Dr. Iliff’s 2015 Practice Newsletter/Rant

23 1/2 Hours: I'm putting this first--again, in 2015-- 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.

Avoiding the Common Cold:  Get a flu shot.  Exercise every day.  Take 2 grams of Vitamin C and a probiotic daily.  Get at least 7 1/2 hours of sleep every night.  Wash your hands.  Don’t avoid sick people.  I’ve been doing all those things except the probiotic, and haven’t missed a day of work in two decades. 

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

Orthorexia Nervosa: The condition where patients have stopped eating so many "dangerous" foods that they are starving.  Found concentrated between Marina del Mar and Malibu, along with susceptibility to measles caused by Immunization Nervosa. Current obsession: gluten.  Gluten, one of the most heavily consumed proteins on earth, is created when two molecules, glutenin and gliadin, come into contact and form a bond. That happens when bakers knead dough. The bond creates an elastic membrane, and gives bread the texture we enjoy. Genetic studies have revealed that celiac disease (true gluten intolerance) has increased in incidence from 1 in 500 to 1 in 100 patients in the last 60 years. No one knows why. That means that I have 35 truly gluten-intolerant patients in my practice, instead of 7.  Research has demonstrated that far, far more patients have GI distress due to fermentable oligosaccharides than gluten, and that's why I have given many of you a FODMAP diet sheet to experiment with. Unfortunately, there are a few goofballs in my profession who are attempting to convince you that gluten causes everything from arthritis and asthma to multiple sclerosis and schizophrenia. It doesn't.  It's a disease-of-the-year  fad.  It's what wealthy Americans do instead of eating a sensible, nutritious, well-balanced diet.  Please-- don’t listen to Dr. Oz.  He’s a hustler.

Logical Risk Assessment: Economist Steven Levitt, in the 2005 bestseller Freakonomics, points out that having a swimming pool in your backyard is 100 times more likely to kill a child than having a gun in your house.  That doesn’t mean the gun shouldn’t be locked up; but don’t forget to lock the back door, and the gate.   What’s the number one risk of premature death for people under 50?  Hint: if you don’t wear your seatbelts, it is completely irrational to spend a dime on disease prevention. 

Bullying: Here’s a subject everyone has experienced, and almost everyone (except bullies who never got bullied) hates.  It has become a national obsession.  I wish I had a cure, but I don’t.  Once I was involved in running a private school, and we finally had to remove a bully who had great parents, and went on to a productive life (he’s an orthopedic surgeon with five kids).  On the margins, attentive teachers can sometimes intervene positively.  The risk of over-concern?  Increasing the number of tattletales, whiners, and victims.  We’ve already got a culture dedicated to making victims out of drunks, drug abusers, and ne’er-do-wells of every stripe.  Let’s not create any more.

Hack, Hack, Hack:  No, I’m not talking about the flu.  Anthem, the nation’s second-largest health insurer, just had 90 million records hacked, probably from China.  It’s not just Home Depot and Target anymore.  Shoot, Islamic hackers hijacked the Pentagon’s Twitter account, so who’s safe?  Well, we are, for one.  We don’t take credit cards, we don’t store your social security number, and we don’t use electronic medical records.  All a hacker could find out about you from us is how much Lipitor you’re taking for your cholesterol, and in case you’re wondering, there’s no value in that information for anybody.  We’re Neanderthals, and happy.

Mobile Monitoring: An interesting story on National Public Radio examined the impact of all the new wearable devices which will check your sleep patterns, pulse, steps, etc.  Coming soon will be home devices to check common blood tests.  The question: Does this empower patients, or just confuse them?  In my opinion, there is no simple answer.  Consider home monitoring of blood sugar for diabetics, which has been around a long time.  When a patient brings in a 3-page spreadsheet of numbers, this may have been of value to her, but usually not to me.  Most of the peaks and valleys aren’t caused by what she thinks; it wasn’t the apple pie the night before, it was the cold coming on.  All I need is the HgA1c, which averages all those readings over a long period of time.  OK, so what if she can do her own A1c?  Is she going to ring me up during the Super Bowl and adjust her own medicine?  Not!  What I do during the office visit involves a series of decisions based on multiple discreet pieces of evidence, some of them acquired by examination, not to mention “by-the-way” questions about Aunt Tilly, or that worrisome spot on the back of the knee.  There’s just no way to shortcut this process, and anybody who tells you otherwise also has a bridge he will sell you.  By the way, that’s what NPR decided, too.  If the information gathered by the gadgets is interesting or motivating, by all means, take advantage; but knowledge is not power.  Wisdom is power.

Computers Are Crashing Airplanes: Well, not exactly.  What’s happening is that pilots are relying so much on automated cockpit controls that they are losing their flying skills.  That’s one reason why I’m skeptical about the future of cars that drive themselves; the other reason is the number of times Google Maps has led me astray.  Same goes with medicine, or any other profession requiring experience to function well.  Computers are an enormous help, but they need to know their place.  As I’ve said before, by all means use your search engine to diagnose your symptoms.  When you come to me, you’ll be way ahead in the education game, and I find it easier to prune hedges than irrigate deserts.  But I’m not worried about being replaced.  Dying-- now that’s worth worrying about.

Does Bacterial Deficiency Make Me Fat?  Maybe.  Babies are born without bacteria, but eventually harbor 100 trillion in their adult bodies-- ten times the number of body cells.  We’re learning more all the time about the useful role they play-- try digesting food without them, for instance.  Recently evidence is turning up that a bacteria called Christensenella inhabits the gut of people who tend to be lean.  Transferred to germ-free mice, it makes them lean, too.  The question: is there something in the genes of lean people which allows them to harbor this bacteria, or could it be transferred to fat people?  So far it’s an open question.  In the meantime, you’re still responsible for your food choices, portion sizes, and exercise patterns.

Putting Your Money Where Your Mouth Is:  Researchers at New York University’s Dirty Money Project found genetic evidence of over 3,000 bacteria on one dollar bills-- and the other 80% of genes couldn’t be typed, but weren’t human.  Lesson: don’t eat or breath money.  Morons.  With too much government research money to waste.  What’s next?  Have they sampled doorknobs and toilet seats?  Which brings me to (back for a second straight year):

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.  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.  Therefore…

Measles: Once upon a time, measles killed 6,000 people per year.  In the decade before the measles vaccine was introduced in 1962, each year 4,000 people developed measles encephalitis (brain swelling) and 500 died.  By 2000, measles was eliminated in America by vaccination.  Then internet “education” took over.  Look at it this way.  If you’re a Christian, as I am, and you are concerned about the health of your child, and that concern leads you to protect your child by putting every other citizen’s child at risk of a deadly disease-- doesn’t that strike you as unChrist-like?  What would Jesus do?

The Baby and the Bathwater:  I’ve written in newsletters past that the healthiest skin belongs to people who don’t bathe-- mainly primitive societies.  It won’t fly in America, I know, but you can’t change the fact that stripping oils and dead scales off our skin every day was not God’s design.  There has been an increase in the incidence of childhood eczema in recent decades, and baby bathing habits may be the problem.  The average baby gets a bath 5 times a week-- that’s about twice as often as they should.  After that bath, you should apply a hypoallergenic, fragrance-free, oily moisturizer over baby’s whole body.

Your Mother Was Right About a Good Breakfast:  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.  Or after bedtime. 

Good Fat, Bad Fat:  So-called brown fat is metabolically active-- it burns calories.  White fat just sits there.  Turns out you can “beige” white fat, making some of it more useful.  How?  Here’s a surprise:  Exercise.

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