General

Many people get sick when they fly on airplanes. Often patients come to me for immune support for when they fly. Our current "air travel" protocol of supplements has been very effective for many patients for preventing acute sickness when they fly.

We have always assumed that the reason people get sick when they fly is the concentration of people they are exposed to at the airport, and of course, on the airplane, including the person sitting next to them.

Now a new article has appeared in the medical literature entitled, "Management of Exposure to Aircraft Bleed Air Contaminants Among Airline Workers: A Guide for Healthcare Providers."

This article points out that the outside air supplied to the cabin/flight deck on commercial aircraft ("bleed air") may sometimes be contaminated with Pyrolyzed Engine Oil and/or Hydraulic Fluid.

The article goes on to state that "as a result of this contamination, airline workers and passengers may develop acute and/or chronic health effects."
 

The list of symptoms which the article reviews, the common symptoms that we see in patients who have flown, include eye, nose or throat irritation, wheezing, and cough.

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The American Heart Association has just released new guidelines for patients with Mitral Valve Prolapse.

With rare exception, taking antibiotics before your dental appointment or your surgical procedure is no longer required!

The rare exception would be somebody with severe mitral valve prolapse with significant mitral valve regurgitation. The few of you in my practice who have this are aware of who you are.

Things have come so far in the last 40 years with the issue of antibiotics in Mitral Valve prolapse patients. In 1970 it was two days of antibiotics before the dentist. About 1980 it was just one dose before and one dose after the dentist. Then about 1990 it reduced to one dose ONLY before the dentist, and now this good news of NO antibiotics before Dental work is most welcome by me and all my patients!

Prevention of Infective Endocarditis. Guidelines From the American Heart Association. A Guideline From the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group.Prevention of Infective Endocarditis. Guidelines From the American Heart Association. A Guideline From the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation. 2007 Oct 9;116(15):1736-54. Epub 2007 Apr) 19.])

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From the previous article that I wrote on the coronary CT Angiogram, most all my patients now know that this has been the definitive test for screening for coronary artery disease, the most common cause of death in men and women in our country.

Many of my patients have done this test (as have I), and over the last year, over a dozen of my patients have had cardiac interventions to prevent heart attacks because of the information from this test.

A few things have held patients back from getting this test.  The first understandable reservation was about the amount of radiation given on the coronary CT Angiogram.  It has been equal to approximately 50 current chest X-rays. 

The other consideration holding people back, understandably, was the cost, which is $1500.

I am happy to let everybody know that now through major technology improvements both Cedars Sinai Hospital and Cardiovascular Medical Group (CVMG ) have been able to drop the radiation dose by up to 90 per cent!

Below I have a summary of estimated radiation doses for the new vs. the old cardiac imaging studies which Dr. Daniel Berman and I put together. 

You can see that the amount of radiation with the new low dose coronary CT Angiogram is now approximately the same as a simple CT coronary calcium scan (also known as EBCT)! 

To me this is very exciting news as previously wanting to avoid the large dose of radiation with a CT Angiogram, we have been doing the simple CT coronary calcium scan (EBCT).  But because this only shows calcified plaque on the wall of the arteries, we have also had to do a treadmill test to make sure there is not an extreme amount of soft plaque which will be missed by the simple EBCT.
 

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A recently published medical article discusses research done at the Functional Medicine Research Institute  in Gig Harbor, Washington. One of the principle authors of the article is my long time friend, teacher and colleague, Dr. Jeffrey Bland (see my picture with him below). Dr. Bland reviews this article in  his May 2006 monthly audio newsletter. Many of his comments are so well said that I have copied them into this article. Whenever I am quoting from his newsletter below you will see quotation marks around his words.

          For decades our society has assumed that calories are the name of the game; specifically, as long as you adjust the calories with the right ratio of protein, fat and carbohydrate percentages, there will be a favorable outcome.

          Now there comes an exciting study that shows the role of Nutrigenomics on our biochemistry and subsequently on our health in general.
          Nutrigenomics is the science that studies how our nutritional intake affects the expression of our genes. We learn in medical school, and many people still believe, that if you have a “certain gene” you are predestined to develop a certain health condition. The new science of genetics however shows us this is quite erroneous. Specific environmental factors –  which include the very nature of the food we eat and other nutrients we intake, as well as toxins in our environment — can turn on or off the genes that we have received from our parents. This is all to say, “there are many you’s within you."

The food we eat delivers information to our genes and thus affects how those genes express themselves. As the genes express themselves, so is our biochemistry.
 

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I have been friends and colleagues with Jeff for over 25years. He is a brilliant biochemical-nutrition researcher and teacher and he always teaches me wonderful information that allows me to help my patients using Nutritional Therapies.

In my earlier posting on Vitamin D, I talked about its role in boosting our immune systems, especially in the winter time, in regard to influenza, colds and other infections.

However, in recent months, information on Vitamin D has been flooding the news media. Insufficient Vitamin D levels are linked to diseases as diverse as osteoporosis, diabetes, cancer, heart disease and multiple sclerosis. Simply stated, insufficient Vitamin D weakens the immune system.

Vitamin D is an unusual vitamin in that we do not get it from food (except as added by the food industry), but rather from direct sunlight onto our skin.  Prior to the Industrial Revolution, people had no trouble getting significant amounts of sunshine and therefore Vitamin D. Nowadays, with people working more indoors, and dermatologists recognizing the connection between excessive sun exposure and skin cancer, people are wearing sunblock every time they step out the front door. Sunblock is now even put into cosmetics that women use routinely.

A recent article in the American Journal of Clinical Nutrition speaks to the subject of dietary Vitamin D requirements during pregnancy and lactation.  It appears the current governmental recommendations of 200-400 International Units (IU’s)  per day are woefully inadequate; at least 1000 IU’s per day are required by a woman during her pregnancy to assure optimal nutrition for both her and her fetus. Some specialists are suggesting even higher doses are required during pregnancy.

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Influenza kills an average of 36,000 people in the United States every winter. Flu vaccines are an effort to protect against this but are notoriously ineffective.

Recently the Vitamin D Council has published a paper entitled, “Epidemic Influenza and Vitamin D” by Dr. John Cannell. In this article, Dr. Cannell and his colleagues propose that Vitamin D deficiency is the reason influenza is much more common in the winter than in the summer.

Vitamin D is the only vitamin made by the human body and for that reason it is called a Pro-Hormone. We need ultraviolet B radiation (UVB) from the sun, in order to allow the skin to manufacture Vitamin D for our body. In Northern climates, including most of the United States, we just don’t get enough sunshine and therefore not enough UVB to make adequate Vitamin D in the winter. In addition, ozone (for example, smog) blocks the UVB, so even those places like Southern California that are getting plenty of sunshine, have a reduced amount of UVB in the winter.

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The CT Angiogram is the latest in cardiac technological developments. Through new GE Lightspeed technology, with 64 bit computer processing, we are now for the first time able to perform an angiogram of the heart arteries without significantly invading the body!

What does it mean, and why is it important?

For years the gold standard for evaluating disease or plaque in the arteries of the heart, called coronary arteries, has been the angiogram. To do an angiogram, you are taken into an operating room at the hospital. An incision is made in your groin and a very long, approximately 36 inch catheter, is inserted into your groin up your aorta and into the heart arteries. Under x-ray fluoroscopy the doctor injects dyes through the catheter into your heart arteries and then takes Cine pictures. These pictures show plaque or blockage of the arteries and we can get an exact measurement of whether your arteries are completely open, 20% blocked, 50% blocked, 80% blocked, 95% blocked. Once an artery is over 90% blocked, there is significant risk for an immediate heart attack.

Because the traditional angiogram of this type is obviously very invasive and quite expensive, we have never been able to do this in a routine fashion.

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The purpose of this blog is to share with the world more information on Integrative Medicine (IM). I have been practicing Integrative Medicine for over 28 years. I am a board certified internist and integrate Diet, Nutrition, Acupuncture, Herbal medicine, and homeopathy into my traditional Internal Medicine practice in Beverly Hills. Because my patients over and over have told me how much they have benefited from this approach, and because I realize not everyone wants or can have an IM physician, I have created this blog to share some of the information that I give to my patients on a regular basis. The special areas that I will be discussing will include:

1. Integrative medicine subjects in the news
2. Environmental Medicine and its impact on human health.
3. Cutting edge testing that can help to prevent chronic diseases.
4. Cutting edge medical tests that can detect early disease.
5. Integrative Medicine Healing techniques.

I hope you will stay posted and learn things from my site that can have positive impact on your health and the health of your family.