.
We all know the grim statistics. The four most common causes of death in the US in the last few years have been heart attacks, cancer, stroke and chronic lung disease, accounting for almost two thirds of all deaths, or close to two million deaths last year. Health care expenditure in the US is now over 2.2 trillion dollars a year, approximately $7,400 per person in 2007. The cost is now over 16% of our gross national product, and is expected to rise to 20% within 10 years. The out of pocket cost to you in the form of co-pays, deductibles and non-covered services is also increasing dramatically, from an average of $850 per person 3 years ago to an estimated $1,400 in less than ten years. And in comparison with other industrialized countries, we are losing our edge and are actually lagging by many measurements of health care, such as longevity and infant mortality.
What does all of this mean to you, the health care consumer? As you’ll see, you’ll have to actively participate in your own health care.
Sunday, November 29, 2009
Tuesday, November 10, 2009
Better sleep, better golf
.
Are you a golfer, and do you have sleep apnea?
If so, the news is quite encouraging. In a study presented at the 2009 annual meeting of CHEST in San Diego, it was shown that patients with sleep apnea who were treated with a continuous positive pressure device during sleep (a common treatment for sleep apnea), improved their golf scores significantly after several months of treatment.
This study only confirms what we already know about sleep, lack of sleep, and sleep apnea: Better quality sleep improves performance.
So, if you (or someone who observed you while you sleep) think that you have sleep apnea, be proactive, take the next logical step and seek medical advice.
Are you a golfer, and do you have sleep apnea?
If so, the news is quite encouraging. In a study presented at the 2009 annual meeting of CHEST in San Diego, it was shown that patients with sleep apnea who were treated with a continuous positive pressure device during sleep (a common treatment for sleep apnea), improved their golf scores significantly after several months of treatment.
This study only confirms what we already know about sleep, lack of sleep, and sleep apnea: Better quality sleep improves performance.
So, if you (or someone who observed you while you sleep) think that you have sleep apnea, be proactive, take the next logical step and seek medical advice.
Sunday, November 1, 2009
Exercise prevents diabetes
.
We have known for many years that regular exercise (cardio, plus weights, plus stretching, for 20 minutes or more each session, most days of the week) helps a great deal in the control of diabetes.
Also, we've been saying for over ten years, that vigorous exercise plus dietary discretion can delay the onset of diabetes for an indefinite period for many individuals.
An October 29, 2009 article in The Lancet reports a study (Diabetes Prevention Program, DPP) done on patients at high risk for the development of diabetes. The study concludes that an intensive lifestyle prevention program can prevent or delay the onset of diabetes for at least 10 years.
This really validates much of our thinking about the development of diabetes.
Imagine, another 10 years free of diabetes with lifestyle changes and no medications!
And imagine the cost saving to you and to the health care system.
So what are you doing it? and if not, what are you waiting for?
We have known for many years that regular exercise (cardio, plus weights, plus stretching, for 20 minutes or more each session, most days of the week) helps a great deal in the control of diabetes.
Also, we've been saying for over ten years, that vigorous exercise plus dietary discretion can delay the onset of diabetes for an indefinite period for many individuals.
An October 29, 2009 article in The Lancet reports a study (Diabetes Prevention Program, DPP) done on patients at high risk for the development of diabetes. The study concludes that an intensive lifestyle prevention program can prevent or delay the onset of diabetes for at least 10 years.
This really validates much of our thinking about the development of diabetes.
Imagine, another 10 years free of diabetes with lifestyle changes and no medications!
And imagine the cost saving to you and to the health care system.
So what are you doing it? and if not, what are you waiting for?
Monday, October 26, 2009
How important is Apo B?
.
Most of us realize how important it is to control your cholesterol level, especially if you have additional risks for the development of heart disease. Of course, it’s not necessarily the total cholesterol that has to be controlled. Rather, it is cholesterol’s most important components, the “bad cholesterol” (HDL), and “good cholesterol” (LDL). Depending upon gender and age, HDL level should be at least 40-55 mg/dl. Depending on the risk of developing a future heart attack, LDL should be kept less than 70-100 mg/dl.
HDL levels are determined primarily by genetics (blame you parents for this one). LDL levels are determined by a combination of genetics and lifestyles (eating and exercise habits). Abnormal LDL levels are much easier to control than abnormal HDL levels.
Drug therapy is aimed primarily (but not exclusively) at lowering LDL to the recommended level of 70-100 mg/dl. But is this good enough?
After many years of research, it turns out that apolipoprotein B, Apo B for short, is a much more reliable predictor than LDL of the risk of developing heart attacks, and it also provides a much better assessment of cholesterol therapy.
In abbreviated form, the reason is as follows: The risk of LDL is not expressed by the usual measurement of how much LDL is in your blood stream. Rather, it’s the number of LDL particles in a given volume of blood that determines the risk, and this depends on how large the particles are. Small particles are much more dangerous than large particles. The Apo B measurement is a fair estimate of the LDL particle number and thus a better estimate of cholesterol risk and of progress of therapy.
The use of Apo B has already been adopted in Canada, but to my knowledge has not yet been adopted by our own National Cholesterol Education Program Adult Treatment Panel III (NCEP ATPIII) or by other “guidelines makers” in the US.
We appear to be years behind in the treatment of a condition that is the number one killer in the US! As a country that boasts of having the best medical system in the world, why have we not taken this simple step?
Many doctors, including yours truly, are already using Apo B as a guide. But in recent weeks I have gotten numerous complaints from patients who have received bills from their labs because insurance companies (mainly HMO’s and alike) stopped paying for the Apo B lab test. This is absurd.
Both patients and physicians must fight this non-payment trend. The physicians must fight it because this trend impedes their duty and ability to treat effectively, and the public must fight it because this trend will yield suboptimal medical outcomes.
Let your political representatives know that you care and want to change.
Most of us realize how important it is to control your cholesterol level, especially if you have additional risks for the development of heart disease. Of course, it’s not necessarily the total cholesterol that has to be controlled. Rather, it is cholesterol’s most important components, the “bad cholesterol” (HDL), and “good cholesterol” (LDL). Depending upon gender and age, HDL level should be at least 40-55 mg/dl. Depending on the risk of developing a future heart attack, LDL should be kept less than 70-100 mg/dl.
HDL levels are determined primarily by genetics (blame you parents for this one). LDL levels are determined by a combination of genetics and lifestyles (eating and exercise habits). Abnormal LDL levels are much easier to control than abnormal HDL levels.
Drug therapy is aimed primarily (but not exclusively) at lowering LDL to the recommended level of 70-100 mg/dl. But is this good enough?
After many years of research, it turns out that apolipoprotein B, Apo B for short, is a much more reliable predictor than LDL of the risk of developing heart attacks, and it also provides a much better assessment of cholesterol therapy.
In abbreviated form, the reason is as follows: The risk of LDL is not expressed by the usual measurement of how much LDL is in your blood stream. Rather, it’s the number of LDL particles in a given volume of blood that determines the risk, and this depends on how large the particles are. Small particles are much more dangerous than large particles. The Apo B measurement is a fair estimate of the LDL particle number and thus a better estimate of cholesterol risk and of progress of therapy.
The use of Apo B has already been adopted in Canada, but to my knowledge has not yet been adopted by our own National Cholesterol Education Program Adult Treatment Panel III (NCEP ATPIII) or by other “guidelines makers” in the US.
We appear to be years behind in the treatment of a condition that is the number one killer in the US! As a country that boasts of having the best medical system in the world, why have we not taken this simple step?
Many doctors, including yours truly, are already using Apo B as a guide. But in recent weeks I have gotten numerous complaints from patients who have received bills from their labs because insurance companies (mainly HMO’s and alike) stopped paying for the Apo B lab test. This is absurd.
Both patients and physicians must fight this non-payment trend. The physicians must fight it because this trend impedes their duty and ability to treat effectively, and the public must fight it because this trend will yield suboptimal medical outcomes.
Let your political representatives know that you care and want to change.
Sunday, October 18, 2009
Sleep apnea, do you have it?
.
More than 18 million Americans have sleep apnea, and almost everyone knows someone who has it. Many cases go undiagnosed for years. But what is sleep apnea, how do you make the diagnosis, and how is it treated?
There are three basic types of sleep apnea: Obstructive Sleep Apnea (OSA), which accounts for most cases, Central Sleep Apnea (CSA), and a mixture of the two. Here, only OSA will be addressed.
Sleep apnea was first described in medical literature in 1965, as a breathing disorder characterized by numerous brief interruptions of breathing during sleep. But don’t be misled; it’s been described quite accurately by Charles Dickens in his Pickwick Papers in 1837-1938, when he portrayed Joe as the fat, red faced boy who was repeatedly falling asleep during the day.
Sleep apnea is defined as the presence of more than 30 episodes of apnea (cessation of breathing), each lasting more than 10 seconds. In severe cases, apnea periods may last longer than 60 seconds, and may recur hundreds of times a night. Obstructive Sleep Apnea occurs mostly in the obese person, typically with a short neck. It may occur in persons who have abnormalities in the nose and throat, such as enlarged tonsils, polyps or excess adenoid tissue, which obstruct the flow of air while asleep. Most OSA patients are heavy snorers. During an apnea episode snoring stops, then breathing resumes with a typical “snort.” While sleeping, the tongue and throat muscles relax causing airway blockage. When the apnea period ends, these muscles tighten up temporarily, allowing breathing again until the next episode.
Full blown OSA leads to irritability and lack of concentration; learning and memory difficulties; sexual dysfunction, and the development of high blood pressure, headaches, irregular heart beats, premature heart attacks and sudden death. In sleep apnea there is a major disturbance of the sleep cycle. Sleep quality is poor, and in reality you are sleep deprived. As a result, you may fall asleep irresistibly during the day, even while driving. You may not realize that you fell asleep during the day while in a meeting or at lunch; but your friends notice it, and will hopefully tell you about it.
While you may strongly suspect sleep apnea, the definitive diagnosis is made in a sleep laboratory, where the severity of the disorder can be quantified, and treatment suggested.
Treatment is individualized, usually consisting of a pressurized face mask at night to allow better airflow and to minimize the number and severity of apnea episodes. Surgery to remove excess tissue in the throat is occasionally recommended. Alcohol and caffeinated beverages have to be kept to a minimum, and sleeping medications must be avoided.
Most importantly, the long term therapy of Obstructive Sleep Apnea must include weight management. Reducing weight to normal or near normal range frequently eliminates the sleep apnea altogether, allowing you to return to normal life.
If you suspect that you have sleep apnea, have it formally diagnosed and, above all, take care of your health, no one will do it for you...
More than 18 million Americans have sleep apnea, and almost everyone knows someone who has it. Many cases go undiagnosed for years. But what is sleep apnea, how do you make the diagnosis, and how is it treated?
There are three basic types of sleep apnea: Obstructive Sleep Apnea (OSA), which accounts for most cases, Central Sleep Apnea (CSA), and a mixture of the two. Here, only OSA will be addressed.
Sleep apnea was first described in medical literature in 1965, as a breathing disorder characterized by numerous brief interruptions of breathing during sleep. But don’t be misled; it’s been described quite accurately by Charles Dickens in his Pickwick Papers in 1837-1938, when he portrayed Joe as the fat, red faced boy who was repeatedly falling asleep during the day.
Sleep apnea is defined as the presence of more than 30 episodes of apnea (cessation of breathing), each lasting more than 10 seconds. In severe cases, apnea periods may last longer than 60 seconds, and may recur hundreds of times a night. Obstructive Sleep Apnea occurs mostly in the obese person, typically with a short neck. It may occur in persons who have abnormalities in the nose and throat, such as enlarged tonsils, polyps or excess adenoid tissue, which obstruct the flow of air while asleep. Most OSA patients are heavy snorers. During an apnea episode snoring stops, then breathing resumes with a typical “snort.” While sleeping, the tongue and throat muscles relax causing airway blockage. When the apnea period ends, these muscles tighten up temporarily, allowing breathing again until the next episode.
Full blown OSA leads to irritability and lack of concentration; learning and memory difficulties; sexual dysfunction, and the development of high blood pressure, headaches, irregular heart beats, premature heart attacks and sudden death. In sleep apnea there is a major disturbance of the sleep cycle. Sleep quality is poor, and in reality you are sleep deprived. As a result, you may fall asleep irresistibly during the day, even while driving. You may not realize that you fell asleep during the day while in a meeting or at lunch; but your friends notice it, and will hopefully tell you about it.
While you may strongly suspect sleep apnea, the definitive diagnosis is made in a sleep laboratory, where the severity of the disorder can be quantified, and treatment suggested.
Treatment is individualized, usually consisting of a pressurized face mask at night to allow better airflow and to minimize the number and severity of apnea episodes. Surgery to remove excess tissue in the throat is occasionally recommended. Alcohol and caffeinated beverages have to be kept to a minimum, and sleeping medications must be avoided.
Most importantly, the long term therapy of Obstructive Sleep Apnea must include weight management. Reducing weight to normal or near normal range frequently eliminates the sleep apnea altogether, allowing you to return to normal life.
If you suspect that you have sleep apnea, have it formally diagnosed and, above all, take care of your health, no one will do it for you...
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