The Medical Insider

Corrections on fish oil and rabies, but not vaccines

In three years of writing this health column, I’ve made mistakes.

In my Oct. 15, 2019, column “Bacon and red meat: A hard 'no'?” I said, quoting from a 2018 JAMA article, that fish oil supplements were not helpful. But I failed to note a later study which showed that high-dose fish oil (4g daily) reduces cardiovascular events and death among a unique group of people – those with high triglycerides (a type of cholesterol) and at risk for heart diseases. The result of a similar study is about to come out. A correction is in order.

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Volume 11, Issue 22, Posted 9:31 AM, 11.19.2019

Chasing better odds: BP meds at night?

Recently I came across a study, the result so fantastic that my first reaction was – it’s too good to be true.

But curiosity got the better of me. I tracked down the article and read it. (It was either that or rake leaves.)

Published in the October issue of the European Heart Journal, the study has a pretty name: Hygia (the Greek goddess of health) Chronotherapy Trial. And a simple goal: Compare health outcomes between taking blood pressure (BP) medications at bedtime and in the morning. Drugs are once-daily.

The researchers followed tens of thousands of people for about six years. Astoundingly, when compared to morning-pill-poppers, bedtime-pill-poppers had half the rate of heart attacks, strokes and deaths.

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Volume 11, Issue 21, Posted 9:29 AM, 11.05.2019

Bacon and red meat: A hard 'no'?

On Oct. 1, the Annals of Internal Medicine published several studies on the health consequences of consuming red and processed meat. Their conclusion: Cutting down on red meat did nothing to smaller-ish nothing to improve our health.

The scientific and public health sectors are incensed.

The World Health Organization lists processed meat as a carcinogen, red meat as a potential carcinogen. The 2015-2020 U.S. Dietary Guidelines recommend limiting red meat to one, 3 ounce serving per week (steak the size of a deck of cards). The Harvard School of Public Health pitched a fit. Their 2012 study showed each extra daily serving of processed meat could increase the risk of death by 20 percent.

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Volume 11, Issue 20, Posted 9:25 AM, 10.15.2019

Vaping casualties skyrocket

Sept. 26, 2019: The Centers for Disease Control and Prevention (CDC) just updated vaping-related lung injury to 805 cases, 12 confirmed deaths. When I started this article a few days ago, the count was 503, 7 confirmed deaths.

By the time you’re reading this article, I’m guessing it’ll be past a thousand.

On Sept. 20, a 59-year-old Beachwood man became the first confirmed case in Cuyahoga County.

What’s gone wrong? Vaping – the harmless steam smokers use to quit smoking – has been around for over a decade.

The FDA is hunting for culprits.

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Volume 11, Issue 19, Posted 9:16 AM, 10.01.2019

Drugs 101: Reduce out-of-pocket costs

I'd like to share three simple steps which can significantly reduce your drug costs. No, they don’t work all the time (I don’t know what to do with drugs like Lantus, a long-acting insulin, either). But when they do work – oh, you’re gonna love me.

First, let’s debunk some myths.

  1. Only one drug works.
  2. Insurance offers the cheapest option.
  3. Doctors know drug prices.

All false.

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Volume 11, Issue 18, Posted 9:12 AM, 09.17.2019

No time for shingles

Why bother with shingles?

Because 1 in 3 people will get shingles. I did.

It’s caused by the chicken pox virus. The first time you’re infected, you get a diffuse rash – that’s chicken pox (varicella). The virus then sleeps in nerve endings (no, it never leaves). With age, weakening immunity or idiopathy (medical term for "worst-luck-ever"), the virus wakes up and causes a localized rash – that’s shingles (herpes zoster).

Thus its fancy-pants name – varicella-zoster virus (VZV).

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Volume 11, Issue 17, Posted 9:47 AM, 09.04.2019

Fatty liver: what you need to know

We have an emerging liver problem. Better you hear from me first.

Fatty liver, or non-alcohol fatty liver disease (NAFLD), is the main reason I encounter mildly abnormal liver blood tests these days. Obesity is the most common risk factor.

Worldwide, 25% of people have fatty liver; in the overweight population, it's three in four. Another scary thing: It doesn’t spare children. In the general pediatric population, 3% to 10% of children have fatty liver; the incidence increases to 80% in overweight children.

What’s fatty liver?

Our liver filters blood – detoxifies bad stuff and synthesizes good stuff – and does everything under the sun to keep us out of trouble. Plus, it stores fat.

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Volume 11, Issue 15, Posted 10:17 AM, 08.06.2019

Stem cells and knee arthritis: ready for prime time?

Piper, 54, plays piano, walks for exercise. Doesn’t own a TV!

You can’t tell by looking at her how knee osteoarthritis (the wear-and-tear kind) dictates even minor movements. In her 20s, Piper played wallyball (it’s volleyball on steroids), diving and bouncing off the walls. Today, rising from a chair, her knees hurt. After a long plane ride, they feel like they’d “explode.”

She takes sulindac (an NSAID, like ibuprofen) daily. This spring, she got a hyaluronic-acid knee injection. Like a miracle, she could walk up and down stairs pain-free. But in two to three weeks, the pain returned.

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Volume 11, Issue 14, Posted 10:10 AM, 07.16.2019

Sleep: a fountain of youth

In a New York Times interview last year, Elon Musk, CEO of Tesla/SpaceX/whatever, said he works 120 hours a week and pulls all-nighters. As a very, very minor stockholder, I’m struck by his sacrifice, discipline, super-human productivity. But as a doctor, none of this is OK.

Why sleep?

Our body is a machine, programmed to shut down daily for maintenance. The younger you are, the more physical you are, the more sleep you need. Sleep is more than a La La Land where your dreams build a human colony on Mars. During sleep, your body and brain work tirelessly to connect, reconnect, grow, learn, repair, regenerate, remove toxins, ready to reboot for a new dawn. Sleep is your built-in fountain of youth.

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Volume 11, Issue 11, Posted 10:28 AM, 06.04.2019

The irony of diabetic treatment: weight gain

BB, 47, is a long-term diabetic who needs pills and insulin injections. She’s been off insulin for a year – just can’t afford it. Her eyes are blurred; she feels irritable. I refill her meds, switch her insulin, add metformin (more about that later), and send her out with my fingers crossed.

Two weeks later I see her. ”How’s the glucose?”

Better. Her numbers make me smile.

But she’s not smiling. “I gained eight pounds in two weeks,” BB said. “I can’t fit into my size 4 pants.”

The irony of weight gain in diabetic management is not lost on me. Excess weight exacerbates insulin resistance – the last thing a diabetic needs.

But it doesn’t have to be that way.

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Volume 11, Issue 10, Posted 10:29 AM, 05.21.2019

Is this test necessary, doc?

Ever wonder if you needed a test or procedure?

“Should I start another pill for my diabetes?” “Do I need an MRI for my joint pain?”

You’d be right questioning the decision 20% of the time. Here’s why.

In a national survey, doctors estimated 20% of overall medical care was unnecessary, including one in five prescription drugs, one in four tests, one in 10 procedures. The two major reasons they give: fear of malpractice and patient pressure/request.

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Volume 11, Issue 9, Posted 2:17 PM, 05.06.2019

CBD oil: Truth and hope about a cannabis product

Years ago, Jim, age 50, had back surgery. Two lumbar vertebrae fused, screws placed. Two weeks ago, severe back pain shot down his left knee, knocked him to the floor, curled him into a fetal position.

He’s been to the ER five times. Doctors think it’s his hip, groin or back. He’s frustrated. Last night, for his pain, he bought a jar of CBD (cannabidiol) cream from his masseuse. “This stuff’s flying off the shelf,” she told him.

What’s CBD oil?

Marijuana plants contain hundreds of chemicals. The two big stars: CBD and THC (tetrahydrocannabinol). CBD does not produce a “high,” unlike THC.

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Volume 11, Issue 8, Posted 9:49 AM, 04.16.2019

The powerful emphysema treatment nobody knows

My father was a 3-pack-a-day smoker. Started in the military. During the Chinese Civil War, he was conscripted to an island outpost, fighting the communists. Daily the two sides exchanged fire. Nightly, frogmen – nicknamed “water ghosts” – ambushed and killed patrols, cutting their ears off for tally. “Brothers killing brothers,” Father said. “You smoke or go insane.”

My mother tells a different story. The active war ended. In 1964, the U.S. Surgeon General first warned: "Smoking causes cancer." His words reverberated, reaching remote corners of the world, except, apparently, my dad’s ears. “Everybody quit but him.” She was not sympathetic.

At 62, he had a heart attack. After a five-vessel bypass, a grim-faced surgeon informed Mother that while the heart surgery was a success, he feared the worst. Dad’s lungs?

For the first time, we learned that he had advanced emphysema.

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Volume 11, Issue 7, Posted 9:42 AM, 04.02.2019

Worrying about Alzheimer’s? Don’t.

Last week I gave a short talk on dementia.

The church was set back from boisterous Detroit Road. In a sunlit, spacious room, home-made dishes packed two tables. The air was casual, familiar, coffee-warm. In the snow-capped meditation garden, I spotted half a dozen wild turkeys.

In my Sunday best, I was smart, gracious, gregarious and blissfully forgot an important message.

Here’s my talk, again, turkeys and punchline included.

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Volume 11, Issue 5, Posted 9:55 AM, 03.05.2019

Surviving pet allergies

Years ago, Deb, my neighbor, found a litter of kittens. The mother, a ropey black-and-white feral, was a neighborhood darling. “A working girl,” Deb said proudly, as she kept garden mice in check.

We called the Cleveland Animal Protective League for help. “The kittens need to be socialized, neutered and adopted; the mother, spayed and released,” we were told.

I’m cat-allergy exhibit A-Z: rash, runny nose, itchy eyes, coughing, sneezing, wheezing. After visiting cat homes, it takes me days to breathe normally. Deb handed me a kitten, the silky hair, wicked pupils, electrifying purring. In seconds, I was kitten-hooked.

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Volume 11, Issue 4, Posted 9:56 AM, 02.19.2019

Ideal age to start mammograms

Bertie, 47, went for a regular checkup. Her gynecologist, who’d known her for 18 years and delivered her two kids, walked her to the mammography suite after the visit.

“No appointments. Took me in right away. Such personal care,” she said cheerfully.

I had questions for my good friend. But first, does Bertie get a say in this?

To most of us, breast cancer has a face – friends, family, colleagues, ourselves. An estimated 41,400 people (40,920 women and 480 men) will die from breast cancer this year. Every pink ribbon renders a wrenching story.

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Volume 11, Issue 3, Posted 9:54 AM, 02.05.2019

An old nemesis returns

The midwife consulted me on a genital ulcer. Popped up weeks ago, more irritating than painful.

I saw the ulcer, clean-scooped like a shallow half-teaspoon. I knew what it was. Hesitated. Because I couldn’t recall the last time I’d seen a case.

The next day, a simple blood test confirmed my suspicion. Among a dozen possibilities, it was indeed syphilis.

The old nemesis. For centuries, it was blamed for the brutality, paranoia, madness and dementia of the powerful and the famous: Henry VIII, Ivan the Terrible, Oscar Wilde, Friedrich Nietzsche, Al Capone.

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Volume 11, Issue 2, Posted 10:05 AM, 01.22.2019

Take the bite out of holiday heartburn

My husband’s family is Scottish Canadian. Frugal, reserved, hard-working, tough as the granite they farmed in Eastern Ontario. Thrive on dry humor.  

One thing they do with abandon: Christmas dinner. Every year, we cross the Peace Bridge to his family home, to herb-studded roast beef, glazed ham, bricks of cranberry jelly and fruit cakes, strawberry trifle in brandy and sherry, egg nog, Yule Log. And my absolute favorite: Yorkshire pudding (egg batter baked in beef drippings).  

It’s a hard day’s night of eating – and heartburn.  

Heartburn presents differently in different people: burn, bile taste, hoarseness, lump in mid-throat, difficulty swallowing, coughing, worsening asthma or nothing.

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Volume 10, Issue 24, Posted 10:05 AM, 12.18.2018

You might exercise more than you think

My brain free-associates: my mom reminds me of Costco. Texting while driving: natural selection. Vladimir Putin: mutating Swine Flu.

But when people see me, their brains wander to exercise.

Colleen: “Want to come over for dinner? Five-ish? I should start swimming again.”

Liz: “Your dog is at my house again. No, I didn’t give her all the leftover chicken, just half. By the way, I did four miles on the treadmill today. On an incline.”

A stranger walking his dog: “That’s a pile of leaves you got there. I need to lift weights.”

I don’t know what it is about my face that drives people to exercise. But here I am, again, talking about the new exercise guidelines. Before you toss me to the same-old health-advice boneyard, let me tell you some wonderful news.

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Volume 10, Issue 23, Posted 10:22 AM, 12.04.2018

Tired of pain, tired of being tired

Pat, 60, is a home assistant. She can take pain. She had a root canal without anesthetics. A nerve conduction study using needles and electric shocks was a piece of cake, that is, compared to her fibromyalgia.

As a child, Pat had “sinus headaches”; as a teen, painful periods. One time she ended up in the ER for foot pain and swelling. The ER doctor said her “muscles are more sensitive than others.” This explanation stuck because she thought it made a lot of sense.

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Volume 10, Issue 22, Posted 9:37 AM, 11.20.2018

One man's journey to sobriety

He wants to be referred to as a member of AA.

At 49, he sports a Paul Bunyan beard. He has blue eyes, is calm and kind. He tells a story how years ago, he drove out of his driveway and woke up a killer.

He first got drunk at 13, typical of most alcoholics he knows.

In high school, he drank on weekends. At 18, he enlisted in the Marine Corps. In Desert Storm, he worked two days on, two days off and every other weekend. The off-days were one big party.

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Volume 10, Issue 21, Posted 9:54 AM, 11.06.2018

Handle urinary incontinence easily

For this article, I diligently researched incontinence jokes, but none put me in stitches. So I'll lay it out straight.

Women lose urine. And it’s not an “old-woman’s” thing. One-third of women between the ages of 30 and 50 report urinary incontinence.

If you can handle the occasional accidents and still find pee jokes funny, then do what you’ve always done. But if you sleep poorly, have tripped and fallen while rushing to restrooms, or find these accidents annoying, depressing, embarrassing and activity-limiting – know there’s help.

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Volume 10, Issue 20, Posted 10:07 AM, 10.16.2018

How much drinking is safe?

After Wednesday evening swim practice, I caught up with Sue leaving the locker room. She led our lane today. At a brutal pace.

“My grandson, one year old already,” Sue flashed a picture of a baby Buddha on her phone.

“Looks nothing like you,” I said honestly.

“Yeah,” Beaming still. “What you up to?”  

“Thinking about alcohol consumption,” I said, walking faster to keep up.

“Good idea.” In the parking lot, Sue waved her key fob like a wand. A white sedan blinked and blipped in response.

“The WHO reports alcohol causes one in 20 deaths worldwide,” I said, tailing her to the car.

Who reported on what now?”

“Not who, Sue. W-H-O – the World Health Organization.”

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Volume 10, Issue 19, Posted 9:55 AM, 10.02.2018

The not-so-scary truth about osteoporosis treatment

Cruising Sanibel Island on a single-speed beach bike, my neighbor Sharon, then 52, did a “Flintstone front brake” (remember how Fred Flintstone stopped his stone car by dragging his heels? Yup, that one) and broke her right foot.

Her doctor frowned. “Something’s off,” he told her. A bone density study later, she was diagnosed with osteoporosis.

Two years ago, an infection caused a dental implant to fall off. Sharon became alarmed when two dentists refused to operate on her because she’d been on “antiresorptive medications” for osteoporosis for 12 years.

Sharon – and four out of 10 white females in the U.S. – will experience a spine, hip or wrist fracture sometime in their lifetimes; the rate is 13 percent for white male per the Centers for Disease Control and Prevention.

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Volume 10, Issue 18, Posted 10:13 AM, 09.18.2018

Osteoporosis: A fanged dog without a bark

Our bones are a dynamic organ, like a house that’s constantly been remodeled.

Bone loss is natural aging. But when the demolition crew far outpaces the construction crew, bones thin critically, liable to fracture with minor injuries – it’s osteoporotic.   

Osteoporosis is diagnosed based on a bone density study (DXA). The U.S. Preventive Services Task Force recommends screening women once at age 65. Earlier if they have additional risk factors: parents with hip fractures, smoking, weight less than 127 pounds, excessive drinking, among others.

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Volume 10, Issue 17, Posted 9:14 AM, 09.05.2018

Add years to your life

I want to talk about ways that can add 10 years – or more – to your life expectancy. Not just any years, active years – physically and mentally productive ones.

But before you light an extra candle for me, I have a confession to make.  

I like numbers.

Science is about hard, reproducible numbers. Yet in medicine, our numbers come from studies that are based on 5 million people – or 25. Some data, like the benefit of aspirin after heart attacks, measles and polio vaccines, and eating your greens, are Category-5-hurricane proof; others, less so.

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Volume 10, Issue 16, Posted 8:50 AM, 08.21.2018

Sex and vaccines: The pre-college prep talk

It’s tough sending kids off to college.

Sure, my kids, like yours, never get in trouble. They exercise an hour a day, limit Fortnite/video games to two hours, put schoolwork before network, eat broccoli before brownies. Still, I believe they need certain facts straight. So when one of them says, “Hypothetically, if one …,” they can help each other, know what’s available, where to turn.

In launching my second child towards college, I keep these health issues in my peripheral vision.

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Volume 10, Issue 15, Posted 9:51 AM, 08.07.2018

The tale of two prostates

Allen, 56, has a decision to make. Should he start prostate cancer screening? He knows two prostate cancer survivors.

His father was diagnosed with prostate cancer, young – in his 50s. Opting out of treatment on his doctor’s advice, he died at age 84, of Alzheimer’s complications.  

His friend Kevin, 73, was diagnosed at 53. He underwent prostatectomy, radiation and followed up diligently. Though he felt fine, last year a workup showed bone metastasis to his ribs, shoulder and hip.

Prostate cancer is very common.

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Volume 10, Issue 14, Posted 10:04 AM, 07.17.2018

Combating escalating drug prices

Alex, 18, is home from college. He’s studying to be a respiratory therapist. For his summer job, he bikes 16 miles from Avon to North Olmsted and back, leaving at 5:10 a.m. every morning. He’s affable, athletic and “not unique.” Most remarkable, he’s been a diabetic since age 4 – and managed to keep nearly perfect glucose control.

Alex’s body makes no insulin. For every meal and activity, he calculates his carb and insulin needs. He thinks nothing of it. But in the past few years, a problem has crept up on him, and eight million other insulin-dependent diabetics in the U.S.

From 2002 to 2013, the price of insulin tripled (a vial of insulin went from $231 to $736). Who knows why. A survey shows almost half of diabetics skip needed medical care because they can’t afford it.

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Volume 10, Issue 13, Posted 9:26 AM, 07.03.2018

Is organic food better?

I buy organic products, but inconsistently. I buy organic milk, but not organic yogurt or butter. I track the Dirty Dozen, but balk at the cost of organic strawberries, and how fast they rot. It’s fair to ask how do organic foods, a palmy 46-billion-dollar industry, actually benefit us?

Good Earth policy?

Pouring less chemicals into the soil and water is a good thing. But massive imports of organic produce from overseas creates pollution. It makes equally good sense to buy local produce, and reduce food waste.

Better nutrition?

The American Academy of Pediatrics (AAP) states organic food doesn’t provide “any meaningful nutritional benefits or deficits” over conventionally grown foods. An apple is an apple is an apple. With or without the organic wink, potato chips will – always and above all – be a junk food.

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Volume 10, Issue 12, Posted 9:26 AM, 06.19.2018

Tackling migraine: a new defensive player

Anne’s migraines started in her 20s. During an evaluation as a fledgling flight attendant, she developed a blinding headache during final descent and threw up all over her supervisor. That was the memory of her first migraine.

One in five women (most common between ages 18 and 44) suffers migraines – twice the frequency of men.  

Doctors tackle migraines using two lines of attack: mitigate and prevent. To mitigate acute pain, many drugs (or combinations) work. Two stand out: fast-acting NSAIDS (ibuprofen, naproxen sodium) and triptans.  

Most migraineurs have their own cocktails. The problem I see often is taking drugs too late.

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Volume 10, Issue 11, Posted 10:07 AM, 06.05.2018

New uses for the old Pill

The Pill, oral contraceptive pill, is the most important innovation of the 20th century. (I’m a woman, sue me.)

Margaret Sanger, founder of Planned Parenthood, pushed relentlessly and heroically for its discovery and legalization. In 1910, Sanger, a nurse in New York City, witnessed the burden of unwanted pregnancies on women and families and the horror of self-induced abortions. (Her own mother had 18 pregnancies in 22 years and died young.) Birth control, she thought, would allow a woman to be “the absolute mistress of her own body," improving her well being and social equality.

Since the inception of the first pill, Enovid, in 1960, the Pill has come a long way.

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Volume 10, Issue 10, Posted 9:36 AM, 05.15.2018

The ACP lowered the boom on glucose control: Is it right for you?

Recently diagnosed with diabetes, Al, 65, a chopper pilot and chef, is taking two drugs, still short of ideal control.

Last month, he was relieved when the American College of Physicians (ACP) proposed a more relaxed goal for Type 2 diabetics (or adult-onset diabetes, 90 percent of all diabetics). But as soon as the guideline was released, it came under fire from multiple well-respected organizations including the American Diabetes Association (ADA).

“What do you think?” he asked.

Personally – and call me what you want – until the thinking caps calm down, I’m hiding. Staying dry, upstream, above the fray.

So, what’s the rationale behind the ACP’s change in attack plan?

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Volume 10, Issue 9, Posted 10:11 AM, 05.01.2018

Can't remember what's its name? Senior moment or Alzheimer's?

Little yellow and blue flowers peeped out of melting snow, you snapped your fingers, trying to remember their name. Halfway to the gym, you turned around because you weren’t sure if you unplugged the iron. A trip to Aldi, you got three bags of groceries, everything except the one thing you actually needed: half-and-half.

How much forgetfulness is healthy? Given that I’ve just described my last week, let’s go there. 

Alzheimer’s disease (AD) accounts for the majority of dementia cases. Luckily, the age-specific cases are on the decline, have been for decades. In a 2017 JAMA article, Americans over the age of 65 diagnosed with dementia had decreased from 11.6 percent in 2000 to 8.8 percent in 2012. But with more people living longer, total cases are increasing. 

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Volume 10, Issue 7, Posted 9:41 AM, 04.03.2018

Five no-no rules for fostering animals

Rule 1. Your husband threatens to leave you – don’t blame the kids

Your husband, one-quarter of a decision tree, never had pets growing up; he likes a clean house. But you grew up with birds, dogs, turtles, anything you could rescue and adopt because your mom, like you, had no boundaries. He said he’d leave you when you brought home the dog, then when you got a rabbit, and again when you got the second rabbit.

So, when the kids got into animal foster care, frankly, he looked relieved. At least after two weeks the animals go back to the shelter.

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Volume 10, Issue 6, Posted 10:12 AM, 03.20.2018

Picking a PCP – for the squeamish

At every annual checkup, in front of the vet’s office, my 70-pound shepherd mutt, Rosie, hams a scene for the Oscars. Collapsing dramatically on the concrete. I tug; she wails. I pull; she howls like she’d glimpsed an afterlife without liver bits, belly scratches, squirrels.

But I’m her. I hate going to doctors. Last year, I got my blood pressure almost down – there they went lowering the cutoff again.

Having the right primary care physician helps. How do you begin?

Within insurance network

Recommendations from your neighbors, yoga instructor or dentist are good starts. But don’t start with an out-of-network provider, not unless you absolutely need a second opinion from an expert – the only one of two in the U.S. who can explain why your family has odd-numbered toes.

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Volume 10, Issue 5, Posted 9:34 AM, 03.06.2018

How to love an addict

Do you have an addict in your life?

Mine texted me yesterday; he needed groceries. A short list: frozen bagels, cream cheese, potatoes, white sauce, coffee for him, tea for her, canned soup. I ignored the nutritional value – now that most of their calories come from liquor, burned off by cocaine.

I want to help, yet these days I find myself asking the simplest questions: Am I helping? What happens to his unemployment and her disability checks? I can guess.

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Volume 10, Issue 4, Posted 9:46 AM, 02.20.2018

Is surgery the answer to obesity?

Tens of millions of Americans qualify for weight-reduction surgery, yet less than 1 percent pursue this option yearly. Shows like “My 600-lb Life” both promote and stigmatize bariatric surgery as a desperate measure for the desperately obese. I think differently. If you’ve dieted, exercised, divorced your carb crutch and still struggle with weight, diabetes, sleep apnea, back and knee pain – then surgery might help.

The criteria for bariatric surgery are simple: BMI of 40 and over, or 35 with at least one weight-related medical condition. If you’re 5’4” and weigh over 235 pounds, or over 205 lbs with diabetes, you’d qualify.

Currently your two best surgical options are gastric bypass and gastric sleeve. Adjustable gastric band, popular a few years ago, is disappearing because of unsatisfactory weight loss. Five-year data show both procedures have comparable weight loss, maintenance and complication rates. Gastric sleeve is easier surgically, but it’s irreversible and may worsen reflux, a major reason for reoperation.

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Volume 10, Issue 3, Posted 10:03 AM, 02.06.2018

The surprising reason you need a flu shot

When I offer flu shots, most people refuse.

“Never had the flu, I’ll take my chances.” I’m told. “I know someone who got the flu from the shot.” (You can’t.) And this year, “I heard flu shots don’t work.”

We need better flu protection. The measles vaccine, for example, struts a consistent, robust and reassuring 97 percent protection rate. The flu vaccine, with its "maybe we got it this year – or not" protection rate, makes science look like the fumbling guesswork of a colorblind chameleon.

Personally, I have two irrefutable reasons to get vaccinated.

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Volume 10, Issue 2, Posted 9:22 AM, 01.23.2018

Treating depression: What to expect

Third in a three-part series on depression.

I consider depression a systemic disease affecting both mind and body. Adequate treatment can lead to better life choices, medication compliance, pain control and sleep; faster recovery from heart attacks, chemotherapy or a simple cold.

But lumping all depressions as a single disease is like calling everything you got on your birthday, a gift: the speeding ticket, the hangover headache, a gift certificate to a cooking class (your family can only hope). 

Upon diagnosing depression, I offer both drugs and counseling, but not all experts agree with this approach.

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Volume 10, Issue 1, Posted 9:31 AM, 01.09.2018