Sunday, July 8, 2012

Obesity, A Rant

I found this fascinating.

Yesterday we saw a young family, the parents and two little girls probably 8 to 10 years old. The parents were noticeably overweight but not what I'd call obviously obese. I'd say average based on the majority of people I see these days. But the little girls were both fat, in my opinion, at least working on obese.

I wonder, what are these kids eating, how much are they eating and what, and what are they doing all the time?

Allow me to rant for a while.

Obesity is one of the most pressing issues we have to deal with not only here in this country but worldwide, as it's spreading. Pun not intended.

It caught my eye not only because I'm interested in the topic, but I used to work for this organization, Scottsdale Healthcare, it's a good hospital system and good place to work, doing some cutting edge work in certain areas like bariatrics. 

I first saw this in one of the e-mail medical newsletters I read daily.

Diabetes is an extremely costly disease. The complications: cardiovascular disease, neuropathies, infections, organ dysfunction especially of the kidneys and eyes. Limb loss. Sepsis. Dialysis. Premature death.

We also need to attempt to stop it before it happens, like not letting people get to a BMI of 30 in the first place, even though some people are more likely to go there due to genetic influences. The video doesn't talk about changing behavior early on, intervening before a person starts to become obese and the metabolic signaling results in diabetes.

Years ago people were not so fat. They were more active. They didn't have the range of sedentary activities to keep them mesmerized. There wasn't the range of bad food, and the ingredients, and the portion sizes.

There is a huge genetic influence on obesity. But that doesn't mean we throw up our hands and say, wait until the person is diabetic then give them a sleeve gastrectomy.

We need thinkers like Dr. Blackstone to manage the medical approach to managing this disease, but we also need more action on the prevention end of things. We certainly aren't doing enough lifestyle interventions to help solve the problem.

Workplace habits, city planning, commuting time, work schedules, stress, availability of healthy foods, lack of leisure time, leisure time choices, lack of physical education that truly teaches kids how to develop healthy lifestyles, all of these things and more add up to what? Sleeve gastrectomies?


Exercise and nutritional screening, behavioral screening for tobacco and alcohol consumption, electronics use and TV watching. Simple things! Doctors aren't necessarily good examples at all.

I'd like to see total screening in preventive care as an ongoing intervention, education and practice throughout the lifespan. It doesn't belong primarily in the domain of preventive health care in a doctors' offices. The schools could play a huge role, along with the community organizations that sponsor youth activities. What to eat, how to cook, what to buy, what to avoid. How to increase activity, emphasizing less sedentary time.

As people get older, include thyroid screening. You wouldn't believe how many patients I see, when I look at their labs, I see elevated TSH and they're not on thyroid meds. When I ask about it, they look perplexed. Many cancer treatments can affect thyroid function but many of these patients are not getting treatment for cancer. They say they are tired.

The thing is, we already know all this stuff. We know what would work. But there's a lack of organized, coordinated societal effort. In the video, Dr. Blackstone acknowledges that some of the other medical disciplines such as oncology and cardiology have had a lot of success with combination therapies, including behavioral interventions and medications, in addition to surgery. It is a multifaceted problem and needs to be treated accordingly.

But when I see little kids who are well on their way to becoming obese adults, it makes me cringe, and I know we are setting them up for failure early on, before they ever get a chance to learn to make healthy choices for themselves.

And I think that's a major failure on the part of the adults in this country. We know better, and it's outright negligence to continue to allow this to happen.

end of rant, for now.

(cross posted at Journey to Badwater )

Tuesday, April 3, 2012

Seeing through the (Brain) Fog

One of the most frustrating things about hypothyroidism, when it isn't adequately treated, is the brain fog that goes along with it. At least it's that way for me. I don't feel good when I can't think clearly. I am a high functioning person and I use and expect a lot of my brain all the time. When it's not working, I feel like I've shut down. My quality of life is so diminished when I can't concentrate that it depresses me.

When this goes on for a period of time, it can make you question the meaning of your existence, and not in the philosophical sense. I've heard people say it feels pointless to go on living like this. That's another reason why we need to be vigilant about our physicians' handling of our treatment. They might not have ever experienced brain fog, but I bet if a doctor had to deal with their own brain fog, they would understand. Completely.

Being an oncology nurse, I am constantly hearing about chemobrain, a phenomenon that many people experience when going through chemotherapy, and for months to years after treatment, or even permanently. I have never experienced chemobrain but from the way patients describe it, it sounds just like hypothyroid brain.

One of the newsletters I subscribe to featured this article on concentration recently, intended to help people experiencing chemobrain to function better. When I read it, I found it perfectly applicable to hypothyroid brain.

I hope this helps. I'd like to hear your comments.

Monday, March 5, 2012

Do I always have to take my medication on an empty stomach?

I was just asked this question again today and I've been meaning to post about this, but then I always forget.

Doctors and pharmacists always say you need to take your thyroid medication on an empty stomach. Why? Because food, especially foods with calcium or iron in them, will interfere with thyroid hormone absorption from your stomach. Also, some medications, like antacids, can bind to the thyroid medication and prevent absorption. (Caution: If you do take other medications along with thyroid meds, check with your pharmacist to see if there might be any interactions between drugs or any reason that you absolutely need to take them separately from your thyroid meds.)

Here's the scenario: You're newly diagnosed with thyroid disease and need to start taking medication. Upon hearing that you need to take it on an empty stomach, you realize that means you won't be able to eat breakfast in the morning for an hour even if you tke the pill first thing when you wake up. That disrupts your whole morning routine. So you get this great idea: you'll wake up an hour early, take your pill, and go back to sleep. Sounds great, right?

WRONG! Not fun. Plus, how many times do you wake up out of a sound sleep and have to do something, and then can go right back into a sound sleep for another hour? (If you can, then you're either lucky, or not perimenopausal)

One of the biggest fallacies about taking thyroid meds is the waiting an hour until you eat. If you always do the same thing, and are always consistent, the absorption thing will work itself out in the testing and dosing. I take mine every morning with my coffee (which has milk in it) and I eat breakfast soon after. You need your sleep more than you need to be woken up every morning just to take a pill. I know so many people who think they have to do it that way and really, it makes no sense.

Here's what I learned from my old endocrinologist in Arizona. She had her thyroid removed and took thyroid meds every day. She took hers with her morning latte. She explained it like this:
If you always have the latte, then the test will be based on your thyroid med absorption with the latte. So whatever your TSH comes out to be based on thyroid meds with latte, you can be medicated based on thyroid meds with latte.

I never worry about it, and I've never had a problem. In races, like I said, just do it when it's the same time of day. One day doesn't make all that much difference in your overall TSH if it's done slightly differently due to a race. Especially considering you'll only be getting tested every few months at the most.

Enjoy your sleep! (And your coffee)

Thursday, January 12, 2012

Medical News: Older Surgeons May Not Be Better Surgeons - in Surgery, General Surgery from MedPage Today

I just found this article. I'm not endorsing this as the way to go in all instances, and it's not specifically thyroid surgery-related, but it is something to consider if you ever find you need surgery or some procedure done on your thyroid, or anything in your body. Food for thought. Always remember to interview a doctor or surgeon before you decide to go with them. How long have they been doing the procedure/practice? How many of these surgeries have they done? You also might want to google on the doctor and see what sorts of reviews they have.
Medical News: Older Surgeons May Not Be Better Surgeons - in Surgery, General Surgery from MedPage Today