Complications of Coronary Artery Bypass Surgery
In this day and age of modern medicine it seems as though people don't have to be concerned about getting ill. We now have a wide variety of therapies and replacement parts available, some of them with very good results: eg Alonzo Mourning. Although the real statistics on modern cancer therapy aren't quite as impressive, few cancers escape the slash and burn approach. We have many replacement joint parts including knees. Not too many of those however, continue their NBA basketball career. I can still remember, when as part of my medical internship at IUMC hospitals, I spent three months at St. Lukes hospital in Denver. While I was there, Dr. John Grow, performed the first coronary artery surgery to reestablish blood flow at St. Lukes. That year was 1970. A lot has happened since then and today coronary artery bypass surgery is a common and accepted procedure. But, as usual, there is no free lunch. Before you eat that next super-sized double bacon cheeseburger at your local golden arches, check out some of these complications.
Some Current Studies
read original article
Postperfusion syndrome (pumphead), a transient neurocognitive impairment associated with cardiopulmonary bypass. Some research shows the incidence is initially decreased by off-pump coronary artery bypass, but with no difference beyond three months after surgery. A neurocognitive decline over time has been demonstrated in people with coronary artery disease regardless of treatment (OPCAB, conventional CABG or medical management).
* Nonunion of the sternum; internal thoracic artery harvesting devascularizes the sternum increasing risk.
* Myocardial infarction due to embolism, hypoperfusion, or graft failure. * Late graft stenosis, particularly of saphenous vein grafts due to atherosclerosis causing recurrent angina or myocardial infarction.
* Acute renal failure due to embolism or hypoperfusion. * Stroke, secondary to embolism or hypoperfusion.
* Infection at incision sites or sepsis.
* Deep vein thrombosis (DVT)
* Anesthetic complications such as malignant hyperthermia.
* Keloid scarring * Chronic pain at incision sites
* Chronic stress related illnesses
from the British Medical Journal
read original article
A prospective study of 312 patients undergoing elective coronary artery bypass surgery was undertaken to determine the incidence, severity, and functional impact of postoperative neurological complications. Detailed evaluation of the patients showed that neurological complications after surgery were common, occurring in 191 of the 312 patients (61%). Although such a high proportion of the total developed detectable changes, serious neurological morbidity was rare. Neurological disorders resulted in death in only one patient (0.3%) and severe disability in only four (1.3%). Forty eight patients were mildly disabled during the early postoperative period, and the remaining 138 with neurological signs had no serious functional disability. The postoperative neurological disorders detected included one death from cerebral hypoxic damage. Prolonged depression of conscious level was observed in 10 patients (3%) and definite stroke in 15 (5%); 78 (25%) developed ophthalmological abnormalities and 123 (39%) primitive reflexes; postoperative psychosis was observed in four (1%); and 37 (12%) developed disorders of the peripheral nervous system. The incidence of serious neurological problems such as fatal cerebral damage, stroke, and brachial plexopathy is in accordance with experience elsewhere. Lesser abnormalities, whose detection required detailed neurological examination, were much commoner than expected from previous reports.
from Jackson Memorial Hospital
read original article
Complications of Coronary Bypass SurgeryHOOSHANG BOLOOKI M.D.1; LEONARD S. SOMMER M.D.1; ALI GHAHRAMANI M.D.1; DAMAIO CUNHA M.D.1; Michael Gill B.S.1 1 From the Division of Thoracic and Cardiovascular Surgery and Cardiovascular Laboratories, Jackson Memorial Hospital-University of Miami School of Medicine, Miami, Florida.
In the past three years, among 170 patients undergoing aortocoronary bypass surgery, 11 (6%) developed acute myocardial infarction within 24 hours after surgery. An additional four patients (2%) developed myocardial infarction within three months after discharge. Clinically, acute myocardial infarction was suspected because of sudden, transient hypotension associated with dysrhythmia, angina, or cardiac arrest which responded to conventional therapy. Elevation of serum enzymes with acute ECG changes was also observed. Three of the 15 patients developing myocardial infarction died. In 12 patients cardiac catheterization studies were performed within two to ten weeks after the incident. Eleven of the 20 grafts were found occluded, and progression of coronary occlusive disease was seen in five. There was a marked decrease in left ventricular function, contractility, and compliance in all patients with left ventricular aneurysm formation or dyskinesia. Eight of these patients were asymptomatic. The results indicate that after coronary surgery a combination of sudden arrhythmia and transient hypotension is diagnostic of graft closure or development of acute myocardial infarction. Also, in spite of depressed cardiac function, most surviving patients remain angina free.
Death Coma and Stroke
Back when I was a radiology resident, we would obtain informed consent from any patient scheduled for a procedure. Seriously, the first three words on the informed consent form were death, coma and stroke. It seemed as if most were not too overly concerned. I was very fortunate in that none of the procedures I was involved in resulted in any serious complications. I did however witness some other less than optimal outcomes. In reviewing the complications of coronary artery bypass, all three, death, coma and stroke, were there in significant proportion. If the statistical mortality or significant morbidity from any given procedure is even just 5% but that complication happens to you, then for you, that percentage is now 100%! There is nothing better than "original equipment."
another look at the numbers
seeing through the statistical haze
Estimates for the number of coronary artery bypass procedures are approximately 500,000/year for the United States to approximately 800,000/year worldwide. If we take an average mortality of even just 2%, that would translate into 10,000 deaths/year for the United States alone and 16,000 deaths/year for the world.
Statewide Figures for CABG Surgeryfor Pennsylvania
read original article
* in-hospital mortality rate 2.4%
* 30-Day mortality rate 2.7%
* 7-Day readmission rate 6.2%
* 30-Day readmission rate 14.5%
* Average post-sugical length of stay 5.8 days
* Average hospital charge $59,939
That seems to me to be an awful lot of people for a procedure that does not address the real problem that causes coronary disease in the first place -poor eating habits.
Looking at the combined morbidity and mortality for this procedure I think I would much rather just quit eating meat and sugar, eat fewer times per day to get my glucagon going and take my chances with my original equipment.
Chunky Cole Slaw
Lesson from the Jackrabbits
Summertime here in Tucson is rather hot. It becomes difficult to maintain good hydration since you are sweating most of the time. Many times running in the heat of the desert summer, I would see jackrabbits and cottontails. I would marvel at how they could even survive here, much less run as fast as they do. They never drink water. They rely soly upon eating what green there is that grows in the Sonoran desert. They literally eat their hydration.
purple (red) cabbage
peppers (all three colors are not necessary)
Chop all ingredients as coarse or as fine as you prefer. I prefer larger chunks, but some would rather use a food processor and get really fine or small chunks. Traditional cole slaw is usually made from more finely shredded ingredients.
Mix all in a bowl.
red wine vinegar
dash of salt if you prefer
The dressing is made from about any combination of the above
ingredients that you prefer. This is not a traditional creamy
dressing but certainly that could be substituted. Usually about
eight ounces or so of dressing will suffice.
Mix in the dressing and stir. Put any excess that you will not
eat today into storage containers and keep chilled in your
refrigerator. This is a very low on the glycemic index taste
treat that keeps well and because it is mostly waterfood, it
will help keep you hydrated during the long hot summer.
Thanks for your attention.
Copyright © John Mericle M.D. 2005 All Rights Reserved
For more information please visit:DrMericle.comcole slaw
Asbestos Asbestosis Mesothelioma
It has been estimated that approximately 25 million people have been exposed to asbestos over the past 40 years. The word asbestos is derived from Greek meaning inextinguishable. It is a naturally occurring mineral that when crushed yields silicate fibers. It has been mined for years because of its heat and acid resistant properties. It was banned in 1986 in America for health reasons. It is, however, still mined in other less developed nations.
Asbestosis is one of the pneumonconiosis (lung disease that occurs from inhalation of dust etc) and is caused by the inhalation of asbestos fibers with resultant damage (fibrosis) to the lungs. Asbestosis usually requires about 15 years before it becomes clinically apparent.
The word mesothelioma implies a tumor of the mesothelium. The word mesothelium refers to the lining cells of body organs such as the lungs (pleura), heart (pericardium) and abdominal organs (peritoneum).
Mesothelioma is a neoplastic process(cancer) that typically involves the lining of the lung (pleura), the lining of the heart (pericardium) or the lining of the abdomen(peritoneum). It is a consensus that it is related to exposure to asbestos -the fibers of asbestos are often found within the tumor itself. Asbestos has been used for over 2000 years for its heat resistant and non-combustible properties. Use in the United States peaked in the years 1930-1960. It was used to insulate buildings and homes, ships and was also used in auto repair.
How mesothelioma starts ...
The fibers of asbestos are inhaled and end up in the portion of the lung where oxygen exchange takes place -the alveolus. Specialized cells in the lungs called macrophages go to work to try to rid the body of these fibers, however, the fibers are too long to be completely ingested by the macrophages and this results in the contents of the macrophage being spilled into the alveolus. The fibers are also very resistant to being digested by the macrophage. The spilling of the intracellular contents of the macrophage into the alveolus damages the alveolus and this results in decreased ability to exchange oxygen. Some of the damaged lung by necessity abuts the visceral pleural surface of the lungs(lining of the lungs) and this is where the mesothelioma will start to grow after many years of chronic inflammation and irritation by the fibers of asbestos.
Some thirty to forty years later
The damage to the alveolus(lungs) smolders for years, as the fibers continue to cause inflammation with resultant scarring. Typically some thirty to forty years later, the affected pleural cells can become malignant resulting in a malignant mesothelioma. This is what makes this an extremely difficult disease to treat. By the time it is clinically apparent it has been there for a long time. This makes treatment problematic at best. The average life span for newly diagnosed malignant mesothelioma is only eleven months.
Typically symptoms do not appear until thirty to forty years following the exposure.
Pulmonary (lung / pleural) symptoms:
shortness of breath
both of the above may be related to the accumulation of fluid in the chest
abdominal (peritoneum / peritoneal) symptoms:
both of the above may be related to the accumulation of fluid in the abdomen
Other symptoms of abdominal (peritoneal) mesothelioma may include bowel obstruction, anemia, fever and blood clotting problems.
Asbestosis and Malignant Mesothelioma
To make the diagnosis of asbestosis is somewhat difficult in a lot of the cases. History of exposure to asbestos and an appropriate time interval are necessary. Specific findings on a chest xray such as bilateral calcified pleural plaques are diagnostic but only occur in about 15% of the cases. Other findings such as non-calcified pleural plaques and a honeycomb pattern in the lower lung fields are less specific. The disease process asbestosis does indicate a definite exposure to asbestos and in people with asbestosis, there is a five fold increase in lung tumors including malignant mesothelioma.
Treatment for malignant mesothelioma ...
As is fairly obvious from the statistics above, treatment has not been very effective. The average life span of only eleven months is a rather dismal at best, prognosis. As with any cancer, therapy should be directed at boosting the immune system as much as possible since -cancer is a sign of a compromised immune system. If there is chance of a history of exposure to asbestos or one has asbestosis but does not have malignant mesothelioma, it would be optimal to boost the immune system as much as possible. Even with the diagnosis of malignant mesothelioma, it is still a very good idea to try to keep the immune system working as well as it can.
The MericleDiet and the Immune System
No other diet today takes care of your immune system like the MericleDiet. It is sugar-free so your infection and cancer fighting white blood cells will be operating at top speed. It is the only 100% organic diet that will keep nasty immune-system-wrecking pesticides, hormones and antibiotics out of your body. It is 100% vegan which will further reduce any chance of cancer as much as possible. To visit the MericleDiet please click on the link below.Visit the MericleDiet
Other ways to boost your immune system ...
* Exercise ...Regular exercise that elevates the heart rate has been shown to improve immune system function.
* Avoid any pesticides in your yard or house.
* Avoid new carpet that off-gases many toxic immune system depressing chemicals.
* If you live in a toxic environment (such as under a flight line) try to move if possible to a more healthy environment.
* Avoid as much as you can any antibiotics, steroids or any hormone that can depress immune function.
Thanks for your time.
John Mericle M.D. D.A.B.R.
Essential Fatty Acids EFA's
Fats (triacylglycerols) and Essential Fatty Acids
Some basic terminology ...
fat or fatty acid ...
In the human most of the important fatty acids are
between 14 and 24 carbon atoms in length with the
most common being 16 or 18 carbon atoms. There is
a carboxy.. (acid) group at one end (COOH) and a methyl
group at the other end (CH3). Carbon number one is the
carbon atom in the carboxy.. group and the omega(w) carbon
is the carbon atom in the methyl(CH3) group at the other end.
(For purposes of this discussion we will use the w symbol
for the omega symbol).
saturated fat ...
A carbon atom can have four atoms attached(bonded)
to it. Methane gas for example is CH4. There is one carbon
atom with four attached hydrogen (H) atoms. When a fatty
acid is termed "saturated" this means that all the bonds
between the carbon atoms are "single" bonds. All the four
available spots for bonds are either taken up by an
adjacent carbon atom or a hydrogen (H) atom. For example
the omega end of linolenate would look like this ...
CH3-CH2-CH=CH-CH2...rest of the molecule
There is a single bond between the omega carbon (first from
the left) and the next carbon. The second carbon atom has
two hydrogen atoms and two carbon atoms bonded to it. But,
what about the third carbon from the left?
Unsaturated fats ...
If we look at the above example the third and the fourth
carbon atoms have a "double" bond between them and only
one hydrogen atom each. This is an example of an
unsaturated bonding, ie not as many hydrogen atoms are
bonded to the carbon atom as there could be. If we make
the rest of this molecule linolenate and name this
according to the location of the double bond what would
we call this fatty acid?
Polyunsaturated fatty acids ... These are fatty acids that
have more than one "double" bond. Lineolate is a good
example of one having double bonds at the 9th and 12th
carbon atoms (from the acid end) or the 9th, 12th and
15th carbon atoms.
Essential fatty acids ... "Mammals lack the enzymes to
introduce double bonds at carbon atoms beyond C-9 in the
fatty acid chain."
Stryer Biochemistry 4th Edition p623
This can be a source of confusion since the above statement
is counting from the acid end and the omega acids are
counting from the omega end. The two main "essential"
fatty acids are:
linolenate (w-3)also known as alpha linolenic acid(LNA)
linoleate (w-6)also known as linoleic acid (LA)
The w-3 tells you that the first double bond will be at
the third carbon atom from the w- end. The w-6 tells you
that the first double bond will be at the sixth carbon
atom from the w- end. These acids are termed "essential"
because human (mammalian) biochemistry cannot
Insulin and Glucagon revisited ...
Just an aside here, but it is worth mentioning again in this
discussion of fat metabolism. In starvation the level of
free fatty acids rises because of the hormones glucagon
and epinephrine. Glucagon "mobilizes / utilizes" fat and
stimulates the breakdown of fat in the fat cells. Insulin
by contrast however, inhibits the breakdown of fat and
actually promotes the storage of fat / energy.
The good fats ...
Both of the above fats are "good" fats and necessary for
human biochemistry to proceed normally. The omega-6 linoleic
acid can be found in more foods than the omega-3 linolenic
acid. People are typically deficient in the omega-3 linolenic
acid. The good fatty acids "compete" with the bad fatty acids
(saturated animal fat, trans-fats etc) and diets that are
too heavy in the bad fats make it difficult for the good fats
to do their required biochemistry. Also, it is felt that there
should be a balance maintained between the omega-3 and the
omega-6 fatty acids. The ideal intake ratio of omega-6 to
omega-3 should be close to 1:1. However, most Americans get
a ratio closer to 25:1 (too much omega-6 relative to omega-3).
What do EFA's do ...
EFA's are integral to cell wall maintainance, the immune
system, nervous system, cardiovascular and reproductive
systems. They are precursors to the fatty acids necessary
for prostaglandin formation, which control vital functions
heart rate, blood pressure, immune function, fertility and
Symptoms of omega3/6 imbalance and or deficiency ...
Omega 6/3 imbalance is associated with many symptoms
including depression, insulin resistance, diabetes,
cancer, heart disease, aging, obesity and schizophrenia.
Food sources ...
Flaxseed oil is probably the easiest and best way to cover
your EFA requirement. One tablespoon of flaxseed oil per
day will give you the necessary omega-3 linolenic acid
you need. This is also an excellent source of omega-6
linoleic acid. Other sources of omega-3 linolenic acid
walnuts, pumpkin seeds, Brazil nuts, sesame seeds,
avocados, some dark leafy green vegetables (kale,
spinach, purslane, mustard greens, collards, etc.),
canola oil (cold-pressed and unrefined), soybean oil,
wheat germ oil, salmon, mackerel, sardines, anchovies,
Sources of linoleic acids (omega-6) are
Flaxseed oil, flaxseeds, flaxseed meal, grapeseed oil,
pumpkin seeds, pine nuts, pistachio nuts, sunflower seeds
(raw), olive oil, olives, borage oil, evening primrose
oil, black currant seed oil, chestnut oil, chicken,
corn, safflower, sunflower, soybean, cottonseed oils
(Thank PamRotilla.com for these sources)
Refined oils ...
It must be stressed here that any oil that has been refined
will have no EFA activity. The essential fatty acids
are very unstable and will not tolerate either light or
increased temperature. Your flaxseed (or any) oil should not
be refined. While refining may produce a pretty, clear oil,
it destroys most of the good things found in oils including
vitamin E. Make sure your source for EFA's is kept in
the refrigerator section of your grocery, in an opaque bottle.
Thank you for your time ...
Angina Doesn't Care If You Are Half-Right
Comment from one of our readers ...
I did find it interesting that your list of recommended
books did not include any by Ornish, McDougall and others.
But then I recognize that you stress the elimination of sugar
while the others stress the reduction of fats. It seems to
me to be different paths to the same place of greater health.
So much for genetics ...
My father had diabetes, my mother had diabetes and of course,
you would expect that at some point, I would have it . Some would
point to a "genetic" pre-disposition. I feel that it is much
more likely a "lifestyle" pre-disposition. I drank a lot of
cow's milk as a child and ate more than my share of "boxes of
24 Clark bars from the local Shell gas station."
The Eisenhower tunnel 1974
Driving through the Eisenhower tunnel in the fall of 1974 I
had this "unusual" pain in my chest. I thought to myself then
-could this be angina? January 1975 I would self-medicate
myself through a bad episode of bilateral pyelonephritis
(kidney infection). Fall 1990 on an attempted 20 mile run
around Lake Wawasee in Indiana, I would stop at twelve miles
due to severe chest pain into my left arm, relieved by rest.
That afternoon still feeling bad, I would sit and wonder
what they would do if I went to an emergency room. How
could this be angina? I was in year thirteen of a daily
running streak and had been vegan for all those years.
About three years later, circa spring 1993, I headed out for
a seven mile run from Broad Ripple in Indianapolis on the
beautiful canal path, only to have to stop in the first
half-mile. That is the first and last run I have ever had
to stop anytime in the first mile. I had severe chest
pain into my throat, left arm then right arm, then
the whole upper half of my body. This was accompanied by
some dizziness, disorientation and an extreme uneasiness.
I managed to run / walk another six miles. I would rest
for a while, let the pain subside, then run till it got
bad again, and then rest.
The answer ...
I would have to wait until July 5th, 1997, to get my answer.
On June 23 of that year I fell and broke the fifth metatarsal
in my right foot. I managed to run the next day, but it was
very painful. However, the fracture healed very rapidly.
While at work on Saturday July 5th, I had one of the
Radiology techs at St. Anthony's hospital take a film.
I was right about the fracture as I had suspected. Being
a Radiologist trained to look at the whole film, I as
usual, examined the whole film. I couldn't believe it when
I saw it. Atherosclerotic vascular calcification of the
Monckeberg variety (diabetes), in my right foot. I expected
to see that in films of other people, especially at VA
hospitals, but never in my own foot.
The last "six pack of Pepsi and late night box of Mike and Ikes" ...
That was the end of my "almost a six pack of Pepsi every day"
habit. That was my last late night box of Mike and Ikes. How
could this be happening to me, a running vegetarian. I had
been a great fan of Dr. Dean Ornish, the "black sheep"
Cardiologist who now is not quite such a black sheep, who
advocated a low fat vegetarian diet to reverse heart disease.
I pulled his book out of my library and reread it and I
quote, "There is no proven relationship between sugar and
coronary artery disease." Something here is not quite right.
Sudden death from "heart attack" in diabetics
I remember from my medical school days the old adage that
"approximately 50% of all people dying with their first
heart attack with no prior history of coronary disease,
would turn out to have adult onset diabetes mellitus." How
can you explain that the days after my anginal episodes
I would run normally with no angina as I still do "mostly"
in the 26th year of my running streak? Significant
obstruction of any of the major coronary vessels would
not go away the next day. Why do so many people with diabetes
die with unexpected and undiagnosed coronary disease?
Coronary arteries and arterioles
Coronary artery disease that we talk about is usually that
which we can diagnose. To make the diagnosis, contrast is
injected into the coronary arteries and then rapid sequence
images are obtained. However, modern imaging techniques
can only measure the larger vessels. To date, there is no
way to image the extremely small vessels (arterioles) where
the oxygen and nutrient transport takes place. There are
basically two types of atherosclerotic changes. Those that
occur around areas of normal turbulence, ie wherever an
artery bifurcates, there will be some turbulence from
boundary layer separation. I associate that type of change
with animal protein and fat ingestion. Then there is the sugar
induced calcification that involves the entire artery. It
is systemic and generally speaking if you have it anywhere
-you have it everywhere.
Stiff pipes ...
What does the calcification of the arteries and arterioles
do? It causes the artery or arteriole to become stiff,
rigid and "non-compliant." This becomes a rather significant
problem whenever one ingests a large fat load, especially
some of the bad fat loads that are out there today. The
normally compliant arteriole can expand to let the larger
fat molecules pass. The stiff, diabetic and non-compliant
arteriole cannot accommodate the larger fat molecule and
voila ... it becomes blocked. Does this cause angina?
You bet! It blocks oxygen and nutrient transport
as surely as a permanent lesion in one of the larger
arteries proximal to the arteriolar level. There is however,
one major difference -once the fat clears, if you survive,
the blockage can be gone.
Don't be "half-right" ...
Before my first severe episode of angina I had eaten some
fat (olive oil on toast) that I had never had before. About
twelve miles into that run I had severe angina. The day before
the worst episode in Broad Ripple, I had eaten a vegan scone
in Bloomington, that was loaded with all kinds of bad fats.
Most diabetics who die with their first heart attack usually
have eaten a big meal, just before the heart attack occurs.
Dr. Ornish is definitely right about eating low fat.
But, that is only half of the equation. The other and
very much the larger half, is NO SUGAR -PERIOD.
The MericleDiet and sugar ...
The MericleDiet is the only "Sugarfree" diet plan today. The
integrated system to cook once a week or so, maintain a
refrigerator stocked full of everything from complex
carbohydrates like rice and potatoes to lower glycemic
index foods like beans and salads, makes it easy to transition
away from all the ubiquitous "sugars and sugar substitutes"
that are in almost all processed and packaged foods. Also,
the MericleDiet is the only diet that is 100% Organic. I
had to make it sugar free for myself, vegan to reduce the
risk of cancer and organic to find any real nutrition.
Use Stevia, if you must have sweet ...
For those of you who have been on this list for some time you
already know about Stevia. Stevia is a naturally occurring
sweetener that has also been demonstrated to lower blood
pressure. For more information click on the link below.For More Information on Stevia To Visit Carol Bond Health Foods For Stevia(Stevita on her site)
Thanks for your time.
Headlines From The Washington Post
"Sick and Broke"
By Elizabeth Warren
Wednesday, February 9, 2005; Page A23
Nobody's safe. That's the warning from the first large-scale
study of medical bankruptcy.
Health insurance? That didn't protect 1 million Americans who
were financially ruined by illness or medical bills last year.
A comfortable middle-class lifestyle? Good education?
Decent job? No safeguards there. Most of the medically
bankrupt were middle-class homeowners who had been to
college and had responsible jobs -- until illness struck.
As part of a research study at Harvard University, our
researchers interviewed 1,771 Americans in bankruptcy courts
across the country. To our surprise, half said that illness
or medical bills drove them to bankruptcy. So each year,
2 million Americans -- those who file and their dependents
-- face the double disaster of illness and bankruptcy.
But the bigger surprise was that three-quarters of the
medically bankrupt had health insurance.
How did illness bankrupt middle-class Americans with health
insurance? For some, high co-payments, deductibles, exclusions
from coverage and other loopholes left them holding the bag
for thousands of dollars in out-of-pocket costs when serious
illness struck. But even families with Cadillac coverage were
often bankrupted by medical problems.
Too sick to work, they suddenly lost their jobs. With the
jobs went most of their income and their health insurance
-- a quarter of all employers cancel coverage the day you
leave work because of a disabling illness; another quarter
do so in less than a year. Many of the medically bankrupt
qualified for some disability payments (eventually), and had
the right under the COBRA law to continue their health coverage
-- if they paid for it themselves. But how many families can
afford a $1,000 monthly premium for coverage under COBRA,
especially after the breadwinner has lost his or her job?
Often, the medical bills arrived just as the insurance and
the paycheck disappeared.
Bankrupt families lost more than just assets. One out of
five went without food. A third had their utilities shut off,
and nearly two-thirds skipped needed doctor or dentist visits.
These families struggled to stay out of bankruptcy. They
arrived at the bankruptcy courthouse exhausted and emotionally
spent, brought low by a health care system that could offer
physical cures but that left them financially devastated.
Many in Congress have a response to the problem of the
growing number of medical bankruptcies: make it harder for
families to file bankruptcy regardless of the reason for
their financial troubles. Bankruptcy legislation -- widely
known as the credit industry wish list -- has been introduced
yet again to increase costs and decrease protection for every
family that turns to the bankruptcy system for help. With the
dramatic rise in medical bankruptcies now documented, this
tired approach would be no different than a congressional
demand to close hospitals in response to a flu epidemic. Making
bankruptcy harder puts the fallout from a broken health care
system back on families, leaving them with no escape.
The problem is not in the bankruptcy laws. The problem is in
the health care finance system and in chronic debates about
reforming it. The Harvard study shows:
• Health insurance isn't an on-off switch, giving full
protection to everyone who has it. There is real coverage
and there is faux coverage. Policies that can be canceled
when you need them most are often useless. So is bare-bones
coverage like the Utah Medicaid program pioneered by new
Health and Human Services Secretary Mike Leavitt; it pays
for primary care visits but not specialists or hospital care.
We need to talk about quality, durable coverage, not just
about how to get more names listed on nearly-useless
• The link between jobs and health insurance is strained
beyond the breaking point. A harsh fact of life in America
is that illness leads to job loss, and that can mean a double
kick when people lose their insurance. Promising them
high-priced coverage through COBRA is meaningless if they
can't afford to pay. Comprehensive health insurance is the
only real solution, not just for the poor but for middle-class
Americans as well.
Without better coverage, millions more Americans will be hit
by medical bankruptcy over the next decade. It will not be
limited to the poorly educated, the barely employed or the
uninsured. The people financially devastated by a serious
illness are at the heart of the middle class.
Every 30 seconds in the United States, someone files for
bankruptcy in the aftermath of a serious health problem.
Time is running out. A broken health care system is
bankrupting families across this country.
The writer is a law professor at Harvard University.
Elizabeth is to be commended for the fine article above which
deals with so many of the problems associated with our health
delivery system today. During my last days in the Radiology
Department I had become increasingly concerned that we weren't
doing something right for the vast majority of so many sick
people. I was seeing more advanced disease earlier and earlier
in life. You could never convince me that we have extended
the "useful" lifespan of anyone. In fact I don't think now
that the lifespan is extended anyway. I saw way too many
young women in their forties die of breast cancer and many
men of similar age with advanced heart and carotid vascular
Becoming proactive ...
You could just wait until you get ill, lose your mortgage and
house, file bankruptcy and try to pay your medical bills with
your credit cards or ... you can adopt your own life and health
insurance plan. By taking an active part in your own health
and learning what you can, you can seriously reduce your risk
for "wallet" threatening disease. Getting sick is bad
enough without having to be broke, out of your job and your
house. Get good insurance, health insurance and also while you
are at it -some proactive quality of life insurance. The
MericleDiet will reduce your risk for disease about as much
as it can be reduced.
The MericleDiet "Quality of Life Insurance Policy"
While health insurance costs in the hundred of dollars
per month and catastrophic health care costs in the thousands
per month -The MericleDiet and the information associated
with it is a real bargain at $49 one time fee for life.
Even if you utilize just a tenth of the available
information, it is easily worth much more than that.
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Glucagon Fat-Burning Aging -Breakfast How Not To Start The Day Part III
A question from one of our readers:
With respect to burning "fat" energy in the mornings before
eating, what if you are not a long distance runner? The average
person is not, particularly someone who is overweight. A typical
run for me in my current condition is 2-3 miles. Would I still
be burning fat with a 25-30 min. jog?
Answer: Yes, you would still be burning fat as long as you
stay in a glucagon state.
This is a very good question since most people today don't run
at all -much less even 2-3 miles a day. This touches on one of
the most important aspects of the MericleDiet and exercise
as it relates to weight loss. Exercise for your immune system,
but don't rely on exercise to lose weight and or keep weight
off. Even running seven miles a day is not enough to burn
any significant calories.
Back to the glucagon state of energy utilization
In the last newsletter I discussed the importance of entering
a glucagon state for some part of every day. For me,
running helps as it is a real distraction, something I do
every day and I have my own rule of never eating before I run.
The reason for not eating is that it is a lot easier to run in a
state of energy utilization (glucagon) , not energy storage
(insulin). Usually in hot weather I will run first thing in
the morning. This actually shortens my glucagon phase as
compared to running in the late afternoon. Usually if it is
hot and I run early, I will try not to eat when I get back
from the run until noon at the earliest. This gives me at
least four or five hours in a glucagon state -higher energy
levels and I get a lot more done. If you are going to eat
early in the day, it is best to eat low on the glycemic index.
Organic fruit, carrot or celery sticks and fresh organic
salads are good choices.
You don't need to exercise to enter a glucagon state
Exercise can help to get you into a glucagon phase but is not
necessary. All you really have to do is not go into an insulin
state by eating. Most of us are going to eat something during
most days but it is optimal if you can limit the time of food
ingestion to the mid-day hours, noon to 6:pm or so. You
will have a good glucagon phase in the morning and not go
to bed on a large load of insulin in the evening. As mentioned
previously, hyperinsulinism is implicated in many of our
serious lifestyle illnesses.
Dr. Roy Walford and caloric restriction
It may seem hard to believe, but during periods of starvation
during WWII, those who had their caloric intake reduced,
had improvement in diseases such as heart disease and cancer.
It was also noted that they did not age as much. This has
been studied by the late Dr. Roy Walford, who was part of the
Biosphere. There is no question that calorically restricted
mice age much more slowly than those who are allowed to eat
what they want. Dr. Walford also made the point that the
calories that are eaten must be "nutritionally dense." This
is also one of the premises of the MericleDiet. I don't
want to suggest that one live a life of caloric restriction,
but there is no doubt that reducing your caloric intake and
not eating as often or as much will improve your health and
slow your aging.
Insulin Glucagon Aging
Somewhere in the basic premise of caloric restriction and
retarded aging is the yin and yang of human energy
management -Glucagon and Insulin. Too much of either is
not good and as noted previously, most people in America
have way too much insulin. If you want to feel better and
look better while you age more slowly, think glucagon,
not insulin. Try to achieve "balance" between them.
If you spend four hours a day in an insulin state,
try to spend at least as much time in a glucagon state.
Understanding how glucagon and insulin affect your health
and your weight is one of the most important concepts one
can learn. Not only will you be able to work better, feel
better and control your weight more easily, there now is
impressive evidence that restricting your insulin secretion
by reducing your frequency and quantity of feedings will
Dr. Walford and Caloric Restriction
Stryer Biochemistry Fourth Edition
Thanks for your time.
Copyright © John Mericle M.D. All Rights Reserved