Pain

There are aches and pain of daily life and then there is pain: post-operative, orthopedic or associated with cancer. In the acute situation pain relief will lead to less stress on the body and the mind with the hopes of accelerating recovery. This type of acute pain is an appropriate use of narcotics. In the unfortunate situation the pain becomes chronic. In the past one learned to live with the pain but then the tide turned and the goal was to make everyone ‘pain free.’ The unintended consequence of a ‘pain free’ existence has been an epidemic of drug abuse.

The use of narcotics may be entirely appropriate in acute and self-limited situations but the long-term goal now is to maintain functionality even the face of pain. Complementary medicine, such as acupuncture, plays an important role in the management of pain. Health care practitioners are embracing a new paradigm, some more enthusiastically than others.

The Department of Consumer Protection in Connecticut monitors all dispensing of controlled substances. These include sleeping pills, tranquilizers, codeine cough medicine and most pain medications. From the website: The prescription monitoring program collects prescription data for Schedule II through Schedule V drugs into a central database, the Connecticut Prescription Monitoring and Reporting System (CPMRS), which can then be used by providers and pharmacists in the active treatment of their patients. The purpose of the CPMRS is to present a complete picture of a patient’s controlled substance use, including prescriptions by other providers, so that the provider can properly manage the patient’s treatment, including the referral of a patient to services offering treatment for drug abuse or addiction when appropriate.

Prescriptions for controlled substances cannot be called into a pharmacy but must be written on special paper. The prescriber is mandated to check the database for any prescription for a more than seventy-two hour supply of medication. Prescriptions for chronic pain are typically written for a twenty-eight day supply with the ultimate goal of weaning the patient from narcotics to other modes of pain management.

Body Weight Planner

Kevin D. Hall, Ph.D. is a scientist at the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. He recently developed the NIH body weight planner, an evidence based tool to reach and sustain a healthy body weight.

The tool is now web based but the NIH is developing mobile apps. Dr. Hall’s introduction:

A lot of people want to change their lifestyle to lose weight and improve their overall health but really don’t know what it takes. The recently developed NIH Body Weight Planner can provide support. It’s the first tool to use personalized information to calculate the required eating and physical activity changes to help people reach and stay at their goal weight. The Planner uses technology based on years of scientific research to accurately model how your body adjusts to changes in your eating and physical activity habits. Its calculations reflect the discovery that the widely accepted paradigm that reducing 3,500 calories will shed one pound of weight does not account for slowing of metabolism as people change their eating patterns and physical activities. This old rule of thumb is still widespread, but substantially overestimates how much weight people will actually lose.

Try the Body Weight Planner by entering your weight, sex, age, height, and physical activities during work and leisure. Then enter a target date for reaching your goal weight. You can also add details like percent body fat and metabolic rate. The Planner will then calculate your personal calorie and physical activity targets to achieve your goal and maintain it over time.

Eggs

Your cholesterol level in your blood is more complicated than once thought and depends on more than the amount of cholesterol in your diet. Cholesterol is found in all foods that come from animals: poultry, fish, meat, eggs, milk and cheese.

About twenty percent of people of European background have a gene called apoprotein E4 (apo E4) that is associated with raised blood cholesterol. This gene has been linked to increased sensitivity (in terms of raising cholesterol) to dietary fat, especially saturated fat. While liquid vegetable oils are much better than animal fats and tropical oils, all fats and oils are natural mixtures of saturated and unsaturated fats. The tropical oils, such as palm oil, palm kernel oil, and coconut oil are very high in saturated fats. These fats are often used in packaged foods to extend their shelf life.

Egg yolks have a lot of cholesterol but also contain nutrients that may lower the risk of heart disease including protein, vitamins B12 and D, riboflavin and folate. Recent studies have shown a lack of relationship between eating eggs and developing heart disease, even in those people who have a genetic predisposition (carrying the apo E4 gene).

Eggs can play an important role in the diet. The nutritional bomb is not the egg but the extras: bacon, processed cheese and roll made with white flour.

Here is more information (sponsored by industry, but still worthwhile).

Testicular Cancer

Testicular cancer usually affects men from age 20 to 39. Testicular cancer is uncommon: about 8,250 cases were diagnosed in 2006, with about 370 deaths. This represents only 1 percent of all cancer diagnoses. However, testicular cancer is the most common cancer in men between the ages of 15 and 34.

Although common sense suggests routine testicular cancer self-exams should catch it earlier, this has not been definitively established. The U.S. Preventive Services Task Force also does not recommend testicular cancer self-exams. At the same time, there is no reason that men should not do self-exams.

Testicular self-examination is when you (or someone else) check your testicles for any abnormalities. It is important to know what feels normal and to be able to notice any changes. Changes are not always cancer. If it is cancer and you catch it early, you have the best chance for a cure. The best time to check is after a bath or shower when the scrotum is relaxed.

Most testicular cancers are discovered by the men who have them. The most common symptom of testicular cancer is a painless mass (lump) in one testicle. Other symptoms to look for are testicular discomfort, pain or swelling, any change in size or the usual "feel" of the testicle, a sensation of heaviness in the scrotum and/or dull aching in the abdomen, back, or groin.

Many men delay seeking medical attention once they notice something. That’s a shame, since early diagnosis can lead to a better outcome. Everyone is busy – but anyone can spare a few minutes for medical care. And please don’t be embarrassed to death.

And there's an app for that!

F is for February

Now that February is here many of the New Year’s resolutions are a distant memory. Thanks to Elizabeth Pector, MD for a fresh take on the “F’s.”

Even if you stuck with your intention to lose weight for a couple of weeks, chances are you were feeling better. Life is better without chronic heartburn from poor food choices or eating late at night.

Fear is a powerful motivator. If a close friend is diagnosed with colon cancer a patient will be open to booking a screening colonoscopy or mammogram.

Finances are a strong incentive. Many employers will offer a discount on insurance premiums or lower co-pays if patients have well exams or adopt better behaviors. Check with human resources to see what is offered.

This is a good time to counter fallacies with facts. Give the ‘natural remedies’ a try but don’t be too proud to accept help from pharmaceuticals. It’s terrific to get blood pressure until control with diet and exercise but that will take a will. Use medication as needed and then wean off as you are successful in achieving your goals. And remember that you already chose your mother and father – genetic risks don’t go away.