If you have a medical problem, or something is bothering you or a member of your family, The Jackson County Times now has a local physician, Dr. John Spence, of the Panhandle Family Care Associates available to respond to your questions via e-mail.
Anyone who knows me intimately, and many of those who don’t, are aware that I am a basketball junkie. I have followed college hoops for longer than I can remember and have been a fan of the Duke Blue Devils for longer than that. March Madness marks the one time of year in my life where everything else takes a back-seat. Akin to a religious zealot, I watch games with a frenzied passion rivaled only by the face-painted lunacy of the Cameron Crazies. As the first round of the NCAA Men’s Basketball has come to a close, one thing is certain. Uncertainty. Witness the ascension of teams like St.Mary’s, Cornell, and Northern Iowa to the Sweet 16. There is predictability in the unpredictability of the tournament. An astute reader at this point (perhaps bored to tears) may ask, what does this have to with medicine. You are a physician, not a sports journalist!
The comparisons between March Madness and medicine are blatantly obvious and unnerving. Regardless of what we think it going on with a patient, regardless of what a lab may tell us – there is always a degree of inherent uncertainty that exists in medicine. The ever changing medical landscape never ceases to amaze me. For example, a recent journal article suggested that vitamin D supplementation may actually be DETRIMENTAL as it may cause increased calcium deposits in blood vessels. The same journal reported that lowering blood sugars in diabetics to less than 165 on average resulted in increased mortality. This was a reputable journal, by the way, not just some wayward information I pulled off wikipedia. This is counterintuitive to everything we recognize to be true! Is there any validity to these studies? Only time will tell.
A professor and mentor of mine once stated that 50% of what he had learned in medical school and residency was obsolete only 15 years later. Now, I hold him in high regard as a scholar, and it has nothing to do with the fact he graduated from Duke University School of Medicine. His jump shot may be horrific, but he knows medicine. This is a scary proposition – perhaps a large part of what we are doing academically is flawed. I can relate the stories of dozens and dozens of patients who either defied the odds, beat the statistics, or had remarkable, miraculous recoveries where none were expected. What does this tell me? There is always uncertainty. This is certain. Sound familiar?
There is predictability in the unpredictability of life, medicine and the NCAA basketball tourney. In medicine, we use trends, clinical experience, education, and clinical research to dictate our treatment plans. Sometimes we “go with our gut”. We generally do a good job, but there is always that potential margin of error that must be accounted for. The same is true in hoops. I don’t care how many games you watch, how many statistics you analyze or how much of an inside scoop you think you may have.
No one in their right mind could have predicted that Northern Iowa would beat Kansas. If you did, there are only one of two explanations. You know nothing about college hoops or you live in Northern Iowa. Which is why I picked Kansas!
Do you have any medical questions or concerns that you would like addresses? You can contact Dr. Spence by email at panhandledailydose@hotmail.com or by mailing your question to Daily Dose, P.O. Box 6107, Marianna, FL 32446.
Imma Akin
Dear Dr. Spence,
I have been unable to tolerate any of the statin medications like lipitor or zocor due to muscle pain. Is there any alternative? My bad cholesterol is through the roof.
Signed,
Imma Akin
Dear Imma,
A recent study performed at the University of Pennsylvania has shown that red yeast rice therapy performs similarly to pravastatin (pravachol) in head to head trials. They randomized 43 patients who had previously been unable to take statins due to muscle pain, to either red yeast rice or pravastatin. The lowering of LDL (bad cholesterol) was 27% in the statin group and 30% in the red yeast rice group proving that the alternative therapy was just as effective. Though muscle pain was still a possibility, it was half of what was seen with the pravastatin.
Red yeast rice is made by fermenting polished rice with strains of a particular yeast. It has been a staple of Asian culture and medicine for centuries. Its actions are similar to prescription drugs in that they lower cholesterol by inhibiting a key step in cholesterol production in the liver. Not all practitioners have adopted the use of red yeast rice due to lack of knowledge about the product and the general lack of FDA regulation of the various preparations.
A Chinese analysis from 2006 examined 93 separate trials that involved nearly 10,000 patients. It showed that not only can red yeast rice lower LDL cholesterol as effectively as some statins, it also appeared to increase HDL (good cholesterol) and improve triglycerides. Most importantly, red yeast rice seemed to be extremely well tolerated.
Given that so many people suffer muscle pain as a result of being given statin medication, it seems only natural to look for alternative sources of cholesterol lowering. Red yeast rice is a low cost option for those in need of additional help. The remaining question is – does it provide any true protection against heart attack, stroke, or death? This, unfortunately, is less clear. Medications like zetia have fallen out of favor despite their ability to lower LDL, as they have not proven to decrease death rates. Future studies may elucidate the positive effect that red yeast rice has. Until that time, we have to simply rely on the data at hand.
In your case, I think that red yeast rice would be a great option. Other options include fish oil, flaxseed oil, red wine, and garlic (among others). They all work to a lesser degree but they may be more tolerable. Remember! According to statistics, a decrease of 2 mg/dl in LDL represents a 1% risk reduction in heart disease, so every little bit counts.
Do you have any medical questions or concerns that you would like addresses? You can contact Dr. Spence by email at panhandledailydose@hotmail.com or by mailing your question to Daily Dose, P.O. Box 6107, Marianna, FL 32446.
I have been unable to tolerate any of the statin medications like lipitor or zocor due to muscle pain. Is there any alternative? My bad cholesterol is through the roof.
Signed,
Imma Akin
Dear Imma,
A recent study performed at the University of Pennsylvania has shown that red yeast rice therapy performs similarly to pravastatin (pravachol) in head to head trials. They randomized 43 patients who had previously been unable to take statins due to muscle pain, to either red yeast rice or pravastatin. The lowering of LDL (bad cholesterol) was 27% in the statin group and 30% in the red yeast rice group proving that the alternative therapy was just as effective. Though muscle pain was still a possibility, it was half of what was seen with the pravastatin.
Red yeast rice is made by fermenting polished rice with strains of a particular yeast. It has been a staple of Asian culture and medicine for centuries. Its actions are similar to prescription drugs in that they lower cholesterol by inhibiting a key step in cholesterol production in the liver. Not all practitioners have adopted the use of red yeast rice due to lack of knowledge about the product and the general lack of FDA regulation of the various preparations.
A Chinese analysis from 2006 examined 93 separate trials that involved nearly 10,000 patients. It showed that not only can red yeast rice lower LDL cholesterol as effectively as some statins, it also appeared to increase HDL (good cholesterol) and improve triglycerides. Most importantly, red yeast rice seemed to be extremely well tolerated.
Given that so many people suffer muscle pain as a result of being given statin medication, it seems only natural to look for alternative sources of cholesterol lowering. Red yeast rice is a low cost option for those in need of additional help. The remaining question is – does it provide any true protection against heart attack, stroke, or death? This, unfortunately, is less clear. Medications like zetia have fallen out of favor despite their ability to lower LDL, as they have not proven to decrease death rates. Future studies may elucidate the positive effect that red yeast rice has. Until that time, we have to simply rely on the data at hand.
In your case, I think that red yeast rice would be a great option. Other options include fish oil, flaxseed oil, red wine, and garlic (among others). They all work to a lesser degree but they may be more tolerable. Remember! According to statistics, a decrease of 2 mg/dl in LDL represents a 1% risk reduction in heart disease, so every little bit counts.
Do you have any medical questions or concerns that you would like addresses? You can contact Dr. Spence by email at panhandledailydose@hotmail.com or by mailing your question to Daily Dose, P.O. Box 6107, Marianna, FL 32446.
Mediterranean diet
The Daily Dose
I have frequently been known to extol the virtues of the Mediterranean diet, not just for its potential weight loss effects, but also due to its inherent abilities to slow or prevent the progression of cardiovascular disease. What makes the diet so beneficial? Obviously, the diet is rich in vegetables, fruits, whole grains, fish, wine and lean meats. We presumed that it was the abundance of omega-3 fatty acids that reduced heart risk. Newer research, however, points to one of the diets major components – olive oil; specifically olive oil compounds known collectively as olive oil polyphenols. Further, combinations of olive oil polyphenols, omega-3 fatty acids and resveratrol (found in red wine) may reduce the incidence of neurological disease, age-related bone disorders, and even cancer.
Most notable is the cardiovascular benefits derived from the olive oil polyphenols. They are all capable of increasing the HDL (good cholesterol) while lowering triglycerides and LDL values (bad cholesterol). One study demonstrated significant drops in these numbers with use of only 0.84 fluid ounces per day for three weeks. In combination with the omega-3 fatty acids found in fish, there was dramatic decrease in inflammation within blood vessels, thus theoretically decreasing overall cardiovascular disease. Another study (granted, it was done in filthy rats!) revealed a decrease in plaque formation at the aorta by 54%. Not bad even for vermin.
There is mounting evidence that olive oil polyphenols may work as well as aspirin for those at risk of heart attack or stroke. It has anti-clotting and anti-inflammatory properties similar to that of aspirin without the same potential to burn a hole in your stomach. According to the British Journal of Nutrition, hydroxytyrosol acetate from olive oil inhibits the synthesis of the body’s natural clotting factors.
There is ample data to suggest that the Mediterranean diet can help confer some benefit against certain cancers. It is felt that the mechanism revolves around the suppression of fatty acid synthase, an enzyme responsible for converting carbohydrates into fat in the body. Compounds like olive oil that block this enzyme have been shown to induce anti-cancer effects. Olive oil polyphenols may also inhibit the growth of cancer cells, especially in colorectal cancers, a leading cause of cancer death in this country.
Can something so simple and easy to purchase be this beneficial? It would appear so. Olive oils, while rich in heart-healthy monounsaturated fats, also provide valuable polyphenols which may be the true reason for the successes of the Mediterranean diet. When combined with the other components of the diet, it is hard to argue for a more complete regimen. After all, we truly are what we eat.
Do you have any medical questions or concerns that you would like addresses? You can contact Dr. Spence by email at panhandledailydose@hotmail.com or by mailing your question to Daily Dose, P.O. Box 6107, Marianna, FL 32446.
I have frequently been known to extol the virtues of the Mediterranean diet, not just for its potential weight loss effects, but also due to its inherent abilities to slow or prevent the progression of cardiovascular disease. What makes the diet so beneficial? Obviously, the diet is rich in vegetables, fruits, whole grains, fish, wine and lean meats. We presumed that it was the abundance of omega-3 fatty acids that reduced heart risk. Newer research, however, points to one of the diets major components – olive oil; specifically olive oil compounds known collectively as olive oil polyphenols. Further, combinations of olive oil polyphenols, omega-3 fatty acids and resveratrol (found in red wine) may reduce the incidence of neurological disease, age-related bone disorders, and even cancer.
Most notable is the cardiovascular benefits derived from the olive oil polyphenols. They are all capable of increasing the HDL (good cholesterol) while lowering triglycerides and LDL values (bad cholesterol). One study demonstrated significant drops in these numbers with use of only 0.84 fluid ounces per day for three weeks. In combination with the omega-3 fatty acids found in fish, there was dramatic decrease in inflammation within blood vessels, thus theoretically decreasing overall cardiovascular disease. Another study (granted, it was done in filthy rats!) revealed a decrease in plaque formation at the aorta by 54%. Not bad even for vermin.
There is mounting evidence that olive oil polyphenols may work as well as aspirin for those at risk of heart attack or stroke. It has anti-clotting and anti-inflammatory properties similar to that of aspirin without the same potential to burn a hole in your stomach. According to the British Journal of Nutrition, hydroxytyrosol acetate from olive oil inhibits the synthesis of the body’s natural clotting factors.
There is ample data to suggest that the Mediterranean diet can help confer some benefit against certain cancers. It is felt that the mechanism revolves around the suppression of fatty acid synthase, an enzyme responsible for converting carbohydrates into fat in the body. Compounds like olive oil that block this enzyme have been shown to induce anti-cancer effects. Olive oil polyphenols may also inhibit the growth of cancer cells, especially in colorectal cancers, a leading cause of cancer death in this country.
Can something so simple and easy to purchase be this beneficial? It would appear so. Olive oils, while rich in heart-healthy monounsaturated fats, also provide valuable polyphenols which may be the true reason for the successes of the Mediterranean diet. When combined with the other components of the diet, it is hard to argue for a more complete regimen. After all, we truly are what we eat.
Do you have any medical questions or concerns that you would like addresses? You can contact Dr. Spence by email at panhandledailydose@hotmail.com or by mailing your question to Daily Dose, P.O. Box 6107, Marianna, FL 32446.
Mammography Arguments
If you have a medical problem, or something is bothering you or a member of your family, The Jackson County Times now has a local physician, Dr. John Spence, of the Panhandle Family Care Associates available to respond to your questions via e-mail.
Mammography Arguments
Another new year is upon us and like so many times before, controversy rears its ugly head. The most recent head scratcher involves the changes in mammogram screening recommendations as proposed by the United States Preventative Services Task Force (USPTF). This panel of doctors and scientists recently concluded that most women in their 40’s do not need mammograms and should wait until their 50’s to get one on a biannual basis. Furthermore, they suggest that breast self-exams are not effective. This is in staunch opposition to the recommendations enforced by the American Cancer Society which has set the standard for screenings – mammogram every year after age 40 and possibly a baseline for those deemed “high risk”. So where does this leave us, outside of confused?
The logic behind the newer recommendations is based on data suggesting that mammography more often than not leads to false positives and unnecessary biopsies without much improvement in women’s survival. False positives are a substantial source of anxiety for affected women. But what about those who have found lumps and subsequently have been treated for breast cancer? Most of these women stand by the previous recommendations and are less likely to be swayed.
Based on pure numbers, roughly 1300 women in their 50’s would have to be screened to prevent one death as opposed to 1900 women in their 40’s. What the USPTF is telling us is that mammography does save lives, but not enough of them. It stands to reason that they believe that screening is a burden to the healthcare system and additional screening is inherently too costly.
I have had women within my own practice that have found a suspicious lump through their own monthly self-checks. They underwent eventual biopsy and surgical intervention at an early stage. I believe that their diligence in monitoring may have saved them from a more aggressive, undetected cancer at a later stage. Tell that same woman that self-exams are useless and see what kind of response you’ll get. I can assure you that it won’t be pretty.
Regardless of which side of the fence you lay on, we may see a trend towards reduced insurance coverage for mammograms in 40 year old females. I will not let the USPTF guidelines change my approach at this time. I still think there is good science behind mammogram screenings. At this time, we do not have a better, more cost effective means to detect breast cancer. Until we do, I’ll be quite happy doing what I’m doing!
Mammography Arguments
Another new year is upon us and like so many times before, controversy rears its ugly head. The most recent head scratcher involves the changes in mammogram screening recommendations as proposed by the United States Preventative Services Task Force (USPTF). This panel of doctors and scientists recently concluded that most women in their 40’s do not need mammograms and should wait until their 50’s to get one on a biannual basis. Furthermore, they suggest that breast self-exams are not effective. This is in staunch opposition to the recommendations enforced by the American Cancer Society which has set the standard for screenings – mammogram every year after age 40 and possibly a baseline for those deemed “high risk”. So where does this leave us, outside of confused?
The logic behind the newer recommendations is based on data suggesting that mammography more often than not leads to false positives and unnecessary biopsies without much improvement in women’s survival. False positives are a substantial source of anxiety for affected women. But what about those who have found lumps and subsequently have been treated for breast cancer? Most of these women stand by the previous recommendations and are less likely to be swayed.
Based on pure numbers, roughly 1300 women in their 50’s would have to be screened to prevent one death as opposed to 1900 women in their 40’s. What the USPTF is telling us is that mammography does save lives, but not enough of them. It stands to reason that they believe that screening is a burden to the healthcare system and additional screening is inherently too costly.
I have had women within my own practice that have found a suspicious lump through their own monthly self-checks. They underwent eventual biopsy and surgical intervention at an early stage. I believe that their diligence in monitoring may have saved them from a more aggressive, undetected cancer at a later stage. Tell that same woman that self-exams are useless and see what kind of response you’ll get. I can assure you that it won’t be pretty.
Regardless of which side of the fence you lay on, we may see a trend towards reduced insurance coverage for mammograms in 40 year old females. I will not let the USPTF guidelines change my approach at this time. I still think there is good science behind mammogram screenings. At this time, we do not have a better, more cost effective means to detect breast cancer. Until we do, I’ll be quite happy doing what I’m doing!
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