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Doctor's Corner
The chicken and the pig were walking across the farmer's front yard, and they spied the family eating breakfast. The farmer's wife was scrambling some eggs and the chicken noted....
"Do you see what I contribute?" said the chicken with a little pride in her voice. "Sure.... you contribute" said the pig, while pointing to the bacon in the skillet, "Yes you contribute. ...but we show commitment."
Commitment is very important to us here in the office. We pride ourselves on doing what's needed to provide you with great medical care. Despite our teamwork, we sometimes fall short.... and if we do, we apologize, but know that we always try our best and make it our goal to show you excellence in all we do.
No matter what goes on with 'health care' in Washington, you should know, and feel confident, that our group of 10 is working hard on your part, to do what needs to be done to maintain your good health and to take care of the details involved in your health care.
Sincerely yours,
Dr. Lakin
As Elvis would say, "Taking Care of Business"
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VOL 5/Issue 1
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Winter 2010 |
"In the depths of winter I finally learned that within me there lay an invincible summer."
- Albert Camus
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| Your body's big enemy? You're sitting on it! |
 Most of us spend our days on our behinds - and it's killing us.......
You might not want to take the following stat sitting down: According to a poll of nearly 6,300 people by the Institute for Medicine and Public Health, it's likely that you spend a stunning 56 hours a week planted like a geranium - staring at your computer screen, working the steering wheel, or collapsed in a heap in front of your high-def TV. And it turns out women may be more sedentary than men, since they tend to play fewer sports and hold less active jobs.
Even if you think you have an energetic lifestyle, sitting is how most of us spend a good part of our day. And it's killing us - literally - by way of obesity, heart disease, and diabetes. All this downtime is so unhealthy that it's given birth to a new area of medical study called inactivity physiology, which explores the effects of our increasingly butt-bound, tech-driven lives, as well as a deadly new epidemic researchers have dubbed "sitting disease."
The modern-day desk sentence
"Our bodies have evolved over millions of years to do one thing: move," says James Levine, M.D., Ph.D., of the Mayo Clinic in Rochester, Minn., and author of "Move a Little, Lose a Lot." "As human beings, we evolved to stand upright. For thousands of generations, our environment demanded nearly constant physical activity."
But thanks to technological advances, the Internet, and an increasingly longer work week, that environment has disappeared. "Electronic living has all but sapped every flicker of activity from our daily lives," Levine says. You can shop, pay bills, make a living, and with Twitter and Facebook, even catch up with friends without so much as standing up. And the consequences of all that easy living are profound.
When you sit for an extended period of time, your body starts to shut down at the metabolic level, says Marc Hamilton, Ph.D., associate professor of biomedical sciences at the University of Missouri. When muscles - especially the big ones meant for movement, like those in your legs - are immobile, your circulation slows and you burn fewer calories. Key flab-burning enzymes responsible for breaking down triglycerides (a type of fat) simply start switching off. Sit for a full day and those fat burners plummet by 50 percent, Levine says.
That's not all. The less you move, the less blood sugar your body uses; research shows that for every two hours spent on your backside per day, your chance of contracting diabetes goes up by 7 percent. Your risk for heart disease goes up, too, because enzymes that keep blood fats in check are inactive. You're also more prone to depression: With less blood flow, fewer feel-good hormones are circulating to your brain.
Spending the day on your rear is also hell on your posture and spine health, says Douglas Lentz, a certified strength and conditioning specialist and the director of fitness and wellness for Summit Health in Chambersburg, Pa. "When you sit all day, your hip flexors and hamstrings shorten and tighten, while the muscles that support your spine become weak and stiff," he says. It's no wonder that the incidence of chronic lower-back pain among women has increased threefold since the early 1990s.
And even if you exercise, you're not immune. Consider this: We've become so sedentary that 30 minutes a day at the gym may not do enough to counteract the detrimental effects of eight, nine, or 10 hours of sitting, says Genevieve Healy, Ph.D., a research fellow at the Cancer Prevention Research Centre of the University of Queensland in Australia. That's one big reason so many women still struggle with weight, blood sugar, and cholesterol woes despite keeping consistent workout routines.
In a recent study, Healy and her colleagues found that regardless of how much moderate to vigorous exercise participants did, those who took more breaks from sitting throughout the day had slimmer waists, lower BMIs (body mass indexes), and healthier blood fat and blood sugar levels than those who sat the most. In an extensive study of 17,000 people, Canadian researchers drew an even more succinct conclusion: The longer you spend sitting each day, the more likely you are to die an early death - no matter how fit you are.
The non-exercise answer
So if exercise alone isn't the solution, what is? Fortunately, it's easier than you think to ward off the perils of prolonged parking. Just ramp up your daily non-exercise activity thermogenesis - or NEAT. That's the energy (i.e., calories) you burn doing everything but exercise. It's having sex, folding laundry, tapping your toes, and simply standing up. And it can be the difference between wearing a sarong or flaunting your bikini on your next beach vacation.
In his groundbreaking study on NEAT, the Mayo Clinic's Levine used motion-sensing underwear (hot, huh?) to track every single step and fidget of 20 people who weren't regular exercisers (half of them were obese; half were not). After 10 days, he found that the lean participants moved an average of 150 minutes more per day than the overweight people did - enough to burn 350 calories, or about one cheeseburger.
Fidgeting, standing, and puttering may even keep you off medications and out of the doctor's office. Think of your body as a computer: As long as you're moving the mouse and tapping the keys, all systems are go. But let it idle for a few minutes, and the machine goes into power-conservation mode. Your body is meant to be active, so when you sit and do nothing for too long, it shuts down and burns less energy. Getting consistent activity throughout the day keeps your metabolism humming along in high gear.
When you get out of your chair and start moving around, you turn on fat burners. Simply standing up fries three times as many calories as sitting on your butt, according to Levine. And, he adds, "NEAT activity can improve blood flow and increase the amount of serotonin available to the brain, so that your thinking becomes sharper and you'll be less likely to feel depressed."
Get your move on
Shake things up throughout the day by interrupting your sedentary stints as often as possible. "Stand up every half hour," says Neville Owen, Ph.D., of the University of Queensland. "If you have to sit for longer than that, take more extended and active breaks and move around for a few minutes before sitting back down."
When you're reading e-mail and taking phone calls, do it standing. Walk with colleagues to brainstorm ideas. And consider trading your chair for a large stability ball. "It forces you to engage your muscles, and you're likely to stand up more because you're not melting into a chair," Lentz says.
At home, it's simple: Limit TV time to two hours a day or less. Better yet, watch it from a treadmill or exercise bike. Among women, the risk for metabolic syndrome - a constellation of health woes including high blood pressure, high cholesterol, and high blood sugar - shoots up 26 percent for every hour per day they spend watching the tube.
Not sure how much of a difference these mini moves will make?
Swapping a more active approach for just a few of your daily activities can help stave off the one-to two-pound weight gain most women accumulate every year - and it can keep your metabolism buzzing the way nature intended it to.
By Selene Yeager, Womens Health
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New Mammogram Advice Raises Doubts.......
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 Benefits of screening before age 50 don't outweigh risks, task force says.
For many women, getting a mammogram is already one of life's more stressful experiences.
Now, women in their 40s have the added anxiety of trying to figure out if they should even be getting one at all.
A government task force said Monday that most women don't need mammograms in their 40s and should get one every two years starting at 50 - a stunning reversal and a break with the American Cancer Society's long-standing position. What's more, the panel said breast self-exams do no good, and women shouldn't be taught to do them.
The news seemed destined to leave many deeply confused about whose advice to follow.
"I've never had a scare, but isn't it better to be safe than sorry?" asked Beth Rosenthal, 41, sitting in a San Francisco cafe on Monday afternoon with her friend and their small children. "I've heard of a lot of women in their 40s, and even 30s, who've gotten breast cancer. It just doesn't seem right to wait until 50."
Her friend agreed. "I don't think I'll wait," said Leslie David-Jones, also 41, shaking her head.
For most of the past two decades, the American Cancer Society has been recommending annual mammograms beginning at 40, and it reiterated that position on Monday. "This is one screening test I recommend unequivocally, and would recommend to any woman 40 and over," the society's chief medical officer, Dr. Otis Brawley, said in a statement.
But the government panel of doctors and scientists concluded that getting screened for breast cancer so early and so often is harmful, causing too many false alarms and unneeded biopsies without substantially improving women's odds of surviving the disease.
"The benefits are less and the harms are greater when screening starts in the 40s," said Dr. Diana Petitti, vice chair of the panel.
The new guidelines were issued by the U.S. Preventive Services Task Force, whose stance influences coverage of screening tests by Medicare and many insurance companies. But Susan Pisano, a spokeswoman for America's Health Insurance Plans, an industry group, said insurance coverage isn't likely to change because of the new guidelines.
Experts expect the revisions to be hotly debated, and to cause confusion for women and their doctors.
"Our concern is that as a result of that confusion, women may elect not to get screened at all. And that, to me, would be a serious problem," said Dr. Len Lichtenfeld, the cancer society's deputy chief medical officer.
The guidelines are for the general population, not those at high risk of breast cancer because of family history or gene mutations that would justify having mammograms sooner or more often.
The new advice says:
Most women in their 40s should not routinely get mammograms.
Women 50 to 74 should get a mammogram every other year until they turn 75, after which the risks and benefits are unknown. (The task force's previous guidelines had no upper limit and called for exams every year or two.)
The value of breast exams by doctors is unknown. And breast self-exams are of no value.
Medical groups such as the cancer society have been backing off promoting breast self-exams in recent years because of scant evidence of their effectiveness. Decades ago, the practice was so heavily promoted that organizations distributed cards that could be hung in the shower demonstrating the circular motion women should use to feel for lumps in their breasts.
The guidelines and research supporting them were released Monday and are being published in Tuesday's issue of the Annals of Internal Medicine.
Sharp criticism from cancer society
The new advice was sharply challenged by the cancer society.
"This is one screening test I recommend unequivocally, and would recommend to any woman 40 and over," the society's chief medical officer, Dr. Otis Brawley, said in a statement.
The task force advice is based on its conclusion that screening 1,300 women in their 50s to save one life is worth it, but that screening 1,900 women in their 40s to save a life is not, Brawley wrote.
That stance "is essentially telling women that mammography at age 40 to 49 saves lives, just not enough of them," he said. The cancer society feels the benefits outweigh the harms for women in both groups.
International guidelines also call for screening to start at age 50; the World Health Organization recommends the test every two years, Britain says every three years.
Breast cancer is the most common cancer and the second leading cause of cancer deaths in American women. More than 192,000 new cases and 40,000 deaths from the disease are expected in the U.S. this year.
Mammograms can find cancer early, and two-thirds of women over 40 report having had the test in the previous two years. But how much they cut the risk of dying of the disease, and at what cost in terms of unneeded biopsies, expense and worry, have been debated.
In most women, tumors are slow-growing, and that likelihood increases with age. So there is little risk by extending the time between mammograms, some researchers say. Even for the minority of women with aggressive, fast-growing tumors, annual screening will make little difference in survival odds.
The new guidelines balance these risks and benefits, scientists say.
The probability of dying of breast cancer after age 40 is 3 percent, they calculate. Getting a mammogram every other year from ages 50 to 69 lowers that risk by about 16 percent.
"It's an average of five lives saved per thousand women screened," said Georgetown University researcher Dr. Jeanne Mandelblatt.
False alarms
Starting at age 40 would prevent one additional death but also lead to 470 false alarms for every 1,000 women screened. Continuing mammograms through age 79 prevents three additional deaths but raises the number of women treated for breast cancers that would not threaten their lives.
"You save more lives because breast cancer is more common, but you diagnose tumors in women who were destined to die of something else. The overdiagnosis increases in older women," Mandelblatt said.
She led six teams around the world who used federal data on cancer and mammography to develop mathematical models of what would happen if women were screened at different ages and time intervals. Their conclusions helped shape the new guidelines.
Several medical groups say they are sticking to their guidelines that call for routine screening starting at 40.
"Screening isn't perfect. But it's the best thing we have. And it works," said Dr. Carol Lee, a spokeswoman for the American College of Radiology. She suggested that cutting health care costs may have played a role in the decision, but Petitti said the task force does not consider cost or insurance in its review.
The American College of Obstetricians and Gynecologists also has qualms. The organization's Dr. Hal Lawrence said there is still significant benefit to women in their 40s, adding: "We think that women deserve that benefit."
But Dr. Amy Abernethy of the Duke Comprehensive Cancer Center agreed with the task force's changes.
"Overall, I think it really took courage for them to do this," she said. "It does ask us as doctors to change what we do and how we communicate with patients. That's no small undertaking."
Abernethy, who is 41, said she got her first mammogram the day after her 40th birthday, even though she wasn't convinced it was needed. Now she doesn't plan to have another mammogram until she is 50.
Barbara Brenner, executive director of the San Francisco-based Breast Cancer Action, said the group was "thrilled" with the revisions. The advocacy group doesn't support screening before menopause, and will be changing its suggested interval from yearly to every two years, she said. Mammograms, like all medical interventions, have risks and benefits, she said.
"Women are entitled to know what they are and to make their best decisions," she said. "These guidelines will help that conversation."
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2010 Winter Olympics.......
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On July 2, 2003, the International Olympic Committee selected Vancouver as the host city for the 2010 Olympic and Paralympic Winter Games. Athletes and spectators from around the world will gather in Vancouver and the alpine resort of Whistler in February and March 2010 to celebrate winter sporting excellence.
The Games, along with the region's spectacular natural playground and its vibrant venues, will put Vancouver in the spotlight as a premier sporting destination.
Vancouver will host the following Olympic and Paralympic events in February and March of 2010:
Opening and Closing ceremonies (BC Place Stadium)
Ice hockey (Canada Hockey Place and UBC Thunderbird Arena)
Figure skating (Pacific Coliseum)
Speed skating and short track speed skating (Richmond Olympic Oval and Pacific Coliseum)
Freestyle skiing (Cypress Mountain)
Snowboard (Cypress Mountain)
Curling (Vancouver Olympic Centre)
Ice sledge hockey (UBC Thunderbird Arena)
Wheelchair curling (Vancouver Paralympic Centre)
Quick facts about the Vancouver 2010 Olympic and Paralympic Winter Games:
Number of Olympic athletes and officials: 5,500
Number of Paralympic athletes and officials: 1,350
Countries participating in Olympic Winter Games: 80+
Countries participating in Paralympic Winter Games: 40+
2010 Olympic Winter Games events tickets available: 1.6 million
2010 Paralympic Winter Games events tickets available: 250,000
Estimated number of media representatives: 10,000
Estimated number of Games volunteers: 25,000
Visit: www.vancouver2010.com for more information.
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When the Elephant in the Room isn't Really There! |
The 69-year-old man saw the spider clearly, whacked at it, yet the spider wouldn't die. At night, people he knew started visiting his bedroom, sitting in the armchair beside his night table. But he hadn't invited them. Oh, and there were animals roaming around his house.
A different patient saw a double decker bus in the living room. Another saw fire hydrants just like the one that used to sit in front of her childhood home. Then there was the woman who saw small children sitting atop her piano. She didn't know them and had no kids of her own, but there they were.
These people, whose cases were documented in medical journals, are not crazy.
They are affected by a condition called "Charles Bonnet syndrome," (pronounced bow-NAY), a somewhat common hallucinatory condition among people suffering various forms vision loss. The condition was named for an 18th-century naturalist who described it in his grandfather.
Recently, Ed Connors, a 61-year-old software engineer near Boston saw a woman walking her dog on his street. In reality, it was just a shadow. Sometimes when in a shopping mall, Connors thinks he sees people and will move to get out of their way. Except nobody is there.
Connors has a disease called vitelliform macular dystrophy or Best Disease that has impaired his vision. He was diagnosed with it about 10 years ago. "Shortly after that," he said, "I started seeing phantoms."
People who experience these kinds of hallucinations are typically thought to suffer from dementia, Alzheimer's or some other psychiatric illness, Dr. Mary Lou Jackson of the Massachusetts Eye and Ear Infirmary explained. Actually, Connors and other people experiencing the syndrome are mentally healthy, but are frequently misdiagnosed.
Often, "patients are afraid to tell doctors they are hallucinating for fear of being thought they're crazy," she said. "It takes good clinicians to spend time to realize the person is clear thinking."
The disorder occurs when there is a total or partial disconnect along the path between the eyes and brain's visual cortex. That disconnect can be caused by any number of diseases and conditions - glaucoma, diabetes and stroke, for example - as well as injuries. In the absence of real visual information the brain is liable to make up images of its own.
"If the primary visual cortex does not get a message, that means subsequent stops [on the path of a visual image] are not getting them either," Jackson said. "That lack of a message into the brain triggers the other parts to put pictures there spontaneously."
For years the syndrome was thought to occur almost exclusively among the elderly, but recent research shows it can happen to anybody.
A small study by Harvard Medical School researchers tested the mechanism of the syndrome on 13 people with normal vision. They wore blindfolds for five days. Ten of the 13 experienced hallucinations after an average of one day.
Often the hallucinations are not as elaborate as an elephant in the living room - a common vision among people with the syndrome - or phantom children playing piano. Many of the images consist of geometric patterns. There is some controversy over what standards to use for diagnosing the condition. Some doctors will diagnose Bonnet syndrome if patients see flashing or colored lights, but others disagree.
Most people who experience Bonnet syndrome are either not troubled by it or may actually find it pleasant. For example, many see loved ones who have passed away, or images re-created out of a fond memory. They know the people aren't really there, but enjoy the visit.
The prevalence of Bonnet syndrome among visually impaired people can vary widely, ranging from 2 percent up to 33 percent depending on the estimate. Roughly a quarter of Bonnet syndrome cases resolve themselves as mysteriously as they began after about a year, Jackson believes. Some may last weeks or many years, like Connors'. There's no specific treatment - for most patients, simply realizing what's going on is comforting enough.
In fact, Connors has adapted to his visions so he's usually able to suss out when what he's seeing is real or not real. While he never feared he was losing his sanity, receiving the diagnosis from Jackson eased his mind. "I was relieved to know it had a name and to hear how common it was."
- By Brian Alexander
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6 Surprising Heart Attack Triggers.......
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There are other surprising situations and times when the chance of heart attack rises dramatically. If you or someone you know has a history of heart trouble, here's when to be watchful:
First thing in the morning
The risk of heart attack increases 40% in the morning, Harvard researchers estimate. Why? As you awaken, your body secretes adrenaline and other stress hormones, increasing blood pressure and a demand for oxygen. Your blood is also thicker and harder to pump because you're partially dehydrated. All this taxes the heart. Protect yourself: Build some time into your wake schedule so you can hit the snooze button and wake up slowly. If you're a morning exerciser, warm up thoroughly so as not to additionally stress the heart. And if you're on a beta-blocker, take it before bed so the medication is at full strength in the AM.
On Monday mornings especially
Twenty percent more heart attacks occur on this day, probably because people are stressed and depressed about returning to work. Protect yourself: Relax on Sunday, but try not to sleep in. Getting up early on Monday after sleeping late Saturday and Sunday can raise blood pressure even more because your body is fatigued and its natural rhythms are out of whack. Try to maintain a regular sleep/wake schedule all week.
At the podium
From the heart's perspective, public speaking can be similar to unaccustomed exercise. Extreme nervousness raises blood pressure, heart rate, and adrenaline levels, all of which can make the presentation itself a secondary worry. Protect yourself: To counter these effects, some of my patients take a betablocker before speaking, flying, or doing anything that makes them overly anxious.
After a high-fat, high-carb meal
Studies show these foods constrict blood vessels, making blood more prone to clot. Protect yourself: If you must indulge, keep your portion sizes reasonable. A daily aspirin will also help prevent blood "stickiness."
During a bowel movement
Straining increases pressure in the chest, slowing the return of blood to the heart. Protect yourself: Eat lots of fiber, stay hydrated, and avoid straining.
During vigorous exercise you're unprepared for
Having a heart attack while shoveling snow is a classic example of this. The heart attack occurs because the victim isn't accustomed to that kind of effort and stress hormones skyrocket, causing blood pressure and heart rate to jump. Protect yourself: Regular exercise protects your heart. But increase your intensity level gradually.
- Arthur Agatston, MD, Prevention, MSNBC.com
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Tucson Doctor a Crusader for CPR Change; urges 'chest compression only' to be medical standard |
Dr. Gordon Ewy strolls into a conference room at the University of Arizona's Sarver Heart Center and sets a book on the glass table.
"Look at Chapter 2," he says, opening the newly released "Cheating Death" by Dr. Sanjay Gupta, CNN's chief medical correspondent. Chapter 2 is about resuscitation.
"Sanjay Gupta calls me cantankerous and opinionated," says the 76-year-old cardiologist and director of the Sarver Heart Center.
"It's OK to be cantankerous and opinionated if you're right," he says. "And we're right."
For more than two decades, Ewy (pronounced AY-vee) has been on a crusade to change the way people are treated for sudden cardiac arrest, a leading cause of death in the United States.
He has challenged what for years was a kind of sacred cow in the medical profession and a prescription for good Samaritan behavior worldwide: the mouth-to-mouth rule of cardiopulmonary resuscitation, or CPR.
Ewy has pioneered the use of chest compression-only CPR on adults whose hearts suddenly stop pumping. Mouth-to-mouth only detracts from the more effective compressions, he insists.
Since the mid-1990s, Ewy's advocacy has often been a thorn in the side of venerable medical establishments such as the American Heart Association. Ewy has written letters in medical journals demanding change and accused the association, whose influence is strong, of not moving quickly enough.
In the past five years, though, there has been a gradual realization that the outspoken Tucson doctor is on to something.
In a major shift in 2008, the American Heart Association issued an advisory that said compression-only CPR can be used to save lives and is an option for people who aren't trained in CPR or who are unsure of their CPR abilities. People who are trained can do either, it says. The advisory applies only to cases of adults in cardiac arrest, not children, and excludes drowning and drug-overdose cases.
Now, the compression-only version may be on the verge of going worldwide, as an international health group considers whether to revise its guidelines to make it the preferred method.
Not everyone has bought into Ewy's approach. Evidence is mixed. Research in the U.S., Netherlands and Japan has found that chest-compression-only yields similar or better survival rates than standard CPR. Some European studies report better results with mouth-to-mouth. Still, Ewy is convinced it's only a matter of time before compression-only CPR becomes the standard for cardiac arrest.
Why CPR is important
Every year, cardiac arrest kills about 325,000 people in the U.S. Its main underlying cause is heart disease, and the majority of cardiac arrests happen outside the hospital.
As bad as that is, prospects were worse for victims before modern CPR emerged about five decades ago.
Two American doctors, Peter Safar and James Elam, are credited with inventing CPR, and the technique spread rapidly after the American Heart Association endorsed the idea in 1963.
CPR works under the premise that pressing on the chest moves blood to the vital organs while mouth-to-mouth breathing gets oxygen into the lungs.
When a person's heart stops beating, the first few minutes are critical. If nothing is done, the chance of survival drops 7 to 10 percent every minute.
Yet studies show most people are averse to performing CPR for a variety of reasons, including a fear that they will hurt the victim or an inability to get beyond the "yuck" factor of mouth-to-mouth contact. Instead, they call 911, as CPR courses teach, but then just wait for paramedics to arrive. Bystanders attempt CPR in less than a third of cardiac arrests. That's one reason so few people survive: More than 95 percent of people who suffer sudden cardic arrest die.
Ewy says the compression-only method is better than standard CPR for a simple reason: In standard CPR, when a rescuer stops after 30 compressions to give two breaths, the blood stops moving through the patient's body, essentially starving the organs. Continuous compressions keep the blood flowing. Doing only those also is simpler and easier to remember than standard CPR.
Ewy's story
Ewy grew up in a small western Kansas town, knowing as a boy that he wanted to be a doctor. He got interested in cardiology while working at a Washington, D.C., hospital, where he successfully pushed for heart defibrillators to be standardized so they put out the same electrical output. That led him into cardiac-related research, which he continued when he moved to Tucson in 1969.
Over the next two decades, he and his colleagues did research, including studies using pigs, that touched on nearly every aspect of CPR. At first, he believed in standard CPR. But he also believed that compression-only CPR was better than nothing. Surveys conducted by the Sarver Heart Center showed people were four times as likely to perform compression-only CPR than standard CPR. Ewy and his team decided to research whether one was more effective than the other. Their findings favored compression-only CPR.
In the early 1990s, Ewy heard something that really convinced him. He was in his office listening to a recording of a 911 call that someone had sent him. A Seattle woman was giving her husband CPR while she waited for paramedics to arrive.
After several minutes, the woman got back on the phone and said, frustrated, "Why is it every time I press on his chest he opens his eyes? And every time I stop and breath for him he goes back to sleep?"
Ewy was amazed. The woman had summed up in two sentences what he had spent 20 years researching.
"What she was actually saying was this: 'Why is it every time I press on his chest, he's not in a coma? And every time I stop and breathe for him, he's in a coma?'"
Struggle for acceptance
Since the mid-1990s, Ewy's goal has been to convince the medical community that he is right.
Along the way, he and his research team have made other breakthroughs, including pioneering new protocols for paramedics and a treatment that involves cooling body temperatures to minimize brain damage.
Critics have raised several objections about the CPR findings. One is Ewy's use of pigs in his studies. Unlike people, pigs gasp during cardiac arrest, making them more likely to survive, critics say. Ewy went back and looked at Arizona data and found that many people gasp during cardiac arrests.
Some doctors worry that bystanders can get confused and do only chest compressions in drug-overdose and drowning cases.
Some critics wonder if the research has been sufficient.
"We weren't outcasts, but people really vehemently disagreed with us," Dr. Karl Kern, Sarver's associate head of cardiology, says of the Tucson group.
In 2000, Ewy pressed the American Heart Association to change its guidelines to compression-only in cases of cardiac arrest, but the group was reluctant.
Ewy and his colleagues took their campaign locally, first in the Tucson area and then statewide.
The Arizona Department of Health services got on board in 2005, launching a statewide campaign to promote compression-only CPR.
In 2007, Ewy wrote an editorial for a leading medical journal, advocating for the American Heart Association to change its guidelines, which weren't up for review until 2010. The following year, the association issued the advisory endorsing compression-only CPR as an option.
Colleagues say it would have been easy for Ewy to back off his campaign in the face of criticism over the years.
"He really has forged ahead. I think what it's showing, now that we have more and more human data, is that Dr. Ewy was right," says Dr. Ben Bobrow, a medical director for the DHS.
Going forward
Next month, Ewy will fly to Dallas for a meeting of the world's major resuscitation groups. No one knows whether the International Liaison Committee on Resuscitation will endorse compression-only CPR as the preferred method. It's fair to say the discussion will be controversial and Ewy again could face an uphill battle. But he is not giving up.
Sitting in the Sarver Heart Center's conference room on a recent day, he is optimistic that change will come soon. "Yes, it's frustrating, but there is this book called 'The Tipping Point,' " he says, referring to a best-seller about forces that make change unstoppable.
Ewy raises his right arm at the elbow, then drops it halfway down to his left. "I think we're about there," he says.
- by Anne Ryman, The Arizona Republic Back to Top |
| Three Steps You Can Take Right Now To Start Losing Belly Fat............. |
1 Eat no more than 15 grams of sugar daily. You'll reduce your risk of sickness and disease and stop producing too much insulin, the key to fat production. An apple, for instance, has 12 grams of sugar.
2 Get more fiber into your diet. Fiber helps promote belly-fat loss by creating optimum digestive health. Raspberries, artichokes, legumes and whole-wheat pastas are great sources of fiber.
3 Exercise for the right reasons. I recommend regular exercise, but you should do it to improve your health, to strengthen and tone your muscles, and to relieve stress -- not just to look better in your clothes. - USA Weekend
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| Reach for Heart-Healthy Snacks....... |
 Want some popcorn with your movie? Eat up:
Microwave popcorn has 16 grams of fiber per bag.
Research shows that popcorn and other snack foods, such as breakfast cereals, have the potential to reduce the risk of heart disease, cancer and other chronic diseases.
Scientists at the University of Scranton recently announced that whole-grain cereals and snacks, lauded as good sources of fiber, also contain powerful antioxidants known as polyphenols, which remove free radicals (potentially harmful chemicals) from the body.
Whole-grain products have comparable antioxidants per gram to other sources of polyphenols, including chocolate, tea, coffee and wine. Popcorn, in particular, reigns supreme among whole-grain snack foods, with the highest level of antioxidants.
University of Scranton researcher Joe Vinson, lead author of the study, warns that consumers must read food labels carefully to make sure the whole grain is listed as the first ingredient. If it's listed farther down, he says there is no way to tell if there is enough whole grain to be beneficial.
"We are eating a lot of fiber; the government is urging us to do so. But it's refined fiber, where polyphenols are removed," Vinson says. "Focus on looking for whole grains, which are rich in antioxidants."
And if you make popcorn your go-to snack, skip the butter.
- USA Weekend
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| Dr. Lakin's Late Night TV Favorite Host Survey..... |
With all the news about the "late night show" programming changes recently, especially on NBC, Dr. Lakin is doing his own private survey.
Who is your favorite funnyman to watch?
 Are you a Jay Leno groupie? Are you a Conan O'Brien junkie?
or are you a David Letterman aficionado?
Watch for the results on our website blog!
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| Barb A's Movie Reviews ........ |
FORGET IT! +
RENT THE VIDEO + +
ENTERTAINING + + +
GREAT + + + +
A MUST SEE! + + + + +
+ + + + + UP IN THE AIR A captivating comedy, which was smart, funny, and very grown up. How could anyone not love this movie and the wonderful hunk, George Clooney?
+ + + + + IT'S COMPLICATED I can't stand Alec Baldwin. I will never see anything he is in. However, I saw this one. He was magnifico, I absolutely loved it! Meryl Streep's aging skin showed, and she was overweight. (Oh my God, I feel so much better!)
It is hilarious from start to end - a feel good movie. My friend, Joan, laughed until tears rolled down her face!
+ + + + + A SINGLE MAN Anything with Colin Firth has got to be good. He was not only good, but he was brilliant. His desperation after the unexpected death of his partner is powerful. This is a deep wonderful movie for the afternoon or evening at the theater.
+ + + + + THE MAID Raquel is the maid in a family (Chilean I think). She is family, but not really family. Her future is defined by the house. The interaction of this family with their maid is fascinating. The development of her character is worth every minute. Fascinating!
+ + + + + BLIND SIDE Anything with Sandra Bullock is a delight, as was her performance in Blind Side. (How can she live with the man with all those tattoos?) This is a feel good movie for the whole family from beginning to end.
+ + + + + CRAZY HEART I see two Academy Awards here - surely Jeff Bridges and supporting for Maggie Gyllenhaal. Poor worn out Bad Blake (Jeff Bridges) is a pathetic, drunk, comical, tragic country music singer. His relationship with Jean and her son is heart wrenching. A must see!
+ + + + + BROKEN EMBRACES Who doesn't love Penelope Cruz? This one I lived. Joan wouldn't go because of the subtitles, but after 30 minutes you don't realize you are doing the reading. This is a movie that is about breakups, divorces, and revenge. It goes from past to present and back with a hitch. I was really into this one!
LOTS OF GOOD MOVIES, HUH?
See you at the movies!
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| Valentine Jokes for 2010! |
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Q: What do squirrels give for Valentine's Day?
A: Forget-me-nuts.
Q: What did the valentine card say to the stamp?
A: Stick with me and we'll go places!
Q: What did the stamp say to the envelope?
A: I'm stuck on you.
Q: Who sends a thousand valentines cards signed', guess who' ?
A: A divorce lawyer.
Q: What did the light bulb say to the switch?
A: You turn me on.
Q: Did Adam and Eve ever have a date?
A: No, but they had an apple.
Q: What did the boy octopus say to the girl octopus?
A: Can I hold your hand, hand, hand, hand, hand, hand, hand, hand, hand, hand? 
Q: What did one snake say to the other snake?
A: Give me a little hug and a hiss, honey.
Q: Why did the banana go out with the prune?
A: Because it couldn't get a date.
Q: What is a ram's favorite song on February 14th?
A: I only have eyes for ewe, dear
Q: What travels around the world but stays in one corner?
A: A stamp.
Q: What happens when you fall in love with a French chef?
A: You get buttered up.
Q: What is a vampire's sweetheart called?
A: His ghoul-friend.
Q: If your aunt ran off to get married, what would you call her?
A: Antelope.
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How to Choose the Perfect Chocolate.......
Bittersweet? Creamy smooth?
Use these tips to select the right kind for chocolate-loving friends. |
 Chocolate is the ultimate go-to gift -- and one that most people will gratefully accept. But instead of reaching for the same brand-name chocolate the next time you shop, try thinking outside the candy box, says Clay Gordon, editor and publisher of TheChocolateLife.com, a social networking site for chocolate lovers. Yes, some people will be impressed if you spring for an expensive, high-end brand. But there are other ways to find outstanding chocolates that will please each unique recipient even more. Here are five ways to start.
Think about the recipient's tastes. "If they say, 'Let's do sushi,' and they're always ordering the most exotic stuff on the menu, then get more exotic chocolate flavors," Gordon says. But if he's more of a traditional burger-and-fries kind of person, then shy away from wasabi- and ginger-infused chocolates, and go for the classics -- solid chocolate bars or truffles -- instead.
Seek help at a specialty store. You wouldn't go to a drugstore or a supermarket for the best-quality bread, so why would you go there for top-notch chocolate? Find a specialty shop in your area and ask for help. It will have fresher selections, thanks to a higher turnover, and it will offer more knowledgeable help, Gordon says. Your local shop may even be your best ally in sussing out your intended's tastes.
"By pulling a few little pieces of information from customers, we find they know a lot more about the person's taste than they think they do," says Susan Fine of dark-chocolate emporium The Chocolate Path in Montclair, N.J. "Then we can point them in the right direction."
Make it personal. "Chocolate is one gourmet food that has very strong emotional connections, so you use chocolate as a way of telling stories and making connections," Gordon says. "Explain the motivation behind your gift. 'I remembered you loved orange flavors, so I thought you'd like these.' Or, 'They taste just like some delicious chocolate I had in Rome."
Less can be more. A handpicked selection of a few really flavorful chocolates always beats a generic 2-pound assortment. "Show me that you spent time talking to the person behind the counter, and you were thoughtful about the choices you made," Gordon says.
An attractive presentation goes a long way. Put loose pieces in a cellophane bag tied with a nice bow. If you buy a bar and a bag of truffles, wrap the bar in tissue paper and tie the truffles on top. "Thinking about the type of chocolate somebody would like is a gift itself, especially when presented nicely," Fine says. "A Hershey's bar with a pretty bow on it can be special." - by Allyson Dickman, USA Weekend
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| Super Bowl XLIV Sunday, February 7! |
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Congrats to the Colts and the Saints......
Good luck! 
(Too bad our Cardinals aren't playing...... )
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Happy Winter! 
Dr. Lakin & staff
Paradise Valley Medical Clinic PC
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Enjoy!