New anticoagulant now approved by FDA

The journal Circulation has now released an article on dabigatran (marketed as Pradaxa) discusses the indications and uses. Dabigatran will be available as an alternative to the usual anticoagulant, warfarin (coumadin), for prevention of stroke that can be an associated risk in patients with atrial fibrillation. It is not indicated for other coagulation problems at this time.

Many patients are enquiring about this alternative medication since measuring of blood tests (INR, Prothrombin time) will not be required.

However, patients need to consider ...

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Muscle cramps with statins

I am often asked by my patients what can be done, short of discontinuation of the medication, for cholesterol lowering statin drug induced muscle cramps. The cause seems to be related to impaired fat oxidation within the muscle’s mitochondria (the cell’s “furnace” for making energy for contraction).
I would suggest considering the following plan for my patients:
1. Try a fat restricted diet with a higher focus on high carbohydrate diet due to the problems with fatty acid oxidation
2. ...

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Dietary “pearls” to think about!

Trying to lower your LDL cholesterol? From Penn State comes a study which showed a 13% lowering of your bad cholesterol when two servings of pistachios are consumed per day. The thinking is the high content of “phytosterols” that are found in nuts that bind cholesterol in the gut.

It’s always better to focus on whole grain breads than refined white bread. The American Journal of Clinical Nutrition showed that those individuals who ate mostly whole grains had 17% less abdominal ...

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New therapy for asthma?

A new therapy for the management of uncontrolled asthma has now been proposed in a recent article in the New England Journal of Medicine. In the September edition, 2001, an article appeared which has stirred the interest amongst pulmonologist. Stephen Peters, MD, of Wake Forest University Baptist Medical Center in Winston-Salem, North Carolina, was the principal investigator. The study was released by the US National Heart, Lung, and Blood Institute.
The patients evaluated were on low dose inhaled corticosteroids (beclomethasone ...

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Welcome to Grand Rounds on Sarcoidosis

A recent excellent article appeared in JAMA (January 26, 2011; 305;4:391-399) by Drs. Iannuzzi and Fontana. So many of my patients with sarcoidosis ask about this peculiar disease and wonder “why me?”, “what causes it?” and “what is going to happen to me?”. All reasonable questions amongst the many others that are raised.

This was an article for Grand Rounds at The National Institute of Health and summarizes very well the current “state of the art” of understanding this disease.

Sarcoid affects ...

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COPD and rationale usage of medications

In a GLUCOLD Study from the Neitherlands, by adding inhaled fluticasone (inhaled corticosteroid, ICS) to inhalation therapy in patients with chronic obstructive lung disease (COPD) it was demonstrated to improve “quality of life” parameters, reduce inflammation in patient’s airways (as shown by a reduction of mast cells, neutrophils and eosinophils in sputum, and reduced airways hyper-responsiveness compared to placebo at 6 months of treatment. Cessation of the fluticasone resulted in reversal of benefits back to baseline. This could mean that ...

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Cortisol and “stress” on your body

In patients or athletes who stress their body through disease or performance but consider the negative impact of having high blood cortisol levels.

When the body is stressed (eg. disease or high intense exercise) cortisol is excreted to a higher amount from our adrenal glands in response to producing more glucose to feed our cells (eg. muscles). While this is a normal response to have our bodies find more energy for our other cells in the form of our nature fuel, ...

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Update on fish oils and omega-3′s

John Lee, MD in Mayo Clinical Proceedings (March 2008; 83: 324-332) demonstrated that there was a 19-45% reduction in cardiovascular events when examining three large studies covering more than 32,000 participants. This improvement was independent on whether the patients consumed natural fish containing omega-3 rich products or gel capsules. It was his recommendation that patients who have cardiovascular disease consume 1 Gm per day of fish oils (as combined docosahexaenoic acid [DHA] and eicosapentaenoic acid [EPA]) while patients who do ...

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Learning how to exercise

All day medical professionals are trying to get you to stop smoking, diet, loss weight, walk, reduce the sugar intake, and cut back on alcohol. So, I thought it would be informative to see just how easy it can be to shed those unwanted pounds this new year and make a promise to walk the road to a better health.
I especially like the sit-ups at the end! Watch the whole video….

diet, exercising, humour, walrus
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Elevating HDL cholesterol

While we are able to experience excellent results with the application of various statin medications to lower the “bad” form of cholesterol (LDL), there has been less ability to raise the “good”form (HDL) with medications. High HDL levels most commonly occur with those individuals blessed by “good genetics”. Exercise can promote an elevation of HDL but often requires a serious commitment to a significant amount of exercise to truly experience the bump in HDL desired by most patients with a ...

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