but can we afford it

BUT CAN WE AFFORD IT
thats what i thought when i read about these two treatments
one for stroke
the other for cholesterol which if controlled can help prevent
stroke heart disease and maybe alzheimers disease

now i have an elevated homocysteine level that some
neurologists believe is associated with an increased risk
of stroke heart disease and alzheimers disease


the treatment is easy
take folic acid 0.8 mgm a day
thats the amount in a prenatal vitamin

i take folic acid (folate) every day
and
buy it in a bottle of 120 for $9

a cheap treatment easily available without a prescription

a new study showed that those with high blood pressure that
took folic acid reduced their risk of stroke by a significant amount

so for $36 a year i could reduce my risk for stroke by a third
check that one off my list

the new alzheimers vaccine that is being studied extensively is
called solanezumab
if it works and comes to market
its expected to cost $20,000 a year

remember the ending of that drug ...umab

my ldl the bad cholesterol that increases ones risk for
stroke heart attack and alzheimers disease
is quite elevated off medication

the first time i had it done it was 240
thats heart attack stroke high

using diet and exercise that was lowered to 140
a reduction of about 42%
at a cost of $0 a year

adding generic lipitor for $5 a month at a cost of $60 a year
the ldl is lowered to 80
a reduction of 67% of my ldl
at a cost of $60 a year


now a drug company has developed at new drug
are you ready for this
called evolocumab
its an injection like the new alzheimers vaccine
that produces antibodies that grabs ldl cholesterol
and removes it from the circulation
at
a predictive cost of $10,000 a year
to get the ldl down to a 60% reduction

now i did that at a cost of $60 a year

i like my way better dont you

now
i can think of one patient i had who would have benefited
from taking this injectable medicine
sky high ldl like mine but she could not tolerate any medicines
of course there is no way she could afford this medicine

so thats the question we are going to have to answer about these
new treatments

can we afford them
and
are there better cheaper treatments

the organicgreen doctor

dont have a stroke

DONT HAVE A STROKE
in my practice which was a family practice
made up of mostly young healthy folks with some
older folks
i didnt have many patients who had strokes

if had a patient with a stroke it was usually a young person
sitting here trying to think of the men i had that had strokes
i remember only one and he was 19 when he had his
before he became my patient
his was caused by smoking uncontrolled blood pressure obesity
and severe high cholesterol

but the rest of my stroke patients were young females of
child bearing age
luckily for them there strokes were not life threatening and they
all seemed to have recovered well

there was usually some explanation like the pill hormone replacement
smoking migraines high blood pressure eg

new guidelines came out recently for women for stroke prevention
in addition to the usual recommendations
quit smoking
control blood pressure
control cholesterol
control diabetes
maintain a normal weight
exercise

uh thats the same as ways to slow down or prevent alzheimers also

the new guidelines focused on stroke risks more common in women
stroke is the third leading cause of death in women
they live longer than men so this may be one explanation of the increased
risk of stroke in women

here are the risks

migraine with aura
the women who suffers with these have a prodrome or warning before
that awful headache occurs
things like dizziness ringing zigzag lines in your vision light sensitivity eg
i had the zigzag lines once when i was in practice
my first thought was oh shoot im having a dang stroke
women have migraines more common than men and they seem to
be hormone related
if you add smoking birth control to this mix then the risk for stroke
is increased
women with migraine with aura should not smoke
nor should those who dont have migraine with aura

atrial fibrillation increases the risk for stroke
women over 75 should be screened for it
the left atrium fibrillates or doesnt beat right and a clot
can form there which can be dislodged and sent to the brain
causing a stroke
most of these i picked up was simply from listening to the heart
beat during an office visit
the treatment is converting this to a normal rhythm with medicine
or mild shock treatment
some women who have this have to take coumadin long term
to prevent clot formation

menopause 
women use to be given hormones to prevent strokes and heart attacks
thanks you drug companies for lying to us for years

birth control pills
women should be screened for high blood pressure before starting
the pill
they probably shouldnt take the pill if they have high blood pressure
or smoke
both increases the risk for stoke

most of the clotting events i had in female patients on birth control
were deep vein thrombosis a clot in the legs and
pulmonary embolism a clot in the lung
which can be fatal
it seems most of those clots were in women who were on the pill
and smoked

pregnancy
if a women has preeclampsia which causes elevated blood pressure
in pregnancy they are at increased risk for strokes later in life
and quadruple the risk for high blood pressure
the greatest risk for stroke during pregnancy with preclampsia is
the last 3 months and during the early postpartum time

elevated blood pressure before pregnancy needs to controlled

some women with this condition may need low dose aspirin treatment
during pregnancy

aspirin therapy
is recommended for women who have had a stroke not caused by a
ruptured blood vessel but by a clot
is recommended for women over 65
is recommended for women with type 2 diabetes
no one though should take aspirin unless they discuss it with
their doctor

so we men are well acquainted with the fact that women are different
than men
live with one and you know that for a fact

women do have risk factors for stroke that are also different
hopefully women will
take note of these new guidelines on stroke prevention in women

the organicgreen doctor

more texting

MORE TEXTING

ive written about texting before

texting while driving-what more can be said than dont do it
its like drinking and driving
bad things have happen to people who do this as well as
to innocent people in other cars and pedestrians

pedtexting is texting while walking-heck ive done this one a few times
ive even walked off a curb and walked into other people and
walked into a post but at least i didnt walk into the water
like that one lady did or walk into that fountain like another one did

cyclotexting is texting while bicycling-my wet suitcase sisterinlaw
crashed her bike that one time when she tried it


jetexting is texting while flying-no not you texting while you on an airplane
but
some pilots have been caught texting instead of flying the airplane
that one bothers me
sure makes me not want to fly
the captain asks that you turn off your cell phones please
doesnt apply to him

skitexting is texting while skiing-i now my sisterinlaw and her crew
have done that one
you think she would learn her lesson


now there is sleep texting or
sleeptexting
i dont think ive done this one yet
it seems its the younger generation that does so much texting all day
long that are the ones susceptible to sleeptexting
also those who have to get up in the middle of the night to communicate
across the globe to folks in china and elsewhere
some people wake up and text their dreams before they really wake up
you know when you are in that no mans land between the dream and
reality

i wonder if ambien use can cause sleeptexting since people sleepeat
and sleepdrive on that stuff

maybe what i should do is sleeptext my aricept dreams that i have
sometimes well almost every night
that way i would always remember what they were about
maybe i could text to my blog and just post them

how to prevent sleeptexting
turn the dam thing off
put it across the room or leave it downstairs
im surprised my wife she hasnt sleeptexted before
since she loves her smartphone so much
and
its an extention of her left hand now

then there is dystextia
you know like
dyslexia-you see words backwards and all jumbled up
dysgraphicism-thats what i have but thanks to the computer and
spell check you dont notice it
i think all doctors have this problem

dystextia is separate from butttexting or that texting that autocorrect does for
you sometimes that makes your message all garbaly

dystexia was demonstrated recently from this article from npr

a pregant young lady was leaving the obs office after a checkup
her husband texts whats the deal
she texts everywhere thinging days nighing
she texts some is where
he texts what the hell does that mean
he texts you are not making sense


well it seems his wife was having a stroke
he recognized  something was wrong
this was more than butttexting

he met her and took her to the hospital
she was having a stroke involving the area of the brain that
affects speech

usually with this type of stroke a persons speech would be impaired
but this lady had laryngitis and couldnt talk so no one noticed it

so dystexia can be a sign of a stroke

which tree drove french fries cloudy days

no just teasing

the organicgreen doctor

no flu no mi, wrong fish, 2 much fd

NO FLU NO MI

in a recent study patients given a flu shot had a 50% reduction in
the incidence of heart attacks compared to those who did
not get a flu shot

this has been noted before
there also is a reduced incidence of stroke and pulmonary embolism

the thinking is that the cholesterol plaque is a source of inflammation
in the artery and a flu infection worsens this inflammation and
cause s clot to form
thus causing a heart attack or stroke

get a flu shot prevent a heart attack or stroke or pe

also the shingles vaccine and the pneumococcal vaccine also
decreased the incidence but not quite as much as the flu shot

get your immunization against the flu
i did as
that would really tick me off if i got the flu and then had the
big one

also get the other two if they are indicated in your age group
if you are over 65 all three are indicated

WRONG FISH

i was reading the other day about how important it was to eat
fish 2-3 times a week for their omega 3
heck i was taking omega 3 fish oil but got tired of burping
fish all the time so i quit them
i know you need that extra omega 3
i also dont like the taste and smell of some fish for some reason

now
it has been found that close to 80% of red snapper is not really
red snapper
and other fish sold is not really the fish you were buying
thanks to dna analysis done on samples from restaurants and
fish markets and grocery stores
maybe thats why i dont like it

another worse offender was sushi
another reason not to eat sushi

so now i have another reason to not like fish
you may be getting ripped off
that red snapper may be a carp

2 MUCH FD

thats text lingo for too much food
thats what we are doing
throwing away too much food

40% of food is wasted
the average family of four wastes 20 lbs a year
and $2,275 worth a year

thats a lot of garbage

our family of two rarely throws food away
well my wife she is a food hoarder in the refrigerator

(maybe we could do a reality show on refrigerator hoarders
know where the first show could be)

so i do have to throw out some food
however its changed so much by the time i find it
i may not know what it was

if there is extra food thrown out
it goes to our chickens who love it even if they cant
tell what it is either
they produce eggs and compost which eventually
cycles back to us as food
so its really not lost

the biggest offender to this waste is big portions
so get a smaller plate yall

the organicgreen doctor

medicare wellness not exam, more strokes, horns win

MEDICARE WELLNESS NOT EXAM
as part of the healthcare protection act medicare now covers
an annual wellness not exam which includes

an update of the medical history
an update of the patients providers
preventative questions about screening as recommended
by the us preventative task force
screening for  depression
and a required screening for cognitive decline-may be an important
part of the visit as it is a required component

these are all important components but it
sounds like an almost annual physical battery of questions
but not as complete
therefore this medicare well not exam is a good thing but the

problem is
1 the wellness not exam was announced to be started january 2011
however it will not be implemented until april 2011
sounds like double talk
ie you can have it done jan feb 2011 but we wont pay for it until april 2011
maybe

2 they just need to pay for a physical and be done with it
the medical doctors payment will be about the same
and a better evaluation will be done
the appropriate tests based on this physical history and exam
and based on the recommended accepted guidelines for screening
for diseases can be then be ordered

it should be that simple

as a physician you can order a $3000 mri without problems but
can not do a $150 physical

that aint right

MORE STROKES
well its finally starting to hit the next generation
the prediction is that this next generation-your kids and grandkids-
will  not live as long as my/our generation does
probably all related to diet, obesity and lack of exercise

the american stroke association just announced that the incidence
of strokes in men 15-34 years old rose 51% since 1995 and
17% in women of that age while the incidence dropped in adult
males over 65 by 25% and women over 65 by 28%
the incidence of stroke increased by 47% in males 35-44 years old
 and by 36% in females 35-44 years old

this increase is probably been caused by obesity and the lack of
exercise and poor diet

lets see diet and exercise can be used to treat or prevent
depression, anxiety, diabetes, high blood pressure, osteoporosis,
cancer, stroke, heart attacks, mild cognitive decline, and maybe
alzheimers

the cost to do these treatments is zero
sounds like a cost effective treatment to me

HORNS WIN
horns basketball continues to roll
they beat oklahoma there easily
could they go unbeaten in conference
they probably need to loose at least one game
in conference play or the big 12 conference
to help them get ready for the big dance in march

togd