Archive for June, 2010

You probably need Vitamin D

Tuesday, June 29th, 2010

As my friend and mentor on Mad Money, Jim Cramer, likes to say: When the facts change, change your position. It is so easy to make fun of experts after they stake out a position that is tenuous at best, even when they are your colleagues. So it was when I took out my pen-cudgel and attacked the bandwagon proponents of Vitamin D. You know who they are. They are the doctors who have you come in repeatedly for the same blood tests, give you medicines which are natural and homeopathic and of course which are good for you. They are the doctors who use baby talk as when they refer to “your tummy” or listen to your heart and take blood pressure through your clothes and who interrupt you as your describe your symptoms (oops, did I do that?). They are doctors who rationalize that placebos are actually good for you because they do no harm. So here I am indignantly self-righteous, proclaiming truths and pithing the parochial platitudes of self indulgent monoliths of medicine.

Thus it was that I took out my sword and slayed the dragons who proselytized the universal good of Vitamin D. Indeed they would have you believe it cures everything from cancer to depression to arthritis, to gout. It can be bought over the counter or with a prescription and in doses from 400 units to 50,000 units and damned if anyone knows where it came from or how it works but we all need to take it and for sure follow it with repeat blood tests.
Yet now I am taking vitamin D and I can tell you I am swallowing a lot more than a little capsule with each morning dose. So maybe if I give you a little information I can expiate some of my guilt and still maintain my peacock airs: Previtamin D comes from cholesterol. Yes, the same cholesterol you are paying your doctor to reduce. It is converted to vitamin D in the skin. It has been linked to heart disease and to diabetes and there are a host of other diseases which have been implicated. I am struck by the first two. I am also struck by the fact that Vitamin D concentration diminishes with age and most especially by a reduction in exposure to sunlight. So here is the kicker. The darker skinned a person is the more likely he will have vitamin D deficiency. And by extension if you are an adult (chronologically) and a city dweller you have up to a 70% chance of being deficient in Vitamin D after the age of 40; worse if you are African American. One last point: sun screens may reduce the ability to form Vitamin D. For all my readers in Miami you are stuck between a rock and a hard place. But listen up Chicago: we are lucky if the sun shines 4 months a year! It is OK to lighten up on the sunscreen during the winter and other cloudy months.
So there you have it. I took a friend’s advice and measured my own Vitamin D and I am really deficient. I took my friend’s advice and began with large doses of Vitamin D3 (the stuff we normally make) and then followed it with repeat blood tests and as my levels headed toward normal I switched to the exogenous or externally produced forms. I would worry about my forthcoming guilt but I think I am developing Alzheimer’s and I will forget my embarrassment by tomorrow. For those of you living in the city and over 40 years old, it may not be a bad idea to have your doctor draw vitamin D levels. But never tell him that it was I that suggested it.

To Evaluate Your Appearance, Really Look in the Mirror

Sunday, June 20th, 2010

A person cannot live without seeing with his eyes. A blind person is also a person but if you are not seen you are nothing.
Per Olov Enquist
My appreciation to my wife for translating this beautiful piece of prose from her native Swedish.

As you can “see” seeing with your physical eyes is not the subject of this man’s observation. Seeing with your heart and mind is. I am torn between the emotions of Father’s Day, the emotions of my Swedish wife and friends on the day after the wedding of the Swedish princess, and the consternation of some of my patients’ who do not appreciate their reflection in the mirror.
For Father’s Day: I am struck at the perceptions I keep with me as I reflect on life with my father. I remember now how he would pull the car off the road on vacation and take the time to say “Look how beautiful that tree is”. I had no idea what he was talking about. Now it is I who pull off the road. When he spoke of every man being equal he had never heard of The Tea Party or envisioned Arizona, embattled with crime, unemployment, and a housing crisis passing a law to discriminate against one ethnic group. And he loved to travel and visit people with other customs and other heritage. I didn’t know I would marry my lovely Swedish wife and she would introduce me to cultures and customs I only vaguely appreciated.
As to the wedding of the Princess: I have no feelings. But I finally grasped how we took the Kennedy’s into our hearts, how Barbara Bush taught us family values, and how I enjoy seeing President Obama’s children grow up. I cannot relate to the Princess but I value the tears of joy my wife sheds for a nostalgic connection.
Now for the mirror. I have clichéd the lies of the mirror portrayed in Cinderella for years, yet the cliché’s do not go away. Most of us would not drape a child in make-up, revealing clothes, high heels, or hair spray; nor would we cover their beautiful faces with coiffured hair, or piercings through every orifice imaginable. Yet time after time I see people do this who see something odious, something distasteful, something shameful in the mirror. Rather than enhancing their image they vilify their appearance. All of this in an attempt to be seen. To be valued. To be important to others and secondarily to themselves.
For me, we can each do ourselves a favor. Pull your hair back off your face; lose the make-up and jewelry for a day; lose the earphones, the cell phones, and the music; go for a long walk; smell the smells of nature; and be grateful that we are alive and some of God’s beautiful creatures.

Stretch Marks, Wrinkled Skin, Scars, Cellulite Now Treatable

Saturday, June 12th, 2010

For the last decade fads and bogus claims have promised to remove or reduce stretch marks, wrinkled skin, scars, and cellulite without actual proof. These money-making schemes have brought riches to some entrepreneurs and little pleasure to patients who have opted to have a variety of creams, potions, and treatments applied to their faces, bodies, and especially thighs. At last the wait may now be over as effective treatments have been elucidated to improve and in some cases resolve these age-old cosmetic concerns.
Pioneering research from the University of Michigan Department Of Dermatology has revealed some of the answers to questions of how to regenerate skin. While more research needs to be done, their work conclusively demonstrates that old or damaged skin has frayed collagen fibers which do not stimulate fibroblasts (the cells that produce collagen) to do their jobs efficiently. In fact, just the opposite. The frayed fibers somehow induce the fibroblasts to curl up and produce collagenase which further dissolves the good collagen that exists. The therapeutic pearl of their work demonstrates that fibroblasts can be made to stretch out and again produce normal collagen, even if they are old in age or worn out by injury. The only caveat is that the fibroblasts must still be present in the affected tissue.
First described in Europe and now elucidated at the U of Michigan, injected hyaluronic acid (aka Restylane and Juvaderm) has been repeatedly shown to stretch fibroblasts and thereby induce them to produce new collagen. Therefore, the rejuvenating effects of injected hyaluronic acid fillers are not only due to their volume but also to new collagen production.
Saline was also tested for its stretching abilities at the U of Michigan and it was found to be less effective than hyaluronic acid. Nevertheless, work by Dr Mitchell Goldman and repeated by me at MetropolitanMD, has repeatedly demonstrated scar remodeling when used to stretch scars in which there has been a loss of tissue volume.
And for the coup de gras, further work showed that injury to the epidermis, the outer 1 millimeter of skin, sends a message to the dermis, the bulk of the skin, to stimulate fibroblasts to make new collagen. Now we understand a mechanism for the healing effects of ablative fractional laser therapy.
Here is the skinny: Stretch marks, wrinkled skin, scars, and cellulite are now treatable using a combination of salt water injections, hyaluronic acid injections and fractional laser resurfacing. The bad news: as this information hits the mass media medispa charlatans and entrepreneurial physicians will advertise their ability to use these new applications of available technology and because of the nature of their business the public will again be abused.