Towards a Healthy 2013

So you started the new year with big plans to exercise more, eat healthy, keep your doctors appointment ...  three weeks after you are forgetting your agenda. I'm here to let you know that you are not alone. Many people who make new year resolutions often break it before February.

It is not because you can't make commitments,  there is too much happening in your life that affect your decisions. A complete lifestyle change over night is impossible for many. Like everything else in life, you have to take things in phases and work in moderation. You don't have to go overboard, make the changes work for you, at your pace, in your comfort zone. If you are not in sync in what you are dong you will not succeed.

Loosing weight
First think on many folks mind after the holidays is to loose weight. Loosing wait can be accomplish by a combination of diet and exercise. The mistake many make is dieting only, this is never a wise choice. Reducing or completely removing the types of food that have high calories only decreases the amount of energy that will be stored as fat. Exercise burns the stored fat, using the energy produced to tones the muscles thus firming the body which result in decrease mass.

You often worry what to eat, which diet plan really works. For me, High protein and veggie diet is my favorite choice. Food such as beans, fish, skinless chicken and vegetables are easy to prepare and can be tasty depending on your choice of herbs. Vegetables are really not a favorite choice because it is not as tasty as the other food choices. The reason is that vegetables are often eliminated from diet and you never give your taste buds the chance to develop the taste. I am sure you know of a food that your friends may find to be very delicious but you just feel is yucky. Their taste buds have adapted to liking that food but because you probably have never tasted it or never given yourself the time to appreciate the taste thus you would not like it. Veggies are similar, many people who savor the taste would agree that at first they never appreciate it but grew to love the taste. So phase in your vegetables, one day it will be all the healthy you crave.

It is important to count your calories and eat complete meals as to avoid snacking. Go online and  do a calories check of some of some of the common  foods in your super mart and keep a copy of the results in your kitchen. After a while you will know the calories present in each food item by heart. Mix and match your meals as you like keeping your daily meals within the range that will best suit your agenda. It is also important to know your Basic Metabolic Rate (BMR), it tells you how much calories you burn per day just by doing nothing. With your BMR you can calculate your Daily Caloric needs by using the below information:

• If you are sedentary (little or no exercise) : Calorie-Calculation = BMR x 1.2
• If you are lightly active (light exercise/sports 1-3 days/week) : Calorie-Calculation = BMR x 1.375
• If you are moderately active (moderate exercise/sports 3-5 days/week) : Calorie-Calculation = BMR x 1.55
•   If you are very active (hard exercise/sports 6-7 days a week) : Calorie-Calculation = BMR x 1.725
•  If you are extra active (very hard exercise/sports & physical job or 2x training) : Calorie-Calculation = BMR x 1.9

 If you are trying to loose weigh, your goal is to have a negative energy balance. A negative energy balance means that the daily caloric needs does no exceed your BMR. If you are trying to maintain your body mass, then your intake must balance your energies used.

When skipping meals, you will tend to eat more at the subsequent meal resulting in a positive energy balance. For instance  skipping breakfast would result in your body breaking down stored glycogen and fatty acids to maintain your blood glucose so as to fuel the brain and other tissues. Utilizing of store fat is good, but not sufficient enough to loose noticeable pounds. At lunch you would be twice as hungry thus eat more food that you would on a regular  basis and this would result in extra energy being stored as fat. When skipping meals you also tend to snack more often and not pay attention to amount of calories being consumed.

Breakfast is the energy house, a healthy breakfast starts your day just right. My preference is a 'fruitful' breakfast.  Diced banana (95kcal) and some strawberries (100g=28kcal) in 1 cup skim milk (86 kcal) averages less that 220 kcal. The same for a banana smoothie and a cup of tea. You should always have 2 protein bars at hand, one for a mid-morning snack and one for a mid afternoon snack. Grapes (1 cup =62kcal) or banana is also  great choice for snacking. Lunch and dinner should be simple. Vegetables, beans, bake or grill meat in any combination would be fine. The idea is just to eat in moderation and minus the high carbohydrates and fats.

Exercise

When we exercise we convert stored energy to generate fuel for muscles and to cool the body. An increase heart rate and excess sweating tells you you body is having a good work out. My favorite video instructor is Tracy Anderson, 30 minutes of cardio and 30 minutes of transformation. If you don't think you have the motivation to do it on your own, join the gym. Many would start, few will finish. You have to find the motivation to make it possible. You have to maintain a weekly exercise regimen. Dieting helps you to shed the weight, exercises also do but importantly help to maintain your weight by burning the excess stored energies that daily meals may provide.

 If you are concern about your weight you should be equally concern about what is going on within. Knowing your blood pressure, fasting blood sugar and lipid profile is recommended by most physicians. The conditions are usually affected by patients diet and physical practices and can be easily corrected by change in lifestyle. Make an appointment to visit your family physician and have your regular check-ups.


Staying healthy in 2013 is not as difficult as it may seem, wanting to means your are half way there, accomplishing the goal depends on you. A positive mind will always make it through, get motivated, get your calorie check, get tested.

Prostate Cancer in focus

Over the past months i have experience a number of cases of prostate cancer. All, unfortunately, were end stage cancer. What puzzles me is that although there is a secondary prevention method (having a PSA test done) and warning signs that something is wrong, still there is an alarming number of prostate cancer being detected at the later stages.

What can be done?

Check for the warning symptoms

• hesitance during urinating 
• decrease free flow of urine
• increase frequency of urinating 
• difficulties starting the urine stream 

It should be noted that these symptoms are also common in two other disorders, Urinary Tract infection and Benign Prostatic Hypertrophy (BPH).  BPH is very common in men older than 50 years and results from increase stimulation of the prostate by male hormones. This can be treated and not necessary develop into cancer.

When should you see a doctor?

Immediately after experiencing any of the above symptoms.While it might be benign, it is important to rule out the worst case, prostate cancer.

What to expect at the doctor's office?
The first test the doctor should do is a digital rectal examination (DRE) where he/she would incert a gloved and lubricated finger into the anus to feel for any enlargement of the prostate. This is usually an uncomfortable but accurate test that is considered the gold standard test in diagnosing prostate cancer. When the prostate is enlarge due to hormonal influence (BPH) the enlargement does not affect the peripheral lobes of the prostate, only the central lobes. Cancers however affects the peripheral lobes and thus will be felt pressing against the rectum during a DRE.

A PSA test will also be ordered. The PSA blood test measures the level of a protein called prostate-specific antigen. It is able to detect early prostate cancer, although it has limitations.

 

Importance of Delay Cord Clamping in Newborns

What is the correct time for umbilical cord clamping? In the early 1900's obstetric practitioners shifted from the early (20-30 sec) to delayed (approx 3 mins) umbilical cord clamping. It is not understood why modern practitioners has reverted to the early cord clamping but many speculated that with hospital overcrowding and need to get mothers out of the labour room quickly may be a factor. Some may say it prevents polycythemia in newborns but despite what the reason may be, there is no evidence that early cord clamping is beneficial to both mother and child (WHO).

The World Health Organisation (WHO) started campaigning for the practice of late cord clamping in the effort to improve maternal and child nutrition, health and development. Posted below are some facts to justify this practice:

1.      40 ml per kg of placental blood transferred to the infant after a delay in clamping of at least 3 minutes.



Reproduced from van Rheenen, P. F et al. BMJ 2006;333:954-958 with permission from the BMJ Publishing Group. - http://www.paho.com/



2.      Below chart outlines the short term and long term benefits of delay cord clamping (PAHO):



PAHO - CA - Beyond Survival - http://www.paho.org/



The current method practice, obstetric practitioners cut the cord within seconds of birth. The cord is usually milked to remove as much maternal blood within the cord for the newborn. While this may contribute to an increase in blood supplied to the newborn, research has shown that the umbilical vein continuously receive blood from the placenta within the first 3 minutes of birth. Thus with delay cutting of the cord, for approximately 3 minutes, can significantly reduce the chances of anemia in the new born and thus decrease the need for risky blood transfusion.

I remembered during my clinical training in Obstetrics, one of my colleagues was placed on antiretroviral medication because she was exposed to the patient blood during the cutting of the cord.  Within those 3 minutes after birth, the cord is distended with blood and still pulsatile, thus there is a risk of having spillage of blood from the cord. Waiting until the cord is relaxed and there is no pulsation can further protect the practitioner from becoming expose.

So is this a common practice in your facility?

For more information on Delay Cord Clamping practices please visit http://www.paho.org/

Medical Breakthrough for 2010

Times magazine has released its top 10 Medical Breakthrough for 2010. Sitting on top of the list is, "AIDS drug lowers the risk of HIV infection." I agree that this is one of the most striking pieces of research that been published this year. With over 36 million people worldwide infected and millions more at risk, i am enthusiastic that science has taking a big leap towards trying to curbing this devastating pandemic. While there is no vaccine identified, scientists has however found that the antiretroviral drug, Truvada, reduce the risk of HIV infections in high-risk groups by 73% in patients who were compliant to their medication, when compared to the placebo group. There was however a 44% overall reduction. I know these percentages may not seem like an attractive figure but to us it is a good 'play field' for more welcoming results.

There were also many successes in stem cell research for 2010. The most admirable was the fact that stem cell drug, known as GRNOPC, was approved in the treatment of spinal cord injury. In October, it was announce that Shepherd Center, a spinal cord and brain injury rehabilitation center in Atlanta, has started using this drug. GRNOPC contains cells that produce myelin, a coating that allows nerves to move along nerves. If myelin is reproduce on the damage nerves then there is a possibility that signals can once again be transmitted at that location and the patient can once again regain function of that affected areas.

While there were many successes in 2010 in medical research there are still many haunting illnesses knocking on the doors of science. I am excited to see new vaccines, more potent stem cell breakthrough and of course answer to the 'whys', the 'hows' and 'whens' in medical sciences.

Times Magazine 2010 Top 10 Medical Breakthrough 
More about Truvada