Those electrifying electrolytes!

My friends and I were talking about a fellow Jazzerciser who had been hospitalized because she had passed out. Hospital personnel discovered that her electrolytes were almost non-existent (not necessarily the cause of her passing out). I knew that if you sweat a lot, you lose electrolytes, a condition that often causes muscle cramps. But one of my friends spoke of one relative whose electrolyte imbalance caused a seizure and another who became incoherent because of it. Goodness!

Electrolytes are nutrients/chemicals—including sodium, potassium, magnesium, and chlorine—that regulate nerve and muscle function, hydration levels, blood pH, blood pressure, and the rebuilding of damaged tissues. They are essential for life. That’s pretty important.

When dissolved in water, electrolytes carry a charge. Our cells (especially nerve, heart, and muscle) use electrolytes to maintain voltages across their membranes, making it possible to carry nerve impulses and muscle contractions to other cells. For example, a muscle contraction needs calcium, sodium and potassium to contract properly. An imbalance can lead either to weak muscles, or muscles that contract too severely. Your kidneys and several hormones normally keep electrolyte levels in balance.

Our electrolyte levels tend to change when water levels in the body change. For example, when we exercise and sweat we lose sodium and potassium. Drinking liquids restores your water level and your kidneys and hormones do the rest. 

Sometimes, though, the level of an electrolyte in the blood can become too high or too low for other reasons. Besides sweating, they can become low from vomiting, diarrhea, kidney disease, cancer treatment, and some drugs, such as diuretics for high blood pressure. (A study revealed that 20% of patients taking diuretics end up with reduced sodium and potassium levels.) Symptoms can include irregular heartbeat, weakness, twitching, confusion, seizures, and numbness.

But I don’t want you to worry about this! 

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Coding for dollars

For every diagnosis and procedure you have at a hospital or at the doctor’s office—no matter how insignificant—a code is assigned. It’s how they get their money from insurers. Listen to the heart: code; insert a line: code; take blood pressure: code; and so forth. The more they code, the more money they receive from insurers. The more procedures, the more codes.

Hospitals and doctors have learned to game the system by “upcoding” to a higher diagnostic level. For example, a code designation of 428.21 (“acute systolic heart failure”) instead of 428 (“heart failure”) can make a difference of thousands of dollars. This is called “creative coding.” Coders can and do offer suggestions to hospital staff for ways to upcode.

Insurance companies also employ coders who battle the hospital coders to bring costs down. As you can imagine, coding is a growth enterprise and coders' salaries account for a sizable share of medical costs. Membership in the American Academy of Professional Coders has risen to more than 170,000 from roughly 70,000 in 2008.

If you are uninsured, such that no one is negotiating on your behalf, you will pay 2.5 times more for your hospital treatment than people who are covered by health insurance and three times more than the amount allowed by Medicare. Here’s an example: an uninsured woman had a subarachnoid hemorrhage—blood leaking into the space between her skull and brain. She received a hospital bill of more than $350,000 (this does not include around $150,000 for doctor and other fees). She was a resourceful person and was able to get various experts (pro bono) to help her fight the bills. Their research showed that, were she on Medicare, the cost would have been $80,000; if she were a vet, it would have been $70,000. The case went to court.

I don’t know about you, but I think this system is wrong.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Bariatric (weight loss) surgery

People usually choose bariatric surgery as a last resort, after dieting doesn’t solve their obesity problem and they fear their health is in jeopardy. As a rule, the surgery is reserved for those with a BMI of 40 or more. It is the only treatment that leads to profound and lasting weight loss. And, for patients who choose gastric bypass, it’s not just because it makes their stomachs smaller; it’s also because removing a part of the stomach causes profound changes in a complex, interlocking physiological system. (This is not the case for the band procedure, in which a band is placed around the upper part of the stomach such that that part of the stomach quickly gets full. It’s what Governor Chris Christie had.)

The reason gastric bypass works is that it lowers the brain's "fat thermostat"--the amount of fat that the brain wants the body to have. It does this by altering the activity of more than 5,000 of the 22,000 genes in the human body and by affecting the complex hormonal system that sends messages from the gut to the brain, helping to suppress hunger and appetite, and improving the feeling of satiety. It also affects the thousands of strains of bacteria in the intestinal tract as well as the white blood cells, which send their own signals. (White blood cells play a major role in setting a person’s weight by, among other things, helping to control metabolism.) 

The down side of this surgery (besides the initial pain) is that you must take vitamin and mineral supplements for life and you’ll have big flaps of loose skin that can only be removed through plastic surgery. A friend of mine, who lost 75 pounds with the band procedure, reports that he now throws up easily, but that doesn’t seem to be the case for most patients.

Also, you won’t get thin. Because of data collected on thousands of these patients, doctors can predict your body’s new set point. For example, one patient, who, at five-foot-three weighed 295, was predicted to stop losing weight when she reached 180 pounds, and that’s what happened. To lose more than the new set point, it’s back to dieting.

On the up side, patients report more energy, loss of joint and back pain, improved blood pressure, and even being able to do away with diabetes medications. Most, however, still feel fat—and, by popular standards, look fat. Importantly, though, they don’t get the disapproving stares from strangers.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Analyze your semen with a smartphone!

 I know. The visuals are terrible. But it’s true. You (if you’re a guy) can check out your sperm count as well as how well they’re moving. It’s as simple as a home pregnancy test, they say. Apparently, you do this by clamping a 3-D printed microscope onto the phone, as shown in the photo below. I don’t know where the semen sample goes. Also, do you need to buy the gloves?

Apparently, this is the wave of the future, according to Dr. Eric Topol, author of The Patient Will See You Now: The Future of Medicine is in Your Hands. (I thought the subtitle was apt.) You will be able to do your own ultrasounds, run all your vital signs, measure your breath and lung function, keep track of your sleep patterns, continuously monitor blood glucose, and analyze blood and other fluids. Actually, those smartphone functions are operational now. For some of those functions, such as blood glucose and heart functions, you stick a band-aid like sensor on your body and the output from those devices goes to your phone. 

“Bypassing doctors,” Topol says, “people will be generating a significant portion of their medical data themselves.” As much as I love to bypass doctors, it seems to me that the problem with this continuous monitoring is that people will needlessly and continuously worry about the state of their health. For example, they will see that the time they spend in deep sleep is not what someone deems optimal. I think people worry too much about their sleep as it is.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

It's not all downhill

For nearly twenty years, I've been complaining about pain in my hips, thighs and other lower body parts. Sometimes everything hurt from the waist down (mostly one leg). It became hard to walk very far or do gardening or housework without pain in my hips. And then the knee started to go. I couldn’t bend it without pain. An MRI revealed a “shredded” meniscus (cartilage). To top if off, I developed sciatica!

Over the years, I’ve been going to a chiropractor, doing yoga, and having massages. I also had myo-fascial release treatments—a type of massage that focuses on connective tissue and fascia—as well as a session or two of “structural integration” (I forget what he did). I’ve done trigger-point therapy and been to a physical therapist. I’ve tried putting tape on the offending parts—the kind you see some Olympic athletes wearing. I also got a brace for my bad knee, which I wear for golf and Jazzercise.

I’ve also had cortisone shots: one in my left hip for bursitis and three (over the course of a year and a half) in my right knee. The orthopedic surgeon said he could clean up my meniscus (I declined) and hinted at knee replacement, which I also declined. I had about given up, assuming this is just how it is in old age.

My yoga teacher, who's also a chiropractor, had been nagging me for years about my ankles, which were not properly stacked up over my feet, as shown in the picture. This misalignment can lead to a chain of imbalances, including internal rotation of my knees as well as a tilt of my pelvis. I finally caved and got custom-made orthotics. At the same time, I've been careful to keep my ankles stacked upright over my feet--not letting them cave in. Of course, this requires being conscious of what my ankles are doing and correcting their alignment all the time. But it worked: my knees and hips quit hurting.

So the key to my problems is proper alignment, starting with my feet. It seems so simple. I wish I'd made these changes years ago. 

This post was meant to be inspirational: it's not all down hill! But, let's get real; it mostly is.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.