Friday, August 26, 2011

Bone Density Alert: Cell Phones

This week I had a DEXA scan to monitor my bone density.  The results were a mixed bag:  the reading for my spine was the best it had ever been, a 10% improvement over two years ago but the numbers for my hips were worse, slipping out of the normal range into osteopenia.  After doing some research i learned that there was new research relevant to my situation.

Dr. Fernando  D. Sravi of National University of Cuyo, Mendoza, Argentina tested a group of 24 healthy men who usually carried their cell phones on their belts at the right hip and 24 who did not.  The results, though not statistically significant, showed that the cell phone carriers had lower bone mineral density on the the right side than on the left and that the difference was greater for those who carried the phones for more hours.  He concluded, "The different asymmetries between right and left hip dual-energy x-ray absorptiometry values in nonusers and mobile phone users suggest that these devices may adversely affect bone mineralization."

For a couple of years I have been listening to music on my cell phone when I exercise at the Y.  I put my cell phone on my belt and pick up a signal through blue tooth headphones.  From now on I'm going to put the cell phone on the other side of the room.

Thursday, August 25, 2011

Frozen Shoulder: What Worked for Me

When I was in my late forties I went back to school to earn a master’s degree in instructional design.  I was also selling real estate and my husband and I had some rentals so life was busy and stressful.  Sometime in the midst of all this I injured the back of my left shoulder.  I’m still not entirely sure what happened but perhaps I tore something while working out on the rowing machine at the Y. 

The pain got worse and worse.  At night when I tried to sleep it was like someone stabbing me in the back of the shoulder.  The anti-inflammatories suggested by my doctor didn’t help so she sent me to a physical therapy program run by the hospital.  The therapists taught me a bunch of exercises using stretchy bends tied around a doorknob.  They also tried stronger anti-inflammatory meds, some of which gave me a slight buzz (allergy?) and none of which helped the pain.  It was winter and my left shoulder was so stiff and sore that I was putting on my seat belt with my right hand.

One evening we happened to go to dinner at the house of friends of ours who had used acupuncture for health problems and had success with it.   I thought, “What have I got to lose?” My doctor was skeptical:  “All it does is stimulate endorphins,” she said but I went ahead anyway.  The acupuncturist I saw was Ying Jia, who earned a medical degree in China and does acupuncture and traditional medicine here in Bloomington.  She looked at my shoulder and said, “This is pretty bad but I can fix it.”

The first time Ying treated me with acupuncture I could feel that something was happening.  There was a warm, heavy sensation in the area where the needles were centered.  I continued to have treatments two or three times a week and the pain gradually subsided.  By this time it was late spring and I could sleep again but my shoulder was still frozen.  Since the acupuncture didn’t seem to be helping with that I stopped going.  I pretty much know what I had to do next.

Over the next 4-6 months I used yoga and other stretching exercises to gradually get the movement back into my shoulder.  It was a tedious, uncomfortable process but it did work.  One of the happiest moments of my life was when I woke up one morning with my hands above my head.  Six months earlier I wouldn’t have been able to stretch my left arm out like that in waking life, much less in my sleep.  Years later a trainer told me that my rotator cuff areas were weak and taught me YTWL’s and other exercises to strengthen the areas around my shoulders.  Perhaps the weakness in that part of my body predisposed me to get this injury.

Monday, August 22, 2011

Mammograms and the Cost Conundrum

Dr. Number One walked into the room. He wore a T-shirt and khakis. A cell phone dangled from a ribbon around his neck. He was a radiologist: He was coming to tell me he had seen something on my mammogram that might be an early sign of cancer.  As he explained it, the calcifications that had been on my mammograms for years had changed in appearance. Some calcifications, he told me, are clearly OK, some are clearly bad and some are in the middle. During the past year, mine had moved from the clearly OK category to the middle category. If I were a relative of his, he said, he would recommend a biopsy.

At this point, warning bells started going off in my brain. The previous week, I had seen an article called “The Trouble with Mammograms” by science writer Christie Aschwanden, which appeared on 8/17/09  in the L.A. Times.  Essentially, the trouble with mammograms is that they are very good at detecting slow-growing tumors that might never threaten a woman’s life and very bad at finding aggressive cancers that spread quickly. In addition, mammograms are the leading cause of malpractice lawsuits against radiologists, a powerful motivation for doctors to find cancer whenever possible. 

The combination of these two factors has led to a veritable epidemic of overdiagnosis and overtreatment of nonlethal breast cancers.  Referring to recent research, Aschwanden cites some truly hair-raising statistics:

• In a Danish study, the research team calculated that “for every 2,000 women screened by mammography over 10 years, one will avoid dying from breast cancer and 10 others will receive treatments for a cancer that would have never become life-threatening.” Of those who received unneeded treatment, some were undoubtedly harmed by it. Probably a few died.
• “Autopsy studies have found undetected breast cancer in about 37 percent of women who died of some other cause. And a study of 42,238 Norwegian women published in November 2008 calculated that 22 percent of symptom-free cancers found on a screening mammogram naturally regressed on their own.” 

“Don’t we want to know something about how fast this process is moving?” I asked Dr. One. “There are some slow-growing cancers that will never kill you.”  “This is your chance to catch the cancer at a very early stage,” he said.  “I want a second opinion,” I said. Dr One replied that I had a right to do this, but he was clearly not happy about it. He wished me luck and went on his way. I went home and called the office of Dr. Number Two, who had done several of my previous mammograms but now practices out of town. I had an appointment with him less than a week later. 

Dr. Number Two came into the room. He wore a lab coat over a dark-colored sweater and pants and had grown a beard since the last time I had seen him. The spots on my mammogram were random calcifications like the ones that had been showing up for five or six years. He explained that, especially with the advent of digital mammography, mammograms provide too much information and that radiologists vary widely in their interpretations of this information. What we need now, he told me, is technology that will allow us to distinguish the really dangerous cancers. He also said that many breast cancers grow slowly, giving you time to consider your options. 

“We need to re-evaluate what we call abnormal on a mammogram,” says Dr. H. Gilbert Welch of the Dartmouth Institute for Health Policy and Clinical Practice, quoted by Aschwanden. “Instead of looking so hard for very early cancers, doctors should focus on finding the ones most likely to turn deadly. Perhaps, he says, some minor abnormalities could be ignored, in particular small microcalcifications, miniature specks of calcium that are usually harmless but occasionally occur in tandem with precancerous changes in the breast.”

This new thinking puts doctors in a difficult position. If they fail to treat a cancer that becomes aggressive and deadly, they risk a lawsuit. If they order needless biopsies for healthy women,they incur the displeasure of people like me.  The overtreatment of nonlethal cancers not only harms individual women but also contributes to the cost of health care borne by all of us. It is an excellent case in point illustrating the “cost conundrum” discussed by Atul Gawande (New Yorker, June 1, 2009) — more health care treatments and higher costs leading to poorer medical outcomes. 

An earlier version of this post was printed in the Bloomington Herald Times.

Tuesday, August 9, 2011

Let's Rediscover Preventive Health Care

For a long time the practice of medicine in the United States has been on the wrong track and patients have been losing confidence in doctors.  There are a number of reasons for this change.

  • Modern, western-style medicine treats symptoms rather than seeking to identify underlying causes.
  • Contemporary medicine emphasizes the use of expensive, high tech equipment and procedures, some of which are incomprehensible to patients.  It does this even in situations where less expensive, more straightforward approaches might work just as well.
  • Increased specialization has led to a situation in which nobody (except the patient, if s/he is capable of doing so) takes a holistic view of the patient’s situation, yet the human mind/body is a complex system whose parts interact in complex ways.
  • As a result of the first three conditions, many individuals adopt a passive role in relation to their own medical care.  They take no responsibility for maintaining their own health through diet, exercise, and other means available to them.  When problems do arise they expect the doctor to provide a solution in the form of treatment.  If the treatment does not resolve the problem they often blame the doctor.
  • In order to economize on time, doctors categorize patients rather than treating them as individuals.  While this approach may save time, it can lead to misdiagnosis and to treatments that are useless or even harmful.
  • With the exception of diagnostic tests, contemporary medicine in this country has largely abandoned preventive medicine.

For the most part, the deficiencies in current medical practice are not the fault of doctors.  The vast majority of physicians are sincere, caring people who are doing their best to treat too many patients in too little time.  Preventive maintenance is better than crisis intervention but most doctors are so busy doing crisis intervention that they do not have time for preventive maintenance for either their patients or themselves.  Doctors work impossible hours; they are harassed and talked down to by insurance providers; and they must protect themselves (at great cost) against lawsuits for malpractice.  We need a new approach to health care, one that costs less, does not increase demands on already-overstressed doctors’ schedules, and is customized to suit individual needs.  How can we accomplish this? The first step is to help and encourage patients to take more responsibility for their own health. 

First, there needs to be a new type of health care professional, a health coach, with training in fitness, nutrition, and general health, who would meet with an individual and help him or her create a health and fitness plan with appropriate goals. The coach would follow up with that individual as the plan was implemented and provide information and suggestions on exercise and diet. (Medical issues would be referred to a doctor or nurse.)   Health coaches could work in doctors’ offices, in schools and community centers, as well as in the workplace. 

Second, we need to discard outmoded notions about health and human life.  Traditional medical practice treats the human body, once it has reached adulthood, as solid and immutable.  In fact, the mind/body continues to change and develop throughout life.  It is malleable and capable of improving itself at any age.  The recent example of Dara Torres shows that motivation and hard work trump chronological age, when it comes to fitness.  The traditional view of old age as an inevitable process of deterioration needs to be set aside.  Many of the problems that are often attributed to aging are actually the result of inadequate exercise and improper nutrition.  If these issues could be addressed through education and follow-up with a coach, our health care system could save millions of dollars annually.

Third, we need to set up a system of health share networks, in local communities and nationwide, where people could communicate ideas about health and arrange to exercise together in groups.  These could be especially valuable in small communities where there are not enough doctors.  Taken together, these three approaches could vastly improve the quality or health care for individuals and diminish its cost.

An earlier version of this post was published in the Bloomington Herald Times.

Saturday, August 6, 2011

What's Wrong With BMI

In studies dealing with body weight in relation to mortality scientists often use BMI (body mass index) to determine whether or not a particular individual is overweight.  In recent studies a high BMI has been a good predictor of mortality in young people but not in seniors.  Some scientists have been puzzled by these results.  I think the problem is with BMI as a tool; it is not a very accurate indicator of whether an individual is fat.  To determine whether a person is obese you need to measure their body fat.

BMI is calculated by relating weight to height.  You multiply your weight in pounds by 4.88, then divide it by your height in inches squared.  For example I weigh 143 pounds (x 4.88=697.84) and I’m 5’5.5” tall (squared = 29.81) so my BMI is 23.4, at the high end of the normal range   (For an online BMI calculator go to http://www.nhlbisupport.com/bmi/)  In people who are muscular (like me) BMI tends to be high even though body fat may be quite low.  At the other end of the spectrum are very thin people with very little muscle mass; their BMI’s will be normal even though their body fat might be high. 

Getting back to those confusing studies, let’s imagine a group of people in their 30’s whose BMI’s are high, some because they are too fat, others because they are more muscular than average.  So BMI is lumping together people who are in poorer than average physical condition and people who are in better than average shape. 

Fast forward 40 years and measure the BMI’s of the same group.  In the Too Fat sub-group some have died, while others have moved into a lower BMI category because of illness, malnutrition, or other weight loss.  The More Muscular Than Average sub-group has tended to change less.  As compared with the TF’s, fewer have died and more have exercised regularly because it is easier for them to do so.  Because of the exercise they have less illness and less age-related weight loss.  Even MMA’s who never exercise (like my late mother-in-law) tend to live longer because their hearts are likely to be strong like the rest of their muscles.  So this later version of the high BMI group is going to have more people in better than average shape than the earlier version.

The good news is that it is possible to build muscle mass at any age, given reasonable health and nutrition that is sufficient to support muscle development.  I am a case in point.  At 30 I couldn’t do a single pushup; now, at 65, I can do at least 40.  Protein is an important part of this picture and many older people do not get enough in their diets or their bodies don’t adequately process the protein they do ingest.  Fortunately, protein supplements and proteolytic enzyme supplements (to help digest protein) are widely available in stores and on the internet.

Thursday, August 4, 2011

The Upside of Blood Work

This week I got back the results of my annual blood tests, a preliminary to the annual physical exam.  I don’t love fasting until mid-morning and having blood drawn but this year I was thrilled with the actual results which are a measure of how far I have come – and how much healthier I am – than I was ten years ago.

In my early 50’s my cholesterol had been borderline high but the doctor and I decided to let it go.  By 2000, when I was 55, my total cholesterol was 265, the HDL (good cholesterol) at 80, and the LDL at 163 and the doctor recommended that I start taking statins.  Because of a general aversion to taking medications when I’m not obviously sick, I said, “Let me try diet and exercise instead.”  This kicked off a ten-year quest to finally accomplish what I had wanted to do since my early teens: to get into shape.

During my years in the diet-and-exercise wars I have learned that almost everything works for a while.  This time, in the spring of 2000, I tried the Slim-Fast plan which involves substituting one of their bars or shakes for one meal a day.  I did this for six weeks and lost 10 pounds.  At the same time I started increasing my exercise time at the Y; I had been walking and using a few weight machines but now I started working out on the elipticals.

The following year’s blood work showed that my LDL had gone down 16 points but that was still too high.  I went back to the Slim-Fast program and this time lost about 8 pounds.  I also decided that my balance needed work so I learned how to rollerblade.  At Western Skateland I hung onto the wall and crept around the track while 5-year-olds whizzed by me.  Eventually, I could let go and actually enjoy skating indoors and later outdoors on the newly paved Clear Creek Trail.   My balance improved and I lost inches around the thighs.  By 2002 my LDL was a respectable 109.

By this point I’d become convinced that exercise was magic, that it could transform me into a stronger, healthier person.  In the winter of 2003 when I started having soreness in my shoulders and upper arms I began doing more upper body work.  The pain went away.  For the next few years, things stayed about the same.  I couldn’t seem to lose any more weight and my total cholesterol stayed around 220, a bit high but not enough to worry about.

Then in 2007 I read a great article in the Sunday New York Times magazine about how swimmer Dara Torres, then 41, was trying a new approach in training for the Olympic Games, using lighter weights and stability balls.  While traditional weight lifting uses a limited part of the muscle, stability ball exercises involve stretching, movement, and instability to make the muscle flexible and versatile as well as stronger.  A trainer taught me a few exercises and I found many more in a book called Strength Ball Training by Peter Twist and Lorne Goldenberg. 

By this point, at the end of 2007, I was pretty satisfied with where I was.  My weight had gone from 178 to 155 and my body fat percentage had dropped from the high 30’s to the low 20’s.  My total cholesterol was 208, LDL 106.  But by then I had discovered an unfortunate fact about exercise: if you don’t keep doing harder and harder workouts you lose condition.  In 2008 I began doing training sessions with Greg Simmons, an instructor at Indiana University and a world class weight lifter.  I also tried out some of Tony Horton’s P90X workouts on days when I wasn’t going to the gym.

Last year Greg and his wife Susan, also a kinesiologist at IU, started me on a custom-designed cardio program using technology from New Leaf Active Metabolic Training  An initial test measures how your body uses oxygen.  Based on the results, a cardio workout is designed that improves your body’s ability to burn fat.  With the help of this program, my weight is now 143, body fat around 12%, LDL and HDL cholesterol both in the mid-90’s.  At this point I don’t want to lose any more weight or body fat; it’s a matter of maintaining the present levels   At 65, I feel much better than I did in 2000, I sleep soundly and I rarely get sick.  I feel very lucky to have gotten here.