Summer Grilling

We all love grilling, especially in the summertime. It’s a smart way to prepare food since the preparation can be low fat and the kitchen stays cool. However, there are a few things to remember about cooking on the grill.

Be carful when cleaning the grill. The wire bristles from the grill brush can become loose and end up in the food. If swallowed, the bristle can cause serious health problems. Scraping with a spatula is safer.

The most basic: stay safe! The grill is hot, hot, hot and will stay hot for a long time. Have an exclusion zone around the grill so no one will accidently back into it. Of course, children should keep their distance.

Before you grill, the food should be kept cold to minimize the risk of food poisoning. Get is hot quickly, then either keep the food hot or get it cold again. Discard marinades after use.

When muscle meat, including beef, pork, fish or poultry is cooked over high heat certain chemicals are form that in the lab have been shown to cause changes in DNA that may increase the risk of cancer. Try to avoid charring meat – turning meat often is helpful. Trim excess fat from foods to avoid flare-ups.

Alcohol and the grill are a bad combination. The grill master can enjoy a drink when someone else does the dishes.

Malaria

For many, summer is the time for an exotic vacation. Others will head to tropical resorts during the winter. Anyone who travels should remember that an unfamiliar locale may mean exposure to unfamiliar diseases.

Malaria has been eliminated from the Unites States, but is still prevalent in tropical and subtropical countries. One million people die every year from malaria. Malaria is caused by a parasite that is transmitted by a mosquito bite. Other modes of transmission include blood transfusions and sharing used needles. Symptoms typically start within a few weeks of exposure but the parasites may lie dormant for years.

There are several different parasites that cause malaria. The most deadly ones are found in India, Africa south of the Sahara, some Pacific Islands and Haiti. Medication taken before, during and after a trip to a malaria area can help protect against infection. Different medications are used for different varieties so it’s important to know your exact itinerary.

In addition to taking the appropriate medication, you should reduce your exposure to mosquitos. Skin should be covered with trousers and sleeves from dusk to dawn. You should sleep under insecticide treated mosquito bed nets. Pregnant women and young children are at increased risk for severe disease and complications – and may want to consider vacationing elsewhere.

Although malaria can be a deadly disease, illness and death can often be prevented.

For more information, the Centers for Disease Control and Prevention has a comprehensive website.

Gas

While looking for a handout for a patient I came across a fantastic summary about gas in the digestive tract. Gas can be a huge source of distress since there are only two points of exit for gas (upper and lower).

Points to Remember

•    Gas is air in the digestive tract.

•    Everyone has gas. However, many people think they pass gas too often and that they have too much gas. Having too much gas is rare.

•    Gas in the digestive tract is usually caused by swallowing air and by the breakdown of certain foods in the large intestine by bacteria.

•    Most foods that contain carbohydrates can cause gas. In contrast, fats and proteins cause little gas.

•    Foods that produce gas in one person may not cause gas for someone else.

•    The most common symptoms of gas are burping, passing gas, bloating, and abdominal pain or discomfort.

Gas can be treated by reducing swallowed air, making dietary changes, or taking over-the-counter or prescription medications.

Burping, or belching, once in a while, especially during and after meals, is normal. However, people who burp frequently may be swallowing too much air and releasing it before the air enters the stomach. Passing gas around 13 to 21 times a day is normal.

People’s eating habits and diet affect the amount of gas they have. For example, eating and drinking too fast may increase the amount of air swallowed, and foods that contain carbohydrates may cause some people to have more gas. Tracking eating habits and symptoms can help identify the foods that cause more gas. Avoiding or eating less of these foods may help reduce gas symptoms.

Breakfast Like A King

“Eat breakfast like a king, lunch like prince and dinner like a pauper” is an old nutrition tip that we should remember. You are better off consuming calories early in the day, when you need them. Weight control appears to be related to when you eat – the same number of calories per day eaten late at night can pack on the pounds. A lot of people don’t feel hungry for breakfast because they are eating too much at night. Eating at night can also disturb sleep patterns – and disordered sleep is also associated with obesity.

 Most people eat very little protein at breakfast, have some with lunch and eat the majority of their protein at dinner. Eating protein with every meal will help maintain energy levels during the day and help with muscle protein synthesis. A protein rich breakfast will provide essential fuel to the brain and muscles in the morning.

Adding a fruit or vegetable to every meal is an easy way to improve nutrient intake. Stay away from juices since the fiber in the fruits and vegetables will aid digestion.

 Small changes can make a big difference.

Magnesium

The blood magnesium concentration is not usually measured as part of routine blood tests and is ordered when there is a clinical suspicion that the level might be too high or too low. Common reasons to check for a low magnesium level would be chronic diarrhea, alcoholism, diuretic use or chronic protein pump inhibitor for reflux/heartburn/peptic ulcer disease. Less common manifestations of low magnesium would be unexplained low blood potassium, low blood calcium or cardiac arrhythmias.

Patients with severely low magnesium levels should receive intravenous therapy with cardiac monitoring. Oral replacement is appropriate for an asymptomatic patient.

Magnesium is excreted by the kidneys and can rise to toxic levels in renal failure. The body’s reserve of magnesium is stored in the bones but the high levels of magnesium in renal failure is due to dietary magnesium, usually from medications such as antacids or laxatives in usual doses. Patients with renal impairment should not take over the counter medications that contain magnesium.

Medical Trivia: Extremely high blood magnesium in conjunction with very high blood calcium is seen as a unique feature of Dead Sea water poisoning since the Dead Sea contains very high concentrations of both magnesium and calcium.

Too Old For a Mammogram?

When to stop screening? My 85 year old patient was ‘disappointed’ that I turned down her request for a mammogram requisition slip. Her mammogram was a birthday ritual and had been for decades. She had no unusual risk factors for breast cancer and performed breast-self examinations monthly. While a matter of debate, finding breast cancer at age 85 may not help my patient survive longer, but it may cause medical problems, diminish her quality of life and cause unnecessary distress.

There is no doubt that screening mammograms will pick cancers at an earlier stage. The question of what to do if a cancer is found will be based on type of cancer, if there are other medical conditions, expected life expectancy and the wishes of the patient. Most of the studies that looked at women who had screening mammography after age 80 have found that those women tended to be white, married, and have higher education and income levels. They also were in better health with fewer other conditions such as heart disease or diabetes. The data are not clear if early detection of breast cancer in elderly women increase survival. For women with other medical problems (lung disease, peripheral vascular disease, heart disease, diabetes, rheumatologic disease), mammograms did not increase survival.

This discussion is about screening mammograms only. Any breast mass or breast change requires an evaluation – which could include mammogram, ultrasound or MRI.

I read an excellent guideline – women should have a yearly screening mammogram until they believe that they don’t have ten good years left.