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Low Testosterone in Men

Joseph Galati - noemail@yourhealthfirst.com — Sun, 08 Mar 2009 21:45:00 GMT

This week, Dr. Morgentaler will join Dr. Galati and discuss low testerone in men.

Abraham Morgentaler is an Associate Clinical Professor of Surgery (Urology) at Harvard Medical School Beth Israel Deaconess Medical Center and the founder and director of Men's Health Boston (www.MensHealthBoston.com), a center focusing on sexual and reproductive health for men.

Dr. Morgentaler lectures nationally and internationally on the latest research regarding the diagnosis and treatment of hypogonadism (low testosterone), sexual dysfunction, male infertility, and prostate disorders, as well as on vasectomy and microsurgical vasectomy reversal.

Dr. Morgentaler’s newest book, Testosterone for Life (McGraw-Hill/Harvard Health Publications, November 2008), is the culmination of thirty years of research. The first consumer book about low testosterone by a specialist in the field, it explains every aspect of this common medical condition and its treatment (testosterone therapy).

Dr. Morgentaler is also the author of The Male Body: A Physician's Guide to What Every Man Should Know About His Sexual Health (Simon and Schuster 1993), and The Viagra Myth: The Surprising Impact on Love and Relationships (Jossey-Bass/Wiley, October 2003). In addition to publishing articles in numerous urological journals, his work has appeared in The New England Journal of Medicine, The Lancet, The Journal of the American Medical Association, Fertility and Sterility and European Urology.

Dr. Morgentaler is a regular contributor to television and radio shows addressing male issues, and has appeared on ABC News Now, CBS Evening News, NBC Nightly News, CNN with Anderson Cooper, and NPR’s The Connection. His work on testosterone has been featured in The New Yorker, and his opinions about men’s medical issues of the day are regularly sought after by such prominent magazines as Men’s Health, Newsweek and US News and World Report.

8-Mar-09 4:45 PM

Coach Willis Wilson: Steroids in Youth Sports

Joseph Galati - noemail@yourhealthfirst.com — Sun, 22 Feb 2009 18:00:00 GMT

Willis Wilson, who is synonymous with excellence when it comes to coaching and teaching the game of backetball, will be joining Dr. Galati this week to discuss the use of steroids in youth sports, and the recent article in the Houston Chronicle reporting on the results of state-wide drug testing in high schools.

Coach Wilson has spent the past 25 years coaching basketball, 16 of which were as Head Coach of the Rice University Owls. He has a unique perspective on student athletes, and the issue of anabolic steroid use. Wilson has produced more than 25 professional players during his tenure at Rice and he has been recognized as the Western Athletic Conference Mountain Division Coach of the Year in 1999 and was the NABC District 9 Coach of the Year in 2004. He has coached 5 NBA players including; Adam Keefe of the Atlanta Hawks and Utah Jazz; Brent Scott of the Indiana Pacers; Mike Wilks with the Atlanta Hawks, Houston Rockets, San Antonio Spurs (where he won an NBA champions in 2005), Denver Nuggets, Washington Wizards, Seattle Super Sonics and Orlando Magic; Michael Harris of the Houston Rockets; and Morris Almond the 27th player taken in the first round by the Utah Jazz in the 2007 NBA Draft.

When it comes to developing talent there is no better teacher of the game in America than Wilson, who coached the 2007 Conference USA Player of the Year, and All-America selection Morris Almond. Almond led all of C-USA in scoring for two straight seasons at 26.1 points per game in 2007 after averaging 21.9 as junior in 2006. In addition Mike Wilks and Michael Harris were named College Insider Conference Players of the year under Wilson?s direction. The eighteen All-Conference selections during Wilson's tenure are by far the most by any coach in Rice Basketball history.

Links of interest on anabolic steroids, and their negative impact on health, are listed below.

Steroid Fact Sheet (NIH)

Office of National Drug Control Policy

Steroid Info for Teens

Anabolic Steroids in High School Sports

Partnership for a Drug Free America: Steroid Abuse Report

22-Feb-09 12:00 PM

Kelly K. Hunt, M.D.: Bilateral Mastectomy: Predictive Factors

Joseph Galati - noemail@yourhealthfirst.com — Sun, 01 Feb 2009 18:00:00 GMT

Kelly K. Hunt, M.D., F.A.C.S., will be joining Dr. Galati tonight to discuss new research on breast cancer surgery.

Dr. Hunt is Professor of Surgery, Department of Surgical Oncology Chief, at MD Anderson Cancer Center Surgical Breast Section, and Chair Breast Committee American College of Surgeons Oncology Group.

Characteristics of both the tumor and the patient may help determine who would benefit from prophylactic contralateral mastectomy, researchers said.

Factors predictive of contralateral malignancy included five-year Gail risk of 1.67% or higher and an ipsilateral tumor with moderate- to-high-risk pathology, multicentric location, or invasive lobular histology, Kelly K. Hunt, M.D., of the University of Texas M.D. Anderson Cancer Center, and colleagues reported in the March 1 issue of Cancer.

Using these factors to define the risk when counseling patients may help to reduce the rate of contralateral prophylactic mastectomy, especially since patients have less extreme options for risk reduction, the researchers said.

Other strategies to reduce contralateral breast cancer risk include systemic chemotherapy and endocrine therapy and the use of MRI along with mammography to improve contralateral breast cancer detection, they noted.

Patients most often choose contralateral prophylactic mastectomy on the advice of their physician or because of their own fear of developing another breast cancer, desire for cosmetic symmetry, family history, or fibrocystic breast disease that makes surveillance more challenging.

However, "most patients will not experience any survival benefit," the researchers noted, "because the risk of systemic metastases from their index cancer often exceeds the risk of developing a contralateral breast cancer."

To determine what factors might determine which patients would benefit, the researchers analyzed findings for 542 unilateral breast cancer patients who underwent prophylactic contralateral mastectomy at M.D. Anderson over a seven-year period.

These patients were found to have a low risk of occult cancer in the contralateral breast (4.6%).

By comparison, the incidence of contralateral breast cancer was 0.56% per year (2.4% at 50.2 months) among a tumor stage-, age-, and race-matched control group of 1,574 breast cancer patients who did not chose prophylactic contralateral mastectomy.

This finding suggested that contralateral prophylactic mastectomy "led to early detection and resection of already existing contralateral breast cancers more than prevention of expected contralateral cancers," the researchers noted.

In the overall multivariate analysis, the independent factors predictive of a malignancy in the contralateral breast were:

An ipsilateral invasive lobular histology (odds ratio 3.4, P=0.01).
An ipsilateral multicentric tumor (OR 3.1, P=0.004).
A high five-year Gail risk (1.67% or greater, OR 3.5, P=0.005).

When the findings were stratified by whether patients received neoadjuvant chemotherapy, the independent predictive factors among those who didn't receive chemotherapy were an ipsilateral multicentric tumor (OR 3.7, P=0.03) and high five-year Gail risk (OR 4.6, P<0.0001).

But only ipsilateral invasive lobular histology (OR 21.3, P=0.0009) was predictive among those who got chemotherapy.

Dr. Hunt's group acknowledged that their study was limited by its single-institutional, retrospective design and the relatively short follow-up time. "Whether the contralateral breast cancer incidence will remain low in our contralateral prophylactic mastectomy cohort remains to be determined."

Breast cancer sites of interest are listed below to learn more.

National Cancer Institute: Breast Cancer pages

Susan G. Komen Foundation

American Cancer Society: detailed guide to breast cancer

Breastcancer.org

1-Feb-09 12:00 PM

Christopher Kennedy Lawford Talk about Hepatitis C

Joseph Galati - noemail@yourhealthfirst.com — Sun, 07 Dec 2008 14:00:00 GMT

Christopher Kennedy Lawford, the first child of famed ‘Rat Pack’ actor Peter Lawford and Patricia Kennedy, was born and raised in southern California. As the nephew of President John F. Kennedy, Lawford grew up with U.S. presidents and movie stars as close relatives and personal friends. Today, he is an inspired writer and accomplished actor.

Lawford began his acting career in the 1980s playing a variety of parts, including roles in films like “Thirteen Days” and “The World’s Fastest Indian.” His acting repertoire also includes recognizable roles in the

daytime TV shows “All My Children” and “General Hospital.” In addition to acting, Lawford is also a celebrated author. His memoir, Symptoms of Withdrawal: A Memoir of Snapshots and Redemption, was on the New York Times Bestseller list.

Lawford is currently working on several other books and film projects, including a non-fiction book called Moments of Clarity, which will be available in January 2009. Lawford can also be seen in the 2007 film “Slipstream,” written and directed by Sir Anthony Hopkins.

Although he is immensely successful today, Lawford's early life was marked by the traumatic assassinations of his beloved uncles Jack and Bobby Kennedy. By the time he entered his teens, he had succumbed to the growing drug scene of the 1970s, and entered into a deep, long descent into near-fatal drug and alcohol addiction that stretched into the early 1980s. Lawford believes it was during this time that he contracted the hepatitis C virus (HCV).

It wasn’t until 2001 that Lawford was diagnosed with HCV. Although he experienced no symptoms, the disease had already begun to damage his liver. Today, six years after successfully completing treatment with pegylated interferon and ribavirin, there is no detectable trace of HCV in his blood. During treatment, Chris kept a stubbornly positive outlook, and maintained a healthy lifestyle with yoga and regular exercise.

Today, Lawford is an advocate for HCV disease awareness and is dedicated to sharing his experience with HCV to help increase diagnosis and treatment of the virus. He encourages people to stop and consider their own potential exposures to the disease, get tested and, if necessary, speak with a doctor about available treatment options as early as possible.

Lawford has three children and currently resides in Los Angeles, CA. Prior to starting his writing and acting career, he attended Tufts and Georgetown Universities, graduating from Boston College’s Law School in 1983. After his battle with addiction, Lawford set up a clinic to treat opiate dependency and served as a lecturer in psychiatry for Harvard Medical School.

Hepatitis C Links of Interest

Therapy for Hepatitis C

Hepatitis C: Dr. Koop

Hepatitis C Research

Centers for Disease Control and Prevention

Liver Specialists of Texas

What I need to Know About Hepatitis C

7-Dec-08 8:00 AM

Is Our Soil Hurting Us?

Joseph Galati - noemail@yourhealthfirst.com — Sun, 28 Sep 2008 18:00:00 GMT

Gabriel Filippelli, Ph.D.
Professor and Chair
Department of Earth Sciences
Indiana University-Purdue University Indianapolis

Dr. Filippelli from Indiana University will be joining Dr. Galati this week to discuss the exciting research he and his team are performing on soil sample in urban cities. They are finding that the levels of lead are in the toxic range, and contributing to increased lead levels in our children. An article in the Houston Chronicle earlier this year discussed elevated lead levels in Galveston soil.

Chronic lead poisoning, caused in part by the ingestion of contaminated dirt, affects hundreds of thousands more children in the United States than the acute lead poisoning associated with imported toys or jewelry. Could treating contaminated soil with water prevent this public health scourge?

In a study appearing in the August issue of the journal Applied Geochemistry, Gabriel M. Filippelli, Ph.D., professor of earth sciences and department chair at Indiana University-Purdue University Indianapolis, conducted a literature review of studies of urban soils as a persistent source of lead poisoning and also investigated the lead burden in the soils from a number of cities, including Indianapolis. His findings reveal that older cities like Indianapolis have a very high lead burden resulting in a lead poisoning epidemic among their youngest citizens.

Filippelli suggests two possible remedies, one of which he believes to be feasible from both the practical and monetary perspectives and doable almost immediately.

According to 2007 U.S. Census Bureau data, there are approximately 20 million children below the age of five in the United States, the age range of greatest susceptibility to the harmful affects of lead poisoning. Filippelli notes that about 2 percent of these children (approximately 400,000) have lead poisoning, many in epidemic proportions.

While acute lead poisoning from toys and direct ingestion of interior paint has received more publicity, these cases account for only a portion of children with lead poisoning. Many health officials are increasingly concerned with chronic lead poisoning, which occurs at lower levels of lead in the blood and are harder to diagnose. Babies and young children may develop chronic lead poisoning when playing in dirt yards or playgrounds or in areas with blowing dry soil tainted with the lead, which is ubiquitous in older urban areas.

"These national numbers for chronic lead poisoning are staggering but the percentage of affected children in older urban areas is much much higher than in rural areas or newer cities. The blowing soil and dust young children ingest contains large amount of lead from lead paint and leaded gasoline deposited decades ago, and from industrial contamination. In Indianapolis, we found high levels of soil contamination. Many older urban centers, have lead poisoning rates that are 5 to10 times the national average." said Filippelli, who is a biogeochemist studying environmental contamination of heavy metals and its effects on children's health.

Going into neighborhoods where yards are dirt rather than grass-covered and spraying clean water with high power shower systems when tests show that soil moisture is low (usually mid-July to mid-September in Indianapolis, for example), would significantly decrease the chronic lead poisoning in children, according to Filippelli. Since contaminated dirt blows from one property to another, this cannot be done on a house by house basis but must be carried out on a regional basis.

A better but less feasible remedy would be to put a layer of clean soil on top of the contaminated soil and to hydroseed the fresh dirt with grass. While preferable it is less practical as the grass has to be maintained, more costly and probably unrealistic to expect money-strapped municipalities to attempt. The high end remedy, removal of all contaminated dirt, perhaps two feet deep, is unattainable, except in small areas around industrial sites such as lead smelters.

Lead levels in the dirt in which children play are a public health hazard. "Our review plus the new directions we suggest for remoisturizing soil to prevent blowing of contaminants, confirm that our approach to estimating lead burden and its remediation can be done anywhere in the U.S. where there is a lead concern. The Environmental Protection Agency and the U.S. Department of Housing and Urban have focused their attention on indoor contamination as the direct source of lead to children. It is now time to open the door and solve the contaminated soil problem. We hope our study will raise awareness, and ultimately funding, to stop the poisoning of America's children, especially those living in older urban areas," said Filippelli, who is associate director of the Indiana University Center for Environmental Health.

Young children, especially those who crawl, put objects in their mouth, eat dirt, or are exposed to blowing dirt, and can consume a significant amount of lead. Children's developing digestive systems are very susceptible to lead poisoning. To a child's body, lead looks like calcium because they both have same ionic charge and size. As their neurons develop, the nervous system tries to use lead in place of calcium and the child's neural systems fail to form correctly. This impairs neural function leading to irreversibly decreased IQ and increased attention deficient issues.

Chelation, which purges lead from the body, is used to treat acute lead poisoning but is much less effective in chronic lead poisoning.

Dr. Filippelli is a leader in the emerging field of medical geology. He is the first elected chair of the Geological Society of America's Geology and Health Division and is currently immediate past chair. This study was funded by the IUPUI School of Science.

28-Sep-08 1:00 PM

Dental and Oral Care: What You Need to Know?

Joseph Galati, M.D. - noemail@yourhealthfirst.com — Sun, 03 Aug 2008 21:00:00 GMT

Proper oral care is required to maintain overall good health and wellness. This week, Dr. Steve and Mark Lukin, D.D.S. of Lukin Family Dentistry will join Dr. Galati and discuss some of the basic concepts related to good oral health. The podcast of the interview is available for listening.

Links of interest are posted below:

3-Aug-08 4:00 PM

Jack LaLanne Joins Your Health First this Week

Joseph Galati - noemail@yourhealthfirst.com — Sat, 28 Jun 2008 14:00:00 GMT

This week on Your Health First, Jack LaLanne will be joining Dr. Galati. The is no other person on earth that has had such a huge impact on health, wellness, exercise, and fitness as Jack LaLanne over the past century. When you think of exercise and fitness, Jack LaLanne comes to mind.

Fifty years ago, Jack was preaching the merits of exercise, good nutrition, and a healthly lifestyle. Those very words are true today. If you listed to his comments back then, they are appropriate for the health issues we face today, including obesity and their related health complications.

Jack LaLanne, often called the Godfather of Fitness, is a mover, shaker, and motivator. Jack is a pioneer who opened the first modern health spa in the United States in 1936, and in 1951, brought exercise to TV. Although now into his 90s, Jack looks 50. He and his wife Elaine speak all over the world, inspiring people to help themselves to a better life, physically, mentally, and morally. It is an honor to have Jack on the program this week to share his wisdom with the Your Health First listeners.

Taking a trip down memory lane, we have selected some of the more memorable moments of Jack LaLanne's career. Listen closely. His insight over 50 years ago ring true today.

"Sugarholics"

"Tired People"

"The Perfect Lunch Menu"

"Sample Meal Plan"

"How to Cook Fish"

28-Jun-08 9:00 AM

A New Way to Address Obesity in America

Joseph Galati - noemail@yourhealthfirst.com — Sun, 22 Jun 2008 20:00:00 GMT

Measuring Your Waist at Work: Do We Need to Follow Japan's Lead?
Chuck Garcia: New York Health Enthusiast

Chuck Garcia, regular contributer and long-time chum of Dr. Galati, will join him this week to discuss a throught provoking article recently published in the New York Times on how far an employer can go when it comes to health? Japan is measuring the waists (read the full article) of their population, and if they are too large, they are referred them for mandatory for weigh management education. Should we do this in America, considering the massive problems with obesity we face every day?

(From Tara-Parker-Pope: NY Times)

Imagine if your employer started measuring your waist as a measure of your health.

That’s what’s happening in Japan. As my colleague Norimitsu Onishi explains in today’s Times, a Japanese law that came into effect two months ago requires companies and local governments to measure the waistlines of Japanese adults. The government limits are 33.5 inches for men and 35.4 inches for women. Those who exceed the standard and also have another weight-related health concern are given “dieting guidance” to drop weight. (To read the full story, click here.)

While the Japanese plan seems onerous, it’s not without scientific basis. Studies clearly show a person’s health risks increase as waist size grows.

In March, an analysis in The Journal of Clinical Epidemiology showed that body mass index is the ‘’poorest'’ indicator of cardiovascular health, and that waist size is a much better way to determine, for both sexes, who is at a higher risk for hypertension, diabetes and elevated cholesterol.

Studies suggest that health risks begin to increase when a woman’s waist reaches 31.5 inches, and her risk jumps substantially once her waist expands to 35 inches or more. For a man, risk starts to climb at 37 inches, but it becomes a bigger worry once his waist reaches or exceeds 40 inches.

Last month, The International Journal of Obesity suggested that, particularly for young people, the waist-to-height ratio might be a better indicator of overall health risks. Put simply, your waist should be less than half your height.

To read more about health and waist size, click here. And click here to check out whether your body shape is an apple or a pear.

22-Jun-08 3:00 PM

Dr. Joseph Rogers Discusses Tim Russert's Heart-What Went Wrong?

Joseph Galati - noemail@yourhealthfirst.com — Sun, 15 Jun 2008 03:00:00 GMT

What Happened to Tim Russert's Heart?

Dr. Joseph Rogers, a cardiologist at Duke University, and Medical Director of the Cardiac Transplant and Mechanical Circulatory Support program, will discuss the recent and unexpected death of NBC's Tim Russert.

According to news reports, Mr. Russert was being treated for asymptomatic cardiovascular disease, high blood pressure, and mild obesity. He suddenly collapsed in his office Friday, and despite efforts to perform CPR and use an automatic external defribrillator (AED), he did not survive this tragic event.

Dr. Rogers will join Dr. Galati this week and discuss this case, explaining issues related to heart disease, heart attack, sudden cardiac death, and risk factor reduction.

Links of interest are posted below.

Overview of CPR

Heart Attack Warning Signs

Preventing a Heart Attack

American Red Cross: AED's

Sudden Cardiac Death

14-Jun-08 10:00 PM

Vaccines and Autism Revisited

Joseph Galati - noemail@yourhealthfirst.com — Sun, 25 May 2008 19:00:00 GMT

Paul Offit, M.D.
Chief: Section of Infectious Disease
Children's Hospital of Philadelphia

Dr. Paul Offit, Chief Section of Infectious Disease at Children's Hospital of Philadelphia, will join Dr. Galati this week and discuss his recent New England Journal of Medicine article discussing the ongoing questions surrounding vaccines and autism.

On April 11, 2008, the National Vaccine Advisory Committee tookan unusual step: in the name of transparency, trust, and collaboration,it asked members of the public to help set its vaccine-safetyresearch agenda for the next 5 years. Several parents, giventhis opportunity, expressed concern that vaccines might causeautism — a fear that had recently been fueled by extensivemedia coverage of a press conference involving a 9-year-oldgirl named Hannah Poling.

When she was 19 months old, Hannah, the daughter of Jon andTerry Poling, received five vaccines — diphtheria–tetanus–acellularpertussis, Haemophilus influenzae type b (Hib), measles–mumps–rubella(MMR), varicella, and inactivated polio. At the time, Hannahwas interactive, playful, and communicative. Two days later,she was lethargic, irritable, and febrile. Ten days after vaccination,she developed a rash consistent with vaccine-induced varicella.

Months later, with delays in neurologic and psychological development,Hannah was diagnosed with encephalopathy caused by a mitochondrialenzyme deficit. Hannah's signs included problems with language,communication, and behavior — all features of autism spectrumdisorder. Although it is not unusual for children with mitochondrialenzyme deficiencies to develop neurologic signs between theirfirst and second years of life, Hannah's parents believed thatvaccines had triggered her encephalopathy. They sued the Departmentof Health and Human Services (DHHS) for compensation under theVaccine Injury Compensation Program (VICP) and won.

On March 6, 2008, the Polings took their case to the public.Standing before a bank of microphones from several major newsorganizations, Jon Poling said that "the results in this casemay well signify a landmark decision with children developingautism following vaccinations."¹ For years, federal health agenciesand professional organizations had reassured the public thatvaccines didn't cause autism. Now, with DHHS making this concessionin a federal claims court, the government appeared to be sayingexactly the opposite. Caught in the middle, clinicians wereat a loss to explain the reasoning behind the VICP's decision.

Web sites of interest regarding vaccines are posted below:

College Student and Young Adult Vaccine Schedule

Pre-Teen Vaccine Schedule

Childhood Vaccine Schedule

Immunization Action Coalition

Centers for Disease Control and Prevention

25-May-08 2:00 PM

Grandma Galati Talks Food-Again

Joseph Galati - noemail@yourhealthfirst.com — Fri, 23 May 2008 02:00:00 GMT

Celebrating Mother's Day, Dr Galati's mother, Agnes, will be a guest on the program this week. It has long been her opinion that it is the parent's responsibility to keep your children healthy, including the important task of feeding them well. Feeding your family well does not refer to the amount of food, but rather the quality of food they eat. Home cooking is something of a lost art in this disjointed, overactive society that we live in. We have created an environment that creates obesity, rather than control it.

The never ending availability of "ready to eat-throw in the microwave " foods is growing faster than ever. The nutritional value of these foods is poor, and they are "food product" rather that real foods from the ground. Careful review of these food show that they are excessive in sodium, carbohydrate, and fat content, fueling the obesity and diabetes problems we are facing.

Listed below are some of the companies producing these "food products". Review the nutritional content and see how poor they are, and why you want to avoid these at all costs. Instead, the argument can be made that it is far better to make these meals at home, providing vastly better food and nutritional value. Planning your meals for the week is the first step in feeding you family better.

Claim Jumper

Kids Cuisine

Banquest Frozen Meals

Marie Callender's

22-May-08 9:00 PM

Diabetes A through Z: Interview with Diabetes America (part 2)

Joseph Galati - noemail@yourhealthfirst.com — Tue, 06 May 2008 16:00:00 GMT

Diabetes: Everything You Need to Know
Diabetes America
Wendy Hawkins, M.D.
David Erani, M.D.
Elizabeth Bello, R.D.

The professional staff from Diabetes America will be joining Dr. Galati for an extensive discussion of diabetes, including risk factors for developing diabetes, treatment options, preventative steps to take, and nutritional intervention.

6-May-08 11:00 AM

Diabetes A through Z: Interview with Diabetes America (part 1)

Joseph Galati - noemail@yourhealthfirst.com — Sun, 04 May 2008 19:00:00 GMT

Diabetes: Everything You Need to Know
Diabetes America
Wendy Hawkins, M.D.
David Erani, M.D.
Elizabeth Bello, R.D.

DiabetesAmerica health centers are the first ever facilities built expressly to fulfill the unique needs of diabetes patients, all under one roof.

On-site physicians
One-site diabetes educators
On-site Lab testing and Diagnostic Centers
One-site diabetes educators
Education and diagnostic centers
Complete treatment in one visit with one co pay

Diabetes can lead to numerous complications. A review of these complications is listed below.

Diabetes mellitus is a chronic condition that can lead to complications over time. These complications include:

Coronary heart disease, which can lead to a heart attack

Cerebrovascular disease, which can lead to stroke

Retinopathy (disease of the eye), which can lead to blindness

Nephropathy (disease of the kidney), which can lead to kidney failure and the need for dialysis

Neuropathy (disease of the nerves), which can lead to, among other things, ulceration of the foot requiring amputation

Many of these complications produce no symptoms in the early stages, and most can be prevented or minimized with a combination of regular medical care and blood glucose monitoring.

CONTROLLING BLOOD SUGAR — The long-term complications of diabetes result from the effects of hyperglycemia (elevated blood glucose levels) on blood vessels. Two important studies, the Diabetes Control and Complications Trial (DCCT) in patients with type 1 diabetes and the United Kingdom Prospective Diabetes Study (UKPDS) in patients with type 2 diabetes, found that patients with lower blood glucose values had fewer complications than those with higher values.

Thus, keeping blood sugars close to normal can help prevent the long-term complications of diabetes mellitus. However, there are some risks associated with tight control, particularly an increased risk of hypoglycemia (low blood sugar).

Monitoring blood sugar levels — Monitoring blood sugars with finger sticks at home can indicate how well diabetes is controlled and serves as a guide to adjusting therapy. (See "Patient information: Self-blood glucose monitoring"). For most patients, a target for fasting blood glucose and for blood glucose levels before each meal is 80-120 mg/dl (4.4 to 6.6 mmol/L); however, these targets may need to be individualized for a patient by their doctor or health care team.

A blood test called A1C is also used to monitor blood sugar control; the result provides an average of blood glucose levels during the previous one to three months. An A1C of 7 percent or less is recommended; this corresponds to an average blood glucose of 150 mg/dL (8.3 mmol/L). The target may be somewhat higher in people who are older or who have other conditions that increase the risks associated with hypoglycemia. Patients who are unable to reach this goal can be reassured that even small decreases in A1C lowers the risk of diabetes-related complications to some degree.

The combination of A1C and fingerstick blood sugars provides information about the average blood sugar as well as daily fluctuations in blood sugar.

Type 1 diabetes — Blood sugar control in type 1 diabetes requires some form of insulin, which can be given with insulin injections, an insulin pump, or a combination of inhaled insulin and insulin injections. Most healthcare providers recommend intensive insulin therapy, which requires frequent injections, inhaled insulin, or use of an insulin pump and blood glucose monitoring.

Intensive insulin therapy increases the risk of low blood glucose, is more expensive than traditional insulin therapy, and requires that patients monitor their blood glucose levels, dietary intake and activities; the severity of diabetic complications or hypoglycemia may limit this form of therapy in some patients with type 1 diabetes. Patients can experience weight gain with intensive insulin therapy; regular exercise and monitoring dietary intake can prevent weight gain.

Type 2 diabetes — Blood glucose control in type 2 diabetes may be possible with lifestyle changes alone or in combination with oral medications. Insulin is necessary in some cases in early treatment; many patients who do not initially require insulin may do so over time as their ability to manufacture insulin decreases. Generally the insulin regimen for type 2 requires fewer injections and less intensive monitoring than for type 1, although intensive insulin therapy may be recommended for some patients.

EYE COMPLICATIONS — Regular eye examinations are essential for detecting eye complications (called retinopathy) at an early stage, when they can be monitored and treated to preserve vision. This examination should be performed by a doctor who specializes in the eyes (called an ophthalmologist or optometrist). An eye exam should include dilating the pupils (with medicated eye drops) in order to completely visualize the retina. Unless the pupils are medicated, they contract in response to light, making it impossible to view the entire retina.

In some patients with retinopathy, photographs of the retina will be taken to monitor and better visualize the changes. The risk of diabetic retinopathy varies with the type and duration of diabetes and with other life events. Thus, the screening guidelines differ from one person to another.

Type 1 diabetes — People with type 1 diabetes should have an eye examination by an ophthalmologist or optometrist beginning five years after they are diagnosed with diabetes, although screening is usually not necessary before puberty. Patients who have difficulty with their vision or who require glasses or contacts may need to be seen sooner. The frequency of subsequent examinations will depend upon the results of the initial exam. Doctors usually recommend eye exams every one to two years after the initial examination.

Type 2 diabetes — People with type 2 diabetes should have an eye examination by an ophthalmologist or optometrist when they are first diagnosed with diabetes. The frequency of subsequent exams will depend upon the results of the initial examination. Doctors usually recommend eye exams every one to two years after the initial examination.

FOOT CARE — Diabetes can decrease the blood supply to the foot and damage the nerves that carry sensation. These changes put the feet at risk for potentially serious complications such as foot ulcers. Foot complications are very common among people with diabetes, and may be unnoticed until the condition is severe.

Self exam — Patients with diabetes should examine their feet for changes every day. It is important to examine all parts of the feet, especially the area between the toes. Patients should look for broken skin, ulcers, blisters, areas of increased warmth or redness, or changes in callus formation; a healthcare provider should be notified if any of these changes are found.

Patients should include a self-examination in their daily bathing or dressing routine. It may be necessary to use a mirror to see the bottoms of the feet clearly. Patients who are unable to reach their feet or see them completely, even with the help of a mirror, should have someone else (such as a spouse or other family member) assist with the examination.

Clinical exam — During a routine medical visit, the clinician will check the blood flow and sensation in the feet. In people with type 1 diabetes, annual foot examinations should begin five years after diagnosis. In people with type 2 diabetes, annual foot exams should begin at the time of diagnosis.

During a foot examination, the clinician will look for changes such as ulcers, cold feet, thin skin, bluish skin color, and skin breaks associated with athlete's foot. The clinician will also test the sensation in the feet to determine if it is normal or diminished. Patients with decreased sensation are at risk for foot injuries that are unnoticed due to lack of pain.

KIDNEY COMPLICATIONS — Diabetes can alter the normal function of the kidneys. A urine test which measures the amount of protein (albumin) in the urine can alert a healthcare provider that diabetes is affecting the kidney's filtering action. Microscopic amounts of albumin in the urine (microalbuminuria) can be an early indicator of diabetes-related kidney complications (called nephropathy). The amount of albumin in the urine can also help the provider determine if nephropathy is worsening. (See "Patient information: Protein in the urine (proteinuria)").

Urine screening tests should begin in people with type 1 diabetes about five years after diagnosis, and in people with type 2 diabetes at the time of diagnosis. If the test shows that there is protein in the urine, tight blood glucose and lipid control are recommended; a medication may be recommended if albuminuria does not improve.

A blood pressure medication (an ACE inhibitor or angiotensin receptor blocker [ARB]) is generally recommended for patients with albuminuria that does not improve, even if blood pressures are normal. Patients with elevated blood pressures and albuminuria are also treated with an ACE inhibitor or ARB. These medications decrease the amount of protein in the urine and can prevent or slow the progression of diabetes-related kidney disease.

HYPERTENSION AND RELATED COMPLICATIONS — Many people with diabetes have hypertension (high blood pressure). Although high blood pressure produces few symptoms, it has two negative effects: it stresses the cardiovascular system and increases the progression of diabetic complications of the kidney and eye. A healthcare provider can diagnose high blood pressure by measuring blood pressure on a regular basis.

A blood pressure reading below 130/80 is an ideal goal for most people with diabetes who do not have kidney complications; a lower blood pressure goal (<120/75) may be recommended for people with diabetes who have kidney complications.

If a patient is diagnosed with prehypertension (>120/80), the healthcare provider may recommend weight loss, exercise, decreasing the amount of salt in the diet, quitting smoking, and decreasing alcohol intake. These measures can sometimes reduce blood pressure to normal. (See "Patient information: High blood pressure, diet, and weight").

If these measures are not effective or the blood pressure must be lowered quickly, the provider will likely recommend one of several high blood pressure medications. The provider can discuss the pros and cons of each medication and the goals of treatment.

HEART COMPLICATIONS — In addition to lowering blood glucose levels, a number of other measures are important to reduce the risk of cardiac disease.

Quit smoking

Manage high blood pressure with lifestyle modifications and/or medication(s)

Patients should have a fasting lipid blood test to measure cholesterol and triglycerides, and modify their diets. some patients may need medication to lower their LDL ("bad cholesterol") or trigylcerides, if they are high.

If medication is needed, a statin drug should be included whenever possible. The statin drugs have been shown to decrease the future risk of heart attacks, strokes, and death in people with diabetes who are over age 40, even when cholesterol levels are normal. The American Diabetes Association recommends that patients with diabetes have a low density lipoprotein (LDL) cholesterol level less than 100 mg/dL. Some studies suggest lowering LDL to 70 to 80 mg/dL.

Aspirin (81 to 162 mg per day) is recommended for all persons with diabetes over the age of 40 years. (See "Patient information: Aspirin and heart disease").

PREGNANCY AND DIABETES — Control of diabetes and its potential complications is especially important in women planning to become pregnant, as well as in those who already are pregnant. Controlling blood glucose levels before and during pregnancy decreases the risk of a number of complications in both the mother and the baby. A separate topic review is available on this subject.

Pregnancy can cause a worsening of diabetic retinopathy. Thus, women with type 1 or 2 diabetes who become pregnant should have an eye examination by an ophthalmologist or optometrist during the first trimester (three months) of their pregnancy. The frequency of subsequent eye exams during pregnancy will depend upon the results of the initial examination. In most cases, doctors recommend eye exams every three months until delivery.

These guidelines do not apply to women who have gestational diabetes -- a form of diabetes that develops during pregnancy and usually resolves after delivery. These women are not at risk for diabetic retinopathy.

THE IMPORTANCE OF REGULAR MEDICAL CARE — Regular medical care is critical to long-term health for people with diabetes, particularly when it comes to preventing, detecting, and slowing the progression of complications. A healthcare provider can recommend a regular schedule for visits, screening, and monitoring tests based upon a patient's type of diabetes (1 or 2), the duration of the disease, the presence of any complications, and the presence of other underlying medical problems.

In addition to diabetes care, patients also need to be sure they have regular screening for other health problems. For women, this may includes a cervical cancer screening, mammogram and clinical breast exam, and bone density testing. For men, prostate cancer screening is recommended after age 40. For both men and women, colon cancer screening is recommended after age 50.

WHERE TO GET MORE INFORMATION — Your healthcare provider is the best source of information for questions and concerns related to your medical problem. Because no two patients are exactly alike and recommendations can vary from one person to another, it is important to seek guidance from a provider who is familiar with your individual situation.

A number of web sites have information about medical problems and treatments, although it can be difficult to know which sites are reputable. Information provided by the National Institutes of Health, national medical societies and some other well-established organizations are often reliable sources of information, although the frequency with which they are updated is variable.

National Library of Medicine

(www.nlm.nih.gov/medlineplus/healthtopics.html)

National Institute of Diabetes and Digestive and Kidney Diseases

(www.niddk.nih.gov/)

American Diabetes Association (ADA)

(800)-DIABETES (800-342-2383)
(www.diabetes.org)

The Hormone Foundation

(www.hormone.org/public/diabetes.cfm, available in English and Spanish)

4-May-08 2:00 PM

Calorie Counts on Menus: Chuck Garcia Weighs In

Joseph Galati - noemail@yourhealthfirst.com — Wed, 23 Apr 2008 17:00:00 GMT

A chocolate milkshake is the obvious pairing with a fast food hamburger and French fries. The creamy shake balances out the salty and greasy fries and meat, delighting the palate until the last dollop is loudly slurped through the plastic straw.

It might not be such a logical choice, however, if diners saw their meal’s calorie count before purchasing. Last week, a federal judge finally approved a New York City ordinance, more than a year in the making, to move nutritional information from countertop brochures and the Internet to where the customer can’t miss it: right next to the items on menus. Similar laws already exist in cities around the country, including San Francisco and Philadelphia -- and Chicago may be next.

23-Apr-08 12:00 PM

Should You E-Mail Your Physician? A Discussion with Tara Parker-Pope

Joseph Galati - noemail@yourhealthfirst.com — Fri, 29 Feb 2008 04:00:00 GMT

Tara Parker-Pope from the NY Times was a guest with Dr. Galati on February 24th, 2008, and discussed one of her recent articles she posted on her New York Times Blog.

Simply providing a surgeon’s e-mail address nearly triples the likelihood that a patient will contact the doctor about the surgery, a new report shows.

Doctors have long debated whether e-mail communication with patients is a good idea. Many physicians believe good medicine can only be practiced in person and are wary of initiating online communication with patients. Legal experts fear e-mail trails with patients could be used in malpractice litigation. But many doctors believe e-mail can be a useful tool for busy surgeons to answer easy questions from patients. E-mail may also increase the odds of detecting postsurgical problems by making it easier for patients to communicate, some doctors say.

A report today in The Archives of Surgery tested whether offering e-mail addresses to patients had any effect on their willingness to communicate with doctors or their satisfaction following surgery. Dr. Peter Stalberg of the Royal North Shore Hospital in Sydney, Australia, and his colleagues studied 100 patients scheduled to undergo thyroid or parathyroid surgery.

Half of the patients received an information sheet that included the surgeon’s e-mail address and a statement informing them that the surgeon’s preferred method of communication was e-mail. The remaining patients received an information sheet that did not include an e-mail address or any comment about the surgeon’s preferred mode of contact. The surgeon’s e-mail address was available to both groups on the appointment card and a Web site.

About one in four patients initiated additional contact with the doctor outside of regular appointments. Outside contact was most common in the group given e-mail instructions: 38 percent, compared with only 14 percent in the other group. Most used e-mail to contact their doctors, including 18 in the e-mail group but only four in the group not given specific instructions. Another three patients used the fax machine, and one patient used the telephone.

Most of the patients using e-mail were just seeking general information. Others were asking about postoperative recovery and results, while four patients were seeking reassurance. The study showed no difference in patient satisfaction between the two groups.

“People who use e-mail certainly would like to have e-mail access to their physicians,” the authors wrote. “Despite the many concerns, we believe that this study shows that the provision to patients of readily available e-mail access to their surgeon provides a very effective means of improving communication prior to patients undergoing elective surgery.”

28-Feb-08 10:00 PM

Dr. Pat Wood Discussed Organ and Tissue Donation

Joseph Galati - noemail@yourhealthfirst.com — Fri, 22 Feb 2008 13:00:00 GMT

Dr. Pat Wood, Medical Director of Life Gift Organ Donation Center, Discusses organ and tissue donation, and some of the myths associated with it.

22-Feb-08 7:00 AM

February is Women's Heart Month: Guest Dr. Amy Woodruff-Cardiologist

Joseph Galati - noemail@yourhealthfirst.com — Sun, 10 Feb 2008 05:00:00 GMT

February is "Go Red for Women", a program sponsored by the American Heart Association, stressing the need for women to learn more about heart disease, and the additional efforts women need to take regarding their heart. Heart disease is no longer a mans disease.

Dr. Amy Woodruff, a cardiologist at St. Luke's Texas Heart Institute, in Houston, TX, will be a guest with Dr. Galati Sunday, February 10, 2008. Dr. Woodruff is a regular contributer to Your Health First, and every year discusses women's heart issues with Dr. Galati.

The American Heart Association web site has excellent information on the Go Red for Women program, as well as other excellent pages on general healthy heart information for the patient and consumer. The most impressive part of the American Heart Association web site this year is a self assessment you can take on line, to see what specific risks you may have regarding heart disease, and the interventions that you may need to consider.

Excellent links related to women's heart issues, and general heart disease concerns are listed below.

Heart Health Recipes

Texas Heart Institute "Hear Healthy Heart" Pages

Women and High Blood Pressure-Unique Concerns

Patient-Physician Visit Check List

More "Go Red" Information

9-Feb-08 11:00 PM

Dr. Joseph Rogers Discusses the Use of Statins

Joseph Galati - noemail@yourhealthfirst.com — Wed, 06 Feb 2008 17:15:00 GMT

Joseph G. Rogers, M.D.
Duke University Medical Center
What's New in Cardiology?

Dr. Joseph Rogers is a cardiologist, specializing in heart failure and heart transplantation at Duke University Medical, located in Durham, NC.

Dr. Joe Rogers, a regular contributer to Your Health First, will discuss with Dr. Galati a recent magazine article in Business Week discussing the dangers of statins. The title of the Business Week article is "Do Cholesterol Drugs Do Any Good?" will be discussed, as well as an article reviewing side-effects associated with cholesterol lowering medications.

6-Feb-08 11:15 AM

Mark Ghobrial, M.D. Comes to Houston to Head Up Methodist Liver Transplant Program

Joseph Galati - noemail@yourhealthfirst.com — Wed, 06 Feb 2008 13:00:00 GMT

R. Mark Ghobrial, MD, PhD, FRCS (Ed)
New Director of Liver Transplant Program
The Methodist Hospital, Houston, TX

Dr. Ghobrial is currently Professor of Surgery in the Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles (UCLA). He is the Director of the Living Donor Liver Transplant Program and the Pancreas Transplantation Program at UCLA.

Dr. Ghobrial has been recruited to the Methodist Hospital, Houston, Texas as Director of the Comprehensive Liver Center; Director of Liver Transplantation ; Director of the Immunobiology Research Center and Professor of Surgery, Weill Cornell University School of Medicine, he will begin his position, March 1, 2008

After earning his MD degree from Cairo University Medical School in Egypt, he completed his internship at the Massachusetts General Hospital in Boston and his surgical residency at the University of Texas/M. D. Anderson Cancer Center in Houston. His clinical fellowship in multi-organ transplantation was conducted at the Dumont-UCLA Liver Transplant Center. During his surgical training, Dr. Ghobrial completed two postdoctoral basic science research fellowships in immunology at Harvard University and the University of Texas Medical School at Houston. He went on to receive his PhD in immunology from the Graduate School of Biomedical Sciences at the University of Texas.

As a researcher, Dr. Ghobrial maintains an active laboratory for basic science studies which focus on transplant immunomodulation and the inhibition of chronic rejection by indirect presentation of class I major histocompatibility (MHC) molecules and co-stimulatory pathways in allograft recipients. His clinical research interests include partial liver grafting, adult-to-adult living donor liver transplantation, immunosuppression and transplantation for hepatitis C. He is the principal or co-investigator of NIH-sponsored basic and clinical research studies, as well as multiple clinical trials associated with liver transplantation. Dr. Ghobrial is the author or co-author on well over 100 journal articles and book chapters. He lectures extensively on a variety of topics related to liver transplantation in both national and international forums, and has received multiple honors and awards. Currently, he is an active member of multiple transplantation and surgical societies, additionally, the American Surgical Association and is a fellow of the Royal College of Surgeon of Edingburgh.

6-Feb-08 7:00 AM

15 Super Foods You Need to Know About-Again

Joseph Galati - noemail@yourhealthfirst.com — Sat, 12 Jan 2008 14:00:00 GMT

On Sunday May 6th 2007, I had the opportunity to discuss on the program a list of "15 Super Foods" with Chuck Garcia, an expert on nutrition (as well as a long-time friend of mine). This segment was so well received by the listeners that I am now posting the list here for even great distribution.

In the months that have passed, this article remains one of the most popular segments we have ever done. Listeners are concerned about nutrition.

Understanding nutrition is such an important part of health and wellness, as well as disease prevention. I am not claiming that nutrition is the only cure for disease. Disease prevention, treatment, and education is a complex matter, keeping in mind that nutrition is a vital part of the entire process. Most adults have a limited understanding of nutrition, and tend to eat the same foods over and over again. Use this list of 15 Super Foods to expand your nutritional horizons. Experiment with them, and see which ones you like, or could get to like. A complement to this list is a web site I always talk about, and feel is one of the finest for those interested in food and nutrition. The World's Healthiest Foods can be used to look-up these super foods, to get additional ideas on how to prepare these foods and enjoy them even further.

Share this list with your friends and family. I will be talking about these food again in the weeks to come.

Here is to good health, and keeping Your Health First.

Dr. Galati

12-Jan-08 8:00 AM

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Dr. Joseph Rogers is a cardiologist, specializing in heart failure and heart transplantation at Duke University Medical, located in Durham, NC.

Mark Ghobrial, M.D. Comes to Houston to Head Up Methodist Liver Transplant Program

R. Mark Ghobrial, MD, PhD, FRCS (Ed) New Director of Liver Transplant Program The Methodist Hospital, Houston, TX

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Professor and Chair
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Duke University Medical Center
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R. Mark Ghobrial, MD, PhD, FRCS (Ed)
New Director of Liver Transplant Program
The Methodist Hospital, Houston, TX