Power to the Plants

Thursday, June 28, 2018
David Abrams

Dieting fads and trends come and go. Low Fat/High Carb - Low Carb/ High Protein, The Zone, Atkins, Blood Type Diet, Paleo, Whole 30 have enough advocates and detractors that it can be difficult to discern what is considered a healthy diet nowadays. More recently with the promotion of several popular books and documentaries, there is an increasing public awareness of the proven benefits of a plant-based diet.  A plant-based diet is just as it sounds based on foods derived from plants including vegetables, fruits, legumes, whole grains, nuts, soy products, and little to no animal products particularly red meat and dairy.

When you redesign your plate by centering around plant-based products, you are enriching your diet with important fiber, vitamins, antioxidants, phytochemicals and healthy fats. In one way or another these elements when added to the diet are known to contribute to reducing the incidence and severity of chronic diseases including heart disease, hypertension, diabetes, and high cholesterol. There is also some evidence that the opposite is true of a diet dominated by processed and animal-sourced foods.  

Beyond promoting cardiovascular health following a plant-based diet supports and can promote good health in a variety of other ways. Legumes and veggies high in fiber help aid in the healthy flora of the gut, naturally increase healthy bacteria and may decrease gastrointestinal problems. Fruits and vegetables have plenty of vitamins and antioxidants that are beneficial for collagen production and skin health. And, while most adults gain weight as they age, a plant-based diet often helps maintain weight perhaps even lose excess weight in a healthy way that does not involve strict calorie-cutting guidelines.

There is no doubt that transitioning away from processed foods and incorporating more plant-based foods can be challenging or even intimidating. Constant media attention aimed towards processed foods and accessible 24/7 drive-thru's are alluring and convenient. On the other hand, most food markets now have significantly enlarged their plant-based product section and most restaurant menus will highlight their “vegetarian friendly” menu items. The best way to begin a plant-based lifestyle is to start off by a simple substitution system. Consider substituting some dairy products with those created from almond milk or soy milk. Try replacing at least some of your animal protein sources with legumes such as foods created from beans peas nuts. When you do include animal protein in your menu as much as possible avoid red meat and replace that with fish and remember to use olive oil.

In my practice, I encourage my patients to recognize the real value of incorporating plant-based foods and reducing the intake of red meats. Then, combining this with a regular exercise program together we monitor their significant progress to better health.

 

Should I Forget About It?

Wednesday, May 16, 2018
David Abrams
 Many of our patients are concerned about memory loss.  We call this phenomenon age-related memory disorder.  As we grow older, changes occur in our body and the brain is no exception. As a result, some people may notice that it takes longer to process or learn new material or forget and misplaced personal items. These problems can be frustrating, but occasional episodes of memory lapses most often reflect a normal part of the aging process and not a warning sign of serious mental deterioration or onset of dementia or Alzheimer's disease.  And, owing to the burgeoning awareness of social media and cable news cycles in recent years age-related memory loss has been widely publicized causing even more worry among the old and elderly who may have experienced periodic difficulty with memory. 

These forms of periodic memory difficulties have minimal impact on a person's daily performance and activity. Forgetting your keys is annoying, but not debilitating. Retrieving memories from long-term storage such as remembering a name may take a little longer.  But in fact, there are things that everyone can do to improve the situation.  There are aids such as context and cues can help recover the information. For example, posting a sticky note on a fridge to remind you of important things or keeping a daily journal can help facilitate recall. Similarly, creating mnemonics by linking the desired information with a visual image, sentence or word can also support the learning and retention of new memories. 

Additionally, it is well-known that adopting healthy habits of proper diet exercise, in particular, resistance exercise is very helpful in maintaining brain function.  Proper.  On the physician side, we want to be certain that medications do not adversely impact cognitive function and that we are particularly careful about maintaining proper blood pressure and surveillance of blood chemical test.

 In contrast, true cognitive decline is a more complex phenomenon with multiple causes and can manifest in a variety of ways. Dementia is marked by persistent, disabling decline in intellectual abilities. Significant changes in personality, neglecting personal safety and hygiene even becoming lost in familiar setting are potentially more serious signs of cognitive regression.  In that circumstance, we will be making recommendations that patients undergo more significant evaluation and testing.

There are many ways to mitigate the inevitable age-related memory difficulties that patients experience as well as things that one can do that reduce risk of cognitive decline. To maximize brain function it is important to include physical, mental and social activities that stimulate the brain. Exercising and eating healthy, obtaining annual wellness exams and challenging the mind with mind-training exercises help to improve brainpower. Attention to proper, restorative sleep patterns and stress reduction possibly engaging in mindfulness and even meditation are definitely beneficial.

  In the office we can more completely evaluate symptoms evaluate symptoms, review personal risk factors and carry out specific tests to determine memory and mental ability. Early diagnosis and prevention can treat causes of memory loss and result in a better quality of life

Blood Pressure: The High's, The Low's and Everything in Between

Thursday, March 22, 2018
David Abrams

While 120/80 mmHg is the standard benchmark for good health in adults, factors including age, gender and other existing conditions all contribute to varying blood pressure numbers. In recent articles from various organizations including the American Heart Association and the American College of Cardiology there is a widespread promotion of new and at times somewhat conflicting blood pressure guidelines.  With all this new information, it is of no surprise that patients with high blood pressure can be overwhelmed. In my practice, I am able to take the time to customize a blood pressure range that takes into account the individual variations and preferences of my patients using home blood pressure monitoring.

 

Everybody has different medical conditions, different choice of medications and different sensitivity to medications. Blood pressure fluctuations are extremely common and not all spikes and dips prompt concerns. The changes in blood pressure reflect the body's ability to adapt and can be a part of a normal daily physiology-- even laughing, talking, walking can cause noticeable increases. However, distinguishing between the normal from the abnormal is crucial. Setting a target blood pressure range based on one's medical history, current medications and overall health goals is achievable. To recognize and acknowledge this conclusion is the key to not only reach healthy blood pressure but also maintain an overall healthy lifestyle.  

 

Thanks to advances in electronic communication my patients keep me up to date with secure email, text messages, even old fashioned fax transmissions of their blood pressure readings and perhaps any symptoms they are having. That is Telemedicine.

Telemedicine is getting noticed

Tuesday, October 06, 2015
David Abrams

An article recently appeared on MedCityNews.com discussing my favorite topic: Telemedicine. In it, the American College of Physicians, known as the ACP, acknowledged that telemedicine can “increase access to care and patient satisfaction while delivering care that is more efficient and less costly than in-person encounters.”

The ACP went on to say that telemedicine might be a threat to regular office-based visits, from a bottom-line standpoint. They think that direct-to-patient telemedicine should only be used once in a while as an alternative to visiting a physician, rather than as a replacement for. I don’t agree with that, and it’s not simply because I’m a practitioner of telemedicine. I think it’s the way of the future. I believe that it makes seeing a doctor easier for most people because to see a doctor simply means looking into a computer screen and camera. There’s no travel involved; no hassle in getting there. You’re already where you need to be.

Even with their reticence, the ACP “supports the ongoing commitment of federal funds to support the broadband infrastructure needed to support telehealth activities.”

There were just two comments to the article, one from a man named Roger Downey who said this: “For those wondering what the important distinction is, telemedicine involves a remote physician seeing a patient via realtime videoconference at a location recognized for reimbursement as an "originating site" by Medicare, Medicaid and/or state law. Typically, there is a patient "presenter" with the patient following the doctor's instructions to perform an exam with integrated medical devices such as a stethoscope, otoscope, exam camera for closeups of the throat, eyes, and skin, ultrasound probe, EKG, spirometer and vital signs monitor. The images, audio and data are shared live with the physician, but at the end of the patient session they can be preserved in the patient's electronic medical record for continuity of care.”

Here’s what I said in response: “There are individual docs such as myself who practice telemedicine from other than an "originating site" with their own patients who see this as an extraordinary benefit for access. Importantly, the patients also benefit from more and faster attention to acute illness and closer monitoring of chronic illness. And, in my case I will when necessary even send a trained assistant to their home with those same devices you mention. I do appreciate the ACP for their cautious approach while the experience of the D2C telehealth companies is assessed.”

I feel confident that telemedicine will make the practice of health care and the opportunity for quality care available for all, and that it will ultimately benefit the patient by providing easier access to a primary care physician.

The Art of Telemedicine

Tuesday, August 18, 2015
David Abrams

Telemedicine, defined as the use of technologies—including telephones—to remotely diagnose, monitor and treat patients, has actually been practiced for decades. Beginning in the 1960s when the space program began, the National Aeronautics and Space Administration (NASA) was able to chart their astronauts’ vital statistics thanks to specially designed monitors attached to their spacesuits.With the advent of satellite technology, NASA also pioneered several earthbound projects that allowed them, for instance, to deliver health care to the Papago Indian Reservation in Arizona. In 1974, the agency first used high-quality videotape during a health exam conducted by a nurse but monitored by a doctor via close-circuit television. Fast forward four decades, and Telemedicine is fast becoming one of the most accurate and cost-effective ways to conduct doctor to patient evaluations.While it cannot accomplish everything that a patient may ultimately need in terms of health care, it has become a very viable alternative to in office visits, saving a patient valuable time while allowing a doctor the time to do what he or she does best – practice the art of medicine.

The practice of Telemedicine differs from a standard office visit in that it makes innovative use of advanced technologies to communicate more directly with patients.

Thanks to the digitization of many diagnostic devices and the increasing popularity of mobile health and tracking devices, like Fitbit, Fuel Jawbone and now Apple iWatch, anyone can keep better track of their own health and vitality. Then with Telemedicine they can reach out and share that data with their healthcare provider who can be just about anywhere.

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