50 Years of Friendship

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Paula and I attended her high school class reunion this past weekend. It was great to see people reminisce and catch up; some of them hadn’t seen each other for 40 or 50 years or more. Some still live in the same community, some left but came back to live near where they grew up, and some, like Paula, have bounced all over the U.S. There were marriages, births, divorces, and deaths as you might expect and an incredible diversity of careers. But there were also enduring connections between human beings from different backgrounds who were thrown together in school. This was an example of a true social network, and it has endured for over 50 years.

I also noticed that just about everyone had a cell phone. I watched a group of men standing around talking and one began to show pictures. It could have been of grandchildren or even great-grandchildren. One comment I heard was “If we’re looking at pictures, I’m getting my phone, too.” The technology of today hasn’t escaped this Baby Boomer generation.

It made me wonder how things would have been different if they had today’s technology back then. A recently published study on the use of digital media by teenagers could give us some insight. We’ll take a look on Thursday.

What are you prepared to do today?

Dr. Chet

 

Getting What You Need from Your Office Visit

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Here’s what we know. Patients get frustrated with office visits because they don’t always feel that they’re being heard. Research confirms that even when the physician asks “What brings you in today?” patients are usually interrupted before they can finish their reason. Where does that leave us?

Let’s take a look from the physician’s perspective. They have a limited amount of time to determine what the problem is, and they’re faced with patients who may take a long time to explain their problem. They may interrupt to ask a question about a symptom. While the physician may ask it with good intentions and think it will save time, it may redirect the patient to somewhere other than their main issue.

Don’t forget that physicians are trained to be problem-solvers. That’s different from being trained to take a healthy person and help them to attain optimal health. They’re trained that when people come to their office, something’s wrong and they need to fix it. Nothing wrong with that approach, but it’s also possible they miss issues during that process.

What can you do? Here are three steps to getting what you need from your office visit:

  1. Be organized before you go to the office. You’re going to be asked what medications you’re taking and any dietary supplements you’re taking. Write them all down, names and dosages, preferably in a printable document separating prescriptions from supplements. You’ll be asked about other doctors you’ve seen and why, plus any medical tests or procedures you’ve had. Note them on your list. Then write down the most significant symptom or symptoms you have.
  2. Take control of the visit. If you’re not asked, state as succinctly as possible what’s bothering you. Then answer the questions that are most likely to be asked. When did this begin? How bad is the pain? What have you already tried? You can anticipate questions and be prepared to answer them. If you’re interrupted, there’s nothing wrong with saying, “Please let me finish before I lose my train of thought.” Keep it on point; don’t stray into health issues that aren’t your objective that day.
  3. When you both decide on a course of action, get a verbal summary and written instructions if necessary. Ask questions. “We’re doing this blood test in order to test whether my blood sugar level is high? Do I have that right?” You want to leave that office with a plan of action. Understand that this visit may not completely resolve your issue until there’s more information to evaluate, but it starts the process. It’s up to you to follow through on what the doctor ordered and the steps you agreed to take.

The Bottom Line

Being healthy—and that includes when you’re not healthy and need to get back to it—requires teamwork. You have to find a way to make your physician listen to you, and you have to be precise in how you talk to him or her; remember they’re scientists at heart.

In my observation, many physicians haven’t been trained to treat patients as human beings. It isn’t that they can’t, it’s just the inherent weakness in their training as problem-solvers. Some doctors will be naturally good at listening and understanding, but it’s probably their personal instincts or experience rather than training.

Understand one thing about this process: you’re the customer and they’re selling their services. Patient satisfaction is becoming an important measure of how healthcare services of all kinds are evaluated. You’re the one in charge. I don’t say this lightly because I know access to healthcare can be challenging in some areas, but if you don’t get the service you need, fire that doctor and find another who will listen to you as a human who needs his or her expertise. Then do your job to be ready to help them do theirs. It’s the only way this crazy system will ever work.

What are you prepared to do today?

Dr. Chet

 

References: J Gen Intern Med (2018). https://doi.org/10.1007/s11606-018-4540-5

 

You Have 11 Seconds: Go!

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Did you ever leave a doctor’s appointment feeling that you never really described what the problem was or that you got sidetracked onto less important issues? Even if you went in organized to the extent that you could, your real concerns were shoved aside? I know hundreds of people who’ve felt that way. Let’s get back to the study I described Tuesday.

The researchers examined a randomized sample of the office visits, which were viewed independently and then ranked as to the nature of the visit. They first looked at whether the physician attempted to elicit a reason for the patient’s visit or not: turns out that the physicians asked only about a third of the time.

If they did ask, the researcher then timed how long the patient was given to explain their health issue before the physician interrupted the patient. The average was 11 seconds. The researchers did not explain the reason for the interruptions, but that’s all the time the patient had. Only the speedy patients who could somehow get it said in six seconds weren’t interrupted. The researchers concluded that not asking why the patient was in the office may not have set the priority of the visit towards what mattered most to the patient. Easy to see how that could happen.

What can you do to make sure that doesn’t happen to you? I’ll give you my thoughts on Saturday.

What are you prepared to do today?

Dr. Chet

 

References: J Gen Intern Med (2018). https://doi.org/10.1007/s11606-018-4540-5

 

The Unproductive Office Visit

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I recently got an email from a long-time listener to my local radio show Dr. Chet’s Straight Talk on Health. The gist of what she wrote went something like this. “You always tell me to work with my physician for my better health, that they should be my partner for good health. What if I can’t get their attention to listen to what I have to say? I had to get a new primary care physician (PCP). They didn’t really listen to me and just wanted to order a bunch of tests for no specific reason.” I’ve heard that before.

When we lived in Buffalo, Paula got an appointment with a new PCP. Paula goes to the doctor prepared; she always takes a list of her medications and because this was a new PCP and she knew she might forget something critical, she had printed a list of symptoms she wanted to discuss in hope of arriving at a diagnosis. The physician threw the list on the desk without looking at it and proceeded with his agenda. That’s not the way to get along with Paula; it went downhill from there.

Is this a common problem? Physicians who don’t take the time to listen to what ails us? Researchers wanted to find out. They examined video and audio tapes of office visits that were recorded for training purposes. This is a complex task because in some cases, a nurse may inquire about the nature of the visit while getting baseline information. In others, residents working with the physician may interview the patient to determine the purpose of their visit. In many cases, it was the first contact between patient and physician. What they found was interesting and disturbing; more in Thursday’s Memo.

Tomorrow night is the July Conference Call for Insiders. If you want to take part, simply go to DrChet.com and join as an Insider. I’m going to be discussing several topics including the effectiveness of complementary medicine in cancer treatment. As always, I’ll be answering Insiders’ questions as well.

What are you prepared to do today?

Dr. Chet

 

References: J Gen Intern Med (2018). https://doi.org/10.1007/s11606-018-4540-5

 

Travel Bugs: Everywhere but Planes

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Given the results of this study, where would a person most likely pick up a bug while traveling? Remember, the results of the air and physical locations of the plane that were tested and sent for analysis showed no measurable respiratory viruses of any kind, so the authors speculated about the most likely locations for picking up a virus. They believe you’re more likely to find a bug in transportation to the airport and then to the hotel. Or in the airport at a restaurant or store. In the gate area where people are less confined. In bathrooms where people are more likely to spread the virus to surfaces.

In other words, you can pick up a virus just about everywhere you can imagine but the plane. It’s a good idea to pay the closest attention outside the plane—keep your hand sanitizer handy and wash your hands often—and then don’t worry so much about the inside. Kids are a germ magnet at any time, so be extra vigilant when traveling.

You can also do what I do beginning the day before I leave for a trip: start taking echinacea, garlic, and extra vitamin C to boost your immune system. That’s my way of avoiding respiratory infections or any other form of illness when I travel. After 20 years on the road, it still serves me well. Get the details in the Health Info section of DrChet.com: Immune Boost 1-2-3. In it you’ll learn all about how to tune up your immune system to get ready to meet new germs and viruses, along with the latest info on echinacea, and one more step you can take to get your insides ready to hit the road.

What are you prepared to do today?

Dr. Chet

 

Reference: www.pnas.org/cgi/doi/10.1073/pnas.1711611115

 

The Safest Seat on a Plane

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If you want to boost your odds of remaining healthy after a flight, let’s begin with the location of your seating assignment. Researchers determined that the people in the center of coach had the most contacts with other passengers and flight crew. That makes sense. Everyone with the need is going forward or backward to use the bathrooms. But the contacts increase if the passengers leave their seats. In addition, there’s more contact with the crew in the center of the plane.

As to seat location, the aisle seats get the most contact with crew and passengers, the middle seats a little less. The seat with the least contact with passengers or crew is definitely the window seat; in fact, there are zero contacts about 10% of the time. The crew has the most direct contact with passengers; that’s to be expected as they distribute food and drinks, answer questions, and conduct safety checks.

Here’s the surprise: the results of the air and physical locations that were tested and sent for analysis showed no measurable respiratory viruses of any kind. That seems unusual because eight of the flights were during cold and flu season. But finding no viruses means they found no viruses using standard virus-detection tests. It should be noted they did not test for bacteria that could have been present, just respiratory viruses.

Based on the results, the researchers estimated that the major points of contact would be one meter in front and behind a sick passenger sitting in any row. If you were outside of that zone, you could be reasonably confident you didn’t catch a respiratory infection while on a flight, even if some of the passengers were infected with a respiratory virus. In this day and age, the fear of catching some form of respiratory superbug on a flight is extremely low.

Yet we know travel often results in illness. Where could people pick up a bug? I’ll let you know on Saturday.

What are you prepared to do today?

Dr. Chet

 

Reference: www.pnas.org/cgi/doi/10.1073/pnas.1711611115

Can Airline Travel Make You Sick?

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Have you ever flown for a vacation and found you were beginning to get a cold or other respiratory infection? How about when you fly for business? Just when you want to be at your peak, you’re feeling congested and beginning to cough. You immediately want to blame the flight for making you sick; after all, being in an enclosed area and breathing all that recycled air in a confined space, you obviously picked up a bug from another passenger. Is that a reasonable conclusion?

The risk of respiratory infection is on the minds of those of us who travel for business and pleasure—okay, maybe not the first thing we think about, but it’s on the list. With the possibility of infections being easy to transmit on flights, it’s a global concern as well. The airline manufacturers are concerned because they provide the delivery systems for billions of passengers. It’s also on the minds of researchers who want to know how infections are spread on planes.

Researchers from Emory University, Georgia Institute of Technology, and the Boeing Corporation sought to find out. Using prior research as a guide, they created a methodology of how to assess the course of respiratory infections. This is the kind of study research assistants dream about: they got to take 10 intercontinental flights from Atlanta to several West Coast locations. However, they were not just sitting quietly. They had to track the movement of every passenger and flight crewmember for the entire flight to monitor contacts between passengers and crew. And since they were on Boeing 757s, that’s quite a few passengers. Then they had to sample 22 different surfaces per flight.

I’ll let you know what they found on Thursday.

What are you prepared to do today?

Dr. Chet

 

Reference: www.pnas.org/cgi/doi/10.1073/pnas.1711611115

 

Rising CO2 and Nutrition: The Bottom Line

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All of nature is a delicate balance; when any component changes, there will be some sort of effect—maybe good, maybe not. The mineral nutrient and trace element content composition of a plant, technically called the ionome, reflects a balance between carbon, obtained through CO2 in the air, and the remaining nutrients, obtained from the soil. If the CO2 increases in a disproportionate way to the nutrients available from the soil, it could create an ionomic imbalance. In other words, the balance of nutrients is disrupted. This imbalance in CO2 and soil nutrients could affect the nutrient content of the plant including the protein and micronutrients.

That’s exactly what scientists found in their research. Remember, they used a CO2 level in the FACE-field testing to mimic CO2 levels at the end of the 21st century. Most species of rice declined in protein, iron, and zinc, but that was expected based on prior research. But there were also consistent reductions in vitamins B1, B2, B5, and B9. On the upside, they did find an increase in vitamin E in some varieties of the rice.

Here’s the concern: rice is a staple for two billion people. In fact, it’s their primary source of nutrients because food is not plentiful in many of those countries. A 10% decline in protein could have a major impact on the growth and development of the people dependent on rice for their primary food source. The same is true for any of the other nutrients; they’re critical for the immune system and many other biochemical functions.

The Bottom Line—For Now

While this research is real, it’s most definitely not complete yet. The CO2 projections for the turn of the century may not be accurate; they could be lower or they could be even higher. What if they were higher? Let’s take it one step farther and consider the food supply in the U.S. and Canada right now. What if the current CO2 levels are having an impact on our food supply now, not just on rice, but in all the food that’s grown? What if our food is becoming less nutritious?

This raises two points. If there were ever a reason to complement your diet with dietary supplements, this would be it.

Take it a step further. I get more queries on what people can and cannot eat because they have issues with specific foods such as wheat. What if it’s not the gluten in wheat that’s the problem? What if it’s the changes in nutrient content that upsets the balance of amino acids? Or the B vitamins? That imbalance may be the actual culprit. Only more research will tell.

This one is far from over. I’ll keep watching to keep you informed.

What are you prepared to do today?

Dr. Chet

 

Reference: Science Advances: DOI: 10.1126/sciadv.aaq1012.

 

How Researchers Determined the Effect of CO2 on Nutrition

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An international group of researchers wanted to know how higher CO2 levels would impact the nutrient content of a staple in the diet of over two billion people: rice. If the nutrient levels change substantially, that could have an impact on the nutritional status of many people who might already be undernourished.

Over several years the researchers grew 18 strains of rice that are raised throughout the world. They used an interesting technique called FACE, which stands for free-air CO2 enrichment. The technique uses tubing to emit CO2 near the plants. The amount emitted is dependent on the CO2 levels on the plot of land and controlled by sensors. That allows them to keep the CO2 levels constant just as they would be when grown in fields while the plants grow in a natural outdoors setting.

The researchers used the CO2 levels that are estimated to occur by the end of this century. True, none of us will likely be alive by then, but most of us know people who will be. The knowledge gives agricultural scientists time to develop plants that can grow with adequate nutrient content in those CO2 levels. CO2 may not increase as expected, but future generations can be prepared if they do.

What did they find? I’ll let you know on Saturday.

What are you prepared to do today?

Dr. Chet

 

Reference: Science Advances: DOI: 10.1126/sciadv.aaq1012.

 

Does Carbon Dioxide Affect Nutrition?

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Carbon dioxide is a waste product of energy metabolism. When we burn the food we eat, the protein, carbohydrates, and fat will be eliminated as carbon dioxide and water. When we use the gasoline in our cars or lawnmowers, CO2 and water are also released during that form of metabolism (called combustion) as well. The benefit for us and our cars is that we get energy. The problem is that we’re producing too much CO2 from gasoline and other fossil fuels.

CO2 levels have risen and fallen over the millennia in response to global trends, but since the invention of the internal combustion engine, the atmospheric CO2 levels continue to rise. As the number of uses for engines has increased, so have CO2 levels; they’re now 100 ppm higher than the previous highest level.

What does this have to do with nutrition? After all, don’t plants need CO2 for photosynthesis? They combine CO2 and H2O together to make sugar, right? Correct. But what researchers wanted to know is whether the excess CO2 would affect the nutrient content of specific crops. Are we growing supercrops? That could have immense implications for global nutrition. I’ll talk about what they discovered on Thursday.

What are you prepared to do today?

Dr. Chet

 

Reference: https://go.nasa.gov/2zkpdjL.