Bite Point

11:59

It's 11:59. All your little Fears and Limiting Beliefs are now officially irrelevant. Go ahead and do that remarkable thing that you were thinking of. We need you.

 

The Technical Part Is Certainly Not All That Matters

Recently, our own Reese Ruffino visited a medical specialist and had an experience that was, in every respect, how we do not wish to treat our patients.  Since this is so commonplace today, and since so many of you will no doubt identify with what she went through, allow me to have Reese recount what happened in her own words:

'Let me tell you about my recent visit to the office of a medical specialist.  I find it very interesting to see what people go through and may not even realize how poorly they are being treated.  It could be because I work for a dental practice where we put our patients first!  We treat our patients with the same standards with which we treat ourselves.  I found that this standard is not the norm in the medical field overall.

 

My appointment was scheduled for Wednesday, November_.  I received a call from the specialist’s office the Friday before.  The woman asked a series of questions, verifying my information, the reason for my visit etc.  I thought this was a bit different but a way to get some information ahead of time. 

 

The day of the visit I walked in and headed to the front desk; there was a sign “Check In” with a sign in sheet.  I signed in and being that I’m a new patient I waited for the front desk staff to acknowledge me standing there.  I was not greeted with a hello or a smile, just a “What is your name?”  I gave them my name and asked the receptionist if I had paperwork to fill out.  She handed me a clipboard with no pen.  Not a problem, I had a pen.  I returned my paperwork, paid my co-pay and took a seat. I waited for about 20 minutes.  My name was finally called and I was taking into an exam room. 

 

The doctor’s assistant started asking me a series of questions.  I wondered what is her name, or what her actual position is?  She told me to undress from the waist up and gave me a paper gown to put on (similar to the ones given in the hospital but more like a half top).  Then she told me to lie down and started putting on a series of stickers on my chest, attaching heart monitor clips, although she never explained what they were.  She then ran a test, again with no explanation of what to expect or what it means.  A piece of paper printed out and she told me “the doctor will be in shortly”.  I was left sitting in a gray colored room with doctor degrees on the wall.  I waited for about another 15 minutes with nothing to do but stare at the diplomas on the wall.  The doctor came in and again ran a series test and asked questions.  The doctor told me he would like to take one more test.  He told me to grab my things, we are going down the hall.  As I reached for my clothes and backpack, I got to the door and he was gone!  Okay where did he go?  I looked down the hallway and oh there he is.  I made my way halfway down the hall and the nurse told him  that he has another patient before me.  He told me to have a seat in the hallway.  I was left sitting in an open hallway with a paper cover over my chest!  I was left in this uncomfortable predicament for another 20 minutes. 

 

The next nurse came to get me.  I was greeted with a “Hello, my name is Jane, I will be performing an echo cardiogram test”.  She walked me through the procedure before she even started anything- the first time that anything was explained to me during this entire visit.  This relaxed me and she showed me my heart on the monitor.  She showed me how my blood flow moves throughout my heart; I could even hear the sound of my blood flow.  I was so amazed by this piece of equipment.  When she finished she assisted me with cleaning up and gave me a few minutes to change back into my clothes.  When she returned she walked me down the hall into another exam room. 

 

There was another nurse again; I was never told her name but she seemed friendly.  She was going in and out of the room looking for a heart monitor that I must wear for 24 hrs.  She set down a box with wires next to me.  I looked down and think to myself “are you kidding me with this!”  It was filthy!  I don’t think it had ever been cleaned before.  The wires had sticky tape residue on them.  I think there was a left over chest hair still attached to the wire.  She came back with sticky tabs.  She was having trouble with the chest stickers because her nails were about 3 inches long with nail polish chipped off of most of them.  I must have been busy looking at her nails because before I knew it, I had a dirty heart monitor attached to me.  The doctor walked in and was telling me to keep a diary of my events.  He said I do not have to go into detail.  He left the room.  Events?  What was he talking about?  I asked the nurse.  What am I supposed to do?  She told me, as she was entering information into my heart monitor, not to worry about it no one really returns a log.  She informed me she ran out of something and she had to make more copies.  I asked her what to do and she told me I must keep this equipment on for 24hrs, and if I have any weird events to write down the time it happen and what I was doing.  She informed me I was finished and I could make my way up to the front desk. 

 

I grabbed my stuff and again I was left there.  Where was the front desk??  I made my way to the front desk to the sign that says Check out.  Once again I was not greeted with a “Hello” but with that impersonal “What is your name?”  I gave her my name and she told me to have a seat because she doesn’t have my paperwork.  After a few more minutes I was called to the front desk and she asked me to schedule an appointment for 4 months and if I don’t need it she will call me.'

 

 

 

 

Well then! While I'm sure that we make mistakes at times in patient management, this episode reads like a manual of how not to deal with the people that we have trained to serve!  It's 180 degrees in the wrong direction.  Our heroine was not treated like I'm sure the staff would wish to be treated in their own lives.  She was not given sufficient information about what would be happening next during each procedure.  She was left several times with nothing to do, and no idea of where to go next.  (Anyone who has been to Disney World can do a quick mental comparison between how the hospital establishment and Disney view the concept of waiting.  Disney has done a great deal to make the lines for popular rides interesting and sheltered from the elements.  There's even the "Fast Pass" system to reduce the chance of waiting in a line at all!  Hospitals on the other hand seem to think nothing of leaving you in a cold room wearing only paper with nothing to do- for as long as they wish.)

While this type of treat-you-like-another-number experience can happen in any industry, it should not be happening in medicine- ever.  First of all, the entire point of medicine is to enable people to heal from injury or a disease process; isolation, confusion and even fear are going to interfere with this.  Second, if postoperative instructions are not clear, medical mistakes can occur and in this scenario they are not the fault of the patient.  (We already know that in the best of circumstances patients only remember about 20% of what they're told in a medical visit.)  Finally, medical care is universally acknowledged to be expensive and when we pay a lot for something we deserve to be treated accordingly well.

That last points to one of the roots of the problem.  It all comes down to who is paying whom.  In dentistry, no matter how much insurance is involved, our patients pay us directly; there's always some direct and visceral flow of money when we treat a patient.  We therefore face an immensely strong disincentive to treat our patients as poorly as in Reese's astonishing example.

In medicine, someone else is paying the majority of the bill!   Now I'm not suggesting that we all start paying $50,000 hospital bills out of our own pockets.  Medical insurance is a necessity.  But- the fact that a faceless corporate structure pays another corporate structure which then pays doctors, nurses and staff removes one of the main incentives for treating people with excellence.  There is still pride in one's own work, and there is still the fear of being sued- these are strong motivators for sure.  But the lack of a visceral monetary connection between provider and patient takes away that sense of "Hey, they're all my employers, when you get right down to it!" that we feel in dentistry.  It's left to individual medical establishments to decide to treat people with excellence because they want to, because they are proud to.

Unfortunately, there are too many who simply don't care to think that way.

 

How Sweet It Is.

It seems worthwhile to run down a list of pros and cons of sugar and the most common artificial sweeteners.  So, here goes:

Sugar- table sugar is sucrose.  It tastes just like sugar because, well, that's what it is.  It can be a factor in obesity, diabetes and coronary artery disease.  Certainly it leads in a very direct way to tooth decay, and in that case it's all about the frequency of eating or drinking foods that are high in refined sugars. Yet it's natural and if used in moderation is something we gain a great deal of enjoyment from.  The moderation is the tricky part.

Saccharine- This is in the brand Sweet n Low.  It was first produced in 1878 at John's Hopkins University.  To many, it tastes sweet but not in an entirely pleasant way.  The health effects of saccharine have been controversial since the start.

USDA scientist Harvey Wiley, 1908, to President Theodore Roosevelt: "Everyone who ate that sweet corn was deceived. He thought he was eating sugar, when in point of fact he was eating a coal tar product totally devoid of food value and extremely injurious to health."

President Roosevelt's famed heated response: "Anybody who says saccharin is injurious to health is an idiot."

Since the 1960's many studies have attempted to link saccharin to cancer, particularly bladder cancer.  This has been demonstrated in rats yet the application of these findings to humans has been questionable.  It seems that no study has definitively linked saccharine to human cancer.

Since saccharin is not a sugar molecule, it has negligible calories, it does not predispose to diabetes and it does not cause cavities.

Aspartame- This is Equal and Nutrasweet.  Aspartame is an amino acid (one of the building blocks of proteins and certainly not anything related to a sugar) which just happens to taste astonishingly sweet.  Also steeped in controversy, everything from its rapid FDA approval in 1974 to the question of whether it, too, is implicated in cancer seem to be sources of ongoing debate.  (So far as I know, however, President Nixon never called anyone an idiot over the matter.)  Testing has been very thorough and over 90 countries approve its use.

(Still, in this author- and occasional user's- personal view, the fact that a protein tastes as sweet as a refined carbohydrate is pretty darn weird.)

Again, since aspartame is not a sugar molecule, it has negligible calories, it does not predispose to diabetes and it does not cause cavities.

Sucralose- This is Splenda.  Sucralose is simply the mirror-image molecule of sucrose, our old friend table sugar.  Here's how to think of this product:

Look at your right hand.  Let it represent natural sucrose or D-sucrose which is a "D" sugar.  "D" stands for "Dextro" or "right".  (Not in all contexts though.  No one says, "I'm dextro and you're wrong!")  Anyway your left hand then represents sucralose or L-sucrose which is an "L" sugar.  "L" stands for "Levo" or "left".

In 1981 my organic chemistry professor, the aptly named G.N.R. Smart PhD, explained to us that L-sugars could be made but the process was not cost-effective; he stated that if a company could make L-sucrose on a commercially viable scale it would be a highly profitable venture.  Brilliant!  This is precisely what Tate & Lyle accomplished in the early 1990's.

I hope that Dr. Smart had bought stock.

Differences from natural sugar?  Health concerns?  Natural sucrose dissolves in water to form a clear solution, sucralose looks cloudy.  Sucralose also does not attract water and so baked goods can seem a bit drier when made with it.  The taste of sucralose is percieved by many people to be closer to natural sugar than the other products mentioned above, but a percentage of people find its taste to be objectionable.  There are no known instances of President Clinton calling anyone an idiot over this substance either.  Sucralose is the only artificial sweetener ranked as "safe" by the consumer advocacy group Center for Science in the Public Interest.  The majority of sucralose ingested is not absorbed by the GI tract, so 70-80% is excreted unchanged in the feces and 20-30% is metabolized and passed in the urine.  Some concern has been raised about an immunological effect of sucralose on the thymus.  Once again many studies on this topic have been completed and to date no harmful effects have been found.

Since sucralose is a mirror-reversed sugar molecule, it has no calories (the body doesn't recognize it as food), it does not predispose to diabetes and it does not cause cavities.

Yet.

Now why would I make a meshuggeneh comment like that?  Yet?  What's with the yet?

Well, as many people use sucralose as a sweetener over many years, we're passing tons of a potential food source past the oral bacteria that crave sugar just as much as we do.  Sooner or later, it's entirely possible that a spontaneous mutation will allow the cavity-causing germs in our mouths to feast on L-sugars.  Once that happens cavities might come from sucralose just as readily as they do from sucrose and its kin.  For now, though, you're safe, dentally anyway.

So:

Of the four substances discussed above, all of which have significant (and varied) negative qualities when it comes to our health-

Which one do you think fills this container in my pantry?

I mean, you have to chose, and I always say, "When it comes to health and nutrition, there's no free lunch..."

 

Gatorade- Selling the Sizzle, not the Slake

(Joe Gibbs gets a Gatorade Bath from Clinton Portis and Rock Cartwright after the Redskins beat the Cowboys in Dallas on Sept. 19, 2005. Despite being down 13-0 with less than four minutes remaining, the Redskins came away with a 14-13 victory for the team's first win at Texas Stadium since 1995. Photo: Jonathan Newton, Washington Post.)

The "Gatorade Bath" has become a sports tradition more recognizable than each year's Indy 500 winner drinking that inexplicable bottle of milk.  Athletes everywhere of every age drink in the philosophy of Vitamin G- Gatorade- Is it in you? The website, www.gatorade.com is one thing; their auxilliary site http://www.missiong.com/ is on the verge of scary.

And yet this one fact is so often overlooked: Gatorade can cause cavities.  Just as much so as soda.

The big selling points for the "scientifically proven" claims about Gatorade are that it replaces electrolytes lost during athletic performance and also provides energy along with hydration.  Our first question should then be: how much of a concern is electrolyte loss during exercise?

During low- to moderate-intensity exercise of less than one hour, a person can lose from 1.0 to 2.0 liters of water through sweat.  In this example there are minimal electrolyte losses because the body can reabsorb most of the electrolytes from the sweat. As we get to high-intensity exercise of greater than one hour, the electrolyte loss in sweat becomes significant and the sweat rate is too fast for re-absorption of electrolytes. 

Even here, though, we must be careful.  In David Gordon Wilson's superb 3rd edition of Bicycling Science, he demonstrates that cycling creates such a significant airflow that heat is carried away from the athlete's body with far less sweat loss than, say for a runner, assuming equal power output over time.  It stands to reason that much the same effect occurs for competitive swimmers.  We could then say that activities like cycling and swimming cause less water and electrolyte loss than activities such as running and tennis, again assuming roughly the same time and power output.

If we decide that, in a given exercise event, we may still need to replace electrolytes due to the endurance and level of activity, what, specifically, needs replacement?  Let's compare a medical concoction to the commercial one.  Lactated Ringer's solution was designed to be administered by intravenous infusion for replacement of loss of fluid and electrolytes.  (That means it gets hung in IV bags because it's faster than having the patient drink it, and because it doesn't taste good!)  This is one of the mainstays in hospital ER's of treating dehydration and fluid loss due to trauma.

So here's the throwdown:

Lactated Ringer's ingredients, one liter: water, sodium chloride 600 mg, sodium lactate anhydrous 310 mg, potassium chloride 30 mg and calcium chloride dihydrate 20 mg.

Gatorade's ingredients, 8 oz. serving: water, sucrose (table sugar), glucose, fructose, high fructose corn syrup, electrolytes (110 mg sodium, 30 mg potassium, 93 mg chloride), sodium citrate, monopotassium phosphate, artificial colors.

There's quite a bit of sugar in there!  63 calories for the 8 oz. serving, 158 calories of you drink the entire standard 20 oz. bottle.  256 calories in the larger yet still oft-quaffed 32 oz. jug.

Sometimes, of course, fast calories are necessary during athletic performance, and in liquid form they get absorbed fast.  (Can any of you fellow cyclists out there say "bonk"?)  For sedentary people though, these drinks represent the same empty calories that soda has.  Then there's our dental concern- frequent, prolonged sipping of any sports drink containing sugars will lead to high potential for cavities.  "The Resurgence of Dental Caries" explains why in detail; it comes down to acid attack in the mouth driven by sugars where the body never has a chance to recover.

This is not a theoretical concern.  Many of our patients have experienced cavities that we could attribute to no other cause but liquids in their diet, and specifically sports drinks.  One patient had Gatorade standing by courtside during tennis practice- which was 7 days a week, all afternoon.

So- these drinks have their purpose, but this is a very specific purpose and as with anything that we eat or drink there are pros and cons.  Sugared sports drinks should be used at defined times during training and athletic events and our mouths need long periods of rest between episodes of sugar attack.  Cleaning between the teeth with floss or SoftPics is highly preventive.

Not to single out one particular brand, but the brand in question has deliberately and steadily created a mythos for itself that weaves through the entire sports world in the U.S., from grade school to the arena of professional $port$.

Use it carefully.

 

 

Influenza

A friend has created an astonishing website concerning influenza.  It's here:

http://influenzaap104.webs.com/

Amrit is a student and this project of hers is a very refreshing change from the media's strident, heavy-handed take on this health issue.  Her site is informative, enjoyable and well worth a look.