Saturday, May 10, 2008

MOTHER'S DAY: TIME TO GARDEN

    As Nurse's Week comes to a close, Mother's Day is just beginning.   If you're a nurse and a mother, you're pretty much kicking 110% ass right now.   If EVERYONE isn't giving you flowers, you better start slapping people.
    In Denver, Mother's Day is also the day you can be assured with 95% certainty that you are beyond the last of the killing frosts; the bane of early spring gardeners.  That means: it's time to plant!
    People in NYC, SF, and other large cities often assume that because they don't have a yard, they can't garden.   Nothing could be farther from the truth.   You can grow almost any vegetable in a container- which means that your porch, your front steps, even your windowsill can be a source of fresh, home-grown food.  And if you think vegetables are easy to grow, you should try growing cooking herbs.  There is nothing like cooking a dish using fresh herbs you have grown yourself!
    My college buddies were the ones who taught me that gardening and healthy eating were inextricably linked- I hope I can convince my (handful of) readers of that.   Today's blog is dedicated to them!   I'm signing off to give some TLC to my baby tomato and eggplant seedlings...

Friday, May 9, 2008

DRINK WATER? YOU MAY BE ON 56 MEDICATIONS YOU DON'T KNOW ABOUT

In March the Associated Press released results of an investigation into the contents of municipal drinking water in 24 major cities. The results were rather concerning: in all areas studied, municipal tap water was found to have trace amounts of pharmaceutical medications and their metabolites. These were present in extremely low amounts, but at present we just don't know if small amounts of these drugs can have health consequences for humans. Animal studies are not reassuring: many aquatic animals, such as fish and amphibians, have demonstrated severe physical and reproductive abnormalities in response to pharmaceutical concentrations even LOWER than what's in our own drinking water. In Philadelphia municipal tap water, small amounts of 56 pharmaceutical drugs were found! Even if the amounts of each drug are incredibly small, we just don't know what this veritable stew of drugs might do when present in large combinations. So far, it doesn't look like much, but scientists acknowledge that we might not have reached the tipping point yet, which could occur as the number of drugs and drug metabolites in our water increases (as it is likely to do).
As you may know, bottled water is not going to be the solution. First, many commercial bottled water manufacturers ADMIT they are just selling bottled tap water. Second, the EPA is starting to get concerned about hormone analogs that leach into water from polycarbonate, the clear plastic that is used in the vast majority of beverage bottles. Bottled water, in fact, may be MORE hazardous to your health than your city's tap water.
So what to do? There are no great answers yet, until we find better ways to dispose of medications and improve wastewater processing- but there is a good compromise. I recommend drinking municipal tap water, but filtered through a Brita filter into a pitcher. The filter/pitcher combo is sold at Target and innumerable other home and garden stores, and the filter in these things contains activated charcoal. Activated charcoal not only can bind heavy metals and industrial contaminants, but it does an impressive job soaking up pharmaceutical drugs. Incidentally, activated charcoal is what we'll pump into your stomach if you come into the Emergency Room with a drug overdose. It works to neutralize huge quantities of drugs in human stomachs, and it can work to soak up most, if not all, the drugs in your drinking water.
SUMMARY:
1. use your tap water to drink.
2. filter it through a Brita filter first.
3. to make it portable, put it in a METAL OR GLASS reusable drinking bottle to take with you.
4. DON'T FORGET to change the filter in your Brita pitcher! Most people I know actually DON'T do this enough. I recommend every 3 months.
5. if you have a medication to throw away, DON'T flush it down the toilet. Seal it in a plastic bag and put it in the trash. It's less likely to get into the water supply this way.

Thursday, May 8, 2008

IT'S TV WEEK: AMAZON WANTS YOU TO SIT ON YOUR ASS

I was just kindly notified by Amazon.com that it's "TV Week." That means DVDs of all the most popular serial TV shows, which are rarely worth watching more than once, are now on sale at cut-rate prices. The timing seems atrocious. After all, it's Spring: the sun is shining, the birds are chirping, and the days are long. There are bike rides to be taken and gardening chores to do. Why would anyone want to be sitting on their ass indoors watching a recording of a sitcom or TV drama? Everyone know what they should be doing this time of year: sitting on their ass indoors watching the NBA Playoffs!
But seriously: none of us should really be watching anything. We should be out doing things. I'd love to be out playing basketball, but I only have one move, the "fade-away airball." But I don't let that stop me from getting some calories burned. I mean, do I really need to stay off my bike so I can watch the "Orlando Magic?"
If you are somewhat addicted to watching playoff basketball, like I am, try this exercise:
1. Look at the physiques of the players- preferably the ones that are NOT from Europe, where apparently razor blades are not in common use.
2. Then strip down to your underwear, and look at YOUR physique in a full-length mirror. Don't pull your underwear up over your gut- be honest with yourself.
3. If you notice a large discrepancy, it's time to turn off the TV and go get more exercise.
4. Repeat steps 1-3 until the NBA season is over and you are on your way to looking like LeBron James (or Serena Williams if you are a woman).

Wednesday, May 7, 2008

DOES HILLARY WEAR COMFORTABLE SHOES?

    You bet she does.  So does Obama.   You can't be on your feet or on some bus all day wearing high heels or cowboy boots.   Well, you can, but your feet will hurt severely.   Like the Governor of Colorado.   He wears cowboy boots all the time and I know that dude has got some sore feet at night.   Why do I mention this?  Because it's time for a
SHOE UPDATE: YOU DON'T HAVE TO WEAR CROCS
    As I was dropping some serious cash in "The Walking Store" over the weekend, I realized I may be pushing Crocs too hard as the perfect shoe.   In fact, there are a number of brands that make shoes that are good for your feet.   Most of these shoes have the same key factors I mentioned with respect to Crocs:
1. Good arch support
2. A heel slightly higher than the forefoot (1/4 to 1/2 inch or so)
3. Plenty of room for the toes up front, or a "wide toe box"
4. Good padding
    I met an extremely knowledgeable foot surgeon at a sports medicine conference, and she told me that she thought perfect shoe for preventing foot pain already existed- and it wasn't my beloved Croc.  She thought it was the "Dansko clog."   And she knows more about feet than I do.
    My brother swears by Ecco shoes, or at least he used to.   I got a pair once in Amsterdam and somehow I lost them, but I remember they were pretty comfortable.   The pair I got at the mall this weekend were "Mephisto" brand, and as I examined them closely I was shocked- they had all the features I admire so much in my Crocs, at only 6 times the price!   Unlike my Crocs, however, they are not too hideous to wear at work.
BOTTOM LINE: Buy some Crocs first, so your feet will know what they are supposed to feel like.  Then take them to the mall so you can use them as a "starting point" from which to explore buying more comfortable shoes.  If you have a brand you swear by, leave a comment so I can discuss it here!

READER QUESTION OF THE WEEK: WHEN SHOULD I GO TO THE E.R.?
     This is a very, very tough question to answer.   It's probably much easier to discuss when you SHOULDN'T go to the E.R.  But in either case, we often don't really know who should and who shouldn't go to the E.R. until they have gone to the E.R. already and been diagnosed , and in that case we're using hindsight.
     In reality, it will take me all year to answer this question.  However, let's start with some general rules and work toward the specifics over the next 12 months.
RULE #1: Unless you are a doctor, no reasonable doctor expects you to know when or when not to go to the E.R.   So don't feel bad about it if you do go.
RULE #2: If you don't have HEALTH INSURANCE, you may have to go to the E.R. for many of your health care needs.   By definition in this country, if you don't have health insurance, you probably don't have a regular doctor.  So what are your options?  A free or sliding-scale clinic, if you happen to live in one of the relatively few cities that has one; or perhaps a drop-in Urgent Care clinic, which is a type of clinic that is rapidly growing (largely due to how many people in this country don't have insurance).   
RULE #3: THE MOST IMPORTANT RULE: If you think something is going seriously wrong with your health, MENTAL OR PHYSICAL, and it's not something that can wait until the next day, you NEED TO go to the E.R.  If it's during clinic hours you can certainly call you're doctor's office first for an appointment or advice, and if it's evening there may be an Urgent Care clinic you can go to.  But if it's at night or early morning, the E.R. is usually the only place to go.
RULE #4: IF YOU'RE bleeding and it's not minor, go to the E.R.  "Minor" means bleeding that is not internal, and bleeding that you can stop relatively easily.
RULE #5: IF YOU'RE HAVING A HARD TIME BREATHING, go to the E.R.
RULE #6: If you've overdosed on a drug or medication, OR if you're contemplating suicide, go to the E.R. 
RULE #7: RULE #3 is the most important.  Read that one again.
         More later.  Dr. Tofuhead has a lot to think about regarding this question, but that's a good start.

Tuesday, May 6, 2008

LOOKING GOOD: OBAMA, NURSES, THE HORNETS, AND AVOCADOS

It's been an exciting Tuesday. The celebration of Cinco de Mayo continues, Nurse's Week just started, the NBA Playoffs are as dramatic as ever, the Democratic contest may finally be drawing to a close, and I'm going to talk about avocados!
In California, many of the most authentic taco/burrito restaurants pile on the avocados or guacamole at no extra charge- it's considered essential, like cheese. In Colorado and most other states I've been to, avocado/guacamole always costs extra when you add it to your Mexican dish. I guess I can't blame these restaurants; it's hard to grow avocados in all but the warmest climates, and it can't be cheap to truck avocados out to Colorado. These precious commodities often go for $3 apiece in the markets here! But it's rare that I'm not willing to pay precious extra cash for the unbelievably great taste and texture of avocado.


FOOD OF THE DAY: AVOCADOS
Avocados appear in a few different varieties in supermarkets: California, Florida, Mexico, and Hawaii all supply them in huge numbers, and the different varieties vary in size and skin color. To me, they all taste about the same; and their nutrient content does not vary much between avocado types. If you want them cheap, get them from a Mexican supermarket if you have one near you. If you live in California, Hawaii, or Florida, you can even grow them at home!
People seem tremendously confused about whether avocados are "fattening" or not. The truth is that they CAN be; they are relatively high in fat and calories, and some of this fat is saturated. However, most of the fat in avocados is unsaturated fat, similar to what is found in nuts and fish. This kind of fat does have abundant calories, but it tends to have a GOOD effect on your blood cholesterol. In a later blog, we'll discuss different types of fats and how they affect the different types of cholesterol in your blood.
AVOCADOS: BENEFITS
-Delicious, filling, and versatile, they can really liven up salads, fish dishes, sandwiches, and Mexican food.
-Tremendously high in fiber; a single avocado has a full 50% of the fiber you need in a day.
-A good source of vitamin C, vitamin K, and some of the B vitamins.
-Packed with unsaturated vegetable fats which can have a favorable effect on your blood cholesterol and potentially reduce inflammation.
AVOCADOS: DRAWBACKS
-Not really a "low-calorie" choice if you are watching calories. A single whole avocado has 300-350 calories.
-Not a ton of saturated fat, but some. An avocado has about 3 grams of saturated fat, more than most plant foods.
-Can be expensive if you're not shopping at a Mexican grocery store.
-Don't keep well once you cut them open. If you eat half and avocado, plan on eating the other half the next day.


PEOPLE OF THE YEAR: NURSES
Do you know anyone who is a nurse? If you do, send them a card or at least give them a hug this week. This week is Nurse's Week, and nurses deserve more recognition than any mere week can give them. Nurses, with few exceptions, work their ASSES OFF, and they are truly the ones who keep the health care system going. Did you know that in hospitals and clinics, it's the nurses that provide the vast majority of the patient care? Without attentive nurses, few doctors would be able to handle the crushing load of patient health problems and questions that arise in an average clinic day. Without caring nurses checking medications, allergies, and vital signs constantly, few patients would make it out of the hospital alive. When my patients survive a life-threatening illness and hospitalization, and come into clinic talking about the wonderful care they received when they were ill, more often than not it's the great nurses they remember. And as a doctor with a busy practice and a ton of stress, I certainly know who I can count on to boost my morale and keep a smile on my face when times are tough: the nurses on my team. So do yourself and our society a favor: take a moment to appreciate NURSES!

Monday, May 5, 2008

MEDICAL MARIJUANA: FACT OR FICTION?


Hello and happy Monday! There have been loads of exciting new reader questions, and some great ideas for product reviews, so this promises to be an informative and action-packed week on Dr. Tofuheads' Truth in Medicine! I am also working on a new addition, which will be book, web site, and newsletter reviews. That way I can help my readers get an inside look on good sources of health information, and sources to avoid.

Also: It's Cinco de Mayo! It's time to dust off those dried pinto beans that have been sitting in your pantry and actually cook them for a change! (See last week for instructions)....I'll keep the Cinco de Mayo tradition by focusing on Mexican food all week. If there is any food Dr. Tofuhead can't get enough of, it's Mexican food!


PRODUCT OF THE WEEK: PEDOMETER

What is a pedometer? Basically, it's just a step-counter. It's a small device that costs 7-20 bucks and clips onto your belt. As you walk, each step shakes a small bead inside the device and it counts the number of steps you take, with remarkable accuracy. You can then use your total step count to determine how far you walk in a day; most people take 2500-3000 steps to walk a mile.

Why get one of these things? Because knowing your step count gives yor a sense of how much activity you get in a day, and it tends to encourage people to do more. In a recent large study, just having a pedometer, with no particular guidance on what to do with it, led people to get more exercise and lose more weight compared to those who did not have the device. There is likely a psychological effect, in which getting a higher number on the pedometer gives people a sense of reward; therefore they are motivated to get more steps. I personally find it fascinating how many steps you can take just running errands and being at work, especially if you find yourself using the stairs more, and taking walks at lunch.

Perhaps you're already hardcore about exercise, and counting your steps sounds like a joke. But if you don't get as much exercise as you would like, consider getting a step-counter. It may motivate you to go for a walk or a hike instead of sitting on the sofa with a beer. It worked for Dr. Tofuhead!



READER QUESTION OF THE DAY: WHAT'S THE DEAL WITH MEDICAL MARIJUANA, AND IS THERE SUCH THING AS MEDICAL LSD?

I often get patients asking me for medical marijuana, which in Colorado requires some paperwork and registering as an official "marijuana patient" with the state. More often than not, patients don't even know why they want medical marijuana, and it turns out that most of them just want to see if they can score their recreational marijuana legally. Naturally, those folks are not getting jack from Dr. Tofuhead, except maybe a little "education."

Medical marijuana is so tied up in the politics of government regulation, and state jurisdiction vs. federal jurisdiction, that it can be hard to even find medical facts about the plant itself. Many states have legalized medical marijuana use in some way; but the Federal Government can still bust any marijuana user in any state, regardless of the medical facts. Unfortunately, the facts are few and far between. That's because marijuana is criminalized, and doing research on its effects and uses is an administrative nightmare. We just haven't studied this potentially useful herb as much as we need to.

For the time being, it has been proven, at least controversially, that marijuana helps a small subset of patients. Those include patients on chemotherapy suffering from nausea and poor appetite, those with cancer with the same symptoms, and those with HIV Wasting Syndrome. The latter occurs with advanced AIDs, in which patients have relentless nausea and find it so difficult to eat that they literally waste away and die. The role of medical marijuana in neurologic syndromes that cause chronic pain and muscle spasm is less clear, but some patients with neurologic problems swear by marijuana. I tend to think there is a lot of potential in this area, but we really need more research.

Bottom line: if you have a serious condition that causes unintended weight loss and nausea, you might benefit from medical marijuana. As long as the drug remains illegal at the federal level, however, you will have a hard time finding a doctor who will recommend this herb for any other medical problem. And don't whip out your prescription dime bag if federal law enforcement personnel are around!

AS FOR MEDICAL LSD: there is no health condition that I know of that has been treated with LSD, though it has been researched as an adjunct to therapy in psychiatric patients. This research largely occurred in the 1960s and 1970s, before the laws regarding use of LSD were so strict. LSD is still used as a research tool in studying the distribution and role of serotonin receptors, but this research is done on animals or in test tubes. It's possible that this drug is studied more in other countries, but I don't know enough to comment on that.

Sunday, May 4, 2008

SUNDAY-DON'T READ THIS BLOG

     Whoa!   It is amusing to have my brilliant brother Randy doing the illustrations to this blog- it allows me to be shocked by my own posts when I see the associated images.   Today's post was foiled by a loss of internet connection for the entire day, and by the fact that I forgot to buy my intended "food of the day" when I went to the supermarket.   You see, I never post information on a food unless I have the actual food in my hand.    I want to do my homework.     When I'm talking about pasta, I want pasta to be there to defend itself if need be.   So now it's 11 PM, and the only food in my hand is water.    And water is saying, "I'm so perfect there is nothing you can say about me that hasn't already been said, except that no one drinks as much of me as they should."  So this is going to be it for Sunday's blog, but we'll be back tomorrow.
      Randy in "imaging:" Can you come up with some images for today that will help readers understand what a "Laker" is?