what doctors know - vol 1 issue 7

7/27/2019 What Doctors Know - Vol 1 Issue 7

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Phoebes daddy hasbig dreams for her.

St. Jude patient Phoebe:Daddys Princess

But at this moment, shes fighting cancer.Thats whySt. Jude Childrens Research Hospital spends every moment changing

the way the world treats children with pioneering research and exceptional care.

And no family ever pays St. Jude for anything. Dont wait. Join St. Jude in finding

cures and saving children like Phoebe. Because at this moment, she should be home

enjoying story time, hugs from daddy and play dates in the park.

Help them live. Visit stjude.org.


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whatdoctorsknow.com

Steve Porter, MD

Publisher and Chairman

On Call with Dr. PorterAugust is here. That means summeris starting to wind down and itstime to put the boat and camping

gear away and get back to a routine,which includes paying the price for allthose summer picnics and barbecues.

Before you hit the gym, take thetime to read my article this month onThe Skinny on Fat. The article willhelp you understand calories, fat andnutrition which should help gettingrid of those summer hot dogs, beer,hamburgers, ribs, potato salad, etc.

August, for so many, means itstime to start thinking about backto school. While school supplies books pencils, backpacks, etc areobvious needs for the back to schoolage, lets not forget about the backto school health needs, includingimmunizations for adolescents,

adults and senior citizens. As much as we all would like to believe it, diet andexercise cant entirely help our immune system fight measles, shingles, the flu,meningitis, and some other life threatening diseases no matter what age.

Its ironic that we often look up to the older generation as an example for life. Yet, its theolder generation that most often ignores the need to keep up with immunizations. In this case,the older generation is setting the bad example. Ignoring immunizations can be deadly.

Take time to look through this issue and see what shots you may need and please sharethe information with others. We address infants, toddlers, adolescents and of course,the elderly. For more information on immunizations, visit this link (NFID.com) forcharts, schedules and more. We could have dedicated an entire magazine to the topic,but felt it would be enough if we did our part to bring awareness to the subject.

I hope you enjoy the information, and as always, if you have a special topic you would like to see inan upcoming issue, drop us a line and well have one of our experts provide you with an answer.


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Taking Control08 Put Your Best Face Forward12 VaccinesNot Just For

Children Anymore

16 Can Allergy Shots Help?

18 Its a Great Time for Back Pain

22 Trading Places: Footballs to Stethoscopes

WHAT DOCTORS KNOWAnd you should, too!

P12P38

Inquiring Minds30 The Skinny on Fat

36 Vaccine-Preventable Diseases

38 Getting a Grip on Memories

40 A Females Aching Knees

42 Vaccine Benefits OutweighPotential Risk

44 Psoriasis: More Than Skin Deep


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whatdoctorsknow.com

Vol. 1 Issue 7

01 On Call With Dr. Porterr

04 Meet Our Doctors

06 House Calls

26 CDC Vital Signs

46 HealthWatchMD: Why YouShould Start Eating Clean

In Every Issue

P50

Contents

Health Hints48 The Lowdown on

Adolescent Vaccinations

50 Get Your Back UpTipsfor a Healthy Back

54 Stop Cavities, Step UpYour Oral Hygiene

56 Dont Let SummertimeWreck Your Waistline

58 Facts About Psoriasisand Psoriatic Arthritis

60 10 Reasons To Be Vaccinated,Not just for kids!

62 Get the Facts onHands only CPR

12 VaccinesNot Just ForChildren Anymore

22 Trading Places: Footballsto Stethoscopese

30 The Skinny on Fat

On The Cover


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whatdoctorsknow.com

Meet Our Doctors

Copyright 2012 by What Doctors Know, LLC. All rights reserved. Reproduction of this magazine,in whole, or in part is prohibited unless authorized by the publisher or its advertisers. The

Advertising space provided in What Doctors Knowis purchased and paid for by the advertisers.Products and services are not necessarily endorsed by What Doctors Know,LLC.

Vicki Lyons, MD

Founding memberand chairman of theeditorial advisoryboard of What DoctorsKnow, Dr. Lyons is a

board certified and fellowship trainedallergist and immunologist practicing inOgden, Utah. She has been practicingfor 20 years. Contact Dr. Lyons at(801)387-4850 or www.vicki-lyonsmd.com.

Steven Porter, MD

Founder andpublisher of WhatDoctors Know, Dr.Porter is recognizedas one of the topgastroenterologists in the country.He is the medical director of the

endoscopy lab at a leading hospitalin Ogden, Utah and has beenpracticing for more than 25 years.Contact Dr. Porter at (801)387-2550.

Calling All Doctors. Our readers want to hear from you. What healthcareissues do you want to address? What do you want to tell patients all

over the country? Whats new in your practice, in your specialty?

Drop us a line and let us know about any healthcare topic you want

to address in What Doctors Know. Remember, we want to inform andeducate our readers. We know, an informed reader has the opportunityto live longer and happier. You can be part of that healing process.

Our readers look forward to hearing from you.

Send story ideas to: [email protected]

Mark Newey, DDS

Board certified oraland maxillofacialsurgeon, Dr. Neweystarted his privatepractice in 2005. Hebelongs to a number of organizationsincluding, American Oral &

Maxil lofacial Society, and AmericanSociety of Dental Anesthesiologists.Contact Dr. Newey at (801)825-1116or www.neweyoralsurgery.com.

Mark B. Taylor, MD

World-renowneddermatologist andcosmetic lasersurgeon, Dr. Taylorhas been in practicefor more than 30years. He has beena leader in the field of cosmetic lasersurgery, pioneering and teachingmany new laser techniques to morethan 4,000 doctors worldwide.Contact Dr. Taylor at (801)595-1600or www.gatewaylasercenter.com

Raul Weston, MD

Anesthesiologyresidency completedfrom the Universityof Utah, Dr. Westonis a fellowship

trained specialist in interventionalpain medicine. Contact Dr.Weston at (801)294-7246.


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whatdoc torsknow.com

WHAT DOCTORS KNOWAnd you should, too!

Published by

What Doctors Know, LLC

Publisher and Chairman

Steve Porter, MD

Editorial Advisory Board

Vicki J. Lyons, MD, Chairman

Editorial and Design Director

Bonnie Jean Thomas

Senior Designer

Suki Xiao

Design Associate

Cayden Chan

Executive Director, MarketingLarry Myers

Production

Kai Xiao, Vice President

IT Manager

Eric Lu

For more information on ad placement orcontributing an article, please email [email protected], or call (801) 825-4600.For information on subscriptions, pleasevisit www.whatdoctorsknow.com

Corporate OfficeWhat Doctors Know

1755 E Legend Hills Dr., Suite100, Clearfeld, UT 84015

(801) 825-4600

Special Thanks To:


8/68

Q:

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females?ValL.

A:No. Eatingdisordersoccurinmales.Few

solidstatisticsareavailableontheprevalenceofeating

disordersinmales,butthedisordersarebelievedtobemorecommon

thancurrentlyreflectedinstatisticsbecauseofunder-diagnosis.

Anestimatedone-fourthofanorexiadiagnosesinchildrenareinmales.TheNationalCollegiate

AthleticAssociationcarriedoutstudiesontheincidenceofeating-disorderedbehavioramongathletes

inthe990s,andreportedthatofthoseathleteswhoreportedhavinganeatingdisorder,7%weremale.

Forbinge-eatingdisorder,preliminaryresearchsuggestsequalprevalenceamongmalesandfemales.

Incidenceinmalesmaybeunderreportedbecausefemalesaremorelikelytoseekhelp,andhealth

practitionersaremorelikelytoconsideraneatingdisorderdiagnosisinfemales.Differencesin

symptomsexistbetweenmalesandfemales:femalesaremorelikelytofocusonweightloss;males

aremorelikelytofocusonmusclemass.Althoughissuessuchasalteringdiettoincrease

musclemass,over-exercise,orsteroidmisusearenotyetcriteriaforeatingdisorders,a

growingbodyofresearchindicatesthatthesefactorsareassociatedwithmany,

butnotall,maleswitheatingdisorders.NationalEatingDisorders

Association,www.nationaleatingdisorders.org

House Calls

whatdoctorsknow.com


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Disclaimer:

The information contained in the magazine is intended to provide broad understanding and knowledge of healthcare topics. This information shouldnot be considered complete and should not be used in place of a visit, call, consultation or advice from your physician or other healthcare provider. Werecommend you consult your physician or healthcare professional before beginning or altering your personal exercise, diet or supplementation program.

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whatdoctorsknow.com 7


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whatdoctorsknow.com

TurnYourBack

onAcne Scars-Forever

PutYour

Best

FaceForward


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Disfiguring facial acne scars can have a life-long social and psychological impact.Fortunately, treatment for this conditionhas been greatly improved in the last year.

Approximately 90 percent of boysand 80 percent of girls in the United

States develop acne during their adolescent years.The disease can persist well into adulthoodwith asignificant number of individuals left with scarring.

Acne scars are caused by an accumulation of oil andbacteria in the skin that elicits a strong inflammatoryresponse from the bodys immune system. Thisinflammatory process causes swelling, inflammation,and tissue damage. When the inf lammatory processfinally heals, one is often left with pockmarks (ice

pick scars), depressed areas of skin (box car scars),ridges and valleys (rolling scars), all of which givethe skin a markedly uneven appearance. Thereare two types of scarring, atrophic (loss of skintissue) and hypertrophic (excessive scar tissue).

Hypertrophic scars are present in approximately 20percent of people who develop acne scars. In this form,the scar extends above the level of the surroundingskin. Keloids are hypertrophic scars that are nodularand extend beyond the border of the original acne site.

Some of the acne scars develop excessive pigmentation,making the effect of acne scars that much worse.

Treatment for Acne Scars

Traditional treatments for atrophic scars includechemical peels, dermabrasion, and microdermabrasion.

A variety of surgical procedures have been used toremove or modify the scars. Subcision, cutting thescar tissue at the base of the scar to allow the scarto rise toward the surface has been used with somesuccess. Fat transplantation and other augmentationmethods have been used. Hypertrophic scars often aretreated with laser devices. Nonablative fractional lasers(such as Fraxel Repair) have been used. This array ofapproaches often achieves improvements but does not

provide satisfactory resolution of acne scars for manypatients. There are several scoring systems that havebeen proposed and used, but usual results are describedas 30-50 percent improvement. These proceduresalso required a great deal of downtime to heal.

New Approaches to Treating Acne Scars.

Recently, a new approach to treating acne scars hasbeen developed that takes advantage of combiningthe best of the new ideas and instruments. This newmulti-modality approach is providing results that areclassified as 60 percent to 100 percent effective.


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whatdoctorsknow.com0

These acne scars were treated with ablative fractional laserresurfacing. In very little time, improvement was already evident.


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whatdoctorsknow.com

Tumescent anesthesia is a new technique forproviding local anesthesia that decreases the risksof local anesthesia and decreases blood loss. A large

volume of dilute lidocaine and epinephrine is injected

beneath the skin (subcutaneously). This causes theskin to become swollen and firm. The firm, swollenskin allows much more effective anesthesia andthe more effective use of corrective procedures.

Subcision, the surgical severing of deep scartissue that holds down depressed atrophicscars, is much easier after tumescent anesthesia.

The surgical instruments used for subcisionhave been improved markedly in recent yearsallowing more precise and effective treatment.

New laser devices such as the Fraxel Repair Laser

and the Lumenis DeepFX lasers have been developedthat can more effectively resurface the scarred skinand allow normal skin to cover the old scar surface.

A central feature of some of the new laser proceduresis the discovery that treating the entire skin surfaceis not nearly as effective as fractional treatment.

New laser devices can deliver precise, microscopicpulses that treat precisely separated microscopic siteson the skin surface. As these microscopic injuriesare repaired by the surrounding normal skin, theresults are quick, atrophic scars are raised, andthe skin has a much more normal appearance.

The Taylor Method of Acne Scar Therapy

Tumescent anesthesia

Advanced subcission

Advanced laser resurfacing

Limited chemical peel and otherpatient specific interventions

Usually a single one hour procedure

Healing time usually 10-14 days

For many patients 80-100% improvement

For more information visit www.gatewaylasercenter.com

Other interventions. In addition to subcision andthe new laser techniques, some specific types ofscars may need other additional kinds of treatment

such as trichloroacetic acid treatment of some icepick scars. Isotretinoin often is used to suppresspost procedure oil formation when excisingpitted scars. In some cases, tissue fillers may beneeded. Healing time is usually 10 to 14 days.

Taken as a whole, there have been important advances inthe treatment of acne scars. The breakthrough has beenthe result of improvements in the technology of oldtreatments and the skillful use of multiple interventionsas part of one treatment regimen.-Mark B. Taylor,MD, Gateway Aesthetic Institute & Laser Center


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whatdoctorsknow.com

VACCINES......NOT JUST FOR CHILDREN ANYMORE...


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M

ore than 50,000 adults in theUnited States die every year because they think they areimmune to immunizations. Tensof thousands of US adults die eachyear from vaccine-preventable

diseases and their complications, more than eitherbreast cancer, HIV/AIDS, or motor vehicle trafficaccidents, yet overall vaccination rates remain low.

Many adults think when they hit the voting age; itstime to start ignoring the simple steps to stayinghealthy and living longer. Just as our cars needmaintenance to last longer, the body needs maintenance,and that includes recommended vaccinations.

The National Foundation for InfectiousDiseases (NFID) in partnership with a numberof leading medical experts and national healthorganizations recently launched a campaign to

bring awareness to adult immunizations.

Keeping up with recommended vaccinations couldsave your life, and they can also help prevent a numberof serious diseases as well, such as shingles, the flu,etc. Vaccines are for everyone, not just children.

There are some vaccines specifical ly recommendedfor adults. These adult vaccines protect againstdiseases more common in adults than children.Some vaccines protect against diseases that canbe more serious when contracted by adults.

Getting vaccinated reduces your risk of getting diseaseslike shingles, measles, whooping cough and influenza.

For example, the influenza vaccine (flu vaccine)is available for both adults and children and isrecommended annually. In this case, its not that ourimmune system forgets how to fight the influenza virus;rather the virus can change from year to year so we haveto retrain our immune system to fight the new strains.Each years influenza vaccine may contain differentantigens from the previous years vaccine. The newantigens are specially customized to train the immunesystem to fight the current seasons influenza viruses.

Shingles is a disease caused by the same pathogen as

chickenpox. The pathogen hides in nerve cells for years andcan re-emerge in older adults to cause shingles. This meansanyone who has ever had chickenpox is at risk. Shingles israre in children, so the vaccine is generally recommendedfor adults. Chickenpox, contracted by an adult, cancause serious complications including pneumonia.

Pneumococcal disease is a very serious illness for adults.Invasive pneumococcal disease kills way too manypeople in the United States each year, most of them 65years of age or older. A single dose of pneumococcal

vaccine is all older adults need to be protected.

Anyone can get pneumococcal disease. In additionto persons 65 and older, high-risk groups includeindividuals with weak immune systems, sickle celldisease, as well as Alaskan Natives, certain AmericanIndian populations and residents of chronic or long-term care facilities. Further, children under 2 yearsof age who live in group care settings and those withcertain illnesses are at higher risk than other children.

There are other adult vaccines that are boosters ofchildhood immunizations. The immune system usesmemory cells to remember how to build the tools tofight a pathogen, over time this memory fades. Booster

vaccines refresh the immune systems memory so itcan continue providing protection against the disease.

CAN VACCINES GIVE YOU A DISEASE?

Live, attenuated vaccines contain a version of the livingmicrobe that has been weakened in the lab so it cant causedisease. Because a live, attenuated vaccine is the closest

thing to a natural infection, these vaccines are goodteachers of the immune system.

This is an intended part of thevaccination process. The yellow fever,varicella (chickenpox), smallpox,typhoid and measles-mumps-rubella (MMR) vaccines areexamples of live vaccines that maycause an extremely mild formof the disease. In these cases,its worth a little discomfort totrain your immune system tofight the pathogens responsible

for the disease, since thebenefits far outweigh thetemporary inconvenience.

whatdoctorsknow.com

Vaccinesthat are not live(or inactivated) willnever cause the disease,even a mild case, because theydont contain live disease-causingpathogens. For example, the inactivated inf luenza shotis not a live vaccine and so it cant give you influenza. So

why do some people come down with flu-like symptomsafter a vaccination? Influenza vaccines are generally givenduring flu season which is prime time for all sorts of


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whatdoctorsknow.com

viruses that cause upper respiratory infections. Influenzavaccines only protect you from the influenza virus, notthe dozens of other viruses that can cause similar, butgenerally much milder symptoms. So, theres a reasonable

chance of getting a cold or some other flu like illnesssoon after getting the influenza vaccine. It doesnthelp that we call so many illnesses the flu that arentcaused by the influenza virus. For example, there is norelationship between what most of us call the stomachflu and influenza virus. Intestinal upsets are causedby an entirely different set of viruses. So, the influenza

vaccine will not protect you against stomach flu.

DO YOU AVOID VACCINES FOR FEAR OF SIDE EFFECTS?

The chance of experiencing a serious side effect, likean allergic reaction after vaccination, is less thanone in a million. That means 999,999 people out of

1,000,000 do not suffer any serious adverse effects aftervaccination. It is more likely for someone to suffer asevere allergic reaction from aspirin than a vaccine.

Vaccines are always safer than contracting the diseasesthey are designed to protect against, but to say

vaccines are completely harmless isnt true. Vaccinescan cause side effects, but most are short-lived and

result in only very mild discomfort. Redness andsome swelling around the injection site are someof the more common side effects of vaccines.

A word of caution, anyone who is allergic toany component of a vaccine, has had a seriousadverse reaction after vaccination, or anyoneimmunocompromised should speak with a physicianbefore being vaccinated. Pregnant women shouldconsult their physicians about vaccination. Some

vaccines are recommended during pregnancy andcan help protect your child after birth, othersare not recommended during pregnancy.

-

This information provided courtesy of NFID (TheNational Foundation for Infectious Diseases)

NFID and its partners have created a comprehensivecampaign to address recommended vaccines andtimeframes specifically for adults, which includescharts, FAQs and links to other informational sites.This information is available on the foundationswebsite atwww.adultimmunization.org.

Be sure and visit the site for information about yourimmunization needs, and as always, be sure andvisit your physician for specifics and suggestions.

Its smart to take the right steps tomaintain good health at any age.


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Every time you see our pinwheel,

take a breath. And then help us

spread the word about COPD, or chronic

obstructive pulmonary disease. Because

its a leading cause of death in the US,

and it took my grandmother. COPD is

slowly robbing as many as 24 million

Americans of their ability to breatheand

an estimated half of them dont even

know they have it. Its a race against time

to spread awareness.

Find out at

and talk to your healthcare professional.

2012 COPD Foundation Inc. All ri ghts reserved.DRIVE4COPD is a trademark of the COPD Foundation.NASCAR is a registered trademark of the National Associafor Stock Car Auto Racing, Inc.Danica Patrick is a spokesperson of DRIVE4COPD.FOUNDING SPONSOR OFFICIAL HEALTH INITIATIVE OF NASCAR DRIVE4COPD IS A PROGRAM OF THE COPD FOUNDATION


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whatdoctorsknow.com

Allergy season has either hit or is about tohit in your area of the country. Potent

western weeds such as sagebrush and

western ragweed are pollinating as mostpeople are still heading outdoors for hiking,biking, hunting or other recreational

activities. At the same time, allergy and asthma sufferersare grabbing boxes of tissues as well as their rescueinhalers. Allergy sufferers are all too familiar with pollenseason, a time when they can be forced indoors whileothers are enjoying the beautiful weather and foliage.

Allergen Immunotherapy, also known as allergy shots,can help people who suffer from allergic rhinitis (nasalallergy), allergic conjunctivitis and allergic asthma causedby allergens such as pollen, mold and animal dander.

Patients who receive Immunotherapy are safely injectedwith small but increasing amounts of specific identifiedallergens over a period of time. Immunotherapy hasproven to prevent the development of new allergies, and inchildren, it can prevent the progression of allergic diseasefrom allergic rhinitis. It is also recommended for treatmentof allergic asthma by the expert panel/2007 NationalHeart, Lung and Blood Institute (NHLBI) guidelines.

How Does Immunotherapy Work?

Over the last century, much has changed in thestandardization of extracts and the number of evidence-

based studies proving effectiveness. Immunotherapy

works like a vaccine. Your body responds to the injectedamounts of a particular antigen given in graduallyincreasing doses by developing immunity or toleranceto the allergens. As a result, allergy symptoms decrease

when a patient is exposed to that allergen in the future.

There are generally two phases to Immunotherapy:

Build-up phase: This involves receiving injectionswith increasing amounts of the allergens twicea week until the effective dose is reached.

Maintenance phase: This begins once theeffective theraputic dose is reached. The effectivemaintenance dose has been studied and hasbeen found to be effective in clinical trials.

Low-dose immunotherapy is not effective. Clinicaleffectiveness requires administration of adequate doses.During the maintenance phase, Immunotherapy inducesregulatory T-cells that dampen the allergic response toallergens. The resulting immune response in a treatedpatient resembles the response of a non-allergic individualto that antigen. The clinical and immunologicalbenefits of a successful course of Immunotherapypersist for years after treatment is discontinued.

When Can Immunotherapy Be Helpful?

Immunotherapy is recommended for patients withallergic rhinitis, allergic conjunctivitis and allergic

asthma. Beginning Immunotherapy early can preventrather than reduce the chronic inflammation causedby allergies, as well as prevent further development ofsevere disease such as asthma in a patient with allergicrhinitis. Also, starting Allergy Immunotherapy earlyappears to be the most effective treatment for asthmain children and young adults. Furthermore, in youngerpatients, Immunotherapy offers the advantage of atreatment that may be successfully discontinued afterthree to five years, as opposed to management withmedication, which must be continued indefinitely.

In What Situations Can Allergy

Immunotherapy Be Ineffective?The benefits of Allergy Immunotherapy are dose-relatedmany patients who have received poorly standardizedextracts at low or sub-therapeutic levels in the past maynot have achieved relief. Inadequate doses of allergen inthe vaccine can lead to treatment failure. Also, missingallergens not identified in the allergy vaccine can leadto treatment failure. Board-certified, fellowship-trained

Allergists and Immunologists are trained to providepollen and inhalant identification levels typically postedin local newspapers and television and are trained toprovide the appropriate testing and treatment formulas

CanAllergy ShotsHelp?


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for specific Allergen Immunotherapy. High levels ofallergen in the environment secondary to inadequateindoor environmental control can also lead to treatmentfailure. Exposure to tobacco smoke or some occupationexposures can also offset the success of Immunotherapy.

What About Allergy Drops Under The Tongue?

The rationale for developing an oral treatment wasaimed at reducing the inconvenience and discomfort ofinjections. Oral treatments have been studied in a varietyof forms including coated tablets, capsules and oraldrops. European studies of Sublingual Immunotherapy(allergy drops under the tongue) appeared to be effective.However, several similar studies repeated in the UnitedStates in 2008 failed to achieve the same results.Instead, these recent studies reported no significantbenefit from oral treatments. Allergy drops under thetongue or swallowed are approved for use in Europe;however, questions remain regarding the safety andeffectiveness of Sublingual Immunotherapy in the US.

There are currently no FDA-approved sublingual allergyextracts in the US, and Sublingual Immunotherapyis typically not covered by most insurance plans.

Is Allergy Immunotherapy Cost Effective?

Immunotherapy is less expensive than conventionalover-the-counter medication or prescription therapyfor the treatment of allergic rhinitis and asthma

when administered by fellowship-trained, board-certified Allergists and Immunologists. The greatestimmunotherapy costs occur in the first year whenimmunotherapy is 33% less costly than medication.In years two to five, immunotherapy is 75% less

expensive than medication. These cost savingswere confirmed recently in a 2006 European studyin patients with allergic rhinitis and asthma.

Who Should Prescribe Allergen IMMUNOTHERAPY?

Immunotherapy should only be given under thesupervision of a specialized physician in a facilityequipped with proper staff and equipment toidentify and treat adverse reactions to allergyinjections. Ideally, Immunotherapy should be givenin the prescribing allergist/immunologist's office.

Given the complexity of the decision-making process asto whether Allergen Immunotherapy is indicated and

the knowledge that is required to formulate a properallergen extract (vaccine), it should be undertaken onlyby a physician with specialty training in the field. Yourboard-certified Allergist and Immunologist is a specialist,trained to provide evidence-based treatment for allergicrhinitis, allergic conjunctivitis, and allergic asthma.

For more information, take a look at the followingwebsite: www.allergyandasthmarelief.org.

But most of all, find a board-certified allergistand immunologist, start allergy shots and startfeeling great again!-Vicki Lyons, MD


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Back pain is never a welcome guest in our liveshowever if you suffer from low back pain, takecomfort in knowing the medical community isengaged in more pain research than ever before.

As a result, you have more treatment optionsavailable today than any other time in history.

It has been said more than once: Its not a matter of if youwill have back pain, but when. According to a recent study,Americans spent $40 billion for back pain treatment in

2008. Work loss and disability were estimated to have costbetween $100 and $200 billion and during the same period,three million people were sent to the emergency room fortreatment at a cost of $9.5 billion. With baby boomerscoming of age, these numbers are expected to skyrocket.

Back pain has been a fact of life for scores of peoplefor generation after generation. Some estimatessay 4.6 million Americans will be faced with backsurgery this year. Until now, any kind of back surgery

was a last resort. Usually, back surgery only meanta means to alleviate pain. Certainly not a cure.

It's a GreatTime forBack Pain

whatdoctorsknow.com


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Lumbar Spinal Stenosis

Generally found in people over 50 years of age,lumbar spinal stenosis (LSS) is being diagnosed in 1.2million people, each year, in the United States. LSS,in simple terms, is the narrowing of the lower spinalcanal that causes numbness, pain, and limits mobility.

While providing support for your body, the spineprotects the spinal cord, which houses the nervesthat run between your brain to your lower body. The

spinal cord is sandwiched between the bony partof your spine and ligaments, providing protection.Usually there is plenty of space between the spine andthe spinal cord, known as the spinal canal, to allowan unobstructed flow of the nerves. However, as

we age, the ligaments and bones outside the spinalcanal can begin to thicken, and calcify. The wordstenosis literally means choking, which isexactly what begins to happen to the spinalcord. As the spinal canal narrows, it putspressure on, or pinches, the nerves in thespinal cord causing pain and numbnessand limiting mobility. Osteoarthritis and

disc degeneration are also causes of LSS.Pain or numbness in the lower back whenstanding up, and pain, numbness and tinglingin the legs or buttocks when walking, arecommon signs of LSS. These symptomsare often relieved when bending forwardor sitting. Those suffering from LSS oftendont like to walk without support. Thinkof your trips to the grocery storehowoften is the grocery cart used for supportrather than holding your purchases?

Minimally Invasive Lumbar Decompression

The FDA recently approved a minimally invasive

surgery for those with LSS cal led Minimally InvasiveLumbar Decompression or mild. Offering patients

with LSS a nearly 80 percent success ratethesepatient are experiencing a significant reduction in pain,

while signif icantly increasing their mobility with thisnew procedurecompared to the 60 to 80 percentsuccess rate realized by open surgery procedures. Keepin mind, the key term here is minimally invasive.

Before mild, the most conservative route of treatmentmay have included physical therapy, over the countermedications, and injections. While these could beconsidered minimally invasive they usually only offer

short-term relief, leaving open surgical decompressionas the only other option. The thought of open surgerythat requires a three to five day hospital stay not tomention the painful recuperation resulting from alarge incision is often a deterrent. Traditional opensurgical decompression has had a lower success rateand comes with the downside of high surgical risksand complications including dural (the outermost


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layer of tissue covering the spinal cord) puncture

or tear, infection, the need for blood transfusions,epidural bleeding, nerve injury or hematoma.

Not all who suffer from back pain are candidatesfor this new procedure. Typically older individuals

who have developed nerve compression and lumbarpain symptoms such as the inability to walkmore than a short distance without leg pain, maybenefit from mild. After a complete evaluation,your doctor can determine whats best for you.

The mildprocedure is typically performed in anoutpatient setting under light sedation, and localanesthesia. Through a small skin incision, less than thesize of a baby aspirin, a probe is inserted in the backand through an imaging machine the surgeon is ableto target the stenosis. Specialized mini-instrumentsnip away at the excess bone and ligaments, relievingthe pressure. More space is created and the chokingeffect is reduced, relieving pain and numbness.

The entire procedure takes about an hour.

Life after mild

The biggest benefit of any minimally invasiveprocedure is the reduced recovery time, andmild is no exception. Performed as an outpatientsurgery, most patients return home the same day.

There are no stiches or implants left behind, andpatients can usually resume light tasks and everydayactivities within a few days of the surgery.

Studies have found there are no serious complicationswith the milddevices or techniques. mild is as safeas or safer than similar spinal stenosis treatments.

Living with back pain is becoming a thing ofthe past. The time is right for you to visit yourpain management specialist and regain that activelifestyle you deserve.-Raul Weston, MD

Explore the benefits of mild

* No general anesthesia required onlya mild sedation and local anesthesia.

* Outpatient procedure (usually performedin 1 hour),traditional surgeries requirea 3-5 day stay in the hospital.

* Low complication risktraditionalsurgeries can run as high as 23.5%,mild are as low as 0.02%

* No stiches or implants left behindmildis performed through a tiny incisionsmaller than the size of a baby aspirin.


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When you consider the alternative, eating right andstaying active really dont seem so bad.

Many of the nearly one million deaths each year from

type 2 diabetes, heart disease and stroke could be

prevented with a few lifestyle changesincluding

regular physical activity, healthier food choices and

not smoking. Its not easy. But it is worth it.

Talk to your doctor about your risk for type 2 diabetesand heart disease. Its your life. Listen to your doctor.

Eat better. Get moving.

Staying healthy isnt easy.

Then again, neither is dying.

For more information, visit CheckUpAmerica.org, or call 1-800-DIABETES.


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FOOTBALLS

TO

Trading Places:

Dick Butkus may have been

assessing his own capabilities,but if he were addressingstudent athletes of today, he

would be far from accurate.According to data from the

NCAA, the student athlete graduation rateis nearly 20 percent higher than the generalstudent body. In fact, more than eight outof every ten Division 1 student athletes isearning a college degree within six years,the highest ever rate for graduation.

If I was smart enough tobe a doctor, I'd be a doctor.I ain't, so I'm a footballplayer.-Dick Butkus

Champions...On the field and offSTETHOSCOPES


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Colleges may be creating powerhousesports programs with athletes achievinggreat success on the field, but many of thesesame athletes are amassing great successstories in the classroom. Programs, suchas these at Louisiana State University,

are turning out National ChampionshipSports Programs, but they are alsoturning out student-athletes achievingsuch honors as the Deans List, Academic

All SEC, Academic All-American, NCAATop Student Athlete, National FootballFoundation Scholar-Athlete and more.

By the way, athletic programs like LSUare also turning out doctors. Lots ofdoctors. Among the notable LSU studentathletes who went on to great scholasticachievements are Dr. Abe Mickal, Dr.

Joseph Nacho Albergamo, Dr. Steve

Ripple, Dr. Brad Davis, Dr. Jim Kadi, Dr. LeonardPop Neumann, Dr. Del Walker, Dr. Dexter Gary,Dr. Mike Robichaux, Dr. Chad Loup, Dr. GaryDildy, Dr. Robert Dugas, and Dr. Keith Melancon.

This is a group that turned in their equipmentand went on to excel as doctors, dentists,teachers, and leaders of their specialties maybenot despite being athletes, but because of beingan athlete with a built in desire to achieve.

I got hurt and was always in the doctors office,remembers Dr. Robert Dugas, a former LSUoffensive lineman who went on to become AssistantProfessor of Orthopaedic Surgery at LSU HealthSciences Center New Orleans School of Medicine.

Dugas, who grew up in the small town of Luling,Louisiana started playing in the ninth grade and wastoo big to play Pop Warner football. There were nophysicians in his family, no footsteps to follow, justlots of injuries and surgeries through his years atHahnville High and as an offensive tackle at LSU.

Dr. Ken Saer, who was the New Orleans Saints teamdoctor, took care of me in high school. He actually didthe first operation on me. I guess I liked what he did,and I think that probably had something to do with me

wanting to become a physician. As a team physician, hehad the best of both worlds. He went to all the gamesand he was a doctor. That prompted my decision tospecialize in Orthopaedics and Sports Medicine andallowed me to be around sports and athletics, which

were always a part of my life growing up, says Dugas.

Dugas, who is board certified in Orthpaedic Surgeryand Sports Medicine and is also the physician in charge

of Orthopaedic Surgery clinics and surgeries at LSUsUniversity Medical Center in Lafayette, LA, was able tocombine his love of sports with his love of medicine.

Ironically, after finishing medical school, residency anda sports medicine fellowship; Dugas was recruited bythe University of Nebraska Athletics program to becomethe team physician the same program he had turneddown as a high school senior to play for LSU. Dugasspent 16 years as a doctor for the University of Nebraska

Athletics program taking care of 700-plus athletescompeting in 22 sports, before coming home to LSU.

#72 Robert Dugas,

1983 LSU Tigers

Dr. Robert Dugas assessing a patient,2012 LSU University Medical Center


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Five members of the 1983 graduating class of LSUHealth Sciences Center New Orleans played footballat LSU. Dugas roommate and left tackle, Chris Rich,became an orthopaedic surgeon practicing in Alexandria,LA. Center Jay Whitley became an orthodontist, andis the current President of the Southern Association

of Orthodontists. Whitley and Steve Ripple are onthe faculty of the LSUHSC School of Dentistry.Mo Lonergan was another dental school classmateand his younger brother Pat, is also an alumnus anddentist. Pats son, P. J., is LSUs current center.

Dr. Keith Melancon, LSUHSC Assistant Professorof Orthopaedic Surgery and member of the Boardof Directors of the LSU Healthcare Network,also traces his decision to go into OrthopaedicSurgery to time spent in treatment.

Getting hurt was what led me to Orthopaedics. Themore I saw the doctors, the more I liked what they did.

I actually went to work for one of the team physicians

in Baton Rouge in the summer so I could learn moreabout what Orthopaedics, Melancon pointed out.

But Melancons path was even more unusual,and recollections of his days as a memberof a championship team are colorful.

I started on an academic scholarship and I was awalk-on, said Melancon, who played offensiveguard at LSU from 1982-86. And after my firstsemester, I was awarded a full athletic scholarship.

Despite fully enjoying his college experience,Melancon finished his pre-med studies early enoughto double major in finance which really came inhandy later on. He joined a private group orthopaedicsurgery practice after he finished his residency andbelieves that football prepared him in ways thatmost doctors dont get the chance to learn.

I was used to the meeting aspect of football, whichis something thats foreign to most physicians, henotes. Before you ever go out to practice, you meetfor two hours. And then you go to practice, and youpractice for two hours. And then you watch film for anhour. So theres as least as much time dedicated to thereview and preparation as there is to the actual workof football. And the same thing didnt transfer overto medicine. I was able to use that with my partners appropriate preparation and we were very successful.Football also allows you to interact with people ofall kinds of backgrounds, different socioeconomicand educational levels. Working within that verystructured very large group of people gives you the

opportunity to learn to appreciate and help each other.

Dugas agrees that playing footballmade him a better doctor.

The best thing about medicine is having the abilityto help people overcome their problems. As a sportsmedicine physician, I think it is a huge benefit tounderstand the athletes side of the equation. Mostathletes dream of continuing to climb the ladderof athletic success as far they can reach. Injuries arecertainly setbacks. An athletic injury alters the paththey have laid out for their desired accomplishments.

And so if you can f ix what takes them away from

their goals and then see them once again enjoy theirgame, that s whats been most enjoyable for me. It isextremely rewarding to see those individuals overcomeadversity and continue to pursue their dream.

Both Dugas and Melancon are pursuing dreams, tooalthough different ones. They are touching the future,shaping the practice of Orthopaedics by teaching thenext generation of doctors at LSU Health SciencesCenter New Orleans School of Medicine. This changeis particularly poignant for Melancon now. Five yearsago he was diagnosed with a brain tumor that robbed

#66 Keith Melancon,1983 LSU Tigers


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him of the functionaluse of his right arm.Characteristically, hesdrawing from thisexperience to benefithis patients in new

ways, his studentsand his colleagues inthe LSU academicfaculty practice.

Its difficult. I cantbutton a button or tie ashoe, but that actuallyallowed me to changemy focus from alwaystrying to be a bettersurgeon to a whole newexperience being apatient. Ive been on

both sides of this, so Ivetried to develop my skillsin rehabilitating peopleto the point where theydont need surgery. ButI am also aware of what surgery is going to offer them,and what they can expect from surgery. I can advisethem in a way that maybe their family practice doctor orother physicians whove never been part of the surgicalportion of this discipline cant. Since I cant fix them

with a knife any more, I try to fix the experience.

Melancons students are learning far

more than how to fix broken bones.I love teaching. I hope if I pass on anything tothem its that this is the best job anyones ever had.

This is your chance to be that guy or that girl whohelps somebody in ways that most people dont everget a chance to. We all hear about the kid who dials911 to save the grandmother or the guy who pullssomebody out of the car those people are heroes.But in some ways, you get a chance to be a hero on asmaller scale to each and every one of your patients,especially if you work hard to make them involved init as well. The hero business is a team concept here.

But the biggest change in Melanconslife is in his personal life.

When you define yourself by your profession and youlose that, you may say why me. Is it weird to say thisthing thats so terrible has been a blessing? The onlything its kept me from doing is the thing that mademe feel important to me, which was surgery. Andnow, Ive had to develop skills that I kind of neglectedbecause I could fix anything. I mean I wasnt a perfectsurgeon, but there was nothing I was scared of. Thisbrought me back to the world with everyone else. Andit really has been sort of a strange blessing because

in the 10 years that I had a family before this tumor,I really didnt know them. I worked all the time. Iloved my work. I got a lot of satisfaction from goingto work and taking care of folks, but I neglected myfamily. This has made me keenly aware of the fact thatI need to be there for them. He and his wife havethree kids, two boys and a girl 14, 12, and 10.

I spend a lot more time with my kids, with myfamily, my wife. And get a lot more out of it, too,because its not these little cameo appearanceswecan go to dinner tonight, but Ive got to go backto work afterwards. That was typical. Now I pickmy kids up from school and we go work out, orgo fishing, or I bring them to practice and actually

watch practicesomething I never did before.

For Melancon, it really is quality over quantity.

Id much rather have a shortened, productive life thana lengthened, nonproductive life. It may sound weird,but Im lucky. Ive had a great life. Im 47. Id love to

see my kids all get married, but that may not be in thecards. I know the father they have now is the father theydidnt have five years ago. Im still far from perfect, butIm so glad to have had the chance to change, and thatssomething not many of us really get a chance to do.

The next time you are sitting in front of your televisionset watching a college event, keep in mind these arent

just jocks. These are future doctors, lawyers, teachersand leaders. They are athletes on a journey a journeyto their future away from the playing field.-LeslieCapo, LSU Health Sciences Center, New Orleans, LA

Dr. Keith Melancon consulting with a patient,2012 LSU University Medical Center


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www http://www.cdc.gov/vitalsigns

Six times as many peopledied of methadoneoverdoses in 2009 than adecade before.

About 5,000 people dieevery year of overdosesrelated to methadone.

5,000

Methadone contributed tonearly 1 in 3 prescription

painkiller deaths in 2009.

6x

1in3

PrescriptionPainkiller Overdoses

Use and abuse omethadone as a painkille

Prescription painkiller overdoses* were

responsible for more than 15,500 deaths in 200

While all prescription painkillers have contributto an increase in overdose deaths over the last

decade, methadone has played a central role in

the epidemic. More than 30% of prescription

painkiller deaths involve methadone, even

though only 2% of painkiller prescriptions are

for this drug. Six times as many people died of

methadone overdoses in 2009 than a

decade before.

Methadone has been used safely and effectively

to treat drug addiction for decades. It has been

prescribed increasingly as a painkiller because

it is a generic drug that can provide long-lasting

pain relief. But as methadones use for pain has

increased, so has nonmedical use of the drug an

the number of overdoses.

* Prescription painkiller overdoses refers to deaths from usingharmful amounts of opioid or narcotic pain relievers, including d

such as Vicodin (hydrocodone), OxyContin (oxycodone), Opana

(oxymorphone), and methadone.

Want to learn more? Visi

National Center for Injury Prevention and Control

Division of Unintentional Injury Prevention


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Problem

Methadone use

poses risks

Methadone is frequently prescribedfor pain.

Methadone, like other painkillers, iscommonly prescribed for chronic problemslike back pain even though it might not helpthese problems in the long run.

More than 4 million methadoneprescriptions were written for pain in 2009,despite US Food and Drug Administrationwarnings about the risks associated withmethadone.

Methadone is available as a low-costgeneric drug. It is often listed as a preferreddrug by insurance companies.

Methadones risks include:

The difference between appropriateprescribed doses and dangerous doses ofmethadone is small.

Methadone has special risks as a painkiller. Foexample, taking it more than 3 times a day cancause the drug to build up in a persons body,leading to dangerously slowed breathing.

Methadone can seriously disrupt thehearts rhythm.

Methadone can be particularly risky whenused with tranquilizers or other prescriptionpainkillers.

In one study, four in ten overdose deathsinvolving single prescription painkillersinvolved methadone, twice as many as anyother prescription painkiller.

As methadone prescriptions haveincreased, so have the number ofmethadone overdoses. But manypeople who die of painkiller overdosesdont have a prescription. How canthis be?

Its because some of theseprescriptions are illegally sold orgiven to people who use them fornonmedical reasons. This is known asdiversion.

Diversion is a major factor in theprescription drug abuse epidemic.More careful prescribing will helpreduce diversion and save lives.

Why have methadone overdoses increased?

Rx

Diversion


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Methadones share of prescription painkillers dispensed in each state

Death rate from overdoses caused by a single prescription painkiller

Source: Substance Abuse and Mental Health Services Administration, Center for Behavioral Statistics and Quality, Drug Abuse WarningNetwork Medical Examiner Component, 2009.

Buprenorphine Hydrocodone FentanylHydromorphone Oxycodone Morphine Methadone

12

10

8

6

Rateper100kilograms

4

2

0

Growth of methadone use for pain and methadone overdoses

Sources: National Vital Statistics System, 1999-2009; Drug Enforcement Administration Automation of Reportsand Consolidated Orders System (ARCOS), 1999-2010.

Methadone use for pain (kg/100,000 people)

Methadone-related overdose deaths per 100,000 people

1999 2003 20072000 2004 20082001 2005 20092002 2006 2010

3.0

2.5

2.0

1.5

Rateper

100,0

00people

1.0

0.5

0

Percentage

4.4 - 6.6

6.7 - 8.5

8.6 - 11.4

11.5 - 18.5

CA

FL

NY

WA

MT

OR

NV

UT

ID

WY

KS

LA

AL

NC

ME

WI

AR

IN

MI

AK

HI

AZNM

CO

ND

SD

MN

IANE

TX

MS

SCOK

MO

TN

KY

IL OH

WV MD

DE

NJ

VT

RICT

NH

MA

PA

VA DC

GA

Source: Drug Enforcement AdministrationAutomation of Reports and ConsolidatedOrders System (ARCOS), 2010

Numbers account for differences in drug strength.


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www http://www.cdc.gov/mmwr

What Can Be Done

CS

The US government is

Enforcing federal laws to prevent nonmedicaluse of methadone.

Educating health care providers and

consumers about the correct useof methadone.

Tracking prescription drug overdose trendsand the impact of efforts to stop overdoses.

States can

Develop and promote the use of safeprescribing guidelines for methadone.

Support the use of methadone as a treatmentfor opioid dependence in opioidtreatment programs.

Use prescription drug monitoring programsto identify patients who are using methadoneor other prescription painkillers fornonmedical purposes.

Health care providers can

Follow guidelines for prescribing methadone

and other prescription painkillerscorrectly, including

Screening and monitoring for substanceabuse and mental health problems.

Prescribing only the quantity needed basedon the expected length of pain.

Using prescription drug monitoringprograms to identify patients who aremisusing or abusing methadone or otherprescription painkillers.

Monitor patients on high doses for heartrhythm problems.

Educating patients on how to safely use,store, and dispose of methadone and how toprevent and recognize overdoses.

Health insurers can

Evaluate methadones place on preferreddrug lists.

Consider strategies to ensure that pain

treatment with any dose higher than 30mg of methadone a day (the recommendedmaximum daily starting dose) is appropria

Individuals can

Use methadone only as directed by a healthcare provider.

Make sure they are the only ones to use themethadone and never sell or share it

with others. Store methadone in a secure place and

dispose of it properly. See www.cdc.gov/HomeandRecreationalSafety/Poisoning/preventiontips.htm for correct storage anddisposal of medications.

Get help for substance abuse problems1-800-662-HELP orwww.samhsa.gov/treatment/.

For more information, please contact

Telephone: 1-800-CDC-INFO (232-4636)TTY: 1-888-232-6348E-mail: [email protected]

Web: www.cdc.govCenters for Disease Control and Prevention1600 Clifton Road NE, Atlanta, GA 30333Publication date: 07/03/2012


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The Skinny on FatIts August and time for the nutrition article I have been leading upto for the past two months. We started with information to help

understand digestion, followed by an explanation of food as fuel.Now you should have the background to move forward. Im fiftytwo years old. When I was growing up, truly obese people were nota common sight. Neither were fast food restaurants or frequent foodadvertisements on TV. How did we get here, and how do we go backbefore we spiral into the nightmare of health problems that are justaround the corner. Lets see if a little bit of education can help, as BenFranklin said an ounce of prevention is worth a pound of cure.

Brief reviewEnergy from the sun is transferred into the chemical bonds in the food weeat. The process of combustion means burning fuel to release energy equalto the energy put there during photosynthesis. What we didnt discuss,

is that metabolism of food involves a process very much like combustion.The difference is that with combustion, our body would burn itself upfrom the energy released. What makes extraction of energy from the foodfeasible is that chemical bonds are broken down using enzymes (complexesin the body that facilitate reactions without major energy release or input).

Process of energy production in the cellThe process of energy production in the cell is called Cellular Respiration.Remember from the last issue that plants produce glucose and oxygen. Wetake in glucose and oxygen for the production of energy at the cellular level,

which is why we breathe oxygen into the lungs and exhale CO2 (carbondioxide). We use glucose, whether it is ingested or manufactured by the body.

One molecule of glucose is brought into the cell with the help of insulin.

The glucose is converted into fructose and broken in half. The resultingenergy release is magnified in the mitochondria by involvement oftwo chemical processes called: Krebs Citric Acid Cycle and Electron

Transport Chain (both of which will be covered next month).

This enzymatic process results in the production of 36 molecules of ATPfrom the breakdown of one molecule of glucose. This is an extremelyefficient system with an efficiency yield of 41 percent. This means 41percent of the energy available from the glucose molecule is used toproduce ATP, which will be used later by the cell for work, and about59 percent of the energy is lost as heat production, which is necessaryanyway. By comparison a car engine is about 25 percent efficient.

onFAT

TheSKINNY


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whether in the form of protein,carbohydrate or fat, will resultin storage of a pound of fat.If you take in an extra 400

calories per day, it willtake about 10 days to

gain one pound of fat.How to lose onepound of fat

Losing one pound of fatrequires a deficit of 4000

calories. For instance, a person couldeat 400 calories less than required for 10 days or performa total of 4,000 calories worth of exercise. The problem

with trying to lose weight by fasting or dieting withoutincreasing exercise is the body will compensate bydecreasing the metabolic rate and go into survival mode.

This defeats the purpose of fasting -- successful weightloss requires increased activity with portion control.

Metrisize meOne problem with portion control in the UnitedStates is that we are an island of non-metric, ina sea of metric. The average American doesntunderstand calories because they dont understandthe metric system. Here is a basic metric primer:

One pound = 454 grams *carbohydrates = Four calories per gramHalf pound = 220 grams **proteins = Four calories per gramQuarter pound = 110 grams ***fats = 9 calories per gram

*carbohydrates include: Sugars, starches (rice, bread,potatoes) most of the substance of fruits and vegetables.**proteins: lean meat, some dairy, beans***fats: butter, oils, nuts (anything that tastes really good)

The resulting ATP is used by thecell to do work, such as producingother cellular material or fornormal bodily functions. Aseach molecule of ATP is used, itis broken down into ADP and

phosphorus. The resulting energyis used for driving work of thecells. The flow is illustrated here.

One molecule of glucosehelped into cell by insulinconverted to fructosebroken in halfto form two molecules of glycerolenergy isreleasedresult of energy release is that adenosinediphosphate (ADP) combines with phosphate to form

36 molecules of adenosine triphosphate (ATP).

ATPBreaks down to ADP and phosphate. Theprocess starts over as more glucose is broken down.

This process of glucose breakdown is called Glycolysis.The energy released drives the work of the cell.

No matter what fuel the body is using (carbs, fats,

proteins) it must first convert to glucose then follow this

pathway. ATP is the only currency for cellular work and the

final common currency of energy in all living organisms.

What is the caloric requirement?The daily requirement for a man (to maintain bodyweight in a sedentary lifestyle) is about 2,000 caloriesand the caloric requirement for a woman is about1,500 calories a day. By todays average Americanhabits, thats not very much food! If there is significantexercise during the day, more calories are required.

For example: swimming at a vigorous pace burnsabout 900 calories per hour. A swimmer training fivehours a day would have a massive caloric requirement.

A two thousand calorie daily requirement plus fivehours of swimming at 900 calories per hour (about4,500 Calories) equals 6,500 calories per day.

If you arent Michael Phelps, but eat like him,you could gain more than one pound of fatper day. Remember from last month: energyequals matter. The food we eat must

either be converted into energy, heat oradditional matter (meaning fat). Youdont have to be an Olympic athlete if you go out and walk every day,you can enjoy that piece of pie.

How to gain onepound of fatRemember, one poundof fat (454 g) is about4,000 calories. Everyextra 4,000 calories,


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For example:

If I were to put onepound of food in front ofyou and tell you it is allcarbohydrates, could youtell how many calories

are on the plate? Firstunderstand that one poundis equal to 454 g. Multiply454 grams x 4 caloriesper gram (energy yield forcarbohydrates) = 1,816calories. Therefore, onepound of carbohydrates

would just about equalthe needs of an adult manfor a 24-hour period, orabout 600 calories morethan an adult woman

would require. Thinkabout a one pound bagof pasta (with no oil orsauce), or five cups of plaincooked rice. How about20 medium sized plainbaked potatoes? Vegetablesand fruits contain lots of

water, so the 454 gramsdoesnt exactly work.

One pound of protein would be 454g x 4 caloriesper gram = 1,816 calories for the day.

One pound of fat would be 454g x9 calories pergram, equal to about 4,000 calories or about twice

what an adult man requires and about three timesthe requirement of a woman. To meet his dailycaloric requirement, a man could consume one cupof olive oil or two boxes of cream cheese per day,but is that something he would want to do?

One pound of food in equal proportionsof carbohydrates, proteins and fats

would work something like this:One third of 1,800 protein calories = 600 caloriesOne third of 1,800 carb calories = 600 calories

One third of 4,000 fat calories = 1,300 caloriesTotal intake 2,500 calories: about 700 caloriesmore than a man would require and more thantwo days for a woman. It is something to consider

when ordering in a restaurant. Please recall thatfat contains twice the calories for the same unitof weight as protein and carbohydrates.

Another major problem with portion control comesfrom not counting drink calories. Look at a two literbottle of soda. You have to do the math. Two liters(about a six pack of 12 ounce cans) contains a half

pound of sugar or more than 1,000 calories. Thenutrition label says 170 calories per serving. Howmany soda drinkers understand the difference in a

serving size and drinking the entire bottle? Howmany walk around with a fast food mega cup - 44ounces or about two thirds of a two liter bottle?

Factors that affect calorie calculatingWater Content

Water makes up between 60 and 70 percent ofvolume of most foods except for fat, which usuallyexcludes water. The water doesnt have any nutritional

value, but it will increase the weight significantly.In other words, one pound of lean meat mightactually only be one third of a pound of proteinand a small amount of fat and the rest water.

Carbohydrates associated with fiber

This can be misleading, because fiber is often listedunder carbohydrates. However, fiber is typicallycellulose, a component of the plant cell wall andcomposed of very long and complex chains of glucose,

which cant be digested by humans. This fiber isimportant for binding fats and cholesterol in the liningof the intestine, al lowing some fat and cholesterol to passunabsorbed. This is important as a scrub brush effect inthe colon, increasing bulk of the stool and clean out ofthe bowel. Typical minimal fiber requirement is about


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30 g per day, which may be listed under carbohydrates-- but would not count in terms of nutritionalconsumption. Fiber grams should be separated fromregular carbohydrate grams in calculation. Therefore,foods high in fiber and water content help in the dietby filling the stomach with water and fiber, leading to

a sense of fullness. A salad is a good example (avoidtoo much dressing and adding cheese and meat).

How are unused calories stored in the body?It is important to understand, calories not useddaily are basically stored in two forms.

Glycogen

Glycogen is a complex of up to 30,000molecules of glucose stored in the liver andmuscles and is readily available for work.

The total-body store of available glycogen at any giventime is about 500 calories (100 grams), meaning just

enough for about one hour of running or about ahalf hour of intense swimming. After the glycogenis depleted, there is a drop in blood sugar, which isreferred to as hitting the wall. This will trigger a risein the hormone glucagon, produced in the pancreas.

This in turn will drive gluconeogenesis throughwhich fatty acids are broken down and convertedto glucose to be used for energy production.

Fat

Fat is a compact and economic way of storing energy. Itdoes not change the balance of water storage in the bodythe way storage of glucose or glycogen will. Avoiding

fat in the diet does not mean you wont store excessdietary carbohydrates in the form of fat. Fat serves asthe major source of energy production on demand.

Does it matter what you eat?Your cells prefer glucose. The brain works exclusively

with glucose. When we do not have glucose in the bloodstream, the body responds by breaking down fat througha process known as gluconeogenesis. We do not useprotein unless the available glucoses and fat are used up.

It stands to reason it doesn't matter what weeat. The body will produce what it needs.

Glycemic indexMuch has been made about the glycemic index.Magazine articles and Talk Shows are full of discussionabout good carbs and bad carbs. It basically amountsto this. The Glycemic Index is essentially a measureof the availability of carbohydrates immediately aftereating. Glucose is absorbed after interaction withsalivary amylase (the enzyme in the mouth whichinitiates glucose breakdown for absorption). It is themost rapidly available route for energy delivery to thebody. Glucose itself has a glycemic index of 100 (thehighest) and complex carbohydrates such as fructose

from fruit have a much lower glycemic index of around20. It is important to understand that all of these sugars

will be absorbed by the body in the absence of somemedical abnormality like Celiac Disease or FructoseIntolerance. The problem with rapidly available glucoseis that it causes a sudden peak in the insulin level which

may then remain elevated after the glucose has beenabsorbed into the cells causing more aggressive uptake ofsugar into the cells resulting in a rebound hypoglycemia(or drop in blood sugar level). In other words, the morecomplex a carbohydrate structure is, the more slowly it isabsorbed into the body. This is not to be confused withfree calories. It does not mean that you can eat as manycomplex carbohydrates as you want without gaining

weight. It does not matter whether they are goodcarbs or bad carbs and again, every carb over the dailyrequirement, without added exercise is a bad carb.

InsulinInsulin is a hormone produced in the pancreas. It is

required for absorption of glucose into the cell. Most peopleare familiar with diabetes, of which there are two forms.

Type 1 diabetes

A condition in which the cells in the pancreas thatproduce insulin have been destroyed by an autoimmuneprocess resulting in the loss of production of insulin.

Type 2 diabetes

A condition in which there is a genetic predispositiontoward insensitivity to insulin in the cells of the body.

In either situation, glucose cant enter the cells so

even though there may be more than adequateglucose in the blood stream, the cells are not ableto process the glucose for energy production.

If there a drop in the blood glucose level. There isa compensatory process involving production ofthe hormone glucagon (also from the pancreas),that turns on the process of gluconeogenesisbeginning glucose production from fat stores.

If we do not eat fat, the body makes it from sugarthat has not been used for energy production. If wedo not eat sugar, our body will produce it from theavailable fat stores. A common saying is we are what

we eat but that isnt true. It is more accurate to saywe are the amount we eat, regulated by the body.

The food pyramidStarted by the FDA in 1992 and modified about fiveyears ago, the food pyramid is a graphic breakdownof recommended food intake. Basic understandingshould include that about 70 percent of caloric intakeshould be in the form of carbohydrates, mostly complexcarbohydrates rather than simple sugars. About 20percent in the form of fats. About 10-15 percent inthe form of proteins. Remember also, calories are


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calories according to the body and will be used as fuel.It is important to keep the total caloric intake at orbelow the necessary level for ongoing good health.

The role of hormones in metabolismLeptin

A hormone produced in the fat cells of the body thattriggers a hunger response with loss of fat. Remember,a person is genetically predisposed to have a certainnumber of fat cells in the body. As we are gaining

weight, we are not adding fat cells, we are increasingthe storage of fat causing the cells to balloon up. With

weight loss there is decreased fat content within each cellcausing a release of the hormone leptin to trigger hungerresponse in the central nervous system. This hormone

works in conjunction with the hormone Grehlin.

Grehlin

This is a hormone produced in the stomach that sendssignals back to the central nervous system to let thebrain know the stomach is full. This hormone worksin conjunction with leptin to try to maintain fat storesby increasing appetite in the setting of weight loss.Remember these two hormones as fat protective.

Thyroid hormone

The basal metabolic rate is the resting rate ofmetabolism of the body and is affected by thyroidhormone levels. Metabolism is accelerated inthe setting of hyperthyroid or over producingthyroid hormone, associated with inflammatoryprocess such as Graves' Disease or Hashimoto's

Thyroiditis. Basically, the inflammatory processcauses overproduction of thyroid hormone with anincrease in the metabolic rate. The eventual resultis that the thyroid tissue becomes burned-out andis no longer able to produce thyroid hormone,

resulting in a condition called hypothyroid, loweringthe metabolic rate and increasing weight gain.

People are always looking for an easy way aroundthe laws of matter and energy. Everybody wantsto be able to eat whatever they want and not gain

weight. This isnt possible and would violate theprincipals of physics and biochemistry. The questionis: how can you increase the caloric intake withoutincreasing activity and maintain weight. The answeris. You cant! If someone tells you that you can, restassured that they are trying to sell you something.


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Diphtheria(Can be prevented by Tdap vaccine)Diphtheria is a very contagious bacterial disease thataffects the respiratory system, including the lungs.Diphtheria bacteria can be passed from person toperson by direct contact with droplets from an infectedpersons cough or sneeze. When people are infected,the diptheria bacteria produce a toxin (poison) in thebody that can cause weakness, sore throat, low-gradefever, and swollen glands in the neck. Effects from

this toxin can also lead to swelling of the heart muscleand, in some cases, heart failure. In severe cases, theillness can cause coma, paralysis, and even death.

Hepatitis A(Can be prevented by HepA vaccine)Hepatitis A is an infection in the liver caused byhepatitis A virus. The virus is spread primarilyperson-to-person through thefecal-oral route. Inother words, the virus is taken in by mouth fromcontact with objects, food, or drinks contaminatedby the feces (stool) of an infected person. Symptomsinclude fever, tiredness, loss of appetite, nausea,abdominal discomfort, dark urine, and jaundice

(yellowing of the skin and eyes). An infected personmay have no symptoms, may have mild illness for a

week or two, or may have severe illness for severalmonths that requires hospitalization. In the U.S.,about 100 people a year die from hepatitis A.

Hepatitis B(Can be prevented by HepB vaccine)Hepatitis B is an infection of the liver caused byhepatitis B virus. The virus spreads through exchangeof blood or other body fluids, for example, fromsharing personal items, such as razors or duringsex. Hepatitis B causes a flu-like illness with lossof appetite, nausea, vomiting, rashes, joint pain,

and jaundice. The virus stays in the liver of somepeople for the rest of their lives and can result insevere liver diseases, including fatal cancer.

Human Papillomavirus(Can be prevented by HPV vaccine)

Human papillomavirus is a common virus. HPV ismost common in people in their teens and early 20s.It is the major cause of cervical cancer in women, as

well as anal cancer and genital warts in both womenand men. The strains of HPV that cause cervicalcancer and genital warts are spread during sex.

Influenza(Can be prevented by annual flu vaccine)Influenza is a highly contagious viral infection ofthe nose, throat, and lungs. the virus spreads easilythrough droplets when an infected person coughs orsneezes and can cause mild to severe illness. Typicalsymptoms include a sudden high fever, chills, a drycough, headache, runny nose, sore throat, and muscleand joint pain. Extreme fatigue can last from severaldays to weeks. Influenza may lead to hospitalization or

even death, even among previously ealthy children.

Measles(Can be prevented by MMR vaccine)Measles is one of the most contagious viral diseases.Measles virus is spread by direct contact with theairborne respiratory droplets of an infected person.

Measles is so contagious that just being in the sameroom after a person who has measles has already leftcan result in infection. Symptoms usually include arash, fever, cough, and red, watery eyes. Fever canpersist, rash can last for up to a week, and coughingcan last about 10 days. Measles can also causepneumonia, seizures, brain damage, or death.

Meningococcal Disease(Can be prevented by MCV vaccine)

Meningococcal disease is caused by bacteria and is aleading cause of bacterial meningitis (infection aroundthe brain and spinal cord) in children. The bacteria arespread through the exchange of nose and throat droplets,such as when coughing, sneezing or kissing. Symptomsinclude nausea, vomiting, sensitivity to light, confusionand sleepiness. Meningococcal disease also causes bloodinfections. About one of every ten people who getthe disease dies from it. Survivors of meningococcaldisease may lose their arms or legs, become deaf,

have problems with their nervous systems, becomedevelopmentally disabled, or suffer seizures or strokes.

Mumps(Can be prevented by MMR vaccine)Mumps is an infectious disease caused by themumps virus, which is spread in the air by a coughor sneeze from an infected person. A child can alsoget infected with mumps by coming in contact

with a contaminated object, like a toy. The mumpsvirus causes fever, headaches, painful swelling of thesalivary glands under the jaw, fever, muscle aches,tiredness, and loss of appetite. Severe complications

Vaccine-Preventable Diseases

and Vaccines that Prevent Them


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for children who get mumps are uncommon, but caninclude meningitis (infection of the covering of thebrain and spinal cord), encephalitis (inflammationof the brain), permanent hearing loss, or swelling ofthe testes, which rarely can lead to sterility in men.

Pertussis(Whooping Cough) (Can be prevented by Tdap vaccine)

Pertussis is caused by bacteria spread through

direct contact with respiratory droplets when aninfected person coughs or sneezes. In the beginning,symptoms of pertussis are similar to the commoncold, including runny nose, sneezing, and cough.

After 1-2 weeks, pertussis can cause spells of violentcoughing and choking, making it hard to breathe,drink, or eat. This cough can last for weeks. Pertussisis most serious for babies, who can get pneumonia,have seizures, become brain damaged, or evendie. About two-thirds of children under 1 year ofage who get pertussis must be hospitalized.

Pneumococcal Disease

(Can be prevented by Pneumococcal vaccine)more severe forms of pneumococcal disease. However,in some cases pneumococcal disease can be fatal orresult in long-term problems, like brain damage, hearingloss and limb loss. Pneumococcal disease spreads whenpeople cough or sneeze. Many people have the bacteriain their nose or throat at one time or another withoutbeing illthis is known as being a carrier. Pneumoniais an infection of the lungs that can be caused by thebacteria called pneumococcus. This bacteria can causeother types of infections too, such as ear infections,sinus infections, meningitis (infection of the coveringaround the brain and spinal cord), bacteremia and sepsis

(blood stream infection). Sinus and ear infections areusually mild and are much more common than the

Rubella (German Measles) (Can beprevented by MMR vaccine)

Rubella is caused by a virus that is spread throughcoughing and sneezing. In children rubella usuallycauses a mild illness with fever, swollen glands, anda rash that lasts about 3 days. Rubella rarely causesserious illness or complications in children, but canbe very serious to a baby in the womb . If a pregnant

woman is infected, the result to the baby can be

devastating, including miscarriage, serious heart defects,mental retardation and loss of hearing and eye sight.

Tetanus(Lockjaw) (Can be prevented by Tdap vaccine)

Tetanus is caused by bacteria found in soil. The bacteriaenters the body through a wound, such as a deepcut. When people are infected, the bacteria produce atoxin (poison) in the body that causes serious, painful

spasms and stiffness of all muscles in the body. Thiscan lead to locking of the jaw so a person cannotopen his or her mouth, swallow, or breathe. Completerecovery from tetanus can take months. Three often people who get tetanus die from the disease.

Varicella(Chickenpox) (Can be prevented by varicella vaccine)

Chickenpox is caused by the varicella zoster virus.Chickenpox is very contagious and spreads very easilyfrom infected people. The virus can spread fromeither a cough, sneeze. It can also spread from theblisters on the skin, either by touching them or by

breathing in these viral particles. Typical symptoms ofchickenpox include an itchy rash with blisters, tiredness,headache and fever. Chickenpox is usually mild, butit can lead to severe skin infections, pneumonia,encephalitis (brain swelling), or even death.

Zoster (Shingles, Herpes Zoster) (Canbe prevented by the zoster vaccine)

Shingles is caused by the varicella zoster virus, the samevirus that causes chickenpox. After a person recoversfrom chickenpox, the virus stays in the body in a dormant(inactive) state. For reasons that are not fully known,the virus can reactivate years later, causing shingles.

Almost 1 out of every 3 people in the United States willdevelop shingles, also known as zoster or herpes zoster.

About half of all cases occur among men and women 60years old or older. People who develop shingles typicallyhave only one episode in their lifetime. In rare cases,however, a person can have a second or even a thirdepisode. Herpes zoster is not caused by the same virusthat causes genital herpes, a sexually transmitted disease.

If you have anyquestions about vaccines,talk to your healthcare provider.-Thisinformation provided courtesy of the CDC


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Getting a Gripon Memories

H

aving a fat head may not be a badthing, according to new findingsat The Johns Hopkins University.

As reported in the February 9 issueof Neuron, Hopkins researchers

have made a significant discoveryas to how adding fat molecules to proteins caninfluence the brain circuitry controlling cognitivefunction, including learning and memory.

When you learn something, you strengthen and inhibitcertain transmissions and sculpt a particular circuit.Recall [or memory] is using that circuit again, saysRichard L. Huganir, Ph. D., professor and director ofthe Solomon H. Snyder Department of Neuroscience at

Johns Hopkins. His teams latest finding describes for thefirst time how one protein chemically alters another inthis circuit strengthening process and represents anotherstep toward understanding a key part of how memoriesare made and maintained within the brain, somethingresearchers believe could provide a pathway towardtreating disorders like Alzheimers and schizophrenia.

In studying the molecular underpinnings oflearning and memory, Huganir and his team

have focused on one of several processes inwhich a molecule is tagged by another

molecule of fat. Tagging sends themolecules to a particular destinationwithin a cell. Specifical ly, the team

has studied DHHC5, which isknown to add a fat moleculeto other proteins. Until nowit was not known whichproteins receive this tag.

The scientists suspected atarget molecule would need tobind DHHC5, which wouldthen transfer fat onto it. Todetermine what DHHC5could bind, they used it

as bait in a large pool ofrat brain proteins to fishfor those that stuck toDHHC5. Within thatpool, DHHC5 boundfour different proteins,researchers found. Usinga computer program,they compared thesewith other proteinsimplicated in learning


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and memory. All four shared similarity with thebrain protein known as GRIP1, mutations of whichhave been linked to disorders such as autism. Thescientists then tested GRIP1 and DHHC5 directlyand found that they bound each other as well. Next,they put GRIP1 into human kidney cells, either byitself or with DHHC5, and analyzed each group ofcells to see what happened. They found that only theGRIP1 proteins that were added to cells with DHHC5

were tagged with fat. From this they concludedthat DHHC5 does indeed tag GRIP1 with fat.

The researchers then wanted to know if this processhappens in a brain. However, they needed a way to lookinto a living cell and be able to tell apart GRIP1 thathad a fat tag and GRIP1 that didnt. They designedtwo distinct GRIP1 proteins: one permanently tagged

with fat, and another mutated so that it could never betagged. They added color markers to both proteins sothey could track them under a microscope, and thenadded one type or the other to living brain cells. Thefat-tagged proteins seemed to form clusters extendingto the cells edges in a pattern resembling that of

cellular recycling-center proteins. The untagged

proteins, in contrast, seemed to diffuse aroundthe center of the cell. From this, the teamconcluded that DHHC5 tags proteins likeGRIP1 with fat to send them to be recycled.

According to Huganir, protein recycling iscritical for strengthening and maintainingmemory circuits. Since GRIP1 is involved withrecycling, it may be important in this criticalaspect of memory formation. Huganir believessome day researchers could learn how to controlthis mechanism and reverse the disease processfor disorders like Alzheimers and schizophrenia.

Some day we may be able to inhibit oractivate these molecules, Huganir says.These molecules are involved in mediatingeverything in the brain, all behaviors.

Besides Huganir, authors on this studyinclude Gareth Thomas, Takashi Hayashi,Shu-Ling Chiu and Chih-Ming Chen.

This research was funded by the HowardHughes Medical Institute and the NationalInstitutes of Health.-This informationprovided courtesy of Johns Hopkins Medicine


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A Female's

The knee is formed by the femur (thigh

bone), the t ibia (shin bone) and thepatella (the knee cap). It is essentiallya hinge joint that is held in place bythe medial collateral (MCL), lateralcollateral (LCL), anterior cruciate (ACL)

and posterior cruciate ligaments (PCL).

Most of us have heard that female athletes are moreprone to suffering from a traumatic knee injury. But

what most people don't know is that you don't haveto be a weekend warrior to end up with a serious kneeproblem. Each year, roughly 10 million women see

their doctors for knee pain, often caused byactivities that are not related to sports, suchas lifting boxes, going up a flight of stairsor squatting too much while gardening.

Why are women winding up with more kneeinjuries? Researchers suspect one of the mostlikely causes is the way women are built.

Women tend to have wider hips and areslightly knock-kneed (their thighbones tendto curve inward from the hip to

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