askDrJim.com

High-tech Care with Old-Fashioned Values

Help With This Site

Now that I have a new iMac and can find time to work on this website more I am thinking about how to change it for the better. I would like to have a separate blog for medical issues and one for other things. I would like to look into some podcasts. I would like to compile RSS's from other sites that have breaking medical news for folks. Given an interest in diet and exercise I would like to push out some tips or foods to make or buy. I would like to think of automated emails to people who would like to have a regular update of some type. I would be interested in doing some chat times "ask the doc" like times.

Help me filter out the things that would not be good and those that might be interesting. Thanks.
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KISS Principle

Yesterday I went to the Franklin Graham Festival in Knoxville. It was youth day and that meant lots of energy and 2 bands before the message. The kids loved the bands. I would say the music but, yes I am officially old, I heard mostly chaos. I think that the fusion type of hip hop that is common right now is interesting. Synthesized voices, samples for beats and background and then several folks giving lyrics in rhythms that accentuate the background. Generally one singer singing a few repetitive phrases that are catchy or function as a counter-tune. All of this is done with a general frenzy and energy that includes jumping, hand pumping and slamming bodies. The "lead" singer generally acts like a DJ asking the crowd to respond and the energy increases. Sometimes the words are good....mostly the singing is not. Finally it all seemed very choreographed and thematic. Both bands could have come out of the same blender....but the kids liked it and that was important.

Now to the real heart of this blog. When it was time for Franklin Graham to come up and speak, he did so with very little of the polish and emotion that you see from TV preachers. The message was plain and simple and very brief. He didn't talk down to folks and didn't use a lot of theological language. He got the basics of the gospel and the call to repentance and then he was done. I had been praying during the sermon that God would move in a mighty way but as Franklin spoke, I began to waver. I thought this might be the first time no one came forward with a decision to come to Christ.

Now I know that the crusade places counselors all over the hall and they also come down at the time of the invitation. This helps those "on the fence" gain the courage to step out as they see others coming. I don't know how many folks were there as counselors. All I know is that hundreds of people, both adults and children, came forward to the floor. I was humbled and marveled at the strength of the Spirit that could call people with such force when what I had seen did not seem compelling from a human standpoint.

This brought home to me the fact that God does not call us to save others. He does not require that we be polished or have all the answers. He does not need us to be perfection. He only asks that we go and witness to what we have seen and heard and to make disciples. He supplies the eloquence, the power and the salvation. I am so glad He does.
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Turn off the Lights and Watch Them Glow!

Twice a year I do a New England Journal of Medicine education program that forces me to dig deeper in the journal to look at research and reviews that often help me in my practice. The next few blogs will be seasoned with some of the gleanings. Did you know that over 4 million CT scans are performed each year on children? That in and of itself might not be bothersome but increasingly these CT's are repeatedly done on the same child as a condition is followed or symptoms persist. Think of the child who complains of headaches. Of course it could mean they need glasses, become hypoglycemic from their high sugar diet or have migraines brought on by lack of sleep or preservatives in their food but IT ALSO COULD BE A TUMOR or some other rare but dangerous condition. Picture the desperate parent going from doctor to doctor and ER to ER without relief AND without communication between doctors. Eventually several CT scans of the head may be performed. A review in the November 29th journal commented that, compared to abdominal x-ray, a CT of the abdomen had more that 50 TIMES the organ dose of radiation that is absorbed. There is reasonable evidence by looking at nuclear survivors and cancer development that having had several CT scans increases the risk for organ cancer development in adults and "The evidence is...very convincing for children." This should be a cause for concern and restraint on the part of both doctors and patients. One straw poll of radiologists cited in the article suggested that perhaps 1/3 of all pediatric CT scans could be avoided without significant clinical harm.

We all know the data about childhood obesity in America. I have outlined before the link in my mind with high carb diet (especially corn based sugars), lack of exercise and action oriented video games. These kids can and do lose weight if those things are changed. End of story....right? Well, not exactly. A Study by Baker, Olsen and Sorensen in the December 6, 2007 Journal reviewed body mass index (kind of a weight by height ratio) in childhood and the risk of coronary heart disease in adulthood. What they found was increased risk stronger in boys than in girls. We need to get our toddlers off sugar and exercising. Doing so may help prevent not only coronary disease later but hypertension, diabetes, some types of cancer and degenerative arthritis. We are spoiling our kids literally to death with our poor habits and parenting and our society will pay.
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Hidden in My Tent

Today at church Brian, my pastor, drew a startling connection between a familiar Old Testament story and a New Testament truth. His sermon was about facing our sins. He described several types including : hidden, open and secret. The open ones are the ones we have become so familiar with that we excuse ourselves before the Spirit can prick our conscience. I heard an African once describe sin as "a triangle in my heart. Every time I sin it turns a little. At first it is painful but with time the triangle cuts a circle and I feel the pain no longer". These are those open sins: the angry look on the freeway, the impatience with the clerk while in line at the grocery store, the prideful words when comparing ourselves with our neighbors.

The secret sins are different. These too can become numb to us as they are so common to us that we excuse ourselves before reflecting upon them. These are the ones not anyone but you and God see: the lustful look at a stranger, the anger we will not release, the delay in loving others until they love us.

Hidden sins are the ones we do know are harmful but we collect them and store them away. Maybe we are afraid to ask for God's forgiveness, maybe we know he will ask for repentance and restitution that we do not want to give, maybe we want to sin again and want to ignore the Spirit's warning.

These last were the focus for the Old Testament story. Jericho has fallen but Isreal has not been able to succeed in another battle. God reveals that this is because of a specific sin and the accused is revealed by God to Joshua. When confronted the man admits to taking spoils from Jericho in direct disobedience to God's stated desire. He tells the men that he has hidden the gold and other spoils in the dirt in his tent. He and his family and all his animals are stoned and burned and buried. Tough stuff.

Then Brian brought the connection home. He reminded us that OUR BODIES ARE THE TENTS that now contain the Holy Spirit! Our hidden sins are exactly like the other story. We seen to be unable to find joy or God's blessing in our lives but we have hidden sins in our tents and seem unaware that He knows and HE CARES. For me this is a revelation. Surely I have open sin that all the world can see. Though sometimes hard to face these are the easiest with which to deal. I can ask God and the others who see the sin to forgive and support me. It's the ones buried deep in the dirt of my tent. Those I would rather not face. The man in the story said he "coveted" the gold and silver and cloth he took. He loved the created more than the creator and when he coveted he took and completed the sin.

My sins too often seem precious to me....I mean that I don't want to let them go. I find something base in myself that likes the sin and won't let go. For me pride and gossip are two of the worst. I think they are the same for to gossip generally means you put yourself up in a better light than those about whom you are speaking. So pride seems to be the root of much of my "hidden" sin.

The story doesn't end, cannot end there. We know that God has forgiven our sin. Not "will forgive", not "forgave in the past once". God has ongoing knowledge of our sin and HAS forgiven us. We must work with the Spirit to see, dig up and throw out the sin for it creates a barrier to our effectiveness that will not go away by other means but God's love is a constant not some type of popularity poll. Sanctification is painful and messy but we need to have a clean tent with which to house our Lord.
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Oops, We Did It Again!

I know I'm a week late on the Vytorin, Zetia mess but I had no way to get to the site. For those of you following the box score, Zetia and Vytorin (Zetia mixed with generic Zocor) recently were "outed" in a study reviewed at a national cardiology conference in Chicago and then published in the New England Journal of Medicine last week. The study looked at over 700 people who carry a gene for VERY HIGH cholesterol levels. The company-sponsored research set out to prove that the 2 drugs were better than Zocor (a "statin drug") used by itself. The results looked good for the company: ALL THE INTENDED LAB VALUES MOVED IN THE RIGHT DIRECTION. The cholesterol and sub-fractions of "bad" cholesterol all went down, the good cholesterol rose and the measure of inflammation (CRP) thought to contribute to heart disease/attack went down.

In other words it looked like the study had done what the companies wanted: proved that we all need to take the new drug not the old drug (that a few years ago they convinced us we all needed). One little problem, the cholesterol plaques they monitored in the patients DID NOT GET SMALLER. And to make matters worse, there appeared to be no mortality benefit. Too bad. Guess we'll just stick to the older, cheaper drugs.

BUT WAIT. It appears that the company knew the results for a couple of years now. By the way during those 2 years they marketed the Zetia/Vytorin like crazy and they became MULTIBILLION winners for the company and its stockholders. So releasing the study now isn't quite so hard for them to swallow. In the end patients AND doctors have to shake our heads and wonder "what it the truth anymore?" when it comes to research.

More concerning (enough to prompt some comments in the editorial) is the thought: "if everything we wanted to have happen went right then could our entire theory of the progression of heart disease be flawed somehow?" The closest we saw was a suggestion that there must have been another mechanism at work that gummed up the outcome. But I ask again: Could we have this wrong? We see folks with low cholesterol have heart attacks and we see smoking, cholesterol consuming Frenchmen living long and happy....what if we are wrong? More importantly...what if we are being told what best sells stock? Be careful out there.
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Get Going Again

Well, I have an new iMac for use and so I should be able to update this site more readily. I am thinking about having a portion of the blog be questions from patients or site visitors who want some type of medical information. This would give me food for thought. I am also looking at trying to do an email list to send out updates and possibly a podcast. Ambitious, I know, but it will keep me busy and away from the TV. The new iMac is a joy as usual. So easy to get going and so easy to back up. The new keyboard is a small metal one and I really like the feel of the keys. I don't have as many sticking keys as the other iMac.

I also have a iTouch iPod that really excels. It can do wireless internet through my or other open networks it encounters and allows web browsing and Email! I am looking at software that would allow me to update the Blog from email remotely which would allow me to do it sitting in McDonald's etc. Next medical.
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