Monday, May 22, 2017

Say NO! To Type 2 diabetes and Yes!! To a Healthier Life

Deya Chatterji and Nauman Mufti, MD

One of every three Americans, that is,  86 million of us suffer from an early, stage of diabetes known as prediabetes and most are unaware of this dangerous condition. The good news is that prediabetes is preventable at this stage.

If detected at prediabetic stage, the horrible complications of diabetes can be prevented. These complications include cardiovascular diseases, stroke, blindness, kidney disease, numbness and frequent infections leading to amputations.


The simplest parameters used to categorize a person as prediabetic are combination being overweight, having parents or siblings suffering from diabetes, age older than 45 years, sedentary life style or previous history of gestational diabetes.  If you have any of the above risk factors, kindly see your doctor for a simple blood test called Hemoglobin A1c. This test measures your blood sugar levels for the last three months. This test will determine whether you are prediabetic and thus eligible for enrollment into Center of disease control and prevention (CDC) s Diabetes Prevention Program.

Better Medicine Company, has two locations which participate in CDC’s Diabetes Prevention Program.

 The central idea is to implement evidence based, high quality yet affordable life style modifications that will not only reduce their risk for type 2 diabetes but also improve their overall health. Moreover it’s drug free! It has been designed as a yearlong program divided in 2 parts of 6 months each. The modules are taught by a life coach trained to guide each participant.  Participants are encouraged to have a goal that is realistic, doable, specific and flexible. The course has 26 modules of which 16 are presented in the first 6 months. After the primary introduction to the program, the next few sessions are about how to track consumption of food, activity and best ways to shop. Some sessions instill techniques of stress and time management along with persistent motivation. It involves technology, humor and simple ways of making life prediabetes free and stress free. Ordinary parts of life such as eating, shopping, working on the desk, resting, eating in a restaurant is taught to be made healthy and exciting. Simple things such as making a portion healthy and filling with half part green fresh veggies, quarter part proteins such as meal and fish and the rest being simple energy giving carbohydrates are demonstrated. The sessions often provide sample healthy finger food and real life stories of how people turn their lives to a better direction. The life coach not only motivates the participant to be compliant to the program but also teaches people how to deal with stress in life which directly affects their eating and body metabolism. Overall the participant becomes much more disciplined and feels better right from the beginning.

The second part or the next six months focuses on compliance. It is designed to help people maintain the weight they have lost and the confidence and better health they have gained. People are encouraged to enjoy, get more sleep and get back on track.  Each participant must attend at least 9 sessions and encouraged to lose at least 5-7% of weight. Yearly assessment is conducted.  Use of social network media and new fitness applications help track patients and their overall progress. 

Sunday, February 12, 2017

Why I Became Passionate About Prevention

Nauman Mufti, MD, MPH. 
Medical Director Allies Medical Group and Better Medicine Company.

After spending years in a medical college, dissecting cadavers, learning about human body...its anatomy, physiology, and pathology. Seeing patients under the supervision of senior clinical faculty, I became a freshly minted physician. Similar to the medical education elsewhere in the world, the next step was to receive residency training which in Pakistan was called a 'house job'. My very first clinical rotation was in Cardiac Surgery ward, commonly known in Mayo Hospital, Lahore as the 'thundi ward'. It was so named because it was the only ward which was air-conditioned. This was a huge attraction at least for me as my training started in July...the middle of a brutal summer with outside temperatures exceeded 110 degrees Fahrenheit.  In this ward most admitted patients had lesions in their heart valves. The average age of these patients was between 18 and 20 years of age. Compared to their Western counterparts, these patients were rather young (lesions of heart values in the US and other European patients are commonly seen in patients of 50 years and older.
It was very hard to see these young teenagers struggling to breathe and turning blue and breathless at the minimal of physical exertion.
By this point, you might wonder why had they developed these life-threatening ailments at such a tender age.
You see, most of these patients were here from the remote areas of Punjab and Khyber Pukhtunkhwa (close to the Afghan border)Province.

These people lack the most basic health care. There were no trained doctors in those areas in early to mid-1980s. Medical history of most of these young patients was the same. They had a sore throat

as a child. They never saw a doctor. Most went to local quacks who treated them with the cheapest of the analgesics. They were never diagnosed nor treated for Strep Throat. They never received any antibiotics what so ever. Now Strep throat if left untreated can cause lesions in the heart valves and or glomerulonephritis (a severe kidney disease). Most common valve disease that we saw were either Mitral Stenosis ( a valve of the heart becomes misshaped and narrow thereby leading to lungs not getting oxygen).
As the physicians in training, we became rather close to these young patients. One of them, I remember to this day was named Sajid. He was 16 years old and came from a small village near Mingora, a small town in Swat district of Pakistan's Frontier Province. He was nearly always smiling, regardless of how grim his physical ailments. He had Mitral Stenosis. Slightest of exertion would turn his lips and fingers the purple color of an eggplant and make him severely short of breath. His smile and his will to fight his illness made him stick out among his cohort of very brave young people.
Since the treatment at the hospital was primarily free (the boarding and lodging and cost of surgery and the imported heart-valve was borne by the Government of Punjab) however, their parents were still expected to pay for some medicine needed during the surgical procedure) Sometimes rich local citizens did visit our ward and pay these extra expenses when patients were extremely poor or very lucky. 
Soon it was time for Sajid to undergo the surgery to correct the defect in his Mitral value. I had managed to secure the needed additional medicine through a generous donation from the mother of my college friend. She was a white lady of German descent married to a prominent Justice of Pakistan. The last hurdle was to collect enough blood for the needed surgical procedure. For this, we made a request Lahore studio of Radio Pakistan (the only radio station that served the about 7 million residents of Lahore). The job of getting Sajid ready for surgery was squarely on my shoulders. In response to our request on the radio for blood donation, enthusiastic Lahorites came in droves to donate blood. For my part, I bought chilled fruit juices for all the donors in appreciation of their donation in sweltering heat. 
When Sajid was rolled into surgery, he had a big smile on his face. He was confident that this surgery would treat his disease and he will be able to go back to his village to play soccer (called football locally).
Alas, that was not to be.  Although surgery went well, he developed post-surgical complications and passed away. 
His young death was particularly very devastating to me since he and I had developed a sweet friendship. After his death, I did a soul search trying to make sense of this tragedy. Then it dawned on me, Sajid died because his sore throat was not treated with antibiotics when developed a Strep throat at the age of five. A few doses of the cheapest of antibiotic such was amoxicillin would have PREVENTED this tragic end. Soon after finishing this rotation I decided to focus on Preventing the disease rather than a futile effort to save a life later.
With this goal in mind, I came to the United States and became Diplomate of American College of Preventive

Tuesday, August 19, 2014

But, I do not have allergies Doc

On my drive to work I often wonder what type of day is in store for me. You see, in my walk in medical practice there is no typical day. And that is what I like. I could start my day with a patient who has been up all night with a headache or I may see some on who accidently cut their finger while opening a box with a box cutter. Sometimes the symptoms are precise and the diagnosis obvious at other times however the symptoms may be more general and diagnosis less clear. On such patient was a middle age teacher. She told me that lately she has been feeling very tired and weak.  She was also concerned about her cough. ‘I am okay when I am sitting up, but as soon as I lay down, I cough. ‘Last night, I had to sleep propped up in a couch’.
I examined her. She did not have any fever and her lungs were clear. I did notice that she had fluid behind both her ear drums and her nostrils were swollen from inside. When I looked at her throat carefully, I could see a droplet of clear fluid hanging from her uvula (soft piece of flesh that hangs from the roof of the mouth). I told her that although I am not absolutely certain but her symptoms may be due to allergies.
‘But I do not have allergies Doc’, she protested. ‘Pollen does not bother me and besides this is summer time, not the time for allergies’ she added. 
‘In my exam, I found that your nostrils are swollen and…
‘What does that mean doc’? She interrupted.
‘That means that you may have signs of Rhinitis which simply means inflammation of the nose’ (Rhino is ancient Greek word for nose). ‘There are two types of allergic rhinitis. First, Perennial Allergic Rhinitis is commonly caused by house dust mites, pet dander and mold. Eighty percent of Allergic Rhinitis is either perennial or mixed (both perennial and seasonal).  The second type of rhinitis is called seasonal allergic rhinitis. It is commonly associated with ‘allergies’.  It is caused by pollen, grass or trees.’
‘I think you may have perennial allergic rhinitis.’
‘You said, “May have”, does that mean that you are not sure?’
‘Yes’ I am not 100% sure. However we could do a blood test right here in my office that tell us whether or not you have allergic rhinitis, in addition we may be able to tell you what you may be allergic to.’
‘Okay, I understand that now’, but why am I coughing so much’.
‘In my exam, I did notice that you have a lot of post-nasal drip. When you lay down at night, the post nasal drip can trigger cough. In fact post-nasal drip is the most common cause of chronic cough.
‘Okay so that explains my cough, but why do I feel so tired Doc?’
‘You may be feeling tired because your sleep is interrupted due to coughing’
‘That makes sense! She said, finally smiling.

‘Good, I said, I will be prescribing you some medicines and we will also draw some blood to find out if you have allergies. In addition we may be able to tell exactly what you are allergic to and what measure you can take to minimize the exposure’.

Saturday, January 21, 2012

Make this a smoke free new year

I can’t shake off this cough doctor, said a young looking woman in her mid-thirties. She told me that her cough has been persisting for six weeks. She had tried over-the counter remedies. When that did not work she went to a medical clinic where they gave her antibiotics but nothing seem to work. I asked her if she smoked. She said no. Then she added, ‘I had quit last week’.
She did not have a fever and her blood pressure was slightly elevated. Nothing too remarkable I thought; people can be a bit nervous when they come to see a doctor. I listened to her lungs. Lungs were mostly clear except for some coarse respiratory sounds in one area of her lung.
I told her that I could not tell her what was causing her cough just yet. Perhaps a chest X-ray might help. The X-ray showed a nodular mass in her lungs. CT scan confirmed my worse fear. She had lung cancer. The cancer in her lung was causing an obstruction to her airways, leading to the persistent cough. I learnt that she had smoked heavily for the past 20 years and quit recently due to persistent coughing

Cigarette smoking causes 1 in 5 deaths in the United States. Most of us know that smoking leads to crippling diseases such as lung cancer and other diseases of the lung and heart and of course stroke. It saddens me to observe death and disability particularly in cases where it could have been prevented. Yet smoking still continues to take a heavy toll on people in the United States and elsewhere.

Quitting smoking may not be easy but the rewards are significant and some of them immediate; such as extra money in your pocket and improvement in your health. Your blood carbon monoxide level drops to normal in 12 hours. Within 3 months your lung function improves. Your risk of coronary artery disease is half that of a smoker in one year. In five years your stroke risk is reduced. In addition, the economic rewards are significant. Think of all the money you could be saving. I tell my patients to make a list of other things they may be able to afford with the savings.

When I talk to patient about smoking cessation, they tell me that they are worried that they will gain weight when they quit smoking. I tell them that although it is common, weight gain after quitting smoking is not a sure thing. There are some steps you can take to reduce weight gain (good diet, exercise). A good smoking cessation plan should also have a strategy in place to fight weight gain.

So are you ready to quit smoking? Good news is that more assistance is available now to help you quit smoking. There are nicotine replacement products such as nicotine gums, patches, lozenges and sprays. Here, the idea is to gradually taper the dosage of nicotine, without the harmful chemicals of cigarette smoke. These medicines are safe for most people and generally double the chances of quitting and staying quit. Additionally, there are prescription medicines such as Zyban and Chantix which can help you quit. These medicines do have side-effects. I would recommend that you discuss with your physician which of the above methods may work for you. This is a new year. Make this the year you quit smoking!

Acknowledgement: Some of the material for the essay was extracted from American Cancer Society’s booklet ‘Set yourself free’.

You may order this booklet for free by calling 800-227-2345 or you may pick up a copy at Allies Medical, 2 Bridgewater Road # 100, Farmington, CT 06032. Phone 860-678-9900.

Thursday, May 5, 2011

Your Car or Your Life

I missed my appointment and was furious at myself. How could I forget my appointment with my auto dealership for 60,000 miles maintenance check? I should have been upset; I need my car to run smoothly for me to reach my destination. I am sure you can relate to that. After a while, my thought drifted to other machines that require maintenance on a regular basis. Our heating and air conditioning unit, our lawn mowers, our roofs and gutters to name a few. Most of us are good at maintaining our autos, machines and houses. Are we as diligent about maintaining our own body? Think about it.

In my 25 years experience as a physician, I have seen countless patients who find out about their hypertension only during a mandatory medical exam for truck driving or they find out that they are diabetic only during the medical examination required by the insurance company. In late 1980s, I worked on a National Institute of Health’s research project on kidney failure in diabetic patients. We noticed that some patients developed renal failure in about 10 years while it took 25 years for others. So what was the biggest difference in the two groups? Yes, how effectively one controlled blood sugar was a factor, however the finding that surprised us was that blood pressure control was as important. Some, who developed kidney failure in a very short time, were not even aware that they had diabetes and high blood pressure.

The irony is that screening for blood pressure and diabetes are about the simplest, least expensive tests in medicine. So what are we to do? Everyone, even the healthiest among us, should go for a physical once a year. Clearly, our body deserves at the very least as much attention as our cars. So what is more important to you, your car or your life?

It reminds me of Jack Benny radio sketch. A mugger corners Jack Benny in a deserted alley, shows him his gun, and asks him. ‘Your money or your life?’ When he hears no response, he asks the question again, this time more forcefully. To this Jack Benny replies, ‘Don’t rush me, I am thinking, I am thinking’.

Sunday, April 24, 2011

Prevention is the Cure

We equate better health care to expensive diagnostic tests and miracle drugs. We spend 80% of our health care dollars in the last year of life when it is too late. We pay attention to our bodies only when it really hurts. How wise is it? Let us see what one of our highly respected leadership and organizational expert has to say about this.
Stephen R. Covey in his book ‘The 7 Habits of Highly Effective People’ teaches us how to manage time and resources. He categorizes daily tasks into quadrants: Quadrant 1 is for things that are urgent and important. He calls it the ‘Symptom quadrant’ and the time spent in this quadrant as ‘crisis management’. The second quadrant is for things that are important but not urgent. He calls it the ‘Cure quadrant’. Mr. Covey urges us to spend most of our time and resources in this quadrant. The activities in this ‘cure quadrant’ include planning, preparation, relationship building and prevention. Yes prevention in the ‘Cure quadrant’. Thus prevention is not better than cure, as the old saying suggests. Prevention is the cure.

Tuesday, April 19, 2011

Are you concerned about your weight?

It was a rare slow day at my clinic. I saw my last patient an hour ago and was eagerly awaiting the arrival of my next patient, a top executive of national company. I enjoyed doing these Executive physicals as these physicals were geared towards the preventive aspects of medicine, a subject that interests me immensely. Mr. Rothberg arrived, a tall, well-built gentleman and apologized for being late. When I asked him what his main concern was, he said, ‘I am very concerned about my weight’. This surprised me. I could see well-developed muscles under his medical gown. I asked him ‘Why does it concern him so much?’
He told me ‘Doctor, according to the weight chart I am 20 lbs above my ideal weight. I have been exercising for 45 minutes 5 days a week and the weight does not seem to budge. If anything, I may have gained a couple of pounds’.
I smiled and wished my other patients would have this ‘problem’ too.
You see Mr. Rothberg did not have a ‘weight problem’, he had an ‘weight chart problem’.

Typical weight charts may mislead you if you are highly muscular. For an equal mass, muscles weigh more than fat. In reality, Mr. Rothberg could have a low level of fat with excellent body composition (the proportion of muscle to fat in the body). Conversely, many people who weigh in at the ideal weight may have too much fat on their body, and too little muscle - in effect, a poor body composition.

Ideally, it is important not to lose lean weight, as it is mainly this lean muscle tissue that maintains your metabolism, the rate at which your body burns the calories.

Key to effective weight management.

The greater the lean weight, the faster the body burns energy at rest and during exercise. Therefore, it is particularly important to maintain and even increase lean weight during weight-reducing Exercise/diet programs.

The normal Range for lean weight is 80 - 86 %

Body water—an important part of Body Lean. Water is the most important for human life. Water keeps your system moving, flushes out impurities, and cools the inner organs, regulating your body temperature.
Some fad diets tend to lower your weight by simply lowering your body’s water content. These diets seem to ‘work’ because your bathroom scales show your weight to be less. When in fact all you lost was water and water Loss may be dangerous. Normal Range of water in the body is 55 - 65 %

Fat weight and not total weight determines health risk, it is clearly advantageous to maintain bodyfat levels within the recommended normal range.

So Fat is Bad. We should get rid of Fat as much as possible. Right?
The answer: Not necessarily. Not all fat is useless.

You see, here are two forms of fat tissue:

Essential fat (approx. 4% for men and 10% for women) serves as a shock absorber and protective shield to the vital organs of the body such as the heart, liver, kidneys, brain and spinal cord.

Subcutaneous fat stored beneath the skin acts as an insulator to protect the body against the weather. Any excess calories derived from food intake will be stored here as fat.

As fats are essential for normal body functions, body fat should not be reduced below the recommended lower limit unless under the supervision of a health care professional
So what is the Acceptable range of fat?
Acceptable range of fat is 14-20% . Men should strive for the lower end of this range while women may stay at the higher end of the range.

I measured Mr. Rothberg’s percentage body fat with the help of body composition machine. His percentage body fat was well within a healthy range.
I shared the above information with Mr. Rothberg. The anxiety on his face was gone and he was positively smiling. As he left, I could not help notice a certain spring in his stride.