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20Mar/110

Any Suggestions for the Big 56 ?

Santa Barbara FlowersQuestion:

Hello Dr Wise

I'll be 56 in two weeks.  I've been working out twice a week with a trainer very strenuously and walking a couple of miles 2 or 3 times a week for exercise.  I've been doing this for about 7 months now.  My doctor tells me I should be getting 45 minutes of vigorous exercise 5 days a week to get my heart rate up into the 75% range but it's a real pain to even do what I'm doing now.

I'm always sore though.  My muscles all ache all the time and I'm stiff and creaky.  I drink plenty of water, my diet is very good as I'm losing weight, I do smoke, I don't own a hot tub, I'm trying not to take ibuprofen unless it's really bad.  I don't drink.

Any suggestions?

thanks

Dr. Wise Answer:

Being almost 56 is a good thing, considering that the average life expectancy in 1900 was 40 years old.

I cannot think of one good reason to smoke (except for lighting firecrackers). Please read the posting on my site about why nicotine is in tobacco and then stop smoking. You could use the smoking money for hobbies or your new health program.

I would hope that when you turned 50 you had a check up including an echocardiogram and stress test. Remember that in 50% of men (60% of women) with heart disease the presenting complaint is sudden death.

Steady moderate exercise is better than too infrequent excessive exercise. There is also evidence that when running it is better to have intermittent sprints alternating with walking rather than the steady pounding jogging.

Consider doing a "super circuit" of weight machines alternating with the cardio exercise stations if you have access to a health club facility. I have a patient who came back from 10% cardiac output after a heart attack and pacemaker placement to 60% output in 2 years by using his "total gym" at home for 60 minutes every day because he was diligent to steady exercise.

Moderate intake needs to be part of a conditioning program. Consider the Atkins diet or south beach diet. Both have limited carbohydrates, more vegetables and protein foods. Our systems are not made for the large amounts of carbohydrates that are overwhelming the "modern diet".

One of the most common causes of fatigue and muscle aching is vitamin D deficiency. About 85% of Americans have low levels of vitamin D and need supplementation. Often the vitamins C and K are also low. Ask your physician to check your blood for basic blood tests and these vitamins. Usual appropriate levels of vitamin D replacement is 4000 to 12000 units daily (Really!) This is 10 times the usual daily tab of 400 units.  When you get tested and start on replacements be sure to have follow up tests to adjust correctly.

Avoid acetaminophen and ibuprofen since they are toxic compounds.

Please include thyroid and parathyroid testing in your labs.  Since you are 55, include a PSA and testosterone level.  Have a colonoscopy since most cancers start just up the tailpipe and early detection means better cure and survival.

Most importantly, get started today! (Especially the stop smoking part!) Sign up on my website for the newsletter too.

Be Well

Sam Wise MD



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20Mar/111

Drug Resistant Bacteria

An Article Written by Dr. Wise

Drug Resistant Bacteria

One of the current questions patients ask Me quite often today Is "What about bacteria which are resistant to antibiotics?"

The media is loaded with scary stories about such bacteria these days, seemingly looking for who is to blame. I know who is to blame.

Firstly what are the concerns? Much has been raised about methacillin resistant staph aureus (MRSA) and vancomycin resistant enterococcus (VRE). By reading those sensational  articles It would  seem that these new superbugs have been purposely  created by hospitals and purposely given to the hapless for unknown malicious reasons. Rather than review actuality, hysteriae have been set forth on our country.

Nothing much has been said about multi-drug resistant tuberculosis bacteria or entero-pathogenic E Coli (EEC) which have become increasingly common.

When did you ever see a report about penicillin resistant bacteria? The last one I remember seeing was when I was in training as a medical technologist in the 1970's.

Remember that wild and crazy guy named Darwin who sailed in a boat called the beagle to some lost islands somewhere off the coast of south america to study the animals which had been trapped as individual populations on those rockpiles to change over time into distinctly different forms? His famous study of finches and  iguanas is masterful in it's scientific importance. Basically, over  time there is the survival of those forms best  suited for a specific environment. The faster the generation time, the quicker the selection process is evident. Populations of Tortoises take a longer time to adapt than quickly replicating forms like fruit flies. Even faster adaptation can occur with fast dividing lifeforms like bacteriae. It doesn't take long to exterminate the weak germs and select out the strong (resistant ) ones. Had Darwin known more about his future discovery at the time of his voyage ,He would have collected bacterial specimens also.

Tuberculosis is a bacteria which grows relatively slowly but is fairly resistant (like the sloth of the germ world). Typically , treatment with antibiotics is recommended for extended periods of time (12 months) in order to have a "curative" effect. The problem is that within a relatively short time after starting the medications to treat TB, the afflicted will feel better, move away and stop taking the antibiotics. This selects out the bacteria which are not killed by the antibiotics and they grow to cause more  infections in other exposed persons. The result of this selection are strains of tuberculosis which are almost impossible to treat. This is a major world health problem that is not properly addressed.

EEC is a major problem, driven by greed and improper livestock practices. When cattle are crowded into unnaturally confined spaces such as feedlots to be fattened up for market, they get stressed and get severe diarrhea called the scours. This makes the cattle fail to fatten up, lose weight or even die. This causes the feedlot to lose money. The answer by the industry was to load the feed up with antibiotics to prevent the scours and increase weight gain. The bovine e-coli then can become resistant to all the antibiotics given. Soon they are resistant to all know oral antibiotic families. When bacteria from the cattle's intestines get onto the meat products because of unsanitary slaughter the product is tons of hamburger full of dangerous bacteria. When that hamburger is handled non-hygeincally the cooks get sick and if not adequately cooked, those who eat the product often die.

Proper feedlot management can essentially prevent the scours without using antibiotic feeds and produce healthy fattened cattle, but not as fast . Proper slaughter techniques can minimize bacterial contamination of the meat, but is slower and less profitable. Bulk grinding of meat trimmings can produce prodigious volumes of inoculated burgers.

Greed , greed, and more greed.

Estimates of prevalence for VRE and MRSA in the united states  is roughly %50 of the population! So, if you went to the mall and cultured 100 people in a row, 1/2 of them would have MRSA . Out of that same 100 people, 1/2 would have VRE . I have no idea what percentage  of those 100 would have both, but it is known that bacteria are often very friendly to one another (even EEC to MRSA) and freely exchange genetic material called plasmids which contain drug resistance coding. That is the mechanism by which most of these resistances have spread in our population. We all have staphylococcus and enterococcus bacteria , and resistance development  is inevitable with sufficient drug exposure.

Why are there no more reports about penicillin resistant bacteria? It is because essentially all bacteria in our bodies have become resistant to penicillin since it was discovered by Alexander Fleming on September 3rd 1928. After that date , antibiotic production and distribution has reached humongous industrial proportions. Just look at the ads on TV for a clue.

We could blame it all on the father of antibiotics but please don't. Instead, why not Ask for rational policy on antibiotic usage in all areas of application from feedlots to clinics to hospitals? Please Don't take antibiotics unneeded. Have cultures taken to assure proper selection of antibiotics and effective completion of treatment. Be certain to finish your course of antibiotic treatment  properly , how many partial bottles are sitting in your medicine cabinet?

Remember that we live because of a delicate balance between that which is within and that which is outside of us all. Very Few live in a bubble.  Neglecting the rules of our ecology will result in unintended, negative consequence.

Use your brain first and Stay Healthy !

Regards

Sam Wise  MD

 

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17Mar/111

Your thoughts on Tramadol.

Ask Dr. WiseQuestion:

I checked into the use of codine for my Mother's arthritis pain and codine is not recommended for kidney disease patients. However in searching the internet, I came across a narcotic called tramadol that is recommended for kideny patients.  What are your thoughts on this drug?

Dr. Wise Answer:

Codeine has no negative kidney effects

DR. Wise

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17Mar/110

Too much Iron Pills?

Ask Dr. Wise

Question:

Dear Dr. Wise,

I couldn't give blood last week because my iron was low,by 1 pt. I am now taking Iron pills (325 ) mg's. I'm taking one a day. Is that too much and should I cut down?

Thank You very much.

DR Wise Answer:

Iron alone will not build up your blood.  Be sure to take B12 supplement, 4000 units of Vitamin D, 500 mg of vitamin C, and some protein food too!

Regards,
DR Wise

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8Mar/110

I have heard Vitamin D Is important Is this true?

Question:

I have heard Vitamin D Is important.  Is this true?

DR Wise Answer:

Vitamin D has been found to be very important and that 85% of people in the united states are deficient.  As the vitamin is better studied , many illnesses have been found to be associated with low vitamin D. The most common is "fibromyalgia"  which often is actually periostitis ( inflammation of the outer membrane of the bones ). This will gradually correct with addition of dietary vitamin D3 at 2000 to 5000 units by mouth daily. To be sure, have a blood level of  vitamin D measured .  Test for both 25-hydroxy and 1,25 dihydroxy forms of vitamin D.

Some helpful links for you to read:

 

Vitamin D: It's Not Just For Bones Anymore

http://www.youtube.com/watch?v=qpFgy8RkWO0&feature=user

25-Hydroxyvitamin D and Risk of Myocardial Infarction in Men

http://archinte.ama-assn.org/cgi/content/abstract/168/11/1174?etoc

Low vitamin D tied to depression in older people

http://www.reuters.com/article/2010/05/12/us-vitamin-d-idUSTRE64B5OQ20100512

 

DR Wise

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1Mar/110

How can I safely lose weight?

Question:

How can I safely lose weight?

DR Wise Answer:

Obesity is a major problem in the USA , even in children. Reduced activity and excessive intake of carbohydrates are major causes. This can lead to other illnesses like diabetes and heart disease.

Sugar is a strong stimulus for weight gain by causing the release of insulin.  Insulin causes the metabolism to switch to  fat building in order to save the sugar.

If you use the bucket model, losing weight can be more logical. If there are too many calories , the body saves them as fat, if there are fewer calories taken in than needed, the body uses stored fat and weight is lost.  Eat less and do more.

I counsel my patients to use low carbohydrate  protein sparing diets. A good example would be Dr Atkins diet  ( http://www.atkins.com/ )  or "the south beach diet".  A do it yourself diet would reduce starches and sugar but keep protein foods and vegetables .

Check your body mass index   http://www.nhlbisupport.com/bmi/

If your BMI is above 30 , have a full medical exam including blood testing for anemia and thyroid disease before starting a vigourous diet.

DR Wise

 

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