The Secret to Quit Smoking

Yeah, I know what you're thinking. Some of you out there believe I'm going to tout the latest prescription drug on the market. Others of you are probably thinking I'm going to talk about alternative medicine choices for smoking cessation. (Image credit)

Well, you're both wrong. The secret to stop smoking is simple -- Take A Walk! It's simple. It's natural, and has no side effects. What? Do you think I'm kidding? Do you think I'm out of my mind? (this is possible, ha) But here, I tell the truth.

Described in this Associated Press story, researchers at the University of Exter have found that as little as five minutes of exercise can help smokers quit. The research is published in the medical journal called Addiction.

[Dr. Adrian] Taylor and [his] colleagues reviewed 12 papers looking at the connection between exercise and nicotine deprivation. They focused on exercises that could be done outside a gym, such as walking and isometrics, or the flexing and tensing of muscles. According to their research, just five-minutes of exercise was often enough to help smokers overcome their immediate need for a nicotine fix.

"What's surprising is the strength of the effect," said Dr. Robert West, professor of health psychology at University College London. West was not involved in the review. "They found that the acute effects of exercise were as effective as a nicotine patch," he said.

Who would have thunk this? Exercise conquers nicotine cravings? That's an interesting idea. I wonder if it works for food cravings as well. I'll have to try this out myself. Maybe I can put my tennis shoes next to the potato chips to remind myself. Hmmmmm.....

Heat Wave

For the first time in what seems a long time, the temperature has reached close to 70 degrees around here. Yay! I guess it's finally time to wash all that salt off my car from the wintertime.

I guess I have the guy above to thank for this heat wave. I mean it is global warming that is causing this today, isn't it. Yeah right! I mean, the guy did invent the internet after all. (Sorry, these funny jabs are just satire, you know.)

Anyway, looking ahead at the weather forecast, it's supposed to get back down in the 20's with snow showers by the weekend. So, today is the day to enjoy! Maybe I can even sneak out to the muddy golf course later. We'll see.

Finally, in the ongoing saga of my sitemeter (like anyone cares), here is the latest post from the The Sitemeter Weblog:

We’ve discovered as have many of you that not all the stats categories have updated since March 3rd. We have our tech team digging into the problem. When we have the problem identified and fixed we’ll post a notice here.

s25 is still lagging heavily [that's me]. This is also being addressed.

As always, we’re doing everything we can as quickly as we can. We understand the importance of timely stats, which is why we are also working on the development of a load balanced server system. Until we complete the new backend server configuration and can migrate everyone over we are faced with the reality of trying to manage individual server problems, traffic surges, and other unforeseen issues as they develop. We appreciate your patience and understanding.

Even this message does not bother me today. Maybe I can even try to cut out of work early to enjoy what's left of the day. Pshaw! Like that'll happen. A guy can dream, can't he?

Don't forget to check out a relatively new section of the Doctor Anonymous blog: Dr. A's Video of the Day. Currently, it's at the top of my sidebar. I may change this video a few times a day, depending on what I find. But, "video of the moment" didn't sound as cool. Oh well...

The March Madness Meme

Yes, that's right, boys and girls - It's March Madness time again. Don't know what this is about? Well, it's a marketing ploy, that actually works. This refers to the annual national college basketball tournament in the USA. And, I admit that even I get caught up in the hype.

I remember back in college (Oh no! Not another college reference!). The first full day of the tournament (Thursday) is usually a national holiday on college campuses across the country. It's college basketball on TV almost from dawn to dusk (depending in which time zone you live).

Of course, you want to win the entire thing. But, for those who don't know, the last four teams in the tournament, are proud to call themselves, "The Final Four." Ah, memories. Anyway, where's the meme part, you ask? Well in re-living these memories, I thought of a meme that I think wil be interesting....

You can call this, "The March Madness Meme," or, "The Final Four Meme." Here it is: Name four colleges/universities. That's it! Isn't that simple?

It can be your Final Four teams. It can be a college or university that you went to or are going to. It can be a school you would have wanted to attend and why. This meme is pretty flexible. Without further ado, here's my list:

THE Ohio State University: My parents told me that I would flunk of school and never get into medical school if I went here. And, they were probably right. I would have loved to go there, though.

University of Notre Dame: I know Ms. Emergiblog likes this choice! I took a tour of the campus during football season there -- what a great atmosphere! What can I say, I had twelve years of Catholic school education, and I had a lot of friends going there. Oh well, I guess, was not meant to be.

University of Santo Tomas (Philippines): I don't know how good their basketball team is but this is where my father went to school. Now, that would have been interesting to see my father as a college student.

Georgetown University: I dunno why this choice. I think I just wanted to be in the movie St. Elmo's Fire. Yes, a closet Brat Pack fan. All those movies were classic 80's movies - Breakfast Club, Sixteen Candles, Pretty in Pink, etc.

That's the meme. Have fun with it. I'm wondering how many schools around the world people will name. I'm not tagging anyone. If you feel like taking up this challenge, that's great. If not, that's fine, too. Finally, GO BUCKS!

Hospitals can hear you now

Agent 86 would be proud of the following news story. Depending on your age out there in blogland, you'll understand this reference to a great television show from the 1960s.

Anyway, everytime you walk into a hospital, there's a sign at the front door saying "No cell phones." To be honest, everyday I go into my hospital, everybody from docs, to nurses, to staff, to patients, to families -- I see cell phones used all over the hospital. But, I digress...

Hospital policies across the country forbid mobile phones from being used citing possible interference with electronic equipment. A recent study done at the Mayo Clinic states that normal use of cellular phones does NOT cause interference with "patient care equipment." (Reuters)

Dr. David Hayes and colleagues said their tests suggest the ban is unmerited. They tested cell phones using two different technologies from different carriers, switching them on near 192 different medical devices. During 300 tests run over five months, they reported no trouble with the equipment.

So, I'm sure that everyone out there will now take this study to your medical executive committee and/or favorite administrator to get this cell phone ban lifted, right? Sure, I'll get right on that.

Something interesting, as a kind of unintended consequence of all this, is the use of camera phones within the hospital. I'm not so concerned about the phone part as I am the camera part.

I know what you're thinking, "Well, Dr. A, what do hospitals have to hide?" That's not it. I've talked about the litigious society that we live in now. And, people (especially the press) like to take things out of context.

I'm not just talking about taking images of docs, but any person in the hospital who cares for patients - like nurses, aides, physical therapy, techs, dietary - and the list goes on. What would be the full implications if camera phones were actually permitted in hospitals?

The bottom line is this. As far as their use in the hospital, cellular phones have as much chance of interfering with hospital equipment as they do of interfering with airplane equipment on takeoff and landing. HA! Can you hear me now? YES!

Sitemeter woes

Does anyone remember this movie? I distinctly remember this movie because it was right around the time I started college. And, a bunch of us pre-med nerds bought tickets the weekend it opened.

Personally, I wanted to see Julia Roberts as a medical student (How You Doin?) and dreamed of her being in my future med school class (Ahhhhhh....). For those who haven't seen the movie, in a word, it was, "Eh..." Not great, but not bad either. Remember, this was a few years before television's ER and the current string of hit medical TV shows.

Anyway, what's this have to do with sitemeter? Probably absolutely nothing! But, this week, I've been pulling out my hair because my sitemeter has shown ZERO (meaning flatline) for days. I thought that I was doing something wrong. Or, would this be my first complaint using the new blogger?

However, in doing some research on this, I find that the problem is on the end of sitemeter and not me and not blogger. Whew! That's a relief. Here's the quote from the sitemeter blog:

s25 - Update
We are aware of delays and lag on s25 and are doing are best to resolve it. In this case we had a particular site that has been running a promotion, nearly quadrupling their traffic. We’re working on relocation this site to another server. We expect to see the lag dissipate over the weekend. Thanks, The Sitemeter Team

That makes me feel better. I was getting concerned when I kept seeing a big fat ZERO on my stats and seeing this sentence, "The statistics for visitors from the last 3896 minutes are not yet available." I wonder how big that number will get until the problem is fixed. We'll see....

The Myth of Morning Coffee

You might want to sit down for this caffeine story. No, this is not about the entrepreneur in India who is trying to steal the name of Starbucks for his own chain of coffee shops. This is a serious story! LOL.

Question: How many people out there in blogland swear by their first cup of coffee in the morning? You absolutely cannot live without your first cup of coffee (or cappuccino or espresso or latte or whatever). For me, my caffeine of choice is above.

Researchers at the University of Bristol are reporting that coffee does NOT boost you in the morning. (BBC News) Actually, coffee in the morning helps ease caffeine withdrawl symptoms. Withdrawl? Coffee is a drug? Pshaw!

Professor Peter Rogers, a biological psychologist who led the research, told the BBC: "We do feel a boost from caffeine in the morning, but that's probably due to a reversal of the withdrawal symptoms. That alertness you feel is you getting back to normal, rather than to an above normal level.

First off, a "biological psychologist?" What's up with that? Second, what you feel is "getting back to normal?" What's normal? Call me in denial, but I believe that this study is complete bunk. Caffeine rules! Long live Diet Coke and caffeine. I'm with the pro-coffee activist group on this one.

Zoe Wheeldon, of the British Coffee Association, said the research was interesting. But she added: "There are two sides to the debate and a wealth of scientific evidence suggests that moderate coffee consumption of four to five cups per day is perfectly safe for the general population and does have a beneficial effect on alertness and performance even in regular coffee drinkers."

Yeah! You tell 'em, Zoe. Finally, there are other people out there who see a different use of caffeine - Specifically the combination of Diet Coke, Mentos, and David Letterman.

I Won the Mega Millions Jackpot!

Cha-Ching, baby! I'm on easy street. I'm quitting my job and moving to Hawaii to live my dream of becoming a Magnum P.I. wannabe! Gimme a Ferrari. Gimme a private jet. Gimme my own Dr. A private golf course. Yes!

Actually, not. To be honest, I didn't even play. There was a huge collection at the office today. Sometimes, I wonder, what if the office staff did win? Would everyone quit their jobs tomorrow? Maybe for a piece of the record $370 million dollars, they would. Who knows?

I always remember those stories about a group from work somewhere who hit it big, only to just spend it all. Or, the greed degenerates into eventual lawsuits among "friends." Or, the winners being driven into solitude because the winner's private life disappears. You never know who comes out of the woodwork to claim that they are your relative and/or friend, "Where's my piece of your $370 million!"

So, the waiting game begins. With a record jackpot like this, it's unlikely that it will be one person. It's usually a group of co-workers who grouped their money together to buy a bazillion tickets. These people will become instantly famous, and we'll see how they handle their fame and fortune.

Charmed Heart

Too often, we hear about climbers who are lost as they try to reach the top of a mountain somewhere. Here's a story where a climber not only found the summit, but also is living out a dream.

Last week, this AP story reported that Kelly Perkins and her husband Craig, recently scaled a peak in the Andes mountains. Her other conquests include the Matterhorn, Mount Fuji and Mount Kilimanjaro. What's so unusual about these feats? She did it with another person's heart beating in her chest.

Perkins grew up around Lake Tahoe, Calif., acquiring a love for the outdoors that led to annual backpacking trips with friends. Her zeal for mountain trekking and climbing only increased after her transplant on Nov. 20, 1995. Any fears about stressing her new heart were overwhelmed by a desire to rebuild her strength.

Some 3 1/2 years earlier, she had been diagnosed with cardiomyopathy — a disease in which heart muscle becomes inflamed — which doctors blamed on a virus. For more than three years, she and her husband shuttled in and out of hospitals seeking a donor heart.

I was also able to find their website simply titled craigandkelly.com. The site shares the stories about their climbs and has amazing pictures, like the one above. Let tell you, this is very inspirational stuff.

The Andes adventure was all free climbing, using ropes and protective gear only for safety's sake as she moved up the rock under her own power, using only hands and feet to find natural holds in the crevices of the rock.

She dubbed the route the "Charmed Heart" as she led her team up one of several unnamed peaks in the remote Cajon de Arenales region near Argentina's border with Chile, more than 650 miles west of Buenos Aires.

Craig Perkins, who has given his wife a gold charm for every major mountain climbed since her transplant, gave her another atop the "Charmed Heart" route — this one of a woman mountaineer leaping for a peak and grabbing it by one hand. A tiny sparkling ruby represents her heart.

Thanks Kelly and Craig for sharing your story. I know a lot of my patients and friends who will love to hear your story. Keep climbing as many mountains as you can! I'm glad that you didn't let anyone or anything get in the way of your dream.

What flu epidemic?

"Hey Doc, how's that flu thing going on this time of year," a patient asked me this week. "I mean, you practically made me get a flu shot last fall," he continued in a joking manner. I smiled (kind of).

The press really hasn't said anything about the human flu season. There are countless stories about bird flu, like, how it's in other parts of the world, or, how the United States is no way near ready for a bird flu pandemic.

So, being curious, I checked out the CDC (human) flu website. In case you didn't know, they have a week by week report during the flu season. And, I was surprised from their latest data which is from the week of February 17.

From a epidemiology standpoint, stating there is an "epidemic" occurring is misleading (but makes for a great post title). A small map is above, and in the nation's midsection, where the color is red, there is "widespread" influenza occurring. Here is the summary from the CDC flu website:

During week 7 (February 11 - February 17, 2007), influenza activity continued to increase in the United States... Twenty-four states reported widespread influenza activity; 14 states and New York City reported regional influenza activity; 10 states and the District of Columbia reported local influenza activity; and two states reported sporadic influenza activity. The reporting of widespread or regional influenza activity increased from 33 states for week 6 to 38 states for week 7. The percent of deaths due to pneumonia and influenza remained below baseline level.

The last sentence above is probably why there has been no press coverage on this story, yet. My state is in the "local activity" category, but almost surrounded by the widespread states. So, we'll have to see what happens.

My prediction is that when and if the "weather" story starts to be less newsworthy, then the press will start to pick up on the "widespread flu" story. By the way, as I tell all my patients, it's never too late to get that flu shot. That is, if you can still find one in March.

Pain Management Dilemma

The Washington Post came out with an article on Tuesday with the attention grabbing headline, "Doctors Warned About Common Drugs For Pain: NSAIDS Tied To Risk Of Heart Attack And Stroke." The American Heart Association came out with a statement discouraging use of Cox-2 inhibitors because of it's association with heart attacks and stroke.

"In the past, many physicians would prescribe the Cox-2 drugs first," said Elliott Antman, a professor at Harvard Medical School who led a group of experts assembled by the heart association to study the issue. "We are specifically recommending that they should be used as a last resort."

"This is a very firm statement we are making," he added. "It is our belief, hope and desire that physicians will take our advice, and by doing so it is our belief and hope that we will reduce the number of patients who suffer heart attacks and strokes."

Now, I have no problem with this. My patients have been scared off from these drugs with all the press coverage that has been surrounding these drugs, that the mere mention of these drugs during an office appointment sends the patient running away.

Here's where I start to have a problem with the AHA statement....

Patients should be treated first with nonmedicinal measures such as physical therapy, hot or cold packs, exercise, weight loss, and orthotics before doctors even consider medication, said the AHA scientific statement published in the journal Circulation.

Patients who get no relief after those measures have been exhausted can be considered for drug therapy, but doctors should try drugs only in a certain order, the statement said:

"In general, the least risky medication should be tried first, with escalation only if the first medication is ineffective. In practice, this usually means starting with acetaminophen or aspirin at the lowest efficacious dose, especially for short-term needs."

While most patients are likely to be helped by those drugs, a smaller number may need to try a drug such as naproxen. Patients who require additional help should be given other nonprescription painkillers such as ibuprofen, and only after that option has been exhausted should physicians consider Cox-2 inhibitors, Antman said in an interview.

I can tell you as a primary care physician, most of our patients already do the non medication therapies even before seeing me. In addition, they have already tried a number of over the counter antiinflamatory therapies. When they come to me, they are usually looking for the next step up in therapy. Then, when I introduce the idea of the Cox-2 inhibitor, they balk. So, now what? Hold that thought....

In doing more research on this topic, I ran into an article entitled, "The Poor Management of Pain." It talks about how physicians do a poor job at managing chronic pain, especially with the reluctance in using opioid/narcotic medicines.

It is seemingly a no-win situation. On the one hand, the more you treat pain with opioids, the more likely you will be investigated by state or federal authorities. But, on the other hand, the less you treat pain with opioids, the greater your chances of being sued for civil damages on the grounds of undertreatment.

“Lawyers are lining up right now...looking for cases of poor pain management,” according to remarks given by Bill McCarberg, MD, director of the Chronic Pain Management Program at Kaiser Permanente in San Diego and an assistant clinical professor at the University of California, San Diego, who also serves on the board of the American Pain Society. “Whenever you encounter litigation against doctors for pain management, it is never because...we do not allow the patient to get a muscle relaxant...It is always about opioid management. We get sued because we’re not using opioids.”

So, on a daily basis, I'm constantly challenged on how to adequately treat my patient's pain. On the one hand, there are antiinflamatory medications which have the dangers of heart attack and stroke - News Headline: Doctors Warned About Common Drugs For Pain. On the other hand, there is the use of narcotic pain mediciations which have the dangers of addiction and tolerance - News Headline: Doctors Do A Poor Job At Pain Management. I apologize for the whining, but sometimes all this stuff really makes my head spin.