Dr. Iliff’s 2014 Practice Newsletter/Rant
23 1/2 Hours: I'm putting this first--again, in 2014-- because if you don't do anything else as a result of picking up this letter, do this: Go to doctoriliff.com, and at the bottom of the page you'll see PLEASE WATCH NOW!!! in red letters. Follow those instructions carefully. Once you've mastered the secret instructions included in that decoded message, Google The Simple 7. Then take the assessment. You've already mastered one of the 7-- the most important-- after putting 23 1/2 hours into practice. Only 6 more to go!
Pain Relief Without Narcotics: Start with extended-release acetaminophen 650 mg (Tylenol Arthritis), 2 pills every 8 hours. Then, as long as you aren't diabetic or suffering kidney disease, add ibuprofen 200 mg (Advil), 3 pills every 8 hours. You can take both drugs at the same time. That will handle almost all acute and chronic pain. Next stop: tramadol 50 mg (prescription) every 8 hours.
The Power of Suggestion: All of you have heard about placebos, or sugar pills. When I am evaluating a drug, the manufacturer will always provide information about the effectiveness of the medication compared to a placebo. Neither the patients not the scientists know whether they are using the real stuff. The amazing thing is that the placebo always has a beneficial effect, although not as much as the medication (if the effects aren’t statistically different, the FDA would not approve the drug). No one knows why this happens so consistently, but it does. Same thing with side-effects. I can see the bad things that were reported (muscle pain, diarrhea, headache, etc.) with the drug and the sugar pill. Usually there’s not much difference. When you watch an ad on TV, and they list all the complications of the medicine, you might be tempted to freak out-- because they usually don’t tell you that the sugar pill “caused” all those complications, too. It’s my job to tell you about complications which occur significantly more often on the real drug. I deliberately don’t tell you all the other stuff, because I don’t want to trigger “placebo” side-effects. But wait-- things get even weirder: researchers in Finland did placebo surgeries to remove torn knee cartilage. That’s right-- half the patients got anesthesia and had scopes inserted in their knees, but nothing was removed. Guess what? The patients who got the real surgery felt a little better immediately afterward, but there was no difference in one year. We’re going to see a lot more studies like this done to evaluate popular surgeries. There will be surprises.
Tired of Busy Signals at Our Office? Me, too. Here’s a big time-waster for nurses on the phone: Calling in 30 day prescriptions for patients who run out of medicine before making an appointment to get more.
Want to Reduce Allergies, Asthma, and Infections in Childhood? Get a dog. Give your baby peanut butter at 6 months. Let your kids play in the dirt. Leave the hand sanitizer at home. Throw a chickenpox party-- wait, the vaccine has eliminated chickenpox! But you get the idea. It’s called the hygiene hypothesis, and it’s getting closer to becoming a fact as research accumulates. We have way more bacterial cells than body cells. A large part of our DNA is viral in origin. We live, folks, in a sea of disease, and the best defense is NOT to raise your kid in a germ-free bubble. What I want for my kids, and grandkids, and patients is a robust, vigorous, well-exercised immune system. I want antibodies against everything that’s bad. You don’t get that from being a hypochondriac, just like you don’t get a good football team by watching replays of the Super Bowl. Your immune system needs practice, and that comes from exposure. The enemy is over-protection. Worried about all those shots for babies? A kid gets more exposure to antigens every day than all of those shots put together. A little knowledge, and a healthy imagination, and exposure to nuts on the Internet is a dangerous thing. Get the shots, and be thankful! I am! I used to do 2 or 3 spinal taps every year on youngsters, because I was worried about meningitis. I haven’t seen a case of meningitis in over a decade. Same thing for adults. Get every immunization you’re offered, including the flu shot every year. No, the flu shot didn’t give you the flu. That was a coincidence. You got it from the snotty little kid next to you in the supermarket line. Meanwhile, young adults are dying of H1N1 in Topeka this winter.
Help From Apps: Serious about diet and exercise? MyFitnessPal. Trouble remembering to take your pills? MedicineCabinet. Shopping with cash for the cheapest drugs at local pharmacies? GoodRx. Help with training plans? RunKeeper. (Thanks to patients for these useful tips!) Menstrual hassles, need help getting pregnant? MyDays.
While We’re on the Subject of Protecting Children, let’s talk about the real threat to their well-being in 2014. They are way over-exposed to electronic devices. Is that related to the rise in autism and attention-deficit disorder? The jury’s still out, but consider this: children ages 8 to 18 spent an average of 7 hours and 38 minutes a day consuming media for fun, including TV, music, videogames and other content in 2009, according to a 2010 report from the Kaiser Family Foundation. The report was based on a survey of 2,002 third- through 12th-graders, 702 of whom completed a seven-day media use diary. That was up about an hour and 17 minutes a day from five years earlier. About two-thirds of 8- to 18-year-olds said they had no rules on the amount of time they spent watching TV, playing videogames or using the computer, the Kaiser report found. Use of mobile devices by young kids has soared. A new report from Common Sense Media, a child-advocacy group based in San Francisco, found that 17% of children 8 and younger use mobile devices daily, up from 8% in 2011. Folks, there is no reason for little kids to have a mobile computer. Excessive media use is associated with obesity, poor school performance, aggression and lack of sleep. New guidelines from the American Academy of Pediatrics emphasize that families should have a no-device rule during meals and after bedtime. Parents should also set family rules covering the use of the Internet and social media and cellphones and texting, including which sites can be visited, who can be called and giving parental access to Facebook accounts. The policy also reiterated the AAP's existing recommendations: Kids should limit the amount of screen time for entertainment to less than two hours per day; children younger than 2 shouldn't have any TV or Internet exposure. Televisions and Internet-accessible devices should be kept out of kids' bedrooms. Do I need to mention the problem of texting while operating a motor vehicle? Or sexting with a boyfriend? There are tools to help parents monitor use of mobile devices by their adolescents: My Mobile Watchdog, Mobile Spy and Net Nanny Mobile, to mention just a few. Yeah, they’ll whine and roll their eyes, but you’re paid to be the adult. And for youngsters, Just Say No.
Let’s Talk About Diet Pop:why you worry about this is beyond me, but lots of you ask. So here’s the deal. The chemicals are harmless. They don’t cause cancer, and they don’t cause weight gain. That’s why we call it “diet” pop; one can of sugared pop a day is 13 pounds of fat every year, and most of you don’t need more fat. Yes, it’s true: if you leave a tooth in a glass of pop, it will eventually dissolve. So will marble. The key is to not hold the pop in your mouth all day. Just swallow it. Then don’t brush your teeth for a while, until your saliva has neutralized the acid. Immediate, compulsive brushing CAN etch your teeth. Same thing for wine, unless you’re having wine and cheese. The cheese counterbalances the acidity of the wine.
Feverphobia: The reason we treat fever is that we all feel miserable when we're running one. But we're not helping our immune system get us well. Rats who are deprived of the ability to generate a fever die more quickly of infections; recent research suggests that ibuprofen and acetaminophen may raise the number of flu cases and deaths by 5%. Parents, take note. Up to 103 or so, let it go.
Uh-oh. Fatty Liver Disease Hits Children: A type of liver disease once thought to afflict primarily adult alcoholics appears to be rampant in children-- more than 7 million are thought to have the disease, according to recent studies. The condition, in which the normally rust-colored organ becomes bloated and discolored by yellowish fat cells, has become so common in non-drinkers that it has been dubbed nonalcoholic fatty liver disease. The disease's prevalence is alarming doctors who worry about its progression to nonalcoholic steatohepatitis, or NASH, when the fatty liver becomes inflamed and cells are damaged. That leads to the end stage of cirrhosis, when the liver forms scar tissue and ultimately stops working. Reminder to parents: you're the parent. If your child is overweight, it's your fault. There are lots of things that go wrong with kids that we can't do much about. This isn't one of them.
Your Mother Was Right About a Good Breakfast: Skipping breakfast and overeating in the evening have been shown to play a significant role in weight gain and obesity. A study in the journal Obesity found that consuming the heaviest meal of the day at breakfast and the lightest at dinner can lead to significant weight loss. On a 1400 calorie diet, obese women who ate half their calories at breakfast lost 19 pounds in 3 months, compared to 8 pounds for those who ate half their calories at dinner. Furthermore, HDL (good) cholesterol only increased in the big-breakfast group. The absolute worst time to eat: before bedtime.
Men and Women Diet Differently. Everybody knows that. Women enjoy obsessing about the ins and outs of nutrition; men just want a simple “eat this, avoid that.” Women will often join a support group; men wouldn't be caught dead at overeaters anonymous. One recent diet that appeals to some men is the “fast diet,” known as the “bloke's diet” in England. It entails eating normally on weekdays, then dropping to 500 calories per day on the weekend. If that appeals to you (or your husband), go for it. I'm not a fan of fad diets-- the devil is in going back to business as usual-- but, oh well.
ObamaCare Has Arrived, and I can't tell much difference in my practice. Many of you have asked what's going to happen nationally, and I don't have a clue. Here's the deal: there will be downward pressure on costs if hospitals start getting paid for all the uninsured care they provide, and upward pressure on taxes and insurance when we all have to start paying for it. Which will be greater is anybody's guess at this time, but we'll have an idea by 2015. As I've been saying and writing for 15 years, the best policy would be a high-deductible health plan attached to a health savings account for everyone. You can get one of those with a “bronze” plan under ObamaCare. The HSA encourages everyone to be responsible for your own health (half of health costs are due to lifestyle), and to shop wisely when necessary.
Latest on Supplements: Fish oil is out, according to latest research. No, wait! It’s back in. Multivits are out. Vitamin E is back, if you’ve got early dementia. Extra calcium is out. Now it’s back. Now it’s out again. Oh, shoot. I’m not paying attention any more. Do what you like. But statins for high cholesterol? Recommendations are for more aggressive usage, like I’ve been doing.