The Argument AGAINST Screening for Prostate Cancer

The United States Preventative Services Task Force (USPSTF) is a government commission that is responsible for reviewing the medical literature (i.e. research studies) and then formulating screening guidelines for various diseases. The USPSTF recently concluded that screening for prostate cancer with a digital rectal exam (DRE) or a PSA blood test does more harm than good and this is why. Both DRE and PSA testing can and do increase the number of prostate cancers that are detected—the problem is that there appears to be no mortality benefit (no lives saved on average) for doing this. How can this be??? Let’s first look at the numbers and then we’ll talk about the explanation. Before DRE/PSA screening an American man had a 1:11 chance of being diagnosed with prostate cancer and after DRE/PSA screening the number is 1:6. In other words, DRE/PSA screening has nearly doubled the cases of prostate cancer that are detected by physicians. The problem is that the chance of an American man dying from prostate cancer hasn’t changed—it was 1:34 before the DRE/PSA screening era and that number hasn’t changed! In other words, we’re detecting a whole lot more prostate cancer but it isn’t doing any good, at least not on average when you look at the U.S. population.

Is this to say that prostate cancer screening never does any good? Absolutely not. If you happen to be one of the rare men who has a potentially lethal prostate cancer and it is caught early and removed, then DRE/PSA screening just saved your life. The problem is, and it is a rather large problem, that MOST men eventually get prostate cancer and most men never suffer any problems from it—they end up dying from something else that is unrelated before their prostate cancer causes any problems. This is because prostate cancer is usually an incredibly slow growing cancer—sometimes it isn’t, but most of the time it is and you can (and many of the male readers probably are!) live with it for decades and never have any symptoms. Again, that’s not to say that prostate cancer can’t be deadly and rapidly progressive, because it most certainly can be—the only cancer that kills more American men than prostate cancer is lung cancer. But this is relatively rare compared to the cases of indolent (slow-growing) prostate cancers.

In a nutshell, routine DRE/PSA screening appears to have resulted in physicians detecting a lot more clinically irrelevant, indolent prostate cancers without decreasing the rate of death from malignant, deadly prostate cancer. This is a major problem because popping positive on a routine DRE/PSA screen sets you up for a biopsy, probably followed by either surgery, radiation therapy, hormonal therapy, or a combination of the above. All of these treatments have substantial side-effects including a 1:200 chance of death on the operating table during surgery, urinary incontinence (you pee on yourself for the rest of your life), erectile dysfunction, and bowel dysfunction. Again, DRE/PSA screening followed by biopsy and treatment does save some lives—but it results in a heck of a lot more men having nasty side-effects from the treatment of a cancer that never would have bothered them in the first place because it was so slow growing that something else would have killed them first (a heart attack, stroke, car accident, etc.).

While the USPSTF recommends against prostate cancer screening, they have caught a lot of flak from the urological and cancer societies for this position. Urologists (doctors who specialize in the genitourinary tract, including the prostate) especially are up-in-arms over the new USPSTF recommendations, but the problem is that both urological and cancer societies have a vested interest in this issue (they make money through cancer screening and the increased biopsy and treatment procedures that result from it). On the other hand, the USPSTF is a neutral body—guess whose opinion I give more weight (it’s the USPSTF, in case you didn’t recognize my sarcasm). The USPSTF isn’t saying that DRE/PSA screening isn’t indicated for some men—if you have a history of multiple family members that have died from prostate cancer then you should definitely speak with your physician about the risks-vs.-benefits of screening. What they are saying is that routine DRE/PSA screening of every man does more harm than good on average and that this position is well-supported by a large body of high quality medical research.

Hoffman, RM. Screening for prostate cancer. In:UpToDate. http://www.uptodate.com/contents/screening-for-prostate-cancer?source=search_result&search=prostate+cancer+screening&selectedTitle=1%7E17. Accessed March 27, 2013.

Dr. Leonardo Noto

Physician and Author of Medical School 101, Intrusive Memory, The Life of a Colonial Fugitive, and The Cannabinoid Hypothesis.

Author Bio: Dr. Leonardo Noto is the nom de plume of a former airborne battalion surgeon who is now in civilian practice. Dr. Noto is the author of four books and he also writes for a medical education corporation that assists medical students, interns, and residents as they prepare for the medical board examinations. Dr. Noto is the proud father of an extremely spoiled 12-month-old American Bulldog who enjoys slobbering everywhere and tearing up things that he is not supposed to! Dr. Noto is an amateur practitioner of muay Thai and Brazilian jiu jitsu and he recently began learning to play the guitar (but he is currently a quite terrible musician, as his neighbors will readily attest).

Remember to discuss all health concerns with your personal physician (I don’t count!) before making any medical decisions. www.leonardonoto.comis intended to present general medical information for entertainment purposes and not as specific guide to any medical treatment. The author has made every effort to present accurate information; however, due to the ever-changing nature of medicine and the intrinsic caveats that are inherent in any particular case, no medical decisions should ever be made based on information gleaned from the internet (duh!). The internet and self-education are great, but they don’t replace your Doc!

The Life of a Colonial FugitiveIntrusive MemoryMedical School 101The Cannabinoid Hypothesis

What the Heck Did My Doctor Just Call Me!!!—Medical Lingo 101.

I thought that we’d have a little fun today and go over some commonly used medical lingo—yes, some of it SHOULDN’T be commonly used, but it is! While we’re at it, let’s briefly discuss medical specialties and, keeping with our lighthearted theme of the day, the stereotypes that go with each.

1. Supratentorial: Due to an etiology (cause) that is located above the tentorium cerebelli, a thick membrane that roughly divides the old “reptile” brain from the conscious/thinking part of your noodle. Example—“I think that his back pain is supratentorial in etiology.” “I concur and I suspect that he may be narcotic-seeking.”

2. Concur: A way of saying “I agree” in the pretentious, better-than-thou, manner that is favored by some physicians. See also, “Napoleon complex” and “short urethra syndrome.”

3. Frequent Flier: A derogatory term that is used to refer to people who present to the Emergency Department every single day for dubious complaints—often secondary to narcotic addiction/drug-seeking or due to psychiatric illness.

4. FOS: Full-of-stool or full-of-sh^t. A commonly reported finding in abdominal X-rays that is also used alternatively to describe some common clinical scenarios. Example—“He’s FOS on X-ray; you should order a laxative.” “This guy’s totally FOS! He’s complaining of back pain one minute and playing basketball the next!”

5. High Fiver: A derogatory term for a patient who is HIV+ (“V” = 5 in the Roman system of numerals).

6. Candy Man: A physician who is notorious for prescribing excessive quantities of narcotics to questionable patients, i.e. drug-seekers.

7. Black Cloud: A physician who, when present, seems to result in an excessive number of admissions to the hospital and an increase in the amount of work for everyone else.

8. Angel of Death: An unfortunate physician whose presence seems to result in an increase in the death of patients on his service.

9. Turf: Sending a difficult patient to another service so that they are no longer your problem. “Buff and Turf” refers to the process of patching a patient up just enough to make them look stable so that they will be accepted by the service that you are trying to sucker into taking them.

10. Rock: A patient who is medically stable but can’t be discharged from the hospital due to social issues. “It kills me that we can’t discharge any of these rocks today because the rehabilitation center doesn’t accept patients who don’t have insurance.”

11. Pimping: The process of teaching by the Socratic Method on rotations. Example: “My attending asked me ten pimp questions during rounds this morning and I didn’t know an answer to any of them—I think that I’m going to cry!” Pimping is also used, quite effectively, by some attendings and residents to inflate their egos at the expense of medical students and interns.

12. Attending: A board-certified physician who is responsible for supervising residents, interns, and medical students in the hospital or in the clinic.

13. Medical Student: A pitiful being who has no life outside of medical school. Often referred to as a “scut monkey,” a “med stud,” or “#%&*@%” by interns, residents, nurses, and attendings.

14. Intern: One of the more miserable humans on the face of the planet. The internship is the first year of post-graduate medical training and interns are usually the most overworked, most harassed, and least happy people in the hospital. Sometimes referred to as “’terns.”

15. Resident: A physician who is still in post-graduate training but who has completed his intern year, thus allowing him to dump “scut work” onto the unfortunate interns on his service. This allows the resident enough free time to have some semblance of a life outside of the hospital.

16. Moonlighting: The common practice of working extra shifts in low acuity settings (e.g. in an Urgent Care) during residency to earn extra income.

17. Wards: A term for the regions of the hospital that are devoted to specific services. Example—“I work on the surgical wards, which is why I hate my life.”

18. Life Support: The vernacular term for mechanical ventilation (a machine that breathes for the patient).

19. DNR: Do Not Resuscitate order. Often signed by patients who are terminally ill with a disease for which there is no curative treatment—this is because advanced resuscitation is a violent and potentially painful procedure that is of dubious benefit in a person who is terminally ill with an incurable disease.

20. GOMER: Get Out of My Emergency Room! A derogatory term for chronically ill (and usually elderly) patients who present to the ER on a regular basis. A term that is rarely used today (thankfully), GOMERs were common in the pre-DNR era when patient’s with incurable diseases were kept alive for as long as possible (and usually with an utterly miserable quality of life) whether they liked it or not.

21. Code Blue: Specifically, a cardiac arrest in the hospital. Less specifically, any situation in which a patient is actively attempting to die while in the hospital.

22. MICU: Medical Intensive Care Unit. The area of the hospital that is reserved for patients who are extremely ill and who are (usually) being treated with a mechanical ventilator. The ICU is managed by either a Pulmonologist or an Intensivist—both subspecialties of Internal Medicine. An example of a patient who would be treated in the MICU is someone who has just suffered a massive heart attack.

23. SICU: Surgical Intensive Care Unit. The area of the hospital that is dedicated to the postoperative care of the sickest and most fragile surgical patients. An example of a patient who would be treated in the SICU is an electrical worker with burns to 70% of his body.

24. Medicine: Internal Medicine—Warning: Do not use this term around Family Medicine physicians because they find it offensive. Stereotype = bookish/dork. Note: An Internal Medicine physician who has completed their residency but who has not completed a fellowship is called an “Internist.” An Internist is not the same thing as an Intern!

25. Psych: Psychiatry. Stereotype = crazy and lazy. “What is an alcoholic? A person who drinks more than their psychiatrist does.”

26. FP or FM: Family Medicine. The classic general practitioner/jack of all trades. Stereotype = inferiority complex.

27. OB/GYN: Obstetrics (dealing with pregnant women) and Gynecology (anything else that has to do with the female reproductive tract). Male Stereotype = misogynist. Female Stereotype = femi-nazi.

28. Gen Surg: Pronounced “jen” surg and sometimes used as shorthand for General Surgery. General surgery = surgery on anything that isn’t covered by another surgical specialty (e.g. neurosurgery/brain and spine; orthopedics/bones; vascular surgery/blood vessels and heart; etc.). Stereotype = narcissist/jerk.

29. Peds: Pediatrics (pronounced with a long “E”). Stereotype = immature.

30. ER: Emergency Medicine (pronounced with a long “E” and a short “R”). Stereotype = attention deficit disorder; intellectually challenged.

31. Anesthesia: No real lingo here, but the Stereotype = “druggie” due to a high incidence of narcotic addiction (dentists have a high incidence of this problem too).

32. Derm: Dermatology. Stereotype = lazy and superficial.

33. Ortho: Orthopedic Surgery. Stereotype = jock/bonehead. “Where do you hide a $100 bill from an orthopedist? In a medical journal.”

34. Path: Pathology. Stereotype = genius with no social skills.

35. Ophtho: Ophthalmology. Stereotype = blind as a bat. Note: Ophthalmology is pronounced with an “F” sound (“ph” = “f”) while optometry is not (no “h” after the “p”).

36. Fellowship: Post-residency training that is performed to become a subspecialist. Fellowships are especially common in Internal Medicine, where they are the norm. Most fellowships are 2-3 years in length. Example: To become a Cardiologist you must complete a 3 year Internal Medicine residency and then a 3 year Cardiology fellowship.

37. Rheum: Rheumatology (pronounced “room”). A subspecialty of Internal Medicine that focuses on the treatment of autoimmune diseases.

38. ID: Infectious Disease. A subspecialty of Internal Medicine that deals with infectious diseases that are especially difficult to treat (e.g. HIV, tuberculosis, and Fever of Unknown Origin).

39. Nephro: Nephrology. A subspecialty of Internal
Medicine that specializes in the treatment of kidney diseases, including patients who require mechanical dialysis.

40. Pulm: Pulmonology. A subspecialty of Internal Medicine that specializes in the treatment of lung diseases, including patients who require mechanical ventilation.

41. Vascular: Vascular Surgery. A subspecialty of General Surgery that focuses on the surgical correction of diseases of the arteries and of the heart. Stereotype is narcissist/jerk.

42. Neurosurg: Neurosurgery. Sometimes also referred to simply as “neuro,” much to the consternation of neurologists (a neurologist is essentially an internist who specializes in the central nervous system, even though they are now days a separate specialty from internal medicine). Stereotype = sleep-deprived genius who never leaves the hospital. Vitamin D deficiency is an occupational risk of this profession due to extensive hours spent in the hospital without exposure to sunlight (not joking).

43. Hand: Hand Surgery. A subspecialty of Orthopedic Surgery—at high risk of being sued for malpractice because if you make a mistake while operating on someone’s hands you screw up their life!

Dr. Leonardo Noto

Physician and Author of Medical School 101, Intrusive Memory, The Life of a Colonial Fugitive, and The Cannabinoid Hypothesis.

Author Bio: Dr. Leonardo Noto is the nom de plume of a former airborne battalion surgeon who is now in civilian practice. Dr. Noto is the author of four books and he also writes for a medical education corporation that assists medical students, interns, and residents as they prepare for the medical board examinations. Dr. Noto is the proud father of an extremely spoiled 12-month-old American Bulldog who enjoys slobbering everywhere and tearing up things that he is not supposed to! Dr. Noto is an amateur practitioner of muay Thai and Brazilian jiu jitsu and he recently began learning to play the guitar (but he is currently a quite terrible musician, as his neighbors will readily attest).

Remember to discuss all health concerns with your personal physician (I don’t count!) before making any medical decisions. www.leonardonoto.com is intended to present general medical information for entertainment purposes and not as specific guide to any medical treatment. The author has made every effort to present accurate information; however, due to the ever-changing nature of medicine and the intrinsic caveats that are inherent in any particular case, no medical decisions should ever be made based on information gleaned from the internet (duh!). The internet and self-education are great, but they don’t replace your Doc!

Doc’s Books!

The Life of a Colonial FugitiveIntrusive MemoryMedical School 101The Cannabinoid Hypothesis

Screening Hippies for Hepatitis C (Baby Boomers, Read This!).

The CDC now recommends that EVERYONE born between 1945-1965 should undergo a one-time blood test for hepatitis C infection. Hepatitis C is a virus that causes (surprise!) hepatitis and it is spread primarily by body fluids, especially by blood. Hepatitis C is most common in people who have EVER used intravenous drugs and shared their needles. Since the disease can lie dormant for decades before reactivating and destroying your liver, the CDC has decided that all of you former hippies who lived in the drug experimentation and free sex era of the ‘60s and ‘70s should be screened for this disease (it can also be transmitted sexually, but this is thought to be fairly uncommon). Hepatitis C is a leading cause of liver cirrhosis—a destructive process that turns the liver into a ball of scar tissue—and it also predisposes people who are infected to vasculitis (an inflammatory disease of the blood vessels) and to liver cancer. There is currently no effective vaccination for Hep C and the drug treatments for this disease are rather nasty–but better than dying young from liver failure or liver cancer.

Hepatitis is a generic term for inflammation of the liver (“-itis” means “inflammation” in medicalese) and it can be caused by a litany of diseases processes. The hepatitis viruses, hepatitis A-E, are the most common infectious causes of hepatitis. Hepatitis A is a foodborne illness that is spread by people who don’t wash their hands—this disease is very common in the developing world and it also is occasionally spread by your friendly fast-food restaurant when employees fail to wash their hands before preparing your triple-heart-attack-megaburger. Hep A is an acute disease and once you’ve recovered you’re generally immune—there is also a vaccination that is highly effective and that is a really good idea to get before you go on that trip to Central America. Like hepatitis C, hepatitis B is a chronic form of hepatitis—a gift that keeps on giving! Hep B is spread by body fluids–sexual transmission is common. There is an effective vaccine for Hep B and this makes me very happy because healthcare workers are at high risk for Hep B secondary to needle stick injuries in the hospital. Hepatitis D and E are more common in developing countries than in the U.S. Hep D is especially dangerous to pregnant women while Hep E is an acute disease that presents with a clinical picture that is similar to Hep A. Excessive alcohol consumption and some medications, including a the tuberculosis drug isoniazid, are common non-viral causes of acute hepatitis.

Dr. Leonardo Noto Physician and Author of Medical School 101, Intrusive Memory, The Life of a Colonial Fugitive, and The Cannabinoid Hypothesis.

Author Bio: Dr. Leonardo Noto is the nom de plume of a former airborne battalion surgeon who is now in civilian practice. Dr. Noto is the author of four books and he also writes for a medical education corporation that assists medical students, interns, and residents as they prepare for the medical board examinations. Dr. Noto is the proud father of an extremely spoiled 12-month-old American Bulldog who enjoys slobbering everywhere and tearing up things that he is not supposed to! Dr. Noto is an amateur practitioner of muay Thai and Brazilian jiu jitsu and he recently began learning to play the guitar (but he is currently a quite terrible musician, as his neighbors will readily attest).

Remember to discuss all health concerns with your personal physician (I don’t count!) before making any medical decisions. www.leonardonoto.comis intended to present general medical information for entertainment purposes and not as specific guide to any medical treatment. The author has made every effort to present accurate information; however, due to the ever-changing nature of medicine and the intrinsic caveats that are inherent in any particular case, no medical decisions should ever be made based on information gleaned from the internet (duh!). The internet and self-education are great, but they don’t replace your Doc!

The Life of a Colonial FugitiveIntrusive MemoryMedical School 101The Cannabinoid Hypothesis

Why Chocolate Makes You Feel Good (Hint: It’s not just the Sugar and the Fat).

Chocolate has been consumed in the Americas since at least the days of the Aztecs; indeed, cacoa (aka: cocoa) beans were used as a currency by the indigenous people of Central America before the arrival of Europeans in the early 16th century (1500s). Chocolate is a fascinating food and, as we will see, it is also a psychoactive drug. Though the findings need to be confirmed, there have been several reputable studies over the past decade that have shown decreased all-cause mortality, increased insulin sensitivity, and positive effects on both cholesterol levels and cardiovascular health in people who consume chocolate in moderation verses those who don’t – interestingly, a study in The Journal of the American Medical Association (JAMA) last year also found that regular consumers of chocolate (in moderation) were less likely to be obese than were non-chocolate eaters!

Chocolate grows on cacoa trees in South America (originally), West Africa, and in Indonesia. These trees produce pods that contain cacoa beans which are then dried under the sun. You can actually buy pieces of cacoa beans on the internet and in specialty food stores like Trader Joes; but most cacoa beans are ground up and mixed with dairy products and sugar to produce the chocolate that we all know and love.

The simplest reason that eating chocolate makes you feel good is that the store version contains a bunch of added sugar and fat, both of which cause the release of endorphins (natural opiates) when you eat them — fatty and sugary foods are loaded with energy and this release of endorphins probably evolved to encourage hungry cavemen to eat as much of them as possible whenever they got the chance to store fat for the lean times that were always just around the corner. These same endorphins are released during sex and many other evolutionarily important activities (no sex = no people, right) and they are an important part of the natural rewards system of the brain.

But chocolate is a lot more complicated than your run-of-the-mill fatty and sugary food because it also contains at least five other classes of psychoactive compounds. Chocolate contains anandamide, a naturally occurring cannabinoid that functions the same way THC does when you smoke marijuana – the difference being that there is much less anandamide in a chocolate bar than there is THC in a joint. Chocolate also contains a moderate amount of caffeine, the mild stimulant that is found in coffee, tea, and in caffeinated sodas. But chocolate’s stimulant effects don’t stop with caffeine because chocolate also contains phenylethylamine, a naturally occurring analog of amphetamine. Finally, chocolate contains high levels of tryptophan, the precursor of serotonin (recall that serotonergic drugs are used as antidepressants).

I don’t know about you, but I want some chocolate – Dove Dark Chocolate anyone?

FYI: I just found out that Dove Dark Chocolate is gluten free but Hersey’s Special Dark is not – both contain dairy/lactose.

Dr. Leonardo Noto

Physician and Author of Medical School 101, Intrusive Memory, The Life of a Colonial Fugitive, and The Cannabinoid Hypothesis.

Author Bio: Dr. Leonardo Noto is the nom de plume of a former airborne battalion surgeon who is now in civilian practice. Dr. Noto is the author of four books and he also writes for a medical education corporation that assists medical students, interns, and residents as they prepare for the medical board examinations. Dr. Noto is the proud father of an extremely spoiled 12-month-old American Bulldog who enjoys slobbering everywhere and tearing up things that he is not supposed to! Dr. Noto is an amateur practitioner of muay Thai and Brazilian jiu jitsu and he recently began learning to play the guitar (but he is currently a quite terrible musician, as his neighbors will readily attest).

Remember to discuss all health concerns with your personal physician (I don’t count!) before making any medical decisions. www.leonardonoto.comis intended to present general medical information for entertainment purposes and not as specific guide to any medical treatment. The author has made every effort to present accurate information; however, due to the ever-changing nature of medicine and the intrinsic caveats that are inherent in any particular case, no medical decisions should ever be made based on information gleaned from the internet (duh!). The internet and self-education are great, but they don’t replace your Doc!

What is a Heart Attack and How do I Keep from Finding Out the Hard Way?

The medical term for a heart attack is “myocardial infarction,” which is often abbreviated as “MI.” The heart is essentially a blood pump that receives oxygen-rich blood from the lungs and then pumps it out to the rest of the body. Recall that oxygen is used to oxidize (oxidize ~ “burn”—actually a very close analogy) food for energy to power the cells of the human body. Because blood is a thick fluid that has to be pumped over a long distance, the little ole heart (about the size of a large man’s fist) works its butt off 24/7—never pausing for even a moment to rest over the course of your entire life! Work is powered by energy and making energy from the foods that we eat requires oxygen that is delivered by the blood; thus, the thick heart muscle needs access to a lot of oxygenated blood to keep ticking (the blood inside the heart doesn’t cut it because the heart muscle is too thick to be supplied by diffusion). The arteries that supply the heart muscle with oxygen- and nutrient-rich blood are the left and the right coronary arteries.

An MI is caused by the rupture of a cholesterol plaque in one of the coronary arteries or in one of their major branches. A normal artery—and your coronary arteries are no exception—are as smooth as a baby’s behind on the insides, allowing for blood to flow through them smoothly. High levels of cholesterol do their dirty work by forming little pockets inside the walls of the arteries that are called plaques. People with healthy levels of cholesterol rarely get these plaques, but the generous portions and high fat content of the Western diet virtually ensure that most people in the developed world have started to build up cholesterol plaques in their arteries before they are even legally an adult. These cholesterol plaques slowly grow over the years and decades until finally one weakens and pops open, just like a bulging zit on a teenager’s face. When a plaque ruptures through the smooth lining of the coronary artery that it was growing underneath it transforms the smooth arterial surface into a rough and jagged one in a matter of seconds. This disrupts the smooth flow of blood through the artery. Platelets—the blood cells that are responsible for stopping the bleeding when you cut yourself shaving or when you get a scratch—start sticking to the ruptured plaques and they form a thrombus. A thrombus is a blood clot and a blood clot inside the tiny lumen of a coronary artery is a very, very bad thing because it blocks blood flow to the heart muscle. Like any other tissue in the body, heart muscle dies when it is deprived of the oxygen that is carried by the blood, a process known as ischemic cell death. Ischemic cell death of the heart = myocardial infarction = a heart attack!

In Summary: High Cholesterol Over a Long Period of TimeàCholesterol Plaques in the Coronary ArteriesàPlaque RuptureàThrombus FormationàBlockage of the Affected Coronary ArteryàIschemic Cell Death of the Heart Muscle (aka: Myocardial Infarction or Heart Attack).

The death of heart muscle sets off a vicious cycle because the heart is responsible for pumping oxygenated blood to the rest of the body. This means that a heart that can no longer efficiently pump blood results in the ischemic death of the rest of the body—the body dies of oxygen-deprivation, essentially internally suffocating due to the lack of blood flow. Modifiable risk factors for myocardial infarction/heart attack (i.e. ones that you can change) include: smoking, sedentary lifestyle, high blood pressure, poorly-controlled diabetes (if you’re diabetic), and high cholesterol. So quit smoking, get off your butt and exercise, and get your blood pressure, blood sugar, and cholesterol checked—your heart and body will thank you for it (remember to consult with your physician before starting any new exercise program)!

Dr. Leonardo Noto

Physician and Author of Medical School 101, Intrusive Memory, The Life of a Colonial Fugitive, and The Cannabinoid Hypothesis.

Author Bio: Dr. Leonardo Noto is the nom de plume of a former airborne battalion surgeon who is now in civilian practice. Dr. Noto is the author of four books and he also writes for a medical education corporation that assists medical students, interns, and residents as they prepare for the medical board examinations. Dr. Noto is the proud father of an extremely spoiled 12-month-old American Bulldog who enjoys slobbering everywhere and tearing up things that he is not supposed to! Dr. Noto is an amateur practitioner of muay Thai and Brazilian jiu jitsu and he recently began learning to play the guitar (but he is currently a quite terrible musician, as his neighbors will readily attest).

Remember to discuss all health concerns with your personal physician (I don’t count!) before making any medical decisions. www.leonardonoto.com is intended to present general medical information for entertainment purposes and not as specific guide to any medical treatment. The author has made every effort to present accurate information; however, due to the ever-changing nature of medicine and the intrinsic caveats that are inherent in any particular case, no medical decisions should ever be made based on information gleaned from the internet (duh!). The internet and self-education are great, but they don’t replace your Doc!

Is Coffee Really Bad for You (+ A Blurb about Antioxidants and what they Really Are)?

Thankfully for me and all you other worshippers of the dark nectar of the gods, the answer appears to be “no” based on a new study published in May 2012 in The New England Journal of Medicine. In “Association of Coffee Drinking with Total and Cause-Specific Mortality” the researchers found that people who drink coffee have lower all-cause mortality than those who don’t—in English, that means that coffee drinkers are less likely to die (on average) than non-drinkers of my favorite beverage. This study had a few really strong points and a few weaknesses, with its biggest strength being that it was a huge study, which makes it a lot less likely that the results were due to random chance (in very small studies there is a risk of accidentally picking a non-representative sample of patients, but this is MUCH less likely with a big and robust study like this one). One major flaw in the study design is that the researchers didn’t differentiate between the type of coffee that people were drinking. This might matter because filtered coffee appears to be better for you than non-filtered coffee because the filter removes substances in the beans that raise your cholesterol—not a good thing because high levels of cholesterol in the blood predispose you to heart attacks and strokes. Another major weakness of the study is that the authors weren’t able to determine why coffee drinkers die less often than non-drinkers. One likely reason is that coffee drinkers are less likely to fall asleep behind the wheel or while operating dangerous machinery. Another possible reason is that coffee contains beneficial antioxidants (see below) and that coffee seems to decrease the damage that drinking alcohol does to your liver (alcoholics who are also coffee drinkers have a lower rate of liver cirrhosis).

Since I mentioned the magic word “antioxidants” above, let’s briefly talk about them because people throw out this word about damn near everything today—heck, it wouldn’t surprise me if the Coca Cola company were to put out an advertisement stating that sugary, diabetes-inducing colas are really good for you because they’re full of antioxidants (they’re not, and they’re certainly not good for you). The whole antioxidant thing is based upon your body’s metabolism. Every cell in your body is essentially a miniature coal burning power plant, except instead of using oxygen to burn coal your body uses oxygen (from your breathing) to oxidize (“burn”) the foods that you eat and the fat that you store in your gut and your butt. Oxidation releases energy but it also releases oxygen free radical, little molecules that are damaging to your body just like the soot that is released from a coal power plant is (the coal plant oxidizes coal, by the way). Antioxidants are any substance that neutralizes these oxygen free radicals and there are a lot of them in natural foods. Vitamin C is probably the best known antioxidant but you could probably fill a whole book cataloging all of the ones that are naturally found in nature and another book or two with ones that can be synthesized in a laboratory.

Dr. Leonardo Noto

Physician and Author of Medical School 101, Intrusive Memory, The Life of a Colonial Fugitive, and The Cannabinoid Hypothesis.

Author Bio: Dr. Leonardo Noto is the nom de plume of a former airborne battalion surgeon who is now in civilian practice. Dr. Noto is the author of four books and he also writes for a medical education corporation that assists medical students, interns, and residents as they prepare for the medical board examinations. Dr. Noto is the proud father of an extremely spoiled 12-month-old American Bulldog who enjoys slobbering everywhere and tearing up things that he is not supposed to! Dr. Noto is an amateur practitioner of muay Thai and Brazilian jiujitsu and he recently began learning to play the guitar (but he is currently a quite terrible musician, as his neighbors will readily attest).

Remember to discuss all health concerns with your personal physician (I don’t count!) before making any medical decisions. www.leonardonoto.comis intended to present general medical information for entertainment purposes and not as specific guide to any medical treatment. The author has made every effort to present accurate information; however, due to the ever-changing nature of medicine and the intrinsic caveats that are inherent in any particular case, no medical decisions should ever be made based on information gleaned from the internet (duh!). The internet and self-education are great, but they don’t replace your Doc!

What does your Blood Pressure have in Common with your Garden Hose?

The answer is “quite a lot, actually.” When you turn up the tap on your garden hose, what happens? In addition to the obvious side effect of increasing the water output of the hose, the increased fluid that enters your garden hose also causes it to become firmer and harder to bend. This is because increased fluid in a pipe (or hose in this instance) that doesn’t expand causes the pressure inside the hose to increase. The same thing happens when you have extra fluid in your arteries, something that can be caused by eating too much salt (more on that in a moment) or by some serious medical conditions, especially kidney failure. Returning to our garden hose analogy, what happens when you either partially squeeze the hose shut or place your thumb over part of the hose’s mouth? Again, the pressure inside the hose increases and the result is a spray of fast-moving water jetting out of the end.

Your arteries behave in a very similar fashion, but let’s quickly review some blood pressure basics before we dig in any deeper. Blood pressure is the pressure of the blood inside your arteries (thanks genius, right?). Venous blood enters the right-side of the heart and is then pumped into the lungs to be oxygenated by the air that you breathe. This oxygenated blood then flows into the powerful left-side of the heart and is pumped into the arteries. Blood pressure is measured by compressing an artery in your upper arm (the brachial artery) with a blood pressure cuff while the physician or nurse listens to the brachial artery with a stethoscope. The physician or nurse then inflates the cuff until the pulse in the brachial artery disappears: the systolic blood pressure (top number). They then release the cuff until they can hear the pulse of the brachial artery return: the diastolic blood pressure (bottom number). Blood pressure is recorded in millimeters of mercury (mmHg), a standard measurement of fluid pressure, and a normal blood pressure is about 120/80 mmHg. The systolic blood pressure (top number) corresponds to the highest pressure in the artery, which occurs when the heart is actively beating/pumping. The diastolic blood pressure corresponds to the lowest pressure in the artery, which occurs when the heart is relaxing and filling with more blood to pump out during the next heartbeat.

There are two primary ways that your body can increase the blood pressure, for better or for worse. The first is to increase the amount of fluid in the bloodstream, i.e. increase the amount of fluid in the garden hose. The kidneys are the regulators of the body’s fluid load, with excessive fluid being excreted in the urine. People with kidney dysfunction or who eat too much salt in their diet commonly have high blood pressure due to fluid overload. The second major way to increase blood pressure is to narrow the arteries, i.e. to squeeze the garden hose. The arteries have muscular walls that can contract when the body tells them to. Both the fight-and-flight response (i.e. stress response) and the use of drugs that mimic the stress response cause narrowing of the arteries and the medical term for this is vasoconstriction.

We have seen that high blood pressure (aka: hypertension) is primarily caused by one of two problems: 1. Too much fluid in the arteries/garden hose, or 2. Vasoconstriction. Most blood pressure medications attack one of these mechanisms of hypertension or even both. Diuretics increase fluid excretion by the kidneys, increasing the production of urine and decreasing the amount of fluid in your arteries. Calcium-channel blocks cause vasodilation—relaxation of the arterial walls, i.e. vasodilation. ACE inhibitors attack both mechanisms, increasing the amount of fluid that is excreted by the kidneys and also by causing vasodilation.

Hypertension is known as the silent killer because you feel fine for years, even decades, until suddenly you don’t—and that sudden wakeup call is often a hypertension-induced stroke, heart attack, or kidney failure, all of which are life-altering (if not life-ending) events. So what are you waiting for? Do both your brain and your body a favor and get your blood pressure checked by someone who knows what they’re doing today!

Dr. Leonardo Noto

Physician and Author of Medical School 101, Intrusive Memory, The Life of a Colonial Fugitive, and The Cannabinoid Hypothesis.

Author Bio: Dr. Leonardo Noto is the nom de plume of a former airborne battalion surgeon who is now in civilian practice. Dr. Noto is the author of four books and he also writes for a medical education corporation that assists medical students, interns, and residents as they prepare for the medical board examinations. Dr. Noto is the proud father of an extremely spoiled 12-month-old American Bulldog who enjoys slobbering everywhere and tearing up things that he is not supposed to! Dr. Noto is an amateur practitioner of muay Thai and Brazilian jiu jitsu and he recently began learning to play the guitar (but he is currently a quite terrible musician, as his neighbors will readily attest).

Remember to discuss all health concerns with your personal physician (I don’t count!) before making any medical decisions. www.leonardonoto.comis intended to present general medical information for entertainment purposes and not as specific guide to any medical treatment. The author has made every effort to present accurate information; however, due to the ever-changing nature of medicine and the intrinsic caveats that are inherent in any particular case, no medical decisions should ever be made based on information gleaned from the internet (duh!). The internet and self-education are great, but they don’t replace your Doc!