thought.

There is no question that with PSA testing, many more prostate cancers are diagnosed now and the number will increase as time goes on, and as newer techniques for screening become available.

There is also no question that in many cases, men are treated for prostate cancer when, at least in retrospect, they shouldn’t have been treated. Maybe because they did, or would have, died of other causes, or because the complications were worse than the disease.

It may be true that, overall, PSA testing does not presently lead to increased survival. Some men treated for prostate cancer definitely increase their life span. Others may not, or may even have complications that will shorten their lives.

But, in my opinion, these are not good enough reasons to stop screening men for prostate cancer. Not testing only decreases the amount of information we have, which creates ignorance, not knowledge. And this type of ignorance is not a solution to the question of how to treat prostate cancer, or any other cancer. More than 28,000 men die each year of prostate cancer, and literally ignoring the problem will not solve it.

The issue is that men have the right, and perhaps the obligation, to know if they harbor the cancer. And it is the responsibility of the medical profession to refine its techniques so that Medicine can better identify which patient has a better change to benefit from prostate cancer treatment and who may be hurt by it. As these techniques are refined, prostate cancer survival will increase, just as survival from many other types of cancer is increasing.

I feel that the Task Force report was seriously flawed, and I suspect was motivated by reasons other that good medical decision-making.

On a personal note: my prostate cancer was diagnosed over 5 years ago on the basis of a rise in my PSA, which was still considered normal. On the basis of the post-op pathology report, I know that, had I not had the surgery done at that time, I would have been in big trouble today.

Do you have diabetes? Five thing you must do!

The five must do lifestyle changes that will help you stay out of trouble if you have diabetes, or if you are at risk for the development of diabetes, are:

·        Follow a healthy diet

·        Maintain an optimal body weight (Body Mass Index not higher than 25)

·        Engage in recommended amounts of physical activity

·        Don't smoke (don't even think about it)

·        Keep alcohol use to no more than 1 drink a day for women, and 2 drinks a day for men.

According to data released earlier this year by American Diabetes Association, diabetes was the seventh leading cause of death in the US in 2007. Last year it was the sixth. In reality, the number is much, much higher, because diabetes is a major contributor to heart disease and stroke.

The economic burden to individuals and the country as a whole is enormous. Costs attributable to diabetes in 2007 were $116 billion in direct medical costs and $58 billion in disability, work loss and premature mortality. Again, this does not account for the contribution of diabetes to the cost of heart disease and stroke.

Overall, the risk for death among people with diabetes is about twice that of people of similar age but without diabetes.

All of these numbers are undoubtedly underestimates. Many case of diabetes continue to be undiagnosed.

Need help? We're here

Chronic Pain

Pain is now the most common reason why patients seek medical care. Data compiled by the CDC shows that in 2007, analgesics, as a group, was the number one prescribed category of medications in the US, approximately 13% of all prescriptions. The number is most likely higher now.

Pain can be either acute or chronic. Acute pain is the one you get with injury, such as a motor vehicle accident, moving furniture, or playing sports. Chronic pain is sometimes harder to define. Some authorities define chronic pain as pain that persists, despite attempts to cure it, for six months. Others call the pain chronic after 3 months. It appears that the best definition for chronic pain is pain that persists for a period longer than is medically expected for it to resolve.

Coupons for medications

We are keeping your out of pocket costs in mind!

Did you know that we have a large collection of money-saving coupons for your brand name prescription medications?

Click here to see the list, and check it periodically. It will be expanded and updated regularly.

If you are already taking coupon-bearing medications, all you have to do is drop by the office and pick up the coupon(s). Otherwise, discuss the possibility of switching to a coupon-bearing medication at your next visit.

In addition, our office has the lists of generic medications that are available at major pharmacies at large discounts (e.g. $10 for a three month supply), and antibiotics dispensed absolutely free of charge. Don't hesitate to ask at your next visit.

Weight and antidepressants – what's the connection?

Depression in the US is widespread, increasing gradually since WWII. More than 30 million Americans are thought to have depression, with two thirds of them women. Not surprising in the age of an economic crisis.

Many Americans with depression are now taking antidepressant medication, such as Celexa, Prozac, Wellbutrin or Elavil, to name a few.

Obesity in the US is even more widespread, with 70% of adults classified as overweight, and half of them classified as medically obese. The harmful consequences of obesity are well known; no need to repeat them here.

Does the use of antidepressants affect your weight? For many, this is a valid health question. For others, especially women (but not limited to women), it's also a social issue, a body-image issue, and many times a reason for refusing to use medically-necessary antidepressant medication.

Many patients on antidepressants gain weight. Is it a direct effect of the antidepressant, or is it that some patients begin to enjoy life more, and "celebrate" it with more eating.

Others lose weight. Is this a direct effect of the medication, or is it that these patients can now better deal with the realities of life and better control their eating habits and exercise?

Chronic cough

Cough is common, and can linger, during the allergy season. But does cough equal allergy? Most commonly it doesn't.

A cough can be an annoying, embarrassing symptom, or an important clue leading to rapid diagnosis and effective treatment. It is one of the most common reasons to see a lung specialist, accounting for more than one third of new patient visits in our practice. There is an abundance of confusing medical literature available, most of it on the internet; a recent search found more than 300 articles related to chronic cough published so far this year, and that's only the tip of the iceberg.

Get what's important from your doctor visit

Part of my article in EzineArticles.

The most important thing you should get out of your appointment with the doctor is an adequate explanation to the problem which prompted your visit.

Write down your questions in the order that you feel is the most important. Write down, or ask your doctor to write down, the answers to your questions, including instructions for the use of prescription and over the counter medications, medical devices, and lifestyle changes. If there isn't enough time to have all of your questions answered, then you will have had the most important ones addressed, and could save the rest for the next visit.

Do you have COPD?

If you develop shortness of breath faster than you should, you cough frequently, and are also a smoker, you may indeed have Chronic Obstructive Pulmonary (Lung) Disease, or COPD. The term COPD refers mainly to chronic bronchitis and pulmonary emphysema. More than 80% of COPD is caused by cigarette smoking, with the remainder caused by genetic factors (alpha 1-antitrypsin deficiency), industrial exposure (e.g., coal mining) and questionably air pollution.

COPD is a progressive disease, responsible for an enormous strain on the national healthcare budget, on the work place, and on one's personal well being. More than 12 million Americans are now known to have COPD, and many more have the "hidden" disease. COPD is the fifth leading cause of mortality in the US, and its economic burden is even higher.

The sooner COPD is diagnosed and treated, the better it is. Lives can be saved, jobs can be spared, and extra medical expenses avoided.

So, if you have shortness of breath, smoker or not, make sure COPD is not a factor. Don't delay, see your doctor, you won't regret it!

Think twice before indulging…

Are you planning to exercise away the extra calories of your next meal? Think again.

A typical McDonald double cheeseburger has approximately 440 calories. Add large French fries at 500 calories and you're at more than 900 calories (we won't count the soda because I know you chose the zero calorie one…).

If you weigh about 155 lbs (what used to be the typical adult male weight in the US), and you like to walk, you'll burn 76 calories for each mile.

So the meal you just had would cost you an 11.8 mile walk. No problem, it's still less than a half-marathon distance.

Incidentally, if you were to stop by the Cheese Factory for a cheese cake portion, that will only cost you an additional 9 miles.

Of course, you could do the un-American thing, and have a good portion of no-skin chicken and salad (you can even have a little oil and balsamic vinegar dressing) plus fruit, at less than 400 calories for the meal. Still hungry? Have an apple plus another fruit later.

Do the right thing, your body will thank you for it.

Control your calorie intake

What you see here is just a small sample of what's now available at our Health Extenders practice as part of our newly designed weight loss program. For more information, you may contact us by email. If you live in our area (Fairfield County, CT) and want to have a comprehensive evaluation of your weight loss needs, contact us by phone at (203) 853-1919.

This will help you lose weight and remain thinner

Many of you have been aware of our weight loss programs at our practice for years. At home, Sandy and I find it helpful to control our breakfast calorie intake by using HMR shakes. We prefer the HMR 70 vanilla mix. Try it if you wish. This is how we use it:

1 packet of HMR 70 vanilla mix
1 glass filled ½ with crushed ice & ½ with water
1 tsp Hershey’s powdered cocoa (sugar-free)
Place HMR packet in bottom of blender.
Then add ice, water and cocoa and blend.

Optional additions:
½ banana or,
½ cup berries
extracts (calorie free)

Add to partially-blended shake and blend again for an additional minute.

Enjoy!

Calories:
HMR 70 110 calories
Banana/berries 50 calories (approx)
Hersheys cocoa 5 calories

Total 165 calories (approx)

You may use 1 ½ to 2 packets of HMR, but remember to count your calories. You may experiment with other fruits and extracts to create a special shake for yourself.

Share your experience with us. Selected recipes will be published with full credits (and 6 free packets of the mix with your next order of HMR shakes).

Weight loss 2011 – How we handle it at our practice

So you decided to lose weight, but you're not sure you're doing it the right way?

Know that you are not alone. More than two thirds of adult Americans need to lose weight. Of these, more than half are severely overweight (BMI, body mass index, greater than 30; normal is 20-25), and are at significant medical risk. A major reason why Americans don't live as long as they should is obesity.

Here is some of what we do to help:

• Evaluate your need for weight loss
• Assess reasons why you're having difficulty in losing weight
• Make sure there is no medical abnormality responsible for your increased weight
• Measure (not guess) your metabolic rate, and calculate your daily calorie requirement
• Design a diet-exercise program that meets your specific requirements, taking into account any medical condition thou may have
• Assess your ability to do exercise and prescribe an exercise/physical activity program (and you don't have to be an athlete to do it…)
• Identify and reduce overeating triggers
• Provide calorie-specific meal replacements and snacks
• Prescribe medication to control appetite, where applicable

Don't try to lose weight too fast. One-to-two pounds a week is good.
Don't wait, just do it!