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#1 maineman

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Posted 23 May 2006 - 07:53 AM

Take a look at the CDC death stats at the end of the last thread on "vitamins". It's very telling and addresses how we "Holisitic" doctors approach the person. By looking at what causes death we can work towards prevention of preventable diseases and/or early detection of those conditions that we can treat. When going through the list, keep in mind that "feeling well" does not always mean "being well". #1 Heart Disease: due to cholesterol, high blood pressure, diabetes and smoking. What I focus on every day with patients primarily. Lower the cholesterol, treat the high blood pressure and diabetes and don't smoke. Our impact has been huge. #2. "Cancer": unfortunately all are lumped together for death stats, but they encompass very different diseases. Lung cancer due to cigarettes is the leading cause, so anything we can do to helpyou not smoke is a key part of our day. Without going into a 30 page discussion of the other cancers, suffice it to say that early detection is the key. Colon cancer (1 out of 4 over 40), prostate (annual exam), breast (annual mammogram), Cervical (annual pap smear) and the list goes on. A thorough check over by a rational doc (like me) once a year and you are way ahead of the pack. #3. Stroke: similar to #1 but treatment of High blood pressure EARLY and AGGRESSIVELY has been the factor that has nearly solved this issue. Followed by cholesterol and smoking. Excess drinking (alcohol) adds to the risk. #4. Lower respiratory: this is once again mostly due to smoking. Bronchitis, emphysema, etc. Occupational lung disease is horrible but way down on the list. #5 Accidents: Mostly motor vehicle (around half) and the list peters out from there, with not much to say about it. At my check ups I go over seatbelt safety, drunk driving, home project safety, work place safety, etc. #6. Alzheimers: We are doing such a good job of keeping people alive longer that we are seeing more senility. True Alzheimer's is an active area of research. Most "senility" however is due to the same risk factors as #1 and #3. Untreated or poorly treated blood pressure and cholesterol, leads to clogging of the cerbrovascular tree. Early and aggressive treatment is very helpful. #7.The kidney diseases. Again, unfortunately they are all lumped together,because this gets more complicated. Again, much of it is due to undertreated high blood pressure and cholesterol, clogging up the system but other causes include overuse of non-steroidal drugs, which can and should be limited. #8. Septicemia. This is bad luck and usually accompanies very sick patients who are often ill or near dying from other causes. Nothing you can do in life prepares you for or prevents this. Really sick? Get help asap. #9. Suicide. Ask for help #10. Liver: also "lumped" but obviously alchohol is key. A huge issue is Hepatitis C, now up to 4 million affected in the USA. "fatty liver" is a growing problem due to the rise in obesity and can be prevented by losing weight. I'll stop there. Questions welcome. Stepping back and looking into the list you can see why I tell my patients what I do: There is very little that you can "add" to your body for health, but there is a lot you can choose to avoid to be healthy. It's pretty easy to be well and pretty easy to stay well. mm
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#2 ty250

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Posted 23 May 2006 - 09:28 AM

What are the cholesterol numbers that you believe to be most correct for most people. HDL? LDL? Ratio? Thanks, TY Also I have NASH. What do you recommend as far as a liver cleanse? etc. Thanks again

#3 maineman

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Posted 23 May 2006 - 10:34 AM

What are the cholesterol numbers that you believe to be most correct for most people.
HDL? LDL? Ratio? Thanks, TY

Also I have NASH. What do you recommend as far as a liver cleanse? etc. Thanks again


Currently, no specific therapies for NASH exist, although research on the disease continues. Adhering to the following recommendations may be helpful in managing NASH:
  • losing weight (in persons who are obese or overweight);
  • achieving control of hypertension, diabetes, and hyperlipidemia;
  • following a balanced and healthy diet;
  • increasing physical activity;
  • avoiding alcohol; and
  • avoiding unnecessary medications.
If you already have developed cirrhosis there is nothing you can "add" to your body to improve on that condition. Work closely with your internist or gastroenterologist on this one. This is becoming a huge problem, with the increasing girth of the population.

The cholesterol guidelines are very clear. Tremendous research and quality information. Forget about HDL and ratios, it won't help you manage the situation.

Focus on LDL. Keep your LDL WAY below 130, preferably as close to 100 as you can. Diet can do it, but it takes work. Pills do it for sure and are safe and effective and have been one of the leading causes in the dramatic reduction in strokes and heart attacks! A good (not insane) diet plan along with a tiny dose of lipid lowering medicine and you'll live a long and healthy life.

mm
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#4 ty250

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Posted 23 May 2006 - 10:59 AM

Thanks for the reply. I am not heavy. I do not eat as well as I could or exercise as much as I could . I appear to have bad genetics and the problem was not diagnosed until a couple years ago. I am 52. I am now seeing specialists at the Univ of Penn. I had 0 good cholesterol two times in my blood work and a 2 one time. I am now at 5. Very interesting eh.

#5 maineman

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Posted 23 May 2006 - 11:33 AM

Yes we do see this in people with low cholesterol and not overweight. Children, too, though the numbers are small. I suspect there is a genetic component. That said, we are probably dealing with 2 problems. There is the genetic form, which would be made worse by diet and weight, and there is the "new" phenomenon of "fatty liver disease" which we are seeing in direct proportion to weight and elevated blood lipids. mm
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#6 mss

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Posted 23 May 2006 - 07:44 PM

mainman, I have a question for you. A 42 year old female, 117lb, 5' 4", eats right, fairly active, 3 natural births, has never smoked, 2-3 glasses of wine a month when dining out. Goes to a very respected DR. all vitals are within tolerance. She complains with head aches from time to time and sometimes tired. BECAUSE SHE WAS HEALTHY, HAD NONE OF THE RISK FACTORS, SENT HOME. This went on for 6 months and with a second DR. My question is why do DRs blame or dismiss illness around or the lack thereof on RISK FACTORS. Even in your threads you pound the common risk factors. Have you sent a patient home who had no risk factors to rest ?? I hope to hell not! By the way my father was a DR till he passed away at an early age curing people, and was paid with hams and eggs most of the time. So I have a feel for Drs. problems. p s: the female had a stroke one morning, (headaches & tiredness) Good blood work but NOW-NOW it is clotting. Three months and some one says lets X-Ray the lungs, guess what???? BUT SHE HAS NO RISK FACTORS. mss

Edited by mss, 23 May 2006 - 07:45 PM.

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#7 maineman

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Posted 23 May 2006 - 09:55 PM

MSS, I'm not sure I understand your question or the case. Are you saying that this otherwise healthy young woman complained to her doctor that she was tired and had headaches and there was no work up and she was sent home? As for risk factors, we are talking about basic health prevention. That is very different from the diagnostic part of what we (Internal medicine physicians) do. When a patient comes to me with a specific problem or set of complaints, it is my role to ask the right questions, formulate the right diagnostic decision tree and begin to act in order to DIAGNOSE the problem. When a patient comes to me for annual wellness screening, that is very different. This is where we discuss risk factors, etc. maineman
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#8 mss

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Posted 24 May 2006 - 05:45 AM

MSS,

I'm not sure I understand your question or the case. Are you saying that this otherwise healthy young woman complained to her doctor that she was tired and had headaches and there was no work up and she was sent home?

maineman


Because no risk factors were present, based on great AMA studies, standard test (by AMA studies) did not reveal anything-- therefore she was just too involved with 3 kids and other activities. This was the reason for the headaches and tiredness. This by two good different Dr.s -- AND AFTER THE FACT BOTH said
over and over she HAD NO RISK FACTORS.
My point is way too much attention is applied to AMA and other studies and not enough to looking for causes.

I guess my real question to you is are you putting way too much faith in these studies ??

By the way, thru the grace of GOD, she is so far surviving non-small cell lung cancer.
mss
WOMEN & CATS WILL DO AS THEY PLEASE, AND MEN & DOGS SHOULD GET USED TO THE IDEA.
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#9 maineman

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Posted 24 May 2006 - 06:33 AM

This sounds like a very sad case and clearly I do not have enough information to comment. Once again I'm not sure you and I are talking about the same risk factors here and I don't know what you mean by "AMA" studies? The AMA is a political lobbying arm, the medical association. Most of us don't belong to it, or do so only peripherally. They do the lobbying for tort and malpractice reform, medicare and medicaid policy, and other health policy information, etc. It sounds like a case of an otherwise very healthy women with vague complaints who was mis diagnosed or not diagnosed as having an underlying occult disorder and without her medical history and review of her work up by her doctors I cannot tell you what went wrong. As to the risk factors you keep talking about, in medicine, as in life (and in trading) they are tools to be used appropriately. I think what you are implying is that if a young healthy person who does not smoke, has normal cholesterol, no diabetes and no hypertension comes to my office complaining of "chest pain" you are wondering if I would send them out the door because they "shouldn't" be having coronary heart disease? Absolutely not! On the flip side, a completely healthy appearing person who comes to my office and says they "feel well" would still be encouraged to get screened for colon and breast cancer, anemia, cholesterol, diabetes, hypertension, etc. etc. if they were in the appropriate age range. maineman
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#10 mss

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Posted 24 May 2006 - 06:55 AM

.............. if they were in the appropriate age range.

You just made my point...IF THEY FIT A CERTAIN PROFILE....

You and I both know that in many cases medical history is not worth a s%^t.

mss
btw: Standard treatment for bladder cancer is to remove it.
Five years ago I told them to shove it, a good DR. said, well lets try something else.

You DR.s have got to start thinking "outside the box"--
Go save a life, best to you.
mss
WOMEN & CATS WILL DO AS THEY PLEASE, AND MEN & DOGS SHOULD GET USED TO THE IDEA.
A DOG ALWAYS OFFERS UNCONDITIONAL LOVE. CATS HAVE TO THINK ABOUT IT!!