Tuesday, June 28, 2011

Doctors Adapting and Trying to Survive

Close your eyes and think of a doctor.  Do you see a Marcus Welby type? A middle aged, smiling and friendly gentleman who makes house calls?   Is his cozy office staffed by a long time nurse and receptionist who knows you well and handles everything for you?  If that is what you envision, either you haven't been to the doctor lately or you are in a concierge practice where you pay a large upfront

Food Reward: a Dominant Factor in Obesity, Part VII

Now that I've explained the importance of food reward to obesity, and you're tired of reading about it, it's time to share my ideas on how to prevent and perhaps reverse fat gain.  First, I want to point out that although food reward is important, it's not the only factor.  Heritable factors (genetics and epigenetics), developmental factors (uterine environment, childhood diet), lifestyle factors (exercise, sleep, stress) and dietary factors besides reward also play a role.  That's why I called this series "a dominant factor in obesity", rather than "the dominant factor in obesity".
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Saturday, June 25, 2011

Tennis at San Quentin

Many people can't understand why a law abiding citizen like me would go to San Quentin Prison and play tennis with the inmates.  I've written on this before and it is a fascinating look at life we don't usually get to witness.  Today was another San Quentin tennis day where I got to play some good, friendly tennis as well as hear some stories of redemption.

I spent a good deal of time talking

Thursday, June 23, 2011

Drug Cessation and Weight Gain

Commenter "mem", who has been practicing healthcare for 30+ years, made an interesting remark that I think is relevant to this discussion:
Recovering substance dependent people often put on lots of weight and it is not uncommon for them to become obese or morbidly obese.
This relates to the question that commenter "Gunther Gatherer" and I have been pondering in the comments: can stimulating reward pathways through non-food stimuli influence body fatness?  

It's clear that smoking cigarettes, taking cocaine and certain other pleasure drugs suppress appetite and can prevent weight gain.  These drugs all activate dopamine-dependent reward centers, which is why they're addictive.  Cocaine in particular directly inhibits dopamine clearance from the synapse (neuron-neuron junction), increasing its availability for signaling.
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Tuesday, June 21, 2011

Rob a Bank to Get Health Care

Just when you think things can't get any nuttier with American health care, here comes the strange and sad case of James Richard Verone.  Mr. Verone, age 59, was laid off from his job of 17 years as a Coca Cola deliveryman.  He went through his savings and  took a part-time position as a convenience store clerk but he had no health insurance.   He had a back ache from lifting and bending and pain

Monday, June 20, 2011


This 45 year old man came to his doctor about a triangular shape growth in the inside corner of both eyes.  It had been present for a long time but seemed to be increasing.  There was no pain, no discharge and no visual problem.  The internal eye exam was normal.  What is the diagnosis?
These common conjunctival growths are called a pterygium (pronounced "teryjium").  We don't know what causes

Sunday, June 19, 2011

Stop Unnecessary Medicare Tests

We are in a time when  Medicare is bankrupt and the GOP wants to privatize it and make seniors go to the open market to get insurance. Even the idea that we would dismantle this important social benefit is shocking yet everyone knows we have to bring costs under control.  So now we find that hundreds of hospitals (and radiologists)  in the United States are performing unnecessary CT scans on both

Saturday, June 18, 2011

Food Reward: a Dominant Factor in Obesity, Part VI

Reward Centers can Modify the Body Fat Setpoint

Dopamine is a neurotransmitter (chemical that signals between neurons) that is a central mediator of reward and motivation in the brain.  It has been known for decades that dopamine injections into the brain suppress food intake, and that this is due primarily to its action in the hypothalamus, which is the main region that regulates body fatness (1).  Dopamine-producing neurons from reward centers contact neurons in the hypothalamus that regulate body fatness (2).  I recently came across a paper by a researcher named Dr. Hanno Pijl, from Leiden University in the Netherlands (3).  The paper is a nice overview of the evidence linking dopamine signaling with body fatness via its effects on the hypothalamus, and I recommend it to any scientists out there who want to read more about the concept.
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Thursday, June 16, 2011

No Advantage for Screening Ovarian Cancer

There were 21,880 new cases of ovarian cancer diagnosed in the United States in 2010 and it is the 5th leading cause of cancer death among women.   Women are understandably afraid of ovarian cancer because there are usually no early warning symptoms and when discovered,  the disease is often advanced, difficult to treat and highly lethal. A large and well run study, reported at the American

Wednesday, June 15, 2011

Sunburned Feet

As a follow up to my last blog, check out these sunburned feet from a friend vacationing in Southern California.  Ouch.  Feet are especially sensitive because men wear socks all the time and they never get sun exposure.  Another worrisome area is the head, especially with a bald spot.  Don't let a sunburn ruin your vacation.  Prevention is the key.


Summer is here and this is the time for sunburn because people are so happy to be on vacation or out in the sun, they underestimate how much sun their sensitive skin can tolerate.  Sunburn is caused by UV radiation actually burning and damaging the cells of the skin.  While fair skin is more likely to burn, even people with darker skin can be easily sunburned if they are getting sun during the

Monday, June 13, 2011

Vitamin D Improves COPD

I am frequently extolling the health benefits of Vitamin D because almost weekly there is a new study that correlates high vitamin D levels with reducing some disease.  The latest is from the American Journal of Respiratory and Critical Care Medicine and research shows that high doses of vitamin D supplementation improved respiratory muscle strength in patients with Chronic Obstructive Pulmonary

Wednesday, June 8, 2011

Octomom's Doctor is Placed on Probation

Remember the media blitz over Nadya Suleman, the Southern California mother who underwent IVF and gave birth to eight babies?   The unemployed, single mother of 6 was only the second ever to give birth to a full set of octuplets.   Now, two years after the sensational births, the California State Medical Board has revoked the license of Beverly Hills fertility doctor, Michael Kamrava.  However

Tuesday, June 7, 2011

The Placebo Effect is Strong Medicine

Thanks to Kevin MD , (via Lukas Zinnagl, MD) for pointing me to this fascinating video on the Placebo Effect.  What is amazing is that placebos work even when the patient knows it is a placebo!  That is the power of the mind.  Check it out an be amazed!

Saturday, June 4, 2011

Should Doctors Wear White Coats?

The Doctor's white coat has been a symbol of the profession for decades.  In the 1800's and up through the early 20th Century, doctors wore street clothes while performing surgery...rolling up their sleeves and plunging dirty hands into patient's bodies.  They often were dressed in formal black, like the clergy to reflect the solemn nature of their role.  (And seeing a doctor was solemn indeed as

Heart Disease and Heart Attacks

This amazing site called Kahn Academy is just filled with information on every subject!  This video explains atherosclerosis, heart attack and heart failure.  Watch and learn.

Thursday, June 2, 2011

Why You Need a Colonoscopy

One of my pet peeves as a Physician is when people talk about screening tests "Preventing Cancer".  Mammograms, pap tests, prostate tests (PSA), X-rays, blood tests, ultrasounds do not prevent cancer.  The best they can do is detect an abnormality early and allow for treatment.  None of those tests prevent a malignancy.  There is one screening test, however, that CAN prevent cancer and that is a

Food Reward: a Dominant Factor in Obesity, Part V

Non-industrial diets from a food reward perspective

In 21st century affluent nations, we have unprecedented control over what food crosses our lips.  We can buy nearly any fruit or vegetable in any season, and a massive processed food industry has sprung up to satisfy (or manufacture) our every craving.  Most people can afford exotic spices and herbs from around the world-- consider that only a hundred years ago, black pepper was a luxury item.  But our degree of control goes even deeper: over the last century, kitchen technology such as electric/gas stoves, refrigerators, microwaves and a variety of other now-indispensable devices have changed the way we prepare food at home (Megan J. Elias.  Food in the United States, 1890-1945). 

To help calibrate our thinking about the role of food reward (and food palatability) in human evolutionary history, I offer a few brief descriptions of contemporary hunter-gatherer and non-industrial agriculturalist diets.  What did they eat, and how did they prepare it? 
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Wednesday, June 1, 2011

Facial Cellulitis

This 39 yer old woman had a small sore inside her nostril.  It worsened  and her nose started getting red so she was put on ciprofloxacin antibiotic.  The redness improved but 5 days into treatment two pustules developed and the erythema worsened.  A culture of one of the pustules grew out methicillin-resistant Staphylococcus aureus (MRSA).  She was treated with intravenous antibiotics and her