Thursday, December 31, 2009

Ginko biloba, Not as good as once thought!

Ran across a new article in JAMA about "Ginko biloba for the preventing cognitive decline in older adults."
This study is the best kind of study we can perform in medicine. It was randomized, double-blinded, placebo-controlled trial of 3069 patients aged 72-96 years old from 2000-2008.
Patients were either given Ginko 120mg twice daily or identical placebo. Multiple rating scales employed to objectively rate cognitive decline and or improvement.

The authors concluded that Ginko 120mg twice daily did not result in less cognitive decline in older adults with normal cognition or with mild cognitive impairment.

The bottom line is, if you are taking Ginko for memory you are likely wasting your money.

Here's the article:
Ginkgo biloba for Preventing Cognitive Decline in Older Adults
A Randomized Trial
Beth E. Snitz, PhD; Ellen S. O’Meara, PhD; Michelle C. Carlson, PhD; Alice M. Arnold, PhD; Diane G. Ives, MPH; Stephen R. Rapp, PhD; Judith Saxton, PhD; Oscar L. Lopez, MD; Leslie O. Dunn, MPH; Kaycee M. Sink, MD; Steven T. DeKosky, MD; for the Ginkgo Evaluation of Memory (GEM) Study Investigators
JAMA. 2009;302(24):2663-2670.

Bryan Glick, DO

Wednesday, December 30, 2009

Hangover Remidies

There have been multiple remedies suggested for New Years Day hangover. Personally, I have had great results with taking ibuprofen 4 tablets by mouth with a snack, right before bed and 16-20 oz of water. I also, wake up and do the same. Alcohol dehydrates you so make sure you are urinating and your urine is clear, not yellow.

This article I found from 2007 reports that:
Drinking a glass of milk and eating a slice of toast with honey or syrup may combat that hangover.

check out the article yourself:

Have fun and be safe.
Bryan Glick, DO

Wednesday, December 23, 2009

Red yeast rice and your cholesterol

Saw an interesting article in American Family Physician. It was actually a summary of an article published in the Annals of Internal Medicine June, 2009.

Questions posed: Is Red Yeast Rice effective in Statin-Intolerant Patients?

Typically when patients have high cholesterol, as physicians, we initially recommend therapeutic lifestyle change (TLC) for a couple months. This is when the patient gets the message that they have to change the way they eat and start exercising. Some patients respond but the vast majority don't. "I'm too busy, I don't have time." My response is, "You have to make time to exercise or take time to take a pill." That pill is usually a STATIN class of cholesterol lowering medications. These are the ones you see on TV named Lipitor, Crestor and Zocor for example. These medicines can be prescribed by your doctor and usually your liver function tests need to be monitored periodically.

Now some patients do actually have an allergic reaction to STATIN medications and cannot take them. So they need alternatives. This article addressed one of these alternatives, Red Yeast Rice.

The Study:
Patients were enrolled in 12 weeks of a lifestyle change program and received Red Yeast Rice 1800mg twice daily for 24 weeks. Baseline LDL cholesterol was measured. At the conclusion of the study, the Read Yeast Rice group showed significantly lower LDL cholesterol levels.

The Answer:
The authors concluded that Red Yeast Rice in conjunction with therapeutic lifestyle change may be useful for treating hyperlipidemia in patients who cannot tolerate STATIN therapy.

So this information is good right? Go out and buy your read yeast rice, immediately? I don't think it's a bad thing but you do have to watch the fine print. These patients were in a 12 week lifestyle change program. Likely, provided nutritional and exercise education. I can provide that, but not for 12 weeks. Yes, the medicine helped but it's not clear how much what the lifestyle changes program entailed and to what extent the effect was.

The question always arises, "Doc, what can I do to lower my cholesterol."
The answer is Diet and Exercise and Weight loss. Other options include: Fish Oils, Red wine, 2 servings of oatmeal a day and avoiding saturated fats.

You can read the article yourself at:

Bryan Glick, DO

Tuesday, December 22, 2009

Do you have sinus congestion?

Arizona is known for many things besides the beautiful scenery. Medically speaking, Arizona is known for seasonal, strike that, year round allergies. Many people have post-nasal drip, runny nose, sinus congestion, sore throat and cough. None of these symptoms is associated with a fever usually and patients typically complain that this has been going on for weeks. I personally grew up in Northern California and never had allergies until I settled in Arizona. The relative lack of humidity, year round, is a huge factor.

I have a lot of patients who present with 2-3 days of sinus headache, nasal congestion and post-nasal drip. They always want antibiotics. Do they need them? Officially, no, but do I prescribe them anyway, yes. These reason, I prescribe them when I think this is allergic or viral is because, the patient was concerned enough to come in and be seen. They have to go back to work or take care of the kids and it's not for me to say "No, you can't have that medicine, you'll be fine." Some of you might be think, isn't that the job of a physician, to tell you what medicines you can have and which are unnecessary? Yes, that is the job of a physician but it's also my job to provide care in the best interest of patients. That's why if you want narcotics and don't need them you won't get them here, for example.

There have been many studies on the placebo effect (taking a sugar pill that you think will heal you because you have been told so by your doctor) and how well it works and the ethical questions surrounding it. If I have an antibiotic that you have taken before, and you have attached a value to that therapy ("Doc, every time I get this I take a Z-pak and it goes right away") such that it works and it's all you need, If I deny you that medication, am I doing more harm than good? Don't know. Don't even know how that could be studied. I do know that patients all the time think their illnesses are cause and effect when very little but death and taxes are cause and effect. As a physician, I see them as coincidences or completely unrelated but to challenge a patient to an academic argument when they are ill is the antithesis of care. So, If a patient says "Doc, every time I get a running nose, I take chemotherapy and it goes right away," well that patient needs to be educated and they won't get chemotherapy. Azithro (z-pak) is relatively safe medicine, yes antibiotics resistance is possible but I just wonder if the placebo effect may be the real medicine in this situation.

In an effort to be avoid antibiotic Resistance and possible side effects from unnecessary medications, let me give you a head start on what you can do if you start having either allergic or viral sinusitis.

Initially, you should start with pseudophed OTC 30-60mg every 4-6 hours which will help shrink the sinuses. Don't take it in the evening as it could keep you awake.

Next, you can take ibuprofen at the same time for pain relief but sometimes this isn't necessary because the shrinking of the sinuses allows for drainage which relieves the pressure and takes the pain away. If you are going to take it, make sure it's with some food.

If you feel that your eyes, ears and nose are itchy, this may be a allergic issue and you might want to take plain benadryl 25mg at bedtime as an antihistamine. This will make you drowsy and will help prevent all that mucous production.

A cool mist humidifier will increase the humidity in your bedroom and prevent your nasal passages from drying out while you sleep.

If you feel achy and run down, this may be an viral process and you may want to take one of the many OTC viral remedies. The one I like is Umcka Cold Care.

When do you need antibiotics, you ask?
We reserve antibiotic therapy for patients given pseudophed and ibuprofen for 7 days who have the following:
Facial pain, green nasal discharge, tooth pain, or antibiotics in that last month for another illness.

Using the above treatment regime will not only provide you relief sooner and cheaper but will also aid the doctor in understanding how bad your sinuses are and help you get antibiotics when you need them rather than when you want them.

Bryan Glick, DO

Ibuprofen vs Tylenol with Codeine for Kids

Following an arm fracture, is ibuprofen as effective as acetaminophen (paracetamol) with codeine to relieve short-term pain?

Bottom Line:In the first 3 days following a fracture, ibuprofen is as effective as acetaminophen with codeine in the treatment of children's pain due to an arm fracture. It also causes fewer side effects. One caveat: The total daily dose of ibuprofen used in this study is higher than typically used because it was given every 4 to 6 hours rather than every 6 to 8 hours (as labeled). (LOE = 2b-)

Drendel AL, Gorelick MH, Weisman SJ, Lyon R, Brousseau DC, Kim MK. A randomized clinical trial of ibuprofen versus acetaminophen with codeine for acute pediatric arm fracture pain. Ann Emerg Med 2009;54(4):553-560.

Taken from Evidence Essential Plus, Daily POEM.

Wednesday, December 16, 2009

H1N1 Vaccine Recall

Today you may hear on the news that the CDC has found some of the prefilled H1N1 vaccines are being recalled. The recalled vaccines have demonstrated less immunogenicity (protection) than previously thought. Those children that need a booster should still get it. If you child received one of the recalled vaccines you DO NOT NEED to repeat the recalled vaccine. Just continue to get the booster in the 4 week interval.

CDC website has information about it. See link below for details as well as lot numbers.

If you received you vaccination from our clinic, your safe. We have only multi dose vials which were not named in the recall.
Feel free to call if you have any questions.

Tuesday, December 8, 2009

Experience teaching at the Caepe School

Just returned from TRYING to teach nutrition at the Caepe School in Anthem in Mr. Miller's class of 7th and 8th graders.

Myself and Ben, my medical student, anticipated talking about food labeling and how to read the nutrition facts on the box.

Needless to say, we all had a good time. The kids were very enthusiastic and asked, no joke, 50 + questions. I have taught in high school, college level and medical school before, but never for middle school. I will have to work on keeping the topic focused. One of the topics that one of the students asked about was "tree man." Many of the kids have seen him on the internet. Ben and I had no idea what they were talking about. When we got back to the office we looked it up and apparently this gentleman has a immune system defect that allows viral warts to go out of control. Rather interesting but I need to work on what educational info can be gained by talking about it.

Another good topic that the kids brought up was genetics and I will work with Mr. Miller to do a whole topic on Mendelian genetics. I hope I can present that in 1 hour or less.

I think the kids had to get all of their questions out and next time we can be a little more focused.

In the future, we are trying to coordinate CPR training for the kids along with First Aid.

Overall, an amazing experience, and I think I will be able to teach science in a fun and gross way. The kids did have a bunch of questions about vomit and other gross topics.

Next week, 12/17, we will revisit the food label topic. Finish it and prepare for another topic first of the year.

Really fun to get out of the office.

Bryan Glick, DO

Thursday, December 3, 2009

Do you take a med for cholesterol? Are you taking CoQ10?

We have known for years that CoQ10 is a metabolic nutrient that has been shown to be helpful in patients with heart failure. The Japanese government has advocated daily use of CoQ10 since the 1970's. A significant proportion of our population if not the world are on Lipid lowering medications known as "statins." We know that these statin medications lower CoQ10 levels which may lead to sore muscles and fatigue. There is proven benefit from the addition of CoQ10 in patients with heart failure but conjecture still exists regarding CoQ10 effectiveness in patients taking statins.

The American Family Physician wrote an article re CoQ10 which is a general overview. Make sure to read the "update" section at the bottom for the summary.

Bryan Glick, DO