Archive for the 'General Health' category

A Bit of Sweetness for #KetoLife

Aug 28 2017 Published by under General Health

I think you can pick out July 17...

Like a number of my Twitter buddies, I have been following a version of the ketogenic diet since July 17. Pediatricians often hear about this as a treatment for seizures in children; however, eliminating high-glycemic index carbohydrates from the diet makes the fat practically melt off some people. You can read more about the basics here. One of the challenges of the plan is to find foods that replace your favorite high-carb munchies with something healthier. Over the weekend, a bunch of us got to talking about this on Twitter. I mentioned this creation of mine and promised to blog it.

I purchased a couple of #ketolife cookbooks to start. This gave me ideas for how to achieve flavors and textures associated with forbidden carbs. Love breaded pork chops cooked with Shake-n-Bake? A mixture of almond flour and ground up pork rinds will give you the same texture! Barbeque pork rinds provide a similar flavor! (BTW, the cookbook used this mixture to crispy coat orange chicken).

Sweet things can also be a challenge. One of the cookbooks I bought included Triple Layer Fat Bombs. The layers included a mixed nut-butter bottom, a cream cheese middle, and a chocolate topping. They were frozen, and the nut-butters never really firmed up for me, while the topping layer got rock hard. After playing around with the perfectly textured middle bit, I came up with a chocolate cheesecake dessert.

The most important tool for this dish is a silicone mini-muffin tin. MIne is by Wilton and available at Bed, Bath, and Beyond. You will never get the finished product out of a traditional tin.

Frozen Chocolate Cheese Treats


6 oz cream cheese, divided

6 Tablespoons erythritol, divided

3+ Tablespoons heavy cream, divided

1 teaspoon unsweetened cocoa

  1. Divide cream cheese equally between two small bowls.
  2. Add 3 Tablespoons of erythritol to each bowl.
  3. Add 1 Tablespoon of heavy cream to one bowl and mix well. If sweetener does not dissolve easily, add a bit more cream and continue mixing.
  4. Add 2 Tablespoons of heavy cream and the cocoa to the other bowl and mix well. A bit of additional cream may be necessary for the mixture to be smooth.
  5. Divide the white mixture among the twelve mini-muffin cups. This mixture is thick; after dividing it, scoot the pan back and forth on the counter so the contents level out (see photo).
  6. Top the cups off with the chocolate mixture. Don't forget to lick the bowl.
  7. Freeze overnight.
  8. To serve, pop out of the muffin cup and let it warm up for a few minutes.

Nutritional Information

Serving Size: 1 Treat  *  Calories:  38  *  Fat (g):  4  *  Carbohydrates (g):  0.3  *  Protein (g):  0.5

I have entered these into the Lose It! database for tracking purposes. I hope you enjoy them as much as I do.

No responses yet

Review: @IconUndies the Pee-Proof Underwear

Jan 18 2017 Published by under Fashion (or not), General Health

I'm a woman "of a certain age" to put it delicately. I have birthed some babies, including my 9 1/2 lb son.

Even with lots of Kegel exercises, a full bladder and a sneeze can leave me with wet panties. And not in a good way.

Pantiliners for such events are fine, but not ideal. They get pretty pricey over time. When I saw an ad for Icon Pee-Proof Underwear, I decided to give them a go (pun not intended, but it works).  The crotch of each pair has a special interior lining that can hold several teaspoons of urine without odor or leakage. They can be machine washed and dried without any problems.

After several wearings, I can report that these undies work as promised. I wear the bikini cut (see photo at right), and I tried one thong. They also come in a hip hugger and high-waist version. Colors are limited to black and beige in my size and styles, but what else do we really need? They do seem to stretch out a bit as washed, so you may need to go down a size.

This company also makes Thinx, the period-proof underwear. I don't need those (the certain age thing again), but I bet they work. The site is full of urine puns and "whizdom." And all their products help support the Fistula Foundation, providing surgical repair of obstetrical fistulas. A fistula is a connection between stuctures, in this case the things that empty out down there. Women in countries without modern obstetrical care often suffer genitourinary damage leading to urinary or fecal incontinence afterwards. Fistulas make my teensy bit of urinary leakage seem like such a first world problem...

I still have some other undies at this point, but they will be replaced by IconUndies as they age and go to panty-heaven. It's fun to be pad-free!

6 responses so far

Real World Uncertainty

One of the milestones we use to judge pediatricians in training involves uncertainty in the clinical world. We often deal with probability when diagnosing conditions or prescribing treatments. Many times we are convinced that we know what the patent has, but confirming it definitively cannot be easily accomplished, especially in a timely fashion. We make a provisional diagnosis, treat the condition, and, if the patient gets better, congratulate ourselves on our clinical acumen.

At times, the response to treatment remains uncertain, even when the diagnosis is not. A biopsy-proven kidney disease may respond to a certain treatment 90% of the time. If your patient is in the unlucky 10%, then you must develop another plan to try.

We gauge our trainees' abilities to handle this uncertainty that is part of medicine. We discuss odds and statistics with our patients, but how can we help them deal with this uncertainty? This can be especially fraught with potentially fatal illnesses as I am learning on a daily basis. Do we make a long-term goods purchase? How far in advance do we plan things? What will the future hold?

Odds ratios and averages and other statistics give us information, but we cannot know where each patient fits into the disease spectrum until whatever is going to happen happens. It makes having a disease that much  more stressful and frightening.

No responses yet

Could Yogurt Be the Answer?

Feb 25 2016 Published by under General Health, Kidney Function

You can't swing a dead cat without hitting an article about the microbiome on the internet. Changes in the zillions of bacteria that reside in our bowels now get the blame and the glory for a variety of conditions. Collecting poo and analyzing the actual contents over time to look at contribution to disease development would take years and be cumbersome. Interested investigators therefore think of proxies that may influence microbiota that can be studied with less fuss.

YogurtA group from Buffalo, New York, decided to examine the intake of beneficial bacteria and markers of kidney dysfunction. Some people take capsules of these good bacteria, known as probiotics, while others get these critters from yogurt that still contains the active cultures responsible for its conversion from milk. They used the data from the US National Health and Nutrition Survey (NHANES) to compare yogurt and probiotic use with markers of kidney disease, including microalbuminuria and level of estimated glomerular filtration rate (eGFR). Yogurt consumption was self-reported by participants as frequent (eaten 3 or more times weekly) or infrequent (less than 3 times weekly). Probiotic use was extracted from the study surveys.

From 1999-2012, NHANES included 41,243 adult subjects with complete covariate data available for 32,749 in the cohort with probiotic data (1999-2012). Data on yogurt consumption was limited to 6853 subjects (2003-2006). Yogurt and probiotic use was associated with higher socioeconomic level, more females, and fewer African Americans. Yogurt and probiotic consumers also had fewer comorbid conditions. These differences were adjusted prior to multivariate analysis, since all of the conditions associated with frequent yogurt and probiotic intake reduce the risk of kidney problems. Frequent yogurt and probiotic users showed lower risk of either reduced eGFR or microalbuminuria (OR = 0.76; 95% CI = 0.61 - 0.94). When these markers of kidney problems were examined separately, yogurt and probiotic consumers still had lower risk of albuminuria (OR 0.74; 95% CI = 0.57 - 0.95), while no significant change in the risk of low eGFR could be demonstrated.

This study has a boatload of limitations, including relatively small sample size and its cross-sectional nature. While they adjusted their analysis for confounding variables known to change kidney disease risk, it is still likely that yogurt and probiotic consumption is a marker of "healthier people" at lower risk. While they speculate about effects of probiotics and yogurt on the microbiome, they have no evidence of this effect in their population.

For most folks, eating a few yogurts will cause no harm. It might be beneficial. But this study provides no firm foundation for a recommendation.

Nutrition Journal (2016) 15:10   *   DOI 10.1186/s12937-016-0127-3

2 responses so far

Reflections in a Cracked Mirror

Jan 13 2016 Published by under General Health

In the past 6 months, my feeds brought me numerous articles in the medical education literature about incorporating humanism and reflection. Medical educators encourage students to ask open-ended questions and let patients tell their stories. These techniques should help create thorough, empathetic physicians who can really connect with their patients.

Of course, we then take these idealistic young things and feed them into a grinder that demands a certain level of "production." Patient visits can only last a few minutes, or we cannot generate enough revenue to keep the enterprise humming and the lights on. Increasing efficiency and productivity has worked well in industries. In healthcare, it may be counterproductive, especially when the average patient has multiple chronic conditions to be addressed at each visit.

Physicians also receive instruction now to "negotiate a treatment plan" with each patient. Instead of delivering "the cure from on high" we should take into account each individual's desires, perhaps increasing their buy-in and adherence to the plan. We can help each patient get better, even though we may fall short of the ideal outcome. Of course, the insurers actually paying for the care will grade us and base what we are paid on patient perceptions and our alignment with evidence-based guidelines. A patient may be happy with their plan of care, but it falls short of the prescribed goal of oversight groups. Will the insurer pay me based on the patient's happiness or on adherence to standards?

Is it any wonder that physicians are angry and burned out? Every day I encounter the insolvable problems of the current system. I may see a child that has a trivial lab value in my clinic. That "waste and inefficiency" in the system makes my employer very happy since it's more revenue. Of course, part of this is due to time pressures on primary care physicians. Researching stuff after a visit is unpaid work. If you make the wrong decision, you can get sued. Making that referral is fast, costs you almost nothing, and covers your ass for the future.

I have no answers, of course. This post is merely my reflection on the conflicts I see between what we teach our preclinical students and what our reality is. Think of it as my own bandage for burnout.

No responses yet

Calling Biochemists

Dec 01 2015 Published by under General Health, Uncategorized



For ten minutes every morning I entertain myself with fashion magazines while my hair gets dry. The December issue of In Style greeted me with the advice to the right.

It has been a few years since doctor school, but metabolism of ethanol does not seem to have changed much (discussion here). I have seen a number of theories on hangovers through the years, with most focusing on volume loss and intermediaries of the metabolic process.

Downing a cup of water between overindulging and sleeping it off might help with dehydration. I am at a loss to explain how a tablespoon of vinegar or a drop of raw honey would be of value here.

Here is a link to Nikki Ostrower's integrative nutrition center.

While this concoction certainly will do no harm, I am not conviced that it would prove superior to just chugging water or other fluid. I would also love to see evidence that it facilitates alcohol metabolism.

Your turn, biochemists. Educate me!

6 responses so far

My Week In Review

May 29 2015 Published by under General Health

I have been treating inpatients this week and dealing with a particularly annoying virus that someone gave me last week. I am exhausted and sore from coughing.

Neither of these stopped the calendar. I still gave Grand Rounds on Wednesday, discussing the past and current recommendations for screening urinalysis in children in the US. I have my presentation on SlideShare, and I'm embedding it below. Enjoy the flow!

Have a good weekend. I look forward to thinking about something besides my own mucus next week!

No responses yet

Progress Report: 10,000 steps at a time

Oct 29 2014 Published by under General Health, gizmos

A while back I blogged about the addition of a stair stepper to my standing desk set up. I have gotten much better at typing (keyboarding for you whippersnappers) and doing other work while stepping. Working with our electronic record systems and sending email barely slows me down.

Phone calls still require standing still or sitting; the stepper, unlike a treadmill, requires some oomph from me to move. That gets transmitted in my voice, and I don't want to have to explain why I sound weird.

To give you an example of how this changes my activity level, here is today so far:

8:30 - 10:00:  Made rounds with residents. Saw consult patients. Just over 2,000 steps by Fitbit

10:00 -  Noon:  Office work, including charting, reading manuscripts, email and other correspondence. Current steps at 9,264

Thinking it's time you added a stepper? Some things to keep in mind:

  • Keep padded shoes available; if you have been standing at your desk, you probably have something comfortable stashed under your desk anyway. Unlike standing, my ballet flats and loafers do not suffice when I'm stepping.
  • Some steppers squeak. Mine started out quiet, and then became annoying when I put my right foot down. This noise stopped a couple of days ago for no good reason that I can identify. It's best to close your door while you do this anyway, both because of noise and the weirdness factor.
  • If you are prone to feel warm in your workplace, you may want a fan. You really can get warm with this level of activity, even at an incredibly leisurely pace such as I have.

By the way, in the 8 minutes it took me to write that bullet list, another 400 steps have been added to the total.


4 responses so far

#TweetYourBushMeat Ozarks-Style

Oct 28 2014 Published by under General Health

I grew up in Springfield, Missouri, the Queen City of the Ozarks. This town of approximately 150,000 people and some educational institutions (my dad taught at Missouri State) provided a nice city upbringing for me. However, you didn't have to drive too far out of town to find a different world. The movie Winter's Bone was filmed about an hour away in the hollers and old-growth oak forests. The poor there survive like poor people everywhere; they do what they have to do, including hunting for game (and cooking meth as described in the flick). Below is a scene from the movie in which Jennifer Lawrence (in what I consider her best performance so far) teaches her younger siblings important survival skills:

Lucky for Ree Dolly, squirrels are pretty safe to eat; these rodents transmit very few diseases to humans. If she had settled for rabbit, there would be more significant risks. I know a couple who caught tularemia from skinning and dressing a rabbit. While this disease is treatable with antibiotics (unlike ebola), they did not have fun during their illness.

Nobody blamed them for hunting a rabbit and dressing it to eat (although their kids did tease them about their "road-kill" diet).

I know a lot of people who hunt game for fun rather than survival; this, too, is bush meat (even when you mount the head and hang it on the wall).

The main differences from Africa:

  • We do not call our wilderness "bush" in North America
  • The species that roam the woods and fields are different

Please do not judge those in Africa who eat what they kill; it's for survival.

2 responses so far

Disappointment @Fitbit

Oct 18 2014 Published by under General Health

FitBitOneFor several years I have been wearing a Fitbit of one sort or another. Currently I have a One clipped to my bra, measuring various activity parameters. I love my One and the Fitbit dashboard, enough that when my scale went bad I bought the Aria wifi scale. Having my weight and activity data in the same database has been interesting and helpful.

I prefer Lose It! for diet tracking, but it can interface with the Fitbit dashboard. I can see interrelated health data all in one place!

Earlier this year I found out that my blood pressure was sky high. Fitbit does not make a blood pressure cuff, nor do any on the market automatically record to their dashboard. It has a place to record blood pressure, but I would have to manually enter it. I explored a couple of "fitness dashboards" that said they could accomplish this feat, but none worked.

When Apple announced the Health module in iOS8, it thrilled me. Given the popularity of Apple and Fitbit, I assumed that my problem had been solved. Then Fitbit announced that they would not pursue Health integration for now, and Apple will no longer be selling Fitbit devices.


Like it or not, a single health dashboard that can collect information automatically will give people the best information to track their health habits and results. Manual entry can be performed, but really should be unacceptable in this day and age. Also, there are other devices out there that could be linked up (CPAP machines, etc).

If these corporations were really people, we could put them in "time-out" or "peace chairs*" until they work this out. Unfortunately, disciplining and/or modulating behavior of corporations is proof that they are not really people (is the Supreme Court paying attention to this blog?).

So come on, Fitbit. Play nice with Apple. Please, for me!?!

* "Peace chairs" came to our attention when our daughter was in first or second grade. Children with disagreements were to sit side-by-side in these chairs and work out their differences with words. This concept did not really get our attention until the day that another child would not do the "peace chair" thing with our daughter. She wielded a pair of safety scissors and told him to get in the "peace chairs" or she would cut him. This led to an interesting discussion with her teacher. Thus, I really do not have any data to support the use of "peace chairs" in practice. 


No responses yet

Older posts »