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Friday, July 20, 2018

Texas hospital ends labor, delivery services after 31 years

We are lucky to have four hospitals in BCS. This gives patients a lot of choice not afforded to other similar sized communities which may have only one regional hospital. It also means the health care market in BCS is highly competitive. Due to changing health care economics, each hospital in our community cannot be all things to all people any longer. It would be reasonable to allocate expertise to each of the hospitals such that one is the center for excellence for neurology and trauma, another for orthopedics and cardiac care, and another for women's and neonatal services, etc. By so doing the Brazos Valley may actually have a greater level of multi-specialty expertise than when all compete to be general hospitals but fail to achieve a high level of quality to be a designated and preferred "center of excellence"-- a Jack of all trades and master of none. Other industries have done this. An area may have the best clay to produce high quality pottery, but poor soil to grow cotton for textiles. Yet, another area may have great soil, but poor clay. So, the area best suited for pottery makes and exports pottery and imports cotton. Trade develop and both economies flourish. Health care economics is a bit different. Health care capitalism is competitive by nature and assumes a zero-sum outcome: I have to win, and you have to lose. So while strength allocation for economic and service goals seems good on paper, no hospital wishes to give up a potentially healthy service line to a competitor.
from Rajesh Harrykissoon, MD

Wednesday, June 20, 2018

Science of Sleep: Understanding obstructive sleep apnea

Good information from Dr. Spencer. Makes me happy that our neck of the woods, the Brazos Valley, is getting a boost in the arm for attention to sleep disorders. We’re all happy to help improve your quality of life through sleep medicine. Have better days through better nights.
from Rajesh Harrykissoon, MD

Saturday, June 16, 2018

Heart disease: Erectile dysfunction may double risk

Erectile dysfunction (ED) may be a bellwether of atherosclerotic disease (arterial blockages leading to heart disease and strokes). The penile artery is small (1-2 mm caliber) and is prone to the development of atherosclerotic plaques which block blood flow. Indeed, earlier studies 15 years ago indicate that the penile artery is more prone to early atherosclerotic obstruction than are coronary and brain arteries followed by peripheral arteries in the legs. Thought due to the effects of testosterone in male development, autopsy studies have shown atherosclerotic disease developing in boys as early as age 8. Thus by the 4th decade of life, many men may have had 30 years of accumulating atherosclerotic blockages (women have a delay in this process until post-menopausal then they rapidly catch up to men). Men who develop erectile dysfunction at age 40s versus at age 60s may be at higher risk for heart attacks and strokes. The two groups (ED in 40s vs. 60s) are almost completely different animals medially speaking with better health favoring those who develop ED in their 60s. Consider ED as an early warning. Suppose you were on a road trip and you encountered a sign saying "Danger Ahead. Detour course." Would you continue straight ahead or choose a different course with lesser risk? ED may be that early warning, "Danger Ahead. Detour course." Detour course means lifestyle changes--exercise, diet and controlling the common risk factors for atherosclerotic disease (smoking, high blood pressure, elevated lipids (cholesterol, LDL) and diabetes). Don't settle for the band-aid "blue pill" solution solely, but rather concurrently address the root cause. Speak with your primary care physician or with your urologist.
from Rajesh Harrykissoon, MD

Monday, June 11, 2018

Study: Multivitamins, Other Common Supplements Have No Health Benefits

"The only supplements that showed any benefit among the studies were folic acid or B-vitamins that contained B6, B12, and folic acid, which could lower one’s risk of heart disease and stroke. Folic acid alone showed a 20 percent lowered risk of stroke. " In the developed world, barring chronic illness, it would be difficult to develop a vitamin deficiency. Indeed, the sewer systems of the developed world are considered the most vitamin-enriched in the world due to the over consumption of dietary supplements which simply passes through one's body and into the commode. A diet that includes plenty of fruits and vegetables naturally provide our bodies with vitamins and minerals. A cultural challenge is to invert our dinner plate protein to plant-based ratios. We've been taught that meat is the entree and veggies are the sides; however, the healthy diet is one in which the fruits and veggies are the entrees and the meat is a side dish. Thus, two-thirds of your plate ought to be plant-based.
from Rajesh Harrykissoon, MD

Saturday, June 9, 2018

The faster you walk, the longer you may live

A brisk pace is considered one at which it is difficult to walk and have a conversation at the same time without halting sentences. For instance, "I met Marci for lunch...breathe, breathe...yesterday, and she...breathe, breathe...looks great." This means that as your conditioning improves, what is considered brisk will also change.
from Rajesh Harrykissoon, MD

Monday, June 4, 2018

How long does caffeine last in your system? Metabolism, sleep, and withdrawal

Bear in mind that the half-life given for many products may assume each person is a "standard metabolizer" which typically encompasses 70% of the population. That means up to 30% may be outliers. If you are sensitive to caffeine, even small doses may have persisting effects into the night and affect sleep. Also, consider if you are indirectly using caffeine as a medication for some unrecognized symptoms. Not uncommonly I see patients who claim they have no daytime sleepiness yet they consume 4-8 caffeinated products a day. The salient question is what would happen if one were not consuming such high doses of caffeine.
from Rajesh Harrykissoon, MD