Newsletter 05/24/18 – Breathe, Don’t Inhale

To My Patients and Friends,

Here’s the news of the week… enjoy!

An avoidable side effect

Although antibiotics play an important role in treating infections, they have downsides.  Pseudomembranous colitis is a life-threatening form of diarrhea caused by the bacterium Clostridium difficile, or C. diff.  Each year, C. diff accounts for almost half a million infections in the U.S. and has become the most common cause of healthcare-associated infections, with a fatality rate of almost 10%.  It commonly arises when antibiotics disrupt the balance of beneficial bacteria that normally inhabit our intestinal tract, which then allows for the overgrowth of the C diff. bacterium.  In a 2017 Cochrane review of the medical literature and again in a study recently published in the journal Infection Control & Hospital Epidemiology, it was found that the rate of C diff. colitis can be reduced by 60 to 70% if a probiotic capsule (an over-the-counter supplement that contains various strains of “good” bacteria) is taken alongside an antibiotic.  The repercussions are significant enough that hospitals are now implementing protocols that include probiotics for their inpatients who are on antibiotics.  The primary take-home message is still that antibiotics should be avoided when they’re not needed; but if they are prescribed, talk to your physician about adding an over-the-counter probiotic supplement.

My doctor told me my cholesterol is normal- so am I out of the woods?

Here’s a sobering statistic: about half of heart attack victims have normal cholesterol levels.  So what more can we do to help prevent heart disease?  We know that atherosclerosis is a complicated process that involves many factors, including blood vessel damage due to high blood pressure or inflammation, elevated blood sugar, certain kinds of particles in the bloodstream, genetics and others.  Over the years, a number of tests have emerged that help us to further clarify a patient’s cardiovascular risk beyond just looking at the basics.

Although these newer tests are not included in most current guidelines, they are nonetheless valuable and readily available.  They include some noninvasive imaging studies, such as CT calcium testing (an inexpensive CAT scan of the chest looking for calcification in arteries) and carotid intima-media thickness (or CIMT) testing, which involves office-based ultrasound imaging of carotid (neck) arteries.  Additionally, there are a number of blood tests that take a deeper dive into a patient’s cardiovascular risk profile.  Some of these look for specific disease-promoting particles, such as Lipoprotein (a), which tends to run in families; or lipoprotein-associated phospholipase A2, a marker for inflammation in blood vessel walls.  And the number and size of LDL (‘bad”) cholesterol particles- which can be measured with a simple blood test- can matter even more than the total amount of LDL cholesterol in the blood.  We can even explore genetics as a means of further quantifying risk.  For instance, we know that common variants of the ApoE gene– more commonly known as the “Alzheimer’s gene”- can also confer increased heart attack risk.  And if you are a candidate for cholesterol lowering medication, genetic tests exist that can help determine if you are more prone to side effects.

So if you have a worrisome family history or other risk factors for heart problems, it would be worth discussing these additional tests with your physician.

Vaping: NOT a safe alternative to smoking

This recent case report of a teen who suffered severe complications from using a vape pipe serves as a grim reminder that we shouldn’t accept these risky behaviors as the “new norm.”  This kid nearly died.  Hypersensitivity pneumonitis (or “wet lung”) is a life-threatening form of respiratory failure that occurs when the lungs react to inhaled chemicals.  We are only beginning to understand the potential dangers of vaping (and we certainly can’t count on the industry to keep us informed).  It’s important to check in with our teens consistently, compassionately and without judgement in order to ward off high-risk behaviors and to keep them healthy and safe.  Please talk to your kids!

A link between low testosterone and heart risk

In a study recently presented at the American Association of Clinical Endocrinologists, it was noted that men with low testosterone on long term testosterone replacement therapy had improved heart health.  Testosterone (T) is essential for a variety of physical, cognitive, sexual, and metabolic functions. T usually peaks in adolescence and early adulthood., and begins to drop about 1 to 3% per year beginning around age 40.  This natural decline, however, does not imply that a man is deficient or in need of testosterone replacement therapy.  An actual deficiency is diagnosed in cases where there is a low level of T along with specific symptoms or signs:

Red flags:

  • Low sex drive
  • Low sperm count
  • Unexplained hair loss
  • Hot flashes
  • Low bone density

Additional signs:

  • Decrease in testicular size
  • Diminished lean muscle mass
  • Increased body fat
  • Elevated blood sugar levels
  • Low-trauma bone fracture
  • Problems sleeping
  • Unexplained fatigue
  • Difficulty concentrating, lack of motivation, depression

Disclaimer: the research team for this study had industry connections.  That being said, I still think it makes sense to speak with your physician about getting tested for low T if you notice any of these symptoms.

What lies beneath…

A study recently published in the British Medical Journal draws a connection between severe eczema and increased risk for heart disease and stroke.  This adds to the growing body of evidence that suggests a connection between inflammatory conditions- such as rheumatoid arthritis, cancer, diabetes, psoriasis and gingivitis (gum disease)- and increased risk for heart problems.  This is not surprising, given that inflammation is a key initiating event in the development of atherosclerosis.  So I encourage everyone with a chronic inflammatory condition to stay in touch with their physicians about maintaining cardiovascular health.

A prescription for road rage?

If you’re like me, you know what it’s like to experience stress or anger when behind the wheel.  Given how much time we spend in our cars, this can become unhealthy; at the very least, it’s unpleasant.  And not only is recurrent acute stress bad for our overall health, but those moments of “road rage” can cause us to drive less safely, endangering ourselves and others.  I have become a proponent of mindfulness meditation as a means of improving health and well-being (there’s lots of evidence for this), but people don’t normally think about meditating while driving (for obvious reasons).  However, check out this mindfulness exercise specifically designed to be safely used while driving (it involves a free app download).  I’ve tried it out; it helps!

That’s it for now.  Drive safely, stay healthy, and have a nice holiday weekend!