ObamaCare: On Balance, A Good Thing

I like ObamaCare.  As a practicing physician, I had to reject many deserving patients because they did not have insurance or had Medicaid, which paid so little I would not have been able to pay my rent.  Most of my patients had diabetes and the provisions of the act are especially helpful to them.  The opponents of ObamaCare don’t like the fact that people are forced to buy health insurance or pay a penalty beginning in 2014.  Instead we all pay a penalty in the form of higher premiums to offset the money spent on people without insurance.  And we all pay a penalty for the huge amount of money spent on end-of-life care, care that may prolong life for a week or two, but the quality of that life is often miserable.  To prevent that from happening, many people have a “living will” and you should have one too.

So what are the provisions of ObamaCare?  They seem pretty reasonable to me:

  • Insurers can’t deny insurance to children because of preexisting conditions as of 2010 and to adults as of 2014.
  • As of 2010 insurers could not drop people because they develop a new condition.
  • Health insurers can’t deny coverage to people or increase premiums for any reason.
  • Young adults may remain on their parent’s plan until age 26.
  • A new Cures Acceleration Network finances research into cures for diseases.
  • A new National Diabetes Prevention Program funds community efforts to help people with diabetes.
  • Restaurants with more than 20 locations most post calorie counts.
  • Employers are encouraged to use workplace wellness programs to reward employees.
  • After 1/2014 there’s no annual limit on benefits.
  • After 1/2014 there’s no coverage waiting period greater than 90 days.
  • The amount that Medicare pays for medications rises to 100 % by 2020.
  • Higher Medicaid reimbursement of primary care physicians
  • Access to Insurance Exchanges if people can’t get private insurance.

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What Is Thyroiditis?

Thyroiditis is any infection or inflammation involving the thyroid gland.  It can be due to a virus, a bacteria or autoimmunity, the attempt by the body to damage its own thyroid.  In this article, I will tell you about the common forms of thyroiditis and what you and your doctor can do about them.

Chronic Thyroiditis

The most common form of thyroiditis by far is chronic thyroiditis, also known as autoimmune thyroiditis or Hashimoto’s thyroiditis.  Chronic thyroiditis is hereditary, usually being passed down from mother to daughter, but sometimes to sons as well.  In chronic thyroiditis, the body mistakes the thyroid gland as a foreign invader and produces antibodies (proteins against cells or tissues) that prevent the thyroid gland from working normally.  The result is usually low thyroid function known as hypothyroidism. It must be treated with thyroid hormone replacement.  Chronic thyroiditis is the main cause of hypothyroidism.  The thyroid gland is often enlarged but it is not tender.

Subacute Thyroiditis

Subacute thyroiditis is believed to start as a viral infection in the body that spreads to the thyroid gland.  The course of thyroiditis is divided into 4 stages.

  • Stage 1: the thyroid is tender and painful.  A blood test called the erythrocyte sedimentation rate (ESR) is very elevated, indicating that there is much inflammation.  The patient also has muscle aches and pains.  In this stage the thyroid is damaged by the virus and releases all the stored thyroid hormone and thyroid hormone tests show high levels of free thyroxine, the active form of thyroid hormone.  The condition could be mistaken for hyperthyroidism, but hyperthyroidism is not usually painful.  The high levels of thyroid hormone are also temporary so no treatment is given to decrease production of thyroid hormone as would be done for hyperthyroidism.  This stage may last a few days.
  • Stage 2:  this stage lasts a few weeks during which you experience normal thyroid function as the thyroid levels fall and are not replaced.  The inflammation in the thyroid begins to subside and it becomes less tender.
  • Stage 3 may last a month or more.  The patient is hypothyroid (has low thyroid function) as the free thyroxine falls and is not replaced by the damaged thyroid gland.
  • Stage 4 is gradual return to normal as the viral illness subsides and the thyroid begins to function normally again.  There is usually no long term damage due to subacute thyroiditis.  The patient fully recovers, but occasionally becomes permanently hypothyroid after a time in 5 percent of cases

Subacute thyroiditis is 3 times more common in women than men.  .  It occurs most often when a patient is 40 or 50 years of age.  It may recur years later in some patients.

Treatment is with drugs to reduce the hyper symptoms at first as well as aspirin to reduce inflammation.  If the low thyroid function persists later, thyroid hormone replacement is given.

Postpartum Thyroiditis and Silent Thyroiditis

5 to 10 percent of pregnancies are complicated by postpartum thyroiditis.  It is considered to be an autoimmune disease because high levels of thyroid autoantibodies are found in the blood.  Postpartum thyroiditis is like subacute thyroiditis but the thyroid gland is not hot or painful and the patient has no symptoms of a viral illness.  The patient goes through the following stages:

  • Stage 1 beginning a month after delivery and lasting up to 3 months, the patient has signs and symptoms of hyperthyroidism
  • Stage 2 is the stage of normal thyroid function for a month or two
  • Stage 3 is the stage of hypothyroidism at 4 to 6 months after delivery
  • Stage 4 is resolution of the hypothyroidism, but the patient is at high risk of permanent hypothyroidism after 3 to 5 years.  As many of 50 percent or women with this condition will be permanently hypothyroid.

The woman who has postpartum thyroiditis will probably have it after each pregnancy.  In postpartum thyroiditis, the erythrocyte sedimentation rate is normal.

Silent thyroiditis is similar to postpartum thyroiditis but there is no prior pregnancy and it occurs in men as well as women.  Otherwise the course is the same and it has the same rate of permanent hypothyroidism.

Acute Thyroiditis

Acute thyroiditis is a rare and severe acute illness due to bacterial infection of the thyroid gland.  The thyroid gland is large and extremely tender.  The patient has high fever and structures near the thyroid such as the esophagus and the trachea are inflamed as well.  This may result in trouble swallowing or breathing.

If a needle is inserted into the thyroid, pus is usually found.  It may contain one of several bacteria.  Treatment is with an antibiotic directed at that bacteria.  Other medications such as aspirin for fever are also given.  If the infection does not respond to treatment, it may be necessary to remove the affected part of the gland with surgery.

The thyroid function usually remains normal during acute thyroiditis, but sometimes so much damage is done to the thyroid that a great deal of thyroid hormone leaks out and there is temporary hyperthyroidism.

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Treatment of High Blood Pressure

(This is the third of a three part series on high blood pressure. The first part described the definition of high blood pressure, and the second part discusses signs, symptoms, and complications of high blood pressure.)

Treatment of high blood pressure requires a willingness to change your lifestyle and to take medications regularly if this is necessary.

Lifestyle

Here are the key lifestyle changes that will either prevent high blood pressure in the first place or lower it so that it is not a danger to your health in the second place. If you are willing to maintain these changes, you will not only prevent high blood pressure, but you will have a very high quality life as well.

  • Stop smoking or chewing tobacco
  • Lose weight
  • Limit alcohol intake to 2 drinks or less daily
  • Increase physical activity to 45 minutes four or more days a week
  • Reduce salt in your diet
  • Maintain adequate potassium, calcium and magnesium in your diet
  • Reduce saturated fat and cholesterol in your diet

Studies have clearly shown that a diet that emphasizes fruits and vegetables is very helpful in lowering blood pressure. Such a diet is called the DASH diet (diet to stop hypertension) and is described in detail here:

http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf

If you combine DASH with reduction in salt intake and reduction in calories, the benefits will be enormous.

Drugs

There are more than 60 different drugs that are available for the treatment of high blood pressure. Surely there are several that would work for you. The drugs are divided into different classes based on their mechanism of action. The classes include:

  • Diuretics: drugs that lower blood pressure by forcing the body to rid itself of salt and water through the kidneys
  • Beta-adrenergic receptor blockers: reduce the force of contraction of the heart
  • Calcium channel blocking agents: reduce blood pressure by relaxing the muscles of the heart and arteries
  • Angiotensin-converting enzyme inhibitors: affect the system in the kidney know as the renin-angiotensin-aldosterone system that keeps the blood pressure high. By inhibiting angiotensin converting enzyme, the substance that produces aldosterone is blocked and blood pressure is lowered.
  • Angiotensin II receptor blockers: lowers blood pressure by not allowing angiotensin II to attach to its receptor where it causes contraction of arteries and release of aldosterone

There is definitely a drug in all these that will work for you, but no drug works if you don’t take it.

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Signs, Symptoms and Complications of High Blood Pressure

(This is the second of a three part series on high blood pressure. The first part discussed the definition of high blood pressure, and the final part will describe the treatment of high blood pressure.)

High blood pressure is usually free of signs or symptoms until it has time to do its damage over 10 or more years. Measurement of your blood pressure at least annually is essential. People believe that headache is a symptom of high blood pressure, but most people with headaches have normal blood pressure and most people with high blood pressure do not have headaches.

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What is High Blood Pressure? How is Blood Pressure Measured?

(This is the first of a three part series on high blood pressure. The second part will discuss the signs, symptoms, and complications of high blood pressure, and the final part will describe the treatment of high blood pressure.)

Before you can understand high blood pressure (also referred to as hypertension), you need to know what blood pressure represents. When you have your blood pressure taken, you usually get a result that sounds like 120 over 80 and looks like 120/80 when your doctor writes it down. The 120 is called the systolic blood pressure (SBP). The systolic blood pressure is the amount of pressure in your arteries as the heart pumps blood from its left side to the rest of the body. The 80 is the diastolic blood pressure (DBP). The diastolic blood pressure is the lowest pressure in the arteries just before the heart begins to pump again.

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Are You at Risk for Prediabetes?

Prediabetes is defined by your blood glucose (sugar) just like diabetes. Here is a table that shows you normal values, prediabetes values and diabetes values for the blood glucose.

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Gestational Diabetes and Hypothyroidism During Pregnancy

Diabetes mellitus that develops during a pregnancy is called gestational diabetes. It occurs in about 2 percent of pregnancies. During pregnancy, the growing fetus and the placenta (the tissue between the mother and her baby) create various hormones that help the fetus to grow and develop properly. Some of these hormones have other characteristics, such as anti-insulin properties that decrease your body’s sensitivity to insulin, the hormone that controls the blood glucose, causing glucose to rise. Other actions of the hormones include increasing glucose production, with a further rise in the glucose.

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Diabetes Mellitus: What is Diabetes?

Diabetes mellitus, or simply, diabetes, is a disease that damages the body when the blood glucose (sugar) is allowed to remain too high for too many years.

Major Types of Diabetes

There are several major types of diabetes:

  • Type 1 diabetes is the form that used to be called juvenile diabetes or insulin-dependent diabetes. It starts most often in childhood. The patient has an absolute need for the hormone insulin, since his pancreas, the organ that makes insulin, can no longer do so. The insulin is usually given by injection and must be balanced by food intake in order to keep the blood glucose as normal as possible.
  • Type 2 diabetes is the form that used to be called adult-onset diabetes. It is a lifestyle disease, resulting from excessive weight gain and lack of exercise. The patient does not lack insulin, but has insensitivity to his own body’s insulin. Treatment is started with diet and exercise but may ultimately require pills or insulin.
  • Gestational diabetes is the form that occurs in pregnancy when the hormones of pregnancy overwhelm the body’s insulin so that the blood glucose rises. It can cause problems with the growing fetus who tends to grow large and have a difficult delivery. Gestational diabetes can also become type 2 diabetes later in life.

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Avandia: FDA Restricts Use of Rosiglitazone

At last, the Food and Drug Administration has taken action and banned the use of Avandia, a drug that was developed for diabetes, unless a person with diabetes has failed every other drug for diabetes and has been made aware of the substantial risks of Avandia to the heart. In Europe, the drug’s sales will be halted entirely.

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How Much Vitamin D Do You Need and How Can You Get It?

With all this interest in vitamin D, you want to be sure that you have enough in your blood.  If not, you want to make sure that you build up your level to the right amount.  So what is the right amount?  You determine the level of vitamin D by doing a blood test for 25 (OH) vitamin D.  That’s 25 hydroxy vitamin D.  Most experts agree that a level of 32 nanograms per milliliter (ng/ml) in the blood is optimal for bone health but no one agrees on what is optimal for immune health, heart health, cancer health and all the other important functions that vitamin D appears to have.

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Vitamin D Benefits: Sorting Through The Hype

Lately it seems as though every other article in newspapers and magazines describes a new benefit for vitamin D. Could any substance in your body really be so critical? What is the truth and what is a myth?

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Vitamin D and Osteoporosis: Protecting Your Bones

Osteoporosis is the gradual loss of bone that occurs in both women and men as they get older, but accelerates in women once they reach the menopause, the time when periods are lost. That starts around age 45 to 50. Bone loss speeds up in women because women greatly reduce their production of estrogen, the major female hormone, when women no longer have periods. Once enough bone is lost, both women and men may suffer fractures, especially in the hips and spine, that could lead to permanent disability or death. Bone is very important in our bodies. It is not an inactive organ but has major functions. The functions of bone include:

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Normal Blood Sugar Levels – What Is A Normal Blood Glucose?

What’s a Normal Blood Sugar?

I am often asked this question, “What is a normal blood sugar?” It should be relatively easy to answer, but there is a lot of potential confusion that I need to clarify.

What is the difference between sugar and glucose?

Sugar is the name for any one of many edible carbohydrates that taste sweet. The common one that you know is table sugar, which is actually sucrose, the sugar in sugar cane and sugar beets. Then there is the sugar in fruits, called fructose. But the sugar that really affects your life is glucose. This is the sugar that floats around in your blood, providing energy for your muscles, food for your brain cells and power for the millions of chemical reactions that take place in your body. Continue reading

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Vitamin D Overdose: Taking Too Much Is Hard To Do

One of the fears that people who need supplements of vitamin D describe is the danger of a vitamin D overdose. Take it from me. Unless you’re a toddler, this fear is way overblown.

Most of the cases of vitamin D toxicity occur when a big mistake is made in the dosage, particularly in children. For example, children often take vitamin D in liquid form. Some liquid preparations of vitamin D contain 500 international units (IU) in 2 teaspoons. Other liquid preparations contain 400 IU in 2 drops. If you give 2 teaspoons of the preparation that contains 400 IU in 2 drops, you would be giving 48,000 IU. Even then it would require many days of this wrong dose to cause toxicity, even in children. In adults a dose of 10,000 IU daily for up to 5 to 6 weeks has rarely been associated with toxicity. Continue reading

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