Longevity Metrics

Sycamore is a physician staffing and independent locums company that encourages physicians to run their career like a business. Price transparency, low fees, direct contracts, and aligned incentives set Sycamore Health apart from other physician staffing companies. In this interview, I discuss medicine, health, business, and more with Sycamore CEO, Larson Hicks. 

This episode covers my thoughts and opinions on several different topics.

Please enjoy. More medical knowledge episodes coming soon!

 Thanks again,

Bill Brandenburg, MD

Alcohol Withdrawal, Part 2

Summary

Drinking alcohol (specifically ethanol) on a regular basis leads to alcohol dependence. When alcohol dependent persons stop drinking, they experience withdrawal. Withdrawal from alcohol is very dangerous and should be managed aggressively in order to prevent long term complications and death. This podcast will teach you the ins and outs of recognizing and managing alcohol withdrawal both in the inpatient and outpatient setting.

Morbidity and Mortality

Almost 100,000 people die every year from ETOH abuse in the United States alone. It is not known how many people die a year from alcohol withdrawal. If delirium tremons develops, it is estimated that about 25% of people will die without treatment.

Story

Ever drink too much at night and then wake up suddenly at 5am feeling wide awake? Ever feel inner tension, agitation, or heart palpitations after a long party weekend with friends? If so, you have experienced symptoms of alcohol withdrawal.

Key Points

1. Tachycardia, tachypnea, hypertension, hyperthermia, tremors, anxiety, and GI upset are the hallmarks of alcohol withdrawal.

2. Severe symptoms may include hallucinations, delirium, seizures, and death

3. Vitamin and electrolyte repletion are critical for sick alcohol dependent patients.

4. Aggressively treating withdrawal by slowly coming off alcohol or using medications like barbiturates, benzodiazepines, and other CNS depressants can be lifesaving. Use medication liberally in this setting!

References

-Saitz M, Mayo-Smith MF, Redmond HA, Bernard DR, Calkins DR. Individualized treatment for alcohol withdrawal. A randomized double-blind controlled trial. JAMA 1994

- Grant BF, Goldstein RB, Saha TD, et al. Epidemiology of DSM-5 Alcohol Use Disorder: Results From the National Epidemiologic Survey on Alcohol and Related Conditions III. JAMA Psychiatry. 2015

- https://www.who.int/news-room/fact-sheets/detail/alcohol

- Newman RK, Stobart Gallagher MA, Gomez AE. Alcohol Withdrawal. 

- In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441882/

- Nisavic M, Nejad SH, Isenberg BM, Bajwa EK, Currier P, Wallace PM, Velmahos G, Wilens T. Use of Phenobarbital in Alcohol Withdrawal Management - A Retrospective Comparison Study of Phenobarbital and Benzodiazepines for Acute Alcohol Withdrawal Management in General Medical Patients. Psychosomatics. 2019 

- Wikipedia, alcohol withdrawal syndrome

- Personal experience treating ETOH withdrawal in the inpatient and outpatient setting

Summary

Drinking alcohol (specifically ethanol) on a regular basis leads to alcohol dependence. When alcohol dependent persons stop drinking, they experience withdrawal. Withdrawal from alcohol is very dangerous and should be managed aggressively in order to prevent long term complications and death. This podcast will teach you the ins and outs of recognizing and managing alcohol withdrawal both in the inpatient and outpatient setting.

Morbidity and Mortality

Almost 100,000 people die every year from ETOH abuse in the United States alone. It is not known how many people die a year from alcohol withdrawal. If delirium tremons develops, it is estimated that about 25% of people will die without treatment.

Story

Ever drink too much at night and then wake up suddenly at 5am feeling wide awake? Ever feel inner tension, agitation, or heart palpitations after a long party weekend with friends? If so, you have experienced symptoms of alcohol withdrawal.

Key Points

1. Tachycardia, tachypnea, hypertension, hyperthermia, tremors, anxiety, and GI upset are the hallmarks of alcohol withdrawal.

2. Severe symptoms may include hallucinations, delirium, seizures, and death

3. Vitamin and electrolyte repletion are critical for sick alcohol dependent patients.

4. Aggressively treating withdrawal by slowly coming off alcohol or using medications like barbiturates, benzodiazepines, and other CNS depressants can be lifesaving. Use medication liberally in this setting!

References

-Saitz M, Mayo-Smith MF, Redmond HA, Bernard DR, Calkins DR. Individualized treatment for alcohol withdrawal. A randomized double-blind controlled trial. JAMA 1994

- Grant BF, Goldstein RB, Saha TD, et al. Epidemiology of DSM-5 Alcohol Use Disorder: Results From the National Epidemiologic Survey on Alcohol and Related Conditions III. JAMA Psychiatry. 2015

- https://www.who.int/news-room/fact-sheets/detail/alcohol

- Newman RK, Stobart Gallagher MA, Gomez AE. Alcohol Withdrawal. 

- In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441882/

- Nisavic M, Nejad SH, Isenberg BM, Bajwa EK, Currier P, Wallace PM, Velmahos G, Wilens T. Use of Phenobarbital in Alcohol Withdrawal Management - A Retrospective Comparison Study of Phenobarbital and Benzodiazepines for Acute Alcohol Withdrawal Management in General Medical Patients. Psychosomatics. 2019 

- Wikipedia, alcohol withdrawal syndrome

- Personal experience treating ETOH withdrawal in the inpatient and outpatient setting

This is a conversation I had with Justin Cotton, host of the Policy not Politics podcast. It does not contain any medical knowledge. But it is a thought provoking conversations about my opinions regarding healthcare policy. Please enjoy. This will be the final episode of Full Scope season 2. I am going to take a hiatus for a couple of months in order to focus on Wander Medicine Clinic and Old Dougs Plaza.  Full Scope will return with a season 3 though! Thanks for listening.

Summary

Sleep is the most important thing a person can do for themself. Getting 8 hours of quality sleep equals better cognition (thinking), better body function, less disease, and a longer lifespan. 

Morbidity and Mortality

At least 20% of automobile accidents have been linked to sleep deprivation. Teenagers that start school earlier get lower test scores than those who start later. Doctors make more errors and kill more people when sleep deprived. Without sleep, a person will die.

Other Animals

All known animals sleep. Some bats sleep almost 20 hours a day, while giraffes sleep < 2 hours a day. Birds and marine mammals can sleep half of their brain at a time. 

Key Points

1. Sleep is a physiologic state that consists of various stages including light sleep, deep sleep, and REM sleep.

2. Most all people need > 7 hours of sleep a night to function optimally. Many of us are functioning sub-optimally and undermining our longevity through a lack of sleep.

3. Many medical diseases effect sleep. Being unhealthy appears to be both a cause of bad sleep as well as an effect of getting suboptimal sleep.

4. Improving sleep starts with improving lifestyle. Paying attention to light exposure is also very important. Grounding, cognitive behavioral therapy, certain types of sound, and sleep hygiene can also be useful. Many supplements can be helpful as well. Medications should be used as a last resort to help with sleep.

References

-       Walker, Matthew. Why We Sleep; Unlocking the Power of Sleep and Dreams. Scribner. 2017

-       Troynikov O, Watson CG, Nawaz N. Sleep environments and sleep physiology: A review. J Therm Biol. 2018 

-       Lowe CJ, Safati A, Hall PA. The neurocognitive consequences of sleep restriction: A meta-analytic review. Neurosci Biobehav Rev. 2017 

-       Owens JA, Weiss MR. Insufficient sleep in adolescents: causes and consequences. Minerva Pediatr. 2017 

-       https://courses.drhyman.com/sleep-course-own

-       Getting a Good Night’s Sleep. NIH. https://www.nia.nih.gov/health/good-nights-sleep

-       Brain Basics: Understanding sleep. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Understanding-Sleep

-       Stages of Sleep. https://www.sleepfoundation.org/how-sleep-works/stages-of-sleep

-       How much do animals sleep. https://faculty.washington.edu/chudler/chasleep.html

-       https://www.nih.gov/news-events/nih-research-matters/gene-identified-people-who-need-little-sleep

Summary

Sleep is the most important thing a person can do for themself. Getting 8 hours of quality sleep equals better cognition, better body function, less disease, and a longer lifespan. 

Morbidity and Mortality

Atleast 20% of automobile accidents have been linked to sleep deprivation. Teenagers that start school earlier get lower test scores than those who start later. Doctors make more errors and kill more people when sleep deprived. Without sleep, a person will die.

Story

All known animals sleep. Some bats sleep almost 20 hours a day, while giraffes sleep < 2 hours a day. Birds and marine mammals can sleep half of their brain at a time. 

Key Points

1. Sleep is a physiologic state that consists of various stages including light sleep, deep sleep, and REM sleep.

2. Most all people need > 7 hours of sleep a night to function optimally. Many of us are functioning sub-optimally and undermining our longevity through a lack of sleep.

3. Many medical diseases effect sleep. Being unhealthy appear to be both a cause for bad sleep as well as an effect of getting suboptimal sleep.

4. Improving sleep starts with improving lifestyle. Paying attention to light exposure is also very important. Grounding, cognitive behavioral therapy, certain types of sound, and sleep hygiene can also be useful. Many supplements can be helpful as well. Medications should be used only as a last resort to help with sleep.

References

-       Walker, Matthew. Why We Sleep; Unlocking the Power of Sleep and Dreams. Scribner. 2017

-       Troynikov O, Watson CG, Nawaz N. Sleep environments and sleep physiology: A review. J Therm Biol. 2018 

-       Lowe CJ, Safati A, Hall PA. The neurocognitive consequences of sleep restriction: A meta-analytic review. Neurosci Biobehav Rev. 2017 

-       Owens JA, Weiss MR. Insufficient sleep in adolescents: causes and consequences. Minerva Pediatr. 2017 

-       https://courses.drhyman.com/sleep-course-own

-       Getting a Good Night’s Sleep. NIH. https://www.nia.nih.gov/health/good-nights-sleep

-       Brain Basics: Understanding sleep. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Understanding-Sleep

-       Stages of Sleep. https://www.sleepfoundation.org/how-sleep-works/stages-of-sleep

-       How much do animals sleep. https://faculty.washington.edu/chudler/chasleep.html

-       https://www.nih.gov/news-events/nih-research-matters/gene-identified-people-who-need-little-sleep

Summary

Sleep is the most important thing a person can do for themself. Getting 8 hours of quality sleep equals better cognition (thinking), better body function, less disease, and a longer lifespan. 

Morbidity and Mortality

At least 20% of automobile accidents have been linked to sleep deprivation. Teenagers that start school earlier get lower test scores than those who start later. Doctors make more errors and kill more people when sleep deprived. Without sleep, a person will die.

Story

All known animals sleep. Some bats sleep almost 20 hours a day, while giraffes sleep < 2 hours a day. Birds and marine mammals can sleep half of their brain at a time. 

Key Points

1. Sleep is a physiologic state that consists of various stages including light sleep, deep sleep, and REM sleep.

2. Most all people need > 7 hours of sleep a night to function optimally. Many of us are functioning sub-optimally and undermining our longevity through a lack of sleep.

3. Many medical diseases effect sleep. Being unhealthy appears to be both a cause of bad sleep as well as an effect of getting suboptimal sleep.

4. Improving sleep starts with improving lifestyle. Paying attention to light exposure is also very important. Grounding, cognitive behavioral therapy, certain types of sound, and sleep hygiene can also be useful. Many supplements can be helpful as well. Medications should be used as a last resort to help with sleep.

References

-       Walker, Matthew. Why We Sleep; Unlocking the Power of Sleep and Dreams. Scribner. 2017

-       Troynikov O, Watson CG, Nawaz N. Sleep environments and sleep physiology: A review. J Therm Biol. 2018 

-       Lowe CJ, Safati A, Hall PA. The neurocognitive consequences of sleep restriction: A meta-analytic review. Neurosci Biobehav Rev. 2017 

-       Owens JA, Weiss MR. Insufficient sleep in adolescents: causes and consequences. Minerva Pediatr. 2017 

-       https://courses.drhyman.com/sleep-course-own

-       Getting a Good Night’s Sleep. NIH. https://www.nia.nih.gov/health/good-nights-sleep

-       Brain Basics: Understanding sleep. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Understanding-Sleep

-       Stages of Sleep. https://www.sleepfoundation.org/how-sleep-works/stages-of-sleep

-       How much do animals sleep. https://faculty.washington.edu/chudler/chasleep.html

-       https://www.nih.gov/news-events/nih-research-matters/gene-identified-people-who-need-little-sleep

Summary

Acute care in the United States is considered to be among the best in the world. But do not be fooled. Healthcare is widely considered the third leading cause of death in the US. Additionally, we have considerable room for improvement in the care of our acutely sick patients. This podcast reviews some of the “low hanging fruit” to improve our inpatient systems. These improvements have largely been ignored in my experience. This podcast represents my experiences and opinions. It is not medical advice and I do not cite any sources. 

Morbidity and Mortality

None of the hospitals I have ever worked at have prioritized sleep. As sleep is necessary for healing and proper immunity, this is a tragedy.

Key Points

1. Sleep is completely overlooked in the hospital; we often keep patients up all night.

2. Hospital food is not the food I recommend my patients eat. As food is medicine. This is a big problem.

3. Hospitals offer patients little time outside and almost no natural sunlight. We almost never allow them contact with the earth.

4. We are so afraid of falls that we prevent patients from mobilizing. This is a huge detriment to them.

References

Personal experience working at over 30 rural and urban hospitals across 3 regions in the United States over the last 10 years.

Summary

Diversity in ecology and genetics appears to be a very good thing. The human species has a genetic pool (all the gene variants from all the humans alive) that is diverse and protective for our species. Human bodies and all other multi-cellular organisms also host diverse arrays of micro-organisms that our essential to health. 

Morbidity and Mortality

Antibiotics, pesticide, cesarean sections, baby formula, monocrops, processed foods, disconnection with nature, other pharmaceuticals like proton-pump inhibitors, and other factors have all contributed to a mass extinction of the human gut microbiome. It is estimated that humans have lost 50% of our microbial diversity in the last few hundred years.

Story

Microbial fossils isolated from 1000 year old poop shows 38% novel species (now extinct)

Key Points

1. Human bodies are an ecosystem

2. A diverse ecosystem is associated with health. Dysbiosis is associated with numerous chronic diseases.

3. The food we eat and the way we live our lives has profound effects on our microbiotia and health.

4. In the absence of a genetic disease, our microbiome contributes more to our health than our own genes.

References

- Tu P, Chi L, Bodnar W, et al. Gut Microbiome Toxicity: Connecting the Environment and Gut Microbiome-Associated Diseases. Toxics. 2020;8(1):19. Published 2020 Mar 12. doi:10.3390/toxics8010019

- Blaser MJ. The Past and Future Biology of the Human Microbiome in an Age of Extinctions. Cell. 2018 

- Manor O, Dai CL, Kornilov SA, Smith B, Price ND, Lovejoy JC, Gibbons SM, Magis AT. Health and disease markers correlate with gut microbiome composition across thousands of people. Nat Commun. 2020

- Chichlowski M, Shah N, Wampler JL, Wu SS, Vanderhoof JA. Bifidobacterium longum Subspecies infantis (B. infantis) in Pediatric Nutrition: Current State of Knowledge. Nutrients. 2020;12(6):1581. Published 2020 

- https://www.the-scientist.com/features/neanderthal-dna-in-modern-human-genomes-is-not-silent-66299

- https://www.genome.gov/about-genomics/fact-sheets/Genetics-vs-Genomics

- https://www.genome.gov/about-genomics/fact-sheets/Comparative-Genomics-Fact-Sheet

- https://academic.oup.com/jhered/article/108/6/671/3836924

- Satoh, M; Kuroiwa, T (September 1991). "Organization of multiple nucleoids and DNA molecules in mitochondria of a human cell". Experimental Cell Research. 196 (1): 137–140. 

- https://www.cancer.gov/news-events/cancer-currents-blog/2020/colorectal-cancer-rising-younger-adults

- Seneff, S. Toxic Legacy: Howe the Weedkiller Glyphosate is Destroying our Health and the Environment. 2021

https://www.cdc.gov/ncbddd/autism/data.html

Summary

Diversity in ecology and genetics appears to be a very good thing. The human species has a genetic pool (all the gene variants from all the humans alive) that is diverse and protective for our species. Human bodies and all other multi-cellular organisms also host diverse arrays of micro-organisms that our essential to health. 

Morbidity and Mortality

Antibiotics, pesticide, cesarean sections, baby formula, monocrops, processed foods, disconnection with nature, other pharmaceuticals like proton-pump inhibitors, and other factors have all contributed to a mass extinction of the human gut microbiome. It is estimated that humans have lost 50% of our microbial diversity in the last few hundred years.

Story

Microbial fossils isolated from 1000 year old poop shows 38% novel species (now extinct)

Key Points

1. Human bodies are an ecosystem

2. A diverse ecosystem is associated with health. Dysbiosis is associated with numerous chronic diseases.

3. The food we eat and the way we live our lives has profound effects on our microbiotia and health.

4. In the absence of a genetic disease, our microbiome contributes more to our health than our own genes.

References

- Tu P, Chi L, Bodnar W, et al. Gut Microbiome Toxicity: Connecting the Environment and Gut Microbiome-Associated Diseases. Toxics. 2020;8(1):19. Published 2020 Mar 12. doi:10.3390/toxics8010019

- Blaser MJ. The Past and Future Biology of the Human Microbiome in an Age of Extinctions. Cell. 2018 

- Manor O, Dai CL, Kornilov SA, Smith B, Price ND, Lovejoy JC, Gibbons SM, Magis AT. Health and disease markers correlate with gut microbiome composition across thousands of people. Nat Commun. 2020

- Chichlowski M, Shah N, Wampler JL, Wu SS, Vanderhoof JA. Bifidobacterium longum Subspecies infantis (B. infantis) in Pediatric Nutrition: Current State of Knowledge. Nutrients. 2020;12(6):1581. Published 2020 

- https://www.the-scientist.com/features/neanderthal-dna-in-modern-human-genomes-is-not-silent-66299

- https://www.genome.gov/about-genomics/fact-sheets/Genetics-vs-Genomics

- https://www.genome.gov/about-genomics/fact-sheets/Comparative-Genomics-Fact-Sheet

- https://academic.oup.com/jhered/article/108/6/671/3836924

- Satoh, M; Kuroiwa, T (September 1991). "Organization of multiple nucleoids and DNA molecules in mitochondria of a human cell". Experimental Cell Research. 196 (1): 137–140. 

- https://www.cancer.gov/news-events/cancer-currents-blog/2020/colorectal-cancer-rising-younger-adults

- Seneff, S. Toxic Legacy: Howe the Weedkiller Glyphosate is Destroying our Health and the Environment. 2021

https://www.cdc.gov/ncbddd/autism/data.html