tag:blogger.com,1999:blog-29586049733034388512024-03-20T02:19:38.300-07:00no body's perfectreflections on health, fitness, and medical caregretchen kromer's bloghttp://www.blogger.com/profile/02012944567250392269noreply@blogger.comBlogger152125tag:blogger.com,1999:blog-2958604973303438851.post-80735019874248091002019-04-08T11:01:00.000-07:002019-04-08T11:04:36.320-07:00Confusion in DEXAland<span style="font-family: "calibri";"><em>This a follow-up to two previous posts about my experiences
with DEXA scans:</em> </span><br />
<span style="font-family: "calibri";"><a href="http://bit.ly/2BQlpEC">http://bit.ly/2BQlpEC</a> </span><br />
<span style="font-family: "calibri";"><a href="http://bit.ly/2YDvu2x">http://bit.ly/2YDvu2x</a></span><br />
<br />
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<span style="font-family: "calibri";">When I was in high school, my parents were friends with a
couple called Bob and Marge. In old age Marge, a small, sweet-faced woman,
developed catastrophic bone loss and was forced to wear a sort of metal cage to
hold her body together. She was in constant pain and spent much of her time in
bed. <o:p></o:p></span></div>
<span style="font-family: "calibri";">Osteoporosis is a real and serious condition that can
destroy your life if it gets out of hand. At this point, the only therapy
accepted by the medical establishment is a group of drugs called
bisphosphonates, which are not all that effective and should probably not be
used long term because of an increasing risk of <a href="https://www.ti.ubc.ca/2011/02/23/bisphosphonates-do-they-prevent-or-cause-bone-fractures/">side effects</a> such as fractures
of the femur and osteonecrosis of the jaw. In order to avoid taking
bisphosphonates, I have been using a program of impact exercises for the hip
and spine, initially based on research by Dr. Larry Tucker at Brigham Young, as
described in the previous two posts. <o:p></o:p></span><br />
<br />
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<span style="font-family: "calibri";"><span style="font-family: "calibri";"><span style="font-family: "calibri";">The decision to start bisphosphonate therapy should not be
taken lightly. This is why it is so important for there be clear, consistent,
and reliable data on the patient’s actual condition, both in the present and as
time goes on. This year, as every year, after the DEXA had been completed, I
asked the technician to print me a copy of the report from the machine. (Copies
of pages from the 2019 and 2018 reports are included in this post.) I
immediately noticed that my spine, which had been shown as osteoporotic since
2015, was now back in osteopenia territory; it had improved by one whole
standard deviation within the past year.</span></span></span><br />
<br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhRN6_0OA9b4oRa9Cs9veR9ONGM-fm6AiKmYQNf2Hwlo6ez83YjbdwOSbgzxSLRRK8lXszedFJYWz-6SWcum11wablE8KKWPDUH4YSKw9cypyvjcv-1mGuHSpkqp-4TXz6CVlCW58FEst8f/s1600/DEXA+3-2018-3+edited.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="584" data-original-width="532" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhRN6_0OA9b4oRa9Cs9veR9ONGM-fm6AiKmYQNf2Hwlo6ez83YjbdwOSbgzxSLRRK8lXszedFJYWz-6SWcum11wablE8KKWPDUH4YSKw9cypyvjcv-1mGuHSpkqp-4TXz6CVlCW58FEst8f/s320/DEXA+3-2018-3+edited.jpg" width="291" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh0n5CgMbL_DhRwN-vL97FvZ0QZjsay757hTMa9puWMjCjaq8u6z8GxdxcBlmOUau-ZE0iUam64afjOVGUOCzZLdLOul5McF8MIIxm64vX6aW4kpa-jqHGa1EqYmwkw48A0sgHGE7UVvPiU/s1600/DEXA+3-2019-3+edited.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="550" data-original-width="538" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh0n5CgMbL_DhRwN-vL97FvZ0QZjsay757hTMa9puWMjCjaq8u6z8GxdxcBlmOUau-ZE0iUam64afjOVGUOCzZLdLOul5McF8MIIxm64vX6aW4kpa-jqHGa1EqYmwkw48A0sgHGE7UVvPiU/s320/DEXA+3-2019-3+edited.jpg" width="312" /></a><span style="font-family: "calibri";"><span style="font-family: "calibri";"><span style="font-family: "calibri";"></span></span></span><br />
<br />
<span style="font-family: "calibri";">The technician told me that this year’s report would look
different from last year’s because this year the machine (modestly named the
Lunar Prodigy Advance DXA System) had read L1-L4 instead of the L1-L2 it had
looked at last year. I asked whether the change was an actual improvement or
whether it was just a statistical artifact because the machine was looking at
four vertebrae instead of two and she said it was an actual improvement. She
also alerted me to the fact that the machine would now go back and change the
numbers from all the spine readings of previous years so that the 2019 and 2018
reports would not match up. The hip readings for both years were about the same.<o:p></o:p></span><br />
<br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiwisRYgnGM6iuSEDcJSqOA4YuM5kDDG6yHwEHKrT3YCNGTciN0ugw2orWCvCMN4sZvig0fP_OYgPEWWfzm6riDMHXvjpjAL3tdg4RpTHFseWAycpZodqz04CTxkeiQ-gKstbZ6AcHMVOa5/s1600/DEXA+3-2018-1+edited.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="370" data-original-width="536" height="220" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiwisRYgnGM6iuSEDcJSqOA4YuM5kDDG6yHwEHKrT3YCNGTciN0ugw2orWCvCMN4sZvig0fP_OYgPEWWfzm6riDMHXvjpjAL3tdg4RpTHFseWAycpZodqz04CTxkeiQ-gKstbZ6AcHMVOa5/s320/DEXA+3-2018-1+edited.jpg" width="320" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjPI2xRQUBJ9oakIyCRrLZemkZDgsYqVU2E8rXooDvmvi94r0DcF6w3PYTa16nqpiE4X42ZNccJZJsNOiE8m2AtD27nWug8IiXiMp8Q7aUWSOcXrRloF8pRg1EqOU2JdqCJdXkjxkI2qrwC/s1600/DEXA+3-2019+-1+edited.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="431" data-original-width="526" height="262" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjPI2xRQUBJ9oakIyCRrLZemkZDgsYqVU2E8rXooDvmvi94r0DcF6w3PYTa16nqpiE4X42ZNccJZJsNOiE8m2AtD27nWug8IiXiMp8Q7aUWSOcXrRloF8pRg1EqOU2JdqCJdXkjxkI2qrwC/s320/DEXA+3-2019+-1+edited.jpg" width="320" /></a><br />
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<br /></div>
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<span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";">Looking at page 1 of each of the two, the 2018 report said that my
spine was osteoporotic at 0.798 g/cm<sup><span style="font-size: x-small;">2</span></sup> whereas the 2019 report says
that the 2018 reading was osteopenic at 0.931 g/cm<sup><span style="font-size: x-small;">2</span></sup>. It also revises
the WHO Classifications to show osteopenia for all past years, even though
previous reports have shown osteoporosis in the spine since 2015. The % Change
vs. Previous column shows no significant change in the past year!<o:p></o:p></span></span></div>
<br />
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<span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";">How to make sense of this? It appears to me that machine is looking
at two different dimensions of spine health and bringing them together, rather
awkwardly, on page 1. This looks like poor scientific practice. What is really
serious, though, is that it conceals the improvement in my spine from anyone to
doesn’t actually look at the two reports side by side. <o:p></o:p></span></span></div>
<br />
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<span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";">The radiologist probably didn’t do this. The linear structure of
electronic health records means that the 2018 report was probably buried about fifteen
screens down. Who has time to scroll through all that—and why bother when the
report appears to be giving you the information you need already? A week later a nurse
from my doctor’s office called to say that my doctor was recommending I take a
bisphosphonate. I pointed out that my spine seemed to have improved and that my
hip readings were stable. My guess is that the radiologist recommended the drug
in order to be protected from liability and my own doctor, who probably didn’t
have time to look at one report much less two, just took his or her word for
it.<o:p></o:p></span></span></div>
<br />
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<span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";">I still wanted to know what had prompted the Lunar Prodigy to look
at two additional vertebrae so I emailed GE, the manufacturer. No response. I’m
reserving judgment until next year about the big improvement in my spine but I
do believe that the exercises are protecting my spine and hip bones at least as
well as bisphosphonates would and without the added risks.<o:p></o:p></span></span></div>
</div>
gretchen kromer's bloghttp://www.blogger.com/profile/02012944567250392269noreply@blogger.com0tag:blogger.com,1999:blog-2958604973303438851.post-23005655639940042622019-03-31T07:18:00.000-07:002019-03-31T07:18:03.237-07:00Maintaining Bone Density in My Spine with a Simple (but Time-Consuming) Exercise<div class="MsoNormal" style="margin: 0in 0in 8pt;">
<span style="font-family: "calibri";">In October of 2016 I wrote a post about jumping to retain
bone mineral density (BMD) in my hipbones <a href="http://bit.ly/2BQlpEC">http://bit.ly/2BQlpEC</a>. <span style="font-family: "calibri";"><span style="font-family: "calibri";">Jumping seemed to help my hipbones, though I had to increase
from 15 minutes twice a day to 30 minutes twice a day to reach the point of “no
significant change.” My hips were still osteopenic but the T-scores, comparing
my BMD with a young adult, were mostly in the low 2s, whereas my spine was over
3. </span></span></span><br />
<span style="font-family: "calibri";"><span style="font-family: "calibri";"><span style="font-family: "calibri";"></span></span></span><br />
<span style="font-family: "calibri";"><span style="font-family: "calibri";"><span style="font-family: "calibri";"><span style="font-family: "calibri";">Since impact exercise seemed to work for hips, I came up
with the following impact exercise for the spine:<o:p></o:p></span></span></span></span></div>
<span style="font-family: "calibri";"><strong>Sit on the floor with knees bent up, feet flat on the floor,
hands flat on the floor a little behind your hips, fingertips pointing forward.
Lift yourself onto your feet and hands, a bit like a reverse table in yoga.
Then bring your hips down sharply to bump on the floor. It is important to keep
your feet pulled in fairly close to the hips so that you land on your bottom,
not your tailbone.<o:p></o:p></strong></span><br />
<br />
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<span style="font-family: "calibri";">I started doing this exercise with a small clock in front of
me, one bump every 30 seconds for 15 minutes twice a day. I now try to do 30
minutes twice a day, though I don’t always get there. I’m experimenting with
doing more jumps and bumps per minute to see whether that makes any difference.
It took more than a year for me to see improvement, but the last two DEXA
reports (3/18 and 3/19) show “no significant change” for the spine as well the
most of the hip readings. The T-score for my spine is now in the 2s.<o:p></o:p></span></div>
<span style="font-family: "calibri";">I do these exercises while watching the PBS Newshour (the
only news show I can tolerate) and old movies on TV. Two hours is a lot of time
to spend and I realize that most people couldn’t or wouldn’t do this. On the
other hand, I am post-menopausal. These exercises might work faster for younger
people. What really needs to happen is for someone to build on the insights
provided by this research, either by finding a way to intensify the exercises
or by inventing a machine that would deliver impact to the hip and spine
without harming the body.</span><br />
<span style="font-family: "calibri";"><o:p></o:p></span><br />
<span style="font-family: "calibri";">Doctors continue to remind me that I am at increased risk
for fracture and I’m sure that’s true, though I’ve never actually broken a bone
in my life. They continue to recommend that I take bisphosphonates. Medical
science has known for a long time that these drugs can have horrific side
effects, particularly with long-term use (See this 2011 post from the
University of British Columbia <a href="http://bit.ly/2YDEHrx">http://bit.ly/2YDEHrx</a><o:p>.) </o:p><span style="font-family: "calibri";"><span style="font-family: "calibri";">The side effects are supposedly rare, yet I keep hearing
stories about women who have experienced them. Perhaps they are not so much
rare as under-reported. </span></span></span><br />
<span style="font-family: "calibri";"><span style="font-family: "calibri";"><span style="font-family: "calibri";"></span></span></span><br />
<span style="font-family: "calibri";"><span style="font-family: "calibri";"><span style="font-family: "calibri";"><span style="font-family: "calibri";">People with advanced arthritis or similar disabling
conditions will probably not be able to use impact exercises. For those who
can, impact exercises offer an alternative to the uncertainties surrounding
bisphosphonates.<o:p></o:p></span></span></span></span>gretchen kromer's bloghttp://www.blogger.com/profile/02012944567250392269noreply@blogger.com0tag:blogger.com,1999:blog-2958604973303438851.post-72065278658153412222019-01-07T12:32:00.001-08:002019-01-24T05:17:59.143-08:00The Moral Conundrum of Max the Cat<h4 class="MsoNormal" style="margin: 0in 0in 8pt;">
<em><span style="color: #999999; font-family: "arial" , "helvetica" , sans-serif;">We gave him a comfortable home, improved health, food, toys,
and love–but we took away what he valued most.</span></em> </h4>
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</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhHH1SExC1qwmZK7tfz-zyNU_1EagyJLwCesxIVpCwhlnsuDqpd7xxnZDSiE3ieDEQC0Va4z6nx4lmmp6mF_yVn8pG6iwDY5mDpSx_mUjUMoCfWL5q_UEGd1eucdJjtk_DQew_2RQWEbaQd/s1600/Max+2018.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="756" data-original-width="756" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhHH1SExC1qwmZK7tfz-zyNU_1EagyJLwCesxIVpCwhlnsuDqpd7xxnZDSiE3ieDEQC0Va4z6nx4lmmp6mF_yVn8pG6iwDY5mDpSx_mUjUMoCfWL5q_UEGd1eucdJjtk_DQew_2RQWEbaQd/s320/Max+2018.jpg" width="320" /></a></div>
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<span style="font-family: "calibri";"><span style="font-family: "arial" , "helvetica" , sans-serif;">“Let’s see this prodigy!” I said to our handyman as he
pulled the cat carrier out of his truck. He opened the cage and lifted out a
tiny creature with round eyes and exquisite tiger and white markings. So we brought
the kitten to our house and let him out to explore the back porch. Almost
immediately there were piercing meows whose meaning was perfectly clear. “Where’s
the farm? Where’s my family? I don’t like this!” Later it turned out that there
were compensations: unlimited lactose-free milk, toys, soft pillows to sleep
on, and lots of attention. It seemed OK for a while.<o:p></o:p></span></span></div>
<span style="font-family: "arial" , "helvetica" , sans-serif;"></span><br />
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<span style="font-family: "calibri";"><span style="font-family: "arial" , "helvetica" , sans-serif;">In an earlier </span><a href="http://bit.ly/2nPhMr2"><span style="font-family: "arial" , "helvetica" , sans-serif;">post</span></a><span style="font-family: "arial" , "helvetica" , sans-serif;"> I recounted our first weeks with Max and
Bella, the slightly older female kitten we adopted at about the same time. They
got along well with each other and with our older cat Rowan. They played,
learned new skills, and grew stronger. Years ago, we would have started letting
them out at about this age. Our neighborhood was quieter then and our cats
enjoyed exploring the yard and basking in the sun on the back porch. These days,
it is simply too dangerous. There are more people and more cars. We even have
birds of prey, possibly driven into town by the development of surrounding rural
areas – owls, hawks and turkey vultures – that carry off small animals. <o:p></o:p></span></span></div>
<span style="font-family: "arial" , "helvetica" , sans-serif;"></span><br />
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<span style="font-family: "calibri";"><span style="font-family: "arial" , "helvetica" , sans-serif;">Like Rowan, Bella was content to be indoors, but for Max
there was always something missing. In the morning about breakfast time, he
would run around the house meowing, trying all the doors and windows. This
would go on for about an hour. In the evening, the same routine for a slightly
shorter time. He showed his contempt for our restrictions in other ways, like
pulling a dish towel down on the floor and peeing on it. <o:p></o:p></span></span></div>
<span style="font-family: "arial" , "helvetica" , sans-serif;"></span><br />
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<span style="font-family: "calibri";"><span style="font-family: "arial" , "helvetica" , sans-serif;">Some people have suggested that Max might like a little
fenced-in area outside, but I know better. What he wants is to be completely
free. He comes from a long line of working cats and he wants to be doing the
job he was destined for, killing stuff outdoors. As a barn cat, Max would have
been exceptional. He is very smart; he recently taught himself to open the
drawer under my bed. He loves challenges and risk-taking and isn’t afraid of
anything. He gets up on top of the refrigerator and walks along the upstairs
railing with ease. He is frustrated because his talents are being wasted; he
has wound up in what is basically a spa for cats! <o:p></o:p></span></span></div>
<span style="font-family: "arial" , "helvetica" , sans-serif;"></span><br />
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<span style="font-family: "calibri";"><span style="font-family: "arial" , "helvetica" , sans-serif;">For a long time I tried to think of other options for Max – giving him to someone with a better yard for cats, even sending him back to the farm –
but in some ways he is not well suited to be an outdoor cat. Though mighty in
spirit, Max is not a large cat, only about ten pounds, and could be injured by
a bigger animal. Max is also friendly and loves the company of other friendly cats and people. Outdoors, he would probably be lonely. He might even befriend
a human passerby and get picked up as a stray. Max is also very fastidious and
keeps himself clean at all times. When we first brought him home we got a damp paper
towel and wiped off his tiny feet, which were dirty from being in the cat
carrier. Once he understood what we were doing, he started purring.<o:p></o:p></span></span></div>
<span style="font-family: "arial" , "helvetica" , sans-serif;"></span><br />
<div class="MsoNormal" style="margin: 0in 0in 8pt;">
<span style="font-family: "calibri";"><span style="font-family: "arial" , "helvetica" , sans-serif;">As cats get older, they seem to develop a deeper attachment
to the people and other cats they love. Max and Rowan take naps together. He
and Bella chase each other around the house. Max is two-and-a-half now and the
demands to go out are fewer and less intense. Nobody gets everything they want
in life, not even cats.<o:p></o:p></span></span></div>
gretchen kromer's bloghttp://www.blogger.com/profile/02012944567250392269noreply@blogger.com0tag:blogger.com,1999:blog-2958604973303438851.post-44627156663598921812018-07-21T12:49:00.000-07:002018-07-21T12:49:25.554-07:00An Alternative to Mohs Surgery for Basal Cell Carcinoma<div class="MsoNormal" style="margin: 0in 0in 8pt;">
<span style="font-family: "arial" , sans-serif;">Last summer I
started to notice a spot on my nose. It looked a bit like a pimple but it
didn’t go away. After a few weeks I went to a dermatologist and had a biopsy.
Bad news: basal cell carcinoma, not the worst kind of skin cancer but not to be
ignored. Doctors call BSC “the rat cancer” because it burrows under the skin,
out of sight; there is no way to tell how much (or even where) it has spread. <o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 8pt;">
<span style="font-family: "arial" , sans-serif;">The
dermatologist told me that I should have Mohs surgery to remove the cancer. The
procedure is for the surgeon to shave off skin a layer at a time, testing each
layer as she goes, until a cancer-free layer is reached. There is no way to
know ahead of time whether the surgeon will remove one layer or seven. In an
area as delicate and contoured as the nose, a seven- layer procedure would
leave a large wound that would take weeks or months to heal completely and
might require plastic surgery. For me, that would mean canceling the annual
scuba diving trip and possibly ending up with a permanent, unsightly mess at
the end of my nose. Surely, I thought, there must be a better way.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 8pt;">
<span style="font-family: "arial" , sans-serif;">And there is.
It’s called superficial radiation therapy and it has become available within
the last ten years. It is distinct from an earlier form of radiation therapy
that was commonly used before the introduction of Mohs surgery, which became the
standard treatment for BSC in the 1970s. SRT is not available everywhere and
has advantages and disadvantages compared with Mohs. The experience of having
an SRT treatment is similar to having a dental x-ray and takes about as long.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 8pt;">
<span style="font-family: "arial" , sans-serif;">-<span style="mso-spacerun: yes;"> </span>SRT is non-invasive, painless, and
non-scarring. Like any surgery, Mohs causes bleeding, pain, and an unpredictable
amount of scarring.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin: 0in 0in 8pt;">
<span style="font-family: "arial" , sans-serif;">-<span style="mso-spacerun: yes;"> </span>SRT requires 12-15 very short visits for
treatment. Mohs surgery requires 2 visits, one of which may last all day. If
there are unforeseen complications, further visits may be needed and, possibly,
treatment by a plastic surgeon.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin: 0in 0in 8pt;">
<span style="font-family: "arial" , sans-serif;">-<span style="mso-spacerun: yes;"> </span>The cost of both types of treatment is about
the same and both are covered by insurance. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin: 0in 0in 8pt;">
<span style="font-family: "arial" , sans-serif;">-<span style="mso-spacerun: yes;"> </span>The cure rate of Mohs is slightly higher, but
both are above 90%.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin: 0in 0in 8pt;">
<span style="font-family: "arial" , sans-serif;">- SRT may
increase the likelihood of getting cancer again, decades in the future. (If I’m
around then, I expect that there will be much better forms of treatment
available.)<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 8pt;">
<span style="font-family: "arial" , sans-serif;">For me, the
good news was that SRT <b style="mso-bidi-font-weight: normal;">is</b> available
in Indiana. The bad news is that the best qualified facility is in Muncie, more
than 2 hours from my house (more like 2.5, with road construction at both
ends). But I did it anyway – 14 round trips between late September and early
November of last year. The facility had an oncologist to determine the dosage
but the actual treatments were done by a technician. At the time of the last
few sessions I had some mild bleeding from my nose but that was the only
discomfort. I’m so glad I did this!</span><br />
<span style="font-family: "arial" , sans-serif;"></span><br />
<span style="font-family: "arial" , sans-serif;"><o:p></o:p></span> </div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjeVZmA_x8bHJPdk89_opwn4Bb0nrMiXzV17aOSnHkeslM5LLy1g6EWqhflz3i8-c6eeMVbiCX3Pg2gLdImgcNTkYHxSMF9Ttrae7PdWZypdwYQiXDtEjC-ML_65xxmBesG8CxsA_xAE-v5/s1600/nose2a.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="204" data-original-width="332" height="122" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjeVZmA_x8bHJPdk89_opwn4Bb0nrMiXzV17aOSnHkeslM5LLy1g6EWqhflz3i8-c6eeMVbiCX3Pg2gLdImgcNTkYHxSMF9Ttrae7PdWZypdwYQiXDtEjC-ML_65xxmBesG8CxsA_xAE-v5/s200/nose2a.jpg" width="200" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiaHnPqXiQdbLjMPdXmWa_Dk9ktYUH5-AeP8vxRSoVsk_s6pl8CugEojiLkGd5IyKBN6uj16knrgQBHPiQTBqH6bAgO5hoUyXkRM3B0Ew3xzWsaSeyFhV7dE0NbWKU2-J2IFPib6mloGP3T/s1600/nose1a.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="197" data-original-width="324" height="121" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiaHnPqXiQdbLjMPdXmWa_Dk9ktYUH5-AeP8vxRSoVsk_s6pl8CugEojiLkGd5IyKBN6uj16knrgQBHPiQTBqH6bAgO5hoUyXkRM3B0Ew3xzWsaSeyFhV7dE0NbWKU2-J2IFPib6mloGP3T/s200/nose1a.jpg" width="200" /></a></div>
gretchen kromer's bloghttp://www.blogger.com/profile/02012944567250392269noreply@blogger.com0tag:blogger.com,1999:blog-2958604973303438851.post-63163934105829511922018-04-29T11:38:00.000-07:002018-04-29T11:51:24.036-07:00More Reasons for the Eroding Trust between Patients and Physicians<div class="MsoNormal" style="margin: 0in 0in 8pt;">
<span style="font-family: "calibri";">I’ve just been reading an article by James F. Sweeney, “The
Eroding Trust Between Patients and Physicians”, that appeared in the 4/10/2018
issue of Medical Economics. First, I appreciate the fact that Mr. (Dr.?)
Sweeney is addressing this issue, which is a serious detriment to effective
medical care. Lack of time and of any substantial relationship with the patient
are the causes emphasized by Sweeney, but there are a number of others that
deserve attention.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 8pt;">
<span style="font-family: "calibri";"><i style="mso-bidi-font-style: normal;">Standard of Care
imposes constraints</i> that encourage doctors to play it safe and avoid
creative thinking. Especially in the field of oncology, the threat of liability
intimidates many doctors and may cause them to see each new patient as a
potential lawsuit. The treatments endorsed by Standard of Care sometimes
reflect out-of-date science rather than the latest and best thinking in the
field.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 8pt;">
<span style="font-family: "calibri";"><i style="mso-bidi-font-style: normal;">Reliance on randomized
controlled trials</i> (in addition to lack of time) means that patients tend to
be treated by category. RCTs are useful as an overall indicator, but they don’t
tell the physician anything at all about a particular patient.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 8pt;">
<span style="font-family: "calibri";"><i style="mso-bidi-font-style: normal;">Medical offices
frequently don’t have accurate, long-term medical records for patients.</i>
With the advent of electronic records, decades of precious data on individual
patients were discarded and lost. Unless the patient herself has kept hard
copies, the doctor must make recommendations based on a couple of years of test
results. Adding to this problem is the lack of compatibility among EMR systems.
<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 8pt;">
<span style="font-family: "calibri";"><i style="mso-bidi-font-style: normal;">The connection between
medical practice and science is becoming more tenuous</i>. Protocols for some
tests are not followed correctly. (My favorite example is the taking of blood
pressure, when medical offices don’t have you sit quietly for a few minutes
beforehand, the correct protocol. Then they tell you that you have high blood
pressure.) We hear confident statements that calcium supplements promote heart
disease, when the evidence for this is shaky at best. Medical practice tends
to cherry pick scientific studies and highlight those that support what it is
already doing.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 8pt;">
<span style="font-family: "calibri";"><i style="mso-bidi-font-style: normal;">In spite of substantial
scientific evidence supporting the role of diet and exercise to good health,
many medical practitioners discount their importance.</i> Ads for medical
practices and hospitals featuring photos of overweight doctors and nurses are
clear evidence of this attitude.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 8pt;">
<span style="font-family: "calibri";"><i style="mso-bidi-font-style: normal;">Current medical
practice tends to reject, even scorn, any therapy that isn’t part of the
conventional canon.</i> After developing painful scar tissue in my shoulder and
arms, I was successfully treated by a chiropractor with myofascial therapy
(MRT) and active release technique (ART). Conventional medicine’s
recommendation? Pain meds or surgery.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 8pt;">
<span style="font-family: "calibri";">These are all features of medical practice today that are
causing physicians to lose credibility in the eyes of their patients.<o:p></o:p></span></div>
gretchen kromer's bloghttp://www.blogger.com/profile/02012944567250392269noreply@blogger.com0tag:blogger.com,1999:blog-2958604973303438851.post-40659821577219105622018-02-09T13:36:00.000-08:002018-02-09T13:36:19.434-08:00Foot Surgery the Easy Way<div class="MsoNormal" style="margin: 0in 0in 8pt;">
<span style="font-family: Calibri;"><span style="font-family: Arial, Helvetica, sans-serif;">I was born with curly little toes on both feet. That never
bothered me until the past year, when the left one decided to curl out a bit
more and started rubbing against the insides of formerly comfortable shoes and
boots. For a while, I babied it along with band aids and pads but finally it
was time for a visit to my wonderful podiatrist Dr. Hoffman (introduced in
</span><a href="http://bit.ly/2ESEJm3"><span style="font-family: Arial, Helvetica, sans-serif;">Respect the Feet</span></a><span style="font-family: Arial, Helvetica, sans-serif;">).<o:p></o:p></span></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;"></span><br />
<div class="MsoNormal" style="margin: 0in 0in 8pt;">
<span style="font-family: Calibri;"><span style="font-family: Arial, Helvetica, sans-serif;">“What have you done this time?” he asked. I explained that I
thought I was getting a bunion. Instead, he identified it as a type of hammer
toe, a condition that is often treated by breaking the toe and inserting a
wire; big incision, lots of pain, weeks of recovery time. Instead, Dr. H
proposed a minimally invasive 10 minute procedure in which a tiny incision is
made, the tendon is nicked, and the patient goes back to normal life
immediately.<o:p></o:p></span></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;"></span><br />
<div class="MsoNormal" style="margin: 0in 0in 8pt;">
<span style="font-family: Calibri;"><span style="font-family: Arial, Helvetica, sans-serif;">So I did that. The worst part of it was the shots to numb
the foot. After that, I really felt no pain at all, either during the procedure
or later. Dr. H offered an antibiotic and suggested an over the counter pain
med, but I said “No, thanks” to both of those. The only real hassle was keeping
the dressing dry for a few days, which meant showering with a towel and a
plastic bag around my foot. Now I’m back to wearing my regular shoes and boots.
Dr. Hoffman scores again!<o:p></o:p></span></span></div>
gretchen kromer's bloghttp://www.blogger.com/profile/02012944567250392269noreply@blogger.com0tag:blogger.com,1999:blog-2958604973303438851.post-17556048093167999992018-01-21T06:17:00.000-08:002018-01-21T06:16:59.971-08:00Got IBS D? This Probiotic Yeast Could Be Your NBF.<span style="font-family: "calibri";"><span style="font-family: Arial, Helvetica, sans-serif;">In 2014 my doctor at the time ordered tests in an attempt to
find the cause of my longtime gut problems (discussed in </span><a href="http://bit.ly/2vcg366"><span style="font-family: Arial, Helvetica, sans-serif;">Trouble Down Below</span></a><span style="font-family: Arial, Helvetica, sans-serif;">).
The tests came back negative except for the observation that a few Blastocystis
hominis (BH) organisms were seen. At some point later on, I mentioned this to a
GI specialist and he said, “Oh, that’s nothing!” </span></span><br />
<span style="font-family: "calibri";"><o:p></o:p></span><span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
<div class="MsoNormal" style="margin: 0in 0in 8pt;">
<span style="font-family: "calibri";"><span style="font-family: Arial, Helvetica, sans-serif;">In general, this seems to be true. In 2000, approximately
23% of the US population was infected with this protozoan, most with no
symptoms at all. (In less developed countries, the percentage is much higher.)
BH tends to run with IBS and with colorectal cancer but the relationship is not
clear. For a few unlucky people, it can cause major digestive upsets lasting
weeks or months.<o:p></o:p></span></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;"></span><br />
<div class="MsoNormal" style="margin: 0in 0in 8pt;">
<span style="font-family: "calibri";"><span style="font-family: Arial, Helvetica, sans-serif;">During a trip last month I started to have diarrhea, acid
reflux, and intermittent queasiness. Since I do sometimes have digestive upsets
when I travel, I didn’t think much about it. When I got home, the other
symptoms went away; the diarrhea got worse—many, many trips to the bathroom,
often in the middle of the night. Before calling my nurse practitioner to see
about ordering tests, I did some online research to see what treatments were
likely to be. One word: antibiotics.<o:p></o:p></span></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;"></span><br />
<div class="MsoNormal" style="margin: 0in 0in 8pt;">
<span style="font-family: "calibri";"><span style="font-family: Arial, Helvetica, sans-serif;">I’m not totally against these medications; if I have a
life-threatening bacterial infection, an antibiotic is certainly what I want to
be taking. In my present situation, though, I had reservations. Antibiotics
don’t always work for bowel problems. They can also do </span><a href="http://bit.ly/2tHVDjA"><span style="font-family: Arial, Helvetica, sans-serif;">long-term damage</span></a><span style="font-family: Arial, Helvetica, sans-serif;"> to the
immune system by killing off good bacteria in the gut and they
may have unpleasant side effects, like diarrhea and yeast infections. <o:p></o:p></span></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;"></span><br />
<div class="MsoNormal" style="margin: 0in 0in 8pt;">
<span style="font-family: "calibri";"><span style="font-family: Arial, Helvetica, sans-serif;">I started looking around for other options and came upon a
yeast called Saccharomyces boulardii (SB). This probiotic is a veritable Swiss
Army knife of beneficial functions and has been studied for decades. It has
repeatedly been shown to work well against diarrhea, sometimes as well as or
better than antibiotics. SB is believed to be a strain of baker’s yeast (S.
cerevisiae) and is completely safe and without side effects, except for people
who are allergic to yeasts. SB can be combined with antibiotic treatment to
help support bowel function; since it’s not a bacterium, antibiotics won’t kill
it. SB has been shown in some studies to be effective against Candida albicans,
ironic because they are both yeasts. There are also researchers who are looking
at various uses of SB for cancer patients. <o:p></o:p></span></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;"></span><br />
<div class="MsoNormal" style="margin: 0in 0in 8pt;">
<span style="font-family: "calibri";"><span style="font-family: Arial, Helvetica, sans-serif;">I started taking SB 250 mg. three times a day. The tests
came back showing—you guessed it—Blatocysitis hominis! After a few days with
not much change, I went online again and discovered </span><a href="http://bit.ly/2mtDMbS"><span style="font-family: Arial, Helvetica, sans-serif;">a French study</span></a><span style="font-family: Arial, Helvetica, sans-serif;"> from 1996
about diarrhea in 30 people with AIDS</span></span><span style="font-family: "calibri";"><span style="font-family: Arial, Helvetica, sans-serif;">
(under Clinical Studies in PWAs). The subjects took 3000 mg of SB per day, six
times the normal daily dose. After two days, they saw significant improvement,
at eight days their bowel function was normal. <o:p></o:p></span></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;"></span><br />
<div class="MsoNormal" style="margin: 0in 0in 8pt;">
<span style="font-family: "calibri";"><span style="font-family: Arial, Helvetica, sans-serif;">I started taking 3000 mg per day of SB and also saw
significant improvement after two days. For me, it took about three weeks to get
back to normal. I plan to continue at the same dose for another couple of
weeks, then gradually reduce it. Given the possibility of an allergic reaction,
I think it was just as well that I tried the lower dose first. <o:p></o:p></span></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;"></span><br />
<div class="MsoNormal" style="margin: 0in 0in 8pt;">
<span style="font-family: "calibri";"><span style="font-family: Arial, Helvetica, sans-serif;">SB is sold under the brand name Florastor, $20 for 20 250 mg
capsules, cheaper on Amazon and Ebay. CVS has a generic version that is
sometimes on sale. Swanson, the online supplement store, sells its own version,
$5.99 for a bottle of 30. Are they as good as the brand name, or better? I
don’t know but I plan to experiment later on. Given my gut situation, I expect
to be taking SB indefinitely, and happily too!<o:p></o:p></span></span></div>
gretchen kromer's bloghttp://www.blogger.com/profile/02012944567250392269noreply@blogger.com0tag:blogger.com,1999:blog-2958604973303438851.post-32683063480455503452017-11-03T13:16:00.000-07:002017-11-03T13:27:49.922-07:00Layers of Pain<div class="MsoNormal">
I picture them as cobwebs — layer upon layer of cobwebs — binding
my muscles, tying them to my bones, pinching sensitive nerves, but unlike
cobwebs they are not diaphanous and fragile. These are bands of scar tissue,
solid and persistent flesh, and I have them all over my body, palpable reminders
of all the times I have misused my muscles over the years: the too-heavy load
of books or groceries I just had to carry, the meetings that caused my neck and
shoulders to tense up for an hour or more, the overly ambitious stretch in yoga
class. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Up until last year I wasn’t particularly aware of scar
tissue as a problem. About a year ago, I started getting pains in my upper arms
while doing weight-lifting routines. For a while, I backed off on intensity,
thinking that these were injuries that would heal by themselves. I tried heat
and ice. Finally, after about six months of no improvement, my personal trainer
suggested that I go to a chiropractor, a new experience for me.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The chiropractor turned out to be a man in his early
thirties, a serious athlete, who has had more than his share of serious injuries.
When he asked me to raise my straight arms from my sides to the highest point
possible over my head, he was horrified at the condition of my shoulders. I
couldn’t get to the top position and I couldn’t straighten my arms. (Years ago
I had had a bad injury to my left shoulder, described in this <a href="http://bit.ly/2h9PvNn">post</a>, and later to my right, the most
overworked side because I am right-handed.) Over a number sessions, this
movement improved until he was fairly satisfied with it. But I still had the
pain in my arms and rotating my arms forward in a circular motion hurt my shoulders.
By now the pain was bad enough that it was waking me up at night.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="mso-spacerun: yes;"></span>To treat the scar tissue in my
shoulders, arms and legs, the chiropractor used two approaches: myofascial release therapy
(MFR), where he presses firmly into tight areas, and active release technique
(ART), where he presses into a tight area while I move my arm across a
prescribed path. This process ranges from mildly uncomfortable to quite painful,
but the benefits have been substantial. I can now sleep at night without pain,
though my shoulders and arms are sometimes stiff when I first get up. I am
starting to lift weights again. My range of motion is much better but still
needs work, especially the right shoulder and arm.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
All complex human relationships, especially marriages and doctor-patient
interactions, require a constant readjusting of expectations. The chiropractor
and I had both anticipated that my situation would be resolved in a matter of
weeks, months at the most. It has now been over a year. During that time,
symptoms have come and gone. For a while, I had trigger thumb in my right
thumb; it lasted for a couple of months, then went away. At one point I
mysteriously injured a nerve in my left leg and was hobbling around for a
while. We worked on the left leg and that got better too.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Why is all of this happening to me right now? Age is
probably a factor; I am 71 now. Another possibility is that in 2016 I stopped
taking Premarin, an estrogen supplement I had been happily using for 36 years.
Changes in hormones can affect muscles and nerves so this transition may have
turned a tolerable situation into one requiring treatment. In any case, I am
grateful that these therapies are available to me. Ironically, insurance won’t
pay for interventions that are actually restoring me but it would pay for pain
medication, which I certainly want to avoid!</div>
gretchen kromer's bloghttp://www.blogger.com/profile/02012944567250392269noreply@blogger.com0tag:blogger.com,1999:blog-2958604973303438851.post-23467490185209606542017-05-17T17:35:00.001-07:002017-05-17T17:40:45.869-07:00How To Keep The Weight Off As You Get Older<div class="MsoNormal">
One of the sad truths about aging is that you inevitably
burn fewer calories than you did as a young person, even if you’re physically
active, even if you eat a healthy diet. When you retire you may eat out more
often and take more trips to foreign countries with delicious food, making the
situation even worse.</div></br>
<div class="MsoNormal">
At our house we have instituted a system of alternating big
meals and small meals. A big meal is protein (often chicken or fish),
vegetables, and maybe a starch plus a little fruit for dessert. A small meal is
soup with a small piece of bread or a quarter of a frittata or a tuna melt,
always accompanied by vegetable juice (bottled or homemade). We do three big
and three small each week. On the remaining night we eat at a restaurant.</div>
<div class="MsoNormal"></br>
Lately we’ve been wanting to lose a few pounds so we’ve
started a low food day every week or so, somewhat like the part-fasting diets
that are popular now. Instead of fasting, we have the <a href="http://bit.ly/2cGwXzh">Mango Lassi with Anti-Cancer Spices</a> for breakfast (plus coffee), the <a href="http://bit.ly/2cxnQxh">Pretty Good Almond BerryGreen Smoothie</a> for lunch, and the usual kind of small meal for supper. After a
few weeks we’ve lost a couple of pounds without too much pain.</div>
<div class="MsoNormal"></br>
The advantage of our system is that it is sustainable. With
diets, you eventually go off the diet and the weight often comes right back.
Our program incorporates enough foods we enjoy, including an occasional sweet
dessert at a restaurant, so that we don’t feel deprived.</div>
gretchen kromer's bloghttp://www.blogger.com/profile/02012944567250392269noreply@blogger.com0tag:blogger.com,1999:blog-2958604973303438851.post-13536332256333937702017-03-21T12:58:00.001-07:002019-01-28T12:46:11.879-08:00The New Cats<div class="MsoNormal">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2a7Zo_Dt7mS7ZlnQ4VoMu0WwEfiUy138vL5PrhxZHOtJtH3WRxxt0OJaLZKOx008OWsW2HOOZNjFnxjGL90R0mYVt-DbwT-eQj1A46QmaVTHqvhQEWeBD-Lryup_bCHyayq4Bb1rGKP_m/s1600/max+and+bella.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2a7Zo_Dt7mS7ZlnQ4VoMu0WwEfiUy138vL5PrhxZHOtJtH3WRxxt0OJaLZKOx008OWsW2HOOZNjFnxjGL90R0mYVt-DbwT-eQj1A46QmaVTHqvhQEWeBD-Lryup_bCHyayq4Bb1rGKP_m/s320/max+and+bella.jpg" width="320" /></a>When our old cat Sadie Pearl died last year at almost 18
years of age, our 10-year-old, Rowan, was lonely and bored. My husband wanted
to get another lady cat so we asked our handyman to be on the lookout for likely
candidates at his farm, where most of our cats were born. Sometime in May, he
started describing a litter of three kittens that were living there with their
mother. Even though they were very young, he urged us to take one right away because
he was afraid they might be killed by a predator. (Our cat Rowan was orphaned
when his family disappeared under mysterious circumstances. He was adopted
by the kind people at the farm, later by us.)</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
We arrived at the vet with a beautiful little tiger and
white kitten and the vet’s assistant, a cat expert, said, “It’s a boy.”
However, she just happened to have a female kitten, a feral cat one week older
than ours, that might be a suitable friend for him. So we ended up with Max and
Bella. The picture of the cats when they were small illustrates their
personalities: Max looks straight at you, ready to take on any challenge; Bella
tilts her chin up dreamily, like a medieval saint awaiting guidance from
Heaven.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEggOJwMLArUtQLJ-Sco7L12345aC4r20fotHQHhwmtxJ2dthtN9QoTtM1h_dk1vn11OX8L6ldk2XgMYsiyUBUidXhjfJep1qTquuDNQ-xuOBVLXu6lcUKRWd2Br0VXZ4dZNX4MlEalrbHXk/s1600/small+max.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEggOJwMLArUtQLJ-Sco7L12345aC4r20fotHQHhwmtxJ2dthtN9QoTtM1h_dk1vn11OX8L6ldk2XgMYsiyUBUidXhjfJep1qTquuDNQ-xuOBVLXu6lcUKRWd2Br0VXZ4dZNX4MlEalrbHXk/s320/small+max.jpg" width="180" /></a>During the first few days, I wasn’t sure that we should keep
Bella. She seemed slow, almost lethargic, and her hygiene left something to be
desired; her little face was often smudged with food. The vet’s assistant then
explained that she was a litter of one (very rare) and had been living alone
with her mother in a garage, essentially a sensory deprivation capsule. Max was
born into the rich environment of a farm with other cats, horses, and cows,
along with plants and farm buildings to explore. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Max is not only masculine but a super-male: full of muscle
and bravado. Smart and athletic, he is constantly seeking out new challenges
for himself. All of our kittens have had to learn about gravity the hard way,
by venturing under the railing around the second floor stairwell and falling to
the landing about 10 feet below. For the others, once was enough, but Max has
repeated the experience because he wanted to learn how to walk along the
railing, a skill that none of our other cats ever mastered. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg3WVExrXOGk96z_Ynjz_MCHuJr13KMNcGOEf-GtG2mTW3kljwj9fC2-LQ4eyjCdctH5ZpjI1Wl2lBiR2p6l1UGOKYZBus3i8wCMw_fr_GKuSHUkTEiLdmlX5pv4EJHsgvtbimUMXq2XnwX/s1600/rowan.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg3WVExrXOGk96z_Ynjz_MCHuJr13KMNcGOEf-GtG2mTW3kljwj9fC2-LQ4eyjCdctH5ZpjI1Wl2lBiR2p6l1UGOKYZBus3i8wCMw_fr_GKuSHUkTEiLdmlX5pv4EJHsgvtbimUMXq2XnwX/s320/rowan.jpg" width="180" /></a>For the first months of her life, Bella remained a kind of
slow, dreamy moonchild of a cat but sometime after she was spayed she seemed to
become more energetic and more focused. She and Max have always play-wrestled
but now she sometimes chased him. Sometimes she tries to get Rowan to play with
her, by rolling on her back in front of him and making little chirping noises.
Usually, he considers this beneath him and walks away, though he sometimes
play-wrestles with Max.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
When the kittens first came, Rowan was horrified. He seemed
to feel that these were not cats but alien beings introduced into his home.
Over the next weeks, though, he came to enjoy watching their antics and
gradually to interact with them directly. Sadie Pearl, his previous companion,
had not been much of a role model in this respect. Like many lady cats, she was
rather a diva. The new cats, though, are both friendly, playful, and easy-going, a welcome diversion for an older gentleman cat.</div>
gretchen kromer's bloghttp://www.blogger.com/profile/02012944567250392269noreply@blogger.com0tag:blogger.com,1999:blog-2958604973303438851.post-14678381111850524142017-02-12T06:37:00.001-08:002018-01-12T12:16:15.291-08:00How I’ve Saved the Health Care System Thousands of Dollars<ul>
<li>Orthotics for problem feet, starting in my 40s, allowed me
to do strenuous workouts and possibly to avoid later ankle, hip, and lower back
surgery.</li>
<li>Opted for acupuncture instead of surgery for rotator cuff
injuries.</li>
<li>In my 50s, used diet and exercise to lose weight instead of taking
statins to lower cholesterol. </li>
<li>Started taking protein supplements and proteolytic enzymes
to retain and build strong muscles. Enzymes also help to heal injuries.</li>
<li>Discovered that probiotics could alleviate long-term digestive
problems, improve overall health. Drinking homemade vegetable and fruit juices
may have helped too.</li>
<li>Treated my psoriasis with biotin (Vitamin B<span style="font-size: xx-small;">7</span>), not prescription drugs.</li>
<li>In my 70s, began impact exercise (jumping<b style="mso-bidi-font-weight: normal;">)</b> instead of bisphosphonates to improve
bone strength.</li>
<li>Currently receiving chiropractic treatment (myofascial
release therapy and active release technique) for scar tissue in my shoulders
and arms<b style="mso-bidi-font-weight: normal;"> </b>instead of taking pain meds
or trying surgery. </li>
</ul>
<div class="MsoNormal">
Of these, only the orthotics are covered by insurance and
even those have been said to be ineffective in some studies.Yet athletes use them all the time.</div>
gretchen kromer's bloghttp://www.blogger.com/profile/02012944567250392269noreply@blogger.com0tag:blogger.com,1999:blog-2958604973303438851.post-88287153731494258132016-10-12T08:15:00.000-07:002016-10-13T06:20:16.083-07:00“Sorry, WebMD, Weight-Bearing Exercise Didn’t Help My Bone Density, Jumping Did.”<div class="MsoNormal" style="line-height: normal;">
Bad news from last year’s DXA scan. My readings, which had floated around in osteopenia territory for years, had dropped. My right femur was down 5.2% compared with the previous reading and my spine was now osteoporotic, suggesting an increased risk of fracturing a vertebra.<br />
<br />
Two factors, I think, accounted for this startling and unwelcome change. First, I think my dosage of Synthroid, which I need for my hypothyroidism, had been kept too high for too long. My doctor didn’t want to lower the dosage because my TSH was within the normal range, though just barely under hyperthyroid, for several years. It turns out that too much Synthroid can cause bone loss. Secondly, when the media came out with scare stories about how taking too much calcium supplement can contribute to heart disease (and where’s the evidence for that?), I foolishly cut back on the amount I was taking. The body is a proficient scavenger; if you don’t give it what it needs, it uses up what it has, in this case calcium in the bones.
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhS6z86g5xfEhXNUvLbhUADCj_qUxzRdDHByqHQhMiFlnoXD2qBOoq_6ZxuXORjlFuRlNfPfc7mFNV6pu4_IK5cwegY7DhyphenhyphenPZmF7G1yicjawervXkdGyWExn-kFMdgI7GdTbrjVqQ_uYHVZ/s1600/DXA+results.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="346" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhS6z86g5xfEhXNUvLbhUADCj_qUxzRdDHByqHQhMiFlnoXD2qBOoq_6ZxuXORjlFuRlNfPfc7mFNV6pu4_IK5cwegY7DhyphenhyphenPZmF7G1yicjawervXkdGyWExn-kFMdgI7GdTbrjVqQ_uYHVZ/s640/DXA+results.jpg" width="640" /></a></div>
</div>
<div class="MsoNormal" style="line-height: normal;">
Clearly, this trend needed to be reversed as soon as possible. The standard treatment for osteoporosis is one of
the bisphosphonates, such as Fosamax or Boniva but, according to <a href="http://bit.ly/2e1f2C0">ConsumerReports</a>, these are only modestly effective and can have dangerous side effects. A friend of mine took one of
these drugs and experienced osteonecrosis of the jaw, in which the jawbone
disintegrates and the teeth fall out. Not for me!</div><br />
<div class="MsoNormal" style="line-height: normal;">
Fortunately I discovered some
articles about the research of Dr. Larry Tucker of Brigham Young University and
others, which involved jumping to increase bone strength in the hips. (See
earlier post, <a href="http://bit.ly/2e7kDpq">“Maintaining an Imperfect Body: the Mini-Workout")</a> The jumping routine is supposed
to work for hips but the researchers say it doesn’t do anything for the spine; I decided it was an ideal opportunity to test the notion that weight-bearing
exercise can help bone density. For the six months from 9/15 to 3/16, I did the
jumping routine for 20 minutes, twice a day. During the same period, I did
weight-bearing exercises for the back at a fairly intense level: 50 pushups,
low rows with up to 80 pounds of weight, back extensions holding up to 30
pounds of weight. I also went back to a higher dosage of the calcium
supplement.</div>
<div class="MsoNormal" style="line-height: normal;">
<br /></div>
<div class="MsoNormal" style="line-height: normal;">
When I had another DXA in March
of 2016, the hip readings had stabilized but the readings for the spine had
gone down 4%. If I had waited two years to do another DXA, the usual recommendation,
I could have lost 16% from the bone density in my spine! Clearly, the
heavy-duty weight exercises either hadn’t done anything or hadn’t done nearly
enough for my spine.</div>
<div class="MsoNormal" style="line-height: normal;">
<br /></div>
<div class="MsoNormal" style="line-height: normal;">
What to do? Impact exercises had worked for the hips so perhaps I needed an impact move that would help
the spine. In March I came up with a new exercise to target the spine and
started using it for 15 minutes, twice a day. The results so far are promising
but I’m not going to put it online until I’m sure it works. Stay tuned!</div>
<div class="MsoNormal" style="line-height: normal;">
<br /></div>
<div class="MsoNormal" style="line-height: normal;">
<br /></div>
gretchen kromer's bloghttp://www.blogger.com/profile/02012944567250392269noreply@blogger.com1tag:blogger.com,1999:blog-2958604973303438851.post-28927231998824012032016-08-31T13:05:00.000-07:002016-09-02T15:21:45.259-07:00Food Synergy Pesto with Almonds and Anti-Cancer Greens<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjalYO36e6Ypd5RQcK1u1_bY-4TKKLAP0OBDCs5yRkAepwS6J1ZtBoVgXVP85qRbM03YU-4Ehik6yQxwb5N5HJjThwikNjDI6RrsntDukWuXVsZfN6GMM_KkAsN7CRFN1A0eFItlcCC0uSP/s1600/pesto.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjalYO36e6Ypd5RQcK1u1_bY-4TKKLAP0OBDCs5yRkAepwS6J1ZtBoVgXVP85qRbM03YU-4Ehik6yQxwb5N5HJjThwikNjDI6RrsntDukWuXVsZfN6GMM_KkAsN7CRFN1A0eFItlcCC0uSP/s320/pesto.jpg" width="320" /></a></div>
<br />
<span style="font-family: "times new roman" , serif; font-size: 12.0pt;">Garlic, along with leeks, onions,
and other members of the <i style="mso-bidi-font-style: normal;">alium</i> family
are among the top anti-cancer foods. Most people find it inconvenient to
consume raw garlic but this recipe tones it down with parsley, lemon juice, and
other flavors. Besides the garlic, the anti-cancer foods are parsley, arugula,
and avocado.</span><br />
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "times new roman" , serif; font-size: 12.0pt;">For this quantity of pesto, I use a
mini-blender. The full sized blender tends to slide over the tops of the
ingredients in Step 2.</span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "times new roman" , serif; font-size: 8.0pt;">¼ </span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;">cup
sliced almonds</span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "times new roman" , serif; font-size: 12.0pt;">2 T avocado or olive oil</span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "times new roman" , serif; font-size: 12.0pt;">2 T water</span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "times new roman" , serif; font-size: 12.0pt;">1 teaspoon lemon juice</span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "times new roman" , serif; font-size: 12.0pt;">¼ ripe avocado, skin removed</span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "times new roman" , serif; font-size: 12.0pt;">1 clove garlic coarsely chopped</span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "times new roman" , serif; font-size: 12.0pt;">1 small handful of parsley </span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "times new roman" , serif; font-size: 12.0pt;">1 cup arugula, packed</span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "times new roman" , serif; font-size: 12.0pt;">¼ tsp. of salt, or to taste</span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "times new roman" , serif; font-size: 12.0pt;">1.<span style="mso-spacerun: yes;">
</span>Lightly toast the almonds over medium heat, stirring a few times. They
should be fragrant and slightly crisp, not brown. Pour onto a plate to cool.</span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "times new roman" , serif; font-size: 12.0pt;">2.<span style="mso-spacerun: yes;">
</span>In the bowl of a small blender combine the oil, water, lemon juice,
avocado, and garlic. Puree until it forms a smooth mixture. </span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "times new roman" , serif; font-size: 12.0pt;">3.<span style="mso-spacerun: yes;">
</span>Add the parsley and puree until smooth. </span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "times new roman" , serif; font-size: 12.0pt;">4.<span style="mso-spacerun: yes;">
</span>Add the arugula and puree to whatever consistency you prefer. </span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "times new roman" , serif; font-size: 12.0pt;">5.<span style="mso-spacerun: yes;">
</span>Add the salt and the toasted almonds and pulse a few times. Repeat until
the almonds are coarsely or finely ground, depending on your taste.<span style="font-family: "times new roman" , serif;"> I like mine slightly grainy, as you can see from the photo.</span></span><br />
<br />
<span style="font-family: "times new roman" , serif; font-size: 12.0pt;"><span style="font-family: "times new roman" , serif;">6. You can serv<span style="font-family: "times new roman" , serif;">e this with pasta<span style="font-family: "times new roman" , serif;">, <span style="font-family: "times new roman" , serif;">a<span style="font-family: "times new roman" , serif;">s a garnish for soup, or in a sandwich. I like t<span style="font-family: "times new roman" , serif;">o</span> spread it on whole wheat br<span style="font-family: "times new roman" , serif;">ead with slices of cooked chicken<span style="font-family: "times new roman" , serif;">. <span style="font-family: "times new roman" , serif;">Sometimes I </span>top <span style="font-family: "times new roman" , serif;">the pesto</span> with a slice of cheese and broil at a<span style="font-family: "times new roman" , serif;">round 4<span style="font-family: "times new roman" , serif;">25 degrees</span></span> until the cheese melts.</span></span></span></span></span></span></span></span><br />
<br />
<span style="font-family: "times new roman" , serif; font-size: 12.0pt;"><span style="font-family: "times new roman" , serif;"><span style="font-family: "times new roman" , serif;"><span style="font-family: "times new roman" , serif;"><span style="font-family: "times new roman" , serif;"><span style="font-family: "times new roman" , serif;"><span style="font-family: "times new roman" , serif;"><span style="font-family: "times new roman" , serif;">Other Food Synergy Recipes:</span></span></span></span></span></span></span></span><br />
<br />
<span style="font-family: "times new roman" , serif; font-size: 12.0pt;"><span style="font-family: "times new roman" , serif;"><a href="http://bit.ly/1OqfiFg"><span style="font-family: "times new roman" , serif;"><span style="font-family: "times new roman" , serif;"><span style="font-family: "times new roman" , serif;"><span style="font-family: "times new roman" , serif;"><span style="font-family: "times new roman" , serif;"><span style="font-family: "times new roman" , serif;">The Mango Lassi <span style="font-family: "times new roman" , serif;">With Anti<span style="font-family: "times new roman" , serif;">-Cancer Spices</span></span> </span></span></span></span></span></span></a></span></span><br />
<br />
<span style="font-family: "times new roman" , serif; font-size: 12.0pt;"><span style="font-family: "times new roman" , serif;"><a href="http://bit.ly/1twNQC6"><span style="font-family: "times new roman" , serif;"><span style="font-family: "times new roman" , serif;"><span style="font-family: "times new roman" , serif;"><span style="font-family: "times new roman" , serif;"><span style="font-family: "times new roman" , serif;"><span style="font-family: "times new roman" , serif;">The Pretty Good Almond Berry Green Smoothie</span></span></span></span></span></span></a> </span></span></div>
gretchen kromer's bloghttp://www.blogger.com/profile/02012944567250392269noreply@blogger.com0tag:blogger.com,1999:blog-2958604973303438851.post-47549745260749767102016-06-15T12:29:00.000-07:002018-07-21T10:06:04.508-07:00More Food Synergy – and Evidence That It’s Doing Something<div class="MsoNormal" style="line-height: normal;">
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_A78i63iZrd0o1XgNQ5R4Dkslwyag4zPMiNwMMijHLEOkKIKbsxJGHauwooSjgwFL48YC44u3qICJKhfE9QLG5ac3UJ5eluQio84yCKj_qbSlT9sINpXv8lRI1X2AccYnkXl62szzTYp-/s1600/green+drink.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_A78i63iZrd0o1XgNQ5R4Dkslwyag4zPMiNwMMijHLEOkKIKbsxJGHauwooSjgwFL48YC44u3qICJKhfE9QLG5ac3UJ5eluQio84yCKj_qbSlT9sINpXv8lRI1X2AccYnkXl62szzTYp-/s320/green+drink.jpg" width="320" /></a></div>
<br />
Once I had created the <a href="http://gretchen-kromer-blog.blogspot.com/2016/05/new-cancer-research-and-recipe.html">Mango Lassi with Anti-Cancer Spices</a>, I wanted to make another drink that would feature anti-cancer vegetables and fruit. Green drinks run the gamut from
bitter or sulfury at one end to super-sweet with sugar or fruit juice at the
other. I haven’t been a fan of most of the ones I’ve tried.<br />
<br />
After months of
experimenting, I’ve come up with this combo, where the rich flavor of almond
and grapeseed oil tames the strong flavors of the greens. The raspberries,
lemon, and stevia add just enough sweetness. One of the advantages of the blending process is that you can use the fibrous
parts of the vegetables that normally get thrown away, like the stems of
the broccoli and parsley. The anti-cancer foods in this
drink are the two cruciferous vegetables, the parsley, and the raspberries. </div>
<div class="MsoNormal" style="line-height: normal;">
<br /></div>
<div class="MsoNormal" style="line-height: normal;">
<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">The Almond Berry
Green Smoothie</i></b><br />
<br />
Time: 15 minutes including cleanup<br />
Servings: 1 large drink<br />
<br />
½ cup sugar-free almond milk<br />
1-2 tablespoons water </div>
<div class="MsoNormal" style="line-height: normal;">
½ cup ice</div>
<div class="MsoNormal" style="line-height: normal;">
2 teaspoons grapeseed or peanut
oil</div>
<div class="MsoNormal" style="line-height: normal;">
1 cup of light, leafy cruciferous
vegetable, such as kale or arugula, firmly packed</div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-size: 8pt;">1/3</span>
cup of dense cruciferous vegetable, such as broccoli, cabbage, or cauliflower
coarsely chopped</div>
<div class="MsoNormal" style="line-height: normal;">
1 small handful of parsley or ½
celery stalk</div>
<div class="MsoNormal" style="line-height: normal;">
¼ lemon, peel removed</div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-size: 8pt;">2/3</span>
cup raspberries or blueberries</div>
<div class="MsoNormal" style="line-height: normal;">
1-2 packets stevia</div>
<br />
Add almond milk, water, and ice to the container of a
blender.<br />
<div class="MsoNormal" style="line-height: normal;">
Add the remaining ingredients in
the order given. </div>
<div class="MsoNormal" style="line-height: normal;">
Pulse 20 times to chop the solids,
then puree for a slow count of 30 or until mixture is smooth.</div>
<div class="MsoNormal" style="line-height: normal;">
If the mixture is too thick, add a little more water. If you taste too much of the cruciferous vegetables, add another teaspoon of oil. If you want a sweeter drink, add more stevia.<br />
<br /></div>
<div class="MsoNormal" style="line-height: normal;">
<i style="mso-bidi-font-style: normal;">Notes:</i><br />
I drink this smoothie every day at lunchtime and sometimes follow it with a half ounce of dark chocolate, another anti-cancer food.<br />
<i style="mso-bidi-font-style: normal;"> </i></div>
<div class="MsoNormal" style="line-height: normal;">
Almond milk only lasts about a week
after opening and I’ve only been able to get it in half-gallon containers, way
too much for my needs. Kitchen stores sell little trays for extra large ice
cubes, almost 4 oz. (1/2 cup). I freeze portions of almond milk and take them
out one at a time. When you do this, you will add water rather than ice to the one-cup measure and you will have to puree about 2-3 times as long
because of the extra frozen liquids.<br />
<br />
I've read that cruciferous vegetables contain small amounts of various toxins. In order to limit exposure to any one toxin, it is recommended that you vary the ingredients of the smoothie on a regular basis.<br />
<br />
Tip for Storing Vegetables: Many vegetables will keep longer if they are wrapped in a paper towel inside of the usual plastic bag. If the paper towel gets wet, it should be replaced with a dry one. For greens that come in a plastic clamshell, open the container immediately after you get it home, before storing it in the refrigerator. Put a paper towel on top, shake the container a couple of times, and re-close the lid. Store upside down (paper towel down) in the refrigerator. Each time you reopen it, remove any leaves that are starting to yellow, replace the paper towel if it is wet or stained, and shake the container before putting it away. This helps to keep the leaves from packing down, getting too wet, and spoiling. <br />
<br />
One Way to Re-Use Plastic Clamshells: I give relatively clean and undamaged clamshells to a guy at my gym. He passes them along to Amish farmers who use them when they make butter and cheese.<br />
<br />
<span style="color: red;">Help for Prostate Cancer?</span> Some studies have indicated that lycopene, which is found in tomatoes, may help against prostate cancer. To get a worthwhile amount of lycopene you need to use processed tomato products, such as tomato juice and tomato paste, <i>not fresh tomatoes</i>. You can add a tablespoon of tomato paste to this drink, which doesn't affect the flavor much. With this, use a bit more water and less ice. I like the Italian tomato pastes that come in a tube. Some of them are double concentrated, which presumably means twice as much lycopene. My favorite brand is Mutti, but there are others. American brands in cans work just fine too.<br />
<br />
Other ideas for prostate cancer: quit eating red meat and processed meats like bacon and sausage; if you're overweight, lose a few pounds (see the new post <a href="http://bit.ly/2qTCkU0">How To Keep The Weight Off As You Get Older</a>); if you're sedentary, get up and move around.<br />
<br /></div>
<div class="MsoNormal" style="line-height: normal;">
<br /></div>
<div class="MsoNormal" style="line-height: normal;">
<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">The Evidence That It’s Doing
Something</i></b></div>
<div class="MsoNormal" style="line-height: normal;">
I’ve complained about my
digestive malfunctions elsewhere in this blog (Trouble Down Below, <a href="http://bit.ly/1UzEueJ">http://bit.ly/1UzEueJ</a>. Last year I started
drinking the mango lassi (<a href="http://bit.ly/1OqfiFg">http://bit.ly/1OqfiFg</a>) and the Pretty Good Green Smoothie. Over the next couple of months
I noticed that my fingernails were stronger and my skin looked better. </div>
<div class="MsoNormal" style="line-height: normal;">
<br /></div>
<div class="MsoNormal" style="line-height: normal;">
This week I was doing my usual
pedicure routine: remove old polish, file nails and calluses, wash and push back
cuticles, and apply new polish. After the old polish was gone I noticed that
there was a distinct difference in color between the upper and lower parts of
the nail; the lower part was a nice, healthy-looking pink, while the upper part
was yellowish. The dividing line comes 1/3 to halfway up the nail. </div>
<div class="MsoNormal" style="line-height: normal;">
<br /></div>
<div class="MsoNormal" style="line-height: normal;">
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjyiJlLxjmTs0QNdSXqOTIdjNYrCh5ug_-dfoh6fknByYlCu9Yn86xLS8QpDt863_x9ZKqdOCgjchRN1t5fAhsoqLcRd3xxQilNELeJcHJYo_AwkXHl2Hy8FhyAXOCMNJl0uVF_sswCDIEd/s1600/IMG_0163.JPG" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjyiJlLxjmTs0QNdSXqOTIdjNYrCh5ug_-dfoh6fknByYlCu9Yn86xLS8QpDt863_x9ZKqdOCgjchRN1t5fAhsoqLcRd3xxQilNELeJcHJYo_AwkXHl2Hy8FhyAXOCMNJl0uVF_sswCDIEd/s200/IMG_0163.JPG" width="150" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">6/15/2016</td></tr>
</tbody></table>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhNrzPmpGafbHFaWZxceMGlWA26iYPulmY8vAn5g53UzXG0qOYqywDNI7FWA6I_X2KSF4T7NG3YIz6CdMn3z1g2QYkmRZu0xrZ72_eWXTqHLk7js0awTnbm_KGSoSzEuOqXUBh5Wo6SFgCR/s1600/IMG_0164.JPG" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhNrzPmpGafbHFaWZxceMGlWA26iYPulmY8vAn5g53UzXG0qOYqywDNI7FWA6I_X2KSF4T7NG3YIz6CdMn3z1g2QYkmRZu0xrZ72_eWXTqHLk7js0awTnbm_KGSoSzEuOqXUBh5Wo6SFgCR/s200/IMG_0164.JPG" width="150" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">6/15/2016</td><td class="tr-caption" style="text-align: center;"></td></tr>
</tbody></table>
Toenails
take 12-18 months to grow out so this change represents a process that started
6-9 months ago. Mid-December, six months ago, is when I started with the drinks.
Nothing was different about my foot care
routine so this seems to represent a metabolic change of some kind. What sort
of change is it and what are the implications for my health? I have no idea but
I wish someone would check it out.</div>
<div class="MsoNormal" style="line-height: normal;">
<br />
<br />
<br />
<br />
Update: Here are my feet six weeks later, seven and a half months after I started with the drinks:<br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiXuY7ePzifkAxRcLsYUC9gIj9re5hGH-BFquwVbwYvaOxOXmNZb5WwNyYsl4SMwaNEeltRXtyq1D46cLLj5oSDh5JyrjATZeptC6R28UogHpfynw678emuxnvTF-oCXIiJE3vOgJi2-cNd/s1600/IMG_0217.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiXuY7ePzifkAxRcLsYUC9gIj9re5hGH-BFquwVbwYvaOxOXmNZb5WwNyYsl4SMwaNEeltRXtyq1D46cLLj5oSDh5JyrjATZeptC6R28UogHpfynw678emuxnvTF-oCXIiJE3vOgJi2-cNd/s320/IMG_0217.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">7-27-2016</td><td class="tr-caption" style="text-align: center;"><br /></td></tr>
</tbody></table>
Update on nails, 2/2/2018: I've now been using the Mango Lassi and the Green Smoothie for more than two years and I think I understand what's happening to my toenails. For a number of years, the nails on some of my toes had begun to lift off the nailbeds (onycholysis). In the time since I started using the drinks, the toenails have started to reattach themselves, in effect lengthening the nailbeds. The same thing is happening, in a less obvious way, to my fingernails. Perhaps this is an indication of improved physical condition.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
gretchen kromer's bloghttp://www.blogger.com/profile/02012944567250392269noreply@blogger.com0tag:blogger.com,1999:blog-2958604973303438851.post-70585267652567107822016-05-12T13:24:00.002-07:002022-05-11T12:11:15.868-07:00Food Synergy: New Cancer Research and a Recipe<div class="MsoNormal">
Recent research is suggests an increasingly important role
for nutrition in preventing and treating a range of conditions, including
cancer. In the 1990s, scientists at the University College of Medical Sciences
in New Delhi studied mice that had been exposed to a carcinogen that caused
breast tumors in 100% of them. When nutritional substances were administered
beforehand, the risk of developing cancer was reduced from 50% for the mice who
ingested one substance to 90% for those who ingested four nutrients together
(described in David Servan-Schreiber’s book, <i style="mso-bidi-font-style: normal;">Anti-Cancer: A New Way of Life</i>, p. 110).
</div>
<br />
<div class="MsoNormal">
At Sainte-Justine Children’s Hospital in Montreal Richard Béliveau,
PhD, and his team worked with immune-deficient mice that had been injected with
cancer cells. Mice that were fed a cocktail of anti-cancer nutrients stayed in
better health and developed less serious, slower growing tumors, results
discussed in Béliveau’s 2006 book <i style="mso-bidi-font-style: normal;">Foods
That Fight Cancer</i>.</div>
<br />
<div class="MsoNormal">
A 2013 study headed by Madhwa Raj, PhD, at Lousiana State
University Health Sciences Center tested ten nutrients and found them to be
ineffective when used individually. However, when researchers selected six of
the nutrients and administered them together, 100% of breast cancer cells were
killed with no side effects for normal cells. <a href="http://bit.ly/1rGEZN3">http://bit.ly/1rGEZN3 </a></div>
<br />
<div class="MsoNormal">
Live human beings will not necessarily respond the same way
as mice or cells in a petri dish. Unless there is more research, these
intriguing results will probably be ignored by conventional medicine. Financing
such research is likely to be a challenge when a positive result will enrich
only grocery store owners. In addition, there may be ethical limitations in designing
such studies for people who already have cancer or some other serious illness.</div>
<br />
<div class="MsoNormal">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhgW9ofotyewwO49-tsUtmaEZbwm8wwWcIHAHOw7vsqQstdnM_VK2h9K0zDLpecwreh-_CuLwA7kqxWn8nHtikWYapV_Vsl1yVHdT5LgvAMfV3YceYtchrNASe6yhCpx8ViplEMLZmOHNj5/s1600/mango+lassi.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhgW9ofotyewwO49-tsUtmaEZbwm8wwWcIHAHOw7vsqQstdnM_VK2h9K0zDLpecwreh-_CuLwA7kqxWn8nHtikWYapV_Vsl1yVHdT5LgvAMfV3YceYtchrNASe6yhCpx8ViplEMLZmOHNj5/s320/mango+lassi.jpg" width="320" /></a>As a creative project, I decided to develop a drink that
included four easily purchased foods similar to the nutrients used in the LSUHC
study. It is not the most delicious mango lassi you have ever tasted – the
ginger taste still comes through – but it is certainly drinkable. Will it
really help anyone’s health? There’s no way to know for sure, but the drink is
cheap, easy to prepare, and safe, unless you’re allergic to one of the
ingredients. As an added bonus, the four spices I have used show promise
against Alzheimer’s as well as cancer. I’ll be drinking my mango lassi every day along with my usual breakfast.</div>
<br />
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">The Mango Lassi with Anti-Cancer Spices</i></b><br />
<br />
Time: 15 minutes including cleanup<br />
Servings: 1 large drink</div>
<br />
<div class="MsoNormal">
<i style="mso-bidi-font-style: normal;">Caution: Turmeric can
leave a vivid yellow stain that may be impossible to remove. To avoid damaging
clothing and countertops, wear an apron, measure over a plate or cutting board, and wash
measuring spoons immediately after use. By itself, turmeric is not well
absorbed by the body: mixing it with black pepper and olive oil improves
bioavailability, the reason for the somewhat tricky procedure here.</i></div>
<br />
<div class="MsoNormal">
Before you start: Cut a medium banana into thirds and freeze
it in a plastic bag. </div>
<br />
<div class="MsoNormal">
<i>Ingredients</i></div>
<div class="MsoNormal">
1 green teabag</div>
<div class="MsoNormal">
4 oz. boiling water</div>
<div class="MsoNormal">
<span style="font-size: xx-small;">1/3</span> medium banana, previously frozen </div>
<div class="MsoNormal">
¼ teaspoon wasabi powder</div>
<div class="MsoNormal">
2 level tablespoons vanilla whey protein powder</div>
<div class="MsoNormal">
1 heaping tablespoon Greek yogurt</div>
<div class="MsoNormal">
¼ teaspoon powdered turmeric</div>
<div class="MsoNormal">
<span style="font-size: 8pt; line-height: 107%;">1/16</span>
teaspoon black pepper</div>
<div class="MsoNormal">
<span style="font-size: 8pt; line-height: 107%;">1/2</span>
teaspoon olive or avocado oil</div>
<div class="MsoNormal">
Raw ginger about the size of you first thumb joint, peeled andsliced across the grain</div>
<div class="MsoNormal">
A handful of frozen mango or pineapple chunks, or a combination (<span style="font-size: 8pt; line-height: 107%;">1/2 – 2/3 </span>cup)</div>
<div class="MsoNormal">
Cold water (optional)</div>
<div class="MsoNormal">
½ packet of stevia (optional)<br />
<br /></div>
<div class="MsoNormal">
1. Brew teabag in hot water and let cool while you prepare
the other ingredients.</div>
<div class="MsoNormal">
2. To the container of a blender add the <span style="font-size: 8pt; line-height: 107%;">1/3 </span>banana, wasabi powder, whey
protein powder, and Greek yogurt.</div>
<div class="MsoNormal">
3. Place a clean tablespoon on a plate or cutting board.
Measure turmeric and put it in the tablespoon. Measure black pepper and add it
to the tablespoon. </div>
<div class="MsoNormal">
4. Pour olive oil into a measuring spoon over the blender
container but don’t add it yet. Lift the tablespoon with the spices and hold it
under the olive oil. Add the olive oil to the turmeric and pepper and use the
measuring spoon to blend it into a paste in the tablespoon. Now add the paste
to the blender and wash both spoons.</div>
<div class="MsoNormal">
5. Peel the ginger and chop it into small pieces – you should have about
two rounded teaspoons – and add that.</div>
<div class="MsoNormal">
6. Add the mango chunks and the green tea. Squeeze the
teabag to get out all the liquid.</div>
<div class="MsoNormal">
7.<span style="mso-spacerun: yes;"> </span>Pulse the mixture
15-20 times to chop hard ingredients, then puree for a slow count of 30.</div>
<div class="MsoNormal">
8. If the drink is too thick, stir in some cold water. If
it’s not sweet enough, add stevia.<br />
<br />
Note: Ginger is easier to peel and chop if you wet it first. Thanks to Real Simple magazine for this tip. <br />
<br />
Update: I have recently learned that I am deficient in alpha-linolenic acid. The fix for this is to take one tablespoon of flax seed oil per day. When I add this to the mango lassi, I find that it cuts back the ginger taste. Flax seed oil is expensive so I probably wouldn't use it if I didn't have the deficiency.<br />
<br />
Update: The next post has another example of food synergy, The Almond-Berry Green Smoothie: <a href="http://bit.ly/1twNQC6">http://bit.ly/1twNQC6</a>.<br />
<br />
<br />
<div style="left: -99999px; position: absolute;">
http://bit.ly/1twNQC6<a href="http://bit.ly/1twNQC6">http://bit.ly/1twNQC6</a></div>
</div>
gretchen kromer's bloghttp://www.blogger.com/profile/02012944567250392269noreply@blogger.com0tag:blogger.com,1999:blog-2958604973303438851.post-72943726744870516312015-12-06T16:30:00.000-08:002019-12-27T06:02:47.309-08:00The Negative Placebo - Why Fitness Buffs Avoid Doctors<div class="MsoNormal">
<span style="font-family: "arial" , "helvetica" , sans-serif;">My personal trainer never visits a doctor. Neither do many
of the weightlifters at the gym where I go. Part of it probably has to do with unease
about appearing naked in front of a near-stranger, as well as a dislike of
needles and other painful features of medical treatment. But fitness buffs have
more fundamental reasons for their negative view of doctors.</span></div>
<div class="MsoNormal">
<br /></div>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><b style="mso-bidi-font-weight: normal;"> 1.<span style="font-family: "arial" , "helvetica" , sans-serif;"> </span>They anticipate that the doctor won’t
respect their values.</b></span><br />
<br />
<div class="MsoNormal" style="margin-left: .25in;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Fitness buffs are people who have
spent years of their lives studying and fine-tuning their bodies. They have
learned exactly how far this muscle will stretch and how much weight that one
will lift. They know what foods and supplements work best with their particular
body type. One of the rewards for this hard work is a precise sense of what and
how the body is doing (proprioception). If something starts to go wrong, they
usually sense it. Fitness buffs believe that proper diet and exercise can keep
most people healthy most of the time.</span></div>
<br />
<div class="MsoNormal" style="margin-left: .25in;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Doctors aren’t taught much about
diet and exercise in med school and they don’t learn more afterward. Many don’t
exercise themselves; some are overweight. Ads for hospitals and medical
practices frequently display photographs of these out-of-shape physicians, a
good indicator that they haven’t gotten the message about diet and exercise
either. </span></div>
<br />
<div class="MsoNormal" style="margin-left: .25in;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Doctors tend to give more credence
to test results than to the patient’s own intuition about how she is doing. </span><span style="font-family: "arial" , "helvetica" , sans-serif;">Some believe that patients are
actually better off taking an FDA-approved medication or than trying to
exercise. “People who can take statins are the lucky ones,” an MD told me once. </span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"> </span>
<br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><b style="mso-bidi-font-weight: normal;">2.<span style="font-family: "arial" , "helvetica" , sans-serif;"> </span>They don't want to be exposed to a doctor's negative attitudes</b></span>.</div>
<br />
<div class="MsoNormal" style="margin-left: .25in;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">The pursuit of fitness is based on
hope and aspiration. The workouts I do each year are harder than the ones from
the year before. The increased strength, flexibility, and versatility have
enhanced my confidence and sense of well-being. In spite of scores of studies to
the contrary, many doctors believe that exercise doesn’t work. I smiled when I
read a <a href="http://bit.ly/1Ry3lSe">post</a> on Kevin MD by an orthopedic surgeon expressing appreciation for
personal trainers and surprise that they could make a significant difference. </span></div>
<br />
<div class="MsoNormal" style="margin-left: .25in;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Some doctors worry about injury;
they recommend moderate exercise and advise people to “know their limits.”
Fitness buffs believe that gently but persistently pushing against your limits
is the path to better health. Each person needs to discover what amount and
intensity of exercise works for him or her.</span></div>
<div class="MsoNormal" style="margin-left: .25in;">
<br /></div>
<div class="MsoNormal" style="margin-left: .25in;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Doctors also believe that patients
won’t follow a serious and consistent exercise program so they don’t even
suggest it.</span></div>
<div class="MsoNormal" style="margin-left: .25in;">
</div>
<span style="font-family: "arial" , "helvetica" , sans-serif;">
</span><br />
<div class="MsoListParagraph" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<span style="font-family: "arial" , "helvetica" , sans-serif;"><b style="mso-bidi-font-weight: normal;"><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;"><span style="font-family: "arial" , "helvetica" , sans-serif;"> <span style="font-family: "arial" , "helvetica" , sans-serif;">3. </span></span></span></span></b><b style="mso-bidi-font-weight: normal;">Doctors do crisis intervention, not health
maintenance.</b></span></div>
<span style="font-family: "arial" , "helvetica" , sans-serif;">
</span>
<br />
<div class="MsoNormal" style="margin-left: .25in;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Although orthotics for problem
feet can prevent devastating knee, hip, and lower back injuries in later life,
this painless and inexpensive treatment is seldom recommended. Protein
supplements and proteolytic enzymes can help older patients retain muscle but
they are usually dismissed, along with supplements in general. If there were
personal trainers in doctors’ offices, they might be able to implement some of
these useful therapies and broaden a few minds in the process.</span></div>
<div class="MsoNormal" style="margin-left: .25in;">
</div>
<div class="MsoListParagraph" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<span style="font-family: "arial" , "helvetica" , sans-serif;"><b style="mso-bidi-font-weight: normal;"><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;"><span style="font-family: "arial" , "helvetica" , sans-serif;"> 4.</span><span style="font-feature-settings: normal; font-kerning: auto; font-language-override: normal; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-synthesis: weight style; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b style="mso-bidi-font-weight: normal;">Doctors are relentless in their search for
disease, sometimes finding it where it doesn’t exist</b>.</span></div>
<span style="font-family: "arial" , "helvetica" , sans-serif;">
</span>
<br />
<div class="MsoNormal" style="margin-left: .25in;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Fitness buffs like to think of
themselves as healthy people. Doctors are trained to discover illness and to
empathize with those who are suffering. Many fitness buffs don’t have annual
physical exams because they fear that a misapplied test or misinterpreted test
result will redefine them as sick, setting off a cascade of unnecessary interventions.
I don’t have the option of staying away because I need renewals of the two or
three medications I take and occasional blood tests to monitor my thyroid.
Every year my doctor suspects me of harboring a different illness; every year I
have to prove that I am healthy.</span></div>
<div class="MsoNormal" style="margin-left: .25in;">
<br /></div>
<span style="font-family: "arial" , "helvetica" , sans-serif;">Heart disease and stroke are the major killers of people in
the US. Stress can be a significant contributor to these illnesses. A recent
study showed that women who had false positive mammograms had a
greater risk of developing inv<span style="font-family: "arial" , "helvetica" , sans-serif;">asive breast </span>cancer in future years. The researchers thought that
the radiologist might have detected some subtle feature that anticipated the
change. I would like to know whether these false positive women also had a
greater risk of heart attack and stroke in future years. Perhaps the anxiety
associated with the repeated tests contributed to future illness<span style="font-family: "arial" , "helvetica" , sans-serif;"> of several kinds.</span> For fitness
buffs, the stress involved in visiting a doctor <span style="font-family: "arial" , "helvetica" , sans-serif;">may be</span> too high a cost for<span style="font-family: "arial" , "helvetica" , sans-serif;"> any possible</span>
benefits.<br /><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;">The truth is that both fitness buffs and doctors
have important information to contribute. If those insights could be shared in
a context of openness and mutual respect, everyone would benefit.</span></span><br />
<div class="MsoNormal">
<br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Note: After following @RogueRad on Twitter, I realize that I should have called this The Nocebo - but some of my readers probably haven't taken Latin in school. </span></span></div>
gretchen kromer's bloghttp://www.blogger.com/profile/02012944567250392269noreply@blogger.com0tag:blogger.com,1999:blog-2958604973303438851.post-18934739958886402015-12-06T12:01:00.001-08:002016-10-12T08:15:01.936-07:00Maintaining an Imperfect Body: the Mini-Workout<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Every body
has them – the trouble-making areas where pain, weakness, or disease tend to
crop up. Sometimes they’re hereditary, sometimes the result of the wear and
tear of decades of life. One of the perks of getting older is that these areas
become familiar companions, not exactly friendly but no longer intimidating. </span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Over the
years I’ve identified six or seven muscle groups or parts of my own body that
are likely to cause problems. This year I’ve started doing a mini-workout of
seven exercises every morning to monitore, stretch, and strengthen those areas.
I also do an eighth move which is an experiment; if it turns out not to work,
I’ll quit doing it. The whole series takes about 15 minutes.</span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "arial" , "helvetica" , sans-serif;"><b style="mso-bidi-font-weight: normal;">Neck.</b> When my father was in his sixties
he developed a pinched nerve in the back of his neck that was very painful.
Advised by his doctor, he started using a traction device to relieve the pressure
on the nerve. To strengthen the muscles in the back of my neck and maintain
flexibility I do this:</span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">- Lie down
on a flat surface and raise my head 2-3”. Stay in this position and count. Over
several months I’ve worked up to 100. I take a break by bending forward toward
my feet. I grab my heels (but that’s not essential for a good stretch). </span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">- I return
to the first position but this time I turn my head to the right and to the left
as far as I can, like shaking my head “no” slowly and deliberately. I go up to
30 reps on this one. </span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">- When I was
a child I used to sleep on my stomach all the time, which meant that my face
was turned to one side. As an older adult, I started to lose flexibility in the
ligaments at the base of my skull so I work on them. I lie on my stomach, turn
my face to one side and count. With all neck exercises it’s important to do
them gently and work up gradually.</span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "arial" , "helvetica" , sans-serif;"><b style="mso-bidi-font-weight: normal;">Calf and Hamstring Muscles, especially on
the right side.</b> My legs have pretty good strength and flexibility but my
range of motion is limited in some exercises. This is not because of arthritis
– I don’t have much of that – but because I have tight, bulky calf muscles,
especially on the right side and little sore spots in the calf and hamstring. A
massage therapist told me I have scar tissue in those areas.</span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">- The sore
spots are in different places each day so I start by doing sleeping child pose
to see where they are. (Sleeping child is the yoga pose where you kneel with
your forehead on the floor and sit back on your heels.) When I find a spot, I
rub and push into it with a circular motion to loosen the area. Usually there
are three or four spots. </span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">- I check my
work by standing up, then sitting down into a squat and counting. Then I stand
up without using my hands. Sometimes I have to stop in the middle and work on
more sore spots.</span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "arial" , "helvetica" , sans-serif;"><b style="mso-bidi-font-weight: normal;">Lower Back.</b> In old age my aunt and
uncle on my father’s side both had lower back problems. (My uncle had a
disastrous back surgery that crippled him for life.) With that in mind, I do
five superman reps. Lying on my stomach with arms stretched out in front of me
I lift my upper body for a count of 25. For this one, it’s important not to
tilt the head up but to look down at the floor. </span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "arial" , "helvetica" , sans-serif;"><b style="mso-bidi-font-weight: normal;">Upper Back.</b> As a young adult, my upper
back muscles were so weak I couldn’t do a single push-up. P90X changed that. I
do 50 of these, though I don’t go very deep on the last 10.</span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "arial" , "helvetica" , sans-serif;"><b style="mso-bidi-font-weight: normal;">Sit-ups.</b> Rounding out the core group, I
do 50 sit-ups.</span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "arial" , "helvetica" , sans-serif;"><b style="mso-bidi-font-weight: normal;">Balance.</b> My right leg is a bit shorter
than the left so my balance is not great. I stand in a doorway on one leg and
count to 10. Then I close my eyes and count to 30. If I get shaky, I grab the
door frame. Same on the other side. </span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "arial" , "helvetica" , sans-serif;"><b style="mso-bidi-font-weight: normal;">Back Strength and Flexibility.</b> Using a
pull-up bar, I lift myself as high as I can. I can’t do a full pull-up yet but
I’m making progress.<span style="mso-spacerun: yes;"> </span>Holding onto the bar
but with my feet on the floor, I stretch through the whole length of my back
and count to 75. If I’m in a hotel room I skip the pull-up and use the top of a
piece of furniture for the stretch.</span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "arial" , "helvetica" , sans-serif;"><b style="mso-bidi-font-weight: normal;">Jumping.</b> My last bone density test
showed that I was losing bone mineral density faster than I would like. I read about a <a href="http://bit.ly/1Xzwf9t">study</a>
that showed that a 10 or 20 jumps with 30 second breaks in between
significantly improved BMD in the jumpers as compared with the
non-jumping control group. </span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">We’ll see if
this routine works for me. As for the cause of the lower BMD, I’m guessing that
the dosage of thyroid hormone I take for hypothyroidism has been too high for
too long. My doctor has lowered the dosage. I had also cut back on my intake of
calcium supplement after reading scary stories in the media. That was probably
a mistake and I’ve gone back to what I was taking before. </span><br />
<br />
<br />
<br />
<b><span style="font-family: "arial" , "helvetica" , sans-serif;">Update 12/31/2015:</span></b><br />
<br />
<span style="font-family: "arial" , "helvetica" , sans-serif;">An <a href="http://www.wsj.com/articles/why-you-can-stop-doing-sit-ups-1450722637">article</a> in the Wall Street Journal a couple of weeks ago persuaded me that I shouldn't be doing situps anymore.</span><b><span style="font-family: "arial" , "helvetica" , sans-serif;"> </span></b><span style="font-family: "arial" , "helvetica" , sans-serif;">I now do variations on plank for one minute, followed by 25 rollouts using an ab wheel. </span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">My personal trainer explained to me that the central ab muscle, the rectus abdominis, is designed to be a stabilizer and is meant to be stretched out flat, not curled up. Doing appropriate exercises will improve its appearance as well as being safer.</span><br />
<br />
</div>
gretchen kromer's bloghttp://www.blogger.com/profile/02012944567250392269noreply@blogger.com0tag:blogger.com,1999:blog-2958604973303438851.post-23579461665074278412015-11-25T12:49:00.000-08:002015-11-25T12:49:48.011-08:00Iron Pit Sign<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjTOTpT7BL3Sy2me6VBUfK84nIyRTLHJVsC5cRvdTuGZocIl1T61SZ8fOTfW_KSZW3HCVSMmEVqjuvRdV07DLILU61CecpLJxKU3NfK1xo9P4ZhD7PAGTE5zu5C1sQQDUTZOzy6SqWKYF7k/s1600/Iron+Pit+sign2.tif" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="167" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjTOTpT7BL3Sy2me6VBUfK84nIyRTLHJVsC5cRvdTuGZocIl1T61SZ8fOTfW_KSZW3HCVSMmEVqjuvRdV07DLILU61CecpLJxKU3NfK1xo9P4ZhD7PAGTE5zu5C1sQQDUTZOzy6SqWKYF7k/s320/Iron+Pit+sign2.tif" width="320" /></a></div>
<br />gretchen kromer's bloghttp://www.blogger.com/profile/02012944567250392269noreply@blogger.com0tag:blogger.com,1999:blog-2958604973303438851.post-31795989318743860962015-11-18T13:03:00.000-08:002015-11-18T13:21:11.247-08:00Mammogram Callback Follow-up, A Useful Conversation<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
After
getting a mammogram callback about a dense area in my right breast I was urged
by my doctor to get more tests ASAP. I decided to wait a few months and retest
to see whether anything had changed. I made an appointment with a different radiologist
with a different hospital affiliation. When I made the appointment I explained
that I wanted one follow-up test – a mammogram or an ultrasound – and not a
battery of mammograms like the ones a few years back.</div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
This morning
I got a call from the doctor at the breast center where I had made the
appointment. On the one hand, any doctor who makes a personal call to a patient
(especially a patient she has never met) immediately commands my attention and
respect. On the other hand, this doctor had a definite agenda and she was
prepared to push it very hard. She was also the fastest talker I have
encountered in a long time (including on TV shows) so I had to listen intently to
take in what she was saying.</div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
I was
impressed with the first point she made: that she and the radiologist hadn’t
just read the reports from previous radiologists but had gone back and looked
at my films for themselves. She said they saw calcifications associated with an
area of density and that the dense area had increased in size from one film to
the next. This was new information to me. As far as I had known up to that
point, the dense area had just appeared this year. She said that in order to
learn more about the dense area they would have to look at the appearance of
the calcifications and this would require a “workup,” a series of mammograms.
An ultrasound would not provide the necessary information, she said. If the
results of the mammograms were worrisome, a biopsy might be necessary as well.</div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
She said
that because I was not young and not on hormone therapy a dense area was a
cause for concern. I said, “But I am on estrogen-only therapy.” She said hormone
therapy can contribute to dense areas in the breasts, especially as women get
older. (I later read that estrogen therapy is associated with a higher
incidence of false positives in mammograms.) I started to explain that I take
estrogen because of research indicating that it can protect against heart disease
which is common in my family. I started to say “and certain cancers, including
breast cancer” but she interrupted me. I said, “Please let me finish.” </div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
She stopped
talking and let me finish. Then she said that reduced heart disease among
estrogen users may be because estrogen users probably have better overall
health care and <b style="mso-bidi-font-weight: normal;">that</b> reduces heart
disease rather than the estrogen. (This sounded to me like rationalizing speculation
by the breast cancer establishment rather than proven scientific fact but I
didn’t say so.) She said that a woman’s chances of getting breast cancer
increase as she gets older. I said that we’re still talking about less than 5
percent. I also said that one of the reasons why I feel cautious about
mammography is that it doesn’t take into account the general health of the
person and whether they have diabetes and other health problems although these
factors can be correlated with breast cancer. She said that she has to
look at the situation from the point of view of breast cancer. I said, “Of
course.”</div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
She said she appreciated it when patients were well informed. I said I appreciated her calling me
personally. I’m not happy about this new plan but, based on the information I
now have, it seems inevitable. I can still veto the biopsy if and when the time
comes. I told her I was cautiously optimistic about my situation and she said, “Good.”
This conversation cleared up a couple of important misunderstandings and strikes
me as a great example of why direct doctor/patient communication (rather than
exclusive reliance on tests) is so essential. I'm sure that doctors don't necessarily enjoy talking with opinionated patients like me. On the other hand, they probably understand that patients who get their questions answered up front are less likely to sue if something goes wrong because responsibility for decisions about care was shared.</div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
Two
questions remain in my mind. Why do radiologists believe that they can
accurately interpret films without knowing anything about the patient’s medical
history, including relevant facts like my estrogen use? Is the doctor pushing her agenda so hard because she is pressed for
time or because she herself has some doubts about it, or both?</div>
gretchen kromer's bloghttp://www.blogger.com/profile/02012944567250392269noreply@blogger.com0tag:blogger.com,1999:blog-2958604973303438851.post-7332476696446738242015-09-12T14:45:00.000-07:002015-10-01T19:47:43.615-07:00When I Say No To This Year’s Mammogram Callback, Who’s On My Team?<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 150%;">Peter
Ubel’s article in Forbes,<a href="http://onforb.es/1XGCAxn"> “Has Mammography Created an Epidemic of Pseudo-Survivorship?”</a>
makes for painful reading. By recounting the ordeals of a patient he calls Mary
Vogt, he illustrates how the many women who have been aggressively treated for DCIS
(ductal cancer in situ), aka cancer 0, have been harmed by this therapy. In my
opinion, another casualty in situations like this may be the relationship of
trust between patient and doctor, a relationship that is at the heart of the healing process.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 150%;">Several
years back I wrote a post called <a href="http://bit.ly/1kjkB9V">“Mammograms and the Cost Conundrum.” </a></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 150%;">There
I recounted how radiologist who read my mammogram decided that the
calcifications that had been there all along had changed in appearance and
might now be dangerous. He recommended a biopsy (see Peter Ubel’s description).
I got a second opinion, which was that nothing had changed. The calcification
episode was actually the third mammogram callback I’ve gotten, each time with a
different, vague-sounding story. Invariably, these come about when a new
radiologist looks at my pictures. </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 150%;">After
skipping last year, I went for a mammogram last week. A few days later the word
came back that the radiologist (a new one) had seen a one-centimeter “dense
area” on my otherwise not-dense right breast and wanted me to come back for an
unspecified number of mammograms and perhaps an ultrasound. I said “No.”</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 150%;">The
radiologist, an independent contractor located somewhere out of state, is
telling me that he can’t see this area clearly enough. He probably would like
to know exactly what it is. For me, the only essential question is “Is this
invasive breast cancer?” I want to wait for three or four months and have
another single test to see whether anything has changed. If there’s change, at
that point we can bring in the heavy artillery. The offending area may be any of
a number of benign conditions, such as a blocked duct, or it may be nothing at
all. It could also be DCIS. In any of those cases, I want to leave things
strictly alone. Additional mammograms might provide certainty but they might also
lead to still more testing, radiation exposure, and expense for the system as a
whole. Also, while mammograms are generally no big deal for me, the eight or so done
during the calcifications episode are still vivid in my mind. </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 150%;">My
primary care provider is clearly unhappy about this. She has already urged me
once to get the recommended follow-up and, after I told her nurse what I had
decided, wanted me to come in for “clarification” of the matter. I will try to
avoid doing this because I believe it will only lead to more arguing and
unnecessary stress for both of us.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 150%;">Medical
practice is supposed to be based on science. So what are the facts here? Any
woman in her 60s has less than a 4% chance of developing invasive breast
cancer. Many women in their 60s are overweight, have hereditary or
environmental risk factors, or all of the above. I have none of those. My insurance company just refunded about half of my
Medicare Part B premiums because I’m such a bargain. People in my family die of
strokes and heart attacks, not cancer, and breast cancer is pretty much unheard
of. (The breast cancer types like to talk about all the women with no family
history who get cancer but those figures are suspect because they probably
include a lot of DCIS, which is not a cancer.) </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 150%;">A
couple of unusual circumstances. My mother took stilbestrol when she was
pregnant with me but the women who have apparently gotten cancer from that
cause were all decades younger than I am; I would be medically unique if it
happened to me at 69. I've never had children, which raises my risk 40%, so let's say my risk of invasive cancer is as high as 5%. On the other hand, I take estrogen, which, when started early (age 32)
may <i style="mso-bidi-font-style: normal;">protect against </i>breast cancer,
unlike the mixed type of hormone therapy. For all of these reasons, I think
breast cancer for me is a long shot. Would you bet on a horse that had a 5% chance of winning? Not impossible, but very unlikely. </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 150%;">In
the current state of medical practice the burden of proof is on the woman with
an “abnormal” mammogram to demonstrate that she does not have a dangerous condition. The
burden is transferred to her in the form of radiation and to the system as a
whole in the form of additional cost. The ostensible reason is to save the
patient from dying; an important collateral reason is to protect doctors from
liability – they’ve got to be able to show that they did everything they could.
My doctor is determined to get me to do this; I am determined not to. I told
her nurse that I would be glad to sign a release saying that she had
recommended this option and I had refused it. On the other hand, if my doctor
is simply unwilling to accept my decision, I will have to find a new doctor. I
would be sorry to do this because we have had a pretty good relationship over
the past four years.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 150%;">My
doctor is in a difficult situation. The large outfit she works for is undoubtedly
putting pressure on her to take this approach and she has a family to support.
On the other hand, even after the many articles like Ubel’s that have shown the
damage done by aggressively treating a non-illness, for this medical
organization it is business as usual. I sympathize with my doctor but I will
not agree to repeat this retesting process every three or four years for the
rest of my life. Ultimately, I must make my own decisions about my health care
and take responsibility for them. </span></div>
gretchen kromer's bloghttp://www.blogger.com/profile/02012944567250392269noreply@blogger.com0tag:blogger.com,1999:blog-2958604973303438851.post-73152710567659941582015-08-03T08:58:00.000-07:002015-08-03T16:58:10.584-07:00Three Important Reasons to Keep Hard Copies of Your Medical Records<span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 115%;">This
year, my annual physical was scheduled for late July. I always get the regular
blood tests done a few weeks ahead so my doctor and I can discuss them face to
face and renew any needed prescription. This year, though, my medication for
hypothyroidism was about to run out. Once the blood test results were available, I
asked the doctor’s office to renew the prescription immediately and not wait for the
appointment. It didn’t get done. </span><br />
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 115%;">1. When it comes to your medical records, the
only constant is you, not your doctor or your doctor’s office.</span></b></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 115%;">The
reason my prescription wasn’t immediately renewed was that my doctor did not
have my medical records. The reason she didn’t have my medical records was that
she had moved, from an office affiliated with one of our local hospitals to an
office affiliated with the other. </span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 115%;">2. Electronic medical records systems are
not compatible with each other.</span></b></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 115%;">At
some point after I had made the appointment for my physical, my records were
faxed from one office to the other. Since the systems used at the two offices
are not compatible, information sent by the old office will have to be entered
by hand into the new office’s computer. This may take many weeks or months and
will provide opportunities for data entry errors to be made. In the meantime…</span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 115%;">3. Computer systems in medical offices are
constantly being changed and upgraded.</span></b></div>
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<span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 115%;">Each
time this happens there is more opportunity for error and for records to be
lost entirely. Also, there seems to be no requirement that any new system be
more universally compatible than the previous one.</span></div>
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<span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 115%;">On the
day of my appointment I arrived at my doctor’s office with a fat folder
containing the medical records I have been keeping over the past ten or fifteen
years. (Even when she finally does get my electronic medical records my doctor
will not have a history going back that far.) I had also made a separate list
of my thyroid test results over the past two years so she would know immediately
what dosage to prescribe. While I was there, she made photocopies of other test
results that I had and she didn’t. </span></div>
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<br /></div>
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<span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 115%;">I was still
mulling all of this over a few days later when I got a letter from a hospital
affiliated with an Ivy League university on the east coast. When my mother died
in 1986 of the effects of Alzheimer’s disease, some of her brain tissue was
donated to this facility for research. “Regrettably,” the hospital said, they
had lost track of backup data tapes containing information about my mother.
And, by the way, the tapes were unencrypted.</span><br />
<br />
<span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 115%;">Update: After writing this, I have been thinking about how enormously destructive the transition to electronic records has been. For millions of people, years of health-related data have been misplaced, lost or intentionally discarded. Why did anyone believe we could do without paper records without first having a reliable, universally compatible electronic system in place? </span></div>
gretchen kromer's bloghttp://www.blogger.com/profile/02012944567250392269noreply@blogger.com0tag:blogger.com,1999:blog-2958604973303438851.post-25831287368158997912015-07-11T14:17:00.000-07:002017-05-09T11:59:10.794-07:00Caution, Patients, Large Studies May Be Hazardous to Your Health (and Incur Unnecessary Costs for the Health Care System) <div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "arial" , sans-serif; font-size: 12.0pt;">When it
comes to providing clear explanations of complex medical and health-related
issues, there is no one better than Aaron Carroll. As a person who is regularly
looking for answers in these areas, I am a huge fan. I watch his videos on
Healthcare Triage, read his articles in the New York Times, and follow him on
Twitter. His excitement about food, ideas, travel, and the latest exploits of
his kids are fun to read about. You probably sense that there is a “but” coming
– and here it is: Aaron’s enthusiasm about large studies makes me uneasy.</span></div>
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<span style="font-family: "arial" , sans-serif; font-size: 12.0pt;">Large
studies inform us about what happened to a particular group of individuals
under a specific set of circumstances. They can provide guidance for medical
practitioners when they deal with individuals who appear to be similar to that
group; they can give doctors an idea of what to look for. What can large
studies tell doctors for certain about any given individual? Absolutely
nothing. </span></div>
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<span style="font-family: "arial" , sans-serif; font-size: 12.0pt;">Problems
arise when the guidance provided by studies morphs into a hard-and-fast rule
about what must always or never be done. In some cases conclusions from studies
are over-generalized and made to apply to situations which are beyond the scope
of the studies. </span></div>
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<br /></div>
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<span style="font-family: "arial" , sans-serif; font-size: 12.0pt;">“<a href="http://bit.ly/1Hnc3g6">Arthroscopic Surgery Isn’t Going to Fix Your Knee</a>,”
a recent HCT video, talks about a recent review and meta-analysis of studies on
arthroscopic surgery for degenerative knee. Both the title and the video itself
make it sound as though arthroscopic surgery is <b style="mso-bidi-font-weight: normal;">always</b> a waste of time and money. Yet the studies were really about
attempts to repair degenerative knees. They weren’t intended to address the
issue of repairing knee<b> injuries</b>.</span></div>
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<br /></div>
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<span style="font-family: "arial" , sans-serif; font-size: 12.0pt;">When
patients fail to conform the rules derived from large studies, they may have
great difficulty securing proper medical treatment. Here is what happened to a
friend of mine, a man in his mid-seventies, a natural athlete who was then
playing racquetball a couple of times a week. One afternoon he tripped as he
was going up some stairs. In instant he went from normal to hardly being able
to walk. </span></div>
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<span style="font-family: "arial" , sans-serif; font-size: 12.0pt;">After an
x-ray at the hospital, he went to a local orthopedics practice where the first
doctor said, “You have a torn meniscus. It can be repaired with arthroscopic
surgery – we do it all the time.” That sounded fine to my friend but when he
was passed along to a surgeon in the same office he got a different pitch. The
surgeon said, “You have advanced arthritis and surgery would not do any good.”
He then gave my friend a cortisone shot, which had no effect on his pain or
disability and told him that he would probably require a knee replacement in
the foreseeable future.</span></div>
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<span style="font-family: "arial" , sans-serif; font-size: 12.0pt;">The story
about advanced arthritis didn’t sound quite right to my friend. Before the
injury, he had been able to squat down and remain there for minutes at a time
(the pose of cowboys in front of a campfire). He sought out a second
orthopedist. This doctor, a woman, said, “We don’t normally do knee surgeries
on people in their seventies but I think you are the exception.” Several weeks
later, after performing the surgery, she said, “This knee was like a Ping-Pong
ball. I’ve seen people in their forties who didn’t have knees as good as this.”
This was an injury, not advanced arthritis. The first surgeon had lied because
he didn’t want to operate on a man in his seventies. My friend went back to
playing racquetball.</span></div>
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<span style="font-family: "arial" , sans-serif; font-size: 12.0pt;">Doctors
today have impossible schedules. They see each patient for fifteen minutes, if
that. Under these circumstances, over-generalizations and rules based on large
studies can become a tempting substitute for close observation and careful
analysis of an individual situation. The likely consequences are improper care
for the patient and unnecessary expense for the health care system. In thinking
about my friend’s experience I have sometimes wondered how many older people with
injured, but otherwise healthy, knees have been steered into having knee
replacements when all they needed was a simple arthroscopic surgery.</span></div>
gretchen kromer's bloghttp://www.blogger.com/profile/02012944567250392269noreply@blogger.com0tag:blogger.com,1999:blog-2958604973303438851.post-62845533959865152172015-07-11T12:17:00.000-07:002015-07-11T12:17:55.425-07:00Patient Stereotyping at the Optometry Clinic<div class="MsoNormal">
<span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 115%;"></span><span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 115%;">A friend of mine, now in his eighties, had been unhappy
with his distance vision for several years. Each year or so he had his eyes
tested at an optometry clinic run by a nearby university where there was a
school of optometry. On these occasions he would ask whether he should consider
cataract surgery. Each time he was told that it would probably do no good
because his distance vision was not that bad. This year he learned that he had
drusen, yellow deposits under the retina. These marks, he was told, might be
early signs macular degeneration, which might be contributing to his vision
loss and would not be helped by cataract surgery.</span></div>
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<span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 115%;">At the optometry clinic, my friend’s eyes were examined by
students whose work was then checked by a faculty member. Some of these
students were observing certain eye conditions on a live patient for the first
time; they had only previously seen them in textbooks or online. In addition,
typical patients at the clinic were other students or faculty in their thirties
through early sixties. Relatively few older people were seen there.</span></div>
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<span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 115%;">My friend decided to get a second opinion. He visited an
optometry practice that uses state-of-the-art tests and equipment to examine
and treat conditions affecting vision. There, the typical patient is in their
sixties or older and the doctors on staff have had years of experience treating
such patients. The doctor who saw my friend told him that he was a good
candidate for cataract surgery; that there would be a significant improvement in
his distance vision. After looking at the drusen, he told my friend that there
are different types; the kind my friend had might never cause any vision
problems at all. </span></div>
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<span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 115%;">My friend just got cataract surgery and, after less than a
week, already has better distance vision than he had had with his glasses. </span></div>
gretchen kromer's bloghttp://www.blogger.com/profile/02012944567250392269noreply@blogger.com0tag:blogger.com,1999:blog-2958604973303438851.post-78441502171131310922015-04-27T06:15:00.000-07:002015-04-27T06:21:02.374-07:00An Interlude in Padua<div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><a href="http://bit.ly/1Dde3SO">Prato della Valle</a> is a huge open space
at the edge of the old part of Padua. Once the site of a Roman theater and of
Renaissance jousting competitions, it is the largest piazza in Italy (over 22
acres). We were there to see the <a href="http://bit.ly/1Fe1IUn">Basilica di Santa Giustina</a>,
which commemorates Saint Justina, an early Christian martyr and the patron saint of the city.</span><br />
<br />
<span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 115%;">Inside the church, marble floor tiles are laid in an illusionistic pattern, a surprisingly modern touch. The church is
supported by massive pillars that rise to graceful arches overhead. In the late
afternoon silver-grey light filtered down from windows in the domes high above. A
pigeon had gotten inside and cooed somewhere out of sight.</span></div>
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<span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 115%;">As we left, a monk came out to lock the doors. He had an
easy smile with one tooth angled inward and asked us where we were from. We
told him and asked him if he was Italian (</span><span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 115%;"><span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 115%;">in Italy, </span>priests and nuns come from
all over the world). “Italianissimo!” he answered proudly. Then his cell phone
rang and he had to go. We walked across to a restaurant where we could watch
the sun go down over the piazza. </span></div>
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<span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 115%;">There are moments when the diverse strands of my experience
seem to be woven together into a coherent whole. This was one of those moments.</span></div>
gretchen kromer's bloghttp://www.blogger.com/profile/02012944567250392269noreply@blogger.com0tag:blogger.com,1999:blog-2958604973303438851.post-19157585022935268022015-03-31T13:05:00.000-07:002015-03-31T13:05:18.342-07:00Bells, the New Challenge, and Going Back to P90X<span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 115%;">Last spring I quit going to our local Y. Even with very intense
workout I had been doing - a combination of weights, cardio, and stretching - my
condition was not improving; I wasn’t losing weight or body fat or getting
stronger. Clearly, I was in a rut. I decided to check out the <a href="http://www.ironpit.com/">Iron Pit</a></span><span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 115%;">, a weightlifting gym where I used to work out with a
personal trainer several years ago.</span>
<span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 115%;"></span><br />
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<span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 115%;">About the same time I read an article by Daniel Duane about
his own experience with strength training (<a href="http://www.nytimes.com/2014/05/25/opinion/sunday/fitness-crazed.html">“Fitness Crazed,”</a> <i style="mso-bidi-font-style: normal;">NYT</i> 5/24/2014).</span><span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 115%;"> At the age of 40, Duane found himself fat and weak and went
on a quest for an effective exercise program. After trying and rejecting a
number of approaches (including P90X), he settled on a weightlifting program
designed by Mark Rippetoe, Duane did three workouts a week based on five lifts:
the squat, deadlift, power clean, bench press, and standing press. He did three
sets of five reps of two or three exercises each time. Each workout, he found
that he could lift a little bit more until, after a year, he could squat 285
pounds, dead lift 335, and bench press 235. (This <i style="mso-bidi-font-style: normal;">Men’s Journal</i> <a href="http://www.mensjournal.com/magazine/everything-you-know-about-fitness-is-a-lie-20120504">article</a> gives a more detailed account of his progress.)
</span>
</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 115%;"></span><span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 115%;">I decided to see whether this approach would work for me. Doug
Ballard, one of the owners of the Iron Pit, got me started on the squat, deadlift
and bench press using a 45 lb. Olympic-sized bar. To Duane’s basic five I added
a bunch of others plus cardio twice a week on a cross trainer to keep my heart
rate where it should be. (Duane is actually a biker and a surfer so weightlifting
isn’t his only physical activity.) In order to burn enough calories, I need to
be doing at least 6-7 hours a week of exercise so I rounded the program out
with some DVD workouts, mostly P90X plus some Bob Harper routines. I’ve been
doing this for about nine months.</span></div>
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<span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 115%;">Starting any exercise regimen gives you new insights into
your physical advantages and disadvantages. To do a squat with correct form you
need to push your hips back as you lower your upper body, keeping your chest as
vertical as possible. Near the bottom you need to curve your lower back upward,
sort of like a duck’s tail. I have a short torso so I don’t have much lower
back to work with. I do as well as I can but I struggle with this one.
Deadlifts, on the other hand, feel pretty natural, probably because my legs are
strong. I’m up to 110 lbs. and expect to go higher soon.</span></div>
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<span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 115%;">Unlike Daniel Duane, I <b style="mso-bidi-font-weight: normal;">don’t</b>
find that I can add a little more weight each time. Progress is sporadic,
especially if I have to take a few days off because of a trip or some other distraction.
In terms of physical condition, my weight and body fat percentage are the same
but I’ve lost half an inch from my thigh and a quarter of an inch from my upper
arm, nice but nothing to write home about. The main improvement I notice is
with my posture. Working the back muscles this hard pulls my shoulders back and
down; I’m seeing more of my rib cage than I have since grade school. Also, when
I go back to P90X I find that I’m doing the same exercises with heavier weights
(still can’t do an unassisted pull-up though). </span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgqdsiLpSrfCseNnyLUFQez3mqjkiJYkQ-mCFyMwpwYMI9CMP1MPMIuYASAbHGAyj5m_EQck9J8x8hNPjvc6KwqTbu0JpiBET9Ftst6cRtyt1Sec1R5HHvxiXuVMWErtWkqXHqAYyMMmC1Y/s1600/IMG_0150.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgqdsiLpSrfCseNnyLUFQez3mqjkiJYkQ-mCFyMwpwYMI9CMP1MPMIuYASAbHGAyj5m_EQck9J8x8hNPjvc6KwqTbu0JpiBET9Ftst6cRtyt1Sec1R5HHvxiXuVMWErtWkqXHqAYyMMmC1Y/s1600/IMG_0150.JPG" height="240" width="320" /></a><span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 115%;"> </span></div>
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<span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 115%;">One of the DVD workouts I do features kettlebells. These
are round or squarish weights with handles at the top. Typical moves involve
swinging them in an arc, though you can also use them for regular exercises
like curls and cleans. The swinging motion means that you get into parts of the
muscle that normal strength moves don’t hit. Bob Harper’s 45-minute kettlebell
routine also includes jumping jacks and pushups. </span></div>
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<span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 115%;">When it comes to strength there’s no magic; if you want to
improve you need to work harder. That means lifting weights close to the limit
of what you can do. Doing many reps with a 3- or 5-lb. weight, as is often
recommended for people in their 60s like me, might help to keep you flexible
but if you want to be strong you need to get up into the 10-or-above range. As
you get older, strength training may be the most important type of exercise of
all. I’ve noticed that Bob Harper, when he creates workouts for DVDs, uses
light or medium weights; when he exercises for himself he goes to CrossFit and
does powerlifting.</span></div>
gretchen kromer's bloghttp://www.blogger.com/profile/02012944567250392269noreply@blogger.com0