By: Daniel Pearce, D.O., FCOI, AAHIVMS

This was a hot topic that led to physicians in training to have their hours reduced so that adequate sleep was built into their schedules. There were more suicides and car crashes when the sleep deprived drove home.
Now we have a study showing that people with sleep apnea have more crashes. This is especially true for the elderly. The more their sleep was interrupted, the more crashes. Many don’t get a mask that is best for them and don’t use their machines. At the time that mask seemed the best but then it didn’t. To avoid crashes, heart attacks, strokes, diabetes, obesity risks, it is best to get good sleep and have another visit for a new mask.

Working memory, the memory you have right now to say something to someone, can freeze if there is too much distraction. This is normal. Concentration/focus/being mindful is the key. Whenever I let my mind wander when snowboarding (like looking at another snowboarder), I would fall. Ouch! This weekend I looked at the bathroom key on my neck while walking on a sailboat of a friend’s and fell. We were at the dock so there was no major boat rocking. I was fine when we were out to sea. Sometimes I let go of the rudder/tiller on my 8 foot sailboat for no reason and the boat starts spinning, risking a capsize. Gotta keep your mind on the task!.
My computer slows down on opening pages when there are too many tasks up. I should have bought a laptop with more memory. This laptop’s memory gets full fast with too many open items, just like the human brain.

It has been shown that fat shaming causes the opposite of the desired outcome, more weight gain. It also causes more inflammation, higher risk of depression, anxiety, substance abuse, suicides, avoiding exercise, and hypertension. If you want people to lose weight, do the right thing and do not fat shame. Brazil fined a comedian who fat shamed during his show!

Stapling the stomach and making it smaller and making the fluids bypass some of the small intestine is one way to treat obesity. Other procedures are less involved such as inflating a balloon in the stomach, putting a sleeve around the stomach, or putting a device in the first part of the intestine. Each of these has advantages and disadvantages; your surgeon will discuss what might be best for you. These procedures may be available when a strong try has been made to modify lifestyle but didn’t work well enough.

A larger, better study than the preliminary ones, showed that timing of meals being different in one group but the same calorie level intake for both groups did not show the intermittent fasting group losing more weight. This is frustrating for all of us! Exercise, healthy food and portion/calories control is the proven method.

There is now a study out that shows that those with traumatic brain injury without concussion or loss of consciousness have changes on scans and autopsies showing tiny strokes/damaged brain and other abnormalities associated with more severe head trauma. Therefore, avoid any head injuries. Maybe you should wear a helmet.

Our skin keeps bacteria and viruses out and our immune system cleans out some of what is floating around. It is best to not have any wounds on the skin when you go for joint replacement since all wounds have a little infection. Before surgery the surgeon checks the nose for resistant staph. A new study found that treating staph when found was helpful in reducing infections of the new joints. Artificial joints have no circulation so there is no ability to fight off a minor infection. Foreign bodies, like the metal and plastic of a new joint, a pacemaker, an intravenous line, a silicone implant are desirable places for bacteria to go and make themselves at home. The foreign body must be removed, the wound must heal completely before a new device is put in. Taking out an artificial joint leaves your limb looking like a boneless chicken.

There is more data showing that disulfuram (Antabuse®) also treats anxiety in addition to making people feel quite ill if they drink alcohol. We use it for alcoholics who can’t control their impulses and then remember they will become ill if they drink when disulfuram is in their system. Naltrexone (Vivitrol®) is good for alcohol use disorder too; and is injectable or oral. The injectable form really controls the impulse since they can’t skip a few days of pills and start drinking, if they drink on naltrexone they do not feel the good effects of alcohol—this reminds me of buprenorphine (Suboxone®) which eliminates the high of opioids taken on top of it. Good to know that some medications have two beneficial actions.

From Facebook fame, this couple is funding many basic science projects with millions of dollars. Some of these are:
1. Funding promising young scientists.
2. A public web atlas of all human cells so that each scientist can add their knowledge to this data base.
3. A database of gene research so that others can access this open source database and build on others’ research rather than wasting time and money on the same project. This funding of basic science has paid off and will pay off more later. The funding of collaboration and infrastructure where there has been a hole has been quite a kick to progress.

Keep those questions coming and be safe!

Daniel Pearce, D.O., FACOI, AAHIVMS
Clinical Associate Professor of Medicine, Loma Linda University School of Medicine Adjunct Professor of Internal Medicine and HIV, Touro University California College of Osteopathic Medicine and Midwestern University Arizona College of Osteopathic Medicine HIV, Hepatitis B,C, Transgender, Suboxone Specialist, Borrego Health (Riverside, San Bernardino, San Jacinto) Member, Coachella Valley Clinical Research Initiative