Obesity and Pharmacologic Management of Weight Loss

(For the rest of us)


Obesity rates in the United States are staggering.  It is estimated that by the
year 2030, 86.3% of adults will be overweight or obese, and by 2048
all American adults will be overweight or obese (Kanaya, Vaisse, 2011).

With these statistics and the common knowledge that exercise and proper diet
are necessary to maintain weight, yet are blatantly disregarded, what can
primary care providers do pharmacologically to reduce obesity?


 

weight-loss

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Vitamin D3, Deficiency, What We Know, and Recommendations

poole-joseph004Vitamin D is an important nutrient that should be evaluated and maintained in each adult patient. Because Vitamin D is synthesized in the skin, it is technically a hormone, and because hormone deficiencies disrupt homeostasis, overlooking this vitamin can have unintended consequences including prostate and colorectal cancer, metabolic syndrome and prediabetes (Bender, 2017). The protective benefits of a normal Vitamin D also include respiratory protection and all-cause mortality benefits (Wimalawansa, 2016).

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Anxiety

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Miguel Nunez, MD

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Joseph Poole, FNP


Anxiety is defined as “fear or nervousness about what might happen” (Merrium-Webster, 2016). The condition of anxiety can include fear, nervousness, jitters and even panic. Anxiety is so prevalent, it is said that 25% of all adults will experience it one time in their lives, making it more common than depression (Satterfield, Feldman, 2014). The types of anxiety seen in clinic are exhibited in the following table:
Anxiety Disorder Prevalence in Primary Care (%)

  • Acute stress disorder 3–5
  • Agoraphobia 1–3
  • Generalized Anxiety Disorder 4–9
  • Obsessive Compulsive Disorder 1–2
  • Panic Disorder 1–6
  • Post-traumatic Stress Disorder 2–12
  • Social phobia 3–7
  • Specific phobia 8–13
  • Adjustment disorder with anxiety 4.5–9.2
  • Anxiety disorder due to a general medical condition 14–66
  • Substance-induced anxiety disorder Unknown prevalence
  • Anxiety disorder not otherwise specified (NOS) Unknown (Table 1 Satterfield, Feldman, 2014).

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Hypertension (High Blood Pressure), the Silent Killer

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Miguel Nunez, MD

poole-joseph004

Joseph Poole, FNP


Many people in our community have an easily manageable health problem that can quickly be identified, treated and resolved to prevent future health issues and mortality.

Risks of Hypertension
The most widely known events from having high blood pressure are often known and include heart attack and stroke. While these 2 outcomes are the worst end result from high blood pressure, other less known issues can occur: These include heart enlargement (which can lead to heart failure) and kidney disease (which can result in a patient needing dialysis from kidney failure). Eye damage (retinopathy) and artery damage (peripheral artery disease) can also occur.

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Multiples, the journey begins….

Avolonne Kimble, MDAs a, wife, parent of twin girls AND twin boys and a pediatrician, my perspective of pregnancy, life as a working mother and plans for the future may be a little skewed. I see everything in two’s. Being pregnant and having a baby is a joy and it can also be scary. Being told that you’re having more than one can be even scarier, especially if you have just a little bit of knowledge.

Multiples occur in 3% of all pregnancies with twins being the most common. When carrying two babies the risk of maternal complications rise and prematurity is more prevalent. Higher order multiples occur in much smaller numbers and with even more possibility of complicated pregnancies, risk of prematurity and less chance of survival. In my case, as a pediatrician working full time, co-owner in private practice, considering pregnancy is a very serious one and then to be told that you were having multiples brings in a very different element.

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Colonoscopy Facts

What is colonoscopy? Do I have to get one? How often? Why do I need one? What is the goal of that test?

These are questions that one asks as they visit their physician for their annual exam. A colonoscopy is a test that where the physician looks with a magnifying camera at the inner lining of a person’s large intestine. Sample biopsies may be done at the time of the test. The colonoscopy test is typically performed for colon and rectal cancer screening, but the physician may order it for other reasons as well, which include: blood in the stool, abnormal test results from another colon test, family history of colon cancer, anemia unexplained otherwise. The stated are some indications for colonoscopy, but it is not an inclusive list.

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August is National Immunization Awareness Month

Selwyn Rogers, Chief Medical OfficerIt was a typical Tuesday in my former job as chair of surgery at Temple University in Philadelphia, but that morning I felt sluggish. Although I wasn’t feeling well, I knew I had three surgical operations to perform that morning followed by an afternoon full of meetings.

I trudged out of my apartment and started the 15-minute drive to work.

A few miles into my commute, a feeling of illness suddenly enveloped me. I had to pull over and call my chief resident to cancel the morning’s surgeries.

I turned the car around and headed back home to bed. The next three days were a blur of sore throat and fever; it was the first time I’d had the flu, and I swore that I would never endure that experience again.
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You’re more like your mother than you know

Drs. Norbert Herzog & David Niesel

Drs. Norbert Herzog & David Niesel

Medical Discovery News

While the benefits of breast feeding have been well-documented, scientists were surprised to learn of another one: breast milk contains a mother’s stem cells that become a part of different organs of the baby’s body.

Breast feeding protects infants against infections early in life and reduces their risk of juvenile diabetes, heart disease and cancer as children. It also helps mothers lose weight after giving birth and lowers their risk of osteoporosis and uterine and ovarian cancer.

In addition, seven years ago scientists discovered the presence of mammary stem cells in breast milk. The mammary gland is unique in its ability to go through different stages in anticipation of producing milk, then a period of milk secretion followed by a return to the non-lactating state. All of this can occur as many times as necessary. This massive restructuring of the breast suggested the presence of stem cells. Continue reading

Cigars are no better than cigarettes

Drs. Norbert Herzog & David Niesel

Drs. Norbert Herzog & David Niesel

Medical Discovery News

A common argument made by those who smoke cigars is that they are safer than cigarettes. However, several studies argue that this is not true.

Cigar smoking has increased dramatically in the U.S. Between 2000 and 2011, small cigar sales rose 65 percent and large cigar sales increased 233 percent. Americans smoked more than 13 million cigars in 2010, twice the number from 2000. About 13.4 million people age 12 or older smoke cigars. A cigar culture has arisen, with cigar bars or clubs, shops with walk-in humidors and magazines for those who consider themselves cigar connoisseurs. Their use among sports figures and celebrities has made it seem fashionable or sophisticated, a symbol of status or success.

The tobacco in cigars is cured and fermented to enhance the flavor, but this process also increases the amounts of harmful ingredients. Cigars come in three basic sizes, but the classic cigars are the large ones that contain more than half an ounce of tobacco, and some contain as much as an entire pack of cigarettes.

Just like cigarettes, cigars contain nicotine and can be very addictive. Most people who smoke cigars do not inhale, and therefore the nicotine is absorbed more slowly. However, cigar smoke dissolves more easily in saliva than cigarette smoke, enhancing the amount of nicotine absorbed. Smokers absorb one to two milligrams of nicotine out of the eight total milligrams in cigarettes. The large cigars contain anywhere from 100 to over 400 milligrams of nicotine, and the amount a person absorbs varies greatly depending on how long the cigar is smoked, how many puffs are taken, and how much smoke is inhaled. Second- and third-hand cigar smoke is dangerous, just like it is with cigarettes.

In one study, scientists measured the levels of two biomarkers for tobacco as well as arsenic and lead in over 25,000 cigar smokers. Cigar smokers had higher levels of these carcinogens than nonsmokers and equal levels to cigarette smokers. Overall, the study found that cigars are not safer than cigarettes. Cigar smokers are less likely to develop lung cancer than cigarette smokers, but they are at higher risks of developing other cancers.

Those who inhale while smoking cigars are more likely to develop laryngeal cancer, lung cancer, bladder cancer, pancreatic cancer and cancers of the tongue, mouth or throat than nonsmokers. Even those who don’t inhale the smoke directly still inhale the secondhand smoke and are at an increased risk of lung cancer. Cigar smokers are four to 10 times more likely to die from cancers of the mouth, larynx and esophagus than nonsmokers.

Cigar smoking also increases the risk of other diseases including emphysema, chronic bronchitis, heart attacks, gum disease and erectile dysfunction. One long-term study determined that cigar or pipe smoking costs people 10 years on average — they spent an extra five years in bad health and died five years earlier.

So before you take up cigars in an attempt to look cool, ask yourself if your image is more important than your health.

Professors Norbert Herzog and David Niesel are biomedical scientists at the University of Texas Medical Branch. Learn more at medicaldiscoverynews.com.

Discussing sexuality for seniors

Dr. Tristi Muir

Dr. Tristi Muir

Despite the media and entertainment industries’ constant emphasis and exploitation of sexuality in the youth culture to sell products, services, films, and so forth, the mention of sexuality in aging persons remains a somewhat awkward and infrequently discussed topic.

There may be a number of reasons for this. Maybe good judgment, a more proper sense of decorum, and a natural modesty develop as we age — in some people at least. Maturity also brings with it a sense of perspective of deeper values in life that the raging hormones of youth do not have time for nor even fathom.

Dr. Victor Sierpina

Dr. Victor Sierpina

A recent research study of more than 1,700 seniors in the Netherlands, average age of 71, found that an active love life in older people was associated with improved cognitive function. Those who rated sexuality as “important” or “very important” had higher cognitive and memory scores than those who did not think sexuality was an important component of their lives. Perhaps the group more active sexually had better blood flow to their two most important sex organs- the brain and genitals. Cause and effect were not established by this study though it was an intriguing finding.

Physical capacity for sex changes as we age. Frequency of sexual relations diminishes with age for both men and women, though the desire for it may remain. Most doctors have a number of older patients who are alone due to the death, illness, or separation from an intimate partner but still wish for the intimacy, the touching, and the climactic events of sexuality if it were available to them. Continue reading